[
    {
        "instruction": "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",
        "input": "",
        "output": "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"
    },
    {
        "instruction": "hi doctor I am a 26 year old male I am feet and 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",
        "input": "",
        "output": "hello I have gone through your information and test reports 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"
    },
    {
        "instruction": "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 amlodipine and lisinopril for the last 10 years high cholesterol and triglycerides my cholesterol level is 25 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 my or my 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 module my for 10 days I wish to have your second opinion on this please guide",
        "input": "",
        "output": "hi for further doubts consult a sexologist online"
    },
    {
        "instruction": "hello doctor I have multiple small cysts in both ovaries cos our family friend suggested me to consume kalarchikai medicine powdered mixed with pepper and honey to have it for one mandala 48 days I have completed nearly 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 follicles 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",
        "input": "",
        "output": "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"
    },
    {
        "instruction": "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",
        "input": "",
        "output": "hi for further doubts consult a sexologist online"
    },
    {
        "instruction": "hi doctor I am a year old female who often suffers constipation to the point where I feel like I get minor external hemorrhoids that often bleed again I have not got doctor verification for this but that is what I think recently I have been experiencing pain around the left side of my stomach I cannot localize it sometimes I feel like it is on my back sometimes the lateral side and sometimes the front it usually happens after I eat or pass a stool but I have a minor sensation of discomfort even when I am just sitting all of this has been getting a lot worse the past couple of days I often feel nauseated too I think I may have diverticulitis however I am not sure how common it is for my age I also feel like I have a small localized swelling on the lug that hurts when I press on it I am not sure what is wrong and I really want to go get some tests done but I do not feel safe going to a hospital with certain circumstances",
        "input": "",
        "output": "hello I think you are overthinking about your symptoms to be conscious is good but to be over conscious may fall in the category of anxiety and is not good I will advise you to be relaxed based on your symptoms I do not feel anything to be worried of considering your age and symptoms of constipation and feeling something more probably pointing towards hemorrhoids or some local pathology but physical examination and maybe flexible sigmoidoscopy would be appropriate to confirm underlying pathology or maybe online video consultation with gastroenterologist if you are worried about going to the hospital I will advise you following general measures to follow that will help you try to relax do not overthink there is nothing serious we are thinking of take fibers increase it in the diet in the form of vegetables add ispagol in your diet avoid constipation take plenty of water do regular walk exercise inside your home if you can not go outside do not strain in the restroom take a sit bath daily follow me in case you got further queries"
    },
    {
        "instruction": "hi doctor I am 27 years old my weight is 48 keg and height is 8 feet I am a pure vegetarian I need to increase my body weight I am suffering from psychological problems like anxiety I am not diabetic be is normal I do not smoke and drink please suggest foods to increase weight immunity and fertility kindly advise",
        "input": "",
        "output": "hi how is your eating habits your total calorie intake should be around 200 cal day this will include all three meals with a snack in the evening you can drink any protein supplements at that time include ghee two to three teaspoons a day cheese or paneer weekly thrice exercise every day for 45 minutes to hour simplest is brisk walking your appetite will increase with exercises all fruits and vegetables are allowed take milkshakes lassi protein supplements after your exercise all kinds of days and whole pulses are allowed whenever you are eating high protein diet follow that by light food for example if you are eating canna for breakfast eat a light lunch gradually increase your intake if you follow my diet definitely your immune system will become good weight gain will happen slowly meditation is good for psychological problems concentrate on positive things in life do not worry too much about your weight if your overall health is good it is a very positive sign for you follow up after two weeks"
    },
    {
        "instruction": "hello doctor I am a 39 year old woman I have mild pain in the left side of the chest below the neck and above the breast and then sensation in the upper back from four days it comes and goes sometimes it goes to the right side of the chest also I have done my egg and blood test months ago egg and blood sugar were normal no hypertension but hemoglobin was 10 and vitamin 12 was below average what can I do as in lockdown it is not possible to see the doctor as a person please help",
        "input": "",
        "output": "hello I would like to ask you some more questions do you have symptoms of acid peptic disease or herd or any burning sensation in the epigastric region the center of your chest heartburn if you do it could also present as chest pain so I will guide you accordingly I would also like to rule out any muscular pain for which I will encourage you to take a muscle relaxant and see if it helps take tablet muscoril thiocholchicoside my one tablet once a day when you experience pain and let me know in the follow up in a couple of days to see if it relieves the pain like you said your vitamin b12 levels are below normal it could also be neuropathic pain for which I will only advise vitamin b12 supplements tablet methycolbalmine once a day for three months or complex supplements you can also improve these levels with diet take diet enriched with beef liver and chicken fish and shellfish such as trout salmon tuna fish and clams fortified breakfast cereal low fat milk yogurt cheese and eggs since your he is also below the ideal levels take iron rich foods which are usually vitamin b12 rich as well so I will advise diet modification to incorporate these in your everyday routine or take supplements with iron and vitamin b12 as well because anemia can also present with the said symptoms lastly I will encourage you to reduce weight with exercise and changing your diet and switching to a low fat diet with the addition of more fruits and vegetables to your diet try to start with atleast 30 40 minutes of cardio workout every day and work it up from there according to your stamina and you will see the visible change that you feel you will feel more active and fresh try to bring your mi body mass index as close to the normal range as you can because obesity itself can cause countless problems as well I hope this helps egg electrocardiography do not lift heavyweights take low fat high fiber diet after two days"
    },
    {
        "instruction": "hello doctor I am a 39 year old male I am 168 am in height and 68 keg in weight since last one month I have been suffering from intermittent loose motions yellow colored there is no vomiting no fever or major abdominal pain except for occasional cramps initially I took a combination of norfloxacin and tinidazole for four days but things did not improve thereafter on the prescription of my doctor I took metronidazole 400 and dicyclomine 20 my for a period of 14 days I also took lactobacillus tablets for the entire period during these times I only ate poha rice curd and banana also I took boiled water it is the fifth day now and I have discontinued the medicines despite on such a bland diet no wheat I still have at least one to two loose motions in a day my routine medical tests were done in january this year which was normal my wife and son also developed loose motion in between for a very brief period however they recovered fully within three days please advice",
        "input": "",
        "output": "hello I cannot see any red flags in your symptoms more likely nothing to worry it is the function of your intestines that is triggered by some infection and you are facing overactive intestine more likely it is a functional problem unless proven otherwise I will advise you to keep things simple quit all medications you already took a few antibiotics please follow these general guidelines add fibers in your diet like vegetables and ispagol husk two spoons daily keep yourself well hydrated add yogurt in your diet eat less more important is to keep yourself relaxed the best way of doing is by doing a walk exercise please start tablet mebeverin 135 my before breakfast and dinner for eight days tablet rifaxamine 200 my after breakfast and dinner continue probiotics please follow me after one week I hope you should be fine otherwise I will advise you on some tests"
    },
    {
        "instruction": "hi doctor I am a year old female who was diagnosed with hypothyearoidism genetic when I was 12 over the past five years I have become around 50 pounds overweight and all of my attempts to lose have seemed to fail so I have given up but my weight has stayed the same there is so much information put there about losing weight with hypothyearoidism but it all seems to conflict I am so unsure as to what type of exercise and diet I should follow as a result but I still would like to lose weight but most importantly have my body feel better what can I do I am currently on levothyearoxine buspar and benedryl",
        "input": "",
        "output": "hi you have really done well with the hypothyearoidism problem your levels are normal with less medications which are very good as it is genetically induced it is very difficult to lose weight my advice to you is you should focus on maintaining normal levels of ash thyearoid stimulating hormone and try to remain active having a positive outlook in life or else it will become very difficult to balance your life with the symptoms of hypothyearoidism even though your weight has not reduced be very careful in not putting on weight here afterward everyday brisk walking for hour if you have body pain alternate with exercises and walking avoid all kinds of junk foods processed bakery products rich sweets fatty foods sodas alcohol and smoking avoid partying and binge eating follow the food timings properly have small frequent meals in between snacks should be strictly fruits or any kind of low calorie foods have unsalted nuts around five daily it can give a glow to your dry skin everyday water intake should be around 5 liters you can use flax seeds powder it and mix it in your food it is a fiber which will give you fullness use turmeric fenugreek seeds or powder every day it is a good antioxidants and fenugreek helps in reducing cholesterol levels include low fat milk curd every day egg white lean chicken or fish can be taken daily in moderation anyone organ meats need to be avoided is your menstrual cycle normal please get back if you have any other complaints follow up after 15 days"
    },
    {
        "instruction": "hi doctor I am a 13 year old male and I have had semen leakage for about three months I think it is from weak nerves because last year I would masturbate a lot but then I stopped because it was becoming painful and I was embarrassed then about three months ago I watched something inappropriate and I ejaculated without doing anything then a week later I started to have semen leakage every day about three to four times a day I am just very worried and I just want this to be cured and go away also could this affect my eyes in any way please help",
        "input": "",
        "output": "hi let me tell you that the symptoms described by you suggest that you have a nightfall problem the high quality way to deal with dusk is the use of herbal or selfmade remedies there are no aspect outcomes for such remedy methods you ought to have yogurt at least two or three bowls a day avoid looking at porn as plenty of porn arouses you sexually so it is recommended now not to watch porn sage tea having two cups of sage tea a day will limit the probabilities of nocturnal emission gooseberry popularly recognized as alma acts as an anti oxidant and helps in lowering the nightfall gradually the moist goals trouble will be solved bathing it is a recommendation to take bathtub earlier than you go to bed it helps you have a sound sleep a sound sleep is very vital for averting nightfall I hope this helps"
    },
    {
        "instruction": "hello doctor I was diagnosed with cos in january so my gynecologist prescribed me dinette 35 for six months and bonemac do for one month but from march my periods are regular without taking medicines but there is sometimes slight pain in my lower abdomen and side abdomen should I continue medicines despite having normal and regular periods",
        "input": "",
        "output": "hello if you are having regular periods in terms of flow duration and regularities and if you have already stopped taking dinette since march there is no need to resume its intake immediately unless you need contraception also at the same time or not wanting a pregnancy now in that case you need to use an alternative mode of contraception to avoid your pregnancy please attach your previous prescriptions blood test and ultrasound scan reports based upon which cos was diagnosed also inform your height weight and whether there is excessive hair in the chin upper lip chest and abdomen follow up with reports again also follow the lifestyle modifications described below blood for serum fasting insulin levels blood for serum vitamin do levels us ultrasound tis transvaginal scan if not done in the past three months continue vitamin avoid junk food spicy and dip fried foods low carbohydrates fat restricted gluten free diet is recommended regular brisk cardio exercise like walking jogging cycling swimming for at least 30 minutes a day is a must take frequent small meals"
    },
    {
        "instruction": "hi doctor I am 16 years old I just recently discovered that I have scoliosis I do not know much about it but I will tell you what I know my scoliosis currently has only a degree curve and I am pretty confident it is a shaped curve although I am not sure what do you think are the chances that my scoliosis will develop into adulthood do you think it will stop progressing once I am fully grown",
        "input": "",
        "output": "hello before going into the progress of scoliosis I would like to make you some clarity about the facts on it the cobb angle is a measure of the curvature of the spine in degrees this helps to determine what type of treatment is necessary a cobb angle of 10 degrees is regarded as a minimum angulation to define scoliosis a scoliosis curve of 10 to 15 degrees normally does not require any treatment except for regular check ups if the scoliosis curve is 20 to 40 degrees the orthopedic doctor will prescribe a back brace help to keep the spine from developing more of a curve more than 45 degrees need correction surgery keeping many pedicle screw and osteotomy to correct the curve I hope you go for ray done of your spine and it will be easy to measure properly about the curvature"
    },
    {
        "instruction": "hello doctor I have a 5 month old who I recently noticed developed a tongue tremor I looked up online for the causes and found them as sma she has great motor control we were not doing tummy time as often because she did not like it but have increased it and have seen a big improvement my doctor believes it is benign tongue tremor unfortunately we had a telehealth appointment due to couid so he was unable to see her but he told me not to worry and to keep an eye if things get worse I am so scared it is sma what else should I be looking for",
        "input": "",
        "output": "hello welcome to icliniq com history noted as above your 5 month old has developed tongue tremors please provide me more detailed history such as preterm or full term birth weight normal delivery or lscs how is her weight is she gaining weight and let me know more about family history or any other in the family suffering from sma spinal muscular atrophy sma is confirmed only by genetic testing or by muscle study there are many types of sma some of them develop symptoms later in life and a few develop in early life keep a watch on her development like head holds muscle tone and power and let me know me know if tongue fasciculation increases and the child becomes more hypotonic"
    },
    {
        "instruction": "hello doctor why my ortho does not put brackets in power chains while missing one or two spots I have straight teeth and I am in the sixth year with braces I think instead of closing gaps this is creating gaps please help",
        "input": "",
        "output": "hello there are different types of power chains that are available for the treatment depending on the interlink space short connects every alternate bracket long connects every third bracket closed connects each bracket so depending on the stage of your treatment either of the types can be used which may or may not connect individual brackets also we would require the history of the type of malocclusion you had in the first place as the duration of the treatment varies with the complexity of the malocclusion complex malocclusion which require a lot of rotations and closure of gaps may take longer than usual also the density of your alveolar bone and your body bone remodeling rate affects the duration of final results so in order to give a definitive diagnosis we would require your treatment history which includes preoperative and post operative clinic photographs intraoral and extraoral both preoperative dental rays op and lateral cephalogram treatment history including the types of malocclusion brackets used wires used and the movements caused oral hygiene maintenance routine that you follow during the braces treatment waiting for your reply brush twice daily with fluoride containing paste use of salt water gargles everyday especially after meals tongue cleaning on regular basis a periodic check up with your dentist once every months a visit to the dentist for oral prophylaxis teeth cleaning and polishing once every six months after providing the required information"
    },
    {
        "instruction": "hello doctor I am a 60 year old male who just received the results of a 24 hour hotter monitor key findings include sinus rhythm with frequent supraventricular ectopy 2559 which included couplets and one seven beat she multiplet no complex forms no significant pauses or periods of heart block noted constant feeling of missed beats coincides with frequent supraventricular ectopy very infrequent ventricular ectopy that was isolated and univocal cardiologists not concerned with findings and recommended positive affirmation distraction and cognitive behavioral strategies he was very reluctant to recommend anti arrhythmic treatment seeing this as overkill other matters of interest recent stress echo march indicated above average fitness for age 14 mets and reached a maximum heart rate of 160 bpm moderate aortic regurgitation grade 4 normal ejection fraction 60 lvedv 138 mls no demonstrable ischemia or arrhythmia the recent pacs are very noticeable and I feel every one of them I would appreciate a second opinion or advice on whether there is anything else I can do to stop them I am currently on atenolol 100 my creator 40 my effexor 74 my and valium my",
        "input": "",
        "output": "hello premature atrial contractions or supraventricular ectopic are not harmful per se other than giving you symptoms so antiarrhythmics are not usually recommended so I do not disagree with your treating cardiologist beta blocker is the safest option available although not the most effective one and other options are ablation or antiarrhrythmics so trying behavioral techniques is a good option but if it troubles you a lot then you may request low dose antiarrhythmics like amiodarone for a short period of time but they may again come back after the drug is stopped since there is no atrial fibrillation or set supraventricular tachycardia antiarrhythmics are absolutely necessary but the benefit would be in you is just symptomatic which comes with the risk of side effects however you should have hotter at regular intervals like yearly with echo for aortic regurgitation or if you notice sustained ectopic or irregular rhythm implying development of fibrillation you may discuss changing atenolol to others like metoprolol and see if its help you should try to identify triggers like sleep or gastric disturbances alcohol or smoking if any particular medications which you are on stress etc also if not had recently thyearoid should be tested so in a nutshell antiarrhythmics may be avoided but if not tolerable symptomatically then may be tried I hope this helps"
    },
    {
        "instruction": "hello doctor this is about my 69 years old mother non obese nonhypertensive nondrinker smoker she is not on any medication she is unable to move her left arm for the past three days and also has shoulder pain especially when not sitting there was no injury to the arm and the trouble moving her arms is such that she cannot even braid her hair does this indicate heart disease can a finger pulse oximeter reading of the affected arm be of any relevance in ruling out a cardiac issue what about egg reading please reply",
        "input": "",
        "output": "hello welcome to ilciniq com please attach the egg report it is not attached please clarify whether the pain is prominent feature or inability to move the arm or is it like that she is not able to move arm because of pain or fear of pain now this is not indicative of heart disease left arm pain without chest pain is unlikely to be related to the heart also there would not be any difficulty in moving the arm with a heart attack so it is unlikely to be related to the heart the possibilities are one is cervical and second is shoulder problems like frozen shoulder or arm dislocation even if there is no history of obvious trauma frozen shoulder is more lifely so she will need egg electrocardiography to be sure x ray of shoulder ap lateral view and maybe cervical spine if having symptoms next the pulse oximeter will not helpful in ruling out heart disease however if she has severe shortness of breath and low oxygen reading then this may indicate heart failure so indirectly we may infer however if the pain is mild and weakness is prominent then it is probably either cervical issue or neurological issue so get her examined by local doctor and ray done you may use volini spray or diclofenac spray I hope this helps"
    },
    {
        "instruction": "hi doctor I am 24 years old three months ago I got viral conjunctivitis after two weeks everything was fine but eyes got blurred then my doctor recommended me tobramycin fluorometholone acetate suspension and tear natural forte then after using it for one month my vision was clear but then doctor changed eye drops to tobarest and tear natural forte now my vision is getting blurred again what should I do now I have no other problem such as redness itching etc just blurry vision is there please help",
        "input": "",
        "output": "hello I have seen the picture you are having post viral spy superficial punctuate keratitis in your eyes it is a very common condition after viral conjunctivitis it is that small whitish scar marks on the cornea which leads to blurred vision it will take time to resolve you have to continue drops which have been prescribed by your doctor that is perfect drops only so no need to worry it can take three to six months or sometimes one year to resolve just continue drops which you are using right now both you should use it daily for at least a month then you can taper the frequency of it and slowly you can stop it slowly your vision will improve as lesions on the cornea will get resolved"
    },
    {
        "instruction": "hello doctor my father is 71 years old he having abdominal pain in the middle for the past four to five days pain is constant and mild to moderate in intensity he is not having any issue in passing stools or urine but sometimes complains of burning sensation while passing stools his appetite is good no vomiting or diarrhea no fever his current medial history includes diabetes and hypertension he is an alzheimer patient can you please prescribe some medication for his abdominal pain",
        "input": "",
        "output": "hello I can understand you must be very upset about your father health well you see the abdominal pain in such age is often an alarming finding and I urge you to get him some investigations before giving any blanket cover of medicines common possibilities in his age are mesenteric ischemia which is the narrowing of the blood vessel supplying the blood to abdominal organs this can frequently occur in old age with diabetes and hypertension the pain arises because of lack of blood supply to organs like small bowel large bowel and others the second possibility is pain due to any organ within the abdomen which is inflamed commonly the pancreas a gland over the back of the tummy and large bowel and lastly since he has a problem with constipation the gas accumulation can also be the reason of his abdominal pain but remember we cannot say that it is because of gas distension unless we exclude all other possibilities which are more concerning I suggest you to get investigations which I write below only after the investigation we can be able to diagnose the problem and treat it appropriately I really hope this set of investigations will help us to approach the problem correctly mesenteric ischemia pancreatitis gall bladder or common bile duct stones colitis colonic neoplasia gas constipation related compete blood count serum amylase and lipase liver function tests serum lactate level and serum cop reactive protein hba1c glycated hemoglobin lipid profile stool for detailed report stool for occult blood on consecutive three days stool for fecal calprotectin capsule esomeprazole 40 my half an hour before meals ispagol husk two tablespoons full with water daily follow up after investigation"
    },
    {
        "instruction": "hello doctor my symptoms are watery eyes blocked nose sneezing and runny nose with transparent fluid coming out of my nose it gets worse when I have something from the refrigerator but I am sure it is not common cold what other doctors diagnosed was that I have got allergic rhinitis I feel fine sometimes when I take montelukast fix but sometimes even montelukast does not help this allergy starts from starting june to about september but it is hard to live with a runny nose and sneezing",
        "input": "",
        "output": "hi welcome to icliniq com the symptoms you have mentioned are of allergic rhinitis but it is just not sneezing and watering of eyes it causes major complications in your body starting from sinusitis to asthma which becomes permanent to your life we have to curb it in its initial stages first complete cleaning of fans in your room and also the pillow covers and bed sheet use the mask as much as possible to prevent yourself from dust exposure monte fix montelukast and fexofenadine just gives you symptomatic relief on that day you have to advance to nasal sprays and nasal washes as a permanent solution advance anti allergic drugs have to be started I need to know the details of allergies possible and have to remove the source"
    },
    {
        "instruction": "hi doctor I am in week of my pregnancy and I am worried about some things that happened very early in the pregnancy before I knew I was pregnant I had a few glasses of wine from day to day 20 a total of six maybe and one glass and a half on day 20 I also took corticosteroids betamethasone a single dose of my due to an allergic reaction on day 20 and as if this was not enough I was also on antibiotics flucloxacillin which I finished on day 24 of pregnancy I am so afraid all of this might have had an impact on the baby is there a risk my baby might have been affected",
        "input": "",
        "output": "hello as you have not mentioned the date of your last menstrual period I am assuming by day you mean the starting date of last menstrual cycle because we calculate the pregnancy age from that date so yes the early pregnancy time is very important because the embryo is developing in that time period so as per your query as you mentioned the consumption of wine in the early three weeks I do not think it is going to have any effect on the embryo because it is in the preovulatory phase when even the egg is being formed and released and yes corticosteroids in high doses when used for chronic medical conditions can have a risk of cleft lip and palate but a single shot taken for an allergic reaction should not be affecting the baby also the flucloxacillin is a penicillin group of drug which is usually safe in pregnancy so be calm and stop worrying about the risks it will just increase your stress levels moreover in early pregnancy if any embryo is grossly affected by any insult it either usually abort early if the exposure has been hazardous but if the exposure is nonhazardous it makes through and the baby will be fine this is called all or none phenomenon in pregnancy so your exposure to the medications was not that is something very dangerous so rest assured and more over your pregnancy has reached until weeks that is a good sign that the embryo has not been affected by the exposure to the drugs you have been worrying about please consult your gynecologist for your antenatal checkup and investigations required to be taken as per your local protocols us ultrasound for dating and viability it nuchal scan with dual marker test between 13 weeks routine antenatal investigations as per your local protocols tablet folic acid my daily once after food until 13 14 weeks avoid sexual intercourse until 14 weeks consult your gynecologist before any medications intake or to review the medications already taking for chronic medical conditions"
    },
    {
        "instruction": "hello doctor I have an oily skin type recently I am experiencing pimples white bumps red dots on my cheeks close to my ears sometimes I feel very itchy near the pimples I have developed one or two new big pimples on my forehead also when the pimple subsides after a week or two it leaves a reddish brown mark on that area I feel the need to wash my face very often as it starts feeling very heavy and sticky from all the oil on my face I used clear gel for some time but it is not working on my skin not using any other medication at the moment kindly help me with the same",
        "input": "",
        "output": "hello attach a picture of the lesion for details use ahaglow face wash twice daily for 15 days are there pustules inflammatory red lesions photosensitivity"
    },
    {
        "instruction": "hi doctor I am 23 years old it has been more than a year my liver function test result remains high I have been tested for hepatitis a c and autoimmune hepatitis but the result all came out negative my doctor told to take blood test regularly but it has been almost a year now the result still remains high the lowest result so far I get is ast 90 but my latest liver function test result shows my ast alp and get all 200 may I get any advice on this I did not take any medication consume any alcohol but the result still came out high I am so worried about that please help",
        "input": "",
        "output": "hello I can imagine that you must be very concerned about your persistent elevation of the liver enzymes as you already have viral etiologies excluded this is time to look for other things which could lead to persistent elevation of the liver enzymes notably the wilson alpha antitrypsin deficiency hemochromatosis autoimmune hepatitis type I i want you to upload all your previous investigations ultrasound reports if done and any other testing that you have been performed in the past two years I also suggest you to get following blood tests which would help us excluding the above possibilities it is possible that you have some testing already and I do not want that you should repeat it but do upload the reports as I can see those secondly despite you had a viral screening that showed nothing abnormal but there are certain other tests like he core total which can tell occult or latent infection and cause of your raised enzyme levels since the investigation may cause you significant cost it is possible alternative that you can discuss with me in detail as we can shrink some of those testing by closely inquiring about those causes in history before getting tested I am sure we would reach a conclusive diagnosis by relevant information you provide and after investigations wilson hemochromatosis autoimmune hepatitis type I alpha antitrypsin deficiency chronic viral hepatitis complete blood count liver function test fresh and all previous as I can see the trend he core total hbsab hbsag serum ceruloplasmin serum copper ferritin and transferring saturation anti lam antibody serum alpha antitrypsin level autoimmune or other metabolic diseases follow up after investigations and all previous reports or earlier if want to discuss before getting tested"
    },
    {
        "instruction": "hello doctor I am 30 years old and I am a type diabetic right now I take lantus 30 unit at night in the morning I take gamer is and after breakfast I take 12 my jardiance now my sugar is under control but because of jardiance I usually have penile infection and balantitis I have googled that jardiance have side effects of these types because it flush out sugar from urine can I take any other medicine like voglibose or other which has good efficacy or should I take novorapid along with lantus at morning meal",
        "input": "",
        "output": "hi welcome to icliniq com urinary infection is the most common side effects of the empagliflozin jardiance maintaining thorough hygiene and plenty of water I can advice you for a change in medication but you need to be very vigilant initially for any fluctuations your exact blood sugar values might have given a better understanding though below I am modifying your medication of gamer and adding voglibose stop using jardiance be very strict to yourself in having controlled diet with more of fruit and salads regular yoga and exercise tablet gamer is glimpiride my in the morning 15 minutes before breakfast tablet voglio voglibose 2 my just before first bite of your breakfast rest continue with the same medication at night you may have some stomach disturbances initially but may settle down eventually have good enough amount of curd in your diet measure your values especially after four to five days and get back to me for advice so that depending on how you are managing can decide for any modifications or continuation of the same treatment"
    },
    {
        "instruction": "hello doctor I have two missing teeth in the left and right side of my lower jaw so I have now 16 teeth upper jaw because I have the wisdom there as well and 12 teeth in lower jaw no wisdom can I get the invaslign or just braces will be good and do I have to extract teeth from my upper jaw",
        "input": "",
        "output": "hello I went through your query and the attached image you have two lower second premolars extracted with no third molars in the lower jaw little bit crowding is seen in both upper lateral incisors that might be the reason for you opting for braces well as a specialist upper tooth have a little bit of space in between the central incisors upper front teeth need proximal slicing to facilitate space that space will be enough to realign your both upper lateral to the arch although it is just a front profile if possible upload a side profile of your face to evaluate the overjet but I can say just marginal and proximal slicing of the upper front teeth will be enough and no further extraction needed meanwhile you have missing both lower second premolars get a fixed bridge to cover the gaps or else they will shift and get malaligned upper third molar are also fine and does not need extraction in the near future go for normal braces instead of invisalign normal braces work much better in these cases I hope this helps"
    },
    {
        "instruction": "hi doctor my last period was on april 28 it has been almost seven weeks and I still have not had my period yet I had unprotected sex on may 24 thinking my ovulation day is over but I started getting very paranoid last week so I took a pregnancy test on june 10th and it was negative then I took one more yesterday on june 14th and it was negative but if I squinted hard enough it could have been positive I am very paranoid right now because I do not have a supportive family and I do not have health insurance to go to the doctor to get this checked out and I am not ready to have a child I am 21 years old living with my very conservative religious immigrant parents and I do not know if I should take the second pregnancy test seriously I have been stressed out for the past one month which makes me think I am skipping a month but I am still very afraid that there is a chance I may be pregnant I have no symptoms of pregnancy is it likely that I am pregnant",
        "input": "",
        "output": "hello welcome to iclinq com it is unlikely to be a pregnancy however get a serum beta hug human chorionic gonadotropin blood test to rule out pregnancy as it has some chances of false positivity and false negativity as it is weakly positive the likely cause of the delay could be hormonal anemia weight gain hypothyearoidism stress or change in food and exercise pattern can affect the cycle length and pattern hormonal serum beta hug pregnancy delayed cycle probably hormonal if beta hug is negative then take tablet medroxy progesterone acetate 10 my at bedtime for five days menses occur one week after the last dose of progesterone weight reduction if mi 25"
    },
    {
        "instruction": "hello doctor I am getting increasing acne day by day how to prevent them from coming on my face",
        "input": "",
        "output": "hi acne is very common in one teens and twenties some continue to have breakouts even later in their life especially if there are some underlying hormonal issues or genetic predisposition pimples develop because of increased serum secretion inflammation and bacteria residing on the skin called acres has an important role to play treatment requires knowing your detailed history any hormonal issues any treatments you have taken in the past products you use on your face etc oral medicines and creams gels are used for the treatment of acne for mild eruptions creams containing clindamycin and nicotinamide may be used benzoyl peroxide and adapalene are other commonly prescribed anti acne applications but it is important to discuss with a dermatologist to decide on the correct line of treatment meanwhile eat healthily avoid excess milk and dairy chocolates and junk food exercise regularly and sleep well also avoid using oil or greasy applications on the scalp and face and keep cosmetic use to a minimum I hope this helps"
    },
    {
        "instruction": "i am 53 years old male I am a diabetic and have ed problem for the last months I loose my erection very soon I even tried taking exact on two occassions but it didn't work but do I have to take it continuosly please let me know as to what steps I need to take to improve my erections terry",
        "input": "",
        "output": "hello dear do you feeling difficult to get erections or difficulty to maintain erection for a long time and premature ejaculation diabetic patients with uncontrolled diabetes may lead to erectile dysfunction so please maintain good diabetic control eat green leafy vegetables and fruits avoid smoking and alcohol consumption do regular exercise and yoga use tablet nano leo twice a day for three weeks if you suffering from premature ejaculation intermittent squeezing and interruption may help need partner co operation phosphodiesterase inhibitors may be useful for ed but do not use your taking cardiac drugs for anxiety and premature ejaculation tablet dopaxetine 30 my one hour before bed may useful please get it serum testosterone ultrasound and doppler of penis nocturnal tumnesense test may useful to diagnose the problem if no improvement with medication need prosthetic device insertion or local injection may useful take care"
    },
    {
        "instruction": "i gave birth a year ago I have had problems with diarrhea ever since periodically I did tests for candida helicobacter pyloric bleeding parasites all negative I have a slightly weaker blood count I did a stomach ultrasound and everything is fine I suffer from post traumatic stress and the doctors told me I had diarrhea because of it I have been taking post traumatic stress therapy and I have been feeling slightly better but the diarrhea has not stopped in the last month I go to the toilet 5 times a day in the morning as soon as I wake up I have to go to the toilet and a few more times during the day I am currently taking the following therapy orvagyl 400 daily probiotic forte daily heferol daily vitamin daily seroxat 20mg daily eglonil 100 my daily prazepam 10mg daily",
        "input": "",
        "output": "hello I welcome you to icliniq I can understand you must be upset about your symptoms well the part of problem is explained by certain drugs you are taking like heferol which is iron and usually causes gastrointestinal upset some feel constipation and some feel diarrhea but drug side effects usually settle once culprit medication is stopped I do not whether you taking heferol since last year or started recently and whether you gave a drug free trial to see if it improve your symptoms of diarrhea there is long list of conditions which can cause intermittent diarrhea the few such example is giardiasis food allergies and allergic gastroenteritis I want you to upload all previous testing that you have done and provide me more details about your diarrhea before I can be able to suggest you something below I write down some investigations that you should get before we meet again or if already these tests are available kindly share with me the reports I will help you to settle your problem good day giardiasis food allergies celiac small intestinal bacterial overgrowth functional diarrhea irritable bowel syndrome complete blood count ash ft3 ft4 serum ferrtin level stool detail report stool for ova and parasites stool for fecal calprotectin stool for difficile antigen stool for giardiasis antigen stool for fat globules and reducing substance stool for spot na and spot serum or serum na and serum see me after investigations will decide treatment plan afterwards see me after investigations will decide treatment plan"
    },
    {
        "instruction": "hi this is regarding my husband who is 35 years of age four years back after a nasal septoplasty surgery the doctors realized that his blood pressure was very high after doing all the tests he was diagnosed with moderate concentric lvy my husband who is feet and inches was 98 kegs then he was put on hypertension medicines and was on diet and exercise and he visits his cardiologist every months he has now reduced his weight to 79 kegs in the egg report taken last year the diagnosis is sinus arrhythmia prolonged wave and complete right bundle branch block the echo report at the same time says concentric lvy no rwm normal valves normal la systolic function 62 doctor had advised him to continue with his medicines diet and exercise what do you make of the egg and echo test is it fine to continue with the hypertension medicines diet and exercise his blood pressure is under control now could the lvy be reversed",
        "input": "",
        "output": "hello I have gone through his reports so he has hypertension and he needs to be on medication for long term however in future with weight loss and healthy lifestyle like avoiding fatty oily and high calorie food plenty of green vegetables and fruits etc his requirement for antihypertensive may go down so his future be readings would guide regarding that but as of now he should be on regular be medications with regular be monitoring best be readings would be 10 to 130 systolic and less than 90 diastolic now regarding egg and echo firstly they are all hypertensive changes and not worrisome concentric lvy would be there even if be is under control and it is not going to cause any problems egg does not show complete rbb however there are early rbb changes which are again likely related to hypertension and not worrisome sinus arrhythmia is normal finding and nothing to worry to about prolonged wave so there are changes which are not very significant and alarming so in a nutshell he should focus on be control healthy lifestyle get his lipid profile tested and he should be subjected to treadmill test after age of 40 years hope this helps you and get back if you have any doubts"
    },
    {
        "instruction": "hi I might need a general surgeon for a consult regarding my mother wound she is 81 years old she is had it since end of last year she has seen doctors and has gone lab tests based on her lab results the first doctor up to the third has prescribed mupirocin ointment antibiotic which lasted to 20 days and mefanamic acid only if she feels pain unfortunately it has not gotten any better I hope someone can help thank you she used to have a wound on the same area when she was young between years old to 10 years old but it got better but now it is back",
        "input": "",
        "output": "hello I will definitely help you regarding your mother problem I have seen the image and lab report of your mother there is a ulcer in her leg medial aspect as I can see it is a chronic non healing ulcer because the margins are sharp and base is filled by yellow debris in healing ulcer ulcers are sloppy and base is filled by healthy and red granulation tissue but in your mother case it is of non healing type there are many reasons for non healing ulcer like old age diabetes hypertension and immunodeficiency as your mother age is 81 year than it may be a probable cause because blood investigation seems to be normal one more thing I want to tell you that varicose veins are one cause that may present with this type of ulcer in medial side of leg exactly where this ulcer is located to confirm the diagnosis of varicose veins I need image of whole leg to see the dilated veins you may go through color doppler venous both leg to rule out varicose veins now the treatment part no role of antibiotics now as there is no active pus discharge one thing that can be done is scraping of the dead floor and margins of ulcer so healing will fasten it can be done by local surgeon also you can apply mupirocin ointment start vitamin tablet gram daily it enhances immunity and help in healing of ulcer hope it helps get back to me anytime"
    },
    {
        "instruction": "hello doctor I am 19 years old I am almost three months late for my period and do not know what to do I read some articles and found out that weight loss triggers periods and I have lost around 50 pounds in the last year bringing my weight down to 122 pounds I am super scared about my periods also this morning I had white discharge can that be a sign of my period may be coming",
        "input": "",
        "output": "hello yes excess weight does cause a hormonal disturbance that can lead to delayed periods but there can be other hormonal changes like thyearoid and prolactin that need to be evaluated to look for the cause of the delayed periods sometimes stress also can cause a delay and yes the consistency of the discharge can be a little thicker during the premenstrual phase if ovulation happens but we cannot predict just based on that if you would be getting your periods or not if already three months have lapsed and if there is no chance for a pregnancy then it would be advisable to take medication for withdrawal and get yourself evaluated for the irregular menstrual cycle issues I hope this helps"
    },
    {
        "instruction": "hello doctor I have chest pain for more than one month on and off radiating to neck and jaw sometimes I also get pain in both shoulders sometimes I am diabetic and hypertensive please explain my egg reading I am currently on irbesartan and metformin",
        "input": "",
        "output": "hello welcome to icliniq com your egg is fine there are no significant abnormalities seen in egg electrocardiogram machine generated report mentioned at the top is frequently inaccurate so not to get panic with it now in cardiac pain the pain usually occurs on exertion and relieves with rest this is very classical of cardiac pain if it persists for a few minutes and does not last round the clock more than 2 days now if the pain does not have such characteristic then it may either be related to cervical spondylosis or gastric reflux if you have any bloating burping heartburn or upper abdominal pain then it may be related to gastric reflux or if this pain increases on neck movements associated with tingling numbness sensation in arms then it may be related to cervical pain however considering the risk factors like do diabetes mellitus hen hypertension it is better to rule out the possibility of cardiac pain so you should undergo echo and if normal then treadmill test"
    },
    {
        "instruction": "hello doctor two weeks back I suffered from loose motion after injection and saline I was well but after three days I felt pain in the anus portion because of hard stools it is very painful and I started talking taxi and sit bath and cream that I got from the medical shop I started applying it after a few days itching started and the pain was gone in between these days I just took no masala food like dal curd green and veggies yesterday morning I had hard stool and stomach pain and anal pain also started I have pain on touching while applying the medicine",
        "input": "",
        "output": "hello well it is uncommon to have burning in the anus when someone has altered bowel habits your symptoms might be occurring secondary to anal fissure for which you rightly took dietary precaution and local cream and sit bath now you just need to keep taking fiber in diet or for temporary use can start syearup lactulose 15 my at night time only thing you just need to do is avoid constipation you can continue xylocaine four to six hourly for a few more days and then stop anal fissure follow up if symptoms do not get better in the next three days"
    },
    {
        "instruction": "hello doctor I am a type diabetic and I suffered chronic diarrhea for the past 10 years finally the doctor found tape worms and eggs in the stool I had several rounds of praziquantel last round was weeks ago with 650 my per day with a break in between I took supplements of all kinds and now colonics I am still passing worms I have improvements in health pain and girth around my stomach also improved but I am frustrated I cannot seem to get rid of it please help",
        "input": "",
        "output": "hello I suppose you must give a brief history of the nature of your diarrhea like mostly it is oily and malodorous watery or gassy does it have any relation to meals do you feel any abdominal pain fever or itching at the anal area do you ever have a low he any loss of weight what type of worms did you notice on the stool e report and most importantly is your diabetes controlled worm infestation complete blood count stool routine examination diabetic diarrhea drink boiled water after cooling personal hand hygiene sugar control tablet albendazole 200 my two tablets now personal hygiene"
    },
    {
        "instruction": "hi doctor I have been dealing with a recurring sore throat for the past couple of months my tonsils get sore and swollen with pus and usually I have a canker sore like lesion on them as well I get fatigued with body aches I took tests for mono and streptococcus but I had neither I am currently taking escitalopram and generic ya birth control",
        "input": "",
        "output": "hello now if you are having symptoms at present then you will need an antibiotic course for it and treatment of choice is amoxicillin clavulanate combination for five days you should also have betadine gargles four times a day for five days presence of pus does mean it is likely a bacterial infection may not be strep but other bacterias now regarding the preventive aspect firstly there is no reliable way of preventing it other than tonsillectomy so you should consider this option if this is becoming troublesome for you now some points which would help to catch the infection are maintaining hand and oral hygiene avoiding too cold foods which usually precipitated the infection you should try to identify the triggers which have precipitated the infection last time like cold foods street foods or other triggers you should consider the use of chlorhexidine mouth wash on a regular basis next thing you should have betadine gargles with you with the earliest symptoms of sore throat you should start gargling four times a day which would prevent the progression to frank infection if your diet is not good then you may consider having a course of multivitamin for two weeks otherwise not necessary I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 32 year old male I weigh about 80 keg with a height of 9 I am facing erection issues since last week though there is no change in my sex drive also I feel reduced morning erections too I feel aroused but the erection does not come as it used to before a week healthwise I have sound health and have a moderately active lifestyle and pretty normal sleep pattern anxiety level is suboptimal due to covid19 situation I was using a semen volumizer herbal supplement intermittently I am not sure if this plays any role in it too I drink occasionally in limits and I am a vegetarian my food habits are healthy and I avoid junk food as such these erection problems started just a few days ago and now they are troubling me to a bigger extent please help",
        "input": "",
        "output": "hi I can understand your concern according to your statement you have been suffering from erectile dysfunction for the last few days erectile dysfunction is usually caused by low blood flow to the penis or problems of nerve of penis which control erections most common cause of erectile dysfunction is psychological reasons such as stress or depression it may have resulted from the hardening of arteries high blood pressure high blood glucose high cholesterol medications bph prostatitis hormonal disturbances etc usually erectile dysfunction is common in everyone is life due to many causes in most cases it goes away over time and no treatment is needed you can do some investments like abc complete blood count urine m ribs random blood sugar lipid profile us of a spa etc and hormonal tests such as testosterone oh prolactin thyearoid function test etc to find out the underlying the causes which are responsible for your present sufferings and then treat them accordingly"
    },
    {
        "instruction": "hello doctor my 59 year old husband has had a fever for about 10 days the first two days it varied between 37 and 38 maximum and small diarrhea without any other symptoms we thought it was the couid at the beginning but it cannot be because he had no other symptoms and me and my children have been in contact with him and we have no symptoms knowing that I have health problems and have asthma so we went to a doctor who prescribed diarrhea medication since the fever has dropped and it does not exceed 37 so he continues to take paracetamol but for the past week he has been suffering from abdominal pain more precisely below the navel so we went back to see the same doctor two days ago who gave him an ultrasound that showed nothing abnormal he diagnosed a colopathy but I have the impression that this diagnosis is wrong he started this treatment that same day but until today there is no improvement he still suffers from abdominal pain especially after going to the bathroom and fever although low maximum 37 got as high as 38 tonight no more diarrhea but little constipation what do you recommend that I do could it be something serious knowing that the ultrasound showed nothing abnormal please help",
        "input": "",
        "output": "hello I feel very sorry to hear about your husband and very rightly understand your concern and temptation for his unresolving symptoms you are perfectly right that if treatment were given rightly he should have shown some improvement but unfortunately he did until now so considering all the information you provided to me there are few possibilities first of all is typhoid fever which is a bacterial infection the second is intestinal amebiasis which is a parasitic infection typhoid seems to be likely possibly given his almost 10 days of fever and in second week he started to develop abdominal pain which is suggestive of typhoid ulcers in small bowel I would suggest him an antibiotic course for at least 10 days and a maximum of 14 days which would cover both potential bugs I also want that you get him some blood and stool tests before starting antibiotic course the antibiotic course is relatively safe I also want that you closely examine his chest for the development of rose spots they are very small pinkish marks which develop among patient over the chest in the second week of the illness do not worry they are harmless it is just a manifestation I really hope his symptoms will improve like a fever would start settle and abdominal pain should resolve in the next 48 to 72 hours of the start of the antibiotic regimen I would also want to know the assessment prescription of a previous doctor who said about colopathy the colopathy is a very broad and vague term which means colon large bowel inflammation it has a number of causes the one is painkillers nsaids and recently couid 19 has shows some case reports with colopathy but if your family and he himself does not have any contact history to couid 19 positive or suspected case then the possibility is very rare ultrasound is not a sensitive investigation for the disease which involves the bowel lumen such as in your husband case ultrasound is more helpful in disease involving liver spleen or gall bladder so it is not uncommon to have a normal ultrasound with conditions like typhoid fever or intestinal amebiasis so I am writing him antibiotics for 10 days now if the improvement is shown we would increase up to 14 days I really hope with this course his symptoms will start settling in the next 48 to 72 hours and lastly get some blood and stool tests as I suggest her and discuss the reports once they are available typhoid fever intestinal amebiasis difficile infection colopathy complete blood count blood culture and sensitivity before starting antibiotic course ha titer for histolytica stool detail report and ova parasites stool for fecal calprotectin stool for difficile infection and stool for culture and sensitivity before starting antibiotic course you can ask him to give sample today and start antibiotics just after giving the sample capsule cefixime 400 my twice daily for 10 days tablet flagyl 400 my thrice daily for seven days this antibiotic can cause metallic taste in mouth and or decreased appetite for that you can give him tablet levosulpiride 25 my thrice daily half hour before meals for nausea appetite take home cooked meals take good amount of water mineral water if possible both infections are acquired after a contaminated food or water see me after labs and earlier if any further concern"
    },
    {
        "instruction": "hello doctor my brother has swelling on his left foot he has a boil on his left inner leg inches above his left ankle inner bone the doctor he visited gave him medicines for his boil and said the boil will come out in some days the swelling in his foot has increased and so he visited the same doctor the next day and was advised to see an orthopedic the orthopedic doctor did not diagnose it but referred him to a general doctor who again did not diagnose it but said there is pus buildup inside the foot and it needs surgery my father who accompanied my brother asked the doctor whether it will subside with medicines or if surgery is needed the doctor simply said you can use the medicine or you can do the surgery I am out of the country and feel the doctor may have not specified the situation correctly to my father and also may have not clearly explained why he suggested the surgery I needed a second opinion as I want my brother to receive proper treatment and identify if it is a serious condition and I need to know the best solution I also want to know why the doctor mentioned surgery for a pus buildup and what is the diagnosis of the foot condition I can provide pictures of my brother foot if needed",
        "input": "",
        "output": "hello he is having diabetes if yes what is the sugar level if yes first you have to control the sugar level he is having a deep infected ulcer with cellulitis what medications he is on since it is a deep and swelling extended up to the foot better open the wound and drain pus and send it for pus culture and sensitivity meantime start tablet pan 40 pantoprazole one two times daily before food tablet ciprofloxacin 500 my two times daily tablet combiflam ibuprofen one tablet twice daily and tablet chymorol forte one tablet thrice times daily for five days after food and wound dressing with back ointment"
    },
    {
        "instruction": "hello doctor I have my renal calculi in the right upper ureter please help",
        "input": "",
        "output": "hi it rub kidneys ureter and bladder is 95 accurate to diagnose urinary stones usually stones form in the kidney and drop down the ureter causing extreme pain due to stretch of the renal capsule since your right kidney is blocked I need to check on your kidney functions by doing a blood test called creatinine level especially if you have other medical problems like diabetes or hypertension I also want to make sure you do not have urinary infections after this if kidney functions are normal and no infection then we can try medical therapy for 6 weeks with capsule tamsulosin contiflo 4 my at night daily for six weeks the possibility of passing the stone is 25 if you need more urgent treatment with a 70 stone clearance rate will be shock wave lithotripsy if you got pain again in spite of medication or you got high creatinine level then endoscopic ureteroscopy do stent will be the best first line option on follow up after treatment you need needs calcium level phosphate and uric acid I hope this helps creatinine urine analysis and culture hydration lemon and orange fresh juices needs calcium level phosphate and uric acid"
    },
    {
        "instruction": "hello doctor I am a 25 year old male I am 210 labs and it 10 in lately I have been having really bad upper abdominal pain and tenderness I get really sharp pains in the same area when I lift heavy things it is so uncomfortable at all times I have a history of peptic ulcers from the time I was 16 but this pain is different and constant",
        "input": "",
        "output": "hello well the pain which comes in or worsen after doing physical movements is highly likely secondary to muscle and bone related the pain of peptic ulcer however can be knowing and usually worsens after meals but given the fact that you have been using omeprazole which is a strong acid suppressant is helpful in healing peptic ulcer the presence of peptic ulcers in your stomach seems to be a rare possibility I suggest you to take tablet orphanderine plus paracetamol combination one tablet three times daily for a few days and avoid doing heavy lifting or any thing that you think will worsen the pain and see how does it go if your pain does not solve then I suggest you to increase the omeprazole dose to 40 my twice daily half an hour before meals this would certainly improve the pain if it secondary to peptic ulcer disease lastly there are other conditions which tend to cause pain which worsen with exercise and bearing weight and one such condition is called nerve entrapment pain but I want you to start with step and let me know how things go musculoskeletal pain functional abdominal pain or nerve entrapment pain musculoskeletal pain follow in a few days and update if pain settles if not then I will recommend some testing"
    },
    {
        "instruction": "pain during intercourse spotting after burning urine chronic pain and it is getting worse I am birth control pills went to the doctor about it they said I did not have any sits or studs",
        "input": "",
        "output": "hello welcome to icliniq if the infection are ruled out then the chronic pain could be due to a condition called endometriosis where there can be severe pain during periods and in worse cases it can be a while passing motion or while having sexual intercourse please get an ultrasound done to look out for any endometriotic cysts also get an examination done with your gynaecologist for looking up at your cervix to find out the cause for post coital spotting as for the burning during urine it could be due to urinary infection please get a urine culture sensitivity testing and drink plenty of water you need to start the appropriate antibiotics after collecting the sensitivity test result hope this information help you please feel free to consult me anytime with any further queries or for any further information would be happy to help you out have a nice day ultrasound abdomen and pelvis urine routine and microscope urine culture and sensitivity ti with endometriosis after thorough evaluation and diagnosis of the condition drink plenty of water at least 4litres a day"
    },
    {
        "instruction": "hello good day I have been having difficulty breathing almost everyday and I have a headache along with this problem",
        "input": "",
        "output": "hi I have gone through your medical history and your abc report your abc report does not contain any significant abnormal values to be worried off slight deviations which they have mentioned as or are insignificant so dont worry about your report coming to your breathing difficulty it being present for a very long time and at this younger age it is most probably bronchial asthma apart from this we need to rule out any cardiac ailments I would suggest you to visit a doctor to get yourself examined clinically for presence of asthma signs in your chest of any meanwhile also do the advice investigations amd get back to me and answer me few questions car pa view echo bronchial asthma congenital heart disease deriphyllin retard 150mg stab twice daily to continue avoid dust exposure"
    },
    {
        "instruction": "hi a pleasant day I have a problem with my liver I just have an ultrasound last month to found out I have a moderate fatty lever grade my problems is sometimes I feel some soreness in my stomach if I to rate the pain 10 being the highest around 4 may I ask for sum advice or medication for",
        "input": "",
        "output": "hi I went through your us report and I see that you are worried about your fatty liver need not worry about it fatty liver is something very common in most of the population in the current era all because of our present food habits and less physical work due to digitalization in every industry fatty liver is nothing but excess cholesterol deposition in the liver it is still correctable you need have some diet modifications reduce oily and high fatty and carbohydrate foods and increase your physical exercise engage yourself in regular exercise that will do and do check your serum cholesterol levels and revert back to me we may start medicines if levels are very high see you take care fasting lipid profile fbi pubs fatty liver diet modification as advice regular exercise avoid alcohol"
    },
    {
        "instruction": "hello doctor I have recurring ti last time a few months back after taking medicines for the recurring ti results were normal I took vital syearup and antibiotics after experiencing pain recently I again went for urine test and it shows rbc epithelial cells and bacteria I have attached the reports I was consulting a gynecologist prior to this but she told me to consult a urologist I have attached my last ultrasound and kidney function test along with today urine test",
        "input": "",
        "output": "hi after reviewing your complains and your blood and urine test with ultrasound reports kidney functions are normal your ultrasound is normal your urine analysis showed pus cells and few red cells and white blood cells my question is do you have symptoms like difficulty in passing urine or pain while passing urine if not then did you have urine culture result before your antibiotics treatment if you have documented ti before and you got treated then you have pus cells and white cells in urine your test might have been performed soon after antibiotics the possibilities are incomplete treatment or chronic inflammation of the urinary bladder as sending infections are also common in postmenopausal period you will need to follow up with urine culture test if it is negative and you have no symptoms then no need to treat if it is negative and you are still having symptoms pain while passing urine we need to do more tests I hope to follow up you after urine culture results as preventive measure you need proper hydration cranberry juice yogurt and proper hygiene cystitis incomplete treatment urine culture cystitis bacterial to cystitis observation and hydration cranberry juice yogurt days after urine culture"
    },
    {
        "instruction": "hi doctor I am having abdominal pain on my lower right stomach since yesterday and my parents thought it is just the only bloated stomach I cannot also urinate well and pass stools whenever I pass stools my lower right abdominal get hurt so badly is this appendicitis or other stomach disease",
        "input": "",
        "output": "hello I can imagine you must be very upset about your pain well the pain of appendicitis should be continues and not intermittent pain starts at the center of the abdomen around umbilicus and travel to the right lower part of the abdomen pain of appendicitis is often unbearable accompany with vomiting or severe constipation and sometimes diarrhea now I think you can better figure out what sort of pain is this gas bloating can cause pain but not often severe and usually occur when one have a meal not otherwise the pain improves with fasting or taking a certain diet which does not produce excessive gases pain of gas often worsens after milk and dairy products intake if you feel a strong suspicion for appendicitis an ultrasound abdomen targeted for appendicitis would be the first best investigation to do I hope this helps abdominal pain complete blood count serum amylase liver function tests ultrasound abdomen for liver gall bladder and appendix functional gas and bloating capsule tramadol 100 my for pain until definite treatment is given"
    },
    {
        "instruction": "hello doctor I am currently diagnosed with chronic hepatitis viral load is million iu my sept is 85 and others are in range and hbeag is 06 should I start medication am I in danger I am a 30 year old male I also have a loss of appetite gastritis and bloated stomach please help",
        "input": "",
        "output": "hello yes you should definitely start the treatment but I want you to get a baseline renal function tests and fibroscan of the liver if renal functions are normal then we can start and continue the treatment at the maximum dose you can use tablet tenofovir 300 my once daily if the renal function tests are normal I would urge you to get a fibroscan and alpha fetoprotein app if you are married then please get your wife and children tested I want to know about your rest or family like your sibling mother and father is any family history of hepatitis it is important because screening has to be performed in case there is suspicion of vertical transmission from mother to fetus you can get the tests and see me afteward to discuss the reports of tests and provide other information related to your family I may then suggest testing for them lastly I remember that hepatitis cannot be completely cured but can be substantially controlled with antiviral medicines it requires follow up and guidance chronic hepatitis hbeag positive disease app alpha fetoprotein fibroscan of liver follow up to discuss the relevant family history and to discuss the lab reports"
    },
    {
        "instruction": "hi doctor I am a 17 year old male since I started to grow my hair I began to realize how thin it is naturally is there any way to thicken it up but the main concern is that since I have grown it I started to experience excessive shedding by only passing my hand on my head I would get on average 15 hairs the pattern stopped for a while but my hair is thinning a lot on the sides I can see across my scalp easily by lifting the hairs on the side of my head lateral sides on top of ears and the regular pattern baldness zones it has become excessively thin please help",
        "input": "",
        "output": "hi from the information given it seems you are experiencing the early signs of male pattern hair loss this is a very common condition and there are many factors responsible one of them being genetic if you have other family members with similar patterned hair loss the chances for you to develop it increase too due to the effect of the male hormone on the hair cycle over a period of time the hair follicle starts shrinking and so the hair which comes out is thinner and more fragile and breaks easily also the growing phase of the hair is shortened so your hair does not grow as long it used to and becomes shorter and wispier being just 17 years old I am sure it must be worrying you a lot but do not be disheartened there are several treatment options available and the sooner we start the treatment the better the chances of reducing further hair loss thinning and increasing regrowth a combination of oral supplements to boost hair growth along with application of lotions containing minoxidil to begin with will be the best course of action in my opinion oral finasteride which is the male hormone blocker is used frequently applications with finasteride are available too this will be prescribed by your treating doctor after assessing the extent of thinning and discussing the side effects etc several preparations of bio peptides and other natural ingredients like saw palmetto extract melatonin etc are also available to boost the hair growth pop platelet rich plasma is a popular procedure which is often used in combination with medical treatment to stimulate hair growth further usually a combination of treatments is suggested after the clinical evaluation but using the applications regularly is the key to good results hair regrowth takes a few months to show and you will have to be patient to see the benefit of the treatment I hope this helps"
    },
    {
        "instruction": "hi im a 13 year old boy I have recently noticed a small lump beneath my nipple and was wondering if this is normal the lump is not too hard but not soft and the same time kind of rubbery I have not noticed any other changes so far",
        "input": "",
        "output": "good day I am do david since when did you exactly notice the lump did it grow in size since then any change of color on the skin over the lump did you notice dumpling of the skin over it and is it painful when you touch it I would also like to know if you have relatives that also had this if most of your answers are yes I suggest to say to your parents that you have to see a surgeon right away to be evaluated if not I will still suggest you to see a surgeon but you can take your time lumps should be evaluated properly and will be treated accordingly depending on the physical findings base on your findings it might be a lump of fat cells that formed but still a good evaluation would tell us more thank you if you have further questions you may message me here suggest to do a breast ultrasound suggest to suggest to undergo a surgery consult"
    },
    {
        "instruction": "hello doctor I am tired of being fat and I am tired of diets after a diet I gain double and every time it is harder to lose I am desperate lonely and depressed I do not want to be fat for my entire life I am only 26 and have always struggled with my weight please help",
        "input": "",
        "output": "hello I can imagine the level of your frustration regarding your weight yes it is nearly impossible to keep reduce weight and maintain diet and exercise I may not be able to give you a composite plan of action for your weight reduction since it is not basically a one day consultation task in fact it is a long term commitment towards yourself and towards a multidisciplinary team inclusive of a dietician bariatric endoscopist gastroenterologist behavioral therapist and lastly a bariatric surgeon so I would give you facts and figures for the existing evidence of weight reduction therapies remember your current body mass index mi is 34 the goal of any weight reduction treatment is to reduce weight to optimal ranges where the physical and psychological well being of a person is maintained now anybody whose body mass index mi is more than 40 should straight away consider bariatric intervention in the form of endoscopic or surgical morality and anybody whose mi is 35 but having other conditions such as uncontrolled diabetes coronary artery disease heart disease or lung dysfunction lung hypertension and sleep disorders should undergo interventions but you see not all person fit into above category many have mi less than 35 such as in your case and having very troubling symptoms among such people individualized approach is employed whether medicinal use or endoscopic or surgical intervention diets and regular weight reduction exercises do help to reduce weight by to 10 all medicines which are currently in use help reduce weight by 10 to 20 certain endoscopic bariatric procedures such as balloon placement in stomach and sleeve gastrectomy does help reduce weight around 25 and lastly surgical procedures such as metallic rings around the stomach via laparoscopy and surgical sleeve gastrectomy and surgical roux bypass help to reduce weight by 30 to 35 the figures are ranges they vary significantly in individual cases I also want you to understand that these interventions should be accompanied with optimal dieting and exercise even after surgery or medicinal therapy otherwise the weight can frequently recur to original ones this above description is only to make you understand and figure out things I can recommend you to start with dieting keeping your calories well below 1500 cal daily running swimming and weight lifting on a regular basis I also suggest you to meet a dietician on icliniq or otherwise in person to get a diet plan with respect to your calorie requirement I can suggest you some medicinal treatment but they are prescription medicine may not be ot and the course has to be taken for at least six months to see the effect naltrexone bupropion contrave is proven and fda approved and can be started in your case but I want you to provide more information about your health as I can assess your condition first and treat aimfully rather adding more harm to your health because these medications have some side effects and they should be kept in mind before giving it therapeutically I also want to know about family support any occupational therapist available near your vicinity your current job status and medical health insurance and also information whether the cost of these medicines is covered or not until that time you follow up I want you to get the following blood tests to better know the impact of your obesity on bodily systems I hope this helps obesity complete blood count ash thyearoid stimulating hormone ft3 ft4 liver function test fasting lipid profile serum cop reactive protein albumin total protein and ag ratio arterial blood gases urine detail report and urine for albumin will decide after further information is provided and after investigation thoroughly for any underlying metabolic complications"
    },
    {
        "instruction": "i have granular pharyngitis problems 60 days ply help me medicine name",
        "input": "",
        "output": "hi I had a look at the picture you have sent this looks like more of a chronic pharyngitis the red spot you have pointed out is more of a lymphoid follicle which has slightly increased in size and is present in almost all of us there is nothing that you need to worry about as this is a very common entity we come across and is treatable you can consider following the advice mentioned below drugs mentioned in point 2 and can be taken only if there is an acute infection associated with pain while swallowing if there is no pain or infection the medication mentioned in 2 and are not required make sure you follow points in and as long as possible as this prevents the possibility of developing a throat infection there is absolutely nothing to worry about the red spot over there as it doesn't indicate any cancer or malignancy and is only a lymphoid follicle which has increased in size due to possible previous throat infections I hope I have answered your query in detail if there is anything more you want to know or enquire please let us know and we will get back to you asap please take care warm regards"
    },
    {
        "instruction": "hello doctor I have clogged ears and pain from ears to the throat vertigo and always feeling confused I had a sinus nasal drip which I thought that is why my ears where clogged it has been six weeks and it is still clogged popping and painful I saw an ent and he said I had no fluid and there be any underline issues causing my ears to stay with pressure and fullness like hsv and hsv can cause me to lose my hearing I am 40 years old and never experienced this before my doctor prescribed me antibiotics and they are not working I already took acyclovir and he prescribed it again I just need to know if herpes causes hearing loss",
        "input": "",
        "output": "hi I can understand your concern according to your statement you have been suffering from clogged earache with painful jaw joints and sore throat with vertigo and all these sufferings may result from herpes infection according to your assumption when herpes affects the nerve in the face that spreads to ear known as herpes foster oticus its clinical features are severe earache swelling of vestibular nerve fluid filled vehicles on outside of ear and inside ear canal permanent or temporary paralysis of the face with hearing loss again herpes esophagitis can attack the mouth sores may develop in the mouth and make swelling difficult due to inflammation of the throat this pain can radiate to mouth and jaws sudden hearing loss can result commonly from viral infections other than herpes are measles mumps rubella viral meningitis syphilis aids etc which can cause sudden loss of hearing again bacterial meningitis lyme any tumors in the ear can also be hearing loss any type of hearing loss steroid should be applied immediately it helps in reducing the inflammation and decrease the swelling and increasing hearing ability so along with your current medications you should use steroids immediately to prevent further hearing loss in case of any other query knock me and I will try to help you further"
    },
    {
        "instruction": "hello doctor my eyes are swollen especially in the morning I find it hard to open my eyes after a nap or when I wake up in the morning after that I am fine during the day with watery eyes sometimes no itching but it is little reddish when it is hot around the first week of march I went to see an ophthalmologist who told me I had a bacterial infection of both eyes I was prescribed vigamox and after seven days my eyes were fine due to quarantine I was not able to go back to my doctor around the last week of april I had the same symptoms and since I cannot go out I treated my eyes with vigamox again and was healed after seven days after that from time to time I have swelling not much but mostly in the morning I am a 68 year old female I have allergies seafood pollen and dust I take allerta or claritin from time to time to relieve my allergies I smoke but I am trying to quit before to 10 sticks now reduced to four or five",
        "input": "",
        "output": "hello as you have described in your history it is looking like an infection in your eyes can you please send your eye image to me so that I can get an exact idea about your condition and depend upon that we can plan further it is better if I can see your eye condition and then prescribe you drops so my advice is to please attach your eye image as soon as possible so that we can start your treatment as early as possible and you will feel better after treatment"
    },
    {
        "instruction": "hello doctor I have read that melatonin could possibly lessen the effectiveness of birth control pills my understanding is that there is little to no peer reviewed scientific studies to support this claim but I am still worried as I am sexually active and take my of melatonin each night and I am on the progestin only pill I am looking for a doctor to weigh in on this issue",
        "input": "",
        "output": "hello I understand your concern here and you are right that there are not many or in fact hardly any articles or peer reviewed papers on melatonin and birth control interactions but I would like to keep it simple for you to understand melatonin is produced during the night to ease the sleep pattern in humans post sunset with maximum levels at am and by morning am the levels found are almost negligible so it is produced by the pineal gland in the dark cycle and metabolized at night by the liver now liver also is known to metabolize the birth control pills be it progesterone only or combinations pills hence if taken together then there is a likelihood of slower metabolism of either compound and thereby prolonged residual effect may be seen on concurrent use of pills and melatonin together the effects could be prolonged sleepiness and also melatonin induced increased progesterone levels in the body causing bloating and noticeable progestogenic side effects however the efficacy or effectiveness of the pill is not compromised but metabolism is delayed as melatonin competes with the pill with the liver so ideally the better way would be to switch the pop in the morning hours and the melatonin pill at night 12 hours apart this would prevent any interference with either action on the body or cause any interaction"
    },
    {
        "instruction": "hello doctor I only have one sexual partner for almost a year however during intercourse I feel that I am having a pain in my pelvic area and it is a sudden sharp pain sometimes it is random or happens during deeper penetration it feels like pressure and almost seems like it is gas but I am not sure what it is that I am experiencing a while back I had a ti and since then I have been experiencing this at times sometimes it does not bother me I just want to make sure I am fine or see if this is a concern that I need to come in yesterday I experienced the pressure pain on my left side more and it drew enough for concern I do not know if it is gas or something else",
        "input": "",
        "output": "hello it is important in your case to rule out the possibility of pelvic inflammatory disease now points in favor are history of chlamydia and ti in the past pain on deep penetration and tenderness on the left side of abdomen these are the sufficient point to evaluate for the possibility of pid pelvic inflammatory disease I guess you do not have any discharge per vaginum may be scanty one more thing is just try to see if you are having this pain from the beginning from the intercourse or started after some time because if it is from the beginning then this may be dyspareunia and not related to pid but if it has developed later then it becomes important that you undergo evaluation for pid you will need an ultrasound of pelvis cop reactive protein or ear erythrocyte sedimentation rate vaginal fluid smear however the vaginal examination will also be helpful to see whether there is any cervical motion tenderness which would give a fair idea about the possibility it is important to rule out pid because it can have consequences later like fertility issues so if we get any clues regarding it then you will need a course of antibiotic treatment I hope this helps"
    },
    {
        "instruction": "hello my father who is 62years old has diabetes type recently he started not feeling well he has stopped eating basically does not want to eat or drink anything he been like this refusing food for about days now his blood sugar is anywhere around 250 380 even though he is not eating anything we took him to the hospital and they said it was neuropathy because he is also experiencing body aches my father is extremely fatigued all he wants to do is lay down and sleep any help on what could be happening or what should we do to help him get his appetite back",
        "input": "",
        "output": "hi the mentioned sugar levels are too high the medication dosage is not mentioned only metformin does not work for such high levels he might need insulin too initially to control the levels and then eventually can be on pills depending upon the condition and thorough follow up please do not ignore the condition he must be going into diabetic ketoacidosis need to go through immediate blood sugar levels blood oh serum and urine ketone levels I will recommend you to please immediately visit a doctor physically for through examination and complete detailed history until then just follow some preventive measures blood sugar levels including hba1c blood oh serum and urine ketone levels serum bicarbonate uncontrolled diabetes diabetic ketoacidosis neuropathy excess intake of water to stay hydrated conut water less calorie diet"
    },
    {
        "instruction": "my boyfriend has extreme pain when he breathes in his upper right abdominal area this is the third time this month and it started at around am last night and he went to the hospital last night at 1am they told him they could not find anything on the rays or blood work he woke up this morning and his pain is still extreme can you offer any insight please",
        "input": "",
        "output": "hello dear I welcome you to icliniq I feel very sorry for his pain the causes of severe pain in upper part of the abdomen are gall bladder stones common bile duct stones within the bile duct which drain bile a yellow secretion from gall bladder to small bowel peptic ulcers within stomach and or small bowel pancreatitis inflammation of the pancreas a gland over the back of our abdomen I think he already been advised some medications for that but I just write here in case they are not given cap esomprazole 40 my now and half hour before meals cap tramodol 100 my now it may or may not be ot in case not available give him cap celecoxib 100 my now do not give any other painkillers because they may worsen pain of peptic ulcers if present spy gaviscon 15 my now and half hour after meals for times in a day if you want to provide more information about his pain I may suggest some investigations to rule out above possibilites I hope the medicines will help him to control his pain take care and have a good day peptic ulcer disease gall stones cod stones pancreatitis intusscception volvulus serum amylase ultrasound abdomen follow to discuss and provide more information"
    },
    {
        "instruction": "my father is diabetic and have kidney stones recently he saw blood in his urine after walk exercise what is the reason behind it",
        "input": "",
        "output": "hi thank you for consulting me kidney stones can have different presentations it also can cause blood in urine after exercise and stones should be evaluated properly and treatment your father have diabetes and might have other medical issues so proper evaluation before intervention is required I need more follow up with you to get more detailed history from you about your dad then I will order ultrasound blood tests to check on his kidneys as for now then will proceed further hematuria due to stones fbi creat urine analysis and culture ultrasound rub renal stones urothelial kidney tumor urolithiasis to be decided after investigations hydration and observation if persistent gross hematuria admission and evaluation as inpatient after days with requested investigations"
    },
    {
        "instruction": "hi sir I am an 18 year old boy I have an inborn inguinal hernia but till now it has not given me that much pain as it is giving right now if I lay down for more than hours then it starts hurting and I cannot sleep anymore the pain extends from lower abdomen pelvic region to some upper portion of fimer I cannot take surgery now as I have an entrance exam within a month and also there is corona outbreak outside so I have a fear to go to hospital so sir can you please tell me how can I reduce my pain at least for this month and also should I take surgery immediately or can I wait for this month",
        "input": "",
        "output": "hello your complaints of pain related to the hernia needs to be examined if there is no complications within the hernia in normal circumstances I would suggest all hernia should be operated but since you are having exams you can delay the surgery given that on physical examination and ultrasound you do not have any complications for the time being as a temporary measure you can use what is called as a trust available in the market even online but it is temporary and once you are free fork your exams I suggest you to get operated there after as trust or any other treatment is just temporary and has its own pro and cons but if on ultrasound it shows you have any complication the you need immediate surgery avoid lifting heavy weights add fiber rich food to your diet and avoid constipation to prevent exacerbation of your hernia hope this helps"
    },
    {
        "instruction": "hi doctor I used to have clear skin but since I moved to a new place I started to have lots of acne on my face particularly on my forehead I thought it would disappear once I went back home but it only got worse I did some research and assumed that it was caused by drinking too much cow milk but it has been since I stopped and they would still not go away I also noticed that I get deep acne whenever I am nearing my period along with the usual small red bumps I bought an acne soap and have been using it for a month now but I am not sure if it works I hope you can help me because it has been affecting my mental state lately",
        "input": "",
        "output": "hi there acne has multifactorial etiology only acne soap does not improve if ypu have grade or more grade acne you need to have oral and topical medications this before writing medicines I need to confirm your grade of acne for mild grade topical clindamycin or retenoic acid derivative would suffice whereas for higher grade acne you need oral medicines alike doxycycline azithromycin or isotretinoin acne vulgaris cleansing face with antiacne face wash"
    },
    {
        "instruction": "hello doctor I am not able to conceive after trying for almost one year I was diagnosed with pituitary microadenoma and I am on medication my prolactin levels have now reached normal levels after two months taking medication I suffer from hypothyearoidism and on medication I have had this for five years now and it is well within the limits as per my endocrinologist now this is due to an autoimmune disease where my to thyearoid peroxidase antibodies were high during the diagnosis five years ago my husband and I would like to know how should we best prepare for pregnancy and what to look out for we would have preferred to visit the clinic unfortunately I am not in a position to visit the doctor due to travel restrictions it would be great to get in touch with a specialist I am currently on euthrox 100 mug cabergoline 25 my once a week and folic acid 450 my daily",
        "input": "",
        "output": "hello I have gone through all your reports and your prolactin and thyearoid levels are well in control what is missing in the follicular monitoring profile of the dummy cycle and also your husband semen analysis test you have been following the correct protocol using oh kits for ovulation and post oh surge if a natural trial or timed intercourse did not work then husband semen analysis becomes mandatory then when both male and female infertility causes are ruled out then comes mechanical causes where positions and version of uterus need to be considered and measures implemented anyways please send these two remaining reports before we can proceed further"
    },
    {
        "instruction": "my father male years old with swollen ankle redness of the swollen area has turn into dark red not diabetic since last check up last year he had a stroke before and has undergone liver operation due to cancer years back he has no fever chills or dizziness just pain in the affected area he just informed me this morning I tried getting in touch with his doctor but was not able to talk to him today I scheduled an appointment tom 10am but I am not sure if it is safe to bring him to a hospital for a check up",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello doctor I am a 34 year old male I am experiencing pain in my right side of the stomach about inches right of my navel in line with my navel when I sit or lay down I do not feel pain as long as I do not move I feel pain whenever I take deep breathe cough and move my torso my stool and urine look normal and I do not have difficulty in passing stool and urine I started feeling this pain for the past four days I just noticed that my right stomach looks bigger than my left it seems that it is inflamed please help",
        "input": "",
        "output": "hello are you diabetic do you feel any pain after food intake I have seen the images that you attached with your query possible causes are this is the area for gallbladder possibility of cholecystitis right ureteric stone may present pain in this right para umbilical right hypochondrium area fatty liver colon infection ascending colon gall stones may also present like pain in this region so use the tablet cyclopam dicyclomine and paracetamol twice a day for five days ofloxacin and ornidazole twice a day for five days after food tablet pantoprazole before breakfast for one week drink plenty of liquids avoid fatty foods if symptoms not improved please get it done ultrasound abdomen and post me"
    },
    {
        "instruction": "hello doctor I woke up with a throbbing headache previously I was alright before going to sleep which was around am lately I have been sleeping very late due to working at home for long hours please help",
        "input": "",
        "output": "hello I can understand your concern according to your statement you have been suffering from throbbing headaches during waking up headache which is throbbing in nature may result from the dilation of blood vessels from increased blood flow headache is very common in everyone life strenuous work stressful life dehydration anxieties tension common cold allergies low glucose sugar level etc can cause headaches throbbing headaches may result from some health conditions such as migraines throbbing headache occurs at the top of head cluster headache occurs as throbbing headache behind the eyes occipital neuralgia presents as throbbing headache at the back of headache temporal arthritis occurs as throbbing headache in temples hemicrania continue occurs as throbbing headache on one side treatment depends on the causes you should undergo some investigations like abc complete blood count ray pins paranasal sinus can detect the cause which is responsible for your sufferings and then treat them accordingly you can take for your headache as follows tablet inderal pronolol 40mg 1 for 15 days naprosyn naproxen 500 my 0 for 10 days prevacid lansoprazole 30 my 0 for 15 days in case of allergy or cold take tablet allegra fexofenadine 120 my 1 for 10 days in case of any other query knock me"
    },
    {
        "instruction": "hello doctor I am a year old male I have not had any previous health problems non smoker and non drinker generally I am feeling fine for the past six months I have produced bloody semen with blood clots and producing more recently I have also recently started feeling mild pain behind my right testicle occasionally my left testicles seem to change in size slightly and seem to almost disappear and the right testicle becomes quite tender and firm I had an ultrasound scan about six years ago and there was found some cyst but little concern about a week ago I sensed a small lump rising above my right testicle to my lower abdomen it was uncomfortable but I slept and the discomfort eventually went away I see little blood colored spots appearing on my arms and torso perhaps resembling perhaps petechiae and have an area of this rash on my torso that I am not sure may be related to my concern I have been taking azithromycin since yesterday incase it may be a virus or something bacterial but it does not seem to be helping the problem I had a blood test in january 20 but have not been able to make a follow up blood test yet not sure why it might be necessary what does the problem sound like to you",
        "input": "",
        "output": "hello hematospermia blood in semen is fairly common generally it is not considered as a sinister sign there are whole list of possibilities for this theoretically but once we ensure it is not due to sinister cause and rule out treatable causes say like infections we do not beyond that as it will not affect the management sinister causes mainly prostate and testicular cancers at your age prostate cancer is extremely unlikely but need to ensure no testicular problem with your symptoms with tes you need another scan to be on safe side as the scope for examination to be conclusive I suspect you have epidydimal cysts which are very common and can cause pain etc so if the scan does not show anything other than this I would not worry about it at all I think the rash is completely unrelated to this or any of your urological problems nor the rash or hematospermia is related to old history of chlamydia since you have not had any other urinary symptom I would not worry much about other tests related to urinary tract however I would also recommend sending semen for culture to see any infection in it lastly about prostate cancer virtually unheard in your age finger examination of prostate spa blood test and mri scans of prostate are the screening tests in general but not something I would recommend if tes scan comes back normal and if you are still worried an mri then will be helpful as last resort idiopathic testicular pathology ultrasound scan of tes ideally an examination of genitals including prostate by a clinician semen culture idiopathic hematospermia with reports"
    },
    {
        "instruction": "hello doctor I am a 24 year old female I received a second round of a cortisone shot in my wrist on 18th may for wrist tendinitis during the injection it hurt much worse than the first shot I have been told to keep my wrist in a splint at all times my wrist is still bruised where the injection was given there is now a bump as well where I have injected hurts when touched before the first shot I had a ganglion on my wrist that popped I cannot say for certain if the bump is from the injection or the ganglion is back because of the shot I need to know if this is normal or if I should go to a clinic over the weekend I am currently on autumn wills seroquel 400 my lithium 300 my and ativan my when needed and not often",
        "input": "",
        "output": "hello from the brief history you have given it seems like there is not much to worry about first of all I need to know some more detailed points where exactly in the wrist the shot was given I mean is it the extensor of the thumb de quervain or is it for any other finger also do you have thyearoid issues sometimes when the large volume of fluid is injected into the tendon sheath and surrounding area due to distension it can cause severe pain and patients do complain of exaggerated symptoms prior to injection small vessels must have been punctured quite normal which lead to extravasation of blood hence the bruise it will take a few more days but both the bruise and the bump should go away do apply ice packs there you will get you the necessary relief ganglion cysts are notorious for recurrence but highly unlikely to be associated or related to the injection if you can send me a clinical picture that would be better splint is fine but you do need to mobilize your wrist for a very long time otherwise you might end up having stiff wrist 3 weeks should not cause any stiffness understanding tendinitis is important you need a very specific rehab protocol and few medications and you should feel much better in few weeks time did you get your vitamin levels tested kindly revert with the info"
    },
    {
        "instruction": "hello doctor my father is 86 years old he is a hypertension patient and on metosartan 25 my ecospirin 75 and nexpro for prostrate he is on maxvoid my for the past 10 days he is complaining that while passing urine there is an urge and sometimes he passes stool on medical advice he took imodium four tablets for two days and ofloxin 200 my for five days but still the problem continues please advice",
        "input": "",
        "output": "hello welcome you to icliniq com I can understand you must be very concerned about your father health well I have reviewed his medical history which he has been taking for hypertension prostate and recent use of antibiotics and imodium so typical symptom you mention that whenever he urges to pass urine stools passes by itself which is suggestive of stool incontinence means loss of control stools with his age it is possible that he has weak anal sphincter the anal sphincter is a muscle around the anus which contracts and control the stool output in older age it become weak and lack sustained contraction hence get loosened with every attempt to pass urine which increases abdominal pressure would also lead to evacuation of stools this stool incontinence because of loose sphincter at times perceived as diarrhea however it is not actual diarrhea for diarrhea once has to have stool volume more than 200 my 24 hour and significant change in consistency of stools like watery stools or greenish unformed stools containing food particles if none of these signs which are suggestive of diarrhea I suggest you to stop ofloxacin if given for perceived diarrhea the drug he has been taking for prostate also causes external anal sphincter and hence partly contribute to his stool incontinence I want to know if he is feeling mucus thick jelly like material in stools blood in stools or rectal pain or repeated visits to toilet when nothing comes out this information is important to rule out any inflammatory process beside loose anal sphincter I suggest you few investigation for stool studies which will tell if he has active infection of bowel and if present can be treated with antibiotics then for treatment he can take imodium two tablets thrice daily for two more days excessive use of this medication would cause constipation and can worsen patient discomfort I want you to help him learn pelvic muscle strengthening exercises there are many youtube videos available to learn how to do pelvic floor strengthening exercises while sitting on a common chair lastly biofeedback therapy which is a computerized software which help him to control his anal sphincter while passing urine or otherwise this treatment is offered at physiotherapy department of a hospital avoid excessive fibers and modify liquids to 5 liter maximum intake in a day this would reduce the overall bulk of stools formation in the bowel and hence decreased stool output stop or reduce alcohol intake if taking this also causes diarrhea and loose sphincter controls I hope this helps stool incontinence secondary to age with loose sphincter plus drug side effect digital rectal examination performed by gastroenterologist in person norectal manometry not usually required if digital rectal examination is suggestive of the diagnosis stool detail report stool fecal calprotecin and stool for occult blood stool for ova and parasites stool for fat globules and reducing substance complete blood count stool incontinence secondary to older age and drug related follow up to disclose other parts of history as mentioned above otherwise follow above regimen and see me in one week time after investigation"
    },
    {
        "instruction": "hello doctor I think I have something along the lines of a bipolar hypertension situation I wake up in the morning my blood pressure is prehypertension to around hypertension stage not that bad but in the evening to later in the night my be is through the roof in the midnight my be is measured to be 176 126 on standing when I lay down on my left side and it is down to 10 60 after a few minutes I could use some help in figuring this out I am 20 old",
        "input": "",
        "output": "hello I understand your concern do not be bothered you will be fine I advise you to get a pen and paper write down your blood pressure measurement for three days make sure to measure immediately you wake up from sleep in the morning before any activity get back to me with the readings it will help understand what is happening"
    },
    {
        "instruction": "lower back pain unable to put pressure on legs to walk weeks ago I was lifting my dog into the car I got a sharp pain in my lower back went away in about two days today I was lifting my two year old into an inflatable tube while setting her down I had the same pain but on the mid right side of my back this pain continued all day then while bending down to get a dish out of the dishwasher I got a horrible pain in my lower back the pain knocked me to the ground my husband had to help me off the ground to the bed since then I have not been able to put pressure on my legs to walk without horrible pain",
        "input": "",
        "output": "hello you need to be examined to determine if this is a back strain or a sciatica from a pinched nerve is there any numbness in the leg does the leg feel weak apart from the pain you feel while trying to walk can you control your bladder well does the pain worsen upon straining if the answer to the questions is yes then you have a disc prolapse and you will need to see a doctor and perhaps a mri too in three mentioned to need to take anti inflammatory tablets and muscle relaxant top help with the muscle spasm and apply ice to the sore area on the back rest in bed but not absolute such that you walk as much as to feel comfortable"
    },
    {
        "instruction": "hi doctor hiv tridot antibody test done at weeks and 10 weeks all negative are there chances it will turn positive at 12 weeks now test done with blood taken from vein",
        "input": "",
        "output": "hi following is my opinion for your asked question hiv tri dot antibody test is having good sensitivity and specificity in ruling out hiv as like that of fourth generation elisa usually tri dot hiv test is able to rule out hiv after six weeks of exposure however hiv test can be considered conclusive in ruling out hiv after three month of exposure so I suggest you investigate with hiv rapid test after 12 week again you can revert back with hiv report after 12 week of exposure to check it"
    },
    {
        "instruction": "hello doctor my daughter has acne on her face for the past one month I think that is hormonal acne because it is in her chin and jawline as per my knowledge she is taking cabergoline 25 my per week for an increased level of prolactin as prescribed by an endocrinologist for the past three years there is no acne on her face for the last three years but now suddenly it appears on the face sometimes it is white and small and it often occurs on a daily basis kindly suggest",
        "input": "",
        "output": "hello I have gone through the history and prescription you have attached honestly speaking I cannot understand what is written in the prescription can you send me a picture of individual medication so that I can get an idea of what is she taking it will be of great help to guide you further with new medicines and creams"
    },
    {
        "instruction": "hello doctor I have blood flowing from my left ear without pain please help",
        "input": "",
        "output": "hi most common reason for bleeding from the ear is due to trauma there is nothing that you need to worry about as this is extremely common make sure you do not use earbuds as they often traumatize the ear canal or eardrum and introduce infections please do not use headphones or earphones as well until it heals make sure you keep the ear dry make sure no water enters the ear at any cost for now you can apply ciplox ciprofloxacin ear drops three drops thrice a day and take tablet liz levocetirizine 10 my one tablet at night after meals for the next one week this will reduce any itching make sure that there is no pus like discharge from the ear because in such a situation the infection of the eardrum is more likely and will require systemic oral antibiotics I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 43 year old male I have spots and discomfort on the penis head it has been coming and going for a while now some of the spots are more visible if I squeeze the head and it looks like dark specks under the skin I am using butenafine hydrochloride and cortisone 1",
        "input": "",
        "output": "hi reviewing your history and pictures showed there might be skin irritation which can be from repeated friction like masturbation or reaction to the substance used it also can be due to vitamin deficiency or a skin condition like psoriasis etc fungal infection is rare and it does not present as a spot usually it is whitish material and happens in people who are immune compromised like diabetics or people who have hiv infections since it is not itchy or painful you should not worry about it and you should not use cortisone cream as it makes things worse keep good hygiene area should be dry and clean use nonchemical lubricant like olive oil if you masturbate if you have changed your soap or shower gel it might be the cause take vitamin and vitamin a to replace your vitamin deficiency if you are known to have psoriasis then treatment can be by methoteraxate cream but only for people who are known to have psoriasis follow up is important and please keep me updated for any further queries"
    },
    {
        "instruction": "hello doctor I am in the 13th week of my first pregnancy I had two episodes of postcoital bleeding after which us was done and showed low lying placenta lower placenta is covering the os I had been on bed rest and pelvic rest for the past one week and taking austen 200 be apart from folvite is it fine for me to go to my work place I am a pathologist have to sit for three to four hours only any other precaution",
        "input": "",
        "output": "hi if there is no active bleeding you can safely go to work provided the roads and all are smooth and if it is not a very long drive please avoid intercourse and vaginal douching repeat us after six weeks for a level scan and look for placental migration continue austen progesterone tablet"
    },
    {
        "instruction": "hello doctor what can be done for low calcium in a thyearoid patient",
        "input": "",
        "output": "hello is it possible you can do histopathology of thyearoid gland to rule out you have many metabolic disorders that you need correction relative hypocalcemia thyroid disorder histopatholgy of thyearoid and parathyearoid gland mri thyearoid gland color doppler thyearoid gland relative hypocalcemia thyearoid carcinomatous change thyearoiditis tab fecal max tab po od month"
    },
    {
        "instruction": "hello doctor I am a 26 year old female I have joint pain in widespread bilaterally in elbows knees and ankles I also have muscle tenderness on my neck and shoulders and back pain from a herniated disc I take diclofenac 75 my pin for pain I have had laboratory work done and I have seen a rheumatologist my initial labs ana positive 160 speckled cop was elevated my anti is dna cop and ra factor were all negative secondary lab work through elisa showed negative ana and all other autoimmune laboratories were negative except for positive anti phosphatidylserine prothrombim a at units slightly low vitamin but I take supplements I eat a plant based diet and exercise twice a week my other medical history includes depression and anxiety for which I take medication my question is despite my labs being negative why do I still have joint pain and muscles aches",
        "input": "",
        "output": "hi I would like to ask you a few more queries is your sleep pattern fine morning fatigue how frequently are you taking diclofenac any hair fall oral ulcers dry eyes dry mouth any recent irritability or forgetfulness how much was the level of cop you had mentioned a personal question but is there a particular reason for the depression any family history for endogenous depression there can be many reasons of pain we need to distinguish if it is inflammatory or non inflammatory alone ana positive may not imply much here we have to see if it is impacting your system as well"
    },
    {
        "instruction": "hi doctor I am 21 years old and having regular single heart palpations I have an apple watch which provides an egg and this shows my heart is beating at regular intervals but there is fairly regularly a single beat which is much larger I can feel this in my stomach chest area and feels like a heavy beat or a missed beat I will upload a couple of edf results to show you can quite clearly see when these large beats take place I sometimes get chest pain but I usually attribute this to my stomach or anxiety and the chest pain does not tend to accompany the heart palpitation my main worry is it is quite regularly happening and it is one singular beat which is off I have bad bloating which has been for the last month or two which comes and goes but am unsure if this is related",
        "input": "",
        "output": "hello I have gone through the results you attached you are experiencing missed beats also known as premature ventricular contractions they are usually benign harmless your symptoms can be worsened by drinking caffeine smoking or some medications I usually do not prescribe my patients medication at first except it affects your daily activity firstly avoid trigerrs like alcohol drugs sleeplessness etc try to exercise regularly atleast or times a week for a duration of 30 minutes make sure to sleep to hours daily at night if your symptoms persist you will need a beta blocker medication it acts by regulating how your heart beats ablation is the definite treatment of choice if all measures fail but am hopeful it will not get to that I wish you good health best regards"
    },
    {
        "instruction": "hello doctor I am going to the dentist soon and I know I have a cavity and I think it is pretty big it is easily noticeable and I am just nervous because it is probably obvious that I do not brush the bristles are always a really weird texture for me and I just do not want anyone to be mad at me because I have known about it for a while now I feel bad for saying this but I think it has been around six months and never mentioned it to anyone because I am little scared of going to the dentist I do not like anyone feeling around in my mouth and knowing about this cavity is making me even more nervous for going there today I have had teeth pulled in the past and I hate everything about it but I am not sure they could just fill in this cavity",
        "input": "",
        "output": "hello as a human we all carry some kinds of secrets or fear back in our head I felt glad as you have the courage to admit that most people cannot so be proud of that I think you need a scaling too as you have not brushed for a long time its leads to swollen gingiva that might be the reason of uncomfortable using a brush as you have cares and sensitivity associated you might not necessarily need an extraction if the cares has progressed alot root canal can be done to save your tooth betadine mouthwash gargle in lukewarm water 3 times a day do not worry use it if any foul breath that will be covered and your secret will be safe as you feel uncomfortable using a brush you can brush using your finger and toothpaste that way your mouth will also be clean and issue with bristle will also be resolved you can also take capsule sporidex 500 my one capsule be for days tablet zerodol so tablet be for days capsule pan one capsule be before meal for days you will be needing a scaling to remove any tar once done you can start practising brushing using a soft bristle brush even a baby brush will do for a start I am confident you will succeed but you have to start the habit and you will get used to it trust me you can train and motivate yourself by rewarding a candy or anything special by that way you can overcome your fear and gain comfidence I am glad that I could be someone whom you can share a secret I wish you good luck you can trust me and ask if any further query I will be happy to help further hope your treatment goes fine do as I asked you to do you are brave you will be fine I am confident about that"
    },
    {
        "instruction": "hello doctor I am currently 25 years old and this the first time that my period is late and it has been over 35 days I am not married I do not have cos it is just that my period was never late and now I am worried sick please I need your advice",
        "input": "",
        "output": "hello do not worry about the periods as you are aware that delay in periods can be due to obesity as you had suffered last time however my compliments to you for reducing 14 keg of weight so we can conclude that delay is not due to being overweight then delay can be due to hormonal changes due to various medications specially birth control pills etc which you are not taking stress is also one of the major reasons these days due to corona and associated problems pregnancy can be a reason but only if one is sexually active and you are out of that risk as well may be the cramps you had are signs of periods onset we can wait for 3 days and may be then start with medication"
    },
    {
        "instruction": "hello doctor age of the child 20 months gender male weight 12 kilograms height 30 inches started walking 15 months started sitting months started crawling 12 months problem my baby has started walking at the age of 15 months and is very active he runs jumps rolls and can climb stairs with the help of an adult and can speak words sentences the problem we are facing is a balance issue he is an active child but has an issue in maintaining good posture and is easy to fall when standing straight and static an observer can feel that he is dizzy and swings slightly left and right to maintain the balance he also has lazy neck control at months of age he suffered from torticollis which we have managed to minimize by exercises recommended by other pediatrics he also has digestion problems since birth and has loose motion after week he has also slight drooling my question is this balance problem common in this age group or should we choose to consult an in person doctor which I am avoiding due to couid 19 crisis as the hospitals are crowded",
        "input": "",
        "output": "hello first let me appreciate you for describing whatever your child has appropriately as you have said that the baby has just started walking about months ago the problem with balance could be just his learning curve kids normally do fall while learning to walk am sure even you will be aware of that he is able to walk rule and climb stairs only means he is growing normally now to say if the balancing issue is normal or not you can make a small video of it and show me it is difficult to say without seeing the baby let us assume that it is a part of normal development then you do not have to go to a doctor and you do not have to worry about it now if we assume that it could be because of a physical problem the child will have to be examined my advise is to wait till he completes years if the problem still persists then you have to go to a doctor"
    },
    {
        "instruction": "hello doctor I am a singer but in recent times I have not been able to sing high pitch I develop pain in my throat while singing high notes I want to show you what happens when I sing using a sample song can you diagnose and give treatment after listening to my song",
        "input": "",
        "output": "hi I treat a lot of singers so I totally understand what you are going through to answer your first question yes it is totally possible to diagnose based on an audio clip of you singing though a better method would be a copy of your voice box however I am guessing there are breaks or voice gaps in certain parts when you hit a high note this is common among male singers the issue here is that your voice box has vocal cords that vibrate when you sing the slightest inflammation or irregularity in these vocal cords can produce noticeable changes in a singers voice the problem here is that the slightest change in the singing voice makes the singer more anxious and he tends to practice harder doctors typically prescribe steroids but that will not help unless you give your voice a rest give the vocal cords enough time to heal there is a lot more I would like to say but I will try and summarize my advice for you total voice rest for days no speaking no whispering daily concentrated salt water gargles steroids betnesol 5 my times a day for days pantoprazole 40 every morning for days after days try afresh and record the audio I would love to hear the before and after hope you become a star singer one day"
    },
    {
        "instruction": "i am 30 years old missed period for days now since my 24 day of menstrual cycle was starting using duphaston drug once daily and finish the prescribed dose yesterday and my menstrual cycle is between 26 28 days this month on the days of my periods I got cramps but nothing come out could this be side effects of duphaston or",
        "input": "",
        "output": "hello welcome to icliniq I would like to know the reason why you had been taking duphaston if you have been planning for a pregnancy then it would be advisable to check your urine pregnancy test once if negative you can wait unto two week for your periods to come as you just finished your course of duphaston yesterday it may take maximum unto two weeks for the withdrawal bleed to happen once the duphaston is stopped if you got pregnant this cycle then you may not have periods even after weeks so check accordingly please feel free to revert back anytime with any further queries have a nice day"
    },
    {
        "instruction": "hi I am having pain in my eyes it is like some kind of stretch secondly the taste of my mouth is very irritating and I am not having any urge to eat anything I thinking my body is heating but I am not having any fever",
        "input": "",
        "output": ""
    },
    {
        "instruction": "no current medications female age 21 height 2 159 am weight 15 labs last known why do I always have recurring knee pain sometimes alternates from left and right it hurts so much and it keeps coming back even though im not exerting stress on them such as from running",
        "input": "",
        "output": "dear sending love and peace to you my dear there are some condition which causes knee pain I would also suggest to do some test where we can get knee pain on and off these are few condition where there can be like your symptom my dear I am waiting for your reports to come and I will manage to prescribe drug for you thank you have a good day"
    },
    {
        "instruction": "hello doctor I am a 53 year old male I have been experiencing panics especially when I do not feel better like having acid reflux now the gastrointestinal issue becomes regular the only means to stop it is by drinking alcohol during night time and I feel better and get a good sleep please advice",
        "input": "",
        "output": "hello I suggest you to take once a day pill for controlling your acid reflux capsule esomeprazole 40 my half an hour before meals you can take it in the morning time before breakfast or before dinner if you have predominant night symptoms this acid suppressant will control the symptoms of acid reflux and acidic related stomach pain you can take it regularly for two weeks then take it intermittently whenever you need this medications does not have significant long terms adverse effects well I also want that you should know that moderate alcohol intake is fine which means maximum of three drinks per day the alcohol can help to make someone sleep but it is something which is beneficial for gastrointestinal gi tract excessive alcohol has to do with a lot many things in gi than even we doctors know so just an advise to moderate the intake"
    },
    {
        "instruction": "gender female age 19 weight 320 problem gum mouth problems symptoms numbness behind my two front teeth aches receding I had this problem for or days my gums are numb and I am not sure what I am supposed to do I have tried using hydrogen peroxide and mouthwash and scrubbed inside my teeth I think this mostly has to do with my poor dental hygiene I have not brushed my teeth enough as I should have and I am starting to feel the effects of it but I not sure how else I should treat the problem at home and I am worried to go to the doctor due to the current outbreak is there anything I could do",
        "input": "",
        "output": "hello welcome to icliniq this is your dentist I went through your query as a specialist I would like to help but for that reason I would like to see whats actually causing you the inconvenience I can understand how painful and uncomfortable its been donot worry I will help it ease for now rest when I see the image so kindly upload I will be waiting so kindly upload the image back portion of lower tooth as soon as convenient tar and stain gingivitis with localised periodontitis with respect to lower tooth first I would need tea confirmation first avoid sticky or sweet or chilled food items feel free let me know if any further query follow up after days but first upload the image to confirm the diagnosis"
    },
    {
        "instruction": "please need guidance actually my mother is blind and my family is partially blind I have weak eyesight by birth and by birth glocoma which was operated also I have nystagmus my wife and I are planning to have our first child we do not want our child to suffer as well now please recommend me something to pervert this transmission also something for me as well regards",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello doctor I have severe weakness in the muscles of the hips and butt but no real pain I stopped taking rosuvastatin ezetimibe and paroxetine but I still use enalapril 15 my daily to lower my blood pressure blood tests for muscle rheumatism are negative vitamin is 95 nmol and I use a magnesium supplement to enhance my muscles what is wrong with me",
        "input": "",
        "output": "hello since when are you having this problem any history of trauma or lifting heavyweight any perianal sensory loss or difficulty in holding urine what symptoms do you have like difficulty in walking climbing stairs etc"
    },
    {
        "instruction": "hello doctor I am a 58 year old male I am 180 am in height and weigh about 85 keg I have frequent constipation issues I am currently on obimet so 500 glimisave m1 pinot 40 my pivasta my and clopilet 75 my",
        "input": "",
        "output": "hello would you please answer few of my following questions how frequently do you pass stools per week have you felt any blood in stools do you feel pain in the anal area while passing stools have you noticed anything coming out from the anal area while passing stools have you noticed any loss of weight if yes then how much any abdominal pain do you strain while defecating any feeling of incomplete evacuation after passing stools have you used any medication for constipation any change in drugs for diabetes and hypertension in the past six months do you have alternating diarrhea with constipation do you feel bloated I will start symptomatic treatment and some workup for constipation please feel free to ask anything and answer my questions abc complete blood count hba1c glycated hemoglobin ash thyearoid stimulating hormone serum calcium digital rectal examination ispaghol husk two teaspoons in a glass of water every night polyethylene glycol sachet in a glass of water every night for two weeks take plenty of water do 20 30 minutes walk daily"
    },
    {
        "instruction": "hello doctor we noticed our year old daughter has a visible blood vessel on one of her tonsils she feels fine and says her throat feels fine is this a cause of concern we have never noticed it before it has been three months since she was at the dentist and I know they check her tonsils this is very weird please advise if this is very serious",
        "input": "",
        "output": "hi I have had a look at the pictures you have sent the tonsils are definitely enlarged in this case there is no doubt about it the tonsils have a very rich blood supply and are relatively vascular structure it is normal to encounter leash of blood vessels over the tonsil or its adjacent areas like the anterior and posterior pillars these are two walls in between which the tonsils reside unless and until the tonsils are inflamed and the child is symptomatic we do not need to give any sort of antibiotics as it is not indicated at the same point of time enlarged tonsil indicates possible previous episodes of recurrent tonsillitis as a result of which the tonsillar tissues get hypertrophied and attains a larger size it is always better to maintain strict oral hygiene do saltwater gargles five to six times a day at regular intervals avoid anything cold spicy and oily food beverages maintaining precautionary measures definitely goes a long way in preventing recurrent sore throats or streptococcal infections however in a situation where the child is having recurrent sore throats with associated fever significant leaves from school it is always better to get the tonsils removed there are criteria given by ao hns american association of otorhinolaryngologists and head and neck surgeons who have laid down criteria for a patient to undergo tonsillectomy in nutshell visible blood vessels over the tonsils or related adjacent structures is not a worry as it is very common and seen in health and have not pathology related to it sticking of the uvula to the right tonsil is due to surface tension of the saliva and enlarged size of the tonsil this again has no clinical significance there is absolutely nothing that you need to worry or get stressed about make sure you advise the child to follow the instructions that I have given above to prevent recurrent sore throats in addition she can also use crushed ginger with masuka honey you can add crushed ginger and honey in a cup and give it together one tablespoon three times a day honey has excellent antioxidants antiviral antibacterial properties and so does ginger I hope this helps"
    },
    {
        "instruction": "hello doctor I have three medical concerns that I think might be related one is that I have soreness in my left armpit another is that my left ankle has been swollen lately and finally I have a one in circle ark that looks like a faded bruise in my left groin there is no swelling associated with this and no pain the last one has been persistent for a few months and the circle got darker when I went on bactrim for a ti but then got lighter again could these three things be related is there any cause for concern",
        "input": "",
        "output": "hello since when are you suffering from this condition it may be reactive arthritis reiter syndrome in which urethritis or ti urinary tract infection followed by joint swelling and rash it may be associated with dry mouth and dry eyes it may be a different entity like groin rash which may be a fungal infection joint swelling may be due to arthritis or gout or crystal induced inflammation left axillary pain may be due to herpes foster or boils or shoulder joint arthritis or rotator cuff problem or hypothyearoidism until examination is done it is difficult to say what it is get it done urine culture and sensitivity cop reactive protein ear erythrocyte sedimentation rate and ray of left ankle joint use tablet naproxen 250 my twice a day for five days keep limb on elevation mode while sleeping please review with reports or consult with your physician he will examine and treat you accordingly"
    },
    {
        "instruction": "hello doctor my sept test result is 49 is it dangerous for the liver",
        "input": "",
        "output": "hello well you did not share your body weight do you feel any symptoms like fatigue weakness or loss of energy this information is important because only sept which is just nearly one and a half times raised cannot tell a diagnosis on its own to answer your concern that it is harmful yes it is but whether it is less harmful or highly harmful that depends upon the underlying condition the causes of such raised sept are many folds but of note viral hepatitis obesity alcohol and autoimmune hepatitis are the top most reasons for asymptomatic elevation some drugs have a tendency to cause raised sept commonly paracetamol your rest of the urine report is completely normal I want you to tell me about your symptoms and current body weight before I can suggest a target set of investigations let me know about yourself in detail like prior history of hepatitis family history of hepatitis prior blood transfusion any travel history I also want to know some personal information like alcohol consumption marital status and sexual history recommending your investigation without any information regarding the case is not a cost effective option I hope you understand my point raised sept serum glutamic pyearuvate transaminase viral hepatitis alcohol hepatitis nafld non alcoholic fatty liver disease autoimmune hepatitis follow up to provide more information as I can be in better position to suggest you investigation and treatment plan"
    },
    {
        "instruction": "hello doctor I have been experiencing acid problems I keep burping after eating I started to take 20 my omeprazole I have been taking it for three days once daily but I experience side effects such as muscle weakness headache and shortness of breath how long should I take the medicine and can I switch to esomeprazole",
        "input": "",
        "output": "hello I will definitely help you with your problem burping after eating is a very common problem it is known as gastroesophageal reflux disease I will suggest you some precautions to prevent it eat less quantity of food every time than before you may eat five to six times a day but with lesser quantity there should be a gap of two hours in the night after eating and go to bed walking for sometimes is a must after every eating avoid spicy and fatty foods as much as possible you may switch to esomeprazole it is more effective also add one more drug levosulpiride for 15 days you should take syearup sucralfate two tablespoons three times a day it will help to heal ulcers and for fast recovery I hope this helps"
    },
    {
        "instruction": "hello doctor I have been on a foley catheter since two couid prohibited the procedure at that time I am having a cystoscopy on the 18th of this month if all is well will my bladder be too weak since it has been on the foley for so long foley has been a pain and I am on xarelto and plavix which causes intermittent bleeding during the day but I do not have any infection I am also a diabetic and I cannot self cath what do you think they will recommend I am currently on flomax and finesteride",
        "input": "",
        "output": "hello coming back to your query you need to answer some of my questions first when the catheter was put how much urine came in the first 15 minutes did your bag get filled fully half or what were you on a floral finastride combination before you were put on a catheter for what reason you were catheterized was it retention of urine any abdominal ultrasound done till date which mentions prostate size do you have any urinary complaints like frequency urgency poor stream nocturia dribbling burning or micturition before catheter was placed and how long you were having them if any is your diabetic status under control any hba1c report"
    },
    {
        "instruction": "hello doctor my sister is having severe stomach ache and yellow vomiting and the pain goes around her abdomen to the back she is suffering from this pain for the past one week please help",
        "input": "",
        "output": "hello I can imagine you must be very upset about your sister and I really feel sorry that she is in pain for a week time well the pain you mention that is severe and radiating to back is suggestive of pancreatitis however the possibility of peptic ulcers cannot be completely ruled out ideally the pancreatitis that is inflammation of the pancreas a gland at the back of tummy should be managed in the hospital however the pain of ulcers peptic ulcers in the stomach and small bowel can be managed at home but before making a diagnosis it is required that you provide further history about her pain did she have this before and if yes how long it last did she frequently have heartburn or acidity issues is she on some medications right now you mentioned her age what is her marital status did she have fever or yellowish eyes or dark yellow eyes you mention she has yellowish vomiting but is she able to take orally or she is throwing up everything like water or food that you give to her you see all this information can help us to decide the most probable cause of the underlying pain and consider some treatment to see the response for time being you can give her capsule esomeprazole to my now and half hour before meals expect the reduction in pain if it is due to peptic ulcer disease the pain of pancreatitis will not settle with this capsule if she is unable to take orally then you can visit a nearby nursing clinic and get iv omeprazole 40 my pancreatitis peptic ulcer disease complete blood count serum amylase and lipase liver function tests urine detailed report ultrasound abdomen follow up to discuss after investigation or earlier before getting tested if you have more concerns"
    },
    {
        "instruction": "hello doctor I found a very small dark spot on my thigh today to the best of my recollection I have never seen it before now of course I am thinking the worse and believe I have melanoma I am olive skinned I have never had an issue with moles or dark spots before my mom had a pre cancerous growth removed from her face years ago and she is fine she goes to her check ups and applies sunscreen all the time when I was a kid I never saw my mom applying sunscreen it was the 70 and it was just something we did not do she just turned 76 I attached a photo I am sure you will think it is something that should be looked at and so do I am going to make an appointment with a dermatologist but I also suffer from health anxiety depression and ocd so I am convinced it is melanoma and I am feeling very depressed right now",
        "input": "",
        "output": "hello I have seen the pictures no it is not melanoma it is a normal nexus benign for your confirmation you can go for an excisional biopsy of the lesion histopathology reports will confirm that the lesion is benign or malignant do not worry it is normal nexus due to melanosis increase in melanin pigment"
    },
    {
        "instruction": "hello doctor I have been hearing a wind like rhythmic noise in my right ear it also makes my ears feel full when breathing forcefully it might go away for some time but it comes back again",
        "input": "",
        "output": "hello a ringing sound or wind like sound in the ear lasting for more than five minutes is called tinnitus if less than five minutes it is not significant this particular sound you are describing can be caused due to dysfunctional eustachian tube I the tube connecting the ear and the nose usually it is more in quiet environments and more noticeable when you are attempting to fall asleep crowded and noisy places serve as a distraction and do not let you notice the sound medicines do work but it takes at least a month for them to act that too the sound does not vanish until two to three months have gone by I understand the trouble it is causing you so what is to be done keep a table fan for white noise when you are trying to fall asleep try and distract yourself when you hear the sound get a hearing test done you can use an audiometry app and send me the result follow the prescription saline nasal drops and steam inhalation three times a day for seven days fluticasone nasal spray two times a day for seven days"
    },
    {
        "instruction": "hello doctor my left testicle has a dull ache when I stand for a period of time I can also see an enlarged vein on my testicle it goes away when I sit or lay down for a little bit I will attach a picture of the vein",
        "input": "",
        "output": "hello I think it is a hernia kindly give some other details do it have cough impulse it means the swelling expands upon coughing it is said to have a cough impulse can you get over the swelling this means when swelling is there are you able to pinch your spermatic cord ignore if you are not able to understand do you do weight lifting diabetes or hypertension any medication"
    },
    {
        "instruction": "does using pills like patrol htp mood stress enhancer have more benefits or risks to taking them I have a bottle of 200mg of this product and also want to know if respiratory diseases specifically ems are likely to happen and why",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello doctor my mother is 43 years old and was diagnosed with rheumatoid arthritis months back her lab reports are as follows serum uric acid 3 my dl of i'm antibody 132 units my her treatment was initiated with defcort 6mg for a week methotrexate 15mg weekly for months hcqs 200 daily post dinner for months it b12 shots weekly for a month followed by b12 shots monthly once even after taking medication for almost months her symptoms of keen pain ankle pain radiating from hip to toe has not seen significant improvement she also took a painkiller named setolacer 300mg which was not useful either I request you to suggest the needful",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello sir my son is and half years old from his birth he has cold cough problem that we took abc in that it came normal but abc use to have 2300 from birth till months back and after that he unable to walk and got severe fever and cold and shiverish and he cant able to walk and I consult with doctor who a child specialist he said me to take a abc and I gone through abc test in that abc shows 5800 doctor said me to take scan and I done scan in that it shows he has a plural effusion fluids in that they send for fluid test but the trust reports are not yet came but the doctor started treatment for chemotherapy by saying he has a blood cancer they took bone marrow biopsy in that it shows negative my doubt is to ask you about sir doing chemotherapy done before fluid report came right or not report not yet came but abc everyday took is rapidly increasing and still fluid test not yet came now doctor sayin that they have to do bone marrow transplant I have a younger kids age under doctor saying that siblings match in blood test will have to be a donor for the person affected you plus give me a suggestion and help me from this old sir or madam",
        "input": "",
        "output": "dear your son may have leukemia and there are so many types of lukemia just with abc leukemia cannot be confirmed and there are multiple tests that has to be done fluid tests may not show positive results in a single test it may be repeated they must have done flow cytometry and that will give you better idea regarding the condition is he having fever or any other complaints sore those bone marrow transplantation will be done only after subtyping leukemia chemotherapy will be usually started after knowing diagnosis but if child is sick enough or if it is not going to affect the test result they may start chemo early and wait for the test results hope it is useful let me know with some more details I would like to give my opinion"
    },
    {
        "instruction": "my mother age is 58 height is feet weight around 50 keg she suffered a stomach tumour more than 20 years back which was to be operated upon 13 years back she suffered a brain stroke because of the clotting of a vein inside the brain she is diabetic and has hypertension too since then she is on continuous medications her prescription includes tab ecosprin 150 my cap gemcol is tab glide my tab volix 3 my tab cobadex cos tab storvas 10 my tab covance 50 my tab eso 5 my nowadays she is suffering from some problems sometimes she has a mild fever which usually comes in the evening she is suffering from pain in waist where the pain originates from the back side of the waist and then come in the front part she is suffering from pain on the right side of her face specially the right side of the forehead she has this feeling of heaviness inside the stomach which is very uneasy she sometimes suffers from pain in the stomach near the navel her stomach does not get clear in the morning pain in the bone of the right side of forehead light headache so what should we do",
        "input": "",
        "output": ""
    },
    {
        "instruction": "i got a severe toothache which I was already done a root canal treatment I could not found any dental care due to corona virus can you please suggest some prescription to get a relief from the pain",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello doctor I have recurring anemia for years now I do not know how to manage it via diet",
        "input": "",
        "output": "hi I will give you a few food lists and guidelines to incorporate in your daily diet schedule include iron rich foods if you are non vegetarian then you can also include egg yolk chicken liver fish along with other veg foods if you are a vegetarian then you can include soybean sprouts garden cress seeds oats cous broken wheat pomegranate apple banana green leafy vegetables squeeze lemon on your veggies meat and salad as vitamin helps in absorption of iron you can also take fresh lime juice or orange juice with your meals avoid taking any caffeine with or immediately after meals caffeine hinder iron absorption you can cook your meals on iron tara or iron pots also avoid taking calcium and iron together as calcium also hinders in iron absorption for example if you are taking calcium and iron supplements do not take it together keep duration in between two supplementations I hope this helps"
    },
    {
        "instruction": "hello doctor my granddaughter was normally born on april 20 her birth weight was 6 keg currently weighing keg with persistent jaundice her total bilirubin is 47 and direct is 19 she is breastfeeding along with formula as per pediatrician suggestion with couple of blood tests and ultrasound the ultrasound was tested for biliary atresia and was negative I am recently seeing oil in her stools pediatrician has evaluated it as conjugated hyperbiliruminemia it would be nice if you could review and let me know your opinions is this could be the reason for not gaining weight",
        "input": "",
        "output": "hi persistence of direct bilirubin at two months of age needs to be evaluated properly most importantly what is the color of her stool is your doctor told you anything about the liver whether it is big or normal there are so many causes but most important and serious and need timely intervention is extrahepatic biliary atresia which as per information has been ruled out other common causes can be neonatal hepatitis or some metabolic disorder the list of causes is long so better if you can share all the reports blood urine sonography torch titer tit enzymes alpha anti trypsin etc I can advise you on how to proceed further and whether it needs further investigations"
    },
    {
        "instruction": "hi doctor I am having pain in my right testicle but it is a dull pain and it is hard to pinpoint exactly which side but I would like to say it is my right testicle that gets swollen and also has that fullness feeling in the entire sac it normally flair up every single morning for the past four months and I seem to have an increase in sexual dreams since it has been happening it is not the worst pain in the world but it is discomforting I really do not want to see a doctor as it is very embarrassing for me throughout the day it will become swollen and sometimes not hot baths and masturbation are the only things that help with the pain I normally have to masturbate every single morning to take the pain away I do feel like I can feel something down there on my right side behind my testicle that feels like a smooth tube not sure if this is normal as I also feel it on my left side but it is not as big on my left side a few other symptoms I have experienced with this are lower back pain and nausea but once again this has been ongoing for four months now can you help me I am currently on melatonin and allegra",
        "input": "",
        "output": "hi I appreciate your detailed description testicular pain can be apparent and have a cause or can be idiopathic unknown also testicular pain can be secondary to the inflammation of tests epididymis or both it can be associated with a hernia which not necessarily appears to you if it is small it can as well be due to hydrocele fluid collection around the tests moreover varicocele dilated veins around the tests testicular tumor can also cause pain testicular hematoma blood collection beside the tests or epididymal cyst referred pain from lower ureteric stone lastly idiopathic the accuracy of diagnosis depends on history and examination ultrasound of scrotum and ultrasound rub to role out any abnormality in your urinary system moreover urine tests to rule out urine infection from your presentation I doubt varicocele or hernia but cannot exclude other causes regarding your back pain it might be a referred type of pain from tests so I hope treating the tests pain relief it you will need an ultrasound of your scrotum and urine analysis post ejaculation urine for culture then to follow up with results at the moment for the pain you are advised to take naproxen sodium 500 my twice daily for 30 days do not worry about it I hope I can find the cause and give you the proper treatment after investigations further you can follow up with me at your convenience scrotal support wearing fit underwear will reduce your discomfort I hope this helps ultrasound scrotum ultrasound rub kidney ureter and bladder urine analysis post ejaculatory urine culture naproxen sodium 500 twice daily for one month fit underwear after investigations"
    },
    {
        "instruction": "hello doctor my mother in law is a years old diabetic patient she is suffering from a problem that whenever she eats anything she has feelings to use the washroom please help",
        "input": "",
        "output": "hello your mother in law problem could be because of certain diabetic drugs also I will be able to help you better if you can upload the list of medications she is on and since how many days is she having this problem what is the stool consistency watery or semisolid or solid does she have any abdominal pain has she lost weight awaiting your reply depending on that I will be able to help you better with appropriate treatment is irritable bowel syndrome do diabetic mellitus"
    },
    {
        "instruction": "hello doctor I just noticed a white spot on my gum not anywhere near my teeth I am scared of it",
        "input": "",
        "output": "hello thank you for sharing the image based on the information you have provided it looks like an ulcer it is a common ailment found in most people for a definitive diagnosis I will need some more information since when did you notice this any history of trauma due to accidental lip biting or injury while brushing nature of the white spot does it pain burn on touching and movement of the lip any allergies to any medication your diet nutritional deficiencies autoimmune disorders and blood disorders rare your water intake per day generally oral ulcers tend to heal by themselves within 10 days if there is pain or discomfort hampering routine activities like chewing or talking a topical formulation like an antiseptic coupled with an analgesic gel can be applied to the ulcer directly for symptomatic relief also a nutritional supplement rich in complex vitamins is prescribed to promote healing I hope this helps trauma due to lip biting or during brushing nutritional deficiencies autoimmune or blood disorders rare blood investigations if symptoms do not resolve after 15 days aphthous ulcers stomatitis aphthous ulcers antiseptic and analgesic topical gel to be applied on the ulcer advise use of nutritional supplements rich in complex vitamins daily intake of at least three to four liters of water maintain a healthy diet and exercise routine careful brushing technique without hurting adjacent soft tissue brush twice daily with a fluoride containing paste use of interdental floss to clean the surfaces spaces and contacts between the teeth use of salt water gargles every day especially after meals tongue cleaning on regular basis a periodic check up with your dentist once every six months a visit to the dentist for oral prophylaxis teeth cleaning and polishing once every six months as soon as further details are provided"
    },
    {
        "instruction": "hello doctor I am a 17 year old female I was diagnosed with carpal tunnel syndrome last year but the pain started before that at that time my hand only hurt when it was bent to a certain position and it hurts when I am on my fours or when push up position it did not hurt when my hand was squeezed or doing hand exercises the doctor prescribed me with etoricoxib arcoxia 60 which I took twice a day for a week and told me not to move my right hand I tried not to use it as much as possible but since it was school time it required me to use my hand after the medication was over I was not able to come back to the hospital even though I was told to if the pain did not go away and talk to my doctor about the condition of my hand now my hand specifically the palm of the thumb started to hurt even if it was not bent or I am in a push up position it is more painful when it is squeezed our place is quarantined and I am sure getting appointments will be hard during this time so I am trying to relieve the pain at home but still I want to have some instructions from the professional I have 10 arcoxia pills here at home should I take it to relieve the pain should I follow the initial instructions of my doctor and take it twice every day or just take it whenever I feel pain what should I do",
        "input": "",
        "output": "hello please take the pain killer etoricoxib only if you feel pain try to apply a wrist support belt it will help your wrist to keep in position carpet tunnel syndrome mri magnetic resonance imaging of the wrist nerve compression carpet tunnel syndrome tablet etoricoxib 120 my tablet for 10 days gala 200 my one tablet for one month rabiprazole 20 my one tablet for 10 days memo od 1500 micrograms one tablet for one month do not lift heavy weight with mri report"
    },
    {
        "instruction": "hello doctor I am a 14 year old male and I got these lines between my eyes and cheeks it is saggy but it does not hurt and I do not know why I got it I have been doing some exercises to help reduce the line and I also put aloe vera gel I sleep eight hours and I start sleeping at 10 or am but it does not fade and I sleep on my right side is this one of the reasons sometimes my eyes feel tired what is the cause of this and how do I get rid of them or reduce them without surgery I do not have money to go to surgery I hope I could get an answer",
        "input": "",
        "output": "hello sagging is due to loss of elasticity of the skin do you go out in the sun uv rays exposure is your nutrition proper is your water intake adequate is there any environmental dust exposure stress poor nutrition non surgical therapy such as face massage face packs masks and anti gravity exercises can help protection from extrinsic factor ultraviolet rays with proper sunscreen caps umbrella and clothing use photostable sunscreen 20 minutes before going outdoors for 20 days do daily skincare cleansing and moisturizing do you have adequate sleep and fluid intake avoid smoking and alcohol increase protein intake in your diet like nuts milk almonds pulses lentils eggs and dates maintain iron levels increase citrus fruits also vitamin a and minerals are antioxidants which help in skin rejuvenation I hope this helps"
    },
    {
        "instruction": "hello doctor I am a sinusitis patient but I do not face any breathing problems and I am just 21 year old is corona dangerous for sinusitis patients please tell me I really want to know",
        "input": "",
        "output": "hi corona is dangerous for each and everyone one of us however there are few conditions where the patient body immunity is on the lower side one such condition is recurrent allergy associated sinusitis you may be completely asymptomatic but in general patients probe for allergy and associated sinusitis do have a slightly higher risk for acquiring any infection for that matter it is always better to take adequate care and precautionary measures must be followed at all costs failing which you not only expose yourself but expose others as well make sure that the sinusitis and related symptoms are treated in an effective manner I have not gone into the treatment for sinusitis as your question was very specific regarding the lethality of coronavirus in patients with sinusitis I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 28 year old male I am tested couid positive on 13th may after 20 days I go through all blood tests in which I found serum bilirubin total is 8 direct 8 and indirect 0 are elevated I am always getting a fever around 0 and pulse rate around 95 on resting I also have nausea dizziness fatigue and weakness I am currently on ursocol 300 twice daily pantocid 40 and doll 650 sos no relief yet please guide me",
        "input": "",
        "output": "hello I went through your records I see that you were tested couid positive on 13th may and your investigation was done on 30th may it has been a month from the couid test and two weeks passed after your let liver function test this result could be per se because of couid itself as any viral infection is more likely to involve the liver during the course of illness and take some time for it to recover second possibility all viral infections will suppress your immune system that makes you more prone for secondary infections which may lead to persistence of low grade fever I will suggest you to get investigated for other organ involvement also especially the kidneys and also to repeat the let to see what is the current status as two weeks are already passed by abc complete blood count with peripheral smear let rat renal function test malaria antigen test viral fever induced hepatitis continue the current medications at present"
    },
    {
        "instruction": "hi doctor my husband had a deep filling in his upper second to last molar left side about several hours later he started having discomfort and taking tylenol and ibuprofen interchangeably now it has been the second day with severe pain and his cheek is swollen and the gum over the tooth is in pain but not swollen and it is a throbbing type of pain we have no access to the dentist please help",
        "input": "",
        "output": "hello in this condition the tooth should not be filled and instead root canal should be done as the filling was near the pulp pupal irritation is causing the pain take tablet amoxiclav amoxicillin and clavulanic acid 625 my one tablet twice daily for five days zerodol so aceclofenac paracetamol and serratiopeptidase one tablet twice daily for five days capsule pan pantoprazole twice daily before meals for five days betadine mouthwash gargle in lukewarm water if nothing is available right now warm saline gargle will also help for the time being take the medication your husband would be relieved do not worry but I will advise to get the filling out by your local dentist and your husband needs a root canal kindly upload an image of the tooth along with the affected area treatment was not done properly should have gone with a root canal removal of filling and root canal procedure upload an image and ray available your husband will be fine once he gets the medication but as you both are travelling even warm saline gargle two or three times will help"
    },
    {
        "instruction": "hello doctor I am a singer and I have a big problem with my voice I really hope you can help my voice is fine for the 10 months of the year but right when summer starts I completely lose my voice this started last year when I started getting uncomfortable when singing at first just the higher notes that are not even that high for me but by the middle of july my voice was completely gone I went to many doctors but nobody could help me my voice started getting better in september and was completely fine in november now it is again very uncomfortable to sing I suddenly have breathiness where it should not be my voice is not consistent nor reliable I am considering voice therapy but do not want to spend so much money again and not getting help I also struggle a lot with very bad anxiety but I do not feel it getting so much worse in the summer maybe just a little",
        "input": "",
        "output": "hi I feel you are having seasonal acute laryngitis first and foremost acute inflammation of the vocal cords what we call as acute laryngitis requires proper precautionary measures for a certain amount of time with proper treatment failing which the problems will recur again after a short span of relief my advice to you would be to give absolute voice rest during that period now absolute voice rest means you should not even be saying yes no during the day the vocal cords require time to heal completely and this takes usually 10 to 14 days for things to completely settle down make sure you do not strain your voice during that season you can also follow the advice given and can be considered during the episodes of laryngitis tablet wysolone 20 my once a day after fast for days followed by 10 my for days and finally followed by my for next days this is a steroid and to be taken only when is voice is completely gone and not otherwise drink lots of boiled warm water every hours steam inhalation will also be useful salt gargles to times a day will also bring a lot of benefit absolute voice rest"
    },
    {
        "instruction": "hi doctor the patient met with an accident she is 47 years old in the accident she had a collar bone fracture and a hit in the back of the brain the back of the head is bulging and some spots are observed in the brain it scan I have attached the head it scan report for your reference please help",
        "input": "",
        "output": "hi I have gone through your query with diligence and would like you to know that I am here to help you revert back with the answer to the above question to a neuro surgeon online"
    },
    {
        "instruction": "hi doctor I had my lower right side first molar extraction about a month ago my dentist prescribed a course of antibiotics the pain persisted after I finished the course of antibiotics and so the dentist again prescribed a five day antibiotic course a week went by with no pain and then the pain re occurred my medical doctor prescribed a third course of antibiotics now I fear that there is an infection under the gum line that is not being addressed by the antibiotics since I started the latest course of antibiotics the pain is on and off when I have the pain it bounces around even to the head I feel there may be some nerve damage when the tooth was pulled I am taking clindamycin for this issue also I am on insulin for type diabetes cyclobenzaprine levothyearoxine and lisinopril my regular dentist wants me to see an endodontist on the theory that one of the neighboring teeth is infected and their solution is to do a root canal I hear that the root canals are a bad idea as a dead tooth is left in place to seep bacteria into the body if possible can I get an antibiotic injection at the site of the infection please give me your thoughts thank you",
        "input": "",
        "output": "hi I can understand your concern regarding to dental health for further information consult a dentist online"
    },
    {
        "instruction": "hi doctor I caught lyme disease two months ago I had a hour long vomiting session with it since then I have had tingling in my arms legs hands and feet a month ago I started having kaleidoscope vision followed by a medium headache this is now happening three or more times a week and lasts for about 20 minutes it starts as a small circle or a line like a cut diamond first and then it goes colored which expands until it takes most of the vision I cannot really see anything at this point I feel as if the esophagus is blocked when I swallow food I have never had migraines in my life my mother has ms what could cause these visual disturbances and tingling I am on sulfasalazine melperon leflunomide pantoprazole thyearonajod vitamin b12 and shilajit I have chiri malformation of about 12 78 my at last measure psoriatic arthritis lupus gluten sensitivity herniated cervical disc fibromyalgia bone cysts and spurs restless leg syndrome wrist degeneration and cartilage too",
        "input": "",
        "output": "hi I understand your symptoms well for further information consult a neurologist online"
    },
    {
        "instruction": "hi doctor I am a 25 year old married female my weight is keg and height is 161 am I am suffering from nausea dizziness and light headache mainly around the eyes for nearly three weeks I am a dentist for the last one month I am preparing for other exams as I have a son of 5 years old I used to study in dim light at night to avoid disturbance I am on a diet for the past one month to reduce weight sometimes I am on stress and depression to manage time at workplace home and study I doubt whether I have developed any eyesight issue I feel more dizzy and nauseous in the evening and when I see a computer laptop or mobile I am not trying for pregnancy I need your guidance thanks in advance",
        "input": "",
        "output": "hi for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hello doctor is red warm patches on both legs with tingling early stages of dot I went to the er and they sent me home I am currently on carnitine argentine suboxone aspirin fluoxetine and buspirone",
        "input": "",
        "output": "hello no it is not an indication of dot deep vein thrombosis the earliest symptom of dot would be swelling which is usually unilateral associated with pain rash may occur but in later stages and associated with swelling pain which may occur due to venous congestion also I guess there are no risk factors for dot like bedridden state lower limb surgery long haul flight etc so I do not think this is dot now why are you on aspirin and other medications do you have any systemic disease which could explain these symptoms regarding possible causes these are inflammatory skin rashes which may be due to due to allergies insect bites viral infections skin irritation due to clothes and more likely possibility is of drug induced as you are on medications like aspirin etc so try to correlate with the above mentioned factors I hope this helps"
    },
    {
        "instruction": "hi doctor I am getting anxiety and panic attacks when I am worried or overthink I had pounding and palpitation at that time but I am not feeling anything in specific I am going 20 minutes walk daily about 5 am per hour and burning 200 calories I lost around keg in the past three months I have stopped taking chocolates coke red bull etc as well to help with weight loss I have attached my abc report here for your reference",
        "input": "",
        "output": "hi based on your query and attached report my opinion is as follows iron deficiency eosinophilia iron supplements and iron rich diet also albendazole if worm infection is suspected for further doubts consult a hematologist online"
    },
    {
        "instruction": "hi doctor I feel some tissue or bump on the soft palate it is soft without pain I have been having it for many months the doctors said that it is due to brush injury and will heal but it did not what is it",
        "input": "",
        "output": "hi I understand your concern for further doubts consult an ent otolaryngologist online"
    },
    {
        "instruction": "hi doctor I got a swelling in the left lower eyelid as can be seen in the picture before four days it is painful and the eye turned red since yesterday I have been using ciprofloxacin eye drops but there is no relief I got similar problem in my right lower eyelid a year back since two months I am staying in hot climate also I have mild dandruff what is the diagnosis and treatment",
        "input": "",
        "output": "hi I have gone through the pictures of your eyes revert back after a week to an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor I am a 20 year old female my weight is 48 keg and height is 2 I have a fair skin I had modular acne on face back and shoulder I was on isotretinoin for months and I have got over my acne but my skin looks lifeless unmoisturized and dull in the face hands and shoulder even after applying moisturizer what should I do now to get a healthy and glowing skin all over my body",
        "input": "",
        "output": "hi for further information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor I am suffering from throbbing dull pain in my left eye which is shooting down to the left nostril I feel pressure when I bend forward and also some discharge from the nose with a salty taste I am getting the pain while watching television and when working in the computer I am having a good sleep and my vision is also normal but when I press my forehead just above my left eye I feel throbbing pain I have consulted two neurologists they did not recommend for any scan one suggested gabapentin and another sibelium 10 my once a day at night for a month both asked me to do some physical works like closing eyes stretching hands walk and step one foot after another what is my problem please explain",
        "input": "",
        "output": "hello I had gone through all the details that you have posted the differential diagnosis for your problem would be as follows for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor my mom is extremely depressed and showing the anger towards my dad with the wrong assumptions she is not at all listening to our words whenever we advise on this she is showing abnormal anger which is unusual I tried to take her to a psychiatrist but she is not ready to come she had the same issue before four years and was rectified after consulting with a psychiatrist can you please suggest or guide to deal this",
        "input": "",
        "output": "hi for further information consult a psychologist counsellor online"
    },
    {
        "instruction": "hi doctor I am a 35 year old female I have been experiencing a rigorous hair fall I am also feeling tired and dizzy my skin and hair has become very rough and dry also the blood loss during periods is excessive I got my blood tests done six months back and my serum iron was 36 my doctor had put me on an iron supplement named solve for months I got my serum iron and vitamin tested again I have attached all the reports for your reference my serum iron is still the same and it has not improved at all also I get bruises on my body randomly my thyearoid levels are normal can you advise why my serum iron is not increasing though my he is 9 my transferritin saturation is also low can this cause severe hair loss please advise a solution for my problem",
        "input": "",
        "output": "hi based on your query and reports my opinion is as follows platelet count and endometrial biopsy revert back with the images and reports to a hematologist online"
    },
    {
        "instruction": "hello doctor I have an itchy bump around the nail of one of my toes the second one it has happened in the past years usually when the season gets warmer it started about a month ago and grew into a quite itchy sensitive and swollen area it is now turning to purple I tried antifungal before but it was hard to know whether they made a difference please help",
        "input": "",
        "output": "hi I have read your concern and examine your pictures ingrowing nail gram staining and culture potassium hydroxide koh smears acute paronychia without obvious abscess can be treated nonsurgically like in your case I suggest tablet augmenting 625 my thrice daily combination of amoxicillin and clavulanic acid for days and clotrimazole plus fusidic acid cream twice daily for one week"
    },
    {
        "instruction": "hi doctor I have recently visited er due to sob then I was diagnosed with a pleural effusion of left lung blood work and urinalysis completed during the visit showed normal values I had chest ray and it scan which confirmed such and revealed a mass in this area I went to medical center the next day for pleural fluid drainage and subsequent sample analysis the sample results from fluid were clear and the drainage helped with breathing I just returned from the medical center following the biopsy of that area my radiologist indicated that the biopsy area was more shallow than he has experienced with other patients I would appreciate your thoughts I am currently on lopressor and losartan I had not experienced breathing issue prior to this and it recently occurred just two weeks ago",
        "input": "",
        "output": "hi for further information consult a pulmonologist online"
    },
    {
        "instruction": "hi doctor I was attacked by mumps around three years back and now my testicle sizes are different so I wanted to know about the treatment will I get rejected in visa medical test I am a petroleum engineer please help",
        "input": "",
        "output": "hello I had gone through all the details posted the difference in size of the testicles is mainly because of two reasons orchitis and hydrocele orchitis is inflammation of the testicles which has happened three years back due to mumps there will be redness pain and no fluid around the tests for decrease of swelling and pain we need to use anti inflammatory agents if there is any bacterial infection then we need to use antibiotics in case of hydrocele if the inflammation is more then the fluid will be formed around the tests which needs ultrasound and clinical examination for diagnosis if there is fluid around the tests then it can be removed by surgery if you have hydrocele there is chance for rejection to foreign countries so you may need to be operated if it is only different size of the tests and no fluid then there may not be a chance for rejection so you need to consult a general surgeon and get an ultrasound of the scrotum for further management for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor today I took my 8 years old daughter who is about 13 keg weight and 94 am height to a free growth screening camp the doctor has suggested the following laboratory tests lft kft ash abc s ear vitamin do tg ga level urine and stool routine she has also prescribed bandy plus 10 my oral suspension to be taken before sleep and again the same 10 my dosage to be repeated after 15 days she also told us to show the test reports within one or two days for further advice on the growth of my daughter since bandy plus contains ivermectin and albendazole I am little bit scary further my height is 168 am and her mother is 158 am we are much worried about the growth of my daughter in terms of height however she is very active and one of the best students of her school in sports study and all other extracurricular activities we humbly request to guide us whether all these pathological tests and medication as stated above are in line with the problems or not",
        "input": "",
        "output": "hello genetic hypothyearoidism constitutional short stature genetic revert back with the reports to a child health specialist online"
    },
    {
        "instruction": "hi doctor I am a 56 year old male on the left knee there is a painless black growth and that has been there for around years now in a recent visit my doctor advised to use lactic acid plus salicylic acid based topical lotion this reduced the size of the growth a little bit however after stopping the lotion for 15 days it grew back to its original size again but it did not become bigger than before I have attached the pictures for your reference could you please advice as what this could be also what treatment would one need for this",
        "input": "",
        "output": "hi for further doubts consult a dermatologist online"
    },
    {
        "instruction": "hi doctor a year ago I was told that I have a 5 am splenic aneurysm after a it scan this week I had an mri with and without contrast the report was 2 fusiform aneurysm dilation of splenic artery 6 my 5 my splenic saccular aneurysm and minimal mural thrombus calcified wall with 8 my renal fusiform aneurysm until I see a vascular md I would like to know the treatment for this also a summary is appreciated I am a 69 year old female there is a history of lupus and high blood pressure I am currently on lipitor topral and beinicar thank you",
        "input": "",
        "output": "hi for further information consult a general surgeon online"
    },
    {
        "instruction": "hi doctor my blood test shows lymphocytes 60 where the normal range is 20 to 45 I had immunophenotyping and the values are cd23 1 cd19 30 and cd5 79 what does it indicate am I a leukemia patient please advise",
        "input": "",
        "output": "hello revert back with the answers to the above questions to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am 27 years of age I had gone to study in abroad I was extremely lonely there I am a huge hypochondriac and when I started getting sleep problems I started thinking I had some fatal disease subsequently just three months ago I somehow became convinced that I had schizophrenia and vigorously started searching about my symptoms on the internet I started feeling extremely detached from my surroundings and from everything around me I also started feeling detached from people nowadays I feel extremely scared of any noise made by inanimate objects around me even a running air conditioner scares me though I know that it is a non living thing it seems as if I have lost the ability to process things a bird chirping scares me while I know it is a bird chirping I still get scared of that noise a newspaper moving in the air scares me even though I tell myself that it is a newspaper I know this does not sound good my question is there any possibility this is not a psychotic illness could this be anxiety or depression and if it is a psychotic illness is it possible that it might go away and not last like schizophrenia will I ever be able to work please help me",
        "input": "",
        "output": "hi for further information consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor I have low back pain and neck pain but not simultaneously it occurs alternatively when there is low back pain I do not feel neck pain and vice versa what might be the problem please explain",
        "input": "",
        "output": "hi I have read your question with care for further information consult a neurologist online"
    },
    {
        "instruction": "hi doctor some gum like fluid is coming out of my ear I have this problem for almost two years now please help",
        "input": "",
        "output": "hello for further information consult an ent otolaryngologist online"
    },
    {
        "instruction": "hi doctor I have recently been tested positive for chlamydia which I believe to have contracted around 5 years ago in the past one year I have been to the doctor for the following symptoms increased menstrual pain dull pain during ovulation yellow discharge sickness during menses and one sided pain for a few days after the menses at that time I was given medication to ease the blood flow and pain however now I have been tested positive for chlamydia due to the fact that I must have had it for three to four years with no symptoms until the last year I believe it has developed into pid I am taking a course of doxycycline 100 my and metronidazole 400 my twice daily for weeks which my go gave me however he does not believe I have pid I am going on a holiday next week and will be exposed to sunlight a lot should I hold off taking the antibiotics during this time what are the chances I have pid I am worried about scarring of the fallopian tubes and infertility would an ultrasound detect scarring if any",
        "input": "",
        "output": "hi for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I have a congenital squint problem till 12 to 13 years of age my eyesight was good then I developed myopia it is mainly because of television now I am 21 years old and have power glasses of 5 is there any permanent solution for my condition please explain even if it is a surgery thank you",
        "input": "",
        "output": "hi revert back with the photos to an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor my son is years old and he is not speaking yet he only used to tell some words like dad banana ice etc he is not trying to talk a full sentence please help",
        "input": "",
        "output": "hello for further information consult a paediatrician online"
    },
    {
        "instruction": "hi doctor I am 25 years old my problem is that I loved a girl and now she moved away from me she rejected my proposal now I am getting suicide ideas please help me to come out of this",
        "input": "",
        "output": "hi for further information consult a psychologist counsellor online"
    },
    {
        "instruction": "hello doctor I am a 42 year old female I am facing unexpected suddenly bleeding from yesterday my periods are expected on 20th and it is always too regular date to date I want to point out my periods discharge is always thick clotty and very painful for four to five days this is the first time it is seven days earlier with no indication no pain and no clots too but feeling heavy in the lower side and painful urine infection I am also facing itching in that area today I consulted a gynecologist in my area she suggested pause 500 if needed and also suggested codex ca for 15 days she said not to worry it may be regular periods if bleeding continues for more than seven days then go for us please give your advice also I am hypothyearoid for the past 16 17 years and taking eltroxin 100 my",
        "input": "",
        "output": "hi the medicine your doctor has prescribed is good take tablet pause 500 my tranexamic acid and mefenamic acid thrice a day for five days I hope your doctor also did a vaginal examination and had a look at your cervix to see for any lesion though mostly hormonal it may sometimes be due to cervical disease or cancer if she has not done a vaginal examination I suggest you go to it also recheck your thyearoid levels to see if any dose change is needed go for an ultrasound seven days prior to your next expected period it is called a premenstrual ultrasound pelvis test for fish follicle stimulating hormone and oh lutenizing hormone too on day two of your next periods consult again with reports"
    },
    {
        "instruction": "i lost my smell and taste 12 weeks ago after getting couid 19 I got my taste back two weeks later however I still cannot smell anything at all I have tried steam inhalation steroid nasal spray smell training saline nasal spray and it has not improved what should I do",
        "input": "",
        "output": "hi couid has been somewhat a new entity and thereby we have been seeing its effects in detail on the human system loss of smell or anosmia has been one of the peculiar atypical features of couid and there have been lots of theories and explanations behind it in all circumstances loss of smell and taste are always associated together irrespective of the cause this is attributed to the close approximate of both the processing centres in the brain it usually takes around to months to regain the perception of smell in couid patients there are a lot of aspects that we need to study on regarding ethnicity and its relation to the couid prognosis etc which will take time as its not an easy process there is nothing that you need to worry about make sure you dont have any underlying allergic issues in addition for now you can enrich your diet with loads od fruits and vegetables I dont recommend any drug without any scientific evidence of it being useful for the condition mentioned above I hope I have answered your query if there is any thing more you want to know or enquire please do let us know and will revert back as soon as possible warm regards"
    },
    {
        "instruction": "hello doctor I am a 37 year old female my height is 10 in it I weight around 51 kegs I have been getting dry cough since the last one week this is not throughout the day just intermittently also very slight heaviness in the chest not severe while breathing request your suggestion on how to go about this awaiting your kind response thanks regards",
        "input": "",
        "output": ""
    },
    {
        "instruction": "i have very bad breath and my tongue be white unless I brush really hard and for a long time same issue for years been to the doctor about it and the dentist nothing has helped",
        "input": "",
        "output": "hello welcome to icliniq this is your personal dentist I went through query as a specialist am ready to help you issue of foul breath always related to food accumulation as you mentioned white tongue that depicts food layer deposition so I would recommend get a scaling done once in month that will prevent any tar deposition I will be happy to answer all your queries feel free kindly do not hazitate other causes of foul breath includes these criteia should also be ruled out inorder to avoid for a foul breath and achieve a healthier oral life let me know if any further query these steps will surely help you deal with foul breath issue you can always post me a query whenever you need I will be happy to assist you further your smile matters good day take care"
    },
    {
        "instruction": "i sprained my back years ago now I get sprained in the same spot every 4 times a week besides these days I get sprained very easily when I do simple exercises like my ankle shoulder neck back etc I have done physiotherapy and do stretching every day but none is helping what am I to do please help",
        "input": "",
        "output": "hello welcome to icliniq its not about taking medicines or treatment every problematic symptoms pain and disease needs to be treated with a treatment plan and course to be implemented sprained muscles can easily be reduced and healed with ultrasound therapy for 10 15 days and also applying hot water fermentation using diclofenac ointment at home is also an added advantage to reducing sprain after reducing the sprain and getting relaxed muscles then need to stretch the muscles step by step slowly increasing the exercise day by day or weekly once changing according to improvement here I will suggest you simple exercises for lower back need to be strengthen for a period of 15 20 days apply diclofenac ointment for a week twice a day will reduce anybtype of severe pain if possible take ift inferential therapy and ultrasound for 10 15 days follow up after a week thank you"
    },
    {
        "instruction": "i done kshala sutra treatment for fistula but iam getting pus from that wound from last 10 days continuously surgery was done 15 days back actually I got this problem months back but at that time it was cured temperately but from last months iam facing pus then I contacted doctor he said it is a fistula surgery done but that pus was coming continuously is it indicates any thing wrong",
        "input": "",
        "output": "hello I welcome you to icliniq I can imagine that you must be very concerned about ongoing pus well yes there is some pus but the large part of the wound is healthy and pink it is not uncommon to have pus few days after the surgery the treatment you are taking are rightly prescribed but I did not know the dose of amoxicillin which is a antibiotic if you are taking under dose I suggest you to take go twice daily total of 200 my daily you can simply take a gaze piece and wipe down the pus which is coming it is highly possible that this pus will dry in coming few days you can add tab metronidazole 400 my thrice daily for days to help heal the infection I also want to know do you have any other abdominal symptoms such as abdominal pain diarrhea vomiting or unusual weight loss because it is important to know whether you have other problem within the bowel which is manifesting as anal fistula it is however unusual to have fistula at such a young age I am here to discuss if you have the any above mentioned symptoms stay safe anal fistula recently operated stool fro fecal calprotectin and stool detail report a thorough pertinent history is required before suggesting more targeted investigations as above follow up to provide more information about your symptoms if you do not have any then I only suggest you to follow treatment advise as above"
    },
    {
        "instruction": "hello doctor due to scratch in my eyes the white part surrounded with blood what to do",
        "input": "",
        "output": "hello how did you get this because of the bleeding the depth of the wound could not be perceived if it is not severe enough just with bleeding there is not much problem just the point of worry is that the wound should not be open or otherwise it may be problematic and may require suturing so you should seek emergency advice as well so that somebody can examine it until then use moxitobra moxifloxacin eye drop two hours one drop in the right eye only refresh tears 5 eye drops did one drop in the right eye only avoid any kind of undue pressure"
    },
    {
        "instruction": "hello doctor I am a type diabetic and have been injecting insulin every day for years already with this current quarantine going on I gained some weight which made me worry although my mi says that I am on the normal side it still made me upset because the belly arms and legs have gotten bigger so I started doing minimal resistance training and changed my eating habits for three weeks already I noticed that my legs look leaner but my upper body is still the same this made me anxious because it might have something to do with my insulin medications and I cannot go to an actual dietician since they were still on quarantine so I thought someone might be able to help me online I am hoping to hear from you this would really be a big help to my overall health for the rest of my life",
        "input": "",
        "output": "hi yes insulin might result in some weight gain but if you are keeping a check on your calories and include a good amount of non starchy food including whole grain fresh whole fruits and vegetables will help you to shed some fat keep a check on your exercise minutes you can easily do 150 minutes of aerobic exercise per week which includes walking bicycling and other forms of moderate muscle strengthening exercises just keep in mind that your sugar level must not go down do not reduce your insulin dosage also never skip a meal if you skip a meal you will tend to indulge more calories in the next meal include more protein rich food protein and fiber rich meals will bring early satiety and will easily help build in more muscles than fat I hope this helps"
    },
    {
        "instruction": "hi doctor I am sharing my bedroom with my father he is years old he is in generally good health and has ulcerative colitis I am just having an issue nowadays where he keeps sneezing and coughing without covering his face all over the room I assume that it is due to an allergy he does not like to wear mask and thinks it is funny when he coughs or sneezes around me nothing to do with coronavirus I just wanted to know your expert opinion if I could get something from him because I feel disgusted when I see him coughing and sneezing around me is this cough and sneeze harmless easily taken care of by our immune system or would I possibly get some illness from him and start coughing and sneezing myself",
        "input": "",
        "output": "hello in times of coronavirus that is the first thing that comes to my mind cough and nasal congestion are some of the symptoms of coronavirus sadly if that is the case there is a very high likelihood you can get it from him however if you have got him tested and it is negative it is more likely to be allergic if so it is not possible to transfer the disease to you just by being in your proximity if possible start him on antihistamines and nasal spray as soon as possible to relieve him of his symptoms I will give you a prescription for the same tablet levocetirizine every night 2 hour before sleeping florist nasal spray twice daily in both nostrils diluted povidone iodine gargles times daily syearup macbery cough syearup my twice a day all these for days days"
    },
    {
        "instruction": "hello doctor I am in love with a girl who already got married four years back she was in my relation so we have some common relatives and nowadays we are meeting frequency and I am feeling the same thing about her in my heart which was there years back",
        "input": "",
        "output": "hi welcome to icliniq com first of all we need to understand that this not something which is unusual we all come across with past experiences and associate with them on certain occasions if those past experiences were pleasurable one that there is innate wish to re experience them and same is applicable for you it can be said that this is normal to have fantasy to love and loved by someone who was very close to you however we need to keep track of society and changes that took place over the last four years since she is married it will be completely wrong for her to get associated with you in any romantic relationship since you love her there is a good chance you will not push her in trouble in case you push her in some different way that too create problems for her as well as you at this stage it is important to do following minimise the interaction with her through common friends and relatives if possible avoid meeting her completely engage yourself with productive work do not allow your brain to wander here and there get married or in relationship if still single this is most important part as other romantic relationship will distract you to the core needs of life and will also allow you to understand her situation acknowledge that this is common emotion and you will try your level best to overcome it discuss with your best friends about the situation and moral dilemmas if possible"
    },
    {
        "instruction": "hello doctor wheezing mild sputum cough for the last days asthmatic patient and weather change happening please advise",
        "input": "",
        "output": "hello I understand you have wheezing and a productive cough for the past days you are likely having an acute exacerbation of asthma it could have been triggered by viral infection cold environment allergens such as pollen dust strong odor etc I would also love to know if you had a fever runny nose or currently having chest pain or shortness of breath any contact with a suspected or confirmed couid 19 positive patient due to the current pandemic color of sputum is sputum bloody how many episodes of same complaints you have had recently chest ray couid 19 screening acute upper respiratory tract infection community acquired pneumonia acute exacerbation of asthma I would suggest you use prednisolone tablets 10 my times a day for a week continue with the levolin inhaler puffs whenever needed and allegra tablet per day if symptoms persist you will have to use a nebulizer if available or in a nearby hospital identify and avoid triggers like cold temperature pollen dust strong odors etc please I would love to follow up as soon as the investigations are available or you provide answers to the questions or if you got further question"
    },
    {
        "instruction": "hello doctor lump on tonsil for the past three years full left ear feeling been to ent twice",
        "input": "",
        "output": "hello it looks like a mucocele or cyst do you have any throat complaints throat pain do you smoke"
    },
    {
        "instruction": "hello doctor I went to urgent care today because I had bad heart palpitations while taking a walk along with some guest discomfort I have heart palpitations quite frequently but these felt different they were a but thump behind my sternum several times in a row the ekg reading from urgent care says sinus arryhtmia I have had many eggs done before but it has never said that is this of concern",
        "input": "",
        "output": "hello your egg is fine and sinus arrhythmia is normal phenomenon where heart range varies with respiration it may not be evident always or depends on sensitivity of machine and also it is more pronounced detectable when one is breathing heavily or rapidly so it is not a matter of worry at all next thing were you also having palpitations when egg was taken or subsided by that time because considering symptoms of palpitations and chest discomfort its important to rule out possibility of cardiac arrhythmias like psvt paroxysmal atrial fibrillation which are intermittent and egg would be absolutely normal at other time so normal egg does not rule out possibility of arrhythmia so you should either have hotter monitoring 24 hour egg monitoring but it would detect arrhythmia only if it happened during this 24 hour period or you can buy simple single lead egg devices which would help to monitor your rhythm whenever you are symptomatic so basically we need an egg rhythm during symptoms so as to reliably rule out possibility of cardiac arrhythmia in a nutshell your egg is fine and may need further steps I would also like to know why are you eliquis prednisone and thyearoid problems may cause arrhythmia like atrial fibrillation so ash should be monitored"
    },
    {
        "instruction": "hello doctor I just got my stool results and I would like to ask a doctor to interpret it for me lysozyme 674 500 ng my butyearate 5 8 0 my total scfa 17 0 16 my occult blood positive negative",
        "input": "",
        "output": "hello what are your symptoms what was your dietary intake in 2 days prior to test amy family history of major gastrointestinal diseases now stool sofa and butyearate are slightly out of range which is fine to have also lysozyme is slightly elevated and it is a marker of inflammation in bowel which may be due to multiple reasons like is i'd or diarrhea etc so it is a nonspecific marker but important factor is stool for occult blood which is positive so there is some minor bleeding is going on within a bowels this is the abnormality which should be evaluated further this has multiple causes ranging from i'd to polyps etc however some dietary factors like some fruits vitamin iron supplements nasal bleeding hemorrhoids etc can give positive results now we would like to get total of samples for occult blood testing and if it remains positive subsequently then needs endoscopy or even if having symptoms then still need endoscopy so the concerning factor is stool for occult blood rather than rest three and needs further evaluation"
    },
    {
        "instruction": "hello doctor my ankle started hurting last week and it has gotten worse it is very painful and uncomfortable to walk my question is do I need crutches I am a girl",
        "input": "",
        "output": "hi looking into your problem it seems you are badly in pain and looking for things can help you walk so you remember about crutches as simple protocols use simple formula rice rest ice compression and elevation of your feet are key sutra for severe sprains you might need a brace for protection and stability its good to use ankle brace having binder together in it you may need crutches until you can walk without pain nonsteroidal anti inflammatory drugs nsaids can help to control pain and swelling we need to evaluate ankle with grade I or grade I sprains grade I sprains with complete tears of the ligaments even might need surgery to repair the injured ligaments one thing to remember is that always in most cases follow up rehabilitative exercises are to restore strength and range of motion in the sprained ankle also help to prevent future ankle injuries if it is not healed think of doing ray of ankle you might not know sometime there can be hairline fracture too stress fracture"
    },
    {
        "instruction": "hello doctor I am months pregnant I have bleeding gums from the back of the front tooth while brushing I have a history of plaque formation on teeth even before pregnancy what is the remedy for gums bleed",
        "input": "",
        "output": "hello gum bleeding foul breath are symptoms of gingivitis it is rather common during pregnancy and known as pregnancy gingivitis because of hormonal changes nothing to worry about you can use betadine mouthwash gargle in lukewarm water twice or thrice a day take tablet metrogyl 400 my one tablet be for five days you will need a scaling but as of current lockdown situation I would advise not to hurry as you and your babies safety is of utmost importance you can have it later use a soft brush and learn proper verticle stroke technique of brushing instead of forceful horizontal motion avoid sticky or sweet food as much as possible hormonal changes during pregnancy initiate gingivitis medications for now medication may cause a transient metallic taste but nothing to worry avoid sweet or sticky food"
    },
    {
        "instruction": "hello doctor I get frequently sick with joint and muscle pain and burning legs sometimes feel difficulty walking and climbing stairs I consulted a physical he tested ana and it came back positive but since ear and cop are normal he said no need to test further and I am perfectly healthy but my pain never subsided I cannot go to the office due to ac and joint pain it is affecting my work and quality of life due to frequent sickness and unable to do normal activities after consulting a rheumatologist he further tested ana profile and anti is dna that also came perfectly alright I am confused with my body why my joints are paining so much without any disease",
        "input": "",
        "output": "hello I would like to ask you a few more queries is your sleep pattern normal do you have morning fatigue how long did the viral last any hair fall oral ulcers dry eyes or dry mouth any recent irritability or forgetfulness it more appears to be chronic fatigue syndrome which usually has a previous viral illness but let me know these queries and would guide you further"
    },
    {
        "instruction": "hi doctor I just received my blood test abc is 200 neutrophils are 8700 high absolute immature granulocytes and low lymphocytes I have noticed that for three years my blood tests have been on the high levels for abc should I be concerned I have been in and out and they never call me for a follow up maybe I should change the doctor also can phentermine be the cause of this I only took it for two days before the blood test I am a 39 year old female I have bone pain neck pain dizziness and hair loss",
        "input": "",
        "output": "hello following is my opinion for your asked question your total abc count and neutrophils are high mild increase of immature granulocytes and high count with neutrophilia could be due to infection or inflammation in the body your detailed physical examination and investigation should be done to find the underlying cause for your complaint you can investigate further with ana antinuclear antibody estimation us ultrasound abdomen vitamin estimation serum calcium estimation blood pressure measurement and blood sugar estimation your ear examination also should be done antibiotic courses can be prescribed as per the provided report however before that physical examination and above investigation can be done you need to follow up your abc complete blood count with peripheral smear examination report after a few days to check values once again you can consult a good internal medicine specialist for your examination and investigation accordingly"
    },
    {
        "instruction": "hi doctor I have been having abdominal discomfort for a while at first the discomfort was in the flank portion I went to a urologist he gave me muscle relaxers and a few tablets for clearing any small stones the discomfort went away after taking the medication but after some days may be due to sex or workout am not sure the discomfort returned back I went to the doctor again he suggested a it scan it scan results showed a lot of stools in the bowel he said to maintain a healthy diet and add more water and fiber and do some exercises if the problem persists he asked to check with the general practitioner I had an appointment with my family physician who said the discomfort can be due to lack of bowel movements in the colon he asked me to take a fiber supplement metamucil after taking it I had clean bowel movements and I felt I was relieved of late I stopped taking the fiber supplement for a couple of days I started having hard stools again I called up the doctor he said no harm in taking metamucil so I started it again and drinking at least three liters of water I am doing like he said to have clean bowel movements sometimes the discomfort switches sides left or right at times my backache as well I told the doctor and he said it can be chronic constipation can go for many days I sense my stomach or colon may getting inflamed as the day goes by after bath everything looks normal but as day goes by I feel like stiffness or inflammation in the stomach I am worried because this is been there for like starting january and not going away there is no real pain but it is the discomfort and inflammation that disrupts my day to day activities please advise should I book an appointment with gastroenterologist may be to dig further I read about ulcerative colitis or crohn disease but I could not conclude anything based on symptoms I do have an observation that if I masturbate or have sex after having ejaculation discomfort increases the following day",
        "input": "",
        "output": "hello I can imagine your reason of concern for such ongoing on and off symptoms well first of all if it were ulcerative or crohn disease it should have shown something abnormal on it scan which I presume it did not however remember the it scan reporting is completely a subjective thing it depends highly on the expertise of radiologist who has reported that I would urge if you upload the report in reply to this response I would be glad to see that there will be no charges for that I will allow you one free follow up now the presence of too many stools is not an uncommon finding on it scan since it is basically the function of the colon to reserve stools transit them timely in anterograde direction and finally to be evacuated through the rectum and anal canal if the presence of stool with dilation of the lumen of colon or presence of stools within small bowel fecalization of small bowel and or dilation of the lumen of small bowel suggest an alarming finding normally our small bowel does not usually contain stools it rapidly empties matter to in to large bowel hence the presence of stool in small bowel suggests an abnormal finding I will tell you why this information on it scan is important for example you have a normal size of the lumen of bowel ideally less than am of small bowel and less than am of large bowel with the symptoms you mention it can be irritable bowel syndrome with constipation if the diameter of the lumen is above the normal it can be functional constipation of which two further types the one is chronic colonic constipation or colonic pseudo obstruction called as ogilvie syndrome the other where the small bowel is dilated called chronic small bowel pseudo obstruction I hope you now have an idea why it is important to correlate symptoms with the it scan findings now coming to your symptoms the pain or discomfort is often common when bowel loops are distended with gas or stools and your discomfort which readily resolves after you have good bowel movements suggest the possibility of the same and not otherwise due to a serious underlying cause the intensity of discomfort that changes with the bowel movement again suggests it might secondary to irritable bowel syndrome is metamucil is fiber laxative and really it does not have any harm if taken for years and years the fiber is nonabsorbale molecule it does not go into blood circulation so have no side effects however in some it can cause bloating or belching you can switch to other fibers such as fibrocol if metamucil does not suit you otherwise it is completely normal if you want to resume the same take plenty of water it makes stool bulk large and soft and easy to pass I myself have a habit of taking liters of water in a day and this really makes wonder you should continue that I would wait for your it scan report to see the findings then I will right you some investigations to rule out other possibilities I believe you would not have anyone but just to be on the safe side"
    },
    {
        "instruction": "i have a problem in my ears that always used to sound at night and I get distracted I think I have a tinnitus problem and still now I did not visited to a doctor because I am afraid to get mri and it scan because of these reasons I did not tell to my parents please help me doctor",
        "input": "",
        "output": "dear icliniq user first of all stop worrying start acting today relax yourself tinnitus can be due to many reasons simple ear wax deposition to chance of tumor so do not predict of any severe underlying cause behind the tinnitus that you are suffering from are you listening to loud music through earphones for long time do you feel pressure in ears few tips will reduce your problem for sure avoid noisy situation do not use earphones take the calls on speaker mode divert your mind from the sound and start concentrating on other environmental sounds to simplify it use resound relief app install it from play store there are many collection of natural sounds use it in moderate intensity level on speaker mode at night put the mobile little distant to the bed stop taking caffeinated drinks tea coffee alcohol smoking if at all you are taking bhramari pranayam see the video in youtube start doing in the same way bee like sound production by closing your eyes ear with hands excellent results were observed steam inhalation and sipping lukewarm water frequently is what you can also try when you get a time just go for immitance audiometry and puretone audiometry test consult with audiologist share the reports with me your valuable feedback is expected if at all my recommendations helps you in some way"
    },
    {
        "instruction": "i have moderate cough from last weeks and very little sputum which is very rare also I have no fever no problem is swallowing but I can feel a little pain when I touch my throat below the jaw area I had runny nose weeks back but not so much and now that is also gone so no runny nose as of now also I took augmenting 625 3 days back and cough was better but now it is back not so much though but it triggers more at night and having a lot of gas",
        "input": "",
        "output": "hi the problem what you have is called gastroesophageal reflux disease people those who have this condition would develop dry cough especially at night and sore throat burning sensation in the stomach I would like to know is there any recent history of weight gain sleep disturbances causes gas problems normally our body will produce 12 to 16 litres of gas people those who sleep to hours would not have any gas problem stress sleep disturbances cold is herd sompraz levosulpride 40 75 two times a day gaviscon my three times a day duphalac spy 15 my at night sleep hygiene avoid spicy diet"
    },
    {
        "instruction": "hello doctor I am currently taking amlopin at night and omnitan in the morning my blood pressure taken at home is consistently in the range 140 150 85 90 last time my doctor increased the medicine dose suddenly and it did not suit me and caused palpitations dizziness and weakness please suggest appropriate medicines considering these factors",
        "input": "",
        "output": "hi blood pressure be is controlled with lifestyle modifications and dietary modifications following are the measures to control be avoid smoking and other addictions reduce salt intake in the diet reduce fatty foods junk foods saturated fats mediterranean diet is the best avoid stress and anxiety do regular moderate intensity exercise such as brisk walk for 30 minutes have proper night sleep atleast hours per 24 hours including atleast hours in night uninterrupted sleep reduce weight even if weight is within the normal range drink plenty of water do deep breathing exercises and meditation measure be while you are totally relaxed sit for five minutes in a quiet room without talking to anyone empty bowel and bladder before checking be avoid tea coffee 30 minutes before checking be sit on a chair with feet on the ground back supported hand supported on table cuff at the position of heart check be and repeat after five minutes again then check be in other arm and repeat after five minutes during the entire period remain relax and quiet arm with higher be readings is your be you may take atleast two or more readings and average of readings is your actual be what dose you were taking of amlodipine and olmesartan when your be was 150 90 what medicine was changed are you taking some other medicines as well such as painkillers or steroids"
    },
    {
        "instruction": "hi doctor I am suffering from abdominal pain for the past two months I have done tests like it scan stool test and blood test now I am feeling feverish headache stomach burn and severe pain",
        "input": "",
        "output": "hello it would have been great if you could have shared the report of it scan and blood tests to tell you about your problem the symptoms you mentioned can be due to various causes namely peptic ulcer disease irritable bowel syndrome small intestinal bacterial overgrowth and many others for now I suggest you to take capsule esomeprazole 40 my once daily before breakfast since you have pain which seem to be secondary to peptic ulcer disease or acidity"
    },
    {
        "instruction": "hello doctor I am a 21 year old male I visited a local doctor and he diagnosed a cyst on my left testicle 5 am he suggested that it is not necessary to undergo any surgery now also I have increased levels of estradiol bilirubin and sgot but my general medicine doctor suggested that there is nothing to worry about is cyst the reason for increased levels of estradiol",
        "input": "",
        "output": "hi for further information consult a urologist online"
    },
    {
        "instruction": "hi doctor I had a double fracture in the femur following an accident in 24 hours I got intramedullary nail insertion but it did not heal even after seven months I have started walking on leg before a month to induce self heal but nothing happened either bone graft or plate and nails which is the best recommended treatment",
        "input": "",
        "output": "hi nonunion shaft femur with intramedullary nail for further information consult an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hi doctor I have recently noticed some light colored vertical lines in my thumb and index finger nails I have attached the photos for your reference when I searched on the internet I found very disturbing things including skin cancer I have hypothyearoidism and chronic depression I am on bupron 300 and thyearoxin 100 by looking at the pictures can you help me out",
        "input": "",
        "output": "hi for further information consult a dermatologist online"
    },
    {
        "instruction": "hello doctor I am suffering from persistent bloating in the upper stomach soon after my ovarian cyst laparoscopic surgery which I underwent before eight months today a local doctor suggest a it scan of the whole abdomen in the it scan it is written that few enlarged lymph nodes are noted in the para aortic region the largest lymph node measuring my in short axis duration the rest of the report is normal the local doctor said it may be a serious issue but I read on the internet that my lymph node in the para aortic region is normal size I am not suffering from any infection fever or other problems please guide me",
        "input": "",
        "output": "hello do you have any history of weight loss any history of blood in stools looking at your it report it is quite normal and that para aortic lymphadenopathy without any symptoms is of no concern it might be due to some infection hemogram with ear erythrocyte sedimentation rate cop reactive protein ugh endoscopy dyspepsia enteritis antibiotics avoid pain killers and spicy fatty meals"
    },
    {
        "instruction": "hi doctor four years ago I had an appendicitis surgery there is a flesh like growth where the stitches are placed what should I do now how to get it removed",
        "input": "",
        "output": "hi for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I am a 34 year old male I am suffering from numbness in my hands and toes I also have wheezing I am getting moderate chest pain and cough when I take a full breathe I feel heavy over my chest my body feels like burning but also freezing under comforter I have entire body pain and fatigue I had the same last night do you have any ideas about my problem",
        "input": "",
        "output": "hi I have carefully gone through your query revert back with the reports to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor my mom is 50 years old she takes norfloxacin on daily basis to avoid diarrhea the moment she stops taking norfloxacin she goes through diarrhea please guide some alternate treatment for her",
        "input": "",
        "output": "hi for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am suffering from severe anxiety and heart attack like debilitating panic attacks when presented with work deadlines enclosed spaces such as subways elevators and small airplanes I have relationship fears nothing in my life provides me joy or relieves me of my symptoms I had the same feeling six years ago after a break up now symptoms return easily when in fear of life I had zolpidem for depression before to get sleep but I stopped because of the side effect of brittle bone I am fuzzy headed stressed forgetful regretful of any decision I make and I cannot make decisions without fear I do not have any friends I do not belong anywhere I am not a part of anything I exercise outside every day I eat only healthy foods I am underweight please help me to come out of this",
        "input": "",
        "output": "hi for further information consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor three months ago I had a heart attack then I went through angioplasty with tenting post heart attack I was diagnosed with moderate systolic of with ef at 35 currently I am on clavix rozucor 10 my tide my metocard xl plane 25 my and thelma 20 my I am improving well my ef has improved to 40 on first follow up after a month I have lost about keg to keg weight in the last three months I am under excellent diet control and daily walking about 70 minutes I gave up smoking completely one week back I had my blood checked for various profiles and regarding which I have a few queries my lipids are on the low side that is total cholesterol 123 hel 23 and lil 61 I was on rozucor 40 for the first one month and then I am on rozucor 10 my am I below the target range if yes can I get the dose reduced further my uric acid is high 1 I read that this may happen due to hypertensive medicines particularly diuretics and arbs is the high uric acid a point of concern should I consult my treating doctor my kidney profile with sodium and potassium are within limits my be is constantly on the lowest average of 90 mhg with heart rate of 65 to 72 can I reduce my medicines particular diuretics I am worried about the side effects of diuretics on the kidney my alkaline phosphatase is at 131 just points above the higher limit of 128 is it fine to have this reading post myocardial infarction please explain",
        "input": "",
        "output": "hi I appreciate your concerns after thorough review of your health query I want to answer those questions for further doubts consult a cardiologist online"
    },
    {
        "instruction": "hi doctor my calves have been twitching throughout the day for about two months now but I do not have any weakness it occurs in different spots on both calves what could this be",
        "input": "",
        "output": "hi I would like to know a few more things revert back with the answers to the above questions to a neurologist online"
    },
    {
        "instruction": "hi doctor I have a question for my mother my mother is 50 years old she complains of episodic sudden loss of weight bearing ability on the left achilles tendon this has resulted in two major falls which resulted in trauma these are present for past few months and have become more frequent in the last month she also has pain in her knees bilaterally which has been attributed to osteoarthritis she also complains of hip pain associated with swelling and difficulty in standing lying and changing sides while sleeping there is episodic stiffness present in the shoulders which causes some discomfort in raising arms above the shoulder level she is taking bisoprolol my and amlodipine my for high be and it is well controlled she has no history of any allergy she has kidney stones and so occasional pain in the lumbar area she used to get constipation frequently she was hospitalized four times for normal vaginal deliveries and once for abortion she is monogamous with her husband she has a positive family history of hypertension in mother cad in father mother and brother and uterine cancer in mother she has a history of menorrhagia and cycles have become more irregular now then diagnostic and was performed last year which was normal she will not smoke or drink she sleeps to hours daily and snores at night",
        "input": "",
        "output": "hello I have gone through your mother elaborative history provided here along with the reports attached with this query for further information consult an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hi doctor I am 18 years old I am a student I do not understand my condition I have very important exams I used to get good marks constantly and then everything turned up against me now I prepare my best but I do very badly in my exams I am feeling hopeless even after studying hours daily I am getting very low marks I am completely puzzled why does my brain get numb during exam I have lost all my confidence please help",
        "input": "",
        "output": "hi I have read and completely understand your issue revert back with the answers to the above questions to a psychologist counsellor online"
    },
    {
        "instruction": "hi doctor I have been coughing up green phlegm for a few days now it started to hurt my chest please help",
        "input": "",
        "output": "hi I understand very well the symptoms you describe above in your query for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I had a section before a month a few days after it was found that the surgery site got infected with some discharge all the stitches were removed and the site was irrigated and cleaned everyday for over a week with antibiotics two days ago I went for secondary closure a nylon thread was used and since then the stitches dripping out some substance like a mixture of blood and a colorless fluid we are cleaning the site with medical spirit till now what is the reason for this dripping is it normal is that a sign of healing",
        "input": "",
        "output": "hi revert back after a week to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor two days back I got a hit in my eye with a ball still it is paining with blurred image please help",
        "input": "",
        "output": "hi for further information consult an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor my niece is pregnant and taking subutex she just confided to me that she has also been using heroin along with subutex for the last one month she is afraid to ask her primary care doctor for advice her doctor told us in the beginning that it is more harmful to the fetus if the mother were to abruptly quit using opiates now my niece is afraid to stop the heroin use even though she also has the subutex which I thought is supposed to help with this type of situation how can she safely stop using heroin can she continue her regular dose of subutex daily and just cut out the heroin all together at once",
        "input": "",
        "output": "hi for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor eight days ago I had four dental implants placed in the lower jaw is it normal to have pain on the sides of the gums where I got implants",
        "input": "",
        "output": "hi I can understand your concern regarding dental health for further information consult a dentist online"
    },
    {
        "instruction": "hi doctor I got a tattoo before five months a blood donation drive is going to happen by next month am I eligible to donate blood how long should a tattooed person wait to donate blood",
        "input": "",
        "output": "hi based on your query my opinion is as follows for further doubts consult a hematologist online"
    },
    {
        "instruction": "hi doctor my father is 56 years old and healthy since last few months he is suffering from sudden chewing like action and unconsciousness or seizure like situation this situation remains the same for some time during the mri test our doctor informed about the tumor we are very much worried is it a cancer problem or other tumor he does not want to undergo surgery for this kindly suggest what to do I am attaching the reports of mri and our doctor prescription",
        "input": "",
        "output": "hi I have gone through your query with diligence and I would like you to know that I am here to help you for further doubts consult a neuro surgeon online"
    },
    {
        "instruction": "hi doctor three months ago I had an ma of the brain as I have weird headaches that time the result showed a little thing which they thought could be a small aneurysm between my and my but they were not sure whether it is an aneurysm or anything on the arteries so they advised me to go for a cta my question is which test would show it more clearly",
        "input": "",
        "output": "hi for further information consult a neurologist online"
    },
    {
        "instruction": "hi doctor my daughter is 20 days old she is having loose motion from yesterday night she passed loose stools for about to times between am to am only a few days back we started giving multivitamin drops and vitamin drops after having that she seemed to struggle while passing motion and it was little so for the past two days we have stopped those drops I have also attached an image can you kindly check and advice should we take the baby to the doctor does it have anything to do with breastfeeding many consider that could be one of the causes please clarify it",
        "input": "",
        "output": "hi for further information consult a paediatrician online"
    },
    {
        "instruction": "hello doctor my doubt is about brain power do people in engineering and other professions require a lot of brain power use mind altering drugs to enable them to compete better are people in these professions just naturally gifted I am talking about the people who build automobile factories aircraft space shuttle and the international space station do such drugs exist to improve comprehension and memory please explain",
        "input": "",
        "output": "hi I read your query and understand your concerns for further doubts consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor I had unprotected sex with my girlfriend I ejaculated on her innerwear she immediately removed it and washed her vagina with water later after a minute or two she put on the same this happened on the third day of her menstrual cycle and now she is over two weeks late on her periods can she be pregnant",
        "input": "",
        "output": "hi for further information consult a sexologist online"
    },
    {
        "instruction": "hi doctor I am 27 years old I have cos and have been trying to conceive for four months my gynecologist put me on 500 my of metformin thrice a day and 10 day cycle of medroxyprogesterone at the beginning of each month to force ovulation the medication is working exactly as it should I get my period every month and I have lost weight with the metformin I went in for a follow up today and my doctor recommended that I sign up for an infertility study that she is doing it requires hormone shots extensive testing and in vitro fertilization every month for a period of four months I have been going to the same gynecologist for many years and I know her pretty well let me just say that she has never seemed like she puts much thought into diagnosing and treating me I had to practically beg her to test me for cos even though I have had very irregular periods and other symptoms for years now she jumped straight to if treatment I have heard of women staying on this course of treatment much longer and being able to conceive in vitro is incredibly expensive I am just worried that the only reason she recommended this is because she wants another participant in her study your advice on this subject would be appreciated thank you",
        "input": "",
        "output": "hi I can understand your situation please do not be so hard on her I am sure it is not that she is not interested in diagnosing or treating you however you can wait for some more time before straight away jumping for if in vitro fertilization I have given you the information but participating or not in the trial is totally your decision all the best for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I observed the presence of vaginal discharge almost a month ago and I went for a test it showed the presence of wbcs but no bacteria or yeast or parasite I completed the course of antibiotics but I feel the infection has not cured I can still feel the vaginal discharge which is very irritating and my urine has a foul smell I am really worried what should I do what might be the reason behind it",
        "input": "",
        "output": "hi revert back after a week to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I am a 45 year old male I have been on omeprazole 20 my and thyearoxine 50 mug for the last four years my height is 10 height and weight is 70 keg I have hyperacidity and little vertigo I am attaching herewith my latest blood report please advise whether any medicine is required",
        "input": "",
        "output": "hello I have gone through all the data posted for further information consult an internal medicine physician online"
    },
    {
        "instruction": "i am suffering from severe skin red rash problem in both inner thighs the rash is so itchy and it has completely destroyed my life it looks like fungal like ringworm or jock itch at past also I was suffering from same thing but that time it was scaly like liquid was coming out with foul smell and I visited a doctor and the medicine I used had cured me I forgot the medicine tablet taken but had use itraconazole dusting powder and fluconazole lotion at that time my mother and I have visited the doctor at same time coz she also ha fungal infection but completely different then mine now the current situation is very bad it is so irritating and itches a lot but no scaly liquid is coming out now the same thing now can be seen in my neck and face please I need a good dermatologist attention I am in great suffer in this pandemic and lockdown so I am searching online for medication I have recently taken arzole capsule once weekly for weeks and used dipsalic ointment and also clotrimazole cream which shows no better treatment I was so depressed and used steroid cream called dermicom of plus only two times as it shows some severe bad red rash so I discontinued it I live in hot and humid climate and had wore tight clothes in past the area of rash is always at little more tempreature",
        "input": "",
        "output": "hi thanks for sharing your query you seem to be very distressed by the problem as I can see in the picture it is tinea since it is extensive it is important to start proper treatment with oral antifungal for a good length of time to clear the infection you have been using steroid creams which is going to worsen the infection and make it spread further so you should stop using dipsalic and other steroid applications and start proper treatment you should get your let and kit done and you can follow up with dermatologist usually itraconazole or terbinafine are given orally along with some creams like luliconazole or sertaconazole etc itching can be controlled with antiallergics treatment of family members with infection is equally important let me know if you have more queries hope this helps"
    },
    {
        "instruction": "i got injured while playing I fell and my knee his the ground in order to prevent it I tried to apply counterpressure on the floor using my heel and my heel has developed swelling eversince it been a week in the first days I could not walk properly burning sensation was felt over the heel after a week I could walk better but tingling sensation developed over the heel plus help me out",
        "input": "",
        "output": "dear sending love and healing energy dear due to counter pressure on floor you got trauma over the heel now numbness are over the heel a numb heel is most commonly caused by blood flow constriction or nerve damage the tibial nerve runs inside the tarsal tunnel and may become compressed my dear compression of a small nerve a branch of the lateral plantar nerve can cause pain numbness or tingling in the heel area in many cases this nerve compression is related to a sprain fracture or varicose swollen vein near the heel I would suggest you to do dear pray and pray for your speed recovery follow up with your queries thank you for giving chance to serve you"
    },
    {
        "instruction": "i 32 year old male no co forbids doctor by profession working nephrologist since childhood I have stammering problem not always but when speaking infront of mob or when giving presentation or when history taking from patient or reading book chapter infront of whole class when ever I think of speaking then I start feeling tachycardia palpitations chest pain headache sweating I usually have constipation I used to take bromazepam before giving presentation or speaking infront of mob",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello does having low and high blood levels have anything to do with overly oily skin burning lips a painful throat and thrush I have been feeling these symptoms for months and I cannot take it anymore I am getting a blood test done this week which levels should I particularly make sure are tested I am looking forward to your reply thank you very much",
        "input": "",
        "output": "hi there could be multiple factors involved over here as a result of which these symptoms are occurring I would recommend you to perform the following tests mentioned below all these tests have a purpose and can detect any underlying abnormality that is there in the body on the whole there few things that you can follow the symptoms you have most of the times it is the faulty diet and hydration which is reason behind such constant issues in addition please do get the above mentioned tests done so that we can treat you in a specific and precise manner there is nothing that you need to worry as things will fall in place once we treat the etiology of the problem in concern I hope I have answered your query in detail if there is anything more you want to ask or enquire please do let us know and we will get back you asap warm regards"
    },
    {
        "instruction": "i have had boils appear from time to time the come to a head break and drain this time I have one on my side above my beltline it started outlining lime an ingrown hair with a white head my wife tried to pull the hair with tweezers the zit popped and we never got the hair put some peroxide on it and a bandaid in case it drained more next morning it was like there was more under the skin so did warm compresses it has been ozing out but appears to be coming from multiple pores now it seems to get bigger as more start to drain what else should I do",
        "input": "",
        "output": "hi welcome to icliniq thanks for the query recurrent boils can be a nuisance it is a bacterial infection of the hair follicle and can cause painful pus filled eruptions on the body if you are having frequent recurrence it could be because of persistent infection or reinfection are you diabetic or atomic if so you may be more prone to develop recurrent bacterial infections you mention seeing pus coming from many openings which indicates it could be a carbuncle this may need incision drainage ideally a pus culture should be done to know the sensitivity of the organism and antibiotics started accordingly to completely treat the infection usually penicillins cephalosporins or tetracycline are used orally application of mupirocin in the skin fold areas helps to eradicate the colonising bacteria in these locations some precautions to prevent recurrent boils include hope this helps"
    },
    {
        "instruction": "hi doctor I just found out that I am pregnant ith week at first I was excited then I realized that I went into a very hot sauna 90 degrees celsius for one and a half hours when I was around weeks pregnant weeks from conception the whole point of the sauna is to detox and I definitely was overheating sweating and red faced I did however take two breaks where I jumped in cold water to cool down anyways I read that overheating when pregnant can cause horrible neural tube damage that can lead to birth defects especially in these crucial early weeks when it is forming my question is how worried should I be should I go to a specialist for this is it so bad that I should consider termination my first scan is at 12 weeks and that is the only time I will be able to ask anything and I will be worried it is too late",
        "input": "",
        "output": "hello neural tube defects nod in the baby mostly occur in women deficient in folic acid or who are diabetic or if they have any family history or as an associated defect with other chromosomal anomalies yes the baby organs do develop in the early weeks of pregnancy and any extreme exposures can pose risk for maternal health and also for fetal development but I have never come across the risk of developing nod with exposure to sauna but anyway it would be better if you avoid it for the future as of now you need not worry too much about this exposure stay calm and stay positive the first trimester scanning at 12 weeks is good enough to pick any nods and I do not think that would be too late or you need to go for any termination of pregnancy just because of the exposure to sauna at this early pregnancy there is no means to find out if the baby has developed any abnormalities or not and also the second to scan detailed anatomical scan at 18 20 weeks can also pick most 90 95 of any structural anomalies also regarding your gestational age calculations if your cycles were always regular then you should calculate the weeks from the starting day of your last menstrual period it would have been really helpful if you had mentioned the same it would have helped me correlate if your assumption of weeks of pregnancy are correct or not I am assuming as you said you are in the fifth week now so you just skipped your periods a few days back tablet folic acid my daily once after food avoid sexual intercourse for the first three months of pregnancy"
    },
    {
        "instruction": "hello doctor my eye is paining since sunday my eye is red now it is paining while moving also when the light comes I am felling a little swelling as well",
        "input": "",
        "output": "hello thank you for sending the image so that I can get an idea about it for me it is looking like an infection I can prescribe you medicine so that you can get rid of these symptoms but in the first image there is something whitish area on your cornea so I just want to know that it is really there or its reflection which is visible in the photo just answer me one question because treatment is different for both conditions so I should confirm it from you and then I will give you a prescription of drops that you have to use and you will be completely all right"
    },
    {
        "instruction": "hello doctor I had this problem for three to four months when I pull back my foreskin it feels strain and kind of ticklish and itchy I have been to the doctor and they just gave me pevisone and it did not work there is also a little white substance on the penis head I do not know if it is smegma or not but it is smelly and I cannot seem to clean it may my foreskin be dry or something I have also done sad and test for urine infection",
        "input": "",
        "output": "hello are you a diabetic or hypertensive have you ever tried oral medications for this if yes then which one do you have any urinary complaints like frequency urgency poor stream nocturia dribbling burning micturation do you have any history of unprotected sex with a new partner in the recent past"
    },
    {
        "instruction": "hello doctor I have just got married and I am planning to have a child I am years old have not had a child before and have no medical problems I wish to check if I need to take any medical tablets like folic acid etc or shall I just go proceed naturally as mentioned before I have no health issues and neither do I smoke or drink",
        "input": "",
        "output": "hello congratulations on your wedding first thing you should do is to start folic acid and try for timed intercourse for that if your periods are regular you can download an application of period tracking it will tell you the most fertile days of your cycle since you are where ovarian reserve may be on a lower side I will not advise you to waste much time so while you try for a month or two for natural methods of conception I want you to also get tested in the meantime so that you are ready for any medical intervention for fertility enhancing if needed after two months so please go for oh leutinizing hormone fish follicle stimulating hormone am anti mullerian hormone and ash thyearoid stimulating hormone blood levels also get an gott oral glucose tolerance test and ultrasound pelvis your partner can also go for semen analysis to see if the quality of his sperm is good enough eat healthily sleep well and ask your partner also to avoid smoking and alcohol"
    },
    {
        "instruction": "hello doctor patient is an 82 year old female she weighs only about 45 keg no be no diabetes she is having inflammation and swelling in the right foot it seems to be a blockage somewhere in the right foot blood vessel and it appears bluish one month back and now it subsided a bit but the swelling is there she is on neuroin injection ecospirin and zerodol sp she is moving comfortably now but the swelling is there and the bluish color has reduced a bit",
        "input": "",
        "output": "hello her foot appears to be in good condition now the likely cause for bluish discoloration is blockages only and is called peripheral arterial disease so of she should be treated on the line of blockages itself now blockages in the foot raise the strong possibility of blockages elsewhere in the body like heart brain and its fortunate that she did not suffer any consequences due to that so she should be evaluated with few investigations like egg echocardiogram echo fasting lipid profile sugar if not done recently also to confirm the diagnosis she should undergo it computed tomography angiography of both the lower limbs now coming to the treatment part obviously the best would be to open it with stents but as of now she will need some more medications than what she is having you may continue with neuroin or better to have it in a tablet form once daily and it is just a multivitamin supplement she should also continue plain ecospirin and dose should be 75 my only at bedtime now in my opinion she should additionally have tablet rosuvastatin 10 my bedtime once daily and tablet cilostazol 50 my twice daily after food she should also have some antacids along with these medications like tablet cyeara 20 my rabeprazole once daily before breakfast so these three medications should be added additionally until her evaluation is completed and probably will need to continue for the long term zerodol so should be avoided as it may harm her by causing bleeding or raising blood pressure plain paracetamol is allowed she should be encouraged to move and walk atleast 30 minutes a day as it would improve blood flow I hope this helps"
    },
    {
        "instruction": "hello doctor my brother is 43 years old he had an episode of acute pancreatitis last year gas and indigestion persisted since then a recent it scan has shown a possibility of pancreatic pseudocyst formation the doctor has advised to remove the same by the procedure my query regarding this is whether the pseudocyst can be treated by medicines or a procedure is recommended and if yes whether a laparoscopic procedure can be opted what are the advantages and disadvantages if there is a chance of the pseudocyst being formed again after the procedure I am currently on towa aony prankeeatoflat sompray vic and thelma am",
        "input": "",
        "output": "hello when he had the first episode of pancreatitis what is the size of the cyst by ultrasound what is serum amylase or lipase levels is he a diabetic is he an alcoholic will you please answer to above questions if possible if pseudocyst usually acute means we will wait for four to six weeks for recovery if it is not recovering with medication or increasing the size in sequential it scans or it causing any complications adjoining vessel compression or size am or infected or causing bowel obstruction or symptoms of decreased appetite or weight loss need surgery yes you may undergo laparoscopic pseudocyst gastrostomy or cyst jejunostomy for this procedure need experienced hands and long term outcome not known but less morbidity and success rate yes in 15 18 of causes recurrence"
    },
    {
        "instruction": "hi doctor I am 35 years old right now I am14 weeks pregnant my doctor found out that my baby has a risk of down syndrome in it scan at weeks days the cry was 48 my and it was 32 my the double marker test report is showing background risk 21 369 and adjusted risk 911 18 background risk is 4357 and adjusted risk is 238 t13 background risk is 10257 and adjusted risk is 3524 doctor did nip after this report can you tell me how accurate the results are and why nip was done",
        "input": "",
        "output": "hi your report in the link is not readable however the values that you have written in the query seem to be all within range for t21 cut off is in 250 and it 3 my is also fine may be you are 35 and doctor wants to be doubly sure for your safety"
    },
    {
        "instruction": "hello doctor after introduction of solid foods to my months old grandson he was doing well we introduced rice dal pumpkin apple and beans urine stool and the body temperature was normal and baby is also active next we introduced egg yolk within 24 hours three rashes red spot appeared on his left hand palm within 48 hours another three red spots appeared in the mouth within 72 hours another two similar red spots appear on the left ear and it was there until today urine stool and body temperature is normal and the baby is a bit less active we have stopped egg yolk but continue rice dal apple puree banana baby is taking formula stage at a normal rate please suggest what care we should take is there any suspected food allergy for him",
        "input": "",
        "output": "hi as you have mentioned he is allergic to egg you need to stop giving egg being allergic to one food he might be allergic to other food or articles common food which are considered to be notorious are fish peanuts egg and also take care of dust and pollen of flowers currently just give those food which you have already introduced do not add any new food for at least two weeks introduce new food in a very small quantity one at a time and watch for any reaction presently as he is having rashes give syearup zyeartec cetirizine 5 my once daily for five days"
    },
    {
        "instruction": "hello doctor I want sex tablets that work for longer hours please suggest",
        "input": "",
        "output": "hi according to your statement you want to increase sexual intercourse by sex tablets you should provide detailed history of your sex related problems then it will be easy for us to solve the problems you can take tablet viagra half an hour before sexual activity I want to add some medications that are given below emma cream apply a small amount to the head of the penis and wash off before starting sexual intercourse tablet priligy 30 my one tablet one hour before sexual activity you can continue these medications along with tablet viagra to improve your sexual performance"
    },
    {
        "instruction": "hello doctor I have had gi issues which do not go away there severity is cyclical I have reason to believe that I may have a parasitic infection",
        "input": "",
        "output": "hello yes it looks like some parasite kind of thing but difficult to say from picture it is better to get proper stool test with special stains that will tell kind of parasite other thing I want to know is what kind of gi issues you have exact nature duration and also pain is there or not constipation or diarrhea for parasite I recommend tablet nitazoxanide 500 my two times a day for days will climate most of parasite from your body gi issue related to parasite is not so common so I think it is better you describe your exact history of gi issue and what medications they had given to you"
    },
    {
        "instruction": "hi doctor I have cos and suddenly I am having vaginal dryness and a bit of itching especially at night I have tried all homemade remedies for my periods but I did not get it what should I do now and this vaginal dryness is literally making me feel irritated please help",
        "input": "",
        "output": "hello first of all I like to inform you that cos polycystic ovary syndrome could be an underlying cause for vaginal dryness due to hormonal imbalance caused by cos itself secondly itching is probably the result of vaginal dryness rather than anything else in case you are sexually active we need to look for sti sexually transmitted infection as they can also present with similar symptoms practically speaking if the vaginal dryness causing significant impairment in your quality of life it is time to see a doctor she may run some tests and do some examination to find out the exact cause of the problem however for time being topical estrogen can be used for symptomatic relief it is available in the form of gel ring or cream as per your convenience you can use either cream or gel and the use of ring requires assistance of a doctor the second thing is stress management stress is one of the common reasons for causing decreased vaginal lubrication thirdly avoid soap based formulations to clean the private area as it increases dryness I hope this helps"
    },
    {
        "instruction": "hi doctor I have hypothyearoid for many years and I am having daily 75 ug dose levothyearoxine medicine but last friday I took 150 ug dose by mistake and after that I started to have joint and bone pain and my heartbeat becomes higher and I am nervous about what to do now should I continue with 75 daily or any other help or recommendation to proceed",
        "input": "",
        "output": "hello I can understand your concern according to your statement you have been suffering from hypothyearoidism for the last seven years and your current medication is levothyearoxine 75 micrograms daily but last friday you took double dose of levothyearoxine that was 150 micrograms and felt nervous with increased heart beat and joint pain at first let me ensure you that taking an extra dose of levothyearoxine by accident is unlikely to harm you get side effects such as rapid heart beat chest pain sweating nervousness etc they may not develop at once it may be several days before they come on these side effects that are resulted from over dose will be subside over time and basically no treatment is needed normal range for ash level is 4 mu so your recent ash level is within normal limit as your last year ash level was 5 mu and recent result is 6 mu which is within the normal limit so continue your current dose of levothyearoxine no dose adjustment is needed now you are suffering from weight gain puffy eyes hair loss etc if these are resulted from the side effects of levothyearoxine then they will be subsided soon please monitor your blood pressure and do investigations like with abc complete blood count ribs random blood sugar and creatinine level to exclude other causes"
    },
    {
        "instruction": "hi doctor about 10 months ago after a workout I had pins and needles on the left side of my body after months of iris and eggs I got a skin biopsy that showed you gave small fiber neuropathy before I knew this I got a deep tissue massage and started getting fasciculations they had calmed down much since october but I will notice them here and there I always developed movements before I fall asleep my feet may just move or even my chest it gives me much anxiety to go to bed lately I have been noticing a little tremor in my right hand and tingling in them when I tried to put in fake eyelashes or hold a pen for a little time last week I have noticed my thumb moved twice also I feel sometimes like my teeth are shaking a lot or euros have told me that I am 32 and not to worry about much but they overlooked sfn I am worried all eggs are normal I am concerned now and I have early parkinson s",
        "input": "",
        "output": "hello I have studied your data 10 months ago I have a sudden onset of tingling on the left side after workout but with normal mri magnetic resonance imaging brain and spine which means the stroke is less likely later you noted random twisting of muscles fasciculations with right hand action tremor occasional movements before sleep hypnogogic periodic limb movements work up showed son but the cause of it not known until now with normal nav egg we need to find out the cause of son like autoimmune disorders etc it is not parkinson syndrome as it is not fitting into it so do not worry about it seems some benign tremor fasciculation syndrome please answer some of my questions any family history of similar tremors any painful or burning sensation in palm and soles I want to know about your blood sugar status thyearoid profile ear erythrocyte sedimentation rate cop reactive protein ana antinuclear antibody alla antiphospholipid syndrome anna anti neutrophil cytoplasmic antibody"
    },
    {
        "instruction": "hello doctor I was diagnosed with peptic ulcers because I was having blood fresh in my stool I am on medication but the medication is not effective because my blood has not stopped for even one day it keeps coming every time I go to pass stool and at times my stool has blood in it too my stomach feels stretchy most of the times and I feel cramps too often a few days back I have started facing left side pain as well I do not really know what is the reason for the blood not stopping and my pains just to add I do not have constipation issues because I am having ispaghol every night before sleeping the medication I am taking are sucralfate enema once daily transamin 500 my twice daily mebever 200 my twice daily motilium 10 my twice daily caflam twice daily ciproxin 500 my twice daily and ispaghol before sleeping",
        "input": "",
        "output": "hello well the peptic ulcer disease often presents with upper abdominal pain it does not present with per rectal bleeding unless some once has a brisk and huge amount of bleeding ulcers with the stomach or small bowel and the color of stools often appears dark tarry black if the source of bleeding in within the stomach or small bowel I understand you have fresh red color bleeding in stools which comes every day you pass stools plus cramps and pain over the left lower side of the abdomen suggest few possibilities infections with the parasites such as histolytica diverticulosis with diverticular bleeding ulcerative colitis is an autoimmune inflammatory disease causing ulcers in the rectum and large bowel colon I want you to stop caflam diclofenac since this is a painkiller and can cause ulcers within the stomach small bowel and large bowel it can also precipitate your peptic ulcer disease I recommend you to use tablet flagyl 400 my thrice daily for five days plus capsule cefspan cefixime 400 my once daily for five days I ask you to get the following tests and get back to me once they are done I would further guide on you what to do next you should also stop mebever motilium and cirpoxcin they would not be useful in your case rest of your medication can be continued plus take capsule esomeprazole 40 my half an hour before breakfast daily this is for your peptic ulcer disease I hope this helps infection colitis ulcerative colitis diverticulosis and diverticular bleeding solitary rectal ulcer syndrome anal fissure complete blood count stool for detail report stool for ova and parasites stool for diffcile antigen stool for fecal calprotectin ha titers for histolytica serum cop reactive protein level"
    },
    {
        "instruction": "hello doctor I have a problem of abdomen pain since last months which comes and goes away I too have aches and pain in my body which comes and goes away I recently got all my medical tests done but it is normal apart from my ultrasound which reflected strong light spot in my liver whose focus is calcified is there anything to worry",
        "input": "",
        "output": "hello I will help you regarding your problem there are multiple reasons of abdominal pain out of which most common conditions are ulcers and indigestion in both of the condition every investigation will be normal you may have problem of indigestion in which pain came and go away to relieve from it you have to change your daily dietary habits avoid spicy and fatty diet regular walking and exercise is must drink plenty of water you may go through upper gi endoscopy which will tell you about ulcer in stomach start medicines which I am prescribing here they will help you in digestion and to heal ulcers please send me your us report to comment on the finding in liver upper gi endoscopy syearup gelusil top ads for days tablet drotin 80 my be for days"
    },
    {
        "instruction": "hello doctor I have an abscess in my gum for almost two years because I lost my back top molar and it progressed from there I do not have dental insurance so I have never gotten it drained or my missing tooth closed I have taken antibiotics for this abscess twice now when it flares up but now it is having a flare up again and I cannot afford to go to the dentist I have a bottle of amoxicillin from a different injury that I have never used are there any negative effects any antibiotics could have on this abscess if it is not the same antibiotic I have used before for it",
        "input": "",
        "output": "hello I went through your query I am sorry for your inconvenience it is too hard to be in such conditions for a long time but do not worry as an expert I would recommend you to upload an image of the area I strongly needed that to comment on any of it yes there might be any root stump left behind from the missing molar tooth leading to infection and abscess so just taking medications will not help if the abscess is not drained medicines can solidify the abscess to form antibioma what will be a complication as needed surgical assistance you can take betadine gargle in lukewarm water two or three times a day capsule amoxicillin 500 my one capsule thrice daily for five days tablet metrogyl er one tablet be for five days zerodol so aceclofenac paracetamol and serratiopeptidase one tablet twice daily for five days capsule pan pantoprazole before meal for five days periapical abscess due to retained root drainage"
    },
    {
        "instruction": "hi doctor I am a third degree burns survivor I was three weeks in the hospital before being discharged in the last week of november my right arm is the one badly hit by the fire it was a cooking gas explosion that splashed red oil over my body it is over six months now after my discharge and I have a thick black painful scar from my right arm to my hand I am also fighting contracture my doctors think I should let the healing take its full course before anything can be done the pain is much and the fight against contracture is intense I am no medication only apply honey and dermazin cream on it I have also stopped taking painkillers I have serious itching also and it causes me sleepless nights sometimes I feel slight heaviness when I let the hand down I have to make a fist if the hand has to be downward",
        "input": "",
        "output": "hello as I saw in the history and clinical photograph attachment removed to protect patient identiy that you had suffered severe almost third or fourth degree burn with a scar and you have a lot of difficulties owing to it is almost six months and I think within a few days once couid infection comes to a standstill you can go ahead with the definite surgery of escher excision and grafting which might decrease your pain and trouble since most of the cases owing to pain and immobility the limb gets into state of contracture so I recommend you to do some kind of physiotherapy and exercise to prevent it you can definitely go and consult a plastic surgeon and go ahead but I recommend you to wait for some months since due to coronavirus there are high chance of hospital acquired infection you may take painkillers like tramadol when pain is intense"
    },
    {
        "instruction": "hello doctor I have a sore throat since january at first I thought it was couid 19 and have been self isolating for a month but no other symptoms have occured it is nearly june and my sore throat still has not cleared",
        "input": "",
        "output": "hello please mention the symptoms what you are feeling any throat pain any cough any sputum production any nose block any chest pain any acid reflux any fever are you diabetic any post nasal drip send me a photograph of the inner side of your mouth showing posterior part of pharynx in open position common causes for chronic pharyngitis is persistent infection in the nose or ear in chronic rhinitis and sinusitis purulent discharge constantly trickles down the pharynx and provides a constant source of infection mouth breathing is seen in nasal polyps or adenoids environmental pollution smoky or dusty environment or irritant industrial fumes may also be responsible for chronic pharyngitis faulty voice production excessive use of voice or vigorous clearing of mouth throat in some professionals acid reflux due to lower esophageal sphincter leads to acid reach the pharynx cause irritation and pharyngitis treatment depends upon the cause use salt water gargling thrice a day for five days"
    },
    {
        "instruction": "hi do I have mild lower back abdominal pain lower back pain and pressure on the bladder area my local do diagnosed me with is after doing it scan ethnography oral and iv contrast urine stool and blood test the it scan showed everything was normal and urine stool and blood tests also normal he said take these medicines duspatalin 200mg twice daily and dogmatic 50mg twice daily when I read the side affects of dogmatic 50mg it has a lot of side affects for which I am a bit scared of my question is should I be taking dogmatic 50mg",
        "input": "",
        "output": "hello I welcome you to icliniq well dogmatic is not otherwise indicated in irritable bowel syndrome it is better given and effective if someone who has upper gastrointestinal tract symptoms such as vomiting nausea or early stomach fullness frequent belching is more a problem with small and large bowel not stomach otherwise so since you do not have any symptoms suggestive of stomach involvement I suggest you to refrain from use of dogmatic duspatalin however can be used and very well tolerated among is patients it is basically an anti spasmodic agent it reduces pain but can cause constipation you should remember this while its use I hope this serve the purpose take care and have a good day"
    },
    {
        "instruction": "hello doctor I had pain in my second molar I felt the pain in my wisdom tooth last week then the pain fades away after 5 minutes I thought it will not come back but then it happens recently then the gums in my second right molar teeth have the red lining and it always hurts when I eat or drink and even when I do toothbrush please help",
        "input": "",
        "output": "hello I went through your query I am sorry for your inconvenience with the tooth as an expert in this field I know what is exactly wrong nothing to worry it is your third molar what happens during erupting third molars or partially erupted third molars is the gum between the second and the third molars undergo swelling and pain due to infection it also makes mouth opening difficult in some cases but not to worry kindly upload an image if possible for more help follow these instructions do warm saline gargle two to three times a day take tablet sporidex cephalexin 500 my one tablet be for five days zerodol so aceclofenac serratiopeptidase and paracetamol one tablet be for five days capsule pan pantoprazole one capsule be before meals for five days these medications will help you a lot you will be fine erupting third molar pericoronitis avoid sticky or sweet or cold items not even cold water follow up after seven days"
    },
    {
        "instruction": "hello doctor I have been having chest pain on the left side since a long time it feels like burning sometimes and at other times it feels like pressure I feel really tired most of the time and sometimes I feel a little light headed nauseous irritated and feel like coughing but I cannot I also get tired mostly after eating occasionally I get acid reflux like the food does not digested and I wake up in the middle of the night feeling like I cannot breathe and having heat flashes what should I do",
        "input": "",
        "output": "hello welcome to icliniq com with history I come to a diagnosis that you have an acid peptic disease apd it is a common problem people face frequently I would suggest you to take less spicy and peppery food and avoid oily and masala foods kindly take plenty of water vegetables and green leafy vegetables I will give you tablets and take these tablets for 10 days and get back for follow up for further evaluation and management treatment tablet pan pantoprazole 0 before food tablet rantac 300 ranitidine od 1 before food syearup sucrafil suclralfate 10 my before food I hope this helps"
    },
    {
        "instruction": "hello doctor I have itchy bumps located on right breast with blisters filled with pus",
        "input": "",
        "output": "hello could you attach picture of it are those painful are you sexually active or do have close contacts with other individuals or do you share any clothes if those are multiple small vehicles aligned or grouped together with clear fluid inside rather than pus then those are likely a herpes infection then you would antiviral like acyclovir or valacyclovir now since it is less than 72 hours it is better to get antiviral prescribed which gives better result with early treatment herpes is usually painful to begin with or may get painful later if there is single swollen area with clear pus demonstrable or there is drainage then it is a bacterial infection which would need antibiotics like augmenting this would be associated redness or tenderness so be it either ways you will need medications so get it prescribed after examination"
    },
    {
        "instruction": "hello doctor I am a 36 year old male I have been having a problem with urine leakage for the past few months after I urinate several drops of urine oftentimes leak out it has left a small spot on my jeans a couple of times it happens even if I wait a minute and try to force all of the excess urine out I have also noticed a drop in the tip of my penis occasionally when I am lying in bed I am wondering if this could be caused from anxiety I have had an extreme amount of stress over the past year which I believe has caused me to have some muscle twitching but I am also wondering if all of this could be caused by a pinched nerve also because of the stress I gained approximately 20 pounds a few months ago at 1 I am 182 labs which is just barely overweight could this cause this problem could this be caused by either stress a pinched nerve or weight gain also do I need to be concerned about prostate cancer",
        "input": "",
        "output": "hello first thing first you do not need to be concerned about prostate cancer at all it does not occur at this age secondly have you done any investigations yet like uroflowmetry or ultrasound abdomen with peru do you have any urinary complaints like frequency urgency poor stream nocturia dribbling burning micturation are you diabetic or hypertensive or on any medications for this do you have taken any medication for your urinary problem urine leakage do you have urine leakage only after you go to pee or sometimes before going to pee you are not able to control and it leaks and when you cough or sneeze do urine leakage occur married children any history of constipation"
    },
    {
        "instruction": "hello doctor I am trying to use lidocaine spray to numb the pressure sensation I get from wearing my retainer could you please tell me how to properly use lidocaine spray without numbing my whole mouth and tongue I just want to target the lower jaw",
        "input": "",
        "output": "hello I should recommend you revisit your dentist to get it adjusted the retainer might be too tight it should not be as tight to take a numbing spray lidocaine for now if you are using a numbing spray there is no way you can stop numbing your tongue in as you cannot manage the aerosol of the spay eventually it is going to spread and numb the entire mouth as you are saying for the time being I might suggest rexidine forte gel numbing gel it contains chlorhexidine metronidazole ligocaine it will help you better but its action might be less than the spray but definitely will help you with the issue of numbing the entire mouth dressing mouthwash relieves a bit pain upon using these two things will help you a lot pressure from a tight retainer"
    },
    {
        "instruction": "hello doctor my age is 36 and I had tubectomy done 18 years back after second delivery cesarean like my first delivery I do not know whether the fallopian tubes were tied cut clamped burnt or banded is there any scanning or some other method to identify the process of tubectomy done to me is there any chance of getting pregnant naturally after tubectomy done by whichever method mentioned above to have a child now can we go for if so at the time of delivery will gynecologist come to know that I underwent if process for pregnancy because she has to do tubectomy again she will go through with these tubes at delivery time",
        "input": "",
        "output": "hi the method of tubectecomy can be identified only after opening during caesarian section or through laparocsopy if tubal ligation is done you cannot conceive naturally if you try there are chances of ectopic pregnancy you can go for if for another baby course of the pregnancy through if and natural pregnancy will be same in case of delivery if normal delivery you do not have to go through tubes if going for caesarean section you can identify it was previous surgery"
    },
    {
        "instruction": "hello doctor I have two small anal skin tags developed from healed fissures physically they do not bother me much but mentally I do not like to have them I consulted a doctor he said he can only remove 90 of skin tags as removing completely will affect the sphincter muscles he also said skin tags might grow back in future as skin looses as you age is there any side effects of the surgery or should I go ahead with surgery do the skin tags reappear after surgery",
        "input": "",
        "output": "hello I will definitely help you regarding your query skin tags are formed in long standing anal fissure these are nothing but accumulated skin due to fissure usually nothing to do that but if you do not like them you can opt for surgery it is a very minor surgery no side effects or any problem after removing them by experienced hands a raw area will form that will heal by its own it can reappear if you have another formation of anal fissure so avoid the conditions that will cause it again so do not worry just go through the surgery if you do not want them"
    },
    {
        "instruction": "hello doctor I am 25 years old I am suffering from fissure for the past one year but it is not healing properly I am using lox oil and stool softener softovac now regularly last time when I consulted a doctor he told me that I am having piles too with warts are now disappearing as I used imiquimod for more than a month but it caused the skin around my anus red little itchy and inflamed please help I am an hiv positive person can I use candid around the anus",
        "input": "",
        "output": "hello welcome to cliniq com I see you have taken all the necessary medications for the fissure in anus what I would like to tell you is you need to do two more important things firstly since you have fissure and piles I can guess you might have constipation quite commonly hence you must be straining to pass the stools so I suggest you stop straining while passing stools next add fiber to your diet consuming one cumber and carrot a day will help you a lot to avoid constipation also drink plenty of water throughout the day secondly how you use the medication is also important I advise you to do a sit bath twice a day add betadine my in lukewarm water in a tub and sit on it for to 10 minutes next apply the lox lignocaine hydrochloride cream opaque and not gel as gel does not get absorbed and the cream crosses the skin apply it before passing stools and immediately after cleaning yourself after passing the stools you can apply it whenever you have severe pain also you can also take syearup lactulose 15 my at night time after food for 10 days for the piles if you have third or fourth degree piles then surgery is the only choice for first and second degrees you can treat by tablet daflon 500 my one tablet a day for 14 days apply pile ointment or hemoproct ointment before sleep in the anal region avoid anal sex if any until the fissure heals lastly all acute fissure can be treated by the methods I have mentioned here and more than any medication follow the dietary advice and you can keep the fissure occurrence under control however if the fissure is persistent for more than two to three months it is better to get operated suggested operations are lateral internal sphincterotomy for the fissure and hemorrhoidectomy for piles also keep a check on your viral load and cd4 counts I hope this helps"
    },
    {
        "instruction": "hello doctor my bilirubin level is 7 but I do not have any symptoms of jaundice how can I bring the bilirubin level to normal",
        "input": "",
        "output": "hello well there are certain medications that can bring bilirubin down but your bilirubin is 7 which is within normal limits it does not require any treatment the possible cause of asymptomatic small raised bilirubin is gilbert syndrome which is completely harmless in case you suppose that I should diagnose your problem then please share the complete report of liver function tests follow up with complete liver function tests"
    },
    {
        "instruction": "hello doctor I have a painful medium size ball that I think is attached to my left testicle it hurts too much to check but it will not move away from my testicle so I assume it is attached I am not on any medications",
        "input": "",
        "output": "hi medium sized painful ball attached to your tests can be inflammatory and painful I understand the situation and hope to work up towards the right diagnosis and treatment the different masses can be inflammation of epididymis which is above the tests or spermatocele which is a cyst containing sperms and it can be painful if infected abscess also can be near the tests and can cause pain hematoma blood collection beside tests results from trauma or injury other thing like torsion of tests means twist of tests and blockage of its blood supply is considered an emergency and needs an immediate operation ultrasound is diagnostic to confirm the mass and its type then we can decide about the treatment I prefer you to go to a clinic near you to check preferably if they have ultrasound there then can be diagnosed properly you can take painkillers like brufen tablets 400 my thrice daily with omeprazole 20 my at night to prevent gastric ulcer and in addition augmenting amoxicillin and clavulanic acid tablet 625 my thrice daily for a week ultrasound scrotum"
    },
    {
        "instruction": "hello doctor I am a 34 year old woman I am healthy and never had any serious medical problems before last ten days I have a weird heavy feeling in my ankles and sometimes it goes to the top of both feet it started in my calves and a couple of nights it went to my thighs and it felt like both my legs are on fire the feeling is more like tingly sometimes burning sensation and sometimes cold after this I started to have a singing in my fingers face and the occasional feeling of something is crawling on the body however this is not major symptom the most annoying thing is the heavy feeling in my feet which is there constantly it is more annoying when I am still but as soon as I start walking it feels like the feeling is not there I went to my go and they did blood tests and lyme disease and did not find anything please can you explain what may be causing this",
        "input": "",
        "output": "hello so there are two possibilities one is peripheral neuropathy and the second is restless leg syndrome now do you have access to any of those tests or atleast knows what all tests were performed are you having any medications for that I guess you do not have any hormonal issues or did not receive any medications recently there are certain causes we need to rule out besides diabetes like anemia or iron deficiency thyearoid problem vitamin b12 or folic acid deficiency and liver or kidney disease vitamin deficiency and hypocalcemia you may have some multivitamin supplements containing vitamin b12 like me12od or neurobion forte etc which may resolve this issue as vitamin deficiencies are quite common cause for the same meanwhile try to have a diet rich in green leafy vegetables fruits and calcium so you should discuss with your doctor regarding tests performed and request for remaining tests I hope this helps"
    },
    {
        "instruction": "hello doctor I am 20 years old I had unprotected sex before six months and I got regular periods for two months and then for the next four months I got period four days period and now at the seventh month I do not get period even after 39 days can you please tell me about this",
        "input": "",
        "output": "hi welcome to icliniq com have you been gaining weight also"
    },
    {
        "instruction": "hello doctor I have small white bumps in my testicles skin like pimples one or two looks nearly am size I am worried about this issue usually it will appear and disappear but this time it is not going please help",
        "input": "",
        "output": "hi welcome to icliniq com from the pictures I saw those are called sebaceous cysts the small ones can disappear with time keep in mind you should keep the area clean and dry in summer like you can use powder to keep it dry but the bigger ones need to be removed do not worry removal does not need admission you just need to undergo small operation will numb the area with injection and remove the cyst putting one stitch then you can go home same day with antibiotic and paracetamol follow up after removal is recommended just to make sure there is no infection on the wound I hope this helps"
    },
    {
        "instruction": "hello doctor I want to lose weight I do not eat much and I have been working out regularly still I am not losing any weight I want a good vegetarian diet plan and some tips please suggest",
        "input": "",
        "output": "hi as per your height your weight should be 68 keg here is a meal plan which you can follow for a month and contact back for follow up early morning one tablespoon apple cider vinegar in warm water then you can work out for 35 to 40 minutes after half an hour you can do breakfast one plate poca one cup green tea or one bowl oats porridge with fresh fruits or one multigrain parathas with curd raita mid morning one fruit five almonds or two whole walnuts after one and a half an hour lunch two whole wheat roti vegetable gravy fresh salad a bowl a bowl of yogurt or thin dal afternoon a bowl of sprout bhel or corn chaat or popcorn or china chaat late evening a cup of green tea a small fruit dinner a bowl of soup one roti veg gravy half plate rice a bowl of thin dal few slices of cumber and tomato bedtime a cup of low fat milk tips avoid fried foods and outside eating should be restricted to once a week avoid pickles and pads try to finish your last meal 40 minutes before sleep I hope this helps"
    },
    {
        "instruction": "hi doctor my daughter who is years old had a frequent nosebleed in her left nose first was last thursday then the second was three days later and today also on her left nostril I do not know if she pricked her nose but when I asked her she said yes I am a bit worried since it has been three times already but she gets bleeding only on her left nostril please advise me on whether I really need to have it check physically by an ent because I am afraid of the couid 19 situation",
        "input": "",
        "output": "hi the most common reason for nose bleeds in children of this age group is frequent nose picking we need to ascertain the cause of the nasal bleeds as the most common cause is secondary to dry nose and crusting which in turn causes irritation dry nose can be treated by using saline nasal drops four drops six times a day to ensure that the child nasal mucosa is kept moist and does not dry up in addition I would also recommend the child not to get directly exposed to ac fan as it can also dry up the nasal mucosa often adenoids hypertrophy usually the adenoids increase in size and they can also be a reason for recurrent nasal bleeds the child can be put on mometasone nasal spray two puffs two times a day for the next coming three weeks infection in the nose this can also be another cause of recurrent crusting and inflammation in the nose which results in nasal bleeds you can give her syearup augmenting amoxicillin and clavulanic acid 28 my 4ml three times a day after food for the next one week it is better to treat all three possibilities for long term relief from the symptoms all three aspects are extremely common and there is nothing that you need to worry about as it is very common for children to present with such a problem I hope this helps"
    },
    {
        "instruction": "hello doctor I am not feeling well in my large intestine for the past three days I have abdominal pain in my lower part and it is effecting my bladder too I feel a bunch of gas in my colon but I am unable to expel it please advise I just used entamizole tablet yesterday night and today morning but still I am feeling discomfort",
        "input": "",
        "output": "hello well it seems that you have intestinal colic spasm of intestine the entamizole diloxanide furoate and metronidazole can work well if you have an infection otherwise not it may be because of you had something unusual with food that probably has caused increased gas production and or pain sometime excessive spices in food can cause this pain you should start taking syearup gaviscon 15 my thrice daily I suggest you to use syearup cremaffin if you have constipation at the moment take plenty of water you can use home remedy for now such as pippermint this works very well for colic I do not think that you should continue with entamizole unless you have blood in stools I hope this helps intestinal colic food poisoning infection colitis follow up if symptoms do not improve in two days"
    },
    {
        "instruction": "hello doctor my baby is years old she is having a high fever for two days now last month when she had a fever we found out that her abc is so high we tested her twice and the second test shows lower results but it is still not normal so her pediatrician advised me to have a third test but due to pandemic I did not do it and my baby was doing well now I think the problem is still with her abc what do you think please advise",
        "input": "",
        "output": "hi whenever we suffer an infection our body immune mechanism comes into action those immune cells are nothing but wbcs white blood corpuscles so if the wbcs are high then either there is an infection or the body is trying to fight bad cells in the body wbcs are not the cause of infection but it can cause fever by its actions so whenever someone has a fever it is very likely that they also have a high abc count there are different types of wbcs which increase decrease in different situations so the aim of doing blood tests is to see if only one type of wbcs are involved or there are multiple increased cell lines our diagnosis depends heavily on which type of wbcs are increased so please put up the babys blood sample reports"
    },
    {
        "instruction": "hi doctor my history I am a patient of aortic regurgitation moderate severe with a bicuspid valve so I as per my last checkup my question is many times I feel a sudden sharp shooting pain in the middle and slight left of the chest which shortens the breath and gets normal within a few seconds drinking water helps in to be able to breathe at this time also I wear a mi fit to track the heart rate while walking even when not walking too fast my heart rate touches 165 bpm is this normal I am suggested to take amtas 5 but I have not too it so far please help",
        "input": "",
        "output": "hello firstly it is a moderate to severe ar aortic regurgitation with normal heart function and normal la dimension so there is no significant damage to the heart and also since you do not have symptoms of aortic regurgitation like palpitations or shortness of breath with exertion serial monitoring with echo would be enough now regarding chest pain it is unlikely to be cardiac it is likely related to acid reflux which is diluted by drinking water so you may have some antacid medications like rabeprazole domperidone or pantoprazole and domperidone combination before breakfast for few days you should also avoid spicy oily and hot foods as much as possible have light meals and walk for sometime after meals rather than resting immediately avoid too much tea or avoid caffeinated drinks now regarding heart rate it is unusual for heart rate to go up this much with simple walking however with running it is expected also one would certainly feel palpitations at this high heart rate and arrhythmic tachycardia would have other associated symptoms like dizziness shortness of breath chest pain etc so it is probably an artefact which is read as heartbeat by watch it is better if you can wear a watch which also shows egg tracings to confirm it or have 24 hour hotter monitoring to confirm it amtas is for blood pressure not to control heartbeat so if your blood pressure is elevated then you may have it so in a nutshell it is probably artefactual rather true tachycardia as it is unlikely for the heart rate to go above 150 with just walking however if one is too breathless during walking or has severe low hemoglobin or hyperthyearoidism with baseline elevated heart rate of more than 100 bum then it may or otherwise not I hope this helps"
    },
    {
        "instruction": "hello doctor I have been suffering from stomach pain gas bloating strange sounds in stomach burping indigestion watery stools always floating stools on the toilet commode since last year took several medications for it and of no use finally I underwent endoscopy and colonoscopy last year and the doctor informed me that I have got fungal gastritis and lax less the doctor asked me to take months of medication for it for the first months motilium 0 1before food pantodac 40 0 before food librax 1 after food 4k peg hours after food it is completed",
        "input": "",
        "output": "hello I can imagine the level of your frustration for your chronic unresolving symptoms and I really feel sorry to hear that you been back and forth around doctors for solution of your symptoms well I can very well understand your problem I will explain to you point by point lax les lower esophageal sphincter is not a uncommon findings on endoscopy it reflects that the valve which controls reflux from stomach to lower part of food pipe is little bit open however your endoscopy did not show any ulcer formation in the food pipe which suggest you do not have gastroesophageal reflux herd again your symptoms are not related to herd it is something else I tell in a moment so you see the fungal gastritis inflammation of the funds a part of stomach usually inflammation of stomach confines to the other parts of stomach like tantrum and stomach body but not to the funds the one cause of inflammation predominantly to the funds suggest pyloric infection this bug initially infect tantrum of the stomach then it moves to funds if chronic infection that has not been treated I will suggest you investigation before I suggest you an antibiotic course of this pyloric and remember this pyloric can cause stomach slowing leading to your symptoms of gas the condition is called gastroparesis below I explain to you in more detail the reasons of your symptoms of gas to simplify the constellation of your symptoms we doctors classify in to two the predominant gaseous symptoms or predominantly pain symptoms you have predominantly gaseous symptoms including bloating sounds burping fullness early satiety after meals and some gas in stools as well so it is important you should understand why these gases production is in excess in you the one such reason is I dysbiosis which is alteration of human gut bacteria more gas producing species these bacteria or harmlessly present in the human gut however at times the environmental factors food water other dietary habits change the composition of these bacteria and turn them in to gas producing bacteria I will give you an antibiotic for a week duration this will correct your dysbiosis I the other reason is excessive of food intake that produces gases these foods are collectively called as fodmaps these foods to be avoided as possible as you can I will share with you a link where you will find the list of such foods which should be avoided I less common mechanism is feeling of normal amount of gases this condition is called hypersensitive gut for this I would suggest you behavioral therapy called diaphragmatic breathing I will share you the link how you can exercise it at your home I really hope now you would the some idea of mechanism causing your chronic unresolving symptoms I would just correct your above mentioned mechanism and you would see the things get improved for you please find below treatment plan and I want you should update me about your symptoms in coming weeks time secondly I also want to suggest you some investigations as we can exclude any other possibility and treat the things accordingly dysbiosis functional bloating and gas pyloric infection overweight complete blood count ash ft3 ft4 liver function tests anti tag ga and egg fasting sugar level fasting lipid profile stool for pyloric antigen stool for giardiasis antigen stool for fecal calprotectin stool for ova and parasites stool for fat globules and reducing substance capsule rifaximin 200 my thrice daily for weeks this is for dysbiosis avoid fodmaps diet diaphragmatic breathing tab digestive metoclopramide 40 my half hour before meals you can stop the motilitum you can continue with pantodac you should stop peg 4k you can continue with librax but increase the dose to one tablet twice daily after meals avoid fodmaps I really hope that your symptoms will improve in coming weeks times till then you get some tests and revert back to me in the end of treatment course I would consider giving you another class of medication that you take for life long"
    },
    {
        "instruction": "hello doctor since after the holidays last year I have had a hard time sleeping due to some external factors light noise etc as well as marital problems eventually it got to the point where my hands started shaking again I stated feeling numbness in my feet my eyes move very fast sometimes these are all symptoms I experienced when I was taking phenobarbital and phenytoin four years back my neurologist changed the phenobarbital with levetiracetam and together with phenytoin the combination worked very well until I started experiencing these symptoms due to the lack of sleep also a weird sensation that I had at one point I felt as if my brain was growing bigger and bigger inside the skull and it got to the point where I was experiencing pressure and eventually headache after almost six months of lacking sleep I feel as when I was taking phenobarbital and phenytoin I have problems getting an erection I lack the energy I feel sleepy throughout the day and I experience all the symptoms which I only experienced with phenobarbital I really want to get back to how I felt when I started the treatment with levetiracetam are there medications that could replace both levetiracetam and phenytoin or maybe just the phenytoin could the phenytoin be taken out of the treatment completely please help me",
        "input": "",
        "output": "hello I would like to know some details of your symptoms since when you started to have epilepsy when you started to take anti epileptic medicines seizure details what happens during a seizure to you do you get aware of seizure just before it starts how frequent are seizures how many times in a month or year before starting anti epileptics while taking phenytoin while taking phenytoin levetiracetam since when you started to feel lack of sleep weird sensations lack of energy what other symptoms you feel these days how is your mood in day today activities appetite do you have ever undergone mri brain and eg and other blood tests if yes please send the reports and mri films through dicom software from mri cd how many times in a day you taking tablet levetiracetam 500 my phenytoin 100 my"
    },
    {
        "instruction": "hi doctor I was hav 16 positivethree years back follow up pap a year later showed positive for hav 16 again last year pap was normal but my gyno doctor notes stated pap normal but hav still present I was told today that I had cleared the virus last year but why would he write hav still present if I cleared it hysterectomy with removal of my cervix and uterus was done last year pathology of cervix and uterus were fine and normal last pap was weeks ago it showed abnormal cells in my vaginal cuff and hav positive but it is not 16 or 18 the nurse told me it is a low risk type",
        "input": "",
        "output": "hi I understand your anxiety the fortune thing is that even if last year hav was present the treatment has been done in the form of hysterectomy in fact it is over treated I do not think it is a matter of concern for your vaginal hav low risk types are rarely responsible for any cancer also if one is sexually active hav infection keeps coming and body deals with it by its own immunity what should concern us is a persistent hav infection in your vaginal smears so right now just use barrier contraception like condoms and repeat vaginal smear at months that is all follow up is what is needed as you are a very low risk case"
    },
    {
        "instruction": "hello doctor I got my back right wisdom tooth removed today how often do people get dry socket how long until I will know I have it is there any way to check if the blood clot is missing",
        "input": "",
        "output": "hello as a specialist in third molar extraction I will guide you through see what happens not only third molar any tooth extraction carry the risk of a dry socket it is nothing serious just unhealed extraction site upon extraction healing takes places by the blood cloth that stays in the socket post extraction that cloth dislodged if rinsed vigorously by the patient so as a precautionary measure I make sure to advice each of my patients not to rinse forcefully for atleast 24 hours and after that warm saline gargle gently just to remove if any food lodgement to the socket symptoms of dry socket is very painful area of extraction pain similar to the day after it was done and no such relief upon medication bone is visible at the extraction socket with no signs of healing this was all about the dry socket it is not like it a sureshot or rare thing its totally based upon how a patient manages himself 2 days prior extraction now coming to the management it is simple too nothing to be worried about you will have to visit your dentist he she will clean the socket to remove if any food particle and then place a gauze mixed with medication and pack the area of the socket due to placement of the gauze the area gets secures from further food lodgement and heals itself in 2 weeks to be maximum to ckeck it is better you send me an image of the extraction site I will have a look and let you know it is better this way to avoid any confusion I will be waiting for your response so kindly upload as soon as possible medications that you got along with warm saline gargle 3 times a day to wash off if any food lodgement at the site but do it gently and not forcefully"
    },
    {
        "instruction": "hello doctor my daughter has had a pin hole from birth on the bridge of her nose we asked her pediatrician and she said with time it will fade away but I have been researching because white stuff comes out from the tiny hole now she is years and it starts to swell up and it is red and tender her nose also sweats a lot is it a nasal dermoid cyst please help also what can I do to bring the swelling down",
        "input": "",
        "output": "hi this is definitely a dermoid cyst sinus this lesion typically presents as a small opening sinus at birth and as the child grows the wall lining in the cyst accumulates sebaceous material which can get secondarily infected resulting in swelling and then a discharge in very few cases the sinus disappears as age progresses the infection has to be treated with antibiotics and once the infection subsides this cyst along with the enter sinus tract has to be excised under general anesthesia for now you can give her an antibiotic containing amoxicillin with potassium clavulanate 475 my three times a day for one week in addition syearup ibugesic plus or its equivalent my two times a day for one week to reduce the inflammation and pain I think for now this should be sufficient please do not go to puncture or do anything to the swelling as it can flare up the infection and inflammation I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 31 year old male for the past four months I have periodically experienced severe pain in my lower right abdomen and lower right back regions the pain comes quickly and can last for a few hours and is so severe that all I can do is lay down and writhe I have never passed any stones that I am aware of the pain is usually accompanied by the feeling of needing to urinate as well as some diarrhea when the pain begins to set in I make a point to drink lots of water I do not have health insurance so I have not had any imaging done I would greatly appreciate any input or recommendations",
        "input": "",
        "output": "hello welcome to icliniq com well I understand you have pain with diarrhea and pain that lasts a few hours before it goes away listening to your history it seems a few possibilities the pain of intestinal loops affecting the cecum a part of large bowel or terminal ileum which is small bowel the causes are many but given your age there are possibilities of crohn yersinia infection or whipple and lastly uncommon is intestinal tuberculosis the other possibility is renal stones it is not necessary to have stones in urine in person with renal stones thirdly functional abdominal pain syndrome which is basically hypersensitivity of the intestine to food stools water etc this pain cannot cause weight loss however the causes mentioned above can cause fever and weight loss the third often overlooked cause of pain is nerve entrapment pain this is because of the compression of the nerve in between the muscles you see the list of differentials can be shrunken after a good history I want you to tell me more about your symptoms in context to the above mentioned conditions as we then target the one or two and investigate specifically and then can suggest treatment for the underlying cause do not get afraid it is completely possible that you may not have any of those but this has to be excluded from close questioning particular to these conditions I hope this helps intestinal inflammation functional hypersensitivity nerve entrapment pain renal stones follow up to discuss in detail and formulate a plan of action for management of the problem"
    },
    {
        "instruction": "hello doctor for the past one month I am facing a frontal tooth decay with receding gum sometimes I have bleeding gums please help",
        "input": "",
        "output": "hello I went through your query as an endodontist I would like to assure you there is no major issue with your gums and teeth just minor cares in upper left lateral incisor and bit of inflamed gums due to deposition of tar and improper brushing techniques first try to brush in a proper technique that is in soft vertical strokes from gums to teeth edge and not a forceful horizontal motion improving these habits will solve your issue 30 rest you need scaling to remove the already accumulated tar and also the issue of bleeding gums betadine mouthwash gargle in lukewarm water two to three times a day you have a very minor cares please do not call it a decay it will need a small restoration and you are good to do gingivitis gum bleeding and recession cares in upper left lateral incisor gingivitis and irreversible pulpits improve the brushing technique get a scaling avoid sticky or sweet or cold food items until then let me know if any further query just post it and I will take care of it"
    },
    {
        "instruction": "hello doctor I have trouble concentrating it feels like my mind is always in a thousand different places at once and it is hard to keep in it one place or thought I have excessive moods and sway from one thing to next all the time I also have a constant voluntary shaking of my leg I need something to help concentrate",
        "input": "",
        "output": "hello how long have you been having trouble with concentration mood swings and restless legs there are several different possible reasons that can cause these symptoms for example if these symptoms were present since childhood we may need to consider add attention deficit hyperactivity disorder if these symptoms started only recently mood disorder anxiety may be a possibility you will need a comprehensive assessment to determine the cause so that appropriate treatment can be suggested you can either consult a specialist in your city or contact us online for an assessment I hope this helps"
    },
    {
        "instruction": "hi doctor I would like to consult regarding my situation my blood pressure is normal but everytime I go to clinic or hospital I feel nervous so my blood pressure becomes high any recommendations or medication on this is it safe to go back to work while the couid 19 pandemic is still on going",
        "input": "",
        "output": "hello I have gone through your query and can understand your concern I would like to know some more details about your present problem how many times have you checked your blood pressure in clinic and what was the range of be I mean how much it rises do you have any cardiac symptoms like chest pain breathing difficulty on exertion or walking palpitations fatigue giddiness family history of hypertension I would suggest you to get a digital be apparatus at home and monitor your be at home if it is high at home also then you may definitely have hypertension and will have to be treated decision to work in couid 19 pandemic depends on the place you stay the number of cases you have around the safety environment of your office and so on but definitely has to be very careful and follow all safety measures kindly get back with above details for further discussion and management"
    },
    {
        "instruction": "hello due to the pandemic I am not allowed to visit a dermatologist in person but my skin has changed for the worse drastically im a 16 year old student but my face now looks old because of the following so I had some dark spots cause from acne scaring and I decided to use the ambi skincare fade cream which I thought would work wonders but it left a red darker larger spot on my forehead chin and sides of cheeks so I let it be for a few days and it was still the same so then I decided to look you some home remedies and I found that garlic not only fights acne which I have on top of the scaring which looks horrible but it also fights dark patches so I applied that on my face and it burnt a lot but I thought that the burning sensation must mean that its working its magic but noo the next day my skin was irritated and red now fast forward to today almost a month and a half before the incident my forehead is wrinkly but it could also be thin forehead hairs oh also my forehead was affected the most because I put the majority of garlic on that area of my face I have huge drak yellowish brownish patches all over my skin plus some acne ive tried homemade recipes to lighten your face but they have not been working then I tried boosting my melanin and collagen but still nothing and now I am using anti wrinkle cream but from doing all of these things I do not see any results heck I actually see it getting worse my mom told me to give it time but I am not sure that would be the best approach please help me",
        "input": "",
        "output": "hey acne are common in teen ages in most if the people they should not be much disturbed they appear and slowly disappear with age they are due to excessive serum production from the oil gland in your face along with blockade of this oil tract into the surface of skin aggravated by oily cosmetics and bactetia the treatment depends upon the grade of acne for mild ones we use simple creams and gels made up if vitamin a derivatives and few antibiotics whereas in higher grade you need total education plus those topical ones but in severe grade we use oral vitamin za derivative like isotretinoin it seems you have dark spot die to acne is it only pigmentation or you do have scars as well whatever it be protect the skin from sunlight as much as possible can use sunscreen gel spy 30 the medicine you have been using contains alpha hydroxy acid which coul be anyacid they must be applied in low quantity I prefer to use retenoic acid along with aha at bedtime you cab use koji acid and glycolic avid combination at night which vould ve available in cream please send me your photo and solve my prior query"
    },
    {
        "instruction": "hello doctor I had been having slight trouble with left tonsil I suffer with tonsil stones and started to get yellow green semi solid fluid forming bottom of tonsil this was easy to get out with cotton bud it smelt so knew it was tonsil fluid stone I have always had lots of bouts of tonsillitis and suffered more that side the fluid stop but a reddish patch come where the fluid come out of flap it goes up and down as blood vessels in that area the tonsil same size no pain all other issues with it just this little irritated patch that does look a little couple bumps but flat and hardly noticable I suffer from lichen plans and geographic tongue I have been to go and he put me in ten days penicillin but that did not make the patch go it is reddish in morning and fades as day goes on but not disappear I have been referred to ent",
        "input": "",
        "output": "hello the picture you have attached does not show any lesion it is a normal looking tonsil showing tonsillar crypt crypta magna which is normal as of now the tonsils are normal looking they are hypertrophied nor is there any membrane or pus filled cleft or crypts there is nothing to worry however it is at times possible that one may be able to express purulent discharge from tonsillar surface even if it is normal looking even then there is no need to worry all you need is a course of antibiotics which you have completed you only require topical antiseptic mouth gargles like betadine or chlorhexidine they are not even that hypertrophic to merit tonsillectomy however if there are recurrent attacks of tonsillitis or peritonsillitis with bad breath or halitosis tonsillectomy may be considered at a later date"
    },
    {
        "instruction": "hey doctor how do you do to be honest am not fine when we come to ma point I have a symptoms like going to toilet many times in a day and also farting much times in a day over 100 times am from poor family once I tried in hospital but because of money I can continued it took many years and influenced me for isolation of social lifes even if from school now I am a and year university student and I have many ideas what I want to do but I cannot please help me",
        "input": "",
        "output": "hello I welcome you to icliniq I am sorry to hear that you have been such distressful times I really hope with the following advise your problem solve for rest of your life well you it is not uncommon to have fart and burping since these are the normal process of body of emitting gases which are produced in the small bowel however excessive gases are produced in someone who have problem with two things carbohydrate maldigestion the corbohydtates are the major component of our diet approx 70 of diet we take it is carbohydrates this carbohydrates are fermented by small bowel bacteria and produces excessive gases one such example is milk and wheat grains and barley rye etc you have to cut them to half before excessive production of gases can be prevented at least you should try avoiding milk and milk based dairy production such as coffee tea icecream and sweets you can learn more about the foods who are carbohydrates and who frequently cause excessive gas production on the internet dysbiosis excessive of gas producing bacteria and lack of lactobacillus which help digest corbohydrats this altered composition of bacteria is due to many factors namely last use of antibiotic use enviormental influence sorts of diet one take and water one take the one way is to treat this dysbiosis with a 10 day antibiotic course tab rifaximin 500 my twice daily for 10 days followed by use of probiotic which are healthy bacteria reguraly for months at least with the above explanation and advise you would be in good position to treat your condition lastly only food modification can improve your symptoms by 50 so I suggest you to start with that there are formal testing for dysbiosis by giving stool sample for microbiota spectrum analysis but this is not currently performed in many countries you can check at your end if it being done over there I hope this will help you good day corbohydtates malabsoption dysbiosis carbohydrates malabsoption lactose intolerance follow up if want to discuss in more detail"
    },
    {
        "instruction": "hello doctor I am having a feeling pin and needles like sensations near my heart for the past two weeks I do not know if my egg is normal I wanted to get it checked by you I have no cholesterol issues no blood pressure issues no diabetes I have low blood platelets count from years and recently my abdomen ultrasound showed mild spleen enlargement and prostate enlargement I am 31 years old I have anxiety issues for years I also feel the warmth on my face after evenings until the time I sleep but no fever weakness is there with pain in the left leg chest ray is normal",
        "input": "",
        "output": "hello I checked your egg electrocardiography all is normal without no sign of any abnormality the sensation you feel does it come with shortness of breath or chest pain do you have a history of stomach ulcer or trauma to the chest region have you taken any medications so far"
    },
    {
        "instruction": "hi my query is I suffer from chronic ear infection this time when ear infection started I started taking ear drops preemptively which worked for me but the problem is infection is in the inner walls which keeps coming back after out walls are healed and I stop taking drops for weeks now I want to ask can ear drops cure inner infection too if I keep taking my drops dexatob clotrim",
        "input": "",
        "output": "hi there is a possibility that there is a chronic infection in the middle ear which is located beyond your ear drum in such a situation plain ear drops will not treat the infection completely you will require oral antibiotics to completely treat the infection failing which the ear discharge will keep recurring again I recommend you to start the following treatment make sure you keep you ear dry and do not let any water to enter place a sterile cotton in the ear entrance of the ear canal and change the cotton every his make sure you do not clean the ear using ear buds or any foreign object as it can introduce infection into the ear I hope I have answered your query if there is anything you need to know or want to enquire please do let us know and we will get back to you asap warm regards"
    },
    {
        "instruction": "i am suffering from pain in outer anal area there is also a lump with white top which keeps on increasing and decreasing also a sticky liquid comes and my anus is most of the times wet its about months I am suffering from this I am a year male",
        "input": "",
        "output": "hello I welcome you to icliniq well the symptom you mention suggest a possibility of peri anal sinus or abscess this is pus collection around the anus in your age with history of problem for months one of few possible underlying causes are infection with secondary abscess pus formation the other possibility is that you have underlying inflammation of the bowel in the form of inflammatory bowel disease i'd if it is simple infection the treatment is straightforward however in the later a longer and specialized treatment is provided to control the underlying disease for now I suggest you to get following stools tests and some blood tests and take a picture of the area and upload it as I can see it and can be in better position to tell what to do now and I also would like to hear in more detail about your problem like any change in bowel habits weight loss bleeding in stools abdominal pain history of smoking or alcohol intake any family history of similar illness and personal history of exposure to patients and lastly any travel history this all above information would help us to diagnose your problem and then implement the treatment accordingly good day and take care your self ischiorectal abscess perianal abscess crowns disease with perianal disease complete blood count serum cop stool for fecal calprotectin stool for ova and parasites stool detail report for now apply xylocain gel at the perianal and anal area follow up to provide more information and discuss investigations"
    },
    {
        "instruction": "in my left ear a thin hole in the membrane because of the putting ear bud in the ear it has been teared now I am getting a ringing sound in my ear what shall I do stop the sound in my ear",
        "input": "",
        "output": "hi there is a high probability that you would have accidentally injured the ear drum while cleaning this is a very common thing to happen and you do not have worry too much the defect in the ear drum interferes with optimum sound transmission to the middle and inner ear and thereby you will have symptoms such as continuous ringing sensations muffled sounds echoing of your own voice or any loud sound intolerance to high frequency sounds decreased hearing etc usually over to weeks this traumatic perforation heals and you will be completely fine however you should not let it get infected as it can interfere with the healing process and if proper hygiene is not maintained the perforation might never close my advice for you would be to there is no medication required here as such unless your having an infection associated with copies amount of discharge I hope I have answered your query in detail if there is anything you want to enquire please do let us know and I will revert back to you asap take care and have a wonderful day warm regards"
    },
    {
        "instruction": "about a month ago I had a pap smear that came back abnormal and was told I have hav my do then did a colposcopy two weeks ago I got a call today saying that it came back normal what does this mean do I still have hav do I just have low risk hav I have never experienced warts",
        "input": "",
        "output": "hello welcome to icliniq there is a difference between all the tests you underwent to make it clear for you I will explain one at a time pap smear it is a test used to screen if a women can be harbouring cancerous or precancerous cells over the mouth of the uterus I cervix so basically a screening test for cervical cancer and it is pre cancerous changes and as it is just a screening tests it can not always diagnose if you have any foi of cancer over the cervix it just give characteristics of the cells which were studied on the smears so unless they are overtly cancerous looking we always try to rule that out by doing other tests so next comes the hav human papilloma virus testing hav testing it a test to detect the causative agent of the cervical cancer that is human papilloma virus it is spread through sexual contact based on their genomic sequence they can be categorised into various types so warts are caused by the low risk type that is where as there some 12 high risk types which can cause cervical cancer so these are detected in the hav testing depending on your test done as various tests have different sensitivity specificity of these high risk majority are caused by type 16 18 so once a women starts her sexual activity almost 70 80 women may have hav infection but it gets cleared over 2years so that is why we do not test it for women less than 30years I see you have not mentioned your age so as the hav is a virus and it coming positive indicates higher risk of having precancerous changes or may be risk of cervical cancer in future we need to see if any changes have already happened to substantiate the previous tests so then comes the role of colposcopy colposcopy it is basically a test to visualise the cervix under huge magnification and to see for any deviation from normal and to look for any changes over the cervix which can hint on being abnormal or precancerous so that from that particular abnormal sites biopsies cane taken and subjected to histopathological examination where a pathologist sees the tissue under microscope to look for any cancerous cell so as your colposcopy finding are normal your gynaec may call you repeat testing after 12months for repeat cytology hav testing if the repeat screening are negative twice then you can just follow the screening protocols routinely as other women please share the reports of your hav pap smear so that I can go through guide you through in case you any further doubts hope the information helps you have a nice day"
    },
    {
        "instruction": "hello doctor for the last three years my wife had an acute abdominal pain due to gastritis all the blood reports sonography reports ray are normal please help",
        "input": "",
        "output": "hi if it is due to gastritis you should go for endoscopy until that time you can start tablet pantakind der pantoprazole"
    },
    {
        "instruction": "hello doctor my mother is having lower hip side pain for almost a week now she is taking maintenance medicines for high blood pressure approvel and 24 units of insulin everyday what could be causing the pain and can I give her pain reliever",
        "input": "",
        "output": "hi looking into mother problem you have got both hypertension and diabetic under insulin with hip pain first of all we need to understand what is the association between the current problem and existing diseases once we understand why it is happening and try to find its link then it is easy to understand the diseases to diagnosis and help long term treatment preparation uncontrolled diabetes can affect the muscles and skeleton leading to joint pain nerve damage there is a link between diabetes arthritis and joint pain both rheumatoid arthritis ra and type diabetes are autoimmune disorders in both cases the immune system is attacking an otherwise healthy part of the body according to arthritis foundation guidelines losing 15 pounds can significantly improve the level of hip pain in a person with osteoarthritis so I would recommend to do radiography of hip joint ap lateral view to assess oa changes ra rheumatoid factor cop to assess condition of active joint inflammation and destruction I will follow up with the report"
    },
    {
        "instruction": "hi doctor I am a 20 year old male for the past seven months I have had widespread muscle twitching the most annoying ones occur in my eyelids I am diagnosed with anxiety and ocd and I took lexapro for 90 days a couple of days ago I was instructed by my doctor to stop the lexapro due to the feeling of being off balance and some minor changes to my vision I am terrified of having als amyotrophic lateral sclerosis within the past few days I have had the urge to clear my throat every few minutes I do suffer from health anxiety please help",
        "input": "",
        "output": "hi I would like to know how it started and progressed in detail how it was with the said medicine please answer a few more questions is there any weakness of hands or leg or anywhere is there any abnormal sensation or loss of sensation is there any loss of muscle mass is there difficulty in swallowing chewing in which part of the body fasciculations started and then migrated to which part or it started all over the body simultaneously do you take any cos stimulants such as coffee or any addiction or abuse of substance what were the components of blood work what is the content of medicine lexapro and how you were with lexapro in terms of fasciculations"
    },
    {
        "instruction": "hello doctor I have a black patch on my back which is almost circular and is itching constantly it has become quite big in the last three to four months can you please suggest what it could be and what I can do it feels good when I put hot water on it and it becomes very dry it has a small line on its edges the itching is happening continuously it subsides a bit when I apply moisturizer but the black patch seems to become darker",
        "input": "",
        "output": "hi can you attach the picture of the lesion for an accurate diagnosis and treatment plan please attach a picture of it"
    },
    {
        "instruction": "hello doctor for the past three months I was having a dry cough I consulted a doctor who advised me augmenting 625 my grilinctus betadine gargle and steam for five days that gave me a lot but not full relief I continued gargle and steam for some more time since then the cough is reducing but some amount of mucus remains in my throat nothing comes out but keeps giving me a feeling of something there",
        "input": "",
        "output": "hello the problem you are suffering is a viral illness that is temporary you also need to check for any triggers that cause the mucus to increase if you started with a dry cough there should be no mucus build up anymore the feeling in your throat may possibly be due to dryness of your membranes please double your water intake and you should notice a considerable change you can also take a tablet neksium 40 esomeprazole on empty stomach in the morning so that any gastric irritation can be prevented by this"
    },
    {
        "instruction": "hello doctor my year old son has been having chest pains since six months he takes medication for acid reflux anxiety and asthma currently we had a it scan done but the doctor says it should nothing to be concerned about however some of the stuff in the report I feel is of concern and I am looking for clarification on some things he is currently on omeprazole levabuterol atomoxetine flovent and guanfacine",
        "input": "",
        "output": "hello I have gone through the it report there are variations in the branching pattern but this is fine to have many individuals have such a branching pattern without any consequences slight bulging was mentioned at ramification but they also commented that it appears to be within normal limits and such slight bulging would not cause pain or would not have any consequences unless there is any obstruction within it important is that there is no obstruction or abnormal course of left coronary artery they have mentioned that the left coronary has a slightly high take off which is fine and unlikely to be responsible for symptoms or complications so as far as coronaries are concerned they are unlikely to be responsible for his symptoms and unlikely to end up in any adverse consequences now I guess he must have had an egg and echo which would give additional assurance to this now if according to symptoms they are again not classical of heart if they were cardiac then they would have certainly aggravated by activities so unlikely to be a cardiac issue now considering his reflux issue the first possibility should be considered of acid reflux and secondly of musculoskeletal even if there is no definitive demonstrable tenderness omeprazole may not be able to counteract reflux totally so it is worthwhile to try locally acting agents like syearup sucralfate and see if it helps light meals and some walking after meals locally acting agent diclofenac gel may also be tried I hope this helps"
    },
    {
        "instruction": "hello doctor I had unprotected sex last march but took emergency contraceptive afterward six days after I had the bleeding associated with the emergency contraceptive two weeks after that in the first week of april I had my period for six days my usual period lasts five to seven days in may I had five days of the period although the last two days were only very light bleeding now I was due for my period four days ago but I still have not got it what are the chances that I am pregnant and if not should I be worried about my late period",
        "input": "",
        "output": "hello firstly as you had three episodes of menstrual bleed including the withdrawal bleed post emergency contraceptive after you had intercourse in march so it is unlikely that you would be pregnant due to your sexual encounter in march as you have missed your menses now by four days and if you have been sexually active during this cycle as well then you must rule out pregnancy first with a home urine pregnancy test kit if negative then the delay is most likely stress induced and you should wait for at least five days to allow menses to start naturally if not then you would need an ultrasound pelvis to check for endometrial thickness which if more than my you can be offered a withdrawal bleed with progesterone to resume your menses"
    },
    {
        "instruction": "hello doctor few months ago I got stung by a bee in arm it is not the first time I was stung by a bee but this time 30 minutes after it happened I got swelling under my eyes on my cheeks and it was getting bigger as time passed I went to er and they gave me corticosteroids iv now I was wondering if this means I am allergic to bee stings and if in future I get stung by a bee again does it mean anaphylactic attack can develop",
        "input": "",
        "output": "hello yes that is correct it seems you are allergic to bee sting for an allergic reaction to develop initial exposure must occur in order for your body to create an immune response to it this might have happened a few months ago when you were stung before since there was already an exposure and established immune response subsequent exposure may result in allergic reaction severe allergic reaction resulting in anaphylaxis may occur but most of the time allergic reaction is mild and not life threatening symptoms such as excessive skin reactions including hives and itching and flushed or pale skin low blood pressure constriction of your airways and a swollen tongue or throat difficulty breathing weak and rapid pulse nausea vomiting or diarrhea and dizziness or fainting warrants immediate consult I hope I was able to answer your concern is there anything else I can help you with"
    },
    {
        "instruction": "hello doctor from my late teens to now I am thirty I started becoming very insecure about my face especially my side profile it is heavy thick and my mouth is more forward I was prettier as a child I want to inquire about surgeries that can be done to adjust my jaw also I seem to have some degree of overbite I do not know if it is more about the overbite or that either my maxilla or mandible are too big or forward I hate taking pictures because I always look ugly and I also have had people make comments about my forward looking mouth please help",
        "input": "",
        "output": "hello I am sorry for your suffering but the picture you sent me is not clear please send close up pictures of your front face and side face with the mouth in resting position there is a surgical treatment for this problem it is called orthognathic surgery in this procedure both the maxilla and mandible can be brought forward or pushed backward but it is important to decide which procedure is suitable for you please send me the pictures and let me help further"
    },
    {
        "instruction": "hello doctor I crunched a hard piece of ice a week ago and those few teeth left corner teeth were a bit sore since but starting sunday the pain became increasingly intense I put a solid clove in my teeth for about 30 minutes and it helped the pain but as soon as I took the clove out the pain returned this has caused disturbance in my sleep for the past few days monday majority of the tooth pain went away a few teeth still slightly hurt but not bad at all but now my entire left side of the face is swollen and it became worse overnight under the eye nose and top lip something in my gum hurts but there is no pimple or bubble there I have a slight fever but it is not bad and my left ear hurts sometimes sounds like an infection but I do not know why I want to blame this on the ice but it is odd that the prominent pain started so long after the incident how long will this continue and what is the best at home treatment should I see a dentist I have been trying to avoid it because of couid 19 is this a serious issue or did crunching the hard ice just trigger an infection somehow",
        "input": "",
        "output": "hello actually ice leads to transient sensitivity but actually has zero role upon your infection it might be a gum problem periodontitis let me know if you notice visible stain and tar on your tooth or it might be cares that leads to infection and sensitivity from the ice triggered the pain but infection was already there upload an image of the area for better perception applying clove is a good idea but chronic clove oil acts as irritant and lead to burning sensation ulceration it might add to the pain too if used for a long time please do not worry kindly answer my questions meanwhile as we all are in a lockdown state I can suggest you medication to ease your pain and manage the infection so do not worry betadine mouthwash gargle in lukewarm water 3 times a day capsule sporidex 500 my one capsule be for days tablet metrogyl 400 my tablet be for days tablet zerodol so tablet be for days capsule pan capsule be before meal for days these medication are the safest and will work like miracle but upload the image for confirming the diagnosis to prevent any future pain or discomfort cares or tar depending upon the image periodontitis irreversible pulpits cares avoid sweet or sticky or cold food items stop the application of clove maintain oral hygiene"
    },
    {
        "instruction": "hello doctor I recently fell off a roof after er visit it scans and rays I received staples in my head and was discharged prescribed cephalexin and percocets I went home for recovery two days ago while coughing I felt an excruciating pain what seemed to be under and behind my lowest rib on my right side this pain continued only when I strain myself such as with a cough or sneeze etc since beginning this pain has gotten more intense with each involuntary strain",
        "input": "",
        "output": "hello have you undergone any chest ray while coughing is there any sputum have you feeling any pain in the abdomen is there any blood in urine did you land on head or abdomen during fall if possible answer above questions please"
    },
    {
        "instruction": "hi doctor I was diagnosed with genital molluscum contagiosum about a month and a half ago I am being treated now and there are few number of bumps left less than when it first appeared there were 9 bumps I wanted to ask if this had anything to do with the hiv virus I have almost never been in a relationship without protection but that still made me worry for a while please let me know if I should panic",
        "input": "",
        "output": "hello genital molluscum is a viral infection but not caused by hiv virus it is a sexually transmitted diseases and therefore usually spread from sexual route genital molluscum is considered to be a marker of hiv infection therefore it is usually advised to rule out hiv infection in patients of genital molluscum as you are having genital molluscum does not mean that you are having hiv infection if you are practicing safe sexual practices then chances of hiv infection is minimal at least not because of sexual route but to be in safe side I will advise you to rule out hiv infection by doing hiv testing as it is considered in protocol to test for it incase of genital molluscum"
    },
    {
        "instruction": "hi I am 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 months old what should I do please response thank you",
        "input": "",
        "output": "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 ozing out of the umbilicus any time for the worm infestation please ensure that pets and domestic animals are separated from the babys 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 babys condition"
    },
    {
        "instruction": "hi I am a sped teacher and currently I am about to teach a non verbal child with down syndrome I would like to ask where to start I do not know where and how to start teaching the child most especially that today we do online sessions also it is my first time to handle a non verbal child hoping that you can answer my query thank you",
        "input": "",
        "output": ""
    },
    {
        "instruction": "when I started paroxetine paxil 20 my 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 years then disappeared I think when I started exercising it helped disappearing that last year as per my do instructions I switched to paroxetine or 25mg cause the paroxetine 20 my was out of stock for 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 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 do not 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 do not want to change meds what to do to reduce more and more any meds or supplements could be taken with the seroxat",
        "input": "",
        "output": ""
    },
    {
        "instruction": "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 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 have taken another stressam about and a half hours ago but it is not seeming to work I am afraid I might have an anxiety attack again tonight because of it I have recently been placed on acnetret for my once days ago but my do 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 or 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 do rooms are closed right now age 15 male 176 am 164 8",
        "input": "",
        "output": "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 do not 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 would not 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"
    },
    {
        "instruction": "hi I am patient of hyperthyearoid my weight was 52kg cause of hyperthyearoism but I start my medicine from and half years before and recovering from thyearoid 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 difficulties for walk and in the morning when I wake up its very difficult for heel to walk so help me for my heel pain and is it ok to walking exercise",
        "input": "",
        "output": "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 hyperthyearoidism 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 hypothyearoidism you may be gaining weight you may fail to lose weight despite ramping up exercise and reducing calories neuropathy low levels of thyearoid 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 ray of foot to see any bony spur check thyroid level tit precursor 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"
    },
    {
        "instruction": "hello doctor pain started in my back after 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 advice me to consult a neurologist as physical pain and muscle weakness is not going away",
        "input": "",
        "output": "hello I read carefully your question and reviewed your ray report your ray shows a normal vertebral column just muscle spasm 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 plasma levels and magnesium plasma levels for possible deficiency another treatment option to consider would be gabapentine or doluxetine"
    },
    {
        "instruction": "hello doctor I have white spot on my right tonsil I do not have any fever what medicine can I take",
        "input": "",
        "output": "hi it is common to have white spots over the enlarged tonsils unless the tonsil is inflamed or it is troubling you it is not required for you to take any antibiotics or painkillers you can follow the advice given below salt water gargles atleast to 10 times a day for month avoid oily spicy and cold food beverages keep sipping on boiled warm water every 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"
    },
    {
        "instruction": "hello doctor I have redness in the eyes for 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",
        "input": "",
        "output": "hello kindly attach the image of your eye for further diagnosis"
    },
    {
        "instruction": "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 5 my",
        "input": "",
        "output": "hi you need to understand first of all that every chest pain should be taken as heart problems until proved otherwise so if previously egg 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"
    },
    {
        "instruction": "hello doctor my serum creatinine is 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",
        "input": "",
        "output": "hi reviewing your presentation and details of your test attached 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 be 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 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"
    },
    {
        "instruction": "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",
        "input": "",
        "output": "hello the possible causes for loss of smell are rhinitis sinusitis ethmoidal polyps neurodegenerative diseases vitamin b12 and folic acid deficiency tumor of the cos central nervous system 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 so use salt water gargling thrice a day for five days use water vapor inhalation thrice a day for five days use decongestant like phenylephrine tablet lecope ad and anti histamines to decrease congestion avoid cool drinks and ice creams use otrivin nasal spray twice a day for five days use tablet amoxicillin and clavulanic acid 625 my twice a day for five days if symptoms are not improved please get done 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"
    },
    {
        "instruction": "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 herd 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 tantrum 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 tantrum 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",
        "input": "",
        "output": "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 pi 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"
    },
    {
        "instruction": "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 og 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 back for my sticky and slightly swollen foreskin betnovate for my rashes in my inner thighs and put me on a seven day course of amoxicillin 500 my for three days I am on day 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",
        "input": "",
        "output": "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 sad 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 sad screening which is chlamydia testing by swab taken from urethra gonorrhea testing syphilis tests trichomonas tests human papillomavirus hav herpes test hepatitis surface antigen test hepatitis 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 sad screen for both and urethral swab of the patient in case symptomatic sad sexually transmitted disease"
    },
    {
        "instruction": "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 prescription for the fertility medication there are no other issues regarding the period cycle or health",
        "input": "",
        "output": "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 thyearoid or prolactin hormone or due to a lifestyle condition like cos 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 let liver function test rat renal function test 75 glucose tolerance test fasting hour hba1c glycated hemoglobin levels serum calcium vitamin and b12 levels serum fasting and post prandial insulin levels serum fish follicle stimulating hormone oh leutinizing hormone free testosterone estradiol prolactin levels thyearoid profile to ash 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 hug hysterosalpingography tablet folic acid my daily once until you conceive reduce weight maintain menstrual cycles diary regular exercises at least hour daily dietary modifications"
    },
    {
        "instruction": "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",
        "input": "",
        "output": "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 your boil may become infected so for your boil you can take cefixime 400 my twice daily with clindamycin 300 my twice daily and apply locally topical mupirocin or bacitracin ointment on your affected area you can take vitamin supplements for quick healing and you should undergo some investigations like abc complete blood count ribs random blood sugar etc"
    },
    {
        "instruction": "hello doctor my child is one and a half month old which milk is better for him cow milk or artificial milk as breast milk is not enough",
        "input": "",
        "output": "hello please know that until the baby is months of age there is nothing better than mothers milk if you feel mothers milk is not enough there are medications to increase mothers milk has it been tried how frequent are you breastfeeding what exactly is the mothers psychological status I mean willingness to breastfeed notions about mothers 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 how frequently the baby is offered breastfeed how well the baby is sucking the milk secretion increases according to the babys demand more sucking more milk mothers diet 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 dilution before feeding please know that if a baby is given breast milk for months he she will have better immunity better mental abilities and psychological strength compared to babies fed on formula milk please do not start cows milk or buffalo milk or pasteurized milk so early"
    },
    {
        "instruction": "hi doctor recently I had rare surgery for prostate cancer my he level post surgery fell to 10 and I was advised to stay on iron supplement dexorange syearup 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 he level has improved to 12 I had a abc 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 syearup 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 pyloric have been treated and stomach lining restored currently I am taking nexpro 40 my in the empty stomach and librax once at night my abc report issued an alert for anisocytosis my amylase level is around 174 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",
        "input": "",
        "output": "hi based on your query and reports 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"
    },
    {
        "instruction": "hi doctor I do not have any health issues but my cholesterol level is high at 20 do I need to take any medicine please let me know I have attached my laboratory reports for your reference",
        "input": "",
        "output": "hi revert back with the answers to the above questions to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am a 32 year old male my height is feet and weight is 145 labs I am facing a significant unexplained weight loss of more than 45 labs in four months my normal weight since high school is 185 to 180 labs 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 and the second opinion was clearly reactive bilateral nodes seen at level and in your opinion what would be the appropriate course of action either fob 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",
        "input": "",
        "output": "hi based on your query and attached images my opinion is as follows fnb for further information consult a hematologist online"
    },
    {
        "instruction": "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 labs 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",
        "input": "",
        "output": "hello for further information consult an internal medicine physician online"
    },
    {
        "instruction": "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",
        "input": "",
        "output": "hello for better understanding I need more details from you revert back with the answers to the above questions to an endocrinologist online"
    },
    {
        "instruction": "hi doctor my brother was diagnosed to have alk positive before two years he had brain and bone metastasis he got a brain surgery war and spine radiation he was on crizotinib for 10 months and after brain and bone metastasis progression he was on ceritinib for 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 war 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",
        "input": "",
        "output": "hello I understand your plight for further information consult a medical oncologist online"
    },
    {
        "instruction": "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",
        "input": "",
        "output": "hi revert back with the reports to a cardiologist online"
    },
    {
        "instruction": "hi doctor I have chronic ankle sprains in both the ankles I have this for maybe a year now I went to it 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",
        "input": "",
        "output": "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"
    },
    {
        "instruction": "hi doctor I am 27 years old I got married before 5 years I have cos 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 years my gynecologist prescribed me dinette 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 dinette 35 will I be able to conceive naturally I am also overweight for my height my height is 3 and my weight is 75 keg I want to have a baby now and want to conceive naturally without any medical treatment is that possible",
        "input": "",
        "output": "hello it is good that you continued dinette 35 cyproterone acetate and ethinyl estradiol till date your menses would have been regular after being placed on dinette 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 or cycles remain annular after prolonged usage of dinette 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"
    },
    {
        "instruction": "hi doctor I am suffering from severe vomiting and diarrhea I vomited times in the last 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",
        "input": "",
        "output": "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"
    },
    {
        "instruction": "hi doctor my last lap was 17th as my periods delayed seven days I had a pregnancy test the beta hug value was 355 30 miu my why the value is too low than the normal range is this something to worry",
        "input": "",
        "output": "hi for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I am trying to get conceive we have tried two times but no positive result I have thyearoid but it is normal now my age is 26 and weight is 78 keg I am a little overweight for my height what is the problem please help me",
        "input": "",
        "output": "hi revert back with the report to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "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",
        "input": "",
        "output": "hi I hope you are feeling better now with regard to the pain for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "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 ith 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",
        "input": "",
        "output": "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 you need to stay informed for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "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 amnio 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",
        "input": "",
        "output": "hi first let me say that I am sorry for your wife trouble in this pregnancy for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "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 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",
        "input": "",
        "output": "hi your vitamin levels thyearoid 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"
    },
    {
        "instruction": "hi doctor my wife is 45 years old since last month she has had continuous abnormal vaginal bleeding she has been prescribed by doctor devilry 10 my twice a day even after one week of medication no improvement has been seen please help",
        "input": "",
        "output": "hi I totally understand your situation for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hello doctor I have had every sad 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 ago pills yeast infection drugs ti drugs",
        "input": "",
        "output": "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 to 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"
    },
    {
        "instruction": "hi doctor I have attached an ray report of my year old baby girl the report was ill defined laziness 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 ray was suggested and the consulting doctor is out of town for the next two days what should be done next",
        "input": "",
        "output": "hello I understand your concern mantoux test complete blood count gastric aspirate for aft acid fast bacilli an antibiotic should be given for seven days revert back with the answers to the above questions to a paediatrician online"
    },
    {
        "instruction": "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 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",
        "input": "",
        "output": "hello strenuous activities 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"
    },
    {
        "instruction": "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 cab only solution or partial tenting may work or is it fine to give only the medication as there are not much clinical symptoms his tit was strongly positive he is a smoker and also takes alcohol he is a blood pressure patient and takes amlopress thelma and ecosprin",
        "input": "",
        "output": "hi I have carefully reviewed your health query and feel sorry for your father 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 cab 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 cab right away for further information consult a cardiologist online"
    },
    {
        "instruction": "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",
        "input": "",
        "output": "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 go or family doctor you will need to undergo an egg 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 egg observations heart rate and be and blood glucose cardiogenic arrhythmia presyncope 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"
    },
    {
        "instruction": "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 thelma 40 and ecosprin 150 regularly because four years back he had a paralysis attack",
        "input": "",
        "output": "hello I have gone through the mri report enclosed by you degenerative condition or post injury as per clinical examination for further information consult an orthopaedician and traumatologist online"
    },
    {
        "instruction": "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",
        "input": "",
        "output": "hello I can understand your concern revert back with the answers to the above question to an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor I had my kidney transplant two months ago now I am suffering from piles can you suggest me some medicine",
        "input": "",
        "output": "hi revert back with the answers to the above questions to a nephrologist online"
    },
    {
        "instruction": "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",
        "input": "",
        "output": "hello welcome to icliniq com what are your symptoms exactly if they are of depression then the treatment with an sari 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"
    },
    {
        "instruction": "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 16 bpm be 164 102 mhg respiratory rate 18 weight 247 labs 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",
        "input": "",
        "output": "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 will supply blood to all parts of the body due to age related atherosclerosis dyslipidemia and hypertension aggravate it"
    },
    {
        "instruction": "hello doctor I am 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",
        "input": "",
        "output": "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 to 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"
    },
    {
        "instruction": "hello doctor I am a 27 year old female I have severe headaches for the past two days with loss appetite nausea fever diarrhea and stomach cramps I am taking paracetamol for my problems please help",
        "input": "",
        "output": "hi let me tell you that the symptoms described by you suggest that you have acute gastroenteritis I suggest antibiotic metronidazole 400 my three times a day for five days and continue paracetamol for pain and fever management avoid taking non asteroidal 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"
    },
    {
        "instruction": "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",
        "input": "",
        "output": "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 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 tablet sinarest paracetamol phenylephrine hydrochloride chlorpheniramine maleate one tablet twice daily after food 12 hours apart for 15 days tablet allegra fexofenadine and montelukast one tablet twice daily after food 12 hours apart for 15 days tablet zerodol the aceclofenac and thiocolchicoside 4mg or its equivalent one tablet twice daily after food for five days tablet clarithromycin 500 my one tablet twice daily after food 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 tablet mucomix 600 my acetylcysteine one tablet twice daily for week tablet wysolone prednisolone 10 my one tablet after breakfast for 10 days steam inhalation to times a day 10 saltwater gargles at to 10 times a day for one month 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 it 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"
    },
    {
        "instruction": "hello doctor I have jaundice my biliurubin was 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 it 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",
        "input": "",
        "output": "hello well your us ultrasound and it 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 epstein bar virus cytomegalovirus non viral causes are wilson hemochromatosis alpha trypsin deficiency the causes of predominantly raised bilirubin jaundice with normal it scan suggest microscopic primary sclerosing cholangitis primary biliary cholangitis benign and progressive familial intrahepatic cholestasis the hematologist 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 hematologist 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"
    },
    {
        "instruction": "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 occurring for 24 hours",
        "input": "",
        "output": "hello I need to know whether the loose stools are really having organic cause or just secondary to functional changes occurring with time of periods loose stools are said when stool volume is more than 200 my 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 or in one liter of water and take 200 my to 300 my 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"
    },
    {
        "instruction": "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 decloyearan 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",
        "input": "",
        "output": "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 my 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 hours and then starts settling in next to 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 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 my 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"
    },
    {
        "instruction": "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",
        "input": "",
        "output": "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 severe please rate the severity from to 10 where 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 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 migraine or cluster headache and it is curable degenerative spinal disease rarely cause headache and in your husband case it is not the cause"
    },
    {
        "instruction": "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",
        "input": "",
        "output": "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 corticosteroids tablets in the dose of my for each keg of your body weight daily for example if you are 70 keg you need 70 my of corticosteroids per day for 10 days the most popular corticosteroids is called prednisone tablets chewing gum will be useful for you"
    },
    {
        "instruction": "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",
        "input": "",
        "output": "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 thyearoid 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"
    },
    {
        "instruction": "hi doctor I am 13 years old I have been curious about puberty and height I am currently feet 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 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 5 inches erect and inches flaccid I have attached a photo I wear a shoe size of how tall can I expect to be and how far into puberty really am I also have hairy parents",
        "input": "",
        "output": "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 everybodys 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 5 inches to your height"
    },
    {
        "instruction": "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",
        "input": "",
        "output": "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 paragon forte chlorzoxazone 500 my 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"
    },
    {
        "instruction": "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 peyearonie however in peyearonie 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",
        "input": "",
        "output": "hi after reviewing your history it seems to me peyearonies disease but I need pictures flaccid partial and complete erection from you to confirm it presentation is secondary to fibrosis in tunic 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"
    },
    {
        "instruction": "hello doctor I am 34 years old my lipid profile shows total cholesterol 154 my dl hel 26 my dl lil 67 my dl triglyceride 298 my dl fbi is 95mg dl and ribs 132 my dl blood pressure 146 82 mhg can I use the cholesterol medicine for triglycerides",
        "input": "",
        "output": "hi I can understand your concern according to your statement you have been suffering from back pain and hypertriglyceridemia with low hel 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 fatty acid for your low hel 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 supplements so you can continue the medications as follows capsule lofibra fenofibrate 200 my 1 after meal tablet naprosyn 500 my 0 after meal for 10 days tablet lioresal baclofen 10 my 0 for one month tablet carbocal 400 1 for two months capsule bio marine omega and fish oil 1 continue tablet prevacid lansoprazole 30 my 0 before meal for one month"
    },
    {
        "instruction": "hello doctor my 40 day old son left tests is undescended sonography shows his tests on the upper end of the inguinal canal please suggest whether it will come down naturally",
        "input": "",
        "output": "hi according to the report you have sent the child has left sided undescended tests it is a common practice to wait until the baby is six months old before operating there is a small chance that the tests might descend on its own by six months they usually do not descend after six months and also the risk of that tests becoming nonfunctional if waited beyond six months is high another thing is there is a small risk of that tests 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 months of age"
    },
    {
        "instruction": "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",
        "input": "",
        "output": "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 my 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 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 ash thyearoid stimulating hormone start capsule esomeprazole 40 my half an hour before meals once daily for now follow up after investigation"
    },
    {
        "instruction": "hello doctor I am 39 years old recently I have done some health check ups the report shows my lil cholesterol is 140 triglycerides 165 hel 30 should I take any medicine or should I start walking or exercise my vitamin level is 20 15 what medicine should I take for my low levels of vitamin",
        "input": "",
        "output": "hello I have gone through your reports your lipid profile and liver enzyme alt are deranged and vitamin is low for low vitamin you should have tablet prise do or calcirol sachet 60 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 lil 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 my bedtime once daily for six to eight weeks I hope this helps"
    },
    {
        "instruction": "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 6 years how do I improve my gut health and does it have anything to do with my sudden skin problems",
        "input": "",
        "output": "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 canna 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"
    },
    {
        "instruction": "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 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",
        "input": "",
        "output": "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"
    },
    {
        "instruction": "hello doctor I am 24 years old last month I had a motorcycle accident I did an 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",
        "input": "",
        "output": "hello looking into your ray pictures 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 ray around in four weeks and then in six weeks and see the final callus formation and healing"
    },
    {
        "instruction": "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 years prescribed medicine also used it had been 20 year of not using any medicine and treatment since my birth I had not my mother love and care now I want to get her treatment her condition right now she is healthy do not remember anyone quiet calm sometimes do whatever we told is there any chance to recover please give me some advice as I do not know what to do",
        "input": "",
        "output": "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 cannot suggest exactly what needs to be done but I will explain how it works the fact that you mentioned that she does not remember anyone could be a part of dementia for which you would require a neurologist medications can help to an extent psychosis or depression can have such reactions you will require a psychiatrist for this a complete evaluation is required the doctor might do a it 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 old 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"
    },
    {
        "instruction": "i am 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 ray I am having pain now again in that jaw after months what should I do due to couid 19 I am not sure I should visit a dentist",
        "input": "",
        "output": "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 7 times daily if the pain does not subside you can take painkiller tab ibuprofen 400mg two times daily for 3 days after meal please send me the pictures for proper diagnosis and better treatment plan thank you for contacting us"
    },
    {
        "instruction": "hello doctor I have back pain tiredness more sleepy feeling and inflammation on the foot",
        "input": "",
        "output": "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 result and found that your vitamin do level is below normal get gamma glutamyl transferase level slightly high hel high dentist lipoprotein level below normal to thyearoglobulin and vldl very density lipoprotein level significantly high ash thyearoid stimulating hormone level normal at the upper limit total leukocyte 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 do deficiency clinical features of vitamin do deficiency are repeated infections tiredness back pain depression bone pain muscle pain fatigue delayed wound healing feeling sleepy etc again high to 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 ash level is normal at a higher limit so you should repeat the thyearoid function test within three months for your vitamin do deficiency you should need more exposure to sunlight for vitamin do synthesis as well as take vitamin do enriched foods and supplements for your high to level you should continue fenofibrate along with omega fatty acid for low hel 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"
    },
    {
        "instruction": "hello doctor I am a 21 year old male I have thinning hair and was planning of preventing through medication I was planning on taking finasteride",
        "input": "",
        "output": "hi from the information given it seems you are experiencing the early signs of male pattern hair loss this is a very common condition and there are many factors responsible one of them being genetic due to the effect of the male hormone on the hair cycle over a period of time the hair follicle starts shrinking and so the hair which comes out is thinner and more fragile and breaks easily also the growing phase of the hair is shortened so your hair does not grow as long it used to and becomes shorter and wispier there are several treatment options available and the sooner we start the treatment the better the chances of reducing further hair loss thinning and increasing regrowth a combination of oral supplements to boost hair growth along with the application of lotions containing minoxidil to begin with will be the best course of action in my opinion oral finasteride which is the male hormone blocker is used frequently applications with finasteride are available too this will be prescribed by your treating doctor after assessing the extent of thinning and discussing the side effects etc several preparations of biopeptides and other natural ingredients like saw palmetto extract melatonin etc are also available to boost hair growth pop platelet rich plasma is a popular procedure that is often used in combination with medical treatment to stimulate hair growth further usually a combination of treatments is suggested after the clinical evaluation but using the applications regularly is the key to good results hair regrowth takes a few months to show and you will have to be patient to see the benefit of treatment I hope this helps"
    },
    {
        "instruction": "hello doctor I have multiple conditions going on right now and fear that it could be a parasitic condition and need some expert advice started off with a terrible skin rash that has large and small lesions but no itch next a pretty substantial ear infection with swelling and discharge now the infection seems to be in my eye were small whitish yellow things were coming out from under my eyelid from last evening I have begun to inspect my mucus as it appears to have the same particles I am very scared at this point and I appreciate anything you can offer",
        "input": "",
        "output": "hi I can understand your concern according to your statement you have been suffering from skin rash without itching ear infection with swelling and discharge eye infection with coming out of something whitish yellow under eyelid and mucus with the same particles all these sufferings may happen due to parasitic infestation that is your assumption I have gone through your case several times and I think that all your sufferings may result from any infection due to any cause or allergies your skin rash may develop from any kind of allergies like food allergy drug reaction or allergy dust or mite allergy then you developed an ear infection which may be due to bacterial cause after that you may suffer from conjunctivitis which is easy to catch through touching you may get conjunctivitis by touching your infected hand that had touched your ear in conjunctivitis whitish yellow discharge may come out under eyelid you can use an antibacterial drop on your affected ear and eye with antihistamine along with or without broad spectrum antibiotics orally but in the case of viral infection these medications do not work wash your eye with water regularly and before touching any part of the body wash your hands with soap or sanitizer I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 19 year old college student I have been diagnosed with depression two years ago and I have been taking sertraline ever since my mental health is a mess right now I think I have restless leg syndrome and I always have the urge to move my feet and legs especially when I am lying down also I have been dissociating every once in a while real life feels like a dream and I sometimes cannot recognize my own face in the mirror but here is what really bothers me the intrusive thought of death that cannot leave me at all I close my eyes and see horrible images and think about death and visualize my loved ones dying I have also been having recurring nightmares almost daily really disturbing and often death I also tend to worry a lot about my loved ones and always feel the need to check up on them it became like an obsession and I fear losing control and losing stuff I have a lot of doubt about my spiritual and religious life in total I am really anxious and distressed I now have heavy heartache feeling and I tend to clench my jaws and fists I also suffer from a restless sleep please help",
        "input": "",
        "output": "hi I have gone through your concern and it seems that you have an obsession and your restless leg can be due to iron deficiency or it may be due to sertraline so check out your hemoglobin and complete blood count to rule out iron deficiency anemia restless leg can be managed by adding pramipexole or gabapentin tablet you did not mention about the doses of sertraline if required its dose can be up or downed to manage depression avoid coffee or tea maintain a diary of your symptoms do regular exercise take a healthy diet I hope this helps"
    },
    {
        "instruction": "hello doctor recently the last week at the most my lymph nodes in my neck have been very swollen when looking at the back of my throat I can see small tonsil stones small but many there is swelling which I am hoping is associated with the stones and there is a lot of swelling at the top of my right tonsil the right side of my tonsil definitely is sore but fluctuates throughout the day I have used tobacco products fairly consistently for the last two years smoking at most a cigarette per day and vaping there are also flesh colored bumps on the back of my mouth on the left side they are not painful though there is one on the top and one down by the tongue I have not noticed these previously my depression sometimes affects my hygiene so I am hoping that this could be the cause of the stones I have been brushing twice a day flossing gargling with salt water and mouth wash since doing this I have noticed much less swelling in my lymph nodes and a little less in my tonsils my diet also has not been the healthiest lately eating about one meal a day and my sleep schedule has been a wreck I am just really hoping it is not cancer but I have yet to go see a doctor",
        "input": "",
        "output": "hi I can understand your concern according to your statement you have been suffering from swelling of lymph nodes on the neck with swelling of tonsil and sore throat you lead an erratic life you are a smoker you do not maintain your oral hygiene regularly you also do not take your meal regularly your presenting clinical features can result from strep throat peritonsillar abscess tonsilloliths tonsil stone tonsillitis non hodgkin lymphoma or carcinoma etc according to your picture that is provided here you may suffer from tonsil stone or peritonsillar abscess in both cases treatment are almost the same you should take a broad spectrum antibiotic for 10 days with gargle with salt mixed warm water mouth wash apple cider vinegar and brush regularly usually tonsil stones dislodge themselves over time if the clinical features such as difficulty in deglutition difficulty in breathing difficulty during sleeping pain radiating to ear etc occur consider as a medical emergency and consult with an ent specialist for tonsillectomy you should observe your lymph nodes carefully any sudden change in size or shape of lymph node high fever weight loss night sweating persistent fatigue respiratory distress etc should be considered as alarming signs for carcinoma so do not be worried take balanced food and maintain oral hygiene strictly"
    },
    {
        "instruction": "hello doctor I have taken meningitis vaccination for visa process I suffered headache with visual aura with dreamy sleep and less sleep for three months I started treatment in india and took cipralex and escitalopram it scan was normal my symptoms relieved for about 80 90 I gradually tapered off the treatment later mild dreamy sleep problem with mild and sound sensitivity occurs I did not took any medicine for that I also suffered from scalp pain in head and treated for three months with phenergan and neocalm plus I felt only temporary relief mri was done in consultation with neurologist results are normal I was on cipralex 10 my naproxen sodium 250 my then gradually tapered after that I am suffering from dreamy sleep all day and localized head pain episodes 3 times in a week when sleep disturbed in the previous night meanwhile I was heavily stressed due to family issues and job pressure once again I was prescribed the same medicines but I did not take and tried to control it with yoga and meditation I have mild light and sound sensitivity which is quite tolerable my major problem is disturbed dreamy sleep and episodes of localized head pain in the scalp only I took vitamin b12 calcium for six months my elevated triglycerides are due to sari 230 my dl at present I am alright but want to get rid of symptoms my symptoms are muscle tension and nerve pain I did eyes test oct and my eyes are normal my questions are even if I am not stressed I do not get dreamless and refreshing sleep why which is suitable medicine in general can flunarizine cause more deficiency of calcium as already I am deficient cipralex and esclitopram are habit forming but I was very comfortable with that it causes weight gain and elevation of triglycerides so I tapered off to end but after some time dreamy sleep and scalp mild pain comes back what to do kindly suggest and advise some medicines",
        "input": "",
        "output": "hello your symptoms seem to be related to tension type headache which is a benign headache light and sound intolerance are features of migraine but the other symptoms you explain are more compatible with tension type headache nevertheless I agree with your doctor treatment regarding escitalopram you should know that the sleep disorders are related to different causes depression daily stress and anxiety vitamin deficiency an abnormal sleep regime caffeine intake etc I would recommend taking vitamin if there is low plasma levels of this vitamin regarding your sleep disorder I would recommend starting zolpidem for a couple of weeks 10 my before sleep you can try half a tablet before going to 10 my melatonin intake can regulate your sleep rhythms too but it is taken for a more prolonged time than zolpidem and its effects are lower a good sleeping hygiene sleep always at the same time avoid straining physical or emotional activities before sleep avoid caffeine intake would help too if all these tips and drugs are not helpful a prolonged brain eg electroencephalogram during sleep would help diagnose any possible sleeping disorders regarding flunarizine I would explain that this is a calcium channel blocker and as such it can interact with calcium or vitamin in high amounts but usually it does not affect the calcium levels you can try taking escitalopram for three months initially and then try flunarizine if no good results on escitalopram I would not recommend taking them both initially you should know that escitalopram achieves its effect after three weeks from the starting and the main changes to be seen are a reduce in the frequency of headaches and also mood changes optimism you can try taking amitriptyline too if you do not have any symptoms relief after the first month on escitalopram it can be really helpful with the sleep too all the drugs have some adverse effects but the benefits are higher I hope this helps"
    },
    {
        "instruction": "for the last one month I am having gastric issue as I feel that some thing got sticking in my chest or stomach and have acidic feeling in throat more over constant air get passes through my mouth but nothing relaxation at all got heavy chest pain on left side during the period my digestion process also get disturb as stool didnot come properly",
        "input": "",
        "output": "hello I welcome you to icliniq well it seems you have gastroesophageal reflux herd you acid symptoms can be defined by presence of herd I hope this will help you come back to discuss if any more concern you have good day herd nothing for now motility disorders nerd herd as above follow up in week to inform how you respond to treatment"
    },
    {
        "instruction": "hi doctor I searched the symptoms of social anxiety online and I think I have it I am a student and it has been affecting my daily life especially my school life I struggle to have new friends and do tasks that require social interaction like class presentations I tried changing my behavior tried making new friends talk to people but it only ended up in vain I thought that if I cannot change myself now what about the future I worry that social anxiety will be a hindrance of achieving my dreams if I am not going to be successful in life I might as well end this now to not be a burden to the people around me but I hope that is not the only solution doc please help me",
        "input": "",
        "output": "hello thank you for your query this is very common and about 10 15 percent of people have this problem it is also very easily treatable you will need to visit a psychiatrist and he will prescribe you sari type of medicines such as escitalopram 10mg or fluoxetine 20mg etc which will help with your problem it basically happens when some neurotransmitters such as serotonin reduce in your brain leading to a problem with handling the day to day stresses of life medicines are usually given for 4 months and then tapered off slowly and stopped in addition to the medicines you can also undergo a few sessions of cognitive behavioral therapy from a clinical psychologist also do consider doing deep breathing exercises or progressive muscle relaxation daily escitalopram 10mg once at night for 30 days"
    },
    {
        "instruction": "hello doctor my wife has arthritis and has become very weak over the last few months now she has a condition that is more or less like raynaud phenomenon her fingers are turning pale violet and one of the fingers had gangrene like occurrence not only hands but even the toes are experiencing the same please help",
        "input": "",
        "output": "hello you are right in saying that she has the symptoms of raynaud with digital gangrene which is on going with arthritis there are 50 variants of it and it is very important to distinguish which one she has it as the management will differ for every arthritis I would like to ask a few more queries any history of oral ulcers hairfall any history of fever which joints are affected swelling in the joints any deformity any changes in skin color or skin becoming tightened any history of dry eyes or dry mouth any muscle weakness which you have observed with the start of raynaud it seems like a systemic involvement more something like lupus but we need to rule it out kindly let me know these queries and I am advising a few tests if they have been done please attach the reports as well abc complete blood count ear erythrocyte sedimentation rate cop reactive protein rheumatoid factor anti cop antibody a na by immunofloroscence serum creatinine urine routine connective tissue disease"
    },
    {
        "instruction": "hi doctor I am 25 years old I am having weak erections for two months I think it is because of more masturbation so I stopped doing it since 35 days but still I am not having erections I am also having a prominent vein on the top and either side of the penis even when flaccid I do not smoke or drink I exercise regularly I am worried now please help",
        "input": "",
        "output": "hi according to your history it looks like you have psychogenic erectile dysfunction stopping masturbation would not help the best would be to start a short course of medicines and take cognitive behavioral therapy to reduce the anxiety which has caused this problem the vein in the picture looks absolutely normal and it is in fact a sign of a healthy penis remember it is temporary and most men face this issue sometimes maintain a healthy lifestyle and sleep for seven to eight hours at a stretch use lavender aroma in your house which helps reduce your anxiety"
    },
    {
        "instruction": "hello doctor I have an ear infection on my right ear for the past one week so my doctor prescribes me some antibiotics amoxicillin with prednisolone but my tinnitus did not go away how long will it take for the tinnitus to go away if there is no pain in my ear",
        "input": "",
        "output": "hi the answer to your question entirely depends on how you developed the ear infection in the first place in general until the eardrum heals you will be having weird noises tinnitus and ear discomfort due to interference with sound transmission and processing if the ear infection has happened secondary to recurrent allergy or cold then you will have probably developed a eustachian tube catarrh due to which the fluid is still present in the middle ear causing the tinnitus and will take around two months approximately in to for tinnitus to resolve if the ear infection has occurred due to trauma by earbuds etc the tinnitus will take approximately four to six weeks as this the average time it takes to heal the ear drum I am sure you fall into one of the two possibilities mentioned above there is absolutely nothing that you need to worry about as this usually takes a while for things to normalize at the same time make sure there are no triggering factors out there some one they include use of earphones headphones exposure to loud sounds consumption of alcohol smoking stress etc try to maintain a healthy lifestyle as much as possible and do not think too much about the tinnitus nor try to google about it too much I hope this helps"
    },
    {
        "instruction": "i having prblm of piles without any lump only mild bleeding at the time of defecation which is seen on the toilet paper only while wiping there is no bleeding seen in the stool sometimes constipation is there but motions not hard facing this prblm from last months I mean it happens to times in last months sharp pain only at the time of defecation after that no pain but the prblm is that it reoccurs in 2 months rat now I taking arshkalp vat one tablet twice in a day and abhyarishta along with alma juice in the ming empty stomach from last 20 days and feeling relief no pain no bleeding after one day of taking these medicines but I afraid it comes back when I stop taking them these medicines safe for long term use how much time does it take to get rid of this prblm from these ayurvedic medicines and the duration of these medicines ply guide",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello doctor I have rashes on my inner thighs they are itchy and have infected areas of dark color there is no pus but just itchiness",
        "input": "",
        "output": "hi it seems the rash and itching on the inner thighs could probably be due to a fungal infection of the skin this is very common especially in tropical countries and more so in the hot humid summers to accurately diagnose the same further information like images of the affected area total duration of the rash any other areas affected any discoloration of nails etc are needed if it is indeed a fungal infection the following can be kept in mind treatment of fungal infections includes applications which contain ketoconazole sertaconazole luliconazole etc oral antifungal like terbinafine and itraconazole are often used in combination for better clearance and reducing recurrence local hygiene is very important taking bath daily drying the skin folds after bath keeping soap and towels separate and drying your clothes in sunlight and ironing them before wearing will help to kill the fungal spores so I will recommend evaluation by a dermatologist to decide on the treatment I hope this helps"
    },
    {
        "instruction": "hello doctor I have been having consistently a very low resting pulse between 50 and 58 and I do not know if this is a sign of a problem I do not have any other issues besides nausea sometimes I am 39 years old and overweight mi 32 should I be worried",
        "input": "",
        "output": "hello this resting pulse is perfectly normal in healthy peoples this pulse will rise once you exert rise in heart rate with exercise and fall during rest is a normal phenomenon that is controlled by our autonomic nervous system in healthy persons it even falls in 40s during sleep so nothing to worry the only thing that I would like to ask you is whether you have any symptoms such as dizziness during low pulse rate another thing is egg electrocardiogram I want to see your egg to see whether it is a sinus rhythm or is there any block as your cardiac workup is done and is normal I do not think you need any more work up but if there are occasional symptoms associated with low pulse rate as graying of vision dizziness etc I would advise you to have a hotter monitoring done for 24 to 48 hours to see rise and fall of heart rate during daily activities including sleep if you have no symptoms just relax and do not worry"
    },
    {
        "instruction": "hello doctor I am a 35 year old male I am concerned about the amount of precum when aroused from my understanding a teaspoon full would be normal I have probably four times more it is disturbing and I would like to reduce it via medication",
        "input": "",
        "output": "hi welcome to icliniq com precum is the fluid coming naturally out before ejaculation its function mainly is to lubricate during intercourse it man contain sperms as well this fluid comes naturally and it is good for us actually and the amount will vary with age and sexual desire there are medications to reduce it but I do not advise you to take it as those medications are also reducing sexual drive other way if it really disturbs you during sexual intercourse then you can masturbate before intercourse to remind you this precum can contain sperms so if you intend for pregnancy then you have to do protected intercourse I hope this helps"
    },
    {
        "instruction": "hello doctor I have seronegative inflammatory arthritis with ana positive joint pain especially at right knee shoulder joints map ip joints unbearable in the night for the last three months relieved with said non steroidal anti inflammatory drugs patient cannot walk chairbound with in situ catheters for more than four years I am taking ultracet if pain unbearable few days back I have taken injection kenacort 60 my im on the advice of rheumatologist with some relief but again pain resurfaced apart from that patient is on apixaben 5 daily mirabeg 50 soliton 20 and donezepil vitamin go daily no be and do issue I am taking inhaler lab with corticosteroids for long",
        "input": "",
        "output": "hello I have gone through your reports and history there seems to be some inflammation going on in the blood reports and with a diagnosis of previous arthritis it looks like it is coming back again does rheumatologist did not want to start on methotrexate or any other dmard are you not on any medications for the ca prostate any other symptoms of oral ulcers dry eyes or dry mouth do let me know these queries and I would advise you further"
    },
    {
        "instruction": "hello doctor I am a 31 year old male who until recently weighed about 100 keg for the last six months to a year I was obsessively performing a valsalva maneuver because I had health anxiety and ocd and I was worried about an operation when I was younger I could have impacted my continence I have been having some gi issues lately and read that you can cause a hiatal hernia from chronic straining is it possible that I could have caused a hiatal hernia at my age are six months to a year chronic enough if I have caused a hiatal hernia will it stay forever or can I reduce it and the hernia size through exercise to tone and strengthen the diaphragm and weight loss I am extremely worried I have caused a hernia and will have to live with it forever I have had a standard ray of the chest which came back normal could a hernia have been missed",
        "input": "",
        "output": "hello I can very well understand your concern and at the start I want to tell you that chronic straining does not lead to the development of hiatus hernia however your weight can hiatus hernia is an anatomical change that can present since birth and after certain surgical procedures over abdomen or diaphragm overweight to obese can develop hiatus hernia because of the excessive pressure over the stomach from belly fat causing upward lifting of the lower part of food pipe and formation of hernia and lastly due to the old age when the diaphragmatic muscle gets weakened allowing part of the lower esophagus to get pulled in the lower part of the chest in a young healthy people diaphragmatic muscle is strong enough to prevent this from happening valsalva maneuver if performed vigorously can cause tears in the lower part of the esophagus which is an acute complication of this but it will not alter the anatomy or produce a hiatus hernia valsalva can harm somebody if it is done without a reason there are certain indications for medical conditions but it can only cause damage to the lower part of the esophagus acutely but would not alter the anatomy of it I hiatus hernia yes an ray plain without contrast can easily miss a hiatus hernia a special ray with contrast named barium is swallowed and serial ray images from the chest are taken that can diagnose the hiatus hernia instantly however a plain chest ray cannot detect the presence of hiatus hernia so now coming to your second concern that you have to live with it well it is not yet proven that you have a hiatus hernia secondly it is not uncommon to have hiatus hernia in people without any symptoms and it can remain undiagnosed until their whole life the point is it can present harmlessly in human for years and years and does not necessitate any investigations the time to develop a hiatus hernia is variable but it does take many years of overweight to cause hiatus hernia very less likely within to 12 months time it is not a rule that every hiatus hernia would cause symptoms or disease or any complications I would not suggest you even to worry about it and get tested for it because it would not change anything for you simple exercises keeping a healthy lifestyle reduce weight are all that is required the weight loss is very compulsory this will not only help you preventing hiatus hernia but also other things like gastroesophageal reflux herd bloating gas distention constipation I hope this helps overweight barium swallow if worried about it or have symptoms suggestive of gastroesophageal reflux weight reduction follow up to discuss if any concern"
    },
    {
        "instruction": "hello doctor I have a 30 year old male I am feet and inches with 75 keg weight I had difficulty initiating urination and also had a case of erectile dysfunction the problem with starting urination was many years ago which I ignored because I thought it would go away normally I only recently found out about my ed a few months ago I have no problem while masturbating after visiting a urologist they asked me to take several tests reports attached below the report showed that I had a case of chronic prostatitis with a bacterial infection I was asked to take medication for two weeks antibiotics and then supplements for three months I have taken the antibiotics for another two weeks I have not been able to go for another checkup due to lockdown I took hippo azithromycin and panto pantoprazole supplements I took recital care neuro care caldoz lovaza and cholecalciferol capsules dv 60k the doctor also suggested me to exercise maintain nutritious diet and take vitamins for the ed I have taken two doses of edsave 10 my tablets for two weeks this helps with strong erections I still feel that the medication has not fully worked because I need to wait for some time to start urinating I have attached all my reports",
        "input": "",
        "output": "hello one thing you have not tried yet is tablet alfuzosin 10 my for two weeks you can try this I think your flow will become better"
    },
    {
        "instruction": "hello doctor I am years 175 am 72 keg I have diabetes from 2009 and hypothyearoid from 2011 I am taking janumet 50 500 be and thyearonorm 75 od my blood sugar is 105 hba1c 7 ash is1 93 and he is 9 my lipid profile is normal serum creatinine is 16 my diabetes has been under control by medicines since inception my be is 125 82 mhg temperature is 98 f sometime I feel cold in my toes even when my feet are sweating can you suggest some remedies",
        "input": "",
        "output": "hi hba1c glycated hemoglobin is still on the higher side it should be below to be normal do regular testing of fbi fasting blood sugar pubs postprandial blood sugar to monitor the blood sugar levels coldness in feet can be due to less blood supply to feet that can happen in case of any clot in blood vessels peripheral neuropathy is also common in diabetes which can lead to less sensation in feet I would suggest you undergo color doppler leg to rule out any clot tablet gabapentin once daily you can start along with previous medicines"
    },
    {
        "instruction": "hello doctor I need help regarding with some circle bump appearing on my left buttocks it is so very itchy and sore I just bought antifungal cream and antifungal soap over the counter but I still want to know what really is this appearing on my buttocks I did take some pictures of it so I can send it over here please give me prescription of what medicines needs to make it disappear and heal",
        "input": "",
        "output": "hi I can understand your concern according to your statement you have been suffering from red colored circular bumps on your left buttock which are very itchy and sore according to the pictures that are provided here I think you are suffering from folliculitis they are developed when hair follicles become infected due to bacterial infections like staphylococcus aureus or friction or shaving they may be caused by viral or yeast infections too initially folliculitis may look like rashes a patch of small red bumps that are very itchy with sore and form whiteheads overtime they can spread and progress to crusty sores you can take flucloxacillin 500 my four times daily for 10 days by applying antibacterial cream on your affected area along with your current medications you can apply topical steroid cream too wash your affected area daily with antibacterial soap and wear loose clothing along with maintaining personal hygiene"
    },
    {
        "instruction": "hello doctor I am a male 43 year old I have redness on the inside of the penis foreskin and burning sensation on a small part of the penis prepuce I had a similar condition about four years back and consulted a skin specialist and got cured I was recommended some medicine and pyearimon eye drops for the problem again I think a similar condition I want to consult for treatment of late I see some redness remains at a particular spot on the inside of the penis foreskin",
        "input": "",
        "output": "hi if possible provide me photographs of the affected areas which will help me for a better understanding of your skin problem and proper treatment plan"
    },
    {
        "instruction": "hello doctor I have pain in left buttock and sore left leg after walking please review my ultrasound report I am currently on cholesterol aspirin and blood pressure",
        "input": "",
        "output": "hello I have seen the report it has occluded posterior tibial artery which is the cause of pain in the leg after walking also there is a possible stenosis or block of the stent in common iliac vessels which is the possible cause of limping doppler or duplex report is just a suggestion to confirm the above mentioned finding it computed tomography angiography of the lower limb is mandatory continue the same treatment I will advise you one more drug to start please go through it angiography so further management decisions can be planned I hope this helps it angiography bilateral lower limb"
    },
    {
        "instruction": "hello doctor I am having pain at my back neck since morning and could not even move my neck years ago I had same mri showed disc bulge at c3 c4 and c6 c7 is causing thecar indentation central disc protrusion at c4 c5 and c5 c6 is causing thecar indentation",
        "input": "",
        "output": "hello looking into your problem you had chronic neck pain I should say and you are struggling with it since long time years mri from the past is showing that there is problem from c3 5 7 but major level that is producing pressure symptom in your spinal nerve is c4 and 6 has central disc protrusion I would love to see that film that gives us real guide how to produce and plan for surgical treatment best option is endoscopic cervical disscetomy at two level 5 and 6 and if either go acdf a interior cervical dissectomy and fusion but today you got again back pain and spasm of neck muscle meanwhile I would suggest to take muscle relaxants and neuroleptic drug and cervical traction you can do cervical traction at home and everyday do cervical traction exercise which will prevent spasm of neck muscles drugs for you capsules gabapentin actavis 300 my po after food twice daily for one week tablet chlorzoxazone 500 my three times a day for one week"
    },
    {
        "instruction": "hello doctor is there anyway that a it scan can determine whether an enlarged lymph node is benign or malignant",
        "input": "",
        "output": "hi it is a structural imaging method that relies on assessment of lymphnodes lens based on their anatomy viz size shape margins and enhancement patterns among these size is still the most common criterion a short axis diameter of more than am is generally accepted as a threshold for malignancy in most studies however the diagnostic sensitivity of this standard is weakened by the fact that many a times malignant lens can be normal in size false negative and many invective nodes can be enlarged in size thus giving false positive results on imaging nowadays it is combined with pet positron emission tomography to get both anatomical and functional information it is called fusion imaging and is mainly used to diagnose and stage metastatic cancers such as lymphomas it also uses ionizing radiation rays that is another disadvantage which needs to be considered so to sum it all structural imaging methods such as ultrasound it conventional mri do not distinguish benign lens from malignant ones with 100 accuracy conversely functional imaging methods such as dwi diffusion weighted pet have low spatial resolution and are time consuming therefore now we are seeing a shift towards fusion imaging techniques such as dwi t2w1 mri pet it etc as these techniques bypass the above mentioned shortcomings"
    },
    {
        "instruction": "symptom of numbness in the face and ear area started and spreading begins two days after inflammation in the tooth area numbness and itchy in the face area and occasionally in the body started like some insect or fly was on my skin when I touch it I realized it is just me and symptom turn into numbness dentist was schedule to treat it next week after inflammation is better dont know if it related",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello doctor I am a 56 year old male I was told that my creatinine level is 3 after my last hba1c I am type diabetic I am now on atkins diet to reduce dramatically lower carbohydrates what is the significance of increased creatinine level what is considered as a critical level please explain so that I can get some sort of a deeper understanding I have also increased drinking water I do not smoke or drink I am not using any drugs too thank you",
        "input": "",
        "output": "hi we are here to help you revert back with the reports to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am 18 years old and virgin lately I have been having some problems down there I have a bump or something on the right lip of my vagina sometimes I feel itch and it sting unexpectedly throughout the day it also did not heal I am sure that it cannot be an sti or sad because I am not sexually active can you help me",
        "input": "",
        "output": "hi well I do understand your dilemma I have a few simple suggestions for you bear in mind though that the best method of treatment in your case is for you to visit a gynecologist and have him or her see the lesion for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I have gum recession due to bruxism and aggressive brushing none of my gum measurements are over should I get a gum graft now or should I wait",
        "input": "",
        "output": "hello for further doubts consult a periodontist online"
    },
    {
        "instruction": "hi doctor can color blindness gets generated by means of other issue or problem except birth is there any remedy for it",
        "input": "",
        "output": "hi for further information consult an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor for the past couple of days I have been having left side pelvic tenderness it does not hurt very much when I lay down or stand up but hurts when touched especially if pushed down or put any pressure on that area the pain is right in the area next to my left hip bone I do not know why this pain is happening and I have never experienced anything like it before my period was due and I am a few days late this time I have not tested for pregnancy yet today I started spotting some pink discharge and a very small amount red blood it was not in the underwear and I found it only when I wipe I am getting concerned and do not know what is going on could this just be early pregnancy or is it something worse",
        "input": "",
        "output": "hi well firstly I would like you to get a blood test done to rule out pregnancy it is serum beta hug you must also get a vaginal ultrasound done urgently the reason I am asking for these tests is either you could be having these symptoms because of an ectopic pregnancy or an ovarian cyst the pain may be an indication of the process of either expelling out from one side of the tube or rupturing and thinning of the tube the more serious of the two situations is the possibility of ectopic pregnancy which can be ruled out by the tests if it is a cyst then it can usually be made out by an ultrasound I urge you to take these steps and let me know revert back with the reports to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor my head got injured after some part of a concrete ceiling collapse it scan done and I have attached the reports I was hospitalized three days an ent opinion was taken and also an audiometry was done it showed a minor injury in the right ear and less audibility now I have some pain in the left side of my head ear area and heaviness all around the head please suggest what to do further please check the attached histopathological diagnostic reports",
        "input": "",
        "output": "hi revert back after a week to a neurologist online"
    },
    {
        "instruction": "hi doctor eight years ago my family and I went on a vacation when my mother got out of one of the outdoor pools she started feeling a sting on her arms and all of her legs below the knees she has been to the doctor for this condition and she has gotten numerous ointments the only ointment that does help the uncontrollable itching and stinging has been zyeartec but she still continues to have itchy and stinging skin she cannot take any exposure to the sunlight which is why she wears long sleeves and pants during summer days along with an umbrella I recently looked online and I found some symptoms of solar urticaria when I read them to my mother she confirmed to have all the symptoms she does not have any noticeable rashes but she does say that her skin is extremely stingy and itchy which really impacts her days and some of the sleepless nights that come with this itching would it be possible that she has solar urticaria would you recommend her to take a photo test to see if it is solar urticaria",
        "input": "",
        "output": "hello as you explained that your mother has developed solar urticaria here I explain a few other importance of solar urticaria intense itching swelling and rashes develop in sunlight you can correlate it whenever she goes in the sun she gets these things if you are able notice this then undoubtedly it is something related to the sun many times only itching is the main symptom which your mother has now once it has started avoiding the cause is the best way to treat once you are sure that it is happening due to sun just avoid going out in the sun photo test is not a treatment it is a test to know that your mother has a sunlight allergy or not and it can get noticed by symptoms so no need to get tested if you already sure about the cause regarding treatment sunscreen is must use sunscreen without fail it does not matter whether you are going in sunlight or not you have to use it should be thrice in a day it could be like am 12 am and am anti allergic tablets like levocetirizine evil pheniramine maleate teczine etc continue it for three to five months these have totally no side effect and subside the allergy and itching consult a specialist doctor discuss with him or her and take the medicine with consent continue using your ointment with a good moisturizer too avoid sweats sometimes sweating itself increase allergy for further information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor I have some skin problem above my right ear it is the place where a put my spectacles it is neither itching nor painful blood is not coming from that but still I feel some difficulty to wear spectacles I have been taking treatment for months I am using fusiwal and I put cotton there but there is no improvement so please help me I am also attaching a photograph for your reference",
        "input": "",
        "output": "hi I have read your query in detail and do understand your concern I also viewed the attached pictures revert back with the answers to the above questions to a dermatologist online"
    },
    {
        "instruction": "hi doctor I am 24 years old recently I got an endoscopy the report shows that I have erosive gastropathy I have been using medicines for one month now for a few days while spitting phlegm a small amount of light red blood comes out from my mouth I also have some throat and chest pain but I do not have a cough I have joined the night shift job and had sudden weight loss please give your suggestion",
        "input": "",
        "output": "hi revert back with the details to a medical gastroenterologist online"
    },
    {
        "instruction": "hi doctor I had sex on 13th of this month and my period was due on the 20th but it has not come yet I took I pill within one hour of intercourse and due to lack of knowledge took one more dose the next day now I am worried will overdose of I pill affect my body also I did my urine pregnancy test after days of missing my period and it was negative what to do",
        "input": "",
        "output": "hello I had gone through all the data you have posted for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I work from am to am and cannot sleep once I am back my food habits are also messed up as I cannot sleep properly I get up late hence I am missing my breakfast and having heavy brunch some days I even miss lunch and have dinner around am I have also started putting weight unlike before I guess it might be because of the erratic sleeping and eating patterns I need to know what kind of food habits I should follow to sleep well I would also like to have healthy food please help",
        "input": "",
        "output": "hello for further information consult a sleep medicine physician online"
    },
    {
        "instruction": "hi doctor my mother is under treatment for hypothyearoidism hypertension and osteoarthritis of knee joints which is stage I have attached her current medication list and egg report I request you to kindly have a look at the egg and advice whether there is any indication of heart issues although the egg is marked as normal our doctor had suspected the possibility of lbb so I want to get your kind opinion in this matter I have also attached a copy of her lipid profile test reports done a few months back for your kind considerations thank you",
        "input": "",
        "output": "hi we are here to help you I have seen the attached report for further information consult a cardiologist online"
    },
    {
        "instruction": "hello doctor my mother has been diagnosed with probability of lower gi bleed in proximal jejunal small bowel loops through nuclear scan she is a heart patient and had been operated in the past and got her two valves replaced she has to take blood thinning medications like warfarin my mother had low hemoglobin due to blood loss in stool but it used to get resolved with changing the dosage of warfarin but this time she is getting blood loss on more frequent duration and thus doctors asked to do nuclear scan to check for any gi bleeding she has been advised to undergo surgery to get gi bleeding treated please advise if there are still possibilities to cure her with medications if surgery is required as a last resort then which one would be less threatening",
        "input": "",
        "output": "hi warfarin induced bleeding once stool color changed to normal from black can proceed with it scan abdomen to find out the cause jejunal ulcer medical management if general condition is stable if general condition is unstable then required more than bottles of blood transfusion if active bleeding is continued even after dosage modification of warfarin then consider surgery with high risk for further information consult a surgical gastroenterologist online"
    },
    {
        "instruction": "hi doctor I have asked to apply tazret 05 on the bald area for regrowth I have applied on hairline too but it made my hair further thin and loss please advise to cure my problem",
        "input": "",
        "output": "hi revert back with the answers to the above questions to a dermatologist online"
    },
    {
        "instruction": "hi doctor I have been suffering from severe itching near pubic area and the skin turned black previously I had pubic lice issue which was cured using permethrin lotion I am currently using flucort cream but it is not effective please suggest some medicine for it thank you",
        "input": "",
        "output": "hi revert back after 10 days to an allergy specialist online"
    },
    {
        "instruction": "hi doctor I have been on birth control continuously for three years about a month ago I took a pill late instead of in the morning my boyfriend has not ejaculated in me but I noticed that I have gained weight what are the chances of me being pregnant after taking a pill late I do not have periods since I take the pills continuously",
        "input": "",
        "output": "hello this is a common mistake that you have faced however a single late pill intake is in no way could turn you fertile as well as pregnant even if you miss a single pill the chance of pregnancy is very remote now continuous pill intake could be the reason for absence of cycle we advice this sort of continuous pill intake only if you have endometriosis a disease produces painful menses however you need to take pills with a gap of days pill free period or have to be on inert pills for days then only you will have cycles for further doubts consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I was recently diagnosed to be diabetic I am on glycine so 500 one week back I got a small injury in my right leg now some pus is coming from that injury last week my fasting and postprandial blood sugar were 139 and 28 respectively please let me know the treatment that I need to take to cure the injury",
        "input": "",
        "output": "hello revert back after two weeks to a diabetologist online"
    },
    {
        "instruction": "hi doctor I have these on my penis ears and inner thigh I have had them for over 10 years and they did not get red or inflamed also you cannot pick them off I am married and it did not get spread to my wife what is it",
        "input": "",
        "output": "hello can you please upload a picture so that I can review it they may be simple skin tags but it is hard to tell without a picture please also share if you have any history of sad sexually transmitted disease in the past and if you were tested for any recently revert back with the photos to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am 24 years old I got married month back I am bleeding after each sex it happened around four to five times also I get some pain and this is ignorable previously I suffered with period problem facial hair and cos please help",
        "input": "",
        "output": "hi as you rightly said it is due to cos polycystic ovarian syndrome you need to undergo a gynecological checkup especially a speculum examination to rule out any abnormalities of the cervix and vagina because of bleeding during sex if you are not planning for baby you can be on crimson oral contraceptive pills under gynecologist supervision or else you need to consult an infertility specialist and take medicines to regularize your cycles and ovulation reducing weight also will improve ovulation and periods I suggest you not to delay fertility in view of cos for further information consult a sexologist online"
    },
    {
        "instruction": "hi doctor my nail beds are not smooth the area from where nails are coming out is broken I am having this problem for more than six years first it was there only on a single nail and then it started spreading sometimes watery pus forms near the root of the nail I have sent the images for your reference",
        "input": "",
        "output": "hi I have seen your query and images for further information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor my wife takes acitrom my tablet daily and she also takes teaspoon of dried basil with milk is it alarming do I need to stop her eating basil",
        "input": "",
        "output": "hi revert back with the answers to the above questions to a neurologist online"
    },
    {
        "instruction": "hi doctor I am 23 year old male I am working as a software professional I recently had some discomfort with digestion I had severe bloating gas formation and a frequent sensation of motions I went to a gastroenterologist and he made an endoscopy and endoscopic biopsy the biopsy result is yet to come but I am scared after seeing the endoscopy report he said it is not serious and some bacterial infection the report looks scary to me I had astral gastritis a year back and took medication for some time I am always eating outside food but nothing spicy I have attached my endoscopy reports here and I just want to take a second opinion from you kindly explain me the problem and give a solution",
        "input": "",
        "output": "hi as your doctor said there is nothing serious pyloric infection and spicy food specific antibiotic course for pyloric for 14 days continue your current medications for acidity avoid spicy food and take bland diet till the completion of your course of therapy also try to reduce any form of caffeine and nicotine for further information consult a medical gastroenterologist online"
    },
    {
        "instruction": "hi doctor I am suffering from bleeding piles with pain please help",
        "input": "",
        "output": "hi revert back with the reports to a general medicine physician online"
    },
    {
        "instruction": "hi doctor I had a brawl on the phone with a few persons they are believed to be not so social kind of people ever since that day I feel a kind of heaviness in my head what is it",
        "input": "",
        "output": "hi for further information consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor I have been having a strangling feeling in my throat for around seven months this came post thyearoidectomy and so I thought it had to do with surgery however my gastroenterologist did an endoscopy and found bile in my stomach as I researched this I immediately thought of my gallbladder removal surgery two years ago anyhow she put me on acid reflux medicines and that do not seem to be helping at all I have pain in the upper right quadrant of my stomach and this strangling feeling every day I am taking carafate four times a day as well I have just changed my thyearoid medicine to nature thyearoid grains per day my ash was at and I know it should be closer to what to do",
        "input": "",
        "output": "hi small hiatus hernia if gastritis is ruled out then consider barium study for hiatus hernia infection induced pangastritis continue medications for gastritis avoid spicy food and try to reduce any form of nicotine and caffeine do not sleep immediately after dinner try to reduce liquids during meals revert back with the answers to the above questions to a medical gastroenterologist online"
    },
    {
        "instruction": "my baby is months old last month he had rashes and a loose motion we did a stool test of oh and reducing substance done the report says that the reducing substance is positive the doc advices to stop mothers milk and start isomil formula the baby did not take isomil so I continued with breastfeeding and after some days we checked his weight it was good the baby is growing properly he is active does not cry coz of colic he poops to times max he is exclusive breastfeed he frequently passes urine the only thing is poop is bit greenish but the test report say it is yellowish brown other than that there is no issues of rashes also everything is fine baby sleeps well and passes the gasses well the stool test was done again yesterday and it is the same as last test ie reducing substance is positive my queries are as below from above description shall we still follow doc by stopping breastfeeding and using isomil why has this issue come up in months before it was all good how long will this intolerance last I have stopped dairy products I cannot have a small cup of tea also can I have it can I use half cup milk for tea",
        "input": "",
        "output": "hi am glad to hear you did not stop breast feeding and that the babys weight gain is good babies of months may pass stools after every feed which means if you feed 10 times they may pass stools 10 times so that is not a thing to get worried regarding the colour of the stools green yellow golden brown are all normal shades of stools so you do not have to worry about green colour please remember one more important thing if the baby is not having any problems symptoms then do not get any tests done because even in a completely normal person there can be a few parameters outside the normal range we cannot keep chasing the lab report completely forgetting the babys condition if you get a routine health check done during your visit to your pediatrician for vaccination it is sufficient that is if the baby is not having any problems symptoms any change in the mothers diet changes the composition of the breast milk to a small degree which then is reflected on the childs routine you may start taking milk with tea initially small amounts and gradually increase the babys bowel movement pattern might change but that does not mean it is not good for babys health but do not start to feed cows milk pateurised milk to the baby yet let the baby be atleast 7 months for that please let me know if you have any questions"
    },
    {
        "instruction": "hello doctor I have a super itchy skin rash around my genital not on my genital and on hip it has been there for a few months now first it was around my genitals and hips but now it is on my hips only whenever I used to scratch dead skin and dry blood comes off at first I thought it was just a rash and will go away but now it has been a month and it is not going anywhere it is continuously itchy",
        "input": "",
        "output": "hi it seems the rash and itching in the groins and waist area could probably be due to a fungal infection of the skin this is very common especially in tropical countries and more so in the hot humid summers to accurately diagnose the same further information like images of the affected area total duration of the rash any other areas affected any discoloration of nails etc is needed if it is indeed a fungal infection the following can be kept in mind treatment of fungal infections includes applications which contain ketoconazole sertaconazole luliconazole etc oral antifungal like terbinafine and itraconazole are often used in combination for better clearance and reducing recurrence local hygiene is very important taking bath daily drying the skin folds after bath keeping soap and towels separate and drying your clothes in sunlight and ironing them before wearing will help to kill the fungal spores so I will recommend evaluation by a dermatologist to decide on the treatment if you have any queries please feel free to reach out hope this helps"
    },
    {
        "instruction": "hello doctor I was on the depo injection finished it four months back then started the pill for days only I wanted to try for a baby I was wondering as I have spotted last month and had a period 14 days later but all the time before that I have had unprotected sex and not caught pregnant is there a problem as I am trying for a baby I have not ovulate this month could this be due to the depo or the pill or something else I am not pregnant as I have done test it is negative",
        "input": "",
        "output": "hello it is for your information that post prolonged use of depot injection the menstruation cycle is likely to be anovulatory for 3 cycles after it restarts post stoppage of injection you had your initiation of bleed last month and had a proper menses 14 days later but this cycle is likely to be anovulatory in most of the cases so even though you may be trying yet you would not conceive it would be best if you can start using ovulation kits from the next cycle from day 10 daily to check for oh surge which would help find the time of ovulation again whether or not you ovulate as well and you would be able to have a better control over your actions"
    },
    {
        "instruction": "hello doctor I have an year old daughter yesterday there was a faded blood in her panty and we thought that it was the start of her menstrual period however the menstruation did not show after she changed her panty until now please advise",
        "input": "",
        "output": "hello years is too early to start menses I would like to know does she have her secondary sexual characters developed as in does she have the breasts developed and axillary and public hairs if not then mostly she is yet to achieve her puberty many a times the minimal bleeding or spotting could be either due to local genital infections or some ulcers or trauma sometimes even a piles problem or fissures bleeding may be confused as vaginal bleeding if you observe the bleeding again you can visit a gynecologist for general examination to look for any local cause as of now I would advise to wait and watch if you do not feel any signs of infection like burning itching pain etc"
    },
    {
        "instruction": "hello doctor I recently had a meeting with a hair transplant clinic and they told me I needed 300 3500 follicular units 800 follicles attached is a photo of my hair loss is this overkill I am afraid of running out of the donor area",
        "input": "",
        "output": "hello it is androgenic alopecia male pattern baldness it is a genetic sex hormone imbalance disorder there is a shortening of hair growth cycle and delay in new hair growth increase in dihydrotestosterone dht causes in our case can be hormonal imbalance insufficient protein intake iron deficiency hair procedures rough handling stress and drug related treatment minoxidil percent lotion my at night for 30 days on hair thinning area it slows hair loss and grows new hair nizoral shampoo twice weekly for six weeks laser therapy low level laser therapy to stimulate the growth of follicle hair transplant last morality of treatment eat oranges avocado carrot yogurt sweet potato salmon spinach vitamin a folate iron green leafy vegetables eggs chicken drink lot of water drink green tea no caffeine tea soda eliminate stress stop smoking scalp massage aloe vera gel onion juice extract as a home remedy try this before thinking of hair transplant"
    },
    {
        "instruction": "hello doctor I have swelling in the neck and tested in the laboratory about three years ago they say I have a problem with my thyearoid and I need to consult a doctor unfortunately we do not get a chance to go back to the hospital again because of a lack of money I am 17 now and my neck is still swelling I do not feel any symptoms as of now the last doctor who checked my neck says it is a non toxic thyearoid problem but they did not tell what my illness is because it is just our school medical better to consult a doctor is there any recommendations to prevent my neck from swelling what are the foods and activities to control the swelling is there any thyearoid home test I should try to identify how is my thyearoid I will consult a doctor if the situation is totally fine",
        "input": "",
        "output": "hi in most cases when there is a swelling associated with the thyearoid the swelling moves when you swallow and can be seen when you turn your neck backward and swallow the surest test to detect a thyearoid swelling is by doing an ultrasound to assess minor details size blood supply and other aspects which we need to know before we treat you secondly you need to get a thyearoid function test wherein we assess the level of the thyearoid hormones in your body thirdly we also do a fine needle aspiration cytology fnac to find out what was the cause of the swelling to occur in the thyearoid here we insert a needle in your thyearoid gland in areas of interest and then observe these cells under the microscope for patients having thyearoid problems hypothyearoid to be specific we usually avoid foods belonging to the brassica family such as kale rape cabbage cauliflower and broccoli these are known to block the synthesis of the thyearoid hormones leading to its deficiency and thyearoid enlargement seafood bread and milk are rich sources of iodine also understand that a hyperfunctioning thyearoid also can cause a thyearoid swelling and the tests mentioned above are basic and have to be done to evaluate any patient with a thyearoid problem so in a nutshell the doctor who deals with thyearoid problems will definitely get these investigations to manage the problem further I hope this helps"
    },
    {
        "instruction": "hello doctor I am having persistent floats on the lower side of the eye I have consulted a doctor and since the eye power is the same 5 she did not dilate the eye she told me it is because of the sore eyes and it will get resolved but I want to be sure as the floats are more severely occurring in the right eye",
        "input": "",
        "output": "hello see first of all floaters at the age of 21 is not a common condition it can be due to so many reasons but I feel in your case it is because of your high refractive error that is 5 as you said so my advice is you should be very careful regarding your symptoms if floaters are not much then no need to worry but when you will have suddenly excessive floaters or if you feel like flashes in your eyes vision is getting affected then immediately you should consult your ophthalmologist because all these are symptoms of retinal detachment that is common in high myopia patients one more thing is you should undergo a complete ophthalmic check up every six months"
    },
    {
        "instruction": "hello doctor I am currently on fluconazole 150 my and I am on my second dose I just took it yesterday for a yeast infection I was given clotrimazole betamethasone topical cream to apply on the affected area twice a day however it seems to make it hurt in an hour after application I first felt myself getting irritated in the vulva area about a week and a half ago and then started monistat with refilled cream applicator and it seemed to improve however a few days later it seemed to reverse then I received the diflucan and it seemed the discharge has been less inside however the external seems red and irritated and itchy still my question is in order to cure a vaginal yeast infection do I need to apply the antifungal cream externally along with the diflucan or will the diflucan alone take care of the external and internal infection",
        "input": "",
        "output": "hi I have gone through your history and understand your concern it could be due to vaginitis caused by a fungal and bacterial infection you have to take vaginal tablet as well as local application of cream you can do one thing use plain candid cream and take antifungal and antibiotics for the same keep the area dry and clean and drink a lot of warm water and eat lots of vegetables and fruits avoid oily and spicy food take probiotics for the same"
    },
    {
        "instruction": "hello doctor I am a 39 year old female fatigue sluggish difficulty concentrating and migraines I have difficulty regulating temperature with periodic tightness in the chest and fluttering sensation my ekg chest it and chest ray are normal with negative couid test my vitamin b12 folate and levels were low and I started supplements last month and the levels are in normal range now but I am still having symptoms I have borderline low white cell count and abs lymphocyte count and slightly high platelets I was diagnosed with lupus as a teenager but then in early 20s I was told that I do not have it father died at 59 of a sudden catastrophic event possibly a heart attack also my dime was slightly elevated and so was my sed rate please help I am currently on lamictal lexapro and birth control pills",
        "input": "",
        "output": "hi following is my opinion for your asked question your attached abc complete blood count report is within the limit platelets count and all are also in borderline and you might need not to worry about that for your fatigue and sluggishness investigate with sept serum glutamic pyearuvic transaminase serum urea creatinine estimation serum ash thyearoid stimulating hormone estimation etc to rule out the liver kidney disease and thyearoid problem as a cause of fatigue ana antinuclear antibody estimation also should be done to do workup for autoimmune disease if no cause found than egg electromyography or nav nerve conduction velocity like investigation done to do workup for fatigue kindly consult a nearby physician for a detailed physical examination"
    },
    {
        "instruction": "hello doctor I tried a new skincare range called gopure and american company half an hour later I developed redness burning itching and swelling I have discontinued the use and used ice and cold water to relieve symptoms after four days my skin is less painful the company suggests watering down two of the products I am reluctant to do so what would you advise",
        "input": "",
        "output": "hi it seems that the new skin range that you tried is not suiting your skin it is important to know what all products you were using and the ingredients in these preparations if it was a concentrate which had to be diluted and used then the redness and burning would be because of the irritant dermatitis this could happen to anyone and the irritation of the skin is due to the very high concentration of ingredients in it this kind of reaction will not happen if you dilute the preparation as advised by the manufacturer and use the product sometimes it can also be due to allergy to some components and this will recur every time you reuse the product once the skin is back to normal you can try testing the product by applying a small amount of the diluted product on the skin behind your ear or on the skin of the inner forearm observe the area for 24 hours if you develop any itching irritation or redness it may indicate allergy to some ingredients further patch testing can then be advised to know the exact allergen and it will be advisable to avoid the product in that case I hope this helps"
    },
    {
        "instruction": "hello doctor I had a sore throat and fever four months ago I took some antibiotics cebosh referred by an ent and the sore throat went away but I have a constant nasal dripping and throat clearing since then somedays it is more and some days it is normal I can see mucus in my throat and it looks irritated I have no fever no body pain and no shortness of breath I have a severely deviated septum too what can I do to get rid of it",
        "input": "",
        "output": "hi as per your description you are having a deviated nasal septum dna your continuous presence of mucus in the nose and throat clearing is because of sinusitis which is a common consequence of your deviated septum I have given some tablets try using those if not relieved you should nasal sprays but they contain steroids are not advocated during this couid season so it is best to avoid the nasal spray at present and regularly have steam inhalation dna with chronic sinusitis karvol plus capsule for steam inhalation tablet montelukast 10 my twice daily for two weeks cetirizine 10 my phenylephrine 10 my twice daily for two weeks cover your nose while going out avoid dust exposure"
    },
    {
        "instruction": "hello doctor I am having a problem with my eyes I had a black eye a month ago and it swelled and bruised the bruise went from purple to dark purple to yellowish green and then brown now it stuck with brown and I am getting worried that it will not fade away what do I have to do or what medicine do I need to take I am getting worried",
        "input": "",
        "output": "hello I think it is due to any blunt trauma to the eye as you have described it is changing color so that color change will be due to pigments change in the blood is there any trauma history kindly send a picture of your eye so that I can diagnose it properly without an image it is a bit difficult to say and is there any effect on your vision kindly provide answers to the above queries I will guide you for treatment"
    },
    {
        "instruction": "hello doctor about six months ago I developed pain in my lower back mainly in my waistline towards the right side I visited a doctor and we tried it but it did not work I then scheduled an appointment with a chiropractor however it was canceled dude to couid 19 a couple of days ago I was lifting at the gym and everything was going fine I started noticing the left side of my back waistline beginning to hurt so I went home since then the pain has worsened a lot it is a sharp shooting pain that will extend from my waistline into my buttocks I can barely sleep at night because when I try to turn over the pain is too extreme I feel it a lot when walking as well or trying to stand up if I am sitting down also lying on my back causes the area to ache really bad the pain is at its worse when I need to roll over in bed or when I stand up from being in a lying position even if I was lying or lounging for a minute or less I am a 23 year old male in the military the initial back pain that started months ago was found to be caused by wearing my sidearm at work for 13 hours a day and additional gear such as body armor however this new pain is something different please help",
        "input": "",
        "output": "hello you will need some investigations to confirm the cause however the likely possibility is lumbar spondylosis with nerve compressions most importantly you should avoid heavy activities lifting heavy weights etc you will need an ray of spine ap anteroposterior and lateral view and may need an mri magnetic resonance imaging physiotherapy would be helpful you may continue to have alive naproxen according to need you may use local diclofenac gel or hot water fomentation we usually give patients a multivitamin like neurobion forte b12 which is good for nerves and next in the line is pregabalin which is a nerve stabilizer I hope this helps"
    },
    {
        "instruction": "hello doctor my dad is 78 years old recently one month back he had acute left medullary infact with hyperacute infact of the midbrain after which he is unable to open both of his eyelids on his own but can see when we lift the eyelids also his voice was very low after a month now his speech has improved but the eyelids issue is still there can you please suggest any treatment for his eyelids to open",
        "input": "",
        "output": "hello as you have described your father had brain infact after that he developed all symptoms related to eye right so let me explain you that in case of stroke or infact in the brain there will be involvement of cranial nerves also the cranial nerve which is responsible for elevation of eyelid will also get affected in such situations like stroke so the same thing has happened here in your father case so for treatment of his eyelids only surgery you can plan but you should consult oculoplastic surgeon for that he is the one who will measure all the parameters and depending on that he will tell you which surgery he should undergo so my advice is you should take your father to an oculoplastic surgeon for this problem I hope this helps"
    },
    {
        "instruction": "hello doctor I am having severe localized pain when I lift my left arm over my head and it is in muscles for more than four months the rheumatologist did an ray and blood test which are all normal he prescribed tablet arcoxia 285 90 my and panadol 65 my injection depo medrol 40 my for 14 days seven days have been passed but a bit of pain is reduced but muscle is slightly locked and I cannot freely move my upper arm pain is near triceps and biceps any advice will be greatly appreciated",
        "input": "",
        "output": "hi I read in detail your symptoms it is suggesting periarthritis shoulder the profile does not suggest inflammatory arthritis as the signs of inflammation are lacking and the tests are normal periarthritis shoulder or frozen shoulder mri shoulder adhesive capsulitis periarthritis shoulder continue medication local fomentation range of motion exercise avoid lifting weights avoid gymnasium and weight training avoid heavy bag lifting eggs fish dry fruits for natural omega intake turmeric capsules to boost healing"
    },
    {
        "instruction": "hello doctor my father is recently diagnosed with diabetes along with high creatinine level I need a therapeutic diet plan for a week according to the condition",
        "input": "",
        "output": "hi please let me know the current weight and height of your father also his present age his blood sugar levels and any other lab reports also please do let me know whether you are vegetarian or nonvegetarian and his daily meal pattern with timings"
    },
    {
        "instruction": "hi doctor I am 49 years old and I have been drinking approximately 350 my of vodka every day for approximately 10 15 years I also have smoked half pack a day for 30 years but just recently quit for the past year and a half maybe even two years I have had diarrhea daily I went to a doctor who prescribed is medicine and b12 shots but nothing changed my stomach is large distended and hard when I eat half a sandwich or six bites of salad I am so bloated I cannot move I feel a dull bruise like pain very dull in my lower right quadrant from time to time maybe once every two weeks my ast and alt levels are high 12 and 13 glucose is 16 absolute eosinophils are 720h I have attached my lab reports my guess is this is liver disease pancreas disease or diabetes any ideas do I have to quit drinking or can I cut back I am currently taking stelara for psoriasis",
        "input": "",
        "output": "hello I think there are multiple issues you need proper workup your alt alanine transaminase ast aspartate transaminase are due to alcohol related liver disease better is to do us ultrasound abdomen other issues are I had gone through your blood reports your hemoglobin and hematocrit are in range of polycythemia vera which is a blood coagulation disorder so what is feel is you need a good doctor hematologist for polycythemia and related to your gastric issues us abdomen and endoscopy with biopsy can be done if possible as this will tell us liver and pancreas status as alcohol affects both second thing stop smoking which is a culprit for your high he so to get that worked up there are series of tests need to be done my advice is to choose a good doctor to get everything thing done"
    },
    {
        "instruction": "hello doctor I had a abc complete blood count done yesterday and it came back with elevated abc of 13500 with neutrophils 900 more or less ear 36 and close to normal lymphocytes my urine sample was negative I had a severe eye infection that lasted about 10 days and started clearing up really nicely yesterday when I had the blood work done I was crying for an hour due to unrelated massive stress factors I have severe anxiety and I am going through a rough time I am hardly ever at ease I am mentioning this because I read stress can be a factor I am worried because my levels are elevated and I show no signs of infection apart from the eye which still has a little pus I do not go out due to couid 19 at all food is delivered and handled in a very safe way packages are disinfected and I have no contact with anyone I am puzzled as to where an infection could come from my doctor thinks it is a bacterial infection and has put me on antibiotics I am very worried about cancer should I be",
        "input": "",
        "output": "hello following is my opinion for your asked question your total count and neutrophils are elevated so it could be due to bacterial infection or stress as per provided history you can complete the course of antibiotics meanwhile try to reduce stress and anxiety by yoga exercise breathing exercises etc you can be prescribed anti anxiety medication for stress it does not seem to be cancer according to history provided however kindly attach your all reports so that I can check it and can give you detailed comments"
    },
    {
        "instruction": "hello doctor I am a 24 year old male with no past medical history I have been facing pain while passing stool the pain ceases after a few hours but it comes again if I sit for a longer duration sometimes I see small strips of blood on the stool I have been sitting in warm water and keeping ice pack for some days it does help relieve pain on examination I also saw a small fleshy lobe near the anus I am attaching a picture of the area",
        "input": "",
        "output": "hello as I can know from your history that you are suffering from pain while passing stool and also blood in the stool you have noticed I have diagnosed your problem it looks from your photographs although it is not very clear that you are suffering from anal fissure may I know if you have occasional constipation and if you have work that has a more sedentary lifestyle I suggest you to have leafy vegetables salads high fiber diet cabbages and spinach so that you do not have constipation next you can buy dabur isabgul powder and take two teaspoons in one glass of water or milk you can take at bedtime and drink plenty of water apply anovate ointment beclomethasone dipropionate in the raw area where you have pain after passing stool get back to me after three days and let us see if it works or not take hot sit bath I mean you have to sit in a tub of lukewarm water at least three to four times a day it heals 80 of anal fissure"
    },
    {
        "instruction": "hi doctor I want to inquire what are the causes and possible treatment for acid reflux",
        "input": "",
        "output": "hello welcome to icliniq com the common causes of peptic ulcer disease are pyloric infection non asteroidal antiinflammatory drugs nsaids drugs other than nsaids such as tetracycline iron tablets potassium supplements and bisphosphonates zollinger ellison syndrome and carcinoid tumors the treatment is according to the cause for pyloric the treatment is combination antibiotic therapies including amoxicillin clarithromycin levofloxacin and metronidazole adopted in different first and second line therapy the world common treatment is clarithromycin based triple regimen including amoxicillin go twice daily for 14 days plus clarithromycin 500 my twice daily for 14 days plus any acid suppressant such as omeprazole 40 my once daily for six weeks this is the first line therapy there is a long list of second and third line rescue therapies for pyloric infection treatment for nsaids is simply stopping the medicine and due course of omeprazole for weeks the treatment of the rest of the above condition is variable which could not fit in this single page answer I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 25 year old male my problem is excess night fall as I am masturbating since around the age of 13 14 now I ejaculate within 30 seconds and I am scared of marrying now thinking of failure on the bed so please tell me what to do and the physical health of my penis is not as I expect and the reason behind it is masturbation",
        "input": "",
        "output": "hi as per your history you are suffering from chronic masturbation nowadays masturbation is very common in the younger generation if you masturbate two times a week it is normal but if you do frequently it is bad for your health how to stop the addiction of masturbation stay busy and less alone find another outlet for your time and energy fill your life with engaging activities the excitement of doing something different can help replace the urge to masturbate and you will have a go to distraction next time when you are tempted stop punishing oneself and do not be despondent remove triggers that tempt one to masturbate be persistent and patient you should be busy with your daily routine do regular exercise and join the gym I hope this helps"
    },
    {
        "instruction": "constipation small stools or feces hard to poop straining but not too much",
        "input": "",
        "output": "hi your symptoms seem to be related to chronic constipation some recommendations to help relieve your constipation drink two to four additional glasses of water a day maintain a strategic distance from caffeine containing beverages and liquor which can cause drying out include natural products vegetables entire grains and other high fiber nourishment to your eating routine eat less high fat nourishment similar to meat eggs and cheddar eat prunes as well as grain oat keep a food journal and single out nourishment that constipated you get going work out check how you sit on the can raising your feet reclining or crouching may make having a solid discharge simpler include an over the counter supplemental fiber to your eating regimen more details you may consult with me hope I have answered your query let me know if I can assist you further"
    },
    {
        "instruction": "hi doctor I am suffering from bloating since february and from march I am also experiencing severe constipation I have tried all dietary change but none seem to be helping me here for the past few days I was also experiencing pain in the abdomen sudden sensations in legs and mild pain in testicles so yesterday I went to see a local doctor and done the abc test all the parameters in reports were normal except platelets which were 90k without any further tests to know the underlying cause of low platelets the doctor wrote me some medication I am really very worried about my health and want to know the root cause of all these problems please help",
        "input": "",
        "output": "hello your previous symptoms are suggestive of irritable bowel syndrome constipation type is provided you have no weight loss fever blood in stools and vomiting it is not a worrying disease and you just have to follow some lifestyle modifications and simple treatment as given below your low platelet count should be investigated first of all you should repeat it by manual microscope as machines can sometimes give false readings second as chronic malaria and dengue are common in your setup so it also needs to be investigated please share if you have any history of fever jaundice liver disease spleen enlargement or weight loss peripheral smear dengue serology ns1 malarial parasite hbsag by elisa anti hav by elisa ultrasound abdomen is thrombocytopenia cause movicol sachet in a glass of water every night for two weeks spaghol husk in glass of water continue tablet levosulpiride 25 my thrice a day before meals drink plenty of water exercise after investigations"
    },
    {
        "instruction": "hello doctor I am having difficulty in breathing it is like I always need to take deep breaths and I think it gets worse after I eat on top of that it triggers an anxiety attack most of the time another thing is there is this sensation in my chest I do not know if is right to call it as tightening or pressure usually when I stand up it somehow alleviates that sensation but the breathing difficulty is still there sometimes all of the symptoms go away like for hours but then it comes back I think I am having these symptoms for three weeks or a month now I am doing self diagnosis and I do not really know which of these is it costochondritis angina herd or copd that is why now I am seeking the help of a professional I just hope it is nothing serious",
        "input": "",
        "output": "hello welcome to icliniq com do you have any other symptoms like cough and colds history of trauma fever body aches diarrhea or throat pain when did you feel tightening or pressure in the chest area any numbness or weakness in the left arm do you feel any burning sensation at the epigastric region just below your sternum part of the upper abdomen will you do frequent throat clearing you also mentioned it gets worse after eating what food usually triggers it do you experience bloatedness or frequent flatulation does it get better when you burp or flatulate have you tried any medication do you smoke did this happen before perhaps the anxiety is due to the uncertainty or fear that it might be related to couid but based on what you have described so far it is highly unlikely I understand the eco does not really help and a lot of people are also having the same issue when we confine ourselves within the premises of our home for this long it takes a lot of things from us the quarantine has taken our slight sense of freedom control and changed it to what we know now as the new normal but please understand that it might take sometime before the quarantine is lifted but know all of these things are only temporary so far your symptom is pointing to dyspepsia umbrella for herd hyperacidity etc but I need answers to some of the questions mentioned above in order to strengthen the diagnosis"
    },
    {
        "instruction": "hi doctor it has been a week now and yet I feel like I do not get enough sleep I would sleep from am onwards but tend to wake up every hour and my sleep feels like it is not in deep sleep I could get a deep sleep only aound morning 6 am and woke up at 10 am please help",
        "input": "",
        "output": "hello yes this pandemic is causing a lot of stress in everybody is mind we all processing information at the conscious subconscious and unconscious level of our brain sometimes that is to this kind of disturbance in biological rhythms along with that at times people start having anxiety of not falling asleep so do not worry just follow some sleep hygiene measures try some sleep hygiene measures wake up at the same time every day if after lying down you are not able to sleep for 10 to 15 minutes then get up from bedsit on a table chair and start reading something do not take any tea or coffee after am listen to some white noise or light music start some exercise on a routine basis that will keep you fit and will release some and will release endorphins in your brain that will relax your mind start pranayama and meditation"
    },
    {
        "instruction": "hi doctor I keep getting boils on my abdomen once every two to three weeks they are painful and leave behind scars I have been having this condition for the past two years earlier it was severe with new boils occurring every few days and now it has become less frequent my local dermatologist diagnosed me with recurrent furunculosis and treated me with topical and oral antibiotics courses repeatedly but after the course was complete the boils returned back in a few days I was also made to do a two week cin course can this condition be something else also what is your recommendation for preventing recurrence I am attaching a picture of the latest boil I got yesterday on my abdomen",
        "input": "",
        "output": "hi I have gone through your history and checked the pictures attached the lesions look classical for furunculosis this is a common bacterial infection of the body hair it is usually seen in people who sweat a lot who prefer tight clothing in diabetics in people who visit the hospital frequently and those who have a higher degree of body hair there is nothing to worry as it is a common and easily treatable condition fbi fasting blood sugar plus post prandial glucose test nasal swab for staphylococcal bacterial culture tablet pan 40 my pantoprazole once daily before breakfast for one week capsule dont so 100 my doxycycline and lactic acid bacillus twice daily after food for one week back cream twice daily take bath twice daily prefer loose fitting clothes avoid nose pricking habit if you have wash hands regularly avoid high glycemic index foods"
    },
    {
        "instruction": "hello doctor I am suffering from chest tightness and at times turns into pain I feel like I am breathing into a tight chest with constricted chest wall muscles along with shortness of breath and throat tightness the doctor said I have mild asthma and nothing he is giving me is working albuterol dulera oral prednisone I even tried herd therapy to see if it will help and it is not I am suffering a lot please help I have been tested for coronavirus three times and it came back negative my chest ray and echocardiogram has been normal as well",
        "input": "",
        "output": "hello since when your suffering from chest tightness is it aggravating at night or early morning possible causes are like episodic asthma in which you may feel repeated episodes of chest tightness and breathing difficulty herd gastroesophageal reflux disease in which lower esophageal sphincter lead to acid reflux which may enter into to larynx cause asthmatic episode diffuse esophageal spasm this is esophageal motility disorder that lead to painful spasm of esophageal musculature on barium swallow it appears as a string of beads panic attacks lead to chest wall muscle tightness regarding this attack postnatal discharge neuromuscular disorders etc until examination is done it is difficult to say what it is so please get it done spirometry 24 hour oh monitoring esophageal manometry may useful serum ice levels barium swallow chest ray and absolute eosinophil count avoid spicy food at night elevate the head end of the bed in case of allergic asthma use tablet montelukast and levocetirizine once a day night may be useful use tablet deriphylline twice a day for five days avoid allergens that trigger the episode common allergens like household dust molds mites and pollen if no improvement please consult with your physician or pulmonologist he will examine and treat you accordingly"
    },
    {
        "instruction": "hello doctor I am worried about my mother retinal detachment she has diabetes and hypertension I have an ray of her eye she is currently located abroad and I would love to have a second opinion on what process she should be taking",
        "input": "",
        "output": "hello let me first reassure you your mother case seems to be not urgent judging by the information you gave and the attached c scan you have done the left eye seems quite normal the right eye has some macular edema meaning that there is fluid in the retina that is causing retinal stretching also I can see neurosensory detachment in the retina too this is probably due to long standing diabetes retinal detachment usually manifests with seeing a bright light and floaters in the visual field as well as a drop of vision I will need to know if anything new happened to her vision in this case my opinion is your ophthalmologist will need to intravitreal injections of avastin this will help absorb the fluid leaking in the retina and causing the stretching if there is detachment he will need to reposition the retina with a vitrectomy procedure and retinal fixation and implanting temporary silicone do not worry this procedure can help maintain vision and maybe fix it for the better it can be a little bit costly and you have to select an experienced vitreoretinal surgeon diabetes control your mom will need to check her diabetes with an internist I need to know further information as regards to her vision previous medical history and operation done when was the last time she has checked with an ophthalmologist so I can help you and tell you more about her management retinal degeneration macular edema neurosensory detachment"
    },
    {
        "instruction": "hello doctor eight months before I felt a small lump around the right side of my anus area before I had itching around the anus for several months later that lump became larger and painful in a week I consulted a homeopathic doctor and he gave me medicines paeonia off acid muraticum acidum nitricum I took that medicines and the lump wound burst in three days but that wound skin has not dried yet and it still watery it also feels itchy sometimes besides this issue for a week I am feeling another small lump on the left side of my anus area and I feel like sure it would become big and painful like the previous one so I need your consultation to cure it forever and these wounds appear externally around my anus",
        "input": "",
        "output": "hello it seems you have a perianal abscess perianal means around anus and abscess means collection of pus it can be secondary to chronic itching and excoriation of the skin resulting in abscess formation it can occur secondary to poor hygiene in and around the anal area since the one abscess is already burst this will allow pus to drain and would heal itself but the other evolving abscess would burst and lead to pain as you may be experiencing there was the simple explanation of your problem sometimes there is a problem with the small or large bowel a condition is called crohn disease which causes inflammation of the small large bowel as well as perianal area resulting in an abscess anal fissure and fistula I can recommend you some antibiotics but urge you to see a gastroenterologist in nearby and let be examined by him thoroughly or you can send me pictures of the area which is painful and discharging pus as I can guide you further on this for now take the following regimen for seven days and come back to me to inform about improvement in your symptoms we can then adjust medicine or add others if this does not work perianal abscess crohn disease stool for fecal calprotectin complete blood count crohn disease perianal abscess tablet metronidazole 400 my thrice daily for seven days capsule cefixime 400 once daily for seven days half tub of warm water add my of dettol antiseptic sit in the tub for minutes three times daily for seven days maintain hygiene innthat area regular removal of area avoid long sitting on hard surfaces like table chair or floor follow up in one week with tests and inform me about the improvement of symptoms"
    },
    {
        "instruction": "hello doctor my periods are late even though my home pregnancy test is negative it is still late I had bleeding for a couple of days after having intercourse before three weeks what could possibly have gone wrong",
        "input": "",
        "output": "hi welcome to iclinq com I saw your concern it is unlikely to be a pregnancy the cause for the delay could most probably be hormonal the reason for bleeding could be uterine or ovulatory nothing to worry about it do you have bleeding every time after sex if yes then you need to have in person gynecologist opinion to look at your cervix for the cause post coital bleeding anemia weight gain hypothyearoidism stress change in food and exercise pattern can affect the cycle length and pattern I hope this helps hormonal tis transvaginal scan if the post coital bleeding is recurrent delayed cycle probably hormonal just wait for a week if you do not get your cycles repeat up urine pregnancy test if negative take tablet medroxy progesterone acetate 10 my meparate once daily at bedtime after food for five days cycles revert by one week of last dose of progesterone"
    },
    {
        "instruction": "hello doctor I have a am sized lump on the glans of my penis it appears to be under the skin therefore I ruled out the possibility of it being a fordyce spot which I appear to have and are usually on the skin it is slightly raised while flaccid but really shows in definition when aroused I seem to have a similar definition around the start of the glans and end of the shaft which I have had for some time when I move the skin these lumps it do not move at all unlike fordyce I suffered with bad eczema on my penis when I was a young child and used creams to heal I do have trouble retracting the skin as it is tight and I am not sexually active however I do masturbate usually two to three times a week I wanted to know the possibilities of what it could be should I be worried can I treat it myself if it needs treatment and should I stay away from any sexual activity during this time",
        "input": "",
        "output": "hello I read your query and gone through the attached images first of all I like to inform you that from the attached images it does not look like something serious this is applicable for almost all forms of lumps over the penis the most common possibility for similar looking lumps includes pearly penile papeles and sebaceous cysts the other possibility is scaring from eczema which you experienced during childhood the possibility of a sexually transmitted infection induced lump is out as you are sexually inactive and masturbation carries no risk of sexually transmitted infections most of these lesions are likely to go without any intervention or will stay without causing any damage which means there is no need to do anything on your part however if you see there is a sudden change in size pain during erection or ejaculation any form of discharge or fever unexpected weight loss consider seeing a doctor without delay I hope this helps"
    },
    {
        "instruction": "hi doctor I am suffering an erection problem for the last three years I am married for the last year but I never did satisfaction and natural sex with my wife my problem is I used to do a lot of masturbation heavy masturbation with oil so it is erect for a while and again loose one more thing my penis would not get erect or discharged if my wife do handjob and sex it gets erect only when I touch I am trying a lot to discharge in my wife vagina but I could not do so because at the end movement it is going to loose one more thing I cannot masturbate with my dry hand because I need some oily lubricants to erect my penis after marriage also I am doing masturbation due to heavy masturbation my penis shrinks and sometimes I forgot things I am not able to remember anything",
        "input": "",
        "output": "hello anejaculation is a condition where a man cannot discharge semen it can be absolute when he cannot discharge in any situation and situational when he cannot discharge in certain situations but can discharge in other conditions if he can ejaculate with masturbation but not with sex then it is a psychological issue if he cannot ejaculate even with masturbation or in dreams then it is a physical issue for which some tests need to be done psychological issue is due to inhibition when a man cannot ejaculate in the presence of another person it can be overcome by gradual desensitization he can rub his penis on any body part of the female like buttocks thighs breasts belly etc and try to ejaculate the female can also masturbate him it is a long drawn process and often frustrating but is useful he can also self masturbate and on the verge of ejaculation put the head of penis into the vagina also vibrators can be used but before doing all these enough foreplay should be done if needed help of pornography can be taken also there are medicine to reduce the anxiety related to it and facilitate ejaculation for physical problems the treatment is decided after doing some blood tests and ultrasound tests"
    },
    {
        "instruction": "hello doctor I am a 28 year old female my to is 8 I am obese at 76 keg with 153 am I take 25 my thyearonorm tablet every day weight loss becomes very difficult as thyearoid levels have not decreased in the past five years post pregnancy can I increase my thyearonorm dosage to 100 my",
        "input": "",
        "output": "hi I find you are having hypothyearoidism and consulting for thyearonorm dose adjustment dose adjustment will be made on free to and ash thyearoid stimulating hormone levels and not based on to levels so I request you to upload the full thyearoid profile results then we can decide upon the dosing hypothyearoidism"
    },
    {
        "instruction": "hello doctor I am a 39 year old female I am fatigued sluggish difficulty concentrating migraines and difficulty regulating temperature I have periodic tightness in the chest and fluttering sensation my ekg it chest and chest ray are normal and the couid test is negative my vitamin b12 folate and vitamin were low I started supplements last month and levels are in normal range now but I still have symptoms borderline low white count abs lymphocyte count and slightly high platelets I was diagnosed with lupus as a teenager but then in the early 20 I was told that I do not have it my father died at the age of 59 of a sudden catastrophic event possibly a heart attack also my dime was slightly elevated and so was my sedimentation rate I have a history of cancer in the family especially breast cancer so I am more concerned about cancer I am currently on lamictal lexapro and birth control pill",
        "input": "",
        "output": "hi your reports are normal nothing seems worrisome since you have a family history of breast cancer you should get a mammogram done also get your bra gene breast cancer gene tests done it is a blood test and if it is positive then it means high chances of getting cancer in the future if it is negative it is good also you should take supplements and should stop birth control pills they can also cause cancer sometimes you should use a mechanical method of contraception like condoms and should do regular exercises to reduce your weight too"
    },
    {
        "instruction": "hello doctor I am a 29 year old male and I am diagnosed with crohn disease before years and was taking immuran 150 my day and diagnosed with streptococcus after semen culture at the beginning of this year my main concern is ed and pe but the testosterone level is within the normal range I want to know whether my problem is urology or neurology",
        "input": "",
        "output": "hello you have mentioned ed erectile dysfunction and pe premature ejaculation no details of medications tried so far can you elaborate on this testosterone only indicates sexual drive which you have not mentioned as a problem so that being normal rules out nothing there are no tests for ed and pe specifically history is key better to discuss in person immunosuppressive medications do not generally cause ed or pe you have not mentioned any reason or symptoms for checking semen culture in the absence of any such factors these semen tests can simply be a contaminant even if you have prostatitis it is not likely to cause ed or pe no need to treat semen culture unless you are symptomatic or in other words it will not help have you checked fasting glucose lipids and thyearoid function in the absence of any such symptoms this is likely to be psychogenic especially because of age please check the blood tests as above reassurance correct the factors if abnormal in the mentioned tests need a face to face audio conversation to understand the issues in more detail"
    },
    {
        "instruction": "hello doctor every once a month at least I get a flare up of diarrhea where I go at least six times a day and nothing seems to settle my stomach the stool itself has a weird texture almost sand like most of it float down but some do float up and there is mucus in it other symptoms I am experiencing are lethargy feeling of being full yet hungry loss of appetite and dry mouth any idea of what this could be",
        "input": "",
        "output": "hello do you have lost some weight since the start of symptoms do you have noticed any triggers diets stress change in lifestyle or drinking alcohol before such episodes alcohol has a large amount of fermentable carbohydrates which can cause diarrhea gas and bloating often episodes of binge drinking the common possibilities are that you have one of the above trigger which causes your gastrointestinal gi upsets they can go unrecognized with episodes of symptoms as in your case the other possibility is endometriosis endometrium is the lining of the uterine cavity of the female internal genital tract in menstruation the lining sheds causing bleeding and pain endometriosis is a condition where endometrial tissue is implanted into gut and it behaves similarly as one has menstruation on monthly cycles it causes pain at times very severe diarrhea and even bleeding from the gut it is important that you notice yourself the temporal time relation between the onset of symptoms and onset of menstruation I want that you should provide me more information as I can be able to investigate you properly in a specific direction providing you target management plan which can fit you best I hope this helps cyclical abdominal symptoms endometriosis celiac disease food allergies eosinophilic gastroenteritis endometriosis environmental triggers follow up to provide more information to diagnose and investigate properly"
    },
    {
        "instruction": "hello doctor I have a year old son who complains of shin pain in the left foot once in every month before going to sleep he is generally hyperactive the next day when he wakes up he tells me that it does not hurt anymore we did rays and blood tests all are fine please help",
        "input": "",
        "output": "hello welcome to iclinq com lower limb pains in growing children are usually benign normal blood tests and normal ray reports also point towards the benign nature of pain most probably your child is having growing pains can you please recall anything that is common before the pain starts like excessive physical activity or specific footwear please share the ray image and blood test reports start calcium supplements and regularly massage the legs before bedtime"
    },
    {
        "instruction": "hello doctor I have dry masturbated for years and it created dry itchy skin on my penis shaft I read where conut oil had soothing qualities for sore skin so I tried it for four to five times for three days some of it got into my urethra I noticed some minor redness five days ago so I stopped I have no burning when I urinate no discharge the only sex I have had in months was oral and that person is sad free per doctors tests in march I have never had an sad but it is slightly uncomfortable I have a doctor appointment scheduled for a week from now but was curious what my treatment options could be",
        "input": "",
        "output": "hello normally the tip of urethra is slightly more reddish compared to the rest of the penis head as the mucosa is thin over there compared to the penis head it is possible that you have not noticed it or paid attention to it before and now became more aware due to oil application now if you are very sure that it has gone more red after the oil has entered it then also in the absence of other symptoms you do not need any treatment for it would settle on its own however we would like to get a urine routine examination just to rule out the possibility of urine infection which appears unlikely to me so I think it is not a worrisome issue and you may continue to apply oil or vaseline to penis shaft carefully the next course of action should be urine routine examination and treating infection if we find it which appears unlikely also you should have plenty of water for a few days atleast if possible avoid masturbation for a few days to avoid mechanical trauma to it I hope this helps"
    },
    {
        "instruction": "hello doctor I am allergic to quinolones metronidazole ibuprofen diclofenac and aspirin please tell me whether I am allergic to hydroxychloroquine or not if yes then please tell me ways to how to develop my immunity food that I should eat and should I drink hot or cold water what all the special precautions that I have to take to fight corona",
        "input": "",
        "output": "hello it is less likely you would be allergic to hydroxychloroquine however allergy is not the only criteria a detailed physical examination along with an egg electrocardiography report will have to be done to check if your body can tolerate the medication or no there is no specific food for immunity any home cooked food that is not processed will do you can drink hot water that is bearable important precautions for couid 19 are social distancing use of mask whenever outside the house at all times as soon as you come from outside have a bath and keep clothes for washing without touching anything in the house do not touch your face eyes ears or nose when you are outside hand hygiene is very important keep your hands clean by rubbing with soap and water whenever you touch anything that is not yours you can use a hand sanitizer when outside in this regard if you get any symptoms of fever 100 or more in the thermometer with cough or cold please report to the nearest health facility"
    },
    {
        "instruction": "hello doctor I have regular pain in the stomach while not having food in hours or so I have constant reflux air goes from both ways while burping I feel acid taste frequently after defecation I feel itching in the sphincter I am having a hard time if constipation occurs I am diagnosed with chronic gastritis and pancreas three years ago and was on medication I am seeking for a cure or for something that will get my health back in balance please help",
        "input": "",
        "output": "hello welcome you to icliniq com I can imagine how upset you have been since the start of your symptoms I will try to provide you the best options for your treatment so far I understand that you have pyloric induced gastritis you have taken medications for it but it turns positive every time you have an endoscopy the last which was 5 years back you tend to have stomach pain which is worse on fasting plus you feel burping and acidic taste in the mouth anal itching and constipation worsen your itching so pyloric infection is common worldwide with a prevalence of 50 of the world population is infected with this bacteria pyloric can cause ulcers in stomach and small intestine which is called duodenum pyloric responds to combination antibiotics for a duration of 10 to 14 days however due to excessive use of antibiotics in community this bug is getting increasingly resistant to these first line antibiotics hence use of second line antibiotics are preferred I will write down the treatment below in a while secondly due to failure of first line antibiotic therapy the pyloric will remain in the stomach and can cause ulcers as well as damage to nerve cells within the wall of the stomach and cause slowing of the movement of the stomach medically termed as gastroparesis or weakness of stomach in common words so your symptoms may be partly defined by resistant pyloric infection causing ulcer formations particularly in duodenum plus the nerve damage within wall of stomach leading to gastroparesis causing bloating belching early fullness of stomach and abdominal discomfort and constipation I want you to tell me whether your last test for pyloric was positive or negative if positive then I recommend you to take the following therapy for 14 days capsule pylera bismuth submit metronidz tcn three capsules daily with a glass of water three hours after meals and at bedtime capsule esomeprazole 40 my once daily half an hour before meals for two weeks digestive 40 my half an hour before meals daily for two weeks if the test was negative then I suggest you to test pyloric stool antigen to confirm if the infection is still present if still negative then do not take capsule pylera but continue with esomeprazole and digestive the digestive tablet will help you to improve your stomach movement secondly some precaution for gastroparesis try to avoid large volume meals instead take small frequent meals avoid taking fatty meals such as burger fried things and large carbohydrate meals like potato and sweets and soft drinks which further slows your stomach avoid taking a large volume of water while having meals your stomach pain occurring when you are fasting for two hours is due to ulcers in duodenum once your treatment with pyloric is completed plus acid suppressant medication such as esomeprazole would help you to reduce your pain I want you to upload your endoscopic reports and ultrasound reports which can help me to assess the extent of damage pyloric has caused to your stomach and duodenum I hope this helps peptic ulcer disease secondary to resistant pyloric gastroparesis pyloric induced or idiopathic small intestinal bacterial overgrowth functional dyspepsia post prandial distress syndrome stool for pyloric antigen to confirm if pyloric is still present gastroparesis pyloric induced or idiopathic small intestinal bacterial overgrowth functional dyspepsia post prandial distress syndrome peptic ulcer disease secondary to resistant pyloric follow up in weeks to update about symptoms as I can reassess and guide you further treatment plan for long term"
    },
    {
        "instruction": "i have diabetes type I am a female my age is 27 and my weight is 43 kegs I am currently been taking glimepiride and metformin 500 my height is 1 I have read that metformin 500is recalled due to cancer scare require alternative medicine my last sugar check was 395",
        "input": "",
        "output": "hello greetings happy to give consultation to with the above given history you sugar levels are very much high and you need to control you sugars as early as possible the current medications are not at all enough to control you sugars I will give you the prescription regarding metformin the cancer risk behind metformin is totally wrong it is a good drug of choice even we prescribing this in pregnancy too so do not worry abt the cancer risk behind metformin tats false news I would like few investigations for kindly do all the above investigations and get back for further evaluation I am hereby sending the prescription kindly get these tablets and start taking it will follow up in a week with the above said investigations medicines tab glykind 80 500 0 before food gliclazide metformin tab dynalglipt 20 500 0 tenegliptin kindly take these tablets and get back for follow up with above given investigations kindly contact me anytime for further queries kindly give you valuable feedback thank you"
    },
    {
        "instruction": "i have a grade sprained ankle im male 9 160lbs I had severe swelling to the size of a softball the first day swell as bruising that started to appear overnight on day I went to the doctor and got rays the doctor determined it was a grade sprain but gave me a projected recovery time of 6 weeks which is the recovery time for a grade sprain currently I am still unable to bear any weight but swelling is down drastically bruising is the same and now if my foot is not elevated I suffer extreme pain that causes me to often collapse to the floor if anyone knows why this is happening and if it will heal with the rest of my injury it would be much apreciated",
        "input": "",
        "output": "dear thank you for your query as per the information provided by you I would suggest you to follow price protocol that is protection rest ice compression and elevation also I would suggest you to wear ankle support brace or tapping the ankle to provide more stability and thus accelerate healing also try to move the foot within the brace gradually without stressing much avoid weight bearing on the affected foot also I would suggest if you do not feel improvement within week kindly meet orthopedic surgeon or physiotherapist hope I was able to suggest few helpful information to accelerate your healing regards"
    },
    {
        "instruction": "hello doctor I have a question on tuesday I went to go get tested with my fiance for couid because we thought his dad may have had it since at his job there were so many infected we showed no symptoms but to be safe we went after then I have not seen him just in case today I got my results and I was negative but he was positive does that mean the virus can still get to me I was supposed to go back to work tomorrow and I have showed no symptoms do I need to get tested again like I said since that day I have not seen him",
        "input": "",
        "output": "hi I understand you are worried about couid infection you need to understand that if couid test result shows positive then it is sure that the person has the infection but if the result shows negative that does not prove that the person does not have the infection the person can still be a asymptomatic carrier of couid so at present scenario with huge number of population affected and you being in close proximity with couid positive patients I would suggest you to repeat the test after days if you do not develop any symptoms or earlier itself if you develop any symptoms and since your boyfriend has tested positive you satisfy the criteria of couid close contact you need to isolate yourself at home for weeks and you also need to inform your health officials regarding this couid close contact"
    },
    {
        "instruction": "hello doctor as everyone are worrying about corona virus I have a few doubts relating to it how corona effects on asthma and thyearoid patients will corona effect the persons who are suffering with asthma and thyearoid even if they have strong immune system as corona effects especially on lungs even if the person is having vitamin food will the person die after he gets effected by corona because I have asthma and thyearoid problems and I heard that even the person who is strong with immune system will be effected by corona and will die please answer to my question and please suggest me what kind of food I need to take to boost immune system and fight against corona",
        "input": "",
        "output": "hello please note that there are two important things that decide fate of a person suffering from couid 19 these are immunity and viral load if your immunity is good but viral load is too much outcome will be poor and if immunity is poor and viral load is less outcome again will be poor both immunity and viral load are under our control please note that hypothyearoidism or asthma will put you at a very low risk for couid 19 so it is fine for immunity general good nutrition will help there is no specific need of taking vitamin and mineral capsules for it as regards to viral load it can be controlled by social distancing and by reducing exposure with anybody and everybody outside your house this rule applies to each and every member of the house as soon as you come back home it is advisable to have a bath with soap and water and to keep the clothes immediately for washing when outside wear a mask covering both nose and mouth at all times also avoid touching your face when outside unless you have cleaned your hands with soap and water do not touch any part of your face"
    },
    {
        "instruction": "hello doctor I have asthma since my childhood since last 20 days my asthma is not in control is that related to couid and I do not have any other symptoms",
        "input": "",
        "output": "hi according to your statement you have been suffering from childhood asthma and for the last 20 days your asthma is totally uncontrolled your present medication is foremost 200 respicaps which is a combination of long acting bronchodilator as formeterol with corticosteroids as momentasone and your query is whether you are couid 19 positive or not couid 19 usually attacks the respiratory tract first then eventually other systems as you are a diagnosed patient of childhood asthma so you are more vulnerable to develop couid 19 positive I do not know whether you are quarantined or not you had exposure history or not so you should undergo some investigations like antigen test for active infection and antibody test for previously infected by couid 19 you can also undergo car and pulse oximetry for monitoring of oxygen saturation rate you can take nebulization with salbutamol and salbutamol inhaler hourly or sos with fexofenadine and montelukast along with steroid orally"
    },
    {
        "instruction": "hello doctor since about a week and a half ago I have had tinnitus in my right ear this was after self irrigating the ear with one of those squeezy syearinges that come with the tex ear drops before doing this I was putting in oil drops for about a week prior quite a bit of wax came out but now I have this hissing noise in my ear which gets worse when listening to podcasts and music at low medium levels it also seems to become more pronounced when I chew I have had a subtle amount of ear pain over the past week but that seems to have gone now but the hissing sound has not improved at all I am worried I may have applied too much pressure when squeezing the ear syearinge and have damaged my eardrum I was wondering if this will heal over time and the tinnitus will go away I cannot go see a go due to corona so an opinion would be much appreciated",
        "input": "",
        "output": "hi it is always dangerous to predict and take action in case of their own health the tinnitus in your case is not due to earwax it may be due to the blockage of the eustachian tube connecting middle ear and back of the nasal cavity its primary work is to equalize pressure between environment and middle ear this is also a prediction the real cause can be found after an ear examination as you have already mentioned nowadays it is a little hard to go for treatment what you can do is practice some no side effect formulas steam inhalation start sipping lukewarm water for tinnitus use resound relief app which has so many natural sound combos use that in speaker mode never use earphones do not put oil and do not do the treatment on your own unknowingly you are worsening the conditions"
    },
    {
        "instruction": "hello doctor over a year ago I scheduled an appointment to try to understand why I was rapidly losing weight my gastroenterologist ran some tests and did an upper endoscopy as well as a hide scan the upper turned out negative for all tests however the hide scan reported that my gallbladder was functioning at approximately 40 my gi then recommended a cholecystectomy as my gallbladder was not functioning properly he did also suggest that I could try to repair it with my diet but then told me it would likely be fruitless and I should get the procedure right away I did so promptly and experienced the typical symptoms I am concerned about this only now because I believe I have postcholecystectomy syndrome due to the surgery this would not be an issue relatively however I believe that my rapid weightless was due to extreme stress and was mostly psychological it seems to me that my practitioner should have advised me that gallstones occur commonly when rapid weight loss occurs furthermore I believe that I could have benefited much more from keeping my gallbladder on a rigorous healthy diet and prescribing a biliary control the latter that has taken place has resulted in a year long constant struggle to be happy and healthy",
        "input": "",
        "output": "hello well I understand that a year back you have been diagnosed with gallbladder dyskinesia or dysmotility as reported by hide scan I was wondering whether you have weight loss as the only primary symptom or associated with abdominal pain because gallbladder dyskinesia most commonly causes pain and diarrhea rather simply weight loss or one should have to have evidence that the weight loss was due to gallbladder dyskinesia and not otherwise then surgery was probably the right decision I cannot figure out whether you have other symptoms or not and now what sort of typical symptoms you feel suggesting you as postcholecystectomy syndrome pas I can understand actually that symptoms of pas can be at times very distressing and unbearable the common symptoms are bloating after meal frequent reflux or pain in the upper part of the belly diarrhea after meals or sometimes otherwise and this even can cause weight loss this syndrome basically occurs secondary to an excessive pool of bile stored within a small bowel instead of gallbladder which is otherwise a sole bile reservoir but pas usually resolves within some time the maximum it can take is two to three years until the time your small intestine is adapted to it you can try tablet cholestyearamine go twice daily hour before meal or hours before meals this is a bile sequestrant and will bind and remove excessive bile from the gut to be honest I still do not understand the reason for your surgery year back but cannot completely argue with physician because I was not and he was the best person to decide while understanding your condition at that time postcholecystectomy syndrome follow up in two weeks"
    },
    {
        "instruction": "hi doctor I am facing some depression issues and not able to sleep during the night after two or three hours I can sleep during this time I not able to control myself and crying like anything sometimes it is making me so crazy and angry as well please help",
        "input": "",
        "output": "hello how long have you been experiencing these symptoms like poor sleep excessive crying feeling angry etc did they start after any stressful event I can understand it can be difficult having these symptoms but with the right support you will get better it looks like your poor sleep is related to your emotional disturbance helping you calm down will improve your sleep and overall emotional wellbeing share your feelings and thoughts with trusted family and friends talking to a trusted family member or friend can lower stress significantly exercise regularly as it is the best mood regulator even a brisk walk of 15 20 minutes daily will restore your spirit and help to sleep better try relaxation activities like deep breathing progressive muscle relaxation daily be kind towards yourself treat yourself like how you will treat a friend who is going through a difficult time avoid watching tv electronic screens before bed time it will worsen your sleep if your depression issues are severe and persistent consult a doctor for further assessment counseling therapy and sometimes medication may be needed"
    },
    {
        "instruction": "hi doctor my mother is 58 years old her periods stopped in 2015 later she got her periods once in a year now from the last year blood like brown fluid came from her vagina when she go to toilet she do not feel pain or any other symptoms all test came positive and nothing seen in ultrasound no infection and no fibroid also please guide",
        "input": "",
        "output": "hello blood mixed vaginal fluid in the postmenopausal women need to be evaluated cautiously and carefully although the common cause of such bleeding is due to deficiency of hormones once menopause is achieved the possibility of cervical and endometrial cancer needs to be ruled out ultrasound will not detect anything abnormal if the condition is still in an early stage for which microscopic evaluation of the cells needs to be done to see for any cancerous changes rarely the bleeding can be from the urinary tract or from the rectum which could be mistaken as vaginal bleeding too you need to get her a pap smear and hav human papilloma test testing done along with endometriosis evaluation to rule out both cervical and endometrial cancer possibility if possible please share her ultrasound reports to look for her endometrial thickness value please do not ignore these tests if not done previously I am assuming by getting her evaluated you have already gotten her examination done with a gynecologist if not then please make a visit to your gynecologist for her examination pap smear and hav testing endometrial aspiration with endocervical curettage us ultrasound for endometrial thickness"
    },
    {
        "instruction": "hello doctor I have soreness in vaginal lips for the past four days and having a fever of 102 for the past two days I had a preauricular sinus infection drainage procedure done I took 45 days of antibiotics taxi for 20 days augmenting 625 for days cecil 500 for 10 days and lizobact 600 for 14 days I stopped taking them on this sunday after ear properly healed",
        "input": "",
        "output": "hello welcome to icliniq com I have gone through the attachment picture based on that it appears like a genital yeast infection or other possibilities can be a developing bartholin cyst abscess which can be confirmed only by examination when your gynecologist can feel any cyst or collection of pus there a check up with gynecologist in person would help you rule this out but the yeast infection never causes high grade fever of 102 and less commonly with bartholin cyst too unless infected I would like to know if you are having any increased frequency of urination burning while passing urine if so that could be a cause for your high grade fever also as you have mentioned about the preauricular sinus infection being treated for a long time it would be advisable to check with your doctor regarding any recurrence of the infection at the same site if none of these are a possibility then it would be advisable to get fever workup investigations to be done to find the cause for your fever check with your physician for any other signs which can be the cause for your fever like cough cold gastric upset vomiting etc fever under evaluation urine routine and microscope urine culture and sensitivity complete hemogram let liver function test rat renal function test serum electrolytes peripheral smear for malarial parasites dengue ns1 egg and i'm serology tidal test tablet doll paracetamol 650 my sos for fever candid ve cream local application at the sore area follow up with the blood test review with the doctor for ear infection issue check up"
    },
    {
        "instruction": "hello doctor I generally have regular periods and for the first time I had my period 12 days earlier this month and it is continuing for more than 10 days I am currently on sepia 200 kindly help",
        "input": "",
        "output": "hello before we could determine the exact cause for this prolonged bleeding I would like to know a little more details about your previous cycles as you said you always had regular cycles just wanted to know if your previous period was on time and had a normal pattern of bleeding or was it scanty also whether you are a sexually active individual and if so whether any chances of pregnancy could be there if there is any such doubt it would be advisable to take a home pregnancy test sometimes the scanty flow of implantation hemorrhage could be confused with a normal period and the actual bleeding could be a sign of threatened miscarriage if pregnancy is ruled out by checking urine pregnancy test or if not sexually active the hormonal disturbances of thyearoid or prolactin hormones and sometimes lifestyle related problem that is cos also can cause such irregularities in periods also stress can be one of the reason for hormonal changes and thus causing disturbances in menstrual patterns basically this is suggestive of anovulatory cycles so to find out these you need to take certain blood tests I would like to know if you had any recent weight loss or do you face frequent acne and unwanted facial hair growth problems any headaches or visual problems these symptoms may provide some clues to the underlying problem which is causing a delay in periods for you please revert back to me with the necessary details for discussion so as to find the appropriate cause for your problem and start the necessary treatment to control the bleeding ultrasound abdomen and pelvis home pregnancy test if sexually active thyearoid hormone disturbances cos submucosal fibroids polyps incomplete miscarriage after discussion and evaluation"
    },
    {
        "instruction": "hello doctor I have pain in the bones joints of hands and feet especially in the morning upon waking up it has been consistent for the past couple of months please help",
        "input": "",
        "output": "hello I have gone through the reports there is a high ra factor and low vitamin I would like to take a few more details on the history part but it would be better if someone can examine the joints as it is a long treatment which patient will need so she should be examined properly before commencing the drugs for it does she have early morning stiffness if yes then for how long any dry eyes or dry mouth any oral ulcers any hair fall any recent changes in mood with irritability any history of tending to forget things early"
    },
    {
        "instruction": "hello doctor I have a large nose which I do not really mind however I have one nostril bigger than the other and my nose looks bent at the top it has been like this since around age 15 what could cause this I cannot recall any trauma other than having large cysts or spots on my nose which I would squeeze",
        "input": "",
        "output": "hi the general appearance of the nose happens to change from the beginning until the age of 18 after which it more or less remains constant unless and until there has been an external source of injury to deform the nose if you feel that your nose looks way too weird and it is way bothering you too much you might require a corrective surgery that we call as a rhinoplasty now depending on whether the area in concern has to be reduced or augmented it depends on what type of nose job you want to get done and the surgeon will operate accordingly rhinoplasty is preserved for patients who know what changes they really have in mind and understand that a near close picture can be attained through surgery most nose job surgeons these days do have software wherein you can assess whats the abnormality in the nasal appearance what changes you want and how would it probably look after the surgery all the abnormalities mentioned above can be effectively resolved through operative rhinoplasty and conservative techniques do not really fetch long term results"
    },
    {
        "instruction": "hello doctor I am a 24 year old female my weight is 57 keg height is 163 am my complaint is face chubbiness and I gained about keg for the past months and the main problem is that I am missing my menses this month my lap was on 15th april as per gynecologist advise I did abc fasting sugar ash prolactin hug total testosterone dheas fish oh us pelvis for pod doctor advised to take primolut but I have not yet started the tablet do I need to start that and what is the line of treatment all reports were normal except the two ash 13 740 dheas 53 19 please help",
        "input": "",
        "output": "hello yes you can take the primolut tablet as advised by your gynecologist as your periods have gotten delayed by almost more than 45 days it is unlikely that they would come naturally even if it does it may not be similar to your natural menstrual pattern this is because this is an anovulatory cycle meaning no ovulation must have occurred in this cycle usually when periods come after such a delay it could range from spotting to scanty flow to excess flow or sometimes prolonged bleeding which may need hormonal medications to stop the bleeding I would like to know if you face any acne or unwanted facial hair growth problems if so then you must be having cos even if the us is normal and yes you definitely need to start treatment for your hypothyearoidism as your ash thyearoid stimulating hormone level is high thyearoid hormonal disturbance are quite common with cos polycystic ovary syndrome and also it can disturb the menstrual pattern too so definitely you need to start your thyearoxine replacement medications dheas dehydroepiandrosterone is low so there is nothing to worry about that as you complained about weight gain over the recent few months it would be advisable to reduce your weight do regular exercises and eat a proper healthy diet I hope this helps"
    },
    {
        "instruction": "hello doctor my mother is 65 years old diabetic she has hypertension hypothyearoid and thalassemia minor she is anemic too for 10 days she has been having alternately bloated stomach diarrhea constipation and lower back pain what could these be symptoms of",
        "input": "",
        "output": "hello I can understand you must be very upset about your mother for her troubling symptoms you know diabetes hypertension are chronic ailments that can affect every system of the body some of these effects particularly of diabetes are related to the gastrointestinal tract git certain conditions like diabetic gastropathy involving the stomach diabetic enteropathy when involving small bowel can cause bloating alternate diarrhea with constipation such as in her case it is highly likely that she has one of two of above mentioned conditions but to be on the safe side I will suggest you some tests as we can rule out anything other than this meanwhile start her on tablet digestive metoclopramide 40 my once daily half an hour before meals start her on tablet rifaximin 200 my thrice daily for three weeks this is a safe antibiotic which will correct her abnormal bacteria within the small and large bowel this will help her control her production in the long term use fibrocol or any other fiber which is available two tablespoons full with water once daily with water and the most important of all tight control of her sugars since the problem is secondary to diabetes once diabetes is controlled fairly enough her symptoms improve itself I hope this helps diabetic gastroparesis diabetic enteropathy small intestinal bacterial overgrowth functional bloating and gas complete blood count abc hba1c glycated hemoglobin ash thyearoid stimulating hormone ft4 ft3 vitamin b12 and rec folate serum albumin bun creatinie electrolytes calcium phosphorous magnesium serum cop stool for ova and parasites stool for fat globules and reducing substance stool for difficile stool for fecal calprotectin stool for pyloric antigen follow up after week of use of above medication to see how she respond meanwhile get above mentioned investigation please do not get frightened seeing list of investigations they are just a through overall assessment of her condition if she already had some of these tests before then please do not get those"
    },
    {
        "instruction": "hello doctor I might be suffering from psoriasis I have a flaky reddish itchy hairline back of my ears and almost on my temples how can I treat that at first I thought it was dandruff but as I started to see the flaky skin emerging towards the hairline and gradually towards the back of the ear and the temples I realized it was something more so I googled it and I fear it is psoriasis that I do not have much knowledge about but I would like to take professional help to deal with this issue",
        "input": "",
        "output": "hi thank you for providing information kindly hold on a minute I am typing detail answer and explanation of your query"
    },
    {
        "instruction": "hi doctor I had a total free spa test done and these were the results spa spa free 49 free spa 19 what does this mean",
        "input": "",
        "output": "hello spa prostate specific antigen is only a screening test that can be raised in any prostate abnormality coming back to your query as your total spa levels fall in the grey zone of 10 free spa is done if free spa is more than 25 chances of you having ca prostate decreases to less than if your free spa would have been less than 10 biopsy would have been recommended so when your free spa is 19 so chances of you having ca prostate is relatively less and you can be kept on three months spa and free spa follow up I hope this helps"
    },
    {
        "instruction": "hello doctor I am dealing with sciatica in both of my legs the symptoms I am dealing with are burning tingling sharp shooting pain in both legs aching and pain in my feet it is now becoming hard for me to stand or be on my feet a long time the sciatic flare is from a slip in fall accident I had six years back I was diagnosed with lumbar facet syndrome",
        "input": "",
        "output": "dear sending love and healing vibes looking into your problem we need to understand the basic physiology about the facet joint facet joints helps healthy movement and intervertebral discstability for each motion segment the aging osteoporosis traumatic injury can damage the facet joints and is the leading cause of back pain known as facet joint syndrome therapies include medial branch blocks intraarticular within a joint steroid injections and or radiofrequency ablation rfa percunateous endoscopic lumbar discectomy meanwhile I recommend you to take these drug which helps reduces the swelling of disc and neurogenic problem thank you"
    },
    {
        "instruction": "i had laparoscopic surgery week in a half ago and also he an ercp done for a stone stuck in the duct ok a week goes by I had some stomach pain bloating and diarrhea but most of that is gone now this morning I wake up and had one of the most excruciating pain in my shoulder that radiates into my shoulder down to the bottom of the right blade I also have been suffering from motion sickness as well my family doctor prescribed me with anti vert medicine and some muscle relaxants and pain killers tylenol do not do much but percocets seems to work a little but the pain is still in my shoulder and neck its extremely hard to turn to the right because of my pain in my neck I also have issues maintaining balance because I get so dizzy as if I have some sort of vertigo are these conditions normal after gallbladder surgery what exactly am I suffering with do I have irritation to one of the nerves like the vagus nerve",
        "input": "",
        "output": ""
    },
    {
        "instruction": "i have had a history for years of abusing co codamol often taking ex 30 500mg several times a day I have some mild right upper quadrant pain that is persevered for a few weeks after stopping all codomol use over the last year I have had abdominal al ultrasounds many liver function tests and urinalysis which have all come back in normal ranges or clear I have been told sometimes the liver can still be damaged but still present normal liver function tests and it can be hard to see on ultrasounds is there a chance I have some liver damage",
        "input": "",
        "output": "hello I welcome you to icliniq first of all I give you a vote of appreciation that you were able to stop using co codamol for chronic users of these opioid medicines it is merely impossible to stop well once you stopped taking these medicines it is unlikely that the effect will remain within you and can harm you in long term so I do not think that you should be worried about this now the pain you mention which has started nearly at the time of stop of these medicines suggest narcotic bowel syndrome nos in nos the patient became insensitive to the usual doses of opioids and kept on increasing the doses to relieve the same amount of pain intensity with subsequent higher doses this happen because of chronic use of these medicines would potentially increase the numbers of receptors controlling pain once the medicine is reduced in dose or completely stop in your case a rebound pain develop and it remain until another painkiller or similar opioid is restarted so actually it is vicious cycle pain and increased dose cycle is sometime inevitable and requires a close monitoring of switching to other safe painkillers while at the same time decreasing the dose of opioids the treatment is termed as opioid detoxification therapy to be honest I am not an expert in it but tried my best to explain to you to help you understand your symptoms if you want further guidance on how to control your pain which is possibly be secondary to nos I suggest you to meet with pain management specialist in near by hospital since you already stopped the medicines I suggest to use paracetamol which is rather safe medicine for controlling pain plus you can use cap pregablin 75 my at nigh time daily to control your symptoms I hope this will help you take care and have a good day narcotic bowel syndrome nothing pain assessment only functional abdominal pain syndrome nerve entrapment syndrome nos tab paracetamol which is rather safe medicine for controlling pain plus you can use cap pregablin 75 my at nigh time daily to control your symptoms follow up if you have any concern or want to discuss nos in detail and its management"
    },
    {
        "instruction": "hello doctor I have this hard crusty stuff around the perimeter of my ear canal it itches and if I scratch it will come off but it sometimes causes clear fluid to drain out of my ear it also dissolves if I get water in my ear I am currently on amoxicillin for a tooth infection",
        "input": "",
        "output": "hi probably you have a subclinical otitis externa in this condition there will be a very subtle infection in the ear canal which leads to an intense amount of itching with the use of earbuds the raw area gets exposed and flares up the irritation even more impacted wax can also be a source of the irritation in the ear this is often associated with fullness and pain you can follow the advice mentioned below please stop using earbuds henceforth tablet levocetirizine 10 my one tablet at night for the next 10 days wax dissolvent ear drops three times a day for the next five days keep the ear dry please wear a shower cap while bathing the scab will dry and fall off on its own so there is no need to keep touching it you can continue amor antibiotic as it has nothing to do with the current problem if there is anything more you want to know please do inform me"
    },
    {
        "instruction": "hello doctor I had an sad test done five or six days after unprotected sex with a new partner the tests came back negative but I have learned that you should wait for different windows of time before getting tested for certain studs this was about seven months ago today I went to my gynecologist to get tested again for chlamydia and gonorrhea to ease my mind she said that the original tests were likely accurate given that just barely enough time had passed to be tested but suggested to get another test for peace of mind I did not think until after my appointment to ask if the doxycycline I am currently taking for my acne 100 my twice daily would alter the results I am wondering if the results I get in a week time will be accurate and if you think the original test was likely accurate in the first place",
        "input": "",
        "output": "hello I have gone through your history and understood your concern as the incubation period of organism are different in every infection usually first test should be done after 10 15 days of exposure as your is done little early but as you are not having any other symptoms along with this we can rely on your test results but doxycycline may affect the test results"
    },
    {
        "instruction": "hello doctor I have abdominal pain fullness nausea weight loss leg edema I would like a second opinion and another interpretation of my scans please in february I started having bad abdominal fullness nausea vomiting anemia and weight loss for a few weeks then I felt a little better but then I get the same again I am worried about possible ovarian cancer as three of my aunts had it my mom and five aunts had breast cancer and my grandma died of peritoneal cancer of ovarian origin when I looked at the it scans it seemed of pretty poor quality compared to the images I see online please help",
        "input": "",
        "output": "hi welcome to icliniq com thank you very much for providing detailed history and uploading all the blood tests blood tests give us many clues you definitely have less red blood cells than expected but also you have low white blood cell count that definitely makes me think about some problems related to the bone marrow where those cells produced with the production of less red and white blood cells it is also expected you have a low level of blood proteins let me tell you about your abdomen pelvis scan quality is good they started with noncontrast then got venous routine phase with also additional delayed phase liver gallbladder spleen pancreas bilateral adrenal glands and kidneys look normal uterus and bilateral ovaries are normal bladder is normal what is abnormal intraabdominal fluid ascites which explains your fullness good news is no evidence of ovarian cancer or any other masses I highly recommend you to see a hematologist and maybe sample bone marrow I strongly believe you have bone marrow disease regarding to production of blood cells if you would like to read about it might be some mild form of pancytopenia although your platelet number still looks low normal bone marrow diseases bone marrow biopsy bone marrow diseases"
    },
    {
        "instruction": "hi doctor I am having a problem with sinusitis my doctor ordered me to take co altria 10 my at bedtime I have taken it at am and currently I am experiencing dryness of mouth and headache what to do is this serious I am also taking cefixime 200 my twice daily sinupret thrice daily and nasoflo spray",
        "input": "",
        "output": "hello dryness of mouth might be due to mild anticholinergic effects it may sometime cause drowsiness and also depends on person to person this would take a few days to adjust you can continue this drug along with steam inhalation twice daily"
    },
    {
        "instruction": "hi doctor I am a 37 year old unmarried female with no sexual activity I have been experiencing problem in periods that I have got the period twice a month in the last month without any pain and scanty period my fish is 29 miu my oh is 69 miu my prolactin 6 ng my testosterone total 18 ng dl ash ultrasensitive 470 uiu my usually my cycle is 35 days with three to five days period and I experience pain too I am worried because I am getting married soon and becoming infertile I want to have my own babies I have attached my today blood reports third day of period",
        "input": "",
        "output": "hello welcome back to icliniq com I have seen the reports your hormone levels are normal I would like to know more about your menstrual cycle is it this month or every month you are getting frequent periods I would like to get you a ultrasound pelvis done"
    },
    {
        "instruction": "hi doctor I have been using minoxidil topical solution twice a day on my beard for well over three months to fix some patchy spots under the lip and cheek region after the first month I had hair fall in my scalp this hair fall is increasing in numbers and I am losing more than 100 hair follicles now a days I also want to point out that I use various essential oils with carrier oils in my scalp for more than two years I have many questions kindly provide me detailed information can I apply essential oils on my beard peppermint hibiscus and castor oil in the meantime of applying minoxidil also recommend me some essential oil that are adrogenic nature does all the fallen hair in scalp during this minoxidil period regrow and is there any natural way to stop this hair fall during this period how long does this hair loss lasts and what is this cause for this hair loss since I am only using minoxidil in my beard should I bald trim my head after this telogen phase since I have a long hair 2inch will I lose my hair after stopping the minoxidil usage",
        "input": "",
        "output": "hello yes you can apply but according to our science oil does not act on the roots they will grow automatically nothing more you have to do it can extend up to months hair fall has nothing to do with the hair shaft minoxidil increases the blood flow of hair follicles in the scalp this increase blood flow would persist as long as you are applying minoxidil once stopped you will return to the same stage of hair loss as you would have been without minoxidil I hope this helps"
    },
    {
        "instruction": "hello doctor I have severe headaches neck pain and sharp pain around the chest my query is related to brain meningioma and I am on drugs for epilepsy please help",
        "input": "",
        "output": "hello welcome to icliniq com the patient has a small frontal base lesion that looks like a benign tumor meningioma I would suggest an eg electroencephalography in order to investigate if the epileptic seizures are due to the tumor in that case I would suggest tumor removal if epileptic seizures persist if the epileptic seizures are not related to meningioma I would suggest only mri every year I would also like to send me some images"
    },
    {
        "instruction": "hello doctor I developed intermittent exotropia in late adulthood I am 29 years old and this started about two years now should I concern about it",
        "input": "",
        "output": "hello welcome to icliniq com as you have described you have started intermittent exotropia at later age right see that is called strabismus in medical terminology usually we can treat it if it is by birth but in your case situation is different so there can be some neurological issues which is leading to exotropia so my advice is you should consult strabismologist as well as neurologist also just to rule out the cause of exotropia first you should consult strabismologist and then neurologist so we can fine out the reason for it and depending upon that you can plan your treatment can be idiopathic can be neurological complete ophthalmic assessment cranial nerve palsy squint as described above after week"
    },
    {
        "instruction": "hello doctor I am fat my weight was 130 keg and I reduced 15 keg in five months I was having alcohol and smoking for almost 10 years I had an ultrasound where liver is enlarged more than 20 am and I had a fibroscan as well 353 and 18 median kpa kindly suggest",
        "input": "",
        "output": "hello I can imagine how upset you must be about your overweight and liver issues well I assume you now have a thorough idea of how this weight bears an impact on your liver and with such amount of weight it is not uncommon to have a fatty liver disease with enlargement of liver size the normal liver size should be no more than 13 am despite the fact you have severe morbid obesity thankfully you deserve a vote of appreciation for struggling so high to reduce your weight by 15 keg this is a good sign by the way I would urge you to continue this in future whatever you were doing for the weight reduction since you did not mention whether you still having alcohol and smoking it is important to know that fatty liver plus alcohol can both damage the liver and the impact is much higher if both risk factors are combined I should strongly recommend you to reduce the alcohol intake if still taking or completely stop it your liver may not be able to tolerate more insult because of alcohol now coming to the numbers which you have shared the spa value more than 12 is suggestive of the development of fibrosis which is not a good sign however this value is often erratic or falsely high if someone has obesity or fat within the liver as may be in your case to confirm whether you have that degree of fibrosis you have to get a liver biopsy which can tell the exact grade of fibrosis and can differentiate whether the insult to your liver is because of alcohol you had in past or because of fat due to obesity the cap value of 353 is suggestive of the amount of fat you have in the liver this can however indirectly confirm the damage to your liver is rather secondary to fat and not due to alcohol but again this has to be confirmed on liver biopsy if you are not inclined to liver biopsy I suggest you to continue with the weight reduction strategy completely avoid alcohol intake and keep monitoring your liver function tests and fibroscan every six months alcohol related liver disease plus obesity and fat induced liver disease complete blood count liver function test hbsag anti hav antibody serum ferritin serum iron total iron binding capacity transferring saturation ash ft3 ft4 serum carbohydrate deficient transferin cdt levels serum albumin total protein and ag ratio serum creatinine bun electrolytes alpha fetoprotein app weight reduction alcohol abstinance follow up after investigation to propose plan of action follow up to provide more information and after investigations or earlier if required"
    },
    {
        "instruction": "hi doctor I have enlarged lymph node on the neck fac says granulomatous lymphadenitis consistent with koch afb stain negative in ultrasound it is hypoechoic lesion of approximately 29 34 my abutting the left submandibular gland but appear separate from it similar lesion of approx 14 23 my is seen adjacent to this mass I have been taking rifampicin isoniazid rifampicin ethambutol pyearazinamide for days and I have also consulted another doctor who says that it needs surgery and asked for digital ray of chest I also gained weight please suggest me should I go for surgery currently I am on forecox 150 mycobutol 400 benadon 20 my and neurobion",
        "input": "",
        "output": "hi I can understand your concern according to your statement you have been suffering from to lymphadenitis and taking 4fdc antitubercular drugs for the last days your query is whether surgery is needed for your lymph node or not antitubercular medications are enough for curing to lymphadenitis surgery is needed in rare cases surgery can be done for diagnostic purposes or therapeutic purposes sometimes fine needle aspiration or biopsy of the lymph node are needed for proper diagnosis of to lymphadenitis is known as surgery for diagnostic purposes if to regiment for months or months or months are failed to subside the lymph node then surgery is an option again during to treatment if there is any change in size shape or presence of discharging sinuses or turn into malignancy then surgical drainage or removal of lymph node may be needed otherwise antitubercular medications are enough to treat to lymphadenitis your physician has advised you to do a car chest ray for the detection of chest involvement you should undergo car again prednisolone 40 my day for six weeks followed by gradual tapering over the next four weeks along with your current to regiment are enough to cure your to lymphadenitis without any surgery"
    },
    {
        "instruction": "hi doctor I am a female in my mid 20 I have noticed a weird pattern on the back of my arm today I do not know how long it has been there it does not hurt or do anything just wondering what it is and what I need to do about it",
        "input": "",
        "output": "hi I have seen your photographs and to me it seems like pityeariasis versicolor it usually occur in humid weather or sunny season apply the following medications and it will be helpful increased humidity or sweating pityeariasis versicolor ketoconazole cream for local application in the evening and morning over the affected area"
    },
    {
        "instruction": "hello doctor I have been having pain around my lower ribs towards the back side left side since the past eight days the pain gets worse while lying down and trying to change sides in the night it also hurts while sneezing or coughing feels better if I cough or sneeze by holding the area with my hand it hurts a little sometimes while deep breathing while sitting or standing straight the pain is almost not there and also it does not hurt while bending forward or backward but it hurts a little while bending sideways I did a course of hifenac max for days and the pain did come down slightly however it again got bad last night I was diagnosed with ankylosing spondylitis in 2009 since then I have had two episodes of severe pain in my lower back right side sacroiliac joint but it has never pain in the area of ribs like what is happening now I have also had multiple episodes of uveitis over the past eight to nine years I am hla b27 positive I do not have any other symptoms my appetite is fine and I do not feel any other discomfort my motion is regular also I am not on any regular medication my be is normal measured using an electronic commercial machine at home and my vitals were mostly normal apart from slightly high cholesterol when I did my health check up years back",
        "input": "",
        "output": "hi in the light of the fact that you are ha b27 positive the pain that you are experiencing is due to the same problem this is called enthesitis and it occurs due to inflammation at the attachment of muscles to bones so the treatment also remains similar to that of as you need to take a full dose of said non asteroidal anti inflammatory drugs whichever suits you best for the present you could take voveran so 75 twice daily with an antacid like pantocid if things still bad sulfasalazine may be added calcium and vitamin must be continued regular physical exercise is a must to control this disease please make sure you follow this I hope this helps"
    },
    {
        "instruction": "hello doctor I am having intense itching on my scrotum and penis and along the sides of thighs and also some hard pimples are there on my scrotum please help",
        "input": "",
        "output": "hi as per your history there are two possibilities either you have scabies or fungal infection and treatment of both are different before deciding the treatment I advise you to send me a photograph of the affected area"
    },
    {
        "instruction": "hello doctor I have numbness pressure following a nerve path and tingling in the head while I concentrate more it has been there for eight years and I have done two iris so far and that came back negative",
        "input": "",
        "output": "hi I understand your problem but it is difficult to arrive at a conclusion with limited information please tell me in detail tell me where exactly you have numbness I mean where in the head on top on right or left or front or back of the head which nerve path do you feel pressure is it in the whole head or on the side similarly where exactly is the tingling do you have nausea or vomiting sensation do you have blurring of vision or irritation with light or sound did you take any medicines in the past for the same if yes what was the result how is your sleep what is your profession"
    },
    {
        "instruction": "hi doctor this is for my dad and we found out that he has diabetes he became very worried which makes him difficult to breathe and cannot get enough sleep and rest at night he had stomachache and he used to skip meals and drink coffee and soft drinks after a blood test we found that he has diabetes I cannot get enough sleep and worried he always feels tired and anxious with breathing difficulty especially if alone he is currently taking metformin and omeprazole",
        "input": "",
        "output": "hello perhaps your father has misperception about the disease and that is causing his anxieties and worries it is unfortunate he developed but it does not mean it is the end for him as long as he takes his medications does his routine laboratory workups and checks with his physician then there is nothing much to worry about he must be informed that as long as he consults with his physician regularly then there will always be an expert making sure he is doing alright and making sure that no complications will develop because of the disease if the pandemic is causing more worries it is normal he might be aware that his condition puts him at a disadvantage compared to a normal healthy individual but as long as he adheres to social distancing proper handwashing techniques precautionary measures such as wearing masks and pipes personal protective equipment if needed then there is a low risk he might acquire the disease remember diabetes and couid 19 both are preventable diseases he needs to take care of himself properly and to do this is by following his doctor orders and guidelines during the pandemic however I am worried about the declared respiratory rate of 86 normal is at 18 does he smoke any cough or colds previous hospitalizations at this rate it is best to bring him to the er for further evaluation when counting for the respiratory rate it is the one cycle of the rise and fall of the chest so respiratory rate is equivalent to rise and fall of the chest"
    },
    {
        "instruction": "hello doctor I am suffering with psoriasis please suggest treatment",
        "input": "",
        "output": "hello I saw your photograph you are having psoriasis and I would like to tell you about your disease psoriasis is a relapsing condition and usually exacerbates in winters it will not spread to other people by touching it will not affect your internal organs it is treatable but not curable it will get cleared but can reappear nothing to worry about it as it is in limited area only application of topical steroids will suffice but if there is more body involvement then we will start oral medicines presently I am prescribing your treatment and you can review in 20 days papulosquamous inflammatory disorder liver function test and complete blood count chronic plaque psoriasis topical clobetasol propionate ointment for local application in evening tablet levocetirizine my evening conut oil for local application in evening and morning use oil or moisturizer keep skin supple review after 20 days"
    },
    {
        "instruction": "hello doctor I am 17 years old and I usually suffer from chest pain and burping after eating something or drinking I do not know what is this sometimes shortness of breath occurs for a short period of time I am a little worried about this when I searched this on google there were things like herd acid reflux heart attack and all can you please help me out with this problem",
        "input": "",
        "output": "hi I see you are worried about your chest pain do not worry your symptoms particularly relating to food connects your chest pain to a gastric related problem and it fits into herd gastroesophageal reflux disease in which there will be acid reflux which in turn causes pain due to intolerance of food pipe to the acid herd tablet pantoprazole levosulpiride tablet twice daily half an hour before food for two weeks syearup sucralfate oxetacaine 10 my one hour before food three times a day for two weeks avoid spicy food avoid heavy meals do not lie down immediately after taking food"
    },
    {
        "instruction": "hello doctor I am a 42 year old female I have allergic bronchitis since childhood I take asthalin and beclate 200 rotacap and now in this couid circumstances doctor suggested to take tablet monte la I took those tablets regularly in the first week and now I take on alternate days but then also I feel heaviness in my throat I feel uncomfortable with my throat feel I take inhaler also when needed and not regularly I have pain in my body from neck to whole body and feel like ants walking from the right side down the body please guide me",
        "input": "",
        "output": "hi I see you are more disturbed by your throat problem at present I would advise you to continue asthalin rotacap and stop beclate rotacap at present couid situation because steroids increase the chances of acquiring infection and monte la can be continued on a daily basis are you suffering from a fever if any fever present you need to get checked yourself for couid 19 follow the medicines as advised below and review them with investigation reports abc complete blood count uri upper respiratory tract infection tablet azithromycin 500 my once daily for five days before food betadine throat gargle twice daily tablet aceclofenac and serratiopeptidase twice daily after food for three days mucaine gel tablespoon thrice daily before food review with investigations"
    },
    {
        "instruction": "i have been having a bitter taste upset stomach dizziness for about a month a month ago I got labs everything was within normal ranges my lymphocyte percentage was at 54 a week ago I have the same symptoms and lymphocyte is at 56 I am told its anxiety is that rise in lymphocyte normal",
        "input": "",
        "output": "hi your lymphocyte percentage is not that significant to worry about still it will be more informative if you can upload the full abc panel for better analysis your symptoms could be acid reflux induced gastritis or due to a stone in the gall bladder we need to investigate more before labelling it as anxiety kindly do the investigations mentioned below and review acid reflux abc ribs let us abdomen herd cholelithiasis pantoprazole levosulpiride stab twice daily before food for weeks avoid spicy and heavy meals avoid high fatty meal"
    },
    {
        "instruction": "hello doctor I am a 23 year old male I have been feeling a lump in my throat for quite some time now upon inspection I found it is located on the palatoglossal arch on the base of the tongue it is painless and does not cause any problem while swallowing food or liquid but there is a feeling of irritation sometimes I quit smoking for four years now and consume alcohol moderately I have attached the pictures of the lump I am afraid it is cancerous",
        "input": "",
        "output": "hello I have seen the pictures the growth is just a small salivary gland papilla your symptoms seem to be due to reflux laryngitis and not due to the growth I will be give the treatment for reflux laryngitis but if you have any symptoms like postnatal drip nose block or headache in the morning please revert back treatment for reflux avoid spicy and very hot food items and dairy products drink plenty of water take dinner at least two hours prior to your sleep tablet pan 40 pantoprazole twice daily on an empty stomach for one week do not do gargling"
    },
    {
        "instruction": "hello doctor I have had the following symptoms every few months for a long time now frequent urination burning in perineum area and discomfort after urination I have been treated for general urethritis three times in the last year I do not have any studs as I have been tested these symptoms come along with no apparent cause what is this and what should I do",
        "input": "",
        "output": "hello it can be prostatitis do you have a history of unprotected sex with a new partner before the start of symptoms is ultrasound abdomen has been done before kindly attach reports any report on urine culture you mentioned that you have been treated thrice which antibiotic has been given to you do you have a burning sensation after ejaculation also are you a diabetic or hypertensive"
    },
    {
        "instruction": "hi doctor on my penis I have a small fleshy lump and I have had it for around 12 months my girlfriend has had an sad check within these 12 months and the tests have come back clear so I do not think it is warts I think it may be a skin tag I have been applying tea tree oil to it the past week which has dried it up and made it feel a bit looser the reason I am getting in touch is because I have started to develop black marks on my penis they are very small but I want to make sure it is not connected to the lump",
        "input": "",
        "output": "hi I get to see you ate worried about the lump in your penis I have gone through your pictures not clear though it looks very small considering your statement to be present for the past 12 months with such a small size without any growth or difficulty in skin retraction it is not a significant problem still I need a bit more information for a better understanding as I have mentioned had it been the same size for the past 12 months is there any color change over the lump or redness or pain over the lump do not mistake me for this how many sexual contacts you had only your girlfriend or beyond her was there any watery or pus discharge anytime from the lump do you have any burning sensation while passing urine or cloudy colored urine and regarding the black marks do you have any itching sensation over the black marks are the black marks increasing in number and size do you have a fever it will be helpful to guide you better if you can upload the investigations you have done for sad check and more clear picture of your lesions review back with the investigations advised below if not previously done and upload your previous investigations abc complete blood sugar ribs random blood sugar urine routine tablet amoxicillin and clavulanic acid 625 my twice daily for five days fexofenadine twice daily for five days"
    },
    {
        "instruction": "hello doctor a few months now I have been experiencing discomfort and bleeding after being fingered it does not really happen during sexual intercourse though I have an urge to urinate even after urinating and it stings and the urine will sometimes come out at different random times I have had two unis which I have felt the urine sensation before but the bleeding is what I am most concerned about also we always use protection why am I experiencing bleeding and discomfort after being fingered I am currently taking lamotrigine and adderall",
        "input": "",
        "output": "hello have you noticed the bleeding while you urinate also or else only after fingering in view of your past episodes of ti urinary tract infection it seems the same has recurred again as suggested by the pain after urinating on top of that since women urethral opening and the vagina are very near fingering might spread the infection there also and some injury during the fingering might have caused the bleeding please take the following medications and refrain from fingering and sexual activity until the pain bleeding and ti subsides meanwhile do the following test to confirm urinary infection also please attach the previous prescription where lamotrigine and adderall were prescribed do you have discharge per vagina and pain during intercourse as well urine for routine and microscopic examination and culture sensitivity test vaginal swab for culture sensitivity us ultrasound lower abdomen and pelvis with peru postvoid residual urine tablet nitrofurantoin modified release 100 my tablet twice daily after breakfast and dinner tranexamic acid 500 my tablet twice a day sos if there is bleeding syearup urinary alkalinizer disodium hydrogen citrate two teaspoons with one glass water twice a day avoid fingering and sexual intercourse until bleeding and pain subsides if at all sexual intercourse is done do it with a condom drink plenty of water and oral fluids avoid holding urine before urinating sanitize your toilet seats maintain hygiene at private parts with urine re me and is reports"
    },
    {
        "instruction": "hello doctor I have been to six different rheumatologists one of those rheumatologists said I have fibromyalgia and I still do not agree with this diagnosis my labs come back normal my radiographic test concludes osteoarthritis in both knees and thumbs I have pain in these joints and have a bone island in my right knee I am under pain management but I just feel like we are missing something my body feels way off and I am almost positive with seronegative ra I just feel like the physicians are in someway scared to conclude this diagnosis I have bad flares that are bilateral on my hands knees hips and between my shoulder blades I have swelling and fever in these joints I have no idea what to do but I am progressively getting worse please help I am currently taking nucynta er 150 my xanax my lyearica 100 my is tizanidine my and synthroid 25 mug before meals",
        "input": "",
        "output": "hi you seem to have multiple joint arthritis since cop reactive protein factor anti cop cyclic citrullinated antibody and ear are normal no one is going to conclude this as rheumatoid arthritis or seronegative arthritis I need the following details since how long are you suffering from it do you have an increase in pain and stiffness in the morning when you get up or is it the same throughout the day within how many minutes to hours of getting up in the morning you start feeling lesser stiffness do you have pain and swelling in distal interphalangeal joints of hands"
    },
    {
        "instruction": "hello doctor I am a teen and I believe I have ruination syndrome as 10 minutes after every meal I regurgitate the food I eat but it is not digested and tastes like the food I recently ate I often chew the food again and swallow but it is quite annoying and it happens for about 20 minutes before going away it started several years ago but I brushed it off thinking it was nothing what should I do and is there any treatment",
        "input": "",
        "output": "hello I can understand you must be upset about your condition lasting so long you well described the symptoms and timings which are very important in your case the symptoms you mention can present for many years harmlessly and at the time this accompanies other eating disorders such as bulimia nervosa excessive eating and anorexia nervosa excessive fasting I want to hear from you do you have certain symptoms suggestive those disorders as well ruination is a functional disorder and it can resolve with time on its own but the one recommended therapy is diaphragmatic breathing you can learn how to perform this at home by watching some videos available on youtube secondly you can start the tablet ondansetron my thrice daily this medication will improve gastric accommodation to prevent the reflux of contents the diagnosis of ruination can be confirmed with gastroesophageal manometry with impedance which is a test to measure the change in pressure across the stomach and esophagus while you do this ruination this test is sometimes important because there are certain mickers which present in the same way but have a completely different approach I hope this helps ruination motility disorder of esophagus gastroesophageal manometry with impedance esophageal motility disorder ruination syndrome diaphragmatic breathing tablet ondansetron my thrice daily half an hour before meals follow up to provide more information to decide whether a gastroesophageal manometry is required at the moment"
    },
    {
        "instruction": "hello doctor I have a painful lump on my perianal area I shaved on friday and at first I thought it was only an ingrown hair but I am not sure anymore for the last two days I have been working sitting for many hours and it became very painful and swollen I do not know if it is an abscess please help",
        "input": "",
        "output": "hello well I do not know the particulars of your case it sounds as if you may have what is called a bartholins cyst this represents inflammation of the glandular structure in the perianal area in women it is generally benign but can be very painful and uncomfortable try sitting in a warm tub with warm water several times a day or applying warm compresses to the area such as a warm cloth for about 15 minutes and as it may bring down the inflammation if that does not work then you should probably see a local doctor who has other methods of bringing down the inflammation including the use of antibiotics"
    },
    {
        "instruction": "hello one day when I masturbated my right testicle went up and at the same time I felt a burning in the perineal area after ejaculation I felt an intense pain in that area and from that time I always have problems walking or ejaculating the thing that scares me is that the penis veins have increased in volume and have a dark color initially I thought of a nerve injury but now I do not understand why this veins and pains along the legs the doctor said that I have a prostatitis and vesiculitis but he did not tell me about the veins if I try to walk the lower part of the scrotum becomes dark like a hematoma and I have pain it seems to me that there was damage to the veins and nerves because I always have pains that start from the perineum and branch towards the legs",
        "input": "",
        "output": "hi let me tell you that the symptoms described by you suggest that you have vasculitis inflammation of the blood vessels can cause peyearonie disease more over it may be due to epididymo orchitis in this situation I suggest you non asteroidal anti inflammatory medication like ibuprofen 400mg and antibiotics medication I recommend you lignocaine ointment apply locally use ice packs for good blood supply avoid alcohol and smoking avoid stress and anxiety more details you may consult with me hope I have answered your query"
    },
    {
        "instruction": "hi doctor I have question about hepatite I had vaginal sex with condom but unfortunately the condom was torn during the sex and I stopped it is there any possibility for me to get hepatite in this way actually I did not know her I have tested for hav blood test 60 days after exposure and it was negative if I test one more time at 90 days it will be conclusive or I should repeat the test more thanks for your help",
        "input": "",
        "output": "hello I welcome you to icliniq I want to know which test did you do to check hepatitis if this was a high quantitative per test and if it was negative then you are completely safe if it was antibody test and was negative then I suggest to confirm with quantitative hav per test the antibody response to hav viral infection is slow hence a negative antibody tests does not confirm absence of infection means it can be falsely negative quantitative hav per if negative then it can confirmly rule out the infection for example if you were exposed then per test can come positive as earliest as to weeks do scree yourself for other sexually transmitted disease hav and hiv I hope this will help you understand things good day risk stratification for hav exposure risk stratification for hav exposure follow if required"
    },
    {
        "instruction": "hello doctor my three months baby is avoiding breast while feeding is there any other option to make her drink breast milk without direct feeding",
        "input": "",
        "output": "hello you can express breast milk either manually or by using a breast pump and give that milk to the baby using a spoon but the reason for avoiding breastfeeding needs to be evaluated nose block is a common cause for refusal to feed if the child is having a nose block you can use nasoclear drops two drops prior to each feed you have mentioned the baby current weight as labs for a three months old baby labs fall much below the normal range was the child preterm how much was the birth weight"
    },
    {
        "instruction": "hello doctor I am a 41 year old male who is 10 and in pretty good shape however last week while I was sitting on the couch at night I noticed muscle twitches in my quad muscles I ignored it thinking maybe I walked or exercised more than normal but since then they have not gone away and I notice them in all different parts of my body but mostly the legs calves shins quads of both legs I feel them every few minutes or so while sitting or laying down they are not painful I have not lost any strength while doing pull ups lunges or dumbbell curls I do not drink coffee nor alcohol and I do not take any medicines I took a magnesium supplement for the last few days and it did not help my symptoms I started googling stuff and became very afraid could this be caused by anxiety I did have some restless nights last week please help",
        "input": "",
        "output": "hello such muscle twitching can happen in few medical conditions like anxiety motor neuron disease nerve injury benign fasciculation syndrome and hyperthyearoidism if you do not have any weakness or muscle thinning it may be due to anxiety I suggest to observe it get to and ash thyearoid stimulating hormone test if you are anxious you need to overcome that too if it persists then it may need some further investigations"
    },
    {
        "instruction": "hi doctor yesterday I had roti with spinach which is home made today morning I experienced a stomach bout but not watery should I take a combination of antibiotics idol and ulticept 500 my along with metrogyl and eldoper I am still feeling uneasy please guide me on this every 20 days I am having issues related to the stomach should I go for endoscopy I am scared of my present health condition please advise some tests",
        "input": "",
        "output": "hello revert back with the answers to the above questions to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am 60 years old I am in excellent health I just had medical checkup and everything fine except cholesterol reading of 320 despite a healthy diet and exercise my problem is peripheral edema spider veins and swollen legs which is often very painful after standing for a long time in the past has spent a long time standing at work I have good shoes and surgical stockings for help I am not on any medication for this I have this problem for over five years now please help",
        "input": "",
        "output": "hello I had gone through all the data posted revert back with the report details to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am having severe mental problems and I cannot concentrate on anything I am a civil engineer and working in a private firm I am married and have one child I am unable to take my wife with me because of financial issues my wife got pregnant last year and since then I have stayed alone due to excessive sexual desire I have approached many prostitutes but only after spending lots of money I got physical satisfaction mental desire was still unsatisfied nearly one year I went through many troubles in my jobs including court case and money loses since then I have changed three offices but did not receive proper funding from the company I was all alone with less or no friends I searched in dating sites and found a girl who is a professional sex chat agent she made a personal contact with me out of her job scope in less than a week time I feel like I am in love with her and cannot live without her now she is having some financial problem and seeking money from me for providing sex chat services she is not a fraud and somehow I can manage to give her that by taking a loan on credit card and something I am in constant touch with her since last days and I have yet not done any sex chat because my mind did not allow me to ask her for sex I am thinking about her only and not be able to concentrate on my work I cannot get rid of the problem and cannot take myself out of the situation I am seeking help in this regard thank you",
        "input": "",
        "output": "hi I can understand your mental turmoil I can see that you are deep in trouble for further information consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor myself and my wife are stressed by my mom behavior she keeps changing every single minute and fights with us for small matters kindly help me to resolve this",
        "input": "",
        "output": "hi for further information consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor I got married recently for the last few months I am experiencing erection problems during intercourse and struggling to get the sperm out hence a general physician advised me to take a few tests I have uploaded the results of the test can you please tell me what would be the next step to improve my sexual activities I have high levels of prolactin has that affected my sex desire also I want to know if it really leads to delay in getting a kid please advice",
        "input": "",
        "output": "hi I understand your concern for further information consult a sexologist online"
    },
    {
        "instruction": "hi doctor I had a it scan of my heart to check for calcium buildup in my arteries the score is 83 cubic my and there is a break down in left anterior descending and no detectable calcification an approximately my calcification is present within the proximal aspect of the left circumflex coronary artery about to am distal to its origin and 8 my calcification is present within the proximal aspect of the right coronary artery just distal to its origin please tell me your opinion am I at a risk of heart attack I do not have any previous history of heart issue but heart disease runs in my family last month my cholesterol and lil were 280 and 235 and now 182 and 149 respectively",
        "input": "",
        "output": "hi we follow so many patients but these are just a predictor of screening patient who are at risk even a low score person also gets a heart attack you need to show your report to your cardiologist rather than doing interpretation by yourself even we had seen so many patients with critical blockages in coronary it and found the only minimal disease so it is not a gold standard test still risk factors like obesity smoking high cholesterol are better predictors revert back with detailed history to a cardiologist online"
    },
    {
        "instruction": "hi doctor my son was diagnosed with add before a year and subsequently he was given vyvanse 20 my he has continued to take this medication until this year with a dosage increase from 20 my to 30 my he is years old and weighs about 70 labs I would like to get him off this medication and try an ayurvedic approach last one year when he has been on vyvanse he has not gained any weight and frequently lacks appetite currently he is on summer break and not on this medication he will be homeschooled from this year onwards",
        "input": "",
        "output": "hi rather than just mentioning as add attention deficit hyperactive disorder I would request you mention the dominant symptoms you have noted in him also mention about his bowel movements sleeping and food habits revert back with a detailed history to an ayurveda specialist online"
    },
    {
        "instruction": "hi doctor I am 41 years old I am dealing with separation my husband is possibly a sociopath he left the city two years ago and wants a divorce now I am unable to go ahead with it I need some help for my anxiety and the illusion he created years ago also I was on david 100 my and stopped now",
        "input": "",
        "output": "hello separation from spouse depression mixed anxiety revert back with a detailed history to a psychiatrist online"
    },
    {
        "instruction": "hi doctor I am years old my right eye seems a little more watery than my left eye it is not running down my cheek but does feel a bit more watery I just feel this for a couple of weeks I have not had any swelling or pain in my eye also there is no discharge from my eye my vision is normal could right eye a bit more sensitive than the left",
        "input": "",
        "output": "hi for further information consult an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor I am having cough for two to three weeks now it is mostly dry and frequent throughout the day I am getting two to three coughs at one time and then it continues currently I am taking piriton cs pantocid and monte la I had bronchitis problem a few years back wherein I used to get frequent cough please help",
        "input": "",
        "output": "hello I had gone through all the details you have posted for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor my baby is days old heart mur was identified during check with the pediatrician he said that the cardiovascular system is abnormal with soft systolic grade 6 mur at lsb we have done the echocardiogram and the results are as follows ventricular septal defect q21 with stable condition and atrial septal defect q21 with stable condition moderate size secundum asd moderate size perimembranous vid with pig of mhg I would like to know the risk factor on the identification of the mur and the steps to cure this as early as possible we need your support and guidance on this thank you",
        "input": "",
        "output": "hi I appreciate your trust in our services I have carefully reviewed your query and can well establish the sensitivity of the health issues you described for further information consult a cardiologist online"
    },
    {
        "instruction": "hi doctor I am a 24 year old female I was previously diagnosed with ti for three to four times in the last two years now I have a frequently occurring problem of itching and burning in my urethra about three to four times in a month it stays for around to hours and slowly goes off after drinking lots of water and visiting the washroom every now and then this generally happens when I miss drinking required amount of water I drink a plenty of water of more than liters a day it also happens when I miss going to the washroom if my bladder is full kindly help me as my life is getting severely affected by this and I stay quite depressed owing to this I have taken urispas when the situation gets worse the urine culture reports show nothing negative is there any treatment for this what are the necessary precautions",
        "input": "",
        "output": "hi for further information consult a urologist online"
    },
    {
        "instruction": "hi doctor my brother had pain in the right side under the rib and feeling stomach fullness we took him to the hospital and an egg and a few blood tests were taken both are normal and he was discharged with some painkillers next day morning the same issue repeated when we took him to the doctor he advised to take a urine test after seeing pus cells he asked us to take urine culture the urine culture report came as no growth I have attached the above reports for your reference please look into the reports and suggest the treatment",
        "input": "",
        "output": "hi for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am suffering from depression for the last two years my doctor had changed my drug recently to a new one which is zoloft I have been taking it for a month maybe I am traveling now and in the airplane I got tired along with depression and severe panic attacks even after reaching the place I could not settle down I feel as if my heart is going to stop beating from fear anxiety and panic attacks I do not really know the reason I just need something I can do in order to relax from these symptoms my flight is after two days and I really do not know how and what will happen before a year when the severity of the depression was stronger than now I did not breathe and the emergency staff gave me oxygen how to make myself relax I am really trying to calm down I am telling myself not to fear and relax without thinking anything please help me",
        "input": "",
        "output": "hi I read your query and understand your concerns I am glad to know that you are willing to take necessary steps for avoiding similar problems of depression which had crippled you last year although all kinds of behavioral intervention need personal interaction and complete assessment but deep breathing is the one which can be used in any situations without much effort when you feel something is wrong do deep breathing allow a single breath of in and out around 10 15 seconds this will help you to control the tiredness and fatigue secondly keep yourself hydrated take at least four to five liters of water every day including the day of travel thirdly ensure proper sleep if possible if you are not able to sleep properly without medication then consult your specialist doctor and ask for a prescription for further information consult a psychologist counsellor online"
    },
    {
        "instruction": "hi doctor I am a type diabetic I have been prescribed vista as I have precancerous cells in my breasts I have had multiple biopsies done in the past years and they were always benign I am concerned about the harsh side effects of vista I cannot sit for extended periods of time as blood clots may occur and also I have an increased chance to get stroke being diabetic now I am retired and not as active as I used to be please help",
        "input": "",
        "output": "hello I had gone through all the details you have posted for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I have had about a six years dependency on the drug suboxone I do not abuse it but I have tried several times to taper or wean I have a white collar high profile job and I really need to get this off to avoid problems in the future do you have any recommendations to get this off I would really appreciate any help you could mention thank you for your time in advance",
        "input": "",
        "output": "hi for further information consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor I have some kind of allergy on the head of my penis please tell me how to resolve it and which doctor should I consult my age is 25 I did not consult any doctor before this I do catch a cold in a month or two and I skip my diet many days I saw this allergy a month ago when my girlfriend got tonsillitis after having oral sex she said it was because of this it has still not resolved I thought it as nothing much and it is in the same manner since then I do wash it regularly and I use to masturbate too much",
        "input": "",
        "output": "hello revert back with the answers to the above questions to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am having dot in my left leg I had about a year of warfarin treatment and it was stopped two months back I had my thrombophilia profile and it shows protein deficiency what to do",
        "input": "",
        "output": "hi based on your query my opinion is as follows for further doubts consult a hematologist online"
    },
    {
        "instruction": "hi doctor my wife is 14 weeks pregnant since yesterday night she has been suffering with severe left hip pain she is unable to stand sit and walk comfortably it started with mild pain before a month the pain seems to be unbearable I have applied the pain reliever cream and spray but it did not work kindly suggest me what I have to do",
        "input": "",
        "output": "hello for further information consult an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hi doctor I am 25 years old my weight is 53 keg and height is 3 from yesterday afternoon I have some pain under my rib cage please check the reference image I can breathe easily but it is paining when I am breathing heavy it has also pained when I laugh cough and puke please help me with this recently I took a thyearoid test I do not know of it is useful but I am attaching it thank you",
        "input": "",
        "output": "hello revert back with the answers to the above questions to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor this is regarding the personal health of my husband I am suffering from a very bad sex life due to very low sex interest of my husband to tell about the past we had a long courtship period of 2 years in which I was able to understand from his conversations that he has very low interest in sex I ignored that and got married to him right after our marriage we had sex daily and then it started reducing gradually the frequency fell drastically from having sex once in a week to once in 15 days whenever I tried to initiate or have a word with him about it he said that a man needs to be very free to have sex and busy people generally have low sexual engagements I know that it is not true and I believe that he gives some excuse to his own weakness now at the end of one year of our marriage the sex has reduced to once in a month so you can understand the level of frustration I have landed into which is severely affecting my own personal health and interest in staying with him he hardly gets aroused once in many days and does not react sexually even after I make advancements he does not react does not understand and most importantly not able to enter me without putting a condom he says he gets support with the condom so the second issue you can understand is that with that condom I cannot conceive also he has very low interest in anything related to sex and he is not able to enter me properly as he says it hurts him otherwise he is such a loving husband and its tough for me to believe that he does not want to make love to his wife for any other reason I would like to tell you that he does not have a separate skin from the shaft it rather covers the shaft and that pretty much indicates he even masturbates very less could you please help me could you please tell me if this is normal with some men does the case of my husband look abnormal what are the tests that he must get done to affirm that he suffers from sex issues or low testosterone what line of treatment should I take him to thanks in advance please help me as this is ruining my personal health and would probably push our marriage to the end of divorce as my family knows about it now and does not want me to stay in a marriage with a man who cannot keep me physically happy and still not accept he has some issues thank you so much",
        "input": "",
        "output": "hi I read your query and understand your concerns for further information consult a sexologist online"
    },
    {
        "instruction": "hi doctor I do not have any health issue but I am not in mental peace with my close friends I do something that is unintentional and it bothers my friends this creates a sense of agony in me it bothers me a lot as I overthink the issue can be very small and negligible but I think that one of my friends uses me monetarily may it be a matter of a very small amount I am often embarrassed amongst them but this is because of the reaction of the other people",
        "input": "",
        "output": "hello welcome to icliniq com for further information consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor my grandmother is 80 years old her left side is paralyzed she is incapable of holding or carrying any weight or exert pressure by her left arm for more than 15 years now she met with a fracture in the same hand I have attached the ray of her left arm if the fracture and dislocation of elbow remain uncorrected will there be any problem please advice will it fuse or calcify in some position now she is using an arm pouch sling and feeling no pain in her arm",
        "input": "",
        "output": "hello thanks for posting your query along with the ray image for further information consult an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hello doctor my brother in law gone through ca tongue right side operation followed by radiation and chemotherapy before six months from last two weeks he is getting pain on the left side of the tongue and we consulted the doctor again doctor said that there is no possibility for further operation and radiation therapy he suggested that he needs to go for chemotherapy only though we opt to go for chemo his body is not able to support he became very weak as he underwent surgery radiation and chemo already this also has more side effects and with this he will be unable resist also the doctor said that there is no scope in curing and he advised to go for medicine which is equal to chemo I kindly request you to give best possible solutions to save his life is there a possibility of recurrence of cancer in the left side within this short period what is the stage of cancer before and after operation I have attached his current medication is it fine to continue",
        "input": "",
        "output": "hi I understand that your brother in law has undergone treatment for tongue cancer for further information consult a family physician online"
    },
    {
        "instruction": "hi doctor I met with an accident three months before and my left leg was injured it includes tendon cut and multiple fractures on the next day the tendon was repaired through an operation after 25 days all stitches had been removed and I got plaster on my left leg and now the plaster has been removed yesterday when was going through physiotherapy for my left leg it started paining a lot my face started sweating and I felt dizzy then I had a glass of water and managed my question is that why is it so paining will I be able to run in the future",
        "input": "",
        "output": "hi revert back with the ray to an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hello doctor I am years old I have bartholin cyst for the past eight months it is small but painful daily and has a very tiny pinprick hole on hymen that seeps a translucent non offensive discharge after I bathe or massage the lump the lump is deep under labia major pea sized according to mri it is 1084 my will a gynecologist operate on it being so small and do a biopsy due to my age",
        "input": "",
        "output": "hello I have gone through your description the details you mentioned definitely suggest there must be some infection in the bartholin gland as you have mentioned it has been painful for eight months I would like to know if you took any course of antibiotics to address the infection in your case you can try that as the cyst is still very small although the definitive treatment for a bartholin abscess is excision and marsupialization of the cyst for mild cases a course of antibiotics may provide some relief for some time but there can be a recurrence of infection in such cases in the future if the lesion is persistent or it increases in size excision of the same is recommended and it is usually a very minor procedure and not that painful too so please do follow up with your gynecologist in case you face any such issues I hope this helps"
    },
    {
        "instruction": "i got my wisdom teeth removed days ago I ran out of my medicine and my mouth in severe pain so I went to place again and got gauze soaked in cover oil put into the holes of my wisdom teeth the taste is horrible and burns and is making me sick to my stomach I am wondering if I can just take the gauze out myself",
        "input": "",
        "output": "hello welcome to icliniq this is your personal dentist I went through your query and am deeply sorry for your inconvenience and you have been uncomfortable for these may days as an expert I understood exactly what happened after an extraction we warn the patient of not rinsing vigorously only warm saline gargle as softly as possible after 24 his if this is not follows the cloth at the extraction site dislodged exposing the bones day to day food accumulations also adds up leading to the level of pain you are under so your dentist to heal the socket places a gauge with medication which is not ment to be taken out by you as its helping the wound healing and will eventually reduce the pain and also donot allow food particle to accumulate at the extraction site the smell can be too annoying as one can be deeply irritated by it due ti clove oil it might feel burning sensation too but donot worry that will fade off as soon as the extra medicament which might got rubber on your gums gets risked out do it slowly or you might dislodge the gauze too thats not good you can apply but donot try to take the gauze out let me know if any further query am here to help feel free donot hazitate and upload an image of the site if possible I will be waiting thanks alot"
    },
    {
        "instruction": "i am year old girl I was suffering from urinary infrction I completed my medication and have urine culture but no bacteria found there but I still have high symptoms that is urge to pee and sensation in genital feels like I he to pee all the time I am getting depressed this is now months I am experiencing these things one year back these type of symptoms I have experienced but I did not paid attention and I dont know when they goes away by own",
        "input": "",
        "output": "hello welcome to icliniq I understand how distressing it must be for you please go for thorough evaluation of the cause for recurrent urinary infection first of improve your water intake make sure you drink at least 4litres of water excessive urine while drinking plenty of water will flush out the infection from the body regarding your urine culture it would be advisable to check if you had given the sample prior to starting the antibiotics course as once you start the antibiotics and then submit the sample it may not show any bacterial growth on culture plus you are likely to develop antibiotics resistance infection because of inappropriate antibiotics please get an ultrasound rub kidney urinary blaader to look for any kidney or ureteric stone which can cause repeated infections please feel free to revert back with your queries anytime would be happy to help urine routine and microscope urine culture and sensitivity ultrasound whole abdomen and pelvis haemogram syearup citralka 2tsp thrice daily in half glass water when there is burning tablet urispas twice daily after food for days antibiotic after urine culture sensitivity report drink plenty of water or fluids at least 4litres per day review with reports as advised or if there are any doubts or queries"
    },
    {
        "instruction": "i am observing vaginal burning and not regular but white discharge also I am having cramps after having orgasm very uncomfortable feeling in my lower body what to do also please suggest some hime remedies to help more its been more than months earlier I didn't left pain after having intercourse but now I am feeling pain I dunno why which is why I have become scared to do any further im feeling like vaginal burning cramps after orgasm even though its been months I hadnt done any sexual activity and uncomfortable feeling in my lower body gender female age 26 height 6 weight 72 kegs thanks",
        "input": "",
        "output": "hello welcome to icliniq based on your symptoms it appears you are suffering from genital tract infection I would like to the if you have any offensive odour of the vaginal discharge or associated itching I can prescribe some medications for the pain relief but for definitive treatment with antibiotics more details would be needed please consult me for a detailed discussion so that definitive treatment can be given ideally you should be visiting a gynaecologist to have a physical check up and a pap smear please revert back to me with further details and for definitive treatment ultrasound abdomen and pelvis pap smear tablet mental spas sos after food for pain relief wash for local cleansing avoid sexual intercourse till symptoms subside avoid vaginal douching change undergarments frequently follow up for further discussion and definitive treatment"
    },
    {
        "instruction": "dear sir when my eye power years back my vision was re spy 5 and add 25 le spy 75 and add 25 but wrongly I was using a glass of power re spy 50 add 25 and le spy 50 add 25 yesterday when I went for a test I got to find my vision is re spy 50 le spy 75 so requesting you to guide me how can I get back my previous vision regards",
        "input": "",
        "output": "hello welcome to icliniq com according to your age you are having hypermteropia which is called far sightedness in which you can see distance objects clearly but near focus will be blurred without glasses and one more thing you are 46 years old now so this is an age for cataract and when you will have cataract and once it will start increasing then because of lens changes there will be change in refractive index of lens which will lead to improvement of near vision and worsening of distance vision this you can see in your case you can compare your previous power and recent power now you are not having glasses or power for near vision that means you have cataracts which can be in starting stage so you have to consult an ophthalmologist and you should undergo cataract assessment"
    },
    {
        "instruction": "hello doctor I feel my metabolism rate is slow when I have food I am not getting energy but my stomach and buttock fat level are increasing gradually my weight is also increasing and stamina is also very low please help",
        "input": "",
        "output": "hi your symptoms look more like hypothyearoidism I would suggest you to check for the same and review back take syearup zincovit my once daily for one month abc complete blood count ribs random blood sugar free to ash thyearoid stimulating hormone hypothyearoidism"
    },
    {
        "instruction": "hi doctor I am 23 years old my mi rate is 29 and I am trying to conceive for the past one and a half years I have irregular periods and my doctor prescribed me duphaston tablets for getting periods last year should I take this medicine again it has been 90 days since my last period I tested for pregnancy it was negative my query is what should I do for getting my periods or getting hormone balance these days I cannot go to my doctor due to lockdown please help",
        "input": "",
        "output": "hi you may be suffering from pod polycystic ovary disease if you want to conceive then the entire approach to treatment changes because we then focus on making you ovulate let me know your lap last menstrual period and health history and also any investigations done previously I understand things are difficult with couid but you can get the treatment at home only do not worry"
    },
    {
        "instruction": "hi doctor I have been experiencing flare ups for weeks now I do not know if this has something to do with the change of weather I have been having trouble sleeping lately since I am very uncomfortable right now I am using cetaphil gentle wash and shampoo because my scalp gets itchy as well I am using erica ointment and somehow it helps me with some of the areas that are not really that worse however the uncomfortable feeling is still there sometimes I take antihistamines however I do not think that it helps me feel relieved with my atomic dermatitis I am 28 years old and a project manager my clients are in the us and I need to follow their timezone my shift starts at 10 am to am I weigh around 190 labs and I am 1 I also have an irregular menstrual cycle and I usually get my period every quarter I have asthma and I am currently taking seretide inhaler as prescribed by my doctor please help",
        "input": "",
        "output": "hi atomic dermatitis is relatively more sort of relapsing with seasonal aggravation it has a genetic and familial component as well if you have severe symptoms which is hampering your daily activities you need to start with systemic immunosuppressants like prednisolone and or azathioprine erica ointment I mometasone is good enough for skin lesions but I would rather add on tacrolimus gel 1 over the inflamed lesions but you need to use moisturizer very frequently than previous you need to take antihistamine on a daily basis reduce your stress avoid wool and strong soaps practice wet wrap therapy I hope this helps"
    },
    {
        "instruction": "hello doctor I am 58 years old I have some very minor tingle in my right second toe I am very healthy with no medicines and no other symptoms it started with unilateral tinnitus mri of the spine showed moderate to severe stenosis spine I do exercise and running and my neurologist says this might be normal I had a concussion when I was 17 and spent a day in the hospital my mri brain is obviously abnormal with white matter what is the likelihood of ms I had an mri in 2015 and said chronic microvascular changes mri of a couple of weeks ago said no tumor on auditory nerves please explain",
        "input": "",
        "output": "hello I understand your concern and would explain that your mri findings head and spine fulfill the radiological criteria of is multiple sclerosis there are many old lesions in the head and spine and there is a new lesion in the left parietal lobe which explains the tingling in the right toes although you have no past medical history for paralysis or limb numbness and weakness these brain lesions are compatible with is I recommend discussing with your neurologist about that as there is a new lesion with light contrast enhancement steroids would help to relieve the tingling in the right toes regarding the mild spinal canal stenosis it does not explain the spinal cord lesions in the upper levels which are probably related to is I recommend performing a spinal tap in order to examine your cerebrospinal fluid and visual evoked potentials I hope this helps"
    },
    {
        "instruction": "hi doctor I am a 21 year old healthy male with no underlying conditions today about six to seven hours ago I was getting a haircut and the barber had the cape blanket around my neck pretty tight and so I asked him to loosen it and when he did he yanked it back before unbuttoning it and it choked me for a couple of seconds the cape was lying on above my adams apple so I know it got pressed inward there is not a lot of pain just discomfort like the feeling after getting choked it was not intentionally done hard but it might have been the angle and where it was lying because it is a bit uncomfortable right now if I take my mind off from it I do not feel it but as soon as I am remembered I feel the discomfort wondering if I had any damage permanently or if it is just temporary discomfort",
        "input": "",
        "output": "hello your symptom seems to be temporary you need not worry about it you can take a plain paracetamol 750 my tylenol twice daily for three days after food tylenol will not only reduce the pain and discomfort but also the inflammation post injury instead of semithecone you can take nexium 20 my esomeprazole once daily on empty stomach for three days because tylenol can cause acidity"
    },
    {
        "instruction": "hello doctor when I am trying to pass stools my testicles get really big also there is a cyst in my right testicle besides this I have pain in my lower back what is your advice to get the cyst killed and get back to normal if necessary I can send photos please help",
        "input": "",
        "output": "hi with the history you have told it seems like a hydrocele or an inguinal hernia with extension into the scrotum if possible do send the pictures for a better idea and also answer these questions do you suffer from constipation any abdominal pain any fever any issues while passing urine do you have diabetes awaiting your reply please update a clear picture"
    },
    {
        "instruction": "hi doctor I am 34 years old and weigh about 96 keg my latest lipid profile shows triglycerides 398 my dl hel 27 my dl lil 96 my dl total 175 my dl please advise what to do any immediate medication I need to start which doctor to consult any other tests to be done",
        "input": "",
        "output": "hello I can understand your concern according to your statement you have increased triglyceride levels and low hel high dentisity lipoprotein levels your hel has been varying from 24 to 38 for the last three years and your current medication is colored powder which is a nutritional supplement used for dyslipidemia for your high to triglycerides level you can start fenofibrate trade names finate fenofibrate 200 my at night you can also take omega fatty acid trade name beneficial bree carmax for increasing your hel you should avoid oily and fatty foods continue your current medication with fenofibrate and omega fatty acid after three months repeat your fasting lipid profile"
    },
    {
        "instruction": "hello doctor I had a miscarriage two months ago resulting in a dand at 10 weeks I am now pregnant weeks and days and taking 400 my progesterone suppositories once per day due to low progesterone levels both in the last pregnancy and in the weeks leading up to the confirmation of this pregnancy however my doctor has told me that my estradiol is very low and that is concerning me my results so far 14 do hug 69 l progesterone nmol estradiol 20 pmol two days later 16dpo yesterday hug 129 l progesterone 75 nmol estradiol 239 pmol is my pregnancy doomed because of my very low estradiol I was hoping my doctor would prescribe estrogen medication but he does not seem to think that would be an option why would he decide that do you think estrogen supplementation would help instead he is having me take 25 my daily of dhea do you think this will help and is it safe to take in pregnancy will eating foods high in phytoestrogens g soy help increase my estradiol also do you think my low hug levels are a bad sign at 12dpo they were 15u so they increased rapidly to 69u on day 14 but then slowed a bit to get to 129u on day 16 I am due for another blood test tomorrow I really do not want to lose this pregnancy but these low numbers are making me worry",
        "input": "",
        "output": "hello welcome to iclinq com I saw your concern the normal levels of estradiol in early pregnancy can vary from 188 to 2400 pmol similarly progesterone can vary from 12 to 90 nmol hug human chorionic gonadotropin has doubled which happens only in a healthy growing fetus with good trophoblastic activity do not worry much about estradiol it has no big significance in treating previous early miscarriages everything looks normal continue progesterone for gluteal support and prenatal vitamins as prescribed above all stay positive and confident"
    },
    {
        "instruction": "hi doctor for the past two weeks I have been having calf tightness in both legs I am years old and I weigh around 230 pounds nothing I do seems to make it go away three weeks ago I went to the hospital for chest pain and they did a dime and it came back negative I feel the tightness in my lower calf and upper back of the thigh it is in both legs but I mainly feel it in the left it is not unbearable more of an annoyance I have tried epsom salt baths ibuprofen etc",
        "input": "",
        "output": "hi I see you are suffering from calf tightness and pain for the past two weeks one reason could be due to your overweight other could be blood clot formation in the veins as you are at high risk for it or it could be because of salt imbalance in your body if you are not taking adequate nutrition and water I would like to know do you exercise regularly or go to the gym for weight reduction do you take any medicines as a part of weight reduction plan are you in any regular medicines for any issues like high cholesterol diabetes or thyearoid problems what is your job do you stand for long hours in a day abc complete blood count free to ash thyearoid stimulating hormone ribs random blood sugar serum lipid profile serum potassium both lower limb venous doppler tablet aceclofenac and tizanidine tablet twice daily after food for five days electoral powder one sachet mixed with liter of water to be taken frequently adequately hydrate yourself avoid long time standing"
    },
    {
        "instruction": "hello doctor I am 62 years old a week back I had severe abdomen pain so I took an ultrasound the report says I have my size gallstone I have also checked my lipid profile which are normal I request you kindly suggest further action required I am currently taking lipicard",
        "input": "",
        "output": "hello I have to have more information about this pain before I can tell you what is the cause of this pain usually the gall bladder stone of such size less than 10 my in size does not cause pain and if it does then the pain has to be characteristic one like pain starts within half hour of meals and gradually increases in intensity within next hour and then start declining for the next three to six hours vomiting can occur with increased severity of the pain if you have any of symptoms as mentioned then it is possible that pain is coming from gall bladder stones and the definitive treatment is cholecystectomy I removal of the gall bladder again I want to emphasize that most of the stones of such size usually do not cause pain and remain asymptomatic doing no harm to the patient throughout their life the other cause of sudden and severe abdominal pain are ulcers within the stomach food pipe or small bowel inflammation of the pancreas called pancreatitis diabetes and its complications lead poisoning drugs such as pain killers and few other causes your lipid profile is normal and ultrasound is otherwise normal except that stones which are clearly visible you can start capsule esomeprazole 40 my half an hour before meals it will resolve the pain if coming from ulcers in the stomach however I highly recommend you to provide more information regarding your problem as I can be in a good position to diagnose and tell you what to do peptic ulcer disease symptomatic gall bladder stone pancreatitis drug related functional pain complete blood count serum amylase lipase calcium bun creatinine and electrolytes stool for pyloric antigen pancreatitis drug related lead poisoing peptic ulcer disease asymptomatic gallstones capsule esomeprazole 40 my half an hour before meals once daily follow up to provide more information about the pain"
    },
    {
        "instruction": "hello doctor I have ed problems for about a year I am years old healthy active no other physical health problems a possible reason for this is I had a bad case of blue balls on a night and was not resolved until the next morning I believe this may have affected my veins in my testicles my ed may be mentally too like libido but I do not think that as much as a physical problem with blood flow please help I did a test with that gel stuff on testicles and ray type thing and they said nothing wrong",
        "input": "",
        "output": "hello I would like to know a few information about your general health is ed present all the time or noticing association with anything particular do you take any medications in general or anything for ed the most common cause for ed in your age is psychological any undue stress in life any family history of medical problems diabetes cholesterol etc do you have a partner any change in partner recently any relevance you notice either this also I am not very sure what blue balls exactly describe but seeing that you have had an ultrasound of scrotum I think it is unrelated to ed scrotal scans are not relevant for ed so need more information on how and why you had this stress psychological check fasting lipids glucose thyearoid and testosterone levels also need the reports of scans consultation reports already done varicocele incidental not a cause for present complaint anorgasmia dysejaculation all these are far less likely ed erectile dysfunction ensure no stress take help if needed reassure that ed due to pathological cause at this age is unheard of try a dose of drugs like viagra purely to see responset it is not recommended as long term until we have further information relaxation techniques avoid stress reassure positively highly recommend to take proper urological consultation to work up properly either locally or online"
    },
    {
        "instruction": "hello doctor I am 25 years old I suffer from premature ejaculation I have always had it in the sense if I am aroused I ejaculate within the first 20 to 30 seconds and if I am not aroused it can take longer but still less than two minutes it feels like I am always forcing myself to ejaculate and perhaps this started with me masturbating in my early teens would counseling solve this issue or is it more serious than that",
        "input": "",
        "output": "hi let me tell you that the symptoms described by you suggest that you have erectile dysfunction in this situation I suggest you avanafil medication moreover counseling also helpful for premature ejaculation I recommend you do testosterone therapy trt avoid alcohol and smoking avoid stress and anxiety some exercises also helps like kegel exercise and aerobic exercise more details you may consult with me I hope this helps"
    },
    {
        "instruction": "what are some common causes of one sided si joint pain that comes and goes I am 25 and just had a baby naturally 10 months ago back pain started at months postpartum",
        "input": "",
        "output": "there are various causes of si joint pain which range from considering your history it appears more likely due to pregnancy and incorrect posture it is imperative to know if you are able to fold your legs any pain in bending forward or backward any issue in walking mild si joint pains can get relieved with exercises severe may require si joint injections please let me know if something else is required with regards"
    },
    {
        "instruction": "hello doctor I am 32 years old and weigh about 65 keg with a height of feet I have a problem in my anus actually I had anal fissure before and when it is gone there is a skin tag and warts develop but the crucial thing is an unexplained thing that looks like a wound near in my anus I hope someone could tell me and answer my problem",
        "input": "",
        "output": "hello I will definitely help you with your query skin tags are formed in long standing anal fissure these are nothing but accumulated skin due to fissure usually nothing to do for that but if you have any problem because of it like pain bleeding or pus discharge you can opt for surgery it is a very minor surgery no side effects or any problem after removing them by an experienced surgeon a raw area will form that will heal on its own it can reappear if you have another formation of anal fissure so avoid the conditions that will cause it again like spicy food and constipation I will advise you to start a sit bath in which you have to sit in lukewarm water for 15 minutes twice a day 10 my betadine can be added to it you will get a better result in some time I hope this helps"
    },
    {
        "instruction": "hello doctor I am experiencing pelvic pain for the last few days everytime and my period is late for week as of now I confirmed that I am not pregnant I have an urge to urinate more than normal I also have small nipple pain on both the sides please clarify my doubt",
        "input": "",
        "output": "hi please mention how your menstrual cycles are regarding regularity duration of bleeding etc your symptoms might be due to premenstrual syndrome with urinary tract infection if periods are delayed for days and pregnancy test is negative wait another days for your periods if not repeat a prep colour test again and inform take the tablet below for pain and if pain increases or there is dizziness nausea vomiting or fainting do an us tis and inform urine for re me and culture sensitivity test urine for pregnancy test and us tis if no periods in days prep colour test and us tis if periods dont occur in days urinary tract infection with delayed periods with premenstrual syndrome tablet urispas flavoxate tablet twice daily for days tablet drotin is tablet sos on pain abdomen drink plenty of water avoid salt sugar and caffeine intake days"
    },
    {
        "instruction": "hello doctor approximately months ago some mild pain started in my right shoulder joint but I have not taken it seriously it started bothering me since end of february and it was slowly worsening I daily travel by crowded trains approximately 25 am to my workplace and back by middle of march while travelling by standing in train holding overhead handles my shoulder was hurting with every push from the crowds at various stations during day time there was not much pain I felt but in the night my sleep was disrupted frequently with pain like pulling with a hook on the shoulder I applied dynapar qps diclofenac diethylamine and absolute alcohol non aqueous topical solution my mother was using it for joint pains and she asked me to try it but I got no relief with it then my cousin practicing home medicine advised me some home medicines and it provided only a slight relief in the est week of april I consulted an orthopedic joint pain bone specialist and had taken ray of my right hand in different positions he suggested it is due to frozen shoulder problem and advised rotation of hands shoulders neck etc along with some medicines mainly pain killers and anti acidity medicine even after taking it for 25 days still I am having pain mainly in the inside bend of the right elbow if I raise my hands straight it hurts very little but if I bend it to comb my hair or putting my hands through the sleeve of my shirt it hurts very badly during day time the pain is very minor but in the night after the sleep of an hour it starts paining badly what I assessed is while the weight of the upper body rests on the shoulder or around the area including back side while lying down the pain radiates from this region and it hurts mainly the shoulder joint forearm muscles elbow joint and the wrist after trying various positions to rest the hand and shoulder with pillows soft towels the pain eases little and I fall asleep again this repeats throughout the night I use laptop extensively at work and at home also sometimes I feel a pulling pain in the wrist when I use the mouse more but no problem with key board now I am working from home due to covid19 lockdown but afterwards I may have to travel again by train and I am scared of the pain I will have to suffer",
        "input": "",
        "output": "hi it seems to be frozen shoulder as told by orthopaedic earlier primary treatment of frozen shoulder is physiotherapy pain killer and muscle relaxants are given temporarily start on tablet neorelax my aceclofenace thiocolchicoside two times a day for days along with anti acid tablet pantoprazole 40 my before breakfast for days stop remaining medicines after to days start physiotherapy of shoulder you may consult physiotherapist he may suggest better physiotherapy exercise diabetes has to be ruled out please check fbi and pubs for sugar if not relieved with above then get an ultrasound of that shoulder done"
    },
    {
        "instruction": "hello doctor I am hypothyearoid thyearoid gland destroyed by radioactive iodine 14 years ago my fasting blood sugar level is always in the range of 1 to 5 I have tried intermittent fasting even after hours it does not drop below 0 postprandial is in the range of 5 10 I do not have any sugar or rice or bread in my diet only carbohydrates is brown chapatis am I type diabetic I take 200 mug levothyearoxine everyday",
        "input": "",
        "output": "hi from your history it is evident that you are on replacement therapy for hypothyearoidism post radioactive iodine and also known diabetic since months from your history age and other parameters it is type diabetes mellitus it is not only carbohydrates which contributes to the same insulin resistance is the main culprit from the details above it is clear your blood sugars are not under good control hba1c I would recommend to monitor your blood sugars at different point of time to know at which time it is increasing that is monitoring before and hours after breakfast lunch and dinner using a glucometer and want to adjust your diabetic medications accordingly lifestyle modification diabetic diet regular aerobic exercises for about 30min a day avoid simple sugars juices fruit with high glycemic index modify oral antihypoglycemic agents according to blood sugars"
    },
    {
        "instruction": "hello doctor I went to my doctor in february complaining of burning pee and discomfort they tested me for a ti and yeast infection and said there was nothing then I went to my gynecologist two months after that still having the symptoms she swabbed me and I had a yeast infection sex really hurts and I am scared that it is not just the yeast infection what if sex hurts",
        "input": "",
        "output": "hi please tell me that do you have any discharge through vagina sometimes urinary tract infection along with vaginal infection causes this pain please do get back to me for the follow up once the urine and blood reports are available if sex hurts now refrain from sex till the infection is cleared and use the following medication ti with fungal infection urinary tract infection and fungal infection clotrimazole vaginal pessary 100 my insert into the vagina at bed time for consecutive nights maintain hygiene drink plenty of water and oral fluids"
    },
    {
        "instruction": "hello doctor I have a burning sensation in the left side lower abdomen a bit underneath the navel and nausea for weeks",
        "input": "",
        "output": "hello well to be very honest I am not convinced with the diagnosis of is does cause a significant pain which is obvious in nature and show characteristic spasm like pain not the burning you described pain of is however do occur over lower part of the abdomen the burning nature of the pain suggest may be ongoing urinary tract infection or a nerve pain within the wall of abdomen not necessarily within the bowel itself this may be the reason pain is not responding to colofac which is an effective medication to control pain of is in among every patient I suggest you test urine detail report and ultrasound abdomen with kidney ureter and bladder to exclude if there is underling kidney or ureter stone or infections involving these organs take plenty of water making sure you have adequate amount of urine daily you can continue with omeprazole if you think this helps in this condition otherwise you can stop these medications for now first confirm then I can suggest you some treatment meanwhile for burning you can take capsule pregablin 75 my at night it causes increased sleep that why suggested to take at night this will help nerve and muscle pain nerve entrapment pain rub stones infections urine detail report and ultrasound abdomen with kidney ureter and bladder cap pregablin 75 my at night it causes increased sleep that why suggested to take at night this will help nerve and muscle pain you can follow up after investigations"
    },
    {
        "instruction": "hello doctor I had a bad complaints of ocd years ago then I met with a psychiatrist he advised me clonazepam 5 at night alongwith escitalopram 10 my in the morning I felt a little comfort but for getting more effectiveness I increased myself the dose of clonazepam unto my for anxiety panic attacks etc now I am quite well using the above mentioned medicines and I do not miss my dose escitalopam 10 and at night my clonazepam now I am facing serious problems of sexual erection due to which my marriage life is disturbing because my libido is too much low it is requested to kindly help me or advise me in the matter",
        "input": "",
        "output": "hello I am sorry to hear about your situation I can imagine how hard it must be for you I would put forward a few things you need to consider right now first of all clonazepam at a dose of my if used for long duration can be addictive this medication should be used only for initial few weeks or months to stabilize the anxiety symptoms escitalopram unfortunately can cause sexual side effects what you can do is if medication is working for you ask your doctor to add something for sexual side effects or you can ask for changing the medication please do not worry as this is a common side effect and only stays till the medication is going on and it gets normal after a few days of stopping the medication please do not stop medications suddenly you need to taper them off and also take an alternative medicine otherwise your ocd symptoms can come back you can start therapy cognitive behavioral therapy will help you with ocd symptoms and this will help you getting off of medications soon"
    },
    {
        "instruction": "hi doctor my father is suffering from hepatitis and currently his medication is going on medicines are entaliv 5 my reheptin pantodac livoluk 15 a day ulysses 300 norflox 400 lasilactone once a day let trice a day also tapping is doing condition fluid in abdomen back pain low be 90 60 no improvement even after two months of treatment",
        "input": "",
        "output": "hello I can understand you must be very upset about your father health form history and medication history it seems he has liver cirrhosis in other words it is called scarring of liver shrunken liver or chronic liver disease well the medications he is on and recent history of tapping of abdominal water suggest he has advanced disease which require a close follow up and listing such patient on liver transplantation the liver transplantation is the only definite therapy for advanced liver scarring such as in your father case but it is required to assign liver transplantation not too early and neither too late there are some scoring that should be performed before recommending liver transplant the one such score require blood investigations radiological test such as contrast enhanced it scan the reason why you do not see any improvement even after months of treatment is that all treatment is just supportive and does not correct underlying problem within liver except entaliv which is used for suppression of hepatitis infection to correct underlying liver it is liver transplantation which could help the survival are good after liver transplantation such as on average 70 individuals survive at years after successful transplant I want you to share me the complete blood investigations and tests that have been done as I can be able to stage his disease and give you reasonable approach to the problem chronic liver disease hepatitis related follow up to provide more information and investigations"
    },
    {
        "instruction": "hi doctor I have been feeling a little tired and only right or center part of my forehead hurts no fever but sometimes I get mucus from the throat this is happening form yesterday can this because of frequent showers each time I go outside the house to buy something I get paranoid and take complete head to toe shower this happens 4 times a day can you suggest how to go about it",
        "input": "",
        "output": "hello with the history you have given the problem you have can because of the frequent showers kindly avoid going out and take bath frequently I would suggest a short course of antibiotics with supportive measures take tablet augmenting amoxicillin and clavulanic acid 625 0 monte la montelukast and levocetirizine 1 zencold plus paracetamol phenylephrine and chlorpheniramine maleate and pantocid pantoprazole 0 all these for three days take hot water and avoid frequent showers kindly get back for follow up after three days"
    },
    {
        "instruction": "hello doctor I have pain in my bowel I have had an mri and the doctor noted that I have bowel wall thickening in my distal colon before that I did a stool test that was negative in calprotectin and I had a casa it showed no inflammation negative for lactoferrin no bacterial infection I also had a colonoscopy and it showed clear why there are pain and bowel wall thickening",
        "input": "",
        "output": "hello I can understand you must be very upset about your ill health so the comprehensive stool analysis is well within normal limits particularly calprotectin and lactoferrin which are inflammatory markers their absence theoretically excludes any inflammation within the bowel hence a good finding the me examination and its reporting is a subjective findings means it is interpreted by a radiologist and may sometime have an error in reporting because of differential enhancement pattern within bowel and bowel movements at the time of scan plus given your colonoscopy report afterward also showed no pathology suggest it was possibly an error in interpretation the colonoscopy is however the best morality to explain the me magnetic resonance electrography reported findings given normal colonoscopy suggest that the possibility of inflammation is unlikely now coming to your symptoms and use of medication that you believe helped for some time from your history I understand you have been given mesalamine for the duration of seven months after a colonoscopy that showed colitis and biopsy showed non specific inflammation so first of all mesalamine is an anti inflammatory drug which is commonly being given among patient suffering from inflammatory bowel disease i'd the i'd is further classified into ulcerative colitis uc which is a superficial inflammation usually of large bowel starting down from rectum and goes above to involve large bowel the other one is crohn disease cd which is somewhat deeper inflammation of the gut wall having a tendency to involve almost every part of the gut starting from the mouth toward the anus given your symptoms of mucus or pus discharge and presence of pancolitis on one of your colonoscopy make me think that there is a possibility of ulcerative colitis plus the response you observed to mesalamine is also favoring this diagnosis your second colonoscopy did not show any inflammation possibly because of the remission of the disease the uc tend to have an intermittent course with flares and intervening remissions possibly at the time of second colonoscopy the disease was in remission given your recent stool test and recent normal colonoscopy make me think that you do not have active disease at the moment your disease seems to be controlled with budesonide or previous mesalamine you took the mucus pus discharge suggests that there may be some other problem such as anal fissure anal fistula or anal sinus which may accompany the ulcerative colitis in its course for this I want you to examine your perianal bottom area and see from where exactly the mucus is coming the abdominal pain may be just because of stress and anxiety accompanying the current situation and not necessarily the active disease for such pain sari selective serotonin reuptake inhibitors are helpful for treatment I need to have the biopsy report of your colon both the previous one and recent one as I can see there is ongoing microscopic inflammation budesonide is an expensive drug and it is recommended in uc where the inflammation does not go beyond the left side of the colon you had pan colitis inflammation involving the whole colon and that is why oral steroids such as tablet prednisolone is more effective than budesonide the physician prescribes budesonide over oral prednisolone if the patient is unable to tolerate the systemic side effects which accompany oral prednisolone or patient has diabetes and bone mineral deficiency your physician probably kept this thing in mind so to summarize you likely have ulcerative colitis because I did not see biopsy of your bowel and as you said it was nonspecific the uc is in remission the pus and mucus have to be closely examined by you or by a physician by doing a digital rectal examination the uc can frequently accompany depression and anxiety and that should be taken care of abdominal pain possibly related to stress and you consider taking sari at minimum dose like tablet escitalopram 10 my daily discuss with your primary gastroenterologist regarding oral prednisolone if he is convinced enough you may share your biopsy reports I can advise you on this as well one more thing since you do not have any sign suggestive of active disease the steroid are not required at the moment you need to be given some immunosuppressive medications to control and prevent relapse flare the one more reason for your doctor prescribed budesonide is he might have considered microscopic colitis which is entirely a different diagnosis and requires entirely a different management approach you share me the biopsy and colonoscopy reports that will make me in a good position to tell you what to do now and sorry for such a huge description and lengthy message but I am sure this will really help you to understand your condition I hope this helps ulcerative colitis in remission done already need biopsy reports of both colonoscopies also images of both colonoscopies crohn colitis ulcerative colitis follow up with biopsy report"
    },
    {
        "instruction": "hi doctor for the past one month I am having pain in my anus it pains while throwing waste and even while sitting there is a skin flap that has appeared at the end of the anus towards the outer side there are two flaps one is more white in color and the other is reddish it is not bleeding however I am having pain I am not taking any medication for that as I could not go and see a doctor and thought that it will be cured on its own it actually started at the time of my period when my stomach got disturbed with hard stools please help",
        "input": "",
        "output": "hi the picture and the symptoms suggest you have an external pile mass the pain is due to an underlying fissure or simply a crack at the anal opening these usually result from hard stools or constipation you need to start on dietary measures aimed at making stools soft as well as stool softening medicines also topical medicines to apply at the anal orifice will also help in relieving the acute pain I hope this helps"
    },
    {
        "instruction": "having blood with bowel movements this has been occurring for the last days with a consistent bleed some bowel movements have a heavier bleed and I have a wipe there is an excessive amount of blood the bleeding only occurs during my bowel movements I am not feeling lightheaded dizzy nauseous or vomiting no rectal pain but having lower quadrant tightness no history hemorrhoids",
        "input": "",
        "output": "hello I welcome you to icliniq I can understand you might have terrible time because of your condition the quantity of blood is very important to understand before a list of diagnosis can be made since you said it is heavier and that all started days back it seem most commonly due to acute large bowel infection some parasites and some bacterial can causes inflammation of the large bowel and bleeding I suggest you some treatment at the moment and want that you should get following blood and stool tests and inform me in days about your condition the investigation will give us clue and we can better narrow down list of differentials meanwhile make sure you take only home cooked meals take plenty of boiled or mineral water stomach tightness are rather non specific symptoms can occur if large bowel is inflamed I hope this will help gi bleeding complete blood count bun creatinine lytes ha titer for histolytica urine detail report for ova and parasites stool detail report stool culture and sensitivity fecal calprotectin acute hemorrhagic colitis diverticulitis rectal ulcers inflammatory bowel disease acute infectious colitis tab flagyl 400 my tablets three times daily tablets daily for days it may cause metallic taste in mouth tab cefspan 400 my once daily for days follow up in days with investigations"
    },
    {
        "instruction": "i am a 23 years old female for almost a month I ve been experiencing tightness of chest itchiness of throat and I feel there is something stuck at my throat I am currently taking zykast for the itchiness of the throat I also have a health history of asthma and allergies",
        "input": "",
        "output": "hello welcome to icliniq as you have mentioned you are worried about your symptoms considering your history and previous symptoms you may be having asthma as well as pharyngitis at present I would still advise you some investigations to confirm the diagnosis and if you are suffering from asthma I would have prescribed you inhalational medication because they are the best possible medication available for the treatment of asthma also I would like to know if there are any factors resulting in increase in your symptoms I hope this helps take care ray chest pa view spirometry with bronchodilator reversibility testing bronchial asthma formoterol mug budesonide 200 mug inhaler with spacer puffs twice daily and can be taken up to times daily if required continue zycast avoid exposure to allergens and smoking take nutritious diet and adequate rest"
    },
    {
        "instruction": "hello doctor my father is 68 years old he takes novorapid times 12 and lantus at night 18 unit above that taking olmesor 40 rozucor asp 10 cilacar 10 for the past 9 months new problem of hiccups arises while taking food and drinking water and about to stop his breath if he takes nukast 10 then it is fine allergy test for ice is 29 and full panel are also done what is the solution for this",
        "input": "",
        "output": "hello I understand from your query that your father who is diabetic and hypertensive suffers from hiccups problem since eight months he has hiccups while taking food or water can I get more details does he have hiccups or cough both are different is his sugar and pressure in control does he eat very spicy is there any lump sensation in the throat did he smoke or drink when he takes nukast 10 does his hiccups completely disappear does he have any other symptoms of allergy like runny nose headache nose block or scratchy throat please revert back to me with these details"
    },
    {
        "instruction": "hello doctor I was couid 19 positive on 25th april 20 while on 1th may 20 my repeated test of covid19 was negative after that I feel all the time sweetness taste in my mouth upon that I myself went for blood sugar random and hba1c today on 15th may 20 I received the results of my blood sugar random which is 92 while hba1c is please do advise any medication for it my age is 45 years and weight 73 keg",
        "input": "",
        "output": "hi it is a great news that you recovered and doing well after couid 19 infection considering the current medical reports your hba1c is suggestive that you are in pre diabetic stage and your fasting sugar is absolutely normal you do not need to start any medicine for diabetes sometimes recent infection may also lead to high sugar levels repeat tests after month and from now on I would suggest you adapt more healthier lifestyle choices good nutrition diet regular exercises quit smoking if doing are the basic ways take care of yourself fbi ps hba1c lipid profile vitamin levels pre diabetes healthy life style modifications achieve weight loss from current status and maintain after month with reports"
    },
    {
        "instruction": "hello doctor around am today I had really bad back pain all of a sudden I have a cold so I have been texting so I thought it was just that but around 10 or am the pain started to shoot down my leg as well it hurts when I sit and walk and lift my leg",
        "input": "",
        "output": "hello looking at your problem from very near it would be sudden bending causing pressure on disc and protrusion to lumbar nerve causing shooting like pain on leg the cold and even cough increase the inner disc pressure and causing nerve to more pressure which causes symptom worst so I would recommend you to use lumbosacral belt on lumbar spine at lower back I would also recommend some medicine to take for this problem and follow up with mri for further improvement zanaflex tizanidine my po bid for week capsule neurontin gapapentin 100 my po bid for one week capsule pantoprazole 40 my once daily for one week"
    },
    {
        "instruction": "hello doctor I have been to a counsellor before at my high school about symptoms of anxiety and she told my mother that I may have symptoms of an autism disorder I do not really know what to look for symptom wise but I have done a little research and so far this is what I experience almost daily being easily irritated I do not like doing things spontaneously I need to plan it out beforehand I much prefer to work alone than in groups I fidget a lot I have always been overly emotional being extremely sensitive to criticism daydreaming zoning out especially in school and excessive talking I am 18 and female also sorry about the long list",
        "input": "",
        "output": "hello firstly please do not feel sorry about the long list please relax this does not sound like autism to me in autism there are issues with social communication verbal communication repeated stereotypic behaviours which I do not see in your description what it looks like is that you have issues in managing your emotions and possibly relationships I suggest you to maintain a journal where you document about the events which have been troubling you and then you can discuss with me about specific events so that psychotherapy can be started to help you"
    },
    {
        "instruction": "hi doctor before 20 days I went to a party got drunk and met with a fall my leg started paining from the next day I could not walk without it hurting I went to a and they said it was just a soft tissue injury still now I am having pain and not able to bend it properly or fully extend it without being uncomfortable I am also struggling to walk anywhere far it got seized up today whilst in the shower and I could barely move my leg it just clamped up please help",
        "input": "",
        "output": "hi I understand your pain and concern for further information consult a general practitioner online"
    },
    {
        "instruction": "hello doctor I need an explanatory view for layman understanding in respect of the conclusion drawn in the report attached herewith I would also need to know the effect on the health of baby and mother including down syndrome and also other points mentioned in the report",
        "input": "",
        "output": "hello welcome to iclinq com basically report is normal and there is no evidence of any heart disease in the baby however since it is difficult to completely visualize the baby heart as it is small and deeply seated some diseases may be missed especially minors but at present there is no evidence of any disease and usually major diseases are not missed on fetal echo so nothing to worry at present about the report now I do not know why you mentioned down syndrome as there is no evidence of it in echo but routine ultrasound of the baby rather than echo is an investigation of choice for down syndrome so routine ultrasound of the baby called as malformation scan is necessary to rule out down syndrome also in down syndrome there are abnormalities in the heart as well but echo is fine so it is a negative factor for down syndrome but still ultrasound would be more reliable down syndrome has severe consequences on the baby rather than mother firstly because of various structural abnormalities which may be seen in various body parts requiring surgeries and baby will have developmental delays some mental retardation if it is detected earlier in the pregnancy then abortion may be done I hope this helps"
    },
    {
        "instruction": "hello doctor I want a good rheumatologist for my wife who has been diagnosed with rheumatoid arthritis she has got ra factor 150 and no other problem in blood reports anti cop is negative she has swollen fingers both in hands and legs she is currently on shellcal 500 and joint capsules",
        "input": "",
        "output": "hi I have gone through the reports there is a high ear erythrocyte sedimentation rate ra factor I would like to take a few more details on the history part but it would be better if someone can examine the joints as it is a long treatment which patient will need so she should be examined properly before commencing the drugs for it does she have early morning stiffness any dry eyes or dry mouth any oral ulcers any hair fall any other medications for diabetes or thyearoid is she taking"
    },
    {
        "instruction": "hello doctor I lost a lot of weight fat and a bit of muscle loss with abdominal pain and bluntness I also am stressed and anxious about it I had blood work done with ultrasound and chest ray also I had urine examined for blood and everything came back great no problems in those areas because of the coronavirus colonoscopies and gastroenterology are not available if I had colon cancer or tumor or something serious will the blood and ultrasound show that something is not right I am currently on cirpaex 10 my",
        "input": "",
        "output": "hello welcome to icliniq com how much weight exactly did you lose since when you are having symptoms if we consider there is significant weight loss then other specific symptoms are expected with malignancies like constipation or diarrhea malena or symptoms pertaining to other systems if we consider issues elsewhere in the body also ultrasound would have shown some mass although ultrasound may miss the tumor in early stages since you are having significant weight loss and long duration of symptoms tumor would be beyond the early stage and the probability of malignancy is less at this age group but we are not comfortable unless we find some alternative causes like gastric issues like chronic gastritis diet changes frequent indigestion or any other changes or factors which could explain weight loss if it is significant if there is any addiction like smoking alcohol or drugs it should be reduced you may have antacids like capsule cyeara or pan der pantoprazole for a few days if you have any gastric symptoms like bloating burping upper abdominal pain or heartburn I guess the doctor must have examined you for lymph nodes in the neck and femoral region I hope this helps"
    },
    {
        "instruction": "hello doctor my daughter is 5 years old two of her front teeth are shaky but not falling off but I see the new is growing because of space the old one occupying new one growing is not aligned it looks like it is growing little inward and cross",
        "input": "",
        "output": "hello welcome to iclinq com I went through your query and also seen the image attached as a specialist it is quite fine she is on the safer side as no such visible misalignment once the permanent tooth erupts fully as you mentioned and also visible from the image upper left central incisor baby tooth looks totally mobile it is better to pull it out you can get a numbing gel like rexidine forte chlorhexidine metronidazole and lignocaine gel apply over the gums on the mobile tooth hold the mobile tooth with a piece of cotton and pull it out if possible hold the area with a new cotton gauze to arrest the bleeding if not possible let it be as placed it might fall off itself seeing the condition she will be fine it was better if the tooth was extracted earlier then there would not be any chances of malalignment but it very minute and would not be visible as such try feeding hard food small pieces of hard fruits they might help I hopethis helps palatial eruption of left upper incisor due to delayed shedding of the primary tooth seven days or anytime if you need any more help"
    },
    {
        "instruction": "hello doctor I think I have gum disease my teeth are starting to move will my teeth have to be removed I have no bleeding gums there not red",
        "input": "",
        "output": "hello I went through your query I would like to see an image of the area myself kindly upload let me know if there is any history of diabetes mostly seems to be a periodontal problem"
    },
    {
        "instruction": "hi I have gradually developed unilateral ptosis is there any cream or non surgical way to cure it my eyes were fine till about a year ago gradually my right eyelid started to droop and is getting worse day by day",
        "input": "",
        "output": "hello as you have send me images of your both eye I can see there is ptosis in your eyes right eye it is looking more compare to left eye as you told it started a year ago and not from birth so it can be apponeurotic ptosis but we have to take exact measurements for ptosis and we have to compare both eyes for your query as you have asked if your eye lid is dropping day by day and it is getting worst then only way to treat is surgery there is no medical treatment for any kind of ptosis lips weakness ptosis measurements ice pack test achr ab thyearoid profile med apponeurotic ptosis myasthenia graves ptosis depending upon ptosis measurements and lab test days"
    },
    {
        "instruction": "hello I have a couple of questions first can a sinus ray show if your eustachian tube are closed or not or do the ent have to go up your nose to find out I had a sinus infection and nasal drip my ears are clogged I went to my doctor he said I had fluid and an ear infection and sent me to a ent and he said I did not have fluid then why is my ears still clogged after a month and have pressure I have a septal deviations on my right side umm can that be the reason",
        "input": "",
        "output": "hi before I explain and answer your questions I will take a little of your time to explain what has probably happened in your case the eustachian tube basically ventilate the nose and the ear in a situation where it does not function a negative pressure develops in the side of the ear leading to feeling of vaccum ringing sounds feeling of fluid in the ear and sometimes decreased hearing as well most common causes out there would be allergy or underlying sinusitis which can block up the tubes and there by cause its effects now getting to your question a sinus ray cannot show if the eustachian tubes are closed or not a sinus ray just gives information about the status of the sinuses septum and other bony prominence yes we do a nasal endoscopy to see what is the status of the nasal mucosa sinus drainage pathway details of the nasopharyngeal area and definitely see if the tubal opening is anatomically patent or not in most circumstances we can pick up any functional eustachian tube block by methods you mentioned about the confusion regarding fluid accumulation in the ear if you feel that your ears are still clogged then you can consider the treatment mentioned below this might take around 15 to 20 days for things to completely come down but chiefly depends on how manage to follow the precautionary advice mentioned above I hope I have answered your query in detail warm regards"
    },
    {
        "instruction": "hi doctor I am trying to find out a specific function of the diaphragm when it comes to taking a deep breath there seems to be a deep breath one takes similar to when one is at the doctor and they say take a deep breath and then there is a much more satisfying deep breath one can take which seems to fill the upper lungs with much more air it looks like the diaphragm upper belly moves out a little bit when this deep breath happens can anyone explain the mechanics of this why can this deep breath happen sometimes and not other times it is as if I could hold a musical note for minutes because their is so much of in my lungs",
        "input": "",
        "output": "hi it is an interesting question your observation that sometimes you can take a deep breath that is a bit more satisfying than other times makes me a bit more curious as to whether you are in the same posture every time you try it the diaphragm is a muscle that divides everything in chest from everything in the belly with a few orifices that help get certain things like your food pipe through it helps to expand the lungs by moving towards the belly while to take a breath in thereby creating more space for the lungs since there is a finite potential space I wonder if you feel the difference based on how much food you have had or what time of day is it I suggest a more detailed discussion if you can provide some more information"
    },
    {
        "instruction": "hello doctor I and my friend involved in physical intimacy a few days back and there was no ejaculation and penetration was only for minutes after that considering precum she took unwanted 72 within hours she had bleeding after six days she has regular cycle of 28 to 30 days and her last period was 30 days back she did not have period till now we performed urine pregnancy test at home all are negative is it confirmed that she is not pregnant if yes how long ideally she should wait for period after bleeding is there any medicine required",
        "input": "",
        "output": "hello as she had a withdrawal bleed post unwanted 72 intake and also the urine pregnancy test has been negative till date so pregnancy is ruled out however the conclusive test for ruling out pregnancy remains serum beta hug test which is a blood test if hug levels are less than mlu then she is surely not pregnant also now she should be expecting her menses only after 10 more days as she had her bleed marking the start of her fresh cycle just get the serum beta hug test done to get conclusive results she can wait for her menses"
    },
    {
        "instruction": "i have symptoms of a high pitched sound when I move my jaw up and down while eating yawning and even when I turn my head sideways to the affected side as well as grinding the teeth I also have fullness pressure in the ear when the jaw is motionless I have now had these symptoms for more than months I went to see the doctor last week who thought it was due to the jaw joint although there is no pain or soreness and recommended that I see a stomatologist but she did not think it was because the eustachian tube is blocked I also had an ray performed on the jaw a few months ago and it said that the left mandibular condole is positioned very slightly in front of the most pronounced point of the temporal condole I went to see the stomatologist a couple of days ago who said that I have costed syndrome he said the two sides of the mouth were uneven when I bite and therefore he chipped at three teeth on the right hand side to balance it since the sounds were coming from the left ear I will see him again in weeks time to see if the mouth is even and the symptoms from the ear have disappeared he also mentioned that I would need a night guard temporarily will the symptoms of the high pitched sound when I move the jaw up and down and the fullness pressure in the ear eventually disappear",
        "input": "",
        "output": "hi yes your symptoms of taj clicking will disappear with a proper treatment plan so do not worry its great that you have seen stomatologist and got advised for night guard go for it or I will suggest for acrylic repositioning splint and after this if you do not get relief go for orthodontic treatment for a precise treatment plan investigation required pictures of the upper arch lower arch front rt and lt view while teeth in occlusion op take medicine for days twice a day tab flexor my premature occlusal contact investigation required pictures of the upper arch lower arch front rt and lt view while teeth in occlusion op"
    },
    {
        "instruction": "hi doctor my actual due date of period will be tomorrow but I did not see any signs of the period I did not even have sex I have to travel in five days and I wish to have period by tomorrow or day after tomorrow can you suggest anything to get my period early",
        "input": "",
        "output": "hi for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor my mother was diagnosed to have acute cholecystitis she is 65 years old and is suffering from respiratory and heart problem one mild stroke also happened around two years back she had recently failed pulmonary function test will it be wise to plan gallbladder operation please reply",
        "input": "",
        "output": "hi for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am a 54 year old male with complex medical histories including a current splenic artery aneurysm an occluded right vertebral artery historical major spinal cord trauma from intramural schwannomas removed twice and multiple liver hemangiomas I have had occasional erectile dysfunction my testosterone level is low and I am on trt is it safe for me to use viagra or similar drugs for ed",
        "input": "",
        "output": "hi for further information consult to a sexologist online"
    },
    {
        "instruction": "hi doctor I am new to dentures I am wearing it for approximately two months when I take my dentures off the fixodent makes it difficult to remove and it tears my gums I wanted to know if there is anything I can use to aid in the removal so that it is not so difficult time consuming or painful to my gums",
        "input": "",
        "output": "hi I can understand your concern regarding your dental health for further information consult a dentist online"
    },
    {
        "instruction": "hi doctor while blinking my eyes some round shaped image is appearing in my left eyelid I seek doctors advice and he said that I have a retinal detachment please help",
        "input": "",
        "output": "hi for further information consult an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor I am 30 years old and 20 weeks pregnant I got an abnormal pap result with asc I had another pap two years ago and it was normal my doctor wants to do a colposcopy and biopsy however I read that it does result in complication when biopsy is performed on a pregnant woman can I do biopsy later will colposcopy show how bad the lesions are please explain",
        "input": "",
        "output": "hi I can understand your situation and concern for further doubts consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor when I was opening a powerful glue bottle two small drops of glue went into my left eye after two months I observed black spots on the whitish part of my eye please help",
        "input": "",
        "output": "hi the cause of black spots may since childhood just like moles on the skin most probably they are not related to glue need an eye checkup once please do safety measure while dealing any such thing or any chemical use protective glasses if any accident happens then first of all wash your eyes with water as early and as much as you can and go to doctor revert back with the photos to an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor I am an 18 year old male I had liposuction a year before for gynecomastia I have been in perfect shape for a while I have gained a bit of weight recently and noticed the development of puffy nipples this is bothering me very much I need some guidance please help",
        "input": "",
        "output": "hi for further doubts consult a plastic surgeon online"
    },
    {
        "instruction": "hi doctor my mother has been suffering from diabetes for three years she is 61 years old and weighs 40 keg she was on gamer early morning around am she often complains of excessive sweating and weakness sweating stops after taking tea biscuit or sugar she has stopped taking medication for the last 15 days due to personal loss she has been undergoing stress and tension please suggest the required medical tests that she should undergo thank you",
        "input": "",
        "output": "hi revert back with the reports to a diabetologist online"
    },
    {
        "instruction": "hi doctor I have been suffering from jaundice for the past three months I am feeling fatigued I have been drinking about 150 my whisky every day for the past years but I did not drink anything in the last three months I tested for bilirubin serum hemoglobin my liver shrank in size and the spleen is enlarged my bilirubin 20 albumin 81 ast 49 alt 12 and hemoglobin 30 both hepatitis and are non reactive kidney and pancreas are normal in size the doctor suggested for endoscopy please suggest the diet and precautions is the liver condition reversible",
        "input": "",
        "output": "hi alcoholism let and upper gi endoscopy alcohol induced chronic liver disease with portal hypertension continue medical treatment as suggested by doctor for further information consult a medical gastroenterologist online"
    },
    {
        "instruction": "hi doctor my father is 90 years old he has congestive heart failure and chronic obstructive pulmonary disease he is generally in good spirits and is well taken care of he uses oxygen and his doctors have told him that when his oxygen count goes down to breathe in and exhale through mouth since his breathing is generally weak after every time he walks or climbs stairs he sits down with this oxygen tank and breathes in slightly and then exhales usually with more force than he inhaled I am trying to teach my mother about pranayama and the importance of exhaling through the nose her concern is that the doctors have taught them the breath in through nose technique and exhale through the mouth given that he is 90 with those conditions on oxygen is there a reason that he should use the technique the doctors are recommending would it be more beneficial to breath in through the nose and exhales slowing through the nose even with the tubes in his nose the latter makes more sense to me but since my mother only trusts her doctors she asked to get more information about this thank you so much for your time",
        "input": "",
        "output": "hi thanks for posing this question please find my suggestions below at age 90 it becomes very important to keep the things simple for the patient your effort to teach pranayama is appreciable I would advise you not to go for any difficult pranayama which is tedious to understand nazi suddhi and anuloma viloma or alternate nostril breathing is sometimes confusing for elderly people if the above option is also found to be difficult then just ask him to follow breath awareness where one just needs to focus on breath without any active effort for its manipulation either sitting or lying exhaling through the mouth is perfectly fine as far as the patient is comfortable but there is nothing wrong in exhaling through the nose also let it be decided by the patient whether he wants to exhale through the mouth or through the nose both ways of exhaling seems to be equally good with a bit extra priority to exhaling through the mouth let us not trouble him by putting any unnecessary rules I will consider bhramari pranayama chanting of while exhaling to be best for him if any religious concerns are there about any of the chanting then these can be replaced with either only bhramari pranayama or instead of om some other words like swim can be followed with emphasis on my sound and very minimal swi sound any other similar words or chants can be chosen treatment proposed here is to be followed under supervision and several modifications or omissions and replacements may be needed for different individuals with same ailment or same individual at different stages of ailment for further information consult a yoga specialist online"
    },
    {
        "instruction": "hi doctor I got pregnant with an i'd copper it was confirmed after blood test and the copper was removed my last menstruation was 40 days before shall I continue the pregnancy how will be the growth of the baby do I need any precaution this is my second pregnancy I delivered my first child before six years through section and he is healthy please advice",
        "input": "",
        "output": "hi for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hello doctor my child is 5 years old recently a worm came out of her mouth alive of about to am long without vomit doctor gave her bandy plus and told to repeat the dosage after 14 days please suggest whether it is a tapeworm what are the investigations you would like to suggest for her please advice would there be more larvae or eggs of this kind of worms in her intestines she reports pain in her abdomen and throat often she has problem of constipation as well and because of that she lacks concentration in work or study please suggest what to do",
        "input": "",
        "output": "hello for further information consult a child health specialist online"
    },
    {
        "instruction": "hi doctor I used to spend a lot of time before laptop and tablet now my vision became blurred when I see a computer I had a headache in exactly one part or one side of the brain then I had a check up and everything was found normal the doctor suggested me to take capsule eyetamin for 20 days then I was fine without any problem for approximately a month but again developed the same problem now they prescribed me with a glass spherical arc and 25 along with oxycool eye drop and some medicines it was good till now some 15 days back my vision became blurred and I had a headache though I had my eyeglasses both were gone after I had some sleep I had the problem while I was studying I used to study continuously for hours to hours approximately a day I again had a check up and they did not find any problem eyeglass specifications did not change they prescribed me with zoline plus eye drop even after 10 days of use I do not feel any significant difference after application of the eye drop I could not see properly for some time after some time it was clear now I could watch television continuously I am having problems while studying and I could not study continuously even for half an hour either from a textbook or on laptop I am having eye strain I fear my vision will become blurred again so have stopped reading since last 15 days please suggest what I should do now I will be grateful for your advice thank you",
        "input": "",
        "output": "hello dry eyes blepharitis use lubricant eye drops for at least three times a day avoid prolonged continuous use of gadgets revert back with the investigation reports to an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor last year I noticed hair fall then I had a surgery for appendix and post surgery my hair fall increased severely I have checked vitamin b12 and ferritin levels everything is normal since I am a vegetarian my doctor put me on some multivitamin tablets I am also taking biotin tablets for two months it has been a year but nothing helped my hair has reduced to a sleek pony my family history does not have any hair fall issues three weeks back I started taking minoxidil on a dermatologist recommendation till now I did not observe any change also it has started making my hair dry and brittle please tell me what to do further",
        "input": "",
        "output": "hi for further information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor I have symptoms of pod I have excess facial and body hair along with acne and irregular menstrual cycle it takes two to three months between a cycle when menstruation occurs it will last for up to two weeks please suggest me some siddha medicine and diet to cure the pod problem and hirsutism thank you",
        "input": "",
        "output": "hi first of all you must take purgation for pod polycystic ovarian disease and hirsutism after that you should start with medication all siddha medications are not practically available some medicines are mixed in combination and are prepared by ourselves for better efficacy I suggest tablet abhyathimotak two tablets for one day only for purgation then continue kumar legiyam twice daily I also suggest syearup meryton 10 my twice daily and tablet meryton two tablets thrice a day for 15 days consult your specialist doctor discuss with him or her and take the medicine with consent for further information consult a siddha medicine specialist online"
    },
    {
        "instruction": "hi doctor I wake up with pain in the kidney region every morning after approximately three to four hours of lying in the supine position or on my left side the pain localized beneath the left and right kidneys more on the left and down toward the pelvis on the left side it hurts the most when inhaling my body wakes me up in a 10 pain every morning as a survival necessity if I elevate my mattress by 15 degrees with my head higher than my feet I do not wake up with the pain or it is suppressed approximately 90 when I get up and walk around for several minutes the pain goes away I never experience the pain when I am not lying down there also seems to be hyperintensities in both the cecum region and renal pelvises I found the intensifies in the cecum region to be upwards of 3071 compared to my bone intensity measurements averaging around 1200 I have testicular pain following urination sometimes cloudy or semen like urine following the pain I am unable to completely trace both the ureters without their disappearance and they both seem to be compressed in various regions I can however find them again around the bladder I understand that dilation is absent on the it scan however the pain only arises after hours of laying down so it would seem to make sense that dilation is not visible on the scan also there seems to be an intense vascular network posterior or underneath the kidneys that I have been unable to identify the duodenum appears to be compressed by the sma and the right testicular vein appears to be compressed by the duodenum I need your help to review these issues I feel like I am dying I am 25 years old this has been occurring for more than two years I have extremely itchy skin all the time probably due to urinary leakage or fistula or vascular issue my identical twin brother does not have any of these issues I do not think that I can go much longer I have attached the reports for your reference please help",
        "input": "",
        "output": "hi I have gone through the reports for further doubts consult a radiologist online"
    },
    {
        "instruction": "hi doctor I have had good skin for all my life people would even compliment me on it at times this changed a while ago I have been involved in bodybuilding for the last year and decided to start taking creatine roughly three months ago before that I did not notice any effect of exercise on my skin except some small pimples on my chin area after a month of creatine usage I realized that my skin was getting worse with some breakouts all over my face forehead and temples and especially chin and low jawline area I first removed the protein supplement from my diet thinking it was the cause and only 2 weeks later realized upon the research that creatine was the real culprit I instantly stopped taking it and the only supplement I take now is natural dairy free protein powder along with the skin care regimen I follow this every day I am using a cleanser along with moisturizer twice a day and it has helped almost to clear my forehead and temples I assumed my breakouts were due to dehydration in the period I was taking creatine but only noticed slight progress in my chin area although the bumps on my skin now do not feel as tough and dry as they did and do not itch anymore unless I forget to moisturize I drink lots of water and have just bought a 97 pure aloe vera gel tube that I am going to apply twice a day I am afraid whether this condition could last a long time after quitting creatine I am really worried as it is seriously damaging my confidence and overall wellbeing is there anything I need to know or anything I can do on my own to help the healing process two weeks ago I decided to take a break from working out and thought that I noticed some improvement as in decreased redness but I do not feel too sure about it but I would really hate to quit work out",
        "input": "",
        "output": "hi for further information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor my granddaughter became obese last year the doctors detected some thyearoid problem after taking the pills she became normal now she is expected to have early maturity she is years now before three years she had a head injury but she was normal and it was ignored what treatment she should take now",
        "input": "",
        "output": "hello ultrasonography of neck anti tpo antibody anti thyearoid peroxidase check levels of to and ash thyearoid stimulating hormone revert back with the answers to the above questions to a child health specialist online"
    },
    {
        "instruction": "hello doctor my mom who is 52 years old has developed a heel spur on both legs which was discovered months ago sometimes it pains a lot she is currently on proxy 200 pantosec and zelac I have attached her ray for your reference please advise how to get relief and if any treatment needed",
        "input": "",
        "output": "hi revert back with the test reports to an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hi doctor I am writing this question on behalf of a friend of mine she had breast cancer and was operated on for it before four months she had her tests done again a few weeks ago but she does not seem to believe the results and wants a second opinion could you please interpret the reports of her current situation thank you",
        "input": "",
        "output": "hi for further information consult a surgical oncologist online"
    },
    {
        "instruction": "hi doctor from when I was 17 years old I have used tanning beds on and off up until I was I was not aware of the risks through the internet I learnt about the risks I got to know that it is inevitable and that will develop melanoma at some point do most people who use tanning beds end up with melanoma my skin looks and feels healthy and I only have about four to five moles on my body and a few freckles melanoma does not run in my family I have green eyes but tan very easily I rarely ever burn are my risks still very high from my tanning bed use I did not notice any change in my moles at all and I now use sunscreen every day",
        "input": "",
        "output": "hi for further information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor I am a 30 year old female and planning for a first pregnancy thereby across I came to know about rubella test I have gone through this test recently and it came out to be non reactive egg less than iu my and i'm is less than 10 iu my should I go for its vaccination if yes then how long should I avoid conceiving",
        "input": "",
        "output": "hello for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor for the past 10 days I have been having frequent bowel movements at first it started with lots of pain but the pain got subside after relieving my bowels the stools were softer and of large quantity no blood in stool but a little bit of red color on my toilet paper I have hemorrhoids which I know and I have been impacted by all of this I went to my regular doctor and had an abdominal it scan last week I have not received my results yet I am getting pain to the right of my belly button a few times after about five or six days when the frequency of going to the bathroom slowed down I seemed to strain a bit more to go and the stools were coated in white this would only occur with the harder stools the other stools seem to be softer and more yellowish in color after the it scan I am of course going to the bathroom frequently but no white in stool at that time so my concern is the mucus which I have never had before what is causing the diarrhea ironically I had seen my gastro doctor when all of this began so I have scheduled another appointment I had a colonoscopy two years back all normal except for hemorrhoids and an upper gi at the same time gastritis was the only thing found since then I had an abdominal ultrasound and pelvic ultrasound in which all were fine could colon cancer develop quickly I am a worrying and I am driving everyone around me nuts my current medication includes effexor allegra probiotics and xanax for anxiety thanks for your help in advance",
        "input": "",
        "output": "hi we are here to help you revert back with the answers to the above questions to a medical gastroenterologist online"
    },
    {
        "instruction": "hello doctor I am having itchy and dry eyes for the past one week and recently experiencing some eye pain also for the past two days my eyes are getting tired fast and I cannot look at a laptop screen for long periods there is a constant irritation near both the eye corners but the itching occurs sometimes it is not constant I am taking refresh tears eye drops for times for the past two days and warm compresses and it is feeling better after that in the past one month I had severe tonsillitis for which I took some medications it had some side effects that led to a thyearoid disorder which is getting better now I wanted to know if this condition is serious and whether I should continue taking the drops also my father has glaucoma so is my vision in any kind of danger there is no redness as if now I am a 20 year old female thank you",
        "input": "",
        "output": "hello what you are suffering from is computer vision syndrome modify your computer working habits work in a well lit room always even if using laptop try to work on a table and chair and chair should be good ergonomic supporting your spine main light should come from behind your back remove your eyes from screen every 20 minutes and look at distant object for 20 seconds work on a he screen or retina display screen take minutes break every 45 minutes make a rule whenever you press a common key like enter or space or even when touch track pad you will blink your eye because that is essential to blink eyes 15 times a minute discontinue betonosol eye drop please use refresh tears eye drop times a day regularly if any discharge or redness develops please let me know these are not signs of glaucouma see in glaucoma there is no pain so early then too after situation of lockdown improves then please get top checked to rule out glaucoma"
    },
    {
        "instruction": "hello doctor is it possible to get some sort of sinus infection from accidentally aspirating soup when you are eating I always make the mistake of choking on ramen and it has been happening a lot lately I noticed in the last two months that every time I have ramen and choke on the soup I get a sinus infection or something that feels like uncomfortable post nasal drip could it be because of choking on the ramen",
        "input": "",
        "output": "hi it is very unlikely that you develop a sinus infection following consumption of any food however if your prone for a post nasal drip after consuming anything for that matter it could be related to a food allergy what we categorise as nina non infectious non allergic rhinitis post nasal drip occurs due to accumulation of mucus in the nose which has no place to go other than being blown out or pushed into the throat which often causes irritation and frequent throat clearing I do not really suggest any treatment for this you take steam have warm water and do saline gargles to get rid of the irritation temporarily ultimately it is always best to avoid consuming anything which can trigger such a response"
    },
    {
        "instruction": "hello doctor I vomit after eating and have an upset stomach too I also have a black stool what could be the causes of these",
        "input": "",
        "output": "hello this seems to be peptic ulcer within stomach the pain of stomach ulcer worsen after taking meals do you have a previous history of peptic ulcers the black stools are suggestive of ongoing bleeding from peptic ulcer the bleeding may be small to cause change in the color of stools however a large ongoing bleeding can not be ruled unless I know your blood pressure and heart rate plus do you have vomiting of similar black color in these days I suggest you to start capsule esmoperazole 40 my twice daily before meals take this medication regularly in case if you are feeling fainting or dizziness blurring of vision when you stand from sitting position or your upper level of the blood pressure systolic blood presure is less than 90 or your heart rate above 90 beats per minute I recommend you to visit near by emergency department for treatment and possible need of endoscopy otherwise if you do not have any alarming signs as I mentioned I suggest you can start medications and see if it helps you this medication will suppress the acid production in the stomach and will help heal the ulcers in stomach let me know if I can provide more information about your condition take care peptic ulcer disease complete blood count prothrombin time and in gastroscopy provide more information as I can be able to solve your problem at moment"
    },
    {
        "instruction": "hello doctor my years old daughter has redness around her vaginal wall it looks as if it is an ulcer type or something it hurts her a lot and frequent urination was there we took her to pediatrician he recommended us ti course zocan and trojan 5 my was given and candid gel is given it has been 10 days but still she complains of leg pain and pain near urethra should we go fo sonography please let me know",
        "input": "",
        "output": "hello I need more detail history from you whether there is fever or burning micturation or itching around vagina or any discharge from it how is her behavior after these symptoms as you have mentioned that there is cut on vagina how did this cut happen pain burning or stinging when passing urine suspect pain if a young child starts to cry while passing urine the feeling of cannot wait to pass urine may occur this is called urgency passing small amounts of urine at a time often this is called frequency new onset of day or night time wetting pain in the lower tummy may also occur if the kidney is infected the pain is in the flank the flank is the side right below the ribs unis are a common cause of fevers without other symptoms in young children the urine may be cloudy and have a bad odor sometimes there is some blood in the urine ti on top of the list interstitial cystitis vulvovaginitis trauma or injury child abuse the vulva is the area outside the vagina soaps can cause this area to be red sore and itchy this can lead to unis stool that gets on the vulva is another big factor this can happen with careless wiping it can also happen with constipation a rare cause is if the bladder is not emptied all the way reason urine that stays in the bladder too long can become infected cystitis is more common in girls than boys this is due to the much shorter length of the urethra in girls needs urine re a clean catch urine sample needs to be tested a ti is confirmed by finding white blood cells in the urine a positive culture for bacteria is also needed repeat urine s us abdomen ti on top of the list interstitial cystitis vulvovaginitis trauma or injury child abuse ti on top of the list vascicuuretric reflux or obstruction in urinary tract interstitial cystitis vulvovaginitis trauma or injury o child abuse after proper examination and history education clean from front to back after defecation plenty of oral fluids cranberries drinks education clean from front to back after defecation plenty of oral fluids follow up after reports urine and us pelvis and abdomen"
    },
    {
        "instruction": "hello doctor I am 50 years old I have a fibroid problem for the last two years this month after periods I have severe abdominal pain and fever also I am suffering for the past two days and I manage the pain with combiflam please tell me how much doses I want to take a day and how long can I take it",
        "input": "",
        "output": "hello you can take combiflam ibuprofen tablets after food maximum up to three times a day but however I would like to point out that the fever and pain may not be because of your fibroid problem because you have been diagnosed with the problem long back we have to find the cause for the same without knowing the cause for fever it is not advisable to take combiflam preferably please take paracetamol or doll 650 my for fever one possibility is degenerative changes in the fibroids which can get secondarily infected and cause pain and fever or sometimes a reproductive tract infection or most commonly it can be even because of urinary tract infection so I would like to know if you are experiencing any pain or burning while passing urine or if there is any increased frequency of passing urine if yes please get a urine test for routine microscope and culture sensitivity to look for the infection we may have to start antibiotics because you are having a fever too please revert back to me with the necessary details to look for the cause of the fever urine routine and microscope urine culture and sensitivity ultrasound abdomen and pelvis fever evaluation recommended drink plenty of water and fluids at least three to four liters per day syearup citralka two tablespoons thrice daily in half glass water for three days in case of any burning while passing urine"
    },
    {
        "instruction": "good afternoon I have few symptoms for a month like sour or metallic tongue usually when I eat some food I feel like I have something stack in my throat and I do not feel like eating anything I feel short of breath however some relief if I burp I also have to clear phlegm from my throat all the time thank you",
        "input": "",
        "output": "hello dear I welcome you to icliniq it seems there is problem within your food pipe acid reflux regurgitation of food choking and freqenut salvation and sometime vomiting are all symptoms related to food pipe esophagus metallic taste of tongue food stuck and difficulty in swallowing are just part of armentarium of symptoms of any disease affecting food pipe there are many disorders which could cause such symptoms namely esophageal diverticulum motility disorders eosinohilic esophagitis or some anatomical variations of food pipe these all disorders can reasonably be excluded on basis of good history and some common investugation rarely an endoscopy is required to confirm the diagnosis since with limited history I am unable to make any diagnosis at momemt but I tried to provide you the possibilities I recommend you some testing just get it done and come back to discuss I hope this will be helpful good day esophageal diverticulum motility disorders eosinohilic esophagitis or some anatomical variations of food pipe complete blood count serum ig thyearoid function tests ana profile cpu timed barium swallow tabs motility disorders follow up after investigation or can discuss now before getting tested"
    },
    {
        "instruction": "hi a portion of my skin in my right leg feels sensitive or I feel a little pain when it is lightly touch by clothes or hand I have started to feel the pain I think 5days now and it does not go away I searched online to find what it is and I think it is similar to allodynia btw I am not sure if my previous condition was related to my current condition I have always an issue with my right shoulder and right arm and the doctor said it is a muscle spasm at first my right shoulder hurt then the pain expand up to my right arm I have experiencing this concern for I think 3years now the pain goes on and off also I had an eardrum reconstruction surgery last year in my right ear I am not sure if it is related",
        "input": "",
        "output": "hello the hypersensitivity is caused by effect on the nerve due to any reason it may be from spinal cord to the region in leg problem anywhere can cause this kind of an issue you need to get yourself evaluated clinically by a neurologist as the mri is quite old you can not rely on that further evaluation with mri only if required and nerve conduction study might be required as a symptomatic treatment pregabalin or gabapentin can be used but only after clinical evaluation and if considered by the treating doctor thank you"
    },
    {
        "instruction": "hello doctor this is regarding my mother she is years old last year she was diagnosed with chronic liver disease she had ascites which was cured she has taken proper medication since then but recently since the last three weeks to be precised she was having tremors and difficulty in sleeping we consulted gastroenterologist here who gave medicines but did not help much with these symptoms she also has hypothyearoid and type diabetes since the last two days she suddenly developed nausea and vomiting and we had to hospitalize her for now vomiting and nausea have stopped but she is oversleeping and she still has tremors her sodium potassium and creatinine levels are normal and looking at her liver function test the doctor said she has swelling on her liver and nothing more but I read somewhere about the symptoms of hepatic encephalopathy like oversleeping drowsiness flapping tremors etc and she has all those at present am I right regarding this please help me",
        "input": "",
        "output": "hello I can understand you must be very upset about your mother health the answer to your query is you are 100 right it can be hepatic encephalopathy he it often presents as altered sleep patterns which means day time sleeping and nighttime awakening tremors are characteristically called flapping tremors and sometimes overt neuropsychiatric manifestations such as elevated mood hallucinations and illusions the treatment of he is simple I to avoid constipation and use of lactulose a special laxative agent that help to decrease ammonia gas that causes he plus she should be given tablet rifxamin 50 my twice daily to prevent her from recurrent episodes of he the recent use of painkillers could have caused kidney damage which got recovered and may be a precipitating factor for the underlying development of hepatic encephalopathy I hope this will help you in understanding her problem I want that you should discuss this information with her treating physician can follow up to discuss more about the long term management of chronic liver disease"
    },
    {
        "instruction": "hi doctor I am a 45 year old female I have hypertension for four years and I take co diovan 80 12 in the past days I performed blood sugar tests on accu check device and got the following results respectively in four days after eight to ten fasting hours 283 364 420 483 after the lock down I will go to a doctor my question is can I go on fasting and taking the same medicine what can I do these days to lower the sugar levels",
        "input": "",
        "output": "hi you have diabetes mellitus and your weight is high as well if you do not have symptoms you can go for fasting you need to do hba1c glycated hemoglobin which will show your average sugar over two to three months previously check your eyes for retinopathy kidney function test with urine albumin creatinine ratio check your feet and blood sugar frequently when fasting lifestyle modifications are the best treatment of diabetes low carbohydrates diet and no added sugar no sugary juices no bread rice pasta and potatoes if you cannot stop at least take as little as possible take more vegetable salads and consume fruits only as a sweet dish do not take mango grapes and banana apple not more than one piece strawberries and other berries are fine fasting will also help you to control your diabetes drink more water at night sleep well do regular exercise at least walk 30 40 minutes daily the more you practice these things the better will be your control you may not need medication even but if you cannot take glucophage metformin 500 my in the morning and evening check your sugar frequently your fasting target should be 90 130 my dl and two hours after eating should be 150 160 my dl"
    },
    {
        "instruction": "hello doctor I am trying to conceive for the last 5 years but not successful I was on fertisure and ovabless for six months and discontinued because I did not see any results and I am diagnosed with cos I am now on carbimazole my for hyperthyearoidism",
        "input": "",
        "output": "hello cos polycystic ovary syndrome and also hyperthyearoidism can cause infertility I saw your examination the ash thyearoid stimulating hormone levels is normal the medication you have taken are only supplements if you have menstrual irregular bleeding you can correct it with contraception pills for two to three months and then try to conceive again first I would recommend you to evaluate the ovulatory process with ultrasound examination at 12 15 days or measurement of progesterone at 21 days and after that take some medication that induces your ovulation but you have to be in a close follow up with a doctor"
    },
    {
        "instruction": "hello doctor I have been experiencing ongoing war popping sensations as if I have gotten off a plane for the last two months for the last few weeks I have experienced slight ear pain and symptoms of tinnitus I have tried an ear wax removal kit but still have underlying symptoms",
        "input": "",
        "output": "hi I could not understand what is the point of removing wax here without observing the ear canal please get it very clear your eustachian tube connecting the backside of the nose and middle ear is blocked and some maneuver valsalva maneuver under supervision will surely help what you can try at home is take steam inhalation chew food or chewing gum in an exaggerated way as it may open the tube stretch your ear a bit and you can try putting your little finger inside your ear and move it 10 15 times tinnitus may go away once the tube gets back to its normal position avoid caffeinated drinks tea coffee alcohol if you have it even after that follow up with me"
    },
    {
        "instruction": "hello doctor I cannot breathe properly and I burp every few minutes and I am always dizzy and pale please help",
        "input": "",
        "output": "hello you might be suffering from low hemoglobin the causes are many but to start I want you to get some tests to help diagnose the problem the possibilities are celiac disease pyloric infections food allergies giardiasis and autoimmune enteropathy you also look low for your body weight in this age I want to know how much blood you lose on monthly cycles if it is a large amount then it is one of the possibilities of you having low hemoglobin please check yourself anemia with anemic symptoms complete blood count iron profile vitamin b12 and folate anti tag ga egg stools for pyloric ash ft4 ft3 excessive menstrual loss pyloric giardiasis malnutrition follow up to discuss the management plan"
    },
    {
        "instruction": "hi doctor I an 28 years old and I have a skin problem on my face such as acne blackheads big pores etc it is usually not that bad but once my spot is gone I have a red mark that could stay on my skin very long as a result all my skin looks a bit reddish due to spots marks I would say my skin type is combination since it is dry after I wash my face and then it gets oily especially on my zone I am currently using la noche effaclar duo to get rid of my acne and especially my spot marks but it does not seem to help a lot that is why I was just wondering if you could recommend any skin routine that would help me to get rid of my acne and make my skin look better and healthier thank you very much",
        "input": "",
        "output": "hi skin in adolescent and young adult are covered with serum secreting glands mostly over face and trunk they increase during the summer and varies according to menstrual cycle besides oily cosmetics can hamper the acne formation process and aggravate the problems you can regularly cleanse the skin using facewash containing salicylic acid and or glycolic acid or mandelic acid to improve the acne and facial skin we frequently use gel containing retinoic acids specially at night but if you have bigger acne lesions sometimes we need to have some laboratory investigation to start oral retinoic acid could you please send me your picture so that I can discuss with you in detail"
    },
    {
        "instruction": "hello doctor I am 42 years old I have heavy periods I have my regular blood tests as I can feel so unwell with breathlessness and dizzy I have low blood pressure and doctor never seems concerned as she says my results are around 5 but my systems really affect day to day life should I have further tests",
        "input": "",
        "output": "hello following is my opinion about your asked question your main complaint is breathing difficulty and dizziness for that you need to investigate further with complete abc complete blood count to check hemoglobin level your hemoglobin report is not attached herewith if your hemoglobin level is below the normal range then iron tablet can be prescribed for your dizziness ear examination also should be done to check the ontological cause for your breathing difficulty problem chest ray ekg and spirometry like investigation planned according to the need and after discussion with your doctor your attached reports show no specific abnormalities and liver kidney are functioning well if all comes clear then history about anxiety should be taken to rule out anxiety induced panic attacks I hope this helps"
    },
    {
        "instruction": "hello doctor while sleeping at night I having burning sensation on legs and sweating all over the body and having numbness all over the shoulder and head ache it lasts for to 10 minutes I have a feeling of pain while passing urine I am 48 years old and I have removed my uterus eight years back please help I am currently taking diacardus cifran 500 raceclo xykaa and telvas 20",
        "input": "",
        "output": "hello I have read through the description you mentioned there are multiple issues I will tackle one at a time I would like to know if your ovaries were preserved when you underwent hysterectomy eight years back and if yes probably the symptoms of sweating all over for few minutes could be a sign of hot flushes which is a post menopausal symptom and the numbness and pain could be due to some nutritional deficiencies which need to be evaluated your gastric symptoms of burping and pain and the gurgling sounds are suggestive that you may be having gastritis or acidity issues try eating small meals at frequent intervals and avoid prolonged gap between meals avoid spicy foods totally sometimes antibiotics also can cause too much acidity and also the analgesic nsaids aceclofenac etc may also precipitate gastritis pain while passing urine can be a sign of urinary tract infection try to get the urine routine microscope and culture sensitivity testing to look for the invective agent so that antibiotics could be given accordingly please drink plenty of water at least 4 liters a day urine routine and microscope urine culture and sensitivity tablet panto pantoprazole 40 my daily once in empty stomach 30 minutes before breakfast for seven days try eating small meals at frequent intervals and avoid prolonged gap between meals avoid spicy foods totally please drink plenty of water at least 4 liters a day"
    },
    {
        "instruction": "hello doctor I am a 16 year old guy my height is 168 am my weight is 65kg my father height is 178 am and my mother height is 164 am I wanted to ask to can I consume oxandrolone is it safe for me also how can I increase my height in this stage",
        "input": "",
        "output": "hi your height is almost the average of your parents at 15 17 years in males growth plates close and then there is no increase in height possible after that you are almost in that age do you have any other symptoms of impaired secondary sexual characteristics you can have bone age checked if you want to confirm it oxandarolone is an anabolic steroid it increases weight an not height you should not use oxandrolone if you have prostate cancer advanced kidney disease high levels of calcium in your blood breast cancer or if you are pregnant some people using oxandrolone have developed life threatening side effects on the liver spleen and blood vessels these conditions can occur without warning or symptoms and can lead to liver failure internal bleeding cancer stroke heart attack or death I do not think it will have more benefits than risks it poses"
    },
    {
        "instruction": "hello doctor my weeks ultrasound showed an irregular gestational sack it is mostly round but sort of pointed in one location what does this mean fetal pole 158 measuring weeks and day gestational age please explain",
        "input": "",
        "output": "hi if fetal cardiac activity is present and pregnancy is weeks on ultrasound if you do not have any pain or bleeding per vaginal than there is more chance that with medicines pregnancy has more chance for growth irregular gestational sac sometimes can be due to uterine contraction which can be present throughout pregnancy if this is the case then there is more chance that pregnancy is good and there is more chance for growth one more reason of irregular sac is also a sign of early abortion but we can do only these things do take complete bed rest do minimum activity take small frequent meals take micronized progesterone for to times a day 200 my folic acid tablet and thiamine or multivitamin tablet all these will be helpful for growing pregnancy and repeat ultrasound after 10 to 15 days do drink more water"
    },
    {
        "instruction": "hello doctor I am seeing by my top gumline of my teeth have mild abfractions and are changing color from the gumline down I do not know what to do and I am freaking out are my teeth all dead my last visits to the dentist office is in november of last year and I noticed some color change in february but I did not know it was severe what are my options",
        "input": "",
        "output": "hello I went through your query and seen the attached image the image is not clear to determine any specific concerns of yours as color was not visible properly but as an expert your teeth looked fine you need scaling do betadine gargle in lukewarm water take tablet metrogyl er tablet be for five days your left lateral looked short it might be due to the quality of the image if it is like that I doubt it to be deciduous can be sure the image was hazy anyways no worry nothing is dead so please do not freak out stains and calculus intraoral ray of the upper left lateral incisor scaling and medications avoid sticky or sweet food follow up after days"
    },
    {
        "instruction": "hello doctor I have herd and gastritis I eat three times daily and timely but I am not able to meet enough nutrition gain I want you to help me in the proper management of food",
        "input": "",
        "output": "hi for how long have you been suffering from this problem are you taking any medications for herd is your weight is too low for your height do you smoke if yes please stop immediately what about consumption of coffee tea it should not be more than cups daily 120 my each with a half teaspoon sugar please get back with all details to give proper diet advice small frequent meals are advisable in between snacks you can take buttermilk which is not sour all fruits and vegetables are allowed if you are sensitive to citrus fruits avoid it do not eat any kind of fermented foods if idly and dosa are sour avoid it better if the batter is made at home first day of both are allowed avoid all kinds of junk stuff processed bakery products rich sweets fatty foods etc have light dinner by 30 am so that you have ample time before bed whenever you are eating high protein foods followed by a light meal later include ghee two to three tablespoons daily in your diet I hope this helps follow up with all the details for better understanding"
    },
    {
        "instruction": "hello doctor my right shoulder is excruciatingly painful I play quarterback in football and I am 16 years old since I participate in a throwing sport dead arm syndrome is something that I suspect may be the cause of my pain I have also noticed that my upper right trapezius if lower than my left one please help",
        "input": "",
        "output": "hello as mentioned by you that you might be suffering from dead arm syndrome at present I would suggest you to follow price protocol that is protection rest ice compression and elevation I would suggest you to stop doing any sports activities which aggravate your pain once pain subsides you need to strengthen the shoulder muscles as this condition develops due to weak shoulder muscles I would suggest consulting any physiotherapist to learn how to strengthen your muscles it is very important before you proceed to play otherwise you might get reinjury if your condition does not improves within a week consult any physiotherapist I hope this helps"
    },
    {
        "instruction": "hello doctor I went for doppler scan because I feel a small tiny seed inside my scrotum sack the scan says everything is normal nothing is found testicles are fine but it says mid left hydrocoele found doctor said no need to worry and it is no cause for alarm and that I can drain it if it got bigger I went home after five days I notice a swelling that is not round in shape and close to the left testicles the urologist did another scan for scrotal doppler the report is the same as the first one only a left mid hydrocoele was found the doctor said he is surprised that the scan has not picked up varicoceles because he noticed left varicoceles when he feels it I can feel the right varicocele is small than the left varicocele he asked me to go to another hospital for a scan and mostly they should check for varicoceles surprisingly the third doppler scan for scrotal in another hospital seen nothing wrong and the investigation was normal the urologist says since the three reports have picked up nothing and no varicoceles are found he could not operate on it that this is because the varicocele is not large enough to cause problem for the doppler to see I asked the doctor whether I should go for a semen analysis to see if the semen is normal he says that is a good suggestion to rule out every suspicious of varicocele and my sperm count is normal I ask him about the swelling close to the testicles he said that is normal and I should relax and it will not affect my testicles do you think I should be relaxed about this is the doctor right I have a very loose scrotum sack is this normal the scrotum sack reduces in size only when I feel like using the toilet to pass out stools is this normal",
        "input": "",
        "output": "hi I went through your detailed medical history and the reports you have mentioned here to tell you the fact a small hydrocele is usually harmless but it has the tendency to increase in size gradually over a period of time at which point you might need surgery to help you if the doppler scans are not showing the varicocele it might be at an initial stage it is a good option to get your semen analysis done this will help you to find out if there is any problem with your sperms but will not rule out the cause that is a varicocele it is advisable to get follow up doppler at three months interval but I would not recommend surgery just yet especially if you have completed a family and you already have children surgery is a necessity if your hydrocele increases in size and causes discomfort or a varicocele is found on the doppler scan of the scrotum or immediate surgery is advisable if your sperm count is low after ruling out other causes for a lower sperm count in the meantime what you can do at home is to provide scrotal support you can buy it at any pharmacy or if it is not available then you can wear tight underwear these are just temporary measures until you can get all the tests done I hope this helps"
    },
    {
        "instruction": "hello doctor I have ed and I have taken penile doppler test as per my urologist advice but he did not confirm any physical problem with me but the doppler test result says there is artery insufficiency below is the impression from the doppler test hypoplastic right cavernosal artery with penile erectile dysfunction please help me understand this report",
        "input": "",
        "output": "hi coming back to your query I had seen your doppler report your peak systolic velocity on right side is below normal have you tried any drugs medicines before for how long you are having ed diabetic or hypertensive morning or nocturnal erections"
    },
    {
        "instruction": "hello doctor I did not use left side for eating prior to act little pain was there but not sensitivity after one corner broke then I went to the doctor and they suggested me for act as it happened because of cavity one of my tooth second last from the end of lower jaw one day it broke down and I went to doctor then they said you should go for act and I took act treatment prior to this I did not use that side for chewing as sometimes it hurts suddenly so before act one of the corner was broken down already after act again one corner broke down again and now when I close my jaws it hurts also when I rub my finger slightly it hurts sometimes a little pain no sensitivity is there with cold water but hurts little when I close my jaws or I rub my fingers on it",
        "input": "",
        "output": "hello welcome to iclinq com I have gone through your query and understood your concern when a tooth decays and when the nerve layer of the tooth is affected it starts to give out pain and it loses its vitality becoming more brittle hence it could have fractured also to save such tooth root canal treatment will be performed mild pain discomfort after act is quite normal for the next to days for which you would have been put under pain killers this period is for tooth healing and it is essential that you do not disturb or bite food on that tooth once it completely heals crown procedure is generally performed placing a crown over the root canal treated tooth is mandatory to protect the tooth and to prevent further fracture of the tooth do visit your dentist for the crown procedure and till that do not eat hard chewy foods and avoid chewing food on the involved side"
    },
    {
        "instruction": "hello doctor if an individual has genital herpes and performs oral sex on a non infected person is it possible for it to still be transmitted",
        "input": "",
        "output": "hi I read your query and understand your concerns first of all I would like to inform you that there is definite risk of transmission of hav if there was direct skin to skin contact such as sex oral sex passionate kissing among others however the risk is low provided there was no active lesions at the area of contact but practically speaking people with active genital lesions can have active lesions over the oral mucosa which can shed the virus which can be transmitted to their partner I also like to make it clear that itching and burning sensation are very rare before appearance of lesions it is good idea to get tested for herpes antibodies"
    },
    {
        "instruction": "hello doctor my baby daughter is years months old weight is 12 keg her molar teeth is coming on both left and right side she is have swollen gum she is suffering from pain she always show her finger towards teeth also her mouth is also giving very bad smell please suggest some medicine doctor",
        "input": "",
        "output": "hi kindly answer the following questions for a better understanding is she having fever as well if yes how severe because it may probably be infected and may need an antibiotic course this usually happens in children during tooth eruption you can continue with pum drops every hourly for pain and swelling if severe pain in gums you can use a pinch of mucopain gel for local application also start a calcium syearup if giving syearup calcimax my twice a day it would help in tooth eruption"
    },
    {
        "instruction": "hello doctor my eyes hurt for about a week now I feel like resting for a long period of time they are itchy and dry there is a foreign object sensation sometimes I feel like I am losing my vision or it is getting weaker sometimes I do the 20 rule lately I have been spending a lot of time in front of the screen what could be the reason my eyes hurt currently I am taking isotretinoin 20 my twice a day and topical benzoyl peroxide and topical retinoid and clindamycin for chronic acne",
        "input": "",
        "output": "hello you must get your be and blood sugar levels done monitor if normal or abnormal and consult a physician also get ad echo done as soon as possible and seek a cardiologist opinion the condition that you lost vision suddenly for some time is known as amaurosis fugax I am telling you this first because this is serious also it is a must to get your refraction done and also consult a retina specialist and get the detailed retinal examination done as well coming to your eye symptoms it would have been better if you share a picture of eyes but it seems like you have allergic symptoms I hope there is no discharge or stickiness of eyes you can use bepotastine 5 eye drop ads one drop in both eyes for two weeks soft drops 5 sodium carboxymethylcellulose eye drop six times a day one drop in both eyes for one month avoid any rubbing of eyes use goggles"
    },
    {
        "instruction": "hello doctor my problem is both my underarms are black in color and has a bad smell when it sweats I did not use any medicine for underarm before my face is in oily type with acne spots marks I have consulted you and you suggested me to use yaclin facewash benzoyl peroxide ac for acne and exazel for spots marks I am using these for the past six months but not much results and acne spots are not faded I am 21 years old can I use dermal roller for face can I shave my underarm hair",
        "input": "",
        "output": "hi it would be great if you could send pictures of your face and maxilla to assess the severity anyway start on tablet azithral 250 twice a day for three days a week for three weeks apply clindoxyl gel to the acne spots once a day for three hours only for two weeks for the next two weeks apply derive cos adapalene gel to the acne spots for three hours for black spots please apply melaglow rich cream at night for maxilla apply candid gold powder in the morning hole cream in the night take tablet alaskan loratadine once a day in the night for itching for 10 days drink lots of water remove your hair dermal roller cannot be advised for self use please do not use it"
    },
    {
        "instruction": "hi my dad who is 61 years old has been experiencing hypertension and I would like to ask what are the best ways to ease lower the blood pressure at home hypertension runs in his family he has pain in the nape area and his be is 150 100 same issue happened last month his be was 160 100 and he felt dizzy and no energy he is taking losartan 50mg half thank you so much",
        "input": "",
        "output": ""
    },
    {
        "instruction": "dear do I want some information about the leprosy disease when I go out I often see beggars who are suffering from leprosy skin lesions or deformed fingers and toes I am concerned whether there is any risk of contracting the disease from them please give me detailed information about what is the risk of getting this disease also can this disease be contracted by touching object which could have been contaminated like door handles etc can it be contracted from the ground or soil",
        "input": "",
        "output": "hello it is very commendable of you to find out more about this disease a lot of stigma is associated with the disease and its sufferers common public just sees those people as untouchables or a taboo it is a bacterial infection caused by mycobacterium leprae the organism is similar to bacteria and so their treatments are also similar and run for months together but the treatment and drugs are not the same the leprosy bacteria produces lesions in skin mucous membranes eyes nerves and tissues gradually untreated lesions spread inside and affect nerves causing their swelling and loss of sensation slowly the body resorts the extremities and thats why you see a lot of untreated patients having loss of digits and toes you might have found a lot of people with saddle nose deformity also the transmission of leprosy with what is known occurs after prolonged and close contact with untreated leprosy patients over months it does not spread that easily or fast you dont contract it from ground or soil you dont get it if you touch an object touched by a leper nor would you get the disease if you hug the patient there is very minimal to no risk in contracting the disease from patients who are outside however avoid prolonged contact with the patients wear a mask always when you are outside considering the current situation recently there is some evidence suggesting the disease may be spread by droplets like sneezes or coughs or bodily fluids but nothing has been concluded it is best to avoid close personal contact with a patient and wear a mask to prevent droplet infection treatment of the disease involved multidrug therapy for long durations with adequate therapy the disease is curable is there anything else that you would like to know"
    },
    {
        "instruction": "i have a sensation of a lump in the throat occasional nausea and some challenges swallowing this has gone on for close to months",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello doctor I was diagnosed with epilepsy in late 2016 and have been taking levetiracetam since then 500 my twice a day I have been concerned that it is affecting my mental health I have been experiencing anxiety depression irritability and anger which is very out of character for me it has taken some time to pinpoint but it seems like these behavioral changes may correlate with when I began taking the medication prior to starting levetiracetam I had two grand mal seizures about 12 15 months apart I frequently had what were diagnoses as epilepsy related auras since I have been taking levetiracetam I have not had any more seizures or auras I am happy the medication is working but I am interested in advice about other possible medications or non prescription treatments",
        "input": "",
        "output": "hi your assumption is right levetiracetam causes behavioral disturbance as a side effect there are two options now to taper off the levetiracetam if you have not experienced any seizure or aura in the last four years then we can go straight away with gradual tapering of the medicine for that we need to know the last seizure aura episode but with this there is a risk of recurrence you need to be cautious and under the watch of someone for few months substitute levetiracetam with sodium valproate in this risk of seizure is less but still it is there on the fact the sodium valproate is a mood stabilizer please do not do any of the above by self you can consult a neurologist locally let him manage or get a telephonic consultation"
    },
    {
        "instruction": "hello doctor I have pain on both of my testicles but the pain is more focused on the left I did blood and urinary tests ultrasound and it scan but all were negative I do not have the pain in the same way it was but then I feel like it is a little longer than my right and also heavy what can I do",
        "input": "",
        "output": "hello I have gone through your queries you have bilateral testicular pain discomfort and heaviness and all investigations are within the normal limits it would have been great if you had uploaded those reports however do not worry if us tests with doppler study is within normal limits then there should not be any major concern I would like to advise you to wear tight underwear it will reduce your discomfort whenever there is pain or discomfort in the tests you should elevate it pain will be reduced you can take paracetamol 650 my sos also I would like to undergo the following investigations after one month if symptoms persist us ultrasound l inguinoscrotal region with doppler study urinalysis urine culture us rub kidney ureter and bladder and per postvoid residual urine"
    },
    {
        "instruction": "hello doctor I am a 16 year old male for the past few months I have been getting sudden electric shocks a little bit more than calm in my neck when I move it these are not at all frequent I get them once in a while I am not that fit and I use my tab for studies while sleeping a bit relaxing almost 5 hours a day please help",
        "input": "",
        "output": "hi as you described using the tab for 5 hours a day will make your neck bent forward to see the tab continuously for long hours that might be the reason for your neck pain as all elders advice sit straight keep your books or tab at an elevated location while reading so that you need not bend your neck much and do some exercises for your neck daily while sitting free move your head up and down sideways and slow rotator movements clockwise and anti clockwise neck sprain neck exercises as advised"
    },
    {
        "instruction": "hello doctor I have had an issue with my anus area for a while now the area is always red and there is always an unpleasant smell fish I do not notice any drainage I have a history of pilonidal sinus and abscess I was tested for a few sad but not all I think it may have something to do with the pilonidal sinus as the two issues were consecutive I will attach an image that will hopefully help",
        "input": "",
        "output": "hi if possible provide me photographs of affected areas that will help me for a better understanding of your skin problem and proper treatment plan photographs required for more accurate diagnosis purpose because treatment given without proper diagnosis can be less helpful"
    },
    {
        "instruction": "hello doctor I would like to consult for my disturbing allergic flares I am a year old female I am not known hypertensive diabetic or asthmatic within these three months I have history of morning colds nasal congestion pruritic rashes and eye itchiness I have no fever no cough shortness of breath headache and sore throat I took monetlukast cetirizine once a day and applied olopatadine optic drops four times a day which did not relieve my symptoms therefore I added loratadine 10 my tablet at bedtime I tried a hypoallergenic diet as well after two weeks still without relief I added prednisone my tablet with a tapering dose for two weeks there was no significant relief of symptoms now I am still on montelukast cetirizine once tablet once a day and loratadine 10 my one tablet once a day at bedtime my rashes are getting worse and my sneezing as well please help",
        "input": "",
        "output": "hello regarding the treatment I suggest you continue the medicines as they are I would like to know how much of prednisolone did you start with nextly you must start on intranasal steroids to help relieve the nasal symptoms use fluticasone furoate twice daily two puffs in each nostril twice daily the brands available in the philippines are avamys flutiair nasoflo flusort if you feel the antihistaminics are making you drowsy then you may keep the cetirizine for the evening and take loratidine in the morning apply a mild steroid cream like betamethasone valerate 1 topical cream over the affected skin the brands available in your country are diprolene diprosone and betnovate long term solution you must do a skin prick testing to check what you are allergic to skin prick testing is better than blood allergy testing both the methods check for food and aeroallergens remember that before the testing you should stop the antihistaminics for five days with such a test we will come to know the offending agent and give you the right advice to prevent that particular allergen do revert back for more details apply mild soap and wear loose fitting clothes to avoid friction over the affected area on the skin"
    },
    {
        "instruction": "hello doctor I am a 35 year old male no episodes of helps except chickenpox in childhood no infection of hiv clinically tested every six months for the last seven years my partner and I both are not having hiv clinically tested I had a bacterial or fungal infection with pus and redness in the genital area so I have done the blood test hiv is negative hsv egg 5 positive hsv i'm 29 negative hsv egg 45 negative hsv i'm 69 negative as hsv is mostly non genital infection I did not have any episodes of hsv type helps in my life I never had hsv type herpes anywhere in the body I am straight and have a relationship only with my spouse how can blood show hsv egg positive without any symptoms dermatologist says it is due to past infection and not about present infection doctor told I should take antiviral dose acyclovir for 20 days for hsv egg past infection is it useful to take antiviral dose for the past hsv type infection will it reduces egg level in the blood is hsv egg is false positive",
        "input": "",
        "output": "hi first understand the situation i'm indicates recent infection and egg indicate chronic infection since you have both the i'm negative it means that there is no recent infection secondly about 70 80 of us population is hav herpes simplex virus positive it means they are infected once in a life time and antibodies will remain for throughout life but it does not mean that 80 of us population should start taking acyclovir there are no guidelines for taking acyclovir until you are symptomatic so do not think too much about this figure if you had any other problems you can revert back to me"
    },
    {
        "instruction": "hello doctor I am a 26 year old male I have black brown patches on my back below the neck the whole of my upper back portion has turned black brown it has been around 10 years this discoloration started but is now constant not spreading for the past 5 years",
        "input": "",
        "output": "hi it is pigmented hairy epidermal nexus becker nexus or backers melanosis the first appearance of this nexus is in adolescence it presents as an irregular hyperpigmented patch once present these neve stabilize after several months or years becker nexus is a benign condition and malignant transformation is rare no treatment is required although lasers have been used for cosmetic benefits its cause is familial and occurs due to mutation genetic counseling should be tried"
    },
    {
        "instruction": "hello doctor I am 40 years old my sexual life was good but due to hysterotomy performed on my wife due to fetus complication I am not able to have sex with her till date in the event of this I have been masturbating three to four times a week to relieve my urge for sexual excitement however lately I have noticed that while masturbating my erections are not that rock hard like a couple of months back and even the force by which I used to ejaculate has drastically reduced and my sperm does not come out in force but just dribbles out of my penis on orgasm I have no sort of medical problem or diseases and lead a normal diet without any medicines my wife gynecologist had once prescribed coq la and fertisure medicines for me however I need your advice as to which medicines I should take and the dosage to overcome my problem and even get ready to make my wife conceive naturally",
        "input": "",
        "output": "hi welcome to iclinq com I can understand your concern as such nothing much to worry about erections may not be the same every time these would settle down as you enter your sexual life again generally the following hysterotomy sex life can be started after six months but here the main thing is the psychological part the women is going through spend value time with your wife which would help her get back to her old sex life if you are worried about your fertility profile get a semen analysis done and look for the concentration and motility of sperms and also get a random blood sugar done the very fact that your wife has conceived spontaneously rules out both male and female factors of infertility so just relax the possibility of erectile dysfunction with your complaints is less considering past history have a trying time for to months if pregnancy is delayed then consult a fertility specialist I hope this helps psychological semen analysis ribs random blood sugar psychological reassurance increase the value time for each other"
    },
    {
        "instruction": "i have accidentally drank some amount of green phynel yesterday night I have vomited many times it is 24 his over I did not see any doctor if I do not go to doctor shall I face any problem in future all I will be ok I am really worried and didnot tell anybody about this",
        "input": "",
        "output": "hi I see that your worried about phenyl consumption if it is small quantity and accidental you need not worry but do not induce vomiting on your own as it is not good phenyl is corrosive if you repeatedly induce vomiting it will cause damage your food pipe you need to visit a doctor if you experience any difficulty or pain while swallowing unable to swallow if any giddiness sweating breathing difficulty or persistent abdominal pain as it may require an endoscopy to visualise the inside part of the food pipe and the stomach abc rat let egg accidental phenyl consumption rabeprazole 20mg twice daily half an before food for month spy sucralfate oxetacaine 10ml hour before food thrice daily for month avoid hot and spicy foods take only cold liquid or semisolids for to days review back with investigations"
    },
    {
        "instruction": "left eyelid very swollen and itchy with pain it is also very itchy and painful and also having a white discharge from eye I have been having the issue for a week and it is not getting any better",
        "input": "",
        "output": "hello according to picture you have send its likely to be invective in origin so you have to take antibiotics for the treatment all these you have to take for weeks then you will be fine infection as per now nothing sty infected lid swelling as mention above do not rub your eye do not touch your eye after week"
    },
    {
        "instruction": "hello I am currently in my withdrawal bleeding week placebo pill days I am on birth control yesterday I noticed two abnormal clots on my pad I have experienced blood clots but these were different a little difficult to explain I have a picture but they were large and white with visible blood vessels on the surface and a blood string at the end again a little hard to explain in words because of my current circumstances I have not taken birth control the normal way in the last two months early last month I did not have more birth control at the end of my placebo week and was only able to start a new cycle of it the following week I did not know I should only start the pill at the beginning of my cycle once I found out I skipped the placebo week the following month in order to reset the ovulation placebo timings I am sexually active and knowing I had not used the pill correctly I mostly used condoms as backup I was wondering if these clots could be a result of messing up the pill or if they are something I should worry about thank you for your help",
        "input": "",
        "output": "hello welcome to icliniq based on your description I understand that you skin using the pills in early last month in the beginning of your menstrual cycles and later took it continuously to avoid the placebo pills see first thing you have to understand is that if you did not start the birth control in the first week of your menstrual cycles it is not effective as a birth control at all as the follicular development already sets in which contains the ovum egg so there is a high chance of pregnancy in such cases even if you start it in the following week the clots that you described could be possibly products of conception only a possibility if you had gotten pregnant and had a spontaneous miscarriage so to confirm if this is the situation or not please check your home pregnancy test if that is positive then this confirms the likely possibility of a pregnancy also if you could share a picture of the clot that you have I can have a look to check the other possibilities of your problem please feel free to revert back to me anytime with any further queries or doubts also please check your home pregnancy test once and get back to me with the result have a nice day home pregnancy test ultrasound abdomen and pelvis"
    },
    {
        "instruction": "hello doctor I am having postnatal drip for the past one month and had tablet zee and montair la and took steam inhalation but I think it got aggravated and the drip got thick because of it I then consulted an ent and he gave nasomac af spray tablet alaskan am and raciper 40 no improvement since seven days and then he gave acetylcysteine 600 my the mucus comes out by coughing and I have to constantly clear my throat I looked at the back of the throat and I could see white mucus dripping I am 34 years old",
        "input": "",
        "output": "hello I understand that you are having constant post nasal drip is there any other symptom that is bothering you is there any lump sensation in the throat any nose block or runny nasal discharge any facial fullness did you ever have this problem before this month the treatment given by your ent appears to be correct and complete considering the symptoms you have told me but are you using the spray in the right way antihistaminic mucolyte and spray together should decrease the postnatal drip unless there is some pathology inside the sinuses that is producing constant mucus please tell us more details of your problem continue the same medicines for now take a picture of the back of the throat with open mouth showing the details of the mucus drip and send it to us please let us know if you are using the spray in the right way if you are doing everything properly and this is the only symptom you are facing then probably we need to check the insides of the nose using nasal endoscopy and a it scan of sinuses next is there any allergy that you suffer from do you smoke is your workplace ridden with dust smoke or pollution"
    },
    {
        "instruction": "hello doctor I have a problem of fluid coming from both ears what is the cause there is no blood and foul smell and it is pale and clear please help",
        "input": "",
        "output": "hello since how many days are you having this problem any hearing loss or cold or nose block"
    },
    {
        "instruction": "hello doctor I am having severe allergic symptoms to almost every single food I eat and not really sure what to do for the last year I have been developing what seems like ice type allergic reactions to literally every single food I eat it is getting really bad these potatoes I have been eating for the past month now cause swelling in the back of my mouth and throat that makes me choke so I had to stop eating them other foods cause different types of reactions like frank diarrhea please help ice egg and ga antibodies normal ice skin prick testing normal ca inhibitor slightly low cortisol low acth stim test not performed fasting hypoglycemia testing for insulinoma negative so far and I have mild heart dysfunction diastolic",
        "input": "",
        "output": "hello I have gone through your query and can understand your concern as you rightly said there might be an allergy for a particular type of food you eat you may have allergy probably to one particular type of food you need to observe keenly over getting symptoms after eating a particular type of food you have been eating potatoes for a month and then getting symptoms is little unlikely if at all it is because of potatoes you should get it immediately after eating and not after eating for a month most of the people will have an allergy to milk and milk products or lactulose intolerance most common food products that cause allergy are milk and milk products eggs fish nuts like almonds cashews peanuts walnuts soy or wheat as seen in patients with celiac disease or non celiac gluten sensitivity have you been evaluated for other gastric disorders by a gastroenterologist it would be better if I could see all your reports and treatment given so far by your doctor you need to observe keenly about the food type that is causing the allergy avoiding the food that is responsible is the best way to avoid allergic reactions make sure you have always with you all emergency medications needed to be taken in an emergency as anaphylaxis and other allergic reactions can be dangerous at times kindly get back with the above details your further queries and reports if available for further discussion and management"
    },
    {
        "instruction": "hello doctor this morning I woke up and passed stools and had mild abdominal pain in the center of my belly I went about my day and the pain is getting more intense I defecated again and it still hurts the pain feels like the worst gas of my life but I am not farting I cannot afford to go to the hospital especially if it just ends up going away is there anything I can do to fix this",
        "input": "",
        "output": "hello well the onset of pain with a feeling of bloating and change in intensity after passing stools suggest it is related to gas you probably had something last night or a few days back which has caused you to this gastrointestinal upset well this does not seem alarming in any way I suggest you to take simethicone suspension or capsule whatever available ot pharmacy 60 to 125 milligrams my four times a day after meals and at bedtime for two to three days this medication will break the gas bubbles and will help you pass the gases easily it has side effects of excessive burping belching and farting but use temporarily until the time you feel better if symptoms do not improve in the next 48 hours and if the pain increase in intensity or you started feeling vomiting and complete loss of flatus I suggest you to contact me immediately or get yourself checked to the nearby clinic gas and bloating simethicone 60 to 125 milligrams my four times a day after meals and at bedtime follow up if no improvement in pain or unable to pass flatus"
    },
    {
        "instruction": "hi doctor I had my hips adjusted about a year ago and the trainer who did it yanked my right leg to align my hips it felt good at that time but the next day I had nerve pain down my left leg and into my lower back on the right side every time I stretch my left hamstring or sit in an shape I get a really sharp pain in my right lumbar spin area it has not gotten any better and I have tried nerve flossing but that was making it worse any help would be greatly appreciated",
        "input": "",
        "output": "hello in my opinion you might have your sacroiliac si joint strained and the same is causing you pain in the back and the leg you just need a good mobilization of the si joint and lower spine along with some soft tissue work to relieve the pain and spasm nothing to worry once you start realigning the joint you will gradually feel better you need to start strengthening your lower back and glue stability with hip control exercises as of now keep a lot of icing in the painful area frequently like once in two hours for 10 to 15 minutes gentle stretching of gluteus and hip flexor gentle massage over gluteus muscles and hip mobility program will help you to relax with lower leg symptoms I hope this helps"
    },
    {
        "instruction": "hello doctor I am 29 year old married male I have a baby who feeds on breast milk I had a sexual encounter before months with a professional with a condom I am 95 sure that my protection was intact then I started reading about the hiv symptoms and technicalities of testing online five days later I went to a dermatology and venereology specialist and described about the incident he was confident enough that he advised me not to go for any testing although my fear of infection remained around two months post exposure I felt tenderness here and there like on the back of my head arms one lymph node in my underarm was swollen and I developed cold and cough I started sweating during that time as well I looked a bit thinner I got panicked and went to the doctor again he checked me and was still confident that I am not infected but for my mental satisfaction he prescribed me thorough testing which includes hiv1 vdrl hbsag hav along with urine e e s analysis on 74 the day post exposure I took all those tests and they all came back negative after lapse of a few days again I felt some skin irritation on theback and burning sensation on my forearms although no skin changes can be seen again I got panicked thinking that I may be in the window period for hiv but the doctor remained confident and he advised me not to go for any repeat testing but my sense of fear anxiety panic guilt and impurity continues on 10th day post exposure again I repeated the tests but I excluded the urine analysis this time all the tests came negative again the hiv tests were fourth generation combo test both the time I am on the eighth month post exposure still I feel tenderness hear and there recently I am developing small red blood vessel like dots just underneath my skin on my hand and feet which is staying for 7days and going away leaving faint black spots I again showed it to the same doctor he is confident and repeatedly asked me to stop worrying he also gave me anti anxiety anti ocd anti depressant drugs I am also taking sessions with a psychologist but still my mind is not free from the fear of hiv and also fear that my wife and child might get infected by me my questions are do I need to repeat any test to out rule the probability of hiv are there any probability of error from lab test given the fact that I took the tests twice do I need to worry about the window period as there is conflicting information available on the internet do I need to worry about the phenomenon of delayed seroconversion do I need to opt for the tests from a different lab do I need to worry about hiv 2anymore how to uproot the fear from deep inside my mind any other opinion on my history",
        "input": "",
        "output": "hi the chances of transmission of hiv by the given description is almost nil hiv tests are repeatedly negative and after three months of exposure it is conclusive you are free from hiv there is no need for you to worry about seroconversion you can forget about the episode and lead a normal life there is no need for any further hiv tests in any lab just relax do some yoga exercises meditation etc"
    },
    {
        "instruction": "please give me a meaningful response as I cant afford to reply and I am scared that I am slowly losing my hearing or something I have had tinnitus in my ears for about months now and it sounds kind of like v static and its not loud so its okay but today my phone edited a very high pitch sound and I closed one ear and then opened it and closed the other ear and noticed that I could hear the high pitch sound much better in one ear then the other could this mean im slowly losing my hearing about months ago I got a hearing test done but I dont have the results but they said my hearing was amazing even now I have no trouble hearing at all so what is happening with the high pitch noise why can I hear it better in one ear then the other",
        "input": "",
        "output": "hi welcome to icliniq there are different causes of tinnitus ringing in ears like infections loss of cells inflammation advancing age or few other diseases of inner ear at your age hearing loss is less common unless having a disease there are two possibilities so to two differentiate which ear is abnormal few test are done by audiometerist ent specialist to make final diagnosis I would suggest you to get examined by an ent specialist and he will perform necessary test and manage appropriately you are welcome for any further queries have a blessed day god bless you"
    },
    {
        "instruction": "he my dad becoming weak day by day we consulted doctor who told the urine is containing blood also although its not visible looking at urine his leg was also swelling on medication it became fine he also added it may be liver failure but he did not confirm how he is becoming weak age 73weight 70 height 2i would be thankful if I get a prompt reply",
        "input": "",
        "output": "hello I welcome you to icliniq I can understand you must be very upset about your father the history you provided provides a little clue to what excatly he is suffering with non visible blood in urine is called microscopic hematuria some liver condition can cause this problem such as hepatitis viral infection hepatitis viral infection recent drug use or advanced liver disease secondary to any cause with advanced liver disease platelets white cells in blood which control bleeding are decreased that why patient is prone to develop bleeding from any site may be in urine skin or sometime internally within abdomen the swelling you mentioned possibly be secondary to fluid collection over legs and which resolves with medications called diuretics which increase urine formation if these all findings combined it is possible that your father is suffering from liver cirrhosis also called scarring of liver dear the liver cirrhosis requires a long term management with initially medical and supportive treatment followed by liver transplant which is the definite therapy if you want to discuss with me in more detail plus want to show up his previous investigations I strongly urge you to use icliniq forum you can easily book a consultation via text phone or video and get in touch with me I hope this will help good day liver cirrhosis complete blood count liver function test serum album and total protein ag ratio bun or lytes urine do stool do alpha fetoprotien ultrasound of liver with doppler follow up to discuss and provide more information"
    },
    {
        "instruction": "hello doctor I am a 27 year old female I have pain on the right side of the head neck and shoulder please suggest",
        "input": "",
        "output": "hi I can understand your concern according to your statement you have been suffering from right sided head neck and shoulder pain most head neck and shoulder pain is resulted from sprains and strains by incorrect posture or mechanical injury due to daily works it may result from soft tissue injury including muscle tendons ligaments etc again nerve injury of these area can produce head neck and shoulder pain displacement of cervical disc can produce same type of symptoms known as herniated or prolapsed disc rotator cuff tendons hold your arm with shoulder and rotator cuff tear which is caused by sports or overuse can produce head neck and shoulder pain inflammation of tendons tendonitis or burst bursitis of these areas also can produce the same type of clinical symptoms again heart attack angina stroke cervical artery dissection etc can present the same type of clinical symptoms treatment depends on causes so you should undergo some investigations like an ray of cervical spine it scan or mri of cervical spine ribs random blood sugar abc complete blood sugar us ultrasound of the hepatobiliary system with blood pressure monitoring etc to find out the underlying the causes which are responsible for your suffering and then treat them accordingly for your head neck and shoulder pain you can take naproxen plus and esomeprazole combination twice daily with baclofen twice daily with calcium plus vitamin combination once daily please inform me of the results after undergoing the investigations and then I will be able to help you further"
    },
    {
        "instruction": "i am 40 years old my digestion is always a concern for me but since last month I am having blowing stomach cramps stool discharge 4 times a day medicine taken rifagut actigut for days mental spas continuous pentaprazole 20 days till no at present blowing reduced but stomach cramps stool discharge 4 times a day still persist us abdomain found minimal edamatus wall ave 3mm noted in sigmoid colon rest is ok as per stool test macrophagus present a few kindly advise",
        "input": "",
        "output": "hello I welcome you to icliniq I can understand you must be very upset about your problem well the symptoms you mention seem to be occurring due to irritable bowels the irritable syndrome is a gastrointestinal entity where patient has abdominal pain which change with physiologic activities such as defecation belching this abdominal pain can accompany diarrhea which is called as irritable bowel syndrome is diarrhea predominant is to be precise the blood test urine test and ultrasound abdomen that you shared are very much within normal limits so do not be worry at moment you said stool test contain macrophages but I cannot see any stool detail report among files you uploaded well macrophages or leukocytes can be present in stool harmlessly and does not suggest any diagnosis by its own I would recommend you to get some more stool test that can determine it clearly so the is usually affects small and large bowel and it is not uncommon to have concomitant stomach irritation which is called functional dyspepsia so part of your symptoms such as stomach cramps bloating are secondary to stomach irritation you are on lots of medications many with similar drug class that does not seem a wise to continue for now I just recommend you some medication you can use them and let me know in one week time how that work in your case please find below investigation and treatment plan good day irritable bowel syndrome with functional dyspepsia stool for pyloric stool for fecal calprotectin stool for detail report for ova and parasites and for giardiasis stool for fat globules reducing substance and stool spot na and spot levels serum ash ft4 and ft3 random blood sugar and hba1c inflammatory bowel disease endocrine disorders diverticular disease of sigmoid pyloric gastritis gastroparesis is plus fed tab rifaximin 200 my thrice daily for weeks tab mebervine my 200 my twice daily reduce some weight avoid gas producing diets such as nuts peas cauliflower cabbage certain cereals which you think causing increasing bloating follow up after investigation"
    },
    {
        "instruction": "hi doctor I get cold sores about every years over the past 15 years and they go through the five stages of healing which take about 10 14 days to heal over the past two years I have got two cold sores that have not completely healed one was before a year and the most recent one was in february of this year they are faint but apparent to me and every time I move my lips eat have hot food shower sweat or just about do anything I can feel them on my upper lip I have been to multiple doctors and two dermatologists I have been prescribed valtrex tacrolimus and medicines for the pain I have used many over the counter medicines such as neosporin abreva hydrocortisone vitamin oil face cleansers tea tree oil aquaphor and kept it moisturizer and clean throughout nothing has worked or even made a slight difference I get the constant tingling and it is not super painful but I can feel it there as if it has not healed or subdued my current dermatologist has suggested a biopsy but I am not sure if that is the next step if it is not a cold sore or cannot be healed with what I have been prescribed I nor my dermatologist have any idea what it could be how I can be rid of it please help",
        "input": "",
        "output": "hi as per your information and photographs I can see there is swelling and some small pus filled rash and small scars if it is recurrent then there are some possibilities like herpes labialis cyclic neutropenia neutrophilic dermatoses localized granulomatous cheilitis yes punch skin biopsy will give a more close clue for diagnosis along with it you need to do tzanck smear from lip area abc complete blood count absolute neutrophil count and anna anti neutrophil cytoplasmic antibody do you have diabetes or high blood pressure or on any medicines for the same or any other complaint from your detailed information recurrent herpes labialis or neutrophil abc related skin disorder are more possible tingling and pain indicate nerve fiber involvement which is more possible in herpes virus infection for time being you can start tablet pregaba pregabalin plus methylcobalamine 75 my one tablet in the morning and night after food for 15 days tablet prednisolone 10 my in the morning after food for 10 days flutibact cream apply at morning and night for seven days vitamin 500 my one tablet at night dissolved in water for 15 days and tablet famcivir 250 my ads after food for seven days review after investigation reports"
    },
    {
        "instruction": "hello doctor I am facing this below for more than 15 days my lower and upper wisdom teeth are erupting the lower teeth are erupting and gum got swelling and pain there is swelling nearby the last molar teeth and feeling pain I have a feeling of throat infection and sometimes pain in the throat neck and jaw I have no fever but inside the tongue I found red blisters I need your advice already I am taking loxoprofen sodium 60 my for one week and azithromycin for about three days",
        "input": "",
        "output": "hello welcome to icliniq com first of all please do not worry I went through your query and I am a specialist dealing with third molars I can understand what kind of pain and discomfort you have been through I will guide you to relieve all your pain these teeth are impacted and they will not come out normally and will cause discomfort repeatedly I will prescribe better medicines kindly get them you will be fine visit your dentists office once the lockdown gets over to extraction for now I need you to do warm saline gargle two to three times a day if hypertensive avoid salt use betadine gargle avoid sticky or sweet food maintain oral hygiene avoid direct heat warm cloths from outside take the medications as prescribed impacted third molars pericoronitis follow up after seven days"
    },
    {
        "instruction": "hello doctor anxiety disorder bloated stomach and constipation are troubling me I am a coronary artery disease patient with diabetes thinking about these issues cause me more anxious please help I am currently on mirtaz 5 and david 50 my I have also done sugar lipid profile ad echo egg and tit",
        "input": "",
        "output": "hello I read your query and understand your concerns first of all I like to inform you that anxiety disorder is a treatable disorder during current times as a lot of medications are available in this regard as I can see you are taking two medications for the same but unfortunately dose of both medications is at lower limits I also feel instead of two medications it will be ideal to have one medication with proper dosage for example dose of david sertraline is 50 200 my per day and the dose of mirtazapine is 15 60 my for most individuals in my opinion you need to discuss the optimization of dose with your treating psychiatrist as I can see there are issues with stomach bloating and constipation mirtazapine needs to be avoided as far as possible this is because abdominal side effects along with constipation are very common especially among the elderly there is also a possibility that your medications for cad or diabetes contributing to the current problem for that purpose I feel you need to discuss same with your cardiologist in addition to medications there is a need for stress management I can see that you have excessive concern about the ongoing medical illness first of all we need to acknowledge that these two conditions are treatable and with appropriate care you can have near optimal life to smoother the stress management I am writing down a few of the strategies that will help you diet ensure intake of adequate quantity of fiber two servings of vegetable salad and two servings of fruits one preferable citrus fruit avoid junk food and fast food especially pizza burgers and excessive sweets ensure adequate water intake recommended intake of water is two to three liters a day insufficient intake of water could be a contributing factor in the causation of symptoms early morning exercise and brisk walking for 30 minutes at a stretch preferably in the garden will be very helpful avoid tea coffee nicotine and alcoholic beverages if at all you want to drink something drink fresh lime water it is very much refreshing start your day with a glass of lemon water with two spoons of honey added have a good breakfast do not take work so seriously we all have the feeling to excel in our respective fields and do not spend adequate time with our own self trying to understand our own needs spend time with your family and friends while working take frequent regular breaks I will advise you to take a break of 10 minutes after every 50 minutes close your eyes and rotate the eyeballs for a couple of minutes avoid starring for a longer time at the computer screen or tv steam inhalation before going to sleep will be very refreshing it will also benefit 10 take multivitamin and calcium supplement I hope this helps"
    },
    {
        "instruction": "hi sir mam am female the age of 23 and my weight is for the height of 160 am height for the past one month I have suffering from severe cold runny nose and cough I also felt chest tightness nasal congestion sore throat and shortness of breath too sometimes I can heard some sounds from my chest while breathing I can take some over the encounter medicines when I will get rid off and is that anything seriousness looking forward for ur answers soon thank you doctor",
        "input": "",
        "output": "hello hope you are doing well do you smoke or have allergy to dust is the discharge yellow or green blood stained do you have fever or any associated complaints such as headache have you been taking any antibiotic which over the counter medicines have you been taking you probably had common cold and now you have secondary bacterial infection with low respiratory tract involvement you could be having allergic rhinitis mild asthma and bronchitis there could be some risk factors which need to be investigated so you need to be examined physically with some blood test carried out on confirmation of diagnosis you probably need a course of antibiotics common cold with secondary bacterial infection abc ear he and chest ray allergic rhinitis with secondary bacterial infection and bronchitis common cold with secondary bacterial infection and bronchitis after physical examination and investigations for second opinion"
    },
    {
        "instruction": "im a 14 year old child my concern is that I only have 24 set of teeth is growing at the back but I only have 13 baby teeth and are permanent teeth to be add on I have doubling rows since three years back and have gotten it out last year but it is still hasn't come back to its place because of the lack of space my teeth are a mess I want to get braces but I have so many baby teeth I dont know what to do please help me",
        "input": "",
        "output": "hello welcome to icliniq this is your dentist first of all you will be needing an op its a full mouth view xray extraction of the deciduous teeth as found in the xray will be done now its turn to see where those impacted permanent tooth are present hopefully they will erupt a bit late but they have no tendency to erupts they will be removed if needed ortho treatment at 16 years of age minimum so for now get to your dentist get an op done and get all those baby tooth extracted you can also upload the xray to me so I can assist you more you are a good kid donot worry am here to help you when even you need focus on your grades avoid too much sweet food or chocolates or sticky foods brush twice and donot forget to rinse your teeth will be fine dont worry if possible upload the xray image for me to look at have a good day thanks alot"
    },
    {
        "instruction": "consistent lower back and neck pains yes I have been diagnosed with having a cervical disc herniation since 20 years and a lumbar disc herniation since 12 years an la nerve block procedure was performed in years back the last mri I did was years back",
        "input": "",
        "output": "hello yes the mri does talk about the disc bulges both in the neck and the back but it is now clear as to the degree of nerve root compromise as canal encroachment as this will determine the degree of symptoms and likelihood of conservative management succeeding I really need to see the mri films to comment the obvious thing is that the mri was done years back so the relevance is doubtful if you are having new symptoms and with passage of time the mri picture may change I will recommend that you two a course of duloxetene 30 my twice daily and added pregabalin 75 my twice daily to see the response and do take them for atleast weeks mind you pregabalin makes you sleepy but that will fade with time"
    },
    {
        "instruction": "1 year old son has fever and cold for ex day he is also vomiting temp 39",
        "input": "",
        "output": ""
    },
    {
        "instruction": "cavity on the front teeth sensitivity sudden aches in the front teeth there are dents on my front teeth these dents have lasted for more than a year and visible cavity between two teeth sensitivity and gum redness happens but rarely",
        "input": "",
        "output": "hello welcome to icliniq this is your dentist I went through your query and the image attached its been very tough for you as those tooth seems to be in a preety bad shape please donot worry what has happened is you have a cavity between your left upper central incisor and lateral incisor thats causing the discomfort the cares is due to the position of the left upset mental incisor note its not straight and redness of gingiva foul breath is due to gingivitis you will be needing these are the medications let me know if any further query or discomfort feel free donot hazitate I am here to help thanks alot intro oral xray of upper left central and lateral act depending upon the xray avoid sticky or sweet food or cold food days"
    },
    {
        "instruction": "hi doctor I am currently having a sore throat as I checked it is a bit red and saw a white dot please help",
        "input": "",
        "output": "hello thank you for attaching a photo because that really helps your throat does appear red but your tonsils do not appear swollen so it is unlikely to be tonsillitis most of the time this is just due to a viral infection that will get better on its own without medication healing usually takes about five to seven days as long as you are able to eat drink and remain without fever just allow your body to heal naturally if the sore throat is only getting worse to a point you are unable to swallow anymore due to pain and you are having a fever of temperature 37 and above you might need to see a doctor in person to have it examined and prescribe you antibiotics viral supportive management only drink lots of water take paracetamol every hours as needed for pain difflam lozenges every six hours bactidol gargle three times a day after meals regular handwashing if the throat pain is getting progressively worse until a point that you cannot swallow any food due to pain or if having fever you will need antibiotics feel free to follow up with me in 5 days time regarding your progress"
    },
    {
        "instruction": "hello doctor I have migraines daily for the past two months it gets controlled with painkillers and worsens with movement other than that no other symptoms like dizziness or vomiting are present the pain is usually moderate to severe sometimes one sided and sometimes full head pain I am taking paracetamol or ibuprofen for pain please help",
        "input": "",
        "output": "hello I understand your concern and would explain that considering your aggravated situation it would be reasonable to start preventive therapy for migraine in this regard I would recommend starting topiramate 50 my twice daily it is recommended starting 25 my daily and increase each week by 25 my up to 50 my twice daily this will help reduce the frequency and severity of migraine headaches if you do not tolerate this drug or it does not help reduce the frequency of headaches within the first month I would recommend considering other treatment options like verapamil or amitriptyline you should discuss with your doctor on the above treatment options there is no need to perform any tests as this is a chronic headache and painkillers still help I hope this helps"
    },
    {
        "instruction": "hello doctor my knee is locked in hyperextension I had an injury on my knee had lateral damage that was fixed by knee scope this was successful however about two months ago I twisted the wrong way and my knee got caught in hyperextension I saw my orthopedic surgeon and he told me I had a high rise patella and chondromalacia we did synvisc and cortisone and physiotherapy but my knee is still caught in hyperextension and cannot fix it I am only 32 years old so I need my mobility but now I am in pain and can barely move any thoughts right now I am on naproxen and tylenol",
        "input": "",
        "output": "hello from what I can read and understand by the brief history you have given is that there can be damage to ligaments and meniscus in your knee can you please elaborate on the range of motion of your knee if it is barely movable it means that probably some tissue either meniscus or soft tissue is stuck causing block to the range of motion also are you having hyperlaxity generally people who have hypermobile joints tend to go for hyperextension also kindly update the details of your surgery was there all reconstruction as well as you pointed high rising patella alta is more responsible for patellar dislocation subluxation rather than knee hyperextension do attach a copy of the mri you have"
    },
    {
        "instruction": "hello doctor I am having heaviness in my head since yesterday afternoon especially when I bend and lift my head up also I am experiencing the same heaviness while coughing too I took paracetamol 500 my once yesterday evening and today afternoon but I did not find any change in pain also for the past three days I am having slight constipation I am taking medication for thyearoid eltroxin 75 my also I use glasses for short sight and presently the lens has got scratches with vision not 100 clear I had checked my be in the morning and found it to be 17 62",
        "input": "",
        "output": "hello I would like to confirm a few more before arriving to a probable diagnosis site of pain front back whole or half side of your head or vague episodic or stays the entire day any facial pain apply pressure on the face on either side of your nose on your temple and see whether those areas are tender do you have body pain fatigue sleepiness dullness menstrual irregularities fever sleeplessness nausea vomitings neck pain blurring of vision double vision past history of similar headache or excessive working on laptop or tv for now take tablet naproxen 500 my with food as and when required plenty of oral fluids high fiber diet greens syearup duphalac 15 ca to be taken with two glasses of water preferably at bedtime get back to me with the answers to the above set of queries"
    },
    {
        "instruction": "hi doctor I would like to seek assistance with regard to my concern in skin there is a pimple appearing in my arms and around my wrists I am now using a sulfur soap I am wondering why this happens if the pimples were healed it leaves marks that make my arm and wrists dark I want to have normal skin I was looking forward to take antibiotics but I do not know what to take please help I will attach a photo of my arms for your look",
        "input": "",
        "output": "hello I have seen the photo how long it has been there what are the symptoms of it any other area affected any history of hypertension and diabetes please send a few more photographs taken from different angles"
    },
    {
        "instruction": "hello doctor I am a 60 year old female having a complaint of minor nose bleeding and headache for the last five days I have undergone valve replacement therapy a few years ago and tablet acitrom od going on my recent it value 17 40 in 52 as we do not have access to our doctor what step we have to take ahead to manage the problem",
        "input": "",
        "output": "hello sorry to hear about your experience did you have a history of nose bleed long before the surgery or did the bleeding start after you started taking ecosprin have you noticed bruising in any part of your body alongside the nasal bleed conditions like nasal polyps hemophilia ecosprin medication she is currently using can cause it if it started after the commencement of the escoprin I advise you to call the doctor that prescribed the escoprin there is a need to adjust its dosage or replace it in the meantime try to apply an ice pack on your nose with your face in an upward direction and buy nasal spray oxymetazoline it will help with your situation if your symptoms persist please go to the emergency so as to physically examine your nose"
    },
    {
        "instruction": "hello doctor I am a 20 year old female I have had bad stomach issues since february it started with yellow stool and diarrhea when eating fatty foods I have pain on and around my right rib cage and in the same spot in my back near my shoulder blade I have done an hide scan and my ef was 68 it ultrasound and blood work was normal my doctor wants to remove my gallbladder anyway because he says I seem to be symptomatic without test evidence have you ever heard of this before is this possible",
        "input": "",
        "output": "hello I will definitely help you as per your history and investigation report your diagnosis maybe some kind of hepatitis in which there is a yellow color of stool and urine without any evidence of any abnormalities in us and it scan if us ultrasound is normal and there is no evidence of gallstones then no need to remove gall bladder as it is a very sensitive investigation for gallstones I will advise you to do hepatitis a c and hepatitis marker tests for confirmation of diagnosis please attach all investigation reports for better comments about your illness I need your liver function test also I am advising treatment for you please start as soon as possible avoid fatty and spicy diet drink plenty of water hepatitis a and antigen let liver function test tablet udiliv 300 my be for 15 days pantoprazole 40 my od for 15 days"
    },
    {
        "instruction": "hi doctor I have recently contracted genital herpes I am having an outbreak which scared me I have blisters vesicles on the penis I had a blood test done last week and this confirmed it please help me",
        "input": "",
        "output": "hi I have thoroughly reviewed your health query and can well establish the sensitivity of issues you have thanks for uploading the labs here for reference for further information consult a general practitioner online"
    },
    {
        "instruction": "hi doctor I just noticed that I had some yellowish discharge from my vagina I do not have any itching or burning while urinating and there is no odor from the discharge I was checked for studs about three or four weeks ago and everything came back negative I had protected sex with a condom last week but had unprotected oral sex how likely is it that this is sad I am also on viorele an oral contraceptive and I know sometimes that this can cause discharge what could this be",
        "input": "",
        "output": "hello yes oral sex could transmit sad sexually transmitted disease and they are herpes simplex gonorrhea or even syphilis infections less frequently passed on include chlamydia hiv and hepatitis a but I must tell you that the risks of getting an sad from unprotected oral sex are typically much lower than the risks posed by having unprotected vaginal or anal sex this is because saliva often contains the antibacterial and antiviral agents I think of a prescreen if it persists for more than a week or changes its behavior as you never know how you could contract sad for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I am a year old male my weight is 180 labs and height is 10 I was prescribed a generic brand of adderall 20 my about a year ago it truly has improved my lifestyle up until about two months ago everything was fine I noticed that on the left side of my neck became red randomly I would describe it as looking more like a heat rash that starts around my collar goes up only on the left side of my neck it extends to my left ear and sometimes I get some redness on my left cheek bone it does not itch or bother me in any way but it is very noticeable sometimes I have not been able to find any other factor that could be causing this I have tried not eating particular foods changed my laundry detergent etc my older brother and I both get a redness in our face when we play sports and this has happened every since I can remember I do occasionally smoke cigarettes and have tried different brands to see if that may have a factor but nothing I have been to my local doctor and they have said that it is probably allergies but I just do not agree I am not allergic to anything but I have not got around to getting an allergy test since the redness appeared I am very concerned about this and more embarrassed thank you for any advice",
        "input": "",
        "output": "hi I have read your concern and I appreciate your effort for a detailed and meticulous history revert back after seven days to a dermatologist online"
    },
    {
        "instruction": "hi doctor I have just started fasting from yesterday morning and last night I was having slight kidney pain then I awoke in the middle of the night with some kidney pain and a swollen kidney feeling and urinated with difficulty like having to really push it out similarly last year my kidney got worse when I was fasting when I was under year of age I had an operation on my kidney and have a large scar in front of the bladder or abdomen area it was a blocked urethra which caused whatever fluid back to the kidney causing damage they said that my kidney would have to get removed at one stage in my life and 21 was the oldest patient in the past that lasted before removal I am now 30 my height is 183 am and weight is 85 keg I wanted to know if it would be advisable for me to stop fasting and if so would that be for the rest of my life",
        "input": "",
        "output": "hi kidney stone urinalysis urea and creatinine uric acid and non contract it abdomen and pelvis crystalluria revert back with the investigation report to urologist online"
    },
    {
        "instruction": "hi doctor basketball hit my mother left thumb and there is a regular pain for some two years now the skin becomes harder in that area also that arm becomes thinner as compared to the other arm please help",
        "input": "",
        "output": "hi revert back with more detailed history to an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hello doctor I am a 38 year old male I was diagnosed with bilateral glue ear it has persisted for two weeks now and has seen an ent specialist I am on my third dose of antibiotics moxiclav duo forte 875 125 the condition does not seem to be improving I am also using painkillers nasal spray and antihistamine I am keen to get grommet in my ears just to get some relief as the pressure or fluid buildup is unbearable on occasions the ent specialist seems to be against doing this what would you recommend please explain",
        "input": "",
        "output": "hi revert back with the reports to an ent otolaryngologist online"
    },
    {
        "instruction": "hi doctor I am an 18 year old male I have been experiencing a wide range of symptoms for nearly a year it all started in the last summer I started to experience constant vomiting after eating bloating and weight loss then I was diagnosed with a dientamoeba fragilis infection and given a course of antibiotics I thought I would get better after this but that was not the case I was treated for the bacteria and I still have symptoms like occasional vomiting a lot of weight loss 15 20 pounds bloating and abdominal swelling the doctor did a bunch of blood tests and said he did not see anything wrong the vomiting stopped but I still experience the symptoms and not gaining any weight so my doctor referred me to a gastroenterologist I told him about my symptoms which are as follows herd weight loss occasional abdominal pain abdominal swelling and bloating malnutrition alternating diarrhea and constipation and heart issues like racing heart and heart palpitations my sister has celiac disease my gastroenterologist has done an endoscopy and said he does not think that I have celiac and he said helicobacter pyloric might be a possibility I am really worried because I have got a lot of blood tests and everything came out fine except vitamin b12 and deficiency so I just want to know if you think that I could have helicobacter pyloric I am really anxious please explain as soon as possible and share any other possible illnesses that I could have based on my symptoms thank you",
        "input": "",
        "output": "hi for further information consult a general medicine physician online"
    },
    {
        "instruction": "hi doctor I have been diagnosed with bilateral varicocele grade I and I my urologist recommended microscopic varicocelectomy after reviewing my test results I am 32 years old and all of my blood test results including hormones were in the normal range however my semen analysis showed that there are approximately 34 million sperms and out of which 60 are of good motility that is approximately 20 million my semen analysis from years ago was nearly 90 million sperm count with 60 motility I understand that my current sperm count is at the bottom of the normal range me and my wife are not planning to have kids for the next one or two years and have not tried yet my doctor recommends the surgery because there is going to be some improvement in the sperm count if he performs the procedure I prefer to avoid the surgery if not necessary I have a few questions is the sperm count going to be significantly different three years from now after performing the procedure is there a downside with leaving a permanent suture in my body for the rest of my life what happens to the permanent sutures if the veins shrink or get absorbed by the body I am not comfortable with leaving an external object silk in my case in my body for the rest of my life especially if it causes problems in the future and I have to remove it later on I am a highly active person and play soccer and go to the gym regularly I am not sure how experienced the doctor should be for this procedure my doctor is relatively young and obviously less experienced please help",
        "input": "",
        "output": "hi revert back with the report to a sexologist online"
    },
    {
        "instruction": "hi doctor my girlfriend has thalassemia minor trait and I am a healthy individual person if I get married to my girlfriend is there a risk of this trait for my future children please give me some advice thanks a lot",
        "input": "",
        "output": "hi based on your query my opinion is as follows for further information consult a hematologist online"
    },
    {
        "instruction": "hi doctor for three years I have been at home as a caretaker for my child mostly I feel exhausted and boredom every day morning now I plan to go for a job but I have a fear of facing an interview please help",
        "input": "",
        "output": "hi I first wish to appreciate the love and dedication you have shown towards your family by staying away from work for three years revert back with the reports to a psychiatrist online"
    },
    {
        "instruction": "hi doctor I was diagnosed with cos and my insulin and prolactin levels are 30 and 60 respectively my doctor put me on glucophage and prolactin for these before two months I got my periods on the same month but until now no signs of periods I have mild thigh pain heaviness in my stomach light stomach pain and bloating my doctor told me that if I do not get my periods in the next five days then she will go for a pregnancy test I am really scared of thinking about my pregnancy with these hormonal imbalances is my imbalance too high that it will take time to conceive or to make my periods normal",
        "input": "",
        "output": "hello for further doubts consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor my daughter who is years old has neurogenic bladder her height is 10 and weight is 53 keg she is suffering from voiding dysfunction and constipation she underwent surgery for spinal lipoma when she was 45 days old her bladder trabeculated and grade reflux her right kidney is 83 89 am and left is 40 08 am she had been on nitrofurantoin 100 my and tolterodine tartrate 2mg per day bed time for six years and discontinued three months back kindly advice on appropriate treatment option and prognosis I would like to know if stem cell therapy is useful I have attached her reports for your reference",
        "input": "",
        "output": "hi welcome to icliniq com we are here to help you for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor my penis gets soft very quickly and I cannot sustain erection for a long time moreover after one session it is very difficult to cope up with the next session sometimes when I use a condom it is very difficult for me to enjoy my sex please help",
        "input": "",
        "output": "hi before we can make any conclusions I request you to provide the following details so an impression can be made about the cause of the problem revert back with the answers to the questions to a sexologist online"
    },
    {
        "instruction": "hi doctor I cannot digest dairy products oily foods and sweets these all give me loose motion what treatment should I take to combat it my current medication is normaxin 5 my in the past I had mahacef oz nougat capsules and ilaprazole during aggravation please help",
        "input": "",
        "output": "hello I have a few questions for you revert back with the answers to the above questions to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am a 38 year old male I have ankle pain for the last nine months but I have no problem in walking my ankle ray is fine the mri report summary is as follows subchondral cystic changes seen in the medial and lateral aspect of valar dome with adjacent marrow edema and overlying hyperintensity and irregularity it is suggestive of stage I a osteochondral injury of talus no evident separation of the osteochondral fragment or loose body formation mild ankle joint effusion no evident of ligament sprain or tendon tear please explain",
        "input": "",
        "output": "hi for further information consult an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hi doctor I am suffering from anxiety around the health issues cancer and tend to obsess about things I have been fixating on my breasts and keep thinking I feel lumps my doctor suggested to get an ultrasound four weeks ago for my peace of mind and they were perfectly fine tonight I was scratching and then prodded to the left of my nipple on my right breast if I push firmly down I feel a small knot or pea like thing there seems to be two and one is more prominent I can feel something vaguely on the left side of my breast but not near a prominent am I right in assuming as I had an ultrasound only four weeks ago and everything was fine whatever I am feeling might be some muscle or something I have to press quite firmly to feel it if I just do a normal breast exam then I cannot feel it also if the scan was fine four weeks ago is it possible for a cancerous lump to grow in that time frame sorry the anxiety is tough to deal with please help",
        "input": "",
        "output": "hi I can understand your concern for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I am suffering from unsteadiness muscle tension mild fatigue anxiety and depression I have been diagnosed with gad my doctor prescribed my clonazapem my and escitalopran 10 my is it fine to take half of each tablet will it cause any intolerable side effects I do not want to take medicines my doctor said that it is mandatory she said cut will not work for me please help",
        "input": "",
        "output": "hi I think for a 71 keg young male the chance of side effects with recommended dose is very minimal but at the same time I do not think this could be the final dose your doctor is right in saying take my of escitalopram and this is the minimal effective dose for first time anxiety problem since you are already taking xanax alprazolam I assume that you have this problem for a longtime and it is possible that there will be required to increase the dose in the near future you also mentioned heart arrhythmia in that situation we need to be very slow first start with my than 5 my or 10 my as there are problems encountered by those who has a heart problem I do not mean there is a serious risk but caution is warranted in case if you develop side effects then there is some possibility of headache gastrointestinal disturbance and giddiness which are most common regarding the suitability of treatment I do not find any fault with prescribed treatment as escitaopram a sari selective serotonin reuptake inhibitor is used for definite treatment of gad generalized anxiety disorder while clonazepam helps in initial management of anxiety till escitalopram takes over for further information consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor I have aches on the right side of the upper and lower abdomen as well as in the back that is below my shoulder blade these aches have got worse over time in the past seven months my doctor informed me that I have gallstones and that is the cause of my aches and pains he said that I should get it removed I hope not please take a quick look at my sonogram and tell me what you think of my situation thank you",
        "input": "",
        "output": "hello I had gone through all the details posted revert back with the answers to the above questions to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am 24 years old I am suffering from a neurological disease and due to this I am getting weak day by day my toes are gone almost numb since last two years and the same things are now happening with the upper limbs I had this disease from childhood but in a progressive state so with time my health degraded constantly it started affecting my lower limbs now I cannot even walk or stand properly now it started affecting my upper limb as well I cannot lift heavy objects due to weakness in grip and cannot do any manipulation by fingers quickly such as typing writing etc I have been treated in various hospitals since my childhood currently it was predicted as vasculitis neuropathy and getting treatment accordingly I have gone through various treatments till now but unfortunately nothing worked now my doctor suggested me an injection called rituximab which can possibly stop the growth of this disease the two dosages of this injection are quite expensive and due to this we are worried that how much safer is this injection to me hence I thought that I should take an opinion from you before taking this injection could you please suggest me your opinion by looking at my attached reports is there any possibility to cure this rare disease or at least to stop the growth of this disease should I go for this rituximab injection I know it would be a challenging task but please spend some time and share your thoughts I have attached my reports prescription and life history from childhood any suggestions would be really helpful to save my life",
        "input": "",
        "output": "hi I am here to help you first and foremost I would like to congratulate you for your excellent narration and detailed documentation of the prescriptions and reports which has enabled me to have a good understanding for further information consult a neurologist online"
    },
    {
        "instruction": "hi doctor I have attached the laboratory reports of my wife and the baby stools are green in color please explain whether there is any chance for the baby to get jaundice",
        "input": "",
        "output": "hi I have seen the reports for further information consult a paediatrician online"
    },
    {
        "instruction": "hi doctor I have fillings on the buccal surface of some of my upper incisors and regular metal braces attached currently I believe when I chewed some crackers one of my fillings got loosened I can feel pain and sensation from exposure to water however as my braces are still attached I cannot truly know where and how the filling has been loosened whom should I visit first either my general dentist who did my fillings or the orthodontist can my general dentist be able to remove the braces and do the refilling please help",
        "input": "",
        "output": "hi for further information consult a dentist online"
    },
    {
        "instruction": "hi doctor I have been experiencing breathing problem for the past one week whenever I am trying to take long breathe I am not able to push air completely inside through nose or mouth after consecutive try full breathe happens there is no sign of a cough or pneumonia also I do not have a cold is it due to stress or anything wrong with my heart or lungs does it require any health checkup or consultation with doctor a few days back I ate jamun does it have any relation with this breathing problem earlier I was obese and I have reduced 10 to 12 keg weight now I faced some breathing problem earlier after reducing weight I was absolutely fine what could be the reason for my breathlessness",
        "input": "",
        "output": "hi for further information consult a family physician online"
    },
    {
        "instruction": "hi doctor my daughter is months old she swallowed a small thread will it harm her and her tongue is white and thick she also snores a little she often vomits milk which contains mucus my doctor said this will get cleared as she grows please tell your opinion thank you",
        "input": "",
        "output": "hi for further information consult a paediatrician online"
    },
    {
        "instruction": "hi doctor my boyfriend left me a year before he got married now but I have been dying day by day for his love still I love him a lot please help me",
        "input": "",
        "output": "hi for further information consult a psychiatrist online"
    },
    {
        "instruction": "hello doctor I had a problem with lower left abdominal pain for years which is diagnosed in 2017 as an umbilical hernia I subsequently did the surgery in january 2018 and I was diagnosed with moderate fatty liver during the test prior to the surgery but I was given liv 52 to take for three months and lipitor 20 my but when I reported to work I started noticing mild pain in my heels and imbalance which I thought was due to the drugs side effects somewhere in march I panicked out of sleep and started sweating with my heart beating very fast I rushed to the hospital and they did a brain it and kidney function test which was normal and the gave me some anxiety tablets lexotamil 5 my afterward I noticed that my heel pain was aggravating with flashes of dizziness and minor headaches which I could manage I reported to the hospital and was referred to an orthopedic specialist there I was asked to do and mri of the brain neck and spine with magnesium phosphate calcium and sodium test which were all normal the doctor then gave me reserve and stugeron for the dizziness but still the issue persisted so I reported back to focus and was asked to see and ent specialist and eye specialist I went to an eye center but they all proved negative so I was referred to see a neurologist who asked for an mri of the thoracic and lumbar spines and also test for folate and vitamin b12 but again they were all negative and he said my situation might be idiomatic so he did not give anything but in all these I realized my energy levels were coming down I easily get tired and occasionally my heart rate will go up with a feeling of uneasiness and confusion all coupled with balancing disorders associated with cluster headaches I went back to my hospital and was advised to see a cardiologist he also did his relevant test which all proved negative and he declared me safe but he advised if I am still not normal I should see his boys at the executive heart center which I did they have been working on me since and nothing has come up although the symptoms still persist so just last week I was not feeling very well and had to go for a check up when I was told of the micro pulmonary embolism and was admitted I currently have serious heel pain without swelling in the legs dizziness without spinning chest discomfort unsteady gait muscle weakness and extreme fatigue diminished vision issues with acid reflux and indigestion occasional heart palpitations insomnia and pressure and discomfort in the chest after standing for about minutes or while walking with extreme dizziness I currently take xarelto 15 my motilium once daily stugeron 25 my maalox plus suspension 150 my pariet 20 my carvedilol 25 my and lexotanil 5 my once daily at night",
        "input": "",
        "output": "hello welcome to icliniq com I can imagine how difficult time you have doing all these visit to doctors well I have gone through your history I could not see you have any specific gastrointestinal issues at this moment your main concerns are related to the neurological department not a gastroenterology department I urge you to seek help from a neurology team well some of your concerns like fatty liver and indigestion are related to my field hence I would like to give you some suggestion regarding that so I see you already on some medicine for indigestion such as maalox syearup and pariet which is an acid suppressant medication they are relatively safe and can be taken regularly or intermittently based on symptoms the second concern from gi perspective are fatty liver you did not mention your weight so I could not estimate the body mass index which is a direct tool to assess the level of fat one has over the liver and other body tissues atorvastatin lipitor can reduce some fat from liver but they are not the preferred treatment for fatty liver disease they can control lipids however if elevated atorvastatin can cause myopathy means muscle damage and can cause severe cramps over legs and throughout the body I want you to check your creatine phosphokinase cpu levels to confirm this if you have recently stopped your atorvastatin the preferred therapy for fatty liver disease if you are not diabetes is vitamin 400 my twice daily for at least three months the other recommendation is to reduce your weight by to 10 of current body weight in the coming six months walk 150 minutes week and dieting which is all required I am sorry I could not answer the rest of your concern but I want that should contact a neurologist available online on icliniq to be given proper suggestions regarding your health I hope this helps fatty liver disease indigestion creatine phosphokinase drug induced indigestion capsule vitamin 400 my twice daily for three months you can follow up with me for your gi related issues and discuss long term management of your fatty liver disease"
    },
    {
        "instruction": "hello doctor I have had three nose and septum surgeries and my septum is deviated my workplace wants me to do the nasal coronavirus test as I recently came back from overseas I am already on day 10 of quarantine but they want to do the test is there any risk for me to do this test considering the previous surgeries can they force me to do the test do they need me to consent to the procedure can I request to finish my quarantine instead of testing or is there any other test that is less invasive",
        "input": "",
        "output": "hi I see that you are concerned about previous surgeries nasopharyngeal swab for coronavirus is a very simple test just like how you use your ear buds so ned not worry it can be done even if you have deviated septum at this pandemic season it is recommended by world health officials and your employer can demand you to get tested before joining your work as you have traveled overseas and 14 days quarantine is also recommended by world health organization no other tests is as less invasive and highly yielding than a nasopharyngeal swab test I hope this helps"
    },
    {
        "instruction": "hello doctor I am 26 years old I was diagnosed with proctitis stage of ulcerative colitis in january doctor prescribed mesalamine suppositories and I was healed it again started in may doctor prescribed me three mesalamine suppositories a day but the bleeding still continues any advice on medicine or diet will be highly appreciated",
        "input": "",
        "output": "hello I can imagine how upset you are about your disease thankfully it is limited to the rectum and not extensive to involve the left side of the colon I am sure that your previous gastroenterologist had done biopsy of the rest of colon to exclude microscopic activity in other segments of the colon so if suppository is not working I suggest you to use mesalamine enema you can use grams enema once a day preferably in morning after passing the first stool not thrice a day the once a day dose work fine actually suppositories may not reach up to the extend of disease hence in such situation enema which are rather liquid preparation would work fine plus you should add hydrocortisone enema 100 my once daily at night time you can use hydrocortisone enema for two weeks and mesalamine enema regularly the picture you uploaded suggestive of blood with lots of mucus I also want to recommend to test stool for difficile antigen and blood ha titers for histolytica if any of those infections are found would require antibiotic therapy in addition to the above therapy you can follow up with me and update me about five days of use of the above regimen I hope you would be fine by then I would tell you the long term management of your disease and when exactly you require a repeat colonoscopy I hope this helps ulcerative proctitis stool for fecal calprotectin stool for difficile antigen and blood ha titers for histolytica infection colitis superimposed ulcerative proctitis follow up within one week to update about the symptoms and discuss the investigation that are suggested"
    },
    {
        "instruction": "hello doctor I am 36 years old I am a vegetarian before three years due to stomach disturbance yellowish urine pain and some popup and cracker sound in my legs and knee joints I visited a doctor and he suggest me for liver function test and all reports in normal range except for sugar which was 138 my dl at that time he gave some medicines and referred to an orthopedic for joint pain I visited an ortho specialist and he took an ray of both leg knees and tell that it is an early stage of osteoarthritis of knee and suggest for mri I had done an mri and in the report it is mentioned that the left knee has affected with osteoarthritis after that he give some medicines for 10 days and refers to a physiotherapist for exercise and weight loss I have visited as he told and I reduced my weight and now there is very little pain remain in my left knee but now my other joints hips joints both hand knee has popup sound when movement including neck jaws all have some very mild cracking and popping sound as there is no pain but as it seems to be taken care of in the next few years so I prefer to consult a specialist like ortho and gastro doctors still I did not found any reason behind my current health situation still I have yellowish urine kindly interpret all the reports",
        "input": "",
        "output": "hello well I have gone through your history I would like to ask you a few more questions to confirm the probable diagnosis do you experience a lot of fatigue is the sleep pattern normal or is it disturbed any feelings of tiredness in the mornings after sleep also any history of recent irritability forgetfulness when you say stomach complaints does it mean loose stools or increased frequency of stools or constipation any history of weight loss I have gone through your reports most of them seem to be normal except for mild ana positive you are right that it all looks connected and we need to reach the diagnosis as management gets easier then"
    },
    {
        "instruction": "hello doctor I am 56 years old male and have been treated for depression for 32 years I have tried numerous antidepressants I have responded to eat extremely well in the past but it did not hold me I could no longer afford monthly maintenance treatments I have currently started a treatment called theta burst stimulation after nine minute sessions I have had a few normal days but more days where I feel depressed I am more depressed after I have started this treatment is this normal I am scheduled to have a total of 36 minute sessions",
        "input": "",
        "output": "hello I read your query and understand your concerns although it is too early to measure the effect of tabs theta burst stimulation after the nine sessions there is a good possibility that there will be an enduring effect over the coming weeks my statement is based on the fact that early response may be transient one is an indicator of long term response for most antidepressant therapies including medications tis transcranial magnetic stimulation eat electroconvulsive therapy and now rims repetitive transcranial magnetic stimulation and tabs considering the above fact I like to state that reversal of symptoms after a few days of normalcy at this stage is considered normal and we need to hold on till the completion of therapy although this is not the part of the question I like to draw your attention to the suboptimal dose of effexor for someone who has depression over the 30 years I rarely see any patient who responds to below 150 my of effexor after a prolonged history of depression say 30 years I hope this helps"
    },
    {
        "instruction": "hello doctor I have this pimple in my inner ear and it has been eight days but until now it is still hurt I am currently taking mefenamic acid",
        "input": "",
        "output": "hi welcome back to icliniq com there could be an infection of the hair follicle in the ear as a result of which it can create excruciating pain besides the wax would have further got pushed toward the ear drum causing severe pain plain use of antiinflammatories like mefenamic acid alone will not bring much benefit you will have to take antibiotics as well to handle the infection I suggest taking tablet ciprofloxacin 500 my one tablet two times a day for the next week please take an antireflux tablet such as tablet pantoprazole 40 my once in the morning before breakfast along with this I suggest you to apply candid ear drops three drops thrice a day continue mefenamic acid one tablet two times a day keep your ear dry and do not allow water to enter the ear stop swimming for another two weeks until the ear completely heals please do not attempt to clean the ear at any cost as the infection can further flare up I hope this helps"
    },
    {
        "instruction": "hello doctor my 13 month old baby has neutrophils 23 lymphocytes 73 abc 6100 and hemoglobin level is 9 is there any worry",
        "input": "",
        "output": "hello welcome to the icliniq com following is my opinion for your asked question regarding abc complete blood count of your child the lymphocyte count are usually high in children so you may need not to worry about lymphocytes count but the hemoglobin level of your child is definitely low suggestive of anemia it could be nutritional anemia or hemolytic anemia like cause I suggest you do further work up for anemia with serum ferritin serum iron peripheral smear examination and us abdomen you can consult a nearby pediatrician once for physical examination his pcv packed cell volume and mav mean corpuscular volume is low so most probably he is having iron deficiency anemia according to the cause specific treatment is guided I hope this helps"
    },
    {
        "instruction": "i am looking for a good probiotic I have read conflicting results online and do not know which ones are a rip off or legitimate it seems for one to be affective it needs to survive the trip to your intestines and too many make that claim without knowing if it is true can you recommend one that gastroenterologist recommend that do not cost a fortune thank you so much in advance medical history I am healthy with no gastro problems that I know of only medication I am on is zyeartec",
        "input": "",
        "output": "hello I welcome you to icliniq well it is very hard to define which probiotic is the best to one since microbiota pooled microorganisms in your gut is completely different from the other person and for one to know what range of microbiota is present in your gut you have to get it tested by giving a fresh stool sample and ask for stool mapping for microbiota once you have report in hand anybody can tell which good bacteria are short and should be replaced and which bad bacteria are present to be removed actually there is no specific regimen of probiotics developed to empirically replace with probiotics studies has largely seen bifidobacterium bifidum bifidobacterium breve streptococcus thermophilus bifidobacterium longue subs longue and other lactibacillus species such lactobacillus rhamnosus lactococcus lactis lactobacillus casei lactobacillus paracasei lactobacillus plantarum and longue all work well but there is no single capsule that can fit all you have to take a probiotics which can anticipate and fulfil your need the one which I commonly prescribe is ecotec twice daily beside good diets including fruits green vegetables and yougurt avoid use of antibiotics as possible as can the probiotic use comes after a good healthy diets and avoidance of antibiotics commonly used for common infection of gut and flu I hope this will help good day follow up if need to discuss more about different diets and life style modifications required to keep your gut healthy"
    },
    {
        "instruction": "we are couple married recently we want to plan a baby however due to ongoing couid 19 pandemic can we plan it now is it safe",
        "input": "",
        "output": "dear good afternoon coronavirus dont have any known impact on people planning pregnancy however infertility treatment can be deferred for your family I would advice that corona may continue for few more months as claimed by many studies so you may have difficulty in visiting hospital for routine visits if you can wait for more time it will be ideal there are many tests and medical conditions or factors which are required to be paid attention to for planning family you can contact me subsequently for detailed family planning advice plus let me know if I can be of any further help best wishes after days"
    },
    {
        "instruction": "i recently had a fasting blood sugar test which was 4 amol because I have been experiencing nausea after a couple of hours of not eating now then did a three month blood sugar test which they said was normal I do not know exactly what the results were however I am still experiencing nausea and my belly gurgling and trapped wind what is causing this and due to coronavirus I cannot get an appointment in the doctors",
        "input": "",
        "output": "hello it appears you have symptoms of gastritis as fasting increases nausea I would like to know any pre existing medical conditions that you may have also would like to know about any medications that you are taking reflux liver function test thyearoid function test gastritis avoid being empty stomach for prolonged periods have small frequent meals drink adequate fluids water have 8 hours of sleep daily if these measures do not provide significant help an upper gastrointestinal endoscopy may be needed avoid late night snacking"
    },
    {
        "instruction": "vitamin do deficiency units consuming tablet well a as prescribed by doctor its been months since I am consuming my tablets but there is inflammation and burning sensation on my foot and hands I am 18 years old weight 43 keg height 3 how do I get rid of the inflammation",
        "input": "",
        "output": ""
    },
    {
        "instruction": "age years height 164 cos weight 67 keg I am suffering from sore throat so I took augmenting 625 before 12 13 days back but found no improvement but I started suffering from stomach pain and excessive gases now I am taking below medicines as per prescribed by ent specialist that are allegra tablet rinifol capsule esoz 40 capsule acinil syrup for ten days two days remaining to finish course stomach pain and blown stomach due to gas is still there",
        "input": "",
        "output": "hello I welcome you to icliniq well it is not uncommon to have gastric upsets after a course of antibiotic and antibiotic like augmenting are notorious to cause this occur secondary to effect of augmenting on decreasing the amount of lactobacillus microorganism which are normally present in the human gut and help digest the food you should take yougurt kefir fermented yougurt kefir and there are certain diets with probiotic activity you can start taking it plus take tab ecotec twice daily for weeks and tab levosulpiride 75 my once daily half hour before meals for weeks you can continue with acinil spy while rest of your current medication can be stopped I hope this will correct your microbiota and will bring the same healthiness as before good day antibiotic induced dysbiosis small intestinal bacterial overgrowth antibiotic induced dysbiosis let me know in one week time how you respond to above regimen if persistent of symptoms I would consider testing and giving some safe antibiotic therapy for weeks"
    },
    {
        "instruction": "hi doctor I am a 35 year old woman my height is 3 and weight is 147lbs I do not have a child yet but will be trying to conceive soon I am a vegan and eat healthy I workout five days a week and sometimes will go for a am runs around two to three times a week as well I went off my birth control pill about three months ago and have not had a period since I was diagnosed with cos when I was 15 but after going vegan two years ago doctor said it definitely helped with symptoms I have been eating right and working out for the last three months and my weight has not budged in fact it seems I have gained numbers on the scale three months ago I was 139 labs is there anything in my report that could be the reason for not being able to lose weight or abdominal fat is there anything in the infertility test portion that could indicate the issues in trying to conceive I would like to get a professional advice on my blood work results I am mainly looking to find out if anything on here can indicate infertility or difficulty in losing weight please help",
        "input": "",
        "output": "hello I have gone through the reports for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I have eye allergy for the past 7 years I have consulted many doctors I am using steroid eye drops too but my eye allergy is still present my eye irritates when it contact with blowing air perfumes air conditioner strong odors when I get cold and sometimes suddenly without any exposure occasionally it causes pain in the eyes and head I do not know what caused this what is the permanent solution for this is there any other alternate remedy for this when I take cetirizine my irritation subsides in 30 minutes please help",
        "input": "",
        "output": "hi for further information consult an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor I am 18 weeks days pregnant my friend told me that I am supposed to add two weeks to those 18 weeks while counting is that true can I get pregnant if I had sex during period my period was on the 28th and I had sex on the ith that time my period was on but not heavy could I have gotten pregnant that time how long do sperm stay in the body please explain",
        "input": "",
        "output": "hi for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor when I had my third ultrasound I was 24 weeks pregnant and it appeared like two faces in the ultrasound I keep asking my obstetrician regarding my weight gain I am gaining so much weight when I barely eat and my stomach so huge I found that at 14 weeks on my first ultrasound I was having a boy and that was pretty early for me to find out a gender I eat like two meals at once a day I am now 34 weeks and days pregnant my obstetrician does not check my pelvis and not advised for another ultrasound can I send a picture of my third ultrasound to get a second opinion whether I am having twins",
        "input": "",
        "output": "hi for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I am a 21 year old female I was bulimic for about a year it happens once or twice a week I never noticed any permanent changes in my eyes throughout my episodes however the last time I ever binged and purged three months ago I vomited violently a few weeks after this I noticed that the vessels in my sclera are indefinitely more prominent than before did this happen because of the continuous pressure subjected to my eyes with vomiting or could it just be due to many hours of reading and laptop use I have seen an ophthalmologist and he said that there is nothing wrong with my eyes and suspect a very mild case of blepharitis or bilateral dry eyes I am using optive comfort solution I would like to know if my bulimic phase could have caused the prominent vessels in my eyes as this has not been mentioned anywhere else online",
        "input": "",
        "output": "hello I can understand your concern regarding your complaints revert back with the answers to the above questions to an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor I have experienced a problem in erection since last three months I am a smoker the testosterone level in my last routine medical checkup was 134 please help",
        "input": "",
        "output": "hello revert back with the answers to the above questions to a sexologist online"
    },
    {
        "instruction": "hi doctor my wife is 42 years old she is feeling pain in the right wrist while moving the palm laterally outward the movement gets somewhat obstructed slightly and it is not smooth this has been started after an occasion when she tried to pull or carry one heavy bag a week ago ray has been done on her right wrist which is enclosed herewith please comment on the severity of the wound and its medication thank you",
        "input": "",
        "output": "hello revert back with the photos to an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hello doctor I have twins a boy and a girl aged years I noticed that the girl advanced in skills than the boy in the first few months of life my son was faster than his sister in the growth and everything and then it was reversed I am a graduate of psychology I have a brother suffering from autism and frankly I have a fear of this disease I do not care and I do not want to surrender to delusions but mom and dad insist on reminding me of everything you see them that my son is also the possibility of getting hurt I started since 10 months I am watching my son very much I blame him if he did not implement what I am asking he says dad and mom he loves to play laugh and shake hands if I asked him to do so he looks into my eyes when I talk but I do not feel that he understands what I am saying to him always for example if I asked him to bring me cheesed off the table he does not focus with me and ignore me on the other hand if he feels he is thirsty then he will come to me and say a bottle of water I know this is probably because the rate of a normal iq and concentration varies from one to another child I want a word from the doctor that makes me serenely scream in the face of all of the notes that my son is not normal and I tell them that my son safe and sound the question is how completely I know that my son is not suffering from any problems in communicating diseases or behavior",
        "input": "",
        "output": "hi I have gone through the query with keen interest and understand your concerns before making any opinions I need to inform you that take the things in objective manner and not on emotions I understand there is history of autism in the family and it does not mean your child suffers with autism in a normal growing child there are many ups and downs and not responding on some occasions is not indicative of serious pathology like autism we need to take notice that a child plays well with another child responds to language on most occasions cheerful not having any abnormal repetitive stereotyped movements and communicates with the mother having said this I feel it will be appropriate to fill a simple questionnaire called autism spectrum screening questionnaire assq this is a screening instrument for autism and you will know probably with sure that whether there is problem or not if you still feel there is something abnormal then you may contact the specialist doctor nearby for a physical evaluation for further information consult a psychologist counsellor online"
    },
    {
        "instruction": "hi doctor my friend has been having left shoulder pain for months for the last three weeks he is also having the coarseness in his voice can barely speak and little energy he is eating well but not gaining weight he has no other symptoms he is a carpenter and 50 years old he smokes cigarettes weed and crack cocaine I think he has been doing this for 30 years today his blood test and blood pressure are fine his chest ray came back with a large mass on his left lung it looked large to me he was given a to shot other than that they suggested a specialist it was an er visit so they did not say much other than it could be a cancer what does this sound like to you I deeply appreciate any of your help thanking you in advance",
        "input": "",
        "output": "hi we are here to help you I am really sorry to hear about his state for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I feel cramped itching and lower abdomen pain during urination I had intercourse with my partner last month and since then I have faced this problem I went to meet a gynecologist and she prescribed some medicine and felt fine for 10 days then again I am facing the same problem also I have pod please help me",
        "input": "",
        "output": "hello urine for routine and microscopic examination as well as culture sensitivity revert back with the test reports to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I am having an abscess on my balls it is reddish and painful but not much I have jock itch right now I saw terrific images on the internet but it is not like that please help",
        "input": "",
        "output": "hi please put up two to three clear photos of the affected area for proper evaluation and guidance revert back with the photos to a dermatologist online"
    },
    {
        "instruction": "hello doctor I do not want to be sound like I am panicking but I really do feel quite uneasy since I woke up I feel dizzy my head is rolling and when I close my eyes I feel like the world is rolling around in a full speed it never happened with me any time before I just had my lunch now but I do not feel to eat any due to the same please advise what should I do thank you",
        "input": "",
        "output": "hi for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am 21 years old my weight is 48 keg I am months weeks pregnant now I got chickenpox I am very anxious about the adverse affect for my baby I have visited a gynecologist and she suggested me to get abortion please clarify me the right step",
        "input": "",
        "output": "hi really this is a confusing state but this does not mean you have to abort the fetus right now when mother get infected with chickenpox fetus carries a risk but the risk is only and in those cases the fetus might develop rarely some form of abnormality thus straightaway recommendation of termination is not always a choice definitely there is no direct answer and it is unto you what to do if you want to have the risk of which is very minimal and often equal to an incidence of congenital anomalies in low risk pregnancy definitely you can continue it in that case just go for an anomaly scan from a very good center at the 18th to 19th week to confirm about the integrity of the fetus for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I have a sore in the mouth I have attached the photos please help",
        "input": "",
        "output": "hi revert back with the answers to the above questions to a dentist online"
    },
    {
        "instruction": "hi doctor please find my blood investigation report attached and provide me the required steps to take further thank you",
        "input": "",
        "output": "hi for further information consult a criticalcare physician online"
    },
    {
        "instruction": "hi doctor my child who is years old fell off while playing she got hurt above the left eye with mild scar please suggest some medication thank you",
        "input": "",
        "output": "hello revert back with the answers to the above questions to a paediatrician online"
    },
    {
        "instruction": "hi doctor I am 20 years old my hair is getting thin as my father is bald I fear that I will also get bald also I want to improve my skin texture please help",
        "input": "",
        "output": "hi for further information consult an ayurveda specialist online"
    },
    {
        "instruction": "hi doctor what health implications have been observed with a unilateral paralysis of the diaphragm I have had a plication performed but it failed and is back to the original issue currently I am suffering from shortness of breath chest pain with dizzy spells and increased heart rate I am on propranolol for the heart rate issue please help",
        "input": "",
        "output": "hi traumatic or some cancer causing nerve compression mri scan and spirometry unilateral diaphragmatic paralysis for further information consult a pulmonologist online"
    },
    {
        "instruction": "hi doctor I have some white spot on my tongue I researched on the internet and it looks like white oral cancer lesion any of your thoughts will be appreciable I have attached the pictures for your reference please help",
        "input": "",
        "output": "hi for further information consult a dentist online"
    },
    {
        "instruction": "hi doctor my uric acid in blood shoots up to 9 I do not have the problem or gout or kidney stones how to reduce it I have already started to drink lemon water the whole day I have attached the photographs I have only knee pain which is at the backside of the knee while climbing up and down stairs for the last two years also my left leg thigh muscle has localized numbness for the past five years numbness did not hurt but bothers sometime numbness is not heavy if I use nail on it or scratch on it I sense it well how to cure this numbness is this serious",
        "input": "",
        "output": "hello revert back with more clinical details to an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hi doctor my year old daughter has had three nosebleeds in about hours during the nosebleeds she said her cheek bone area close to her nose hurts what to do",
        "input": "",
        "output": "hello for further information consult a child health specialist online"
    },
    {
        "instruction": "hi doctor I had a tooth extraction and a temporary bridge on my back upper teeth the temporary bridge broke and I got another one after this I started to have some soreness in my left cheek and left side of my tongue my cheek feels swollen and sore I noticed two white bumps on the inner side of my cheek today is this from the dental work or something else",
        "input": "",
        "output": "hi for further information consult a dentist online"
    },
    {
        "instruction": "hi doctor when I look towards my left I can use either left eye or right eye I am unable to focus both the eyes on a single point also when I move my eyes towards left my left eyeball goes little upward than the right please help",
        "input": "",
        "output": "hi revert back with the answer to the above question to an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor my son is 6 years old his weight is 12 keg he is a healthy and active child but he is getting coughs and cold at least once in a month for the past three months currently he has a fever for the past two days 101 degree and cold from today morning I am giving him cetirizine and ambroxol for cough and cold mental for high fever of above 102 degree fahrenheit and crocin for normal fever other than these I am giving him zincovit I guess that the cold which he has gotten subsided once he take antibiotic and cough syearup whenever he coughs too much he will then vomit the phlegm out other than this the phlegm is not coming out either in the nose or through the stools please get me some solution to make the cold come out thank you",
        "input": "",
        "output": "hello viral fever complete blood count cop reactive protein parasite and test cue complete urine examination and chest ray viral pyearexia I suggest the following medicines consult your specialist doctor discuss with him or her and take the medicine with consent syearup cetirizine my once daily at night continue crocin acetaminophen and mental mefenamic acid nebulization with nail sodium chloride twice daily for three days syearup ascoril is combination of ambroxol and salbutamol my three times a day for three days revert back after three days to a paediatrician online"
    },
    {
        "instruction": "hi doctor a person used ability and drank alcohol heavily on ability then switched medications and quit drinking for years can that person go back to ability again will it work or does drinking alcohol make the medication never work again please explain",
        "input": "",
        "output": "hi for further information consult a psychiatrist online"
    },
    {
        "instruction": "hello doctor I am 18 unmarried and I have missed my periods on first two days and I suppose I might be pregnant unplanned as I am not having any symptoms of my monthly periods me and my fiance had a pullout in 10 seconds after he inserted the penis in vagina but there was just a pre cum which he had already ripped away and there was no ejaculation taken place sure is it a sign of pregnancy can I consult a gynecologist alone without parents or guardian can I terminate the pregnancy by medication as it has been only days what should I expect please help I am stressed",
        "input": "",
        "output": "hello please do not get worried or panicked get a beta hug test done it is a blood test to confirm pregnancy a value less than means you are not pregnant even if it is positive you do not need to worry you can get it terminated by medicines you will need to get an us done first you can visit a gynecologist without parents and your privacy will be respected please make sure you visit a qualified gynecologist and do not visit quack out of social fear gynecologists are professional and will not meddle in your private life and will help you get rid of pregnancy without risk to your life"
    },
    {
        "instruction": "hi doctor I am blessed with a baby boy months 10 days I am sharing with you his vaccination card all vaccines are almost due because of the corona pandemic most of the clinics are almost closed will you please suggest whether these vaccines can be delayed a bit till the suspension of lockdown or do I need to arrange it asap really tensed about this unexpected and unfortunate situation",
        "input": "",
        "output": "hello I understand your concern for your child I would say you can wait for some more time till the end of this month as probably after this month lockdown restrictions will be over I believe you should go according to your pediatrician as he would understand the situation best at your place till then best hygiene measures should be taken for your child use hand rub or wash hands properly before touching your child avoid giving bottle feeds if you maintain this there should be no problem all vaccines can be given at a later date"
    },
    {
        "instruction": "hello doctor my friend had accidentally swallowed tooth crown an hour ago she is not facing any problem till now what should she do kindly advise",
        "input": "",
        "output": "hello I understand your concern but I think as so much time has already passed and by god grace everything is fine then I think it has not gone into the airway problem erupts only when it gets stuck in the airway it might have gone down through the digestive tract and shall pass out normally through faeces the biggest question is whether it went inside along with breath or food that will surely subside the confusion and the one who swallowed most probably can feel this I would surely want to know which number tooth it belonged to in order to know whether it was bigger or smaller in size anyway an ray is always advisable for safety if your area is now open for the same be careful and look for the engulfed crown in your passed out fecal matter that will also relax you if you find it sooner it mostly passes out in 24 48 hours you can have banana so as to help it pass digestive tract smoothly"
    },
    {
        "instruction": "hi doctor I have had a bad cold sore weeks ago on my top lip and a bit of the skin above it I used zovirax externally weeks course and acyclovir weeks course to treat it the actual sore improved the blister stopped weeping the scab formed and flaked off within weeks but the redness is still lingering I rung the doctors that put me through a pharmacist who told me to use hydrocortisone cream I used it for a week as he recommended but it still did not go away that was two weeks ago I also had a new flare up three days ago also on the top of my lip symmetrical on both sides it looks different to a cold sore in that it was some redness and skin flaking home remedies I have tried so far aloe vera not much help tea tree oil irritated it masuka oil helps healing where the sore is but seem to irritate the new flare up conut oil irritated it almond oil seems to soothening it at the moment I am worried if this is still unresolved herpes cold sore and can be transmitted to my partner who does not have herpes is it contagious and am I able to keep it simple stupid my partner",
        "input": "",
        "output": "hello as per the current picture sent by you it does not look like a cold sore as of now also I would advise to stop all ongoing treatment including the hydrocortisone and just leave it alone for a week apply dologel only it contains cholinesalicylate along with certain other ingredients that help to heal no application of any lipstick or any other ointments or creams to the region I would not advise kissing for more weeks atleast till things resolve to prevent spread also limit alcohol intake if you are currently consuming alcohol avoid spicy foods too to promote healing"
    },
    {
        "instruction": "hi doctor I took benzodiazepine alprazolam for insomnia for months for a total dose of 30 my while stupidly attending college parties and binge drinking once a week during the period I have never taken the pill on the day I was drinking I did not take the drug every day and after roughly two months I quit the drug altogether the withdrawal that I did not recognize at the time kicked in extreme tinnitus sweating heart racing heightened anxiety I went to ent doctor and she gave me two dexamethasone injections in days I think my I developed during these days a major loss of short term and then long term memory trouble finding words trouble learning in general the physical symptoms of the steroids and enzo withdrawal went away in weeks it has now been a month since I feel physically fine but the cognitive issues persist and they do not get better at all I have been to a psychiatrist because I felt overwhelmed that iam not going to be able to finish school in such a state and she gave me escitalopram thinking it could be psychological but there is no improvement in cognition after a months use does that combination have that drastic side effects and could it caused a chemical or structural problem in brain what can I do to return somewhere close to my old self I am 24 years old",
        "input": "",
        "output": "hi people taking alprazolam should not combine it with alcohol and avoid combining it with other medications such as narcotic pain relievers that cause drowsiness doing so can cause additive drowsiness and reduced breathing as well as other side effects which can be dangerous and possibly fatal alprazolam may be habit forming when taken for long periods of time if you have been taking this medication regularly for a long period of time more than one month do not stop taking the medication without speaking with your doctor a gradual reduction in dose is recommended when stopping this medication to avoid withdrawal symptoms escitalopram works by blocking the reuptake of serotonin so that there is an increased level in the brain serotonin is an important neurotransmitter responsible for mood and well being it is usually taken once daily and may take a few weeks to months reach maximum therapeutic potential so continue taking escitalopram until you see significant improvements in your memory"
    },
    {
        "instruction": "hi doctor my father was previously diagnosed with renal tubular acidosis and diabetes mellitus was maintained on potassium citrate and gliclazide od currently he had an infected insect bite on the left anterior lateral aspect of the leg he was started on co amoxiclav bid currently on its ith day I had his labs taken which revealed hba1c 5 fbi 57 crea 79 my do bun 67 my do hgb 195 hct 58 abc 13 plt 157 with normal lipid profile and uric acid should I start cod medicines already should I step up with the do medicines thank you",
        "input": "",
        "output": "hi high creatinine suggests a cod picture for a long term diabetes particularly uncontrolled do your fathers hba1c is high which shows his diabetic status is not under control high potassium levels is one of the complications of cod in this picture taking potassium citrate is not advisable as it may increase its levels and diabetic drugs also need to be modified when a person lands up in cod most oral medicines cannot be given it is safe to shift the treatment with insulin you need to visit a nephrologist for alterations in your medications and appropriate advice for cod serum potassium sodium phosphorus urine routine us abdomen do cod"
    },
    {
        "instruction": "hello doctor I am addicted to codeine for the past years after my marriage my wife had conceived but that time we did not want it so we aborted and it has been years now we are trying to conceive but it is not happening",
        "input": "",
        "output": "hi welcome to icliiq com I read your query and understand your concerns first of all I would like to inform you that codeine can be stopped in gradual manner scientifically speaking you can go for 10 reduction of original dose every week leading to complete abstinence at the end of 3 months in case this is not possible or you are not able to tolerate the lower dose of codeine you can get yourself treated form local psychiatrist we often recommend clonidine for this purpose which helps in the withdrawal symptoms of codeine the medication dose is decided depending on the dose of codeine age of the patient duration of abuse and blood pressure I mean to say that this is high time to say no to addiction and take this opportunity to come out of this addiction without delay I understand that your concern is not addiction but inability of your wife to get pregnant despite repeated efforts but we need to understand that addiction and infertility are related to some extent and removal of one risk factor might pave for fathering a child in addition it is also important to get semen analysis done for yourself and follicular study for your wife to rule out other causes"
    },
    {
        "instruction": "hi doctor my husband gets sharp cramping in the lower right side of the abdomen over a period of two months it happens once or twice a week and lasts for a minute we checked for appendicitis and kidney stones and all the reports are negative we did a it scan of the abdomen and it came normal but with a finding of stage fatty liver can you please help me understand what is his issue",
        "input": "",
        "output": "hello I will definitely help you right lower abdomen pain has many reasons including appendicitis and kidney stones there are some other reasons like indigestion of food infection of the small intestine or worm infestation this may be functional also in which no cause is identified the main reasons are indigestion and irritable bowel syndrome in which all investigation were normal so if a it scan is normal and there are no other complaints like vomiting bloody stool urinary complaint constipation then it must be functional due to indigestion avoid fatty and spicy food and lots of water have to be taken give two hour gap between dinner and going to bed please get back to me if any of the above symptoms are there and attach an investigation report also for better help"
    },
    {
        "instruction": "hi doctor I am having skin problems for the two months where pimples are like faint and after it disappears that spot becomes black please help",
        "input": "",
        "output": "hello I will help you with your problem you are having acne vulgaris which is the most common skin condition of your age generally the eruptions on healing leave a mild dark spot if the eruptions are manipulated by picking them or squeezing them they leave darker spots on healing in your case if you are having oily skin you should use ahaglow facewash four to five times a day this will prevent oily skin which is one of the main causes of the acne for the treatment of the eruptions you should use derive cos gel on the eruptions at night daily also take tablet azithromycin 500 my three days a week for month days daily dose then days gap then repeat the dark spots if persist after the course of treatment can be treated by other creams then acne vulgaris as mentioned above"
    },
    {
        "instruction": "hi I am 20 years old and a student I am currently having obsessive thoughts and I find it hard to control the thoughts I have fears and getting anxious that something might happen to me yet I am trying to convince myself to not to but then again I ve been seeking for help from psychiatrists that offer free consultations because as I said I am just a student wanting to know more about my condition I hope someone could help me I have ear problems and mitral valve prolapse I for now have medical prescriptions for mitral valve prolapse and have not checked up for this ear problems of mine I am currently taking propanolol",
        "input": "",
        "output": "hello I can understand that you are suffering from obsessive compulsive disorder and having distressing obsessive thoughts ocd is quite resistant illness which involve serotonin a kind of chemical in the brain we generally prescribe antidepressants to increase level of serotonin in the brain antidepressant require in higher amount because you know ocd symptoms are very resistant more than depression there is also a talk therapy which is called as exposure and response prevention it is a kind of cognitive behaviour therapy I would suggest you to visit your psychiatrist again and ask for this talk therapy this will definitely help you hope my answer help you thank you kind regards feel free to ask further"
    },
    {
        "instruction": "hello can you please review my blood test my concern are low level of ferritin high level of b12 and urine abc is very high",
        "input": "",
        "output": "hi welcome to the icliniq following is my opinion for your asked question the low ferrite low mav could be suggestive of early iron deficiency anemia the common cause for high b12 include supplement intake liver disease or kidney disease your liver kidney profile reports are normal so do not worry about that if you have any history of supplement intake than mention it b12 excreted by urine so might need not to worry about that high non veg food also sometime can cause elevated b12 for low ferritin no need of any treatment repeat your serum ferritin serum iron after few days the abc in urine could be due to urinary tract infection for that investigate further with urine culture report meanwhile take more water cranberry juice extract tablet attach the urine culture report once done hope this will help you regards"
    },
    {
        "instruction": "i am looking for my husband doctor because he is a diabetic asking for you what is the better medicine to lower his blood sugar at the same time he has ti",
        "input": "",
        "output": "dear user to decide a medicine for diabetes depends on the current physical and clinical condition there are several aspects to be taken care of it would be necessary for a doctor to start medicine after getting detailed medical history that will include current sugar levels which type of diabetes he has basic diet pattern physical activity status family history of diabetes current medicines he is taking for diabetes and ti his body weight and height any other physical condition etc as long as ti is concerned high sugar levels can also cause recurrent unis we can communicate in detail regarding management of diabetes and ti on this platform ti due to high blood sugar levels fbi pubs hba1c creat urine m maintain good genital hygiene in view of ti practise small frequent meals for diabetes with detailed medical history"
    },
    {
        "instruction": "hello doctor I have on and off fever since last friday and been having chest and stomach pain since yesterday pain somewhere in between the chest and the stomach I have a loss of appetite and can feel acid coming out of my chest a few times I also feel like I always need to poop but nothing is coming out when I try to I already took biogenic for my fever but did not took any medicine for the chest and stomach pain can you please advise me on what medicines to take and food to take or avoid",
        "input": "",
        "output": "hi how high was the fever any other symptoms such as cough colds body aches sore throat and pain during urination how would you describe abdominal pain burning crappy or stabbing does it radiate to the back if yes which side does it occur after food intake do you wake up in the middle of the night because of the pain any other symptoms such as yellowish discoloration of the eyes or skin nausea or vomiting I suggest taking omeprazole 20 my capsule 30 minutes prior to breakfast but may take one dose today complete blood count omeprazole 20 my one capsule 30 minutes prior to breakfast for seven days paracetamol 500 my one tablet every four hours as needed for fever"
    },
    {
        "instruction": "hi doctor I am a 30 year old male I am currently using phimocure silicone rings to loosen up my foreskin yesterday afternoon I accidentally used a large ring 26 my by wearing it for hour 30 minutes after taking off the ring I have this persistent pain like burning and pressure on the tip of the foreskin majority on the left side I still have this pain and wanted to know if it will go away by itself I am also using betamethasone cream",
        "input": "",
        "output": "hello I have gone through your queries the only solution to phimosis is circumcision however you may have minor vascular injury inside the foreskin due to the use of a tight silicon ring you can wait and watch to buy some time for natural regression of the swelling or else you can straightaway go for circumcision after consulting your local urologist by few days to weeks the swelling will reduce but the permanent solution of phimosis is circumcision"
    },
    {
        "instruction": "hello doctor I experienced a sudden and severe pain in my stomach lower part and anus which caused me to shake become dizzy and really pale and I have difficulty breathing I did not faint but if I were standing up then I probably would have it happened to me once before and I was on my period then I had consulted a doctor then as well and was told that perhaps my body was just shocked because I had skipped a few months of my period I am also diagnosed with iron deficiency anemia but I am currently not taking my iron tablets this time around however I had my period last month and was not on my period at all I am not sure what it is but wanted to let you know should you have come across a similar situation with one of your patients please reply",
        "input": "",
        "output": "hello well most of our patients initially complain to us about very vague symptoms at onset just like yours but we explore the possibility based on some more information and yes of course investigating them thoroughly the pain you mention which made you still and shaky can be arising from the gut as in abdominal colic a sudden wave of spasm in muscles within the gut or can be arising from endometriosis which is anther problem of the female genital tract whereby there is excessive growth of normal uterus tissues in the lower part of the belly thirdly it can simply be due to perimenstrual syndrome which is pain occurring at the time of menses for now I suggest you to do some test and ultrasound abdomen and pelvis later we can discuss the findings of your result functional abdominal colic perimenstrual syndrome endometriosis complete blood count ash thyearoid stimulating hormone ft3 liver function tests stool detail report urine detail report us ultrasound abdomen and pelvis follow up after investigation to discuss the results"
    },
    {
        "instruction": "hello doctor I have a tiny hard spot on the head of my penis it does not bother me unless I mess with it has been there for many years but just recently I have noticed a bit of pain when I am just sitting around it is probably the size of a pinhead and it is dark in color I have not had a sexual partner in a very long time years it does not seem like a boil or a pimple the very top of the spot is black please suggest",
        "input": "",
        "output": "hello I can understand your concern according to your statement you have been suffering from a tiny hard spot on the head of the penis this type of tiny spot can result from various reasons such as mole produced from over secretion of melanin by skin cells they are harmless and nothing to be worried penile papule appears around the penis head which does not itch or produce any fluid they may disappear as time passes angiokeratoma is a tiny red bump that appears when blood vessels near your penile skin become dilated they are rough in nature and may become thicker over time lymphocele has resulted from blockage in the lymph channel near your penile head it does not need any treatment and dissolves over time peyearonie disease is resulted from scar tissue which is found on the top of the penis that tends to harden due to calcium deposition treatment is needed when it makes erection of the penis difficult again your penile tiny hard spot may be resulted from a pimple cyst or sad sexually transmitted disease as your penile spot does not create any difficulty in your regular performance so it is nothing to be worried and needs no treatment I think it will disappear over time you can undergo fac fine needle aspiration cytology or biopsy from a tiny hard spot on the top of your penile head"
    },
    {
        "instruction": "hello doctor is there any chance of hepatitis spread through eating food contaminated with infected blood",
        "input": "",
        "output": "hello well the whole blood and serum white fluid within blood contains large amount of virus and virus can live on blood spots outside the human body for the duration of one week so actually it depends upon how much blood and how much time it has been on the stain that can determine the chances of acquiring infection if contaminated with food so I guess my answer can be partially answering your query if you tell me the exact event I may be in a better position to tell you the figures otherwise as a general rule hepatitis does not spread via food having said that it can still spread if blood contaminated food has been ingested since virus invades the human body when comes in close to mucosa lining of our mouth and then spread to blood within human this happens in the same way as one infected person can transmit infection via kissing hugging sharing of a towel spoon plates and so on if you are puzzled with all that information I want you to simply get a blood test for hepatitis infection it is a simple blood test that can give us a clue I hope this helps post exposure risk stratification hepatitis surface antigen hepatitis core total follow up after testing"
    },
    {
        "instruction": "hello doctor my left foot is swollen with purple color and pain I am currently on diamicron 60 my and xelevia 100 my",
        "input": "",
        "output": "hello with history I feel you have left foot cellulitis it is the infection on the foot you might need heavy antibiotics for the infection is warmth present on the wound any pus discharge from the area kindly update these details and also the picture of the purple color and also I would like to know what is your sugars levels in present condition"
    },
    {
        "instruction": "hello doctor my upper stomach area is pulsing suddenly from yesterday after eating what does that mean",
        "input": "",
        "output": "hello welcome to icliniq com I want to know when did you last have albuterol it is used in asthma for air pipe spasm it has common side effects such as tachycardia increased heart rate more than 90 minutes when the person is at rest where people feel there heartbeat I also notice your heart rate is 90 which seems to be secondary to albuterol pounding of stomach however is an unusual phenomenon but can occur due to certain drugs and sometimes without any cause the condition is called tachygastria you can simply decrease the dose of albuterol to see if it works in your case I hope this helps tachycardia gi motility disorder drug side effects and tachycardia reduce the dose of albuterol"
    },
    {
        "instruction": "hi doctor I have been using high quality highly rated penis extended for two days for hours a day and no for the past three weeks now do these things really work is it possible to experience penis shortening instead of enlarging a month ago I was but now I am almost at",
        "input": "",
        "output": "hello I want to know the reason for which you are using a penile extender do you have a very decent size why you want to increase it further it is like your height is feet but you want it to be 3 everything you do has got side effects if not done properly can lead to trauma and hence shortening are you diabetic or hypertensive any other chronic illness"
    },
    {
        "instruction": "hello doctor I am a 26 year old male my height is 9 and weight is 54 keg I do not look healthy I take a regular diet and meals thrice a day I do not have any health problems like cough fever and pain actually I want to put on my weight and develop my muscles because I look very thin could you suggest me any medicines or supplements for my better body growth",
        "input": "",
        "output": "hi good to know that you are eating well what about family history are your both parents or anyone parent is underweight if it is familial it is difficult to gain weight you can try with any protein powders ensure is good for a supplement take it as mentioned in the bottle try to include some evening snacks you can eat milk based sweets like rasagollas milkshake etc prepared at home exercise every day to increase your metabolic rate simplest is brisk walking gradually increase your intake of food do the above said things and get back to me after 10 days ensure two teaspoons daily with milk follow up after 10 days"
    },
    {
        "instruction": "hello doctor I am a 54 year old hypertension patient and in control with medicines ramipril 10 my natrilix 5 suspense release and rosuvastatin 10 my ramipril was causing dry cough and was managing until recently but now cough becomes very sensitive due to current couid 19 situation and so visited another clinic for an opinion and the doctor changed to connor 5mg and amaasc my at least for three months until the current situation improves as constant cough due to ramipril concerns me and others as well doctor asked to reduce the dose of rosuvastatin or to take on alternate days my question are the prescribed medicines safe I read connor does affect the sexual drive to some extent although with my age not so active but with ramipril there was no issue on this ground even otherwise will the combination prescribe now benefit",
        "input": "",
        "output": "hi I read and understand that your concern is about the side effects of the newly prescribed drugs reduction of sexual drive is one of the side effects of beta blocker group of drugs connor contains bisoprolol which is a cardioselective beta blocker the systemic side effects of cardioselective beta blockers are less compared to the general beta blockers so the effect of connor on the sexual drive would not be that significant to affect your usual life and the combination prescribed is safe to take there are no significant drug interactions between these group of drugs"
    },
    {
        "instruction": "hi doctor I was lying on my stomach for about 20 minutes when I moved to a seated position I get the most intense painful headache of my life it was in both my temples and lasted about a minute should I worry it is a brain aneurysm",
        "input": "",
        "output": "hi this pain seems to be due to vasospasm unlikely to be aneurysmal bleed pain if it was aneurysm it should have continued for a long duration I have another set of questions please answer them is this first ever headache of this kind was there nausea vomiting and dizziness was there any blurring of vision are the temples painful on touching is there any weakness in limbs or double vision"
    },
    {
        "instruction": "hi doctor I have pimples on my penis I do not feel any pain when I touch I just want them to dissappear I am having this for the past many months I was feeling shame to consult but now I do not want to take risk please help",
        "input": "",
        "output": "hi I can understand your concern according to your statement you have been suffering from pimples on your penis for the past few months pimples can develop on the penis as they are common elsewhere on the body pimples are resulted from blockage of the sebaceous gland of the skin due to excess serum or debris or dead skin sebaceous glands excess secretion of oil serum can develop pimples for the prevention of pimples you should avoid excess sweat producing activities wear loose clothes for preventing them from friction take bath regularly and do not rub your affected area you can use topical retiniods salicylic acid benzoyl peroxide etc without any medications they are also disappeared with passing of time by keeping personal hygiene strictly"
    },
    {
        "instruction": "hello doctor I am a 59 year old male I have dark spots on my cheeks close to eyes on both sides identical I would like to have medical advice on this problem which I am having for more than three years I am currently taking obimet so 500 glimisave m1 pivasta my pinot 40 my and clopilet 75 my",
        "input": "",
        "output": "hello please send two to three clear pictures of the affected area for better evaluation and guidance do you have any symptoms itching burning over this area"
    },
    {
        "instruction": "hello doctor I have pilonidal sinus I had two surgeries one with the endoscopic method and the second one six months before by incision and drainage method after recovering from this I had a small pimple on the wound doctor said it is normal and it is because of surgery but now I am having redness around that I am using alcohol swap to clean the opening areas of pilonidal sinus and they are closed kindly tell me is this recurrence of pilonidal sinus or boil or what it is it is causing pain while sitting as well",
        "input": "",
        "output": "hello do not worry I will help you with your problem as you said you underwent surgery for pilonidal sinus two times and now you have one boil at the same site as I can see in the image attachment removed toprotect patient identity it can be boil or recurrence of pilonidal sinus that may be due to infection of that local area I will prescribe you some medicine please maintain local hygiene shave your hair in that area get back to me after five days I will add some more medicine and local remedies sit bath in luke water with betadine twice a day tablet augmenting amoxicillin and clavulanic acid 625 my ads for five days tablet chymoral forte ads for five days tablet serradic be for three days capsule a to od for 10 days"
    },
    {
        "instruction": "hello doctor I am 17 years old and have a little bit of white nipple discharge in both breasts but one has it a little worse and the skin on my nipple appears to be white and has little blisters on it does not really itch or anything but it is sore to the touch",
        "input": "",
        "output": "hi I see that you are worried about discharge from both your breasts and you are telling it has blister like appearance white discharge with blister like appearance and sore to touch generally points towards an infection but an infection occurring simultaneously in both breasts at the same time is very rare another possibility is that milk secretion from both breasts which you might think as white discharge do not doubt there are certain conditions where there can be milk secretion even without pregnancy and birth which occurs due to hormone disturbances need some more information too do you have a fever how are your menstrual cycles is it regular is the flow high do you feel any small lump behind the nipples do you take medicines for any other problem do not mistake me but your problem needs a direct clinical examination to visualize the breast discharge and to see if there are any lumps behind the nipples you would not be comfortable to post pictures of your discharge and blisters so I would recommend you to visit a doctor in person and have yourself examined meanwhile do the investigations I have advised and try the medicines given below hypothyearoidism hyperprolactinemia breast infection galactorrhea tablet amoxicillin clavulanic acid 625 my twice daily after food for five days tablet aceclofenac serratiopeptidase two tablets twice daily after food for three days avoid wearing tight vests and too much sweating"
    },
    {
        "instruction": "hello doctor my child is one year old on routine examination his eye has a power of minus 5 and minus 5 refractive error what is the normal refractive error at this age as refraction continues to change doctor said to follow up after six months as glasses may be needed if power increases please help",
        "input": "",
        "output": "hello first of all let me tell you that visual development takes until the age of puberty as your child grows his vision parameters will change because his eyeball grows with him as he ages so visual stability will continue to change until the age of 18 20 years old normally the child is born with a plus refractive error unlike the case here your child has a condition called myopia which is a refractive error with a minus as you said but that is completely fixable as the child grows whether by glasses contact lenses or lasik surgery if it continues and he needs to take glasses off later the most important examination in his age is something called a red reflex you should ask your doctor if he has done it to him also I would ask about the funds examination too if both were normal I would not have any concerns I want to reassure you that your child eyes are in good health he just needs to be examined precisely every follow up every six months as your doctor suggested just to make sure everything is going right and to treat anything if something happens early the glasses will not be tolerated by a child as his age is too small as soon as he can tolerate glasses put them on that could happen in two years if you need further assistance do not hesitate to contact me"
    },
    {
        "instruction": "hello doctor my wife is 50 years and I am 54 years old last night we had sex with a condom but I have doubt it may be unsafe her period occurs once in one and a half months other than this she does not have any gynecological problem can she take any contraceptive pill like unwanted 72",
        "input": "",
        "output": "hello welcome to icliniq com though your wife is in the late part of her reproductive age and might be approaching her menopause yet if she continues to have her menstrual cycles regularly there is a chance that she might be still ovulating and if intercourse happens in her fertile period she might conceive it is better she takes unwanted 72 this time unwanted 72 is safe for her from a medical point of view but it is not 100 percent effective in avoiding pregnancy and cannot substitute a routine contraceptive so please do a pregnancy test also if she does not have her periods at the scheduled time after her next periods follow up for an effective contraceptive with additional benefits for hormone replacement appropriate for her age"
    },
    {
        "instruction": "hello doctor I may have a liver problem and would like to get advice I had done some medical tests recently and the liver turned out to be a bit problematic for me hence thought of consulting a specialist I am currently blood pressure blood thinner cholesterol reducing drugs and medicine for thyearoid",
        "input": "",
        "output": "hello I have gone through your query your be and cholesterol levels seem to be fairly well under control of treatment kindly share all your available reports liver function tests and details of the symptoms and problem that you are facing at present kindly get back with the above details and any other questions if you have further discussion and management"
    },
    {
        "instruction": "hello doctor I had protected sex with a woman after a few days I had an itch at the bottom of one of my ears after 12 days I done an hiv ran per test and it was negative after a few days I had a wart like bump in the shaft of my penis and body itching then after 60 days I have done hiv duo combo test and it was negative in these days I had intense itching with rash similar at the bottom of both of my ears after 90 days I have done the elisa test for hepatitis a and herpes syphilis chlamydia and they were negatives after a few days I had small itchy red bumps in the body after 25 days I done hiv tridot test and it was negative but the itching in the body with bumps continues now I am 314th day after sex what should I do should I go for another hiv test or other sad tests",
        "input": "",
        "output": "hi welcome to icliniq com I have gone through the case in my opinion if you have no contact history for almost a year then there is no need to repeat all the tests but first you need detailed physical examination because there are different types of itchy red bumps and some of these are linked to sex and some are not so do not go for all tests at once"
    },
    {
        "instruction": "hello doctor my eye has become red and is watering I think a foreign object has entered but I am not able to find it what should I do it happened yesterday and icing did not help currently I am under medication for high blood pressure",
        "input": "",
        "output": "hi first this to rule out is a foreign body in the eye for that ask someone to examine your eye with a torchlight and also check the upper lid by exerting it because that is the common site for foreign body sometimes a very small foreign body cannot be seen with the naked eye and need an eye exam by a doctor wash your eye with clean water if there is no foreign body seen then it is most probably conjunctivitis that presents with the same symptoms usually viral conjunctivitis it usually takes 10 days to complete recovery but during this period protect your other eye and other family members because it spreads from one person to another through contact for symptomatic relief keep washing your eyes with cold water and do icepacks that helps to relieve discomfort start antibiotic moxifloxacin 5 eye drops four times a day to avoid secondary infection if pain and discomfort are severe consult your nearby eye doctor for a complete eye exam"
    },
    {
        "instruction": "hello doctor taking ctd 6 25 for hypertension and amaryl my for diabetes for more than five years my fasting sugar level is always above 200 on average besides this I have vertigo syndrome rbb severe constipation and for the last three years itching in lower legs right leg in winter and left leg in summer most of the time I am sitting for my job my height is 181 am and weight 10 keg no change for the last five years",
        "input": "",
        "output": "hello after going through short the medical history I want to address some points for you first important aspect of management of diabetes is diet that will remain the primary objective for the management of type diabetes across the globe please elaborate a little about your basic diet pattern second important aspect of management of diabetes is exercise as you have mentioned your are an accountant and that will make you a less active person during a major time of the day while on the job and presently in lockdown at home take small 10 minutes of time and walk across the corridor start with little things then on the third part comes the medicines you have not mentioned how many times a day you are taking amaryl my please do mention that your weight is also more compared to your height amaryl can cause a little weight gain also you should opt for tablets that will not gain weight there are certain medicines available now which controls blood sugars and also help in weight loss apart from this I would like to know about your family history of diabetes and the stress levels you are facing on the scale of 10 are you getting enough sleep how many times you have to go for urine at night any pain or burning sensation in legs obesity uncontrolled sugar levels fbi fasting blood sugar pubs post prandial blood sugar hba1c glycated hemoglobin lipid profile serum creatinine type do continue the same medicines until we work on detailed diabetic history take six to seven small frequent meals a day more leafy vegetables fruits pulses take less grains maid and processed food once detailed history available and reports done"
    },
    {
        "instruction": "hello doctor I am 51 years old I am having sweaty palms and feet every morning I also feel nausea and headaches what is the cause of this",
        "input": "",
        "output": "hello as per your presenting complaint the diagnosis is migraine headaches are a common cause of combined headache and nausea migraines can cause a variety of symptoms including nausea dizziness sensitivity to light and severe headache you can make small changes to your lifestyle so that you prevent future migraine attacks here are a few steps to take to relieve migraine pain you should drink a lot of water throughout the day so that you stay hydrated at all times you should avoid eating less and should eat enough so you are getting all the nutrition that your body needs eating proper and healthy food is key to ensure your body is healthy you should try and eat at the same time daily sleeping deficiency can trigger migraines which is why adequate sleep eight hours is important you should maintain a steady sleep cycle by sleeping at the same time every night and wake up at the same time I hope this helps"
    },
    {
        "instruction": "i have pain while passing stool and also blood with it sum time spots and some time much more and I have physical exam to a doctor who said it is not piles it is anal fissure then I ask what is this he said in simple words its a cut he suggest me gun 2 and brixin tab if there is no relief in 10 days there will be need of operate please suggest me",
        "input": "",
        "output": "hello I will definitely help you regarding your problem anal fissure is a cut in the anal message due to hard stools it may present with pain and bleeding in percent cases surgery not required but proper medicines and prevention is necessary here I will advise you complete treatment only one gel and tablet will not help follow my treatment you will get better in days follow me after days so I will modify your treatment anal fissure sit bath with betadine times for 15 minutes spy duphalac top is ointment diltigesic locally times ointment south locally times tab enzoflam times daily tab panto der od plenty of water avoid spicy and fatty foods high fibre diet days"
    },
    {
        "instruction": "hello I am looking and would like to discuss my treatment options for my conditions I have bipolar disorder I social and generalized anxiety disorders panic attacks and agoraphobia due to it in past I used escitalopram venlafaxine fluoxetine sertraline lithium depakote quetiapine risperidone anxiolytics venlafaxine was effective but had to discontinue it due to high blood pressure it caused other treatments mentioned did not work for me anxiolytics worked but now I do not have such options to continue this treatment because I am getting used to tranxene currently I am taking lamictal 200 my and 10 my olanzapine I am afraid to go out from my flat I am constantly alarmed nervous anxious cannot eat because of constant lump in my throat anxiety is debilitating I cannot work outside my home at work I get so anxious that I have to take some free days from work if I do not do that I vomit from this anxiety can duloxetine be effective is it common that it can increase pulse and blood pressure as venlafaxine did how long does it take for escitalopram to take effect can prozac decrease anxiety is paroxetine an good option for me",
        "input": "",
        "output": "thank you for taking help from psychiatrist you should continue medications on which you are stable at present duloxetine may be good option for you it does not increases blood pressure tablet escitalopram takes around weeks for full effect after starting medications yup prozac can decrease anxiety but it belongs to same group as tablet escitalopram yup paroxetine is good anti anxiety but tablet escitalopram is better than tablet paroxetine you should follow below advice which can help your anxiety hope you get your answer thank you"
    },
    {
        "instruction": "hi I am a male aged 52years weight 80kg diabetic my doctor has recently advised me gabapentin it 400 for neuropathy earlier I was on pregab150 so while checking about the reviews from the patients on net I found that were against gabapentin which confused me and thought to have a and opinion kindly advise",
        "input": "",
        "output": "hi welcome to icliniq I am do anshul varshney for your help it an excellent drug infact it is an elder sister of pregabalin only gabapentin is little more potent then pregabalin only possible side effect of that drug is dizziness but since your mother has been on pregabalin 150 my then gabapentin should suit her gabapin it also contains nortryptilline which helps further in neuropathic pain dear if you will check side effects reviews of any drugs you would get for all if in doubt discuss with your doctor once again being empathetic I use this drug very often and most of the diabetologists use it so I would suggest you to start it and see if she gets any adverse effects we can go for other options though to be very honest we do not have much options other then pregabalin or gabapentin in diabetic neuropathy I hope it helps you if you have any further questions please ask me"
    },
    {
        "instruction": "i have blood in my stool but no pain I suffering from externally piles but there is no itching and pain in that almost from a week blood is regularly going through out stool",
        "input": "",
        "output": "hello I welcome you to icliniq the external hemorrhoids can cause bleeding and pain when they are enlarged or secondary to constipation which produces an abnormal pressure over anus causing swelling of piles the definite therapy is surgery however if certain lifestyle modification are employed the anal hemorrhoids can reasonably be controlled these life style modifications are I hope this will solve your problem anal hemorrhoids as above can follow up after days of treatment"
    },
    {
        "instruction": "hello doctor I have history of thyearoid and cos I am taking 50mg of eltroxin my period is delayed by days when I tested preganacy test after days of period days two lines are showing but not clearly please suggest me can I go to doctor for a checkup or wait for week for clear result or what type of precaution I should take during pregnancy",
        "input": "",
        "output": "hello welcome to icliniq I see than you have not mentioned the date of your last menstrual period ideally if you have had a regular 28days cycles the urine pregnancy test is usually positive by the time you skip your periods delayed ovulation can be common in cos so I would suggest you to recheck your home pregnancy test with an early morning urine sample tomorrow and exactly at the time interval at which the result has to be read as mentioned on the kit sometimes if seen very late the evaporation line also may seem as faintly positive which is actually a false positive early morning urine sample is supposed to be having concentrated levels of the beta hug hormone which is detected on the pregnancy kit so recheck again tomorrow with a morning sample of urine if you donot have any pain or spotting you can visit your gynaecologist at ease may be in a week and get an ultrasound done for pregnancy viability and localization meanwhile continue taking folic acid eltroxin medications recheck your thyearoid levels as during the pregnancy the dose may have to be changed due to increased requirements in pregnancy hope this helps please feel free to revert back anytime for any further queries or information continue tablet folic acid 5mg daily once till 14weeks continue tablet eltroxin 50mcg daily once avoid sexual intercourse in the first months of pregnancy"
    },
    {
        "instruction": "hello doctor it has been weeks since I have been feeling acid reflux with symptoms of heartburn and back pain I have been taking kremil and omeprazole lately I am experiencing diarrhea I hope you can help me",
        "input": "",
        "output": "hello I have reviewed your history as well as the medication profile you just shared so the part of the problem is secondary to the medicine you are taking such as diarrhea which tends to occur secondary to kremil since this medicine contains aluminum and magnesium both could cause diarrhea I want you to stop it now in addition senokot also causes diarrhea I am afraid that your initial physician has given you both these medicines for constipation or for stomach pain you should stop it as well until your diarrhea gets better omepron omeprazole is a generic medication but there are many which are now available with good effect I recommend you to switch to capsule esomeprazole 40 my take similarly as you were taking omepron before breakfast in the morning if this dose does not help increase the dose to twice daily before the meals let me know in a few days if symptoms persist I may consider adding other medicines for you if it does not work in your case gastroesophageal reflux disease dyspepsia follow up in three to five days"
    },
    {
        "instruction": "hello doctor I am weeks pregnant in my previous pregnancy I had a section at weeks as my water broke presently I am taking aspirin tablets daily my doctor prescribed it but I have a doubt that will it cause excessive bleeding in my delivery as I am near to delivery is it safe to take these tablets I am currently taking ecospirin 150 my diamet metformin 500 my rotate ad folsafe wysolone my and iron tablets",
        "input": "",
        "output": "hello I totally understand your concern but please do not be stressed all you need right now is to relax keep calm and take some rest yes ecosporin is totally safe during pregnancy and mostly your gynecologist will continue it until 36 weeks at least but I would like to know the reason for starting ecosporin and also the steroids wysolone because you have not mentioned it could be related to previous pregnancy events which need to be known in detail and also if you go into labor you can stop it then the effect usually does not last more than a day and the dose that is given in pregnancy is very low so definitely there is not much risk of bleeding I hope this helps"
    },
    {
        "instruction": "hello doctor I am a year old male I have been getting hips legs knees and back pain issues when masturbating I usually masturbate four to five times a week sometimes I can go two to three days without masturbating I have cracking noises in my hips and knees and my quad muscles feel over stretched and tight this problem has affected me and I am very limited in performing any activities such as sports I am not physically active anymore I used to play sports regularly but since I started having so many problems from the waist down I stopped also I get pain even when I am standing sitting or driving and get pain in the morning after waking up I live abroad and to get any medical attention requires months of waiting I currently have an mri booked in five months but my symptoms are getting worse day by day and I do not have the patience to wait until then is masturbation the reason for my problems how can I fix these issues and get my life back to normal is mri necessary if not what do I need instead please help",
        "input": "",
        "output": "hello sorry about your health condition masturbation usually may not cause weakness or muscle problems so do not worry the possible causes for your problem is panic attacks or anxiety which lead to increased tension in muscles hypocalcemia fibromyalgia hypothyearoidism vitamin deficiency rheumatoid arthritis myositis still many possibilities are there so use vitamin capsule like evian 400 my twice a day for two weeks use tablet aceclofenac 100 thiocolchicoside my twice a day for five days avoid excessive masturbation as it may lead to penile mucosal injuries lack of sex drive etc eat more green leafy vegetables and fruits do yoga and meditation regularly to release your muscle tension get done hemoglobin level thyearoid profile serum calcium and vitamin levels also do ra rheumatoid factor ana antinuclear antibody aso antistreptolysin are also useful if symptoms are not improved please consult with your physician or rheumatologist he will examine and treat you accordingly"
    },
    {
        "instruction": "hi doctor my last period was on 25th february 20 I have done urine test twice at home and it is positive and I do have other symptoms of pregnancy I am sure that I am pregnant due to corona situation I am afraid to get out and do other tests and see the doctor I do have a dry cough for the last one month and some time with white mucus mostly when I eat rice and spicy food my cough starts I have called a gynecologist and she told me to have adovas after lunch and duvet rupatadine 10 my after dinner for seven days after seven days I called her and told her that I feel a little better but not stopped coughing and she advise me to take adovas only three times a day I did and it did not help me at all I called her again and she advises montelukast 10 my after dinner and its also not working it has been four days since I took montelukast and I feel like I need to deep breath when I take it I have only cough no fever no pain no breathing problem no headaches and no running nose as you know in this corona situation I cannot go out with a cough to get other tests or see a doctor for my pregnancy advice and lab test would you please help me advising good medicine so my cough stops other than the above I am taking folic acid my two times morning and evening as she told me do I need to take anything else for my pregnancy at this moment please help",
        "input": "",
        "output": "hi congratulations on your pregnancy let me tell you in the first three months of pregnancy vomiting sensation gaseous state mood swings breast and back pain are common I understand it is not possible to have a consultation now for cough do stream inhalation three times a day tablet azithromycin 500 my twice daily for five days syearup dextromethorphan guaiphenesin combination my twice daily for five days we get it as syearup ascoril in india you will be fine folic acid is a must once a day till your pregnancy and tablet dominate doxylamine twice daily before food will prevent nausea and vomiting"
    },
    {
        "instruction": "having pain in anus as well as difficulty while passing stools huge amount of blood loss",
        "input": "",
        "output": "hello I welcome you to icliniq first of all try to reduce your weight at most times it is the obesity which has been causing problems the bleeding while passing stools can be secondary to anal fissure hemorrhoids rectal ulcer due to difficult defecation for better clarification and confirming the diagnosis I need to know more about your symptoms such as how exactly the amount of blood it is does blood form a streak over the sides of poop how painful it is while passing stools and does it causes pain or burning even after hour of opening your bowel and do you have constipation no of stools in a week if you could answer me for above question I would be in better position to tell you what it is exactly considering a possibility of anal fissure I recommend you to apply diltiazem gel over the bottom with a finger times daily and start taking ispagol husk table spoon full in glass of water daily irrespective of constipation or not take at least to liters of water fluid daily reduce weight by brisk walking 150 min week and reduce caloric intake as mentioned above mentioned above as mentioned above"
    },
    {
        "instruction": "hello doctor I am 24 years old female my height is 156cm and I weigh 91kg I had two abortions and still no baby yesterday night I had some blood on my stool and earlier for few months I had gas problems usually gas comes for many times in a day also I feel like gas is stored in my abdominal area and feels like to visit toilet often feeling heavy in my lower abdominal area for me it feels like gas yesterday one time I got some blood on my stool and today I did not get any blood but my abdomen feels heavy and it creates discomfort what is my problem and what I need to do to get relief from this doctor will you please suggest me some opinion please doctor",
        "input": "",
        "output": "hello I welcome you to icliniq actually the chronic problem of gas you mention is common in some one with overweight to obese as in your case may be since your weight appears to be way beyond normal and this has definitely health consequences if not controlled the blood in stool you mention is somewhat alarming and requires a thorough in person examination of the bottom and looking for the causes such as anal fissure hemorrhoids to some serious disorders like inflammatory bowel disease to summarize I want you to go and meet a gastroenterologist in your local area and get yourself examined to determine the cause for your and foresee physician ease just discuss above mentioned causes with him or her so to finalize the gas problem is benign non alarming but the blood you mention is alarming and need to be investigated I hope this will help small intestinal bacterial overgrowth follow up after getting examined by physician in person"
    },
    {
        "instruction": "hello doctor I have had ed for several years now I am able to get an erection but I am unable to maintain it I have been going to a men clinic for seven months now and they have done the gainswave treatment and implanted a testosterone pellet last week after all this there has been no improvement I have been using the ici injections and that maintains the erection sildenafil is effective sometimes but not consistently I have also improved my diet and exercise I also have delayed ejaculation during this but in the last 10 days I am unable to ejaculate at all either through sexual intercourse or masturbation I have been on saris selective serotonin reuptake inhibitors in the past but stopped taking them six days ago at this point I am at a loss and would like to get another opinion and some direction",
        "input": "",
        "output": "hello your lipid values and blood sugar values are absolutely normal I would like to say a few points here lisinopril hctz hydrochlorothiazide is a combo of two drugs in which hctz has erectile dysfunction as one of its side effects hydrochlorothiazide need to be replaced with a different drug or removed you are on three antihypertensives lisinopril hctz and amlodipine is your hypertension that severe testosterone implant may improve your libido but may not benefit ed erectile dysfunction always unless there is a gross hormonal dysfunction sari group of medicines are prescribed to delay ejaculation I do not know why were you prescribed one that is the culprit which has stopped your ejaculation totally better to discontinue it instead of sildenafil for erection you can try tablet tadalafil 10 my cialis after consulting your andrologist the erectile effects of sildenafil are short lasting whereas tadalafil has prolonged effects and one pill on friday will make you have a wholesome weekend it may even stop the need to have intracavernosal injections one investigation which I would suggest you is a penile doppler which gives an idea of blood flow to the penis gainswave is an addons to cure you fast penile doppler study ed"
    },
    {
        "instruction": "hello doctor I had a medical abortion a month ago my period came 29 days after the abortion after the period I did an hug test and it was positive 37 days after abortion my hug level is 18 21 after three days the test showed 17 56 I also did an ultrasound and the doctor said I have my endometrial thickness on one spot he prescribed me duphaston to take from day 15th day to 25th day of my cycle I am scared to take it and also I am scared that maybe I have some retained products but the doctor said I am fine what should I do is it safe to take duphaston in my condition",
        "input": "",
        "output": "hello first of all there is no harm in taking duphaston in your condition it is just a progesterone hormonal analog the same hormone is secreted from the ovaries once the egg is released after ovulation so there is nothing to worry about taking it I would like to know what was the indication for checking beta hug human chorionic gonadotropin value at 37th day post abortion when everything was fine you even got your periods pretty much on time regarding your beta hug value I would like to tell you that beta hug may be detected in maternal blood up to 6 weeks post first trimester miscarriage or medical abortion did you had a missed miscarriage or was it an unwanted pregnancy that was terminated medically and at how many weeks of gestation this is important because sometimes missed miscarriage may harbor partial molar pregnancy which goes unnoticed as biopsy or histopathological examination is not done for such cases but yes any persistence beyond weeks of abortions should be monitored carefully as these may be a hint of development of gestational trophoblastic neoplasia gun as your scan is normal and also endometrial thickness of my is also a normal finding so there is no chance of having any retained products it would be helpful if you could share the ultrasound reports pre and post abortion and the dates of the events along with the date of doing beta hug levels to have a better idea of your situation I would advise you to recheck your beta hug value again after a week please revert back to me with the necessary details I requested you so that I can guide you further serum beta hug value after a week"
    },
    {
        "instruction": "hi firstly I would like to thank for this wonderful and a very helpful service of online consultation my query is I have been using inhaler cipla serflo 250 from almost years as I am an asthma patient as its a hereditary thing that I have but as I am in a foreign country at the moment and my inhaler is about to get over and due to this pandemic time I cannot get it imported to my place but I have a friend who has given me maxiflow 250 from cipla as well so I wanted to know if I can use that as an alternative inhaler as I do not have my serflow 250 inhaler in stock your assistance would be highly appreciated and much obliged thank you",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello doctor my son is 19 months old he is grinding teeth most of the time not eating at all only one spoon after that he has feel of vomiting so am giving food with a long interval between every bite also we giving only mashed foods previously he was taking idlies now even half idle is difficult for him to finish one of my friends suggested me to give albendazole syearup ad his symptoms suggestive of worm infestation can I give albendazole syearup if yes how many my and his weight before two months was 9kgs because of lockdown we did not check his recent weight if no what medication can we give please reply am really worried about his eating habits he became very thin comparing to before thank you in advance",
        "input": "",
        "output": "hello hope you are safe thank you for the elaborate history I appreciate your concern regarding your child I would like to first tell you that grinding is a common phenomenal in children till years most children outgrow it by years however at this age if he is grinding you can give him plenty of water positive feedback helps and for more discussion regarding reward and positive feedback you can consult me on phone as it is difficult to explain those things verbally as for albendazole you can give 400 my once stat dose only repeat at months interval regards"
    },
    {
        "instruction": "age 62 years my mother has severe heart problem she had high blood pressure from long time but didn't get any medication now her feet and ankles are swollen a doctor recommended triforge 160 12 loprin 75mg her be is managed now but she feels high heart rate palpitations and cold sweating please help me I cant afford hospital expenditures waiting for your kind and helpful response s she is also taking epival from last years",
        "input": "",
        "output": ""
    },
    {
        "instruction": "at the ends of my lips I see it is little dark in color so I applied honey and sugar mix on the dark area it now became even more darker so I started applying neutrogena fine fairness cream for lightening the dark color after applying the cream my entire skin started becoming red and I also have little burning sensation so I started rubbing with ice cubes and I also applied aloevera gel and also boroplus antiseptic cream but still I could see my skin red and little burning sensation is still present could you please tell me any home remedy for this or any ointment which could reduce burning sensation and lighten the darkness around my lips",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello doctor I have a positive up and my lap is 31st march I have an irregular period at 13th may and I found some blood spots after that I go for a to ultrasound that shows no definite gestational sac endometrial echo is central and normal in thickness and measures 6 am before to ultrasound on ith may I checked my beta hug and it is 178 and after 48 hours it is 247 is this miscarriage or should I go for another ultrasound because after that I do not have bleeding or cramps or anything please guide",
        "input": "",
        "output": "hello I have gone through the description you mentioned and understand your concern totally but the details are a little confusing it would have been good if you could give details with dates when beta hug human chorionic gonadotropin was checked I understand that scans were performed and the beta hug test on ith may is 178 and on 10th may it was 247 on 13th may you got the scan as you had a spotting right see as your previous cycles have been irregular it is difficult to predict when you would have ovulate exactly so we cannot go by your dates to calculate the duration of the pregnancy may I know when did the urine pregnancy test turn positive for the first time it would be advisable to recheck your urine pregnancy test now again as you had spotting if the levels are falling then it would be suggestive of a miscarriage and mostly this could be like a biochemical pregnancy where pregnancy is detected only in the blood tests but on the scan I cannot find the gestational sac development which has ultimately got aborted as levels you mentioned last were pretty low another possibility to be ruled out more importantly is ectopic pregnancy or pregnancy at some unknown location to rule out all these doing a serum beta hug will clear your doubts serum beta hug level repeat ultrasound after checking the beta hug value report to your gynecologist if you have any sharp pain"
    },
    {
        "instruction": "hello doctor I have fever and leg pain since last night I had preauricular sinus infection pus drainage three weeks back I was on different antibiotics for the last 45 days taxi centil augmenting and lizobact 600 I stopped taking them two days back",
        "input": "",
        "output": "hello I have gone through your query as per your query you have taken multiple antibiotics for a long time which is not good I need to know whether you have done a culture sensitivity test for the pus draining out of the sinus or not because if you take antibiotics according to the culture then chances of recurrent sinus infection and fever are very less can you send me the photos of your infected area preauricular sinus mostly pus discharging sinuses are caused by tuberculosis infection in most of the cases in my opinion you should go for a detailed physical and systemic examination along with some blood tests and chest ray also if discharging sinuses is still persisting then you need to do a pus culture sensitivity test both for bacterial culture and acid fast bacilli aft culture and other advanced tests for tuberculosis now you can take tablet paracetamol 650 my whenever you develop a fever please do not ignore your problem as it can lead to deterioration of your health I suggest you to consult a physician and get a detailed physical and systemic examination done and detailed evaluation along with the above tests"
    },
    {
        "instruction": "hello doctor I have white patch on my face it was very pale but when I apply fluticasone it appears as white even my cheeks are rough and slightly depigmented",
        "input": "",
        "output": "hello how long it has been there what are the symptoms of it any other area affected any other family members affected any history of hypertension diabetes mellitus thyearoid disorder any known drug reaction looking forward to your response in order to help you"
    },
    {
        "instruction": "hello doctor how accurate are early ultrasounds at determining gestational age and conception based on my ith week scan I am 23 weeks today means I conceived around december 25th is it possible that I actually conceived around december ith and baby is measuring small I have had six ultrasounds and the baby has never measured more than days off from the date given at my week scan even though my last period last came on november 28th she has never measured on track for that",
        "input": "",
        "output": "hello welcome to icliniq com the first trimester ultrasound scans done before 12 weeks are the most accurate ones in the assessment of gestational age with an error of only to days in the assessment of gestational age so they are used for obstetric dating and determination of expected date of delivery moreover if you have done ultrasounds and the date calculated from each of them corroborates and does not lag behind then probably your baby is growing well and it is not small as you apprehend the date we calculate from the first day of last periods is accurate only if the periods were regular for the last months and there was no history of miscarriage or ovulatory disorder like cos polycystic ovary syndrome or contraceptive pill intake in case of any discrepancy the date from dating scan at weeks are accurate and to be considered it is a probability that you actually conceived in later part of the cycle which leads to this discrepancy between the date and us"
    },
    {
        "instruction": "hello doctor I am a 36 year old male I previously had a chlamydia infection and was successfully treated will such previous infection interfere or affect my fertility I recently had a scrotal examination and the results were normal",
        "input": "",
        "output": "hello chlamydia infection persistence or recurrence can definitely cause an apparent increase in the pus cell and abc count in the seminal fluid which can easily decrease the total sperm count and its quality if you have been treated it is good but again it takes 90 days for new spermatids to form adults and become functionally mature for fertilization it is always best to get a repeat semen analysis and culture done to be sure that there is no repeat or recurrence of chlamydia infection if you have been sexually active post your previous examination or if your partner was not treated along with you"
    },
    {
        "instruction": "i have a small pimple or swelling in anal area where stools are passing from last one week which is not painful and there is no problem with bowel movement its having an itching sometimes it is piles or any related disease it just had a small itching sensation and had small pain while washing after bowel movement and no pain while passing stool",
        "input": "",
        "output": "hello dear I welcome you to icliniq this seem to be a perianal boil the boil is a pus containing hair follicle hair are the stalk and follicles are the trunk of the hair the follicle can get infected and cause enlarged painful swelling called as boil it is not communicating to your bowel thats why you dont have problem with your bowel the best thing you can do is to keep this bottom are clean and hygienic wash it thoroughly with each bath and remove hairs timely you can apply fusidic cream three times daily over it shall heal in few days of application of this cream I hope you will be fine good day perianal boil folliculitis none fusidin cream for local application follow up if symptom persist"
    },
    {
        "instruction": "please I will like to know what I can do about it dark underarm",
        "input": "",
        "output": ""
    },
    {
        "instruction": "i have always had trouble with my tonsils I get tonsil stones frequently and snore for the past month I have had a mild sore scratchy throat I can tell my left tonsil is swollen and it is causing some pain sometimes the pain reaches my ear but not often my doctor did a swab to check for infections but it came back clean could this be allergies I have never had allergies before except for asthma as a child I have no other symptoms",
        "input": "",
        "output": "hi I understand that you are worried about your long term tonsil problem tonsil enlargement could be due to infection or as a part of some other disease if your swab is negative we need to investigate for other possibilities also I would suggest you some investigations for the same meanwhile also take the tablets as prescribed abc ear peripheral smear it neck chest xray tonsillar enlargement under evaluation cefuroxime 500mg stab twice daily for week after food aceclofenac serratiopeptidase stab twice daily after food for day betadine throat gargle thrice daily review with investigations"
    },
    {
        "instruction": "hello doctor today I had an asthma attack at work and they treated me and did a chest ray I am an ray technician and I just do not think my chest ray looks right please suggest I am currently on concerta omeprazole cetirizine montelukast symbicort pro air emergency pump and albuterol",
        "input": "",
        "output": "hi the chest rays pa and lateral views are showing mildly prominent bronchovascular markings in the bilateral perihilar and lower zones and might be of concern for hyperactive airways after the asthma attack there are no focal lung lesions there is no pleural effusion the cardiac size is normal the retrosternal space is normal the domes of diaphragm are normal please discuss this in detail with your doctor"
    },
    {
        "instruction": "hello doctor I feel rather extremely angry than at the same time very sad I always have this very gory thoughts that I wanted to kidnap and torture the person I hate and again at the same time I want to hurt myself because I am so incompetent and I always feel like all the people think the same way to me that I am incompetent and that if I die everyone will be happy I also started gripping things strongly and I always try to stop when I notice am I really unstable does this mean I cannot do my work properly",
        "input": "",
        "output": "hello how long have you been experiencing these symptoms like extreme anger sadness and other difficult emotions has there been anything ongoing stressors in your life that affects you negatively from the information you have provided it appears that you are stressed experiencing depressive thoughts and need support to cope with the emotional difficulties speak to a trusted family member friend about your difficulties so that they can understand and support you do not keep things to yourself as it will add to your stress having fantasy thoughts of wanting to hurt the person you hate and self harming thoughts can happen if you are overwhelmed by your situation and not having positive coping strategies you need to consult a psychiatrist near your place for a comprehensive assessment to clarify the nature and severity of symptoms based on which counseling or therapy can be provided with the right treatment you will feel more in control of yourself and will be able to function normally I hope this helps"
    },
    {
        "instruction": "hello doctor I would like to get a third opinion in regard to categorizing which uterine abnormality I possess the initial doctor said it is arcuate my current doctor thinks it is bicornuate but I am going to do a ad ultrasound in the middle of my next cycle to get a better idea I have mri and hysteroscopy photos to provide I have had two missed miscarriages the last one hemorrhaged two days before going septic and sent me to the er for five days I have also been diagnosed with a placental site nodule on my right side where both pregnancies have been could my problem be surgically corrected currently we are going through genetic blood clotting disorder and menstrual cycle hormone monitoring genetic counselor said low risk for any genetic causes but is still waiting to complete the blood tests which should be done in four weeks same for the blood clotting tests",
        "input": "",
        "output": "hello having gone through the mri pelvis and hysteroscopy pictures it is evident that you have a bicornuate uterus with a single cervical opening and it is not a septate uterus or an arcuate uterus two different horns of uterus are evident on mri magnetic resonance imaging indicating the bicornuate abnormality the option which you have is called straussman operation where both the horns can be cut in the centre and joined to make a single uterine cavity you may discuss the option with your gynecologist and make a decision"
    },
    {
        "instruction": "hello doctor my mother has paranoia schizophrenia for the past 16 years the delusions have become very absurd and in her story her immediate family is the culprit she has very vid auditory hallucinations and sometimes visual hallucinations she has refused to see a doctor as she believes they are in on it her stage of psychosis is very violent in which she screams and shouts and also turns violent this has been going on for 16 years but now the episodes of psychosis are becoming more intense please advise on how to talk to her or at the very least medicate her because it is taking a toll on our mental health my sister suffers from depression and I suffer from anger management how our father holds it together I have no clue please advise",
        "input": "",
        "output": "hi it is quite difficult to manage such issues when patient refuses to take the drug however nowadays depot injections are available and their effect lasts up to four weeks so talk to your psychiatrist regarding the injection once she is put on a monthly injection then it will be easier for you to give her a monthly dose this will ensure drug compliance and a better outcome I hope this helps"
    },
    {
        "instruction": "hello doctor I am running an it firm for the past four years currently I am having two health issues related to my work lower back pain it started two years back and now it has become worst now I cannot ride a motorbike cannot sit in a normal chair and cannot even sleep on my sides I also cannot walk or stand continuously for more than half an hour currently I am using a belt and it is helping a lot pain in both the shoulders if they are not in action like if I am sitting in the chair for more than an hour without regularly using my hands the shoulders start paining this just started a few months back and getting worst I have not consulted a doctor yet for both of these issues I wish to book an appointment and it would be appreciated if the doctor knows malayalam as my english is not up to mark",
        "input": "",
        "output": "hi well you have a typical problem with people working in an it firm tell me first how much physical activity you have in your daily routine"
    },
    {
        "instruction": "hello doctor my wife has been having itching on her body for the past one year itching subsides with allegra 120 she is taking this medicine for the last one year mostly she gets itching on the area which is not covered by clothes skin becomes red when she scratches it I am attaching the picture",
        "input": "",
        "output": "hello she is allergic the allergy can be due to food sunlight pollen soap moisturizer or powder so she can be allergic to anything as you mentioned that only areas that are not covered by clothes are affected which points to photosensitivity which is an allergy to sunlight it can be an allergy to something else as well it is very difficult to say only on the basis of history I would suggest to look for any particular food if she develops itching after eating something change soap moisturizer and powder cover the whole body while going out which will protect if she is allergic to sunlight you can also go for skin allergy testing which will confirm the diagnosis take tablet montair la montelukast and levocetirizine whenever she has itching stop allegra it is basically prevention from allergens she is allergic to you can find it by yourself by closely watching or go for skin allergy testing"
    },
    {
        "instruction": "hello doctor I am 24 years old I have always been very anxious about health especially my sexual health but when I was about or 10 a spot came up on my penis where the glans and shaft meet it was flesh colored painless and round there was no dimple in it I was never sexually abused or sexually active at this age I did not even masturbate the first time until I was 12 or 13 my mom took me to the doctor and they said like just come back if it gets bigger she had likened it to a wart but it was not very hard or dry anyway it stayed for a couple of years after that it shrinks down it no longer appears as if it is above the skin but appears as a small pin sized bump underneath a skin bridge I am curious if it cannot be an sad and I have never found anything similar online so what could it be I would not think a wart would stick around that long and it really does not look like that at all that was there over 12 years so I would not think it is anything fatal to be even more specific it is on the top side to the right as I said it looks like a skin bridge with a little bump underneath but it really has no sort of texture and the only problem it really causes is some skin rubbing when that extra skin rubs my underwear",
        "input": "",
        "output": "hello this was likely a wart only warts can have very varied morphology and most plausible explanation is for wart only because considering it was a single lesion was not painful or itchy flesh colored and it persisted for a long time and resolved on its own so all these factors favor it morphology can be variable the negative factor was not sexually active although most common causes are sexual contacts but significant number of individuals may have it with non sexual contacts as well it can be transmitted vertically during childbirth and remain dormant for a long time activating later in life it can be transmitted with usual contacts and can be transmitted through clothing like underwear if came in direct or indirect contact with infected individual clothing sharing toilets etc can also transmit it so being not sexually active is not a strong factor against it rest all causes like skin tags which would persist without treatment or fall off suddenly up pearly penile papeles would be numerous papeles other infectious causes would be short lived and multiple lesions and symptomatic like painful tender or red malignancies are unlikely at this age and would progress so the probability is high for wart only I hope this helps"
    },
    {
        "instruction": "the bottom part of my abdomen hurts and I cannot poop",
        "input": "",
        "output": "hello I welcome you to icliniq I can understand you must be very upset about your problem it seems that you have a defecation disorder which is difficulty in passing stools it can occur to any body but common among individuals who have difficult learning the art of passing stools for this you have to relax remove your anxiety and start learning the art of pooping here are some tips for that if all above fail then there is computerized therapy called biofeedback therapy I want you to follow above tips first and let me know if improvement if required I will suggest when to go for biofeedback therapy the pain is a secondary phenomenon once your stools became normal the pain will go away do not use painkillers because they may slow your bowel and can cause more constipation defecatory disorder slow transit constipation defecatory disorder as above follow up in week and update me about your problem"
    },
    {
        "instruction": "hi doctor I am 21 years old I was diagnosed years back with obsessive compulsive disorder I followed treatment with the help of a psychiatrist who included cognitive behavioral therapy and medication of medication as many times as I tried to stop paroxetine seroxat in collaboration with my psychiatrist of course my body reacted with nausea dizziness and other similar symptoms so I take a seroxat 20 my one day and in the next day half alternatively on my own initiative this has been going on for the last few months as I was getting one and a half at first and then one I have been taking them for two years now I cant stop taking the medicine because I am afraid of the symptoms what can I do to deal with the symptoms of the drug cut after I have completed the treatment thank you in advance for your response",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello sir after finishing pack of combination pill 21 tablets I forgot to start another pack on ith day so I started new pack from 10th day we had intercourse in 10th day and I took ecp unwanted 72 after 42 hours of intercourse is the any chance of getting pregnent",
        "input": "",
        "output": ""
    },
    {
        "instruction": "doctors are switching between whether I have crowns or ulcerative colitis based off response to treatment and medicine started humira last month but it has come in for my and round and it is already a month late wont know if that worked or not since I am off schedule this past week the area around my rectum with is very raw has swelled up its around where I have the sexton in from a fistula past week my bowels have nothing but liquids every time I go to the bathroom is expands that area where the sexton is causing excruciating pain I am currently on imodium and flagil I have taken anvil and tylenol nothing has reduced the pain",
        "input": "",
        "output": "hello I welcome you to icliniq I know you must be very upset about your ongoing condition you symptoms suggest that you have crowns disease not ulcerative colitis humira and biologic medications like this work for a while before losing effect till the time of next dose so yes if the interval between two doses is extended the patient can develop flare in interval period the symptoms you mention may be of a mild to moderate intensity flare but can be secondary to infections the clostridium difficile infection which is common you did not mention that the pain in area of where you have sexton is new or occurring before as well and when did you have sexton for fistula the swelling you mention can be an evolving perianal abscess due to active lumnial disease the abscess formation is the first step in the formation of fistula which is a end result due to rupture of abscess from both side lumen on one side and skin on other side so I am afraid you me have this flagyl is good if taken for long time to treat perianal disease but you did not mention for how long you been using this for now you can continue this and get yourself examined by your physician to look for evolving abscess adalimumab humira works well for perianal disease but make sure you need to increase the frequency and do not disturb the schedule I hope this will help take care crowns disease with perianl disease stool for difficile antigen and stool for calprotectin stool detail report stool culture"
    },
    {
        "instruction": "hello doctor I need a multivitamin supplement and digestive enzymes to regain bone ligaments and tendons weakened by digestive issues malabsorption of essential nutrients due to digestive conditions like chronic atomic gastritis resulted in bone loss osteoporosis low stomach acid and joint weakness like ligaments of knee etc I need supplements that do not depend on stomach acid",
        "input": "",
        "output": "hello after going through your query and detailed report I suggest to calm your gut first which in turn helps to increase absorption of vitamin and calcium and start with glutamine supplement og capsule daily preferably before going to bed or at least an hour before meals later you can opt for multivitamin supplements with good food intake along with that follow these tips increase high protein diet including almonds vegetables fish chicken and eggs do muscle strength exercises if allowed by ortho increase fluid intake do rest for 9 hours of sleep manage stress with meditation do breathing exercises manage to follow small frequent meals do take 2500 cal diet if required you need to add supplement whey protein glutamine"
    },
    {
        "instruction": "hello doctor I have acne and oily skin with very bad acne scars and dark spots all over the face please help",
        "input": "",
        "output": "hi if possible provide me photographs of the affected areas which will help me for better understanding of your skin problem and proper treatment plan photographs are required for diagnosis purpose because the treatment given without proper diagnosis can be less helpful or can also harmful for you"
    },
    {
        "instruction": "hi doctor the imaging of the neck region was done and some lesions were detected the operation of lower jaw and neck region was done followed by chemotherapy and radiotherapy and it was stated that things will settle to normal during routine checkup some swelling in neck region was detected and fac was done which shows metastatic poorly differentiated squamous cell carcinoma and after that full body scan was performed the reports are attached kindly look into it as the second opinion is required",
        "input": "",
        "output": "hello I am sorry to know the recurrence of cancer you got diagnosed with squamous cell carcinoma in buccal mucosa of the left oral cavity in december 2019 which was operated then you received chemotherapy and radiation therapy and now on routine evaluation there are some new lesions coming up in the thyearoid and neck so basically there are two sites of new lesions now in parotid and around it one more lymph node so please undergo a biopsy of this lesion from parotid to see if it is same cancer as before or a new second primary cancer if it is confirmed as same cancer as before it will be operated and taken out and also few more lymph nodes on the same side of the neck followed by chemotherapy if a second primary cancer then treatment can be different depending upon what type of cancer it is on biopsy so your first step is biopsy"
    },
    {
        "instruction": "hello doctor red itchy patches on groin area all the way spread around anus and thigh tried treating with camphor mixed with conut oil first then used cosvate go ketoclean and veto soap it has worsened",
        "input": "",
        "output": "hello you have tina corporis cruris which is also known as ringworm fungal infection kindly stop using the earlier medicines you should take capsule itraconazole 100 my twice a day for weeks also take tablet cetirizine 10 my at night for the itching also apply luliconazole sertaconazole eberconazole cream twice a day kindly take bath twice a day this will help in cleaning the sweat on the body which helps fungus to grow also as you are a diabetic you have to maintain your sugar levels in uncontrolled diabetes fungal infection is very common take care and stay healthy tina corporis cruris as explained above avoid wearing wet undergarments"
    },
    {
        "instruction": "hi doctor my niece who is year and months old got choked today when she drank her milk she got cough because of the choke but the cough keeps coming back the whole day I thought it was just a simple choke as it is just milk why does it last for the whole day",
        "input": "",
        "output": "hello for further information consult a paediatrician online"
    },
    {
        "instruction": "hi doctor my son is years old his doctor told that he has a cylindrical power of and 25 he also said that his muscle power is weak is it a must to wear eyeglasses",
        "input": "",
        "output": "hello I can understand your concern regarding your child revert back with the prescription to an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor I am losing my hair day by day can I use finasteride I have hydrocele is it related to my testosterone",
        "input": "",
        "output": "hi please do not go to finasteride straight away first the cause and the pattern of your hair loss have to be assessed it could vary from seborrheic dermatitis to androgenic alopecia to any other skin disorders too then treatment can be planned have a consultation with a dermatologist for physical evaluation and get your problem assessed hydrocele is not related to testosterone it is just a fluid collection in the sac so please do not get confused for further information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor four days ago when I was away from home for some work I felt sick and my hands and feet were numb for several hours then I had fever for three nights with soaking sweats followed by continuous diarrhea for the last four days I am going nearly to 12 times a day I read the symptoms on campylobacter and it seems pretty similar do I need antibiotics does it go away by itself I assume that I should not take medicine to stop the diarrhea I did have chicken before all of this started not sure if that is connected thank you",
        "input": "",
        "output": "hi for further information consult a general medicine physician online"
    },
    {
        "instruction": "hi doctor I am having irregular periods my cycle is usually on the 10th of every month but I had heavy spotting on the 19th of last month then I had my normal periods on the 10th of this month but I had my periods today which is 10 days earlier than the normal cycle during mid of last month I had some iron tablets for around three to four days please help me with this irregular period issue thank you",
        "input": "",
        "output": "hi I have gone through your query and can understand your health concern for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hello doctor over the last two days I have had a bad sore throat it also accompanies with a slight cough trouble in sleeping occasional uncommon sweating body soreness or fatigue slight vomiting and voice loss it is not really getting better it originally appeared to be just a bad cold but today there is blood in my sputum it started about 15 minutes ago and it is only when I spit it out every few minutes should I be concerned my mom thinks that it may be due to a laryngoscope I got at the ent yesterday but no bleeding occurred until now thank you",
        "input": "",
        "output": "hi for further information consult an ent otolaryngologist online"
    },
    {
        "instruction": "hi doctor I am 24 years old I am not on any sort of birth control pills I had a normal menstruation in the starting of this month and normal bleeding after six to seven days I started bleeding again the bleeding was not very heavy but lasted on and off for about six days now after a gap of four days I have got heavy bleeding again it is not brown blood as I normally see during my period it is dark red much thinner and flows readily like a liquid I feel pain in the lower abdomen whenever I get this bleeding I also feel weak there is no pain on urination or sex I do not have a history of any infections also I am not on any other regular medication I am pretty sure that I am not pregnant I have got a go appointment in a week but it is really worrying and painful sometimes what could this be",
        "input": "",
        "output": "hello for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I struggle to focus and I cannot concentrate on my studies I just think about other things not always bad things but sometimes I think about throwing myself out the window when I am asked a question or if there are some people around I used to get panic and struggle to answer my voice will be too low and can hear my heart racing I have been self harming myself for over a year now I have got cuts and scars on my arm I do not get along with my family and I barely do anything anymore either I sleep or think simply lying in bed I sometimes hear voices of people who are not present I feel like tight chest and my breathing is difficult I want to do well at college but I am not happy my mood changes within a few seconds I am too shy to visit a doctor please help",
        "input": "",
        "output": "hi personality issues psychotherapy dbt dialectical behavior therapy for further information consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor I am having a tough time with my skin infection it is being around two months since I got affected by that I am having the hives of dark reddish in color in specific areas like on the penis point and on the buttock it is so itchy and the whole body is getting so itchy like on hands and legs too there developed some red spots can you provide me the best cure till now some dermatologist suggested he mite ointment and I forgot the name of the other tablet he said to apply that ointment for the whole body from neck to legs I did but no improvement please help",
        "input": "",
        "output": "hi revert back with the photographs to a dermatologist online"
    },
    {
        "instruction": "hi doctor for controlling my hypertension I was prescribed benicar 40 12 my once in the morning amlodipine my twice a day and clonidine once in the evening these were prescribed after egg and blood work even after taking the medication my be is usually 160 85 mhg what to do further please advise",
        "input": "",
        "output": "hello I want to highlight a few important points here amlodipine should be used once daily instead of taking my twice daily you should take 10 my once daily which is the maximum dose clonidine on the other side can actually cause rebound hypertension which can explain your high blood pressure it should be the last resort of the treatment of hypertension it would be nice to know the dose that you are taking these days I would like to know when did you take your blood pressure and if you follow a low salt diet benicar olmesartan is a good medication please consult your specialist doctor and discuss my opinion I would like to know if you have any other medical conditions like diabetes stroke high cholesterol or a heart attack to determine your blood pressure goal according to the latest guidelines revert back with the answers to the above questions to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am a 27 year old male doctor prescribed me azithral and fepanil for fever but the fever is on and off for the past seven days my blood test showed normal no malaria or dengue or typhoid first I took azithral and fepanil and then the next day doctor added cefuroxime axetil along with it as the fever continues I have got amikacin intravenous and now I have stopped all the medicines and still have a fever what fever is it I had four fepanil capsules per day for every six hours for the past seven days my blood report is normal and there is no pathogen for malaria dengue or typhoid but the value of abc is high with ear of 50mm showing microcytic anemia with neutrophilia",
        "input": "",
        "output": "hello the possibilities for fever in your case are as follows for further information consult a general medicine physician online"
    },
    {
        "instruction": "hello doctor I am a 28 year old male for the past five years I have few swellings on both underarms recently my mother was diagnosed with breast cancer while browsing on the internet for her condition I found out that my swelling may be of lymph nodes and may be cancerous this urged me to get consulted my swellings are a bit painful while touching it at times gets sore and brings out smelly pus which is yellow in color I am anxious and would like to know what the best way to proceed here many thanks",
        "input": "",
        "output": "hi revert back with the answers to the medical oncologist online"
    },
    {
        "instruction": "hi doctor I had unprotected sex with my girlfriend she took unwanted 72 and vomited within one hour she was late in her period by six days now so we had a pregnancy test and it showed negative it has been eight days and she still did not get her period what may be the reason",
        "input": "",
        "output": "hi we are here to help you for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I have recently noticed a lot of wrinkling of my skin on both my thecar muscles of the thumb I just noticed it a month ago I also have a dent or atrophy on the back of my right hand between the little and middle finger I am not sure whether this is new as it seems to appear in a video of myself taken before three months I am a 35 year old male my grip strength seems good I recently did a personal best hang test of minute 20 seconds two years ago my neurologist told me that I had cramp fasciculation syndrome as I had a lot of calf and feet twitchings I am concerned now that I may have mnd please help",
        "input": "",
        "output": "hi for further information consult a neurologist online"
    },
    {
        "instruction": "hi doctor last week I was bitten by red ant within minutes I was collapsed and immediately rushed to the hospital my be was low at 80 60 mhg it was detected as anaphylaxis I hereby attaching the treatment sheet for your reference six months ago my year old son expired due to unknown insect bite we did not know about anaphylaxis at that time what type of treatment should I get further for anaphylaxis",
        "input": "",
        "output": "hello for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor my wife is having swelling over the collarbone and back our doctor diagnosed rheumatism after blood test now she has pain in ribs when she carries our year old son or any weight our doctor had prescribed bon dk bon ke etc how long will it take to recover is this a serious problem will this get cured please explain",
        "input": "",
        "output": "hi anti cop ana and serum uric acid rheumatoid arthritis soft tissue rheumatism seronegative arthritis for further information consult an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hi could you please review the attached photos and ray taken before treatment post root canal and post temporary filing please let me know whether a post is required or is core filling with crown sufficient",
        "input": "",
        "output": "hi for further information consult a dentist online"
    },
    {
        "instruction": "hi doctor my friend is going to adopt a months old female child certain routine tests were performed on the child I have attached the reports for your reference the he electrophoresis for thalassemia screening is showing an abnormal hemoglobin pattern the treating pediatrician is not sure about the prognosis that is whether the child will be symptomatic and transfusion dependent presently the child is asymptomatic except for mild splenomegaly please suggest about the future prognosis of the child to facilitate the further course of action",
        "input": "",
        "output": "hi based on your query and attached report my opinion is as follows for further information consult a hematologist online"
    },
    {
        "instruction": "hi doctor my voice is very low I am not able to scold or intimidate anyone when my friends abuse me I am not able to reply them they take advantage of me they never heed my words sometimes I feel much worried about it I also hesitate and vibrate while talking people keep me down with their voice I am not able to cope with them my friends suggest me to increase my pitch sometimes I am not audible to my friends also I have this problem since my childhood I am having some fear to speak to people and even my friends give me some tips to improve my speech and articulation skills",
        "input": "",
        "output": "hello for further doubts consult a speech therapist online"
    },
    {
        "instruction": "hi doctor I am a 46 year old male my weight is 74 keg and I am having an excellent physical shape I think I have some sleep issue I did not get proper sleep for any days and hence I feel tired and irritable at times I am very active professionally and leading very engaging life I am not suffering from any depression or mental issues I get a little bit of anxiety at times but nothing serious that I can feel what could be the reason for this what are the remedies please suggest me",
        "input": "",
        "output": "hi I have gone through your query and can understand your health concern for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am suffering from peripheral vision for the past one year I cannot control my peripheral vision by ignoring the people just beside my main vision it is much wider than foveal vision and it seems like I am staring the person please help me to resolve this",
        "input": "",
        "output": "hi revert back with the report and answers to the above question to an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor my brother is suffering from back pain his doctor recommended some painkiller for one month now he also got pain on the right side of his back his doctor recommended laboratory test for kidney and liver along with mri of back the result showed some kidney related problem I want to know whether it is a sign of something serious can it get cured easily",
        "input": "",
        "output": "hi we are here to help you for further information consult a nephrologist online"
    },
    {
        "instruction": "hi doctor my mother had an ankle injury and she cannot walk she fell down inside the house while walking and her leg is twisted we have subsequently taken an ray and I have attached the ray for your reference please help me",
        "input": "",
        "output": "hello for further information consult an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hi doctor I have dry skin I do not have any health problems but my skin got tanned and black as I spent most of my time in the sun my appearance looks more than my age I want to make my skin fair and glow with the ayurveda products I have read a lot of natural beauty products on the internet like turmeric sandalwood multani mitti paya and milk powder but it is confusing as which suits me well to make my skin fair and glow please suggest me the best one for my skin also advise when and how to use that also I read on the internet about kumadi tailam eladi oil and anti vardhaka are these good to use if it is so then how to use it is there any oil and cream in ayurveda to make my skin glow please suggest",
        "input": "",
        "output": "hello yes what you have heard about ayurveda skin products are very good but the product will not be suitable for everyone for further information consult an ayurveda specialist online"
    },
    {
        "instruction": "hi doctor I am a 26 year old female I have checked my pregnancy test on the ith of this month and my last lap was on the ith of last month I have consulted the doctor he confirmed my pregnancy and prescribed me capsule gestafine 200 progesterone soft gelatin 200 one capsule per day for 15 days and folvite my one tablet per day for 15 days after a week I found some brown discharge then my doctor did a scan and said that the baby growth is not well for the one month of pregnancy she said that there is a 50 chance of miscarriage so she prescribed aspirin gastro resistant tablet ip 50 my one tablet per day for 15 days and tranlok two tablets per day for three days as my brown discharge did not stop again I went to the doctor she has done an ultrasonic scan and told me that the baby has started to grow now she prescribed im hucog 500 one injection im austen 200 one injection tranlok three tablets per day for days duphastone 10 my three tablets per day for 10 days austen 200 one tablet per day for 10 days folvite my one tablet per day for 10 days and aspirin gastro resistant ip 50 my one tablet per day for 10 days as of now my brown discharge has stopped I tried to approach you this time because on the internet I found that tranlok is prescribed to stop uncontrolled bleeding in menstrual periods and it is not mentioned for pregnant women since I am pregnant I just want to confirm whether there is any side effect in the above mentioned tablets shall I continue those medicines please help me",
        "input": "",
        "output": "hello I understand your query completely here for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "what is the worst thing that can happen if a small ant crawl in human body through nose or ear",
        "input": "",
        "output": ""
    },
    {
        "instruction": "i am 29 years old a mother of a 17months toddler two years ago I was suspected to have fibroadenoma on the right breast by a doctor who is only done the ultrasound because I have not accept to do the biopsy on the report it is written by the doctor ultrasonographic bilaterally dense glandular parenchyma on the left side there are no signs of pathological echogenicity on the right side is seen lobule hypohehogenic focus of 16mm suspected of fibroadenoma since then I have not done any ultrasound at all and have not used any kind of medication because the doctor havent prescribed me anything and recently I feel pain before the period and then after having the period I dont feel pain but now that I am on the fertile days I feel pain a lot when touching it and I can feel that there is a thick lump near the nipple moreover now I can feel I have lumps also on the left side when I touch it and it is painful but the right side is more painful and this did not happen to me before just to add that I am still breastfeeding I want to do another ultrasound but until then I need your answer about these questions I do not have family history with breast cancer except the aunt of my mother who had breast cancer is it possible this is cancer and not fibroadenoma what kind of a diet should I have to cure this disease I am afraid of biopsy I have heard that it is dangerous because when you get a part of the lump removed and if that is cancer the rest of it will be shared all over the body is it true should I stop breastfeeding and can I plan for another baby after some months or I should better do a surgery before then is it possible that I feel this pain these days because of the fertile days I am going through thank you a lot",
        "input": "",
        "output": "hi I have gone through your narration of symptoms with the history of pain occurring around the periods time it is more likely to be fibroadenosis rather than fibriadenoma I would like to assure you not worry about either of this conditions as both of them are only benign conditions and not cancerous it wont cause any dangerous harm there is nothing much specific help we could get drastically from diet modification for this condition just maintain your ideal body weight but still you need to confirm it by a biopsy need not fear about biopsy as you described it is not removal of part of the lump it is just a pinch of the lump a small bit from it with a small injection sometimes your surgeon might decide to excise it as a whole and send for biopsy in which case it is called excision biopsy but that will serve you dally for diagnosis and also completion of treatment by total removal and it is only a minor surgery not a major one so just throw away your fears on that you can continue breastfeeding and plan for pregnancy but I think the lump may increase in size during pregnancy which I am not sure about you need to consult with a gynaecologist regarding this do the investigations as advice below and review back abc ribs serum lipid profile free to ash us both breasts"
    },
    {
        "instruction": "i am a 21 year old male and take no medications years ago I started having vasovagal syncope episodes that have increased in frequency over the years and I have now passed out from it around 10 times my triggers for it are blood needles and damage to the wrists my clinic reccomended that I wear a heart monitor for 30 days and when I passed out it showed that my heart stopped for seconds and I was told to visit the r I went to the nearest one and the cardiologist there informed me that my heart stopping that long was dangerous so they wanted to put a pacemaker in my the following morning I refused and went to another hospital and they did a cardio ultrasound told me my heart was fine and then their cardiologist said that my heart stopping for that long was normal with vasovagal syncope and that I would be fine and let me go home those are very different opinions and I wanted another should I be worried about my heart stopping for that long and is there any risk in it",
        "input": "",
        "output": ""
    },
    {
        "instruction": "suffering for anal ulcers for months now diagnosed with silo last year which was treated with antibiotics and now experiencing ulcers in the rectum which are very painful been tested for ulcerative colitis and chronos disease which came back negative I have had sti checks so can rule this out also I am so uncomfortable and a bit miserable now as it recurs every few weeks and very painful other symptoms include night sweats itching soreness and ulcers in the nose and mouth",
        "input": "",
        "output": ""
    },
    {
        "instruction": "goodevening I am having headache which got severe nowadays and so I just checked my blood and saw my platelets are increasing in a series of tests in the last test platelets abc and rec are slightly increased body has itching problems usually at night eyes are blurry nowadays and more than am so much tired feels like sleeping always I lost my appetite but he not lost my weight or gained weight my face is full of pimple like marks which fades in between and again comes I have severe periods pain and my periods blood are clotted thick nowadays my joint are aching and having leg and hand pain would like to what it",
        "input": "",
        "output": "hi I see you are worried by many symptoms your platelet levels are not soo high to worry about it is only slightly elevated doesn't cause any significant harm need not worry about that most of your symptoms relate towards hypothyearoidism and your ash level is also high but only mildly elevated ash subclinical hypothyearoidism doesn't satisfy to start on thyearoid supplements unless its value is more than 10 overt hypothyearoidism though we can start when a person is presenting with the symptoms so I need you to retest with free to levels instead of total to and review to see the baseline free to levels and decide better on starting the supplements and I dont see any report showing the cholesterol levels kindly upload the picture of the same if you have not checked your sugars please check that also before next review ribs subclinical hypothyearoidism"
    },
    {
        "instruction": "hello doctor my mother is 57 years old and she is a cardiac patient she is having skin infection around his face neck and ear area for the past two days she is taking the following medicines for this infection surfaz in ointment clotrimazole beclomethasone dipropionate and neomycin sulfate cream zenflox oz ofloxacin and ornidazole allegra 120 my please suggest",
        "input": "",
        "output": "hello I have seen the picture this is herpes foster the following medicines are required for this condition tablet valcivir thrice daily for seven days fusidic acid cream twice daily and tablet doll 650 my as required for pain is there any hearing loss or ringing voices inside that side of ear any face palsy for this you can send front facing a picture of your face with both eyes wide open"
    },
    {
        "instruction": "hello doctor I have been taking steroids on and off for the past three years I got martial fibrillation a year ago never again since then my blood pressure was quite high 152 90 at the doctor la is normal and lvedd is 53 my normal systolic function no regional wall movement abnormalities lvy 14 my and beginning diastolic dysfunction a e 15 la 21 am I already lost 24 keg and now I am weighing 10 keg at 194 am my goal is 93 keg I also stopped steroids and now my blood pressure is 123 75 will my diastolic function recover once I managed to reverse the lvy",
        "input": "",
        "output": "hello I have gone through your query can I know why were you on steroids was there any particular disease that was diagnosed and started you with steroids as there are many determinants causing diastolic dysfunction one of the common cause is hypertension and yes diastolic dysfunction is reversible in the majority of the cases over a period of time if you properly control your be obesity and start doing regular exercise consume a healthy diet and lifestyle modification you should also stop any addictions like smoking or alcohol if any also get your blood sugar levels and thyearoid profile checked get back with details about your disease and indication for steroids for further discussion and management"
    },
    {
        "instruction": "hi doctor I am a 29 year old female lifestyle is healthy with exercise and good food mostly since last year on both sides of my cheeks especially on the right cheek there are three to four pimples they produce the white head dries off leaves a red scar and again another erupts I have slightly oily skin and stops applying all the serums please help",
        "input": "",
        "output": "hello thank you for providing the information if possible provide me photographs of the affected areas which will help me for a better understanding of your skin problem and proper treatment plan"
    },
    {
        "instruction": "hello doctor I have suspected abortion at 10 weeks and days with heavy bleeding yesterday I have my tis ultrasound today and it shows heterogeneous endometrium is it fine",
        "input": "",
        "output": "hello I have seen the report attachments based on your dates if your gestational age is 10 6weeks and if you had heavy bleeding most likely it indicates an abortion wherein the product of conception have been expelled already the heterogeneous endometrium just indicated the thickened uterine lining which develops in pregnancy to support the embryo which will take some time to become normal I am assuming your bleeding would have stopped by now and your gynecologist would have advised you some antibiotics to prevent any infections if not then please consider taking them I hope this helps repeat the scan after two weeks avoid pregnancy for the next two to three months evaluate and then plan a pregnancy evaluate yourself prior to planning a pregnancy in the view of recurrent miscarriages"
    },
    {
        "instruction": "hello doctor I am 5 months pregnant now and I have developed gestational diabetes and consulted with a gynecologist in the nearby polyclinic and made hba1c blood sugar monitoring test and the result is 4 reference range normal up to before pregnancy diabetes range used to be always in normal range nowadays blood sugar while fasting is 130 do I need to start insulin I need your advice I am 24 years old my height is 2 feet and weighs around 105 keg",
        "input": "",
        "output": "hello welcome to icliniq com I just read your query and from what you have mentioned it appears that your blood sugar is not very high as to start insulin treatment as of now but you need to be closely monitored as regards to blood sugar ultrasound fetal monitoring by an obstetrician and a dietician for low carbohydrate diet consumption try to eat more vegetables like green leafy vegetables and not potatoes which contain high carbohydrates you need to check 50 go oral glucose tolerance test fasting and after hour and hours if still high we need to assess the results and do further tests for the same and then decide whether to start insulin or not maintain blood sugar chart by checking it fasting hour post meal and before bedtime be in touch with a physician avoid rice sweets and sugary drinks take folic acid my once daily I hope this helps"
    },
    {
        "instruction": "hello doctor I was diagnosed with fatty liver grade before two years prior to that I had a cough for almost two years and felt nauseated I felt like vomiting for four months that is when I got worried and consulted a doctor I also suffer from severe anxiety and that has led to binge eating disorder and that is one of the reasons for the fatty liver too I followed the doctor advice sincerely and lost weight in a few months and improved my diet I sincerely followed it for a year but then gradually again my diet started going haywire and now again I am at the same stage where I was before I was given pantocid 40 my twice a day lesuride once daily and ulgel during the second consultation after a month I was given pantocid dsr vitamin oil and asked to walk an hour a day with low calorie diet I feel like vomiting and cough after drinking a glass water or eating a meal",
        "input": "",
        "output": "hello I have calculated your ideal body weight which is 5 keg however your weight at the moment is not way beyond limits if you just do what you were doing already such as low caloric intake and regular exercise that is more than anything your doctor gave you vitamin oil that seems to be good since up to now fda food and drug administration has not approved any medication for fatty liver except weight reduction so taking vitamin 400 my twice daily for six months would control your liver function tests but I want you to check for other causes for deranged liver function tests such as chronic hepatitis do you take alcohol if not then fine if yes how much and how frequently the blood tests are within normal limits except your vitamin you just take one dose of injection indrop lac units by mouth just break the vial and take it by mouth and try to take milk almost every day the rest of your symptoms like nausea and vomiting seems to be secondary to anxiety the anxiety and stress have to do a lot with someone is gastrointestinal tract there are certain medication which can control your gi gastrointestinal upset as well as anxiety but they are frequently adherent with side effects I want you to take the following medication for now and let me know if symptom persists I may consider you giving some medication for that for now take the following medications and get these blood tests I can understand it might be upsetting for you to have a lot many blood tests but I really want to help you fatty liver disease functional gi problem hbsag hepatitis surface antigen anti he core total anti hav hepatitis virus antinuclear antibody profile including ana asma and ama overlapping hepatitis fatty liver disease functional gi problem one dose of injection indrop lac units by mouth tablet rifxamin 200 my thrice daily for three weeks this is a safe antibiotic it will balance your gas production within gut abnormal gas production is a process in play in your case tablet digestive 40 my daily before meals to promote your gut motility you may continue pantoacid for now and syearup gaviscon 15 my four times daily after meals instead of antacid syearup ulgel let me know in two weeks how you respond"
    },
    {
        "instruction": "hello doctor having severe pain in rightside back lower body with rashes I will attach photos",
        "input": "",
        "output": "hi you have got herpes foster it is caused by varicella foster virus very painful blisters will be there must be started on antivirals at earliest tablet acyclovir 800 my times a day or other equivalent for pain paracetamol apply calamine lotion to the spots if not available ot please meet your doctor take care do not break the blisters"
    },
    {
        "instruction": "hello doctor heartburn and indigestion all day frequent belching gurgling in throat esophagus throat or esophagus is making a funny noise off and on for years sporadically diagnosed with herd and larapharyngeal reflex clean endoscopy in years back but esophagus is slightly twisted had dilation during procedure other endoscopies were fine is this classic signs of herd saw ent recently for other issues throat looked good just never had the gurgling as much taking gas and protonic and tums here and there also deal with allergies and post nasal drip no vomiting or fever just uncomfortable",
        "input": "",
        "output": "hello most of the symptoms such as burping gurgling within esophagus and funny noise all can be encompassed in to one diagnosis that is herd but thing which make concerned are you have endoscopies and all showing normal without signs of ulceration which is not usually a case in herd patient unless they are on maximal acid suppressant medications and symptom free at the time of undergoing endoscopy so endoscopy result has to be correlated with the timings and weather use of acid suppressant medication before making a diagnosis given some more interesting findings like dilated esophagus and no ulceration at the time of endoscopy with presence of persistent symptoms suggest some other additional problem bystanding with herd such as motility disorder some time herd is just a manifestation of motility disorders because two disorders almost cause similar symptoms secondly for herd one must have oh imepdence monitoring to confirm the diagnosis and in case you have already gone through this then you come in category of refractory herd not responding to usual acid suppressant medications for refractory herd the only single test that can confirm symptoms correlation index acid reflux causing the symptoms or non acid reflux causing symptoms or no acid reflux at all is oh impedence test while person on acid suppressant medications I can understand it must be very exhaustive and confusing for you to understand above things but it can be very easy while investigation all these possibilities I urge you to upload your previous reports and keep in touch with me as I can suggest you how it is further be approached refractory herd oh impedence monitoring motility disorder functional heartburn refractory herd suggest investigation you can follow up with me to discuss about how to approach this"
    },
    {
        "instruction": "hello doctor when I touch the tip of my middle finger I feel pain there as well as on the left side of my chest it just started yesterday is this a sign of a heart problem",
        "input": "",
        "output": "hello I am sorry to hear about your pain please do not be worried you will be fine it is not a definite sign of heart disease there are arthritis angina etc do you have a history of heart diseases in your family do you experience shortness of breath have you experienced dizziness or has the pain radiating to other parts of your body what medications are you currently taking"
    },
    {
        "instruction": "hi doctor I have been diagnosed with cos for more than years recently I have been doing yoga and doing intermittent fasting for the past months now I got my period twice in april and for may month it is spotting for the last days please help me",
        "input": "",
        "output": "hi treatment of women with cos should begin with lifestyle measures for those who are obese a combination of weight loss and exercise may stimulate ovulation intermittent fasting is wonderful lifestyle what is your mode of intermittent fasting are you doing 16 or fast and feast have you tried 36 hours fasting please let me know also low carbohydrates diet with no sugary juices and no added sugar is very beneficial if the woman is not overweight or weight loss is ineffective then taking into account potential adverse effects ease and mode of use the woman mi and monitoring needed clomifene citrate or metformin or a combination of the above for women who are taking clomifene citrate I offer ultrasound monitoring during at least the first cycle of treatment to ensure that they are taking a dose that minimise the risk of multiple pregnancy women prescribed metformin may know side effects such as nausea vomiting and other gastrointestinal disturbances if woman known to be resistant to clomifene citrate we can go for laparoscopic ovarian drilling or combined treatment with clomifene citrate and metformin if not already offered as first line treatment or gonadotrophins so there are plenty of options available and you are not alone we can together make a plan for management please give me more details if you have done investigations ultrasound and harmony tests"
    },
    {
        "instruction": "hello doctor I have been diagnosed with chronic hepatitis since last five years I have been going for follow ups and routine check ups in nimr I went for some tests in march which I have been unable to get the results because of couid 19 they are totally unresponsive to me I have persistent symptoms sharp pains in my upper right abdomen weakness and tiredness joint pains and loss of apettite I am very scared and do not know what to do I have not been placed on any drug so far please help me I do not want to develop cirrhosis or liver cancer what can I do the pain is so much",
        "input": "",
        "output": "hello the pain you describe may be due to variety of causes may be simply be due to gas trouble not necessarily the liver complication of hepatitis infection the cirrhosis and tumor in liver is a long period process does not occur in span of months to clearly answer your question I need to know when did you get your last ultrasound of liver done and what were the findings now as a rule all people with hepatitis infection are supposed to take antiviral treatment I do not know whether you have been given those I highly recommend you to get all these questions answered when you now meet with your physician or you can upload investigations and I can figure out for you how to deal hepatitis in your case follow with investigation days"
    },
    {
        "instruction": "hello doctor I am 24 years old I do not know what is wrong with me I feel depressed all the time I left home two years back because of my parent behavior they always use to make me feel I am worthless and not important for them they also beat me several times and I was facing emotional trauma on a daily basis now I stay away from family alone but seems like things will never change I am all alone here and people I trusted have backfired on me my office situation is very pathetic my manager harasses me emotionally or I do not know if I overreact I just do not know what is wrong I do not have any friends to talk I gave a lot of importance to one person in my life and that person did not understand me at all I cry all day in my room and do not even step outside I get super angry or emotional on little things I always stay alone in the office or at home I feel like there is nothing left for me in this life and I am worthless no one really needs me in there life for whom am I alive I do not know if I am depressed or not I am just done with this life just to add I am a cos patient for the past one year",
        "input": "",
        "output": "hi the symptoms you have mentioned are symptoms of depression you left home because of the behavior of your parents and then you are continuously feeling low because of ongoing things at office and at personal space all these things are aggravating the depression in you the feeling of worthlessness emotional trauma crying spells emotional lability anger outbursts lack of interest in anything etc are part of depression but if these symptoms are persistent and are hampering your personal life and you have negative thoughts then yes we can think that you have a depressive disorder if the symptoms are not persistent then no need to get worried you just have to change your lifestyle try to not to expect anything from others just focus on your life and your things if anyone hurts you then try to ignore the thoughts this is difficult but in some days you will learn to suppress the thoughts and with the time you will be able to ignore any emotional trauma no need to get worried if you are not able to function properly then you can visit a psychiatrist in person and antidepressants can be started escitalopram is a good option in your case the drug is safe and has great efficacy this will help to make your mood better do you have any thoughts like killing or harming yourself any ongoing stress that is bothering you any relationship issue cos polycystic ovary syndrome too is an independent factor that aggravated depression because of hormonal changes control of cos also helps in improving mood symptoms"
    },
    {
        "instruction": "hello doctor I have had issues with my left ear for the past two months I normally clean my ears with peroxide after I added drops of peroxide back last month I noticed that when people spoke to me loudly I would hear wind sound in my ears also my ears felt plugged and I heard thumping heartbeat sound in my ear two days ago I attempted to clean my ear with a home irrigation system I was able to dislodge a large piece of dried white wax my ear felt the best in a long time I was hearing clearly and the sounds in my ear went away yesterday my ear felt plugged again so I irrigated my ear and nothing came out but the plugged feeling and sound went away this morning my ear felt plugged again and I irrigated my ear and nothing came out but my ear felt clear and the plugged feeling and sound went away what is causing this issue why does it keep coming back",
        "input": "",
        "output": "hi it looks like your having a eustachian tube catarrh this tube essentially ventilate both the ear and nose and in an event where this tube has got blocked you might develop fullness and ringing sensation in the same ear self cleaning your ear is the most dangerous thing you can ever do never introduce peroxide or any thing under doctor advice as it can be disastrous considering the ear and it is related structures to be one the most sensitive regions in the body another possibility is that there could be some remnant wax in your ear which can be the reason for you developing this ringing sensation on a regular basis you can consider using soliwax ear drops three times a day for one week and then get the blob suctioned out by an ent specialist other than this take tablet sinarest acetaminophen chlorpheniramine and pseudoephedrine or its equivalent one tablet two times a day after food for the next week otrivin nasal drops thrice daily for five days should help"
    },
    {
        "instruction": "hello doctor I started taking vitamin and calcium more than I should have in the beginning of the year later on I started to feel weak and dizzy at work my feet and hands tingle and would go pale and my neck in the thyearoid area started to hurt I have been to the doctor to have blood work but they say there is nothing significant enough to be concerned but I still have the same symptoms what to do",
        "input": "",
        "output": "hi in your attached he electrophoresis report abnormal hemoglobin is not present so you are not having any abnormal hemoglobinopathy your main complaint is weakness dizziness and tingling so anemia b12 deficiency thyearoid issue liver disease renal disease vitamin deficiency and peripheral neuropathy should be ruled out I suggest you investigate with serum b12 estimation abc complete blood count serum ash thyearoid stimulating hormone estimation sept serum glutamic pyearuvic transaminase got serum glutamic oxaloacetic transaminase serum urea and creatinine estimation for further work up to rule out peripheral neuropathy your neurological physical examination should be done according to cause specific treatment can be given I suggest you rule out diabetes as well by random blood sugar estimation meanwhile you can be prescribed riconia forte like multivitamin tablet for your problem"
    },
    {
        "instruction": "dark red and purple lines in inner thigh no symptoms experienced age 28 weight 58kg height 1",
        "input": "",
        "output": "dear please send few more photographs regards"
    },
    {
        "instruction": "right arm joint unto the shoulder neck pain for the last few days it increased from yesterday evening having difficulty moving 490years male",
        "input": "",
        "output": "hello I read your concern in my opinion it could be due to some nerve irritation following neck spasm due to facet joint irritation nothing to worry as of now I would advise you to if irritation reduces try to maintain neck in mild arching by placing hand on the chin while lying down over stomach hold this for atleast mins during this you should not experience any pain in shoulder there will be pain in the back of neck hope this is helpful for you kindly revert back to me to let me know your status bad posture facet joint arthropathy wry neck rice and mobilisation avoid aggravating postures after a day"
    },
    {
        "instruction": "my father has been having sciatica on lower left leg and back pains this have continuously happened for last months in the past years it only pains periodically what are the best options without surgery or minimal invasive surgery I would be able to share further on the mri scans once I have established a link to upload or email",
        "input": "",
        "output": "hello sorry to hear this the mri does show degenerative disease of the lumbar spine mainly at l45 l5s1 level the main indications for surgery are as follows thus the decision for surgery is generally based on both patient perception as well as thorough clinical examination he needs to visit a surgeon for examination generally speaking the surgeon usually recommends a non surgical treatment first if there are no neurological deficits these may include rest activity modifications medications physiotherapy combination of nerve blocks and or facet blocks etc wishing him a speedy recovery best wishes"
    },
    {
        "instruction": "hello doctor my partner is having a lot of pain in his wisdom tooth I guess he is getting it but his whole mouth got swelling and he is not even able to talk he is having fever also now and the pain is not bearable what should we do right now as none of the doctors are available",
        "input": "",
        "output": "hi your wisdom tooth got infection so there is pain and swelling the infection is spreading that is why you have restricted mouth opening and facial swelling better start with high dose antibiotics and pain killer temporarily it will be easier for me to give correct treatment if you send an image of your face and involved teeth"
    },
    {
        "instruction": "hi doctor I am 34 weeks pregnant and my baby choroid plexus cysts did not clear we did the genetic testing in the early stage of pregnancy and it was negative for trisomy 18 and 21 we had four growth ultrasounds but no one reported anything else wrong with the baby I am scared that they did not look well enough now we are moving to a different state and the doctor there said that they would have done additional screenings amniocentesis talk to a specialist for cysts but that it is too late now to change anything she said two cysts one on each side are more characteristic of down syndrome I have pictures that they gave me from the ultrasounds is there anything specific that I can look for on those ultrasound pictures that would indicate trisomy 18 and 21",
        "input": "",
        "output": "hello I was able to see the images and reports apart from the cysts they have not reported any frank worrying features the nasal bone and face profile images are not very clear in down the nasal bone may be absent or hypoplastic the other direct features associated with downs are hypertelorism or widely spaced eyes which is not seen in your scans there is no neck fold thickening therefore at this stage of pregnancy I would ask you not to stress out just make sure that on your next scan the sonographer is aware of the choroid plexus cysts finding and includes cardiac evaluation and facial evaluation in detail take care"
    },
    {
        "instruction": "mild asthma cough since weeks and couid 19 patient I am currently taking enzo 200mg famotidine 20mg and albuterol as needed",
        "input": "",
        "output": "hello thanx for the query I can understand ur concern according to ur statement you have been suffering from cough which is dry in nature and couid 19 ur past history of having mild asthma and anxiety ur treatment depends on severity if albuterol is not able to ur cough then you can corticosteroids inhaler you should monitor ur oxygen saturation rate by pulse oximetry it will determine where you need oxygen support or not as you a patient of couid 19 so you must be isolated from ur family and friends at least for 14days gurgle with salt mixed luke warm water 4 times daily should strictly maintain ur temperature chart can you provide me the details history like what is the problem now you facing or what type of advice and help do you need if you provide me the details history then I will be able to treat you further if albuterol is not able to control ur cough then you can use corticosteroids inhaler"
    },
    {
        "instruction": "hello doctor I am a very paranoid person the smallest thing that happens to me ends up searching it up on the internet and stressing over it one of my main problems is freaking out about going to sleep and waking up worse for example yesterday I got an eyelash in my eye and it was so close to my cornea but it did not touch it after that I would constantly go to the bathroom to check if there was something in my eye the constant touching led to my eye being sore and I was afraid to fall asleep and wake up blind I ended up sleeping at am I was wondering if you had any tips to help me not be afraid to sleep at night",
        "input": "",
        "output": "hi try sleep hygiene avoid excessive caffeine intake do not sleep at day time maintain a regular schedule for sleeping and waking time do not use mobile phone or watch to when you are in bed go to bed when you fall asleep if you do not feel sleepy in the bed wake up and engage in some activities until you feel sleepy try this first as well as regular exercise or meditation and engage in your regular activity if this does not help try zolpidem 10 my at night time for 10 days eat this medicine and immediately go to sleep along with this take fluoxetine 20 my in the morning after meal"
    },
    {
        "instruction": "hi doctor I had my last period on 15th april which lasted only for 15 hours the due date was 19th but it came four days early my partner and I had unprotected sex on ith but he did not ejaculate inside since yesterday I feel tenderness in my breasts a little fatigue and mild cramps in between is there anything to worry about",
        "input": "",
        "output": "hello I can understand your concern according to your statement you have been suffering from tenderness in your breast and little bit fatigue your last menstrual period was on 15th april which lasted for 15 hours and you had unprotected sexual intercourse on ith usually woman menstrual cycle is 28 days normally so if period occurs seven days before the estimated date as well as seven days after the estimated date is quite normal it may happen in every woman in her lifetime it is nothing to be worried again menstrual bleeding can last for 7 days normally so your last menstrual bleeding lasted for 15 hours which may be quite normal you should not worry about that you should know about the safe period during a normal menstrual cycle it is also known as calendar method in this period no woman becomes pregnant from unprotected sex if your menstrual cycle is 28 days then from the ith day of your last menstrual cycle to the 16 the day of your last day of menstruation will be counted as danger period from ith day to 16th day total days are known as danger period in this period a woman can bear pregnancy from unprotected sexual intercourse the rest 21 days are counted as safe period in this period no woman can become pregnant from unprotected sex so luckily ith april was your safe day so there is no chance for you to become pregnant hormonal fluctuations can cause breast tenderness breasts may become painful before three to five days of starting of a menstrual period and stop hurting after your period begins menstrual cycle causes hormone fluctuations in estrogen and progesterone which make your breasts swell and can lead to sore and discharge those hormonal imbalance may make you fatigue too I hope this helps"
    },
    {
        "instruction": "hello doctor I have had an issue with a topical dermatitis eczema for about a year and a half I have been using steroid creams and anti itch cream but it kept coming back on and off three weeks ago I started getting hives and before two weeks they covered most of my body from my neck to my ankles as per my doctor I went on prednisone and cetirizine but it did not stop now I am on methylprednisolone and cetirizine and it seems to be getting a little better I cannot figure out any triggers though the itching and the hives are pretty much unbearable it does not seem to be a sugar allergy but I am uncertain about a gluten allergy I have had a previous allergy test but revealed nothing except for allergy to a few animals which I have none I never had a gluten test my current medications are amlodipine paroxetine wellbutrin famotidine and cetirizine methylprednisolone for the past four days I am 52 years old",
        "input": "",
        "output": "hello I have seen the attachments it must be difficult for you with the itch and the rashes can you upload the report of your allergy testing why do not you go ahead and get the flute testing it is a blood test and not as costly as the routine allergy panel secondly when did you start paroxetine and wellbutrin were those started recently is there any correlation between their start and the development of the rashes when you take the steroid tablets and antihistaminics are you better off do the rashes stay at bay then are there any triggers inside the house any insects or dust particles any history of change of place of stay"
    },
    {
        "instruction": "hello doctor I had a staph infection and I took antibiotics a month ago I had been in the sun a lot recently and I am feeling symptoms of heat exhaustion but I am worried that the staph infection is causing septic shock is this a possibility",
        "input": "",
        "output": "hi I can understand your concern according to your statement you have been suffering from a feeling of heat exhaustion as you were more exposed to the sunlight and worried about staph infection that may cause septic shock you had a staph infection one month back and you took antibiotics for that so I think your previous staph infection was well eradicated by taking antibiotics even without treatment it can be eradicated within 10 20 days staph infection may cause life threatening condition like sepsis clinical features of sepsis are high fever with chills and rigors rapid pulse rate rapid breathing hypotension vomiting diarrhea etc when staph bacteria enters a person bloodstream and develop an infection that may affect the entire body and cause death is known as sepsis you are not mentioned here that you are affected by sepsis like clinical features and no history of having sepsis in the past so now you are free from staph infection and no chance of sepsis caused by staph infection I hope this helps"
    },
    {
        "instruction": "hi there I have a case of diarrhea since yesterday and I have gone to the loo quite a few times however with each time it starts to hurt more and more and its reached a point where I am scared to poop it hurts as soon as I start to poop and continues till 10 minutes after I am done",
        "input": "",
        "output": "hello I welcome you to icliniq I can understand you must be very upset about this so here are something that I want you to understand since you started to have diarrhea since yesterday which classifies it as acute recent gastroenteritis the most common cause usually a food that has caused poisoning and sudden burst of large volume of poop I want you to start taking oral rehydration therapy or add one sachet of or in one liter of mineral water or boiled water and take 200 to 300 my each time you have loose bowel this will replenish your salt in body and help decrease diarrhea the antibiotics are not really recommend in acute diarrhea except someone has blood in stools so I am not recommending you at this point in time tab lomotil tablets thrice daily no more than days food poisoning enterotoxin mediated diarrhea oral rehydration therapy or add one sachet of or in one liter of mineral water or boiled water and take 200 to 300 my each time you have loose bowel tab lomotil tablets thrice daily no more than days generic diphenoxylate hydrochloride plus atropine I really hope this will surely settle your diarrhea if it does not help in 48 hours ply let me know"
    },
    {
        "instruction": "i am 18 years old my problem is that I cannot sleep at night but when I sleep I cannot get up for like or 10 hours when I cannot sleep I usually keep using my laptop I am very overweighted like my weight is almost 94 kegs I dont know may be I think that this is because of stress",
        "input": "",
        "output": "dear thanks for your query I understand that you are facing sleeping disturbance due to unavoidable sleep patterns actually everyone these days are going through these problems due to uncertainty around us revised and changed work schedules and so on besides yes stress plays a key role in this when thought processes are going on mind finds difficulty in shutting down regarding weight yes it may disturb physical patterns as well but I think more than this stress plays a key role I would suggest you to discuss your stress and find solutions to the issue you are so young and feeling sad is ok but it is important to talk about issues you are experiencing best regards"
    },
    {
        "instruction": "hello doctor I am feeling bloated gas in the stomach heaviness in the chest feeling that there is phlegm in the throat when burping or belching I felt relieved and fine but after a while the above symptoms appear again I am a 60 year old female with hypertension and I am currently taking twynsta 40 10 bisoprolol my",
        "input": "",
        "output": "hello I guess you are on twynsta 40 10 which is a combination of telmisartan and amlodipine and bisoprolol my so this is likely a gastric and reflux problem however sometimes symptoms of gastritis and heart disease overlap in elders with such symptoms electrocardiography egg is recommended meanwhile you should have antacids along with your current medications like tablet pantoprazole der 40 my or rabeprazole der 20 my before breakfast once daily for a week and later whenever needed you should also avoid heavy meals have less oily spicy and fatty foods have a walk for sometime after meals rather than resting immediately have light dinner if you are having constipation then you should get it treated with laxatives like syearup cremaffin plus regular sleep is also important I hope this helps"
    },
    {
        "instruction": "hi doctor I am 43 years old I am having three children up to february my menses cycles were at routine monthly normally at 10 12 the of every month my hop level is at but for the first time in the march I had no cycle and in april I just had spotting now from the est may I am having full bleeding till today the same case happens with my sister at the age of 41 she faced the same issue and on consulting the doctor she was advised progyluton tablet my 5 my for 21 days trihemic 600 tablet due to lockdown I cannot contact my doctor can you please guide me can I follow the prescription of my sister",
        "input": "",
        "output": "hi I understand your concern normal age for menopause is 42 to 52 years during which menses become irregular with excessive bleeding sometimes so in your case you might be transiting into menopause however if you have excessive bleeding during menses then take tablet pause of tranexamic acid and mefenamic acid three times daily if bleeding is heavy also women must take calcium supplement after 30 years please take tablet calcimax once daily after food if your bleeding does not subside with the above medication please get an ultrasound pelvis to rule out the other causes"
    },
    {
        "instruction": "hello doctor I have some problems with my eye and need some assistance I have red eyes from a few months now and have tried some drops and it has reduced but still I have some redness in the eye adding to it I have some headaches and can see a lot of eye floaters from a week now please help",
        "input": "",
        "output": "hi here your symptoms look more in favor of allergic conjunctivitis this may occur due to allergy to dust grass pollen cosmetics soap etc allergic conjunctivitis may be seasonal type try to avoid the above allergens to get rid away from allergy you may have frequent itching in your eyes please keep in mind not to rub your eyes by any means rubbing eye frequently may provoke developing allergic conjunctivitis which was once healed up dust grass pollen cosmetics and soap allergic conjunctivitis olopatadine eye drops once a day preferably at night loteprednol 5 eye drops three times a day put ice packs on closed lids which may give you instant relief use it minimum for 15 days keep in mind you may get symptomatically relieved very soon but allergic conjunctivitis needs time to recover from the roots stay away from the above mentioned allergens try cooling goggles while going out avoid rubbing eyes after 15 days"
    },
    {
        "instruction": "hello doctor I have a constipation problem I think my constipation is due to calcigard retard 20 my other medicines are rental 400 my twice daily for the past twenty years for raynauds five years back I underwent surgery for csi rhinorrhea for be I am taking telsartan 40 my and ecospirin 75 my",
        "input": "",
        "output": "hello since how long you have this issue of constipation and how frequently do you pass stools per week is passing stools painful is there any blood in your stools do you strain while defecating does anything come out while defecating is there any abdominal pain associated with it I will suggest laxatives to you but it will be better to consult your cardiologist too for the shift of calciguard retard to another drug because calcium channel blockers can frequently cause constipation drug induced constipation ash thyearoid stimulating hormone blood sugar serum calcium polyethylene glycol sachet in one glass of water once daily you can increase the dose according to response ispaghol husk two teaspoons in a glass of water twice daily increase water intake daily exercise 20 30 minutes"
    },
    {
        "instruction": "hello doctor two months ago my mother fell down on her knees but did not seem to complain recently she did a bit of house work for a few days and her knee is in pain especially in the back where you bend your leg pain is also notable when she sits down for an hour or longer and gets up and also when waking after sleep",
        "input": "",
        "output": "hello your mother has osteoarthritis of the knee and the fall may have stirred this further the pain that you describe is at the back of the knee this can come from the knee cap as well as the degenerative tear of the medial meniscus as there are a very little mechanical symptom like locking and giving way not there is much of an effusion I feel that the pain is from the knee cap the pain in such cases can be at the back of the knee pain is worse in climbing stairs or coming down worse after having sat down for any length of time this condition is called patellofemoral compression syndrome and can be helped with regular exercise and patellar gaping and a course of anti inflammatory medications like diclofenac or piroxicam in addition she can take paracetamol and tramadol combination for pain she will need to do vmo gluteal core strengthening exercise and hamstrings stretches in addition she needs to avoid squatting the physiotherapist can in addition give ift or tens to help it will take 6 months for the pain to settle down mri also shows an incarcerated needle tip under the patella have but I need to have this physically checked if this was recent and was it from the fall on to a sharp object"
    },
    {
        "instruction": "hello I have been a diabetic for about 20 years my recent arc is 4 from last few days I have been noticing that my fasting sugar readings are really high like 140 180 there have been no changes in the diet interestingly enough within 2 hours it goes up by another 20 points without doing anything another strange thing is before I go to bed it is in the range of 10 130 but in the morning it is always 140 please help me understand this strange phenomen I am taking 100mcg metformin twice a day",
        "input": "",
        "output": "hi thanks for your query its good to see ur sugars are good with hba1c 4 blood sugars go up and down not only with meals but there are many other factors associated as well like other harmon levels in the body for example if ur stressed mentally or excited ur cortisol and catecholamines also increase and thus may lead to increase sugar levels as well same way if you will do exercise it will decrease ur sugar as well as use of alcohol may be ur eating habits did not change much but other factors have something to do with these levels sleep is also important along with medications I always advise for intermittent fasting and low carbohydrates with least grains exercise even if it is just walking 45 minutes daily is beneficial thanks"
    },
    {
        "instruction": "hello I feel pain at my lower left side of abdomen also its hard to pee feeling burning the symptoms looks like I have urolithiasis I need to make sure",
        "input": "",
        "output": "hi I understand your concerns you are finding it difficult to pee and there is a burning sensation these may be due to urinary tract infection more likely or stones in your urine report there are a few microorganisms and red blood cells are also present these are suggestive of urinary tract infection please get an urine culture sensitivity report and an ultrasound of kidney ureter and urinary bladder plenty of fluids is advisable and antibiotics have to be taken on basis of your culture report signs and symptoms of kidney stones can include severe pain nausea vomiting fever chills and blood in your urine diagnosis of stones is based on urinalysis and radiologic imaging usually noncontrast helical it treatment is with analgesic antibiotics for infection medical expulsive therapy and sometimes shock wave lithotripsy or endoscopic procedures hope this helps ti urine culture sensitivity ultrasound of kidney ureter and urinary bladder urolothiasis ti plenty of fluids and antibiotics according to urine culture report plenty of fluids genital hygeine"
    },
    {
        "instruction": "what are the possibilities of transmitting hsv2 from an infected woman to a man and how to prevent it if they intend to enter into a relationship thanks",
        "input": "",
        "output": "hello welcome to icliniq I understand your concern about the hav before I begin to preventive measures let me tell you it how it can spreads it is spread through oral vaginal or anal sex it may be spread even if you do not see blisters it can also be spread to other areas of your body including your eyes lips mouth by touching open blisters unprotected sex increases your risk for genital herpes now as you are well aware about its spreads now you just have to take precautions accordingly follow the following advice fortunately it can be treated effectively with proper medication let me know in the follow up if you need it I hope this will help you regards do give your valuable feedback"
    },
    {
        "instruction": "hi doctor my mother is 59 years old she has gallstone and she was supposed to have cholecystectomy but was postponed due to quarantine last month was the supposed schedule and that time the size of the stone in her gall bladder was am now she is experiencing increased pain on her right shoulder I would like to know if there is something she can do for the pain or should she have her gall bladder removed",
        "input": "",
        "output": "hello I will help you with your problem gall stone surgery is not emergency surgery it should be done in an emergency if there is gall bladder perforation or malignancy in your case the stone size is large and with the age of the patient malignancy is ruled out I will advise to go for it computed tomography scan if possible if not at least us ultrasound abdomen should be done if everything is normal and only stones are there then you can wait for some time consult in an emergency if she developed jaundice any time for pain she may take any regular pain killers avoid fatty diet and get back to me after investigations"
    },
    {
        "instruction": "hello doctor I have a headache in my upper part of the head I do not know if it is connected with my neck because I had stiff neck due to my sleeping position well I lay down to bed most of the time due to quarantine and after I had that stiff neck I had this it is not actually a headache I guess it is like irritation in my upper head I do not know if it should be treated with a pain reliever as it is not that severe I did not take it",
        "input": "",
        "output": "hi welcome to iclinq com I understand your concern I need to know more about your headache how and when does it start is it unilateral or both sides is it intermittent or continuous or any diurnal variation any aggravating or relieving factors light or noise sensitivity does it associate with nausea vomiting or blurring of vision did you have a history of migraines or asthma any history of fever or sinusitis you should always note the red flags of headache such as sudden onset of headache the onset of headache after 50 years of age increased frequency or severity of headache new onset of headache with an underlying medical condition headache with concomitant systemic illness fever and weight loss focal neurologic signs or symptoms blurring of vision in that case you need urgent evaluation if they are absent you need not be worried some times neck muscle tension stiffness may lead to headaches as in your case simple paracetamol or muscle relaxant will be useful adjust your sleeping position try not to use high pillows another most common cause of headache is migraine simple paracetamol at the onset of the headache will be helpful also avoid triggers that lead to a headache you should have adequate sleep avoid stress and take meals on time I hope this helps"
    },
    {
        "instruction": "hello doctor I hurt myself two days ago and it seemed to be getting better but today it is worse than when it started most of the pain is in the right side area today I cannot walk due to excruciating pain the only relief is laying flat on my back or standing at the foot of the bed and bent over with my face on the mattress as said I was doing better the past two days but yesterday I laid flat down on the bed while my husband rubs my legs and I was propped up on my forearms and I am wondering if that did not make things worse I felt pretty good when getting out of the bed and during the shower and then the pain started to come back and quickly accelerated to not being able to even sit in a chair due to excruciating pain again as long as I am lying flat I do not feel it at all but if I try to move side to side I feel excruciating pain",
        "input": "",
        "output": "hi I can understand the pain you are suffering from it is nothing but low back pain radiated to the leg due to constant stress and improper posture you get this taking rest and doing simple exercises will help reduce pain and also you can take anvil ibuprofen for quick relief an mri magnetic resonance imaging of is lumbar spine would help to know better what exactly the problem is here are some exercises you need to do slowly without any pressure low back stretch straight leg raising piriformis stretch bridge leg sliding waist lifting deep abdominal strengthening these exercises will not only reduce pain but also gives strength to the muscles apply heat pad thrice a day follow up with mri reports stress improper posture mri lumbar spine exercises anvil tablet with mri reports"
    },
    {
        "instruction": "hi doctor I have some speech problem I miss the word while talking and I am not conveying it properly I have to stop and think for a while to continue the conversation this happens many times a day my current medication is tablet vilazine 40 please help me",
        "input": "",
        "output": "hi for further information consult a neurologist online"
    },
    {
        "instruction": "hi doctor I had doppler mca the report showed mca psv value of 79 mom what does it indicate please explain",
        "input": "",
        "output": "hello for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I had an annual checkup please have a look at the reports and advise if everything seems fine and healthy",
        "input": "",
        "output": "hi for further information consult a general practitioner online"
    },
    {
        "instruction": "hi doctor I just found out that I am pregnant from the home pregnancy test kits this may sound weird as I am not sure about the date of conception was my last period was on the 17th of last month I had sex on the 14th of last month and also on the ith of this month I have a 38 day cycle is there a way to tell which date the pregnancy has come from without the ultrasound",
        "input": "",
        "output": "hi for further doubts consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor my mother in law is suffering from hearing loss for the last 10 days there is no pain in the ear but sudden hearing loss she can hear but hearing capacity reduced by more than 30 please tell me some solution for this thank you",
        "input": "",
        "output": "hello for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor when I was using tips to clean my ears I slipped and I may have gone a little too deep with one I felt a little discomfort in my ear that was three days ago and I still feel a little weird in that area could I have ruptured or punctured my eardrum is it important to go to an ear doctor immediately",
        "input": "",
        "output": "hi for further information consult an audiologist online"
    },
    {
        "instruction": "hi doctor my aunt has colon cancer for the past three years she has a tumor of am as all other organs are not compromised she stopped with the chemotherapy like one year ago now she has peritoneal pseudomyxoma and ascites in the hospital the doctors say that the liquid in her abdominal cavity cannot be drained with normal methods because of the density of it they sent her home to die slowly without any treatment what can be done to get that thing out of her I have attached her clinical history for your reference please help",
        "input": "",
        "output": "hello for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am a 25 year old male my weight is 100 keg and height is my current medications are as follows atorvastatin 10 my on alternate days for hyperlipidemia allopurinol 100 my three times a day for hyperuricemia and lab plus steroid inhaler for asthma today my be is 139 98 mhg on routine measurement I am thinking to join a gym this week please suggest me",
        "input": "",
        "output": "hi for further information consult a general medicine physician online"
    },
    {
        "instruction": "hi doctor I have morganella morganii infection in the prostate for the past 15 years I have been getting blood in semen I had a short course of antibiotics in the past and I also had a semen microbiological test please recommend some antibiotics",
        "input": "",
        "output": "hi for further information consult a urologist online"
    },
    {
        "instruction": "hi doctor I had plantar fascia release surgery three months ago and my doctor released me to work even though I was supposed to get one more ray after getting the second ray he said the ray looks good but still I am in a lot of pain also the pain has spread to the outside of my foot along with the area of all the joints especially over the last three should I get a second opinion",
        "input": "",
        "output": "hi revert back after 10 days to an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hi doctor there is a mole like appearance on the back of my thigh I am worried if it is a cancerous one please help me",
        "input": "",
        "output": "hi I have read your query and do understand your concern revert back with the photo and the answers to the above questions to a dermatologist online"
    },
    {
        "instruction": "hi doctor I had a biochemical pregnancy before two months initially my hug test showed and after a couple of days it was then I had an endometrial lining scan and it showed a simple right ovarian cyst measuring 27 my so doctor prescribed meprate and I got my periods on the 27th of last month when can I expect my periods of this month do I need to get any other scan please explain",
        "input": "",
        "output": "hello for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor four years before I met with a car accident with no external injury after a week I started getting pain in my right buttock and calf area later I was recommended for an mri and found it was la disc extrusion I underwent the microscopic discectomy the same year now for the past one month I am having severe pain in the same area I consulted my surgeon and took another mri as recommended this time as well I have the disc extrusion in the same disc this time he is recommending for fusion I am attaching the mri reports for your kind advise please check and advise whether I need to go for it my current medications are reserve plus and a painkiller thank you",
        "input": "",
        "output": "hi a few observations are as follows evocative discogram proceed transforaminal endoscopic discectomy revert back with the answers to the above questions to an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hello doctor I am a female of 32 years old I have a chronic issue of throat irritation a year ago I had taken treatment from the ent specialist he told me that everything is fine but some kind of air obstructs the throat unfortunately I lost the prescription I have been to doctors here but I am not satisfied one doctor gave me gastritis medicine and it does not work as per report my throat is fine I do not have tonsillitis or sinus problem but I am keep clearing my throat my current medication includes rabeprazole sandoz 20 my and motilium 10 my I am in a real trouble please help",
        "input": "",
        "output": "hello we are happy to help you from the details you have provided regarding your symptoms and the previous consultations I can conclude with reasonable surety that you are suffering from a condition called reflux laryngitis this is a chronic condition characterized by symptoms like chronic throat irritation feeling of something stuck down the throat frequent clearing of the throat and excessive throat mucous it is because of local production of acid is produced in the stomach to aid in digestion the throat mucosa is not suitable to handle the acid when such local acid production occurs or the gastric acid contents rise up the esophagus they cause chronic irritation of mucosa and produce these symptoms they are seen typically as inflammation of the posterior larynx in endoscopy if you can search for your endoscopy report and share with us it will be helpful the treatment for this condition is to take a proton pump inhibitor like rabeprazole 40 my or pantoprazole 40 my twice daily half an hour before food for about a month also I advise to take a teaspoon of mucaine gel aluminium hydroxide after each meal and before bedtime at night for a week the proton pump inhibitor prevents acid production and the gel which is a combination of antacid and local anesthetic produces relief of symptoms consult your specialist doctor discuss with him or her and take the medicine with consent some additional care to be taken during this treatment are with these measures your condition will improve but it will be a gradual recovery if you do not recover then I would like to do some blood investigations to check if there is any other factor that is causing the throat issue also a repeat endoscopy can be advised to recheck the larynx hypopharynx and cervical esophagus for the throat irritation for further information consult an ent otolaryngologist online"
    },
    {
        "instruction": "hi doctor I have a couple of moles that have changed recently should I get them checked by my go the larger round mole is on my back of about my in diameter now it is a little over am also it has changed over a course of a few months the other mole that I noticed recently is raised while the rest is flat I have uploaded the photos for your reference please help",
        "input": "",
        "output": "hi for further information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor before two years my father was diagnosed with prostate cancer and has been undergoing treatment using eligard and xgeva early this year he got diagnosed with vallecula carcinoma and for which he underwent chemo erbitux six sitting and radiation therapy for 27 days while vallecula seems to have subsided he is now detected with tumor in some of the lymph nodes and for which operation has been recommended by the doctor also as observed in pet scan cancer seems to be spreading to other parts as there are some areas highlighted in the lower part of the lungs doctor has not given clear guidance about that we have been exploring the other options to retard spread of his cancer we need your guidance on therapies that can be considered to extend his healthy life span he is 73 years old wanted to check around immunotherapy for treatment and its availability thank you",
        "input": "",
        "output": "hi I went through the details of your father illness and I will concentrate on the present problem for further information consult a medical oncologist online"
    },
    {
        "instruction": "hi doctor I want to know if my two sister grandson and granddaughter get married will their baby become abnormal or will the marriage affect their kid in any other way please explain",
        "input": "",
        "output": "hello for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I have attached my two egg reports here are they normal they were taken consecutively minute apart the one with 106 heart rate was taken first and the second one with 93 heart rate was taken later I see some broad peak in the second one I am not sure if it is an error or something else my questions are as follows do both egg charts represent healthy heart the reason why I went to the hospital is that I felt chest pain and I checked my heart rate by a phone application it gave a normal reading except for one time it gave 39 but immediately after that it gave 79 do you think the 39 heart rate is an error should I feel relaxed and be assured that my heart is fine what is that broad peak I have very mild mitral valve regurgitation that was diagnosed to not have any treatments also before I did the egg I just ate and I was very concerned about the chest pain please explain thank you",
        "input": "",
        "output": "hi you may rest assured as I have carefully reviewed your health query including both the attachments with different heart rates for further information consult a cardiologist online"
    },
    {
        "instruction": "hi doctor today I noticed two moles on my back with large dark circles around them I have attached the photos of one affected area only I have always had these moles but have never seen these dark circles until today I have had biopsies of moles from my back before and they were not cancerous however in the past my dermatologist and a plastic surgeon removed a pre cancerous mole removed from my right calf and a suspicious mole from my right bicep my mother had a melanoma removed I am also recovering from a case of shingles on my face could my immune system have been weakened from fighting off whatever is going on with these moles please explain",
        "input": "",
        "output": "hi for further doubts consult a dermatologist online"
    },
    {
        "instruction": "hi doctor this is in regard to my mother she is 51 years old her weight is 12 keg she has severe pain in the lumbar spine till her bottom and not the legs she had done an mri of her spine earlier and got detected with slipped discs recently she did another mri of her brain and whole screening of spine I want you to explain the conclusion of the brain mri the report was round to oval to hyperintense foi in bilateral deep peritrigonal and right frontal white matter please explain in detail and also please tell me what treatment would it require also she has slipped discs frozen shoulder and muscle knots please tell a solution for muscle knots due to frozen shoulder she cannot lift her right hand she had injections but did not get relief from a while back she is showing forgetfulness no balance and cannot lead a normal life at all I am sending the copies of the mri and also attached her current medication list I will be awaiting your reply thank you",
        "input": "",
        "output": "hello I had gone through all the data posted I would like to keep my answer as simple as possible so that you can understand easily for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hello doctor my son is 21 months old he is suffering from very acute diarrhea that is four to five times in an hour and frequent vomiting four times a day from the last four days we consulted a local doctor he advised the attached prescription and stool test as per him it is due to severe bacterial infection in the stomach which is resulting in diarrhea my son is not suffering with dehydration and his fluid intake is sufficient he himself is asking for food but due to frequent motions he is weak and the rashes makes him irritated please give your suggestions we are worried as it seems that medicines are not healing it in a faster way he got only relief in three days doctor said that it will take three to four days to become normal and stool test is also fine",
        "input": "",
        "output": "hello I understand your concern for your child I have seen the attached documents acute diarrhea give him or with each loose stool or whatever amount child takes prepare by adding a whole sachet in liter water syearup zinc my for 14 days consult your specialist doctor discuss with him or her and take the medicine with consent revert back with the answers to the above questions to a paediatrician online"
    },
    {
        "instruction": "hi doctor from yesterday I am suffering from loose motions and vomiting I do not feel fever but whatever I eat I feel it is in my throat I feel vomiting sensation I feel very weak drowsy and not able to do my normal work also felt left side shoulder and chest discomfort my age is 31 and I do not have any bad habits I have high triglycerides around 345 and other lipid levels are normal for the past two years my triglycerides are in this range only I have taken panto 40 my some tablets for stopping motion and nicip pain killer for left side chest and shoulder pain I feel tightness also but doctors confirmed it is not a heart problem three days back I ate sweets and since then I feel very discomfort four months back I have undergone egg tit and other tests which showed all normal kindly do the needful thank you",
        "input": "",
        "output": "hi we are here to help you for further doubts consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am too much possessive to all the one who I love because of that I stressed a lot is possessiveness a disease please help me do I need any treatment for this thank you",
        "input": "",
        "output": "hi for further information consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor I am on prozac treatment for two months now for depression and anxiety I am on the minimum dose half a pill a day and I am doing very well to this treatment however I just found out I am pregnant my gynecologist says that I should stop prozac immediately but my psychiatrist says keep taking them as it is a very low dose and it will not harm the baby my anxiety and panic attacks were quite bad before now I am much more relaxed and I am just feeling like a normal person again what should I do should I continue the treatment is it safe for the baby please help",
        "input": "",
        "output": "hi congratulations on your good news and I went through your query for further doubts consult a childbirth educator online"
    },
    {
        "instruction": "hi doctor I am suffering from unilateral headache for the last two months I had an eye examination and that was fine my blood tests were all normal I have seen three doctors my go and two hospital doctors who all say it is likely a benign headache or tension type headache of some description I have no other symptoms other than the pain I was prescribed naproxen 500 my twice daily which helped for two weeks pain came back a week after stopping naproxen but more mild than before then went away for five days and returned now naproxen does not seem to help at all doctors have not been concerned enough to give me a scan because I have no other symptoms and just the pain again this has been going on for two months now and even on pain free days while on naproxen I have still had brief one second flashes of pain at least a couple of times a day I have no sickness or nausea or dizziness I do not have a history of migraine there is no pain behind my eye or tearing I also have no anxiety or tension issues in my personal life to attribute to a headache the pain is in my left temporal area I feel some pressure pinching pain and tightness sometimes it is in the inner ear and sometimes I have pain on the top left of my head before I started the naproxen it was at its worst at bedtime when I laid down but I slept pain free for a month while on the naproxen the pain is quite mild but persistent so it is very annoying and always on my mind now that the naproxen does not seem to work at all and I cannot rely on it for relief why would naproxen suddenly stop working should I be concerned that I have a sinister condition",
        "input": "",
        "output": "hi for further doubts consult a neurologist online"
    },
    {
        "instruction": "hi doctor I am 31 years old last month I had periods on 10th and then we had sex on 23 25 as those were the fertile days also I am doing yoga from past month this my date was supposed to come before 10 as I normally get period before date but got my periods today on 14th is it because I am doing yoga so I got my periods and failed to conceive as initially in this month I was having frequent urination sore breast symptoms but sadly I failed to conceive can you suggest shall I continue yoga and is it advisable to do yoga after having sex current medications folvite and neurobion forte",
        "input": "",
        "output": "hello nothing to worry smaller changes in cycle pattern can be hormonal yoga is good it relaxes you nothing to worry about the cycle fecundity is 12 to 15 percent means every trying cycle has a chance of pregnancy only 12 percent it takes year of unprotected intercourse for better pregnancy rate no worries considering your age if the trying period is more than to 10 months get a baseline tis to look for ovarian reserve and also a baseline semen analysis for your partner hormonal semen analysis tis hormonal reassurance if queries"
    },
    {
        "instruction": "hello doctor yesterday in the evening I felt strong heaviness in my stomach and gas started forming stomach seems to be full without eating anything light pain also started today morning also no clear stool no choice to take food hence only some fruits taken in breakfast presently also stomach feeling full of gas light pain feeling in the morning I have taken one tablet of gas in empty stomach rabiprazole with domperidone what to take for relief since office hours has started and I want to be fit",
        "input": "",
        "output": "hello I can understand you had a terrible time due to this problem since yesterday the gas production in bowel is a normal phenomenon and majorly produces on its own given the number of gas forming bacteria within human gut however there are certain foods and environmental triggers that can increase the gas production foods containing cereals grains such as wheat corn maze barley oats millets and milk cauliflower and many others that even you can find out yourself so your symptoms and just an overnight onset with worsening intensity suggest you probably have one of these gas producing food a day before yesterday if you can find out the foods that make you feel gas then it would be very easy to omit that diet from your diet and go well it is fine to continue with the rabiprazole for now but I want to substitute another medication over domperidone tablet digestive 40 my once daily before meals you can increase the dose to twice daily before meals if you dont feel improvement in next 48 hours gas and bloating I can consider testing you thoroughly if your symptoms remain for a week or so and does not improve with the medications I prescribed silo follow up in days to update me how you doing"
    },
    {
        "instruction": "hello doctor I hope this message meets you well and you are keeping safe please I have some concerns I have a year old son with my husband and we have agreed to make another baby I noticed my period only last two days and when we make love some sperm do not go into me also I ran a scan and which say my uterus is tilted does this means womb shift please provide with answers thank you and have a nice day ahead",
        "input": "",
        "output": "hi I would like to know about the mode of delivery of your son r a vaginal birth or a caesarean section if it was a caesarean section it would have been better for your health for another year regarding your second query spilling of a small amount of sperm outside is not an issue as long as a part of it deposited high inside the vagina also please attach all your previous scan and blood reports including the one which mentioned the tilt and mention whether your periods are regular or not meanwhile follow the advises below tablet folic acid 5mg tablet once daily after lunch to continue"
    },
    {
        "instruction": "hello doctor I am 28 years old I have checked my pregnancy through prea news in home after 48 days of my last periods it shows two lines one dark pink and second light pink I have checked two times but same results I have done an ultrasound but it does not show pregnancy in the report please suggest",
        "input": "",
        "output": "hello I have read the description of your problem there can be three explanations for this either it is an evaporation line if have you have checked it very late than the time mentioned to check on the kit which is a false positive result or this could be a very early stage of pregnancy where the levels are not sufficient enough to be detected in urine so gives a faint positive test obviously at this stage usually the pregnancy may or may not be detected on us ultrasound or the third possibility is that this is a very early pregnancy which is failing if you could give a little bit more details about your previous menstrual cycles the date of your last periods and when the scan is done it could have helped to narrow down the possibility you can check for your blood levels of beta hug human chorionic gonadotropin hormone to check if you were pregnant or not I hope this helps serum beta hug level"
    },
    {
        "instruction": "my daughter is months old and this is what is been going on with her need answers or if over reacting when she eats and even for long time after she is constantly puking sometimes white foamy puke she makes a weird breathing sound when eating and just regular breathing her nose is always running or full of snot she has always got excess saliva coming out of her mouth she always sticking her young out or moving it side to side she acts like she is constantly choking she has weird poop and seems be constipated lot she is not very alert like normal and it is like she cannot talk laugh or cry anymore help ply",
        "input": "",
        "output": "hi choking like act not laughing or crying well is something need a careful detailed evaluation that she might be having delayed milestones and that can have multiple causes if you can connect with me on video chat I can have a look at your baby to confirm it is something to be of concern or not considering your baby is other wise normal with normal events during delivery after delivery small amount of puking is normal which can be due to swallowing little more air during feeding you wrote while eating just to re confirm have you started on solid food noisy breathing during feeds is due to running nose and she is having nose block so she feels difficulty while swallowing use normal saline nasal drops to keep the nose clean open excess salvation at this age is normal for a well healthy baby"
    },
    {
        "instruction": "for consecutive three weeks I have been suffering from acute sore throat and swelling and ear heaviness in the first week I took cefixime for six days then I took pulmocef 500 my for with winolap tab and tab dolonex it for days in this week sore throat tonsil pain swelling in throat stiffness of walls of throat post nasal drip I am taking cepodem up with montair fix now for the last three days still I am seeing thick mucus in back of throat as frequent post nasal drip even full swing fan is causing sinus problem now please guide uric acid 81 male 47 years hba1c 3 no diabetes no hen so far",
        "input": "",
        "output": "hello I am enabling you a free query so that you can reply back to us"
    },
    {
        "instruction": "good morning my daughter 12 years has high canines the orthodontist advised to extract teeth before we start the treatment I would like a second opinion to know if it is really necessary and if necessary which teeth bus I read that the opinion differ to which teeth to extract especially in girls to avoid saggy cheeks in the future thank you rays taken five days back",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hi doctor my current medications are 60 my cymbalta for depression and 300 my seroquel for the sleep disorder I am in my 40s and I have had a few episodes of depression during my lifetime I was lucky enough to be able to attend a psychiatrist in a country I lived in for a long time it was a great help my question at the moment is about medication when I was quite depressed I took cymbalta and another antidepressant which I am fairly certain was wellbutrin I dropped the secondary antidepressant after a year or so as I began to feel better I am just considering using it again as I am now in a state of emotional upheaval due to a family death I have just got in touch with a go for an appointment in the next two weeks what I would like to know is it safe to take cymbalta seroquel and go back to wellbutrin how would I work the dosage would I start with 150 my of wellbutrin and possibly go up to 300 my when should I take the antidepressants can I take them both at the same time or do I need to space them out I am not prone to seizures and I have never had one I am a female",
        "input": "",
        "output": "hi thank you for taking help from a psychiatrist you can take cymbalta and seroquel you are already on both medications so you should continue both medications if you fill depressed then take tablet wellbutrin 150 my once in the morning for a short period of time then we can taper off within months if you do not improve your depression on 150 my of dose after 15 days then we can increase the dosage as per requirement you can take medications together and you do not need to space out but you must take seroquel at night as it causes sedation even you should follow some non pharmacological management as mentioned below do exercises daily for 30 45 minutes like walking do meditation for 20 minutes daily eat healthy home cooked foods avoid junk foods spend quality time with friends and family daily spend time for creative hobbies like read good books write journals painting drawings learn new skills or language or musical instruments take enough 8 hours sleep daily avoid tobacco or alcohol or any substance abuse I hope this helps"
    },
    {
        "instruction": "hello doctor my brother os recently on tagrisso his recent scan is attached which shows improvement he is vomiting while eating grains what is the reason for vomiting and what can be done for this please tell me about this response to tagrisso if it is good how much time does tagrisso take for the remission if it works like this what is the average duration for tagrisso to become resistant please clear my doubts",
        "input": "",
        "output": "hi welcome to icliniq com in reply to your question for osimertinib tagrisso osimertinib demonstrated improvement in pas 18 versus 10 months he 46 95 ci 37 57 and duration of response 17 versus 5 months relative to other ski the pas progression free survival benefit was consistent across subgroups including either patient with or without brain metastases response rates for osimertinib is around 80 to put it to simple terms the disease is controlled for more than 5 years with osimertinib treatment with an egfr ski is generally continued until there is disease progression if there is persistent vomiting we need to do more tests to confirm whether it is leptomeningeal am disease which is diagnosed in approximately percent of patients with metastatic cancer the most common solid tumors giving rise to am are breast cancer 12 to 35 percent lung cancer 10 to 26 percent melanoma to 25 percent headache is the most common initial symptom of am present in 30 to 50 percent of patients with symptoms of confusion forgetfulness disorientation subtle personality changes and or lethargy collectively referred to as encephalopathy or altered mental status are common in patients with am I would request to do gadolinium enhanced magnetic resonance imaging mri of the brain and spine which often provides important evidence of am the definitive diagnostic finding for am is the cytologic identification of malignant cells within the csi cerebrospinal fluid"
    },
    {
        "instruction": "hello doctor I had normal vaginal delivery 10 months ago and breastfeeding my baby since then I did not have my periods but yesterday around 10 am I felt some brown stains but I started worrying when I saw the flow as it is really heavy I used three pads in three hours and that too there were literally in a situation of dripping I do not know whether I should expect this or not could you please help me to find the problem and any medication I can go for",
        "input": "",
        "output": "hello while a woman is breastfeeding post delivery menstrual cycles usually do not resume until 12 months and it will vary from person to person this is like a natural birth control devices by nature to prevent subsequent pregnancies at a shorter interval but however this is not 100 effective the excessive bleeding that you experienced is definitely not normal even if you have resumed your cycles one possibility is that you could have ovulate and got pregnant in the same cycle before you could get your actual periods and it got miscarried if you were not using any birth control methods so I would advise to check your urine pregnancy test once if there is any history of sexual intercourse the second possibility could be excessive bleeding due to other causes like fibroid or any other structural problems or hormonal disturbances which will have to be evaluated please get an ultrasound if possible to look for the same meanwhile to control your excessive bleeding I prescribe some medications which will help to control your flow please feel free to revert back with the urine pregnancy test results to rule out the possibility of pregnancy first urine pregnancy test ultrasound abdomen and pelvis tablet tranexa tranexamic acid 500 my thrice daily after food follow up with the urine pregnancy test results"
    },
    {
        "instruction": "hello doctor I was wondering if anyone could tell me about my condition I used to go to an eye doctor when I was little but I cannot remember when I last went I was never pushed to go by my parents when I was younger only when I needed a new pair of glasses I was born with one eye small the other normal my vision is fine I am very nearsighted but with glasses I see quite well my depth perception is normal too I can see most things and when I tried to drive once it went well in my affected eye pupil is floating around I cannot see much out of it and it is not big enough other than that no other health conditions could anyone tell me what this is it something that progresses and will I go blind someday",
        "input": "",
        "output": "hi you have unilateral microphthalmos I your one eye which in your case is right eye is not fully developed and has developed a squint other eyes appear normal but I will advise you to get a funds in the left eye also to rule out any retinal anomaly the condition in the right will always remain like this and this condition will not affect the left eye if it is normal just do not engage in activities that can lead do an injury in the left eye also so please consult a vitreoretinal specialist to rule out any retinal lesions in the left eye and get yourself rechecked for glasses every six months though your left eye appears very normal from outside but since you are nearsighted I will advise you to get retinal examination in your normal eye too so that if there is any treatable lesion we can fix it at an early stage"
    },
    {
        "instruction": "hi doctor my baby has a bump behind her ear and head I searched it online and found it as lymph node I do not know what exactly it is but she is so irritated and she has a fever I do not know what to do please help she is only year old and I am giving her tempra",
        "input": "",
        "output": "hi you are absolutely right these are lymph nodes everyone has it but due to so many different reasons they become a bit enlarged and can be felt if they are not increasing in size and not painful on touch along with a normal skin over it then not to worry it does not require any specific medication in case any of the above mentioned symptoms and signs are there then it needs to be taken care of presently what have explained regarding fever and skin rash seems a viral infection but if you can share a picture I will reconfirm it meanwhile give these medications syearup cetrizine 5 my once daily for three days syearup tempura paracetamol my as and when she has a fever you can repeat it every four hours if needed"
    },
    {
        "instruction": "hello doctor I have cervical pain radiating to the right shoulder neck and arm until fingers I have this problem for the past eight months and I am currently on medications for diabetics",
        "input": "",
        "output": "hello the symptoms that you have described point towards cervical disc issues with a small disc and bone osteophyte that is irritating to the right sided nerve at c5 level as mentioned in the mri reports usually such cases heal within 8 weeks on and off pain is common but persistent pain in the arm and hand is nagging and decreases productivity especially if it is a dominant hand we need to take mri films to interpret the severity of the disc problem know the handedness know the exact location of the pain and if associated with tingling or numbness and any weakness in the hand or arm until then do warm water fomentation apply pain killer gel locally over the neck and arm avoid lifting weights or jerks to the neck and avoid bad roads"
    },
    {
        "instruction": "hi doctor I have persistent heartburn related symptoms for the last four to five months I visited a gastro and he prescribed me medicines for 14 days my conditions got better but not fully cured so I was given another 14 days of medicine including a proton pump inhibitor soon the lockdown kicked in and I went back to my home I meanwhile took ayurvedic medicines for a month here while it has reduced the duration of heartburn episodes the problem has not gone yet for the last month I have mild heartburn pain in chest for 20 60 minutes in a day spread across three to four intervals 14 30 days my throat felt different 30 last days had acid refluxes but heartburn occurs daily I have tried varying my diet but have not found any significant changes is this a cause of concern that despite having medicines for 42 days I still have mild heartburn occurring daily what should I do how long will it take for a medicine to show the effect should I continue the course and if so for how long and if yes does prolonged usage of medicine have side effects or if left untreated do they have side effects I took somproz initially for four days lesuride 25 and deltone for 14 days and for the next 14 days I took lesuride 25 and nexpro 40",
        "input": "",
        "output": "hello you have briefly and well described your history and I understand that you have very genuine concerns so the problem you have is called gastroesophageal reflux disease herd this is basically reflux of acid from the stomach to food pipe causing heartburn sore throat sometimes cough and shortness of breath our stomach produces approximately liter of acidic juices to help digest food the acid produced does not usually come into food pipe unless someone has loose sphincter at the lower end of our food pipe which prevents acid refluxing into the food pipe there are two further classifications of herd pi responsive herd and pi refractory herd your symptoms suggest that you have pi proton pump inhibitor responsive herd since your symptoms are significantly improved when you are taking pi even in pi responsive herd the symptoms may not completely vanish but are declined to a reasonable level and this may be in your case for this you just need to increase the dose of pi instead of once daily dose you can start taking it twice a day before meals the rest of your symptoms like sore throat will go away once your acid reflux is suppressed well diet may or may not affect the herd however there are certain precautions that you can do to prevent heartburn avoiding large volume meals instead take small but frequent meals avoid taking large meals at night or before going to bed give at least three to four hours gap after night meals before going to bed for sleeping raise the head end of your bed by placing a cement or wooden block down the head side of your bed or there are commercially available anti reflux mattresses that can be used instead avoid wearing tight fitting clothes and belts so your concern about the presence of symptoms despite 42 days of treatment is valid but you see the acid is produced daily and the medicines can decrease the acid production for the duration of time they are in the blood once the level of the drug declines from a certain point the acid production takes over back so taking a daily pill to control your acid production is the only effective way of treating your condition no long term use and side effects well all pi are relatively safe and do not cause significant side effects if taken for years and years however there are studies that have shown renal damage bone protein loss and aspiration pneumonia but in practice these side effects are not that common as elaborated in studies the one daily pill to control your acid and prevailing a normal lifestyle is much more important than unforeseen and often unestablished side effects from long term use of pi I would recommend if pi helps you to do well then there is no reason for stopping for the sake of unforeseen complications but if you still have a concern about the long use of pi then I would recommend you to get oh impedance 24 hours testing to confirm herd and if present then pi again is the therapy but if the test comes out negative then pi can be stopped I hope this helps pi responsive herd ambulatory 24 hours oh impedance testing non erosive reflux disease herd tablet pantoprazole 40 my before breakfast you can increase it to 40 my bid before meals follow up if want to discuss more"
    },
    {
        "instruction": "hello doctor I have scrotal pain for the past one year and my ultrasound is normal please help",
        "input": "",
        "output": "hello do you have scrotal pain while standing or is it there while lying down also do your profession involve standing for long hours any urinary complaints like frequency urgency poor stream nocturia dribbling or burning micturation is the ultrasound you have done is an ultrasound abdomen or scrotum can you upload the report also have you got a scrotum doppler scan also any history of diabetes or hypertension any visible dilated veins on the scrotum or lower limb send pictures if any"
    },
    {
        "instruction": "hello doctor I am a man in my early twenties that started using hearing aids about a year ago I am very happy with this it has really changed my life just recently I started reading up a bit more and now I feel very confused and weird about it all the thing is I was told I had a mild mid frequency hearing loss when I actually look at my audiometry test it shows that as well but my hearing is barely within the range of being considered a hearing loss reading around I found out that most people with such a mild loss can mostly hear fine and do not need hearing aids when I read about what my hearing loss is supposed to be like I do not relate I relate way more to the explanations of what moderate hearing loss sounds and feel like and hearing aids help me a lot when I do not wear my hearing aids it sounds to me like listening to people talking through a door I rely a lot on lip reading if I cannot wear my hearing aids phone conversations were almost impossible before I got them I just cannot make my hearing loss make sense with my actual experience with hearing so I have been wondering what causes me to feel like I hear so bad when my hearing is just slightly below the normal range I should say that I have tinnitus as well sometimes quite a lot so that maybe factors into it too recently I began to wonder whether the reason I hear so much worse compared to other people with my level of hearing loss is that I have add and ptsd which makes it so hard to focus do you think this is a possibility or could it simply be that I handle my hearing loss worse than others I just do not understand why I experience hearing speech as so difficult and why I am so dependent on hearing aids when my hearing loss is technically very mild",
        "input": "",
        "output": "hi let me tell you a statement which explains it perfectly the ear receives the sound but interpretation of sound happens at the brain so many a times with mild hearing loss speech perception is low moreover you have tinnitus too I hope you have fitted with digital programmable computerized programmable hearing aids if yes it amplifies exactly the same as required in each frequency no need to worry about it by the way avoid caffeinated drinks tea coffee alcohol and avoid noisy situations as much as possible puretone is used in the test in which you got the result mild mid frequency hearing loss pure tone audiometry but in day to day life you are not listening to pure tones right it is speech so pure tone audiometry and speech audiometry should be done and correlated if that would have been done then you must have a clear picture of your problem my honest suggestion is to use the hearing aids so as not to worsen the condition if you stop using it that may cause further deterioration"
    },
    {
        "instruction": "hello doctor I am a 32 year old male I have no previous conditions or problems and I take no medications for the last two months my right nipple probably under the nipple I experience pain to the touch some days it seems a bit better and some days worse I have stopped doing weight training due to quarantine but I am not sure if this is related to my problem what should I sign up to check me or will this just go away",
        "input": "",
        "output": "hello I can understand your concern according to your statement you have been suffering from pain on your right breast that probably under the nipple and it is painful to touch some medical conditions can cause breast pain when abnormal growth and swelling of breasts in men caused by excess amount of estrogen and less amount of testosterone production is known as gynaecomastia cyst is a lump under the skin and they contain fluid or air they can cause breast pain putting extra pressure on the muscles can cause a strain fat necrosis occurs where fat tissue becomes damaged fibroadenoma is a non cancerous lump and can be developed in breath and occur rarely in males breast cancer is rarer but can occur in males again chest or cardiac abnormalities acid reflux back neck or shoulder pain may cause breast pain treatment depends on the causes you should undergo some investigations like mammogram ultrasound scan it scan biopsy egg electrocardiography car chest ray etc to find out the underlying the causative culprit for your sufferings and treat them accordingly"
    },
    {
        "instruction": "hello doctor I have high uric acid levels and mild pain in random joints I would like to know about hyperuricemia management please help",
        "input": "",
        "output": "hi welcome to icliniq com definitely your uric acid is very high to discuss about the management I would need to know since when are you having these symptoms only small joints are involved or large joints like knee elbow are also involved any reddening or swelling over the joints any alcohol consumption"
    },
    {
        "instruction": "hello doctor I have been having very irregular periods since I began getting them I have been on birth control to help manage and track them but as of recently I have been having more sporadic periods for instance from the beginning of january through the end of february the pill I was on was no longer helping and I was on my period for two weeks at a time with five days gap in between each period and I have been experiencing more intense cramps during my period that start in my lower abdomen and extend through to my butt if I had to describe it feels like a stabbing pain from my belly button straight through my body to butt if that makes sense I am 19 years old and I have never been to a gynecologist please help",
        "input": "",
        "output": "hello welcome to iclinq com I can understand your concern and what you are going through is a hormonal problem the regularity gradually sets in with maturation of the hop hypothalamic pituitary ovarian axis as you grow older and the treatment of choice is hormonal pills the possibilities of your problem despite pills maybe missing pills in between taking pills not on time these two are the most common causes for such a scenario dose of the pill may not be enough however as you are complaining of severe pain have an in person gynecologist opinion us ultrasound abdomen is done to rule out uterine and ovarian pathology nothing big to worry about and continue with hematinics I hope this helps hormonal us abdomen and pelvis he uterine ovarian causes hormonal ocp oral contraceptive pills after the scan excess weight gain can alter your cycle so concentrate on weight reduction and iron rich diet"
    },
    {
        "instruction": "my wife age 46 suffering from heavy blooding during menstruation period she came into same phase after eight months almost eight months no periods at all periods started on 13 days back continue till date using 6 senetary pads during each day also passing through senior abdominal pain several days also having complain of constipation since last three days consult local physician and than gynecologist in my city she is swallowing medicines as per below tranexa of trexakind thrice a day spasmodart voveran if abdominal pain persists shelcal one per day from yesterday she is taking injection of aquairon 25mg three prescribed by local gynecologist one taken also feeling weakness I want second opinion and finest treatment suggestions online please guide on above case and suggest finest treatment",
        "input": "",
        "output": "hello thanks for the query with the history it is clear that she is in her peri menopausal status and experiencing menorrhagia or excessive bleeding since 13 days which is often seen in peri menopausal women she has been given antifibrinolytics in form or tranexa of which is fine but if bleeding is still not getting controlled then she would require an ultrasound pelvis first to check for her present endometrial thickness if the endometrial thickness is still more than my then she would have to be started on progesterone pills for 10 days to control bleeding along with diosmin and antifibrinolytics together also if she is feeling dizziness and weakness then she may require hospitalization for intravenous support as well regards"
    },
    {
        "instruction": "sir I have piles problem is there any relation between piles and armpit swelling that swelling was soft and no lump and no pain I searched online about swelling in armpit it was showing like best cancer that swelling is there from year in that year my delivery was happened in pregnancy time this was came but I am not best feeding I am very tensed about this swelling out side hospitals are not open in this lockdown any chance of getting fat in one armpit wheneven I am folding my hand it was showing like a bump ply help me is there any chance of cancer please help me this is the sign of cancer or fat I have this from year if it is cancer any other symptoms will come or not please doctor give me a better suggestion and clarification about my situation thanks in advance",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hi doctor I just want to know how long do you have to wait to get tested for hepatitis I got checked for the first three months and it was negative I am just nervous thinking was it too early six months later I did a liver test and blood test and everything came back fine I just want to know should I get rechecked or am I good are liver tests good enough to check for hepatitis and",
        "input": "",
        "output": "hi it is very important to know why are you willing to get hepatitis and tested if you had exposure please mention what exposure it was also mention when did you get the exposure and when did you get the test done"
    },
    {
        "instruction": "hi doctor I was not sexually active for the last one year but recently I resumed my sexual life I am not able to maintain my erection during sex although I am able to achieve it but it is not that hard I never faced this issue before and was not sure what is causing this problem I am 30 years old please help",
        "input": "",
        "output": "hello before moving directly to any treatment follow the advice as given below you are indeed developing the signs of ed erectile dysfunction and me premature ejaculation we may need the reports of the following tests to rule out physical causes of erectile dysfunction and premature ejaculation abc complete blood count to ash thyearoid stimulating hormone hba1c glycated hemoglobin serum testosterone serum prolactin to rule out psychological causes please answer my questions how is your mood how are your energy levels how is your appetite do you have any sleep disturbances or do you oversleep any past history of anxiety or depression any family members suffering from anxiety or depression describe in detail about any use of cigarettes tobacco alcohol cannabis or any other substances of abuse please respond to the above questions and send me reports to enable me to make a complete assessment of your condition and advise treatment accordingly depression can cause ed me and masturbation guilt or compulsive masturbation all that you may require is proper consultation and treatment about your sexual problems"
    },
    {
        "instruction": "hello doctor I got the influenza vaccination about a week ago and have a swollen and painful lump in my armpit",
        "input": "",
        "output": "hi I understand your concern you are having lymph node swelling axillary post influenza vaccination influenza vaccine is a very safe vaccine although some may have local pain swelling and fever some may have local lymphadenopathy is a swelling of lymph node normal gland present in our body which function as clearing harmful substances and providing immunity local and systemic reactions mostly began between day and day when a lymph node rapidly increases in size its capsule stretches and causes pain is usually the result of an inflammatory process it is a reactive response of the lymph node to the vaccination so no need to worry it can be managed by simple paracetamol or anti inflammatory medication such as serratiopeptidase it should resolve within a week if it is associated with fever or any other site enlargement of lymph node you can visit your physician I hope this helps reactive lymphadenitis abc complete blood count ear erythrocyte sedimentation rate us ultrasound axillary lymph node lymphadenopathy anti inflammatory paracetamol 500 my twice or thrice daily or aceclofenac paracetamol and serratiopeptidase combination tablet twice daily for three days follow up after three days"
    },
    {
        "instruction": "a couple of weeks before I got severe heartburn I often felt really bloated and nauseous especially after meals but I kept ignoring it as the symptoms would go away a month back I had a faint heartburn throughout the day and woke up in the middle of the night with severe heartburn all over my chest mid week it was so bad that it went in my throat and everything I went to the hospital and was immediately prescribed ranitidine 150mg for 14days as it came to week I got only worse with no sleep whatsoever lump in my throat extreme fatigue where my leg was involuntarily fluttering and my lip was voluntarily twitching by third week I started omeprazole 40mg with the ranitidine and the heartburn intensity reduced but I experienced lots of other symptoms like bloatedness stomach making noises all the time nausea breathlessness was the main one heart palpitations which were never ending and this constant pressure on my nose and head I am now in week and unfortunately the heartburn is still very much there it comes and goes the lump in my throat has improved from the second week but it still feels very heavy I can almost press it and feel something clicking doc has said to double my dose of omeprazole so to take 80mg plus ranitidine will I get any relief at all from this constant heartburn and all the other symptoms am I in some sort of serious trouble I have lost quite a bit of weight I am on bland food elevated at night and all the lot but yet my quality of life is so heavily impacted as I cannot do anything throughout the day because of the constant palpitations heartburn or pressure in my nose and head or the bloatedness and nausea the heartburn gets worse after I eat please help I am only 28 and do not understand why this happened to me as I was never obese or had any health conditions except hypothyearoidism last thing to mention my stools since having acid reflux issue has been a pale yellow and has only recently started to be brown again what could this mean as well any help would be appreciated as docs are just putting it down to anxiety and stress all the time",
        "input": "",
        "output": "hello I welcome you to icliniq I can understand that must very much frustrated for your ongoing non resolving symptoms I want you to understand why this symptoms of heartburn occurs in reality hear burn is a common symptoms that can occur in normal subjects as well but does remain long in some people heart burn occur secondary to acid reflux in food pipe esophagus which usually settles with one dose acid suppressant medication or twice daily capsule however there is a third group of individuals where by the maximum does acid suppressant does not effect very much as in your case we call this condition as refractory gastroesophageal reflux disease herd so why I started emphasizing on all this because management is different the work up of refractory herd start with an endoscopy a procedure where by a gastroenterologist puts a tube with camera in to your esophagus and see what is inside also there are other battery of test which could confirm what is exactly a problem may be straightforward I reflux but it can be some thing which is micking herd the herd mickers are many the one of most common are esophageal motility disorders which are another set of disorders in itself so to cut the story short I want you to first of all optimize the acid suppressant treatment I know you taking omeprazole 40 my twice daily but it is important you take these medication 30 minutes or sometime 45 min before meal it is very important since at times it is timing which is important than the drug itself but if you are doing it already in that manner I would recommend you to think about endoscopy now but it would help us to determine some other more information not necessarily the acid reflux keep taking gaviscon but increase the dose take 15 to 20 my at one time to times daily and half hour after meals the rest of your symptoms such as feeling lump in throat is common if someone has reflux it is called as globes sensation dont worry about that it will go away once your acid controlled adequately the stress and anxiety sometime create a vicious cycles where the disorder is perpetuated and influenced by it but I think this is not the only explanation of your problem the stress is obvious thing in one with non resolving symptoms for example if do not reach to a particular diagnosis by endoscopy I would consider testing for esophageal motility disorders and some more allergic and hyperalgesic problems of esophagus but for now let the above treatment plan work meanwhile get some blood test done as advised below I hope this would be helpful for you let me know if you need any future consultations have a good day refractory herd complete blood count check your thyearoid status ash ft4 ft3 herd motility disorders esinophilic esophagitis after week"
    },
    {
        "instruction": "hello doctor my baby just turned months I gave him can optipro one for his est to months now I gave him the follow up milk which is can optipro two after two days of drinking he is suddenly having diarrhea now five times a day I tried reaching out for a pediatrician in our area but they are not accepting the appointments he is also irritated because of his blooming teeth and he is eating oatmeal with banana puree I wanted to ask if it is just his tummy adjusting or is there any underlying problem",
        "input": "",
        "output": "hello I appreciate your concern regarding your child I would like to advise that transition can cause diarrhea but it should settle within four to five days if it does not then we should change the feed ensure hydration give him or oral rehydration solution dissolved one packet in one liter of water she must take 90 my of this solution after each loose stool this or contains electrolytes that have lost by stool give it until loose stool subsides syearup zinc my once a day for 14 days it will fulfill zinc deficiency in your child and prevent further episodes of diarrhea and pneumonia also give him semi solid food more along with curd this will help to improve the digestion during this illness watch for any color change in urine output or decreased urine output and any lethargy in case they come please consult"
    },
    {
        "instruction": "hello doctor actually I have been feeling low energy tired and fatigue for a couple months now also I get light dizzy light headed and headache it gets worse when I walk or stand up the headache is concentrated from the sides and sometimes forehead and around eyes however I have been suffering from anxtiey and depression my anxiety is moderate sometimes it lasts the whole day I took multivitamin zinc and vitamin now I am taking feroglobin two times a day for a week now I did not see much improvement how to cure tiredness and lack of energy how to reduce anxiety levels",
        "input": "",
        "output": "hello it may happen sometimes but it will be solved very soon avoid those stressful conditions medication has to be given generalized weakness serum creatinine abc complete blood count urine routine and examination fasting blood sugar lipid profile hypothyearoidism cos polycystic ovary syndrome tablet diazepam 10 my tablet in bedtime daily for 15 days tablet tolfenamic acid 200 my for five days tablet iron polymaltose complex folic acid zinc 150 my 500 my 5 my for three months folic acid my for three months avoid anxiety sound sleep needed eat healthy foods drink plenty of water recreation needed avoid stressful work always think positive please tell me about your menstrual life sexual life and family history"
    },
    {
        "instruction": "hello doctor my wife is having toothache and swollen and inflamed gums for four days this is due to wisdom teeth currently she is taking cataflam 50 my two tablets in 24 hours for the past two days for pain relief her age is 36 years and her weight is 56 keg she does not have any past medical history currently we feel visiting the dentist should be avoided please advise for medication",
        "input": "",
        "output": "hi the proper treatment of wisdom tooth is extraction as wisdom tooth is not able to perform its function of chewing because it is present in the most posterior position of our oral cavity so it is of no use in saving it by act root canal treatment and crown and wasting money and time in it so it is better to go for extraction after lockdown overs and kindly visit a dentist who is taking all the sterilization measures with pie personal protective equipment kit until that time do saline and warm water gargle three to four times a day for seven days take hot pack from outside the mouth and apply it on the affected cheek area to reduce the swelling twice a day for seven days take tablet augmenting amoxicillin and clavulanic acid 625 my be for five days zerodol so aceclofenac serratiopeptidase and paracetamol be for five days pan 40 pantoprazole od before food in the morning and capsule becosule od in case of severe pain take tablet ketorol it two tablets dissolve in a glass of water I hope this helps"
    },
    {
        "instruction": "i have been on my period for weeks its beyond heavy I soak thou a pad and ultra tampon hourly I am also passing golf ball size clots and massive gushes of blood I have some cramping as well no do can see me for weeks due to couid and I do not know what else to do",
        "input": "",
        "output": "hi bleeding so heavily for weeks is really painful and tiring I salute to you for bearing it for so long I want you to know that endometriosis can only be suppressed with taking contraceptive pills continuously for now take tab devilry medroxyprogesterone 10mg thrice daily for one week followed by twice daily for next one week and followed by once daily for next one week and stop eventually I am also concerned about your hemoglobin levels following such heavy bleeding please get hemogram an ultrasound done for now you can take iron folic acid and bit b12 tablets to combat anemia please get back to me if you have any queries regards"
    },
    {
        "instruction": "hello doctor my 85 year old father had mild pain in his thighs and shoulder girdle for two months which intensified in the past two weeks to a point that he could not get up from his bed he was started on oral steroids 30 my once daily for the past three days and has shown a 40 response but cannot stand blood tests were done yesterday showing normal serum electrolytes bilirubin ash and abc with some iron deficiency raised values are cpu 272 bun 50 got 50 sept 100 and leukocytes 2900 his he is and eosinophilia 42 since before kindly suggest the diagnosis",
        "input": "",
        "output": "hello well as per your history it does look like a diagnosis of polymyalgia rheumatic I would like to ask you a few more queries related to his illness when is the pattern of pain more mornings or evenings does he experience morning stiffness as well any history of weight loss or appetite loss any history of jaw pain or headache or fever do you have his reports of ear erythrocyte sedimentation rate cop reactive protein rheumatoid factor available as they are the most important to monitor and diagnose did they do any scans of the chest and abdomen as of now the reports do not seem very great with high leukocyte count and low he diagnosis of polymyalgia rheumatic looks certain but we should rule out any underlying trigger"
    },
    {
        "instruction": "hello doctor I am a year old male I had a hard lump on the left lower back between top of the hip bone and lower ribs no pain to the touch it feels about the size of a marble or the end of a pinky finger what is it most likely I did have a hard fall on my back about a year ago in that area but I am not sure if that could be related I want to know what is the chances of something like kidney cancer as that is what comes up when I use do google can you feel a lump from the kidney that close to the surface does it feel like what I described I included an image of the same I am currently using prilosec",
        "input": "",
        "output": "hello I have seen the picture looking at the location you pointed there should be no lump ideally in that area as it is purely muscular having said that in your case since you had a fall at that point last year possibly a hematoma has formed and not totally dissolved due to lack of movement or physiotherapy this is quite normal and not worrisome chances of kidney cancer if it is painless are actually one in a million if you have no other symptoms especially urinary symptoms I would recommend an ultrasound abdomen pelvis once feasible"
    },
    {
        "instruction": "hello doctor I am 19 years old and asthmatic I weigh around 56 keg my asthma is not severe and it is seasonal asthma and only happens during season change lately my asthma is not going away I did a myteka and feet course along an antibiotic course I do use ventolin inhaler which gives me relief normally these days when I wake up I feel short of breath again it is not that severe it is like 20 when I am not sick my asthma goes away it does not bother me at all during any physical activities I am a chain smoker and have been smoking for two years yet it never made a problem any suggestions",
        "input": "",
        "output": "hi I can see that you are worried about your asthma let us start from scratch firstly let us confirm your diagnosis of asthma and because you are having symptoms now it is the best time to perform spirometry secondly for asthma you have to use inhalational medication for at least a year after diagnosis and then we can taper off as you are relieved of symptoms I totally understand this is a long duration but we need the medication for controlling your future symptoms thirdly the medicine ventorlin will provide you immediate relief but it will not prevent further attacks so you need to add inhalational corticosteroids to your medication and last but not least you need to quit smoking you already know the health hazards of smoking and in your case it is worsening your asthma symptoms it will be a difficult job but I can help you with that only if you want I hope this helps poorly controlled asthma due to smoking not taking medicine regularly and not taking inhalational corticosteroids as well spirometry with bronchodilator reversibility testing poorly controlled asthma inhaler formoterol mug budesonide 200 mug with spacer two puffs twice daily and can be taken up to four times daily if required and once exacerbation is over it can be tapered off for a month tablet fexofenadine 120 my once a day for a month quit smoking avoid exposure to allergens per peak expiratory flow rate monitoring follow up with investigations"
    },
    {
        "instruction": "hi my grandmother is 80years of age over the past year her hallucinations have increased with time from what was occasionally to now daily I have had her to the doc for blood tests she is perfectly healthy in all bodily aspects treated for mild kidney infection on two occasions recently hallucinations seem to be in patterned images like floors tiles counter tops clothing her most recent go has not quite ruled it as dementia as yet short term memory has faded aggression has also increased re arranges the bedroom on a daily basis accusations of personal possessions being stolen by these so called persons in her bedroom how can we treat this desperately needing some advice as to the next steps to take thank you in advance",
        "input": "",
        "output": "hello dear dementia with hallucinations may be common in old age people intermittent episodes of delirium may increase the future risk of dementia most commonly infections urinary respiratory electrolyte imbalance hormonal imbalance drugs or recent surgery cause delirium dementia may be due to alzheimer or multi infact or louie body or multisystemic atrophy etc for delirium we may give low dose of benzodiazapines what is the cause to be evaluated by mri brain serum electrolytes blood sugar levels thyearoid profile and urine examination so please consult your neurophysician he will examine and treat you accordingly take care"
    },
    {
        "instruction": "hi good evening I have fatty lever and feel pain at right side of my stomatch when I touch with hand it give warm pain and I feel it warm touch incide currently taking two times liv 52 is from fee days the same medicine I was taking to months before then I stopped from almost a month I am not walking and doing exercise colistrol is under control due to use of ateroz 10 my tablets please advise thank you",
        "input": "",
        "output": "hi I understand your problem it seem the pain over your part of stomach I secondary to increase gas production as well as increase acid production as far as given no weight loss in these last months I reassure you that it is not some serious problem there are many factors which could abnormally increase gas and acid production the common of which are stress anxiety and sleeplessness and if someone putting on weight there is one safe antibiotic to be taken for at least weeks to show good results tab rifxamin 200 my thrice daily for weeks if your symptoms dont resolve see me in weeks we can consider testing it with investigations for fatty liver there are no approved medication so there is no use or liv 52 if you are taking for fatty liver it is only weight reduction of around 10 of your current body weight which can help to improve your fatty liver uninvestigated dyspepsia and fatty liver disease liver function tests fibroscan see me in weeks time if symptoms does not get better"
    },
    {
        "instruction": "1 I am having cough sore throat for many years sometimes I cough after I wake up from sleep sometimes I just start coughing randomly my throat will be itchy sometimes but no pain suddenly I get headache star at the back of my head until my shoulder I get this headache often it just start randomly for no reason I have gastric issue is this the cause of this pain",
        "input": "",
        "output": "hi there are two possibilities for the problem your having a chronic herd with lor gastroesophageal reflux with laryngopharngeal reflux basically over here acidic gastric contents have a faulty reflux into your throat and this can be the reason of feeling something stuck in your throat or just a itchy discomfort you will not have any difficulties with swallowing as such inflammation around the throat often results in a irritative cough a chronic allergic pharyngitis can also be another reason there could be exposure to some irritative substance indoors itself which can irritate the throat and again be the cause of intermittent cough what can be done avoid exposure to any irritative substance the best thing to counter this is to wear a n95 mask gastric issues have to treated seriously with medications and precautions with more emphasis on the later you can follow the advice mentioned below I think this should suffice and keep your symptoms at bay hope this helps get well soon"
    },
    {
        "instruction": "hi doctor for the past four weeks I have had terrible heart palpitations shortness of breath and bouts of fatigue a thing I have started to notice is it seems to get much worse after eating anything with carbohydrates after I eat the symptoms ramp up in 30 minutes to one hour I can exercise without any issues I am years old and this has never happened to me before I went to the hospital one week ago who confirmed my heart was racing and temperature slightly up but standard blood tests came back normal and there was nothing on a chest ray where do I go from here will this stop many thanks",
        "input": "",
        "output": "hi fever causes a faster heart rate another reason which is not uncommon in young people is vagal atrial fibrillation this is an irregular fast heartbeat that occurs in bouts after eating and during resting and spontaneously revert back what did your egg show was it only sinus tachycardia or rhythm problem such as atrial fibrillation fever usually causes sinus tachycardia which is a normal response to fever when fever subsides the heart rate slows down sometimes it occurs due to gastrointestinal problems in which eating leads to insulin gush which lowers blood sugar and sensation like blackout weakness palpitations and fatigue develop chances of this are very low please send me the egg strip so that I may diagnose your rhythm blood tests that might be helpful include abc complete blood count e urea and electrolytes ash thyearoid stimulating hormone and the egg these are also some rare disorders that cause a sudden rise in heart rate fever shortness of breath and very high blood pressure this condition is called pheochromocytoma but it is extremely rare please tell me the other symptoms you develop along with fast heart rate feelings and fever this along with the above tests will guide to reach a diagnosis if the above tests are normal I will advise you to have hotter monitoring done for 24 48 hours to catch fast heart rhythm if not caught on egg regards"
    },
    {
        "instruction": "hi doctor I have been diagnosed with herd as confirmed by an ent specialist I took medicine for over a month but I did not get totally well I changed my diet plans cut off fatty foods fried foods citrus foods etc started excersice I elevate my head while sleeping but nowadays I wake up in the middle of night with very dry mouth and extreme sore throat sometimes coughing when I drink water even warm water my throat is itching it does not get much itchy while swallowing I am feeling comparatively at day time",
        "input": "",
        "output": "hello do not worry you will get well soon yes you have problem of herd due to acid reflux you have this problem I will suggest you some investigation and treatment for this follow same diet plan try to walk for sometime after every meal get done upper gi endoscopy done from some good institute if not done previously send me blood investigation and other investigation report if available so I will see them and advice you accordingly here I am prescribing some medicine which will surely help you tablet normaxin tab be for days tablet tab od before breakfast syearup gelusil top ads syearup sacral top ads total duration days"
    },
    {
        "instruction": "hello doctor a new mole on a toe that I have not noticed before I know about it probably for a week it is blackish and not round about to my wide and sort of even in color I am 21 years old male and as far as I know we have no cancer history in my family I can provide photos too",
        "input": "",
        "output": "hi I went through your case history and the photos provided by you I can see a dark irregular lesion of about my in size over the tip of the toe as it is to days history the first thing I want to rule out is an history of injury or bruise they do present like this and you may have forgotten the history of trauma secondly moles also appear at this age and they also present like this if you have tendency of moles this may be a normal mole you can just observe it for few days the other thing obviously is melanoma aural lentiginous melanosis this can be dangerous and has to be ruled by biopsy as soon as possible but as you do not have any family history and if you do not have any other or very few moles over other parts of the body the chances again become very less and again such a small history of the lesion the possibility is least but to be sure you should monitor the lesion observe it for days if due to trauma it will diminish and slowly go away if persist and grow more immediately go for a biopsy by a dermatologist for histopathogical examination trauma biopsy after days intradermal hemorrhage nexus excision none after days"
    },
    {
        "instruction": "hello doctor my wife is 70 years old she is diabetic and hypertensive she has dry and itchy skin for that she is taking head bath and applying oil on scalp she is prone to sinus problems now for a couple of days there are boils inside and outside left ear it is troubling her very much please suggest some medication or remedy for immediate relief",
        "input": "",
        "output": "hello with the picture it appears like a hair follicle infection of the small hair in the ear canal considering her age and that she suffers from diabetes and hypertension diabetic people have slightly less immunity compared to normal people I am suggesting antibiotics for her tablet augmenting 625 tablet thrice daily after meals days tablet chymoral forte tab thrice daily before meals days tablet doll 650 tablet sos for pain can take unto three tablets per day in divided doses back ointment use clean little finger and apply the ointment thrice daily over the area if using ear buds take particular care that it does not go deep and injure the ear drum do not let water enter while taking bath keep a cotton plug spread with some back ointment or vaseline inside the affected ear and throw it off after bath this condition is called acute localised otitis external furuncle of external ear it appears that there is a single boil with a lot of redness in the picture you showed it is quite painful please continue your diabetic and hypertension medicines as before I hope you are taking those regularly and the sugars are controlled for a few days avoid applying oil in hairs once she gets better she can put oil over scalp do revert back if there is any worsening please wait for days for the antibiotics and medicines to act please let us know promptly if there is any fever or some other form of worsening happy to help you"
    },
    {
        "instruction": "hello doctor at night time while sleeping the nasal passage of mine gets blocked this results in the stuffy nose in the morning once I get up in the morning and I had to continuously sneeze for a long time in the morning hours whenever I take cetrizine or levocetirizine or montas tablets at night time I get relief from this problem but consumption of this tablet makes me feel sleepy and drowsy throughout the day time please help I am currently on glycomet is 100 and nexpro 40",
        "input": "",
        "output": "hello welcome to icliniq com as per your symptoms of nasal congestion and sneezing you are likely to be suffering from allergic rhinitis one thing that is prime importance is avoidance of allergens then there is also the role of steroids since you are diabetic systemic steroids are better avoided however topical steroid sprays can be used safely are you using any steroid nasal sprays"
    },
    {
        "instruction": "hello doctor patient is a 50 year old female she had a history of early menopause periods stopped after 35 years her gall bladder removed last year and she has hypothyearoidism and taking thyearonorm 25 my for the past three years her present complaint is problem in urination urine flow is low and she has to go to the toilet several times for urination but the urine is very scanty even after applying force sometimes there is urine leakage she was prescribed urimax 2 but she discarded its use as it induced constipation flats and obesity sometimes there is a pain in the pelvic region joint pain and easily fatigued",
        "input": "",
        "output": "hello do you have leakage when you feel to urinate do you have urine leakage when you cough or sneeze when you hold urine at that time did you feel burning or pain for what maximum time you are able to hold urine any history of diabetes or hypertension or any medications"
    },
    {
        "instruction": "hello doctor for the past three days I am having pain in backside of my neck the pain actually is not in the complete neck it is in a part from neck to mid of the back when I turn my head to the left it is a kind of electric shock feeling this may be because of some sleeping angle I do not know but I am feeling it very badly the pain I feel is from goes from neck nerve at the back to the left arm and down to neck till the middle of back from today morning I have a little headache also I am diabetic please help",
        "input": "",
        "output": "hello are you using a thick pillow neck muscles seem to be in spasm muscular spasm give elaborate history on any medications you are allergic to or taking at present"
    },
    {
        "instruction": "hi doctor is this egg normal I had a sudden cardiac arrest sca moths ago this egg electrocardiography was taken a few months before that I have had fatigue hair loss stomach cramps and dizziness for a while I have had some trouble with hypokalemia and hypomagnesemia after being resuscitated my serum potassium was 7mmol they tried to fix that by giving me potassium solutions the solutions did not really work though because of low magnesium I am currently on bisoprolol accord 5 my xarelto 20 my",
        "input": "",
        "output": "hello I am sorry to hear about your health condition this is extremely strange that at 25 years of age you suffered a cardiac arrest have you had problems with hypokalaemia before the attack where you on diuretics do you have history of similar problem in your family have you always suffered low blood pressure or was it after the attack"
    },
    {
        "instruction": "hello doctor my mom has an ear infection for more than one month now she had a cold which led to her ear pain then she took aplosyn for two weeks and now she is taking nasoflo the back of her ear until her neck has pain now what can we do",
        "input": "",
        "output": "hello is there any swelling around her ears or neck is she a diabetic any throat complaints if yes send me a clear picture of her throat"
    },
    {
        "instruction": "hello doctor I did a shave last week and hurt myself pretty badly now I have this bump and it has been a week I have been using neosporin anvil claritin and hot baths what is this",
        "input": "",
        "output": "hello I have seen the pictures that you attached based on the description you mentioned it looks like a folliculitis hair follicle inflammation or a razor bump but you mentioned in the picture that a similar lesion was present since a week even before you shaved the area so I would like to know if you have been having it before and does it have any intense itching with tingling or pain or did you have any fever a few days prior to developing these bumps if you are a sexually active individual I would like to know if you had genital herpes anytime before or if your partner has had genital herpes infection ever I am enquiring all these because another possibility could be genital herpes tablet paracetamol or diclofenac for pain relief"
    },
    {
        "instruction": "hello doctor my dime is getting higher from 5 to 9 within the last four months my heart has been checked and I had a chest ray it of heart aorta abdomen and pelvic floor and doppler of my legs all are clear blood work is normal apart from dime and reactive protein which is 12 my what can it be",
        "input": "",
        "output": "hello following is my opinion about your asked question dime is usually elevated in some thrombotic events in the body like dic disseminated intravascular coagulation deep vein thrombosis or pulmonary embolism but your it chest and doppler leg are normal as per history so pulmonary embolism and dot can be excluded the other causes for elevated dime can be liver disease heart disease inflammation post surgery and pregnancy as well your heart is normal as per history so heart disease can be excluded you can rule out the liver disease by sept serum glutamic pyearuvic transaminase got serum glutamic oxaloacetic transaminase and serum protein estimation if you have pregnancy or surgery history than it can be the cause it prothrombin time put partial thromboplastin time and coagulation profile can be planned by your doctor if dime remains persistently high kindly attach your report to give further comments if possible"
    },
    {
        "instruction": "hi doctor I am an it professional presently working from home for 10 hours a day six days back my laptop keyboard got packed up next three days I worked with an external keyboard and mouse while sitting on the bed instead of a table and chair though I felt strain and discomfort I somehow continued with it I felt sharp and dull pains all over the fingers finger joints wrist etc on the third night I somehow slept after hot and cold fomentation and had an oral painkiller from the next day I am taking complete rest doing nothing with right hand fingers it is almost three days and still there is a dull and sharp pain here and there over my right hand there is no numbness or tingling sensation ever also there is a feeling of discomfort and a sort of weakness in the right hand please advise medicine or ointment or exercise thank you",
        "input": "",
        "output": "hello where is the exact location of pain is it at wrist or elbow is it at shoulder joint too are you suffering from hypothyearoidism or diabetes the possible causes are like neuropraxia carpal tunnel syndrome hypocalcemia hypokalemia viral fever with myalgia spondylosis with radiculopathy pressure induced numbness use tablet pregabalin 75 my once a day for five days and tablet zerodol my aceclofenac 100 my tizanidine my twice a day for three days kindly get serum calcium blood sugar thyearoid profile and nerve conduction study if symptoms not improved then please consult with your physician he will examine and treat you accordingly take care"
    },
    {
        "instruction": "hi doctor I am an 82 year old man and noticed that my pulse was 54 late a couple of nights ago I recorded it yesterday throughout the beginning with am and ending at 10 15 am the pulse was 58 60 80 78 69 and 54 the 80 was after hiking 5 miles I am concerned about the low of 54 I am currently on valsartan and hydrochlorothiazide 325 my 25 my and amiloride my each one per day",
        "input": "",
        "output": "hello thanks for reaching out to us I understand your concern about your health please do not be worried as it is nothing it is perfectly normal to have a slightly low pulse as you age it is a physiological change that occurs with aging perhaps 54 beats per minute can not be said to be too low a normal pulse is between 60 to 90 beats per minute this range differs with people age body size and activity level are some of the reasons for the variation I advise you to continue your normal daily routine without worry you can become concerned if it becomes lower as much as 40 and you experience symptoms like shortness of breath or faintness remain healthy best regards"
    },
    {
        "instruction": "hello doctor my periods are delayed by a month and was prescribed regestrone my twice daily for three days how soon can I expect to start bleeding and is it normal to feel nauseous after taking that dosage until when is it legal to get an abortion for a woman without any complications or failed contraception",
        "input": "",
        "output": "hello as you asked yes it is common to have nausea after taking regestrone pills as it is a hormonal pill your periods will stop only after stopping the tablet and should be getting any time between 10 days after stopping it as it varies from person to person map medical termination of pregnancy can be offered till 24 weeks of gestation if the pregnancy is assumed to be constituting grave injury to the physical or mental health of the woman although they have not clearly mentioned as the scenario you mentioned any unwanted pregnancy arising due to rape or contraceptive failure can be a grave mental injury to a woman also in your scenario I would like to know why would a woman consider a termination of pregnancy at an advanced gestational age if neither there were any complications nor it happens due to contraception failure but one needs to get it approved by two registered medical practitioners for going ahead with the termination of pregnancy I hope this helps"
    },
    {
        "instruction": "hi I am a 29 year old male with 171 am height and 5kg weight and suffer from is every time I go to toilet I have pain while defecating and after it I have a burning sensation in the anus region for the whole day sometimes I also have abdominal pain but I think this is due to is before and after going to the toilet my anal lining is normal but during defecation something bulges out and I am not sure if these are hemoroids or this is mucosal rectal prolapse after defecation I have burning sensation in my anus and mild pain in my left side I also suffer from constipation go to toilet times per week and almost always have to strain when going to toilet when I am anxious I suffer from diarrhea and my stool is mostly liquid but if I am not anxious I suffer from constipation I already excluded all wheat grain as it was causing me gases and pain and my is improved but I still have occasional abdominal pain especially after defecation can you please help me understand if I have hemoroids or mucosal rectal prolapse and what I need to do to cure them",
        "input": "",
        "output": "hi hope you are fine pain while defecating and feeling of bulge this is mostly a hemorrhoid which sometimes could be associated with spot of blood on the toilet seat and sometimes not how to differentiate between a hemorrhoid and a rectal prolapse to be examined by a surgeon other wise it is difficult by history only however being young and healthy it is unlikely to have a prolapse it a disease of elderly and anoreceptor intercourse prolapse is usually completely circumferential but hemorrhoids usually one location described as clockwise related 7 o clock your abdominal pain likely it is having intermittent diarrhea and constipation flavoring it so to help ease your symptoms we need to treat and fix your bowel habits which is more fibers green vegetables avoid carbs stool softener like normacol over the counter drug which is basically fibers sachet per day till having soft easy stool part of is treatment is psychological therapy you need to relieve your stress which will help you a lot with the diarrhea"
    },
    {
        "instruction": "hello doctor I am a diabetic patient for two years and currently entered the third month of pregnancy and till now I did not consult any doctor is my baby safe I am taking iron calcium and zinc tablets for six months please tell me about the precautions and healthy tips",
        "input": "",
        "output": "hello first of all diabetes with pregnancy is a high risk pregnancy the blood sugars should be checked before getting pregnant in case a woman gets pregnant with high blood sugar levels then there can be a risk of miscarriages and certain congenital disabilities in the baby please check your blood glucose levels and hba1c level to see for your glycemic control also I am assuming you are taking folic acid supplements because that is a vitamin that helps prevent certain birth defects neural tube defects in other words brain and spine defects in the baby it would have been good if you had mentioned the medications that you been taking for your diabetes to check if you could continue them also if any dose modifications are required because pregnancy induced hormonal changes can disturb the glucose control as the pregnancy advances and it needs close monitoring please get back to me with the necessary details so that I can help you better and guide you through your pregnancy I hope this helps have a great day"
    },
    {
        "instruction": "i have had off and on neck head pains kind of like a headache my scalp in the back center is a little tender and when I cleaned my left ear I had pain deep inside started days ago with killer headache coming from left side behind ear scalp tenderness towards the back of the head",
        "input": "",
        "output": "hi welcome to icliniq I hope you are doing well I understand your concern I understood that you are having an off and on headache likely a chronic headache for the last days you are having a new onset headache which is triggered by cleaning your left ear associated with scalp tenderness and pain behind ear there are several possible causes of a headache behind the ear one of the most common causes of such type of headache is occipital neuralgia in this condition occipital nerves are injured or inflamed the nature of pain is piercing and sometimes throbbing or similar to the feeling of an electric shock for such pain you need evaluation maybe a scan medications that decrease nerve pain such as carbamazepine pregabalin etc another common cause is mastoiditis it is an infection of the mastoid bone which is the bone directly behind the ear it can cause a headache behind the ear it is mostly associated with fever discharge from the ear in your case it is likely possible as you have a history of ear trauma while cleaning your ear simply taking anti inflammatory medication and antibiotics will help other cause includes temporomandibular joints taj inflammation these joints can become inflamed and painful there is sense jaw tightness and pain in addition to a headache behind the ear lastly migraines can present in a various manner as your having chronic headache it is also a possibility it is important to find out the specific cause so it can be treated appropriately new onset headache we like to search for red flag symptoms this are sudden onset of headache the onset of headache after 50 years of age increased frequency or severity of headache new onset of headache with an underlying medical condition headache with concomitant systemic illness such systemic illness fever stiff neck rash as fever focal neurologic signs or symptoms if these red flags are present it needs urgent medical evaluation some home remedy for symptomatic relief of pain are over the counter anti inflammatory drugs such as ibuprofen paracetamol massage of neck muscles apply heat packs if swelling then apply a cold pack to take rest in a quiet room hope this is helpful regards"
    },
    {
        "instruction": "health query I have thalassemia minor in the blood and I would like to know if there is a final treatment for it and if not then what would you advise me to improve my health symptoms paleness hair loss rapid fatigue medication folic acid tablets vitamin capsules would like to know how much iu vitamin is suitable gender male age 20 height 172 am weight 70",
        "input": "",
        "output": "hi welcome to icliniq well according to your history and complaints I would like to inform you that a sure shot cure for this for thalassemia minor is not there at present but yes many treatments for major thalassemias are there which are not at all needed in minor forms yes symptomatic treatments and supportive therapy are advice but nothing is sure shot to improve your health it is recommended ypu must live a balanced life and acquire healthy habits like adequate work and rest adequate balanced diet mild exercise but with utmost care be vigilant about any new or worsening signs of symptoms I also recommend you to be in touch with your treating doctor and get yourself checked periodically incl blood tests da of it is minimum 600 iu day for healthy individuals and minimum 100 iu day eith ostroporosis although getting vitamins and levels checked and then to discuss the amount with your doctor is advised take care have a nice day"
    },
    {
        "instruction": "hi there we have just recently bought an oximeter and it is reading very well for four people in our household however with my dad it struggles to read his recordings he also has a very up and down heart rate varying from normal to really low however his blood pressure readings are fine thanks",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hi doctor I am having a situation here I am a mother with kids my last first period was 69 days back I am worried and made an up which shows positive 20 days back after 12 years I am pregnant I do faces all the pregnancy symptoms as vomiting and so on unfortunately I am spotting since last week which comes in chocolate color upon ironing only which is not a heavy flow and made my first ultrasound days back doctor says baby is fine then the spotting still have not stop so I decide to refer another doctor since really worried when I did and ultrasound a couple of days back I only can see my empty sac how this possible the doctor request me to come over for another scan after weeks if still empty then I have to abbot it I am depressed really not sure what happen please advise doctor",
        "input": "",
        "output": "dear welcome toiclinq com I can absolutely understand ur concern what you are going through must be missed miscarriage this is because of defective embryogenesis the ovum b'cos of ur age may have meitoic dysfunction resulting in multiplication errors it is a way of natural selection in which only the good embryo moves forward just wait for a week rat us and decide as per reports do not worry you have kids we do come across such worse scenarios in women going through if pregnancies stay bold it shall pass by hope you find it useful regards missed miscarriage tis after a week missed miscarriage as per scan reports if any query"
    },
    {
        "instruction": "i was topper for semesters and I have fear that I will be not topper for ith semester because of this fear I am unable to focus on studies",
        "input": "",
        "output": ""
    },
    {
        "instruction": "results from an hug procedure showed that I have a bicornuate uterus or a thick septum both fallopian tubes are patent but there is an abnormal position of the uterine body possibly due to a cystic nodularity in the right adnexa displacing the entire uterine body toward the left side of the pelvic cavity currently trying to conceive and I am pretty concerned about the complications with both fertility and pregnancy due to the potential above diagnosis further clinical evaluation is recommended what can be done to fix this and or make the changes for a healthy full term pregnancy thanks",
        "input": "",
        "output": "hi thanks for your query woman may never need treatment for a bicornuate uterus if it is required the surgery is known as a strassman metroplasty this surgery may be recommended if a woman has repeated miscarriages and bicornuate uterus is thought to be the cause performing this procedure as a solution to infertility is controversial as the majority of research carried out suggests that having a bicornuate uterus will not affect a womans chances of falling pregnant some evidence suggests that problems such as miscarriage and early birth are more likely in women with the condition though it does not rule out a successful pregnancy and natural delivery women with a bicornuate uterus who do become pregnant should have additional monitoring and checkups throughout their pregnancy to minimize risk and identify any problems early on its not necessary that all those with this condition will get problems with fertility or pregnancy but the chances are more especially if it is septate uterus where there is full septum diving uterus into two sometimes it cannot be established on imaging and laparoscopic view may be necessary"
    },
    {
        "instruction": "hello doctor last february I have had an ear infection from cleaning my left ear too often with a tip I went to the hospital and was prescribed aplosyn optic drops celebrex and an antibiotic which starts with a letter I forgot it as I lost the prescription I am sorry I took it for a week and went back to the doctor to have me flushed he told me my eardrum was not perforated all went well until two nights ago I gently cleaned my left ear with a tip after shower before going to sleep I woke up the following morning with mild pain in my ear maybe because I was sided left all throughout my sleep and have put so much pressure on it today I used a mirror to have a look at it looks like it has pus again and the moderate pain now is up to my left neck what should I do please help",
        "input": "",
        "output": "hi I know how frustrating this problem can get you can follow the advice mentioned below please stop using earbuds tips as they introduce infections into a sensitive region such as the ear if there is pus coming out of your ear there is a possibility of you developing an ear infection that may or may not involve the eardrum take tablet amoxicillin 500 my with potassium clavulanate 125 my combination one tablet thrice times a day after food for one week along with this you can also take a combination of paracetamol phenylephrine and levocetirizine one tablet twice daily for one week keep your ears closed with sterile cotton and change it every six hours do not allow any water or air to enter into your ear as it can keep getting infected and pus or ear discharge will start once again in a case where if by chance there is perforation of the eardrum it will close on its own once the discharge subsides do not worry about it you will be completely fine in a week time I hope this helps"
    },
    {
        "instruction": "hello doctor I am suffering from sinusitis for the last six months I have tried lots of medicines but there is no improvement because of the current scenario of couid 19 I cannot visit any ent specialist please help me and prescribe some medicines",
        "input": "",
        "output": "hi yes I understand how frustrating your problem can be sinusitis is usually secondary to a certain problem such as allergy which is the most common cause once other rare causes are ruled out so considering the treatment of this particular issue we need to always treat the primary from its root source so that the effect remains for a longer time with the least amount of medications what can be done if you are having underlying allergic issues such as sneezing watery nasal discharge ear fullness heaviness in the head and facial regions we need to treat the allergy first you need to wear an n95 mask and nothing else other than that to prevent any irritative substance such as dust fumes from entering your nose and initiating the allergic cascade mechanism leading to its symptoms wearing a mask even at home avoiding exposure to dust and other substances which instigate sneezing according to me is the single most important factor which you have to take care of as other things mentioned below are all for symptomatic relief and we are not treating the allergy as such precisely speaking take tablet sinarest acetaminophen chlorpheniramine and pseudoephedrine one tablet two times a day after food for 10 days allegra fexofenadine and montelukast one tablet two twice for 10 days duonase nasal spray two puffs in both nostrils twice daily for three continuous months do not inhale while applying the spray tablet mucomix 600 my one tablet twice daily for 10 days do steam inhalation two or three times a day for supportive relief take wysolone 10 my once a day after breakfast for 10 days tablet pan pantoprazole one tablet before breakfast for 10days clarithromycin 500 my twice daily for one month saltwater gargles to 10 times a day will keep irritative substances away from the throat all these medications will be useful only if you strictly follow the precautionary measures the requirement of medications will automatically reduce once your symptoms come down with a decreased allergic load please do get a noncontrast it computed tomography of the nose and paranasal sinuses and show it to me once you get it done in the subsequent follow ups I advise you for a follow up after two weeks of treatment so I can evaluate and let you know about the further requirement of medications I hope this helps"
    },
    {
        "instruction": "hi doctor my father has acute heart failure and extensive mi since two months ago also he got a pleural effusion and leg edema he is in bed symptomatic depending on oxygen device most of the time his ef is 21 the egg shows possible left atrial enlargement nonspecific intraventricular block right ventricular hypertrophy inferior infact and anterolateral infact irs 138 with right bundle branch block he sleeps in a 30 45 degree we did not do pi until now I would like to know will crud be good for him",
        "input": "",
        "output": "hi as he had a heart attack first priority is revascularization of angioplasty or bypass surgery if this is done and heart function improves then it will be good in right bundle branch block there is very little benefit of cut cardiac resynchronization therapy if revascularization is not possible then maximum medical therapy is best yes ice implantable cadioverter defibrillator is indicated it should be considered once the patient is out of the acute episode and is stabilized if the patient needs recurrent hospitalization for heart failure or recurrent be drops that need medicines to raise it then the option is left ventricular assist device lvad or total artificial heart tah or heart transplantation subject to availability of facilities first thing is to assess for revascularization if there is viable heart muscle I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 30 year old healthy woman I am diagnosed with anxiety disorder 10 years ago for the past year I have been experiencing crippling health anxiety I have experienced a number of frightening symptoms including brain zaps weakness in legs body twitching dizziness etc last year I had a it scan and mri of the head and neck I consulted with a family doctor and neurologist terrified of is all scans came back clear my doctor said this was all a result of my anxiety and also said he thought I was suffering from herd or acid reflux I felt better for some time but for the past two weeks I started experiencing very strange symptoms that I have never before felt in my life I get on and off tinnitus in my right ear seeing small bursts of light once or twice a day and feeling of spice burning in the back of my tongue while eating bland nonspicy food I have called my optometrist who did a full workup less than a year ago I have 20 vision and no eye conditions I explained the small bursts of light and he was not too worried and simply told me to keep track and let him know if they are increasing so far they are not but these small bursts of light coupled with the tinnitus and also the tongue burning sensation has absolutely terrified me I am terrified I have a tumor or brain cancer this fear is crippling me and I can hardly think straight should I be concerned I am on the verge of running to the er every night and begging for a it scan please help",
        "input": "",
        "output": "hi so the problem here is right ear tinnitus regarding this I need to know is there hearing difficulty in the right ear what type of tinnitus swishing or continuous how long it lasts is there any vertigo associated with tinnitus is there any discharge or fullness of the right ear regarding bursts of light which eye single eye or both eyes at the same time of tinnitus or at a different time are flashes colored or black or white is burning on the back of tongue one sided or both sided is there any redness on the tongue is there coarseness of voice or throat pain please answer all these questions"
    },
    {
        "instruction": "hello doctor my father is 65 years old he had a stroke left thalamic ich a few months back but now his blood pressure remains very high which is 10 180 200 presently he is taking prazopress 5 olmesan 40 0 and cardobis 0 please advise",
        "input": "",
        "output": "hi if there is any acute stressful condition tackle it be will be fine measures to control be blood pressure avoid smoking and other addictions reduce salt intake in diet reduce fatty foods junk foods and saturated fats avoid stress and anxiety do regular moderate intensity exercise such as brisk walk for 30 minutes have proper night sleep at least eight hours a day including at least six hours in the night uninterrupted sleep reduce weight even if weight is within the normal range drink plenty of water do deep breathing exercises and meditation measure be while you are totally relaxed sit for five minutes in a quiet room without talking to anyone empty bowel and bladder before checking be avoid tea coffee 30 minutes before checking be sit on the chair with feet on the ground back supported hand supported on a table cuff at the position of heart check the be and repeat it after five minutes again then check the be in the other arm and repeat it after minutes during the entire period remain relax and quiet arm with higher be readings is your exact blood pressure you may take at least two or more readings and the average of readings is your actual be if these measures do not help then switch medicines but before switching have renal function tests and electrolytes done if the tests are normal and you are not allergic to components of the following medicines then take tablet amlodipine or valsartan 10 160 my in the morning or evening time measure be daily as described above for two to three weeks if it normalizes continue the medicine if not reconsult"
    },
    {
        "instruction": "hello doctor I am a 28 year old male in good health I have suffered bouts of depression for the past few years along with anxiety and ocd I am on zoloft every day and am doing well for the most part I am staying active and keeping busy the reason why I ask this is that on my mother side there are two stories of people with suspected schizophrenia my maternal grandmother mother was said to have been institutionalized for her life because of it and my maternal aunt mom sister is a paranoid schizophrenic according to my grandma does this skip generations neither of my parents or siblings has this condition what are the chances of becoming a schizophrenic do I have anything to worry about",
        "input": "",
        "output": "hello based on the history provided I see that you do not have any first degree relatives with schizophrenia so the risk is not high this condition can run in families but the risk is more when you have first degree relatives with schizophrenia like parents siblings schizophrenia is relatively rare affecting about of the general population so anyone in the world has a in 100 chance of developing schizophrenia your risk will be the same as the general population possibly marginally higher due to extended family history you need not worry unnecessarily as the risk is not substantially higher than anybody else in the world to give you an idea about the genetic risk of schizophrenia look at these figures if there is a first degree relative with schizophrenia the risk increases to 10 if both parents have schizophrenia the risk increases to 50 if there is identical twin the risk can increase to about 50 to 65 you do not fall into these categories you may be aware that genes play a role in the etiology of schizophrenia but they alone are not responsible schizophrenia is caused by a complex interaction between genes environment and psychological factors environmental factors like illicit drug use and high stress levels play a huge role since there is a possible history of schizophrenia in the extended family it makes sense to avoid any risk factors like illicit drugs use weed cocaine etc continue an active and healthy lifestyle continue appropriate treatment for depression anxiety and ocd obsessive compulsive disorder if you have any other concerns you can contact your psychiatrist for a review I hope this helps"
    },
    {
        "instruction": "hello doctor I am four months pregnant my hand and leg palms feel like burning and become very hot and I have the same feeling in my vagina too I also get an occasional sharp pain in my lower abdomen for a few seconds is this normal in pregnancy kindly suggest I have attached my reports and I am currently taking fol 123 duvadilan duphaston 10 my udiliv 300 my pan thyearoxine 12 and eltroxin 75",
        "input": "",
        "output": "hello I read your examination they are all normal the symptoms that you prescribe above are common during pregnancy burning sensation in palms and hand is called carpal syndrome it happens in pregnancy due to swelling of tissues the burning sensation in the vagina is because your sexual organs are more vasculated more blood comes to them during pregnancy to exclude vaginal infection you can perform a vaginal swab and urinary analysis your cervical length is 31 my so you do not have to worry about abdominal pain that does not seem to be a uterine contraction continue your medication and especially you have to consult with an endocrinologist to secure that the thyearoid hormone levels are normal"
    },
    {
        "instruction": "hello doctor I think I may have ringworm it is located on the left side of my stomach almost hip I have tried putting clotrimozol and daktarin on it I am afraid that it may spread to other parts of my body please help",
        "input": "",
        "output": "hello how long it has been there what are the symptoms of it any other area affected any other family members affected any history of hypertension diabetes mellitus or thyearoid disorder any known drug reaction looking forward to your response in order to help you"
    },
    {
        "instruction": "hello doctor I am a 23 year old female I used to urinate on the bed since childhood please suggest me some medicines",
        "input": "",
        "output": "hello have you tried any medication before also do you have a dry period anytime until these 23 years you still do bed wetting on a daily basis or it is just when you cough or sneeze do you have any history of diabetes or hypertension or any medications kindly elaborate on how many times at night you wet and how many times you get up to urinate"
    },
    {
        "instruction": "hello doctor I have severe pain in the neck and shoulders often accompanied by numbness and tingling I also have frequent migraines and some times dizziness as well with occasional fainting which is exacerbated by loud sounds and harsh lighting I used to be a professional bass player 20 years but no longer performing live for the past two years due to worsening conditions I am currently taking ot painkillers and homeopathy medicine for migraines",
        "input": "",
        "output": "hello it would have been better if you had included the mri and ray films or at least the report as I believe it is your cervical spondylosis that may be the cause of your current symptoms I will recommend you to do neck strengthening exercises shoulder elevation exercise and take pregabalin tablets for nerve pain along with duloxetine and take antiinflammatory tablets for a couple of weeks to see the response as your are getting twitching and this may be viral in nature or may be myoclonus I will not to ignore that and perhaps see a neurologist at the next opportunity"
    },
    {
        "instruction": "hello doctor I am 16 years old my weight 87 keg and 73 am tall it has been a year since I am not comfortable having bowel movements I go to the toilet once a week and the stool is usually hard to pass without a natural laxative and I use agiolax I do not know if the use of this laxative is safe or not but it is working every time whenever I use it",
        "input": "",
        "output": "hello welcome to icliniq com you have chronic constipation there is possibility that your large bowel is functioning slow or it may be a problem with the ejection of stools and not necessarily slow bowel to differentiate between I need to have more information the laxative you use is safe but it has the potential to develop tolerance I it can lose its effect if uses for a long time so as far as it is working fine you can use it the other complaint you mention of bloating and fullness after a small meal are secondary to constipation recently the fda food and drug administration has approved some newer medications for primary constipation you can use it take tablet prucalopride my daily you can stop other medications for constipation let me know in a few days how you respond if no improvement we can increase the dose or add some other medicines I hope this helps chronic idiopathic constipation defecatory disorder tablet prucalopride my daily follow up in one week"
    },
    {
        "instruction": "hello doctor my 10 month old baby is facing irritation in her ear with persistent itching",
        "input": "",
        "output": "hello I would like to know is there fever or any other complaints"
    },
    {
        "instruction": "hi doctor my grandmother has purple spots on her legs and arms it looks like senile pura but I cannot be sure the one on her leg is much larger and seems to spread a little over the course of a few days the one on the arm is small she is taking calcium and vitamin for her osteoporosis and I have given her some vitamin ke and do drops as well from time to time she is 85 years old",
        "input": "",
        "output": "hello welcome to icliniq com I can understand your concern according to your statement your grandmother have been suffering from purple spots on leg and arm with osteoporosis when small blood vessels are ruptured causing blood to pool under the skin and can create purple spots on the skin are known as purpura may be resulted from illnesses such as bleeding disorder recent history of blood transfusion cancer she systemic lupus erythematosus infections like hiv human immunodeficiency virus hepatitis civ cytomegalovirus ebb epstein bar virus etc it may also occur due to inflammation of blood vessels blood stream infection vitamin deficiencies medications like heparin aspirin sulphonamide steroid chemotherapy digoxin hormone replacement therapy etc pura are usually benign and may resulted from above mentioned causes and it sizes can vary from small dots to large patches senile pura is benign which affects older people as their skin and underlying blood vessels become more fragile with aging and may bleed from minor trauma the treatment depends on causes and most of the pura does not need any treatment and dissolved over time it may take to weeks to heal the treatment are only needed for those which are not disappeared over time you can use topical retinoids along with her current medications I want to add that according to the pictures that are shown here your grandmother have been suffering from age related senile pura give her vitamin and citrus foods like orange lemon etc with application of sunscreen and sun protective clothing along with previously mentioned medications"
    },
    {
        "instruction": "hello doctor I started the depo shot before six months and I missed my second shot I did not continue getting the shot so I have been off birth control it was my first depo shot I have ever received and I am not sure how long it takes to be totally gone but I have been very sexually active with my boyfriend for the past few months I have not started my period as I got the shot yesterday I bled very lightly but only for a couple of hours and then it stopped completely I am wondering if this could be implantation bleeding I have had a couple of bad headaches recently but do not feel as crappy as I do when I am on a normal period I was wondering that any chances to become pregnant or not but I have not noticed any morning sickness or weird cravings please suggest me",
        "input": "",
        "output": "hi for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hello doctor my partner who is 36 years old broke his ankle fibula break before 5 weeks I had been for his appointment where he had an ray and found that the bone has not knitted together he smokes approximately 10 cigarettes per day I have found through online research that smoking hinders bone healing and have advised him to stop even if short term to assist with the healing of the broken bone he had cast for three weeks and then was transferred to a walking boot with vague instructions on how to deal with it he is being told that he should be walking more on the ankle which is broken but he is worried as he will cause more damage as it is not yet aligned also should he be wearing his walking boot at all times he wears while sleeping and he removes it while bathing daily please explain to him that how the bone will heal and whether he should be wearing his boot all the time",
        "input": "",
        "output": "hi revert back with the ray report to an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hi doctor I am 27 years old I have knee pain in both the legs and it is paining alternatively for the past 5 years pain starts with swelling around the knee and stay for three to four hours and the pain will be at least once in one to two months I feel like pinching with needle in the feet I also get backbone pain in the early morning I have consulted a specialist and he told to do the attached laboratory tests I have aso titer 800 iu my and I do not have any tiredness headache fever history of jaundice joint pain etc please help",
        "input": "",
        "output": "hello I have noted your complaints and also gone through the reports carefully anti dnase and echocardiogram rheumatic fever nsaids nonsteroidal anti inflammatory drugs like celecoxib 200 my piroxicam 20 my twice a day it can help to reduce the symptoms of pain and swelling for further information consult a general practitioner online"
    },
    {
        "instruction": "hi doctor my son is years month old his height is 19 am and weight is 25 keg he is a very normal and healthy boy my height is feet inches and my wife height is feet I am worried about his height please explain me",
        "input": "",
        "output": "hello genetic and nutritional thyearoid profile and ray both wrist joints for bone age estimation constitutional or genetic short stature for further information consult a paediatrician online"
    },
    {
        "instruction": "hi doctor for four years I have the really bad coordination I fumble things a lot I am very clumsy weak tired and I pee all the time I drag my feet along the ground while walking and my legs do not work when I try to stand but that is a rare thing for me I have memory issues moderate vertigo blurry and double vision and often trouble using my hands severe anxiety and depression but I do not have any emotions my mood changes rapidly sometimes while talking I slur my words and I often have jumbled speech when I was 15 I was kicked and punched in the head while I was sitting down and I was unconscious for about 10 minutes also when I was around to 10 years old I fell off from the roof and twisted my vertebrae I have done my brain scan and spine scan please help me",
        "input": "",
        "output": "hello I read your query and understand your concerns from the available description there are two possibilities which need proper evaluation for further information consult a neurologist online"
    },
    {
        "instruction": "hi doctor I had my periods on the 31st of last month then I had sex on the 26th with protection I also used emergency pill when will I get my next periods are there any chances of pregnancy please explain me",
        "input": "",
        "output": "hi revert back with the answers to the above questions to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hello doctor four months before I was diagnosed with fatty liver slightly elevated fasting sugar and the level of total cholesterol my current medications are tablet viboliv 500 daily two times in a restricted diet and nexpro rd I had consumed spicy foods rarely in the last four months I lost keg weight however today I have repeated the same tests and all the blood tests are normal but there is something in my us of the whole abdomen my us report of liver is as follows liver is enlarged the echogenicity is diffusely increased without any focal lesion the intrahepatic structures are normal and no focal area of altered echogenicity is noted the hepatic ports are normal the common duct at ports measures my and the portal vein measures 10 my to porta final impression is hepatomegaly with fatty liver and this is my recent us report my other organs are normal and I feel pain in the run and flatulence is present also I tested for fbi let and lipid profile is it a reversible condition also please let me know how much time will it take will you please guide me about the seriousness of this condition thank you",
        "input": "",
        "output": "hello revert back with report and answer to the above question to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor my son is 20 months old he is suffering from ti since yesterday he cries while urinating in the morning he has fever for two days and cough and running nose for five days the general physician gave cefpodoxime oral syearup but urine test has to be done tomorrow morning only should we start the antibiotic no pediatrician nearby and we have to drive six hours to another town for the pediatrician please suggest me",
        "input": "",
        "output": "hi crying while voiding urine and fever might be due to urinary tract infection ti urine routine and microscope needs to be done for screening and if it suggests infection then urine sample for culture and sensitivity needs to be given and oral antibiotics has to be started the culture report which takes two to three days will guide the further use of antibiotics if any infection positive antibiotics should be started only after giving off a sample for culture and sensitivity if ti is suspected giving urine sample for testing after taking antibiotics might alter the test report and delay the infection for further information consult a child health specialist online"
    },
    {
        "instruction": "hi doctor my 19 year old daughter is having a benign tumor in the liver predicted as unh it has been advised to be removed under surgery since the tumor is growing in size although insignificantly she is having a blood pressure reading of only 90 60 mhg normally for months together can she go for surgery or is it risky her low blood pressure is the concern",
        "input": "",
        "output": "hi for further information consult an anesthesiologist online"
    },
    {
        "instruction": "hi doctor I have been having neuro issues such as seizures headaches etc for the past 5 years I was tested for paraneoplastic syndrome and came up as reactive on immunofluorescence but negative ultimately on western blot still a pet scan was done and it was clear I have had several brain iris over the past 5 years all have noted cerebral microhemorrhages these are unexplained I understand that they have not changed in size or character over the years but one or two more have appeared I understand in the differential diagnosis for these bleeds is hemorrhagic metastatic melanoma no doctor has been suggested it what is the possibility that these are actually melanomas my doctor said unlikely because it has been 5 years and the actual hemorrhages remain unchanged how can a radiologist be sure that these are not cancerous the first scan done before two and a half years was with contrast and the remaining were without contrast I am just concerned about these unexplained hemorrhages in light of my neuro symptoms I wonder if I have brain metastasis without cancer anywhere else in my body please explain",
        "input": "",
        "output": "hi revert back with the scan report to a radiologist online"
    },
    {
        "instruction": "hi doctor for the past six weeks we have been noticing that my father up sugar levels after breakfast are in the range of 195 to 250 depending on what he eats fasting levels are more or less fine he had done his laboratory tests before two months and his hba1c was fine I have attached the blood reports along with his current medications list should we increase the insulin please explain thank you",
        "input": "",
        "output": "hello I can understand your concern for your father for further doubts consult a diabetologist online"
    },
    {
        "instruction": "hello doctor I am a year old female I have found a pink spot on my skin that resembles melanoma a little I was wondering if I can send pictures for you to look at and let me know if it looks like that",
        "input": "",
        "output": "hi welcome to icliniq com I have gone through the picture and blood investigations that you sent this lesion is asymmetric and presents irregular borders and irregular distribution of the pigmentation presents border irregularity color variation and a modular component of diameter my before I make further diagnosis I would like to know for the last few months is there any change in size and new lesion change in color change in shape is there inflammation bleeding or crusting sensory change lesion diameter my meanwhile I would like to classify this lesion as suspicious and would like to advise biopsy for treatment I would wait for the answers to the above questions and give you some iron and vitamin supplements that are deficient in your body melanoma coagulation profile biopsy of the lesion common melanocytic nexus atypical melanocytic nexus traumatized nexus pigmented actinic keratosis seborrheic keratosis melanoma iron and vitamin supplements injection ferric carboxymaltose 100 my in 100 my is over 30 minutes cholecalciferol sachet 60 iu once a week for eight weeks tablet shelcal 500 my twice daily biopsy of the lesion"
    },
    {
        "instruction": "hi doctor my daughter is 15 months old her weight is 2 keg and height is 80 am her food includes apple rice green gram vegetables along with breast milk but I am not adding sugar or salt I am giving her ostocalcium vitamin and multivitamin as suggested by her pediatrician she has got her four upper teeth and two lower teeth last week I noticed that half portion of the upper teeth not covered with white and looks like enamel loss I have attached her teeth photos for your reference does it need any treatment or is it common is it because of the vitamin supplements could you please suggest me the treatment and what needs to be taken care of further thank you",
        "input": "",
        "output": "hi for further information consult a pedodontist online"
    },
    {
        "instruction": "hi doctor a couple of days before I found out that I am pregnant according to the first day of last menstrual period I am about four and a half weeks pregnant this is my fourth pregnancy I had an ectopic pregnancy before four years then gave a birth after a year through emergency cesarean and delivered another baby through cesarean after 15 months after my second baby my doctor advised me not to get pregnant for a minimum of 18 months to years she said that my uterine wall was very thin it has been almost 18 months since my last cesarean I am in a confused state now whether to continue with the pregnancy or not I spoke to my go and she said it is all up to me but there is a risk what should I do now",
        "input": "",
        "output": "hi I think your go has guided you correctly abortion can be associated with complications some of which may be major your gynecologist informed you about your weak uterine scar so continuation of pregnancy can be risky as well in my opinion you should consult your gynecologist who had done your cesarean section then after understanding every advantage and disadvantage you yourself take the decision for further doubts consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor my wife is suffering from feet swelling for the past four years we met nearly seven to eight doctors for this issue but she did not get any relief please help",
        "input": "",
        "output": "hi for further information consult an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hi doctor I had unprotected sex with my girlfriend on ith of last month it was the fifth day of her periods then she took an I pill within three hours she got her periods on the 17th of the same month may be it could be a discharge because of I pill after that till now she has not gotten her periods we have taken three pregnancy tests and all are negative can you please suggest the next step thank you",
        "input": "",
        "output": "hi for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I am a 28 year old male approximately six to seven years back I had urinary infection when I was sexually active with my girlfriend I was advised to take an antibiotic course which I did not complete at that time and the infection was not fully cured after that incident I used to get urinary infection once in a few months during urination I sometimes used to have one or two drops of blood only during the time of urinary infection in addition to the above mentioned problems I have some other issues related to sexual health such as premature ejaculation extremely bad timing sensitivity of the penis skin lower back pain lack of confidence etc very often on my way to the toilet some urine drops are leaked during night time I have to stand up several times to urinate sometimes approximately once a week after urinating suddenly sperm drops are released but I have not discussed this part with my urologist in person I am not a stressful person so the reason behind this has to be something else than stress I have now recently been to a urologist and I was told that the infection became chronic the doctor recommended antibiotics again and I have now completed the course the urinary infection should be cured by now all the new tests were negative the urologist told me that my prostate size is bigger than people in my age please suggest me some good solution for the above mentioned problems I want to get married soon and live a healthy life the ultrasound has been made the urologist here told me that my prostate size is bigger than normal people in my age this is not suppose to happen until a person gets older that is the main reason of feeling weak and not being able to control urine etc I hope you understood all my problems please suggest me some medication for all the above mentioned problems thank you",
        "input": "",
        "output": "hi I assume that your reports have all been normal if not then please forward it to me revert back with the reports to a urologist online"
    },
    {
        "instruction": "hi doctor my baby boy who is months 14 days old his weight is 6 keg and height is 27 inches he is taking arbivit and zincovit drops daily according to the doctor advice are his weight and height fine from few days there are some reddish spots developed on his head and in some parts of the body it is gradually increasing and there is no secretion from this spot what are these spots are these harmful what is the treatment please explain me",
        "input": "",
        "output": "hi for further information consult a paediatrician online"
    },
    {
        "instruction": "hi doctor I have noticed something different on the tip of the nails at the tip of all nails a band of half white color has formed and it is going around the circumference of the nail horizontally they are not an exact horizontal line but a circular band around the tip of the nail I am also attaching the picture of my nails for your better understanding I am not sure whether they were always there or have developed recently but I noticed them recently please tell me what is the cause of this I also have some unusual taste in my mouth or tongue I do not know whether they are related with the nails but I have not had this before please help",
        "input": "",
        "output": "hi for further information consult a dermatologist online"
    },
    {
        "instruction": "i had a sinus infection and was prescribed two weeks clavulin for a total dose of 1500 my per day at the end of two weeks I was symptom free but the day after I finished the meds I got my symptoms back and developed frontal sinus infection I went on clavulin for three weeks at the highest dose and had frontal sinus symptoms the whole time while I was on the antibiotics I finish these antibiotics two weeks ago every day for the last two weeks I have a lot of pressure tension on the top of my head that is pressing down on the top of my head and is very bothersome and also sometimes across the top of my forehead with occasional aches in my eyes it is very hard to focus on anything else because the pressure is so bothersome it has not gotten worse but remains the same every day can you tell me what is going on",
        "input": "",
        "output": "hi apologies for the late reply as you have rightly put it the most probable problem out there is a severe allergic problem with an associated sinusitis frontal sinusitis to be precise I have tried to explain things in a very simple yet precise manner below the cascade of events is explained in a very simple manner below eventhough its not as simple as it looks exposure to dust or any irritative substance that your body is hyper sensitive 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 now this is general cascade that usually occurs in most people but need not be specific to you sinusitis is always secondary to something allergy being the most common out of them there could be other reasons as well for sinusitis to occur such as a hypoplastic frontal sinus narrow frontal outflow tract frontal recess sinonasal polyposis etc another important fact about sinusitis is about its recurrence plain use of antibiotics does not solve the issue but just keeps it off for a while we need to dig down and see what has caused the sinusitis in the first place for appropriate treatment rather than superficially treating it with plain antibiotics precautionary measures is one such thing which if followed such as in a case or allergy will definetely go a very long way in keeping the problem at bay the requirement of medications also will be less and on the whole you will have immense benefit you can consider the following advice all precautionary measures have to be followed strictly for maximum relief other wise medications will not be useful on long term if things do not seem ok even after following the treatment schedule mentioned above a non contrast it is mandatory to find out what exactly could be going on in the sinonasal region anatomical variations extent of inflammatory load are few things we look into while reading a it scan 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 nut shell 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 I hope I have answered to your query in detail sorry again for the late reply get well soon warm regards"
    },
    {
        "instruction": "hi doctor my weight is keep on increasing in spite of diet and regular exercise I got my thyearoid test done and it showed high ash of 7 with normal to and to I am getting regular cold what to do",
        "input": "",
        "output": "hi for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am getting headaches during sex also the pain peaks at orgasms please help",
        "input": "",
        "output": "hi for further information consult a sexologist online"
    },
    {
        "instruction": "my son is and months old we are not in our home town at the place where we live they speak a different language so as to connect him with a common language we speak in english initially he struggled but now he is able to understand english very well he even speak in english very well to few questions we ask he does not answer properly like if we ask him what is your name daddy and mother name he answers perfect if we ask him how are you sometime he answer but sometime he just repeat how are you he has good eye contact he has good social skills even if iam sad or sitting alone he wil come to me ask what happened mommy do you have fever in the beginning when he started to teach him talking if we ask him to say hi even he will say hi but no if we ask him to say hi he will just say hi if he is hungry he wil come and say me he is hungry if he does not need something too he wil say no if he wants to go to toilet too he will say us he wants to go to toilet he needs help only in washing initially he likes to play with rotating objects like rotating a remote control something like that but now he does not do that he is of little shy type but once he mingle with someone he will be very happy and will play with them initially he did not have clarity in speech but now he is good in that too he just does not answer to few of our questions if we show him picture and ask what he is doing he all answer it lke crying laughing eating apple and all tat he is able to identify fruits vegetables and whatever things we give him he does not have any problem with his sleep so I want to know if it is a problem or if he is fine",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hi doctor I am a 28 year old transwoman I am looking forward to start hit I need some advice from you to start on hit for male to female transition thank you",
        "input": "",
        "output": "hi revert back with the answers to the above questions to an endocrinologist online"
    },
    {
        "instruction": "hi doctor a mole like projection has developed in my lip it does not get cured I bite my lip often but I feel it is very abnormal on my lip can you please help me",
        "input": "",
        "output": "hi for further information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor I had unprotected sex on the fourth day of my periods and I took a contraceptive pill within half an hour now I am bleeding after seven days from the day I had taken the pill are there any chances of pregnancy please explain me",
        "input": "",
        "output": "hi revert back with further details to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I am not living together with my husband and we have a six year old boy my child is living with my husband only he used to meet me for some time and tell all the information what he had done before four years when he was years old he said that my husband banged my son head five to six times on the wall and made his nose bleeding now we got to know that my son has add now what should I do to know whether my son is fine or not",
        "input": "",
        "output": "hi first of all let me tell you that you are doing a great job managing a kid with add along with some family issues what you had mentioned for further information consult a child health specialist online clinical examination by a pediatrician"
    },
    {
        "instruction": "hello doctor for the last month I have been suffering with pain on my spine and lower back when I touch a specific point on my spine the pain is severe it hurts when I bend or sit it feels very sore I visited a go and she said that she thinks it is a muscle insertion that causes the pain but she is not sure she did a neurological examination and all was normal I wanted your opinion as my ankles and shin bone now started being painful too I was diagnosed with fibromyalgia four months ago and wanted to know if it is this that causes bone pain my posture is quite bad too so I am not sure what it could be I am very worried in case it is something very serious what I should do now",
        "input": "",
        "output": "hello from your history and being unable to examine you I can only speculate on the cause yes fibromyalgia can lead to trigger spots like tender areas which can be over the muscle belly or their attachment on the bone the good thing was that the neurological exam was normal now coming to your concern that the shin and ankles had become painful I will recommend that you get your ear erythrocyte sedimentation rate cop reactive protein complete blood count abc urine routine vitamin levels and blood sugar tested this will generally show indication about any inflammatory process and bars on that you can be started on antiinflammatory medication including steroids and possibly vitamin too please let me know your investigation results"
    },
    {
        "instruction": "hello doctor my year old daughter is having redness in eyes we consulted her pediatrician and he advised moxicip and mezol eye drops for five days but the redness has not gone away but it is reduced",
        "input": "",
        "output": "hello for how many days you have used these drops is she having itching also any symptoms like running nose cough or fever is there problem in only one eye or both eyes"
    },
    {
        "instruction": "hello doctor I currently have aligners on and since I started the treatment I noticed a little white contour around my gums lower teeth they lift a little bit is it something to be alarmed about",
        "input": "",
        "output": "hello welcome to icliniq com no your gums are absolutely fine and nothing to be alarmed for they are minor issues due to the realignment of the contour of your gums do continue to use aligned when you remove your aligned please apply rexidine forte gel if you feel any discomfort it is just contouring your gums to the same level if you carefully look to the image you uploaded you will notice those white lines only on the tooth that placed below realignment of the gingiva contouring it on the same level continue using aligners I do not think there might be any sharp edge do mention to your dentist if present follow up after seven days apply the gel when not using your aligned use a simple mouthwash like collate plus after brushing your teeth to keep your gums healthy warm saline gargle occasionally"
    },
    {
        "instruction": "hello doctor I just want to ask what is the best medicine for allergy I have hives on my body and so itchy when I scratch them it turns painful I even have them on my soles and palm I am currently on loratadine",
        "input": "",
        "output": "hi itching with hives has various causes treatment of it is mostly according to the cause another treatment is symptomatic loratadine is antihistaminic and antiallergic medicine in your case of itching with hives you can take desloratadine with montelukast dazit or fexofenadine with montelukast allegra but to search for the cause of itching with hives will be more beneficial"
    },
    {
        "instruction": "hello doctor I had tooth decay and got it fixed at my dentist after that I started feeling pain and my dentist told me it is because of the sinus I started using salt sprays after a few days I could still feel the pain yet he did an ray and could not figure out what is wrong but I am still in pain today I have a fever stomachache and my molar still hurts me I read it could be an infection or is this wrong",
        "input": "",
        "output": "hello welcome to icliniq com yes you are certainly correct do warm saline gargle three to four times a day your dentist should have taken an ray before filling it please take tablet sporidex cephalexin 500 my tablet twice after meals for five days metrogyl er tablet twice after meal for five days zerodol so aclofenac and serratiopeptidase tablet twice after meal for five days rantac ranitidine tablet twice before meal for five days your doubts are certainly correct later you might need a root canal or extraction to eliminate the cause completely please do not worry so much it is nothing serious and it will subside once you are on these medications and get proper treatment I hope this helps periapical abscess root canal or extraction warm saline gargle betadine mouth rinses twice or thrice a day after seven days"
    },
    {
        "instruction": "hi doctor I am feeling numbness and cold sensation on the left side of my body from calf legs up to arms and face I am 35 years old with a height of 169 am and weigh about 64 keg I am taking pregabalin for the past two days",
        "input": "",
        "output": "hello well most of your symptoms do look like related to the nerves only as the feeling of tingling and numbness can be related to that I have gone through your older reports as well where there is a mild spasm of the spine but since it is affecting your hands and face it probably looks like coming from the neck region this time you can get an ray done as and when you get time but will guide you with the following lifestyle changes as well you can continue pregabalin for 15 days to 30 days at least if you feel the relief is not adequate you can increase the dose to twice daily for seven days include vitamin along with pregabalin as well to strengthen your bones as for the postures make sure you are not sitting in front of the laptop for too long with head bent forward it should be at a good height so it does not strain your neck too much daily walk for 20 minutes along with spine and neck strengthening exercises for 10 minutes you can use local sprays and gels over the neck for some relief I hope this helps cervical radiculopathy"
    },
    {
        "instruction": "hello doctor we got married for the past three years we planned to have a child after one year we tried to conceive for about a year but were unable to do so then we consulted a doctor who conducted many tests such as endometrial lining hormonal levels etc all tests including hormonal levels were normal but the ultrasound as per doctor showed pro not cos she prescribed medicines for three months duphaston 10 my from 16th day of period peril it and fol at the end of the third month my wife felt pain similar to menses but nothing happened we tested with hug strip which resulted in positive and her last period date is and april now the problem is I am now unable to contact the present doctor due to lockdown I want suggestions regarding whether to continue the medicines or not if not will there be a change in medicine any specific diet plan any exercise yoga etc will complete bed rest help or can she do some house chores in the initial pregnancy period",
        "input": "",
        "output": "hello if the hug human chorionic gonadotropin strip results positive it means that your wife is pregnant based on her last menstrual date she is weeks and days pregnant she can take duphaston for two weeks every day two tablets a day and folic acid 400 mug one tablet a day until 12 weeks of pregnancy she should not take any other medication ultrasound"
    },
    {
        "instruction": "hello doctor I have been suffering from gas for the past three years I have bloating after meals for about 15 minutes after which it passes away I can eat normally but some times I feel bloated and cannot eat I keep burping like once in 20 minutes is that normal and also bloating increases when I have anxiety I am taking sompraz esomeprazole 40 my and levosulpiride 75 my once in an empty stomach daily whenever I try to leave the medicine I have gas and acidity on the second day I also take alcohol like 90 my regularly for three years there is no pain or anything but only burping and bloating I wonder is it just anxiety or something serious I am also very much afraid to visit a doctor least they prescribe endoscopy I am feet inches tall and weighs 78 keg I had an ultrasound about one and a half years ago and it was normal please suggest",
        "input": "",
        "output": "hello well the burping while having meals or just after the meals is a normal phenomenon and I assure you it is not alarming in your case however it may cause trouble if gas trapped excessively and result in belly swelling the reason behind this excessive bloating in your case may be aerophagia engulfing air while taking meals that commonly occur in one who keeps speaking while having bolus can be due to supragastric belching and may be due to excessive gas production after meals the last group of people in medical science are termed as bloater some are early floaters where bloating occurs within 15 minutes of meal and some are late floaters where bloating occurs after two hours of meal this whole explanation is just to make you understand your own condition well you seem to be late bloater and cause seems to be excessive gas production plus aerophagia I want you to take a three week course of antibiotics to reduce the excessive gas production within your bowel the antibiotic is safe without any side effects except in some may cause diarrhea of mild intensity silo small intestinal bacterial overgrowth tablet rifxamin 200 my thrice daily for three weeks and then stop tablet digestive metaclopramide 40 my half an hour before meals for one week and then as per need you can stop sompraz as tab digestive will work in more effective way than this"
    },
    {
        "instruction": "hi doctor I am 26 years old and trying to conceive I ovulate on 16th april and noticed spotting on 17th and 18th april my period was due on 30th april and I am currently days late my pregnancy test is negative and I was prescribed devilry I am on my first day of devilry when can I expect my period and will I ovulate in this cycle",
        "input": "",
        "output": "hi I understand your concern you are absolutely correct that stoppage of pill causes mid cycle spotting why are you taking birth control if you are trying to conceive now coming to your question the dose of devilry medroxyprogesterone is 10 my twice a day for five days you only need to take 10 tablets and your period will start about two to seven days after taking the last tablet it varies from person to person devilry will not interfere with ovulation and since you get regular cycles you can expect to ovulate any time between 12 to 16th day I am sharing a little extra detail that will help you ovulation symptoms that can help you plan intercourse during those fertile days are cervical mucus changes heightened sense of smell breast soreness or tenderness mild pelvic or lower abdominal pain light spotting or discharge libido changes and changes in the cervix you should have intercourse on every alternate day from 10 the to 20 the day of your cycle to increase your chances of conception I hope this helps"
    },
    {
        "instruction": "hello doctor I am 21 years old I have been worried because my penis head has turned blackish and I have horizontal wrinkles on it I masturbate once a day for the past three years and often forget to clean the sperm after masturbating please suggest",
        "input": "",
        "output": "hello I read your query and understand your concerns I have gone through the attached images and it is true that there is some black discoloration at the glans penis head but it does not look like symptom of any illness or disease in other words it can be stated that poor personal hygiene can be the cause and exercising proper care during bath and otherwise can be of much use I must acknowledge that images attached to the query are of low resolution but can be considered of average quality for the initial assessment in case there is no improvement after improving personal hygiene I recommend you to post high resolution images on the follow up query I must also inform you that slight black pigmentation of the penis can be due to the overproduction of melanin which is responsible for the color of our skin this generally represents injury to the penis because of some injury due to aggressive masturbation which may be applicable in your case so it is important to remain gentle with yourself when you hold your penis next time I recommend you to wash with a mild cleanser and rinsing thoroughly so that dead skin can be removed which will change the color to the original it is also recommended to use antioxidants and mineral rich diet in your daily schedule to rejuvenate the skin of the body I hope this helps"
    },
    {
        "instruction": "hello doctor this query is for my daughter who is years and months old she lost her top primary incisor teeth universal numbering before four months she still has not got the permanent teeth until now she however has lost the other three incisors and got the permanent teeth kindly do let me know if the above delay in the growth of these teeth is normal she is taking eltroxin 25 my since birth",
        "input": "",
        "output": "hello as you mentioned your daughter is years and months old please confirm if she has lost all her upper primary teeth or lowers where the permanent teeth have come other thing is if all the upper four primary incisors are gone and three have come generally we need to see which tooth incisor has not come out of four permanent incisors if missing tooth is lateral incisor means next to two central incisors then we can wait and watch for another two to three months other scenario is if only one upper incisor is lost three to four months ago and the rest of the milk primary incisors are intact then we can still wait two to three more months but if out of four upper permanent incisors only one that too central permanent incisor has not come out then it is better to take radiograph iota intraoral periapical radiograph ray first to rule out any hindrance in the eruption of the tooth or any permanent missing tooth if possible click and share the picture of mouth oral cavity with teeth and send it across generally a delay of one year in an eruption of permanent teeth is quite normal but we need to confirm which tooth is missing and need to see the chronology of other teeth simultaneously to rule out any abnormal changes eruption delay if only one primary tooth was lost and counterpart permanent tooth is missing for the past four months iota ray of upper front teeth first need to examine clinically and then if needed iota ray and depending on iota findings treatments to be planned"
    },
    {
        "instruction": "hello doctor I am 21 years old with acne prone skin I have lots of acne scars and pits from popping pimples when younger I tried benzoyl peroxide and did not work what medical procedure can stop pimples and heal the pits and scars I am suffering from this for the past six to seven years",
        "input": "",
        "output": "hello chronic acne with resultant scarring is an indication for treatment with oral isotretinoin besides topical antiacne preparations like benzoyl peroxide or clindamycin for scarring there are cosmetic procedures like laser resurfacing or dermabrasion"
    },
    {
        "instruction": "hi doctor I want to ask about the condition of my ear because I have pain in one ear and I had some fungi in addition to the tinnitus I recently went to a doctor so he gave me some drops to eliminate these fungi but after getting rid of those few fungi I do not hear as well as the other ear some blood started flowing and the pain is more I think that there are infections and something more dangerous because the blood has not stopped please help",
        "input": "",
        "output": "hi as you have rightly put it there is a possibility of recurrent fungal infection what we call as otomycosis this condition is very notorious for its recurrence even after treatment usually usage of earbuds I q tip initiate the entire problem as often the cotton tip is not sterilized in a proper manner thereby introducing infection the entire fungal blob can obstruct your ear canal and you will have fullness along with itching and associated pain it is very essential that the fungal blob be suctioned out completely not leaving backtrace of fungal hyphae as they can form another colony in no time I recommend you to see an ent to get this entire blob suctioned out continue to use the antifungal ear drops I usually recommended a combination containing clotrimazole as it is the most effective in treating such conditions it will take a while before your ear gets back to normal and there is nothing you need to get stressed about as it is a very common entity we encounter in the outpatient department I hope this helps"
    },
    {
        "instruction": "hello doctor I am having a pea like lump in my labia it is not visible but it is like a ball and painful I have started having ciplox 500 and applying a warm compress please help as I am very scared regarding what is it and how will it go away",
        "input": "",
        "output": "hi your history suggests a bartholin abscess or maybe a fungal growth the growth actually needs to be seen before I can give you any coherent advice but I definitely suggest personal hygiene wearing cotton underwear and preferably sun drying your underwear to prevent any infection good diet and exercise goes a long way to provide immunity against genital infections too for relief I suggest you start a warm sit bath and avoid intercourse for a few days any over the counter painkillers like paracetamol can be taken if you have no known drug sensitivity but if still your symptoms do not subside you may have to take antibiotics I hope this helps"
    },
    {
        "instruction": "hello doctor I have semi acute pain in my left ear due to someone slapped in my ear while ragging last year I did not visit a doctor because I feel uncomfortable about discussing this issue but nowadays I feel a sound that is like when water enters our ear now I have feared of phonophobia please suggest",
        "input": "",
        "output": "hi you might have developed an eardrum hole I perforation since the eardrum is a very delicate structure and cannot tolerate a high volume and high impact gush of air in such a circumstance you will definitely have symptoms such as ringing sensations feeling of air coming out irritation unable to tolerate loud sounds and even decreased hearing there is nothing to worry as the eardrum heals on its own in four to six weeks provided you follow certain precautionary measures precautionary measures include not allowing water to enter the ear place sterile cotton in the outer ear and wear a shower cap as well while having a head bath cotton places have to be changed every six hours during the day there is no medication as such required unless your ear has got infected and there is discharge in such a situation the healing process might take even more time or sometimes if adequate care and hygiene are not maintained the hole or perforation might not heal at all and might require surgery to get it closed I hope this helps"
    },
    {
        "instruction": "hi doctor I am suffering from thygeson superficial punctuate keratitis disease and it is chronic my father has glaucoma I have been using steroid eye drop they are fluorometholone ophthalmic suspension and restasis eye drop I have been having this eye problem since about two years I am attaching my detailed description please help me",
        "input": "",
        "output": "hello for further information consult to an internal medicine physician online"
    },
    {
        "instruction": "hello doctor the symptoms I have are bad cold or strep throat itchy eyes and throat but no cough I do not have tonsils but seems like there is a whitish puffiness on one side of my throat it started five days ago and it has been getting mildly worse since then I have been loading up on fruits vegetables preventative vitamins raw garlic and even tried a saline sinus rinse I just moved to a place where it is very dry and I am used to very humid climate I have never had hay fever or sinus issues or been affected by pollen am I sick or is this a severe reaction to the blanket of green pine pollen all over the town can pine tree pollen cause swollen throat earache and headache only on one side of my face",
        "input": "",
        "output": "hello revert back to an allergy specialist online for further follow up"
    },
    {
        "instruction": "hi doctor I am a year old male my uric acid level is 2 can I consume some powder for gaining weight sometime I feel stiffness and joint pain please help me",
        "input": "",
        "output": "hi for further information consult a nutritionist online"
    },
    {
        "instruction": "hi doctor four days ago I had oral sex with a lady who I already know though no intercourse happened I am worried about studs please suggest if I have to undergo any test I am very tensed for this and I want to clear my mind I do not have any problem except stress also please explain where should I get the test done",
        "input": "",
        "output": "hi oral sex does not cause hiv human immunodeficiency virus to the recipient it may cause genital herpes gonorrhea chlamydia syphilis and warts if these infections are present in the partner your doctor may advise you to get hav and herpes simplex virus and vdrl venereal disease research laboratory tests to detect sexually transmitted disease urine test for gonorrhea is done only if there is any burning or pain while micturition these tests are usually free in government hospitals and private laboratory can also perform these tests for further doubts consult a hiv aids specialist online"
    },
    {
        "instruction": "hi doctor what is non specific interstitial pneumonia is salt therapy beneficial for non specific interstitial pneumonia please explain",
        "input": "",
        "output": "hi for further information consult a pulmonologist online"
    },
    {
        "instruction": "hi doctor my months old baby boy is dropping down his head occasionally sometimes he has some mild jerks were at the time after his feeding or after he wakes up that time he just swallows or lick his lips with tongue otherwise his activities are very normal he can hear us identify us clearly take his toys on his own choice starts to grasping things etc he started to crawl and got his milk teeth for example if we ask where is the fan then he automatically sees the roof if the fan is switched off then he just sees it and cry if he crosses some particular color lights or television he will turn his head towards it and watch it when I took him to his pediatrician he said he is absolutely normal also his health is good he asked us not to worry but it makes me fear while he drop his head down or getting jerk he is our second son and it was a cesarean now he is having cold he got his vaccinations on correct time is there any need to take him to a neurologist",
        "input": "",
        "output": "hi I have read your question with care and understand that you are concerned about few jerks your kid has first and foremost I would like to appreciate and congratulate you for giving detailed descriptions for further information consult a neurologist online"
    },
    {
        "instruction": "hi doctor I have a 12 my sac type aneurysm on the vein of galen I am 50 years old and otherwise in a good health I have had bad headaches and nausea for about seven months it led mri and that found the aneurysm I know the risks of an arterial aneurysm rupturing but do venous ones rupture is it very unusual for them to do that my family tends to have a long lifespan could I have another 30 or 40 years of life with this my be is normal my current medications include meloxicam claritin nexium and zofran",
        "input": "",
        "output": "hi for further information consult a neuro surgeon online"
    },
    {
        "instruction": "hi doctor my sister is 46 years old now she got married 17 years back and have a girl child of age 15 for nearly 10 years she is having abdominal pain which will occur during the periods and will last for five days it will start two days before periods and will last three or four days after it the pain will be more and sometimes intolerable it will not even reduce with painkiller and the pain will be more during night time with the following symptoms lack of appetite lower abdominal pain breathing difficulty indigestion bolting and constipation all these symptoms will persist until the pain is there she had been frequently visiting doctors for treatment but the doctor says that she has no major problem in the stomach she was diagnosed with fibroid 10 years back and the size was small the doctors also said that the fibroid will not have pain as she feel whenever the pain is more she used to visits the hospital it will be six to seven visit a year and yearly once she will be treated with antibiotics for severe infection during her last period 30 days back the pain started and did not reduce until now the pain was so severe and for the last four days she had mild fever so she visited a doctor and he advised for a it scan after seeing the results he suggested to immediately go for surgery and advised to get her uterus removed and also said she might have cancer when we went for a second opinion to another doctor she said there is some uterus infection and advised medicine for that and asked to come back after two weeks I have attached the it scan and report kindly comment on it based on the results is there a chance of cancer which the local doctor has said the problem exists for nearly 10 years and many times due to intolerable pain she used to roll on the floor is there any permanent cure for it I have attached the prescription too can we continue it or should go for further investigations why infections reappear yearly as advised by the local doctor is removal of the uterus is necessary will it give a permanent solution please suggest me if any other investigation or treatment is needed or to be followed",
        "input": "",
        "output": "hi after going through the detailed information given by you the issues I think need resolution are as follows regarding fibroid it need removal as that is an important cause of pain abdomen it can be done laparoscopically at this age my suggestion is to remove the uterus instead of the fibroid alone for pancreatic lipoma you should get a second opinion on this with gastroenterology specialists before planning fibroid surgery vaginal infections can be tackled easily it is not a major concern after gastroenterologist opinion we will plan for mri scan if required endometrial biopsy or dilation and curettage with pap smear is mandatory prior to definitive surgery hysterectomy revert back for further doubts to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I am a 35 year old female I have on and off sharp pain in the left upper chest sometimes it radiates to the neck and sometimes shoulder and upper arm my egg bloods and chest ray were normal with all these tests is it likely to be the heart movement does not seem to influence the pain sometimes I get a bit dizzy too pain seems to come randomly doctor prescribed diclac 50 my thrice a day and clorom 500 my twice a day what else could it be colonoscopy has done recently due to family history of cancer and that was clear ultrasound of the abdomen was also clear",
        "input": "",
        "output": "hi I have carefully worked through your case and can well realize your health worries thanks for uploading the details of some laboratory reports for further information consult a cardiologist online"
    },
    {
        "instruction": "hi doctor last week I fell and jammed my thumb into the floor it instantly hurt and I knew I had sprained or jammed something the next day my palm and the thumb muscle were swollen with a painful lump I could not grab or hold anything but I can move it around so I know it did not break it has almost been a week and is still very sore there is no pain in the knuckle and I still cannot hold heavy things and grab things on bending it is very painful I wanted to give it some time before seeing a doctor if it is just a mild sprain typing and working is very difficult so I was wondering if seeing a doctor would help or if it is just going to take time",
        "input": "",
        "output": "hi for further doubts consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor my daughter is 16 years old she met with an accident and got an injury on her face it was operated by a maxillofacial surgeon the upper portion of the right eye is red she can open her eye but she is having double vision what to do",
        "input": "",
        "output": "hi revert back with the medical records and photos to an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor this patient is complaining of prolonged chest pain for three weeks now took medication for gastric issue and the pain has not subsided I have attached the angiogram report egg performed several times and nothing abnormal in it the angiogram report showed mid lad 12 my length and segment eccentric calcification soft plaque in lad causing 50 stenosis what is the recommended course of action",
        "input": "",
        "output": "hi I appreciate your concerns and can well realize the sensitivity of the issues there is considerable calcification of lad left anterior descending artery if it reaches up to 75 that is quite possible in the near future then complications and consequences can be severe in case of single artery involvement in coronary artery disease cad it is best to have an angioplasty of the vessel with stent placement for further information consult a cardiologist online"
    },
    {
        "instruction": "hi doctor we had sex on her fourth day of the period she took an I pill within two hours she got bleeding after five days today is the 27th day after sex she got some nausea at noon but no other symptoms she got an I pill previous month is it the temporary hormonal problem or she might be pregnant can she use pregnancy kit now please help",
        "input": "",
        "output": "hello for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hello doctor my daughter is suffering from cough for the past four weeks she started it out very gently and it is getting worse last weekend she was coughing almost non stop I took her to a walk in clinic and they gave her a cough syearup and an antibiotic I was told to start the antibiotic four days later if she does not get better I have started the antibiotics after six days but she was getting weaker and coughing with choking I took her back to the doctor they told me that she might have whooping cough I was not entirely surprised as she had hypoxia at birth and she did not get that one vaccine the pertussis she only got it from chest ray we came to know that she had pneumonia too but not on both lungs and the ray was not entirely white so it was a smaller pneumonia by that time we were on day three of the antibiotics they made a sample test from the nose for whooping cough I was told that even if she has it the results might come back negative as she took azithromycin we were told to wait and see after the antibiotic the result came back negative the same night her cough got so bad that she was not getting any air she was coughing without being able to breathe she was vomiting and a tone of white long phlegm or mucus came out with the vomiting it was white sticky and lots of it in the emergency room they turned out that she had bronchospasm they treated her with albuterol and steroids she was put on albuterol for two hours there then we came home with an inhaler she has been using that three to four times a day ever since then she has been very weak they checked her again for whooping cough and that too came back negative she took the second dose of prednisone three pills she felt better and was so happy but the next day she did not feel that good today she had more coughs and it is a second sound behind the usual cough sound this second one is like the laryngitis cough but not barking sound it is just a deeper cough I am totally lost I do not what to do anymore she had a different kind of cough sounds throughout for almost a period of four weeks intense barking whooping cough like silent more loud and now this strange one she is allergic on amoxicillin ceftin bactrim and cefalosporins I gave her mucinex to loosen the mucus I would like to know what to do should I go and see a pulmonologist in person",
        "input": "",
        "output": "hi I have read your daughter story in detail I also heard the quality of cough you provided in the sound clip allergy spirometry put pneumonia regular steroid inhalers and albuterol inhaler sos avoid dusts and cold drinks for further information consult a pulmonologist online"
    },
    {
        "instruction": "hi doctor I am suffering from dullness and tiredness all the time also I have anxiety and irritation my current medication includes lodoz 5 and cilaheart val 40 my medical report shows some abnormalities please suggest",
        "input": "",
        "output": "hi I feel sorry for the dullness and tiredness you feel it is really troublesome for a patient at this early age I have carefully gone through your case and thanks for making it easy to evaluate on the basis of the attached reports"
    },
    {
        "instruction": "hi doctor I am a year old male I do not have an eyebrow it has been like this since birth and I am ashamed about it but my siblings have good eyebrows and mine is different I do apply castor oil sometimes but it is not growing at all please help me",
        "input": "",
        "output": "hello for further information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor my husband is suffering from stress my husband does not share anything with me but he does share his feelings with his mother I am unable to handle this and I am becoming weak internally everyone is after my husband health but no one understands my situation due to such tension and stress I am also facing health issues there is no friend of mine with whom I can share things most of the time my husband feels stressed when we plan to go out for some holidays and every time he cancels it",
        "input": "",
        "output": "hi for further information consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor my relative who is years old has a red color mole like thing in her forearm she has been having this red color mole since so many years today only we noticed that there are small fresh red dots inside it looks new what could it be no other associated symptoms we are worried if this might be something alarming what should we do please explain in detail she is hypothyearoid and on medication for the past two years she is also taking medication for more than to 10 years for her cholesterol issue",
        "input": "",
        "output": "hi if there is a change in color size margin and shape in a pre existing mole especially in this age then it is always an alarming sign as you said it is changing its texture and color then yes definitely we should suspect about melanoma in your case it is very difficult to say either it is a just normal change in a mole or precancerous change for further information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor I am having some obstruction feel in the throat and vomiting sensation for the past 20 days there is a feeling of giddiness and strain to the eyes I do not have any pain or burning sensation please suggest some treatment",
        "input": "",
        "output": "hi revert back with the answers to the above questions to an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I am 19 days late for my period I got my home pregnancy test positive but the next day I had a brown color spotting and yesterday afternoon I had brown color bleeding with heavy abdominal cramps and today there is no bleeding but spotting just like on the first day I am confused am I having a miscarriage please explain",
        "input": "",
        "output": "hi for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hello doctor I am a 23 year old male my height is 6 and weight is 74 keg I have a big belly with the rest of my body being a little leaner I have continuous hunger even after I have had food after a meal with five roti and a cup of rice I will feel hungry within an hour or two I have zero activity I sit in front of the computer for nearly seven to eight hours every day is there any tests that I could take to know if anything is wrong I have no sugar and be thank you for the advice in advance",
        "input": "",
        "output": "hi we are here to help you for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor about a month ago I experienced acute pain in my right upper abdomen and that radiated to my back it happened after I had a high fat meal that night the pain lasted for hours and continued as a dull ache for the next week I made an appointment with a gastroenterologist and he advised an abdominal it the report revealed that besides a mildly hydronephrotic kidney for which I have already seen a urologist everything else was normal except for the following a focus of calcification is in the gallbladder lumen or the posterior gallbladder wall the gallbladder wall is minimally prominent however the gallbladder is collapsed all of my laboratory blood work showed that my kidney liver and pancreas functions are normal the gastroenterologist did not really give me any insight he said to find a surgeon in case I have another attack so that the gallbladder can be removed I have found a surgeon but I would like to get a second opinion from a different gastroenterologist I have had a dull ache since the initial attack but I have not had any more excruciating pain should I wait to get the gallbladder out if I do have another attack when the report says focus of calcification does that mean I just have one gallstone though I do not have any extreme pain is this an emergency any advice you can provide would be helpful",
        "input": "",
        "output": "hi we are here to help you for further information consult a medical gastroenterologist online"
    },
    {
        "instruction": "hi doctor my son is 4 years old his weight is 12 keg he has been suffering from fever for the last 12 hours his temperature came down but not to the normal temperature he was given only paracetamol liquid solution three times please suggest",
        "input": "",
        "output": "hello for further information consult a child health specialist online"
    },
    {
        "instruction": "hi doctor I am a year old married female one week before I had intercourse with my husband and took an I pill within 24 hours but we had unprotected sex on the next day morning would the pill be effective even if I had intercourse after consuming I pill if not what are the preventive measures should I take for not getting pregnant please explain me",
        "input": "",
        "output": "hi your question is very interesting for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I have cml up I am on gleevec for the last one year my query is about the skin whitening as it has turned too white will this side effect go away",
        "input": "",
        "output": "hi for further information consult a hematologist online"
    },
    {
        "instruction": "hello doctor my mother is 57 years old she is having skin infection around his face neck and ear area and she is a cardiac patient for the past two days she is taking surfaz in ointment clotrimazole beclomethasone dipropionate and neomycin sulfate cream zenflox oz ofloxacin and ornidazole and allegra 120 my please help",
        "input": "",
        "output": "hello your mother has herpes foster it is caused by varicella foster virus which causes chickenpox earlier in life and gets reactivated later in life to cause herpes foster she has to take tablet valacyclovir go thrice a day for seven days for the pain tablet diclofenac 50 my at night if severe twice a day apply fusidic acid cream twice a day over it to avoid secondary bacterial infection varicella foster virus herpes foster tablet valacyclovir go thrice a day for one week diclofenac 50 my at night for one week twice a day if severe pain along with tablet rabeprazole 20 my in the morning empty stomach follow up after one week"
    },
    {
        "instruction": "hello doctor I have a pulp just outside the ass crack which just originated today and it is painful",
        "input": "",
        "output": "hello I went through your question it seems from the picture that you should be having severe pain attachment removed to protect identity this can be the result of thrombosed hemorrhoids perianal fistula or a pilonidal sinus still to guide you better I need a few more details what is the exact site is it the anal orifice or around the anal orifice is there any discharge serious or purulent is there any kind of bleeding do you have a fever do you have to complain of constipation or straining in the past at present to relieve your symptoms please take tablet aceclofenac 100 my per orally twice daily for two days after you provide me details I will add further specific advice"
    },
    {
        "instruction": "hello doctor I have itching and infection in my private area for the past one month please help",
        "input": "",
        "output": "hello any other area affected any history of diabetes mellitus hypertension thyearoid disorder any family history of disease is itching occurs predominantly at night looking forward to your response in order to help you"
    },
    {
        "instruction": "hello doctor I have had acne since three months I cannot get it to stop I am a 45 year old female and have not had issues since I was a teenager I do not know what is going on it is mostly on my chin occasionally it will be on my forehead and nose they are very painful with clear drainage it leaves terrible scars everything I have tried makes the acne worse I have very sensitive skin I am not sure what to do what are your suggestions currently I am on ativan ambien lamictal effexor and methyl folate",
        "input": "",
        "output": "hello welcome to icliniq com are you a diabetic are you using any hormonal supplements since when your taking tablet lamictal or effexor lamictal in few cases may cause drug induced eruption and acne effexor also cause rash I saw your images not clear but it shows the pustular and modular type of lessons followed by healing with pigmentation you may use clindamycin gel local application twice a day after face wash apply only the area that pustular acne are do not apply near the eye you may take capsule doxycycline 100 my twice a day for one week check your hormonal status like serum estrogen and testosterone levels check your blood sugar levels avoid chemicals new soap or creams application on the face if you developed any allergy to the above drugs please stop it immediately and consult with your physician"
    },
    {
        "instruction": "hello doctor I am a 21 year old female I have hypothyearoid for the past one and a half years and currently on 25 my thyearonorm things have been normal but my period has been delayed this time it is exactly 46 days since my last one I feel tired most part of the day and currently due to lockdowns I could not exercise much can you please suggest some nutrition and about what can I do to get my period and if my doubt is correct thyearoid levels must have been increased but I cannot take a test right now last time when I checked before one year the amount of ash was near normal 1",
        "input": "",
        "output": "hi do you have any other associated symptoms like painful menstruation do you have headaches for how long this problem is going on do you feel you bleed more or is it usual there are many causes of irregular menses any mental stress can cause even your having exams or any other stress related activity can affect the regularity there are hormonal disturbances that can lead to menses irregularities levothyearoxine dose 25 mug is very low if you cannot do your blood tests I think you can increase it to 50 mug and try to check ash thyearoid stimulating hormone in six weeks hopefully until then labs will be open regarding nutrition you need to eat a low carbohydrate diet without any sugary juices or added sugars in any way take a good sleep of seven to eight hours drink plenty of water at least two to three liters if you practice intermittent fasting it will give your health a great boost"
    },
    {
        "instruction": "hello doctor my husband had duodenal ulcer two months back and was treated immediately by a gastroenterologist for the past 70 days he is taking sompraz 40 but sometimes he has wind formation in his stomach he is very nervous and believes that he might have developed cancer he always does this whatever disease thinking about cancer please let me know about the seriousness",
        "input": "",
        "output": "hello any ulcers in the duodenum can cause the feeling of wind anytime proper treatment is required to get rid of it only sompraz esomeprazole will not solve the problems you have to give some other medicines to him avoid fatty and spicy food do regular walk and exercise is a must let done us ultrasound whole abdomen to exclude other problems us whole abdomen syearup gelusil tablespoons ads syearup sacral two tablespoons ads tablet normaxin clidinium bromide and dicyclomine be take all these for seven days after seven days"
    },
    {
        "instruction": "hello doctor I am a 23 year old female who is currently struggling with the unknown of what is happening to my body since I first started menstruating I have always been heavy and longer than average my normal periods last for 10 days and I use typically 5 complete boxes of tampons during a cycle I am in a long term relationship and have only had this singular sexual partner since 2017 I am not on birth control of any means and in some cases I have had to use emergency contraceptives post intercourse in the past two months I have used contraceptives twice once in the end of march and most recently about two weeks ago since then and this is the first time experiencing this I have had dark brown clumpy discharge the closest comparison would be like damp coffee grounds within the past week I had also gotten a thing flesh toned or white clot with blood on it about 5 inches in length I am started to feel concerned as the discharge has not stopped and I believe that is occurring rather than a menstrual cycle at the time I am writing this I should have had my period cycle now but instead I have this dark brown discharge at this time I fear the idea of going to a doctors office for the safety of myself during this pandemic but also do not want to prolong any critical issues I may be facing I have taken photographed images of all of this in worry that the typed description does not come across correctly please help",
        "input": "",
        "output": "hi do not be stressed I am here to help according to your history you have not got periods this month and you are having some abnormal discharge I saw the picture my first suggestion would be to do get a urine pregnancy test I understand that you have used emergency contraceptive but sometimes it fails we need to know whether you have a pregnancy in which cases sometime the discharge is of nature as you described you may be in the process of a miscarriage if this is negative then the next step would be to get a pelvic ultrasound done because the discharge seems unusual but let me assure you that there are more chances of you having a miscarriage due to the failure of emergency contraceptives in case your urine pregnancy test is positive you need to take proper treatment like pregnancy termination kits or misoprostol tablets depending on the condition of the concepts baby at this time in case your pregnancy test is negative you need a pap smear ultrasound and sos biopsy of the tissue you are discharging whatever it is it can be managed properly if it is addressed on time there is no need for panic please follow up with your pregnancy test results I hope this helps failure of emergency contraception pregnancy test endometrial hyperplasia according to the test results"
    },
    {
        "instruction": "hi doctor I have been having heartburn dry cough and nauseous feel for almost a month now I have amended my diet for more than two months and have not been eating pork or beef I am taking veggies and fish now also I am eating small portions already at the onset I experience that food has been stuck in my throat and my stomach feels like it is always full although I feel hunger both my toes cramps at the same time and my toe bumps are also painful I have been diagnosed with gastritis since a decade ago I am a 35 years old female and weighs 51 keg doctor can you prescribe me medication thank you very much",
        "input": "",
        "output": "hi I reviewed your detailed history which is more suggestive of reflux disease I would like to prescribe some treatment at the moment and I am hopeful that it will get better there is nothing to worry about and nothing to panic if you have any other query kindly get back to me thank you no need at the moment herd gastroesophageal reflux disease capsule omeprazole 40 my one in the morning and one in the evening before meals for two weeks and then only one in the morning before meals for two weeks"
    },
    {
        "instruction": "hi doctor I am a 23 year old female I have severe chills that I needed to wear thick sweaters and jackets at home without ac or fan I do not feel the heat and just cold water or slight cold breeze in the morning makes my head frozen or close to shutting down and it is getting worse it always starts with the nose and then my head sometimes I have to sleep to make the symptoms less severe I am not under any medications nor do I have any medical condition",
        "input": "",
        "output": "hello I can understand your concern according to your statement you have been suffering from severe chills that you needed to wear thick warm clothes at home without ac or fan in summer now chills are the sensation of feeling cold chills are caused by rapid muscle contraction and relaxation they are the body way of producing heat when it feels cold they often occur alongside a fever which is when the person temperature is higher than normal however a person can also experience chills without a fever like you and there can be many different reasons for this possible causes include hypothyearoidism is when a person thyearoid gland does not produce enough hormone that regulates their metabolism some people like you are more sensitive to the cold and may feel chills more frequently any type of viral or bacterial infection sometimes produces chills before a person gets a fever chill is a classic symptom of malaria it can have three stages cold stage where a person experience chills hot stage where they have a high temperature sweating stage anemia may develop due to poor diet age chronic illness medications gynecological diseases etc most common symptoms include waking up tired looking pale and always feeling cold with chills hypothermia can be resulted from dropping body temperature below the normal range due to any causes hypothermia can be dangerous especially when your body temperature falls further if the temperature falls below 96 degrees you should seek medical care immediately so you should monitor the body temperature with a thermometer during chills you can do some investigations like abc complete blood count with pbf peripheral blood film thyearoid function test to ash ribs random blood sugar etc treatment depends on causes so we should find out the exact causes of your suffering and then treat them accordingly I want to add that dehydration anxiety panic attacks may cause chills too when your body does not have enough fluids it is hard to maintain regular body temperature and this can lead to hyperthermia and fever like symptoms including chills again anxiety is more often associated with feeling sweaty than feeling cold but sometimes it can cause a chilly feel as well and if you have panic attacks you might experience full body chills according to the national institute of mental health nimh in order to cope up with your chills you can do the following drink lots of fluids including oral rehydration saline and plenty of rest sponge with lukewarm water don bundle up in blankets or use ac or high speed fans enjoy a warm soup and drink warm beverages use a humidifier please inform the results after undergoing the investigations"
    },
    {
        "instruction": "hi I have been diagnosed with plantar fascitis doctor said to use heel pad using it but no relief pain is increasing gradually please help",
        "input": "",
        "output": "hi welcome to icliniq sorry to hear about you being troubled with plantar fascitis it is a fairly common problem heel pad is indeed helpful but apart from it you need to stop walking bare foot as much as possible do not use any acupuncture type of footwear use soft footwear contrast bath is helpful alternative warm and cold water fomentation one after other for period of 10 mins atleast twice a day is beneficial if there is no relief after this conservative treatment along with some pain killers local steroid injection methylprednisolone injection at the site of maximum pain can give you immense relief in those symptoms please get the injection only from orthopedic surgeon I hope you get cured of your ailment feel free to ask any other querry thanks"
    },
    {
        "instruction": "hello doctor my wife has a history of two earlier miscarriages which occurred during the first trimester in the first month we consulted a local gynecologist and the problem turned up to be high toxoplasmic infection reading was egg 82 she received rovamycin forte for three months along with other supplements like folinext and ecospirin for six months now my wife is pregnant again we visited the doctor and she advised to perform toxoplasma egg which again came back positive with egg 78 her first day of the last menses was 27th feburary she has been receiving rovamycin forte once again and duphaston folxt ecospirin and doxinate but now the problem is she is unwell and been vomiting nearly every day during evening hours there is a little brown discharge seen in this situation I am very much concerned about what will happen next will it be a miscarriage for the third time please help",
        "input": "",
        "output": "hello we consider toxoplasmosis when i'm are positive it meas the person has an active infection when egg are positive it means you are protected from future infection your wife is in her first week of pregnancy so spotting is a common finding due to implantation vomiting is also common until 12 weeks she does not have to worry about it she can try small frequent meals baked bread etc I recommend an ultrasound at five or six weeks to evaluate the well being of pregnancy the symptoms that you prescribe does not mean that it will be a future miscarriage it is common in every pregnancy if this pregnancy terminate spontaneously then after that you have to perform several examinations but I recommend you to be positive ultrasound scan"
    },
    {
        "instruction": "hello doctor I am a 30 year old female since last night I am suffering from mild chest pain I took digene and gastric medicine thinking it is a gastric problem but I do not find any difference please help",
        "input": "",
        "output": "hello I can understand your concern according to your statement you have been suffering from chest pain with some numbness in the left arm chest pain can result from various conditions such as muscle strain inflammation of the muscles and tendons around the ribs can result in persistent chest pain which can be become worse with activities acid reflux can result in a recurring discomfort in the chest peptic ulcer disease which are sores in the stomach lining can cause chest tightness or pain panic attack may cause chest pain in addition to nausea dizziness fear rapid heart rate fear etc costochondritis is the inflammation of the cartilage of the rib cage it can cause chest pain which may be aggravated with activities or posture changes any respiratory related diseases like pleurisy to tuberculosis pneumonia etc can cause chest pain again cardiac diseases such as mi myocardial infarction pericarditis hock hypertrophic obstructive cardiomyopathy map mitral valve prolapse etc also can cause chest pain you should undergo car chest ray egg electrocardiogram abc complete blood count echocardiography endoscopy of upper git gastrointestinal tract etc to find out the underlying cause of your chest pain treatment depends on causes so please inform me of the investigation results and check your blood pressure regularly in the meantime you can take gaviscon syearup two teaspoons three times daily domperidone one tablet three times daily lansoprazole capsule30 my once daily for your chest pain"
    },
    {
        "instruction": "hello doctor I would like to know the reason for pain in the stomach at the right side and blood in the stool once I had blood in stool previously and used homeopathy medicine to stop that but it recurred after five days",
        "input": "",
        "output": "hello stomach pain on the right side can occur due to a variety of reasons like stomach infection appendicitis infection in your intestine and problems in your kidneys or the ureters a tube that connects your kidneys to your urinary bladder stomach pain with blood in stools is something to worry about the cause for it can be acute infectious gastroenteritis inflammatory bowel disease or ulcer in your gastrointestinal tract to diagnose all of these I need to ask you some questions do you have any fever do you have weight loss how is the appetite is the blood in stools fresh blood or is it brownish red do you have any history of piles are the stools hard do you have any diarrhea does the stomach pain has any relation to food intake I does it get relieved by eating food or does it increase on eating food once you answer these questions I would suggest what tests to be get done and how to treat the disease I hope this helps"
    },
    {
        "instruction": "hi doctor I am a 30 year old female I weigh about 45 keg with a height of 3 I am experiencing severe stomachache hyperacidity dizziness and nausea this is the first time I felt and I feel like there is too much acid on my stomach what medications can I take",
        "input": "",
        "output": "hello you are experiencing dyspepsia and epigastric pain if I am not wrong it is due to hypersecretion of gastric acid or due to some insult against the gastric mucosa which is a protective layer of the stomach this layer gets eroded due to various reasons like alcohol painkillers etc over secretion of acid might be due to stress lack of sleep lack of alkaline food in the diet etc so check these factors kremil is not competent maalox only gives momentary relief so let us use pips proton pump inhibitors for a few days and shut down the acid production significantly this might give the gastric mucosa some time to heal and become tough again remember these medications which I am going to prescribe are not to be taken perpetually take them as advised gastritis capsule esomeprazole and domperidone early in the morning on empty stomach and at bed time capsule lactobacillus one in the afternoon discontinue maalox sleep well abstain from alcohol for at least 10 days stress relief continue this treatment for ten days and follow up after that"
    },
    {
        "instruction": "hello doctor my question is about my throat at the back of my throat I can feel that there is a gas coming and it feels warm also it has a bad smell I tried everything but nothing provides a solution to my problem I have tried using chlorhexidine mouthwashes but it did not resolve my issue I have already consulted an ent specialist I have been experiencing occasional tonsil stones but he did not advise anything other than removing them manually so far upon inspection there are no stones present is it possible to have esophageal outpouchings I do not experience vomiting or painful swallowing I have occasional hyperacidity which resolves by taking prazoles my problem is bothering me especially when I talk people say that my breath stinks also I am uncomfortable with a gassy feeling behind my throat I have good oral hygiene and have already visited the dentist and ruled out oral problems as the cause I am also thinking of pnd every morning when I gargle there is a thick mucus on the back of my throat I am desperate for a solution please help",
        "input": "",
        "output": "hi welcome to iciniq com the most probable problem out there would be a chronic herd with lor chronic gastroesophageal reflux disease with laryngopharyngeal reflux let me explain what exactly is happening your stomach contains contents that are acidic in nature and is only meant for the stomach if these content reflux or have a reverse entry into your food pipe esophagus or throat which is not meant to handle this acidic oh this can lead to a chronic inflammation leading to chronic ulcers giving a feeling of something stuck on the throat or the floaty feeling repeated belching or even bad odor in your breath yes esophageal diverticula outpouchings are a differential diagnosis and have to be checked with contrast barium swallow the probability of having these outpouchings are less considering as you do not have vomiting or difficulty in swallowing please follow some instructions maintain a strict diet schedule and eat on time avoid oily spicy and cold food items beverages keep a minimum gap of two hours between your last meal and going to bed try to sleep in the left lateral position eat frequently but in little quantities never over eat salt water gargles at least to 10 times a day for one month keep sipping on warm fluids as much as possible avoid exposure to dust by wearing an n95 mask you can consider the following treatment take tablet pantoprazole with domperidome combination once in the morning for 20 days syearup gelusil or mucaine gel one teaspoon three times a day 20 minutes before food the treatment schedule includes more precautionary measures rather than drugs themselves I hope this helps"
    },
    {
        "instruction": "hi doctor I am a 27 year old male for the past five years I have ulcerative colitis my main problem is bleeding form rectum when I take prednisolone I am fine for maximum of three months and after that again it starts bleeding and also continues with mesacol I also took azathioprine azoran but those medicines cannot stop bleeding only prednisolone is a solution for me what can I do and if I start taking prednisolone again is that any problem how many times in a year can I take prednisolone in five years I took prednisolone for 10 times please suggest solution",
        "input": "",
        "output": "hello your history suggests that you have steroid dependent ulcerative colitis so you rightly started azathioprine and I think it should work if you are taking a proper dose you have not shared dose of azoran and your body weight you can take azoran as 5 5 my per keg body weight plus the dose of mesacol is also low increase the dose to at least 4 go day and you can go up to 8 go day maximum regarding frequency of steroid dosing you can take it up to twice per year in case of flare of your disease but it will be better to avoid it if you have a better option azoran because steroid has many long term adverse effects metabolite level of azathioprine complete blood count ear erythrocyte sedimentation rate steroid dependant ulcerative colitis tablet mesacol mesalazine 800 my thrice a day adjust dose of azoran according to metabolite levels avoid nsaids non asteroidal anti inflammatory drugs"
    },
    {
        "instruction": "hello doctor I have erection problems and dry orgasms sometimes due to neuropathy I have diabetes for 15 years and on insulin recently I have blood pressure and started taking medication for the same cholesterol is also high but now under control do I have a problem with conceiving children",
        "input": "",
        "output": "hello I understand your concern I saw your examination report and there are some factors that affect your fertility and some abnormalities first varicocele may affect your fertility a dilated vein can be the cause of your oligoozospermia dry orgasm second semenogram at least 40 of spermatozoids must be mobile in your only and there are abnormalities in your morphology too 30 must be normal in your case there are with normal morphology diabetes may cause abnormalities in your morphology and motility of the semen because the characteristic of semen may vary over time and undergone normal biological variability it is best to repeat the test at least once if abnormalities persist you should have a urologic exam I would recommend a urologic exam and consult a fertility specialist"
    },
    {
        "instruction": "hello doctor I have been self isolating for three weeks due to coronavirus symptoms and spent two nights in the hospital where I was given oxygen and a chest ray showed typical couid 19 changes I was discharged a week ago and told some couid 19 patients have been coming back with dot and or pe I am on clexane heparin twice a day for two weeks my question is there anything else I can do to prevent blood clots while recovering I have been wearing compression stockings the hospital gave me day and night should I be taking these off at night I am doing some foot and calf exercises and trying to walk a little in the garden too is there anything else I can try",
        "input": "",
        "output": "hello kindly answer the following questions to guide you further do you have any risk factors for thrombosis like family history smoking history prolonged bedridden or excess weight does your doctor recommend to take heparin have you confirmed your couid 19 by it per reverse transcription polymerase chain reaction testing by swab are there any other symptoms"
    },
    {
        "instruction": "hello good morning this is not couid related I just want to ask something since I cannot go out for check up I am delayed for days and yesterday I started to have spotting it is unusual to me since I know if I have my period I do not feel any cramps yesterday and even today the flow is not heavy I can feel dizziness sometimes however the result of my it was negative is there any possibility that I am pregnant my husband and I are hoping to have a baby",
        "input": "",
        "output": "welcome to icliniq com as the pregnancy test is negative it is less likely to be pregnancy however inview of false negatives with prep card do a blood test called serum beta hug to confirm it sometimes cycle can be delayed due to hormonal changes stress increase in wt alteration in the diet pattern hypothyearoidism etc if this irregularity continues in subsequent cycles ultrasound pelvis is required to look for the cause note if it is not possible to get blood test done due to lock down repeat the urine pregnancy test right in the morning first morning urine hope the suggestion is useful regards wishes for you to conceive soon delayed cycle hormonal serum beta hug ash us pelvis if irregularity continues hormonal to review with beta hug if any queries"
    },
    {
        "instruction": "hi doctor almost 40 days back I saw bright red drops of blood coming out when I was passing the stool I saw blood bright red in my stool for next two days and then the problem went away but I became conscious since past week I would noticed very small amount of blood in my stool but last night I saw my stool covered in bright red blood I am also constantly seeing mucus jelly type substance in my stool one other thing I am worried about is I often see grey dark grey liquid thing on my stool I am not sure its blood I do feel fatigued but I am not feeling any kind of pain anywhere in my body even when passing the stool I dont feel any kind of pain but my urge to poop has increased lately my age is 23 and weight is around keg my height is it",
        "input": "",
        "output": "hello dear hope you are fine the presentation you described is likely to be a hemorrhoids biles that causing blood in the stool the fatigue you described maybe due to loss of blood that caused anemia I recommend that to confirm the diagnosis to be examined by a surgeon so to make sure it is only hemorrhoid and no other masses there causing your symptoms I also recommend to have blood test abc so to check your hemoglobin once diagnosis is confirmed we will discuss the management which mostly include having high fiber diet and oral laxatives"
    },
    {
        "instruction": "hi doctor I have a 16 year old daughter who gets leg pains on a regular basis but not so frequent it occurs let us say every three months this started from childhood and she still gets it she told me she cannot sleep at night when she gets these leg pains do you have any advice on home remedies and medication to help her get rid of the pain",
        "input": "",
        "output": "hi growing pain are a common cause of leg pain in children these pains are muscle aches that can occur in thighs behind the knees or the calves other possible causes of leg pain that may be more serious can include juvenile idiopathic arthritis jia lupus lyme disease and leukemia if the pain is prolonged fever severe pain rashes sluggish or inactive then it is to worry about but not in your daughter case here some tips which surely will help to treat the pain treatment of growing pains depends on how much pain your child has the following things may ease discomfort and help your child feel better massaging the legs stretching the leg muscles though it is difficult for younger kids need to do it slowly placing a warm cloth or heating pad on the sore leg be careful not to burn the skin and do not use it during sleep the pain should be reduced in two to three weeks if it still continues and she get fever and the above mentioned symptoms then you can take her to the children specialist so that any ibrufen or other medicines can be given by diagnosing it"
    },
    {
        "instruction": "hello doctor last month my mother went to the hospital for diabetics and her reading is 200 my before having food and after meal reading is 300 doctor gave her 35 points of insulin again she took her sugar test yesterday and her result is 180 within normal levels my mother suffering from fever right now so my question is do this fever occur due to high amount of insulin even though she was within limits now what should we do how much insulin should she take",
        "input": "",
        "output": "hi from your history I have noted that your mother was diagnosed with uncontrolled type diabetes and was on insulin since one month now on review yesterday it was found that it is under control with the present dose of insulin coming to your concern insulin will not cause fever whatever dose you are taking but uncontrolled diabetes can be a trigger for infections like urinary infections chest infections and even be more cautious about insulin site infections if you are not properly injecting please make sure you are rotating the sites of injection between the abdomen thighs and upper arm viral fever ti urinary tract infection urine routine hba1c glycated hemoglobin serum creatinine abc complete blood count with ear erythrocyte sedimentation rate continue insulin in the prescribed dose rotate insulin site do regular exercise for 30 minutes per day follow strict diabetic diet review with the above reports please attach your old prescription"
    },
    {
        "instruction": "hello doctor I bleed whenever I get wet and horny I am currently taking a depo shot every three months and adderall every day for add I am 15 years old my height is 6 and I weigh about 200 pounds please help",
        "input": "",
        "output": "hi abnormal uterine bleeding is the most common side effect of depo proverb therapy especially in the early months of use it is a problem whenever bleeding continues for more than 14 days is heavy or symptoms such as pelvic pain accompany it bleeding irregularities that typically occur may include breakthrough bleeding you are having this spotting between periods prolonged periods lighter or heavier periods than normal lack of period usually after one year some women with 10 days of bleeding over two weeks are administered tablet ethinyl estradiol for 10 days and bleeding generally stops in five days other physicians prescribe an estrogen patch if estrogen is contraindicated patients are given 800 my of ibuprofen three times a day for five days in all cases of heavy bleeding apparently related to depo proverb use other causes g cervical malignancy uterine fibroid sexually transmitted diseases should be ruled out before treatment depo proverb acceptors can anticipate irregular bleeding as long as for one year and learn to accept it if not too severe this is the most effective management strategy I hope this helps"
    },
    {
        "instruction": "hello doctor I have manageable shortness of breath chest tightness but no cold my rays are clean and egg is also normal my be looks high 140 90 mainly I am unable to breathe normally I am feeling little shortness always currently I am taking the last doctor medication I understand it is a bit tough for the doctors to find the solution immediately but looking for the best right now believing in my daily food rather than medicine initially it started with cold on last month I took homeopathy tablets I developed a fever of and took homeopathy medication it sustained for three days fever of 9f so the doctor asked me to report to the near by government medical college hospital I reported and took even the couid test and the result is negative the hospital provided me hydroxychloroquine and rantac tablets after taking that my fever is gone I was fine but suddenly got shortness of breath early this month I am not sure if this was due to any allergy to food on that day I took two eggs and four jack fruit the same day I reported to the hospital they gave two more days of hydroxychloroquine from that time I am having shortness of breath but there was no cold or cough doctor says all the reports are normal but still unable to find the solution",
        "input": "",
        "output": "hello welcome to icliniq com I can understand your concern according to your statement you have been suffering from shortness of breath chest tightness without any cough and cold shortness of breath chest tightness can result from some conditions which are mentioned below anxiety is a common condition associated with chest tightness shortness of breath rapid heart rate sweating nausea etc herd gastroesophageal reflux disease occurs when stomach acid travels back up from the stomach to the esophagus and associated with chest tightness shortness of breath difficulty swallowing etc muscle strain typically occurs from intense activities like reaching or lifting when twisting related with the same clinical features costochondritis is the inflammation of the cartilage in the rib and associated with the same type of features even pud peptic ulcer disease valvular heart diseases pulmonary hen hypertension esophageal rupture pericarditis hiatus hernia etc can cause chest tightness with shortness of breath treatment depends on the causes so you should undergo eat exercise tolerance testing echo endoscopy of upper git gastrointestinal tract barium swallow test abc complete blood count etc for detection of underlying causes which are responsible for your sufferings you should also undergo fev1 forced expiratory volume bag arterial blood gas analysis spirometry for pulmonary function test reversibility test etc for the diagnosis of bronchial asthma as your pulmonologist has diagnosed earlier according to your prescription"
    },
    {
        "instruction": "i think I may have chronic sinus infection it started months ago one morning I woke up and blow up my nose with yellow greenish mucus and blood I was having it only in the morning I didn't had any other symptoms except feeling tired I took anvil sinus and used seawater nasal spray it lasted couple weeks after I only had a bit mucus dripping my throat when I woke up but generally felt well until couple months after I started to hurt and feel pressure in my inner right eye I went to walk in clinic and got prescribed amoxicillin potassium clan for days my eye got better but after I stopped antibiotics after couple days I started to feel unwell again so I contacted another doctor online and he prescribed me another antibiotics clarithromycin 500 my for 10 days after I finished them again the same one day past and I didn't felt well I was feeling tired pain in my nose my ears even dizzy my body temperature was higher than regular 37 so I contacted a nurse online and she told me that probably antibiotics doesn't work because I had viral infection and told me to avoid diary take vitamin and probiotics I was taking them and with antibiotics it past two weeks generally I feel better but still have stuffy nose in the morning with a bit yellow mucus hurt my nose or feel pressure in it but I started to worry because I started to have headaches on top of my head sometimes going to the back part and sometimes tingling feeling in the left side of my head also I feel my heart rate is higher specially in the morning I already thinking maybe I am having anxiety when I read what can happen if you dont treat sinus infection I am using corticosteroids nasal spray seawater spray neti pot should I contact again doctor online and ask for more antibiotics I guess with all this coronavirus I cant get referral to ent specialist do you have any advice how I should treat it",
        "input": "",
        "output": "hi looks like your having a chronic allergic problem out there now there are certain things which have to be understood in detail allergic rhinitis is an immune complex issue which is innately present and starts showing symptoms at one particular age it basically is a hyper responsiveness to something which is foreign and has accidentally entered into you nose causing cascade of chemical events leading to nasal congestion watery nasal discharge sneezing itching in eye and nose fullness in the ear and often leads to sinusitis causing heaviness in the area of your face involving the frontal and maxillary regions besides your nose antibiotics has a limited role here unless it is an infection that we are treating you have to wear a n95 mask and not allow the triggering factor to enter into your nose in the first place trigerring factors range from dust pollen animal fur fumes strong odours etc and the list is endless allowing the triggering problem to keep entering your nose is just going to prolong the problem through life and no medication will ever be effective nasal steroid sprays have definelty a role to play I usually suggest a combination of a topical steroid such as fluticasone propionate along with a antihistamine such as azelastine hydrochloride puffs in each nostril times a day 12 his apart for months straight certain antiallergics containing fexofenadien 120mg one tab two times a day 12hrs apart for 20 days is effective antibiotics like clarithromycin 500 my twice a day if taken have to used for long months to be extremely effective I give clarithromycin for both its antibiotic and immunomodulatory activity later of which is more important salt water gargles to 10 times a day for 10 days sipping on warm water steam inhalation avoiding cold spicy and oily junk food goes a long way smoking and alcohol to be completely avoided as it slows down the mucociliary activity and leads to secretions inside your nose causing a severe sinusitis and its related problems hope this advice helps"
    },
    {
        "instruction": "hello I am a 50 year old female who would like to have a breast reduction however I am high risk for vomiting from the anesthesia I have a phobia of vomiting I am a non smoker I have had general anesthesia once before and I vomited several times I am so scared that I have rescefuled the surgery times is there anything else that can be used instead of general anesthesia what can be done to prevent the vomiting thank you",
        "input": "",
        "output": "hi general anaesthesia has known post anesthesia effects of nausea retching vomiting etc also these may be due to direct effect of surgery and pain you seem to be very sensitive and anxious to it but usually it is seen that with each subsequent episode of administration of general anaesthesia these effects tend to decrease in severity so if last time you had vomiting postanaesthesia this time it will be less severe in terms of no of episodes etc this will reduce your discomfort also if you may have preexisting herd or gastroduodenal ulcer gastritis these may also cause nausea vomiting postoperative so I would advice discuss issues with your anaesthesiologist and surgeon nausea vomiting can be taken care of by medicines like proton pump inhibitors h2antihistaminics antiemetics which will be give by your physician in recommended doses some pre op anxiolytic medicines on night before surgery will help you reduce anxiety take a light non oily meal on day before surgery so that stomach stays relatively acid free"
    },
    {
        "instruction": "hi doctor I have stuck a tip in my ear because it was itching and I think I may have burst my eardrum I have some pictures",
        "input": "",
        "output": "hello the pictures are not completely clear but I cannot see any perforation when did the cotton piece stuck inside your ear did you notice any blood drops on the cotton piece after getting it out from your ear do you have any other symptoms as tinnitus or ear pain"
    },
    {
        "instruction": "i have been on nexplanon for a year after my first baby every since the implant I have periods every month before I started birth control I was regular I knew exactly when I was starting my period recently my doctor told me to take birth control pills while on nexaplanon to see if it would decrease my periods I have been taking the pills for a week straight and my period has been on for days which is not normal my period is heavy light it will stop then start again I do not know what I should do I just want my period to go back to normal",
        "input": "",
        "output": "dear welcome to iclinq com implanon is associated with altered bleeding patterns generally it settles by a year time 15 to 17 percent may continue to have very heavy long cycle after implanon this is b'cos of the progestronic effect on endometrium do take hematinics as heavy bleeding may result in anemia continue the pills as advised by your gynec for a month and see for changes in pattern if it does not reduce even after pills support you need to meet your gynec for alternative methods of contraception after removing it regards due to the hormonal progestronic effect of nexplanon on the endometrium reassurance hematinics to continue pills plus nexplanon month think about removal if it is too cumbersome"
    },
    {
        "instruction": "i had a doctor prescribe pack for me yesterday I have shortness of breath and chest tightness I was also wheezing but when he listened to me breathing he did not hear it I am really worried about taking this antibiotic because even though I am not allergic to any medicines that I know of he did not really ask me many other medical questions to see if this was a safe option for me I read this medication can increase heart rate and people have went into cardiac arrest I already have a resting rate of about 105 and pretty bad anxiety I just would like some reassurance that this is safe drug and I do not have to worry about deadly side effects im also a smoker 34 year old female",
        "input": "",
        "output": "hello greetings from icliniq I understand that you are worried about the side effect of the prescribed drug in my opinion azithromycin is one of safe drugs so do take the medicine without any doubt secondly I would like to know your history in detail and last but not least according to me its a good time to give a thought about quitting smoking and I can help you do let me know take care spirometry testing with bronchodilator reversibility testing allergic bronchitis bronchial asthma worsening due to smoking cessation when investigations are available and then as required"
    },
    {
        "instruction": "hello doctor I am a 25 year old female my main concern is dysuria that started the previous night I also had a history of kidney infection when I was young so I am extra cautious about unis I have had a relatively little intake of water this week how can I treat this without going to the hospital for a urinalysis can you prescribe me something",
        "input": "",
        "output": "hello welcome to icliniq com I can understand your concern according to your statement you have been suffering from dysuria is painful or difficulty in micturition it can be resulted from urinary tract infection ti sad sexually transmitted disease kidney stone ovarian cyst interstitial cystitis vaginal infection bladder cystitis pyelonephritis urethritis etc treatment depends on causes so we should undergo some investigations like urine routine urine m us ultrasound of a serum creatinine urine for s to find out exact causes for your dysuria and then treat them accordingly as an example if causes are cystitis pyelonephritis or urethritis then they have resulted from bacterial indecision so anti bacterial medication should be needed take plenty of water and do not hold urine take cranberry juice and citrus foods you can take cefixime 400 my twice daily for 14 days and abstinence from sexual intercourse during antibiotics"
    },
    {
        "instruction": "hello doctor my grandmother is 83 years old and has been suffering from a mild form of glaucoma for three years now when we consulted doctors earlier they suggested using eye drops than surgery so we have been using bravo and tear drops daily and she is also able to see properly since one week she is experiencing pain in her eyes and has trouble looking at the light directly her eyes have also turned reddish please help",
        "input": "",
        "output": "hello has she got operated for cataract any previous record of vision please share the latest one also share the glaucoma test reports in which she was diagnosed as glaucoma and share the photo of eyes"
    },
    {
        "instruction": "hi doctor as of now I am suffering pain in my left rib which results in difficulty in breathing I suspect this happens when I fall asleep on the sofa in an awkward position and when I woke up my throat has a little pain but it did not persist but it started to ache on the left rib part I feel the pain towards my shoulder it is almost about two days since I am suffering from this ache I got breathing difficulty especially when I am lying in bed but while standing or sitting I just felt mild difficulty in breathing maybe there is an artery that has been damaged or had been under the bone I am 24 years old",
        "input": "",
        "output": "hi I can understand your concern according to your statement you have been suffering from difficulty in breathing due to aching of the left rib part that radiates toward shoulder which may occur when you fall asleep on sofa in an awkward position you think your ribs may hurt from sleeping wrong and aching of the rib may radiate towards its intercostal muscle you may feel a sharp pain after intercostal muscle strain or sprain due to sleeping in the wrong position the pain will become worse when you stretch breathe in deeply cough or sneeze the area of the strain between your ribs may be painful to touch again this pain can radiate to shoulders or sometimes side sleeping can cause damage to the rotator cuff and create a lot of pressure in this group of tendons and eventually produce pain you can take tramadol as a painkiller domperidone lansoprazole and diazepam as a muscle relaxant with a sleeping pill"
    },
    {
        "instruction": "hello doctor I have had post nasal drip since last three months it causes me to cough up mucus from my throat it is very thick sometimes bloody or sometimes cloudy I am also having bloody crusty issues in my nose with sneezing I am not sick no fever no aches do not feel bad I just want to stop the mucus it sometimes chokes me and want to stop the bloody crusty nose with sneezing I tried zyeartec that did not help I also tried flonase no help I am afraid to take benadryl because of other medicines I take for sleep and anxiety what other suggestions do you have",
        "input": "",
        "output": "hello are the pictures you shared nasal snort or phlegm from throat attachment removed to protect patient identity do you have any difficulty in swallowing or breathing is there any cough any chest pain do you have wheezing is there any recurrent bleeding in your nasal cavities do you smoke or drink our approach would differ if the bleeding is from upper airways and if it is from the lower in the first scenario we shall give you some nasal lubricant creams with the sprays and see if the bleeding stops in the second we will have to rule out cough and chest problems in either case a nasal endoscopy with a laryngoscope is essential do you have such blood stained mucus from nose throat every single day do revert back to us with all details so that we can help you"
    },
    {
        "instruction": "hello doctor I have noticed some worrying symptoms lately I am a 24 year old male with no other known condition I have noticed that the back of my neck feels very stiff and rigid when I sit at my desk with my head bent forward to read or look at the monitor to the point that I feel the need have to stand or lie down to alleviate the feeling of discomfort I have noticed that the rigidity disappears when I stand walk or lie down I have been feeling stiff since I have started studying again some days ago I have spent the last two months without doing much no physical activity or studying working due to the lockdown I also have widespread twitching in my thighs calves and feet both legs on my back on my chest on my shoulders in my arms in my hands and in my tongue I have felt twitching almost everywhere for a couple of years now I also noticed that I am unable to put the heel of my left foot down when I stand or walk I have had this issue for years and I was told it was due to tight calf muscles although it feels more accentuated now I would greatly appreciate any input you can give",
        "input": "",
        "output": "hi neck pain seems to be due to strain in the neck muscles when you remained in one position for long duration I would suggest you to take simple steps to avoid this take rest for minutes in every 15 to 20 minutes and move your neck side wise and rotate it to right and left in that way strain in neck muscles can be avoided additionally in between isometric neck exercise can be done avoid using thick pillows if this does not work we can start some remedies now regarding twitching do you have weakness anywhere in the body did you lose your muscles mass anywhere in the body do you have any sensory issues do you take any stimulants such as excessive coffee or something else if yes how much do you feel often cramping of muscles regarding foot problem is it always or sometimes can you walk on forefoot can you walk on heels just try walking is it like foot drop lastly why antihistaminic medicines please tell in more and elaborated detail"
    },
    {
        "instruction": "hi doctor I am 30 years old I am facing delayed menstruation cycles it has been 15 years at the beginning I consulted gynecologists they did ultrasound and there was no cyst doctors said it was because of hormones they prescribed progesterone tablets for days my periods are not regular it varies from 30 45 days sometimes days in last 15 years around 5 times it occurs after 60 days this time it skipped two cycles sometimes I feel pain in legs or back vaginal secretion without any odor it has been 20 days or so that my face is full of pimples even my face is not oily there is no extra hair growth on my face I am sexually inactive",
        "input": "",
        "output": "hello welcome to icliniq com the irregular bleeding is also associated with acne and hair growth there are symtomps of hyperandrogenism have you performed a hormonal examination"
    },
    {
        "instruction": "hello doctor on the my bottom my two front teeth the gums have came up over them but not covered but the gum is higher up than it is in any other teeth in my mouth what caused this can I fix this in home itself",
        "input": "",
        "output": "hi that condition of your gum is called localized gingivitis it occurs because of the deposition of calculus and plaque on your teeth and inside the gums margins which causes inflammation of gums that enlarged in size the first treatment is ideally you should visit a dentist and get the scaling cleaning and polishing done once your teeth and gums get cleaned after you will have to maintain your hygiene then after a few days it will become totally fine right now at home you can do proper brushing and flossing and do warm saline I warm water and salt rinses daily it will heal slowly but scaling is genuinely required I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 40 year old male with abnormally high testosterone all other lab tests came back negative what should be my next step I also have malaise muscle aches anxiety and abdominal pain",
        "input": "",
        "output": "hi you sent me cortisol levels report but there is no report for testosterone your cortisol is normal please send the testosterone report"
    },
    {
        "instruction": "hello doctor my father is 76 years old he often complains of breathlessness and uses nebulizer every day he has chronic gastric and digestion issues as well his other health issues include diabetes be spondylitis and back pain I got an ray done recently please advice",
        "input": "",
        "output": "hello I can understand your concern can you send me the ray report and also tell me which nebulization he is using I will be happy to help him further with medicines and investigations"
    },
    {
        "instruction": "hello doctor I did not get my periods for the last one year now I got a lot of hair fall increase in body weight more hair growth in the face I have thyearoid and when checked before three months it was three times high than the normal now I am not able to go to any hospital please suggest",
        "input": "",
        "output": "hi I want to know your age height weight and medications you are on for thyearoid review with your reports"
    },
    {
        "instruction": "hello doctor I have had an angioplasty now I am taking nebicard so and rosuvagold 20 one each daily and I am also taking ginger lemon honey and apple cider vinegar solution two teaspoons daily and gilly daily I am observing that my be is fluctuating what should I do",
        "input": "",
        "output": "hello be blood pressure and pulse are not constant parameters and are ever changing so it is entirely normal for them to show variations we just have to watch that they are not crossing their limits for systolic be 10 to 140 and for diastolic be 60 to 90 is fine and the resting pulse rate between 50 to 90 is appropriate for you so readings anywhere in between are fine also be fluctuations nowadays are more commonly seen due to the use of electronic be apparatus which are over sensitive and cause variations if you are using an electronic be apparatus then you should take three readings at a time with arm resting on the table and completely relaxed and two matching readings are approximate be of yours however if most of the be readings are above or below this range then needs dose change so let me know the details of your readings you should make a chart of it by taking readings frequently say three times a day and each time three readings to know the average for a week period I hope this helps you"
    },
    {
        "instruction": "hello doctor I have mucus on my throat resulting in wet cough especially at wake up I observed no pain on the throat fever and sneezing I am not taking any medicine but I am regularly taking steam ginger or black tea I getting relief only in the chest but not effective on the throat kindly recommend medication",
        "input": "",
        "output": "hi you are probably having what we call as allergic pharyngitis where you usually do not have classical allergic issues such as sneezing watering from the nose but only having mucus and phlegm formation in the throat which causes stickiness irritation and sometimes cough what can be done avoid dust smoke or any irritative substance entering into the nose by wearing an n95 mask salt water gargling at least to 10 times a day for two weeks keep sipping boiled warm water every two hours avoid cold spicy and oily food for the next one month any gastric issues have to be treated in a proper manner you can take tablet allegra fexofenadine and montelukast one tablet two times a day for 10 days tablet mucomix mucinac 600 my one tablet twice daily for 10 days"
    },
    {
        "instruction": "hello I am a 25 years old girl and after year I am totally depressed my life is getting worse without friends family hobbies do not bother me I have already three gastroenterologists and I have tried for a half year helicid famosan ursosan itoprid duspatalin probiotic vitamin vitamin all types vitamin a nothing much help my new doctor said to me I have to get rid of all medicaments and start without them and the pain is caused by lots of stress and lack of sleep I am in third week on this medication and I am in terrible pain every day no matter what I eat please could you give me some help is there any possibility that after your using these medicaments my stomach is only trying to recover from some shock without pills I have to be patient and continue with this process how to start a new week to heal the stomach pain and get on track with standard meals g for whole one week eat only rice gluten free white bread potatoes and after that start to add something is it possible that taking lots of vitamins zinc omega magnesium yeast probiotics can cause stomach pain acid reflux I have problem with acne and I know it is from the worse digestion I love to exercise but jumping or laying on the floor is sometimes painful what is the best kind of sport to do with stomach issues is it possible that yogurt or milk make stomach pain even I was tested on dairy allergy and everything was ok I love yogurt it is possible that underweight mi 15 is causing all my problems and I have to eat a lot even I am in pain to get healthy weight",
        "input": "",
        "output": "hello dear welcome to icliniq I have reviewed your concerns in detail I can sense you are a wonderful lively person who likes exercise and enjoy foods but unfortunately for various reasons you are facing lot of troubles along with health issues that makes the situation even more worse since you have been seen by three gastroenterologist who are expert in the field and are treating you on the line of is major clue is your drugs now for me most important thing is to fix all issues together for that only one person who can do wonders for you is you yourself I am saying it because there is strong gut and brain relation your depression anxiety need to be addressed why you are feeling low and socially isolated we will together work on it as I would recommend you to please sit with yourself in an calm environment and write down the possible solution of ur problems when you will try to find the solutions you can easily kill your problems one by one by different good approaches continue light exerxise practice smiling even to those you do not know just to make ourself happy love nature this is how you life will take lovely turn you will again start to love yourself imagine yourself as a mental fit and happy person how would you feel just imagine for a while I would advise to work on it for your pain related issues please take following meds I hope they will help you in calming the pain to drotaverine 40 my to citalopram 10 my 0 to clonazepam 5 my 1 ispaghol husk 2tsp in glass of water keep it for hours and then take it I hope you all find it useful let me know how you feel after week your feedback will be required so we can help you further humble regards"
    },
    {
        "instruction": "hello doctor I have back pain on the left side and cannot move on that side the pain was between my belly and back but now it is only on my back at the end of the spinal cord while sitting standing or even sleeping I can feel the pain in this area and it lasts for one week I am currently taking ibubrufen",
        "input": "",
        "output": "hi you are very young to actually have persistent back pains there are many causes of pain in the lower back region it can be due to faulty posture related to weak muscles issues with disc narrowing of spinal canal or any bony instability besides many others so accurate diagnosis is the key to proper management of the condition you will have to elaborate on your problem of back pain which means the duration of pain and mode of onset I would also like to ask you if it is associated with any leg pain or any other neurological symptoms like numbness paraesthesias electrical shock like abnormal sensations or any weakness in limbs please also tell me about any associated symptoms like fever weight loss etc what medications you generally take for your existing problem if you have localized back pain with no other symptoms like radiating leg pain neurological symptoms like numbness weakness paresthesias etc then you can start with following recommendations for an initial period of two to three weeks maintain proper posture of your back while working and sleeping if pain is more then you can take a short course of anti inflammatory medication like tab etoricoxib or paracetamol or one which suits you physical therapy initially under the supervision of a trained physiotherapist and then to continue at home adequate calcium and vitamin intake if levels are low in the body ice packs can be applied if your pain is acute then hot fomentation can be done at home analgesic spray for local application can be used and is easily available avoid lifting heavyweight or acute forward bending in the mornings etc we will observe you for the next two to three weeks on how you respond to this conservative management protocol if you are not feeling better then we will have to get some investigations like dynamic rays of lower back and few blood tests for evaluation"
    },
    {
        "instruction": "i have had pityeariasis rose or for about a week and I am currently weeks pregnant I have had no other symptoms other than the rash after reading a study which found a 62 miscarriage rate when women were infected with or during the first 15 weeks of gestation I am obviously terrified can you provide me with any reassurance or advice on any testing treatment that may be required thanks",
        "input": "",
        "output": "thank you for giving me opportunity to treat your skin problem yes you are right there are significant chances of miscarriage if pityeariasis rose appears in first few weeks of gestation mostly miscarriage occurs when pityeariasis rose happens after hav infection according to literature there are also other causes of pityeariasis rose other than hsv6 hsv7 like some drugs medicines vaccination other viruses so first if possible provide me photographs of affected areas of skin which will help me for better diagnosis and proper plan does you had fever or joints pain few days back for viral infection hav you can go for serum ig nested or it per and viral load also pregnancy outcomes depends on body surface area involvement and constitutional symptoms final decision about to continue pregnancy is yours you also consult with your obstetrician gynaecologist for the same thank you"
    },
    {
        "instruction": "hello doctor my wife is 10 weeks pregnant due to lockdown we are not able to go to the doctor she feels body pain and started spitting a lot from the fourth week she also vomits a lot please tell me what should I do and also suggest health supplements for her",
        "input": "",
        "output": "hello nausea and vomiting are pretty much common during the first three to four months of pregnancy which happens due to sudden hormonal changes the body pains she feels is also due to the same reason I am assuming she must be taking folic acid supplements already after she got to know she was pregnant or once the scan was done if not please start them immediately after 14th week she can stop folic acid and switch to iron supplements once nausea and vomiting subside I will be mentioning the tests that she needs to take up as she is already 10 weeks pregnant there will be an important scan in the coming weeks that is between to13 weeks which is called it scan nuchal scan and also a blood test called double marker test which is for the screening of down syndrome in the fetus along with other chromosomal abnormalities called trisomy 13 and 18 please do not miss these tests you can get back to me if you got any further queries pregnancy induced nausea and vomiting it scan 13 weeks dual marker test 13 weeks tablet folvite my daily dominate plus doxylamine pyearidoxine and folic acid two tablets at bedtime for 15 days it reduces nausea and morning sickness tablet emset sos my before food if vomiting is uncontrolled syearup gelusil two teaspoons thrice daily 15 minutes before food for one week small meals at frequent intervals avoid spicy foods drink more water and fluids to avoid getting dehydrated avoid sexual intercourse until 14 weeks to prevent the risk of miscarriages"
    },
    {
        "instruction": "i have taj disorder and I was wondering if there was anything I could do about the left side taj getting inflamed besides just letting it be and relax as it is pushing on the inside of my ear I can feel hear it making a crackling wet noise when I push my jaw forward or a painful pushing feeling inside my ear when I clench my teeth it started yesterday and is better now that I have slept and it is relaxed but it is still bothering me and the crackling pushing is still there",
        "input": "",
        "output": "hi for a taj dysfunction you can consider the following advice spasm in the muscles around the joint can be the reason for this probable dysfunction it will take around weeks for the muscle to get back to normal but chiefly depends on how much precautionary measures mentioned above you have followed I hope I have answered your query if there is anything that I can help please do le me know get well soon warm regards"
    },
    {
        "instruction": "hi I 17 years old my periods are irregular and sometimes it lasts for 15 days sometimes or sometimes days from last month I got my periods for only days with very light flow and now it again started but very minute little I dont know why its happening like this ply help me",
        "input": "",
        "output": "hi dear I understand your concern am also proud that kids of your age are so thoughtful to ask these questions at your age I was not even aware of such things first of all after menarche till 18 years of age your body will be adjusting to the changing hormones and also your hop axis will mature till 18years of age hence irregular cycles are common during this period but in your case your mi is on higher side and obese for your height as per your height your ideal weight should be 5kgs weight reduction will help you best with your periods as more estrogen is produced from body fat it leads to hormonal imbalance also obesity causes insulin resistance and acne also get evaluated for thyroid take tab yaz for months to regulate your periods if you have any questions please feel free to ask if you are satisfied with my answer please leave a feedback"
    },
    {
        "instruction": "hi I am 20 years old I wanted to ask a hematologist a question because I feel like my primary doctors are not taking the right precautions steps with my current symptoms I have hereditary spherocytosis snapping scapula and what I believe to be a spermatocele during some blood work a few weeks ago my bilirubin was highly elevated my abc was low and at my appointment yesterday they took a urine sample and found a large amount of blood in my urine and I feel like this is very serious considering the blood disorder I have and my doctors keep making me wait days at a time before follow up appointments or more tests and I just feel as though this should be acted on immediately since they still do not know what is going on with me and I just wanted to see if a hematologist could give me some input on what I should do",
        "input": "",
        "output": ""
    },
    {
        "instruction": "i have experienced a back injury which has lasted for two months but it has gotten better lately the event happened when I had my back extended to max backbend training and it was just sore afterwards but the next day the range of motions had been very limited which I could not do any extension nor flexion I felt the pain and compression around the sides of my lower back and middle back when I flex and extension degrees was limited as I felt it was at the middle of the spine prevents me to do so I have been doing research about this which can seemingly be al muscle spasm thoracolumbo joint syndrome and have tried gentle stretches also even rested but still experience the pain or discomfort",
        "input": "",
        "output": "hi never try to stretch any body part or full body in a first if given a try the same will happen stretching needs to be done on regular while doing exercises and can be extend day by day not by once anyways dont worry about the low back pain here I will suggest you exercises which at first you need to do slow without any pressure for a week then after a can do little fast this will improve your muscles strengthening of lower back apply the ointment to the area of pain cover it for about 10 15mins with a cloth then clean it with warm water following hot water fermentation then do the following exercises all the above exercises to be done carefully atleast once a day for 10 days do not put pressure if pain is severe diclofenac ointment to be used twice a day take accelofenac paracetamol zerodol for three days once a day slowly the range of motion will increase after a week until then take rest properly and take care follow up after a week thank you"
    },
    {
        "instruction": "hello doctor I have irregular periods and continuous bleeding in the genital area so I am using sanitary pad always and also have some kind of pain in the stomach",
        "input": "",
        "output": "hi I understand your concern please tell me when did you attain menarche have your periods been irregular always if yes tell me your cycle length are you married any children are you taking any other medications when were your last periods when was this ultrasound done according to scan reports your endometrium is thick you need to understand diagnostic as well as therapeutic curratage until then take tablet pause of tranexamic acid three times daily for five days and tablet meprate 10 my medroxyprogesterone thrice daily for seven days followed by twice daily for the next week and followed by once daily for the next one week and stop if your cycles are always irregular following the above treatment start diane 35 for three months also take iron folic acid supplements to prevent anemia due to excessive blood loss please answer the above mentioned questions to suggest if anything extra is needed other than the mentioned treatment"
    },
    {
        "instruction": "hello doctor my lower back pains extremely bad when I stretch backward or forward it is painful to sit as well as while standing when I press my back I feel no pain but the pain starts as soon as my back stretches also my legs shiver due to pain what is the reason",
        "input": "",
        "output": "hi I would like to know what do you do and how much physical activity you have in your daily routine"
    },
    {
        "instruction": "hello doctor I did my blood test yesterday and the cholesterol levels were high the results are as below complete lipid profile test cholesterol 244 my triglycerides 252 my lil direct 174 direct hel cholesterol 34 my do in the cholesterol tests conducted earlier the triglyceride value only was high no medicines were taken started exercises after that again a test was done about a month ago the result was 233 for cholesterol no medicines were taken kindly suggest me if I have to start medication as the value is only going high",
        "input": "",
        "output": "hello welcome to icliniq com it is definitely deranged I assume that the test was done after fasting of hours if not then worthwhile to repeat now since you are young it is important to determine whether you will need long term medications or not so you may give a try of healthy lifestyle for 8 weeks if you think you already having a good lifestyle and there is no scope for further improvement or due to unavoidable factors you would not be able to modify lifestyle more then better to be on medications so you should have tablet rosuvastatin 10 my once daily bedtime for weeks and repeat the lipid profile after that let me know the values after weeks if you want to try a healthy lifestyle which is also an option then you may try for eight weeks have low oily fatty and fried foods have less of fast food low calorie foods low butter ghee and low fat milk avoid meat and egg yellow avoid sweets as much as possible try to achieve some weight loss have regular exercises like brisk walking or running according to the capacity repeat the lipid profile after eight weeks of healthy lifestyle to see the response and if there is no response then you need to be on medications if there is a good response then medications are not necessary I hope this helps"
    },
    {
        "instruction": "hello doctor my stomach gets upset when I drink milk orange juice or even yogurt which is normally good for an upset stomach I cannot digest banana corn flakes and many other foods and it has been going on for a long time I have been to many doctors and they had endoscopy and colonoscopy tests but nothing came out bad please help",
        "input": "",
        "output": "hello I can understand you must be very upset about your condition so you see the diets you are kind of allergic to are containing milk protein yes there are some diets that contain no milk but the diet that predisposed you to have stomach upset will disturb your stomach as often as one has allergies to almost every diets the person takes so I suggest you to cut down your dairy intake it occurs due to the deficiency of an enzyme called lactose which usually digests the milk or you can purchase a commercially available drug containing lactose enzyme tablet lactaid 900 fu just every time before having a milk based diet if you want to discuss more I am here to help follow up in one week"
    },
    {
        "instruction": "hello doctor my main problem is alopecia I had it from 2015 with several patches on the head and now they are gone but the problem is my eyelashes are gone and never grew back I used castor oil garlic and now revitalash and other things two years ago a rheumatologist prescribed me dolquine and I did not have patches but my eyelashes still fell I have lots of problems like hypothyearoidism and hashimoto and currently on euthyearox 100 my doctor told me it has nothing to do with alopecia because it is normal now good to and ash etc I newly knew that I have pro normal result in echo but my glucose is lowered after hour of glucose 75 my intake and my insulin was 60 plus androstenedione 5 and I have hyper prolactinemia for six years on its own did an i'm and no tumor and currently taking dostinex with all these problems I smoke water pipe shisha nargile three times a day",
        "input": "",
        "output": "hi your concern is genuine and you are so brave and facing all challenges very bravely you did not mention your prolactin and thyearoid hormone levels loss of hair can be autoimmune as you were treated for it as well and due to hashimoto as well if there is no skin issue involved in the loss of hair you should consult a dermatologist for it may be due to your autoimmune disease hashimoto is autoimmune as well what you can do is that you decrease the ash thyearoid stimulating hormone target to a lower level with increasing levothyearoxine and then see if it has a better effect I hope this helps"
    },
    {
        "instruction": "hi doctor I need some advice on behalf of my mother who is 67 years old for the past 12 days my mother has been experiencing pain in the throat area feels like something is stuck vomiting mucous weakness body aches white tongue difficulty swallowing and vomiting feeling while talking and eating she vomits about twice a day she consulted an ent and internal medicine doctor ent dismissed her after nothing found in throat using a camera but the internal medicine doctor did some investigations results showed ti epithelial cells 20 25 hpf and pus cells 30 35 and ash 13 raised as well as candid albicans growth from a throat swab she has had this issue every few months and normally clears up on its own but this time it is very severe and not going away current medication cefotil cefuroxime 500 my and clavulanic acid 125 my gelora gel for oral thrush miconazole be motigut for vomiting 10mg thyearoxine 50 mug currently but internal medicine doctor asked to increase the dose to 5 tablets due to high ash urine culture was done and it was normal my query is whether this is a bad infection not bacterial but growth of esophageal candidiasis can be treated by antifungal therapy fluconazole no improvements are seen with many antibiotics oral thrush candid was found on initial appointments and also candid in throat swab is there any harm in trying a course of fluconazole she had a history of fungal infections in the throat which normally clear up on its own this time it seems much more serious if it is fine what dosage would you recommend and for what period",
        "input": "",
        "output": "hello yes your mother is suffering from hypothyearoidism oral candidiasis ti urinary tract infection dysphagia oral candidiasis or oral thrush if not improved within five days after starting local antifungal then you may start oral antifungal medication you may use tablet af fluconazole 150 my once a day for one week but in case of old age people may feel nausea or vomiting for this drug then you can give iv fluconazole foran 100 my once a day for five days in old age vitamin b12 deficiency is also common so it may present like glossitis with pharyngitis take vitamin b12 injection weekly once you can give neurobion injection also use candid mouth paint for local application use tablet levosulfuride 25 my twice a day for nausea and vomiting at the same time check for serum electrolytes levels which may be altered in old age lead to vomiting you may give probiotics like capsule gut ok or sporulac sachets to increase the immunity levels and also prevent gut growth of fungus remaining medications you continue the same response to the treatment may take four to five days diabetic patients are more prone to oral candidiasis so check for blood sugar"
    },
    {
        "instruction": "hello doctor I am a 42 year old male non smoker and non alcoholic for the last two months I am noticing lots of brown patches below my armpits of the left hand and nothing much on the right hand and off late I could sense I am sweating armpits which I never had before will you please consult on this issue",
        "input": "",
        "output": "hi what I can make out from your history is that you are having brown patches over the left armpit for two months I want to know no other symptoms in this lesion like if they pain or burn are they increasing in size or same since their start any other family member having such lesions please send a clear photo send history as asked and photo"
    },
    {
        "instruction": "hello doctor I am writing to you about my partner she has had swollen lymph nodes for the past two years only other symptoms are high car and very slightly higher eosinophils she had an ultrasound of her right side of the neck today and I would like to know if you can see anything unusual also I would like to know what the other two pictures say that are am lymph node or the marked submandibular gland which was operated on two pictures I see three small circles around a big circle and on one of the pictures some of the small circles have something inside of them obviously doctors are investigating possible lymphoma so I would really appreciate your help and if you could take a good look at everything and tell us an opinion about the features of the examined organs",
        "input": "",
        "output": "hi let me start with the right neck lymph nodes seen on the images they have a fusiform shape which is a good sign they are mildly enlarged the index one short axis measures my image lymph node with doppler box showing center blood supply which is again a good sign image couple of mildly enlarged lymph nodes image submandibular gland and mildly enlarged lymph nodes with a white center fatty hilum normal image index lymph node measurement long short axis 21 my I would favor benign pathology versus lymphoma due to fusiform shape central blood supply preserved normal fatty hilum and mild enlargement this can also represent systemic inflammatory diseases I hope this helps"
    },
    {
        "instruction": "hello doctor my baby is months old on starting of 10th month I had a problem in my breasts and stopped feeding by doctor advice I thought cows milk is better than formula because it is natural so I am giving it for the past one month in very diluted form four days before we switched to the formula since cow milk is not available after that he passes stools many times for two days and got fever when consulting a pediatrician he advised not to give cows milk and suggested only formula but now after giving for a day he passed mucus in stools is my baby allergic to formula he is fine with cows milk can I give the same please help",
        "input": "",
        "output": "hello welcome to icliniq com cow milk should not be given until year of age usually as it may cause calcium and iron deficiency any change of feeds in babies can cause some change in stool pattern which formula are you giving and how do you prepare it proper concentration is very important have you started weaning and how many times the baby is feeding milk if only two or three times then you can continue with cow milk but do not dilute it"
    },
    {
        "instruction": "hello doctor I have been using lutera but recently I started having some problems I have been bloated and my period began on the 14th it usually lasts for four to six days so the assumption was that it would conclude on the 19th it is 23rd and I am still lightly bleeding but my breast are tender again I wanted to ask if this could possibly be side effects of the birth control or if there was possibly some other reason for this I did do some research and I found that lutera had been recalled a couple of times I did stop taking it for a while to see if it only happened with the birth control and upon getting back on it the symptoms have persisted I feel like I am gaining weight as well as breaking out with acne a lot more please suggest an opinion",
        "input": "",
        "output": "hello lutera has multiple side effects and is not really good contraception in fact all oral contraceptives are not a very good option as contraceptives bloating weight gain irregular spotting are a few side effects larger and other bad side effects are marked suppression of ovulation leading to suppression of the biological clock of females it changes the vaginal environment and therefore causes the growth of multiple bacteria it is also known to cause obesity diabetes it hypertension and breast lumps the best is condoms by the partner and vaginal tablet to be inserted at the time of contact kindly stop taking that tablet take capsule primosa 100 my once daily also take supplement of antioxidants like grape seed extract and multivitamin stop taking pills"
    },
    {
        "instruction": "hello doctor actually I had sex with my partner during period and after that I have taken I pill within 12 hours after two days my period stopped and now about one month passed but my period did not start yet and I tested with pregnancy kit with negative results some white liquid is leaking and some symptoms make me to feel like I am pregnant what should I do I am confused because the kit shows negative please help",
        "input": "",
        "output": "hello welcome to icliniq com I have gone through your query as the urine pregnancy test is negative you are definitely not pregnant right now sometimes the premenstrual symptoms can also be similar to pregnancy because of similar hormones acting in both the situations some amount of menstrual disturbances are known side effects of the emergency contraceptive pill so if you still have a doubt you can recheck it again after three to four days with an early morning sample if still negative you can be sure you are not pregnant just wait for a week for periods to come please use a better and consistent method of birth control in the future like oral contraceptive pills or condoms and repeated emergency contraceptive pill can take a toll on your hormonal balance I hope this helps"
    },
    {
        "instruction": "hello doctor I was wondering if I could ask a few questions about a potential ectopic pregnancy I recently started new birth control after not taking any sort of birth control for three months called drospirenone and ethinyl tablets up 3mg 02mg and I am now on day of taking the pills I had unprotected sex within the first week of taking the pill however I have always had a really light period and rarely got a period when I was previously taking birth control the last day I had unproductive sex was exactly 19 days ago however about five days ago I started to have more intense cramps on the same side and I am also bleeding this is what it felt like last year before I took a test just way less severe I looked online and learned that I can take a pregnancy test at least 19 days after intercourse so I just took one and it came back negative I am not sure if I am having an ectopic pregnancy or it is just too early to tell if this could be a side effect of the new birth control or if this is just my regular period despite it starting in the middle of my pack",
        "input": "",
        "output": "hello you have to know that contraceptive pills will prevent a future pregnancy if you have taken the pills for seven days after that you can have unprotected sexual intercourse so before that you have to use another form of contraception also if you have had sexual intercourse not in your ovulatory day that means at first day of your cycle the possibility of a pregnancy is low the urinary test has a high acurracy if you perform that after a week of menstrual delay I read that you have experienced a rupture ectopic pregnancy last year the typical symptoms of an ectopic pregnancy are missed period abdominal pain cramps and spotting I recommend you a hug human chorionic gonadotropin blood test you can repeat that every 48 hours to detect a future pregnancy it will double its value in an intrauterine pregnancy meanwhile the rise of hug value in an ectopic pregnancy has another pattern less than a normal pregnancy also the cop and the medication that you take can affect your cycle I would recommend hug blood test at first if you have the bleeding within your expected date without delay it would be your cycle that has come"
    },
    {
        "instruction": "hi doctor I would like to have a second opening regarding my daughter case she is just years old and she was having some seizures at night while asleep for 10 15 days we started to observe that she is having jerking movements stiffening of the body and sometimes teeth grinding for about 15 30 seconds I am attaching her consultation and lab report for details",
        "input": "",
        "output": "hello I can understand your concern according to your statement your two years baby has been suffering from seizure which lasts for 15 30 seconds anything that interrupts the normal connection between nerve cells in the brain can cause a seizure this includes high fever high or low blood sugar drug withdrawal or brain injury there is various type of seizures like absence seizure tonic clinic seizure atomic seizure clinic seizure tonic seizure myoclonic seizure etc by abc eg and mri of brain we can detect the type of seizure and then treat them accordingly as soon as you know your child is starting to have a seizure you should gently try to get your baby in a position where your baby is safe stay with ur child do not put anything in your child mouth do not try to stop or restrain the child movement children often foam at the mouth during a seizure wash that carefully"
    },
    {
        "instruction": "hello doctor I have been experiencing rectal bleeding for the past 10 days at first it was light but today I noticed that the bleeding seems more severe it dripped a lot and covered the majority of the toilet paper the stool itself was not red just light brown and regular as always I do not think I have any external cuts or wounds because I do not feel any pain or stinging sensation as I wipe if it were an external wound it would have healed by now I have been wiping gently or dabbing to stop the bleeding although I feel fine no external or internal pain I am anxious and nervous about this development my rectum does bulge out when I pass stools so the obvious is hemorrhoids but the bleeding seems like something from inside",
        "input": "",
        "output": "hello yes I do agree you are likely having bleeding from hemorrhoids my recommendation for you will be avoid constipation take ispaghol husk tablespoons in a glass of water keep it for a good four hours and take it take tablet daflon flavonoid 500 my 0 for five days do not worry it will settle I hope this helps constipation excessive straining venous insufficiency increased venous pressure hemorrhoids take plenty of water chew food well take a lot of vegetable and fruits"
    },
    {
        "instruction": "hello doctor I was wondering is it is normal to have an irregular period after stopping the depo shot my last shot was administered sometime befor three months I do not remember the date I had taken two shots but decided to stop because I kept bleeding and spotting while on the shot I experienced bad cramping and heavy bleeding last month and it has been a month since then and now I have only experienced ovarian pain and brown discharge I am not sure what this means",
        "input": "",
        "output": "hello as you mentioned it is a known side effect of depo shot to have irregular spotting or occasional bleeding too and usually the effect of the depo proverb shot last maximum up to three months only depending on the dose the present experience of heavy bleeding and cramps may not be related to your depo shots it may be due to some underlying cause so I would like to know why was depo shot advised for you was it only for contraception birth control or was it for any complaints like excessive bleeding and cramps during your periods which may indicate a process called endometriosis irregular bleeding may indicate some underlying hormonal disturbances which need to be evaluated I would also like to know if you have any recent weight gain excess unwanted facial hair acne problems scalp hair loss headaches visual disturbances etc these may give some clue in finding a reason for this irregular pattern of bleeding also if possible you could share some reports of your previous investigations like ultrasound to help me in guiding you for further evaluation"
    },
    {
        "instruction": "hi do I was operated for nasal polyps surgery years back from last one month or so it seems that some mucus is always stuck in my throat and I have to clear it every now and then this gets worse while lying on bed I showed it to my ent specialist and he mentioned that it is herd and prescribed some antacid tab that did not work I have no other symptom and I always feel some kind of phlegm in my throat that hardly comes out or go inside while swallowing this is very irritating please prescribe some medicine any lifestyle changes to get rid of this",
        "input": "",
        "output": "dear welcome to icliniq I reviewed your history and attach file of ent surgeon the problem you described is very typical of two things postnatal drip or herd as ent surgeon seen you and they ruled out postnatal drip so it is more in favour of herd and another supporting evidence is its aggravation on lying down I will recommend to start following treatment and then get back to me after weeks and let me know the response antacids will not help in it herd postnatal drip herd cap deslansoprazole 60mg before breakfast for weeks"
    },
    {
        "instruction": "dear doctor I am female 26years old I have been diagnosed with diabetes from past years I take the following medicines every day diamicron 60mg before breakfast gluconorm 500mg after lunch gluconorm 500mg after dinner due to current couid situation I am unable to visit any medical center to perform diabetes related blood tests but I did test my sugar levels at home after breakfast it was 346 I am worried as to how to consult doctors in this present situation my sugar levels are not coming down I eat normal meals in small portions like roti little rice snacks etc my last hba1c tested months back was more than I use to take jardiance before but stopped as I wanted to plan for my pregnancy since my sugar levels are not coming down I am worried about my future can you please guide and suggest as to what action plan I should take to help reduce my sugar levels to normal range appreciate your timely help in this quarantined environment I have thyearoid too taking euthyearox 75mg every morning regards",
        "input": "",
        "output": "hi good day thanks for your query I have very uncontrolled diabetes ur lipids are also very high that means ur not controlling ur sugar treating diabetes is not just bring sugar numbers down but avoiding complications which are associated with diabetes it can affect heart kidneys eyes nerves brain and everything first of all you need to stop bread rice pasta potatoes eat less fruits especially mango banana and grapes no sugar in tea no sugary juices ice cream or chocolates exercise at least 40 minutes daily even if it is just a walk if you will not change lifestyle no medication can control ur sugar with the time ur all body can be then affected with diabetes its a dietary disease and treatment is with diet only medication help when you change ur lifestyle if ur planning to be pregnant you need to be on insulin and you need to have hba1c less than 5 in pregnancy you know where ur right now I do not think ur taking good drugs right now either these will increase ur weight and that will lead you to have more sugar did you try glucophage before if yes why you had to stop did you try sitagliptin jardiance is a good drug as well so in my opinion you should be in insulin at present situation if you want to be pregnant especially otherwise the drugs I mentioned are the best choices let me know what you feel if you agree we will start those thanks"
    },
    {
        "instruction": "hello doctor I had aggressive damaged wisdom teeth removal about a month ago and since then I have a swollen lymph node in my neck on the side of the removal which sometimes it hurts and feel swollen and sometimes normal but it does not go away but for the last two days both sides are swollen and my throat is sore and hurts when I swallow or smoke is this something serious",
        "input": "",
        "output": "hello I have seen the image it is showing right follicular tonsillitis with keratitis of the right buccal mucosa and attrition of the teeth with discoloration of the teeth present for tonsillitis you have to use antibiotics like amoxicillin and clavulanic acid 625 my twice a day for five days and tablet azithromycin 500 my first day followed by 250 my once a day for five days avoid cool drinks and alcohol avoid smoking and tobacco chewing use water vapor inhalation and salt water gargling thrice a day for keratitis avoid smoking and use capsule vitamin a once a day for one week eat green leafy vegetables and fruits please consult with your oral pathologist he will examine and if possible will take a biopsy and treat you accordingly I would like to some details how old are you since when you are smoking is lymph node feeling hard or soft it is possible that lymph node enlargement in case of any infection in the oral cavity nose or ears if the lymph node is soft painful and easily moving means it is inflammatory pathology but if it is hard matted and non movable means a malignant pathology"
    },
    {
        "instruction": "hello doctor I am 26 years old I have a problem with hyperthyearoidism during my pregnancy I am in my fourth month of pregnancy with ash 07 to 161 to 34 what are the complications with this is it good for me to take ptu",
        "input": "",
        "output": "hi hyperthyearoidism in pregnancy is usually treated with propylthiouracil 50 100 my day generally treatment is withdrawn four weeks prior to delivery after which normal doses may be resumed your hormone levels are still very high you need to increase your dose pregnancies complicated by uncontrolled hyperthyearoidism may result in higher incidences of spontaneous abortion miscarriage preterm labor low birth weight babies or stillbirths complications of pregnancy including pre eclampsia a condition associated with hypertension low blood platelet count protein in the urine and mental changes may also occur so please increase your dosage another thing I want to highlight is that you should do ash thyearoid stimulating hormone receptor antibodies and to see what is the cause of your hyperthyearoidism is it graves disease these antibodies can enter from the mother blood to the baby blood and stimulate the baby thyearoid gland these antibodies should be measured in the mother during her second trimester of pregnancy because the values that are greater than five times normal have been associated with hyperthyearoidism in the baby at birth"
    },
    {
        "instruction": "hi doctor I have been having terrible problems with anxiety and depression I was on trepiline and eltroxin for depression when I was younger and I mainly want to know if I can substitute it john wort for 25 my trepiline these episodes definitely worsen around my period so might a vitamin supplement help I am 35 years old so far I have been managing this with breathing techniques mindfulness etc but I really cannot carry on like this anymore please help",
        "input": "",
        "output": "hello see just because prozac did not work for you does not mean that you will not respond to other medicines there are at least 15 20 types of antidepressants depression and anxiety are very common and a lot of people have it basically happens when some neurotransmitters such as serotonin reduce in your brain leading to a problem with handling the day to day stresses of life medicines are usually given for two to four months and then tapered off slowly and stopped things like it johns wort eltroxin etc will only add to the effect of the primary antidepressant it will never be a substitute for the medicines still if you wish to try these you can take it johns wort twice a day and also take theanine 200 my once or twice a day theanine is also an over the counter dietary supplement which shows good results for anxiety if you have sleeping issues you can take melatonin my over the counter supplement at night yes taking a probiotic compound along with vitamin will also help also take it once a day"
    },
    {
        "instruction": "hello doctor I am experiencing brain fog cannot think properly even a single sentence or a numerical or complex problems feel pressure and blockage in head and dizzy and foggy in eyes when I read a palpitation began to start in my head and in overall body and eyes become blurred frequently heart palpitations became to start again and again and I feel uneasiness in gut area my body is stiff all the time stiffness in jaws neck and back area I feel pressure while speaking and it becomes uneasiness for me to speak softly aggression in facial area and some uneasiness in whole body I have use different psychiatric medications psychotherapy and even homeopathy medicine but nothing works mri and eg is normal blood tests are also normal ply doctor give me advice what is going on with me I have sinus problem also",
        "input": "",
        "output": "hello dear I am sorry about your health condition which antipsychotic drugs are you using yes sinusitis patients feel foggy mind and heavy ness in the head the heaviness may aggravated on head bending position few anti psychotics usage may also cause cloudy mind with confusion so for sinusitis use water vapour inhalation thrice a day for five days avoid cool drinks and ice creams use tablet monterleukast and levocetrizine once a day for five days do yoga and meditation regularly if symptoms not improved please consult with your treating doctor he will change the dosage and treat you accordingly take care"
    },
    {
        "instruction": "hello I am a 25 year old woman who recently discovered they are pregnant my period was due on est of this month that same day I took a test that came back positive I have tested several times sense and all have been positive however on the ith I noticed some bleeding the first time it was on the napkin and a bit made it into the toilet then it went away for several hours and then came back but only on my napkin its now almost am and I noticed I am still spotting but very lightly I do have an appointment today to confirm if I am really pregnant but I am concerned",
        "input": "",
        "output": "hello welcome to icliniq I would like to let you know that any spotting or bleeding in early pregnancy is a sign of threatened miscarriage you need to visit your doctor so that she can perform a scan to check if the pregnancy is still viable or not also if your previous cycles were totally regular then you would be mostly around weeks gestation so please visit your gynaecologist as soon as possible wishing you good luck and a great health ultrasound for viability and also after the ultrasound to consider progesterone support as advised by your gynaecologist avoid sexual intercourse till est months of pregnancy"
    },
    {
        "instruction": "small white little heads on my upper lip and on the foreskin of my penis they are visible only when I pull down my foreskin and they are located on my foreskin only they dont itch or hurt I have searched and it looks like fordyce spots",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello doctor I have been diagnosed with a herniated disc at la s1 and bulge at la I have some lower back pain but I also have pain in the groin area which seems to move also in the testicle my question is could the pain in the groin area and in testicles be caused by this herniated disc",
        "input": "",
        "output": "hello well the pain of la s1 disc herniation typically is pain on the backside of the thigh and radiates down to the leg on the outer aspect and to the foot the nerves of the groin region are more below but as in your case if the disc prolapse is big then it can also compress nerves of the groin region and can cause pain do you have any bladder issues or any numbness in your private parts"
    },
    {
        "instruction": "hello doctor I have missed my period for this month last month my date was 29th and my cycle is usually 28 to 30 days I am married and I had tried for pregnancy during my ovulation days now as soon as I missed my period I took the pregnancy test but it came out negative I am having severe back pain abdominal pain leg pain and constipation two days before there was some vaginal discharge of brownish color but there was no bleeding I am not on any medications I tried for pregnancy test today also but again it came out negative can you please tell me if it is or not pregnancy and why all these things are happening to me",
        "input": "",
        "output": "hi welcome to iclinq com it is unlikely to be a pregnancy as the card is negative however if you do not get your regular cycles even after one more week do check serum beta hug human chorionic gonadotropin blood test to rule out pregnancy as some times false negatives can happen with urine tests such changes in the cycle pattern that you had mentioned can occur with hormonal imbalance stress weight gain changes in diet and exercise pattern anemia hypothyearoidism etc hormonal serum beta hug if the normal cycle does not revert in a week hormonal reassurance if the cycle pattern continues to be irregular in subsequent cycles then you need to take tis transvaginal scan lifestyle modification"
    },
    {
        "instruction": "hello doctor I recently have recurring headaches some a little intense and some not I usually just take paracetamol and the pain goes away last night the pain started at top of my head but mostly on the left side the pain eases when I try to massage my head but what is different was the pain intensifies when I lie down I take 5 my nebivolol in the morning for my hypertension I also have panic disorder yesterday I did experience a panic attack in the morning then my headache started in the afternoon then again at night I took clonidine 75 mug which got rid of the headache and helped me sleep",
        "input": "",
        "output": "hi with the given information I think you are having a migraine please tell me what is the current frequency of headache per month additionally please answer the following questions do you have nausea or vomiting like sensation with a headache is it a throbbing type or tension type is it mostly one side is there irritation to light and sound how long it goes do you have disturbed sleep any visual disturbances"
    },
    {
        "instruction": "hello doctor the frequency of urination and thirst has increased from the last two to three days all of a sudden sometimes it is two to three times even in an hour I am a 29 year old male I regularly do hit exercises two times a day",
        "input": "",
        "output": "hello as you described the complaints you seemed convinced that it is due to hit high intensity interval training only but there could be many more factors associated with it to know the cause and prescribing further treatment I need to evaluate your case better how much is your daily fluid intake approximately and what is your regular dietary routine for your hit since when you are doing hit do you feel heat in the sole any difficulty in urination any symptoms of headache or any other condition let me know in the follow up about the above questions"
    },
    {
        "instruction": "hello doctor I have a query regarding my current pregnancy I had a miscarriage last year at my 16th week due to amniotic fluid leakage the doctor could not tell the reason for it and now I am pregnant again with 16 weeks too and this time my doctor suggested me to consider cervical suture as my cervix size is 26 my and I really did not want to do it considering the risks I will have another scan at 18 weeks to check the size again but I am really worried as I had four miscarriages and I do not want to lose this too currently I am taking aspirin and progesterone could you please kindly advise me on this",
        "input": "",
        "output": "hello welcome to iclinq com do not think twice it is better you get a cervical stitch done considering your history and present cervical length it would be better if you go for cervical suture obviously as the gestation increases the cervical length would shorten up more the cut off is 25 my so no point in waiting also add weekly intramuscular hydroxyprogesterone caproate injection 500 my would quieten the uterus without contractions until 32 weeks and it helps another thing is strict rest avoid any strain like constipation cough sneeze strenuous exercises etc short cervix cervical stitch strict rest avoid sitting positions as it increases the pressure over internal os when necessary"
    },
    {
        "instruction": "hello doctor I have been experiencing tooth pain and mild gum swelling for the last two to three days it is paining a lot and I am unable to eat food too kindly suggest remedies I am consuming rajnigandha pan masala for the last two years have reduced the consumption since pain is there",
        "input": "",
        "output": "hello I suggest some medicines but please stop the consumption of rajnigandha immediately do not take spicy and hot food take tablet augmenting 625 amoxicillin and clavulanic acid twice daily zerodol so aceclofenac paracetamol and serratiopeptidase twice daily hexigel ointment for topical application all medicine for three days if you have any drug allergy history or allergy please consult your physician before taking medicine follow up after three days"
    },
    {
        "instruction": "hi doctor I am a 24 year old male I have been having trouble urinating whenever I urinate I feel like there is a blockage that is preventing all the urine coming out at once this requires me to wait for a long time and continue pushing the urine out and then at the end I am using my fingers to squeeze the urethra to get out the last even after all of that there continues to be some dribbling of droplets also sometimes after masturbating I end up having to go every five minutes 10 times to let out a few more drops until it is all emptied out this is something I have been struggling with for quite a while I showed my doctor and he assigned an antibiotics course that did not make a difference I suspect it has something to do with semen blocking the flow of urine but I am not sure and cannot find anything related on google any advice on this would be appreciated",
        "input": "",
        "output": "hi semen blocking the way cannot happen so this much thing is clear secondly for how long you are having urinary symptoms you mention do you have any urinary complaints like frequency urgency poor stream nocturia dribbling or burning micturation does your poor flow of urine settles or become somewhat better when you strain during micturation I think it can be a structure disease do you have any history of diabetes or hypertension or any medication taken which antibiotics did you take any history of catheterization or trauma to the penile region"
    },
    {
        "instruction": "hi doctor I had done antibody for hive rapid screening test at 63 days which was negative and then I did hiv ran mealtime per quantitative test at 69 days which was also negative target not detected I heard per is very sensitive and conclusive is that true at 70 days as well should I be concerned or am I risk free although I am having diarrhea from a few days thank you",
        "input": "",
        "output": "hi welcome to icliniq as the test are negative at 69 days so you are free from hiv infection and need not to repeat the test per test is usually not used routinely antigen antibody test can detect almost all cases after weeks if you can tell me about these rapid test for hiv and you have done then I can give more detail which generation test you have tested was it ith generation test ith generation test can pick up more than 95 percent case at weeks and you have tested after 69 days and the results are negative so just relax thanks and regards"
    },
    {
        "instruction": "over the last couple of years I have had little red bumps all over my thighs and butt the ones on my thighs are mainly on the sides and the back under my butt they are not painful or itchy at all for a while I thought they were razor burn but I have tried different razors and creams gels but nothing is helping they always show up I get them on my inner thighs as well but they are not as bad as the backs and sides the ones on my butt I feel are acne I do not know how to treat it though they mainly show up after I have shaved my bikini zone they show up right on my underwear line and can be kind of painful occasionally I have not been treated for any of these bumps I would like to know how to get ride of them and get smoother skin if there is a product I could get or something I could do I would like to find out",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hi doctor I am a 40 year old male I am married with two kids I have been experiencing erection problems for the past eight months I am able to get erection most of the time but it doest last until intercourse my morning erections have disappeared I have no diabetic history no blood pressure nor high cholesterol or other medical conditions my desire is lower than before I used to have a very good and active sex life with my partner until last year please advice",
        "input": "",
        "output": "hi I have some questions from my side do partial erection occurs only during intercourse or during masturbation are you able to insert during intercourse or that is also not possible do you have any history of diabetes or hypertension are you a smoker or alcoholic"
    },
    {
        "instruction": "hello doctor the right part of my body feels tighter that the left I feel pain in my right calf and thigh when I wear trousers and in my right underarm when I wear a shirt what can I do to solve this",
        "input": "",
        "output": "hi I understand your concern I need to know more about your symptoms when and how does it start is it increasing day by day or it is the same is it associated with any pain or muscle ache is it aggravated by activity are there any diurnal variations is there any back pain or neck pain any numbness or loss of sensation how about urination any history of trauma or headache the most common cause of stiffness on one side of the body is muscle rigidity also known as muscle tension which can result in muscle pain it is characterized by the inability of the muscles to relax normally we are worried about unilateral stiffness it could be due to spinal cord or brain related conditions such as minor stroke or multiple sclerosis spine injury etc for the same you need evaluation I suggest you should consult your physician symptomatic relief includes physiotherapy isometric exercise and stretching will help you also can use hot fomentation or massage to relax your limbs I hope this helps"
    },
    {
        "instruction": "hi doctor I have had redness in my eyes I began using tetryzoline but it had no effect the redness has increased in the past two weeks it feels dry itchy and occasionally gritty on my eyes I recently began to experience pain around my eyes on the left side I use to work on the computer for hours a day what medicine can I use that will cure the redness",
        "input": "",
        "output": "hi welcome to icliniq com I will tell the medicines as well as ways to tackle the screen time start moxifloxacin plus loteprednol eye drops four times a day for next five days then taper it to two times for the next five days then stop olopatadine 2 percent eye drops two times a day regularly refresh tears eye drops six times a day regularly now coming to the screen time work in a well lit room the main light should come from behind your head every 20 minutes remove your eyes from the screen and focus on a far object for 20 seconds every 45 minutes take a five minutes break from the computer screen make a rule to blink eyes when ever you press space or enter on the keyboard"
    },
    {
        "instruction": "hello doctor my testicles are very swollen and itchy please help",
        "input": "",
        "output": "hello please do mention whether it is painful or not if possible you can attach a photograph of the swelling as of now you can try a topical antifungal that may be available online or over the counter in the us terbinafine ointment apply it over the itching in the morning after shower and before going to bed if possible get a testicular ultrasound done and do post to me fungus us scrotum keep the area dry"
    },
    {
        "instruction": "hello doctor I have been suffering from digestive problems for the past 10 years I have alternative bowel habits diarrhea loose stools or constipation gas and bloating some days I have to go for even three times a day and it always feels like the food is not properly digested I was at first misdiagnosed for having intestinal to and given strong antibiotics but at last it ended up with the diagnosis of is 10 years before I was stressed and stopped taking prescribed medicines and have been seeking natural treatments like siddha and ayurveda now and then and I found it to be somewhat helpful I need a complete treatment for this now as it affects my day to day lifestyle please suggest",
        "input": "",
        "output": "hello welcome to icliniq com I understand that you know very well about your disorder as of now the basic problem with the is irritable bowel syndrome with diarrhea is the spastic contraction of bowel and increased secretion of various gut hormones leading to abdominal pain and diarrhea since you have tried many medications so far I see there is still a role of low dose antidepressant medication which help normalize the gut hormones in balance but unfortunately these drugs have some side effects not necessarily mental wise but some physical adverse effects such as dry mouth dry eyes and can sometimes lead to constipation and also could cause increased sleep but since we recommend the patient to start with a low dose and then gradually step up if tolerated well you can take tablet amitryptline to 10 my once daily at night time and your mind will take sometime before actual improvement like it can give you relief in two to four weeks time try it for four weeks and come back to me to discuss if we need to increase the dose or add some add on medication uncontrollable is follow up after weeks"
    },
    {
        "instruction": "my sister is tracheostomized and bedridden after her fourth surgery done for foramen magnum meningioma she has drooling and now saliva is coming out under the tracheotomy plate she asks for frequent suctioning as she feels difficulty breathing her saturation is above 90 after suctioning since it is lockdown we are worried to take her to hospital is this an emergency",
        "input": "",
        "output": "hi if the patient is tracheostomised and if your really sure that the secretions from the tracheotomy tube is saliva then there is a possibility of developing a fistula an abnormal connection between the food pipe oesophagus and the trachea called as tracheosophageal fistula in such a condition we first need to heal the fistula and it can be done by following below mentioned advice there would be a cuff inflator pipe through which air can be inflated and deflated in and out from the cuff even though the inflated cuff prevents faulty aspiration of fluids from the mouth while swallowing it can also create a necrosis around the trachea thus causing the oesophagus to get connected to it you to need to suction the tube and deflate the cuff every his for 15mins so that this raw surface connecting the two heals and saliva from the tube stops coming for few days the patient might be stopped orally and a rules tube might have to be inserted to feed the patient repeated swallowing can again infect the area and might lead to leak of food also through the tube you can go to the emergency of any hospital to get this tube inserted in case its not there I hope this answers your query you can consult me for any further clarification warm regards"
    },
    {
        "instruction": "hi doctor my wife is 38 years old she had an abortion in 2012 around her six months of pregnancy due to the defects of diabetics from that time onwards she has not taken any treatment for diabetics as per her report pregnancy starts from 18th february we have started insulin eglucent three times and levemir sleeping time as per doctor advice is there any problem to the baby or my wife we are strictly following the diet and taking insulin with regular blood check up four times daily",
        "input": "",
        "output": "hi from your history I gather that you have been taking insulin from early pregnancy and closely following it if your blood sugar levels are well controlled with diet exercise and insulin then there is nothing to worry about there is no specific and extra chance for the baby to have any anomalies baby will have all the features of a normal pregnancy the pregnancy complications rate is same as any other normal pregnancy you do not need to worry you can have an it nuchal translucency ultrasound scan at 14 weeks quadruple marker at 15 17 weeks anomaly scan at 19 weeks and fetal echocardiogram at 24 weeks this is just for your satisfaction for every lady with diabetes or previous history so is tested with this do not worry your wife and baby are both doing fine I hope this helps"
    },
    {
        "instruction": "for piles am using himalayan tablets daily tablets but cant able sit properly due to anal itching please give me a medicine",
        "input": "",
        "output": "hello I have reviewed your history the medication you are on is basically ayurvedic which sometime may help and sometime not I would give you some treatment but I want that you should be examined in person by a local general surgeon if any need of surgical removal of this because if pile remain for so long could lead to significant pain and trouble in daily life style at moment take following treatment let me know in one week time if symptoms improve I have written all generic drugs which could be purchased at local store"
    },
    {
        "instruction": "hi due to this coronavirus pandemic my wife is very scared about the health concerns of our family sometimes she is not able to sleep at all although none of our family is suffering from diseases she is overtly anticipating dire consequences of this coronavirus and obsessively clean this is happening after the pandemic has started no amount of reasoning love patience sensibility is not working please help no other illness age height 7 weight 58",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello doctor I am a 52 year old male my recent labs show elevated levels of bun and creatinine I have hypertension and it is controlled by medication I am a weight trainer and boxer I have followed a high protein diet over the years my lab report shows egfr 71 bun 27 creatinine 32 my fluid intake has been down with my irregular schedule since the pandemic I have increased my water intake now 64 plus oz of water a day and I have stopped taking any protein supplements",
        "input": "",
        "output": "hello welcome to icliniq com I would like to know which medicines you take for hypertension I would like to know whether you have done any urine examination rest egfr glomerular filtration rate of 71 is within normal range for you if urine examination is normal I would advise you to decrease the protein intake and avoid protein supplements you take water as much so that urine daily passed is around 5 liters you should avoid any nephrotoxic drugs painkillers herbal medicines if a urine examination was not done previously I would advise you to undergo one routine urine examination and one ultrasound of kidneys"
    },
    {
        "instruction": "hello doctor my father is 54 years old he has a very heavy sneeze when he sneezes he holds it back and he loses consciousness I tell him not to hold it back but he is physically not able to let it go alone is there anything I can do to help him or anything he should do and are there any dangers in his life",
        "input": "",
        "output": "hi first we need to find out what is the cause of recurrent sneezing if you look into the physiology sneeze is a protective reflex often in response to something irritative and offensive which the body wants to push out in order to prevent it from reaching the lungs and thereby into the circulation most commonly it is dust but can be attributed to other irritative substances such as animal fur pollen smoke fumes etc what can be done prevention of entry of irritative substances is the key and plays a major role in preventing allergic responses this can be effectively done by wearing an n95 mask most times even while indoors in addition a combination of antihistaminic and asteroidal spray containing azelastine and fluticasone two puffs two times a day does wonder holding a sneeze inside can be lethal as it is high pressure reflux and by holding the sneeze reverse pressure can be created which has no where else to go but above to the cranium thereby an increase in intracranial pressure causing a vessel to rupture resulting in a stroke this is a far possibility but in elderly individuals it can happen and is lethal secondly an increase in intrathoracic pressure can also stimulate the vagus nerve resulting in vasovagal syncope causing a brief loss of consciousness it is very important that these measures are followed in order to prevent any untoward incident I hope this helps"
    },
    {
        "instruction": "hello doctor I have two bumps near my vaginal region one is on my thigh and the other is near my vagina they are red outside with a white circle inside what could this be I am currently taking doxycycline for acne",
        "input": "",
        "output": "hello sorry the images were not really very clear I would like to know if there are any similar lesions anywhere else on any other parts of the body or if these lesions have any pain or itching are they the same as they appeared two months ago or their texture or locations keep changing if there was any fever when you have these eruptions and did these come out after shaving or waxing but based on one lesion that I could make out probably which was on the thigh it appears like a folliculitis infection in the hair follicle which has gotten infected you can apply clindamycin gel or doxycycline cream over these bumps if they have this yellow topping which indicates they got infected if painful you can take some analgesic like combiflam or diclofenac folliculitis clindamycin gel or doxycycline cream local application change undergarments frequently avoid excessive sweating in the affected area keep the area clean and dry avoid shaving or waxing in the affected area"
    },
    {
        "instruction": "hi doctor I am writing this on behalf of my mother she is 60 years old and weighs about 86 keg her complaint is very extreme pain on the knee left leg this issue started one year ago and we consulted orthopedics who applied an injection on her knee after verifying an ray report and prescribed a couple of tablets doctor said it is a kind of arthritis there was some relief after that visit my mother again started facing the same problem since last month pain is so extreme from inside the knee that she cannot even move her left leg her right leg is fine kindly prescribe some relief and treatment plan please find the written ray reports for your understanding ray both knee joints marginal osteophytes are seen tibial spines are prominent mild reduction of the medial tibiofemoral joint patellar sour is seen no loose bodies are seen in the joint cavities no soft tissue swelling is seen around the joints impression osteoarthritis note she is not taking any medicine for the above issue for the past one year however she is taking tablets for anxiety blood pressure and diabetics",
        "input": "",
        "output": "hello your rays show grade 3 arthritis is worst in both knees however the ray picture does not always match with the clinical symptom as is in your case I will recommend that you take a course of anti inflammatory tablets like diclofenac 100 my so once a day after meals pantoprazole 40 my before meals tablet ultracet paracetamol and tramadol combination maximum twice daily for pain apply dynapar gel linolenic acid and paracetamol locally four to five times a day ice the knee 10 15 minutes when the spray is not applied that is there had to be a gap of 45 minutes between the ice and spray and vice versa if you have access to physiotherapy then tens transcutaneous electrical nerve stimulation therapy will help too"
    },
    {
        "instruction": "hello doctor I took carbamazepine 200 my for the first and last time at the beginning of this year and stopped right after experiencing some side effects from it a month later I discovered that this actually interacts with contraceptive implants which I have been on for one year looking back I have had unprotected sexual intercourse a day after taking carbamazepine I did get a period in january I also took pregnancy tests in february and they all came back negative I still feel anxious though is there any chance that I am actually pregnant and I have been just having some bleeding also has the effect of my implant been permanently affected due to carbamazepine or not",
        "input": "",
        "output": "hi why did you take carbamezepine do you have epilepsy"
    },
    {
        "instruction": "hello doctor I am a 39 year old woman non smoker some times when I clear my throat I spit mucus with a little blood I am not sick and I have no cough what could it be I consulted an ent doctor before",
        "input": "",
        "output": "hi how many years do you smoke do you drink alcohol what did the ent doctor say about you"
    },
    {
        "instruction": "hello doctor I have a cough that lasts for more than a month now this usually occurs during night time while lying and sometimes at dawn at first it was a dry cough then it turns into a wet cough I do not spit yellow or green phlegm it is all sticky white mucus I do not have any history of asthma and this is the first time I experience this I did not experience fever pain in my stomach and ibm I have already taken azithromycin for three days and ambroxyl but still no relief please help",
        "input": "",
        "output": "hello I can understand how troublesome it is if it is disturbing your sleep these cough episodes you are having are mostly due to hyperactive airways I would advise you certain investigations mentioned below also I would like to know if you get a cough after exposure to dust pollen or pets do let me know anything that might cause the worsening of your symptoms secondly do you have heartburn or on and off cold bronchial asthma allergic bronchitis spirometry with bronchodilator reversibility testing ray chest blood counts with absolute eosinophil count bronchial asthma allergic bronchitis bronchial asthma allergic bronchitis inhaler formoterol mug budesonide 200 mug with spacer puffs twice daily and can be taken up to four times daily if required and once exacerbation is over it can be tapered off for a month tablet fexofenadine 120 my once a day for a month rest continue previous treatment avoid exposure to allergens per peak expiratory flow rate monitoring follow up with investigation reports"
    },
    {
        "instruction": "hello doctor I need to know about my hymns type and whether it requires surgery to have sex please help",
        "input": "",
        "output": "hello I have seen the attachment you have an anterior lunar the opening of the hymen is more posterior but it does not mean you have to undergo a surgery for defloration for further information perform an examination by a gynecologist"
    },
    {
        "instruction": "hi doctor I have tested for sept and got the result indicates that I have sept 214 and got 197 now what shall I do please suggest me",
        "input": "",
        "output": "hello there are a few things I am worried here"
    },
    {
        "instruction": "hi doctor I have a small tear in the knee joint but the doctor advised me for arthroscopy how to manage this problem please suggest",
        "input": "",
        "output": "hi revert back after one week with the report to an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hello doctor I have a speech disorder and a constant headache it started before two months when I try to express myself I often stumble upon words repeat them or it takes time for me to think of an appropriate word to say on that certain occasion this seems to be progressively getting worse it is not that I struggle to think and create an idea about a certain topic posed to me it is just I struggle to express them in words when I searched online for speech disorders the best fitting I found is aphasia as it states most of the disorders I just told you about I believe the disorder is not directly damage or change my intelligence my current medication is nurofen please help",
        "input": "",
        "output": "hello revert back with answers to the above questions to a speech therapist online"
    },
    {
        "instruction": "hello sir I am having pain in apegastric region since months but today very high I had taken acidity tablet and antacid syearap whenever I take medicine I feel better for short period of time after that it as usually paining me what should I do",
        "input": "",
        "output": "hello it has been very difficulty to see medical advise in this time I appreciate you of using this platform for your medical queries from your history it seems the pain secondary to hypersecretion of acid however there are many other reasons of upper abdominal pain that may not be related with just high acid secretion it is of utmost importance to get some blood and stool test before jumping to treat with medicines also the duration of pain you describe is somewhat worrisome for now I want you take cap esomprazole 40 my before breakfast once daily spy gaviscon mylanta or any available antacid spy but make sure you increase the dose you should take 15 my four times daily just 30 min after meals it is important that you should take capsule before meals and antacid spy after meals I also want if you can get these test before your second visit since we need to rule out any serious thing if present serum amylase and serum lipase liver function tests ash serum lactic acid and stool for pyloric antigen univestigated dyspepsia functional dyspepsia peptic ulcer disease pancreatic cause go pathology I would like to see you in week time"
    },
    {
        "instruction": "hi kindly help me out I am a psychiatric patient diagnosed with generalized anxiety disorder who is on fluoxamine 150 my risperidone my clonazepam 5 my I use to watch porn most of the times in a day for about 18 years I left it recently about 15 days ago and not feeling well more than ever having panic attacks crying lot guilt ptsd ocd intrusive thoughts driving me crazy as porn use to increase dopamine and risperidone is an antagonist of dopamine is this causing a problem kindly let me know what I can do about it and what alternatives can I do to feel normal again",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hi doctor I have a son and a daughter my height is 7 and wife is 1 I am extremely worried about my children height as we are short my daughter is now years 10 months old and have 14 keg weight and 38 inches tall she had seizure thrice and taking some sodium liquid medicine for the past three years my son is year old and 10 keg weights and 28 inches tall I want to know what would be the appropriate height of my children as per current status is there anything I can do to increase their height I want my daughter to be 6 tall and son to be it tall will giving protein powder make any difference kindly do the needful",
        "input": "",
        "output": "hello I understand your concern I will try to sort it out for you we can add some calcium supplements revert back with the answer to the above questions to a child health specialist online"
    },
    {
        "instruction": "hello doctor one of my relative aged about 36 years married for years undergone frozen embryo transfer on 14th march and she got positive beta hug human chorionic gonadotropin on 25th she developed vaginal bleeding from ith april varying from light spotting to moderate bleeding on three occasions she was given tranexamic acid for three days on two occasions and this time also advised to take the same she is advised to stop aspirin and enoxoparin which she was on even prior to embryo transfer her scan is showing gestational age of weeks days with fetal heartbeat and such of am she is on duphaston 10 my qid austen 400 qid progynova my qid folic acid mecobalamin aspirin and enoxaparin 60 my daily which she stopped today please advice further management",
        "input": "",
        "output": "hello welcome to iclinq com I can understand the struggle she is going through the such subchorionic hematoma is big yet the positive thing is fetal growth of weeks with for fetal heart rate she is on the right medications and I would like to add an antibiotic like augmenting 625 my along with the medication she is already on medication for five days to avoid infected subchorionic hematoma as its big am nothing more could be done let her stay at rest with a sound and a happy mind threatened abortion threatened abortion reassurance continue the same treatment with just an added antibiotic rest and stay positive"
    },
    {
        "instruction": "hi doctor I had lasik at the age of 26 and had 20 15 vision after the procedure I had 5 and 25 before the surgery I am now 31 and have developed some slight myopia 0 25 and 50 and astigmatism one thing I have always noticed was that both before lasik and now my left eye always seems a bit blurry when looking out of them separately at a distance at times I feel that up close with my corrective lens on it is the reverse and my left is slightly clearer I mean could this just be due to them being two separate organs and maybe my right eye has a higher visual acuity than my left eye at a distance in addition even without my glasses I can read things that my wife cannot at a distance we had her vision checked thinking it must be myopia and she tested 20 or better though I do not really suffer from dryness I use similasan drops frequently throughout the day as a protective measure I work long hours in the computer probably for 12 or more a day I have anti glare coating on my glasses I asked my optometrist if I should be worried about the excessive time on a computer and he said as long as I am using the drops and resting my eyes every 20 30 minutes it should have no effect on my vision as my issues are related to the length of my eyeball even though my prescription is weak I have always been extremely sensitive to the difference in both eyes I know it sounds absurd some things I do are lubricate rest muscles where my glasses which are anti glare etc and have recently changed to lights in my working areas that mic daylight could you summarize and give me a detailed answer as I am actually ocd diagnosed and I obsess about this for some reason I felt that coming here and getting a detailed answer from an ophthalmologist might be more enlightening thank you",
        "input": "",
        "output": "hi for further doubts consult an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor my back is really sore I feel dizzy and I sleep on the floor please help",
        "input": "",
        "output": "hi for further information consult a chiropractor online"
    },
    {
        "instruction": "over the past 20 hours ive had constant lightheadedness vertigo and during the day today ive gradually started feeling nauseous no vomiting abdominal pain cramping headache neck stiffness in the past week ive had some abdominal pain on off and acid reflux as well as headaches and general soreness in my neck and shoulders I am only 20mg of dexamfetamine 10mg in the morning and 10mg at midday for add I have fibromyalgia and chronic fatigue syndrome and is but these symptoms do not feel similar to what I usually experience no other medications ive been trying to drink water and eat crackers but the nausea and abdominal pain makes it difficult I havent noticed any fever but I did have chills come and go with some sweating but didn't feel feverish",
        "input": "",
        "output": "hi thanks for your query the temporal profile suggests mild ongoing inflammation that is causing the problem it could be subclinical inflammation and or infection like a stomach bug also a possibility of drug intolerance to ample along with a drug interaction may be suspected in addition of on phenomenon of am or cos along with gad superimposed may result in this condition in the subsequent sentences and para I would reflect on some measures to mitigate after performing certain investigations flare of inflammation subclinical infection cos flare am flare drug interaction abc ear cop vitamin ash creatinine as above medication effect sari or duloxetine anti inflammatory foods please consult by contacting me through I clinic for rapid assessment and equation to prevent flare or co morbid medical condition emergence"
    },
    {
        "instruction": "hello doctor I am a 27 year old female this query is all about my frequent nose bleeding it started when I was in grade school I got nose bleed when it is very hot or when the air is dry and it only happens once a month or once every two months for the past three months I got frequent nosebleed for two to four times a week I am doing the basic list to prevent it such as lean a bit forward pinch the nose put ice packs and use petroleum jelly but the thing is it is stressing me out I panic when I see blood I have asthma as well and I do not think that petroleum jelly can help me with it I am taking vitamin 500 my per day and I use seretide 250 diskus for my asthma please help",
        "input": "",
        "output": "hi I hope you are doing well I understand your concern I assure you that you need not be worried epistaxis or nasal bleeding is a very common condition and has been reported to occur in up to 60 percent of the general population most nosebleeds are not serious and can be handled easily as you have mentioned most will stop on their own or with simple first aid actions common causes of epistaxis are local causes such as chronic sinusitis nose picking foreign bodies intranasal neoplasm or polyps irritant g cigarette smoke medications g topical corticosteroids rhinitis septal deviation etc if the nose bleed is related to an injury you should be assisted in finding medical assistance urgently some people may be taking medications that make them more prone to bleeding these people should also seek care urgently signs and symptoms include bleeding from one or both nostrils bleeding in the back of the throat causing the victim to vomit blood first aid interventions sit upright and lean forward spit out blood that collects in the back of the throat or mouth pinch the nose firmly use your thumb and index finger to pinch your nostrils shut breathe through your mouth continue to pinch for to 10 minutes local drops such as oxymetazoline or phenylephrine solution can be helpful to prevent re bleeding do not pick or blow your nose and do not bend down for several hours after the bleeding episode during this time remember to keep your head higher than the level of your heart I hope this helps"
    },
    {
        "instruction": "hi doctor I am 30 years old I am recently doing stretching exercises to loosen up my foreskin the urologist advised me to use betamethasone to help with the exercises or get a surgery which I do not want I finally able to see my glands now and noticed these tiny brown spots is this serious or is it normal I am really worried",
        "input": "",
        "output": "hi I have gone through your case in my opinion there are two to three different diagnoses plane warts which are vital infection and mostly acquired sexually the treatment of this is fulguration or cautery lentigenes or freckles which usually require no treatment normal variant moreover betamethasone has nothing to do with these brown spots there is no urgency but see dermatologist physically for one of the above confirmed diagnosis"
    },
    {
        "instruction": "hello doctor me and my fiance got into unprotected intercourse it was days after my ovulation date both intercourse were not completely done but I doubt on one of the intercourse a pre ejaculation went inside next day I took an spill and my first period after that got delayed for days I supposed to be having my period on 25th but got it on 29th I thought everything is alright and there is no chance of getting pregnant but my second period got delayed for more than days still there is no sign of it I supposed to be having small pain before my period and now there is not even a simple pain please tell me is there any chance of getting pregnant like this",
        "input": "",
        "output": "hi please let me know few questions when were your last periods have you had any sex after that are you practicing any methods to avoid pregnancy"
    },
    {
        "instruction": "hello doctor nine weeks post septoplasty turbinate reduction my nose feels swollen and tender on the inside it feels like there is dry and ice cold air going up my nose how long does it take to completely heal I have used nasal rinses sprays etc",
        "input": "",
        "output": "hello septoplasty is corrective procedure the wound on your nose will heal fairly quickly and your breathing is likely to improve shortly after the procedure however the overall healing process can be slow cartilage and other nasal tissues can take up to a year to fully settle into their new shape tips for a quicker recovery include elevating your head at night to keep the swelling down not blowing your nose forcefully after surgery wearing shirts that button up in the front so you will not have to pull clothing over your head also remember to avoid hot cold and dry air slow nasal breathing exercises after permission from your surgeon can help recovery faster nasal rinses if advised should be continued wishing you speedy recovery"
    },
    {
        "instruction": "hi doctor my father who is 79 years of age has got prostate tumor we have done all the medical tests and pet scan the oncologist has confirmed us tumor now due to lockdown we are unable to reach doctor also we want second opinion too the doctor has told us that the solution is surgery but if there is another solution or remedy we would go for it as my father is 79 years of age and also his health has deteriorated day by day we do not want to go for surgery please let us know some solution due to lockdown we are unable to take him to the hospitals as hospitals are also in red zone kindly suggest",
        "input": "",
        "output": "hi your father has apparently a stage I penile cancer the ideal management is surgery which may only involve a wide local excision this can be done by a general surgeon or even a dermatologist who can perform skin surgery should you however cannot have the surgery done the other option you may consider is radiotherapy of the penis radiotherapy is not the optimal treatment but given your current situation this is the option that maybe more feasible the third option is laser therapy directed to the penile mass"
    },
    {
        "instruction": "hello doctor there is white mucus layer on stool actually I am suffering since last month there were two drops of blood after stool had passed and after days at night I had stool with mucus and the next day I went to washroom four times with mild pain in abdominal and I went to the doctor he prescribed me ciplox tz and vyzilock and one medicine for acidity and after two days because of mild pain I went to meet a specialist he also prescribed one pro biotic capsule of do ready one tablet for acidity and shine 10 and after 15 days I was again suffering with diarrhea went to washroom 15 times and recovered myself and again after a few days I was again suffering with severe colon infection I had recovered from infection but not 100 and now there is white layer mucus on my stool and there is very light blood spot like lace on inch with blood dot on stool is there I have no symptoms of anus infection or itching or pain in rectum",
        "input": "",
        "output": "hello I can understand how frustrating you are regarding your problem I have reviewed your complete history and understand that you have ongoing infection within the lower part of your large bowel which is called as rectum medically it is termed as proctitis I inflammation of rectum the blood and mucus which you describe a whitish layer is common among patients suffering with proctitis I have seen you have taken some antibiotics however it seems the duration of antibiotics was not okay and ciprofloxacin that you have been prescribed is no more effective in your case other acid suppressant medications would not help you much in problem relating to rectum so I want you to start a week course of antibiotic which is very safe and does not have significant side effects except in some patient it could cause mild diarrhea it is very safe tablet rifxamin 200 my thrice daily for weeks avoid any other medications you come back to me in next to week I hope that your symptoms by then would go away in case if that does not happen then I would ask you to get some stool and blood tests done and would further modify your treatment"
    },
    {
        "instruction": "hello doctor over a year ago I had operation to correct a deviated septum things started to get much better after healing now I am starting breathing issues when I lay down depending on which side my head is turned when I lay down that side of my nose that would be touching my pillow slowly starts to close while the other nostril remains open this happens on either side depending on which side I am laying on I was taking amox clan 875 and fluticasone but neither of those helped during the day while I am up I have no issues it is just at night when I lay down I do not think it is allergies at all",
        "input": "",
        "output": "hi well to begin with why was septoplasty performed in the first place did the similar symptoms exist before you underwent the surgery if you did then there is only one possibility left for the problems that you having right now that is undercorrection or incomplete surgery considering that there is absolutely no allergic issues whatsoever and there are no other associated nasal issues that we could be seeing here antibiotics and nasal steroid sprays are not going to bring much benefit either and should be taken for a long term on the other hand what you could possibly do is to lay down with your head upwards facing the ceiling rather than taking a posture which can aggravate the obstruction you should be meeting the operating surgeon to see what could be the reason for the current problem because he she is the best person to answer that question"
    },
    {
        "instruction": "hello doctor my dad has type diabetes he is on insulin 14 my a day and twice on some days he has been having severe stomach pain for weeks and now he has lost a lot of weight since being on insulin his feet have become swollen and his eyes yellow prior to insulin he was on metformin but his blood sugar was still high now he is suffering more I really do not know what to do now please help should he go back to metformin",
        "input": "",
        "output": "hi from your history it seems your father is suffering from uncontrolled diabetes mellitus for seven months or more which was not controlled with metformin the present complaints you have mentioned after starting insulin may not be actually related to insulin rather may be due to uncontrolled diabetes or else a systemic disease most probably involving liver in view of jaundice or even a renal problem can cause the same because he is on pain killers ibuprofen which may effects negatively to kidneys in such patients first stop ibuprofen at the earliest make sure insulin is injected at proper site rule out insulin site infections rule out kidney and liver involvement by doing rat renal function test and let liver function test along with blood routine why insulin was directly started after metformin is also a doubt there are many good oral tablets which are stronger than metformin that may be tried before insulin if no contraindications weight loss may be due to uncontrolled sugars which are signified by blood sugars postmeal liver function test renal function test complete blood count with ear erythrocyte sedimentation rate hba1c glycated hemoglobin proper diabetic diet regular aerobic exercises for 30 minutes per day insulin maybe continued special care on storage site of injection methods of injecting may be shifted to anti diabetic tablets once the patient is stable"
    },
    {
        "instruction": "good day please I was diagnose with hep positive 18months ago my consulting told me my condition I inactive and need no medication some month back I was feeling hurt at my chest I was later diagnose with ulcer some weeks now have been having pains around my chest and most especially middle of my check please what is happening to me",
        "input": "",
        "output": "hello welcome to I clinic you have been diagnosed with inactive hepatitis for that I will request you to send me all your laboratory work so that a decision about the treatment can be taken you now having central chest pain which looks like to due to esophageal ulcer called esophagitis and you may be also having some retrosternal burning with it for this I am prescribing some medications it will help out in this pain you need to take cap esomeprazole 40mg before breakfast and spy sucralfate 10ml did both of these should be taken for weeks and let me know incase you have no improvement end if no improvement with medications esophagitis chronic hav esophagitis cap esomeprazole 40mg before breakfast spy sucralfate 10ml did before meals avoid spicy foods needs follow up for hav"
    },
    {
        "instruction": "hello doctor I am a 21 year old male I am losing like 15 20 hair strands on a daily basis now for the last nine months I am facing this problem I never had this type of hair fall or any hair fall before where I stay there was hard water so I started using drinking water for bathing a few months later I got to see some less hair fall than before which is around 30 hair strands a day so now I cannot have my previous hairstyle and I can see some small patches in my crown corner but the thing is that I do not think my new hair is growing vigorously I got worried when I see four to five strands in my pillow cover every morning and most importantly my hairs are thin which falls and some dandruff problems nowadays as I got no family history in baldness I am so anxious about this issue please help",
        "input": "",
        "output": "hi hair fall can mainly be divided into two types you can have increased shedding or thinning of hair increased shedding means seeing more than 50 100 hairs falling per day less than that is a normal hair fall cycle and usually grows back increased shedding can happen because of dietary deficiencies stress high fever water change harsh shampoos dandruff since you are noticing patches of emptiness most likely it is thinning or male pattern baldness this can happen due to genetics and male hormone testosterone acting on the roots smoking thyearoid issues and consuming whey protein can accelerate it by genetics it need not necessarily mean your father or mother it could be uncles or grandparents as well minoxidil is the treatment of choice for patterned balding also checking up for deficiencies like serum ferritin vitamin and b12 and ash thyearoid stimulating hormone will help photographs are needed to exactly identify if you are having patterned balding and accordingly treatment can be started"
    },
    {
        "instruction": "hello doctor I am a teenager and I had sex for the first time weeks ago and now I am worried that I might be pregnant we used a condom but I am not on birth control or anything else I have had irregular periods for some years now so I do not know if missing my period would be a sign of pregnancy also after a day we did it my period came but I am not sure if it is related to the fact that I lost my virginity or it was my actual period so now I am really scared to wait another weeks or who knows maybe a month or two I cannot talk to any adult and I really need a specialists opinion on this",
        "input": "",
        "output": "hi how are you doing for a young lady the only way to check for your chance of pregnancy is blood test lady can have a bleeding vaginally when their hymen membrane rupture clinically we see bleeding which can be mild spotting to heavy bleeding as you mentioned that you have irregular cycles exact date of ovulation cannot be guaranteed simple way out is 15 20 days after the sexual contact have a serum beta hug test even the earliest of pregnancy can be detected as you had used condom chance of pregnancy is low but blood test is confirmatory"
    },
    {
        "instruction": "doctor everything is eat tends to upset my system it causes me to stool water and sometimes when I have bowel movement I feel stomach pains my stool has been watery for the past three months went to the hospital did a stool test the report was worm infection which I was given medications but to no avail it was serious years back but only occurred if I took something peppery and on the first day of my period please what could be wrong with me cause flagyl and tetracycline does not work",
        "input": "",
        "output": ""
    },
    {
        "instruction": "my baby is one year old I bought that he is getting addicted to the smell of gutka intake by one of my relatives and he takes my baby everyday he is 70 year old whenever my baby sees him my baby gets crazy and after going to him baby never wants to come back easily even to his mother ply help whether it is addiction to intoxicating smell or its normal over attraction to old person ply help me and my baby",
        "input": "",
        "output": "hi the very first thing confirm whether your relative is giving gutka to your baby also what kind of gutka he is taking baby may get addiction if he has got the taste of it and started taking it orally addiction with smell is difficult to comment on possibility of a normal preference and attraction with the person where your baby is feeling more confortable more affection or some interesting action which your relative might be having and your baby is enjoying it I suggest you just keep a close watch take care"
    },
    {
        "instruction": "flatulence and urinary incontinence abdominal pain and restlessness no medicine male 30 6 height",
        "input": "",
        "output": "hello good day I appreciate you seeking medical help via icliniq I have your query so to answer to your query I want you to understand production of gas and feeling of fullness is more or less a normal phenomenon of human body one can not completely shut down the gas production since it has its own disadvantages however having said that gas production can be still be decreed to help patient to have comfortable life this gas usually produced by many bacteria within human gut I want you to start one antibiotic which will help balance good bacteria is bad bacteria tab rifxamin 200 my thrice daily for weeks ait is very safe antibiotic except in it can cause diarrhea which is usually mild and does not bother a patient much I want you to avoid gas producing meals particularly avoid rice cereals and grains in your diet sometime milk can cause bloating if this is in your case I suggest to better cut down your dairy intake see me in week time and lets see how it goes see me after week"
    },
    {
        "instruction": "hi doctor I have 25 months girl who feels discomfort at sleep for a couple of days for the time she has also lost some of her appetite I have checked her symptoms and signs her body temperature is normal around 34 but sometimes her hands get hot she has attended all her vaccines and currently we are on lockdown while in the home during the daytime she feels bored and sometimes cries for no reason or feel discomfort with her toys I am asking this in this pandemic we cannot get outside to see a pediatrician or a consultant clinics and hospitals might lead to carrying a virus or infection please advice me in this regard thank",
        "input": "",
        "output": "hello thank you for the elaborate history hope you are safe I appreciate your concern regarding your child this behavior is normal because as the child grows he she wants more attention becomes more aware of things"
    },
    {
        "instruction": "hi doctor I am facing swelling in anus area which is not getting shrunk even after trying some medicine and cream for piles",
        "input": "",
        "output": "hello welcome to ilciniq com good day I have reviewed your history and picture that you have uploaded it seems to me a sentinel pile they are not actually pile hemorrhoids blood sac but a anal fissure that has been present for so long and leading to bulging appearance resembling a pile well having said that the treatment you are on is majority ayurvedic but there are available allopathic medicines which can be used instead I would give you some treatment but I want that you should be examined in person by a local general surgeon if any need of surgical removal of this otherwise at moment take following treatment ispagol husk top daily with water irrespective of if you have soft stools or hard stools fibre has to do with many other things in your gut besides just stool softening effect tablet ciprofloaxcin 500 my twice daily for days tablet flagyl 400 my thrice daily for days can cause some gut upset and mettalic taste in mouth but fairly low side effect profile sit bath put approximately my of dettol or any antiseptic and put in bath tub filled almost half with rapid water and at least try it times a day keep your area clean near your bottom remove hairs reduce weight increasing weight would impair your defecation stooling mechanism and that would abnormally high pressure over your bottom this worsens anal fissure in long term let me know in one week time if symptoms improve"
    },
    {
        "instruction": "hello doctor my lymph nodes in the groin region became swollen last night and I am irritated please help",
        "input": "",
        "output": "hello first of all please do not freak out if we have adequate information it would be easy to figure out the cause for such groin node enlargement it would have been a little more informative if you could mention the size of the node that you could feel whether on single or both sides whether it is a single node or multiple if multiple whether they could be felt discreetly or they are stuck together also if you had any history of fever recently that could have given some idea about the nature of these groin nodal swelling the most common causes for the enlargement of the groin nodes is any infection or inflammation in the sites they drain the lymph fluid which includes the genital area including the lower third of vagina and legs so I would like to know if there is any genital infection or ulcers or any infection or wound in your legs many times in sexually active individuals it could represent a presentation of sexually transmitted infections like chancroids syphilis or sometimes in herpes too please get back to me with details so that appropriate cause can be identified and treated appropriately"
    },
    {
        "instruction": "hello doctor I am facing acute sore throat for the last one month and now feeling pain also in the left side from centre of the throat I am doing gargle with salt water and taken tush also but no good relief in addition to this I am facing gastric problem and constipation also",
        "input": "",
        "output": "hi only this syearup and gargling will not help you completely it say some kind of throat infection maybe acute pharyngitis or tonsillitis and you need antibiotics for that otherwise this may progress are you allergic to any particular medicines so that I will prescribe you some medication"
    },
    {
        "instruction": "have hypothyearoidism last years down to 75mg levothyearoxine the issue now is blood sugar levels over last one year do has put me on several meds which I reacted to at that time level under 200 this year changed do he said no medication lifestyle change has been difficult weight up sugar levels 299 do put me on januvia last week scared cuz of reviews side effects of the medication I read online already feeling like neck swollen pain in chest sometimes cant go to hospital now because of couid dont want to get infected is januvia ok what do you suggest",
        "input": "",
        "output": "hi good day thanks for your query ur weight is quite high with uncontrolled diabetes definitely you need to change lifestyle and thinking pattern as well you need to trust a doctor and follow his advice every medication has effects otherwise it will not be effective but we always weigh risk and benefits if ur sugar will not be controlled it can lead to badly effect all ur body especially it can lead to kidney failure stroke heart attack nerve problem and many more modification of lifestyle is the main stay of diabetes treatment you need to reduce carbohydrates especially simple carbohydrates like sugar ice cream sugary juices if cannot stop you have to 70 reduce bread rice pasta and potatoes eat fruits only as a sweet dish mango grapes and banana especially can increase sugar quickly you have tried many medications and I am not sure which are those medications I will advise you to take glyxambi 25 one tablet daily check ur fasting sugars for few days and let me know to modify dose accordingly ur fasting should be 100 130 thanks"
    },
    {
        "instruction": "hi doctor kid age months weight not sure since yesterday she is having loose motion problem today also she is having frequent loose motion or solution and paracetamol syearup given but got little bit control again started",
        "input": "",
        "output": "hello welcome to icliniq loose motion diarrhoea is common problem in young kids it is very important to make sure that your daughter is well hydrated till she gets better it is very good that you are already giving or solution which needs to be given frequently loose stools can last for some days before getting better it will help to clear the body of germs toxins I need to ask you a few more questions to guide you in the right direction how many times day does she have loose stools is there any blood in stool is she is any pain does she cry while having stools is there any vomiting is there any fever if there is no fever there is no need to give paracetamol any signs of dehydration lips tongue dry not passing urine as usual is her weight gain good and within normal range is she otherwise her usual self or is she ill looking crying confused treatment plan provide your daughter with frequent sips of or throughout the day for every loose stool she needs to be given 10 mes keg of or assuming her weight to be 8 kgs you should give 80 mes or for every loose stool or needs to be continued till loose stools stop you can also give tender conut water if available give bland non spicy food like plain idli rice for some days if she is still breast feeding it is good to continue if available you can give enterogermina oral suspension mini ampoules a day for days you can mix with water and give her zinsy syearup mes once a day for a week most common reason for loose stools at this age is viral so antibiotics are not needed but if she has fever or bloody mucus stools she will need to be examined otherwise loose motion will settle in 5 days important due to the coronavirus lock down visiting hospital clinic may be difficult but if your daughter shows any of the following signs she needs to be taken to the nearest hospital clinic to be examined by a paediatrician looks sick not drinking or lips and tongue getting dry not passing urine even once in his looks dull and crying excessively blood in still if you have any further concerns you can contact us again for further advice take care"
    },
    {
        "instruction": "hi doctor I have a severe toothache that prevents me from sleeping and eating and there is a big hole in my teeth I am currently using tylenol",
        "input": "",
        "output": "hi thanks for describing your dental pain it clearly indicates that the tooth is visibly decayed and gone deeper to involve the nerves and blood vessels of that particular tooth ideally there will be sensitivity if the first two layers of the tooth are affected enamel and denting if the third layer pulp is involved and further the bugs percolate inside the length of the teeth then the symptoms you feel would be there now the situation looks like you must visit a nearby dentist for either root canal treatment or extraction depending on your preference the steps involved would be an ray first to check the shape of the roots of the tooth two or three roots if it is a molar tooth you sound like an emergency please visit the hospital or ring the dental practices who attend patients with an emergency during the couid 19 times also adding that pain killers will not help you come out of this for not more than three hours I highly recommend you to visit the dentist closely"
    },
    {
        "instruction": "hello doctor I have a gastroenterology issue for over a month I have a mild to moderate upper and lower abdominal pain on the left side the pain also extended to my left leg also I pass stool twice a day diarrhea like stool with large white balls in it and I am facing weight loss I took trimebutine and mebeverine for over four weeks I have is also I am taking probiotics and digestive enzymes what is concerning me the most are the large white balls in the stool that are not mucus they are quite firm and the weight loss due to couid 19 I want to avoid physically seeing a doctor so please suggest a possible cause and treatment",
        "input": "",
        "output": "hello yes you might be having is irritable bowel syndrome and you might have developed small intestinal bacterial overgrowth silo with is which can occur commonly in silo you get fat malabsorption which can lead to white stools can you please tell me whether you get greasy stools and bloating or not let me tell you that greasy stools are identified by a foul smell and floating on top of commode water also share how much weight have you lost in how much time I will start you on the treatment of silo but meanwhile we have to investigate and rule out other diagnoses whenever feasible for you silo abc complete blood count reactive protein ash thyearoid stimulating hormone stool routine examination and culture stool for fat content stool for reducing substances colonoscopy or sigmoidoscopy if needed in the future pseudomembranous colitis tablet rifaximine 50 my thrice a day for 14 days mebeverine thrice a day oral rehydration solution exercise after two weeks"
    },
    {
        "instruction": "hello doctor I am a year old male and I weigh about 85 keg I have neck pain especially at the sides and arm for the last one year my left arm feels weaker sometimes I feel tingling in random fingers I have morning neck and back stiffness also please guide to a set of exercises that I can do regularly to free the nerves and start my earlier workouts currently I am doing neck exercises including chin tucks and posture correction however nerve pain persists I did my mri last year impression generalized posterior bulge of c3 ca and ca c5 intervertebral discs however not causing any significant cervical cord or nerve root compression generalized posterior bulge of c5 ca intervertebral disc with indentation of bilateral exiting ca nerve roots generalized posterior bulge of ca intervertebral disc however not causing any significant cervical cord or nerve root compression",
        "input": "",
        "output": "hi I have gone through your query as you mentioned you are suffering from neck pain which shows as nerve pain as per your experience as your complaints are left arm feels weaker sometimes tingling in random fingers with morning neck and back stiffness I feel it is compression at spinal cord root levels as that is even confirmed by mri scan which you have already undergone so my provisional diagnosis with view of your age gender height and weight is cervical spondylotic radiculopathy which can best to be treated with physiotherapy and lifestyle modification I will suggest some exercises and lifestyle modification follow it for 15 days do not lift heavy weight more than keg lessen the use of mobile and computer to only two hours a day go for daily walking for about hour if not jog inside the house our primary goal should be to relieve compression and strengthen the muscles around the neck and shoulder chin tuck exercise is good only in addition you can do neck and shoulder girdle exercise also you can lie on the belly and do the neck and shoulder elevation exercise pendulum exercise also will give you much relief you lie flat on the floor or use a very thin pillow as this lockdown finishes you need to take cervical traction and ift interferential therapy at a physiotherapy center nearby take only warm water regularly another important thing is change in lifestyle join art of living online happiness program where all exercises with yoga can be done online I hope this helps"
    },
    {
        "instruction": "hello doctor I would like to ask you about treatment recommendations maybe a few variations for my condition I have bipolar disorder type I social and generalized disorder and panic disorder however I am in constant depression for one year I do not cycle anymore if I do my hypomania is very mild and short lived moreover anxiety is debilitating I am afraid to go out from home feeling constant anxiety physical symptoms such as sweaty palms and feet chest pain blood pressure rise racing heart and much more I need something to ease my depression symptoms but also something that would affect my anxiety in a positive way my current medications are lamictal 200 my 3x5 my tranxene my olanzapine and 75 my venlafaxine I am unable to take more venlafaxine because from 150 my blood pressure and heart rate were out of control my previous medications were lithium depakote carbamazepine anxiolytics escitalopram zoloft quetiapine which I cannot use because of its negative effects on anxiety and blood pressure just for me and risperidone I am wondering about paroxetine citalopram and prozac if escitalopram 20mg was without any effects for two months is it reasonable to try out citalopram I tried prozac in past I could not bear initial side effects but that were different times does it affect anxiety disorders from your experience paroxetine suits best which of these medicines could benefit me the most",
        "input": "",
        "output": "hello thank you for your detailed query and history with regards to your anxiety symptoms you have tried out sari selective serotonin reuptake inhibitor and sari serotonin norepinephrine reuptake inhibitor class of medications so I would like to suggest you try a tea tricyclic antidepressants class of antidepressants like amitriptyline 75 100 my dosulepine 100 my or nortriptyline 75 100 my they are indicated in people who have had partial results with sari or sari medications if you do not wish to try out the tea and coming back to your query about the three medicines the best results for anxiety will be with paroxetine between 12 my to 37 my and citalopram will also work fine at 20 my in addition to these you can also consider augmenting the action of these by adding mirtazapine 5 my at night I would like to suggest that you should consider reducing olanzapine to 5 my since you are not in hypomania and have depressive symptoms reduction to 5 my will make it an augmenting agent again for the antidepressant and also further help with your anxiety issues also just to mention some people do get benefit from having a few sessions of cut cognitive behavioral therapy from a clinical psychologist"
    },
    {
        "instruction": "hi doctor a few days back I got hit on my finger with a tennis ball I am unable to fold the finger from that time I thought it as normal and applied ice also I am using an ointment given by an rmp it is almost two days now and still I am unable to fold the finger if there are three joints in a finger then I am getting pain in the middle joint whenever my dad or mom does some massage with ice kindly help me with the above issue thanking you in advance",
        "input": "",
        "output": "hi I know how it feels when the finger got hit and unable to fold first of all after applying ice for 10 15 minutes ask someone to hold the finger from hand to the first joint as you know there are three joints in a finger ask them to slowly move the first joint without disturbing the second joint and then do the same with the second joint by holding the first and the third joint repeat this for at least four times a day if unable to do movements then you can visit a surgical shop and ask for a single finger grip which helps in the immobility of fingers if available can take paraffin wax used in physio treatment melt the wax and apply it on the finger for 10 minutes the wax therapy will be available at any physiotherapy centre I hope these remedies will provide some relief from pain and gives mobility of the finger follow up after a week for the further treatment plans thank you"
    },
    {
        "instruction": "hi doctor I am a 37 year old male my weight is 7 keg I am facing erectile dysfunction problems it has been going on for a few months now I am consulting for the first time regarding my erection issue",
        "input": "",
        "output": "hi I hope you are doing well kindly let me know a little more information to guide you better for how long you are having this complaint do you have a problem while masturbation or only during intercourse are you able to ejaculate and penetrate into the vagina are you a diabetic or hypertensive and on any medications do you consume alcohol or smoke"
    },
    {
        "instruction": "hi doctor I have low vitamin a and levels are vitamin a and supplements safe to take with liver disease what are the highest doses that are safe to take I have fatty liver but I do not know if it is a simple fatty liver or has progressed to nash and fibrosis I am a year old female I smoke and have a history of acid reflux low heart rates fat indigestion and fatty liver lab tests showed vitamin a 9 umol and vitamin 37 nmol previously I had an abdominal ultrasound and it showed liver 14 am in length which gives rise to a moderately coarse dense echo pattern consistent with fatty infiltration alt level was 58 l I am currently on acetyl cysteine nac thank you",
        "input": "",
        "output": "hello your vitamin a level is marginal rather than low less than 7 or 5 is considered low and up to 05 is considered marginal so you will probably need supplements at a very low dose total intake of up to 10 units daily is unlikely to cause any harmful effects so supplements of 7500 units or even 10 units per day for a month or two would be enough for you I guess you do not have any symptoms of vitamin deficiency like xerophthalmia or visual difficulties where one would need higher doses also for vitamin supplements like calcirol sachet are recommended in dosing of 60 units once a week for eight weeks with milk and following which you may have it once a month for the next six months both these are unlikely to interfere with liver issues considering fatty liver and high alt level you are unlikely to have progressed to the severe liver disease within such a short period and without symptoms hope this helps you and get back if you have any doubts"
    },
    {
        "instruction": "hi doctor I am a 30 year old male I have urination problem it started a day ago I observed low output of urine that is only a small amount every time I have urinated but when I exercise or do some abdominal massage the urine output level is more I also uploaded the lab test report kindly check and suggest medicines thank you doctor",
        "input": "",
        "output": "hi your reports are grossly normal except for isolated ketonuria I think you get repeat urine for ketones test done as I do not find a cause for it can be lab miscalculation mostly ketonuria occurs in uncontrolled diabetes starvation prolonged vomiting and diarrhea glycogen storage diseases severe sustained exercise dietary imbalance high fat or low carbohydrate diet and high grade fever so repeat the test and we will discuss it if still positive for ketones I will prescribe medication for your urinary problem and just a few questions do you have any urinary complaints like frequency urgency poor stream nocturia dribbling or burning micturation is there any history of surgery or catheterization in the past do you have any history of recurrent ti I am looking forward to your answers thank you"
    },
    {
        "instruction": "hi doctor I have hypothyearoidism and hashimoto my doctor currently only tests my ash and treats me with levothyearoxine I feel extreme fatigue after a year of this treatment even with my ash in the normal range my doctor says free to and reverse to are not important labs to run I am wondering if I should see an endocrinologist or just continue the treatment I am on my ash started at 8 last year got down to 08 I feel great when it was that low mow my ash is 8 and I feel extreme fatigue I am taking 12 mug levothyearoxine daily thank you",
        "input": "",
        "output": "hi good day and thanks for your query some people treated for hypothyearoidism may still experience symptoms even if blood tests show that their thyearoid stimulating hormone ash levels are well within the normal range the reasons for this are complex but the bottom line is that having a normal ash value does not necessarily mean that all of your symptoms will go away evidence suggests that situations like this are not as uncommon as one may think even when placed on levothyearoxine the drug considered the gold standard of hypothyearoid treatment many people fail to reap the physical benefits of treatment so first you can lower down your ash target if you are still having symptoms for that we can increase your medication if still symptomatic the next choice is to change the brand of thyearoxine and if still not feeling well then think to go to supplement rather than to that is thyearoxine thanks"
    },
    {
        "instruction": "hello doctor I have been experiencing slight itchiness in my throat for the past one and a half months I do not feel it at night while sleeping in the morning when I wake up and eat something the itchiness or abrasion starts again there is a slight redness in the throat and sometimes it pains feebly when I cough sometimes the throat feels slightly scratched and it feels prickly when I take deep breaths there is no problem with swallowing food and water I have had issues with thyearoid and acidity problems as well I am taking pantosec and took hcqs pill for corona before this itching starts",
        "input": "",
        "output": "hello I need a few more details before we can come to a conclusion did you travel outside the country any contact with couid positive patient did you take hcqs on your own or with a doctor prescription have you completed the course do you smoke or drink is there throat pain or difficulty in swallowing or lump sensation is there chest congestion or difficulty in breathing or wheezing can you please take a picture of your throat with open mouth showing details of the back of the throat and send me I want to see the area which you said is red please answer my questions to help you further"
    },
    {
        "instruction": "hello doctor my mom is a 92 years old with congestive heart failure it scan showed extensive atherosclerosis of the aorta probable high grade stenosis of the right common iliac artery and the bilateral common femoral artery she also has kidney disease in the left kidney and extreme fatigue for two years would she be a candidate for a stent or some other procedure to unblock the artery and could this condition be causing her fatigue none of her doctors can figure out the reason for fatigue please help",
        "input": "",
        "output": "hello welcome to icliniq com this is a non contrast it computed tomography so it is not accurate in estimating the extent of stenosis she will need a contrast it angiography of abdominal vessels however the common iliac artery and femoral arteries are usually amenable to tenting unless it angiography shows diffuse disease whole of the artery is involved with no normal segment where tenting would be difficult however a disease involving these arteries is unlikely to cause generalized fatigue but it can cause pain or weakness in the lower limbs while walking regarding the cause for fatigue I guess the common causes like low hemoglobin be issues any medications deranged kidney function low vitamin deranged blood sugar are ruled out one important cause that should be ruled out in her is the cardiac cause because her it scan shows mild fluid in bilateral lungs which may be related to heart and also with such extensive aortic disease cardiac arteries are also expected to be involved cardiac disease may cause fatigue shortness of breath on exertion so she should undergo egg electrocardiography echo and also it angiography of heart vessels if possible along with it angiography of abdominal vessels also some routine tests like hemogram let liver function test rat renal function test vitamin thyearoid profile sugar lipid profile ear erythrocyte sedimentation rate and cop reactive protein should also be performed if not done recently I hope this helps"
    },
    {
        "instruction": "hello doctor one day while having regular sex just before and during ejaculation I experienced a sudden severe headache it was painful and lasted for about 10 minutes it started as a dull ache from my neck and head and it build up just during ejaculation two days later I tried to have sex again and the same experience but I managed to ejaculate yesterday I tried to have sex again and the same experience and I did not ejaculate due to the pain I am so stressed that my erection is getting weaker now I just have an erection and I am having mild headaches I have never experienced a situation like this neither have I ever heard of a situation like this I am 40 years old is there any solution for this I am very worried and I am already thinking that this is the end of my sex life because of this coronavirus I am even afraid to go to the hospital please help",
        "input": "",
        "output": "hello you might be suffering from a disease termed as benign vascular sexual headache to make its diagnosis we need to rule out intracranial bleed first get mri magnetic resonance imaging brain done to rule out structural disease once structural causes are ruled out you can be sure of the diagnosis preventive medications like indomethacin can be used 30 minutes to one hour before intercourse once we confirm the diagnosis benign vascular sexual headache mri brain benign vascular sexual headache structural brain lesions benign vascular sexual headache tab indomethacin 50 my 30 to 60 minutes before sexual activity maximum of two tablets per day avoid strenuous activity during intercourse review with mri report review after days for response to medications"
    },
    {
        "instruction": "hello doctor can I eat cold foods when suffering from tonsillitis I think cold is not related to tonsillitis because a virus or bacteria cannot live in cold or hot why is there still a misconception in that some doctors say you can eat and some say you cannot what is the illusion",
        "input": "",
        "output": "hi if you are having a susceptibility for throat infections you need to understand why it is happening having cold drinks or fluids bring down the body immunity by shade and that is why it can attract a viral or bacterial infection it is not about whether the bacteria can survive in cold or not but it is about whether your body immune system is able to fight the infection to neutralize it before it spreads viral particles and bacteria are all there in the air that we breathe and usually the body fights back to protect from getting invaded by these organisms everyone has one particular level of immunity some have a weak immune system while some have very strong immunity and can still bear eating junk food and drinking cold drinks all day and still not get an infection it all depends from person to person if your body is sensitive to cold things or anything for that matter it is better to avoid such items to prevent you from acquiring an infection and taking unnecessary antibiotics and medications I hope this helps"
    },
    {
        "instruction": "hello doctor I have a query related to the use of viagra I have the problem of erectile dysfunction sometimes though I get an erection I am unable to sustain the hardness and do intercourse I took viagra 50 my once and it worked well is it safe to use viagra to get my wife pregnant will viagra cause any effect on my fertility will it affect the sperms hope to listen from you soon",
        "input": "",
        "output": "hi I read your query and understand your concerns about the effect of viagra sildenafil on sperm or its quality I like to inform you that the formation of sperm is an independent process from erection you will be surprised to know that the sperms that will be released in the next few sessions may have completed their manufacturing weeks back if not the months in other words sperm formation takes around two and a half months and has no casual relationship with the erection or mechanism of erection which is affected by viagra on the other hand viagra acts on certain receptors on the blood vessels and remains effective for a few hours 6 hours I mean to say that as per the available literature no harm is made to sperms or sperm quality by viagra even on the frequent use you can safely go ahead with viagra to father a child"
    },
    {
        "instruction": "hello doctor I had a medical abortion during my ith week of pregnancy and bleeding lasted for 10 days a few days after the bleeding stopped and I had pain in the right lower abdomen that lasted for 24 hours two weeks later bleeding started again which I thought was my first period it was brown with clots later turned red it has been three weeks now and it still has not stopped it has been moderate throughout and now for the last three days it is brown and somewhat reduced I do not have any abdominal pain or tenderness no foul smelling discharge or fever either I am worried why the bleeding is so prolonged is this normal do I need and",
        "input": "",
        "output": "hello welcome to icliniq com having prolonged irregular bleeding after medical termination is not a normal phenomenon it definitely indicates some problem one of the most common causes for prolonged bleeding could be retained products of conception which need to be evacuated or sometimes a condition called gestational trophoblastic neoplasms can also cause prolonged bleeding I would like to know two important things do you had a scan prior to your medical termination and if that was a normal intrauterine pregnancy or not to rule out ectopic pregnancy second thing is did you got a check scan done after the bleeding stopped to check if the expulsion was complete if retained products are present then evacuation would be required as they are a potential source for infections and can cause post abortal sepsis please revert back to me with the details I asked for so that I can guide you further ultrasound abdomen and pelvis serum beta hug levels depending on the test results"
    },
    {
        "instruction": "hi doctor I am a male with wavy thick coarse asian hair that frizzes and I wanted to ask you how I could get my hair thick long silky smooth and frizz free I could send pictures of what hair I want please help",
        "input": "",
        "output": "hello given your natural type of hair described and what you would like it to look there are some things you can consider wash your hair with shampoos that are intended to reduce frizz and will say so on the bottle also use a conditioner that is intended to reduce frizz there are hair styling products for thick wavy hair that also reduce frizz and will say so on the product description a more permanent solution would involve using either a blow dryer with a stunning attachment that will temporarily straighten your hair and give it a sillier appearance be sure you use a product intended to minimize heat damage to the hair that you apply to the hair before you blow dry if these measures are not satisfactory to you then you may wish to consider applying a chemical relaxer to your hair that will make it straighter and smoother but you will have to redo the roots about every two to three months to maintain the look if you decide to chemically straighten your hair you should only wash it once a week to maintain a smooth frizz free appearance chemically straightened hair requires a little more care and a little more attention to keeping it well conditioned for maximum results"
    },
    {
        "instruction": "hello doctor I am on fasting for the auspicious month dry fast but I also have to take lithium for my bipolar disorder I have seen that higher lithium concentration can cause serious damage to the kidney due to dehydration and also to the metabolism during fasting and with veto diet the body needs a lot of potassium but the cells get lithium instead what is your opinion about that is dry fasting veto diet and lithium intake at the same time harmful I take normal lithium carbonate 650 1250 my a day",
        "input": "",
        "output": "hi see lithium can be harmful if hydration is not well maintained in such cases we recommend to increase the amount of fluid that is to consume a good quantity of fluid in the morning before your fast starts and to drink fluids once you open your fast in the evening and continue till the next morning take lithium tablets along with two glasses of water each time do not go for the veto diet you should take a proper balanced diet avoid taking a high protein diet so usually in auspicious month the fasting duration is for 12 hours in the remaining 12 hours keep on taking fluids to compensate there is no indication to stop or reduce the dosage of lithium during ramadan I hope this helps"
    },
    {
        "instruction": "hello doctor for the last weeks I have a kind of a rash and itchy feeling on my anus I am a year old male without any sexual contact in that area I have done every sad test and all came negative I noticed some white spots right above the anus I cannot really see the shape and because of the coronavirus I could not get it checked on a clinic yet is it possible to have an outbreak of hav in a place where you have never had any sexual contact I have a lot of hair in the area and I think it could be folliculitis like I had on the other regions in the past but I want to be sure",
        "input": "",
        "output": "hi I have seen the picture there is definitely an inflamed swelling in that area central area is white as you are having a lot of hairs that area can easily get infected are you having any fissure problem please check your blood sugar it is not hav human papillomavirus warts will be presenting as asymptomatic growth so it is not herpes also it is furunculosis bacterial infection of the hair follicle please start on antibiotics doxycycline 100 my twice a day for one week apply mupirocin ointment in that area drink lots of water see that you are not having constipation wash the area with water and soap after defecation after the corona crisis meet your doctor I hope this helps"
    },
    {
        "instruction": "hello doctor my husband has a heart condition that means his arteries build up a plaque at a much higher rate than normal he had to have a stent put in his heart and will be medicated for the rest of his life he has been told that it is vital he eats low fat and low cholesterol diet I cook for him and I am worried whether I feed him the wrong things I know that meat is not good for the heart so we limit it and always go for lean cuts but I am confused about the difference between animal based saturated fats and plant based saturated fats for example everyone raves about the health benefits of conut oil and conut milk but both are extremely high in saturated fat I googled this and find reports stating that it is a different kind of saturated fat and does not affect the heart badly but I do not know if this is true for someone like my husband is all saturated fat bad also is chicken really healthier meat than beef it seems to have a high cholesterol content so I do not know if he should be eating it any advice would be much appreciated he is currently rosuvastatin bystolic and aspirin",
        "input": "",
        "output": "hi I understand your concern on the high fat diet and follow the mentioned points below just to make it easy we need some fat which is good and hel high density lipoprotein like almonds and walnuts are good as these are rich in omega and fatty acids similarly the fat we have in conut oil is different the fat in the chicken can be removed by removing the skin where as beef has inbuilt fat which cannot be removed easily hence we suggest to include fish and chicken avoiding beef considering fat we miss out on other nutrients too so it is advised to reduce the oil intake like healthy individuals can take half a liter of oil per month if you are two your cooking should be within liter of oil only conut oil is having saturated fat but it burns easily in high humidity areas if we live in high humidity area it is better to include conut oil to protect our joints and skin if we leave apart from high humidity area it is better to use refined oil"
    },
    {
        "instruction": "hello doctor I have some symptoms for the past one and a half weeks that mic the symptoms when I found I was pregnant with my daughter I was supposed to have my period tomorrow last week I started with light spotting and it happened on and off for a day maybe less then within two days I started bleeding I thought it just started early but I have been on occasional bleeding lighter to heavier for two days I have had cramping back pain headache and today I had a lot of blood clots and tissue coming out with it along with right groin pain for a couple of days I have never experienced these symptoms and they are intense I am scared this is the start of a miscarriage but any test I have taken has been negative I am on the patch for almost a year and have not experienced anything like this and I have a weird feeling now",
        "input": "",
        "output": "hello first to confirm a pregnancy you should perform a pregnancy test two weeks after having sexual intercourse so perform a urinary pregnancy test or hug human chorionic gonadotropin test to exclude or to confirm a pregnancy and after that perform an ultrasound to evaluate the uterine cavity on the other hand maybe your menses have come earlier and has a different pattern compared with other menstrual bleeding as you use the patch for one year there are low chance of pregnancy always if you have used it correctly"
    },
    {
        "instruction": "hello doctor my baby is weeks old and she is on exclusive breastfeeding she prefers the right breast than the left and cries to latch on the left so I started to pump and bottle feed from left and direct feed from the right I pump three to four times a day and make around 100 my from the left my breasts are lopsided and the right side is full most of the time while the left side feels very soft this week all of a sudden my little one prefers bottle than my breasts so I wanted to wean of bottle feeding the pumped milk she now sucks like around 30 minutes a day from the left and rest from the right I do not want to pump or express again from the left to increase the supply my question is how can I balance feeding from both breasts without pumping my little one does not like spoon feeding the expressed breast milk please help",
        "input": "",
        "output": "hello it is normal for a baby that he or she chooses any one side of the breast on its own but if you feel that your breast lopsided then you need to take some tricks start to feed your baby from the small one let him suck more and more from the small one after some days it will become large and engorge but do not avoid to breastfed from the larger one too when the large one fills please feed your baby from this side or express milk by using hand you can use a breast pump to express milk from the larger breast but if you do not want to use pump use your hands you do not need to feed him with this expressed milk do continue breastfeeding a few days from small one more and more after some days both will become balanced one thing do not practice your baby bottle feeding then he will not breastfeed again"
    },
    {
        "instruction": "hello doctor I recently bought a blood glucose meter because diabetes runs heavily in my family I have not been diagnosed with diabetes but I checked my blood sugar today 16 hours without eating and it was 103 I know that it should be below 126 after eight hours of eating but what is it supposed to be for 16 hours after eating I am 21 years old and I weigh 230 labs",
        "input": "",
        "output": "hi from the above history it is noted that you are having a strong family history of diabetes and also you have been noted with prediabetic range blood sugars in the past coming to your query it is ideal to have less than 100mg dl blood sugars after 12 16 hours post meal but we cannot label you as prediabetic or diabetic by noting a single value so I would take it as a prediabetic state if you have been noted with increased blood sugars in this range on multiple occasions or if three months average blood sugars are between 6 I would like to stress the point that from the data it is found that you are having class obesity which must be addressed with due importance because it can lead to early diabetes any lifestyle disease and sleep apnea too hba1c glycated hemoglobin lifestyle modification diabetic diet regular aerobic exercises 45 minutes daily"
    },
    {
        "instruction": "my age is 20 one of our relative informed us to contact you as we needed it badly I have eczema and I have been taking medications from years with multiple doctors with no end results some worked some did not main problem is I have running nose from years skin gets round around mouth with black scars full black rough skin on the neck and past months I have got allergy in eye with watery eyes sometimes redness itching and full dark circles around the eyes I have been consulting with one a doctor from months I will share the prescription which she gave thrice in months and was informed to use only for 15 days not more than that but after 15 days now again I have got severe eye pain in and surrounding on dark circles I have also checked with eye doctor and they gave multiple ointments and drops which did not worked out requesting you please help with prescribing similar medicines which will help me with issue",
        "input": "",
        "output": "hi I went through all pictures and prescription the problem what you have is atomic dermatitis it a disease that is not infection but your immunity will be working abruptly and uncontrollably triggers are food dust any bite or cosmetic it a lifelong problem presenting with different issues at different ages you have perioral dermatitis ocular dermatitis allergic rhinitis and conjunctivitis its all because of your atop please start on tab defcort 6mg twice a day for week 1_0_1 after one week tab defcort once a day for week 1_0_0 tab taxi 200 twice a day for days few areas infected tab xyzal levocetrizine monteleukast 2_0_1 half morning night tablet weeks for itching zensoft max or cetaphil lotion morning on spots momate cream mix with calosoft af lotion night on the spots drink lot of water review after weeks stop all triggers take care"
    },
    {
        "instruction": "i have a cough and the mucus is white every night I suffer this kind of situation I have a background medical records and the doctor said that I was allergic to dust and cold beverages but I dont think that I am allergic to dust because I dont have any symptoms of it every night I take cetirizine because it works everytime I take it the cough stop but im scared that it might be worst what should I do",
        "input": "",
        "output": "you are probably having what we call as an allergic pharyngitis avoid spicy oily and junk food altogether for a few days yes dust can be one reason why your nose throat might be creating a lot of phelgm sometimes even dust at home as in when you vacuum or mop the floor or look into old stuff having dust can lead to such issues besides even the slightest of acidity can be one hidden cause in allergic pharyngitis you will not have many tel a tale signs except of mucus irritating your throat advice have simple food with least spices avoid dust at all costs wear an n95 mask cuz that is the only thing effective against dust consider salt water gargles one glass of boiled warm water with tips of salt dissolve and gargle keep sipping on warm water long term use of levocetrizine is not recommended start an antireflux treatment with tab pantaprazole 40 my once a day in the morning 25mins before fast"
    },
    {
        "instruction": "i doing pod recent times I getting panic attack and anxiety sudden and I fear of being alone in home my mind always think some things bad will happen to me I trying to concentrate myself on other activities I not able to concentrate suddenly I feel racing my heart beat and difficult in breathing decreased energy level body pain lot more it all started happening from before one month due to this I am not able to sleep and eat correctly please let me know the solution",
        "input": "",
        "output": "thank you for using our website first of all there are two scenarios for your cases the first scenario is you could have faced a stressful situation and this situation has triggered the panic attack the situation may have appeared trivial but it could pointed to an important events in your childhood the second scenario is you could drink a lot of tea or coffee or you could have a systemic illnesses the high consumption of saturated fat and salt can cause hypertension and heart problems too much amount of tea and coffee can affect your heart and decrease the level of vitamin complex in your blood resulting in increasing heart rate moreover the oral contraceptive pills the hormonal replacement therapy and irregular menses may cause the similar symptoms egg and echo exclude the systemic illnesses reassurance use buspirone 10 my half a tablet before meals once per day for three days then half a tablet twice per day before meals then half a tablet three times per before meals then the dose should increase by half a tablet every three days to one tablet three times before meals for 90 days then you should withdraw the drug by decreasing the dose by half a tablet every week until you take half a tablet once every other day for two weeks then you should stop the drug"
    },
    {
        "instruction": "hello doctor for over four months I have been experiencing vaginal discharge that has an offensive smell I am in the military I have been to the doctor and they continue to tell me it is just a symptom from my birth control but have not sent me to a gynecologist the discharge has an offensive smell white yellowish color with small bubbles in it but not foamy I have been tested for gonorrhea and chlamydia both came back negative I think it might be trichomonas or be I do not have any other symptoms besides discharge and smell",
        "input": "",
        "output": "hello the bad smell and the discoloration of your vaginal discharge could be due to either a candid fungal or bacterial vaginosis be bacterial infection trichomonas usually has a fishy smell which you do not have candid infections usually have something like a curdled milk appearance and have itching which you do not seem to have if you do not think you have candidal symptoms then the diagnosis of be is more fitting treatment would be to start antibiotics both oral and vaginal for 10 days also if you are sexually active please do your pap smear test if not already done please abstain for a period of two weeks from sexual activity during the treatment to prevent reinfection also repeated infections would also affect your partner blood sugar pap smear candid bacterial vaginosis antibiotics sexual hygiene after one course of antibiotics"
    },
    {
        "instruction": "hello doctor my wife is having headache every day for the past two months pain is only mild but it extends up to the neck area sometimes if she has severe pain she vomits",
        "input": "",
        "output": "hello regarding your concern I would explain that this kind of headache could be a migraine I recommend starting verapamil 40 my three times daily and amitriptyline 25 my half a tablet before sleep a brain it computed tomography scan would help exclude any other brain lesions but considering the couid situation I would not recommend going to an er besides the situation is not an urgency considering the fact that she suffered from headaches like this before for rapid pain relief I would recommend taking ibuprofen 400 my three times daily coupled with acetaminophen I hope this helps"
    },
    {
        "instruction": "hello doctor I have a urinary tract infection again I had it two times within past two months it is the second time I took sefdin and megatas but still no improvement please assist me",
        "input": "",
        "output": "hi I think there has to be some cause due to which you are having recurrent ti urinary tract infection do not worry you will be alright first I will write a prescription which you have to start tablet levofloxacin 500 my for five days syearup alkamax citraalka 10 my ads for two weeks tablet pyearidium one tablet ads for two weeks tablet utwell cranpac cranberry extract twice a day for two weeks do a sit bath twice a day for 15 minutes after five days of levofloxacin you have to start tablet niftas nitrofurantoin 100 my for four weeks next is you have to get some tests done urine culture ultrasound abdomen with peru postvoid residual urine rat renal function test"
    },
    {
        "instruction": "hello doctor I have shallow and fast breathing usually bubbling and wheezing at bedtime along with nasal congestion and post nasal drip my mucus is low and clear with a little cough I have these symptoms for the past three months I used mucinex nasal spray salt water spray and benadryl I am a smoker for 30 years I did not get any health problems so far I have no fever but a little pain in chest with heart palpitations",
        "input": "",
        "output": "hi I can understand your concern by your history and description the possibility of bronchitis is more likely it is commonly seen with smokers it is the inflammation of airways this inflammation causes bronchospasm which intern causes wheezing breathlessness mucus production etc so please let me know how many cigarettes you smoke in a day have you ever undergone a chest ray and put pulmonary function test"
    },
    {
        "instruction": "hello doctor I have recurrent folliculitis the most common areas are in my upper legs and skin where my pubic hair lies I hope you can help me out in explaining why this happens to me I have this for almost two years now I was given antibiotics once in the past",
        "input": "",
        "output": "hi recurrent folliculitis occurs in people who has deficiency to fight staphylococcus aureus bacteria these are small boils which occur repeatedly at multiple sites of the body antibiotic heals them but they again appear after a few weeks or days it can develop any time during life and may vanish within a short period repeated antibiotic courses has to be done but precautions which I am writing down if taken properly mitigate this problem first thing is you have to take an antibiotic course for the presenting complaint take amoxiclav 625 my amoxicillin and clavulanic acid thrice daily for five days and mupirocin ointment twice daily this has to be continued for a longer period of up to month apply it inside the nostril in the maxilla in the pubic area in umbilicus daily twice use antibacterial soap like cetrilak cetrimide do not touch the parts of the body repeatedly like scratching as it also transmits this bacteria in some people if amoxiclav does not work we give other antibiotics but you have to try this first review after four weeks"
    },
    {
        "instruction": "hi doctor I would like to ask about my grandpa coughing situation as it already lasted for almost three weeks he has been taking his medicines since then but his cough still remains the same are there any suggested medicines or easy home remedies to follow",
        "input": "",
        "output": "hi it seems your grandfather is having a cough for three weeks cough in adults are classified as acute subacute or chronic based on the duration acute cough lasts up to three weeks subacute cough lasts three to eight weeks and chronic cough lasts longer than eight weeks subacute cough often has a post infectious origin and will typically resolve without treatment it is usually secondary to asthma or bacterial sinusitis reassurance is a good approach in otherwise healthy patients oral or inhaled corticosteroids ipratropium or cough suppressant may be prescribed to help with sleep the viral infection or bacterial infection mostly produce a fever and cough with expectoration these symptoms you did not mention I assume they are absent post viral cough can be last up to six weeks I would like to ask about red flags symptoms such as weight loss night sweats and hemoptysis if they are present you need further evaluation on an urgent basis other common causes of chronic cough usually more than eight weeks are allergic most often chronic cough is due to postnatal drainage asthma and or gastroesophageal disease some drugs such as ace inhibitor a type of anti hypertensive medication also results in chronic cough stopping such medication helps other remedies are steam inhalation alone or with menthol cough drops or lozenges soothe an irritated throat saltwater gargle honey is also helpful antacid for herd gastroesophageal reflux disease and at night sleep with two pillows so that head remains elevated"
    },
    {
        "instruction": "i took an antibiotic a year and a half ago and I have had digestive issues ever cents I crave sugar often and mostly eat carbohydrates like bread and chocolate I recently started to have a green smoothies that had two big handfuls of spinach in them with protein powder every morning for four or five days plus eating regular meals some being salads and some being more protein based its been about a week since I started this and I feel like I have not fully gone to the bathroom since I feel somewhat of a pain in my stomach and I wake up feeling like I have a fever and I am just afraid somethings not right and that I am very constipated constipation was one of my main issues this past year and a half and I am here is if make an appointment with my gastroenterologist and if I need to get this removed thank you",
        "input": "",
        "output": "hi there thanx for the query I can understand ur concern according to ur statement you had digestive problem and you took antibiotics for one and half year that antibiotic name is not mentioned here now you have been suffering from constipation for one and half year and for the seven dayser it has become very severe firstly exact causes should be found out and then treat the causes the causes of constipation vary such as dehydration or eating foods with too little fibres again more serious cases it can be result of stress hormonal changes spinal injuries muscle problems carcinoma and other structural problems affecting the digestive tract you should try the following quick treatment to make ur moves take fibre supplements like calcium polycarvophil fibercon psyllium metamucil konsyl methylcellulose etc eat a serving of high fibre food like oats whole grain bread or cereal fibrous veggies and fruits rice and beans etc proper dehydration typically at least eight ounce glasses of clear liquid per day is necessary for normal bowel movement take a laxative stimulants designed to force a bowel movement by squeezing the intestines like bisacodyl dulcolax ducodyl senna sennosides senokot etc take an osmotic laxative is designed to help move fluids through the colon like magnesium hydroxide phillips milk of magnesia polyethylene glycol miralax lactulose kristalose etc try a lubricant laxative such as mineral oil add a slick coat to ur intestine walls allowing stool to move through ur colon and out of ur body more easily use a stool softener such as docusate sodium colace or ducosate calcium surfak can moisten the stool by pulling water from intestine try an enema include sodium phosphate fleet soapsuds tape water enemas etc rectal suppositories like glycerin bisacodyl etc help encourage bowel movements by softening stool try to perform light exercise regularly try colonic massage you should undergo us of a mri of spine thyearoid test to ash abc etc to find out the causes responsible for ur chronic constipation please inform me after taking above mentioned measures and undergoing investigations then I will be able to treat you further"
    },
    {
        "instruction": "hello doctor I am an 18 year old male I have a lump on the inside of my groin it is about the size of a cent australian piece and I can feel it under my skin almost as if the skin moves over the top of it so I do not think it is a dermatological thing I have little spots around my pubic area but I think that is because of the hairs this feels like something different it does not look inflamed from the outside and it is not sore to touch just a bit tender it feels like it rolls underneath my skin but stays in the same spot obviously",
        "input": "",
        "output": "hi if I am not wrong cents australian piece is around am in size as you have described it is a lymph node in your inguinal region the human body has about 600 lymph nodes their role is to clean antigens from the extracellular fluid it helps in fighting inflammation and infection lymphadenopathy lap is the term to describe the conditions in which lymph nodes become abnormal in size consistency and number a normal sized lymph node is usually less than am in diameter an inguinal lymph node size up to 5 am should be considered normal lymphadenopathy can be called generalized when it affects two or more parts of the body enlarged lymph nodes associated with significant fever night sweats and unexplained weight loss more than 10 in less than six months are considered as red flags it required an urgent evaluation for lymphoma those are not present in your case pain and tenderness on a lymph node is a non specific finding it is typically due to minor infection other causes of the inguinal lymph node are benign reactive lymphadenopathy sexually transmitted disease cellulitis or local infection etc benign reactive inguinal lymphadenopathy is seen in patients who walk barefooted outdoors if it is tender you can take paracetamol keep watch avoid walking barefoot keep hygiene of your private parts if it persists and associated pain or fever or other site engaged lymph nodes you will need an evaluation I hope this helps regards"
    },
    {
        "instruction": "hello doctor I am a diabetic one month back I used to drink alcohol about 350 my every night and in the morning I take one tablet of trajenta since I have stopped drinking I feel to eat some sweet and I do eat some ice cream once a day or a bournvita milk when I check my sugar randomly now on touch ultra it is between 200 to 265 my do so to maintain my sugar level can I have two tablets of trajenta in the morning and evening",
        "input": "",
        "output": "hi from your history I could understand that you are suffering from uncontrolled type diabetes for one month usually uncontrolled blood sugars may not initially show symptoms that does not mean it is safe to have high blood sugars for a long time we are controlling sugars to prevent complications which are usually manifested 10 years later in your case the blood sugars might have slightly lowered after stopping drinks that might be causing relative hypoglycemia symptoms which usually will be over within a couple of weeks anyway still your blood sugars are uncontrolled I will advise you to follow a better diet pattern with limited calories according to your activities and a low glycemic index food intake also try to spend 30 minutes daily for regular aerobic exercises coming to your medication do not increase trajenta linagliptin continue the same dosage you can add a new tablet for better sugar control avoid drinks completely for avoiding sugar fluctuations hba1c glycated hemoglobin serum creatinine and urine albumin creatinine ratio continue trajenta my 1 add tablet amaryl my 0 before food funds examination by an ophthalmologist to rule out diabetic retinopathy review after three weeks"
    },
    {
        "instruction": "hello doctor my gynecologist told me that I had an abnormality in my pap test and I have hav eventually she will need to look at my cervix to make sure what strain it is the information she gave me was very bland all she told me was that if I have sex just use a condom which I always do but I wanted to know what can I do physically and sexually with what I have",
        "input": "",
        "output": "hello may I know what was the abnormality detected on your pap smear as per your gynecologist if you have got hav human papillomavirus infection high risk hav strains that is responsible for the development of cervical cancer you need to be further evaluated so your gynecologist would be having a look at your cervix through a magnified camera that can pick up certain changes on the cervix and can hint on the development of any precancerous changes if present it can be tackled at an early stage before actual cancer sets it so cervical cancer screening methods can detect changes almost five years before the actual development of cancer so it is advisable you get regular pap smears as advised by your gynecologist and be under her follow it would have been helpful if you could share the reports of pap smear and hav testing with me so that I could guide you better the reason your gynecologist asked to use condoms is that hav infection is usually acquired through sexual contact so to prevent repeated infection and also to prevent other sexually transmitted infections which can further aid in acquiring hav infection can be prevented by using condoms regularly regular pap and hav testing avoid smoking and multiple sexual partners"
    },
    {
        "instruction": "hello doctor I am experiencing gum pain on a back molar I am trying to catch it before it becomes an abscess please help I am currently on levothyearoxine",
        "input": "",
        "output": "hi I am sorry for the pain you are bearing though I needed more details and a photograph what type of pain is it is it only around the gums or in the tooth also if it is only in the gums means there is some periodontal problem maybe some food has got stuck up there do you remember eating any such thing recently where you felt a sudden pressure on it or from the sides under the prevailing situation you cannot go for a scaling even but kindly go for it as soon as possible for now I would suggest you to do a salt warm water rinse four to five times a day and gentle finger massage you can also apply clove oil if you have if pain is not bearable you can go for a pain killer paracetamol or ibuprofen as you have not mentioned whether there is a cavity or not I cannot prescribe you antibiotics do revert back for more queries"
    },
    {
        "instruction": "hello doctor I had heart palpitations every day and egg has picked up some downward spikes when I feel a palpitation please explain my egg",
        "input": "",
        "output": "hello I have gone through your query that you frequently have palpitations but I am sorry to tell you that I am unable to see the egg image you have attached it is not getting downloaded probably due to some error or a corrupt file I kindly request you to please attach a new image of your egg along with a few more details about your present symptoms do you have any known cardiac disease whenever you get palpitations do you have any other associated cardiac symptoms like chest pain shortness of breath giddiness or sweating during palpitations do you feel increased heartbeats or a missing skipped beats or just a bounding pulse do you have anxiety or stress kindly get back with the above details and a new egg image for further discussion and management strategy"
    },
    {
        "instruction": "hi doctor I broke a foot blister with a pin and the skin appeared intact I disinfected it and put a dressing but it hurts when I walk is this normal",
        "input": "",
        "output": "hello you have broken the blister with the pin and I would recommend you not to do that in the future as it is a non sterile method of doing so and can cause infections in that area having said that I would like to ask you is there redness around that area is there any discharge coming out from the wound if yes then you need to start some antibiotics and also take care of the wound make sure you clean it everyday and dress it up well as foot is the dependent part of the body and all your body weight is on it so even a small blister will be painful during walking standing etc for a few days until the blister heals blister foot blister local trauma tablet paracetamol one tablet twice daily betadine ointment for local application tablet augmenting 625 amoxicillin and clavulanic acid twice daily for five days proper foot hygiene regular dressing you might get a little diarrhea after taking the tablet augmenting which will subside once you stop the drugs usually eating probiotics like yogurt will help with the diarrhea"
    },
    {
        "instruction": "hello doctor I have pain in the gums and lower teeth I also note some redness at the base of the tongue please suggest",
        "input": "",
        "output": "hello I read your query and also saw the image you had sent you have pain in the gums and teeth also redness at the base of the tongue causes for the gum pain are improper oral hygiene because of which you have gum problems and also the recession of gums badly decayed teeth in the image I can see some teeth are decayed because of these you have an infection in gums and the redness you have to visit the dentist for full mouth rehabilitation means you have to take radiograph of all teeth detection of cares checking mobility treatment plan visit the dentist for full mouth cleaning maintain proper oral hygiene by following two times brushing with a soft toothbrush use chlorhexidine mouthwash twice a day after brushing use can use metrogyl gel to massage the gums for pain take tablet ketorol it ketorolac twice a day for three days capsule amoxicillin 500 my two times a day for three days and antacid before meals tablet pan pantoprazole two times a day for three days after three days"
    },
    {
        "instruction": "hello doctor I have cold three weeks ago and I got a sound in my ear which is similar to a heartbeat but the rhythm is very irregular last week it got worse with another sensation which is a kind of sound around the neck in addition to that I have sounds coming from my jaw on the same side which is accompanied with physical cracking in the place where the jaw is connected ti the skull my relatives can hear the sound when I eat also I tried to wash my ears with water and water might have went into my ear I had a scarf around my neck from yesterday and my lymph nodes suddenly got swollen with slight neck pain last but not least I have a clearly sensible lymph node behind my ear which is about the size of a small bean and is movable generally I am healthy and do not have any chronic disease I do not have an opportunity to reach my doctor if it is urgent but I am afraid it can develop to something serious",
        "input": "",
        "output": "hi I understand your concern your symptoms suggest a condition called tinnitus is defined as an auditory perception of internal origins such as a buzzing ringing or whistling tone and can be perceived as either pulsatile or non pulsatile it can have a significant influence on well being and performance in daily activities your symptoms suggest it is pulsatile in nature identification of the underlying cause of pulsatile tinnitus is important for adequate treatment and for prognosis estimation it can be due to cold and inner ear infection as you also have painful lymph nodes but you did not mention a fever if it is infection antibiotics dose will be helpful complete and detailed history is essential which includes possible accompanying complaints like vertigo hearing loss ear discharge and earache we are worried about an underlying vascular etiology that can be suspected when pulsatile tinnitus is influenced by vascular compression or when a vascular bruit is heard by auscultation in general head and neck mri magnetic resonance imaging and it computed tomography provide complementary diagnostic imaging information I suggest you consult an ent specialist"
    },
    {
        "instruction": "hello I am 18 year old and I want to help my girlfriend who is also 18 years old he suffers from headache vomiting dizziness and sometimes forgetfulness in 2018 he checked for his head and also had it scan and the result was that he was negative for brain tumor but in recent days he experienced signs and symptoms of a brain tumor but was unable to check up due to enhanced community quarantine here do you have any tips for reducing the pain she is feeling",
        "input": "",
        "output": "hi welcome to icliniq I hope you are doing well I understand your concern I need to know more about the symptoms I need to know how frequently she gets a headache how long she gets a headache whether it is continuous or intermittent any precipitating factors are present such too much noise or too much light at this age the most common headache is migraine headaches it is intermittent associated with nausea stomach upset some times vomiting and dizziness aggravated by noisy surroundings and lack of sleep some time there are triggers such as lack of sleep strong smells hunger you also must know about red flags or warning symptoms such as severe unilateral headache fever a new type of headache blurring of vision or weakness if they are present she may be required evaluation again migraine is benign conditions can be managed by avoiding triggers have a healthy lifestyle and maintain adequate sleep for pain paracetamol 500 my is useful hope this is helpful regards"
    },
    {
        "instruction": "hi doctor I have scratched by my pet vaccinated dog today few hours ago also there was no bleeding in my hand but there is some redness there so guide me that it is still necessary to have are also before months ago I was vaccinated with are when there is scratch of dog then",
        "input": "",
        "output": "hello welcome to icliniq although unvaccinated animals are more likely to transmit rabies vaccinated animals can also do so if the vaccination of the biting animal was ineffective for any reason a history of rabies vaccination in an animal is not always a guarantee that the biting animal is not rabid animal vaccine failures may occur because of improper administration or poor quality of the vaccine poor health status of the animal and the fact that one vaccine dose does not always provide long lasting protection against rabies infection in dogs cats the scratch on your skin comes under category I for post exposure prophylaxis for which anti rabies vaccine is indicated and although you have taken the vaccine months before and your dog is also vaccinated there are very minimal chances of you or your dog having rabies but there is a very miniscule chance but according to the guidelines you should get vaccinated again make sure to clean the area of scratch properly and thoroughly with soap and water observe your pet for the next 10 days and see if it is health deteriorates which if does would be a strong indication to get vaccinated dog bite anti rabies vaccines wash the area thoroughly with soap and water follow up after 10 days"
    },
    {
        "instruction": "hello doctor my mil is 60 years old she just had an appendectomy and is having some complications including a severe headache and vomiting the first day she ate some food and was fine today she tried to drink some milk and vomited repeatedly several times we live in a developing country and the doctors are not knowledgeable about these things what are the potential complications that could cause such vomiting and what treatments should be given",
        "input": "",
        "output": "hi it would have been nice if you mentioned how many days over after the surgery there are many causes for your symptoms but this would depend on the indication for which surgery was done and intraoperative findings some common causes and management I will explain post spinal headache avoid using pillows more liquids and coffee will help some antiemetics can be added on this is commonly seen in the first week after surgery if you had a bad infected appendix post operative infected collections are common and this can cause your symptoms but this will also cause fever and abdominal pain sometimes postoperative medications can cause small stomach ulcers and can cause these symptoms you need to see your doctor and ask for antacids overall if you are not having fever loose stools severe abdominal pain and vomiting and headache is not continuous then nothing much to worry about you can see your doctor if the symptoms are troubling you a lot simple paracetamol should help you with headache us ultrasound abdomen peptic ulcer"
    },
    {
        "instruction": "hi doctor I am having pain in my lower tooth whenever I go to sleep due to lockdown I am unable to consult the dentist can you please tell me any tablet that I can use in the meantime",
        "input": "",
        "output": "hello sorry for the pain you are bearing because of the prevailing situation as you have already mentioned there is a cavity and when it reaches up to the pulp there develops an irreversible stage which generally is more painful during night time as we sleep I think your tooth has reached the stage of irreversible pulpits and a root canal treatment is now must in order to save the remaining tooth so go for it as soon as the situation in your area gets better for now take amoxicillin clavulanate 500 my thrice daily for five days paracetamol 500 my to thrice daily sos do not take paracetamol when there is no pain but do complete the amoxicillin course additionally you can take any one for gastritis if you have a tendency to develop gastritis with antibiotics you can take pan pantoprazole or omen omeprazole take them on empty stomach do salt water rinse regularly you can apply clove oil at the site it is a good anti inflammatory maintain good oral hygiene regularly but for sure get it treated avoid eating from the affected side until it gets treated or even if you eat make sure nothing gets lodged in that tooth do mouth rinses with plain water regularly so that there is no food stuck drink plenty of water I hope this helps"
    },
    {
        "instruction": "hello doctor I am suffering from extreme hair fall and boils on my scalp hair is falling from the root for the last couple of years these boils come with pus and they settle down become dry and turn into dandruff it is quite painful when the boils are in full swing as if someone is pulling your hair I have had this problem earlier also and I have seen many doctors they have loaded me with medicines and supplements every time I consulted a doctor I would have their medicines for a month or two and then stop thinking it has not suited me or I find no difference they use terms which confused me more than giving me confidence I tried allopathy unni and yoga for blood circulation one doctor even suggested mesotherapy serums etc but now the hair fall has been so bad from a normal sized clutch I have started using two sizes smaller and even that pokes there is hair everywhere when I do shampoo or comb when I just run my hands through it there are a lot of gaps literally it pulls down my confidence I am currently on recital woman once daily bin forte once daily rise sachet once a week with milk",
        "input": "",
        "output": "hi I went through all your pictures investigation and detailed history recurrent boils on the scalp can be a continuous problem for many people it can also be pre runner for seborrheic dermatitis minoxidil should not be used irregularly once started with minoxidil the result will be after six months and you should not stop in the middle otherwise it will be followed by severe hair fall your vitamin is low but you are already on medication hemoglobin is also very low please start iron supplements along with fresh vegetables dates and fruits rich in iron keep your dandruff under control continue bin forte biotin forte and recital for iron take zincofer tablet daily please start on microdot lex doxycycline and lactic acid bacillus 100 my once a day for two weeks do not scratch the area use scale shampoo dilute it with water and make sure of 10 minutes contact with the scalp then wash off second line antibiotics to be changed only step by step"
    },
    {
        "instruction": "hello doctor I am a 67 year old female I have a significant past medical history of to and a lifetime history of bronchitis my arthritis is currently being treated with remicade last month while in a temporary job I developed severe altitude sickness sob fatigue and confusion followed by bronchitis stuffy nose and productive cough while there I needed to schedule a remicade infusion and the doctor there said she heard crackles in my lungs and sent me for an immediate chest ray high resolution it scan and a multitude of labs to my surprise I was diagnosed with ra not spa as my rheumatologist had diagnosed me before itself anyway the radiology results state honeycomb lung damage amongst other ominous findings at my follow up I was told I have ra ild I am now back to my place and have no symptoms to alert me of any lung problems I followed up with my pop last week and she did not hear crackles in my lungs my peak flow rate is 400 and my of sat is 100 at rest and 98 with fast walking I will send my radiology report and lab results my question is can the latent to lung scaring be misdiagnosed as ra ild or if I would appreciate your opinion",
        "input": "",
        "output": "hello I can understand your concern according to your statement you have been suffering from chronic bronchitis with rheumatoid arthritis with recently diagnosed with ra related interstitial lung disease or idiopathic pulmonary fibrosis you had a history of pub and taking anti tubercular drugs you are concerned about your recent diagnosis based on hrct chest whether it is ra old if or latent to related complications for your past sufferings and now you feel a lot better your hrct of chest reveals interstitial fibrosis characterized by peripheral traction bronchiectasis irregular reticulation in all lobes microtubules with calcification in mid and lower lungs lower lobe predominant microcystic changes without significant ground glass opacifications hilar calcified lymph nodes consistent with chronic granulomatous disease and bronchial wall thickening bilaterally similar type of radiological findings can be found in post to fibrosis chronic obstructive pulmonary disease which includes two key components chronic bronchitis and emphysema ra old or if etc you may not tell your doctor about your previous history of latent to for that reason his diagnosis was ra old or if as you are suffering from ra so he was not wrong as your radiological reports suggest the above mentioned differential diagnosis again on high altitude your doctor found crackles as you are suffering from cold and it may be associated with infections that time and now it not heard as your infection was subsided"
    },
    {
        "instruction": "hi doctor there is a sort of pink colored oval slightly raised flat patch on my bikini line and it is very painful I do not know what it is and I am terrified I get cysts on my bikini line quite often but they always go away it does not look like a cyst and it just appeared like one or two days ago sometimes it hurts to walk I was on my period last week so I wear different type of underwear and maybe that was too tighten on my bikini area also I have been lying down on my side for an extended period of time due to social distancing the lump is not really feeling over the area just raised and flat I have not had this issue before the cyst only started to hurt when the side of my underwear pressed against it hard please help me",
        "input": "",
        "output": "hello I have read through your problem thoroughly and seen the pictures too to me it looks like an inflammatory boil with some induration thickening of the underlying skin due to some skin infections it is mostly a folliculitis hair follicle infection in the skin it will mostly go away in two to three days you can take some analgesic for pain relief and use some antibiotic cream for local application to prevent it from getting infected just keep the area aerated and change your undergarments frequently avoid shaving the bikini like till it heals or else it may get infected tablet combiflam paracetamol ibuprofen sos after food for pain relief if too painful sit bath a small tub of lukewarm water with some betadine solution or a spoon of salt three to four times a day for pain relief clean the genital area gently after using the restroom and apply the antibiotic cream to the affected area only clindamycin gel or soframycin cream framycetin change undergarments frequently if the lesion becomes like a collection of pus as of now does not seem to have formed pus you can take oral antibiotics"
    },
    {
        "instruction": "hello doctor I am suffering from pain while passing stools and there are some blood spots on the stool the pain is unbearable but there is no swelling as such I am unable to go out due to the lockdown situation please guide me on what to do is this normal I am a diabetic",
        "input": "",
        "output": "hello I understand your condition you say you are having bloodstained stools and there is no swelling in the anal region which is a good sign now based on your history I suspect you must have had constipation a couple of times constipation ultimately will lead to hard stools which can cause a tear at the anal region I also guess that you are having a fissure in the anal region I a tear at the anal verge and since it is painful and recent it is of acute nature I suggest you consume a high fiber diet regarding treatment you have to sit in a tub filled warm water twice daily for five to ten minutes for ten days it is advisable to put in 10 my of betadine solution but if you are not able to go out due to lockdown you can use it as plain warm water this process is called as sit bath if you can get to a pharmacy get an ointment lidocaine apply it thrice a day at the anal verge better to apply before and after defecation avoid straining and avoid constipation by including green leafy veggies in your diet and drink plenty of water kindly keep your sugar levels under control"
    },
    {
        "instruction": "hello doctor I am suffering from severe constipation for the past 10 days there is also discharge and itch from the anus I am also feeling excessive weakness after passing stools",
        "input": "",
        "output": "hello from your history it looks like severe constipation but I would like to know a few more details so that I can confirm the diagnosis have you had similar episodes in the past do you have any abdominal distension or pain how is your appetite if you were to describe the stools is it hard and dry or loose when you say weakness do you mean you feel tired or do you have other symptoms also like numbness over feet or hands do you have any fever or vomiting please get back with the above answers so that I can confirm the diagnosis and prescribe you the right medicine"
    },
    {
        "instruction": "help doctor my penis is swollen in the front part with itching and irritation from yesterday I was trying to check online it says maybe it is balanitis not sure though please guide what needs to be done I am currently on medications for high be and uric acid",
        "input": "",
        "output": "hi it is very likely to be balanitis with the background of acute infection and swelling you can take tablet cisma it cefpodoxime 200 my twice a day tablet nice nimesulide 100 my twice a day tube dermiford for local application twice a day take all these medicines for seven days review in a week if not resolved check your hba1c glycated hemoglobin levels and send reports are you sexually active if yes is your partner having white discharge if so your partner also needs treatment to prevent balanitis"
    },
    {
        "instruction": "hello doctor I have a headache migraine for almost five days now and I am feeling dizzy from time to time I am taking paracetamol and mefenamic acid for toothache I am a year old female my height is and weigh around 80 keg",
        "input": "",
        "output": "hello since you have mentioned migraine does it come in episodes how severe is it is it limited to a specific region is it associated with nausea is there any intolerance of light is there any neck pain do you have a fever is there any blurring of vision how is your balance"
    },
    {
        "instruction": "i have very thin loose motions and pain in abdominal area since days and feeling weakness taken flaygel medicine today please recommend any medicine and precautions and diet ply",
        "input": "",
        "output": "dear welcome to icliniq com with history of days diarrhea with weakness seems that you are on dehydration side est of all most important step for you is to keep yourself well hydrated and replace electrolytes use or mix in litre water and take as maximum as you can avoid spices fried outside meals take liquid or soft food for 3 days at least and eat less add yogurt and ispagul and banana in your diet continue with flagyl 400mg three times a day take ciprofloxacin 250mg after breakfast and dinner for days also take mebeverine 135mg before breakfast and dinner also take antibiotics like enflor sachet once daily for days I hope you will be fine soon in case issue persists after days please let me know take care stay healthy"
    },
    {
        "instruction": "hi doctor I gave birth normally to a 2 keg baby boy however with a small cut that was stitched and healed its now coming to four months ever since I gave birth my problem is that my vagina let us out air almost like a fart though not smelling it could happen even during day time when I had just produced but now only comes at night around 0am am stressed worried and I do not really what to do am asking for help on what can really be done am tired of this situation in my life thank you doctor",
        "input": "",
        "output": "dear welcome to iclinq saw your concern I can understand you completely first of all make it clear that gas from vagina is queefing vaginal fart not a pathology it is because the roomy vagina holds air and during the rigorous act of coitus or ant bit strenuous work or excersises it passes out with a sound just similar to fart as it is from a hollow organ as you had mentioned it is not associated with smell it is unlikely to be a fistula rectovaginal fistula so just relax nothing can be done to prevent it may be some positional changes avoid more of butt up in air positions both during work excersises sex if you just understand that it is normal you would laugh it out regards best wishes hope you find it useful physiological due to roomy vagina vaginal fart reassurance revert back if any queries"
    },
    {
        "instruction": "hello doctor my oldest son is years old he understands everything you say to him but he refuses to talk he used to say a variety of words and now he only does animal noises and a handful of words I would like to know what I could do in order to encourage his vocabulary or if I should be worried about it in the first place I am also wondering if his decreased vocabulary and stubborn behavior are linked to the arrival of his baby brother a year ago I am currently trying the apps speech blues and abc mouse he also likes puzzles and games but he will not sit for the songs or story telling any advice would be appreciated",
        "input": "",
        "output": "hi it seems like a regression of speech is there with normal receptive skills and affected expressive skills rather than finding the cause now focus on how to improve the condition apps are good but not in the initial stage start with some interesting real life activities to extract some simple utterances first do not give anything without his utterances even if minimal it should be there pa pay in a musical manner like other phonemes also start extracting he will surely enjoy from this go to combining like pay tea too then potato then tell see we will cut potato cut the real potato and show him get a video consultation with me if you want to get the demonstration for a better understanding implement these techniques and give feedback on this thanks"
    },
    {
        "instruction": "hello doctor I am 36 years old I have a problem on the right side of the large intestine I have four babies with cesarean surgeries my youngest baby is 13 years old my uterus was removed five years ago due to rasoli after this operation I felt pain in my anus and a year later I was alright but later on my mother suddenly passed away due to sorrowness I felt pain in my stomach and a pull in my belly followed by I had constipation and piles no bleeding now whatever I eat or with empty belly I feel heavier on the right side of the large intestine after eating something I feel that it has blocked due to any hindrance I thought it may due to eating beef or meat but now doctors say that my large intestine is infected and even using medicines show no improvement my hunger is normal but I have constipation and little pain in the right intestine with a large amount of urine with crystals in it please suggest medication",
        "input": "",
        "output": "hello I have reviewed your situation for confirmation what is going on you need to visit to a gastroenterologist and get booked for upper and lower gi gastrointestinal endoscopy but reading at your situation it looks you have both acidity problem and constipation till you meet some gastroenterologist you can take capsule nexium 40 my esomeprazole once a day before meal and isphagol husk two teaspoons in a glass of water keep it for four hours and then take it if you still feel symptoms you can follow us so we can upgrade the treatment I hope this helps"
    },
    {
        "instruction": "hi doctor my sister is 15 years old she is having a problem with growth she is not growing even a single am from year I am too scared about her future she is only 150 am now many advised her to do skipping swimming cycling etc though she is doing skipping it does not help much I just need some scientific help please help me out I am scared of her growth",
        "input": "",
        "output": "hi good day thanks for your query I am afraid that I do not have good news for you in your sister age it is not possible to increase height of about or inches with any medications the growth plates in the bones close after 13 15 years of age in females and no increase in height possible growth plates are the areas of new bone growth in children and teens they are made up of cartilage a rubbery and flexible material for instance the nose is made of cartilage as kids grow the growth plates harden into solid bone a growth plate that has completely hardened into solid bone is a closed growth plate after a growth plate closes the bones are no longer growing growth plates usually close near the end of puberty for girls this usually is when they are around 13 15 years old and for boys it is when they are about 15 17 years old what is the height of your father and mother your sister may have an average height of both of them another option is limb lengthening surgery thanks"
    },
    {
        "instruction": "hi doctor I am 20 years old I am sexually inactive for a year now I am having some issues with my body parts I had a film around my clitoris that came back often after washing it in the past few days I have been experiencing yeast infection symptoms so today I got an over the counter medication for it I inserted the tablet and it is being only for 12 hours when I went to the washroom white fluid came pouring out I have never got treated for yeast infection before so I was just wondering if that was normal my current medication is only birth control pill please explain me",
        "input": "",
        "output": "hello for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hello doctor my wife is 25 weeks pregnant she is 27 years old her weight is 64 keg and height is 2 this is our first pregnancy now doctor found one problem in level two ultrasound report fetal head mildly dilated lateral ventricle 6 my I consulted with doctors they are saying that it will be fine in the next four weeks automatically without any medicine but I am not satisfied please explain",
        "input": "",
        "output": "hi I read your query and understand your concern for further doubts consult a fetal medicine physician online"
    },
    {
        "instruction": "hi doctor I am a 23 year old male I am suffering from acute lymphoblastic lymphoma and I am going to finish my last chemotherapy my abc count has reduced due to discontinuation of gcsf after the completion of chemotherapy session how to recover abc count please suggest me",
        "input": "",
        "output": "hi for further information consult a hematologist online"
    },
    {
        "instruction": "hi doctor I am 18 years old this time my period lasted for five days but it came down lighter than usual my period is always consistent but normally during my periods I would just skip one day and my period is always heavy yesterday and today I have not been bleeding or even spotting is that normal please explain me",
        "input": "",
        "output": "hello for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor my child who is years old has bedwetting problem please suggest me",
        "input": "",
        "output": "hi for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor my husband had an issue since he was 18 years old doctors have brushed him off time and after time but I know that his symptoms are very real he feels hopeless that he will never find an answer for every four to six months he gets a flare up as we call it the symptoms are itching bug crawling sensation twitching diarrhea fatigue headache agitation dry skin peeling and loss of bladder control it seems to be inflammation based we do not believe it as an allergy he has had pail a year before the problem existed please suggest me",
        "input": "",
        "output": "hi I am sorry to know that no proper answers were extended by doctors for his condition for further information consult a neurologist online"
    },
    {
        "instruction": "hi doctor I have had braces before two years during that time I had a jaw expanded for my upper teeth as they were too crowded I was wondering if my dentist is giving me false information because she is scared as she will ruin my teeth from my picture the lip piercing side is my left side and the front of my teeth the tooth that is on the right of my bunny tooth is a few my behind the rest of my teeth I recently consulted a specialist because the bunny tooth next to that tooth was losing the root and was hurting they said we needed to stop my brace pressure as soon as possible so I asked my dentist if she could fix the tooth that is slightly behind the bunny tooth and the one beside it after being persistent she tweaked it a little to help it now the real issue I am having is in image 2100 which is the image on the side showing my lip piercing it shows that my teeth are good however the image 2101 which is the side image without my lip piercing my upper teeth and lower teeth are touching tip to tip I also noticed that these particular teeth are slanted inwards towards my tongue rather than being straight like the rest of my teeth the dentist told me that my teeth have worn from all the grinding that I do however when I check face front you can clearly see that the upper teeth are slanting inwards and I do remember when doing elastic it was pulling them down from a lot of pressure I believe this is a cross bite the dentist would not admit it and saying there is nothing to be fixed I have checked past photos before I had braces and from close inspection the cross bite area was never like that in fact the upper teeth overlapped the bottom teeth and was fine in that area I am wondering whether my dentist is correct that my teeth are fine and that it cannot be fixed I am pretty sure if she put a button behind the tooth and then I did elastic it not be fixed and brought forward and overlap the bottom teeth my current medication is doxycycline please help me",
        "input": "",
        "output": "hi for further information consult an orthodontist online"
    },
    {
        "instruction": "hi doctor from last two years we are trying to conceive and recently my wife had so test the result of the prolactin blood test is 89 no my and ash is 84 the fish result is 83 mlu my also the luteinizing hormone range is 83 mlu my and right ovary adnexal is 38 my 24 my please explain the result to me",
        "input": "",
        "output": "hi revert back with the reports to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I have developed some brown patches and freckle like spots on my left hand overnight I went to bed last night with a new light brown freckle on the palm of my hand and woke up this morning to it being darker and there being more freckles and patches there are a couple of patches on my ring finger and it looks like a stain the brown spots seem to have become darker over the day and a couple more have appeared what do you think this could be as far as I am aware I have not been exposed to anything thank you",
        "input": "",
        "output": "hello for further information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor my father abuses me a lot and eats a lot he is really aggressive he also has some memory problem due to over consumption of alcohol unless we give food he starts destroying things so I think he is suffering from bipolar disorder what should I do",
        "input": "",
        "output": "hi increase appetite aggressive behavior and destroying things are symptoms of bipolar mania but in bipolar mania there is decrease need for sleep so it may be bipolar mania to make a definite diagnosis I need to know more details about his behavior revert back with the answers to the above questions to a psychologist counsellor online"
    },
    {
        "instruction": "hi doctor I am a 27 year old unmarried male approximately six to seven years back I had a urinary infection I was told to take an antibiotic course which I did not complete at that time the infection was not fully cured and it used to come and go during urination I sometimes used to have one or two drops of blood only during the period of infection in addition to the above mentioned problems I have some other issues related to sexual health they are premature ejaculation extremely bad timing sensitivity of the skin penis area lower back pain lack of confidence etc when I have to urinate I cannot hold it at all very often on my way to the toilet some urine drops are leaked during night time I have to stand up several times to urinate approximately once a week after urination suddenly sperm drops are released I have not discussed this part with the urologist I feel joint pain as well during winter I freeze a lot especially over thighs hands ears neck and chest I have now recently been to a urologist and I was told that the infection became chronic the doctor recommended antibiotics again and I have now completed the course the urinary infection should be cured by now all the new tests were negative a few years ago I used to masturbate frequently which is still the urologist told me that my prostate size is bigger than people in my age please suggest me some good solution for the above mentioned problems I want to get married soon and live a healthy life thanks in advance",
        "input": "",
        "output": "hi for further information consult a urologist online"
    },
    {
        "instruction": "hi doctor I am 36 years old I am trying to get conceive but my periods are irregular in the past I was never able to conceive with irregular periods I do have children but they were conceived when my cycles were normal I do not feel like I have time to wait it out though I have been trying for a year now I need to know if clomid would be a good option me please explain",
        "input": "",
        "output": "hi I have read your problem for further information consult an infertility specialist online"
    },
    {
        "instruction": "hi doctor it has been two days that I am feeling some irritation around anus today I noticed some small lumps that are tender to touch and causing mild irritation regularly apart from that I have upset stomach and I am getting semi solid motion a month back I had a stone in the urinary tract which came out of its own and I have been taking cystone two or one tablet twice a day in the past I had balanitis which happened due to taking ofloxin and ornidazole I am feet height and 86 keg weight",
        "input": "",
        "output": "hello use 2 to 4 nitroglycerin cream twice daily for six weeks if you are having soft stools then you are good since you are having semi solid stools please add fiber to your diet you can try isabgol husk one teaspoon every morning in warm water you should not be straining for the poop to come out since it will cause further tears revert back with the answers to the above questions to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I have red bumps which are non itchy and keep on spreading also I am attaching the picture for your reference please explain me",
        "input": "",
        "output": "hi I have read your query and examined your picture with that much of the descriptions I can say it may be allergic contact dermatitis or insect bite hypersensitivity or urticarial vasculitis I suggest you to use facto calamine lotion local application twice daily and one tablet levocetirizine once daily for five days consult your specialist doctor discuss with him or her and take the medicine with their consent revert back with the answers to the above questions to a dermatologist online"
    },
    {
        "instruction": "hi doctor I have a kidney stone in my right kidney and I have abdominal pain is there any medicine to clear out the stone or is the operation the only way please help me",
        "input": "",
        "output": "hi revert back with full detail and test report to a urologist online"
    },
    {
        "instruction": "hi doctor I am a 31 year old female when I met with an accident before six years my left leg below knee got injured and the doctors has done wrong surgery please help me",
        "input": "",
        "output": "hello revert back with reports and more detailed history to an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hi doctor I have had first larger and dark lesion that is bump behind my left knee since I do not know when but it certainly not since birth I noticed it before two to three year and from that time the lesion is the same and has no pain now there is this another small lesion have appeared on the left leg and thigh when I lay on my side it is a kind of makes my left leg ache kindly let me know if I should panic",
        "input": "",
        "output": "hi for further information consult a dermatologist online"
    },
    {
        "instruction": "hello doctor my ear has been blocked for the past three days there are mild pain and discomfort this could have been caused because of the earbud I used ciplox ear drops and have tried crocin pain relief but it does not help ear feels extremely uncomfortable and hearing is muffled please suggest some anti inflammatory antibiotics as I am unable to visit a doctor because of the couid 19 situation",
        "input": "",
        "output": "hello it does not necessarily have to be due to earbuds causing otitis external though that could be one possibility there are others also can you tell me if you had a cold recently does it feel like there is a fluid inside the ear do you feel like you need to pop your ears is there any throat irritation how severe is the earache it could be secondary to middle ear infection also"
    },
    {
        "instruction": "hello doctor I am a 30 year old female I weigh about 87 keg I am a mother of a year old kid and still breastfeeding no history of pod and my periods are regular with a cycle of 28 days I conceived after three years of marriage life I had a natural delivery in 2018 and got my regular periods back in march 2019 my period pas symptoms include bloating mood swings and temperaments now my problem is for the past three months my periods are super heavy I am using 10 pads per day for the first three days and normal to less in the next three days this makes me drained and weak I am unable to sleep properly and cannot do anything it also leads to bad stomach cramping today is my second day of menses and yesterday I fainted as well what to do",
        "input": "",
        "output": "hello welcome to iclinq com I can understand your concern the reason for your excess flow could be most probably hormonal yet if the bleeding continues to be more in subsequent cycles then a pelvic ultrasound should be done to rule out any new pathology in the uterus check your he hemoglobin and thyearoid levels sometimes hyperthyearoidism can cause excess flow because of heavy menses in previous cycles your he must have come down causing this severe weakness and giddiness moreover lactation consumes iron for milk production this would have added up to your anemia start iron supplements as soon as possible and take iron rich food you can take tablet tranexamic acid 500 my twice daily during the cycles to reduce the flow and get a gynecologist opinion in person if your problem continues hormonal anemia he ash thyearoid stimulating hormone pelvic scan hormonal anemia hematinics tablet tranexamic acid 500 my to decrease the flow and pelvic scan if bleeding continues"
    },
    {
        "instruction": "hello doctor I am having a mild pain at my right shoulder joint or below I am unable to lift weights and sometimes even cannot lift up my hand also kindly suggest",
        "input": "",
        "output": "hello you are having pain in the right shoulder with weakness in the right hand please answer my few questions can you hold a cup of tea in your right hand or it is dropping from your hand can you hold the bathtub while bathing is that pain continuous or occasional any history of trauma or accident are you suffering from diabetes or high blood pressure any history of neck pain"
    },
    {
        "instruction": "hello doctor I have worn braces for four years and finished my orthodontic treatment before five years I am 20 years old since then my teeth have been healthy but I have been suffering from an eating disorder for three years and I am still in recovery two months ago one of my top central incisors started feeling slightly wobbly and after looking at it in the mirror I noticed the gums had receded by my compared to the pictures I had from last year I saw my dentist who told me everything was fine but since then my tooth has become even more wobbly and my other top central incisor has started to wobble too I had a look at all of my teeth today and realized that all of the gums had receded by 3 my I brush my teeth with a soft toothbrush and floss twice a day and I use mouthwash every two days I am very scared that my teeth are going to fall out because I can feel the roots being unstable when I chew food and I cannot bite into a sandwich or any other harder texture without feeling discomfort due to couid 19 I am unable to see a dentist right now unless it is an urgent case causing a lot of pain what should I do",
        "input": "",
        "output": "hi nothing to panic as such your gums need complete scaling cleaning but due to couid 19 you cannot have now if the gums are swollen you will definitely have a wobble feel do enforce brushing twice daily with normal paste and medium toothbrush use betadine gargle thrice daily take tablet oflox oz 10 twice for five days and becosules capsules once daily for five days if you have an eating disorder you can try with probiotic sachets for five days preferably in the nights visit the dentist once the pandemic is over do salt water gargling twice daily"
    },
    {
        "instruction": "hello doctor can my ekg be overread please my general practitioner read mine and I would feel better if a cardiologist looked at it I have a lot of fluctuations in heart rate shortness of breath chest tightness fatigue and dizziness labs show a positive dime elevated sed rate elevated platelets vitamin 12 folate and vitamin deficiency ruled out clot in lungs with it scan no signs of fluid in lungs no mono and negative for couid 19 waiting for hotter monitor results I started treatment for vitamin deficiencies",
        "input": "",
        "output": "hello your egg electrocardiography is normal I think you are talking about a slight variation in heart rate in this egg strip yes it is there and it is called sinus arrhythmia sinus arrhythmia is a perfectly normal arrhythmia it is one of the only two rhythm problems which are called good arrhythmias do not worry about this sinus arrhythmia means your heartbeats are perfect if you are talking about some other type of heart rate variation hotter will clarify it if there is any rhythm problem you feel concerned for you can ask anytime positive dime is very nonspecific and diagnosis cannot be made on it alone keep taking folate vitamin b12 and supplements I hope this helps"
    },
    {
        "instruction": "hello doctor I have facial flushing in my cheeks for about one month and have not gone away it varies from mild to bright red day today it began after I tried using retinal and experienced peeling so I stopped after one week I saw a doctor who said it was contact dermatitis because I used other harsh products during the retinal treatment however I can see broken capillaries on my cheeks is this rosacea how can I make the redness go away",
        "input": "",
        "output": "hello flushing persistent redness and telangiectasia could be signs of rosacea moreover retinoids can flare up rosacea a common cause of rosacea in some individuals is the usage of potent topical steroids on the face is there such a history however they are not implicated in a large number of cases I suggest you to use a broad spectrum sunscreen and avoid the sun do you also have acne why were you using retinoid what other products you have been using I request you to kindly upload an image of the skin so that I am able to have a look and guide you accordingly"
    },
    {
        "instruction": "hello doctor I woke up a few days ago with a large bruise on the back of my left thigh unsure of how this happened as I do not remember or have knowledge of hitting this area I was drinking heavily the night before but do not believe this is a reason for the bruise I have been working out a lot last week and possibly thought it could be a muscle bruise I am more concerned with the shape and placement of the bruise and effective area of smaller bruises around the larger one I have never got random bruises I do suffer from anxiety and this is making it factor right about now I am currently on prozac",
        "input": "",
        "output": "hello welcome to icliniq com I have seen the attachment your bruise is clearly due to hematoma you should get a us ultrasound of your thigh take some rest and bruise will disappear gradually also if there is severe pain at that location then ray should also be done to rule out any fracture muscle tear us of left thigh ray of left femur ap anteroposterior and lateral muscle tear femur fracture take rest review after the us report"
    },
    {
        "instruction": "hello doctor I am a 39 year old female office worker currently I am on work from home status I am experiencing occasional tingling in my fingers and legs what could be the cause of this I have taken station medicine last january for around months due to an elevated level of cholesterol but discontinued as advised by our office or company physician as my cholesterol levels are within the normal range however my last lab test showed the following results fbi 10 cholesterol 46 triglyceride 02 hel 62 and lil 1 with this should I resume taking station if so how frequently my previous prescription is daily at 10 mug also is it safe for me to take vitamin complex supplements thank you very much",
        "input": "",
        "output": "hello tingling sensation suggests neuropathy we need to find its cause and treat it for now vitamin b12 will be more preferred over the vitamin complex your cholesterol is slightly elevated you can try dietary restriction and exercise if cholesterol still remains high you can start atorvastatin 10 my before sleep daily neuropathy evaluation dyslipidemia ash thyearoid stimulating hormone vitamin b12 and folate level neuropathy evaluation workup tablet meganeuron alpha lipoic acid and folic acid once a day tablet atorvastatin 10 my at night if cholesterol still high avoid oily food daily 30 minutes brisk walking review with reports"
    },
    {
        "instruction": "hello doctor I am suffering from ear pain and a kind of the whole head is blocked like sensation the left and right ears are blocked with some air or water like state I have this ear pain for four days gradually on the same pain note I have taken aceclofenac with paracetamol and amoxicillin I have also tried otorex ear drops but the pain neither reduced or increased the right ear is a kind of inflamed and not even let the drops go through I am already on deplatt a connor and imdur in the morning and along and rosuvastatin in the night for my angina complaint I am also on thyearonorm 75 mug in the morning I am scared to go out to a hospital due to the pandemic effects so please advise",
        "input": "",
        "output": "hi it looks like you have developed what we call as eustachian tube catarrh this tube ventilate both the nose and the ear and can get blocked due to allergy or sinusitis or in any upper respiratory infection such as common flu if you have allergic issues it has to be adequately treated tablet sinarest a combination of acetaminophen chlorpheniramine and pseudoephedrine one tablet two times a day I 12 hours apart for one week can be considered otrivin nasal drops three drops three times a day for 10 days should also help valsalva exercise 15 to 20 times a day steam inhalation also do give a little relief antibiotics and painkillers will not help as it does not treat the problem however complete the course of your antibiotics and do not stop them halfway I hope this helps"
    },
    {
        "instruction": "hi doctor I have high blood pressure for the last four years according to my doctor it happens from genetic since both parents suffering from it usually I have a problem with diastolic blood pressure it has reached 95 and even more since the systolic stays with 130 or max 140 since that time I am using amlodipine my and connor 5 my in the morning daily my pressure is very good with the two pills and it is always 10 75 my question is about amlodipine can I change it with another medicine I am asking this because since I start with it I started feeling tinnitus in both ears is it possible to be the reason I saw in one report that amlodipine cause tinnitus some time",
        "input": "",
        "output": "hello it is rare but yes amlodipine can cause tinnitus and it is worthwhile to change it to other medications the best alternative option is of arms angiotension I receptor blockers like telmisartan the equivalent dose would be 40 my once daily and it would take a week for full effect and if blood pressure remains elevated after a week which is unlikely then you may need 80 my if telmisartan is not available then olmesartan 20 my is equivalent to telmisartan 40 my it may take a few weeks for it to disappear after stopping it if it persists after few weeks then it needs to get examined by ent specialist for other causes I hope this helps you and get back if you have any doubts"
    },
    {
        "instruction": "hello doctor I am having issues with hearing pain pressure and sensitivity to noise can slough in ear be painful I am currently using topamax allegra baby aspirin tylenol aleve and ibuprofen",
        "input": "",
        "output": "hello sorry I need more details but I will comment on the pictures as clear as possible the first picture shows a lot of shaded superficial layers of the skin this can be painful this may be a dermatological disease like eczema I still do not know which ear is it right or left the last picture seems to be of the left ear the drum is intact no perforation the white patches in the drum are called tympanosclerosis which is deposition of calcium granules within the drum tissue this can happen spontaneously or after healed drum perforation and drum surgeries"
    },
    {
        "instruction": "not been feeling to good for more than weeks now no appetite so have lost weight night sweats whole body feels weak and uncomfortable all day this has gotten worse during the past week and a half nose and throat feel like they are on fire coughing more after eating stomach also feels like it is on fire gets worse after eating stomach acid reflux after eating and burping a lot after eating sometimes burping up acid reflux calves have difficulty moving very tired no appetite more severe night sweats wake up every half an hour just about each night very tired",
        "input": "",
        "output": "hello I am sorry to hear that you are not feeling so well reading about your symptoms the most common differential diagnosis would be herd or gastro esophageal reflux disease it is basically reflux of the acidic content of the stomach into your food pipe or oesophagus that causes all these problems and to confirm the diagnosis I suggest you to meet a gi specialist after the couid situation settles down who will then do an endoscopy to confirm the diagnosis till then try avoiding alcohol citrus juice tomato based products and coffee after meals take a walk inside your premises and wait for 3 hours and then lie down keep an extra pillow to elevate your head while sleeping also stop taking omeprazole and start talking tablet esomeprazole nexpro red nexpro have 1tsp of syearup sucralfate 30 minutes before taking esomeprazole endoscopy urea breath test tab esomeprazole domperidone syearup sucralfate"
    },
    {
        "instruction": "hi doctor my husband is having pain in penis head the foreskin got backwards and now it not coming back to original form and not covering head of penis yesterday when my husband was urinating he tried pulling foreskin and it went backwards after that it not coming to front before also he was not able to pull it backwards so while having sex and wearing condom there was no problem once when we had unprotected sex his foreskin went backwards and he was in pain the foreskin was coming forward he is in pain what can be done is it normal or not we had sex a month ago with precaution",
        "input": "",
        "output": "hello it looks like your husband is suffering from a condition called phimosis is a condition in which the foreskin is too tight to be pulled back over the head or glans of the penis now this can happen due to a number of reasons and can be diagnosed only after examination this usually happens when one does not clean under the foreskin can lead to bacteria fungus or other germs accumulating there when this happens for some time it can lead to balanitis inflammation of the glans or the head of the penis has this happened before tight shiny skin on the glans redness around the glans itchiness or irritation of the glans an unpleasant smell tight foreskin that cannot be pulled back etc when this happens it can lead to phimosis after examination only I will be able to diagnose whether it is balanitis or phimosis and whether this is due to bacteria or fungus or some other cause the treatment varies depending on the findings therefore if the pain is severe it would be best to take him to a urologist and get it examined on the other hand if the penis is red and swollen you should take him to the emergency room if you want I can give you a cream for the pain but if there is infection there is a chance it will become worse I understand there is lockdown but if the pain is not too severe you can wait until lockdown is lifted let me know what you decide and any other queries you may have"
    },
    {
        "instruction": "my mums be level was raised to 160 140 days back we took her to the doc but no one got her admitted to the hospital because of the couid situation they just gave her medications her be is normal now but she has very much weakness she is feeling a lot dizzy she cannot even sit or stand she starts feeling dizzy she has lost all her energy what can I do to get back her energy and she does not have a stable be her be fluctuates some times it is very high sometimes it is very low so she does not take any medications for be cuz her be is fluctuating I need help what can I do",
        "input": "",
        "output": "hi I hope you are doing well I can understand your concern I need to know whether she had past history of hypertension or she was on any medication prior to this episode the sudden rise to blood pressure can be due to simple stress anxiety some time pain if she is known hypertensive then skipping medication can cause a sudden rise of blood pressure I have noticed that her diastolic be was high you need to monitor her be regularly also in supine position and standing position also during day time and night time do three to four readings of be it will give us an idea about her blood pressure fluctuation the symptoms she is having are probably due to low blood pressure especially hypertensive elderly people tend to take less salt than required which leads to low salt in their body resulting in hyponatremia which can result in such symptoms I suggest you monitor blood pressure if possible do serum electrolyte and random blood sugar and creatinine continue amlodipine as advised by your doctor I can be changed as per be monitoring hope this will help you"
    },
    {
        "instruction": "hi doctor my year old son is having a lot of trouble sleeping he snores every night and tosses and turns and has trouble breathing through his nose his doctor says he has enlarged tonsils and adenoids I think he has obstructed sleep apnea because I hear him gasping for air sometimes we did a sleep study and the night of the sleep study he slept well but every night at home he has a lot of trouble sleeping he wakes up a lot talks in his sleep has nightmares and I think he has sleep apnea because I hear him gasping for air sometimes the doctor said we could try flonaise to help him but we read that flonaise can stunt a childs growth the doctor said he could grow into his tonsils and I also heard that years old is very young for tonsil surgery my questions are how worried should I be about his troubled seeping I am not getting any sleep lately because I listen to him all night is it dangerous to let him go on trying to sleep and have so much trouble breathing each night with possible sleep apnea please help I am very concerned",
        "input": "",
        "output": "hi if symptoms are too severe we can go for tonsil and adenoids surgery now also flonase is a steroid and it does not affect growth as it will be administered inside the nostril and will have the action only there will not be any systemic or bloodstream absorption how much worried you should be about his tonsil and sleep apnea problem are change in facial features producing adenoids facies irritability of kid he cannot hear properly due to adenoids blocking ear tubes ear discharge reduced development of speech do not get worried just because of the snoring and sleep apnea give him nasal steroids and antihistaminic syearup like zyeartec or allegra syearup of appropriate dosage in some cases we even give oral steroid syearup it does not cause any stunting the way you have understood once you exhaust the above medical treatment option and find no or not much benefit we can discuss about the surgery your doctor is right in giving the medicines flonase etc that is the protocol we can follow the same here the decision to operate may vary with different surgeon take a pediatrician opinion as well do revert back to me if you need more support"
    },
    {
        "instruction": "hi doctor before two months I had one stent put in the complete blocked artery scans showed heart muscle damage from an old heart attack this was caused by me not taking my be drugs so for the first time in my life I have stuck to taking all my prescribed drugs these were aspirin 75 my amlodipine 10 my atorvastatin 80 my bisoprolol 25 my ticagrelor 90 my it has been eight weeks I felt a great minus few chest giggles presumed this was stent settling and I am still smoking 20 a day now for the last one week I have a severe dry mouth all the time despite drinking and my urine output is liters to my input of liter at night I am going after every two to three minutes my doctor is thinking I have a ti despite being negative for it now they are testing me for gonorrhea and chlamydia my suspicions are that the drugs I am taking causing this I feel like stopping them all together or having the dosage I cannot see my cardiologist until next year is there a link between my drugs and these symptoms and am I safe to temporarily stop a few of them to rule them out if so which ones are crucial and which are not I am eternally grateful for your help",
        "input": "",
        "output": "hello all the medicines you are taking are essential medicines and should not be stopped except in case of severe allergy none of these medicines cause increased urination amlodipine is a blood pressure lowering medicine it can be changed to some other medicine this medicine may cause fluid retention and swelling of feet in some patients regarding increased urination possibilities include maybe you are taking medicines called water pills or diuretics which are sometimes given in heart patients these increase urine output please review your medicines ti urinary tract infection may cause increased urination raised be itself may cause increased urination keep be blood pressure in control please reduce weight take mediterranean diet do regular exercise and have a proper sleep never stop or switch to any medicine without consulting a cardiologist"
    },
    {
        "instruction": "hello doctor I am a year old male I feel pain in my chest as well as back not on a fixed place it was moving pain sore and bad before 25 days after a few days I had a cough during the night then I consulted a doctor and he prescribed me the following medicines augmenting 625 twice daily montair la once daily taco 60 once a week vitamin twice a day after eight days I was normal but it started again after two days then he recommended the same for the next seven days after five days again I was normal but after two days I feel pain in my abdomen center only then I stop taking the medicine and after two days I was normal since last night I am feeling again moving pain in the chest and back and sore throat and pain in the abdomen today I tried for an ray but no one was ready without prescription but I have a report for let please help",
        "input": "",
        "output": "hello I can understand your concern according to your statement you have been suffering from chest and back pain which is moving in nature and not fixed with a sore throat and abdominal pain since last night you had a cough at night and on medications now for that you had a similar episode three months before too according to your description you are suffering from acid reflux and asthma acid reflux occurs when acid travels up the food pipe to the mouth this can happen when the muscle at the bottom of the food pipe which acts as a gateway to the stomach becomes weak or loose heartburn is a burning sensation in the chest or abdomen and it has nothing do with the heart people feel heartburn behind the breast bone after eating in some cases pain can be felt in the back as well so symptoms of heartburn caused by acid reflux include a burning sensation in the chest a sour taste in the mouth and pain in the middle of the back you can take syearup gaviscon domperidone thrice daily before each meal with lansoprazole once daily before meal and you should always remember that your acid reflux may worsen the asthma condition"
    },
    {
        "instruction": "hello doctor I have been having rashes on my hands forearms trunk and feet for four weeks now the rashes on my hands and feet have lesions the rashes are not itchy except for those with lesions I also have a small wound or sore on my anus which has been there for three weeks now I believe this is syphilis I have taken loratadine for seven days as prescribed by a doctor here however nothing happened I cannot have it checked due to the quarantine in my area does my condition need immediate medical care or can I take medicine to treat this while waiting for the eco to be lifted I did not have a fever or flu when this started I would also like to add that I have been having dandruff on my beard and mustache and an itchy scalp there are also dry patches on the area near my chin and they are flakey they do not flake sometimes though I have been applying moisturizer on my face since they started to appear another thing the folded skin on my underarm and area behind my knee can sometimes have a burning sensation I did not know what is happening I hope you can help me with this",
        "input": "",
        "output": "hello prior to the onset of rashes did you observe any lesion or wound on your penis or sexual encounter with someone who had such may I ask questions about your sexual history how many sexual partners have you had male or female are you aware of your partner promiscuity what do you do any other diseases is this the first time this has happened besides loratadine have you tried taking any other medications any allergies based on the given health data it is likely you may have secondary syphilis can you send photos of the rashes on your trunk or arms where did it start and how did it spread any throat pain or gun lesions if you are having difficulty of breathing fever changes in sensorium numbness or weakness please proceed to the er otherwise we could start treatment for now but will require laboratory results to confirm the diagnosis please do vdrl or ror whichever is available and fta abs or oppa whichever is available I suggest to start doxycycline 100 my twice daily for 14 days please do lab works before starting your medication the results may turn out negative if you have taken your dose and if it is negative we will have to stop the treatment regarding dandruff I suggest to shave your beard use anti dandruff shampoos may continue the application of moisturizer on the affected area regarding the burning sensation it maybe related to syphilis are there any rashes present is it often damp is the area reddish continue to take baths and maintain good proper hygiene please send your abc complete blood count results vdrl venereal disease research laboratory or ror rapid plasma reagin and fta abs fluorescent treponemal antibody absorption or oppa treponema palladium particle agglutination assay abstain from sex for now proper hygiene"
    },
    {
        "instruction": "hello doctor I have increased ringing in both ears I have been diagnosed with post nasal drip the left ear feels blocked and the left side of the throat feels clogged as well I had taken antibiotics on the prescription but that is not working my ear testing results were normal",
        "input": "",
        "output": "hello your problem seems to be due to sinusitis itself can cause clogged feelings in the throat or sinusitis can cause secondary pharyngitis which can cause throat problems do you have a headache or nose block or excessive sneezing I will want you to send me a clear picture of your throat where I can see your tonsils and posterior pharyngeal wall also please let me know the name of the medicines you have been taking and also the duration I am enabling free follow up please revert back"
    },
    {
        "instruction": "hello doctor my mother is 65 years old she is having a fever for the last seven days she also suffers from stomach problems for the first five days she did not have any stools then she passes stools four times the day before yesterday and few times yesterday probably she has severe amoebiasis but her fever is not receding what to do she is currently on omen once ofloxacin 200 my be azithral 500 my od vizilac one tab ads metronidazole taken for five days and now stopped or in ample amount",
        "input": "",
        "output": "hello I reviewed your mother history and investigation the history and low tac total leukocyte count and low platelets on abc complete blood count are suggestive of enteric fever kindly do the following things it does not look like to be amoebiasis us ultrasound abdomen enteric fever continue azithromycin in the same dose and complete five days injection ceftriaxone gram iv in 100 my is daily for seven days tablet paracetamol three times daily or oral rehydration solution use a soft diet get back to me with the us report"
    },
    {
        "instruction": "hello doctor I have severe heartburn difficulty in breathing gas pain and burping please suggest",
        "input": "",
        "output": "hello I can understand your troubles regarding heart burn and difficulty breathing you are having herd gastric esophageal reflux disease and indigestion obesity smoking drugs pregnancy abc complete blood couont ash thyearoid stimulating hormones end esophagogastroduodenoscopy pyloric infection herd dyspepsia capsule esomeperazole 40 my 0 before 30 minutes of meal for 10 days then follow me syearup gaviscon 20 my after every meal maintain a healthy weight excess pounds put pressure on your abdomen pushing up your stomach and causing acid to reflux into your esophagus stop smoking decreases the lower esophageal sphincter ability to function properly elevate the head of your bed if you regularly experience heartburn while trying to sleep place wood or cement blocks under the feet of your bed so that the head end is raised by to inches if you cannot elevate your bed you can insert a wedge between your mattress and box spring to elevate your body from the waist up raising your head with additional pillows is not effective do not lie down after a meal wait at least three hours after eating before lying down or going to bed eat food slowly and chew thoroughly put down your fork after every bite and pick it up again once you have chewed and swallowed that bite avoid foods and drinks that trigger reflux common triggers include fatty or fried foods tomato sauce alcohol chocolate mint garlic onion and caffeine avoid tight fitting clothing clothes that fit tightly around your waist put pressure on your abdomen and the lower esophageal sphincter follow after seven days"
    },
    {
        "instruction": "hello doctor I am weeks pregnant I used to vomit once or twice a day until now but today I have been vomiting after eating or drinking anything do you suspect it to be a food poisoning or it is normal also can you please suggest some home remedies",
        "input": "",
        "output": "hello did you take any outside food or any food that you are not comfortable with recently do you have loose stools if your answer to both the questions are no it is most likely to be vomiting in pregnancy home remedies would be to have a small two hourly food take enough water especially kanji water glucose water etc in the morning as you wake up do not have tea or coffee it would be best to have a dry item like a risk or a biscuit have breakfast only after one hour also please walk around the house or if you are working take small breaks take a good amount of dry fruits have you done your scan and your routine blood tests if not please do those if still not responding to the above measures you can start medications which have no side effects try these for three to four days and then you can get back to me"
    },
    {
        "instruction": "hello doctor my year old son has a skin colored mole on his back that occasionally appears and causes irritation he has had the mole for the last one year it appears every few months usually when he is active rolling around on the floor or wrestling I notice that the mole looks inflamed and even appears to be filled with fluid after two or three days it always goes back to normal it happened again last week and I am wondering if it is time to get it looked at to ensure it really is just a mole that gets irritated easily",
        "input": "",
        "output": "hi kindly send the pictures it can be a boil or molluscum because a mole will not disappear"
    },
    {
        "instruction": "hi doctor my month old baby is having loose stools for the last 15 days for the last or days the color of poop turned from yellow with mucus to greenish yellow with bad smell I consulted with a pediatrician and he gave antibiotic injection and drops to him but I could not see any improvement homeopathic drops reduce poop frequency but as I stop giving the medicine it all started again I am clueless and under lockdown so I am not able to visit a good doctor",
        "input": "",
        "output": "hello thanks for your query you did not mention how many times in a day he passes stool and the name of the antibiotic does your baby breastfeed and please do not give him home or other kinds of medication give him syearup erythromycin one third teaspoon four times daily for seven days please add oral rehydration solution five teaspoonful after each purging please do continue breastfeeding there is a rule for making or please follow the rules for making or make the whole packet at a time and you will be able to use it up to hours after this period please discard the residual you keep an eye on whether your baby urine output is adequate or not if possible do a test for your baby the name of the test is stool m routine microscopic examination and s stool culture and sensitivity test kindly consult in the future if needed"
    },
    {
        "instruction": "hi doctor I had a tonsil stone removed a few days ago thinking that is what I was feeling in my throat but it was not there is something else I feel when I swallow it does not hurt but just uncomfortable it looks black maybe like a pimple or some kind of a bump",
        "input": "",
        "output": "hello I went through the picture you sent the throat especially the posterior pharyngeal wall and palatine pillars appear a bit congested now this could be due to a few reasons either allergy and repeated throat itch infection flu and acid reflux there also seems to be minimal post nasal drip we of course can see the blood clot it could be due to the removal of the stone and the area could have had mild bleeding which eventually formed the clot will you please provide us more details is there any allergy symptom runny nose itch watering of eyes sneezing breathing difficulty etc do you smoke or drink how many times are you gargling how are your eating habits do you have a fever or weakness I would suggest if it were just minimal allergy or flu to take an antihistaminic tablet decongestant or saline nasal spray and a proton pump inhibitor I would go with zyeartec and protonic for a few days zyeartec in the evenings and protonic before breakfast for a week avoid spicy and oily diet desist from smoking and drinking temporarily but it would be ideal if you provide us the details sought so that we can make a more decisive diagnosis and get you the right advice"
    },
    {
        "instruction": "hi doctor I have a lot of stress issues and thyearoid which causes my hair fall out a lot I came across romaine foam I am wondering if it is safe to use it for me I do not have any patches just hair loss and thinning",
        "input": "",
        "output": "hi hair loss occurs due to a variety of reasons most commonly at a young age is it occurs due to androgenetic alopecia it is a type of alopecia due to the sensitivity of our frontal scalp hair to the androgens which increase during puberty it appears at frontal areas and progressive gradually according to the genetic makeup of a person in females it is in the central part of the forehead other type of alopecia occurs due to chronic illness chronic stress chronic drug treatment like chemotherapy and it commence three months after the inciting illness so to treat it we have to rule out any disease in the body stop any drug which may be causing their fall if possible avoid smoking alcohol and do mild exercise take a balanced diet and keep yourself stress free medical treatment includes minoxidil twice daily over the scalp tablet calcium pantothenate and biotin preparation daily regain also contains minoxidil foam preparation better but costly this treatment initially is continued for six weeks then we review the progress in androgenetic alopecia it has to be continued until you need hair to be normal because genetically those hairs have to be fall with medical treatment we are only stopping them associated disease or stress should be treated accordingly initially due to minoxidil there is increased hair fall because the hair which will be weak suddenly fall and strong and dense hair at the place grow which takes time and maximum improvement is seen after eight months of the treatment hair loss has multiple factors so try eliminating all in addition to testing your thyearoid I hope this helps"
    },
    {
        "instruction": "i have fever very high which was not going I have taken overdose of tynel anvil now the fever is gone after taking medication but now I feel shivering and having a feel like I am having fever but after I check there is no fever my body weight is going down and I feel shivering a lot during day but at night I feel very well",
        "input": "",
        "output": "hello sir I am a family doctor from icliniq and will try to answer your questions it seems to me that you have two the first concerns your use of tylenol and anvil you may not have meant to say overdose if however you have taken more than 800 my of ibuprofen or 100 my of tylenol those are excessive doses and could be associated with side effects I would advise you to call the canadian or us poison control center they give excellent free advice about overdoses the second question is in regard to your fever and weight loss I am not sure how long those things have been going on with couid 19 in your area it is possible this could be your problem there are many other causes of fever such as influenza and various other viral and bacterial infections often when a fever falls a person can feel chilled some things that you can do besides using ibuprofen 400 my up to three times a day or tylenol 100 my three times a day include drinking lit of liquids getting rest and isolating your self from others things that would make you want to seek a doctor care would be increasing cough trouble breathing chest pain trouble thinking clearly or inability to care for yourself I will pray that you feel better soon please let us know if you are not getting better or have additional questions"
    },
    {
        "instruction": "hello I am a 20 year old female I have a few questions regarding my i'd hav and be the itch around the genital area I had first last year and it went away and came back three days ago the ob said I was spotting I recently got my i'd when I visited the ob I got my copper i'd last year and have been experiencing spotting since its not everyday but it happens before and after my heavy periods is this normal I have been to the ob before that too and they told me I have genital warts inside my vagina I plan on just letting it go away since there seems to be no other option I am concerned if the i'd will make the hav worse at the same visit I took a pap smear and results came back positive for be like flora I went undiagnosed will my be go away on its own I do not have symptoms like grey discharge or fishy odor so I am not that worried the reason why I went to the ob last time was because I was itching like crazy down there my discharge was like cottage cheese it went away for a while but just now I checked for the string to my i'd and my finger came out with some cottage cheese like substance do I have a yeast infection been itching for a few days too",
        "input": "",
        "output": "hi I understand that your i'd and the vaginal infection is troubling you regarding the i'd it normal to have spotting after putting it in for some time I assume you are having regular periods if so wait for a month as your bleeding is not heavy if it does not normalise then it is wise to see a gynaecologist who will need to check you to see if the position of the i'd is normal regarding the be it would be wise to treat it at the earliest as even if you do not have symptoms now later it can cause issues regarding the hav once your be is treated it would be good to consider taking hav vaccines if you not already vaccinated"
    },
    {
        "instruction": "is it possible to overexert yourself and then not be able to breathe afterwards for days like chest feels really tight and burns and feels like ive got asthma or something from lifting something heavy been feeling like this a few days now was feeling sick with suspected covid19 for a few weeks felt like I was starting to get better then overexerted myself carrying heavy bags and immediately experienced intense tightness in chest and shortness of breath worse than before went to the er they didn't see anything wrong with heart or lungs got an appointment with a doc but its not until later whats going on er said it could be stress or anxiety and gave ativan which helps some but is it ever going to go away",
        "input": "",
        "output": "hello the situation you are going through I can understand its a pandemic that people of the world are suffering your condition is quite similar to covid19 cases but do not worry symptoms like fever loose nose difficult in breathing cough cold and throat pain are for couid positive persons you have just breathing problem here I will tell you something important which will help you in keeping yourself stress free use the tab prescribed by the do also from today start deep breathing exercise at first you wont be able to do breath deep but try to do slowly at first 10 secs increase the count of breathing every minute after few minutes take a deep breath hold for 4 secs and then release increase holding of breath for unto 20secs I know you can do it and you have to do this you are so tired and got over stressed by yourself never get panicked apart from deep breathing exercise do regular walk little bit of muscle strengthening exercise as well all this will help you in gaining your confidence health and heart beat to normal sleep full eat healthy avoid alcohol if consumes never get stressed always stay safe thank you"
    },
    {
        "instruction": "hello doctor ra patient for 13 years and on treatment with methotrexate leflunomide then suffered from aplastic anemia and at treatment done with partial recovery presently on cyclosporine on the advice of hematologist and hcqs on advice of rheumatologist yeti man chemotherapy was done since then ra was in remission until january 20 lab reports show creatinine 0 urea 39 uric acid 59 hemoglobin 7 tac 26 platelets 168 now the patient is having typical attacks of ra in various joints like hip knee shoulder and neck etc feels lethargic early morning finger joints are swollen with severe pain taking aceclofenac100 with paracetamol 325 almost daily if the pain is less she takes paracetamol 650 please advise medication during lockdown",
        "input": "",
        "output": "hello I have gone through your reports it seems her arthritis is flaring up again eventually cyclosporine and hcqs are both very mild when it comes to arthritis management she may have had a prolonged suppression due to rituxan injection at this stage my suggestion would be to restart leflunomide as the tac total leukocyte count is still low methotrexate may not be the best choice secondly she can take injection kenacort 80 my triamcinolone intramuscular once a week for two weeks it will settle the inflammation fast thirdly use minimum pain killers as they are not a wise option when aplastic anemia is in the background I hope this helps"
    },
    {
        "instruction": "hi doctor I have gouty arthritis and currently I am drinking urinorm to lower my uric acid I am not eating anything that may increase uric acid but I do eat fish and pork right now I am experiencing a pain in my right foot and I was wondering if I can drink colchicine I bought it when I had my gout attack and I do not want to experience the pain again I already had three attacks this year please suggest",
        "input": "",
        "output": "hi welcome to icliniq com first of all you need to be sure that you are having pain due to an acute attack of gout or something else since you are already taking urinorm and if you have been regular in taking it you should not have got the attack in case you have been irregular in taking urinorm or you have started it recently it can be an acute attack an acute attack is best treated by nsaids like diclofenac along with serratiopeptidase colchicine you can take but is not going to help you just in case you have been taking urinorm regularly so taking diclofenac is the right choice at this point of time with or without colchicine I hope this helps"
    },
    {
        "instruction": "hello doctor for the past three days I am having unbearable pain in my right ear I doubt somehow in the meantime of bath some water must have gone through it and by my right ear I could not able to hear anything my right ear hearing capacity is 10 15 and it is closed I have faced this issue twice already please help",
        "input": "",
        "output": "hi there are three possibilities for your problem first is impacted wax can be there which can create lots of pain ear fullness and decreased hearing you can use soliwax drops three drops thrice daily for five days second possibility is a fungal infection which usually presents with ear fullness itching and pain if there is no itching and mild discharge then there is very less likely to have a fungal infection third possibility is a eustachian tube catarrh wherein the pain is not as much but your main symptom will ear fullness decreased hearing feeling of water inside your ear history of recent upper respiratory infection or history of previous allergic symptoms and there is usually no itching associated here you can take a tablet containing paracetamol levocetirizine and phenylephrine combination whichever is available in your country one tablet twice daily for five days if the ear fullness does not come down you have to get your ears cleaned by an ent specialist"
    },
    {
        "instruction": "i have month old twin girl babies after delivery under my left toenail under blood clot and another toenail light shade of grey color no pain but sometimes not comfortable to walk can cure or not mam I am afraid for this so tell the reason and suggestion cure or not all corner of fingernail become bluish after taking onabet lotion drops they are hidden but toenail not cure now I taking zincovit syrup triboost tablet last two month sertaconazole nitrate drops lotion put to all finger nail height 147cm weight 57 keg please tell suggestion mam",
        "input": "",
        "output": ""
    },
    {
        "instruction": "i have cylinder power from past 10 months first my power was 5 in right and 75 in left but now I have in my right eye is 5 axis is 180 and in left eye 25 axis is 180 do I need to wear glasses all the time can I wear lenses for this power and also can I go for lasik surgery please reply and my eye power got increase within 6 months is it possible to increase power grastically and also even if I were sex I fell so uncomfortable may be dry eyes and am using eye drop too even though I feel blur not clear uncomfortable in my left eye with power 25 cylinder power any natural treatment is there to reduce the power like exercise food please answer",
        "input": "",
        "output": "hi welcome to icliniq I will try to answer all your questions one by one so first of all cylindrical change from 75 to 25 is not significant and most probably it was due to interobserver variation usually refractive error does not change after 20 years age and as you are 27 so less chances are that there is any change 5 change can be observed between exams even on same day so dont worry if you feel comfortable with glasses then you should wear otherwise this is very small error you will be able to do most of your tasks without glasses thats unto you yes you can use lenses no lasik is not suggested for such a small number because even after that you might have error of 5 so don go for any surgery you are almost normal even without glasses change in power already explained above if you are not comfortable with 25 then you should use again go with 75 probably that was your correct preacription no such diet food available that corrects refractive error I hope you I have answered all the questions and have not missed any you are most welcome for any further queries have a nice day god bless you"
    },
    {
        "instruction": "hello doctor my daughter is going to be years old soon she does not pass stool on daily basis after a gap of 4 days she passes the stool with lot of difficulty which is very hard and sometimes she gets rashes and slight blood stains appear in her potty she eats everything we try giving her lots of water she is also very active this issue has started from last months of irregular potty we tried giving her ayurveda medicine swauff water but that too is not making her do every day before that she used to do every day without any issue kindly advice me what can be done to make her potty loose and the ways I can guide me child to do potty every day awaiting your reply thanks regards",
        "input": "",
        "output": "hello hope you are safe thanks for the elaborate history I appreciate your concern for your child regarding constipation first of all include high fibre in diet avoid milk at night start lactulose syearup my 12 holy it will help and please be in follow up may I know the weight of the child and is there any associated complaints abdominal distention is the child passing normal urine is there any fever regarding diet if possible arrange a telephonic conversation with me or if not possible I will send a diet chart which will help regards hope my advice helps idiopathic constipation conservative high fibre diet after day"
    },
    {
        "instruction": "i have some white spots on my neck and my face too I even noticed a white hair in my eyebrows I have white hair from a long time on my head I have pod problem two months before I had a section delivery after the delivery these spots have come kindly check the pictures attached",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello doctor my husband has been having a lot of issues in the past year he does have a history of colon cancer in his family and I am more concerned he gets excessively bloated looks like a pregnant lady very often he gets bad gas that causes pressure on his chest sometimes he will have problems of belching or passing any kind of gas he will have numbness and tingling in his hands sometimes he gets lower back pain stomach upset and abdominal pain that he describes as feeling like his stomach is being shredded he has trouble with bowel movements often and there is usually a lot of blood he does have hemorrhoids but it is still a lot of blood even with that and I do not know if it is related he is having pain in his testicles not with urinating or ejaculation he has an appointment with a gastroenterologist but it has been pushed back due to the pandemic please help he is currently on cymbalta xanax and adderall",
        "input": "",
        "output": "hello it is good that you are concerned regarding your husband with a positive family history we should be alert for any conditions if they are running in the family as per you your husband has multiple gastric problems with back pain and numbness these problems may be due to indigestion and less physical work up it is very common in these lockdown days the alarming issue is he has blood in stool that cannot be ignored it may be due to hemorrhoids but complete checkup is necessary I will advise you some medicines and blood investigation that should be done as early as possible avoid spicy and fatty diet and water intake should be adequate start some physical workup like cardio on treadmill if not possible to go outside regular habit of walking after ever meal will help get back to me any time after investigation gastric upset with bleeding or rectal bleeding colonoscopy with biopsy ultrasound whole abdomen and pelvis complete hemogram with let liver function test kit kidney function test and blood sugar syearup cremaffin four teaspoons at bedtime for seven days tablet rifagut rifaximin 400 my twice daily for seven days pan der pantoprazole once daily on empty stomach for seven days normaxin clidinium bromide chlordiazepoxide dicyclomine twice daily for seven days"
    },
    {
        "instruction": "hi doctor I currently have recurrent epistaxis this has started since four years on a yearly basis to a daily basis since six months I have been seeing an ent consultant but due to couid 19 I am unable to see him until august I had recent blood tests and mri which came back all clear I had an endoscopic examination that said there was some crusting on the left side and rest all fine believing it is posterior and not anterior epistaxis this is affecting the quality of my life I have also developed bruxism and end with blocked ears now and then I have also got gingivitis as well no hayfever or allergies I am aware of I have had suspected sinusitis but this was not confirmed but every day I have a watery eye especially on the right eye",
        "input": "",
        "output": "hello welcome to icliniq com you have recurrent epistaxis and you have been cauterized also a number of times there does not seem to be any obvious pathology on examination by endoscopy I must point out that epistaxis can be idiopathic in more than 50 patients this is because certain patients tend to have nasal mucosa far more friable than others and susceptible to even most trivial trauma like nose picking or forceful blowing even minor colds can cause epistaxis however one has to be careful to rule out other causes hypertension is an important cause but that is usually an affliction of elderly at your age one would like to rule out bleeding diathesis did you ever have bleeding from any other site have you done a coagulation profile though you have mentioned blood tests what about liver and renal function tests are you on any medication other than this further deviated nasal septum with spurs can cause epistaxis did mri mention anything like that in case there is nothing to suggest any underlying cause it is likely to be idiopathic and role of precautions become all that necessary one important thing is to prevent your nose from becoming dry as occurs in dry weather and colds you can use liquid paraffin nasal drops to prevent mucosa from becoming dry and friable further you need to avoid blowing hard or frequent cleaning of nose you can also use topical decongestant like xylometazoline 02 if you develop a bleed avoid using them for more than seven days at stretch you can go for a it computed tomography nose and pins para nasal sinus for having a better information on sinus details"
    },
    {
        "instruction": "hello doctor my wife has small pimples in between her fingers on both hands and they are itchy it subsides when she uses ice water even wearing gloves gives relief when using detergents or soap it increases two months the back same thing happened and it got cured this is the second time and it is there for the past seven days please suggest remedy",
        "input": "",
        "output": "hello I would like to know a few things before coming to a diagnosis is anyone in the family has such itching is itching worse at night does any other part of the body has red spots which soap and detergent you use what all housework you do the attached photos are blurred please send a photo of better quality"
    },
    {
        "instruction": "hello doctor I noticed that I have a penile skin bridge I thought it was normal at first but after searching on the internet I found that at the age of 24 it can only be removed by surgery is there any other method apart from surgery to remove the penile skin bridge please help",
        "input": "",
        "output": "hello if you are talking of phimosis inability to retract the foreskin fully over your glans penis then yes it can be removed only by surgery but do you actually have phimosis is the real question try to retract the skin and the point where it is not possible then click a picture and send it as it is a clinical diagnosis I will be in a better position to tell you what to do next"
    },
    {
        "instruction": "hi doctor I would like to know what does my lab tells you about my current liver function I began to struggle with daily gout pain a few months ago and finally gave in to taking the traditional drugs about one and a half months ago both allopurinol and probenecid caused worrisome impacts on my body I began to experience flank pain confused thinking and fatigue around this time I was also compelled to have my arc checked because I was struggling with headaches insomnia and various degrees of itching after eating my arc turned out to be 7 I stopped taking the drugs and did a lot of research and was fortunate to find some supplements that seem to be effective at the intersection of both metabolic syndrome and gout presently I have found that berine approximately 100mg day works gout pain is essentially gone and blood sugar seems to be coming under control with each day though my caloric intake in unsustainable low admittedly I have taken some hesperidin ala chromium nac ecgc nigella sativa oil or triple strength turmeric occasionally if I was having a momentary concern not all at once or even all in a day but occasionally my concern is for my ongoing liver function though things seem to be getting better as the day goes on and I have taken some supplements I will start to feel pressure in the middle of my back kidney area and left flank discomfort it tends to have gone away by the time I wake up in the morning on looking at my labs the markers for liver function have fluctuated but my primary care doctor never made mention of them is there anything you can tell me about what the changes in these ratios say",
        "input": "",
        "output": "hi I have seen your blood works it is all normal usually during the acute attack of gout we do not start allopurinol or uric acid decreasing medications as it can exaggerate the situation we usually start after the acute situation is treated with drugs like nsaids non asteroidal anti inflammatory drugs allopurinol is started with caution if there is liver disease kidney disease diabetes congestive heart failure and high blood pressure are you pregnant or breastfeeding are you receiving chemotherapy drugs allopurinol can decrease the number of blood cells in your body that causes blood clot and that help you fight infections which can make it easier for you to bleed from an injury or get sick when exposed to others who are ill it can increase liver enzymes to decrease the blood elements but I have seen your blood works and it is fine if someone has kidney stones due to increased uric acid or recurrent gout episodes or uric acid deposition on soft tissues that is the time usually allopurinol is started and continued I think you do not have these problems you need to decrease your protein intake like less meats fish lentils eggs and avoid diuretics which are used to treat high blood pressure alcohol intake to be reduced as well you told your hba1c glycated hemoglobin is 7 that is pre diabetes or borderline diabetes so better check your fasting sugar and sugar after two hours of eating you need to do exercise even if it is just walking for one hour daily stop or reduce carbohydrates especially sugar in tea and sugary juices bread rice pasta and potatoes intermittent fasting can also help in decreasing weight and controlling sugar lifestyle modifications can help a lot in your case have you done any ultrasound abdomen"
    },
    {
        "instruction": "hello doctor I have noticed some alopecia on my beard it has been there for the past few months I have never had any issues like this before and worried that the hair will not grow back is there anything I can do I am currently taking hydrocortisone for dermatitis in private area",
        "input": "",
        "output": "hello I can understand your concern according to your statement you have alopecia on beard it has been there for the last few months and you are on medication like hydrocortisone for dermatitis you may be suffered from alopecia areata which is a peculiar form of hair loss that usually affects the scalp but can occur on any hair bearing skin like your beard for most patients the condition resolves without treatment within a year but the hair loss is sometimes permanent the cause of alopecia areata is probably an autoimmune reaction this means the body immune system incorrectly attacks the body own cells in case of alopecia areata the cells under attack are in the hair follicles structure that grow hair especially follicles within hair bearing skin alopecia areata can be resulted from autoimmune disorders such as atop allergy thyearoiditis vitiligo etc even some studies show that stress family history of alopecia vitamin deficiency like biotin vitamin a d etc nutritional deficiency like iron zinc protein etc can also cause alopecia areata for the treatment of alopecia areata you can use intralesional corticosteroids injections topical minoxidil anthralin cream or ointment and topical corticosteroids by using any of the above mentioned medication and taking vitamin and nutrition that are mentioned above you can get rid of alopecia areata within some months"
    },
    {
        "instruction": "hi doctor I am 27 weeks pregnant and have been detected with high sept 17 I have full body itching which is getting worse and my doctor has prescribed me udiliv 300 my five times a day for one month is it safe to take udiliv 300 my five times",
        "input": "",
        "output": "hello based on the description you mentioned it appears that you have this condition called intrahepatic cholestasis of pregnancy icp which can cause elevated liver enzymes or bilirubin along with itching but however it is important to rule out other causes of elevated liver enzymes got sept all like hepatitis help syndrome of hemolysis elevated liver enzymes and low platelet count each condition can have different implications in pregnancy please check for your blood pressure records platelets count coagulation profile viral markers hbsag anti hav he egg and i'm it would have been good if you could share the reports of your liver function tests and ultrasound abdomen for liver and also given details about any other symptoms you have faced like any stool or urine color changes skin or eyes color changes any fever any raised blood pressure records or any skin rashes excluding that caused due to scratching because of itching and yes udiliv is totally safe in pregnancy and has shown to improve the symptoms and also the level of liver enzymes in icp please take vitamin supplements to avoid any coagulation defects"
    },
    {
        "instruction": "i have schizophrenia and am on medication my query relates to how much of medication to have that it has least impact on my professional life my earlier symptoms related to auditory hallucinations and these were handled through medication and a visit to the rehab for months last year I am currently consulting a doc but he is unavailable during these times and I would like to change my doctor too I am six feet tall and 87kg in weight I was first diagnosed as a schizophrenic some years ago the medication I am taking are asprito 40mg olimelt 10 my and diva od 750 my",
        "input": "",
        "output": ""
    },
    {
        "instruction": "ten days ago I was eating some soup when some got under my tongue and I felt a sudden sour twang through the right side of my mouth and jaw it gradually subsided in intensity and I examined the inside of my mouth for any tender areas or asymmetries under my tongue there was a very slight swelling of my submandibular duct on the right side but no tenderness or anything strange palpable later that night I was eating some chips when I noticed rapidly increasing discomfort in my right jaw earache and pain when swallowing I felt my throat and discovered a golfball sized swelling under my right jaw on the advice of my father who said it sounded like a blocked salivary gland and said he recently had one as well I used warm salt rinses and external warm compresses within a short period of time the swelling reduced by about half and with repeated rinses gradually reduced over the next day until it was minimal since then I have still had a palpable asymmetry when feeling both sides of my jaw and my submandibular gland has not returned to its ordinary size last night I felt discomfort in that area and realized on examination that it was beginning to swell again I quickly used more salt rinses and a compress and the swelling stopped but it remains a bit more enlarged than it has been over the past few days this morning it seems to be fluctuating slightly in size but I hit it with more salt rinses and compresses and it appears to be stable for now though with a slight referred earache the submandibular duct has not seemed particularly swollen since shortly after the first day of symptoms when I noticed a small white spot forming at the head of the duct which disappeared shortly after using salt rinses I infer that this may have been a very small salivary stone pushing its way out I have been eating and drinking somewhat infrequently for the past few weeks due to a major housing disruption that has only recently been resolved so it is my hope that due to a combination of dehydration and infrequent stimulation of the salivary glands I may simply have developed some small salivary stones that could resolve on their own if I am diligent with salt rinses and compresses at no point have I had any sort of fever or foul taste in the mouth nor any symptoms in any other salivary gland besides my right submandibular gland I also recall eating some hard sharp food 10 days ago that had cut my gums here and there through miscalculated bites so it also seems possible that I traumatized the duct at that time although it is strange to me that swelling would be recurring now after relative reduction of symptoms for over a week though as I noted the gland has never fully returned to a non palpable size even at its best I suppose it must sound like I have self assessed the situation reasonably well but due to the recent resurgence of symptoms which I confess may be due to getting lax with salt rinses or proper hydration I just wanted to seek some qualified medical advice as to whether I am doing the right things so far and at what point I should seek treatment if it does not completely subside the only local ent is not available by referral for 10 months so my only alternative would be to go to the er for assessment or attempt to find a general practitioner in the area we just moved here so we had to leave our old go behind both options are bad for exposure given the current pandemic and my wife is a very high risk individual so I am doing my best to limit exposure unless I cannot help it thank you for listening and for any advice you can lend",
        "input": "",
        "output": "hi you have assessed the condition in the best manner any patient could do so considering the problem out there like you have rightly put it looks like we are dealing with an infected gland sialolith or a traumatised duct in all three cases I suggest you to follow the advice mentioned below hydration is the key keep drinking to litres of boiled warm water every day whether your thirsty or not salt water gargles to 10 times a day for month will definetely go a long way you can consider antibiotic clindamycin 300 my three times a day for days this antibiotic has the property of getting excreted majorly through the alive and majorly reaches the salivary glands a shade more than other antibiotics please eat on time spicy oily and junk food have to be avoided at all times for the next one month an ultrasound of the glands is definitely mandatory to see if there is any impacted stone parenchymal issue etc but to be done only once the pandemic subsides considering that you should not be going to hospital for risk of acquiring an infection this will take a while for it to subside but chiefly depends on how much you happen to follow the above advice hope this helps get well soon"
    },
    {
        "instruction": "hello I had a pilonidal surgery with the cleft lift procedure done an year ago a week or two back I had a slight pain the same region on my lower back and it was a pimple not a big one but just a small one it looked the same I felt like it was filled with pus so I found some home remedies a paste made of baking soda aloe vera turmeric and apple cider vinegar I applied it for on the area and left it to sit for like 2 his everyday it worked wonders and the pimple almost dissapeared today after like days after it had healed I saw that the area was red and a bit too red on two spots im not sure what it is so im concerned im guessing it might be infected or something im not a doctor so I dont know hope you can help me out here coz I dont want another surgery",
        "input": "",
        "output": "hello do not worry I will help you regarding your problem you underwent surgery for pilonidal sinus year back now you have or pimple at the same site that may be due to infection of that local area I will prescribe you some medicine please maintain local hygiene shave your hair of that area get back to me after two days I will add some more medicine and local remedies pilonidal sinus sit bath in luke water with betadine times in a day tab augmenting 625mg ads for days tab chymoral forte ads for days tab serradic be for days cap a to od for 10 days"
    },
    {
        "instruction": "my dad is 57 years only and he is a diabetic months back he was experiencing ear discharge and visited an ent specialist and was diagnosed with an hole in the eardrum he was given medication but the discharge hasn't stopped yet now is not able to hear from the left ear why is this happening is it serious is it curable",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hi doctor can ginseng be taken along with antiseizure medicine like valparin I have been asked by my fitness trainer to take ginseng to increase stamina and immunity please suggest me",
        "input": "",
        "output": "hello revert back with answers to the above question to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I had my hemoglobin abc and iron test the result indicates that I have low hemoglobin however my iron level is normal 122 I am confused to take the next step I have been eating spinach beans and red meat also I am taking iron supplements what to do further please suggest me",
        "input": "",
        "output": "hello revert back with your blood report to a hematologist online"
    },
    {
        "instruction": "hi doctor I am a year old male I have been suffering from social anxiety for the past one year although I was extremely shy as a child and up to about 25 years of age after that I overcame my social anxiety and became confident I managed somehow not to care about other peoples opinion about me I could convince with almost anybody because I ignored what the people think or say but for the past one year I have lost my ability to ignore what other people think or say and I have started to value their opinions about me rather than my own opinion about me I have become self conscious shy and quiet I am not feeling depressed or sad but this feeling has made me extremely unproductive and I just think what others think about me my past medication is olanex for the social anxiety please recommend some other medications as this condition has been disturbing my social as well as professional life and my colleagues have started to make fun of me",
        "input": "",
        "output": "hi I have read your query and understand your concern social anxiety disorder is really a disturbing condition but can be controlled with proper medicines and behavior therapy anxiety disorders occur in episodes and sometimes follow waxing and waning course you had anxiety before 25 years of age and the anxiety relapsed since last one year the feelings that people are judging you ideas that what others will think or say self consciousness are typical symptoms of social anxiety feelings that you are good for nothing and unproductive are due to co morbid depressive symptoms of social anxiety do you have anxiety during a presentation or in group discussions do you feel shy or stutter while talking to some person of big stature or any problems in talking to females in severe social anxiety such type of anxiety situations is also seen medicines especially selective serotonin reuptake inhibitors saris are drugs of choice for social anxiety I suggest you to use escitalopram drug the drug is started with my dose for about 10 days and then can be increased to 10 my the drug should be taken in the morning after meals and should be used for about three to four months after four to six weeks the dose can be reduced gradually I suggest you to use propranolol for anxiety provoking situations the drug can be taken about half to one hour before some situations like presentations or group discussions consult your specialist doctor discuss with him or her and take the medicine with their consent these medicines will definitely help in improvement breathing exercise and relaxation exercises will help you to control anxiety apart from this relaxation exercise behavior therapy also helps in reducing the symptoms revert back with answers to the above questions to a psychologist counsellor online"
    },
    {
        "instruction": "hi doctor I have attached my blood report here for your reference please have a look and give me your suggestion",
        "input": "",
        "output": "hello revert back with answers to the above questions to an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I have moles under the nails of each of my big toes they appeared over the last months but I do not remember exactly when the one on my left toe is a round dot in addition to a diagonal line next to it and that goes to the right edge of my nail while the one on my right toe is just a round dot the nails themselves are also somewhat cracked and do not look good I am wondering if there could be cause for concern I am sending a photo of my toe please help me",
        "input": "",
        "output": "hi revert back with answers to the above questions to a dermatologist online"
    },
    {
        "instruction": "hi doctor I am a 45 year old male I had an accident before 10 years at that time my knee ray was done and I was reported to have osteoarthritis I have been suffering from pain for few years I have lower back pain and pain in some of the joints for the past few weeks I have pain in my left palm particularly in my finger joints and more on left middle finger joint also on my foot joints I also feel very fatigued and tired my blood pressure be was 10 70 mhg a week back I am enclosing a comprehensive blood test report which was done very recently and I have advised to take tablet nusam 400 for six months I have been taking for the past two months please suggest me the remedy and preventive measures",
        "input": "",
        "output": "hi vitamin deficiency and autoimmune cause ultrasound abdomen and pelvis rheumatoid factor mri of spine with sacroiliac joint and mri of the whole spine screening and ultrasound of hands to look for active arthritis hbsag hepatitis surface antigen and hav hepatitis virus seronegative spondyloarthropathy rheumatoid arthritis seronegative spondyloarthropathy calcirol sachets vitamin 600 units once in a week with a glass of water for six weeks and tablet doll 650 my acetaminophen for pain avoid alcohol and excessive weight lifting also try to avoid painkillers as your liver functions are abnormal for further information consult a rheumatologist online"
    },
    {
        "instruction": "hi doctor my vitamin level is good and all my blood reports are fine but why am I getting body pain even I sleep for seven to eight hours and still I do not feel fresh I always get the feel to sleep more I took ibuprofen but it does not work it disturbs me in sleeping most of the time pain in lower legs hands and shoulder does not go away do I have cancer in my body and it spread to my bone marrow and result in body pain do I have any cancer in my stomach or pancreas do I have any blood disorder or autoimmune disease or any cancer like leukemia lymphoma or non hodgkin lymphoma in my body also I do not have a fever or cough I do not experience any weight loss I feel tired all the time and feel vomiting after eating please explain my problem and the treatment",
        "input": "",
        "output": "hi based on your query my opinion is as follows thyearoid function tests and serum calcium if they are normal then lifestyle modifications lifestyle modifications for further information consult a hematologist online"
    },
    {
        "instruction": "hello doctor I have an ear infection for about two years but now my ears hurt very badly and feel like they are closing up please help",
        "input": "",
        "output": "hi welcome to iciniq com the reason for a chronic ear infection can be due to two reasons there is an abnormal permanent defect in your eardrum such a hole which has not closed up due to the normal healing process leading to recurrent ear infection and discharge in some cases superadded fungal infection might also be present causing itching and pain a dysfunction in your eustachian tubes which basically equalize pressure between your nose and your ear in both scenarios you will feel blocked ears ringing sensations heaviness and decreased hearing would certainly be there follow these steps you have to maintain adequate ear hygiene not allowing any foreign substances such as outside air or water to enter into the ear and thereby creating a recurrent infection do not use tips as they worsen the existing problem by introducing more disease since the tips are often not sterilized get your self examined by an ent specialist to see what exactly is happening in your ear and the probable cause of the problem I hope this helps"
    },
    {
        "instruction": "hi I had miscarriage then abortion in hospital a year back after that till now I have periods every month same timing like 26 days but no bleeding at all only thick brown discharge drops in a day and it only lasts days I used to have very heavy 6 days periods I am 37 years old I done all tests with doctors no internal external uterus tests nothing found then doctor suggested me to me take contraception pills for months for thinning lining doc said it may be because of it but after months treatment of contraception pills nothing improved what I can do thanks",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hi doctor our close family member has leprosy should we need to take met please explain",
        "input": "",
        "output": "hi I want to share few facts about leprosy for further information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor my mom is 65 years old her blood pressure is 180 90 mhg she is suffering from urine infection and her serum uric acid is 6 my do I have attached her other reports for your reference she is currently on norflox 400 twice daily ciploric 300 one tablet daily at night thelma am one tablet met al 50 and alkasol liquid two teaspoon thrice daily please help",
        "input": "",
        "output": "hi for further information consult a criticalcare physician online"
    },
    {
        "instruction": "hi doctor I am a 25 year old male I have been dealing with erectile dysfunction for nearly three years now my sex drives do come and go but it is based on the quality of my semen comes out sometimes I have a good sex drive along with a good hard and my semen will come out rich white and a normal amount of it but those days when I have trouble in getting hard on along with low sex drive semen comes out with a little tint of yellow also my penis is not fully hard not as sensitive and aroused I have dealt with anxiety but later I have been fine but this problem is not getting much better nor getting worse this problem started three years ago in the past one year I am also getting some throbbing pains in the vas deferens I am not too sure of the area because it is hard to pinpoint I feel a pain from the bottom near my testicles to my abdomen and sometimes slight pain in the prostate area it is a pain that I can feel enough to dismiss it and move on I know I should get checked but first I would like to get an opinion from a doctor thank you",
        "input": "",
        "output": "hi your descriptions are absolutely right for further doubts consult an andrologist online"
    },
    {
        "instruction": "hi doctor I am a 25 year old male I am scared of turning into a gay or homosexual in the past I had senseless and intrusive images popping in my head that I am kissing a guy whenever I used to be with my male friends I never felt an attraction towards any guy it happened six years before but never thought about the reason this thing stopped when I asked about this issue to a doctor and he said it as ocd everything was fine for over six to seven months but when I over think about why I am getting those images in my mind then the thing gets worse I check every time when I see a guy whether I am attracted to him or not indeed it sounds like I have gone mad in my office there is a guy who is very attractive but when I fantasize him just to check whether I am normal or turning into a gay I feel weird but I cannot stop myself looking at him I envy him too because I always wanted personality health and voice like him whenever I see him I feel something different as if I am looking a girl I am scared now please help",
        "input": "",
        "output": "hello after analyzing your current complaint and taking into consideration your previous history I am of the opinion that your current symptom is also a symptom of obsessive compulsive disorder ocd an obsession is an automatic repetitive intrusive and senseless thought or image which pops into a person mind your previous symptom of seeing images of kissing a guy was an obsession a compulsion is an action that you cannot resist doing despite knowing that it is senseless and should not be done your current symptom is a compulsion obsessive compulsive disorder cognitive behavior therapy anti ocd medications like fluvoxamine or clomipramine for further details consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor I am having rough period I am worried about my health and about breast cancer as I have fatty breast albeit rare in men also I had undergone ultrasound before seven months and everything was normal before a couple of days some little red marks had appeared in my chest when I press that I feel a tiny bump really close to the surface of the skin but no pain at all what is it please explain me",
        "input": "",
        "output": "hi for further information consult a general practitioner online"
    },
    {
        "instruction": "hi doctor I have red bumps on hands lower back and legs it is also itching a lot in some body portion blood patches had happened due to itching for this itching estrogen liz and locate are used as current medication but no use I am going for liver function test as soon as possible are injections safe to use during pregnancy for severe skin itchiness please help me",
        "input": "",
        "output": "hi I have gone through the pictures for further information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor my son is 20 years old he is tired fatigued and unmotivated for two years since from the childhood he has been troublesome and different from his siblings but he was friendly and loving at that time he had the habit of bedwetting till the age of to it seems that he has add as I go through the symptoms on the internet but a psychiatrist said that he has ocd my son has been disinterested sleepy unmotivated tired moody frequently emotional and angry he quit the college and lost two jobs due to inefficiency he loses interest very quickly and generally lacks enthusiasm he would like to sleep and watch movies all day he goes out to play some days and does not seem to have any close friends we have been trying to get him to see a doctor for over a year finally he came to us and said that he knew he has add he read some stuff online I took him to a psychiatrist the same day and doctor saw him for privately for 10 minutes and said it as ocd he prescribed solotik 50 my and xanax also doctor prescribed vitamin tablets he is not a dwarf but of shorter stature compared to me and his brother also for this he had thyearoid test when he was very young but when he agitated about this we left him should he continue the same medicine please suggest me",
        "input": "",
        "output": "hello please describe his symptoms in more detail to help in making diagnosis of ocd obsessive compulsive disorder in general patients with add have high energy and they tend to be impulsive for further information consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor my father is 50 years old he has swelling in left knee and some liquid is coming out of the knee he consulted an orthopedic doctor and he prescribed some tests and medicine to him also the doctor said his bones are weak please explain me what should I do know also let me know whether my father is taking the right medicine or not what should he do according to you and about doctor comment on weak bones also how to cure that should he massage with hot water bag or ice I am attaching the photos of my father knee and prescriptions please guide me for the next step",
        "input": "",
        "output": "hi revert back with the ray report to an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hi doctor I am a 36 year old male I have been having itchy rashes and white layer on my penis with burning sensation since 20 days the symptoms subsided with dettol hand wash but again it reappeared please help me",
        "input": "",
        "output": "hello I have gone through your query and I have understood it for further information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor a chinese fir tree needle stuck in my arm it caused a red bump or rash on my arm the infected area has spread and has grown it is itchy and burning I am taking epipen injection for my mushroom allergy I had two benadryl tablets and hydrocortisone for the rashes please help me",
        "input": "",
        "output": "hello I have gone through the details quoted for further information consult a general medicine physician online"
    },
    {
        "instruction": "hi doctor I took one I pill yesterday morning at am and then had an unprotected sex at am do I need to take another pill what is the side effect of consuming I pill twice what is a regular birth control",
        "input": "",
        "output": "hi for further information consult a sexologist online"
    },
    {
        "instruction": "hi doctor my teeth are very translucent I do not know the reason is there a medical reason for this I never smoke and rarely drink are there supplements that I can take to remineralize them would that help",
        "input": "",
        "output": "hello for further doubts consult a dentist online"
    },
    {
        "instruction": "hi doctor I am a 30 year old female actually I have hormone problems I have periods problems and without medicine I will not get periods my uterus and ovaries were smaller in size now with artificial hormones the size of the uterus has become normal can I get if will it be successful",
        "input": "",
        "output": "hi revert back with the answers to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I am 25 years old one night when I tried to go off to sleep I had racing thoughts that I had no control over I did not hear any voices just thoughts I could not track them or process them I was really scared as a result this phenomenon has been happening whenever I try to go off to sleep or wake up from sleep now very recently I moved abroad I felt extremely depressed and stressed about this I started having sleep problems all of a sudden being a hypochondriac I thought this must be something fatal this led me to be stressed anxious and depressed I have been searching on the internet obsessively for five months and I came across schizophrenia I was terrified ever since then I started searching for schizophrenia obsessively and my symptoms worsened I thought I started to hear voices after reading about them but actually at most they are silent thoughts that occasionally mock me I have random words pop into my mind at odd occasions after reading about paranoias I seem to be developing them too I get scared or threatened by people for no reason I am more concerned about the fact that why am I getting scared of people rather than actually scared of them I feel extremely detached from reality like I am just going through the motions I am extremely tired and sleepy throughout the day my appetite has declined completely I cannot do anything I visited four doctors and all told me that I have extreme anxiety and depression can anxiety and depression cause these symptoms can being a hypochondriac lead to this when I talk to a friend on the phone I have an engaging conversation laugh and cheer up and then I think should I feel threatened by him am I losing control I speak fluently and I go about my activities fine most of the symptoms that I have developed have been after I got to know about the symptoms on the internet and obsessed over them I constantly cry about what has happened to my life and why did this happen to me so what is happening to me moreover these symptoms come and go in 10 days",
        "input": "",
        "output": "hi I read your query with keen interest and understand your concerns first of all I must assure you that there is no evidence of disease called schizophrenia in your case schizophrenia is often presented with different kind of prodromal symptoms and they do not match to your current symptoms having said this the symptoms are more indicative of anxiety disorder with added obsessive and compulsive behavior this is more likely as you are already suffering with hypochondriasis which is again a disorder from same spectrum of psychiatric disorders like obsessive compulsive disorder I also like to inform you that stress anxiety and depression can present with symptoms mentioned in the query and there is no doubt about that for your clarification worsening of symptoms and spontaneous remission of symptoms are indicative of obsession rather than psychosis such as schizophrenia in my opinion it is time for you to engage in therapeutic process rather than moving from one doctor to another as constant approach will bring out the positive outcomes for further information consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor I am 34 years old I always have regular periods with a 28 day cycle I have pregnancy like symptoms for the past two weeks I feel nausea cramps strong smell etc actually my period was ahead of due for the past 15 days I have very light watery bleeding started and is still on it is not heavy at all and not like my usual periods is this pregnancy or any other issue",
        "input": "",
        "output": "hello I had gone through all the data posted based on your symptoms pregnancy is a possibility but as you said your periods are due now you can wait for another four days if you did not get periods then do a urine strip test for pregnancy at this time no one can confirm pregnancy even if you go for a hospital visit and even with ultrasound the urine strip test will tell us the answer and we need to wait for another four to five days once the urine strip test is done then we can decide further course based on its report for now kindly avoid unnecessary medications take proper diet and rest for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I am 32 year old female my past medical history includes rosacea 15 years perioral dermatitis years melasma and hyperpigmentation in the upper cheeks for three years and add I am currently under noritate occasional elidel during flare up and adderall 5 my daily my hyperpigmentation on my upper cheeks has been progressively getting worse over the last several months the pigmentation is well demarcated with areas of normal skin I work indoors and the most sun I get on a daily basis is my short 15 minutes car ride from home to work I cannot pinpoint the cause of the hyperpigmentation and melasma I am not on any type of birth control and do not believe the source to be hormonal I am hesitant to try lightening agents as I have had adverse effects in the past I am going to trace back the pigmentation for you and maybe you can help me out before three years I applied noritate and diana to my face my skin in general was fine I had only one area of pigmentation on my face right side of face inch as that was noticeable I asked a dermatologist if there was anything that I could do to lighten it she gave me tri luma I decided to put the tri luma on the affected area and also a few freckles on my upper cheeks the next day I became extremely red and out of fear of triggering my rosacea I dropped tri luma immediately then after a month I stopped taking diana because I moved back to a colder climate and my face was getting too dry after some eight months the area of pigmentation right side of cheek was started getting darker so I decided to give another try for tri luma I again applied it to the larger area of pigmentation and to the tiny freckles on my upper cheeks the decision to apply it to the freckles was purely a cosmetic decision the next day those freckles turned into full blown pigmentation I immediately stopped the tri luma and the pigmentation in those areas has basically been there up to present day at that time a local dermatologist had suggested me to apply some cortisone cream to the areas to lighten them up the pigmentation subsided very minimally I did not apply the cortisone cream thereafter the pigmentation from this point waxed and waned in intensity up until two months back then it has remained prominent there were a few times during this two year span where my perioral dermatitis flared up and I was told to restart diana which also made the pigmentation worse I was unsure whether the diana was bringing the pigmentation to the surface or whether it was in fact making it worse I went to two dermatologists who had differing views of stop diana and keep using diana I decided to stop as it appeared to be getting noticeably worse again I do not know if this was a whole process of bringing the pigmentation to the surface or not please share your thoughts",
        "input": "",
        "output": "hello well here I discuss everything one by one for further information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor I am a 74 year old male for the past two years I am house ridden but not bedridden yet I feel tired after walking a mere half a kilometer I walk with the help of a walking stick because I lose balance while walking sometimes I feel orthostatic hypotension I consulted a cardiologist a pulmonologist an endocrinologist and a urologist cardiologist took an egg and an echocardiogram he ruled out heart trouble even though I had undergone aortic valve replacement six years back pulmonologist asked me to take a thoracic it scan and did not find any significant malignancy of the lungs urologist who 10 years ago diagnosed me having gu aft and cured me with a six month course of aft treatment ruled out recurrence of aft in gu area endocrinologist prescribed various tests like serum cortisol test thyearoid test act test and ruled out addison or cushing disease last week when I was going through those records I read in the thoracic it scan report that my right adrenal gland has hyperplasia on the internet I found that hyperplasia means growth of additional cells since the previous it scan was one and a half years old I decided to have another it scan of abdomen to find out the condition of my right adrenal gland hyperplasia I knew that I cannot have an mri scan as I had a replaced aortic valve the radiologist had my serum creatinine tested before administering me with the liquid necessary for contrast the new it scan report appeared to me as a death sentence the report did not find any change in adrenal hyperplasia but the report of my kidneys appeared to be concerned I consulted a nephrologist in a renowned leading hospital in my area he did not prescribe any treatment for me at all he even chastised me for taking a it scan telling me about the radiation effect of the scan and effect on kidneys of the contrast liquid he asked me to come back after six months after thinking about it for the past one week I have come to the conclusion that the honorable doctor decided that my kidney condition is terminal and it is futile to prescribe anything as I spend lots of time surfing on the internet I had a whim of having a second opinion online",
        "input": "",
        "output": "hi please attach all your it reports and your blood profile for my best opinion thanks revert back with the reports to a nephrologist online"
    },
    {
        "instruction": "hi doctor I have dealt with leg swelling fairly constant for the last 10 years the bottom of my legs including my ankles and feet are swollen every day they have turned very dark the discoloration was happening for about the last five years and has gotten worse over time basically it will not respond to any type of moisture so that the area is always dry I am overweight but not diabetic the only medication that I am taking currently is coumadin because I recently had a blood clot in my right leg however it is my left lower leg that has the most swelling and discoloration how can I heal the skin that is damaged due to poor circulation",
        "input": "",
        "output": "hi I have read your concern overweight prolonged standing color doppler for venous insufficiency stasis dermatitis lichen simplex chronicus stasis dermatitis keep the area clean with soaking in solution of potassium permanganate in 10 dilution apply good quality moisturizer twice daily and apply propysalic of combination of clobetasol propionate and salicylic acid lotion once daily for two weeks consult your doctor discuss with him or her and take the medicine with consent put a pillow underneath your feet while sleeping avoid prolonged standing and try to reduce your weight revert back after a month to a dermatologist online"
    },
    {
        "instruction": "hello doctor I am trying to get pregnant for a year now so far it has not been a success and the main reason is I have irregular periods and difficulty tracking my fertile window I have been tracking my ovulation this month and according to calculations this week I should be ovulating so this whole week I kept checking my cervical mucus and did some ovulation tests the last five days my ovulation tests all came back negative until today I saw only a faint line but from here I got very confused the reason is according to my knowledge if you reach your ovulation your cervical mucus should also change to a watery slimy or egg consistency when I check my mucus it is grainy and white which probably refers to yeast infection but I have no other symptoms no burning feeling or any itching or bad smells just white grainy mucus does this mean I do have a yeast infection even though I have no other symptoms can this affect my chance to get pregnant",
        "input": "",
        "output": "hello welcome to iclinq com yeast infections are usually associated with symptoms like itching or pain the description of the mucus looks more like an ovulatory discharge the discharges are not always bookish it varies with individuals and patterns may have some changes during active sexual life so do not worry and have regular intercourse during this time as it is the fertile period generally timed intercourse adds stress to both partners so have casual stress free sex it actually makes wonders I hope this helps ovulatory discharge ovulatory discharge"
    },
    {
        "instruction": "hi doctor my daughter has skin irritation near hands in the joining area after itching she gets blood in that area and at night time she is having itching on her whole body and she has dry skin my daughter is years old and she is a thyearoid patient please suggest solution currently she is on erythromycin and lecope",
        "input": "",
        "output": "hi kindly attach the pictures of the skin problem and old prescription the picture you sent is that of blood soaked cloth how much is her thyearoid level is she taking eltroxin is she having wheezing or dust allergy send me the pictures of the hand and joint"
    },
    {
        "instruction": "hello doctor patient is a 61 year old female six months ago she was diagnosed with bone to and undergoing medication ethambutol rifampicin and isoniazid after six months of usage her eye vision is suddenly diminishing then her doctor told to discontinue ethambutol immediately and started using some b12 1500 my injections on alternate days after one week they started steroids just to rule out if there might be any optic nerve inflammation we have done mri and the findings are below tiny flair hyperintense foi in the frontal and parietal and white matter small vessel ischemic changes widened perioptic csi space to hyperintense signal is seen in the chiasm and optic tract kindly suggest what to do",
        "input": "",
        "output": "hello I passed carefully through your question and reviewed your uploaded mri magnetic resonance imaging report I would explain that these mri findings to hyperintensity in the optic nerve and the optic chiasm are indicative of optic nerve inflammation neuritis which could be related to ethambutol adverse effects the troubles with vision are a clinical sign of optic neuritis too so considering that there is a correlation between radiological and clinical findings I would conclude about optic neuritis and would recommend to stop ethambutol as soon as possible in order to avoid possible blindness I hope this helps"
    },
    {
        "instruction": "hello doctor I am a year old female I am concerned about a lump on my genital area and I am very worried it is a wart I have had this problem on and off for about eight months now I also have vaginal itching soreness and discharge I visited a sexual health clinic and they said it was not herpes but I am still suffering with the symptoms and the lump seems to have grown please help",
        "input": "",
        "output": "hi please provide me dome details do the blisters appear first then this type lump is it painful does every time you get only one such lump or multiple also do you have any fever have you noticed small blistering anytime it will help me figure out your problem for time being it is difficult to conclude it as a wart but if you give the above information then it will be easy to conclude serum i'm and egg for hav herpes simplex virus and if possible serology for hav human papillomavirus follow up with details"
    },
    {
        "instruction": "hi doctor this is a bit of an awkward question for me as I have never talked about it before but I have been worrying about the condition of my prostate if I masturbate or just ejaculate for that matter I get a very harsh pain more than once in about 24 hours period which I believe to be in my prostate it is in the same place every time and it can go on for quite a while and even come back multiple times throughout the day I am just turning 20 I am very active and healthy so something like this has harmed me physically and psychologically please help",
        "input": "",
        "output": "hello you need to understand that painful ejaculation both during masturbation or intercourse is mostly due to infection or inflammation of the sexual tract such as seminal vesicle prostate urethra or with the use of certain drugs sometimes it can be due to psychological causes with the partner I do not think you fall under later categories please answer some of my queries do you have intercourse before any relationship issues do you have hematospermia blood in semen anytime any surgeries in childhood any testicular swelling or ti urinary tract infection in the past any foul smelling discharge from urethra any other urinary symptoms such as frequency urgency poor stream nocturia dribbling burning micturation are you a diabetic though I still believe that your symptoms are due to inflammation of sex organs but above questions will help me to reach a proper diagnosis"
    },
    {
        "instruction": "hello doctor I am a 35 year old male I feel pressure and a sort of burning sensation in my food pipe my very first symptom occurred in the form of trapped burp in the chest last month I had a bit of bulgum alongside which I keep throwing out I took pan 40 for two weeks and stopped thereafter as it was not doing much wonder I consulted one doctor online he suggested me a five day course of medicines rifagut 50 librax and radium dsr I started feeling better in the due course now it has been two days there have been mild symptoms like burning and pressure feeling in the food pipe post taking meals kindly suggest what to do",
        "input": "",
        "output": "hello your symptoms sound more of a problem known as gastroesophageal reflux disorder which is due to reflux of contents into your esophagus from your stomach have short frequent meals do not overload yourself have a walk after meals and do not directly lie down cut down your intake of coffee and alcohol I would suggest you to continue a couple of medicines that will make you feel better"
    },
    {
        "instruction": "hello doctor I am having a lot of pimples on the scalp pimples are with white pus there is a lot of pain and a lot of dandruff along with this what should I do",
        "input": "",
        "output": "hi you seem to be having scalp folliculitis which is an infection of your glands on the scalp it can sometimes be related to dandruff in which case scalp pustular psoriasis has to be ruled out you need to reduce your sugar and milk or milk product intake reduce eggs and red meat folliculitis can sometimes be recurrent which would then require a long term treatment I need to know if you are on any other medications have any known drug allergies or other health issues so as to give you the right treatment in case nothing of these are there you can take tablet minor 50 my minocycline at morning and night after food along with tablet oflox 200 my at morning and night after food you can use fusiscalp lotion at morning and night over the scalp and wash your scalp with tarscalp shampoo"
    },
    {
        "instruction": "hello doctor I am years old I have problems with my penis it is inches when erect and the foreskin is very tight and sometimes I feel pain while urinating are there any methods to increase the size of the penis",
        "input": "",
        "output": "hi coming back to your query I will let you know that the average penile size erect is 7 inches so your should be quite normal if you do not have difficulty with intercourse and your partner is satisfied then I do not think there is a need for any medications has a limited role and has side effects too if you feel there is phimosis inability to retract foreskin get circumcision done it is a very basic procedure and will let you to urinate better moreover there is no hygiene related problems after circumcision you can try some non invasive methods to increase the size and strength such as penile pump jelquing in this when penis is erect apply any lubricant oil around base of the shaft and milk towards the end it helps to increase in both length and girth try to shed some weight you can give a try of tablet tadalafil 5 my once a day for month and see the results it will not make you dependent so do not worry"
    },
    {
        "instruction": "my symptoms are that for the past day so or so I have had some congestion in my chest that comes and goes a few times a total of about hours in days very mild chest pain so I have been staying in bed and on tamiflu for a few days and 2500 my of amoxicillin since yesterday with mild improvement my other symptom includes that I get a bit tired if I walk more than minutes not had a fever chills cough or a sore throat and have not lost my taste or smell I am just paranoid about couid also I have had one incident of yellow drainage that came from my lungs as flew but more instance of clear drainage but only small ones I am also not fatigued and actually insomniac as I usual am sleep a few hours at night",
        "input": "",
        "output": "hi welcome to icliniq I am do anshul varshney for your help what we know about corona with current available experience is that it has presentation in most cases with dry cough and fever which may later turn into breathlessness fever has to be there in couid since you have had no fever cough is productive couid is virtually out you might be having allergic cough or some lower respiratory tract infection you are on amoxicillin which is a very good drug for respiratory tract infection however in case you have any recent contact with corona patient or there is a community spread in your area then you should get in touch with your doctor if he doubts he would get you tested for couid or you can request him for a chest ray as well as complete blood count that would help in confirming so I hope it helps you and I wish you as well as the whole world a speedy recovery regards do anshul varshney"
    },
    {
        "instruction": "hello doctor I am having an allergic reaction on both of my feet it will start like fluid filled vesicle then it will get hardened and will start peeling off the skin there is an excess of itching in that affected area I had consulted a dermatologist and was told that it is contact dermatitis doctor prescribed me momate ointment for two weeks and asked me to change the footwear it did not subside after two weeks and then the doctor prescribed halovate ointment and levocetirizine for two weeks then also it is not subsiding it has been more than two months and still eczema is present and new areas on my foot are getting affected",
        "input": "",
        "output": "hi very itchy rash over the feet with fluid filled vehicular lesions is tina pedis vehicular type no response to steroids also confirms that contact dermatitis also mics it and bilateral also gives suspicion of dermatitis but you did not respond to steroids I can see some involvement of toe cleft please tell me are cleft involved how much duration since the start how it started like which area and which foot do you buy any new shoes or anything new when they started do you have wet work of feet often any other medical condition you have like do be etc renal or liver disease start the following treatment capsule itraconazole 200 my be after meals for three weeks terbinafine cream twice daily for three weeks loratadine 10 my once daily for itching for 10 days ke dusting powder avoid wetting or sweating of feet keep dry shoes in sun change socks daily fungus contact dermatitis antifungal keep dry after three weeks"
    },
    {
        "instruction": "hello doctor I am a 42 year old female I have a 12 year old son my husband is years old and is a heart patient who has undergone a cab 10 years back my husband is such a nice support and love to me my son is very smart and vibrant I try my best to be happy with them but I fail desperately my issue is I feel like crying very often I feel being hated by my friends and acquaintances I fell into a toxic relationship one and a half years back he betrayed me but I cannot let him go as I am so addicted and now I do not have any close acquaintances to turn up on I was under psychiatric treatment for the past one year I was put on fluvoxin 100 and decorate which I stopped due to weight gain now I do not want to be under medication some therapies or strategies would be better for me it seems please help",
        "input": "",
        "output": "hello you have clear depressive symptoms it happens due to reduced levels of certain neurotransmitters such as serotonin which reduce the stress handling capacity of the brain medicines help to replace chemical deficiency and correct the imbalance counseling will on augment or add to the effectiveness of the medicines but it cannot replace it I will give you one example in fever crocin paracetamol helps is given to this you can add cold water sponging which helps but you cannot replace crocin with sponging this is the exact same thing there are medicines which also help you not gain weight or are weight neutral you can ask your doctor for the same one example of such a dose plan would be fluoxetine 20 my and lithium 300 my and aripiprazole my also if you wish you can consult a psychologist for some sessions of cut cognitive behavioral therapy and undergo six to eight sessions online or locally"
    },
    {
        "instruction": "hello doctor my mom has a pretty severe case of shingles starting on the left side mid back and goes around to the belly she has been prescribed pregabalin and it is not helping they tried gabapentin and she has bad side effects from it we have tried compounded pain ointments ice cool water etc nothing is helping she is 74 with late stage cold diabetic and has osteoporosis severely as well is there anything else we can do to try to ease her pain she is bellowing out in pain every minutes",
        "input": "",
        "output": "hi shingles or herpes foster occur due to reactivation of chicken pox virus which hide in spinal nerve ganglion during childhood reactivation can occur in immunosuppression or old age thus it runs along a nerve in girdle like fashion it starts with fluid filled lesion which heal within unto weeks but nerve damage can give severe pain which may last longer it is called post herpetic neuralgia I hope there is no active fluid filled lesion if so kindly send a photo and renal function test report otherwise start so tablet pregabalin 25 my plus 1500 mug methylcobalamin tablet twice daily capsaicin or lidocaine patch application tablet tramadol if severe pain sos once daily calamine lotion thrice daily review after weeks it is sometime resistant other modalities like intraspinal steroid or botox injection can also be tried but let us fist see how this responds"
    },
    {
        "instruction": "i have been having stomach issues for almost years now when I was put on two rounds of back to back antibiotics for a bad tooth abscess I was put on augmenting and then clindamycin along with the use of motrin and tylenol as directed by my dentist since then I have had stomach issues including going to the bathroom more often feeling pressure when having to go to the bathroom occasional mucus in stool and more recently bouts of nausea bloating cramping and very smelly gas I have had various blood panels tried probiotics including vsl rifaximin diet changes and I am currently on viberzi which helped but made me a bit constipated tired bloated so I lowered the dosage to pill 100mg per day instead of which decreased side effects but also decreased effectiveness of the drug also it seems my metabolism has shifted after the antibiotics and I gained weight faster than I ever have and I am still struggling to keep my weight down after making significant diet and lifestyle changes any insight here into the weight gain and then anything else I could try for the stomach symptoms thank you",
        "input": "",
        "output": "hello welcome to icliniq I have reviewed your concern after taking antibiotics your gut bacterial composition has been changed and it has started to cause troubles for you weight gain is also seen in such cases since you have tried a lot of things and finally viberzi showing some results for you I am happy things have finally got some control for your concern regarding relatively rapid weight gain and metabolic shift is genuine I would say you are a good observant what further helps you to restore your gut bacterial composition is to opt for natural selection like food changes you have to avoid junk and bakery products as much as possible take lot of yoghurt natural probiotic and fruits increase use of vegetables avoid alcohol if you are taking continue exercise or at lease try to remain active collectively this will change the story you will feel better but definitely process is slow and it will take time so you have to exercise patience I hope you will find it super helpful give your feedback let us know after a week how you feel if we could do further for you we will definitely do but it depends how you take the things from here humble regards"
    },
    {
        "instruction": "good evening I have a month old daughter who fell off the bed yesterday at around 4pm I did not saw if she hit her head or how she hit her head I gently attended to her and looked for signs of any injury after making sure that there is no injury I started consoling her because she was crying uncontrollably when she stopped crying and calmed down she started being drowsy but I did not let her sleep because I was worried at around 30pm she vomited at 6pm she finally went to bed but I was still monitoring her after monitoring her for 24 his I noticed that her sleeping pattern changed and she cries very easily becomes angry easily and exhibits extreme emotions",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello I am writing an enquiry regarding my weight I am a 18year old female and I weigh 42 8kg and my height is 158 160cm I have been this weight since I was around 13 years old my weight has always been around 40kg I was wondering how I could gain weight in a healthy manner the main reason why I do not eat a lot is that I am not hungry so on some days I eat one meal in a full day however there are some days where I will eat meals including snacks however even on those days even if I feel as if I have had a lot of food my weight remains the same I am concerned as I have realised that I am well below my average age group in terms of weight and I am not sure what to do also I am not sure how much I should eat in a day because when I ask people around me I realise they eat less than me but maintain a healthy weight so I am really unsure how to approach my problem thank you",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello doctor I am 46 years old I no longer get my periods what are my chances of conception doctors say I am at menopause can I have a successful if",
        "input": "",
        "output": "hi the best age for a lady to get pregnant is 19 35 years the principle behind this is every day your eggs are growing and out of the cohort of eggs the best egg is selected and remaining growing eggs go for atrophy so by 35 years most of the good eggs are gone after that age too you have the chance of pregnancy but lesser than the age of 35 years after 40 years of age the chance of pregnancy further reduce as the age of lady increases the eggs left behind are not as healthy as the previous month so even if you get pregnant the baby is at risk of developing anomalies but if your period has stopped then you need to know if there are any eggs in ovaries you can have any of the birth control pills packet of 21 pills twice daily for 10 days no matter what the cause is you will have periods within 10 days on day or of the period do serum fish follicle stimulating hormone and am anti mullerian hormone fish miu my and am ng my means egg count is below normal the only option for pregnancy is if using donor eggs this can definitely be the best option to get pregnant I hope this helps"
    },
    {
        "instruction": "hi doctor I was diagnosed with endometriosis and had surgery last year now we are married for four years and I am not getting pregnant my age is 40 and my husband is 42 please suggest",
        "input": "",
        "output": "hello I understand it has been a year since your endometriosis surgery I am not clear if you have taken any treatment following that to enable conception from the limited information you have given me and assuming that your partner parameters are normal as you have not mentioned anything about it I will try to make my suggestions as age advances the maternal ovarian reserve comes down which means the number of eggs a female has come down endometriosis is a disease that not only affects the ovaries but later causes adhesions which also hamper your chance for pregnancy it is also notorious to recur putting all these together the chances of a natural pregnancy comes down though definitely not impossible but the medical advice here and the ideal thing would be not to lose too much time and go in for art procedures like if in vitro fertilization because once the maternal ovarian reserve becomes too low the chances of pregnancy in an if cycle also becomes less so it would be ideal not to waste time and think of approaching any of the if centers also I would like to add that this couid time is not the right time to start an if treatment though I hope this helps"
    },
    {
        "instruction": "hello doctor my mom is 67 years old she got exposed to a sudden loud noise from fireworks about a month ago and it caused loss of hearing to about 50 audiometry she started taking prednisolone three days after the incident and also some multivitamin pills but no improvement yet mixed voices or phone calls teases her ears and she can stand only for a few minutes I wanted to know if you have any recommendations are hearing loss pills or hear all pills effective",
        "input": "",
        "output": "hi welcome to icliniq com with age the hearing ability reduces for all no partiality that is called presbycusis in medical term moreover the loud noise added to the process of deterioration if she is diabetic and hypertensive those factors will add on to the deterioration process now coming to the point of using medicines please get it very clear these medicines can help improvement in hearing but that has no visible effect whether it is 50 do loss or 45 do loss the problem is all most the same right so without wasting further time kindly with the report go the audiologist and fit her with digital programmable hearing aids if both the ears are affected then both ears should be fitted to have balance hearing and to make hearing areas of the brain active in both sides of the brain"
    },
    {
        "instruction": "hi doctor I am a 30 year old male in the space of two weeks I developed an allergic reaction to three different foods peanuts shellfish and avacado I never had problems with either of these foods or any food for that matter before and this hit me very suddenly so far the reactions are mild just some minor tingling and flushing of skin particularly on my arms but they are significant enough to be noticeable I have always been into health and fitness and take a variety of vitamins and supplements though I am cutting back on those out of concern that they may have aggravated my immune system into producing this allergic response my questions are is it normal to develop an allergy to multiple foods simultaneously and what can I do to prevent the onset of any further reactions developing I am currently on memantine and adderall",
        "input": "",
        "output": "hi first of all allergic reactions to food are sudden and happen without any prior history it is very common for people to develop allergies yes it is common to have these kinds of food allergies some people have episodic allergies and they subside completely and for few people it stays no one can prevent an allergic episode in the future it is your genetic system that has caused this you should always keep anti allergic tablets steroid tablets and always have a back up to get a steroid shot for allergies because sometimes these might range from basic skin rashes itching and flushing to life threatening spasms hence should always be careful when you consume the above foods next time keep observing for symptoms I hope this helps"
    },
    {
        "instruction": "help doctor I am a male I have discovered a lump in my right chest area just below my nipple it appears to be roughly 5 am in diameter movable against all surrounding tissue and it feels smooth even shaped and firm but not hard rather elastic no pain no visible changes from outside I am 49 years old and have the following established preexisting conditions like hashimoto slight hypertension migraines since childhood and some allergies I do have recurrent episodes of polyuria for many years that were diagnosed as stress related some years ago after all differentials had been excluded a blood panel ordered by my go now returns a slightly elevated free beta hug level 24 miu my with a reference value of 0 for males all other results including abc are normal spa and afp as well as hug are negative sexual hormones panel is normal I cannot detect any abnormalities with my testicles I understand that any detected beta hug in males indicates a malignancy how worried should I be",
        "input": "",
        "output": "hi first of all I must say you have written your history very well what I searched and concluded is about your hug human chorionic gonadotropin level your hug is raised while total hug is normal get it repeated from some other lab if still raised then proceed to step and 2 get ultrasound scrotum to see for any hyoechoic areas or area of calcification get fac fine needle aspiration cytology or excision biopsy of 5 am lesion below your nipple I understand that any detected beta hug in males indicates a malignancy how worried should I be to answer this question I was just wondering why you got hug done in first place as you were asymptomatic neither of the drugs you are taking does not interfere with this test hug you cannot just ignore and sit on it if hug is deranged you have to find a cause be it faulty lab investigation itself"
    },
    {
        "instruction": "hi doctor I am a 35 year old male I have a problem in my skin especially on joints I have had already consulted a dermatologist and she suggested consulting a rheumatologist based on the symptoms due to couid 19 I could not consult but now it is spreading very fast could you please help I also have vitamin deficiency and taking rise and locate ointment",
        "input": "",
        "output": "hi I have gone through your query and reports your vitamin is significantly low for which you are already on the supplement I want to ask you about skin problem and joint pains since the prescription was not fully loaded I could not figure out the exact diagnosis of what the dermatologist has said did they mention about psoriasis as psoriasis and joint pains can be related if you could attach a picture of the skin lesion it may be helpful is there any early morning stiffness in the joints any backpain or neck pain any one in the family with a history of skin problem do let me know these answers and picture of your skin lesion to guide you further"
    },
    {
        "instruction": "hello doctor I was smoking weed for almost six years daily last july I stopped and then I started to have panic attacks with heart palpitation I went to a cardiologist and everything was fine but since then I became so anxious and I was aware of everything going on in my body after that I started to notice muscle twitching in every muscle at first I thought it was a heart issue but after seeing three cardiologists the results were the same my heart is fine then of course I googled it and I see some scary diseases like als I went to a neurologist who after some questions and examination said that it was due to an anxiety issue to be sure he sent me to an institute specializing in the detection of neuromuscular disease a neurophysiologist did a clinical examination strength reflex and an egg and no abnormalities was showed it were before three months a month later as my twitching was still going on I went to another neurophysiologist he did another egg and again everything was normal my neurologist said that it is impossible its als because muscle twitching for nearly eight months without any weakness and I started to have so tingling and buzzing sensation again my neurologist said that it is very common with an anxiety disorder like mine I started to take pills and to see a therapist for one month I have to say that twitching is way better when my anxiety is low but sometimes it came back strong I am so worried about als my questions are is egg test reliable is it true that usually fasciculations come after or along with the weakness in als fasciculation for eight months without any weakness does rule out als does als cause pain",
        "input": "",
        "output": "hi I understand the problem you are facing it is partly due to anxiety and partly due to nerve and muscle hyperactivity coming to your specific questions yes fasciculations and weakness in als amyotrophic lateral sclerosis come together actually weakness comes first and fasciculations are generally unnoticed by patients they are usually revealed upon asking or found by egg electromyography egg is reliable and diagnostic for als fasciculations without weakness ruled out als eight months are a long duration for als if it would have been als it would have progressed to much extent and als is painless it is motor neuron disease so the sensory system is perfectly normal I would suggest you to try one tablet called carnisure plus contains levocarnitin 500 my and methylcobalamin 1500 micrograms it is a vitamin for muscle and nerves you can take it in the night daily for a few weeks and see the effect avoid coffee and other stimulants"
    },
    {
        "instruction": "good day doctors I am 2yo my last period was on 18th to 21st last month I just took pregnancy test this 26th and it is positive first baby I bought annum maternal milk after I knew I am pregnant but I am having diarrhea and I vomit more than usual since it is still eco I cannot go out to have prenatal check up I wonder how many weeks I am pregnant and I would like to know if is it bad to sleep in the morning while awake in the evening I slept a lot in the morning thanks for the response take care",
        "input": "",
        "output": "hello welcome to I clinic congrats for your pregnancy so lap of yours is 18th last month so you are weeks days you have to perform a ultrasound to evaluate the embryo and heart activity second vomiting is one of the most common symptom of pregnancy that may accompany you still at 12 weeks there are some minor side effect of anus maternal like diarrhea upset stomach eat if the diarrhea is moderate to severe or tha last for a long time you can stop the supplements the most important tablette to take during 12 weeks of pregnancy is folic acid 400mcg one table a day you can sleep and rest as you want but a light activity will maintain you healthier I hope I ve been helpful best regards"
    },
    {
        "instruction": "hi doctor I just wanted to find out is it possible to lighten a dark skin tone without damaging it if so could this be done at home or at a dermatologist would you recommend a teenager getting it when I was younger I had a light skin tone but due to lot of swimming and sun exposure I damaged it and got dark is it possible to get the same skin tone I had I am a female 18",
        "input": "",
        "output": "hi skin color is genetic amount of sun exposure can increase or decrease it as per your genetic constitution of skin melanocytes the dark pigment producing cells dark skin is healthy as it prevents its bearer the side effects of sun exposure thus lesser chances of dreaded skin cancers and delayed skin ageing still ignorant people think white skin is better and a false psychological cosmetic superiority is associated with it this is fostered by fairness cosmetic industry to promote their interests white skin need additional sunscreen protection to prevent aging and cancers but for those who still need fairer skin can avoid sunlight as much as possible and also sunscreen then the melanocytes in their skin will produce less dark pigment and thus fairer skin so you can avoid sun exposure and use regular sunscreen that much is best non harmful way to be so called fairer"
    },
    {
        "instruction": "hello doctor I have experienced ringing in my right ear days ago and it has not stopped since then it is not that loud and I do not hear it when the environment is noisy it is really bothering and stressing me out and I do not know what to do I wanted to have this checked but it is just so hard to get an appointment and go out right now given the couid situation please help me understand this thank you",
        "input": "",
        "output": "hi taking your age into account I would like to recommend you not to use earphones or listen to very loud music avoid caffeinated drinks like tea coffee alcohol if any sleep completely do not take stress please mention which type of sound you are perceiving tone type or noise type use resound relief app android ios on speaker with moderate sound during silence because the inside sound must be bothering you during silence and sleep this is called tinnitus that you are suffering from most probably with these practice it will go away please after this situation goes normal go for puretone audiometry test and immitance audiometry test along with otoscopy"
    },
    {
        "instruction": "hello doctor for the past one year I am having diarrhea I went to the doctor he wrote me some tests my blood urine and feces are normal and negative for parasites my stomach ultrasound colonoscopy are normal six months later I went to the dentist she asked me to take flagyl 500 my metronidazole on the next day my feces was normal and tight I asked another gastroenterologist and he said to continue the flagyl for 14 days after 10 days I had diarrhea again the doctors are telling me that I have very sensitive intestines and advise me to take probiotics and ibutin gelsectan I still have diarrhea what is your idea about my problem",
        "input": "",
        "output": "hello as you described this condition to be lasting for almost more than a year it can be is irritable bowel syndrome but is usually starts at an early age than this although it can happen at any age that is why it is important to rule out all organic causes before labeling it as a sensitive bowel is please answer the following questions to rule out organic causes do you have any weight loss with it how many episodes of loose stools do you have in 24 hours do you get up in the night for stools do you have any crappy abdominal pain with it is there any blood in stools or mucus is your sleep disturbed any stress any travel history to tropics any biopsy was taken during the colonoscopy to rule out microscopic colitis meanwhile do a few of these lab tests and start this treatment in addition to probiotics but the tablet should be taken four hours apart from probiotics ash thyearoid stimulating hormone cop reactive protein is tablet rifixamine 50 my 0 for 21 days"
    },
    {
        "instruction": "hi doctor my question is about couid 19 I am very worried about this virus I am 29 years old and my job is essential so I am still out in the field I am overweight and take medications for high blood pressure including lisinopril and metoprolol everything I read said this puts me at way more of a risk for severe complications or death if I catch it I am also worried about my children who are both under the age of two is there anything I should know or to help in preventing this virus or help not take a turn for the worse if I contract it due do being overweight and taking high blood pressure medications",
        "input": "",
        "output": "hi certain important points that can be put to good use by you wear a surgical mask or an n95 mask it is a little suffocating when you go out to work make sure to not touch any part of your face ears or head after touching any object outside your house if you have the urge to touch or scratch your face please wash your hands with soap and water and then and only touch your face push buttons and open doors and handles with the elbow or with the forearm or arm and not with the hand that way your hand surface will not be contaminated for a long time maintain social distancing feet between two people and no gathering of four people or more in a place for more than 15 minutes as soon as you reach home from outside prevent your kids from touching you head straight to the bathroom have a warm bath with soap and keep all your clothes that you were wearing for washing continue taking your medication on time as going on also maintain a healthy diet I hope the above points help"
    },
    {
        "instruction": "hi doctor I am a 27 year old male I have never had an increase in moles except for the past two weeks I have had over 50 show up on my chest in the past two months I moved from one country to another and a month ago I had a really bad sunburn in indonesia",
        "input": "",
        "output": "hi moles are genetic collection of melanocytes which go through a cycle of emerging in childhood then become darker and fade by middle ages in fair skin up to 50 are normal more than that increase the risk for skin cancer and change in size symmetry color symptoms also is a risk factor mole or neve as called in medical term appearing in adult age like in you are always a risk factor and in such an abrupt manner more so they need to be followed up for any change in color size symmetry border symptoms and so all your moles that I can see in the photo are harmless mole does increase after prolonged sun exposure as you give history I hope you do not have any other medical problems I advise you an initial in physically examination by a dermatologist you can wait for lockdown not an emergency then you can do it yourself all the mole for the changes described earlier at least once a month and a complete work done by a dermatologist once every six months lifetime risk is very low but if you have fair skin adult moles more than fifty you need that follow up to be on the safer side I hope this helps sun exposure workup for changes seborrheic keratosis screening for changes every six months"
    },
    {
        "instruction": "hi doctor I am having frequent urination and feeling extremely thirsty especially during the night after dinner and before bed while I am sleeping I get up just once to urinate sometimes not at all do you think I have diabetes I got my blood sugar checked and it came out as perfectly normal 91 normal range is 80 100 for fasting I think it is highly unlikely I am going to get diabetes in less than two years after the last checkup but I wanted to confirm since my family has a history of this illness and that is scaring me a bit I am a 28 year old male with asthma and acid reflux I am currently on montelukast advair and omeprazole",
        "input": "",
        "output": "hello I can understand your concern according to your history you have been suffering from frequent urination and feeling extremely thirsty especially during night after dinner and before bed you have a family history of do and you have a history of acid reflux and asthma according to your description your present sufferings can occur in some situations like di diabetes insipidus nephrogenic diabetes ti urinary tract infection kidney stones cystitis hypercalcemia etc you should undergo fasting blood sugar test 2habf 2hrs after breakfast hba1c test us of a urine routine serum electrolytes serum calcium water deprivation test etc at first we should find out the causes which are responsible for your present sufferings and then treat them accordingly"
    },
    {
        "instruction": "hello doctor I have tooth and gum ache not sure where it comes but on the below right jaw on day the pain was there continuously and used naproxen I was able to have coffee and tea on day pain was there then contacted physician on icliniq and suggested ultracet for days on day I used ultracet twice a day pain was there sometimes continuous pain gone on day I used ultracet twice a day pain was there sometimes not able to drink hot coffee if I take coffee pain comes immediately and after gargling with water it goes away on day today I had breakfast had one ultracet tablet pain was there for some time after having breakfast and now it is fine but I am scared of taking any hot coffee or tea now I stopped completely",
        "input": "",
        "output": "hello I have gone through your query and attachment I can see some gingival inflammation and also abrasion of teeth near the cervical area that abrasion is also a cause for severe sensitivity to hot that you are having abrasion needs to be treated clinically with restoration once this pandemic of couid 19 gets subside then you can get it treated in a dental clinic for time being use sensoform of toothpaste first apply it on your teeth then keep it for 30 40seconds then brush it as you do daily this is the way to use sensitivity toothpaste use mouthwash for gargling at least at night before going to bed after tooth brushing for pain if severe you can take ultracet or if not severe then can continue with ultracet when needed it will be better if you upload images of your teeth from the occlusal surface so that I can see any cares or gingival infection"
    },
    {
        "instruction": "hi doctor I am 38 years old I am diabetic for the past three years and sugars are not always in control I am taking medicine euclid 80 my and galvus met 50 500 and novomix 30 injection 10 units injection only for few days my issue is post diabetes I am experiencing severe recurring yeast infection in vagina and itching in groin area and near anal area due to scratch the area has become sensitive and scars and cuts are there is burning sensation when the area comes in contact with water I have tried all clotrimazole creams does surfaz candid etc but no relief itching is severe at night and very uncomfortable please help which medicine or cream to apply to stop this infection everytime I am unsure if that is eczema are there any tests which show what kind of infection is that",
        "input": "",
        "output": "hi diabetes is comorbidity that makes patients prone to fungal infections and some times there is a secondary bacterial infection too I advise you to follow certain steps first step proper sugar control anti diabetic diet and exercise proper genital hygiene use of clean cotton underwear keeping the area clean and as dry and aerated as possible no tight clothing no talcum powder application do not use regular soap and hot water to clean genital areas take itraconazole 100 my two times a day for two weeks luliconazole cream to be applied three to four times daily on area of infection after proper cleaning and drying combinorm wash to clean the genital area I hope this helps tina cruris tina cruris tablet itraconazole 100 my two times a day for two weeks luliconazole cream to be applied three to four times daily on the area of infection after proper cleaning and drying combinorm wash to clean genital area please follow up after completion of the above course and sos if need be"
    },
    {
        "instruction": "a small piece of my tooth broke off weeks ago and I feel pain since week pain is getting worse I went to a dentist today and he took a xray after looking at the xray for 30sec he said there are only options root canal treatment or extraction is this really necessary what is your opionion thank you soo much it is the tooth in the middle of the xray",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello doctor I have a hiatal hernia I am wondering if protein shake hurt my hernia the pain is usually mild and comes and goes recently I have been not feeling too well and my hiatal hernia pain become moderate and doest really go away I am currently on rabeprazole and motilium",
        "input": "",
        "output": "hello I reviewed your endoscopy and histopathology report you have a small hiatus hernia and it has no specification association with proteins shake your report also shows chronic gastritis which also adds to your discomfort this issue usually improves with medications but recurs after some time my recommendations will be some changes in your medications for some time and then will readjust and down titrate again meanwhile you need some precautions as well hiatus hernia leading to herd gastroesophageal reflux disease or gastritis capsule rabeprazole one in the morning and one in the evening before meals for four weeks and then only in the morning for four weeks tablet motilium before meals for two weeks syearup gaviscon alginate 10 my three times daily after meals for two weeks and then as per need avoid late night eating no eating two hours before bed decrease coffee intake avoid smoking drink plenty of water one hour regular exercise after 10 days"
    },
    {
        "instruction": "hello doctor I am 34 years old I am concerned about my absence of menses my last menses was on the 16th of previous month which was about a week earlier than the before periods I was diagnosed with autoimmune hepatitis and under medication of steroid 10 my prescription attached now I am completely normal and my last let test was completely under the limit please inform me whether the delay of menses is due to the side effect of steroids or due to other reasons is it a serious worrying issue",
        "input": "",
        "output": "hello I have gone through your history and also saw the prescription you uploaded of your recent visit to your hematologist gastroenterologist as I can see from the prescription he had asked you to continue the medications you were taking for autoimmune hepatitis which includes immunosuppressants like steroids omnacortil and azathioprine let me tell you that chronic steroids therapy can hamper with your menstrual cycles by disturbing the regulatory hypothalamo pituitary ovarian axis so what I mean is it is common to have disturbed cycles when you are on chronic steroid therapy so most likely that is the cause for delayed cycles as I see even your thyearoid level ash appears to be within the normal range although close to the higher side of normal range please do not worry or panic as there is nothing grossly serious to worry about as of now you will most likely be requiring this treatment and will take some time to wean off from these medications as they are more important medication saving your life from redevelopment of autoimmune hepatitis so please continue these medications as advised by your gastroenterologist cycles should mostly resume or get regularized once you are slowly taken off from the steroids therapy for autoimmune hepatitis presently on omnacortil 10 my daily serum prolactin levels continue vitamin do supplements as advised continue omnacortil azoran folvite follow up with your endocrinologist as advised"
    },
    {
        "instruction": "ear ache pressure headache on same side pain when I wash that side of my face near my ear for almost a month",
        "input": "",
        "output": "hi I hope your doing well I understood your concern regarding headaches I learn that you are having a headache and earache on same side also it is more when you wash your face I like to know the nature of pain whether its electric shock like whether its comes and go or it is dull boring continuous in nature this type of pain mostly due to inflammation in ear or trigeminal nerve pain trigeminal neuralgia if it is associated with light and sound sensitivity it could be due to migraines sometimes ear wax can harden and block the ear canal causing discomfort and itching earache I like to suggest simple antiinflammatory to try first such as paracetamol or ibuprofen you should take them after food further plan if no benefit we should evaluate for trigeminal neuralgia depends upon your symptoms if it is trigeminal neuralgia pregabalin 75 my is or caobamazepin 100 my at night time initially then gradually increasing to times a days both this medication has significant side effects like dizziness and allergic skin rash so it needs to take with a doctor prescription hope this will be helpful regards"
    },
    {
        "instruction": "my left ear hurts if I press the back of my ear it would really hurt sometimes it feels itchy and throbbing also it feels like it is clogged inside last month my other felt like this too I had to take medication for it",
        "input": "",
        "output": "hi there are only possibilities with the complaints you have mentioned impacted wax in the left ear which is causing pain and a blocked feeling for this you can use wax solvents which liquefy the wax and resolve the issue infection involving your outer ear which can be the cause of itching and pain eustachian tube catarrh which is associated with allergy and usually does present with only feeling of pain and blocked sensation the treatment you would have taken earlier using anti allergic would have been to treat the eustachian tube catarrh you can consider taking a combination of paracetamol with fexofenadine montelucast levocetricine phenylephrine combination whichever is available in your country in addition you can use ciplox ear drops times a day if your having allergic issues it has be effectively treated to prevent recurrence of such episodes however if the above treatment does not work consider meeting an ent specialist to get your ear examined and get treated accordingly"
    },
    {
        "instruction": "hi doctor I am curious about my friend blood results blood tests show that his lymphocytes abs is 71 before six months and 35 before three months compared to the normal range that came with the results which is 30 60 10 l do you think is there something to be worried about",
        "input": "",
        "output": "hello I reviewed the records having more lymphocyte count is known as lymphocytosis benign or reactive lymphocytosis transient nature can be seen in an infectious disease like viral illness this does not seem to be the case as it persists for a few months other causes that could persist are noninfectious causes like stress drug reaction having spleen removed in the past etc malignant lymphocytosis there is an entity called chronic lymphoproliferative disorders clad this is a very slow growing blood malignancy usually happens in individuals more than 60 65 years some times patients do throw symptoms like low grade fever weight loss anemia night sweats etc they may or may not be associated with low platelet count to anemia which is not the case with your friend with all this background knowledge please see which ones is fitting for him I will discuss the worse scenario because I guess you will be curious otherwise having clad is less likely as your friend is young and he is not having anemia or low platelet counts regarding the clad prognosis it is one of the very slow growing entity we do not treat the early stages as well as they are so slow treating has more drug side effects than the clad itself getting a flowcytometry is rational in his case but it is not urgent you can wait for even few months if there is an issue of lockdown due to coronavirus again I am not saying he has any particular disease but I want to explain everything in detail so that you have a good understanding"
    },
    {
        "instruction": "hello doctor I had a spinal fusion surgery down my entire back about two years ago when I was 17 I never had terrible back pain but as of recent it is been somewhat bad I feel like a 97 year old woman I have difficulty in sleeping because some positions just make the pain worse will this last forever",
        "input": "",
        "output": "hello I read your concern in my opinion post surgery you should start work on a little bit of rehabilitation to strengthen the spinal muscles that would have prevented these kinds of issues do not worry I would like you to have a good recovery session frequently inside a pool and stretch your body to work on whole body flexibility within the limits it allows and progressively extend more do not try to push too hard as it will increase tightness I would like to know if you have any sort of pain and spasm or pins and needle sensation or tingling sensation anywhere in the upper and lower body if so get yourself properly checked up with your surgeon I would also recommend you to be active keep moving around and hydrate yourself properly have good food and support yourself in every position properly especially those positions you are required to maintain for a longer period kindly try these things and then let me know how you feel after three days I hope this helps"
    },
    {
        "instruction": "hello doctor my infected sebaceous cyst has burst 10 days back and daily dressing is being done by professional I was on antibiotics but the course is over what should I do next I do not want to go to the hospital and get the surgery done since more than ten years two cyst was there and of late it merged into one may be in the second week of last month I started getting an itching sensation and the place becoming red and after a few days it burst since then regularly it is being dressed with the removal of pus it has created a deep hole please help",
        "input": "",
        "output": "hello do not worry I will solve your problem wound healing is a very common problem in diabetic and hypertensive patients even when they are controlled I will advise you treatment with some basic precautions and investigations check your blood sugar levels regularly pus is still present so the antibiotic course is required for further five days I will advise you some dressing spray to heal early wound dressing with removal of pus and black margin is essential every day hba1c glycated hemoglobin ruptured cyst tab ifi cefixime 200 my be for five days chymoral plus trypsin chymotrypsin be for three days limcee od for 10 days capsule a to od for 10 days dressing with ovum spray and megaheal ointment"
    },
    {
        "instruction": "hello doctor my son took accutane to treat his acne and stop taking the same his acne is gone but he said he started having burping sometime after he took accutane mostly every day in the morning and whenever he eats to prevent his burping he does not eat much he does not feel bloated nor pain in his stomach whenever he burps he does not even feel acid in his throat the burping does not bother him much and the frequency has reduced doctor prescribed pepcid for 30 days but nothing changed he was tested for pyloric which came back negative and all his lab works were fine except his low on vitamin 10 and his a ratio was slightly elevated 5 he drinks water last night before his test and no water since which may or may not explain his slightly elevated a doctor scheduled him for endoscopy and told him to take align probiotics my son does not want to do the endoscopy and will not do it is this endoscopy really a must he just wants to take the supplements no cancer history of the stomach in our family is there any other different and saddle approach for handling this like just take his probiotics and other digestive enzymes for months and wait and see",
        "input": "",
        "output": "hello thanks for providing a detailed history of your son this excessive burping usually occurs due to aerophagia patient is usually not aware of it and they swallow a lot of air during eating or drinking we normally swallow a little air and we sometimes have one or two burps in routine but those who swallow more air have more burping coming to his lab tests this a ratio is not that significant and his vitamin should be replaced both these tests are not associated with burping he has no alarm sign so endoscopy is not mandatory and he can avoid it his endoscopy report will be most probably normal he needs diaphragmatic exercises to avoid burping the way forward is that after eating or drinking he should hold a pencil in his teeth and take a deep breath via nose and exhale via mouth for about five minutes and it will help out he can take tablet baclofen my three times daily before meals for 10 days and should avoid chewing gums"
    },
    {
        "instruction": "hello doctor I had voice box swelling before two months I had taken medicines for around 10 days it subsided and my voice was getting better but at the beginning of this month it started again I could not visit any doctor due to the lockdown I tried to rest my voice and did continuous steaming but it is impossible to not talk because I have a day job that involves talking to clients I am unable to sing now I do not know up to what extent my voice is damaged",
        "input": "",
        "output": "hi first and foremost acute inflammation of the vocal cords what we call acute laryngitis requires proper precautionary measures for a certain amount of time with proper treatment failing of which the problems will recur again after a short span of relief my advice to you would be to give an absolute voice rest for the next 10 to 14 days now absolute voice rest means you should not even be saying yes no during the day if your work involves the use of your voice I advise you to take complete off from your job for the next 10 to 14 days the vocal cords require time to heal completely and this takes usually 10 to 14 days your voice might return to normal in five to six days however there is always a hidden inflammation in your vocal cords which can resurface if measures are not followed adequately treatment if you are having gastric issues consider taking tablet pantoprazole 40 my once a day for 15 days tablet wysolone prednisolone 20 my once a day after breakfast for two days followed by 10 my for two days and finally followed by my for the next two days this is a steroid tablet and is effective in reducing inflammation in the vocal cords but the above preventive measures should be taken if you want your voice back"
    },
    {
        "instruction": "hello doctor I have been experiencing headaches for the last three days it is more of a burning or tingling feeling at the back of the head that seems to travel to the front sometimes it is not a severe headache it is more of a dull ache and also my scalp feels sensitive when I scratch or touch in those areas I have no eyesight problems besides blepharitis and no unsteadiness or vomiting I have done an mri of head and neck six months back and it was clear and I was diagnosed with fibromyalgia four months back",
        "input": "",
        "output": "hello regarding your concern I would explain that your symptoms are suggestive of tension type headache which is a benign type of headache related to psychological stress a wrong posture can also cause such type of headache so in my opinion there is no reason to panic I would just recommend taking painkillers acetaminophen or ibuprofen and try to relax a warm bath can help too if the headaches persist I would recommend taking duloxetine considering also the diagnosis of fibromyalgia or amitriptyline there is no need for brain mri as I am sure that it will result in normal I hope this helps"
    },
    {
        "instruction": "hello doctor this is for my 19 year old son who has been struggling with not being able to regulate his sleep schedule for several years he is up all night and sleeps all day he consulted a sleep specialist once he suggested sleep modifications but they did not work this has really not allowed him to graduate or be involved in life at all I believe it is also making him withdraw and depressed I am very scared of medications side effects and becoming addicted to them can you suggest any advise to help him",
        "input": "",
        "output": "hello sleep disorders to the extent like your son which is continuing for so long and it is not getting better need a evaluation in my opinion thyearoid function test serum vitamin b12 are the basic blood tests need to be taken sleep modifications is must and do not worry about medicines and their addiction or side effects because his future life is more important than any medicine side effect also nothing is addictive if it is taken under the supervision of a qualified doctor you can choose to give him over the counter hormone called melatonin in doses between my to induce sleep in night this hormone is produced by the body naturally to induce sleep once your son has a good night sleep his sleep cycle would be fine and his issues will solve"
    },
    {
        "instruction": "hi doctor I am a 63 year old female I started getting flashes in the right eye a couple of days ago and now have a floater in the shape of the flashes I was not too worried but today flashes have started up again in the same area given the pandemic eye doctors are only open for emergency care and I really do not want to get exposed at what point is this situation an emergency I am currently on estrogen patch sertraline and nexium",
        "input": "",
        "output": "hello flashes can signify many conditions affecting the inner layers of the eye starting with the vitreous the gel structure pressing down the retina in high mopes it is usually dissociated where floaters are usually located if you have high blood pressure or diabetes elements of blood can form in that space and start floating floaters the way to detect if it is in the vitreous is to look sideways and if the floater follows the motion of the eye slowly in the same direction then it is in the vitreous and does not require quick intervention if the distortion is in the same position in whatever direction you look then we are talking about the retina and retinal detachment which should be urgently excluded if you are seeing a halo around the source of light then your eye pressure might be increased and requires urgent attention"
    },
    {
        "instruction": "hello doctor I have an erection problem and I cannot have a morning erection too I am married but my penis becomes soft while having intercourse I have done all tests like penile doppler scrotum diabetes and prolactin but all were normal what is wrong with my sexual organs please guide me to solve this problem I am currently taking exact twice daily",
        "input": "",
        "output": "hi coming to your query I have some questions do you have diabetes or hypertension are you on any kind of medication other than you mentioned what does exact contain is it arginine with a multivitamin is your erection tight enough such that you able to penetrate into the vagina and after that it becomes flaccid are you able to masturbate and ejaculate"
    },
    {
        "instruction": "hello doctor this query is for my father in law aged he is 58 years old and is diabetic and currently under medication for be also he has a history of two major heart attacks in the last five years he did not have any major heart issues recently due to extensive amount of medications taken for a long time he started showing signs of high amount of creatinine currently 9 we did a few dialyses now doctors have advised doing an av fistula on his left hand his left hand is partially amputated from a previous septic shock treatment about four years back his right hand is fine but an av fistula there might terribly limit his movements and self care we wanted a medical opinion about where the fistula can be placed or can it be near to chest area as an alternate option",
        "input": "",
        "output": "hi there are three main types of auf arteriovenous fistula the radiocephalic fistula is a forearm fistula created by anastomosing the side of a radial artery to the end of a cephalic vein it is also referred to as the brescia cimino fistula the brachiocephalic fistula is an upper arm fistula created by connecting the side of a brachial artery to the end of a cephalic vein or slightly central to the level of the elbow finally the brachial arterytotransposed basilica vein btb fistula is another upper arm fistula this fistula is created by anastomosing the side of a brachial artery to the end of a basilica vein that has been transposed laterally and elevated superficially to make it amenable to dialysis cannulation other sites could be leg also I advise you to discuss it with your doctor the patient requires dialysis for sure or you can put a central line and replace it every 15 to 20 days but av fistula is the best option"
    },
    {
        "instruction": "hello doctor I took I pill on 17th of last month and had a withdrawal bleeding on the 27th when will I get my next period I again had unprotected sex today do I need to take I pill again or is this safe period my period cycle is 28 32 days",
        "input": "",
        "output": "hello I have gone through your details many times some people do experience some kind of disturbance in menstrual patterns after taking an I pill as you got your periods on 27th march which was a withdrawal bleed ideally speaking you should have been getting it around 24 28th april as per your routine cycle length and this also not your fertile period as your cycles were always regular but I would still advise you to take an emergency contraceptive pill because the previous cycle was disrupted with high dose hormones contained in I pill and the present cycle we do not know when exactly you ovulate so it is better to take a preventive method as precautions although repeated emergency contraceptive pills are not advised please use a more consistent method of birth control in the future like condoms and oral contraceptive pills which give a wider window of safe period and also would not disturb the menstrual cycles like emergency contraceptive pills I hope this helps"
    },
    {
        "instruction": "hello doctor I am a year old female I have some mouth and throat concerns I have ulcers sore throat occasional oral thrush difficulty swallowing lump on the throat larynx night sweats fever loose teeth and abnormal discoloration in mouth I am currently on birth control patch dextro amphetamine and cymbalta I have been struggling for months now with quite a few mouth and throat issues I have constant mouth ulcers that are taking weeks to heal I get the sensation that I have not swallowed something completely down and that it stuck so I will keep swallowing and swallowing it drives me mad it is not easy for me to keep doing this because swallowing feels harder than it should be almost like my throat is too swollen I have a sore throat 80 of the time I have odd waves of oral thrush and my mouth also has pale and red areas on my soft palate my hard palate is just very pale I have a couple of loose teeth but otherwise in very good shape frequent random nose bleeds that are usually heavy but can be light at times night sweats every night and feeling easily overheated during the days I have also now become more concerned since my throat developed a hard lump on the top of my larynx it feels very swollen where it is almost like it is ready to explode it does not move and it stays firm putting a lot of pressure on my throat I am assuming this is why it feels hard to swallow it does not hurt but if I push on it to feel the firmness it causes discomfort to the surroundings mostly underneath the lump",
        "input": "",
        "output": "hi first and foremost I would advise you not to panic or get disheartened according to me there is no major issue out there and we usually encounter such issues very often in our outpatient department now looking at your case oral ulcers can be due to various causes right from nutritional and vitamin deficiencies to infections or repeated trauma getting each and every parameter tested often becomes extremely expensive and might frustrate you even more coming to your second major concern difficulty in swallowing with no major pain as such can be due to some ulcers down in your throat or infection in your pharynx throat or constant gastric irritation advice consider taking a good multivitamin for two to three months follow a healthy hygienic lifestyle avoid smoking alcohol etc avoid having spicy oily and junk food items salt water gargles at least to 10 times a day you should keep your oral cavity free from contaminating organisms and hence the throat infection keep sipping on boiled warm water consider antireflux therapy if you have the slightest of reflux issues get your viral markers for hiv hbsag and blood sugars done too do not google too much of your symptoms out 10 do not correlate too many unnecessary things and do not take stress at any cost sometimes stress can be responsible for non healing ulcers"
    },
    {
        "instruction": "hello doctor I am having back pain at rest for the past for one month I am also having an issue with sleep since it is hurting and it keeps on tingling when at rest please advise",
        "input": "",
        "output": "hi you are very young to actually have persistent back pains there are many causes of pain in the lower back region it can be due to faulty posture related to weak muscles issues with intervertebral disc narrowing of spinal canal or any bony instability besides many others so accurate diagnosis is the key to proper management of the condition you will have to elaborate your problem as to a detailed discussion of your back pain which means the duration of pain and mode of onset I would also like to ask you if it is associated with any leg pain or any other neurological symptoms like numbness paraesthesias electrical shock like abnormal sensations or any weakness in limbs any associated symptoms like fever weight loss etc what medications are you generally taking until now for your existing problem if you have localized back pain with no other symptoms like radiating leg pain neurological symptoms like numbness weakness paresthesia etc then you can start with the following recommendations for an initial period of two to three weeks maintain proper posture of your back while working and sleeping if pain is more then you can take a short course of anti inflammatory medication like etoricoxib or paracetamol or one which suits you physical therapy initially under the supervision of a trained physiotherapist and then to continue at home adequate calcium and vitamin intake if levels are low in the body ice packs can be applied if your pain is acute then hot fomentation can be done at home analgesic spray for local application can be used and is easily available avoid lifting heavyweight acute forward bending in the mornings etc we will observe you for the next two to three weeks how you respond to this conservative management protocol if you are not feeling better then we will have to get some investigations like dynamic rays of lower back and few blood tests for evaluation"
    },
    {
        "instruction": "hi I had hard stool days back since then I facing enormous pain while passing stool each day I visited doc and he has prescribed me ano metrogyl cream to be used 4 times a day but it ist helping also I drink softovac powder once at night situation is not getting better though",
        "input": "",
        "output": "dear welcome to icliniq you developed acute anal fissure due to hard stools which are now causing pain to you there are ways of sorting it out you have to use local cream to relieve pain and made the anal sphincter relax you have to take medications to make your stools soft I am prescribing following medications it will help out try to drink plenty of water and avoid hard stools thanks hard stools acute anal fissure gun cream mix this cream with ano metrygl cream in equal quantity and apply it times daily locally"
    },
    {
        "instruction": "i have right basal pneumonia but why is my left side hurt much when I cough and taking deep breath its very painful I started taking antibiotics yesterday it will just go away for how long the pain will ease",
        "input": "",
        "output": "hi I hope you are doing well I have gone through your symptoms you are having pneumonia on the it side pneumonia is inflammation of lung parenchyma it can result in fever cough with expectoration and breathlessness sometimes it can result in pleural effusion fluid accumulation in between the lung covering and pleurisy inflammation of lung covering when there is inflammation of lung covering it can cause sharp pain when you take deep breath and cough it is possible that you are having pleurisy it is part of early infection to your left side of the lung this infection could be due to bacteria or viruses I suggest you continue to take a proper antibiotic in proper doses and proper duration you should watch red flag signs such as persistent fever breathing difficulty increased breathing rate and heart rate if this happens you should report to your physician for pain you should take paracetamol 650 my twice or thrice in a day as required you should take this after food you can also youse ibuprofen if you are not allergic to it regards"
    },
    {
        "instruction": "hello doctor I am a 46 year old female I have been suffering from melasma for the last four years it is only small patches on the cheekbones but very dark I have been told it is dermal which is very stubborn and does not go easily I took lots of treatment from good dermatologists like used topical creams like hydroquinones retinoids etc few chemical peels are done but no effect and that area became thin and wrinkled what treatment should I go for currently I am using only kojitin is it safe to use it for a long time I hope it will not make my skin thinner",
        "input": "",
        "output": "hi welcome to iclniq com I have seen your query with your descriptions it seems you have developed dermal melasma kojivit is safe and it is non asteroidal it does not cause thinning of skin and safe for long term use beside this must use sunscreen like blinds sunscreen daily during morning and use dermadew glow face wash twice daily also take antioxidants tablet once daily protect from uv ultraviolet radiation and repeat sunscreen after four hours if you are going out"
    },
    {
        "instruction": "hi doctor I am a senior year medical student in greece and I would like to ask you a question about my mother she had a history of hyper hypothyearoidism about 10 years ago but the last two years her thyearoid has been managed and she stopped taking to her cardiologist told her about 10 years ago to start taking inderal propranolol 20 my per day divided in a two time dose because she had palpitations and some arrhythmias she had an echo egg about a year ago and her heart was fine and her cardiologist suggested stopping inderal but being a very anxious person and having frequently anxiety tachycardia she did not stop it which brings me to the present having been diagnosed the past six months by her pulmonologist with allergic rhinitis asthma and having frequent wheezing episodes even though she takes antihistamines when the episodes occur shouldn she change her beta blocker to a cardio selective one she finds herself not being able to breathe while on inderal but the symptoms reappear when she takes it what would you recommend as a cardioselective beta blocker would it be safe to change from inderal to let us say atenolol if yes how would she do it",
        "input": "",
        "output": "hello I have gone through the history you have described for your mother I really appreciate the way you have presented it with all details it is very important to know the reason to start tablet inderal at first point what kind of arrhythmia it was and all in order to evaluate does she really need to continue any beta blocker as your cardiologist year ago after cardiac evaluation did not find any reason to continue the medication as per your history as we see in a day to day practice patients with palpitations just due to anxiety or stress and without any cardiac issue non selective beta blockers would definitely aggravate her symptoms be you have mentioned in your description is wrong I guess as it appears to be 12 20 something might be a type error but looks normal to me for time being you can change the beta blocker to a selective beta blocker like metaprolol 12 my or nebivolol 5 my or atenelol 25 my on a very low dose get her evaluated again with her cardiac reports whenever possible and if not required better to slowly taper her beta blocker medication and stop as well because though cardioselective beta blockers has some or minimal effect on beta receptors as well even I would advise to start meditation and yoga to overcome her anxiety issue that will help her in controlling palpitations if they are related would like to review her all previous and recent cardiac records to further discuss and clarify management strategy"
    },
    {
        "instruction": "hello doctor I was diagnosed with ofa and parasomnia sleepwalking I have been on crap for several months now with success but still having some episodes at night where I act out my dreams and I am afraid and run out of the house onto the street I was also violent and aggressive towards my partner during this time of the last episode which was two nights ago she has children that live with us and we are extremely concerned about their safety if I have one of these episodes I do not drink alcohol smoke and try to reduce my stress level I have been using the crap religiously but would like a backup method to suppress these violent episodes that may not happen it is really affecting my sleep especially since I broke my foot please help",
        "input": "",
        "output": "hello I understand your concerns your sleepwalking is mainly because of your ofa obstructive sleep apnea but as you said it is under control then sleepwalking should also be in control you can try some measures to prevent any harm to others and yourself always cover your window and doors before going to bed place an alarm on door and on windows remain away from stress you can try some pranayam and meditation as well exercise during day time so that you feel tired physically which leads to a deep sleep we start you on some medication as well like clonazepam in the range of 25 my to my you can repeat your sleep study also if you have any other doubt you can always consult me here on icliniq"
    },
    {
        "instruction": "hello I was due to have my upper left wisdom tooth taken out last friday but my dentist has been closed due to the corona virus I had an ray done on my last visit and my dentist said it was a very awkward tooth to remove and not straight forward I am in a lot of pain at the moment as my wisdom tooth is only half way through but has split into the side of my cheek I am struggling to eat clean my teeth it is constantly throbbing and my face has swelled out on one side I work in a hospital and had a telephone consultation today with a doctor who asked me questions over the phone one being how many fingers could I fit into my mouth I can only fit one finger in my mouth right now my mouth tastes of blood and it bleeds lots when I try to clean it I have been prescribed anti biotics for now but I am very worried as after I finish the anti biotics I do not know whether I will be able to have the tooth removed due to not being able to even open my mouth properly any help advise is appreciated thank you",
        "input": "",
        "output": "dear patient I read your complete writing and I totally understand your concern your mouth opening is really less now I am sorry for the pain you are bearing the first thing you need to do urgently after reading this kindly begin warm water salt rinse 6 times a day it will surely relax your mouth opening a bit continue your antibiotics and stop as and when said will not prescribe any medicine for now as you are already taking one session of antibiotics cannot continue with this although you can give a gap of days and can again take a five day regimen if it still pains sometimes you can take a pain killer paracetamol or ibuprofen temporarily as you have not mentioned any allergies do revert back for more queries I hope it helps feel free to contact me again kindly keep me posted about the improvements stay safe take care"
    },
    {
        "instruction": "hello this is not an average question but I hope someone may help me a few months ago I have been diagnosed with atypical dermatitis my symptoms were red spots regularly appearing and disappearing they were not itchy except slightly on the scalp and forefront shower was exacerbating the symptoms for about 30 min but a reaction to shampoo and soap were excluded as this was happening even only with water I took oral antifungal on go prescription but nothing changed now for the weird part I work as a pod student in preclinical oncology I often work with mice and I realized that some of the mice I came in contact with were developing red spots the only difference is that while my spots are slightly swallowed on the mice they are deep like the outer layer of the skin is missing the vet said they are not in pain they seem not to spread the disease g mice per cage only with symptoms for several months this happens only on mice I came in contact with the spots on mice extend with time up to 20 of the skin surface for what we observed but causing no mortality the mice used here are mri nude mice lacking linfocytes I think an atypical dermatitis is not contagious so how could it be could my diagnosis be wrong or are the spots on the mice an uncorrelated thing than you in advance for any help",
        "input": "",
        "output": "hi the type of description of your reasons it appears that you are having hives or urticaria it is a slightly raised red or white lesion which occur on the skin and disappear on its on after few minutes or hours this occur due to allergy to some internal or external agent that maybe water in case of aquagenic urticaria had you included a photo I would have helped you more as far as the lesion in mice are concerned you are saying that outer layer of the skin has gone so it actually appears to be type of skin like necrosis and in your case there is no such lesion a typical dermatitis as diagnosed by go is vague term and general term sometime used when you cannot reach a specific diagnosis please send a photo if it is due to water note that whenever you touch water to some part of the skin it happens or not take fexofenadine 120 my once daily for a week and then tell me how much response you have you can also take it as per need like alternate day for every ord or ith day do lot of oiling of the skin dont use harsh soaps and avoid any irritant application thankyou"
    },
    {
        "instruction": "hello doctor it has been more than a month the problem started with gastric issues in my stomach then it started with some stomach irritation and cramps and then gradually I felt like whenever I ate something I feel like going to toilet I reported it to my go and she said to take pantaprazole which I took for two weeks but then the situation was not improving and I insisted then she wrote a stool test for me and in the report helicobacter antigen bacteria was detected she then prescribed medicine amoxicillin 100 my pantoprazole 40 my clarithromycin 500 my which I took for one week on the fifth day I felt like my body has no energy at all anyhow I took the entire days dose now it has been close to two weeks after completing the antibiotics but even today I feel unbearable weakness in the morning after toilet the weakness is so much that I lie down and the body starts shaking for medicines as of now I am only taking probiotics and multivitamin though the frequency of the days when I feel the weakness is reduced but yes once or twice in a week I have it and also when I am having food I feel like going toilet please suggest the best I can do in such situation",
        "input": "",
        "output": "hello you have two problems h pyloric associated dyspepsia for which you received treatment and hope that it will improve you have postprandial defecation and going to toilet which is more suggestive of irritable bowel I will advise to continue your pantoprazole probiotics as per the prescription of your go and take the following medications in addition it will help improve your bowels and subsequently your weakness in two weeks time dyspepsia irritable bowel tablet mebeverine 135 my one tablet three times daily before meals for two weeks"
    },
    {
        "instruction": "hello doctor I am a 31 year old female my right eye is red and very sensitive to light it is painful while I move the eyeballs center of the eye is paining with irritation",
        "input": "",
        "output": "hello a couple of things come to mind when an eye presents like you described red painful photophobic the first one is an eye inflammation officially called an anterior uveitis this is usually an isolated incident it is considered idiopathic which is just a fancy way of saying we do not know what causes it if there is a history of this happening before sometimes lab work is ordered to rule out various diseases those might include things like crohn disease or sarcoidosis or spondyloarthritis for an anterior uveitis there is nothing over the counter ot to treat it a visit to an eye doctor to confirm this tentative diagnosis is in order if you are a contact lens wearer this could be a corneal ulcer those present the same way as an anterior uveitis anterior uveitis again there is nothing over the counter for this if you indeed have an anterior uveitis it would need to be treated with prescription steroid drops and we need to be careful with steroid drops if you have an eye infection the steroid will make the eye infection much worse and steroid drops have other side effects that need to be monitored they can cause cataracts and they can cause an increase in the eye pressure putting the patient at risk for glaucoma nothing can be done to prevent this does not appear to be self limiting I am happy to give you all this information but follow up with a doctor is definitely the next step"
    },
    {
        "instruction": "hello doctor I am having severe heartburn and acidity issue today I got blood in stool and after I felt burn around the anus is anything serious what should I do stool antigen ict result is negative my symptoms are heartburn after eating bad breath from stomach sometimes feeling bump on the right side only in throat while eating or drinking water red bumps on the back of the tongue with white coated color or sometimes yellow on the back of the tongue I also have red acne on back of body after eating need to go washroom for passing stool sometimes I feel burn while passing stool with more gas issues continuously I feel burning at the upper side of the stomach when I eat spicy foods it becomes worse whenever I think I am having issue in stomach it triggers more burn when I woke up I feel dryness in throat and smell comes from nose and throat too any permanent solution",
        "input": "",
        "output": "hello you have two main issues the heartburn and all the throat problem is due to reflux disease which aggravated by your hiatus hernia this disease is controllable with medications but it could not be eradicated you have to change your lifestyle and use some medications regularly for some time and then as per need the blood in stool occurs due to hard stool and burning in the anal area is due to fissure I am giving you treatment and it will help out herd gastroesophageal reflux disease anal fissure capsule dextop 60 my in the morning and evening before meals for four weeks and then only in the morning for four weeks syurp dijex my alumina magnesia two teaspoons three times daily after meals for 20 days diltiazem gel apply at the anal area twice daily fibrocal sachet one sachet two times daily avoid spicy and junk food avoid late night eating elevate the head end of the bed about inches"
    },
    {
        "instruction": "hi doctor I have been very prone to acne and I have pimples and pimple marks almost everywhere on my face for three years even though I use master anti pimple facial wash and master anti pimple cleanser every night it does not seem to be the solution I am about to use skintight body care rejuvenating set and I also have a skinmate shark oil is it fine to use the set with the shark oil can you please suggest a solution is it necessary for me to use pore minimizer are my pimples might be caused by strong products do I have to buy stronger products to get rid of my pimples and pimple marks",
        "input": "",
        "output": "hi pimples present on whiteheads blackheads abscesses over the face this is the spectrum of acne vulgaris which is common at a young age in your case as you have reported there are active lesions as well as active acne this occurs due to androgen production during the young age which leads to sebaceous gland overactivity and their blockage and inflammation it can be cured by drugs as well as general prevention general prevention includes avoiding oily things over the face and over the scalp avoid steroid creams over the face diet has no much role in acne vulgaris some cosmetics also increase acne drug treatment includes capsule isotretinoin 20 my od with meals at night for four weeks clindamycin gel twice daily for four weeks salicylic acid face wash use for 30 seconds daily if there is a lot of dryness due to this treatment use salicylic acid face wash only alternate day take plenty of fluids do not touch the face too often this treatment sometimes has to be continued for three to four months as per response when active acne stops coming acne star are treated according to their type by microsurgery methods please review after four weeks with photo I do not advise taking any other extra tonics oils or any food supplements as they can increase acne I hope this helps"
    },
    {
        "instruction": "i have painful swelling of lateral nail fold of the ring finger right hand I also had chronic paronychia of index finger of right hand for the index finger I used onabet cream twice a day for three weeks on the nailfold completed also loceryl nail lacquer once a week for months I cannot take oral antifungal due to previous allergic reaction so my doctor recommended nadoxin cream twice a day on ring finger nailfold for week along with augmenting 625 my for days I followed the doctor advice but there seems to be no improvement rather the symptoms have aggravated kindly assist",
        "input": "",
        "output": "hi chronic paronychia is very resistant disease you have used almost all treatments which are actually recommended in this case treatment also depend upon the incriminating factors of the disease most of the time it is due to irritant which come in contact of your hand repeated washing also lead to increased fungal growth sometimes on drugs also lead to this condition and some diseases also likes psoriasis pemphigus cancers at other sites of the body so you can tell me if you are having any of these conditions but if not I will advise you following treatment plan according to the history that you are not able to take antifungal and antibiotics and topical has not worked on you kindly follow this treatment for weeks and then tell me with photo how much improvement you have I must tell you at this moment that some cases medical treatment is not successful in such cases some surgical treatments has also been used like complete removal of the nail folds re tacrolimus 1 at night hydrocortisone cream in morning both for weeks tab cefuroxime clavulinate 500mg twice daily for five days avoid cold to body and hands cover your hands with gloves to avoid contact with some allergens you may be exposed review after weeks"
    },
    {
        "instruction": "i having uneasiness in my lower left side of my belly since a year I visited several doctors but the problem persisted despite so many medications and endoscopy first I was told that its a normal infection of my gut and that I will recover after few months of medication nothing such happened I went to another doctor but after medicine intake period is over loose motions and stomach cramps in my lower left side continues I am very much disappointed by the way I lost so much money without treating the core of my problem which I don know as I do not have such equipments at home nor the medical qualifications to treat myself can you help me",
        "input": "",
        "output": "hello I can totally understand your pain I have come across several patients with similar pain most of whom have undergone upper gi endoscopy and lower gi colonoscopy and some have found to have irritable bowel syndrome which is often missed if it is of the mild form it will be apparent on a colonoscopy only when it gets severe I see from your treatment history you have been treated for colitis or the infection of the bowel which is usually the most common diagnosis and subsides after the antibiotics in your case as it is chronic I would suggest a closer look and further investigation so starting with the simplest stool fob stool for ova test if both of them are inconsistent then we may think of irritable bowel syndrome you will have to modify your diet and find out if you have any food allergies avoid any kind of spicy diet and certainly avoid red meat for the time being I will also prescribe a medication which you can take it twice a day for a week and follow up I would like to know if you had any previous surgeries follow up with the stools tests"
    },
    {
        "instruction": "hello doctor I had a white bump on my penis for the past three months it did not cause any pain when I touched it and when I tried to remove it in the shower it did not budge it is single and there was nothing else resembling it that showed up on my penis it showed up maybe a day or two after sexual contact with my girlfriend I am not sure if it is an sad today during the shower I realized it was not there anymore it either fell off or shrank I have not been paying much attention to it the last couple days so I am not really sure I am attaching a picture of what it looked like when I had it and what it looks like now it does not look like any studs I have seen online so I am at a loss as to what it could have been any help would be appreciated",
        "input": "",
        "output": "hi the lesion is not looking like an sad sexually transmitted disease from your history it is asymptomatic and pain free whitish concretions can form due to the collection of subpreputial discharge or it can be fordyce spot wart can be asymptotic and go for spontaneous resolution but it would have spread by now apply mupirocin ointment on the spot clean the area with mild soap observe next time if it is forming again please consult with your doctor and remove it and give for biopsy along with blood tests for sad for reassurance"
    },
    {
        "instruction": "hello doctor I have had a mild cold symptoms over three weeks ago because of this global pandemic I got stressed and started feeling chest pain and abdominal muscle pain etc I did not have a fever like not a single day so I know that chest pain can occur due to stress and anxiety and to make myself feel better I went to the doctor office so my doctor can listen to me breathing with a stethoscope she said that my lungs are totally clear and that there is no strange noises she said that I should take vitamin and I was diagnosed with oral candidiasis now I am feeling a sort of bubbly feeling at the top of my chest and in my throat but only when I lay in bed and I feel like there is something stuck in my throat and I have a bit of discomfort when swallowing so if my doctor said that my lungs are fine what can it be",
        "input": "",
        "output": "hello most common symptoms of couid 19 are fever cough and dyspnea you mentioned you do not have fever cough nor dyspnea so it is least likely you have couid 19 moreso your lungs were clear however since we are in a pandemic observation and self quarantine is still advised yous symptoms of lump sensation in the throat and difficulty in swallowing may be caused by gastroesophageal reflux disease or herd stress may have triggered it I recommend you take omeprazole 40 my one tablet for two to four weeks avoid eating spicy oily fatty and dairy foods avoid drinking alcohol carbonated caffeinated drinks avoid smoking and avoid lying down within an hour after eating I hope this helps"
    },
    {
        "instruction": "hello doctor I have severe groin pain days after sexual encounter I have no lesions or bumps I have prior hav I had no other symptoms but bad pain I had pain in the penis and testicles now three months after I have a tingle in upper thighs and pelvis when laying down at night lymph nodes in groin never swelled but I can noticeably feel them in the groin and are tender after sex or to touch I have been painful for years on and off though but not as bad as now I have tingle weird feeling in testicles when sitting down during the day no outbreaks ever I am thinking and scared it is hav what is going on i'm and egg are negative six weeks after sexual encounter what else could possibly be causing this",
        "input": "",
        "output": "hi generalized body aches are most probably not due to any sad sexually transmitted disease if there is no swollen lymph node again it is not sad hav herpes simplex virus do not present like that it has blisters which periodically you should not worry about that if there is no burning micturation no discharge from the urethral opening no itching over the penis no ulceration on the penis it is probably not sad but still you should avoid unprotected sex for these symptoms you can take paracetamol tablet sos azithromycin 500 my once daily for five days and show to the physician as these are medical symptoms"
    },
    {
        "instruction": "hi doctor I was having a small boil under my lower lip edge and I pressed it and opened the pus my lower lip is fully swollen with yellowish and there is a small cut while pressing for pus this is very painful now",
        "input": "",
        "output": "hello welcome to icliniq com according to your statement you have a boil under your lower lip edge and your lip is swollen after pressing it is painful too boil is a skin infection caused by staph aureus and its aggravating factors are do diabetes mellitus immune compromised anxiety etc you should continue your current medication you can add flucloxacillin neoflox for 14 days along with your antibiotic cephalexin as it is caused by staphylo aureus apply warm compresses and soak the boil in warm water when the boil starts draining wash it with an anti bacterial soap until all the pus is gone and clean with rubbing alcohol if any complications occur please inform me I will try to help you further"
    },
    {
        "instruction": "hi doc good morning I have been having really bad headache for weeks now its a throbbing headache that affects the front and back part of my head I also notice that it gets worse when I am lying down there are times I vomited also last week I noticed that I have fever for days but the fever went away this week I tried drinking painkillers to last week medical seemed to work but I noticed the headache was getting worse and the painkiller is no longer working",
        "input": "",
        "output": "hi good morning headache vomiting starting with fever is suggestive of infection we need to rule out meningitis and raised intracranial pressure my questions do you have blurring of vision or double vision do you have neck rigidity you will feel like stiffness and pain in back of neck you will not be able to touch your chest with chin if any of the above is there please consult locally as early as possible to your go neurologist if above things are not then you need to do two things get on mri brain with contrast done to look for invective focus or parenchymal lesion get your eyes checked for pappiloedema to look for raised intracranial pressure meanwhile you can take pantoprazole and domperdon pantocid before breakfast take tablet naproxen 500mg in place of medical when required for headache thank you"
    },
    {
        "instruction": "hi I have a problem in throat for the last one month initially I have a stomach problem so I just start stomach relief medicine like rebicid and gavascone syearup I feel better after some days and now my stomach is good but I have a problem in the throat I feels like some thing stuck in my throat and it irritate me a lot and I am feeling this for the last one months I was feeling good after 10 days and 10 days of the middle of month was good and I was not feeling something stuck feeling but after 10 days again I am feeling that something stuck in my throat and it irritate me a lot and sometimes I lose body energy and I feel weakness and also a little fever I have a history of depression and anxiety I was taking anxiety and depression medication for 6 years approximately 10 years ago for the last 10 years I am not taking any anxiety and depression medication I have a stomach problem herd but I was okay for the last 3 years now again I have a herd problem I think due to this I have a throat problem that I am feeling that something struck in my throat please advise me what should I do due to couid 19 I have no facility to check the ent specialist I will be very thankful",
        "input": "",
        "output": "hi your prediction is almost as right as what I am also considering the most common reason of having this irritation in throat with a feeling of lump or something obstructing while swallowing can definelty be a feature of chronic herd eve though you might asymptomatic in between the inflammation in the throat often exists in the hidden form and can resurface when adequate care is not taken what can be done these precautionary measures have to followed for life since your chronically have gastric issues maintain a strict diet eating on time avoid spicy oily and cold food drinks keep a gap of his between meals and going to bed don over eat rather keep your stomach half empty and have regular intermittent light food like fresh cut fruits in between major meals salt water gargling to 10 times a day for 15 days follow the prescription as advice and you can come for a follow up consultation after weeks tab pan 40 my once in the morning before fast for 14 days spy mucaine gel top three times a day 20mins before meals for 14 days"
    },
    {
        "instruction": "respected doctor I need few clarification on how to protect testicle of us and right foods to eat for good testicle as well as for prostate and scrotum health also provide how one can prevent cancer in these areas like prostate testicle and scrotum",
        "input": "",
        "output": "dear hope you are doing well very nice question at a very young age I must say diet things to avoid things to eat more if I come specifically for avoidance of prostate cancer then in non veg fish salmon sardines as these containers omega fatty acids berries strawberry blueberries raspberry blackberry as they contain antioxidants green tea as again contains antioxidants broccoli contains phytochemical tomatoes as it contains lycopene which is also good antioxidants for scrotum health as it is a skin covering over the testicles you have to do things like you do to take care of your skin anywhere else like keep proper hygiene proper cleaning with soap and water everyday avoid unprotected sex with unknown partner etc I tried to answer your questions as far as possible thanks regards feel free to ask anything else you have any query related to sex education or related to keep your kidneys and bladder healthy"
    },
    {
        "instruction": "i am hoping you can give me some answers insight about what I can do for health optimization going forward about myself I recently turned 25 and have been lifting weights seriously since 18 years old I am 198 labs and about 14 bf when I was 19 I did an anavar solo cycle with clomid put and I did one halodrol cycle at 21 with another month of clomid put I have been off all anabolic since and wish I had never touched them I have some fear that this brief usage impacted my hormonal profile going forward my recent hormonal panel at 25 was a total test of 535 no do estradiol 30 pig do and I had a ash of 9 do you think the brief usage impacted my natural hormones going forward I wish these levels were higher as I do not have the libido that I used to however these are totally within the normal range and I would not do anything but low dose clomid or aromasin to slightly increase could this work would watching these levels and starting try at 30 be a healthy decision would you pursue levothyearoxine to get ash below 5 I am starting medical school soon and mainly trying to start with confidence in my health",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello doctor I am 30 years old I am facing premature ejaculation and my ejaculation time is less than one minute please help I am currently taking prodep capsules daily",
        "input": "",
        "output": "hi do not worry it is completely curable you need to send me a detailed history of your condition including the onset and progression dietary habits and addiction then we can proceed with your treatment and please stop prodep fluoxetine because it will do more harm than good follow up after two days with detailed history"
    },
    {
        "instruction": "hello doctor I have a circular rash beside my nose and did not subside I have tried antibiotics face cream and face wash nothing seems to work it does not itch though it burns when it is really hot",
        "input": "",
        "output": "hi welcome to icliniq com I went through your case I need to know the following things before arriving at a final diagnosis what is the total duration since it first appeared is it sensitive to touch does it burn in sunlight any similar lesion elsewhere in the body is it thick on pressing I need a clear photo to see if the skin over it has any scale or you ever notice any scale over it any variation in size or always progressing and never became normal please reply to the questions die discoid lupus erythematosus tina faciei facial granuloma hansen pile polymorphous light eruption"
    },
    {
        "instruction": "hello doctor I am 16 years old my eyes were yellow alt level was 26 hepatitis result was 4 my I went to a gastroenterologist for checking and he prescribed me few medicines siliver sulvorid dexxoo in the follow up he prescribed me ipride after taking that medicine I am having loose motion and feeling cold now",
        "input": "",
        "output": "hello from your symptoms and your test reports it looks like you have viral hepatitis particularly hepatitis viral hepatitis affects your liver cells and causes their inflammation which can lead to dysfunction in the normal functioning of the liver the disease can vary from being self limiting to highly fulminant hepatitis has been known to lead to fulminant hepatitis which has quite a high mortality the course of infection has two phases the prodromal phase and the icteric phase prodromal phase symptoms include myalgia arthralgia fever anorexia nausea vomiting weight loss dehydration and right upper quadrant pain icteric phase symptoms may last days to several weeks and include jaundice yellowish discoloration of skin and eyes dark urine light colored stools itching pruritus I would request to see a doctor and get admitted as soon as possible for further evaluation your liver enzymes have to be monitored regularly along with it in prothrombin time report to see whether liver is synthesizing the clotting enzymes well now coming to the treatment acute hepatitis in immunocompetent persons usually only requires symptomatic treatment as almost all of them are able to clear the virus spontaneously the acute illness may result in anorexia nausea and vomiting predisposing patients to dehydration these symptoms tend to be worse in the afternoon or evening patients should attempt to ingest significant calories in the morning as they improve frequent small meals may be better tolerated hospitalization should be considered for patients with dehydration ribavirin an antiviral drug is reserved for people who worsen you can continue taking dexxoo dexlansoprazole stop pride itopride hcl if it causes loose stools eat light food and drink plenty of fluids take tablet paracetamol 500 for fever consult a doctor immediately if you think your condition is worsening I hope this helps"
    },
    {
        "instruction": "hello doctor I have noticed a scar like bump on my penis shaft and it has not gone away for one month since I noticed it I did have sex related sore in the same location several months earlier for what I believe to be friction burn but have not been sexually active since one month the mark does not cause me any discomfort and no change in appearance since I noticed it",
        "input": "",
        "output": "hi is the bump itchy or any discharge present if itching present then whether it is more at night when you had it the first time did you took any medication for the same or it went of its own in how many days what about the size at that time do you have any history of unprotected sex with a new partner two or three weeks prior to this lesion are these lesions present anywhere else on your body or on the body of your partner are you diabetic or hypertensive or any kind of medications unrelated to this also"
    },
    {
        "instruction": "hello doctor I am 25 years old unmarried I think my penis size is small because of masturbation I have a problem with ed I would like you to suggest medicine for these two problems",
        "input": "",
        "output": "hello before jumping to any treatment follow the advice as given below you are indeed developing signs of ed erectile dysfunction you also seem to have exaggerated guilt of masturbation understand that 90 of males start masturbation by the age of 14 rest 9 start after 14 so virtually every man masturbates it is a normal male sexual behavior if done in moderation but excess of everything is bad we may need reports of the following tests to rule out the physical causes of erectile dysfunction abc complete blood count to ash thyearoid stimulating hormone hba1c glycated hemoglobin serum testosterone serum prolactin to rule out psychological causes please answer the following questions how is your mood how are your energy levels how is your appetite do you have any sleep disturbances or do you oversleep any past history of anxiety or depression any family members suffering from anxiety or depression please respond and send me the reports to make a complete assessment"
    },
    {
        "instruction": "hello doctor I have pain in the upper right abdomen the pain goes to the back and side especially when I sleep on the side sometimes the discomfort is in the middle right and lower abdomen I have taken a it scan of the abdomen and pelvis with iv contrast I had an ultrasound done a few months ago which revealed grade fatty liver I feel tired all the time I have gained keg within four months I also get frequent leg pain and weakness especially in the morning when I wake up I had vitamin b12 deficiency and have taken 15 injections before three months I have a lot of gastric issues with this as well I am uploading my it images please help",
        "input": "",
        "output": "hi I have seen the attachment the it abdomen scan is showing mild fatty changes in the liver and a left inguinal hernia the ultrasound scan abdomen is showing fatty changes in the liver the upper gastrointestinal endoscopy report is showing a small hiatus hernia the blood test is showing upper limit of normal sept serum glutamic pyearuvate transaminase and got serum glutamic oxaloacetic transaminase the contrast it scan images of the abdomen are viewed the fatty changes in the liver are not significant such fatty changes are visualized in many people however if you are having a high fat diet or alcohol regularly then you need to discuss with your doctors and take precautions the hiatus hernia is a small herniation of the stomach above the diaphragm this causes discomfort on bending down please avoid bending frequently avoid lying down for two to three hours after a meal avoid smoking take meals in small amounts if you feel discomfort when eating too much for the left inguinal hernia you need to consult a surgeon and take an opinion it might need surgery and repair coming to the pain it is possible that the hernia can cause pain in the lower abdomen at the same time other causes of weakness need to be discussed it will help to know if you got a complete blood test done other than given liver tests and vitamin b12 test and if there are other areas that need attention"
    },
    {
        "instruction": "hello doctor I need a urologist to look at my labs I also have prostate spa biomarkers like total spa free spa and prostate specific antigen free ratio",
        "input": "",
        "output": "hi let me tell you your reports are absolutely fine this ratio has got significance only when your total spa prostate specific antigen level is out of normal range you can repeat this test annually no intervention is required right now some of my questions are why did you get spa done as it is not indicated at 31 years of age do you have any urinary complaints frequency urgency poor stream nocturia dribbling etc do you have any previous episodes of ti urinary tract infection are you diabetic or hypertensive or on any medications"
    },
    {
        "instruction": "when I lift my left side of my lip it feels like a muscle is pulling it is just to the left of my nose my face is not drooping nor is my mouth I do not see any red or white spots and there is no pain it just feels weird it started about a week or so ago I do not smoke",
        "input": "",
        "output": "hello your description of your symptoms sounds a bit strange to me but if your lip moves involuntarily then you may have muscle twitching due to too much caffeine if you drink a lot of coffee but there are also other less common causes if you have tingling this could be an early sign of recurrent herpes infection though it lasts only a few days before the vehicles start to appear and one week is a long time there may also be a spasm in your lip muscles so try hot pads on your lip for starters to relax the muscle and if you take a lot of caffeine reduce your consumption and eat foods rich in potassium like banana if you start to feel tingling or see any redness in that area you may need to consult a doctor an oral medicine specialist or dermatologist for an antiviral prescription there are other rare possibilities that may be the reason behind your symptoms but as they are uncommon I would not worry about them at the moment having said that I suggest seeking further medical attention if you do not improve after a few days"
    },
    {
        "instruction": "hello doctor I am a 17 year old female there is a milky vaginal discharge that I have been experiencing every day for six consecutive months the first time I went to a doctor was when I was experiencing a cottage cheese like white discharge with super itchy feeling and burning sensation when urinating the doctor gave me itraconazole sporanox and imiquimod aldara it got better my white discharge started after that but I did not mind it because it was not accompanied by itching I went to a different doctor again because I was experiencing a cottage cheese discharge again with itching she gave me clotrimazole vaginal tablet the only problem I have now is I am having a white milky discharge every day it does not seem normal to me",
        "input": "",
        "output": "hello some amount of vaginal discharge is a normal phenomenon but if the discharge is thick white like curds and offensive in smell or is associated with itching then it is candid or yeast infection if you again having the cottage cheese like thick discharge with itching you start taking clotrimazole vaginal tablets for seven nights along with a tablet fluconazole which you need to take by mouth single tablet maintain a good genital hygiene try to change your undergarments twice daily if there is no itching and not a thick curly white discharge then rest assures it must be a normal vaginal discharge check your blood sugars fasting and postprandial tablet fluconazole 150 my by mouth single dose clotrimazole vaginal pessary for seven nights continuously"
    },
    {
        "instruction": "dear sir I have right side throat pain from last months when I take the antibiotics then pain is gone when I stopped antibiotics it will start again doctor said it is pharyngeal wall congestion how I can cure from this disease kindly help me",
        "input": "",
        "output": "hello good to hear from you I understand your situation the typical recurrent pain you complain might be because of the following most common causes chronic tonsillitis pharyngitis chronic gastritis persistent post nasal discharge as you say it is subsiding with antibiotics it might be because of a recurrent infection whatever be the reason firstly start yourself on the medication I suggest later make certain lifestyle changes medication tab amoxyclav 625 my twice daily after lunch for days tab aceclo plus twice daily for days tab panto der once daily before breakfast for 15 days betadine gargle 10 my in 150ml of luke warm water thrice daily after food for days life style changes avoid cold food make sure the food and water you take are hygienic avoid spicy food eat on time dont let your stomach be empty for more than his do not sleep soon as you eat infection"
    },
    {
        "instruction": "i have severe pain in my upper abdomen possibly because of an acid reflux and I cannot sleep after eating I feel a sudden pain in my upper abdomen or more specifically in the epigastric region last week I am surprised that even though I do not have any problem digesting milk or dairy products I got suddenly become lactose intolerant after drinking an sterilized milk I thought first it is just a common digestive problem so I take loperamide however after a few minutes I suddenly feel the symptoms of a heartburn so I take kremil is there is a home remedy that can lessen the pain",
        "input": "",
        "output": "hello I am a family physician with icliniq and would be glad to try and answer your question thanks for all the information you gave about your question whenever you share with us a problem it is always helpful to the doctor when you give information like when the problem started it is location and severity other accompanying symptoms like diarrhea vomiting fever if you have had it before and what response there has been to treatment also it is important to know if a doctor has seen you for this problem in the past whether you smoke or drink and whether or not you have other medical problems for which you regularly take medicine there can be many reasons for upper abdominal chest pain in your age group I will list them for you as well as the most common treatments if none of these help you would need to contact us again with more information gastritis ulcer disease can cause severe pain and sometimes bleeding in the upper abdomen you might have dark stools feel dizzy from loss of blood or have lots of soreness to touch in your belly often patients do better when they stop taking any pain medicines like aspirin or ibuprofen which can irritate the stomach and use a proton pump inhibitor like omeprazole 20 my 30 minutes before breakfast every day for weeks some people use a 2 teaspoon of baking soda in a 120 my glass of warm water which can help but is not used regularly another problem is acid reflux it is very similar to gastritis but usually causes heartburn as the acid goes up into the esophagus in the chest it also responds well to omeprazole abdominal pain can come from stress which irritates the large intestine loperamide often will help that pain usually 4 my at a time when you feel the paint up to times a day a stomach and intestinal infection can cause pain it is usually accompanied by diarrhea and sometimes fever most stomach infections respond to loperamide and increasing your fluids gallbladder disease stones can cause intense pain especially after meals that are fatty this problem is best diagnosed by having an ultrasound done and seeing a surgeon pancreatitis is an inflammation of the pancreas which is often caused by drinking alcohol there is often very severe pain and vomiting patients can get better by stopping any alcohol and not eating for 2 days often they need to see the doctor lastly couid 19 the virus which is causing the pandemic worldwide can cause diarrhea fever and cough it is always wise to think about whether or not you have had contact with a patient who was diagnosed with the virus and consider getting tested as always any problem that is not getting better or is getting worse despite what you can do at home needs to be seen by a doctor hope this information is helpful to you"
    },
    {
        "instruction": "hi doctor I am 25 years old I am a breastfeeding mother for months baby I have a sore throat from yesterday and feel difficulty in swallowing with light fever but not continuous today my right eye is slightly reddish and I had a cough again but not continuous currently I am taking azithrol rantac and monte these medicines were given to me while I had a cold before month doctor said to continue it if I had further cold I am frightened to go to doctor in this pandemic time please help",
        "input": "",
        "output": "hi thanks for sharing your medical info with us I totally understand your concern and I will try to recommend the best you can take to help you relieve your symptoms please do not take montac and rantac since they are not the best options for your current situation you are dealing with an upper respiratory tract infection so you need relevant medications take azithromycin tablet two tablets on the first day then one for the next five days loratadine tablet is recommended if not available go for fexofenadine both are perfect antihistamines with minimal to zero side effects they are non sedative unlike others tylenol is alright it helps with the fever and generalized symptoms also safe while breastfeeding try an herbal cough depressant the ones with ginger and honey take lots of fluids and I also recommend a bit of isolation at home for a tiny chance of having the virus I hope this helps"
    },
    {
        "instruction": "hi doctor I had an ultrasound last week and I just got a few informations they said that my baby was around weeks and days with a heartbeat and measuring my but they did not said about the frequency I had a brownish discharge this week and I did a blood test and the beta hug was growing since my last beta hug that was on saturday I am with a few cramps with progesterone and bed rest because of this brownish discharge is there any chance that I may have an abortion I am very concerned and everyone is freaking out because couid 19 and they do not want me to have another ultrasound should I need to be concerned",
        "input": "",
        "output": "hi I have seen your reports as of now you are on the best treatment possible to prevent abortion as your gynecologist has already started you on progesterone too because of your spotting which is helpful in supporting the pregnancy yes definitely having spotting in early pregnancy can pose you for risk of miscarriage but there is nothing more anyone can do that start with progesterone supports and take good rest stay positive and everything should be fine hopefully avoid going out unnecessarily as the risk of couid 19 can be more life threatening once the crisis gets over you can follow up with your gynecologist for a follow up scan to check for the baby heartbeat bed rest continue progesterone avoid intercourse"
    },
    {
        "instruction": "hi doctor for the past eight months I have been struggling with brain fog tension headache fatigue and inability to concentrate I have been trying to identify the source of my problems with no luck an mri of the brain coincidently showed fluid retention in the left maxillary sinus so I have done a it scan of the sinuses to confirm the findings I need to mention that I smoke water pipe shisha and after smoking I find mold growth in the humid parts of the shisha so I thought this must be fungal sinusitis in addition to the previous symptoms I sometimes feel pressure behind my right eye and I always feel sputum in the back of my throat my doctor thinks that the sinus in the it scan is minor and would not have contributed to my issues please suggest an opinion I am currently taking lexapro 10 my",
        "input": "",
        "output": "hello as per your it scan there is some mucosal thickening in the left maxillary sinus and some inflammation in both posterior ethmoid sinuses the nasal passage are very much compromised the turbinates are hypertrophied this may be due to sinusitis as well as your smoking shisha the findings explain the dullness you might be feeling behind the eyes and on cheeks the occasional headache and pressure behind the eye this however does not explain the brain fog tension and fatigue you will be benefited from some sinus medications you should quit shisha you will need to use steroid nasal spray for many weeks you will need an antihistaminic also however since the nasal passages are obstructed the medicines may not reach the destined areas if we encounter that problem we will have to think of surgery but for now you start on a steroid nasal spray and antihistaminic"
    },
    {
        "instruction": "hello doctor I have a back pain that earlier moves to my right leg through hip knee and unto downside of foot for last one year it has been started in left leg also though left side pain does not move to foot but at hip it pinches like a needle while driving specialy now during lock down due to excess use of mobile and sitting etc pain and stiffness has been started in my neck that moves from left back side of neck to head sometimes though I have started some yogasans with help of tube but have no relief rather it is increasing I think earlier I had taken physiotherapy for month but all in vain kindly help me and suggest me some exercise or yogasans if possible online",
        "input": "",
        "output": "hi I got your point and understand how you feel when it pains as per mri reports you mentioned its a la low back ache which radiated to leg and now shifting to left lower body as well and about your clerical problem may be there is a nerve compression and that neck pain radiating to shoulder if ignored it will pass through arms so I suggest you some best and pain relieving exercise and ply follow it if you want to reduce and stable the pain actually you need ift and ultrasound therapy for weeks with immediate effect but may be not available due to lock down but at home you can try the following which is also very effective in reducing pain apply diclofenac ointment in the area of pain mainly at lower back neck shoulder and knees and cover it for 10 15mins with a cloth then clean it with warm water following hot water fermentation repeat this twice a day and if lawn is severe you can take zerodol tablet once a day exercise to be done are as follows lower tummy strengthening it is important to strengthen your lower tummy muscles because these muscles work in partnership with the lower back deep abdominal strengthening bridge pelvic tilts lowe back stretch leg stretch piriformis stretch these exercise need to be done daily once for first week each exercise 10 times and two sets of each and for cervical do the following neck stretch neck tilt neck turn head rotation these exercise will help in reducing cervical pain and strengthen muscles please do not over pressure while doing it as it may increase pain so do all the exercise gently and in a proper posture if you can get a mri report it will be very helpful to study further about the condition as you pain history is long so it takes easily 4 months to complete the treatment hope you will follow the treatment plan as advice follow up after days over audio call if possible take care thank you stress improper posture mri is cervical pain disc bulge exercise and medicines zerodol diclofenac no forward bending no heavy object lifting days"
    },
    {
        "instruction": "hello dear doctor my mother had a issue about her abdomen it has been or maybe nearly month she is felling an unusual pain in the abdomen which is accompanied by bloating and severe intestinal gas we saw an expert doctors one of them said the gallbladder is oily after seeing the result of the ultrasound and another doctor said the bile duct is dilated and due that he recommend us to take mrcp image and we did that and receive images but due to corona virus outbreak and especially my mother age which is 54 years old we afraid to go to hospital and show that to the doctors which recommend us to do mrcp and we cant make online contact with him maybe to be helpful and for more information my mother has been using opium for 25 years I will really appericiate if you help us thank you for your attention best regard",
        "input": "",
        "output": "dear great to meet you welcome I reviewed the history and mrcp report of your mother oily liver or gall bladder is not an issue her biliary ducts are dilated but the is no obvious cause of dilatation there is no stone or tumor in it may be secondary to chronic use of opium but it will needs further evaluation by endoscopic procedure called ercp but in my opinion that is not an emergency meanwhile start using following treatment and it will help out in her symptoms opium periampullary lesion ercp lots abc periampullary lesion opioid induced opioid induced sod dysfunction tab levosulphride 25mg three times before meals"
    },
    {
        "instruction": "i was wondering if I can speak to someone about pain while insertion ive never been able to insert a tampon and I experience discomfort and a blockage when I try to insert a finger it is most likely related to psychological and irrational fear of sexual activity and also stress im afraid to ask my doctor about this and plus with the pandemic I cannot see a doctor expect for emergencies or id like to see if there are home solutions it is even frightening to ask on here so",
        "input": "",
        "output": "hello hope you safe I understand your anxiety many people do have this issue but with slow and persistent efforts you can overcome it from your history I realise you are slightly on the bulkier side if you could try and reduce your weight say about ekg in the next 2months will feel considerable difference in your sexual interests too please take care of your vaginal hygiene too to avoid itching etc please get your thyearoid and prolactin also tested meanwhile once the pandemic is over plus get a gynaec to examine you becoz at times a rigid hymen or a septum may be the problem since you mentioned a blockage later if these do not work we can try vaginal dilators which are available in the market hope this helps"
    },
    {
        "instruction": "hello sir madam actually my father has do hen psoriasis and psoriasis arthritis now from some days he has neck stiffness sudden severe head ache pain usually start from back of the head or temple side pain start anytime throungout the day weakness in leg hand tingling walking weakness sir the is suddenly occur or times a day please help gabapin 100mg betacap 20 my and naxxdom 250 at sos these three medinice are recently prescribe by local medical note I have latest it scan available",
        "input": "",
        "output": "hello welcome to icliniq the symptoms that you have mentioned in your father suggest towards brain infection or meningitis encephalitis or cerebral vascular accident ca which means either a bleeding from the vessels or blockage in the vessels the good thing is that the most lethal out of the above which is bleeding in the brain has been ruled out by the it scan the other things still need to be ruled out by some more evaluation based on all this I will be able to narrow down my differential diagnosis but you still need to visit a doctor in the hospital where they would examine your father completely and will be able to come to a diagnosis your father might need a lumbar puncture test in which a needle is inserted into the back to take minute quantity of csi which is the fluid that circulated around the brain to come to a diagnosis and for all these things he would need to go to the hospital also an mri scan may be required as a it scan only picks up gross abnormalities and some pathologies may be missed in the it scan mri brain lumbar puncture abc renal function tests liver function tests ca meningitis meningoencephalitis migraine meningitis to be decided after the investigations follow up with the above reports"
    },
    {
        "instruction": "hello doctor I have nerve pain in my left hand I had fallen from a bike last one week since then I thought it was muscle pain today I consulted an is ortho and he said there is no issue he gave medicine for pain relief I was feeling nerve pain in the left hand and the pain is getting severe at night currently I am taking lupiflex panto and enzoloy",
        "input": "",
        "output": "hello welcome to icliniq com I would like to know some details about your symptoms in which part of the left hand you have pain at shoulder between shoulder and elbow at elbow between elbow and wrist at wrist or in palm and fingers what kind of pain is it stretching or heaviness or pins and needle sensation burning type or some other type is pain persistent or intermittent do you have any neck pain also is there any weakness in left hand grip have you noticed any factor which increases or decreases the pain like neck movement arm movement gripping something in hand touch or pressure at some point was there any swelling or redness at the site of pain please revert with above mentioned information if possible also send pictures"
    },
    {
        "instruction": "hello doctor I have a sore throat since this wednesday my dad is a doctor and he gave me augmenting every 12 hours the pain has not gone yet but I feel like an object anytime I swallow it hurts and it feels dry and sore just on the left side it is been a few days but nothing new yet it hurts everytime I swallow and it feels full and pressured there is some yellow mucus close to the crypts but cannot understand if it is a stone or infection I tried to remove possible stones but ended up making my tonsil bleed every time I try to clean possible stones and garbled with salt and water I am really afraid it is something bad I am 24 years old",
        "input": "",
        "output": "hello your tonsil looks infected I can see pus coming out of your tonsil you complete the course of augmenting take it for seven days go 12 hourly along with that take plenty of fluids at room temperature I not very cold and not very hot do mouth gargles combination of chlorhexidine and benzydamine three times daily for five days which will soothe your throat as well as remove debris from the crypts take proton pump inhibitor pantoprazole 40 my twice daily on empty stomach for a week and also paracetamol 650 my thrice daily for three days do take all the medicines just augmenting is not enough do not touch your tonsils and do not try to remove the debris with fingers also if possible send more pictures of your throat I want to see your right tonsil and posterior pharyngeal wall clearly"
    },
    {
        "instruction": "hello doctor I have small rashes in pubic area I masturbate with a fabric usually so thinking this might have irritated it in small scales I used neosporin on it and it healed I just heard people can get herpes with mild symptoms or be asymptomatic the itchiness at first is what worried me no blisters or lesions just white scaly flat skin please suggest",
        "input": "",
        "output": "hi scaly itchy rash in your pubic area is fungal infection exacerbated by irritation due to fabric you have to be gentle with yourself and use ample lubrication like oil and it should not be irritating as it is going on since year as I can make out from the history you have given and it responded to neosporin there may be a secondary bacterial infection as you worry about herpes simplex do cause lesions in genital area but lesions are different they occur recurrently like every month or every two or three months in susceptible individuals the lesions in you are not suggestive of herpes simplex they are like blisters even if you may be infected with herpes simplex if you do not have lesions you need not worry you will never have you are actually immune to herpes but still can transmit to others for the present lesion I advise you not to irritate the area do not use invective things over the area and keep it clean and dry do not use any harsh soaps or solutions which may irritate for fungal infection I advise you tablet terbinafine 250 my be for two weeks with meals for itching tablet loratadine 10 my od for 10 days or when itches terbinafine cream twice daily for two weeks mometasone cream once daily for five days mupirocin ointment twice daily for five days review after weeks fungus oh scrapping herpes genitals tina cruris antifungal and general measures avoid irritant use moisturizer be gentle"
    },
    {
        "instruction": "my head hurts but only on the right side specifically around the area of my temple sometimes the headache spreads to my right eye the pain in itself is tolerable but every time I lay down to sleep it becomes more painful next to that my stomach also hurts since the other day I feel nauseous too earlier this morning I experienced a weird thing at breakfast I was feeling nauseous and then suddenly my eyesight was blocked by this wall of black and white dots my ears were ringing I closed my eyes thinking it was just an illusion but when I opened my eyes the wall of black and white dots was still there I felt really weird all over my body too there was this tingling feeling on my limbs and when the wall of black and white dots finally cleared up a bit I looked down and I was surprised when I felt the wetness between my legs I urinated I did not even felt it until I saw the puddle below my feet I felt like I blacked out my blood pressure is 90 70 temperature is 36 or is 85 resting pi is 1 and blood oxygen saturation level is 97",
        "input": "",
        "output": "hello thank your for reaching out your headache may be a of migraine type I would recommend you take celecoxib 200 my tab twice a day for pain and topimarate 25 my tab at bedtime for week I would then recommend further consult done after week of taking topimarate I would also recommend that you check your abc to check for anemia and your serum electrolytes since you mentioned you blacked out the results will help us understand your condition better is there anything else I can help you with"
    },
    {
        "instruction": "last monday we went to the hospital to check what is on me before we go there I feel that for days long I search about the symptoms and the internet says it is migraine but when the doctor have checked me they said it is just a tension headache he gave me a medications openadrine citrate paracetamol for my headache and benadryl for my night sleeping pattern problem I have taken these medicines for days now I can say that these meds are not enough to deal with headache and also with my sleeping day after the check up afternoon I eat food that triggers the migraine they said its a tension headache so I thought there is no effect for me I also take the meds they recommended to take those meds every hours or 12 hours sadly it triggers me to the point that I slept with the pain I end up being awake in the evening around 30 0pm 10 am I tried to eat but not the foods that triggers migraine because I know that it happens again if I try again after I eat I take the my meds for my headache and sleeping pill medicne just to feel sleepy it takes hours when I get to sleep it 12 when I fall asleep but I wake up again at 2am after that I cannot sleep again and I feel the pain in me I feel fatigue in my whole body and a mild headache that different headache that I feel compare to the previous headaches I felt I spend the night sad feeling nervous and confused all I want to do is to cry and I cannot stop myself day it am when I feel better I tried to eat for my meds it feels like the pain is like already gone but I still took my med for assurance that I okay so I take my meds around 9am 12nn after I took my med I feel something a mild headache so I end up go to bed and sleep to not feel the pain when I wake up around 7pm I feel hungry and its different from the days before I checked up by a doctor because before when I eat more the more the headaches occurs but that time its different because I feel hungry and that caused the headache after I eat I took my meds and this time I took my meds earlier to make myself sleepy before 1pm so took my meds 9pm and I sleep around 1pm 1am that caused me stressed and I end up crying again I feel so hot and outside the body and inside the stomach I dont know what to do that time after that I tried to make myself busy to eliminate stress I tried to watched a drama even though I know that it also triggers me everytime I feel sad or happy or highly emotion in the drama but that night it was different I spent the night with that drama from am to 8am day again I feel okay I try to ride a bike to excerise my body to get tired to help my sleep pattern be normal so I ate breakfast before I ride a bike it feel like normal and eat lot compare to the other days I stop exercise at 10am and I took a bath because I smell bad after that I watched a drama again from 1pm I dont know why but I feel that my stomach is still full so I continue watching until 30pm I took my lunch even I still feel im full cause my tummy says I hungry so I took my lunch and I didn't take my meds cause I know it still gives me headaches so I dint take it I do not feel headache but I feel my stomach looks like burning cause its hot inside so I search it on internet and its say stomach burn this was the point when I realize that I have this last night and today I was hoping if its still just a tension headache or it turns out into other decease I have seen some information to the internet about migraine stomach burn acid reflux they said it was a gastric headache I want to know your approval if what is true about what I supposed to do now thank you",
        "input": "",
        "output": "hi the difference between the pain of migraine and headache are that migraine pain has a throbbing quality and many people report even slight physical exertion such as walking up a flight of stair case may worsen the pain in contrast the pain associate with tension type headache tends to be more chronic and steady also in migraine one can feel aura means person knows that he or she is going to get headache I think you have provided non of such details so I am assuming on bases of your history that it looks like tension headache take care"
    },
    {
        "instruction": "hi doctor I have a few small painful bumps at the back right side of my tongue on the skin that attaches to the mouth in front of the right tonsil bumps are hard and I have lots of pain when swallowing only on that one side not throat I have a burning sensation and swelling",
        "input": "",
        "output": "hello according to your statement you have been suffering from a few painful hard bumps at the back right of the tongue and in front of the right tonsil and feel uncomfortable during swallowing usually inflamed papillae or taste buds are small painful bumps that appear after an injury from a bite or irritation from the hot foods herpes is a common viral infection that can develop blisters on the tongue or gums oral herpes is contagious and can spread through saliva direct contact sexual exposure etc canker sores may appear on the tongue which are red white or yellow in appearance and can feel raw and very painful some foods seem to trigger bankers sore again food intolerance and allergic reactions may cause bumps on the tongue and it may swollen an infection in the mouth or on the tongue may cause swelling and pain at the site of the infection people with syphilis sometimes develop tongue sore as an early symptom of the disease and can contract the infection through direct contact during vaginal oral or anal sex people with oral thrush usually notice rough white patches on the tongue and there is often redness and a sour mouth as well it can result from do diabetes mellitus hiv nutritional deficiencies some medications like corticosteroids etc even to tuberculosis carcinoma can develop bumps on the tongue treatment depends on the causes of the bumps you can use antifungal medication antibiotics antiviral medication and maintain good oral hygiene you should provide some additional history like smoking substance abuse previous disease medications history of sexual activities fever etc"
    },
    {
        "instruction": "hello doctor I have acne inflammation on the hair follicles on my butt for a long time which goes on and off but the marks and blackness of skin have been there forever the marks are dry and persistent when a particular one dries the skin can be easily pulled off and it often has a tiny whitish needle in the middle it does not pain but the marks are really bad I have just used home remedies like aloe vera and conut oil please suggest a lasting solution",
        "input": "",
        "output": "hi I went through your case though photo are bit blurred upload a clear one if possible characteristics you mentioned are spines dry and their persistence but again you said they go on and off I can see some are having small pus that is important make it clear if they are always or have any seasonal variation you did not mention itching I want to be clear do they itch or not do you have a history of allergy in the form of itchy rash are these bumps only on buttock area or elsewhere also like elbow neck etc did they ever make large pus filled abscess do you have any other medical conditions it is a chronic and rare disease but to be sure I need above history then I may advise you a biopsy to confirm the diagnosis constitutional biopsy for he histopathological examination keratosis pilaris lichen spinulose and follicular eczema ureative20 cream in the morning tretinoin 05 cream at night moisturizer review with history and photo then plan further"
    },
    {
        "instruction": "hello doctor I am a 32 year old female whatever I eat within one hour I am urged to go to the toilet my stomach hurts every time I go to the toilet I cannot eat fish milk products some gluten products or chicken my sister thinks I may have crohn disease I need to find out what is going on I have been dealing with it since I had coil four years ago",
        "input": "",
        "output": "hello I can understand your concern according to your statement you have been suffering from abdominal pain followed by defecation one hour after taking your meals you cannot eat fish milk some gluten products or chicken which can aggravate your sufferings the most likely cause of needing to pass stool right after eating is the gastrocolic reflex the reflex is a normal involuntary reaction to the food entering stomach for some people it is mild causing no symptom for others it may be intense and the urge to poop after eating can be severe like you certain health conditions such as irritable bowel syndrome or is can cause a person digestive tract to move food through their system at a much faster rate other conditions like food allergies food intolerance anxiety gastritis celiac disease inflammatory bowel disease or i'd crohn disease etc all can give rise to digestive symptoms like abdominal pain bloating increased frequency of defecation diarrhea constipation alternating diarrhea and constipation etc so you should undergo some investigations like abc complete blood count us ultrasound of a stool culture sigmoidoscopy and rectal biopsy colonoscopy and jejunal biopsy to find out the underlying cause of your present conditions in the meantime you can avoid some foods like fatty or greasy foods high in fiber dairy products etc again if you are suffering from anxiety stress or any other psychological distress then you should take steps to remove them after getting your investigation reports and knowing some additional history like weight loss hormonal imbalance previous diseases medication history family history I can help to treat you further you had an coli infection four years back and from then you have been suffering according to your description I think you took medication for your coli and coli usually disappears from the body with 14 days but it may aggravate some rare long lasting complications like is crohn disease ulcerative colitis etc"
    },
    {
        "instruction": "hello doctor my mother is 65 years old she is ra positive for the last 25 years currently she takes hcqs methotrexate pain killer and rantac at present she has pain nodules in hand and turned feet please suggest proper medication her let and kit are normal",
        "input": "",
        "output": "hi I have gone through your query but the report images could not reveal anything I would like to ask you a few more queries before suggesting the medicine as any new dmard disease modifying antirheumatic drug started has to be taken with caution you mentioned pain is it in the joints or the whole body is there dryness of eyes or mouth is the sleep normal or disturbed any forgetfulness irritability when is the pattern of pain more mornings after waking or constant throughout please message me the dose of folitrax as well which she is taking and the name of the pain killer do you have the last ear erythrocyte sedimentation rate and cop reactive protein is she taking calcium and vitamin supplement I understand she has an aggressive disease considering nodules deformities persisting but lot of times people with long standing arthritis develop secondary fibromyalgia and the management is very different we can only be 100 percent sure after clinical examination but will help you in the best possible way we can try to reattach the reports as well"
    },
    {
        "instruction": "hello doctor the first day of my last period was on the and of march it lasted till ith of march I had unprotected sex on the 10th of march but he did not ejaculate inside me but there is a chance that pre cum may have gotten in so for safety I took contraceptive pills postinor on the 1th on the 16th I noticed light bleeding and it lasted till 19th I am yet to see my period for this month although I usually experience irregular menstrual cycles is it possible I am pregnant or has it worsened my case of irregular menstrual cycle",
        "input": "",
        "output": "hello welcome to icliniq com I have gone through the details and the sequence of events you mentioned and totally understand your anxiousness see the emergency contraceptive pills are high doses of progesterone hormone so at times there can be withdrawal and some times there can be a delayed period too the effects vary from a person to person as you already had a history of irregular periods it is difficult to predict just based on the sequence of events whether you could be pregnant or not so a definitive test would be to check for a urine pregnancy test preferably with an early morning urine sample if that is negative then you can rest assured that you are not pregnant and you can take the medications mentioned below to get your periods and get yourself evaluated for the cause for your irregular periods regarding your irregular periods I see that you are slightly overweight for your height so mostly this could be due to cos polycystic ovary syndrome too that you have your irregular periods which need to be evaluated or maybe some hormonal changes in thyearoid or prolactin hormones ultrasound abdomen and pelvis complete hemogram lipid profile let liver function test rat renal function test 75 glucose tolerance test fasting hour hba1c glycated hemoglobin level serum calcium vitamin and b12 levels serum fasting and post prandial insulin levels serum fish follicle stimulating hormone oh leutenizing hormone free testosterone estradiol prolactin levels thyearoid profile to ash anti tpo on second or third day of the next menstrual period cos tablet meprate or devilry 10 my twice daily for five days and then stop to wait for withdrawal bleed within next 10 days to get blood tests done on second or third day of periods reduce weight maintain menstrual diary regular exercises at least one hour daily lifestyle and dietary modifications"
    },
    {
        "instruction": "hello doctor I have chest discomfort and upper and lower back discomfort since yesterday I passed stool twice today and the last one was cloudy I am a 32 year old male my height is 6 and I weigh about keg",
        "input": "",
        "output": "hi I reviewed your history do you have a burning epigastric sensation difficulty in breathing do you have hypertension or diabetes what is your last meal all these significant history points are important to exclude any cardiac problem or any gastric problem"
    },
    {
        "instruction": "hello doctor I am 38 years old and I have been taking high and anavar for six months for my training and weightlifting I am also single and had no plans for ever getting pregnant but I am now weeks pregnant and do not know a safe way to get off the gh I was taking iu a day I am not sure if it contributed to me getting pregnant as previously I have had two miscarriages and an ectopic pregnancy when I was married two years ago I have stopped the anavar as soon as I found out what is the best way to come off gh shall I just stop or do I need to wean off of it I am worried if I just stop my body would not produce for a while and it will cause pregnancy at a risk to survive",
        "input": "",
        "output": "hello congratulations on your pregnancy and on having escaped literally in the nick of time from the potential risks of anavar contains oxandrolone which is a male hormone derivative if taken inadvertently during pregnancy then it causes virilization masculinization of the female fetus it takes a few days to metabolize form the body so I recommend you to stop both with immediate effect and start on folic acid supplementation sooner the gestation is only weeks as on date and the fetal pole has not yet arrived if you do not stop then there are high chances of you getting an anembryonic pregnancy which is pregnancy without a fetal pole or a chemical pregnancy which can be confirmed only after two weeks with a scan to check if fetal heart rate has arrived or not it would confirm if the pregnancy is viable or not if no heartbeat then there are chances that it may have been affected by the effects of anavar and high growth hormones and hence non viable avoid exposure to any teratogen during the length of the pregnancy"
    },
    {
        "instruction": "hi I am writing this because lately I have been having some issues lately related to my health and I was hoping to get some answers advice and help because I want to stop the problem from getting worse and start getting better and I am a male and I am years old now one of the symptoms I have been having are headaches like they would happen emma say every couple days like it comes and goes like now I do not have a headache at the moment second symptom I had was nausea and I had it yesterday for a short period of time but I managed to eat something and I do not have it right now currently other symptoms I have been experiencing to like eye pain to that comes and goes but mainly in my left eye like twitching and tingling to little loss of balance when I get up out the bed I guess from resting for a certain period of time like now my balance is fine now but I have this cold feeling in forehead and lips now which is new to me I never had it before so it is happening right now but yea and little tingling feeling in throat and tingling in private area that comes and goes I was wondering if a neurologist can help me out here because I am wondering if this is a nerve problem and how serious this is please",
        "input": "",
        "output": "hi welcome to icliniq I have analysed your complaints you are suffering from episodes of headache with nausea which are not present every day also having left eye pain and twisting with tingling imbalance while getting up tingling in throat and over genitals coldness over forehead I would like to suggest to do some routine blood investigation tests and this symptoms seems like vitamin b12 deficiency or hypothyearoidism are you vegetarian any history of weight gain constipation is there any addiction of alcohol or drugs please check your abc serum electrolytes na cl ca my vitamin b12 level thyearoid profile"
    },
    {
        "instruction": "hi doctor my stool is hard first and then it becomes soft otherwise it is soft always I pass stool once daily like other people also I have no pain in the stomach but due to soft stools my legs and other body parts are always in pain when I get up early in the morning I feel very tired due to soft stool condition of my stomach and when I take pills like flagyl or imodium my stool becomes correct and my legs and other body pain get some relief please suggest",
        "input": "",
        "output": "hi two important points that I find in your history are others in the family also have it but you have told only about the male members what about female members of the family secondly it improves with flagyl or imodium so the possibilities are water borne disease which is now in chronic phase or incomplete treatment or irritability of bowels which could be because of type a personality related anxiety I would suggest the following investigations abc complete blood count sept serum glutamic pyearuvic transaminase tidal stool for routine microscope and occult blood also following medicines should be given one course ofloxacin 200 my twice a day for five days ornidazole 400 my twice a day for five days ivermectin my and albendazole 400 my once a day for three days capsule vsl once a day for 10 days I hope this helps"
    },
    {
        "instruction": "hello doctor I have a problem with the second last toothache of left side lower jaw and also headache what can be the problem and the medicine used by me does not give me any relief mom 500 limcee oxalgin twice daily for three days then the other dentists suggested me these medicine ordent seradic pan dsr but also no permanent relief from toothache and headaches what can be the problem and solution",
        "input": "",
        "output": "hello I have gone through your query and understood your concern unfortunately taking medicines is not a permanent solution to dental pain there are several factors that cause dental pain and associated headache the most common cause is tooth decay however a clear clinical picture or an ray will help determine what is causing your pain when decay reaches the nerve of the tooth it starts to give out symptoms the nerve which supplies the tooth also supplies that side of the face hence the referred associated pain taking painkillers will help control the pain to some extent but it does nothing to cure the decay it can only be manually treated by removing them you may require an ray procedure to determine the extent of the decay and if the nerve of the tooth is involved a root canal treatment is generally done to remove infections and decay since it is the time of the pandemic dentists are providing emergency care only and some dentists prefer telephonic consultation prior to dental visit and treatment if the pain is unbearable even after taking medicines it is best to call up a dentist providing emergency care and get it treated I hope this helps"
    },
    {
        "instruction": "hello doctor does cervical neck lordosis affect the quality of sleep this week I have not enough sleep at night or even day and my arms are in pain I cannot understand because sometimes my nose are clogged at the right sometimes at the left and my neck hurts when I do my exercise as recommended by my chiropractor I had my three adjustments last month which supposedly should be 36 it stopped due to the couid pandemic and now I am at home but I cannot sleep well it feels like my body is not straight by the way my pelvis is tilted to the right and also my spine but just a little bit can I ask some help or tips from you with regard to what can I do to at least ease the pain or sleep way better or a few stretches to at least help my body to slowly reposition to normal",
        "input": "",
        "output": "hello I read your concern yes the position of cervical lordosis will affect your sleep if it is not properly supported the tightness and pain could be due to irritated neck muscles so support them ice them up so that spasm gets reduced and neck feels better as of now I recommend you to maintain good posture and support your neck properly in everything you do like sitting and sleeping avoid postures that might aggravate the issue like texting a lot watching movies in an upward position etc do not do exercises while in pain do icing and relax support will help you come out of the issue faster first sleep properly and things will automatically fall in place keep hydrating properly back and other issues could be due to faulty postures and irritable muscles they will reduce once you do the above mentioned things I hope this helps"
    },
    {
        "instruction": "good evening do I require your kind advice regarding my mom medication she is 53 years old you see my mom had persistent ti coli infection for almost a year throughout 2018 2019 her health deteriorated due to which she had a fall last year got fractures in her spine right shoulder for which she was operated with screws rod insertion I dorsal spine fixation proximal humerus plating however she had incidents of granulation tissue pouring out on the spine suture area twice after the initial surgery due to which she had been operated two more times to sort out the problem the reason for the granulation tissue pouring out was described as the do as being due to high ti coli infection she took iv antibiotics for weeks and was also prescribed nitrofurantoin 100mg for year which would completely eliminate her ti coli my mom however had for only months quit it been months now since she quit now suddenly she is experiencing frequent urination overactive bladder and urine incontinence since days also there is inflammation during urination kindly suggest me if there is no harm if she starts nitrofurantoin 100 again and so for how long I remaining months or any other period",
        "input": "",
        "output": ""
    },
    {
        "instruction": "ok so I am a 20 yo femal for years I have had inconsistent periods I would bleed nonstop for months then go for or without a single drop I have had normal cycles as in a days cycle normal flow only a couple of times in my life I went to different obgyns did ultrasounds and everything looks normal they would just tell me that I am still young and that my hormones are just all over the place I am sure if my anemia was not as severe they would just brush me off but they give me pills I really do not remember the names that would work for the months that I am on them and the sec the treatment finishes everything goes back to usual I do not get cramps like ever and I get blood clots and obviously really heavy flow pad change every 30 mins it seems to be triggered by anxiety attacks or just depression episodes now I have been bleeding for weeks and I already feel the symptoms of anemia and with covid19 I cannot go to a doc plus help I feel like I am losing my mind and blood",
        "input": "",
        "output": "hi welcome to iclinq what you are going through is just the hormonal imbalance for a perfect normal monthly cycle the hypothalamus pituitary and your ovaries should work in coordination that coordination takes few years and varies with individuals as of now correct your anemia with hematinics would give a prescription on pills continue the pills everyday for all 21 days without fail at the exact time without missing it generally bleeding stops by second or third day once you start the tablet that would stop the problem anxiety depression diet you consume also regulate the quantity of flow no worries hormonal stress he ash cos hormonal ocp hematinics iron rich diet you need take the pills for two cycles and review"
    },
    {
        "instruction": "hello sir this query is about a pain in veins of my mother which is started from her left side hip and spread in whole leg this pain is unbearable she is 46 years old her height and weight is 4 83 keg she have problem in her knees too due to over weight kindly advise me the best solution to resolve the problem",
        "input": "",
        "output": "hello welcome to icliniq com can you describe the pain a little more and share some pictures of the affected leg if possible usually the various causes of unilateral leg pain include usually the following investigations are required to diagnose kindly answer the above questions so that I can tell you the further course of management meanwhile if the pain is unbearable you can try local analgesic spray like vovran spray and tablet aceclofenac sos whenever the pain is present"
    },
    {
        "instruction": "hello doctor what does high risk 50 trisomy 21 mean at an age of 32 and 18 weeks pregnancy",
        "input": "",
        "output": "hello I totally understand your anxiety but please do not panic the risk for trisomy 21 or in other words down syndrome mentioned is 50 which is above the general population risk of 250 in other words if we take a general population and consider any women in general there is a risk that one in 250 women may have a baby who is affected with down syndrome but in your case the risk appears to be increased compared to the general population which needs to be evaluated further this is a test that determines the risk which means it is only a screening test and not a confirmatory test meaning the baby may or may not be affected by down but the risk appears to be high compared to the normal population it would have been helpful if you had the shared few more details like your period of gestation of your pregnancy when and at what gestation was the test taken and any previous scan reports in the first trimester you have done kindly share the reports to guide you better and also provide details if you had any previous pregnancy or miscarriages etc now coming to confirming this for definitive and accurate methods it includes amniocentesis with karyotyping and fish test which are little expensive tests and not done in all individuals except those with high risk for down syndrome for this test to be done the water around the baby inside the uterus is taken in a small amount which contains the shed cells of the baby and are cultured so as to do the chromosomal analysis of the cells this is an invasive test as it comes with the risk of 2 risk of miscarriage as we are putting a needle inside the uterus another recently introduced test which almost as closely accurate to this is nip noninvasive prenatal test which is again a screening test but highly accurate and involves only testing your blood for fetal cell free dna and then they are analyzed for the same you can consult a fetal medicine expert or your gynecologist for further information on these and necessary timely action I hope this helps"
    },
    {
        "instruction": "hello doctor I began to see streaks of light across my vision in the dark and realized I have a gray shadow in the left peripheral vision of my right eye since yesterday evening I have been spending time on my laptop or phone for more than 10 hours a day and sometimes I watch the screens in the dark I slept for 12 hours and still seem to have the shadow area it disappears if I look directly at it please tell me what to do",
        "input": "",
        "output": "hello using a computer for a long time causes dry eye syndrome due to decreased blink rate take frequent breaks and look at far objects as the eyes are strained looking at close object for a long time keep the brightness of the system to minimal use tear drops twice a day along with antiglare glasses about the peripheral shadows there is a jelly like substance in the eye called vitreous and as age progresses it starts to liquefy and you start seeing floaters you should go to an ophthalmologist immediately in case if there is an increase in the number of these floaters or if you are seeing flashes of light because these are the signs of retinal detachment get your retina checked once the lockdown is over"
    },
    {
        "instruction": "hello doctor I am a teenager and I got periods five and a half years back in the start they were irregular I took medicines for 21 days and I got my periods after a month but as soon as I left them after three months my periods became irregular then for some time I did not take any medicine but still my periods were irregular I used to get two to three menses in a month I got very sick and anemic I stayed in the hospital for three days where I was given intravenous iron treatment three bottles I had regular periods after that for a year or less but my doctor told me to consult a specialist after that they were again irregular and then I had them for five months without stopping I have taken many medicines but all in vain it has been five years and my periods are irregular still I have got two menses in this month I have become so skinny and my weight has not increased for the last five years I will be very grateful if you suggest me something to get better my ultrasound results do not have any problem",
        "input": "",
        "output": "hello I understand you are deeply troubled by your menstrual cycles heavy and frequent bleeding as you suggested will cause anemia and weakness and needs to be treated on the other hand if periods are infrequent and less flow you can treat it without medications too in your case your mi body mass index is very low which is not healthy at all first you need to eat healthily include lots of proteins and lots of iron rich foods in your diet secondly the cause of this bleeding is a hormonal imbalance which usually gets better as you move on to your 20s meanwhile you will have to take hormonal tablets regularly for at least one to two years at a go without changing the medications I hope this helps"
    },
    {
        "instruction": "hello doctor I am a year old male I am having a slight pain in the middle of my throat adam apple as if some small inflammation is there at the end of the tongue or neck for the past one week I am not having any difficulty in speaking or eating but some kind of irritation prevails I tried salt water gargling twice or thrice a day and feel relief to some extent it is to state here that about five days back I was reciting slokas a little loudly for about one hour and I had the pain I stopped reciting in loud and the pain came down yesterday when I recited slokas a little loudly my pain returned no cold no cough no fever and no difficulty in breathing my hearing is good no reduction in appetite or in taste I feel comfortable when I take warm liquids I have long belching for at least five to six times after intake since lockdown is continued I am unable to visit an ent specialist now can you please assist me",
        "input": "",
        "output": "hello you might have caused some mild injury to the vocal cords while reciting the slokas loudly you need to give your vocal cords rest by not talking or singing for a few days followed by restricted use of voice for the next week you must not sing or speak loudly or in unnatural frequencies you should not shout or whisper also you will need medicines for stopping belching and acidity antiallergics and antacid syearup may help if there is any nasal complaining please let us know as we would have to give some medicine for that too do revert back if you need details"
    },
    {
        "instruction": "hello doctor I have a missed period for four months this has happened before and my period came normally for one to two years after there is no pain and no medications for that no symptoms or chances of being pregnant please suggest",
        "input": "",
        "output": "hello irregular periods can be due to many reasons a little bit more information will help in making the right diagnosis may I know when you had your first periods have you lost or gained weight recently any change in lifestyle or stress recently are you having any pimples hair growth in face chin etc all the above reasons can contribute to irregular periods you could also be dealing with a condition called cos polycystic ovary syndrome"
    },
    {
        "instruction": "hello doctor I have severe acne with the scar left on the skin I have very oily skin and the acne is a little painful and sebaceous I am currently using benzoyl peroxide",
        "input": "",
        "output": "hi I went through your photograph and found that you are suffering from modular cystic acne with scarring it is a severe type of acne is common at a young age it occurs due to blockage and inflammation of sebaceous glands under the influence of androgen hormone they also occur due to cosmetics diet has a little role and generally they subside in mid twenties they need treatment to avoid scarring which may be permanent if you have increased hair growth and menses irregularity you have to rule out pod polycystic ovary disease you can take capsule isotretinoin 20 my once daily with meals for four weeks clindamycin gel twice daily over the pimples salicylic acid face wash once daily only for 30seconds and tablet azithromycin 500 my once daily on empty stomach for one week and three on consecutive days per week for three weeks if you want to use sunscreen review after four weeks scarring or pores left after healing can be treated surgically by needling microderma abrasion or by laser only after remission hormonal lipid profile if history of cholesterol disorder in the family acne nodulocystic for three to four months as per the response do not touch the face too often do not use oil or greasy cream over the face or scalp take ample amount of fluids if there is intolerant dryness with this use petrolatum or vaseline on lips dryness generally subside within one week"
    },
    {
        "instruction": "hi doctor all day I been have constant worry thinking something is wrong with me I had a fever last week but all symptoms are finished the only thing I feel I have is when I breathe through the nose it feels blocked but I can breathe fine since the day I got unwell I have been feeling I have serious illness my whole body feels tense",
        "input": "",
        "output": "hello your concerns are valid in light of the current pandemic related to coronavirus infection the good news is that your symptoms have improved significantly and you can breathe much better than what you were feeling before you also do not have any fever or shortness of breath difficulty in taking a breath in and out if anything I would say you are over the difficult part you can try using a nasal spray that has steroids or saline you can also take an antihistamine if your nose is running which would include loratadine among others since you are almost symptom free I would suggest you wait another one week before coming in full contact with other people around you it is hard to say if you had the coronavirus infection or not but you are doing much better which is excellent news please make sure that you are washing your hands thoroughly and cleaning the surfaces around you I would also suggest wearing a mask at least for another one week"
    },
    {
        "instruction": "hello doctor I am a 29 year old female 250 labs I do not smoke or drink tonight while looking at my throat I discovered my right tonsil is swollen lumpy and covered in a thick white layer of skin upon initial inspection I mistook these white patches for tonsil stones but they are not they seem to be stuck to the surface of my tonsil I managed to scrape some off with a bit of effort the tissue underneath began to bleed the white layer appears to be skin I do not feel sick apart from allergies the pollen count is quite high here right now any thoughts as to what could be causing this I am currently on hctz metoprolol lexapro",
        "input": "",
        "output": "hello I can understand your concern according to your statement your right tonsil is swollen lumpy and covered in a white thick layer of skin white spots on the tonsils usually indicate an infection infections may be due to bacteria fungus or viruses strep throat is a bacterial infection caused by streptococcus complications include rheumatic fever and ear and sinus infections if infection spread to other parts of the body additional symptoms that may indicate strep throat include sore throat fever swollen glands in the neck and headache oral thrush is a fungal infection in the mouth it can occur in people with a weakened immune system or oral steroid ingestion white spots may the only symptom of oral thrush but when additional symptoms develop they may include sore throat pain when swallowing loss of taste etc tonsillitis can develop due to viral infections such as rhinovirus adenovirus respiratory syncytial virus symptoms may include swollen tonsils painful swallowing fever earache nasal congestion infectious mononucleosis is a viral infection caused by epstein bar virus along with white spots on the back of the throat symptoms may include fever sore throat and fatigue you should undergo throat culture and blood tests indicate if certain antibodies are present which helps identify specific infections so treatment depends on finding the causative agent which are responsible for your present sufferings and treat them accordingly"
    },
    {
        "instruction": "hello doctor due to lockdown I have a bad schedule of sleep I am not able to sleep at night and when I sleep in the morning I can sleep only for four to five hours and wake up with a bit of pain in my hands and feet I am 20 years old",
        "input": "",
        "output": "hi well let me tell you that this is a very common problem for people these days during the lockdown it is because our body is used to a certain amount of work that makes it and especially the mind tired which makes you sleep normally during your routine days so you do not need to panic and just make a few changes to your lifestyle first of all keep yourself engaged in activities throughout the day workout a little try reading a book do not spend too much time on the bed all day and only use it when you want to relax do not drink any caffeinated beverages after am get your body and mind to constantly engage in something so that it is tired and it wants to relax during the night try this for seven days sleep pills usually work but I will advise you not to use them as the mind and the body get used to them easily and it is very hard not to use them later I hope this helps"
    },
    {
        "instruction": "hi I am 14 I really never cared much about brushing my teeth and it is been awhile since I have not brushed them I woke up one day and it felt like the right side of my gum was hurting and I went to go brush my teeth cause I figured maybe it was a tooth growing in or something and to my surprise when I went to go brush them my teeth or my gums started bleeding as I noticed on the toothbrush I kept brushing because I figured I got something this gum or tooth pain I do not know which one has been going on since a month",
        "input": "",
        "output": "hi greetings for the day as you said you are 14 years old and at this age it is very common to have bleeding gums there could be two reasons as you are getting new teeth and another one you are attaining puberty when you attain puberty there will be hormonal imbalance which is happening inside body which leads to swelling in gums and further bleeding whenever you touch it if it is painful you can take paracetamol tablet whenever it pains otherwise just use mouthwash and keep ice on the area where there is swelling it would be of help if you would send me a picture of the area concerned don worry it happens during this age and you will fine follow up after a week if the problem does not resolve will prescribe other medicines regards icliniq com"
    },
    {
        "instruction": "i have developed some skin allergy on my back and it itches a lot and sometimes uncontrollably the allergy is fading but the burning and itching is still there the affected skin area has got rough and it feels weird also for the past year I have realized that all my wounds never recover fully and they keep itching forever I have had scratches from months ago and they still itch the affected skin area is rough just like the one I have developed now and by the looks of it seems like its a burn or something all my wounds scratches turn into something horrible and do not recover what could be the reason please help me it frustrating especially now since all the clinical are shit and I cannot go consult someone or get it fixed thanks taha",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hi doctor I have a deformation on one of my fingernails with a deep crack and it is a bit yellow on a small part near the skin at the start of the nail please help",
        "input": "",
        "output": "hi I went through the photo you sent most probably it is a fungal infection of the nail but I want to confirm a few things before how long it is there any history of trauma are you having high blood sugar or any other disease is it painful please answer these questions in the follow up because the short duration and more pain will be indicative of bacterial infection for fungal of the nail take capsule itraconazole 200 my twice daily after meals for seven days per month seven days then no dose for three weeks then again seven days like this continue for three cycles then review fungal or bacterial or growth get glucose tolerance test oh test acute infection secondary to trauma beau line due to internal disease onychomycosis antifungal for one week per month for a minimum of three months avoid wet work keep hand dry"
    },
    {
        "instruction": "hello doctor my wife is feeling pain inside her right ear according to her she feels the pain more when she lies on the bed or recline her head for any purpose the intensity of the pain is also showing up around her ear too it is her feeling that there is something inside the ear which may be water or something like that all these have started the day before yesterday please help she used paracetamol for the same",
        "input": "",
        "output": "hello your problem could be due to an infection inside the ear or secondary to nose and throat problem I would like to know if she has any nose block excessive sneezing or throat irritation any ringing sensation in the ear or giddiness any discharge from the ear if yes for how long any relief after taking paracetamol please get back to me with the reply"
    },
    {
        "instruction": "hello doctor are implant supported bridges good will they cause bad breath in the long term I have dental bridges in my four front teeth for about eight years but now it is causing bad odor",
        "input": "",
        "output": "hi implant supported bridge is an extremely good option for replacement of missing teeth implant is the best treatment option in dentistry and it is a lifelong treatment option it stays for ur whole life without causing any problem once osseointegration has taken place successfully it acts extremely perfect but you have to maintain your oral hygiene nicely you have to use electric brushes for maintaining your implant and you have to visit the dentist every year for follow up for scaling and polishing just for maintaining your oral hygiene go for it is the best treatment option if you are healthy systemically patients suffering from high blood pressure or diabetes might have some problems so your dentist will decide what is best in those conditions after all the blood tests op and cbct will decide your bone condition diagnosis I hope this helps"
    },
    {
        "instruction": "hello doctor I think I have telogen effluvium because my hair has been diversely thinning for over a year and I have even lost hair on my neck area and sides of my head along on top the scalp I went to the dermatologist once last year and he thought it was te but it has not gotten any better and they did not prescribe me anything please help",
        "input": "",
        "output": "hi in telogen effluvium there will not hair loss involving the neck area is there any history of acute illness or systemic upset before the start of this problem why telogen effluvium was diagnosed is there any family illness of baldness hair loss over neckline is looking like alopecia areata type of hair loss diffuse type of hair loss can be seen in alopecia areata and also in telogen effluvium nutritional deficiency is the commonest cause keep your hemoglobin above 12g dl take biotin containing hair supplements have dates fresh vegetables and fruits rich in iron after the corona crisis meet your doctor and do a scalp biopsy to confirm the diagnosis"
    },
    {
        "instruction": "hi doctor I need a consultation on my diabetes my fasting plasma glucose is 26 my do and in up it is 390 my do I am currently on diamicron my volix 3 and novomix pen 30 70 please suggest",
        "input": "",
        "output": "hi your sugar is uncontrolled and vitamin is low as well you did not tell how much you are using diamicron volix and novomix please let me know the doses another thing is you should get checked urine albumin creatinine ratio and I think you may need a change in medication your overweight is also due to these medications"
    },
    {
        "instruction": "hello doctor I have psoriasis vulgaris anxiety disorder and dry cough for a long time recently I have taken hydroxychloroquine and azithromycin along with my usual medicine like topical corticosteroids sertraline montelukast and rosuvastatin is taking these medicine like hydroxychloroquine do any harm or do I need any adjustments with my regular medicine",
        "input": "",
        "output": "hello I am sure some healthcare providers must have advised you to take these drugs and he would be aware of these interactions before starting if you are self medicating ourselves I would strongly advise you against that using hydroxychloroquine together with sertraline can increase the risk of an irregular heart rhythm that may be serious and potentially life threatening although it is a rare side effect you may be more susceptible if you have a heart condition called congenital long it syndrome other cardiac diseases conduction abnormalities or electrolyte disturbances for example magnesium or potassium loss due to severe or prolonged diarrhea your doctor may already be aware of the risks but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications you should seek immediate medical attention if you develop sudden dizziness lightheadedness fainting shortness of breath or heart palpitations during treatment with these medications whether together or alone with rosuvastatin the risk of peripheral neuropathy may be increased during concurrent use of two or more agents that are associated with this adverse effect patient risk factors include diabetes and age older than 60 years in some cases the neuropathy may progress or become irreversible despite discontinuation of the medications it does not have any interactions with topical corticosteroids and montelukast"
    },
    {
        "instruction": "hello doctor I am a 42 year old female in good health aside from anxiety currently taking my citalopram a month ago I suddenly experienced muscle twitching all over both legs and this went on for two weeks I took magnesium and it subsided and has not really returned except for an occasional twitch here or there I am extremely concerned because over the course of the month I have had three episodes where I forgot how to swallow for a second it was scary and now I am afraid I have the onset of als I do also have a long time habit of throat clearing although I have not experienced any muscle weakness are those symptoms indicative of als",
        "input": "",
        "output": "hi twitching of muscles can be due to anxiety as well as citalopram what is important is that you mention having them before initiating citalopram so it is unlikely to be due to the drug if it is occasional then you should rather not bother yourself because twitching intermittently is there even in an otherwise healthy individuals what is important is your sensation of forgetting to swallow this is drug induced akathisia or abnormal movement citalopram is known to have abnormal sensation restricted to tongue also hence if you feel that this is bothersome and progressing then you may change the medicine but my experience is that my is a very small dose to be causing side effects these symptoms are due to your anxiety as twitching was there before too and improved with magnesium your habit of throat clearing along with anxiety may be the cause of your feeling of forgetting how to swallow I have personally seen people having this because of acidity with reflux people with a habit of gulping food etc in many simple life situations I would rather like you to assure and to get relaxed with behavioral techniques and meditation if possible if it still persists then change of medications may be considered as far as als amyotrophic lateral sclerosis is considered I can only say that it requires nav nerve conduction test egg electromyography and mri magnetic resonance imaging for definitive diagnosis about have a family history but one should get thyearoid function parathormone and vitamin be tested because these are common and mics als twitching if reduced should be a reassurance against als I hope this helps"
    },
    {
        "instruction": "hi doctor I am 13 weeks pregnant last week I undergone for it scan the report was normal and the same time I gave double marker blood test yesterday from the hospital they called me for blood test because the first report shows abnormal I am so scared whether second time double marker test shows normal they did not give the report of first test but simply told first test was abnormal so we sending for second time I am confused please tell me whether second time test shows normal result if it is abnormal is there is any early treatment to protect the baby from down syndrome",
        "input": "",
        "output": "hello first of all congrats on your pregnancy let me clarify that double marker is only a screening test it not a confirmatory test double markers are not repeated if they showing high risk sonif the lab has asked for a second sample it may be due to some other reason it means even if we say ur second test shows a high risk chances of which less it only means that this baby for some reason has a higher risk for a genetic problem you still need to do an amniocentesis and do a karyotyping to confirm the genetic problem we see many double markers which abnormal but very few if those have an abnormal karyotype on confirmation so rest assured and enjoy your pregnancy let the results come nothing is decided by a double marker test taking folic acid months prior to pregnancy is onevway of preventing a downs syndrome so plus wait for the result theres no need to panic have a safe pregnancy"
    },
    {
        "instruction": "good day doctors I have a concern with my tattoo that I got months back I have five tattoos with different colors blue yellow red green and purple I have been experiencing itching on my yellow and green tattoos from time to time that lasts for about weeks it subsides eventually for days then itching comes back again the itching tattoos are bumpy and hard what should I do thank you",
        "input": "",
        "output": ""
    },
    {
        "instruction": "i cannot rotate my left shoulder from days and continues sever pain which dont let me sleep",
        "input": "",
        "output": "hi the main shoulder joint is a ball and socket joint which allows a very wide range of movement the joint is surrounded by a tough fibrous sleeve called the capsule which helps to hold the joint together a group of four muscles and their tendons make up the rotator cuff which controls movement and also helps to hold the joint together theres another smaller joint where the top of the shoulder blade meets the collarbone the acromioclavicular joint you can take accelofrnac paracetamol tab for severe pain once a day for two days following exercise will help reduce pain and increase range of motion reducing the strain when raising your arm or lifting objects reduce the strain or pull on your shoulder by keeping your elbow bent and in front of your body keeping your palm facing the ceiling to lower your arm bend your elbow bringing your hand closer to your body your pain should ease within weeks you should carry on with exercise for 7 weeks to help prevent symptoms returning pendulum exercise let your other arm hang down and try to swing it gently backwards and forwards and in a circular motion repeat about times try this 23 times a day shoulder stretch stand and raise your shoulders hold for seconds squeeze your shoulder blades back and together and hold for seconds pull your shoulder blades downward and hold for seconds relax and repeat 10 times raising arm and bending towards shoulder wall walk all these exercise will not only help in reducing pain make shoulder to normal also you can apply diclofenac ointment and clean it with warm aftern10 15mins following hot water fermentation it will help you reducing pain fast follow up after days for further investigation and medicines and exercise thank you"
    },
    {
        "instruction": "hi doc my wife recently got pregnant we checked with my relative sister who is a gynae and her report is attached in the documents my wife is facing below symptoms due to pregnancy tireness fatigue continuous nausea type feeling lethargy unable to eat properly loss of appetite minor menstrual cramps constipation we want to know if we can have normal sex with mentioned condition of my wife if we can have sex does it needs to be protected or we can have unprotected sex too or will it affect the baby due to corona issue we are reluctant to go to another doctor with our query and our current doctor is in our blood relation so we are feeling shy to ask her the question of having sex",
        "input": "",
        "output": "hello congrats on your pregnancy though you have not mentioned clearly how many weeks of pregnancy I assume in must be within the first 12weeks as you have said she is recently pregnant the symptoms of tirednes nausea lethargy unable to eat very common first trimester symptoms the key is to eat small frequent foods which good in protein lots of fluid intake also is advised have you done a first trimester scan if not you advised todo the scan to rule out any cause for the menstrual cramps and also the position of the developing placenta if she has menstrual cramp like symptom I would advise to notbstrain yourself too much sexual activity is better avoided in the first 12weeks as it can lead to abortions afterv12weeks if ur scan is normal and the placenta is not low lying unprotected intercourse can be done avoiding penetration would be another way to keep it safe in the second trimester provide all other factors are normal hope this helps"
    },
    {
        "instruction": "hi doctor I noticed a little red bump on the top of my labia minor right underneath the clitoris it looks a bit swollen and it is sensitive to touch I did notice a small bump on the outer side of that labia minor too but I cannot be certain that was not there before I have had bartholin cysts in the past so I know it is not that and I do have genital herpes and it does not seem like it is an outbreak either I really do not know what it could be please help if need be I will even attach a picture",
        "input": "",
        "output": "hi your text mentions the lump to be below the clitoris so is it just above the opening where you pass urine urethra in that case it could be a urethral carbuncle you can search for the images of the urethral carbuncle and see if it matches your problem if not send me the pictures so we can make a diagnosis"
    },
    {
        "instruction": "hello doctor this is the ith day after wisdom teeth extraction and I still have a painful swollen gland under my jaw",
        "input": "",
        "output": "hi I know it is a bit hard for you at this stage after wisdom tooth surgery some of the times the wisdom tooth surgery is a little aggressive because the tooth is lying deep into the bone and to remove it a lot of work has to be done and some of the bone has to be removed to achieve this but do not worry this is a temporary phase and you have been through most of the hard time hot and cold application in the beginning may help to reduce the pain and swelling you can still apply the cold application you can buy a cold pack in the drug store put it in the freezer and then apply on the area for at least 10 15 minutes also take the pain killer your doctor gave you in case you do not have any prescription medicine left try over the counter painkiller like ibuprofen 400 my at least three times a day use listerine mouthwash and clean the area with a soft brush I hope this helps"
    },
    {
        "instruction": "hello doctor we have a month old baby girl she has five brown marks two of them are am size and the other three of 5 am they are irregular in shape initial two marks appeared when she was months old and now when she is months three more for added that are comparatively light and 5 am of size are these birthmarks will they fade with the time do we need to take any precautions so that they do not increase or get added further can we also provide any medication to cure them",
        "input": "",
        "output": "hi please send me a photograph of the lesion on the basis of history it seems to be cafe lait macules but to be sure I need photographs of the lesion presently I will not suggest any medications as baby is small and I need to be sure kindly review with photographs"
    },
    {
        "instruction": "hello doctor I have taken a pregnancy test a few days ago and it turned out to be positive I took two tests just to make sure and they both were positive I was supposed to have my period on march 29 but conception happened on march 14 and the first day of my last period was february 29 I do not feel any changes at all is it possible that may not be true at all or the tests I took were not accurate if I got my period this april 29 what does it even mean since I already missed my supposedly period on march 29 I am currently taking myeara and potent cee",
        "input": "",
        "output": "hello as you checked twice for urine pregnancy test and it turned out positive it implies you have been pregnant it is not necessary that everyone experiences nausea and vomiting or early signs of pregnancy similarly some may not feel any symptoms or some have mild symptoms the urine hug human chorionic gonadotropin tests are definitely an accurate way for testing pregnancy rather than just relying on symptoms and they cannot be wrong as you had missed your periods too and it tested positive twice and if you are pregnant you would not be even getting your periods again this april too it would be advisable to get an ultrasound to confirm the pregnancy if in doubt the site intro or extra uterine the gestational age and the fetal viability also you can start using folic acid tablets routine antenatal investigation tablet folic acid my daily avoid sexual intercourse in the first three months"
    },
    {
        "instruction": "hi doctor I have a protrude mole on my leg light color but it will become black if in contact with water it lasts for about two or three years or more I have no symptoms other than it will fall off as time pasts and grow back itself I was wondering what would it be as I am worried if that is some kind of melanoma",
        "input": "",
        "output": "hi welcome to icliniq com I have seen your query and examined your given picture it seems you have developed seborrheic keratosis or a mole do you have this mole since birth nothing looks like melanoma shave excision with the histopathological examination is a good option in your case because it is curative and diagnostic both"
    },
    {
        "instruction": "i am 28 years old I got married before 5 years but no child I trying for conceive but still I suffering from cos irregular periods nowadays this month my periods comes regular without any medicine intake but problem is bleeding flow normal it is comes only days after ith day start bleeding in one day after ith day I can make sex connect it is light bleeding occur my question is can I take gettin my on day 15 can make me pregnant can I have pregnant with gettin tablet I have no pregnancy abortion history my husband hav 20 million sperm count 60 motility please answer my question mam I am waiting",
        "input": "",
        "output": "hello hope you are safe I understand from ur mail that you are trying for pregnancy and you had some basic evaluation for the same taking gettin will in no harm ur chances for pregnancy but gettin is a synthetic progesterone we prefer natural progesterone like duphaston wen you trying for pregnancy as they much safer so it would be wiser to substitute gettin with a natural progesterone you have not mentioned your thyearoid band sugar profiles in the history if not done in the last three months it would be advisable to do those a reduction in your weight by about 3 keg will also increase your chances for pregnancy it would be advisable to have intercourse regularly betweenthe 10th and 23rd day to increase chances of pregnancy if you not already taking folic acid plus start taking once daily duphaston can be taken from 2nd april onwards day once wish you good luck if you still do not conceive after months of trying in the above manner it would be advisable to further equate which we can discuss the options later thank you"
    },
    {
        "instruction": "is there a risk of becoming addicted to 60mg of prednisolone prescribed to anti inflammatory purposes once a day for a month I have already been prescribed this medicine I am not asking for a prescription my doctor has not mentioned anything about becoming addicted and I did not ask when I was in hospital however because of the pandemic I cannot go and ask my doctor if there is a risk and I wanted to make sure that I do not suffer from craving steroids after I have come off my prescription",
        "input": "",
        "output": "hello welcome to icliniq the dosage of prednisolone prescribed to you must be according to your body weight which is usually my per keg or in same cases the physician may prescribe an even higher dosage depending on the underlying disease the body definitely gets used to addicted long term steroids like prednisolone and therefore we cannot stop these drugs suddenly and abruptly so your doctor will slowly taper down the drugs depending upon the disease response like he will bring down the 60 to 50 my followed by 40 my and so on I would gradually decreased to low doses the body gets used to it although steroids have short and long term side effects they are usually helpful for the disease they have been prescribed for as your doctor would have explained it to you before starting them"
    },
    {
        "instruction": "hai past underwent miscarriages after taking inj progestrone were chemical pregnancy and is sac was formed but miscarriage happened now I am having the pregnancy symptoms my last lap was on 40 days back",
        "input": "",
        "output": "hello welcome to icliniq based on your obstetric history it is necessary to evaluate the cause for your recurrent miscarriages but please do not be disheartened if sometimes no cause is found which happens quite a lot of times dear progesterone injection will never cause miscarriages as progesterone is the hormone that is required for the continuation of pregnancy and act as a support for pregnancy so the most common causes for recurrent miscarriages can be either thyearoid hormonal abnormalities or impaired blood glucose levels or sometimes immune causes like alla syndrome as per your lap you are exactly 6wks pregnant today so try to get a scan to check if this is a viable pregnancy and also for dating and localization of pregnancy so that if viable we can start with progesterone support in the form of oral progesterone supplements to sustain this pregnancy also I have mentioned the blood test that you need to undertake apart from the routine antenatal investigations to look for any abnormalities I mentioned above please do get them done please feel free to contact me in case you have any queries blood group and oh typing complete hemogram he electrophoresis urine routine and microscope let rat 75 oral glucose tolerance test in each trimester hba1c level hiv vdrl hbsag anti hav alla work up that includes lupus anticoagulant beta glycoprotein egg i'm anti cardiolipin antibodies egg i'm it scan 13weeks dual marker test 13weeks level scan 18 20weeks to look for any structural or developmental anomalies in the fetus to consider progesterone supplements either oral vaginal or injectables after checking viability low dose aspirin or heparin may be considered after ultrasound for viability the blood tests evaluation avoid intercourse in the first trimester small meals at frequent intervals to avoid nausea or bloating"
    },
    {
        "instruction": "hi doctor my dad had an angioplasty a month back and now he complains of sob and numbness in his hands while walking it occurs only while he goes for a walk otherwise he is completely normal please help he is currently on connor beta blocker ascard lipiget and brilanta",
        "input": "",
        "output": "hello one of the reasons for breathlessness can be a side effect of tablet brilinta ticagrelor it happens quite frequently in patients taking it about 13 percent of the patients to be precise but I would suggest you not to stop the drug until the breathlessness is quite severe because it is very important to keep the blood thin and the stent open so he should continue taking brilinta another reason for breathlessness can be decreased ejection fraction pumping of his heart water getting accumulated in the chest and hence the breathlessness and to make sure that this is not the cause I want you to answer my few questions is he having any swelling in the feet is he having difficulty breathing when he lies down does he have a cough if the answers to any of these questions are yes and to prevent the water from accumulating in the lungs you can add a diuretic which will make him do more urine and get the water out of the lungs but to confirm it as soon as the couid situation settles down you can get an appointment with your doctor for a echocardiography and get it done for numbness it can be usually a sign of a neuropathy either due to nutrient deficiency or any metabolic disease I would prescribe you a few drugs does he a have history of diabetes mellitus brilinta induces dyspnea la dysfunction egg ad echo la dysfunction brilinta induced dyspnea brilinta induced dyspnea tablet torsemide my 0 neurobion 1 continue taking concor asgard lipicure and brilinta maintain a healthy lifestyle follow up after seven days"
    },
    {
        "instruction": "hello doctor I am a 61 year old male I have a mole on the thigh and is slightly itchy please suggest",
        "input": "",
        "output": "hi moles or melanocytic nexus are genetic collections of melanocytes the dark color producing cells they go through a cycle of evolution with disappearance in the middle age increased number size and genetic history of cancer are the risk factors for the development of cancer called melanoma moles are dangerous if there is sudden change size color shape border or become symptomatic in this condition they should be immediately removed surgically and sent for histopathological examination here I see a darker mole I wanted to know when this mole changed its color though it is not large the border is irregular there is also some reddish area with crusts below it when it appeared is it symptomatic"
    },
    {
        "instruction": "hi doctor in the past few months I acquired spider veins and varicose veins on both sides of my penis the veins are thick dark blue and engorged with blood even when the penis is flaccid varicose veins run in my family but never thought I could have them there they also are accompanied with dull aching pain it seems they are just becoming bigger every day is there any treatment to have these veins removed if I get them removed will it affect my erections which I currently have no problem with",
        "input": "",
        "output": "hi varicose veins are a very rare entity if they are present on your penile skin most of the time they need no intervention unless they are causing so much pain which is interfering with your daily activity or for cosmetic reasons as they are superficial removing them does not result in loss of erection do you have varicose veins elsewhere have you ever get doppler ultrasound done if not get it done to stratify the grade of varicose veins if you can upload a photo it will be great lastly does your job involves standing for a long time"
    },
    {
        "instruction": "hi doctor I have had a bit of silent reflux in the past which I have been able to identify by some coughing in the night however this was usually associated with certain alcohol or foods and it has never been a problem then I was a bit sick and I noticed I had developed an itchy throat and cough in the next few days which turned into quite a swollen feeling in my throat right up inside my ears and also sometimes on the chest it has stopped now at first I thought it was viral or bacterial and took apple cider vinegar lots of vitamin and was prescribed antibiotics all of which made my stomach very sensitive and the acid reflux worse to the point I was also having a low grade fever every day I changed my diet to low acid foods and have been using gaviscon double and it feels somewhat better but laryngitis has not healed my voice is crack and has been for a month another doctor has prescribed lansoprazole I took it one day and my tummy was quite sore I am unsure if I should continue it my stomach has been very sensitive since taking the antibiotics I am at a bit of a loss of how to fix all this though I take soft foods and gaviscon my throat is not healed yet I am a 40 year old female the only other issue I have is the gallstone issue please help me",
        "input": "",
        "output": "hello your symptoms are suggestive of reflux which can cause laryngitis leading to sore throat and changes in voice I will recommend you continue lansoprazole but if it is causing a problem then it can be changed to esomeprazole this salt may help I will recommend starting the below treatment and it will help out may need endoscopy if no improvement after two weeks reflux associated laryngitis capsule lansoprazole one in the morning before breakfast for four weeks domperidone 10 my one tablet three times daily before meals for two weeks syearup gaviscon 10 my three times daily after meals for two weeks avoid late night eating increase height of head end of your bed by inches avoid coffee tea and chocolate"
    },
    {
        "instruction": "hello doctor I am having a history of hypertension for the last 13 years my mi is around 39 and recently I found grade diastolic dysfunction what is your advice on going out to the office as I am working in a bank and it comes under essential services what precautions should I take against couid 19",
        "input": "",
        "output": "hello welcome to icliniq com certainly you fall into hig risk category and prevention is very important in your case so ideally you should avoid going to bank or outside as much as possible but this may not be possible for essential service providers like you doctors if you could not manage to stay home then take full precautions like using mask all the time keeping distance from all the individuals using sanitizer frequently etc if your be is remaining above 140 90 mhg for most of the times then you need to get some more medications added like tablet cilinidipine 10 my once or twice daily depending upon the requirement also lil cholesterol of 181 is too much elevated and you need to be on medication for it as well along with healthy lifestyle like tablet rosuvastatin 10 my bedtime for eight weeks so you need to take full precautions as you fall into high risk category I hope this helps"
    },
    {
        "instruction": "hello doctor I have had some bumps for about three days they do not hurt I am not sure if I have herpes simplex I have not been with a partner for over two months I currently do not have any other symptoms besides the bumps they are clusters closed together and I am not sure if it is acne or ingrown hairs or herpes I am a 19 year old male and currently on no medications",
        "input": "",
        "output": "hello I can understand your concern according to your statement and picture you have been suffering from bumps around your penile part with pus filled blisters which are red and white color according to your picture it may be genital herpes which is caused by herpes simplex virus hav it is a sexually transmitted disease but you have mentioned that you have abstained from sexual intercourse for two months many people often do not know that they have the virus because many people who are infected with hav have no symptoms or their symptoms are very mild first genital herpes outbreak may cause multiple outbreaks later again it can spread from oral sex if your partner is infected again your symptoms can occur from other skin conditions like pimples or ingrowing hairs and contact dermatitis also can show the same scenario contact dermatitis is a skin condition that can cause red itchy cracked dry or scaly skin blisters or a rash it usually occurs within minutes to hours after touching an irritant or something you are allergic to common causes include reaction to medications detergents cosmetics and jewelry so we should find out the exact cause for your sufferings and then treat them accordingly in case of herpes infection you can take antiviral medications like cream and tablets for contact dermatitis you can use antihistamine avoid the irritant or allergens that are suspected"
    },
    {
        "instruction": "hi doctor I am a 20 year old female I never got my periods and it hurts too much to have sex",
        "input": "",
        "output": "hi from the history that you have posted I believe that you are suffering from a dry vagina due to some reasons you should get evaluated because you are 20 years old and it is high time that you should start menstruating maybe ovaries are not optically working and hormones like estrogen is deficient and other glands that should act on local genital areas to lubricate it are not working sometimes dryness may be due to allergy and anti allergic medications may help in this it is necessary to involve in enough foreplay before actual penetration it helps in stimulating your genital glands to provide proper lubrication for penetration normally the walls of the vagina stay lubricated with a thin layer of clear fluid the hormone estrogen helps to maintain that fluid and keeps the lining of your vagina healthy thick and elastic a drop in estrogen levels reduces the amount of moisture available it can happen at any age from a number of different causes it may seem like a minor irritation but the lack of vaginal moisture can have a huge impact on your sex life fortunately several treatments are available to relieve vaginal dryness you can use my jelly locally in and around the vagina before attempting intercourse I hope this helps"
    },
    {
        "instruction": "hello doctor I have swelling in the right side of my neck location supraclavicular lateral to sternocleido mastoid muscle for about one month I also have left lower back pain towards the mid axillary line it is not superficial pain but pain on deep press for about two weeks and right wrist tendon tear for about four months please help",
        "input": "",
        "output": "hi welcome to icliniq com it seems you are suffering from muscle problems passing through the spine I simply suggest you only three things at first wear soft collar wear wrist band back strengthening exercise for low backache you can take pills like anvil ibuprofen or alive naproxen once a day after food doing hot water fermentation will also help reduce pain and swelling moving head in a circular motion clockwise and anti clockwise bending left to right and right to left and moving the head up and down holding for 10 seconds this staring exercise will reduce neck pain and for wrist tear wear a wrist band and take aceclofenac tablet do not put pressure on the injured hand as it may increase more danger to the tendons I advise you to get x ray or mri of cervical spine ap anteroposterior and lateral view x ray of the wrist joint strain and stress improper posture ray of the cervical spine and lower back ray for the wrist joint after two days"
    },
    {
        "instruction": "hello doctor my wife is in remission from stage breast cancer she underwent chemotherapy and radiation last year as a result of her treatment she did not have her period for roughly 13 months her period returned last month but she seems to have missed her period this month my question is are irregular periods normal after what she has been through or is it more common for her cycle to be regular",
        "input": "",
        "output": "hello loss of ovarian function can happen temporarily or permanently depending on the dosage of the chemotherapy this happens due to the damage to the immature ovarian follicles containing the immature eggs by the chemotherapeutic agents so the chances of resumption depend on the ovarian reserve left undamaged so usually post chemotherapy a woman may resume her cycles anywhere from a few months to more than a year some women may even develop premature ovarian failure as per your query irregular cycles are quite common post chemotherapy once the periods are resumed but I need to know one more important thing that is the hormone receptor status of the biopsy and whether your wife is on any medication called tamoxifen if she is on such medication then bleeding needs to be monitored by an ultrasound scan to look for the uterine lining thickness I hope this helps ultrasound abdomen and pelvis in case on any abnormal bleeding pattern keep a track of menstrual cycles please connect with me through chat in case you have any further queries on periods"
    },
    {
        "instruction": "hello doctor my major complaint is headache and dizziness this has been ongoing for years despite being to several doctors I am currently on levothyearoxine for hypothyearoidism along with bisoprolol for ist I have had an mri and it scan done on my head both of which came back abnormal my doctor has sent in a referral to a neurologist but he has yet to look at any of my information I just want an opinion to begin with",
        "input": "",
        "output": "hello regarding your concern I would explain that these it scan and mri findings are not related to the headache and dizziness I would like to know more about headaches is it throbbing or like pressure do you feel nausea during the headaches how long do they last do you tolerate the light during the headaches in my opinion considering the location of the headache in half of the head it could indicate migraine I would recommend starting therapy with sertraline coupled with verapamil regarding the mri findings in my opinion they could indicate a normal variation of the brain structures anyway a brain mri after a year would be necessary I hope this helps"
    },
    {
        "instruction": "hello doctor my wife is suffering from chest infection she is also having cough vomiting and fever every time after getting diagnosed with chest infection please suggest",
        "input": "",
        "output": "hello I can understand your concern according to your statement your wife has been suffering from chest infection fever and cough with vomiting does she have a history of repeated chest infections you have not mentioned the duration here please provide the history of allergy previous disease medications environment family childhood acid reflux etc she may be suffering from chronic cough followed by vomiting so she have to undergo car chest ray abc complete blood count ear erythrocyte sedimentation rate he circulating eosinophil skin prick test last test reversibility test etc reversibility test is done to determine the presence of asthma she can take broad spectrum anbiotic like azithromycin nebulization with salbutamol inhaler fexofenadine montelukast and antiemetic medications"
    },
    {
        "instruction": "hello doctor I am on birth control and taking it regularly the majority of the time I had sex on february 16 and he did not use a condom but used pull out method I had my period the week before I had a period on time the next month but it is lighter this past month I had a very light period for a day and a half which could probably be considered spotting I have no pregnancy symptoms but should I be concerned is it likely the change in period could be due to stress of thinking I am pregnant",
        "input": "",
        "output": "hi I understand your concern I presume that you have not missed your birth control pill and I presume that your cycles are regular in that case your egg release would happen around 12 to 16 the day of your period if you count the first day of period as day you had intercourse on the eighth day of your period so you are protected from pregnancy by three things you are on pill you had sex before egg release you used withdrawal method during sex I need to know if you are having delayed cycles also please give me certain details are you having weight gain is there excessive facial or body hair how much delayed are your periods any dark pigmentation around neck or armpits cycles can range anywhere from 21 to 35 days in adults but if any of the above is developing then it is probable that you are developing hormonal imbalances during the lockdown period the physical activity of most of us is a bit restricted and also there looms a lot of stress regarding couid 19 these are factors that may lead to hormonal imbalance and hence delayed cycles it is important to engage in some exercises that can be done at home and it is advisable to eat green vegetables and fruits and drink milk regularly meditation diet and exercise forms the primary regime to avoid irregular cycles it is better to avoid excessive cheese fat butter ice cream fast and junk foods I hope this helps"
    },
    {
        "instruction": "hello doctor I have small spots or granules on both sides of my cheeks and on lip corners for the past eight years I was a smoker and occasional tobacco user I quieted this four years back I have no pain or irritation and I am in touch with a local dentist and taking vitamin supplements I need an advice for further treatment",
        "input": "",
        "output": "hi welcome to icliniq com the long term habit of smoking and tobacco chewing has caused this on the inside of your cheek good to hear that you stopped the habit the vitamin supplement you mentioned is also nice but it takes time to heal for years together the inside of your cheek has been exposed to heat and tobacco which are responsible for such a change it will heal no doubt but it takes time be patient have your dentist consultation regularly and avoid hot foods use a medicated mouthwash the time taken to heal is generally more than the time taken for those spots to appear"
    },
    {
        "instruction": "hello doctor I am suffering from premature ejaculation for last five years treatment is going on but no effect my age is 47 years any injection is available for premature ejaculation suffering from the last five years I am taking tablet duralast 30 sos but the result is very poor no sugar or blood pressure problem yet any injection is available for its treatment or surgery",
        "input": "",
        "output": "hello premature ejaculation is defined as ejaculation with minimal sexual stimulation before the patient desires and before or within one minute of penetration there are two major reasons for premature ejaculation frequently performance anxiety could be a cause of premature ejaculation in that case you can take deep breaths for two minutes before sex it will relax you enough if you still feel anxious you can take tab alprazolam 5 my half an hour before sexual activity remind yourself that you are having sex for mutual pleasure and relaxation it is not an ordeal or duty where you are supposed to be the performer if it is due to excess sensitivity of the glans penis front portion of the penis the first technique is known as squeeze technique in it when you reach close to orgasm you or your partner should squeeze on the ridge between the glans and the shaft of the penis till the erection subsides then begin with your sexual activity once again repeat this a few times before you finally ejaculate this will increase your time to ejaculation and also give you some voluntary control the second option is you can use lignocaine spray once on the glans penis 15 minutes before sexual activity it will reduce the extra sensitivity of the glans to the normal level you can also use lignox jelly instead of spray if these techniques are not working for you can consult a sexologist who will examine you physically to find the cause and advise accordingly"
    },
    {
        "instruction": "hello doctor my stomach hurts really bad whenever it hurts it is very severe do you have any subjugation for me",
        "input": "",
        "output": "hello you have given nonspecific history as it hurts either every day or occasionally it has any relationship in empty stomach or after taking a meal is there any relieving factor or triggering factor your daily bowel habit your drinking history your smoking history is there any surgical history are you relieved after vomiting your family history of any disease your age are you sexually active or not duration of your abdominal pain menstrual history or fever etc you should undergo us ultrasound that will reveal any abdominal abnormalities like pid pelvic inflammatory disease cystitis cholecystitis pancreatitis ovarian cyst pregnancy etc abc complete blood count will give some idea about your abdominal pain like increased ear erythrocyte sedimentation rate will suggest appendicitis increased abc white blood cells will suggest of infection etc urine m will determine urinary tract infection again you can also undergo endoscopy of upper git gastrointestinal tract serum amylase serum lipase etc you can follow tablet visceralgin tiemonium methylsulphate three times a day in case of abdominal pain tablet domperidone 10 my three times a day for ten days capsule omeprazole 20 my twice daily for 10 days in the meanwhile please perform your investigations and inform me the results then I will be able to diagnose your cause that is responsible for your abdominal pain and vomiting and treat the cause"
    },
    {
        "instruction": "hello doctor I would like to ask about my situation last night I decided to clean my ears using cotton buds after hours I felt like my left ear did not function as how my right ear does it has the same feeling when you got out of the water from the swimming pool as if there is a stucked water inside days pass two days to be exact I started to feel pain whenever I touch my ear and also I observe that there are times wherein there is a liquid just a bit but not too much that comes out of my ear but it has no odor and color I feel scared and bothered I am afraid of losing my hearing since I mostly use my ears for my job please help me is this dangerous will I lose my hearing because of this what are the medications I can take to ease the pain and cure this problem",
        "input": "",
        "output": "hello I understand your situation your symptoms are suggestive of an acute ear infection nothing to worry since you say your ear is discharging follow these suggestions visit an ent doctor near you so that your ear can be visualized endoscopically and treated accordingly if you do not have the chance to visit an ent consultant start yourself on the following medication tablet amoxicillin 500 my twice daily for five days tablet levocetirizine once daily before sleep for five days ciprofloxacin ear drops three drops thrice daily try to keep your ear dry at all times regarding your hearing in most cases it will be back to normal after the underlying infection subsides but nothing can be confirmed without examining your ear get out of the habit of using earbuds to clean your ear it is designed to only clean the outer ear lobe not to clean inside your ear this habit will only worsen things for you infection of the external or middle ear endoscopic examination of the ear pure tone audiometry impudence audiometry keep the ear dry at all times follow up regarding the symptoms in three days"
    },
    {
        "instruction": "hello doctor I have a problem with my foreskin swelling and also experiencing pain I am a 37 year old male and had my circumcision done seven years back there were some inflammation and occasional pain through these years but recently have been experiencing more inflammation and pain in that area please advise on the treatment for this I am currently using anti inflammatory medication and a corticosteriod cream to the inflamed area siloderm mixi augmenting 625 my and lytix tablets",
        "input": "",
        "output": "hi the treatment you are taking is perfect since how many days are you taking these current medications based on the information you already gave I recommend you to add on to this treatment xylocaine jelly or lidocaine spray local application twice a day tablet pregabalin 75 my od for four weeks and see for the results any history of exposure to a new partner or unprotected sex are you a diabetic have you ever been checked for the same it will be great if you can upload a picture depicting your swollen glans I am asking the picture because the swelling and inflammation you are talking off may not be actually the same instead you might be having hyperesthesia or neurogenic pain so in that case we might have to revise the treatment"
    },
    {
        "instruction": "hello doctor I have foot pain and I suffer from flat foot pain is mainly located at the lateral and medial side of the heel please suggest",
        "input": "",
        "output": "hello flat foot is a very common condition and causes pain due to stretching of tendons ligaments and soft tissues of the feet I guess an ray must have already been done for you just make sure that apart from the flat foot you do not have any other associated condition like abnormality of bone or abnormal bone growth if you are overweight then you need to take care of it as excessive weight increases flat foot pain furthermore if you have any other comorbid conditions such as diabetes or hypothyearoidism please control that as well there are special shoes that are tailor made according to your foot so that there is less strain while walking or running kindly get them also visit a physiotherapist or a chiropractor who will teach you specific stretching exercises that you will have to keep doing regularly at your home to minimize pain and discomfort when your pain is severe take a painkiller of said non asteroidal anti inflammatory drugs group I prefer tablet aceclofenac 100 my as it is known to cause less gastritis it can be taken twice daily after food in addition taking a multivitamin and mineral pill will help in nerve health I hope this helps developmental congenital ray foot ap oblique and lateral blood tests include complete blood count abc blood sugars fasting and post prandial thyearoid profile to ash thyearoid stimulating hormone flat foot physiotherapy exercises and stretches custom made shoes painkillers as and when required avoid overweight long running"
    },
    {
        "instruction": "i was driving bike suddenly the weight of the entire bike shifted to my right hand its been more than a month I usually do not have pain when my wrist is normal only when I move my wrist or hold something heavy I feel uneasy or like something is not right with the wrist what can be the reason and what should i",
        "input": "",
        "output": "hi welcome to icliniq sad to hear about your accident obviously if fallen from bike and the pressure took by the hand while your hand touches the ground it causes jerk and can damage internal carpet bones your wrist bones connect your hand to your forearm wrist movements are controlled by the forearm muscles here I will tell you some exercise to strengthen wrist muscles sit comfortably and bend your arm at the elbow resting your upper arm on your leg or a table or hold it with your other hand make fist and flex your hand as far as you can and downwards in the same position of you hand move wrist from right to left and left to right these will help you in relaxing wrist muscles and helps increase range of motion then stand with your elbows bent and palm together and fingertips pointing up at a level that is just below your chin lower your hands toward your waist keeping your hands pressed together and close to your stomach and the last one you do is to squeeze ball exercise sit comfortably and take the ball or putty in your hand wrapping your fingers and thumb around it squeeze it hard as you can do repeat this for about 10 seconds all these exercise need to be done twice a day apart from the exercise I suggest you to take ray of wrist ap lat view to know if anything damage in wrist bones follow up after days with report of ray remember always try exercise only until you can do not put pressure to stretch the muscle you can apply diclofenac ointment following hot water fermentation if you feel pain hope you will follow the exercise as mentioned thank you once again for being here to consult about your health"
    },
    {
        "instruction": "hello sir 29 year old last few days I am suffering from heel pain when I get up its pain too much and whole day its pain please tell me it is dangerous and what I do",
        "input": "",
        "output": "hello I am sorry you feel that way has there been any trauma on your heel has anyone hurt you physically before pain appears what have you eaten before pain appears if there has been no trauma on your heel I am considering gouty arthritis it is a kind of arthritis inflammation of the joints due to elevated blood uric acid usually the pain is severe early in the morning the affected joint could be unilateral or bilateral here are my advise take pain reliever diclofenac na voltaren 50mg tablet take tablet every hours as needed for pain I advise that you undergo blood uric acid test drink plenty of water it could help lower your blood uric acid you can apply warm compress on the affected joint you can also take vitamin complex it could help lessen the pain avoid high uric acid diet like beans internal organs liver sardines more than serving of meat a week spinach cauliflower I advise you follow up as soon as possible when your blood uric acid test result is already available I hope my advise will help you feel a little better take care"
    },
    {
        "instruction": "hello doctor my year old daughter is experiencing severe bleeding in her gums prior to this she has a fever and sore on her tongue and somewhere near the tonsil please help",
        "input": "",
        "output": "hello I understand your concern when it is a kid matter first of all I would suggest you look in her oral cavity properly if she has caused any toothbrush injury or any source of bleeding if available for bleeding gums you apply a cold compress or ice packs right now at the affected site next make her do salt warm water rinse if possible one home remedy with honey is effective you can take honey at your fingertip and apply all over her gumlines properly kindly make sure she does not brush in upward downward motions rather in a circular motion brush her teeth twice daily and bristles of her brush should be soft apply a bit of toothpaste two to three minutes before brushing all over her gumlines and then brush after one to two minutes but make sure she should not swallow it give her gums smooth finger massage after she has done brushing make her rinse her mouth properly after every meal kindly post me about the updates"
    },
    {
        "instruction": "hi doctor my father is 63 years old he suffered from a mild stroke yesterday and we would like to seek the second opinion on the proper treatment for his case he was given catapres to lower his blood pressure and was asked to continue taking his maintenance medicines for hypertension losartan his latest be taken just a while ago is 140 80 mhg we would also like to ask for guidance whether this warrants a trip to the er since the hospitals are now full of confirmed and suspected couid patients we are concerned that going to the hospital may be more detrimental to his health please help",
        "input": "",
        "output": "hello regarding your concern I would like to explain that his blood pressure values are normal I would like to know his symptoms did he perform a brain it scan as he suffers from diabetes the most probable cause would be an ischemic stroke blood clot for this reason besides antihypertensive drugs antidiabetic drugs it is necessary taking baby aspirin 80 100mg daily in order to help prevent a future stroke I hope this helps"
    },
    {
        "instruction": "hello doctor I have been extremely stressed lately I started a new job a couple of months ago I am going through a divorce and I have health issues pertaining to a brain surgery I had two years ago I had a normal pap smear last year my periods were normal until three months ago I was late by over a week for the past two months I got my period between 18 24 of last month I stopped and then again bled for a week from est to ith of this month this is the normal time I would have gotten it months ago now again a week later I am bleeding it started with dark brown blood that had tissue like small pieces in it and is now dark red going on day three my periods are always very heavy I always have ovary pain and bad cramps I had a section with my daughter and was told I have scar tissue during an exam I suffer from very painful periods when I sneeze or move or cough or stretch during ovulation and the beginning of my period I have a feeling like my right side is ripping apart why am I bleeding like this it has never happened to me before and I am scared it could be cancer I just had bloodwork I went to the hospital for an unrelated issue this week before the bleeding started and my red and white blood cells and normal abc workup was normal please help I am trying not to stress",
        "input": "",
        "output": "hell first of all stop worrying we can take care of this stress can also play a vital role in hormonal functions so try to calm and relax yourself first see in general an average length of the menstrual cycle that is considered normal is 28 plus minus days so any deviation either before or after is abnormal coming to your present menstrual history you got early bleeding this time this mostly suggests some hormonal disturbance which needs to be evaluated it could be related to your thyearoid hormone or even a lifestyle related problem called cos polycystic ovarian syndrome but however any structural causes like polyps or fibroid also need to be ruled out for which ultrasound is required along with an examination by your gynecologist based on the past history it appears probably you must have had an entity called endometriosis or scar endometriosis in your cesarean scar this usually happens under the influence of the hormones that occurs in natural menstrual cycles when you are ovulating right now probably you did not ovulate either because of stress or due to the hormonal changes we need to evaluate I am suggesting a few tests that you need to take so that we can have a look into this meanwhile try to work on your lifestyle changes do regular exercises and take adequate dietary precautions avoid fatty or sugary or high carb junk foods all these measures will have beneficial effects on you try to meditate or do yoga for relaxation I would also like to know if you had any recent weight gain or weight loss any excess acne development or excess facial hair growth or scalp hair loss also if you have any headaches or visual changes it would be good if you could share the details of your recent ultrasound reports your scar tissue biopsy report if any done and the details of your previous issue which I am suspecting it to be endometriosis to guide you on the present problem the reports you shared show a good hemoglobin levels so nothing to worry in that ultrasound abdomen and pelvis complete hemogram lipid profile let liver function test rat renal function test 75 glucose tolerance test hba1c serum calcium vitamin b12 levels serum fasting and post prandial insulin levels serum fish follicle stimulating hormone oh leutinizing hormone free testosterone estradiol prolactin levels thyearoid profile to ash anti tpo on second or third day of next menstrual period hormonal imbalance cos polyp fibroid to be ruled out with ultrasound if the flow is heavy with passage of clots you can take tablet tragic 500 my thrice daily after food can avoid if the flow is normal yoga or medication maintain menstrual diary regular exercises at least one hour daily lifestyle and dietary modifications please revert back with the necessary details through chat preferably"
    },
    {
        "instruction": "hello doctor my height is 7 and I weigh about 159 pounds I am a male with anemia I got a colonoscopy but they could not stop the bleeding so I got a transfusion and I also got another colonoscopy to make sure that the bleeding stopped I have to get another colonoscopy between 6 months from the first colonoscopy I went to see my primary care doctor and they gave me some iron pills to be taken for three months which are over the counter called ferrous sulfate I went to see the gastroenterologist last month and they told me to come back this month to make an appointment to get another colonoscopy I cannot get in touch with my doctor right now because of the couid 19 I wanted to know that if I still have symptoms of anemia could I take some more iron pills or three months is enough",
        "input": "",
        "output": "hi you have mentioned that you had bleeding per rectum and you had gone for the colonoscopy can you share the report of colonoscopy so that I can know what was the cause of bleeding it is perfectly safe for you to continue the iron medicines until the time you get an appointment with your regular doctor"
    },
    {
        "instruction": "hi doctor I missed my period then I took a pregnancy test two days before and it is positive I got two lines the first line is dark second line is light pink but today morning I got abdominal pain then light bleeding also it is anything wrong I am really scared now",
        "input": "",
        "output": "hello I saw that the urinary test pregnancy is positive congratulations on your pregnancy it will be better if you have written the first date of your last menstruation so I can calculate the gestational age in the first week of pregnancy at 6 weeks woman can experience dark brown spotting it quite normal due to the implantation of trophoblast but there are also other causes as hematoma if the bleeding becomes heavier red with clots or lasts for several days you should discuss it with a specialist at 7 weeks of gestation you should consult with an obstetric specialist because you should undergo several lab analysis and an ultrasound to ensure an intrauterine pregnancy and to detect the heart activity of the embryo trophoblast implantation ultasound the first lab examination egg i'm for civ cytomegalovirus rubella toxoplasma blood and group blood analysis ash thyearoid stimulating hormone etc hematoma folic acid"
    },
    {
        "instruction": "hello doctor I am suffering from panic disorder for the past four months initially when I got my first panic attack I just suffered without taking medical help since I am frightened to take medicine this made matters worse and I started to have almost regular panic attacks followed by mild depression a month later I am a 37 year old healthy male with no diseases I used to regularly jog or workout in the gym I eat a healthy mostly homemade vegetarian diet in limits I never drank alcohol or smoked I was happy with my life and had no regrets but after I got my first panic attack I got so scared that I started to research internet furiously and overthink a lot this made matters even worse for me and finally I consulted my local go he prescribed me with stalopam 10 my at night and 5 my clonafit twice a day I was afraid to take them and finally after my panic was getting bad enough to cause insomnia reluctantly with gas persuasion I started to take the medicines I took stalopam daily but disregarding my go I took only 5 my clonafit at night as I heard it can cause addiction initially for two to three weeks I felt a little depressed every now and then but the panic attacks intensity decreased immediately though I got the attacks they were not scary after the first month the depression too became better then I halved the clonafit and started to take only 25 my at night it has been now two and a half months and I am feeling a lot better though some days I get anxiety episodes it is not disturbing and depression too has gone so I requested my go to stop it accordingly he asked to me take my stalopam with 25 clonafit for 30 days and stop completely do you think it is right on my part or would it be advisable to continue the standard dose 10 my for a few more months until anxiety completely disappears",
        "input": "",
        "output": "hello it is good to know that you are feeling better and the medication have been helpful regarding your query about medication it is advisable to continue stalopam 10 my escitalopram for at least six months even if you are feeling better stalopam is an sari selective serotonin reuptake inhibitor which is effective in treating anxiety disorders panic symptoms and depression if you are not experiencing any side effects stalopam is safe to continue for a longer term clonafit clonazepam is meant for short term use I agree with your plan to take 25 my at night only cut down to half the dose again for four weeks and then stop it can be used sparingly as needed if you feel anxiety is high you also need to consider managing any underlying issues which precipitated this panic attacks was there anything stressful happening in your life during this period share any difficult feelings with a trusted family member or friend if needed consider counseling develop self help interventions to manage stress and prevent relapse of anxiety regular exercise helps cut down on coffee tea and alcoholic drinks take up yoga if feasible I hope this helps"
    },
    {
        "instruction": "hello doctor I am 48 years old I have two fibroid am total size and was advised to take 500 my three times a day but it completely stops the bleeding but the bleeding starts after three days again I have had on and off bleeding for two weeks now is this a common problem with the medication I am extremely worried and cannot be normal please help and advise",
        "input": "",
        "output": "hello welcome to icliniq com it would have been helpful if you could attach the report of your ultrasound for me to have a look based on what you mentioned about the total size of two fibroid to be am I am assuming each one must be less than am and not so huge fibroid would not cause irregular bleeding unless they are lying close to the uterine cavity usually in the perimenopausal age group of women like you are already 48 we prefer to give medical management so as to control the bleeding in those who have excess bleeding as with age your menopause may set in and menses will eventually stop and then you will not have any problems because of the fibroid this is done to avoid unnecessary surgery when the bleeding would anyways stop after menopause in your case I would like to know if the fibroid are close to the uterine cavity on ultrasound which may cause irregular bleeding also in your query the drug name has not come but I guess it is tranexamic acid or tragic or pause which just controls the excessive bleeding means will reduce the bleeding but will neither stop the bleeding pattern due to hormonal disturbance in the perimenopausal abnormal bleeding nor due to the fibroid which bleed due to the close situation to the uterine cavity other causes if irregular bleeding apart from fibroid need to be evaluated like hormonal changes thyearoid issues or uterine lining endometrial thickening etc if it is due to fibroid position that is causing off and on bleeding it may not stop with tragic but only will reduce in amount and may stop only after menopause or after the surgical removal of the uterus but if it is due to the hormonal disturbance or due to the perimenopausal phase it needs to be controlled with some hormonal medications it would be good if you could connect with me through chat and share the reports of yours so that we can have a close look if any further evaluation needs to be done regarding the abnormal bleeding pattern ultrasound report needs to be reviewed thyearoid abnormalities perimenopausal rub abnormal uterine bleeding ca cancer endometrium ein endometrial intraepithelial neoplasia please revert back with reports"
    },
    {
        "instruction": "hello doctor I had pain and irritation and also heartburn while eating spicy foods I guess for the past three days today morning I had severe hunger and more thirsty feel after I drink plenty of water now I am feeling fine but still while eating I am feeling some pain on the upper stomach or under the chest please suggest I use gelusil antacid",
        "input": "",
        "output": "hi the symptoms which you have described are suggestive of too many problems related to the gastrointestinal system to come to any specific diagnosis I will need a few more details do you have these symptoms only while eating is it relieved after eating what is your regular dietary routine do you sit for long hours did gelusil give you any relief do you have pain in the lower abdomen kindly let me know these details in follow up I shall plan your treatment accordingly"
    },
    {
        "instruction": "hello doctor I was diagnosed with prediabetics 102 two months before now I noticed white spots on my upper gums are the spots related to diabetes or some serious problem please guide",
        "input": "",
        "output": "hello before commenting anything about diabetes and its relationship with oral problems I would like to see images of your gums having a white spot so that we can discuss appropriately"
    },
    {
        "instruction": "hi doctor I am a 54 year old male I have floaters in my eyes mostly on the right eye and sometimes on the left I also have dry eyes here are my optomap images from the optometrist for your evaluation please guide me",
        "input": "",
        "output": "hi revert back with the old pictures to an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor I am concerned about one of my relatives she may have some psychiatric problems first she faced a problem in her life before 10 years she believes in different sociology and culture she has a fantasy of smoking drinking and living together she does not believe in marriage she becomes angry if someone tries to correct her after that she had taken care by several doctors but the problems never uprooted for one and a half year she is running through the treatment she made the first visit only after that her parents are visiting with those doctors as a witness I noticed some irrelevant behavior 10 days ago which makes us very annoying I have a chronological prescription my only question is at this moment is she able to enjoy her marriage life if she gets married will she able to get pregnant please describe the family life difficulties including sex life I will be very thankful to you",
        "input": "",
        "output": "hi I will summarize the clinically relevant aspects of her case the illness started early around the age of 17 years it has not cleared completely until yet and she has not returned to her previous personality the symptoms are suggestive of paranoid schizophrenia or bipolar disorder though more information and detailed history will be required to confirm it these factors suggest a poor prognosis and incomplete recovery from the illness her future will be decided by how much her symptoms improve if she visits the psychiatrist regularly and takes electroconvulsive therapy if the doctor suggests then her situation is likely to improve but at the current situation she does not appear to be mentally fit for marriage or children marriage is stressful in itself and she might not be able to handle the stress though there is no direct effect of the disease on her ability to get pregnant a mentally healthy mother is required to take care of herself during pregnancy and the baby after childbirth she currently does not appear to be capable of handling the stress of pregnancy and childbirth besides pregnancy and delivery are stressful and might worsen her psychological condition also the medicines that she takes might affect her ability to get pregnant and maintain a healthy pregnancy I would like to recommend a course of electroconvulsive therapy it works better than most medicines in such cases for further information consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor I have been battling with back pain since a year I associated this pain with a kidney stone which I had for a couple of years I had a ureteroscopy crushing and removal of the stone a month ago but however the back pain still persists an ray done today is attached I had some back pain before two years due to herniated disc I have undergone bariatric surgery for weight loss my weight today is 13 keg five months before during the gastric bypass surgery my weight was 145 keg my worry is that I cannot exercise or walk long distances as soon as I walk for 10 minutes the back pain is terrible and I need to either sit and rest the spine or press and stretch my back to get some temporary relief the pain is quite unbearable I current taking ultracet and myoril please do suggest the best remedy to enable me to become pain free at the earliest",
        "input": "",
        "output": "hello I have gone through the investigation reports mri of dorso lumbar spine with extension to is junction x ray is spine lateral flexion and extension views to look for the amount of instability at la level revert back with the investigation reports to a spine health specialist online"
    },
    {
        "instruction": "hi doctor I had not had periods for years there was some spotting for around a year the endometrial thickness is the complex echo suggesting menstruation though not having periods please help me",
        "input": "",
        "output": "hi for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I am worried for my 63 years old elder sister who is almost bedridden now due to the following ailments she has severe pain in the stomach started two months ago knee pain for four years and swollen legs for three years doctors are of the opinion that she is suffering from severe arthritis and acute gastritis the medicine which she is taking for arthritis is causing pain in stomach how she will get relief from all these ailments please advise a copy of prescriptions and pathological investigation reports are attached herewith thank you",
        "input": "",
        "output": "hello revert back with the details to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I have been married for two years now we have been trying for baby since last one year but not getting any positive result we used to intercourse as per ovulation calculator but my problem is that I can ejaculate only when she is on top but I failed to ejaculate in another position otherwise I suddenly lose my erection within 50 to 60 seconds is there a chance to get pregnant when women on top what should I do to increase my stamina and how to overcome sudden erection loss while intercourse in the missionary position I have attached my semen report I am on fertisure and my wife is taking ovacare",
        "input": "",
        "output": "hi I read your query with keen interest and reviewed the attached reports for further information consult a sexologist online"
    },
    {
        "instruction": "hi doctor I was diagnosed with a cervical polyp and my gynecologist had said it was caused by hav I have been getting sharp cutting pains in my vaginal area for the longest time hence we decided to go for a hysteroscopy and then we found out that I had the cervical polyps so now for the past few months I have been bleeding between my periods bleeding after having intercourse and my discharge also has a foul smell it also sometimes has a bit of blood mixed with it and I am starting to think this polyp might have developed into cervical cancer I am not sure what to do as these symptoms are not normal at all",
        "input": "",
        "output": "hello welcome to icliniq com based on the symptoms you mentioned it definitely implies that you need to go check with your gynecologist for an examination to see and rule out any cancerous changes or for any presence of polyps without examining it is difficult to say the color and odor of the discharge indicate the presence of infection in that pathology why am I suspecting cancerous or precancerous changes is because you have been tested for hav two years back which was positive hav human papillomavirus is the causative virus or the invective agent that develops changes in the cervix which over many years mostly 10 years but not strictly turn into cervical cancer it would have been very helpful if you had provided the biopsy reports and discharge summary details of the hysteroscopy done and any pap or colposcopy reports if you have done in the past for a better understanding so that I could guide you better I am prescribing you the medication to take care of the infection but you need to visit your gynecologist for evaluation at the earliest for early intervention mri magnetic resonance imaging abdomen and pelvis if required ultrasound whole abdomen and pelvis cervical examination followed by pap smear and colposcopy or biopsy according to the findings blood investigations chest ray chronic cervicitis pre invasive lesion of cervix ca cervix tablet ofloxacin plus ornidazole twice daily for five days after food please follow up with your gynecologist for checkup and necessary evaluation and management"
    },
    {
        "instruction": "hi doctor I would like to have an opinion about my brother recent medical condition he has been diagnosed with neurocysticercosis please explain",
        "input": "",
        "output": "hi I feel sorry for your brother recent disease for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I had a cesarean operation before nine months but my stitches have not been cured yet earlier pus used to come out of the hard structure and began to gather on my belly now after two months again a little bit of stitch has been opened please help me",
        "input": "",
        "output": "hi I had gone through all the details you have posted for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I am 28 years old I am planning to get married to a girl who is known to me we have a very good understanding but we have different blood group mine is positive and she is ab negative since the blood group is a factor for having babies do you think having a different blood group could create problems in the future generation what will be the problems in future for us to have a baby how can we get rid of problems during that time please give me some explanation for this are there any precautions that need to consider for having a baby",
        "input": "",
        "output": "hi based on your query my opinion is as follows for further information consult a hematologist online"
    },
    {
        "instruction": "hi doctor I used to perform cardio exercise for around 30 to 40 minutes and weight exercise strength training between 20 to 30 minutes daily I have been using one natural protein product my wish is to lose fat I am confused whether I should replace my natural protein product with the second one which I found on the internet I have a few queries which are as follows the second protein product has a prefix over all the amino acid ingredients and also contains glutamine in addition to bcaas what does it mean is glutamine necessary I take maximum 25 of supplementation in my dietary intake daily is 25 sufficient or do I need to increase or decrease lastly should I continue with the first protein product or the second one I am attaching the photos of the protein products here for your reference please help",
        "input": "",
        "output": "hi for further information consult a nutritionist online"
    },
    {
        "instruction": "hi doctor I have missed my periods but there are no symptoms of pregnancy if get pregnant within how many days of pregnancy can I opt medical abortion what are the tests to be done before medical abortion please suggest",
        "input": "",
        "output": "hi medical termination can be carried out safely and effectively up to weeks after nine weeks you would need to go for a surgical evacuation this would require you to get an ultrasound scan to see from the gestational age of the baby and a hemoglobin of this patient to check for anemia as these procedures can result in severe bleeding however if you have undergone for medical abortion it would be best to do it under medical supervision as incorrect technique and dosage can result in severe side effects and even incomplete abortion for further information consult an obstetrician and gynecologists online"
    },
    {
        "instruction": "hello for the past nine months I have been suffering from mental trauma because of a professor I studied in a good college during my first semester I did really badly but then I improved a lot as I failed in the first semester I was told to pass that paper for my promotion to the second year many people who had less than me went to second year but to me every time it was a cold shoulder from management when I attempted again unbelievably the questions were much harder I did my best but I failed again the professor harassed me I am sure I deserved more should I stand up and fight for the injustice done I cannot bear the entire burden please help me to understand the problem",
        "input": "",
        "output": "hi for further information consult a psychologist counsellor online"
    },
    {
        "instruction": "hi doctor I cleaned my ear with a tip and now I cannot hear please help",
        "input": "",
        "output": "hello for further information consult an audiologist online"
    },
    {
        "instruction": "hi doctor I accidentally ate a small piece of paper last night I drank plenty of water and also ate normal food but still I can feel it what to do",
        "input": "",
        "output": "hi I can realize the sensitivity of the issues you have right now but do not worry as there is nothing that cannot be managed for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am a 24 year old female I have a skin problem on and off for the past two years the doctor said that it is not acne and I had undergone homeopathy but I did not get any improvement from that also it is not an allergy it is so embarrassing to have this type of skin I also took some acne medicine but did not suit me and I just started getting chest pain with this skin condition I cannot go outside the house I eat good food and I do not have drinking and smoking habits now what shall I do please help me",
        "input": "",
        "output": "hi revert back with the detailed history to a dermatologist online"
    },
    {
        "instruction": "hi doctor my father has spot level with oxygen is more than 95 and without oxygen is 75 80 he also has cold but all tests are normal like it scan us and ray please explain",
        "input": "",
        "output": "hello for further information consult a pulmonologist online"
    },
    {
        "instruction": "hi doctor I am 45 years old normally my speech is good but when I am doing a television show serials or in films my speech is blocked I cannot throw proper dialogs as per the script my ear gets clogged due to some breathing problems I am feeling panic to see that many more people watch me and concentrate on me so it is my great fall in my profession my weight is 70 keg and height is 4 please help me",
        "input": "",
        "output": "hello for further information consult a speech therapist online"
    },
    {
        "instruction": "hi doctor my son is years months old with 92 87 and 90 as fasting blood sugar level in last two months is it a normal range does sugar level of kids differ from adults please explain",
        "input": "",
        "output": "hi for further information consult a diabetologist online"
    },
    {
        "instruction": "hi doctor recently I was diagnosed to have is with diarrhea I also have chronic low back pain I am now depressed by thinking so much about my diseases now I have no interest in any work and also not happy when my boss or other coworker say something about any work I am getting tense also my mood changes daily what is my problem my current medications are rantac 150 twice daily rifagut 200 twice daily normaxin twice daily and zincovit thrice daily I have been taking all these for the past 10 days please help with my condition",
        "input": "",
        "output": "hi for further information consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor I have bumps around my nose upper lip area and eyebrow I have been to two dermatologists and they did not able to provide a treatment to get rid of them I have had the bumps since I was 16 no topical creams have ever been able to help the bumps do not cause any pain one bump along the crease of the nose was extracted by a dermatologist for laboratory testing and the report came back as negative I would like to know what exactly these bumps are",
        "input": "",
        "output": "hi I have read your concern and examine your pictures for further information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor a few months ago after having a couple of falls my mother was diagnosed with progressive supranuclear palsy by a neurologist last week she suddenly started to experience urinary incontinence over the past few days she has complained of the urge to pass urine quite often and sometimes as much as several times within an hour when she does visit the toilet she sometimes passes little or no urine last night we got her tested for ti and the test came back negative we are concerned and exhausted we look forward to getting your input thank you",
        "input": "",
        "output": "hi the increased frequency of urination and urinary incontinence are due to bladder overactivity your mother should undergo an urodynamic study to know what exactly is happening in the bladder during filling I think she will get good benefit by taking antimuscarinics like trospium hydrochloride or darifenacin for further information consult a urologist online"
    },
    {
        "instruction": "hi doctor my mother who had a stroke from a blow injury heavy fall and hit the back of her head to the lower back of her head before nine months is still having headaches on physical exertion especially at work she is a nurse and occasionally has to help move or lift patients which always causes her headaches after resting a few days she feels fine again she had done all the required head scans such as it and mri which are normal her neurologist does not seem too concerned she has booked another appointment with her neurologist in a month she is currently on aspirin what could be the cause of her headache after nine months she also needs a hysterectomy done for her uterine fibroid which is enlarging is it safe for her to go under general anesthesia considering she still has these headaches",
        "input": "",
        "output": "hi I have read your question with care and understood your concern for further information consult a neurologist online"
    },
    {
        "instruction": "hi doctor I am trying to conceive my periods have been irregular for years and never come on time I am using an application to calculate my cycle as best as I can I should have ovulate on ith and my period should have started on 26th however it did not yesterday when I wiped there was a stringy slimy discharge tinged with orange and I started getting mild cramps not quite as strong as menstrual cramps yesterday was the only day I have seen this type of discharge and it happened twice and was gone then today I noticed a brown kind of discharge that then turned to a light pink and red color I have just spotted a little which are not enough for a tampon or a pad and not enough to really fill a panty liner I have seen a few small clots but not many at all and the cramps are still very mild normally when my period starts it will start as spotting for the first hour or so and then pick up and it is always heavy and dark red I have never had this before according to the app I used to calculate my periods my period is now three days late again they are irregular and I never know when I will have them I took a home pregnancy test yesterday and it came back negative I did have unprotected intercourse a few days before I was supposed to ovulate and on the day of ovulation at first I thought it was implantation bleeding but now I am not sure I do have the oh factor and I am oh negative I had a rhogam shot when pregnant and now my daughter is 19 months old I had a miscarriage before years my nipples were really sore a few days ago and I woke up with sudden nausea the same day but nothing since then any help or insight would help a lot thanks in advance",
        "input": "",
        "output": "hello a delay of three days is not considered as irregularity also urine home pregnancy test is not sensitive before eight days past missed menses please rule out any chances of pregnancy with a serum beta hug test human chorionic gonadotropin as of now if the hug levels are less than ng dl then you are not pregnant at all in that case the spotting that you are experiencing is likely to indicate that your menses shall start in next few days the present spotting pattern is due to stress and shall be fine once the flow starts it is advised to be patient for a week at least as the cramps can be a part of pas premenstrual syndrome if pregnancy has been ruled out definitively for further doubts consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I have been diagnosed with atrial flutter I have been in this condition three times in the last two years this is flutter and not fibrillation two years ago I was stuck in atrial flutter for three weeks after being on an anticoagulant for three weeks I went through a successful electrical cardioversion and was free for two years I am 73 years old thin built and vegetarian for several years I walk miles a day no other heart or health issues other than some pvc which I have had since youth six weeks ago I had a flutter return for about minutes I went through a 24 hour monitor and was completely clear I can tell when I get into flutter it is clear and uncomfortable but tolerable then about a month ago it returned and this time for about hours during that time I had an ekg to confirm and my doctor transferred me to a cardiologist who can perform an ablation on the right atrium this new doctor was not too interested in details I felt and I am scheduled for this procedure in a few days I am very statistical I understand the flutter may return at any minute and it may not return ever or for years what is the subjective probability of returning flutter each year for my condition would you have a recommendation should I have this procedure I am currently taking my ace inhibitor and my be is good with this",
        "input": "",
        "output": "hi thanks for the detailed query and I have reviewed every aspect of it to come to a point of decision that may be better for you in the long run for further information consult a cardiologist online"
    },
    {
        "instruction": "hi doctor I am receiving root canal treatment on the right side ith teeth yesterday my doctor has completed till the second step now I am unable to control the pain even after taking the tablets prescribed by him kindly help me",
        "input": "",
        "output": "hello for further information consult a dentist online"
    },
    {
        "instruction": "hello doctor I am a 34 year old male and have an issue with my thyearoid gland I was diagnosed with diffuse toxic goiter in 2005 age 19 and ever since I have been on medical compensation thyearozol I have taken 20 30 my of thyearozol for couple weeks then gradually reduce the amount to zero after a couple of weeks month symptoms were back and I resumed to medication last recurrence appeared a month ago and my doctor recommended surgery complete removal of thyearoid gland currently I am taking 30 my of thyearozol to prepare for surgery as surgery leads to hypothyearoidism is any other options I have in this situation last tests results before getting medications ash 08 to 9 ash receptor autoantibodies 32",
        "input": "",
        "output": "hi there are three ways to treat hyperthyearoidism as what you are having first is with medication and you are already taking that usually it is given for 18 months but 50 of people will have recurrence once they stop medications so the choice is to either continue the medication for life long or go to the other morality which is either thyearoid surgery or radioiodine therapy now you are advised to have thyearoid surgery which has two main complications one is complications during surgery including bleeding infection and losing voice due to recurrent laryngeal nerve damage and you will need thyearoid hormone for the rest of your life for hypothyearoidism about radioiodine it is one of the best treatments nowadays available right now it has a very low chance of malignancy which may be negligible it can cause hypothyearoidism as well but it is over years if your goiter is causing problem like you do not like its appearance or it makes difficult for you to breath which it can cause once it enlarge and obstructs the air pipe so if that is the case you can go for surgery"
    },
    {
        "instruction": "hello doctor I have a wrist pain on the top of it usually when I use it in daily life it is all nice but as soon as I even swing a tennis racquet soon afterward pain develops the pain is on the top and prevents my wrist from pronating whenever I play tennis it is usually only for five minutes the pain goes away in a few days but recurs as soon as I even swing a racquet what is the problem",
        "input": "",
        "output": "hi the wrist pain that you are experiencing could be due to the following reasons tfcc triangular fibrocartilage complex injury drug distal radioulnar joint instability carpal tunnel syndrome osseous bone injury cartilage injury if you are having a history of trauma there are high chances of osseous or ligamentous injury in and around the wrist joint I would like to suggest you to get an mri of the wrist joint to get a detailed understanding of the intraarticular and extraarticular pathology causing the wrist pain wearing a brace would definitely help you when the pathology is acute but since you are experiencing this pain for the past three years and it is not subsiding I recommend further investigations"
    },
    {
        "instruction": "hello doctor I have diabetes and my reading before fasting is 165 and after fasting is 325 I am taking glycomet 250 three times a day and taking diabetes tablet once a day can you kindly advise on the diet to bring the after fasting reading down",
        "input": "",
        "output": "hi welcome to icliniq com you need to first stop all sugars and sugar drinks fruits to be taken as a sweet fish only especially grapes mango and banana should be cut down many people think it is fine to eat bread rice or pasta but if you see deeply one bread of about 30 50 grams contains about 12 13 spoons of sugar I have seen people avoiding one spoon of sugar in the tea but eating two or three breads at the same time so cut down your bread rice pasta and potatoes and eat more vegetables you can take more lentils beans and salads another important aspect is intermittent fasting that can also help to control your sugars even there is growing evidence that intermittent fasting can reverse diabetes I hope it makes sense you need to check your sugars more frequently especially fasting and after two hours of eating and cut down anything which leads to higher sugar levels usually fasting sugar target is 100 120 and post prandial 160 180 and hba1c less than currently your sugars are high so you need to compliant with medications diet and may need drug modification as well"
    },
    {
        "instruction": "hello doctor I have been struggling with a lot of upper abdominal pain since six months I have constant chronic pain in my upper right abdomen and chest I was adamant it was my heart but have had all heart tests done and everything is fine except for palpitations they think are from anxiety gallstones have also been discovered but that pain would be on my right side and not on my left the left side pain is unbearable sometimes it hurts to breathe in deep it is very tight there is popping sensations a lot and I really struggle with constipation and then I can have a couple of days with diarrhea I have completely changed my diet and lifestyle given up smoking and alcohol for two months now I only drink water and the occasional green tea have cut out all other drinks I eat clean now and have lost 20 labs in the last two months my bloating has dramatically gone down but the pain has not I have taken so much gaviscon since four months that it does not work for me anymore I have cut out nightshade vegetables gluten unhealthy fats and dairy except for the occasional non fat greek yoghurt in my smoothie the pain is still there I have been to the hospital multiple times and they just say it is gastritis I know I have indigestion problems but I feel like there is something else going on an endoscopy showed nothing wrong just told to continue gastritis medication but the medication does not work the change of lifestyle is also not working any advice on what could be wrong would really help",
        "input": "",
        "output": "hello I have reviewed your concern thank you for the extensive details I am happy to know there is no sinister problem going on all you are suffering is functional problem you have mixed features of dyspepsia and is and both have unknown causes most of the people have underlying anxiety or depression my recommendations for you would be continue sertraline and propranolol take buscopan as per need if you feel colicky abdominal pain because it can cause constipation if taken frequently take ispaghol husk two teaspoons put in a glass of water keep it for four hours and then drink it to make your bowels regular avoid foods that you think that troubles you most so you have to decide which are those foods for you keep yourself well hydrated take capsule esomeperazole 40 my once in the morning before breakfast take tablet levosulpiride twice per day before meal take ecotec sachet once a day follow up after seven days stress is dyspepsia avoid lying down after meals remain active stay cool and calm chew food well take a small but frequent diet after seven days"
    },
    {
        "instruction": "hello doctor I have a week old baby he is only breastfeeding no formula he had gas problems like any other baby and the doctor prescribed us simethicone for infants 5ml three times a day to help relieve it he eats and defecates normally at least once a day sometimes once every two days lately he has begun crying hysterically and inconsolably we thought of it to be colic so we exercise his legs bicycle kicks and massage his stomach but that only soothes him for a few minutes and then he resumes crying today I noticed that he was grunting we offered him the breastmilk thinking he is hungry but he latched on then immediately threw his arms up stiffened his back and let go then it seemed like he was grunting while trying to poop I know babies cry it is how they express their feelings but when he cried we could figure out what the reason was hunger discomfort wet diapers etc but now we are dumbstruck please help",
        "input": "",
        "output": "hello welcome to icliniq com I understand your concern usually at this age babies have gas or colic problems it seems like that only I need a few more questions to be answered does he regurgitate feeds also any relation of such episodes with feeding is it happening since birth not these severe episodes but milder ones have you checked the perianal area is it red anything other than mother milk like ghutti etc what are all medicines been tried for how many days do you burp the child after each feeds is there a lot of flats that baby pass does he pass stools with force how is the child between episode active"
    },
    {
        "instruction": "hi I had my i'd irena removed months ago as I am planning to start trying to conceive soon I am no prior pregnancies and otherwise healthy I have been taking an oral contraceptive pill since the i'd removal as I did not want to become pregnant immediately but I am concerned now that both periods I have had while on the pill since the i'd removal have been extremely light both have only lasted one day and only needed tampons total my periods were typical prior to the i'd and stopped completely while the i'd was in for years before that I was on an ocp so periods were regular but I have been using hormonal contraception since I was a teenager so I am not sure if my physiologic periods would be regular or not I am a pediatrician so please feel free to use medical language I am concerned that these very light periods indicate abnormal endometrial function or some other abnormality that may affect my fertility and I would be very grateful for any insight you have thanks raisin",
        "input": "",
        "output": "hello doc welcome to icliniq I will explain you a little bit how estrogen progestin contraceptive and a levonogestrel did effect fertility combination of cos suppress basal fish and oh they diminish the ability of pituitary gland to synthesize gonadotropins when it is stimulated by hypothalamic gnrh ovarian follicles do not mature little estradiol is produced and there is no midcycle oh surge ovulation does not occur corpus luteum does not form and progesterone is not produced this means that interferes and block negative and positive feedback of who axis also the i'd mirena which contains levonogestrel reduced the fish there is less follicular activity less estradiol production and no oh surge also cause an local inflammatory section inside the uterine cavity the blockage of who is reversible as far as you interrupt the cop pills the estrogen and progesterone levels will fall may be it will take a few months so who axis will start to functionate normally and the cycle will be ovulatory again so the change of the quantity of bleeding is not so important if your cycle are ovulatory only if you have amenorrhea more than months after discontinuation of cos pills shoud undergo evaluation so it normal to experience change of menstrual cycle after i'd I hope I ve been helpful kinds regards"
    },
    {
        "instruction": "when I sit in class and try to focus in class my pupils moves at corner of eyes involuntary my eyes if try to focus to the blackboard I feel strain in my brain and feel difficulty in breathing I am having this problem from last year this arise when anybody is sitting around me I used watch video more than hours per day I also had stress last year but this year I do not have any stress I had checked my eyes but these are normal eye number and also checked my thyearoid test it also normal I have already asked this question many times but I did not get satisfactory answer please give suggestions",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello doctor I have been suffering from taj for a long time and I had left it untreated for long now the situation has gotten worse where it has become difficult for me to smile open my jaw fully and also I feel extreme discomfort facially but I have consulted a dentist and he has blamed jaw clenching and improper alignment and for treatment he has asked me to use a night guard this problem of taj has made me unhappy these past few days and I just wanted to know that will it get better now that I am getting treatment and also will I regain my happiness as I believe I am a jolly person in general",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hi im a 20y female with average health I have always been afraid to ask about sex whether with my gun or my doctors I am not always sexually active but when I am with my partner I do not feel anything vaginally during intercourse during foreplay I feel some but not much however when masturbating I am perfectly fine and I feel amazing I have some slight anxiety and I have had major depressive disorder in the past but now I am doing much better on zoloft 50mg with limited symptoms now im aware that my medication has proven to have negative effects on my sexual libido but my real concern is why there is such a difference in my sexual experiences when with my partner versus myself thank you",
        "input": "",
        "output": "hello feeling satisfied in intercourse depends on a number of factors sexual desire spontaneous sexual interest including sexual thoughts erotic fantasies and daydreams etc psychological issues relationship issues another important point is that during masturbation you are aware of the pleasure points in your body and can therefore attain maximum pleasure while with a partner a lot of other factors are involved also maybe you should consider using another drug instead of zoloft 50 sexual desire is typically more psychological and situational in women influenced by how they feel about their bodies as well as the quality of relationship with their partner I suggest you talk with your partner so that you can experiment with different techniques also to find what suits you and your partner best so that both of you can understand each other better sexually many women do not experience desire until after they are genitally aroused and arousal may require an extended period of foreplay"
    },
    {
        "instruction": "hi my last periods was weeks days back and I discovered that I am pregnant when I checked using the home test however when we went for a scan today the doc says the sac measures 75 cos and it is weeks days why is there a difference of one week when from last period which is weeks days to sac weeks which is weeks days is it normal",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello doctor I seem to get lesions or blisters maybe on my arms they are usually round with one pus filled bump and at times it could be many small ones they rarely itch burn or anything they crust over and peel and leave dark acne like marks on my arms it is so annoying because I am embarrassed by the marks on my arms I always get at least one of them per month",
        "input": "",
        "output": "hi I saw the photo you sent as you say there is pus formation and you are getting it recurrently almost every month I like to know a few things before finalizing my diagnosis and treatment is there any pain if pus discharge how much do you get them at the same site always or different or in any particular fashion like linear are you a diabetic since when are you having them any fever associated"
    },
    {
        "instruction": "hi doctor I am a 19 year old female with constant gas heartburn chest pain breast pain dizziness nausea and back pain I went to my doctor and was told it was due to anxiety so I started zoloft and prilosec I had panic attacks and hyperventilation but my severe gas and pain will not go away I tried every gas indigestion medication and these problems still persist could this be heart related no known family history of heart problems",
        "input": "",
        "output": "hello I have gone through your query and concern your egg report is given as normal I would like to know some more details about your present symptoms in order to suggest further management strategies I would like to know that after starting medications for your anxiety do you still have chest and breast pain where is the exact location of pain duration of pain is it on exertion or at rest exact nature of your pain is it dull aching heaviness sharp pin prick type squeezing type is it associated with breathlessness kindly get back with the above details for further discussion and management"
    },
    {
        "instruction": "hello doctor my year old son has a diaphragm problem he has a heart problem post operated for vid and having pacemaker from his 1th month now he have a new problem like vomiting urine problem fatty liver gall bladder wall thickening mega cardio 30 percent heart function only what is the main problem here and what treatment to give",
        "input": "",
        "output": "hello I am very much concerned about all the problems your son is going through now he has a few different issues overall not a single problem his urinary problem looks like due to inflammation of urinary bladder called cystitis which needs investigation of urine and if needed antibiotics for that his heart functions are weak and that may be leading to fluid accumulation and back pressure on the liver leading to gall bladder thickening and liver congestion and enlargement he may also be having some edema in his feet or some fluid in the abdomen kindly send me his ultrasound and all the reports recently done so that I can decide about his proper treatment and guide you accordingly"
    },
    {
        "instruction": "hi doctor I am a 20 year old female my height is 1 and weighs around 160 pounds I am having sharp burning pain in my chest and back in the mid to left side between the shoulder blades and under the breast bone it lasts between 30 minutes and a few hours of this sharp pain usually it becomes difficult to breathe or move my upper body until it goes away as a kid we visited a doctor for some chest pains but the doctor said they could not say anything wrong other than a possible heart mur there is a history of heart disease in my family",
        "input": "",
        "output": "hello I have gone through your query I would like to know some more details about your present complaint what type of mur has your doctor described history of which heart disease your family has and who has it is your chest pain associated with any other symptoms like breathing difficulty palpitations giddiness does this pain gets aggravated on movement or on exertion is it localized or diffuse is there any tenderness I pain increases on pressing with the hand any reddish discoloration on localized area of pain since when you are having this pain if possible attach all the available reports like egg echo and any other reports kindly get back with the above details for further discussion and management"
    },
    {
        "instruction": "hello doctor I have eye floaters I have done the retina exam by dilation vision test etc please help",
        "input": "",
        "output": "hi I hope you are enjoying good health what are your questions about floaters"
    },
    {
        "instruction": "hello doctor the scan for my maid husband shows early liver cirrhosis we need a consultation on the scan he has stomach pain with water filled abdomen is surgery necessary",
        "input": "",
        "output": "hello I have reviewed your given details I agree with you that he is suffering from end stage liver disease and ultrasound is showing fatty liver we need to look at the cause of this fatty liver which could be due to excessive alcohol intake or obesity related or it could be because of certain drugs for treatment of water filled abdomen I need further information to decide whether it can be treated with drugs or he will require paracentesis is a procedure in which needle is inserted into the abdominal cavity and inside accumulated fluid is taken out I need to know about how much discomfort he feels because of this water filled abdomen is there difficulty in breathing and will need the following test abc complete blood count bun blood urea nitrogen creatinine serum electrolytes let liver function test serum albumin urine analysis perfect cure for end stage liver disease is liver transplantation which is a long procedure before deciding whether he needs it now we need above workup so we can calculate scores how early he will need it viral hepatitis alcohol nash metabolic cause abc bun creatinine serum electrolytes lots serum albumin urine do it in app hbsag anti hav antibodies liver cirrhosis liver cirrhosis decompensated with ascites will decide after investigations take low salt diet avoid constipation by taking syearup lactulose 30 my at bed time should pass two to three stools per day if target does not achieved then take 30 my twice a day follow after reports as soon as possible please answer the asked questions history of alcohol intake weight and height of the patient history of viral hepatitis history of iv drug abuse family history of liver disease or cancer"
    },
    {
        "instruction": "hi doctor my son is months old and weighs about 5 keg he has reached all his milestones in time but the problem is he does not sleep well at night maximum at a stretch it is only one hour he keeps walking up and only a bottle can soothe him during the day he is active but nights are really tough he does not wake up completely but will be crying in his sleep itself and can soothe only with a bottle please suggest something with regard to this",
        "input": "",
        "output": "hi do not worry it is a common problem among children aged between months to years baby is asking for the bottle because it pacifier him so to put him to sleep follow these steps wake him up at morning am do not allow the baby to take more than two naps per day each nap should be less than two hours avoid all screens and gadgets screen time should be less than half an hour give him a warm bath at night before going to bed rocking motion that is cradle helps to make baby sleep better put him in the cradle usually babies wake up at night due to short sleep you can make routine by putting him to sleep without picking him up you can give the bottle once or twice during nights engage the baby in physical activities in the morning like making baby crawl or creep light should be dim at night and you have to make him see early morning sunlight because it resets clock in the body first try all this if it does not help then I will prescribe a hormone behavioral"
    },
    {
        "instruction": "hello doctor I was diagnosed with fungal infection in hand fingers for more than six months I was taking treatment with more than four different medicine for about a month long for each medicine but it was not cured my physician said it was due to the winter season and also advised me to do not use detergent or any other cleaning products even if I maintained this and complete the treatment for a month after withdrawing the treatment with the doctor permission it would appear again it was on the fingers near the nail and also between the fingers joints with water blisters it ozes out then dry and cracks it hurts like burn some time especially when I use my finger to touch or peel onion or ginger or garlic it aggravates since it was lockdown I cannot go to the hospital and the doctor asked me to use the ointment until it looks normal then told me to stop using it I followed him but after stopping it appear again but I do not know whether I could apply the same ointment which I used for treatment for two months because he said it will make the skin thinner",
        "input": "",
        "output": "hello I have read your query and understood your concern as per history and pictures it seems to be allergic contact dermatitis to me such condition tends to recur very often I would advise you to kindly use double layered gloves always while doing household work using detergent or chemical since long term use of such creams make the skin thinner so it is advised to continue the creams containing steroids like clobetasol halobetasol for a week followed by maintenance therapy meaning apply the creams over weekend like saturday and sunday while active disease you may use oral anti allergics like levocetirizine my once daily in the night time for a week use ample amount of moisturizer to keep the skin hydrated I hope this helps"
    },
    {
        "instruction": "hello doctor I am having gum pain and swelling near wisdom tooth in the lower jaw for three days I am unable to open the mouth fully and eat or bite properly please help",
        "input": "",
        "output": "hello as per the description you are suffering from pericoronitis as per the current outside scenario of viral outbreak one should not visit the dental clinic unless it is an emergency so for temporary relief I can tell you medication and a few home remedies but for that I need to know a few more details do you have any infection pus to that site if possible upload the image of your concern area until then gargles with lukewarm water and add a little salt in it do it for two to three times daily get back with the above details for appropriate medication"
    },
    {
        "instruction": "hello doctor I would like to know about small freckles on the cheeks and forehead of month old male child also the left eye is watery and collection of yellowish mass after few hours near the inner end of the left eye please suggest",
        "input": "",
        "output": "hi it is very normal for a newborn baby up to months of age to develop such minor skin problems it is called milia there is no need to worry about it is due to insignificant obstruction in sweat glands I will prescribe a lotion please apply the lotion three to four times a day for the next two weeks please stop using talcum powder if you are already using it and regarding this watery discharge in the eyes if the discharge is very mild no need to give any medications for the same if the discharge is significantly high I will prescribe an eye drops which is to be given four times a day for one week duration only if the discharge is significantly high please give a gentle massage on the inner side of the eye nasal side for four to five times a day in some babies such insignificant discharge can persist up to three to four months it will settle with regular massaging daily for the next 12 months milia conjunctivitis dacryocystitis"
    },
    {
        "instruction": "what could be the possible diagnosis of injury for someone who suffers from lower back pain I started my office job approx months ago it is desk based but does involve some lifting and carrying and a driven commute of an hour each way I have had an office job role for years I have onset of pain around weeks ago and is getting worse pain is intermittent and sharp 10 nprs at worst my symptoms get worse through out the way and I find it hard to get out the car pain is mostly at the left sided lower back which spreads down the back of the left leg and knee after sitting down for a while I get pins and needles into the left foot I find it particularly hard to perform lumbar flexion and left side flexion as they are painful also I feel tenderness over la and la towards the left and centre thank you",
        "input": "",
        "output": "hi just gone through your query it is nothing but you are suffering with la due to prolonged sitting improper posture bending straight down causes low back ache which radiates from knee to foot only using paracetamol tablets wont help you I advice you to go for ray or mri of spine to get exact point of pain starting like la or la s2 as a precaution wear is belt jumbo sacral belt which helps stop pain during pain always straight sit do not bend forward if want to pick up something sit and then pickup take accelofenac tab per day after food apply diclofenac ointment to lower back and cover it with cotton cloth for 10 15mins following with hot water fermentation try this for a week and get back to me with mri of spine or ray of spine ap lat view diclofenac ointment helps reduce pain use it for twice a day if possible if pain is severe do not do any exercise relating to back if you can bear the pain you can do back strengthening exercises after xray can get back to me after a week or days you may further need physiotherapy treatment which includes ift ultrasound and traction hope you will follow the steps to stop I told to prevent more radiate of pain stay safe take care thank you prolonged sitting improper posture mri of spine xray given remedies to stop pain is belt accelofenac tab diclofenac ointment after days"
    },
    {
        "instruction": "sir since yesterday evening I am unable to open mouth widely it is only opening fingers long when I am trying to open more widely I am feeling pain in right side of mouth jaw I had also gone to a doctor yesterday night and he injected me given tablets at morning 0am I tried to open mouth but after a once try I was successfully open mouth for tries after that once the jaw locked till now",
        "input": "",
        "output": "hello any previous history of dental treatments like fillings tooth removal root canal treatment habits history tobacco chewing smoking any associated tooth pain any recent fall injury this lock jaw could be due to several factors like tensed jaw muscles wisdom tooth issues jaw joint issues or could be a condition called osmf which is caused by a long term pan chewing habit initially this condition is treated with painkillers and muscle relaxants please continue using the tablets for the said number of days this will take atleast a week to come back to normal state however a clinical examination is required to diagnose and treat it suitably and do not open mouth forcefully because this can restrict the mouth opening still more and delay the recovery please continue the meds and report back to your doctor for review and practice the mouth opening exercises that your doctor had instructed good day"
    },
    {
        "instruction": "hi doctor I am 37 years old I have mild pain in left tes and it hangs more than usual this happens for the last four to five days I feel discomfort during walking and mild pain in the lower abdomen just above the left testicle please help",
        "input": "",
        "output": "hi hope you are doing well coming back to your query I think you are having an infection in your left tests a condition known as epididymo orchitis first you have to give yourself scrotal support a langot relatively small shaped underwear to support your tes from hanging second start medication as in the prescription see attachment are you a diabetic do you have any urinary complaints night frequency burning micturation poor stream any previous history of accident trauma urinary catheterization are you on any medications are you a smoker or alcoholic if you can click a photo of both tests then it will be great last the ultrasound you uploaded has photos if you can upload a picture of the report then it will be better"
    },
    {
        "instruction": "hi doctor I am 28 years old I have been suffering from breast pain for the last one year the pain was only on the left side breast consulted with a surgeon took a scan and found fat necrosis and lymphadenitis on the left side and was told it was cyclic pain and was given vitamin tablet and neurobion forte for three months and a review after three months a few weeks later I found a small swelling under my left armpit and there were three to four small red bumps in that arm as well I usually get these rashes on the left arm is this a matter of concern",
        "input": "",
        "output": "hello do not worry I will give you the solution to your problem before that I need some extra information from you whether you are married and have any child I need your scan report also to see the exact condition you can attach photographs of that here as per your concern probable diagnosis is cyclical mastalgia in which during periods there is some hormonal changes in the breast and maxilla causing pain due to fat necrosis it is self limiting condition regress by own there is no chance of cancer in this condition as cancer is a painless condition please share above mentioned thing and get back to me cyclic mastalgia mammography in both breasts cyclic mastalgia with fat necrosis tablet evian 400 my od for one month capsule primosa 100 my od for one month chymoral plus be for five days after meal"
    },
    {
        "instruction": "hello doctor I have a few medium sized pimples on my penis it was only one pimple a few days ago but now it has grown to four I have started drinking garlic water after watching few suggestions on youtube",
        "input": "",
        "output": "hi welcome to icliniq com according to your description there are multiple things that could present as such it could be molluscum contagiosum genital warts or herpes sometimes even physiologic changes such as pearly penile papeles can also present like this if you are sexually active it could be an sad sexually transmitted disease as well kindly revert to me with photos and sexual history so as to aid in diagnosis and treatment"
    },
    {
        "instruction": "hello doctor patient is a 35 year old woman many years ago she suffered from increased perspiration during night from the child when year old this was continuous making several changes of clothes a day necessary the situation was worse during physical or emotional stress in addition she had polydipsia but urine volumes were normal she was underweight even though she had polyphagia and was with tiredness and asthenia the latter was increased in recent years she tried many treatment types but none successful and improvement in her condition was not seen by the time the patient was 37 keg 160 am and was eating 0 500 calories per day her blood pressure was normal with 100 beats per minute her temperature was 36 8c 37 8c but sometimes rose to as high as 38 4c no thyearoid toxicity or thyearoid gland enlargement was present normal blood tests except for an elevated 24 hour urine creatinine but it was noted that her basal metabolic rate varied between 140 and 210 percent above normal specimens of muscle tissue were taken under local anesthesia from the patient the latter showed that respiration could proceed at a nearly maximal rate in the absence of add when add was supplied in excess phosphorylation to produce at proceeded as normal I have to diagnose this patient but I am in a dilemma because I think that from the details I have for her as mentioned above the biochemical pathway that is likely to be dysfunctional is glycolysis or glucose I am more towards the thought that she has a dysfunctional glycolysis pathway am I right for this or not what do you think also can you please suggest me what might be the underlying cause for the symptoms of hypermetabolism seen at her and what can be an evolutionary advantage for her",
        "input": "",
        "output": "hi I have gone through your case details I am with your thought process of diagnosis let us try symptom analysis and the clinical syndrome that patient has the major symptom is hyperhidrosis that is increase sweating this can be due to primary hyperhidrosis or secondary hyperhidrosis this is less likely primary hyperhidrosis generalized sweating is mostly due to an underlying systemic illness or as a side effect of medication while focal sweating is generally due to a neurologic disorder or primary hyperhidrosis in this case it is generalized sweating we need to find out are there signs and symptoms of infection acute or chronic neoplasia metabolic endocrine disease diabetes thyearoid pheochromocytoma carcinoid high catecholamine state respiratory failure heart disease pain drug etoh withdrawal drug therapy propranolol antidepressants pilocarpine physostigmine neurologic disease dysautonomia diencephalic epilepsy hypothalamic lesion structural brain abnormality in your case it has a high metabolic rate with the childhood onset disease process so metabolic endocrine and high catabolic state is likely diagnosis in the metabolic it is more mitochondrial metabolic disorder likely diagnosis the mitochondrial damage results in defects in the electron transport chain can affect any tissue tissues requiring the highest levels of energy production are the most severely affected certain red flags which should immediately increase the suspicion of a mitochondrial disorder these include short stature neurosensory hearing loss progressive external ophthalmoplegia axonal neuropathy diabetes mellitus hypertrophic cardiomyopathy and renal tubular acidosis hope this insight will help you primary hyperhidrosis secondary hyperhidrosis metabolic myopathy mitochondrial disorder electron chain transfer morgan syndrome autoimmune serum lactate muscle biopsy for metabolic myopathy mitochondrial disorder genetic analysis mitochondrial disorder as per diagnosis antioxidants vitamin and riboflavin avoid excessive exercise to keep hydrated"
    },
    {
        "instruction": "hello doctor my daughter went ice skating last month and she fell a few times but she was able to stand up and skate again the next day saw bruises on her legs especially the knee area but that disappeared after a few days she mentioned that she still feels some pain but she can walk move around and jump with it so I thought it is fine however recently I noticed that she cannot stretch it to its maximum although she can move around with it she says there is still a pain when she stretches it too much what do you think is the problem it is not broken right we cannot have it rayed due to lockdown",
        "input": "",
        "output": "hello if she is able to walk putting her full weight she might not have a major fracture but I want to ask you a few more questions to come to a conclusion is there any swelling around the knee now is there any history of massaging it every time she fell is she able to straighten out her knee completely now probable causes here can be some joint fluid in her knee which is causing an inability to stretch completely if she is limping now also if she is complaining of pain with every step we should think of any ligament injury or else if she does not have any pain on walking do not worry she does not have any fracture"
    },
    {
        "instruction": "hi doctor I am a 30 year old woman I was diagnosed with cos last year and according to the doctor prescription I have been taking contraceptive pills since then now I and my partner want to have a baby for which I stopped taking the pills last month and we had unprotected sex during my ovulation time for this month I was supposed to get my periods on ith but until now I have not got my periods and today is 12th I also did the pregnancy check which came as negative now I am not sure whether to take contraceptives to have periods or to wait until sometime",
        "input": "",
        "output": "hello I recommend to wait some more days because there are false negative result from a urinary pregnancy test or you can exclude a pregnancy with a hug beta human chorionic gonadotropin blood test"
    },
    {
        "instruction": "hi doctor I was eating wheat bread sandwich last night after eating I felt like something was stuck on my throat I slept on it and the next day I still feel that something is stuck like a knife feel I am currently on effexor my and mirtazapine 5 my",
        "input": "",
        "output": "hi the bread could have caused injury to the posterior pharyngeal wall or larynx can you send me a picture of your throat"
    },
    {
        "instruction": "hello docor my father is a chef patient he always had normal kidney function levels but suddenly in one month it got increased also recently he was having 100 pus cells in the urine test he was having burning too but until last month it was fine and suddenly these numbers he was admitted for shortness of breath for edema before two months when he got admitted also the numbers were perfect now suddenly everything increased creatinine bun uric acid etc what could be the problem they are saying it is because of chef but suddenly how it gets increased in a few days",
        "input": "",
        "output": "hello patient with chef congestive heart failure has a baseline tendency for renal dysfunction also the diuretics like lasik which is on cause renal derangement which are usually reversible now in his case the cause appears to be multifactorial over and above the baseline tendency it is probably a urine infection which has initiated this and his infection was severe urine infection alone can cause renal dysfunction and probably it is a precipitating factor any infection can worsen chef which subsequently needs elevation in dose of diuretics and all of these can cause renal dysfunction so it is multifactorial and contribution from all three factors but good thing is usually this dysfunction is reversible and settles with time I hope his urine infection was adequately treated and subsequent urine tests were clear I hope this helps"
    },
    {
        "instruction": "hello doctor I witnessed bleeding in my left ear all of a sudden I am listening to recordings and on phone calls continuously for the last one month to have a clarity of what other person is talking I am using high volume please suggest",
        "input": "",
        "output": "hi your question was incomplete did you have pain or having pain now how much was the bleeding is there any swelling in and around the ear did someone hit you on your ear were you exposed to sudden loud sounds like a cracker did you use earbuds or put any other object in your ear if the answer to all these questions were no then we need to examine and evaluate the site from where it is bleeding and the cause for bleeding"
    },
    {
        "instruction": "hi doctor I feel head numbness lightly or I can say its dizziness like thing since two days but its not bothering me all the time but it is kind of numbness I am feeling when after getting up from sleeping or sitting position as I do work from home most of the time note I have dandruff problem I done a sugar test and blood test all the reports are fine except below findings lymphocytes 42 observed values 20 40 biological reference intervals lymphocytes absolute count 3500 observed values cells cmm 100 300 biological reference intervals please help me with your valuable feed back and why I am getting this problem thanks in advance",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello doc every night for almost weeks now I experienced itchy hands like only every night when I am about to sleep so itchy that I cannot sleep I do not notice any insect bites or red spots or rashes on my skin I really cannot sleep well every night because of this I think the itchiness is coming from the inside of my hands help me please I tried taking cetirizin because I thought it may ease the itchiness but nothing happens thank you",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hi do my wife is pregnant in her est trimester roughly she is in her ith week of pregnancy lately we went to a gynecologist for consultancy during her ith week we able to see heartbeat but now on ith week as per our calculation but the do said its her ith week and cannot see the heartbeat he said it abnormal growth and asked to abort we are in big confusion now can you help us on this what shall we do",
        "input": "",
        "output": "hello based on the description you mentioned it appears your wife has missed miscarriage I am really sorry to say that in such case the fetus fails to grow as the fetal heartbeat has stopped even if you do not take medications to abort it will eventually be removed by the body as in it will abort itself in due course of time it unto you to wait for it to happen on its owns or you can consider going for the medications for the abortion as advised by your gynaec in case you want to wait for it to happen spontaneously it is advisable to get weekly blood tests monitored as advised below and you can wait for maximum 3 weeks for it to expel spontaneously or else it would be better to go for evacuation from your gynaec hope I was able to solve your query blood group oh antigen testing complete hemogram with platelets coagulation profile weekly once if waiting for spontaneous expulsion condition options explained"
    },
    {
        "instruction": "my teenage daughter has struggled with bad breath for at least two years she has impeccable teeth cleaning habits and visitors dentist every months I cannot help but believe it has something to do with sinuses or perhaps tonsils any ideas thoughts on this causes her to be very self conscience thank you for any help advice you can offer",
        "input": "",
        "output": "hi how are you sorry to hear about your daughter teenager has a problem of not having good oral hygiene I will give some tips and hopefully it will be reduced buy an electric toothbrush if you dont have one the good thing is the all electric brush has a timer in it when you start it with pushing the button it will stop after minutes so dont turn it off before that and if possible continue for a little bit more start from one side of mouth by placing it at the junction of gums line and tooth and keep the head of brush there for at least 5 seconds do not move the brush in scrubbing motion nack and forth after seconds move to next adjacent area and keep it there again for seconds in this do the complete mouth the outer surface of teeth inner surfaces and the biting surfaces use of floss is very important at least once a day all the teeth buy listerine zero mouth wash 15ml for 30 secs at least use 30 mins after brushing and not right away chew xylitol gum if you have any other question please feel free to contact thanks"
    },
    {
        "instruction": "hello doctor I have a cough for almost eight days my cough was not frequent and I have no fever till now I feel like something is in my throat sometimes can it be a couid 19 I take azithromycin 500 my once a day after meal and rhinokast before sleep",
        "input": "",
        "output": "hello do you have any recent travel to countries or areas with couid 19 how about any recent exposure to someone who is positive with couid 19 if your answer to these questions is none then it is least likely for you to have couid 19 couid 19 initial symptoms would include cough accompanied by fever on top of that most patients would also experience difficulty breathing since you mentioned you did not have a fever it is least likely you have couid 19 at this point however if symptoms persist worsen or new onset of symptoms such as difficulty breathing and fever further consult is advised"
    },
    {
        "instruction": "hi doctor I have major sleeping problems where I do not get sleep at night sometimes until late or sometimes at all I also have a lot of mood swings where I am really happy at times and the next second my mood switches I feel very confused about my behavior and in general I do not like interacting or making conversations with people so I get really conscious and think about scenarios about how to say what I keep worrying a lot about different things and have difficulty focusing on things and especially because of irregular sleep I am having problems I get scared of sleeping at times and have nightmares at times when I do",
        "input": "",
        "output": "hi I am so sorry to hear about your situation I can imagine how hard it must be for you with the little information that I have I think your sleep issues are just an external expression of underlying anxiety it is the fear that is keeping you awake so to help you with your sleep issues first we need to take a few measures to help you in increasing your relaxation levels which would calm you down for that you can try why deep breathing exercises like box breathing progressive muscle relaxation meditation before sleep you have to maintain your sleep hygiene which essentially means regulating your bedtime and your process of going to sleep which in common language is called night rituals once you have established this then you need to work on your anxiety as you have also mentioned that you were sent for anger management 10 years ago I would suggest starting psychotherapy as soon as possible which will help you understand the negative thoughts which are causing all these mood symptoms taking care of anxiety and anger is one thing then the next step is finding the root cause of it and getting rid of it will help you solve the issue permanently so I would suggest you to start psychotherapy you can find a local counselor or we can start therapy online via video consultations I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 28 year old male I am having mucus collected in my throat region for almost two weeks now as long as I remember maybe from 10 years or so I have been suffering from this condition which some have called bronchitis dust allergy etc any change in weather any perception of dust any smoke and fragrance from vehicles agarbattis powders or scents exposure to cold and cold items cause this secretion of mucus in my throat area it usually is just a mucus collection in my throat for days together usually no cough or fever or throat pain or running nose the collection is more in the morning after I wake up from sleep the condition is more prevalent in cold weather I was outside of my home town for a few years but did not face this issue as much as I do it when I am visiting my home town I want a permanent solution for this I have not undergone any major tests or anything for this problem it is more like visiting a local doctor when symptoms occur and take medicines for infection I am taking monte fix fexofenadine and montelukast and florist nasal spray from 10 days while the condition has improved I am still not back to the normal and I still can feel the mucus is sitting in my throat region kindly help",
        "input": "",
        "output": "hello after going through your query it seems you are suffering from allergic bronchitis usually this condition is precipitated only if you are exposed to the particular allergens called triggers also environmental pollution makes the situation more worse as you said it is very obvious that symptoms recur in your home town but never appeared in other places where you stayed so it is very important to find out the particular trigger in our surroundings and avoid outside pollution as much as possible to rule out any other pathology and possibility of asthma it is advisable to do a chest ray and spirometry test if the reports suggest the possibility of asthma then there is a need to start an anti inflammatory inhaler called controllers expectorants work magically in any kind of bronchitis and help in expelling the thick mucus out allergen avoidance remains the main priority you can continue tablet monte fix and florist nasal spray rest of the medicines as follows environmental pollution and allergic triggers chest ray spirometry test asthma allergy tablet lotof 500 my levofloxacin daily once for five days tusq 10 my for seven days continue monte fix and florist nasal spray avoid environmental pollution and known allergic triggers"
    },
    {
        "instruction": "for about a year now I have experienced a lot of thick white mucous in the back of my throat this inhibits swallowing forcing me to hack it up and spit it out I think this can make my voice scratchy but other than that I am not experiencing any other symptoms I have gone to an ent previously and I believe I tried a proton pump inhibitor but it did not have an effect",
        "input": "",
        "output": "hello good to hear from you I understand your situation there are two reasons for your complaint mostly one as the doctor who has seen you previously suggest must be because of a reflux from your stomach second might be because of something called as a post nasal drip for dealing with the reflux just a pi would not help you should make certain life style changes such as avoid spicy food eat on time your stomach should not be empty for than hours do not sleep soon after you eat give atleast 3 hours of time between your meal and sleep try to keep your head end elevated by a couple of inches while sleeping now regarding your post nasal drip do have frequent episodes of cold nasal discharge if yes take the necessary medications for it so I would suggest you with the following medication continue your pi like pantaprazole 40 my once daily before breakfast if you have a cold take an antibiotic like amoxicillin 500mg twice daily for days an anti histamine like levicetrizine 5mg once daily before sleep a nasal decongestant like oxymethazoline thrice daily in both nostrils reflux ray pins direct laryngoscope acute rhino sinusitis herd medical life style changes follow up in one week after the life style changes medication suggested"
    },
    {
        "instruction": "hello doctor my front lower teeth have become extremely sensitive and I have very severe pain in them the gums are not hurting but the tooth itself is hurting how to relieve the pain",
        "input": "",
        "output": "hello take a painkiller like doll 650 my or acenext aceclofenac and paracetamol three times a day use warm salt water gargle twice a day for a week send a picture of the area if possible"
    },
    {
        "instruction": "hello doctor I have a large red painful cyst like bump on the left side of the clitoris it hurts to walk sit or stand I have been doing a warm compress three a day and a hot shower once it seems to be getting more painful I cannot go to the doctor because of couid 19 please suggest",
        "input": "",
        "output": "hi from your history and pictures I gather that it is vulvitis which has got localized to a single point usually infection starts in the vagina and later it gets localized it forms a blister and over time it forms a pustular lesion pus as in your picture steps to solve this avoid tight undergarments no undergarments at night so the area will be dry abstinence until the infection resolves have a course of antibiotics which will reduce infections and pain take tablet azithromycin 500 my two tablets after food fluconazole 150 my after food capsule amoxicillin and clavulanic acid 625 my twice daily for five days use pain killers with serratiopeptidase use vaginal wash douches and avoid any vaginal discharge soiling the area do not use any local antibiotic ointments this will form antibioma to reduce the local edema and pain you can apply little glycerine and magnesium sulfate ointment over the painful area then place a small gauze over it this will immediately reduce the pain apply twice daily for three to five days"
    },
    {
        "instruction": "hello doctor I am experiencing severe pain in the first molar teeth I did the filling one year back I had three combiflams to reduce the pain please advise",
        "input": "",
        "output": "hello as per your description it seems that there is a reinfection in your treated tooth do you see any discoloration over that tooth for permanent solution you have to get it done in the dental clinic as any reinfection can be confirmed only after ray of that tooth but as per the current outside scenario of viral outbreak one should not visit the dental clinic unless it is an emergency so what you can do at home is take tablet augmenting 625 my amoxicillin and clavulanic acid twice daily for three days after food ultracet tramadol twice daily for three days after food gargling with lukewarm water and add a pinch of salt in it for two to three times daily if possible upload the image of your concern area I need to know a few more details is there any swelling or pus associated with that tooth or gums is there is any reddish discoloration or are you having any fever I want to know what kind of restoration you had"
    },
    {
        "instruction": "hello doctor I am having itching in throat and little cough for more than two weeks and cold no fever no body pain my be and sugar are normal I am taking cetirizine and calvam 625 with little improvement",
        "input": "",
        "output": "hello do you have any postnatal drip or cold do you have any acid reflux stomach ache or sour eructations is there any cervical lymph node do you smoke can you attach a picture of your throat"
    },
    {
        "instruction": "hello doctor I am 32 years old we are planning to extend our family whenever I will be perfect in health so that there should not be any health issues to the baby and the mother I would like to elaborate on my health condition so that you can advise us on how to improve my health condition please note that the below tests have conducted before three months and after that I have gone through some medication for one and a half months iron vitamin and hemoglobin my hemoglobin remains low every time I go for annual health check up for the past seven years currently it is 10 iron 18 tic 492 transferring saturation 6 vitamin 19 91 yeast infection in vagina I have been suffering from recurrence of yeast infection in the vagina for the past one year it comes again and again and I am taking fluke every week one tablet after taking fluke I feel no itching and no yeast infection but within a week or so it happens again boobs itching and enlargement of area around nipples for the past four to five years I have been observed that area around my nipples has enlarged and that area is really very dry and itchy although there are no lumps in the breast and armpit I visited a gynecologist but they told that it is a dermatology issue hence I also visited a dermatologist and the doctor suggests that it is just because my skin is extremely dry and it can be cured after applying good moisturizer in the long run but I have not seen any improvement till date I really want to be healthy and want to get rid of the above issues before conceiving the baby",
        "input": "",
        "output": "hi first thing I would like to tell you that you are a healthy individual even though you were anemic before now you have made good progress in your hemoglobin now coming to your recurrent fungal infection in the vagina it seems that you have adequately taken antifungal and antibiotics I would recommend you to get done your blood sugar level thyearoid profile test now coming to soreness and itching at nipples yes it happens due to dry skin and micronutrients and minerals deficiency I would like to suggest you to apply the moisturizer and take nutrients supplement nutritional deficiency blood sugar levels thyearoid profile test multicomponent deficiency tablet azithromycin 500 my once a day for three days candid ve pessery every night intro vaginal for six days tablet omeprazole 20 my twice a day for three days avoid sexual intercourse until recovery from infection follow up with the above said investigation after days"
    },
    {
        "instruction": "hello doctor I am 38 years old I am having pain in the neck and it has gone to my left arms and there is stretching like pain I have consulted an ortho doctor who asked to do mri as initially post taking ray and doing physiotherapy for a week did not give relief I took mri and now due to couid 19 old doctors not available he asked to check with spine specialist what needs to be done the pain is severe in the upper arms and it is from the last one week I would like to share the mri report for reference please suggest some medicines I am diabetic too from the last three years",
        "input": "",
        "output": "hello I have seen your mri reports but as no films were included I will go by your description and mri report you have a c5 ca level issue with indentation of the exiting nerve root on the left side which matches weakly with your symptoms at present there is no need to panic take a course is antiinflammatory tablets like voveran 75 my twice daily after meals and antacids before meals secondly take pregabalin tablets 75 my twice a day for three to four weeks this may make you feel a bit sleepy but it will go away avoid working on the computer for too long or on the phone do simple mechanical strengthening exercises and shoulder weak elevation exercises give yourself a couple of weeks minimum and come back if this does not improve"
    },
    {
        "instruction": "hello doctor I just want to consult about my skin condition that happens annually every year my hands has this condition where it will itch and form rashes with liquid inside then skin itself most of the time it starts on december then end on february however it differs every year this year it started on march and up to now I experience this every year as in yearly so I assumed it is normal it is not hereditary I assume because none of my family members is experiencing it other than me my mother told me that maybe it is because of cold weather which I agreed it is there for the past years I have never consulted any professionals about it since it does not look severe however I am curious what is this condition called",
        "input": "",
        "output": "hi seasonal itch and swelling over the exterior parts of the palms soles ear nose occur due to a type of cold allergy called perniosis orchilblains lesions for increased itchy swelling occurs mainly during the start of cold weather and end of the cold weather when there is temperature change in the environment I am not sure which part you are living in as you have not mention treatment for this is avoidance of cold exposure wearing warm clothes calcium dobesilate gel twice daily diltiazem 30 my tablet be for weeks during the lesions for itching you use loratadine10 my once daily for two weeks or whenever there is itching apply aloevera moisturizing cream over the hands multiple times with rubbing of the hands and feet and the parts so that good circulation bring warm blood flows into those area"
    },
    {
        "instruction": "hi doctor I have had this issue for two to three months now and my symptoms are changing it started with my throat feeling like it was closing every now and again and between my ears and jaw was sore for weeks my tongue feels swollen and irritated all the time with little red dots around the edges my tongue also gets sore around the edges mostly in the morning I have had blood test and after that one doctor told me it was in my head but my recent go says it is definitely not I cannot get to see a specialist due to this couid 19 mess and my symptoms are worsening and now my throat around my glandular area is sore and throat feels restricted and swollen I do not have trouble swallowing food or drink but just swallowing saliva sometimes gives a choking feeling no one so far can tell me what is going on please help I am currently on pantoprazole 20 my and anvil",
        "input": "",
        "output": "hello having read through your symptoms I think if any of doctors could not find any particular cause it might be what we call as burning mouth syndrome with globes sensation it may be due to certain local conditions like ill fitting dentures jagged sharp or curious teeth it may occur due to acid reflux or in disease like diabetes even post nasal drip due to sinusitis can cause burning in mouth prolonged intake of any medicine can cause this however do you have any of these of these gastric acid reflux is often the most important cause do you smoke can you attach a picture of your throat and tongue lesions"
    },
    {
        "instruction": "hello doctor is beta blood hug test quantitative done post 12 days of missed periods considered as accurate my hug level came less than does it mean that I am not pregnant",
        "input": "",
        "output": "hello based on the present hug levels it suggests that you are not pregnant at present or today as beta hug level is quite low but if you frequently have irregular periods and there had been history of sexual contact and if you had delayed ovulation then there may be chances of pregnancy or in other words chances of beta hug increasing in next few days depending on the time of ovulation and sexual intercourse and if your cycles have been previously regular and if this is the first time it got delayed then you need to evaluate for the causes of it please get back to me if you have further queries with the exact timeline of events and your suspicions based on the event meanwhile you can take medication for withdrawal periods as already 12 days have lapsed from your expected date or you could wait for another 4 days and if still not getting periods you can start taking it and evaluate yourself for the cause for delayed periods ultrasound abdomen and pelvis complete hemogram thyearoid profile serum prolactin level tablet meprate or devilry 10 my twice daily for days and then stop this medication is not harmful even in case you turn out to be pregnant later to wait for withdrawal bleed within next 10 days to get blood tests done on and or ord day of periods"
    },
    {
        "instruction": "hello years ago I had chicken pox last year I did a herpes test and they said I had antibodies to hsv1 with a range of 6 and I did another test after months with a range of 6 and 3 I have never had any of the symptoms I read about I am concerned so what do you think",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello I have been having symptoms for a long time now about years something constant that I feel is a pressure or imbalance on the upper left side of my body I get brainfog frequently other symptoms come and go sometimes my upper rib feels tight when inhaling sometimes I get dizzy and heart races palpates I have had some exams done recently and found out I have an inflamed supraspinatus tendon since that ive tried doing exercises and stretches but they have not helped that much I have even tried palpatine the tendon but it doesn't even feel tender recently I have tried doing some neck stretches and the next day my upper left shoulder went almost completely numb one thing I feel I have to mention is before these symptoms starting appearing I had an incident at the gym where I pushed too hard doing an exercise and something happened that my vision went dark and I had constant pain on shoulder neck area for a few weeks I apologize for the wall of text but I am at a standstill whatever this is it is keeping me from being able to function in everyday life I am currently a shell of my former self",
        "input": "",
        "output": "hello after going through the detail you provided its clearly a symptom of jerk you felt at the gym while exercise I advice you to stop doing any exercise related to shoulder or neck take accelofenac paracetamol tablet twice a day fir days and consult in person with any physiotherapist near you need personal attention and proper treatment a physiotherapist will guide you during this time on how to perform exercise properly during pain and if needed he will apply ift and ultrasound to reduce pain and for relaxing muscles stay safe thank you"
    },
    {
        "instruction": "five days ago I had thick mucous in my nose and from the carving of my nose I had a wound without special nosebleeds I put vaseline and it stopped the next day but the mucus continues they are yellowish sticky and odorous and every time I try to blow my nose I bleed again I put only rinopanteina when I see bleeding what can I do",
        "input": "",
        "output": "hello welcome to icliniq can you tell me if this discharge is unilateral or bilateral how profuse is it do you have any nasal blockade or obstruction of any type do you have cold how is your smell do you get sneezing is your nose tender"
    },
    {
        "instruction": "query regarding chronic cough almost dry not completely dry from last days gets more persistent during sleep no fever whatsoever took tab of citrizine on day one thinking its allergic since no fever or stuffy running nose so ruled out allergy since then no medication taken just some ot antacid digene mild heartburn twice at night coughing was so strong that I puked looks like herd to me non smoker male 25 years old no history of any other illness height 167cm weight 64",
        "input": "",
        "output": "dear welcome to icliniq thank you for providing a detailed history I just want to clear one thing what do you mean by chronic cough the history you provided is of just five days so it is not chronic but you used word chronic which means cough for months or years so if it is just five days of cough then yes it is suggestive of some reflux episode which is leading to laryngeal irritation followed by cough and occasionally can lead to choking like sensation in sleep I will like you to start the following medications and it will help out cap deslansoprazole 30mg cap twice daily before breakfast and before dinner for weeks spy rondec dextromethorphan 10ml three times daily for 10 days you need to avoid late time eating three should be a gap of at least hours between dinner and going to bed avoid smoking avoid evening coffee or tea thank you incase of any further query get back to me"
    },
    {
        "instruction": "hello doctor I cannot concentrate because when I study I feel I am not able to memorize I want any medication maybe for month for concentration my doctor gave me bupropion but it is no good for me",
        "input": "",
        "output": "hello from your query I can understand that you are having difficulties related to poor concentration there can be different reasons for struggling with poor concentration more information will be needed to clarify the etiology behind poor concentration so that you can be guided about getting appropriate medication and treatment how long have you been experiencing concentration difficulties was it present when you were a child and did you have problems with studying whilst at school or did the concentration problem start in recent months or years are you experiencing any other difficulties are you sleeping well are you eating normally are you using any alcohol or recreational drugs if poor concentration has been a problem since early childhood you need to be assessed for neurodevelopmental conditions like add following a comprehensive assessment if you fulfil criteria for add stimulant medication can be considered to improve concentration and inattention difficulties stressful situations and conditions like depression anxiety can also cause poor concentration I see that your doctor has prescribed bupropion which is a helpful antidepressant medication have you been having problems with low mood how long have you been taking bupropion if it is not effective despite taking for more than weeks discuss with your doctor about optimizing the dose or alternative antidepressant needs to be considered also physical health problems like low iron levels low thyearoid etc can also cause concentration problems so this needs to be ruled out as well so if you are able to provide further additional information regarding your symptoms we can guide you appropriately"
    },
    {
        "instruction": "hello doctor overall tightness in right side of the body especially tightness in the right knee above knee cap leading to pain front and top of knee also tightness in the groin both sides unable to feel the groin stretch on inside of the leg more of a locking feeling at the upper inner groin and outer hip tight hamstring only on right side I do not feel a stretch when stretching right quad but do feel a stretch on the left right shoulder discomfort and tightness in the back lower right side and right hip looks to be slightly lower when standing",
        "input": "",
        "output": "hi it may be due to weak muscles apply diclofenac ointment on the pain above knee and shoulder cover it up for 10 minutes give it hot water therapy try to slowly strech your thigh muscles until you feel pain more and relax yourself repeat it for twice a day take aceclofenac tablet for a day if you have more pain and for shoulder do shoulder exercises at home after trying these if you still feel the pain after three days you can go for ultrasound therapy following ift this will surely help you get rid of the problem jerk while running or walking sleep distress ray for shoulder ift ultrasound avoid lifting heavy objects do not bend"
    },
    {
        "instruction": "hello doctor my sister a 15 year old female patient complains of intermittent pain on sublingual area and neck submandibular area graded 10 at rest and aggravated when eating to 10 past medical history she developed fever recently and was diagnosed with ti and was given cough remedy persistence of cough prompted us to another my consult and was diagnosed with pneumonia of the lower lobe she was on antibiotics for 10 days she started complaining of the pain on march 25 my thought of tonsillitis and was asked to gargle warm water with salt up until now there is still pain on the area grade tenderness on the submandublar triangle area no fever mild cough still feeling of lump on the sublingual area pain when tongue presses on the area patient complies with my recommendation of drinking a lot of water and gargling",
        "input": "",
        "output": "hi it is 23 days now since the infection started that is quite a long time her chief complaint is pain in the submandibular and sublingual region which can happen due to tonsillitis as well as infection of the salivary gland which is located in that region typically these are both treated by antibiotics the best way to differentiate is take a look inside her mouth with a torch and see if there is redness in the tonsils however the treatment you need is a proper course of antibiotics and pain killers with antiseptic gargles and chewable vitamin acute tonsillitis acute sialadenitis tablet amoxicillin and clavulinic acid 625 my twice daily after food for days"
    },
    {
        "instruction": "hello doctor I underwent a hair transplant before three months I might not be sure but I may have roughly massaged my head or while wearing shirts a scab fells off will this result in failed hair transplant",
        "input": "",
        "output": "hi hair transplant failure or success is evident within four weeks the follicles which have been implanted into our skin of the scalp would die initially within two weeks or they lead to the growth of the good hair after that you massage it or do anything it will not have any effect on the hair transplant because the hair follicle by that time would have established at that place as the original ones so the effect of rubbing friction or any disease will be the same whether transplanted or not so I do not think you need to worry about that but what you should worry is that there is not any other infection like fungus on this lesion which I can see on your head if there is anything itch or burning and the lesion is expanding kindly tell me with a clear photograph of the skin of the forehead regarding hair transplant it is successful you need not worry about it I hope this helps"
    },
    {
        "instruction": "hello doctor I am 27 years old I have sinus issues like night time colorless running nose for about one to two hours I also have throat pain and sneezing problem increases if I have milk or cold food",
        "input": "",
        "output": "hello to start with if you have throat pain with fever and cough or weakness in the body please consider going to a coronavirus old to get tested considering the present times it is possible now assuming that you do not have the above symptoms it is very likely that you are suffering from allergic rhinitis which is worsening your sinus problem it typically presents with bouts of sneezing more at a specific time in the day and related to some material for eg dust apart from dust there are many other materials that can cause allergic rhinitis also patients also may not have itching in the eyes itching in the nose eye watering headache watery nasal discharge since your it computed tomography scan is normal we can start with treatment immediately however remember that allergic symptoms have a high likelihood of reappearing after treatment is complete so you will have to follow up after 15 days take tablet levorid levocetirizine every night half an hour before sleeping for seven days duonase nasal spray two puffs in the morning and night for 15 days and whenever you feel symptomatic thereafter"
    },
    {
        "instruction": "hello doctor I have a rash on my penis head it does not hurt much and it does not look severe but it is uncomfortable and I feel very sensitive now and also it stings when I urinate but not always because of couid 19 I do not want to visit a doctor so I browsed the internet and I am afraid it is not getting better as it is it has been a month now and it comes and goes I took zithromax for three days and locoid lipocream but nothing happened after one week I am taking zithromax and I took augmenting every 12 hours for one week and fucicort cream it got better but the skin felt very sensitive and stinginess inside shaft started I stopped fucicort now and using erica at night and just vaseline in the morning for three days now as I am afraid to get worse it does not hurt much but I still have slight redness and stinginess on the outside",
        "input": "",
        "output": "hi you have used steroid creams and a lot of antibiotics but I do not know how it started at all was it itchy to start urine burning or after you urinate because steroids change every morphology and just cover symptoms and signs I want to know if there was any discharge from the urethra to start with any history of unprotected high risk sex fever or itchy red rash in partner if none of the above then follow this take tablet fluconazole 150 my of for seven days sertaconazole cream twice daily for seven days and conut oil review after seven days single dose fluconazole for your partner if you are diabetic control it and keep dry"
    },
    {
        "instruction": "hello doctor for the last six weeks I have a feeling like a lump inside my throat on my right side no pain no problem with swallowing it also feels a little dry if that makes sense and it is worse when I workout with open mouth breathing I think my tonsil is bigger on that side although I do not think it is inflamed as it is not red I have photos I can show you I did call my doctor but with the virus he cannot tell over the phone so he put me on 250 my az and it made no difference he ran an ultrasound and bloodwork and it showed nothing he wants to send me to an ent but with the virus they are not taking appointments if I show you a photo can you give me input as to what this can be",
        "input": "",
        "output": "hello the pictures are very clear it appears you have a milk reflux problem that is causing these symptoms additionally there seems to be a small element of post nasal drip chasing the dryness and worsening of lump feeling down the throat I am suggesting some medicines for you these will be over the counter please take those in the way I am telling you let us see after a week and you can get an online consult with me to let us know the progress and change any medicine if necessary tablet nexium 40 esomeprazole one tablet once daily before breakfast for a week zyeartec 10 cetirizine hydrochloride 10 one tablet once daily in the evening for a week flonase nasal spray fluticasone furoate or propionate 27 mug two puffs in each nostril once daily after breakfast for weeks avoid smoke dust cold pollution direct air conditioned air spicy oily foods take food at regular intervals do not fast"
    },
    {
        "instruction": "hi doctor I am taking rabies vaccination right now I have completed two doses of my injection my question is if I get another bite during my vaccination do I have to restart my rabies course from starting or should I continue the same course",
        "input": "",
        "output": "hello I can understand your concern according to your statement you are taking rabies vaccination and you have already completed two doses of rabies vaccine now you want to know what will you do if you get another bite during your vaccination and the answer is simple there is nothing to be worried just complete your rabies vaccination schedule no need to start the vaccination from the first dose again so you should complete your current schedule and rest of the doses of rabies vaccination should be given"
    },
    {
        "instruction": "hi doctor my daughter is years months old and she is stuttering a lot for the last four months initially it used to come and go but in the last three weeks we are noticing it very constant and she is struggling a lot to speak she never used to have this problem before and she is a very talkative person we wanted to know if this is temporary or it will be permanent and do we need to go for any speech therapy now itself",
        "input": "",
        "output": "hi being parents overprotective is a common phenomenon that is observed do not point out the mistake like you have pause oh see you struggled by this the little one will be more conscious and surely avoid talking better talk to her in a normal way follow these points tell her to inhale then say two to three words then again inhale to say some more finger tapping while saying one word one tap tell her to count backward 20 19 18 etc tell her to stop where she is feeling problem without trying to say it with stress stop then relax again start saying most important it is not stuttering it is a part of developmental process called normal non fluency"
    },
    {
        "instruction": "hello doctor I feel a little uneasy sensation around my waist kidney area I got my complete blood checkup done that included kit and abc in it my red cell distribution width mean platelet volume and eosinophils are little high and absolute basophil count is low due to this I also got my ti test which is normal can share both test results please guide me with the reasons behind these and advise me on good medication",
        "input": "",
        "output": "hi results are normal need not worry do you have any pain in and around the pelvis area or back is uneasiness present always or intermittent passing stool freely no constipation do us ultrasound abdomen now you can take tablet pan 40 pantoprazole one tablet before breakfast syearup sucralfate 10 my did after food review with the us abdomen report"
    },
    {
        "instruction": "hello doctor I went to the dentist recently and they told me I have gum disease and receding gums but there is no damage to my teeth or bone so I just have to improve my brushing since then I have taken their advice but my gums still bleed my whole mouth is sensitive and I have noticed my teeth feel slightly loose it is currently impossible to get to a dentist so I am concerned please help",
        "input": "",
        "output": "hi yes I can make out from ray and picture it is gum disease for obvious your lower front teeth have grown gingival inflammation better called gingivitis needs to be treated by a procedure called gingivectomy means removal of excess gingiva home remedies as such there are not many or much effective in this case yet I can understand the situation cannot permit you to go out for now only until the situation gets better try the following warm water salt rinse three to four times daily if you can get some guava leaves crush them and mix with warm water use as mouth rinse for one to two minutes and spit out crushed cloves act as good oral treatment in pain and gum diseases or if you can get clove oil that will be great to apply for loose tooth you can apply a mixture of table salt and mustard oil where there is loose gums and then later spit it out rest keep brushing teeth twice daily kindly use soft bristle brush and do not brush very hardly or for very long you need to brush softly for one to two minutes only before brushing apply toothpaste all over teeth and at place teeth attaching to gums leave it for two to three minutes then do the brushing after brushing must give soft finger massage overall teeth and especially gums brush in a circular manner and not in up and down motion I hope this helps I advise you for a complete deep scaling and root planning as soon as things get better in your area"
    },
    {
        "instruction": "hello doctor I have always had a weak urine stream I had medicines several times for bladder infections never feel like I fully urinate but lately I have a bigger issue I find myself not able to urinate sometimes I recently realized if I ejaculate then it is worse two nights ago after sex I went to urinate and not a drop by morning I felt like I was going to explode so I was headed to the er when on the way it finally released I decided to wait till I got home I am a truck driver to go see someone probably tomorrow I am currently able to urinate I am a 36 year old male been going to the doctor all my life for bladder problems but this too much please help",
        "input": "",
        "output": "hi I have a few queries before jumping on to the conclusion have you ever been catheterized any history of trauma smoker or any chronic illness diabetes or hypertension any record of rug or mug or ultrasound is done before have you been on any medications for this improper urination other than antibiotics how many times in the past year did you take antibiotics for a bladder infection where do you live if you have that much recurrent infection why you never get investigated thoroughly until now any blood investigations or urine culture done in the past during sex what happens is bladder neck contracts just before ejaculation so that one can ejaculate properly but in your case it does not relaxes due to which you feel retention like condition before prescribing your medication I want to know certain answers to the above questions which are very important"
    },
    {
        "instruction": "hello doctor if nasal bone is absent due to trisomy 21 will that fetus suffer from mental retardation can mental retardation or other such problems detected by ultrasound at 30 weeks",
        "input": "",
        "output": "hi absent nasal bone is a soft tissue in ultrasound to diagnose trisomy 21 absent fetal nasal bone is one of the strongest soft markers in the second trimester ultrasound screening detailed prenatal diagnosis is advisable to rule out abnormal karyotype when absent nasal bone is associated with other ultrasound markers of fetal aneuploidy or structural abnormality nearly two thirds of 15 week old fetuses with down syndrome lack a nasal bone according to fetal medicine specialist for normal fetuses the figure is this makes it unlikely that the test would wrongly diagnose down syndrome mental retardation cannot be diagnosed in 30 weeks scan but if only an absent nasal bone is there with no other structural abnormality and nip noninvasive prenatal testing or amniocentesis is normal then please understand that the risk of isolated no absence compared with non isolated no absence is much lower"
    },
    {
        "instruction": "hi doctor I have small lesions near the groin area I just noticed this three days ago it is not very painful but a little irritating with little pus",
        "input": "",
        "output": "hello I have seen your query and the image as well I need to know some more details about your problem that will help in appropriate management do you have diabetes do you have a fever did you get any injury trauma there or a bite or it just started as a boil and further had pus and all kindly get back with the above details in order to modify treatment if required until then follow the following management wash the area with warm water and soap two to three times a day avoid spreading the pus in nearby area that may increase the wound apply warm compression if very painful apply topical antibiotics ointment like mupirocin or any that is available in your country oral antibiotics tablet augmenting amoxicillin and clavulanic acid 625 my twice a day for three days review with above details"
    },
    {
        "instruction": "hi doctor this is regarding my mother who is 67 years old and has a previous history of slightly high be and sugar and she is taking medicines for both the issue is that on sunday she experienced a burning sensation while urinating and then the sensation was gone but on monday night she again felt the burning sensation while urinating she also said that the urine was darker yellow and also a bit warmer than usual she has not been taking too much water and I have told her to drink more water and see tomorrow if the burning sensation returns when peeing however since she complained I thought of at least contacting a doctor on a preliminary basis what could be causing this sensation and if it persists what steps to take",
        "input": "",
        "output": "hello sorry to hear about your mother problem most probably your mother is having a urinary tract infection ti which is quite common at her age but still not normal I recommend as she is diabetic as well as hypertensive to get investigated the following test should be done abc complete blood count rat renal function test urine routine and culture ultrasound abdomen with peru and hba1c I am going to start her on empirical treatment see prescription for three days so that she gets herself investigated meanwhile and relieved of her symptoms but if there is any obvious underlying cause of ti which will get clearer after all investigations we may have to act further she is overweight try if she can shed some weight with exercise ti plenty of fluids after three days"
    },
    {
        "instruction": "hello doctor my child is years old since one month he is repeatedly urinating for more than 30 times a day we consulted a doctor and he prescribed for an antibiotic but it is not working he went through urine culture and ultrasound everything was normal is there any way to come out of it please help he is currently taking ofloxacin oral suspension ip 50 my 5ml and also lactulose solution up 10 15 my",
        "input": "",
        "output": "hi see your child is suffering from urinary tract infection ti as per the symptoms can you please describe the other symptoms in more detail like any history of fever or chills rigor pain abdomen pus or blood in the urine or any stool abnormality any history of burning urination or any history of local inflammation in the genital area any previous significant history any history of similar complaints in the past how is the hygiene of the genital area also birth history of child is there any other chronic illness in child along with the above history kindly upload urine culture and sensitivity reports along with all other investigations done along with the date of investigation if not done then get one complete blood profile urine culture sensitivity blood pressure serum urea creatinine and electrolytes and follow up with reports till then continue with same antibiotics and lots of fluid intake give more vegetables and maintain proper hygiene see maybe antibiotics are resistant for the infection that is why it might not be working so we need to change the antibiotics as per the reports so kindly attach the reports in the same follow up"
    },
    {
        "instruction": "hello doctor I am 30 years old I am a healthy individual with no signs of be or heart issues I have done a healthy heart screening where they checked heart plus blood flow in legs lipid profile liver function test vitamin and everything is normal my morning erections frequency is fine not every morning I get it sometimes during afternoon sleep I have a phimosis issue recently last three attempts I had an issue with erections and unable to maintain it I am worried and piling up stress another issue is ejaculation I feel I have delayed ejaculation as I am not able to ejaculate when I masturbate I can ejaculate in the normal interval I am not able to understand if phimosis causing delayed ejaculation and ed issue apart from the last three instances I had this issue for a few months and then it resolved I got erections for the next 10 12 sexual instances in addition I do not have diabetes I used to masturbate a lot by watching porn kind of addicted a few years ago then the frequency reduced as I became more mature I am worried if this is the reason for ed when I start sex all my attention goes to whether I am getting erections or not I eat a healthy diet and do cardio three times a week please guide",
        "input": "",
        "output": "hi I have gone through your query and find that you are physically active and healthy you have phimosis but that is not causing you much problem for the last few occasions you have erection problems and delayed ejaculation it can occur because of many issues including the stress or performance or time hurry once you had one episode of ed erectile dysfunction or delayed ejaculation it can cause you anxiety and that can lead to ed for the next sexual activity if the issue is not affecting you regularly or at least 50 percent of your sexual activity then it is not required any medical treatment just continue your cardio workout and take healthy food and take adequate sleep"
    },
    {
        "instruction": "hello doctor I have a few sores on my penis I have taken a few pictures can you check it is herpes",
        "input": "",
        "output": "hi some more questions to come to the diagnosis are these spots painless did these appear first on glans and then on the shaft do you have a mild fever headache myalgias any discharge from these lesions present anywhere else g mouth lips are you on any kind of medication"
    },
    {
        "instruction": "hello doctor I have been taking intermittent treatment for allergic cold and bronchitis with my family doctor pulmonologist and for some time for et ear problem with a local ent doctor I had allergic sneezing and irritation for about 12 days but no fever or cough a local ent gave me azithral 500 and nasivion drops for five days however as I got diarrhea on the fourth day I called my family doctor in another city who prescribed guncef 325 twice for five days montair la once daily and formonide inhaler in case of heavy breathing I have completed four days and infection is better and spitting of whitish phlegm is very less but I still get nose irritation sneezing and intermittent throat sore I do not have a fever or cough kindly advice",
        "input": "",
        "output": "hello from your description it seems that you are suffering from allergic rhinitis and mild intermittent asthma from the symptoms it is very obvious that the symptoms like nasal irritation and frequent sneezing are because of nasal allergy you have already completed the antibiotic course so it is not advisable to repeat it again start avamys nasal spray fluticasone furoate one puff twice daily in each nostril and continue montair la montelukast and cetirizine for the time being nasivion nasal spray can be taken as required formonide inhaler must be continued if you have a cough and breathing difficulty disturbing your daily activities you should always gargle after taking formonide inhaler every time you should try to find out and avoid the allergy trigger responsible for your symptoms once you start taking these medicines regularly all your symptoms will automatically get controlled in case no improvement you should visit your local pulmonologist to find out any other pathology nasal allergy spirometry to confirm the diagnosis of asthma avamys nasal spray puff twice daily in each nostril montair la daily once at bedtime formonide inhaler as per need nasivion nasal spray as per need avoid known allergic triggers"
    },
    {
        "instruction": "i am 18 and I am sexually active and had sex twice last month both using a condom but I am not on birth control I did not get periods in these last two months I have frequent late period by a few days but they always come so I took a pregnancy test a week ago and it came out negative I have no idea if I am actually pregnant or how I could tell that something else is wrong",
        "input": "",
        "output": "hi dont worry I am there to help I need to know about the date on which you got last periods also please give me certain details are you having weight gain is there excessive facial or body hair how much delayed are your periods any dark pigmentation around neck or armpits since your pregnancy test is negative you may not have conceived its probable that you are developing cos too during lockdown period the physical activity of most of us is a bit restricted and also there looms a lot of stress regarding couid 19 these are factors that may lead to hormonal imbalance and hence delayed cycles its important to engage is some exercises that can be done at home and it is advisable to eat green vegetables and fruits and drink milk regularly meditation diet and exercise forms the primary regime to avoid irregular cycles its better to avoid excessive cheese fat butter ice cream and fast and junk food hope this helps please follow up with above details"
    },
    {
        "instruction": "i have a gynaecological issue my husband and I have not had intercourse for more than months a few days back when we tried to have one it hurt a lot and he withdrew he did not ejaculate inside the very next day I had a brown discharge and since then tiny blood clots ranging from red to brown have been surfacing along with light stomach cramps is this a sign of an internal injury my husband erection lasted a few seconds and he could not penetrate properly since I started to get hurt",
        "input": "",
        "output": "hi hope you are doing well from the history that you have posted I believe that you may be suffering from a dry vagina due to some reasons were you experiencing pain during cycles previously how are your periods now interval and amount of bleed normal or reduced are you breast feeding have you ever gotten pap smear done sometimes dryness may be due to allergy and anti allergic medications that probably you could have taken due to pharyngitis its necessary to involve in enough foreplay before actual penetration it helps in stimulating your genital glands to provide proper lubrication for penetration normally the walls of the vagina stay lubricated with a thin layer of clear fluid the hormone estrogen helps maintain that fluid and keeps the lining of your vagina healthy thick and elastic a drop in estrogen levels reduces the amount of moisture available it can happen at any age from a number of different causes it may seem like a minor irritation but the lack of vaginal moisture can have a huge impact on your sex life fortunately several treatments are available to relieve vaginal dryness you can use my jelly locally in and around vagina before attempting intercourse an internal injury is unlikely but please follow up with a gynaecologist if pain or bleeding is severe to get an examination done please use tab doll 650 to ease off pain and hot water bag around lower abdomen during menses to avoid cramps and the jelly I prescribed above to help reduce discomfort during intercourse since menses are heavy your estrogen levels are not sufficient so no hormone supplements needed premenstrual syndrome manifests as severe cramps sometimes and since you do not plan to get pregnant as of you can consider taking contraceptive pills it will slowly reduce the excessive cramps and will make your bleeding volume moderate hope this helps"
    },
    {
        "instruction": "hello doctor I am getting dizziness while getting up from the bed for the past three days my vitamin b12 is low in the report taken last month whether my dizziness is due to that or it is vertigo please suggest me some medicine",
        "input": "",
        "output": "hello the giddiness does not appear due to vitamin deficiency the symptoms are suggestive of benign paroxysmal positional vertigo bppv we need to confirm the diagnosis for this you have to provide details as follows is it spinning sensation or is it weakness does it get triggered by turning your head or getting up from the bed how long does the spinning last say few minutes or a few hours is there vomiting or nausea along with it is there any hearing loss or ringing sound inside the ear or fullness of the ear during this giddiness is there any ear discharge or decreased hearing based on your replies we shall confirm the diagnosis and suggest the right exercise and medicine for you the exercises cannot be explained via text you would need to confirm for a video consultation so that we can show you the same if the diagnosis is bppv then I shall guide you on what to do next"
    },
    {
        "instruction": "hello doctor I have chronic granular pharyngitis I was having throat pain for the past eight weeks initially I took home medicines and it did not cure then I took azithromycin and metronidazole for a few days and I stopped this currently I take tablet claribid 500 my twice daily morning and night after food betadine gargle tablet nexpro rd once daily on empty stomach acecloplus for pain if required I do not have too much pain monte la at bedtime after food I started these tablets for two days but it seems that my condition is worsening",
        "input": "",
        "output": "hello please send photographs and report of your throat"
    },
    {
        "instruction": "hello doctor I had sex with condom is there any chance to get affected with hiv until now there are no symptoms generally how many days will it take to identify hiv after sex please suggest and I am a bit worried generally in my company they conduct medical tests yearly and in that it shows negative",
        "input": "",
        "output": "hello welcome to icliniq com doing sex with condom is safe unless it has torn or leaked was your partner a known case or later diagnosed to be hiv positive company tests that you have done if it was for hiv and if it is negative then you need not worry about it as test results will be positive in four to eight weeks after exposure and the symptoms and presentation may be late and vary depending on the patient immunity and other things it is present with some symptoms be delayed even up to a decade or more if you are already tested for hiv and it is negative then I do not think there is any reason to worry about your incident if not yet tested and you want to clear your doubt get it checked after this couid period it is not an emergency be careful and take safety measures"
    },
    {
        "instruction": "hello doctor my daughter is almost 14 months old she had a rash on her vulva for maybe one and a half months we have tried everything desitin maximum strength a ointment triple paste aquaphor boudreaux butt paste and prescription hydrocortisone we change her every four hours and blow dry her privates for about five minutes her diet has not changed much since turning one because she still only has two teeth so we continue feeding her pureed jar foods but introduced ritz crackers and string cheese as snacks we do switch out her powder formula for whole milk but her stools are still the same there is no blood or diarrhea my mom rarely has cold sores and when she does she is careful about washing her hands and generally avoid the baby what can this be and what should I do you think she has herpes",
        "input": "",
        "output": "hello welcome to icliniq com is there any itching any other area affected is it increasing or persistent in nature"
    },
    {
        "instruction": "hello doctor I have a painful armpit lump please suggest",
        "input": "",
        "output": "hi welcome to icliniq com it is an infection take tablet cefixime 200 my twice daily for five days mupirocin ointment daily for five days take antiseptic soap for bathing tablet aceclofenac and serratiopeptidase once daily if there is pain review after five days infection will subside if lump remains it need to be removed surgically send a photo after five days bacterial infection fasting blood sugar"
    },
    {
        "instruction": "hello doctor I have an urge to urinate since 15 days top of my penis glans become darker some days before I get the urge to urinate I have constant urge throughout the day I am 27 years old",
        "input": "",
        "output": "hi coming back to your query have you started the treatment of your own though the picture you provided is of low quality but I can make out some bluish discoloration near the tip is that you are talking about have you had any history of unprotected intercourse or oral sex have you encountered similar problem in the past have you seen this kind of discoloration after use of condoms before or you can correlate this time any history of diabetes or hypertension I am writing you the prescription for the complaint you told me do update me with answers tablet roliflo tolterodine plus tamsulosin 0 0 syearup alkamax citralka 10 my tablet chymoral forte 0 stop ibuprofen after three days from the day you start continue rest of your medications as before for total of seven days if not get settled we will get some investigations done"
    },
    {
        "instruction": "hello doctor about a week ago I started to notice a fuzzy tingling sensation going down my neck and back when I look down at the floor if I continue to stretch my head forward and back I no longer get the sensation down my back and neck but this sensation will come back after I have not looked down for a while the closest thing I can find that matches my symptoms is the lhermitte sign I do not have any other symptoms my vision is fine I have no problems with balance or anything else associated with is as lhermitte is typically found in is sufferers but this was the only disease I could find that fit my symptoms best nothing is painful it is just a weird sensation I have had no accidents or traumas to my neck or anywhere and I do not take part in any aggressive physical activity I am otherwise active and healthy mi of 26 I am a 25 year old male just to mention I do have a bad back posture if this is contributing",
        "input": "",
        "output": "hello welcome to icliniq com your query will be addressed properly and you will be provided with best of the treatment I assure you that now coming to your condition your mi 26 comes in preobese category which could be one of the cause of tingling sensation because weight puts more pressure on your spine and your bad posture may add up to your condition do you spent lots of time in front of screen like mobile or laptop given your medication history are you taking it for asthma which other medications have you taken for it before is it under control I can prescribe you proper drugs and exercise but I have a few questions about your condition that need to be asked if you can join me for the follow up or hotline chat it will help me to analyze you properly and you will be fine with proper guidance follow up with details"
    },
    {
        "instruction": "hello doctor my contact scratched my eye the other day my eye has become progressively worse it is my right eye and it is red closet to the inner corner and when I blink it feels gritty I think it is just an eye infection",
        "input": "",
        "output": "hello welcome to icliniq com it is conjunctivitis use moxifloxacin eye drops four times a day for two weeks just tears eye drops carboxy methylcellulose four times a day for two weeks do warm compress three times a day stop using contact lenses until the eye is quite if the black part of the eye cornea starts becoming white at the corner it is corneal ulcer which requires vigorous treatment and you need to consult a local ophthalmologist as soon as possible since you gave history of scratch keep checking the cornea black part of the eye"
    },
    {
        "instruction": "hello doctor I have had these red bumps on my stomach for six days a little up my chest neck and arm they are not itchy too much I have been using cortisone and it has not gotten any better now it sort of looks like my boyfriend might be starting to get them on his back not 100 percent sure I am currently on lexapro",
        "input": "",
        "output": "hi welcome to icliniq com lesions are looking like red papeles miliaria is common if you are sweating more some are looking infected is there any fluid coming out of some lesions any chance these are subsiding after a few hours if your friend is also getting it then it can be folliculitis it is a mild bacterial infection if available please use mupirocin or fusidicacid cream apply calamine lotion once anti itch medications in the night drink a lot of water"
    },
    {
        "instruction": "hello doctor I am having frequent urination for the last four to five days coupled with bloating I used to have the same problem in the last year also please guide can this be symptom of ovarian cancer recently I lost 8 keg of my weight",
        "input": "",
        "output": "hi do not think of ovarian cancer as such with a single symptom frequent urination can be due to ti urinary tract infection cystitis bulky uterus or uterine prolapse it acute onset points towards infection more likely just drink more water that keeps urine clear keep the vaginal area as dry as possible avoid having sex you can take liquid vital tablespoons two to three times daily tablet niftas 100 my two times daily for 15 days if not relieved then only we have to look for other problems right now I am giving treatment and precautions for ti only for bloating it may be due to acidity or stomach upset starvation or not walking like home lockdown can also increase the acidity so avoid spicy and oily food do not starve do not take stress you can take tablet onde my like tablets two times a day or pan 40 once daily if weight loss is without decreasing food habit and other things then need to do one ultrasound abdomen and pelvis along with one chest ray may be required means need to investigate for finding the reason ultrasound will also tell about any other pathology if you have doubts about your ovaries and if symptoms are increasing then urine routine test and if pus cells found than culture sensitivity of urine also required you can start with drinking more water and precautions and other medicines will see in two or three days whether decreasing or not"
    },
    {
        "instruction": "hi male age 36 I have sides bottom big teeth its infected completely every six months I get severe ache the teeth is hallow do I need to close the gap what do you suggest this teeth is infected almost years above I hope but recently since a 20days the tooth ache is severe bottom end munching big tooth both sides are infected and its hallow cant munch anything just having liquid type food avoided sugar content foods very rare tea taking antibiotic and pain killer from medical stores and ogling salt water also cloves near infected tooth for relief",
        "input": "",
        "output": "hello I have gone through your query and understood your concern a clear clinical picture or an ray of the teeth will help determine the present condition and the extent of the decay this tells whether the teeth can be saved with a root canal treatment or it needs to be extracted if this pain is manageable with the meds I suggest you to continue using the same meds and home remedies let this pandemic settle after which this can be treated safely if this pain is unbearable even after taking meds please visit a nearby dentist for an ray and an emergency procedure since it is the time of the pandemic the dentists are providing emergency care only and sometimes with prior telephonic consultation call up a nearby dentist to get an appointment and if your planning to go out to get this treated make sure to follow measures for self protection I hope this helps good day and stay safe"
    },
    {
        "instruction": "hello doctor I have been experiencing a chronic cough and it has clear bubbly phlegm and I am so bothered about it because it has been a year since I have it sometimes I vomit especially when my cough is severe and it sometimes makes me breathless I have been taking antihistamine for it but it has no effect I am so bothered and worried because it is been a year but still I am not well please help",
        "input": "",
        "output": "hello according to your statement you are suffering from chronic cough for almost a year now that makes you breathless you did not mention here about your family history working history living history allergic history smoking history and the factors that make you breathless sometimes there is no history of nutritional status night sweating or weight loss as we know chronic persistent cough that occurs most of the days for three months for two successive years is called chronic bronchitis again cold chronic obstructive pulmonary disease includes chronic bronchitis along with emphysema so my probable diagnosis is cold can be confirmed by reversibility test as it is irreversible so fev1 will be 15 after salbutamol or steroid trial you should undergo lung function test that will reveal fev1 fvc 7 tac increased rv increased car sputum for s blood gas analysis etc by using salbutamol or anticholinergic inhaler corticosteroids or oral steroid intake occasionally oxygen inhalation you may control your chronic cough to some extent please inform me about your investigation results as soon as possible"
    },
    {
        "instruction": "hello doctor I got on an airplane and started having stomach pain when I landed I used the restroom but could not empty my bowels I then drove for two hours and had terrible stomach pain I then used the restroom and was able to terminate a little but it was not a normal amount I continued to be constipated for days I finally took ex lax and that cleared me out but I could not go the next day so I waited a whole day and took it again it worked but I cannot terminate it has been days I usually go three times a day I have been running hydrating and eating well I am not stressed my stomach is completely bloated and each time I take ex lax the bloating is gone and my stomach is four times smaller I took some prune juice and my lower abdomen started having painful contractions for an hour followed by diarrhea I am at a loss I have tried fiber too and nothing helps please help",
        "input": "",
        "output": "hello a couple of things use of stool softener or laxative is not recommended unless you have constipation for three days and you are passing gas you are most likely to have diarrhea if you use it earlier also you may have post diarrhea ileum the gut can go into a stunning situation and you would be constipated my recommendations would be not to use any stool softener or laxatives and allow your natural habit to return please add vegetables in your diet and salads please only use miralax polyethylene glycol 350 it is a laxative solution from day if you are not still going also the bloating is a side effect of the product you are using"
    },
    {
        "instruction": "hello doctor I am having pain in stomach and having loose stools I also have a bad taste and feel like vomiting please tell me the treatment",
        "input": "",
        "output": "hello kindly tell me how long these symptoms appeared do you have past history of any illness do you take any medicine on a regular basis are you married current history of pregnancy delivery do you have regular periods any recent lab test or report if these symptoms appear recently without any history of cough fever sore throat no chronic illness not taking any medicine on regular basis no history of pregnancy delivery breast feeding having regular periods no recent labs then take the following treatment tablet flagyl 400 my three times a day motilium 10 my three times a day half an hour before meals take the above treatment for five days then followup if you have any history other than the above issue or if you have positive answer to any of the questions mentioned above then please do not take this treatment and immediately take the opinion from a doctor I hope this helps"
    },
    {
        "instruction": "hi good morning I am 41 yo female with partner h5 65 kegs I would like to consult about the chest and back pain that I am feeling lately chest and back pain usually happen 2 hours after I eat or at night no fever the pain usually take 15 minutes or longer I felt like I being choked by the air in my esophagus and my stomach bloated when I take antacid like kremil chewable or omeprasol I felt a bit relieved but still too much gas in my stomach my be is normal is there any alternative medicine that I need to take I have no allergies to medicines hope to have meds that are not harmful to liver as I am diagnosed as hepab asymptomatic or hepab carrier thank you in advance for your help god bless",
        "input": "",
        "output": "hello sorry to hear that you are suffering from chest and back pain if it is happening after eating then probably it is more of a stomach issue as your query goes regarding alternative medications apart from omeprazole and kremil syearup we can definitely change to lansoprazole which is similar to omeprazole but slightly stronger dosage would be 30 my twice a day for days there are other things that I would like to discuss as obvious the above medications are for symptomatic relief but we need to find the root cause of the problem possibilities include gastritis pyloric infection a type of bacteria affecting stomach ulcer in the stomach or upper part of small intestine to rule out any of these you would need to see a gastroenterologist who can then do an endoscopy and get a tissue sample from your stomach to check for pyloric I know that you might be afraid of these tests but there is nothing to worry as the procedure is usually painless and done as a day care so that you do not have to stay in the hospital atleast maintain a healthy diet reduce spices and carbonated drinks in your diet some aerobic exercise like yoga should also help all the best take care I hope you get well very soon"
    },
    {
        "instruction": "i am 32 years old healthy male without any relevant medical history I am married since years and do not have kids till months ago I used to have weekly sex with my wife but now since last months I have been staying without her in some city so meet her only once a month I also masturbate once a day mostly in last 45 days we have met three times but I felt less confident in maintaining erection enough to have sex so I had my tadalafil and did intercourse comfortably but yesterday I had to take 10 my tadalafil and then also I was under confident kindly suggest if I have erectile dysfunction and need to take medicine if it is just psychological condition and need not worry or keep consuming 5mg 10 my tadalafil every time having sex but I am afraid this will be habitual and long term usage for next 15 20 years shall have side effects on my body and family planning or whatever you suggest is right thanks a lot",
        "input": "",
        "output": "erectile performance and ejaculation can be influenced by many factors if you are anxious sad or stressed this can get lower performance if you are relaxed and happy you will have better performance because it is affected by neurotransmitters which is influenced by mood stress level etc the more relaxed happy and stress free you are the more levels of these neurotransmitters and better performance it is also influenced by emotional factors with your partner if any problem between them can lead to psychological erectile dysfunction which is common in young couples and when partners stay away they are not doing sex often and they get distanced in emotions and some level of anxiety builds up when they perform"
    },
    {
        "instruction": "i have been having deep ear pain on and off for months now with the feeling of drainage going down my throat from my ear no drainage to the outside whatsoever a few years ago I had eustacian tube dysfunction with all of the pain pressure hearing loss etc this is not that its been going on and off for the past few years after that time right now I have had a low grade fever for days generally feeling unwell have lost about labs and this ear pain and tons of drainage which is starting to drive me just crazy I do not know what is wrong with me can you help",
        "input": "",
        "output": "hello I would consider a low grade otitis external as a possible source of some of your symptoms consider clotrimazole drops this can be ordered online as it is hard to find in pharmacies sometimes use twice a day days if this does not help then get back with me in the meantime if you cannot pop your ears and relieve the pain pressure then you are probably right that it is not et dysfunction but if you can start a nasal steroid spray twice a day next few months you could also have sinusitis causing the drainage that would require a visit to an ent finally if you have poor sense of smell and fatigue with the low grade fever there is a chance that you have couid if symptoms worsen then get this checked out in the meantime follow strict social isolation"
    },
    {
        "instruction": "recent blood tests revealed that proteins in urine is 486 against 130 in the 24 hour unit test I am diabetic however it is under control fasting sugar is 106 and after break fast it 120 I am using diapride 5 for blood sugar and citanil 40 for be I consulted nephrologist and he told me that for my age of 62 and being diabetic the said protein loss is not unusual and the tablet citanil 40 will take care of the problem of protein loss my present problem is I am feeling terribly weak should I need to change the tablet or take medicines for weakness",
        "input": "",
        "output": "dear thanks for the query as per the records you have diabetes hypertension and related complications such as retinopathy nephropathy your blood sugar control is good and other investigations also look fair your doctor has rightly prescribed you cetanil which contains telmisartan which is used to treat proteinuria the proteinuria can not explain the weakness two main reasons for weakness in your case may be low blood pressure or low blood sugar so monitor thess check your blood pressure in lying down position and after that stand up and after minutes check it again if there is a fall of more than 20 my he in systolic blood pressure or 10 my he in diastolic blood pressure then we need to reduce your antihypertensive medications diabetes related complications monitor be as advised postural hypotension to rule out may require antihypertensive reduction after checking"
    },
    {
        "instruction": "help respected dermatologist I have pigmentation dark spot melasma on my face since last 16 year I have taken lot of medication and consulted lot of dermatologist which are well known by every one in our country sir but is was in vain past medications include clripex clarimax dermaclean cybelle bellence tablets feefall sangobian evion glutamax seapio colophylum lycopodium and much more if I will start writing I thing this text box is not enough too complete my whole medication I have used too many creams wiyh passage of time I have also used this commercial creams stillmans goldenpearl arina etc",
        "input": "",
        "output": ""
    },
    {
        "instruction": "my daughter age 12 year has gone under cal eye surgery a month back due to lock down its not possible to consult the doctor I would request kindly advise till when we have to continue these eye drops from 27 days we are continuing vigamox moxifloacin ophthalmic solution ip 5 v times a day and carboxymethylcellulose eye drops ip times a day how long we have to continue this or what other basic precaution should we follow please help if it possible I would like to consult from you either video audio",
        "input": "",
        "output": "hi good afternoon I hope you doing well most probably cal done for keratoconus usually post op antibiotics drop vigamox are prescribed for 6 weeks so you can continue vigamox 3 times a day till weeks second drop is lubricant artificial tear that can be used long term to avoid dry eyes so continue that till you ger re examined by a doctor if there is no redness pain or any other problem nothing to worry about after cal you would need long term follow up to assess that disease is stable or still progressive for that your de may advise topography scan after months or yearly so stay at home stay safe you are most welcome for any queries god bless you"
    },
    {
        "instruction": "hello my wife and I had unprotected sex exactly two weeks ago she mentioned that it was or days after the end of her last period she has mentioned that she has felt soreness in her breasts since three days back and we are worried that she may be pregnant we do not want her to have a baby at this point and no abortion pills or abortion clinics are available in the country we live in with the couid 19 spread around the world at this time travel to conduct an abortion at a clinic is not possible for us the closest thing we have here are yasmin pills will taking them two weeks after having sex have any impact please help",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello doctor for the past two and a half months my son years old has had total bright green poop sometimes pasty he is in daycare for the past two months I have also started to have total bright green stool inside and out with bright green mucus 80 of the time without eating anything green significantly enough to cause consecutive green bus consistently in and throughout even while missing meals due to lack of appetite I had lost 15 labs in a month and a half I have to force myself to eat due to all the complications I had been facing I am a particularly healthy individual eat fairly healthy have healthy habits never been to the hospital except to have pregnancy and delivery but have been four times in the past two months for feelings of passing out fast and high heart rates from out of no where very scary feelings of extreme exhaustion low energy and tired quickly feeling dizzy with feeling off balance I forgot about the bright green be of my son that had been ongoing and decided to tell his doctor she said it could be an infection I have had test on my heart from cardiology they ruled out everything cardio test for vector like illness from my travel and id ruled out those things like dengue fever I did not stress the be at that time and for the virus going around presently all negative I am feeling defeated my job has started to suffer and I am a very hard worker what type of infection causes bright green be and could this be the culprit of my all of the sudden odd symptoms",
        "input": "",
        "output": "hello I am very much concerned with all the problems you are facing as both of you have the same problem and at the same time you are losing weight and also developing some vitamin deficiencies due to which you are feeling exhausted and having problems with your memory you are also having some travel history to me it looks like to be chronic giardiasis but needs to rule out other causes as well I will like to suggest some tests and will advise some initial treatment hope that it will help out in your and your baby problem if you still remain symptomatic get back to me early try to use multivitamin and a lot of fluid intake this you dont have to worry lot it all will settle with treatment and I think that all your symptoms are associated with these loose stools which are leading to nutritional deficiencies I will advise you to take multivitamin containing folic acid and vitamin complex complete blood count electrolytes stool for ova and cyst giardiasis tablet tinidazole tindamax gram once as a single dose for you and 50 my as a single dose for your child use boiled water get back to me with these lab workup"
    },
    {
        "instruction": "hello doctor my head has red patches for the last six years my hairs are falling white hair only I also suffer from low testosterone level for the last six months please help",
        "input": "",
        "output": "hi you have a condition called as scalp psoriasis this happens due to an increase in turnover of cells at the level of skin stress infections climatic change and consumption of eggs or red meat can cause this to increase you can use a clobetasol with salicylic acid lotion on the patches everyday morning and night for two weeks you can also use a coal tar based shampoo to wash your scalp on alternate days consuming fish is beneficial you can also take fish oil capsules like seven seas you can apply cobiwell salicylic acid and clobetasol lotion over the patches morning and night for two weeks use polytar shampoo thrice a week leave on scalp for five minutes and wash"
    },
    {
        "instruction": "hi doctor I had consulted earlier here I had complained with issues of cold and strep throat doctor had prescribed azithromycin crocin and fexofenadine the strep throat is recovering I no more have running nose but I feel that my chest is heavy while breathing could you please tell me what it is nothing to worry right",
        "input": "",
        "output": "hello welcome to icliniq com according to your statement you had a strep throat and now your chest is heavy while breathing upper respiratory tract infection is very common complication of untreated or partially treated strep throat it makes your chest heavy while breathing due to thick mucus production you do not mention here about your fever or joint pain or shortness of breath or chills or cough etc again strep throat can cause several complications like pneumonia bronchitis acute and chronic streptococcal toxic shock syndrome rheumatic fever etc which associated with chest pain heaviness fever cough etc you are on medications like azithromycin fexofenadine paracetamol etc you can add montelukast nebulizer with salbutamol three to four times daily with mucolytic agents like mucinex carbocysteine bromohexine pulmozyme etc to make your thick mucus loosen and remove easily through coughing you should undergo car chest ray abc complete blood count egg electrocardiogram etc to find out the cause and carry on your medications if any complications occur inform me I will help you to treat further"
    },
    {
        "instruction": "hello doctor I got liposuction surgery last month I was in the hospital for two days and then I was discharged I come from a small town so I had to go a bit far from my hometown for the surgery my doctor claims that he has liters of fat removed from my body my bodyweight before surgery was 90 kegs and post surgery it was around 79 I got liposuction in my thighs buttocks abdomen and arms I searched online and it says that this much amount of fat removal from one surgery is not healthy to give an idea of my mi my height is 2 the problem is it is already 21 days since surgery and I have one of the drains which my surgeon kept open still draining it started to drain post days of surgery and it is on the back of my right thigh and this is the third that opened since surgery but the two drains have already closed and clean I still have swelling all over my body and I am facing a bit of problem in walking normally because of the lockdown in my city I am unable to meet my surgeon and get post op care but he suggested that any general surgeon can help me so I consulted a general surgeon in my town and he said everything is fine also I have skin necrosis on my left thigh I do not know what I should do as I have read online that most of the patients get well after 21 days of surgery and here I am still going through drain let alone nowhere close to healing completely",
        "input": "",
        "output": "hi drains left open for fluid discharge generally close within two weeks I think you were done a tumescent type of liposuction you do not have any immediate complications as per your description so I think it was done nicely but prolonged complications in drain discharge needs some supervision I hope you do not have any fever because that indicates infection in that case you have to start antibiotics as per culture sensitivity immediately I also wanted to know about your urine intake and swelling and thus you need to be done kidney function tests for the swelling if there is skin necrosis it also needs immediate intervention I advise you to have some tests which I am writing and get help from a good surgeon infection which spread to internal organs can be dangerous and so the skin necrosis emergency services are not blocked in lockdown liposuction rat renal function test let liver function test complete hemogram"
    },
    {
        "instruction": "hello doctor my daughter is years old with a tube in her left ear and a perforation in her right ear the doctor does not want to fix the perforated ear until the tube falls out of the left ear and is healthy for a year in the meantime it is suggested that a hearing aid be used until the perforation surgery does this sound like a normal course of action and will ear perforation surgery improve the situation",
        "input": "",
        "output": "hello we shall do the ear perforation surgery only when we are sure that eustachian tube ventilation to the middle ear is normal and not hampered by any reason the functioning of the eustachian tube is indicated by the successful falling off of the ventilation tube the grommet the falling off indicates that middle ear pressures are getting maintained by the natural eustachian tube usually kids of this age have some remnant adenoids which causes tubal obstruction causing recurrent ear issues like in your kid usually the adenoids regress by this age if they don then the kid will have symptoms of mouth breathing snoring teeth crowding and protrusion and other signs of adenoids facies if these issues are there then before we attempt ear surgery we will have to remove the adenoids and tonsils because the source of ear infection is adenoids tonsils otherwise we can wait for a while until the natural eustachian tubes function well and then we can repair the eardrum we would need to do an adenoids ray to check for the adenoids size meanwhile hearing aid is the best option because you cannot risk your child not hearing properly at this age as it would adversely affect his speech and development for any queries on this matter please revert back to me"
    },
    {
        "instruction": "hello doctor I have absence of ductus venous during pregnancy during the first and second trimester please suggest",
        "input": "",
        "output": "hi absence of ductus venous during the first and second trimester scan is a vascular condition that might be of concern for fetal abnormalities it can put the fetus at risk of other congenital anomalies including facial cleft hemivertebrae cardiac genitourinary and gastrointestinal anomalies"
    },
    {
        "instruction": "hi doctor I have done some research and I am pretty sure I have depressive bipolar disorder I have struggled with something I thought was depression for a long time but it was always more like episodes of suicidal thoughts and me being in a deep depression like if I do have it the other night I had one that lasted four hours and last year I had one that lasted three months but I did not tell anyone I would like to do something about it now or know what I actually have by the way the episodes are completely random but there have been a few times when there is a trigger I also want to be on medication because I have tried everything else as nothing works",
        "input": "",
        "output": "hello what are your symptoms exactly if they are of depression then the treatment with an sari selective serotonin reuptake inhibitors 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 and hypomanic phase then you probably suffered from major depressive disorder or generalized anxiety disorder so if you are just depressive then saris are to be used and if you are bipolar then a mood stabilizer will be added to the prescription"
    },
    {
        "instruction": "hello doctor I am experiencing irregular periods sometimes two times a month latest before three months and sometimes it will skip for two or three months I also noticed that I suddenly have hair growing on my stomach and chest also I do not have hair on my legs before but now I have a few hairs growing on some spots I also noticed that there are suddenly pimples on my back which never happened before this occurred last month I have not done any tests on my thyearoid or hormones I used to also take pills diane to regulate my menstruation but after two months I stopped",
        "input": "",
        "output": "hello I can understand your concern according to your statement now you are suffering from amenorrhea absence of menstrual cycle hirsutism hair growth in women in the male pattern acne pimples one type of acne on the back and having no history of thyearoid or hormonal test and issues cause you are on childbearing age suggests that it may be cos polycystic ovarian syndrome cos can be established by your clinical features with some investigations result you should undergo abdominal ultrasound which can detect bilateral polycystic ovaries you can undergo some blood tests too like blood for testosterone increased sex hormone binding globulin decreased oh fish ratio increased and thyearoid test to exclude hormonal diseases you can start metformin bigunide therapeutic class to restore your regular cycle and fertility and supportive management for your other complications and estrogen therapy"
    },
    {
        "instruction": "hello doctor I was going on a regular day without fever or feeling anything bad with my body then I suddenly started sneezing every ten to fifteen seconds my eyes became a bit watery I went home and suddenly started to have a nosebleed it happened once only this afternoon but now I feel a bit of weakness and headache I would like to know what possibly caused the nosebleed I cannot get into a hospital to consult because the roads here are still blocked by the military because of the couid 19 situation by the way I am a 24 year old female I am not taking any kind of medication as of this moment",
        "input": "",
        "output": "hello I can understand your concern is this the first time you have noticed that bleeding from your nose since you do not have other symptoms that can qualify to suspect for couid 19 you do not have to worry for time being however you must follow the who world health organization guideline and keep yourself safe and isolated at least for two to three weeks and wash your hand with soap and running water with an adequate amount of time before and after touching any things place which might be contaminated also avoid touching your face mouth as much as possible as for now you do not have any symptoms and sign so you do not have to worry about couid 19 for bleeding from the nose kindly press that area using your clean hand for a couple of minutes and it will be stoped normally keep yourself hydrated with having enough fluid water juice etc I hope this helps"
    },
    {
        "instruction": "hello doctor I am 19 years old I weigh about 70 keg and my height is 57 my semen has been yellow color for the past one week and now it seems like it has urine in it but it has no foul odor and my penis is quite itching also sometimes I experience discomfort when urination I wonder what is this condition I am having right now and what is the possible treatment",
        "input": "",
        "output": "hello according to your statement you are 19 years old sexually active person suffering from discharging of yellowish colored semen itching of penis and feeling of discomfort during urination and all your symptoms indicates sad sexually transmitted disease your sad is either chlamydia which is caused by chlamydia trachomatis most common or gonorrhea which is caused by gonorrhea or both diseases present similar clinical symptoms and treatment is almost the same single dose of azithromycin is the treatment of choice by collecting urethral swab it can be specified either chlamydia or gonorrhea in gonorrhea urethral swab shows the presence of gram negative diplococci and in the case of chlamydia swab shows non specific urethritis urine for s can also be done after undergoing the investigations please inform me about the results"
    },
    {
        "instruction": "hello doctor I am concerned about a head twitch I have gotten in a habit for seven months of twitching my head if I am consciously thinking about what I am doing I can stop it however it is extremely difficult and I feel an overwhelming impulse to do it similar to how one would feel when cracking his or her knuckles it seems like it has become a habit and I do not know how to stop it I also want to make sure there are no underlying medical conditions however as I mentioned when I pay attention I can control it even though it is difficult and uncomfortable and I have to put a lot of effort into not doing it I read online that it may have something to do with stress or anxiety",
        "input": "",
        "output": "hello from your description it looks like you are experiencing a motor tic do you have any other symptoms how old are you at present you mentioned this tic started befor seven months have you experienced any tics before any vocal tic tics can be suppressed temporarily but can be uncomfortable as you mentioned tics can wax and wane depending on stress anxiety tiredness etc usually tics are common and harmless it is advisable to consult your doctor to clarify the diagnosis and to exclude any conditions that can mic tic disorder mild tics can be managed by stress management and relaxation exercises if tics are severe and persistent it can be managed by specialist therapy cognitive behavioral intervention for tics cbit sometimes medication can be used as well I hope this helps"
    },
    {
        "instruction": "hello doctor I am 19 years old I am facing some kind of fear from about six to seven years I thought it naturally demolish with the time but now it is increasing day by day before I have the only fear of suffocation and enclosed space like jet lift etc now from about two months I am facing one more new phobia which is I cannot catch my breath then my heartbeat rise rapidly I cannot focus on my life goals due to these problems I cannot go foreign or everywhere where I want to go please help",
        "input": "",
        "output": "hi yes you are experiencing panic related symptoms under anxiety issues as you have shared of phobia it requires adequate counseling and brief psychotherapy to deal with anxiety problems the symptoms you are experiencing are part of panic attack feelings and symptoms like palpitations getting heart attack difficulty in breathing digestive concerns and sleep problems can be a part of heart related problems or anxiety at first you must need to get proper assessment identifying the cause of this anxiousness whether it is work related or some personal issue it can be done by analyzing thought processes when you are having such symptoms after analyzing thoughts cognitive behavior therapy thought channelization and restructuring are quite helpful in addition to make yourself relax you can do the following deep breathing exercises walk for at least 30 minutes per day workout if possible to release toxins out of your body reduce smoking if you do avoid junk and spicy food soft drinks increase water intake thought diary or journaling will be also helpful for analyzing and restructuring of thoughts underlying cause of the problem you can also have an appointment with the counselor to help you in assessing and provide you with individualized therapy as per the requirement"
    },
    {
        "instruction": "hello doctor I have erosion in my stomach severe burning sensation and sometimes vomiting and bloating I have done endoscopy colonoscopy angiography and hospitalized for about four times recently again I have done endoscopy found astral erosion please advice",
        "input": "",
        "output": "hello you have recurrent complaints of astral erosion and ulceration I will advise some treatment and hope that it will help out you should send me all your previous endoscopies and other reports done until now I will also like to know about your pyloric status none at the moment peptic ulcer disease capsule dexlansoprazole 60 my one before breakfast for four weeks levosulphride 25 my three times a day before meals for two weeks syearup gaviscon alginate 10 my three times after meals for 10 days avoid spicy foods follow up after one week"
    },
    {
        "instruction": "hi I straightened my hair for times after my third time my hair became really dry and curly also there is a lot of hair fall while shampooing please let me know whether I can make my hair better",
        "input": "",
        "output": "hi hairs are basically dead keratin only the hair follicle inside the scalp skin from which hair grows is living so when you straighten them or when you bleach or when you do any styling over them some part of the is always damaged so that cannot be repaired by the hair itself only the new hair which will grow from the follicle below will be normal so as you have said you have straightened them three times so you can imagine they are quite damaged they will break there will have split ends and there will be lusterless without any good conditioner so if your otherwise hair growth has been normal you have no other option but to just wait for the new hairs to grow and replace the existing damaged ones to increase hair growth you can use minoxidil twice daily over the scalp tablet calcium pantothenate biotin for weeks both minoxidil and calcium pantothenate increase hair growth and hair are thick also I hope this help thank you"
    },
    {
        "instruction": "hi my mother is 48 years old she experienced irregular spotting and missed periods last month consulted a doctor and got blood tests sonography done sonography was normal but her ash was high around 17 and she is suffering from hypothyearoidism the doctor prescribed eltroxin 50mg tablets and she has been bleeding in low to medium period flow since weeks the doctors are not available due to couid 19 please advise",
        "input": "",
        "output": "hello could you share the scan report if it is possible for you thyearoid abnormalities do cause some bleeding irregularities and also you mom is in the perimenopausal age group where anovulatory cycles are common which can lead to irregular periods as she has been bleeding for the past weeks and is not stopping it would be better she starts of with the hormonal medications to control the bleeding right away I have mentioned the same below also some supplements to improve her hemoglobin which she would have lost in the bleeding would be helpful ultrasound done recently says normal ash 17 started on eltroxin 50mcg already tablet livogen daily once after food for a month iron supplements tab tragic of or pause of thrice daily after food during heavy menstrual flow can stop if flow is normal continue eltroxin 50mcg daily once empty stomach after brushing teeth tablet primolut 10mg 5mg 2tablets thrice daily till bleeding stops followed by dose reduction to tablet primolut 10mg 5mg 2tablets 0 twice daily for days followed by dose reduction to tablet primolut 10mg 5mg 2tablets 2 once daily for next 14days then complelety stop it she will get her periods after stopping avoid missing the pills in between that may lead to irregular bleeding again other brand to consider sysron regesterone weight reduction regular exercises diet modifications avoid goitrogenic foods like cabbage cauliflower broccoli radish soya products etc to upload the reports on app prior to next consultation if bleeding keeps persisting may need endometrial evaluation"
    },
    {
        "instruction": "i was accutane for 10 months at 40 my for the majority I have been off of it for months and am noticing bumpy skin they are not pimples just small slightly elevated bumps",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello doctor I have the following symptoms bladder cannot be emptied fully due to this I frequently go to the bathroom during urination I have to do forcefully be due to anxiety forget learning and memory skill is weak before taking medicine for anxiety my heart pounds during tense after taking medicine I am comfortable but presentation skill memory skill is very low",
        "input": "",
        "output": "hi did you have investigation related urine problem like abc complete blood count renal function test us ultrasound whole abdomen to rule our protest pathology did you take any medicine for anxiety you have mentioned high be now what is your be any medicine for this how long do you have all these problems"
    },
    {
        "instruction": "hello doctor I have swelling on my feet and tongue as well kit report was normal only my creatinine was 6 it is a chronic problem I have already used lasilactone 50 my and torsemide 10 my but no relief I use insulin mixtard 40 units twice and galvus met 50 850 be for my diabetes type maybe galvus causing swelling so I stopped it recently and want to switch over to janumet",
        "input": "",
        "output": "hello according to your statement you are suffering from chronic kidney disease now you have swelling on feet ankles and tongues you have do diabetes mellitus for 20 years do you suffer from an allergy or are you allergic to some foods medications irritant etc hypersensitivity reaction can be a cause for your present swelling again you are a patient of chronic kidney disease so you can suffer from anemia either caused by chronic disease or vitamin b12 deficiency due to taking metformin for do if you have anemia you can suffer from the present swelling too again you are using drug like solitral for bah thelma for hen hypertension can cause swelling as their side effects and hypersensitivity reaction in case of heart failure liver diseases obstructive uropathy hormonal problem etc can cause swelling too so you should undergo some investigations like abc complete blood count he hemoglobin ear erythrocyte sedimentation rate to detect anemia status at present us ultrasound to detect obstructive uropathy or any other abnormalities skin prick test last test to detect hypersensitivity or allergens thyearoid hormone to ash to detect hormonal deficiency car chest ray to detect any abnormality in the chest egg electrocardiogram for cardiac status liver function test serum electrolytes etc at first we should find out the causes that are responsible for the swelling and then treat them accordingly so you should continue your current medications and inform me after getting the investigation results in your hand then I will try to treat you further"
    },
    {
        "instruction": "hi doctor so I am experiencing a loss of sensitivity in my penis I still get erections but it takes way to much effort I mainly just get them at night I have no conditions that I know of and I am 24 years old",
        "input": "",
        "output": "hello I have some questions do you smoke or drink are you diabetic if not still get your ribs done blood test what about your blood pressure any sleep disorders any previous surgeries your cholesterol and testosterone level any other mental illness such as anxiety depression stress and relationship problems kindly let me know the answers to the above questions"
    },
    {
        "instruction": "hello doctor I feel itchy but I do not see any weird symptoms like foul odor yeast etc",
        "input": "",
        "output": "hello welcome to icliniq com if no unusual foul odor or curly white discharge therefore no sign of infection itchiness can be secondary to irritation whether chemical or mechanical chemical in the form of the soap used or feminine wash and mechanical in the form of panty liners pads or even underwear for now infection cannot be totally ruled out since it can be early infection wherein the discharge is still pooling inside the vaginal canal I would suggest for you to use feminine wash with chlorhexedine content once a day for three consecutive days like gone pro feminine wash for bath soap use only hypoallergenic soap or mild baby soaps do not use shavers in the feminine area use cotton underwear and no panty shields please pat dry the area every after washing and change underwear as often as possible take also antihistamine tabs like claritin or loratadine 10 my once a day or any anti allergy medicines once a day to decrease the feeling of itchiness irritation if there will be discharge or foul smelling discharge on the succeeding days it needs follow up yeast infection chemical dermatitis hygiene antihistamine and lifestyle modification hygiene follow up after three days"
    },
    {
        "instruction": "hello doctor I have been experiencing upper left abdominal pain just beneath lower ribcage and on the opposite side in the back I have intermittent dull and deep chronic pain I am 43 years old nonsmoker but consumes alcohol not for the last four months my blood pressure is 120 80 my hg I am currently on omeprazole 20 my daily one month I am diagnosed with pneumonia and pulmonary embolism it is confirmed by chest it I was prescribed pradaxa for three months stopped taking medication on mark 26 I have a history of acid reflux sleeps on a inch wedge pillow to manage the symptoms tests I underwent are abdominal it with contrast unremarkable mild diverticulosis not considered relevant to pain chest it with contrast unremarkable pe and pneumonia cleared blood tests all normal no sign of pancreas or kidney trouble my primary care physician suggests pain is associated with pe my pulmonologist says it is very unlikely to be associated with pe and recommends to confer with a gastroenterologist could this be an ulcer or some other issue within the stomach or gi tract perhaps caused by the pradaxa medication would the abdominal it have uncovered peptic cancer or other serious gi issues what further testing would you recommend should I wait to see if things get better or act soon if it is safe to wait how long should I give it",
        "input": "",
        "output": "hello I must appreciate the detail history you provided which is very helpful in diagnosing your condition after reviewing your history in my opinion this pain is not related to pulmonary embolism it looks like to be associated with some gastritis and stomach issue now coming to your queries the it abdomen has ruled out serious abdominal issues such as malignancy but it could not rule out peptic ulcer disease you can just wait for it and take the medications which I am prescribing I do not think that waiting is going to cause any further issues as it does not look like to be something serious take the following treatment for two weeks and if no improvement then we can consider end none at the moment gastritis peptic ulcer disease esophagitis gastritis continue omeprazole but increase it to twice daily before meals syearup gaviscon alginate 10 my three times daily after meals both these for two weeks if no improvement will consider end"
    },
    {
        "instruction": "hi doctor I would like to ask for your advice about the pain at the base of my right thumb I suspect this is the result of what I did back before two months I always squeeze a lemon fruit using my hands this pain started last month and still continues to this day I feel pain when I stretch open my palm the thumb is in pain when I use it I do not feel so good because I cannot play table tennis and the piano because of this can you help your advice is greatly appreciated",
        "input": "",
        "output": "hi I totally understand that you are suffering from first metacarpophalangeal joint arthritis this condition occurs when you involve in repeated twisting motion of the thumb this is partly confirmed by the vague bulge at the joint region I would suggest you to get an ray of the hand once to confirm the same meanwhile I would suggest you with treatment protocol repeated usage of the joint ray hand ap lateral rheumatoid nodule arthritis of first map joint tablet lornaxicam and paracetamol be after food for one week tablet rabeprazole 20 my od before breakfast for one week tablet tendofit forte be after food for one week diclofenac sodium gel twice a day for local application hot fomentation twice a day do not use the same thumb at least for two weeks review with reports"
    },
    {
        "instruction": "i have had nerve issues for a couple of months such as random stabbing pains loss of sensation heavy limbs and a constant mild pressure in my head with occasional increased pain weeks ago I had shortness of breath a tight chest constant burning sensation in my chest with sharp pains into my back when inhaling deeply the doctor put this down to pleurisy after listening to me breath through a stethoscope but as I had no cough or virus leading up to this it seemed odd the burning sensation and pain when inhaling deeply went after a course of antibiotics but I am still left with nerve issues headache and muscular pain I have recently noticed one of my shoulder blades is far higher than the other in a relaxed standing position and from the front my left rib appears to be further outwards and I would say an inch or so lower do you think it is possible that some sort of rib shoulder trauma could be the culprit of the pleuritic symptoms and nerve problems and what can I do about it if so",
        "input": "",
        "output": ""
    },
    {
        "instruction": "gender male age 21 height it inches weight 12lbs symptoms in chronological order extreme fatigue for days unbearable pressure in the head including behind the eyes along with pain and in the ears my head felt like it was going to explode neck stiffness complete inability to move my head in any direction this lasted for around 40 minutes adverse reaction after eating full meals pressure build up through chest and left side of neck up to head this was mainly left sided this would last for hours the left side of my neck felt like it was going to burst open after one adverse reaction I was unable to move my left arm for about a half hour I could feel what felt like the hindering of my heart beat it was very slow breathing was a struggle before being hospitalized my lungs felt heavy shivers and shaking any exercise even slight resulted in shortness of breath and chest pain for hours gastro intestinal issues being extremely gassy what felt like acid buildup that at times would come up to my back and chest remember what felt like an intense heat felt like my whole head was cooking 10 headaches of types an occasional kind of spacing out like I under water everything just feels so slow brain fog type a headache or something that I can only describe as an unbearable head pain every time it happened I accepted my death my body would go completely limp I could only slump in the spot I was whenever it occurred type confusion and what I call light thoughts made me very uncomfortable could not complete a single task in any intended order type a headache that was like someone torching my head would last for hours this headache radiated from the back of my neck and up into the middle of my head type it felt as though someone had cupped their hands around my brain an intense pressure I remember just wishing someone would bore a hole in my head to ease the pressure generally feeling like my head was going to blow up nerve issues coldness and tingling in my hands and feet noticed blurry vision at this point 12 occasional muscle spasms of my neck muscles got so bad it straightened my cervical spine 13 occasional loss of ability to walk properly or walk at all if unaided 14 occasional unresponsiveness to questions I can hear but I cannot answer full body numbness 15 extreme anxiety and depression 16 constant headache ear pain and occasional chest pains center of chest 17 joint pain especially in legs 18 everyday I wake now I just feel very unwell I have been unable to go back to my studies in actuarial science I just do not know what is happening to me I am truly sorry I know it is allot but I really would just like to know what is happening peace of mind would help even if there is no real assistance I can get I just want to know the source of my pain and suffering it is been months now more details about the presenting complaint sudden onset on december 26th after eating then exercise was breathless for about hours previous history of the same issue none current medications fourth capsules and panadeine past medications of the same issue augmenting days relcer gel otrivina had a weird reaction to this fexil had a weird reaction to this calcort another antibiotic got this on separate occasions cetamol cold and flu had a weird reaction to this vitamin avamys lanzaparazole and panto denk lab tests performed cbcs liver function tests autoantibodies pyloric cortisol urine and serum hydroxyindoleacitic acid creatine kinase bun and urea electrolytes etc",
        "input": "",
        "output": ""
    },
    {
        "instruction": "am a 37 year old male who has been getting bouts of dizziness as well as what can only be described as electric shocks in my head there has also been what feels like a nerve twitch in my temple I have also found that my reaction time is a little slower I have gone for cardiac screening which involved a stress echo blood test and holster monitor all clear my doctor the referred me to an ent as well as sent me for mri of the brain and a second mri of the ear both clear the ent sent me for tests to check my vision and also check for vitigo the test came back listing that my eye movement was out of coordination which they said is consistent with a central reason my questions are what is causing the brain zaps spermatic dizziness what is a central reason and surely it would have shown up on an mri is a central reason a degenerative disease and does it lower life expectancy is it curable or reverseable hi marc welcome to icliniq I am a neurologist and here to help you are suffering from dizziness and electric shock over your face with some indoctrination of eyes as per your ophthalmologist nothing from cardiac eye and ent side but it seems neurological disorder it good that your mri brain is normal that means no structural lesion like tumor or mass or demyelinaion still there are many reasons that can not be seen on mri and we need to evaluate those answer we need to find out those causes with further testing answer central lesion means brain or brainstem related causes of your dizziness answer degenerative lesion at age 37 is less likely we need to evaluate it and only after that I can say so firstly give me detail description of your dizziness bouts how it starts any trigger lasting how long duration of your disease is it aggravates with position change have you suffering from slurred speech imbalance while walking I wants to see your mri brain you night need mri brain with angiography and contrast injection study then I will give further advise thanks I have had these symptoms for over years they come and go and can last anywhere from 3min to hours I also wanted to advise that in the last three years I have had iris hello marc ok I have seen your mri which is done on 10 12 2019 which is normal are you suffering from ringing sound in ear or vomiting like sensations any history of slurring of speech or blurred vision are you suffering from headache like migraine you all need mri brain with angiography and if needed gadolinium contrast study are you having any kind of addiction please give me your medication history if any I wants to see your routine reports like complete hemogram ear serum electrolytes na my ca serum creatinine got sept hiv hbsag anti hav urine routine regards okey what about headache that means episodic dizziness and tinnitus I think it looks peripheral vertigo not central ok I saw the blood routine reports now please do audiogram with bear mri with contrast regarding follow up doctor follow up messages 16 oct 2019 07 2am his ply answer me hello I have now had ringing in my ears lasting for four week what does this mean is this a risk for stroke what are the stroke risks can now confirm that I have now had the mri with contrast and it was unremarkable when I went to the ent they checked my hearing and advised it was fine the I have also been for more blood work which came back fine I do not know what else it could be hello I have now had ringing in my ears lasting for four week what does this mean is this a risk for stroke what are the stroke risks currently I am getting these brain zaps sensations around 90 times a day I have had these things for over a year now but only with in the last week I have been getting them that often sporadic dizzy spells lasting min to 10 hours electric shock pulse pressure type feeling ringing in my ear for the last weeks no hearing loss can watch to and have a conversation with out a problem what could this be",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello doctor I want to know what is wrong with the test results I have done blood test urine liver and kidney function tests urine test shows pus cell 6 and rec 3",
        "input": "",
        "output": "hello I have reviewed the lab results that you have sent and I see that the urinalysis shows rec 3 and pus cells of 6 but there were few epithelial cells seen may I ask how did you get the sample did you get it midstream because a poor catch may yield unreliable results your abc complete blood count also showed relative lymphocytosis but aside from that all rests are within acceptable limits any recent history of cough or colds in addition to that may I also know your symptoms and why were the tests requested do you have painful urination or back pain any other medical condition such as hypertension or diabetes I would be needing this to clinically correlate your test results"
    },
    {
        "instruction": "hello doctor my gums surrounding my third molar wisdom tooth lower left jaw seem to be swollen I started to feel pain on it yesterday morning and garbled with bactidol this morning the pain seemed to intensify I feel pain when I swallow open my mouth and when I gargle somehow I feel the pain in my throat already I took my first amoxicillin as advice by a dentist friend any advice",
        "input": "",
        "output": "hi it is a case of pericoronitis do not worry take tablet oflox oz twice daily for five days hexidine mouthwash do gargles with it thrice daily for one week tablet zerodol so twice daily for five days it will relieve it I tell you amoxicillin will not help with this problem get these medicines you will be relieved"
    },
    {
        "instruction": "hi doctor my son is years old he has one black mole on the left hand measuring about my in diameter with some elevated surface it is from the last about one year and looking growing but can not sure about the growth he has no complaint of itching and pain but when asked yesterday about this today he is complaining of some itching and pain I have one photograph of this for your review please advice",
        "input": "",
        "output": "hi I have seen the pictures this is a mole in medical terms it is called melanocytic nexus majority of them are benign and go through growth cycle of inapparent to getting dark and with age slowly losing the color but in some rare cases they do have inflammation and can have itching or pain in some patients there are numerous melanocytic neve over the body in those there is a risk factor of melanoma moles which is present with itching and inflammation are not necessarily melanoma but to be on a safer side they need to be removed and sent for histopathological examination to rule out any malignant changes in them if your child has only one nexus and it is having inflammation but no sudden increase in growth it can be safely treated with anti inflammatory cream but if inflammation or increase in size or different color on different parts of the mole appears you should immediately remove it and send for pathological examination you should share the histopathology report examination with me because some melanocytic neve they do present histopathologically as malignant but actually are not so that has to be reviewed clinically histopathology report will be of malignant changes but only with clinical consultation and growth parameters we decide whether it was melanoma or not for the time being you can apply hydrocortisone cream twice daily and fusidate cream twice daily for five days give syearup citizen one teaspoon once daily if there is itching I advise not to irritate it or fiddle with it that will lead to more irritation kindly review after five days if inflammation persists or there is an increase in size it needs to be removed and sent for histological examination by the time lockdown will also be over so you can always do that it will be a minor procedure and will be done under local anesthesia can be completed within half an hour genetic excision biopsy excision no fiddling five days"
    },
    {
        "instruction": "hello doctor I got these scars post scabies some eight years back I want to know of a procedure to remove them immediately",
        "input": "",
        "output": "hello I understand from details and image given that there is dark pigmentation mainly on the lower portion of both buttocks the skin over this area looks a little dry and thick as well I recommend you to use a thick moisturizer body cream twice a day which helps in softening and renewing the skin avoid wearing tight fitting clothes that may rub over this area very important if you have any itching please seek to get the symptoms treated first before moving on to pigmentation treatment once the skin is softer a skin lightening cream containing glycolic acid or koji acid can be applied at night to the affected area"
    },
    {
        "instruction": "hello doctor I have by pass surgery done I am having respiratory problems and bronco asthma I have swelling of body parts like face feet and legs",
        "input": "",
        "output": "hi your respiratory issue could be due to chest infection kindly answer the following questions for a better understanding of your health issue what is your be status is there any cough and sputum or fever do you feel breathless on walking or even while sitting or lying has the swelling appeared suddenly or was it always present is there any other issue like burning in urine etc please reply in detail so that a preliminary diagnosis can be reached"
    },
    {
        "instruction": "hello doctor I am a 24 year old male who has spent the last three years severely overweight I had a sports injury and I packed on a lot of weight afterward in total around 100 pounds I felt fairly healthy at 1 280 pounds I was playing collegiate rugby I decided to make a change in the last two weeks and I have completely cut out sweets candy soda fast food and junk for the most part I have been eating once a day midday a meal that consists of rice fish chicken salad and sweet potatoes it would be around 800 100 calories I take around a 30 minutes walk that I have been building upon with light bodyweight exercise just going as I feel comfortable so my question is do you think going from a 300 400 calorie a day diet and dropping to 100 a day is too drastic I am trying to cut a lot of weight I am hoping around 75 pounds in the next three months I feel fine and it is not overly fatiguing I take multivitamin and if I feel really hungry or have a sweet tooth I just have a spoon or two of peanut butter when I started I was 388 pounds and today I weighed myself at 373 my water intake has been consistent as well just wondering if what I am trying to accomplish is attainable or realistic and if it is fine for my long term health I feel like obesity is just as bad looking forward to your response",
        "input": "",
        "output": "hello well yes gradual loss of weight is always advisable for your health it will be difficult but needs patience over time you can continue with the amount of items taking but do jot skip any meal always have a natural source of multivitamin like fresh fruits or vegetables have some chicken slice vegetable salads which will include protein and vitamins it can be taken as a wholesome meal per time exercising twice daily for at least 30 minutes is best treadmill walk or pilates or dance aerobics also helps in cutting out the weight never starve yourself you can have juices of all kinds without sugar which will keep your stomach full water intake should be optimum but not over drinking diet and workout both will aid in maintaining a healthy weight meditation and good sleep contribute a lot in maintaining a good mental state"
    },
    {
        "instruction": "hello doctor I have high blood pressure and I take labetalol 200 my once a day I was started on this before eight months after my daughter was born I notice now while monitoring my blood pressure that my heart rate is very low like 53 bum should I be concerned",
        "input": "",
        "output": "hello your pulse rate at 53 bum is slightly low but not too low to cause any concern it can be of concern when it becomes lower and presents with symptoms such as lightheadedness or fainting in case you develop these symptoms please contact the physician that prescribed the labetalol about adjusting the dosage"
    },
    {
        "instruction": "hello doctor I have chronic kidney disease and wanted to know about the treatment before they consulted doctors for nearly six months for prostate that is urine infection they were told it is urine infection and were under medication and taking painkillers more but recently they come across these kidney problems which is serious",
        "input": "",
        "output": "hello have you done any kit kidney function test before from the reports and diagnosis it seems you have underlying kidney disease which got aggravated by urinary tract infection you have received appropriate antibiotics and hopefully it will improve regarding dialysis you would need to continue it and monitor kidney function tests also you have anemia for which you are getting injection anfoe which should help you would need to make av arteriovenous fistula at earliest also tell me what was your serial kidney function tests for the last six months"
    },
    {
        "instruction": "hi doctor I am 16 years old I am hypermobile especially in my knees and almost every day especially nowadays I get horrible pains in my whole knee deeper than the surface my knees are bent inward so like the opposite of being bow legged and I was just wondering if these were just growing pains or anything more",
        "input": "",
        "output": "hi your knee pain could be due to certain reasons but common ones are chondromalacia pain due to knee instability inflammation etc if there is no history of any injury and no inflammation or infection like swelling skin redness or local warmth on touching then I will like to advise you for conservative management initially in form of intensive physical therapy with a focus on strengthening of quadriceps and stretching of other groups of muscles gentle anti inflammatory medications like tablet etoshine or paracetamol can be taken in small doses for five to seven days adequate calcium and vitamin supplementation as per the requirement ice packs at home three to four times a day see how it goes for around two weeks time if your condition does not improve then we will have to get certain investigations done including rays of the knee and a few blood tests"
    },
    {
        "instruction": "hello doctor my mom is suddenly getting breathless for about a month it never happened before now the shortness of breath has increased a lot and she cannot even sleep all night please help she is 46 years old",
        "input": "",
        "output": "hello I can understand ur concern according to your statement she has been suffering from breathlessness for one month and it becomes worsen while she is lying sudden breathlessness can occur in asthma heart failure cold chronic obstructive pulmonary disease interstitial lung disease pneumonia psychogenic problems like anxiety etc at first we should find out the cause for which she is suffering now in case of nocturnal asthma patient suffer from breathlessness chest tightness etc more at night but you do not mention if she had past history of asthma allergic rhinitis or repeated respiratory tract infections again we do not know about her physical structure like lean and thin or healthy her occupational history environmental history like living status cooking history of fever or sudden weight loss history or hypertension history or is there any added sound with her shortness of breath you did not mention is there any swelling in her ankle or face or any parts of the body her nature of breathlessness is constant or not that means is she suffering more at night than day become weak or breathless after light exercise is her chest movement is restricted or not if she is obese then she can be suffered from obstructive sleep apnea she should undergo car pulse oxymetry egg monitoring blood pressure etc for her breathlessness she should be placed on propped up position during her sleeping time along by using nebulization with salbutamol solution saltolin along with inhaler azmasol two puffs four times a day and inhaler iprasol two puffs two times a day with weight reduction and be monitoring she can get some relief"
    },
    {
        "instruction": "hello doctor I am suffering from penile yeast infection since a week candidal balanitis due to lockdown I could not see a doctor and researched online and used clotrimazole cream ip but no betterment since yesterday itching and pain has increased can you please help me out with this",
        "input": "",
        "output": "hi candid infection present as a whitish membrane over the penile head with reddish mucous it is very itchy I hope it is diagnosed by a dermatologist only clotrimazole is effective in most of the time candid is a normal commensal in our body but in some it causes symptoms and balanitis aggravating factors are diabetes moisture and some are allergic to it so first thing is wash with mild soap and dry always after intercourse if you can keep your penile foreskin retracted good that will keep it dry but if not possible as it is painful if you are not used to it make sure it is dry take capsule fluconazole 150 my once daily for seven days one single dose for your sexual partner tell her to keep dry especially during menses miconazole gel dk gel twice daily for seven days tablet fexofenadine180 my once daily for itching keep dry it will cure it follow up after seven days candid blood sugar get glucose tolerance test candid allergy candid balanitis antifungal keep dry as far as possible always send a clear image with symptoms"
    },
    {
        "instruction": "hello doctor I am a 23 year old female I am having some problem in my throat and I think those are tonsils as I am not having any pain or difficulty but whenever I am looking into my mouth I feel something around tonsils please help",
        "input": "",
        "output": "hello I can understand your concern over the swelling in your throat that you observed recently in this period of couid 19 outbreak I checked the image and I can definitely see some swelling there I have a few questions for you have you observed this on the back of your throat for the first time in the past did you have a similar issue have you been in contact with anyone who had respiratory tract infection recently do you have a fever or a cough sometimes this type of swelling is a result of an allergic reaction to some specific food or allergen which can be triggered after you consume anything cold as far as there is no pain and difficulty swallowing food and water you do not need to worry much although keep a check on it for a week or two and see if there is any change in the swelling you can gargle with warm water and adding little salt in it for four to five times a day and avoid eating anything cold for some duration feel free to contact me if you observe any change in the swelling and stay safe as the couid 19 is spreading quickly maintain social distancing and wash your hands before you touch your face nose or eyes"
    },
    {
        "instruction": "hello doctor I would like to get a second opinion and ask a few more questions regarding the condition that I have on my foreskin I am 43 years old and I have two brown spots on my foreskin they are there for about one to two years possibly longer they do not itch or bleed or change in size only the one is closer to the glans is possibly getting a bit lighter can you please have a look at the photos and opinion of a dermatologist they suggest that it could be condyloma bowenoid papulosis or seborrheic keratosis as I mentioned when I was younger I went to visit a urologist and they told me that I have a mild case of phimosis I do not have any issues in maintaining hygiene or having sex except sometimes if my foreskin stretches and it is dry I feel a bit of pain and discomfort what I would like to add is that I am straight and married for the past eight years and in those eight years I only had sex with my wife not sure how long is the maximum incubation of condyloma or papulosis and does it exclude it also it mentions that condyloma is cauliflower shape which I am not sure about these spots one closer to glans is totally flat and the other one that has a shape of a mole is slightly above the skin but I cannot say it is cauliflower shaped could you please let me know do you agree with your colleagues opinion I am very cancerophobic if that is even a word for a person who is generally scared of cancers so my main concern is to rule out that option I am currently away from home and cannot go visit urologist in person for at least two months",
        "input": "",
        "output": "hello I have gone through your queries and attachment you are having viral warts on your preputial skin you need to contact your local dermatologist there are several methods of managing viral warts that may be electrocautery or simple local application of antiviral or keratolytic ointments that will be decided by your dermatologist if you are having phimosis then contact your local urologist as you may need circumcision if you undergo circumcision the skin with these lesions will automatically be excised out and biopsy report will tell the final story"
    },
    {
        "instruction": "hello doctor my girlfriend is having light cramps and today she observed slight spotting her last two menstrual cycles were 32 and 37 days long and her last periods started a month back we engaged in unprotected intercourse one week later once with us stopping and taking protection in between I did not ejaculate inside her we are concerned about a possibility of pregnancy",
        "input": "",
        "output": "hello I can help you with this with the history I think her periods are a little irregular the time of sexual intercourse is not much near her ovulation time and if you have not ejaculated inside the chance of pregnancy is very rare if you have had no unprotected intercourse thereafter and if she by chance had become pregnant urine pregnancy test should show positive by now so to be on safer side it is better to do a urine pregnancy test now even though she is having spotting if it is negative now then definitely she is not going to be pregnant due to the sex so then you can wait for another week for her to get her periods finally light cramps and spotting may be preceding her normal periods urine pregnancy test review with urine pregnancy test result"
    },
    {
        "instruction": "hello doctor I am years old male I have very mild asthma since my teenage years into my mid 20s for the past years or so my asthma has been very rare maybe once every couple of months but now it seems to be coming more recently active after doing yard work or exercise but no medicines needed as symptoms would go away on its own unfortunately for the past months I have been getting more symptoms which I assume is due to season and high pollen count I am now taking albuterol sulfate as needed and going on my third dose of symbicort 80 5 as of yesterday my concern is with this coronavirus am I considered high risk with my level of asthma is it a good idea to start a corticosteroids like symbicort or should I be on something more mild I am considered an essential mail worker so I am wondering if I should continue to work side note my wife is months pregnant on top of all this",
        "input": "",
        "output": "hello I can understand your concern according to your statement you are suffering from childhood asthma which is worsening now due to season and high pollen count and occupational hazards you should undergo serial measurements of peak expiratory flow fev1 at work and away from work that will determine whether you should go outside for your job or not you can also undergo last radioallergosorbent test that will determine the amount of ice that reacts specifically with pollen you have history of atop and you are on corticosteroids now and your occupational history suggest that you are immunocompromised now an immunocompromised person is more vulnerable to couid 19 or coronavirus if you are attacked by coronavirus it will be a life threatening condition as ur respiratory tracts are weak and history of repeated respiratory tract infections recently it is also very contagious too so from you it can be spread to your wife and your unborn child which is life threatening to both of them if you are feeling better with your current medication you can continue you can also add nebulization with albuterol to times daily along with inhaler albuterol sos you should abstain yourself from work and environmental exposure that will be beneficial for you and your family if any complications occur inform me and I will try to lessen your sufferings"
    },
    {
        "instruction": "i feel like sore throat and feel weak sometimes but do not have fever and cough",
        "input": "",
        "output": "hello if you have sore throat and weakness and you do not have running nose neck pain high fever probably you have simple flu or bacterial infection you do not have to panic about couid 19 coronavirus you can use augmenting 625mg for days three times a day tablet and have plenty of lukewarm water to keep yourself hydrated as in india right now lockdown is going on if you have other antibiotics available you can tell us we can reply which you can use for current symptoms also if you want you can wait 3 days if the symptoms persist or increase contact us we can help you out with the best possible treatment for you don panic stay healthy and eat healthy keep wash your hand before touching your face mouth nose if you have any symptoms persist let us know"
    },
    {
        "instruction": "i am 40 I have had glandular fever shingles influenza and have an autoimmune condition hashimotos disease I believe I may be more vulnerable than the average person my age to get coronavirus due to my weakened immune system should I be self isolating I am ok to do",
        "input": "",
        "output": "hello thank you for reaching out I understand bases on the available data those who are 60 above and with medical condition such as hypertension cardiovascular disease and diabetes are the most vulnerable population thyearoid disease and any other autommine condition is not known to be associated with increased risk of viral infections in general nor is there an association between these disease and severity of the viral infection however if you mild symptoms of cough and fever I would still recommend that you do self quarantine and monitoring I would still recommend that you wash your hands regularly with alcohol soap and water and practice social distancing I hope I wa able to answer your concern is there anything else I can help you with"
    },
    {
        "instruction": "hello doctor I have been dealing with some health issues for three years I had an ultrasound before showing my spleen was mildly enlarged to 12 am since then I have had on and off spleen enlargements last week I had an ultrasound with again a mild spleen enlargement at 12 am sometimes the spleen returns to a normal size of 8cm I have also noticed in my ultrasound that my liver was enlarged to 16 am when my liver was previously normal at 15 am I have also done a bunch of blood work and my bilirubin levels went to 27 when they should be below 20 and my conjugated bilirubin was when it should be below I have had my alt and ast testing and all is fine there I have had my abc and differential and all is good with this too I am very concerned about what this could be and what is happening to my body my doctor is sending me to a hematologist please help me to understand what is happening if this is cancer or something serious please help",
        "input": "",
        "output": "hi I hope you are safe I reviewed your doctor report while I can understand your concern but as of there is no one pick and choose a reason for your case to be frank I am not bothered by your spleen size or liver size yes they are close to the above normal range I do not know if you have some component of fatty liver your us ultrasound may tell you that if you drink alcohol do you think it is worth trying to see what happens to the size sometimes we take a few medicines which tend to increase the bilirubin etc examples are cops oral contraceptive pills birth pills there are many more just get your medicine list reviewed by your pop easy bruisability over the skin do you have gum bleeds as well but your platelet count is well above the normal range as well do you have any family history of bleeding and do you have excessive menstrual bleeding"
    },
    {
        "instruction": "hello doctor I am having some chest pain on my left side it feels like it is around my heart kind of a slow deep ache from my armpit over the whole chest up to the clavicle I have been having a bit short of breath and when I stand up I feel really dizzy and light headed it takes about 10 15 seconds to feel normal again it has been like this for the last three to four days but I have experienced pain in my chest like this before but it has gone away in a day or two I am 29 years old I have a healthy diet and no previous health concerns",
        "input": "",
        "output": "hello firstly this does not appear to be cad coronary artery disease related pain to me however it should be evaluated to rule out some unusual cardiac causes especially valvular problems because of your age long duration of symptoms without treatment and atypical nature of pain it does not look like pain due to cad now angina pain would typically increase or occurs on exertion and relieves with rest and cardiac pain would persist for a few minutes rather than seconds and does not remain round the clock intermittent chest pains may not be cardiac such pains are usually due to acid reflux acid reflux pain occurs more frequently in lying down position occurs intermittently persists for a few seconds to minutes so yours may be related to it other gastric symptoms may be associated like epigastric pain bloating and burping etc another possibility should be considered is of costochondritis if there is definite tenderness over the chest wall see if you also have any neck pain tingling numbness etc for cervical pains regarding dizziness it is likely postural hypotension this may occur due to dehydration so keep yourself well hydrated and have a proper diet if you have a be apparatus then should check your blood pressure be now if shortness of breath is significant then this needs early evaluation with examination and tests like egg electrocardiography and echo so your symptoms are nonspecific and overlap with many non cardiac and benign causes as well but you will need a thorough evaluation with an examination egg and echo to rule out cardiac problems I hope this helps"
    },
    {
        "instruction": "hello doctor I am a female and weigh about 50 keg I am currently having chest tightness and anxiety I have been prescribed zapiz 25 however it is not helping much can I take another about a year ago I was asked to start serlift and I started weaning off them about three months ago sometimes I feel chest tightness difficulty in sleeping and butterflies in my chest for which I was prescribed to take zapiz 25 as an sos I took a tablet about half an hour ago however do not see any relief I wanted to know if it would be fine if I took another tablet of zapiz 25 all my respiratory heart and chest tests etc are clear",
        "input": "",
        "output": "hello your symptoms are of active anxiety but only zapiz clonazepam is not going to cure anxiety for you zapiz is a temporary relaxant benzodiazepine are relaxants used in an emergency and works well when there are active symptoms of anxiety but it is not a permanent solution why was serlift stopped and have you taken any therapy sessions cognitive behavioral therapy will help you recognize the negative thoughts which are keeping you in the loop of anxiety and you will be able to not let yourself get affected by them because we have to also focus on why you are getting anxiety at all medications and cognitive behavioral therapy combined are a good way to treat anxiety disorder also long term use of zapiz is not good for health as of now you can take zapiz 25 twice it will relax you a little I would suggest you to reconsider your medication and also start therapy sessions to get good results I hope this helps"
    },
    {
        "instruction": "i have a sore throat for more than weeks now and I am done taking antibiotics dalacin for days but it is not going away I feel that there is something stuck inside my throat esophagus I have a mild headache but no fever pain scale is ranging 6 out of ten I also gargle every hours using difflam gender age 36 it 1 wt 191 labs",
        "input": "",
        "output": "if this got worse after antibiotics it is likely thrush a yeast infection of the throat often found after antibiotic and or steroid treatment see if you can get your physician to prescribe fluconazole 150mg daily 10 days not days like prescribed for female yeast infections this would not be long enough if it got much better after the antibiotic and has stayed level you might consider that whatever bacteria you had was partially resistant and another should be tried a good one to consider if you have not had this yet is clindamycin 450md three times a day 10 days if you have had that already consider amoxicillin clavulinic acid 875mg twice a day 10 days if none of these are the case see an ent to rule out an abscess behind the tonsil know as a peritonsillar abscess or some other cause"
    },
    {
        "instruction": "hello doctor I am not feeling comfortable with my scrotum I feel it is squeezed and not free some time ago I had pain I am feeling this for two years also I visited a urologist who saw this and went through the sonography and urine test but he said I cannot find anything what might be the cause",
        "input": "",
        "output": "hi this looks like chronic prostatitis long standing inflammation of the prostate it can be confirmed by a rectal exam sometimes enlarged prostate on sonography and in some cases positive urine or semen cultures in some cases diagnosis is clinical as all tests are negative treatment includes long term antibiotics anti inflammatory and medicines to soothe irritated nerves I would suggest a semen culture a post prostatic massage urine culture and sonography of prostate start tablet moxiflox moxifloxacin 400 my once daily for 10 days enzoflam paracetamol diclofenac and serratiopeptidase twice daily for seven days pantocid pantoprazole 40 my once daily for seven days and tryptomer amitriptyline 10 my once daily for 10 days moxiflox may cause joint pain or tendinitis tryptomer may cause sedation let me know the above reports and also how it goes"
    },
    {
        "instruction": "dry cough and tickle in throat pain occasionally from right side of neck to my ear mri showed a mass on right side of thyearoid had a fine needle aspiration done on it they poked it times to try and get enough for the screen the results came back saying this needle core was done in the possibility that may not be enough epithelium in the cytology specimen the core however does only shows benign soft tissue and skeletal muscle and is noncontributory and said it is benign that was months ago and I now have a cough and a tickle in the throat also occasionally with a pain in my ear should I get another doctor to look at it free to 29 thyearoid stimulating hormone 95",
        "input": "",
        "output": "hello good to hear from you I understand your situation firstly regarding the neck swelling that concerns you since there is no evidence of malignancy in any of the investigations do not worry about it as your blood thyearoid levels are also normal without any medication do not be concerned about it secondly about the cough throat pain that you have it has nothing to do with your neck swelling do did you have any cold the cough might be because of a mild infection or an allergy or a reflux so if you can get treated for this you will be fine I suggest you to try the following medication tab amoxicillin 500 my twice daily after food for days tab levicetrizine my once daily before sleep for days tab pantaprazole 40mg once daily before breakfast for days syearup gunaphesin 10 my thrice daily infection allergy chest ray unti medical avoid cold food after completing medication"
    },
    {
        "instruction": "from about 3 months I am experiencing hair fall I never had such problem I am 19 years old I never had hair fall issue ever I took creatine monohydrate for body building purpose about months go the hair are falling from the root most of them have the white bulb at the end",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello doctor for the past two years I have been getting a smelly vaginal discharge more like a fishy odor I have never had any sexual intercourse during those two years my vagina was itching and sometimes it was unsupportable I never went to a doctor as I do not know what to tell them and via message it is easier to talk about well it would be great if you looked into the matter as I am scared of having got a vaginal infection thank you for your attention",
        "input": "",
        "output": "hi how are you doing hope you your loved ones are safe and healthy for a young lady of 18years not sexually active diagnosis are if you use vaginal wash or touching frequently use too many antibiotics frequently for any other reason this could be bacterial vaginosis it not an infection it just an imbalance between the healthy unhealthy bacteria in your vagina every lady has a balance between these good bad bacteria they act like a security preventing any new infections entering body using vaginal wash or touching or antibiotics can kill both bacteria and disturb the balance treatment would be to stop these use oral lactobacillus capsules vaginal wash daily for 10 days with yogurt or curd twice daily if you use vaginal tampons or any foreign body this could be source of infections into vagina then you will need a good course of antibiotics orally vaginally check your blood sugar levels especially if you have any family history of diabetes if yes correction of blood sugar levels will cure the problem rare possibility is vaginal tuberculosis especially if anyone in your proximity is suffering from to also if your area has too many cases of to can have your menstrual blood checked for to need to contact your doctor then from your history I do not think it is anything serious to hope I have clarified your query do write back if any more queries for your feedback all the best take care"
    },
    {
        "instruction": "hi doctor I am 18 years old I am a student and I am excessively addicted to masturbation I cannot concentrate in fact I started doing sex with my partner regularly I just treat her as satisfactory material and this causes a deep regret in me I am not good at studies anymore as well as I just cannot concentrate everything in my life is stuck out with my problem it started when I was in class I saw a porn film then all this has been started and now I am just like addicted please help me out I am in a great depression sometimes I feel like I should end up my life how should I overcome with it",
        "input": "",
        "output": "hello I can understand your problem first of all it must clear to you also that it is harmless practice which is done by almost 100 male and 70 of females in there lifetime I mean it common in your age do not feel guilty this activity will not affect your married life you will be able to produce children yes it is a release process and not have any ill effect until it becomes an obsession and interfere in your functioning you can quit it by diversion of your thoughts try to seek interest in other activities and make a friend involve in your hobbies do moderate exercise you can have sex with your partner no problem in it if unable to relief with above you can go for pharmacotherapy like prodep"
    },
    {
        "instruction": "hello doctor I had an aorta aneurysm removed four weeks ago while in the hospital and rehabilitation I complained of my ear hurting I often collect ear wax so I thought that was the problem now that I am home and have a can and therapist helping me get stronger the ear pain is the only pain I have she put debrox and hylands earache drops in my ear she flushed the ear with warm water for two days the pain is so bad that I can hardly eat because chewing hurts it hurts in my mouth too I have been putting saltwater in but it does not seem to help might I have an ear infection I am not well enough to go to an ents office and I am not sure if they are open any advice you can give would be greatly appreciated",
        "input": "",
        "output": "hello it is likely that you have developed otitis external following wax removal syearinging often leaves some moisture in the ear and this provides an ideal medium for fungi to grow in do you have pain while touching your tragus or moving your pina if you have severe pain then you may need analgesic it would be better to use paracetamol 500 tablet as and when required you can also use ear drops containing clotrimazole neomycin or ofloxacin beclomethasone and lidocaine eg candibiotic ear drops if there is visible swelling or redness of the ear canal you can also use a topical ointment like mupirocin cream with a tip twice or thrice a day hot fomentation around pina also helps in reducing pain and inflammation"
    },
    {
        "instruction": "hi doctor I feel pain in testicles when I touch them can you please help me with this issue",
        "input": "",
        "output": "hi you can have two things epididymo orchitis or testicular torsion treatment for both are totally different can you please tell me if you lift your tests then pain decreases or increases and how much is the pain is it excruciating or mild history of masturbation or intercourse just before pain"
    },
    {
        "instruction": "hello doctor I am 68 years old I was supposed to meet you after 15 days of treatment prescribed by you due to lockdown unable to appear for consultation in person the bacterial infection on the face and neck pus filled boils initially got reduced but new eruptions has started to emerge the tablet course also have got over kindly suggest the way forward in this treatment I am attaching the old prescription",
        "input": "",
        "output": "hi I have seen the attachment I have not got the picture of your skin lesions but as you are giving the history of boils again please keep the blood sugar under control hba1c 4 is high this is the reason for recurring boils again and again please start tablet augmenting 625 amoxicillin and clavulanic acid twice a day for one week levocetirizine or vozet half tablet twice a day for three weeks apply back cream on the boils if paining add doll 500 twice a day for five days"
    },
    {
        "instruction": "hello doctor I was hospitalized in january in india for two days and then in nigerian I live here for dry cough a bit of breathing trouble and pneumonia ray of the lungs was clear and also had a bit of difficulty in breathing however they treated me for community acquired pneumonia and malaria still at times I use to face a slight difficulty in breathing not all the time one of my friend radiologist suggested an let test and also a it chest let did not show much variation however it showed calcification in the aortic valve in january the ear was showing high and platelets were also low however in march it shows normal except for breathing issue at times no other issues experienced as of now I know my weight is high and I am working towards reducing it and joined a gym I am also following veto diet kindly advise due to lockdown because of couid 19 I cannot travel to india and options of good cardiologists are very limited here",
        "input": "",
        "output": "hi you had breathing difficulty altered consciousness allergic condition and you were admitted for that now you have slight difficulty in breathing I have gone through all your reports not to worry you have a calcified aortic valve for which nothing to be done as you cannot come to india for lockdown until then I suggest you some medicine which will help you to take care of your breathing difficulty at times and also take care of allergic factor which you had dublin inhaler two puff two to three times daily at the time of breathing difficulty tablet montair la montelukast and levocetirizine one tablet daily around am daily for two weeks based on the response we will review lockdown in india will be over by that time then you can do physical check do breathing exercises take a deep breath and hold for seconds and expel it out forcibly for a period of five minutes daily"
    },
    {
        "instruction": "hello doctor I had globes pharyngeus for about 10 days and today it has evolved to a pain in the back of my throat which when I swallow causes pain in my left ear for a second too",
        "input": "",
        "output": "hello I understand your condition do not worry it is a quite common scenario very manageable firstly it is caused by one or few of the conditions like severe gastric reflux infection in the throat postnatal drip due to conditions like a sustained common cold smoking and rarely a foreign body in the throat so you should analyze what is causing this condition in you I would suggest you to first start yourself on the following medication and make some lifestyle changes tablet amoxicillin 500 my thrice daily after food for five days ibuprofen twice daily after food for five days pantaprazole 40 my once daily before breakfast for 10 days povidone gargle 10bml in 150 my lukewarm water to be garbled thrice daily if there is a persistent cold take xylometazoline nasal drops thrice daily along with the medication take the following precautions avoid cold food stop smoking if you do take food on time do not take spicy food do not eat for at least three hours before you sleep infection or reflux direct laryngoscope herd gastric esophageal reflux disease acute pharyngitis medical after the medication"
    },
    {
        "instruction": "hello doctor should I get a permanent retainer months after braces and use of a removable retainer part of my overbite has returned since I got my braces off due to tongue thrusting partly because I never wore my retainers as much as I should have can I get a permanent retainer at this point or is it too late",
        "input": "",
        "output": "hello first of all you should wear your retainer regularly ideal position of teeth or occlusion which is obtained with the help of orthodontic treatment is maintained by regular use of orthodontic retainer use of orthodontic retainer is equally important and is part of orthodontic treatment you can read about orthodontic retainer from icliniq articles as per your description you have tongue thrust so it should be corrected otherwise it will be a cause of relapse after successful orthodontic treatment you can read about tongue thrust from icliniq articles as you have stated that your bite has relapsed so if you use permanent retainer then it will retain faulty occlusion this is what you can see about changes but as the bite has relapsed definitely there must have some other changes or movement of teeth happened you have not uploaded any image of your concern area that you cannot see but being expert in that field we can see so for any kind of second opinion one has to check clinically or at least have an image of your concern area so kindly upload an image of your concern area or teeth for appropriate treatment planning"
    },
    {
        "instruction": "hi doctor my tongue feels numb and dry every morning when I eat some food recently my mouth started to burn then I noticed some small cut like lines on the top of my tongue then do not hurt unless the food is hot they sting if I eat certain foods I am extremely concerned",
        "input": "",
        "output": "hi thank you for sending across the photographs for further information consult a dentist online"
    },
    {
        "instruction": "hi doctor post spine surgery my it says evidence of pre and paravertebral soft tissue and differentiation of hematoma may be considered does this mean there is a blood clot",
        "input": "",
        "output": "hi I have read your question with care and understand that you want to know about a it report for further information consult a spine surgeon online"
    },
    {
        "instruction": "hi doctor can normal tests tell that a person will have abnormal kids or no kids at all please explain",
        "input": "",
        "output": "hello revert back with clear details to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor my girlfriend suffers from a very rare disorder called gas guillain barre syndrome initially she was attacked by the virus three years back and was treated successfully now it has relapsed before two days I want to ask how this is going to affect our future married life is there any chance of recurrence",
        "input": "",
        "output": "hi I have read your question with care and understood your concern for further information consult a neurologist online"
    },
    {
        "instruction": "hi doctor I am 29 years old I had protected sex with a call girl before five months but I want to confirm whether I was infected with any disease I have read on the internet that window period for hiv is three months and hence to confirm I have undergone hiv testing called elisa the result of which is non reactive and the value is 062 again now I repeated the test and it showed result as non reactive with the value of 104 the two reports have been attached here regarding symptoms I did not develop any fever or allergy in the last four months is elisa test reliable is there any need for me to take any other test or repeat the test can I stop worrying as I have already covered window period why did the test show some value like 6 and 104 does it indicate the presence of any disease what is the window period please help me in detail as I am much worried",
        "input": "",
        "output": "hi let me answer one by one for further information consult a hiv aids specialist online"
    },
    {
        "instruction": "hi doctor I have been having panic attacks for the past 13 years I have been to the hospital on multiple occasions and have been diagnosed with anxiety attacks every time I have had eggs and blood work done all the reports are fine sometimes I am having multiple panic attacks in a day and also I am getting these every day any help would be greatly appreciated thank you",
        "input": "",
        "output": "hi for further information consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor I have an eye power of 5 in both eyes I want to go for lasik but in the hospital they said that I am not suitable for lasik please explain why they said so",
        "input": "",
        "output": "hello I had gone through the data posted revert back with the information to a family physician online"
    },
    {
        "instruction": "hi doctor I am switching from a combined pill to pops I am switching due to a history of chronic migraines and the estrogen in the combined pill was not helping my migraines I was instructed to take the placebo pill a week before starting the pops so I did but now after taking the first mini pill I am reading that I should have started before the placebo week I have already started my first week of pops so how will they be affected will they still work should I use a backup method for a few weeks",
        "input": "",
        "output": "hello for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I have a boil near my vagina I had it for a week and it did not cause any discomfort but from yesterday it is causing some discomfort I do not feel any pain during urination kindly recommend a cure",
        "input": "",
        "output": "hello I had gone through all the details posted revert back with the answers to an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I have a case of a 47 year old man who went through a car accident the scan showed a compressive fracture of t12 with predominance into the canal my the patient was told to stay in bed with a plastic corsage around his waist to prevent sudden movements around two to three months later the patient was able to sit and stand but he did not remove the plastic corsage then five months later which is two weeks ago the patient could not move his right leg and he could barely feel his right arm he did a scan and the result as follows multiple subcortical and periventricular hypo dense lesions on both hemispheres calcified arteriosclerotic plates on arterial vertebralis dexter no distinguishable lesions on posterior cranial fossa free basal cisterns free paranasal sinuses overall it says that the multiple ischemic lesions lead towards vasculitis I must include that the patient suffers from heart pressure and diabetes can you lead me to a specific path of treatment how dangerous is this diagnosis",
        "input": "",
        "output": "hi I have read your question with care and understood the concern for further information consult a neurologist online"
    },
    {
        "instruction": "hi doctor I am 19 years old I have clusters of tiny fluid filled blisters on my right palm arm and below the neck at backside these are causing inflammation and painful when touched or pressed it has rapidly increased in two days and is now spreading to other body parts in the past I had psoriasis and has got cured completely please suggest",
        "input": "",
        "output": "hello I had gone through all the details posted kindly answer some questions based on your symptoms the possibilities are I would have been able to further narrow down the differential if I had seen the photos do not burst those blisters with anything apply betadine ointment povidone iodine over the burst ones and you can start tablet clindatec 300 my clindamycin twice daily in the morning and night for seven days antibiotic to prevent infection kindly update me with the answers and photos revert back with the photos to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I have a tooth that is missing one side of it the tooth next to it grew crooked and become impacted I had pain last week while drinking water I did not discover the side missing till today I am in a lot of pain now and nothing is helping my wisdom tooth got removed four years ago please help",
        "input": "",
        "output": "hi for further information consult a dentist online"
    },
    {
        "instruction": "hi doctor I am 20 years old I had a pretty bad cold three weeks ago the cold seems to have subsided but my lingual tonsils seem to be enlarged I also have little bumps on the back of my throat I have drainage in the bottom of my throat as well also a few patches of white under my right tonsil I do not seem to have any painful symptoms except once in a while my thyearoid or adam apple presents discomfort but nothing painful though I will include pictures if that is an option I had an appointment with an ent and he said everything looked normal just curious as to why this has not subsided or showed any real signs of recovering it had been occurring for about three to four weeks thank you",
        "input": "",
        "output": "hi lingual tonsils may get enlarged during an episode of upper respiratory tract infection also with details you have provided it appears that you have some remnant inflammation in your upper respiratory tract that is causing the granular pharyngitis tonsillitis and mucus drip down the throat I suggest you take the following medications tablet of trypsin chymotrypsin combination that acts as anti inflammatory twice a day before meals with acetaminophen tablet as and when needed with steam inhalation and chlorhexidine mouth gargles continue this for five days I also suggest you a tablet of omeprazole once daily before breakfast for two weeks if still your symptoms do not subside then we need to do a throat swab and an endoscopy consult your doctor discuss with him or her and take the medicine with consent for further information consult an ent otolaryngologist online"
    },
    {
        "instruction": "hi doctor my question is about third hand smoke my husband and I do smoke and we are trying to quit my daughter in law is so concerned about third hand smoke we are no longer allowed to see our grandchildren until we have completely quit smoking we only smoke outside and are down to five cigarettes a day we have never smoked around our grandchildren she says that even we smoke outside the third hand smoke gets to us and we transfer it to our house are we really putting our grandchildren health at risk",
        "input": "",
        "output": "hello for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am having a swelling around my tooth also one side of the wisdom tooth is infected I feel pain over the area what to do",
        "input": "",
        "output": "hi for further information consult a dentist online"
    },
    {
        "instruction": "hi doctor I am a 27 year old male I am suffering from a unique neurological disorder for about years I have consulted many doctors but there is no improvement so I want your suggestion in regard to this I am explaining my problem below five years ago one morning when I got up from bed I felt numbness in my left lower limb it continues for a few days and then my right lower limb also felt the same apart from that I also started feeling difficulty in passing urine I consulted neurologist and they performed a number of tests but could not find out the reason they took the mri of whole spine and brain but there was nothing today after five years the condition is that I have very difficulty in walking and also I am using a catheter for passing urine each time using the process of self intermittent catheterization sic my life has become a burden for me I become a fully dependent person to others if you can help me anything in this regard and if there is any cure of this disease please let me know I will be always thankful to you",
        "input": "",
        "output": "hi I understand that you have numbness and weakness in legs difficulty in walking and difficulty in passing urine please scan and send all the reports you have with you we will evaluate and get back to you revert back with the reports to a neurologist online"
    },
    {
        "instruction": "hi doctor my family relative got shot yesterday as of right now he still has the bullet inside the bullet went in through his left ear and did not come back out I am not sure exactly where inside the bullet is he is currently hospitalized but no doctor has come up with a solution my relative is in severe pain to the point where he starts to shake I would like a second opinion and want to know what a doctor would do",
        "input": "",
        "output": "hi for further information consult an internal medicine physician online"
    },
    {
        "instruction": "i stopped a strict 800 calorie diet with 7 days of hit and light weight lifting about weeks ago I developed extreme migraines fatigue body pain and energy loss as I also tried to stick to 20 25g of carbs every day I lost about keg being on this regime for two months being 57 keg and 149cm tall prior to diet I was about 49 after although I was so proud of my weight loss I became extremely unhappy moody unsociable and felt isolated I have also resorted to binge eating and cannot stop consuming carbs and unhealthy foods I still try to weight lift and it is helping me mentally and luckily a lot of the weight I put back on 5kg has gone to my glutes but my belly too which makes me super insecure I want to lose a little bit of the weight again but in a healthy way and still build muscle the way I enjoy through weight lifting what kind of eating regimen do I implement to do this and to repair my relationship with food",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hi I am having headache generally in the afternoon towards back side of head also having cough today had a vomiting after excessive coughing could not control it need some suggestions gender male age 24 height it 10 inch weight",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hi doctor I am a 36 year old female I had moms surgery on my temple my hole is big and it is pretty deep they went three rounds my question is it better to heal by secondary intention or to have a plastic surgery with flap in which he would take skin from behind the wound on my head will it mean the hair will be placed on my temple would I have to shave it so in that case I need to deal with now two wounds how easily and long will my wound heal naturally considering the depth and how long do I keep a band aid with vaseline on for if I go that route",
        "input": "",
        "output": "hi I have seen your picture and history for further details consult a dermatologist online"
    },
    {
        "instruction": "hi doctor I am a 15 year old boy and I have hyperhidrosis I sweat so much my shirt cannot stay on for at least minutes in some half an hour to one hour my whole shirt and armpit area will drench in sweat yes I take a shower twice a day and put deodorant every day I have even tried the antiperspirant deodorant but that did not stop it and I think it made it worse I really want to believe it is just puberty as this has been going on since I was 12 or 13 but something tells me that it is not because of puberty everyone else at school does not have this problem and some relatives in my family has it too just like my shirt my pants will start soaking after 30 minutes of sitting down I really want a diagnosis or close to one before I actually go to a doctor as I have not yet regarding my issue also are there any home remedies or other over the counter deodorant to help minimize this issue or completely stop it I am really fit and regularly lift weights play lots of sports soccer boxing etc and keep my body in good shape I know that weight lifting could not be a problem if that was a suggestion I sweat a lot when I am in social places such as school or when I go out it is not because of anxiety but I rarely feel nervous when my arms are getting drenched this is a more serious problem in the morning either at home or at a social place and gradually calms during the afternoon when I am at home it is so bad that my armpits can drench two layers of clothing for example if I wear a shirt and a jacket over it then it does not really matter how many layers and by the end of the day my clothing will be soaked in sweat I do not really have any symptoms besides the fact that I am always on alert when I am out this is really embarrassing and I have no idea what to do about this please help",
        "input": "",
        "output": "hi for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I am a 45 year old female I feel nervous sometimes that I cannot sleep and have sticky saliva in the throat that feels like acidic stock in my throat every time I feel worried about the covid19 situation I am having had time to relax myself and these symptoms start to happen again I take some probiotics and moringa capsule",
        "input": "",
        "output": "hello do you have a history of anxiety or acid reflux disease what have you tried so far to make yourself feel better"
    },
    {
        "instruction": "hi doctor for a while my memory has been really bad a recent event with my memory is as follows my alarm goes off at 04 am and I looked at my clock at 05 am and I could not remember how my alarm had gone off which was only a minute later but things I memorized before some years are still remain in my head for example as a hobby I learnt mathematical pi I can still recite it but I have forgotten some numbers and I am frequently mixing things up another thing that has happened is that I cannot sleep at nights I have to leave the window open and wrapped in several blankets to sleep because either I feel too hot or too cold where in a split second I am either sweating or shivering I also get massive waves of heat or cold my hands and feet normally go cold and numb during my cold episodes and when I get hot I feel dizzy and nauseous I feel distressed I generally see myself as a person who barely eats or drinks but for the past month I have been drinking three times more than usual and eating full but healthy meals I would just like to know if there is a diagnosis or at least some steps that I can take to minimize this thank you",
        "input": "",
        "output": "hi revert back with the report to a psychiatrist online"
    },
    {
        "instruction": "hi doctor before 16 years I had two high risk exposure with sex workers and the risk was condom break in both situations after three months from my last exposure I did elisa test for hiv and it came back negative again I did the same mistake after one year condom break with a sex worker then after five years I did hiv test elisa and it came back negative I was about to get married that time I did not believe the results because my brain keeps telling me maybe the last laboratory did not do a good job or maybe the one who is working in the laboratory did not know how to perform the test they convinced me it as negative and I do not have the virus I did my best to believe it and move on in my life I got married and when my wife got pregnant she did the hiv test in her first and third trimester during her pregnancy and it came back negative my questions are is performing elisa test hard or easy I do not know what elisa generation it was should I believe and trust the laboratory is it possible that it has been more than 13 years from my first high risk exposure and I am still in a good health can my wife get hiv from me please explain",
        "input": "",
        "output": "hi for further information consult an hiv aids specialist online"
    },
    {
        "instruction": "hi doctor I have one white patch in my mouth it is exactly in the front part of my tongue and it affects my daily life strongly I am really uncomfortable and my mouth has slobbered all the time I used to have this in the past but I did not have for more than a year sometimes it is totally white and sometimes the color changes I read on the internet that to wash with salt water helps I am doing it now and it helps for a while now this is the ord day and I still have it what can I do to make it better I would like to receive some natural home remedies also I am fine with medicine suggestion as well",
        "input": "",
        "output": "hi revert back with the answers to a dermatologist online"
    },
    {
        "instruction": "hi doctor I am having stomach pain in the lower abdomen for the past few days I am also feeling bloated abdomen along with stomach pain all day I have been trying to poo and I just did once when I looked at the toilet paper there was a tiny bit of blood also my anal region hurts now it is itchy and sore my urine is also dark yellow in color please help",
        "input": "",
        "output": "hi per rectal examination anal fissure hemorrhoids irritable bowel syndrome constipation and anal fissure tablet rabeprazole once a day early morning on an empty stomach to avoid any acidity consult your doctor discuss with him or her and take the medicine with consent if there is increased bleeding per rectum fever and vomiting then immediately head to the emergency room drink plenty of water keep anal area hygienic and clean wipe using wet wipes eat healthy diet of fruits and vegetables for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor my lap was on 27th of last month then I had sex for the first time with my fiance but it was coitus interruptus now this month I did not get my periods yet and I have some symptoms also my cycle is always regular do I need to check for pregnancy when is the right time to check",
        "input": "",
        "output": "hello for further doubts consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "my 4year old kid has nasal polyps which is ith covered into his left nostril and ith covered in right nostril he always breaths through his mouth whenever he does some activity he feels little dypsnea but never stops being naughty he snores while sleeping which is more concern to me till now he did say any headache or other issues like pain in nostril or something please need your help due to this lockdown cannot visit ent clinics near by",
        "input": "",
        "output": "hello welcome to icliniq nasal blockade due to any cause be it adenoids or polyps do cause snoring it is because any obstruction in the nasal cavity nasopharynx does alter the normal resonating properties of the nasopharyngeal chamber causing snoring the masses you are seeing are not polyps they are turbinates are normal structures the left one seems to be enlarged though what problems does your child have does he complain of nasal obstruction is his sleep disturbed he is probably having adenoids usually grow only up to years and disappear on their own by to11 years however if it is causing difficulty in breathing then you can get them removed however snoring is not that much a problem you can use decongestant like otrivin nasal drops that would help relieve the congestion and improve breathing"
    },
    {
        "instruction": "hello doctor I have a month old baby boy I feed him mother milk only till now by next month I need to join my job so this month I want to start other foods which food can I give to him",
        "input": "",
        "output": "hi as your baby reached five months great that you only gave exclusive breastfeed now once he approaches six months you can start giving weaning diet all homemade stuff along with breastfeeding until year of age it is always better to introduce baby with rice potato first as they are gluten free and gradually built up to multi cereal diet like grilled thick dal mashed banana mashed dal mashed roti bread biscuit mixed in sweetened undiluted milk cheeku mango and paya as snacks basically our aim is to give small energy dense feeds at frequent intervals you can add ghee or oil to make it more energy dense until 12 months keep frequency three to four times at least per day if breastfed always make the baby sit on your lap and then feed and maintain all the hygiene and clean your hands before preparing food and while feeding avoid all packed food"
    },
    {
        "instruction": "hello doctor a doctor gives an injection to my mother after 45 days that starts to pain with swelling and red area of about inches I checked again he asked to take oxidil iv injection after six oxidil injections the pus comes out and the red area decreases now pus does not come and we are using a bandage on it oxidil was stopped now and after about one week pus comes again today and the red area is about 5 square inches the area below that red is hard what do you suggest should I use some more oxidil or augmenting she is 65 years old and we are trying to avoid surgery kindly guide me",
        "input": "",
        "output": "hello I understand the problem your mother is facing according to the history you have provided I believe she has developed injection site abscess though it is not uncommon in elderly people it can happen your doctor has started her on a single antibiotic injection oxidil ceftriaxone but it is my opinion that it is better for her to undergo incision and drainage procedure it is a small procedure once wound is opened she will have immediate relief following by antibiotics if she has no other conditions such as diabetes her wound should heal within a week or two if you continue to treat her only with antibiotics oxidil I believe it will not subside completely and it will reoccur she should have also been given injection metronidazole iv thrice a day if pus is present if you send a picture of the wound site I can comment further in my opinion surgery is still the best option I hope this helps"
    },
    {
        "instruction": "hello doctor my 5 years old child fell down in a deep pit last week and her nose skin is badly injured and cut with bleeding unfortunately due to the recent coronavirus crisis we were unable to find any nose specialist and went to a local hospital where a general practitioner stitches her nose now after a week wounds are almost normal and nose stitches are going to be removed tomorrow but there are dark stitch marks on her nose skin which has totally changed the face shape of our child now how can stick marks permanently be removed from her nose to restore actual previous shape what is the treatment name of this case which doctor or specialist should we consult for the said treatment please guide",
        "input": "",
        "output": "hi sorry to hear about the injury to your child these injuries lead to permanent scarring if not properly stitched at the initial kindly attach the photo because I have to see whether the bone part is deformed or the cartilage the front part is deformed if deformity is permanent it can be later mended by a plastic surgeon so for that you have to consult a plastic surgeon later on for darkening or minors scar marks I will advise you to use sunscreen like calamine lotion during the daytime vaniza gel polysiloxane and silicone dioxide twice daily over the lesions darkening do recover with time and scars also recover with time but if there is disfiguration of the bone of the cartilage they cannot be cured without intervention by a plastic surgeon I hope this helps"
    },
    {
        "instruction": "hi doctor I am weeks pregnant and having mild bleeding from the last seven days seven days before I went to a pa scan which showed weeks day fetus with good cardiac activity I was put on duphaston be and austen od after seven to eight days my bleeding is little more and red I am advised to start tablet slate 500 my thrice daily along with previous tablets of duphaston and austen so I need suggestion is it right to take so many tablets",
        "input": "",
        "output": "hello welcome to icliniq com it is safe to take these medications in pregnancy do not worry about the number of medications as these have been put for you by your gynecologist to support the pregnancy as you had threatened abortion based on the scans the baby is totally fine slate etamsylate is to control the bleeding as of now try to take adequate rest and avoid straining yourself and keep complete abstinence from sexual intercourse and continue taking duphaston austen so progesterone sustained release if the bleeding increases further there can be a risk of miscarriage so that is why all these supportive medications have been given to you goal to push your pregnancy to viability to avoid any loss stay positive everything will settle fine continue duphaston austen so and slate 500 abstinence adequate bed rest follow up with your obstetrician in case of any cramps or pain or increased bleeding follow scans as advised by your obstetrician"
    },
    {
        "instruction": "hello doctor I am a 32 year old female and I have got throat pain on 2nd and met a doctor on 26th for the same he gave me zee 250 my and one multivitamin for five days and I have taken it till 30th from that day I am doing basic gargling and taking milk with pepper and haldi in the night but yesterday I got the message that whoever visited one mall from the date 10th 17th and having any symptoms of couid 19 should seek medical support I visited that mall on 12th and after that I got throat pain but it is already days since I visited that mall and almost 10 days I have this throat pain should I consider this throat pain as a symptom I do not have any temperature or any other problem I called the helpline and told them that I visited the mall on 12th march but not that particular shop and told me about my current situation and the person told me to take the zee tablet for two more days if I still have mild throat pain I want to know since it is already days I visited the mall and also my throat pain is already there for almost 10 days do I need to worry about anything I am very scared and panicked after seeing that news please help me with your suggestion",
        "input": "",
        "output": "hi is there any cough or breathing difficulty or wheezing does anyone else in your family have similar symptoms is there any nasal congestion or discharge or block can you please take a picture of the back of the throat with open mouth showing details of the affected area and send it to me"
    },
    {
        "instruction": "hi doctor I have a fungal infection for years now I believe I have been trying to treat it back and forth since the medicines being prescribed are so expensive every time I see my skin healed I stop the medication the fungal infection I first had was ringworm recently my infection started acting up again then I did the same routine taking medication and putting cream but this time my doctor told me to use vinegar instead cause my skin was not healing well and instead make it worst but this time I plan on finishing the medication so that I will finally be gone for good the couple of weeks I have my skin treated well and it was healing just right until this quarantine happened my skin was still good the first week of the quarantine then the second week my grandma showed me some vitamin that I believe would be good since it is just vitamin but after a few days my skin started showing some bumps in arms also feet they are very small bumps but also so itchy I am still taking the same medicine prescribed to but why did bumps like this start showing up was this done by the vitamin while I was taking medications why was my skin healing when there was still school before and now is not healing properly and is looking a lot worse I am honestly so insecure about my skin now I hope you can help me since I cannot go out and go to a near hospital the medicine I am currently taking is itraconazole the cream I used to use clotrimazole to now just pure vinegar I drink apple cider every morning use a sulfur soap these are all prescribed by my doctor",
        "input": "",
        "output": "hi fungal infections are very difficult to treat and your case is resistant fungal infection in such cases I give itraconazole as last resort only some patient respond to itraconazole some patient respond to terbinafine and in some both have to be given take ketoconazole bath soap wash your clothes undergarments especially daily dry them in sun wear clothes after drying the body only after drying your body properly avoid sweating and moist conditions keep your room dry and well ventilated do not wear much clothes during the night so that is sweating may promote the growth of fungus keep your body clean the bumps are actually bacterial infection not fungal do not use any over the counter steroid in ever they also increase fungal infection follow the following treatment given below and revert me back after three weeks take tablet terbinaforce 250 my twice daily after meals for three weeks terbinafine cream twice daily for three weeks tablet citizen once daily for itch tablet medicine 200 my twice daily for five days review after three weeks"
    },
    {
        "instruction": "hello doctor I have a rash on my forearms about or days ago I noticed two dark reddish almost purple spots on my right forearm when I woke up I think they are under the skin not raised non itchy my skin is extremely dry and I neglect that so I started putting jergen ultra healing lotion I thought maybe I had scratched my arms while sleeping that is what it looked like but each day much smaller spots have appeared the only medication I take is my xanax twice a day for anxiety I was diagnosed with cirrhosis before three months and spent three days in the hospital I had a blood transfusion and treated for swelling in my feet and legs post hospital stay I was given two iron infusions since then I was supposed to follow up with a gastro and the hematologist for a blood draw recheck but with the coronavirus that has not been possible for me to go in so I do not know if this rash has anything to do with that but I would like to know what it is",
        "input": "",
        "output": "hi sorry to hear about the problem you are having as you have cirrhosis and iron infusion I suspect there is some blood clotting defect which is very common in this condition these lesions are actually small hemorrhages or bleeding into the skin they do heal with time if the clotting defect is improved or no more new bleeding occur I hope you are not having dark colored stools or nose bleeds or blood in cough of vomiting or any small injury taking more time for the blood to stop if any of these condition persists you need to see an emergency service and get you your blood coagulation profile done skin is dry in your condition use emollients do not use harsh cleansing soaps use only mild ones that too on alternate days as you say new lesions are coming I am afraid you should get your coagulation profile done if it is normal use emollient like aloe vera on these they do subside gradually"
    },
    {
        "instruction": "hello doctor today when I was taking my bath as usual I cleaned my penis shaft and cleaned the area under my foreskin after dried my body I saw 10 drops of blood on the floor and the bleeding continued for two minutes maximum I have a short frenulum problem but not serious I am an unmarried male never go for masturbation and never go for sexual intercourse with anyone now I am feeling mild itching inside kindly suggest",
        "input": "",
        "output": "hello you seem to have short frenulum bleeding can be due to trauma during cleaning if it recurs kindly see the source or exact site for itching you can take tablet levocetirizine on demand you can also apply lignocaine jelly locally which may decrease some sensation for some time avoid aggressive cleaning of glans you can use wet dry cotton for the same do not worry you will be fine"
    },
    {
        "instruction": "hello doctor my niece ear is paining a lot a few days ago she has inserted her finger insider her ear which might have hurt her she also bled twice now the bleeding has stopped but the pain is still there she is taking pain killers since no doctors are available due to lockdown kindly advise as to what might have happened and also suggest some medicine",
        "input": "",
        "output": "hi is she having a cold or cough the ear pain can be due to ear infection due to cold and cough did she hurt her ear canal"
    },
    {
        "instruction": "hello doctor I am a 27 year old male I have had a mild burning sensation in the middle of the chest for the past few days and along with slight irritation in my throat I also sometimes feel bloated and have slightly more than normal amount of burps I have no cough or fever checking temperature on a daily basis and highest is 98 6c",
        "input": "",
        "output": "hello based on your history and symptoms you may be having gastroesophageal reflux disease herd if the acid goes up to the throat area it might cause thick mucus in this case this is classified as laryngopharyngeal reflux disease lor you would need to take a different medication I recommend you take omeprazole 40 my one tablet 30 minutes before breakfast for two to three weeks I would also recommend you avoid oily fatty spicy and dairy food avoid alcoholic carbonated and caffeinated drinks avoid smoking and avoid lying down within one hour after eating I hope this helps"
    },
    {
        "instruction": "hello doctor I am 29 years old and six feet tall my iq is very good I can easily understand even difficult concepts of science but tend to forget quickly my memory has continuously decreased over the last four or five years I am preparing for a competitive exam I forget things very quickly I find it difficult to concentrate while studying I have to read things several times to remember it takes a lot of time it is quite depressing and demoralizing it has now started affecting my professional life please suggest any medicine or other way to improve my memory power",
        "input": "",
        "output": "hi welcome to icliniq com I can understand your problems your memory issues are due to lack of concentration and lack of concentration is due to your stressful preparation of competitive exam I will suggest you to take vitamin b12 injection which will boost your memory tell me something about your sleep food and stress any problems with those do mind relaxation exercise and you nigra sleep meditation which will improve your memory take tablet rejunex cd3 once daily for two months"
    },
    {
        "instruction": "hello doctor I have throat pain for the last seven days doctor gave me pox 200 and hifenac felt better at first but my condition is not improving there is also a slight problem in breathing as I am asthmatic for the last 10 years I am currently on foracort 400 rotacap duonase nasal spray",
        "input": "",
        "output": "hi can you send me a picture of your throat for how many days did you take antibiotics"
    },
    {
        "instruction": "hi doctor I got a fever last week after two days my fever went and I developed flu today I do not have cough no fever no flu but my mouth is sore why",
        "input": "",
        "output": "hello according to your statement you got a fever that subsided after two days and then developed flu and mouth sore mouth sore is a common complication of flu again mouth sore may developed by a viral infection like herpes simplex virus most commonly fungal infection nutritional deficiency like iron zinc vitamin b12 etc some medications like corticosteroids chemotherapy sulfa drugs phenytoin etc autoimmune disorders like lichen plans also for your flu like running nose and body ache you can take anti histamine acetamenofen or paracetamol topical antiviral cream vitamins containing b12 with zinc and iron if any complications occur or your symptoms do not subside within seven to ten days inform me as soon as possible I will try to help you further"
    },
    {
        "instruction": "hi doctor my eyelid is swollen for a couple of months at first it was purple and itching hard I used ciprofloxacin ointment for two weeks applying every eight hours reduced purpleness and swelling in the first two days then stopped helping tried doxycycline for two weeks but still the same for the last week vision distorted or slightly blurry in that eye and today feeling pain around that area but not eyelid more like in the head hard to describe any suggestions on how to treat",
        "input": "",
        "output": "hi can you send me a closeup picture of your eye"
    },
    {
        "instruction": "hi doctor I am a year old male I would like to consult about my recurring mild cough during night time and sneeze and runny nose in the morning that usually go away before lunchtime I recently consulted a pulmonary doctor due to severe cough she gave me antibiotics anti histamine in the morning seretide oral spray and medicine that uses a nebulizer I have finished it the cough as well as the sneezing and runny nose went away for a couple of days suddenly the mild cough sneezing and runny nose came back I also mentioned the recurring allergic attack to the pulmonary doctor that is why she gave me the anti histamine because she told me that the cough might be an allergic reaction I just take in vitamin tablets and ginger daily I do not use any medications right now last night I experienced mild cough again I have resorted to use the seretide oral spray because I experience slight discomfort in breathing I have no idea what I could be allergic to I have no food allergy I usually have a jacket when I sleep because we sleep with air condition on it is fine if it is just me but I sleep with my partner and a year old kid in a room I do not have a fever or any symptoms of coronavirus I can no longer consult an allergologist near me due to the lockdown in our area I hope you can put an end to this recurring problem thanks",
        "input": "",
        "output": "hi please continue the antihistaminic preferably pair it up with montelukast take the medicine at am in the evening you need a asteroidal nasal spray like mometasone as well take albuterol inhaler sos and a budesonide inhaler twice daily for a week avoid exposure to cold air from the ac keep the blower of aircon away from you keep an optimum temperature of 25 degrees do not lie down directly under the fan keep all surfaces extremely clean and tidy wipe all areas with a wet cloth every few days keep carpets curtains upholsteries puffed toys etc very clean and dust free wash your weddings twice a week with warm water"
    },
    {
        "instruction": "hello doctor I have done a gastric sleeve surgery before seven months and I recently did a rhinoplasty surgery last month am I allowed to have accutane 20 my for a period of months and will I gain weight from it",
        "input": "",
        "output": "hi accutane also known as isotretinoin prescribed for the treatment of acne used as a last resort if no other treatments are showing a promising response gastric sleeve surgery is not a contraindication to take this medication and it will not cause any weight gain although in some studies it has been noticed that accutane is better avoided when a cosmetic procedure such as rhinoplasty is undertaken for up to a period of six months however the drug has other side effects which are rare but you should have been informed by your physician before they prescribed it to you such as sensitivity to sunlight headache and many others remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects I hope this helps"
    },
    {
        "instruction": "hi doctor I am a 36 year old male I had my checkup and get was 51 and alt was 67 all others were within limits now I have a problem of headache fast heartbeat only when trying to sleep also feel like my left chest has a lot of gas why I am especially worried is I vomited and I highly suspect blood in it and also feels shortness of breath I am taking 5 my cilazapril",
        "input": "",
        "output": "hi welcome to icliniq com as per the liver function test let of your blood you have a mild increase in get gamma glutamyl transferase and alt alanine aminotransferase get suggests there is a possibility of mild damage to the liver and biliary system especially due to alcohol we need to have full liver function reports so we can compare your ast aspartate aminotransferase and alt ratio blood or dark brown colored vomits is always abnormal you need to find the cause if you are taking alcohol drinks please try to minimize pain in the chest with blood in the vomits can be of a reason for stomach or esophageal pathology also so please get checked and followup with reports please do abc complete blood count let coagulation profile and bleeding time"
    },
    {
        "instruction": "hello doctor my whole body gets itchy after sex earlier it used to be random but now it is almost every time my face neck chest legs even hands and arms are involved I am 29 years old",
        "input": "",
        "output": "hello according to your statement you are suffering from allergy just after sex you did not mention here whether your partner uses condoms or not you may be allergic to the condoms or any added ingredient like spermicide that you or your partner used although it is possible to be allergic to any type of condoms latex is the main common culprit between 6 people of your race are allergic or sensitive to latex like you again spermicide are commonly used in gels suppositories and lubricants noxynol is the most common active ingredient in spermicide is known to cause irritation or allergy to some people especially when used frequently by using skin prick test last test etc it can be determined which ingredient is responsible for your allergic reaction latex causing allergy will be subsided with one to four days your partner can use condoms of latex free ingredients you can also take anti allergic medication too"
    },
    {
        "instruction": "hello sir I am a student age 23 five days ago I had a severe feeling of vertigo severe headache moderate fever nausea vomiting loss of balance this symptom started every evening and after sleeping I was totally fresh in morning here due to corona pandemic I could not go to hospital I have a chronic of history of infection in this right ear I had not vertigo in past but have a history of fungal and pseudomonas infection was prescribed otosporin a lot eardrum was fine according to previous diagnoses I used drop of dexcip for two days feeling of vertigo are not there now but still some dizziness is and there is a continuous ringing and sometimes pain and allergy in my right ear left ear is fine",
        "input": "",
        "output": "hello good to hear from you I understand your scenario is your ear discharging frequently as per your complaints it is suggestive towards a chronic supportive otitis media com are you sure your membrane is intact and normal have you seen an endoscopic picture I understand you cannot go to a hospital now so for the time being start yourself not the following medication tab amoxicillin 500 my twice daily after food for days tab montac la once daily before sleep for days tab panto der once daily before breakfast for days ciplox ear drops thrice daily tab betahistine 24mg sos keep your ear dry at all times get an endoscopy done for the eat and get the discharge cleaned at the same time once you have access to an ent doctor infection endoscopic ear examination ray both mastoid otitis external com it medical keep ear dry after medication"
    },
    {
        "instruction": "i have burning sensation in my throat for last days still no other symptoms may I effected from couid",
        "input": "",
        "output": "hello I can understand your concern as your area is facing more cases of covid19 it is good that you are seeking medical advice for your symptoms first of all I would like to say do not panic the burning sensation in the throat can be due to some irritation that has caused due to especially cold things that you might have consumed as its summer and drinking cold drinks cold water or ice cream can cause it another reason for this can be nutritional deficiencies of some vitamins like vitamin vitamin so balance your diet with appropriate foods that are rich in vitamins and minerals keep yourself well hydrated throughout the day make sure that you do not drink anything that is extremely cold it should get better in a few days now as you are worried if this is due to couid 19 I would know if you have a recent travel history anywhere in or out of your country also have you come across any covid19 patient recently I also want to tell you that symptoms of covid19 are cough fever occasional sneezing in your case there is just a burning sensation in the throat so do not panic and keep yourself healthy with proper food also maintain social distancing as well as continue hand washing before touching your face eyes nose when you come in contact with anything outside if you get the above mentioned symptoms in the future then do visit your nearest covid19 test center hope this helps feel free to contact for any further queries in the future"
    },
    {
        "instruction": "too much mucus on chest not allowing to breath breathing difficulties due to thick mucus in chest couldnt get rid of this by coughing or medicine or nebulisers have herd seasonally catches cold and thus use monte la regularly last months gradually getting this breathing difficulty some times before coughing or sneezing gets mucus out the of the lungs and then I can sleep properly now last months finding very difficult to remove the mucus out I am currently taking yes azithro 500mg allegra 120 my antiflu75mg deriphyllin 150 my foracort inhaler thick mucus formed which does not allow to breath kindly find the test done and medicines taken presently",
        "input": "",
        "output": ""
    },
    {
        "instruction": "i am suffering from major depressive illness sleep deprivation anxiety attacks heavy breathing fatigue and exhaustion I am a doctor myself and currently taking petrol 5mg I need help",
        "input": "",
        "output": "hello welcome to icliniq how long have you been experiencing features of depression anxiety and related symptoms is there any ongoing stressor in your life that is exacerbating your symptoms being a doctor can itself be an exhausting and demanding job I note that you are taking petrol 5 mugs clonazepam petrol is good for short term management of stress anxiety and help you to calm down as you know it is not recommended for long term use due to risk of dependence and tolerance you can use petrol occasionally as needed for unto weeks if depression and anxiety symptoms are severe and persistent you will benefit by taking saris like fluoxetine sertraline or escitalopram in addition to medication make lifestyle changes to improve your mood regular exercise helps try walking for atleast 20 30 mins daily talk to a trusted family member friend about any ongoing difficulties if feasible consider cut which will be helpful to manage and prevent relapse of depression anxiety hope this helps take care"
    },
    {
        "instruction": "hello doctor I need a second opinion on my ultrasound result transvaginal ultrasound reveals cyst on ovary or hydrosalpinx ultrasound was done on day of menstrual cycle I stopped taking birth control months ago I am currently not taking any medication perhaps you have another opinion or have other findings thank you",
        "input": "",
        "output": "hello I have gone through your brief clinical history and the images you have provided though I would like you to answer a few more questions so as to provide you better diagnosis and suggest appropriate management are your menses regular is the flow normal heavy or low do you have children normal delivery or cesarean sections any abortion miscarriage or and done any history of urogenital infection or chronic discharge per vaginum now coming onto your query and analysis of the images you have sent first image shows anterverted uterus with a 9 my calcific focus in endometrial region this calcification is most likely due to earlier invective or inflammatory pathology nothing to worry about second image shows minimal amount of clear fluid in the endometrial canal with thin endometrium for ith day of cycle third fourth and fifth images show an oblong soft tissue structure adjacent to the left ovary this could either be part of the bowel or fallopian tube I can differentiate it on a dynamic scan or an ultrasound video rather than a still image the left ovary looks normal with few follicles seen within it no obvious cyst is seen in the image provided also the left tube is not dilated and therefore no hydrosalpinx is seen the last sixth image shows part of normal bowel loop in the right adnexa no right ovary or dilated tube is seen in the image provided I hope this helps invective inflammatory hormonal assays serum fish follicle stimulating hormone oh lutenizing hormone prolactin and androgen levels complete blood count ruined routine and microscope sos pap smear follow up with reports"
    },
    {
        "instruction": "hello doctor my question is when can I drink more than two glasses of wine a day or a whole bottle without it hindering the healing process after my dermapen session of micro needling and also because I was occasionally drinking a few bottles of beer after I had gotten it done does that mean my healing time has to be longer than six weeks by the way I did my acne scar regions with 0 my needles",
        "input": "",
        "output": "hi alcohol use can diminish wound healing it increases the blood flow so it can also cause bleeding excessive alcohol intake also reduces the immunity of the body which can lead to delayed wound healing same principle applied to micro needling micro needling is also a small type of injuries created in the facial skin so that the healing process makes a healthy smooth skin and remove the scar so if you take alcohol during that process alcohol is going to affect that healing process and it can lead to infection so I advise that you should completely avoid alcohol if possible a small amount of one glass of beer per day can be taken if you cannot control your urge to take alcohol I hope this helps"
    },
    {
        "instruction": "hello doctor I had a cough since the start this month but it was just a dry cough it has got severe when the quarantine started and I could not schedule anymore consultation I had taken mucolytic which gave me severe coughing but it released a lot of phlegm yellow or greenish color I tried calling my friends who are nurses and I got a doctor whom I consulted and gave me prescription of co amoxiclav I had no fever chills and night sweats I have a chest stabbing pain for more than two weeks now today the pain level for me is 6 whenever I clear my throat or cough a little I have taken co amoxiclav 625 my three times a day for the past one week but the pain did not go away but my cough stopped and I had just very few episodes of coughing usually when I wake up my throat does not hurt or itch anymore but I am more bothered by the chest pain now the inner pain started before just below my breast on the right but now it is nearly on the chest itself but still on the right please advise",
        "input": "",
        "output": "hello the most probable cause for the chest pain in the setting of the problems described by you is due to muscle spasm on account of indiscriminate coughing when the infection was present now the phlegm is less signifying decreased infection or healing what you need are some muscle relaxants and pain killers couple this with some balm application locally followed by steam and hot fomentation take adequate rest this shall pass nothing to worry if you need any further support or clarification do not hesitate to contact me"
    },
    {
        "instruction": "hi doctor when it is hot I feel itchy after taking a bath this feeling can last for around 15 minutes I also feel itchy when I start to sweat but when I sweat a lot after some times the itchiness decreases I also feel uncomfortable at night sometimes using a fan just makes the itchiness much worse lastly there are no visible effects on the skin",
        "input": "",
        "output": "hi welcome to icliniq com you are actually suffering from aquagenic urticaria such patients are actually allergic to water content and or temperature changes lead to histamine release thus itching this condition is most of the time very resistant to treatment only treatment is that you take antihistaminics daily sometimes in some patients it resolves on its own after some months or years take care to avoid extreme changes in the heat take antihistaminic plus montelukast tablet like fexofenadine and montelukast 180 my daily for four weeks and use calamine lotion some people report relief after doing exercise they have an itching for few minutes after sweating due to exercise but during whole of the day then they feel relieved different people behave differently according to the level of allergy they have in your case according to your description I suspect that you are allergic to water content and change in temperature so kindly take care to avoid such situation that is not always possible so take the tablet and calamine lotion which I have advised I hope this helps"
    },
    {
        "instruction": "hello doctor I have a few questions regarding inflammation anywhere in the nose or throat whether mild moderate or severe does drinking a lot of water gargling with salt water taking tablespoons of honey each day and getting a lot of sleep remove it fast and also prevent it in the first place also what are the best and quickest natural ways to get rid of inflammation fast and prevent it from happening in the first place from then on if able you can also share medicines that are for it I am also curious as to whether dust can cause allergies that can lead to inflammation I am trying to learn more about health and medical care this has been only recent and I would say it is rather mild I realize each time it occurs it is in the spring or if I have not been eating healthy and enough not getting enough consistent sleep and areas of my home have dust especially since I have been inside at home for the past three weeks straight checking in if I am doing the right things to properly take care of it",
        "input": "",
        "output": "hello all the habits of water honey etc are helpful no doubt about it one more thing if you can do is put almond oil provided you are not allergic to almonds 5 my in each nostril for two to three days it really works well I personally vouch for it you will sleep better too as you said it is seasonal so allergic components will be there so you will require the following for proper resolution take one tablet montelukast 10 my levocetirizine my once a day in the evening as it causes little drowsiness montelukast is available as singular 10 my levocetirizine is available as xyzal my I hope this helps"
    },
    {
        "instruction": "hello doctor for the past five years I have been getting a stuffy nose and itchy eyes on top of these symptoms every time I get a stuffy nose I get lightheadedness dizziness stomach upset diarrhea and headache I also noticed that when this happens if I move just my eyes to the left or right I get this literal pulse of dizziness and I can also feel a buzz in my ears and they feel full these symptoms come all at the same time and are non stop for about two to three days and it is during all seasons a stuffy nose is always an indicator that I am going to get all of the other symptoms right now I am on my second day of this type of episode I have been to numerous doctors and other specialists and I have had mri it scans and rays but no one has ever been able to give me a diagnosis or treatment that works I have tried dozens of medications that either do not work at all or only work for about a month I am desperate for help at this point I just cannot take this anymore it makes it impossible for me to do anything work school travel and I am even starting to lose weight do you have any idea what could be going on and how I can fix it I am currently on venlafaxine simvastatin vyfemla flonase propionate nasal spray and afrin",
        "input": "",
        "output": "hi welcome to icliniq com your nasal symptoms are more suggestive of allergic rhinoconjunctivitis the dizzy feeling and associated changes are more suggestive of benign paroxysmal positional vertigo bppv there is no direct relation between both symptoms but an allergic exacerbation may aggravate bppv for allergy the treatment of choice is skin prick test and immunotherapy please contact an allergy specialist that is the only way to cure an allergy with everything else symptoms may exacerbate on and off bppv is a condition that may not show any findings on mri magnetic resonance imaging or it computed tomography treatment of choice is vestibular rehabilitation exercise and maneuvers like dix hall pike and epley antivertigo medicines are mainly supportive only in your case you have to get both the conditions treated simultaneously I hope this helps allergic rhinoconjunctivitis bppv vestibular rehabilitation exercises"
    },
    {
        "instruction": "hello doctor my father is 65 years old he seems to have developed some patches on his skin they are blackish red and also seem to have some pus he is a diabetic and currently under medication for diabetes heart and urine issues",
        "input": "",
        "output": "hi I have seen the picture it is diabetic dermopathy with bacterial infection skin lesions like carbuncle ecthyma are common in diabetics diabetic microangiopathy is responsible for diabetic dermopathy usually they appear on legs but may occur on forearm as in our case post inflammatory hyperpigmentation are seen on forearm of long standing diabetic patients also faulty insulin injection techniques cause induration scar formation keloids and abscess formation the treatment is control of diabetes follow the adage do no harm potent topical steroid like renovate cream at night for 15 days can be tried under occlusion focus should on preventing ulceration fucibet cream fusidic acid and betamethasone twice daily for 10 days use cetaphil moisturizing lotion for 20 days and tablet ifi 200 my cefixime twice daily for five days"
    },
    {
        "instruction": "hi doctor I have prediabetes 8 fasting blood glucose can low doses of human growth hormone used for bodybuilding lead to type diabetes my mother has type diabetes mellitus",
        "input": "",
        "output": "hi for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am a 31 year old male and single I am getting pain on my back in recent days I used to maintain my weight around 70 keg to 75 keg recently after my kidney stone surgery my weight increased up to 80 keg after an increase in weight I started getting back pain when I walk for more than minutes and when I try to do some exercises or if I do any activities at home a few years back I also faced the same issue as I gained weight and later I worked out to reduce but this time it seems too worse please suggest me how to avoid this back pain and why I am getting pain when body weight is increased there is only increasing in belly fat and the pain is like back bone gets very tight and not able to move or keep another step please help",
        "input": "",
        "output": "hi for further doubts consult an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hi doctor I had a first I one week ago the egg was to rupture on the same day egg size was 5 my and endometrium size my also for the past one month I am taking oral austen 300 how much chance is there for successful implantation",
        "input": "",
        "output": "hello for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor for two years I have been suffering from map mitral valve prolapse then I have undergone egg and tit but no map detected but I was advised to take the tablets given for map which includes metolac er 50 and dothimax 25 will these tablets cause any side effects",
        "input": "",
        "output": "hello mitral valve prolapse cannot be detected on egg electrocardiogram or a tit treadmill test unless has very advanced and causing severe problems it can be picked up by an echocardiogram which is a heart ultrasound now coming back to your medications dothimax dosulepin is an antidepressant caution should be exercised in patients with a history of epilepsy high blood pressure increased eye pressure and urinary retention the most common side effects of dosulepin are dizziness blurred vision fast heart rate urinary retention tremor blood disorders low blood pressure sexual dysfunction and sweating less common side effects are nausea vomiting loss of appetite headache giddiness chills sleeplessness and anxiety metoiac metoprolol is a beta blocker this medication is used as a hypertension or be medication and also just to reduce the heart rate in people with arrhythmias abnormal heart rhythm or rate meaning fast and irregular most common side effects are depression low be low heart rate erectile dysfunction and dizziness please do not suddenly discontinue these medications for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I had a cut in the gum after having some food later I garbled with listerine and it worsens the condition with swelling I am having bleeding gums while brushing I am 35 years old and I am diabetic please do the needful",
        "input": "",
        "output": "hello for further doubts consult a dentist online"
    },
    {
        "instruction": "hi doctor I have attached my blood test reports here kindly help me with it because some of the values are not normal thank you",
        "input": "",
        "output": "hi I have reviewed all the attached reports for further information consult a general practitioner online"
    },
    {
        "instruction": "hi doctor I am an mobs student my mother aged 47 years is suffering of typhoid which is a case of relapse and this is the 12th time she is having a temperature nearby 102 103 degree fahrenheit three years before she was given ceftriaxone iv twice be and after that she was given ampicillin 500 my thrice daily for the treatment of typhoid now after three years she is again detected with typhoid kindly suggest me how we should proceed",
        "input": "",
        "output": "hello revert back with the more detailed history to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I keep getting these bumps on my breast that turn red then get hard and very painful after a few days they burst and drain yellowish fluid mixed with blood then I am left with a big hole that will heal and scar I have had this happen a few times over the years but recently it has become very frequent I just had one last week and I am already getting another one starting",
        "input": "",
        "output": "hello for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor my breast core biopsy pathology reports have different information in one it is mentioned as specimen collected at 10 am and cores taken and in the other specimen collected at am and cores taken does that sound strange",
        "input": "",
        "output": "hi for further doubts consult a pathologist online"
    },
    {
        "instruction": "hi doctor I have scoliosis from my 15 years of age now I am 36 years old I am a very active teacher and mom the pain medicines are not helping me now and I have started to limp and lean can it get corrected through surgery",
        "input": "",
        "output": "hi for further information consult a chiropractor online"
    },
    {
        "instruction": "hi doctor I had doses of rabies vaccine along with rabies immunoglobulin before two years a month later again I was bitten by a dog and took three doses of rabies vaccine then after a year when I was bitten by a dog I had two doses of vaccine now again I was bitten by a stray dog and took two rabies doses still is there a possibility to get rabies",
        "input": "",
        "output": "hi for further doubts consult a community medicine physician online"
    },
    {
        "instruction": "hi doctor I have a blister in hand this was caused because of playing tennis I initially got this three years back but it is still persisting it does not trouble when I do not play but is uncomfortable while playing since I have it for long please suggest any ointment also advice if it can be removed completely with any procedure",
        "input": "",
        "output": "hi revert back after four weeks to a dermatologist online"
    },
    {
        "instruction": "hello doctor I just noticed that in my face near to mouth I have something like eczema but colorless I checked on the net and it is like ringworm I am very much worried what should I do I am currently on beta blockers last week when I had a blood test my doctor advised me to take iron supplements",
        "input": "",
        "output": "hi please put up some clear pictures of the affected area for proper evaluation and guidance thank you revert back with photographs to a dermatologist online"
    },
    {
        "instruction": "hi doctor I am 30 years old after completion of school and I did not join college for eight years then I joined a diploma course my father consulted many psychiatrists to find out my problem unfortunately I was admitted by one doctor in nursing home for around three months for treatment I hate both the doctor and my father for punishing me by placing in this nasty place my only fault is I do not like printed education and not sociable with people I like loneliness and withdrawal from society I love my desktop computer and spent time there now I am giving good interviews on different company and getting jobs in many places but cannot serve longer period I am working there only for a short period I cannot stay in the service at present another psychiatrist prescribed oxetol or 300 and nextto plus one per day I cannot understand my problem kindly help me to continue my job",
        "input": "",
        "output": "hi after reading the history I can say that your main current issue is difficulty in continuing a job for long for further doubts consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor I had sex on the second day of my period then my bleeding stopped after five days I had a pregnancy test and it was negative but now I am having frequent urination with burns and sometimes a single clot in urine am I pregnant",
        "input": "",
        "output": "hello for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hello doctor I have a symptom similar to gonorrhea and chlamydia with chronic testicles pain and swelling at the tip glans has a weird color and pain under the abdomen sometimes the urine test reveal negative for sad I am waiting to see a urologist and it has been for a year now symptoms seem to change and getting worse and I am getting worried",
        "input": "",
        "output": "hi from history it seems you have pain in testicle and at the tip of glans I need to know about frequency of urine at night urgency to pass urine sense of incomplete voiding how is the flow of urine any straining to pass urine unprotected sexual exposure constipation how is the pain in tes aggravated any associated swelling or redness of scrotum kindly share a picture of the glans abnormality you describe"
    },
    {
        "instruction": "hi doctor I am a 60 year old male my height is 9 and my weight 150 labs diagnosed with type diabetes three years ago at 140 labs weight I went on with metformin 100 my per day it worked well for a while but not good enough then I opted insulin and gained some weight of about labs but stopped insulin due to inconvenience of injections then I had jentadueto for a while now I just started invokana 100 my and it is bringing down the numbers greatly 20 years ago I was diagnosed with hyperthyearoidism now it is in normal range with synthroid my blood pressure is also normal I feel great but I am now down to 125 labs I do not exercise with a fear of losing more weight I also have attached some test result why am I not gaining weight",
        "input": "",
        "output": "hello for further information consult an endocrinologist online"
    },
    {
        "instruction": "hi doctor I am planning to get an operation for all injury after how many days of operation will I walk normally and do bike riding how fast will I recover my weight is 80 keg is there any problem for quick recovery with this weight kindly guide me",
        "input": "",
        "output": "hi for further information consult an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hi doctor I had postpartum thyearoiditis with my first child and it presented again with second child at months postpartum I am dealing with anxiety higher than normal heart rate fatigue and trouble sleeping during previous pt I could not tolerate medicines and it resolved when my child was 13 months old is it normal to cycle back and forth between hyper and hypo cycles numerous times with postpartum thyearoiditis is it fine to not treat it since it is cycling back and forth if it should be treated what would be the proper treatment since the levels fluctuate so rapidly my three months consecutive ash levels are 85 0 and respectively also tpoab 96 high and si 53 within normal limits my current medications include prenatal vitamin still nursing probiotic vitamin and moducare",
        "input": "",
        "output": "hi for further information consult an endocrinologist online"
    },
    {
        "instruction": "hello doctor I am a year old female with the history of bronchitis I was diagnosed with bronchitis at the age of 17 approximately for five months I had been facing breathing problem and now I have continuous pain in the right abdomen and occasionally on the left I also have a type of sting like pain around my left breast I referred a doctor and he diagnosed me of sinusitis and hence the breathing issue recently the doctor said that my liver is becoming inactive or something I weigh 41 keg and my height is 1 my weight is constant even after having a lot of food daily as the doctor recommended me I want to know if there can be any other reason because I cannot understand the liver issue as I am a non alcoholic person and also in my ultrasound there were some small nodes found near my stomach and they were less than am in size should I be worried",
        "input": "",
        "output": "hi for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I have a question dealing with a disorder that I have had for a long time now I am suffering with severe anxiety I want to know that in what way can I handle my bad anxiety I have tried many methods to deal with my anxiety but nothing much is changing I recently started to wonder if it is something more than just anxiety since my problems and suffering seems a bit too much I am curious to know any possible idea I can try to do about it soon thank you very much",
        "input": "",
        "output": "hi I understand that you are suffering with severe anxiety and panic attacks our brain is designed in such a way that we react to external signals and stimuli our reaction depends on the stimuli if the stimuli are less then we react less and if the stimuli are more then we react more anxiety is a stage where we react more for less stimuli or sometimes no stimuli at all this may be due to two reasons temporary stress and biochemical abnormalities in the brain if it is the former reason then it will go away after a few days if it is the latter reason then you may need to take proper tablets as per your narration since you are having this for a long time it is probably due to some biochemical abnormality in your brain but please do not worry this can be treated quite easily with tablets just like diabetes increased blood sugar and hypertension increased blood pressure which are basically biochemical abnormalities anxiety can also be treated with tablets for further information consult a neurologist online"
    },
    {
        "instruction": "hi doctor my daughter is 14 years old she is 2 height and her weight is usually between 10 and 15 pounds she has not started her period yet and I am a little bit worried she started puberty growth when she was so it is almost three and a half years now she has all the symptoms of premenstruation now as well it includes frequent discharge mood swings occasional cramps pubic hair growth of breasts etc I did not get my first periods until 16 years of age but she is much more developed than me also the last time when we went to the doctor they told us to expect it to come within the next few months but it has been almost a year now I am worried that something is wrong and that is why she has not got it I know that this is a common concern among teen girls but I would really appreciate your advice thank you very much",
        "input": "",
        "output": "hi for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I am a year old female I had an epileptic seizure and then passed out whilst sitting in front of my laptop I bumped my knee on the table not even hard enough to bruise then the seizure happened this has never happened before also for a month or so I am hearing some wheezing sound in my head I feel tired and stressed lately whilst in front of a computer I feel tics in my right eye frequently my go told me to ignore the seizure he prescribed me vastarel 35 my for a month recent blood tests show everything fine which includes fbc iron ferritin and glucose he advised me to have a brain examination only if I have another seizure is he right or do I need further checkups also what could be the cause for this seizure thank you",
        "input": "",
        "output": "hi let me share some facts of seizure a seizure is due to abnormal or synchronous activity in the brain and presents as a mild tremor to violent shaking or change in the behavior epilepsy is due to recurring epileptic seizures as a result of malformed or brain malfunction usually associated with abnormal eg electroencephalogram and scans thus seizure is not synonymous to epilepsy the most challenging fact is to define the actual episode and confirm it to be a true seizure if yes to above then just stay away from those provoking factors and everything going to be alright unlike that if it is unprovoked requires work up like eg video eg and later mri brain to confirm epilepsy revert back with the answers to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I do not have any real complaints I just got my laboratory test results they show bun 29 creatinine 01 bun creatinine ratio 29 and egfr 64 I do not have any bad symptoms other than some retention of fluid I urinate a lot but I am on triamterene 75 50 twice a day I do drink lots of water and tea without sugar I have heart disease and had bypass before 10 years my general physician said that everything is fine because creatinine was fine I am still concerned after things I have read should I seek a visit with specialist",
        "input": "",
        "output": "hi revert back with the reports to a nephrologist online"
    },
    {
        "instruction": "hi doctor my friend abused weed alcohol and cocaine in a span of 20 days last two days he had cocaine twice even though that was the first time and did not sleep then he travelled and became sick with 104 degree fever cough swollen tonsils and right knee numbness his blood test result showed rec count 13 and abc 1300 with leukocyte 16 this happened before a month and he is still coughing he just had medicine to reduce body temperature please help",
        "input": "",
        "output": "hello hiv ran by per not the antibody testing monospot test throat swab and culture hepatitis ran by per it would depend upon the results if you can get the results to me then it would be great I suggest tablet ibuprofen or diclofenac sodium every hours for fever consult his specialist doctor discuss with him or her and take the medicine with consent if he is unable to eat or drink jittery confused having a high heart rate and low blood pressure then he should be seen in the emergency room revert back with the report to an internal medicine physician online"
    },
    {
        "instruction": "hello I am an 18 year old female who is currently sexually active last year I had sex multiple times with only one person and everything was fine recently I had sex with a my new partner during intercourse I started to bleed I went to see a doctor and she said it could be the result of getting my period she also said that my vagina just looked irritated the day after that there is no sign of blood I was just wondering what is actually wrong with my body I got tested for gonorrhea and chlamydia and both were normal is it fine to have sex without bleeding",
        "input": "",
        "output": "hello for further information consult an internal medicine physician online"
    },
    {
        "instruction": "my vaginal lips are falling out and my age is just 27 any reason why the vagina walls are lying outward its just because of sex or some hereditary issue",
        "input": "",
        "output": "hi hope you your dear ones are doing fine I would like to put forth few features symptoms to differentiate normal from pathological labial hypertrophy vaginal wall enlargement if wall prolapse is painful tender associated with excessive vaginal discharge especially yellow or greenish color foul smelling with itching if swelling increases after sexual exposure around the time of periods discharge increases with all above features associated mild feverish feeling around periods cramps in lower abdomen before periods all these suggest that it could be infection in vagina following sexual exposure you need to meet your gynecologist use medications for yourself for your partner if the lips of vagina are not tender free of the above mentioned symptoms then this could be just hereditary as you mentioned then it needs no treatment hope I have clarified your query do write back if any more queries for your feedback all the best"
    },
    {
        "instruction": "hi doctor I think my 21 month old kid might have dental caries I think my daughter has an early childhood caries she has brown spots in the front four teeth at the back and a hole on one front tooth we brush her teeth twice daily so I have no idea how this has happened",
        "input": "",
        "output": "hello the picture you have sent is not clear but yes early childhood cares is common in infants I understand your concern because you are taking good care by brushing twice for now I will suggest the following if she sleeps with a bottle in mouth you must be careful to remove her bottle and get her mouth rinsed at least with plain water only do rinse her mouth regularly with water after she has taken candies or any food rinsing mouth thoroughly is a good habit make her develop this habit notice and inform me if she has comparatively has less saliva if her oral cavity is sticky in touch rest all is fine and these are common in infants so nothing much to worry for cares as soon as corona effect are decreased get her cavity filled do send me a clear picture if possible"
    },
    {
        "instruction": "hello doctor before two weeks I have undergone I and for breast abscess from that day I have stopped feeding my baby on 21st of march doctor checked and said no need of dressing and there is a small lump still present keep warm compress it will go and told me not to feed the baby I am keeping warm compress daily once but no result yesterday the wound completely healed and there was no leakage of milk from the wound so I started feeding my baby in the night I fed my baby on the wounded breast but in the morning I observed swelling again on the breast so I kept hot compress and started pumping then I observed a very thick pus on my nipple just a drop after that I am trying to hand express and pumping but the pus is not coming out now I am very afraid that my gynecologist may again suggest I and in the present scenario it is very tough for me to go hospital every day for dressing carrying a small baby please tell me whether it can be healed by antibiotics can I feed my baby if I feed baby will that pus affect my baby",
        "input": "",
        "output": "hi please do not worry a single episode of a small amount of pus exudation may occur ideally you should have pumped away the first set of milk and then started feeding but please do not get distressed now keep breastfeeding your baby keeping following things in mind after feeding from the affected side use the breast pump to evacuate any residual milk do not worry your body will generate enough milk for the baby keep hot compressing twice a day maintain proper breast hygiene do visit your gynecologist if you develop any fever or rise of local temperature"
    },
    {
        "instruction": "1 am 21 years old I am facing hairless since years I went to one dermatologist he prescribed menabol tablets zydip lotion its hair minoxidil solution and seboclear shampoo and asked me to go on diet eggs and cheese I started to get some good but again after sometime it was same I am losing hair from each part of head now I have very much less density of hair by just touching my hair I loose min strands of hair this is nightmare now my hair are not dense enough and I just 21 what the hell is wrong with me please help me",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hi can you please help me I recently got my braces off and got my retainer about a week later I started realizing that my bite was a bit weird before I got my retainer which is the waiting time for my retainer I realized that when I bite both sides of my teeth do not come in contact at the same time so after I got my retainer its been almost a week now it is still the same and I think it got worse when I first got my retainer off I did not have this problem but after a few days I started feeling it and I thought it would get better after I wear my retainer but its still the same is this normal or should I call my dentist at first after I got my braces off I did not have this issue but while I was waiting for my retainer I started feeling it and now even when I am wearing my retainer I still feel it should I wait longer or is this because my retainer was not done properly",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hi doctor I want to confirm something about my pregnancy I have missed my period today is 63 days my last period date is january30 in pregnancy kit I am getting negative I checked at 50 days when can I take pregnancy test six months back I have pod after that I used medicine after that I went for checkup doctor told that after scanning no pod please suggest me when can I take pregnancy test currently I am taking ovofit and police acid tablates can I take this medicine after my pregnancy confirm",
        "input": "",
        "output": "hi you are having delayed periods probably due to anovulation as your pregnancy test was negative at 50days I would advise you to recheck again tomorrow morning if it is negative it is advisable to take medication for withdrawal bleeding and cos is not diagnosed based only on the ultrasound reports it is a lifestyle disorder so you need to work on modifying the same like weight reduction regular exercises dietary modifications to get your hormonal balance in place so that you get periods on time which will ensure you are ovulating on time too in that way if you have been trying for a pregnancy that also can be natural without the need for any medications cos thyearoid complete hemogram glucose tolerance test hba1c levels lipid profile rat lots serum calcium vitamin do b12 levels serum fasting post prandial insulin levels serum fish oh estradiol prolactin levels thyearoid profile to ash anti tpo on and ord day of next menstrual period thyearoid or prolactin abnormalities tab meprate or devilry 10mg twice daily for days and then stop to wait for withdrawal bleed within next 10days to get blood tests done on and or ord day of periods reduce weight maintain menstrual diary regular exercises at least one he daily follow health coach instructions lifestyle and dietary modifications as per diet coach advice future risks of diabetes hypertension heart diseases explained possible difficulty in conception explained to consult fertility expert for the same to follow up with the test reports advised"
    },
    {
        "instruction": "notice a couple small rash type about inches under the armpit then a rash on the chest and back xu weeks ago red blushes not itchy it slowly started to cover most of the chest and all of the back there are just a few on the upper arms a couple of different types more like pimple types on the buttocks and a few very small individual rashes to the knee I have used hydrocortisone cream xu weeks and has not gone away some seem like pimples rubbing a finger over top you can barley feel the rashes I am on 100 my wk test enanthate and 25 mgof dea and 2mg arimidex months no issues I changed the dose to 50 my of dea and my arimidex with 100 my wk test enanthate I did how ever take one dose of test cypionate between test the one week when I started to take hug and up the dose 50 my of dea and my arimidex week I stopped all meds days ago and the rash has not really gone done I am healthy and eat well no past medical history sex activity has been protected march and 16 39 yo male not losing any hair no headaches dont recall feeling the flu no mouth issues no cuts or open lesions no pains",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello doctor I have experienced pain during penetration in the past but for the past six months sex has become such a painful experience for me I no longer enjoy it and I have a nonexistent sex drive I have no sex drive at all and I no longer enjoy sex and it has become so painful I also tend to dry out so quickly my partner and I have tried lube but it does not help at all I still experience pain",
        "input": "",
        "output": "hi having vaginismus is just like having any other medical problem the only difference is not many people talk about vaginismus not able to have sex can be emotionally exhausting and mentally disturbing but the good thing is that it is a completely curable condition treatment involves a combination of couple counseling and pelvic floor physiotherapy which consists of a thorough pelvic floor examination along with complete objective history by certified pelvic floor physiotherapist following with some relaxation exercises also called myofascial release either with direct interaction or using vaginal dilators physiotherapy increases the chances of success up to 98 patients mostly do not even need medication to treat this condition anxiety relieving medicine may be prescribed for some but only if required the primary treatment methods involve understanding the vagina and exploring it and slowly desensitizing it using vaginal dilators under the guidance of pelvic it for partners of vaginismus patients wise advice would be to be more supportive communicative and sensitive ones rock solid support to their partner is crucial for the chance of a complete cure intimacy is important but there are many ways to express your love pleasure is not the result of just one move take out the time to research and learn about each others bodies love and support is the key in such times"
    },
    {
        "instruction": "hello doctor a couple of days ago I punched a brick wall after the punch I felt a very sharp pain in my entire hand like a throbbing pain about 30 minutes after my hand was still hurting and when I would try to make a fist my pinky and ring finger would not go all the way my pinky also felt very numb I could not feel it now my pinky and ring finger knuckles are badly bruised and swollen I can make a fist and move my hand but it hurts every time I try to make a fist it feels like a huge amount of pressure is being put on my pinky and ring finger knuckles it also hurts a lot when I touch them to the point where I cannot touch them finally I have pierced skin around and on the bruise I am simply not sure if I have bruised the knuckle or if it is something else so would it be worth going to see a doctor",
        "input": "",
        "output": "hello sorry to hear about your hand I think the bruise you mentioned could be because of any bony injury or just soft tissue injury but it would be worth to get an ray of the hand to rule out a fracture the mechanism of injury you mentioned might cause something called boxers fracture fifth metacarpal fracture if ray comes out clear then you would just need to ice your hand and keep it elevated when you go to sleep by using a pillow also use regular pain killers if it is broken then it needs to be looked at by a hand surgeon"
    },
    {
        "instruction": "hello doctor my daughter who is three years old is believed to be having like tapeworms or threadworms she usually has itchy around her anus bloating feeling vomiting spitting and no appetite these days she is also losing weight day by day kindly prescribe medicines to remove the worms and include the required vitamins for her health",
        "input": "",
        "output": "hello with the list of symptoms mentioned it appears to be due to worm infestation any abdominal pain restless sleep irritable did you notice white thread like worms in the potty does she eat mud any other family member having a similar complaint well do this examine the anal area around the anus in the night two hours after she goes asleep pinworms usually come out of anus during the night this is only for confirmation always need to be confirmed whether we are treating the cause as there are many ailments that need to be ruled out for an unintentional weight loss treatment includes a single dose of tablet albendazole 400 my to be taken by all the family members once irrespective of symptoms at once if she has severe itching apply lotion caladryl in and around itchy areas now the most important aspect prevention wash her or bathe her immediately as she gets up as this gets rid of the eggs that have stuck to her butt area with hot water change her underwear and bed linens every day trim her nails every alternate day not to scratch no nail biting wash her and your hands frequently"
    },
    {
        "instruction": "hello doctor I have lip infection with a bump lip cracks are already there over a year and consulted a doctor from icliniq they suggested me chapter lip balm but no more good result now a bump has appeared about one day",
        "input": "",
        "output": "hello I have gone through your query and attachment I can understand your concern this bump on the inner side of your lips is called aphthous ulcers simple mouth ulcers so many factors can cause ulcers in the mouth it could be because of vitamin deficiencies hormonal changes psychological stress allergies accidental injury during brushing by food poking or bacterial infection this may take a week to resolve this is absolutely normal avoid hot and spicy foods until the ulcer heals do warm saline mouth rinses thrice daily rinse mouth after every meal if required if it hurts a topical anesthetic like dologel or hexigel can be applied over the ulcer with a clean finger maintaining good oral hygiene and following the above said instructions will prevent further infection of the ulcer and promotes faster healing chapped lips occur when our body becomes highly dehydrated we are exposed to long term cold weather or air conditioned environment and direct sun constant lip licking wetting habit which makes our lips even drier mouth breathing habit if constant nose blocks occur this can be taken care of by following simple tips at home drink lots of water and keep yourself hydrated at all times use honey or sugar to exfoliate the dried skin over the lips applying lip protection creams over dried and flaky skin will have no effect so rub those over the lips to remove dried flakes of skin and then apply lip protection creams for best results you can apply conut oil over the lips for faster healing if present it is best to break the lip licking and mouth breathing habit I hope this helps"
    },
    {
        "instruction": "hi doctor I am a 24 year old female when I was 18 I went to the doctor and they said I was leaking high amounts of protein also I had some bacteria showing up in my urine so she gave me medicine for that which I had to stop taking before the dosage was out because I reacted badly to it then she sent me to a kidney doctor who ran a bunch of tests and found nothing wrong he said I might have autoimmune deficiency and they might have to do a biopsy it scared me and I never went back six years later and I feel perfectly fine no frequent urinating or none of the symptoms I looked up I was always been in shape even though I do not eat healthily I was wondering after all these years should I be concerned about my kidneys I do not want to have kidney failure also my mom has the condition sarcoidosis which I know causes protein and a bunch of other stuff to happen",
        "input": "",
        "output": "hello going by the history given by you it seems that you had proteinuria that is protein leaking in the urine due to some defect in kidneys there are multiple conditions which can lead to proteinuria the treatment varies depending upon the cause which can be established by kidney biopsy there are a few causes which can resolve spontaneously which most probably happened in your case still I would advise doing a kidney function test urea creatinine urine routine urine protein creatinine ratio spot if these investigations show any abnormality we should proceed with a kidney biopsy to guide further management also please check your blood pressure as well"
    },
    {
        "instruction": "hello doctor I have chest pain and shortness of breath it started on 16th march since then it is still present continued discomfort in chest and back I am on my of atorvastatin",
        "input": "",
        "output": "hello I have gone through your reports resting egg and echo showed no abnormalities and stress test does not show any abnormalities although could not be completed so we cannot be certain that this is not cardiac pain but appears to be less likely so you should undergo further testing with either pharmacological stress test or it computed tomography coronary angiography now normal bop brain natriuretic peptide level is against cardiac cause for shortness of breath your thyearoid shows significant abnormalities you need to be on thyearoid supplements like eltroxin and should begin as soon as possible now do you get this chest heaviness at rest or on exertion if this heaviness occurs at rest only then possibility of other causes like acid reflux should also be considered especially if you have other symptoms you should try antacid then if heaviness classically occurs on exertion and relieves with rest then strongly suggest cardiac cause only and then should undergo further cardiac resting so possibility of non cardiac cause should also be suspected however should undergo further cardiac evaluation I hope this helps"
    },
    {
        "instruction": "hello doctor I had unprotected sex with my partner on 18th and 19th of last month where 18 was the next day after my periods took I pill on 21st morning because he was not sure if he has ejaculated inside but also he ejaculated sperm outside too now I have missed my periods which is supposed to be on 17th of this month also I had five days of spotting a week after the I pill I am years and my periods are regular is there a chance of pregnancy or will periods have missed this month because of hormonal imbalance",
        "input": "",
        "output": "hi thanks for the query I can understand your concern according to your description the possibility of pregnancy is less in your case as usual ovulation is not possible the next day after periods but emergency contraceptive pill may not give accurate results after 72 hours of unprotected intercourse the spotting and delay in periods could be the side effects of the pill better to go for a urine pregnancy test once to rule out the possibility of pregnancy if the test is negative better to wait for one more week and you may get periods if not please consult your doctor once and take tablets for withdrawal bleeding I hope this helps"
    },
    {
        "instruction": "hello I am 21 years old with a prominent pulmonary stenosis my work is staying open during the couid 19 pandemic and are wanting to know what employees will work I feel like if I say I do not want to work they may hold it against me in the future it is family video so people are constantly coming in and out and touching things my county just had their second confirmed case and the patient was around many people during the time before she was diagnosed therefore going to spread quickly does having a pulmonary stenosis put me at a greater risk or is it safe for me to wait out the situation and work in the meantime thanks",
        "input": "",
        "output": "hi welcome to the icliniq following is my opinion for your asked question pulmonary stenosis puts you at higher risk for complicated couid infection so if you get couid infection than course might be aggressive in you your country as mentioned not reach at stage where complete lockdown needed however it is good if you can avoid contact with other individual and if you can stay at home with your family surface contact hand shaking kissing all can also favour spread of couid so avoid close contact and use frequent hand sanitizer hope I have answered your question let me know if I can assist you further regards"
    },
    {
        "instruction": "hi doctor I am currently on adderall 30 my twice a day for narcolepsy with cataplexy and lexapro 20 my for resistant major depressive disorder my previous psychiatric nurse practitioner tried me on many antidepressants that did not work lexapro helps some but not much at all I have very bad anxiety and low mood with irritability is there another antidepressant I can take with adderall as it interacts with so many please help",
        "input": "",
        "output": "hello it looks like you have been tried on several different types of antidepressants already but did not help since you are on adderall for treating narcolepsy taking antidepressants will potentially lead to an increase in side effects this applies to all saris selective serotonin reuptake inhibitors and saris serotonin norepinephrine reuptake inhibitors type of antidepressants so you will need regular follow up by your prescribing doctor to monitor your response to the medication combination since you are saying lexapro escitalopram helps to an extent it will be worth trying to continue it and have additional psychological therapy like cut cognitive behavioral therapy to manage anxiety and depression if lexapro is not effective at all there are other options like sertraline and fluoxetine but they belong to the same class of medicines saris risk of potential interaction applies to these medications as well also ensure that narcolepsy is optically controlled it will help to improve your mood and help you to function better I hope this helps"
    },
    {
        "instruction": "hello doctor a week before I fell from riding a bicycle after going to market and my left knee hit the ground first I was able to stand up although I got wounded I went home and did first aid on my wound after a week my wound was healed but until now I feel the pain on my left leg there is less pain when standing and walking but when I sit and needed to bend my left leg I still feel the pain like that of rayuma I took biogenic to ease the pain I am allergic to ibuprofen and arcoxia please help me what to do and how this pain will heal I am anxious because I do not want to go to the hospital to consult this",
        "input": "",
        "output": "hello I am sorry you are having these symptoms this might still be due to injury resulting in soft tissue contusion I am not considering fracture at this point because you were still able to stand up but an ray of the left knee all would be recommended in the meantime I would recommend that you take mefenamic acid 500 my one tablet three times a day as needed for pain apply indomethacin gel and warm compress as needed for pain I would also recommend you do a range of motion exercises to decrease pain and improve flexibility if symptoms persist worsen or new onset of symptoms occur follow up consult is advised"
    },
    {
        "instruction": "hello doctor on march est I flew to utah from texas and developed cold symptoms after three days it was a normal cold but as it was almost gone no more congestion did not feel sick anymore I lost the sense of taste and smell overnight I have not had a sense of taste or smell for days now I do have a history of losing my sense of taste and smell for a few days during cold with congestion and for four weeks when I had mono I did speak with a general doctor and he seems to think my loss of taste and smell is cold or allergy related so he does not think I have coronavirus however this loss of sense of smell is different than all the rest I have never been without smell for this long after a normal cold and I have had a fairly clear nose for the entire duration of it so it cannot be due to congestion I just wanted to get a second opinion on if you think it could be coronavirus as news has just come out that this is a possible symptom of asymptomatic coronavirus carriers I am currently on amoxicillin for sinus infection",
        "input": "",
        "output": "hello I appreciate your timely picking up of the signs and reaching out to us we have two scenarios first is that you have coronavirus infection and the cold allergy and loss of smell are due to it unless you develop more severe symptoms like fever temperature breathing difficulty respiratory distress you do not go anywhere out of home you are going to remain quarantined till 15 days from now take plenty of fluids and water eat good and normal diet exercise indoors if you can second it is allergy related in this case it should subside in some time you can try some nasal steroids and other measures told above in the first scenario also nasal steroids can be tried you can revert back to us if you need any further support"
    },
    {
        "instruction": "hello doctor I have non allergic asthma diagnosed before six years currently I am using a corticosteroids foster inhaler two times a day with two inhalation each time after the inhalation I clear my throat with throat cleaning solution and also I use a sprayer with propolis and ethanol several times per day and yet despite that I got the oral thrush with white dots all over my throat I thought that maybe it is just temporary and will disappear after a while but three weeks passed and it still stays the same do I need to buy some medication or do I need to just wait for it to disappear while still using the sprayer also can this be related with my higher temperature which is varying in the interval 37 37 4",
        "input": "",
        "output": "hi oral thrush that is oral candidiasis is a kind of yeast infection that in your case can be attributed to long term steroid use this is a kind of untoward effect due to inhaled steroids you need to clearly examine the entire oral mucosa with regard to the extent the creamy layer has spread coming to the treatment aspect you need to apply nystatin suspension on the affected area four times daily which means the sequence should be food gargle apply medicine nystatin should be applied to the white areas inside of each cheek and or on the tongue apply gently with your finger continue for 48 hours after all of the white spots have disappeared also get fbi fasting blood sugar done to screen for diabetes"
    },
    {
        "instruction": "i am daily planning since 15 years to wake up early in the morning and do some exercise yoga but till date I am unable to wake up early and no exercise in my life style I daily put alarm but daily when alarm starts I very vastly switch it off I am unable to break my comfort zone I am so lazy in my work that I can take whole day to write simple official letter reply I am very slow in doing every work for example if I go to toilet and bathing I take almost one hour if I go to wash my clothes I will do it almost in one hour I want to change my way of living life and want to do everything with proper time and duration I want to come out of my comfort zone and do things with proper timing so please advise",
        "input": "",
        "output": "hi thanks for your query I understand its difficult to keep your self motivated and win over to your own self that the hardest part in life to start with please limit and write down goals first make sure your goals must be practical which you can do easily start with small steps g if you want to start exercise dont limit yourself to morning time with 1hr start with anytime in a day foe 15 20mins also start with simple walk please remember intensity and duration also keep us motivated once you establish a routine than you can keep it moving also its better to do with some friend or partner it also helps in motivation foe other activities apply the similar rule"
    },
    {
        "instruction": "hi sir me and my girlfriend had romance during that time my tennis tip entered her vaginal opening thrice I didn't ejaculated before or during the romance time but after few days she missed her periods what might reason thanks waiting for the reply what will be the reason",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello I am writing to ask about some symptoms I have been experiencing I am 57 years old for almost a week I havehad persistent low grade fever never more than 100 after the end of the week today I no longer has a fever we did a blood test and found abnormally low amount of platelets 127 thousand microliter when we did the blood test six months ago it was at normal level of 166 thousand microliter during the fever I had no other symptoms no cough no throat pain no runny nose no breathing issue etc even though the fever seems to be gone since today I am very worried as to what may have caused it if it could be linked to a serious disease so far the platelet count is the only abnormal thing showing up in the blood test thank you",
        "input": "",
        "output": "hello keeping into the current circumstances your fear is completely justified good thing is your fever has subsided excellent is not having any upper respiratory tract symptoms during the febrile episode now coming to low platelet count medically known as thrombocytopenia your count that is 27 m3 falls in mild range 00 m3 50 m3 which can happen due to multiple reasons lab error pseudothrombocytopenia due to the anticoagulant used edta low platelet count is considered when associated with bleeding symptoms like spontaneous or easy bruising petechial rash bleeding gum bleeding etc you have none hence I foresee it to be a lab error edta induced further if you are worried you can get that rechecked by going for reanalysis of platelet count in heparin or sodium citrate based collection or peripheral smear I can assure you with the history of your current illness provided that your health is safe and sound and all is well eat well sleep well stay safe take care"
    },
    {
        "instruction": "hello doctor my brother age is having severe abdominal pain and he has history of pancreatitis he is currently in the hospital and yesterday mri was done below is the highlight of mri report reports pancreatic body and tail appear mild atrophy with peripancreatic fat streakiness accessory pancreatic duct draining the body and tail region appear dilated umm with irregular wall and drain separately into minor papilla main pancreatic duct is dilated 6mm and joint to cod forming common channel of length 17mm before drain into duodelenum distal end of common duct show a hypnointense calculus of size 4mm a hypnointense calculus is also seen at proximal part of main pancreatic duct liver appears normal in size portal venous system appears normal gall bladder appears normal in appearance and wall thickness no o calculi detected cod is dilated 1mm with dilated ihr spleen appear normal in size visualise portions of l kidneys appear normal in size now doctors are saying we need to do tenting I wanted to know why tenting is required and is it necessary at this stage what will be the complications after tenting what if we do not do tenting now what are the alternatives for tenting",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hi doctor I have vocal nodules how to treat it faster at home",
        "input": "",
        "output": "hi if vocal nodules are confirmed by a doctor then there are a few things which you should know vocal nodules are small thickening in both vocal cords which usually occur secondary to excessive voice use and very common in singers teachers and any professional voice user more than percent of vocal nodules resolve with simple measures such as voice rest steam inhalation drinking warm water frequently to avoid throat dryness and sometimes voice therapy may be required only one percent of vocal nodules need surgery especially in people who do not follow the above measures so you need to continue voice rest steam inhalation drink warm water have two teaspoons of honey three times daily it prevents excessive dryness"
    },
    {
        "instruction": "hello doctor I had sex on 13th of last month last period was 31st before the condom burst inside me and cum went inside so after five to six hours I took unwanted 72 then from 17th to 2nd there was bleeding and cramps but now it is about one month and I did not get my periods is there any chance I am pregnant",
        "input": "",
        "output": "hello yes there is some chance do urine pregnancy tests if the test comes positive then there is pregnancy and if the test comes negative then it is disturbed menses due to emergency pills here are some detailed explanations unwanted 72 is an emergency contraceptive pill and it can disturb your menses it can disturb the cycle for two to three cycles you may have irregular periods or delayed periods also at the same time it is not 10 effective to prevent pregnancy there is some chance of failure even if taken within the time period you have periods on jan 31st and have intercourse on 13 feb which is almost near ovulation period after taking unwanted 72 there is withdrawal bleeding mostly within seven days that does not mean period after that it is almost a month so do a urine pregnancy test for confirmation if it is negative then you can take tablet primoult daily for five days and then wait for periods it should come in 10 days after the last tablet in case if the test comes positive then you are pregnant and you can continue or terminate pregnancy do drink more water can do one ultrasound sonography for other reasons for delaying menses like an ovarian cyst"
    },
    {
        "instruction": "hello doctor I have an abscessed bartholin gland cyst this is like my 10th go around with this thing I had marsupialization a few years ago it did not work the way I was told it would but it did make it so afterward every one I would have got pus drain and go away easier but this one is not draining I am in pain I have no insurance and now I am out of work so I have no money please give me some antibiotics I am currently on levothyearoxine",
        "input": "",
        "output": "hi it needs marsupialization or complete removal and if there is recurrence so many times mean you are not following proper hygiene and precautions told by the doctor you can take amoxicillin and clavulanic acid 625 my like combination two times a day and metronidazole 400 my two times a day both for five to eight days you can take a painkiller along with it but if there is pus then it should be drained or the best thing is to reoperate drink more water keep the vaginal area as dry as possible hot water fomenting may help if increasing more than need a clinical examination and also require to send pus for culture sensitivity test to find out which antibiotics work perfectly on it and according to the report antibiotics should be taken also complete the course of antibiotics send some photos to see at least how severe is the infection I hope this helps"
    },
    {
        "instruction": "hello doctor to start I have bipolar disorder type I social and generalized anxiety disorders previously I failed to sari medications such as zoloft prozac lexapro I tried lithium depakote and carbamazepine with no success however currently I take 50 my of lamictal and 75 my venlafaxine this treatment kind fits me because I have lessened anxiety levels for sure it is my first week on venlafaxine or and the second week on lamictal in a few days we will increase lamictal to 100 my and after two weeks to 200 my I also take tranxene 10 my if needed as well as olanzapine 10 my how come I responded to venlafaxine or so fast when I did not respond to sari I lack energy and motivation should I increase venlafaxine or to 150 if so will it have more effects on my anxiety and depressive episode",
        "input": "",
        "output": "hello it is good to know that you are responding to your current medication venlafaxine or is an sari serotonin norepinephrine reuptake inhibitors which can be helpful when saris selective serotonin reuptake inhibitors have not been effective I note that you have been tried on different saris and mood stabilizers before with no success it is positive that you have found venlafaxine or 75 my to lessen your anxiety I will advise to continue with the titration regimen suggested by your prescribing doctor do not rush to increase the dose to 150 my as titration needs to be carefully considered after weighing up your response and any side effects as you are also on increasing dose of lamictal it makes sense to do the titration gradually have regular follow up with your prescribing doctor as you are on multiple medications and need to monitor along with medication I hope you are also having therapy counseling to manage your health I hope this helps"
    },
    {
        "instruction": "hello doctor my son incurred puffy eyes last week until now he experiences fever and headache fever reduces when I give him paracetamol but it will recur again and still he is having swollen puffy eyes please help",
        "input": "",
        "output": "hi welcome to icliniq com as per the picture it seems your child is having some kind of allergy or infection are there any other symptoms like itching pain or any eye discharge how is his left eye is he having an allergy to anything he ate or came in contact with anything unusual we will do basic investigation urine routine including proteins and rec red blood cells complete blood count and blood pressure presently you can give him paracetamol 500 my twice a day for three days and can repeat paracetamol by keeping a gap of at least six hours between two doses if fever persists and tablet cetirizine my once at night for five days and maintain proper hygiene of eyes avoid warm compresses for now please upload a picture with an open eye and let me know the history in detail"
    },
    {
        "instruction": "hi doctor I am currently on a low carb high fat diet to lose weight how much of a calorie deficit do I need to accomplish weight loss decrease body fat percentage more than muscle mass",
        "input": "",
        "output": "hi your mi is 23 which is near normal it might be with muscle mass or fat content I need to evaluate still and need details for proper nutritional assessment to provide a correct advice according to who world health organization you need 200 cal day for most people a calorie deficit of 500 calories per day is sufficient for weight loss and unlikely to significantly affect your hunger or energy levels to create this calorie deficit you need to know what your maintenance calories are"
    },
    {
        "instruction": "hello doctor I have a cough at certain times almost every day due to post nasal drip I take allergy medication cetirizine but it does not seem to help I have tried other techniques like lavage and have tried thinning my mucus by drinking more water as advised by all the medical web sites all the explanations I read online say that post nasal drip is caused by a thickening of the mucus that the mucus membranes make about a quart a day of mucus which normally is thin enough to slide down the throat unnoticed and ends up in the stomach but if it is too thick it is noticeable and it ends up going down the windpipe and needs to be brought up through coughing here is what I do not understand normally the passage that is open is the trachea the epiglottis only closes when swallowing and furthermore it is behind the esophagus so why the thin mucus which is sliding down our throat unnoticed does not go down into our lungs it makes no sense if I do not notice it and thus do not consciously swallow it how does it go down the esophagus it should be the opposite please suggest",
        "input": "",
        "output": "hi I am so delighted to read your query my initial thoughts were that you were kidding but when I thought I realized how beautifully you have thought about the question we need to know about mucociliary clearance direction of mucus movement closure of airway by the epiglottis supraglottis and by the glottis mucociliary movement occurs towards the throat and that is what brings the mucus towards the throat like you said when the mucus gets thick due to allergy or infection or rhinitis one gets a feeling of the movement cilia are small brush like extensions from cells which beat in a particular direction so as to drive the mucus film over the cilia towards the throat from the throat the brush border epithelium that is the ciliated columnar respiratory epithelium pushes the mucus towards the pyeariform fossa preferentially the epiglottis and aryepiglottic fold and the inter arytenoid region form the supraglottic closure which acts as the first check point towards aspirating one own saliva the next check point is the glottis or the vocal cords which remain closed to prevent aspiration in such times when the mucus drip is constant and thick then some microaspirations occur due to the nature of the mucus as well as due to any lax behavior of the closures causing some cough or chest infection you must understand that the vocal cords trachea and the respiratory pathways further below are also lined by ciliated epithelium which also have a mucus layer on top of them this mucus layer traps smaller particles which escape the upper airways and bring them away from alveoli they also moisturize the air we inhale in your case you need to arrest the cause that is causing the thick mucus that is inside the nose you need a asteroidal nasal spray taken in a particular way for a few weeks this supplemented with an antacid like protonic and cetrizine will provide you lasting relief you should also take mucolite for a few days to lighten the mucus couple this with steam and plenty of water avoid exposure to sun smoke pollution and dust"
    },
    {
        "instruction": "hello doctor my condition is herd and lor and I am so stressed out with this I cannot even sleep I take esomeprazole 40mg per day but still no improvement I sleep but sometimes acid reaches my throat when I wake up I am on this for one month and I feel every time I take pills that they remain stuck in my throat like down the esophagus and I must drink a lot to push it down I am on diet with no spicy no coffee no alcohol and I have a list with acidic foods I am scared about my esophagus to not be very damaged this will destroy me for real I am only 24 should I double the dose should I change medicines now with the coronavirus I cannot find any doctor I do not feel heartburn but I always hear my stomach making a weird sound when lying in bed please help",
        "input": "",
        "output": "hello I understand your concern and at this point I would recommend further evaluation in order to better assess your condition I would recommend a barium swallow ray endoscopy esophageal manometry and 24 hour esophageal acid test I would recommend you shift your esomeprazole to ranitidine 150 my twice a day for two weeks and metoclopramide 10 my one tablet four times a day for five days if symptoms persist worsen or new onset of symptoms such as diarrhea further consult is advised I hope this helps"
    },
    {
        "instruction": "hello doctor my aunt seems to have a psychotic episode she talks nonsense things a few times a day mostly normal sleepless nights for five days while nearing menopause she was prescribed lithium mirtazapine olanzapine and citalopram which she used for three months a year back and stopped them since she started again yesterday as we asked her to what is happening to her is her treatment appropriate",
        "input": "",
        "output": "hello from your description and prescribed medication it looks like your aunt may have been experiencing psychotic symptoms with an affective disorder additional past history and current assessment will help to clarify the exact diagnosis mood disorders affective disorders can be influenced by menstrual cycle changes usually the cause will be a combination of biological psychological and social factors a complete assessment will help to identify the triggering factors for your aunt illness and help with her recovery it is advisable to consult a psychiatrist to clarify her diagnosis and start medication appropriately lithium is a mood stabilizer olanzapine is an antipsychotic which also acts as a mood stabilizer mirtazapine and citalopram are antidepressants depending on her current symptoms she may need to be started on the most suitable medication at a starting dose and gradually increase it is not advisable to start all the medication at the same time dose needs to be proper as well these medications are helpful but are potent so should be used under medical supervision only so it is safer to consult the doctor who prescribed these medications for review try to be supportive of your aunt avoid any conflicts and arguments as they can make her more unstable at present sleep is important to help in her recovery if possible encourage her to do some exercise at home she will gradually settle down with appropriate support she may need to continue medication for a longer term"
    },
    {
        "instruction": "hello doctor I am 36 years old I am a vegetarian and I weigh about 79 keg before three years due to stomach disturbance yellowish urine pain and some popup and cracker sound in my legs knee joints I visited a doctor and he suggests me lab test of liver function test and all reports in normal range except of sugar which was 138 at that time and gave me some medicines and referred to orthopedic for joint pain I have visited orthopedic specialist he took ray of both legs knees and tell that it is an early stage of osteoarthritis of knee and he suggested for mri and I had done mri in the mri report it is mentioned that left knee has affected with osteoarthritis after that he gave some medicines for 10 days and referred to a physiotherapist for exercise and weight loss I have visited as he told and now I reduce my weight now there is very little pain in my left knee but now my other joints hips joints like left hand thumb finger and both hand knees has popup sound during movement as I prefer stomach specialist consultation over orthopedic because I want to know the reason behind this situation and still I have slight yellowish urine kindly correlate all the reports related to the stomach liver arthritis and please diagnose my problem and suggest treatment for the same and suggest reports to do if needed",
        "input": "",
        "output": "hello I had gone through your all reports nothing looks like alarming except slightly low vitamin levels for yellow urine I assure you it is totally insignificant as your all liver related test are normal including bilirubin level and fibroscan so do not go on chasing it I had seen doctor did all test which was very costly and not needed for your issues so more doctor you go more test they will do now coming to your popping sound from joints let me tell you it has nothing to do with stomach related issues if you are thinking of gas from the stomach causing this then forget it as it is not the cause hoping most of the time is a normal phenomenon when cartilage or ligaments rub against bone some percentage of person have osteoarthritis which can lead to this but alarming hoping is always with pain swelling redness and deformity in walking so chill I do not think you should worry about this thing unless the above symptoms present and at your age arthritis is very unlikely so my advice is to regularize your daily activities which include milk for vitamin in your diet do exercise of any kind for 45 minutes daily for stomach upset you can use syearup gaviscon two tablespoons whenever you get symptoms as it is safe and locally acting do not do doctors shopping"
    },
    {
        "instruction": "hello doctor mri report shows left cerebellopontine angle arachnoid cyst measuring 18 12 10 my displacing ith and 10th cranial nerves ventrally misc prominent bilateral level lymph nodes also left level a lymph node measuring 29 my I went to an ent because I was dealing with terrible pressure in my head and also pulsatile tinnitus I constantly hear my heart beating or blood pumping in my left ear I have had grand mal seizures and a febrile seizure when I was a toddler in 2018 they did not see anything in my it scan ent referred me to a neurologist for the pressure in my head being migraines and also to a neuro otologist for the cyst who then referred me to a neurosurgeon that I have not went to due to couid 19 outbreak only procedure I ever had done was an epidural injection in my lumbar for bulging disc which after the procedure I dealt with massive head aches doctor told me they would subside I am 21 years old I am just looking to see some opinions on this matter and how it should be treated forgot to add in I have been dealing with neck pain also now",
        "input": "",
        "output": "hello I would like to know more about your headache heaviness in head like the location of pain frequency severity a particular time of the day when it occurs associated vomiting nausea or blurring of vision how long does it last does it require medicines to be taken always I also would like to know tinnitus is in the left ear only any medicines for seizures also it would be nice if you can send images of mri to have a better idea about the arachnoid cyst please elaborate on the problems and answer all these questions and send mri images so that I can suggest you better"
    },
    {
        "instruction": "hello doctor I have been bitten by a stray dog on the left leg on march 10th the next day I went to a nearby doctor and he advised me to take two doses of vaccine as I had taken three doses earlier before four years there was no blood visible at the wound and I washed it in soapy water also for five to ten minutes but from march 23 I am feeling pulsating sensation at the bite site often they come and go it does not happen always I have consulted with four nearby doctors and they all told me this not a sign of rabies so is it for rabies or for extreme anxiousness the dog is still alive and fine",
        "input": "",
        "output": "hello welcome to icliniq com firstly yes this is not a symptom of rabies and it would have progressed by now if it was rabies also since you are vaccinated and the dog is still alive you are unlikely to get rabies so it is unlikely to be rabies and trust local doctors also keep watch over the symptoms so you should not worry at present"
    },
    {
        "instruction": "hello doctor I have a sore throat since yesterday there is also a slight fever of 37 I suspect my swollen tonsil I had taken juices and garbled warm water with salt for the fever I took paracetamol if needed",
        "input": "",
        "output": "hi do you have any other symptoms such as cough or difficulty breathing any recent history of travel to china or any exposure to someone who may be possible with couid 19"
    },
    {
        "instruction": "hello doctor I have been diagnosed with catastrophic antiphospholipid syndrome before three years and had a brain stroke in the same month due to blood clots since then I have not encountered any blood clot and have been on acitrom my ecosprin 75 my and azathioprine 100 my three weeks back neurologist had replaced azathioprine with hcq 300 my ana test was done before changing ana result was negative now for the last two days I am experiencing pain near the heart line the pain lasts for around one minute pain is such that it starts from deep inside and it pulls the skin organs inwards I have experienced such pain three to four times since two days my query is this due to a change in medication whether hcq be stopped and azathioprine be restarted what is the use of azoran in as and are these both drugs somewhat similar kindly guide as I am worried should I continue with hcq and if not is azoran safe in the long run I am taking azoran for more than 5 years",
        "input": "",
        "output": "hello welcome to icliniq com what treatment did you get during catastrophic antiphospholipid syndrome was your alla la test was positive azoran is an immunomodulatory drug and has some role in alla syndrome hcqs is a good drug for alla as it has an anti inflammatory plus anticoagulant effect but your symptoms started after three weeks of hcqs please try to consult your physician as he has examined you and he knows complete details so he can guide that azoran should be restarted or not according to my opinion in your case I think you should restart azoran and stop hcqs"
    },
    {
        "instruction": "hi doctor I have had one ear plugged completely with limited to no hearing on that side I have been to the doctor and received amoxicillin and steroids for it as well as ciprodex ear drops and a bromide nasal spray but my ear is still plugged I woke up last week with this condition and debilitating vertigo as well this is the first time I have had such debilitating vertigo in general I went to urgent care and received a shot of zofran to stop the nausea and purging the dizziness has tamed down a bit but still I get woozy when I turn my head or look up and down I am worried about the lasting condition of my ear and would love some help as I have not been to an otolaryngologist yet",
        "input": "",
        "output": "hi your ear bulging is mostly because of eustachian tube dysfunction and middle ear inflammation use nasal decongestant drops as otrivin while lying down on your back and your head is lower than your whole body trendelenburg position chewing gums may help in opening the obstructive eustachian tube too now about vertigo it is now related to certain positions as looking up or down so this type of vertigo is related to your inner ear many drugs can end this vertigo but it has a dramatic side effect as it destroys the normal compensatory mechanism of your vestibular system so the best choice is to get help from an audiovestibular specialist who can help you performing a maneuver something like physical therapy in the form of or visits after which the vertigo can be completely treated"
    },
    {
        "instruction": "hi doctor I am a 21 year old female 129 14 labs over a year ago I was diagnosed with anorexia eating disorder by my initial counselor and I have been under recovery for the same for over a year during the course of my recovery I had to change my therapist the new therapist recently during one of our session told me that I do not have anorexia but just an eating disorder however all my symptoms are that of anorexia restricting food intake starving and inducing vomiting I have lost my weight from 73 keg to 58 keg I have been confused immensely since then regarding what illness do I really have my query is can a person show symptoms of anorexia but not be anorexic can they just have an eating disorder what is that even supposed to mean I have also been diagnosed with ptsd depression mild anxiety I am currently on flunile 50 my spenzo my",
        "input": "",
        "output": "hello anorexia is a type of eating disorder where the weight is 85 or below the normal range in addition to eating disorder symptoms like restricted food intake self induced vomiting menstrual disturbances etc the body weight has to be 15 below normal to diagnose anorexia nervosa based on your reported weight and height your body weight and mi body mass index fall within the normal range perhaps that is why your counselor may have said it is an eating disorder and not anorexia nervosa irrespective of this technicality it is important to get appropriate treatment to address the eating disorder cognition and behavior which is important if you are still having self induced vomiting discuss with your counselor doctor about having a blood test and physical examination to ascertain your physical health status I hope this helps"
    },
    {
        "instruction": "hi doctor I am writing this to inform you that I have had a crushing pressured injury in my hands while I was at work three weeks ago as I was pushing set of 10 chairs with the chair troll and they were quite heavy as I was pushing the troll forward it managed to almost lean towards me in other words it pressed on my right hand underneath my knuckles back hand to be specific for at least seven seconds my colleague and I managed to push the chairs away from me eventually my right hand was sore causing me to hand tingling feels and irritation to cold weather which I did not have before but no pain this monday that had gone by it started causing me burning sensations on both my back hand including the one that has not been injured it was extremely discomfortable and unpleasant feeling I even found it hard to sleep at night by tuesday and wednesday it began to slowly progress the burning sensations inflammation towards my wrist and towards my arms through the biceps and even towards my neck I have started taking amitriptyline and anti inflammatory medicines which have slightly helped but not much I did see an emergency doctor in between and suggested that it could be potentially cops or nerve irritation but they cannot know for certain due to the pandemic of couid 19 it is very difficult to see any doctors at this present moment and I am self isolating myself at home having said that I am very worried about my situation and would like to get more clarity to this situation is this a continuous problem that will go on is this cops and if so can I recover can it be a nerve compression and is my nerves misfiring or is this a sign of recovery currently these are the following feelings I currently experience burning sensations in my hands and neck now hypersensitivity skin irritations wearing clothes using blankets etc affected areas feel weak and sore",
        "input": "",
        "output": "hello I read carefully your question and would explain that your symptoms are suggestive of a pinched nerve compression the nerve compression could be on the wrist carpal tunnel or in the neck a possible bulging intervertebral disk which is causing radicular nerve pain in the arm and hand for this reason it would be necessary consulting with a neurologist for a physical exam a cervical spine ray study and nerve conduction studies anyway considering the virus infection I think that all these tests can wait as it is not a serious medical condition I would recommend avoiding weight loss and wearing a splint in the hand during the night wrist splint for carpal tunnel syndrome which you can find in the drug store if it helps improve your situation it would indicate carpal tunnel syndrome as the main cause underlying your complaints I would also recommend taking gabapentin to help relieve the burning sensation I hope this helps"
    },
    {
        "instruction": "hello doctor my son is 10 years old he is having a problem in the left ear where a yellow liquid comes out with pain for the last three days please suggest",
        "input": "",
        "output": "hi I can understand your concern the possibility of left ear infection is more likely I would like to know is there any fever any reduced hearing in that ear please reply so that I can guide you better"
    },
    {
        "instruction": "hi I had enlarged lymph nodes on both sides of the neck I sought consult and had a neck dissection and biopsy I believe I healthy I dont feel anything except for the enlarged lymph nodes it was noted in the result histiocytic necrotizing lymphadenitis consider kikuchi fujimoto lupus adenitis correlation with serum studies for she is suggested so what to do I was advised to consult with rheuma doctor I hope you can help me thank you so much",
        "input": "",
        "output": "hello have gone through the details submitted localised painless cervical lymphadenopathy kikuchi lymphadenitis is a well known though uncommon idiopathic lymphadenitis its a self limiting entity and will remit on its own its close differential diagnosis is lupus she lymphadenitis has to be ruled out any joint pains any fever any myalgias fatigue other region of lymph nodes like in arm pits inguinal regions if enlarged just slide your fingers in these regions and see for any enlarged nodes any skin rash any other systemic symptoms if you have any of the above symptoms you need to get screened for she to rule it out ana screening and them ana profile else stay cool dont even think about it maintain good oral hygiene do warm water or salt water gargling frequently if any of the above complaints appear positive do revert get peripheral smear ear seum lah done along with above in case your symptoms increase take care regards do geeta"
    },
    {
        "instruction": "it has been weeks that I am experiencing front neck pain first weeks it is just the right side that is painful and the pain is just manageable on the third week this week the pain worsen that I have to take pain reliever the entire front of my neck is painful and I can feel swollen lamp nodes already the pain radiates to my ears and it is painful to swallow I also experience dry cough only at night I took paracetamol neozep then the pain stops but recurs after hours in the last two days my body temp increase the highest is 37 celsius but it will be lowered when I take paracetamol I take paracetamol tylenol every hours and consumed tablets already the pain subsides but still recurs I try to compare what I am feeling with couid 19 symptoms but I only scored based on specified symptoms of doh",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hi doctor having shoulder pain from yesterday right after getting up from bed yesterday it was mild but today it got increased and having pain while moving shoulder and during shoulder movements having pain during shoulder movements like lifting and feeling shoulder stiffness",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello I am 28 years old and currently have a medical issue every time after a meal I feel this sort of soreness in the root of my tongue it feels like the root is pushing the tongue up the same happens when I drink coffee and coca cola I was wondering if I could get some help diagnosing the issue I am an asthma patient but do not feel like the two are connected thanks",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello doctor I have been trying to conceive for one year I am 30 years old I have children already tracking but and oh to determine ovulation days which I have found my peak I had lots of irregular periods with 20 day cycles last cycle was 26 days I want to try clomid because I believe I may be having problems with the release of eggs please help",
        "input": "",
        "output": "hello before opting for ovulation induction in your case it would be important to learn if your partner semen analysis is normal on the first hand your cycle seems to be regularly irregular which is often seen in cases of women with estrogen deficiency and the ones with progesterone deficiency as you have mentioned that your thyearoid is normal but my primary concern with regards to ovulation remains the estradiol levels fish oh am serum testosterone on day of your cycle and serum progesterone on day 21 of your cycle without having these reports handy it would not be recommended to opt for clomiphene citrate to induction ovulation please share your latest ultrasound pelvis as well to check for your endometrial thickness in proliferative or mid cycle also app tracker for oh is futile rather it is suggested if you can opt for oh ovulation kits to actually determine your oh surge during cycle as that would be more objective"
    },
    {
        "instruction": "hello doctor my partner is schizophrenic she is not medicated because she does not have health insurance for the past five days she has been talking to herself thinking she is having a conversation with others for the last two days she has been having episodes thinking that the imaginary people are putting snakes inside of her I have taken her to emergency room times but she leaves shortly after arriving because she is being told by the voices that she is not at a real hospital I am worried that she might hurt herself not purposely but by accident since she truly believes the voices are putting snakes inside of her I do not know what to do please let me know what to do",
        "input": "",
        "output": "hello yes those are symptoms of schizophrenia it happens due to a chemical imbalance of certain neurotransmitters in the brain levels of dopamine are usually increased and medicines will help reduce the level and get it back to normal and restore the balance medicines like anti psychotics are usually prescribed by psychiatrists please take her to a psychiatrist and get started on medicines most such patients do not comply with medicines so in that case there are other options that you can discuss with your psychiatrist some medicines can be given in food or water or any beverage which are tasteless colorless and odorless once her acute symptoms are reduced she should comply with medicines also there are depot injections that can be given once a month or two months"
    },
    {
        "instruction": "hello doctor I am male 26 years old sex insecure and low experienced first trauma got during bombing of yugoslavia had to get new urinal channel and product of that is I am circumised later in school I have been bullied for years constantly physical and mentally by my school friends could not get into relationship till 25th year old had times sex with 10 seconds each troubling to stay erect fast ejaculation and even lower self confindence than before now I am troubling and overthinking what will happen next time will there be next time although it is hard to get into relationships because of that cannot stop pressuring myself with being bad in bed and unexpirienced as time pass it only gets worse",
        "input": "",
        "output": "hello I am so sorry to hear about your situation I can imagine how hard it is for you so you are describing a few things here when is the problem of premature ejaculation second is performance anxiety which is making you overthink third is low self confidence probably that came from the bullying and the trauma that you endured I would suggest you to start therapy sessions to help you build your confidence which will help you in decreasing the performance anxiety and then it will of course improve the problem of premature ejaculation if the mental health is stable sexual issues often resolve is there some neurological issues you will need to talk to a neurologist or a urologist for that try doing kegel exercise regularly which will help you in strengthening the muscle of pelvis which helps in premature ejaculation apart from that you will require therapy sessions to work on your confidence building and reducing anxiety cognitive behavioral therapy will help you in achieving this"
    },
    {
        "instruction": "hello doctor I am female 25 years old 159 am and 52 keg I have experienced sinusitis last year I felt pressure behind my left eyes and it went away after days then I noticed my left ear is slightly blocked and slight post nasal drip I went to a ent specialist at my vacation destination and was given amoxicillin for days and later augmenting and amoxicillin for days I felt my ear was getting better but it did not fully recover back in my country it is dificult to see a specialist so I finally went to onenext month eardrum normal hearing test came back normal and I was given nasonex and loratadine and was told to give it sometime and wait for the next appointment I went to another specialist and was given another course of antibiotics and oxy nase for weeks and was told to do the exercise of pinching my nose and swallow due to covid19 I am unable to visit the doctor again recently I found out if I lay on my left side for a period of time my left ear will feel more blocked and a slight hearing loss it goes away to 10 mins after I sit upright when I am bloated in the morning after waking up my swollen left eye would go away slower than my right eye what is wrong with me",
        "input": "",
        "output": "hi I can understand your concern happy that you could connect over here in times of outbreak when going outside will not be safe I have read your query and you have mentioned everything so clearly now coming to the point of your query the symptoms you are experiencing is due to middle ear infection one thing I would still need to know that if the doctor had a look inside your ear and told there was no rupture of tympanic membrane if not then this can be purely middle ear infection and may take some time to subside other reasons can be sinusitis wax impact which can take longer time to recover although clogged ear can be annoying here are some tips that can help alleviate the symptoms continue to do valsalva maneuver inhale steam take ot medicine as advised by your doctor do not use earplugs earbuds avoid any kind of water going to ears resting or sleeping sitting up rather than lying down can help fluid in your ear drain this could ease pressure and pain in your middle ear prop yourself up in bed with a stack of pillows or sleep in an armchair that leans back a bit if all of the above things are helping alleviate the symptoms then I would not worry and only give time for sinusitis to resolve please feel free to reach out in case of any doubt"
    },
    {
        "instruction": "hello doctor I am a 31 year old male suffering from hair dandruff for the past one year heavily I have a history of dandruff but I only used anti dandruff shampoo before only this last year it got so intense that now it is not only in my scalp but it started to show on my face it is showing a little bit above my upper mouth lip but a lot more intensive on my eyelids and I always have a burning sensation above my eyes when I wake up and sometimes it is itchy and looking red but it is burning intensely these days",
        "input": "",
        "output": "hi these are typical symptoms of seborrheic dermatitis it is a chronic condition due to overactivity and inflammation of the sebaceous gland sometimes aggravated by fungus malessezia a normal inhabitant of the body you need to stop all oil application keep dry use anti dandruff soap ketoconazole soap capsule itraconazole 200 my twice daily for two weeks after meals tablet levocetirizine 10 my once daily at night tablet deflazacort 30 my after breakfast once daily for five days tablet pantoprazole 40 my once daily 30 minutes before breakfast for five days ketoconazole shampoo to apply it twice weekly over the scalp and affected area for 10 minutes before bathing I hope this helps depend on the body some are more prone none sebopsoriasis less oil after two weeks"
    },
    {
        "instruction": "hello doctor does spotting on birth control mean your pill is not being effective",
        "input": "",
        "output": "hi how are you doing spotting in between cycles when you are regularly taking birth control pills means that the endometrium or the inner lining of the uterus is not being fully supported by the hormones if you are not punctual on taking pills or had vomited immediately after taking the pill then that will be the problem so you have to make it a point to take the pill regularly preferably at the same time every day if you are taking low dose pills then the dose is insufficient so you have to switch to the higher dose pills component of ethinyl estradiol in the pill of 30 mug is a high dose and good for these spotting instead of the 20 mug pills if you have been putting up weight recently hormones may be insufficient for that new weight I hope pregnancy had been ruled out before starting the pills and local factors like polyps or fibroid projecting into the uterine cavity have been ruled out by ultrasound scans of the pelvis local factors like spotting or discharge from the cervix especially after sex need a local examination and treatment if all possibilities have been ruled out then just give support of tablet estradiol valerate my progynova two tablets a day until the day of periods this will support the lining and spotting will stop in a day or two"
    },
    {
        "instruction": "hello doctor I am a 25 year old girl I have been feeling symptoms for two days but this is happening to me between periods and the other but now it is I feel constriction in the heart area there is no pain but I feel constricted and disturbed this increases when I stand for a long time but when I eat something sweet or salty these symptoms disappear this symptom is also accompanied by simple stomach pain gas and some muscular pain in the back pain ratio I would say about 10 I suffer from depression and anxiety",
        "input": "",
        "output": "hi welcome to the icliniq com your main complaint is pain and fatigue with some gastric issue let me know you that excess stress with anxiety can lead to chest pain as well as gastric ulcer for gastric issue pantoprazole tablet can be prescribed for two weeks if gas excessive then simethicon containing tablet or syearup can be taken for stress try to solve problems leading to stress if exams were not good you can read well now and can make goals for better reading yoga meditation and exercise will be having great effect in reducing stress if panic attacks comes frequently than fluoxetine like sari selective serotonin reuptake inhibitors group of drug can be started after doctor consultation if needed for anxiety issue you can consult a psychiatrist here I do not think you are having any heart problem if pain is increasing in severity then investigate with ekg electrocardiography also check your abc complete blood count report to look for low he hemoglobin"
    },
    {
        "instruction": "hello doctor I wanted to ask which medicine I can take that does not have any side effects so that I do not discharge early as I have once taken suhagra force which contains dapoxetine is there any medicine for it without any side effects and how often can I take it before intercourse secondly I want to ask is there any medicine to increase the size and width of my penis if yes then how it should be taken if there is any ayurvedic medicine then also you can suggest",
        "input": "",
        "output": "hello there is no medicine available to increase the size of the penis but by cosmetic surgery the size can be increased by one to two inches premature ejaculation is mostly psychological first you try to divert your self in between while having sex if you are about to cum then squeeze your glans in between your thumb and index finger you can also use local anesthetic gel but then it is better to use a condom with that finally there are a few medicines available which will increase your timing like dapoxetine which you have used but there are some side effects of all the drugs"
    },
    {
        "instruction": "hello doctor feeling of something stuck in the throat that comes and goes it is mostly there all the time but sometimes it will go away it actually feels more like that flap in my throat is twisted or I am swallowing it or something I had a scope down by a gi last week and they said they only thing they found was a hiatal hernia I just did a barium swallow test today waiting for the results a few weeks ago I had a swallow study done and they could see somewhere food was catching there on my epiglottis I just do not know how much more of this I can take I feel like it is a hairball or something stuck there or like a small flap or skin my question is would not gi doctor have seen it if that little flap in my throat or epiglottis or it was messed up or swollen or something",
        "input": "",
        "output": "hi the feeling of something stuck in the throat is usually due to gastric acid reflux causing pharyngeal irritation gastroenterologist will definitely see the epiglottis but it is not the pathology the regurgitation of swallow can be seen only on swallow studies that tell functional problems endoscopic examination can tell anatomical causes hiatal hernia is a cause for it even your swallow study is suggestive of this you should take some antacid regularly but the best solution for this is surgical correction this can be done laparoscopically too I hope this helps"
    },
    {
        "instruction": "hello doctor approximately one week ago I had my wisdom teeth removed on my lower left I have a dry socket which I am getting treated for via packing at least I think that is what it is called on the right side healing is just fine however I noticed some white stuff lodged in the gum I am not sure if it is food or scar tissue because when I tried to get it out with a toothpick it did not come out very easily so I left it alone is this food or scar tissue it is mildly bothersome I brush my teeth but know to be careful around the surgical sites so they do not get irritated it seems like a lot of plaque builds up back there because of this and I am not quite sure what to do also there is a very small spot of red gums on the front side of my second molar I put a bit of mouthwash on it with a toothpick and left it alone I have two questions what is the whitish stuff that feels like food trapped in my healing gum socket and what is this small patch of irritated gum on my second molar any help is appreciated I am currently on celexa for depression 600 my of ibuprofen for wisdom tooth pain",
        "input": "",
        "output": "hi as it is just one week of wisdom teeth extraction the white stuff seems to be most probably healing tissue only it is a normal appearance of healing tissue post extraction a white patch of irritated gum can be due to injury or ulceration that can be due to accidental injury with the extraction instrument or can be due to injury with a toothbrush or any hard food you can apply chlorhexidine gel over it do warm saline gargles antiseptic mouthwash gargles and brush your teeth twice a day for keeping plaque and deposits less accumulated I hope this helps"
    },
    {
        "instruction": "hi doctor I am constantly unable to focus on anything in my life my brain just seems like damaged I feel alone depressed sudden anxiety attacks shivering numbness extreme mood disbalance fatigued extra exhausted strange short feeling in which I feel very bad for myself like guilty of anything my mother always curses me and my brothers our family is wealthy educated but my mother and father have some domestic issues which have never ever been closed even I have become 18 years old I do not want to kill myself but I do not have any light ahead for living I am not able to describe each and everything right now I need to contact a psychiatrist or psychologist for better consultation",
        "input": "",
        "output": "hello you seem to have a mixed anxiety depressive disorder this is very common and about 10 15 percent of people have this problem it is also very easily treatable you will need to visit a psychiatrist and he will prescribe you sari type of medicines such as escitalopram 10 my or fluoxetine 20 my etc which will help with your problem it basically happens when some neurotransmitters such as serotonin reduce in your brain leading to a problem with handling the day to day stresses of life medicines are usually given for two to four months and then tapered off slowly and stopped in addition to the medicines you can also undergo a few sessions of cognitive behavioral therapy from a clinical psychologist also do consider doing deep breathing exercises or progressive muscle relaxation daily nextto 10 my escitalopram 10 my daily one at night after food"
    },
    {
        "instruction": "hi doctor I have a general question that relates personally to myself in relation to couid 19 I am a woman of 45 years and several years ago I had a severe case of pneumonia and I was hospitalized for a few weeks which I have completely no memory of it took me further 12 weeks to start to feel normal again since then I have had at least two chest infections a year and have also in the past two years I had many ti and kidney infections one of which was a few weeks ago and took lots of antibiotics to help at the moment I have a slight sore throat and like many do not know what and how to react to this I have never been diagnosed with any conditions but as I said get chest infections unis and kidney infections often am I more at risk of catching couid 19 and would I be put into the category of someone who has for example cold etc I am very worried and scared as I know how ill I was when I got pneumonia and also my husband has diabetes and high blood pressure which makes me even more concerned I am currently on naproxen co codamol when required due to back and neck pain resulting from a car accident fluoxetine daily",
        "input": "",
        "output": "hello welcome to icliniq om we all are at risk to covid19 but regular washing sanitization of hands and use of masks outside the home can reduce the risk since you have encountered pneumonia earlier your defense system must be boosted up still I would recommend that you talk to your physician and get yourself vaccinated with influenza quadrivalent vaccine yearly pneumococcal vaccine every sixth year these vaccines provide good prophylaxis against typical bacterial and viral infections"
    },
    {
        "instruction": "hello doctor my foot is swollen right now and I am sure that my uric acid went up again it happens in the past and I need some medication for the pain and the inflammation my height is 6 it and my weight is 95kg",
        "input": "",
        "output": "hello firstly the photo uploaded is not informative as the extent of redness or inflammation is not well demarcated secondly do you have any past history of gout if yes how many acute flares did you have in the past how severe only foot single joint or multiple joints any triggers like boozing food intake rich in rate any history oh physical exertion well management of gout includes three steps acute flare management acute flare prevention to clearthe uric acid stores and ti decrease deposition in joints for now management of pain is crucial naproxen 750 my stat and then naproxen 250 my thrice for 7 days with meals panto 40 my in the morning before breakfast rest avoid urine rich diet no to alcohol beverages get the uric acid levels checked revert to me with uric acid levels good photograph with proper focus on the affected area along with normal leg for reference detailed past history diet and drug history that includes both medicines and else as well very important is to follow proper diet veto diet no00 loose weight finally the urge to treat without a proven diagnosis is always resisted hence diagnosis is mandatory for best management as we practice evidence based medicine get well soon regards do geeta"
    },
    {
        "instruction": "hello doctor I have been diagnosed with osteoarthritis in both hands one doctor suggested erosion in the left hand while another read that the right hand did not see evidence of that I was wondering what your opinion is do you agree with osteoarthritis diagnosis and if so is there evidence of erosion all blood were negative for any autoimmune causes ana of ear cop etc",
        "input": "",
        "output": "hi osteoarthritis is not an autoimmune disorder so autoimmune markers are expected to be negative in an osteoarthritic joint as cartilage is irreversibly destroyed and bone abnormalities develop movement becomes painful and more difficult in my opinion regarding left hand ray I agree there is interphalangeal joint distal more pronounced narrowing and sclerosis I hope this helps osteoarthritis anti inflammatory and pain medication such as acetaminophen and non asteroidal anti inflammatory drugs topical analgesic injections of cortisone to decrease inflammation and physical occupational therapy self management strategies"
    },
    {
        "instruction": "hi doctor age 26 year sex male the problem is my knee pain befor month my knee pain when I sit and up for or minut please consult me for the relief my knee pain",
        "input": "",
        "output": ""
    },
    {
        "instruction": "my periods are not coming it one week more than the previous date nothing happened like this with me previous",
        "input": "",
        "output": "hi usually 28 plus minus days is considered a normal length of menstrual cycle so if this is the first time you had skipped your periods I would advise you to wait for another week if you still do not get your periods you can take the following medication mentioned below for your withdrawal also keep a track of your menstrual cycles if this gets repeated we need to evaluate it further and please check your urine pregnancy test if you are a sexually active individual or else you can ignore if there is no history of any contact stress thyearoid profile hemogram serum prolactin ultrasound abdomen pelvis thyearoid abnormalities cos for withdrawal bleeding to take tab meprate or devilry or primolut or regesterone 10mg twice daily for days and then stop to wait for withdrawal bleed within next 10days regular exercises avoid weight gain to follow up with the blood tests ultrasound as advised"
    },
    {
        "instruction": "i have recently like a month started to get acne and pimples on my face and my face itches a lot through out the day for no reason I do not have any rashes or anything it just randomly itches and I have been trying to get rid of the acne by take pantothenic acid vitamin be pills I am not allergic to anything that I know of at least and I have always had acne on my cheeks but very faded they have recently popped up and turned into pimples and my face itches for no reason it is the most annoying feeling also I have been getting a bunch of pimples on my nose and I have one that is been there for a month and it does not look like it is going to go I did not really struggle with acne before on my whole face but I always had a little cheek acne and eyebrow pimples pantothenic acid vitamin be it was not prescribed I just got it cause I seen a video of a lot of people saying it helps",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello doctor I am 41 years old my height is 7 and I weigh about 74 keg I am suffering from ed to 10 to 4 ash 37 total cholesterol 238 last year and 249 recently 25 oh vitamin total 58 87 no my blood glucose random 104 blood glucose post prandial 124 do hba1c 3 level 30 ash 60 uiu my fish 250 oh 400 prolactone 540 free testosterone 75 90 pig my there is a smoking history of 20 years one packet per day but I completely quit from the last six months doctor give me four to five testosterone injections and a sachet to drink with hot water later an endocrinologist told no need for medicine and hormones are functioning properly",
        "input": "",
        "output": "hi all your tests are normal except for high level of fish follicle stimulating hormone and oh lutenizing hormone and prolactin and your endocrinologist advises for no medicine for managing your ed erectile dysfunction try the life style modifications and use of sildenafil or tadalafil as on when required basis avoid alcohol and tobacco products if using currently go for a regular morning walk at least 45 minutes daily or go for exercise daily spend more time during foreplay take adequate sleep eat healthy food and drink plenty of water I hope this helps"
    },
    {
        "instruction": "hello doctor I had a mild sore throat last friday and started to take strepsils then the pain gone last sunday but early morning today at around am I had chills until the morning I took paracetamol right away my body temperature is 37 currently should I go to the hospital are my symptoms same as the couid 19",
        "input": "",
        "output": "hello viral infections produce similar symptoms common cold or seasonal flu produces similar symptoms as does coronavirus however it is the severity of symptoms that are worrying in coronavirus and the body response to contain the virus there is no need to panic right now just take precautionary measures like proper hand hygiene and proper respiratory etiquette and maintain a sort of isolation take plenty of fluids and other supportive measures as required if symptoms do not improve or worsen over a couple of days you can visit a health facility however if there is any history of contact or presumed contact with someone with suspicious symptoms or a travel history then it is better to report"
    },
    {
        "instruction": "hello doctor I have bipolar disorder panic attacks social and generalized anxiety disorder I have one to three panic attacks per day constant anxiety and fear of leaving the house no motivation to work no energy apathetic without mood right now I am in a depressive episode I previously tried valproic acid lithium carbamazepine xanax lorazepam clonazepam rudotel lexotanil fluoxetine sertraline and escitalopram sari does not have an effect on me right now I take lamictal 50 my daily and tranxene 5x5 my daily tranxene loses its anxiolytic effects and my anxiety becomes more severe I am planning to titrate lamictal 100 my however it should not help with anxiety what are my treatment options benzodiazepine are not an option because I am getting used to them two days later I have a consultation with my psychiatrist but I want to hear possible treatment for my conditions from another option I have done thyearoid heart function men hormones prolactin kidney and liver function tests all are normal",
        "input": "",
        "output": "hello if your anxiety is not responsive to sari selective serotonin reuptake inhibitors then you should consider trying tea tricyclic antidepressants class of antidepressants they will help with your anxiety and panic attacks apart from tranxene and benzodiazepine there are few other options for anxiolysis if you are specifically looking for something to be added to the tea such as propranolol buspirone tofisopam clobazam hydroxyzine and pregabalin also you can consider mirtazapine which will act as an antidepressant and also for anxiolysis it is a massa noradrenergic and specific serotonergic class of antidepressants"
    },
    {
        "instruction": "hello doctor I am having breathing difficulty for the past four weeks I went to a respiratory specialist after doing blood and urine test and the doctor told me everything shows normal but due to consuming too much coffee you have too much acid in your body that is the reason for the breathing issue for the past two weeks I completely cut my coffee and tea I feel better but still I am not fully recovered some food and fruits like chilli noodles red apple lemon and any food with preservatives I consumed during this time I could feel that it tightened my breathing flow I do not have pain or fever I am a smoker I do not have asthma the ray shows my heart and lungs are very healthy the question is how do I fully get rid of this issue I do not know how much longer it will take or what should I avoid eating when I drink chocolate milk yogurt rice potato my breathing is normal my nose also gets blocked most of the time the doctor gave me bilastine 20 my but I never used it I am a 35 year old male",
        "input": "",
        "output": "hi where is the breathing issue is it in the lower airways like in the chest or upper airway like in the throat is there any blocked feeling or lump sensation in the throat that you are mistaking as breathing trouble is there sneezing runny nose or post nasal drip"
    },
    {
        "instruction": "hello doctor my husband aged 31 is suffering from chronic back pain near the lower part extending till the upper part for the past eight months please help with the diagnosis he has a bad habit of sitting with a laptop for hours together he barely does walking or exercises he has taken an ray and ultrasound report looks to be normal but his pain has not reduced everyone says it is a muscle spasm is there any treatment for it",
        "input": "",
        "output": "hello I cannot see the film of the ray but the report is on mild straightening of the lumbar spine vertebra and disc spaces are normal us is normal except for mild fatty liver it seems that there are two issues here lack of exercise and long hours of sitting not lead to weak core muscles and as a result the structure of the back is feeling the strain usually the muscle help to take the load of the upper body but if they are weak the disc and facet joints start sharing more load and hence the back pain the best option is to start physiotherapy do core exercises planks bridges superman position cat camel clamshell etc you will get videos on the internet if you cannot go to a physiotherapist avoid sitting for more than 20 minutes at stretch preferably use a standing desk take a course of anti inflammatory tablets and apply ice and pain gels though not together come back after three weeks"
    },
    {
        "instruction": "hello doctor I have seen a dentist recently who said that I have periodontitis the dentist could not do an ray as I am 17 weeks pregnant the lower jaw front two teeth are lose and I am very anxious whether I will loose the teeth what treatment options do I have to fix the loose teeth",
        "input": "",
        "output": "hello as per your description you are having periodontitis and you are pregnant it is the inflammation of the periodontal ligament it should be treated because it may affect the health status ofcourse for any kind of second opinion one has to check it clinically or at least have an image of concern area you have not uploaded any videos or image of concern area I would like to tell that it is advisable to do only non surgical procedure during pregnancy if they are needed during pregnancy hormonal level also varies so it may also be the reason for your gingivitis you can read about pregnancy associated gingivitis or periodontitis regarding your lower teeth that are moving one has to check how much mobility is there and also the bone condition of teeth is important if grade one mobility is there then you do not have to worry and it will recover again one has to check clinically precautions that you should take are brushing twice daily gargling after every meal"
    },
    {
        "instruction": "hello doctor my symptoms are distinct white patches on the back of the throat persistent swollen lymph node in the neck for at least a week possibly longer slight soreness in throat near the node no fever but have had headaches throat flared up in soreness about a week ago then subsided though lingered and lymph node has stayed swollen preceding this flare up was a long period of post nasal drip and feeling something thick in the back of the throat looking at photos of my throat from 2015 it looks like I had very similar white patches on the back of my throat then as well so it is not clear if they are there permanently or chronically I cannot find many images online that correspond to this particular shape and pattern of white blotches at the back of the throat please advise I am a male of 39 years old I take 100 my sumatriptan when needed",
        "input": "",
        "output": "hello welcome to icliniq com what you are seeing are enlarged lymphatic channels in the back of your throat this condition is called cobblestone throat it is a term we use to describe irritated throat with visible bumps and lumps at the back remember that these bumps are due to enlarged lymphatic tissue in the tonsils and adenoids these are small pockets of tissue in the back of your throat which when you get irritated due to allergies postnatal drip or infection can become large and obvious you do not have strep throat or fungal like picture I would suggest trying anti histamine and tylenol for the next few weeks and see if it improves if not consult an ent I hope this helps"
    },
    {
        "instruction": "hi doctor I need your help as I am worried sick and it is affecting me mentally now that something serious is wrong with me seven months ago I began experiencing pain on my left side I went to my doctor who said it was just muscle pain the pain went on and got a lot worse four weeks I went to the toilet and I noticed I was peeing fresh blood the doctor gave me trimethoprim for three days which did not help as my urine was still showing high leukocytes and blood so she gave me ciprofloxacin 500 my for seven days and there is still blood showing up in the dip stick tests my doctor has ordered me a it scan to look for kidney stones but with this world virus I am not going to get my appointment anytime soon as we are in lockdown my urine looks clear now but I have noticed today there are streaks of blood in it now and I am terrified incase I have cancer I am still getting a stingy pain only left side which comes and goes and sometimes shooting pain I have multiple sclerosis also and I took my treatment of immunosuppressants in the last five weeks I am honestly going out my mind with worry incase this is cancer I am worried about the streaks of blood when I urinate as this has been going on for about four weeks now it clears then it comes back again",
        "input": "",
        "output": "hi I have gone through your queries please relax and sit at home do not worry you need not be in a hurry to get a it computed tomography program done at this pandemic state I am explaining the condition now you are having hematuria associated with flank pain hematuria was episodic at your age and profile it is unlikely that you have a urinary bladder or upper tract cancer the possibility is very less probable cause of your hematuria is stone disease it may be a kidney stone or ureteric stone you get these investigations done once the lockdown gets over check your serum creatinine cent rub and it program if creatinine is within normal limits these will tell you the final diagnosis in the meantime you can take tablet tamsulosin 4 my one tablet at bedtime for 30 days drotaverine 80 my sos when you have pain tamsulosin cannot be taken if you are having pregnancy take plenty of water orally 5 to liters per day"
    },
    {
        "instruction": "hello doctor I have a severe pain at the end of my upper left jaw exactly where my wisdom tooth was removed two years ago I have an ray of the area to show as well toothache starts in the morning everyday since about five days I do not have blood pressure diabetes or any other major issue today I started danzen is 20 minutes before food and synflex right after food in the morning I gargle with saline water and benzarin mouth wash five times a day each",
        "input": "",
        "output": "hello I have gone through your attachment the medication you are taking are right and oral hygiene measures also to the point I want to know a few more details about your site of concern do you have any injury or any kind of trauma over there any hot foodstuff or any sharp food thing hit there how does that site look like as you have not uploaded an image of that area or site so soft tissue evaluation is difficult if any minor injury or trauma is there or pain is there at that local site then you can apply ghee over there or local anesthetic oral gel lukewarm water with a pinch of salt in it for gargling will help more does any tooth from the lower arch hitting that site because that may be one of the reasons for local site pain"
    },
    {
        "instruction": "hello doctor a week ago I slightly injured the white area of the left eye a small red spot developed on the eye with some pain now that red spot gets pale but the pain is still there please suggest",
        "input": "",
        "output": "hi mostly it is sub conjunctival bleed that is not harmful it will take a week more to settle down start nepafenac eye drop twice daily for three days then taper it to one time a day for the next three days then stop"
    },
    {
        "instruction": "hello doctor I have been using cialis for years with great results but recently it is not working well what could cause this",
        "input": "",
        "output": "hi tadalafil has no known interaction with the drugs you have mentioned but magnesium must be taken two to three hours apart from the drug to prevent decreased absorption do you have morning erections is it situational difficulty or on all occasions on a scale of 10 how do you rate previous and present erections any recent stressor for how long are you having the issue any other comorbidities smoking"
    },
    {
        "instruction": "hi doctor I discovered a lot of white spots in the back of the palate and I am super afraid that this could be cancer I do not know if it is possible to upload a picture I am 29 years old non smoker but I do drink alcohol sometimes I am currently on thyearox 75 my",
        "input": "",
        "output": "hello since how many days have you noticed these spots is there irritation while eating hot or spicy food it might be just starting of a throat infection and definitely not cancer are you taking any medicines did you take any specific food items or very hot drinks etc use warm salt water gargle twice a day for a week"
    },
    {
        "instruction": "hello doctor I have an abnormal skin growth around the vagina they are tiny and white in color they are only around the vaginal hole",
        "input": "",
        "output": "hi I need to see some pictures how many numbers size redness swelling it can be many things from allergy warts skin tags tumor etc some times we need to send a biopsy of the grown skin to confirm the diagnosis and do treatment accordingly allergy can goes off as the allergen contact decrease warts may require cryotherapy like treatment skin tags and tumor may require surgery give some more details about the growth since when it occurs is it increasing or not painful other related histories"
    },
    {
        "instruction": "hello doctor my 18 year old son got an egg and blood tests last month as a requirement for medical screening he jogs every night for 30 minutes he looks healthy we consulted our cardiologist early this month and he requested for ad echo and treadmill stress test unfortunately we were scheduled for a consult but now we have lockdown for couid 19 I hope you can help me understand the condition of my son thank you",
        "input": "",
        "output": "hi could you upload his egg electrocardiogram if it has been taken and also his echo and treadmill results"
    },
    {
        "instruction": "i have induced my period last month due to its delay after confirming no pregnancy this month as well period us delay by a week but urine pregnancy says negative should I induce periods every month iam trying to get pregnant after taking treatment for hypothyearoid",
        "input": "",
        "output": "if hug is normal and you have irregular periods than have to try different dose of medicines to induce ovulation and do ovulation study and if required than injection for healing ovulation intercourse after ovulation for days and endometrium support hormonal medicines and if no pregnancy than periods will come but this treatment you have to go to gynaecologist and ultrasound sonographis for ovulation study in the middle of the cycle wait for one or two months due to current pandemic than consult nearby gynaecologist for further investigation and treatment"
    },
    {
        "instruction": "hi I am really scared about touching things in general because of the coronavirus but I also have a paper cut on my thumb and want to check if it is possible to contract it through it getting through my cut thats not possible right I am so scared of touching anything I am scared to get up or even make a cup of tea because I am so scared of touching anything I feel stressed and exhausted and need help I feel utterly terrified and can hardly think of anything other than germs any help would be appreciated thank you",
        "input": "",
        "output": "well there has been no evidence suggesting parental transmission its entry into body has been largely suggested to occur through mucus membranes of nose mouth and conjunctive in any case of a person happens to pick virus even if does not enter through blood it is likely to enter through mouth or nose or eyes luckily the virus is susceptible to even common disinfectants so a thorough decontamination of the objects once followed by regular handwashing eliminates almost all the risk being cautious is good however being overly concerned is not right at this point in time where you are already stressed just maintain proper hygiene there is nothing to worry"
    },
    {
        "instruction": "hi doc my son fell when he was years old and his head hit by sharp stone inward he undergo it scan right after and was discharge after few days but years pass by he experience frequent nosebleed even sleeping he is now years old I feel worry for him now is nosebleed is the long term effect of the incident years ago or something else I hope I can get some answers to this thank you",
        "input": "",
        "output": "hello it is not uncommon for children this age to get nosebleeds along with the elderly the children usually grow out of it by age 15 or so it is likely that he might have a deviated septum from the trauma that might need to be addressed in the distant future for now I would use nobleed it is a cream that you apply with the tip of the finger do not use tips to apply this will only stir up bleeding to the inside of the nasal septum and then pinch it back by pinching the nostrils this gently squeezes the cream back do this twice a day month then once a day month then once a week the frequency of the nosebleeds should slowly go down to none if tis persists despite this treatment then see an ent for cautery one tube should do the trick and it is cheaper than the estrogen cream that can also work in this situation also make sure his fingernails are trimmed very close over the next 4 month"
    },
    {
        "instruction": "hello doctor I am a 57 year old male with polycystic kidney disease my mi is 27 and I am a non smoker my creatine 25 egfr 63 I am currently on 30 my lisinopril 12 my hydrochlorothiazide daily most recently I changed to months ago taking 40 my lisinopril only and noticed be increasing so added the hct since starting hct hypernatremic na 130 my query is I get a rapid spike in blood pressure over the course of two to three days from well controlled 130 80 mhg to 165 105 mhg which has maintained for the last seven days and continues what are the possible causes of such a rapid sustained spike",
        "input": "",
        "output": "hello the causes of this accelerated phase could be multiple is there any change in dietary habit with increased salt intake any recent change in antihypertensive did you by any chance miss antihypertensive medications any consumption of pain killer nsaids nonsteroidal anti inflammatory drugs if none of this is true sometimes it could be just because of variation in weather with winters starting my advice will be to continue with lisinopril as advised as hctz hydrochlorothiazide is causing hyponatremia I will stop that and can add tolvaptan which has been approved specially for adpkd autosomal dominant polycystic kidney disease this has to be done by your nephrologist though for better control of be add amlodipine my once daily and monitor blood pressure please note that a common cause of hyponatremia in such a scenario is increased water intake salt restriction reduced protein intake and hydrochlorothiazide combination of these factors is common in adpkd patients as doctors would be advising for all these"
    },
    {
        "instruction": "hello doctor I am a 28 year old female currently under investigation for ra and have been for a while now I began having knee problems at the age of 15 my mothers problems began in her knees at the age of 13 and the problems remained there for a few years in the last three to four years my symptoms have massively progressed to my hands fingers shoulders hips toes and ankles making daily chores quite painful it sounds silly but when the blood tests came back and did show inflammation I was bizarre pleased I had been made to feel like I was over exaggerating a lot so to have it proven was one step in the right direction the private doctor I saw was the one that recommended medication I take celebrex 200 my in the morning with 15 my lansoprazole as previous medication has upset my stomach this medication seemed to be working until eight months ago my blood tests showed my inflammation levels rising again recent stressful situations have I think caused quite a bad flare and I am taking paracetamol more religiously than I would usually small tasks like doing a jigsaw were causing my shoulder to ache I recently got a new set of blood tests done and the results along with results from the last 5 years have been included I would appreciate any advice you can give me I also hand scans of my knees and hips done the scans came back showing effusion in my knees I was told it is nothing to worry about at the moment as the fluid buildup is at a level that could be absorbed back in by the body if it were to get worse though I was told I would need it drained manually my hip scans came back normal but at the time of the scan my hips had only been part of the problem for maybe a year whereas my knees had been bad for the best part of 10 years I am getting frustrated with myself because of my inability to do simple tasks some days I know it is no fault of my own but that does not help when your only 28 and cannot wash the dishes or mop the floor because something will start hurting and I will have to stop I have also progressed quite badly with hand issues I have had occasions where my left wrist and hand will start shaking I have also regularly found myself dropping things like pans cups my cell phone my medication among other things my left side of my body has always been worse than my right side although my right side is slowly catching up I am unsure whether to mention my condition while looking for future work at the moment it is not preventing me from working I have had to occasionally wear braces on my knees or wrists and my current job is aware that if I am sitting down in class it is medically necessary I am aware that compared to some people my inflammation levels when looking purely at bloodwork are very low but the actual pain I am in is very real and I would very much like some advice on how to proceed primarily I am looking for a more effective way to manage my pain levels so I can get back to doing more things typical of a 28 year old rather that sit with a hot water bottle on my back and paracetamol at the ready I have attached a blood tets",
        "input": "",
        "output": "hi I have gone through your query and blood reports I do have a few queries to help you reach the correct diagnosis I want to be really sure we are dealing with inflammatory arthritis and so we can modify your medicines accordingly as celebrex 200 would not be a solution for a long term do you experience early morning stiffness and swelling if yes for how long are these pains intermittent in nature or persistent how is the sleep pattern do you have early morning fatigue as if you did not sleep well any recent complaints of irritability and forgetfulness any persistent headaches any bowel upsets like increased frequency of stools do let me know these answers because for pain there are many reasons if inflammation is one we should act early"
    },
    {
        "instruction": "hello doctor I recently turned 19 I suffer from irregular periods I did not have my periods for two to three months and then when I have them it would continue for a whole month straight without a pause I have had the period gap problem for a few years now and recently started with these elongated periods I have also consulted all kinds of doctor but never actually could find a permanent solution to it is this some kind of dangerous issue in my body never had any physical relationships",
        "input": "",
        "output": "hi this could probably be cos polycystic ovarian syndrome which is a lifestyle disorder and because of the hormonal imbalances it causes can lead to irregular periods or maybe even thyearoid abnormality which needs evaluation there is nothing to be worried about and it could be easily tackled and controlled I would advise you to kindly get the blood tests and ultrasound and get back to me meanwhile keep a track of your menstrual cycles of they get delayed by more than two months please consult your gynecologist for withdrawal complete hemogram glucose tolerance test hba1c levels lipid profile rat renal function test let liver function test serum calcium vitamin do and b12 levels serum fasting and post prandial insulin levels serum fish follicle stimulating hormone oh leutinizing hormone estradiol prolactin levels thyearoid profile to ash anti tpo on second or third day of next menstrual period may need hormonal pills for cycle regularization reduce weight if overweight maintain menstrual diary regular exercises at least one hour daily lifestyle and dietary modifications consult a dietician get back to me with the reports when possible so that we could discuss and correct this"
    },
    {
        "instruction": "hello doctor my partner had a miscarriage unknowingly that she was pregnant five to eight weeks maybe she had negative home pregnancy tests a negative test at the doctor and had a miscarriage the next day after doctors test my question is could it be possible there is another fetus remaining inside I only ask because we each have one parent that is a twin please advise she thought she was on her period the entire week bled for seven days she attributed it to the plan pill she took several weeks back we had unprotected sex but I still pulled out she is on birth control and used a plan pill how is any of this miscarriage stuff possible especially after just seeing the doctor the day before miscarriage",
        "input": "",
        "output": "hi if bhcg beta human chorionic gonadotropin test or urine pregnancy test says she is pregnant then we can say she is pregnant and if bhcg test is positive and healthy if it is decreasing with the history of bleeding then we can say it was a miscarriage or we find a fetus part in ultrasound scan or test bleeding parts then we can say that it was pregnancy it can be possible the twin part I cannot say need to do an ultrasound scan to check the status of pregnancy sometimes early there is implantation bleeding only"
    },
    {
        "instruction": "hello doctor I have mouth and throat ulcers lasting for the past eight to nine days no fever cough or difficulty breathing I consulted a doctor over the phone and took three days of azithromycin dologel and some pain relief medicine after no improvement after three days the doctor changed the medicine candid mouth gel alusil I have been taking this for the last three days still there is only minimal improvement",
        "input": "",
        "output": "hello welcome to icliniq com can you kindly share the pictures of the lesions are there any blisters how did the lesions appear in the first place if it is not responding it might be oral herpes"
    },
    {
        "instruction": "hello doctor I am not able to achieve proper latch and quantity of my breast milk is also low need help for both please suggest my baby is weeks old",
        "input": "",
        "output": "hello I would be very glad to help you because being a mother of two I could very well understand your state of mind now this is a common problem that most of the new mothers face at this point of time first of all sit back and relax do not take too much of stress because stress is going to affect the quantity and quality of breast milk proper latching is essential for both you and your child to feel comfortable during feeding first sit in a chair comfortably leaning your back with good support lift your baby and hold him near your breast you can keep pillows below the baby to achieve the height without much weight over your hands when your baby opens its mouth you have to put the nipple and the areola around it inside the mouth search for breast feeding photos or videos online and you can very well understand it amount of breastmilk secretion depends upon various factors important one is demand if you feed the baby often the whole day today definitely your secretion will start to increase from the next day as your body will sense the demand and produce more milk feed minimum once every hours in the day and once every to hours in the night keep hydrated drink atleast to litres of water per day as 80 of breastmilk is water take balanced diet include lot of vegetables and fruits definitely you can produce the quantity of milk your baby needs"
    },
    {
        "instruction": "hi doctor I am 35 years old I have experienced visual auras migraine aura for the past three years maybe once every two to three months it often occurs after alcohol consumption I have eye floaters and have experienced seeing streaks of light a speck of light with closed eyes and sometimes light sources are burned into my vision for about 10 minutes I have noticed it is mostly in the right eye I got examined and diagnosed with lattice degeneration right but never really understood what it means or if any other reason for my visual phenomena are still there",
        "input": "",
        "output": "hello I understand your concerns and would to let you know that lattice degeneration is a symptomatic condition that is to say that lattice degeneration by itself will not cause any symptoms whatsoever to put it very simply lattice degeneration is an area of thinning in the retina the nerve which helps you see if left alone there are chances that this weak area would give way and tear lead to a serious condition called retinal detachment most doctors leave lattice along but sometimes they will have to be lasered as far as your other symptoms please continue with your migraine medication for the sensation of floaters and streaks of light please keep follow ups with your ophthalmologist at least once every year I am not very convinced about what you have mentioned about light sources being burned although this is a very common normal condition we see in normal people I doubt that it would last as long as 10 minutes in case you could please get in touch with me about this issue other than that I feel that you do not have much to worry as lattice are easy to monitor and laser if needed I hope this helps"
    },
    {
        "instruction": "hello doctor I am negative and my husband is oh positive I have a baby of 6 years old oh positive now I am pregnant of six weeks and do not want to continue so I take an abortion kit but after taking all four misoprostol pills bleeding not started yet and it is almost 24 hours gone what to do now do I have life threatening risk I am worried",
        "input": "",
        "output": "hi you need to do one ultrasound scan to confirm the pregnancy if you had done scan before taking pills then wait for 12 days and if no bleeding then repeat ultrasound scan and if you did not do ultra scan then get it done you should bleed but if not then either you had wrong pills or pills did not work and will require surgical abortion you need to consult a nearby gynecologist or abortion center one rare chance is to have an ectopic pregnancy if you did not do an ultrasound scan but if it was there then you should have more pain in the lower abdomen on one side it will clear in the next ultra scan in that case treatment may vary after bleeding starts you should take oh anti 150 ug injection within 72 hours because we do not know the fetus blood group do drink more water and if you did not do ultrasound scan then you can repeat the urine pregnancy test also because sometimes kits also come faulty and give false positive results so to compare or confirm you can repeat"
    },
    {
        "instruction": "hello doctor I am a female aged 34 years a year ago I did pyloric test which came positive and the doctor gave me weeks antibiotics course and then I did not retest it most of the time I face burping and acid reflux problem I have gallstones also to my multiple stones now since a week fever is coming which is a low grade fever from 37 to 37 please advice me",
        "input": "",
        "output": "hello welcome to ilciniq com with the given data it is difficult to tell which test was done to confirm pyloric if it was a stool antigen test or a breath test rarely done or a serum test given that you mentioned it came out positive anyways you need to take a pyloric eradication kit which includes antibiotics along with a pi plus one more agent depending on physicians preference as you are on weeks of antibiotics you should get your self tested again for pyloric with stool antigen test if it is negative you do not need to take anymore antibiotics otherwise you will need another 10 days of different set of antibiotics or you can take more weeks of antibiotics and repeat test again but the symptoms you are having might not get better with pyloric eradication they might be due to acid reflux which is totally different from pyloric you should get your self evaluated with an upper gi endoscopy and rule out herd you should avoid fatty food and exercise regularly and keep a gap between meal and naps shedding off a bit of fat will definitely help as your mi is about 27 try getting it to 25 and you will see the difference"
    },
    {
        "instruction": "hello doctor I am super embarrassed but I have been having trouble with being positive about this situation I have been having issues with my downstairs area about smells to me it is very unpleasant and I am very uncomfortable",
        "input": "",
        "output": "hi how are you doing hope you and your dear ones are safe and healthy for a young lady of your age following are the possibilities and solutions if using antibiotics frequently bacterial vaginosis caused by imbalance in healthy and unhealthy bacteria and vaginal flora to correct this avoid frequent antibiotics use avoid vaginal douches use capsule lactobacillus twice daily for 10 days if you have frequent respiratory tract infections you may be transmitting the viruses and bacteria to your vagina unknowingly when you sneeze or cough into your palm later when you wash your genital area after using the washroom you will transfer respiratory infections to vaginal tract to correct this issue use a good course of antibiotics like cap moxacillin clavalunate 625 my twice daily for week also wash hands with soap before using washroom if you are diabetic check your blood sugar levels fasting and post prandial only after correction problem will be solved if you are sexually active infection from partner could be the reason meet your doctor and both of you will need antibiotics course use vaginal wash daily once for 2 weeks twice daily during periods this will improve your vaginal discharge problem"
    },
    {
        "instruction": "hello doctor I have been having vertigo for over five weeks I was prescribed doxycycline and mescaline unfortunately the mescaline did not make me feel better I think my issue is that my eustacian tubes are clogged and need to be drained how can I do this is there a medicine",
        "input": "",
        "output": "hi ear blocking sensation with vertigo for five weeks especially if it is bilateral is unlikely to be due to eustachian tube dysfunction eustachian tube dysfunction in general does not cause significant vertigo unless there is associated infection of middle ear or fluid in the middle ear since you do not have pain it is unlikely to be due to infection of middle ear so possible cause can be fluid in the middle ear glue ear which is usually due to long standing eustachian tube dysfunction most of the times it is a self resolving condition treatment for this condition is symptomatic with anti vertigo medicines such as cinnarazine or betahistine taken every day for a week for fluid in the middle ear you can use decongestant nose sprays such as oxymetazoline or xylometazoline steam inhalation two times daily also can be beneficial if these medicines do not work then detailed examination of ear for inner ear dysfunction and hearing tests such as pure tone audiogram and tympanogram may be required"
    },
    {
        "instruction": "hello doctor I am a year old male my height is 167 am and weighs about 71 keg I am a diabetic type since 12 years family history my father is a diabetic and expired due to cardiac arrest I am currently on humalog lispro 100 insulin via medtronic pump I take both vegetarian and non vegetarian diet my blood work shows fbi 16 hba1c 6 uric acid lipid profile total cholesterol 27 my do trigycerides 70 my do hel cholesterol direct 5 my do lil cholesterol direct 94 46 my do vldl cholesterol 94 my do cool hel ratio 12 lil hel ratio 12 stress test report attached doctor has prescribed tritace ramipril 5 my tablet once every night for three months my problems are unable to eat wheat or carbs as sugar shoots up to 250 300 and takes time to come down pain in the fingers of both hands unable to close fist easily after sleeping sometimes pain in the arms I need to get diagnosis of pain and long term solution medications for sugar",
        "input": "",
        "output": "hello welcome to icliniq com I will provide you the outline of management in your case however actual changes in treatment regimen should be done after discussing with treating doctor firstly your heart looks alright with no evidence of blockages however blood pressure is an issue which needs to be taken care of you are started on ramipril but you should check it frequently at home as 5 my alone less likely to completely normalize your be so if home be remains elevated more than 140 90 mhg after 5 my ramipril then it has to make twice daily next regarding sugar it is not very well controlled especially post meals now I do not know whether you were tried initially on any medications or not if not then medications should be tried now metformin is a basic and most important medication for it so you should discuss with your doctor regarding initiating it also you will need add on drugs as metformin alone will not be sufficient which includes teneliglipitin and glimepiride which comes in combination of metformin if medications are not feasible at the moment then dose of bolus insulin which is delivered with each meals should be increased by two units in order to take care of post meals surge so that you are able to have proper diet also regarding pains it is likely a neuropathy due to deranged sugars for that sugars should be tightly controlled and you will need supplements like neurobion forte once daily if this does respond to multivitamin supplements then you will need nerve stabilizers like pregabalin etc also your triglycerides level is too much elevated for that you need to have a healthy lifestyle like avoiding fatty oily foods have regular exercises like brisk walking for at least 30 minutes a day this will also bring your sugar level down also you will need medications here to control triglycerides like tablet fenofibrate 145 my bedtime daily for eight weeks there are some issues and there is good scope for improvement also you should undergo tit treadmill test at regular intervals of three to four years also considering your family history of heart disease it is better you also undergo it computed tomography coronary angiography once as it has got very high sensitivity and can tell us if even minute blockages and preventive medications can be started I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 28 year old female I have chest pain after flu like symptoms my height is 171 am and weighs about 61kg it started about one and a half months ago as a normal flu with coughing and runny nose I took some flu medicines lemsips pills I got rid of the runny nose but I still had the cough which was dry after a few weeks the cough began to be productive and the pharmacist prescribed some cough syearup robitussin and paracetamol after a blocked ear due to inflammation I had to take antibiotics as well amoxicillin now I only cough in the morning but I have this chest pain mostly when I lie down I do not have any other symptoms such as fever runny nose etc",
        "input": "",
        "output": "hi it seems like a little infection in lungs maybe so I am prescribing some drugs and tests as well take medicines properly and do the test and show me abc complete blood test pulmonary function test chest ray take syearup dextromethorphan two times daily amoxiclav 625 my amoxicillin and clavulanic acid three times daily for five days diclofenac and paracetamol two times daily for three days and levocetirizine my once daily for five days take medicines with warm water drink warm water with honey avoid smoke exposure infection chest ray abc put"
    },
    {
        "instruction": "hello doctor is there possible of tetanus vaccination as a prevention of couid 19 I know that tetanus is caused by bactrim but couid 19 is caused by coronavirus",
        "input": "",
        "output": "hello you must not use tetanus for couid 19 coronavirus prevention however you can wash your hand after touching anything which might be infected it is advisable to stay inside the home or keep yourself isolate at least for three weeks the vaccine is always prepared from the disease bacteria with carefully removing the virulence factor toxin removing that normally helps to get from that particular bacteria or virus which was used our researchers are trying their best to find out the possible treatment and vaccination for current illness couid 19 until then please keep yourself isolate and stay away from the crowd and wash your hand appropriately avoid touching your face nose and mouth without washing at least one minute with running tap water use soap for better result"
    },
    {
        "instruction": "hello doctor I have not had my period for days I have taken four tests and all negative and I am currently not taking any contraceptives my last period was 12th before two months and since having my daughter I have experienced really bad pain during intercourse to the point I have had to tell my husband we have to stop because I start crying I get random cramping pains in my pelvis area and back pain both really sharp I have also got pain in my upper butt area that makes it painful to walk or sit down",
        "input": "",
        "output": "hi how are you doing hope you and your dear ones are safe and healthy from your history I gather that you have two problems delayed period and lower abdominal pain and cramps for the delayed period I see your body weight could be a reason with a height of 152 am your expected weight is 52 keg the extra fat cholesterol can get converted into hormones and cause an imbalance of hormones needed for normal ovulation thus due to impaired ovulation period will be delayed on and off at present to have period take any of the birth control pills packet of 21 pills ones used for contraception twice daily for 10 days no matter what the reason is you will have periods within 10 days after the last pill through good dieting not fasting and proper work out reduce your weight loss of just keg is enough to correct hormone imbalance about pain in the lower abdominal area and during sex there could be two reasons a pelvic infection in and around the uterus infections enter with semen symptoms are vaginal dryness during sex burning sensation in vagina after sex pain throughout which increases around the time of ejaculation following day excessive vaginal discharge with or without itching and foul smell similar discharge just before period blood is darker thicker and stickier mild feverish feel before period cramping pains just before period if this is the case avoid sex meet your doctor at leisure both you and your partner should have a good course of antibiotics it will get fully resolved endometriosis due to blood causing adhesive areas around uterus increasing over the months and years but I do not think you could be having this both these need medical help you can solve the issue of period with the pills I hope this helps"
    },
    {
        "instruction": "bump on the left side of the nose feels like cartilage or bone always been there since I can remember the right side of my nose does not have a bump whatsoever I have always experienced breathing problems don know if I should be concerned or that it is just something that will always be there",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello I am a 36 year old female weight 10 height 4 I have been diagnosed with gad and agoraphobia my symptoms are severe I am writing to receive medical advice regarding my hair I suffered a severe psychotic breakdown in october of 2017 and my hair stopped growing it stayed exactly shoulder length the whole year afterward my bangs did not grow I cut my hair in december of 2018 to see if I could better tell if my hair would grow my hair did grow about six inches from january 2019 to june 2019 starting around july 2019 I had another less severe psychotic episode and my hair started to thin and seemed shorter again my hair has not grown at all since then I am taking various supplements like ginseng ginkgo biloba taurine nac it john wort fish oil and vitamins c and I just started taking zyprexa zoloft and seroquel I would like to know what to do about my hair growth",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello doctor my daughter is 3 years old she weighs about keg she is having pimple type nearby under arm area at the right hand side it is newly grown and old ones are blackened and healed",
        "input": "",
        "output": "hi please get the child evaluated for scabies the child may need to be started on permethrin please get the child evaluated physically by a pediatrician in order to assess and start permethrin"
    },
    {
        "instruction": "hi doctor I have pain for the past four weeks already the pain is consistently sharp and takes my breath away and stabbing and with the pain I have spasms all over my body I can feel some pulsation inside my left upper side under my ribs and the pain starts with the cramps on my back going to the front with the contraction pain my blood and urine are fine I had done an mri scan and the mri says normal appearance of the liver no focal lesions are seen the gallbladder is normal no intrahepatic biliary duct or common bile duct dilatation I just would like to know what if no intrahepatic biliary duct or common bile duct dilatation is normal please help me to understand",
        "input": "",
        "output": "hi inflammatory conditions like costochondritis must be ruled out as of now you can use analgesic and anti inflammatory combination like aceclofenac seratiopeptdase for symptomatic relief if symptoms persist it is better to consult a physician and get evaluated"
    },
    {
        "instruction": "hello doctor I have had mild pain from one of my vertebrae for about eight months it is one of the thoracic vertebrae I am not certain of which one it is approximately in the middle of my back it feels slightly sore when I bend backward also if I press with my thumb on the spinous process I am wondering if it could be a fracture and I worry a little bit about bone cancer there is no lump it does not hurt unless I move a certain way I think it might have started when I was doing some yoga poses lying on the floor",
        "input": "",
        "output": "hi eight months period is quite a long time and I feel you should not ignore it a few things I want to know do you have any other ailment like diabetes or hypertension or hypothyearoidism what you do and how much physical activity you have in your daily routine have you noticed fever and weight loss in these eight months"
    },
    {
        "instruction": "hello doctor I felt pressure in my head on monday thought I was getting a headache I woke up tuesday morning with blood in the white of my left eye this morning I saw blood on my pillow the size of my thumbnail what is my next step I am currently on pristiq lamictal and potassium chloride",
        "input": "",
        "output": "hello it seems to be subconjunctival hemorrhage are you 65 years is her blood pressure levels controlled with medicines if not then monitor your be and then get the treatment accordingly do you swim or do yoga any history of fever"
    },
    {
        "instruction": "hello doctor my wife is 38 old she has been suffering from muscle pain in the right leg for 10 days pain is worst while walking radiates from buttock up to the ankle she is breastfeeding kindly suggest",
        "input": "",
        "output": "hello you have mentioned that your wife is suffering from muscle pain in the right leg for last 10 days so a few questions from my side is there any low back pain as well apart from pain is there any associated numbness weakness paresthesias as well any rays or blood tests if you have done recently kindly send it to me as far as management goes we cannot prescribe much since she is breastfeeding but what she can do is physiotherapy with modalities like laser swd and ift for back and tens for leg symptoms isometric back exercises slr knee quadriceps exercises will help strengthen the muscles hot fomentation at home can be done along with the application of analgesic ointment or spray if available activity modification as in no acute bending no heavy weight lifting etc if at all medications are needed take tablet calpol 650 my sos can be taken for pain management calcium and vitamin supplements should be continued as per protocol for a lactating female"
    },
    {
        "instruction": "hello doctor I am a 32 year old male I am having chronic idiopathic pancreatitis I am regularly on anna 2500 three times cretox up three times a day my problem are cold and cough for two years approximately almost four to five days a week even sleeping under the fan my nose gets blocked in the morning and nowadays I feel uncomfortable when dust is around as well did total ice report is quite high please diagnose and suggest medicine",
        "input": "",
        "output": "hello we are happy to help you I understand that you have these complaints for a few years it most probably is a manifestation of allergic rhinitis the total ice in serum is just an indication of the allergy status at the time of taking the blood sample it is not very significant in allergy practice nevertheless it shows that you have an allergy you need some medicines to keep allergy under wraps and prevent the blockage and cold you also need to find out which allergen is offending and causing the problems the best way to diagnose is getting a skin prick test done at a good allergy diagnostic lab meanwhile you will be benefitted by an antihistaminic with leukotriene inhibitor combination steroid nasal spray and allergen avoidance you would need to be taking these for about two to three months allergen avoidance is the best solution could you provide us more details about the complaints so that we can guide you better is the problem seasonal or perennial does it only occur in the nights when you lie down under the fan or any time of the day does it get worse in winters or when you visit any hill station where do you live do you smoke what is your diet like do you get exposed to vehicular exhaust pollution or smoke and dust of any kind have you tried nasal sprays before is the cough wet or dry is there any breathing difficulty or wheezing is there any change of voice"
    },
    {
        "instruction": "hello doctor I am a year old male with good health I wear contact lens air optic day and night only on the left eye pwe 10 75 be 6 dia 13 I am currently on vigamox I am getting pain in my eyes as a result I am wearing my glasses mostly and my contact lenses sparingly the problem is I must have got a grain of sand or cement under my contact and had continued to work when I pulled my contact I noticed there was a tiny whitish dot on the cornea in the area of the iris I can email you an image but I do not see a way to attach a jog at this time the tiny white dot has not gone away it has been a week now I have no vision problems I need a consultation",
        "input": "",
        "output": "hi it seems to be a corneal ulcer absolutely discontinue wearing contacts do not throw them they will be needed for bacterial culture later on start vigamox eye drop 12 times a day I every one hour buy a fresh vial amikacin eye drop six times a day I every two hours homie eye drop at bedtime will cause blurring of vision but relaxes pain use refresh tears eye drop six times a day at bedtime occupol eye ointment inside the eye do not touch ur eye if not required while bathing try to shut your eyes tightly see an ophthalmologist in person asap"
    },
    {
        "instruction": "hello doctor it is about one of my closely known relative who is of the age of 19 now and has tested her thyearoid and us was done her weight is 80 keg and height almost 165 am I just want to know two things on the basis of the two reports that I will be attaching here within polycystic ovarian pattern was shown in the us so will it be harmful to her post marital life in case of delivery and it was also written less release of eggs so is it due to her age that is going to get alright after her marriage or is it anything serious if anything such serious please do prescribe some medication or way to mend it her thyearoid ash testing was 79 though it is normal doctor has prescribed her to have 25 power tablets for the sake of not letting it grow further so is it advisable for her to start with the medicine given I want your valuable piece of advice in both cases her periods are regular",
        "input": "",
        "output": "hi polycystic ovaries can give problems in conceiving 50 to 60 females have polycystic ovaries so right now there is no need to worry and especially if her period is regular there is no such treatment to take right now she may require treatment to get pregnant otherwise there is no such problem if thyearoid is normal then there is no need to start medications right away if you have some doubt then she can repeat the test with fasting blood sample"
    },
    {
        "instruction": "hello doctor I had my last molar extracted about a year ago and never had my top wisdom teeth pulled is it possible for my wisdom tooth to try to come down in the empty space that the molar was extracted I have a swollen jaw and slight pain when touched",
        "input": "",
        "output": "hello I understand your concern when a tooth is extracted the opposing tooth tends to compensate by over erupting since there is no stop for the tooth to rest on this is called as sutra eruption from your query and the details provided it looks like your upper wisdom tooth is sutra erupting and is infected the only option is to get that tooth removed if the pain is quite disturbing you can take mild painkillers like acetaminophen paracetamol or try warm saline mouth rinses thrice daily during this pandemic couid 19 dental offices are instructed to provide emergency care only so minimal and non emergency procedures are generally postponed three weeks later for now you can call your dentist or the nearest dental office and get an appointment if the pain becomes unbearable I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 24 year old female I am 185 labs and feet inches in height I have never had allergies or asthma about six months ago I started having shortness of breath wheezing and the feeling that my air was not catching I have sudden sharp pains that feel like something wanting to burst when I breathe in that double me over I immediately quit smoking cold turkey and drinking energy drinks I used to be a pack and a half a day smoker and drink about three energy drinks a day since 15 the er diagnosed me with a panic attack which I knew was wrong as I was no breathless from panic I was panicked from breathlessness I then made an appointment and the doctor heard the wheezing and diagnosed me with walking pneumonia she gave me antibiotics and albuterol which did nothing my sputum test came back normal even though it is black and brown gelatinous and sticky and so I did my two chest rays we have no pulmonologists or respiratory therapists in my town I made another appointment and asked my doctor about chlamydia pneumonia not the sad turns out he was a physician assistant had to google what it was and then gave me hydroxicycline mono and more albuterol which I am currently on still no relief at all I am worried I have of or cold and have had a miscarriage from coughing and so depressed for the last six months because I cannot think or focus on anything I constantly feel like I am just catching my breath like the edges of my lungs are not getting any oxygen it is noticeable when I try to have a conversation eat or drink or do anything it is ruining my life but what it is and I do not know what tests to ask for I am terrified of having chronic adult onset asthma or other cold or something irreversible I am worried that even if it was reversible to begin with after six months of being put on my clinics merry go round with no diagnosis it is probably irreversible now which I try not to think what does this sound like what are the chances it is a curable issue what tests should I ask for could the energy drinks have caused heart damage please help",
        "input": "",
        "output": "hi welcome to the icliniq com before labeling dyspnea from a panic attack psychological cause all organic causes need to be ruled out your chest ray and sputum examination are normal hence invective etiology is less likely to rule out any organic cause your work up needed as follows auscultation for rhonchi if heard abc complete blood count pulmonary function test if you have asthma or cold then put will rule out it ekg for cardiac evaluation and finally your calf should be examined if calf swollen with inflammation is present then dime done from these investigations your diagnosis will be clear if no organic cause found then panic attack can be considered as etiology for your condition for doing put pulmonologist is needed so try to make a visit to nearby pulmonologist in another city for examination and doing put if panic attack is the diagnosis after rule out other causes by the above investigations then yoga meditation are beneficial and suitable medication will be started by the psychiatrist"
    },
    {
        "instruction": "hello doctor I get a cough for the last few days which is heavy during night times no raise in temperature but feeling tired with no travel history no contact with any couid 19 persons it has been four to five days and has drunk a lot of benadryl and took paracetamol too doctors have shut the op so do not know what to do please help",
        "input": "",
        "output": "hello I understand your concern I just have a few more questions does your cough has phlegm any other symptoms like difficulty breathing any other medical condition such as asthma hypertension are you a smoker alcoholic beverage drinker"
    },
    {
        "instruction": "hello doctor I made a tattoo almost six months back even at the time of receiving tattoo the artist used multiple needles in which I saw changing few and missed some I asked him about needle changing to which he said he did my concern is what are the chances of contracting hiv in worst case scenario that he did not change a few needles also till now I never had any fever or body pain or infection around the tattoo made",
        "input": "",
        "output": "hello needle can transmit hiv only if the needle was freshly used in another person send the amount of blood collected in the needle is significant this is because the hiv virus dies very quickly outside the body in my opinion the odds of transferring hiv infection in the above scenario are quite less as the chances of both these conditions are present together is very less it is a good point that you have not had any fever or other symptoms testing is being mentioned because we are talking about the worst case scenario in short testing not needed ordinarily after tattooing however if you have much doubt about due precautions taken by the artist you can go for it"
    },
    {
        "instruction": "hi doctor good evening I had tumor in uterus was admitted in hospital last month and successfully uterus fallopian tube lymph nodes all were removed biopsy report came after a week it says tumor involving more than 50 of thickness of the myometrium lymphovascular space invasion present fig stage I doctor advised for imrt and we completed 12 days but now due to pandemic situation doc advised her not to come hospital doc advised we can finish the next 13 days sitting once this pandemic is over I am worried if we stop inbetween will it impact in later stage because I am diabetic and having be can you please give me the clear direction should I continue the imrt or considering the current situation should I stop for a while",
        "input": "",
        "output": "dear I am sorry for your predicament it is indeed difficult time due to pandemic ideally there should not be any gaps in treatment since gap result in increased chances of disease recurrence I would advise to continue treatment however considering the pandemic the decision to continue radiation is associated with accepting the risk of developing infection with you having do and hen you are at a higher risk from getting infected please discuss this with your treating radiation oncologist every hospital has some policies example in my hospital we are continuing the existing patients but not starting any new patient I hope I am helpful kindly revert in case of any further queries regards"
    },
    {
        "instruction": "hi I just went to the dentist for a general cleaning my dentist is great and very hygenic today when he came in the room he washed his hands and put on gloves half way through he needed to go and check on another patient he took his gloves off and let the room I dont know his he needed to treat or just talk to the other patient he came back in my room and put new gloves on but didn't wash his hands and continued he off couse may have washed his hands in the other room I have anxiety about my health and worry about contracting something like hiv or hepatitis during my cleaning my gums were bleeding and I am worried that maybe there was cross infection am I right thinking that it would be unlikely that he could have infected me with something like hiv hepatits this way",
        "input": "",
        "output": "hey that is great that you are cautious about hygiene but its perfectly fine your doctor would have definitely washed hands before wearing gloves secondly hiv hep viruses do not act at other person in seconds it takes months or years to become active and then start with some symptoms after years this will not be the case you are healthy ma bleeding during scaling is very common when tar is removed at boundaries of gums it promotes a healthier gums production later for being having no doubts about any viruses you can get your relevant blood tests done like abc hiv tests done monthly that will definitely rule out this thing in your mind take care stay blessed and happy feel free to ask any further queries do tooba"
    },
    {
        "instruction": "i have been having hourly mood swings sometimes 10 20 minutes im not sure I will be fine then im sad lke super sad and then I have this burst of energy I cant even get out of bed is this normal for depression I have been diagnosed with these dermatillomania anxiety depression with psychosis ptsd",
        "input": "",
        "output": ""
    },
    {
        "instruction": "my ear right ear its like something is there something blocking I cant hear",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hello doctor I was struggling with reddening itching and tenderness on the penis head and under the foreskin I self diagnosed a fungal infection and started applying candid cream twice a day for a week with a slow recovery I decided to take oral medication for the same my pharmacist suggests fluke 150 fluconazole oral tablets I took the medication for four days daily single dose yesterday after drastic improvement in my symptoms I discontinued taking fluke now I am having abdominal discomfort passing excess gas and feeling slight anxiety should I continue the medication for how many days is it possible I misdiagnosed my condition",
        "input": "",
        "output": "hello welcome to icliniq com get physically examined and investigated to rule out any medical condition and treat accordingly take medicine only under prescription and close observation of the doctor check vitals drink plenty of water and fluids maintain strict hygiene wear loose cotton comfortable clothes and underclothes avoid sexual contact if any for a while avoid cream lotion salon treatments cream lotion oil massages perfumes etc take tablet rantac twice daily unless otherwise contraindicated with water for three days before meals feel free to follow up anytime follow diet modification"
    },
    {
        "instruction": "hi doctor my partner is on her periods and yesterday was her third day and she notices some white jelly kind of thing coming out with blood clots and today also this happens I have pictures but I do not know where to attach it I am trying to sign up also but I am not getting the option please let me know how I can send the picture or how can we communicate further",
        "input": "",
        "output": "hi white discharge can be normally also and it can be after intercourse also if there is no burning itching or foul melling of discharge than no need to worry vaginal infection can happen routinely if you do not follow some precautions if the discharge is increasing or have urinary burning than have to do some investigation and antibiotics accordingly do drink more water so that urine should be clear keep the vaginal area as dry as possible change pads more frequently during menstruation eat healthy and less oily and less spicy food do urinate and clean the vaginal area immediately after having intercourse do follow these precautions and discharge should go down normal white discharge can be due to stress also in the photo the discharge looks like normal but if foul smelling then tell if you have more doubt and thinking of bacterial vaginosis then you can take metronidazole 400 my tablet twice daily for seven days but I think if no other symptoms then it is not required do drink more and more water to clear the minor infection"
    },
    {
        "instruction": "hello doctor a year old kid of 15 keg weight is having a general cold for almost three months sometimes cough and nasal congestion otherwise he is fine he has no fever or weakness",
        "input": "",
        "output": "hello welcome to icliniq com I understand your concern for your child as you told me this is happening for long and there is no fever it seems to be some allergic condition are you still bottle feeding the kid is there any difficulty in breathing any sounds or snoring while breathing or sleeping give syearup mantra chlorpheniramine my thrice a day for five days nasal drop xylomist one drop in both nostrils twice a day for three days"
    },
    {
        "instruction": "hello doctor I am suffering from a cold sore type infection in my mouth especially at lips same was occurred last year and again it repeated this year and as on today it is the third time it is coming and curing within a period of 10 to 20 days I want to add photographs but do not know how further currently it is on my lips and additional sores are there inside the upper part of my mouth there is no pain please advise so that this can be permanently cured I am currently taking acivir 800",
        "input": "",
        "output": "hello I understand your concern I have gone through your query attached pictures and your previous prescription these cold sores are of viral origin and it is called herpetic stomatitis this has a high recurrence rate meaning as long as the immune system is little underperforming it can come again and again also taking antiviral drugs could put your immune system down you should compensate by eating healthy foods and drinking adequate water there are certain instructions you can follow to reduce its recurrence taking antiviral medicines on time without skipping or forgetting the dose the antiviral drug which your previous doctor had prescribed will suffice please take the same set of medicines for another course this time without skipping doses and take them at the correct time avoid hot spicy salty foods citrus fruits and its juices carbonated drinks etc drink lots of water these treatments can make your body dehydrated eat healthily take a balanced and nutritious diet increase fruits and vegetable intake you can place ice cubes intermittently over those sores for faster relief maintain good oral hygiene rinse your mouth after every meal brush twice daily this will prevent any bacterial or other infections over those sores and promotes faster healing it is highly contagious and hence limit personal contact with others and children I hope this helps"
    },
    {
        "instruction": "hello doctor I was recently diagnosed with a blood clot in my left jugular vein and put on eliquis 10 my twice daily for a week now my twice daily I was also recently diagnosed with some sort of autoimmune disorder but it is not clear yet which one after being diagnosed with the blood clot my rheumatologist performed a lupus anticoagulant panel to see if I am taking the correct blood thinners everything came back normal except the drvvt which was prolonged with 52 seconds the drvvt mix was 45 seconds and I was told that it is negative I have read a lot about drvvt testing online now and I am concerned that I am still la positive because the mix can show false negatives I have also read that converting the results into a ratio is preferred also my apt was slightly elevated 37seconds I have no risk factors for blood clots normal weight no hormonal birth control what is your opinion do I need further testing how likely is it that I should be taking different blood thinners",
        "input": "",
        "output": "hi if you have antiphospholipid antibody syndrome as then your anti cardiolipin antibody or lupus anticoagulant should be positive additionally in as the raised rat renal vein thrombosis is not corrected by adding normal plasma so lupus or as chance seems to be less in your case I suggest you investigate with full coagulation profile workup including coagulation factor assay and factor estimation as well you have been given apixiban which is a very good drug in thrombosis patients kindly continue its intake as suggested by your doctor follow your hematologist advise and discuss all these"
    },
    {
        "instruction": "hello doctor my boy is years and months old he is having allergic sneezing on and off cold from the past eight months my wife has a regular allergic sneezing regularly he is good but since three days he is having occasional cough and sneezing occasionally especially in the morning I have been consulting a pediatrician regularly but cold is always keeps coming back so we have been using homeopathy medicine for him for the past two months the problem cold and cough has not gone it is less but now since there is a lockdown everywhere and he is coughing I am just worried kindly suggest allopathic treatment for my son",
        "input": "",
        "output": "hello it looks like allergic rhinitis you should give an anti allergic syearup I hope that there is no fever"
    },
    {
        "instruction": "hello doctor I think I am so much addicted to masturbation it has affected me both socially and emotionally I have problems with my self esteem and self confidence I find difficult to talk to girls every time I think it is because of my low self esteem I do not have a girlfriend but I really want to have one I really want to quit this habit I have tried to quit several times but I end up crawling back and wank a lot more please help",
        "input": "",
        "output": "hi doing masturbation three or four days a week is completely normal also it is a myth that masturbation causes weakness and loss of energy but if you are doing it daily try to engage your mind with something else which you like such as watching to shows playing games eating listening to music etc you can try initially to not masturbate one day in a week then two days after two weeks etc if they are of milder intensity please do a google search for techniques like thought stopping and use any of the methods described such as slapping thigh yelling stop snapping rubber band etc if thoughts are extremely disturbing I would suggest you please visit a local psychiatrist who can give you some medication for a couple of months which will help prevent excessive thoughts"
    },
    {
        "instruction": "hi doctor I have a question about my gums I had a jaw surgery for an open bite a few years ago and the gums were all pink and normal looking a few months ago now they have a lot of white on the upper gums with the area slightly above the gum line being the non whitened and discolored part I have a picture the discoloration showed up more recently and never in the past if I recall I am currently on vistaril prozac zyprexa june birth control",
        "input": "",
        "output": "hello the gums looked blanched or whitish due to lesser blood circulation and less inflammation than before there is no need to worry as it occurs as the gums are completely healed and also could happen due to decreased blood pressure and complete healing of inflammation post surgery even medications like anti depressants can cause some drying or blanching of soft mucosa tissue of gums"
    },
    {
        "instruction": "hello doctor how do I help my 16 year old teen brother who refuses to get help I believe he needs help but the last time we went to the doctor they sent him to a counselor who did not do much when talking to a counselor and other people he does not show his true colors at home he has a very bad temper and tries to fight with everyone the only one he gets along with is one of his brothers he has threatened to kill himself because he does not have his laptop anymore it broke and he has also stated along the lines that he wants to kill our parents because it is their fault he is like this to be fair our parents are very religious I do not know how to help him because he does not want help he says no one cares about him and we all want his life to be bad what do I do to help",
        "input": "",
        "output": "hello it can be difficult to see your family going through challenging circumstances from your report it looks like your teenaged brother is struggling to regulate his behavior blames others and is not able to take responsibility for his actions as you may know already there is no quick fix solution try to be supportive and available whenever your brother needs you he is lucky to have an understanding sister like you he needs to gently changed when he says no one cares about him why does he think so is he misinterpreting things you said he gets on well with one of his brothers use it positively and involve this brother in getting help for your troubled sibling encourage him to enroll in some course apprenticeship which will give some positive experience for him encourage him to join some sports clubs discuss with your parents about adopting a supportive firm boundaries relationship with your brother and avoid criticism and confrontational interactions it may help to have a mentor to talk to him regularly and guide him to make the right choices it can be any responsible adult whom your brother trusts and will talk to finally encourage him to see a counselor or doctor again if problems persist"
    },
    {
        "instruction": "hey hoping you are doing okay do my virgin girlfriend and I had our first intercourse two days ago now and she started experiencing pains severe pains she has to lie down on the floor to ease when I asked her she says it is more than her menses pain what could be the problem",
        "input": "",
        "output": "hi we are doing fine thank you hope all of you are also doing good when a lady hymen ruptures that is after first sexual exposure there will be few tears in around the external genitalia also the vaginal wall these will be the point of entry of minor infections already present in the normal vaginal flora also in the semen this will be more if you have not used a condom these infections will enter the uterus thereby into the pelvis lower abdomen causing cramps on off similar to the menstrual cramps you do not need to worry all you need to do is avoid sex for few days till pain subsides fully have a short course of any antibiotics like tab azithromycin 500 my daily once for days or tab levofloxacin 500 my daily once for days use any of the antispasmodics usually used by women during periods for pain like dicyclomine 3 times per depending on severity of pain use condom during sex hope I have clarified your query do write back if any more queries for your feedback all the best"
    },
    {
        "instruction": "hello doctor I think I have had an adverse reaction to invisalign retainers over the past few years I think they have caused me jaw issues chronic facial tension radiating to all areas in my face and associated with droopy eyelids and jaw clicking and aberrant jaw positions etc and I can move this tension around with purposeful movements of facial muscles and pressure sensitivity on the face tension is trapped worsened altered by glasses pressure and prescription and eye movements I believe this began when I stopped wearing them 24 and particularly when I switched to wearing them every other night I have noticed that my jaw is asymmetrical and perhaps small particularly on the res may be a link to why I was initially getting tension symptoms on the res so maybe invisalign causes issues stretches small and asymmetric jaws excessively or I have some random unexplained predisposition to my jaw getting confused by regularly changing bites or something still think the latter may have something to do with the former I just wanted to inform you of this as I have been told these symptoms are unique functional and although invisalign is known to sometimes cause taj problems it is not heard of causing issues like this I am open to suggestions thanks",
        "input": "",
        "output": "hello the symptoms described by you are rarely caused by invisalign it may cause taj temporomandibular joint problems in some people but for a shorter duration as it is not permanent actually allergy means that you have redness in the area and if you wear for some time it cause some reactions in the local area and may also in the body do you have something like that the symptoms are mostly related to taj the reason may be that you can not bite on your teeth and you are now biting on invisalign and this can increase your bite where it normally was the best in my opinion will be to consult your orthodontist if you can pause your treatment stop wearing invisalign rest your jaw for as long as you can like do not eat hard or crunchy or sticky food soft diet no prolong talking do not open wide too much especially yawning also use over the counter pain killer for relief I hope this helps"
    },
    {
        "instruction": "hello doctor I have cos from the last year I get my periods regularly in the gap of two to three months my weight increased almost double within this time and I am not taking any medication please prescribe",
        "input": "",
        "output": "hi periods can be irregular due to cos polycystic ovary syndrome but it is your hormonal cycle which is disturbed and periods are irregular due to it you can take ovral like hormonal medicines for 21 days and then seven days gap and repeat for 21 days for three cycles period should come in the day pills free period do thyearoid profile test try to reduce weight because hormonal imbalance is very difficult to treat and the same you can achieve by just losing weight because your body requirement decrease and your body produces same amount of hormones periods can regularize on its own do drink more water you may need to do other hormonal tests if it does not regularize after all these but with delayed period and cos there is no much to worry problem can be delayed menses and difficulty in conceiving with delay in menses your blood levels become good yes if you are trying for pregnancy then you may require treatment otherwise no need to take much tension about periods I hope this helps"
    },
    {
        "instruction": "hi doctor this query is for my aunt who is 60 years old she has knee pain both for more than 15 years initially she used to get swelling around the knee and pain she keeps taking injection and painkillers for pain for the last 15 years recently she was ill for around three months with a bacterial infection in her legs as she was under treatment for that infection her pain got subsided for some time due to pain killers and other antibiotic effects now again she is getting pain she also has some kidney issue and her current creatinine is 5 but it was high six months ago she was prepared for knee replacement surgery and it was canceled as her husband got a stroke a day before surgery while going through the tests before surgery we got to know that her kidney is under trouble her creatinine was so high at that time as I am far from her I could not present any of the reports now also she was advised to stay away from pain killers and other medicines to prevent further kidney problems kindly suggest some ointment or medicinal oil to apply for knee pain",
        "input": "",
        "output": "hi you need to take the following tablets tablet tramadol 50 my 0 for 10 days after food rabeprazole 20 my 0 for 10 days before food shelcal calcium 500 my 0 for 30 days before food wintogeno cream ayurveda formulation which can be purchased from ebay can be used by her twice daily take these tablets only if you are not allergic to them do not take them if you are a known case of bronchial asthma follow up immediately in case of any untoward reactions advice activities that cause pain should be avoided temporarily if the knee is swollen or sore squatting kneeling twisting and pivoting jogging aerobics dancing and playing sport should be avoided until knee pain and swelling resolve you should wear a knee cap for support to the knee joint wear it all day and you can remove it at night apply ice packs twice daily for 15 minutes each you need to get your ray of both knee joints ap standing and lateral views do the rays and upload them for accurate advice this professional advice provided by me stands subject to the actual examination of report image and is based entirely on inputs provided to me it should be correlated with clinical findings"
    },
    {
        "instruction": "hello doctor I have a bump on my labia it does not hurt and it is not too big but I have had one before so because it is reoccurring I am a bit nervous it is close to where I shave so I am hoping it is just a dull razor issue or a pimple but the fact that I had it before is concerning to me I have not tried to pop it and it does not look like it is filled with pus or anything it is also flesh colored I know it is hard to give me a diagnosis since you cannot see me but I was wondering for some insight on what this could be because I know self diagnosing myself is not the right thing to do I do plan on seeing a doctor but seeing with the virus going on right now I cannot make an appointment so this is my only hope to get some kind of answer to ease my mind for the time being",
        "input": "",
        "output": "hi thanks for the query I can understand your concern according to your history there is a possibility that the lesion you described could be a bartholin cyst but as you mentioned by direct examination only we can make the exact diagnosis now at this situation what you can do is if it is painful please go for some analgesic drugs you can take a sit bath with lukewarm water and with few my of disinfectant liquid like dettol with this the symptoms of inflammation can be relieved and size of the lesion can be decreased you can do this twice a day for three days if the lesion persists or recurs you may need to consult a local gynecologist for examination and treatment I hope this helps"
    },
    {
        "instruction": "hi doctor my husband was diagnosed with all before six years he underwent treatment by following the pethema protocol for all after consolidation phase ma revealed there is still of pal ra using fish ra test while negative on cytogenetics his doctor proceeded to his maintenance phase two years on atra mercaptopurine and methotrexate for two years monitoring blood counts are within the normal range ma was done this year and revealed there is still on fish ra is this considered a minimal residual disease or incomplete remission does he need to undergo chemo again or start a new atra",
        "input": "",
        "output": "hello sorry to hear about your husband diagnosis he is having acute promyelocytic leukemia cancer and it is considered among favorable outcome leukemia after starting chemotherapy complete remission includes less than blast in bone marrow aspirate and more then 1500 platelets more than lakh extramedullary hematopoiesis absent and molecular testing negativity after consolidation chemotherapy if cytogenetic study remains positive then prognosis cannot be considered good as compared to a negative cytogenetic leukemia patient after chemotherapy and it can be considered here as a minimal residual disease treatment was given in the right way along with proper chemotherapy and retinoic acid as well but you have to discuss your case with your treating oncologist and he will guide you further about what is the future treatment protocol I hope this helps"
    },
    {
        "instruction": "hello doctor this is a bit embarrassing I am afraid of going to the doctor because I am embarrassed and ashamed I have bad anxiety and social anxiety and depression I pick at my skin constantly and I do it unknowingly and also when I am aware I feel like I cannot help but I do it and I do it mostly when I am having an anxiety attack I also do it because I feel as if I need to pop everything on my body and I am creating scars on my body and try to avoid looking in the mirror as much as I can because I do not want to do it to my face what is wrong with me and how can I help myself is there anything I can get myself over the counter that I can take or put on my skin to help so maybe I would not have anything to constantly pick at",
        "input": "",
        "output": "hi I am so sorry to hear about your problem I can understand it must be really difficult for you anxiety has to be managed in two ways medical management you will require some medications if the problem is severe I cannot prescribe them online because it needs complete evaluation and some blood test might also be required so for that you will have to see a local psychiatrist therapy psychotherapy is one of the most effective ways of controlling anxiety and depression you need to understand the negative thought pattern which is causing the anxiety in the first place so that you can either stop them or at least not get affected by them cognitive behavioral therapy is one such tool as you have mentioned that you are not comfortable with going to a doctor which is completely understandable I would suggest to opt for online counseling sessions which are equally effective and works well for people who either have social anxiety or have difficulty traveling the counseling sessions are done online once a week via video consultation therapy and medication combined are the gold standards for the treatment of anxiety and depression apart from that take out some time every day and engage in some relaxing activities like deep breathing meditation progressive muscle relaxation etc I can understand it is overwhelming when you have kids around and so much to do but it is important that you also take care of yourself and make yourself a priority too only if you are healthy you will be able to provide a healthy environment for the family if you want to start with therapy sessions you can let me know"
    },
    {
        "instruction": "hello doctor I want to lose 50 pounds I have ra and steroids have caused me to gain a lot in the last six to eight months I started the veto diet two weeks ago but blood works is showing elevated liver enzymes which are causing issues with a medication I have to take for ra what diet is best for people who have elevated liver enzymes due to methotrexate what can I do I really need and want to lose excess weight I am currently taking levothyearoxine methotrexate multivitamin and hydroxychloroquine",
        "input": "",
        "output": "hi intermittent fasting will give rest to the stomach and hence enhance metabolism and use stored fat to energy in the absence of food for physical and psychological activity a balanced diet with increase of fruits and vegetables is considered to be best or you can try mediterranean diet I still need many details for proper medical intervention so that I can provide a customized diet plan till then follow these tips increase the high protein diet and include six almonds six walnuts and two dates per day fish green leafy vegetables egg whites and poultry do muscle strengthening exercises increase fluid intake do take eight to nine hours of sleep manage stress with meditation do breathing exercises manage to follow small high calorie frequent meals do take 1700 cal diet if required need to add a supplement I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 50 year old female overall healthy but recently having issues with tiring easily when biking and doing stairs ekg was fine abc showed low abc low union gap and vitamin deficiency I had a low 4 temperature earlier today in light of couid 19 and being that I work in public should I be concerned I currently on focalin and triamcinolone acetonide",
        "input": "",
        "output": "hi welcome to icliniq com I have gone through your detailed history and studied the lab results as per your history you feel feverish and tired your tac total leukocyte cont is low record of temperature is 98 degrees so firstly you have a viral fever but there is no cough or difficulty in breathing so corona is not the main diagnosis but do keep in mind if you have not been with any corona case take rest take tablet tylenol be if you are not allergic to it keep isolated from a crowd then your symptoms are due to a bit of vitamin do deficiency for this take drive 60 two times a week and you will be fine keep me informed viral infection corona to be a remote possibility bed rest tylenol be take rest avoid public gatherings tell me in three to five days of any fresh symptoms"
    },
    {
        "instruction": "hello doctor I am a 37 year old female for about a month my tonsil left side has looked enlarged and irregular if I press on it I will sometimes see a little pus or white fluid coming out from behind it occasionally feels just a tiny bit scratchy I did see our urgent care and they prescribed amoxicillin finishing the script 875 my for 10 days did not rectify I have an in person ent appointment within two weeks however with everything going on I am nervous that I would not get in I would also just love some reassurance if this is not wildly abnormal",
        "input": "",
        "output": "hello I have seen the pictures tonsillar surfaces are irregular normally due to the presence of crypts the tonsil does not appear to be grossly enlarged however a better picture showing both tonsils would be of help pus discharge from tonsils can happen in both acute and chronic tonsillitis however in acute there will be fever sore throat dysphagia etc and in chronic there will be vague irritation in the throat recurrent sore throat and bad breath or halitosis in either case since it is exuding pus you need a systemic antibiotic as you have already taken you also need topical antiseptic like chlorhexidine or betadine gargles plenty of fluids and analgesic for pain"
    },
    {
        "instruction": "hi doctor last month I was given a depo shot to stop intermenstrual bleeding that started before six months after proverb tablets did not work unable to do a pap smear because of the bleeding transvaginal ultrasound revealed tiny 1x1 3cm uterine fibroid three hemorrhagic cysts and a heterogeneous endometrial cavity earlier I passed clots that look like blood mixed with chicken meat I am terrified is this a side effect or do I need to go to the er please help",
        "input": "",
        "output": "hi thanks for the query I can understand your concern according to your description the possibilities are hormonal imbalance leading to thickened endometrium and menstrual irregularities if there is any possibility of pregnancy please go for a urine pregnancy test once to rule out missed abortion if the bleeding with passage of possible endometrial tissue persists better to go for dilatation and curettage once with this the possible cause your problem can be identified and sometimes curettage by removing abnormal endometriotic tissue may cure the problem and may regularize next menstrual cycles antifibrinolytic drugs like tranxemic acid can help in controlling abnormal bleeding I hope this helps"
    },
    {
        "instruction": "hello doctor I am a cook with meals on wheels and I would like to get some well balanced meal ideas for the elderly I cook for I have people with diabetes ebs diverticulitis and high blood pressure please suggest",
        "input": "",
        "output": "hi good to know the profession you have chosen ideally you can keep a dietician for more help and meal planning as she will plan the diet according to requirements and budget and considering company development these tips may be helpful choose good carbs not no carbs whole grains are your best bet pay attention to the protein package fish poultry nuts and beans are the best choices choose foods with healthy fats limit foods high in saturated fat and avoid foods with trans fat plant oils nuts and fish are the healthiest sources choose a fiber filled diet rich in whole grains vegetables and fruits include more vegetables and fruits go for color and variety dark green yellow orange and red calcium is important but milk is not the only or even best source includes almonds dates nuts and seeds water is best to quench your thirst skip the sugary drinks and go easy on the milk and juice eating less salt is good for everyone is health choose more fresh foods and fewer processed foods moderate drinking can be healthy but not for everyone you must weigh the benefits and risks 10 a daily multivitamin is a great nutrition insurance policy some extra vitamin may add an extra health boost I hope this helps"
    },
    {
        "instruction": "hello doctor I just had my routine medical check up and I got my abc report my platelet count is 2100 and in range but my mav mean platelet volume is 12 is it anything to really worry about",
        "input": "",
        "output": "hello you need not to worry about your platelet count and mpv in your attached report total abc white blood cells count is borderline low and lymphocyte count is borderline high so it could be a temporary viral infection you can repeat your abc complete blood count after a few days to check the count again do not worry and repeat abc after a few days you can revert back once you repeat abc"
    },
    {
        "instruction": "hello doctor three months before I got an ear infection in my right ear and I had a ringing sound in my right ear I went to a doctor and was given ear drops and medicines the ear infection went away but the right ear still felt blocked I was told to take a tympanogram and they said that I had fluid behind my ear I was given a medicine for it after a few days my left ear started getting blocked too and it started ringing too my nose also started getting blocked every morning and I had a popping sound in both my ears when I swallow and sometimes it randomly pops I was told to use otrivin and have alaskan am tablet for five days the next week the issue was still there and I also started having a cough I was told to have alex of cough syearup for a week avamys nasal spray for two weeks two puffs in each nostril morning and night and relent tablet after two weeks the cough went away but I still had the issue with my ears but my ears started feeling less blocked I did another tympanogram and they said I still had fluid behind my eardrums I was told to continue the avamys nasal spray and the relent tablet and was also given predmet my tablet for five days a month passed and my ears still had the popping sound when I swallow and randomly I went to the doctor again and took another tympanogram and he said the fluid is almost completely gone and I should continue the avamys nasal spray and relent tablet I also had a pure tone audiometry test which he said was normal I have been using the avamys nasal spray and relent tablet for the past two months throughout and I was told I did not have to take the relent tablets anymore and the fluid was completely gone I still had popping clicking sounds when I swallow and my ears still feel a bit blocked so I was told to keep using the avamys nasal spray at the end of last month I could not get the avamys nasal spray so I was told to use fluticone it instead I have been using it ever since and I was also told to do the valsalva maneuver 10 times every morning and night which I have been doing my right ear pop with no issues but my left ear usually does not pop and it has only popped three times last month I found something online called the eustachi that says it helps with popping ears is it safe to use I still have popping crackling in my ear when I swallow I feel like the ringing sound has reduced but I am not sure I have not been able to go to the hospital because of the coronavirus warnings and would like to ask what exactly is wrong with me and how long will it take to heal it is already been three months should I keep using the nasal spray",
        "input": "",
        "output": "hello the whole problem is due to malfunction of eustachian tubes we call it eustachian tube catarrh initially it was an infection that resulted in blocked tubes causing fluid accumulation inside the ear otitis media with effusion subsequently the fluid has gradually drained but the tube is still not functioning to its fullest you seem to have undergone a decent treatment you have taken decongestant drops antihistaminics antibiotics steroid tablets and sprays you have also religiously tried valsalva maneuver now what you need to understand is when the tube gets blocked it takes some time for it to become fully functional you need to continue the steroid nasal sprays if you are using fluticone it then that is good it is better than avamys do you know how you should use the spray and what it is meant for you also should note if you have any nasal allergies any nose block sneeze or runny nose even if not you are supposed to avoid all allergens you should wear a mask avoid smoke dust pollution pollen molds etc you should be very careful you may continue valsalva for another month you need an antihistamine medicine for another two to three weeks till your problems get resolved completely drink plenty of warm water and fluids keep yourself well hydrated do revert back to me if you need further support"
    },
    {
        "instruction": "hello doctor my baby is having fever ranging from 100 to 104 which subsides after taking mefenamic acid of dosage 60 my per keg of body weight there are no other obvious symptoms except fever what should I do please suggest me the course of treatment",
        "input": "",
        "output": "hello since when is this happening is there any difficulty in breathing is the child feeding well it seems just viral fever I would say just give paracetamol every six to eight hourly do not give mefenamic acid if it gets controlled with pum"
    },
    {
        "instruction": "hello doctor I am beginning to have a semi bald spot in an area around my scalp I have had ongoing dandruff issues for around two to three years now I used to scratch my scalp vigorously to get rid of dandruff I have stopped doing so ever since I have noticed that my hair is thinning also I have a noticeable amount of white hair for my age I do not know if this is related whatsoever however I have applied ketoconazole nizoral shampoo for the first time earlier in order to fix dandruff issues",
        "input": "",
        "output": "hi on semi bald spot apply renovate cream at night for 15 days tablet it forte once daily for 30 days for greying and hair fall keraglow ad shampoo twice weekly for six weeks other good medicated shampoo you can use for dandruff are scale shampoo fora shampoo no scruff shampoo lotion and ketoconazole shampoo all are good effective for dandruff do not stress eat nutritious and healthy food"
    },
    {
        "instruction": "hello doctor my partner and I had protected sex on the 15th of this month but I bummed in the condom but kept going not taking any chances she took a pill on the 18th from the next day after taking the pill she had light bleeding in the form of blood clots and also experienced abdominal pain the pain has persisted till now but the severity has decreased could you please tell me whether she is pregnant or not",
        "input": "",
        "output": "hi if you had protected sex then she should not be pregnant do one urine pregnancy test for confirmation abdominal pain can also be due to stomach infection or kidney stones do drink more water eat healthy and less oily food if not decreasing then she will require an ultrasound scan for further diagnosis"
    },
    {
        "instruction": "hi doctor I am a 36 year old male I have a sore throat for two weeks now and I am in my sixth day of antibiotics dalacin but it is not going away I feel that there is something stuck inside my throat esophagus I have a mild headache but no fever pain scale is ranging 6 out of ten I also gargle every three hours using difflam",
        "input": "",
        "output": "hello I have reviewed your history and it seems on top of the acute tonsillopharyngitis you also have herd gastric esophageal reflux disease this may explain the persistent throat discomfort in spite of taking the antibiotic for six days I recommend you continue your current regimen and finish the course of pantoprazole as prescribed for the headache you may take ibuprofen as needed on a full stomach I also recommend that you avoid eating spicy oily fatty dairy foods and avoid drinking alcoholic carbonated and caffeinated drinks if you are a smoker you should stop smoking and also avoid lying down within one hour after eating if symptoms persist worsen or new onset of symptoms such as difficulty swallowing or voice changes further consult is advised"
    },
    {
        "instruction": "hello doctor I am a 26 year old female I recently found out via online test results that I have an enlarged heart but no reason was given for why it is enlarged or how enlarged it is the impression is cardiomegaly with no evidence of focal infiltrate I am currently obese but in good health with the exception of this enlarged heart and insulin resistance not diabetic or insulin dependent is it too late to reverse this heart enlargement with diet weight loss and lifestyle changes I am currently on metformin xanax and proverb",
        "input": "",
        "output": "hi enlarged heart only on chest ray is not reliable ray is just like a shadow the farther you stand from the wall the larger will be your shadow in the same way if you stand away from ray film even a few centimeters it will give an enlarged shadow of heart on the film best way to assess the size of the heart is via echocardiography is indicated if you have symptoms of shortness of breath not explained from other causes if you have such symptoms have echocardiography and egg done I hope these will be normal"
    },
    {
        "instruction": "age 30 gender male medications started lyearica pregabalin yesterday 25mg moving to 50mg tomorrow issues generalized anxiety social and performance anxiety query did my go prescribe the right meds I mainly suffer with social and performance anxiety talking to people talking in groups meetings at work etc for the past 10 years my voice breaks when I talk and I have a chronic dry mouth from stress anxiety every day even when off meds I worry and overthink lot about what others think of me I have tried amitriptyline tricyclic antidepressant when I was in my early 20 im 30 now and also tried lexapro and zoloft in more recent years but they did not do much for me and gave me lot of annoying side effects I have tried beta blockers too for the past years I have been medication free but every day becomes tougher and tougher to get through due to symptoms of anxiety I would not say I have low mood or depression I have tried benzos also and I did abuse them for a few months and had to go through a horrible withdrawal I have not touched them in over years my new go recommended I try lyearica pregabalin and wants to see how it goes for a couple of weeks in battling my anxiety im starting on 25mg once daily and moving to 50mg tomorrow or next week which is a low dose does this make sense to try with my history I have a chronic dry mouth from chronic stress and anxiety and most drugs make my mouth way worse the doc also mentioned possibly trying amitriptyline again too if lyearica does not work of course I very anxious about the side effects any advice would be appreciated",
        "input": "",
        "output": ""
    },
    {
        "instruction": "hi doctor I am a year old and have had memory problems for the last five years it started back in high school and I would wake up and not remember what was going on in my life but not just for a few seconds it would stay like that I would know the friends I have but I was not able to remember what was happening to me right now if I am mad at anybody right now do I have some guy that I am talking to etc when I would check my messages I would see approximately what was going on in my life but I would still not remember when was the last time I saw some of my friends do I have some special birthday gifts planned for them do we have a special joke for something at a time I would just remember they are my friends and maybe like 30 of our time together it was the same about school and I could not remember what we were doing and what I already studied so I had to do it from the beginning again the situation got worse when I went to college and now it is even worse for me because it happens that I wake up and everything that is happening to me feels so distant like it was a few months ago and not yesterday previously it would usually only happen every couple of months over the night but for the last three nights it keeps repeating I would like to say that I have no problems with drugs marijuana etc I have never used all of this I already told to my doctor but she did not take me seriously enough they did take photos of my brain and I do not have injuries I would also just like to mention that I have very low sugar so do not know if it could be related to my memory my doctor advised me nothing about that she only said that she does not know how I am alive with such low sugar but that it did not matter because I am young please help",
        "input": "",
        "output": "hi first of all a good memory needs a balanced diet which contains all essential vitamins and minerals such as vitamin complex carbohydrates proteins and a small amount of fat moreover some drugs like oral contraceptive pills can lead to decrease in vitamin complex in your body stress pollution and junk food have a negative impact on memory the brain needs glucose to work properly but too much glucose can disturb the memory and the whole brain function vitamin complex deficiency patient may have memory problems related to lifestyle the patient should take vitamin complex once per day after meals and benfotiamine 40 my twice per day after meals the patient should eat healthy food and avoid too much fat sugar and salt in her diet"
    },
    {
        "instruction": "hello doctor I am suffering from coughing throat infection from last week at that time fever did not persist and also did not felt any chest pain two days later I consulted with a doctor he prescribed cavidur 625 monte la ambrolite syearup and betadine gargle solution since then throat infection improved and frequent cough also coming out coughing also improved remarkably though not completely from yesterday onwards fever is occurring maximum 100 degree celsius I have not come in touch with any foreign returned person nor went outside in our state there is no incidence of couid 19 please suggest what to do",
        "input": "",
        "output": "hi I can understand your concern in my opinion you should get done a chest ray and abc complete blood count if both these are normal then no need to worry much I hope this helps"
    },
    {
        "instruction": "hello doctor earlier this year I proactively got a root canal and crown for one of my back molars the procedure went fine but the coronavirus hit before I was able to get the permanent crown installed as a last step my temporary crown is still in and functioning fine and I was able to acquire my permanent crown before entering quarantine and thus have it with me I have heard oral infections can be dangerous and I am mostly navigating around avoiding danger but obviously I am going into town to get dental work done is also dangerous nowadays I would like to understand how much more likely I am to get an infection or some other serious complication if I end up going without a crown for a couple of months especially given I have had an endodontic treatment of the relevant tooth I have dental cement and I am similarly curious whether doing an at home cementing of the crown would be protective or dangerous",
        "input": "",
        "output": "hello I have gone through your query and understand your concern firstly going without a permanent crown but with a temporary crown in place does not going to cause any serious complications to make this more clear I would like to explain the need for a permanent crown after a root canal treatment once the tooth is root canal treated and the infected pulp tissues removed the tooth becomes dehydrated and is more prone to fractures or chip offs and secondary infections if left uncovered the tooth is ideally shaped and reduced to receive a crown so going without a crown could actually lead to sutra eruption of the opposing tooth so a root canal tooth has to be covered with some sort of crown to prevent chip offs secondary infections and sutra eruption generally a ceramic or a zirconia crown which can withstand our enormous biting force is installed to protect the underlying tooth since the fabrication of such a crown takes time a temporary or a little less hard crown is installed meanwhile this can withstand and stay in place for a couple of weeks depends on the crown and cement material but if on following certain instructions you can expect it to come a little extra longer than that maybe a couple of months avoid biting hard and chewy foods hard foods can cause the temporary crown to crack and chewy and sticky foods tend to dislodge the crown fruit seeds nuts chewing gum cheesy foods burgers etc brush gently and skip flossing for that tooth keep your permanent crown safe probably after a couple of months let us hope the situation gets fine and you can get it fixed safely please do follow these and let us expect it to come a little longer let this pandemic settle and you can get the permanent crown fixed right away and it is not advisable to do an at home permanent crown fixing procedure because permanent crowns are strong and are not malleable and adaptable so if fixed in a very slightly different way could change your bite and cause jaw issues and tooth pain sometimes at the doctor office the permanent crowns will be adjusted and refinished a little before fixing to bring a proper and stable bite so fixing at home is not a good idea and just in case if this temporary crown decements by accident do not worry this is not going to cause serious trouble in the future I hope this helps"
    },
    {
        "instruction": "hello doctor my question is about the coronavirus I have been having some symptoms such as indigestion sore throat slight heaviness in the chest area sometimes and dizziness sometimes dizziness could be because of panic",
        "input": "",
        "output": "hello please do not panic it is not couid 19 if there is no fever for sore throat you can start warm saline gargles"
    },
    {
        "instruction": "hello doctor I am a 23 year old female I am 70 keg 3 feet I am currently experiencing shortness of breath it started a week ago and never went away even though I am taking lagundi or herbal cough medicine 500 my three times a day after meal I also feel like I have a lot of phlegm that I cannot release it just feels heavy on my right chest that passes through my back I am having paranoia on having couid 19 but I am afraid to get checked because I might actually get it from the hospital please help",
        "input": "",
        "output": "hello I understand your concern I do not think it is couid 19 as you do not have a fever but you need an antibiotic I believe it may just be pneumonia are you taking any antipyearetic drug because you need to know if you have a fever for couid 19 you should have a fever cough and difficulty in breathing"
    },
    {
        "instruction": "hello doctor I am 32 years old my sickness started with a slight fever tuesday night then wednesday I got a higher temperature of 38 then thursday night rashes appeared I went to a local doctor friday morning as my fever reach 39 degrees they gave me a fast drip to lower my temperature then saturday morning my temperature went down to 37 but I still have few rashes then I started feeling my swollen joint hands and feet pain now I already took a bath as my temperature is 36 c I am just worried about my swollen feet and hands and the pain is troubling I am currently takin biogenic paracetamol",
        "input": "",
        "output": "hi has this happened before or is it the first time can you describe the rashes or better a photo of it is it itchy is it generalized or located in specific areas blanching flat or elevated regarding the swelling of the hands and feet is it the first time does taking paracetamol help with the pain is it swollen or just painful and which joints are specifically affected the wrist or joints along with the fingers what about feet and ankle what did the abc complete blood test reveal"
    },
    {
        "instruction": "hello doctor I have been to a spa about a month ago and I had a small redness on my dick hardly worrying it went away after a couple of days and did not think about it no pain no itching nothing two weeks later I went for a lingam massage dick massage with oil included for like an hour and I fall asleep after it at home did not take a shower well I woke up to a complete nightmare my dick looked horrible I did not masturbate for two weeks and used betadine and it slowly went away then I masturbated and boom red again I went to a urologist who prescribed me a cream called travocort and told me to use it for one week and if symptoms do not get better go for a sperm test well I used it for a week stopped it when a week was over and it is getting red again also it started to have a little pain on urinating and it was an absolute hell to masturbate I would go for the sperm test to see if I have an sad which I believe is hardly possible because I have not had sexual intercourse with a woman since three months no male either but I really want to ignore hospitals now that the coronavirus is absolutely going ham",
        "input": "",
        "output": "hi welcome to icliniq com did you have oral sex is there any itching burning in urine difficulty in passing urine or fever is there any history of allergies this can be either an allergic reaction which gets aggravated due to some reason or a fungal or chlamydia infection I would suggest tablet evil pheniramine maleate two to three times a day for three days at least capsule doxycycline 100 my twice daily for 14 days miconazole cream locally twice daily if the evil does not improve things avoid applying betadine locally as skin is very sensitive"
    },
    {
        "instruction": "hello doctor I have had two blood tests conducted within the last two weeks the results from both tests showed high amounts of alt and ast liver function I am interested in knowing if there is anything I should do to lower these levels to normal",
        "input": "",
        "output": "hi welcome to icliniq com see your liver enzymes amylase lipase and creatinine is raised to treat this we need to know the cause I would like to know if you have been consuming alcohol I would also like to know if you have diabetes high blood pressure or any other chronic illness have you got your ultrasound done please mention the symptoms for which the test was conducted I hope this helps"
    },
    {
        "instruction": "hello doctor I had tonsil infection last week for which I went to the doctor who gave me antibiotics and pain killer my throat infection is healed but still I am having pain in my throat again I went to the doctor and he told it is lymph swelling and he prescribed me with cetirizine and pain killer I am taking this medicine from the last two days but I am not getting any relief still I am having pain on one side of the throat please suggest",
        "input": "",
        "output": "hello please take a picture of the back of the throat with open mouth showing details of the affected area and send to me is the lymph node palpable is there any fever did you complete the antibiotic course fully or did you stop abruptly"
    },
    {
        "instruction": "hello doctor I have had a feeling like something had been at the back of my left side of the throat for a few days I do not know what it is tonsils are not inflamed throat a bit dry and does not hurt to swallow",
        "input": "",
        "output": "hi one of the reasons for your symptoms is anxiety which you told globes hysterics is a feeling of something like a lump in throat which cannot be swallowed or swallowed and reappears tonsils usually are asymptomatic unless very large and obstruct throat are inflamed causing severe pain if your throat is red or you run a fever then chances of inflammation are more alternatively you may send a picture of your throat so that I may see any visible inflammation or tonsils"
    },
    {
        "instruction": "hi doctor I went for an ultrasound for my thyearoid and the result is diffuse thyearoid enlargement with small solid nodules consider adenomatous thyearoid hyperplasia my to result is 59 to 135 and ash 17 34 this result was taken before two months after a month I took to and to again resulting in to 52 and to 95 59 the last clinic gave me a food supplement black cumin seeds oil and vitamin do my question now is what does the ultrasound mean anyway I am a male of 39 years old",
        "input": "",
        "output": "hello welcome to icliniq com I just read your query and from what you have mentioned it appears that you had enlarged thyearoid gland due to hyperthyearoidism and the ultrasound also meant that the thyearoid gland was enlarged simply because it was hyperfunctioning and now that you are on medications which can possibly help them with normalization of their function and they might as well likely reduce the size of the gland as well I hope this helps"
    },
    {
        "instruction": "hello doctor I have a dark line in my toenail for a long time since I was a kid I realize that but never came into my mind that could be dangerous the same happened to my fingernail many years after I became an adult I would like to know if it is something serious and should I care about it",
        "input": "",
        "output": "hi welcome you to icliniq com I have seen your query and examined your given picture it seems you have developed melanonychia the cause of this are many such as inflammatory nail diseases like lichen plans racial nexus in nailed and rarely melanoma you need to go for nail biopsy for confirmation"
    },
    {
        "instruction": "hello doctor my 75 year old son started thursday night with these twitches and jerks he is battling a cold it appears with a runny nose watery eyes and sneezing no fever this has been the same time as these motor items have developed overall he has acted fine and there is no change in consciousness he was seen one month ago about starring spells but neurologists thought it was low risk for seizures we are not sure what these are he does them when at rest versus active playing or eating we want to try to get him in to the test but given the current situation we are hesitating to take him we need to do a sleep study is this seizure activity could it be related to cold could it be growth related he was just to pop and development is well above age group for mental and physical he does twitch and jerk as he falls asleep often also he is prone to crying and talking in sleep he is not screaming but enough to get your attention he is asleep when we check on him please help I have attached the videos",
        "input": "",
        "output": "hello I passed carefully through your questions and reviewed your videos in the first video I cannot distinguish but the last video is very suggestive of seizures for this reason I would recommend performing an eg electroencephalography I understand the situation but I do not think that this is an emergency as these episodes are not so frequent they usually occur several times a day you can wait a month or two as the situation of coronavirus is more clear you should discuss with his pediatrician about this I do not think these episodes are related to a cold as he has no fever I would exclude any possible relationship to the cold I hope this helps"
    },
    {
        "instruction": "hello doctor three weeks ago I noticed my left tonsil seems slightly enlarged and I have a lump with white head right behind it a little background for the past six months I have been experiencing daily low fevers and severe night sweats which are undiagnosed my pop told me it was just a tonsil stone but I am almost positive it is not it looks nothing like any that I have seen in my research I would love to submit a photo for a second opinion I will eventually make it to an ent if needed but with the coronavirus I would like to wait if it is nothing to worry about most labs done prior to lump looked normal except I had a positive ana with a low titer 40 my cop was considered normal but 1 which says I am high risk for heart disease I am a pretty active healthy 34 year old so while considered normal it seems off to me chest ray looked normal to test negative",
        "input": "",
        "output": "hello you are right it is not a tonsillolith it is a tonsillar cyst indeed it is nothing to worry about and such a small may not even need any treatment furthermore your tonsils are not that grossly enlarged or even congested to give you the spikes of fever low grade fevers and night sweats need to be evaluated for other more important causes like tuberculosis have you done any serological tests and baseline blood tests"
    },
    {
        "instruction": "hello doctor I am traveling to the solomon islands next week assuming planes still flying I am seeking malaria prevention medication I will be there for two weeks longer if the return flights are canceled I am in good health I am years old and I exercise daily I take no medications except multivitamin walk briskly two to three miles a day no surgeries and implants",
        "input": "",
        "output": "hello you are doing a great job to preserve nature it is better to take malaria prophylaxis while traveling to an endemic area among many regiment I suggest you the following effective regimen mefloquine 250 my tablet to be taken weekly once start two weeks prior to the travel continue during the travel and four weeks even after return to hometown so all these days the dosage will be 250 my tablet weekly once this tablet gets over then start tablet primaquine 15 my this tablet to be started from the next day of the last dose of mefloquine for 14 days two weeks daily buy 14 tablets of primaquine this can destroy any dormant form of all types of malaria you please go ahead of your services which should not be stopped because of malaria"
    },
    {
        "instruction": "hello doctor I recently had parathyearoid surgery to remove one adenoma nine weeks ago the recovery started out pretty well and have been feeling good on and off but in the last two weeks I have been having some neuropathy in random parts of my body my endocrine surgeon and pop say that it is just my body leveling out due to the adjustment of normal calcium levels now in my body after abnormal calcium levels I had for three years prior to surgery however it makes me nervous and I want to rule out any nerve disorders all of my blood labs are current and are normal this includes a full thyearoid panel and abc I have been recovering from parathyearoid surgery and have been having some new symptoms of nerve discomfort the past two weeks on and off it ranges from a feeling of a pinched nerve in the right arm and muscle weakness in both legs as well as burning and tingling feeling on random parts of the body as well as tingling in the bladder and vulva region it is not there every day some days I feel great with no symptoms but other days I have it I have had zero symptoms like this in my life and this only appeared post surgery this was my after visit summary with my pop general appearance alert appears stated age and cooperative head normocephalic without obvious abnormality atraumatic lungs clear to auscultation bilaterally heart regular rate and rhythm s1 so normal no mur click rub or gallop abdomen soft non tender bowel sounds normal no masses no organomegaly extremities normal atraumatic no cyanosis or edema blat le with p and der blat patella and no ankle clonus neurologic grossly normal I take 30 my paroxetine daily and have been taking xanax and klonopin to help with the anxiety I have been feeling about this besides that I take calcium vitamin multivitamin and iron supplements daily",
        "input": "",
        "output": "hello welcome to icliiq com your physician has rightly said it seems that nerves are adjusting to the calcium metabolism in addition to your medication you can take tablet pregabalin 50 my along with tablet mecobalin 1500 micrograms for about one month to alleviate your symptoms by that time it should get relieved"
    },
    {
        "instruction": "hello doctor for about two weeks now I have had a twitch in my left arm triceps that seems to be worse when I have my arm straight and down by the side of my body and less noticeable when I have my arm over my head and bent at the elbow the twitch seems to be worse at times without any particular reason for it this night I had difficulty sleeping because it was very annoying I used to do some resistance training before this so it might be some type of nerve injury but I have not experienced any pain or discomfort during exercising before the twitch began also I have stopped training ever since discovering the twitch I am starting to worry that this might be some type of motor neuron disease as it is not going away and it is not improving at all I cannot visit a doctor earlier than monday so any advice or explanation of what this could be would be greatly appreciated",
        "input": "",
        "output": "hi this is acute onset localized twitches started after strenuous activity this seems to be physiological twitches that are occurring due to minor muscle or nerve injury just check for any weakness or loss of muscle mass in the region where you are developing twitches if they are not then no need to worry excess consumption of coffee and smoking can cause the same so avoid excessive coffee and smoking if any is there this is unlikely to be motor neuron disease and at this age and will have prolonged course sometimes they are unnoticed completely"
    },
    {
        "instruction": "hello doctor hardness is going down very fast within two minutes after intercourse I am unable to penetrate properly with this problem I want to harden it for some time to penetrate and release properly I also used sildenafil personally but if I use this drug the semen is not releasing properly we are trying for a baby I have one baby girl already I have is I will get bloating while doing sex",
        "input": "",
        "output": "hi erection problems can be due to many causes including stress and physical causes such as diabetes hypertension and endocrine problems so first visit a doctor to rule out the physical condition you can try tadalafil instead of sildenafil as it has lesser side effects and see does it suits you or not also avoid alcohol and tobacco products do regular exercise or go for a walk at least 45 minutes daily take healthy food spend enough time in foreplay I hope this helps"
    },
    {
        "instruction": "hello doctor I have got my left leg pain when I walk and stand after 30 minutes",
        "input": "",
        "output": "hello your laboratory tests are quite normal and not indicative of any infection considering the past medical history for seizures I would recommend performing an eg in order to exclude seizures as a possible cause underlying muscle twitching regarding the pain I would recommend performing a doppler ultrasound of the leg vessels coupled with nerve conduction studies in order to examine the nerves and leg vessels"
    },
    {
        "instruction": "hello doctor I suffer from erectile dysfunction and also ejaculate even just with holding a women how can I solve this problem I am a healthy person who exercises regularly is not over weight and my lab reports are also fine I know I suffer from lack of libido but do not know how to handle it",
        "input": "",
        "output": "hi your blood test are normal except low vitamin and b12 attachment removed to protect patient identity erectile dysfunction and premature ejaculation can be due to many causes if erectile dysfunction is more prominent then first try sildenafil and if it is improving then okay otherwise go for penile doppler study for both premature ejaculation and erectile dysfunction sildenafil plus depoxetine may be helpful take this tablet 30 minute prior to sexual activity also try the behavior methods called start stop technique or coitus interruption or squeeze technique you can read these online and start practicing any one these methods give good result but you need to do these daily and results are only evident after a few weeks also take vitamin and vitamin b12 supplements serum testosterone ed and me sildenafil plus depoxetine regular exercise avoid alcohol or tobacco"
    },
    {
        "instruction": "hello doctor I am years old I am trying to conceive for the second time I have a year old son and it was a natural birth I am not on any medication my period was always regular and I get them every month but about months ago my period days changed from the beginning of the month to the middle when it was all messed up I was getting a period twice a month but that has stopped about two days ago I thought I was getting my period but I am lightly spotting it is a light red color it is not dark or anything it is more faint when I am usually on my period I bleed a lot I have been pregnant before and know the symptoms but would it be possible I do not understand this light spotting am I on my period do you think can I be pregnant or it can be my cycle changing",
        "input": "",
        "output": "hello there are multiple reasons for not being able to conceive first it depends on the time for which you guys are trying only after a year of unprotected intercourse we can start the evaluation and that you have conceived once naturally means the mechanics are all correct I see that your mi body mass index is high that could be the reason for irregular periods you must work on your weight and bring the mi between 18 to 25 if you are concerned about your cycles you will be prescribed contraceptive pills if you want to conceive they might start the evaluation depending on the policy"
    },
    {
        "instruction": "hello doctor it hurts to talk because I had screamed and lost my voice I screamed again the next day before my voice was back and that is when it hurt my doctor said I had laryngitis but that was like a month ago he gave me some antibiotics to take and keep quiet for 10 days which I did I still cannot talk fully I do not have hoarse my normal speaking is clear but I cannot talk louder or in higher pitches it kind of feels like there is a lump in my throat",
        "input": "",
        "output": "hello when you had screamed some micro bleeding and abrasion of vocal cords would have occurred the same would have caused you pain and loss of voice temporarily the doctor would have tested laryngitis now you are possibly suffering from mild inflammation and edema of the region due to the said trauma the same makes you feel that there is a lump in the throat you need some supportive treatment for another few weeks I would suggest you take a proton pump inhibitors medicine like rabeprazole 20 my or pantoprazole 40 my twice daily in empty stomach for 15 days you also would have to take anti inflammatory medicines like trypsin chymotrypsin rutopside combination in an empty stomach twice daily for a week and then once daily for next week you should take antacid syearup like mucaine gel one teaspoon after each meal you are advised to avoid masala curries spicy food alcohol and smoke until you are better this way we help the tissues heal properly and vibrate normally do revert back if you need any further support or clarification"
    },
    {
        "instruction": "hello doctor I had smegma since 5 years which resulted into balanitis that is what I think as per symptoms like difficulties in pulling foreskin cuts pain rash swelling etc and recently I applied candid cream non steroidal twice a day for 10 days and smegma seems to be gone and also balanitis seems to be fine but my foreskin and glans still becomes red and I can see small red spots after rubbing penis to clean also just saw a blister at the opening of urethra it is little inside and need to spread the opening to see it what could be the reason",
        "input": "",
        "output": "hi can you tell me if there is any burning pain discharge itching or difficulty in passing urine are you able to retract your foreskin up completely is there history of sexual exposure are you married when we rub on penis head or foreskin it can become red as the skin is very thin and sensitive the skin lining the urethral opening is usually pink or red sometimes what we think is a blister may be normal mucosal skin if there is a blister or ulcer see your doctor or a urologist let me know answers to the above questions"
    },
    {
        "instruction": "hello doctor I have to wear wire retainers and every time I put them in I have a panic attack and break into tears I do not know what I should do",
        "input": "",
        "output": "hello retainers are worn in two situations post braces treatment or for minor teeth alignment correction if you are wearing this after braces treatment there are two other types of retainers which you can opt for fixed wire retainers essex retainers clear plastic tray like a retainer the retainer which you have should have a passive fit after ortho treatment if they fit too tightly that needs to be adjusted to bring it to a passive fit please get back to your orthodontist and get it adjusted if you are uncomfortable with this retainer you can always opt for a different type but if you are wearing it for minor tooth alignment issues it should be a little tight again if uncomfortable this needs certain adjustments and do note the retainers need to be worn for the maximum duration as instructed by your orthodontist for it to become comfortable other times it should be stored in a container with water to prevent it from shrinking accidentally if the retainer is deformed or shrunken a little this could cause such difficulty in wearing however this can be adjusted by your orthodontist"
    },
    {
        "instruction": "hello doctor I am inquiring about a concern I have about my abc results I have shown a abc of 9 for almost two years and recently had a followup abc and it showed 6 I have felt like I have been fighting off a head cold and particularly stressed with the current virus situation do you think this kind of count is of any cancer of course I get on google and got worried about things like leukemia or some sort of illness that could compromise my immune system with the current virus going on the other levels are below rec 5 neutrophils 56 lymphocytes 31 monocytes 4 eosinophils basophils platelet count 292",
        "input": "",
        "output": "hi welcome to icliniq com first of all I wish you very safe health during this couid 19 crisis coming to your question I reviewed your records and I am glad that you came up with your concerns I will be happy to answer that based on my experience one thing which I can say confidently is that you do not have cancer so good to hear those four words yes that is not the way cancer presents and not specifically at your young age your lymphocyte count and neutrophil counts are good and there are no abnormal cells as well with regard to the current coronavirus I agree that we all should be vigilant your lymphocyte count and platelet are good and hence blood work wise you need not worry but I am sure you must be aware of when to get couid 19 testing based on the symptoms rest assured you do not have cancer just get lab check yearly"
    },
    {
        "instruction": "hello doctor I am a hypertensive person and I take medicine olsar 20 occasionally from the past two weeks I am feeling muscle pain in hands and knee joints with headache backside sometimes while lying down to sleep I am sensing fluttering in my chest left side for which I feel afraid and sit for a while and sleep on the right side for the past one week I am sensing a lower abdomen pain as well both right and left also I have kidney stones measuring my and my in the left and right respectively as per the test I did about six months back and was advised for noculi suspension in water and which I took for two months I am afraid as I am away from home is this any issue related to my heart and kidneys please advise what immediate action I need to take is any serious issue",
        "input": "",
        "output": "hello firstly this does not appear serious to me however you should get yourself evaluated this does not appear to be related to kidneys your egg echocardiogram is normal and lipid profile shows elevated cholesterol level which would increase the risk of heart disease in the future so to reduce it you should have healthy lifestyle like avoiding fatty oily diet less of non vegetarian foods and regular exercises like brisk walking or running according to the capacity have less fast and fried food you should try a healthy lifestyle for eight weeks and repeat lipid profile after that to see for the response if there is a response then it is fine or else you will need to start medications regarding heart fluttering this may be an extra beat which are usually benign or may be enhanced awareness of normal heartbeats however to be sure you should undergo hotter monitoring which is 24 your egg monitoring because egg taken during the symptoms can only reliably rule out cardiac arrhythmia alternatively you may attach mobile based egg monitors like kardia device or other devices another thing you should take be medications regularly as you are not measuring be all the time and be may go up during that time which would damage the internal organs also measure be frequently you should also get your vitamin and thyearoid tested for body aches"
    },
    {
        "instruction": "hello doctor I have been having vaginal itching for a while which led to vaginal fissures down to my bum and have done a test which I need you to help me clarify and advise what to do thanks",
        "input": "",
        "output": "hi I have seen the report fissures are due to continue scratching over the itching part avoid scratching report says you have a vaginal infection with candidiasis fungal infection and coli growth found which is normally not found in the vagina and sensitivity report says that all the medicines with are sensitive or effective against these organisms so basically you can take candid ve like vaginal pessaries along with that amoxyclav amoxicillin and clavulanic acid antibiotics two times a day for five days and metronidazole 400 my two times a day for seven days do drink more water so that urine should be clear keep the vaginal area as dry as possible change pads more frequent during menstruation eat healthy and less oily and less spicy food all these precautions to avoid recurrence do not scratch it will increase the problem if you are not following the proper precautions these infections are bound to reoccur so be alert also do clean the area with water after sex and do urinate immediately"
    },
    {
        "instruction": "hello doctor after going to a medical check up a few days ago a doctor notified me I had a papilloma in my tonsil I am a 28 year old male otherwise healthy I had been having an itch like feeling in my throat and some inconsistent feeling when swallowing or in ear pressure I cannot go to a doctor at the moment I am quarantined due to couid pandemic overseas is this something that deserves immediate urgent attention what can should I do expect",
        "input": "",
        "output": "hi I see that this is not an emergency use antihistamine to overcome the itching sensation use nasal decongestant drops twice daily for five days when lying down on your back to relieve the ear pressure sensation also chewing gum can help after ending the quarantine period you can follow up with your physician again"
    },
    {
        "instruction": "hello doctor I recently was referred to an oncologist hematologist after having two rounds of blood tests both showing a high white cell count as well as a few other abnormalities I saw the oncologist hematologist who ran additional tests I see a multitude of abnormalities however she told me I am just iron deficient my concern is when I saw her she literally gave me less than three minutes of her time because she was in a hurry she basically picked up her back and ran out I am worried she missed something and I did not get the opportunity to ask questions I am currently on ventolin asthma inhaler vitamin and daily iron tablet",
        "input": "",
        "output": "hello welcome to the icliniq com following is my opinion about your asked question your two rounds of abc showing high total abc white blood cells count and high neutrophils immature granulocytes are elevated slightly the inflammation infection excess stress etc like causes might be responsible for that in the second abc complete blood count decrease and neutrophils also reduced in number hence it does not look like leukemia or blood cancer immature granulocyte can be increased slightly in any inflammation your count and differential count are not to the level suggestive of leukemia so it does not seem to be blood cancer as per my opinion kindly repeat abc with peripheral smear examination after a few days the value will fall within range after a few days I hope this helps"
    },
    {
        "instruction": "hello doctor I have testicular pain in the right tests I consulted with a primary care doctor they gave me an ultrasound which came out negative but revealed tiny right tunic albuginea cyst I am covered under va health care and the urologist consultation has taken months with no follow up meanwhile I have a dull aching pain there and poor sexual performance from time to time when I had a climax or orgasm it is very weak uncomfortable low volume and unsatisfying when at the peak I feel the dull aching and pressure in the right tests then feel the above results can you help me figure out what is going on and how to fix it I am embarrassed to talk with va doctors of fear they would know what to do I also have kaiser but the doctor is new",
        "input": "",
        "output": "hello welcome to icliniq com I have gone through your queries you are having two issues one is testicular pain another is me premature ejaculation and ed erectile dysfunction firstly I come to testicular pain it may be due to mild epididymo orchitis or it may be due to the cyst do not worry please use tight underwear or scrotal suspensory bandage it will help you to alleviate testicular dull aching pain now for the problem of ed me do you have normal morning erection do you have diabetes or any other comorbidities please undergo one us ultrasound doppler study of penis it will tell you about the vascularity of penis we can manage this problem according to the report of doppler study do not worry both problems can be solved or rather treated successfully meanwhile you can use tadalafil 10 my plus dapoxetine 30 my 30 minutes before sex this drug will act only after you get to involve in foreplay"
    },
    {
        "instruction": "hi doctor six years ago I had a it scan that incidentally found three small lung nodules I had a follow up scan six months later and they were the same and resembled scars I just started worrying about them as I have been a bit tight cheated for a couple of days I do have asthma every now and then and I am worrying that what if they were cancer back then and are now grown into masses and are causing symptoms am I right in thinking that if they were malignant back then that I would have had serious symptoms before now I have attached my report",
        "input": "",
        "output": "hi the nodules found six years back would have manifested into multiple lesions by now if there were cancer and you are right in your thoughts usually cancer nodules double in 30 to 180 days time and if the nodules did not change in six months then cancer is not a likely possibility an annual chest ray is a recommended test to keep track and for a general check up purpose"
    },
    {
        "instruction": "hello doctor last night I was getting chills feeling more cold than usual and lightheaded and a lot of burping maybe like every 30 minutes or less or so feel more chills running down my body and chest feeling bit weird like I am starting having trouble breathing then goes back to normal and repeats with weird feeling like chills down my left and right lungs or left and right upper chest also my heart was pumping fast also some minor coughs were there since seven days ago still here I have white mucus and have not gotten yellow yet I took medicines yesterday but today I got severe cold and flu medicine with a pain reliever the chills did not go away then today I called the doctor on the phone and told him what happen last night and the same thing happened this morning too I had minor coughs feeling lightheaded feel like maybe cannot breathe or something and a lot of burping I told him the burping issue was going on for at least two years but somehow this time I am feeling lightheaded he just gives pepcid a try maybe herd I ate that today still feeling chills now and still burping a lot right now still some chills on arms with breathing issue or something makes my chest feel weird and arm sometimes so should I be worried I do not think I have a fever now but do not feel hot on the forehead was it herd or flu it is coronavirus or something else I hope it is not coronavirus I am 21 years old and weigh around 10 15 keg",
        "input": "",
        "output": "hello please answer the following any travel history in the last one month any use of airports any fever have you checked the temperature any cough any mucus or phlegm how is your sleep is there any malaise or body aches or weakness"
    },
    {
        "instruction": "hello doctor I happened to breathe fumes from chemical exposure two days ago got tightness in chest sternum and a little shortness of breath when biking the next day and did fine after riding a bike I had a little phlegm but now have irritated trachea and still a little tightness in sternum it has been 48 hours I can take a deep breath should I be more concerned",
        "input": "",
        "output": "hi I can understand your concern this kind of exposure can cause bronchitis it is the inflammation of airways this inflammation causes cough and bronchoconstriction which intern cause wheezing breathing difficulty etc all these events depend on many factors but the most important factors are amount of exposure duration of exposure smoking habit underlying lung conditions present or not so please let me know the answers to the above asked questions so that I can guide you better I will be happy to help you further wish you good health"
    },
    {
        "instruction": "hello doctor I have complicated migraines simple partial seizures and are controlled by lamictal I have a long time pain from sound intake and it has worsened into my face other sensory triggers the pain it has become just way too much to handle I sought advice from friends and groups and nurses that have trigeminal neuralgia and they suggest carbamazepine I learned it lowers lamictal I contacted pharmacy that said many will test blood serum of lamictal and then add carbamazepine and adjust lamictal to therapeutic levels my doctor is a bit concerned she is not a pain doctor or neurologist I am waiting to see one but my condition makes it hard to travel in a car my doctor asked I seek advice do you agree that checking the serum and adjusting is fine to do in order to take carbamazepine the second option is oxcarbazepine in your experience is it a good pain drug for to and does it mess up lamictal I found a study that said it did not I was thinking I could start it now while I wait on lamictal levels and see if it helps just really struggling pain cream not helping much in certain places my old neurologist wanted me to lower glutamate as much as I could and suggested namenda at one point I know many people are on two and three drugs I hope to try injections for the pain soon do you have any suggestions",
        "input": "",
        "output": "hello firstly we need to be sure if your pain is really trigeminal neuralgia to as there can be other causes of facial pain like idiopathic facial pain post herpetic neuralgia sometimes dental causes of facial pain can mic to trigeminal neuralgia has sharp shooting episodes of pain in any distribution of the trigeminal nerve pain is mostly along one side of pain and lasts for a few seconds pain can be triggered by brushing teeth cold air chewing of food mostly there is no baseline pain for to medications carbamazepine is the first line fda food and drug administration approved drug second line drugs are lamotrigine lamictal baclofen oxcarbamazepine phenytoin and gabapentin you are already on lamotrigine which is effective for to as add on medication you can do any of the following take carbamazepine and monitor serum levels of lamotrigine both combined will give good relief for to you can take oxcarbamazepine it does not interact with lamotrigine its effects are like carbamazepine I would suggest you to take oxcarbamazepine to avoid hassles of blood monitoring I have seen patients getting good relief with oxcarbamazepine remember that these medications take two to three weeks to show results and reach blood equilibrium most important is to confirm the diagnosis and then start the treatment you may require an mri brain to rule out any vascular loop pressing on trigeminal nerve ultimately for to you can go for radiofrequency of affected division of trigeminal nerve surgery is considered if there is a vascular loop I hope this helps avoid exposure of face and ear to cold air wrap a scarf around neck and face when exposed to environmental temperature avoid your trigger practice deep breathing sleep for seven to eight hours avoid swimming avoid smoking and alcohol"
    },
    {
        "instruction": "hello doctor I have been looking for the cause of my constitutional symptoms including lightheadedness and fatigue I have enlarged lymph nodes with the biggest being behind my jaw just under my ear on the left side I used a camera to look inside of my ear and I found a concerning discolored area of the skin inside my left ear canal it does not look like ear wax and it does not hurt but I am concerned that it is melanoma or another harmful growth I have images of it I will try to attach",
        "input": "",
        "output": "hello welcome to icliniq com the area of discoloration does seem to be something like a nexus though uncommon nexus can occur in the external auditory canal otherwise your external auditory canal and to tympanic membrane are normal and are not a source of fatigue and lightheadedness did you try palpatine the lesion did you clean ear by syearinging malignant melanoma in this region is very rare and can be very silent the best way of making sure that the node below your ear is not due to the lesion is to go for fine needle aspiration cytology further you need to monitor for the growth of the lesion however it is most likely to be a benign lesion"
    },
    {
        "instruction": "hello doctor I have been experiencing light headed feelings and daily headache as soon as I wake up I will be uploading an mri summary and want to know what the results mean if this is treatable or is it terminal I am currently on temazepam 30 my daily for sleep diazepam my as needed for meniere disease and some as needed for low back issues",
        "input": "",
        "output": "hello I read carefully your question and would explain that there is a non specific finding in your brain mri attachment removed to protect patient findings which could be a small inflammation region a born defect or a tumor this lesion is too small for biopsy so the next step to follow would be a lumbar puncture in order to examine the cerebrospinal fluid and exclude any possible infection or inflammation of the brain if the cerebrospinal fluid is normal follow up with a new mri after three months would be necessary in order to investigate for possible progression increase in dimensions or a new lesion I hope this helps"
    },
    {
        "instruction": "hello doctor I would like an opinion as to why the ring finger on my sons left hand is swollen the middle finger is a little swollen and possibly some fingers on his right hand are too but less so they are not painful this started about a year ago a rheumatologist saw him then and thought that it was not arthritis rays are taken last year were normal this is what the ray report says technique pa lateral and oblique views of the bilateral hands were obtained findings the alignment and joint spaces are normal there is no fracture osseous lesion or dislocation the soft tissues are normal impression no osseous or soft tissue lesion noted mri may be of value blood work taken a year ago was normal images attached",
        "input": "",
        "output": "hello I have gone through the history and the pictures along with the reports I would like to ask you a few more questions to conclude the diagnosis and how to proceed further with it does he complain of early morning stiffness that he has to move his hands to open it anyone in the family has any degenerative arthritis like osteoarthritis any complaints of backache or neck pains as of the reports your rheumatologist are right it is not inflammatory arthritis we are looking at some metabolic causes of these swellings or some other genetic ones"
    },
    {
        "instruction": "hello doctor I am concerned about my reproductive health due to poor planning I ended up taking the next choice generic plan pill three times within two weeks period after the third time I have had mild cramping and spotting every day for two weeks straight now I am very concerned that I did some permanent damage by taking so much progesterone I took a pregnancy test so I know I am not pregnant I have also been taking my normal birth control progesterone only liza pill normally since taking the last dose of plan any suggestions on what is happening to me",
        "input": "",
        "output": "hi plan is emergency pills and there are only study about once in a month there is no study about its effectiveness more than that and three times in a week is high number so you cannot say whether it is working or not and you are taking progesterone only pills after that now these tablets you can take but have to start after the period and these bleeding is actually not your period it is breakthrough bleeding due to high progesterone drink more water cramps is one of the side effects of progesterone stop every medication and wait for your menses and if you are still bleeding then consult a nearby gynecologist she has to see the amount of bleeding do urine pregnancy test after four to five days according to the bleeding amount you may have to take combined pills for a month emergency pills can irregularize your period do not use this many tablets next time without any consultation and consult a nearby gynecologist and do have one session about what to use and when to use contraception options available to you"
    },
    {
        "instruction": "hi doctor my mom is 57 years old she was diagnosed with to disease two months back through exclusion as her tests were negative but she had enlarged lymph nodes in the chest low fever night sweats etc biopsy showed negative for lymphoma and sarcoma she started att medicine and after 10 days she got rashes so the doctor stopped after 10 days she was restarted with att and suddenly she got pura and bleeding from nose and cough she was taken for tests where her platelets came as 100 it has been 12 days and she has been on steroids as sos rivolade past days but the platelets are still below 100 and rec and he are also dropping she is bleeding through urine and stool her other tests are normal including bone marrow biopsy attaching her latest report please advise",
        "input": "",
        "output": "hello welcome to the icliniq com according to your history it idiopathic thrombocytopenic pura might comes under suspicion but you are not having it as bone marrow is normal and megakaryocyte not showing any sign of it check hypersplenism by us ultrasound abdomen investigation second rule out dengue by ig dengue testing elisa or card test check your kidney profile investigation for serum urea creatinine etc blood infections has to be ruled out like septicemia by blood culture your bleeding and all other complaints are because of low platelets low platelets with bleeding need transfusion of platelet in form of sip or random donor platelet hence first rule out all the above cause if present and then if no cause found we have to strongly suspect autoimmune hemolytic anemia because of your abc report showing normoblast and high reticulocyte count and for that further investigation done with act direct combs test and other suitable workup steroid needed if act is positive and autoimmune hemolytic anemia if confirmed"
    },
    {
        "instruction": "hi doctor two days after my partner last period we had sex I am sure that the sperm did not go inside according to the last period schedule and as per 28 days cycle she was expecting her periods by yesterday or today which has still not come I have some queries what are the chances of her being pregnant which should not be the case because we had done sex in a similar way previously also without any issue can she still expect her periods considering a slight delay what are the methods or characteristics so that she can diagnose if there is any pregnancy if yes then considering this is still an early stage around 28 days what can we do to avoid pregnancy",
        "input": "",
        "output": "hi welcome to icliniq com how are you doing I do not see any chance of pregnancy for any lady ovulation will be around 12 16th day of the period life of egg is 24 hours and that of sperm is 72 hours since you had sex on day of periods there is no chance of sperm being alive till date ovulation and the egg will not be available on the ith day of periods so in total there is no chance for pregnancy delay in periods is not due to pregnancy it can be delayed even if any significant mental or physical stress any severe anxiety or depression as you had sex so early in periods when there was no egg available with full protection then there is no chance for pregnancy chances of pregnancy are zero you can wait for periods up to 10 days after the expected date this is normal if you want to diagnose pregnancy it can be done with a home urine pregnancy test earliest one day after the expected date if doubtful it can be confirmed with blood serum beta hug human chorionic gonadotropin tests this can diagnose the smallest of pregnancy anywhere in the body there is no chance of pregnancy but if you still think there is a chance then you will have to have map pills mifepristone once pregnancy is confirmed I hope this helps"
    },
    {
        "instruction": "hi doctor I have been dealing with anxiety since childhood I am years old now I have been smoking weed for about six months and my quality of life drastically improved now I could sleep at night I went back to being myself happy my confidence went up and my social anxiety virtually disappeared once while watching videos on the internet I came across one talking about reality and how we might be part of some sort of virtual reality when I started thinking about that it really freaked me out and I had a panic attack then the mixture of the anxiety and being high made me really entertain the idea of this reality was fake I was in a constant state of being on the brink of a panic attack for a few days afterwards even while being completely sober I am better now through the day I am fine even thinking back on it makes me kind of laugh but when I am alone at night the thought comes back and no matter how hard I try I cannot take my mind off it I could not sleep because of the anxiety related symptoms putting on a podcast and listening to people talk is the only way to calm me down I hate this and I cannot stop thinking about how I may become this crazy person who truly believes were in some sort of matrix and end up in some asylum rocking back and forth should I be worried about this am I going crazy I do not want to develop schizophrenia and lose touch with reality I have not smoked since the incident and I have gotten better but I am worried that I will never be able to shake off these thoughts although I know these thoughts are completely ludacris and I am truly fine will time resolve this",
        "input": "",
        "output": "hi I read your query and understand your concerns before I answer your question I like to congratulate you for taking the necessary step of stopping cannabis for further information consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor I am a 30 year old male I am suffering with the below symptoms which feels like a disorder I have this disorder running in my family a few of my paternal uncles also have them but in a mild form I had these symptoms since childhood but it was very mild at that time I had ignored them previously but over the course of time this has got severe and now it has started to concern me the symptoms are severe anxiety panic struck sweating palms facial sweat getting nervous trembling hands and legs voice breaking down throat gets dry extensive sweating of palms and sweat starts dripping from palm within a few minutes hyperhidrosis I am having the above symptoms when I attend any public or office meetings where I have to speak in front of a crowd in any social gatherings where I feel I am at focus and when I face any adverse condition or under mental stress due to work pressure however I am perfectly normal when I am alone or relaxing at home having no sign of anxiety or sweat I have tried a lot to keep my anxiety under control before going out for meetings but these symptoms appear involuntarily and starts making conditions worse for me this is making my life difficult and I have started avoiding meetings or gatherings am I suffering from any neurological disorder if yes please suggest what kind of treatment I should undergo to bring my life back to normal",
        "input": "",
        "output": "hi I have read your question with care and understand your concerns for further information consult a neurologist online"
    },
    {
        "instruction": "hi doctor two years back during my holidays I developed a large rash over the whole of my legs it was described as petechiae when I got back to my native the infection had got into my blood stream and my white blood cell count was extremely high it took some time for it to return to normal I always have problems with reactions to the sun I used to develop rashes swellings severe burns even if only going out for five minutes also fully covered dizziness and tiredness however I am again going on holiday later this month I would like to know how I can protect myself so this does not happen again I have been taking antihistamines for two months now I noted that sunscreen did not help to prevent this last time please give some advice regarding this thank you",
        "input": "",
        "output": "hi confine your summer excursions to early in the morning and late in the evening wear clothes that cover exposed areas uniformly use sunscreen with spy 50 particularly that which has zinc in it I also suggest vitamin supplement and antioxidants like carotenoids and polyphenols consult your doctor discuss with him or her and take the medicine with consent avoid your tour to high altitudes and snowy areas as snow reflects sun and may cause worse sun burn for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am a student and unmarried I decided to quit masturbation but sometimes I cannot control my thoughts and actions and watch pornographic content when I full erection I will realize that I decided to quit masturbation and somehow come out of it leaving my erection unattended erection goes away within some time will avoiding masturbation after an erection affect my normal health or sexual health in any way",
        "input": "",
        "output": "hi for further information consult a sexologist online"
    },
    {
        "instruction": "hi doctor for the past one year or more I have been suffering from occasional severe abdominal bloating but for the last few months it has been all day I have been tested for celiac disease and the result was negative my stomach becomes so big and I cannot walk or when sit I cannot see or cloth my legs it feels like it is just going to burst I have a poor appetite and anything I have eaten just comes back up I have vomited blood on two occasions and I always feel nausea I cannot use the toilet sometimes for days otherwise I cannot stop going sometimes at the end of urination the pain can be so sore the pain is constant under my right rib and runs down the right side and into the middle of my front please help with my condition",
        "input": "",
        "output": "hello celiac disease if not ruled out by a biopsy of the colon crohn disease pud peptic ulcer disease helicobacter pyloric infection gastritis abc complete blood count end esophagogastroduodenoscopy and colonoscopy it would depend upon the endoscopy and biopsy results for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I was injured at work before four years and till date I have not received any treatment in the course of trying to get medical help I have been suffering with severe pain and have been on strong pain medication for over three years I also had two surgeries earlier for disc herniation before two years I was diagnosed with major depressive disorder and severe anxiety due to pain I am fighting for my treatment there is no support and I lost my career in 29 years of age I lost my home and I am living alone I have begun to have what I would describe as a nervous breakdown with thoughts of suicide overwhelming feelings of terror and hallucinations I am on klonopin buspirone risperidone hydromorphone and oxycodone er I also have been diagnosed with narcolepsy I am taking dexedrine for narcolepsy and I am unable to drive these horrifying feelings of abandonment a conspiracy involving my workers claim loneliness depression and anxiety is so bad and paralyzing I need to know what is wrong with me as my psychiatrist does not seem to put much urgency in my treatment please help",
        "input": "",
        "output": "hello I can understand your concern for further information consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor I am an 18 year old healthy female all day today I have had sharp pain in one tiny spot on my left hand there is a tiny red mark that looks like a scratch but it is not it is not warm but the pain is also spreading to my arm I have also had the same type of pain in both my legs and my foot for a couple weeks now but no veins or redness are there I have anxiety which makes me always think the worst I am scared that I have dot and that any minute now I am going to drop dead please give some suggestions as to what this might be could it be something with muscles or nerves should I go to a hospital any information would help thank you",
        "input": "",
        "output": "hello vitamin b12 deficiency hyperthyearoidism thiamine level and abc complete blood count if the above are negative then nerve conduction study or electromyography egg of the affected hand it would depend upon the blood work it does not appear to be a dot from the information provided revert back with the report to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am a 23 year old girl I am suffering from irregular periods for the last two years with medication period occurs but the problem persists when the medicine is discontinued I had my last periods two months back tests done for ash and pelvic ultrasound done please guide",
        "input": "",
        "output": "hello revert back with the detailed history to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor my friend advised me to check my glucose on her glucometer the results were as follows after eating a meal with the following nutrition specs carbohydrates 98 fiber 21 protein 28 fat 27 saturated fat 5 calories 720 blood sugar after hour 13 after hours 131 and after hours 121 am I diabetic or pre diabetic or igt I have never had an gott or any other test for diabetes before",
        "input": "",
        "output": "hi for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am 21 years old I have muscle weakness in both arms and legs since childhood I cannot climb stairs without support and I feel tired most of the day I cannot stand for long and also cannot run or walk my legs and feet always get numb I have decreased sensory sensations in both feet a few months back I was diagnosed with hypothyearoidism and vitiligo I visited a doctor last month my egg and nerve conduction study shows symmetrical sensory motor demyelinating polyneuropathy with clinical diagnosis of cidp cpu is 27 reference range 24 195 l I am on prednisolone 45 my levothyearoxine 100 mug and multivitamin for the past 17 days please guide me about my disease prognosis and any rehabilitation that might help",
        "input": "",
        "output": "hi I have read your question with care and understand your concerns my opinion is as below you are having both myopathy and neuropathy you need to get treatment for both hypothyearoidism and vitiligo are may be signs of abnormal functioning of the pituitary gland you have to do a complete pituitary hormone profile along with thyearoid profile please also do a diabetic profile and lipid profile the further course of action can be decided based on the reports complete pituitary hormone profile along with thyearoid profile diabetic profile lipid profile revert back with the reports to a neurologist online"
    },
    {
        "instruction": "hi doctor I had carpal tunnel radial and ulnar nerve surgery a tumor was removed from my elbow on the ulnar nerve then my two little fingers have no feeling and are completely curled in along with my thumb for this my surgeon advised nerve transplant surgery when I went for second opinion nothing abnormal with nerve conduction test egg test and mri now my surgeon has changed his opinion to electronic shock therapy it has to be done three times a week for six weeks also he is not sure about the outcome I have constant pain burning tingling and sometimes swelling in my elbow and hand it affects my daily life activities as well as my job my surgeon also said that my arm muscles are weak to go for surgery what shall I do is there anything to do with this issue or am I stuck with my curled fingers",
        "input": "",
        "output": "hi bracing and splitting revert back after three months to an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hi doctor two days before I got my periods and I started having sudden sharp stabbing pain in my right ovary these pains would slowly subside although I could always feel a small sensation in the same spot until it flare up again it seemed to be agitated by the movement I stay perfectly still most of the time and so there is no stabbing feeling I asked my mother who is a nurse to check it out she validated that the pain was ovarian and cleared me of having appendicitis over two days the pain has continued at random times but not worsened now I am on my period the blood is thick sticky and totally brown to pretty bright red with heavy bleeding I am normally a heavy bleeder during the first few days but the color and consistency are unusual I am also having my usual period symptoms such as achiness and bloating hence it is hard to pinpoint whether it is just my period or the ovarian pain I have had normal period before this one and no sexual exposure during or in between so I know I am not pregnant I am also at a very low risk for studs I am worried as the women on my mother side have a history of ovarian cancer and cysts I know I am quite young for such a thing to happen in me as I do not have any other symptoms related to other causes such as pid I do not know what else it could be I just started on birth control pills again last night otherwise I am not any oral medication except topical treatment for itchy scalp acne and eczema am I crazy in worrying what could this be please help",
        "input": "",
        "output": "hi I can understand your worry for further doubts consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hello doctor before 20 years I had total thyearoidectomy for follicular and capillary thyearoid cancer I also had three surgeries to remove benign lymph nodes my levels had been pretty steady until the last one and a half year I am post menopausal I am now with the highest ash value of 13 I did not even miss any dose I am eating very healthy and doing work out my ash works best for me at now I am on 12 mug synthyearoid my doubts are as follows is thyearoid cancer any way related to adenoma is follicular modular hyperplasia similar to adenoma can unh show up in multiple areas of body my first true diagnosis was thyearoid cancer later his and unh in left lobe of liver the hyper attenuating mass was 0 0 am and changed to 1 4 am in the last scan I also have benign tumor and cysts in ovary the thyearoid nodules are reactive and enlarged lymph nodes in neck my dad had kidney cancer prostate and melanoma now he is fighting cll my son who is 10 had several am lymph nodes in the neck removed his doctors went on thinking lymphoma due to the size it was benign but he had a streptococcus bacteria he also has cysts on his thyearoid which is under observation is there some relation or syndrome possible for this please explain",
        "input": "",
        "output": "hi for further information consult an endocrinologist online"
    },
    {
        "instruction": "hi doctor over a month ago I had an episode where my heart started racing out I got lightheaded and dizzy I thought it as a heart attack however I went to my doctor and he listened to my heart beat checked my pulse and my blood pressure he said that everything was fine and I just had a panic attack however I did not get convince I was scared and anxious so went to the er there they also took my pulse and blood pressure along with an ekg and a chest ray the doctor said that I was fine and I am not going to have any heart attack he then listened to my heart and told me that it was just stress and anxiety can you help me out and relieve my worry",
        "input": "",
        "output": "hello there are various reasons for having palpitations followed by dizziness the most important one being an abnormal heart rate or rhythm which starts suddenly and terminates abruptly this could be detected by different monitors that you can carry with you and these devices can pick up the abnormal heart beats second of all is a thyearoid disease excessive thyearoid hormones can cause stimulation of sympathetic nervous system and you will feel hot flushed with palpitations weight loss and diarrhea along with excessive appetite may also occur last but not the least is the most common type and is called as vasovagal phenomena it happens when you suddenly change position from sitting to standing your body does not have enough time to compensate and you may feel having racing heart beats followed by dizziness a panic attack is a diagnosis of exclusion and I would not jump to this conclusion as of now I believe that you experienced the last type I mentioned above that is vasovagal if you get another episode then I would suggest seeing a cardiologist try cutting down the caffeine intake including soda and other caffeinated beverages I request your doctor to check your thyearoid profile for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I had an mri last year which indicated a herniated disc and stenosis at ca left so I had cervical surgery acdf still had pain for a couple of months and the mri showed to my dismay that I still had stenosis with displacement of the ca nerve root also it showed that c5 ca protruding disc and partial corresponding osteophyte with no nerve root displacement or stenosis at c5 ca before two months I elected to go with a posterior cervical foraminotomy and was told the ca nerve was then released four days after my second surgery my thumb went completely numb on the top half and has stayed that way the thumb is normally associated with the ca the surgeon told me that sometimes radiculopathy overlaps and I just have to live with this doctor did not want to follow up with an mri I thought at least an mri should be done just to confirm why the numbness may be there can you please advise",
        "input": "",
        "output": "hi for further information consult a spine health specialist online"
    },
    {
        "instruction": "hi doctor I am going to have laparoscopic surgery to remove an ovarian dermoid cyst I am afraid of being under general anesthesia in the presence of neuromuscular blocks is there a way to ensure that I am unconscious before administering the neuromuscular block I have read a horrible story about someone being paralyzed first before the other drugs took effect and being conscious during intuition is a neuromuscular block necessary during this entire surgery or is it only in the beginning for intubation is it possible that intraoperative awareness is more common than we realize because amnesia inducing drugs erase people memory of it or would anyone with conscious during surgery also have a memory of it are any sort of analgesic used in this surgery is it true that if I experience awareness I would also be experiencing severe pain if heart rate and blood pressure are indeed sufficient indicators of awareness then why have other healthy young people like myself experienced awareness while paralyzed without anyone noticing their stress response and therefore deepening the anesthesia how was that able to occur and what would prevent it from occurring in my case I read that some drugs used in anesthesia can block the body normal stress response so that heart rate and blood pressure would not increase even in a state of intense pain and anxiety would I be receiving any drugs that would produce such an effect blocking my body normal stress response and preventing those indicators of awareness is it possible to listen to a recording on headphones while in surgery I have a guided relaxation tape that makes me more confident I would stay unconscious or at least be able to cope with an awareness experience thank you so much for reading my questions and I look forward to hearing the answers",
        "input": "",
        "output": "hi for further doubts consult an anesthesiologist online"
    },
    {
        "instruction": "hello doctor when I was in my late teens I was engaged in a lot of high cancer risk activities the one I have been most worried about was using cannabis the cannabis itself does not worry me too much although we occasionally had access to papers being teens and also not the smartest we inevitably utilized plastic bottles to create make shift bongs or waterfall pipes with aluminum foil bowls I know that using a flame anywhere near plastic should be considered a cancer risk and I am sure the heated smoke coming into the container released some kind of bra like chemical at one time I even used a beer can which even at 17 that seemed like a bad idea but I was drunk and who cares about your long term health now I am 27 and just graduated I am at that point where I know I am not invincible so have I all but guaranteed myself a cancer diagnosis down the line I had this risk factor for around two to three years at which point I left to my college would this be on par with a couple of decades of smoking or much more worse any assistance or information would be greatly appreciated",
        "input": "",
        "output": "hi for further doubts consult a medical oncologist online"
    },
    {
        "instruction": "hi doctor I am 40 year old recently I tested my thyearoid and the report shows to to 4 and ash 7 please advise me which medicine is currently safe for me my health problem includes fatigue and occasional depression also my lips are dry please help",
        "input": "",
        "output": "hello anti tpo anti thyearoid peroxidase free to free thyearoxine and ash thyearoid stimulating hormone should be repeated six weeks after the last test was done hypothyearoidism due to medications hashimoto thyearoiditis autoimmune disorder result in hypothyearoidism subclinical hypothyearoidism subclinical hypothyearoidism you would be treated with thyearoid hormone only if your anti tpo antibodies are positive otherwise I would not suggest treatment with any medications yet thyearoid hormone if used inappropriately could be harmful to health"
    },
    {
        "instruction": "hi doctor I am 32 years old my height is 7 and weighs about 10 keg I am having irregular periods from a long time pod was detected and prescribed dinette 35 and my tone as I remember I took for two months and my weight was increased by 10 keg and so I stopped no medicines at present I used to take primolut for delaying periods during any functions but now I stop that too I am facing severe abdominal pain cramps during irregular periods usually occurs once in one and a half to two months making me unable to move sleep walk ride vehicle etc my friend asked me to take apcod sachet for irregular periods but I did not take yet it would be great if you could help me with my period issues or prescribe medicine I am allergic to cold and dust and my chest specialist has asked me not to take any steroids due to overweight rest I do not have any problem I have done us pelvis and abdomen thyearoid to and ash I do not have a thyearoid problem",
        "input": "",
        "output": "hi the main issue for you is your weight once you lose weight the medicines will act better kindly do join a gym and reduce your weight and bring mi to at least 25 you must lose weight in a healthy way and not only by dieting avoid junk food and follow a healthy lifestyle medicines that were prescribed to you are correct and do not cause weight gain so do not worry I cannot prescribe medicine online but you may continue taking dinette along with weight reduction only then it will cure the disease if you are not able to reduce weight despite gymming consult a bariatric surgeon"
    },
    {
        "instruction": "hi doctor one of my daughters has got beta thalassemia major and g6pd deficiency is there any treatment for her please advice",
        "input": "",
        "output": "hello for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hello doctor three weeks ago I had headache in late night I managed to sleep but it was still there in the morning it was unilateral headache on the left side of my head pain is in my temporal area which sometimes radiates across my cheek and even down my jaw as well as on the top left of my head I have occasionally felt discomfort on my chin too almost like a bruised bone feeling when pressed the pain subsided with paracetamol and ibuprofen but returned the following evening medication no longer had any effect on it after a week of non stop pain I went to my doctor he could not work out why I was having the pain when I have absolutely no other symptoms I feel fine other than the pain he sent me to other hospital for further evaluation my bloods were taken and came back normal and I passed all of the doctor strength reflex and cognitive tests it was a mystery to him too he referred me to a specialist who said it was likely a benign tension headache and I was discharged while the pain is not generally as bad as it was it is still there every day I get a few moments of pain every now and then as well as head pressure but some days the pain lasts all day a dull ache that does not seem to shift the most annoying part of is that within a minute of my head hitting the pillow at night severe pain suddenly kicks in my left temporal region and back of the head I could not sleep without taking medication at home I have tried three different pillows yet I still get pain the only medication I take for it is a combination of paracetamol and aspirin I am currently taking it each night about 30 minutes before bed to ensure the pain will not kick in if I do not do this I simply cannot sleep I do not want to be reliant on these pills or take too many so I am trying to limit myself to just two of each before bed I still have no other symptoms other than the unilateral pain and pressure I do not suffer with migraines and do not feel anxious or stressed at the moment the only anxiety I have recently felt was during hospital visits as my pulse rate went a little high but returned to normal later is it really a tension headache or something else I must stress that despite days where the pain has subsided the discomfort has been constant throughout I am always conscious of it please help me out of this thank you",
        "input": "",
        "output": "hello my main concern here would be trigeminal cephalgia the most common being trigeminal neuralgia trigeminal neuralgia is a sharp shooting unilateral headache that becomes extremely worse with nerve irritation that could be caused by shaving brushing hair or teeth or any one touching the scalp or wearing cap the other important fact could be medication induced headache extremely common it happens if you are using painkillers for 15 to 30 days a week mri of the temporomandibular joint taj to rule out taj arthritis mri of the brain nos nerve conduction studies and egg electromyogram trigeminal neuralgia gabapentin 300 my three times a day start from 300 my at bedtime and increase it to three times a day for one or two weeks as tolerated avoid any irritation to the scalp revert back after a month with the reports to an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I have been to doctor three times in the last two months and was prescribed many medications but I am simply not getting any better initially I went in for respiratory issues I had a terrible hacking cough and was literally using my ventolin inhaler more than I should as I am asthmatic I was placed on a nebulizer and given several other medications including prednisone to take after completing the medication the symptoms returned I went back to the doctor who changed the antibiotic it cleared up temporarily and again once the medication was completed symptoms returned today I am literally just feeling awful because I do not want to go back to a doctor as nothing seems to be getting better I feel nauseous I have headaches I am using my inhaler frequently and there is still a very heavy congestion on my chest I wake up in the middle of the night hacking I cough until I cannot breathe I overall feel dizzy lightheaded and I have no energy please help",
        "input": "",
        "output": "hi there are few important points to consider follow up in a week to an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I had severe throat inflammation and went to an ent doctor at that time he was with a hiv patient who has sore throat and ulcers he used a spoon like equipment to check the throat of the hiv patient the spoon like equipment is contaminated unfortunately the doctor used the same spoon like equipment on me without sterilizing the equipment I already have severe throat inflammation I am worried whether I will get hiv please help me",
        "input": "",
        "output": "hi for further doubts consult a hiv aids specialist online"
    },
    {
        "instruction": "hi doctor I have just tested positive by preganews but I am suffering from diarrhea and consumed a tablet of norflox and pan will it cause any effect on my baby please inform me thank you",
        "input": "",
        "output": "hello firstly congratulations for having conceived for further doubts consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor why do I feel extreme fatigue pain and tiredness I cannot sleep the whole night peacefully because of the pain in my body I have attached my blood work do I have any blood cancer like lymphoma or non hodgkin lymphoma",
        "input": "",
        "output": "hi based on your query and attached reports my opinion is as follows revert back with the report to a hematologist online"
    },
    {
        "instruction": "hi doctor I have been concerned about my tiredness before I could stay up all night but now I cannot I have no idea what it is sometimes when I get home I get really tired and take a nap when I take a nap in the afternoon I sometimes wake up feeling shaky and feel horrible even after the nap I still feel tired then when it is time to go to bed I fall asleep so quickly I do not know if it is just me getting older or some disorder can you give some answer on what it could be",
        "input": "",
        "output": "hello I have gone through all the data you have posted revert back with the reports to an internal medicine physician online"
    },
    {
        "instruction": "hello doctor there is a gap between my front two teeth I want to close the gap can you please suggest any process for it",
        "input": "",
        "output": "hello yes there are two treatment options ortho braces treatment tooth colored fillings gap closure by braces is a permanent solution your teeth will be aligned and the gap can be closed naturally this option is suggested when the gap is very wide and this helps correct other tooth alignment issues if present whereas in the second option the gap is closed with a tooth colored filling material this is not a permanent solution this filling can last anywhere between three to seven years if this filling fractures in the future you may require a new filling in its place however the longevity of this filling depends on our maintenance this will best suit if the gap between the two teeth is less than my the option that best suits you is determined by the amount of gap present general oral hygiene and your gum health a clear picture of the gap will help suggest if you want to close your tooth gap naturally without any filling please visit an orthodontist to start a braces treatment but if the gap is minimal and you want a filling to close the gap this procedure is best done by a cosmetic dentist I hope this helps"
    },
    {
        "instruction": "hi doctor my mother is 63 years old her weight is 60 keg and her height is 2 for the last two three days she was getting an eye burn yesterday she felt like a sand particle inside her left eye also dropping of the eyelid so today we started putting some over the counter eye drop while putting drop we noticed a black mark inside the white of her eye is it a matter of concern",
        "input": "",
        "output": "hi welcome to icliniq com I have seen the picture this appears to be a mole by seeing her eyelids it appears a bit swollen so can be a mild infection start moxifloxacin eye drop six times a day for seven days refresh tears eye drop six times a day for seven days fml tobramycin fluromethalone acetate eye drop three times a day for seven days take tablet cefixime 200 my twice daily for three days kindly rule out any allergies beforehand occupol eye ointment chloramphenicol and polymyxin sulfate at bedtime"
    },
    {
        "instruction": "hello doctor I am having concentration in my studies my board exams are going on I have become too irritable I am also able to make myself happy again but the stress of studying is bothering me as I cannot concentrate also I am motivating myself but still I cannot",
        "input": "",
        "output": "hello board exams are indeed stressful for every student and especially with this huge coronavirus scare thats going on it is even worse I am sure although now that your board exams have been suspended for the next 10 days you may breathe a sigh of relief I can still give you some tips on handling exam pressure study in small clusters of time like study for 50 minutes then take a 10 minutes break and then restart have a proper three square homecooked meals a day with two small snacks in between no junk food aerated drinks tea or coffee spend one hour every day in engaging in your hobby even during exam time this will recharge your mind and you will feel more concentrated and productive in studies keep your phone and other gadgets at bay switching them off until exams get over is the best thing to do catch up on good sleep at night and keep sleep timings fixed I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 25 year old male my weight is 82 keg I have sudden rashes on my body and back of the neck I get this at least once in a week please help",
        "input": "",
        "output": "hi you are suffering from urticaria since you have not mentioned the duration to say it is acute or chronic it is of two types erogenous and endogenous if you can pinpoint any cause like eatable or after wearing some clothes or any contact it is erogenous you have to avoid that in endogenous it is due to internal factors in your body which you cannot change but it is sometimes associated with some other diseases so I would advise you about some investigations complete hemogram thyearoid function tests egg levels for follow up treatment tablet bilastine"
    },
    {
        "instruction": "hello doctor my mother is 53 years old nondiabetic she is hypertensive 150 100 and having all over body pain fatigue and morning stiffness we consulted a neurologist and she was diagnosed with fibromyalgia she was going about daily activities by using painkiller every day innova my diclofenac paracetamol chlorzoxazone before the diagnosis the prescription for fibromyalgia was formalin methylcobalamin pyearidoxine folic acid one tablet in the noon duloxetine gastro resistant duloren 20mg duloxetine my 25 tablet for first days 10 my for the next five days and 20 my there after our main concern is duloxetine she has started my per day dose for a week but is scared to take this medicine as we have come across online references where duloxetine cymbalta actually aggravated the problem like duloxetine changes a person behavior for worse like the person taking it does not remain the same anymore after taking it for few months becomes emotionally vulnerable and may have suicidal tendencies etc also duloxetine has severe withdrawal problem the dose has to be tapered very slowly changing to different medication becomes very difficult is it true duloxetine damages critical organs like liver also can cause serotonin syndrome she is not on any other sari psychotropic medicine for how long she has to take duloxetine will she be ever off on it once she feels better if the medicine is to be continued do we have any other safe pharmaceutical alternatives to duloxetine would you recommend any supplements for fibromyalgia since it is sari will it adversely affect her blood pressure she is taking atenolol 50 my per day currently and her be under control with it please advise regarding the safety and efficacy of this drug as there are countless negative reviews about it on youtube and social media",
        "input": "",
        "output": "hello welcome to icliniq com regarding your concern I would explain that morning stiffness is not a typical sign of fibromyalgia but it could indicate a rheumatological disorder coming to this point considering her slightly elevated erythrosedimentation I would recommend performing other tests before concluding about fibromyalgia in this regard I would recommend performing rheumatoid factor plasma levels ana anti nuclear antibody and anna anti neutrophil cytoplasmic antibody titer a nerve conduction study is also necessary to exclude possible neuropathy although she does not have diabetes if these tests result normal she can continue taking duloxetine and gradually increase the dose up to 60 my daily which is the maintenance therapeutic dose you should not worry so much about this drug it can be stopped gradually like the way she is starting it if it is started slowly it does not lead to serotonin syndrome as long as she is not taking any other sari selective serotonin reuptake inhibitors after stopping this drug other drugs may be tried like pregabaline etc anyway the internet is not the best doctor to ask because the information is very wide and nonspecific every drug has adverse effects but they usually occur in a low percentage of patients especially when high doses are used without starting slowly I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 16 year old female I have been sick lately sore throat coughing up yellow green stuff etc but this morning I woke up with my cough worse and my ear aching and ringing and throbbing anything I can do to make it stop",
        "input": "",
        "output": "hello this appears to be an upper respiratory tract infection leading to throat congestion and blocked eustachian tube leading to symptoms you should have augmenting 625 my amoxicillin and clavulanic acid three times a day along with some antacid like tablet pantoprazole 40 my before breakfast once a day for five days also have betadine gargles four times a day for cough you have syearup ascoril two teaspoon whenever needed up to three times a day and also have anti allergic tablet allegra 120 my once a day for three to four days also have decongestant nasal drops xylometazoline drop two times a day for two to three days for pain you could have tablet acetaminophen 500 my whenever needed have steam inhalation three to four times a day avoid cold food items I hope this helps"
    },
    {
        "instruction": "hello doctor I am having some allergy on the head of my penis and inner skin of my penis my inner skin of penis is always red and I have this problem for a long time please help",
        "input": "",
        "output": "hi from your description it can be balanitis but to rule out herpes genitals please send a good quality image and revert back is it associated with itching or burning sensation or pain if sexually active does your partner suffer from a similar complaint"
    },
    {
        "instruction": "hello doctor we are adopting a child through the foster care system and his mother and grandmother were both diagnosed with schizophrenia we wanted to talk to someone about the risk factors what it looks like if he does develop it if there are things we can do to help prevent it",
        "input": "",
        "output": "hello if one parent has schizophrenia there is about a 10 or 12 percent chance for the child to develop the same 90 percent chance of normal child if at all the child develops then some early prodromal symptoms will be apparent in late teens to 20s 15 to 25 years such as social withdrawal irritability decline in academic performance anxiety or depressive symptoms these are seen before the proper symptoms of schizophrenia also the use of substances like cannabis or alcohol will increase the chances of this if alarming symptoms are noticed early on then usual treatment is to give antipsychotics for one year or two and then stop I have seen many patients who have been detected early and then been off medicines for quite some time now in another one or two decades there should be greater improvement with the medicines available so do not worry too much about it and just parent the child regularly and keep a watch on the things I have mentioned above"
    },
    {
        "instruction": "hello doctor I just found out I was pregnant a couple of weeks ago I smoke weed I am slowly trying to stop I have about seven months left of my pregnancy if I was to cut way back and stop completely at five months of my pregnancy would I and the baby be clean when I deliver",
        "input": "",
        "output": "hi we need to worry about what the baby is facing now and not about what will happen after you stop all the components of smoke the bad air carbon dioxide tar the chemicals in the smoke which may vary with what you are smoking are all powerful vasoconstrictors I mean they narrow the blood vessels so they reduce the blood flow to the baby if we could go back I would have advised you to stop it the moment you got pregnant late better than never everyday baby is growing so the requirement of blood flow is increasing as the baby vital organs are growing and getting blood for that so if the flow is compromised even a day we do not know if any damage has occurred this may not be visible on any scan but it would be safe to immediately stop smoking and start having lots of highly nutritious food with lots of sugars juices do yoga or breathing exercises in short improve the supply of nutrition and oxygen to the baby as these two are the secrets of a healthy and active baby hope I have made it clear baby will not have any of it in its body but the damage caused by the smoke will be seen in the baby body for your baby sake do try to stop it today or as soon as possible"
    },
    {
        "instruction": "hello doctor this is about a 71 year old male psychiatrist said that a plain it scan and another it scan should be taken with contrast but after four attempts they could not create channel in his veins so contrast it scan of the brain was not done plain it scan of the brain showed cortical sulci sylvia fissure basal cisterns at places and supratentorial ventricles are mildly prominent lacunar infact in right claustrum mild bilateral cerebral cortical atrophy age related background he was unnecessarily fearing that my relatives neighbors and municipality will search and steal his clothes newspapers only one day he had a delusion about dead relatives making a phone call after taking prescribed medicine olanzapine my one tablet per night he is behaving properly he is under medication for one and a half months previously he used to sleep for two hours now he sleeps for four hours",
        "input": "",
        "output": "hello welcome to icliniq com the symptoms you have described of paranoid ideation suspiciousness restlessness decreased sleep are all indicative of a psychotic type of illness most probably schizophrenia it will require treatment from a psychiatrist with antipsychotic medicines olanzapine is one such medicine this happens because due to elevated levels of certain neurotransmitters such as dopamine in the brain which leads to reduced stress handling capacity of the brain the medicine will get the levels to normal and help with the problem for the first episode of this illness treatment is recommended to be continued for one year and then medicines are stopped for the second recurrence for three years and for the third time of recurrence it is lifelong that is why please complete the course of the medicine as per the doctor advice the lacunar infact in the brain also is one contributory region for this problem and for that I am sure the other general physician or neurologists must have given medicines to take care of the infact and anti clotting medicines if the size is small please continue those and it will reduce along with olanzapine my you can add phenergan 25 my promethazine it will help him sleep better also consider raising the dose to 5 if symptoms of suspiciousness do not reduce"
    },
    {
        "instruction": "hello doctor I am a 34 year old male in good general health until 20 years of age I never experienced any issue with erections or sexual health when I turned 20 I had an episode with my girlfriend where over two consecutive nights we had no sex but rather very prolonged foreplay due to the prolonged arousal my erection stayed for most of the night without ejaculation this episode of two prolonged erections and arousal obviously hurt my penis as it went through some visible changes back then both in shape and feeling while it was not painful it lost some thickness and the side erectile tissue eventually lost some elasticity becoming somewhat hardened in a flaccid state since a slight curvature initially appeared I can only guess this was peyearonies eventually in the course of some years it did recover partially and as of now there is practically no curvature at all however the erectile tissue is still not as it used to be somewhat hardened and when I have an erection the blood seems to get trapped in a way in both sides of the penis while the glans have difficulties getting sufficient blood and arousal and often remains softer I have no problems getting and maintaining an erection myself but when being with a partner it tends to be more difficult and the erection often goes away quickly if not actively stimulated the softer glans often leads to less control and premature ejaculation I assume I may have gotten some degree of penile fibrosis which was triggered by the episode of prolonged erection when I was 20 my question is would there be a natural way to help reduce this tissue hardening and enhance regular blood flow particularly to the glans since this is not a serious issue and it seems the damage was not that substantial I still have morning erections for example and the feeling is often close to normal I would be looking to some natural therapy with as little side effects as possible I read about some allegedly very good results of combining arginine and pine bark extract when it comes to enhancing erection quality overall would you happen to know about this or could you recommend some other natural treatment options which would not cause any other health issues my main concern would be getting priapism due to some medicine like viagra as it was exactly the prolonged erection that caused my problems if arginine and pine bark extract are overall safe I would be glad to opt for this",
        "input": "",
        "output": "hi from the events you described you had normal erection and ejaculation but over the years it has reduced you have difficulty in maintaining erection and premature ejaculation have you recently changed the partner or stress in relationship how much time do you take before ejaculation intravaginal natural extracts are effective but the effect may not be titrate as per the dose and excessive may lead to possible priapism with progressive exposure to more sexual experience the quality of erection goes down but a person becomes more confident to satisfy a female for a female the way of doing sex and getting her to orgasm is more important than the penis solely for you I would suggest tadaflo my low dose tadalafil used in bah patients as you do not have erectile dysfunction but need to support erection for a few days premature ejaculation if persistent problem I may treat that later tablet tadalafil my on alternate days evening"
    },
    {
        "instruction": "hello doctor I am a 25 year old female I have been experiencing worsening symptoms over the past three months I was thinking pregnancy but that was tested negative with a gynecologist and pc two blood labs for hug and one abc as well as a thyearoid and hormone test my symptoms are frequent headaches and shock like pain below the right temple migraines that last for days dizziness even when resting in bed weight gain fatigue and sleep for 14 hours straight change in taste I toothpaste taste like hairspray and kombucha tastes like hairspray smelling burning plastic and no one else can smell it losing balance when trying to do yoga and work seeing shiny flex of light pain in back stiffness in shoulders and neck numbness in the foot for a week tingling in arms and fingers painful electric shocks in the leg mood changes crying and laughing for no reason menstrual changes show shorter cycles and never before pregnant but nipples have left yellow streaks in the bra fumbling with tools at work my current medications are effexor 37 my smarty pants multivitamin vitamin complex I also consume daily probiotics",
        "input": "",
        "output": "hi your symptoms apart from migraines are due to nerve involvement causing parosmia altered taste sensation most probably due to vitamin b12 deficiency methylcobalamine or vitamin b12 supplement 1500 mug per day for a few weeks is usually advised and you are already taking it for migraines you can try aspirin ibuprofen 400 my to 800 my every six to eight hours naproxen initially 500 my then 250 my every six hours ketoprofen 25 to 50 my every six to eight hours one of these can be tried should be available over the counter if one of these is not effective then you may need one of the prescription medications mentioned below specific for migraines g sumatriptan zolmitriptan eletriptan naratriptan"
    },
    {
        "instruction": "hello doctor I am a 23 year old man I have anxiety and depression but no immunodeficiency disorders or chronic diseases first I want to know if my immune system is weakened and how likely am I to die of coronavirus second I have itchiness in my throat and shortness of breath I always have it because of anxiety but now it is more persistent than before I also feel a very subtle feeling of pain burning sensation and itchiness in my chest I did not go out during the past ten days and have not been in contact with someone with positive couid and I quit smoking past week down to one or zero cigarettes from 20 a day why am I feeling itchiness and pain and burning sensation how likely am I to have couid 19 and how likely am I to die from it",
        "input": "",
        "output": "hello anxiety can manifest itself in physical or psychological symptoms or both the irritation sensation you are experiencing is a part of your anxiety also please do not believe the hype about couid it has a low mortality rate of 3 percent that too mortality is very high in people above 60 70 years with other co morbidities you do not have any such disorders and you have not even been in contact with anyone so do not worry please continue to take your medicines for anxiety if you are taking them if not please consider visiting a psychiatrist and get started on some low dose sari type of medicines also if needed a low dose benzodiazepine can be added temporarily also please do some deep breathing exercises or progressive muscle relaxation you can also take some honey with water to reduce the itching in the throat and also try doing some gargles with lukewarm salt water"
    },
    {
        "instruction": "hello doctor I am currently undergoing medication for vertigo and ear infection as per the doctor my symptoms were head spinning at regular intervals when heads start spinning I am unable to sit also nausea dizziness and headaches I went to an ent and did an mri and audiometry test mri is normal but my audiometry shows a significant hearing loss as per the latest findings my right ear has hearing loss with continuous ear ringing and headache on the right side behind the ear also the doctor said that this is happening due to weak nerves of hearing and balancing please suggest I am currently on vertidiz and diligan 25",
        "input": "",
        "output": "hello please upload the reports of audiometry and mri magnetic resonance imaging how much of significant hearing loss is there is it nerve related or conductive loss did you have any ear discharge before the problem started"
    },
    {
        "instruction": "hello doctor I need your help",
        "input": "",
        "output": "hello I am here to help you"
    },
    {
        "instruction": "hello doctor recently I have noticed two little white pimple like dots next to my molar tooth on the cheek and there is no pain I was wondering what it could be and if it is serious",
        "input": "",
        "output": "hello is your lower wisdom tooth removed it seems to be a mild epithelial injury which occurs during chewing at the corner of jaws where last wisdom teeth meet no need to worry about it as it usually will go away on its own in a week or two use warm salt water gargle twice a day for a week or two and if need apply an antibiotic gel at the spot three or four times a day if it does not go away show to a dentist to check if the upper wisdom teeth are causing the problem and need to be removed"
    },
    {
        "instruction": "hello doctor I forget things quite often and have anxiety problems that lead to a change in behavior I have never experienced such problems and my head aches a lot and I am suffering from anxiety please help as my behavior is changed a lot which affects people living with me I have not got any tests done",
        "input": "",
        "output": "hello welcome to ciliniq com you seem to have a mixed anxiety depressive disorder this is very common and about 10 15 percent of people have this problem it is also very easily treatable you will need to visit a psychiatrist and he will prescribe you sari selective serotonin reuptake inhibitors type of medicines such as escitalopram 10 my or fluoxetine 20 my etc which will help with your problem it basically happens when some neurotransmitters such as serotonin reduce in your brain leading to a problem with handling the day to day stresses of life medicines are usually given for two to four months and then tapered off slowly and stopped in addition to the medicines you can also undergo a few sessions of cognitive behavioral therapy from a clinical psychologist also do consider doing deep breathing exercises or progressive muscle relaxation daily in case you are having problems with sleeping you can try some sleep hygiene methods like maintain good temperature no noise or light one hour prior to bed wind down and try reading or music do not use the laptop to or phone one hour prior avoid caffeine alcohol or tobacco two hours prior to sleeping avoid exercises three hours before sleeping and take warm milk at bedtime go to bed only when sleepy and avoid other activities on bed use bed only for sleeping or sex if you do not get sleep do not toss and turn get up go to another room walk about for 10 15 minutes and come and lie down see for 10 minutes if not sleepy go out again"
    },
    {
        "instruction": "hi doctor I have a daughter of years old recently since four days I have noticed on her face a small patches more of like skin allergy I am attaching her picture which shows her allergy on the left upper lips and cheeks kindly advise ointment for her as we live out of the country so you are requested to prescribe an ointment I have used dermal due ointment and even virgin conut oil but there is no use",
        "input": "",
        "output": "hello I have seen the pictures this seems to be a type of sun induced dermatitis commonly present in children apply sunscreen like photostable regularly twice daily over the face eg at 0 am and 12 am apply any moisturizer repeatedly you can apply mometasone or hydrocortisone cream over the lesion once daily for 10 days only and then stop this cream"
    },
    {
        "instruction": "hello doctor I am having too many health issues for the last three weeks I feel sleepy all the time even I sleep eight hours already I am feeling weak tiredness dizziness and headache on the right side of my head pressure and dullness my bowel habit changed to three to four times a day I have attached my blood work do you think I have any abnormality in blood do you think I am having a stroke or heart attack do I have too much thickness in blood as high hemoglobin and hematocrit do I have any kind of blood cancer like polycythemia or polycythemia vera in spite of having too much hemoglobin and platelets why am I having weakness do I need to take blood thinner medicine",
        "input": "",
        "output": "hello welcome to the icliniq com hereby I am giving opinion regarding your case first let me know do you have any stress or anxiety issues as severe stress can lead to hyperventilation and dizziness stress can change bowel habits as well and it can lead to headaches as well if stress is present consult a psychiatrist for counseling and anti anxiety drugs if stress is not present then the causes for weakness are overexertion lack of exercise depression kidney problems for that urea creatinine investigation done myositis etc as for three weeks you are not improving you can be investigated with egg electromyography ekg electrocardiography investigation for further workup answers to your questions are as follows I do not think this blood report is abnormal it should be repeated as two weeks passed in stroke vision problem half part weakness slurred speech like problem present so the stroke chance is very less but ekg investigation can be done here as dizziness present since many times your he and hit are not much high that needs immediate concern I do not think it is polycythemia vera case repeat abc to check hit and rec value now for weakness rule out the above causes no ned of taking any blood thinner include green leafy vegetables and fruits more in your diet"
    },
    {
        "instruction": "hello doctor my platelet count was 974 hemoglobin was sedimentation rate was 140 and iron was with a saturation of I went to the doctor because I lost vision in one eye for about an hour they have done and mri and ekg both normal two units of blood and iron transfusions started in the morning once a week for three weeks no idea about what is going on please help",
        "input": "",
        "output": "hi welcome to the icliniq com your transferring saturation and he seems very low if you provide full abc complete blood count report then it can be clear whether it is iron deficiency anemia or hemolytic anemia platelet count here can be high as a result of reactive thrombocytosis it is because of il release and activation of thrombopoietin in certain conditions like post hemorrhage inflammatory disorder infections in iron deficiency anemia etc your anemia should be treated with blood transfusion as this hemoglobin level is very low after anemia correction ear erythrocyte sedimentation rate and abc report need to be repeated again ear is very high in your condition it suggests some form of infection or inflammation like condition here temporal arthritis like condition if needed can be ruled out by biopsy if clinical examination favors for visual loss problems after anemia correction ophthalmologist reference can be done here to do direct ophthalmoscopy examination and neurological examination if optic nerve affection present"
    },
    {
        "instruction": "hello doctor I have been diagnosed with ocd my doctor also briefly talked to me about schizotypal personality disorder I am currently taking fluvoxamine 200 my at night risperidone my at night and modafinil 100 my in the morning it has been well controlled for more than four months now 90 reduction in symptoms for the past two days I have not been able to sleep because I have been seeing shadows moving at the periphery of my vision it scares me so much and when I try to close my eyes I can hear certain noises like laughter or someone moving around this only happens when it is mostly dark at night for this reason I have not slept the first night and somehow fall asleep very late am the second night can you tell me what is causing this",
        "input": "",
        "output": "hello what you are experiencing is called hypnagogic hallucinations which occur normally when sleeping sometimes but in your case it is due to the modafinil it is known to interfere with sleep and also cause hallucinations also the metabolism will be slowed by fluvoxamine and it lasts longer you should not take it does not affect ocd obsessive compulsive disorder and I would just advise you to stick to fluvoxamine and risperidone and if possible do some sessions of cut cognitive behavioral therapy from a clinical psychologist also it is advisable to not suddenly reduce the modafinil but taper it slowly take 150 my for three or four days then 100 my for a week and then 50 my and then stop also with 90 percent improvement you can consider either reducing the dose of fluvoxamine or also try taking 50 my in the morning and 150 my at night instead of 200 my all at once it will give you better results"
    },
    {
        "instruction": "hello doctor can an ectopic pregnancy be detected on a transvaginal or simple abdominal ultrasound if I am in two to three weeks of pregnancy what are the chances that an ectopic pregnancy miscarried spontaneously in case of rupture to the fallopian tube in the ectopic pregnancy does the pregnancy ends on its own or does it keep growing I read that in an ectopic pregnancy hug levels grow at a lower rate than they would in case of normal pregnancy I got a positive hug urine test a full week after my missed period is it possible that the pregnancy is ectopic I kept testing on the day of the missed period and two days later but it came up negative what are the chances of the success of methotrexate injection in ending an ectopic pregnancy",
        "input": "",
        "output": "hi transvaginal ultrasound can detect ectopic as early as two weeks much before tas transabdominal sonography ectopic pregnancy always terminates as miscarriage but inside the abdomen with profuse bleeding intraabdominally that can be life threatening pregnancy ends on its own in case of ruptured ectopic along with it can end life too hug levels are low in ectopic but they are enough to turn a urinary pregnancy test positive in fact up urine pregnancy test cannot decide if pregnancy is ectopic or intrauterine methotrexate can manage an ectopic pregnancy but chance are that it can also deplete ovarian follicle reserve which may lead to infertility"
    },
    {
        "instruction": "hello doctor I have daily sleep attacks during the day irresistible sleep attacks and before I fall to sleep I see things like I am dreaming but I knew I am awake at night before I fall asleep I have multiple episodes of sleep paralysis sometimes in every morning I have sleep attacks and I fall asleep and sometimes I have dreams but when I am awake I realize it has been only seconds or a few minutes it started last year initially I was unable to stay awake beyond 10 am then I started to have multiple episodes of sleep attacks during the day it started as an irresistible urge to sleep which I tried to resist but then I go into a hallucination where I see and hear things like a dream but I am aware that I am awake and when I realized that the sleep become more intense and I fall asleep this episode lasts for 12 30 minutes and in between the episodes I feel refreshed but only for a few minutes and then the next attack will start at night upon falling asleep I have sleep paralysis and it is usually once but two incidences happened for three consecutive times it mostly happened when I am not doing activities after meal using phone watching to or when I am sitting in the car for long distance this been happening for a duration of four months and after that it comes and go with no specific pattern I saw a doctor and my labs were all normal I did a sleep study and melt and also normal and I do not have depression what do you think is the possible cause of that",
        "input": "",
        "output": "hello irresistible sleep attacks during daytime are called narcolepsy they are usually considered harmful and should be treated with stimulant drugs amphetamines are used to treat them sleep paralysis is also treated with antidepressant medicines and benzodiazepine usually it is observed that if a person has good night time sleep there will be a reduction in the sleep attacks during the daytime the reasons are usually not very clear but some genetic factors play a role I would advise you to contact a sleep medicine expert at your place and start the treatment"
    },
    {
        "instruction": "hello doctor a 12 year old boy having fluctuating thyearoid for the last two years I have attached the last three reports and paper attached I need to know whether the medication should be continued or not if to be continued then for how long duration please advise",
        "input": "",
        "output": "hello welcome to icliniq com I have seen the attachments I just read your query and from what you have mentioned it appears that your son has slightly high ash thyearoid stimulating hormones you can increase the dose of his thyearoxine tablet to 25 mug five times weekly monday to friday and 50 mug twice weekly saturday and sunday repeat his thyearoid function test again after six weeks and then we will review again"
    },
    {
        "instruction": "hi doctor I am 31 years old I am trying to conceive for two years and did four comic cycles ovulation happened but no conception then did letrozole cycle and got pregnant but was later diagnosed with molar pregnancy and had and then took a break for six months again did two clomid cycles ovulation happened but no conception now did letrozole cycle but no conception I do not understand what is the reason for no pregnancy my husband did his semen analysis it is 42 normal my hormones tests for fish prolactin was normal and pelvic ultrasounds are normal could you please guide me regarding this I am really upset",
        "input": "",
        "output": "hi as you have taken many treatments but pregnancy is not happening actually I need to see all the investigations before coming to a conclusion but with your history I can say that you can do hysterosalpingography to see the tubes are good or not if not satisfactory then you may require a laparoscopic hysteroscopic examination to see the tubal cyst and endometrial lining there is a history of molar pregnancy so need to do some more test also pregnancy is not a simple process you can consult infertologist with all the previous reports and can continue the treatment many times it takes more time because it is very complicated and the chance of pregnancy is only once in one cycle patience and a positive attitude towards treatment are also as important as the treatment itself"
    },
    {
        "instruction": "hello doctor last week I went to the doctor for several reasons like headche weakness tightness and pressure in the head and body pain he ordered some blood work and chest ray doctor told me that chest ray report is good and he just told I have low vitamin b12 level and I have bacteria in stomach he prescribed me omeprazole clarithromycin and amoxicillin and I took five shots of vitamin b12 but still I feel tightness in the head and several headaches my hemoglobin and hematocrit level is too high my bowel habits is also changed I pass stools right after eating three to four times a day all my symptoms meet cancer do you think I have polycythemia or polycythemia vera do you want me to consult hematologist please give your opinion",
        "input": "",
        "output": "hello welcome to the icliniq com I have gone through your history and reports you had a complaint of left side abdominal pain with a headache hence gastritis can be the possibility and for that antibiotic and antacid course are prescribed sometimes upper gastrointestinal infection can lead to poor absorption of vitamin b12 and so deficiency can occur but here your b12 value is borderline in the report so further work up can be done at that time by measuring homocysteine and methylmalonic acid measurement for confirming b12 deficiency anyhow you completed the course of b12 injection so no need for measurement of homocysteine your stool frequency is increased and it seems to be stress related irritable bowel syndrome stress anxiety lead headache as well yoga meditation and exercise will be beneficial in reducing stress consume more fruits and green leafy vegetables if needed psychiatrist help can be taken if stress and anxiety are not related then us ultrasound abdomen or endoscopy like workup can be planned only if gastrointestinal symptoms worsening in your attached abc report values are within limits in polycythemia which you are suspecting he is greater than 17 abc count and platelets also can be high rec values are high and hit is more than usually so here polycythemia is not the possibility repeat abc after completing your antibiotic course lack of sleep hypoglycemia smoking stress irregular meal habit migraine etc are some other causes for headache I hope this helps"
    },
    {
        "instruction": "hi doctor I have of with fish 101 I am taking progyluton from three months but I still feel hot flashes and breast pain after starting brown tablets and these become worse in pill free days am I taking right dose of hormones",
        "input": "",
        "output": "hello I just read your query and from the reports you mentioned it is clear that you have premature ovarian failure and you have been prescribed the drug progyluton as a hormone replacement therapy you have mentioned that you experience some symptoms such as hot flashes and breast pain in spite of taking hormone replacement therapy and they get worse during the pill free period well the hot flashes are common in premature menopause as in your case and the breast pain occurs because of progesterone component in your progyluton it will decrease with time sometimes up to a year and a half your dose is right all I suggest is that you need to take these pills to prevent other problems from occurring such as decrease in bone density cardiac problems endometrial problems so on and so forth and also to prevent overt symptoms of menopause I hope this helps"
    },
    {
        "instruction": "hi doctor does the length of time in critical care always reflect the severity is the length of time on a ventilator depend more on the cause I longer if lung infection rather than neurological etc can you have severe illness complications and still be in icu for a short while when I was 21 I had severe uncontrolled tonic clonic seizures constant on and off for a day then last over an hour and a half apparently I had every medication could have if the last drug did not work then there was nothing else I could have apparently I then had a cardiac arrest where the doctor had said it was very difficult to get me back tried for a long time my heart was struggling and was not breathing I was anesthetized and on a ventilator I had blood gases showing acidosis high lactate also egg showed it changes and right axis deviation echo showed dilated cardiomyopathy and right ventricular dilatation this was not there just weeks before no urine output apparent renal insufficiency blood glucose in the 30 amol eg showed non reactive background alpha cat scan showed low attenuation temporal lobe mri showed matter changes my family were told to come in immediately in the middle of the night as doctors felt I might not make it and if I had another seizure would not be able to stop it I had a do not resuscitate order put on why did they put do not resuscitate order on me at 21 I hear of people who were in critical care for much longer I have memory flashbacks and cannot figure out why the length of stay does not relate to severity I was on a ventilator for 12 hours and sedation coma reduced over two days I was in for three to four days I feel it was rushed and if it had not been then I may have not got the lasting problems I have now the word anoxic brain injury has been mentioned after in icu I have had many problems seizures ataxia very brisk hyper reflex is reflexes more in legs than arms babinski reflex tremor myoclonus altered sensation numbness of arms down to feet especially back of hands I have memory problems and a different personality I find it hard to learn new things etc are these common symptoms of anoxic brain injury",
        "input": "",
        "output": "hi I am so sorry that you went through so much and I am glad to know that you have made it you are extremely lucky to have survived all this it seems like after persistent seizure you developed acidosis that pushed you in cardiogenic shock very few people come out of it you are the second case in my 12 years of experience that I have seen communicating ventilators has its own complications and they can lead to mortality and morbidity which are more difficult to battle than the real problem therefore it is always recommended to wean as soon as possible anoxic brain injury occurs right there an then when the event occurs ventilators could only prevent part of it and not the entire process I was curious to know what brought it on in the first place why did you had the seizures like did you had the seizure disorder or an infection process anoxic brain injury can have various consequences and yes it can cause different psychological motor and cognitive deficits depending upon which part of the brain was involved I hope this helps"
    },
    {
        "instruction": "hello doctor first of all I feel just fine I have no issues with infections cold and cannot recall the last time when I was sick I do have allergy induced asthma and I take advair and flunisolide I had a abc recently and all values were normal except for abc which is 9 my pop ordered a repeat abc with the differential count this time my abc is 2 absolute neutrophils 54 reference 8 absolute lymphocytes 05 reference 2 2 eosinophil 10 reference 3 monocytes 4 reference 8 my nrbc were immature neutrophils and absolute neutrophils low end of normal for the past eight years my abc were fine but 10 years ago they were 9 and 5 your advice is appreciated",
        "input": "",
        "output": "hello welcome to the icliniq com I can understand your concern absolute neutrophil count is slightly low as per the provided report temporary associated viral infection along with allergic inflammation can lead to low neutrophil count here main concern is high eosinophil count normally if allergic inflammation is under control then eosinophil count is not high you are taking steroid nasal spray and salmeterol plus steroid combination inhaler but as eosinophils are high you can be prescribed montelukast plus fexofenedine combination drug as an antiallergic medication for seven to ten days asthma confirmation and severity can be assessed by spirometry investigation you can investigate with allergy testing to know the allergen that leads provocation of an asthma attack repeat abc after one week of taking antiallergic medication consult a pulmonologist for examination and spirometry and discuss my answer with him I hope this helps"
    },
    {
        "instruction": "hello doctor I have pain in my shin there is one spot that in particular hurts it hurts no matter what I am doing the pain started when I started jumping rope yesterday earlier in the week I started doing snatches for the first time and I may have not had proper form I have now stopped the only time I get some relief is when I put ice on it and the pressure that the ice packs give help a bit the pain is only in my left leg on the bottom half sometimes the pain moves into my foot in the area on the foot bone between my big toe and second toe my height is 6 and I weigh about 140 keg",
        "input": "",
        "output": "hello from your description the likelihood of a stress fracture is minimal unless you are grossly vitamin deficient there is a good chance this is tendinitis or periostitis which are both inflammatory conditions as that arise in the tendon and lining of the bone respectively the fact that rest and ice help favors the above two conditions I suggest that you stop skipping at the moment take said non asteroidal anti inflammatory drugs as available ice the area regularly three to five times a day and see how you are at the end of next week if pain is better then gradually return to physical activity if no improvement then seek professional help for a complete examination and suitable blood tests"
    },
    {
        "instruction": "hi doctor I have had tinnitus for five to seven years now I had suffered a lot during the initial years as there was no solution and doctors had to control using anti depressants I am on a regular low dose of escitalopram even now my tinnitus is a very shrill sound and has no trigger or cause and is constant I had done audiometry and there was a slight loss of hearing in one ear lately I chanced to read up on some forums and have found that there are various medications that are being tried for tinnitus tinnicar pinko biloba complamina retard so etc can you suggest in your opinion what I should take to reduce or end the tinnitus what dosage and for how long and for pinko biloba which is the best brand my other problem is I have a sinus problem due to cold exposure such as sleeping under an a I get stuffed sinus congestion I can feel some liquid behind my cheeks when I jump up and down and my nose and my ears are blocked this is not very troubling however this causes a loud buzzing sound in my left ear which is what gets me terrified because of my already existing sinus problem the sinus stuffiness and buzzing stays for a few days even if the nose blockage and stuffiness goes away it takes a few days and I have seen that exposure to heat and hot areas makes the buzzing subside quicker however even after the buzzing sound is gone my tinnitus gets and stays louder than normal for an additional few more days this used to happen regularly every few weeks however now it has become a constant problem I have a constant buzzing in my ear I went to an ent and was prescribed lukotas tinnicar and xylometazoline drops however I wanted your second opinion should I take something like solving to relieve pressure again read from similar cases in forums note in my childhood I can recollect that I had a similar sinus congestion a couple of times and the doctors had drained my sinus using a syearinge put in through my nose",
        "input": "",
        "output": "hello your tinnitus problem could be due to sinusitis which blocks the eustachian tube and causes tinnitus but if the tinnitus is due to sinus problem it should subside with decongestant etc in your case I do not think so that your ear problem is due to sinusitis to rule out that we need to get audiometry and tympanometry done also let me know if you are on any medication or if you are exposed to loud sounds I do not support multivitamin supplements for tinnitus but you can take any of them for a month and see if symptom improves then you can take for a longer time but again we will need an audiometry test for recurrent sinusitis you should get a nasal endoscopy done if needed it computed tomography scan of nose and paranasal sinuses also only then we will know the severity of the disease"
    },
    {
        "instruction": "hello doctor these past few days I have been bad as I have focused back on my schizophrenia obsession it mainly focuses on times I have been paranoid or times I have visualized things as something else examples when slacking off at work thinking what if there are cameras in the office or internet tracking software when having a bad intrusive thought thinking what if someone around me can read my thoughts and thinks I am crazy seeing the silhouette of something really far away and imagining it is something else like a door stopper from very far away looks like the shape of a bird or a sandbag propped in the shape of a cat these are just a couple of examples that make me fear I am paranoid delusional or on the edge of hallucinating things there are other ones along those same lines that pop up on random occasions that I do not necessarily believe 100 but the possibility still causes me anxiety then the fact that they cause me anxiety causes me even more anxious after the fact wondering if these are paranoid or delusional thoughts I have talked to my therapist about these fears in the past but I may have left something out or not brought up these examples in clear enough detail she does not believe I have schizophrenia I also have talked to a psychiatrist and she told me these types of paranoid ideas may occur in anxiety or depression I am just terrified that paranoia is not a symptom of ocd and my poor vision cannot explain the minor visual imaginings not even hallucinations just premature constructions of shapes outlines and that I am not taking appropriate action to combat a much deeper mental illness my only issue with my thoughts is that they did not occur after I started fearing schizophrenia I have always had general anxiety they all have happened throughout my past after I started fearing schizophrenia I combed through my memories to try to find evidence that I am developing it and in that ruination process I picked out all the times I have had paranoid thoughts though I usually do not believe the thoughts or hold them to be true I still get anxious at what if I am hoping that is the defining characteristic that proves they are products of anxiety and ocd versus schizophrenia am I schizophrenic could it be just anxiety I also have an uncle who is schizophrenic and that always scares me does it mean I am too",
        "input": "",
        "output": "hello thank you for such a detailed history it makes things very clear I will sum up the main clinching reason why you do not have schizophrenia you have insight means you know what is wrong with you and you can attribute a reasonable logical cause to this and know where to seek help this is not the case with schizophrenics they do not have insight into the paranoia they will believe it is real this is an anxiety spectrum disorder and this over inclusive repetitive thinking can also happen in ocd obsessive compulsive disorder as well as a generalized anxiety disorder treatment for both essentially remains the same only the dosages differ a little do not worry this is not schizophrenia also do not keep in mind that schizophrenia has a higher chance of transmission from parents having an uncle with schizophrenia means you just share some genetic component keep in mind that the same gene is responsible for schizophrenia autism bipolar disorder and depression anxiety so if your uncle has schizophrenia that means you can have some sort of mental illness either something as mild as anxiety or as severe as schizophrenia please get started on sari selective serotonin reuptake inhibitor or sari serotonin norepinephrine reuptake inhibitor type of medicines in addition to your therapy if you have not undergone some sessions of cut cognitive behavioral therapy please do that with a clinical psychologist since it will help you manage the symptoms of anxiety also please do deep breathing exercises daily four to five times a day when you are anxious you can do some more sessions of deep breathing until you calm down it will reduce the panicked feeling that you have"
    },
    {
        "instruction": "hi doctor I am experiencing dryness on the head of my penis and it seems to be not self lubricating if I do not put any lubricate on the head of my penis it will become dry and there is a stinging pain for the last four months I have been applying steroid cream to the head of my penis as well as the foreskin to treat it for phimosis I have stopped using the cream for a few days now and I am still having the dryness I have seen a few doctors and they said it is a side effect of the steroid cream I wanted to get your opinion on this matter and to know what I can do to help fix it",
        "input": "",
        "output": "hello I have gone through your queries you are having dryness of glans penis and from the photograph attachment removed to protect identity what I assume is you are having balanitis you had phimosis and you applied steroid cream for that now your foreskin is retractable beyond the corona glandis that means you are not having phimosis as of now the redness which you are referring to is due to balanitis please apply some conut oil or some moisturizer over the glans penis it will take care of the dryness you can take azithromycin 500 my once daily for five days you need clinical examination too hence you can contact your local urologist and get treated I hope this helps"
    },
    {
        "instruction": "hello doctor I have done my ash test recently and the result is 0 but my doctor did not suggest any medication what should I do now I am having many problems like weakness gaining weight dizziness trembling back pain and waist pain my skin is getting pale and dry day by day I remain frightened all the time I also get a problem while breathing sometimes and my blood pressure gets high like 120 90 or 130 80 mhg and it becomes normal again I am having these problems for five years sometimes they show up high and sometimes they become normal I sleep a lot please help",
        "input": "",
        "output": "hello welcome to icliniq com I just read your query as to why your doctor does not want to prescribe any medication for your raised ash thyearoid stimulating hormone well in my opinion he is right because your ash is a bit high but not above 10 when we need to prescribe treatment for the same your symptoms which you have described are mainly due to the anxiety and depression which you have for a long time and you already took medicines for the same these medicines which you mentioned are also partially responsible for the weight gain and side effects they are currently not related to thyearoid issues the ash is not so high that it would give rise to these symptoms well I would suggest you follow up with a good psychiatrist in your area for these symptoms also I would suggest you do complete blood count and repeat thyearoid function tests in three months I hope this helps"
    },
    {
        "instruction": "hi doctor I am a 20 year old female I am having some issues please help me I had my period on the and of last month and it lasted till ith I had sex with my partner on the 12th via withdrawal method and this month I have been expecting my period since ord and till today I have not seen my period I am scared am I pregnant I took multivitamin and grape for two days for stomach disorder and nausea could this also affect my period because right now I am having a headache and I always feel as if my period is there and once I check it nothing was there please help",
        "input": "",
        "output": "hello possibility of pregnancy cannot be ruled out at this moment since you had sex during your fertile period you did not take any I pill and withdrawal method has a significant failure rate multivitamin and grapes usually will not affect the periods and regarding symptoms these can be due to gastritis but the possibility of pregnancy is there so you should get a urine pregnancy test up done now and repeat it after 12 hours although somewhat delay up to seven days in periods is normal as well but do not worry and get up done if it is negative then no need to worry and positive termination by medicine can be done as it is early next time take all precautions especially I pill or condom"
    },
    {
        "instruction": "hello doctor I take lisinopril for blood pressure symbicort for asthma metformin for cos and flonase for allergies today I was sitting and just talking and I got a pain in my left eye I went to the restroom and looked in the mirror and I guess I had a broken blood vessel what is worrying me is it is not that painful but I have discomfort to touch and it feels scratchy please suggest",
        "input": "",
        "output": "hi this is called subconjunctival hemorrhage it happens when a blood vessel bursts and gives some blood out under the superficial layer of the eye called conjunctive it happens because of high pressure in the vessel like high blood pressure or coughing or constipation or holding heavy objects the treatment usually is only by lubricant eye drops if it happens for the first time but if it is recurrent every week or so you should go for blood tests it prothrombin time put partial thromboplastin time in international normalized ratio for blood coagulation tests finally since you are coughing so there is an obvious cause for the bleeding I recommend to treat it with installing any lubricant eyedrops a few times a day the eye should go back to normal in about ten days to two weeks if not or if it happens again go to your doctor for blood tests I hope this helps subconjunctival hemorrhage"
    },
    {
        "instruction": "hello doctor I may have an abscess and I am worried about going into the dentist because of the coronavirus currently I am experiencing an achy jaw and ear congestion on one side a slightly stiff neck and a mild sore throat this comes before one month after a filling repair and two weeks after I had to go back to get the bite adjustment it is not debilitating pain but it is irritating and I am wondering if I can put it off until it is safer to go to the dentist",
        "input": "",
        "output": "hello I can understand the fear you have not to go to the dentist but please do not risk your health because of the fear of coronavirus there are precautions to that and the dentist will also be taking precautions as the state has already issued guidelines for the doctors regarding your concern I would advise visiting a dentist as soon as possible to look into and in case you need medication and intervention if still you want to avoid just take over the counter pain killer like anvil and also use listerine to subside the infection if possible impacted third molar pericoronitis clinical rays pericoronitis impaction pericoronitis oral hygiene and wash away debris and later on surgery may be required eat soft food on the side and strict oral hygiene follow up is important to see infection subsided and no complications"
    },
    {
        "instruction": "hi doctor I am 38 years old and concerned about anti aging hyperpigmentation and texture I am an african with dark brown skin I have some glycolic skincare products that I want to use I eventually want to start using retinal and vitamin I know these products cannot be mixed and used at the same time I recently read something about glycolic acid thinning the skin what is the best order for skin products and how many days a week is too much for active ingredients I do not want to harm my skin I do wear spy 46 or 50 sunscreen on my face too I am currently on carbamazepine metformin vitamin and folic acid",
        "input": "",
        "output": "hi you can try microdermabrasion chemical peels laser skin resurfacing dermal fillers botox injection anyone suitable for you also sunscreen should be applied 20 minutes before going outdoors differing cream thin layer it is a retinoid and can be used if you are ready to wait for good effects it takes long to show effects for about three months also the above procedures require sessions and sitting to show effect and have minor side effects like skin reddening rash irritation and burning if you choose chemical peeling 20 percent lactic acid peel is a good choice dead skin cells will exfoliate and skin rejuvenation will occur also the diet should be healthy and nutritious exercise and skin cleansing should be done take tablet limcee vitamin 500 my for one month you can take"
    },
    {
        "instruction": "hello doctor I am 40 years old I have irregular for the past six months I got checked my prolactin as per doctor advise which came out to be 27 then the doctor prescribed me estrogen progesterone then the cycle was still irregular after that my prolactin rise to 38 cabergoline was prescribed for a month now from the past month my cycle became regular gynecologist suggested me to go for endocrinologist I am worried about the mri as she hinted about I need your suggestion",
        "input": "",
        "output": "hello I just read your query and from what you have mentioned it appears that you had slight high prolactin levels and you took cabergoline to treat that well if at all you had some pituitary problem it gets resolved with cabergoline and unless you do not have the same period problems like no periods at all for two to three months or headache persistently then there is no need for mri magnetic resonance imaging pituitary repeat your prolactin when you finish your cabergoline dose I hope this helps"
    },
    {
        "instruction": "hello doctor I am experiencing pain during sex during three separate sexual encounters over the last few months no sex in between these encounters upon recent inspection a white spot was noticed on the inner portion of the vulva which seems to be the source of the pain outside of sexual intercourse there is no major symptoms but may have slight discomfort I have used canesten topical ointment for 14 days and experienced some relief but did not resolve",
        "input": "",
        "output": "hi image is not much clear but looks like some inflammatory changes there must be vuvlovaginitis or bartholin gland infection if previously there was no pain during sex and now pain is there then there should be some problems there may be skin infection or hair follicle infection paraurethral glands are there ti urinary tract infection also can give pain there is one chance your partner may have some problem do urine routine and culture sensitivity report do one ultrasound scan of perineum to find out any cystic swelling keep the area clean drink more water change pads more frequently during menstruation can take tablet doxycycline 100 my for seven days azithromycin go one time for two days this is empirical treatment for diagnosis we have to do some test and need to see clinically along with per speculum examination can take any antacid to prevent acidity avoid oily spicy food I hope this helps"
    },
    {
        "instruction": "hello doctor I am having facial hairs acne and pores problem for the past five years I have tried almost everything but have not had good results I am currently using dox it isotretinoin 10 my I have done a blood test",
        "input": "",
        "output": "hi I have gone through your query and reviewed the attached photographs I can understand your concern but your problem seems to be hormone related I would recommend you to get these tests done thyearoid function tests serum testosterone levels serum dehydroepiandrosterone serum prolactin levels fasting insulin levels and ultrasound pelvis to rule out pod polycystic ovary syndrome meanwhile I would recommend you to start with tablet minor od minocycline hydrochloride 100 my once daily at night tracnil sachet myoinositol folic acid and vitamin twice daily use facecare facewash twice daily and epiduo gel on the pimples at bedtime for 30 minutes and then wash it off with plain water continue this for four weeks and revert"
    },
    {
        "instruction": "hello doctor I am asking question on behalf of my niece my niece is 8 years old considering the present situation regarding corona virus can we give a flu shot to her irrespective from her normal vaccination schedule also I want to ask you for a suggestion regarding a travel to do and also meeting a person who came from us one of her aunt came from us recently so my sister and my niece were actually planned to meet her but we came to know that she got fever and voting after she came to india but she told that she is doing fine now but we were in dilemma to send my sister and niece to her in this little confusion kind of period where we do not know what decision to make so please suggest which you feel good option",
        "input": "",
        "output": "hello I understand your concern yes definitely you should give a shot of flu vaccine which will protect from getting infected it gives protection for a year regarding meeting someone having a fever with international travel history my opinion is you should avoid the meeting and wait at least weeks till no fever and other symptoms"
    },
    {
        "instruction": "hello doctor from your desk of concern I want to ask some questions regarding my pregnancy I have sex with my partner about five days ago we did not use any precautions even though the penis is not properly ejected in my vagina but from how penetration was done and he discharge I feel some of the liquid go inside but as the penetration was not too much we have a doubt we go by it test on the fifth day in the evening and that was positive but still we are confused kindly guide us on how to do further confirmation regarding pregnancy but we do not want this fetus to develop in my uterus also guide me about abortion",
        "input": "",
        "output": "hi with unprotected sex pregnancy can happen pregnancy test does not come positive after five days of intercourse you need to do one ultrasound for confirmation about pregnancy and how much growth is there and where is it growing according to that we will decide how to abort but if the baby is live then every country has its own laws about abortion so you have to consult nearby gynecologist or abortion center and follow the proper guidelines according to the doctor and local laws for effective and safe abortion do not go here and there and put you in trouble legally also and if you bleed more than there may be problem to your health and or life also"
    },
    {
        "instruction": "hello doctor I am a 52 year old female I have an underactive thyearoid condition I had nuclear medicine a few years ago and had been going for regular checkups but recently due to some reasons my ash level had increased so I was given a dosage of 150 mug of thyearonorm my check up was due four months but due to some circumstances I could not go and I went two months late the doctor told me I had an overdose of it so he asked me to continue only with 100 mug I was wondering if I would feel better if I skip the medicines for two days because it is making me feel tired a lot and weak too",
        "input": "",
        "output": "hello I just read your query and from what you mentioned it appears you had hyperthyearoidism which was treated with radioactive iodine and now you are hypothyearoid well it is perfectly normal phenomena after radioactive iodine ablation of the thyearoid gland we usually expect patients to be hypothyearoid in your case it just took so long to develop you should have gotten your thyearoid function test done at that time but nonetheless your dose has been reduced so it is perfectly fine you feel tired because of the excess 50 mug which you had been taking until now anyways give it some time and it will settle down no it is not going to be dangerous just regularly do your thyearoid function test every three months until it stabilizes I hope this helps"
    },
    {
        "instruction": "hello doctor for the past two months I had severely chapped lips from the cold weather I tried okeefe blistex la noche posay cicaplast lips vaseline conut oil and plain slices of cumber all of which resulted in burning itchy lips I then decided to stop using anything at all for the last month and although the chapped lips have gone the itching has started again and I really do not know what to do I have atomic dermatitis and I am nervous about putting anything on my lips again in case it flares up and I have to wait another month for it to heal any advice would be greatly appreciated",
        "input": "",
        "output": "hi this condition is called cheilitis it is due to vitamin deficiency low level of iron and zinc also environmental exposure licking your lips eating spicy foods cold dry weather may lead to chapped lips vitamin deficiency low iron and zinc levels cold dry weather lip licking habits allergy to saliva spicy foods environmental exposure hemoglobin iron levels lip lick dermatitis angioedema angular cheilitis apply good quality lip balm with sunscreen moisturize the lips proper lip hygiene becosule capsule for 10 days drink lots of water exfoliate dead skin of lips with warm water and moisturize your lips do not lip lick after 10 days"
    },
    {
        "instruction": "hi doctor I feel that I am addicted to online casino games and betting sites I have a gambling problem and I want to quit gambling I lost a huge amount in gambling during my whole life I want to quit gambling what can I do please tell me I am tired now I am feeling depressed and sad I am not focusing on my studies properly please help",
        "input": "",
        "output": "hi accepting the thing that this is your concern is the first step towards recovery you have realized that online games and betting sites are a problem for you otherwise many people stays in denial and do not accept that they have a problem this type of behavior addiction is very much similar to drug addiction stay away from these sites as much as possible start spending your time with your hobbies spend time with your friends and family members maintain a diary each time you visit betting sites and record your emotions and thoughts just before and after visiting these sites this will help you to realize what is the urge or emotion that leads you to go to betting site and then you can alter them visit a nearby psychiatrist or psychologist for cognitive behavioral therapy this is a talk therapy where you are taught how to modify your addictive habits and how to restructure the thought process this is quite helpful to modify your behavior"
    },
    {
        "instruction": "hi doctor I am 34 weeks pregnant what are the symptoms of listeria I read somewhere that a pregnant women may not have symptoms at all how would I know if I have it also there is opened unpasteurized cheese in the fridge can that cheese contaminate an opened package of cheese just by being beside it I am worried about listeria and would appreciate your advice on this topic thank you",
        "input": "",
        "output": "hello for further doubts consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hello doctor I have an itchy tongue I can describe the itching like putting a needle on right and left corners of the tongue I am using steel tongue cleaner for the last 15 years and I have stopped now please help",
        "input": "",
        "output": "hello revert back with the asked details to an ent otolaryngologist online"
    },
    {
        "instruction": "hello doctor initially my wife was having few joint pains in her knees and shoulder last year she was diagnosed with high aso level in blood with 800 positive at that time the medicine physician has prescribed her to inject penidure la12 benzathine penicillin injection at every interval of 21 days for at least five years accordingly since then my wife is continuing with penidure la12 injection till date and by now she has already completed two years of benzathine penicillin injection presently a month back her latest blood report the aso level is reported negative with 175 also now my wife is months pregnant and is under the supervision of a gynecologist the gynecologist has prescribed her with austen so 300 two tablets per day intravaginally and all one tablet after food at night also the gynecologist advised her to continue with penidure la12 and having the opinion that penidure la12 is safe during pregnancy and may be continued shall I continue her to inject penidure la12 injection during her present pregnancy stage or should I stop it and also let me know whether this injection will have any adverse effects on the baby lastly for how many years actually this injection has to be taken by her she has already completed two years thank you looking for your advice at the earliest",
        "input": "",
        "output": "hi revert back for further information to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hello doctor I had a blood test done around six days ago and my arm is paining now it aches when I curl my arm and also when I stretch it out flat this has never been an issue for me previously what might be causing this pain on my arm please help",
        "input": "",
        "output": "hello for further doubts consult a family physician online"
    },
    {
        "instruction": "hi doctor my mother is 53 years old she is a diabetic and under medication her list of medications is as follows for diabetes glyciphage so go 0 and volibo 2 1 for cholesterol stator 10 1 and for stamina od 0 under medication her sugar levels before food and after food are 103 to 160 and 190 to 200 respectively while not having the medicine the level is 210 before food the issue now is with the medicine whenever she takes the diabetes medicine she is getting tired feeling dizzy with overall mental and physical weakness and literally wants to be on bed at times she is frustrated as well please advice what we should do",
        "input": "",
        "output": "hi for further classification consult a diabetologist online"
    },
    {
        "instruction": "hi doctor recently I got my semen test from a laboratory detail of the test is as follows volume 0 my color gray white viscosity thick total sperm count 60 million active mobile 20 sluggish mobile 30 and non mobile 50 pus cell 4 hpf and morphology 45 I want to know that how can I active my sluggish and non mobile cells according to my report what I have to do now please advise me some herbal medicine which has no side effect",
        "input": "",
        "output": "hi I appreciate you seeking help I would recommend the following in your case for further information consult a naturopathy specialist online"
    },
    {
        "instruction": "hi doctor before three years I had lasik surgery for my eyes which were in both afterwards I started developing hypermetropia reaching 75 and 5 recently I started losing focus and binocularity when dealing with near objects and my left eye tends to shift away from my nose that is exotropia to fix this I have to put some strain to regain binocular vision my doctor told me to keep wearing my glasses which I always do and I have continuous mild headache and dull aches around my left eye besides I developed floaters afterimages and halos around light I got my vision acuity intraocular pressure and funds examination which were normal kindly let me know the proper management of my case",
        "input": "",
        "output": "hello for further information consult an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor I am a 26 year old female will eating bricks affect uterus I do not have any side effects other than early periods in the last two cycles my periods were five days earlier please explain",
        "input": "",
        "output": "hi for further information consult an ayurveda specialist online"
    },
    {
        "instruction": "hi doctor my son has some brown spot on face for over 10 months I am applying pander ointment please help",
        "input": "",
        "output": "hello this is a clear cut case of pityeariasis alba which is very common in young kids it is a kind of mild allergy due to sunlight food or any other external and internal factor it is treatable and not a worrisome problem some time due to lack of calcium and presence of worms also cause it treatment for pityeariasis alba is very simple and almost always effective I suggest you tablet ostocalcium calcium phosphate one tablet every day for one month give him milk and good nutritious food tablet albendazole 400 only one tablet has to be taken apply flutivate cream fluticasone propionate over the white patches once in night for one month do not rub the cream consult your doctor discuss with him or her and take the medicine with consent to avoid sunlight allergy use sunscreen suncros 50 spy over face twice in a day which is during morning and afternoon continue this treatment for one month and the problem will be resolved definitely for further information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor I am a 25 years old female I am suffering from breathlessness and cough since several months finally I consulted a go 20 days ago and had several tests done they are ash lipid profile cbp chest ray lung function test liver and kidney functioning blood sugar urine test and egg all the reports came back normal except that I have vitamin b12 deficiency and low levels of iron I have hypothyearoidism for which I took ayurveda medicine for three months also I have a weird problem whenever I bend my head backwards and try to swallow my throat gets severely irritated and gets blocked then I have to cough to clear up otherwise while swallowing with my head backwards I feel like I am losing consciousness I also feel that there is something stuck in between my throat while I swallow anything whenever I cough I could be able to take air inside at a time and breathlessness gets normal and I gain start to feel breathlessness after some time my doctor has prescribed monte la saying that it could be due to allergy I took monte la for two weeks but still did not find any improvement in breathing problem also my doctor had advised me to stop taking ayurveda medicine as it causes these symptoms I started taking thyearonorm 25 mug is there any relation between my breathlessness and trouble to swallow please advise me",
        "input": "",
        "output": "hello we are happy to help you revert back with the reports to a general practitioner online"
    },
    {
        "instruction": "hi doctor my dad had trab360 surgery a relatively new technique for glaucoma done on his right eye when he initially got the surgery he still had vision in his eye afterwards but the next morning the vision in that eye got very blurred now there is blood accumulation in the iris as well as some fluid his eye seems to be getting more blurred and not better after two days the recovery period is supposed to be only three days it seems that his eye is getting worse rather than better should we be concerned",
        "input": "",
        "output": "hi please do not panic revert back with medical records to an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor my mom wants to take me to a doctor because she thinks I need help but I told her I am fine and refused to go I started to wonder whether I really do have a problem she started telling me I needed help because I would just lie about something stupid instead of telling the truth also how I could just stop caring about anything another thing I would do is just pretend fake happiness about something that I really did not care about I also started to care more about how I look and try to look perfect but I do not have any one to impress I just feel like if I do not look perfect something is wrong if you have any ideas about what is happening I would love to know thank you",
        "input": "",
        "output": "hi for further doubts consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor I am suffering from pain in my right shoulder hip knee foot and lower back I have a bunion on my right foot I sometimes feel that my hip is not in place and if moved wrong it will result in knee pain I broke my collar bone as a child and I am not sure if that would be causing any shoulder pain now pain is not always intense but worsens as the day progresses neither lying down nor icing and applying heat does not help also tylenol does nothing for it is this arthritis",
        "input": "",
        "output": "hi for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I had an abortion four months ago I never went back to get checked out and it was a and I am also on depo proverb second dose I am experiencing dark brown and black discharge with clots I feel bloated and I have bits of pain is this normal",
        "input": "",
        "output": "hello for further doubts consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I am a 41 year old male my recent ultrasound of thyearoid revealed multiple bilateral ganglion formation in area iv the most prominent was my diameter in lower right cervical area it was mentioned homogeneous thyearoid my doctor suggests clinical follow up due to the number of ganglion in area iv and because they were spotted last year in another ultrasound I am attaching the ultrasound scan images what are your main hypothesis for diagnosis from the images and prognosis also what follow up should I do thanks in advance",
        "input": "",
        "output": "hi for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am 24 years old I had my tooth crowned before nine years I have no problem with it but a dentist wants me to get a crown replacement I do not even feel any discomfort is it necessary to replace",
        "input": "",
        "output": "hi for further information consult a dentist online"
    },
    {
        "instruction": "hi doctor for a while I have been extremely sensitive to light and sun whenever I am in bright light or sunlight I get headaches or a migraine two weeks ago I developed migraine ever since then I have not been able to get on the computer to work as I get pressure in my head and headache I am fine when I am not on the computer or watching television now seeing computer or reading something on paper also causes this pressure and then result in headache my current medication is cloraz depot 75 my once daily please help",
        "input": "",
        "output": "hi I have read your question with care and understand your concerns revert back with the detailed history to a neurologist online"
    },
    {
        "instruction": "hi doctor I am beta thalassemia minor if I go for a relationship dna test with my son will the dna report be false due to this",
        "input": "",
        "output": "hi based on your query my opinion is as follows for further information consult a hematologist online"
    },
    {
        "instruction": "hi doctor I am a 29 year old female I washed my face and did not apply moisturizer or any other thing then I placed the bore pore strip on my nose while removing it ripped my skin it was red burns bad liquid comes out of it and looks like a huge blister I had this for about almost three weeks ago I tired alcohol which makes it burn also tried neosporin vaseline and aloe vera I have consulted a doctor and he asked me try mometasone or hydrocortisone or triamcinolone or naftin one at a time for about three to four days it itches and burns I did not find any improvement in healing please help",
        "input": "",
        "output": "hi I have read your concern and understand your problem patch test irritant contact dermatitis I suggest potassium permanganate compress take two crystals of potassium permanganate and dissolve it in half bucket of tap water then take a clean gauge immerse it in this solution and keep over the affected area for three to five minutes repeat it twice daily for five days after cleaning the area just apply fluticasone and fusidic acid combination twice daily for five days I also suggest tablet levocetirizine once daily for five days consult your doctor discuss with him or her and take the medicine with consent never in future use bore strip before using any new product first of all do patch test revert back after five days to a dermatologist online"
    },
    {
        "instruction": "hi doctor I have gone through the bariatric sleeve surgery before three years now my stomach skin is sagging please advise me what to do",
        "input": "",
        "output": "hi since you have gone for bariatric surgery I just want to elaborate the things for better understanding for further information consult a cosmetologist online"
    },
    {
        "instruction": "hi doctor when I had sex with my boyfriend last time neither I had started my new pack of birth control nor used a condom I started a new pack around one and a half to two weeks later but last week I started what seemed to be period about a week early the flow has been a lot heavier I am going through tampons like crazy and there are a lot of large clots further the blood is bright red I am having the worst cramps I have ever had in my life and it has been going on for 10 days now is there any chance that it is an early miscarriage this is so abnormal for me I cannot think of anything else that would cause these symptoms I do not know if it matters but I have cos I have never experienced this since I am regularly taking birth control",
        "input": "",
        "output": "hello for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I am getting one sided headache I do not get them often they are behind my right eye and temple area now this time I am also fighting with heavy cold and cough it came on late morning today and it hurts more when I cough or shake my head or bend over prior to this I had the same headache about four months ago at that time it came on midafternoon and lasted till next morning prior to that I had the same headache exactly on the right side and lasted for a day I am on cab and protonic I am scared of brain tumor please help",
        "input": "",
        "output": "hi based on what you have told this is more likely to be due to sinusitis sinuses are small air filled cavities in your skull bone they can get infected and when they are infected you will get headaches behind eyes such headaches will be more common during cold and cough brain tumor headache will be on both sides more in forehead and you will also have vomiting in that case based on what you have told this is more likely due to simple sinus infection instead of brain tumor it brain and it paranasal sinuses for further information consult a neurologist online"
    },
    {
        "instruction": "hi doctor I am a software engineer I am suffering from back pain at the end of ribcage since one month I have been facing this issue pain starts when I sit for longer time like one to two hours continuously if I walk frequently then also the pain starts slowly and sometimes the pain is unbearable after lunch it is increasing more if I walk for 20 to 30 minutes then I am able to sit for 20 minutes then again the pain starts I am unable to concentrate my work due to this pain I thought it as a big issue and I went for a full body health checkup after checkup I have consulted cardiologist and general physician both told me that there is no problem general physician suggested a few medicine for gas trouble please see the attached doctor prescription for your reference after completing the course of medicine I am still feeling pain so I have consulted an orthopedician after taking ray he suggested a few medicines I have been taking these medicines from last 10 days but still pain is not going away I had a gynecomastia surgery one and a half years ago now again I can see the gynecomastia I have not consulted the doctor in this regard but the primary problem is related to pain which is making my life hell please help me in this regards",
        "input": "",
        "output": "hi we are here to help you I read your detailed history and studied your reports it seems to be muscular in origin it can be costochondritis pain and that takes at least four to six weeks to settle down my recommendations in such case would be to do hot fomentation at least three to four times a day also to walk after all meals to avoid indigestion taking a combination of gabapentin and nortriptyline helps greatly in some cases such pain could be an initial symptom of herpes foster where initially there is neuropathic pain followed by lesions after few days or weeks if you develop any write back to me I would otherwise suggest you to keep patience for a few weeks and the pain would go away for further information consult a general medicine physician online"
    },
    {
        "instruction": "hi doctor I have been diagnosed with temporal lobe epilepsy following a tonic clonic seizure before nine years from then before two years I was seizure free having been put on lamotrigine before two years I had another to seizure and my dosage was raised cannot remember the dose precisely and I was seizure free for almost a year when I had another to seizure at this point my dosage was raised again to 125 my twice a day despite this I have had a number of absence seizures this seizure was followed by a 24 36 hour period of not just extreme tiredness but very strange mental sensations including what felt like a rush of intelligence as well as frequently repeating thoughts and unexplainable strange thoughts not distressing more like feelings of another time as well as what I guess are best defined as nonsense thought trains about advanced concepts such as genetics or psychology following this I had an mri which reported nothing abnormal say for a small number of tiny foi of to hyper intensity within the all white matter of both hemispheres non specific the areas of the left frontal lobe where there has been previous eg evidence of epileptogenic focus were normal all of the above paragraphs is directly quoted from the radiologist letter to my go since then I have had two absence seizures with similar post seizure symptoms my lamotrigine dosage has increased to 200 my twice a day now I am having regular nocturnal seizures two to four weeks which leave me similarly confused and with the same weird thought patterns I had one about three days ago where these symptoms were particularly acute and have worried me greatly in all cases I recovered quickly and found sleep to be a major contributing factor to my recovery now just over 48 hours since my last seizure these symptoms have again subsided they have occasionally appeared prior to seizures making me think they are auras but they do not seem to be anything like the aura descriptions I have read about during a recent appointment with a clinical nurse I was put on a new prescription of brivaracetam ex 25 my alongside the current lamotrigine dose I have yet to begin this the fact that there is a little reference online to these symptoms is quite distressing to me particularly given how bizarre they are these potentially a result of the point of epileptogenic focus might they be a reaction to the lamotrigine my current medications are fluoxetine 40 my per day atorvastatin 40 my per day metformin 100 my 10 units insulin glargine lamotrigine ex 200 my brivaracetam ex 25 my yet to commence",
        "input": "",
        "output": "hi as per the given information I can understand that these symptoms are the effects of seizure and unlikely to be due to lamotrigine the primary goal of the therapy is to control seizure episodes for which you have been prescribed brivaracetam you must start the new medicine along with the old one with which the symptoms must go mri magnetic resonance imaging scan may not reveal epileptogenic focus other than hippocampal sclerosis and some volume loss the best way to find epileptogenic focus would be eg electroencephalogram if possible can be done later if seizures are not controlled with the prescribed medicines"
    },
    {
        "instruction": "hello doctor this query is regarding my baby boys health he is 18 months old and recently had his varicella shot last month last week he suddenly started shouting in the middle of his sleep and kept scratching his forehead and neck region when checked two mosquitoes were near him and had bitten him generally he gets popular urticaria after any insect bite but after three days he got lesions all over his face arms and legs checked with my doctor and initially it was ruled out as chickenpox along with insect bite allergy but even after a week he still did not show improvement the older ones are very slowly recovering but everyday new lesions are coming up and he scratches like anything despite a lot of medications please help his current medications are aciclovir 5 my thrice completed the day course azithral my night only for seven days xyzal my thrice daily now the doctor has started him on omnacortil steroid medication and kid red 5 my twice daily please suggest if we are treating him the right way he weighs 10 keg no fever cold or body pain symptoms",
        "input": "",
        "output": "hi as per the history and pictures shown I would recommend to get the child evaluated for scabies if the above treatment does not work until then continue the treatment as going on it appears to be fine as per my knowledge as I have not evaluated the child physically if the treating doctor feels that it is scabies after examination it would be advisable to use one dose only of permethrin on the body and on the scalp I hope this helps"
    },
    {
        "instruction": "hi doctor my husband is an active person who plays badminton football and running regularly he also attends the gym he met with a sports injury in his right ankle we thought that as a muscle sprain and kept icing he recovered 80 in two days but used volini or oxalgin gel regularly after some 20 days he drove the car for around six hours then he felt some pain and inflammation the next morning we consulted an orthopedician here who recommended an ray and it scan I am attaching the reports here please let me know the further treatment",
        "input": "",
        "output": "hi I have been through your reports your rays and it are normal the point you have marked indicates the attachment of anterior talofibular ligament so it could be a sprain of that ligament just do intrinsic muscle strengthening exercises could you please tell me that how many days have passed since the injury"
    },
    {
        "instruction": "hi doctor this is for my husband on saturday he had a master health check up and a few values are not good I would like to hear your opinion on those he is 35 years old his weight is 71 keg and height is 168 am the abnormal values are as follows serum globulin 2 go do high normal range 3 2 to 46 ug my high normal 6 10 whereas to and ash are normal vitamin 65 low serum hel 34 low other triglycerides and lil values are normal vitamin b12 144 low normal 180 914 also I attached his egg where it was mentioned unconfirmed report please check and let me know the outcome of the report he is an athlete who is active in a cycling race running and swimming but he was out of the sport for one year and hence gained weight around 75 keg from 68 keg now again he reduced keg in the last three months but he is following bad diet plans such as paleo one week intermittent for the next week proper balanced normal food for one week hence I am really worried about his health",
        "input": "",
        "output": "hi I feel his low vitamin b12 levels may be linked to his paleo diet which can be deficient in legumes nuts which are beneficial for the heart he need not be so fastidious about the diet I feel and vitamin b12 can be got from dairy products eggs fish and chicken his low vitamin levels are almost very prevalent in indians and basically this can be rectified by more outdoor activity and if need 60 units of rise once per week for six weeks his hel levels are low and although his lil bad cholesterol levels are also low I would recommend daily exercise half an hour daily to boost hel levels his isolated high to levels mean you need to check for a thyearoid goiter and possibly do a thyearoid scan but it could also be linked to high globulin levels isolated high globulins need work up too possibly disorders of immunity or rare disease like multiple myeloma possibly consult a hematologist I hope this helps"
    },
    {
        "instruction": "hello doctor I am a year old male my weight is 16 keg and my height is feet inches my problem is I am using nutrition food and milkshake to lose weight 15 days ago my weight is 123 keg but now it is 16 keg I am doing a gym too this is a product from herbal life I want to go to my sister marriage party for four days I may have some alcohol but my trainer is saying if I drink alcohol then my liver will be damaged I am also taking liv 52 tablets can I get some medication or advice",
        "input": "",
        "output": "hello it is important to know what is the contents of your supplements however common supplements contain creatinine for muscle building with which alcohol is safe in moderation however if the content is not known then it is better to withhold supplements two to three days prior to alcohol consumption and then probably there should not be any problem with it but even otherwise if there is no baseline liver damage or disease then having one or two drinks should not create any problems and I think you can have it there is no role of anti medicine I hope this helps"
    },
    {
        "instruction": "hi doctor I am four weeks pregnant and I have be vaginosis and some candid hyphae my gynecologist prescribed me to apply internally zidoval gel for five nights and then take two days break and apply canesten soft gel pessary the following night I already asked her if it is safe to take during early pregnancy and she said yes I am now doing some online research and found many contradictions do you think that these are safe to apply I am so much worried",
        "input": "",
        "output": "hi as such local application is somewhat safe and if you have diagnosed infection then it is always a query whether to take or not if the infection is not much severe then you can wait for 12 weeks of pregnancy and then take the medicines in early pregnancy there are many contradictions whether to give or not to give tablets but if the infection is severe then infection itself can cause harm to the pregnancy which is less than the medication hopefully because there is no certain study available to count actual risk while treating this type of infection in early pregnancy so you have to choose wisely and if the infection is not severe then avoid any drugs and drink more water"
    },
    {
        "instruction": "hello doctor I am a diabetic my weight is 69 keg and my height is 180 am my up glucose level is 150 210 my do I am taking glynase of one in the morning tablet exermet go 501 one in the evening my be is normal I tested my glucose levels today and postprandial glucose level is 204 my do I am interested in taking insulin replacing oral medicine I heard that oral medicines cause weight reduction and dangerous for kidneys",
        "input": "",
        "output": "hello the metformin component of the oral anti diabetic medications aids in weight loss and is usually preferred in overweight candidates but there are other medications that do not lead to weight loss so you can definitely ask your physician to shift you to such medication also just like all medications have side effects long term studies in patients taking oral anti diabetic medications have shown deteriorated kidney function many people are not compliant in keeping up with daily injections of insulin also the risk of hypoglycemia is higher with insulin hence not many people prefer it if you feel you can cope up with it please speak to your local physician or diabetologist they would make a chart depending on your daily sugar levels as to how much units of insulin would you require also they would educate you regarding rotation of sites for taking the insulin injections how and when to take them also do not forget to ask your physician to explain the symptoms of hypoglycemia and also to tell you when exactly should you be taking the insulin injections before food during food morning or night basal dose depending on its duration of action I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 37 year old female I previously asked a query in icliniq and was attended by a doctor who advised as follows since all your reports are normal except for very mild anemia and a mild increase of abc count then the cause of your lower back pain that extends to your hip thigh and knees could be either sciatica or lumbar disc prolapse this should be diagnosed by a it scan of lumbar vertebra you also need an ray of your hip joint to exclude osteoarthritis for the anemia you should take iron and folic acid supplements for a month last month I had pain in my legs thighs lower knees and in my back I met an orthopaedician and find nothing wrong with the knee joint pah and lumbar spine my us abdomen and pelvis are also clear now my blood pressure remains high I am feeling pain in my back thighs and legs below my knees and I am feeling very weak as per my last report my abc is high and hemoglobin is low report attached currently I am taking ultra do 100 iu once in a day fludac 20 my capsule twice a day gemcal once in a day stamlo twice a day",
        "input": "",
        "output": "hello after revising your rays it seems that you have degenerative changes in your knee joint and in your spines with diminished disc space between lumbar vertebra number and spinal vertebra number these degenerative changes actually indicated the presence of osteoarthritis which is a chronic progressive disease of joints treatment aims at stopping the progress and managing the symptoms it should include analgesic and anti inflammatory medications corticosteroids physiotherapy that should include stretching to improve flexibility and mobility of joints and exercising as well as for your blood pressure you should start a strict salt free diet and monitor your blood pressure for 10 days if still high then you will need an antihypertensive medication"
    },
    {
        "instruction": "hi doctor I need some advice I had a baby eight and a half months ago one week after she was born I went and got the depo injection I did not get a period at all until 17 days ago and still has not stopped it is very heavy in the morning but light throughout the day please suggest",
        "input": "",
        "output": "hi do you mean you had only one shot of depot eight and a half months ago in that case its effect is gone it lasts only for three to four months only I hope you are breastfeeding now usually in the postnatal period there is a long phase of no periods then gradually as you reduce breast milk and gradually increase the top feeds the hormones gradually come back to normal so you get periods but still it will not be fully balanced so do not worry about the initial few periods after this long phase of no periods you do not need any medication it will get regularized your next period will be normal if you want to reduce bleeding have tablet tranostat 500 my three to four times a day depending on the severity of bleeding it is not a hormone and has no side effects I hope this helps"
    },
    {
        "instruction": "hello doctor I am 26 years old I am diagnosed with hypothyearoid about four years ago I started from 25 mug levothyearoxine and now taking levothyearoxine 75 mug recently I lost pounds which is very bad because I am 6 tall and my weight is 16 pounds I feel weak and dizzy very often I also have irregular heavy periods and symptoms of having too much male hormone too much hair on legs bikini etc severe acne especially a week before expected period since one year my periods cycle became longer before it used to be 28 days and now it is 38 days I am also worried because of low insulin and pretty normal glucose what does it mean may it be because I am on gluten free diet for two years please also look at my sex hormones prolactin looks too high and I am not sure about testosterone",
        "input": "",
        "output": "hello I just read your query and the detailed information you have mentioned in the attached reports the thyearoid function is good and you must take your medicine regularly as usual do not worry about the insulin levels it is a good thing it means you are perfectly normal your prolactin levels are the ones that you should be worried about as they are the ones causing your irregular periods they need treatment I would suggest that you take tablet cabergoline 25 my orally twice a week for two weeks and then repeat your serum prolactin levels your testosterone levels are within normal limits and perfectly normal as well I hope this helps"
    },
    {
        "instruction": "hello doctor I took an hiv mia test on 26th day after a sexual encounter the test result is negative I had protected sex but I saw some blood on the inner parts of my partner and also at the time I was having two pimples on my penis at the end and not on the tip I am concern about that is an hiv test on 26th day conclusive",
        "input": "",
        "output": "hi hiv negative test report at 26th day post exposure is quite assuring but a confirmatory hiv antibody test is further required at three months of last exposure there are no specific symptoms by which we can diagnose hiv the complaints which you are having could be due to multiple reasons and do not necessarily means hiv for the complaints you mentioned besides getting tests for other sits sexually transmitted infections like hbsag hepatitis virus antigen anti hav hepatitis virus vdrl venereal disease research laboratory gonorrhea per polymerase chain reaction herpes simplex and I also suggest you to get vitamin do and vitamin b12 levels is there any fever as well if so please send the temperature record please revert with the reports"
    },
    {
        "instruction": "hello doctor will fertilization occur immediately after an egg is released and will the ovulation test show positive regardless of fertilization has occurred immediately I had sex three days ago but the ovulation test still showed positive today please suggest",
        "input": "",
        "output": "hi ovulation test is not confirmatory for ovulation it means oh luteinizing hormones increased during the menstrual cycle fertilization can happen within 24 hours after ovulation once oh surge happens ovulation actually occurs after 36 hours of oh surge ovulation test comes positive when oh surge happens so you should have sex after two or three days of positive ovulation test it is the most likely time of ovulation but it is not confirmatory ovulation does not always happens after oh surge ovulation test does not have a relation with fertilization may or may not occurs even after ovulation"
    },
    {
        "instruction": "hello doctor my month old daughter had a rash for three days it started with small discreet spots on the legs and lower back the next day she had a rash on her face and body these are red flat spots it itches she has no fever and is in good general condition we consulted a doctor who was thinking about the onset of chickenpox but the evolution of the rash does not seem to go in this direction the doctor cannot give us any other diagnosis we fear an amoxicillin rash the rashes first appeared as small spots and our daughter finished an day treatment for otitis do you think that is possible what else could it be",
        "input": "",
        "output": "hi I have gone through your case in my opinion there are two to three possibilities for the rash first yes it could be drug eruption as the rash is itchy and appeared after she took treatment for otitis drug rash can either occur immediately or even after six weeks second it could be due to any viral or bacterial infection which first caused otitis and then the rash but as she did not have a fever and there are no vehicles so in my opinion it is not chickenpox third possibility is insect bite or popular urticaria last possibility is gianotii frosti syndrome it is common in children of this age group and rash in it is itchy please apply percent hydrocortisone cream on lesions two times a day for 10 days rash will disappear in two to three weeks"
    },
    {
        "instruction": "hello doctor my son fell down at school recently due to fits he is 12 years old boy we consulted a neurologist he advice to take mri we took mri and it disclosed as left menial temporal sclerosis hence I request you to give me an advice",
        "input": "",
        "output": "hello I understand your concern and would explain that there is no reason to panic there is no correlation between eg and the mri findings as these mri findings are suggestive of a birth defect in the brain which causes epilepsy seizures his blood laboratory tests and cardiac ultrasound are unremarkable he has had no seizures so there is no need for medication or surgery in my opinion this is an incidental finding and all you can do is to repeat the mri and eg after a year"
    },
    {
        "instruction": "hello doctor I am a girl who has faced a lot of trauma in the past years I have recently lost a group of my most trusted friends and after this happened I have been feeling almost numb to emotion at times I do not care at all and at times I feel suicidal I have been eating and sleeping too much and have noticed myself becoming extremely lazy and careless in school is this serious should I consider visiting a doctor",
        "input": "",
        "output": "hello you seem to have a mixed anxiety depressive symptoms your symptoms of low mood suicidal ideation loss of energy loss of interest sleeping and eating issues is typical this is very common and about 10 15 percent of people have this problem it is also very easily treatable you will need to visit a psychiatrist and he will prescribe you sari type of medicines such as escitalopram 10 my or fluoxetine 20 my etc which will help with your problem it basically happens when some neurotransmitters such as serotonin reduce in your brain leading to a problem with handling the day to day stresses of life medicines are usually given for 4 months and then tapered off slowly and stopped in addition to the medicines if needed you can also undergo a few sessions of cognitive behavioral therapy from a clinical psychologist also do consider doing deep breathing exercises or progressive muscle relation daily"
    },
    {
        "instruction": "hello doctor I will try to keep this short I had a quick question I have eaten really bad for a very long time but over the past week I have completely changed up my diet I do not eat processed foods bad sugars and fats and hardly any gluten I have been eating chicken salmon mainly fruits veggies and unsaturated fats mainly I have been taking a couple weight loss supplements as well since yesterday before I took the supplements yesterday my lower part of my stomach has had a little pain is that because my stomach is trying to adjust to the change in my diet thank you",
        "input": "",
        "output": "hi first I would appreciate the fact that you have switched from unhealthy eating habits to a healthy diet and healthy eating habits stay motivated if a person had been into extensive unhealthy eating habits from a long time it may be difficult for his digestive system to adjust the digestive system needs some time to adjust if you have been eating a lot of fiber fruits and vegetables recently gradually increase fiber in your diet as your stomach needs some time to get accustomed to it the pain may be due to more intake of dairy products increase dairy products gradually low or high intake of certain healthy foods can cause bloating or gas but it does not mean that you should go back to unhealthy eating habits the pain must not demotivate you consistency is the key if the pain persists make sure to go to a physician or gi specialist moreover you can eat gluten if you do not suffer from gluten intolerance you can eat oats barley whole wheat just do not eat refined floors and cereals do not fall into the trap of buying everything from the market that is labeled as healthy"
    },
    {
        "instruction": "hi doctor I am breastfeeding mother with ash level 83 in the last trimester which is I suppose hypothyearoidism my milk supply is low I want to know if ash value can affect milk supply I am on 50 mug eltroixin dosage now if it does affect I want to know what should be the normal values for ash free to free to value for breastfeeding mother and if I increase the dosage does it affect my baby through breast milk please help",
        "input": "",
        "output": "hello I just read your query and from what you mentioned it appears that you are being treated for hypothyearoidism since the last trimester of your pregnancy although the ash thyearoid stimulating hormone you mentioned was not that high as to begin therapy but still I am not aware as to what were your to and to levels at that time as well I understand that you are breastfeeding and that your milk is not enough for the baby well that is not related to hypothyearoidism but related to your diet and fluid intake the levels for a lactating mother is the same as a non pregnant woman I would still advise you to repeat your thyearoid function test after delivery to know what are your levels now please do not increase the dose without any tests and no it does not affect the baby adversely I hope this helps"
    },
    {
        "instruction": "hello doctor I am not sure what I am feeling I struggle with self confidence and low self esteem I am in a management position at my work place yet this has been my struggle for a long time now I am a single mom and my previous partner was a narcissist I think it pushed me further into fear of relationships I am scared of failing even as a parent I hate socializing yet I need friends I just do not know how to break from this when a guy shows interest in me I get so overwhelmed and clingy and never works I have isolated myself from my family and friends I do not know how to build relationships and I have to fake my friendship I cannot sleep at night fully and I wake up every two hours losing at least two to three hours of sleep a night or more my boss in the office has already noticed and given me feedback I need help I feel like I am losing it",
        "input": "",
        "output": "hello you seem to have an anxiety type disorder mixed with depressive episodes you will need to visit a psychiatrist and he will prescribe you sari selective serotonin reuptake inhibitor type of medicines which will help with your problem it basically happens when some neurotransmitters such as serotonin reduce in your brain leading to a problem with handling the day to day stresses of life medicines are usually given for two to four months and then tapered off slowly and stopped the medicines I have mentioned are usually prescribed by psychiatrists apart from those you can take melatonin or 10 my it is available in any decent pharmacy over the counter and does not need a prescription you can try taking that daily at night apart from that you can try some sleep hygiene methods like maintain good temperature no noise or light one hour prior to bed wind down and try reading or music do not use the laptop to or phone one hour prior to sleeping avoid caffeine alcohol or tobacco two hours prior to sleeping avoid exercises three hours before sleeping and take warm milk at bedtime go to bed only when sleepy and avoid other activities on bed use bed only for sleeping or sex if you do not get sleep do not toss and turn get up go to another room walk about for 10 15 minutes and come and lie down see for 10 minutes if not sleepy go out again try deep breathing exercises progressive muscle relaxation techniques or yoga or meditation it will also help"
    },
    {
        "instruction": "hi doctor currently I am 14 weeks pregnant with my second baby I am attaching my it and double marker report for your reference I have a year old son and no abortion in the past I have conceived naturally both times my doctor has asked me to do either nip or cos and I am not sure if I really need to do any she has asked me to take ecospirin 150 immediately if not doing cos else start after cos I have some queries do I really need to go for either nip or cos or I can forgo these tests should I take ecospirin 150 as my previous pregnancy did not have any complications and at present also I am in good condition with no health issues also I do not drink and smoke are there any issues with my beta hug and pa a value do you see any other concerns in my report please reply",
        "input": "",
        "output": "hi I have seen the report now every laboratory has its own calculation methods to come to a risk ratio after the test hug and papp a levels are also different at different times of pregnancy and also has some effects of weight and age on it this is a genetic screening test and we do this test to find out what is the risk of this pregnancy having a congenital abnormal baby specifically downs edward turner and patau syndromes this risk ratio has cut off values means trisomy 21 downs has a risk ratio of 365 in your case and cut off is 250 now with this report we are calculating the risk of having a baby with downs syndrome is in 365 pregnancy with your age and with the test and ultrasound reports you have we are calculating the risk and the report is always low risk or high risk there is never no risk practically also after doing all available tests we never can rule out all the possible abnormalities in the baby cos chorionic villas sampling and sometimes amniocentesis are 100 if they found baby dna in the procedure to rule out that the baby does not have trisomy 21 or other major chromosomal anomalies that does not mean all genetic abnormalities are ruled out both of these procedures also have some risk of abortion during or after and that is why we advise these test in high risk double marker nip non invasive prenatal testing is also a screening test like double marker but the test is less risky as compared to cos and amniocentesis but at the same time more costly and test sensitivity to rule out trisomy 21 and other is 99 after all these details you must be confused now other trisomies are definitely low risk but in case of trisomy 21 your report is 365 and which is somewhat near cut off 250 ideally I advise further testing of cos and amniocentesis if the value is below cut off value but 365 is also near the cut off value so it is a debatable issue 365 means that out of 365 pregnancy 364 will be normal and pregnancy will have trisomy 21 secondly you can start ecosprin tablets we usually start it in some high risk patients if you have pregnancy after 30 years then you come under high risk group so you should start it in cos there is chance of bleeding inside and that is why your gynecologist does not ask to start it if you are going for cos and every pregnancy is different and we cannot say that if previous pregnancy did not have any problem nor the baby has any problem then this pregnancy will not have anything wrong yes we can say that if previous pregnancy was normal then there is somewhat more chance that this pregnancy will also normal go through all details two or three times to understand it properly and then ask anything if you have more questions I hope this helps I am not able to open it scan report yes but the second report is saying that it is 93 and nasal bone is seen mostly these two sonography markers are also used to calculate the risk in double marker apart from hug beta human chorionic gonadotropin and papp a pregnancy associated plasma protein a both it nuchal translucency and no nasal bone are normal"
    },
    {
        "instruction": "hello doctor I was diagnosed with minimal change disease before a few months and started on prednisone I was into remission within a week but the disease relapsed while on the full dose cyclosporine was added and steroids were tapered to within six months recently last month I had an injury during a ma mixed martial arts fight and since I was to run a ok military obstacle marathon in the coming week I decided to consult a doctor the consultant was a third year pig who was my sister senior in medical college while there was not any signs of injury he noticed changes of an in left femoral head I had an mri the same day that showed stage an with kerboul angle of 205 in the right hip and stage with angle 170 in the left I recently underwent core decompression in bilateral hips what are the chances of the disease reversing its course and if I do require a hip replacement will I be able to do high impact activities with it I am really worried since I am only 23 years old I have uploaded my post core decompression ray what are the chances of prognosis in my condition",
        "input": "",
        "output": "hello an vascular necrosis of the hip is usually due to a number of causes prolonged steroid intake is one of them the treatment of an hips ranges from rest core decompression and eventually hip replacement since you have had stage and in your respective hips core decompression was a good choice this procedure involves drilling one larger hole or several smaller holes into the femoral head to relieve pressure in the bone and create channels for new blood vessels to nourish the affected areas of the hip when osteonecrosis of the hip is diagnosed early core decompression is sometimes successful in preventing the collapse of the femoral head and the development of arthritis core decompression is often combined with bone and cartilage grafting to help regenerate healthy bone and support cartilage at the hip joint a bone graft is a healthy bone tissue that is transplanted to an area of the body where it is needed the tissue may be taken from a donor allograft or from another bone in your body autograft core decompression prevents osteonecrosis from progressing to severe arthritis and the need for hip replacement in some cases your ray does not appear too bad and I am hopeful that core decompression could help in reversal I hope this helps"
    },
    {
        "instruction": "hi doctor I had sex with cow I had sex two times and each time I wore two condoms which was intact after sex but appeared that it had come a little front from my body side I also filled water in the condom before throwing and confirmed that it had no breakage as water did not come out she had bit me near ear and the next day a mosquito bit me at the same place and I had a swelling there for some two days due to anxiety I started having bromhexine for mucus syearup and ulgel a antacid I also lost weight during this time I had taken a liver protection injection later I underwent an hiv elisa test 12 weeks after sex 89 days after sex the result was negative would bromhexine ulgel or liver protection injection interfere with the elisa test or can I consider this test as conclusive later I got two swellings one in my hand other in my neck the swelling in the neck went off in two days again I get some sort of swelling in hand and in the leg a small size lump appeared and it disappeared within few hours I am noticing this happening frequently from three days however two of such lump have turned red earlier I used to get infected very easily by cold and throat infection even before I had sex could that be a pre existing immunodeficiency given all this can I conclude that hiv elisa test 12 weeks after sex 89 days after sex as conclusive or should I have another test after six months please help",
        "input": "",
        "output": "hi let me answer your question step by step your chances of contracting hiv or for that matter any other sti sexually transmitted infection was non existent with the consistent and corrective use of a condom you had mentioned that there was a slight slippage of the condom and it is assumed that you had a low risk of contracting hiv or any other sti if the other person will be having it the elisa testing kits for hiv used these days are highly sensitive and specific and gives accurate results your negative hiv test at three months of exposure is highly conclusive of your negative hiv status majority 9 of the people who are infected with hiv after exposure develop antibodies by three months so your negative test result is quite reassuring there are very rare cases of late seroconversion or positive antibody response at six months has also been reported in the literature there are recommendations and I also suggest to my patients to repeat the rapid hiv antibody test at six months of last exposure and if that will be negative you need not to repeat it further the symptoms which you have mentioned could be due to various other causes or just due to anxiety also there are no hiv specific symptoms or signs relax as you have crossed three months hurdle I suggest you to get your routine hemogram biochemistry fasting blood sugar thyearoid profile and lipid profile done I hope this helps"
    },
    {
        "instruction": "hello doctor after how many days a normal person years suffering from all symptoms and just have tested hiv and and tridot test with negative result at 120 days develop antibodies I have symptoms from day 10 is my test at 120 days conclusive I tested that six months back and I am very worried about hiv will I die with it or is it a normal virus that can be controlled is the result of 120 days test accurate please provide information as I am suffering from lots of tensions I gained weight in the last two months I have stretch marks on my body with pimples and headaches there is a blood vessel break in my eyes and it is like a red dot should I get a test for hiv again or else should I relax",
        "input": "",
        "output": "hi antibodies are the proteins produced by the body in response to fight the foreign substance antigen virus infectious agent it enters the body when antigen enters the body it stimulates the immune system to produce antibodies it is very difficult to tell that how much time a particular person takes to develop antibodies your negative hiv antibody test at 120 days means that 9 of your body has not been exposed to hiv the test kits used these days are highly sensitive and specific and give accurate results 120 days hiv negative test is highly conclusive of your negative hiv status but I think that you are not letting it go the symptoms are more likely due to stress there are very rare cases reported in the literature where the person has been exposed to antigen but the time taken by the body to produce detectable antibodies was longer up to six months there are recommendations and I also suggest to my patients to repeat the test at six months and if that will be negative you need not repeat it further I hope this helps"
    },
    {
        "instruction": "hi doctor my father was suffering from stable angina so he had an angiography 10 months before in which he was told that he had three arteries blocked and was suggested cab but he was afraid now he suffers from severe angina pain with little activity and sometimes while resting or sleeping he consulted his cardiologist and he gave him the date for surgery next month but his chest pain is making him so much scared that until next month he will be able to survive or not please advise what should he do",
        "input": "",
        "output": "hello I have seen he attachment yes he will need bypass surgery but no need to worry his medicines need to be optimized and anti angina drugs need to be added along with aspirin clopidogrel and station like atorvastatin or rosuvastatin he should be on beta blockers like tablet metoprolol or 25 50 my once a day nitrates like nitroglycerin 6 or 4 two times a day if not responding to 6 take tablet nikoran my twice a day trimetazidine 35 my twice a day and ranolazine 500 my twice a day so these are all medicine which will help in reducing angina and probability of any complications so we need to modify according to his current medicine so let me know his current medicine I hope this helps"
    },
    {
        "instruction": "hello doctor I have grade fatty liver I am 154 am in height and weigh about 65 keg I am trying to lose weight can you suggest me a diet to cure my fatty liver as well as reduce my weight",
        "input": "",
        "output": "hello here are some nutritional guidelines that you need to follow I will tell in detail about the foods that you need to include in your diet include nuts in your diet especially almonds peanuts hazelnuts all types of nuts have healthy fats in them which have been proved to be healthy by a bundle of researches done over the years they do not have cholesterol and the fat in them does not lead to weight gain instead studies are consistently showing that nuts lower the cholesterol levels of an individual nuts can prove very beneficial to have satiety satisfaction and in improving your blood glucose levels they can control your hunger pranks while providing you satisfaction in this way they can assist in weight loss you can include nuts in your breakfast or can consume it as a snack in between meals you can eat a handful of them or you can add them to your cereal plain cornflakes weetabix porridge sagudana kheer gravy or raw boiled salads you can also consume them in the form of milkshakes g almond milkshake or you can simply mix almond or walnut powder in milk and consume it as a mid morning snack or as an evening snack or before bed homemade almond or peanut butter is also good you can use honey or brown sugar 5 tablespoons on a daily basis include seeds in your diet basil seeds chia seeds pumpkin seeds sunflower seeds you can season them on your salads in your milk milkshakes yogurt porridge basil seeds need to be soaked in water before use chia seeds are eaten both raw as well as soaked pumpkin seeds and sunflower seeds are eaten raw use olive oil season it on your salads egg toast fish lean meat extra virgin olive oil can be used for cooking as well you can use edible corn oil sunflower oil mustard oil soy bean oil for cooking add more vegetables and fruits in your diet use more green leafy vegetables add whole grains in your diet whole wheat oats barley do not use refined and polished floors white flour is also a refined flour use fish poultry red meat use lean cuts use low fat dairy products and sugar free as well strain milk before use make home made yogurt using strained milk do not drink any kind of juice or fizzy drinks juice made from juicer is also not allowed if one wants to drink juice simply add one recommended fruit in water and grind it in a milk shake jug do not add sugar you can use boiled rice or take walk chawal twice a week only one small plate do not consume rice in dinner I hope this helps do not add sugar or artificial sweeteners in your daily foods do not use commercially prepared nut spreads do not use nuts with sauces mayonnaise as both of them are fattening do not use nuts with added salt in them if you suffer from high blood pressure do not use margarine do not use flavored cornflakes limit the consumption of canned and tinned foods biscuits cakes and desserts"
    },
    {
        "instruction": "hello doctor I had sex with my partner last month after the third day of my periods there was no intercourse and also we used condoms my period date was and of this month but did not get my period then I consumed primolut for three days thrice daily today is the ith day after the last dose I have back pain cramps and also abdominal pain I also ate paya this week I also did a home pregnancy test but the results are negative but I do not understand why periods are not coming I am very tensed is there any chance to get pregnant please help",
        "input": "",
        "output": "hi if you had sex on the third day of menses then there is no chance of pregnancy periods can be delayed due to stress and even due to taking primolut you need to wait for five more days I think the period should come in these five days do not worry as the pregnancy test is also negative"
    },
    {
        "instruction": "hello doctor I am 36 years old and healthy I had vitamin do deficiency with back pain four years ago when I was abroad I came back and did physiotherapy and ayurvedic treatment things got better in two years but I still have the following symptoms back pain comes when sitting for a long time specifically in certain kinds of chairs sometimes twisting pain comes suddenly when I sit in certain chairs for long standing continuously in certain types of floors is an issue lifting weights is fine but still need to comfortably lift more than keg standing is comfortable in roads shops etc for a long time spine pain radiates to the back of the head and neck at times when that happens I sometimes get lightheaded when seeing objects rotate pain comes when I sit and clean objects if I do no fully sit pain does not come long scooter rides sometimes cause back pain the next day",
        "input": "",
        "output": "hello you have symptoms that are typical of core and back muscles weakness I will advise you to take up some regular exercise schedule whether it is gym based or at home like yoga or even at work where you do chair based exercises that help you with core strength and back toning and flexibility exercise you can see a good manual therapist or a physiotherapist who will be able to guide you should be mindful of poor posture and avoid sitting in position for any length of time"
    },
    {
        "instruction": "hello doctor I got my annual health check up done last weekend from the report the values show I have blood readings variations page and of 26 do I need to take any medication variation of cystatin 07 against max of 03 any medication required if so please suggest tables vitamin deficiency page of 26 any medication needed or just sunlight is enough page 21 and 25 variation any medication needed if so suggest tablets high cholesterol please let me know if I need to take any medicine if so please suggest tablets high creatinine shows 25 the report reference is 6 to whereas on the internet it shows it can go up to 3 let me know if any medication is required scan report did spa test based on ultrasound it looks clean grade fatty liver any medication needed if so please suggest medicine tit looks clean please suggest",
        "input": "",
        "output": "hello I have seen the attachment the us ultrasound abdomen and the tit treadmill test are not cause for concern the prostatomegaly I prostate enlargement seen on the us has been correlated with a normal spa level the high hemoglobin 17 go may cause symptoms due to clotting and blood slugging like headaches chest pain and sometimes stroke so that you should need to be evaluated by a hematologist if you are a smoker you should quit smoking as that too could cause high hemoglobin levels low vitamin levels are seen very commonly in india you can do some running getting at least half an hour exposure to sunlight and take rise 60 units per week for six weeks to improve these levels do not worry about cystatin as your gor glomerular filtration rate is normal the cholesterol especially the lil low density lipoprotein is worrisome I would advocate daily aerobics for half an hour stop fried foods and bakery foods more nuts and green leafy vegetables if you want to take a medicine to lower cholesterol then rosuvastatin 10 my would be good the creatinine is again a value and egfr being normal I would not advise anything but if you wish further information you could consult a nephrologist"
    },
    {
        "instruction": "hello doctor six months ago following a mild concussion I started to have symptoms that were vaguely consistent with bilateral cervical radiculopathy the cervical mri showed severe stenosis and disc herniation at the ca level going right and c5 going left the worst symptoms were numbness tingling and weakness down the left arm these symptoms really did not follow the c5 dermatome however they were all over the place in the left arm six months later the numbness and tingling have resolved I feel stronger overall however I have had body wide fasciculations for four months and I can see wasting of the first dorsal interossei muscle of the left hand it is subtle but I notice it I have trouble holding a pot or a phone with elbow bent past 90 degrees I have seen two neurologists including one neuromuscular specialist at an academic center both eggs were clean they needed the dorsal interossei muscle and all the other major muscles of the left arm clinical exams were also normal though benign fasciculations were noted how do I know that I do not have als what are the chances that these fasciculations are benign given the perceived weakness atrophy and fasciculations body wide how long does it take after the beginning of atrophy for an egg to pick up als what else could this be would not it be odd to develop ulnar neuropathy worsening rotator cuff issues and bodyside fasciculations at the same time I am not a doctor but these seem like system wide problems currently I am taking lamictal zaleplon and lipitor",
        "input": "",
        "output": "hi welcome to icliniq com it is highly unlikely that the eggs electromyography are clean in the presence of muscle wasting and fasciculations I believe the symptoms and signs you are experiencing are due to cervical stenosis and not due to als a ca disc herniation can cause all the symptoms you have described is it possible for you to upload the mri magnetic resonance imaging pictures in als amyotrophic lateral sclerosis usually egg findings precede clinical symptoms such as fasciculations and muscle wasting this is also the case in radiculopathy due to cervical stenosis"
    },
    {
        "instruction": "hi doctor it has been six months of my marriage and I am getting so much heartbroken and emotionally weak since the first day of my marriage my husband has some or the other issue like trust with the clothes my siblings and my friends he hardly cares for me no love is there between us over it my in laws are also very much interfering at this point I do not know what should I do because with such circumstances it is not possible for me to be in this relationship but somewhere I feel can the circumstances change please help",
        "input": "",
        "output": "hi I completely understand that you feel disturbed due to your partner related problems every girl faces challenges at the start of marital life for some girls it may be difficult to adjust with the new partner family some of them get adjusted after spending time with in laws and understanding them"
    },
    {
        "instruction": "hello doctor I had my tooth removed befor three days bottom left first molar and it was a tricky one to get out around an hour or fighting with it until it gave in before this I have had an ongoing infection in the tooth and had previously around three courses of antibiotics I finished my last course two weeks before the extraction the pain on the day once the anesthetic wore off was very bad I had to take paracetamol and dihydrocodeine since then the pain has reduced a little maybe 10 20 less painful but it is still causing pain today it looks a bit manky is this normal and expected here is the tooth as of today third day healing I have done my best to keep the clot in place I only had soft foods not had any kind of sucking motion in my mouth no smoking etc the teeth on the bottom front left are also very painful but the right side of my mouth is fine applying any pressure in that area hurts",
        "input": "",
        "output": "hello I have seen the picture the extraction wound looks normal the pain you are feeling is also normal given that it was a difficult extraction and your dentist had to struggle pulling it out you can use salty lukewarm water mouthwash and add ibuprofen to the painkiller you are taking and take them regularly three or four times a day not as required and you should be fine in a couple of days do not forget your diet and eat nutritious foods rich in proteins and vitamins as this is important for the healing of your wound and can get ignored in the middle of your pain I hope this helps"
    },
    {
        "instruction": "hello doctor I think I am bipolar just a couple of weeks ago I felt and was told by my friends that I was more energetic and crazy than usual now I feel like there is no hope and nobody really cares but there is also that little bit of me that is telling me that I am faking this and that all I want is attention I just want to know what the heck is up with my head",
        "input": "",
        "output": "hello it is a little early at your age to be diagnosed with bipolar illness sometimes that part of normal teenage hormones and puberty when it is mixed with some depressive symptoms 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 or hypomanic phase then you probably suffered from major depressive disorder or generalized anxiety disorder"
    },
    {
        "instruction": "hello doctor I am a 49 year old female I weigh about 62 keg and my height is 168 am I have a long time problem with receding gums on all my teeth the teeth are quite tight also I have also had esophagus hernia for many years and the stomach does not close properly and this makes it so that I feel the effect of my stomach acid like heartburn it is very unfortunate for the teeth because it also changes oh in my mouth and makes it acidic this happens especially when I sleep at night since I feel some dull pain in my teeth at night or when I wake up in the morning I am trying to do something so I take the medicine that hinders acid production before I go to bed prazol and I also rinse my mouth with water whenever I wake up even at night still I think this acidity weakens my gums and teeth the tooth that is in the picture has been fixed a few times with neck filling but now I feel there is some inflammation there that causes pain and the gum is very sensitive I can hardly brush this tooth I have an ointment that I started to use yesterday it is called carident and is made of framycetini sulfas painum and natrii benzos do you have any recommendations on what I should do I could go to a dentist to try to put a new neck filling but I am afraid that the gum has gone so low already that there is not enough of it left to put another filling I am not even sure what will happen when I have this tooth extracted if it will be possible to make up for the hole in the gum I am quite worried about it",
        "input": "",
        "output": "hi I checked your query and attached files I can totally understand the situation you are going through the best part is you know the root cause is stomach issue you are doing best and accurate already to keep the oh maintained I would like to add some points do saline water mouth rinses instead of normal water rinses take a pinch of salt in a half cup of lukewarm water and do its rinse before sleeping and after breakfast do it for one week this is the best remedy by book and by practice so far for strengthening the gums as healthy gums will grow they will attach to tooth more firmly change your brushing habit do brush with very light hand pressure this canine tooth root exposure as is evident in the picture clearly indicates that while brushing unconsciously more pressure or harsh brushing is done at this corner of the mouth so if this is the case try breaking down your habit this will prevent gum from going down further at this stage extraction is not recommended take brufen 400 my twice a day for three days this will cover the inflammatory condition at the gum line of this sensitive tooth now get slight scaling done of this area and get neck filling done again this will save the tooth do not brush this area as it is very sensitive oral gel revomet plus metronidazole and chlorhexidine gel can help with swollen gums put at the affected part thrice a day for five days do all these recommended things and please give me followup after five days I hope this helps acidic oh of mouth due to stomach problem and hard brushing habit it would be very helpful if a pa ray is done of lower right canine filling act root canal treatment filling and scaling medications plus scaling followed by filling I need follow up right after five days"
    },
    {
        "instruction": "hello doctor I am in 24th day post possible hiv exposure it was a broken condom with a sex worker on day I started experiencing pain in my legs which has continued until this day I have also gone through a period of intense stomach gurgling and shoulder and neck pain I have monitored my temperature and have been normal until yesterday on day 23 where I woke up to 100 degree temperature that lasted all day last night I experienced bed sweats I did an hiv ran tea test by labcorp at day and 16 both are negative can I have comfort in the results of these tests as being negative I plan to retest but I am getting conflicting answers on the timing and accuracy of this test the most recent consultation said these tests were the best out there and I can rely on the results I have your professional opinion is much appreciated",
        "input": "",
        "output": "hi the test which you underwent on day and 16 was definitely the best available test for that duration and you can surely rely upon the results this test is highly sensitive for this duration to catch the infection if there had been any exposure as far as the timing of this test is concerned it is conclusive as early as 14 days post infection unlike the other tests this will always give a positive result as long as there is hiv in someone is blood also if there had been an hiv infection hiv antibodies must be present in the person blood studies have shown that the majority of the hiv antibodies develop in two to eight weeks period if there had been any exposure to hiv furthermore I suggest you to undergo an hiv antibody test also and at this time you can undertake fourth generation hiv rapid test this is again a highly sensitive and specific test and gives accurate result if the same is negative then you repeat the rapid hiv antibody test at three months I hope this helps"
    },
    {
        "instruction": "hello doctor I found in my test report with high mentioned below bilirubin total 4 my do triglycerides 251 my do 150 lil cholesterol 108 my do 100 vldl cholesterol 50 my do 40 cholesterol hel ratio 28 5 fasting blood sugar hexokinase 126 my do 70 100 mchc mean corpuscular hemoglobin concentration 34 g 31 34 monocytes 5 2 0 thousand 2 10 please let me know is there any problem",
        "input": "",
        "output": "hello abnormal reports are one is lipid profile you are having hyperlipidemia and secondly blood sugars which are just in a diabetic range bold figures are not necessarily abnormal and slight variation is acceptable get one egg electrocardiography done as well you should have a healthy lifestyle like avoiding fatty oily and high calorie diet have a low salt diet and monitor blood pressure regularly and should not be persistently more than 140 90 mhg take lots of green leafy vegetables fruits fish once or twice a week and avoid meat avoid smoking and alcohol if any there should not abdominal fat deposition or obesity also you should be started on lipid medicine like tablet rosuvastatin 10 my at bedtime repeat the lipid profile after eight weeks for sugars I think we should try vigorous lifestyle changes which includes strict avoidance of sweets regular exercises like brisk walking jogging according to your capacity at least 30 minutes a day and five days a week and above mentioned changes repeat fasting and postprandial blood sugar after two weeks and also get hba1c glycated hemoglobin done if they are still in the diabetic range then you need to take medicine like metformin I hope this helps"
    },
    {
        "instruction": "hello doctor I was chewing tobacco for the past few years and I stopped it forever but sometimes I have a little throbbing on my gums and the color of my gums changed to black is this any serious disease",
        "input": "",
        "output": "hello it is good that you stopped chewing tobacco for how many years you had a habit of tobacco chewing and what was the frequency at what site you used to keep the tobacco does the change of color of your gums is limited or it is generalized do you have any burning sensation over that site any loss of taste above all counter questions are necessary to rule out possibilities so kindly answer so that we can come to the diagnosis and can plan treatment I would like to see the images of your concern area that is your gums where you are noticing the change"
    },
    {
        "instruction": "hi doctor I am a 52 year old man my height is 2 and I weigh about 215 labs I work out three times a week I am typically healthy although under a lot of stress in general I drink more alcohol than I should approximately three glasses of wine each night I stay away from food and drinks with sugar other than wine typically my family doctor is english speaking and my urologist is spanish speaking six months ago I noticed that I was urinating more often and when I had to go I felt an urgency to go previously I was told that I had a somewhat enlarged prostate at about centimeters and figured that may have been it or infection and thought that would pass I recently went to my family doctor and he recommended that I get an ultrasound for the prostate the radiology stated the below prostate was well visualized and is enlarged measuring 7 7 4 centimeters there is a nodule that is pressing into the bladder that measures 9 1 4 centimeters this nodule does not have blood flow within as visualized by ultrasound my family doctor then sent me to a urologist I showed him my lab results and he pointed out my spa level of 54 he also pointed out my urine test which said specific gravity 015 hidden blood traces leukocyte esterase oh 0 I can upload that and the blood test I will upload the tests but they are in spanish but the technical words are the same he also did a rectal exam with his finger he told me that he thinks that I almost definitely do not have cancer and I have prostatitis he prescribed levofloxacin 500 my once daily for one month meloxicam 15 my once daily for 14 days doxazosin my taken every night once daily for two weeks I am basically healthy other than having some short term memory problems and stress that may be from having a b12 level of 185 which I discovered two weeks ago and have taken two complex shots for that so far after reading the side effects of these prescribed drugs that scared the crap out of me I do not want to have some reaction and lose my good health are these the drugs you would prescribe what are your thoughts he told me no alcohol coffee or carbonated drinks while taking the medicines that I can do please suggest",
        "input": "",
        "output": "hello I have seen all your reports I think you are in good shape except for the urine problem yes your urologist has diagnosed you properly there is no evidence of cancer prostate at present it looks like prostatitis only what you need is antibiotics course for one month levofloxacin is the best antibiotic for prostatitis as prescribed by your doctor meloxicam is for inflammation and doxazocin is to relax your prostate muscles all of these medicines have side effects but they are very rare we prescribe these medicines regularly and no one had any major side effects so go ahead and finish your medicines course you will be alright"
    },
    {
        "instruction": "hello doctor I am having slight fever at evening time severe body pain eye burn restless feeling head feels heavy and heavy stomach I am a diabetic on glyearee my jardiance 25 and rozavel please advice suitable medicine",
        "input": "",
        "output": "hello it is probably a viral infection along with gastritis I assume there is no burning while urinating this is to rule out urinary tract infection at this moment you just have tablet doll 650 my whenever needed up to three times a day also if it does not respond in two days then you should start on capsule augmenting duo go amoxicillin and clavulanic acid two times a day for five days and also better to get complete hemogram and urine routine examination done you should avoid fatty oily and spicy diet you should get prescribed tablet pan der 40 my pantoprazole or esomeprazole and domperidone combination before breakfast once a day for a week for immediate stomach heaviness relief you can have antispasmodic like tablet dicyclomine 20 or hyoscyamine 10 my whenever needed up to three times a day I hope this helps"
    },
    {
        "instruction": "hello doctor after two weeks of lap I had mild cramps and non stop light vaginal bleeding it lasted for three days I experienced non stop light vaginal bleeding once again after this month periods this morning I started to have light bleeding again given my concerns I had bloodwork this week my blood counts are normal my thyearoid hormones and pituitary gland levels are all normal and I am not on birth control however my urinalysis revealed that my erythrocyte is 25 my leukocyte esterase is 3 my and my egfr is plus my ferritin is 10 initially my doctor believed my abnormal bleeding between my periods was due to a hormone imbalance but we now know that it is obviously not the case can this be due to gynecological cancers I am only 32 I am healthy I am not on birth control I am not pregnant I am not on hormones and the possibility of having cancer makes no sense to me I would appreciate talking to someone because I am terrified",
        "input": "",
        "output": "hi overall looks like normal there is no ultrasound scan which is required if you having irregular bleeding secondly there are 100s of hormones producing and out of which we can do tests of few only so cannot say by 100 that it is not hormonal issue irregular menses can be due to other reasons also like starvation environmental factors stress eating habit there are some food nutrients which may have effects like hormones or may acts against hormones do one ultrasound scan and may require dilatation and curattage and send endometrium to rule out endometrial cancer do drink more water"
    },
    {
        "instruction": "hi doctor my dad recently had chest pain we took ekg and echo and it turned out as though he had a slight abnormality we got the angio done the reports shows lad type I lad has 50 proximal stenosis mid and distal has a mild diffuse disease ri has 80 proximal stenosis lex non dominant lex is normal ca dominant ca has 80 proximal stenosis mid segment has diffuse disease distal segment has tandem 80 or 90 stenosis pda has 60 mild segment stenosis diagnosis coronary artery disease right dominant system severe ca disease recommendation pi to ca I would like to know how many stents are needed on the right and what changes need to be done in the lifestyle his bad cholesterol 60 good cholesterol normal be with vitamin b12 and deficiency",
        "input": "",
        "output": "hello I passed carefully through your dad medical history and tests and would like to explain that it is necessary to perform percutaneous coronary angioplasty followed by stents implantation in the right coronary artery in several segments 80 proximal stenosis but also in the distal segment where there are consecutive stenosis 80 90 so at least two to three stents will be most likely necessary to properly treat his ca right coronary artery on the other side life style modification would be necessary to stop the progression of atherosclerosis in several parts of the coronary arteries tree first vitamin b12 and vitamin deficiencies should be properly corrected then a balanced diet with low saturated fat animal fat and rich in green vegetables should be encouraged he should refrain from every smoking contact and periodically check his blood lipid profile and blood pressure values after tenting special antithrombotic drugs are prescribed as well I hope this helps"
    },
    {
        "instruction": "hello doctor I have fluid retention and high blood pressure which caused me multiple strokes and tias my plasma rein activity is 12 and my aldosterone to rein ratio is 3 which qualifies clinically as primary hyperaldosteronism my aldosterone la is my potassium level 0 it scan of my abdomen did not show my adrenal glands how likely is it that I have primary hyperaldosteronism I am currently taking creator 20 my amlodipine 10 my and aspirin 325 my",
        "input": "",
        "output": "hello welcome to icliniq com I just read your query and from what you have mentioned it appears that you do have primary hyperaldosteronism and it is a very high likelihood for it to be a possibility based on your results you can try mri magnetic resonance imaging scan for proper visualization of your abdomen I hope this helps"
    },
    {
        "instruction": "hello doctor I am 49 years old I am a non smoker my father was a chain smoker and I lived with him for 19 years before four months I developed a mild case of pneumonia as a part of this I developed a wheeze on my lower right lung since that time I have had varying degrees of mild to moderate wheezing intermittently tied to a feeling of chest congestion as well it seems to get worse whenever I catch any sort of respiratory cold allergies post nasal drip etc I went to a doctor last month and rays showed nothing breath volume test was somewhat inconclusive the doctor prescribed flonase to minimize any post nasal drip which does help for allergies but not when I catch colds I am having a slight head cold right now and my lung issue is already flaring up again I am really at a loss as to what this is or what to do next to get relief any advice you could offer would be appreciated",
        "input": "",
        "output": "hello can you tell me how often do these symptoms come do you have any cough sputum production shortness of breath chest pain do you have palpitations do you have a fever how long do the symptoms last are these persistent and are there any exacerbating factors what is the severity of these symptoms"
    },
    {
        "instruction": "hi doctor I am years old for the past year and a half I have taken supplements containing some phytoestrogens I have also taken the birth control pill my throat has been feeling dry and sometimes I feel this burning sensation in one of my ears interchangeably sometimes my eyes feel dry when I try to come off birth control I just bleed continuously so I just keep going back on the pills I believe this combination has left my hormones unbalanced and causing me to have headaches low energy and low concentration whilst I can ignore most of the symptoms the dry feeling in my throat that affects one side of my throat at a time along with sensation in my ear at the same side makes me wonder if there is anything wrong with my thyearoid or if I have an sti that is not normally tested for at sexual health center",
        "input": "",
        "output": "hello welcome to icliniq com I just read your query and from what you described it appears that you have withdrawal bleeding which usually takes place when you discontinue hormones it takes sometime but it does stop in a week or so if not then you need to see a doctor for stopping your bleeding as for the symptoms you mentioned regarding your throat and ear it does not seem like it is from the thyearoid gland although it does look like a respiratory tract infection if you are worried about sti sexually transmitted infection then you can just have your throat swab test done to know what sort of infection you have also have your complete blood count done to know if you have low hemoglobin to check why you have low energy and concentration levels I hope this helps"
    },
    {
        "instruction": "hi doctor last month a doctor with hiv gave an injection in my vein without using gloves she did not use any cotton she just put her finger to stop the bleeding she also rubbed my vein with her hands when it was still bleeding am I at risk I did hiv dna per after days and after one month fourth generation elisa test one of the doctor told me that the window period is 90 180 days what test should be done after six months",
        "input": "",
        "output": "hi let me answer your query step by step there was no risk of hiv involved by the injection given by hiv infected doctor surgeon even if she touched with her finger at the bleeding site with the naked hand you were not at risk hiv cannot be transmitted by touching hiv infected person your risk was unwarranted in the scenario you mentioned the test which you took was highly sensitive and specific and gives accurate results window period is the time taken for antibodies to develop after infection and then to be detected by a particular test 9 of the people who are infected with hiv develop hiv antibodies by three months it is good that you know your hiv status now you do not require any further test I hope this helps"
    },
    {
        "instruction": "hi doctor my last exposure was protected but I am not sure about whether the vaginal fluid touched or not since I was drunk that time after that I went to an hiv specialist and he suggested me hiv dna per test at days period the result is hiv not detected then at 83 days tridot rapid test is negative day tridot rapid test negative 93 day tridot non reactive day tridot immuno filtration antibodies and nonreactive then I took hbsag hav vid total all are non reactive is it enough for hiv testing is dna per at days in window period useful is tridot test useful or not in the window period time I used fever tablets antibiotics and levocetirizine many days will it affect my window period please give me brief information I have a family and a child can I have sex with my wife without protection next test needed or not",
        "input": "",
        "output": "hi welcome to icliniq com it is great that you have been found negative for hiv and other sits sexually transmitted infection all the tests which you had taken for hiv were highly sensitive and specific and gives accurate results it is unlikely for antibiotics and other medications which you had taken for fever could affect the result window period is the time taken for antibodies to develop after infection and then get detected by a particular test the length of the window period varies between individuals there are recommendations and I also suggest my patients to repeat the test at six months of last exposure testing at three and six months of possible exposure can detect almost all hiv infections you can take precautions consistently and correctively using a condom with your wife until the time you are undergoing tests I hope this helps"
    },
    {
        "instruction": "hello doctor I was diagnosed with anemia last month my serum iron level was 12 I was put on ferrous sulfate 325 my twice a day my doctor suspected a gi bleed because I have acid reflux that is under control with medications but I wanted to try supplements first I am not having any crazy gi symptoms though they said to try the iron for a month and then go back for another test I just went for a blood test last week and my serum level came back at 102 I am feeling much better and yesterday I had a follow up appointment at which my doctor said to stop taking the iron supplements and to retest in three months that seems like a long time to stop taking iron supplements after having only taken them for one month I also wonder about the validity of the recent test because I am now reading that supplements can falsely elevate your actual iron level I was not told to stop taking the supplements before the test was the iron serum blood test accurate if I did not stop taking iron for a short period beforehand also is it safe to stop taking iron for three months I am currently taking omeprazole prozac and klopin",
        "input": "",
        "output": "hello yes the test is still valid the results would show the effect of increased iron intake for the past weeks that you have been taking it and a few days of not taking it will not have much effect not taking it for three months is still fine I believe your doctor has already concluded that you do not have gi bleed as of now so most likely your body can replenish the iron through diet without any need for supplements but if you have symptoms of dizziness fatigue and lightheadedness seek further consult with your doctor in the meantime I recommend stick with a high iron diet such as meat and green leafy vegetables I also recommend you take food and drinks high in vitamin to better absorb the iron in the gut is there anything else I can help you with"
    },
    {
        "instruction": "hi doctor my sister has cerebral palsy with grand mal seizures she is 28 years and weighs about 25 keg today she had a seizure attack for about times that would last for almost a minute per attack our neurologists are out of town so we just needed an opinion on the following interventions we did in the morning we gave her lioresal 10 my tegretol 200 my and rivotril my in the afternoon diazepam valium 5 my whether we should add more for tonight she still had two minor seizures for a few seconds she was not able to sleep overnight last night until today",
        "input": "",
        "output": "hello I would recommend taking tegretol 200 my carbamazepine three times daily and clonazepam my two times daily in case of repeated seizures diazepam should be administered 5 my during each seizure if seizures become frequent despite therapy I would recommend bringing her to the er because the situation may become life threatening I hope this helps"
    },
    {
        "instruction": "hi doctor I recently had a graft on my nasal septum due to a large ulceration on the left wall if it tissue was taken from one of my turbinates and stitched onto my septum but I know that I have a splint sutured into my nose this is the problem they whistle when I breathe and one of the stitches hangs free and blocks the air passage of the left splint I do not know how to ask them to get it removed I positively cannot stand the whistling it prevents me from sleeping and distracts me in school please help",
        "input": "",
        "output": "hello with the details you have given I understand a graft taken from nasal turbinate has been placed onto nasal septum to cover ulceration also post operatively to prevent bleeding and to keep the graft over the desired area a splint has been placed for further doubts consult an ent otolaryngologist online"
    },
    {
        "instruction": "hi doctor I am concerned about my upcoming surgery during past surgery I woke up and then went into a mild coma after being given more anesthesia how likely is this kind of complication how can it be avoided",
        "input": "",
        "output": "hello revert back with a detailed history to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor my nephew has been unwell since few days since two weeks he has small blood patches on thigh calves and ankles petechial rash and bruising are also present the doctors have diagnosed him with it idiopathic thrombocytopenic pura I am writing to you to get a second opinion he has been prescribed prednisone 10 my three times a day I have attached his blood profile for your reference please help us",
        "input": "",
        "output": "hi for further information consult a general medicine physician online"
    },
    {
        "instruction": "hello doctor I have a 14 day old baby girl she is exclusively breast fed and has been known to spit up quite a bit after every feeding but her pediatrician said it may just be my milk flow is too fast and she is swallowing a lot of air her stools are usually orange with stringy bits in it but this morning her stool was green and very watery I thought it could be because I took emergen yesterday she has been very fussy all day urinating normally but not passing stools as much and when she does it is green and very dry after feeding her she was laying down on me and she projectile vomited a large amount of milk I took her temperature rectally and she does not have a fever it is at 97 I am worried she has a stomach bug please help",
        "input": "",
        "output": "hello welcome to icliniq com according to me hold the baby in one arm keeping his head at the elbow joint and the buttocks in the palm of the same arm and feed the baby for 15 to 20 minutes hold the outer palm of the baby in between the thumb and index finger and press the palm whenever the baby sleeps or stop feeding after feeding put the baby on the left shoulder and pat just behind the stomach level for five minutes to burp baby usually burps within three to five times after burping lay down the baby on the right side of the baby putting a pillow below head maintaining the head above the level of stomach"
    },
    {
        "instruction": "hi doctor I get in a depressive phase for a while and I cannot seem to get out of it and then I feel completely fine like nothing happened so I did not tend to take any actions but it is recently been affecting my personal and work life I tend to not feel like myself currently I am on lame 25 zapil and zotral my doctor just prescribed these medications when I told him about my anxiety issues and extreme mood swings I am still unaware of the diagnosis as it is still affecting my day to day life",
        "input": "",
        "output": "hello what are your symptoms exactly if they are of depression then the treatment with sari selective serotonin reuptake inhibitors is ideally given for six months or so the lame 25 lamotrigine is just a mood stabilizer if the psychiatrist is suspecting bipolar disorder zapiz is a benzodiazepine and I would not advise you to take it for longer periods basically if you are depressed you will feel irritable low feel like crying sad do not wish to eat have difficulty sleep 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 episodes of 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 probably you might suffer from a major depressive disorder or generalized anxiety disorder"
    },
    {
        "instruction": "hello doctor I had unprotected sex on est of last month and missed my period on 20th I did a urine pregnancy test on ord of this month it came negative and then I took regestrone 10 my for five days one tablet each day from ord to ith then on ith I did a bhcg which came negative and today I got a slight spotting and when wiping a little brownish kind of discharge came am I pregnant",
        "input": "",
        "output": "hello no you are not pregnant as urine pregnancy test and hug human chorionic gonadotropin test are negative you have taken regesterone so your period is delayed more your period should start now it normally takes two to seven days after the last regesterone tablet so do not worry you are not pregnant because it is already more than 30 days after unprotected sex and all tests are negative brownish discharge can be the starting of menses you are definitely not pregnant do not take much stress"
    },
    {
        "instruction": "hello doctor I have had permanent cramps and a constant ache in both buttocks I have pain down the back of the legs in the calf and when I walk it feels like it is about to cramp and I get pain in front of the thigh I have a constant aching feel when I press my skin on both thighs it feels sore I had it for over two months I have pain on both sides of my thighs and legs regardless of if I am sitting or resting I got admitted to the hospital for two weeks and they did an mri scan on my spine and found nothing they did a lumbar puncture and found nothing they also did a nerve examination and nothing was found I am currently on gabapentin codeine and paracetamol",
        "input": "",
        "output": "hi it looks like a nerve compression to me if all investigations are normal it does not mean it cannot be nerve compression it could be meralgia paresthesia or neuralgia I would recommend you to take vitamin b12 shots also discuss with your doctor to prescribe you a combination of pregabalin along with nortryptilline in the night this may take a few weeks to months to recover I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 40 year old male I weigh about 79 keg and my height is 1 my be is 130 78 and pulse rate is 90 bum I have no diabetes and I am a non smoker and non alcoholic I am a software engineer I am having neck and back pain issues for the past 10 years particularly more severe neck pain for the last one week as my neck is hurting and pain is radiating into my head and shoulders etc till now there is no pain in my hands or fingers my job is computer programming so I have to focus hours on the screen this is one of the main reasons behind it as I never had any vehicle or sports accident now more terrible thing is that I have started vertigo spinning in head while lying down and move my head towards the left side because of this vertigo fear I kept laying straight on my back full night I can cope with the pain but vertigo spinning of my head is putting me under stress and depression as it could affect my daily life too I have taken thousands of medicines in the last ten years currently my doctor advised me some medicines which I am using since four days I take zenorit 8mg azithromycin lavistina 16 my betahistine dihydrochloride paragon chlorzoxazone 250 my and paracetamol 300 my and neurobion forte well my first question is what is the main reason for having vertigo spinning head while lying down and tilt the head on the left side my doctor has diagnosed that my ear is having balancing issue is that true however I guess any of my cervical disc pinches some nerve or artery while I lay down and turn my head as you can see from the mri report that almost all of my discs are having issues moreover regularly I do a light massage with deep heat cream and then keep a hot water bottle on my neck back for some time earlier I had some physiotherapy sessions as well for pain management however there is no chiropractor available in our city I will be greatly thankful to you if you could at least diagnose the root cause of this vertigo which comes up while lying down and turn head to the left side once the vertigo is subsided we can start working on pain management please note that I feel quite relax and less pain while I walk or even stand up however having full of pain while sitting and had neck pain and vertigo in the bed",
        "input": "",
        "output": "hello I read your history and reviewed your total spinal mri do not be nervous vertigo that you are experiencing is not related to your discopathy you have disc bulging in the cervical spine c5 ca and ca c7 at least one mild disc bulging in the thoracic spine and two more disc problems in the lumbar area especially in la s1 that is complicated by spondylolisthesis I spinal body sliding nevertheless as I said none of them is related to vertigo your vertigo is a benign paroxysmal peripheral vertigo bppv that is caused due to a benign problem in one of your horizontal semicircular canal in the inner ear in simple words one of your sensors which reports the brain any horizontal rotation of the head suffers from a temporary problem and gives exaggerated data to the brain I agree with the prescribed medicine except the antibiotic azithromycin that seems unnecessary if you do not have a fever or ear pain the key treatment is not medicine please accept my advice and do not avoid the head movement that triggers your vertigo in contrast repeat it more and more in every try you will notice that the severity of vertigo will lessen it is similar to seasickness by repeating the movement and sending exaggerated data by your ear your brain habits the situation and will neglect the bad data and you will improve if this strategy does not work after five days in combination medicines then you will need to be treated by a maneuver that is called gufoni maneuver it should be done by a trained neurologist or ent specialist I hope this helps"
    },
    {
        "instruction": "hi doctor I have a history of ear problems seven surgeries as of right now I had tubes placed in both ears when I was younger and more recent before few years after the tubes were removed both ear drums were left with holes in them which have been closed with surgery in the left ear there was only one tympanoplasty done as for the right ear there was a fat plug done and failed next there was a tympanoplasty which also failed finally a neurotologist preformed another tympanoplasty with cartilage back up and it has taken within the last three months I have had fluid in the left ear twice and prednisone has been used once I was flying and caused barotrauma from being sick and flying the other was just fluid sitting there which is still there after 12 days of prednisone also I have been told to take amoxicillin three times the last three months only I did it with the barotrauma as there was blood sitting behind the ear now I have got three different opinions from ent doctors and still I am confused as to what to try the normal ent that has done all but the last surgery where he made me go elsewhere because he was not comfortable trying again and said the hearing in my right ear has gotten worse from the last hearing test I do not have a copy of the most recent hearing test he wants to put a hole in the right ear the neurotologist was for putting a tube in the right after surgery as there was fluid behind the ear drum but he has left the country so my choices are limited to go back to him I have been traveling back and forth 12 hours each way for the last few months and driving after the barotrauma is getting pain in the left ear now the second doctor opinion he said that he would not recommend tubes as both ear drums are intact he recommended for an allergy test if it helps at all I have been using flonase as well continuously all three doctors said to do it the third doctor told me he would leave the right ear alone and recommended a tube in my left ear with my travel schedule he basically said I need to determine if I want to live with holes or leave them intact and have pain when it comes on also I have been diagnosed with taj after the first tube surgery which I think that lead to the pain that made me go through with the tubes in the first place I have had treatment for that I hit all the limits I could with my dentist and am now having a day time splint made all the problems in the left ear have started since three months back I was placed on prozac by a doctor which is known for making clenching worse I have done the botox in the masseter for taj which has helped in the past and we did 25 units this time last time was 15 units overall I am wondering if it is in my best interest to try and pull off the prozac with the doctor permission or just getting tubes in both ears and not doing any more reconstructive surgery",
        "input": "",
        "output": "hello thanks for the detailed history I can understand that you have gone through a lot because of your repeated ear issues very clearly none of the conditions you have either fluid in middle ear or hole in the eardrum are painful conditions surgery for these conditions is done mainly to improve hearing repeated collection of fluid in the middle ear can occur due to various reasons such as eustachian tube dysfunction adenoids allergy etc the most common being eustachian tube dysfunction now coming to the treatment of your condition you can continue flonase nasal spray for a few months and see if there is any improvement in fluid in the middle ear if that is not working then the next option would be to undergo balloon dilatation of eustachian tubes which may work sometimes last option would be the insertion of grommet again but an operated ear grommet can cause permanent perforation and you have to live with it all your life as far as pain is concerned it is probably due to taj dysfunction as you said prozac worsens bruxism and you may need to stop it with your symptoms or doctor consent these chronic conditions such as eustachian tube dysfunction are difficult to treat and eustachian tube balloon dilatation may be a good choice for you as you are a frequent flyer"
    },
    {
        "instruction": "hello doctor I had some composite fillings placed on the front surfaces of several teeth last year at the top of the tooth near the gum line where denting had been exposed due to wearing away of the enamel several of the fillings have fallen out they were not worn down by brushing but actually they are detached as a whole from the tooth I was shocked that they had lasted less than a year because online searches indicate they should last for five to seven years under normal circumstances how long should composite fillings last",
        "input": "",
        "output": "hello I went through your images usually composite restoration lasts for four to five years composite filling is not as strong as amalgam fillings moreover it has to be taken care of more than amalgam fillings precautions to be taken for successful composite filling should be followed to last it longer most of it are the job of the dentist who is performing procedure but there are few things that should be followed by patients also avoid taking or biting hard food or candies with those teeth if there is any microfractures line of the tooth because of any hard substance bitting or trauma then it is harmful to the composite filling if any trauma or impact to filling then composite filling will not last long if you having any habit of nail biting then it is not good for filling if you have a habit of bruxism or night grinding then it is aggravating factor for fracture of restoration you should avoid tea coffee or hard drinks consumption too frequently because it will lose its property and color apart from these things there is natural shedding or wearing of composite layer like natural teeth wears as the time passes yes your dentist is right if there is a fault in preparation of restoration or while doing composite feeling then it would have gone within few weeks so for permanent solution you can go for root canal with zirconia crown if zirconia is costly then you can ask for other options for crown to your dentist which are available to them I hope this helps"
    },
    {
        "instruction": "hi doctor I have a seven and half year old son he has metabolic genetic illnesses mcadd and not able to break down fats to produce energy so has to eat carbohydrates and drink on time to maintain his blood sugar levels as well he has chylomicron retention disease which is not being able to absorb fat and so he needs soluble vitamins such as vitamin and he needs a special low fat diet he also has developmental delays in all areas at that time I thought it was normal because his illness was not found out until he was nearly years old and had been failing to thrive before that he was under malnutrition I also have two other boys who also have developmental delay but not as severe as how my oldest one was consultant are saying now that maybe some genetic issues must be going on and put us all in the 100 genomes study research hoping to find some answers for the abnormal blood result of my seven and a half year old his ok levels have been persistently elevated his last reading was 155 ast to 70 units per liter and alt to 71 units per liter they are still investigating and hoping to find some answers his other blood were normal for thyearoid function glucose and lactate ammonia in plasma uric acid in plasma and renal functions all were fine due to persistent ok levels it is pointing more towards a myopathy I am very confused and yes he has been showing certain signs like he cannot walk too much with feet pain and on and off finger pains it seems to me that he is not a strong child for his age but seems fine other than that",
        "input": "",
        "output": "hi this seems to be more of a genetic disorder unfortunately the genome sequence of your family needs to be done in order to find the fault however this is only from a diagnostic point of view it is not going to change the medical treatment for the children also the diet and supplements that you are giving for your child are to the best of my knowledge please continue the same unfortunately for developmental delay not much can be done you can try physiotherapy for the same along with all the other efforts that you are taking also please follow up urgently with your nearest hospital in the event of any abnormal behavior or convulsions in any of your children as I have not physically examined the child take care"
    },
    {
        "instruction": "hello doctor my wife is 25 years old her right eye has been detected of idiopathic cnvm she had an oct test already she has been asked to take three injections of accentrix with a gap of one month in between each I read various articles all refer to an injection of a drug called bevacizumab brand name avastin are accentrix and bevacizumab brand name avastin the same is this the only way of treatment will this treatment completely cure the idiopathic cnvm and my wife will have her normal vision back which would be the best place for treatment in india what is the rough cost of the complete treatment",
        "input": "",
        "output": "hello avastin and accentrix are both more or less equally efficacious in cnvm choroidal neovascular membrane the difference lies in the fact that accentrix is fda food and drug administration approved but avastin is not in case any side effect appears after injecting avastin though very rare then your treating ophthalmologist will land up in trouble and media will blame him for using avastin and he may be in soup it is irony of our nation that due to some uneducated people doctors are forced to offer costly treatment when cheap options are available this is not the only option but yes this is the best option I am sorry but the prognosis is guarded she may recover fully and gain good vision or she may not attain vision again and she may have central scotoma regarding the best place treatment is same everywhere you may get the treatment from any place of your choice regarding the treatment cost it is difficult to say she may need more than three injections also so be mentally prepared for that also I hope this helps"
    },
    {
        "instruction": "hi doctor I am a 26 year old female this might sound odd but when I was I was playing with two small round magnets pretending to have a nose piercing in the septum the magnets stuck together and went up either side of the nose clamping the septum I panicked and did not tell anyone about a week later I remember getting tweezers and pulling one out and it smelt bad and looked disgusting I do not ever remember pulling the other out but I may have because I kind of never really thought about it again until later when I seem to have issues breathing through my nose and always have recurring extremely painful sore throats and swollen tonsils this makes me panic and remember what happens and if I ever did remove the other magnet and if I did not would it cause a lot of damage being there for so long it sounds ridiculous but I do not feel comfortable telling my doctor please suggest",
        "input": "",
        "output": "hello welcome to icliniq com well firstly I would like to assure you that as doctors we come across much stranger things and hence it is important to get yourself checked whether the other magnet is still stuck in your nostrils or not the doctor might do an ray of your sinuses after he thoroughly checks you up to see if it has dislodged further up the symptoms you are experiencing are classic of an infected sinus leading to the spread of that infection to other parts of your upper respiratory tract it can be possible that the magnet is compressing one of the sinus openings leading to secondary infection and hence the symptoms please do not delay any further meet your nearest physician as soon as possible for proper examination and treatment I know you are embarrassed but it can be dangerous if this infection is not controlled and spreads to other sites"
    },
    {
        "instruction": "hello doctor I have occasional needle pin in hands and numbness mild itchy rash on nose and both upper shoulders still there and barely visible I also have slight hand tremors increased permanent floaters in both eyes I have civ egg recent infection all sad hiv hepatitis ebv and hav and are negative could civ cause all these in an immunocompetent person ophthalmologist said that my eyes are perfect after an examination neurologist did a nerve conductivity test and said all reports normal infection specialist did western blot for hiv and at 16 weeks after symptoms started and said it is negative hiv combo antibody and antigen also negative if it is civ what is the treatment",
        "input": "",
        "output": "hi welcome to icliniq com answer to your queries are civ egg positivity indicates past infection the exposure to civ cytomegalovirus might have been there some weeks to years earlier civ is common in general infection and up to 60 are egg positive sero positivity percentage increases with age treatment for civ is not given based on civ egg positivity I suggest you to get following to rule out active civ infection p65 antigen elisa civ i'm civ quantitative test repeat your civ egg titers at least after six weeks of the above tests I suggest you to do thyearoid profile serum vitamin b12 and do tests you can send pictures of your rashes for further assessment I hope this helps"
    },
    {
        "instruction": "hello doctor my friend undergoes frequent delusions and nightmares about some men raping her she is 20 years old now when she was around 10 years old she went to a wedding ceremony she made friends with a boy much older than her he took her to someplace on the very same day telling her something nice and all then she saw four to five boys standing outside a dark construction site she fainted then and after that she only remembers waking up she says that all these are coming back now because she is curious about what happened to her that night her delusions and nightmares were triggered by a rape scene she was seeing in a daily soap recently which made her remember the incident what is worse is that if she gets to know what happened that night and if it is really something that bad she might commit suicide or hurt herself recently while I was at her place talking about these problems suddenly she felt dizzy and sat down and then she stared intently at the entrance for at least five minutes if not ten after which again she was normal but she does not know any part of the time when she was looking at the door and thinking something I am very much worried about her please I need some advice about what can I do about and how can I help her she is in so much of pain please help",
        "input": "",
        "output": "hi it appears more of an anxiety spectrum disorder rather than an actual delusion which antianxiety drug was started on her and what was the response she might respond to a small dose of escitalopram 10 my at morning and 25 my clonazepam at night if there are severe nightmares there is also an option of prazosin my at night you could meet a local psychiatrist for these I would recommend you to not actively talk about the rape thing to her or do any online therapy since it can make her focus too much on the topic try to distract her and keep her engaged yoga and muscle relaxation exercises can help if there is a clinical psychologist near your area she can be started on a cognitive behavior therapy but again I would recommend the above options before trying it out"
    },
    {
        "instruction": "hello doctor I would like an opinion regarding surgery for acalculous biliary dyskinesia I have had run pain and colic attacks for the past three or four years ultrasounds at the time showed no symptoms then I had a hide scan that showed 12 ejection fraction so the doctor suggested surgery to remove the gallbladder even without stones or anything I declined I modified my diet the attacks became more sporadic but last month I had an acute acalculous cholecystitis event an ultrasound showed some sludge and my wall thickening again surgery was suggested and scheduled but symptoms resolved within a week and I am completely asymptomatic now I am really scared of having unnecessary surgery if I have no stones what is the worst that can happen if I just decline surgery I am afraid of having ongoing new indigestion symptoms post surgery I do not want new problems I am really afraid",
        "input": "",
        "output": "hi since you had go sludge with multiple attacks of biliary colic the chances of getting a repeat attack are very high sludge or microlithiasis denote a dysfunctional gall bladder it is always better to remove a dysfunctional gall bladder as it has a high probability of stone formation all attacks need not be mild as you had at times severe attacks may happen which need emergency surgery there can be infectious episodes too the next severe complication happens from secondary pancreatitis this microlithiasis are not easily picked up on ultrasound scans so if you see the risks of retaining gallbladder and the advantages of surgery the advantages overweight the risks I would definitely recommend a planned surgery before developing complications and ending up with an infection and unplanned surgery I hope this helps"
    },
    {
        "instruction": "hello doctor I am 29 years old one year back I had a miscarriage now I am not pregnant and not feeding but when I press my nipples white and some times clear secretions are coming I do not have any pain and I am having regular periods and sometimes days and sometimes days flow will be there and sudden fatigue is there is this breast cancer or any problem can you prefer any test",
        "input": "",
        "output": "hi it looks like a clear case of hyperprolactinemia the hormone prolactin or ash thyearoid stimulating hormone may be raised go for serum prolactin and ash levels and further treatment will be based on the reports you may go for a breast ultrasound also just to be more careful"
    },
    {
        "instruction": "hi doctor I am a 50 year old female with a history of childhood asthma that was virtually a nonissue in my adult life until three weeks ago I had a recent saf adipose stem cell treatment for oa with a cold on board I felt tight cheated then but not bad enough to take my ventolin a few days later I developed a persistent tight chest and difficult exhalation that led to a respiratory admission for asthma or reactive airways in spite of prednisolone seretide ventolin and atrovent I do not feel better I am unable to work and doing very minimal things around the house because of the severity of the symptoms my mother had cold I am frightened this is cold and I am terrified actually I am also scared that maybe the stem cells have caused an adverse lung reaction I cannot continue to live like this I have had a normal ctpa normal cxr normal echo no growth in my sputum and apparently a normal looking lung function test that might be indicative of asthma different people tell me different things please help",
        "input": "",
        "output": "hello I have gone through your symptoms and investigations thoroughly and your treatment records first of all it is not a cold chronic obstructive pulmonary disease and asthma as suggested by normal pulmonary function tests and normal chest ray it is also very unlikely due to stem cell reaction as chest ray is normal I have reasons to suspect that symptoms are not due to lungs rather due to heart the condition is known as cardiac asthma I want to know one thing do you have swollen leg on both sides and are you on any antihypertensive agent congestive heart failure egg echocardiography atypical lung infection cardiac asthma tablet aldactone 50 my spironolactone one tablet thrice a day for five days"
    },
    {
        "instruction": "hello doctor I have bipolar disorder I and diagnosed with social and generalized anxiety disorders currently my medication fails to uplift my depression I take lithium 3x450 my olanzapine my escitalopram 20 my previously I tried valproic acid carbamazepine topiramate zoloft prozac clonazepam tranxene rudotel and lexotanil I experience more depressive episodes than hypomanic and I cannot take lithium anymore due to kidney damage done what are my treatment options we are considering changing to lamictal and a small dose of wellbutrin what do you think about this",
        "input": "",
        "output": "hello welcome to icliniq com yes bipolar depression is difficult to treat and it can be persistent many people do respond to a combination of lamotrigine and quetiapine popularly called as lami quel it takes time to act but it is highly effective currently I would suggest that instead of lithium you use lamotrigine 25 my then 50 my and finally 100 my dose titration is every two to three weeks instead of olanzapine I would replace it with quetiapine 50 to 100 my for start and raise if needed based on the sedation also continue escitalopram if needed or replace it with a tea tricyclic antidepressant class of antidepressants and yes do add bupropion wellbutrin also you can consider doing a few sessions of rims repetitive transcranial magnetic stimulation if possible"
    },
    {
        "instruction": "hello doctor actually I get my periods once in 40 days for one month and within 28 days the other month it is continuing for a long time previously I had one miscarriage and vaginal infection currently I am on folinal please help",
        "input": "",
        "output": "hello periods can be irregular it can be normal when periods are irregular than there could be two problems one is difficulty in getting pregnant and second is more bleeding and the variance cyst do fish follicle stimulating hormone oh lutenizing hormone prolactin level estrogen progesterone serum ash thyearoid stimulating hormone anyone ultrasound scan all these investigations to find out anything abnormal if anything found then treatment can be given or you may require treatment if you want to conceive if everything found normal and you also do not want to conceive now then there is no need to take any treatment now do drink more water you can elaborate on other problems if you have"
    },
    {
        "instruction": "hello doctor cervix radiation treatment fears me how will it affect my sexual life attracting the opposite sex pheromones sex drive sexual stamina and my attraction for others",
        "input": "",
        "output": "hello radiation therapy leads to a lot of sexual adverse effects and poor quality of life it will lead to loss of ovarian function leading to infertility loss of sexual drive decrease stamina etc also radiation may affect the length or caliber of the vagina and decreased vaginal lubrication and elasticity and can adversely affect sexual function however some of the side effects will alleviate with time and hormonal replacement therapy for fertility preservation there are options available so overall radiation has significantly higher incidence of sexual dysfunction as compared to surgery or chemotherapy higher incidence of pelvic pain and pain during sex also there will be higher incidence of bowel dysfunction higher incidence of urinary incontinence I hope this helps"
    },
    {
        "instruction": "hi doctor I went for an hiv test at six weeks after low risk exposure and get false positive at eight weeks both fourth generation and hiv ran per are negative at and 10 weeks rapid test is negative at 12 weeks hiv ran per is negative is it conclusive my doctor told me no need for further tests",
        "input": "",
        "output": "hello welcome back to icliniq com to answer your query I want to give reference of published research that although the reported sensitivity and specificity of fourth generation tests are more than in numerous studies there are several instances of discordance between screening and confirmatory techniques liu et al aids research and therapy 2016 13 false positivity can be due to user error or cross contamination if there is ongoing some other illness eg malaria or if there is a history of blood transfusion autoimmune diseases a positive test result always needs to be routinely confirmed using a different type of test or testing kit fourth generation tests are more than 95 accurate at six weeks and this needs to be confirmed after three months with a second test if the test in your case has been performed at three months after the exposure and is giving negative results and you have not had another risk you do not have hiv your fourth generation test and ran per at and 10 weeks and further 12 weeks negative ran per suffices to rule out infection if you still have apprehension get a repeat hiv antibody test at six months of exposure no need to repeat it in between take precautions in the future consistent and correct condom usage I hope this helps"
    },
    {
        "instruction": "hello doctor I have been experiencing oral pain for quite some time now and I was wondering if tonsillitis might have effected my jaw somehow more my teeth than the jaw I see an ent tomorrow but does in the meantime saltwater gargle help reduce some swelling I am currently taking clindamycin tylenol with codeine culturelle multivitamin and vitamin do I have done a it scan and mri showed cysts",
        "input": "",
        "output": "hello warm saline gargles do help to reduce swelling and inflammation you may do it till you see your ent tomorrow meanwhile tonsillitis will not cause jaw pain however if frequent tonsillitis occurs it may cause swelling up of lymph nodes below your jaw which may be the cause of pain in your it scan report it is mentioned that you have some sinus inflammation sinus inflammation especially in the maxillary sinuses may cause pain in the face and also pressure feeling in the upper jaw probably you may be noticing that meanwhile for a better understanding of the condition I want some more details regarding the problem when and how it started does it cause difficulty in swallowing or breathing any pain while swallowing any fever any visible swelling in the neck any point of tenderness anywhere on the jaw any thick nasal discharge and running nose or nose block any decrease in sense of smell etc"
    },
    {
        "instruction": "hi doctor I am a 63 year old male I am having balanitis I am a diabetic taking the following medicines novostat ca 10 optidoz glimisave max forte two tablets daily fourth and hcqs 200 for ra factor I have no bad habits and stopped sex two years back due to health reasons upon medical advice online I took norflox 400 tablets for the past five days and had to take that for two more days I also took azithromycin go single dose a small amount of pus and blood was coming a few times with irritation and pain now after taking these medicines no more pus blood traces no swelling and cuts noticed earlier in the bulb of the penis I have some pain and irritation while pushing back the foreskin while applying the ointment now I want to ascertain through a lab test as to whether the infection has totally gone kindly suggest me regarding further course of treatment and prescribe me a lab test",
        "input": "",
        "output": "hi I have gone through your complaints I would suggest you to carry out complete blood count to rule out infection which will be reflected by increased total leukocyte count or increased neutrophils also carry out urine examination and random blood glucose to rule out urinary tract infection and also see sugar is under control otherwise it may lead to balanitis mild pain left on retraction of foreskin is due to residual inflammation that will subside within two to three days do gently retract the skin and not forcefully keep the area clean and wear loose cotton underwear"
    },
    {
        "instruction": "hello doctor I had sex with a sex worker without a condom now I am worried I have hiv or aids please help",
        "input": "",
        "output": "hi welcome to icliniq com the only way to clear the doubt after an unprotected exposure is to get tested I will suggest you to get your hiv rapid test now this will tell your baseline hiv status if it is negative get your fourth generation rapid test at four weeks of exposure if the same is negative it needs to be confirmed by a repeat hiv rapid test at three months and then at six months of exposure the test can be undertaken at any accredited lab or the government run ictc integrated counseling and testing centers center where it is done free of cost I suggest you to consistently and correctively use a condom with your partner I hope this helps"
    },
    {
        "instruction": "hello doctor my wire was poking out on one end and I attempted to put it back in place but it would not stay I wanted to let it go until I could get it fixed by my orthodontist but it was scratching the inside of my cheek so I used tweezers and removed all the rubber bands from each individual bracket and then removed the wire all of the orthodontist offices near me are closed for the weekend is it safe to wait until monday",
        "input": "",
        "output": "hello as per your description you have removed wire from all brackets and now no wire is there ideally you should not do this may hamper your treatment progress when your wire was disturbing you then you should have contacted your orthodontist atleast by telephone for reducing discomfort other things are there like use of orthodontic relief wax to reduce irritation from wire end or bracket projections or use of wet cotton pellets instead of directly removing wire as there are more 3 days that your brackets will not have wire or any force will not be there so there are chances of getting your teeth malpositioned or loss of alignment again at what stage your treatment is going on is not mentioned this step will hamper the progress now I advise you to visit orthodontist as early as possible again I would like to see images of your concern area"
    },
    {
        "instruction": "hello doctor I am struggling with dizziness due to ca being out my chiropractic sessions are not helping my chiropractor does not hold the ca itself but just my head and cracks is what he is doing wrong should not he grab the out of place bone and crack it",
        "input": "",
        "output": "hi welcome to icliniq com I have reviewed your question I am sorry you are experiencing back pain and dizziness believe it or not 80 of people will experience back pain at some point in their life I do have several questions before I can fully answer your question how do you know ca is your issue and how do you know it is out have you had any other diagnostic tests to explain your dizziness any it scans mris etc when did the dizziness start have you tried any exercises for this issue answers to these questions would be very helpful since I do not have the answers to the above questions I can only say this chiropractors are taught to examine the whole spine and evaluate the whole body symptoms and all if your chiropractor is not adjusting ca like you want him to it probably means that he is finding something else that he believes may be more of an issue for you with that being said it is ultimately your decision as to whether or not you continue to see this chiropractor without answers to the questions above and without reviewing the chiropractors notes it does not sound like he she is doing anything wrong by not grabbing the out of place bone and cracking it I would always encourage my patients to get a second opinion if they wanted I hope this helps"
    },
    {
        "instruction": "hi doctor I am suffering from kidney stones problem for the past four days I took an ultrasound scan test in the report it mentioned that tiny my calculus is seen in the upper pole of the left kidney mild hydronephrosis is noted on the left side with dilated ureter due to obstructing 5 my calculus in the lower ureter doctor prescribed me dytor aceclofenac and paracetamol drotavarine hydrochloride and mefenamic acid tablets but today again my sharp abdominal pain is seen what to do please suggest",
        "input": "",
        "output": "hi stones smaller than my are likely to pass without any intervention those that are larger than my or which cause severe pain vomiting or fever need surgical removal endoscopic in your case the stone should pass in a few days time if pain recurs you can go for admission and flush therapy intravenous fluids to flush out stone for one or two days you can stop either aceclofenac or mefenamic acid as both are pain killers take either of the two also add capsule urimax 4 my tamsulosin and dutasteride once daily for five days this may relax your ureter and help decrease the pain repeat us ultrasound after five to seven days to confirm the stone passage"
    },
    {
        "instruction": "hello doctor I have an open bite due to a tongue thrust I have had since I was a baby I am now it is affecting the way I talk eat and I sometimes find myself gasping for air when I sleep I have been looking into ways to correct it and also close my bite will corrective jaw surgery help with my tongue placement as well as close my open bite",
        "input": "",
        "output": "hello welcome to icliniq com as per your description you having open bite and tongue thrust for correction of open bite the exact cause must be ruled out tongue thrust is the cause and is also aggrevatinng factor also if corrective jaw surgery works or not or whether any skeletal jaw problem is involved can be suggested only after clinical examination if there is growth direction of maxilla or mandible is altered or there posterior vertical maxillary excess and etc is there then that have to be ruled out before planning for corrective jaw surgery option first tongue thrust should be taken care with help of habit breaking appliance and then malocclusion should be corrected with orthodontic treatment provided skeletal factor is not involved again I would like to see images of your concern area and teeth for detailed diagnosis and management of problem"
    },
    {
        "instruction": "hello doctor I have a discoloring on skin of penis why",
        "input": "",
        "output": "hello the condition you are presenting is hypopigmentation of penile skin relating to penile vitiligo its an autoimmune condition vitiligo can be present in other parts of skin or hairs also turning the color light or white it is not related to any studs but if any history of injury itching is present kindly do mention and for treatment of this hypopigmentation few ointment like tacrolimus ointment has found to be effective other than this you can also get help with light therapy both of these will decrease the spread and density of vitiligo thyearoid profile for autoimmune disorder do mention from how many days if any injury has occurred or not any prior infection"
    },
    {
        "instruction": "hi doctor I am a 29 year old female I have had ear pressure and fullness since may of last year in my left ear only I had a hearing test that showed mild hearing loss about a week ago I noticed a small lump maybe in my neck it feels hard but hurts when I push on it sometimes I do not have an ent appointment for a few weeks and I am worried I might have nasopharyngeal cancer",
        "input": "",
        "output": "hello the chances for it being nic is minimal to rule it out we need to do a nasal endoscopy what hearing loss came out in the test conductive or sensorineural did you take any antibiotic to remove the neck lump in case it is due to any infection I suggest you try a course of amoxicillin clavulanic acid appropriate for your weight so that the lump goes off if it is due to some infection if you have the report of audiometry please upload the same"
    },
    {
        "instruction": "hello doctor I am a 49 year old male 100 keg 180 am I exercise cardio regularly however carry a little extra weight I suffer from anxiety and are presently on inderal lyearica and prozac over the past weeks I have noticed my resting heart rate on my smart watch is about 48 bum traditionally it has been around 58 bum other than anxiety I do not have any symptoms what could be the causes of this and is this of concern",
        "input": "",
        "output": "hello I understand your concerns do not worry you will be fine the inderal you are taking is what is reducing your heart rate a 48 bum to 58 bum is not bad so long you are not experiencing symptoms like fainting or shortness you are fine I advise you to continue to monitor your pulse to make sure your heart rate isn't dangerously low for now it is not a cause for concern"
    },
    {
        "instruction": "hi doctor my mother aged around 60 years had depression she thinks negatively and fears what will happen next in life she does not feel hunger and if eats something then gets vomit like feeling with very less sleep we went to a doctor he prescribed some medication and she becomes better in some two months however that doctor is suggesting to continue medication even after 10 months in between when we stopped medication then the nearly same symptoms start appears again she also had eg done in the awake state using 10 20 is of electrode placement and the outcome was like alpha activity 10 he and 20 35 microvolts in amplitude arising from both the occipital areas and getting by eys opening her medications are pregsal so 75 my pregabalin so tablets clomidon 25 my clomipramine hci or zoro 25 my paroxetine hydrochloride controlled release tablet zool dsr rabeprazole sodium and domperidone sustained release capsule alzitier my and bloserv my do these medicines really need to take that long or any of these have some addictive phenomenon I request you to please share your valuable suggestion on current and future medication or course of treatment thanks a lot",
        "input": "",
        "output": "hello thanks for asking though more details are needed to make an exact diagnosis but the symptoms you mentioned suggest some underlying anxiety negative thoughts fear that what will happen lack of appetite etc could be occurring due to depression and anxiety mainly of obsessive thoughts type she is on the right drugs and if she responded with these medicines then the medicines should be continued for long once she becomes stable and is symptoms free for around six months then the drugs can be stopped by gradual dose reduction the medicines are not addictive and no need to get worried about that visit your doctor regularly and she will be better in the coming time thanks"
    },
    {
        "instruction": "hello doctor every night around 3 am any thought that crosses my mind makes me overthink about it I am worried about such things that do not have a fixed solution it may or may not happen I have tried listening to meditating sounds calming sound during that time but to no avail after an hour or two I do get normal but then I am so full of energy that I cannot fall asleep so I get up and start some work I am a freelancer working from home I usually cannot sleep until my head feels heavy eyes start closing and I start dozing off while working for a few weeks I have been sleeping in the afternoon or evening for three to five hours only rest of the time I am either thinking or working sometimes if I cannot stop thinking I smoke around two to three cigarettes to get over it does not help me sleep but helps me focus on work more and overthinking stops quite instantly",
        "input": "",
        "output": "hello your blood report is absolutely normal and I do not think there is anything alarming yes your lipid profile is deranged and if you are overweight then try to reduce weight at your age it is not common to see raised cholesterol regarding the issues you have during sleep in my opinion this is probably occurring due to anxiety you should seek a psychiatrist consultation for treatment improve your sleep hygiene and this will improve the symptoms avoid giving attention to minor things take a high protein diet and complex carbs and low in fats I hope this helps"
    },
    {
        "instruction": "hello doctor I have a lump behind my left nipple for around 10 years it is a painless and hard lump which is just behind the nipple and it seems to be round in shape and is about more than am in size it is not growing and is of fixed size I also notice skin discoloration on the breast like slight melanin patches I also notice a few minor or very small fluid lumps in the right breast area please tell me if the lump can be cancerous",
        "input": "",
        "output": "hello it looks all these lesions are benign non cancerous this small lump which is there for 10 years is certainly benign as cancerous lump grows and spreads regarding skin discoloration looking like melanin patches and fluid lumps you have not mentioned the details regarding discoloration and fluid lumps whether they are new or old whether they have increased in size as compared to the previous one or whether they have shown any change in appearance etc nothing to worry about but it is recommended to visit a mammalogist and let them examine all these breast and skin lesions if needed they will put you on close follow up or investigate further the major risk factors for developing breast cancer are family history of breast cancer obesity certain genetic syndromes any previous breast lump hormone replacement therapy history of estrogen intake early menarche or late menopause in case you have any family history of breast cancer then you must go for genetic counseling also"
    },
    {
        "instruction": "hello doctor I noticed a swollen and hard bump on the inside of my ear a few days ago yesterday I noticed it was now soft and squishy almost like a pimple but today I touched it and it popped and began to bleed along with some pus I was not too worried until I took a photo and saw two large holes like a spider bite and the area is a little tender after I cleaned it does it sound like it could be an infected spider bite",
        "input": "",
        "output": "hi it could very well be an infected spider bite it could also be an infected follicle anyway apply some antibiotic cream over it bacitracin or fusiderm or povidone iodine apply twice daily and clean the wound with warm water while bathing do not insert anything inside the ear though if there are any worrisome changes please contact us like color change of rest of pina pain tenderness swelling increased redness spreading of the redness etc you may take tylenol if there is pain oral antibiotics are not necessary if you suffer from diabetes hypertension immunosuppression or cancer we need to be careful in that case do let us know"
    },
    {
        "instruction": "hi doctor I met with an accident before a few days where I happened to have a deep cut and I got in touch with the blood of another guy recently I had a pimple on my penis shaft and when I approached a dermatologist he advised that I get tested for hiv I had a third generation test using vitro epi post five to six weeks past exposure and tested negative my doctor advised me to get a test at least after 10 weeks post exposure for confirmation I am pretty nervous regarding the same can you please advise me what are the chances of contracting hiv and do the symptoms definitely occur in every individual post hiv contraction",
        "input": "",
        "output": "hello firstly risk depends upon whether that guy has hiv or not if not then nothing to worry but considering the second possibility then some risk remains of transmission but not cent percent now if the test is negative after five to six weeks then it is unlikely for you to have hiv as majority of those who are exposed becomes positive within this period only a minority of patients develop delayed seroconversion so considering overall status I think there is no need to worry about it and you are unlikely to have hiv however get tested after a few weeks to clear out doubt and be sure so you should not worry now and get back to routine and get tested at later date I hope this helps"
    },
    {
        "instruction": "hello doctor I felt doing snowboarding days ago my shoulder hurts more and more my chiropractor gave me a prescription for an ray I have my ray but nobody to read it before next week can someone read it for me and tell me if I need to go to emergency hospital or it can wait",
        "input": "",
        "output": "hi welcome to ilciniq com I am so sorry for what happened I can certainly help you to read your ray if you are able to move you arm most probably it is not a complete fracture of course there may be incomplete fracture need to see the ray meanwhile try to stabilize your left shoulder and arm"
    },
    {
        "instruction": "hello doctor I have a torn meats and would like an opinion on a couple of pictures I took of it about its condition and if I should get medical assistance for stitches or something I have already gone to an urgent care who looked at it but it looks bigger or more open or something now I am on an antibiotic for a infection I guess that is there causing pain itchy burn and cannot wear clothing on it yet at all",
        "input": "",
        "output": "hi connect me with those images for better diagnosis and treatment"
    },
    {
        "instruction": "hello doctor kindly help me to understand my elder daughter behaviour she was born 14 years back at her childhood she was very energetic and hyperactive we had put her in pre school at 5 years and now she is in class she is 13 years old now I am finding her maturity level is far below her classmates and she hardly have any friends she is also very poor in study we are in such a condition that we only expect her to pass the examination sometimes I am feeling guilty about the fact that she is always under pressure she nowadays does go out and keep herself busy with mobile and to cartoon I have another daughter who is 5 years old and the elder one cannot get along with her sister most of the time she always tries to attract the attention by some means or other she is only growing physically but I am finding the mental growth is not at par kindly help me",
        "input": "",
        "output": "hello I am sorry to hear about your situation I can understand how difficult it might be for you what you are describing needs a physical examination as well as a mental status examination and iq testing you will have to consult a neurologist or a pediatrician you can also consult a psychiatrist and they will guide you further the doctor will require to meet your daughter and talk to her to be able to understand whether the issue is neurological or a behaviour issue if you are mentioning that her mental growth is not at par you will have to go for iq testing which are available with psychiatrists as well as pediatricians"
    },
    {
        "instruction": "hello doctor 21 years old female today I noticed some bumps on the back of my tongue and another bump I noticed at the back of my throat I have no idea how long this has been going on for as it does not cause me any pain I had my last dental check up about months ago so I know it has developed sometime after then",
        "input": "",
        "output": "hi I have seen the picture you have attached along with the complaint unfortunately the picture of your tongue swelling could not be downloaded but I saw the picture of the back of your tongue that tiny little portion right at the center and back of your tongue is called uvula and it is a part of the soft palate which is the entry to your pharyngeal tube airway I do not see any reddish coloration or swelling in it and it looks absolutely normal that is the part which gets itchy when you have sore throat even if you encounter inflammation and swelling of the uvula it is mostly due to sore throat or simply dry mouth in that case drink more fluids sugarless to keep yourself hydrated and you will be relieved soon otherwise there is no abnormal findings I could see and you are completely alright thanks and regards"
    },
    {
        "instruction": "hello doctor I have a lump near my vaginal entrance I researched and it may be a bartholin cyst it is not painful nor uncomfortable to do my daily activities can the lump go away on its own without treatment what can I do to remove it is there anything I can do to avoid going into a gynecologist personally I really wish I would not have to go to a doctor personally",
        "input": "",
        "output": "hi thanks for the query according to your description the lump you mentioned could be bartholin cyst as you are thinking usually it occurs due to the blockage of bartholin duct small cyst may not cause any problem but when a size increases or the cyst gets infected that can lead to formation of abscess in that case you may experience pain and discomfort as per as possible better to get examined by your gynecologist to find out the actual nature of the cyst sometimes antibiotics are sufficient to decrease the size of the cyst if it gets infected and increases in size you may need to go for minor surgical procedures like incision and drainage or marsupialization if you want relief now before going to your doctor you can take sit bath with lukewarm water and 10 to 15 my of betadine solution twice a day with 10 minutes duration this will help in reducing the pain and size of cyst take care"
    },
    {
        "instruction": "hello doctor my daughter had an oral surgery on wednesday to remove her gum tag so her gap in her braces can close up the swelling and pain still have not gone away how can we reduce this further",
        "input": "",
        "output": "hello I have gone through your query and understand your concern pain and swelling after minor oral procedures are quite normal for the following to days this pain and swelling will eventually fade off and regress for lingering pain even after taking pain killers please do not skip doses and take them on time please advise her to take prescribed pain medicines on time thrice daily because if the dose is missed or taken after the pain had already started will not be that effective in controlling pain avoid hot spicy hard and chewy foods this can cause swelling to increase and delay healing please leave the area undisturbed because any irritant in that area could delay healing avoid forceful mouth rinsing follow gentle brushing rinse mouth gently after every meal to remove food deposits coz food lodgement in that area could cause an infection if the pain relief is not that adequate please talk to your dentist and get the dosage increased following the post operative instructions precisely will help better and faster healing"
    },
    {
        "instruction": "hi doctor I am years old my height is 1 and weight is 100 keg I had a condom on and I did not know that she was on her period as there was blood on the condom I removed it and had a new one we had sexual intercourse again and again until she was bleeding badly as far as I remember the condom did not break both times but she cleaned her vagina and without proper washing she gave handjob and I ejaculated can I get hiv from the above act is there any possibility that the virus transmitted with her hand to my penis as her hands could have period blood on them and there was no lubricant involved while handjob if so what is the risk probability can blood on the condom somehow get to the foreskin of the penis could that blood transmit hiv the exposure happened 48 hours ago and started pep after hours of exposure I am on tafero em and ritocom am I taking the correct medicine am I safe",
        "input": "",
        "output": "hi hiv does not get spread through such acts in case there was any tear in the condom the blood can seep through and put you at risk there is a risk in such exposure and it may range from 03 to 5 pep post exposure prophylaxis if started within 72 hours then it would be helpful your pep prescription is fine"
    },
    {
        "instruction": "hi doctor this is for my dad he has epilepsy and is now 52 years old last saturday he went on his normal routine of getting ready but did not know what happened and he walked out of the house without any clothes when we asked him if he was okay he said yes but after the whole episode when we asked him if he knew what he did he said no we do think that his epilepsy is triggered by less sleep and the only medication he takes is gabapentin we think that he is getting depressed because he has a loss of appetite loss of weight slowness in activity concentration problem and occasional mood swings his current neurologist does not do anything and all he does is keep doing a blood test each time",
        "input": "",
        "output": "hi thank you for your question history of epilepsy and intermittent episodes of confusion with loss of memory of the episode amnesia is concerning for seizures for the workup of seizures he should get routine brain wave testing eg electroencephalogram or a long term eg monitoring to identify any abnormal brain discharges which can cause a seizure other things to look at it is head imaging like it head or mri brain if not done already as it is not uncommon for elderly patients to have blood collection around the brain subdural hematoma to present with altered awareness or confusion I agree with blood tests as an initial test to look for metabolic encephalopathy due to deranged blood electrolytes level and body metabolites such as bun blood urea nitrogen ammonia etc please do not hesitate to reply if you have any other questions or concerns"
    },
    {
        "instruction": "hi doctor I recently had a laparotomy due to an endometrial cyst on each of my ovaries on my right ovary the cyst measured at 18 am and on my left the cyst measured at 13 am the surgeon was able to save my ovaries with no problem my ovaries just needed to be stitched up after having the cyst removed my question is when can I try to conceive I am 20 years old and my doctor recommended I get on the pill due to the endometriosis but I really do want to conceive really soon none of my reproductive organs were bothered other than my ovaries being stitched I am currently on june 5 30",
        "input": "",
        "output": "hi how are you doing great to know that the surgeon could save your ovaries though the cysts were really so large during surgery surgeon would have removed all the visible I mean all macroscopic endometrial deposits but there will be microscopic deposits not visible to the eye and they will not allow proper fertility outcome immediately following surgery or any such physical stress the egg or follicular response also will be less so rest for ovaries for a period of months will do good during this period of waiting the use of hormone pills or injections like leuprolide will allow a better follicular response so I would advise as your doctor did you are so young and will surely have a good follicle reserve left to use hope I have clarified your query do write back if any more queries and for your feedback all the best"
    },
    {
        "instruction": "hello doctor I am currently redesigning the common nutritional label to make it more to encouraging people to make healthier decisions while grocery shopping I would love it if you can take a few moments to answer some of my questions below as they are important to our research and final design please feel free to answer as many questions and at any length that is comfortable for you what do you think is the most common and most damaging misconception people have when it comes to purchasing food in the supermarket do you think that people focus too much on calorie counting and not enough on eating healthy foods if you can include only three things in a nutritional label what would you choose in your experience what do people mostly focus on when studying nutritional labels calories fats or sodium what do you think they should be focusing on the most in your opinion how can people make more educated decisions when grocery shopping do you think the nutritional label is enough to rely on if you were to design a completely new nutritional label how would you make it easier to understand or read than the previous five examples of nutritional labels do you have any suggestions of the many food trends that constantly spring up should the average consumer believe any slogan slapped across the packaging of food products what are some tell tale signs to be aware of thank you so much for taking the time to answer my question you are helping in more ways than you might think",
        "input": "",
        "output": "hi all the best for your projects I think it will take time to teach people to understand the importance of nutrition labeling but with my experience I can answer your questions from the way I have understood by my patients misconception spreads mainly through advertisement people does not read and they want to just understand what media say the trend of looking into calorie content is increasing mostly on our it people I would prefer calories from sugar calories from fat and sodium content of product per 200 about calories I think we need to teach each detail of sources of fat sodium and potassium levels I guess all medical professionals need to teach the importance of reading food labeling as we can observe an increase rate of metabolic disorder if we guide in the proper way it could be helpful it might be in schools or some awareness programs a small note on the ingredient used and its importance or guiding note on macro as well as micronutrient uses in points the mantra of advertisement needs to be changed or we need to explain the concept of being healthy with the use of daily simple products"
    },
    {
        "instruction": "hi doctor I cannot stop nocturnal emissions I sleep on my back and I do not even put any blankets on myself I neither watch something or think about it but it happens two or three times a week I get brain fog from it and my voice badly changes I get tired of it please help",
        "input": "",
        "output": "hi nocturnal emissions usually occur in sex dreams and often even without dreams sleep ejaculation are healthy and normal for everyone they do not cause any problem in your sexual life either now or in the future just as pressure cooker releases steam every time the pressure inside the cooker increases so also your body expels the unused semen once in a while and gives way for the production of new sperm or semen this is nature way of releasing the sexual tension building up in you probably it is also a way to check that your sexual system is working fine and to make sure semen does not become stale night falls disappear once you enter into regular sexual life there are a number of myths in society about night falls buying those myths causes psychosomatic symptoms like brain fog weakness fatigue etc be assured all these are myths and misconceptions due to a lack of scientific knowledge so the next time nightfall occurs laugh it off wash it off and enjoy it if the symptoms persist they may have other reasons behind them get a general medical check up to identify the causes"
    },
    {
        "instruction": "hello doctor I would like to know an orthopedist opinion about my mother situation she had femur plasmacytoma 20 years ago and prostheses because she had many infections after the operations she remained with her external popliteus paralyzed now she began to feel his knee mobile and she could not walk because of it there are some noises too a few doctors said she needs megasystem link prosthesis which would totally replace her hip and knee what is your advice is there any intermediate option like replacing only the actual prosthesis and adding pieces of bone we heard that in case of choosing the megasystem that can lead to amputation so we are looking for a second opinion I have attached the radiograph links please check",
        "input": "",
        "output": "hello the entire femur seen is grossly osteoporotic and the knee is showing evidence of osteoarthritis though I could not see the knee in the ap view she needs a knee replacement but with the large hip prosthesis and very weak bone stock I would support the use of a total femoral replacement this in reality would need the whole femur to be removed but is not equivalent to amputation the knee would have to be a constrained variety of her knee ligaments"
    },
    {
        "instruction": "hi doctor I am 25 years old I have been diagnosed with cos years ago I was on the pill till around this year however due to a few issues and after removing my gall bladder due to gall stones my go advised I stop my pill my periods have been on and off however I have not actually bled as such there is just continuous dark brown discharge for a few days but no red flowing blood what could this be and how do I go about treating it",
        "input": "",
        "output": "hello if you have been on pills for pod for more than years now and yet your hormones remain uncontrolled and menses have not been regularized then there is definitely something wrong in the treatment protocol or you may not be following the lifestyle changes which you may have been advised to follow it is best to stop pills for at least months after such a long treatment already and switch to lifestyle changes now for results if pregnancy is not a concern lately then the pills can be avoided however darkish brown blood indicates irregular shedding and this could be due to isolated progesterone deficiency which can be evaluated by your serum progesterone levels however immediate control of bleed can be achieved with antifibrinolytics you may discuss it with your treating gynecologist please feel free to discuss this further in detail regards"
    },
    {
        "instruction": "hello doctor I am a 21 year old female non smoker I noticed a bump at the back of my throat the other day but I am not sure how long it has been there as it does not cause me any pain I had my last dental visit before two months so it must have developed sometime since then I got the three stage gardasil vaccine when I was younger so I am not sure if that helps rule out hav or not I am out of the country until four months so I am wondering if this is something that needs immediate attention or can wait until my next dental appointments what is this red bump at the back of my throat I am currently taking ortho tri cyclen",
        "input": "",
        "output": "hi I have seen the picture you have attached along with the complaint it looks like a pharyngeal ulcer because of the patchy and reddish appearance chances of infection of the tonsils are also greater but you have mentioned that it is totally painless and has been there for a while so I reckon you visit an ent specialist not a dentist for this issue if this is painful while swallowing or drinking cold food please put it to the attention of the doctor it can be treated with simple antibiotics then if not this has to be addressed quickly to rule out any other infection with a blood test apart from hav as you got vaccinated for it I hope this helps"
    },
    {
        "instruction": "hello doctor I want to know about my dad spa prostate biopsy report the report is in french language and I will translate it in english doctor advised him to take hormone therapy and radiation therapy will that work biopsy report shows adenocarcinoma of prostate gleason score associated with ultra ducal carcinoma with extra prostate presence of numerous enlarged nerves I want to know its treatment and side effects my dad is 78 years old and he has high blood pressure he did bone metastasis and it came back negative what is the best treatment for my dad",
        "input": "",
        "output": "hi it looks your father has been diagnosed with prostate cancer the good thing is that his bone scan is free of metastasis spread I will suggest them to do an mri magnetic resonance imaging pelvis and ray chest plus abdominal ultrasound for staging these investigations will show the extension of the prostatic tumor if the tumor is confined to the prostate only he needs a surgical assessment for the possible radical removal of the prostate along with the tumor if they found him unfit for surgery or inoperable tumor then the next step is radiotherapy and hormonal therapy in general prostatic cancer is usually a slow growing tumor it takes years to spread to other parts from stage to stage prostate cancer five years of survival is almost 100"
    },
    {
        "instruction": "hello doctor please explain my it scan report and double marker test my present age is years my it scan was done on 12w 5d cry 64 my nasal bone present it 8 my ductus venous normal flow placenta anterior double marker result hug corr mom 64 no present it corr mom 12 pa a corr mom 42 down syndrome 81 edward syndrome 3234 patau syndrome 3135 please explain whether I can continue with my pregnancy how far is the risk",
        "input": "",
        "output": "hi welcome to icliniq com it scan is just a screening test to pick up cases of trisomy nuchal translucency of 2 my nasal bone seen and normal blood flow in ductus means the chance of trisomy is very low to confirm this doctor has done a double marker test they too are within normal limits these values are extrapolated over a graph of general values as mom multiples of median both the markers are normal in your case only risk factors which have given a risk of 81 is your age any ratio 250 has to be further investigated which unfortunately cannot be altered when the values are graphed over your age they fall at high risk but do not worry so the ideal next step is to undergo an amniocentesis at 14 16 weeks of pregnancy and genetic analysis can give you a diagnostic result I feel it will be normal just relax and wait for that normal result you can definitely continue the pregnancy I hope this helps"
    },
    {
        "instruction": "hi doctor I have had some on and off spotting for three to four days it is pinkish color and then I have a little brown color when I clean myself I have had no cramps no pains no nausea the only thing that I have had is my areola are super sensitive my last period was the last week of last month and they are usually spots and not irregular I have taken two pregnancy test and both came back negative I have looked online and have heard of implantation so I am wondering if this could be a really late period or possible pregnancy my husband and I do not use protection and I am not on birth control either the spotting is off and on not all day usually I have to change pads often for my cycle but I can use a light pad for all day use with the spotting if this seems like implantation when can I test and get a positive how far can implantation happen usually my cycle has clots in it and is super heavy and I have some pretty bad cramps but I have not had any type of pains with this I have one son already and did not notice this earlier",
        "input": "",
        "output": "hi according to your information today is a bit early to have pregnancy test positive none of these signs predict pregnancy urine pregnancy test and also the serum beta hug human chorionic gonadotropin is usually suggested at least one day after the expected period breast tenderness or pins and needle sensation is due to the progesterone hormone which is normal before a normal period the pink spotting can be either an excessive discharge from the cervix due to congestion so also the brownish discharge which is old altered blood one more reason if I may suggest is your weight your expected weight is 52 57 keg this extra cholesterol can get converted into hormones altering the hormonal support to the endometrial lining so this gluteal phase defect can cause these clots fleshy masses in periods blood with quite disturbing pain some leftover old blood also may be falling out now the pain will be more if you have a cesarean section since your last delivery mostly your body weight has not reduced anyway check your urine for pregnancy at one day after your expected periods use the morning first sample of urine I hope this helps"
    },
    {
        "instruction": "hi doctor I am 26 years old two years back I found that I have autoimmune hepatitis at that time they did fibroscan in that spa is 14 fu last one year I took medicines steroids and I stopped now it again came back and doctors did a biopsy in that it is showing portal and globular hepatitis with areas of confluent hepatocytic necrosis and isak fibre score are is it possible for my fibrosis to come from fu to f0 how is my liver now based on that biopsy report",
        "input": "",
        "output": "hi in autoimmune hepatitis it is possible to decrease the fibrosis or other possibility may be that initial fibroscan was done in acute inflammatory state hence it may be falsely high we need to compare it with the liver enzymes at that point of time autoimmune disease may be episodically triggered by various factors you must continue the medication"
    },
    {
        "instruction": "hello doctor I female 21 years old 8 height and 42 keg weight I am suffering from psychic problem I think I have bipolar disorder I get too much angry anxiety stress and get depressed soon I will break every object when I get angry I will become out of mind in that time I broke more then 25 mobiles and other things and I repented for all that after some time but I cannot control that behavior every time I do that and I repent after some time I am fed up with that I tried committing suicide also many times once I was saved in difficult situation so I do not have guts to try that again and I do not like to but I cannot live like this I have less friends I am creating problem to my parents also I really tried to change my behavior but I am not able to do anything about it I beat my mother in angry I am in that guilt currently I do love my parents but my anger is the main problem my current mood is I do not want to live and I do not like to die in between this please help me to come out of this problem",
        "input": "",
        "output": "hello I am sorry to hear about your situation I can understand it must be really difficult for you right now what you are describing looks more like depression with anxiety for bipolar disorder there has to be episodes of mania which can be diagnosed after complete evaluation and psychiatry history first thing you need to understand is that your behaviour is partially in control of you when you have a mental health disorder and the actions that you do because of depression or bipolar is not much under your control but with medications and proper therapy treatment you can control these there are two things that you will need to get help with this starting psychotherapy that is counselling sessions which will help you in controlling your anger and it will also help you vent out your emotions and all the guilt that you are holding which is making you even worse secondly you may need medications which can be decided after complete evaluation please find a local therapist or a psychiatrist they will guide you if you cannot find the local therapist we can start therapy online via video consultation please do not worry it might take some time but it is definitely manageable"
    },
    {
        "instruction": "hello doctor I am 24 a male recently I had some intense shoulder pain and a full panic attack I suffer from panic attacks and depression I went to the er and I had a 2100 total abc count chest ray abdominal ecography and urine tests all were okay the rest of the abc I believe was okay since the er doctor was not concerned and gave me some painkillers for the shoulder after day I went back because I was worrying for that high abc count and this time it was 1500 abc but again I did not see the rest of the abc and then I went back a week later and the abc was 750 with 38 lymphocytes 40 is the limit it says and platelets were 350 within normal rangeand the rest of the abc was normal clinically I feel good but as I have depression I cannot stop worrying about the abc and I am scared it might be leukemia I had a head it scan years ago and I read some inconclusive studies that it might slightly increase the chance of leukemia please if you can answer",
        "input": "",
        "output": "hello this pattern in which abc has behaved does not fit into leukemia is an uncommon cause for abc elevation other common causes are infection steroids or any bodily stress can lead to this it not expected to go down in leukemia and counts are usually much higher than this also you are asymptomatic so does not appear like a leukemia to me you can get your count repeated after a week or so and also request to do peripheral smear to look for morphology of the cells so does not look like a worrisome to me hope this helps you and get back if you have any doubts"
    },
    {
        "instruction": "hello doctor I am 23 years old recently I have strange symptoms firstly I had numbness in my left hand then in my right hand then I had the same symptoms in my legs and feet I have numbness and also tingling then I had headache mouth numbness and also right face numbness I have been checked by the doctor I did the vitamin test and I have deficiency 20 are my results and the doctor advised me to take b12 vitamin injections and also annister 25 ul two for two weeks and then I have to take them every month for three months it has been three days that I took the supplement and I do not have improvement I am afraid please do you have any suggestions for me",
        "input": "",
        "output": "hello firsty the complaints of tingling numbness indicates some neuronal insufficiency which could be due to various reasons including vitamin b12 deficiency multiple vitamins deficiency thyearoid dysfunction I can say there is not much to worry if you have healthy dietary habits and medications thyearoid profile b12 deficiency thyearoid dysfunction 12 deficiency tab neurokind la at night 10pm after food 20 days tab met once daily afternoon after food 20days tab it do 60k iu weekly once for weeks review with reports after week"
    },
    {
        "instruction": "hello doctor is real time viral load reliable for hiv test after 14 days of sex encounter I got normal result I also did p24 on 15th day and get negative result now can I be safe from hiv I use two condoms at the same time during intercourse and I do not know my partner hiv status with other partner I just kissed her without any physical relation",
        "input": "",
        "output": "hi the answers to your queries are if you had used the condom consistently and correctly changed for each sexual act with one person and it did not break or slipped off during the act and you removed it while the penis is still not soft your risk of hiv is nonexistent hiv cannot be transmitted by touching or kissing alone the test you performed is highly sensitive and specific and gives accurate result a negative hiv ran test needs to be complemented with fourth generation hiv combo test at four weeks if the result is negative hiv rapid antibody test needs to be repeated at three and six months of last exposure I hope this helps"
    },
    {
        "instruction": "hello doctor I had oral sex before months I did the following tests hiv combo ith generation mia during and ord ith and ith month after exposure all results are negative hiv combo ith generation and elisa during ith month all results are negative hiv test from ictc center in general medical college hospital in the ninth month with a negative result sad tests are also done hav on ninth month by elisa method now months have passed and I have lymph node under the jawline on both sides both lymph nodes are equal in size as that of green peas it is moving but I do not have any pain is it lymph node do in normal body is there such type of lymph nodes present or is this symptom of hiv is this a serious condition I am 32 years old with good health I have attached all my reports please provide information on what is my status should I need to test more or not what is the size of the lymph node in the normal body under the jaw line some say that hiv test may take nine months in some cases what are they sometimes I feel muscle pain and some mouth infection is ti sign of hiv as per naco there may be very rare chance of some persons to show positive after nine months who are they",
        "input": "",
        "output": "hi I have gone through the details and reports the chances of transmission of hiv by unprotected intercourse with an hiv positive person is very low 200 to 100 if protected it is nil chances of transmission by oral sex are almost nil unless there are bleeding wounds in both the risk is nil if hiv antibodies tests are negative after three months and are repeatedly negative until nine months it is conclusive that you are free from hiv you can allay fears of hiv totally there is no need for further hiv tests other studs too are negative the symptoms are nonspecific and do not suggest hiv the lymph nodes swellings may be due to simple respiratory infection or tonsillitis antibodies are formed by two to six weeks latest by three months in the very rarest of rare cases who has immunosuppressive disease it may be positive by six months they have severe symptoms and signs of immunosuppression since childhood you need not worry about such issues forget the episode and lead a normal life"
    },
    {
        "instruction": "hi doctor my year old daughter was diagnosed with pneumonia eight days ago examination and ray she was put on amoxicillin six more days and placid supply finished today although she is tired during the day and breathless trying to climb out stairs she is lots better in the last day or two she has come out with a red rash all over her face and for the past two nights she has been constantly coughing as soon as she lays down to sleep I have to hold her upright on my lap to control her cough is this a normal stage of recovery",
        "input": "",
        "output": "hi as per your description the child seems better but since the child has gone through so many problems the recovery may be prolonged what you are explaining does not exactly fit the picture of a recovery as the child is breathless and a new rash has developed the rash may be a drug induced rash but there should be no breathlessness I would strongly advise nebulizing the child with dublin every four hourly and budecort every six hourly also I think a repeat ray film should be obtained to find out if the patch of pneumonia is still the same or it has increased if it remains the same it is fine since the time of two weeks to up to one to two months may be required before a complete radiological clearing also you have not mentioned if the child was given an iv medication or oral in the current scenario I would have preferred iv intravenous medications also sometimes one of the complications of pneumonia is an effusion which will lead to breathlessness but since your child does not have fever currently that is ruled out another important point I want to know is if there is a history of asthma in the family because if there is then this phenomenon that you are describing may be completely different from pneumonia and may actually be the start of asthma"
    },
    {
        "instruction": "hello doctor I am 25 years old I have palpitations for the past three months no anemia tit is normal mri abdomen and chest are normal echo shows atherosclerotic aortic valve with ejection fraction 60 hotter shows minimum he 120 and maximum he 190 I have associated fatigue at times tremor and difficulty in breathing chest pain is aching sometimes and pins and needles more often I have seronegative arthritis previously I had dengue cerebral malaria and typhoid I am currently taking betacap to 40 my be for one month then stopped clonazepam 5 my be for two months but no help",
        "input": "",
        "output": "hello doctor I have thoroughly gone through your case and can well understand your genuine concerns first of all you have a high mi body mass index try to reduce the weight as you know it is high for this age and height ejection fraction of 60 shows you have aortic stenosis due to sclerosed aortic valve in this regard we have to keep in mind that this much back pressure on the left ventricle with every heartbeat is making the ventricular walls and interventricular septum more thickened and dilated improper output is making your heart beat faster and it also reduces the cardiac output stenosed aortic valve hindrance to outflow of blood cardiac angiography beta adrenergic blocking agents are the mainstay of treatment to reduce heart rate and control palpitation and to reduce cardiac oxygen demand that has increased due to increased heart rate maybe we need cardiac ablation and also there may be a need for valvular replacement sometime later in life avoid strenuous physical activity no junk foods caffeine tea coffee chocolates and energy drinks"
    },
    {
        "instruction": "hello doctor I am 21 years old I have pimples problem if I do not take non vegetarian and fast foods my pimples disappear but if I take egg or chicken or meat it comes out again and most important is that if I avoid nonvegetarian foods but if I do not drink six to seven liters of water even pimples come out please advise me is six to seven liters of water harmful for me and I want to eat eggs how can I eat if I take spicy food after a few hours something burns in my stomach I cannot even take spicy foods what do I do I want to eat everything please help",
        "input": "",
        "output": "hello the pimple problem or acne is a very common issue for young men of your age it affects morale and creates constant anxiety in the minds the solution to this problem requires one adheres strictly to certain diet regiment and take abundant care of their skin drinking so many liters of water is not harmful continue it water helps to wash off bacterial toxins and remove pimples make sure you do not fill your stomach with water immediately after a meal as that would distend the tummy and make you fat over time but taking so many liters of water intermittently is beneficial you are advised to avoid oily foods the yellow of egg is completely cholesterol while preparing non vegetarian foods to make sure minimal oil or butter is used use boiled meats better fish oils are good for health and fish is the healthiest non veg food red meats are not very healthy and so is beef or pork which have a lot of fat in them you must use a good face wash that will remove excess oil from the skin as well as maintain adequate moisture in the skin however if your skin is dry type then you must use a face wash that hydrate the skin well and does not add to its dryness deciding on the right cosmetic product takes time and patience but once you arrive at the right one for yourself then there is no looking back if you are unable to tolerate spicy food it is best to avoid it if this problem is a recent one then you may take some anti acid reflux medicines like pantoprazole 40 my twice daily for two weeks and mucaine gel syearup two teaspoons thrice daily after meals this will remove acidic reflux in the tummy and reduce the burning sensation after meals you are advised to reduce the intake of coffee tea smoking and alcohol last we have many anti pimple or anti acne creams available in the market clindamycin adapalene nicotinamide retinoic acid and benzoyl peroxide are all very effective if you can send a picture of your face with clarity then I can assess the severity and recommend the cream and how to use the same do not use these creams on your own as indiscriminate use can worsen the condition and lead to disastrous side effects I hope this helps"
    },
    {
        "instruction": "hello doctor I was on birth control aviane for almost two years I stopped taking the pills after my serious relationship ended before two months my first period after my withdrawal bleed happened in the middle of last month it lasted about two days was somewhat heavy but then I mostly spotted for two days since then all of my periods have been the same somewhat heavy for two days then light spotting for two or three days my cervical mucus has not seemed fertile and I have not felt any ovulation pains like before I was on birth control everything about my period seemed different and I have been thinking that meant that I was not ovulating like before but I know that might not be the case I had unprotected sex on day 10 of my cycle we used the pull out method but just to be safe I took five orange pills aviane about 12 hours later then five more orange pills 12 hours after the first dose today four days later I am feeling mildly crappy but I am experiencing a lot of white thick discharge my question is are my chances of pregnancy low considering everything and also if I experience a withdrawal bleed from the be pills when should I expect my real period again",
        "input": "",
        "output": "hi since you have taken pills there is no chance of pregnancy these symptoms could be because of hormonal changes due to the pill you have taken your next period could be a bit erratic because of the hormonal changes due to the pill you have taken but from the third month usually it get back to normal so relax and do not worry however if you have any doubt then get back to me"
    },
    {
        "instruction": "hi doctor my mother is 62 years old she is under regular medicine for be since five years she is taking olmy 20 my and cilapam plus at night she is suffering from prolonged cough and fast breathing after long walk and climbing stairs I am attaching her recent egg echo and ray reports please suggest whether she needs angiography as a further investigation her doctor advised ecosprin 150 and gun 6 which she is taking from yesterday",
        "input": "",
        "output": "hi for further information consult a cardiologist online"
    },
    {
        "instruction": "hello doctor I am a 27 year old male my skin complexion is close to dark and I have been suffering with acne black spots on my face I tried few creams but I am not able to get rid of these black spots I also used lemon juice to cure my black spot but there is no improvement please suggest me something to get rid of these acne marks",
        "input": "",
        "output": "hi revert back after three weeks to a dermatologist online"
    },
    {
        "instruction": "hi doctor I am a 34 year old male I am married I have good general health and good sexual appetite but I am suffering from premature ejaculation from the day of my marriage when I insert the semen ejaculates within a few seconds I took a test and consulted a sexologist he suggested nano leo uphold and ultra do at night and ultra do and seem cure in the morning when I took these tablets at night I woke up at night of the clock with heavy sweating nervousness shivering and indigestion so I just stopped all tablets what can I do now we not yet had a proper intercourse yet please guide us",
        "input": "",
        "output": "hi I have read and understood your problem for further information consult a sexologist online"
    },
    {
        "instruction": "hi doctor I am taking stalopam 10 be fludac 20 od and alprax 5 od for anxiety and depression I feel sleepy in daytime and frequent yawning I feel fatigue and no energy or activeness I am also on olmesartan for high be party and actor ez for high cholesterol levels kindly suggest some medicine which will give energetic and active signal from brain to body",
        "input": "",
        "output": "hi I can understand your concern for further information consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor I am 37 years old five months back I missed my period and then got bleeding for two days in the following month now again for the past two months I did not get my periods sometimes I feel tired am I pregnant",
        "input": "",
        "output": "hello revert back with the reports to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I am an 18 year old girl I am feeling stings in my upper body for quite some time the stings are sometimes in my chest and sometimes in my lower abdomen they last for nearly 40 seconds but are occasional and there is a lump in my right breast it is a solid lump and it does not cause pain I have bruises on my legs for three to four months and they are not fading my hairs are falling too much since last month do the signs predict any sort of cancer",
        "input": "",
        "output": "hi first calm down and be relaxed for further information consult a pain medicine physician online"
    },
    {
        "instruction": "hi doctor I snore and wake up tired daily sometimes my nose is runny all day I have attached my it report for your reference I just wanted to know if surgery necessary will it benefit me please explain",
        "input": "",
        "output": "hello we are happy to help you your it scan concludes that you have retention cyst inside both maxillary sinuses and the right frontal sinus retention cysts form when fluid collections in the sinuses get covered with a mucus lining these cysts produce nasal symptoms of obstruction or running nose which can cause a blocked nose in the night and thus mouth breathing mouth has lot of soft tissues unlike the nose which vibrate while breathing and produce snoring sound yes you will get benefit from surgery an endoscopic clearance of the pathological sinuses will remove your nasal symptoms and help you breathe through the nose at all times including at night by avoiding mouth breathing and snoring for further information consult an ent otolaryngologist online"
    },
    {
        "instruction": "hi doctor I have done inversion method in yoga for the last six days now I have got pain in head and eyes what can I do now",
        "input": "",
        "output": "hi for further information consult a yoga specialist online"
    },
    {
        "instruction": "hi doctor my daughter is 13 years old she is suffering from strange allergy since two years it became very bad and affects her psychologically it started when we changed our location before two years I have consulted three doctors and all of them said it as strange and did not show response to any medication I even tried biopsy to find out the disease her doctor just advised to avoid potato chips cream etc she become more frustrated and looks sad always please help us",
        "input": "",
        "output": "hi I have seen your concern and examined the given pictures anxiety depression and personality disorder no specific laboratory blood tests are required to establish a diagnosis of dermatitis artefacts nor are any diagnostic imaging studies indicated dermatitis artefacts fictitious disorder striae distensae dermatitis artefacts general dermatologic care measures include baths and debridement thorough cleaning I suggest you to apply emollients like emoderm cream white soft paraffin and liquid paraffin twice daily along with topical antimicrobials like fusidin cream fusidic acid twice daily for five days consult her doctor discuss with him or her and take the treatment with consent consultation with a psychiatrist is recommended she needs to be observed closely and she really requires psychological support revert back after a month to a dermatologist online"
    },
    {
        "instruction": "hi doctor I am 26 years old I just found out that I have high cholesterol my doctors advised me to change my diet but they did not give any suggestions other than to avoid fast food and fatty food my issue is that my diet option is already limited due to my food allergies strawberries melons and shellfish also I am suffering from crohn disease kindly help with my diet",
        "input": "",
        "output": "hi for further information consult a dietician online"
    },
    {
        "instruction": "hi doctor I am a 46 year old male my weight is 75 keg and height is feet I do not have diabetes and be I have asthma which is under control I am facing problems in getting erections it is getting worse with time I tried some treatments for depression and practiced relaxation techniques with no success my erectile dysfunction problem is there during each sexual activity the problem started some five years ago I used to take viagra 50 my the result was good initially but the hardness lasts only for 30 minutes maximum I could not bear the side effects like headache and face swelling even that tablet is not working for me recently my problem reached to unmanageable levels recently I get early morning erections I would like to be treated for this I would like to know what tests to be done for identifying hormonal or any other deficiency I will provide any other information as required thank you",
        "input": "",
        "output": "hi I understand your problem revert back with the reports to a sexologist online"
    },
    {
        "instruction": "hi doctor since five days I am having non radiating chest pain after having a cup of coffee there is no palpitations sweating or other symptoms my be is right now 100 76 mhg the pain is tolerable but occurring on certain movements and also when lying down it occurs there is no past history of such a kind of pain and no family history I do not have any general allergy or for drugs while having food too it is little bit paining while the food is passing through trachea I think it may be due to gas and took rantac but that did not help it is happening on certain postures and movement only it is a kind of annoying to me please help as soon as possible",
        "input": "",
        "output": "hi I understand your concern egg and chest ray for further information consult a cardiologist online"
    },
    {
        "instruction": "hi doctor I am a 29 year old male my height is 1 and weight is 90 keg I am going to be married next year my problem is that I am suffering from erectile dysfunction and premature ejaculation in my case the erections are there but the ejaculation is even quick the erections are not full what I have analyzed is that I can stand only till foreplay or a maximum of two minutes during foreplay I get erected very easily even a single thought can get me erected please help me in this regard",
        "input": "",
        "output": "hi anxiety and hyperexcitation serum testosterone and prolactin sildenafil and dapoxetine combination for further information consult a sexologist online"
    },
    {
        "instruction": "hi doctor I had unprotected sex with my girlfriend but I have not ejaculated in her is there any chance for pregnancy some yellow substance was there on the tip of my penis what is that",
        "input": "",
        "output": "hi the process you have adopted while performing sex is termed as withdrawal method though this is a commonly practiced method there exists reason for failure the cause is some of your sperms could be present in your precum that is some amount of clear secretion from penis before the ejaculation it could cause a pregnancy contrary to your belief no sperm will be present in the yellow deposit termed smegma finally you have to consider in which day of her period you had sex if she is in between day to day 17 of her cycle chances are high otherwise there is no such apparent risk for further doubts consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I am a 28 year old male I got married before two years for the past three to four months I have a condition of irritation at the base of the head of penis head tight foreskin and redness especially where the foreskin is connected to the head it happens after intercourse and it takes about four to five days to become normal this happens after each intercourse for the past three to four months please advice",
        "input": "",
        "output": "hi for further information consult an andrologist online"
    },
    {
        "instruction": "hi doctor I applied 35 tea peel before two days and then I got some burning and redness on the area it is all black now and also getting darker day by day how can it heal faster is there a chance of leaving out scar",
        "input": "",
        "output": "hi revert back with the photographs to a dermatologist online"
    },
    {
        "instruction": "hi doctor why are men generally affected by cancer than women do they have less tumor suppressor genes p53 than women or is there a different reason entirely",
        "input": "",
        "output": "hello for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I got married three years back and I gave birth to a baby boy two years back however due to complications I lost my child in just seven days I never had breastfeeding session with him as he was in nicu but sent milk to him through a tin pot for five days however after this unfortunate incident doctor prescribed me few medicines to stop my milk soon my body stopped producing the milk meanwhile I was going through some emotional turmoil as separated from husband and my mother cancer treatment since two years I have been living separately from my husband four days ago when I was trying to convince my husband regarding relationship he messaged me that he do not want me back in his life till now I realized that something like milk is coming from my breast is this breast cancer or is this because of emotions about my baby I am unable to discuss my emotions with my husband as he is not willing to listen please help",
        "input": "",
        "output": "hello first of all I must tell you to relax stress tension and medicine blood for ash thyearoid stimulating hormone to triiodothyearonine to thyearoxine and prolactin mammogram of breast hypothyearoidism hyperprolactinemia stress induced nipple discharge revert back after the tests to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I have severe intolerance to stress low blood pressure dehydration hyperpigmentation and a lot of other troublesome symptoms when I eat my face flushes and my heart rate goes up and my body sweats I have carbohydrate intolerance as well my skin is brown in color with a lot of freckles which is not normal for me I was recently diagnosed with reactive hypoglycemia and it is getting worse my diurnal saliva cortisol are as follows at am 37 am 1 am 3 and at midnight 65 I have a high hiaa test too and the value was 2 my biggest symptom is the intolerance to stress and low blood pressure with severe weakness",
        "input": "",
        "output": "hello revert back with the answers and reports to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I have been having many issues in the last two years my main issue right now is that I get a weird feeling in my stomach like I want to growl but I cannot I am having shortness of breath numbness of hands tingling and heavy feeling I feel like passing out and my heart starts to race I usually burp when I get these feelings I cannot walk far distances and these started happening about a week ago I have had two stress tests the first one was six months ago with heart echo I wore a hotter monitor for a month and had several eggs but nothing found in all of them now recently I have had my blood pressure shoot up and I am currently on blood pressure medicines I am 35 years old and overweight I have lost about 100 labs and I am at 265 my other issues that I have been diagnosed were diverticulitis gallbladder dyskinesia gastritis and herd my cardiologist wants to do a cardiac catheterization next is there are any other alternative test that are not so invasive also really do I need it these attacks I get are very scary and I have ended up in it several times but nothing was found could this be something else I have read about vagus nerve issues as well as stomach issues that can cause similar symptoms should I get the cardiac catheterization test",
        "input": "",
        "output": "hi for further information consult a cardiologist online"
    },
    {
        "instruction": "hi doctor I am having painful urination when I pass urine only 10 my of urine I pass and then end up with so much of pain the pain is like something stuck in my penis or like some wound inside the penis and I am also getting blood in urine this is happening to me for the last two days please help me this is the first time and I am drinking as much water as possible",
        "input": "",
        "output": "hi based on your query my opinion is as follows for further information consult a general practitioner online"
    },
    {
        "instruction": "hi doctor can dead skin and excessive serum buildup cause itchy skin if so then what is the most effective treatment for clogged pores",
        "input": "",
        "output": "hi if you have excess serum then you can develop acne or seborrheic dermatitis which can cause itching the best way to remove excess of serum is steaming your face which not only open your closed pores but also reduce the chance of acne and other skin disease you should do frequent face wash with water and use alcohol and acetone free face wash twice apply non greasy moisturizing lotion eat healthy diet with lots of fruits and salad also avoid oily and spicy food take plenty of water daily which hydrate your skin and do regular exercise for further information consult a dermatologist online"
    },
    {
        "instruction": "hello doctor I am married and I am years old I have erection problem sometimes I get good erection but it lasts only for two minutes I did consult a sexologist he told I am normal and I also checked my sperm count which is normal too my work life is stressful sometimes I take late capsule but it does not work as I expected but later I took caverta 25 my it works fine shall I continue to take the same please suggest me a suitable tablet for better and longer intercourse nowadays a lot of medications are available and I do not know which one to take please suggest",
        "input": "",
        "output": "hi I can understand your situation revert back with the asked details to a sexologist online"
    },
    {
        "instruction": "hello doctor early this morning I lost vision in one of my eyes for about two minutes my vision then came back gradually over a period of couple of minutes I could not see any light at all it was not painful and I have not experienced this before I experienced an allergic reaction to a progesterone cream when I applied to my face the same day it burned my face and turned it red symptoms subsided after washing it off I am traveling and cannot get in to see a doctor until I return home in two weeks is it fine if I wait to see a doctor please help",
        "input": "",
        "output": "hello for further information consult an eye care ophthalmologist online"
    },
    {
        "instruction": "hello doctor my month old son is having eczema issues since he was around months old I presume because of allergies we have tried many things to find what causes his issues but still have not got it to go away long term my main concern is that he has had issues with digestion for the past few months he gets constipated very easily and has to eat things that help to keep him from getting too uncomfortable he has breastfed up until this point but recently has self weaned he eats lots of solids and drinks diluted juice I avoid giving him dairy since he seemed to have a bad reaction to formula very young he had swelling in his lips when he tried yogurt for the first time he is only 13 pounds in months which is very low he eats great but is still so little he is not crawling or scooting he sits by himself and watches everything he sleeps what seems like more than usual he wants to be held most of the time he listens to you and watches you closely he grabs things and can switch it from one hand to the other he can put his pacifier in himself and he likes to drop things on purpose he does not babble much at all and does not play as much as I would expect",
        "input": "",
        "output": "hello protein calorie malnutrition eosinophilic gastroenteritis for further information consult an general medicine physician online"
    },
    {
        "instruction": "hello doctor I am 30 years old my height is 166 am and weight is 56 keg can you please suggest some medicines vitamins minerals or something to increase my height by few am can I take some anabolic steroids for short duration to increase my muscle mass at this point I just like to mention that I am diagnosed with crohn disease and taking azoran 100 my folvite and razor daily in my breakfast and afternoon snacks I take eight slices of bread two boiled eggs two bananas one spoon of albumencare protien supplement in lunch and dinner I eat rice and dal and boiled vegies I do not take fish or meat",
        "input": "",
        "output": "hello unfortunately after the age of 30 it is a little less likely to increase the height further however doing stretching exercises using vitamin 50 iu once a week and b12 100 mug daily may help to improve the posture and give you an extra am or so also remember if you ended up using steroids of any sort then please do get a bone scan to look for osteoporosis weak bones which can result in loss of height"
    },
    {
        "instruction": "hello doctor I have been having tiny random muscle twitching all over my body which seems like a constant thing at bottom of my feet in both legs both forearms and even my stomach for almost two months now I am scared of als diagnosis I do not have any muscle weaknesses or balancing problems I can lift 40 labs dumbbells with no problem and still do push ups and other exercises with no problems and sprint and run without falling or tripping I have had some sort of issue for almost a year where it feels like I am not getting a satisfying breath from time to time so I bought a spot meter and my of level fluctuates between 95 98 with an average of 97 most of the time I am just freaking out because everything I search for comes back to als I even watched a similar story last night and I had a panic attack afterward I guess I am just looking for a little reassurance to calm down",
        "input": "",
        "output": "hello I read carefully your question and would explain that your symptoms do not seem to be related to als amyotrophic lateral sclerosis you should know that there are a lot of benign causes underlying muscle twitching like anxiety physical activity thyearoid gland dysfunction benign fasciculation syndrome vitamin b12 or vitamin deficiency low calcium or magnesium levels etc as long as there is no progression no weakness no muscle wasting there is no reason to panic about als I would recommend performing some tests thyearoid hormone levels blood electrolytes vitamin b12 and vitamin plasma levels complete blood count per polymerase chain reaction ear erythrocyte sedimentation rate for inflammation nerve conduction studies would help to completely exclude als and thus put your mind to peace I recommend discussing with your doctor on the above tests I hope this helps"
    },
    {
        "instruction": "hello doctor I am 16 weeks pregnant and hypothyearoid I am currently taking 75 my per day of eutirox synthroid during weekdays and 100 my per day on the weekends about a month ago I got my ash and ft4 levels tested and the results are ash 65 mu ft4 16 pmol reference values est trimester 12 19 and trimester 6 17 ord trimester 4 15 today I got my ash and ft4 levels tested again these are my results ash 91 mu ft4 15 pmol reference values est trimester 12 19 and trimester 6 17 ord trimester 4 15 antibodies htg",
        "input": "",
        "output": "hello I just read your query and from what you have mentioned it appears that your requirement is increased during pregnancy you have not mentioned what was the dose that you were taking before getting pregnant however you can increase the dose from the current twice per week 100 mug that you are taking to thrice per week 100 mug and 75 mug for the rest of the four remaining days of the week repeat your thyearoid function test after six weeks and then we will review again you need to repeat your thyearoid function test throughout the pregnancy every six weeks I hope this helps"
    },
    {
        "instruction": "hello doctor I think I have a certain level of erectile dysfunction my penis becomes hard but only from the left side and refrains from staying erect what is the remedy for this situation",
        "input": "",
        "output": "hello I can understand your concern if there is poor erection on one side then this cannot be ignored this could be due to some vascular issues have you got any injury during sexual intercourse in the recent past or sudden bending during masturbation is there any history of hypertension or diabetes please provide the details in the followup"
    },
    {
        "instruction": "hi doctor this afternoon I decided to clean my bathroom of mould using gloves but no mask I chose to help my breath instead there was orange mould on the inside of the bath and black mold on the walls I used a wet sponge to clean off the orange mould it was easy to remove as it was soft and slimey I held my breath and cleaned it quickly then came back to clean some more and so on until it was all gone I also held by breath to clean off the black mould which I scraped off at no point did I breathe in any mold smell however a few minutes after cleaning the orange mold I returned to shower it off and there was still a musty smell of mold I only breathed it in for a second because I held my breath even for this task but I am worried the small amount I breathed in could affect me I am very sensitive to strong smells and can suffer tightness of the chest although I am not asthmatic I do however suffer from hypothyearoidism is there a danger I could have negatively impacted my lungs breathing",
        "input": "",
        "output": "hello different types of molds can give hyper reactive response to the airways it is always advisable to wear mask as much as possible you may still be exposed despite of you holding your breath but if you have no immediate shortness of breath or chest tightness then it is less likely to effect you please let me know if you have any other questions"
    },
    {
        "instruction": "hi doctor I am 35 years old male with no medical history over the past few years I have started to lose my hair I am not bald visibly but have developed thinning of hair especially in the middle area of my scalp I have been using ayurvedic hair oils for the past free months which has reduced hair fall visibly but did not help to grow new hair do you recommend to use minoxidil if yes which brand is effective and how to use it can I continue to use hairoil during minoxidil treatment I also have very less facial hair is this medicine suitable to be used on face as well to promote facial hair growth I do not have any dandruff problems but the hair is usually very dry awaiting your response",
        "input": "",
        "output": "hello I understand your concern but there is no attached photographs in your message kindly send a picture of the affected area to help better I need to see the affected area to assess the condition and to suggest the appropriate treatment please send the picture of the affected area take care"
    },
    {
        "instruction": "hello doctor my daughter is four months old now she breastfeed only she used to defecate once or twice daily sometimes she defecated once in two to three days recently she has started defecating four to eight times a day generally very small amount though and her feces have become more liquidy we went to a doctor who suggested some probiotics and told not to worry she is otherwise healthy and shows no symptoms of any illness however we thought to have a second opinion we did a stool test and I am attaching the recent one please suggest if there is anything to be worried about she is on usual vitamin and iron supplements",
        "input": "",
        "output": "hi it is normal for babies to have variable stool frequency sometimes they pass once or two times in a day sometimes more some babies have exaggerated gastrocolic reflex it means they pass stool after almost every feed no need to worry if the stool is not watery and small amount baby is passing urine activities are normal no fever and gaining weight no need to give probiotics or other medication continue breastfeeding maintain hygiene gastrocolic reflex normal variations of stool frequency none continue breastfeeding maintain hygiene as per your requirement"
    },
    {
        "instruction": "hello doctor my 19 year old son is suffering from major depression and has been on at least four different medications eat and ketamine treatments eat and the ketamine seem to show the best results so far but are short lived and I hate to keep shocking his brain if this is not going to work he has completed 10 sessions now all I have been doing is research on how to help him because I know his doctor has only one hour with him every two or three weeks where I am with him every day for hours I ran across an article about using tramadol to treat depression and I was wondering if taking this every day would produce the same or near same effects that the ketamine treatments do but over a longer time right now he is on cymbalta 90 my rexulti 5 my wellbutrin 150 my hydroxyzine 50 my as needed clonazepam 5 my as needed",
        "input": "",
        "output": "hello resistant or long standing depression needs treatment with a mood stabilizer that has not been given the list on ongoing medicines I would recommend that you add a mood stabilizer like divalproex sodium or lithium carbonate it will help hold the mood in place once it has been elevated by antidepressants also cymbalta is not a very good antidepressant it is the least potent among sari serotonin norepinephrine reuptake inhibitor class of drugs normally after this you can try using a tea tricyclic antidepressants class of antidepressant and if that does not help then a combination of venlafaxine and mirtazapine is highly effective it is also been evidenced by star trials the largest clinical trials for resistant depression this is also my clinical experience in addition to the primary antidepressant sari or sari or tea and the mood stabilizer also an atypical low dose antipsychotic will augment the efficacy of the antidepressant such as 50 to 100 my of amisulpride or my of aripiprazole etc so there are a lot of options available which have not been tried and I would request you to consider these first in addition to the ongoing therapies and finally do not use tramadol daily that would lead to an opioid type of dependence and ultimately worsen his depression"
    },
    {
        "instruction": "hello doctor I am 21 years old but my skin is very loose and it looks very old get wrinkled on the upper part of my hands feet and also in some other parts some areas are too stiff I never get exposed to the sun for these I am using nivea spf30 I take proper diet with fruits and vegetables but my problem is not solved I have consulted a lot of dermatologists but there is no improvement I do not want any wonder results but I need some improvement I was very depressed by this condition please suggest any lotion or cream to solve my problem",
        "input": "",
        "output": "hello this is genetic and you cannot do anything about it with lotions and medicines there is a temporary procedure called dermal fillers which will give fullness and youth to your hands and legs but that is not cheap and the results last for nine months to one year if you are interested in these procedures you can meet a cosmetic dermatologist or plastic surgeon who does fillers"
    },
    {
        "instruction": "hi doctor I have insomnia and for the past two years I have been experiencing a weird emotional state I decided to seek online advice and then go to a doctor once I confirm what I am going through I cry almost every day for no particular reason I have anger issues and frequent headaches whenever I am walking on the road I feel a weird urge to go right in front of a vehicle and for the past one month it has increased a lot and I have not inflicted any self harm if that is one question which might arise in your mind but a year back I did try to cut my wrist with the help of a blade but later realized that it is lame to do as my life is very important but a sudden turn of events in my life has caused a very weird emotional situation for me I completed my 12th last year and now I am in my first year of law I try to avoid people as much as I can and avoid going to college as well and I do not know the reason why I cry so much I hope you can help me",
        "input": "",
        "output": "hello you seem to have an anxiety type disorder mixed with depressive episodes you will need to visit a psychiatrist and he will prescribe you sari selective serotonin reuptake inhibitor type of medicines which will help with your problem it basically happens when some neurotransmitters such as serotonin reduce in your brain leading to a problem with handling the day to day stresses of life medicines are usually given for two to four months and then tapered off slowly and stopped the medicines I have mentioned are usually prescribed by psychiatrists apart from those you can take melatonin or 10 my it is available in any decent pharmacy over the counter and does not need a prescription you can try taking that daily at night apart from that you can try some sleep hygiene methods like maintain good temperature no noise or light one hour prior to bed wind down and try reading or music do not use the laptop to or phone one hour prior to bed avoid caffeine alcohol or tobacco two hours prior to sleeping avoid exercises three hours before sleeping take warm milk at bedtime go to bed only when sleepy and avoid other activities on bed use the bed only for sleeping or sex if you do not get sleep do not toss and turn get up go to another room walk about for 10 to 15 minutes and come and lie down see for 10 minutes if not sleepy go out again try deep breathing exercises progressive muscle relaxation techniques or yoga or meditation it will also help"
    },
    {
        "instruction": "hi doctor I am an 18 year old male and recently I had stopped smoking and now my throat is sore is it something serious I have been smoking for four months",
        "input": "",
        "output": "hello with the conversation I understand you are an 18 year old male who started smoking four months back and now quit it recently however you are suffering from throat pain now my assessment is that the sore throat is just a throat infection it has got nothing to do with any cancer if that is what you are worrying about the throat pain may have got aggravated by the smoke and the agents in it kindly follow these suggestions hot salt water gargles daily thrice steam inhalation take plenty of hot fluids like soup rice water etc take all the foods hot and warm avoid cold drinks alcohol cold foods outside foods or drinks do not smoke again if after the precautions told above still you have no improvement kindly consult an ent surgeon who will look into your throat and check if there is anything wrong he will arrive at a decisive diagnosis and institute the right treatment that will help you get rid of the problem a note on smoking now that you have quit it kindly hold on to it is easy to get back to smoking due to peer pressure and friends however once you become addict to it there is no going back also it takes a few years for the damage to the lungs and throat to become severe enough to cause cancer however only if you have a strong will power will you be able to quit it completely once you restart your habit I hope this helps"
    },
    {
        "instruction": "hello doctor I have a serious eating disorder issue for six years I never vomit or work out a lot after I eat a lot of high calories food like cakes donuts chocolate ice cream chips and so forth in these six years my weight was up and down repeatedly between 100 labs and 190 labs I have been looking up to this kind of surgery for a period of time and I know it would have some side effects on my body however I am tired of dieting and working out as well as eating too much afterward it is so frustrating I need this surgery to help me get rid of this pressure therefore I can live a normal life",
        "input": "",
        "output": "hi surgery for obesity is considered as a treatment option for patients with a mi body mass index of 40 keg my or greater who have tried but failed an adequate exercise and diet program and those with obesity related comorbid conditions such as hypertension diabetes mellitus hyperlipidemia and obstructive sleep apnea etc it has few long term side effects such as a possible need for reoperation gallbladder disease and malabsorption more importantly you will have to still control over eating and exercise even after surgery I would not recommend surgery it would be better to consult a psychiatrist to help you get over your eating disorder and naturally help with your weight issues I hope this helps"
    },
    {
        "instruction": "hello doctor I currently suffer from anxiety attacks and panic attacks it has been changing over the course of about four years getting better and worse again in everyday life it is manageable but the attacks cause some unreasonable thoughts and ideas to form I have heard about the use of benzodiazepine for anxiety can they be taken to stop panic and anxiety attacks without needing consistent everyday dosages during panic or anxiety attacks I usually feel very worthless and in some cases try to or think about hurting myself generally my anxiety tends to do with social situations where I feel like I am not liked or if I said something wrong I have visited a counselor in the past very briefly ironically my anxiety was worsened with the guilt of therapy being very expensive so I stopped seeing her",
        "input": "",
        "output": "hello anxiety and panic attacks are extremely common and 15 to 20 percent of people suffer from this issue at some point in their lives standard treatment for anxiety is the use of sari selective serotonin reuptake inhibitor type of medicines they are usually given for two or four months and then stopped slowly by tapering it off they take two weeks to usually start taking the effect till then low dose benzodiazepine can be used I do not recommend the use of benzodiazepine which you are considering since it just takes care of symptoms of anxiety and the intervals at which you will need to take it will reduce as you keep on using it and eventually it will lead to addiction this is because withdrawal from benzodiazepine will produce the same symptoms as that of anxiety also consider doing deep breathing exercises or progressive muscle relaxation along with medicines"
    },
    {
        "instruction": "hello doctor my husband and I recently underwent an if cycle and it failed originally my husband has a problem with morphology but now I a have poor ovarian reserve I am 39 years old and my am was 24 however my fish was last time am was not repeated I was stimulated with the maximum dosages and only produced three eggs which all produced embryo I do not know the quality only that one had progressed normally by day we did a day transfer on the second day after the transfer I had what I can only describe as scab like discharge about the size of a tear one the sixth day I finally left the house and started to resume so level of normal activity no heavy lifting and that afternoon I had a very bright red urine flow like a small amount of blood pass when I used the bathroom I thought that it might have been implantation bleeding but clearly not I want to try if again but I am afraid of the same results in doing research I found a book that suggests many environmental factors such as bra and phthalates can play a part in egg quality quantity and affect the sperm as well the book suggests waiting three to four months prior to beginning if to get the full effect of supplements recommended as well as let the harmful chemicals leave your body my questions are given my numbers in your opinion will my number of eggs change drastically while waiting or should I be normal should I retest my am before making this decision also is there any way for me to preserve my eggs not menstruate until the month before the if procedure my thought was to take birth control pills for three months and not take the sugar pills is this safe can it be done what are the repercussion finally based on our numbers would you recommend that we use donor eggs instead of trying another cycle this time around will have to be the last as we do not have any money after this one it is critical that we make the right decision",
        "input": "",
        "output": "hi looking at your case history it would better to go for donor eggs ovarian reserve decreases with age and retesting for am anti mullerian is not going to affect the outcome increase ovarian reserve so no point in retesting am by taking of oral contraceptive pills continuously you cannot halt a decrease in ovarian reserve loss of eggs menses is just an indicator of loss actually a woman loses 400 600 eggs per month irrespective of whether she gets menses or not what you see on ultrasound is just loss of dominant follicle the loss of those 600 follicles cannot be seen it can be perceived indirectly by decrease in am increased requirements of hormone injections during if in vitro fertilization reduced number of eggs retrieved and low pregnancy rate one more effect of advanced age would be increased risk of down syndrome in the baby if you try with your own eggs so considering your advanced age low am poor response to stimulation low number of embryos formed in the last cycle and increased risk of down syndrome with own eggs I would suggest to go for donor eggs"
    },
    {
        "instruction": "hello doctor I was accustomed to donating platelets in the blood bank recently I received a letter stating I am no longer eligible to donate platelets anymore I can donate whole blood and double red cells only they said the reason is that I have white blood cell antibodies which can occur in response to pregnancy the issue is I am a male if I recall correctly from my biology class males do not get pregnant which leads me to think this is something else I tried asking them more details but they were vague or maybe uninformed as to why these antibodies seen in male when they themselves said it was often seen in pregnant women internet searches prove fruitless I cannot be the only male that ran into this the only other thing I can think of is possibly cancer only because I remember reading somewhere that if a man were to do a instant pregnancy test and it is positive it is an indication of maybe being cancerous I do not know some insight into this is appreciated I am currently taking levocetirizine and atarax when needed",
        "input": "",
        "output": "hi based on your query my opinion is as follows I can assure you that there is no cancer or even suspicion of that any patient with suspected cancer or with cancer unless completely cured will not be asked to donate any component you are still eligible to donate whole and double red cells which is good there are numerous conditions like viral infections which can lead to a condition called as autoimmune disease or autoantibodies maye without symptoms of autoimmune disease maybe secondary to an infection you might be having antibodies against abc white blood corpuscles or platelets you are asked not to donate abc or platelets because there is an antibody which could damage the recipient abc or platelets which can reduce the efficacy of the donation and complicate management your blood test is not attached however I think it will be normal if you are looking for any antibodies they are numerous common ones like rheumatoid factor anti dna antibody and anti phospholipid antibody may have been screened if the type of antibody is known further opinion will be possible I hope this helps suspected viral infection specific antibody screening antibodies cannot be removed as it is always forming so not to worry and go on with the donation of other components no cancer I can assure you"
    },
    {
        "instruction": "hello doctor my mother is 64 years old and is suffering from several kinds of diseases g be thyearoid sugar cholesterol she is taking medicines regularly as prescribed by the doctor her medications are tripride altroxin 50 stamlovita met al 25 losartan atorva 10 my presently she has waist pain and stomach pain we went to the doctor and they prescribed calsma do 60k once a week remac cd3 vitasonic plus eurosure 500 my pregabid it from three to four days astrologist suggest nexpro he morning and evening I want advice that is our treatment going in the right way or something wrong because presently she is not feeling unwell what should we have to do",
        "input": "",
        "output": "hello I have gone through the provided details and treatment prescription from various doctors although it will not be possible for me to comment on whether the treatment is right or wrong without seeing the patient but I feel there is a need to explore other options than the medications as I can see she is taking medication for almost every common ailment of senior citizen life but there is no mention of lifestyle changes the lifestyle changes are either equal or more important in chronic diseases such as hen hypertension diabetes thyearoid and hypercholesterolemia in addition to these ask your mother to have at least 45 minutes of moderate physical activity it is also important to take a diabetic diet and restrict the intake of salt and fats regarding the current medications I do not see any role of remake cd3 eraser 500 and vitamin plus please stop all the three medicines and give her plenty of fluids to drink in addition get an ultrasound of her abdomen and revert back to me"
    },
    {
        "instruction": "hello doctor I have been getting panic attacks very frequently it comes with shortness of breath my chest feels tight and painful and an emotional breakdown I often feel dizzy light head and like I have no control over my body this has been happening for four days now and yesterday I had three panic attacks today I had three again my chest feels tight all the time and I have a hard time breathing for hours the panic attacks come in very randomly and are unexpected I always overthink about the smallest things and I cannot put my mind to rest it is all hard to manage every day I feel lethargic restless and exhausted my sleep schedule is horrible and I cannot sleep at night lately I have been staying up until am I have talked to my mother and found out she had also been experiencing panic attacks around my age",
        "input": "",
        "output": "hello many times anxiety and depression coexist and it leads to the symptoms you have been experiencing moreover the body heals in sleep and that is also disturbed for you so that is not allowing you to recover this basically happens due to a deficiency of a neurotransmitter in the brain called serotonin which reduced the stress handling capacity of the brain apart from stress there are genetic factors also and that is another reason you are having this problem please consult a local psychiatrist who can examine you and start you on sari selective serotonin reuptake inhibitors type of medicines which are the first line of treatment and are highly effective it is normally given for two to four months and then tapered off slowly the medicines take about a week or 10 days to start taking effect and until then usually low dose benzodiazepine are given for immediate effect in addition to the medicines please do deep breathing exercises daily yoga meditation progressive muscle relaxation etc which will help calm your nervous system"
    },
    {
        "instruction": "hello doctor I am trying to get pregnant but I am breastfeeding I only had two periods after giving birth but I do not have a period in over two months what can help me conceive without giving up breastfeeding",
        "input": "",
        "output": "hi may I ask how long it has been since your last delivery from your given history of breastfeed I can understand that your baby is still quite small and so I would suggest until he or she is at least three to four years of age before trying to conceive again this is so that in between deliveries your body needs time to recover and repair itself if you get pregnant too soon it will adversely affect your baby as your cycles have not yet regularized it implies that you may not be ovulating regularly this can happen sometimes during breastfeeding it will resume order on its own I would suggest you start the following iron and calcium tablets as well as folic acid tablet livogen it once daily at night with lemon water tablet calcimax 500 my once daily tablet folvite my once daily if you are planning to conceive please continue to breastfeed your baby regardless of whether your periods come or not and kindly consider what I have explained above"
    },
    {
        "instruction": "hello doctor for the past three days I am experiencing itchiness within inside the head of my penis there is mild pain while touching the head and it becomes bad post masturbation and urination no boils found under the skin but it seemed to be red in color",
        "input": "",
        "output": "hi your complaints are more in favor of urethritis or balanitis this could be a consequence of multiple factors ranging from infections to even renal stones kindly mention if there is any pain when passing urine is there any pus discharge from the urethra is there any burning when passing urine also mention have you been masturbating excessively off late do you have had any recent change of partner do your partner is also having similar complaints kindly upload appropriate images if there are any lesions syearup citralka 10 my in one glass of water twice daily take plenty of fluids avoid excess masturbation and have a monogamous relationship review back with answers for the above queries"
    },
    {
        "instruction": "hi doctor I have been taking my of xanax a day to treat severe panic attack syndrome and associated high levels of general anxiety for 15 years my doctor arrived at the my per day amount gradually and it works very well along with cut from a therapist before two months when I received the medication from the pharmacy it was for my day I asked them to double check and that was the quantity that my doctor had written I call his office and the office manager said that she would ask him about it when I called the next day she said that he did not make a mistake and I asked for an explanation and was told that he did not give one I started to feel sick a few days later and panic attacks actually started to increase the day that I talk to his office manager I suffered minor but disruptive withdrawal symptoms physically and mentally for about two weeks and then they subsided but panic attacks continued to occur at random every day and my gad symptoms increased to the point where cut methods were not working then last month the script was back to my per day normal dosage I thought yes back to normal but again this month the script was back down to my per day which means I am going to experience a minor hell again I am a defense and aerospace engineer who works on a contract basis through an agency and the client had noticed a drop in my performance before month but back to normal last month now they are going to see it again and I will probably lose the contract job I also started online system engineer classes and I am freaking out over being able to handle the exams and homework as I typically work on the class at night and am now without my evening dose I again asked for an explanation and was not given any my question is a 25 cut in dosage physically dangerous and I am well aware of the strong psychological addition issues so will this settle down before my career and social life and general well being take a hit and I revert to hiding in my apartment with my dog and my employer and friends will give up on me",
        "input": "",
        "output": "hello there are a few clarification and advice that I need to make reducing the dosage of alprazolam results in alprazolam withdrawal a reduction by 25 is unlikely to be physically dangerous but the withdrawal symptoms are going to be highly unpleasant the anxiety of withdrawal is quite similar to your panic and generalized anxiety and it is difficult to make a difference between the two withdrawal anxiety will reduce over time I do not think that your disease will worsen because of this to the initial level but the withdrawal will cause distress for a few weeks I recommend using more nonpharmacological therapies like relaxation training during this period ask your doctor to avoid making sharp changes in dose and consider adding drugs like saris selective serotonin reuptake inhibitors etc breaking your tablets and taking the pieces in such a way so that you reduce the inter dose interval without changing the dose I hope this helps"
    },
    {
        "instruction": "hi doctor I just got all four of my wisdom teeth removed two days before and I have a bad taste in my mouth that tastes like sour dough but more like metallic there is not really any pain there my jaw is just sore from being held open for about an hour but the taste has been happening for about a day and a half I am worried that it may be an infection even though I have been carefully brushing my teeth twice a day and using a lukewarm saltwater solution is there really anything for me to worry about when it comes to that and is there a way to get this horrid taste out of my mouth so I can stop losing my appetite I am also on contraceptives so that is why I am a little worried that it may be a dry socket but I do not have the excruciating pain which is what confuses me",
        "input": "",
        "output": "hello it is very strange that you have all your wisdom teeth removed at the age of 14 these teeth normally start to erupt or come through at the age of 18 years or later when they start to cause trouble and we think of getting them out anyway if you had all the four removed or even one of them and had the wound closed with stitches check in the mirror and see if the stitches are still there in which case you are unlikely to be having a dry socket if you however find the socket or the hole that was holding your tooth open it is more likely a dry socket and it is best to get back to your dentist where you had the operation to get it cleaned and covered with a dressing until then continue brushing your teeth and rinsing your mouth with salty lukewarm water or you may use an antiseptic mouthwash such as listerine or chlorhexidine instead"
    },
    {
        "instruction": "hello doctor I have a question about syphilis I am 29 years old female I am not sexually active but I got engaged recently and my fianc had previous relationships he only kisses me sometimes which I am worried that by kissing some disease might be transferred to me from him I got skin rash on my palms and feet days ago and when I was searching I came across syphilis can syphilis be transmitted through a kiss I went to a doctor and he told me it is a skin virus hfmv and gave me antibiotic cream I did not mention the kissing part to him but he took blood test cop was normal also blood count test was normal I did not mention this to my partner yet I am really worried that it could be some other disease",
        "input": "",
        "output": "hello syphilis cannot be transmitted through kissing it is only transmitted through oral anal and genital sex however syphilis can cause oral ulcers if you kissed someone with an active oral ulcer then the risk of getting syphilis through kissing may occur is there anything else I can help you with or anything that is not clear to you I would gladly clarify them"
    },
    {
        "instruction": "hello doctor I was diagnosed with parkinson last year at the age of 45 I am on azilect since then my symptoms are mild stiffness lately I did not sleep well and I suffer from res about 5 nights per week I do sport but everything which required quick movement I am not able to do it well my neurologist suggested that I start sifrol er 26 my should I start or not I have a neuro patch samples my which I tried days ago I sleep better and have more ability to move quickly so I see the difference but I feel headache little bit should I start treatment with agonistes dopaminergic what is the best first treatment for early onset in my case is there neuro my could I take neuro my each two days",
        "input": "",
        "output": "hello I read carefully your question and would explain that in the early stages of parkinson disease in young persons it is recommendable to start treatment with ima which you are already taking azilect and a dopamine agonist in the this regard both neuropro and sifrol er would be good treatment options dopamine agonists can help improve res too you can increase the dose of neuropro to my daily after two weeks headache and increased sleepiness are common adverse effects of this drug if you do not tolerate it you can switch to sifrol er"
    },
    {
        "instruction": "hello doctor hope you are fine and doing well my mother has been diagnosed grade breast cancer last month she had abscess drainage last month on left breast so now she is taking femara 5 every day and took zometa 0 my recently as per doctor advise so the next day she felt sick like fever the next day she was felling weakness and then lost consciousness temporarily for 30 seconds then we took her to the emergency they did some tests which they found the sugar level was 31 pop level was 18 pco2 was 26 and now she is fine and under treatment so doctor I selected you as our second opinion and I will keep following up with you concerning her treatment I am attaching all the reports and doctor advise which we received here please check the reports and doctor note and advise in detail",
        "input": "",
        "output": "hello I have gone through all the reports it looks like she is having a metastatic inflammatory breast cancer with lung and bony metastasis my recommendations she needs to control her diabetes with diet exercise and medication consult a diabetic clinic or endocrinologist replace zometa to denosumab if possible as her kidney may be suffering from diabetic nephropathy denosumab is more effective and comparatively safe for kidneys after denosumab she needs calcium and vitamin supplements breast abscess once drained can recur so doctor should examine it at every visit also in case of fever one possibility may be reaccumulation of abscess as she had an episode of temporary loss of consciousness it can be related to sudden drop of calcium after zometa or can be related to some brain pathology if she will develop same symptoms one more time she should do an mri brain with contrast she has a multilevel disc disease with thecar compression need a neurosurgical review urgently regarding treatment of breast cancer she should continue with letrozole but alone it is not enough so need to add palbocicib or go for letrozole plus fulvestrant continue for to months followed by it scan workup etc for reassessment before further decesion"
    },
    {
        "instruction": "hi doctor my question is for a child years female keg symptoms has frequent urination during day minutes hour starting from about a month ago if she wakes up at night she will go pee she is diagnosed with pollakiuria and cystitis the symptoms started with gradually more and more frequent urination she has no pain when urinating or during a medical examination of the lower higher abdomen stool is normal consistency with a frequency of 3 days other medical condition general condition is okay she has constant small pain around the belly button since she was little unconnected to what she eats time of the day or stool pee she is used to ignore it she has a light form of vulvitis meaning it gets red and starts scratching so in order to fix this we use a dermatologic creme recommended by a dermatologist cicalfate before bed each day we wash her and use the creme and the skin returns to a normal aspect if we keep using the creme we tried other crimes as well mostly they work but if we stop the treatment it starts inflammation again there is no kind of liquid or secretion from vagina",
        "input": "",
        "output": "hi the child has only day time frequency if she wakes up then she voids this is very significant history this means there is no organic disease a diseased bladder will lead to frequency day and night no constipation normal urine examination normal ultrasound findings such frequency is transient behavioural issue do not pay attention to her demand to pass urine neither positive nor negative response stool habits are important avoid constipation during this transient period of symptoms may give tablet oxybutynin my extended release after breakfast if persistent symptoms repeat urine analysis no need of culture if no significant pus cells leukocytes"
    },
    {
        "instruction": "hello doctor I am a 17 year old male I have an extremely poor back posture it came from forever not keeping my back straight and watching to reading and other sedentary activities that leave my back hunched over now despite being skinny my core is lopsided there is no tone whatsoever and I imagine it had done a lot of mental effects as well I would also like to mention that I cannot push out my belly and breathe deeply without hurting my lower back when I try to stand up with correct posture I shake uncontrollably as if I have no stability I want to know if there is any possible program to help with this to get me back on track physically are there ways for me to recover from the mental and respiratory effects too I have pictures of me to give you an idea of what I am dealing with what exercises can I do to develop muscles here",
        "input": "",
        "output": "hi I have seen the pictures yes you can get back to normal if you start now your back does not look too bad you need to start an exercise program called mckenzie back stretching exercises mckenzie back strengthening exercises core strengthening exercises shoulder deltoid strengthening and trapezius strengthening exercises these exercises will help you with all your problems also start yoga and breathing exercises slowly and then build up do all this under the supervision of a physiotherapist this will really help you I hope this helps exercises follow up after one week of starting exercises to tell me about the improvement so that I can change the level of exercises"
    },
    {
        "instruction": "hello doctor I am 35 years old my triglycerides are 628 I am taking adilip 135 but since I have started taking the medicine I have lost my appetite I I do not wish to eat anything and I am feeling heavy stomach always simultaneously I am having extremely dried lips round the clock I have started using olive oil in my food I take one glass of milk dairy non creamy daily my diet is three chapatis in the morning five chapatis in the noon one bowl of roasted chooda in the evening three to four chapatis at night and I glass of milk I take approximately 5 liters of water in a day kindly suggest me why I am having dry lips and loss of appetite do I need to change my diet",
        "input": "",
        "output": "hello I have thoroughly gone through your case and can well understand your genuine concerns what about the family history of high cholesterol in your family is there family history of diabetes in your family is there heart disease history in family anybody in your family have diabetes are you a diabetic if not ever got screened for diabetes do you have hypertension if not have you ever screened for it any other medications you are taking for any reason the symptoms you have may be due to side effects of the fenofibrate you are taking for hypertriglyceridemia diabetes also leads to the issues you have fasting lipid profile fasting blood sugar levels do not just tell me the triglyceride levels make a picture of the reports and please upload them in a follow up query along with the aforementioned asked details in the history your best treatment is lifestyle modification add exercise in your routine life jogging for 10 steps at a healthy pace daily will lead to a fair decrease in your triglycerides levels olive oil is also good canola oil is also a good option for cooking but try to cook in non stick utensils without using more than a few drops of oil no meats fried food fast and junk foods beverages alcohol and cigarettes no added salts and sugars no spices and caffeinated drinks for you avoid cheese yogurt ketchup etc you need to change the diet one chapati for breakfast and one for lunch half chapati at dinner you are taking extra diet our diet makes cholesterol not only fatty and oily meals lead to the production of cholesterol but also the sugars carbohydrates and proteins amino acids also lead to the manufacture of de novo cholesterol through a metabolic process called metabolic cross talk take salads vegetables and fruits fish is better for protein intake"
    },
    {
        "instruction": "hello doctor I have had a tingling pain all over my body for weeks the pain however is mainly located in my chest I have almost had any heart disease ruled out can a bad cough for a few weeks cause subluxation should you be able to feel a subluxation do all vertical subluxations show up on rays what is the rate of patients who come into chiropractic treatment with subluxations and can subluxation cause deep chest pain or pain in various areas of the body",
        "input": "",
        "output": "hello yes cough can lead to rib head subluxation although not a common mechanism of subluxation but cases are seen in patients with vigorous coughing episodes careful palpation of the region can point to the abnormality they usually go back into place on their own if not they should be best dealt by a chiropractor or orthopedic surgeon self adjustment techniques are available over the internet by videos ad images but a lot of people find it hard to learn or perform it during the first instance rib subluxation is usually anterior or posterior hard to visualize on ray and are mainly clinically diagnosed from history and examination these subluxations come quite often to chiropractor or orthopedic surgeon but do not cause pain in various areas of the body or tingling all over the body I hope this helps"
    },
    {
        "instruction": "hello doctor I am months pregnant now before pregnancy I have been suffering through allergic rhinitis sneezing and dry coughing but as my pregnancy started I got a cough with white phlegm I wanted to avoid medicines during the first three months of pregnancy but due to late night coughing and phlegm I went to see a gynecologist at first she tried to control my cough through a mild cough syearup with ivy leaves but cough does not go away then my gynecologist asked me to visit a pulmonologist after a detailed checkup I was diagnosed with bronchial asthma he advised me to take budesonide with formoterol dry powder inhaler and montelukast sodium I am feeling better nowadays I do not have a cough now I do visit my gynecologist for a monthly checkup and she knows that I am taking dry powder inhaler for bronchial asthma this month my gynecologist advised me to take rejuva tablet that contains vitamin and it is a kind of nutritional supplement for bone health and fiore tablet for iron deficiency my he is nowadays my question is it safe to take iron tablets and nutritional supplements while taking bronchial asthma medicine I am afraid that may be due to iron I will get cough again secondly I am extremely worried due to the reason of diagnosing bronchial asthma in pregnancy I am taking medicine for asthma and I have heard it affect the unborn baby in terms of low birth weight but my asthma is under control due to this medicine and I am feeling much better nowadays I visit my gynecologist monthly for baby growth and she says it is perfectly fine note I cannot take dairy products citrus fruits and rice because I got cough and throat irritation due to bronchial asthma",
        "input": "",
        "output": "hi you should continue bronchial asthma medicines as it is required to control your symptoms and to make you healthy if you do not take it then the effect on baby can be worse than while you are taking as baby growth is fine do not worry about it iron and calcium are also minimum requirements during pregnancy and if you do not take it and your he is down during delivery then it can be very dangerous if you bleed more so it is required during pregnancy and mostly it will not have any effect on bronchial asthma"
    },
    {
        "instruction": "hello doctor I have observed a white smegma on my penis head there were irritation and red bumps on it before but I oiled it so now I do not have any pain or irritation but in the morning the white smegma is still there and my foreskin is hard and rough what should I do please help",
        "input": "",
        "output": "hello if your foreskin is hard and rough you may get benefit from removing the foreskin I circumcision I suggest you show it to the urologist nearby and get it done"
    },
    {
        "instruction": "hello doctor I fell last sunday and hit my face including my front teeth four teeth and top gum become numb for the past eight days I can bite my teeth though I feel numb please help",
        "input": "",
        "output": "hello I understand your concern do you find any changes in the way your teeth rest do you find any tooth that hits when you bite on any tooth sensitivity any fractured or chipped tooth this is not normal and you need to visit a dentist straight away and get your jaw and front teeth rayed the dentist may check for the vitality of those teeth if the teeth are vital has sensation and is disturbed you will require a splitting procedure that will hold your front four teeth in position for the next two weeks if the teeth had lost its vitality no sensation you may require a root canal procedure to remove the clotted blood from inside the teeth this procedure prevents a future color change of your front teeth due to clotted blood the injured front teeth get discolored in the future if left untreated please visit as soon as possible and get it checked because if there was clotted blood inside the injured teeth or if the teeth are slightly disturbed this could cause complications like cysts or jaw issues in the future I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 24 year old male my main issue is people say that I behave like a 10 year old boy I think I have dyspraxia I lack gross motor skills I cannot play any sports I cannot drive a car properly people get averted due to my behavior I have bad handwriting and I attempt things in a clumsy way I have an unusual gait so basically I have learning disabilities in everything I have a migraine and bipolar depression too people often tell me that there must be definitely some maturity problem with my brain as I behave very oddly please look for any developmental anomalies in my brain mri or any abnormalities I have attached the file currently I am using htp anti depressant for my mood enhancement",
        "input": "",
        "output": "hi as discussed earlier there is no doubt about the diagnosis of motor coordination disorder or dyspraxia many of your problems can be explained on the basis of dyspraxia itself and I feel you are right in saying that you have dyspraxia however your current post does not contain any file or attachment for view I request you to attach the file in proper format or possible way so I can see whether there is any structural abnormality I hope this helps"
    },
    {
        "instruction": "hello doctor I am a year old male today I woke up and before taking a shower I felt a burning sensation when I touched the spot between my left leg and my scrotum then I discovered some wounds similar to cuts in the area they were not there yesterday I also have to mention that they had appeared before in the same area about three times in the last three years and they usually disappear in about three or four days I have a partner and I am really worried about this being herpes because if that is the case I would absolutely consider leaving her just to avoid her my problems I had sex with two strangers with one of them about four months before getting this for the first time I also removed my pubic hair with a machine about two weeks before this",
        "input": "",
        "output": "hi what is the complaint in it is it on one side or both sides have you ever noticed any blisters what is your profession looking forward to your response in order to help you"
    },
    {
        "instruction": "hello doctor I had an experience with a tooth as a child that I have never received an answer my baby teeth were always kept pretty clean and well taken care of but this one incident happened where one tooth literally disintegrated in a matter of seconds I was sucking on a sucker and noticed that small white hard particles were all over it I was not sure what was happening inside my mouth and realized about 4 of a molar baby tooth was gone and I was spitting out hundreds of small pieces of the tooth I went to my dentist to remove the rest of the tooth and my adult molars came in fine what could have happened",
        "input": "",
        "output": "hello I have gone through your query and understand your concern when did it happen at what age how many molars any history of bottle feeding diet history of dental checkups and dental treatments had during that period more history of the details would help it could be tooth demineralization caused by occult cares or backward cares this cannot be diagnosed clinically by the dentist and may not be apparent to our eyes it can only be seen in a radiograph primary or baby teeth are more prone to decay even if well maintained if not decay the baby molar could have demineralized and become weak enamel by birth sometimes medicines taken by mother during her pregnancy typically during the in vitro formation of that tooth bud could have caused this demineralization if not decay but the most common likelihood is by hidden decay I hope this helps"
    },
    {
        "instruction": "hello doctor does methamphetamine interfere with local anesthesia my friend was told she would not have to stop adderall before surgery I know that is not the same but is there anything particularly dangerous about methamphetamine and local anesthesia what about phentermine",
        "input": "",
        "output": "hi welcome to icliniq com as such local anesthesia is safe and one can readily go through the procedure it is recommended to avoid any sort of illicit substances during anesthesia"
    },
    {
        "instruction": "hello doctor I have been having severe pain in my left side for a few months now I have been to the doctors who told me it was nothing to worry about but the other day I went to the toilet and I was urinating blood I went back to the doctor who did a urine dip test and I have leukocytes 500 blood 200 and so 025 I am worried as that is a lot of blood in my urine it is the highest mark I have been given ciprofloxacin 500 my for seven days I am scared in case this does not clear up I am worried sick as I have is multiple sclerosis",
        "input": "",
        "output": "hello welcome to icliniq com I have gone through your queries you are having hematuria blood in urine when someone gets hematuria it has to be taken seriously and has to be investigated in detail please undergo the following investigations us rub and per ultrasound kidney ureter and bladder and post vidal residue urine is culture test urinalysis urine for malignant cells for three days serum creatinine but do not get worried as you are young and the possibility of benign conditions as a cause of hematuria is more in your case meanwhile you continue with the course of antibiotics"
    },
    {
        "instruction": "hello doctor I am a 47 year old male I am a known case of bronchiectasis since childhood is there any new treatment or new interventions for the best quality of life",
        "input": "",
        "output": "hi I can understand your concern yes a new pulmonary antioxidants is available may I know his current medications is put pulmonary function test report done or not"
    },
    {
        "instruction": "hello doctor would you please take a look at the attached pictures and diagnose as the felt symptoms are rare itchiness is this hav or vestibular papillomatosis",
        "input": "",
        "output": "hi I have seen the pictures it is vestibular papillomatosis but tell me the answers to some questions since when it is present painful or not is it also present in areas other than mentioned in the photo if it is since childhood not painful and not present anywhere else then it is vestibular papillomatosis there are many thoughts on the condition and some also believe that it can be caused by hav human papillomavirus it is a debatable issue so if you are confused with two or three opinions then you can go for biopsy for confirmatory diagnosis but as I said it is vestibular papillomatosis on the first look with symmetrical spread only on labia"
    },
    {
        "instruction": "hi doctor I have a unilateral submandibular lymph node swelling on the right hand side of the neck I had an ultrasound and at this time the lymph node measure 6 am and the onset were sudden with pain after three course of antibiotics augmenting two doses and clindamycin one dose I was referred to have another ultrasound this was after two months of the initial appearance of the lymph node this ultrasound scan showed the lymph node had become am but was still present so the doctor ordered fac the results of this have come back and there is no sign of metastasis or no sign of to lymphadenopathy the doctor has suggested yet another course of antibiotics of doxycycline and remeasure the lymph node after three weeks the fac said it was an inflammatory lymph node does this mean reactive lymph node what else could be causing this",
        "input": "",
        "output": "hi I want you to be completely calm because according to the course of the lymph node enlargement symptoms and investigations the lymph node enlargement is just an inflammatory reaction it is not a tumor at all just complete your antibiotic treatment then follow up on the lymph node again just for assurance the lymph node may decrease in size but never comes to its normal size again this is normal now about causes any neck mouth or pharyngeal inflammation can cause inflammatory enlargement of a submandibular lymph node even without the previously mentioned inflammations a submandibular lymph node inflammation can start by itself as the lymph node works as a filter for the blood picking up pathogenic microorganisms"
    },
    {
        "instruction": "hello doctor I was diagnosed with if last week my two rays two lung function tests and hrct scan showing that I had scarring but I am confused because I feel better than I have felt in 10 years I have always smoked and had cough for years I have been on a diet and have lost one stone so far I have been doing some tests at home such as at rest I can hold breath for minute 25 seconds with relative ease breaths per minute sitting at rest are 15 and my blood oxygen levels at rest are between 95 to running up and down stairs three times my blood oxygen levels drop to around 91 to 92 and it rises to 95 to 96 in less than a minute when I wake up in the morning my blood oxygen levels have been around 86 rising to 92 to 94 in around two to three minutes the other thing is that when I had my second lung function test five months ago I was at the end of a cold or flu I did mention this to the consultant do you think I could have been misdiagnosed is it worth me asking for a second opinion please guide",
        "input": "",
        "output": "hi for further information consult an general practitioner online"
    },
    {
        "instruction": "hello doctor I have a concern about my cholesterol levels and the possibility of an underlying condition I am a 37 year old female with uncharacteristically low cholesterol I donate blood regularly which gives me the opportunity to have my total cholesterol level tested about a year ago I created an online account with my area local blood bank where I found they keep a record of your past health screenings it was at that time that I realized how low my cholesterol was the lowest being 18 my which was several years ago when I was in my 20 but most recently and over the past year my levels have averaged in the 134 137 my range for my age I have been overweight for close to 10 years I had never dieter or limited my cholesterol intake I began researching online for any information that might explain levels this low while there is an abundance of information regarding high cholesterol regarding its causes and risks there is practically no information available regarding low cholesterol levels or causes outside of the obvious low cholesterol intake vegetarian or vegan diet or use of cholesterol reducing medications such as statins with one exception celiac as I began to read through the signs and symptoms of this disease I could not believe how many I had been experiencing in fact some of these were things I never even realized were symptoms of anything one specific symptom however that each and every article I read seemed to use to define a celiac was weight loss or being severely under weight months later I stumbled across an article about celiac disease going undiagnosed because of the misconception that with celiac you cannot be overweight so I decided to raise the question with my go unfortunately after giving the doctor a rundown of my symptoms and explaining my concerns as soon as the word celiac came out of my mouth he quickly dismissed this as a possibility stressing that because I am not underweight and it was absolutely out of the question that I could have the condition he then dismissed all of my symptoms saying they were nothing to worry about and added that the lower my cholesterol was the better in his words I should be thrilled at how low my cholesterol was and I must have good genes and with that he sent me on my way for close to a year after that appointment I too dismissed all of these symptoms then six months back I was admitted into the hospital for an emergency cholecystectomy due to gallstones that caused me to have a severe gallbladder attack at the time I knew nothing about the gallbladder function or its purpose so there was no argument from me when the doctor explained that some people just get gallstones and the only way to treat gallbladder disease is to remove the gallbladder needless to say my week at home following my surgery I spent a lot of time learning about the gallbladder and almost immediately I found information describing the correlation between gallstones gallbladder disease low cholesterol and yes celiac this past weekend I attempted to donate blood and for the first time in my life I was turned away because my iron was too low I went online thinking my iron counts for previous donations would be noted in my wellness chart and although they were not my cholesterol result from my previous donation just 3 weeks after my surgery was down to 128 my would the fact that I am overweight truly rule out any possibility of celiac if it would what other conditions might explain all of my symptoms are there any others conditions with the same or similar symptoms also present with weight loss or being underweight if celiac should be ruled out due to being overweight what can I do to convince a doctor to test me for it",
        "input": "",
        "output": "hi I welcome you and want to assure you need not worry as everything is going to be fine if proper care and treatment is opted in for I have thoroughly gone through your case and can well understand your genuine health concerns there are a lot of reasons for this to not being celiac disease diarrhea in celiac is very prolonged and there are watery stool not only pale they are greasy and floating on the pan they are foul smelling too"
    },
    {
        "instruction": "hello doctor I skin is too oily on my face but skin around my mouth and nostrils is very dry and flaky it has also been making a ring form around my mouth it is of different color from the rest of my skin tone how can I fix this please guide this",
        "input": "",
        "output": "hello for further doubts consult a dermatologist online"
    },
    {
        "instruction": "hello doctor I am hepatitis patient my current status is as follows hbeag negative 010 hav antibody or ag positive 031 and hav dna quantitative per less than 17 iu my please advise whether this can be cured to become negative as it is affecting my career",
        "input": "",
        "output": "hello anti hbc both i'm and egg liver panel ultrasound of the liver in it and serum albumin if not part of the liver profile chronic hepatitis 2 chronic carrier state acute infection in window phase with less infectivity yes it is treatable but I would be able to give you a better answer once I have the complete set of blood work and ultrasound results revert back with the investigation reports to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I have some sores that have shown up on my buttocks it started off as red itchy bump and I used some apple cider vinegar on a few of them thinking it was ringworm and it scabbed I am not sure what these scabs are it does not look like the pictures I had seen of studs but I am wondering if I should be concerned about possible sad",
        "input": "",
        "output": "hi I have seen the pictures attached it seemed to be caused by a fungus named tina you have got a fungal skin infection you can apply clotrimazole ointment after consultation with dermatologist and take ibuprofen per oral wear cotton only and loose clothes avoid tight fitting jeans as that causes the buttocks line to closely approximate and the itching to aggravate for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor my symptoms over the last four months are as follows I sat down on my mother bed and could not get up I had severe pain in lower back on left side shooting down my leg they felt like electric shocks and it lasted for a little over a week during that time I had a lot of memory issues and I forgot my son birthday too three months back I had an episode of double vision was double out of my right eye but when I covered my left eye I could see during this period my head felt heavy it only lasted for about five minutes and then got corrected by itself the next day my eye was very sore it started to hurt when I look from side to side I had lot of flashing lights in my left eye that look like shooting stars on and off throughout the day I just did not feel very good I am having trouble finishing sentences the thought just goes away and I forget what I am saying the next day when I had laid down to rest I realized my left arm felt weird it was numb and tingling from the shoulder down I thought I would just take a nap and see if it got any better I woke up at still it was numb and tingling took a hot bath and got out but it remained the same it felt as if I had rubbed icy hot all over it felt very cold to me but not to touch by the time I reached er I was having trouble talking I could not get my words from my head to my mouth it was like they were getting stuck I had it scan done and laboratory tests all were normal er doctor recommended seeing a neurologist I got an injection of solu medrol immediately the following day I was stuttering and even my thoughts were stuttering the more I tried not to the worse it got both hands started tingling and there was left leg tingling from the knee down at night while I was lying on the couch I had excruciating pain on the left side of my face my entire cheek felt like it was going to explode off my face I took 800 my motrin the pain lasted for about 45 minutes and just stopped it did not gradually go away just stopped then the next day still felt off and very shaky I felt hard to even type or text I cannot focus on thoughts I had very fuzzy head along with stuttering my hands feet arms and legs still tingling on and off I have started feeling my scalp tingle as well following day had very shaky hands my hands hurt and felt weak it felt like I have been holding onto something really tight and just let go still do not feel right glasses were not helping eye still hurts and still seeing flashes of light next day I drank a very small amount of wine that was not even a full glass hands felt like they have been hit with a hammer and my scalp tingles so bad it made my eyes squint and gave a horrible feeling I have no energy I feel so tired and could not even cook supper my arm was too weak to brown hamburger meat head feels very strange like someone is pushing on the right side of my temple it is all still pretty much the same the following week my scalp tingling still stuttering along with a lot of weakness in hands and arms left leg has started giving out on me and had fall in my living room black out when I stood up I am still seeing flashes of light not sure what night this was but one night when I went to bed it was like my body had the hiccups and my arms and legs just kept jerking I woke up feeling really bad head hurt eyes hurt hands and legs are still tingling still stuttering sometime mid day I noticed my thoughts were no longer stuttering the stuttering was gone and slowly that day I started to feel better no more tingling scalp hands or feet for the most part this is how it has been since thanksgiving I had a very small amount of wine again not even a glass and felt horrible again scalp tingling body hurt and even fell into the wall other than a few little tingles here and the symptoms have stopped no more flashes in eyes and no pain other than headaches I am having some strange red and purple feet and hands my hands hurt when they get cold feet and hands turn purple in the bath normal mri with contrast what should be the next step",
        "input": "",
        "output": "hello for further queries consult a neurologist online"
    },
    {
        "instruction": "hi doctor I am 18 years old I have problem with my dad he is a kind of hitler I want to die I cannot live with him he hates me he abuses me every day please help",
        "input": "",
        "output": "hi I can understand what you are going through and you have my sympathies for the same for further information consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor I would like to know which avenue to go down to treat my issues I believe I have something wrong with my legs which cause my body to strain the first memory I can remember was having very excruciating pain in my legs at night when I was a young teenager as I got older my knees started to ache regularly the impact of walking and running has been very painful I cannot walk up a steep hill or even jog downhill or run without getting shin splints I am getting severe shin and ankle pain for many days even if it is only five minutes of jogging downhill the impact is severe I have tried exercise such as running on a treadmill and then my ankles became very red itchy and visibly swollen I have never had visible calf muscles and I am a thin build I have been active most of my life although I have never been able to build natural muscle in the bottom half of my legs most season of the year I get cold my ankles and feet will stay cold and no blankets or socks can warm them up as the cold feeling is internal in winter it becomes very painful and I become immobile because of the feeling my ankles and feet feel like a bag of ice I have had other problems like pinched nerves in my neck and severe tension headaches after seeing a chiropractor it was visible that my spine has become out of alignment in my neck and in my lower back a bone now protrudes on the left side of my buttocks and has been painful to sit on these problems have existed for a long time and progressed to further issues mentioned no doctor has been able to give me solid advice as there are many factors the doctors have not been patient enough to listen to my issues thank you if you can help me in any way possible",
        "input": "",
        "output": "hi for further information consult a general practitioner online"
    },
    {
        "instruction": "hi doctor I am 27 years old I have pain inside my anus my anus outside is normal with no pain and injury along the same line of my anus right inside I feel the pain no blood and passing stool also easy when I sit on the toilet I used to sit with legs spread out a bit otherwise when I walk or before I sit down or when I intend to change my sitting or lying position I feel pain no other sign of sickness present I do not have fever please note that sneezing coughing or even spitting out increases the pain also in the morning the pain seems to reduce but as the day progress the pain increases I am out of town for a project so I cannot go for any test there is also some loss of appetite the same thing occurred before two years also currently I am taking of ofloxacin and ornidazole prowl and cremaffin I just started taking them this morning but no effect as of now",
        "input": "",
        "output": "hi for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor two years ago my brother started noticing a red circle under his eye next to his nose it was in the shape of a pill from time to time it causes skin peel once he removes the peel it leads to redness and blaze also it is growing with time when he met a dermatologist he gave him some medications it includes momenta sebodiane is from noreva kelual is shampoo from ducray and funzol 150 for permanent disappearance",
        "input": "",
        "output": "hi I have read your descriptions and also read the ingredients of medicine which you have used for further information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor I have some weird redness on my cheeks all the time no matter what weather it is I have attached my photos for your reference it is just there and it does not hurt at all but I want to overcome it is there any way I am 18 years old now thank you",
        "input": "",
        "output": "hi I have seen your pictures and description it looks like melasma or post inflammatory hyperpigmentation melasma is an acquired pigmentation of sun exposed areas that receive excessive sun exposure including the cheeks upper lip chin and the forehead are the most common locations melasma can be difficult to treat the pigment of melasma develops gradually and the resolution is also gradual regarding treatment there are certain general measures to follow other treatment options are glycolic acid chemical peel and yag laser neodymium doped yttrium aluminium garnet with variable results you need regular follow up with dermatologist for further information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor I am 20 years old and struggling with my health right now I went to doctor and he asked me to get certain tests I have been vomiting since four months but most of the time while travelling in the metro though I have been traveling through metro since many years never faced such problem the fluid that I throw up is clear like water two weeks ago I had mild abdominal pain which roughly lasted for three days I have lost my appetite and it is resulting in weight loss I feel weak and tired most of the time my hand and leg sometimes due to headache or abdominal pain get really cold what could I probably be suffering from what am I dealing with please help",
        "input": "",
        "output": "hello revert back with the answers to an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I have been sexually active since four months we initially did not use protection in order to avoid pregnancy I have used emergency contraceptive pills for a few times now my periods got delayed by a day or two but with no major changes in the cycle last month I found spotting around the time of ovulation and assumed that it was a sign for fertility this month again I found spotting but it is a little severe not much as during periods but still more than just spotting is there anything to worry",
        "input": "",
        "output": "hi for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I have been having red itchy bumps on my face and arms for the past three weeks I was given fluocinonide hydrocortisone and hydroxyzine by my doctor and dermatologist the medications have not been helping at all please help",
        "input": "",
        "output": "hi I have seen your picture and written descriptions it looks like popular urticaria or urticarial vasculitis or polymorphic light eruptions pile you can try 1 mometasone cream twice daily over arms and fluticasone 05 cream once daily over face along with tablet monteder combination of montelukast and levocetirizine once daily for five days if your bumps did not disappear in five days then go for skin biopsy to rule out urticarial vasculitis and pile you really need regular follow up to dermatologist if your lesions does not subside for further information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor my daughter is months plus now she has started with solid foods but because of being new mother I am mainly rely on books for her nutrition or diet however I am looking for expert advice so that I can give her the best chart below I have explained her current routine I am a working mother and currently on maternity leave so in the morning after waking up I feed her breastmilk thereafter during 10 am she takes mosambi or pomegranate juice in the afternoon between 12 to am she takes water of moon dal or water or rice plus moon dal between to am she takes extracted water of boiled apple in case she is awake I feed her breastmilk in the evening if she is more hungry I give her moon dal water please suggest a good diet chart for her when should I take her next updated diet chart her pediatrician advised not to give any external milk or formula can I give her cerelac instead once I start going office apart from all these I give her boiled water to drink sometimes and one day I gave her conut water she liked conut water a lot and drank a lot but normal boiled water she takes very little kindly provide a good diet chart for my daughter also her baby sitter is asking me if she can give my daughter biscuits dipped in water or milk how much nutritious it would be to give my daughter biscuits and from which age it can be given my baby weight is keg and height is 69 am thank you very much in advance",
        "input": "",
        "output": "hi for further information consult a dietician online"
    },
    {
        "instruction": "hi doctor I have acne like bumps all over my upper arms I have tried retin a but it did not help please guide me",
        "input": "",
        "output": "hi is your acne like bumps only localized over arms or do you have these kind of eruptions over face upper back and chest if yes please review with picture with your descriptions it seems you are having keratosis pilaris which usually localized over upper arms keratosis pilaris kp is a genetic disorder of keratinization of hair follicles of the skin it is an extremely common condition that manifests as small rough keratotic papeles often described as chicken bumps in characteristic areas of the body particularly the outer upper arms and thighs the affected area may be washed once or twice a day with a gentle cleanser such as dove or cetaphil you can try combination product of lactic acid lotions amlactin or alpha hydroxyacid lotions glycolic body lotions urea cream carmol 10 salicylic acid salex lotion and topical steroid creams triamcinolone 1 locoid lipocream retinoic acid products such as tretinoin retin a best results may be achieved with combination therapy for further information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor I am a 25 year old male there is a lot of itchiness in eyes for the past three to four days please tell me what to do which medicine can I take",
        "input": "",
        "output": "hello for further information consult an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor my grandmother was diagnosed with breast cancer three years ago and had a right mastectomy she however did not have chemo or radiation she has a little extra fat to the lateral area of the breast that after surgery it looked like a small third breast right over the old incision has developed a large ulcerative cauliflower like wound the tumor is protruding and is very vascular it currently has no odor but it is bright red and bleeds excessively once the dressing is removed she is 86 years old with a history of high blood pressure cold chef diabetes cad tia and pacemaker she still ambulates alert and oriented also she understands what is going on we visited the oncologist and were told she will either need to undergo chemo or radiation the surgeon who did mastectomy is recommending surgery to remove the protruding tumor which is the best option to do first my family is very leery about her ability to handle chemo and frankly does not want her to have chemo we know that removing it does not cure the cancer should we do radiation first then remove it with surgery if we were to consider chemo should we do some cycles first then remove it with surgery which option would you say is the safest route we want to keep her around many more years if we can thanks for your time",
        "input": "",
        "output": "hi here are my suggestions assuming that you want to undergo full treatment the best method would be to start chemo and radiotherapy the cycles of chemotherapy will depend on the medicine chosen by your oncologist this will reduce the tumor size then go ahead with the surgery and then complete the treatment with further cycles of chemo and radiotherapy another option is surgery followed by a few cycles of chemo and radiotherapy the above options are important because if left untreated the site may get infected other complications are of course to be considered the other option is no treatment at all just palliative medicines to keep her comfortable this way she can live a comfortable life considering that you have said she is stable please note that I am just explaining the option the choice of treatment would be your decision I suggest getting a pet scan before deciding for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I was diagnosed with anemia due to heavy periods I was told to double up my iron supplements my iron is already high and ferritin is low my binding is not even registering my results are as follows ferritin 0 no my iron ug do iron binding capacity and transferring saturation not calculated due to unsaturated iron binding capacity of less than ug do can you help me understand my results thank you",
        "input": "",
        "output": "hi based on your query my opinion is as follows continue iron supplements until ferritin becomes normal repeat biochemical tests after three months if early tests needed reticulocyte count will be more helpful revert back after three months to a hematologist online"
    },
    {
        "instruction": "hi doctor my baby girl is weeks old and she has a problem with her right nose she cannot breathe and the physicians said me that it is an obstruction but not an imperforation the physicians tried to aspire and the secretions are gelatin the secretion is bacteriologically negative the next step is to dilate surgically with a thicker tube in nose is there any tube to dilate this nose without surgery I am looking forward to your answer please help",
        "input": "",
        "output": "hi for further information consult an ent otolaryngologist online"
    },
    {
        "instruction": "hi doctor I have a small formation in my leg which developed approximately before three years I have attached the images for your reference it is brown in color somewhat similar to a burn it itches sometimes and it is very dry in nature this formation was initially around am but now has increased in size to am which is the reason of my concern whenever it itches I only use antiseptic lotions suthol besides I have parkinson disease and I take sleeping pill every night please advice",
        "input": "",
        "output": "hi I have seen your pictures and well understand your concern you are having lichen simplex chronicus lac it arises because of repetitive scratching or rubbing I could see thickening of the skin with variable flakes lichen simplex chronicus usually described as stable itchy and thickened one or more areas however thickening of the skin occurs on any location that the patient can reach like nape of neck extensor forearms and elbows scrotum upper medial thighs knees lower legs and ankles in your case it involves extensor aspects of ankles cause for lac includes age related dryness venous insufficiency like tortuous veins or pooling of bloods due to prolong standing or weakness of blood vessels wall due to aging and eczema in old age due to bath with hot water asteatotic eczema are common factors age related dryness venous insufficiency like tortuous veins pooling of bloods due to prolong standing weakness of blood vessels wall due to aging eczema in old age due to bath with hot water asteatotic eczema skin biopsy for histopathological examinations and serum immunoglobulin 1 lichen simplex chronicus neurodermatitis lichen simplex chronicus apply xerina cream glycolic acid or moisture cream combination of urea liquid paraffin propylene glycol and lactic acid wait for 15 minutes and then apply topical steroids with salicylic acid should be applied twice daily for two to four weeks and also take one tablet levocetirizine once daily for similar duration propysalic of lotion clobetasol and salicylic acid combination occlusive dressing will be more helpful the method of occlusion is after application of propysalic lotion put flat polythene cover then cotton bandage and leave it for whole night for two to three days occlusion is not need in day time you can also try injection kenacort triamcinolone acetonide 10 my 1 my am intralesional at the three weeks interval should be given by dermatologist try to avoid scratching whenever you feel itch apply moisturizer or dip wet cotton in normal tap water and put over it revert back after a month to a dermatologist online"
    },
    {
        "instruction": "hi doctor a year ago I got a biopsy for two nodules in thyearoid the result for one was benign and the other inconclusive this year I went back to a different doctor to redo my indeterminate biopsy she advised me do for both again because through ultrasound they look angry or vicious in my right side which was benign is the largest at 6 mixed solid and cystic with vascularity and the other that was indeterminate is more of a solid or heterogeneous this time my report came back as indeterminate for the benign one and the other as 40 suspicious for cancer this was done through firma gene expression I also have one more nodule on the lower portion that is too small to test doctor is pushing me for thyearoidectomy I am still young and active I hate the thought of removing such a vital thing in my body and taking pills everyday just on chance if I come to know it as cancer then I have no problem to take it out is there any more in depth test I can do before I change my whole life what would you do I am scared and I just feel stuck unfortunately I do not have my reports any advice would be deeply appreciated thank you",
        "input": "",
        "output": "hello for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I have ringworm on my arm I used daktarin and that did not work then I used cider vinegar and it has turned black should I be worried",
        "input": "",
        "output": "hi I have read your query in detail and do understand your concern also I have viewed the attached pictures this is irritant dermatitis which has developed due to the use of vinegar it is very less probable that the fungal infection has been cured proper oral and topical medicine for one or two months is needed to cure your disease remember to wear loose cotton clothing especially when at home avoid hot humid climate keep the affected area dry and avoid synthetic innerwear if any other family members are affected they must also be adequately treated to prevent recurrence also get your blood sugar levels tested meanwhile you may apply antifungal cream such as clotrimazole twice daily over the lesions of ringworm revert back with the answers for the above questions to a dermatologist online"
    },
    {
        "instruction": "hello doctor which oil is safe to use there are many theories and so I am confused some chocolates and snacks have trans fat content as 01 or 02 or oz are they safe to eat do you have any suggestions for chocolates and snacks brands which are healthy without toxic chemicals which is the good time to drink tender conut water without disturbing digestion milk sometimes gives me bloated feel and also triggers bowel movement what is the good alternative to get equivalent calcium I am trying to drink cumin water daily for good digestion is it better to heat it directly in water or powder it and then heat in water latter has any better advantage in terms of nutrition when is it good to drink it",
        "input": "",
        "output": "hi for further doubts consult a nutritionist online"
    },
    {
        "instruction": "hi doctor please comment on my ultrasound report single fetus in cephalic presentation placenta anterior gr and amniotic fluid is adequate afi 16 fetal measurements are as follows bad 80 my he 306 my ac 280 my and fly 58 my it humerus 52 my radius 45 my ulna 50 my tibia 50 my and fibula 50 my and it humerus 51 my radius my ulna 49 my tibia 50 my and fibula 50 my get age 32 weeks days fetal weight is 1811 fetal heart pulsations 141 beats per minute fetal tones and movements are normal no obvious lethal structural congenital anomalies fetal biophysical profile is good with score 10 doppler study shows umbilical artery d 57 ri 61 and pi 91 uteroplacental and fetoplacental blood flow velocities are within normal limits no diastolic notch in the uterine arteries cerebral flow pattern is normal the conclusion is ultrasound findings are suggestive of single live fetus of 32 weeks and days in cephalic presentation uteroplacental and fetoplacental blood flow velocities are within normal limits all long bones are 25th to 50th gentile and normal",
        "input": "",
        "output": "hello for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hello doctor I am on the generic form of seasonique and I am starting the third month for the past two weeks when I go to the bathroom and I wipe there is this brownish stuff on the toilet paper then when I had sex the other night this big glob of red stuff came out of me when I got off of my partner is this normal is there a way to stop this",
        "input": "",
        "output": "hi I have read your complaints seasonique is an extended cycle birth control pill where period occurs once every third month the pills are active pills and remainder pills periods will occur when you are taking the reminder pills it seems likely that you are taking reminder pills which lead to periods could be of longer duration when on seasonique breakthrough bleeding is also common in the first three months of usage the body takes time to adapt and it could also be because of that please consult your doctor if bleeding is persistent or heavy the big blob that you have mentioned it would have been better had you mentioned the size nevertheless I hope that you did not miss any dose in between missing dose increases the chance of pregnancy if you did miss a dose please get an ultrasound done to rule out if an abortion occured you could also get your hemoglobin level tested as this could cause persistent bleeding if your hemoglobin is low you need to get that corrected first if all investigations are normal and still the bleeding is causing discomfort you could stop using seasonique and choose some other method of birth control I hope this helps"
    },
    {
        "instruction": "hello doctor I had an umbilical hernia repair days ago it went fine but 10 days later when I laid down my belly button pup out one inch then went back down the next morning my belly button is out half an inch my surgeon said just wait for a couple of days to see if it goes back down I need to know if I should wait or get in right away the belly button is a little tender",
        "input": "",
        "output": "hi as it has been only 10 days since your surgery I suggest you wait for a few more days and see your surgeon if necessary it is quite likely that there may be a small collection of fluid in the region which may get absorbed or may need aspiration it is quite unlikely to have a recurrence so soon unless the surgery did not go well if the swelling appears on coughing or straining it may suggest a recurrence it is best tested by the surgeon as attempting the same at home may precipitate a recurrence take adequate rest be active take a good diet avoid straining or lifting weight for at least six months see your surgeon if it still persists next week I hope this helps"
    },
    {
        "instruction": "hello doctor my wife is 25 years old she was pregnant for months last week we lost the kid due to some troubles got aborted and was not done but the fetus got out normally after medical treatment my question is within what time we can engage in sex again what all care should be given to her I mean any medicines to increase her strength when we can try for the next baby",
        "input": "",
        "output": "hi welcome to icliniq com very sorry to hear about the loss you can start trying for a baby after one month as the uterus and hormones take that much time to come back to the proper state but if it is only sex then two weeks is fine there is no special care or medicines required for her just give her good nutritious food like fruits and vegetables that is enough if her hemoglobin is less then iron supplementation tablet roofer for a month or two is needed but if her hemoglobin is normal nothing is needed if her hemoglobin is not tested after abortion get it tested I hope this helps"
    },
    {
        "instruction": "hello doctor I eat chicken every week two to three times but I did not get the fat my weight is 60 keg and my age is 19 years but everything which I eat is like a cold drink which is helpless for me",
        "input": "",
        "output": "hello I understand you want to gain mass to your lean body a combination of right diet and right exercise can help you gain mass at the right places without becoming fat also it is important to develop mass at the right place so that you put on weight healthily and look good as well your mi body mass index is less than what is required for your physique however there is no cause to worry you are a tall young man in your teens 19 years hence you would have attained your sudden growth spurt a year or two back understand that boys grow suddenly in their late teens when they do not put much weight and hence appear very slim that is what has happened in your case for gaining mass your dietary intake should be more than what the body burns also you must do adequate weight training to improve your muscle strength to improve your weight follow these suggestions take two whole eggs in the morning and two egg whites in the evening you may increase egg whites in the morning or evenings to a maximum of four or five drink plenty of milk and eat nutritious healthy home food when eating non vegetarian food prefer boiled meat to fried items fish is healthier than other meat drink at least four to five liters of water daily even during winters when you do not feel thirsty buy some weights at home and start working out find out the right exercises for you may find it on the internet various home exercises catering to specific muscle groups when you exercise one muscle group give it rest for two days which you may exercise some other muscle group you may even enroll in a good gym with a physical trainer or instructor who can guide you with exercise machines and what exercises you must do before work out and after work out take a protein shake or a milkshake in the beginning days incorporate a lot of fruits vegetables greens and salad in your daily diet so that you consume a balanced nutritious diet complete in every way you can get detailed advice regarding diet if you contact a dietician who we have in our panel in icliniq itself they can guide you with the right protein powders the ingredients in a diet for gaining mass at your age I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 17 year old male from india at this time my exams are going on so I cannot visit any doctor kindly help me I am feeling some health problem symptoms for about a week like excess sleep short breath when I lie down on the bed it get worse some times I have a feeling of rubbing of knee bones while walking and also have waist pain yesterday I took modafinil 100 my tablet as suggested by my friend but my symptoms gone worse I have trouble breathing lying down throat pain and breathing trouble high blood pressure blood in stool pain in backbone excessive waist pain muscle and joint pain today I got relief from some symptoms but still I am feeling breathing problem back pain rubbing of knee bones sweating tiredness sleepiness mind goes blank and black in front of eyes when I standup suddenly please help",
        "input": "",
        "output": "hello well from the information it appears you have an acute stress reaction but I need more data before reaching that conclusion as you are experiencing breathing problems on lying down and blood in your stools did you experience similar symptoms in the past do you have any past medical history are you feeling stressed out due to exams breathlessness on lying down persists for how long and how is it relieved do you use any recreational drugs and most important of all do not take any drugs like modafinil without prescription it could be dangerous do you experience these symptoms during each exam because it appears your symptoms are related to stress and anxiety of exams please tell everything hide nothing it will be confidential"
    },
    {
        "instruction": "hello doctor my mom is above 50 years of age and she has been complaining seriously of pains for about 20 years now and it was recently diagnosed to be hypercementosis she needs a solution also she is an asthmatic and doctors have also said that the inhaler she uses increases the pain just for more clarity see the summary below summary doctors remove an impaired tooth as they said the root of the teeth entered the jaw bone and over time the jawbone was infected due to infections the jaw bone where the tooth was removed is still paining and it is swollen doctors say that the inhaler she uses for asthma aggravates the pain as the jaw bone is sore she has taken augmenting dalacin 150 my and others over time recently a few months ago she is diagnosed with hypercementosis status looking for treatment therapy to solve both asthma and hypercementosis",
        "input": "",
        "output": "hello there is no permanent treatment for asthma it can be subsided only and if the inhaler is causing trouble you can opt for medicines tell her physician all the details your dentist gave her and her physician will surely give medicines for the treatment of hypercementosis the exact etiology needs to be diagnosed and removed whether it is any trauma any other disease vitamin a deficiency or rheumatic fever or any other cause which can be confirmed only after tests and observation I am unable to open your link kindly resend the correct link else I have tried to understand your problem I hope my suggestions were helpful"
    },
    {
        "instruction": "hi doctor when I was young I tripped and chipped my tooth it was when I was 20 years old that I got braces and the dentist told me I had to get a root canal for that specific tooth she said that the tooth was dead already I thought it was just a chipped tooth because it looked normal and did not show any discoloration at all then after the root canal that tooth starts turning gray now that I had gotten out of my braces it really got me worried that the discolored tooth is really obvious it also got me thinking that I should not have done a root canal cause before it looks normal but now it is really gray can this dentist be wrong about my tooth",
        "input": "",
        "output": "hello welcome back to icliniq com when you banged your tooth and part of it chipped away the pulp or the core of nerves and blood vessels that provide nourishment to the tooth probably died it is not possible to judge this now but your dentist must have done the required tests to come up with this diagnosis the discoloration that you noticed following root canal treatment could be due to decomposition of pulp remnants left inside the tooth following treatment the problem can be solved in different ways you may try first internal bleaching which is a form of tooth whitening directed at the inner part of the tooth if this fails you can think of a veneer or even an aesthetic tooth colored crown to mask the discoloration of your tooth"
    },
    {
        "instruction": "hello doctor my father is suffering from hypothyearoidism and was having thyearoxine 137 my for the past four months but on his own started 125 my from the past two months report readings to 04 to 12 60 ash 1 he is a diabetic and even had angioplasty done please suggest the best for him",
        "input": "",
        "output": "hello welcome to icliniq com I read your query and from what you have mentioned it appears that your father has overcorrected his thyearoid he must take 100 mug thyearoxine only repeat his thyearoid test after three months only ash thyearoid stimulating hormone his diabetes is not controlled I would like to know his medications name dose and times per day he has some urine infection likely because of high blood sugar once sugar gets controlled the infection will resolve drink 10 glasses of water daily please do not change the dose of thyearoxine on your own as it can be risky in patients with heart disease like your father I hope this helps"
    },
    {
        "instruction": "hi doctor my baby girl is around 15 days old I have had a normal delivery at first when she was three days old till the eighth day I had engorged breasts with full milk but later there was a sudden drop in the supply what might be the reason will the hot summer influence breast milk production also I have taken a lot of stress due to the death of one of my relatives so now what should I do to increase my milk production can I use lactate capsules and lactolina powder together if so how long should I use and what is the dose I have been using fenugreek since three days are there any other natural techniques to increase breast milk production without the use of these capsules I do not have any complications throughout my pregnancy everything was normal then why did this happen to me I am worried please help me because I want to breastfeed my baby exclusively for at least six months if possible until year",
        "input": "",
        "output": "hi I understand the problem which you are going through during breastfeeding period if there are any stressors like excessive worry regarding the baby sudden demise in the family it decreases the prolactin reflex in the body and hence reduces the milk output there are a few tips which may be helpful be relaxed calm and positive try to generate lots of positive feelings towards the baby keep continuing with a good diet and adequate sleep if the baby is on formula feed now try to attach the baby to the breasts every time before giving formula try to find out local causes like inverted or sore nipples if any these are the few ways that you may try to increase milk output naturally you can try taking shatavari powder in milk twice daily and the capsules you are already taking these things may be sufficient to increase the milk output because most of the times it is the psychological impact that affects the milk output I hope this helps"
    },
    {
        "instruction": "hello doctor my scan report reveals the study reveals circumferential asymmetrical wall thickening of pyloric tantrum of stomach extending unto first part of duodenum the wall thickening is for a length of about 12 am maximum wall thickness is about 8 cos in the posterior wall there is a luminol narrowing with proximal gastric dilation there is anterior gastrojejunostomy the thickening is extending along the greater curvature up to the anastomotic site there is perigastic and mental gat stranding adjacent peritoneal thickening is seen there is a loss of fat plane between the lesion and gall bladder there is infiltration with abnormal mucosal enhancement of gall bladder impression malignant wall thickening of the pyloric tantrum of the stomach extending along the greater curvature of body to the anastomotic site of anterior gastrojejunostomy mental and perigastric fat plane thickening suggestive of infiltration when compared to the last it study the extent of wall thickening has mildly increased",
        "input": "",
        "output": "hi the report suggests that there is malignant cancerous growth in the stomach that has metastasized to gallbladder as well as spread to anastomotic joining site of stomach and jejunum momentum fatty tissue around the stomach is also involved as compared to previous it computed tomography scan report the growth has increased and infiltrated deeper layers of the stomach wall you had done surgery treatment for cancer and also round of radiation therapy and chemotherapy radiation therapy uses high energy rays to destroy cancer cells the symptoms in stomach cancer may include blood in stools abdominal pain nausea vomiting loss of appetite and weight and excessive fatigue in the last stages depending on the part of the body to which cancer has metastasized spread symptoms other than these may appear it may metastasized to the brain liver bones or lungs and may produce associated symptoms you strictly follow the advice of your doctor or seek a consultation with a surgical oncologist"
    },
    {
        "instruction": "hello doctor I am a year old female I weigh about 52 keg so from the last one year right after my graduation I am at home as I was diagnosed with to so being at home I feel depressed my mood changes every minute my behavior from the last six months is irritating and arrogant the people around me make me feel helpless like I am of no use just wasting my time I know from inside how much I feel lonely and weak like there is no energy left nothing excites me these days I am noticing that I get so negative I get very easily attached to strangers I cannot sleep at night what kind of illness I am facing",
        "input": "",
        "output": "hello your description and symptoms are typical of major depressive disorder this happens very commonly one in four women can have this at any point in their life due to any prolonged stresses sometimes the stress handling capacity of the brain gets reduced due to the reduction of certain neurotransmitters in the brain the medicines will just replace these chemicals and make you feel better medicines start taking the effect in about a week or so and show full effect in about two weeks medicines are usually continued for two to four months and then tapered off please consult with a psychiatrist for the same he will start you on sari selective serotonin reuptake inhibitors type of medicines such as escitalopram 10 my for example and with some other medicines if needed to augment its effect"
    },
    {
        "instruction": "hello doctor patient is an 82 year old female ultrasound report says sludge with the distended gall bladder ongoing medicines pantodac ulysses 150 what to do",
        "input": "",
        "output": "hi I have read through your query in detail please find my observations below the gall bladder is a bag like organ adjacent to the liver where bile gets collected when we eat food at that time the bile is released from the gall bladder into the small intestine the patient has the formation of sludge within the gall bladder this happens when the person does not have food on time and does regular fasting it might also happen in those who take a lot of oily food what happens is that the bile acids cannot get expelled because the person does not eat food regularly if the bile stays in the gall bladder for longer periods then there is sedimentation and the bile solidifies into a semisolid consistency called gallbladder sludge after a few weeks and if not treated then the sludge will transform into stone pantodac is a medicine to reduce acid formation in the stomach and treat gastritis ulysses 150 is ursodeoxycholic acid and is given to dissolve the gall bladder sludge and prevent stone formation please get liver function test repeated every two months if she is given this medicine for a longer duration please continue giving the medicines as recommended by your doctor most important is to make her eat in small amounts of food at regular intervals since she is elderly therefore the food should be prepared with less oil and made easily digestible also give her adequate amounts of water and fresh juices"
    },
    {
        "instruction": "hello doctor I am a 34 year old married woman I had physical intercourse on the day of my ovulation after that I am having cramps in my lower abdomen specifically pelvic area also yesterday I had an indigestion problem and I am feeling sleepy for the entire day my last ovulation date was five days ago but my pregnancy test showed negative results yesterday what are the chances of pregnancy considering my age",
        "input": "",
        "output": "hello if you had unprotected intercourse around your ovulation period then there is 40 to 50 chance of getting pregnant if everything is fine ovulation can be plus or minus and we have to calculate it retrograde after getting period if you have a regular period then there is more chance that your ovulation date it to be final even if there is pregnancy it takes 14 to 15 days to turns urine pregnancy test to be positive you have to wait for those days age is important but more important is hormones releasing in your body and the quality of ovum produced in this cycle which is more important than anything else there are hundreds of factors that can affect the course but at last we have to wait for 15 days you can do bhcg beta human chorionic gonadotropin blood test after 10 to 12 days but you have to repeat to see whether the pregnancy is there and it is growing or not pelvic pain and indigestion problem can be due to stomach infection or urinary tract infection do drink more water during later half of the cycle weakness can be due to progesterone releasing in your body as I said there are many things and many explanations so the best thing to do is to wait for 10 to 12 days and do bhcg blood test or wait for 15 to 16 days and do a urine pregnancy test I hope this helps"
    },
    {
        "instruction": "hello doctor my daughter suffered a concussion 16 weeks ago she is still struggling with several symptoms like constant headache fatigue trouble falling asleep feeling weird and occasional dizziness she does feel a little better compared to a couple of weeks after it happened but unfortunately she still feels pretty bad she has taken the impact test with her doctors twice since it happened just to track her progress the first one she failed but she just took another one this week and passed her score was back to baseline how can her cognitive function be back to normal when she still feels so bad does she need to continue to rest as she has been for four months does she still have a concussion she has special accommodations at school right now should those continue her case is being referred and sent to a neurologist as the pediatric concussion specialist does not specialize in post concussion syndrome or symptoms and he wants her to get the best treatment possible we are awaiting that appointment so I do not currently have a doctor who can answer these questions the only medication she has been taking is naproxen aleve the doctors have not allowed anything else but we are hoping the neurologist will prescribe something she is also taking a lot of vitamins to try and help her energy level I have attached a file",
        "input": "",
        "output": "hi I can completely understand your concern for your daughter illness I have seen the attachment sports concussion injury is a new concept in medical sciences concussion is basically a very mild injury to the brain which impairs the basic mechanism in which a brain functions under normal circumstances concussion can be caused by a direct blow to the head or by indirect blow for example when an athlete is sprinting very fast and suddenly stops or changes direction leading to the sudden change in movement of the brain tissue leading to a friction between the brain tissue and inner surface of the bones of the skull let us discuss the queries asked by you one by one regarding how can her cognitive function be back to normal when she still feels so bad well at present her problem is not concussion brain injury because concussion brain injuries usually heals within a few days various scientific studies shows that 90 95 of concussion injuries heals as fast as within eight to nine days after the injury and only 10 injuries take more than 10 days so medically and technically it is post concussion syndrome which she is presently dealing with post concussion syndrome can develop in a person with a very mild concussion and on the contrary do not develop in some patients who suffered a major injury which in turn means that development of post concussion syndrome does not depend on the severity of brain injury it happens in some and do not happen in others but the good thing is that in sooner or later the person gets cured with time 90 cases of post concussion syndrome resolves in two to three months and 10 resolves six to eight months after the initial injury and very rarely it may take maximum unto one year but the point is that almost 100 cases get resolved maximally within one year after the injury regarding does she need to continue to rest as she has been for four months yes as she is still having symptoms of post concussion syndrome I headache fatigue dizziness sleeping disturbances etc she needs to continue both physical and mental rest till all the symptoms go away the medical reason behind recommending both mental and physical reasons is that doing physical activity the heart starts beating fast and more forcefully leading to increased blood flow in the brain which intern can exacerbate the symptoms of post concussion syndrome and can cause the symptoms to reoccur similarly performing cognitive activity and even mental activities like thinking use energy in the brain and can slow the recovery process of post concussion syndrome regarding does she still have a concussion no she does not have concussion now as I have already explained that in almost all cases concussion injury heals within 10 days her primary concussion injury has healed and presently she only has the symptoms of post concussion syndrome regarding her special accommodations at school right now yes she should continue and follow those special accommodations till all her symptoms of post concussion syndrome subside and go away otherwise as I explained above any physical or mental stress can delay the recovery and can re trigger the symptoms repeatedly I hope this helps"
    },
    {
        "instruction": "hello doctor for three years my rec has been slightly elevated 9 my dna results show a homozygous good game genotype for snap rs12340895 of the jake gene indicating greatly increased odds of developing jake v617f positive mpn I have no symptoms and I am in good health should I see a hematologist to establish a baseline and periodically monitor for mpns",
        "input": "",
        "output": "hi based on your query my opinion is as follows numerous dna mutations are always present and it is difficult to monitor for any specific malignancy however speaking specifically the mutation you have described can be seen in 50 of the normal population which is very high considering the percentage of man prevalence a higher rec count can be seen due to high altitude lung problems smokers athletes etc rec count above would suggest a possible risk 9 is too low to comment and the only thing I can comment is it is very good hemoglobin levels based on your mi I would consider you to be physically fit and this rec count should be appropriate not to worry no monitoring is necessary for now annual checkup of complete hemogram should be adequate I hope this helps"
    },
    {
        "instruction": "hi doctor I have been doing zumba for six months three times a week a month ago my instructor significantly increased the intensity of choreographies and my shins started hurting after dancing they hurt all along the tibia all the time it is not extremely painful but quite annoying I would like to continue exercising but I am scared of potential long term consequences should I just slow down and avoid some moves like jumping should I switch to pilates",
        "input": "",
        "output": "hello I have read your query I would suggest you to reduce the intensity or time duration of zumba if possible do some warm up exercises before starting with high intensity zumba dance you can also do some low intensity zumba dance before moving into the higher intensity every day please have a look below for more informations start with warm up exercises or low intensity zumba dance before starting with high intensity zumba dance take frequent brakes between the high intensity dance you may simply stand or sit for two to five minutes in every 10 15 minutes of dance you may use shin support braces during the dance this may reduce the pain you get after the dance dip your legs in warm water for 10 15 minutes after going home or take hot pack on the shins rest in between the high intensity dance shin supports or braces while practicing zumba try the above suggestions and see if you still feel the pain let me know you may later opt for pilates instead of zumba"
    },
    {
        "instruction": "hello doctor more than 20 years ago I suffered from anxiety derived from the use of drugs and my family situation from which I recovered with deanxit and psychoanalytic therapy of course I quieted cocaine forever I was in therapy for seven years at the end I recovered completely having a full and happy life for more than 10 years I have a great wife and daughter and very good friends and have a good relation with my family the fact is that I was feeling very well until about two years ago I began to experiment as if I could not enjoy things a few months later being quiet at home at night an incredible and strong chemical depletion suddenly came over me it was like a feeling of chemical depletion of the neurotransmitters or something like that in the brain that caused me a downturn similar to when you use drugs like when you have a sudden drop of blood pressure it was not the depression of being crying feeling of worthlessness deep sadness it was these desperate and unbearable feeling this lasted about days so I went to my psychiatrist because I could not take that feeling of intense downturn anymore I have to say that years ago I had already felt those feelings for short periods of time like a few minutes and then disappeared but I did not give them much more importance he prescribed me deanxit again two times a day and after four days I was fine the fact is that he withdrew it a month and the next day I noticed again the unbearable symptoms of the beginning I went back to the medication and felt good again but I wanted to switch to a stronger one following my psychiatrist advice because sometimes I was still feeling bad I tried many others that did not work or made me feel worse I have tried in between other therapies such as cognitive behavioral emdr acupuncture and I believe that none comes to the heart of the matter that it is a serious chemical imbalance that is happening to me and that I cannot overcome and balance I have also performed neurofeedback as well as resonance of the head requested by a neurologist and they saw nothing I am a person who is not obsessed at all with things very cautious in life and have a successful business for years I do not usually stress except on some occasions and I consider myself quite rational in general so I cannot understand why this is happening to me I am looking for someone who can diagnose my disease beyond the generic term of depression and anxiety in which because of the symptoms that I have explained I am not reflected I think that the dysphoria would be the closest but I also do not feel that irritability that accompanies it have you met a patient with similar symptoms before or maybe someone to whom you can refer me to understand what is happening here I absolutely trust science and I just want to return to the state of normality that I had before all these crises that I repeat are so intense and unbearable that I want to die when I suffer them and that I need to understand what happens to me having more opinions from other experts",
        "input": "",
        "output": "hello welcome to icliniq com you have actually got everything right with what you think you are experiencing it is dysthymia basically the neurotransmitter deficiency be it for whatever reason is the cause in males it usually appears between 30 to 40s also it is not necessary to have irritability to be called dysthymic basically if you look at a figure of 50 between to 100 as normal and the baseline for mood you are persistently unable to return to the baseline and are always beneath the normal mood what people call as mildly depressed this dysthymic period when an episode of depression is superimposed is called double depression which is the episodic problems that sometimes occur the core of treatment here is the addition of a mood stabilizer such as lithium that in addition to an antidepressant will show you the greatest improvement basically the antidepressant will elevate your mood and the mood stabilizer will hold it there rest in addition to the medicines you should continue your therapies as advised I hope this helps"
    },
    {
        "instruction": "hello doctor my father had cataract surgery yesterday his sugar levels were fine before surgery today he was given a deja injection my in his eye due to inflammation after that the sugar levels have stayed between 280 300 through out just before dinner his sugar levels were 300 my do as advised by our doctor have gave him 16 units of mixtard instead of 14 which he takes regularly along with regular sugar medicines my questions are does deja injection increase the sugar so much and when will the effect go in addition he is also putting one drop of steroid eye drops predmet every hour from tomorrow it will be once every three hours can this also increase the sugar level from tomorrow how should we manage the sugar levels will the effect of steroids go away please see the attached prescription of all the eye drops after cataract surgery he is taking mixtard insulin 30 70 50 units in the morning 14 units in the night glycomet gpa 0 linagliptin my 0 fibator 10 my 1 metolar 25 0 dynapres 4 1 arreno 0 ecosprin 75 0 thyearonorm 25 my one tablet from monday to thursday and two tablets from friday to sunday cap prise once a month",
        "input": "",
        "output": "hello welcome to icliniq com I just read your query and from what you have mentioned it appears that your fathers blood sugar has increased because of steroids as for your questions let me answer them one by one yes deja injection increases the sugar so much and it will have decreased effect once your father is off steroids completely yes steroid eye drops predmet methylprednisolone can also increase sugar level regarding managing the sugar levels if his fasting is above 250 then increase his evening dose of insulin by adding two more units if his dinner blood sugar is 250 my dl above then add two more units to his morning dose of insulin and continue monitoring accordingly if drops to 200 then do not increase his insulin at all and maintain at that dose of insulin keep following his blood sugar closely and watch for any signs of hypoglycemia as well like increase sweating or shivering or headache or hunger or cold skin etc I hope this helps"
    },
    {
        "instruction": "hello doctor I have been diagnosed with pod and endometriosis suffering from irregular bleeding which does not seem to stop I saw a gynecologist last month she happens to be my regular doctor I am also planning to conceive so she gave me certain medications that would help me to plan but the main problem arising is my period does not seem to stop and now it is really disturbing I am confused with my medications also when I am planning to take contraceptives to regularize my period it would not be good for me I guess kindly suggest something which will regularize my period and also help me continue with baby planning medications I am currently on folic acid with metformin tablets",
        "input": "",
        "output": "hello the pod polycystic ovary disease is confirmed by ultrasound transvaginal and there is a presence of a small fibroid as well in the posterior wall of the uterus along with a left ovarian endometriotic cyst this simply confirms that there is an estrogen depletion and testosterone excess in your body which needs to be rebalance and that can be done with the help of oral contraceptive pills and myo inositol and chiroinositol supplementation for at least three cycles you have to understand that pod is alike diabetes and cannot be completely treated but can be controlled and prevented with lifestyle and dietary modifications post medical treatment you need to be placed on medications before you start ovulating naturally which you are not due to pod the presence of a hemorrhagic cyst unlikely endometriotic too can be addressed with the pod regimen the insulin resistance in your body would too have to be controlled and you need to avoid oily spicy and fried foods to an extent along with brisk walking daily with adequate daily water intake please do not opt for an ovulation induction cycle as that would be an attempt in vain"
    },
    {
        "instruction": "hello doctor I cannot get any sari medicine to work anymore after 25 years I have anxiety only from morning to mid afternoon doctor put me on oxcarbazepine 300 my daily for anxiety but this seizure medicine is making me dizzy and very tired and off balance my head feels weird I just weaned completely off zoloft three days ago what new family of medicines do you suggest for me to try for my anxiety lately I can get it under control for four to five hours taking ith of a 25 my of xanax I take a sliver tablet of 25 my three to four times a day or maybe once anxiety ends every day at around 4 am each day and I sleep fine too",
        "input": "",
        "output": "hello considering your age it will be difficult to try a low dose of tea tricyclic antidepressant but if nothing works that is always an option apart from an sari selective serotonin reuptake inhibitors there is always sari serotonin norepinephrine reuptake inhibitor like venlafaxine which is pretty effective for anxiety also instead of oxcarbazepine you could try a low dose of may be 200 my of sodium valproate also there are some dietary supplements like theanine 200 my which can be taken two times a day or on sos basis finally instead of xanax alprazolam you can try tofisopam which is a different type of benzodiazepine with lesser addictive potential no sedation or impairment in work performance also consider doing deep breathing exercises daily and when you have an anxiety attack do more repetitions of deep breathing also consider starting with yoga meditation progressive muscle relaxation or other types of calming exercises"
    },
    {
        "instruction": "hello doctor I have high eye pressure of 30 and 24 visual field loss and at times I go completely blind in both eyes I have also gone blind in just one eye I just went back to the eye doctor when I had the pressure of 24 and 30 I have been there three times and each time I had a high eye pressure he at first told me everything looked good until I asked him what my pressure was again because he specifically said my pressure was good when I knew that it was high he told me that it was fairly high when I asked for it but he says I do not have any optic nerve damage and that it is highly unlikely that I have glaucoma because I am 23 years old but my research has told me differently that high eye pressure alone does not mean that you have glaucoma but if you have visual field loss or optic nerve damage with your high eye pressure then you do so I do not know what is going on can you please help me understand and is it possible that I do have glaucoma and should go to another doctor",
        "input": "",
        "output": "hello I reviewed your history the presence of elevated intraocular pressure is called as ocular hypertension if it is associated with visual field changes or optic disc changes it is called as glaucoma however ocular hypertension alone also requires treatment particularly in your case as intraocular pressure is high hence you need to consult glaucoma specialist for evaluation and advice accordingly increased intraocular pressure visual fields oct optic coherence tomography glaucoma antiglaucoma drugs once in six months"
    },
    {
        "instruction": "hello doctor I am a 20 year old male I am having throat pain with red tonsils and white patches on them frequently clear throat excessive mucus with low and not clear voice please help",
        "input": "",
        "output": "hi from your description I understand that you are a male aged 20 years having the symptoms of throat pain excessive throat mucus throat irritation and change of voice from perusal of your symptoms I conclude that one of the following could be the most probable causes acute follicular tonsillitis it is the infection of tonsils may be accompanied by an infection of the pharynx and upper respiratory tract it produces acute pain painful swallowing change of voice and throat irritation diphtheritic tonsillitis it is a serious condition where after healing of tonsillitis the diphtheria organism can cause myocarditis inflammation of myocardium and nerve palsies neuralgia is a nerve associated pain the symptoms of your case that match this condition are in addition to throat pain red tonsil are the patches you mentioned diphtheria forms a dirty white membrane over the surfaces other less probable conditions are infectious mononucleosis tonsillar malignancy vincent angina however the details you have given do not seem to match these however I must insist that only when we examine you we can be sure of what the findings are and what could be the diagnosis you could take a picture and send us for a better understanding of your problem meanwhile try the following these are just suggestions I would recommend you to do the following tests for a more decisive opinion complete blood count throat swab and albert staining of the swab some general measures you can take to alleviate the pain and change of voice are take plenty of warm and hot fluids avoid spicy oily and cold foods take salt water gargles many times a day take steam inhalation take pain killers to alleviate the pain only after a more decisive opinion can we provide you with antibiotics or more specific measures"
    },
    {
        "instruction": "hello doctor I am having a lot of irritation on my vagina opening and when I scratch it feels good but it gets more irritated I went to the doctor recently and I had a ti however I am still feeling very itchy and I am getting concerned I am years old and right now I am only taking the antibiotics for the ti",
        "input": "",
        "output": "hi it looks like boil and mostly it is ti related attachment removed to protect patient identity continue taking antibiotics can be in healing phase and that is why itching must be there but you can take syearup vital like liquid times a day for 15 days and can also apply candid like ointment which will help in reducing itching do not scratch it will increase the infection drink more water keep the vaginal area as dry as possible if you have white discharge per vaginal then can take candid ve tablets vaginally every night for days if not controlled with given antibiotics then may require to change antibiotics or antibiotics by injections"
    },
    {
        "instruction": "hi doctor I have an issue that really needs taken care of I am not sure which type of medical professional I should be seeing I have gone to a gastroenterologist and got a colon exam they said they did not see anything wrong but I have had this issue for a few years now and it is not getting any better I seem to constantly have a fecal odor my rectum area always feels moist and smells constantly like poop I will be in the shower scrubbing and soaping up my butt and by the time I get out my anus already smells like poop every time I have a bowel movement I have to either shower or use soap and water to clean off as best I can even though minutes later it starts smelling again I clean myself much more thoroughly than I feel most people do but it does no good I am also really gassy if that might be related always feeling like I have to fart or like I need to poop it never feels like I am able to fully evacuate my bowels on the toilet I am also very sweaty in my groin butt area it probably does not help any what should I do now",
        "input": "",
        "output": "hi I read your query you have feeling of incomplete evacuation smell of stool persistently and also gas problem I would like to know what is your daily bowel frequency I would suggest you to check with gastroenterologist regarding finding of your rectal examination which should be done by finger if it was not done it should be done to check the synchronization of your rectal muscle contraction and anal sphincter contraction as you have mentioned you have incomplete evacuation a special test called manometry can also help to check the muscle coordination regarding gas problems you can modify your diet g if you are lactose intolerant reduce milk and milk products if you are taking too much protein in your diet you can reduce it you can give me feedback once you try this suggestion"
    },
    {
        "instruction": "hello doctor the radiologist stated scattered white matter lesions but does not tell the location or size they state as unsure etiology or clinical significance the ordering physician suspects is due to symptoms like disorientation incontinence and body pain if the radiologist suspected is would not they state the size and location and diagnoses suspected disease or kind of lesion was this a poor report or was he basically not sure of what is going on I leave it up to the ordering doctor I have done blood for lupus arthritis lyme disease and complete blood test",
        "input": "",
        "output": "hi the few scattered white matter lesions could mean that there are areas in the white matter of brain which are seen as small pinhead size on to and flair sequence this is commonly from small vessel ischemic changes and is seen usually in older age and slightly uncommon in the young population the cause is sometimes unknown suspicion of is multiple sclerosis is by diagnostic criteria and matching it with clinical examination there is mcdonald's criteria for imaging in is and if the radiologist did not mention any findings which are under these criteria then it is unlikely to be is from this scan the criteria specify that the patient might require a subsequent mri scan and the new scan is compared with the old one to make a probable diagnosis of is in you it is clear that the findings are less likely to be from is on this scan talking about radiologist every person has their comfortable style of reporting and I feel mentioning the location of the larger white matter lesions would have been good for your ordering doctor I will not say this is a poor report but surely it can be improved by providing the size and location of the larger white matter lesions I hope this helps"
    },
    {
        "instruction": "hello doctor I am a year old female and I weigh about 168 labs seven months ago I was in the er with severe lower abdominal pain I had blood work abdominal ray internal ultrasound and an abdominal it scan with contrast they found that I had a ruptured cyst however for a couple of months now I have had on and off nausea bouts of diarrhea some blood in toilet when wiping and I have started to poop a little more than I used to now I will say that my diet has been kind of crazy since moving to another state I am not sure if I should be worried about what is going on",
        "input": "",
        "output": "hi I understand that the earlier severe abdominal pain might have been due to the rupture of an ovarian cyst form which you have made a good recovery since as you have already pointed out a change of location and with that an erratic diet pattern the focus should be on any infection involving the large bowel which might be causing your symptoms it is important that you keep in mind the following please have well cooked and hygienic foods at all times drink plenty of water and fresh juices and visit washrooms regularly never skip meals during the day and if time permits have helpings of fruits and snacks in between larger meals control your anxiety and stress levels this can also cause some of the symptoms mentioned by you if you ever have diarrhea for more than 24 hours then please consult a doctor for emergency first aid and medicines"
    },
    {
        "instruction": "hi doctor I was just wondering how long germs would live on in a liquid lipstick around five weeks ago I had a vomiting bug most likely gastro I went out on saturday night and wore a liquid lipstick and was sick on sunday will these germs still be living in the liquid lipstick and make me sick again or will they have died also if I shared my liquid lipstick with someone who potentially had a cold sore I am not sure if they get them or not would those germs live in the liquid lipstick",
        "input": "",
        "output": "hello welcome to icliniq com I understand your concern there is exactly not much research done on how long bacteria or viruses could survive in a liquid lipstick if you have had a gastrointestinal infection and if your lipstick came in contact with your saliva the microbes could have gone into the lipstick how long they survive in the lipstick and how fast they multiply largely depends on what kind of chemicals were used in the making of the lipstick moreover different microbes need different kinds of growth environment so it is hard to comment on that I would advise you to avoid using cosmetics when you are sick regarding sharing of your lipstick it is never a great idea to share your cosmetics with others cosmetics should be used as personal items just like you would use your toothbrush sharing cosmetics can lead to the spread of skin infections if you think you have shared cosmetics with someone you think might have some kind of infection I would advise you to dispose it and buy something new I hope this helps"
    },
    {
        "instruction": "hello doctor I picked up a grade hamstring injury from playing football around four months ago stupidly I tried to play football again three to four weeks after the initial injury which caused me to pull my hamstring again I have then left it for around two and a half months and I have slowly tried to get back into exercise I started by cycling which I had no problems with I have also been away skiing and I have not felt any pain whatsoever however since I came back from skiing I went to play football yesterday and although I was fine for the majority of the game once the game had finished I noticed my hamstring felt sore it also is still a little bit sore this morning is this a good thing or a bad thing I could easily run on it now no problem but it does feel slightly sore is there anything I should or should not do",
        "input": "",
        "output": "hello I read your concern in my opinion you had enough time to recover from tears however a grade hamstring injury needs a bit more concentrated management I think you should do proper rehabilitation to completely gain strength and stability exercises like bridging single leg bridges clamshell swiss ball jackknife swiss ball hamstring curls step ups and goblet squats will help you gain stability and strength slowly you should start running if everything goes well then you should start gradual progressive running sessions these exercises to be done for three weeks and then progress with the next level of rehabilitation after progressing to full strength and stability and once you are confident then slowly you should return to play I hope this helps"
    },
    {
        "instruction": "hello doctor for the past two months I have had a pretty consistent elevated heart rate not by a lot but noticeable for me compared to what I was coming from I cut out alcohol and caffeine and that helped but it always returns my resting heart rate I wear an apple watch is pretty consistent in the 53 58 range but when I get up go up or downstairs it will jump to 100 pretty fast then average out in the 80 as I move about my day when I am sitting at work it is 78 85 bum this is a good 10 bum faster than when I am at peak health I am not sure what is going on I did a fair bit of cocaine and took some ed pills a few times with the cocaine before three months so I wondered if maybe there is a connection I have not done anything like that since then I am a runner but now when I run or jump it goes up to 150 bum and higher pretty fast if I push myself anywhere close to hard I am at 170 180 bum pretty easily so I slow down and it seems my body does not recover quite as fast so I have stopped running hard and just do light jogs and play tennis I recover pretty easily there but it is annoying as I want to run and push myself I will go two to three days with no caffeine alcohol and then I notice my walking around rate is lower like what it used to be mid 70 when it is like that I can feel it noticeably I feel much more complete and whole I feel great and no shortness of breath so then I will have a few glasses of wine that night and maybe a dessert I like sugar at night and I will lay down to sleep and my heart seems to jump up to 85 95 bum for a while and it takes two to three hours before it rests at 53 58 bum and then the cycle starts again I am so confused I do not know what the deal is it the alcohol or sugar I drink this one type of white wine a lot but I have noticed my heart rate does not react as much when I just drink beer one night I had white wine then tequila and my resting rate was like 68 78 bum all night I saw a doctor about three weeks ago and they did an egg and listened to my heart and it showed no issues or irregularities I do not have heart pain though I did have a few sharp pains over the past two months maybe two to three times all lasting about one second and then it is gone all when I am lying down in bed trying to go to sleep I do have shortness of breath due to the elevated heart rate when I am carrying stuff going upstairs etc I do not have pain in my chest jaw left arm etc sorry this is so long but I really would love to discuss this with someone who maybe has heard of this before to be clear what is annoying and confusing me is that my heart rate will steadily be 10 bum higher at all times aside from resting rate for like a 10 days before it feels like it goes back to normal but then there is always something that sets it off again I never see it spike over 105 or so",
        "input": "",
        "output": "hello welcome to icliniq com I understand your concern but I assure you that there is nothing to worry about it is normal for the human heart rate to fluctuate for instance during exercise the heart rate can go as high as 350 bum in some people it does not mean there is a problem it is normal it is also normal for the heart rate to slow down when laying down but it can increase while laying down in cases where you take alcohol just like in your case you are having issues with anxiety probably because of the cocaine you used I advise you to resume your exercise start jogging it will help with your situation you can only worry if you begin to experience shortness of breath chest pain or fainting"
    },
    {
        "instruction": "hello doctor I have a positive ana titer 640 ac homogeneous ana titer 640 ac 4 29 speckled rip antibody positive 5 all other antibodies are low serum cortisol high 30 at 15 am symptoms pulse races sometimes can control with breathing exercises especially when nervous vague muscle aches and pains bilateral that come and go it could last a day or two and then leave I also have muscle fatigue the symptoms tend to be very vague and come and go no raynaud no swollen hands or fingers sedimentation rate cop 4 my does this sound like anything to be concerned with I am anxious about the antibody findings I am currently taking nexium clonapin my at night",
        "input": "",
        "output": "hi welcome to icliniq com I would need to know first of all the symptoms for which ana antinuclear antibody test was done any joint pains facial erythema or any fever revert with the asked details for better help"
    },
    {
        "instruction": "hello doctor a couple of weeks ago I woke up with a bad headache and a very stiff neck it was so painful that I could not make it through a regular day without crying and intense pain since this time I have been to the doctor four times and each time they gave me more medicines I have also been to a chiropractor four times because one of the doctors recommended it after he took an ray the headaches have gone away I suffer from headaches and this pain is so different now I have constant pain in the back of my lower neck and only on the left side the stiff neck has improved and I can manage a day but I am still in intense pain the only medicines I am taking at this time are over the counter medicines what do I need to do",
        "input": "",
        "output": "hello your symptoms may be related to occipital neuralgia which is an irritation of the occipital nerve which lies in the back of your head I would like to know what were the results of your neck ray this neuralgia can be exacerbated by cervical spondyloarthritis I recommend starting indomethacin twice daily if you have no contraindications to it stomach problems or high blood pressure I recommend consulting with a neurologist for a careful physical examination an antiepileptic drug like valproate or lamotrigine may be necessary to relieve your pain I hope this helps cervical spondyloarthritis or intracranial cause neck ray brain it computed tomography scan indomethacin anti epileptics valproate topiramate or lamotrigine"
    },
    {
        "instruction": "hello doctor I had oral sex three weeks ago that day also I faced the same issue I I was unable to retract or pull back my foreskin completely it took like three to four days to get to normal two days ago I masturbated and again facing the same issue I unable to retract the foreskin completely it will be back to normal in another couple of days I never faced such problem before is it that I might have developed some an infection during that oral sex but if there was infection how it went normal after three to four days I have attached the video of it so you can examine I have a few questions can I apply some ointment like betadine or soframycin the betadine is the same betadine brown color ointment which we apply on cuts etc or is there any specific for this private part how to apply the ointment for how long also should I wash with water or keep it dry for long in the video I also have shown some pus filled pimples below stomach in pubic hair region that occurs occasionally I never trimmed pubic hair is it because of that is it advised to trim the pubic hair also can you suggest an antifungal shampoo for public hair my head is very sensitive to touch so it pains on the touch of cloth or hand is it normal how can it be fixed is there any tablet I can take to cure this issue like fuss 50 my tablet",
        "input": "",
        "output": "hi I have seen your attachment the foreskin opening appears to be slightly narrow due to which you are not able to pull up the foreskin easily this may need some lubrication like my jelly or conut oil before pulling up the skin the boils in the pubic area are due to skin infection apply soframycin framycetin or back mupirocin cream twice daily and take cefuroxime 500 my twice daily for five days this would heal the boils avoid shaving the pubic hair just trim with hair clipper or scissors penis head is always very sensitive I would suggest you get your blood sugar checked once sometimes raised blood sugar can cause skin infections"
    },
    {
        "instruction": "hello doctor I have been experiencing numbness in my left foot it comes and goes sometimes throughout the day and sometimes it is completely normal this has been happening for the past year at night when I lay down the back of both my calves feel like they are rhythmically pulsing only when lying down I am freaking out that it might be the start of is I am a 36 year old female I have also had a mild case of mono age 20 and have read that can increase my chances as well as being of scottish descent I very occasionally have neuralgia in a spot right above my collar bone and it is always in the same spot and very random the shock lasts for about a few seconds then disappears this has been happening for probably for the past seven years I have also read this can be an is symptom I am trying to decipher if my symptoms are anxiety related or if I truly need to be concerned with is",
        "input": "",
        "output": "hello your symptoms are not typical of is multiple sclerosis the numbness in your leg may be related to a pinched nerve the pulsating feeling in your legs may be psychological or related to venous insufficiency regarding the pain in your face it is not typical of trigeminal neuralgia which lasts for minutes and irradiated in the nerve branch territory I recommend consulting with a neurologist for a careful physical examination if suspicions are raised a brain mri magnetic resonance imaging may be needed I also advise performing a nerve conduction study and a doppler ultrasound of your legs to exclude the above mentioned disorders I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 42 year old male my height is 1 and I weigh about 120 keg I do not do any exercise just a month ago I experienced painful stomach cramps diarrhea excessive gas sweating and belching with bad taste which lasted for one night I rested up for two days and felt much better but a cold sore appeared on my lip which again only last a few days I am not sure if it is related but quite shortly the aforementioned incident I noticed enlarged papillae slightly apart from the others I was naturally curious so rubbed it with my finger and it did not feel any pain so I just forgot about that shortly after I started to feel pain in my tongue the pain would change location throughout the day and often move to my hard palate I then noticed my tongue appeared white coated I started to use oral thrush lozenges rinse my mouth with mouthwash gargle with warm water and salt brush my teeth and tongue before bed I never used to after a few weeks my tongue appeared pinker but the pain is still on and off I finished the lozenges hoping that would be the end of it but I have noticed today that my tongue again appears white coated and I now feel sore on the hard plate near the front teeth also a new cold sore has appeared I have read and looked at the photos about oral thrush hairy tongue and so on but really I have no idea what my condition is I have not been to see a doctor or dentist because quite honestly I am very scared reading that white coated tongue causes can be anything from excessive alcohol tobacco use right through to hiv or cancer is simply terrifying me I did purchase a diabetes home test kit urine which did not show any traces I drink and vape once a week but on that day I consume both excessively please shed some light and guidance photos run in chronological order",
        "input": "",
        "output": "hi first of all thank you for the detailed history of your symptoms and photos which you have attached before I discuss further about possible diagnosis let me assure you that your symptoms or the photos you have sent do not show anything sinister in your mouth or tongue analysis of your symptoms are suggestive of a condition known as laryngopharyngeal reflux disorder lprd where backflow of digestive acid causes significant injury to throat and mouth structures including tongue and palate in your case symptoms seems to be triggered by an initial attack of acute gastritis and reflux which may have caused significant injury acid can injure tongue papillae causing a coating of tongue multiple small ulcerations inflammation of tongue papillae if the reflux continues to occur it can keep injuring different areas of tongue and mouth leading to migration of symptoms occasional binge drinking and vaping seems to be causing further damage to already injured tissue you may need to take a few week course of anti reflux medications and avoid drinking and vaping while on treatment to facilitate the healing process other than this I do not see anything dangerous as per the photos you have attached also it does not look like oral thrush oral candidiasis so antifungal lozenges may not be of much use"
    },
    {
        "instruction": "hello doctor my father is 59 years old and suffering from diabetes for the last 15 years within control limit of sugar recently he got attach with a brain hemorrhage on the right side and he stopped to talk and his right side hand and leg become inactive slowly with medication and physiotherapy exercise he recovered somewhat and able to speak he can walk with rod support and his hand is still inactive his creatine level in blood keeps on the higher side from 0 to up to 0 in the last few days he started vomiting and unable to digest any foods doctor advised for immediate dialysis and is undergoing the procedure within a week time this is the second time he is going with the procedure the first time it lasts for one and a half hours and for the second time it lasts for three hours while discussing with the fellow patient taking the procedure they said this is a regular procedure and may require on a daily basis also my query regarding dialysis is if once we opted is it a regular procedure please clarify the doubt",
        "input": "",
        "output": "hi I have thoroughly gone through your case and can well understand your genuine health concerns no this is not a permanent procedure for every patient it depends on the status of kidney functions and roughly we can predict from creatinine levels just to make it clear to you if he gets creatinine levels of 2 2 my dl and the kidneys will be doing normal functions then we can stop doing dialysis as kidneys are now doing their job by themselves dialysis is alternative kidneys actually the job which kidneys do normally dialysis does the same for the time being until the patient gets normal kidney functions back I hope this helps"
    },
    {
        "instruction": "hello doctor my brother having a problem when he was years old he underwent an operation in the bladder I have attached all the summary for your reference now he is 25 years old still he cannot control the urine for sometimes could you please suggest what we can do for this please help",
        "input": "",
        "output": "hi I have read through your query in detail please find my observations below your brother was treated for a tethered cord with a lipoma in close proximity to the cord at the sacral region it means that he had a fat containing tumor in the lower end of the spinal cord these are birth and developmental problems that cannot be completely treated at 25 years of age he can get another mri magnetic resonance imaging scan of lower back done and discuss it with a neurosurgeon if there is any persisting area where there is pressure on the spinal cord or the nerves usually if any pressure effect on the nerves or cord is present now then they can think of releasing the pressure and this might improve his symptoms if his condition is not possible to be treated after discussing and doing an mri scan then the only way is to pass urine at regular intervals and avoiding an over distended bladder"
    },
    {
        "instruction": "hello doctor I am on dialysis for kidney failure and I have noticed a fluctuation in my monthly blood work for the creatinine and bun levels at the beginning of the year my creatinine was and it has decreased every month to I was also making more urine as I went along all of a sudden last month my creatinine jumped back up to 10 I have not changed anything in my routine or treatments does anyone have any ideas",
        "input": "",
        "output": "hello I have worked as a chief in a hemodialysis center for 20 months once the kidneys have failed and the patient is hooked up on dialysis the creatinine value is always high at this time we do not care about the creatinine values because once we start dialysis on a patient it is assumed that his kidneys have incurred permanent damage and he cannot come back to normalcy at this juncture we use the patient creatinine value as a measure of protein intake if a dialyzing patient creatinine value is high it is assumed that he is having good protein intake through diet and high creatinine value is desirable in dialysis patients since intake of much proteins gives them a long life when creatinine value drops we start worrying that the patient is not taking much proteins so the drop in your creatinine value may be because you have started taking less proteins than usual in this situation we advise you to take more protein containing foods for a dialyzing patient the most important parameter is blood urea see what is your blood urea level before and after a single dialysis session ideally there should be a 60 reduction then it can be comfortably assumed that dialysis is effective if you do not achieve this reduction complain to the dialysis technician he will do the needful adjustments with the machine the big factor we have to afraid of is potassium it should never cross I hope this helps"
    },
    {
        "instruction": "hello doctor it has been seven months since I got my braces on I got then to treat bimaxillary protrusion my dentist has placed thin wires and elastic and also extracted four teeth to make space the space has not yet completely closed and he has never changed the wires when I asked him when he would change the wires he replied that he would not be removing the wires for the monthly appointments only repairments of broken braces were done for a few appointments he did not even change the elastic should I continue with the same treatment or should I change to another orthodontist please reply as I am extremely worried about the situation",
        "input": "",
        "output": "hello as per your description you are having bimaxillary protrusion case told by you needs extraction in the initial phase alignment of the teeth occurs wire will proceed only when correction happen with previous wire till then the only religation has to be done when there is bracket debonding or bracket broken in that case treatment gets delayed so for that purpose you have to take care not to break or debone the bracket to avoid bracket debonding you have to follow certain precautions in oral hygiene measure and while taking food I avoid sticky hard food etc space closure occurs on is stainless steel wire that is a stiff wire again I would like to see the images of your concerned area of the upper and lower arch for a detailed discussion of your problem"
    },
    {
        "instruction": "hello doctor I was diagnosed with fibromyalgia a few years ago over the past three years it has gotten much worse I take lyearica two times a day and tramadol as needed for the pain I still have a great deal of pain every day the lyearica makes me feel like I cannot think straight and the tramadol just does not work anymore I was prescribed cymbalta which I took for approximately two years it did nothing for me either it was after that I started taking lyearica I have been taking it now for about six months I recently saw my provider and he did some trigger point injections which do help in the areas injected he told me he does not know what else to do for me I just feel like there are no doctors that want to even try to help people with fibromyalgia especially those with which all the current medications do not work I am terribly frustrated and very tired of being in pain every day I never get a break from the pain anymore what other treatments are out there now anything new that I may have not heard of any help would be greatly appreciated I work full time and I just do not want to be so miserable while doing it apart from lyearica and tramadol I am also taking estradiol progesterone levothyearoxin and fluoxetine",
        "input": "",
        "output": "hi fibromyalgia is a very frustrating condition but with the help of the patient a doctor can treat it I have treated my patients with all the drugs you have mentioned by managing the doses but I always ask my patients to do meditation that would help the most in this problem in your case I would recommend you to take lyearica pregabalin at the dose of 50 my in the night time which would not affect your thinking process you should also take cymbalta at doses of 60 my per day your doctor would adjust these doses according to the symptoms you have been getting as well as the side effect profile I hope this helps ash thyearoid stimulating hormone"
    },
    {
        "instruction": "hello doctor prostate biopsy was prompted by rising spa over several years 20 25 per year reaching over this past year spiked at 3 which I think really is why they wanted the biopsy but I expect it to come down since then 12 core came back benign but I do not understand the implications for some of the additional descriptive language and why I need continued six months follow up dre had nodules and trust shows calcification and volume of 27cc path description says reactive and atrophic acing and locally reactive does that mean bah or prostatitis or is that a precursor to pa I have no symptoms of bah or prostatitis other than getting up between am and am every morning I think it is just an age factor I am not interested in the does and trust procedures if it is not going to tell anything new and I can have bloodwork done without the time and expense of a doctor visit",
        "input": "",
        "output": "hi I have studied your reports and consulted with my pathologist as per her advice and mine too your reports are normal the biopsy changes are age related in the biopsy no carcinoma is identified doing dre digital rectal exam and trust transrectal ultrasound again will not be beneficial as biopsy has already been done and results are negative for cancer and bah benign prostatic hyperplasia biopsy was done because in benign prostatic hypertrophy and prostate cancer calcification occurs in 10 of cases and your biopsy is normal biopsy is the choice of diagnosis and your biopsy is normal your doctor has asked for the followup to see the changes in prostate calcification yes trust and dre will only show if the calcification and volume are increased or decreased nothing else rest you can discuss with your physician for diagnosis and management"
    },
    {
        "instruction": "hello doctor I have an extremely embarrassing issue with bad breath it is not your typical bad breath it smells like dog poop I am so embarrassed to say that but it is true it smells terrible even after I brush it has affected me my whole life over the years I have had people consistently make comments about how bad my breath is I have great dental hygiene see the dentist twice a year brush twice a day floss throughout the day mouthwash etc and nothing helps finally now that I am a 38 year old woman I mustered up the courage to talk to my dentist about it and also to see an ent doctor about it and they both have stated they do not believe it is a mouth or ear nose throat issue probably about 15 years ago I was on an antibiotic for something and it amazingly took my bad breath away and when I had a bowel movement the smell was not as bad either that is also an odor issue I have I am extremely embarrassed about my bathroom smells I have is so it is a common thing in my life I remember when I took this antibiotic noticing that it took away my bad smells I had typical not so pleasant odors but nothing extreme and I could also tell in my mouth I did not have this kind of yucky taste that I commonly have I was so relieved but that was short lived once the antibiotics were gone I cannot remember at all what the antibiotic was maybe doxycycline or metronidazole I am desperate for advise or help this has effected me in so many ways in my life I try not to get close to people when I talk and I avoid my husband like the plague when he tries to get close I am desperate to find some help with this issue",
        "input": "",
        "output": "hi I have read your query and yes it seems likely that this is a medical issue and not a dental one since this is a long standing issue diabetes or kidney disease seems unlikely as you would definitely have had other symptoms too by now you already suffer from is which could be secondary to acidity the cause for bad breath and bad taste of mouth usually dietary modification and medicine are good enough for management but considering your history of breath getting better with antibiotics you should get tested for pyloric a bacteria causing gastritis if positive for it follow up for a proper antibiotic course also not to neglect other causes do get abc hba1c and urea and creatinine tested also in the meantime avoid spicy oily or rich in proteins foods increase carbohydrates and use yoghurt if you cannot tolerate milk elevate head end of bed walk at least 15 minutes after dinner do not lie down til hour post meals drink fluids with meals to decrease acidity eat dinner hours before bedtime eat smaller portions for ease of digestion simultaneously using omeprazole 40 my at night will improve things"
    },
    {
        "instruction": "hello doctor my dad is 64 years old and suffers from severe constipation anxiety numbness in his arms but only during sleep buzzing in ears and insomnia he cannot sleep at all at night we have to give him sleeping pills sometimes does not talk much to us but always wants us to be beside him and always mumbling what will I do or other things I cannot recognize he did mri two months ago and it showed involutional changes early small artery disease but the above symptoms were not there was only constipation but now after we went to a doctor he gave him two medicines for his anxiety and sleep but after taking these two pills his condition got worse please explain in detail that what is going on with him and can the medicines really worsen his condition what are we supposed to do now please help",
        "input": "",
        "output": "hello I will suggest some of the medications as well as remedies for quick result first of all do not be so anxious everything will be going to alright ringing in the ear is known as tinnitus please follow these precautions to prevent the buzzing sound in the ear avoid excess cold water head bath avoid excess traveling avoid intake of so much spicy and bitter food administration of the cow ghee one tablespoon every day applying oil around the ear and on the scalp treatment for severe constipation include intake of to 10 gram of the ghee in diet daily intake of food rich with diet fibers intake of warm water in the morning and evening treatment of insomnia include stimulus control therapy this method helps remove factors that condition the mind to resist sleep for example you might be coached to set a consistent bedtime and wake time and avoid naps use the bed only for sleep and sex and leave the bedroom if you cannot go to sleep within 20 minutes only returning when you are sleepy sleep restriction lying in bed when you are awake can become a habit that leads to poor sleep this treatment decreases the time you spend in bed causing partial sleep deprivation which makes you more tired the next night once your sleep has improved your time in bed is gradually increased sleep hygiene this method of therapy involves changing basic lifestyle habits that influence sleep such as smoking or drinking too much caffeine late in the day drinking too much alcohol or not getting regular exercise it also includes tips that help you sleep better such as ways to wind down an hour or two before bedtime sleep environment improvement this offers ways that you can create a comfortable sleep environment such as keeping your bedroom quiet dark and cool not having a to in the bedroom and hiding the clock from view relaxation training this method helps you calm your mind and body approaches include meditation imagery muscle relaxation and others I hope this helps"
    },
    {
        "instruction": "hello doctor I am 26 years old I got scratch in my cornea eye due to nail basically corneal abrasion I have got this a month ago and got treated now it occurs again what I should do",
        "input": "",
        "output": "hi welcome to icliniq com corneal abrasion usually occurs due to a trivial or serious injury to the cornea it should be treated immediately to avoid a more serious sight threatening complication like corneal ulcer injury to the eye test for dry eyes should also be performed for recurrent corneal abrasions corneal abrasion can be best treated by administration of vigamox moxifloxacin hydrochloride eye drop one drop every two hourly and systane eye drops every two hourly difference between the two eye drops is approximately five minutes application of panthegel eye ointment dexpanthenol along with zymar gatifloxacin eye ointment at bedtime it is a good idea to patch the eye for the whole day with a sterilized eye pad to avoid any dust and minimize the blinking rate for an effective and speedy recovery of the abrasion avoid cleaning the eye with water or any unsterilized cloth or whatsoever if the condition is associated with pain and redness homie homatropine hydrobromide eye drop once daily along with anti inflammatory tablets like combiflam etc can be taken twice daily for three days if the condition does not improve in three days you should consult an ophthalmic consultant for proper examination and treatment of the pathology use of contact lenses to be avoided at all times avoid use of water patching of the eye with sterilized eye pad for the whole day avoid use of contact lenses and eye cosmetics use of topical steroids should be avoided at all times if the problem does not improve in three days proper slit lamp examination of the eye should be done by a trained ophthalmic surgeon"
    },
    {
        "instruction": "hello doctor I have been dealing with severe lower back pain hip pain butt and leg pain fatigue insomnia hot and sweaty pain in wrist and fingers foot pain left foot my toes are curved down and one is curved to the left I do not know if this has anything to do with arthritis but there are occasional lesions in my nose and occasional neck pain I am currently taking cymbalta I have had arnold chiri malformation and underwent decompression surgery",
        "input": "",
        "output": "hello I am sorry you are having these symptoms have you had any laboratory workups done before how about imaging studies there are many causes of your current symptoms and this makes it more complicated since you have arnold chiari malformation this includes autoimmune condition degenerative condition and metabolic conditions I would recommend that you do further testing to understand your condition I would recommend that you check your abc complete blood count of rheumatoid factor sept serum glutamic pyearuvic transaminase and got serum glutamic oxaloacetic transaminase bun blood urea nitrogen creatinine ear erythrocyte sedimentation rate cop reactive protein thyearoid function test and fbi fasting blood sugar as initial tests in the meantime I recommend that you undergo a physical therapy program to include ultrasound tens transcutaneous electric nerve stimulation william flexion exercise myofascial release joint conservation techniques range of motion exercises within pain free range endurance exercise as tolerated I would also recommend you take naproxen three times a day for pain and ibuprofen twice a day for breakthrough pain once you have the results of the tests please do follow up I hope this helps follow up with lab results"
    },
    {
        "instruction": "hello doctor I am a 34 year old woman I have a year old son and I have been trying to conceive my second child with no success during the past several months during the pregnancy with my son I had a cervical cerclage placed which was not removed at the cesarean section the doctor forgot the cerclage got infected three months later after birth when resuming sexual activity I went to a different doctor who removed the cerclage and gave me a course of augmenting antibiotic I had no more infection however during my period I would perceive a vague fishy smell of the blood no other smell during any other time of the cycle I had multiple cervical and vaginal cultures done including mycoplasma ureaplasma gonorrhea chlamydia and everything is always negative my pap tests are also normal but show non specific reactive inflammation I was given doxycycline and metronidazole for 14 days and I also took cephalexin for seven days during this month for a ti however when repeating the pap and cultures last week it is still inflammatory with negative cultures I am also scheduled for a sonohisterosalpingography this week can this procedure be done when I have an inflammatory pap considering cultures are negative and the pap is still inflammatory despite antibiotic treatment is it safe can the inflammation be related to the cerclage somehow or can it show in fact some cervical cancer or dysplasia and if there are precancerous changes in the cells of the cervix although the pap did not say that could the sono hug actually push them into the uterus and ovaries and possibly cause cancer there or am I over reacting I need to mention my paps were always normal before the pregnancy and the cerclage situation I am worried and do not know what to do",
        "input": "",
        "output": "hi do not think much if you have a negative culture and you had course of antibiotics after an inflammatory pap test then mostly infection or active insects are removed from the cervix now in hysterosalpingography dye is pushed inside the uterus and two or three rays are taken for tubal potency and along with that many times doctor prescribes one antibiotics course as a precaution for prophylaxis against infection inflammation can be chronic can be post delivery or age related but do not worry if you have taken antibiotics already secondly hysterosalpingography is mostly prescribed to see the tubal potency to rule out any problem related to fallopian tubes so it is a safe procedure do not worry I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 47 year old female I started to have severe joint pains and inflammation around three weeks back then one day as I was giving a presentation my team members noticed that I was bleeding profusely from my nose the in house nurse was called and I was found with high pressure of 210 120 mhg and was subsequently hospitalized for a day after extensive blood tests I was found that my anca mpo anca is 202 u my and anca pr3 anca is 40 74 my what does this mean I was prescribed imuran 50 my once a day",
        "input": "",
        "output": "hi I have gone through your query I need to clear a few doubts before giving you the final answer I understand you had some problem which started three weeks back with joint pains followed by high blood pressure causing a nose bleed I would like to investigate why you had sudden blood pressure rise is it due to inflammation in the kidneys or some other reason if previously things were normal do you have any history of fever recurrent nose blocks or hearing loss were the other blood tests done like cop reactive protein urine routine chest ray ear erythrocyte sedimentation rate as per the results these are the markers for vasculitis so we need to be sure these are the ones that are causing your joint pains or high blood pressure because the management will change if there is renal involvement and imuran alone would not be enough cop ear urine routine x ray chest pa postero anterior view abc complete blood count let liver function test and serum creatinine"
    },
    {
        "instruction": "hello doctor my year old son has high fever since last night I gave my of 100 my nurofen syearup it helped but did not bring the fever fully down he had another dose of syearup this morning for the same issue he has wet diapers passed stools ate a bit but not much drinks water and is breastfed he has a bit of cough wet and a very runny nose we did bloodwork any thoughts",
        "input": "",
        "output": "hi I understand your concern I have gone through the blood investigation which is suggestive of viral fever with low thrombocytopenia low platelet count from the history and investigation it looks like a viral fever which usually requires symptomatic treatment and will subside over a period of five to seven days give fever medicine round the clock four to six hourly instead of nurofen ibuprofen give local brand of paracetamol 15 my keg per dose nurofen affects platelet counts so it is usually avoided in viral fevers make sure that the throat is clear no congestion which is usually a source of infection use warm saline gargles frequently and use soap to wash your hands if fever does not subside after 48 hours please do visit a doctor I hope this helps"
    },
    {
        "instruction": "hi doctor my year old son has had a pretty bad cough that we are treating and he is improving last night he had some pretty severe coughing fits but we got through those with herbal tea cough drops and a small spoonful of honey when we got up this morning and I looked at him I was alarmed to see both of his eyes had puddles of red blood over part of the white areas I did some online research and it looks like a subconjunctival hemorrhage everything that I read about this condition says it will heal on its own but I would like a professional opinion he did have some eye goop the day before as part of his cold sickness but that cleared up on its own",
        "input": "",
        "output": "hello I reviewed your history and the photos attached to the question the photos show sub conjunctival hemorrhage as rightly thought by you this is because of the collection of blood under the conjunctive this occurs most commonly following injury but can also occur in cases of coughing or severe sneezing as in case of your son this will resolve slowly as the blood gets absorbed over a period of two to four weeks no treatment is required use of vitamin tablets will help in quick resolution the cough needs to be treated appropriately you need to consult an ophthalmologist if there symptoms like pain diminution of vision otherwise no need to be worried he will be fine I hope this helps"
    },
    {
        "instruction": "hello doctor I am taking akt tablet for to it is affecting my ear and mind please suggest an idea to stay against it",
        "input": "",
        "output": "hello the anti tubercular drug at is a cocktail of four drugs namely isoniazid rifampicin pyearazinamide and ethambutol I will concentrate on the side effects that have disturbed you now side effects on the ear and the neurological effects most of the neurological effects are caused due to isoniazid it is known to cause decreased sensations altered mental status numbness etc to counteract the same pyearidoxine 100 my per day is given pyearidoxine is a complex vitamin whose function is affected by isoniazid nextly ethambutol can cause some mild neurological disturbances and significant vision problems it can result in decreased field and accuracy of vision if you experience any such defects with vision please contact the doctor who prescribed at and ask him if ethambutol can be substituted ear side effects are common with streptomycin another anti tubercular drug but streptomycin is not present in at so you need not worry tuberculosis requires dedicated treatment for a long time some amount of side effects are inevitable for the sake of curing the disease earlier longer therapies were advocated for to which used to have even more side effects a good diet regular exercise calm and peaceful mind and vitamin supplements are all necessary to tide over the many of the side effects caused by these drugs"
    },
    {
        "instruction": "hi doctor I have been having burning sensations in my chest arms and back numbness in both sides of face and shortness of breath I have also been having weakness of the legs I went to the er on sunday and they did not know what is going on",
        "input": "",
        "output": "hello I understand your concern and would explain that your symptoms are suggestive of possible anxiety from the other hand vyvanse can lead to such symptoms as a common adverse effect coming to this point I would recommend taking alprazolam at a low dose for anxiety if this does not improve your situation I would also recommend performing further tests thyearoid hormone levels for possible thyearoid gland dysfunction blood electrolytes vitamin b12 and vitamin plasma levels for possible deficiency an exercise cardiac stress test you should discuss with your doctor on the above tests if all the above tests result normal I would recommend gradually reducing the dose of vyvanse and see if your situation improves stopping this drug may be necessary"
    },
    {
        "instruction": "hello doctor last night I worked out my arms mainly my biceps and today I woke up and noticed that the upper region of my biceps has caved in a little it seems like it has changed its shape slightly it does not look like a popeye there is no constant pain but I do get a dull pain when I firmly touch that region what could this be could this be a tendon rupture or tendinitis",
        "input": "",
        "output": "hello I have received your query and have gone through your physical findings and my diagnosis and treatment advice regarding this would be as follows you said that previous night you have worked out your arms the next day you had pain in anterior shoulder and pain is not constant yes I do suspect it might be a biceps long head tendinitis I am saying this because you had more pain in the anterior shoulder this thing could be because of your heavy workout sudden lifting of weights sudden high tensed overhead activity improper maintenance of posture while workout which could stress your biceps long head which origins from the anterior shoulder blade and lead to pain inflammation tenderness swelling and minimizing activity levels I would say that in your case it might be an acute mild or moderate injury and not severe my advice would be please do break your workout for some days do not perform any overhead activity no external rotations of your shoulder no pulling or pushing using your shoulder apply ice for 15 minutes for two to three times a day until pain and swelling subside if symptoms do not subside please do consult an orthopedic or qualified physical therapist there are many techniques available for further rehabilitation protocols such as soft tissue mobilization iontophoresis ultrasound tens stretchings phonophoresis etc can be used if injury is severe and long term rehabilitation is planned I hope this helps"
    },
    {
        "instruction": "hello doctor I am suffering from irregular periods and cos for more than 10 years I had to take clomid and with hug injection conceived my first baby three years back now I have been trying for my second baby with the help of clomid I took clomid for six months with no luck this month my doctor had prescribed a combination of clomid 50 my from day to day 10 tablets for five days and nolvadex 10 my tablet from day to day 12 20 tablets for 10 days going through the purpose of the tablet I understand nolvadex is for treating breast cancer I am scared to take this tablet now as it also says that it may harm the fetus can you please enlighten me in this regard will it help with fertility please let me know the possibility of having a healthy baby by taking nolvadex during tc will it affect the baby by any means",
        "input": "",
        "output": "hello novaldex is tamoxifen which is a selective estrogen receptor modulator yes it is one of the most common drugs that is used for treating breast cancer patients and also certain birth defects are possible if you take this medication when you pregnant in your case this medication is being used because you are resistant to clomid with failed attempts at getting pregnant with clomid treatment this is being given in the phase of your menstrual cycle when even the egg formation has not happened and basically to help your egg or follicles formation so that you can conceive with the medications so there is absolutely no harm taking this medication to get conceived recently few studies have shown improved ovulation rates with tamoxifen in clomifene resistant women however I would suggest you to please consult your fertility expert again before you start the course and be confident about your treatment and solve further queries regarding the same because trusting your treating doctor is important before you start any treatment"
    },
    {
        "instruction": "hello doctor I am 19 years old and have had acid reflux for the past five years I have had a cough and whistling sound wheezing with it for five years and over the past few months I have had rattling in my chest the doctors cannot hear the rattling but I feel it mostly when I lay down in addition to the rattling the cough has gotten worse it is much more of a dry cough and it burns also for the past five years it feels like it is hard to breathe but the doctor say my lungs and says it sound clear an ray was also performed a few weeks ago and they said the results were normal what could cause this my biggest fear is chronic bronchitis I am having another endoscopy soon but would a bronchoscopy be better",
        "input": "",
        "output": "hello from your history it is very clear that you are suffering from too many problems in your teenage first thing I want to clarify is you are having morbid obesity also you suffer from chronic gastroesophageal reflux disease I herd so you are having dry cough for such a long duration the current symptoms you suffer are suggestive of bronchial asthma herd is the aggravating factor for your dry cough the most important investigation to rule out asthma is spirometry also called as pulmonary function test put obesity is making all symptoms worse so you should also concentrate on weight reduction and regular exercise if put is suggestive of asthma you need definitive inhaler treatment to keep your asthma under control chest ray may appear normal but dry cough for such a long duration again suggest asthma priority should be given for weight reduction allergy to dust herd and obesity put or spirometry ace absolute eosinophil count blood test bronchial asthma herd bronchial asthma inhaled corticosteroids through metered dose inhalers antacids for reflux and weight reduction for obesity avoid spicy food needs regular monthly follow up with your doctor to keep your asthma under control"
    },
    {
        "instruction": "hello doctor I would like to know about weekly chemotherapy for peritoneal cancer of 76 year old lady instead of full dose chemotherapy at 21 days interval weekly chemotherapy is done at a lower dose to have a less side effects first chemo charged on her caused severe side effects like dysentery diarrhea please confirm this whether this is really fruitful for elderly patients whether the weekly scheme is as effective and less toxic please help with your answer I am writing for my writing for my 76 year old sister suffering primary peritoneal carcinoma before four years one my medicine while treating her for asthma problem detected by clinical examination a huge lump in abdomen he ordered for us of lower abdomen and pelvis the report says kidneys both kidneys are normal in size but maintains shape outline and position cortical echogenicity is increased with maintained corticomedullary differiention no evidence of any hydronephrosis renal calculus or mass lesion is seen right kidney 4 am left kidney 5 am ureter both ureters are not visualized hence not dilated urinary bladder urinary bladder is seen normal in size shape and wall thickness no intraluminal lesion is seen uterus and ovary it is not visualized removed in 1996 suprapubic region mesentery is grossly thickened and appears as sol 10 4x5 am with displaced bowel loop around it impression mesenteric mass suggest it scan bilateral small size kidneys with grade I renal parenchymal changes next seen by an oncosurgeon he ordered for noncontrast it of upper abdomen noncontast because as her creatinine level was 9 compared to a maximum of 0 for females it scan of upper abdomen done and report shows the liver is of normal in size and is of normal contour and attenuation no ihr dilation gallbladder is well distended with normal wall thickness pancreas is normal in size and attenuation peripancreatic fat planes normal mad not dilated spleen is of normal size contour and attenuation no focal lesions sections through the lower abdomen show mental fat stranding and nodularity the bilateral kidneys are mildly contracted the pelvicalyceal system are normal adrenals are seen no evidence of any focal lesions no evidence of ascites no retroperitoneal lymphadenopathy is noted visualized bowel loops reveal normal in position caliber and wall thickness scoliosis noted with convexity towards left side impression mental stranding and nodularity the surgeon also asked for contrast enhance mri of pelvis the report shows mri report patient postoperative case of ovarian malignancy no documents available study reveals mental thickening and nodularity caking there is a focal protrusion of the momentum through a defect in the umbilicus postoperative post contrast study shows enhancement of the momentum dwi images show restricted diffusion within the momentum no abnormal lymphadenopathy seen bones under review are within normal limits uterus and ovaries are not visualized postoperative there are minimal pelvic ascites on post contrast study thin smooth peritoneal enhancement is seen with few nodules at places enhancement is also noted along the sigmoid and descending colon impression modular cake like mental thickening smooth peritoneal enhancement with nodularity at places in a patient with previous malignancy features suggest possibility of peritoneal carcinomatosis advise mental biopsy next core needle biopsy from mental mass was ordered the report shows us guided core biopsy from mental mass microscopic examination section shows deposition of malignant gland formed by cuboidal cells within fibre collagenous tissue with desmoplastic stromal reaction impression adenocarcinoma deposit I have forwarded to you four reports in respect of her for us it scan mri biopsy probably she is suffering from extra ovarian primary peritoneal cancer eopcc which happens to candidates whose ovary uterus already removed for her hysterectomy was done some 20 years back when biopsy report was normal please also note that her ca 125 is 2948 almost 80 times the normal value please intimate me in short whether any first dose of chemotherapy given caused heavy side effects like acute dysentery diarrhea for her whether at this age of 76 chemo with one single drug is advisable as per discussion with doctors here this peritoneal cancer resembles almost like ovarian cancer treatment mode also same although ovary removed some 20 years back",
        "input": "",
        "output": "hi I have read through your query in detail please find my observations below the investigations conclude the presence of peritoneal cancer which has characteristics like that of ovary cancer most patients are diagnosed at stage I or iv and chemotherapy is the preferred treatment I confirm that the treatment is same as ovary cancer chemotherapy protocols are being updated every day but what your doctors have suggested is in the right direction treatment is usually with medicine like carboplatin and paclitaxel with some patients being given cisplatin dysentery and diarrhea are known adverse effects of chemotherapy and occur in some patients weekly treatment is good as full dose chemotherapy with comparable rates of response talking about single drug and multi drug options every cancer is different and the treatment course is closely monitored and changes made appropriately every cancer patient is different and changes should be made after carefully studying the patient condition in conclusion as a patient relative you can help maintain a good general condition of the patient and give adequate fluids and nutrition side effects are uncertain and cannot be predicted I hope this helps"
    },
    {
        "instruction": "hello doctor I am 24 years old I am having a problem with premature ejaculation and I am afraid as I have all symptoms of premature ejaculation due to excessive masturbation I need your help",
        "input": "",
        "output": "hello I am sorry to hear that you are facing premature ejaculation problem before we proceed we need to identify the cause of the problem in some case it occurs from initial time and known as primary in few others it occurs after a normal sexual period and known as secondary premature ejaculation I hope you read my article at icliniq regarding premature ejaculation if not first of all I request you to read it completely to know the basic information once you read it revert back to me with the following details your duration of problem how the problem started whether it was on off or continuous from the beginning frequency of the problem in a week or in a month out of what number of sexual interactions were a failure in a month what are the factors that increase the problem factors that relieve the problem thoughts situations partner place etc your marital status and partner details is she very critical demands sex more than what can you think does she feel superior to you effect on your relationship so far details of medical illness if any medications you are receiving currently if any your description of the problem once you post these details I will try to analyze the cause of it and will suggest you accordingly"
    },
    {
        "instruction": "hello doctor I have been having sleepless nights for about a few months even if I get six to eight hours sleep at night sometimes less than five I always end up being tired throughout the day I am always sleepy even if I drink coffee but when I decide to get some sleep I cannot sleep I am 18 years old and weigh about 74 keg I have severe vitamin deficiency for which I was prescribed vitamin tablets which I stopped taking after a year however as per my last medical test my condition has not improved I go for a 30 minutes walk every morning and I am on a veto diet my finals are coming up and I need a way to get proper sleep and not be drained throughout the day",
        "input": "",
        "output": "hi I understand you are concerned as sleep is vital for a proper functioning of the body we need to look at a few things like have you gained weight recently or does this coincide with the sleep disturbances you have been suffering from as I can see you are overweight and this can cause obstructive sleep apnea which keeps waking you up while asleep due to temporary episodes if apnea so when you finally wake up you may or may not have a headache and you are drowsy throughout the day total inability to fall asleep could be stress related do you suffer from chronic anxiety or stress or even depression in these cases practicing yoga or meditation can help tremendously but if you have the former you need to reduce weight in order to diagnose exactly what is causing your sleep disturbances give me more details like is there headache nasal obstruction symptoms of frequent stress or depression etc I hope this helps"
    },
    {
        "instruction": "hello doctor for about a few months I have been surviving on less than an hour of sleep per night for the first 27 years of my life I have always had a little bit of trouble getting sleep overactive mind but I have never had any trouble getting a full night rest anywhere from to hours this recent bout of extreme insomnia had nothing to do with the habit I it is not like I made the choice one night to sleep only a little bit and then my habit got out of hand try though my brain simply is unable to let me sleep normally one day I could not sleep at all the next day and the day after that the same thing happened I finally managed to get a decent night sleep the next day and after that the pattern of only being able to sleep for less than an hour if at all maintained itself I struggle and struggle to sleep and then I dream for a little bit and then my brain kicks me out of sleep and I cannot go back I cannot even nap and yet usually my mind and body find a way of feeling rested after one measly dream I ought to feel like a zombie but most days I feel physically well rested I have heard of cases where people who used to sleep well became insomniacs after periods of great stress or depression I am almost certain that I became an insomniac because I was nervous about starting my new job the thing is though that it does not look like it is going away any time soon will it be permanent how scary is that I know the dangers of not getting enough sleep and I have tried certain things like sleep hygiene relaxation techniques etc nothing seems to work the only thing that helps a little is 400 my of seroquel prescribed by my psychiatrist however I have such a high tolerance for sedatives that I have to stop it and reintroduce the drug after a matter of days I guess what I am trying to say is there probably is not a solution for my extreme condition yet as sleep and the human mind are both great mysteries however I would like to have an opinion as to what is going on in my mind and how it started I hold the theory that the stress leading up to my new job somehow fried my brain I do not know in what sense exactly did the sudden onset of stress somehow deplete some of the chemicals in my brain that are necessary for sleep or could there be another explanation or hypothesis",
        "input": "",
        "output": "hi you have a unique situation and though I do not have a clear answer to your complaints I can give you some relevant advice the first thing to do is to evaluate your insomnia I would suggest you use a camera to video record your sleep you can use your phone camera with good memory capacity and place it somewhere higher so you can see your movements at bedtime the reason for this is that personal evaluation of one own sleep is far from objective I frequently come across patients who say that they cannot sleep while their partners say they do and occasionally even snore there are phone applications like sleep as android etc which record your movements in bed and can give you a reasonable estimate of your sleep time another possibility is that you are sleeping but not getting enough deep sleep deep sleep is characterized by slow waves on eg electroencephalography and the feeling of having rested during sleep that is why sleep study is the ideal investigation for sleep issues as it does an eg recording as well as a video recording of your sleep as android also gives a rough estimate of your deep sleep percentage during your entire sleep in such a scenario there are specific medications which enhance deep sleep like pregabalin which you can ask your doctor about sometimes trying too hard to sleep is counter productive beliefs like I should get seven hours of sleep at any cost and if I do not it will cause great harm to my mind and body are incorrect and very likely to impair with sleep these irrational thoughts need to be addressed via cognitive behavioral therapy if you think this could be the problem with you the most important component of sleep hygiene is if you cannot sleep leave the bedroom sit somewhere else and do stuff like reading or listening to music this breaks the classical conditioning association between your bed and inability to sleep go to bed only when you feel sleepy remember that the use of electronic displays in the late evening could be a major cause of insomnia keep their use to minimum and use a blue light filter app on your phone after evening try taking natural sleep promoters like melatonin 6 my which you can find on the internet this should give you some guidelines to investigate into your sleep and hopefully improve it"
    },
    {
        "instruction": "hello doctor I get sick every two three months my doctor diagnosed me with chronic bronchitis about a year ago I get the same symptoms every time the illness flair up again the symptoms consist of a snotty nose fever shaking weak shortness of breath and a persistent horrible cough I also throw up some of the things I eat and foam when I drink things I have an inhaler that I plug into the wall and inhale the albuterol vapor that the machine produces I would just like to know what else I can do to treat this painful illness",
        "input": "",
        "output": "hello in many cases of chronic bronchitis acute symptoms appear due to infection so I would advise in such a scenario to get a hemogram with ear erythrocyte sedimentation rate and chest ray done if the chest ray and these blood investigations show no sign of infection then you would be treated for bronchitis treatment constitutes antiallergic drugs like levocetirizine and montelukast and in severe cases inhalers containing like salbutamol and steroid inhaler like budenoside in case of severe spasm and coughing a steroid like prednisolone can be used for a short course after being sure that there is no active infection or pneumonia if you do not have a severe cough or respiratory distress and your chest if found clear on examination then a cough syearup containing salbutamol levocetirizine dextromethorphan will help you greatly benzonatate pearls are helpful in an allergic cough only as they just anesthetize the throat and reduce the allergic cough response but in cases of severe chest congestion they are not useful also do steam inhalation for symptomatic relief I would advise you to see your doctor and get investigated share my opinion with him I am sure he would agree to it and would prescribe you accordingly I hope this helps"
    },
    {
        "instruction": "hello doctor I am 35 years old I am taking the following medicines for the past seven years but I am extremely suffering from erectile dysfunction and premature ejaculation what can I do bisoprolol 5 my once daily flupentixol and melitracen 5mg 10mg once daily theophylline 400 my twice daily aspirin 75 my once daily montelukast sodium 10 my in the evening atorvastatin 10 my once daily clonazepam my amlodipine and telmisartan my 80 my once daily kindly advice",
        "input": "",
        "output": "hi why are you taking anti depressant and antipsychotic drugs that too for so long time why these medicines were started are you also suffering from some heart problems please reply so that I may guide you accordingly regarding erectile dysfunction most of the antidepressants do cause dysfunction I would suggest you to consult a psychiatrist to taper down antipsychotic medicines or replace with other ones as for as cardiac point of view bisoprolol also causes erectile dysfunction in some patients replace this medicine with nebivolol 5 my which also enhances erections you are taking aspirin atorvastatin bisoprolol which are usually given for ischemic heart disease which is uncommon in this young age in old age blockage of arteries also causes erectile dysfunction but in young age this is less likely if this problem started suddenly then most probably due to anxiety or depression if progressed slowly over years I would advise you to have penile doppler ultrasound done but before that I would recommend providing a bit detailed history of your past illnesses family history so that costly investigations may be avoided follow up with detailed history"
    },
    {
        "instruction": "hello doctor I am suffering with headaches a feeling of pressure in my head occasional dizziness and tinnitus I am on the waiting list to see a neurologist but in the meantime I paid for non contrast mri scans months apart both of which came back normal apart from the second one picked up a small pineal cyst my I would like to know whether these scans are sufficient to rule out a brain tumour or whether this is still a possible diagnosis given that the scans did not include contrast",
        "input": "",
        "output": "hello I passed carefully through your question and would explain that two mri are more than enough to exclude any possible brain tumor attchment removed to protect patient identity the pineal cyst may be an incidental finding as it does not seem to be related to the symptoms that you describe it is strange that it results in the second mri and not in the first one maybe the radiologist did not see it in the first one I recommend comparing with your radiologist these two mri in order to compare the presence of this cyst if it is a new finding or just was not described in the first mri in my opinion the type of headache that you refer coupled with dizziness and tinnitus are typical of tension type headache which is benign type of headache caused by a wrong posture and psychological stress so there is no reason to panic I recommend you to perform regular physical exercise trying to avoid staying before your smart phone for a prolonged time and trying to correct your posture avoiding caffeine intake will help too"
    },
    {
        "instruction": "hello doctor I am 61 years old male 80 keg weight 165 am height and I am a diabetic for the past 18 years and now I am on low cargo high fate diet veto I am taking now januvia 100 my tablet 0 I had a pricing pain in the heart side of chest two days back and went to a hospital they have taken egg echo and blood test and found normal and hence they asked me to go for it coronary angiogram find attached the it angio report please advice me what medicine I should take now to avoid heart attack in future",
        "input": "",
        "output": "hello it shows minor disease only so need to focus on healthy lifestyle which I guess you must be having which includes healthy diet like avoiding oily fatty and high calorie diet regular exercises like walking or brisk walking according to your capacity such pricking pain are usually related to gastritis and reflux disease rather than cardiac however you may experience some exertional pain due to myocardial bridging which is usually benign these 20 30 percent blockages would not cause any pain in my opinion you should be on antiplatelet station combination like ecosprin av 75 10 my bedtime for long term for preventive purpose so should discuss this with your treating doctor if you get any pain on exertion which relieves with rest then it may be due to myocardial bridging then you may require beta blockers like metoprolol in the future you should also undergo echo and tit testing every 3 yearly to keep check on the blockages hope this helps you and get back if you have any doubts"
    },
    {
        "instruction": "hi doctor I am 19 years of age I have been suffering from a kind of allergy for almost years my mother has been suffering from same kind of allergy but her case is not worse than mine I feel runny nose sneezing itchy nose and eyes mild rashes after having a shower and breathing difficulty also my heart beat gets faster and rapid I am also suffering from noise sensitivity I cannot tolerate loud voices my heart starts beating faster and I feel dizziness and headache in my own residential area I catch allergy for almost 360 days of the year I am feeling much suffocation and rapid heart beat another thing whenever I get stuck in some kind of mental or emotional stress my heart rates becomes faster and irregular and at that point of time I feel suffocation too a nearby doctor suggested me the treatment of nebulizer but I am not feeling much better",
        "input": "",
        "output": "hi I have read your query and there are two components so I will deal them separately first the increased heart rate in stressful conditions that is anxiety and not uncommon you can try breathing exercises but if not controlled or aggravates to full panic attack you will need cut by a psychiatrist or psychologist and medication best breathing exercise is placing a paper bag over mouth and nose and completely inflating and deflating it till heart beat and breathing become normal now for your allergy seems to be allergic rhinitis sinusitis you can use a maintenance therapy of myteka 20 my once a day with once a day soften and increase soften on excessive exposure to allergens like dust pollen etc"
    },
    {
        "instruction": "hello doctor I am 18 years old this all started two weeks ago I started to have some loose stools abdominal pain lasts about two seconds it comes and goes almost twice a day and grumbling in the stomach my doctor gave me a three day course of buscopan charcoal and apo ranitidine after which the loose motions and cramps have stopped but now the problem is that I have frequent toilet urges and feel that my bowel has not completely emptied I am also experiencing a lot of gas and grumbling in the stomach I have had gas problems from childhood but since these two weeks it has turned a little worse what am I suffering from and any treatment",
        "input": "",
        "output": "hi occasional abdominal pain loose stool urges for toilet all suggest that you might have irritable bowel syndrome this is a chronic condition if you experience worsening of symptoms change in consistency of stool any episode of any amount of bleeding along with stool then you might need further evaluation in terms of colonoscopy or it scan of the abdomen primary treatment is medications which you suppose to take for a long time as prescribed by your doctor you also need to change some sort of life style modification in terms of avoiding food which worsen these symptoms and also suggest to take high fiber low gluten diet might require a colonoscopy indigestion inflammatory bowel disease"
    },
    {
        "instruction": "hello doctor first I went to the doctor for extremely itchy scrotum that felt as if it had cuts in it and red spots on my penis that dry white my itchy scrotum is now healed but I have got little cuts at the base of my penis and those spots will not go he gave me scabies cream but I do not know if it is working is this an sad I am scared I am currently using permethrin cream",
        "input": "",
        "output": "hi I have reviewed the attached photograph and I can see few red erosion at the base of the penis they can be either an irritant reaction to something you have applied over the penis or due to herpes virus infection which is an sad sexually transmitted disease in herpes infection there are small fluid filled blisters to start with followed by erosion which are painful and heal over two to three weeks to confirm herpetic infection you can go for elisa enzyme linked immunosorbent assay test hav herpes simplex virus egg hav i'm hav egg and hav i'm in scabies there is excessive itching on the body especially at night positive family history of scabies and itchy red bumps on the body including penis and scrotum but cuts or erosion are not seen in scabies on the erosion you should apply topical antibiotics like mupirocin or neosporin neomycin ointment I hope this helps irritant herpes virus elisa for herpes virus irritant contact dermatitis herpes genitals mupirocin ointment or neosporin ointment wash the area with plain water avoid soap on the affected area after seven days"
    },
    {
        "instruction": "hello doctor I am a 27 year old male for the past six months I do not do any physical activities no exercise I work only on my laptop and drink very less amount of water I masturbate almost daily for the past 10 years I never had sex with any girl I never used any kind of contaminated stuff with my penis I never had erection problems in my life in fact I got erection any time I wanted except when I was extremely stressed and I always used to have morning erection until I started research on internet I usually wear tight briefs and often while wearing tight briefs when I got erection the tight fitting underwear tries to restrict the erected penis inside and due to tight fitting brief my penis bend where shaft meets the penis head inside the underwear and I firmly believe this caused the injury to my penis when I urinate sometimes some drops of urine are left in my penis head which comes out later after a minute when I walk back to my room for the last two months I have been suffering from very high levels of stress depression anxiety anger related to my job health relations past and future and I am severely constipated for the last two months may be due to these stress I do not have frequent urination last month I thought I should ask a doctor about this extra skin on my unelected penis see attached photos I started research on the internet at this time I do not have any erectile problems and I was not aware of any kind of terrifying disease that can happen to the penis everything was alright but then I started reading about the bend I have in my penis see attached photos and I read about all these terrifying diseases peyearonie disease prostate etc since then I am extremely terrified stressed depressed hopeless more constipated like someone is holding my stomach tightly and I also breathe very slowly when I think about these things I cannot take my mind off these problems I am terrified like I may have one of these untreatable diseases after this internet research I cannot think about porn and stuff which I used to think for erection and masturbation and even if I watch porn or try to think about porn all these queries and worries are running into the back of my head all the time and I cannot get erection yesterday I masturbated with a fully erected penis and I am able to get full length erection if somehow I draw my attention off these terrifying things I am having very mild pain in my penis on erection it is like a muscular pain inside the penis and had premature ejaculation this particularly started after internet research what is the cause of this pain are pain and premature ejaculation related what can be done to solve these problems I am suffering from erectile dysfunction problem in maintaining an erection it does not get hard for more than a few seconds what is the cause I noticed a darker patch of skin located on my penis shaft more specifically it is located on the very bottom of the shaft starting where the shaft meets the scrotum and traveling up towards the head little ways it is oval in shape the color is a bit darker than my usual skin tone what and why is this black skin on the lower side of my penis shaft what can be done for this extra skin on my unelected penis see attached photos is my penis shape normal or not why is my penis head bends downward is this normal why is the head of my penis is large in length and it often remains less hard spongy on erection while shaft gets very hard why not my penis erection is not parallel to the floor which it used to be it always slopes downward is this damaged suspensory penile ligament because tight briefs forcefully restricted the erect penis in a downward direction",
        "input": "",
        "output": "hello I have seen every picture you have uploaded and I understand your concern premature ejaculation is when you discharge within 30 seconds of masturbation or doing intercourse do you ejaculate before 30 seconds when you do masturbation the pain you are having is because you are doing excessive masturbation you should reduce your masturbation habit to two times a week otherwise you will have a lot of problems when you will be married if you are having early morning erections then you are fine it is your stress which is causing premature ejaculation you have to understand that premature ejaculation can be diagnosed when you really do sex with someone it is normal to have dark areas in penis like you have in the indian population you are comparing yourself with people in porn movies my advice to you is that you must reduce watching porn movies because it will affect your sexual life when you start doing sex with your partner people in porn movies take drugs thats why they have a longer duration for doing sex and also you will expect your partner to be like the women you watch in these movies which will also spoil your relationship with your partner the extra skin can be reduced by doing circumcision but it should be done if you are having a problem in rollback on your skin when your penis is in erect form or if you have a problem in doing sex with someone in your case since you are a virgin we can say anything for now and yes the shape of your penis is normal you are taking too much tension the only thing which you really need to do is to reduce doing masturbation if you do not you will have a lot of problems in the future take vitamin tablets for 15 days once daily I hope this helps"
    },
    {
        "instruction": "hello doctor my year old daughter continues to have strong abdominal pains couple of months before it was really bad and was also coupled with mono and fifths disease at that time her levels were crazy high ast 1312 alt 1692 these levels freaked out the doctors so we went back the next week still high but much lower ast 394 alt 807 get 84 we also did a sonogram at that point which was inconclusive we went back two weeks later and not better ast 532 alt 682 get 71 doctors have no answers and no idea about what was going on the doctors seem to phone it in at that point my daughter started feeling better so we did not push it for a couple of months and went back in and the levels seem close to normal ast 57 alt 42 get 12 we were given no comfort as to what caused it my daughter does complain a couple of times a week about her stomach hurting but she is not in the extreme pain she was in until this week she is back to waking up in pain spending most of the school day in the nurse office so now we are heading back to the hospital for more blood as we did not get any answers from the first 37 vials of blood they have taken any clues what might be causing this",
        "input": "",
        "output": "hi I can understand your concerns this appears to be a case of obstructive jaundice the main cause of obstructive jaundice is gallstones since get gamma glutamyl transferase levels are raised more than 70 in the first report it suggests an obstructive cause ast aspartate aminotransferase and alt alanine aminotransferase can increase in both hepatic and obstructive causes in obstructive jaundice the level of direct bilirubin increases more as compared to indirect bilirubin levels gallstones are easily visible on the ultrasound abdomen it also causes severe acute abdominal pain there are some syndrome like rotor syndrome which can also cause obstructive jaundice nevertheless the enzyme levels are falling and the child is improving now but I suggest you to repeat ultrasound to look for gallstones review with ultrasound report and liver function test report especially bilirubin levels I hope this helps"
    },
    {
        "instruction": "hello doctor my month old daughter has been sick for about a week she was throwing up all day and vomiting and there was blood mixed with it at one pint we were giving medicine to stop the vomiting her diarrhea has continued since sunday night it is progressed to the point that she is passing stools almost instantly after drinking anything the diarrhea smells like a sour milk is this a reason for concern",
        "input": "",
        "output": "hello before I answer your query I would like to ask you some questions until when did your daughter have exclusively breast milk when did you start other food along with breast milk did she have similar episodes in the past did she receive all her vaccines regularly kindly provide me with the answers so that I can tell you further on the diagnosis and the reasons behind it as of now it seems like a case of acute gastroenteritis which is quite common in this age group so do not worry much at this point the treatment plan consists of some considerations generally we prefer to give or oral rehydrating solution to the baby at regular intervals and as much as the child wants to drink continue breastfeeding normally add zinc to the baby as per the dosage schedule antibiotics are not mandatory it depends upon the condition of the baby after a thorough checkup I would suggest you to continue with or solution and breastfeeding and you can take her to your pediatrician for further consultation I hope this helps"
    },
    {
        "instruction": "hello doctor I have had a compound fracture of both the radial and ulnar forearm bones that resulted in two bones sticking out of my arm torn ligaments and muscle and nerve damage I had the arm reconstructed with titanium and it has been two years since then to this day I still have nerve pain and aching in my bones and I am trying to find relief I have been using an average of eight ibuprofen a day for nearly two years and it is not getting the job done I feel as though the nerve pain is not getting better but instead worse my question is what recommendations do you have for me to help relieve the pain I have tried almost every common remedy that doctors have recommended should I give up on trying to avoid the pain and get a consultation to talk about possible options",
        "input": "",
        "output": "hi I have gone through your complaint and seen your pictures I feel sad that you had to undergo such a procedure and pain since you have chronic pain I would suggest you to use opioid analgesic like oxycontin oxycodone and percocets oxycodone and paracetamol which are very effective in chronic pain alternatively you can use piroxicam tablets and flupirtine centrally acting analgesic capsule which has also shown good results in chronic pain management if the pain is of neuropathic origin then gabapentine and pregabaline are the best drugs you can discuss all these options with your treating physician and get prescribed the medicine that best suits you"
    },
    {
        "instruction": "hello doctor I did see the facts I was looking for on your site maybe you can answer some questions the best you can this is about a 16 year old female if the mesentery and or pancreas has a tear in one or both and if that tear was big enough to bleed where would the blood go would it go through the tract of the vagina or rectal tract to seep blood out of the body how long does it take the body and skin to show bruises or an area that has been injured somehow when you cut let us say your arm or leg with some kind of tool after the cut when does the blood start clotting if someone was sexually assaulted and have tears from stretching or penetration when do the tears start healing how long will it take minutes or hours or days or months",
        "input": "",
        "output": "hello pancreas is highly vascular and is surrounded by major vessels hence pancreatic trauma may be associated with life threatening hemorrhage and shock pancreatic injury or pancreatic trauma can be as follows due to blunt trauma as well and car accidents when the internal hemorrhage ensues into the peritoneal cavity it leads to peritonitis or retroperitoneal hematoma when it is because of sharp penetrating injury as in stabbing external hemorrhage the wound occurs a bruise is bleeding under the skin and is due to the rupture of vessels in the skin due to blow or any impact the timeframe for the appearance of bruise is in relation to the amount of the injury in case of significant trauma it appears immediately the classic feature of the bruise is to change its color the force that is enough to rupture the skin capillaries is all that defines the bruise when you suffer a cut your body immediately reacts in seconds to stop bleeding by hemostasis your blood should clot with in one to nine minutes by primary platelet plug formation again the time is variable as it depends on the nature and depth of the wound if it does not clot in nine minutes it should be evaluated for platelet dysfunction vaginal tears like any other wound start healing immediately after the injury but again time for healing is based on the degree of the tear first degree or second degree vaginal years usually heal within seven to ten days third and fourth degree may take months to recover any vaginal tear longer than an inch requires suturing I hope this helps"
    },
    {
        "instruction": "hello doctor my year old daughter has scalp ringworm I am using head and shoulders intense medicated shampoo and topical ketoconazole antifungal cream her doctor also prescribed an oral antifungal lamisil packets granules 125 my to be taken in food for a month I am terrified of giving my year old daughter an oral medication with such a scary track record or side effects including liver failure and death as well as vision problems low white blood cell count and psychiatric problems is there any alternative to this terrifying drug for curing scalp ringworm",
        "input": "",
        "output": "hello welcome to icliniq com scalp ringworm infection stays for a longer time topical ketoconazole cream is good the oral medication prescribed is also good for the infection there are a few alternatives any medicine carries some side effects along with it we need to weigh the benefit and risks if the benefit is more we go for the medication side effects are mentioned but are rarely seen it is usually tolerated well by children alternative medication is called griseofulvin which is to be used for four to six weeks or more if required it would not be available over the counter it needs a doctor prescription it also has some side effects but usually tolerated well fungal infection of the scalp griseofulvin or terbinafine"
    },
    {
        "instruction": "hello doctor I am years old and got ovulation spotting on 27th of last month after this I tried to conceive my period date is 1th of this month I faced many leg cramps and abdominal pain in the period also the period was light as usual and got frequent motion after the period I am feeling irritated with many smells on 24th again I got some spotting ovulation day I did a pregnancy test but it is negative I am messed up can I be pregnant in this scenario my doctor prescribed devilry 10 my for 10 days please suggest me is that medicine is safe if I get pregnant",
        "input": "",
        "output": "hi it is not always that you will be surely pregnant if you had sex during ovulation it is also not 100 that there is bleeding when there is ovulation spotting can be due to other reasons and can be the sign of irregular endometrium due to hormonal imbalance you can get devilry medroxyprogesterone acetate and even if you get pregnant mostly no harm consult a nearby gynecologist and do take proper consultation and counseling session about pregnancy and its treatment performa you may need to do some basic investigation to find out whether there is any problem or not whether you are ovulating or not during the mid cycle and confirming it by ultrasound you can take a repeat urine pregnancy test after eight more days"
    },
    {
        "instruction": "hi doctor I recently had full body health checkup I am uploading the reports can you please review and suggest me required medical care or treatment it seems lipid profile and ultrasound reports are not satisfactory please review and advice and one more thing is I am suffering from urticaria getting red rashes on skin which scratch or apply pressure on skin these rashes disappear in few minutes from last 5 years I am taking desolor my tablets thrice a week can you advice me if any advanced and permanent treatment to this problem instead of prolonged usage of tablets I do not have any smoking or drinking habit",
        "input": "",
        "output": "hi I can understand your concern I have gone through the reports you have attached you are having grade fatty liver you are also having elevated cholesterol which justifies fatty liver so you need start lipid lowering drug like rosuvastatin 10 my once a day at night before going to sleep for 30 days get done repeat lipid profile after 30 days avoid oily and spicy food avoid junk food avoid cheese butter etc do regular exercise like walking running cycling and swimming etc for urticaria take montelukast and levocetirizine combination monte la"
    },
    {
        "instruction": "hello doctor I have done a pre marital test with a prospective groom and he has beta thalassemia trait and I am not a carrier is it safe for pregnancy and child his hemoglobin count is 13 and hba2 is how safe is this for child health",
        "input": "",
        "output": "hello following is my opinion for your asked question if you are not having beta thalassemia minor then no need to worry your future child can have thalassemia minor but no need to worry for trait of thalassemia minor thalassemia major is the dangerous one in which life span is reduced but as your report is normal as per history there is no chance of thalassemia major in your future child"
    },
    {
        "instruction": "hello doctor my father is out of coma and on regular physiotherapy however we have a major concern now with frequent drop in his sodium level every five to six days his sodium level drops to 10 120 when that happens his consciousness level goes down and stops body movement or response he is given injection sodium chloride isotopic solution with fludrocortisone one tablet per day it takes about five to six days for his sodium level to improve around 130 when he starts responding he opens his eyes and moves body parts we have seen this three to four times since last one and a half months eight days back his sodium level went down to 109 and currently it is 121 but he has not shown much of body movement yet normally he recovers within five to six days please suggest what has to be done for faster recovery what has to be done to prevent this happening again and again I have listed the medicines he is taking currently initially tolvaptan is given for 10 days currently stopped fludrocortisone 10 extra salt per day with liquid food tablet ofloxacin 200 my capsule or tablet phenytoin sodium 100 my tablet vitamin complex tablet losartan potassium 50 my tablet metoprolol 50 my and tablet pantoprazole 40 my",
        "input": "",
        "output": "hi I am sorry to note that he is having problems with sodium levels I suggest the following serum specific gravity urine specific gravity serum and urine osmolality revert back after the investigations to a general medicine physician online"
    },
    {
        "instruction": "hi doctor I am 58 years old I do not have any health problem except high be in spite of medicines my be does not come down first I tried eso my and amlodac my and now I am on cilaheart 10 my but my be remains at 140 100 mhg I do not smoke or drink I eat less and avoid red meat and high protein please suggest a suitable medication thank you",
        "input": "",
        "output": "hello we are here to help you primary hypertension get the following test done serum creatinine fasting lipid profile urine for microalbumin and egg adding up a diuretic and lifestyle modification revert back after two weeks to a cardiologist online"
    },
    {
        "instruction": "hi doctor I am suffering from stromal viral keratitis my doctor mentioned in my report as stromal keratitis herpes is that herpes also I was prescribed red forte add tears and acivir ointment are these right medicines this is the second episode after five years please help",
        "input": "",
        "output": "hello let me share some facts about viral infection of eye for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor from young age I have had little red dots all over my legs and not much hair I am a 31 year old male and I want to know the problem there might be ingrown hairs but I do not know I have more of them hair especially on the back",
        "input": "",
        "output": "hi I have read your concern and examined your given pictures revert back after two weeks to a dermatologist online"
    },
    {
        "instruction": "hi doctor I am 43 years old I feel weak body pain and headache during menstrual cycle also feeling like depression my height is feet inches and my weight is 74 keg I have attached my recent blood test report please let me know the findings from the blood report thank you",
        "input": "",
        "output": "hello let me help you to deal with your problems repeat vitamin b12 after four months also check ear erythrocyte sedimentation rate as it was not done before vitamin b12 deficiency vitamin deficiency prediabetes overweight metabolic syndrome cholecalciferol 60 iu once a week for four weeks tablet vitara vitamin b12 1500 mug plus folic acid my once daily in the afternoon for two months tablet zentel albendazole 400 my one tablet at night for three days ointment oxalgin nanogel diclofenac for local application over the site of joint pain avoid oil foods and junk items revert back with after four months to a general medicine physician online"
    },
    {
        "instruction": "hello doctor I am in major pain now I noticed that my wisdom tooth is coming in about a week and a half ago since then I have been having this pain in the lower corner of my left mouth it is located right where the gums and my mouth meet and resembles a cut it is a slit with yellow and white outside and a brown on the inside I would like to schedule an appointment as soon as possible I would very much appreciate a reply soon because this thing made me stressed out thank you",
        "input": "",
        "output": "hello for further information consult a dentist online"
    },
    {
        "instruction": "hi doctor I have bilateral congenital cataracts with no other issues my parents do not have them please let know the percentage of passing this to my kid I knew that is autosomal dominant but what is the possibility of this to become familial is my kid 50 prone to it",
        "input": "",
        "output": "hello for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor my son is 10 days old his right eye has never turned towards right it has looked left straight up and down but never right his left eye has a full range of movement I have read about squint strabismus however I do not read anything about a restricted eye movement should I be concerned",
        "input": "",
        "output": "hi for further information consult an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor I have a perforated right ear for more than two years I do not want surgery also antibiotics did not work what are the best steps to be taken",
        "input": "",
        "output": "hi for further information consult an ent otolaryngologist online"
    },
    {
        "instruction": "hi doctor I have got some spots on my penis can you please identify what is it also please let me know the reason for development it is a recurring episode can you also suggest a remedy thank you",
        "input": "",
        "output": "hi revert back with the answers to a dermatologist online"
    },
    {
        "instruction": "hi doctor I have a lot of fantasies about my life partner I am keep thinking about this all time I do not care about my career I am a 29 year old male I do masturbation too please get me some solution",
        "input": "",
        "output": "hi for further information consult a psychologist counsellor online"
    },
    {
        "instruction": "hi doctor I am having fungal infection on my inner thighs ankle arms and back for about six months now I have taken 250 my terbinafine for one month along with antifungal cream but I did not see any difference what should I do",
        "input": "",
        "output": "hi I read your descriptions revert back after a month with photos to a dermatologist online"
    },
    {
        "instruction": "hi I am 20 years old next month I am going to have my squint surgery for cosmetic purpose I do not have vision in my right eye now and it turned inwards after this surgery will both my eyes look straight either I see left or right or up or down will both my eyes work together how many hours will it take to finish the surgery while surgery will I realize the pain please explain",
        "input": "",
        "output": "hi for further information consult an eye care ophthalmologist online"
    },
    {
        "instruction": "hello doctor I walked for around 10 am two days back I am not a habitual walker I felt cramp twice in my right leg during first am and after stretching it was better then I consumed fair amount of water but after 24 hours I got severe pain in calf muscles and there is slight swelling please suggest some medication or exercise I frequently face this issue kindly help",
        "input": "",
        "output": "hello for further doubts consult an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hi doctor my daughter is 14 years old I wonder whether she has herniated disc because she has all the symptoms except the numbness in legs and feet it hurts in the lower part of my back usually a herniated disc is from sports injury and heavy lifting but she recently have not had any sports injuries or have not done any heavy lifting but in the past she had her back has been hurting when she cough sneeze sit or even walk down my porch steps it has been hurting for may be two to three weeks now I have not heard people of her age have a slipped herniated disc and other stuff please help",
        "input": "",
        "output": "hello let us analyze different reasons for back pain of her age plain rub ray to look for renal stones and urinalysis with culture back sprain ti less likely ovarian cyst or kidney stones tylenol two pills every hours for pain on as needed basis flexeril my cyclobenzaprine every 12 hours as needed for pain revert back after a week with investigation report to an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I am years I had emergency contraceptive pill last month and got my periods 39 days back for four days duration but this month still did not get my periods as expected we had sex but there was no ejaculation or precum discharge so we decided not to take any pill now I have been feeling a little cramp like feeling in my lower abdomen as I feel during periods but only water like white discharge as in ovulation time coming out why is my periods late",
        "input": "",
        "output": "hi I pill effect urine for pregnancy testing missing period following taking emergency pill revert back after the tests to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I had some symptoms like heaviness in stomach frequent urination breast tenderness and morning sickness last week when I took hug blood test it was 34 my doctor advised me to repeat a test on couple of days and it was 26 I used to travel many hours to office this week I did not have any symptoms but still I did not get my periods what would be the reason for this before a year I had periods continuously for 24 days so I took yamini tablet for three months same time I had a scan as well and that was normal",
        "input": "",
        "output": "hello for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor years ago I had genital warts as I embarrassed to go to the doctor I ordered aldara online and it worked my question is what if I missed a wart after all this time I do have a few very tiny white specks on underside of the head on my penis when I showed them to my regular physician five years ago he said they are pearly papeles and not warts can I trust him is he right I am seeing a new partner and do not want to infect her please guide me",
        "input": "",
        "output": "hello first I do want to make sure that recurrence of wart after years is almost impossible now you can get genital wart only after exposure due to sexual contact done recently the second possibility of untreated or remaining part of wart also impossible as in year untreated wart would have become significantly large in size and would never remain unnoticed all these years the penile pearly papule and wart are very different condition and can be recognized by photos if you are able send me photos of your condition I would definitely tell you what it is penile pearly papule is not a disease or any treatable condition it is just sweat and sebaceous gland which are a bit bigger in size these are small multiple and arranged around the penile skin it does not increase in size totally asymptomatic and natural thing wart has rough surface they appear four to five in number it will appear after a sexual contact history within a month revert back with the photos to a dermatologist online"
    },
    {
        "instruction": "hello doctor I am 37 years old three years ago I had spine surgery for herniated disc la s1 after the surgery strange symptoms began four hours after surgery when I tried to sleep I got myoclonic jerks then I had problem with ligaments my ligaments started to stretch so easily that I began to hurt myself I was healthy before surgery and had no problems I also have hyperreflexia I have done mri of head and whole spine and the reports are fine rheumatologic test and genetic test for connective tissue are negative too muscle enzyme and egg testing were fine but my problem is getting worse and all this started after general anesthesia and never stopped neurologist says I have hyperreflexia and it is symmetrical but they do not know the reason for the same can this be something neurological is there any neurological condition that would affect ligaments which tests do I need to do please help",
        "input": "",
        "output": "hi revert back with the detailed information to a neurologist online"
    },
    {
        "instruction": "hi doctor I think I have got ti I usually have this problem every summer I am finding it difficult to pass urine since I have a burning sensation I am diabetic and also suffering from hypothyearoidism I take diapride my on empty stomach helmet 500 after breakfast and dinner and thyearonorm 50 mug on empty stomach there is no white discharge please help it is really bad my blood sugar levels are on the higher side as shown by my home device I am going tomorrow to the laboratory for a test",
        "input": "",
        "output": "hello yes diabetic patients are very prone to develop frequent ti urinary tract infection possibility is more if you have uncontrolled blood sugar primarily you need fasting sugar up postprandial sugar estimation and a routine urine examination as well as culture sensitivity to know the nature of organism along with the sensitive antibiotics this can be done by urine testing tomorrow meanwhile you start taking plenty of water by mouth I suggest flavospas or urispas tablets flavoxate hydrochloride thrice a day which can relieve your symptom a bit ultimately you need an appropriate antibiotic as well as a strict control of blood sugar this can be done through an appointment with your physician please share with me the detailed reports by sending pictures of them revert back with the reports to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I have been on klonopin that is clonazepam prescribed before 14 years for panic attacks and anxiety I am currently on the my dosage and taking it four times a day this is monitored every few months by my family doctor for the past one week I have noticed that I have been experiencing non stop severe panic attacks I cannot really work and concentrate my appetite is down and I only get about one hour of sleep I have heart palpitations tingling restlessness loss of concentration numbness shaking of hands and legs muscle pain in shoulders shortness of breath lack of motivation constant thinking that does not stop feeling out of place and worried I am researching whether I am going through drug dependency I just read that syprol a beta blocker is helpful in the current situation I am in so that I do not go into withdrawal from this drug can you please help me as my doctor is on vacation I really need something to help me get through this thank you",
        "input": "",
        "output": "hi I can understand your concern for further information consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor my year old son has eye allergy for over two months now when I consulted first doctor suggested after inspection that it is a kind of seasonal pollen allergy and to give the eye drop olopatadine along with cellulose based eye lubricant as it was not completely cured they gave steroid based eye drops also there was some improvement with steroid based drops but the doctor said it cannot be given for a longer time I have also shown him to other eye specialists and they too said the same thing the problem is that it looks like there is improvement but again the eye turns red it is present in both eyes please help us",
        "input": "",
        "output": "hi for further information consult an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor I had to switch my birth control from the mononessa to ortho cyclen today do you have a better recommendation I was on ortho cyclen when I was 16 and I remember hating it did not help with my cramps or make my periods any shorter I still bled for plus days I am now 23 years old and sexually active please help me",
        "input": "",
        "output": "hi for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I understand that a resting ekg cannot show catecholaminergic polymorphic ventricular tachycardia cpvt I had numerous eggs and echoes and all were normal I read that the stress test is the only way to diagnose cpvt I have had major panic attacks during eggs with heart rates up to 140 to 150 numerous times and they only showed sinus tachycardia I also read that cpvt will show up during heart rates of 120 to 130 bum why the cpvt is not evident on eggs",
        "input": "",
        "output": "hi we are here to help you for further information consult a cardiologist online"
    },
    {
        "instruction": "hi doctor last night during sleep I was awoken by a violent diaphragm convulsion I felt a sensation of being drawn down into a cold dark blackness it was very much disturbing and I felt like I was going to die I had benign arrhythmias with follow up hotter monitor and stress test revealed no signs of heart disease it occurred thrice in the last 18 months please help",
        "input": "",
        "output": "hello revert back with the answers to a cardiologist online"
    },
    {
        "instruction": "hi doctor I have these questions can you please help me to clarify does pausing and resuming urine while flowing improves sexual performance in men please tell me the procedure of this and does this cause any side effects to urinary system what is the kegel exercise I read somewhere that we can do this everywhere like in office home while driving how to do that and how often we can do that I have only one tests as I have undescended tests which was surgically removed recently I have sexual feelings as normal so do I need to take any extra care as I have only one tests or having one healthy tests also completely okay please answer in detail as it is very helpful to overcome my mental fear regarding these things",
        "input": "",
        "output": "hello please find following answers for your questions pausing and resuming urine would only cause problems this will not cause any improvement in sexual functioning better to avoid this completely this could cause development of diverticula in bladder or urethra kegel exercise is a good option to improve the sexual performance the exercise can be done at home or at any place without any issues this is nothing but pelvic muscle strengthening exercise in this one should tighten the pelvic floor muscles and hold the muscles in tightened position for around 10 seconds on count to after holding the muscles should be relaxed this should be done multiple times a day do as if you are holding gas in your anus or as if you are lifting the anus try to do this and you will come to know about movement of anus one testicle does not cause any problem no need to do any thing specific for that have good meals and exercise daily you will remain healthy having one tests is completely okay"
    },
    {
        "instruction": "hi doctor I am 17 years old and I weigh almost 300 labs I absolutely hate my weight and body so much as I always wanted to be skinny I lift weights four times a week at my school weight room I am a diver on my school girls swim and dive team and I am a thrower on track and field team I guess you can get me why I always hated my body I need to lose weight and keep it off I have tried so many times just to find how to do this but it is completely hard just to find guidance my mom scheduled me an appointment with a nutritionist I am currently on elinest birth control",
        "input": "",
        "output": "hi there are a few things that need to be addressed here please be happy about who you are as an individual do not judge yourself with the weight nobody can mess around with you there are certain things that you are doing wrong here if you want to lose weight stop lifting heavyweights stop using birth control pills if they are being used for therapeutic reasons please find another alternative do more of a cardio workout like the treadmill and the step climber lift the lightest weights possible with up to 20 reps per set and three sets per exercise continue swimming consult a nutritionist for advice on nutrition and follow those orders like word of law"
    },
    {
        "instruction": "hello doctor I have been going through a tough time for long I have been looking for a job for about two years and it is very difficult to find one although on my previous job I had several problems with the management taking me for granted people I trusted dearly broke my trust hurt me badly and I had still do ongoing problems with my parents as they were not understanding my issues and start arguments with me as the relationship is not good to speak and at work they could not be fully supportive to me yesterday on my way back from alcohol and drug testing on the train I felt sick nauseous dizzy and headaches I have work tomorrow I do not know what to do I sent an email to my manager that I cannot come tomorrow and explained the situation about my health I would like advice and guidance tips for me especially on the therapies too after taking online cut talking psychodynamic and emdr my therapist told me I suffered a lot in my time here that I need a change go to a different country and start a new life and job it is difficult as I have been traumatized with memories flashbacks important dates and numbers relating has ingrained on my mind unconsciously",
        "input": "",
        "output": "hello I am so sorry to hear about your situation I can imagine how hard it is for you right now I can understand that changing the place could be a big step to take and not always possible I would suggest you continue the therapy istdp intensive short term dynamic psychotherapy and cut cognitive behavioral therapy can prove helpful in your case for emotional blocks only cut is sometimes not enough you need to learn to not get stuck by the past memories and have control over your thoughts instead of your thoughts controlling you and your behavior the physical signs are an expression of the psychological and emotional stress that you have been suffering from such a long time so on your own start with maintaining a mood journal and keeping a note of your thoughts and emotions which overwhelm you try to spend a few minutes a day practicing relaxation techniques such as box breathing progressive muscle relaxation otherwise hear light music that makes you feel calm you will also require some life coaching to being yourself on track and become the best version of yourself you need to learn to make yourself and your well being a priority I hope this gives you some idea of what you need to do again so you can find a therapist locally or if you need it we can start therapy sessions online via video consultation"
    },
    {
        "instruction": "hello doctor my year old daughter has asthma she was diagnosed with a moderate asthma flare at urgent care four days ago flovent was increased to mug twice daily albuterol 5mg every four hours for 48 hours and prednisolone 15mg 5ml one and a half tablespoon once daily for five days she seems to be having retraction at night between 10 am and am like clockwork they are not severe as her respiration rate is 28 pulse oximeter reading is 96 98 pulse is elevated at times due to albuterol and the highest recorded is 160 with no fever she is tired and is pale in the face with dark circles under her eyes I followed up with the pediatrician yesterday and he diagnosed her with an ear infection and put her on augmenting he listened to her lungs and said they sounded fine she had an albuterol breathing treatment about one hour prior to her visit these symptoms that comes on night are scary productive cough and the sound of occasional constriction in the throat causing a gag with these mild subcostal retraction it is hard for me to determine do we go to the er or not it is hard to justify a trip to the er with normal vitals and these sets of symptoms wanting suggestions regarding is my daughter on the right treatment could this be something other than ear infection and viral illness causing asthma flare she has been sick with a stuffy nose postnatal drip and mild cough for three weeks she is also taking claritin singular ot tylenol or ibuprofen for ear pain and mucinex I also have a video clip of these retraction and I am attaching it",
        "input": "",
        "output": "hello as per your history it is very clear that your daughter has asthma exacerbation it can be because of an ear infection or viral infection in the airways as you said in spite of antibiotics oral steroids and frequent nebulization it is not under control she needs urgent hospitalization to give her urgent care and to find out other problems if any this flare up is a valid justification for her hospital admission as she is very young child she needs treatment under observation the very fact that oral treatment being not effective she needs intravenous drugs and steroid nebulization ray and other blood tests so I advise you to go to the hospital for admission without wasting much time this will help to recover her fast and find out the exact cause for her flare up once she is settled and the acute problem is under control she can continue with her inhaler medicines as advised I think this explanation is enough for you to explain her situation to you I hope this helps ear infection or viral infection ray blood tests iv antibiotics steroid and levoalbuterol nebulization"
    },
    {
        "instruction": "hello doctor my daughter years old and having allergic cold symptoms sneezing irritation of eyes nose and wheezing in some occasions our pediatrician prescribed montair la kid syearup my daily given for three months I want to stop the medicine but the doctor suggested to give it on alternate days if the medicine is stopped even for a day she gets back the symptoms severely is there any alternative how to taper the medicine",
        "input": "",
        "output": "hi as your child might have airway reactive disease it suggests she is having airway reactive problems or allergy to some substance the best plan of action will be to give montelukast sodium my tablet in the night time give salbutamol syearup 5 my once daily for five days buy a nebulizer and give nebulization with normal saline to asthalin solution in a concentration of one to one ratio rest medication will be gradually tapered off stop all syearups and rest of the medications gradually medicines will be reduced according to the symptoms allergy complete blood count asthma reactive airway disease asthma allergens to be avoided like dust pollen extreme hot and cold weather should be avoided"
    },
    {
        "instruction": "hi doctor I was three months pregnant and recently had a medical abortion I had unprotected intercourse four days before the abortion I was given 200 mug of mifepristone and two days later misoprostol which expelled the pregnancy the intercourse occurred six days before the misoprostol I am worried that this may start a new pregnancy after the abortion was completed as sperm can live up to seven days and if I ovulate immediately after abortion the sperm could be alive to start a new pregnancy please can you help me and give me an explanation of the following can 200 mug of mifepristone be effective at preventing pregnancy if taken four days 96 hours after unprotected sex I have found information on the internet which says in some countries that mifepristone is used as an effective emergency contraceptive however they say small doses of up to 50 mug please tell me whether 200 mug would be most effective",
        "input": "",
        "output": "hi welcome to icliniq com there seems to be confusion about the dose of mifepristone which you know about usually three 200 my tablets 600 my total orally administered mifepristone as a single one time dose and two days later misoprostol is given your idea about 200 mug mifepristone is therefore incorrect regarding ovulating immediately after medical abortion is not possible this is because the hormones in your body are still abnormal and ovulation will not occur in this situation I guess you have been given 200 my of mifepristone and there is no risk of pregnancy from sexual intercourse four days after the abortion the uterus is not ready to have another pregnancy right now so there is no risk to you"
    },
    {
        "instruction": "hello doctor yesterday I had an ultrasound of my abdomen they gave me the report online and I am not sure how to read it the things I am looking up are extremely worrisome it is all saying cancer I am going for a it scan within a week it is without contrast because I have myasthenia graves and the contrast really affects my breathing will contrast make a huge difference below I have pasted the results and it says normal liver and gallbladder left renal calculus complex heterogeneously hypoechoic cyst in the upper pole of the left kidney for which further imaging is recommended also I have been urinating almost every hour and it feels like my bladder is never empty I have had a kidney stone four years ago but the part about the complex cyst on my kidneys is troubling me",
        "input": "",
        "output": "hi welcome to icliniq com I understand your concern so you have a cystic lesion in the upper part of your kidney first of all you are only 28 years old and at your age I would favor many benign lesions over malignant ones if they are not talking about solid components of the lesions it again favors benign lesion let them do it computed tomography with I intravenous contrast if possible share both ultrasound images and it images with me one more thing if you do not have any sign of night sweating weight loss or redness in your urine again malignancy risk is too low I hope this helps"
    },
    {
        "instruction": "hello doctor I recently was on cymbalta minimum dose but did not feel better I felt worse and was told to up the dose then I took 120 my still felt bad so I abruptly stopped this and it triggered discontinue syndrome and hypermania I have not felt the same since I am not suffering so much now from hypermania after a month or two I am lamictal and when needed on seroquel on current medicines I feel blank unstable unable to think normal and some frustration anger thinking concentration and speech affected at times I feel I need to go back to antidepressants my brain needs that and boosts mood and taper off appropriately like effexor or lexapro I have had success but lexapro cause stomach issues and effexor is good but can cause weight gain or if working in the night it can cause mood swing I believe my current issue is just because of cymbalta induced hypermania I did get psychosis from led do you think I should taper off lamictal to effexor low doses",
        "input": "",
        "output": "hello welcome to icliniq com considering the history of mania even if it is drug induced it is not advisable to start effexor alone in my opinion so I would suggest you discuss with your treating psychiatrist regarding starting seroquel regularly as it also acts on depressive symptoms or starting low dose effexor along with lamictal as mood stabilizer I hope this helps"
    },
    {
        "instruction": "hi doctor I am 29 years old I am having constant cold problems not a runny nose but I always can feel phlegm passing down in the back of the throat throughout the year when certain conditions like prolonged exposure to cold temperatures symptoms like dry cough heaviness all over the face especially in cheeks eyebrows sneezing congestion in nasal passages snoring etc happen after following remedies like steam inhaling drinking warm water situations usually comes back to normal but the feeling of phlegm passing down in the back of the throat remains all the time is there any permanent solution to this or any effective ways to deal with it not using any medication regarding this otherwise using thyearonorm 25 mug for a thyearoid issue please help",
        "input": "",
        "output": "hello welcome to icliniq com is there any throat pain any long term nose block any decreased sense of smell can you please take a picture of the back of the throat with open mouth showing details of the affected area and send it to me"
    },
    {
        "instruction": "hello doctor I am trying to find out what the following images show images attached are there nodules if so how many and what size what types of nodules do you see what are the chances of the nodule being benign maybe a colloid what characteristics do the nodules show hypo or hyperechoic any vascularity and if so is it peripheral or intranodular flow and any other info you can provide",
        "input": "",
        "output": "hi I have seen the images there is a larger nodule in the left lobe and a tiny one in the right lobe of thyearoid the left thyearoid nodule measures 14 19 my and is isoechoic and solid areas and shows peripheral vascularity with a small focus of possible cystic change within which can be cystic changes probably colloid changes the right thyearoid nodule is my and is iso to hypoechoic it is too small to comment on vascularity there is no calcification in the nodules in my opinion it is likely to be a benign condition but fac fine needle aspiration cytology from the larger left thyearoid nodule is suggested for confirmation usually 80 percent of thyearoid nodules are benign I hope this helps"
    },
    {
        "instruction": "hello doctor is mental health not as important as or more important than physical health why what seems to be the dominant approach to treating people with depressive disorders and how do you think it could improve to prevent mental health crises namely suicide how should the topic of mental illness and more specifically depression and suicide be discussed what role should religion or faith have in the diagnosis and treatment of depression is suicide morally wrong and why how should it be portrayed in education",
        "input": "",
        "output": "hello welcome to icliniq com sharing my thoughts based on my professional experience and expertise mental health is as important or probably even more important than physical health because most physical ailment or issue starts within the mind or if it is not for to a mental process its tolerance and recovery depend highly on the mental state of the patient depression has a biological basis of primarily disbalance of the neurotransmitter serotonin so first and foremost medications should be taken which is sari selective serotonin reuptake inhibitor which are a group of medications that help in increasing the level of serotonin and are first line treatment of depression therapy cognitive behavioral therapy cut is one of the most tried and researched form of therapy which works really well for most of the patients therapy and medications combined are gold standards for the treatment of depression suicide is one of the consequences of untreated depression almost 80 90 percent of people who attempt suicide have been estimated to have an underlying mental health disorder so one way to prevent suicide is creating awareness creating resources and trained professionals treating mental health disorders early depression suicide or any mental health issue should be discussed as often as possible and just with the same approach as any medical illness because they all essentially are biological disorders it is important to normalize the approach which helps in reducing the stigma related to mental health role of faith or religion is similar to having any personal goal because they give a sense of purpose but it can be sometimes a negative influence as well because sometimes religion teaches us that our suffering is a consequence of our actions and people often are denied treatment based on this belief suicide has nothing to do with morality it is an end stage consequence of long term suffering it has been proven that people who attempt suicide in most cases have an underlying mental health condition that might have not been detected it is important to address this issue and educate people as much as possible"
    },
    {
        "instruction": "hi doctor I have hyperthyearoidism I also have tendinitis in both my shoulders I have been having joint pain for years and I work a lot of physical jobs lots of bending kneeling lifting and twisting I hang my hands quite a bit as well I have been getting hives for the last two months I have been using tide and gain in my laundry for eight months my mom is allergic to tide my endocrinologist mentioned lupus because of joint pain and hives I have an appointment with a rheumatologist in four months I am considering changing my detergent back to see if the hives stop could it all be coincidental how long would an allergy take to show I have always thought it was the onset of arthritis I never got a butterfly shaped rash on my face I am currently taking methimazole 10 my multivitamin and gianni birth control",
        "input": "",
        "output": "hi well the hives do go in favor of urticaria it can be a part of lupus or can be independent as well but usually it is an autoimmune process triggered by some allergen it is possible it is detergent in your case but the joint pains you have do not really point towards lupus since it is only restricted to the shoulders most of the time shoulders have a mechanical cause that is you are overusing it in the wrong way but never the less since your appointment is far away I would suggest you get a few tests done even with urticaria we do these tests meanwhile change your detergent and take a course of antiallergics and see if it improves you can let me know the results when available abc complete blood count ear erythrocyte sedimentation rate ana antinuclear antibody cop reactive protein ultrasound of the shoulder anti allergics with reports"
    },
    {
        "instruction": "hello doctor I have had some muscular soreness for about one and a half years I have no other symptoms normal hematology abc bloodwork always comes out fine the only thing in the last bloodwork is I had ana positive with 160 homogenous and the dna is abs came out as which said it was positive as well ear creatinine c3 ca all come out normal can you help shed some light on this I have been googling and it says I could have an auto immune disease if so which ones are likely with this bloodwork I am currently on nexium xanax and proair when needed",
        "input": "",
        "output": "hi you have mildly positive antinuclear antibody titer which suggests auto immune disease and anti didna double stranded dna which is slightly above the normal range suggests that you might have she systemic lupus erythematosus but there are other criteria out of which four should be positive to confirm she people who have positive ana or anti is dna but cannot fulfill the clinical criteria for she need to be followed closely because they are at risk to develop she in the future she is a chronic autoimmune disease that can affect almost any organ system muscular manifestation includes myalgias as in your case titers of anti didna antibodies often fluctuate with disease activity and are therefore useful in many patients for following the course of she I would suggest you to consult a rheumatologist you need to take drugs that suppress your immunity steroids are the treatment of choice I would advise repeat testing for both ana and anti didna after one or two months to look for any change in the titer rising titers or very high titers of egg anti didna antibodies are closely associated with impending or already flared she genetic anti didna and ana titer collagen vascular disease she steroids"
    },
    {
        "instruction": "hello doctor I and my partner have two children I am years old and she is 32 years over the past four or five years our sex life has almost completely fallen apart I have several heart issues right bundle branch block bicuspid aortic valve patent former oval and high blood pressure right now it does not seem they are major issues but just monitoring them the other night we had sex and I got heart palpitations severe in my throat which was odd but I do not know why however her sex drive is very low now and she says she is always tired she considered hypnosis to change her sex drive but I do not know if that works our biggest issue is our 10 year old daughter even if we get her to bed at am she will not go to sleep until midnight and we are too tired then to have sex any suggestions",
        "input": "",
        "output": "hello welcome to icliniq com I got your concern the main issue in both of you is fear you being a heart patient keeps on having fear which you actually do not have consciously but subconsciously this fear is there and if these kinds of things when the partner comes to know or if she used to be worried about your health this fear of doing any thing with you let her desire decrease and both of you started having mild depression also which is causing both of you tired but I assure you that with this activity you will not be having any problem both of you need to do some regular relaxation exercises and some meditation and both of you are not old enough that your tiredness cause problem in your personal life take some break from your work and spend some time together with free minded without any hurry or work stress and try to feel cheerful and confident that we are young and well even when you do not feel so I promise that these few steps will add freshness and happiness in your life and if there will be no improvement then I would like to start you on some mild antidepressants but until that time you please follow these steps"
    },
    {
        "instruction": "hello doctor I am 32 years old and had an herniated disc and had surgery a few years back it was a post delayed surgery due to the delay in surgery 18 days I left with a foot drop and right leg weakness I was bedridden for months totally weak but I gradually developed doing physiotherapy and with some ayurvedic treatment I started waking now with out any help but my foot drop is still there but I can lift my toe and ankle little bit from last month can I come to my normal life how long I need to wait to get cured from foot drop",
        "input": "",
        "output": "hello I can advise you in detail if I have your detailed neurological charting including assessment of motor power sensory charting of lower limbs and evaluation of deep tendon reflexes also latest mri of is spine is required to see for adequacy of decompression to answer your query the best results come early after the spinal decompression surgery if motor loss can be ascribed to compression in spinal cord or roots also intensive physical therapy helps you to gain power but since you have started gaining power it can continue for at least more months so my advise to you will be to continue with intensive physical therapy including muscle stimulation vitamin b12 intake and come back to me with your neurological charting and mri films so that I can see and advise you further"
    },
    {
        "instruction": "hello doctor I would like to know the causes of stroke and its prevention what are some of the causes of stroke what are some signs and symptoms how can you prevent a stroke could a lack of sleep or stress cause a stroke please suggest",
        "input": "",
        "output": "hi there are major risk factors for stroke such as hypertension diabetes mellitus old age smoking alcohol obesity high cholesterol and family history of heart disease or stroke though there are many more rare causes of stroke common presentations are acute onset deviation of angle of the mouth change in voice weakness of hands arms legs and imbalance in walking though many more presentations can be there in stroke depending on which area of the brain gets affected stroke can be prevented by maintaining a healthy lifestyle and healthy food regular exercise keeping blood pressure be and sugar under control take regular medications as advised by a doctor lack of sleep and stress can lead to increased be impaired blood sugars and increased sympathetic response in the body which can be a risk factor for stroke if stroke is suspected rush the patient to the nearest hospital having it computed tomography and mri magnetic resonance imaging facility as soon as possible"
    },
    {
        "instruction": "hello doctor what are the causes of sleep disturbances what are some ways to tell if your sleep troubles are sleep anxiety and not a hormonal problem what is the difference between sleep disturbances that are caused by hormones is stress how might someone address each of these different causes of sleep disturbances",
        "input": "",
        "output": "hello first we should know the patient gender then if female ask if the sleep problems are all the time or more evident prior to periods due date then I would ask both female and male patients to run a thyearoid function test while female patients to also check sexual hormone levels in the blood stress makes it difficult to fall asleep and keep asleep and altering sleep quality hormonal changes will cause an increase in body heat which becomes not stable and adrenalin which alter the quality of sleep and time of sleeping estrogen will cause an increase in body fat in women more around the tummy this will cause snoring and sleep apnea we should ask patients more details about their sleep like is it difficult to fall asleep why do you wake up during the night how many times if yes why in this way we will find more details about the sleeping problems my patients are having sometimes they can sleep but they are so anxious and feel not enough to sleep"
    },
    {
        "instruction": "hello doctor is conut oil bad for the skin a few years ago conut oil was all the rage we were told to slather it from head to toe for miraculous benefits however lately it is been getting some backlash thanks to its comedogenic properties my questions are what are the pros of using products that contain conut oil on your skin what are some potential cons what skin types can benefit most from conut oil what skin types should stay away from it how do you recommend using conut oil in one routine to reap benefits and avoid breakouts if someone wants to use natural conut oil on their face what kind do you recommend using I unrefined organic etc",
        "input": "",
        "output": "hi conut oil is extracting traditionally from raw conut or from dried conut kernels it is saturated oil and frequently used in skin hairs or cooking purposes this oil has health promoting properties it contains several fatty acids that have benefits to skin health as well now we will discuss some more about conut oil step by step conut oil contains several fatty acids which of them laurie acid and myearistic acid are very common these fatty acids have antimicrobial properties which help to protect the skin against harmful microns conut oil also has anti inflammatory properties it helps to protect the skin from inflammation contact dermatitis eczema or other inflammatory conditions it also helps to nourish and moisturize the skin conut oil does not contain protein or carbohydrates and a trace amount of a few nutrients the fatty acids found in conut oil raise bad cholesterol like lil these are the cons of conut oil this oil can be used in dry skin or hairs to moisturize them it benefits skin health but not ideal for everyone conut oil could potentially clog the pores and causes black heads sensitive skin people should not use conut oil if anyone has dry skin or hairs those can apply they can do gentle massage with this conut oil conut oil is very healthful if used externally as it contains highly saturated fatty acids and raises bad cholesterol so those who have bad cholesterol should be avoided to use it internally conut oil has a lot of benefits but one should use it after knowing its properties and their health conditions"
    },
    {
        "instruction": "hello doctor my mother is provisionally diagnosed with sca spinocerebellar ataxia is this disease treatable or her condition will worsen please help",
        "input": "",
        "output": "hi I have read your question with care and understand that your mother is provisionally diagnosed with spin cerebellar ataxia for sca type to 28 idebenone a free radical scavenger glutamate antagonist riluzole may offer modest benefit acetazolamid can be used for treatment for other ataxias the most important step in management is to identify treatable disease entities mass lesions diagnosed by imaging treated by removal or decompression paraneoplastic disorders diagnosed by clinical patterns specific autoantibodies primary cancer treated by removal of the tutor immunotherapy ataxia with anti gliadin antibodies and gluten sensitive enteropathy treated by gluten free diet malabsorption syndromes leading to vitamin deficiency may lead to ataxia treated by vitamin supplementation vitamin deficiency form of friedrich ataxia treated by vitamin 6 vitamin be deficiency treated with vitamin be vitamin b12 deficiency treated with vitamin b12 hypothyearoidism treated with thyearoxine"
    },
    {
        "instruction": "hello doctor I would like to know about urinary incontinence in women why is urinary incontinence more prevalent in women why do pregnancy and menopause contribute to incontinence",
        "input": "",
        "output": "hello female unlike men have short urethra and less effective urinary continence systems than men as a part of normal anatomy female normal continence is dependent on normal sphincter anatomy normal vaginal anatomy and pelvis muscle strength thus any factor causing changes in the above mentioned area can lead to incontinence after vaginal birth delivery it is a normal process that the pelvic floor muscle becomes lax thus support system of bladder is reduced this leads to hypermobile urethra and defected continence system so problem like stress incontinence urine leak during increase abdominal straining like cough and sneezing are increased and are typically common in elderly women with a history of vaginal delivery earlier after menopause the loss of estrogen in the body can cause vaginal atrophy which leads to less urethral support and is again one of the causes of incontinence in women it is important to diagnose the cause of incontinence so that treatment can be individualized sling surgery trans obturator tape trans vaginal tape are few surgical morality where support is given to bladder neck and urethra respectively thus improving the continence"
    },
    {
        "instruction": "hello doctor my husband is a type diabetic as he is a hotelier the working hours are stressful for him he has no time for exercise also his meal timings are very odd he takes his lunch at around 30 am in the hotel cafeteria and usually takes his dinner at 12 am 12 30 am at home he takes slimy before breakfast and janumet 50 100 post breakfast and after dinner since his triglycerides are high he has been taking stanlip 145 his sugar levels are fine now with hba1c at 74 but the recent kidney tests show higher levels of serum creatinine at 7 also his amylase and lipase values are significantly high with amylase at 86 and lipase at 98 he is just 32 and has been a diabetic for seven years a general physician says that the elevated levels of creatinine and lipase indicate the risk of the organs malfunction also he says that slimy and janumet are to be blamed for the harm what should we do to protect the vitality of the kidney and pancreas kindly guide",
        "input": "",
        "output": "hi well I do not think elevated creatinine is due to medications it is most likely due to diabetes itself but elevated lipase is due to high triglycerides apart from high triglycerides alcohol intake can also cause elevated lipase for the protection of pancreas his triglycerides have to be controlled when was his triglyceride tested and what is the value he needs to do exercise daily as of his kidney is concerned his medicine janumet 50 100 has to be stopped and instead he can use tablet galvus 50 my vildagliptin two times a day he should avoid pain killers and inform the doctor that his creatinine his on the higher side before any doctor prescribes any medications repeat serum creatinine after one month and revert back with reports"
    },
    {
        "instruction": "hello doctor I had all four impacted wisdom teeth out a week ago the pain has been absolutely horrible which I knew it would be however my left side has healed very well is no longer swollen with minimal sensitivity now my right side is still as swollen as day two or three it is hard sensitive and the constant dull throbbing pain is still waking me up at night and literally bringing me to tears it is not even the incision site that hurts it is my entire jawline from my eye all the way down into my lip my surgeon said this was normal and stuck some medicated gauze there and called it a day that in which did not help the pain actually only made it worse I cannot open my mouth wide enough to even fit a spoon should not this be improving by now after seven days should I be concerned about the bone fragments or possibly a fractured jaw bone I am really stressed and my surgeon has provided zero help I understood that it is four days of recovery time and not seven days of the same miserable swelling and pain with no improvement I am currently taking penicillin and ibuprofen",
        "input": "",
        "output": "hello let me explain a few things first wisdom tooth first of all can be fully erupted partially erupted or totally unerupted sometimes lying deep within the bone the swelling of the extraction site depends on the amount of bone removal to take the tooth out it is not that easy job it occasionally happens that a nerve lying close to the tooth gets lacerated giving rise to prolonged numbness another thing a chance of fracture is there when the tooth lies too close to the angle of the jaw bone I would advise you to take an op orthopantomogram first make sure you gargle with chlorhexidine mouthwash and apply ice packs at least five times daily it will help reduce swelling greatly there is nothing to worry though keep your mind at ease just visit your dentist soon and determine the cause first I hope this helps"
    },
    {
        "instruction": "hello doctor I have been having infrequent deep chest pains along with pain in my left arm right arm and legs at times the pain mics that of a heart attack but I had an ekg echo blood and it everything has come up normal so far when I am on the computer I usually slouch and have poor posture could my pain be related to the back like the thoracic spine and is there any way this could be diagnosed or a chiropractor could do about this",
        "input": "",
        "output": "hello you have already ruled out the fearful cause of such pain so the second most common cause of such pain is improper posture more than a chiropractor you need to understand the need for correct posture as you have to continue working in a similar environment for the next 40 years proper working table and chair are a must for good posture the chair should be stable and adjusts easily for the height and tilt chair with a backrest that supports the curve of your lower back should be used you should sit back in the chair when you work on a computer thighs should be horizontal with your knees and hips at the same level feet should rest comfortably on the floor or on a footrest while seated the height of the desks is at about elbow level when sitting down the chair should be adjusted such that back can rest against the chair while working on the computer your elbows should stay near your body in an open angle allowing circulation to the lower arms and hands your arms are nearly perpendicular to the floor your wrists are nearly straight along with this regular muscle stretching and isometric strengthening exercises for the neck shoulder girdle and lower back must be done to avoid such pain acute pain such as in your case requires analgesic narcotic hot fomentation tens transcutaneous electrical nerve stimulation ultrasound by a physiotherapist and alternative treatment modalities like acupuncture for immediate relief and yoga and meditation for long term benefits I hope this helps"
    },
    {
        "instruction": "hello doctor I am diabetic and hypertensive I also have arthritis I am taking gamer folvite febituz methotrex weekly once ecosporin and replace 25 my fasting blood sugar level is 140 my do and on taking gamer my postprandial blood sugar is 72 my do why this happens",
        "input": "",
        "output": "hello yes it happens in a diabetic fasting blood sugar usually results from a combination of factors the two most important being what you ate the day or night before and how high your blood sugar spiked if you have very high blood sugar the night before you should expect your fasting blood sugar to be elevated sometimes an eight hour fast is just not long enough to bring down the blood sugar dawn phenomenon is common in diabetics and it is when hormones that you produce in the morning cause your liver to release more glucose for energy either way higher fasting levels result often dawn phenomenon and high blood sugar from the day or night before work with each other when you eat the liver stops pumping out so much glucose and postprandial blood sugar can drop which is what happened to you my suggestion is to do a pre dinner sugar and see what is your blood glucose level before dinner if it is high 130 we have to alter the drugs and dosage I hope this helps"
    },
    {
        "instruction": "hello doctor my wisdom teeth came a few years ago the top ones are straight but too close to the molars next to them so they broke the molars those top molars next to the wisdom teeth as well as those top wisdom teeth are broken decayed and sometimes painful my bottom wisdom teeth have not damaged the molars next to them but they are not fully erupted out of the gums one is impacted but does not cause trouble the other is straight but in pain it is also infected there is green pus that comes out from between the gum and that tooth as well as from the tooth in front of it there is also a cracked second molar which the gum is partially detached from and it also has some pus coming from it now here is the dilemma I have been taking amoxicillin 250 my three times a day for a month now and just yesterday I switched to 500 my three times a day to try to clear up that infection yesterday there is no pus but today there is I do not have an appointment with the oral surgeon until a few weeks I am afraid that this infection will not clear up with the 500 my amoxicillin and the big problem is that I am on medicaid and they only give us 100 dollars a year which resets every july I only have about half of that left which means I cannot go to any more appointments until after this oral surgeon I can only have three to four of the six bad teeth out so do I have to extract the bottom infected wisdom and cracked tooth or the semi painful broken decayed top teeth and to make it even better I have high blood pressure and severe anxiety and happen to be on propranolol for the blood pressure and heart rate I know that propranolol interacts with local anesthetics that have vasoconstrictor in it but local anesthetics without vasoconstrictor do not last as long and I am severely afraid of death from dental work or from infection so I do not know which teeth to do what to do about the anesthetic and I am afraid of the infection spreading please help",
        "input": "",
        "output": "hello put your mind at ease there is a high chance of food getting stuck between the wisdom tooth and the molar because of the position of the molar this gets unnoticed during brushing and over time gives rise to the decayed tooth plain amoxicillin will not help in decreasing the infection you need amoxicillin and clavulanic acid combination 675 my two times a day for three days this with metronidazole 400 my three times a day for three days before having these it is mandatory that your blood pressure is within the normal range local anesthesia with vasoconstrictor can be used for hypertensive patients with proper guidelines being followed do not worry please visit the dentist first take the revised set of medicines bring your be under control as well let the infection subside and then remove the infected tooth"
    },
    {
        "instruction": "hello doctor is hyperpermeable intestine treatable and or curable kindly suggest",
        "input": "",
        "output": "hi I hope the following information will help you understand the condition first and thereafter the possibility of cure and treatment together it should help you get your answer to start with I am sorry but your question does not have a simple yes or no answer normally the gastrointestinal epithelium provides a semi permeable barrier that allows nutrients to be absorbed while preventing larger potentially toxic antigenic or pathogenic molecules or organisms from crossing into the bloodstream abnormally increased intestinal permeability allows the individual to absorb the bad food molecules and absorption of bacteria and or yeast from the gut to extra intestinal sites such as mesenteric lymph nodes liver spleen and systemic circulation this can be also be due to certain drugs microbial overgrowth radiation stress alcohol intake enteral parenteral nutrition or injury increased intestinal permeability occurs commonly with diseases including inflammatory bowel disease rheumatoid arthritis ankylosing spondylitis asthma eczema food allergies alcoholism trauma and surgery glutamine phosphatidylcholine flavonoids soluble fiber and fish oil as well as probiotic organisms including lactobacilli and saccharomyces boulardii can assist in correcting this abnormal permeability it would be necessary to avoid triggers like alcohol and of course other conditions like rheumatoid arthritis should be looked for the treatment of cause will help remove the cause so the treatment and cure would depend on how well one is evaluated"
    },
    {
        "instruction": "hello doctor I have pain in the pubic area urine test revealed protein in the urine but there is no pain while urinating but I get pain only when I touch the area I am just getting sick and wondering what it might be",
        "input": "",
        "output": "hello well the presence of proteins in urine is not a good sign let me explain to you in simple words that why it is not a good sign the whole of the blood in our body flows through both the kidneys in our body and kidney functions as a filter the harmful substances and toxic molecules are taken up by the kidneys and are excreted out of the body via urine proteins are very essential for our body and proteins are big molecules in size so they do not pass through the small filtering mechanism of the kidneys so the filtering mechanism of the kidneys is such that it allows toxic molecules to pass through the filter but does not allow substances to filter out which are essential for our body but when the filtering mechanism of kidneys is damaged due to some underlying disease then the proteins also start leaking out so if there are proteins present in the urine that means that the kidneys are not functioning normally so I would advise you to get the following tests done so that I can do a detailed evaluation of your reports to make a precise diagnosis and find out the reason which is damaging your kidneys so please get these tests done complete hemogram let liver function tests kit kidney function tests blood sugar fasting and postprandial ultrasound rub kidney ureter and bladder region get your blood pressure checked once you get these tests done kindly send me a scanned copy of your reports for evaluation and please do not get panic everything shall be fine"
    },
    {
        "instruction": "hi doctor I am a 24 year old female I am 7 and weigh approximately 280 labs I am overweight my question is that I have had this calf pain intermittently ever since I went bowling over a month ago it comes and goes and the pain is honestly very random when it appears it does not hurt worse with walking or working out and I really notice the pain only if I am not focused on something I work as a nurse and never notice at work it is maybe a 10 pain it is not a sharp pain sometimes it feels like I need to stretch my leg and other times it feels like a burning pain I am also having a chest pain intermittently no short of breath it changes with positioning I basically want to know your opinion do you feel it is a dot with a pe or that I could have pulled a muscle I should also note that I just started a new job which gives me a massive amount of anxiety and worry which I realize does not help with any of this I am currently taking norvasc and lisinopril for hypertension please suggest",
        "input": "",
        "output": "hi after reviewing your info I think there are a couple of things I can tell you I am assuming you have a bilateral pain and aching discomfort and not a sharp localized pain some of the causes for your pain are most likely you have dehydration my second differential would be varicose veins medication side effects of your anti hypertensive drugs psychosomatic pain because of stress if you have a history of coagulation disturbances then I would suspect something on the lines of dot deep vein thrombosis take care of your hydration status in consultation with your cardiologist most likely this will help also discuss the side effect of your medicines second get a good sleep and watch out so ofa sleep apnea third if these do not help then work up for varicose veins I hope this helps"
    },
    {
        "instruction": "hello doctor I had sex with a lady and after three days my penis gets pain a lot in the night I cannot sleep much in pain after one week I checked with the hospital they give me antibiotic medicine but there is no relief I have done my hav hav vdrl and hiv test all test are negative now one year has gone still I have pain little inside the urine pipe when I go for urine and on the tip of my penis a red dot appears on applying candid cream the red dot goes away but when I stop applying the cream again that red dot appears I am also taking af 150 I am sending you my picture please help",
        "input": "",
        "output": "hi I have gone through your history and reviewed the attached photograph according to me there are two possibilities one is candidal balanoposthitis and the other is herpes genitals since you have mentioned that your hav and tests herpes simplex virus were negative then chances of candid infection is more but I would recommend you to repeat hav and tests again to rule out herpes infection as far as treatment is concerned wash the affected area with water only and keep it as dry as possible apply sertaconazole cream on the affected area twice daily for at least two weeks and take tablet fluconazole 200 my twice weekly for two weeks you can revert back to me after two weeks candid infection herpes infection elisa for hav and candidal balanoposthitis as mentioned above as mentioned above"
    },
    {
        "instruction": "hi doctor I have been diagnosed with a small renal cyst on my left kidney I understand this is rare in my age group please help",
        "input": "",
        "output": "hi I have read your query and the first thing to know about a single kidney cyst is that it is usually harmless you have not mentioned if this was an incidental finding usually they are or are you experiencing any symptoms like dull flank pain or abdominal pain or problems with voiding urine in case of former no need to do anything and get an ultrasound every six months to see if the cyst enlarge in case of latter or if size is increasing two options exist but conservative management with medicines will only provide short term relief surgical intervention is the only long term solution that said considering your age you are a candidate for body maturity onset diabetes of the young especially if you have a family history of diabetes also if on any later ultrasound you find more than one cyst polycystic kidney disease or even wegner might have to be taken in to account for now you need to get the following tests done hba1c glycated hemoglobin abc complete blood count and u ce urea and electrolytes follow up with the test results and also do elaborate on why was ultrasound done and what were your symptoms for proper future management"
    },
    {
        "instruction": "hello doctor my friend is 21 years old and suffers from anxiety he feels like it is getting in the way of his daily activities and interactions with people he used to get attacks more often but that is a lot better now he decided to start taking theanine pills or supplements I would like to know more about these pills how safe are they how long or often should they be taken he currently takes them with caffeine 200 my of supplement for every 100 my of caffeine average of 400 my theanine a day could they become addictive does it have any side effects what more should we know",
        "input": "",
        "output": "hello theanine is an amino acid synthesized from tea it helps with reducing stress and anxiety and induces a sense of calmness by increasing serotonin and dopamine in the brain which are the feel good chemicals as such it is a supplement and not a medicine per se so there are no fixed guidelines issued by any regulatory authorities normally people do get relief with 200 to 600 my since it is synthesized from a stimulant tea it is advised not to combine with other stimulants like caffeine it can increase anxiety once the effect of caffeine wears off apart from that there are no side effects as such and not really addictive if the anxiety issues are troubling it would be advisable to visit a local psychiatrist and take a short course of sari selective serotonin reuptake inhibitors class of medicines which will help with this problem also consider doing deep breathing exercises or yoga or meditation"
    },
    {
        "instruction": "hello doctor this is regarding my father years old is a patient of cold he is an ex smoker for almost 40 years and has been suffering from a shortening of breath for the last few years but his situation got worse in the last year he was prescribed with home oxygen machine for at least 10 12 hours nebulization on daily basis and few other medicines he used to have swelling in his body and having difficulty urinating doctors prescribed him with diuretic medicine a few months back I took him to emergency and spent a night over there later transferred to icu intensive care unit for almost a week his situation gotten worse and doctors put him on a ventilator for 72 hours he came okay and spent a few more days in icu then transferred to a private room spent a week in the hospital and discharged at home his situation was on and off and not actually improving now he was on 24 oxygen machine and occasionally on bipap too use to do sections on suction machines under the supervision of a male nurse provided to him for 24 nebulization thrice a day but the situation was not improving much a week ago he was found unconscious and rushed to the emergency again put him on a ventilator for 48 hours and improving at a slower pace being a daughter I want the very best for my father and want advanced cold treatment available only in few countries called endoscopic lung volume reduction treatment by introducing a small valve with minimally invasive surgery within 20 30 minutes I need your advice in this matter I have uploaded the medical history report and the tests we have done here",
        "input": "",
        "output": "hello thanks for writing your query to me I can understand your concern about your father I have seen all the reports attached herewith considering his general condition now your concern of air travel is very important to analyze before you book tickets with the airlines also it is not as simple as we think but with careful evaluation and guidance he maybe able to fly shorter destination flights very important to remember that he is still recovering from bad respiratory failure and cardiac event also still he is oxygen dependent at room temperature being hypertensive and recently hospitalized it is advisable to avoid any travel at least for weeks to prevent further complications fitness to fly for cold patients need to comply a definitive pre travel eligibility criteria and need necessary documentation from treating pulmonologist during air travel in commercial flights oxygen level falls considerably due to low cabin air pressure and we must supplement oxygen to prevent further hypoxemia and other complications so it is advisable to keep checking oxygen saturation frequently if the resting oxygen saturation is less than 92 he may require supplemental oxygen in flight but commercial flights generally dont allow to carry our oxygen cylinder but you can carry oxygen concentrator with prior confirmation from airline can provide supplemental oxygen if required during flight but it will be very costly and has to be booked well before in advance while booking tickets so it is very important to take opinion of his treating pulmonologist and do pre flight evaluation if he is fit to fly or not necessary medicines inhalers and tablets need to be refilled before flying once he is fit to fly while booking seats consider seat neat toilet to avoid walking frequently check oxygen saturation and avoid tea coffee or any other drinks during air travel please make firm confirmation for all the concerns with the airlines before you book tickets do not forget to get fitness certificate and medical prescriptions from your doctor and carry them during air travel uncontrolled moderate to severe cold pre flight fitness evaluation hypoxic challenge test if available locally oxygen supplementation either by cylinder or oxygen concentrator"
    },
    {
        "instruction": "hello doctor my wife is weeks pregnant two weeks back my brother got infected with chickenpox and after that even my sister in law is infected with chickenpox my wife has already had chicken pox in her early schooling days I have a few questions is it advisable for my wife to stay in the same house as we are would there be a chance that a person would get infected more than once in a life with chickenpox we performed a varicella egg test for my wife and the report says equivocal what does this mean I have attached the report how bad and critical is it for her to get infected at this stage of pregnancy is there anything that could be done to protect the baby if she gets infected",
        "input": "",
        "output": "hello I have seen the report I can understand your concern I will answer one by one as you told me it is ith week I would like to tell you that in the first 12 weeks the overall risk of transmitting infection to the child and development of severe disease in child is only 4 percent in your case the mother already has protective antibodies egg antibodies cutting down the risk further but still we do not want to risk the child whatever risk may be so I will advise for isolation of mother or patient until all the lesions of chickenpox get crusted because after they crust they get noninfectious the chance of getting chickenpox again in life is a rare phenomenon but at times if the immunity is low it may occur equivocal in the report means that the mother has protecting immunity against chickenpox but not very strong it would be strong if the levels were more than 12 but it is not negative that means the mother can fight some infection it is not very bad to get affected at this stage but if it happens near the delivery time or within five days of delivery then it is very bad right now even if she gets infected she will develop immunity and pass on to the baby some antiviral drugs can be given if infected but I do not think she requires it now and yes definitely until the invective stage of your brother and sister vanishes you should think of isolation"
    },
    {
        "instruction": "hello doctor I went to the r twice in the past two weeks and I went to two different hospitals I am 20 years old the first time I went to the er with chest pain they did an ekg ray blood work and put me on the monitor for two hours everything came back fine and they sent me home the doctor said everything looked good well the second time I went to a different hospital and did all the same tests and the doctor came back and said everything looked great and I should not worry he sat down and talked to me and my husband for about 30 minutes he said he is pretty sure of what I am feeling is bad anxiety because I was in a bad car accident about five months ago I hardly leave the house and he said it might be a depression sitting in with anxiety because I am just sitting at home and not doing what I normally do and go out he said another thing I have two small kids and lifting them and playing with them can cause aches and pains my chest still hurts only when I am lifting something or moving my arm or body in the wrong way I also think I am a hypochondriac because ever since my chest first started hurting that is all I think about then new things pop up like headaches back pain neck shoulders ribs and I keep having to use the bathroom and it is runny I keep thinking something is wrong and my husband and family keeps telling me I am fine two doctors said I am fine and I am just over reacting which is making my body tense into thinking something is wrong can that really happen I do not have any health insurance so it is hard to just up and go to the doctor I just want some reassurance",
        "input": "",
        "output": "hello such chest pains during stress occur because of anxiety only and we label then non specific cardiac chest pains but we should always keep in consideration cardiac chest pain and acid reflux it is important to differentiate between the all however the cardiac chest pain is severe and crushing in nature it increases on activity like walking exercising it is also radiated to the left arm in such a scenario you should get an egg electrocardiography and chest ray done if they are normal I would advise you to go for a treadmill test and echo if they are also normal then the pain is not due to cardiac issues for acid reflux I would advise you to take a combination of pantoprazole and domperidone once a day for anxiety you would be treated with antianxiety drugs like etizolam share my opinion with your doctor before acting upon it I hope this helps"
    },
    {
        "instruction": "hello doctor I was diagnosed by urinatory tract infection my scrotum testicle doppler ultrasound was perfectly alright but I have visible veins from then my testicle are misaligned right is forward and left is backward do I need to see a doctor if it is normal can anyone tell me why this happens and how to fix it",
        "input": "",
        "output": "hello I can understand your concern as you have urinary tract infection and problems with testicles let us discuss both the aspects one by one urinary tract infection urinary tract infection means you have a bacterial infection anywhere in your genitourinary system I anywhere in kidneys ureters urinary bladder prostate or urethra you should get these three tests done to precisely diagnose the location and the bacterial organism causing that infection the tests are a ultrasound of prostate and rub kidney ureter and bladder urine complete analysis urine culture and sensitivity urine culture and sensitivity will reveal which particular bacteria is causing infection and most importantly it will enable us to know that to which particular antibiotics this bacteria is sensitive to once you get this culture and sensitivity report you can either consult your doctor or else you can send me a scanned copy of your report so that I can prescribe you the appropriate antibiotic course along with dose and duration for which antibiotics and other drugs to take I would strongly advise you not to take any antibiotic blindly on hit and trial basis it can cause more harm than a benefit so get the culture and sensitivity test and only after that start taking antibiotics testicles as you have mentioned doppler us ultrasound of the testicles was normal you should not worry about the visible veins are very superficially located in the scrotal skin and it is perfectly normal to have visible veins especially in the scrotal region the only point is that in some people they are less prominent and in some more prominent thats it and it is absolutely normal to have visible veins having one testicle forward and one backward is also perfectly normal and everybody has one of either testicles placed forward and another one backward it is not misalignment it is what the normal alignment is so shed off all your worries completely out of your thoughts and relax both your testicles are absolutely normal and also there is nothing wrong in the veins of your scrotum I hope this helps"
    },
    {
        "instruction": "hello doctor my baby is months old now and turning months in four days he had loose motion three days back since yesterday he is better but he has lost his appetite and weight as well he used to have 120 my of formula milk in three to four hours gap but now he is having only 60 my of milk now what can I give him as he is turning months soon",
        "input": "",
        "output": "hello welcome to icliniq com for loose motion give walamycin is colistin sulfate my twice a day for five days syearup vizylac lactic acid bacillus my twice a day for five days after meals according to me after completing months stop milk from am to am and give semisolid diet like dal dalia khichdi alu kela rice apple upma halwa patola rab kadi idle poca satu custard etc and from am to am mother milk is preferable if not give top milk without water and add sugar as per your taste to start with stop milk for four hours for 15 days and give a semisolid diet then for the next 15 days stop milk for eight hours and give a semisolid diet lastly stop milk from am to am and give a semisolid diet for your knowledge 100 my milk gives 70 calories of energy 100 my juices give calories of energy and 100 go of semisolid diet gives 350 calories of energy according to me give following supplements vitanova do drops half my once a day zincovit drops my once a day ferris drops ferrous ascorbate and folic acid drops my once a day and syearup ostebon calcium and vitamin do my twice a day continue all the above supplements for at least year of age"
    },
    {
        "instruction": "hello doctor I have had an ear infection right ear for the last several months including fullness pain in and behind the ear and foul smelling discharge recently I completed the 10 days dose of ciprodex drops and the discharge has cleared but fullness and pain have not reduced recent hearing test also showed mild moderate hearing loss in the right ear and tinnitus I have a history of cholesteatoma in the left ear doctor noted visualization of granular tissue in the attic during the last appointment and ordered a it scan to rule out cholesteatoma in the right ear is there anything remarkable in either ear on these scans any evidence of cholesteatoma if so has it done any damage to the middle ear structures also can you tell me what surgery they did on my right ear",
        "input": "",
        "output": "hi I have seen the it report there is a residual soft tissue density in your right middle ear likely granulation tissue additionally there is right mastoid effusion meaning air cells in the mastoid bone filled with fluid combination of mastoid effusion and middle ear soft tissue results in fullness and may explain the pain soft tissue around the middle ear ossicles results in conductive hearing loss it is expected that you have a mild or moderate hearing loss good news it is usually reversible with regression of granulation tissue regarding granulation tissue it usually regresses and your symptoms usually get better with time regarding evidence of cholesteatoma there is no evidence of bone resorption especially sputum is very well preserved unfortunately this granulation tissue may progress to cholesteatoma you understand that if your symptoms get worse on the left ear there is evidence of cholesteatoma surgery partial mastoid resection mastoid cavity looks clean very minimal soft tissue in the left middle ear bilateral inner ear meaning the sensorial part looks good additionally minimal mucosal thickening in right posterior ethmoidal cells are present I hope this helps right middle chronic otitis without evidence of cholesteatoma follow up if symptoms get worse repeat ent examination and scan"
    },
    {
        "instruction": "hi doctor I used to play football a few years ago however I had to stop playing due to symptoms of immediate fatigue after a maximum of one sprint wheezing dizziness and palpitations they were first attributed to asthma however upon having a cardiac mri I was told there are no issues with my lungs and the problem lies with my heart they took an egg and I was told I have two slightly impaired valves with some regurgitation and a slightly swollen right side I might possibly have arvc however I am still waiting to get a hotter strapped what I would like to know is will the hotter definitely let the doctors know if I have arvc if it is not the case can the performance of my valves be rectified or will my heart condition remain permanent",
        "input": "",
        "output": "hi arc arrhythmogenic right ventricular cardiomyopathy is diagnosed on echocardiography or mri magnetic resonance imaging then further risk stratified on past history family history of arc or sudden death in the first degree relatives or hotter monitoring to detect ventricular tachycardia furthermore genetic testing can be done especially if your first degree relatives also have the same disease competitive sports are a risk factor for the progression of this disease and also for sudden death so exertion is contraindicated it will be easy for me to guide you better if you share your echocardiography and mri reports with me and also send egg"
    },
    {
        "instruction": "hello doctor I am 23 years old I weigh about 70 keg I usually pass stools several times a day that means after wake up at 15 am I pass stools then again after break fast at 45 am then I pass again at 0 am then again after lunch and once in the evening at am I have a stooling sensation through out the day is this a serious problem please suggest",
        "input": "",
        "output": "hi frequent passing of stool is definitely abnormal but the cause depends on the consistency of stool if it is loose then we need to be worried I need some information and would suggest a few investigations what is the consistency of stool is there any blood or mucus in the stool any fever weight loss pain in the abdomen if the answer for all these questions are no then do ray abdomen is there any constipation we also need to do a complete blood count abc with ear erythrocyte sedimentation rate now tag tissue transglutaminase can be done later if there is any abnormality in these tests abc tga ray abdomen tablet albendazole 400 my one tablet stat and one tablet after two weeks rest of the things to be decided after reports or details review back with details"
    },
    {
        "instruction": "hi doctor my son is years old and his weight is keg he has a problem of cold and fever since last week I consulted a doctor on icliniq and he suggested tablet combiflam thrice a day and allegra 500 my before sleeping however I took syearup of both and understand that the doctor would have missed the kid age and prescribed the tablets I have been giving him both for the last four days but there is no improvement in fever and it comes back as soon as the medicine effect goes off please advise further",
        "input": "",
        "output": "hi I can understand your concerns fever for four days in a child with mild cough can be due to upper respiratory tract infection typhoid or malaria kindly do tests like abc complete blood count malarial antigen test and tidal test give syearup ziprax 5 my three times a day for three days syearup sinarest my three times a day for three days and syearup crocin my if fever occurs review with reports"
    },
    {
        "instruction": "hello doctor I am 29 years old from birth I am suffering from dust allergy eosinophils when the seasons change I get suffers from cold and cough I live in a city full of tress and dust too due to cough I get little breathing problems before three months whenever I get these problems with the help of syearup or medicines I get rid out of it but for the last three months I am not getting any relief one of my doctor friend prescribed me levocetirizine which gave me relaxation for two to three days before 10 days I consulted with another doctor and he gave me formoterol fumarate and budesonide and montelukast he told me that I am suffering from little asthma I do not have high problem of breathing but then also I am taking this medicine for the last 10days please help me to get rid of this I also checked my allergies the report shows 100 egg",
        "input": "",
        "output": "hello welcome to icliniq com from your query it seems that you are allergic to dusts and pollen grains and as the second doctor rightly said you are suffering from asthma and allergic rhinitis currently you are on right treatment so continue formoterol plus and fluticasone inhaler in prescribed doses and also tablet montelukast 10 my one at night in case of emergency you can take asthalin or levolin inhaler for relief from cough or breathlessness consult your doctor regularly to adjust the dose of the inhaler if you are not getting any benefit usually you must continue inhalers as no other medicine will cure asthma permanently there is no permanent cure for asthma once your allergy is well controlled you can stop montelukast but continue with inhaler"
    },
    {
        "instruction": "hello doctor I had a sexual encounter with cow which was protected and I have no symptoms after six months I have another sexual encounter with cow which was also protected after a month a weird thread like thing started appearing in my penis and it got disappeared in a few days now again I get this same thread appearance and it keeps multiplying in different areas in the penis also I am having intercourse with my wife unprotected she has no symptoms and she is breastfeeding is there any possible risk for her or for the baby let me know if anything else is required also I think it is high time to have a full sad test I had one last year and it was clear",
        "input": "",
        "output": "hi please attach photographs for further guidance"
    },
    {
        "instruction": "hello doctor I have an allergic itchy nose and throat and sneezing all the time itchy eyes and coughing with a different sound and also sometimes I have difficulties with breathing and I keep having itching throat I went to the doctors they always give me medication that does not stop the allergy I do not know what to do",
        "input": "",
        "output": "hello nasal congestion running nose itching of the nose watering of eyes sneezing etc are classic symptoms of allergic rhinitis added to this breathing trouble wheezing mucus production in lower airways are signs of asthma which signifies allergies of deeper air tracts these two constitute the presentations of the hyper reactive airway it is also termed airway hyper responsiveness the best way to treat allergy is to find the offending agent or what we call the allergen once that is done we can give small subclinical doses of allergen into your body to make you immune to the allergen this is called immunotherapy before we subject you to immunotherapy we first want you to take a skin prick test various common allergens of your area are injected in small doses in skin intro serially and response noted positive response to allergens noted specific immunoglobulin produced against these allergens are measured in the blood by tests after quantifying immunotherapy is started any other form of treatment is only symptomatic only immunotherapy can give you lasting relief from allergy if however you require immediate temporary relief from allergy you may take the symptomatic treatment which usually consists of a short course of steroids intro nasal steroid sprays antihistaminic and leukotriene inhibitors these drugs are prescribed by the medical practitioner and if you require those kindly revert back to me I will be happy to help you with the drugs and their correct dosage and how to take them I must also say avoidance of allergen plays a great role in keeping allergy at bay"
    },
    {
        "instruction": "hello doctor I am a patient of bipolar disorder I am not experiencing bipolar disorder symptoms for more than two years so can I leave medication gradually I have completed my education during my treatment I was diagnosed with this disorder a few years back I am constantly being treated for the past six years until now and unable to understand the timing of leaving the medication I skipped the medicines all of a sudden two times before but not after that my psychiatrist says that you are in a stable condition but I cannot tell you when I shall end your minimal medicines he even does not give any clues about this to my parents and all of us are confused and upset because of this condition please advise I am currently taking adablizer 10 my ith tablet only at night oxalepsy 300 my one in the morning and one at night",
        "input": "",
        "output": "hello normally after the first episode of bipolar illness medicines are advised to be taken for one year and stopped slowly after a second relapse it is advised for two or three years and then stopped for the third relapse it is to be continued lifelong if you have taken them regularly as you have said you can try reducing them slowly over course of four to six weeks and if you feel that symptoms are recurring you might need to go back to the previous dose you felt comfortable on reduce aripiprazole 10 my to my for four to six weeks then reduce oxcarbazepine 300 twice to 300 half in the morning and one at night for four weeks then make it just one tablet at night then aripiprazole my half for four weeks then 300 my half for four weeks finally you can stop oxcarbazepine and lastly after another four weeks stop aripiprazole"
    },
    {
        "instruction": "hello doctor I missed my period but I am not sure why I am not pregnant my last period was on 14th of last month and my period is due on 10th of this month I do have a lot of disturbed sleep due to my 18 month old baby who does not sleep very well and wakes at night I am always very tired my weight has always been the same I have not had this problem before with a late period unless I was pregnant should I go and see a doctor or be worried I do no do any exercise nor under contraception also I am not sexually active for the past three months",
        "input": "",
        "output": "hello if you have missed your menses and the home pregnancy test is negative as on date then the most common cause of delay in menses during this cycle would be stress induced hormonal imbalance however if you are breastfeeding then sometimes irregularity in menses is possible as well next the best thing to do in your case would be to wait for another five days and if no menses then repeat the urine pregnancy test and then if negative again then opt for a transvaginal ultrasound to check for endometrial thickness if the endometrial thickness is more than my then you can opt for a withdrawal bleed with progesterone to resume your menses keep your daily water intake to three to four liters as it is the best anti oxidant and de stressor considering your disturbed sleep pattern this would help regularize cycles naturally maintain a menstrual calendar for the next three months to understand your fresh pattern of bleeding and if no change and this being a singular episode then no apparent need for any medications for regularization of cycles would be required"
    },
    {
        "instruction": "hello doctor I have a chronic migraine for almost five months now no medicines or treatments have worked and transferring to a hospital with more resources soon over the past few years I have noticed that I am having more and more trouble hearing you could knock walk into the room and ask me something and I will not know you are there alarms will go off in other rooms for more than ten minutes and only after I am aware they are there and I actively try and hear it else will I hear it at all the bell in my high school has gone off and I have not noticed it if I listen to the audio without subtitles I cannot figure out what is being said I cannot understand the phone calls and often in conversation if someone does not speak clearly and at a good volume I will not be able to hear and understand what they are saying at all I also have occasional pain in my inner ear the pressure that feels as though my ears clogged even if they are not the other day my hearing was tested at an ent and they told me my hearing is perfect and that auditory processing disorder and was a possible answer but that if so there would not anything to do I have looked into and it was described as almost auditory dyslexia which does not sound like an accurate description of what I am dealing with it is hard to process what could be going on based on the fact that my ears were tested to be in perfect help if you have any insight or advice I would love some guidance",
        "input": "",
        "output": "hi auditory processing disorder could be the possible reason but before that the initial level of otosclerosis spongy bone formation in the middle ear ossicle restricts the sound transmission middle ear infection should be ruled out my advice is to consult with an audiologist available nearby please undergo pure tone audiometry speech audiometry impedance audiometry bear test brain stem evoked response audiometry if possible go for hrct temporal bone high resolution computed tomography also that will give us a much clearer picture of your problem if everything is fine then it is attention towards the sound that should be taken into an account"
    },
    {
        "instruction": "hello doctor I have a birthmark behind the right side of my neck which looks like a black thick mass I had once consulted a skin specialist to check if there are any options to get this removed I was told that even if it is removed by surgical means there are chances that it may reappear I want to confirm this do we have any options to remove it by surgical or nonsurgical means are there laser treatments available will I have to remove my hair if I need to undergo treatment I have attached a photograph of the affected area",
        "input": "",
        "output": "hi I have seen the photo I understand your concern the condition is known as nexus sebaceous in case of deep surgical excision in nexus sebaceous chances of it coming back are very less the thing is the excision should be deep to minimize the chances of recurrence laser treatments are there but not very effective and chances of recurrence are more hair needs to be removed as the area should be devoid of it to perform surgery cost depends on the different doctors and their location or specialty"
    },
    {
        "instruction": "hello doctor I had a chest pain less than a year ago I went to the emergency department and they did an angiogram and I was told that the arteries are clear my question is how long before I have another angiogram as I have similar pain again I am currently taking lisinopril 10 my",
        "input": "",
        "output": "hi you need to lower risk factors such as blood pressure diabetes and blood cholesterol levels do regular exercise if you feel chest pain have tit treadmill test done if there are high risk features in it then do angiography no need for angiography otherwise"
    },
    {
        "instruction": "hello doctor it would be very useful for women to know how to have a better period for instance are there foods that can lessen the bloat are there any techniques that can relieve cramps are there any approaches that can help with the anxiety and mood swings associated with our cycles please explain why the technique works",
        "input": "",
        "output": "hi there are a few things that you can try before the period starts which would help to make it less painful and some which you can try during the period when you are not having a period include physical exercise at least 30 minutes to increase the strength of your body eat healthy food less fried foods and gradually reducing the portion of each meal so instead of three big meals have five small meals yoga poses such as child pose knee to chest pose camel resting corpse are a few which help a lot in menstrual cramps if done regularly have enough sleep during the menstrual cycle the warm water bottle is always the easiest way to soothe the cramps keep it handy having lighter and warm meals like soups or porridge instead of heavy like bread is a better choice hydrating yourself is essential and will keep your energy levels high avoid caffeine eat more fruit and vegetables do light exercise take a warm bath and get enough sleep 8 hours track your period if possible start eating smaller meals at least a day or two prior to start of the period it helps a lot"
    },
    {
        "instruction": "hello doctor what are the worst foods for your arthritis mention the name of the first food and why it can negatively affect or worsen arthritis symptoms I am hoping to highlight inflammatory foods high in sugar foods high in saturated and trans fat and dairy which may be a cause for arthritis for some people due to its casein proteins please try to name a specific food I yogurt and not a group of foods I dairy and reference studies when possible please specify the name of the second and third food and why it can negatively affect or worsen arthritis symptoms",
        "input": "",
        "output": "hello there are some lifestyle and nutrition recommendations that can be given to any patient suffering from arthritis that may help reduce the pain diet rich in omega and antioxidants some studies have shown that omega help decrease swelling or inflammation and the antioxidants help reduce the free radicals in the body avoid alcohol and red meat some patients suffer from high uric acid levels which may worsen arthritis symptoms red meat contains high levels of purines which are then metabolized in the kidneys and may affect and increase the uric acid levels alcohol dehydrates the body and this makes it even more difficult to eliminate the purines or toxins from the kidneys the easy way to achieve a healthy weight and include omega and antioxidants in the diet is by a mediterranean diet this means cutting back on red meat and eating fish and legumes beans lentils chickpeas as the protein source omega rich foods are healthy fats like avocado olive oil nuts seeds and olives and also salmon the mediterranean diet suggests that you eat lots of vegetables and fruits which are rich in antioxidants stick to natural grains like quinoa or brown rice and avoid processed foods like white bread or pastries"
    },
    {
        "instruction": "hello doctor what are all the foods men should eat every day kindly name them why they should eat it why men specifically should be eating those foods daily due to unique and common health issues the gender faces I men tend to be low on fiber and this packs grams of fiber per serving an example of how the reader could eat the food every day add to smoothies toss in a salad afternoon snack etc please comment on why men should eat it",
        "input": "",
        "output": "hello men can take berries which are good to heart steak prepared with lean meat to give full of protein especially for active men dark leafy greens to get fiber and folic acid for proper functioning of metabolism eggs to provide lutein for boosting brain function plus preventing a cardiovascular accident in the future bananas provide full of minerals especially potassium broccoli will protect from prostate cancer water to keep well hydrated especially active men olive oil to prevent cardiovascular events and stabilizing blood lipid levels for breakfast whole grain toast with two boiled eggs with a glass of water for snack take one banana for lunch broccoli carrot and salt with olive oil lean meat soup for an evening snack berries smoothie for dinner yogurt with dark leafy greens and olive oil salad this is what I recommend to my patients normally to change every day not the same menu"
    },
    {
        "instruction": "hello doctor how to relieve muscle soreness what works on epsom salt baths foam rolling using a theragun or a similar tool hydrating eating foods that are high in antioxidants sleeping a lot eating foods high in antioxidants cryotherapy active recovery lacrosse ball facial work stretch for each reason can I ask you to explain how exactly that helps the sore muscles what are the signs that your sore muscles are something more serious than just sore muscles anything else you would like to say about doms",
        "input": "",
        "output": "hello muscle soreness or does delayed onset muscle soreness generally occurs if someone does strenuous physical activity in any form strenuous physical activity means when one body is unable to do more physical work but that person pushes his body to do that it can occur within 24 to 72 hours it occurs due to small scale damage in the muscle fibers the best way to get rid of it is to increase any physical activity gradually because it will help in increasing the strength and stamina epsom salt bath massage or sauna etc are helpful in muscle soreness because first they relax the muscles and second they increase the blood flow the clear role of cryotherapy is still not understood I hope this helps"
    },
    {
        "instruction": "hello doctor I am seeking experts to comment on low carb diets what is the complete macronutrient breakdown for a typical low carb diet how much fat should you eat on a low carb diet how much protein should you eat on a low carb diet we are looking for suggestions on vegan foods for energy name the foods you are recommending and set description as to why you are suggesting this food",
        "input": "",
        "output": "hello I just read your query in general a person requires 1500 200 calories per day carbohydrates in general can fulfill approximately 50 of our daily calorie requirements people should usually take around approximately 200 325 grams of carbs daily but if someone is aimed at losing weight then they should aim for a low carbohydrate diet then people should take around 50 to 150 grams of carbohydrates daily who are adopting a low carb diet also proteins and fats are also important parts of our diet if someone is on a low carb diet then they should consume 38 130 grams of protein per day depending on their weight one can consume between 30 60 grams of fats while on a low carb diet from healthy sources there are a variety of vegan foods that you can use for energy like spinach oats almonds lentils fresh fruits and chia seeds etc these foods are easily available and have a variety of nutrients and also easy to eat so they are recommended for quick energy needs"
    },
    {
        "instruction": "hello doctor I am writing to you in connection with my partners allergic reaction which happens when we are together basically she is already allergic to dust and has atop on her right hand since she was a child now she is 23 and I am 27 which is sometimes stronger sometimes weaker but always there as she is a japanese girl living in japan we have met three times in various places but her symptoms have appeared every time small red rashes appear on the hands and later on the legs too her face gets itchy and breaks out in pimples too these always start days after meeting again and get better some days after we leave each other we also tried sleeping apart and that helped a bit on the symptoms no sexual intercourse yet so I am afraid I might have something that makes her produce such reactions she also blames my dreadlocks which indeed catch not few dust but I will cut it before we meet soon so that possibility will be crossed out because of her dust allergy they live in a very clean environment so I also suspect that staying longer at an inherently duster place like my flat might get her reactions acting up also she had a lot of stress because of traveling to meet me which also does not help such skin diseases in some places we slept in hotels so we always suspected the local washing powders to cause these effects but in my work place I deliberately bought a new linen bed to avoid such a problem although I washed it before using it dishes were different in the three countries so I cannot see that there would be a common ground for an allergic reaction I will buy new clothes and will wash them myself according to her hygienic discipline and we will see how it goes I do not regularly use deodorant nor aftershave and I had different shower gels all the time what else could we change to stop her reactions or to find out what caused them how could we soothe them maybe after being together for a long time she would get used to my flora and she would eventually stop her reactions in an environment with less stress of course I sent her to a specialist as well to get checked to see whether I can be the cause",
        "input": "",
        "output": "hello you have described your partner problem very nicely she is suffering from chronic urticaria is an allergic reaction that takes the form of itchy red bumps on the skin as shown in your pictures name anything that can cause an allergy and it can also cause hives including pollen dust dander dust mites shellfish and other foods first thing in the management is to find out the trigger to avoid hives you need to figure out what causes them if you do not know start keeping a daily diary the most probable suspects are things that you eat drink or swallow drink supplements and medications but even if you do not see any obvious connections continue keeping your diary noting other factors like weather stress levels clothing or the amount of time that you spend in the sun with careful tracking you may link a specific lifestyle factor with the eruption of those red itchy welts foods most likely to trigger hives include shellfish nuts chocolate fish tomatoes eggs fresh berries and milk some people react to preservatives in certain foods and wine such as sulfites once you have identified a food trigger eliminate it from your diet and see whether you have fewer outbreaks common drug triggers include antibiotics and nonsteroidal anti inflammatory drugs nsaids such as aspirin and ibuprofen but doctors have heard about many other triggers including sedatives tranquilizers diuretics diet supplements antacids arthritis medications vitamins eye drops eardrops laxatives and douches seek emergency medical treatment if you develop hives around your eyes or in your mouth or experience difficulty breathing wheezing light headedness or dizziness you may have a life threatening condition called anaphylaxis and the internal tissue swelling can block breathing passages so better you get done her blood allergy test that will give you a clue about your trigger so that you can avoid it tablet levocetirizine or desloratidine are helpful when you have a rash calamine lotion or astringent help shrink blood vessels so they do not leak so much of histamine or mix one teaspoon of any kind of vinegar with one tablespoon of lukewarm water and apply the mixture to your hives with a cotton ball or tissue to soothe the itching take fish oil in capsule form three times a day the primary treatment is to increase the immunity of the body an excellent remedy is to take one teaspoon of turmeric powder haridra khand with a glass of milk or water two to three times a day massage the skin with mustard oil for 15 minutes followed by a bath with lukewarm water make a paste of two cups of oatmeal and three teaspoons of cornstarch and water apply this paste on the affected areas until the itching is reduced stress can cause hives or make them worse so avoid it in any form try meditation or yoga to boost your immunity so after allergy test avoid that specific trigger I hope this helps"
    },
    {
        "instruction": "hi doctor I visited an asian massage parlor and received anilingus and a whole body tongue massage on an exposed pimple on my back that was slightly bleeding from irritation during the massage after the massage I immediately showered with soap am I at risk for any studs or sits I do not currently have any symptoms or visual changes but I am still worried also should I be concerned about rabies she was not symptomatic but she mentioned that she was recently from shanghai and had a dog I did not notice any bite marks on her and she appeared in good health but I am still worried is rabies a concern at all",
        "input": "",
        "output": "hello rabies can only be transmitted only if she is infected and her saliva is having rabies viruses so rabies is not a concern because probably she is not infected as she is not having any symptoms if she does not develop any symptoms for another ten days then it is highly unlikely because this is the time period within which she develops symptoms if her saliva is having viruses however the possibility of sti sexually transmitted infection is definitely possible and depends whether she is infected or not I hope this helps"
    },
    {
        "instruction": "hi doctor my mom aged 45 years is having a fever for almost two months the temperature used to vary from 100 degrees celsius in the night times and gradually it comes down she was weighing 105 keg and now she is keg now she is having bone pain and light fever in the night when there is a pain in the bone she has been advised with calcium and iron tablets she is also getting her regular periods menopause has not reached yet kindly advise",
        "input": "",
        "output": "hello the fact that she has been having fever off and on for the last two months and is a low grade fever especially in evenings with accompanied weight loss and bone pains indicates a possibility of tuberculosis infection it is better to get her mantoux test and ada adenosine deaminase levels done to rule out the same as she has been in a colder country the possibility is unlikely if she has been staying with you for more than six months or if she has recently visited you two months back then there is all possibility of her having contracted the infection from india and she carried it with her keep her well hydrated in the meantime and start multivitamin tablets daily to increase the appetite which may have also suffered a loss for last two months now please follow up with the reports"
    },
    {
        "instruction": "hi doctor I had unprotected sex weeks before and I took I pill the next day my periods are due on 18th of every month but 14 days after taking I pill I had two to three drops of blood and did not get proper periods again after one and a half weeks I thought I am having periods but just two to three drops of blood last night we had protected sex but when my partner ejected out he ejaculated on his hand the condom did not get torn though I am really scared now should I eat the I pill again",
        "input": "",
        "output": "hello I have gone through your history and understand your concern I will try my best to help you if no spillage of semen inside the vagina and no touching of the vagina with his semen in hand then no need of taking I pill and the menstrual irregularities through which you are going is the side effect of I pill but still to be on the safer side take a pregnancy test and if the test is negative no problem"
    },
    {
        "instruction": "hello doctor I am pregnant but I feel like I cannot do anything I am weak and my body feels like it is on fire but it is not I am wanting to throw up all day I am using the restroom more than normal my heart rate goes racing and I get light headed what is wrong with me I have been dealing with this for over three months and I cannot deal with it I have a month old baby and I am totally weak to hold and play with her but I am also months pregnant",
        "input": "",
        "output": "hello the fact that you are months pregnant and frequenting restroom more than normal with fatigue and weakness and likely lower back pain and nausea as well indicates a possible urinary tract infection having set in you should get a urine routine and culture microscope test done soon to rule out infection and establish the organism you may have to be started on tablet nitrofurantoin 100 my thrice a day for seven days this is a safe drug in pregnancy in fact a drug of choice for ti in pregnancy please get yourself examined and lab tested soon in the meantime continue your prenatal and increase your water intake to allow early flushing out of infection you may take cranberry juice once a day if you like it again as urine alkalinise and it shall help but a visit to your physician is to be scheduled sooner else weakness body ache nausea and often increased frequency urgency even burning while urination may aggravate"
    },
    {
        "instruction": "hello doctor how does the consumption of okra promote a healthy pregnancy how does vitamin content in okra help to reduce respiratory illnesses like asthma what is the relationship between okra and kidney disease how can eating okra daily help reduce kidney damage how can okra help reduce the absorption of glucose in diabetics why is it beneficial to add okra to your diet to lower bad cholesterol levels how does okra aid your immune system",
        "input": "",
        "output": "hello okra is a vegetable with amazing health benefits it aids bowel movements in constipation lowers cholesterol and reduces the risk of colorectal cancer research shows that this vegetable has natural anti diabetic properties remember that the benefits of okra are due to its fiber and its mucilage that unpleasant slippery inside so if you cook the veggie in such a way that you leave the fiber and the mucilage intact you can enjoy its immense health benefits chop off the ends cut them into a few pieces and soak them in a cup of water overnight the next day remove okra and drink the water naturopaths maintain that this medicine also works great for joint pains due to the viscosity of okra which aids joint movement it is wise to consume okra like other vegetables but okra alone cannot do miracles like getting pregnant in a woman with some gynecological problem or it cannot cure kidney stone"
    },
    {
        "instruction": "hi doctor I recently hurt my middle left side of my back in wrestling I pretty much got picked up and slammed on a corner of a table and now I feel a sharp pain in that spot it is a kind like a black and blue but there are no visible marks just sharp pain whenever I move also when I take a deep breath I get pain in my left shoulder can this be healed on its own and how long will it take to heal",
        "input": "",
        "output": "hi you have mentioned the injury to your middle left side of the back region if you have localized back pain with no other symptoms like radiating leg pain and neurological symptoms like numbness weakness paresthesias etc then you can start with following recommendations for an initial period of two to three weeks maintain a proper posture of your back while working and sleeping if pain is more then you can take a short course of an anti inflammatory medication which suits you physical therapy initially under the supervision of a trained physiotherapist and then to continue at home adequate calcium and vitamin intake if levels are low in the body ice packs should be applied three to four times a day 10 15 times every time analgesic spray for a local application can be used and is easily available avoid lifting heavyweight acute forward bending in the mornings etc we will observe you for the next five to seven days how you respond to this conservative management protocol if you are not feeling better then we might have to get some investigations like dynamic rays of the lower back and few blood tests for evaluation I hope this helps injury ray of the specific region if no relief from pain as advised"
    },
    {
        "instruction": "hello doctor this is not a health inquiry but a problem I would need your help to solve I would like to know what foods are good to eat before a test or exam I am getting things like omega 3s proteins complex carbohydrates and water my problem is I cannot find much tangible information on why these things help us perform during tests can you point me in the right direction of where I need to go to get this info or do you know what foods are the best to eat before a test",
        "input": "",
        "output": "hello yes as you have searched information is right and coming to its detail complex carbohydrates will give you energy and you will not be lethargic as carbohydrates are an easy way to breakdown for its energy levels especially for brain cells you can opt for whole wheat oats muesli banana apple etc protein are a good source or considered as building blocks this will help to manage immunity help to build tissue tear and keep you manage good health by not letting any infection easily it can help you to be healthy you can find these in eggs lean meat like fish and chicken omega and fatty acids boost the memory as it has antioxidants and increases the memory power like in almonds walnuts and fish include fibers with fruits and vegetables in the diet as these are rich in antioxidants and anti inflammatory and helps in good blood circulation boost energy memory and good health"
    },
    {
        "instruction": "hello doctor I met a car accident three weeks ago and I have three stress fractures in my to and I still feel tender though I hurt my neck and shoulder I took it easy I have been using my legs to help me get up etc my lower back is sore as well I have a sore bottom and tail bone due to the seat around me I have a little ache in my back when I move I use my arms to get me up and my legs a lot as I go on my knees to do a few things last night I noticed that my left arm is tight sore and had a tingling sensation also in my left leg around my ankle and feet I felt throbbing and tingling sensation I am wondering it started last night but I have not moved much and used the muscles and my scan reports were good except for the stress fracture my shoulder is still sore and thighs are not too bad but I can feel it",
        "input": "",
        "output": "hello it is only three weeks post injury injuries will take some time to heal with constant sitting or lying down you will additionally get pain or sore muscle aches try to move your position frequently do you have a tingling sensation after a prolonged posture or continuously nerve compression can lead to a tingling sensation compression at the cervical spine level leads to tingling in arms and compression at the lumbar spine will lead to tingling in legs reconfirm with your orthopedic surgeon there should be no signs of nerve compression after physical examination if there is no nerve compression nothing else needs to be done time will heal the rest"
    },
    {
        "instruction": "hi doctor I am not sure I am over stressing but I have noticed when I drink cold icy water I can feel it go down to my stomach I hurt my tummy muscle four weeks ago and still not 100 percent cured it still burns and I get acid reflux as well my throat is dry and sore my breath is smelly and I get sinus problem and feel like phlegm is going back down to my throat",
        "input": "",
        "output": "hello as for the feeling of cold water going down your thirst and the acid reflux both indicate an inflammatory condition esophagitis and gastritis this can be treated with a proton pump inhibitor controloc pantoprazole once daily and an antacid ranitidine before every meal the bad breath could be due to inflamed gums or an infection such as pyloric so I recommend you get a test for pyloric infection and consult a dentist to examine your gums bad breath can also be due to sinusitis can also be the cause of the post nasal discharge phelgm at the back of your throat and can be treated with an anti inflammatory ibuprofen twice daily and an antihistaminic as cetirizine or zyeartec once daily before going to bed for 10 days"
    },
    {
        "instruction": "hello doctor yesterday my wife on her annual checkup got an abnormal egg the report says normal sinus rhythm incomplete right bundle branch block inferior infact age undetermined she is a little overweight otherwise healthy we are very worried",
        "input": "",
        "output": "hello I understand how worried you are about your wife health do not worry she will be fine soon the egg shows evidence that points to the fact that your wife has a injury to the right part of her heart this can cause a disruption of electrical impulse traveling to that area which show cased as right bundle branch block I advise you see a cardiologist she needs to do further investigations like echo to ascertain how well her heart is working and to know the extent of damage I wish her a speedy recovery best regards"
    },
    {
        "instruction": "hello doctor male 170 am 60 keg non smoker non alcoholic vegetarian day before yesterday nose and ear bleeding was there in the early morning done blood test and found platelets count 2400 only the doctor suggested to take rest for days",
        "input": "",
        "output": "hi welcome to icliniq com following is my opinion for your case your platelet count is low and suggestive of severe thrombocytopenia the bleeding could be due to that the reactive large platelet also seen in smear so platelet destruction might occurred in your body dengue and viral infection are common cause for that your platelet count need to be monitored at 48 hour interval drink lots of water if platelet count still go down and bleeding does not stop than platelet transfusion might given you can rule out dengue by elisa or rapid card test"
    },
    {
        "instruction": "hello doctor I need help for my 19 year old son he has tried sari which did not work then we had the gene testing done and it showed that he should not be on the one that he was on and seemed to make him worse he is now on an sari the same one that his mother is on and that is not working as it should either we have tried the ketamine treatments and they seem to help short term a couple of days we stop those treatments when he was hospitalized at the end of last year he was required to be hospitalized to be observed for eat treatments which were started we saw a great improvement with the eat and after about treatments he was backed off to once a week which seemed to work okay with only one bad day then he was moved to every two weeks and it got bad again we got him in a few days before the two weeks were up and he still had some very bad days he is a psychiatrist but my son is not honest with him because he fears being locked up again I guess my question is this what medication in the sari class have you found to work the best for major depression I know he has been labeled treatment resistant but the anxiety medication he takes seems to work is there another class of medication that you would suggest we try",
        "input": "",
        "output": "hello firstly sir it is just a brief labelling to broadly differentiate classes but many people who do not respond to one sari will do well with another drug of the same class so cross switching between classes is also done among the sari my personal experience as well as the literature supports the use of venlafaxine as superior compared to others lets assume that we are going to use venlafaxine as a primary drug in non responders or resistant usually augmenting agents are given I do not know what agents have been tried for your son so far but normally sari with mood stabilizer like sodium valproate or lithium or sari low dose second generation antipsychotic or sari plus combinations of mood stabilizer and low dose antipsychotics can be used apart from this other classes of drugs can also help such as mirtazepine bupropion and as and when needed temporary use of low dose benzodiazipines and propranolol can also be added the goal here will be remission of symptoms or atleast reduction to an acceptable level in patients with resistance usually or drug combinations will be needed also many psychiatrists do not reach the maximal dosage recommended of most drugs and that also needs to be tried out apart from this you should consider getting to sessions of cognitive behavioural therapy from a clinical psychologist it will also help and add to the effect of medicines"
    },
    {
        "instruction": "hello doctor I would like to know what is your role in working with children with hearing loss or more specifically what are the duties that involve the children with hearing loss when you work with children who have hearing loss what are the two or three consequences or effects of the hearing loss that you think have the biggest impact on the childs life do you think that children with hearing loss are being adequately served in the area where you work what kinds of things would you like to see happen differently for children with hearing loss where you work if you are familiar with the speech and language services that children with hearing loss receive in your school or community do you think that these services are meeting the needs of the students what do you think about this if you are aware of the hearing related services that children with hearing loss are receiving in the schools or community where you are do you think that these services are meeting the needs of the students what do you think about this do you have anything that you would like to see done differently by people who work with kids with hearing loss g programs funding devices etc",
        "input": "",
        "output": "hi the primary role in working with children with hearing loss is an early diagnosis of the disease and etiology once the diagnosis is made our duty is to treat the reversible cause of hearing loss this is more common than irreversible or genetic causes our goal is prevent the probable diagnose the inaudible treat the curable rehabilitate the disabled hearing is one of the most important sense organ mutually connected with vision for speech and language development which is a must for communication most important consequences of hearing loss are speech and language development and overall psycho social development this is dependent on communication children with hearing loss have special importance as they have to be diagnosed early to prevent the delay in speech and language development the best means to achieve this can only be universal neonatal hearing screening this scheme is not followed in our place due to various reasons like a social factors requiring community and individual participation economic resources government policy support I would like to have a universal hearing screening program because only if we can diagnose early we can do something so the first step is early and all the cases to be diagnosed hearing and speech and language services for hearing impaired are meeting the needs of students who are receiving treatment facilities at tier and few tier cities but at the rest of the places these services are not adequate the reason is again a lack of awareness of available facilities constant changing of technology and products low literacy also prevents parents from utilizing these resources lack of funding and support from dedicated organizations human resource and society participation few important needs are a universal neonatal hearing screening social awareness of the impact of hearing loss and treatable diseases funding for hearing impaired children with the provision of financial support for special schools need of low cost and effective rehabilitation devices that should have stable technology easy to boot does not have much maintenance cost increase in more and more audiologists are needed especially to serve the needs I hope this helps"
    },
    {
        "instruction": "hello doctor I am 38 weeks pregnant 38 weeks and days I took an ultrasound today my report shows biparietal diameter 93 am 36w 1d head circumference 32 17 am 36w ad abdominal circumference 31 65 am 35w 4d femoral length 98 am 35w 6d average age of gestation based on today scan 36 weeks estimated fetal weight 2765 grams I just want to ask if I need to be worried as my doctor said the baby is small is there any problem for the baby because I am on 38 weeks days now but base on my ultrasound the baby is 36 weeks",
        "input": "",
        "output": "hello the growth of the child is two weeks smaller for 38 weeks but corresponding to its ultrasound age the weight of the baby is fine there is a likelihood that you may have had an irregularity in your menses earlier and your ovulation may have been delayed and leading to late conception however best would be to undertake a biophysical profile and an umbilical artery doppler ma doppler studies middle cerebral artery to look for cause for decreased supply to the fetus if at all if these parameters are normal then your dates are probably wrong or you have had delayed ovulation and fertilization because fetus would then be considered growing and pregnancy can be continued and followed up with serial ultrasounds but nevertheless even if dates are not good still it is advisable that one should go with your dates as at 38 weeks and deliver the child by 41 weeks considering the child has matured and the average fetal weight is also good I hope this helps"
    },
    {
        "instruction": "hi doctor my son is 10 years old he had cough and low grade fever five days later I showed him to a pediatrician she advised augmenting 625 my mucolite and dublin nebulizer the next day my son has symptoms of reaction with augmenting like diarrhea so my doctor switched to zee 250 my after 10 days my son still has a little wet cough that only interferes a little at night with no fever his chest is clear but the doctor has advised zocef 250 again and she says though the chest is clear productive cough is there please advise me what should I do should I give him antibiotics again",
        "input": "",
        "output": "hi welcome to icliniq com your 10 year old son had a cough and fever which required augmenting and nebulization this means that the child has got wheezing with lower respiratory tract infection augmenting contains amoxicillin and clavulanic acid which may cause diarrhea in some children so rightly the antibiotic needs to be changed you have been given zee which contains azithromycin antibiotic which has made the system better now there is a mild cough but it is wet or productive a productive cough may persist for some time as the infection which was earlier there in the chest of your child has formed mucus or phlegm which needs to come out from the body this productive cough will persist for some time even if you take an antibiotic in my opinion there is no need for any antibiotic now and you should only give cough syearup this productive cough will subside in one week just protect the child from cold temperature avoid cold drinks and ice cream I hope this helps"
    },
    {
        "instruction": "hello doctor I have a stage to bladder prolapse I would like to get the surgery but I am suffering from anxiety and panic attacks I am terrified about getting the surgery in my mind it got fixed that if I go there I will die from that surgery it is said that it will be done through the vagina and she will fix it to the solid part of the pelvis no mesh will be used and it will be by spinal and not general anesthesia I am someone who does not tolerate the medication I always have bad reactions even if it is demerol morphine or codeine it does to me the opposite effect that it is supposed to do could you tell me more about the surgery what are the risks will I die from getting the surgery I do not even have a date for it and I think about it all the time I am terrified I do not want to die can it be done by local anesthetics only",
        "input": "",
        "output": "hi I have gone through your question and understand the concerns vaginal surgery for the bladder repair is safe and there are no major risks associated with it complications like bladder injury can occur which is not at all life threatening and can be surgically managed spinal anesthesia is safer than general anesthesia and all the vaginal surgeries are done in it cannot be done in local anesthesia you should consult a psychiatrist and get properly treated for panic attacks and anxiety before going for surgery bladder prolapse cannot be treated medically and surgery is the only option I hope this helps"
    },
    {
        "instruction": "hi doctor I am 24 years old and I have had cos and was on homeopathy for five years sonography reports came normal now I want to know that if there are any chances of it coming back as sometimes I do feel pain in the left ovary also my grandmother has breast cancer and at times I cough and sneezes a lot are there any chances of me getting the same",
        "input": "",
        "output": "hi I understand your concerns but you should not worry as there is no reported association between cos and breast cancer also you should know that cos cannot be cured completely medications and homeopathy can control only the symptoms and increase the chance of fertility if required advice take oral contraceptive pills gynera once daily for 21 days then days off repeat every month metformin 500 my twice after lunch spironolactone 50 my once before sleeping as anti androgenic please send me a copy of your sonography report as well as any performed lab tests g fasting blood sugar postprandial glucose level etc send me a photo of the acne or facial hair if still there follow up after two weeks note if you desire to be pregnant seek advice some of these medications must be changed"
    },
    {
        "instruction": "hello doctor I am not on any medicines but yes I have tried before I am very active successful and driven my world is just a dark place and I really do not know why there is no reason for it to be but it just is it has gotten worse over the years and now I cannot deal with the anxiety I cannot deal with the lows and I contemplate leaving away for good so many times",
        "input": "",
        "output": "hi I am sorry to hear about this I can understand how hard it is for you right now personal beliefs and thoughts are formed through our experiences social background parenting and family structure during our childhood as you have mentioned that you have always felt this way this means there are subconscious thought patterns called cognitive distortions in technical terms which are faulty and dysfunctional and are clouding your thinking I would suggest you to start psychotherapy there are various techniques through which these fixed beliefs can be brought to conscious understanding and then changed and learn to cope up with then work is done to find out where and when in your past experiences you picked up these beliefs and you can remove your emotional blocks away and get past these sometimes high functioning depression or anxiety presents like this please do not delay this can be resolved and there is hope take care of yourself"
    },
    {
        "instruction": "hello doctor I have cholesterol level 189 after one month diet control and with exercise before month my level was 194 and to level was 218 and lil 102 hel 41 now after one moth exercise and diet control my cholesterol is 189 to level is 24 lil 13 and hel 39 whether I am a cholesterol patient or not because instead of decrease in triglycerides level it increases and lil also increases but the general cholesterol level decrease I am so worried kindly reply I am male 32 years",
        "input": "",
        "output": "hi you need to monitor definitely levels are elevated and changes in a month not to be considered please continue for next months and do recheck reports you will get good results I am not clear with diet pattern what you are following to plan a customized diet plan I need more details follow these tips do regular walk with minutes slow 20 minutes speed and minutes slow walk a complete cycle do it in a level road include lean meat in diet as it improves hel avoid excess oily foods but oil is also essential not zero oil include fish almonds walnuts as it has omega 6 fatty acids increase fruits and vegetables in diet divide your meals to 7 meal pattern increase fluid intake do meditate to manage stress"
    },
    {
        "instruction": "hello doctor my father 70 years old is just recovering from a septic shock and amputation he has had is leg amputated below the knee he had an infected wound on his foot and fell into a septic shock he has kidney failure and needs dialysis his blood pressure dips too low during dialysis and it had to be aborted is there anything that can be done for him to keep his blood pressure up during dialysis his amputation wound is not healing can anything be done to promote wound healing could another amputation above the knee help the wound to heal",
        "input": "",
        "output": "hello there are number of ways to try to avoid fall in blood pressure do not take blood pressure medicines prior to dialysis avoid eating during dialysis may be tell doctor to reduce his fluid removal on he reducing the dialysate temperature by 5 celcius or still issue persists can take tablet gutron midodrine 5 my tablet prior to dialysis and dose can be increased to 5 my regarding wound healing elderly take some time for wound to heal we can wait sometime and ensure adequate nutrition normal he and still problem persist can consult surgeon about further plan"
    },
    {
        "instruction": "hello doctor echo report shows physiologic pericardial effusion eustachian valve remnant at right atrium rvsp 30mmhg inferior vena cava not dilated mild mitral tricuspid valve regurgitation does this report show a normal result",
        "input": "",
        "output": "hi I have worked through your query and understand your health issues I assure you not worry as you have consulted the appropriate expert physician who will take care of all of your medical concerns I will simplify the things for your understanding and will go through whole of the echocardiography report attached there is no tumor seen inside heart chambers no blood clots seen means your heart is pumping in such a normal way that there is no turbulence of blood and heart valves are not causing any thrombi formation all the chambers of heart are seen normal inside pumping of blood to the lungs and to rest of the body by right and left ventricles respectively is all normal relaxation of heart chambers during beats is also normal no abnormal connections between the heart chambers very mild mitral and tricuspid valve regurgitation of blood and that is insignificant and considered normal nothing to worry right now but keep a follow up with a cardiologist in the future too right ventricular systolic pressure of 30 mhg is a little in the higher figures 15 25 mhg being normal range usually they have suggested an eustachian valve remnant at right atrium eustachian valve is a fetal structure and we usually see just a flap of the valve after the birth of the baby after birth it has no function and it is seen usually and normally on echocardiography so it is normal for you too problem was if there was a giant eustachian valve that may have been dividing the right atrium into two chambers inferiorly due to rigid overgrowth of the eustachian valve another abnormality you do not have related here is cor triatum dexter and needs cardiac surgery to correct it you are safe final impression normal echocardiography report I hope this helps"
    },
    {
        "instruction": "hello doctor I was wondering if I have a reaction to cardboard and or the chemicals in them about eight months ago I started working in a warehouse working with cardboard boxes after about a week my fingers started to tingle and bother me best way to describe it if you fall asleep on your hand the only thing that would help was to ice them after I stopped working there within a week or two everything was back to normal I recently started working with boxes again and the same exact thing is happening to my fingers so is there something in the cardboard that I have a reaction to I wear work gloves ot pain pills did not help bio freeze help a little is there anything I need to do for this to go away",
        "input": "",
        "output": "hi well the sort of complaints you are saying looks more of a nerve compression than an allergic reaction allergies are common at workplace where you deal with new stuffs but in allergy you get more of skin eruptions and peeling contact dermatitis since you have more symptoms of tingling and numbness it fits in more with nerve compression probably due to fine motor movements you have to do which compresses the nerve something like carpal tunnel syndrome to confirm this we need to do nav nerve conduction velocity studies meanwhile I would suggest you wear a wrist band while working to prevent the nerve from getting pressed you can read up on the internet about it and let me know if your symptoms match this"
    },
    {
        "instruction": "hello doctor I am undergoing major spinal deformity surgery next month anterior and posterior I am 50 years old and this is my fourth scoliosis surgery in recent years I have developed a sensitivity to morphine and I cannot take dilaudid hydromorphone because it gives me terrible headaches what other options are available to put into my spinal catheter for post operative pain control in the hospital I know that fentanyl is short acting and they do not use demerol any more in my place what can be done for me also I am currently on 50 my oxycodone per day and zohydro 80 my for pain so my tolerance for opiates has gone way up",
        "input": "",
        "output": "hi from your brief history I can sense that you have already become tolerant to opioids once tolerance develops to one group of opioids simultaneously other opioids also develop the same way I would suggest the addition of clonidine dexmedetomidine through your spinal catheter since opioid tolerant patients do have good postoperative pain relief with this drug multimodal analgesic with intravenous ketorolac buprenorphine through the spinal route can be another option but I do not know whether your anesthesiologist is comfortable with these drugs kindly have a discussion with your physician"
    },
    {
        "instruction": "hello doctor I am 56 years old diabetic with high blood pressure in the last four years when I am sleeping I have multiples erections dreams and not a calm night of sleep my wife always complains and we argue because during day time I have no desires and it is very hard to have an erection and this makes more friction between us sometimes we take a month to have intercourse we have been together for almost years the problem of erection during sleep time started with fewer times and now it is getting worse sometimes six times during a night I really need some help to have a calm night what do you suggest I am currently taking medications for diabetes and high blood pressure along with insulin and baby aspirin",
        "input": "",
        "output": "hi firstly you will need good control of your sugar levels it will help with the erection problem and sleep start a good exercise regimen and lose some weight also search on the internet for kegel exercises and do them daily it will help strengthen the muscles at the base of the penis and help with good erections also start a good multivitamin with a lot of complex group of vitamins finally for a few times you can try taking sildenafil or tadalafil to help with getting erections for sleeping you should try taking something harmless initially like melatonin supplements or you can try to take something which will give you sleep and also help with your stress such as mirtazapine 5 or vilazodone 20 my which do not have any sexual side effects"
    },
    {
        "instruction": "hello doctor I have a burning sensation in the penis for the last 20 days for the first seven days I took terbinafine tablet and candid cream the next seven days I took oflomac 400 afdura and urispas but the burning sensation is still there I also have a little bit of swelling in the glans penis for the past 17 days ultrasound report shows mild urinary bladder wall thickness with insignificant pvru urine culture no aerobic pyogenic grown urine e pus cells 1 abc hpf epithelial 1 epi cells hpf rec 36 much 6 monocytes 10 basophils 0mpv 12 sugar creatinine normal",
        "input": "",
        "output": "hi I have gone through your queries you may have complicated ti urinary tract infection you have to undergo another test send vb3 voided bladder urine or es for culture and sensitivity es means expressed prostatic secretion voided bladder sample means urine after prostatic massage for all these purposes you need to visit the office of a urologist please do that as soon as possible and get all these tests done and get further treatment you need clinical examination too for further treatment"
    },
    {
        "instruction": "hello doctor my son is 9 years old and has a problem in the upper four teeth ray attached and doctors are suggesting for act root canal treatment as they are very much decayed so I just wanted to confirm the same",
        "input": "",
        "output": "hello I have seen the ray if the child is cooperative and can sit through the procedure then it is fine to have pulpectomy procedure I root canal treated if your child does not have any pain or swelling and the tooth does not appear to have some large hole or pink fleshy growth inside which can be seen then it is fine to let it remain like now and use fluoride toothpaste for kids to prevent further decay it is difficult to have a cooperative child at this age so do not put too much stress on the kid if he is very afraid if you see swelling or if there is pain then go by your pediatric dentists advice and do a root canal"
    },
    {
        "instruction": "hello doctor I understand that a high vacuolated neutrophil result can be indicative of impending sepsis is it possible for someone to have this result and an infection that does not make the patient symptoms visibly worse for a week if so could you give some examples of such infections the patient is not on antibiotics can a high vacuolated neutrophil result indicate some sort of problem other than an infection",
        "input": "",
        "output": "hi I appreciate your knowledge you are right vacuolated neutrophils suggest towards invective etiology more likely but let me know you in such a case usually neutrophilia is also seen so vacuolated neutrophils interpretation should be done in accordance with total abc white blood corpuscles and total neutrophils count your clinical correlation and physical examination are also necessary vacuolations in neutrophils suggest phagocytic function of it in infection g pneumonia fungal infection septicemia typhoid etc sometime in inflammation also such cells are seen as you have rapid weight loss cause for that should be searched some of the causes are hiv acute infection cold gastrointestinal problems like celiac disease and inflammatory bowel disease hyperthyearoidism diabetes tuberculosis etc so the clinical correlation is necessary to do further work up provide your other reports if it has been done along with full abc complete blood count report I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 31 year old male I am married for the last six years before getting married there was an incident where I had a sexual encounter with a girl however during this I had erectile dysfunction so after about one year I got married to my long term friend in the initial three to four months I had issues of not being able to maintain an erection however over time we adjusted to a pattern and we got over it after about six months we have been having frequent sex over the last four to five years however throughout this time maintaining the erection for more than say 10 mins has always been impossible recently I had a sexual encounter with another girl but had a lot of problems in getting the erection and maintaining it I have a well built physique and do regular exercise and play games my weight is 89 keg and height is around 10 I am a heavy nonvegetarian and eat lots of fish chicken and beef after the above incident I have started doing a bit of diet control along with my regular exercise I also have an inguinal hernia over the last few years and I am planning to get it operated soon I have been thinking of buying tented royal but wanted to take advice from you before going ahead with any medication",
        "input": "",
        "output": "hello from your query I could infer that you had difficulty in getting and maintaining an erection with the new girl only you were able to have frequent and normal sex with your wife before the encounter with the above said girl it means that the cause for erectile dysfunction at the incident was due to performance anxiety which is purely situational and psychological hence nothing to worry much about physical causes and be relaxed and enjoy your sexual life with your wife and masturbation once in a while I will not recommend any such enhancers like tented royal as it makes you feel that you lost your vigor and you have regain which is not real what you lost is your confidence which you need to regain exercise yoga etc can make you fit which in turn improves your sexual life if you are so much worried about physical causes then you need to do routine blood and urine test serum testosterone fasting state fbi fasting blood sugar and pubs post prandial blood sugar ash thyearoid stimulating hormone prolactin these are basic tests for male dysfunction do mention about the frequency of masturbation erection status during masturbation early morning erections etc"
    },
    {
        "instruction": "hello doctor my wife is months pregnant she is treated in one of the reputed hospitals she has been advised to take feronia it and cal 360 tablets over last three to four days she is having cough in the night time and she is afraid to use any tablets or tonic kindly suggest which tablet or tonic she should take",
        "input": "",
        "output": "hi blood test to check for hemoglobin level total count and differential count cough in pregnancy revert back after the investigations to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hello doctor a red rash with white tiny bumpy spot has grown on my buttock it is very itchy I guess it is a fungal infection please help",
        "input": "",
        "output": "hi revert back with the asked details and pictures to a dermatologist online"
    },
    {
        "instruction": "hello doctor I have attached my mother urinalysis report she is experiencing burning sensation while urinating but no fever she is diabetic and on following medicines glycomet go 850 one in the morning and one at night voglibose 3 one in the morning telmisat am my orcas my nextto 20 my and alzolam 5 my please help",
        "input": "",
        "output": "hi I saw the report revert back after the test to a urologist online"
    },
    {
        "instruction": "hello doctor patient left leg is swollen at ankle with severe pain at the joint for the past 10 days he is unable to walk regularly as before he has taken antibiotic and still the pain remains the same patient has done ray and blood test and everything seems to be fine there is no accident or any hit there he used to go for evening walk daily for around to am these symptoms started 10 days ago patient is 61 years old having gastric issue and has undergone stomach surgery twice please advise me how to deal with his health issue",
        "input": "",
        "output": "hi I guess you are talking about your father here in this query to arrive at a provisional diagnosis kindly answer these questions follow up with answers to the above questions for better evaluation of his condition to an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hi doctor my palm sweats a lot also my skin is too sensitive and gets tanned how to get rid of it why there is a sudden growth of hair on my face",
        "input": "",
        "output": "hi I have read your concern review after few weeks to a dermatologist online"
    },
    {
        "instruction": "hi doctor why do we always have runny nose when we catch flu or cold how do we get flu I have headache and fever for almost a week my tongue is sometimes white and lymph is a bit painful to touch but not swollen are these the symptoms of flu",
        "input": "",
        "output": "hi for further information consult a family physician online"
    },
    {
        "instruction": "hi doctor I am having pain during sex penetration of any kind hurts me the most painful are the inner lips especially on the right side I get burning sensation inside too but not very high I had some bleeding last night and it stopped fairly quickly we were not being rough either I am on depo proverb shot I think that I might have vulvodynia but I have pain inside too please help",
        "input": "",
        "output": "hello I have seen the pictures that you have attached for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hello doctor I have natural red hair I have been told that I should never dye my hair because the natural hair color will never be the same is this true",
        "input": "",
        "output": "hi for further information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor just now I got my cardiac it report I seek opinion of my radiology report before I see my cardiologist in a couple of weeks conclusion is that the stress test and echocardiogram results were fine the it cardiac report is as follows moderate coronary calcification detected with can score of 134 which is more than 90th for his age and gender there is evidence of vessel remodeling with ectasia in all three coronaries without obvious atherosclerotic change in the affected segments there is a mild to moderate diffuse non obstructive disease in the lad and ca there is relative non atherosclerotic luminol narrowing in the distal lad compared with the ecstatic segment I can provide the detailed report is it something that can be controlled with lifestyle change or medications I am on cholesterol medication and my cholesterol is under control I am also pre diabetic which is borderline",
        "input": "",
        "output": "hi we are here to help you your report is suggestive of coronary artery disease but the good news is that this does not require any intervention treatment if there are no symptoms associated like chest pain on exertion I would recommend you to do regular exercises and avoid alcohol and smoking in case you do I would also recommend you anti platelet drugs like aspirin for blood thinning and prevention of acute cardiac event for further information consult a cardiologist online"
    },
    {
        "instruction": "hi doctor I do not eat spicy but I have acidity I have slight pain in the bones of foot I am on blood pressure medication since five years in my let there is a slight increase in got 45 u and sept 4 l I have attached my entire blood report for your reference please advise if it is of some serious concern",
        "input": "",
        "output": "hi for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I always feel sleepy and lazy my height is feet and my weight is 70 keg I am also snoring while sleeping I used to sleep hours in night still I am feeling sleepy the whole day why please help",
        "input": "",
        "output": "hello thank you for sharing your complain with us for further information consult a general practitioner online"
    },
    {
        "instruction": "hi doctor my partner has spells that are occurring more frequently and I am really worried the symptoms start with extreme anxiety and the need to get away and also sometimes dejavu followed by numbness mostly just one side of his face and body but also total body once or twice he says he can still see but it is like he is looking at himself he loses control of his body but not conscious this usually lasts for about 30 seconds and when he snaps out of it he starts sweating profusely and intense nausea but never vomits this lasts for only a minute or two and then he gets better it started 10 to 15 years ago he used to get it only once in a couple of weeks and sometime long periods of time without happening but it has happened five times today your help and information will be appreciated greatly thank you",
        "input": "",
        "output": "hi for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor my mom is suffering from skin disease for the last two months on her palms and bottom part of her legs she has an itchy feel from inside and usually her hands are getting tight and dry the upper layer of her palm skin is coming out in patches please guide me with the pictures attached",
        "input": "",
        "output": "hi I have seen the pictures and the given history of your mother certain general measures have to be followed such as for further information consult a dermatologist online"
    },
    {
        "instruction": "hello doctor I fairly often ingest such things as paper rubber bands fingernails scabs or dead skin string grass small amounts of wood certain rubbers and plastics although I do not have cravings for non food items or ingest them in large amounts I do not eat dirt rocks metal or tough things this is obviously not normal for an 18 year old am I suffering from pica please help",
        "input": "",
        "output": "hi I have gone through your disorder for further information consult a general practitioner"
    },
    {
        "instruction": "hello doctor I am 30 year old male and had been smoking for the last 10 years I smoke four to five cigarettes a day I stopped it completely for the last 36 days now I am suffering with severe acidity and constipation I am taking sompraz 40 in the morning for the last 10 days but no great improvement felt I want to know whether there can be some kind of withdrawal symptom or do I need to consult my physician again my sept and got are and respectively total cholesterol is 216 lil 157 hel 36 and vldl 3 I do not have any diabetic background please let me know whether this is the reason for lasting herd",
        "input": "",
        "output": "hi for further doubts consult an internal medicine physician online"
    },
    {
        "instruction": "hello doctor my friend is 40 years old she was attacked by polio at the age of and unable to walk she is under depression due to work stress she is reacting like a mentally challenged sometimes we do not know what is in her mind since two months she has been reacting this way please help us understand what is going on in her mind",
        "input": "",
        "output": "hello for further doubts consult a psychiatrist online"
    },
    {
        "instruction": "hello doctor I got my periods exactly one month back I had unprotected sex with my boyfriend seven days back I had one I pill after two days at lunch time my periods are regular will the tablet consumption affect my periods is there any possibility for pregnancy kindly help me",
        "input": "",
        "output": "hi hope your periods are regular of around 28 to 30 days in that case nothing to worry as you had sex very much after ovulation period and no need of I pill also you should not be taking I pill frequently it is an emergency contraceptive pill for further doubts consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor here are the results of a prostate biopsy what do you think of the results do you recommend surgery or chemotherapy for a 71 year old",
        "input": "",
        "output": "hello for further information consult a urologist online"
    },
    {
        "instruction": "hello doctor I am assuming it as an unknown bite and it has spread almost around the neck yesterday I had taken amoxicillin prior to dental cleaning the condition in the attached report emerged last evening any idea of what it is I am traveling this weekend please guide",
        "input": "",
        "output": "hi I have seen your pictures and history two possibilities are there if you have history of bite anything then it could be blister beetle dermatitis if it has unilateral involvement associated with burning pain fever body ache then it could be herpes foster second possibility is more common in your case since old age is there and you are a diabetic episodes of herpes foster are generally self limited and resolve without intervention since diagnosis of herpes foster is based primarily on the history and physical findings you must visit nearby dermatologist for further physical evaluation for further information consult a dermatologist online"
    },
    {
        "instruction": "hello doctor I had cold a few days ago during that time my ear was clogged I originally thought that it was earwax but I tried everything for earwax and it did not help it has been a few days now and I am trying to find out what might be wrong please help",
        "input": "",
        "output": "hello for further clarification consult an ent otolaryngologist online"
    },
    {
        "instruction": "hi doctor my father in law has blood under the skin on his leg and ankle he has had a stroke in the past and is on blood thinners he said it is not painful and he cannot recall any hit there is some swelling in some black and blue he is on cholesterol medicines too please help",
        "input": "",
        "output": "hi revert back with the details to a general medicine physician online"
    },
    {
        "instruction": "hello doctor my mom has thyearoid capillary carcinoma five months back she got a surgery in both sides of her thyearoid gland what is the best treatment for this please guide",
        "input": "",
        "output": "hi sorry to hear about your mother state for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor my wife is 17 weeks and days pregnant she has been diagnosed with to thyearoid 237 hemoglobin 10 and low rec count currently she is taking aspirin gastro resistant 50 my milical od 740 my and fecontin 61 my one tablet per day does this have an impact on child what measures or corrective steps to be taken for normal delivery I have attached all her reports please guide",
        "input": "",
        "output": "hi I have seen all the attached reports for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hello doctor for the past six days I feel softening continuously around the anal area when I walk now I am suffering from slight constipation I have no hemorrhoids and no staining in the undergarment I have no blood in the stool and no pain in the anal area and also on bowel movement then why do I feel so please help",
        "input": "",
        "output": "hi functional constipation sigmoidoscopy avoid constipation avoid non vegetarian foods and take lots of green vegetables revert back after sigmoidoscopy to a medical gastroenterologist online"
    },
    {
        "instruction": "hi doctor my wife is suffering from bartholin cyst the problem is on the left side of her vagina for the last one month she does not experience any pain in the cyst currently the cyst is lengthy in shape and not circle we got married last month but before intercourse only she found that she had a cyst and since then we have not involved in sex her age is years and weight is 48 keg she has taken medicines for about two weeks but it does not help the cyst to sit completely now we have consulted three doctors and everyone is saying for a surgery I am afraid of some points will it affect our future sex life will there be complication at the time of pregnancy will it recur in future is it easy for her to recover from the surgery will it be painful for many years should we wait for some more time or go ahead with the surgery can you please advice for some medicines or home remedies for cure thank you doctor",
        "input": "",
        "output": "hi for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor my son was exposed to warfare chemical in the navy during his tonsil surgery he was found to have bleeding disorder he is suffering from hemophilia and is undergoing a colonoscopy tomorrow should he receive coagulant for this procedure",
        "input": "",
        "output": "hi based on your query my opinion is as follows no extra coagulation factor necessary if it and apt are normal for further information consult a hematologist online"
    },
    {
        "instruction": "hello doctor my brother has done a mcardle test in hospital they concluded that the glycolysis in cytoplasm is normal but reduced function of mitochondriosis have been seen in muscle they conclude this abnormality through the blood analysis the respiratory and the cardiac functions have been judged normal my question is what abnormality can be seen on the blood sample result what is in excess or lack either potassium or ammonia I have attached his blood analysis for your reference",
        "input": "",
        "output": "hi genetic autosomal recessive disease genetic testing for enzyme glycogen phosphorylase glucose rich and protein rich diet have instant source of glucose energy like glucon and candy for further information consult a general practitioner online"
    },
    {
        "instruction": "hello doctor it has been 27 days since I missed my periods my last period was almost two months back I was feeling sick and slight spotting was noticed for three days I had breast pain for more than eight days but now the pain has reduced 19 days back doctor said follicle is observed so periods may commence in a week time if not he advised me to go for a pregnancy test two days back I took a home pregnancy test hit turned out to be negative I am feeling very uneasy please help",
        "input": "",
        "output": "hi I have read your problem for further doubts consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hello doctor I have ear pain going all the way down to my foot I also have vertigo and tinnitus it has been two years I feel constant pressure around ear and nerve twitches in whole body please help",
        "input": "",
        "output": "hi I understand your problem as you say you have radiating ear pain along with pressure around the ear and vertigo and tinnitus there can be many reasons to this have you got any checkup done if not I feel right away you will need the following investigations based on the results of these two investigations I can further guide you as to need for any more tests or treatment meanwhile I will suggest you the following medicines if symptoms does not resolve you may need a neurologist opinion as well however as of now get the above tests done revert back after the tests to an ent otolaryngologist online"
    },
    {
        "instruction": "hi doctor mri says mild cerebral atrophy causing impaired motor coordination for my grandfather aged 64 but diagnosed as parkinson will there be any relation but another doctor who saw the report said that it is not parkinson and his condition is getting worse due to the dose of ad drug taken he is taking syndopa since diagnosed for ad once he had fallen of the bike while driving from then it has started slowly and progressing now only his hands are not properly functional he can speak with analytical reasoning so I got a little doubt and seeking out any advice on his condition would be helpful",
        "input": "",
        "output": "hi I have gone through the provided details and attached mri report although it is not enough to refute diagnosis of parkinson disease as parkinson disease can be diagnosed through clinical examination and there is no test to confirm or rule out but there is a possibility of parkinson plus disease in which condition deteriorates with use of parkinson drug levodopa for further doubts consult a neurologist online"
    },
    {
        "instruction": "hi doctor my wife keeps coughing at midnight and has breathing problem sometimes so doctor suggested an ray I am attaching the report here for your reference I tried searching information online and got some details but want to know the exact cause stage and treatment so please guide me thank you",
        "input": "",
        "output": "hello it would be very helpful if you would share how long she has the symptoms of cough also did she have any associated symptoms like fever body ache did they bring up phlegm is there any history of weight loss or change in appetite I assume that your symptoms were less than a week and this may well represent acute bronchitis it can be viral or bacterial keeping in mind the current viral season influenza it is most likely viral in origin but I can be more certain if you would kindly answer the questions above revert back with the asked answers to an internal medicine physician online"
    },
    {
        "instruction": "hello doctor my period is delayed and I took pregnancy test after seven days and it was positive on ith day that is four days ago I had slight bleeding with brown blood and till now bleeding continues with mix of little and medium flow doctor recommended me not to continue with the pregnancy kindly suggest which tests I should take ultrasound is not possible presently as suggested by doctor earlier I was suffering from pod I am really worried shall I continue with the pregnancy or not please help",
        "input": "",
        "output": "hello revert back after the ultrasound abdomen to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor five years ago I was diagnosed with cos then three years later I started suffering with very bad skin my skin was excessively oily and I always have spots and deep pores sometimes my skin has red blotches but they are not raised and there are no heads I seem to have controlled the oiliness but I still have spots and redness I am desperate to resolve it as I did not suffer as a teenager I am looking for any advice and recommendations that will help with this I am currently on contraceptive pills to control hormones",
        "input": "",
        "output": "hi since you are already a diagnosed case of cos polycystic ovarian syndrome which is known to be associated with seborrhea acne hirsutism and alopecia called as sara syndrome but with your history it seems that you are having only acne which is a good prognostic marker in your case this condition will partially get resolved with your hormone pills topically you can use antibiotics cream like clindamycin or nalidixic acid during morning hours and topical retinoids like adapalene gel during night for oil control of your skin you have to do certain dietary restrictions like not to take oily and spicy food junk food milk products and non vegetarian take lots of water which hydrate your skin cos hormone profile sara syndrome acne vulgaris revert back after a month with photographs to a dermatologist online"
    },
    {
        "instruction": "hello doctor I have lots of problem in focusing on things I do lack of confidence in dealing with public and get nervous in social gathering I become irritated when something wrong happens and always have negative ideas I have hydrophobia too please help",
        "input": "",
        "output": "hi I read your query and understand your concerns for further information consult a psychologist counsellor online"
    },
    {
        "instruction": "hello doctor I am currently on microgestin birth control and I have been instructed to take it constantly to have no periods about a year ago I was treated for chlamydia and never had a problem since then about a month ago I missed my pill for birth control while having the flu and a week back I have noticed white sticky discharge with no smell and very light spotting and I am wearing a pad because it is very wet and uncomfortable there is nothing abnormal other than the discharge am I ovulating or going through some sort of cycle please guide",
        "input": "",
        "output": "hi I understand your concern please get pap smear and update the report revert back with the pap smear report to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor my arms and legs have started itching very badly from last three to four days first I thought it is happening due to not applying moisturizer after swimming now I am applying all kinds of moisturizer and oils but no effect it is not dry but very itchy when I stretch my arms or legs it starts itching very badly what is the reason of this itching and what should I do please help",
        "input": "",
        "output": "hi from your descriptions it seems that you are suffering from scabies swimming pool induced if you can send some pictures it will be helpful for me in management part scabies is an intensely pruritic skin infestation caused by the mite the diagnosis of scabies can often be made clinically with a pruritic rash and characteristic linear burrows over limbs regarding treatment you can you use single below neck application all over body of permethrin cream during night leave it for 10 12 hours and then take a bath also take tablet ivermectin 12 my single dose wash your used clothes thoroughly and use fresh clothes after bath and get a review after one week revert back for review after a week to a dermatologist online"
    },
    {
        "instruction": "hi doctor my kid is 12 years she had grade medulloblastoma after brain tumor surgery she is behaving like a new born baby she is not walking or talking every minute she is screaming her neck is not balanced it is around three weeks now after surgery after physiotherapy slight change in her walk please advice",
        "input": "",
        "output": "hi for further information consult a neurologist online"
    },
    {
        "instruction": "hello doctor I am using new face product but it made the tiny pimples and bumps more visible am I experiencing purging phase",
        "input": "",
        "output": "hi I have read your concern revert back after five days to a dermatologist online"
    },
    {
        "instruction": "hi doctor I am a 28 year old male I have rashes over hands and legs they are not red rashes but more like insect bites I also have swelling especially on the feet my doctor has prescribed benadryl anti allergy tablet I am also experiencing shivering when body is feeling hot what am I looking at I am really worried please help",
        "input": "",
        "output": "hi contact dermatitis drug induced scabies viral exanthem fever with rash tablet evil pheniramine maleate twice daily emollients like facto calamine tablet paracetamol 650 my twice daily or during febrile illness and cold sponging avoid sun exposure and scratching revert back with detailed history and pictures to a general medicine physician online"
    },
    {
        "instruction": "hi doctor I am having something like acne they are superficial spots and a lot of them are mainly on my forehead jaw and chin area I am suffering with this problem for over a year now also I have clogged pores and blackheads I visited a doctor before and he said that he would not do anything and transferred me to a dermatologist I have no idea what to do anymore I am so upset about this I feel like I have tried almost everything please help",
        "input": "",
        "output": "hi I have seen the picture and read the query in detail may be hormonal imbalance and cos hormone profile and ultrasonography of abdomen to rule out cos acne vulgaris and rosacea revert back with the investigation reports to a dermatologist online"
    },
    {
        "instruction": "hi doctor I am always having stomach pain every sunday my stool is extremely messy but it happens only on sunday what is the reason I admit that I do not eat right but why is it always on the same day currently I am on anti anxiety medication please help",
        "input": "",
        "output": "hi I understood that you have constant mild stomach pain and your stool is messy on sundays revert back after 15 days to an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I am having persistent cough with phlegm for the last four months I also have fatigue I am currently taking cymbalta ability topamax baclofen lorazepam and trazodone please help",
        "input": "",
        "output": "hi I understand your concern for further information consult an ent otolaryngologist online"
    },
    {
        "instruction": "hello doctor I was exposed to mouse poop it was in my clothes drawers and on the floor the mouse was in my apartment I swept it up I was exposed to them for about three weeks it has been 27 days since I have been around them but today I am getting cough and scratchy throat does this sound like hantavirus",
        "input": "",
        "output": "hi for further doubts consult an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I have been suffering from this problem for a few years and every year it seems to be worsening than the previous one I am overweight and by working hard I have lost about 15 pounds I got yearly rash outbreaks on arms especially forearms I have diabetes and taking many medications but doctors say that none of my medicines are responsible for it happens mostly in the summer they are very itchy and do not go away in spite of using creams I took some pills that did not help either it leaves horrible scars even a dermatologist I saw did not seem to know what was wrong I am sure it is partially a heat rash but it has completely scarred up my arms I am attaching the list of medicines I am taking as well as the biopsy report please help",
        "input": "",
        "output": "hi it looks like polymorphic light eruptions may be allergic contact dermatitis you can use full sleeve cotton shirts to cover the photo exposed area you need absolute sun protection good quality broad spectrum physical sunscreen it is a chronic problem and it may occur off and on you can use mid potency topical steroids over the affected areas once daily for around one week and can continue hydroxyzine control your blood sugar go for photopatch test polymorphic light eruptions allergic contact dermatitis photoallergic reactions to drugs polymorphic light eruptions revert back after the investigations to a dermatologist online"
    },
    {
        "instruction": "hello doctor I have a few things and I am worried about that I feel it could be connected firstly I keep getting patches of blood spots on my body they are not of huge in size but still noticeable I am also getting frequent nose bleeds for no apparent reason I hardly ever got them before also severe night sweats I have lost lot of weight in a short span of time I am not exercising more than usual but always feel tired I am suffering with these symptoms for more than four to five months now please help",
        "input": "",
        "output": "hi leukemia lymphoma mycobacterial infections myelodysplastic syndrome chronic viral hepatitis and hiv human immunodeficiency virus infection little stock from basic laboratories abc complete blood count bump basic metabolic panel test blood cultures and chest ray it would depend upon the laboratory results and imaging for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor my mother is suffering from platelet disorder from the last one month she had nearly about 58 units of platelet transfusion but still her platelet count is not up to the mark what to do further",
        "input": "",
        "output": "hi based on your query my opinion is as follows revert back with the detailed history to a hematologist online"
    },
    {
        "instruction": "hi doctor I have some problem in my penis I have attached the photos for your reference it is round always remain dark purple and the tip remains red it is like this since many years sometimes I can feel some irritation kindly advice",
        "input": "",
        "output": "hi for further doubts consult a urologist online"
    },
    {
        "instruction": "hi doctor my mother is 62 years old she has purple like patches on her arms and legs as shown in the attached picture she said that she has it for over three to four years and these patches fade in a few days once they appear my mother also has diabetes and hypertension she is using some antibiotics for diabetes and hypertension she also has substernal goiter and her biopsy was negative I am attaching her blood and hormone results which are in the normal range liver function tests were also normal what are these fading purple like patches",
        "input": "",
        "output": "hi I have gone through the pictures and reports blood thinner agent minor trauma bleeding time and clotting time ecchymosis senile pura revert back after a week to a dermatologist online"
    },
    {
        "instruction": "hello doctor my husband has an open sore on his head it is the size of a softball with redness under it and it is causing a shocking pain into his ear it is swollen and has caused soreness in his neck and swollen adenoids it looks like it has mucus or pus which is trying to come out but nothing does he has been squeezing it like a pimple and soaking it with hot water and epsom salt previously he got bit by a spider twice and the wound had to be cut open and drained but it has never got like this before I can send pictures for your reference",
        "input": "",
        "output": "hello infected sebaceous cyst developing an abscess excision of the cyst and antibiotic treatment preferably reflex cefalexin bactrim comprises of sulfamethoxazole and trimethoprim or doxycycline for further information consult a internal medicine physician online"
    },
    {
        "instruction": "hello doctor I am a year old male two years back I had severe running nose and could not breathe through nose especially during the night then I was diagnosed with antrochoanal polyp in my right nose after taking medications I no longer felt cold and running nose however my right nostril always remains blocked so I decided not to go for fess and manage with blocked right nose however for the past three months I started feeling right ear blockage and sometimes feel liquid movement in my right ear when I move my head over last 15 days I feel ringing in my right ear so I got shocked and got my right nose fess surgery done however even after seven days of surgery I am not relieved of tinnitus although I can breathe now normally from both nostrils I can feel reduction in volume and my pure tone audiometry is normal please help",
        "input": "",
        "output": "hi the nasal blockage did not cause tinnitus and hence it is not relieved the fess surgery functional endoscopic sinus surgery you had was for nasal blockage and its consequences of auditory tube blockage and middle ear fluid retention now after surgery your nose is opened auditory tube and middle ear fluid must have settled down or will settle down and just a week after surgery you should not start calculating improvement coming to tinnitus there are various causes you need to be evaluated for it discuss with ent ear nose and throat surgeon on your next visit for further doubts consult an ent otolaryngologist online"
    },
    {
        "instruction": "hi doctor I have been away to abroad and developed skin rashes all over my stomach and legs there are red dots everywhere and it is very itchy I am worried it could be linked to hiv",
        "input": "",
        "output": "hello you have developed maculopapular erythematous lesions with itching which can occur in multiple conditions please inform whether the lesions are also in finger webs and genital area if there is intense itching one of the differential diagnosis is scabies have you undergone your hiv test anytime if no get it done from any accredited laboratory to know your status please revert with complete information"
    },
    {
        "instruction": "hello doctor we are looking for a second opinion on my friend mri scan of both the knee joints as he is experiencing excruciating pain just above the patella he has a sudden onset of severe pain on both the knee joints about two weeks ago previously he had a similar episode about two to three months ago and it subsided after resting and painkillers",
        "input": "",
        "output": "hi I viewed the right and left knee mri images left knee the mri left knee joint shows a complex tear in the posterior horn of the medial meniscus area and mild left knee joint effusion there is some fluid between the semimembranous and medial head of gastrocnemius muscles there is a small area of focal cartilage defect in the upper pole of the patella with mild edematous fat the anterior and posterior cruciate ligaments are normal the medial and lateral collateral ligaments are normal right knee the right knee joint shows mild increased signal intensity in the posterior horn of the medial meniscus area and minimal knee joint effusion there is minimal fluid in the back of the lower thigh and not significant there is a suspicious strain in the left anterior cruciate ligament interiorly but largely the attachments are normal the posterior cruciate ligament is normal there are subtle changes in the upper pole area of the right patella and mild edema there is mild edema around the bilateral distal quadriceps tendons but there is no obvious tear of the tendons"
    },
    {
        "instruction": "hello doctor I was born 14 weeks premature and was told that do not circumcise that young I believe I have a condition called aposthia but I need help in identifying what it is",
        "input": "",
        "output": "hello I have seen images sent by you aposthia is the absence of skin covering glans in the flaccid state there is definitely a skin covering your glans in erected state definitely glans skin gets pulled behind the coronal sulcus so I do not think you have any abnormalities"
    },
    {
        "instruction": "hello doctor I do not get my period for over a year after stopping birth control I have stopped the birth control pill last year and have not had a period yet I do eat a very healthy diet and do not do excessive sport my periods before being on birth control were regular and I do not have a history of cos why am I not getting a period I do not want to go back on the pill what can I do instead I have attached my lab reports",
        "input": "",
        "output": "hello I have gone through the reports and your hormonal profile is normal just that progesterone are way too low indicating that you are not ovulating and hence no menses sometimes amenorrhoea is seen after prolonged use of oral contraception however this can be given a restart by offering a withdrawal bleed with progesterone you can be prescribed progesterone only pills for five days and in the next three to five days and you shall get withdrawal bleed you can discuss it with your medical provider and opt for the same"
    },
    {
        "instruction": "hello doctor I was born with a structural birth defect where my left hand is completely deformed my left arm is normal from the wrist and above I would like to know if this defect is hereditary if I try to have a child what are the risk for me as a father passing any defects to my future children",
        "input": "",
        "output": "hello I can understand your concern it will be of great help if you can send me the picture of your deformity I will be happy to help you further"
    },
    {
        "instruction": "hello doctor I have a question with respect to doxypal do medicine and my question is whether the delayed release remains active when I would open a capsule to remove half of the pellets the capsules are 100 my and I would like to take 50 my but I need the delayed release to remain working because otherwise I get too many side effects with nausea the side effects are also the reason I would like to take 50 my two times a day instead of 100 my once a day I investigate and found that the delayed release mechanism can be in the capsule and if this is the case I cannot open it to remove half of the pellets because it will loose the delayed release mechanism but I read on the internet that the delayed release mechanism can also be in the pellets inside of the capsule if this is the case I could open it and remove half of the pellets and the delayed release mechanism would still be working I want to know is the delayed release mechanism of doxypal 100mg re contained in the pellets or is it due to the capsules",
        "input": "",
        "output": "hello the delayed release capsule contains the active drug doxycycline and few other excipients that slowly release the active drug from it so the active drug is mixed with the excipients and put into the capsule so if you divide the capsule into equal half it still works still it is delayed release and you can make 50 my dosage you also see that whether the infection in acne is controlled with 50 my dose if so you can follow it if not controlled then 100 my must be taken the benefit and side effects should be weighed to choose the balanced dosage"
    },
    {
        "instruction": "hello doctor eight months ago I had severe rev lasting for 10 weeks I am years old athletic fit and in perfect health before rev I took no prescriptions whatsoever I got rev from my friend infant at church my husband is a double boarded physician and recognized the rev very quickly I had acute wheezing and coughing I was on five prescriptions the usuals for 10 weeks I was off all medicines and back on the treadmill daily and also at the gym the one very noticeable thing that has remained and is very troubling is that every time I climb stairs in my home about 18 stairs to the second floor I am quite out of breath this does not happen on the treadmill but just on the stairs I am convinced this is damage from rev the two rays six months apart are showing scarring from the rev I was recently at a high altitude after many visits to that same location and I was seriously struck with altitude problems I was extremely short of breath and had to get a prescription inhaler which helped enormously when I returned to my place of low altitude my breathing greatly improved my questions are can I improve my lung scarring in any way should I get pulmonary studies if I am not wheezing will an inhaler help shortness of breath upon exertion this is a problem for my fitness program and my very busy personal life",
        "input": "",
        "output": "hi scarring is an irreversible process so it cannot be cured your breathlessness is due to less lung reserve because of scarring kindly share your ray chest image your lungs will not become normal but breathlessness problem will be corrected by medications and respiratory exercises pulmonary rehabilitation medications are simple bronchodilators like tablet doxophyllin 650 my od with inhaler combination of formeterol and budesonide respiratory exercises can be done in the form of pulmonary rehabilitation download edf form of pulmonary rehabilitation and do it slowly in increasing way I hope this helps rev respiratory syncytial virus hrct chest high resolution it scan bag arterial blood gas test treatment plan will be changed after investigation prevent infection and maintain hygiene follow up after one week"
    },
    {
        "instruction": "hello doctor I have a few problems with my body since last year I was under work pressure I could see my blood sugar gone up to 289 my do on post prandial up last month and reduced to 175 on up and 109 on fasting last week in the meantime for the past two weeks I suffer from fissure I am a case of vitiligo and epilepsy for 20 years and under medication with valproic acid 500 my reduced to 250 my for the last 10 months and clonazepam 5 my I have been noticing that my penis skin is shrinking for the last eight months and now narrowed down to my opening on the penis forehead skin for the last three months I am suffering from back muscle spasm after consulting my medicine I am taking a sit bath for fissure continuing valproic acid 500 my for epilepsy and back pain following a strict diet for blood sugar and no medication for vitiligo he suggests circumcision as the only option for penis skin problem I request your second opinion",
        "input": "",
        "output": "hello I understand your concerns I have checked all the attached reports thoroughly attachments removed to protect patient identity and here are my notes repeated high post prandial sugar above 200 means that you are diabetic and need to start therapy do you have polyuria frequent urination do you drink water more than usual repeated cholesterol level above 200 along with fatty liver grade means dyslipidemia that requires management stress egg shows some changes that could mean some cardiac ischemia do you feel any chest pain especially with efforts if yes could you describe it all other investigations are within normal limits advice healthy life style that includes daily 30 minutes walk a healthy diet with low sugar starch and oily foods metformin 500 my after meals plus glimepiride amaryl my before breakfast for diabetes rosuvastatin 10 my once per day for high cholesterol a retinal fundoscopy and urine analysis for microproteinuria are required continue other medications you have follow up after one week regarding the penis problem I agree with circumcision I hope this helps"
    },
    {
        "instruction": "hi doctor I am feeling dizziness and vomiting sensation for over one week rest everything is fine periods are normal and just had periods ten days back I just had my blood test done kindly advise the possible medication and preventive health care I am attaching my complete blood report",
        "input": "",
        "output": "hi based on your query and attached report my opinion is as follows most of the values are borderline normal early iron deficiency anemia manifestations through low mav and mchc are present however iron levels are normal and should get corrected within two months hemoglobin being the lower limit of normal it should not be the cause of the symptoms being experienced at present vomiting and dizziness sensation appears to be possibly local cause like gastritis or gastric reflux esophagitis proton pump inhibitors like pantoprazole with domperidone should be helpful in curbing vomiting irritation in the stomach or esophagus is known to cause dizziness I hope there is no tarry or black color stools if present it indicates bleeding in the stomach you need to reduce stress eat regularly and avoid spicy foods sleep should be regular and proper avoid lying down immediately after food at least for two hours also you need to concentrate on nutrition to improve borderline values take protein rich diet with green leafy vegetables two egg whites and vitamin rich fruits should help in improvement also maintain good hydration with at least five to six liters of water per day avoid coffee or tea if possible as it can cause gastritis and also reduce iron absorption for now pantoprazole with domperidone should be helpful along with lifestyle changes as indicated above I hope this helps"
    },
    {
        "instruction": "hello doctor my granddaughter is 17 months and one week old she was a term baby born out of a normal vaginal delivery she weighed keg during birth and was 8 keg when we were discharged from the hospital four days later she was exclusively breastfed for six months after which we introduced solid foods in addition to breast milk which is still continuing she is a very bad eater however we are managing to feed her protein rich food thrice daily using a lot of diversion tactics my questions are why her anterior fontanelle is still not closed still there is a little bit of space left she seems otherwise healthy and active and seems very intelligent in the way she grasps things through books remembering every single thing her weight also seems normal although she is not overweight or chubby is it normal for the fontanelle to still remain open a little bit I know it is supposed to close completely by 18 months but I am wondering if it will close in the remaining three weeks suppose it takes longer than 18 months to close is it fine please let me know",
        "input": "",
        "output": "hi from what you mentioned your kid seems completely normal you do not have to worry you should add supplemental calcium and vitamin drops also by 17 months she should be able to walk warning signs that you should watch for are persistent vomiting fits or delayed motor development just follow up and the fontanelle will close within a few weeks I hope this helps"
    },
    {
        "instruction": "hello doctor I have been having back knee and foot pain and numbness for some time so I am wondering if I should see professional help it started about a year or more ago and then it was merely the lower left side of my back it would go numb for a brief time after riding for about thirty or more minutes however as time has progressed the pain has gotten worse and mostly the pain is in my left knee I own apartment buildings and I love working on the properties but it is beginning to wear on my body being a 53 year old male yesterday was especially hard because I was on a ladder a lot and it makes my lower back and left knee hurt when I use a ladder and I went up and down three flights of steps numerous times moving supplies from one apartment to another and it took its toll therefore today I am experiencing pain in my left knee on the side of my knee and in the back last night I woke up with a lot of pain in my left knee and it was a burning sensation but my back did not hurt as it usually does I had a baker cyst many years ago on this same knee and my doctor advised me to take it easy for a few days and take anvil once I did as he recommended the pain went away and until recently I have had no problems with my knee one more thing most of the time when I feel a sharp pain going through the left part of my lower back it makes my foot numb if I sit or lie down and pull my leg up to my chest it gives me a lot of relief most of the time if I am feeling this sensation in my lower back and it starts to go down to my left leg pulling my leg up to my chest for a couple of minutes will usually make the pain go away completely most of my time is spent about ten hours a day at my desk working and while my favorite thing to do is work on my properties I have to sometimes hire people because of spending so much time at my desk at one time about ten years ago I used to lift weights free weights and workout on a cross trainer for two to two and a half hours a day from monday to friday although as I got more responsibility for my work I started cutting back on the exercising and eventually gave it up altogether so I do not do anything outside of working on my properties for exercise and I hope to start lifting weights again and doing cardio because my waist has gotten up to a 34 and I want to stop it from expanding more however I am afraid to start any exercise routine before I find out what is going on with my left side the pain I am referring to is strictly from my waist down the leg and to my foot I have no problems with my right side and if a doctor recommends surgery it is not going to happen because I grew up with a dad that had perthes and I have seen how he has suffered his entire life and how many times doctors have replaced hips telling him this one is the last one only for him to have to go back over and over until he is finally in a wheelchair sorry there is one more thing my primary doctor has retired and I have not been sick in over seven years so I have no primary doctor to give me a referral but I have to do something about this pain thanks for any advice or ideas you can give me because I always worry it might be cancer because my grandmother died of osteogenic sarcoma I am currently taking vyvanse sawpametto vitamin magnesium and multivitamin",
        "input": "",
        "output": "hello welcome to icliniiq com your symptoms back pain radiating in the knee and leg are suggestive of a bulging slipped intervertebral disc in the lumbar region which is causing irradiating radicular pain in the knee for this reason I would recommend consulting with a neurologist for a physical examination and a lumbar spine it computed tomography scan or mri magnetic resonance imaging study prolonged sitting position or weight lifting could be the cause of such clinical situation for this reason I would recommend having some rest avoiding prolonged standing up or sitting position and avoid weight lifting painkillers acetaminophen ibuprofen coupled with a muscle relaxant flexeril can help improve the pain local warm packs on the lower back and massage or physiotherapy can help improve your situation a nerve conduction study would help to determine the possible damage to your nerves you should discuss it with your doctor on the above tests I hope this helps bulging lumbar disc lumbar column it scan or mri scan nerve conduction study painkillers muscle relaxants and physiotherapy avoid weight lifting prolonged sitting or standing up position"
    },
    {
        "instruction": "hello doctor I think I have a counting disorder whenever I do certain work I do not know from where this feeling comes to me that I have to do that same thing several times until I get satisfied for example whenever I pick a book then I have to pick that book four or more times and sometimes 20 times another example is that whenever I wash my clothes then also I pull out the clothes from the bucket 20 times until I get satisfied is my case normal or serious please help",
        "input": "",
        "output": "hi I am sorry to hear about your problem let me try to explain your problem in detail what you are describing is called obsessive compulsive disorder ocd a person suffering ocd has repetitive thoughts that are beyond control for example in your case it is this feeling of doing the same thing several times these are obsessions the act you do to feel better and get rid of these thoughts are called compulsions coming to the management the first thing you need to do is start cognitive behavioral therapy in which the therapist will help you recognize his thoughts and teach you techniques to control them and not get involved in this behavior the second thing is medication in severe cases medications are required this can be checked after complete evaluation medication and cognitive behavioral therapy combined are the gold standard treatment of ocd I hope this helps"
    },
    {
        "instruction": "hello doctor I have unprotected vaginal and oral sex with a sex worker three weeks ago I do not know her status of hiv although she said she is clean exactly after seven days of my exposure I feel something wrong with my body as it is feeling uncomfortable I had oral thrush loss of appetite swollen lymph nodes in neck body aches needles like pain all over my body night sweat although no fever but I can feel the temperature is high it is 98 9 degrees for the next couple of days so I suspected that I got infected with hiv due to anxiety I took the hiv antibody test on the ith day of my exposure which I know is a bit early come out negative but then on the 10th day exactly after days 10 hours I took hiv ran tea test on stdcheck com which they said 95 accurate in 1 days after exposure I got the result yesterday as negative no hiv ran detected now still I am in confusion because I am 100 sure I got infected with hiv I do not know if these tests are conclusive or not I do not have guts to do another test please help and also some of my symptoms are gone but I discovered some additional like pain in kidneys lower abdomen chest pain joint pain and extreme fatigue for two to three days",
        "input": "",
        "output": "hi I have gone through the details and reports all the tests are negative is a good sign the chances of transmission of hiv by unprotected intercourse with an hiv positive person is too low if negative it is nil you can allay fears hiv ran per is negative and is a good sign it is almost conclusive the chances of tests coming positive later are nil but it is better to get tested for hiv and antibodies after three months to have conclusive results"
    },
    {
        "instruction": "hello doctor I have been experiencing a muscle spasm above my lip on the left side it is a rapid vibration that I can see when I look in the mirror and feel when I touch the affected area I do not experience any pain when the spasms are happening and I can still talk smile and otherwise move my face I first began noticing the issue last year the spasms seem to come and go for the past few days they have been occurring at night sometimes the spasm is still happening when I go to sleep but by the time I wake up the spasms have stopped last night I noticed the spasm started after a workout where my heart rate got up to 171 bum I have talked to a few doctors who have recommended magnesium and I have noticed that when I take 400 my per day dose the issue does not last as long that said the spasms are still happening I do not drink large amounts of caffeine never more than one cup a day so I do not think it is related to that a couple of weeks ago I noticed a similar spasm under my left eye but that only happened for a day and then disappeared completely last winter I noticed an eye spasm as well which lasted for a few weeks but then disappeared entirely my go did hba1c ash to free ok sedimentation rate magnesium basic metabolic panel and gor all results came back normal she provided me a referral for a neurologist and I am working on getting an appointment there are some long wait times so I am hoping to speak with a specialist in the meantime to get a little bit better of an understanding of what this might be",
        "input": "",
        "output": "hi I can understand the issue it is basically the facial muscle spasm that you have in the classical pattern it involves larger areas of the face and not smaller area or single muscle the cause for it can be mild compression more of irritation than compression over the nerve which runs into the facial muscles the site of compression can be near its origin secondary to pressure from a neighboring blood vessel the less common cause can be viral involvement of the nerve in the ear for that you should be investigated with the torch panel viral screening test depending on results we can plan further management a short therapeutic course of steroids may help if it persists for a long time then botox injection into the muscle to inactivate it will help"
    },
    {
        "instruction": "hi doctor I am a 19 year old female doing mobs everything is really good in my life but I certainly do not understand the chit chat going on in my mind all the time I do not feel going when I meet people I do not like noise parties and going out but this was not the case earlier I like dressing up and going out for shopping now I do not feel like doing these things I just like studying and following my normal routine I do not want to be like this please help I am very anxious about my face as I have acne scars so I am always very conscious about them I just take medication for it I often have severe headache attacks probably migraine especially when I go out with my friends or hear a very loud noise",
        "input": "",
        "output": "hello I am sorry to hear about your situation I can see that you are under a lot of stress what you are describing looks more like anxiety disorder it is possible that because you have been under a lot of stress for a long time mobs is a very tough field and even though you must be a good student it does take a toll on your mental health with chronic stress problems like severe headaches migraines social avoidance can occur I would suggest you to talk to a counselor and they will help you find out the negative thoughts which are causing this anxiety and this type of behavior and they will help you to cope up with them and be able to enjoy your life again either find a local counselor or you can opt for online counseling sessions with me via icliniq if these are severe you might require anti anxiety medications but as you have mentioned that you are able to function well I think they might not be required the counselor will evaluate you and take a detailed history and advise you accordingly I hope this helps"
    },
    {
        "instruction": "hello doctor I had a minor injury four weeks ago when my partner while on the bed accidentally hit my erected penis on the left side next to the frenulum under the head I had some minor pains here and there but I stopped all sexual activities I did notice a very sharp pain today after an erection only and the pain was at the same location of the injury as I wanted to feel if there is a lump I did feel something there at the same location I described above size of 2 millimeters please tell me if this will heal in a good way such as no scar tissue or bad way with scar tissue and peyearonie as my age is only 26 and I do not have any medical history or problems and the same for my family I do have varicoceles on my left nut sack grade I have attached a picture of the frenulum my questions are what will be the healing time and pain healing time what are the percentage of chances of developing or not developing scar tissue or peyearonie at this age will you recommend any medicines like pentoxifylline or anti inflammatory I am not taking anything now",
        "input": "",
        "output": "hello I have seen the pictures if the trauma was at the level of frenulum then you can go for frenuloplasty so that frenulum will be freed from glans and there should not be any problem further peyearonie disease generally develops after trauma to the shaft of penis there is no recommendation to start medication for this prophylactically take some pain killers and anti inflammatory medicines so that pain and inflammation will subside early it may take three to five days"
    },
    {
        "instruction": "hi doctor I am a 30 year old male and I have been on cipralex 20 my for my depression for more than a year now when I started cipralex 10 my I was fine however when my depression worsened I was given mirtazapine 30 my and my weight increased like hell I gained 15 keg in three months mostly around my belly and hip I consulted you and my medicine was changed from mirtazapine 30 my to topomax 100 my I lost 10 keg in three months with topomax and stopped it eventually nevertheless my weight has started increasing drastically around the belly and hips I feel bulky and the tummy is growing out it is so embarrassing as I am a lean guy and with a belly protruding out I am going low on confidence I cannot leave my depression tablets but I cannot ignore my increasing weight either could you please let me know what should I do to lose this excess weight and get back to shape I cannot walk as I have a slipped disc problem I cannot go to the gym either as it is not recommended by doctors if on leaving topomax I am going to gain weight again then it is only a temporary solution further in spite of taking cipralex 20 my at night I am extremely sleepy and feeling tired all day I fall asleep unconsciously even while driving and working on the computer I have disturbed sleep at nite and the weight gain is another trouble I still feel I am depressed and cipralex is not doing all it can I need your help to tackle my depression sleepiness tiredness and my increasing weight please help",
        "input": "",
        "output": "hello stopping topiramate is not the reason for weight gain in your case topiramate resulted in weight loss and the drug is also a good mood stabilizer drug this helps in stabilizing the mood and supplements the antidepressants so stopping topiramate probably result in worsening of depressive symptoms and thus altered food intake which consequently resulted in weight gain in my opinion you can start topirmate again and this will help in controlling the weight gain the drug will help in improving the depressive symptoms too so there is no harm in restarting the drug apart from this please change your dietary intake avoid any foods with refined sugars and high fat take high protein diets rich like meat and animal food avoid fried food totally lime juice in an empty stomach daily without sugar should be included in the diet please take at least a cup of green tea which will help to dissolve the belly fat this will help in making you fit again if you are feeling sleepy and tired then drugs like modafinil can be added to your prescription modafinil will help in improving alertness and will reduce your tiredness this will help in improving the depressive symptoms too so you can make these changes and you will definitely come out of depression"
    },
    {
        "instruction": "hi doctor I am 34 years old and I have facial droop in the lower half of the left side of my face it has been with me for years I would not call it a paralysis or bells palsy as I have full control of my forehead and eyebrows but the lower part when I talk it is noticeable that the lip from the left side is way lower and the nose as well seems lower from one side I was wondering what this could be all the searches online say stroke but I am young and never had any symptoms of stroke so what else could it be and what would you advise me to do",
        "input": "",
        "output": "hello I would like to know some details about your symptoms when first time you noticed facial drop in left lower half face did it happen suddenly or it happened slowly and gradually did you had any weakness in left arm hand left leg along with had you any change in voice that time have you ever undergone some tests for its evaluation have you any symptom in left ear hearing difficulty ear discharge hearing abnormal sound have you any other significant medical history apart from this facial droop at what time this facial droop is most noticeable at normal forward face look while smiling while speaking while eating while laughing have you any difficulty in swallowing revert with above mentioned information and also I suggest to make a short video of your face in normal smiling speaking laughing and upload here as attachment mri brain ent ear examination serum ace level viral markers hiv hbsag anti hav antibodies nav bilateral facial nerve"
    },
    {
        "instruction": "hello doctor I had unprotected intercourse two days after my period the first time we used the condom the second time without and did the withdrawal method I took the action about one and a half an hour later I do not know when I was ovulating and did not think it could be my fertile week I started bleeding five days later and it was light and pink then has gotten heavier and turned red and moderate enough to soak a panty liner I have taken hit twice and both showed negative is this implantation bleeding or withdrawal bleeding",
        "input": "",
        "output": "hello if it was your second day of your period and you take an emergency pill after intercourse that it is withdrawal bleeding and due to the tablet your period can be irregular this time and may take two to three cycles to get regularize and maybe the next cycle will be normal depends on your body own hormonal cycle if hit home pregnancy test is negative then no need to worry you are not pregnant and the second day of menses is counted as safe days of any cycle so you cannot be pregnant during that period because of no ovulation during menses drink more water and wait for your period and do not get much stress everything is fine and under control and if you get your period for three to four days and if you have intercourse two days after that also you had taken the precautions like condom withdrawal and at last emergency pill and it also comes in safe period so do not worry more chances that it is withdrawal bleeding and sometimes ovulation bleeding in both cases you do not have to worry because if it is ovulation bleeding then it is happening now and no need to worry about before I hope this helps"
    },
    {
        "instruction": "hi doctor I have a symptom of redness on my penis and with no pain and itchiness on it for the past one day can you please suggest me something I had unprotected sex due to condom break two weeks back with an unknown person for that I am taking tavin em and instgra medicine now for 28 days as prescribed by the doctor",
        "input": "",
        "output": "hello I could not get the contents of the medication prescribed to you could you send the same with details I would be able to comment on the issue secondly get a forth generation elisa test done for hiv and six weeks and repeat the test at three months from the date of exposure along with hbsag and vdrl tests lastly is there any swelling in the groin region or any foul smelling or milky discharge from the penile tip"
    },
    {
        "instruction": "hello doctor I have multiple questions recently I might have been exposed to mercury vapor in a hotel room I was sleeping in for around 10 hours the room was small and the type of mercury was unknown I remember the one type of chemical was clear liquid watery substance and the other once was more clay grey with dissolved in water I left the room around 10 hours later and did not touch anything but I might have breathed in the vapors in this small room I also washed away the crystals that has landed on the carpet all of these substances I have no clue about what was except when I asked I was told mercury 5 months later I got a pins and needles feeling in arms and feet with has lasted a month but no other symptoms until now I feel like I have some kind of internal vibration in my feet and my knees are shaking when I stand up like I am freezing or have done a hard workout from time to time I went to the doctor in my area and told him about what had happened and showed him pictures of the various substances and I took a urine test and a blood test and this was made around 130 days after possible initial exposure and the test came back at normal levels but can it be that I had a toxic exposure and the mercury has already settled in organs and therefore do not show in blood or urine I am not sure about the half life times in these metals or can I settle down and accept the test results are final and that mercury levels do indeed declear that I have not had an exposure of toxic levels and that my symptoms might be of other cause if not number one is the cause then a few months before that I got an acute pins and needles feeling in hands and feet paresthesia which continued until today and it increased over the one month before it stabilized a little it went from pins and burning sensations different parts of the hands and pins feeling in the legs a few times I got shooting pain from a finger and up my arm but very rarely which has not returned after alcohol consumption one weekend it went from stabilized to worse and I also noticed my knees shakes a little when I stand still but not when I am walking the feeling can be compared to when you are freezing or after a hard workout on your feet it started with a sensation under my feet like I was standing on a vibrating phone and then moved up to my calves which felt like they were bubbling inside and now my knees which shake when I stand but the vibration under the feet is gone my hands also one week felt like they was shocked and they turned red and stiff the kind of feel like I put my hands down in hot water and then removed them red spots on my hands underneath the skin appeared and the closest thing I found resembling it was pura when I looked up causes online my hands are much better now but it still feels like some areas are sunburnt and my fingertips are peeling but I think that is because of winter and dry weather the red spots remains I have taken multiple blood test for vitamins deficiency and other things which turned out normal besides vitamin which was a little to low and neurological test like standing on one foot with eyes closed and finger pointing and sensation test of sharp cold hot which all was normal I am taking a mri next month to check for is and other conditions sorry for making this text so unclear and poorly written but I have no idea of what this might be so doctor do you have any ideas about what this can be",
        "input": "",
        "output": "hello I read carefully your question and would explain that your symptoms are not typical of mercury intoxication anyway I would recommend performing nerve conduction to in order to examine your nerves and a brain mri in order to examine your brain as the neurological exam is normal I do not think it the brain mri will result abnormal a cervical spine mri may be necessary too in order to exclude possible spinal cord compression in this region due to a bulging disc"
    },
    {
        "instruction": "hello doctor I am a male 51 years old height feet inches balanitis problem an unpleasant smell redness around the glans inflammation soreness itchiness or irritation of the glans",
        "input": "",
        "output": "hello if the symptoms have been present since a week did you take any medicines or cream for those did you start any antibiotic how is your personal hygiene can you take a picture of the affected area with retracted foreskin and send to me are you circumcised you need a course of ciprofloxacin tinidazole or ofloxacin ornidazole with some anti inflammatory medicines local application creams and lukewarm water rinses of the penis twice daily you may refrain from sexual activities till you get better please provide us more details so that we can help you better are you a diabetic is there any medical condition for which you take medicines regularly"
    },
    {
        "instruction": "hello doctor due to an accident I had unsafe sex I went to the pharmacy to get a epic or morning after pill however they said they were not being sold they prescribed althea cypriterone acetate ethinyl estradiol my 35mcg tablet from trust and said to take per day for the next 21 days however if I understand correctly is this a normal contraceptive I read some things about the yuzpe method how would this work with the contraception described and I already took one pill an hour ago what should I do I do not want to get pregnant especially since this is the 13th day since my menstruation I am getting worried",
        "input": "",
        "output": "hi you should get emergency pills if they are selling normal contraceptive pills anyway in emergency pills the dose of hormones are more so you can take tablets two times a day for dose can also works same as emergency pills but at the same time you should understand that emergency pills are not 100 safe and there is up to 30 chance of failure but have only option after unprotected sex when you stop taking tablets than there can be withdrawal bleeding within days and your cycle can be irregular for or periods if you are not pregnant best way to confirm whether pills worked or not is to wait for 15 days atleast and do urine pregnancy test on kit and see if turns to be positive than you are pregnant and if negative than pills worked well do drink more water chance of failure is because pills worked by stopping ovulation but if ovulation already happened than it will not work so have to wait and watch after taking pills"
    },
    {
        "instruction": "hello doctor my dad has been on dialysis for years and has only recently been getting pounding headaches hour into dialysis he says they are pretty painful and it only occurs in his forehead and just to the right of the forehead it does not make him sensitive to light sound or any vision changes he was in the hospital a month ago for a left leg amputation and while in the rehab unit he had a seizure that we witnessed and it took him days to wake up from it the mri showed posterior reversible encepholopothy caused by very high blood pressure luckily he is almost 100 neurologically and memory regained I bring that up because only after the seizure and pers mri result is when the headaches started on dialysis he never had headaches before on dialysis prior to the seizure headache the doctors did not put him on any new medications after this and tylenol helps the headache greatly but it still bothers him and I do not like him taking tylenol almost every day he is on metoprolol 50mg extended release ex per day usually in the morning and his blood pressure is fairly controlled usually in the 130 70 however sometimes it gets high during dialysis I have an appointment with a neurologist in january as that was the first available any answers",
        "input": "",
        "output": "hi having headache one hour into dialysis suggest either it could be related to transient increase in blood pressure or changes in electrolytes during this interval is his be monitored during dialysis and where do they stand one way to get around is by slowing the dialysis speed which will help in slower change in electrolytes and body fluid thus preventing fluctuation in be see if has be fluctuation during dialysis and his nephrologist should be able to help you metaprolol is also a migraine prophylactic medicine thus it should help with headaches there are other medications also but will discuss once we are sure its not related to be taking tynelol daily is not good it can cause rebound headache the day you dont take it limit its use to day or max 3 week and or max 10 month how is his mri brain now he had pres but has it completely resolved not just clinically but also radiologically is he on any anti seizure medication post seizure how was his eg is it normalized"
    },
    {
        "instruction": "hello doctor I get frustrated even for very small things I take too much stress before starting some work and thinking that it will not work and also my temper is becoming too high whenever I get angry I cannot control myself please help",
        "input": "",
        "output": "hello I can understand it must be really hard for you to be in this situation what you are describing looks like an anxiety disorder there is nervousness in starting anything new because the mind has negative thoughts which overwhelm you and make you feel it might not work out and then the mind gets fixated on this pattern of negativity and you just cannot stop the overthinking which gives you stress and long term stress produces aggression what you need is to start psychotherapy via counseling psychotherapy cognitive behavioral therapy the therapist helps you find out where these thoughts are coming from and help you in changing these thoughts in and controlling them so that inside it is not produced in the first place second part is anger management where you learn some techniques to control your temper and also via therapy you will be able to find out the source of your anger I would need to talk to you in detail to be able to find out why you are having these thoughts after I take a detailed psychiatry history and evaluation you can find a local therapist or we can start therapy sessions online via video consultation if the problem is severe which we will be able to find out after evaluation we can decide whether or not you need medications I hope this helps"
    },
    {
        "instruction": "hi doctor about a month ago I had protected sex with a woman and unprotected oral sex with her as well then two days after that I had unprotected oral sex and fingered a different woman five days later I got a low fever of about degrees the following day I got chills night sweats joint pain and a bad fever about 102 degrees that broke that same night the next day I got a rash that covered my entire stomach chest arms and legs I went to the hospital and they told me they thought it was a viral rash the rash went away in about 24 hours I got an hiv ran and fourth generation test done ten days after the last incident and then I got another hiv ran and fourth generation test done again at 17 days from the last incident both came back negative I tested the woman that I had protected sex with using oraquick and she came back negative but I did not test the woman that I had unprotected oral sex with could this still be hiv I have never gotten a rash like that before in my life what are the chances that this could be hiv based on the two negative ran tests",
        "input": "",
        "output": "hi see a rash does not confirm the diagnosis of hiv a rash is a very common finding in viral infection and you could have got the viral infection from your partners only luckily this time the virus was not hiv the fourth generation per tests are highly sensitive and hence you do not require any further evaluation I would hereby conclude based on the details that you do not have hiv I would also recommend you to avoid unprotected sexual exposures as well as to indulge with more than one partner every time you cannot be lucky like this time I hope this helps"
    },
    {
        "instruction": "hello doctor after a neck injury five years ago I get a headache every morning because of this I cannot sleep for more than five hours headache wakes me osteopath helps not more than one or two days please tell me what could it be experts whom I consulted do not know exactly what is the source of headache and treatment does not help",
        "input": "",
        "output": "hi I feel really sorry for this painful situation you have to face after careful review of your detailed case I want to add that musculoskeletal insult is the main cause behind this pain and lifestyle modification is its main solution I will elaborate all of this in a very simple way so that you may come out of this pain and can sleep comfortably thanks for uploading all the supporting documents and I have thoroughly reviewed all of them fortunately your cervical spine and the surrounding structures bear no visible signs of major trauma that may have warranted immediate interventions by an orthopedist and neurosurgeons your cervical spine spinal ligaments and the muscles got extreme stress due to excess weight on them the spinal in cervical region is not made for weight bearing due to stress or strain caused by weight there had been a stretch and or compression causing a change in anatomical structures out there you need to change the sleeping posture and position your head so that there is a least possible strain on the cervical spine keep track of everything you are doing to modify sleep habits adopt the one that best suits you buy a mattress that is angle adjustable there are smart mattresses available in the market that makes sleeping a bit comfortable for the cervical spine patients and the general healthy population too at the same time they are temperature controlled too so if you need to provide heat to the body they help doing it with the click of a button first try sleeping without pillows underneath your head try sleeping straight supine position your whole body facing upwards then try sleeping on the right side then on the left side of the body it is only you who can tell which ever suits you best then you may try keeping a soft pillow under the head if it hurts again you need to try the angle adjustable mattress and try different angles every night keep track if raising the angle soothes you or decreasing the angle is a better option for you meanwhile physical therapy is my advice for you please consult a physical therapist for proper evaluation and management accordingly it will assist you in getting out of this pain very fast you may use heat wraps around the neck to soothe the deep neck structures it alleviates the pain and improves circulation keep a balanced and healthy diet and avoid stressing your spine out by spending a lot of time in front of to laptop smartphone etc these are bad for your cervical spine as they all make the neck stiff at a certain angle if required"
    },
    {
        "instruction": "hello doctor I am a 31 year old male I have been diagnosed with crohn disease before years and I have been on humira 40 my every two weeks I had unprotected sex with two different girls a year ago I have had done three hiv tests and one hiv comb elecsys at 10 months from the last possible exposure after a few days of the first possible exposure I had flu after a few weeks of the last possible exposure I started to have some skin condition sebopsoriasis around my mouth and under my armpit I am also losing some muscle weight all my hiv and elecsys test results came back negative my questions are my tests reliable does crohn disease affect hiv test results being on humira will it affect hiv tests does humira cause a false negative also I know that sebopsoriasis is associated with hiv is there any other tests I have to do I am under huge stress I need your help",
        "input": "",
        "output": "hello going by your description it seems highly unlikely that you have contracted hiv infection the elisa enzyme linked immuno0sorbent assay detects antibodies to hiv antigens whereas the comb test detects both antibodies and antigen since you have done these tests much after the exposure I believe there is a little chance that you could be harboring hiv infection the rashes you have developed are more likely to be a part of crohn disease syndrome progression humira although may suppress the production of antibodies it does not affect the detection of hiv antigen crohn disease has various non intestinal manifestations that could crop up anytime I believe the new rashes are a part of crohn disease syndrome complex"
    },
    {
        "instruction": "hi doctor for about two years I have constant problems with my hand skin there are spots on my hand where my skin gets extremely dry to the point where it peels sometimes even cracks and bleeds it regenerates quite quickly even deeper wounds heal in three to five days I consulted several dermatologists here is what I was able to confirm so far it is not a fungal or bacterial infection it may be a blood vessel problem smoking tobacco seems to make symptoms more severe more peeling and cracking the problem occurs only in few places on my hands mainly index fingers and right thumb please see attached photo cream with urea content seems to give the best effects barrier creams did not help diet does not seem to have a noticeable impact on my condition silica q10 and collagen supplementation did not help sometimes when my condition gets a little better and there is no dried peeled of skin on my hands small red dots are visible just under the skin one of the doctors mentioned they look like burst blood vessels they are visible in one of the attached photos please suggest",
        "input": "",
        "output": "hi from the pictures it is looking like hyperkeratotic eczema over palms it is a kind of dermatitis and not related with any blood vessels it can aggravate during winter seasons treatment includes judicious use of moisturizer and along with mild potent steroid in case of any erythema apply moisture cream on the whole palms twice to thrice daily apply halovate habbetasol propionate cream apply only on the erythematous or fissure areas if any daily night for one month"
    },
    {
        "instruction": "hello doctor I am a 25 year old female my mi is I am a non smoker with no ongoing conditions like diabetes I am not breastfeeding and have never been pregnant I developed mastitis very suddenly about three weeks ago by that evening I was in a and with a lump the size of an egg in one breast I was prescribed codamol and 500 my flucloxacillin a day after the first course which was 10 days I saw the doctor again as the lump had reduced to the size of a large grape but was still painful I often had fevers and I felt unwell doctor put me on another seven day course of flucloxacillin and booked a breast cancer screening I just finished my second course and I am still in pain with lump still the size of a small grape and still feel ill and feel like I am getting worse again breast is back to being red and swollen my only option to see a medical professional before my breast screening is to wait for several hours at an urgent care clinic after work should I try and get more antibiotics if so should I insist on getting a different kind also please be honest I know there is a chance it could be ibn but as a young healthy childless woman is it actually likely that I should prepare for bad news or not",
        "input": "",
        "output": "hello let me assure you that there are no cancers which come suddenly and settles with antibiotics one breast cancer which progresses over a few period is inflammatory carcinoma of the breast but it does not come in days and settle with antibiotics you have a breast abscess that settled with antibiotics and some times a part of it gets walled with fibrous tissue were antibiotics do not reach it is called antibioma I would suggest you take linezolid 600 my twice a day as there are chances of resistance to flucloxacillin"
    },
    {
        "instruction": "hello doctor for someone suffering from anxiety ocd intrusive thoughts this person was on my of cipralex for quite a few years then about months began a change of medicines about 7 in this time finally this person was given 25 my fluvoxamine first days everything was fine then anxiety attacks started as of last night dose went up to 50 my result is the person is feeling calmer however they feel very disconnected and cannot do anything cannot concentrate cannot think or analyse things I forgot to say that when they started fuvloxamine they stopped the drops of cipralex we do not know what to do tonight whether to stop this fluvoxamine and go back to cipralex or whether to keep going and maybe these side effects will stop if so how long aproximately we are very confused and cannot get hold of the psychiatrist that prescribed this please if some doctor there is an expert on these meds and there side effects that could help us a lot of these medicines and maybe all give strange and serious side effects that are not listed by the pharma companies",
        "input": "",
        "output": "hello I can understand your concern as you have mentioned that the patient is feeling better with this medication I would suggest you to continue 50 my fluvoxamine for atleast another to days and see if they feel okay fluvoxamine has a sedative effect and that is why the patient is feeling all these symptoms of not being able to concentrate or do anything etc I would suggest you to take the medicine before sleeping 50 my is actually a low dose so you should not be worried continue same dose for a few days and see if body adjusts sometimes if anxiety is under control with fluvoxamine some medicine can be added to prevent the side effects secondly you have not mentioned details of the patients age etc I would suggest you that if possible patient should start therapy as well medications and therapy when combined give faster results take care of yourself"
    },
    {
        "instruction": "hello doctor I always had a lower left brow causing the lid to appear more droopy than the right side however the skin on the left side has recently become thinner in the past year I would say causing less of my lid to appear and I feel a sensation now on that eye like something is sitting on my lid I am only 18 so I feel like I should not be having any issues with my eyes yet however I did have hashimoto and thyearoid cancer and got the thyearoid removed and all of my thyearoid levels have been stable since then however the skin on my left lid never went back to normal also I feel like I might have a little bit of ptosis in both of my eyes but it does not obstruct my vision when I look back at old pictures when I was a baby up until the age of 12 my eyelids appear much more open so is it normal for eyelids to droop as we age I am currently on synthroid",
        "input": "",
        "output": "hi you have explained your history nicely you have not mentioned about photos both are recently taken or different in the photos attached first one which is showing your lower lids down seems to be taken in a slightly down gaze that is a normal thing when we look down lower lid goes down with the eye while in the second picture light reflex is central in both eyes and lower lids are in normal position your both upper lids are in a normal position normally upper lids cover 2 my cornea superiorly I would not say these as droopy lids while in cases of thyearoid disease skin changes occur like skin thinning and dryness so these sensations could be due to hypersensitive skin for dryness of the skin around the eye or dry eyes you can use artificial tears it seems you are thinking too much about it no significant changes are seen in your eyes or lids after seeing these photos just relax nothing to worry about and you are absolutely fine if these are older photos you can send the latest ones and do not take photos yourself selfies because it is not taken in primary gaze looking straight I hope this helps"
    },
    {
        "instruction": "hi doctor after shaving my face six days ago I saw a big red bump on the right side of my nose above the mustache at first I thought it might be a pimple last week I felt something wrong on my throat and visited a doctor said lymph node inflammation and prescribed me penicillin doctor did not ask me anything about that red bump in my mustache area at that time I have been suffering from mild fever as well after my lymph inflammation right now I am worried again since the red bump on my mustache becomes large and from two or three openings drains watery liquid when I tried to squeeze it is really painful and irritates a lot I am worried about hav since it is near my mouth I am having mild fever and lymph infection I am not in sexual contact for the last seven years what is your suggestion what might cause this problem",
        "input": "",
        "output": "hello welcome to icliniq com two broad differential diagnoses are folliculitis or hav herpes simplex virus infection most likely I would want you to know that we all are exposed to hav and it could spread without sexual contact it stays in the ganglion nerve endings and pops up when your immunity goes down it is also known as fever blister my feeling is that since you were about to come down with the sore throat which seems like strep throat you had a reactivation of the hav and got these lesions as you feel better they will subside you may use acyclovir if you want but usually we treat the underlying cause and you are receiving the antibiotics for sore throat please do not squeeze it you can use any anti inflammatory agent for pain and fever like acetaminophen you can also try topical steroids like desonide I hope this helps"
    },
    {
        "instruction": "hi doctor I had unprotected intercourse but no ejaculation was done I have a fear of being exposed to hiv what necessary steps should be taken earliest",
        "input": "",
        "output": "hi unprotected sexual intercourse is a risk factor for studs sexually transmitted disease including hiv however the risk is very low 03 there is no reason to panic at the moment if possible please get the partner tested first if she is a known case of hiv then it would be advisable to consult the nearest dermatologist for post exposure prophylaxis pep in case if this is not possible it would be advisable to weigh the risk benefit ratio for pep in your case high risk exposures such as homosexuality contact with blood during intercourse sex with a commercial sex worker may warrant a need for pep hiv by elisa at and months after exposure hbsag hepatitis virus antigen anti hav hepatitis virus vdrl veneral disease research laboratory if high risk exposure then consider pep"
    },
    {
        "instruction": "hello doctor I am 34 years old and diabetic my penis foreskin is not pulled back it is swelled and tears on the tip of foreskin are not healing and are very painful penile glans has white discharge",
        "input": "",
        "output": "hello the diagnosis seems to be something called candidal balanitis or fungal infection of a part of the penis are you married and if so does your spouse experience any discomfort or white discharge this information will be helpful to plan the treatment for both of you simultaneously so that we can eliminate the chances of ping pong infection and recurrence"
    },
    {
        "instruction": "hello doctor I am a 32 year old male one month back I checked my be it was 120 90 mhg and today again I checked it was 140 90 mhg both were done in doctor clinic I did blood hemogram and cholesterol tests everything is normal two years back I did us of full abdomen it was normal in my family my mom is having a high be due to which she is a cod patient and on dialysis that is why I am a bit concerned whether this be figure indicates that should I start the be medication I have changed my food habits kindly suggest whether I should start the medication so that it does not affect me in my later life as my mom",
        "input": "",
        "output": "hi blood pressure is different at the same time by different machine or the instrument used previously now regarding the value of blood pressure it is not mandatory that the value is fixed it is different for different people of the same age but it depends on weight height food habits regular work out etc take a low salt diet and avoid pickles family history did not count but you can prevent it by changing the lifestyle I regularity in food habits exercise etc avoid consuming alcohol stop smoking if you do avoid or decrease the non vegetarian diet as it may increase your cholesterol levels and leads to atherosclerosis heart disease kidney failure etc in nutshell all organs may be affected do not start blood pressure tablets as 120 90 and 140 90 mhg does not make any big difference the upper value is called systolic pressure which up to 150 160 is no worry and the lower value is called diastolic pressure in which 90 is the lower limit of high blood pressure I hope this helps"
    },
    {
        "instruction": "hello doctor every year during summer and winter I face problems with continuous cough irrespective of the type of food I consume I am having an allergy to both dust and smoke I got a lot of gas generation and irregular motion again irrespective of the food I take I am a 51 year old male with a family history of asthma I am not under any medication",
        "input": "",
        "output": "hi such type of cough is called allergic cough which occurs in a particular time gas formation is due to irregular bowel habits advice hot saline gargle before breakfast lunch and dinner stop fried things it enhances the problem are you hypertensive check out your blood pressure also treatment tablet azithromycin 500 my once every day for three to six days nexpro red 200 my one before breakfast and dinner esmoprezole plus sustained released domperidon for three days one before breakfast for five days or whenever required for irregular bowel habits take one bowl of salad in the morning and evening add curd in lunch take buttermilk in the afternoon it is very good for health take husk isabgol three teaspoons full at night with milk it is a herbal remedy good for the intestine also it forms a slimy layer and protects the mucosa of the intestine you can take it in the morning also cough syearup again produces irregular bowel habit amrodil plus one teaspoon full at night is sufficient I hope this helps"
    },
    {
        "instruction": "hello doctor this is a request to analyze my mri report I would expect detailed guidance with what kind of treatment we have to proceed what is the prescription for the condition and how long to use the prescribed medication please reply with the prescription as soon as possible please let me know the cautions and care we have to take",
        "input": "",
        "output": "hi I can understand your concern I have gone through the report you have attached you need urgent immobilization of knee by cast or slab along with painkiller and anti inflammatory drugs the next step is an arthroscopic correction surgery for all anterior cruciate ligament repair I hope this helps"
    },
    {
        "instruction": "hi doctor last week I and my partner had a romance I did everything expect for the penetration of my penis into her vagina at last I was masturbating outside with my hands when the sperm came out it spills out over her legs and also near to her vagina so we got scared that if sperm spill over was only outside her vagina incase if the spillage over her vagina was only outside means will it cause pregnancy if it causes pregnancy means what are all the symptoms immediately or with in a week if in case pregnancy means how to stop now please tell us if there is any solution for our safer side to keep us without fear when the period will stop incase of pregnancy please help",
        "input": "",
        "output": "hi pregnancy can happen rarely in the scenario you described there will not be any immediate symptoms of pregnancy the earliest symptom is missing the next expected period you cannot do anything to stop the pregnancy right now if she misses her period she can confirm pregnancy at home by doing a urine pregnancy test if pregnancy is confirmed you can consult a gynecologist for abortion through medicines in case she becomes pregnant she will miss her next expected period remember one thing pregnancy is very rare most unlikely in the scenario you described so there is no need to fear just wait for her next period and things will become clear by then"
    },
    {
        "instruction": "hello doctor I have recently got married and moved abroad when I was in india last time we got the medical tests done and diagnosed with diabetes hba1c of 10 and fasting blood sugar as 235 doctor gave me cetapin or 100 my and asked me to use it for three months and get the medical test done I have got the tests done and now the hba1c is 4 and fbi is 124 my do with total cholesterol 173 103 is bad cholesterol 47 is good cholesterol and rest is vldl I have low vitamin of 18 doctor asked me to continue cetapin or 100 my for another three months and gave me medication for cholesterol lipitor 10 my every night and vitamin do 50 units once a week for three months I have attached the medical reports please look into it and let me know your feedback",
        "input": "",
        "output": "hi I went through your reports and your hba1c glycated hemoglobin has improved really well I am happy about that as advised by the doctor continue taking cetapin the same dose but as of lipitor is concerned I think only my is sufficient in addition you have to reduce nonvegetarian food avoid alcohol butter cheese and potatoes eat more vegetables hope you are exercising every day continue vitamin supplement weekly once for three months repeat hba1c and lipid profile after three months and revert back with reports"
    },
    {
        "instruction": "hello doctor I wanted to know about my wife eye condition two doctors have said that she has keratoconus and another doctor says no it is not that",
        "input": "",
        "output": "hello it is very difficult to comment without examining you kindly send me your topography reports so that I may study them and guide you"
    },
    {
        "instruction": "hi doctor my son is thalassemia major subject his age is months male boy his weight is he is suffering from headache and fever every now and then some times heart beet is fast his liver and spleen are enlarged he has been blood transfusion in one time in last week now he is taking folic acid 5mg flovita a tablet 2 per a day kindly suggest if he needs to take any other precaution can you please provide a diet chart for my child which can help him to grow up his body",
        "input": "",
        "output": "hi he is suffering from thalassemia major here there is destruction of the blood cells due to which haemoglobin becomes low frequently hence he will need blood transfusions regularly he is prone for infections because of low haemoglobin which can also cause fast heartbeat and cardiolmegaly increase in size of heart and tiredness hence please consult a good pediatric hematologist who will make a monthly follow up plan for your baby and monitor his growth haemoglobin levels and start appropriate treatment based on his health condition and reports continue breast feeding the baby you can give the normal weaning food rest will discussed by the hematologist in detail his low weight gain is due to the low he mainly and not related to food if his haemoglobin is monitored and maintained at near normal levels his growth will improve"
    },
    {
        "instruction": "hello doctor I have a fracture of the bone joint on my right hand ring finger which was caused by a road traffic accident were I was hit by a van pulling out of a side road I was due surgery to repair the injury last month the surgeon decided not to operate as under the live ray he was able to manipulate the bone back into the joint therefore asked physio to splint the finger the issue is each time I take the splint of to clean the bone is back as fracture and am not able to bend my ring finger I am due to see my surgeon as the splitting is not working any advice of what I need to ask my surgeon to do is most appreciated",
        "input": "",
        "output": "hi well there is intro articular fracture of base of middle phalanx of your ring finger if I would be the surgeon then I would have gone for operative treatment because intro articular fractures need perfect reduction if he has decided to treat it non operatively then he could have applied plaster or strapping which is not removable like your current splint"
    },
    {
        "instruction": "hello doctor continuous dizziness losing balance could not sit or stand for more than few minutes age 65 height 2 weight 20 lb",
        "input": "",
        "output": "hi your mri spine reports osteophytes at multiple spinal levels along with bilateral neural foraminal stenosis at ca c7 level these cervical changes though can cause dizziness but persistent imbalance is not usually seen with these spondylotic changes if you would have presented to me as an outpatient I would have asked you the following questions to answer your query well do you have history of double vision do you have history of hearing loss or tinnitus please follow up with answers to these queries meanwhile please start taking tablet tryptomer 10 my once a day at bedtime tablet pregalin 75 my twice a day tablet calinept once a day please take medicines under a physician guidance only"
    },
    {
        "instruction": "hello doctor is kissing babies really deadly I am sure you have seen the story in the news today about the newborn baby who is in critical condition after contracting meningitis from someone kissing her according to her mother I am working on a follow up story on whether parents really do need to shield their babies from kisses contact with other people specific questions do new parents really need to worry about someone making their baby very sick by kissing it how common are occurrences like the ones in the news today what should parents allow not allow in terms of people having contact with newborn babies",
        "input": "",
        "output": "hi I do not recommend kissing a new born baby firstly a newborn baby immune system is not fully developed and is prone for infections secondly contact with the baby can transmit many types of bacteria and viruses which can cause various infections hence hand washing before touching the baby handling only by mother and a couple of caretakers is ideal when a baby is kissed there can be transmission of various bacteria germs which are normally present in the mouth of people these generally do not cause any infection in healthy people who have a strong immune system but these can cause infection in people who have low immunity and newborn baby is one among them kissing cannot cause meningitis per se but can transmit few bacteria which can first cause a mild respiratory infection which can spread to brain especially in low immunity people like newborns kissing can transmit viral infection like herpes simplex and infectious mononucleosis hence it is better to avoid kissing the baby especially by friends and relatives etc even parents should avoid if possible"
    },
    {
        "instruction": "hello doctor I have a big scar in my right thigh that has led to a contracture with little flexure on my knew joint for over ten years I have recently underwent a corrective plasty release but with only little gains in flexure the doctor said the contracture had develop a fibrosis that needs to be removed is there any non surgical method of releasing fibrotic contracture",
        "input": "",
        "output": "hi from what I can see in the pictures is that you have got a massive tissue loss over your thigh and that too over such a long period that it has gone for severe contracture only the plasty will definitely not give you enough results as your doctor has suggested you will have to go for complete removal of the scar and fibrotic tissue with reconstruction by a large free flap before that few investigations will be required which will give the idea about how much post op benefit you will be gaining non surgical methods are there for removing the fibrosis but definitely not for such a massive one ray of the knee and hip mri of thigh region vascular doppler of donor vessel for a free flap scar and fibrosis excision with reconstruction by free flap"
    },
    {
        "instruction": "hello doctor I took a banana shake and started feeling imbalance so I came back home because of restlessness imbalance and palpitations I vomited that night so the next day I went to the hospital there intensive care doctor said it is due to high acidity at that time my be was 150 90 mhg and pulse 10 bum that imbalance subsided in some time and then it occurred once in a week if there is a little bit of anxious environment it will come back since then I had been to cardiologist my psychologist and ent all of them brought it down to anxiety I had done all blood tests ray and mri of neck there was ca budge in mri and mild scoliosis in ray rest all tests were normal my symptoms are imbalance during sitting and walking feeling best in moving vehicle heavy head like a tight band at the back of head restlessness and have started physiotherapy with some relief physio is saying nerve compression due to spondylitis so he is giving ultrasound neck traction and neck exercise and said I do have bad posture too what is it exactly",
        "input": "",
        "output": "hi I have gone through all your records symptoms like imbalance while sitting and walking with head heaviness restlessness and palpitations with stress precipitating them indicate a non organic or what we call as a functional problem I nothing wrong with hardware a little software issue nothing to worry at all I have my reservations for associating vomiting with your functional problems which I feel may be due to gastritis you do not have any issues with your neck please avoid traction to the neck even if you are feeling better with physiotherapy since there is no evidence of any root compression in mri magnetic resonance imaging I feel what you can start is amitriptyline 10 my every night for a month do regular yoga and mindfulness meditation these things will definitely help you do not be preoccupied with your illness you are absolutely fine if you have underlying stressors you can contact me"
    },
    {
        "instruction": "hello doctor we are four sisters and I am the first daughter to my parents I have taken treatment for depression before years I am now happy and my studies are going on my sister is studying 10th grade and she was also a black belt in karate now she is mentally disturbed and thinking about her self not concentrating on her studies and she wants to stay alone she is writing on papers on the wall or otherwise writing on notes like why I was born I want to die she is having this problem for the past six months please suggest solution to solve this problem",
        "input": "",
        "output": "hello I read your query and understand your concerns first of all I feel your sister is suffering from the same depression for which you got treated in the past the possibility is very high as there was a similar problem in genetically related elder sister I mean you as the presence of family members with depression increases the risk of depression among other family members I must acknowledge that you do not need to feel anything wrong as the genes are at fault and not the family depression as a diagnosis is based on the fact that your sister have poor academic performance at a time when we expect better performance board exams in addition the social isolation and preference to stay alone indicate depression as people with depression lose interest in almost all activities especially the pleasurable ones the presence of expressed wish to die is another thing which indicates the possibility of severe depression in my opinion it is urgent to seek help from a psychiatrist you may argue that I am a psychiatrist and I must handle the case but the presence of suicidal ideas points toward need of urgent and personalized care and online help is not sufficient I hope this helps"
    },
    {
        "instruction": "hello doctor a few months before I felt burn and pain in the chest area when I swallow anything like my own saliva it lasted more than a week and again I felt normal again yesterday I started to feel this pain and I started to think about that and felt stress tonight when I swallow anything I feel this chest pain and burn and when I do not swallow also I feel pain in the chest area is it serious and should I worry about that when I searched on the internet it says big diseases like esophageal cancer the symptoms say difficulty in swallowing coughing and things and now I feel like I am feeling all those symptoms please help",
        "input": "",
        "output": "hello the symptoms you have been experiencing such as difficulty in swallowing and burning pain warrant a more extensive study with barium studies in which you swallow a material composed of barium and then you will be radiographed the esophageal structural pathologies are going to be demonstrated by this way such as strictures and endoscopy to have a more clear view of esophagus and stomach gastroesophageal reflux which is the backflow of acid into the esophagus is the most common reason and it can be treated easily with medications gastritis or pyloric infection needs to be treated with specific medications ubt urea breath test is required to rule out pyloric infection the results of the aforementioned test are required to make a definite diagnosis however esophageal cancers are extremely unlikely given the duration of your symptoms and your age I can assure you in your age most common etiologies are esophageal spasm and strictures former can be treated with calcium channel blockers and antidepressants and in case of strictures endoscopic dilation can be done to relieve the pressure"
    },
    {
        "instruction": "hello doctor I broke my nose in kindergarten I am 26 right now and just now realized how my facial features are not symmetrical how much does a broken nose affect that as you can tell my right side of my face is more laid back and natural looking even my mustache above my lip and my left side looks more tight and my mustache and lip does not match the right side what causes this",
        "input": "",
        "output": "hi definitely there is a whole lot of asymmetry as you suggested because of the old broken nose I can also see that the base of the nose is a bit too broad and gives a feeling of oddly joined fractured segments this can be confirmed by few rays further correction if this is as well simple we call it osteotomy and splitting that will give you more symmetrical looking sleeper nasal dorsum it better if you can get yourself examined by a board certified plastic surgeon"
    },
    {
        "instruction": "hello doctor after sex with my partner I am feeling pain in my penis and my tes are also too small I am feeling weak after sex",
        "input": "",
        "output": "hi I read your query and understand your concerns first of all I like to inform you that your question have a lack of details and this will limit my response to generic one rather than specific applicable to your problem the pain in penis after sex is indicative of infection if it occurs up to 24 hours or more if the pain was immediately after sex most probably it was due to vigorous sex in there former condition you need to get blood investigations and urine examinations such as abc complete blood count urine microscope urine culture and sensitivity if the later condition applies to you a simple rest for a few days will resolve the condition on most occasions regarding smaller tes I will suggest semen analysis this will reveal the amount of sperm produced and thus the measure is tests capacity weakness after sex is non specific and indicates your poor health the abc test advised above will assist us in this I will request you to eat healthily and do regular exercise I hope this helps"
    },
    {
        "instruction": "hello doctor I have had a clear wart looking things pop up on my genitals for a few years now never many I just burn them off and all is fine however a few months ago I had three darker color things popped up and I burned one off but it did not heal fully it actually got bigger and redder and more painful I have attached a picture can you tell me what I am dealing with here please",
        "input": "",
        "output": "hi I have seen the picture this does not seem to be herpes genitals in case of herpes you would have got vehicles that would burst to leave erythematous erosion these can be verruca plan variety of wart the second one looks inflamed use antibacterial cream for it between I hope to burn them of means getting them treated medically"
    },
    {
        "instruction": "hello doctor I have had an sad for 30 years but it occurs only on the surfaces for every four or five years and only under much stress I was able to photograph it this time but still cannot see a doctor for a couple of days I am afraid it will vanish again before I see a doctor the bumps are in clusters of three on my shaft it lasts for two or three days and then goes away",
        "input": "",
        "output": "hi I have seen the photo attachment removed to protect patient identity it is herpes genitals is it associated with itching or burning sensation does your partner suffer from a similar problem how many episodes per year if you have recurrent episodes you should consider oral antiviral medication standard treatment for herpes genitals is tablet acyclovir 400 my three times a day for seven days after meal rantac 150 my before meal twice a day fusidic acid cream twice a day can be applied partner treatment is a must avoid sexual contact in case of recurrent episodes patient is given suppressive therapy for more than seven days with a low dose you said you have sad for 30 years means have you done sad profile before if not you should get it done in herpes genitals vehicles appear on the genital area commonly on the glans or shaft of the penis which burst even without touching leaving small clean looking ulcers which usually heal within seven days it is associated sometimes with itching or burning sensation"
    },
    {
        "instruction": "hi doctor I had some vocal fatigue for a while and I have been resting my voice for pretty much one month now I was not so sure if I should start speaking again or not I am a bit afraid if it is going to affect my singing voice either way the first time I consult an ent they said I had hemorrhagic patches on my anterior one third of both of the vocal cords I have been drinking a lot of water and also I took some proton pump inhibitors I also have a phonatory gap but I do not think that is the problem here really anyway I was just wondering how much time do you think I still have to keep resting",
        "input": "",
        "output": "hello I assume that these videos are one month prior to today condition I see some amount of inter arytenoid pachydermia suggestive of acid reflux and associated changes in the posterior part of vocal apparatus and anterior phonatory gap although I cannot see the anterior one third of the vocal cords that clearly I understand that your ent has found that those portions had some hemorrhages he was right in advising you voice rest and proton pump inhibitors ideally a week of absolute voice rest is sufficient followed by voice restriction vocal hygiene antiallergic treatment nasal sprays based on nasal symptoms increased hydration etc now considering you have taken a month of voice rest I think it is sufficient but do you have any symptoms whatsoever now any nasal symptoms or allergic symptoms any history of substance abuse do you suffer from diabetes or hypertension in my practice in addition to antireflux pi tablets antiallergics antihistaminics like fexofenadine allegra deslor etc hydration voice rest dietary and lifestyle changes I add some voice therapy probably you should explore some vocal hygiene tips from a speech language pathologist or voice therapist"
    },
    {
        "instruction": "hello doctor I have some pain due to injury last week I was at a construction site and marine plywood that is used for construction fell and hit me on the back of my head my head is fine but my upper back is still in pain and chest also I did not fall down when I was hit but the impact pushed my upper body down and forward I think beyond normal that is why I am getting back and chest pain I did not go to the hospital because I do not feel the need I am sure they will just tell me to give time and take pain killer can I get your advice is it possible I fractured my spine what should I do I am just taking ibuprofen pain is not very bad I am still doing things normally and I can move I am just wondering why I am still in pain after one week can this be a fracture please advise",
        "input": "",
        "output": "hello it seems that you have suffered whiplash injuries this is common following high energy impacts on the upper body from the mechanism you described it seems unlikely to sustain a fracture however it is very difficult to be certain without clinical examination and rays how is your pain is it tender at any particular spot is the tenderness is on the midline of your spine or on the sides pain directly in the midline with a particular spot of tenderness is something I would recommend that you get an ray the fact that you are otherwise moving and carrying on with life normally is reassuring however unfortunately whiplash injuries can take many weeks to settle with regard to the chest pain it is possible that the injury might have caused a crack in your ribs rays are not very good at showing this the treatment in any case is rest and painkillers I hope this helps"
    },
    {
        "instruction": "hello doctor I try to help a mentally limited woman of 36 with as complaint from which the egg is not clear I have a photo of her egg it seems inferior wall ischemia or nstemi I try to get her examined but difficult to explain to her please can you help in reading the egg",
        "input": "",
        "output": "hi I have gone through the attachment yes definitely there are ischemic changes in the inferior wall as well as lateral wall suggestive of ischemia if possible do give her an antiplatelet agent like aspirin and clopidogrel after consulting the local physician better still take her to a cardiologist"
    },
    {
        "instruction": "hello doctor I am having knee pain how will I manage it",
        "input": "",
        "output": "hi your knee pain could be due to many reasons but common ones are chondromalacia pain due to knee instability inflammation due to an underlying pathology or just degenerative joint disease etc what was the cause of onset of pain in your knees and what has been the total duration of your symptoms apart from pain do you also have any associated swelling skin redness or any other local inflammation like skin warmth etc as well what management and investigations have been done until now by you for the existing problem if there is no history of any injury and no inflammation or infection like swelling skin redness or local warmth on touching then I will like to advise you for conservative management initially in form of intensive physical therapy with a focus on strengthening of quadriceps and stretching of other groups of muscles gentle anti inflammatory medications like etoshine or paracetamol for five to seven days usually helps in such cases take according to your body suitability adequate calcium and vitamin supplementation as per requirement ice packs at home three to four times a day and see how it goes for around two weeks time if your condition does not improve then we will have to get certain investigations done"
    },
    {
        "instruction": "hi doctor I am 29 years old I never had intercourse before I was dating and my partner did oral sex and fingering for a few minutes I am not too sure if he had semen on his hand or his hands were clean I am really worried if this will lead to pregnancy I am feeling stomach cramps on and off after that please advise",
        "input": "",
        "output": "hi welcome to icliniq com please tell me when was your last period pattern and cycle length so that I can tell you about the chances of getting pregnant if you had the act before a week it is too early to detect pregnancy please share the period details for further guidance"
    },
    {
        "instruction": "hello doctor I have a abdominal pain in my left side it is not acute and continuous but when I sit or stand for a long the pain arises my doctor prescribed banocide and ultracet tablets",
        "input": "",
        "output": "hi there could be many reasons for the problems you are stating so to know exactly what is the cause of pain many more questions need to be asked I would like to know exactly where on the left side does the pain occurs is it below the ribs or lower than that do you have any change in taste or acidity does the pain also go to the back what is the color of your urine any other problems like loose motion or vomit do you have a fever these questions will help me come near to the diagnosis and then with relevant tests we could come to a confirmed diagnosis as far as the medication that are prescribed to you I would like to say that both of them are strong pain killer which are given for problems like kidney stones but they will not cure the problem so the diagnosis is a must to find out what is the problem with you in order to give you the correct drugs"
    },
    {
        "instruction": "hi doctor I have got a skin problem in both armpits due to scratching the skin was torn the images are attached please help",
        "input": "",
        "output": "hi I have seen your query and concern with your descriptions and given pictures it seems initially you have tina corporis of this area due to the application of steroid containing creams like quadriderm or salim lotion or foderm now you developed eczematization this is my assumption since you have not sent detailed treatment history or it may be irritant contact dermatitis due to duo now I can make severe eczematization so I would advise you not to apply any such thing if you have applied in the past start applying mometasone plus sertaconazole twice daily over the affected area for seven days then stop mometasone and continue sertaconazole also take terbinafine 250 my once daily for 21 days and cetirizine once daily for five days get review after five days with detailed history"
    },
    {
        "instruction": "hi doctor I am suffering from neck pain for over three weeks now I got an mri done two days back but must wait for my results for a couple of weeks I have the images of the mri and would like to know is there is any disc herniation or anything else wrong with my cervical spine would you be able to have a look at it and let me know if everything is fine I am in a great deal of pain and just want to know what is wrong with my neck",
        "input": "",
        "output": "hi I received your neck mri images and saw it now there is a loss of cervical lordosis straightening of your cervical spine there is squaring of the vertebral bodies signal changes in the bodies suggestive of marrow edema more at levels ca c5 ca and c7 the discs are hyperintense on both to and to suggestive of calcification early syndesmophyte formation at c4 c5 levels the height of the disc spaces are maintained there is no disc herniation there is no cord or root compression well this was the scientific description of the set of images you have sent me the message for you is stated below the good news is that there is no disc herniation or budge and pressure on the cord but there are changes suggestive of the inflammatory changes in the spine at multiple levels and that is the reason for your pain in the neck regarding inflammation my first impression would be an autoimmune disorder called ankylosing spondylitis we need to do several lab tests to catch the diagnosis the most important being ha b27 assay the others would include the ear erythrocyte sedimentation rate cop reactive protein ra factor rheumatoid factor and anti cop anti cyclic citrullinated peptide antibodies the results of these tests would find the cause of the inflammation regarding treatment the primary or first line treatment of all the inflammatory disorder is common nsaids like ibuprofen thrice daily after food along with this you should take pantoprazole 40 my one tablet before 20 minutes of your breakfast if ibuprofen causes uncontrollable heartburn you can go for other options in said group going through the tests is required to establish the cause of inflammation in case the nsaids does not work further treatment depends on the cause also the ear and cop levels help in monitoring the response to the treatment with nsaids I hope this helps"
    },
    {
        "instruction": "hello doctor I would like to know the substitute for melacare cream as I got the look after using the cream and want to stop it",
        "input": "",
        "output": "hi why was it prescribed to you wat was the complaint how long did you apply because it also contains steroid and should not be used for long time you should use sunscreen daily safer option like kojiglo cream can be used"
    },
    {
        "instruction": "hello doctor I and my partner are sexually active although we take precautions using two condoms at a time there is always a sense of fear when it comes to her each time she gets her period it is delayed by two weeks or 10 days at least and less discharge in terms of flow last time she had a normal flow days according to her but had a little abdominal pain with watering mouth and a bit of headache may I know the cause for why her periods get delayed and a reduced discharge because it creates an impression as if it is of implantation bleeding and leading to pregnancy request your understanding of how things work as it creates daily confusion and stress also does she require to seek a personal doctor inspection she is 25 years old",
        "input": "",
        "output": "hi no there is no need for inspection you can go for pregnancy tests with home testing kits this change in periods duration and flow is normal for her as she is active sexually and there are emotional and hormonal changes that cause all of this if there are no flow excess flow missing periods unbearable and sustained pain in her abdomen back and thighs then there is a need for a gynecologist visit for checkup"
    },
    {
        "instruction": "hello doctor I am a married woman with two kids and a regular cycle my first day of last period was on the ith of last month on 26th I had intercourse and took mensovit plus on 30th and est and yet to get periods please advise I have not done any family planning post my second delivery but we are having our intercourse safely this time I am a little worried as I have no plan for a kid now",
        "input": "",
        "output": "hello this seems you have sex on the 19th day of your cycle this could turn you pregnant and as such why do not you opt for a pregnancy testing now mensovit plus is a hormonal nonspecific medicine but not protective of pregnancy so do a test first and let me know the result"
    },
    {
        "instruction": "hello doctor I am a year old male I played soccer throughout my teens competitively five years ago I injured the muscle in my thigh what I presume was a tear of which I sat out from sports for a week or two however was rushed back into playing by my mother who thought I was faking the injury I injured the muscle again and these proceeded to happen again once more leading me to quit sports and focus on going to studies the following year currently now whenever I stretch my thigh muscle by pulling my leg up behind me I get a slight uncomfortable feel in my thigh muscle which I know is not normal however it is not painful enough to tell me to stop doing it furthermore I have been in the gym and jogging where my muscle seems to be fine but when I decide to sprint there is a 50 percent chance that I will get into discomfort again however it does not feel like a tear but it will become numb for a few days and finally if I go to kick a ball it is almost certain that the same result from sprinting will happen I have recently started to stretch the muscle to try and see if I can regain its strength to allow me to do these few things again without worrying about hurting my muscles again I am not sure what other things I can do to help this such as different types of stretches etc",
        "input": "",
        "output": "hello I read your concern in my opinion you had a tear of your quadriceps muscle which has not healed properly and got reinjured again within less time so there is a possibility that a scar formed on the tear area of the muscle leading to stiffness and numbness is due to any neural stiffness around the scar area possibly there will be nerve entrapment do not worry all you have to do is get a deep friction massage to relieve the tension in the muscle slowly release the scar by massaging the scar frequently gently stretch the muscle and hold it keep icing that area frequently before attempting any running or any strenuous activity I advise you to properly activate and then strengthen that muscle progressively increase the load on the muscle I hope this helps"
    },
    {
        "instruction": "hello doctor I hit my head twice this week and wondering if I should see a doctor I am a 29 year old female the first hit was four days ago on the top right of my head when standing up underneath something metal it was a pretty hard hit it hurt on and off for a day just the spot itself on my scalp I did not have a headache or nausea or any other symptoms today I leaned forward quickly and bashed the front top of my head onto a wooden dresser it hurt pretty badly and I felt my teeth chatter I do not have a headache now other than the spot itself hurting I am not nauseous nor do I have any other symptoms of concussion I have read that if you hit your head twice two concussions within days you should go to a doctor but I am not even sure these are concussions I am not sure when a simple bump actually is a concussion or really how to tell do you have any advice",
        "input": "",
        "output": "hi I have carefully and thoroughly reviewed all the details related to your case and feel sorry for the health issues you have there is no major harm to the brain when hitting like this even twice in quick succession your concerns are notable but that worrisome situation is when someone gets an impact harder enough to cause some signs of real concussion like nausea vomiting getting unconscious severe headache vertigo etc you did not have that large impact in both cases and there is no need to go for immediate medical care you need to handle it at home take ibuprofen for pain and apply local painkiller and anesthetic ointment on the scalp if needed these are available over the counter at any pharmacy apply heat to the site of impact and take care of yourself remain vigilant on your moves and be safe"
    },
    {
        "instruction": "hello doctor I have been using fluvoxin 100 my oxetol 450 my and quetiapine 100 my for depression and ocd for five years my problem is I am not regular to work as I do not feel to go to work I feel like this only in the morning I want to be in the bed I do not feel it is because only of sleepiness I do not understand the reason as well I have lost 12 jobs in the last five years all because of the irregularity please find the reason for my problem I am extremely upset with my behavior as my family depends only on my salary I am facing extreme financial problems because of frequent job loss please help",
        "input": "",
        "output": "hi it seems that your depressive symptoms are bothering you it may be helpful to increase the dose of fluvoxin fluvoxamine and reduce the dose of quetiapine so discuss with your psychiatrist for increasing the doses of antidepressant fluvoxin do regular exercise or go for a morning walk at least five times a week"
    },
    {
        "instruction": "hi doctor my wife is 26 weeks pregnant and she is suffering from cold and cough for the past two days also she is having a chronic nose block from her 12th week and using nasal spray for relief she is finding it very hard to sleep for the past two days because of continuous cough her cough is without phlegm please suggest some safe medicines she is taking calcium and iron tablets along with eltroxin 50 mug for thyearoid",
        "input": "",
        "output": "hi any infection is not good for pregnant women please confirm if your wife has any fever meanwhile you can take the following measures to help her feel comfortable dabur honitus cough syearup two teaspoons thrice a day honitus ginger cough lozenges once in two hours give ginger slices soaked in honey or raw to suppress the cough also please provide the following information any fever any sputum while coughing if yes what is the color any breathing difficulties any lower backache spotting or leaking of fluid I would suggest visiting an ent specialist for examination as well"
    },
    {
        "instruction": "hi doctor I am looking for a specialist in pulmonology my wife has been diagnosed with pulmonary fibrosis she is having a small rim of pneumothoraces bilaterally with subcutaneous disease and mediastinal emphysema I am attaching here her medical test reports for review by a specialist who can suggest a treatment to manage this condition",
        "input": "",
        "output": "hello I have gone through all it scan reports and images it looks like this is a long standing problem and it is progressing as well but unfortunately there is no mention of the chief complaints of the patient and no previous treatment details are available before we plan any treatment it is very important to review previous medicines and see if there was an improvement or not as per it scan it looks like to be sip nonspecific interstitial pneumonia a chronic type of interstitial lung disease also it is complicating as leakage of air surrounding the lungs and heart it is very important to see what is the oxygenation status of the patient and other comorbidities the treatment of sip mainly consists of steroids as per the weight if oxygen saturation is not maintained above 92 on room air oxygen supplementation either by cylinder concentrator or ni non invasive ventilation must be considered so it is advisable to see a specialist pulmonologist near to you and take medicines and other required treatment under his observation as it has to be reviewed frequently according to the condition of the patient if the patient is suffering from any other comorbid autoimmune disease it should be treated simultaneously then only the lung pathology will be under control I hope I have elaborated the treatment plan in detail for you autoimmune old interstitial lung disease idiopathic pulmonary fibrosis sip nonspecific interstitial pneumonia steroids like tablet medrol methylprednisolone as per the weight of the patient supportive treatment as required oxygen supplementation"
    },
    {
        "instruction": "hello doctor I am 24 years old since last few days I have observed thick jelly like clear whitish mucus coming out from my vagina it is very thick and dry it is not like the regular stretchy moist discharge there is no irritation or pain I am not sexually active there is no odor also since last five months I am having scanty bleeding my period that would normally last five days now lasts only for three days I will visit a gynecologist in person in some days but I just wanted to know whether this is of anything serious otherwise I am very healthy thank you",
        "input": "",
        "output": "hi revert back after the test to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor my father had chest pain three months back but he took it lightly in the last two months the pain has increased now I took him to a doctor after all the tests and angiography he suggested to do bypass surgery as we are not much aware of these types of diseases in family we are looking for a second opinion I request you to kindly look at the report and suggest your opinion",
        "input": "",
        "output": "hi for further doubts consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I had unprotected sex two months back and developed streptococcal infection within a day I took amoxicillin to get rid of it within five days developed yeast infection and got treatment for that now I have reactive arthritis I got two painless red bumps on the back of my hand and I do not know whether it is related to reactive arthritis my urine sample was negative for chlamydia but doctor found gram positive staphylococcus and said it was normal he suggested loxonin which is a said is staphylococcus infection dangerous I had abc and got the result as monocytes and cop were elevated in a gap of two weeks time repeated abc again and everything was normal now the urine test came out as gram positive I am suffering from multiple joint inflammation lightheaded fatigue upper respiratory difficulties papeles conjunctivitis and gram positive staphylococcus what is the solution",
        "input": "",
        "output": "hi for further information consult a rheumatologist online"
    },
    {
        "instruction": "hi doctor first let me clarify that I have been to a doctor for this problem already but the clinic is closed right now and I will not be able to get the diagnosis for a couple of days but waiting without knowing the cause is troubling me so I am asking for my peace of mind and also to have a second opinion I lifted some heavy boxes of floor tiles a little over a week ago since then I got a swelling to my left side between the hip and ribs and to my abdominal area my doctor noted that those areas felt hard and said it might be fluid buildup I am done with my rays now but do not know the results of it the swelling has not gone up or down since then there is no pain but sometimes there is a pressure as if I am wearing a belt too tight the swelling is most obvious when I stand when lying down or wearing pants it looks almost normal bodily functions have been normal I do not have any diarrhea unusual stool vomiting and so on what do you think it could be thank you for your time",
        "input": "",
        "output": "hello abdominal muscle sprain or muscle strain or inflammation less likely but ventral hernia is a possibility cold compressions ibuprofen 600 my three times a day with food available over the counter in 200 my pills avoid excessive exertion that requires the use of abdominal muscles for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I have a friend suffering from identity confusion she resorts to create several characters to identify what she is feeling each character has its one likes and dislikes and people it trusts she usually has a smooth change in between characters but this time the change is not going smoothly I read what did is but I found the symptoms too extreme in describing her case she does not have a memory problem in remembering what each character did I have tried to advise her to seek professional help but due to personal reasons she cannot seek this help I wanted to ask if you can give me a clearer image of her case and how I can help her through the change and make it smoother she has been living through her characters for a long time and does not know who she is now this is one of the main reasons of her confusion and frustration she is disgusted by herself and feels this as not normal please help",
        "input": "",
        "output": "hello for further doubts consult a psychiatrist online"
    },
    {
        "instruction": "hello doctor I am getting itching in the area where I wear my undergarments I tried many medicines for fungal infection but it does not go away it has been there for more than a year it keeps recurring currently I am applying miconazole cream and clotrimazole powder please help",
        "input": "",
        "output": "hi with your given description it looks like resistant tina cruris infections or may be erythrasma skin condition affecting the folds in the body you have not mentioned the duration of individual drugs you have taken itraconazole is a good drug for this but you have to take 100 my daily for around 28 days along with this you can try sertaconazole cream with fusidic acid cream to cover erythrasma twice daily for minimum of three months follow certain general measures such as may be not taken full duration of the course of medicines for fungal infection blood sugar skin scraping for oh potassium hydroxide tina cruris erythrasma candidal dermatitis recalcitrant tina cruris revert back after the tests to a dermatologist online"
    },
    {
        "instruction": "hi doctor I am facing problem whenever there is a season change I tend to lose my appetite and I cannot eat much if I try to eat then I feel like vomiting my weakness also increases during that time why",
        "input": "",
        "output": "hello for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am a 42 years old male I had low mood with anxiety problem around two years back I was on desvenlafaxine 50 my er tablet prescribed by go I took it for around eight months and felt better then I consulted my psychiatrist and told that I have only anxiety so he prescribed clonazepam my and alprazolam 5 my in the morning and nitrazepam 10 my and clonazepam my in the night and stopped desvenlafaxine 50 my er tablet I slowly tapered from first month itself to finally in around one year I was on 25 my clonazepam in the morning and 5 my nitrazepam in the night which I felt has same effect as I started later I tried to come out of it without any medication but I was feeling anxious actually I felt better with desvenlafaxine 50 my er tablet compared to other anti anxiety medicines so I asked my psychiatrist and he said start taking desvenlafaxine 50 my er tablet but I do not have the same effect as I felt earlier now it is almost seven weeks I am taking 5 my nitrazepam in the night and occasionally clonazepam 5 my or alprazolam 25 my or 50 my when I feel more anxious so I want to be only on desvenlafaxine 50 my er tablet as earlier should I wait for some more time or should I increase dose to 75 my or 100 my I really appreciate your help by the way I feel more anxious only at traffic signal or sometimes waiting in line at grocery store or sometime anticipatory fear in going far from my home thank you very much for your help",
        "input": "",
        "output": "hi I can understand your concern desvenlafaxine is a good antidepressant and anti anxiety drug the drug should be continued for long time to see its full effects drugs like benzodiazepine clonazepam alprazolam or nitrazepam can help to control anxiety symptoms immediately but these drugs are not the definite treatment of anxiety high risk of tolerance and increased abuse potential are the main reasons that these drugs should not be taken regularly for more than four weeks it is good that you have started taking desvenlafaxine again and the drug will help you to come out of the symptoms currently you are on 50 my dose and in my opinion the dose should be increased to 100 my per day to see more effects and to get better control of symptoms so you can increase the dose of the drug without worries keep other drugs like clonazepam and alprazolam for use on sos basis only as and when necessary you continue nitrazepam for some days and then gradually reduce the dose and stop the drug completely wait for at least four more weeks to see the effect for further information consult a psychiatrist online"
    },
    {
        "instruction": "hello doctor I had ringworm problem for the past three to four months I used absorb clotrimazole powder and betnovate go cream it did not stop but increased spreading to other areas then I went to a doctor and he diagnosed it as tina incognito he prescribed terbinafine 250 levocetirizine dihydrochloride daily at night after dinner upcan 150 twice a week in the evening ketoconazole cream and veto plus soap after two weeks there was very less improvement and he added itraconazole twice a day along with same cream and soap it has been a week and improvement is very slow and at times it itches very much in between two days I missed itraconazole during the morning can it cause itching",
        "input": "",
        "output": "hi if you are having ringworm infection then you are going on right track you have applied betnovate cream betamethasone which is a topical steroid it usually suppresses or hides your lesion that is why it gets converted into tina incognito fungal infection masked due to application of a topical steroid now you are using two oral antifungal simultaneously one terbinafine 250 my which usually requires three weeks and itraconazole 100 my once daily for 28 days or twice daily for at least two weeks use certain general measures for fastest recovery like use of topical steroids betnovate skin scraping for oh potassium hydroxide follow up till lesions completely regress to a dermatologist online"
    },
    {
        "instruction": "hello doctor I am a 23 year old female I am bulimic for the past nine years and also suffering from anxiety and depression for the past five years I like to drink alcohol a lot I recently had a checkup and I have attached my test reports for your reference I am just taking vitamin supplements I have looked up all of these online my doctor wants me to come back in and get an ultrasound of my liver I need to know my possible diagnosis please guide",
        "input": "",
        "output": "hi alcohol induced hepatitis viral hepatitis versus fatty liver disease nash nonalcoholic steatohepatitis hepatitis serological panel hepatitis virus antibody hav ab fibrosure non invasive test to check liver status ultrasound of abdomen hiv test avoid sharing razors with family and friends unless the viral hepatitis has been ruled out please taper down your alcohol dose and try to quit do not abruptly discontinue it otherwise you can go into withdrawal safe sex is encouraged revert back after the tests to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am weeks pregnant now I had slight fever and muscle aches recently I am scared about listeria while pregnant could you please tell me the symptoms of listeria also if it is listeria how long will it take to affect the baby I need some advice about listeria please",
        "input": "",
        "output": "hi for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hello doctor recently I had acute pancreatitis which resulted in gallbladder surgery two weeks post operation I have noticed tiny black dots appearing on my body now it has spread some are raised and some are flat should I be concerned what are they I have attached the picture of my stomach area currently I am taking ondansetron hydrocodone singular and dulera",
        "input": "",
        "output": "hello revert back with the asked details to a dermatologist online"
    },
    {
        "instruction": "hello doctor my skin hurts and itches during the workout and also it gets hurt when I am out in the sun when my body temperature is high my skin starts to hurt and itch after my body cools and heart rate gets stable the itching and hurt stops especially in my face chest and back but I do not feel it in my legs I have acne on my face chest and back I had acne like two years ago but I did not have these problems with my skin nowadays especially this year in spring this problem appeared I should point that I had been consumed doxycycline and trichopol but I have already stopped consuming them I have been using acne cleanser and I stopped consuming it also as my problem is not solved I have stopped consuming these things a month ago what do you think about it what is that how to cure that I cannot go out for it because these symptoms start when I am out in sun what do I need to do how to treat it",
        "input": "",
        "output": "hi you can use certain general measures to reduce the above two conditions for further doubts consult a dermatologist online"
    },
    {
        "instruction": "hi doctor a couple of months ago I took out my lower wisdom tooth there were complications and my inferior alveolar nerve was compressed during the extraction I dealt with lip and chin numbness for over a month and I still have swelling below my chin in the jaw and neck area it looks like a double chin and I did not have it before the extraction I was wondering if it was fluid buildup is there any way to get rid of it because it is not going away by itself I had taken antibiotics but the swelling did not reduce please help",
        "input": "",
        "output": "hello revert back after the test scans to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am a 38 year old woman and have been losing my hair for about six years all tests came back negative my go prescribed a shampoo as she thought I had dandruff but I have never had dandruff I am taking fexofenadine for urticaria and naproxen for costochondritis also I have a irena coil due to very heavy periods I do have thyearoid diabetes and vitamin issue any help would be great thank you",
        "input": "",
        "output": "hello with your descriptions it seems that you are suffering from female pattern hair loss if you can send picture of your scalp it will be better to diagnose you did not comment on test reports are you a diabetic are you suffering from hypothyearoidism since you are having heavy periods you should go for serum ferritin level and hemoglobin level if you have diffuse hair loss you can start minoxidil my local application daily and tablet biotin vitamin or vitamin be supplement once daily to see visible response it will take two to three months female pattern hair loss chronic telogen effluvium female pattern hair loss follow up monthly to a dermatologist online"
    },
    {
        "instruction": "hello doctor I am writing on behalf of my wife she is facing continuous bleeding from vagina since seven days after post pregnancy bleeding here is the complete scenario we blessed with a baby 38 days ago and it was a section delivery 16 days back the bleeding had stopped completely everything was normal 10 days back my wife started to have vaginal bleeding again and bleeding till today we thought that this is her monthly period after pregnancy the bleeding is heavy so she needs to change to 10 pads a day she is feeling tired and her be was low due to excessive bleeding we have also visited doctor nearby yesterday she has given two tablets to eat twice and day pause of and methergine were the tablets given after having these tablets bleeding is happening at same flow be and tiredness has disappeared there is no other complication like fever stomach pain etc except bleeding she needs to feed one month baby as well also note that there is no sex done post delivery please help us I am attaching her abc it in ptt reports for your reference",
        "input": "",
        "output": "hello your wife is having bleeding per vagina following one month of cesarean section this is termed postpartum hemorrhage and often creates an emergency this could be caused by an infection of section wound commonly but as per your report she is having some form of blood clotting disorders raised prothrombin time it and international normalized ratio in now definitely she needs hospitalization she might have another bout of bleeding and in that case you will not be able to control the situation pause of combination of tranexamic acid and mefenamic acid and methergine methylergometrine can subside the bleeding temporarily but she needs intravenous antibiotics and may need clotting factor transfusion fresh frozen plasma as well as blood transfusion as her hemoglobin is 10 it is substantially low to combat another episode of massive bleeding I know the baby will be deprived but do not take the breastfeeding as a priority in contrast to your wife impending danger if any blood coagulation disorder routine blood liver function tests let urea creatinine platelet count bleeding time bt clotting time it prothrombin time it and activated partial thromboplastin apt us ultrasonography whole abdomen postpartum hemorrhage admission along with iv antibiotic as well as fop transfusion and blood reserve required revert back after the investigations to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "dear doctor here is my lab report bilirubin total bilirubin direct 5 sept 4548 got 4153 I have taken drip and injection for nausea now nausea has been cured I have only abdomen pain now and my fever has been cured before three days color of urine is yellow and color of stools is white also my constipation is still remaining what shall I do now please give your opinion",
        "input": "",
        "output": "hi for further queries consult a gastroenterologist online"
    },
    {
        "instruction": "hello doctor my marriage is ahead in 13 days we are planning for honeymoon after four days of our marriage but my fiance monthly cycle date is on the fifth day following our marriage we need help in postponing her period as well as about birth control please guide",
        "input": "",
        "output": "hi for further doubts consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hello doctor I recently had my blood test and the results came back that I had mild neutropenia it has got me a little concerned since this has been present on my last two blood tests with the lymphocyte count being significantly higher but still within the normal upper limits I have had no infections fever night sweats aches no splenomegaly and no history of anything I currently take propecia 25 my for hair loss my first blood test five months back was this way neutrophils 42 and absolute neutrophils 1 lymphocytes 45 and absolute lymphocytes my newest blood test as of this week reads neutrophils 30 and absolute neutrophils 2 lymphocytes 59 and absolute lymphocytes 3 I will upload my most recent laboratory work if more information is needed then I can get the previous one thank you",
        "input": "",
        "output": "hi based on your query my opinion is as follows low grade viral infections increasing lymphocytes the normal lymphocyte count is 20 to 40 and here is 59 improve nutrition to fight the low grade infections maintain good hydration repeat test after three months and get back to a hematologist online"
    },
    {
        "instruction": "hi doctor it started with a burning sensation on my neck and then I have noticed red dots in the inner side of my arms then it spread to my stomach and back they itch sometimes I have previous history of psoriasis on my knees but this is different I also had shingles when I was years old",
        "input": "",
        "output": "hi I have seen your picture and read your given history your case looks like a guttate psoriasis this type of psoriasis occurs in individual who had plaque psoriasis and developed sudden appearance of an outbreak of red drop like lesions all over body trigger of the disease is often streptococcal bacterial sore throat followed within two to three weeks by the eruption or chicken pox usually this type of psoriasis goes away in a few weeks without treatment simply moisturizing the skin may be sufficient if throat culture comes positive for sore throat then starting antibiotics for the infection will be helpful for further information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor my friend is getting married in another six months and it is love marriage when his fiance was in her second relationship she fell in love with my friend after few months only he came to know that she does not seriously love him she started loving him so seriously when he lost his conscious and fainted on the floor one day from then onwards she realized his love and they decided to get married my friend requested her many times to share her past but she denied now he came to know she had been in a long term relationship with two guys before also he came to know that she used to text many guys with keep it simple stupid symbols etc now my friend is unable to forget her past and psychologically he is not well he has not been into any kind of relationships with anyone why he has got a girl like this day by day he is becoming psychologically tired please suggest something your valuable replies will be the tonic for my friend it will be really more helpful thank you",
        "input": "",
        "output": "hi for further information consult a psychologist counsellor online"
    },
    {
        "instruction": "hi doctor I had meniscus surgery before two and a half weeks still there is a kind of swelling around my knee I feel little pain outside the knee and also there is still a crack noise when I bend why",
        "input": "",
        "output": "hi for further information consult an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hi doctor yesterday I was diagnosed to have chlamydia I am freaking out because I want to get it cured as soon as possible to prevent damage to my ability to have children later in life unfortunately I am not able to get treatment from the nearby hospital for a couple of weeks I was wondering if there is another way to get the treatment sooner if possible the clinic offered free treatment but my peace of mind and less damage done is worth me paying for the prescription as long as I can afford it I just do not know where to go or if the clinic could fax the results somewhere thanks for the help",
        "input": "",
        "output": "hi I can understand your concern chlamydia trachomatis is a sad sexually transmitted disease you have got the infection from your partner so you both should be treated ideally a vaginal swab test should be done to confirm the diagnosis you have not mentioned whether you have taken the test to confirm chlamydia infection first line agent for uncomplicated infection in non pregnant patient is ceftriaxone with azithromycin orally for one dose or doxycycline 100 my orally twice daily for seven days if you can share your vaginal swab test with cultural and sensitivity then I can suggest you the right treatment do not panic it will be cured once you take proper treatment revert back with the swab test report to an general practitioner online"
    },
    {
        "instruction": "hi doctor my son is years old and has been diagnosed with add odd and sensory integration disorder he had adderall or my for a while and recently was changed to strattera 27 my son has been experiencing major insomnia high aggressive behaviors which involved throwing objects at people hitting punching people kicking and biting especially adults as his mother I do not believe that he has add although he has odd it is a normal thing in a year old however the behavior is not becoming better and it has actually become worst to the point where he is on the verge of being kicked out of everything I want to take him away from all medications because I do not want my year old on them to begin with however I am out of ideas and it scares me because my son could be really wonderful but currently he is not at all can you help me with any suggestions",
        "input": "",
        "output": "hello revert back with the answers to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor my 10 month old daughter had a fall from bed she had little blood in her nose blood is just little and not dripping is it something to worry about",
        "input": "",
        "output": "hi revert back with the reports to a paediatrician online"
    },
    {
        "instruction": "hi doctor I am 25 years old and a virgin I used to watch too much porn movies two to three years back because of issues in personal life I had watched it before that also but once or twice a week after my breakup I was totally depressed and shattered a friend of mine deliberately forced me to watch porn movies to come out of depression after that I got addicted to it now the problem is I have a small penis and whenever I masturbate I ejaculate very soon say four minutes and pain rises in my back tailbone as if the inner nerves are stretched too much it seems like I cannot be in the field of encounter for a long time what should I do please help",
        "input": "",
        "output": "hi you are contributing porn watching and masturbation to your back pain masturbation is a healthy way of satisfying your sexual desires and you can masturbate weekly twice or thrice anything in excess is not good it will not affect your sex life or general health by watching porn continuously and masturbating daily is common in your age it will not cause any serious damage except early ejaculation that is because you have trained yourself and your penis to ejaculate early lot of constructive time was wasted in this you can divert your mind by concentrating in your studies or professional career also learn yoga and meditation which will help your back ache and assist you to concentrate on useful activities you can watch porn for five to ten minutes and masturbate weekly twice or thrice but train yourself to ejaculate late by delaying stroking for your back pain consult an ortho doctor"
    },
    {
        "instruction": "hello doctor I am 30 years old I am having a problem of restlessness in legs fatigue tiredness irritation confusion lack of sleep or disturbed sleep I am currently taking calcium tablets",
        "input": "",
        "output": "hi welcome to icliniq com you seem to be suffering from restless leg syndrome res this however needs exclusion of other issues like thyearoid disorder iron and calcium deficiency as well if all these investigations are normal my recommendations for your treatment would be pregabalin along with lifestyle modifications like yoga meditation I hope this helps"
    },
    {
        "instruction": "hello doctor last night I fell from my bike on my right side as it got slipped while driving my right hand and right shoulder directly hit the road and cause severe pain on the right side of the abdomen a local doctor prescribed some medicine and I got relieved from my side pain I went for an ray of the right chest it was normal but after 36 hours I am having pain in the right shoulder scapula and while sitting or arising out of bed or moving hand on the upper side the pain increases a lot is it normal or need better medical assistance",
        "input": "",
        "output": "hello you should get yourself examined by an orthopedic surgeon and ray of the shoulder region is required any pain in the shoulder after trauma requires evaluation and any pain cannot be considered as normal there are chances of soft tissue alone with no bony injury but I would recommend a re evaluation till then you can apply ice to the affected area and take analgesic for pain relief kindly follow up with your ray and feel free to discuss further"
    },
    {
        "instruction": "hello doctor I had bell palsy before few months and it resolved within two months I was treated by a neurologist then but now I feel that my taste buds are blunt and I cannot taste very well within the past day or so I have no other symptoms of bell palsy yet but this is how it started back it was on my left side I am worried that I am getting bell palsy again is it possible to get it so soon again and if I feel it is what shall I do shall I start my steroids and acyclovir again",
        "input": "",
        "output": "hello welcome to icliniq com I can understand your concern try finding any other cause of taste loss like consumption of any drug like metronidazole if you are sure that no other cause explains it then I will suggest to get nav nerve conduction velocity egg electromyography test because it can pick up delay in nerve conduction earlier than the symptoms results are available by the same evening bell palsy prophylaxis is not recommended anywhere however if I imagine myself in your position I would start the medication by the time all these investigations are done you can also get a detailed neurological examination many a time clinical signs can be seen when a patient cannot appreciate symptoms if it proves to be bell then we will have a discussion for further causes of recurrent bell s"
    },
    {
        "instruction": "hello doctor I have silicone mentor gel smooth round moderate profile breast implants that were placed befor years I have reason to believe I have what the community is calling breast implant illness I am curious if the integrity of the implant is intact and if there are any lesions that could be free floating silicone the right breast is a 350 ca implant and the left is 400 ca",
        "input": "",
        "output": "hi breast implant illness is a term associated with symptoms of health concerns in women having breast implant surgery done it includes a wide spectrum of physical symptoms and commonly involves fatigue chest pain headaches anxiety vision problems nerve and hormone problems this is not officially a confirmed medical term in use and is a more general expression of symptoms however one should not ignore if there is a likely possibility of implant rupture mri magnetic resonance imaging scan is useful to search for any areas of rupture in silicone implants if there is a clinical indication you can get an mri breast scan done and it will confirm the integrity of the implant"
    },
    {
        "instruction": "hello doctor I was diagnosed with a candid albicans I used emergency contraceptives as and then but I treated it with ciprofloxacin antibiotic I also started using cotton pants took care of my vagina too then last month I went to the clinic and retook the test hoping it would come out clean then they said I have a staphylococcus infection it was moderate and I took the same antibiotics they prescribed I did not have any symptoms but I treated it anyway then earlier this month I had catarrh which I also treated with an antibiotic now I am four days late from seeing my period I am very scared I do not think I am pregnant because I check with a strip two days ago and it tested negative I am just very scared because I feel it was the infection that is delaying my period and it is messing with my system inside how dangerous are staphylococcus infections and why have I not seen my period",
        "input": "",
        "output": "hi welcome to ciliiq com you do not need to be scared vaginal infection should be taken care of but these infections are not uncommon in sexually active females so do not worry if there are no symptoms taking antibiotics every time may not be the right thing to do just maintain hygiene staphylococcus infection is also not an uncommon vaginal infection sometimes even contamination from the surrounding areas while taking swab may show such a picture period delay due to this seems unlikely wait another week and recheck in the urine if still negative see a gynecologist who can examine you and find out the reason for it could be hormonal imbalance or a uterine or ovarian pathology I hope this helps"
    },
    {
        "instruction": "hello doctor a few months before I developed a gastric issue that required treatment with pips soon into using the drugs I developed headaches dizziness and nausea I changed the type of pi three times but the symptoms persisted the symptoms included a feeling of pressure above my right ear and behind my right eye later I came off the pips and after using over the counter headache painkillers for three days the severity of the headaches eased but the feeling of pressure remains to this day on the right side of the face I often feel heavy head or even light headed with a slight dizziness often as if I am hung over the symptoms come and go but are there every day for differing periods of time and the constant is this feeling of slight pressure on the right side of my head above the ear and extending sometimes down to the cheek and behind the right eye",
        "input": "",
        "output": "hello I read carefully your question and would explain that the dizziness does not seem to be related to pi adverse effects as it would have disappeared now for this reason I would recommend consulting first with an ent specialist in order to exclude a possible inner ear disorder which could trigger this clinical situation it is also necessary to perform a sinus ray study inflammation tests complete blood count per ear and thyearoid hormone levels in order to exclude a possible thyearoid gland dysfunction if all the above tests result are normal I would recommend consulting a neurologist for a physical exam a brain mri may be necessary I hope this helps"
    },
    {
        "instruction": "hello doctor I was diagnosed with mugs ga when I was seeing a neurologist for some burning in my palms of my hands and soles of my feet which is awful at night and prohibits me from sleeping this has been going on for six months but has gotten worse so I went back to the neurologist ordered an mri for next week to see if the six white matter brain lesions I had were changed since the mugs I followed up with hematologist three times and he said my numbers are so low they do not show up on spike all other labs were normal I saw a dermatologist to see if burning was skin related she said no maybe vascular so I saw a cardiovascular doctor who is also running tests I also saw a rheumatologist so does not believe it is rheumatology based on blood work my question is if my numbers at hematology were so low they do not show spike could they be causing the random burning in the palms of my hands and soles of my feet just want answers and as of right now I get the neuro saying it is mugs and hematologist saying it neuro I am scared and exhausted please help my primary complaint is burning red palms of my hands and red soles of my feet not fire engine red just slightly red my hands tend to get a little swollen on the top and my veins are swollen and then it goes away and my hands are looking normal and are cold sometimes well it happens all day regardless of what I am doing with the activity is it randomly pops up definitely when I am moving around or running the vacuum or doing something like that but it is really bad at night so far I have done myeloma profile abc ana and cop tests",
        "input": "",
        "output": "hi welcome to ciliniq com I am sorry to hear with regards to your complaints and how much you are going through I have seen your hand pictures to be frank it is really a tough case there can be a few things that can be looked for chronic inflammatory demyelinating disorder rarely mugs monoclonal gammopathy of undefined significance can be associated with neuropathy it can be raynaud phenomenon any heavy metal related I have a few suggestions which you can ask your neurologists or hematologist if they have thought about them did anyone think of getting a nerve conduction study later on can a nerve biopsy give an answer if we are thinking cid chronic inflammatory demyelinating neuropathy sometimes can any heavy metal can cause this kind of symptoms lab work for raynaud phenomenon if your symptoms fit into that criteria looks less likely though any remote chance of amyloidosis there is a test for that as well known as fat pad biopsy please ask the doctors to consider these points to your question mugs has been shown to have an association with neuropathy related pain though less likely I am here always if you need further guidance I hope this helps"
    },
    {
        "instruction": "hello doctor this is pertaining to my period and my birth control I had my daughter a little over two months ago and started my birth control last month I was still having on and off bleeding but it stopped about a week or so after taking my birth control I started my period on the ord of this month and it stopped completely yesterday until I had sex last night when I went to the bathroom after the fact I was bleeding as if I were on my period and my vagina hurt and burned a little not when I urinate just in general is this normal am I still on period next is my birth control as I stated in the first question I started my birth control last month well I still have one more pill to take out of it and I had unprotected sex last night I take it at am every day never missed one but we are late taking a couple especially yesterday I was late by an hour taking the pill am I able to get pregnant immediately due to the fact it is still my first month on it and I only have one pill out of the pack",
        "input": "",
        "output": "hi what I could gather from the information you gave was that you are on birth control since last month what I would want to know is what was the mode of your delivery vaginal or operative it has a bearing on the answer also what kind of pills are you on are they continuous pills without a break or like three weeks on one week off pills were you still taking pills when you had your periods on the ord if it was a vaginal delivery sudden bleeding could be due to vaginal laceration if the bleeding was while on pills it could be a breakthrough bleeding if only one pill is left and you have been taking it for more than two weeks regularly pregnancy seems unlikely being late for pill by one hour does not decrease its efficacy if you are breastfeeding your child chances of pregnancy are even lesser I would suggest you to see your doctor and understand clearly how and when to take pills to avoid such problems in the future I hope this helps"
    },
    {
        "instruction": "hi doctor I have hypertension and diabetes for 25 years I am taking 250 units of insulin for six years gor 20 creatinine is 1 should I take cremaffin to reduce the creatinine I am taking ten 100 telmisartan 80 benina 8mg I had edema in legs and started lasik 120 my and pyloric 500 my weight had gone up suddenly by 10 keg I weigh about 100 keg I had a kidney stone of 15 my six years back and now it is my suddenly my weight increased and so the be I was taking amlodipine but now changed to benina my",
        "input": "",
        "output": "hello I have seen the reports sent by you your creatinine is 1 which is not very high also your other blood reports are fairly fine but your hba1c glycated hemoglobin is high it should be below your diabetes is not under adequate control other parameters like calcium sodium and potassium are fine you are presently suffering from diabetes and hypertension related chronic kidney disease your treatment should include adequate control of diabetes and hypertension proper exercise and lifestyle changes no smoking and alcohol fluid intake should be 500 my more than the total urine output diabetic renal diet is very important can consult a dietician for proper diabetic renal diet other antihypertensives lasik and insulin to be continued as it is cremaffin will not help in reducing creatinine as it is chronic kidney disease it is irreversible and your goal should be only to prevent progression by strict diet and medicines"
    },
    {
        "instruction": "hi I am a 32 year old male my mri report says posterocentral protrusion of la disc is abutting the la nerve root bilaterally in mri it is black between la and kind of poking the nerve my back pains occasionally and I think it is the nerve which is hurting because the pain is like a sting currently I am taking rest and doctor said that he will check if physiotherapy can be started after a couple of weeks I am afraid of the pain especially when it is near the neck or shoulders I am able to walk and work I am being treated by a spine specialist please let me know if I have to go to another doctor like a neurosurgeon and can I lead a normal life in future",
        "input": "",
        "output": "hi I am not sure of your neck symptoms as the neck has nothing to do with your lower back and from your description it is not clear if you have any leg symptoms or bladder symptoms however I need to see your mri scan to be able to make a judgment on the further management revert back with the reports to a spine health specialist online for further follow up"
    },
    {
        "instruction": "hi doctor my it scan says defined streaky opacity with associated loss volume and clustered tree in bud nodules have developed in the anterior segment of the upper left lobe the associated central bronchi are impacted without an obvious mass although a small central lesion is not excluded the impression at the end said a focus of bronchitis and bronchiolitis with airway impaction has developed in the anterior segment of the left upper lobe an infectious etiology is suspected but a small endobronchial lesion could be obstructing this is not a typical site for aspiration follow up is recommended to confirm resolution I am of course concerned about lung cancer but my pulmonologist said this mass looks like pneumonia but the airway leading to pneumonia cannot be seen well that is where the bronchoscopy comes in as the airway cannot be completely visualized on a it scan if there were to be any abnormality in the airway it would be more along the spectrum of a benign growth than lung cancer does this make sense do you agree",
        "input": "",
        "output": "hello revert with more information to a pulmonologist online"
    },
    {
        "instruction": "hello doctor I just got home from a mission trip three days into the trip I started getting chills accompanied by diarrhea once or twice a day usually in the morning I took imodium each day and continued doing activities three days after diarrhea I got a scratchy throat the next day I got a stuffy nose as well the day after that I flew home my throat felt less scratchy but my glands swelled up and it was painful to swallow I still had diarrhea that morning the next day yesterday I got a fever of 100 chills fatigue and coughs I had a stuffy and runny nose throughout the day and the left side of my nose got congested that there was painful pressure in my sinus on the bright side there was no diarrhea yesterday and the swelling in my glands went down but last night diarrhea came back and then happened again this morning it is now been a week since diarrhea first started I still feel feverish and I am still very congested should I be concerned I am currently taking ibuprofen sudafed and mucinex",
        "input": "",
        "output": "hello I went through your post you have mentioned the duration of illness as one week which makes it an acute illness the characteristic features of your illness are loose motion fever congestion in nose and sore throat all these are features of acute viral infection because of loose motion the possibility of influenza are high viral infections of this kind are self limiting and settles in one to two weeks I would suggest to stop ibuprofen as it causes rashes and platelet dysfunction in viral infection you can take paracetamol 650 my eight hourly last but not least take plenty of fluids and go for abc complete blood count to see whether there is any decrease or increase in cell count"
    },
    {
        "instruction": "hello doctor please help me to understand my sad results hav egg type spec 31 10 hav egg type spec",
        "input": "",
        "output": "hello I read your query and understand your concerns the available test report indicates positive for herpes simplex virus test positive however I must clarify that the unit is not provided and if the unit is provided the answer can change I request you to attach the test report if possible I hope this helps"
    },
    {
        "instruction": "hello doctor I wanted to take a second opinion about my mother in her ultrasound it was diagnosed that she had gall bladder stones there was no pain but it was accidentally observed in the ultrasound we waited for three years but then later on one of my friends mother developed gall bladder cancer which was fatal this incident prompted us to take a second opinion and this time the doctor also suggested that gall bladder should be removed because the stones might create problems in pancreas therefore we had her operated and the gallbladder was surgically removed after the operation biopsy of the gallbladder was also done all the relevant reports are attached the pre operative medical tests are also there in one of the reports in history it is written that patient gives a history of pain in abdomen complaints of acid peptic dyspepsia she had no pain in the abdomen and no problem of gas or indigestion before the operation after the operation she had pain in the operation area which was healed later on she has had typhoid thrice and to once when she was young she had chikungunya type fever last year which was negative for chikungunya tests but the doctor said it might have been chikungunya and the tests might not have been done in the right time period that is why they came negative she also takes medicines for blood pressure knee and joint pain calcium cataract homeopathic medicine for nose polyp infection here are my questions the biopsy report says the impression of chronic non specific cholecystitis should we worry about it is chronic non specific cholecystitis cancerous my mother faced gas problems after the operation which became normal after a week or so and rarely she has that like recently she had some dal parathas which was oily and caused the gas is this normal would she be frequently having gas incidents since her gall bladder is removed we never did a biopsy of the gall bladder stones should that also be done",
        "input": "",
        "output": "hi having gone through the reports I just need to reassure you that the surgery was done by a world class surgeon reply to your queries no need to worry about non specific cholecystitis it is not a cancerous lesion if she avoids fried and fermented meals then there will be no issues of gas stones are analyzed not biposed but it is fine if that was not done type can be interpreted from the gross appearance but anyways it does not affect management I hope this helps"
    },
    {
        "instruction": "hi doctor I have a very painful skin condition on the sides of my thumbs and forefingers it started months ago and is steadily getting worse and spreading to other fingers I also have it on one of my toes the nails have gone very thick and have a chalky formation under the nail this is not painful but I have lots of tiny water filled pockets under the skin that eventually crack and bleed I have to wear plasters on my fingers to stop the infection as the skin is constantly splitting and bleeding my doctor has prescribed me four creams over the last four months they are betnovate dermovate lotriderm and fucibet but none have worked I am very aware that these creams need to be used very sparingly but my skin seems very thin so I have stopped using the last cream he prescribed fucibet as I am worried that it may give me lasting damage like all of us with medical problems I have been online and I am pretty sure that I have discord eczema I have been waiting for a dermatologist appointment for two months I cannot wait any longer what do you think and what treatment if any can I get",
        "input": "",
        "output": "hi I have seen the pictures yes this is eczema only and you are using the correct cream but the problem is that it is a very resistant condition so it takes time to get resolved you should avoid touching soap detergent chemical cement or any other chemicals you have to take oral steroids also to get faster relief also use good moisturizer frequently can apply fucibet fusidic acid and betamethasone cream and put some cover over the finger to allow the cream goes deeper also use moisturizer at least three to four times a day if you feel itching then you should take levocetirizine 10 my"
    },
    {
        "instruction": "hi doctor I have been wearing braces for teeth alignment I am towards the end of my treatment and have developed a high pitched sound in my right ear I consulted with my orthodontist and temporarily removed the wires on two occasions both times the ringing went down after some weeks when I put on again the sound started one ent I consulted said it could be an allergy to dust in the area I live in based on the information I received and the symptoms I am not sure how to proceed what is the cause of this issue",
        "input": "",
        "output": "hi tinnitus due to braces is not possible tinnitus can be due to many reasons like hearing loss or nerve loss or any loud noise exposure or trauma to the ear or even nasal infection or some medicines please tell me do you have any relevant history dental procedures that involve the use of dental burn can cause tinnitus but not just the braces you should get pure tone audiometry done and follow up with the required information so that I can suggest you better"
    },
    {
        "instruction": "hello doctor I have been scratched by my pet dog and I think it reached beneath my skin I got red areas and I did not take any rabies medicine and it is the third day can I take medication now",
        "input": "",
        "output": "hello welcome to icliniq com yes you can still take the medication do you have rabies or tetanus vaccine if not or you are not sure I recommend you go to a nearby hospital to have a rabies vaccine and tetanus shots or at least booster shots I recommend you to complete the dose as per your doctors advice in the meantime I recommend you wash it with clean soap betadine solution and clean water every day to avoid infection if in pain you may take ibuprofen twice a day as needed for pain is there anything else I can help you with or anything that is not clear to you I would gladly clarify them"
    },
    {
        "instruction": "hi doctor I am uncircumcised and never had sex I masturbate three to four times a month for about a week there is an issue which I think is inside my penis it feels uncomfortable like a vein is swollen or hurt there is mild irritation but nothing abnormal while urinating or masturbating I have no clue what is the issue I am unable to describe it I guess it gives a very mild pain or rather I will say discomfort it is annoying now the same feeling every time like the vein got hurt or swollen please help",
        "input": "",
        "output": "hello if possible send me images so that I can see and suggest you properly it might be because of violent masturbation I suggest you to avoid masturbation for two weeks I will give medicines after I see the images"
    },
    {
        "instruction": "hi doctor I am a 25 year old male I do not have any medical history been always healthy for the past months I have been experiencing this facial tightness which comes pretty often throughout the day with different intensity the facial tension usually comes half an hour after I leave the bed the tightness on my face happens to be on both sides of my face but usually more intense on the right at times I can feel it from my neck all the way up to my face as of recent I have been feeling this slight burning sensation on my chest to my shoulders as well prior to this facial tightness I have been suffering from this burning feeling on the centre of my chest for about a month it was my first time experiencing heartburn and I thought it was heart related went for rays and echo heart ultrasound everything came out fine I have a healthy heart what made the burning chest sensation go away temporarily is lying down eating exercising and drinking alcohol and the weird part is the same thing helps me relieve my facial tightness temporarily is the same thing as that for the burning chest sensation lying down eating exercising and drinking alcohol since having this facial tightness I have paid numerous visits to different doctors even the neuro specialist and they all said it was anxiety the doctors did facial senses test where they take a piece of fine cotton to touch different parts of my face I had to close my eyes and tell them where the spot is I have no troubles at all I did blood test it came out normal they told me I do not need to do any scans and that it was merely anxiety and it will go off by itself I convinced myself that I had anxiety because of the one month heartburn ordeal that I was suffering from even though the facial tightness was there I tried my utmost best to ignore it I do not think that I have any anxiety in me now as I try not to think of the weird tightness sensation however it has been whole months and now I am getting alarmed and worried that it is still here and with newer sensations as I described above in all honesty I do feel that the intensity of the facial tension as compared to I first experienced it is less however it is always there even as when I am typing this I do not see any physical change on my body not sure if it is neuro damage I am worried sick hope I can get some form of advice and diagnosis",
        "input": "",
        "output": "hello I read carefully your question and would agree with your doctor on the fact that all your symptoms are suggestive of anxiety the fact that your symptoms are relieved by lying down alcohol or physical activity is another argument in favour of anxiety anyways before coming to this conclusion I would recommend checking vitamin plasma levels for possible deficiency and blood pressure for possible imbalances it is also necessary performing a cervical spine ray study in order to exclude any possible bulging disc in the cervical vertebral column which could lead to burning sensation in the neck and shoulders in the meantime I would recommend taking magnesium supplements to help relieve the muscle spasm"
    },
    {
        "instruction": "hi doctor I had periods on 26th and had protected sex on the ith of the following month after that I took an I pill within hours now I am bleeding like my periods ie after days of I pill is this my period if not can I expect my periods on the coming 26th",
        "input": "",
        "output": "hi it is a withdrawal bleeding after I pill as you are bleeding now your menses going to be irregular mostly now your period is going to delay mostly and very little chance that it comes on time I pill is a hormonal pill so it can disturb your normal cycle withdrawal bleeding can be very small and also can be like normal menses so do not worry please wait for your menses but keeping in mind that I pill can not be 100 effective do a urine pregnancy test after 26th once or twice in your case there is almost no chance of pregnancy because you had protected sex so do not worry but yes periods can be irregular for two to three cycles so watch for it drink more water hopefully you got your answer if you still have more query then you can ask in follow up"
    },
    {
        "instruction": "hi doctor I am a 35 year old male I have been to several doctors neurologist and I have not been told what is wrong and what I can do to fix it my symptoms are for the last ten months when I go to sleep I wake up with one or both of my arms being numb from my elbow down to my pinky and ring finger so I know there is something up with my ulnar nerve this happens when I am asleep on my back which is why I got an mri of my neck to see if it was happening from there when I saw the spine specialist he said my mri was normal for my age this is what the mri report showed c5 ca my disc protrusion mild effacement of thecar sac ap canal diameter 5 my ca my disc osteophyte complex moderate effacement ap canal 5mm ca to umm disc protrusion ap diameter 5 my he looked at the images and said nothing would be happening to the nerve from the neck also I saw a neurologist and they did an egg nerve conduction study eg and mri of the brain they said everything was normal everything I have found online points to ulnar neuropathy or cubital tunnel syndrome I just have not had any doctor confirm what is going on and I do not know anybody personally that has experienced this issue it is disrupting my sleep causing me to wake up multiple times each night my questions are what can I do to fix this physical therapy surgery etc are there long term effects for having this",
        "input": "",
        "output": "hello sorry about your present health condition usually during sleeping on supine position or sleeping on sitting position with hands side by side may can cause some compression of ulnar nerve lead to temporary signal interference call neuropraxia which is common in all individuals but more in obese people or hypothyearoidism or diabetic or b12 deficiency or hypocalcemia or anemia or hypokalemia conditions so prevent medial rotation of arm while sleeping get it done serum calcium and electrolytes als get done your blood sugar and thyearoid status use vitamin b12 and folic acid tablets tablet pregabalin 75 my is useful at night time if no improvement please review with the above investigations avoid smoking and alcohol consumption because it aggravates the condition rest your arms on pillows by the side"
    },
    {
        "instruction": "hello doctor I am 54 years old I have been diabetic for long years and under insulin I also suffer from diabetic retinopathy for two years I did more avastin injection and laser sessions eight months ago I had an ischemic stroke just a few months after the injections my blood pressure was very high the left gauges are 20 better thanks to physiotherapy I returned as before except in the legs the pelvis and purse erection problem and the rest constipated for 100 meters of walking I am exhausted and tired at the level of the purse I have burning sensations at the level of the pelvis it hurts if I try to sit on the floor or to turn on the bed the pains are rather nocturnal than at rest same also at the level of the left arms when I press or turn in rotation drugs insulin humalogu mix 25 insulin lispro mix 25 insulin lispro and 75 insulin lispro protamine suspension approvasac 300 my 5mg 0 fludex indapamide 1 alas 20 atorvastatin 20mg 1 ultracet paracetamol 325 my 0 1",
        "input": "",
        "output": "hello I went through your post you seem to have diabetic neuropathy which is the cause of your erectile dysfunction and easy fatiguability in addition there are features of osteoarthritis instead of paracetamol 325 I would suggest sustained release form like it para og half tablet twice daily and neurotropic medicines like a combination of methylcobalamine with pregabalin which will improve neuropathic symptoms good control of your blood sugar is important to decrease or slow the progression of diabetic complications evaluation of cardiac status is important as it may cause easy exhaustion the ray does not show any gross abnormality"
    },
    {
        "instruction": "hello doctor I have been suffering from dry eyes for four years I have seen many eye doctors but no cause has been found a while ago I started noticing my eye lids looking weird I also discovered I had demodex mites on my face but none were found on my eyelashes however I made some photos of my eye lids and found the base of my eye lashes looked white my question is could this after all be the sign of demodex mites during these four years of dry eyes I get occasional left eye pains the problem is exacerbated by computer use reading being outdoors my eyes are not red no blurred vision no excess tearing warm compresses eyelid massages eyelid hygiene and diet changes did not help around a year ago eye lid problems started my eyelashes do not fall out easily though",
        "input": "",
        "output": "hi we do have natural microbe or flora on our face and eyelashes but demodex mite cannot be it is a foreign microbe that needs to be treated I can see the images and there is redness beneath the eye and also white at the base of the eyelash there are many reasons for it firstly are you having psoriasis which itself can be flared up and needs treatment by a skin specialist this also has an effect on eyes causing dryness and burning secondly as you are saying dandruff that you have to check do you observe it at your hairs shoulders and eyebrows that also has to be treated by antidandruff shampoo again call for a skin specialist thirdly blepharitis because it also causes similar symptoms apart from the face do you have any other symptoms like thirsty mouth itching in any part of the body or rashes well I would suggest you to get it checked once with a skin specialist also because it is now a chronic condition I will write medications for you eye ointment dexamethasone over the eyelashes at night and day for 15 days eye drop systane ultra polyethylene glycol four to five times a day for 15 days eye ointment neosporin at the face just down to eyes where rash is there genteel gel at night and day inside the eye use any anti dandruff shampoo use anti mite shampoo for hairs lid scrub by scrubbing it with buds dipped in one part of shampoo and two parts of water this should be continued for 15 days please consult a skin specialist it is important since you are so much in pain"
    },
    {
        "instruction": "hello doctor I am a 49 year old male I took prevacid for 17 years one or two pills a day I stopped five months ago after I read about that it increases the risk of dementia if I do not have dementia now and I have stopped the medication do my risks of dementia remain elevated for the rest of my life is the effect reversible does stopping the medication mean I am no longer at higher risk for dementia is the damage already done even if it is not noticeable at present I asked my go and she said nobody knows that even if I took an extensive test from a neuropsychologist it would only mean I do not have dementia today but it does not mean that my past prevacid use would not cause dementia in the future that leaves a life of uncertainty ahead is that the answer we just do not know I wanted to ask a neurologist before I accept that answer",
        "input": "",
        "output": "hello after careful review I understand you are worried about the side effects of lansoprazole prevacid now as you have stopped taking it the risk of side effects do not remain the same as with taking the drug the reversibility of effects is based on the extent and the nature of damages done by any drug for example if a drug causes scarring fibrosis of the liver tissues it usually does not come back and is an irreversible side effect dementia does not come so early and usually decades are needed for its development and not every patient on lansoprazole ends up with dementia to give you good news the link between dementia and lanoprazole is not certain it is still under research and is not an established fact as of today also we have to see that lansoprazole prevents the patient from serious bleeding and ulcers of the stomach so it outweighs the risks of dementia if any for better understanding you have the option to consult a neurologist he will be able to articulate this fact in a better way based on your clinical evaluation yes your go is right in saying that but based on the facts in pharmacological post marketing research there are the least chances if any of dementia I hope this helps"
    },
    {
        "instruction": "hello doctor I hate myself and my life because my biggest enemy and weakness is me I am the biggest trouble maker of mine I am stupid and foolish I have grown up in the environment of too much care fear and adopted fear in my nature I have too much hesitation and assertiveness my communication is very poor and cannot express in a polite manner giving an impression like an arrogant what I feel inside is good but cannot express as easily because I feel ego my biggest problem is fear I shout loudly in sleep sometimes I always feel I do not know anything and others feel bad about me and I will be shameless I used to depend the most on parents and I used to do what they say my life decisions also I cannot take myself and did what they said I came to a city for pursuing a degree I felt inferior by looking at the environment I used to stay in a small room and I did not even know any languages properly not even my mother tongue because that slang was not that good I tried and could not complete the course wasted that fee also when I got backlogged for exam fee and attendance shortage I had to keep my dad watch in pawn brokers shop later my dad came to know and screwed up like anything I did not like all these by hurting my parents and cheating them 10 years got wasted I did fraud things like this after that long gap I was in big trouble and my mind became blank do not know what to do I feel shame about myself I started social media chatting to overcome my emotions and got addicted I wanted to get easy money so I got attracted by the lottery but never got anything I tried online easy money sites also I got a small job in a hospital for 6500 per month that also closed after two years I searched for some other jobs I got offered for small pay and my dad suggested doing a business with the help of one of my uncles I deposited some amount to start the business in our town itself we completed the project on time and submitted but he did not pay and said the client cheated I started searching for other projects but all looked like fake or some other risky things depression got doubled then I joined ok math and did a personality development course and attend some classes as per my brother suggestion I learned sap and did certification could clear it successfully I studied so in correspondence due to the long gap in education I did not get a job in any good mnc so I had to join some small company without pay after eight months they sent me for a project on ta steel I struggled a lot to adopt with hindi atmosphere and work environment also it took almost six months to get adopted in those circumstances I worked there for around two years I had to leave this job because of less pay and homesickness I applied for many companies and placed in a small company I felt a bit relaxed I did well in the interview I proud this moment because I got it with my own efforts good mnc is not accepting me for the gap in education I feel every time work pressure and insecurity of losing the job my parents are very much worried about me I am no more can avoid this worry from them whatever I do not want to give them any worries and let them enjoy and live peacefully I feel like ending my life and let my parents be relaxed and live peacefully since I am no more supporting my family and becoming like a big burden on them my age is 34 and not married where all of my friends settled and married living happily all good things happening lately I need discipline good daily routine good attitude enjoy the work and the way of life I should behave politely and confidently enjoy work and challenges I am facing I want to lead happy life with peace and enjoy all challenges and grow in life honestly",
        "input": "",
        "output": "hello I can understand your concern first of all stop blaming yourself for anything you are not your biggest enemy and you are not a trouble maker your anger is getting directed to yourself only and this has resulted in depression repeated failures whatever be the reason resulted in a state of helplessness and you lost your confidence due to shifting from a small town to city and then language issues all resulted in poor performance in studies and which ultimately costed failure in engineering after that you could not finish your studies and then got deceived in business and ultimately this also failed all these setbacks resulted in learned helplessness your anger is towards yourself and this is the main reason for your depression first of all keep one thing in mind that never leave a job unless you are sure that you will be getting a good offer since there is a study gap so you will have to try hard in order to get a good offer continue to do your work sincerely and you will definitely get success suicidal ideation low mood poor confidence etc all resulted in severe depression if you are not able to control your depressive symptoms then please consider consulting a psychiatrist for opinion out of your depression you are getting irritated and this is resulting in arrogant behavior which later causes guilt so to come out of these symptoms please visit a psychiatrist for treatment"
    },
    {
        "instruction": "hi doctor I have a slight bulge on my tonsillar wall which is different compared to the other side should I be worried it is not a different color",
        "input": "",
        "output": "hi I have seen the pictures you are having chronic tonsillitis there is an enlargement of tonsils no other abnormality is there so you can relax please tell me what symptoms are you having and what medicines have you been taking so far so that I can suggest you better follow up with the required information"
    },
    {
        "instruction": "hello doctor I have been treated for anxiety disorder for the past eight years they are now suspecting a thyearoid problem I have lost more than 25 labs in the last eight weeks which has triggered the doctors to look closer into this I have elevated anxiety shaky and unsteady high pulse rates especially in the morning 100 15 beats per minute and fatigue I am currently taking xanax I have attached a couple of blood tests that I have on hand please let me know your thoughts",
        "input": "",
        "output": "hello I just read your query and saw the results which you have attached and it appears to be an absolutely normal thyearoid function test results as your ash thyearoid stimulating hormone is within the normal range your thyearoid function is normal the slightly high to is not responsible for your symptoms since it is just a variable component so as long as your ash is normal your thyearoid function is normal although you have impaired blood sugar levels since hba1c glycated hemoglobin is normal therefore just diet control will help take low carbohydrate and low fat diet with daily 30 minutes of walk you could benefit from a prior egg electrocardiogram I would suggest taking tablet bisoprolol 5 my once daily for your tachycardia and anxiety it will decrease your heart rate to normal levels and help you with your anxiety as well try also to do yoga and meditation daily I hope this helps"
    },
    {
        "instruction": "hi doctor I have schamberg disease dry skin on face ears scalp and mustache redness on face steroid induced erythema geographic tongue and fissure tongue please help",
        "input": "",
        "output": "hi schamberg disease is a progressive pigmentary dermatosis which basically involves lower legs have you consulted a dermatologist earlier please send images of body parts involved and revert back also are there any associated symptoms"
    },
    {
        "instruction": "hi doctor I am a 37 year old police officer who has been in the job for over 19 years I have seen tons of tragedy in my career I have always been a hypochondriac and ultra sensitive to any irregular heartbeats or heart related issues I grew up around a family who always helped each other out and was cared for by my grandmother mom and dad always worked the older family members have all since passed away but I think growing up with them and my job has done me more harm than good I now constantly question every single thing I feel going on with my body I am 6 and weigh 170 labs I do not typically work out since we have a ton of animals at my house so I am doing an activity with them daily I would not call it a workout but it is me moving around I am currently on several medications since I have high blood pressure and anxiety I take lisinopril inderal hydrochlorothiazide asprin fish oil and nexium a few years ago I had one brief episode of a fib they believed it was holiday heart syndrome my rhythm reset itself and never had that issue again so with that being said lately I have been feeling down and out about my health I bring a laundry basket from my basement up to my second story bedroom and I am out of breath I constantly think about having a heart attack I am so worried that it makes me sick to my stomach and also my anxiety starts to give me symptoms I have been so worked upon certain occasions that I actually went to the er and they said nothing was wrong I do not know what to do to stop thinking about this and worrying it is going to happen to me my family does have hearth issues but all lived well past their 80 I had an episode a few months ago where I started to get really nauseous and felt like my heart was skipping a beat when I felt it skipping a beat is when I felt the overwhelming nauseous feeling I went to my cardiologist and he gave me a monitor to wear he did notice that I had an extra heartbeat from time to time and said it was completely normal I told him I can feel this each time and it gives me extreme anxiety I am afraid it is just going to stop beating I had a stress test was done about months ago and all normal another one of my big fears is that my arteries are clogged or getting clogged I wish there was a non evasive way to test this so that I can ease my mind that is what I need a way to ease my mind that everything is working as it should and no issues I know it may sound weird but I just need peace of mind I do not know what to do at this point I do not want to have a heart attack and I want to stop thinking about it all the time what can I do how do I know that when I feel these extra heartbeats it is normal I have never had an abnormal ekg besides when I had the round of a fib this is most likely why I have high blood pressure and anxiety is there any hope for me getting over this fear I do not want to be the 37 year old that has a heart attack",
        "input": "",
        "output": "hello I appreciate your detailed write up it made it easy for me to understand what the problem might be I really do understand your situation having to constantly live with fear of having a heart attack can weigh you down but I assure you everything is fine the extra heart beats you feel are called palpitations they are harmless and do not pose any harm stress caffeine smoking sleeplessness are often the cause the ekg stress test lipid profile tests are enough to tell us if you have a chance of heart attack to some extent you are fine since these results are normal you should avoid from fear of a heart attack most likely the cause of your high blood pressure is because you are overweight at 37 high blood pressure is quite common amongst overweight people I advise you start a proper workout for atleast times a day for 30 minutes to an hour this will help your palpitations and will bring down your weight get sufficient sleep avoid smoking or caffeine and diet these will reduce the rate at you get palpitations avoid worry it kills faster than any disease your test results are enough to prove that you do not suffer from heart disease"
    },
    {
        "instruction": "hello doctor I have two inner ear conditions both are somewhat rare right semicircular canal dehiscence and left patulous eustachian tube dysfunction what I want to know is whether I can fly take an airplane without getting ill and sustain further inner damage",
        "input": "",
        "output": "hi super semicircular canal dehiscence is a rare inner ear condition in this condition there will be giddiness and imbalance when exposed to loud noise and imbalance echoing of once own voice etc this condition usually does not get worsened by change in environmental pressure so air travel will not be an issue in this condition in any case keep anti vertigo medications such as stemetil handy when you fly patulous eustachian tube is a condition involving middle ear and nose my guess is because of similarity in symptoms you have been given both the diagnosis I can say that if there is vertigo then it is superior canal dehiscence if there is no vertigo chances of patulous eustachian tube are high in any case people with patulous eustachian tube will have certain degree of pressure symptoms in ear when they fly but most of the times it will not be very severe you can use simple saline nasal spray before boarding the flight and every two hours in air to reduce symptoms"
    },
    {
        "instruction": "hello doctor my age is 28 I had a unprotected sex a month back but only the top part of penis inserted into the vagina it was not a full sex and the sperm was on the outer part of vagina actually I am confused later I took an spill after one hour I missed my periods this month I took a pregnancy test with showed negative result after days today I took a test with prea kit and cipla kit both results are negative but I am so tensed about my periods am I pregnant or is this the side effect of I pill",
        "input": "",
        "output": "hello as pregnancy test is negative you can wait for 10 days more for the periods to start if no periods by that time then repeat pregnancy test if test is negative even after 10 days then you can take tablet norethisterone my twice a day for days to get period you should be getting periods within 15 days of finishing the tablets the delay in periods could be a side effect of I pill follow up with me in need take care"
    },
    {
        "instruction": "hi doctor if you perforated your rectum from anal sex would you know within five hours I am feeling more gas than usual",
        "input": "",
        "output": "hello I read your query and understand your concerns in my opinion any tear involving mucosa can be known to the individual within seconds rather than hours I mean to say that if there is perforation of rectum you will know it within seconds and five hours are not required the symptoms often include excruciating pain at the affected part and tearing sensation I hope this helps"
    },
    {
        "instruction": "hello doctor I went to a beach and I ordered for conut water possibly when the conut water was given there was a straw that the conut vendor put in the conut with his hands on that day my lips were chapped or cracked I drank the water by the straw after that I saw that the fingers of the conut vendor were bruised and blood might have had been put on the straw by him accidentally which might have had touched my chapped lips if in case if the conut vendor had hiv could it be possible that the blood on the straw could have had touched my chapped lips and infected me",
        "input": "",
        "output": "hi your risk of hiv human immunodeficiency virus acquisition is unwarranted in this case hiv can only be transmitted by sexual contact through the exchange of contaminated syearinges or needles blood transfusion or there can be vertical transmission from hiv infected mother to her child during pregnancy delivery or through breast milk hiv cannot survive outside the body or even in the old healed lesions or bruised sites"
    },
    {
        "instruction": "hello doctor I am on birth control pill femilon for the last three months and I have followed 21 regime from the last three months I got my last two periods on the ith and ith pill free days respectively and now I have advised to follow 21 day regime by my gynecologist for proper efficacy of pill I am still being confused that I have to continue 21 regime or 21 my gynecologist said to me do not think about your menses just follow 21 regime whether menses come or not so I want to ask is it normal to lost menses for two to three months because I feel that if my menses came on ith or ith pill free day on 21 7regime then if follow 21 then I have to start my pack on the ith day after five pill free days and if my menses will not come in these five days then after starting the new pack my menses will not start still a month is it normal what I have to do",
        "input": "",
        "output": "hi how are you doing I would sincerely advise you to keep having pill in the 21 pills pill free cycles this will avoid all the confusion hormone control will be the same if you take pill free or pill free cycle we give the gap for proper hormone withdrawal so that the bleeding will be completed and the inner lining of the uterus is completely lost so I would say you just follow the three weeks pills and one week pill free cycle"
    },
    {
        "instruction": "hi doctor when flaccid my penis is 3 inches and sticks straight when erect it points straight up to my chin and has a large curve back to my belly button my erection feels tight I am circumcised I also have very tender testicles and after sex my lower back hurts and so do my testicles",
        "input": "",
        "output": "hi from what you say it seems to be excessive upward curvature of penis towards belly button though it is abnormal no active treatment is necessary as long as you are able to have sexual intercourse only when it prevents sexual intercourse treatment may be pursued a photo taken during good rigid erection can help in better suggestions regarding treatment pain after ejaculation is usually due to retrograde ejaculation if ejaculate is coming out of the penis then there may be partial retrograde ejaculation check your urine after ejaculation for any evidence of semen by testing in a lab consult a urologist to examine you and to suggest appropriate drugs for post ejaculatory pain"
    },
    {
        "instruction": "hi doctor this is about my brother earlier he used to get very angry over small matters he was not able to concentrate on anything and was not able to sleep he was confused and used to think that everybody was watching him he used to harm the family members sometimes he started his medications three months back he was on fluoxetine 40 aripiprazole 10 quetiapine 50 and divalproex 750 he is now calm but has tremors in his hands and legs and feeling numbness in head and is very confused he is feeling as if he is mad he is mostly confined in home and hardly goes out need your advice on what to do and when he will feel better is antidepressant fluoxetine not working",
        "input": "",
        "output": "hello I read your query and understand your concerns first of all I would like to inform you that three months are generally enough for the antidepressants to show effects secondly 60 my of fluoxetine is generally a sufficient dose for antidepressant purposes considering the fact that there is some response despite the presence of adequate dose for sufficient time indicates the possibility of partial response thirdly the above observation is not unique as problems are often encountered in patients with long duration of untreated illness now regarding the tremors I think divalproex is likely to cause tremors as a common side effect in my opinion 250 my of divalproex has a little role on this day as his aggressive behavior already reduced regarding the next course of action I feel adding another antidepressant is the first option in case there are reasons for not doing the same adding low dose antipsychotics can be used provided there is aggressive behavior still present I often prefer low doses of olanzapine my to boost up the effect of fluoxetine I must assure you that over a period of time he will improve further I hope this helps"
    },
    {
        "instruction": "hi doctor I am 30 years old I just want check whether my e values are proper not because I am suffering from most of the symptoms of high estrogen levels like enlarged prostate extreme fatigue anxiety muscle loss belly side fat loss of libido knee and joint pains etc for more than 10 years around six months back I got checkups for gastritis there they said it is minor gastritis only and all readings are good including thyearoid but better to check for e and spa levels as they see enlarged prostate do I need to take any medicines to inhibit levels like arimidex please check the below readings testosterone 580 43 pig my prostate size ca weight 75 keg mi 25 height 172 am visceral fat 10 body fat 27 9",
        "input": "",
        "output": "hi I read your query and understand your concerns first of all I would like to inform you that your testosterone is completely normal but not estradiol the maximum physiological level is 40 pg my and the level above this rings alarm bell and should be investigated the increased level of spa prostate specific antigen along with prostate enlargement indicates there is abnormal aromatization of sex hormones which could be due to simple overweight to sex steroid secreting tumors regarding the treatment there is a definite need for treatment and aromatase inhibitors could be the right choice for you there are multiple options for this purpose including arimidex I hope this helps"
    },
    {
        "instruction": "hi doctor I am 31 years old and weigh about 54 keg I underwent appendix operation before four years and the histopathology came as appendix with mutinous cystadenoma after a few months I started getting stomach pain and constipation and doctors used to give me stool softners my stomach pain became severe before two years and I got admitted to the hospital they did a colonoscopy and said everything is normal but my problem did not go off recently again I got admitted in the hospital due to severe pain and they did right hemicolectomy and said I have a mutinous carcinoma and it is not curable only death can be postponed by giving treatment kindly advice and help me",
        "input": "",
        "output": "hi I have read your query and seen the attached files but nowhere is it documented that it is mutinous carcinoma and that it has spread the uploaded colonoscopy was not done recently what was done after that till now please upload all the doctors notes and recent investigation reports for thorough advice"
    },
    {
        "instruction": "hi doctor I had unprotected sex before three days today it is almost 72 hours completed I have taken mifepristone 200 my are there chances of pregnancy still",
        "input": "",
        "output": "hi welcome to icliniq com there is a less likely chance to get pregnant as you had taken your contraceptive within 72 hours of unprotected intercourse"
    },
    {
        "instruction": "hello doctor I am married from last years and I am suffering from sever premature ejaculation sometime ed also from beginning mostly ejaculate in less then minute I used prosolution pills boostero climaxagen pills nothing works for me only promescent sprays works for delay but it will cause erectile problem below are my details also I am attaching my complete lab test including ultrasound let testerone abc cholestrol gender male age 34 height feet inches weight 78 keg please recommend some medicine to solve the problem permanently",
        "input": "",
        "output": "hello I can understand your concern I have gone through the reports you have uploaded and almost all reports are normal except low testosterone relative to your age low vitamin levels and slightly altered lipid parameters you are 35 and your height is around 175 cand your weight is also in normal range in a lot of individuals obesity is one of main reasons for low testosterone but your mi is normal and also your main issue is me and not ed me is not related to testosterone levels and in most of individuals hyper excitation poor experience and anxiety are main reasons for early discharge I would advise you to start taking vitamin supplements 60k iu per week for at least months and this will bring the levels to normal range for me drugs like dapoxetine can be utilized you can use the drug on sos basis about one hour before sex and this will surely help to delay the ejaculation time the drug is safe to use and has no serious side effects dose of 30 my is normally used you can talk with a doctor for prescription of this drug this will help to treat your problem and in the mean time you will regain the confidence and your problem will go by own thanks and take care"
    },
    {
        "instruction": "hello doctor a 5 year old young girl got ray diagnosis bronchopneumonia but her blood tests are all fine nor she has a temperature just cough we would like to see a second opinion on ray images",
        "input": "",
        "output": "hi I have viewed the ray chest image sent by you there are mildly prominent lung markings in the bilateral lines and this can suggest hyperactive airways or a mild lung infection there is no focal lesion or patchy opacity visualized there is no pleural effusion keeping in mind the above findings there is a possible mild respiratory infection there is no obvious pneumonia patch visualized it is important to keep track of the symptoms and report to your doctors if there is an increase in cough or persistent fever which I guess is not there right now"
    },
    {
        "instruction": "hello doctor I and my partner had healthy sex the next day she had periods and after six days we had unprotected sex due to which she had taken I pill on that evening two months passed she still did not get her periods I am worried please suggest any solution two years back also she has taken I pill this is the third time she is taking is it possible that she may not have periods for the whole life please help",
        "input": "",
        "output": "hello it is unlikely to be caused by I pill does she has any underlying periods problem it is probably not a permanent problem and she will have her periods soon at this stage we first need to rule out pregnancy she should undergo a urine pregnancy test twice at an interval of 12 hours for confirmation if it is negative then she will need a detailed evaluation of the cause she will need ultrasound pelvis for uterus and ovaries and hormonal profile like thyearoid function test serum fish follicle stimulating hormone and oh luteinizing hormone she should visit a gynecologist once for examination and for these investigations medicine could be initiated after ruling out the pregnancy and finding the cause I hope this helps"
    },
    {
        "instruction": "hello doctor there are skin lesions in a 29 year old female who happened to be healthy before the lesions started to appear two weeks ago it has now increased on hands back and foot there is no itching associated with it please help",
        "input": "",
        "output": "hi revert back with asked details to a dermatologist online"
    },
    {
        "instruction": "hello doctor I am a 28 year old woman I am suffering from a radiating pain that spreads from back to the lower half of the body I have this issue since a year it aggravates when I ride bike occasionally the pain may also radiate upward if I keep hard item then I get some relief I am taking muscle relaxants for pain relief please help",
        "input": "",
        "output": "hello revert back after the investigations to an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hi doctor I am a 24 year old unmarried lady now I am in a very panic period of stress and in seek of your advice I had intercourse with my fiance on the first day of my periods and again after 20 days that is on my most fertile day I got my periods 13 days later and it lasted for around three days first two days of the periods were little heavy compared to the third day usually my periods are a bit heavy and will last for at least five days I am worried about pregnancy after reading articles on implantation bleeding in order to get rid of this confusion I took two home pregnancy tests and both came up negative later on I underwent a beta hug test and the value was 3 as it was more than I went for another test in two days and the value got down to 75 now please tell me whether I am pregnant or not",
        "input": "",
        "output": "hi I understand your concern for further doubts consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor my daughter is months old she started rolling at her fifth month birthday she rolled for two or three days but she did not roll since yesterday is this normal",
        "input": "",
        "output": "hi for further information consult a paediatrician online"
    },
    {
        "instruction": "hi doctor I am hiv positive I am now years viral load free my cocktail consists of sustiva isentress and epzicom my doctor has suggested switching me to other due to the adverse effect of sustiva my genotyping indicates that I have a resistance to ziagen and epivir what are your thoughts in this issue",
        "input": "",
        "output": "hello revert back with the reports to a internal medicine physician online"
    },
    {
        "instruction": "hi doctor since last two to three years I have high blood pressure ranging 145 95 mhg this was mainly due to less physical activity and anxiety I had medicine thelma 40 telmaxx 25 etc only one at a time but be and anxiety did not get controlled again doctor advised me for cilacar my twice or 10 my once I found this effective in comparison to earlier medicine but since last two months I was not feeling comfort with my left chest it is not chest pain but occasional muscle cramp type feeling egg was taken that showed left atrial enlargement cardiac blood test taken including lipid profile found to be fine doctor prescribed me cilacar and ecosprin av 150 along with vitamins now again since last three days I am not feeling well same muscle cramp like feeling in chest occasionally I have no issues with my be also occasional pain in left hand again I have taken blood test for cardiac and other reports attached for your reference kindly advise me some best medicine and if anything emergency",
        "input": "",
        "output": "hi I have thoroughly gone through your case and reports and can well understand your genuine health concerns your lipid profile is all fine and there is no risk to cardiac muscles and blood vessels of the heart due to this cholesterol and its counterparts index is safe according to the blood work"
    },
    {
        "instruction": "hello doctor my sister takes 25 my pregabalin for fibromyalgia at am but it is not giving any relief from pain she has severe back pain we tried another 150 my at 10 am and the pain reduced fairly what is the right dose and at what time it should be given I am attaching her medicine list for your reference her vitamin is no my please guide",
        "input": "",
        "output": "hi for further clarification consult a rheumatologist online"
    },
    {
        "instruction": "hi doctor I met with a car accident three weeks ago I was injured and had trauma to the chest wall muscles my chest muscles went into spasm periodically but has subsided somewhat my right side lower chest is the only area still hurting after rest for a long period or sleep when I activate the muscles in that area I have cramps my question is will chiropractic service help alleviate the pain",
        "input": "",
        "output": "hello take nsaids nonsteroidal anti inflammatory drugs for a couple of weeks get myofascial release mfr and strengthening go with local gel application and ice massage ultrasound therapy for further information consult a chiropractor online"
    },
    {
        "instruction": "hi doctor I have tremors on my left hand I am on amantrel 100 my ads frisium 30 my and propranolol 40 my I have been through two stents in my heart but I have no myocardial infarction I am on beta blockers talent 40mg od and retorlix my od my neurologist says this as rural syndrome and my very senior physician said this is more likely to be muscle weakness because through a strict regime I have come down to keg from 140 keg in the past 19 months I would like to slowly discontinue frisium because it makes me drowsy my question is should I taper one medicine after another just to see what works best the physician told me to stop all medication completely which I do not think as a great idea can you please help",
        "input": "",
        "output": "hi I understand your concerns let me try to help you rural tremors slow tremors at rest parkinson disease parkinson plus disorders group of neurodegenerative disorders parkinson disease continue tablet amantrel amantadine do daily morning and evening 45 minutes of walk revert back after two weeks to a neurologist online"
    },
    {
        "instruction": "hi doctor I am suffering from acute lower back pain for the last five days now I am getting better with medications and bed rest this severe and acute pain happens every six to nine months since the last four years it knocks me out for three to four days on a regular basis I have lower back stiffness and dull pain especially in the mornings it gets better through the day I regularly exercise am of brisk walk along with cross trainer cycling and even skipping without much discomfort my current medications are ultracet and tizan an mri has been done and the report of which I have attached I request you to interpret the report and tell me the diagnosis and treatment options",
        "input": "",
        "output": "hi I have read your mri report for further doubts consult an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hi doctor my urine is yellow in color for the last two months one week back I had blood test urinalysis and lfts all the reports were normal what is the reason for the yellow color of my urine",
        "input": "",
        "output": "hello high colored urine can be because of various reasons drinking less water in the hot weather can also cause high colored urine revert back with the answers to a forensic medicine physician online"
    },
    {
        "instruction": "hi doctor for the last two years I have been suffering from severe chest pain the exact location is behind the breast and the pain radiates to the left hand I have done enough of evaluation like tit ad echo lipid profile mri thoracic area mri cervical it chest with contrast and other blood test none of these reports are positive or identified any issue or problem I have visited cardiologist neurologist psychiatrist and general medicine doctors everyone tried to give me some painkiller and that works for a week and then the pain will be back after a week or so over last three months the pain is so severe and I am rushing to the nearby hospital they used to take an egg and give me three to five injections through iv to control the pain I am sick and tired in finding the root cause and also very depressed because of this pain I am unable to bear it most of the time please help me out in directing a right specialist or doctor to visit who can get me some relief from this pain as I am unable to concentrate my professional and personal life is on stake because of the pain I am looking forward for your quick response",
        "input": "",
        "output": "hi we are here to help you revert back with the endoscopy report to a cardiologist online"
    },
    {
        "instruction": "hi doctor how long will a benzodiazepine that is valium and nitrazepam remain detectable through urinalysis the drug has not been used so long may be of seven to eight days what is the best method of detoxification",
        "input": "",
        "output": "hi taper off the valium diazepam and nitrazepam by 10 every four to seven days in case of higher dose reduce the dose by 10 per week revert back in a month time to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I have been sick for two years I was diagnosed with hav two years back but no treatment was done recently I was diagnosed with anemia I have lower back pain fatigue tingling in legs right and left pelvic pain currently I am taking effexor and adderall I had an ultrasound done what does the ultrasound show",
        "input": "",
        "output": "hi the outcome of ultrasound is as follows for further information consult a radiodiagnosis physician online"
    },
    {
        "instruction": "hello doctor I am a 50 year old male I am attaching a picture of blister like formation on my right ankle which is very old one and is present without any pain now I am feeling some uneasiness while wearing shoes though still there is no pain is it of a sincere concern that to be taken care of immediately I did not mind it till my elder sister started insisting me to investigate the matter in recent past it is also to note that the size has recently been increased very slightly since its formation probably 20 years back please advise and remove my anxiety",
        "input": "",
        "output": "hi I have gone through the pictures for further doubts consult an internal medicine physician online"
    },
    {
        "instruction": "hello doctor do you know what kind of mitochondrial poison can stay in the body for more than five years I have a patient with symptoms which looks like a mild mitochondrial poisoning for the past five years there are only few mitochondrial poisons so do you think any one of them can stay in the body for such a long period",
        "input": "",
        "output": "hi for further information consult a pharmacologist online"
    },
    {
        "instruction": "hi doctor I got my lipid test done my cholesterol was 24 and lil was 124 after how long should I get the test again please guide",
        "input": "",
        "output": "hi revert back with the details to an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I have a sore shoulder and neck in the back of my neck I feel a lump I can feel it when I bend my neck forward and on my left side I also get some burning sensation in my neck please help",
        "input": "",
        "output": "hi for further doubts consult a chiropractor online"
    },
    {
        "instruction": "hello doctor I am having a problem with my penis it feels hard like a hard rubber tube even while flaccid the veins have also become very prominent sex is now painful and my penis becomes sore and red after intercourse I had all the tests done all sad tests came out negative the problem has been for six months and none of the urologist that I have been to are able to tell me what it is I am getting erection but I am unable to maintain it I have also noticed that since this problem began I have started to sweat profusely during stressful situation in my daily life is this a stress or pelvic floor related issue please help me out as this is affecting the sexual health of my marital life",
        "input": "",
        "output": "hi I have read and understood your problem revert back with the reports to a urologist online"
    },
    {
        "instruction": "hello doctor my mother is getting varicose veins it has just started I just noticed these bulging veins today I suspect the reason is chronic constipation and absence of hunger chronic pathogenic infection of gi tract may also be there flatulence and low energy levels are also present what to do",
        "input": "",
        "output": "hi revert back after the ultrasound to an internal medicine physician online"
    },
    {
        "instruction": "hello doctor my mother is suffering from thyearoid high uric acid 8 and be due to which she is not able to sleep and has cough from two weeks she has been taking the medicines recommended to her please help",
        "input": "",
        "output": "hi revert back with the asked details to a general medicine physician online"
    },
    {
        "instruction": "hi doctor my wife is suffering from left knee pain while walking she drags her left leg but she can fold her knee normally it started a few months ago without any cause what is it",
        "input": "",
        "output": "hi revert back with the knee ray to an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I would like to know about pseudomonas species infection its treatment and risk factors please guide",
        "input": "",
        "output": "hi for further clarification consult an ent otolaryngologist online"
    },
    {
        "instruction": "hi doctor whenever I eat sweets I get hyperactive I feel like running and after a few minutes I used to get headache can you help me understand what kind of disease is this do we have a name for it how do I control it how can I treat my headache do I need to go for any special treatment",
        "input": "",
        "output": "hi we are here to help you for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hello doctor my wife who is months pregnant was slightly scratched by a cat almost half a drop of blood was visible on one of the scratch cat is not vaccinated it just sleeps and eats in our house please help",
        "input": "",
        "output": "hi avoid handling cat litter follow up in two weeks to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor are amplified musculoskeletal pain syndrome and fibromyalgia the same thing if not what are the differences between them my current medications include topamax neurontin cyproheptadine zyeartec peppermint oil capsules and vitamin b2 thank you",
        "input": "",
        "output": "hi for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am 26 years old I have noticed that sometimes I wake up with my heart beating too fast and can feel my heart this first happened when I woke up and took a look at my little child and thought my child was not breathing that time my heart rate increased strongly after this sometimes when I take a nap in the afternoon I woke up with heart rate increasing and little pain in chest that lasts for a few seconds my heart goes back to normal within a few seconds it does not happen at night I am a stressful person and always worried I am overweight too also I have trivial my that was diagnosed last year but I was not advised to have any treatment my oxygen level is always above 96 what do you think about this is it just due to anxiety or a heart problem",
        "input": "",
        "output": "hi please follow exercise and diet to reduce weight trivial my mitral regurgitation can progress and cause atrial fibrillation irregular fast heart beat so for now check your thyearoid functions to and ash thyearoid stimulating hormone egg electrocardiogram echo to see my status and hotter monitor a 24 hour egg take a tablet lonazepam md 5 my clonazepam under tongue while you have this episode because it can be due to panic or anxiety check plasma glucose for diabetes and check lipids also revert back with the reports to a cardiologist online"
    },
    {
        "instruction": "hi doctor I am a 23 year old male I am facing a few issues for which I seek your help I have oily face but a very dry body skin please advise what I can do to overcome this I stay in a joint family and as a result have to masturbate very privately most of the times also most of the times I end up masturbating with my underwear and cum remains trapped in the foreskin of the penis as I do not get an opportunity to freely ejaculate I would like to know whether this will result in any infection or other health issue at times I wake up with early morning erections which are embarrassing please help",
        "input": "",
        "output": "hi I would like to reply it in pointwise for further information consult a venereologist online"
    },
    {
        "instruction": "hi doctor I am suffering from dizziness I was getting lightheaded and close to fainting lately I have been passing out a lot I have an early morning flight tomorrow is it safe to fly is there a possibility of me fainting on the plane my current medication includes prozac trazodone and gabapentin",
        "input": "",
        "output": "hi for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am having mild chest pain over the last three days I also feel lazy and less energetic for few months I have done routine checkup can you please give suggestion based on the report attached",
        "input": "",
        "output": "hi get egg electrocardiogram ad echo and tit test treadmill test to rule out any cardiac risk your homocysteine levels are little high which may be the factor responsible for hypercoagulable state repeat homocysteine after a month take tablet folvite my folic acid once daily do regular exercise as it can control your borderline raised cholesterol do overlook for any numbness in legs or breathing difficulty revert back with the reports to a cardiologist online"
    },
    {
        "instruction": "hi doctor I believe that I have extreme hyperhidrosis my entire body sweats profusely when I experience even the slightest change in temperature start exercising and even when I am simply resting my back armpits forehead and buttock sweat the worst and this affects my entire body it has prevented me from going out in public on some occasions and doing anything social about an hour into my day my clothes are soaked with sweat no matter what I do I have tried drysol and over the counter antiperspirants but they did not help either I do not know what else to do you have any advice",
        "input": "",
        "output": "hi I have read your query and can well understand your concern for further information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor for the past two months I have had ongoing right breast pain it first began as sharp stabbing pain that would last only a few seconds now I am getting some nipple discharge and burning sensation when I spoke with my doctor about it she said it might happen sometimes I had some blood work done for my hormones which confirmed my testosterone was high I have attached my hormone test report for your reference I am taking now estradiol my progesterone 80 my and testosterone my applying ca to inner thigh daily my previous history includes complex ovarian cyst hypertrophy of uterus dysmenorrhea menorrhagia and hair loss should I get further testing from another doctor last year it was confirmed on ultrasound that I have two cysts in my right breast could this be the cause for my issues sometimes applying a heat pad to my right breast helps at times it will swell up so large and I feel like it is going to burst this is concerning me please help",
        "input": "",
        "output": "hello check prolactin level and repeat ultrasound of the breast if last one was more than six months ago hyperprolactinemia fibrocystic breast disease try vitamin and also continue other medications for further doubts consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am 28 years old and suffering from facet hypertrophy I have continuous lower back pain I cannot stand for more than five minutes I am taking nuroday daily I would like to know the treatment",
        "input": "",
        "output": "hello degenerative disc disease mri spine and rays of the affected part of spine revert back with the reports to an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hi doctor my son has storage pool defect now his doctor suspects crohn disease on him all cut tests will result in horrible bleeding time should hematology be involved should the doctors use coagulant as a precaution your further advice would be helpful thank you",
        "input": "",
        "output": "hi based on your query my opinion is as follows if planning for biopsy then platelet for transfusions to be kept ready along with antifibrinolytics revert back for further doubts to a hematologist online"
    },
    {
        "instruction": "hi doctor every month I am getting some burning sensation and my urine is very dark that time also I get body ache and slight fever now from yesterday I am having the same problem I assumed it as when my water intake is reduced I get this problem and started drinking more water is this the reason or anything to be concerned thank you",
        "input": "",
        "output": "hi for further information consult a family physician online"
    },
    {
        "instruction": "hi doctor I am 28 years old I am suffering from sore throat and earache I have white spots on the inner right side of my throat when I eat anything chill throat will be more painful from childhood I am getting the problem for at least once a year now this is the second time in six weeks couple of weeks ago I got pink eye pictures attached were of my throat and medicines I am using I am allergic to amoxicillin and had a bad reaction called erythema nodosum",
        "input": "",
        "output": "hi for further information consult an ent otolaryngologist online"
    },
    {
        "instruction": "hi doctor one year back I had problem in my right knee like loose feeling instability slight pain etc when I consulted a doctor he suggested cartigen duo miol od and acepark gel in ray he found that the pain was due to cartilage damage in knee I continued full course of medicine and after that there was no problem in knee I have attached that ray report and doctor prescription here for your reference if I walk long distance then problem starts again and it gets cure as soon as I apply that gel however since last week again the problem started this time I am using kneecap for support while walking what is the exact problem with my right knee should I start cartigen duo and miol od again please suggest any alternative gel as the earlier one is not available what should be done for permanent cure of this knee problem can I walk long distance what precautions should be taken for knee pain I am looking forward for your positive reply thank you",
        "input": "",
        "output": "hi I have gone through your history as well as the images attached with it for further information consult an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hi doctor I am suffering from memory problem I am in 12th grade now my aim is to get into mobs but I do not remember anything that I learnt in 1th grade I do not even remember what I studied a week before please get me a solution",
        "input": "",
        "output": "hi for further information consult a psychologist counsellor online"
    },
    {
        "instruction": "hi doctor my husband often goes on long trips for work we have sex normally in an interval of 15 to 20 days we are together for two years but I still cannot satisfy him the problem is whenever we have sex the first time it goes smoothly but after that I have so much trouble to get intimate I have allergy of condoms whenever we use them I get rashes in my vagina and it hurts so badly it burns like hell because of that I cannot get involved with him even without condoms I get that bruises on my vagina after two or three sessions and so I cannot have sex due to pain how to treat this situation is there any problem with me do I need any checkup please let me know thank you",
        "input": "",
        "output": "hi condom allergy psychological reasons for further doubts consult a sexologist online"
    },
    {
        "instruction": "hi doctor five years ago I was licked by a domestic dog on my foot there were cracks below my foot but I did not know whether the dog touched those cracks or not the dog lived for another four years and died is there is any use if I take rabies vaccine now",
        "input": "",
        "output": "hi for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I had a bike accident is it possible to lose one intelligence or iq from a head injury",
        "input": "",
        "output": "hi I am sorry to hear this revert back with the detailed history to a neurologist online"
    },
    {
        "instruction": "hi doctor my mom is 62 years old diabetic patient the following details are her thyearoid gland ultrasonography report thyearoid gland is in the normal position the size of the thyearoid gland is increased and extends to the substernal area in the right lobe of the thyearoid gland there is a cystic degeneration area of 32 26 my and there is a heterogeneous hypoechoic solid nodule containing calcifications also there is a my diameter solid hyperechoic nodule in the left lobe of the thyearoid gland there is a 10 my hypoechoic solid nodule both of the thyearoid gland parenchyma structure is in homogenous appearance neck soft tissue is in normal view no detection of pathologic lymph node the main vascular structures are in normal view the results are substernal goiter and thyearoid nodules identified the thyearoid test revealed ash 607 miu normal 27 2 miu ft4 64 no do normal 9 7 and ft3 72 pig my normal pig my based on the above what is the risk of thyearoid cancer",
        "input": "",
        "output": "hi for further information consult an endocrinologist online"
    },
    {
        "instruction": "hi doctor I am a 25 year old female I have got some pale discoloration patches on my back as can be seen in the attached picture these started a few months back as point sized spots and slowly grown to present size it is not itching or painful I am from rural area please let me know the diagnosis and treatment thank you",
        "input": "",
        "output": "hi for further information consult a dermatologist online"
    },
    {
        "instruction": "hello doctor recently I was diagnosed with an intercostal strain the symptoms are pain in the area of strain and swelling unfortunately I have developed a frightening symptom where I am coughing up blood coated mucus my father who worked as an emt says that it is not an emergency and that I should be fine however I am still concerned the amount of blood in the cough is not exponential but it is noticeable it is not frothy or painful to cough outside of the pressure it puts on the muscle strain I do have allergies and I am a smoker I also suffer from anxiety and depression I am years old I can breathe deeply although with pain to the strained area should I go to the doctor tomorrow or is this just a side effect or something I also take zoloft 100 my ibuprofen 800 my thrice a day for pain and cyclobenzaprine 10 my at night",
        "input": "",
        "output": "hi revert back after the tests to an internal medicine physician online"
    },
    {
        "instruction": "hello doctor my mom took 40 my of geodon accidentally and has also taken the following medicines that are on severe interaction list with geodon in the last 24 hours zithromax codeine thyearoid medicines omeprazole triamterene and hydrochlorothiazide she is sleeping now for 5 hours after taking geodon 40 my orally and having stomach ache she also used albuterol and steroid inhaler she has prescription for medrol dosepak but has not yet taken she also takes vistaril but her last dose got over 72 hours back please help",
        "input": "",
        "output": "hi for further clarification consult a pharmacologist online"
    },
    {
        "instruction": "hi doctor I am overweight for my age I am wondering whether you could help me out I also feel that I have male breast enlargement I just wanted to check what I can do further",
        "input": "",
        "output": "hello for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I had a put done when I asked about the results my doctor said they were fine that was not good enough I have fev1 fac ratio of 64 increase in residual volume to 156 what does this mean my echo is with ef of 50 I am a 31 year old non smoker I am a wildland firefighter I am 2 overweight and I have pitting edema in my legs up to my knees for about 4 inches deep I have been using albuterol every 30 minutes or so for about six months now every day is worse and I am so exhausted I cannot exhale I am air hungry but too full to inhale sometimes I have a bitter thick clear jelly when I cough up there is no pus green or yellow though and it is somewhat like a sticky jelly I am currently taking spironolactone and advair please help",
        "input": "",
        "output": "hello thank you for writing your query elaborately allergy avoid known allergen for further information consult a pulmonologist online"
    },
    {
        "instruction": "hi doctor three years ago my right hand was accidentally ran over ray showed no broken bones but throughout the year I had extreme pain on the right hand side of my wrist next to the bone I never know when the pain on the right hand side of my wrist is going to happen or how long the intense pain will last it does not hurt to bend my wrist down but I cannot raise my hand up or turn my wrist in anyway sometimes the severe pain has lasted for 24 hours this happens twice in a month and my right hand is useless to do anything even simple stuff is impossible it keeps me up all night I felt severe pain yesterday while reaching for my wallet with my right hand set please help me to set of this debilitating pain I am desperate",
        "input": "",
        "output": "hi I have gone through your history for further information consult an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hello doctor my father is 93 years old with several comorbidities he fell suddenly and this happens to be his first fracture high blood pressure and diabetes both are under control with medication he also has two stents and a bioprosthetic valve he suffered a fractured hip it appears to be intertrochanteric fracture he is taking beta blockers blood thinners insulin and diuretics what treatment options are available is minimally invasive partial hip replacement possible please advise",
        "input": "",
        "output": "hi the images attached have very poor quality revert back with clear photos to an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hello doctor my brother has done a muscular biopsy I want to know whether the general functions of the mitochondria have been checked and verified in this muscular biopsy in the hospital they have checked the muscular biopsy and they are as follows atpases 4 63 35 menadione succinate dehydrogenase dnph phosphorylase adenylate deaminase and cytochrome oxidase",
        "input": "",
        "output": "hello for further information consult a family physician online"
    },
    {
        "instruction": "hello doctor I am 25 female suffering from intestinal tuberculosis and got operated three years back now I am undergoing medical treatment for that but I was experiencing huge hairball and I got a good and effective solution from here I am totally satisfied but I have one more query about my skin I am getting too much pimples and glow is totally vanished",
        "input": "",
        "output": "hi are you on any medications at present if yes please mention the medications depending on grade of acne further medications can be decided what is your daily skin routine at present what products do you use"
    },
    {
        "instruction": "hi doctor I am a male of 59 years diabetic for years and hypertensive for 19 years my hba1c always will be below and creatinine at 9 that is minimum recently I undergone microalbuminuria spot urine test which showed 141 my and complete urine analysis showed all the parameters negative including protein in the urine but traces of sugar from this should I be worried about kidney disease please comment I am currently taking the following medicines dog go morning and night rita met plus morning olmezest beta 50 one in the morning olmesar 20 my night and ecosprin av 150 my at night",
        "input": "",
        "output": "hi as you said your hba1c is below so it means your mean blood glucose level must be less than 180 my if it is so then your kidney is having the power to excrete the sugar but you stated there are traces of sugar in your urine if you had done your hba1c more then 60 days back then please get it done again and check what is your mean glucose level it is always mentioned below your hba1c reading and if less then 180 nothing to worry but if it is more then 180 then you need to control your sugar level please go through as advised below uncontrolled diabetes renal profile and hba1c early renal involvement type I diabetes mellitus continue with the same medicines you are taking it can only be changed once we get the tests done increase your physical activity do walking about to am per day avoid all type of sweets learn to say no when visiting your relatives or friends when they offer any sweet please consult once tests done"
    },
    {
        "instruction": "hi doctor I have just finished three rounds of chop for stage a diffuse large cell lymphoma and currently receiving radiation to my hip or groin recently I found another lump on my elbow bone not inside crease but outside two weeks ago my elbow was red and sore possibly bursitis but can feel a small lump underneath the fluid is it common for lymphoma to spread to these parts",
        "input": "",
        "output": "hello as per your history you had stage a dlbcl diffuse large cell lymphoma and have already completed chop on radiation currently which is standard therapy regarding the lump I would like to know since when it is present do you have any pain or tenderness experienced any trauma fever or involvement in sports mostly it looks like bursitis as it is very unlikely for stage ia dlbcl to affect this site and if consistency is suggestive of fluid underneath then it becomes highly unlikely I would advise symptomatic treatment and follow up"
    },
    {
        "instruction": "hi doctor my mom is always complaining of a severe burning sensation in her head she is 67 years old she has some problems detected by mri with a white matter like minute clogs she started forgetting short term events she is on medicine but the burning never goes away do you have a solution thank you",
        "input": "",
        "output": "hi what medications she is on currently do you have the mri report so I could have a look at it based on the mri we can treat her does she have any cardiac issues has she tried clonotril"
    },
    {
        "instruction": "hi doctor I have ed my penis does not erect whenever I tried to have sex with my wife it goes down in less than a minute I feel really bad please help me out regarding this",
        "input": "",
        "output": "hi I read your query and understand your concerns before we can make any conclusions I request you to provide the following details so an impression can be made about the cause of the problem how long are you facing this problem how the problem started whether it was sudden in onset or build up slowly over the months or years what is the frequency of the problem in a week or month are you able to have some successful sexual intercourse in a typical month out of what number of sexual interactions or masturbation do not achieve success what are the factors that increase the problem what are the factors that relieve the problem such as thoughts situations partner place etc do you get an early morning erection if yes how frequently and how intense is your partner very critical and demands sex more than what can you think does she feel superior to you or bothers you in some other regards what is the effect on your relationship so far due to this problem please share the details of previous or other medical illnesses like duration any complications treatment received to date medications you are receiving currently if any including ayurvedic homeopathic or any other medication you received in past and their effect do you have any psychiatric illnesses like anxiety depression fear etc what are the investigations done to date and reports of latest investigations such as serum testosterone ash to and any other I must assure you that once we identify cause it will be easy to correct it I look forward to seeing more details thanks and regards"
    },
    {
        "instruction": "hi doctor two years back my mother underwent uterine hysterectomy operation and she was given six cycles of chemotherapy when her ca125 result is 47 after six cycles she was back to normal before four months her ca125 levels are and now her ca125 is 350 and she has lesion found on the liver I am attaching the complete test results including it scan we are writing to you to get a second opinion regarding the treatment the present doctor suggested four cycles of chemotherapy for four months with four weeks interval we would like to know the present condition and the pros and cons of the treatment suggested is the situation too serious does the lesion go away with the chemotherapy or surgery is required what kind of diet should be followed to get well soon during chemotherapy",
        "input": "",
        "output": "hi I have seen the reports attachment removed to protect patient identity ovarian cancer recurrence is classified normally as platinum sensitive or platinum resistant since it is more than six months from initial treatment would be classed as platinum sensitive so the treatment options would be carboplatin alone three weekly or carboplatin plus paclitaxel three weekly sometimes four weekly since ca125 is a good surrogate marker you can monitor it every two months and scan after four cycles yes it is serious but it all depends on the degree of response to chemotherapy treatment is not curative but to keep cancer under control and to give two years disease free interval there is a good chance of response surgery is not an option no specific diets have shown to be beneficial"
    },
    {
        "instruction": "hello doctor at the time of marriage my age is 34 and my wife age is 29 she is having hypothyearoidism her thyearoid level was high so we were regulating with medication then she gets some stomach pain doctor diagnosed her with gallbladder stone we did laparoscopic cholecystectomy after one year of time we planned for a baby her hug report was positive at that time then after two weeks time she got a miscarriage doctor said it may be a chemical pregnancy then we tried for natural pregnancy but not succeded so we did a hysterosalpingogram we found that one of her tube is blocked we had hope on the other tube and tried again properly then we did laparoscopy for endometriosis doctor confirmed the blocked tube and the other one was also blocked partially now we decided to go for csi so I would like to know the checklist of hormonal tests to be taken prior to csi treatment please give me the hormonal test check list all required test names which day of the cycle and when fasting or non fasting this test sample to be given",
        "input": "",
        "output": "hi welcome to icliniq com the decision to go for if in vitro fertilization or csi intracytoplasmic sperm injection as per your history seems to be the right decision as I can see in history the age of your wife is now 30 plus ovarian reserve becomes an important analysis in the age above 30 years more so when she has endometriosis am anti mullerian test is the test for it irrespective of the cycle day also ash thyearoid stimulating hormone and prolactin test should be done the other tests may vary from center to center wherever you decide for treatment the above said tests are must along with a good ad and ad pelvic us ultrasound and semen analysis see your doctor in person with these reports"
    },
    {
        "instruction": "hi doctor I have had severe tummy cramps just under the ribs for about a month some days I cannot keep any food or drink sown but other days it is tolerable I have not been doing much bowel movement and feel constipated but when I do go it is still soft at first it was thought to be herd but the medication did not help and has lasted over a month now my doctor has booked me for an endoscopy to check for gall stones or ulcers I have not had any pain in the last few days and doing more of be does this mean the gallstones have passed do I still need the gastroscopy done I do not want to do any unnecessary tests the pain has been pretty severe but at the moment it is not too bad I am confused I am currently taking nortriptyline seroquel lamotrigine and metformin",
        "input": "",
        "output": "hi it seems you are suffering from acid peptic disease or acid reflux disease this usually presents with pain in the upper part of abdomen however I would like to rule out any evidence of gall bladder stones that can cause pain if you have any hunger pains any fullness of stomach or gaseous distension of the abdomen after taking meals you should go for upper gi endoscopy to rule out peptic ulcers ultrasound abdomen to rule out gall bladder stones I would advise you to take a combination of pantoprazole and domperidone and to take antiflatulent and antacid syearup like digene or gelusil for symptomatic relief do not consume any alcohol as even a small amount of alcohol can precipitate that there is an infection called pyloric infection which causes recurrent gastric and duodenal ulcers and such episodes of acidity so if during an endoscopy your doctor finds ulcers he would take a biopsy and rapid grease test done for pyloric infection and to get it treated share my opinion with your doctor before acting upon it I hope this helps"
    },
    {
        "instruction": "hello doctor I am one week late as of today for my menstrual period currently my cycle is 38 days I have been having protected sexual intercourse the past month but just recently day 35 of my cycle the condom of my partner leaked at the base so I immediately took emergency contraceptive which is four birth control pills at am then another four birth control pills at am the following morning I started feeling the side effects but I am worried since my period is a week late already and I just woke up at am on day 38 unable to sleep with a weird feeling in my stomach and I am extremely constipated with tender breasts and feel sick overall I would like to know if my period will come soon if there is a possibility I am pregnant or if I am just feeling all these symptoms due to hormone imbalances what I should do in this whole situation since I am very worried about it",
        "input": "",
        "output": "hello yes you are right your period will come soon and that is most likely possibility your symptoms can be due to both pregnancy and or hormones because in pregnancy there is increase in amount of hormones and you just take higher dose of hormones and symptoms you are experiencing is due to the higher level of hormones in your body which can be due to both reasons but it is more likely that symptoms are due to the pills you had taken because if it is due to pregnancy then pregnancy must be due to earlier intercourse which was protected so there are very fewer chances of failure in that case and right now your periods also get extended due to the pills you had taken basically in this situation you should do a urine pregnancy test and see if it comes positive then it is due to the failure of previous precautions and if it turns to be negative then just wait for seven more days and periods will come and even after that if your symptoms are increasing in two days then you need to go for a test for confirmation to clear the confusion drink more water and do not take much tension with your history it is more likely that it is just delayed menses due to emergency pills and side effects of oral hormones your period can be irregular for one or two cycles"
    },
    {
        "instruction": "hello doctor I am a year old male yesterday I had sex with a guy we had protected anal sex for one to two minutes only apart from this we both had oral sex at first we had unprotected oral sex and after that we had protected one none of us ejaculated during the whole sex after one day I am having sores in the penis and mouth now I am having a fear of getting hiv so I want to ask that what are the chances in the above situation of getting aids if my partner is hiv positive when should I get tested for hiv if supposed I had sex today can I have a per hiv test for now and how accurate is this",
        "input": "",
        "output": "hi I need the following details to help you better whether your partner is infected with hiv or any history of multiple sexual contact chances of transmission of hiv is more among homosexual individuals have you noticed these ulcers frequently or how long these ulcers are present over your genitals"
    },
    {
        "instruction": "hello doctor my father is 63 years old and is diabetic he is suffering from swelling of testicle before this he suffered from urine infection from coli bacteria and the treatment lasted for one month initially he underwent his treatment in my hometown and later went to the nearby city for treatment doctor suggested to take antibiotics for 10 days and wait for 15 days and asked to come for re checkup doctor told us if there is no improvement then he suggested my father to remove his swelled left testicle please find previous reports and the recent one as well could you please explain the report and disease and also let us know is it something serious should we change our doctor is testicle swelling cannot be cured with medicine kindly suggest us whether my father should undergo operation if so kindly let us know is there any side effect and risk associated with the operation as my father is a diabetic and he is concerned about it can a laparoscopic specialist treat urology disease",
        "input": "",
        "output": "hello I have seen the reports he is suffering from epididymo orchitis of the tests as already antibiotics course is over the report still shows epididymo orchitis this shows that it became a chronic case what are his present symptoms does he have a fever pain in the tests or urinary problems if the symptoms are severe symptoms then it is better to remove the tests if there are no symptoms then we can wait but the swelling will take four to six months to resolve tests removal is a minor surgery and he can undergo the surgery no need to worry about and no need to change the doctor as his treatment is fine is general surgeon and laparoscopy surgeon can perform surgery no problem"
    },
    {
        "instruction": "hi doctor I have some questions I would like answered on cervical spinal cord injuries please if a person only had a partial transection of the cervical spinal cord would their final outcome still be a complete cervical spinal cord injury where they no mobility or sensory function or is it possible their final outcome could be an incomplete cervical spinal cord injury where they have some mobility and sensory function can a person with a neck fracture die from their cervical spinal cord being compressed because of bleeding and swelling from the fracture compressing against the cord can a person with an incomplete cervical spinal cord injury caused by a traumatic accident die four days after the accident because of the cervical spinal cord failure to control blood pressure and heart rate or respiratory failure because of damage done to the cord or would they have to have a complete cervical spinal cord injury to die four days after the accident because of the same reason stated above and lastly would it be possible for a elderly male aged 80 who has had a fall and has either a partially severed his cervical spinal cord or his cervical spinal cord been injured by being compressed from bleeding and swelling as result of a neck fracture be physically able to walk roughly 50 meters with someone assisting him if it is possible what would their balance be like for example if the person assisting the injured man was holding him with one their arms holding him at the waist would be able to walk in a straight line or would his walking be staggered unbalanced and uncoordinated",
        "input": "",
        "output": "hello I read carefully your question and would explain that the cervical spinal cord is a very delicate part of the spinal cord because in its beginning are located the most important centers which control the heart rate the pulmonary function and the blood pressure values it is true that just after a trauma a man can walk with or without assistance for 50 meters and this can sound strange in fact this can be related to the lack of damage to the spinal cord in that moment there is only the fracture of the vertebral column while the central nervous system is intact while walking the instability of the damaged vertebral column causes further damage to the spinal cord and the person gets paralyzed regarding the partial and complete damage of the spinal cord it is difficult to judge all the damages begin as partial but because of the spinal cord instability the lack of right immobilization and the bleeding and swelling the damage may become complete in the next days the swelling and bleeding tend to spread and the spinal cord is trapped within the vertebral column and can not expand further so the swelling and bleeding cause further damage to the spinal cord it is difficult to judge in the first days of trauma but because of the swelling in the first days after the trauma first week the person may die because of acute cardio respiratory arrest due to the dysfunction of the heart and respiratory function the swelling tends to spread in the upper cord and the paralysis becomes complete affecting also the respiration and the heart rhythm I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 24 year old female who has been suffering with episodes of tachycardia and ventricular ectopic beats for years now I have had many tes domed on my heart these include various ecgs a 24 hour heart monitor a day heart monitor a day heart monitor and an echocardiogram all of these tes came back normal other than occasional ectopic beats and episodes of tachycardia ranging from 100 160 recently my ectopic beats have been a lot more intense by this I mean that I get a very large thud in my chest that makes me feel abit giddy and shook up I have been to the doctors but nothing has come of it I suffer with chronic anxiety but feel I am not loving my life because of this and the constant tachycardia could you give me some advice",
        "input": "",
        "output": "hello your reports appear to be fine other than ectopic and probably sinus tachycardia which are benign you should get your thyearoid test and hemoglobin level done if not done recently you should assure yourself that these are benign and will not cause any harm you need to discuss with your doctor regarding withholding salmeterol or use it to the minimum it can cause or aggravate these also coffee intake should be minimized and if symptoms are too troublesome then you should discuss with your doctor regarding starting betablockers or calcium channel blockers which would subside these if not contraindicated in you"
    },
    {
        "instruction": "hello doctor I am a married guy of years old for the past two to three years I am facing problem to get a proper erection at my teenage I did masturbate frequently somehow I lost flexibility and elasticity of the penis and loosen skin at age 28 I was affected by depression and I take medicine sizodon is risperidone and trihexyphenidyl and econ 5 clonazepam but now I stopped this medicine for about one year I have already consulted a doctor and he asked me to get some tests done he advised me to take nano leo total sachet twice a day in milk for a month he also advised me to do regular exercise and after month I found some light difference in erection but mild erection results are not satisfied but still I am not getting a triggering effect like I was having at my younger age in my teenage erection used to happen even by thought but now I am not getting a proper erection after struggling on the bed with my partner too the duration is very short without proper erection I get discharged when I want to perform I tried lots of ayurveda medicine but not satisfactory please help lab reports attached",
        "input": "",
        "output": "hello I read your query with keen interest and understand your concerns first of all I like to inform you that masturbation is completely harmless process and not associated with any side effects however depression is one of the common causes of poor erections and it is possible that there is still some effect of it in addition the medication you used for treatment also causes an elevation of prolactin as a side effect the high prolactin in turn causes loss of libido erections sexual desire among other side effects I mean to say that both diseases as well as its treatment is somehow responsible for the loss of erections which are experienced by you for the last two to three years fortunately all the attached blood reports are normal and there is a little to worry in regard to tested blood and urine parameters regarding the management I will request you to get the following blood tests and revert back to me serum testosterone serum prolactin I also take this opportunity to inform you that a typical course of nano leo total arginine and zinc capsules for sexual problem lasts for three months the complete effects are observed after a long time and it will be premature to expect results at the end of one month I look forward to guide you further"
    },
    {
        "instruction": "hello doctor my urinal passage is sore and the foreskin of the penis is not moving continuous irritation is there I am a diabetic of 63 years not having any bad habits my diabetic level is under control taking diabend tablets hcqs 200 one tablet novostat ca 20 one tablet optodoz and norflox now for infection",
        "input": "",
        "output": "hello it is likely to be an urinary tract infection it is better if you can provide some more details of your symptoms like any fever frequency and urgency of urination any white patches over penis pus discharge through urethral opening duration of symptoms diabetics are prone for infection and their spread you should get urine routine examination and urine culture sensitivity testing also if urine is positive for infection then it is recommended that you should also under ultrasound of the kidneys to look for infection there you should drink plenty of water continue norflox 400 my twice a day for seven days you should also clean penis with soap and water try to push foreskin back gradually gently and repeatedly"
    },
    {
        "instruction": "hello doctor I tried magic mushrooms and the last time I took it sounds from the to in the next room felt like they were entering me afterward I started ringing bells of unknown homes and simply run around everywhere I also had delusions I was given a diagnosis of paranoid schizophrenia and was treated with eat and risperidone my I returned to being normal without any delusions then after a while I stopped taking my medicines and in a week I was having delusions again my intellectual capacity was lessened and I was in the hospital again and I was treated with eat and risperidone again I went back to normal before I took magic mushrooms I was socially not that talkative but I still I had friends in my class but beyond that I did not have many connections apart from my three school friends and one other friend I had failing marks no one ever said I talked weirdly or has delusions or is abnormal I still avoid socially but I have friends in my current class my academics are better and I do not get failing marks but that is because I got better in managing my computer addiction and to study in my spare time I am currently taking risperidone my question is do I have schizophrenia and I want to discontinue my medications because its side effects are unbearable can you please help me to do so",
        "input": "",
        "output": "hello I can understand your concern you consumed magic mushrooms and the symptoms started after that there was a clear cut relationship between the use of the drug with psychosis as per your history this was four years back you responded well to treatment and are doing good in academics and social domain well if we consider whether the medicines should be continued or not then that depends upon the treating doctor you developed two episodes of psychosis within a year gap and on stopping the medicines it is positive that you are doing good so in my opinion a gradual dose reduction of medicines can be done you are currently on risperidone and its doses can be reduced gradually over the next three months and there should be no problem you have one episode of acute psychosis precipitated after magic mushroom use but the second episode is pointing towards schizophrenia the worsening of symptoms post stopping the medicines cannot be explained by acute psychosis so yes you might have schizophrenia or psychosis nos in my opinion you are yourself seeking treatment and are clear about history which is not very common in schizophrenia so you can try to reduce the doses gradually and this should help you"
    },
    {
        "instruction": "hello doctor I have chest congestion with heaviness in chest I also have a constant cough with sputum I am not taking any medication at present for this could this be due to smoking",
        "input": "",
        "output": "hello your cough and chest congestion is probably due to bronchitis smoking can be the underlying reason however at the moment you are experiencing a phase of exacerbation due to infection or an allergic reaction I would like to know about the onset of your symptoms and how long you have been experiencing these productive coughs and chest pain nonetheless car chest ray is the necessary step before prescribing appropriate medications your probable diagnosis is bronchitis likely an allergic one I recommend using a nasal corticosteroids to subside the symptoms such as mometazone or beclomethasone you will also benefit from using antibiotics such as azithromycin macrolides such as azithromycin are not only anti microbial agents but have some anti inflammatory effects that are quite impressive in bronchitis gargling warm saline along with installing a humidifier in your room will be of great importance also a pod purified protein derivative test is always recommended as a primary tool to screen tuberculosis in patients with chronic cough do not freak out about it but it is worth the visit since prevention is always far better than treating a late stage infectious disease allergy infection pod sputum test car infectious bronchitis allergic bronchitis cold tuberculosis pneumonia bronchitis beclomethasone nasal spray azithromycin on the first day then 500 my for five days theophylline suspension one table spoon every night"
    },
    {
        "instruction": "hello doctor I am facing a bad breath problem sometimes gums get swelled and bleeding happens I do not feel comfortable speaking to someone because of the bad breath issue what can I do to eradicate this problem",
        "input": "",
        "output": "hello I understand your concern gum bleeding gum swelling and bad breath are the signs of gum condition called gingivitis is the inflammation of the gums caused due to constant irritation by tar or calculus hardened yellow deposits on the tooth food deposits or plaque that settles on the tooth get calcified in the long run and become hardened calculus deposits constantly irritated gums become weak and start to bleed when we brush or in the morning time after waking up a professional scaling and polishing procedure is done by an ultrasonic scale instrument to remove that calculus once removed the gums take a day to heal and the gum bleeding and gum swelling will resolve the next morning you will also see an improvement in your bad breath issue please visit your dentist and get this procedure done this procedure can be done once in six months if required although we do a proper brushing every day there are certain spots between teeth where the bristles fail to reach hence a professional tooth cleaning is always advised once in a while there are certain brushing techniques that can be followed to prevent calculus accumulation get to know that from your dentist and please do follow them and you should start cleaning the tongue with a tongue cleaner or by using the back of the brush this will be effective in reducing the bad breath issue I hope this helps"
    },
    {
        "instruction": "hello doctor I am a female who is turning 20 years old in two months I was recently diagnosed with high functioning autism after suspecting for two years that I could have that condition I have never had any kind of ticks or repetitive and involuntary movements or sounds when I was 15 I started to become really hypochondriac since I have had anxiety since and tourette syndrome was my nightmare every year I would suspect without symptoms that I was starting to develop it recently I started to get spasm face and legs before falling asleep and those spasms are now in my eyebrows and eyelids as well including during the day my eyes feel like blinking normally once every 10 15 seconds without me controlling it is it possible that I am developing tourette",
        "input": "",
        "output": "hello tics are quite common and experienced by many people tics happen more prominently when you are worried and stressed you have been reporting anxiety and particularly worried about tourette's syndrome tourette's syndrome is a severe form of tic disorder where a person has both motor and vocal tics present consistently for more than a year from your description you do not appear to have tourette's syndrome I can understand you are excessively worried about possible tics which is making your anxiety worse it will be helpful to try relaxation strategies to manage anxiety deep breathing techniques and jacobson progressive muscle relaxation exercises will help tics become less when you are less worried if anxiety is getting worse consult a doctor or psychologist for professional support I hope this helps"
    },
    {
        "instruction": "hello doctor bright red blood is coming from the rectum after using the bathroom the rectum is also very itchy and no signs of external hemorrhoids rectum has been itchy for a while especially when wiping every now and again there is a light and spotty bright red blood there was a little more during my last be which caused me to be concerned it may be an anal fissure I am currently taking cortisone 10",
        "input": "",
        "output": "hi it could be a fissure or internal hemorrhoids or i'd inflammatory bowel disease just to differentiate one from the other if you could help us out by answering these questions does it hurt when you pass stools bm do you have constipation how much was the blood did you felt dizzy do anyone have colon cancer in the family do you have any weight loss"
    },
    {
        "instruction": "hello doctor I have a red swollen and infected ingrown toe nail it is speeding quickly and painfully yesterday I saw dermatologist for the first time and she wrote me a prescription antibiotic of ciprofloxacin 500mg thrice day for one week and then do a partial toe nail surgery later my last lab test was done and it was showing that my liver functions sept alt kinetic 96 70 l while the normal rate is from 10 to 50 l and an ultrasound report on my liver says diffuse severe fatty infiltration of the liver I did not purchase the antibiotic because I am worried for my liver since I am on seven other medications daily my question is can my liver sustain different drugs while taking a 500 my of antibiotic",
        "input": "",
        "output": "hello thank you for providing the details in your history my question is that is it the first time that the liver fatty infiltration has been discovered did you have had a test called fibrosure or liver mri biopsy cipro is relatively safe with liver disease but honestly it will not be my first choice for treatment of ingrown toe nail infection"
    },
    {
        "instruction": "hi doctor I had an injury to my penis about two and a half weeks ago which caused a blood clot at the base of the penis the clot has healed within three to four days however on one side of my penis there are prominently visible veins when flaccid that looks irregular and also there seems to be a vein that is harder than the others when I am erect that runs all the way up the side of my penis when erect I wondered if I could post a before and after photo and ask you if I need to seek treatment or if everything looks normal I wanted to know if there is a chance I have sustained a permanent injury to my pens or if these veins might settle over time I am not experiencing any pain except for the veins",
        "input": "",
        "output": "hello welcome to icliniq com I have gone through your queries you had an injury over the base of the penis and had a hematoma over there and there are prominent veins at the side of injury let me first assure you it was most probably a superficial injury as you are not having any erectile dysfunction and any deformity after erection the injury has not involved the deep layer of the penis which is also called tunic albuginea so you need not worry the veins even if prominent will cause no harm it will create a few collateral and drainage will be as fine as before but if you are still anxious you can undergo a us ultrasound and doppler study of penis it will tell you regarding the integrity of tunic albuginea as well as the competence of blood vessels supplying the penis it is only to assure you can also visit the office of your local urologist as you need clinical examination too but do not worry I hope everything will be fine soon"
    },
    {
        "instruction": "hello doctor my mom had a heart attack at my house they did a stunt and then she had some brain bleed and had mini strokes she was in a coma and recovered even had a temporary tracheotomy she went to a rehab facility and was very dehydrated so bad she had to go to the er the doctor said her sodium was the highest he had seen well as they slowly dropped it she began to talk again with her voice then as the sodium levels got back to normal she had started whispering again do you have any answers for this or anything that can help me she is currently under synthroid depression medicines and anxiety medicines",
        "input": "",
        "output": "hello I understand your concern and would explain that it is quite normal to have high sodium levels due to dehydration anyway there is no reason to lose voice while rehydration which causes the normalization of sodium levels anyway the changes in concentration of sodium can lead to temporary brain dysfunction due to swelling of brain cells or their shrinkage depending on sodium concentrations this may be a possible explanation of what has happened as her brain was accustomed to high sodium levels and then the drop in such levels could have lead to a local brain cell swelling in some region of the brain which is more susceptible due to previous damage I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 43 year old female I take 20 my trintellex as well as bio identical progesterone testosterone dea and thyearoid I take a sublingual methyl 12 as well as zinc p5p magnesium vitamin glutathione and forage oil I received bloodwork back today with troubling results serum testosterone 1049 extremely high vitamin b12 1288 high folate 13 dea sulfate 41 low vitamin 170 high my other hormones estradiol 62 not sure which phase very irregular if at all progesterone 1 thyearoid profile ash 975 triiodothyearonine free serum 4 to free direct 09 looking at the high or low pieces one by one is troubling from my online research however I do not know how to look at the whole picture of the lab results to understand what is going on I listed every result I was given please suggest I knew my hormones were off as I have been feeling extremely depressed lately I had postpartum depression when I had my two children and experienced post partum depression which is the same as I am feeling now so I knew I had a hormone issue",
        "input": "",
        "output": "hi I do understand that your blood levels of both make and female hormones are elevated but most likely they are due to erogenous consumption I was wondering as to why were you taking these hormones"
    },
    {
        "instruction": "hello doctor I have a feeling of mucus or something in my throat for the last three weeks for a week I had a feeling of swallowing issues where I felt not all of it was sticking to my throat now that sensation has more or less gone away I still do feel like grain in my throat after finishing the meal I have a lot of dry coughs and my throat feels like irritated constantly I am not sure if its due to herd or lor I am taking prevacid 30 my since last week I am not sure if that is the reason for my swallowing getting better but the sensation is still there now I am worried that this could be some neurological issue I am going to see an ent but that is a month from now my question is how is muscle weakness of the throat diagnosed is my issue more of an indication of some neurological issues or anxiety and herd I also feel like the mucus or the foreign object sometimes interferes with my breathing when I am tensed or anxious it feels like a ball when I am calm I do seldom feel it but when I take a big swallow I feel something in the middle of my throat I have done an endoscopy oh and manometry test which does not show much my doctor diagnosed me with is",
        "input": "",
        "output": "hello welcome to icliniq com the symptoms you are experiencing classically fit into globes pharyngeus manometric studies endoscopy being normal organic causes are ruled out hypo or hypomotility disorders would present in a typical manner and manometric studies would have shown something neurological or neuromuscular afflictions would have other symptoms globes sensation can be a headache to deal with nervous dyspepsia is irritable bowel disease globes sensation are all parts of a spectrum of conditions involving gut brain axis cutting down on anxiety is of prime importance"
    },
    {
        "instruction": "hello doctor I have been suffering from panic attacks and anxiety for several years and on top of that essential tremor affects my everyday life a couple of weeks ago my doctor prescribed klonopin clonazepam for me but there are some things I am worried about after googling a bit does klonopin increase the risk of it prolongation or other serious heart problems I just do not want to take any risk because I have been suffering form pics every day for over a year sometimes I have also bradycardia and every now and then short burst of an accelerated heartbeat with fluttering sensation they are still under investigation I have had lots of ecgs and at one my it etc was 412 47 at a heart rate of 71 bum and I would not like to make my it any longer I have also used oxazepam is it a safer option when it comes to the risk of it prolongation or can I continue taking klonopin",
        "input": "",
        "output": "hello long term clonazepam as well as high dose clonazepam puts you at a risk for developing acquired long it having said that a etc of 47 sec is within the prescribed I 460 sec limit for women oxazepam is safer but if you combine either of these with another it prolonging drug the it may become dangerously prolonged also avoid a low potassium blood level and diuretics medications which promote urination your description of pics leads me to suggest a hotter and egg just to rule out any pause dependent arrhythmia do get an echo done to rule out structural heart disease"
    },
    {
        "instruction": "hello doctor I have been having constant moderate to severe headaches for the past four years and I mean every single day all day long from the time I wake up to the time I fall asleep nothing ot medicine has helped nothing prescribed has helped I have been told it is just a tension headache I was prescribed a medicine but cant remember the name it did not work I had a it scan done was told it came back clear no one has been able to tell me why I have these headaches it is getting me to where it is hard to function I just cant take it anymore I am waiting to see a specialist but not sure yet when that will be the headache is not just on one spot it is on my whole head top of my head the sides my forehead the back of my head my neck my eyes feel constantly strained and my ears are always ringing a doctor told me that my ears could be ringing if I take medicine on a daily basis so far doctors could not figure out what it could be please help",
        "input": "",
        "output": "hello I would like to know some details about your headache what is your age since when you started to have headaches is it four years only or even before that where do you feel that headache in which areas of head what kind of headache do you feel heavy throbbing stretching bursting shooting pain electric current like pain or some other kind is it severe moderate or mild is your headache episodic or persistent in episodic headache how long time one episode of it lasts from onset to complete relief without medication how frequent are these headache episodes before and now like how many times in a week as you mentioned is it two times a week since beginning do you feel any vomiting or watering from eyes or redness in eyes or nasal congestion during headache how is your day to day mood how is your sleep and vision have you noticed any trigger factors for this headache do you have any ear discharge or hearing impairment what medicines haveyou taken before and in what dosages are you taking any medicine now also"
    },
    {
        "instruction": "hello doctor I am almost weeks pregnant and today I saw a bit bleed when I wipe it with a tissue paper fet was done 20 days after my lap three embryos were transferred blastocyst my hug taken between two consecutive days was 494 86 and 2597 respectively is small amount of bleed normal I am confused please help",
        "input": "",
        "output": "hi it could be implantation bleeding if you are taking any blood thinner like low molecular weight heparin ecosprin then stop immediately also inform the hospital where you are taking treatment so that additional progesterone and hug support can be added to avoid abortion also take complete rest do not bend from the waist a lot continue taking other medicines and injections except for blood thinner"
    },
    {
        "instruction": "hello doctor I am having pain in my right shoulder probably because of my sporting activities or weight training the doctor ordered an mri and I got it done I want to check if there are any findings",
        "input": "",
        "output": "hi I reviewed your mri report there is a partial thickness tear involving the anterior and mid fibers of the distal supraspinatus tendon over the humerus head and can be seen to be prominent along the burial surface of the tendon there is kicking of the middle glenohumeral ligament and injury of the subscapularis muscle tendon other than the arthrogram contrast there is likely joint effusion and fluid in the axillary recess and superior subscapularis recess I do not find any significant labrum injury there is no significant bone injury please do let me know your doctor suggestion after reviewing the images and their findings"
    },
    {
        "instruction": "hi doctor I am 14 years old and I have been obsessing over calories for six months since then my period has stopped but when I started being obsessive my period was irregular I have noticed that I have lost weight and my family and friends have noticed my weight loss and my obsession with calories and food in general I do not do a lot of sport but I get to 100 steps most days and I do a seven minutes workout in the mornings a few months before I used to eat around 100 calories a day and now I eat around 1300 calories a day approximately I want to eat more because I want to get my period back and I have noticed my boobs have shrunk however I do not want to look like I have visibly gained weight or I do not want my stomach to become untoned I also do not know how much I should eat in order to maintain my weight but I do not think I am losing weight at the moment with eating 1300 calories per day I spoke to my mom and friends about it and they all encouraged me to eat more but they do not understand that I do not want to look like I have gained weight so I want to try and gain muscle but I do not have a lot of time to go to the gym and do weight training do you have any advice",
        "input": "",
        "output": "hi according to the given data your mi body mass index is 18 which is in normal range which means the right weight for your body trying to reduce more weight might cause under nourishment similarly your requirement according to who world health organization standard is 1700 cal day to maintain your weight follow these tips manage stress do meditation as stress increases hormone imbalance divide your meals to small frequent meals to increase metabolism increase fiber and protein content in the diet which helps to build good muscle mass do regular workout at a stretch of 20 30 minutes to avoid extra fat deposition or opt for spot reduction exercise increase fluids for good oxygen supply and blood circulation"
    },
    {
        "instruction": "hello doctor last week I had sex with a guy with expired condoms I saw the packets only after sex and found that they are expired is this a problem could I be pregnant also I am not sure if this is linked or not but three days ago I had a really sore stinging and itchy vagina I have had thrush before and do not know if this is what it is I got canesten thrush comb internal and external cream packet and have been rubbing some cream on my vagina for the last few days it does not feel as weird burn as much as the first day but still feels weird about half an hour ago I inserted the internal cream my vagina has been feeling really weird but it feels like a urine infection in a way but does not burn to urinate I do not know if this is thrush or an infection like a sexual infection from an expired condom I have not gone to the doctor when I did put a finger inside the other day there were some white bits on my finger my opening to the vagina hurts and is sore when I try to finger myself could I be pregnant or could I have got a sexual infection due to an expired condoms the soreness started a few days after the sex with expired condom I feel uncomfortable and do not know what to do is it true that once period comes it clears up please suggest",
        "input": "",
        "output": "hello if the condom is expired it means it may break easily if it has not had breach then it is as safe as normal condoms according to your information three months have passed after this incident and during these three months did you had normal periods normal period means no pregnancy the symptoms you are mentioning are suggestive of thrush and oral fluconazole 150 my one tablet daily will take care the ideal thing would have been if you had uploaded an image so that one could see what is there and yes you have to avoid sex for a few days until soreness settles"
    },
    {
        "instruction": "hello doctor please examine my heath checkup report with the abc report extensively and help me to understand my present health condition",
        "input": "",
        "output": "hello welcome to icliniq com I reviewed your reports all and all it looks very good but I have a few questions if you can answer them do you have any one in the family with heart attack if yes who were they and what were there ages did some one shred with you that you snore or stop breathing when you sleep do you live on a hilly or mountainous area high altitude area or you travel frequently do you have any medical conditions allergies or taking any supplements are you a vegetarian"
    },
    {
        "instruction": "hello doctor I am suffering from heavy mood swings if something is happening against my will I lose my patience and I am not able to tolerate this that phase is very short like for a few minutes but in that short phase I threw something or grumble my teeth or utter bad words to anyone who is in front of me after this stage is gone I am extremely normal and start feeling guilty of my actions I am facing this problem for the last seven to eight years I am becoming very short tempered are there any medicines which can help me to get out of this situation I have tried yoga meditation but nothing helped me please help I am a software engineer with a profession my age is 27 years I am a sole child my dad is no more and my mother and I stay at different places I am a bisexual top I have a girlfriend and a boyfriend too many times I broke with my boyfriend over pitty issues which spoils the entire relationship",
        "input": "",
        "output": "hello I read your query and understand your concerns first of all I must assure you that there are multiple medications which can be used to control anger most of these medications stabilize your brain and help in controlling mood swings after a trivial incident the options include sodium valproate lithium carbonate propranolol topiramate atypical antipsychotics and lot more I need to acknowledge here that there is no universal medication for control of anger and every patient responds differently to each medication before selecting a medicine for an individual it is important to have complete details about the patient regarding the efficacy of medications as per my experience patients report 60 80 reductions with different regiment and report a great improvement over a period of time I hope this helps"
    },
    {
        "instruction": "hello doctor for the past three days I am having sniffles but today morning when I got up I found a small amount of blood spots in my cough so please advise me what to do now I never found this before I am currently taking corectia glyciphase 500 my ovipauz and aspirin gastro resistant tablets",
        "input": "",
        "output": "hello the image that you sent shows brown rusty expectoration for which you need not worry it is due to the capillary leak at the inflamed mucosa due to the medical condition do you have a watery nose do you still sniffle do you have a sore throat sneezing itchy nose tearing eyes dry cough or history of allergies if yes do revert so that I can help you to control your sniffles"
    },
    {
        "instruction": "hi doctor I am a 30 year old male I have been suffering from severe headaches and loss of memory sometimes I get light headedness at times and it throat dries up did an mri brain the contents are to hypointense to flair hyperintense lesion on right peritrigonal region involving optic radiation possibly an area of focal demyelination mri plates also show a bright white spot is it severe I am currently taking medicines for uric acid and headaches",
        "input": "",
        "output": "hello I would like to know some details about your problem since when you started to have headaches in which areas of head you feel that headache what kind of headache is this is it heavy throbbing stretching bursting or some other kind is it severe moderate or mild does this headache happen persistently or episodically was it initially episodic and now turned to constant headache if episodically how long time one episode of it lasts how frequent are these headache episodes like how many times in a week do you feel any vomiting or watering from eyes or redness in eyes or nasal congestion during headaches how is your day to day mood how is your sleep and vision have you noticed any trigger factors for this headache have you ever took any regular medications for these headaches I suggest you to send the mri images because I need to see the images ophthalmology examination to look for intraocular pressure and funds revert with above mentioned information and also send mri images for better understanding and judgement"
    },
    {
        "instruction": "hello doctor I did protected sex with a known lady two times 65 days before and 36 days back she has breast milk I swallowed a couple of drops at that time I felt fatigue and a couple of bumps on the back of the neck after five days of second exposure I got tested hiv duo combo after 28 days of the second exposure both the antibody and antigen are non reactive on 36th day I and that lady got tested with hiv spot test it is non reactive for both however I can feel burning sensation on some parts of the sole of feet and left palm I am concerned about this do I need to take any other tests please suggest",
        "input": "",
        "output": "hello thanks for sharing your medical info with us in terms of hiv detection tests elisa enzyme linked immunosorbent assay test is the first test to be done and then if positive western blot is recommended you and your partner have both tested negative with rapid hiv test which guarantees the exclusion of hiv you mentioned burning sensation on soles and palms I am wondering if you also have lesions in these areas the bumps you are experiencing are however due to some other etiologies most likely molluscum contagiosum these lesions have an umbilicated appearance they might itch and sore they are extremely contagious but fortunately they resolve on their own without any treatment you might or might not have these lesions at the moment keep in mind these lesions could also be stress rashes common after sexual activities if the lesions still exist and hurt and do not have the typical umbilicated appearance I recommend taking a biopsy so investigate the pathology if they do not exist at the moment plan on taking a biopsy when they reappear the burning sensation you feel in your palms and soles is due to a different pathology most likely a neuropathy further information needed to put the right diagnosis on these symptoms most importantly a detailed history of when and how they started and how long have you been experiencing this burning sensation do you have any medical history or family history of diabetes nonetheless these symptoms are not related to hiv infection all I can recommend for assuring a reliable hiv test result is to repeat the test three months after exposure and see if you are still test negative rarely antibody formation might take longer than usual"
    },
    {
        "instruction": "hi doctor I am 51 years old with a complaint of bloating loose stools burning sensation in the abdomen 15 years back I managed two years without medicine I was advised to use rabeprazole to which my symptoms subsided a little bit from then I cannot tolerate spicy foods fruits caffeinated drinks and curd if I take these foods my stomach starts bloating with loose stools burning sensation in the abdomen at times I get pains in the hands and feet burning sensation and pain in the back of the head and breathlessness these symptoms subside by passing flats and belching and on using medication I was evaluated and diagnosed as a case of is I am uploading my complete details please find attachment",
        "input": "",
        "output": "hi I reviewed all your medical reports and I can say as follows first of all you need to be examined with upper endoscopy and colonoscopy plus abdominal ultrasound your symptoms may be related with herd and hiatal hernia or gastritis stomach ulcer in the meantime I would suggest using pi proton pump inhibitors and antacid to improve your symptoms after completing the exams mentioned above I will give you a more accurate opinion regarding your possible diagnosis"
    },
    {
        "instruction": "hi doctor I would like some help with my blood test results as my doctor has not been able to help I have a multinodular goiter with six nodules the largest is am I am particularly concerned about the high ft4 while ft3 is below optimal level high pth low vitamin high cop and ear high insulin and high ga do you have any suggestions on what could cause these results my symptoms include chronic diarrhea occasional constipation abdominal pain fluid retention extremely irregular periods fatigue with trouble sleeping frequent headaches occasional dizziness bone joint pains and weight gain most of these only showed up in the last few months after goiter was found my saliva cortisol results are also on the very low end of range I have attached my blood test results I am currently taking tramadol",
        "input": "",
        "output": "hello I just read your query and the results that you have attached it does not seem you have any thyearoid disease as of now since your ash thyearoid stimulating hormone is normal and your to and to are at acceptable levels and nothing to worry about that some people do have thyearoid nodules which should be assessed yearly by ultrasound to make sure they are not increasing in size or texture my advice for this aspect would be repeat thyearoid function tests yearly and do an fac I an ultrasound guided biopsy of the thyearoid nodule to be sure it is benign yes you do have vitamin deficiency and when you have this you automatically have high parathyearoid hormone levels that is called secondary hyperparathyearoidism and that occurs usually with vitamin deficiency and gets better when that is treated my advice is to have sun exposure 30 minutes daily and take vitamin and calcium supplements I do not know what type of hyperparathyearoidism your niece is having but I assure you that yours is not to be worried about your saliva cortisol I do not think we usually worry about salivary cortisol levels try doing a serum cortisol levels if you are worried to be sure in the morning particularly I know your serum cop reactive protein and immunoglobulin are high but they are signs of allergy or immune reaction to any food they could also be the cause behind your bone and joint pains including vitamin deficiency what I am concerned about is your high insulin levels as they suggest that you have insulin resistance that could be due to polycystic ovaries or sedentary lifestyle or impending diabetes or metabolic syndrome my advice would be to have a pelvic ultrasound since you also have irregular periods and you might benefit from a consultation with the gynecologist in the meantime try to exercise 45 60 minutes daily and sleep for eight hours and consume low carbohydrate low fat diet and avoid sweet drinks absolutely take the help of a nutritionist to lose weight you might benefit from tablet metformin 500 my thrice a day it will help you with your cos polycystic ovary syndrome and the metabolic syndrome as well and help with the high insulin levels and also cause slight weight reduction I hope this helps tablet metformin 500 my thrice a day lifestyle modification"
    },
    {
        "instruction": "hi doctor just over a week ago I developed severe swelling and soreness on the left side of my throat particularly at the base of my tongue my left ear is also in a lot of pain swallowing is extremely difficult and I went to see local urgent care where they prescribed me with amoxicillin 500 my and said it was most likely pharyngitis even though I have not had tonsils for many years my main concern even though it is a worse case scenario is esophageal cancer through hav can occur as my girlfriend was recently diagnosed with hav again I know this is the worst case scenario but since she was diagnosed I really been concerned about hav related cancers from what I read and what I have been told there are no real tests to check in men for hav and even though there is the vaccine it is not recommended for men ages 26 to 45 years I have already been taking amoxicillin for about four days now and nothing improves I have also tried taking regular over the counter cough drops and gargling with salt water this has not helped at all either I have also been told that throat cancer from hav can usually be spotted unless you have lesions in your oral area right now I am at a loss of what I really need to do any help or advice would seriously be appreciated I am also under amlodipine my",
        "input": "",
        "output": "hello your problem can be due to pharyngitis it is possible that amoxicillin is not effective enough in your case you may need some other antibiotics I want to see your throat myself can you send me a picture of your throat I should be able to see posterior pharyngeal wall and tonsils we can think of hav related problems only after ruling out other infections did you lose your weight are you having any swelling in the neck lymph node enlargement the only way of ruling out hav related oral cancers is by taking an oral biopsy before concluding anything please send me a picture of your throat I will be able to guide you in a better way"
    },
    {
        "instruction": "hello doctor my sister is going through psychiatric treatment for depression she had a miscarriage 10 years back and childless after that since the last six years she is in depression and unable to mingle with society doctor asked for routine blood tests and her ash level are above normal she advised her to visit an endocrinologist she is lacking energy in her day to day work and always complains of body aches like in waist area and in back she is very silent and only responds to any query after knocking her two to three times she cannot walk for more than 500 meters at a stretch and feels tired always she also complains about constipation and less sleep she is 41 years old and her weight is keg with a height of 161 am blood pressure is normal 10 80 mhg I have uploaded her reports and her medications are tablet arpizol 15 my nextto my neuro do 60k and optineuron please advise for her ash levels and vitamin levels it is low iron and calcium levels are low as well I would request you to upload a prescription if possible so that I can buy the medicines from local shops or online",
        "input": "",
        "output": "hello I just read your query and the detailed reports about your sister well the ash thyearoid stimulating hormone is not that high as to require a treatment currently usually it so happens when the patient is already under some physical ailment and this is often temporary I suggest no treatment for her subclinical hypothyearoidism at this stage although I would advise to repeat just her ash to and to after three months and then regularly at six months twice and then once yearly to rule out any future thyearoid disorder regarding her vitamin levels I saw the prescription which said it does contain 60 iu of vitamin so no need for anything from that aspect from me as well although it is better to give her sun exposure regularly early in the morning daily for 30 minutes both for vitamin deficiency and her depression as it helps for both conditions rest all her symptoms are due to her psychological disorder and not due to thyearoid as of now I hope this helps thyearoid function test after three months"
    },
    {
        "instruction": "hello doctor I have a prostate congestion issue that comes and goes from years lately I am having a slower urine stream even slower than the times I had my prostate congestion before also I am having uncomfortable feeling above my anus itchy or uncomfortable feeling at the tip of my penis and some discharge from my penis I had my tests done urine and semen culture swab from the tip of my penis and s for my urine and semen before the results doctors been telling me that I might have an sti and they gave me a one time injection with tablets of antibiotics when the results came it showed no sign of any bacteria in all my tests the swab is clean no sad I only had a higher abc count in semen culture which was around 10 15 where the normal reading was 5 my doctor told me thay I have an infection in my prostate or inflammation he gave me anti biotics for 10 days and an alpha blocker medicine he did not do physical check or ultra sound I need a second opinion I am afraid I have a cancer it does not make sense to have an infection without bacteria discovered in all the tests",
        "input": "",
        "output": "hi it looks like prostatitis chronic often in this condition diagnosis is clinical most tests are negative on rectal exam sometimes prostate can feel tender sonography can show swollen prostate uroflow may be reduced there may be bacteria or abc in semen also post prostatic massage urine culture may be positive even if all these are normal and there is clinical suspicion you may be given treatment for prostatitis usual course is for 5 to months symptoms can recur but usually are less severe than first attack people get prostate cancer after age 50"
    },
    {
        "instruction": "hi doctor I am 35 years old I am married for last years and having a kid I led a sedentary lifestyle my fasting blood sugar was 257 and up was 353 my hba1c was 3 I was diagnosed to have diabetes I consulted my friend with is a doctor and under his guidance I changed my diet and started the exercise I reduced my weight from 103 keg to 91 keg after three months my fasting was 17 and up 153 with hba1c 5 my lipid profile is normal for the past one week when I check my glucose level in glucometer at home it is less than 10 I am not in diabetes medicine I think I have ed what are the test that needs to be done to diagnose the same",
        "input": "",
        "output": "hello I read your query and understand your concerns first of all I like to inform you that there is no test which alone can tell you whether you have ed erectile dysfunction or not other than the history and proper physical examination this is the thing which are done by the doctor when you present yourself in his or her office based on the observation doctor decides whether the tes are required or not in case required he only decides what are the tests required based on the available history details and clinical examination I mean to say that you need to see a properly trained sexologist to determine the number of tests required this is because the presence of abnormal test does not mean the test abnormality is the cause of the problem and similarly the presence of normal test result does not rule out the problem however in routine practice we order normal biochemistry blood sugar get glucose tolerance test hba1c lipid profile let liver function test and thyearoid profile hormonal profile free and total testosterone prolactin oh luteinizing hormone and fish follicle stimulating hormone us abdomen and pelvis and penile doppler study among others these are often a minimal requirement and the number of tests can change as per the need of the individual patients I hope this helps you feel free to write back to me if you have more questions"
    },
    {
        "instruction": "hi doctor I was seen at emergency care and diagnosed with a sinus infection my eardrums were red and there was fluid behind them I was prescribed to have zithromycin 250 my pak which I have been taking now four days later my left ear is completely plugged and the right ear is somewhat plugged my hearing is affected I also suffer from tinnitus this infection has made the tinnitus louder and much more intrusive should I hang on for a while longer or do I need to be seen by my ent doctor immediately",
        "input": "",
        "output": "hi since you had sinusitis it is very likely that the infection has spread to your ear which is causing the blocking sensation I would also like to know whether you are suffering from tinnitus for long have you had age related hearing loss earlier as well do you have ear pain either it can be just the infection in resolving stage which will take around two to three weeks after the infection subsides or it is possible that you are getting sensorineural hearing loss to confirm this audiometry is required along with impedance audiometry"
    },
    {
        "instruction": "hello doctor I suffer from is about twice a month I began with pain on left side of chest and left side of tummy it then goes across the bottom of tummy I then clear my bowels starting with constipation then followed by very soft stools until I empty once emptied I am usually fine with just a tender tummy today is so different I am still having terrible spasms by belly button and both sides of tummy as well as radiating back ache at same time I feel sick as I do not want food either I am using a hot water bottle right now will this pass eventually",
        "input": "",
        "output": "hi you did not mention what medicine at present you are taking is a type of autoimmune disorder where you are body defense system works against you why it is considered to be genetics origin so first of all you should keep in mind that you have to adjust your routine diet daily activities medicine are there but they are having very limited actions one of that is equirex tablet three times a day at let for 10 days fiber rich food like fresh fruits avoiding stress are one of the important habit choices which helps you much better way let us start with this then we see what is the result and where we stand"
    },
    {
        "instruction": "hello doctor for months I have struggled with low mood debilitating anxiety intrusive thoughts about the past avoiding anything to do with the past suicidal thoughts self harm and daily guilt and shame that has stopped me from hanging out with friends or being successful in school everyday I just try to survive my appetite sucks I have trouble falling asleep and have frequent nightmares I am exhausted all the time I finally decided to get help I saw a psychiatrist today who concluded I do not fit any diagnosis and with therapy I can learn to deal with the situation that causes these things but there is no situation how can someone be in so much pain for so long and the answer is basically that I am just too weak to handle life I have never felt so awful ever and coming to that appointment was a big step for me I feel like such a loser I got nothing out of it except humiliation should I consider reaching out to a different doctor or am I overreacting and she is probably right",
        "input": "",
        "output": "hello I would beg to differ with the psychiatrist who you have consulted and all the symptoms you have mentioned are depressive symptoms which do need treatment with medicines therapy can only help increase the effect of medicines it is not a replacement I would prefer that a psychiatrist or a doctor should prescribe you a standard dose of an sari such as sertraline 50 my and add low dose mood stabilizer such as divalproex sodium 250 my major depressive disorder secondary to a stress in past along with a probable personality disorder will need further history to arrive at a diagnosis also consider doing some deep breathing relaxation exercises"
    },
    {
        "instruction": "hello doctor I have an ultrasonography which states I have bulky ovaries with multiple small follicles I want to know what does that mean and can I take spill and is it safe",
        "input": "",
        "output": "hello the report to me is normal with normal size uterus and also the ovarian size even though it mentions bulky ovaries but an ovary is considered bulky if the volume of each is more than 10 ca the presence of small multiple subcenterimetric follicles indicate developing follicles and cannot be labelled as polycystic ovaries unless the criteria for clinical hyperandogenism like acne hirsutism acanthosis nigerians and oligomenorrhoea is met the presence of frequent urination points towards possibility of a urinary tract infection which can be ruled out with a urine routine microscope test also if you have been sexually active then its always better to take an emergency contraceptive pill within 72 hours of intercourse to avoid unplanned pregnancy"
    },
    {
        "instruction": "hello doctor for the past several months I have been vomiting four to six times a week sometimes my eyes become sensitive to light and I get a massive headache which ends in vomit other times I could randomly dry heave until it eventually comes out without any warning sign pregnancy is not a possibility I am a 19 year old female with no prior medical conditions and healthy diet a few years back I was prescribed birth control for constant headaches it did not help in fact it is very hard for me to keep down pills so I would rather not take them and induce a vomiting spell my question is what could be the cause and possibly some different alternatives other than pills",
        "input": "",
        "output": "hello all the symptoms you have mentioned are suggestive of a clinical condition called migraine we have to rule out other conditions like tension headaches before starting the treatment you do not need to worry as it is highly curable with timely treatment I suggest you consult a general physician and get the following things done a detailed clinical history and examination may be needed to make a diagnosis as initial management you might require analgesic like ibuprofen or sumatriptan for headache to prevent further attacks you may require a long term drug like flunarizine prolonged use of contraceptive pills can also cause headaches so it is better to use alternative contraceptive measures you can also seek help from an acupuncturist for constant headaches migraine conservative do not deprive sleep avoid contraceptive pills"
    },
    {
        "instruction": "hello doctor just after christmas I started losing my appetite I began feeling sick and really lousy and weak then at the beginning of this month I started getting pain in the upper left side of my abdomen just under my bottom rib I am still feeling rough the pains are still happening and as well as being in the front it is also in my back now as well I am hardly eating as it is making the pain a lot worse I have now lost just over two stones since last month my stomach also bloats out and looks swollen on the left side it is also incredibly tender to touch I am being sick even though I am on anti sickness tablets I have seen a doctor and I was sent for blood tests on three different occasions all three tests have shown inflammation currently I am waiting for a referral to a gastro doctor but I have been told it is a very long wait my doctor thinks possible inflammatory bowel disease any advice would be greatly appreciated",
        "input": "",
        "output": "hi by looking at history it seems like chronic pancreatitis for me pain after eating tenderness loss of weight bloating sensation are highly suggestive mesenteric ischemia also presents in a similar way but is usually seen in the elderly with a history of cardiac disease inflammatory bowel disease is another possibility which presents more or less like this I wanted to know your bowel habits to come closer to the diagnosis if loose stools and constipation are seen alternatively probably it is inflammatory bowel disease if it is a small amount of mucus or sticky kind of stool probably it is chronic pancreatitis in any case get an ultrasound abdomen done at the earliest which can lead to some diagnosis before you visit your gastroenterologist"
    },
    {
        "instruction": "hello doctor I am 28 years old I tried using a penis pump for around 10 12 days 15 minutes each to gain size I used a vacuum to keep the penis enlarged maybe I was trying too hard and vacuum it till it started to ache I had no pain after those procedures though ever I was also masturbating around two to three times a day during that period usually it was once a day now I feel my penis has grown softer instead flaccid or erect both ways I cannot feel hard enough to penetrate even if I try to masturbate it still feels squishy and not hard my sex drive is also diminished I have not had a wet dream in 10 12 days still I do not feel high as I used to earlier without sex or masturbation for a day or two I do not feel any kind of pain during penetration or otherwise I of course have stopped both pump and masturbation please help",
        "input": "",
        "output": "hello I am sorry to know that you are facing a problem with the hardness of penis following the use of penis pump to enlarge the penis size it is foolish to believe that the penis pump enhances penis size as it is a scam rather than anything however we cannot correct the past and need to look for the reasons for the loosening of penile tissue in my opinion there is a tear over the blood vessel or sphincter leading to leakage of blood during erection resulting in inadequate tightness however I must assure you that the presence of erection although poor and stoppage of further damage should be enough to allow the recovery of proper erection in a few weeks at this stage it is important to manage your stress as it is unlikely to help you in any regard at the same time it is recommended to get penile doppler to assess the damage at the earliest level I hope this helps"
    },
    {
        "instruction": "hello doctor I underwent a regular blood test recently it shows my monocytes level is low which is 1 where the normal rate should be 2 I just googled what could be cause for the same it says it could be because of viral infections including hiv aids I am worried now I am scared to consult a doctor at the moment please advise",
        "input": "",
        "output": "hello monocytes may increase or decrease it hardly matters one of the cause is viral disease not only hiv virus may cause this but there are also many other viruses like cytomegala virus which can cause this flu is also caused by virus nowadays fever is also called as viral fever which takes a prolonged time to recover if you are suffering from a common cold or sneezing it is also viral nowadays in any disease one of the causes is viral monocytes are not so important except for in leukemia blood cancer which can be detected by peripheral blood film in which monocytes are highly increased but in your case the values are a little bit deranged have you noticed any symptoms in the case of hiv infection various types of symptoms appears even joint pain sore throat ulcers in oral cavity rashes and itching are common advise take a healthy homemade diet both vegetarian and nonvegetarian maintain proper oral hygiene of oral cavity and genitalia undergarments should be washed properly and soaked with dettol or salon add citrus fruits like lemon orange kiwi and blueberry in your diet it increases immunity and overall physical fitness treatment take anti oxidant like recital for male one at night with milk and seven seas cod liver oil pearls one at night both can be continued for a long time they help in general body maintenance and blood picture I hope this helps"
    },
    {
        "instruction": "hello doctor I am a diabetic my microalbumin rates are fluctuating when I was first diagnosed it is around 200 for the first time 18 for the second time 40 for the third time 120 for the fourth time and 27 for the fifth time why these are values are varying can you suggest the best time to give urine sample for microalbuminuria spot test I am using rosuvastatin 20 my and for diabetes istamet 500 my in the morning and gluformin 500 my at night my fbi is 18 and pubs 137 my do I am very much worried about the problem and I am not getting proper sleep due to this tension",
        "input": "",
        "output": "hi welcome to icliniq com see it can vary from laboratory to laboratory moreover timings do not affect it as it is a spot sample since your report is persistently declining it is a good thing a rising level of microalbumin is of a problem and this might needs an evaluation in your case it is reducing and it is good I would recommend you to keep your blood sugar and blood pressure under well control and there is nothing to worry about I hope this helps"
    },
    {
        "instruction": "hello doctor recently I did my blood test and few areas of the result are bothering me I have attached my entire report please do let me know the medication I do not have any health issues except for random tiredness",
        "input": "",
        "output": "hi welcome to icliniq com I have gone through all your attached reports in your report four main abnormal values are present such as lymphocytosis vitamin deficiency vitamin b12 deficiency and homocysteine borderline high lymphocytosis can be from temporary viral infection as no other symptoms related I do not think further workup for lymphocytosis needed just now for vitamin deficiency cholecalciferol sachet 500 or 600 iu can be prescribed which is taken once a week with milk for six weeks for low vitamin b12 cyanocobalamine injections can be prescribed 100 mug intramuscular per week for six weeks folic acid level also should be checked if needed folic acid tablet is also prescribed repeat abc complete blood count after one week with the correction of vitamin b12 and vitamin deficiency your tiredness will be resolved consult a physician for examination and discuss all these with him"
    },
    {
        "instruction": "hello doctor I got a hit on cricket ball four weeks ago and I have pain in my abdomen and after several minutes it is back to normal again after a few days I joined the gym and doing my basics like cycling some weight lifting etc but no abdominal exercises four days ago I passed orange color urine I thought it was dehydration and drank more water my urine turns back to normal again on the same day I have done my routine exercise in the gym and after exercise again my urine seems to be in light red color but this time it starts with light red and turns into normal again I take more water and there is no sign of blood what is the problem",
        "input": "",
        "output": "hello welcome to icliniq com nothing to worry at present there is no relation with the cricket ball hit it might be related to dehydration or gym exercises which also can cause dehydration both of which cause dark urine just get basic tests done to confirm it is blood or just dark yellow urine drink plenty of water get done your urine routine ultrasound abdomen and pelvis"
    },
    {
        "instruction": "hi doctor I have a skin rash on my ankle it has been there for six months now I have tried penicillin steroid antifungal cream and cider vinegar as well but it is slowly getting bigger it is itchy with scaly flaky skin I feel some fluid inside the red raised dots when I scratch it starts to smell after a while",
        "input": "",
        "output": "hi indeed the clinical image is more in favor of tina corporis which is a fungal infection of the body it also has the potential to spread and using steroid based creams will add to the resistance of the problem kindly mention if there are similar lesions elsewhere if you keep your feet soaked for longer times and if you keep wearing the same socks"
    },
    {
        "instruction": "hello doctor I am a 31 year old male I am a smoker for 12 years I am having throat congestion cold and now having excess mucus production with no history of weight loss I have taken a chest ray in which there is a white patch on the right side I wanted to know if it is cancer my father is a known case of cancer lung all my blood test reports are normal",
        "input": "",
        "output": "hi I have seen your ray the chest ray shows a prominent right hilar area most likely due to rotation I mean you were rotated in position when the ray was taken and this might cause a false appearance of right hilar vascular prominence to me it does not look like cancer but thought is to be given to your symptoms if possible please decrease and stop smoking I will suggest a discussion of your symptoms and clinical examination by your doctor and if there is a need then a it computed tomography chest can be done"
    },
    {
        "instruction": "hello doctor is paleo diet really good to lose weight it appears that the paleo diet does not have anything much for vegetarians I want to follow a paleo vegetarian diet to lose about 15 20 keg of weight I am a thyearoid patient and taking thyearonorm 50 mug for the past 15 years I also have high be and taking thelma 40 after breakfast and amlogard my after dinner I was affected by vitiligo about 10 years back and currently not taking any allopathy medication for this I am taking one ayurvedic tonic called lukoskin I have highly irregular periods recently hence taking oral to get periods on time a few months I stopped taking the medicine and did not get the periods for the past three months I have started the medicine again for the past 10 days",
        "input": "",
        "output": "hi welcome to icliniq com well paleo diet is good in a sense of restricting your diet but as you said you have irregular periods too that means sufficient amount of nutrition might not be reaching your body so better have some non vegetarian food products which are excellent source of protein for your body fish and egg are good it sometimes becomes quite impossible to remain away from protein rich food items following a paleo diet with a twist of nonvegetarian foods involved might help include non veg like two pieces of chicken with cabbage or other leafy vegetables and make a salad add olive oil and have it thrice a week you can follow the same paleo diet the other days"
    },
    {
        "instruction": "hello doctor is it bad if my heart rate jumps up to very high bum very quickly during even moderate exercises I am a 26 year old male my height is 1 and weighs about 190 labs who has always been in good shape I lift every day and usually during the summers I run about two miles a day at around a six minutes pace I have a resting heart rate of 58 bum and no matter what I do my heart rate always jumps up during even the most minor activity two days ago I went for a 20 minutes leisure walk with my wife and my heart rate averaged 120 bum and got there in about 10 seconds if I run at a pace any faster than minutes a mile my heart rate will jump to above 185 bum in under 30 seconds and at my fastest it stays around 200 bum for as many miles as I run now it has been like this for as long as I can remember and I never feel extra winded or take long to recover I just know it is not normal please help",
        "input": "",
        "output": "hi the problem you are having is called palpitations your baseline heart rate is 58 beats minute and your maximum heart rate is around 200 beats per minute that is almost three times the baseline heart rate heart rate as high as 200 beats per minute can even lead to sudden cardiac death and cardiac arrest this should be taken very seriously and some of the baseline tests of cardiology are to be done to rule out the cause 24 hour hotter monitoring is most important for you as it will record the nature of your palpitations whether they are arrhythmia or just simple supraventricular tachycardia ad echo and treadmill test to rule out cardiac functions as your arrhythmia is precipitated only during exercise"
    },
    {
        "instruction": "hi doctor I started working 12 hour shifts about a month ago my upper back has been hurting it feels like it starts from the middle up to the upper back it is not a sharp pain but it is like a tension we are supposed to wear steel toe shoes I just recently changed to tennis shoes since I work nights I want to see if it is the shoes or long hours can you advise as to what it could be I feel stressed out and I am very prone to it the tension just does not go away at all",
        "input": "",
        "output": "hi I have reviewed your question I am sorry you are experiencing upper back pain in your question you said you recently started working 12 hours shift and since then your upper back has been hurting it is not a sharp pain but feels like tension most likely you experience muscle fatigue and at some times muscle spasms I would like to know what your job entails many police officers have upper and middle back pain and have something call upper cross syndrome this is were the pectoral muscle are tight and pull the shoulders forward while the muscles of the back are weak it is a stabilization problem usually attributed to wearing the heavy vest all day same thing in your case many students who study with their head down all day or text a lot experience similar pain in their upper and middle back if you were my patient I would perform a chiropractic examination and recommend several home exercises as well as chiropractic adjustments since I am unable to confirm my suspicion I recommend that you go see a local chiropractor for a proper examination if they believe you are a candidate for chiropractic care they will most likely recommend a trial of care as well as a series of home exercises to determine how you will respond to treatment"
    },
    {
        "instruction": "hello doctor I was diagnosed with a left branch bundle block a few years back I have been under the care of a cardiologist to make sure my heart is fine since then I have done stress echo yearly or every two years since and have been told my heart is otherwise fine I just had to switch the other doctor because of insurance and my new doctor says old stress echo are irrelevant that only chemical or nuclear echo work in patients with lbb is this true I have a strong family history of heart disease my father survived two heart attacks mother survived double bypass and my maternal uncle died from a heart attack all were smokers with high cholesterol and high blood pressure I am a former smoker I am a 43 year old female I have been exercising six days per week for over 20 years my cholesterol is high 213 but hel is 140 and triglycerides are low I am a little put off by a nuclear stress echo and would prefer the regular exercise but I want to know what this new doctor says is true then I guess I will have to go nuclear I am currently taking spironolactone 100 my for acne omeprazole and multivitamin I just had an ultrasound of heart and ekg past monday doctor did not mention anything other than lbb that was previously diagnosed",
        "input": "",
        "output": "hello welcome to icliniq com treadmill test is not very informative in case of lbb patient however stress echo either exercise or nuclear is valid stress thallium is the best test to be done in you I guess you did not have any symptoms like chest pain or heaviness during stress test and if so it will still suggest the absence of significant heart disease in my opinion there is not much difference between exercise echo and chemical stress echo and not invalid but nuclear scans like stress thallium is certainly a better test I would advise for a nuclear scan as it would be more informative anyhow you should have a healthy lifestyle like avoiding fatty oily and high calorie diet have a low salt diet and monitor your blood pressure regularly do regular exercises like brisk walking jogging according to your capacity at least 30 minutes a day and days a week eat lots of green leafy vegetables fruits and fish once or twice a week avoid meat smoking and alcohol if any there should not be any abdominal fat deposition or obesity get your lipid profile and sugars tested once"
    },
    {
        "instruction": "hello doctor I am going to have the muscles shortened in both eyes and then my eyelids lifted they say I will be asleep when these muscles are shortened and then they will wake me up so I can talk and move my eyes will they put a tube down my throat I am so scared about having this done as I panic when a lot of people get around me I was in a serious car several years ago and it took for the medical personnel an hour to get me out",
        "input": "",
        "output": "hi welcome to icliniq com as far as anesthesia is concerned in your case the eyelid surgery may be done under general anesthesia which does require securing your airway safely prior to securing the airway you will be given injectable medications to make you fall asleep so that you do not remember and also you are not aware of the procedure when it is being done so I would suggest you not to worry as general anesthesia is a safe procedure when given by an experienced anesthetist now let me tell you about either of two tubes that may be used for the procedure are laryngeal mask airway lma and endotracheal tube lma has advantages over endotracheal tube of less postoperative sore throat and lesser intraoperative rise in blood pressure and heart rate this insertion and removal of airway tubes are safely done while you are unconscious so you are not aware of the procedure so please do not worry general anesthesia is given meticulously nowadays and patient safety is a primary concern"
    },
    {
        "instruction": "hello doctor I am a woman 23 I am 2 137 pds I am currently taking cetirizine I have been coughing badly for the past months when I got my new job at a preschool I went to the doctor he prescribed me the before mentioned drug although when it gets really cold I cough phlegm and other times a dry cough I would like to have a second opinion on what I should do because I am tired of coughing",
        "input": "",
        "output": "hello in addition to cetirizine you need to take a bronchodilator medicine that will help bring out the phlegm better salbutamol albuterol is an excellent drug that helps widen the small airway passages and bring out the mucus it is available in the form of inhalers take puffs thrice daily and gradually taper over a period of weeks whenever the climate changes or you start coughing start on the inhaler second when there is excessive mucus in addition to the inhaler take ambroxol hydrochloride medicine also it is available in syearup and tablet formulations you require 30 my if the phlegm is green in color and tastes bad you may require a short course of antibiotic it is also advisable you wear masks when you go outside avoid cold air in the mornings and late evenings take plenty of warm fluids adequate hydration use a multivitamin temporarily have healthy diet rich in vegetables and fruits taking garlic is helpful as it is known to have ingredients that help relieve asthma and associated bronchoconstriction"
    },
    {
        "instruction": "hello doctor I am a 30 years old male no smoker a blood and urine test was done for me recently and the blood test was all fine but there was blood in my urine ur rec 155 cells ul a more specific ruin test was done after still showing cells ul of which 97 are isomorphic and of which only two were white blood cells further a it program was done were no stones were found or anything else suspicious what could be possible reasons there are still a lot of other explanations but cancer right what should be my next steps I do not know of any of the following things can be related I had a kind of a cold for months already but nothing seriously mostly just a runny nose and a bit tired I had my ankle hurt a month ago and on and off it still hurts and gets swollen again I feel slight discomfort around my bladder and urethra but mostly since I got these results and maybe I just paying too much attention to that part now",
        "input": "",
        "output": "hello firstly likelihood of any malignant cancer is less likely because you do not have risk factors no symptoms young age and cturogram in normal within three months period cancer would have increased in size and became detectable so you are probably having some benign cause and most probably some arteriovenous malformations venous lesions or small mucosal bleeds calcium and uric acid in urine next step is your 24 hour urinary calcium and uric acid levels and also urethroscopy and cystoscopy which will complete the evaluation and usually yields the diagnosis in most cases urologist does these tests you continue to drink plenty of water and liquids"
    },
    {
        "instruction": "hello doctor got surgery done for fracture neck of femur five years back now living life with inch leg length discrepancy highly demotivated hip replacement is suggested by surgeons but not now as I am 30 years old as per them a revision surgery is required after 15 years or so my question is if I go for hip replacement will my leg gets normal why revision surgery is only after 10 15 years and not after 35 years though some doctor say that they do hip replacement and acetabulam remains for 35 years is it possible how can I compromise leg length by using shoe lifts will limping be visible after that or not kindly help",
        "input": "",
        "output": "hi I can understand that limb lengthening can be of concern but you can ealisy wear a heel raise on the normal side of just 5 cos not totally corrected to 5 inches it should always be undercorrected by am limping depends upon you abductor hip muscle strength so you need to do exercises regarding hip replacement if you have an vascular necrosis with a painful hip only then you require a replacement otherwise not and the timing is not fixed hip replacement can be done at a time when you have excessive pain not relieved by medicines after hip replacement you hip should be near normal I suggest you to upload your latest hip ray so that I can see and accurately suggest treatment methods and provide you more information query regarding hip replacement follow up with latest rays"
    },
    {
        "instruction": "hi doctor I took I pill after 40 hours of intercourse due to the suspected entry of precum now I am experiencing mild brown discharge what does it signify moreover I am on my homeopathic medication for irregular periods which I resumed this month on ith last month I had my periods on 10 and I took I pill on the ord of this month please help I do not want to get pregnant",
        "input": "",
        "output": "hi this discharge is mostly a side effect of I pill so please relax and wait for your period the chance of pregnancy is very less still if you miss the period then check for pregnancy"
    },
    {
        "instruction": "hi doctor my son who is 10 years old is suffering from skin problem like a tiny bumps in hand finger and lower part of feet there is mild itching the old eruption dries and disappear there is no fluid sac in the new bumps earlier we applied ascabiol lotion for days and then started permit lotion also given half tablet levocet and applied lactocalamine after a bath",
        "input": "",
        "output": "hello I have read your query and seen the attached images also I understand your concern for your son as per details there are the following possibilities for your son condition scabies it is characterized by fluid filled lesions or red bumps or excoriated marks over the body you have given permethrin lotion for the same however itch and symptoms may persist for a month or so atomic dermatitis it is an allergic condition of the skin characterized by a variable rash in this the child has sensitive skin leading to the appearance of rash with an itch on exposure to allergens I would advise you to apply a cream containing antibiotics and steroid like futon cream fusidic acid over the affected area avoid the use of harsh soap or chemicals to avoid precipitation of allergic reactions you should visit a dermatologist in person for proper examination and evaluation you may discuss my opinion with him"
    },
    {
        "instruction": "hello doctor the gynecologist told me not to have an intercourse because I was having some brown spotting but it stopped and I had a little bit of intercourse but now I am scared something happened should I be worried",
        "input": "",
        "output": "hi brown spotting may be due to vaginal or cervical infection and infection can be from your partner or you can transmit to your partner so that is the reason doctor told not to have intercourse continue the medicines given to you and drink more water"
    },
    {
        "instruction": "hi doctor I am a guy 23 years old and I was suffering kind of social anxiety in my childhood and in my teenage and that is why I visited a psychiatrist when I was 18 years old five years ago and he prescipted me zoloft 50 and olanzapine 5 without telling me the exact problem and by starting taking them I started getting some relationships and better social skills but recently I visited him again because of feeling not okay and getting angry easily and he prescripted me the same old medications plus third one which is sodium valproate 200 he told me that it prevents person from getting angry and keeps the mood stable and he told me that I have depressive personality disorder but my fears and my family fears is about olanzapine and its side effects they see it irrelevant for depression and related to psychosis do I really need olanzapine",
        "input": "",
        "output": "hi I do understand the confusion olanzapine is an antipsychotic that is why you are concerned but a dose of olanzapine unto my is often added with antidepressant to help with initial control of severe symptoms it can be stopped after a while but now that you have mentioned that you have anger issues as well I think olanzapine will help you to some level a dose of 5 is very less and apt for this what you need to do is start therapy and learn techniques to control your anger and reduce your anxiety you can work on confidence building once you start feeling better you can think of reducing the medication about being depressive personality I need to evaluate you properly to be able to justify it"
    },
    {
        "instruction": "hello doctor in recent past I was suffering from ed I visited a nearby andrology specialist he did some tests and found that below values he stated that oh is very high is there any relation of sperm count and ed when we have high value of oh is it curable my oh value is 6 please help me I am planning for a kid",
        "input": "",
        "output": "hi ed can have many causes one of them is low testosterone whenever the testosterone levels are low our pituitary gland tries to stimulate testosterone production by producing more oh I saw your test reports testosterone levels are just below normal and oh levels are just above normal reference ranges this might be due to diurnal variation normally testosterone levels peak during day time around 10 am this is called circadian rhythm it is important to consider this while evaluating borderline variations low testerone can lead to reduced sperm counts since you are also planning for a child do get a semen analysis done after days of sexual abstinence repeat testosterone and oh levels at morning between 1 am before deciding on treatment semen analysis testosterone oh levels"
    },
    {
        "instruction": "hello doctor for the past two weeks I am having pain and bleeding on defecation it started with straining on hard stool I am not constipated on touching I can feel two external hemorrhoids and maybe a fissure not sure I have increased the fruit intake and I am applying sunarin cream to not much relief can you suggest any ayurvedic tablets I am a 39 year old male weighing about 70 keg I am currently taking multivitamin",
        "input": "",
        "output": "hello sometimes external piles do not create problems but due to some reason like constipation and others it causes health issue just you should take care of constipation I am suggesting you some ayurvedic medicines you should continue these medicines for at least two to three months please let me know about any other medications you are taking for any other health problems as it is necessary to know for proper treatment take fiber rich diet like fruits and veggies to avoid constipation the treatment plan is as follows arshhar vat one tablet twice a day after meal abhayarishta two teaspoons twice after meal pile ointment for external application isabgol powder at night before going to bed please give information about any other medications if you are taking right now or any other health problems if you have follow up after seven days"
    },
    {
        "instruction": "hello doctor ever since I was little I would stick sharp pointy things between my teeth and poke and pick at my gums it would cause pain but the pain was addictive it is like I enjoy the pain when I was a child I would use my fingernails to do it until my gums would bleed I know that sounds nuts but it is true as I got older I started using things like toothpicks keep in mind what I am feeling is definitely pain but it is a sensation I like for some reason I tend to do it between my back teeth I am worried about my teeth",
        "input": "",
        "output": "hello I have gone through your query and understand your concern constant tooth picking leads to gaps between teeth gum bleeding and gum weakness of gums and bone creates more gaps which attract food deposits these deposits irritate the gums constantly leading to gum and bone infection this condition is called periodontitis pain swelling and spaces between the teeth getting wider are the signs of periodontitis once those gums and bone get infected those teeth will start to shake and become loose in no time please visit your nearby dentist and get a scaling and polishing procedure done to remove those calculus deposits this cleaning procedure should be done once in six to eight months if required for maintaining healthy gums and please do try and quit the habit because more than the calculus your teeth picking habit causes major damage to your gums and teeth it may even cause multiple teeth decays to start with you can try discarding toothpicks and sharp objects from your sight to stop this habit I hope this helps"
    },
    {
        "instruction": "hello doctor my partner and I have not had sex for quite a few weeks I have talked to him about it around three times and each time he tells me that he wants sex and wants to have more of it and that he will try to push away the thoughts of the stress he is going through that keep him from getting an erection I can understand but why he cannot I have needs too I am currently taking mono linyah",
        "input": "",
        "output": "hello libido can be decreased if a person is undergoing stress and can affect sexual performance I would recommend that he should either visit a psychiatrist and take some medicines if his stress is affecting his personal social and occupational life the doctor will place him on some medicines which should help with the stress part in addition to that you can give him some medicines like sildenafil 50 my or tadalafil 10 my to take one hour prior to having sex provided his blood pressure is fine this will help him achieve an erection stress erectile dysfunction secondary to anxiety or stress tadalafil 10 my or sildenafil 50 my one hour prior to sex unto a maximum of twice a week discontinue in case of headache chest pain or dizziness also do an internet search and start doing kegel exercises which will help improve the muscles at the base of the penis and improve the strength of the erection can follow up after one month if needed"
    },
    {
        "instruction": "hello doctor my partner missed her period we have done home pregnancy tests which showed negative she does not have any pregnancy symptoms either what may be the reason of her missed period",
        "input": "",
        "output": "hello kindly note that we cannot rule out pregnancy still so wait for another days and do urine pregnancy test again were her periods regular before does she have any medical illness like fever in last week any stress any thyearoid problem any mild bleeding per vaginum so kindly answer above questions so that I can help you more"
    },
    {
        "instruction": "hello doctor my son is years old he is feet and inches and weighs about 107 labs I checked his mi it said he was obese in the 95th percentile he is active should I worry about his weight and if so how can I help him with it",
        "input": "",
        "output": "hi welcome to icliniq com your son has good height and for the same reason his weight is not worrisome but definitely he is on 95th gentile for his height as well as for his age also his mi body mass index is 4 which puts him in the category of obese let him have a lot of outdoor activity avoid sitting for a long time in front of the computer or to and avoid junk foods swimming is the best activity for this age and swimming for at least 30 45 minutes daily or at least five days a week will help him let him have a good balanced home food with less fat child obesity at this age has higher chances for him to be obese as an adult with all its other consequences so it is better to have some precautions but no need for a dieting regime at this age as he is a growing boy and needs more calories from proteins for his overall growth I hope this helps"
    },
    {
        "instruction": "hello doctor I am 29 years old I am married from the last 5 years my problem is that from the last two weeks I am not getting proper erection during sex erection comes a bit and goes out instantly it is just happening from the last two weeks before that I was totally fine I am taking some herbal medicines please suggest me why this happening to me right now I cat get any erection sex only a bit if I watch some porn or like that I am having so much tension because of that yes one more thing I used to take one penis size enlarge oil but very rarely might be because of that oil I am having this problem please suggest me best possible option to cure this",
        "input": "",
        "output": "hi I can understand your concern as you are getting erections when you watch porn but are losing during sex this shows that problem is not organic the issues are more psychological confide helps to boost confidence but is not proper treatment for some times you can try tablet tadalafil or sildenafil either of these tablets if taken about half to one hour before sexual intercourse help to improve erection if problem persists then visit a doctor and get serum testosterone and prolactin levels done if levels of both these hormones come normal then remain relaxed no need to worry"
    },
    {
        "instruction": "hello doctor I want to know what the horizontal lines on my fingertips are they appeared within a couple months along with more lines on my hands than ever before",
        "input": "",
        "output": "hi I have seen images attached here attachment removed to protect patient identity it does not signify towards any health issue it seems to be normal flexor creases finasteride drug that you were taking can lead to hand swelling headache weakness nausea etc as side effects if you want to investigate than check your random blood sugar serum cholesterol serum lil serum triglycerides got sept blood urea and creatinine for routine check up if any specific complaint present then let me know about that take care"
    },
    {
        "instruction": "hi doctor I involved in a car accident seven years ago I have been having problems with my neck ever since I recently consulted an orthopedic specialist and had an mri done last week the results are as follow multilevel degenerative disc disease with straightening of lordosis multilevel bulging and spondylotic riding with superimposed disc osteophyte complexes at ca c5 and c5 ca central herniation at c3 ca and multilevel luschka hypertrophy with foraminal encroachment currently I am taking aspirin lisinopril and hydrochlorothiazide omega and also synthroid 5 mug I want to know how to deal with these issues what to expect for the future and which type of exercise to avoid in order to maintain a normal life please suggest thank you",
        "input": "",
        "output": "hello for further information consult a spine health specialist online"
    },
    {
        "instruction": "hi doctor I need an opinion regarding the rays of my neck I met with two car accidents and have chronic neck pain and stiffness what could be wrong",
        "input": "",
        "output": "hi I have gone through your ray revert back with a detailed history to a chiropractor online"
    },
    {
        "instruction": "hi doctor I am a 28 year old male I am suffering from fatigue loss of appetite nausea pale stools and upper abdominal bloating I am addicted to benadryl for the past one and a half years to get sleep I stopped taking it over last three days",
        "input": "",
        "output": "hi revert back with the reports to a general medicine physician online"
    },
    {
        "instruction": "hi doctor I need an opinion regarding my elder sister she is 52 years old she is diabetic and is suffering from severe vaginal pain for the last few weeks while collection of pap smear the swab was bloody and it was very painful for her she is currently using candid cream and candid ve tablet for vaginal insertion I have attached the reports of pap smear and sea carcinoembryonic antigen serum test please help",
        "input": "",
        "output": "hello the reports of both pap smear and tumor markers are within normal limits and rules out any malignancy in terms of possible cervical cancer however the pain in vagina and blood tinge at her age where she is likely menopausal could be due to atrophic vaginitis there will be severe burning sensation and vaginal dryness which can cause pain especially on moving or walking revert back with the details to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor recently I was diagnosed as type diabetic now I am suffering from erectile dysfunction and weakness my testosterone level is 280 do I need to check other hormones",
        "input": "",
        "output": "hi for further doubts consult an andrologist online"
    },
    {
        "instruction": "hello doctor map in weeks lap a few months back checked now it was negative what is my problem when can I expect my period",
        "input": "",
        "output": "hi map pills are hormone based so they can change hormonal balance in body leading to irregular menstruation also carry out pregnancy test I would suggest you to wait for week more and if menstruation does not occur till then consult a gynecologist and have yourself examined but do not worry too much about it since it is a very common problem after taking pills and can be treated easily"
    },
    {
        "instruction": "hello doctor I have red bumps at the back area of my tongue could this be oral herpes I received unprotected blowjob a week back as such is it possible to get oral herpes although I was the one receiving the blowjob and did not engage in any kissing with my sexual partner",
        "input": "",
        "output": "hello I just read your query and from what you have mentioned it does not seem to be herpes infection on the back of your tongue those red bumps are they painful do you have swallowing difficulties if not then those are your taste buds they are present in every one would have been better if you attached a picture as well of these red bumps no it is not possible that you get oral herpes if you are the recipient of the oral sex"
    },
    {
        "instruction": "hi doctor I saw a sports injury doctor with mid back pain at night the first mri scan was poor quality so a second was carried out and that noted elliptical bilateral lumps at segmented levels I have been referred to a neurologist who is examining the scans I am seeking clarification that the description in the report does not indicate malignant disease I only have the reports and not the scans I had nocturnal mid back pain for four weeks and getting slightly better now",
        "input": "",
        "output": "hi your mri report indicates neurofibromas in your dorsal spine which is a benign growth originating from nerve sheath cells often it is symptomless but at times can give discomfort to the patient due to mass effect and pressure in the surrounding structures this growth is usually benign but may rarely turn malignant over a period of time your doctor may suggest a biopsy for the same to confirm the cell type if you have any more doubts please feel free to discuss thank you"
    },
    {
        "instruction": "hi doctor I am years I am facing sneezing and itchy throat due to this problem I am avoiding a few foods like chicken brinjal pumpkin I face this problem in the early morning after I wake up from bad also I start sneezing when I pass through the dusty environment also I start sneezing when I was around any unnatural smell like paint wooden polish etc one doctor prescribed me montelukast and cetirizine last year and I am using the medicine whenever I face this issue it gives temporary relief to me is this medicine good for my health can I use this continuously for a long time please advise thank you",
        "input": "",
        "output": "hello you seem to be having vasomotor or allergic rhinitis we need to diagnose it so that the treatment will address the cause however temporarily the symptomatic treatment would entail the use of steroid nasal sprays with antihistaminic and montelukast the choice of nasal spray and the antihistaminic can be done based on your work and response allergy to dust particles local flora and pollen can be overcome by finding out the offending agent and avoiding it entirely such a diagnosis can be made using blood elisa testing or skin prick testing sometimes the offending agent can be food allergen also regarding the choice of antihistaminics there are second generation antihistaminics with less sleep as a side effect some medicines like cetirizine can produce sleep and dryness of the mouth fexofenadine is slightly better that way asteroidal nasal sprays are generally safe and can be used for a long term fluticasone and mometasone are popular for further support do revert back to me in that case please attach your previous consultation papers any blood investigation reports if you can click a picture of the throat with open mouth showing the posterior pharyngeal wall it will be helpful for us to check for any postnatal drip congestion follicles nodes etc hope to see you in good health soon"
    },
    {
        "instruction": "hi doctor I am 64 and in the postmenopausal stage I had a hormone blood test and my testosterone was very low less than my vitamin was low and my estradiol was 73 I started to take supplements all natural like dea vitamin high and smilax I just got tested again and my vitamin is fine but my estradiol is even higher and my testosterone is 14 now two days before I took the test while on smilax which I know has its effect on testosterone level I am mostly worried about estradiol and ovarian cancer",
        "input": "",
        "output": "hi your estrogen level should be low at the postmenopausal stage but your estrogen level is similar to the level of normal reproductive years estrogen helps bone but carries the risk of breast cancer and uterine endometrial cancer estrogen therapy in the postmenopausal period also carries the potential risk of ovarian cancer dea dehydroepiandrosterone sulfate can help to increase energy and sex drive libido but not definite dea is converted in the body to testosterone"
    },
    {
        "instruction": "hi doctor I want to quit smoking what should I do to quit the habit of smoking thank you",
        "input": "",
        "output": "hi the decision taken is a great thing in smoking cessation you may list the situation when you are tempted for smoking keep chewing gum with you whenever you feel to smoke use chewing gum you may also divert your mind by having coffee tea fruit juices etc in many countries chewing gum containing a small amount of nicotine is available which gives the same kick what we get by a cigarette after a few days gradually we need to use normal chewing gum in many countries the herbal cigarette available which does not contain nicotine but it gives the placebo effect of smoking you may go for yoga and meditation which gives the self control and divert your mind more towards your profession body massage with medicated oil also helps to remove toxic substances from your body panchakarma of ayurveda is another option to remove toxins from your body many psychiatrists and hospitals run smoking cessation clinics they prescribe low dose nicotine containing chewing gum or herbal cigarette they give counseling and practical to come out of thought of smoking this is definitely helpful to you thank you"
    },
    {
        "instruction": "hello doctor sub ne for nip downs reg my wife aged 30 years is 17 weeks pregnant with our second child prenatal first trimester screening report indicated a calculated risk for downs syndrome as 544 final it at 12 weeks days was 8 my considering this an intermediate risk our obgyn advised early anomaly scan during 17th week the findings in ultrasound scan for soft markers came negative and the risk for downs was improved to 2837 our obgyn said that there is an option of nip available for further confirmation but she indicated that it is only optional there is no history of downs edwards or pataus in both our families and our first child is normally active first child no downs was born at weeks pre term because of pre eclampsia through lscs should we get the nip done please help us because we are confused",
        "input": "",
        "output": "hello considering the fact that firstly your it scan measured 8 my which was below 5 my cut off and hence was normal for gestational age secondly the cut off for trisomy 21 being 250 and age related risk as well were lower with 544 and 815 so the screen was negative and there was no intermediate risk as to be considered the age is 30 and does not qualify for advanced maternal age and also the first baby was not a down syndrome hence no increased risk in present pregnancy thirdly the anomaly scan as well do not show any evidence of structural cardiac anomalies or endocardial cushion defects indicating that the chances of the child being down is way too low nip with these reports is not recommended at all"
    },
    {
        "instruction": "hello doctor I am a year old healthy male yesterday I had my first panic attack and it was severe and lasted long I have ended up in the emergency room but they just gave me a diazepam and I was feeling good again but they never told me what triggered and I am curious last night I drank 10 my of phosphate codeine liquid and drank one 600 my beer and then smoked marijuana once I get back home which was a couple of hours later right after I smoked the panic attack started but I am smoking for six years and just strong strains and concentrated and nothing ever happened before yesterday I smoked a really non potent one my question is it possible that the weed is causing the panic attack or it was the codeine with beers I really do not want that to happen again",
        "input": "",
        "output": "hello it could be a combination of marijuana codeine and beer also regular use of marijuana will cause panic attacks it is just that the effects of whatever is taken regularly and do not show up immediately only chronic use of either smoking alcohol or other drugs will cause problems later on I would recommend that you at least try to reduce if not stop the quantity of the drug combination of alcohol weed and marijuana just get a chest egg electrocardiogram done to be on the safer side panic disorder anxiety disorder due to substance use panic disorder or anxiety disorder due to substance use try reduce the quantity of alcohol marijuana and smoking try some deep breathing exercises or other relaxation techniques like yoga meditation or progressive muscle relaxation exercises you can also visit a psychiatrist and ask him to help you with the panic attacks and anxiety issue he will probably start you on some sari selective serotonin reuptake inhibitors class of drugs which is just to be taken once a day for a few months and then tapered down and stopped try combining different substances when using them like tobacco alcohol and marijuana follow up after 20 days in case problems worsen and you need further advice"
    },
    {
        "instruction": "hello doctor I had a bad bout of ti male 72 which started around last month and I started antibiotics a week later by that time there was very heavy blood in the urine and was getting severe chills I took the antibiotics for days everything cleared up and then I traveled and upon my arrival here had cloudy and slow urine with some sensation in the urethra no other symptoms do not feel I have a fever I am feeling reasonably lively and reasonable appetite this latest bout of cloudy slightly smelly urine has been going on now for days it seems to be unchanged a urine test shows high leucolytes oh around glucose negative to normal nitrite positive protein bilrubin urobiinogen and blood ery ul seem fine maybe miniscule amount of blood",
        "input": "",
        "output": "hello I have gone through your queries you had recurrent documented ti with history of hematuria as you are 72 now and you had hematuria you must undergo clinical examination and few investigations you should contact your local urologist he will examine you clinically will do a digital rectal examination to look for prostate size consistancy presence of any suspicious nodule etc you need a few investigations also us kubp and per urinalysis urine is uroflowmetry serum spa urine for malignant cells for days last but not the least you need one cope cystoscopy to look for any urinary bladder pathology hence you please do not be late to attend office of your local urologist ti may be the manifestation of other pathology when you find ti in male person you have to find out the cause in your case prostate pathology may be the cause"
    },
    {
        "instruction": "hello doctor first of all I have an anxiety disorder so I got shaken up by bad news a lot and I just want to ask you about this I am afraid of this and please can you give me an answer that does not scare me more I have had sensitive nasal passages and mild end for about 12 years I get very dry sinuses when the temperature is low and it can sometimes clog up my ears and nose I keep it in check by using nasal rinse with neilmed purified salt and alkalol all natural products these work great we live in a small island country where we get water from mountains straight into a commercial cleaning station with filters and laser I have always used this clean tap water in a netipot and then pour a little bit of boiled water into the netipot to get the temperature perfect but now this morning when my sinus feel dry and just by accident I googled what is the best water is to use in netipot and all kinds of warnings pop put that you should never use tap water for netipot a google report says that tap water is not safe for use as a nasal rinse because it is not adequately filtered or treated some tap water contains low levels of organisms such as bacteria and protozoa including amoebas that may be safe to swallow because stomach acid kills them but in your nose these organisms can stay alive in nasal passages and cause potentially serious infections they can even be fatal in some rare cases very well I can very fast shift to distilled water and sterile water in the future but I just want to ask you if I make these changes now can I be safe that these dangerous bacteria are not living inside my nose already and get problems in the future or would I feel sick right away if I get this after using clean tap water for years without problems can I be safe that I did not get any of these dangerous bacteria will distilled water even improve my nasal rinse",
        "input": "",
        "output": "hello thanks for the detailed history first of all netipot nasal washes are a great way to keep your nose and sinuses clean this method is used in india from ancient times it is a part of yoga practice now you can understand that neti pot washes what was used centuries back were always from tap water and there are no complications written anywhere in the older textbooks and even in yoga literature it is the duty of health department of the country to warn the citizens regarding the use of regular tap water because in some places it may be impure it should not be generalized our body and nose in particular have tremendous local defense mechanisms against bacteria and they can very well take care of small amounts of bacteria if at all they are present in normal water since you have not developed any significant signs and symptoms of infection there is no need to worry tap water has not caused any problems in future you can use boiled and cooled tap water for nasal washes that could take care of bacteria and any remote chance of infection"
    },
    {
        "instruction": "hello doctor I have a question about taj catching and popping about ten days ago my right jaw suddenly began catching and popping with a great deal of pain at the time of the pop since then the pain when the pop occurs has diminished quite a bit but the right side of the jaw still catches each time I close the mouth it does not catch when opening also when it catches or pops my lower teeth do a quick shift then return to center my question is does the quick shift suggest a cause for the tad I am experiencing",
        "input": "",
        "output": "hello I have gone through your query and understand your concern this shift in your lower teeth could not be a cause for your tad temporo mandibular joint is the jaw joint between upper jaw and lower jaw and involves multiple and complex structures like a disc between two jaws chewing muscles and the joining bone structure a complete taj and dental evaluation should be done to determine what is causing your jaw popping swelling and clenching habit jaw clenching bruxism is not a condition but one of the main symptoms of a taj disorder tad could be because of tensed chewing muscles disparity in the disc changes in jaw bone structure other than taj issues psychological stress misaligned or attrited worn out teeth multiple dental treatments or multiple missing teeth recent dental injury or infection recent hospitalization general health conditions or systemic diseases affecting bone like arthritis could also cause tad visit a taj specialist to identify what has caused your jaw swelling from your query and the details provided regarding the panaromic ray op the cause should probably be the change in your jaw bone structure due to the advancing age and long term medicines intake it could also be from the psychological stress if from the recent hospitalization and surgery this psychological stress or an underlying bone disparity could have triggered a subconscious level jaw clenching thereby causing a tension in your chewing muscles leading to a muscle swelling in your jaw initially a muscle relaxant will be prescribed to bring down the tensed jaw muscles and the swelling after which a complete taj evaluation and ray study will be done to pinpoint the cause a splint similar to a night guard called deprogrammed appliance will probably be suggested as a diagnostic appliance to identify the cause and to protect the teeth from getting attrited during jaw clenching once the cause is determined the treatment is targeted right at it"
    },
    {
        "instruction": "hello doctor I am 18 years old the medication I take is bupropion al 150 my I have not wetted the bed since I was years old because I used to have problems then for some reason these past few days I have been wetting the bed again I am not sure what is going on",
        "input": "",
        "output": "hi welcome to icliniq com I am sorry to hear about your nocturnal enuresis involuntary urination at night whilst sleeping rest assured it is according to evidence most likely not due to a serious cause and should be fleeting bupropion is known to rarely cause bedwetting as a side effect especially in the first six months bupropion works therapeutically with your body neurotransmitters chemicals used for signaling and sending of specific nervous system messages and can sometimes cause some of the minor nervous system signals to get confused for a short period making your bladder muscle contract and urethra relax for example causing bedwetting this rare bupropion side effect do go away within four to six weeks in most patients without specific treatment the following is what you could do apply a few general measures to decrease the risk of nocturnal enuresis like not having any fluids two to three hours before bedtime avoiding any caffeinated drinks after 0 am take your bupropion in the morning relax and take your time to empty your bladder completely at bedtime take any other supplements and vitamins in the morning make sure your room is properly darkened with no luminescent clock faces insight quiet room with soothing monotone white noise for example the sound of an air conditioner in the background do not think or worry about whether you might wet the bed it is a silly transient medication side effect which is out of your control for now if you are sleeping well at the moment without having much trouble falling asleep again some evidence does suggest benefit from setting a relatively soft alarm for mid sleep as I mentioned before this particular bupropion side effect should resolve by itself within four to six weeks typically if however it does not one can consider changing a second line treatment or adding one of the tablets we usually use to treat primary nocturnal enuresis this is rarely necessary however and there is a high probability that your problem will resolve within a short period of time"
    },
    {
        "instruction": "hello doctor I have read several studies on the effect of autophagy on material fibrilation I cannot understand most of the conclusions and need some help with this I basically follow a regime where I eat every other day and fast at least 24 to 30 hours at a time as I believe autophagy is activated and can have a positive or negative effect on the heart in particular the atrium and remodeling of electrics can you please tell me if you think what I am doing could possible cause fib or remodeling of my heart I have no current issues low cholesterol and be no family history and have a structurally normal heart however due to my years of excess I have this fear of getting fib I am male 35 years old mixed ethnicity",
        "input": "",
        "output": "hello firstly there is no good evidence for or against this rigorous fasting studies atleast have shown no significant increase in atrial fibrillation with such fasting practically we do not have good evidence for it now if we consider theoretically then yes fasting may stimulate autophagy and may have a beneficial effects on heart atrial fibrillation it does improve your lipid profile and risk of myocardial ischemia which is a risk factor for atrial fibrillation it may also reduce obesity bodily inflammation which is again a risk factor for atrial fibrillation so there is no evidence to suggest that it induces fib or remodeling but such rigorous fasting is not recommended based on current evidence we are also not sure whether you are meeting the daily requirement of essential nutrients dehydration should be strictly avoided you can share some studies with me so that I can clarify on them so fasting for few days say for 5 days a month is acceptable"
    },
    {
        "instruction": "hello doctor I apologize if this is an odd question but I am very concerned as I have been in treatment for recurrent yeast and be infections for over a year several dollar bills were accidentally washed cold cycle no disinfectant detergent along with a pair of pants and a load of underwear the money was lost in the washing machine with my underwear during the whole cycle I did not realize this until the next day when I went to do another load of laundry because they were crumpled in a corner so I had to worn a pair of underwear all day that had been washed in the same water as the money I know that money is absolutely covered in bacteria and being that the underwear was washed in cold and dried in low heat I am wondering how likely it is that a vaginal infection will result from them having been in a wash cycle with several dirty dollar bills again I apologize if this query seems a bit paranoid I am just very afraid of contracting any further vaginal infections especially not from an accident like this",
        "input": "",
        "output": "hello welcome to icliniq com I understand your concern but to me the probability of contracting infection is very less firstly you are not immunocompromised vagina is home to millions of bacteria and whether one will contract infection or not depends on immunity which I guess is intact in you now concern remained is of sad organisms out of those candid and be you already had these organisms must already be present in your vagina in a low number so the risk of acquiring this is low also the probability that those dollars carrying sad organism is less because nobody will frequently touch between note and genitalia and also these infections will usually occur with sex also most of the viruses are inactivated with drying or sunlight so overall risk is very low and I think you should not be worried about it I hope this helps"
    },
    {
        "instruction": "hello doctor I have problems with exhaling and inhaling my exhale is extremely quick with a pause my inhale is really difficult I can feel my throat nasal passage airways and throat contract when I breathe in also all throughout my back I feel pressure from my backsides and lower back when I relax to try and let my body take over breathing but if I just end up rolling my back my tongue slides back and maybe the uvula clogged the airway as well and breathing becomes laborious and takes all my energy and thinking sometimes I can take two breaths before it hurts and becomes laborious I order to breathe alright I have to hold my lower jaw in a position move my tongue out of the way and hold it there try to flex my chest downward and relax my belly it is a lot of work to breathe it is causing stress and anxiety I cannot sleep I have a pounding frontal and temporal lobe headache all the time and I have weird acid reflux unless I breathe a specific way if I stop manually breathing inhaling becomes near impossible and my throat feels like it caves in on itself also causing racing thoughts since when I relax it feels like my jaw and tongue are being stressed out and they twitch around too",
        "input": "",
        "output": "hi welcome to icliniq com I am sorry you seem to be experiencing some trouble with your breathing pattern first of all breathing is an involuntary response meaning even if you try to hold your breath your brain will override this command and make you breathe breathing is an automatic response controlled by the respiratory control center of the brain within the medulla oblongata and pons the muscles of the tongue are controlled by the hypoglossal nerve the jaw thrust maneuver you are describing when you lay on your back is designed to open your airway have you ever had any trauma or head injuries have you ever sought care for this before you mentioned that this had been occurring for several years so I assume you have had it looked at by a medical professional did your doctor do any tests mri or it scan it sounds like you have a lot going on while I believe everyone can benefit from chiropractic care it is my professional opinion based on what you are describing that you are not a chiropractic candidate and that you should be evaluated neurologically at the very least by your primary care physician I believe he will want to refer you to an ent or neurologist be evaluated by your primary care physician I believe that he she will want to refer you to an ent or neurologist in the event of an emergency go to the er respiratory issues can be life threatening and require immediate medical attention"
    },
    {
        "instruction": "hello doctor I am a 16 year old female and not pregnant I have a runny nose mucus cough sore and swollen throat what seems to be liquid in my ears can hear pulsating my face is achy and headaches I always experience sinus infections usually accompanied by strep throat around this time of year but I feel different I can say worse I have had these symptoms for the past three days and they are gradually getting worse they started with an uncontrollable sneeze I checked my temperature today there was nothing alarming but even when I am sick I do not run bad fevers I am currently using nasal spray and allergic medicine",
        "input": "",
        "output": "hello welcome to icliniq com I have gone through your query and I can understand your concerns the symptoms you have described suggestive of simple ari acute respiratory tract infection there is no need to worry as it can be completely cured by timely treatment and chances for the complication is less I suggest you to consult a general practitioner and do the following things simple analgesic like paracetamol or ibuprofen for pain antihistamines like cetrizine or levocetirizine would provide symptomatic relief nasal decongestant like xylometazoline if you have blocked nostrils a short course of antibiotics like amoxicillin for five to seven days can be taken steam inhalation twice a day would be effective generally symptoms will subside within a few days if the symptoms persist despite all these we have to do the following investigations as prescribed by your physician abc complete blood count and urine routine chest ray to rule out pneumonia or other lesions I hope this helps bacterial or viral infection basic blood and urine investigations chest ray sinusitis ari conservative with antibiotics and symptomatic management"
    },
    {
        "instruction": "hello doctor I am 19 years old some of my facial hair change into light brown color from black it looks golden color in sunshine and I have also one or two white hairs in my head when I was 16 all my hair was dark black what should I do now to get their natural hair color back",
        "input": "",
        "output": "hello I just read your query see the color of hairs and skin is determined by a pigment called melanin the variation of this pigment varies from person to person due to their genetics or due to some environmental reasons one to two white hairs are not a problem but you must be aware because your beard starts losing its pigmentation there might be many reasons for this problem like lack of nutrients paternal effects as if your father or grandfather had been gone through the same problem stress lack of proper sleep or unhealthy lifestyle as you are young you can prevent this problem further by adopting all these simple remedies the formation of coloring pigment named melanin is based on many nutrients so start taking a healthy diet add fresh fruits vegetables pulses eggs etc to your diet avoid excessive tea coffee cold drinks junk food spicy food etc sleep adequately at least for six to eight hours and make sure you go to bed before midnight avoid taking excessive stress start taking tablet keisha kuntal vyas pharma two tablets two times a day for four weeks with water it is very effective in premature greying of hair take tablet hairbac two tablets be for four weeks with water it will prevent premature greying of hair take some curry leaves and put them into conut oil boil this oil after boiling when this oil becomes lukewarm apply this oil on your beard and scalp you can do this twice or thrice a week wash your hairs with mild herbal shampoo try all these regularly and it will prevent further greying of your hair and you will soon feel positive results in case you want to use a dye for your beard or hair or you are facing excessive greying of hairs then do consult a nearby dermatologist otherwise try all these regularly I hope this helps genetic or lack of nutrients or stress or unhealthy lifestyle after four weeks"
    },
    {
        "instruction": "hello doctor whenever I am outside of home my face is looking red and many people asks me that why your face looks red please suggest me what should I do for it even in the evening I mean without in sun rays it also looks red I am a 20 year old male",
        "input": "",
        "output": "hello I just read your query there might be many reasons for turning your skin red while going outside most common reasons may include that your skin is very sensitive and whenever you go outside your skin is not able to tolerate the external heat and produces heat stress to your skin and skin turns red to avoid this condition drink lots of water and keep your skin hydrated this will help you to avoid this problem up to some extent during the daytime it might be due to uv ultraviolet rays of the sun it does not matter whether it is a sunny day or cloudy day the uv rays reach the earth and have effects on your skin this might be one of the reasons behind red skin so apply sunscreen lotion while going outside whether it is sun or clouds you can choose any sunscreen lotion of any reputed brand apply half an hour ago while going outside if only sensitive skin is the reason behind your redness then you can also apply aloe vera gel twice a day it is very helpful for sensitive skin and helps a lot with your problem if it is stress or anxiety induced redness then try to keep calm your mind and body and sleep adequately eat fresh fruits and vegetables it will help to keep hour skin hydrated and healthy redness can be mild moderate or severe if it is in mild form and does not causing you any other harm then try all these and you will see very positive results very soon but sometimes it might be due to some hormonal problem or some other underlying problem in that case you need to visit a nearby dermatologist for treatment I hope this helps after four weeks"
    },
    {
        "instruction": "hello doctor my year old daughter has recently been diagnosed with a mild high frequency hearing loss in both ears her hearing levels are only very slightly below normal and it is not impacting her day to day in a noticeable way so for the moment the audiology team are just monitoring it my worry is that I accidentally caused it when she was a baby there was one time when she was a young baby maybe months old and she was in a rear facing car seat in the front of my car I her ears were near the speakers at the front of the car I turned the engine on and the radio blasted out really loud I think it was probably on volume 12 or 13 I turned it down straight away and she did not cry but now I feel awful that I may have damaged her hearing please could you tell me how likely it is a one off incident like this would have caused it",
        "input": "",
        "output": "hello welcome to icliniq com I understand your worry I would say it is possible to develop such a hearing loss due to what we call acoustic trauma noise induced however we can never be sure whether the loss is due to that incident or due to some other or if the loss was congenitally present what you can do to prevent further deterioration is prevent her from listening to loud music keep her away from loud sounds try and use noise isolation buds when there is excessive noise outside eat a healthy diet and meditate rather than worrying about what could have caused the loss I think it will be prudent to prevent any further damage to the ear and guide your daughter on the right path to achieve what she wants to I hope this helps"
    },
    {
        "instruction": "hello doctor I am having cervical fusion levels 17 I am on my of suboxone daily I told the surgeon that I do not want opioids can I stay on my up to the surgery morning I do not want to stop and have withdrawals or take any opioids before or after the procedure",
        "input": "",
        "output": "hi suboxone buprenorphine is given to treat opioid dependence prozac is an antidepressant I think because of your disease process cervical radiculopathy in your case you have been taking some pain killers mostly opioids for a long time doctor might have prescribed suboxone to take you off opioid dependence suboxone can cause a certain amount of drowsiness and has potential to interact with many drugs to cause side effects some of which may be significant the decision on continuing suboxone and prozac until the day of surgery should be taken in discussion with your surgeon and anesthesiologist it also depends on what anesthesia they are going to use during surgery it also depends on ur respiratory system how well it is functioning your fear is that if put on opioid again post surgery you may get addicted again be assured that as long as you are under medical supervision and adhere to instructions addiction potential will be less as far as my knowledge goes they will definitely consider stopping suboxone before surgery because if this is continued further analgesic prescribed post surgery may not work do not be scared discuss with your surgeon and anesthesiologist and they will suggest what is best for your health"
    },
    {
        "instruction": "hello doctor I have horror mornings after I open my eyes and I get out the bed only after I stand up I start sneezing maybe 20 times I have itchy eyes and years and runny I feel like I have sand in my eyes I have done prick tests for allergies and all come back negative I also have done nasal corvettes turbine reduction and all in vain my mornings are the same what is the cause of this",
        "input": "",
        "output": "hello allergic rhinitis is a perrinial manifestation of allergic reactions to unknown triggers also you may have coexisting allergic conjunctivitis though prick test is negative for most of the allergens we can not neglect the role of unknown allergies in your case so I advise you to do blood allergy test with all full panels including environmental food drugs and medicines vegetarian and non vegetarian foods fungus pollen etc definitely we will be able to find out the single cause for your allergy about medications all drugs whatsoever you take are only helpful symptomatically so as long as you take medication you feel good but there is no choice as there is no permanent cure for allergies so I advise you to start montelukast 10mg one at night continue rhinocort nasal spray and claritin it is must to repeat blood allergy test as prick test can not test all available allergens and role of unknown allergens can not be neglected so avoiding the known trigger allergen and continuing the symptomatic treatment is the best solution for your problem continuous scrutiny must be going on to find out exact allergens in your surroundings"
    },
    {
        "instruction": "hello doctor what is this black mark and white spot I am 20 years old virgin and really worried about this it is not itchy or painful but whatever it takes I want to get rid of it also my penis and scrotum has turned very dark want to get back the original color and the whole area has too much foul smell so need to get that cleared too please help",
        "input": "",
        "output": "hi welcome to icliniq com I have gone through the available photographs and your description from the available details it feels the problem is due to poor hygiene I have commonly observed that people while taking bath forget their private parts to clean that leads to infection and related complications presence of foul smiling is clear indication that there is abnormal bacterial growth which is giving bad smells I mean to say that while bathing clean the private area with use of soap dettol to stop the foul smell and to regain original color as well as get rid from black mark regarding white patch it seems as a birth mark and I do not think it can be removed I must acknowledge that if it appeared every recently there is good chance of removing it"
    },
    {
        "instruction": "hi doctor I am a semi professional singer and recently I have been dealing with some vocal problems I think I had a vocal hemorrhage and it seems to slowly heal I am really not sure about what it is so it would mean the world if you could give me your thoughts on it and in how much time it is going to be okay",
        "input": "",
        "output": "hello there are hemorrhagic patches early stage in the anterior one third of both the vocal cords but that will heal if you will take adequate voice rest drink plenty of water maintain vocal hygiene for a month and take proton pump inhibitors as well get repeat laryngoscope done after a month also there seems to be a phonatory gap in posterior third of vocal cord but to confirm if the gap is present I need to see video of laryngoscope if you have a video of scoot please send that to me a picture will not be enough even if gap is present it will go with the speech therapy"
    },
    {
        "instruction": "hello doctor I have some issue with my penis I cannot get it strong enough when I am fully erected the muscle of my penis is weak even when I am very horny and have erection I have done some blood analysis and the results are fine and normal some doctors say that it is a phachological issue I also stopped masturbating for a month and I have not seen any improvement please advise me if there is anything I can do to get it stronger",
        "input": "",
        "output": "hi I read your query and understand your concerns I request you to provide following information point wise so the diagnosis can be made and suitable remedy can be offered how long the problem is there have you experienced similar issues in the past how the problem started it was built up slowly or abruptly what could be the factor according to you for onset of problem frequency of the problem in last one month what number of sexual intercourse masturbation failed in last one month what are the factors that increase the problem factors that relieve the problem you can describe them in detail if any do you get early morning erection if yes how frequent and how intense please answer this necessarily details of past medical illnesses like duration any complications treatment received till date 10 do you take any substance of abuse like alcohol or tobacco and others investigations done till date and reports please attach them 12 do you have any psychiatric illness 13 any other problem you like to report I must assure you that once we know the cause I can you guide you better in regard to treatment"
    },
    {
        "instruction": "hi doctor I have had a possible low risk exposure a year back which is about 53 54 days before this day this has wrecked my life the exposure can be best described as follows and I apologize for the graphic nature of the same no penetration no oral sex but the unprotected penis has touched the vaginal area during a body to body massage with a thai therapist I have had a hiv duo test on day 13 and day 31 both negative non reactive I have had a oraquik home test at day 42 which is was again negative there are no real symptoms except extreme stress a sore throat for which I have not really required a medication as of now I have had a legion boil on my upper back since the last to years which did not affect or bother me as of now but for some strange reason has decided to ache or itch since the last days for which I have consulted a skin doctor and was told that it is a legion because of oil deposits which has become infected now and has prescribed medicines before he can take it off now I request you to please answer the following question can I move on with the possible case of low risk and my tests at more than 28 days for a hiv duo test at more than 28 days which a lot of specialists say is conclusive or should I get tested again do you think that my boil legion flaring up has anything to do with hiv I do request you to pal help me with this as soon as possible",
        "input": "",
        "output": "hi yes the test is conclusive although antibodies take some time to develop it is good that at least you know your baseline hiv status you can go for repeat test at three months although the risk was minimal in future I suggest you to use precautions and condom usage your lesion at back is most likely folliculitis which can be there in any individual because of increased sweating follow the prescription of your dermatologist"
    },
    {
        "instruction": "hello doctor I am suffering form folliculitis for about month I regularly visit my doctor and take all medicines on time the problem is folliculitis present on my legs and hands every week they are gone and then come again then my doctor ask me to do test of blood test and ice test my blood test report was all fine but my ice level is 170 so please tell me what should I do to control my ice and how to get rid of folliculitis permanently",
        "input": "",
        "output": "hello folliculitis is inflammation of the hair follicles usually it is due to bacteria but sometimes fungus can also cause folliculitis most commonly it is seen over face beard chest arms and legs mainly diagnosed by careful inspection of the affected area by the specialist sometimes pus or blood tests and skin biopsy is also required to find out the cause as you said your blood tests shows ice level 170 it is completely normal and it has nothing to do with the folliculitis so nothing to worry about ice levels if your folliculitis problem is recurrent then you have to find out the cause for recurring infection of affected area talk to your doctor for good antibiotic course or antibacterial cream to apply on affected area also it is very important to keep good personal hygiene do not share your towels or clothes with anybody use good quality soap for bath if no improvement then you should see any other skin specialist or dermatologist for expert opinion"
    },
    {
        "instruction": "hello doctor I have been biting the teeth at night for about five years is this harmful to my health",
        "input": "",
        "output": "hello welcome to icliniq com I understand your concern unfortunately yes this is harmful to your dental and overall health bruxism teeth grinding or night grinding is not a condition but one of the main symptoms of taj disorder this could be a temporomandibular joint taj issue temporomandibular joint is the jaw joint between the upper jaw and lower jaw and involves multiple and complex structures like a disc between two jaws chewing muscles and the joining bone structure a complete taj and dental evaluation should be done to determine what is causing your bruxism it could be because of tensed chewing muscles disparity in the disc changes in jaw bone structure other than taj issues psychological stress malaligned teeth multiple dental treatments and recent dental injury or infection could also cause this jaw condition visit a taj specialist to identify the cause initially a splint similar to a nightguard called deprogrammed appliance will be suggested as a diagnostic appliance to identify the cause once the cause is determined the treatment depends on it untreated bruxism may lead to multiple enamel chip outs weak teeth and gums and generalized tooth sensitivity so please visit your dentist as soon as possible and get it treated I hope this helps"
    },
    {
        "instruction": "hi doctor I do have constant headache sometimes due to toothache gum disease no hole or nothing right now my head aches seriously and I have used mixanal tablets the pain still persists",
        "input": "",
        "output": "hello kindly tell me which side of head is effected usually frontal side of headaches are due to sinusitis if you have only frontal head ache then do xray skull sinuses back side of headaches are occur mostly when blood pressure increases if you have back side of headache then do your blood pressure checked and then take blood pressure lowering medication sometimes headache occur due to stress in this situation try to decrease feeling of stress headache occur due to migraine then it present with nausea vomiting blurring vision sensitivity to light noise smell dizziness in this scenario proper course of medicine is prescribed if an individual is facing headache along with complain of vertigo or ear pain or ear discharge then it is concern to treat ear problem sometimes person is sensitive to some smell or allergic to some medicine it also causes headache so kindly give proper history about your headache for proper treatment and prescription"
    },
    {
        "instruction": "hi doctor I am a year old unmarried female with no disease ever diagnosed I live a sedentary lifestyle with very little or no exercise I do not smoke and I do not diet I am taking normal oily curry with bread recently I got my lipid profile done and saw that my triglycerides are 30 is it severely low am I at a risk of heart stroke or brain hemorrhage or do I have undiagnosed cancer or just malabsorbtion can you tell me which tests should I get done in order to diagnose the cause",
        "input": "",
        "output": "hi your triglyceride level is too low and causes are low fat diet hyperthyearoidism malabsorbation syndrome malnutrition these all are important causes of low triglyceride levels and minimum level must be up to 145 so how we can increase and what we should do let us see consequences you may have low vitamins absorption that ultimately leads to other disorders hyperthyearoidism low fat diet malabsorbation syndrome it do it b12 to ash abc ear got sept bl urea creatinine hyperthyearoidism low fat diet mal absorbation syndrome hypocholestrolemia after investigations after investigations after investigations"
    },
    {
        "instruction": "hello doctor my father has diabetes and recently we noticed that his toes turn to purple at night especially when he is not walking or standing it goes back to normal when he walks for a little bit we run some tests and I would like a specialist to look at them we consulted a cardio doctor but I am not sure they know what is wrong so I have the lab results and I need a doctor to give me more information on what they mean and what possible directions we could take I also want to share the list of drugs they gave him so far",
        "input": "",
        "output": "hi gone through the reports you provided he is having diabetes reports suggest that he is having blockages in leg arteries and also in heart arteries doctors have started on anti platelet drugs and cholesterol lowering drugs prescription looks okay further I will suggest be on all these medications if his toes does not improve within to weeks he may need a procedure to open the limb artery blockages as he is not having any heart related symptoms like chest pain breathing difficulty can wait and watch for heart issue with continuation of prescribed medications"
    },
    {
        "instruction": "hi doctor I am 46 years old on no medication apart from zinc daily that seems to help with my low testosterone be averages about 10 63 mhg resting pulse between 58 and 65 bum my height is 10 and weigh about 75 keg about five years ago I noticed odd heart rhythms after playing two hours of badminton I ignored them for months but one day after stopping and bending over I had a large clock in my heart and it took off like a rocket about 140bpm after five to ten minutes it clocked back to normal speed this happened about four times over two to three weeks and has never happened again for the past four years I had a stress test 12 lead egg and echo and two weeks hotter all was fine and no more svt I had a repeat egg and echo a few months ago and all is well apart from the odd strong ectopic I do however still have an issue every now and then like the past two weeks for no reason at all my heartbeat becomes very strong still steady and not fast in the 60 at rest and I feel it almost all the time to the point I can see my handshake to my heartbeat whilst holding a phone etc I feel fine but it is very hard to relax and sleep as it is banging really hard I am generally aware of my heartbeat but this is on a different level it is not linked to stress or any external influence that I know of and I have checked my be whilst it feels strong and it is the usual 10 60 my question is are there any physical reasons for this g my dad had angina and triple bypass and is there anything I can do to help it also if I had blocked arteries would the ecgs stress test and echo have picked this up at all I was offered beta blockers by my go which I refused as my heartbeat is not fast",
        "input": "",
        "output": "hi it seems that all the tests you had are reassuring what you are describing seems to me as ectopic and a small dose of beta blockers could help but if the resting heart rate is less then 65 bum then better to avoid them in this case if the ectopic burden is very high they can be ablated stress tests except exercise egg will pick up old infact resulted from blocked arteries I doubt that this is the case here"
    },
    {
        "instruction": "hello doctor I am a 38 year old male my height is feet 10 inches and weighs about 90 keg I am a non alcoholic and non smoking person I have two children now I am facing erectile dysfunction problem first time I used suhagra 25 my and I enjoyed successfully how long I have to use this tablet for natural erections and what are the habits to overcome this problem",
        "input": "",
        "output": "hi welcome to icliniq com you can use this tablet for the long term as this tablet does not cure your erectile dysfunction it works when you use it and its effect lasts for few hours to days now coming to the habit to overcome this includes daily exercise or morning walk for at least 40 minutes avoid too much oily food consume low fat diet whole grain foods fruits and vegetables will be useful if having diabetes or hypertension then manage them effectively with the help of drugs and exercise"
    },
    {
        "instruction": "hi doctor I went for a regular dental cleaning today and the periodontist is strongly recommending local surgery to remove some muscle between my lower lip and gum he scheduled it as a frenectomy and insists it needs to be done to prevent further gum loss as he says the muscle is above the gum and not below where it should be and is pulling at the gums he says its a 30 minutes procedure I needed some advice on what to expect in terms of what the process will be what to expect on the day and after how painful it is likely to be and whether it is likely to cause any sort of facial deformity the periodontist insists it will not be painful as I will be on anesthetic measure but I could really use a second opinion as I am not finding much online regarding this process would it be advisable to get it done or should I refuse to go for it please also advise on what to expect the periodontist recommended taking three days off work which has scared me a little about how big procedure this is compared to what he is telling me",
        "input": "",
        "output": "hello welcome to icliniq com I have gone through your query and understand your concern if you pull down your lower lip you will see a small stretch of muscle connecting your lip to the gums just below your lower front teeth this small flap of skin and muscle is called the frenulum frenectomy is a minor surgery that removes this small bit of tissue this procedure is advised if the frenum is highly attached to the gums it constantly pulls our gums down on every lip movement this leads to premature gum recession and early tooth loss this process will be much faster especially in the lower tooth because they are the smallest tooth and have little gums surrounding them on the day of the procedure the frenulum and the gums surrounding it will be anesthetized and the highly attached frenulum will be gently snipped and the remaining tissues will be repositioned and sutured this will be a minor procedure after which you will be put under antibiotics and painkillers for the next three days the next three days to a week will be your healing period during which it is better you avoid or limit talking and lip movements you can take three days off so to facilitate easy healing these three days off is not because of the procedure but because of the sensitivity of those small muscles which is in the process of healing this will not cause any major changes to your facial and lip structure if your frenulum is causing lower gum recession I recommend you to get frenectomy done soon to prevent future gum recession and tooth loss I hope this clears all your concerns"
    },
    {
        "instruction": "hi doctor I have pericoronitis swelling and pain behind the wisdom tooth I went to the dentist yesterday and he cleaned my mouth and gave me antibiotics penicillin and ibuprofen 600 I have been taking the antibiotics for two days now and I do not feel an improvement is this normal how long does it normally take until it starts getting better should I go back to my dentist tomorrow I take ibuprofen but it only lasts for two to three hours I am also using chlorhexamed forte",
        "input": "",
        "output": "hello welcome to icliniq com I understand your concern the loosely attached swollen gums over the wisdom tooth is called as pericoronitis the age of eruption of wisdom teeth is from 17 to 21 years beyond that if the wisdom tooth has not erupted or half erupted gives out pain or swelling it is highly likely to be locked inside the jaw since they are the last ones to erupt most of them do not get enough space to erupt and tries anyways and this causes jaw pain swelling and sometimes the surrounding structures like same side temple ear and throat also gives out pain this wisdom tooth is called an impacted tooth during the first visit antibiotics and painkillers will be prescribed the swelling will come down eventually but if that is impacted it may not come down please visit your dentist and get an ray of your wisdom tooth to check whether there is enough space for it to erupt and to check whether it is erupting in the right direction taking painkillers and antibiotics will help to control pain and swelling but if the tooth is impacted this will not be a permanent solution you may require wisdom tooth removal I hope this helps"
    },
    {
        "instruction": "hi doctor I have slight be and high cholesterol I am looking to do cardiovascular exercise I have a concern about the spinning cycle some says it affects your main part of the lower body since you put additional load on the same meaning the seat you are sitting blood circulation reduces due to additional pressure and you may face erectile dysfunction I have seen a few pages on the same as well I am afraid if I could do cycling what is your advice",
        "input": "",
        "output": "hello welcome to icliniq com if you are a beginner then do not start with intense or advance workout choose an exercise and then slowly start it and as time passes increase its duration and holding position any exercise which intensely starts show harmful effects on the organs of body and overall health always involve a proper healthy diet along with exercise just exercise without proper diet has minimal effect on health instead of it sometimes shows harmful side effects it is better for you to start with light jogging then develop its pace and after a month go for particular workout specific workout also starts slowly and then develop its pace and strength if you have already weakness in your body and have other health issues like cardiac etc then do not do exercise without proper consultation with your doctor about the present and past history of illness I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 30 year old female I have thalassemia minor is there any problem in the future relating to pregnancy and delivery or is it fine to be pregnant at this age with thalassemia minor please reply I dont have any problem now my hemoglobin level keeps between 10 to g do",
        "input": "",
        "output": "hello thalassemia minor female can get pregnant and can have a child with normal genome without thalassemia or there can be thalassemia minor in children thalassemia minor is not a major health disease and do not worry about that even though it is present in your future child but you need to rule out thalassemia minor in your husband if your husband is thalassemia minor then the child can have 25 percentage chance of acquiring thalassemia major which is dangerous so kindly rule out thalassemia status of your husband and let me know about that kindly upload your report to guide you further"
    },
    {
        "instruction": "hello doctor I am under the treatment of infertility and I have started my first cycle of if before the start of the cycle my ovary size is right 81 my and left 79 my treatment plan for 12days I took recagone total dose 1700 iu after 12 days in the hospital they took my embryo and sample from my husband and we choose blastocyst for embryo transfer it was planned after five days of sample collection hospital did the sonography before one day of embryo transfer and they told at this point transfer is not possible due to your ovary size is big we asked for the report and they told its volume is around 385 now they are telling we have to free my sample and need to wait until my ovary size becomes normal after that we have to start for the next cycle with the new cycle cost we asked for the reason if we transfer with the present condition then what will be the risk they explained that it might be dangerous to the mother if I get pregnant I am a little bit confused now what should I do I have done all the precautions which they explained I took leave for 20 days to complete this cycle with success but at last the hospital is telling we have to wait and need to start a new cycle if cycle cost is really high so please guide me what should I do should I take the risk of waiting until my ovary becomes normal",
        "input": "",
        "output": "hello with what I understand you have now suffered from ovarian hyperstimulation syndrome where ovarian size and volume has increased to 385cc which is a lot and can cause sudden rupture and collapse in a patient this is a known side effect of follitropin injections if not related now that embryos have formed this cycle they can be freezed for utilizing them in the next normal cycle presently they cannot be used as hyperstimulation syndrome can often be life threatening I hope you have been admitted in the hospital and not at home please report to the hospital or if center and stay under medical supervision until the crisp is tired over no embryo transfer with ovarian hyperstimulation"
    },
    {
        "instruction": "hello doctor I have a small loose gum flap between my top incisor teeth it has been there for a few months now I thought it would go away in time but it is still there when I accidentally bite on it while eating it hurts the only medication I have taken so far is vitamin chewable tablets but I do not think that will fix it what can I do about this problem",
        "input": "",
        "output": "hi I have read through your complaint and the relevant details the loose gummy flap should be caused by any trauma and in my opinion it is getting injured every time you bite by the lower front teeth that could be the reason for not healing instead of plain vitamin I advise you to take multivitamin tablets available in the store as it helps in better healing also I advise you to apply ointment dentogel 20 my thrice daily on the sore area do not rinse it off with water immediately but leave it in place for 15 minutes at least since you said it has been there for four months I reckon you visit the dentist straight to check if there is any particular sharp tooth that hurts that part of your gums if that is the case the sharp portion of the tooth causing injury could be easily smoothened and polished in two minutes if it is possible you could also send me a picture attached with the complaint for better diagnosis"
    },
    {
        "instruction": "hi doctor I was diagnosed with herd six years ago I have gained 10 pounds of weight and I started having phlegm in my throat I am coughing more to get the phlegm out of my throat I am currently taking prevacid over the counter once a day in the morning the phlegm and coughing does not seem to be going away and it is affecting my daily life should I take prevacid at night too is there any medication that I can change to or add to prevacid daily",
        "input": "",
        "output": "hello abc complete blood count let liver function tests upper gastrointestinal endoscopy dyspepsia indigestion herd gastroesophageal reflux disease revert back after 15 days to a medical gastroenterologist online"
    },
    {
        "instruction": "hello doctor over two years ago my eldest son was diagnosed with lymphoma he had pet scans and it scans these started at the end of my last pregnancy and went on while my son was a newborn and infant I do not remember him holding the baby but he came home from scans and was around him they never said this was dangerous or told him to stay away from anyone for any length of time I would like to know whether my baby has been exposed to radiation",
        "input": "",
        "output": "hi I have read through your query in detail please find my observations below for further doubts consult a radiologist online"
    },
    {
        "instruction": "hello doctor I have been sleeping on a bed that has hard side on the upper torso and soft side below it is giving me pins and needles sensation and it has been there for a while now please advise",
        "input": "",
        "output": "hi for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor my husband smokes a lot I am quarreling with him often regarding this issue I feel so sad and depressed when I see him smoking my husband gives me assurance that he will quit but he is doing the same again please help me with this problem and save my family everybody says to ignore it but I could not please tell me how to make up my mind to ignore his smoking",
        "input": "",
        "output": "hi for further information consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor I would like to ask you a few things related to I pill two years I have taken around 10 to 12 I pill tablets in eight months again I had two tablets last year what will be the side effect in future I do not have any complaints rather than weight gain I was 53 keg before and now I am 63 keg please guide me",
        "input": "",
        "output": "hi an I pill contains high amount of hormone for contraceptive purpose I pill designated as emergency contraception which means only to be used after an unaccustomed exposure then definitely there will be problem if you take so much high hormonal pills in such a small period just like in our day to day life our inner body also feels distressed if she has to face emergency regularly surely you have already faced irregular cycles spotting as well as absent cycles just stop it now and switch over to regular pills as you need protection against pregnancy try combined oral contraceptive pills like novelon and femilon combination of desogestrel and ethinyl estradiol for further doubts consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I am 37 years old and normally take hydrochlorothiazide for diastolic blood pressure and zebeta for node dysfunction I am also on metformin my arc is 1 two days ago I started experiencing dull cramping chest pain that was not continuous I went to the er and all the tests came back fine chest ray ekg and blood work he did not know what was the cause for my pain they gave me nitro pill and nitro paste on my chest which decreased the amount of pain up on release my blood pressure was 101 mhg and pulse 61 I had not taken my pills on the day this occurred or the last two days it has been running around 104 63 mhg and pulse 69 my diastolic be without medicine usually runs around 95 and my resting heart rate was 140 before I started medicine so this is a huge change for me these are not new medicines either I have attached all my test reports for your reference",
        "input": "",
        "output": "hi we are here to help you revert back after the tests to a cardiologist online"
    },
    {
        "instruction": "hello doctor I am a 51 year old male I have never had any medical condition prior I spent a very cold day outside and woke up the next day with a feel of dizzy like I am drunk queasy and tired there is no pain cough or discharge when I move my head from side to side my balance gets impaired I also have constant ringing in my left ear it has been more than a week with no improvement please help",
        "input": "",
        "output": "hi your problem seems to be due to inner ear infection leading to impairment of balance on head movements and ringing sensation in ear known as tinnitus you need ear examination and complete vestibular functions assessment and evaluation by an ent ear nose and throat specialist this is to sort out other differentials like meniere disease inner ear disorder gives feeling of spinning benign paroxysmal positional vertigo bppv low blood pressure anxiety many medications migraine overheating or dehydration poor blood circulation take betahistine an anti vertigo and benadryl for the relief after consultation with an ent specialist revert back after the tests to an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I am a 35 year old male I can hear my heartbeat in my right ear when I bend towards my knee in any other position like standing or lying down I do not hear this heartbeat sound my hearing test is normal is it normal to hear this heartbeat sound when a person bends his head towards his knee also I am hearing it only in my right ear is it normal",
        "input": "",
        "output": "hi we are here to help you most commonly such feeling of heartbeat known as palpitations is absolutely normal however this could be due to anxiety issues I would recommend you to get your electrocardiogram egg and thyearoid profile done and write back to me with reports revert back with the reports to a cardiologist online"
    },
    {
        "instruction": "hi doctor about a month ago I bit my cheeks while eating I still have a small gray circular spot inside the cheek it has lessened in color and size but is still there it does not hurt and is not a lump what is it should I be worried it feels like the rest of my cheek except it has a faint gray color",
        "input": "",
        "output": "hi revert back for further doubts to an internal medicine physician online"
    },
    {
        "instruction": "hello doctor two and a half weeks ago I underwent an exploratory laparotomy that resulted in an appendectomy yesterday I went to see my primary care physician who diagnosed a surgical site infection I was given cephalex three times per day for ten days my question is about traveling with my current condition in a few days I am scheduled to chaperone high school students in a four day trip we are traveling by charter bus which will take eight hours there will be considerable walking due to my current condition would you recommend me to attend this trip do you think it will not cause more harm and be reasonably safe your response is greatly appreciated",
        "input": "",
        "output": "hi for further doubts consult a general surgeon online"
    },
    {
        "instruction": "hi doctor my son is 13 years old he is on ritalin la oleanz muzak and lithium I think the doctors do not know what is really wrong and are experimenting on him recently he is telling lies stealing and defiant he does get agitated at times and shows aggression and has become very impatient also he struggles to sleep he was much better before he was put on all these medications what could be wrong",
        "input": "",
        "output": "hi the medications seem to be for add attention deficit hyperactivity disorder and bipolar disorder with psychotic features he should be managed only by a psychiatrist aggression is a part of add the ritalin methylphenidate hydrochloride can cause sleep difficulties and lithium levels should be monitored very closely I am not sure if all of these steps are being taken please refer to our psychiatrist at icliniq for further recommendations do not discontinue any of these medications abruptly add and bipolar disorder with psychotic features hyperthyearoidism liver function test and blood counts abc should be done when on lithium levels should be monitored for at least every three months continue these medicines for now do not abruptly discontinue them for further doubts consult an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I am currently going through depression I have been having suicidal thoughts I have been thinking about death quite often last time when I felt depressed I tried to cut my veins but got caught for example the other day at school I imagined a way of killing a girl I do not know what to think I just hope I am not crazy please help",
        "input": "",
        "output": "hi firstly I reckon that you are going through a very difficult time right now however you are dealing with it courageously and I commend your effort to reach out for help here depression anxiety for further information consult a psychologist counsellor online"
    },
    {
        "instruction": "hi doctor my sister is 21 years old with type diabetes when she was 35 weeks pregnant she had a cesarean section delivery the baby heartbeat stopped and they could not get it started the doctors are blaming it to be due to diabetes they said that the baby blood acid was 25 which is five times higher than normal her blood sugar was 25 at the time of delivery because they gave her a glass of orange juice this does not sound right please explain her condition to me",
        "input": "",
        "output": "hi we are here to help you for further doubts consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor my 10 year old daughter had an appendectomy two days back she was in horrible pain after that they wished to send her home but since the pain could not be controlled with tylenol or ibuprofen they decided to keep her in hospital then the next morning she had bad diarrhea she went around 10 times in two hours it concerned me but they informed me that the diarrhea is normal her pain was still pretty bad so they finally decided to try something stronger that we could take her home it did work for three hours and they sent her home by the time we got home she was in horrible pain she was crying most of the night until falling asleep yesterday I noticed a lump on her back that was warm to touch and when I touched it she said that lump is the reason for her pain and it hurts her really bad as I was concerned I called her doctor but they said that they have no idea what I was talking about and they would like to check her in er the next day I know as a parent we over analyze everything I did not to take her to the er because of a muscle strain also I do not want to over look something that could make her worse what could the lump be should I be concerned she still has fever and pain please help",
        "input": "",
        "output": "hi for further information consult a paediatric surgeon online"
    },
    {
        "instruction": "hi doctor my partner is diagnosed with paranoid schizophrenia he has been taking olanzapine and depakote for the past eight years which has stabled him a lot but he suffers from panic attack when he stays with a group of people his key worker and psychiatrist are recommending him to start using clozapine I am really concerned as I have been told that clozapine should be prescribed only when no other drug has worked my doubt is why cannot he have anxiety tablets can I have some information about this drug as we are planning for a family life I am quite worried about the side effects I am looking for some advice thanks",
        "input": "",
        "output": "hi firstly clozapine is an atypical antipsychotic drug it means that it is one of the relatively newer drugs discovered to be helpful in paranoid schizophrenia clozapine also has lesser side effects and is considered more effective than the typical or older antipsychotic drugs in schizophrenia since your partner is still having anxiety in presence of others clozapine will be helpful however clozapine still has a few side effects to be watched out for some of them are reduction in the number of the white blood cells cardiac toxicity drowsiness dizziness headache drooling of saliva when sleeping and weight gain these side effects last only as long as one is taking clozapine since you are planning for a child it is important to know that many male patients taking clozapine have experienced cessation of ejaculation during orgasm but it has not been documented in drug guides having written all that your partner may have more or less of the side effects mentioned above thus I would say that he may start taking clozapine and see how he reacts to it for some time please consult with his doctor to know any other alternatives will be very helpful for further information consult a psychologist counsellor online"
    },
    {
        "instruction": "hi doctor I had elbow fracture four years ago following which I have limited rom and stiffness now I am also experiencing numbness tingling and pain in palm and fingers why",
        "input": "",
        "output": "hi revert back with detailed history to an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hi doctor when I sleep at night under ac or fan around midnight I feel as if my whole digestive system is moving upwards toward brain and my ears starts ringing I am feeling that my back side of my brain and my eye nerve are also getting stretched I am getting such feeling mostly when I am sleeping for the past six months during daytime I feel some pinches in my body I think food is also getting digested quickly if somebody checks my nerve condition they will come to know about my condition as this is new to me and my family I require support quickly what should I do I started taking loser 25 my four months back and I am taking vitamin b12 supplement and due to this condition my be is fluctuating please help",
        "input": "",
        "output": "hi I read your query and understand your concerns for further information consult a neurologist online"
    },
    {
        "instruction": "hello doctor I can retract my foreskin of penis in flaccid state but when erect I cannot pull it back only 25 of glans will be seen when I pull it in erect state what is the treatment for this will surgery or medicine or stretching exercises be effective also can I make my wife pregnant with this condition I do not have problem in urination and also ejaculation but when I ejaculate it does not go far as foreskin is above glans I lose erection while intercourse as foreskin is forced to slide down while having sex please help",
        "input": "",
        "output": "hi for further clarification consult a sexologist online"
    },
    {
        "instruction": "hi doctor I took my fourth generation elisa antibody and p24 test at 38 days and it was negative I also did my ran per test at 35 days and it is undetectable at 20 copies 100 my am I conclusively hiv negative because I continue to have a pimple or rash breakout on my face and chest also I have diarrhea and feel generally weak with degrees temperature could this be due to some other disease or still I have chance of having hiv",
        "input": "",
        "output": "hi for further clarification consult a hiv aids specialist online"
    },
    {
        "instruction": "hi doctor my penis is small in both length and girth it not even measures inches I just need to know is there anything I can do to make it normal",
        "input": "",
        "output": "hi I have read and understood your problem for further information consult a sexologist online"
    },
    {
        "instruction": "hi doctor I am having trigger problem in the middle finger of my left hand over a year but the same finger of my right hand has now developed the same problem they are especially bad in the morning and it is difficult to straighten them I can feel a very heavy click when I do it I had blood tests to test for arthritis and they came back clear I was diagnosed with breast cancer last year and treated with chemotherapy mastectomy and radiotherapy I have mentioned the problem about my fingers to each of these specialists and none of them had an answer everyone said that it is not a side effect of any of the treatments currently I am taking aromasin inhibitors and triptorelin I am very much worried and confused at the moment I cannot seem to find any answer as to know what it is please help",
        "input": "",
        "output": "hi rheumatoid arthritis could be of positive or negative psoriatic arthritis may occur before the rash gout pseudogout form of arthritis swelling of joints last for some days or weeks osteopenia or osteoporosis causing atypical fractures less likely metastatic disease ray of hands vitamin levels ana anti cop anti cyclic citrullinated peptide antibody rheumatoid factor and abc complete blood count rheumatoid arthritis and psoriatic arthritis it will depend upon the results I would suggest using 200 iu of vitamin and calcium 800 1200 my per day take ibuprofen 400 600 my twice daily for pain with food if possible get a splint to minimize active movement revert back after a month or sooner once the information available to an internal medicine physician online"
    },
    {
        "instruction": "hello doctor my friend had an intercourse and after which she took an I pill after 10 days she had her period it started yesterday and stopped now again it started and she is vomiting whatever she eats she is feeling dizzy and weak please suggest some way to overcome this thank you",
        "input": "",
        "output": "hello you have not mentioned after how many hours of intercourse your friend has taken I pill and secondly she had bleeding after 10 days of I pill to come to a conclusion we should know on what date of her cycle she had sex and when I pill was taken revert back with the asked details to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I am a 25 years old female I am suffering from breathing problem cough and dizziness since several months I get tired very easily I went to a doctor and she suggested for some tests like abc ash to ribs vitamin and b12 level bun creatinine got sept etc I got my test results and found that some values are varying from the normal ranges I am not able to meet the doctor as I am out of station and will take some time to get back I am really concerned about the test results I am attaching herewith the test result reports can you please suggest me what my reports actually mean",
        "input": "",
        "output": "hi revert back after a week to a general practitioner online"
    },
    {
        "instruction": "hi doctor I am a 26 year old male four months ago I noticed strange pink bump of size around my on the base of my penis it does not hurt could it be wart",
        "input": "",
        "output": "hi it is unlikely to get wart at the root of penis if you can attach a photo of the lesion then it would be helpful to make a diagnosis revert back with the photos to a urologist online"
    },
    {
        "instruction": "hello doctor my partner recently stopped taking antianxiety medications he is a severe hypochondriac specifically a cardiophobe he has experienced palpitations of various intensifies for years he has had multiple echocardiograms the most recent one being less than two years ago all of which cleared him of all and any conditions but after going off the medicines he has had a resurgence in the intensity of skipped heartbeats particularly when bending over they also sometimes happen when he is climbing stairs but when he is exercising they do not happen is there a connection between bending over and skipped heartbeats that can occur in people who have no medical condition",
        "input": "",
        "output": "hello welcome to icliniq com generally any type of activity could present with a skipped heartbeat it is just a coincidence that he has heart skips when he bends over there is no correlation between bending over and heart skip I advise him to continue exercising and adopt a healthy lifestyle it will go a long way in helping him beta blockers are also a good option if he is not getting better I hope this helps"
    },
    {
        "instruction": "hello doctor last summer I sat in the sun for a few hours tanning nothing to drink and I used two oils on me my face and chest have been red ever since after then I donated my blood and they sent a letter saying about some blood cells I had my appointment with a rheumatologist and got blood work done and I guess it had come back stating I had lupus everything has cleared up on me with the redness except my so called bufferfly rash what do I do I am starting to get annoying also this week I have also started to notice my hair has been thinning and I have a weird bald spot on top of my head which in fact I have not had my hair cut trimmed in over a year or two so what would you think about that also last year I had pain in my knuckles in the winter every morning I would wake up but not come back that is the confusing part I am starting prednisone tonight to see if that helps and I am on topamax and adipex right now those are it",
        "input": "",
        "output": "hello welcome to icliniq com I have gone through your history and images your rash seems still very florid and the alopecia is setting in I am not sure about the medications you are taking as it does not show up on the phone app but you need to increase your medicines oral steroids are needed in your case it will stop the hair fall and improve the rash although they do come with side effects of weight gain and increased hair over the face it will help to stop the disease process I am sure you are already on hydroxychloroquine that would continue for a long time topical steroids are not recommended for the face as they can cause scarring topical tacrolimus creams are helpful lastly I would like to know if there are any major organs involved in your case from the history it looks like minor organ lupus only but remaining workup is essential to be sure"
    },
    {
        "instruction": "hello doctor I am 71 years old and I am in the process of getting major work done throughout my mouth at the moment I have only three grinding teeth on my upper two on the left and one on the right numbers 12 and 13 days ago the dentist reinstalled the crown on number four but when I left his office there was no contact in number there was only contact occlusion on 12 and 13 of course it was very difficult eating with only two teeth that had full contact after a few days I started to get a lot of pain in my neck and behind my ear and up almost to the top of my head on the side of number right side and there was numbness in the area of my jaw joint in front of my ear I saw the dentist again four days ago and he added some type of material on top of number to achieve occlusion there I still have the pain constantly and it is pretty unbearable 800 my of ibuprofen and aspercreme on the area help me somewhat I called the dentist and he said that the pain was related to some nerve problems inside the number tooth I have been thinking maybe there was some damage in my jaw or something because of my jaw having had overwork trying to make on the right side while eating what do you think",
        "input": "",
        "output": "hi I have read through your complaint and the relevant details firstly I would like to ask you for what reason was the crown was placed for tooth and usually when there is no occlusion on one side you will get pain and soreness on the opposite side if the occlusion is high I too high crown the pain and soreness will be on the same side repairing the crown with extra material would not be ideal if the occlusion is not there the dentist must have given you a new crown in place were there any rays taken for the same tooth in that case any nerve problem can be easily identified please do not worry that you got a jaw problem it is with the construction of the occlusion which helps you to do normal function ibuprofen 400 my thrice daily should work well for this kind of pain heavy doses are not advisable I reckon you check with the ray for that tooth if you have not had any before and forward it to me I also request you to send the picture of the teeth so that I could arrive at a better diagnosis"
    },
    {
        "instruction": "hello doctor I have been having trouble with my weight recently I am a female with a height of 7 hoping to be 125 labs the lowest I have hit was 126 labs but that was about a month ago now it ranges from 127 128 labs I am eating 1800 calories a day on days I do not workout intentionally three days a week and 1900 on days I do my workout routine is quite different I do two workouts a day four days a week my first workout consists of 70 minutes of brisk walking and 20 minutes of abdomen exercises afterward my second workout which is about six hours later is 10 minutes of squats lunges sit ups etc and 20 minutes of brisk walking all in all that is eight hours of exercise a week not including unintended exercise like skating shopping being on my feet all day etc I would love to be 125 labs my waist ranges from 26 inches to 26 inches but I would love to get it to a steady 26 inches I have toned my abs but again I would love to lose these last few pounds what do I do",
        "input": "",
        "output": "hi welcome to icliniq com I have understood your concern about losing weight and you are working hard also for that your protocol for doing exercise workout is quite satisfactory but you can add 20 more minutes of aerobic exercise and resistance exercise combined see weight reduction and gaining both depends upon your metabolism and energy intake and expense even though you work out well but not maintaining the diet then you may not get the results that you need proper vegetable diet is compulsory avoid non vegetarian diet bakery items and outside junk foods which will reduce unwanted calories take homemade food whatever and how much ever you want just do daily exercise and add yogasanas for 10 minutes pranayama practice 10minutes at the end of each exercise sessions so collectively I prefer you need to do daily exercise and pranayama practice"
    },
    {
        "instruction": "hello doctor two months ago I was diagnosed with a very tiny hiatal hernia my chiropractor found my stomach is pushed up very high next to my esophagus he was able to push it back down but with a lot of painful force and manipulation ever since I have been getting sicker and sicker with episodes that are so debilitating that I can no longer work they happened occasionally at first but now three to four times each day always upon weakening and last for hours at a time it begins in my mid abdomen I feel and see pulsating in my abdomen and get a wet sensation as though the fluid is leaking out of my chest or belly if I push on that area or usually all by itself I get an instant rush of blood to my head and start to feel fuzzy my face turns bright red and becomes so hot that I get nauseous the redness sometimes stays sometimes goes away but what always follows immediately is intense heat throughout my whole body like my spine muscles and nerves are on fire everywhere from my head to my palms to my mouth to the soles of my feet then I start to shake uncontrollably with the shakes progressing into worse tremors in my left thigh and right biceps the shaking definitely seems to start from the abdomen or groin area if I press my thighs or groin or even touch them lightly my legs increase in spasticity when these episodes end I feel completely wiped out blurry vision and hard tired muscles but I never return to normal I always feel shaky and not myself I have been at the doctor twice when these episodes were happening the first time my be was a bit high at 130 mhg usually I am spot on at 120 80 mhg and the other time my vitals did not change at all during the episode other information possibly related my left thigh and knee are filled with fluid but my orthopedist attributes that to a popliteal cyst is that the same as an aneurysm he found behind my knee he gave me a cortisone injection four days ago but so far the swelling in the front of my thigh my knee and my calf have not gone down I was also told that I have an umbilical hernia and two inguinal hernias I also have a history of localized scleroderma which I understand can weaken the connective tissues and blood vessels recent blood tests for ana and rheumatoid factor both came back negative not sure how that is possible when I was diagnosed with a positive ana and localized scleroderma morphea 25 years ago I am very scared do you have any idea of what is happening to me or what tests I should have done not sure if this is gi related vascular rheumatology etc but I need to find a way to calm these spells so I can go back to work",
        "input": "",
        "output": "hello welcome to icliniq com well the symptoms do sound a bit different and something we need to look into as per the issues I hope they have looked into any form of venous obstruction I super vein obstruction any compression on that vein can cause the face to turn red and a bit of low blood pressure but it is a very rare thing to happen a it computed tomography of the chest would be advisable to rule out this compression causing the symptoms but yes it does not explain what is happening in your legs the symptoms do see to be of hypersensitivity do these symptoms happen after a hot water bath as well do you feel any shock like sensation from the neck below for the popliteal cyst it is a bakers cyst it is totally different from aneurysm as aneurysm will be pulsating and moreover it is a very unusual site for it to happen normally it does respond to injection cortisone but sometimes if the injection does not go in the right place it can persist you may need to repeat the injection after a month or so incase it is persisting as for localized scleroderma it is a benign form and ana can go negative at times we can either call it a lab error or at times the body does act through to make it negative how much has been the skin extent in your scleroderma though to summarize we need to figure out a cause for your symptoms scleroderma does not explain it we need to see if it is an sec superior vena cava obstruction of the rarest cause with the spasticity happening in your legs on touching I would like to rule out any brain condition as well these sound like paroxysmal dyskinesia I hope this helps"
    },
    {
        "instruction": "hi doctor I had a tooth extraction in the past to replace that I had opted for a bridge as a result the tooth beside my missing tooth was drilled to some extent after having that just in a span of one month a part of the bridge is chipped out I could not chew hard food from that canine and also if I eat some sweet that bridge part gives me sensitivity and there is also one thing which I feel is the side of my face right profile where my bridge is present is saggy there have been so many problems because of the bridge now when I look back I wish I had opted for the inbuilt one so my question is it possible to replace the bridge by an inbuilt I am wondering how would the side teeth which have been carved be fixed please let me know",
        "input": "",
        "output": "hello welcome to icliniq com I have gone through your query and understand your concern yes it is possible to replace your faulty bridge with an inbuilt type of replacement implants the nearby tooth which was reduced for support needs root canal treatment during bridge replacement the nearby tooth is reduced or shaped to some extent for supporting the missing tooth crown while shaping most of the tooth enamel goes away and this causes tooth sensitivity ideally a root canal treatment should be done prior to bridge placement to avoid such sensitivity issues underlying bone availability and quality should be studied prior to implant placement to avoid sagging issues you will require a full mouth ray op for this please visit an implantologist with your ray and get to know which implant type best suits your bone quality I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 25 year old female I experience hair loss in a particular area the rest of the hair is fine and fairly thick I just want to know what type of hair loss is this considered to be what stage is it at if untreated how bad can it get what can we expect it to look like or become is there an easy fix for this is this normal please reply",
        "input": "",
        "output": "hello I have seen the pictures this is frontal hair loss it will be of great help if you can send me a picture taking from above this kind of hair loss is commonly due to pollution dust exposure and wrong combing methods it is also seen if the patient is excessively using cosmetic products on face and hair please let me know if any of the above is present or not or do you have any medical disease"
    },
    {
        "instruction": "hello doctor I have bilateral monocular diplopia this began five months ago along with unilateral tinnitus of the left ear tinnitus is constant eyesight is rapidly deteriorating I had several new glasses prescriptions that help slightly with the double vision but are not completely resolved I recently had an mri of the pituitary without contrast in the last year I had to have two colonic polyps removed but I fear that cancer was missed I believe I have secondary metastases in my brain I also performed fbc cop and sea tests",
        "input": "",
        "output": "hello welcome to icliniq com there is no need to panic about your brain the double vision is not related to any neurological disorder anyway I would recommend checking the thyearoid hormone levels regarding the tinnitus it seems to be related to an inner ear infection as there is a presence of inflammation in the left mastoid sinus right next to the left ear for this reason I recommend consulting with an ent specialist regarding the double vision I would also recommend performing repetitive nerve stimulation in order to investigate for possible myasthenia graves syndrome I hope you will find this information helpful"
    },
    {
        "instruction": "hello doctor my act level is 43 and my cortisol level is 23 I am 25 years old and my weight is 237 labs with a height of 4 what could be the problem I am currently under nova ring 3 my and vitamin 50 units once a week",
        "input": "",
        "output": "hi welcome to icliniq com I have gone through your lab reports I need to know what was the reason and why these tests were done in the first place what were your symptoms and complaints and also why nova ring was started kindly get back with the answers so that I can make the best possible diagnosis for you"
    },
    {
        "instruction": "hello doctor I just went to go today for medication I had to force myself only 30 and suffering major depressive episode had it before I feel I left it too long I have tried some treatment medicines without success I did not really want seroquel but I just got 25 my and 50 my of pristiq my depression is that bad I am basically stuck in my room I know tablets cannot probably get me out of this cause this time it is really bad if they can give me some boost to then be able to do things that could help is that combo possibly effective sometimes they say it might be by adding one I know they have there nasty side effects though would you recommend taking it long term or one month until antidepressant takes effect or what I am so confused",
        "input": "",
        "output": "hello I can imagine how hard it is for you to be in this situation depression takes a toll on us in the worst ways possible you should appreciate yourself to be able to reach out to get help because many people cannot even find the strength or awareness to reach this point you are correct that only medications will not be able to pull you out from this however you need to continue medication atleast for 8 months even after you start feeling better because that is the minimum duration required for medication to balance the neurotransmitters involved and to be able to prevent the relapse secondly I would suggest you to start counseling therapy session what you can do is start therapy online most of my patients who are not yet willing to go out every week and travel to a therapist opt for therapy sessions online psychotherapy and cognitive behavioral therapy will help you with your thoughts and getting a control over the negative thought patterns which are keeping you in the loop of negativity and depression medications when combined with therapy is going to show good and faster results"
    },
    {
        "instruction": "hello doctor my daughter is 17 years old she had a cold for about four days when she started complaining of bad ear pain she was seen in urgent care a week ago and was diagnosed with a middle ear infection the apron noted her ear was pretty angry and prescribed amoxicillin 500 my she is supposed to take two pills in the morning and two at night which she has she also suggested to continue mucinex which is how I was treating the cold her severe ear pain did resolve in a day or two but she still complains of ear pain intermittently I am worried about taking mucinex for so long but even if she does not take it she complains of ear pain she is also saying that she cannot hear out of the ear to be fair she says the pain is not as bad initially but I am still worried I gave her a claritin last night thinking it may help but it just made her stuffy I know we still have three days on the antibiotic but should it be completely cleared up by now should I take her back to the doctor or try something else",
        "input": "",
        "output": "hi welcome to icliniq com complete the course of antibiotics take mucinex guaifenesin once or twice a day like how you have been taking for another three to four days if mucinex has an antiallergic component then no need for claritin or allegra otherwise add either of those to be taken once a day this will help to clear out ear secretions let water not enter the ear while bathing let her take rest and refrain from going to school or playing until she is better after the course of antibiotics gets over it will be prudent to show the ent specialist once so that he can look into the ear with an otoscope and check if the problem has resolved or not"
    },
    {
        "instruction": "hello doctor I suffered from a horrible panic attack this morning which lasted over hours and along with it I got painful cramps in my stomach similar to contraction pains and really bad chest pains it felt like someone has physically squeezed my heart and I have seen my doctor about this previously although my anxiety has not been this bad before but I am not sure what to do I have tried so many different medications and none have helped except valium and oxazipam but my doctor does not want to prescribe it because it is addictive and I do not know what to do because as I said my anxiety is debilitating now and I am a young mother of two I need to be able to look after them this morning I had to get my mother over here to look after them because of how bad my anxiety was worst part is I do not know why I had a panic attack in the first place",
        "input": "",
        "output": "hello I understand that high levels of anxiety and panic attacks can be debilitating and needs to be properly managed your doctor is correct in informing you that valium and oxazepam are not appropriate in this situation as they will make the situation worse if anxiety is persistent discuss with your doctor about trying saris or saris type of medication you have mentioned about trying different medication before there are different options like fluoxetine sertraline escitalopram etc based on your assessment and tolerability your doctor can prescribe appropriate medication and dosage try jacobson progressive muscle relaxation exercise atleast once daily to help to manage stress levels avoid caffeinated drinks alcohol and other drugs which can worsen panic symptoms finally consider having cut therapy counselling which is known to be effective in managing anxiety and panic attacks"
    },
    {
        "instruction": "hello doctor my baby is weeks old I fed her a combination of breast milk and formula milk I changed her formula to enfalac from friscolac slowly and started solely on enfalac yesterday afternoon I changed the milk upon consulting with the pediatric clinic because she was having constipation and gassy stomach my baby had watery stool once yesterday and today only after being completely on enfalac she also is quite gassy most days than not and gets upset with it cries last about 10 minutes my worry is that if she is okay and does the enfalac formula milk agree with her or she struggling with something else I had to add formula milk due to insufficient supply of breast milk",
        "input": "",
        "output": "hi breast milk is definitely best and first choice but as it is insufficient and you need to supplement with formula feeds all these formula milk are cow milk it is not clear from your query which enfalac formula you are giving as there are so many different types and also in the powder form and in ready to feed one watch it with the same formula milk for next 24 hours feed more on breast feeding and keep a watch on urine output it may settle down slowly if not then get stool test routine analysis give pedialyte 15 20 my after each loose motion give as small sips and better to give a milk formula which is ha hypoallergic like similar or can or any other"
    },
    {
        "instruction": "hi doctor I am schizophrenic but recovered I would like to know what next after recovering symptomatically functionally and cognitively over years now do I get to gradually taper off my medications do I get back the level of energy I had during my pre psychotic period before my first relapse",
        "input": "",
        "output": "hello good to know that you have recovered from schizophrenic episode you can gradually improve your functioning by following a bio psycho social rehabilitation model if this is first episode psychosis many guidelines suggest continuing antipsychotics for 2 years after remission of symptoms discuss with your doctor about gradually reducing olanzapine it needs to be done very cautiously under supervision and monitoring to prevent any relapse of psychotic symptoms if you had already had a relapse it is advisable to continue on antipsychotic medication for a longer period at the lowest possible effective dose so there is no straight answer to your question about tapering medication apart from medication try to get some therapy counselling to help you manage with sustained recovery also try to gradually get back into education training or some job to improve your functioning take it easy during the remission period also ensure that you follow a healthy diet sleep adequately and exercise regularly hope this helps take care"
    },
    {
        "instruction": "hello doctor I have to consult regarding my sister who is an epileptic patient she has been having severe headaches since few days",
        "input": "",
        "output": "hi can you describe her headache in details like since how many days she is suffering from headache it started suddenly which part of head is paining what are the triggers what are the deliver factors any history of fever how many attacks of headache in a day week once it starts how long it remains send me radiographic report of mri"
    },
    {
        "instruction": "hello doctor persistent sore throat that feels deep in the back of my throat along with dry mouth for the past two months the pain has gradually worsened my primary doctor indicated there is no sign of an infection or strep",
        "input": "",
        "output": "hi the above given complaints suggests that the source of infection is not in the throat do you have excessive belchings is there any history of gastritis do you have history of sneezing watering of eyes nasal discharge do you have headaches with heaviness of head and thick nasal discharge which is sinusitis so the infection to throat can be due to spread of infection from either nose or from acid reflux from the stomach these two things can affect throat even without infections of throat per se answering these questions will help me coming to a conclusion"
    },
    {
        "instruction": "hello doctor I am a year old female I have mild knee pain for the past six months to one year while working for long hours no constant continuous pain but I have discomfort while bending or sitting down for a long time and climbing stairs I am suddenly getting some discomfort like something dislocating while walking for one year I started with a mild cracking sound the clicking and cracking sound is there always while bending or squatting I am taking collagen powder and I took an ray my questions are chondromalacia patella will go away on its own how long it will take to heal or recover fully will stretch exercise and hot bag alone cure this doctor prescribed repacoll bioactive collagen peptides how many months do I need to take it please give your advice to heal completely asap we are planning for a second kid will this create a problem excess knee pain during pregnancy period and during delivery labor or section will it give any complications",
        "input": "",
        "output": "hi chondromalacia patella is just a softening of knee cartilage it will strengthen with exercises and medication and it will get better chondromalacia itself can take three to six months to get better at earliest if the exercises are strictly done and followed exercises will make your cartilage stronger and it will cure chondromalacia you can take repacoll bioactive collagen peptides till pain reduces and then stop as per your doctor advice best is to do exercises and have an active lifestyle and take medication only when pain is unbearable chondromalacia would not cause any problem with pregnancy however you might have to stop all medication when you conceive"
    },
    {
        "instruction": "hello doctor I got three temporary crowns in the front top teeth in the last week the two middle teeth and one on to the right the one on the left is perfectly fine and only took about 15 minutes to make and put in my mouth the other two had difficulties when being made along with this a couple of cords or what looks like cords are hanging loose on the right middle and the one next to it feels sensitive and hurts this is something that I am worried about and I have read multiple websites stating that my dentist was supposed to take these cords out before cementing the temporary crowns what do I do",
        "input": "",
        "output": "hi welcome to icliniq com I have read through your complaint and the relevant details ideally the permanent crowns usually fixed does not come with any cords I assume that those are the temporary ones which you have in the mouth at the moment with a clue that you said it took only 15 minutes to make one of it moreover if that is the case then those cords should the splints which are placed to stabilize the crowns in place for a good reason you have also not mentioned for what reason have you got the crowns for your teeth it would be of much help if you can send a picture of the same so that I can arrive at a better treatment plan coming to the sensitivity you shall use sensodyne rapid relief toothpaste to replace your regular toothpaste at the night and it helps you greatly I hope this helps"
    },
    {
        "instruction": "hello doctor please help me with my assignment I am an optometry student my question is what will happen to the foi when correction lenses are placed in the case of mixed astigmatism that has one focal point in the front which is nearsighted and one behind the retina which is farsighted will they merge as one when you give spectacle correction or the focal points will remain at their own places even though there is correction already please reply",
        "input": "",
        "output": "hello welcome to icliniq com the condition of one focus in front of the retina and another behind arises in mixed astigmatism as you have already mentioned to correct this we prescribe toxic lenses to the patient which as you must already know have spherical and cylindrical components with opposite signs as we are treating mixed astigmatism the process of how a clear image is formed in this case will be illustrated using a strums conoid this image is easy to find online or can be seen in a lot of basic ophthalmology textbooks here the different meridians come to focus on the retina such that they produce a circle of least confusion this makes the image of the object form with any distortion on the retina anywhere in front of or behind the circle of least confusion the image will be defocused I hope this helps"
    },
    {
        "instruction": "hello doctor I have a history of sinusitis last year I had chronic sinus symptoms and got a it scan it showed nasal septum deviation blocked maxillary and frontal sinusitis due to nasal polyps I got a fess and septoplasty done this year the symptoms reappeared strongly I have severe headaches facial pressure nasal discharge and pain in jaws and ears along with that I have a frequent infection in sinuses and have done an antibiotic course four times in three months I got a it scan and it shows complete pacification of maxillary sinus little ethmoid sinus and hypertrophy of nasal turbinates I am using nasonex steroid spray twice a day getting nasal rinse done repeatedly with saline water I am taking steam and anti histamine before sleeping but not getting better please help",
        "input": "",
        "output": "hello welcome to icliniq com I shall tweak your medicines a bit and let us see if that gets you an improvement change the antihistaminic to one with montelukast say like levocetirizine or fexofenadine plus montelukast 10 my take this once daily take another antihistamine different from above at a different time daily that means you will be getting two antihistamines per day and one with montelukast combination take a short course of deflazacort my twice daily take the same for five days and taper it to once daily for the next five days use the nasonex mometasone furoate spray appropriately twice daily there are particular instructions as to using the spray it has to be held in a particular way and sprayed if you have thick nasal discharge or fever or throat pain it is prudent to add an antibiotic preferably clarithromycin 500 my twice daily for five days let us know the progress with these medicines please upload previous and current it scan films to us when you write to us the next time do provide all previous treatment records and medication details when you get back"
    },
    {
        "instruction": "hello doctor a guy on youtube has videos of how he regenerated his teeth by mixing trisodium phosphate with baking soda and water he says he spits out mixture and not to swallow is this even possible or safe especially since dental work is so expensive",
        "input": "",
        "output": "hi welcome to icliniq com I appreciate you for such an interesting question on dental health talking about the two chemical components separately baking soda is found to be a great alternative in whitening the teeth as it has mild abrasive quality it is also found that baking soda has seven on the da scale radioactive denting abrasion compared to the regular toothpaste which ranges 200 300 just a sprinkle of it on the toothpaste in your regular brushing helps in whitening the teeth but this is not proved on the papers by research coming to trisodium phosphate it is one of the ingredients present in less percentage in the toothpaste which is chemically basic and removes stains but it is a commercial agent used as degreaser and stain remover otherwise the problem using these chemicals in dental cleaning is that you will not be sure how much percentage of the active chemical components you expose on the tooth surfaces in the did do it yourself project these might see effective but lack of studies and research making it unsuitable for daily usage no standardization therefore not used as commonly as a toothpaste also continuous and prolonged exposure of these on the teeth might end up in roughness of the enamel and a hence weaker teeth I hope this helps"
    },
    {
        "instruction": "hello doctor I am 46 years old I am suffering from heavy bleeding and very frequent urination issues for the last seven months my sister in law who is a gynecologist asked me to take a scan my scan report revealed that I have uterine fibroid she prescribed tragic 650 tablet for excessive bleeding I have been taking this tablet during my periods for the last seven months she suggested going for hysterectomy as there is no other effective cure in allopathy but I am not interested in undergoing surgery while searching for an alternative I stumbled upon a study conducted by an ayurvedic doctor which claims that uterine fibroid got cured or reduced in size by taking certain ayurvedic medicines I got excited and contacted the doctor through email and she prescribed certain medicines the details are at the end of this mail I took those medicines religiously the doctor also told me to take two more scans in the subsequent months I am attaching all the three scan reports but there was no improvement in my heavy bleeding condition and urination issue in the meantime the doctor got transferred to another ayurvedic hospital and now I am unable to reach her right now I am not under any medical treatment except taking tragic 650 tablet during the periods to arrest the excess bleeding after seeing your advice to a woman patient with a similar condition my hope has got rekindled I would like to ask you the following questions are uterine fibroid completely curable under siddha I will be consulting only you as I do not want to mix different streams of medicines I would appreciate it if after seeing my reports you could let me know how long it would take to get relief from excessive bleeding and to get completely cured of fibroid apart from this chat is it also possible to talk to you over the phone details of ayurvedic medicines taken amycordial syearup my for two months varanadi kashaya my one and a half months shigeru guggulu for two months kanchanara gulu tablet for 20 days nityananda rasa tablet for 20 days hingvashtaka churn one teaspoon for 20 days haridra hand two teaspoons for 15 days",
        "input": "",
        "output": "hi welcome to icliniq com I have treated many fibroid uterus cases most of them became asymptomatic with a reduction in the size of the fibroid and surgery idea was withdrawn smaller the size faster and complete disappearance of the fibroid medium to large sizes have reduced in size but they would become asymptomatic within one month period they need six months of therapy in your case it is the medium size one please take the following medicines capsule rasaganthi mezhugu one in the morning one and one at night with buttermilk after food tablet chitthira moola kuligai one in the morning and one at night after food van kumar legium buy 200 go take go one spoon in the morning and evening before food these drugs are available in south indian states my tone tablet two in the morning and two at night after food apart from these drugs a few home remedies to be done vaazhai poo banana flower to be fried or any other dishes daily two times uthiya mara patti and naval mara patti buy these barks one keg take 25 grams of each then add eight tumblers of water boil it to reduce to four tumblers this is the kashayam then drink one tumbler kashayam in the morning one in the afternoon and one at night in an empty stomach if not possible in afternoon due to office work then take that dose in evening please buy these drugs and herbal and try them for one month if you do not feel any improvement then continue it for the next three months you may require three to six months of treatment if you do not find any improvement in one month then I advise surgery"
    },
    {
        "instruction": "hello doctor I want to know how bad or serious is type I galassi arachnoid cyst located on the left temporal lobe can it be responsible for mood fluctuations depression and or panic attacks there are no clear symptoms but only mild depression also had recent changes in life and my father died and anxiety no strong pain only a minor one when my heart pounds fast but I have to pay attention in order to feel it is very subtle I am currently taking mild anti stress natural medication and a quarter tablet of betaloc zok 50 my in the evening to lower my pulse I have done my mri also",
        "input": "",
        "output": "hi welcome to icliniq com there are no clear evidence in the literature favoring arachnoid cyst as a primary cause of any psychiatric disturbances having said that its size does affect the lobe functions if it is compressing it so basically if you have symptoms that are not responding to the medical line of treatment then only you should opt for a surgical option"
    },
    {
        "instruction": "hi doctor my problem is my tooth and the color of my tooth is completly brown this happen because of flouride based on this is possible to remove brown colour to white and how much does it cost",
        "input": "",
        "output": "hi I have seen the picture attached along with your complaint you have severe dental fluorosis along with severe external stains it is definitely possible to get whiter teeth with the help of dental veneers firstly the procedure includes complete thorough cleaning of the stains secondly the teeth visible in your smile zone will have to be prepared ground slightly on the front surfaces to fix in the dental veneers coming to the cost of the procedure there are two types of veneers one is composite veneers which has to be done in the clinic manually by the dentist but this has short life and a major disadvantage of discoloration two ceramic dental veneers which have to be made in the laboratory and then fixed on the prepared teeth ceramic ones are much suitable for you as it can long last and hide the brownish colour of your present teeth to a greater extent but this is expensive than composite ones ceramic veneers have different price ranges and it depends on your dentist and the laboratory discuss with the your dentist about it and choose your best suited range"
    },
    {
        "instruction": "hello doctor I am 43 years old I have been experiencing a burning and itching sensation while urinating for about three weeks now I now have the same sensation when I ejaculate after sex also when I squeeze my penis there is pain along the lower part which feels like the pain is along the tract where urine and semen pass through please comment on what can I do about this I think it must be due to unprotected sexual intercourse that I had a couple of times some weeks ago after which I stopped",
        "input": "",
        "output": "hello burning sensation in the urinary tract or urethra can most commonly be due to either infection of bladder or urethra or any stone problem which has either passed in the bladder kidney system causing infection thus burning it can also be due to unprotected sexual intercourse which leads to the infection of the urethra the diagnosis of this condition is important before the treatment is started urine microscope and sonography of abdomen and pelvis are initial urine and scanning modalities which are required for diagnosis physical examination by a urologist is also of paramount importance as something it is the best morality to detect the diagnosis so I would advise you for now you take plenty of fluids as repeated urination can wash out the infection but the above mentioned test and physical examination are mandatory in your case as you have pain in passing semen also it can be a prostate infection which again requires a per rectal examination by a urologist to see for prostate status"
    },
    {
        "instruction": "hello doctor I am 31 years old before 16 years underwent anterior discectomy of c3c4 c4c5 with fusion even had neck pain and pain got radiated to neck and back while working suffering with pain for 16 years but I got used to it but for past few months neck became very week am not able to bare my head weight and not able to keep neck in straight position now for past 20 25 days having severe neck pain weakness of full both hands and legs sometimes with numbness eye pressure and back head pain I am not able to keep neck at straight position getting breaking sound if I rotate the neck movement is restricted I have attached my recent mri report can you please tell me what is the actual issue with this",
        "input": "",
        "output": "hi I have gone through your query and medical history along with the attached reports the problem does not seem to be due to the fused ca or c4 levels infact a disc prolapse at c5 ca with nerve compression is causing the present symptoms I would suggest you to go for physiotherapy sessions including cervical traction along with neck strengthening passive and active exercises swd irt it would always be better to avoid going through another surgery considering the post operative complications hence in my personal opinion you should avoid a re surgery and go for conservative line of management analgesic anti inflammatory tablets hot fomentation and use of cervical soft collar will help if the symptoms do not improve you can consult an orthopedist neurosurgeon for further management"
    },
    {
        "instruction": "hello doctor I have not brushed my teeth in a while due to being incredibly busy I am going to start taking my toothbrush with me but anyways I have some gaps in between my teeth and when I spit out after brushing my teeth there is a bit of brown liquid in there I do not know if that is just food or anything but I have not found anything else unusual",
        "input": "",
        "output": "hi I have read through your complaint and the relevant details firstly the brownish colour every time you spit out after brushing could be the food debris along with some bleeding of gums this is because of the white chalky substance layered on to the tooth surfaces on the gum lines which I had noticed in the picture you sent these are cleanable and needs professional clean up from the dentist just simple brushing will not help get rid of it secondly please do not give excuses for not brushing your teeth it is incredibly as important as you eat food everyday for your little tummy mouth is the starting point for digestion and only when you do not have a clean mouth you automatically flush in all the bacteria into the stomach with every food plus any food debris which are not cleaned up stay in between the teeth and cause tooth decays as well you have mentioned that you had a filling which confirms that you had a decayed tooth so kindly follow your brushing habits as a routine every morning and night with a pea sized neutral toothpaste thirdly coming to the gaps between your front teeth it is just the way your permanent teeth has erupted and nothing to do with the gum bleeding or not brushing etc it can be easily corrected with braces when you are much concerned on the looks otherwise your teeth looks healthy and you are completely alright"
    },
    {
        "instruction": "hi doctor the dentist thought my tooth had a fracture so he put on a temporary crown that worsened the pain and throbbing exponentially so he sent me to an endodontist that said my tissue was extremely inflamed and needed a root canal asap after the root canal the regular dentist put on the permanent crown I felt the throbbing again after he put the permanent crown on I got a second opinion and the dentist did an ray and noticed the crown did not cover my tooth fully I went back to dentist who had to restart he took the permanent crown off and put a temporary crown on again but he had thrown my original imprint away and waited to take a new imprint until after he removed my permanent crown the temporary crown is on now and is tiny compared to my other teeth it looks like a kernel of corn should he have taken the impression first before taking the permanent crown off I worry my new permanent crown that comes in will be tiny",
        "input": "",
        "output": "hello did you have any pain after completion of root canal procedure before permanent crown placement how is the pain is it the same pain which you experienced before root canal if the pain did not stop after completion of root canal and before crown placement then it should be from the tooth you should get back to your endodontist in this case generally a couple of days will be left as healing period before placement of crown if the crown is placed immediately without allowing a period of healing it hurts if the pain started after placement of permanent crown then you should visit your general dentist to check the status and fit of the crown in this case the crown needs some fine adjustments for a perfect fit and bite"
    },
    {
        "instruction": "hello doctor I am 40 years old 20 years back I was diagnosed with severe aplastic anemia idiopathic which was treated with at with prednisone cyclosporine it took a good year to have a complete recovery but it came back to 100 I have always lived a bit in the fear of myelodysplasia but 23 years later no issues other than cholesterol and high blood pressure I am being follow by a family doctor and getting blood counts every month but my last hematologist consultation was a very long time ago and while my doctor is fantastic I know that knowledge of hematology is complex I am tracking by blood counts for the last 12 years in the last years I develop my own concerns around some numbers that seems to trend on lower side first is erythrocyte which are 3 now 13 years back I was consistently around 8 but my last blood count was 3 but after years it has never been above 5 I do not know if this is significant or not but I know that our reference is 7 of the lower value average 13 bloods test would be 53 my hemoglobin is at 132 now my average would be 141 so the difference is not high but I still wonder about if it is significant finally hematocrit at 4 right under the low level it would average out a 41 now a new contender appeared in the outside of normal ranges and its the granulocytes immature at 04 reference is 03 10e9 platelet are doing great with 183 so no challenges here so in a way all of these number are very close to the lower normal I guess I am trying to figure out if I should investigate this further I will see my doctor in a few weeks for a follow up but in our last appointment she did not see any issues there in a way I get her point but I am not sure when I should start asking for an hematologist reference as for current medication I am on rosuvastatin 20mg ibersartan 300mg for a few years already but new to me is allopurinol 200mg for now still working on balance my question is really about if the number above can indicate a trend or not I understand the body change as we are getting older but I would like some opinion on this",
        "input": "",
        "output": "hi I reviewed all the documents you attached attachment removed to protect patient identity I can feel your concern as I have closely followed many aplastic patients before so the fear or concern you have is genuine but I am happy to say that your abc is wonderful I am not bothered at all the slight decline may be due to other reasons sometimes diet nutrition laboratory variation etc I would advise you not to worry and just get a routine laboratory check as per your primary physician like months or so you completely recovered the only advice is to make sure when you start any new drug or take ot drugs herbal medications make sure they do not have side effects of bone marrow suppression so just be cautious rest you are doing good please text me any other concerns if you have"
    },
    {
        "instruction": "hi doctor my lateral incisor fractured at the gumline and will likely require a surgical extraction also while a temporary filling was provided after removal of pulp pending a root canal the root canal was not done for many months due to an insurance lapse and the tooth became infected as well as surrounding bone I have read that some dental surgeons advocate for the removal of the periodontal ligament during extraction to facilitate healing and the proliferation of new bone cells and that this must be done explicitly with a bone burr I have read that this is common practice for biologic dentists and biologic dental surgeons and uncommon otherwise my med cal denti cal providers are not biologic dentists I have four questions how important do you think the complete removal of the periodontal ligament really is if the extraction is surgical is simple is it likely that the ligament would be removed anyway perhaps because some extra surrounding bone may need to be removed if removal of the tendon is not standard practice by the dental surgeon can I request it and would they know what to do and not be offended and finally if an implant is contemplated would the region of the removed tooth and perhaps some surrounding bone immediately be packed with a bone substitute for socket preservation or would the infection need to clear first",
        "input": "",
        "output": "hello there is nothing like biological dentists as such but you might be referring to oral and maxillofacial surgeons anyway the removal of root stump of a lateral incisor is a simple procedure and any dentists should do it there is no separate removal of periodontal ligament which usually is resorted by the wound healing itself in any case if you are planning implant you should not be removing any surrounding bone at all to get maximum implant attachment and minimal bone graft"
    },
    {
        "instruction": "hello doctor I am male 40 years old 187 am and 100 keg I have small wounds in my foreskin and it is red in color looks irritated I am guessing that the cause is our swimming pool party a few days back and I was unable to take a shower afterwards I guess that the dried and concentrated chlorine caused some irritation and wounding in my penis foreskin I am not circumcised it is not really painful unless pulling back the foreskin I have used some aloe vera on it but I was wondering what would help fastest for the irritation to be gone I do not have any pain while urinating",
        "input": "",
        "output": "hi I have gone through the history and description I have seen the image you have attached possibility of infection is more likely so apply betadine cream three times a day please let me know do you have any difficulty in passing urine any pain or burning while passing urine any fever please reply me answers of above asked questions so that I can guide you better I will be happy to help you further"
    },
    {
        "instruction": "hello doctor blood comes from my teeth and my teeth are going to loose its grip how can I stop this blood which is coming from my teeth and how can I strengthen them",
        "input": "",
        "output": "hello gum bleeding and gum recession or weakness is a sign of gum condition called gingivitis is the inflammation of the gums caused due to constant irritation by tar calculus hardened yellow deposits on the tooth food deposits or plaque that settles on tooth gets calcified on the long run and becomes hardened calculus deposit constantly irritated gums become weak and starts to bleed when we brush or in the morning time after waking up a professional scaling and polishing procedure is done by an ultrasonic scale instrument to remove that calculus once removed the gums take a day to heal and the gum bleeding will stop the next morning please visit your dentist and get this procedure done this procedure can be done once in months if required although we do a proper brushing every day there are certain spots between teeth where the bristles fail to reach hence a professional tooth cleaning is always advice once in a while there are certain brushing techniques that can be followed to prevent calculus accumulation get to know that from you dentist and please do follow them follow a healthy diet and lifestyle get a dental checkup once in months to diagnose any issues if present at the earliest follow proper oral hygiene by brushing twice daily especially before bed and mouth rinsing after every meal this way you will have a healthy teeth and gums"
    },
    {
        "instruction": "hello doctor gender male age 51 height 167 weight 74 latest be 140 90 presently no medication slight neck and back pain attached latest report",
        "input": "",
        "output": "hello I just read your query and saw the attached file your cholesterol level uric acid level are increased along with this your ash level is also decreased which is indicative of hyperthyearoidism I am advising you medicine for high cholesterol level and for back and neck pain here take it regularly for two weeks and consult me after two weeks regarding improvement and for further management or you can consult a nearby ayurveda physician as far as hyperthyearoidism is concerned you need hormonal therapy to correct it so for that you should visit a nearby general physician take capsule arjun two capsules two times a day with water after food for two weeks take capsule gilly two capsules two times a day with water after food for two weeks take tablet triphala two tablets at bedtime with lukewarm water do not take anything after taking these tablets capsule shallaki two capsules two times a day with water after food for two weeks take mahanarayan oil and do gentle massage with it of your neck and back two times a day do not sit under fan or ac for sometime after applying the oil two weeks"
    },
    {
        "instruction": "hello doctor I am on an anti rabies vaccination I am very worried as I have been on other medications which I believe may interfere with rabies vaccine modafinil fat burner ingridients yohimbine bioperine guggulsterones synephrine caffeine",
        "input": "",
        "output": "hi as per your medical history I went through I would suggest that the above mentioned medicine will not interfere with rabies vaccine however keep rabies vaccine as the top priority and if possible stop other medications till the course is done as rabies is a much more serious disease then fat burners"
    },
    {
        "instruction": "hello doctor I had my tooth out a few days back because of pain that has been going on since I have had an assess for over a year and not been treated my face is swollen on the one side and my jaw is very painful I have lost so much weight since my tooth has been removed and I am in so much pain I did not have an ray before having my tooth out to see if I still had my assess what should I do",
        "input": "",
        "output": "hello I have gone through your query and understand your concern pain after an extraction is quite normal for the next to days however the intensity of pain comes down each day please take the prescribed medicines without skipping and follow the instructions given by your dentist if the pain is unbearable even after taking painkillers and it is not fading out each day please visit your dentist and get checked for healing sometimes left out root portions disturbed clots could also cause delayed healing and intense pain and you should talk to your dentist and get the dosage increased if the pain management is not adequate with the prescribed pain killers abscess below the tooth drains immediately followed an extraction of the involved tooth so this could probably not be from the abscess"
    },
    {
        "instruction": "hi doctor months back had a spinal compression fracture of the t12 vertebrae caused by a large fall into water currently it is stable meaning I can walk and move no gross deformity I have motor and sensory function within normal limit I have aggravated pain when I bend forward or sit or stand for longer than 10 minutes but I can walk around without pain it is basically just a bone in my spine that is squashed to around 70 of its height and is pressing on the spinal nerve most fractures like this heal in a few months but mine never healed I saw a few different doctors which told me a few different things I got rays and a it scan I would like an opinion on the best non invasive treatment",
        "input": "",
        "output": "hi I have seen your it scan and rays it has been sometime now since you got the injury and I would not expect any more soft tissue or bony healing now suggesting non invasive treatment now would only comprise of daily physiotherapy and extension exercises you need to strengthen your muscles to take the load of the body and reduce load taken by the spine suggesting any invasive stabilization procedure to you would require looking at mri scans rather than it scan but your options unfortunately are limited interns of non invasive management based on physiotherapy only I would not even recommend braces for you mri if ready for invasive stabilisation procedure none as above physiotherapy as of now as wished and required by patient"
    },
    {
        "instruction": "hi doctor I am a 45 year old male non smoker and social drinker I am a generally healthy with no underlying medical conditions or family history of severe illness the only thing I have been diagnosed with is idiopathic hematuria which was told to me around two years ago I have no other symptoms appetite is fine and no major weight loss however the last few weeks I was having twinges around different areas of the stomach and aching kidneys I decided to have an ultrasound yesterday all organs were fine however something starting with was seen in the liver the person undertaking the ultrasound says these are normal but mine has a fuzzy edge and to make sure all is okay she has sent me for a cat scan with contrast her opinion was it looks fine but best to check I have health anxiety so my alarm bells are ringing with liver cancer I understand the chances of me having this are low but would like an opinion from an expert",
        "input": "",
        "output": "hello I have gone through your concern from what you have mentioned the doctor has probably identified a hemangioma which is a common finding and benign the confirmation and characterization of a hemangioma of liver is best done with a it scan the chances of it being a liver cancer is extremely low in view of your health status I would advise you to go ahead with the it scan so that we can confirm and also assuage your concerns"
    },
    {
        "instruction": "hello doctor me and my fiance had sex and seems out of fear took spill because it was unprotected for sometime so many doubts in mind but no leakage or injection of sperm etc three time up done but all negative after taking spill period comes as per regular cycle for days but next period only one two hours bleeding and then stopped this month period is skipped till date say it late by 25 day including today do I need to visit doctor or wait",
        "input": "",
        "output": "hello if you had taken spill within 72 hours of unprotected sex it works well as emergency contraception about 90 since you had a regular periods after taking spill pregnancy is unlikely spill is hormonal pill containing synthetic levonorgestrel which can sometimes disrupt normal menstrual cycle it is possible that your regular menstrual cycle has been affected by taking spill but the side effects are transient and usually menstrual fluctuations disappears by the following cycle since you are reporting persistent delay in having your periods it is advisable to consult an og doctor to have a check up and help to re establish normal periods again it will be reassuring to you as well do not worry there will be no long term side effects due to spill but it should not be taken often"
    },
    {
        "instruction": "hello doctor experience episodes of extreme weakness lethargy tiredness unable to get out of bed going to the bathroom often at night two years back had egg proven tach after an episode went on for several days have had labs done close to two episodes a month back carbon dioxide was slightly low at 19 with trace blood in urine and us 05 and urine oh second one recently again this month had mild low bicarbonate",
        "input": "",
        "output": "hello I went through your reports and labs that you sent you have one report showing slightly low normal potassium level of 8 tac can be because of low potassium level there can be condition called as distal renal tubular acidosis for which check urine sodium potassium and chloride and creatinine and we have to calculate urinary union gap also since how long you are taking methotrexate"
    },
    {
        "instruction": "hi doctor I am totally new to sexual life and I read a lot about it but have some concerns first of all my questions would be about gay sex male with male secondly in my questions I am assuming that no condoms or so protection used assume that both parties do not have any disease and one of the cum with huge load inside the ass of other person does male semen create or causes any major or minor disease by its own when it is contacting male ass similar to the first question what if the cum load semen was in the mouth does male semen create or causes any major or minor disease by its own when contracting mouth what if male cum at the same time inside the ass of one person does the difference of dna in the two different semen cause create make any diseases why always doctors talk about transmitted diseases but not generated created made diseases when I ask about sex safety I feel like I am getting unrelated answers because I am surely not considering to have sex with someone who is not tested but people always seem to talk about diseases that are transmitted so please help me to answer based on the case scenario give",
        "input": "",
        "output": "hi I have read your query as per your scenario the answer is no semen in itself cannot harm rectal mucosa or oral mucosa or make a new disease only if your partner has a disease that is transmitted via body fluids only then you can get it same scenario with two males their dna will not react together to make a disease but that said anal fissures can result from lack of lubrication improper dilatation and improper penetration however you end your query by saying you and your partner are planning on getting tested and want to know tests for this it is better that you both undergo the full panel of studs and also get tested for hep c etc"
    },
    {
        "instruction": "hello doctor my husband is a complete sci paraplegic he is 28 he has been having severe stomach pains come and go for months and is not receiving any answers we were at the er times in a week no results of infection or constipation or anything seen in rays and cat scans he gets very bloated and wakes up almost every morning with gas pains and has to make himself sick if he cannot burp them out no fever but sometimes he will get the chills and sweats still without fever or temperature drop he needs answers it is very unbearable to him",
        "input": "",
        "output": "hi I have read your query but as you have not mentioned how long ago the injury was sustained I will presume it was not recent but the gas build is recent if both are recent you might want to look into the bowel program for sci first make sure his diet is not very high in sugars vegetables like broccoli cabbage radishes etc to decrease methane production in the gut the gas second introducing suppositories or carminatives will help with passing wind tablet motillium 10 my thrice a day before meals promotes gut motility too if it does not work there are other drugs like erythromycin an antibiotic available to promote gut motility that should help with releasing gas have a look at his gall bladder too sludge or sand and not just gallstones causes bloating indigestion"
    },
    {
        "instruction": "hello doctor I had my wisdom teeth pulled out a couple of times back now I am putting on braces my orthodontist said that I have to remove my premolars in order to make room but I feel like you could just push back my molars somewhat where the wisdom teeth used to be is it possible very similar to the bottom except he wants to remove one front tooth to make room but I feel like you could just push back the molars a little bit to make room",
        "input": "",
        "output": "hi first of all you have to understand the fact that not all wisdom teeth are functional what I mean is most of the wisdom teeth are removed not to create space but it does not serve the purpose to chew well instead of harm the surrounding gums and in orthodontic treatment the molars cannot be shifted because that will collapse the whole contacts between the teeth there is a rule that the molars have to hit each other at certain points only then it helps you in chewing your food efficiently hence there is no harm in pulling out the premolars in order to gain space because there would not be any gap left behind after the treatment is completed so I advise you not to panic because you are losing your premolar tooth but that is definitely going to help the treatment become a success"
    },
    {
        "instruction": "hi doctor I am a 28 year old woman and I am likely to get married by next year as I will be 29 by the time I get married should I plan to have a baby right after marriage or can I take some time my fiance is not keen to plan a baby right after marriage he is also 28 now and we want to enjoy a bit before planning a baby but I am worried will I have a problem if I delay it by two or three years",
        "input": "",
        "output": "hi we are here to help you for further clarification consult an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I had irregular periods so my family doctor suggested to have femilon I had femilon for over a year and stopped it three months back after that I had two I pills within a span of two weeks and my periods have started two weeks earlier kindly suggest a solution",
        "input": "",
        "output": "hi I have read and understood your problem for further doubts consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hello doctor I played volleyball on monday night and everything was fine but then I played squash on tuesday night my glutes were really sore on wednesday just deep muscle soreness but I chalked it up to not having played in months then I played volleyball wednesday night too and things were really sore thursday my left glue started hurting around am and by 10 am I could not walk at all so much pain I have been taking hydromorphone and oxycodone and celebrex anti inflammatory pills all night and day friday and today not getting better it is either a really good strain or a tear I have iced it I have got my home tens unit on it right now and often throughout the day night this feels like it is the exact same muscle that I hurt at the rehab center three years back and it really hurts it feels like my glue minimum maybe on thursday I used my massage chair hot tub foam roller trigger point lacrosse ball and my massage gun on it I am thinking that digging into the injury that much probably made it worse or aggravated it sorry so here is my question I have dry needled in the past and it has helped a lot but is it okay to dry needle if it is a torn glue muscle or even a strain the tens machine seems to take some of the pain away but could my tens be making things worse also I have been in bed laid up all day and night yesterday literally only crawling to the bathroom and back I was hoping that staying off of it a few days will make it better but I am not sure what else I can do since it is the weekend and the clinic is closed I was going to look around for a mobile physiotherapist to come to my place and maybe dry needle me or other therapy for some pain relief I honestly do not think I could climb into a car to drive anywhere otherwise I will stay in bed for the weekend and hope that enough of the pain is gone and I can go into the clinic and see someone on monday",
        "input": "",
        "output": "hello from the history it sounds more of a muscle strain or you can say it as does which is sometimes common as one lands or take a flight for taking up the shot but the pain is not reducing is not making things clear whether it is a does or muscle strain as both of it should resolve within 4 days of time so what I can advice is continue with tens and take proper rest tens will never make the injury worse its a morality for reducing the pain I will advice to take tens for almost 30 40 minutes 4 times a day and allow a complete bed rest without doing much mobility we can expect the pain to come down drastically in case after a day or two of applying tens for 30 40 minutes if the pain still persist we need to look for other factors but rest is what is needed without having much mobility in the muscle"
    },
    {
        "instruction": "hello doctor I was suffering from hair fall my hair is very thin then I used mintop 10 finasteride my tablet for one month after starting this prescription for 20 days hair is not falling but for the last 10 days so much hair is falling can I continue or stop mintop and finax",
        "input": "",
        "output": "hi I read your query and I saw your pictures the hair problem you are having this problem is called androgenic alopecia it is common in this age group it is due to hormonal changes in the body especially testosterone and dot dihydrotestosterone the medicines you are taking is very good the only side effects of minoxidil are there which is an increase in hair fall initially which eventually will subside in the next 20 to 30days so do not worry continue your treatment it will take two to three months to show a decrease in hair fall and five to six months to show an increase in hair density age hormonal changes stress not required at present androgenic alopecia androgenic alopecia more 10 minoxidil at night tablet final finasteride my at night tablet keraglo men gamma linolenic acid one in the morning and one at night and use anaboom shampoo after one month"
    },
    {
        "instruction": "hello doctor I have been going to a dentist about a tooth that is sore they started a root canal but then did not finish I have gone back several times and every time they open up the tooth and insert medicine my tooth is in agony right now I am just wondering if this is a standard procedure during a root canal should not the dentist remove the nerves so I am not in so much pain or is it the standard procedure to fight the infection first and then remove the nerves",
        "input": "",
        "output": "hello I understand your concern the number of sitting in the root canal procedure depends on the amount and extent of infection if the infection is more the tooth is opened up and medicated dressing is given to reduce the infection and to kill the nerves antibiotics and painkillers will be prescribed for the next three days to control the pain and infection after three days the root canal treatment can be done painlessly once the nerve had died from your query and the details provided it seems like you are having a challenging tooth quite a lot of infection curved roots pulp stones etc a clear picture of your tooth ray will help to identify the problem talk to your dentist and get to know what is causing this pain and delay in treatment I hope this helps"
    },
    {
        "instruction": "hello doctor I just want to confirm with you that fibromyalgia does not cause bulging discs my workman company blamed my fibromyalgia for disc bulging because in the past I have had headaches and neck pain with my fibre the bulging disc pain was within three hours numb hurting tingling arm all the way down after helping a coworker shovel and then running a big vibrating roller it was different than bursitis I have ever experienced I developed a headache after the pain in my arm calmed down the headache was in the front left of my forehead definitely not a tension fibre headache I also have occipital neuralgia that came with the fibre in the back of my scalp after hearing that it can happen while doing anything was when I came to the conclusion that is the only thing I did differently that day I feel like no matter what happens to me the fibromyalgia will get the blame after researching degenerative disc disease almost everyone has it I do not think this is a well known fact it happens as you age and can be as early as your teens and 20 people also want to blame things on that as a pre existing condition yet if they had an mri they would have it too otherwise my spine is beautiful according to my doctor I am 51 years old and was a heavy equipment operator and a pa for my aunt at the same time while having three teenagers at home the fibromyalgia and stress is really getting to me now though and I am having a tough time even working eight hours a week as a pa just so tired and fed up with misconceptions and lack of doctor and public awareness I hope this post and your answer will help other fibromyalgia patients because I know I am not the only one dealing with this",
        "input": "",
        "output": "hi I have read through your query in detail please find my observations below fibromyalgia is still a less understood illness with pain and discomfort involving muscles and bones and the main feature includes that it is puzzling or difficult to identify it is elusive and is a diagnosis the diagnosis is made on the elimination of known conditions which might cause similar symptoms after using standard diagnostic tests and investigations therefore if a patient is known to have bulging discs then it has to differ from fibromyalgia in other words you might have had fibromyalgia if there is no particular finding in the mri magnetic resonance imaging scan therefore it is important to document mri scan findings and then the diagnosis of fibromyalgia might be set aside and changed to include degenerative disc disease following the proof of bulging discs the problem is that probably earlier investigations have led your employers to believe that you have fibromyalgia however a single incident has changed things for you and they refuse to accept it the best way out will be to have evidence based medical diagnosis and take suggested treatment I agree that there is a lot of miscommunication about fibromyalgia and people with real problems are often labeled wrongly considering an earlier diagnosis which was made months to years back in conclusion fibromyalgia is not concerned with bulging discs and if your mri scan shows bulging discs which might be related to your pain and discomfort symptoms then you have the option of making a point with the workman comp authority hope this answers your question"
    },
    {
        "instruction": "hello doctor my mother is 62 years old she is a diabetic on oh and under good glycemic control she weighs about 56 keg she is suffering from a dry cough for four months now the chest ray is normal and ent consultation also ruled out any local cause she complaints of tickling sensation and coughs following it coughing even wakes her from sleep at night blood investigations done had all findings within normal limits except for high eosinophil count spirometry was done with the following results values pre inhalation are fac 60 47 fev1 63 18 fev1 fac 13 per 68 89 few 25 75 59 25 values after inhalation fac 70 60 fev1 71 72 fev1 fac 10 per 70 few 25 75 54 43 after this the treatment was started with a diagnosis of moderate restrictive and obstructive lung disease she is currently on budamate 200 trans caps one in the morning through lupihaler budate 200 and triohale transcap one cap each through inhaler at night tablet ab phylline one tablet daily at am but her symptoms improve intermittently and again recur spontaneously kindly suggest what to do",
        "input": "",
        "output": "hello I have seen the put pulmonary function test report of your mother let me tell you first that the put test is not done properly as post test is done immediately only after four minutes of the pre test ideally we do it after 15 minutes so we cannot rely on this put report even if we see at the report it shows moderate obstruction and no bronchodilator reversibility so it goes more in favor of cold chronic obstructive pulmonary disease the treatment of cold is mainly bronchodilator drugs by inhaler route so I suggest to stop budamate budate and triohale rotacaps start foracort inhaler 400 with zerostat spacer two puffs twice daily morning and evening and duova inhaler with spacer two puffs only in the morning continue tablet ab phyllis 200 one tablet daily if she feels too breathless after any type of exertion she can take dublin inhaler by spacer two puffs as required strict sugar control is advised I hope this helps"
    },
    {
        "instruction": "hi doctor I had clogged ears from sinus allergy congestion and my mom put a drop of oregano oil in my ear it hurt horribly and was throbbing and burning my ear I got my ear flushed out with water and got antibiotic drops could the oregano oil into my ear have caused permanent damage or caused any bacterial infection the doctor said there was no ear infection but could the oregano oil spread or seep into my ear and cause bacterial meningitis is it dangerous that it went in my ear I am currently taking lexapro 20 my antibiotic ear drops and doctor prescribed doxycycline if it gets infected",
        "input": "",
        "output": "hi before I answer your query I would like to give you a brief over view of the anatomy of our ear our ear consists of three main parts namely outer ear middle ear inner ear the outer ear is separated from middle ear by our ear drum that means that there is our ear drum which prevents entry of anything even air from the outer to the middle ear the middle ear is separated from the inner ear by a hard bone so there is no question of passage of anything from the middle ear to inner ear apart from the sound now coming to your query so seek to have had eustachian tube dysfunction eustachian tube is a tube which connects the ear to nose secondary to the common cold and sinus inflammation oregano oil can be an irritant and can cause significant pain when it comes in contact with sensitive structures of the ear such as skin and ear drum but the ear drum is very resistant and would not allow the passage of air inside the middle ear since the doctor has already examined your ear and ruled out any significant injury to the ear drum or any significant infections there is no need for worry there is no possibility of any bacterial meningitis or any harm to your body due to oregano oil probably there is physical injury to the skin of the outer ear and will heal in a few days"
    },
    {
        "instruction": "hello doctor I am 25 years old I have a small penis size about 5 inches after erection and night falls five to seven times in a month my height is 168 am and weighs about 59 keg I am unmarried doing shift duty I sleep usually six to eight hours a day I have not taken any medical treatment for this problem",
        "input": "",
        "output": "hello I read your query and understand your concerns from the mentioned parameters there is nothing normal other than night fall which is five to seven times per month regarding night falls I like to inform you that this is a natural process our body keeps on producing sperms irrespective of our sexual activity if the sperm get the way of outside by either sexual intercourse or masturbation then the problem is less likely to occur if somebody is not sexually active and not doing masturbation to release these sperm they get discharged automatically this is a kind of overflow this is more likely to occur when we have a lot of sexual fantasies and get dreams of sex or some other activity with beautiful girls the current night fall is may be all these things either you are not sexually active or not doing masturbation or getting dreams of sex or a combination of all these in regard to medical perspective there is nothing abnormal with this but in my view you need to get an appropriate partner for you it happens to almost everybody when they are not sexually active for a couple of days or weeks regarding your small size penis I would like to inform you that the average size of penis across the globe is three to five inches while erect presence of 5 inch size of penis is also absolutely normal and there is nothing to worry about this do not go for porn movies and old stories where a large penis is depicted as manhood capability even in the literature the girth of the penis is given more importance than length I will explain why the size does not matter the normal size of female vagina is about six to seven inches and out of this only outer one third is sensitive so I mean to say that a man who is able to stimulate outer one third of vagina is equal in sexual pleasure to the one who is able to stimulate full length to stimulate one third of female vagina a man need just three inch penis and nothing more fortunately you have much bigger than the minimum size of penis and you can satisfy any women who have normal size vagina other than this the sexual pleasure depends on the other factors like your age lust attraction to the partner your stress level to name a few the most important factor in sexual satisfaction is foreplay which takes place before true intercourse if you can devote sufficient time to it you are a man in true sense I hope this helps"
    },
    {
        "instruction": "hello doctor I have had high hamstring pain a few years ago now it is back again more pronounced on my right side though the left is now starting to match the right I am really active so I want someone to look at my mri and be honest did I tear or strain my hamstring about if I have to stop my active lifestyle if it needs to heal",
        "input": "",
        "output": "hi you have findings suggestive of a hamstring injury involving the left side hamstring muscles from the level of the ischial tuberosity attachment in the pelvis area and continuing to the biceps femoris proximal tendon and in to the upper and mid thigh areas and the myotendinous part along the posterior medial part of the thigh I have sent few images please check the first image is the upper part of the left hamstring tendon the second image is in the left mid thigh area there are minimal findings in the right ischial tuberosity area and otherwise the right side is showing signs of likely resolution as you have mri findings showing left hamstring injury you do need to recover and avoid stressful physical activity to your left hamstrings however the exact nature of active lifestyle is best commented upon after a detailed clinical evaluation"
    },
    {
        "instruction": "hello doctor I fell and hit my chin and my teeth tore a hole inside my lower mouth area between chin and gums it does not hurt but was not sure if I needed to have it stitched",
        "input": "",
        "output": "hi I have read through your complaint and the relevant details but I am not able to see the pictures you have attached the format does not support the files to open only I request you to once again send me the pictures for an accurate answer with the complaint you have given I wonder how there is no pain in spite of you being hurt and there is a tear in the gum you have to visit your nearby dentist if there is bleeding in the hurt area or there are any teeth broken down or if any tooth is loosened and wobbles or if there is a gum tear also you have mentioned that you hit your chin region this part of the jaw is sensitive to fracture in of the cases hence I advise consulting a nearby dentist to eliminate fractures of the jaw firstly meanwhile apply ice packs on the injured region and wash your mouth with lukewarm saltwater which promotes gum healing also avoid hot and spicy or citrus food massage the gums with clean fingers in a circular motion and in case of pain apply ointment orabase benzocaine along with massaging"
    },
    {
        "instruction": "hello doctor I had protected sexual intercourse five months back now tested for sad and everything came back negative I have a question around hav index value for type is 70 and type is 23 it was a type specific egg antibody test is this result conclusive or do I need to retake at any point of time in the future your response is most appreciated",
        "input": "",
        "output": "hello for that above limited information as you have not mentioned your age and sex here which is very important for any clinician and if the question is specific about some sexually transmitted disease because oh of male and female genital organs are different so all bacterial and viral flora growth can be different according to sex as you have told that you have had protected intercourse five months back so it always decreases the chances of studs sexually transmitted disease in any partner and you also mentioned that all reports of your related to sad are negative so I think no need to worry now as you have crossed the incubation period of almost all sexually transmitted diseases five months is a big time for your query about the hav index I think it is negative I could not comment on the specificity of egg however even if it is nonspecific no matters cause your index values are negative so do not worry results are conclusive definitely officially index value greater than is considered positive and index value below 9 indicates a negative result if the egg test is negative and at least six months have passed from the time of possible infection you do not have herpes number between 9 and is equivocal antibody to hav may or may not be present do not worry eat healthy and stay healthy"
    },
    {
        "instruction": "hi doctor I am a 34 year old male with recurring prostate infections with inflammation which is really painful with kidney stones happening all the time I am feet and about 215 labs weight I am currently on trileptal ranitidine and omeprazole and I have been on them for a long time like 10 years or so my symptoms are extreme pain in the lower back and painful urination and ejaculation and it hurts bad when I poop and I have energy I feel totally drained and I have constant hot and cold sweats my questions are can this lead to permanent damage or cancer and also what to do I am waiting to be scheduled with a urologist I have been battling these symptoms for over three and a half months with a few days of relief and the pain starts again any help you can give me will help out a lot also can this lead to me not being able to have kids",
        "input": "",
        "output": "hello the condition you are having could be chronic prostatitis usually bacterial or any obstructive pathology chronic symptoms suggest that you need complete urological evaluation with urine analysis urine culture ultrasound of prostate etc and treatment accordingly avoid caffeine and alcohol consume a lot of clear fluids empirical treatment with cotrimoxazole or ofloxacin for two weeks can be tried if the appointment with urologist is getting late with proper treatment there should not be any problems with fertility you can normally have kids development of or transformation to cancer is highly unlikely which may occur late after many years late after 50 60 you can try urispas flavoxate 100 my tablet twice daily after doctor prescription to get relief from urinary problems"
    },
    {
        "instruction": "hello doctor I had been diagnosed with hypothyearoid nearly 10 months ago my ash was over 100 during that time also I had uric acid which was high doctor prescribed me to take thyearoxine tablet 50 my daily and to increase it to 100 my after one month also uric acid medicine was given I took that for a couple of months but slowly stopped both medicines instead I am now taking 750 my ashwagandha and 400 my shilajeet daily I got my ash and uric acid tested recently and ash comes to 12 and uric acid is 47 both results are still higher than normal can you guide me for a suitable ayurveda medicine to bring thyearoid and uric acid to a normal level",
        "input": "",
        "output": "hi I have seen your attachments and read the complaints carefully it is not a big issue and can be managed through ayurvedic medicines and yoga practices hormonal imbalance metabolic disorders ash thyearoid stimulating hormone uric acid blood pressure and blood sugar you should take the following medicines regularly for one month and after one month you may revert back with investigation reports re kanchanar guggulu one tablet gandamala kanan rasa one tablet gilly ghanvati one tablet thrice a day after meals with lukewarm water punarnavasava 15 my with equal amount of water after meal twice a day alma alovera juice 10 my daily in the morning avoid spicy and fried junk foods drink plenty of lukewarm water regularly avoid milk and milk products egg and non vegetarian foods beans and protein rich food do regular kapalbhati and pranayam like anulom vilom nazi shodhana bhramari and specially ujjai do these things and provide your valuable feedback after one month"
    },
    {
        "instruction": "hi doctor I am a 45 year old female I was treated with intravenous cortisone injection therapy for a week for having acute demyelinating symptoms for almost two months that appeared together with a new lesion at the cerebellum area of my brain there had been three other there supposedly migraine type lumbar showed oligoclonal zones both in the blood and spinal cord my problem is that since then and even if the cerebellum lesion has disappeared I still experience symptoms not as acute as it had been during the episode but quite annoying to disturb my everyday life I have pain in my left arm and joints left leg and joints of both of my legs I also have back pain and tremor but not always I get tired very easily but tired does not mean tired it means that I start having problems with my balance in the left leg tingling eye sight problem cannot cope with too much noise argues and fights with family gets me worse nobody understands there is something going on the last neurologist I saw said that it is a matter of stress so he suggested to consult a psychiatrist my psychiatrist says stress does not cause this sort of pains as I already get a depression treatment for seven years however let me say they are going to get me crazy with all this do you have any idea how I might proceed",
        "input": "",
        "output": "hello I read carefully your question and would explain that your symptoms could be related to chronic lesions of multiple sclerosis is sometimes there is no total improvement after steroid therapy anyway I would recommend starting gabapentin for chronic pain or switch from zoloft to duloxetine which is better for chronic pain I would also recommend performing a new brain and spine mri magnetic resonance imaging in order to exclude possible new lesions it is also necessary to check thyearoid hormone levels for possible hormonal imbalance and vitamin plasma levels for possible deficiency I hope this helps"
    },
    {
        "instruction": "hello doctor I am very itchy one time my finger itched in the same spot for like two or three days intermittently then it was my foot I have also developed skin rashes that come and go doctors say it is either eczema or some kind of skin condition or bug bite these rashes come and go one doctor even thought I had an sad and so I got tested for every sad out there everything came back negative I even got tested for cancers diabetes lupus hepatitis and a whole bunch of other stuff again everything was normal I am also experiencing dizziness where it feels like the room is spinning off and on and tightness of the skull first it was on the right and left side then it migrated to the back and now it is back and the front sometimes my scalp feels like burning I have got chills on my hands and feet I have abdominal cramps diarrhea and nausea what is going on with me I am on the paragard i'd but no one wants to say I am having an allergic reaction and they are telling me everything is fine I am so scared because I think I am being poisoned do you think this is a reaction or do you think I am a hypochondriac I am currently on psychiatric pills and mood stabilizers",
        "input": "",
        "output": "hi I have gone through your query and reviewed the attached photograph it seems to be an eczematous rash also the rest of the symptoms could be a side effect of the i'd intrauterine device you can consider removing it for the rash I would recommend you to apply topical steroid like clobetasol propionate cream on the affected areas twice daily along with antihistaminic like tablet cetrizine 10 my once or twice daily depending on the intensity of itching for two weeks this should help in resolving your problem asteroidal preparations are prescription drugs and you need to see the doctor in person to get them"
    },
    {
        "instruction": "hello doctor so frustrating so a geneticist made a statement that I might have a mild form of hypermobility eds so I went to a rheumy who told me my brighton score was and that he knows I have hypermobility syndrome and would have to see a geneticist to see about the possibility of a mild form of eds it is like I just came from there all I know is I have joint pain clicking and back pain in my white smooth skin you can see most veins I have such bad stretch marks he even questions saying you just had one baby my hair is thin and falls out I have a sensitive tummy and get on and off chest pain I have a skin condition with little red dots everywhere as well as hay fever and cat allergies I know I have not had any dislocation but I have had a couple sprained wrist and ankles as well as a few times my knees gave out it would be lovely if I just got somewhere with my do as my pains get worst with age and I am only 21 this year",
        "input": "",
        "output": "hi joint hypermobility can be due to ehlers danlos syndrome which is characterized by weakness of the connective tissues of the body it is also seen in down syndrome and in people with marian syndrome I do not find a picture of marian syndrome seeing your images however the fact is that it is very rare to get a classical picture of any syndrome usually we get the mixed picture there is no point in finding your problem this way through photographs and reading about the disease on the internet I would advise you to get the following investigations genetic karyotyping echo thyearoid profile x ray of long bones these investigations will give an idea of what you actually have on the basis of available information and attachments my first diagnosis would be eds I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 14 year old male last week I had really bad pain under which I realized was my tonsils I went to a doctor to get it checked out he said they were definitely infected but they did not give me any medication he said it would go away by itself now I have a really bad cough when I cough it makes my tonsils hurt like crazy last night I had a really bad coughing fit that I could not breathe so I ran to the bathroom and ended up coughing up blood also when I sleep I feel as if someone was pressing on my chest and it is hard to breathe and it is also hard to swallow currently when I cough it hurts my tonsils my chest and now also my head only when I cough I get a sharp pain on my left temple I feel awful my mom said I also look really pale and my teachers have been asking me if I am fine because I do not look well I do not want to go see a doctor because it is a waste of time if I do not get any medication please tell me what I can do to feel better",
        "input": "",
        "output": "hi it is surprising that you were not started on medications despite your tonsillitis and throat complaints it may be possible that your symptoms or findings were subclinical when you saw the doctor and it may have worsened further since then it sounds like a throat infection for which you may need a course of antibiotics on an online portal such as this it is not recommended for me to prescribe antibiotics without an in person evaluation however I can recommend the use of antiseptic gargles such as dilute betadine gargling my of betadine in 50 my of lukewarm water do not swallow thrice daily before and after meals for about a week along with over the counter available anti inflammatories such as paracetamol 500 my twice daily for three days if you develop fever or your symptoms worsen it is advised that you show yourself to a doctor or at the er and in such a situation I am certain that you will be treated with medications appropriately"
    },
    {
        "instruction": "hi doctor I am facing skin rashes in private spaces for three days and it is very itching and burning situation kindly advise me medicine I am staying abroad for a project",
        "input": "",
        "output": "hi welcome to icliniq com itching over the private area has multiple causes the most common cause is a fungal infection which presents as red annular patches which keep on increasing or as redness with itching and burning with whitish deposition over the glans and foreskin the second most common cause is scabies which presents as red itchy bumps over the penis and scrotum if you would have shared the picture then it might have helped me to correctly diagnose the problem anyway for now I will prescribe you medicines for both fungal or mite infection tina cruris candidiasis scabies tablet levocet levocetirizine 10 my one tablet in the morning and one at night capsule itraconazole 100 my one in the morning and one at night luliconazole cream apply at night over the rashes clotrimazole cream apply in the morning tablet ivermectin 12 my one tablet once a week for two weeks permethrin cream apply all over body except face from neck to toe at night and wash in the morning complete one cream in one application apply once a week for two weeks after one month"
    },
    {
        "instruction": "hello doctor I need to know whether my child is affected by to or bronchitis I have attached his ear blood test and chest ray kindly suggest",
        "input": "",
        "output": "hi welcome to icliniq com I have seen the reports the very first thing why you suspected that your child may have to tuberculosis what are the problems he is having like prolonged cough are any swelling in the neck or any contact with a person who is known for lung to looking at his weight he seems to be growing well except for it mantoux tuberculin test which 15 my positive all other tests are normal ray findings are non specific best if you can get his sputum test to isolate germs in this age group it is done by gastric lavage or if he has significantly large glands in his neck then a needle biopsy of the gland which a safe and easy procedure there is a very fast and accurate test known as per polymerase chain reaction to confirm the presence of to germs if there is a contact with a confirmed case of lung to then with this it result you need to start medication I hope this helps"
    },
    {
        "instruction": "hello doctor my child is years old she was suffering from cold and cough and was under medication like mucolite timinic septilin and asthalin 5 my for the last two days she was doing mucus potty now it is getting better today we did a test and attached is the interim report please advise the anal side is a bit red and once when trying to clean it she in not allowing it she has no fever",
        "input": "",
        "output": "hi I have seen her reports your child has a respiratory infection and nothing to do with her potty the mucus you say is due to the swallowed phlegm she needs an antibiotic like moxclav dry syearup my twice a day continue astahlin syearup also and give calpol syearup if there is a fever and get back"
    },
    {
        "instruction": "hello doctor I feel pain in my knees only when I climb downstairs I feel pain below around knee cap I am 48 years old and was quite active in running and sprints my mri shows nothing and doctors are stating chondro patella I am on rest but no big difference in four months all medical traits like vitamin are great recently I started taking glucosamine I am healthy and quite fit",
        "input": "",
        "output": "hi I understand you have pain in the knee going downstairs it is good that your knee mri magnetic resonance imaging is normal which means you do not have something major to worry about regarding chondromalacia patella as diagnosed it is usually due to just softening of the cartilage I would recommend you not take complete rest in fact you can just do some exercises of the knee to make your muscle strong like quadriceps hamstring exercises static exercises and knee rom exercises movement of the knee makes cartilage more healthy but avoid running jumping or strenuous activities I would suggest you can continue some medications for calcium and glucosamine for healthy bone and cartilage if you do the above exercises and take good care of your joints your condition will improve"
    },
    {
        "instruction": "hello doctor I have a problem with sex related to long anal masturbation and it is causing my life at risk I cannot concentrate properly on my studies I am feeling constantly with my anus please help",
        "input": "",
        "output": "hi welcome to icliniq com I have read your query but it is not very clear you have not mentioned how many times you masturbate or if it is causing problems other than psychological and the exact nature of these psychological issues however I will address the last part directly where you feel the urge or acting on the urge causes you to lose focus you can try the following divide your day into hours given over to all activities and then try to stay within the allotted time for each this includes meal times time allotted for bathroom breaks and masturbation along with different subjects do not forget to allot yourself free time to pursue whatever you want even if it 30 minutes per day if you feel the urge during a time allotted for another activity it means you have lost focus so shift to another activity and then get back to the remaining time for the former try to incorporate exercise in your schedule endorphins are released in both so that might distract you as well last but not least you do need therapy to figure out which issues bother you anal masturbation in any form excessive masturbation or your inability to concentrate this can be provided by a school or college counselor as a start if you cannot contact a psychiatrist or psychologist I hope this helps"
    },
    {
        "instruction": "hello doctor I am 19 years old last year I failed in maths exam and now I am trying to pass it my exam is in april my mind is telling me not to study because I already know what is going to happen my father keeps asking me when do I have an exam or do you study my nerves can not handle this anymore after some minutes later I start crying for no reason the same thing is when my father yells at me I fall in a bad mood I start feeling bad when this happens I cannot listen to music I cannot watch to or do anything else it feels like I am dying inside I do not know what to do honestly they would probably think that I am not a grown man but I cannot help myself I really want to know what should I do I am nearly giving up I would be grateful for your help",
        "input": "",
        "output": "hi welcome to icliniq com failure can make you feel nervous and a little less of ourselves but understand that your self worth does not depend on exam results everyone has their own strength and weaknesses you too are good at something and bad at others clearly you are under a lot of stress I would suggest you talk to someone you can trust and share your feelings also I would recommend talking to a counselor psychologist or therapist they will help you with coping up with stress and anxiety and teach you techniques to have better control on yourself and also you can learn some study techniques which will help you perform better again remember you are not your exam results I am sure you have amazing potential you just need to find out what you are good at and become the best version of yourself"
    },
    {
        "instruction": "hello doctor I am a 60 year old male diagnosed with bah for three years now I have been taking tamsulosin my and dutasteride my once a day for the entire three years under the supervision of my go for the past three months my symptoms have gotten progressively worse my bladder does not empty completely and I have to urinate every hour the longest I have gone without urinating in the last three months is three hours and it is very rare that I can wait that long I have done some research and see that there are several surgical options I am looking for a recommendation for the least invasive but effective procedure on a side note the only time I can go for hours without having to urinate is if I am drinking alcohol beer after three or four beers I urinate with a very strong stream and for a long time I then do not have the urge to go again for almost three hours I realize that drinking beer is not an effective treatment but thought I would mention it in case it is helpful",
        "input": "",
        "output": "hi you will need to see your urologist and get a uroflow test done if the flow is fair with current medications and you do not hold much residual urine on sonography you may consider continuing the same medications and add an anticholinergic to reduce the frequency of urination if the flow is poor and or if there is large residual urine or if you are tired of taking medications you can consider surgery prostate surgery is minimally invasive done through urine tube and usually requires one to two day stay in hospital the gold standard is turn transurethral resection of the prostate or hole holmium laser enucleation of the prostate hole is basically prostate surgery done endoscopically with holmium laser this reduces bleeding and gives faster recovery compared to the older turn method thulium laser is equally good other less invasive options are green light laser tum transurethral microwave thermotherapy prostate lift etc which are day care but success rates are lower and generally indicated for smaller prostate or unfit patients alcohol increases urine formation and so temporarily you feel better flow but it only puts more strain on your bladder so avoid binge drinking or holding urine for a long consult your doctor for the best decision I hope this helps"
    },
    {
        "instruction": "hi doctor I am 26 years old I was looking for a professional opinion on treatments to remove a double chin and saggy area around the jawline and if possible some type of restoration to the cheek area I have sent some pictures the first five pictures are recent the other two are taken before few years I am a smoker for eight years could this have contributed to the cause of note I weigh about the same weight as I do before a year over the past year I have lost 25 pounds current weight is 170 labs due to exercise and diet yet double chin persists is sagging around the jaw due to loss of skin quality or would more weight loss solve the problem",
        "input": "",
        "output": "hi I have seen your pictures on the detailed analysis of your face it seems you have a bit of prominence of the jowls there is no double chin it seems to be entirely normal but if it worries you can go ahead with botox for muscle hypertrophy or thread lift I would like you to get examined clinically and judge what is required"
    },
    {
        "instruction": "hello doctor I have been experiencing muscle twitches in several areas of my body for a period of three weeks it stared in a small area in my back then stopped returning in my right hip and since then the twitching has appeared at my right shoulder both thighs both hamstrings both calves forearms and both arms it lasts not more than five seconds and stops when I exercise or contract the muscle the twitching tends to increase when I am anxious which is often at present my left forearm and fingers experienced slight pins and needles I have no obvious signs of muscle wastage and no clinical weakness I have full use of all limbs workout daily with no obvious decrease in intensity should I be worried about als as it is causing me to have anxiety attacks and to question everything",
        "input": "",
        "output": "hello welcome to icliniq com twitches are seen in als amyotrophic lateral sclerosis however they usually start in the hands and are accompanied by the thinking of muscles or atrophy of muscles a much more common cause of twitches is anxiety leading to hyperventilation leading to decreased calcium level in the blood in your case the most likely cause of twitches is anxiety however since I cannot conclusively rule out the possibility of als I suggest you do nerve conduction studies which can diagnose als please feel free to followup with the nerve conduction study report and we can discuss in detail"
    },
    {
        "instruction": "hello doctor according to my doctor I have sjorgen syndrome my big issue is that at times I have shortness of breath and it comes and goes it used to happen not too often years ago but now it happens every other month last year I had to be hospitalized due to my racing heart which went to the 180 bum and no one knew the cause of it my pulmonologist prescribed me var and I take it daily my symptoms are starting again where I get so tired even to eat while sitting at rest what should I do",
        "input": "",
        "output": "hello from your description it is clear that you have confirmed sjogren syndrome unfortunately it is a chronic autoimmune disorder and treatment options are very limited the treatment is only symptomatic and supportive in the sense that whatever symptoms you have we intend to alleviate those symptoms but no definitive treatment is effective in the long run as you said you experience shortness of breath on exertion it suggests that your airways and lungs are probably affected by the disease so it is our first aim to detect up to what extent is the lung involvement by doing various tests the characteristics of the disease is dryness of various mucous membranes and dryness of airways which leads to further symptoms like cough bronchitis or bronchiolitis and bronchial hyperresponsiveness pulmonary hypertension can set in the long run so keep watch on it by regular ad echo test of heart for pah pulmonary hypertension also keep watch on various complications of the disease corticosteroids and immunosuppressive treatment have shown some promise but it is not void of side effects var beclomethasone dipropionate inhaler will alleviate your cough and breathlessness but it is better if you take fluticasone plus formoterol inhaler twice daily along with spacer also taking levosalbutamol and ipratropium inhaler for emergency use is also advised immunosuppressive tablets like cyclosporine can be taken under your physician observation overall total treatment is symptomatic I hope this helps"
    },
    {
        "instruction": "hi doctor I had an ear infection about two weeks ago and just finished the antibiotic in the past two weeks I have had a fluid stuck in my middle ear with no relief there is a lot of uncomfortable pressure in my ear and my hearing is completely blocked on that side I believe my eustachian tube is blocked I have tried a number of decongestant and also the valsalva method but nothing has worked I have a few very clear photos of my eardrum I could show you if that helps also in the past few days bubbles are present in the fluid behind the eardrum please help",
        "input": "",
        "output": "hello I have seen the photos attachment removed to protect the patient identity it appears that after the ear infection there is some fluid accumulation inside the middle ear we call it otitis media with effusion this is quite common after an ear infection and usually occurs due to some remnant inflammation inside the eustachian tube that prevents the flow of mucus from the middle ear into the throat through that tube this can be confirmed clinically by otoscopic or endoscopic examination additionally the hearing loss can be quantified by pure tone audiogram pta and the fluid confirmed by the curve in impedance audiometry do you have any pictures of the drum or the tests if so please share it with me usually the effusion takes a couple of weeks to resolve and needs a different type of medicine than the one given for infection you need decongestant oral and local nasal sprays antiallergics and a mild anti inflammatory agent do revert back to me with more details and we shall discuss what has to be done do not do valsalva if there is any nasal block or congestion still as that would push the mucus further into the tubes and increase the block"
    },
    {
        "instruction": "hello doctor I have had a muscle spasm on the right side of the lip that has been going on for a little over 12 hours and it is a constant muscle spasm it goes on for like a minute or two and then stops for a few seconds and happens again I have had muscle spasms before but never one to last this long I am not sure about what I should do I am unsure if it is a bad thing or what is causing it what would cause something like this is this a bad thing should I go to the doctor",
        "input": "",
        "output": "hello welcome to icliniq com I have gone through your history and I want to explain something about lip twitching you told that you have muscle spasm on the right side of the lip this condition is known as lip twitching it is not a serious symptom so do not worry it will happen because of excess stress fatigue excessive intake of caffeine such as cold drinks and coffee the pathological cause is deficiency of potassium ion in the diet it is self limiting it will not cause any residual problems if you have this problem per hour or more than that there will be some underlying pathologies that you have to be investigated but in 90 population lip twitching does not cause any problem it is one type of involuntary contraction of lip muscles it may also be due to the contraction of the muscle fibers as a result of direct stimulation or irritation or injury of the nerve supplying these muscles tics spasms tremors bells palsy and fasciculations general muscle twitching may also cause twitches of the lip but all these disorders have other major symptoms also so there is no need for any treatment and other investigation idiopathic"
    },
    {
        "instruction": "hello doctor I experienced a rash after an allergic reaction that spans from my chest neck and face I removed the allergen from my diet and was prescribed elidel to help clear the rash however I experienced over the course of two to three days white patches which look as there is absolutely no pigment present in these areas will hypopigmentation from the use of elidel fade I was prescribed elidel for the first time for a rash on my face I am pale but these are extremely white patches reminiscent of acne scars but being completely flat is this likely to be permanent will it likely fade if it may fade how long would this likely take what are my potential treatment options no major injury to the sites was noticed aside from the generalized rash that was being treated",
        "input": "",
        "output": "hi if the patch is secondary to the use of elidel pimecrolimus fade cream then it is temporary within two or three months gradually it will subside right now do not use anything else on the face except for sunscreen and moisturizer if it does not subside even after three months then you can go for the treatment in treatment there are medicines available which helps in repigmentation of the skin but right now do not apply any medicines let it heal on its own post inflammatory hypopigmentation sunscreen and moisturizer one month"
    },
    {
        "instruction": "hi doctor I recently visited a gynecologist as I missed period I visited for the confirmation of pregnancy she tested my urine sample and confirmed that I am seven weeks pregnant she prescribed some medicine and asked for my symptoms I said there are no symptoms like nausea and I only bared sharp stomach pains sometimes she suggests pelvic ultrasound at that time and I went for a pelvic ultrasound he tested twice and he says he did not find any gestational sac and also he puts a question mark he mentioned septate uterus in the scanning report I was worried and my doctor saw that report and asked to do the test after one week I am really worried do I have septate uterus why he puts a question what is their opinion I do not know what should I do next please suggest",
        "input": "",
        "output": "hello the report shows septate uterus but no intrauterine pregnancy as per written reports please share your ultrasound pictures for review of septate uterus as far as pregnancy is concerned get a serum beta hug human chorionic gonadotropin test done first and if positive then repeat scan for ruling out an ectopic pregnancy"
    },
    {
        "instruction": "hi doctor I have been getting unusual readings tracking my blood pressure on my moron 10 series I have been following the instructions to try and ensure accuracy over the past several days I have captured readings with extreme isolated spikes in diastolic pressure that coincide with my machine notifying a detectable irregular heartbeat and my diastolic pressure is normally within a very tight range however I am consistently getting readings that jump dramatically as high as 135 mhg when this occurs my systolic reading is not significantly affected from there I take a follow up measurement a minute later diastolic reading normally is lower but still greatly elevated to my normal range the first few times this has happened I ignored it but it is occurring more frequently over a period of several days otherwise I do not have any noticeable symptoms should I be concerned",
        "input": "",
        "output": "hello I understand your concern and would like to explain that those abnormal diastolic be value spikes could be due to erroneous readings of automatic moron be equipment in the settings of episodic cardiac arrhythmia probably extrasystolic arrhythmia atrial fibrillation etc coming to this point probably it would be more appropriate to use a manual sphygmomanometer device several times and get an average value I would also recommend discussing with your attending cardiologist on the possibility of investigating your heart rhythm through an ambulatory egg electrocardiogram monitoring test hotter in addition thyearoid renal and adrenal function tests should be tested to rule out possible organ dysfunction I hope this helps"
    },
    {
        "instruction": "hello doctor I can retract my foreskin in flaccid state but in erect position I am not able to retract it sometimes I can retract it up to half of glans but then it starts hurting what is this condition called should I go for circumcision or any other surgery or can this be treated by medicines",
        "input": "",
        "output": "hi revert back with the details to a sexologist online"
    },
    {
        "instruction": "hello doctor I am a 52 year old female two weeks back I had severe abdomen pain and got a sonography done I have been diagnosed with amoebic liver abscess it was identified 13 days back and I was admitted in hospital for three days and was given saline and metronidazole dosages but still not recovered doctor told it will take 15 20 days to recover but even after 10 days there has been no change my main symptoms are pain near abdomen frequent fever loss of appetite feeling weak and dizzy I am attaching the sonography details and prescription details kindly check and let me know your view on this thank you",
        "input": "",
        "output": "hi contrast enhances it scan of liver triphasic if abscess is present then aspirate the abscess follow up after it scan to a general surgeon online"
    },
    {
        "instruction": "hello doctor I am 53 years old with type insulin dependent diabetes for the past five years my urine stream has become slow as the stream is slow I cannot stand and urinate but I feel that the bladder is empty after urination in all scans the prostate is normal including the latest one it is embarrassing many times I may not find a western seat what do you suggest and what is your opinion about the same I have to constrict the muscles several times for the urine to come out till the bladder is empty I am just taking insulin for diabetes I am attaching my scan reports for your reference please help",
        "input": "",
        "output": "hi I would like to know few more details to help you in a better way revert back with the answers to an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I had nausea a year and a half ago at that time I could not eat and was given iv therapy along with antacid immediately felt better and I left the er I had a colonoscopy about a year ago and it was fine doctor did not do any other test and said I had gastritis from alcohol he gave me some nausea medicine recently I went to my doctor with symptoms of bloating gas belching lower abdominal cramping and nausea I had been drinking pretty heavily for the past five months I have not been vomiting nor had any blood in my stools it has been two weeks since I consulted him and I am still belching having cramps in upper groin area and burping my appetite is fine I have not drunk for17 days now I am taking zoloft what is your suggestion please help",
        "input": "",
        "output": "hi complete blood count abc liver function test let upper gastrointestinal ugh endoscopies and amylase and lipase test dyspepsia impaired digestion take tablet pantocid der combination of pantoprazole sodium and domperidone one tablet once daily before food for a month tablet normaxin chlordiazepoxide and clidinium bromide one tablet twice daily after food for a month tablet rifagut rifaximin 200 my one tablet twice daily after food for 15 days avoid alcohol fasting and spicy food take small and frequent meals avoid cabbage cauliflower milk and tea revert back after the investigation to a medical gastroenterologist online"
    },
    {
        "instruction": "hi doctor I have got swelling in feet and excess pain over last few days I have breathing problem while walking I also feel weakness since few days please help",
        "input": "",
        "output": "hello abc complete blood count urine e routine examination and s culture and sensitivity serum creatinine serum electrolytes prothrombin time it serum total protein serum albumin chest ray a view posteroanterior egg electrocardiogram and echocardiography get your be and pulse checked nephrotic syndrome cor pulmonale an acute glomerulonephritis caf congestive cardiac failure tablet furosemide lasik 40 my only at morning for five days capsule omeprazole 20 my two times daily morning and night half an hour before meal for 10 days do not take fluid more than one liter do not eat any fruit or drink any fruit juice now and do not take extra salt or added salt with your food now have vegetable and no meat or fish has to be taken revert back with the investigation reports to a general practitioner online"
    },
    {
        "instruction": "hello doctor my egg report is as follows pelvic egg pudendal nerve motor latency left 9 and right 4 egg bulbocavernosus muscle and anal sphincter shows denervation with reinnervation and anal sphincter shows high voltage polyphasic potentials does this imply a problem in the peripheral nervous system peripheral neuropathy or any lesion or tumor or does this suggest a problem in the central nervous system like lumbosacral plexus radiculopathy or plexopathy please interpret my egg",
        "input": "",
        "output": "hi I read your query and understand your concerns for further information consult a neurologist online"
    },
    {
        "instruction": "hi doctor I got married two years back I am trying for pregnancy now previously five months back I had a miscarriage when I consulted my doctor he prescribed me fertile 100 my for five days fertisure folic acid and austen 200 from 14th day I have started the dose and today is my 26th day my problem is that I just started light spotting with clots and cramps on the right side is there any problem associated with it",
        "input": "",
        "output": "hi I have gone through your history and understand your concerns for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor the query is regarding my friend he met with a major accident and his lower limbs power 5 after accident there is no sensation below naval and allopathy doctors have given up hopes request your inputs whether such cases can be supported we have tried a lot of doctors now looking forward to your inputs and also looking to get further medications he is going through two rounds of physiotherapy daily I have attached the test reports for your reference",
        "input": "",
        "output": "hello for further information consult a neurosurgeon online"
    },
    {
        "instruction": "hello doctor since four days I am having severe cough what should I do please guide",
        "input": "",
        "output": "hello for further information consult an ayurveda specialist online"
    },
    {
        "instruction": "hi doctor please explain me the uses of misoprostol",
        "input": "",
        "output": "hi misoprostol is a wonder drug which is used randomly in various obstetrical conditions it is used for abortion when the gestation is only few months that is less than weeks along with another drug called mifepristone 200 my is advised to take orally and following 48 hours four tablets of 200 my misoprostol should be given per vaginally for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I am having inferiority complex and fear of insecurity and death I need some drugs to overcome these please suggest some medicines I am having this issue for more than three years and also I used to imagine something that is not even going to happen like natural disasters somebody comes and slit my throat or stabbing me these kind of thoughts repeatedly coming in my mind what to do please help",
        "input": "",
        "output": "hi I read your query and understand your concerns revert back with detailed history to a psychiatrist online"
    },
    {
        "instruction": "hello doctor I am a 32 year old male my buttock always stinks badly please help",
        "input": "",
        "output": "hi excessive serum production due to massive hair in the area can be an issue of the external anal sphincter that causes leakage of fecal matter from anus and causes smell can be a hygiene issue anal sphincter tonometry and anoscopy for proper diagnostic evaluation you need a consultation from gastroenterologist surgeon who may also go for a proctoscopy if needed management options are best decided after diagnostic tests shave the area very well and keep dry while going restroom do not rely only on the paper towels rather use plenty of water to wash thoroughly every time in restroom apply some scented roll on the area for hygiene revert back after the investigations to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am years old I have swelling in the middle of my neck since last two months I do not have thyearoid and I got it tested two months back the result was negative I have consulted a doctor and he prescribed me month fix and lugol iodine solution and it helped me a little but after 10 days I started having loose motion so I just stopped the medication what should I do now please help",
        "input": "",
        "output": "hi for further information consult an ent otolaryngologist online"
    },
    {
        "instruction": "hi doctor my mom is years old we met with a car accident she got hit near eyebrows and so far she is on the safer side she does not have any symptoms such as headache paralysis etc our doctor suggested a it scan of her head in the report they found some white matter which is not clear with it scan report so again doctor suggested for mri with contrast in the report they have mentioned that bilateral asymmetrical to or flair hyperintensities in subcortical frontoparietal and deep white matter suggesting of small vessel ischemic more than expected for the patient stated age please explain the above",
        "input": "",
        "output": "hi we are here to help you revert back with the investigation report to a neurologist online"
    },
    {
        "instruction": "hello doctor a recent non contrast it scan of thorax taken 10 weeks after undergoing a right hemicolectomy showed expansible sclerotic lesion in right rib may be benign bone scan might be useful given that I have only one kidney left how would the injection of radioactive substances affect my single kidney moderate right pleural effusion what are the risks of draining this effusion what natural alternatives are there home remedies how urgent is it to drain this moderate effusion I have right pleural effusion no chest pain but some shortness of breath especially when climbing stairs",
        "input": "",
        "output": "hello welcome to icliniq com to answer your first question it all depends upon your creatinine clearance how good is the remaining kidney functioning also the reason why one would want to investigate this lesion further say for example if I am concerned about a metastatic lesion I would consider a pet it positron emission tomography computed tomography if I am worried about a primary bone cancer an mri and so forth moderate pleural effusion in a diagnosed condition is treated by watching closely and making sure that it is improving by serial chest rays however if it is a new onset of pleural effusion then it should be drained and the pathology should be investigated salt restriction in a patient with heart failure liver and kidney issues helps to improve the pleural effusion I hope this helps"
    },
    {
        "instruction": "hello doctor I take clorazepate quetiapine akineton biperiden ludiomil maprotiline and lyearica pregabalin I am wondering whether I can go ahead with hormone replacement therapy which includes estrogen and spironolactone",
        "input": "",
        "output": "hi revert back with the asked details to an endocrinologist online"
    },
    {
        "instruction": "hi doctor my son is asthmatic since childhood for the past five months he is having breathing problem currently he is using esiflo every morning but he is still having the problem please help",
        "input": "",
        "output": "hi I would like to know more about you as follows revert back with detailed answers to a pediatric allergy asthma specialist online"
    },
    {
        "instruction": "hi doctor my baby boy was born after full term pregnancy by surgery his birth weight is 75 keg but his both testicles are undescended what are the chances that his testicles will descend on its own for how long should I wait before further treatment",
        "input": "",
        "output": "hi revert back with the report to a paediatric surgeon online"
    },
    {
        "instruction": "hi doctor I am a 30 year old male my weight is 85 keg and my height is 174 am I am non smoker and I do not drink alcohol my problems are gas formation uneasy feeling after meals and lack of energy my bowel does not get cleared properly and I feel too much tired after hard work my heart beat become too fast during this time I also have breathing problems after running I have attached my recent blood test report for your reference please check and help me with your suggestion",
        "input": "",
        "output": "hi I have gone through your reports and your complaints revert back after 15 days to a general practitioner online"
    },
    {
        "instruction": "hi doctor I had symptoms of brown discharge and suggested transvaginal scan which shows thickened endometrium and impression of mildly bulky uterus and cervix please see the attached scan report all blood tests are normal like to dc ear he to and my ash is 92 please suggest whether it is of any concern I am undergoing medication for last 10 days sysron thrice daily and since then I am not having any brown discharge I had section delivery before years and then had a and abortion four years back I also have problems of irregular periods",
        "input": "",
        "output": "hello I have gone through your history report and understand your concerns for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I am having really painful stomach cramps I do not know whether it is a symptom of pregnancy will I need any surgery do I need a scan to see any damage in my stomach I am suffering from constipation headache earache and dizziness along with this",
        "input": "",
        "output": "hi unsure at present but need to exclude ectopic pregnancy in the first instance urinary beta hug human chorionic gonadotropin pregnancy test and urinalysis at go practice ectopic gestation gynecological pathology such as ovarian cyst retrograde menstruation dyspepsia or reflux cholelithiasis irritable bowel syndrome to see go to exclude pregnancy and for advice on sex revert back with the answers in detail to a general surgeon online"
    },
    {
        "instruction": "hi doctor this query is for my mother all the time she feels something stuck in her throat the test we already done are endoscopy and scan but nothing abnormal has been revealed she is still suffering from throat irritation feeling please help",
        "input": "",
        "output": "hi for further information consult an ent otolaryngologist online"
    },
    {
        "instruction": "hello doctor I had unprotected sex with my husband 17 days back I took I pill within three to four hours two days later I again took I pill my last period was 23 days ago now since two days I am having slight bleeding of brownish red color and cramps too I usually have cramps during my periods is it implantation bleeding or side effect of I pill",
        "input": "",
        "output": "hello for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hello doctor I have attached a picture which is on my chest for about two years it has not given me any problem around two years back I had a small acne like thing on my chest right side and it became like this ever since the dermatologists I have visited have said it is nothing to worry about but I just want an opinion I fear and hope it is not a skin cancer",
        "input": "",
        "output": "hi revert back with the asked details to a dermatologist online"
    },
    {
        "instruction": "hello doctor I am facing problem of pubic lice please provide effective cream and lotion for it thank you",
        "input": "",
        "output": "hi we are here to help you revert back after seven days to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor my girlfriend is 20 years old she recently started losing her hair now within two and a half months you can see her scalp near the front of her head and the very back of her head it happened suddenly and now she is pulling her hair out in clumps throughout the day I have also noticed that her eyes are very dark and she complaints of being tired she does not sleep well at night either her job has been stressing her out lately she is working as a teacher for the past two years and managing kindergarten kids what I really want to know is can there be such a rapid hair loss due to stress of her job or is it something worse I have almost ruled out thyearoid she is perfectly healthy I have a thyearoid problem and her symptoms are not similar to mine and it does not run in the family too please help with her problem",
        "input": "",
        "output": "hi let me explain everything about hair fall straightening and other procedure also cause weakness of root other condition like fever typhoid malaria thyearoid etc can also cause hair fall but these are less common regarding treatment have good sleep eat proper food with green vegetables and fruits take iron and multivitamin like follihair for at least three months check your blood hemoglobin if it is less then she should start iron and folic acid supplement also check thyearoid and diabetes to rule out other cause for further information consult a dermatologist online"
    },
    {
        "instruction": "hello doctor my sister is suffering from head pain since one month she usually have head pain when she wakes up from bed which gradually gets alright after a while she is taking dynapar for pain the reports of it scan and mri shows everything normal she consulted a few doctors some suggested surgery of her brain has to be done and some say it can be cured with medicine doctors say that there is a fluid in her brain I want to know is there an alternate way to cure this with a medicine if yes then will it get cured completely or will it recur pain is on the backside of her head I am attaching her ray mri and it scan reports for your reference please provide the best way to cure this thank you",
        "input": "",
        "output": "hello we are here to help you I have gone through your sister reports attachments removed to protect patient identity for further clarification consult a neurologist online data answer_ext pb_cause data answer_ext lab_t data answer_ext dx data answer_ext pdx data answer_ext treatment_plan data answer_ext p_tips data answer_ext followup"
    },
    {
        "instruction": "hello doctor I am trying to conceive since seven months I am on medication for the past one month dydrogesterone tablets pyearidoxine hydrochloride and folic acid this month I have not yet got my period and it is four days late by today I just got a light brown drop on third day of missed period and got negative hug test please help",
        "input": "",
        "output": "hello I understand your concern completely here with regards to inability to conceive revert back with the test results to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hello doctor this person is 43 years old and male he takes weekly urine screen at the same time of each week the screen measures creatinine in my do and the previous creatinine results are as follows 17 21 179 147 235 201 173 100 92 123 and 142 about a year ago he had levels as low as 17 and are these normal range of numbers if not what might explain this person wide range in creatinine the tests are to monitor for alcohol use and I believe there is a possibility that this person is falsifying the tests if you know any studies then you could point me to that to have a look at creatinine variations in healthy adults that would be helpful thank you",
        "input": "",
        "output": "hello this is a quite interesting query for further clarification consult a nephrologist online"
    },
    {
        "instruction": "hello doctor I am attaching my wife prescription and test results we would like to know whether the pregnancy will be normal or not please help",
        "input": "",
        "output": "hi the ultrasound suggests six weeks gestation with non visible fetal node revert back after repeat ultrasound to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I am 29 years old my blood sugar levels were fbi 296 and up 41 so I consult with doctor and they suggested to take insulin 14 units in the morning and units at night for 15 days after 15 days it reduced to fbi 180 and up 230 so they stopped insulin and then they asked to take vysov 50 100 twice a day after a month I checked my sugar level and it showed fbi 10 and up 150 they asked to continue same tablet for next three months my question is can I continue the same dosage are there any side effects if I reduce the dose please guide",
        "input": "",
        "output": "hello patient should get his eyes examined for ruling out retinal involvement as in diabetes this is one of the common and a serious complication that comes without any symptoms plus check hba1c every months lipid profile and complete blood count abc revert back after the investigations to a diabetologist online"
    },
    {
        "instruction": "hello doctor my left hand and occasionally part of my left side of the body tends to vibrate it started three months back I do not have any pain or other problems I can eat walk drive and do my job at ease I am a year old male I do not have the habit of smoking or drinking alcohol six months back I got my blood and urine test results of the same have been attached for your reference since two years I have high blood pressure and I am taking amlodac one tablet a day do I have any problem with liver or kidney do I need any more tests please guide",
        "input": "",
        "output": "hi I have gone through your query and can understand your health concern your reports are normal revert back after the investigations to a general medicine physician online"
    },
    {
        "instruction": "hi doctor we had sex after four days of her period what is the chance of pregnancy",
        "input": "",
        "output": "hi for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I do not have any existing problem I live in a very congested neighborhood and it is very much polluted I would like to do pranayama basically for my well being and mental peace shall I use an oxygen concentrator to do pranayama what precautions should I take I am not any regular medication thank you",
        "input": "",
        "output": "hi for further doubts consult a pulmonologist online"
    },
    {
        "instruction": "hi doctor I have a dark patch on my skin it is not itchy swollen or bumpy it is just discolored skin it is about the size of a quarter coin it is evenly colored it has been there since about four years and it may have become a little bigger but I am not sure I wanted to know if I have anything drastic or needs immediate attention since I may not have access to a doctor until next month",
        "input": "",
        "output": "hi I have read your query in detail and viewed the attached pictures and do understand your concern it is an acquired melanocytic nexus they are considered benign melanoma and nothing actively needs to be done for them if the mole shows sudden increase in size differential pigmentation bleeding irregular borders etc then you may go for skin biopsy for further doubts consult a dermatologist online"
    },
    {
        "instruction": "hi doctor I would like to discuss regarding the medical issue of daughter with you she is now 15 months old but her weight is only keg according to doctors all reports are clear except her growth hormone she is not taking any medicine I have attached her laboratory reports for your reference please help us",
        "input": "",
        "output": "hi I have gone through all the medical records of your baby genetic cause mri brain growth hormone stimulation test prolactin level act level blood sugar ultrasound abdomen and pelvis growth hormone deficiency hypopituitarism turner syndrome baron dwarfism growth hormone replacement therapy which has to be decided after detailed investigation revert back with the reports to a paediatrician online"
    },
    {
        "instruction": "hello doctor my mother iron levels are low four months back too we had done her blood tests and got to know that her iron levels are low she had roofer it for two months but still they seem to be low also she had a urinary infection a week back and took a course of antibiotics for that I have attached her recent blood reports please advise she is diabetic and hypertensive and currently on following medication glycomet go 850 one in the morning and one at night voglibose 3 one in the morning telmisat am my orcas my nextto 20 my and alzolam 5 my please guide",
        "input": "",
        "output": "hi based on your query my opinion is as follows repeat iron levels after three months continue roofer it with vitamin supplements or rich diet avoid diet inhibiting iron absorption revert back after three months with the investigations to a hematologist online"
    },
    {
        "instruction": "hello doctor my wife who is 30 years old having pain in both legs in the calf area she is having pain throughout the day but seems to be aggravated during night it started two to three weeks back but it has become severe now she is also having pain in both heels please help",
        "input": "",
        "output": "hi I have gone through your query and can understand your health concern for further clarification consult an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I did hurt my ankle years ago then went for an mri months back the following month I had an arthroscopic surgery ocd mtd now even after nine months it still swells up painful and I do not have full range of motion it hurts a lot when I run or jump I have been doing physiotherapy and trying to strengthen the ankle but I still feel pain I did another mri three months back I have attached both iris please let me know what you think",
        "input": "",
        "output": "hello I have read your query and the mri reports attached for further doubts consult an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hello doctor my son is years old he is dealing with continuous chest congestion and coughing with change in season doctor suggested foracort 100 for two to three months with two shots in the morning and two at night after using nebulization levolin 25 my and budecort my in the past for chest congestion will it affect his immunity he eats healthy food with no junk at all but still gets cough and congestion so frequently please suggest some medicine is it due to pollution or as he grow will the things be better for him",
        "input": "",
        "output": "hi revert back after the tests to an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I had a right inguinal hernia laparoscopic surgery four years back after about 10 days of surgery I started walking for about to am the first two days I did not feel any trouble but on the third day of my walk I begun to feel trouble in the area of the groin and felt weak too starting from there I always feel trouble and weak whenever I go for a long walk it hurts and troubles me more when I lift heavy objects any straining type of exercise in the groin area too hurts and I could never turn on the right side to lie down and sleep the symptoms that I felt after getting hurt in the surgery are not only troubles but feel immensely weak and discomforts in the right side of the flank now it is more than four years but still I have trouble when checked with ultrasound abdomen everything is normal except for the fatty liver which I have since five years some days back I went to the urologist and have done ultrasound scrotum but the results too turned out normal so what really is the problem in me kindly advise me I also want to know what other examination methods can be taken to find out what is really wrong in my surgery please guide",
        "input": "",
        "output": "hi for further information consult a urologist online"
    },
    {
        "instruction": "hello doctor I have a slight swelling on the skin in my mouth near my back teeth it is slightly bigger than the other side it has been there since three days though it does not hurt there is some irritation when I eat or drink I am not aware whether I bumped it while brushing if so then it should have been sore I do not have any other symptoms please help",
        "input": "",
        "output": "hello for further doubts consult a dentist online"
    },
    {
        "instruction": "hello doctor the medicines used are formoflo inhaler asthalin tablet and lukas tablet will these lead to sexual problems as side effects is it reversible",
        "input": "",
        "output": "hello you have given very little information regarding your query actually the side effects of every drug depend on age sex duration of use and doses of that drug however as all inhalant acts locally it cause very rare or nil affects to the systems they are usually devoid of any systemic side effects like sexual side effects so formoflo inhaler will have very rare possibility of sexual side effects I think any inhaler can cause these side effects asthalin tablet contains salbutamol which has not reported any sexual side effects tablet lukas contains montelukast which is an anti allergic drug used for asthma and never reported to cause any sexual side effects so it is also not a cause I would like to mention for sexual problems decrease of sexual desire is an integral symptom of depression and montelukast reported side effects of depression if you have other symptoms like low mood decrease in pleasurable activities appetite and sleep disturbances loss of energy irritable behavior and restlessness then it could be due to depression because of montelukast if you have do not have other symptoms of depression then it could be an independent sexual problem and not due to any drugs which you have mentioned here"
    },
    {
        "instruction": "hello doctor I had irregular bleeding for eight weeks since ten days it is better please examine my pap smear report and hav report I got it done as there was irregular bleeding I have pod and diabetes currently I am taking metformin or 850 my please let me know whether all looks fine",
        "input": "",
        "output": "hi I went through all your reports and they all are fine revert back with the asked answers to a medical oncologist online"
    },
    {
        "instruction": "hello doctor I had blood tests done there was some clorox cleaner or bleach on my arm can this affect the result",
        "input": "",
        "output": "hi based on your query my opinion is as follows if anything abnormal found in report then get back to a pathologist online"
    },
    {
        "instruction": "hello doctor my age is 23 but I weigh only 37 keg for 158 am height my parents consulted different medical practitioners but nothing worked out appetizers did not work too I do not have strong immunity I get fever often no one in my family is lean other than me they all have normal weight I weighed keg when I was born and it was a normal delivery food does not interest me really except sweets and ice creams please help",
        "input": "",
        "output": "hi for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I have developed venereal warts under my penis foreskin they are not painful and are non itchy as well as it is a matter of concern that how I developed it my doctor on seeing it directly asked to go for a laser surgery kindly look over the matter and seek necessary help",
        "input": "",
        "output": "hi genital warts are usually acquired by sexual contact if the lesions are small you can apply imiquimod ointment on them for few days and they will clear if they are extensive then you should undergo laser cauterization or cryocautery if they are confined to prepuce then you can get them removed by circumcision for further information consult a urologist online"
    },
    {
        "instruction": "hello doctor my brother who is 25 years old has been suffering from anxiety for the past four years his doctor put him on effexor and elavil both the medicine has to be taken daily in addition to xanax lately the anxiety has developed into full blown panic attacks two of which resulted in a seizure and passing out briefly in addition we just discovered through a dna test that he has two mthfr mutated genes he seems to be rely more on the xanax now as a safety net or crutch when he feels a spell coming on I am very concerned that he has become too dependent on the xanax and now that he is taking a prescribed vitamin supplement to counter the mthfr it is likely making all the drugs on board more potent than before I have read that the cause of anxiety for some people is the mthfr gene mutation therefore I wonder if he even needs any of the drugs he is on but I realize that he cannot just quit cold turkey he needs opinion he is in a real tough cycle right now where he can hardly function which is not good as he is in final semester of law school please help",
        "input": "",
        "output": "hello I can understand your concerns from your description it seems that your brother might have become dependent on xanax alprazolam xanax belongs to benzodiazepine group of drugs and is quite notorious for causing dependence if used for a longer period hence when not taken it leads to anxiety like symptoms which can mic a panic attack these are actually the withdrawal symptoms of xanax hence I would suggest you to stop your brother from taking xanax as soon as possible substitute xanax with some other drug with less abusive profile like clonazepam and then gradually taper and stop it besides this effexor venlafaxine is an effective drug for anxiety disorder but we need to adjust the dosage to increase the efficacy you need not give him elavil amitriptyline with effexor however he can continue with the supplements I would also suggest you to take a neurology opinion in view of seizure like episodes that happened previously for further clarification consult a psychiatrist online"
    },
    {
        "instruction": "hello doctor I am pretty sure that I have retrograde ejaculation because when I ejaculate it does not come out at the same moment of ejaculation but it does come out seconds later and when I urinate there is some sperm I also have male incontinence and bedwetting problem since I was young and I am now 24 years old and a couple of times this year I found it hard to urinate I felt like my bladder was numbed or something so I went to a urologist and I had my testicles tested because I had pain there and thought it was the reason for all this he gave me antibiotics I also did an ultrasound on my testicles and to check my kidney stones but everything was fine and after the antibiotics nothing change but the testicular pain my urologist said he wants to do a turn transurethral resection of the prostate but I do not know anything about the operation and he told me I will feel pain and I am scared of that but I also do not know why he wants to do this operation I searched online and it says mercury retrograde might be from multiple sclerosis week bladder muscle problem with the nerves a previous operation does not apply to me or medication side effect does not apply to me so I am not sure what to do I want to check for multiple sclerosis and also look at my bladder muscles could it be a problem in the prostate and is turn necessary I want a urologist who really wants to find out what is with me instead of just doing a test and not listening to what I am saying and then tell me to come back a month later I have more than one problem and I want to know what is causing all this",
        "input": "",
        "output": "hello I think that there is an obstruction in your prostate gland prostate gland store semen that is why he wants to do this procedure turn stands for transurethral resection of the prostate you must go for it if you have further questions do follow up"
    },
    {
        "instruction": "hello doctor I am looking for advice and maybe a consultation from a neurologist I have a benign cluster of cysts at the back of my brain that was about 2 am in size when diagnosed after an mri I received this info from my family doctor who read the radiologist report that indicated no further action was needed I was not given a cause and prognosis was all good given the small size and benign appearance after some unusual headaches I had a follow up mri that showed no change and was told nothing further was needed before few months I started having almost daily headaches tingling in my head dizzy spells memory issues and brain fog occasional nausea and pressure sensations in my head an mri was ordered and my appointment for that takes months in my place the symptoms seemed to come and go so I and were not interfering with life so I just waited for the appointment which was last week I had a third mri and was told the cysts have grown to over am and the report shows that rather than a cluster of cysts as diagnosed before it could actually be a slow growing tumor in addition there is now and second unusual spot on the front of my brain since it is unclear what is going on my family doctor has requested to have another mri as well my doctor is requesting an ma because my father had a massive brain aneurysm at age 48 so she has suggested looking at the vessels as well then my doctor will refer me to a neurologist however this process takes time in canada so I have a long wait time based on the fact that I am stable and the initial tumor is slow growing I likely would not have the repeat mri or ma tests for four to eight weeks with neurology consult in three to four months I am looking for advice on what to do next I am an otherwise healthy 49 year old woman however now I am feeling some anxiety over this which has resulted in sleeplessness I really want to get to the bottom of what is going on sooner than later I am currently taking lithium 600 my and lamictal 100 my for bipolar depression",
        "input": "",
        "output": "hello I have reviewed your case it is very much a benign tumor which grew 2 am to am so it is not an emergency at all first thing I want to know which area of the brain having cystic lesion so can you send me the radiologist reports of mri and preferably photos of important mri images so I can see how many cysts or tumors in which part of the brain is located as treatment and prognosis of any brain tumor depend on size number and location second thing please describe your symptoms in detail so I can correlate that is it related to this or not waiting for your response"
    },
    {
        "instruction": "hello doctor I have a history of skin picking mainly ingrown hair I have curly hair and shaving often leads to ingrown hairs for me especially in the pubic region about a week ago I was popping my ingrown hairs as usual and sometimes I go a little overboard and scratch and pick too hard in the same time frame I have had two sexual partners both I have slept with before but one I had not had relations for a while until last week the same guy also had sex with my best friend the same night which I was unaware of I also resumed having sex with my constant partner two days later a few days had passed and the sores from my skin picking have not gone away but instead have ulcerated in some areas there are probably eight or so ulcers they scab up sometimes but the scabs do not stay attached I am concerned now because my best friend has also noticed ulcerated areas in her genital realm and is concerned she has genital herpes I fear that I might also but at the same time I am not sure whether or not it would be an sad or just from where I picked at my own skin at first she was concerned she had gonorrhea or chlamydia I do not have as much concern about those there are hairs centered on all my ulcers the only other concerning factor is that my inguinal lymph nodes are swollen and sore I know I need to go get tested and plan on doing so tomorrow I just wanted an opinion on what else might be going on",
        "input": "",
        "output": "hello I have noted your concerns your details match closely a condition called folliculitis which is an infection of the hair follicles with or without a hair in the center being visible and can lead to ulceration and swollen glands in the draining region which is an inguinal area in your case when you visit your doctor he or she is likely to assess your signs and physical examination and order some tests to look for the presence of bacteria in the lesions and some other venereal diseases some of the conditions can only be confirmed by blood tests it would be advisable to get your friend and contacts too examined and investigated at the same time especially if you are going to have them as partners in the future too whether directly or indirectly at this stage the main concern focuses on herpes blood tests required chancroid tests required and folliculitis for now it would be good to clean up the area with mild antiseptic apply some antibiotic cream and use a pain killer for relief from pain I hope this helps"
    },
    {
        "instruction": "hi doctor I wanted to ask a question about a bump at the back of my throat it is like a bone I went to a local ent and he told me it is normal sometimes it shows to some people I just wanted to ask what is it",
        "input": "",
        "output": "hello I have seen the picture do you have symptoms like pain or itching in the throat it looks like granular lymphoid tissues of the posterior pharyngeal wall or it could be a small cyst of the posterior pharyngeal wall also did you take any treatment for the swelling if not you can just do chlorhexidine mouth gargles three times daily for a week which will reduce inflammation and you can take an oral antihistamine like fexofenadine which will take care of the allergy part sometimes lymph nodes are enlarged secondary to allergy if you have more queries please revert back"
    },
    {
        "instruction": "hi doctor I had a very weird experience last night I woke up suddenly I am guessing I was in the middle of a dream and felt an electric shock type sensation going through my body and I could not move the closest thing I can think of close to it was when I was a kid and touched the metal water hose handle during a storm and felt a current move through me it is extremely strange and I am not sure what to make of it lasted about 10 seconds I am currently on wellbutrin al 150 my once daily straterra 40 my once daily I just started a complex supplement yesterday morning before this occurred last night",
        "input": "",
        "output": "hi from your history it looks like a sleep parasomnic event it mostly happens in the rem rapid eye movement phase of sleep which is a deep sleep phase in that phase muscle tone of the whole body is reduced and if someone awakens prematurely in this phase will be unable to move body muscles and feels like paralysis of the whole body and unable to speak but it is transient and benign in most of the cases many times it can happen due to straterra atomoxetine but very rare complex cannot produce such symptoms but still better to stop it if not a genuine deficiency state in my opinion no need to evaluate further except recurrence or disturb your sleep many times it is physiological so no need to worry maintain sleep hygiene take seven hours of sleep in 24 hours regularize the sleep cycle do not take coffee or tea or neuro stimulant before sleep do not do exercise three hours before sleep I hope this helps"
    },
    {
        "instruction": "hello doctor I have had intermittent pain in my lower left abdomen for seven months now I had a colonoscopy as soon as the pain started in the summer but there were no abnormalities seen there might have been something as the doctor muttered there is this sort of a thing here during the colonoscopy but the doctor who did the colonoscopy would not comment it further because the diagnosis lies in the biopsy samples the case was dismissed after the biopsies came back normal however the pain has continued I think that it now mostly comes before bowel movements unlike before which was more random suggesting a colonic cause but I am not sure I also have soft stools but they could be related to a high fiber diet attached are some pet it pictures were taken five and a half months after the symptoms began the radiologist claimed that there were no modular findings seen in the colon but I can see some mildly elevated modular activity as well as a possible thickening in the lower left abdomen where the symptoms are the axial view is mirrored is the structure highlighted a part of the colon wall or a lymph node what are the black areas that surround the node should I opt for another colonoscopy a needle biopsy or just forget about this",
        "input": "",
        "output": "hello welcome to icliniq com as I read your question I just remembered how distressed my sister becomes when she gets similar pains which enables me to realize your anxieties well however her pains have been determined to be of uterine origin please note that as a radiologist I always feel confident when I can view the full set of the scan that I am asked to review however as you and the reporting radiologist are well convinced about the rest of the imagery my opinion about the selected images that you have attached is as follows the black areas represent the gas in your bowels about the encircled area please note that pet it is based on the principle that many pathological lesions accumulated much higher amounts of fog fluorodeoxy glucose than the normal tissue because of this basic principle positive findings on pet are always vidly visible this is unlike other imaging such as it mri or ray where we often have to look for subtle findings look at the urinary bladder where the excreted fog has accumulated this is excreted fog not a lesion in the bladder if there were any pet positive lesion in your abdomen it would show up as bright as the bladder now look at the area you have encircled it has some brightness and although it looks more prominent than the surroundings its appearance still does not match what we expect a lesion to look like please also note that the main image of these types of studies is the axial image and the others are reconstructed by software also the pet image is superimposed on the it image by software such manipulations often result in the creation of image artifacts in my opinion the brightness in the encircled area and its surroundings is artefactual the mild elevations that you fell you can see are likely due to the folding of the bowel loops yes there are some lesions that are pet negative and there are the causes of lower abdominal pain lap that do not create a change in imaging studies therefore your next step should be to discuss with your gastroenterologist about these types of possibilities truly lap is caused not only by cancers seen on pet but also due to vascular inflammatory invective and other pathologies exploring which may lead to the proper diagnosis and appropriate treatment I hope this helps"
    },
    {
        "instruction": "hello doctor I have taken fluoxetine 80 my for refractory ocd for about six years now obsessions are 90 percent controlled so I am not currently taking it now but sometimes I have mood fluctuations also so currently I have started aripiprazole 20 my the problem is that I feel sleepy in the day my friends say that I am not alert I am preparing for pig exam what should I do now can I take modafinil to increase my alertness and cognition I want to increase my performance also please help",
        "input": "",
        "output": "hi I read your query and understood your concerns first of all why have you stopped fluoxetine who advised that were you seeing a psychiatrist who has advised aripiprazole do you have any improvement in your mood fluctuations from it aripiprazole as such does not cause sedation and excessive sleep it is usually an activating drug are you taking any other drug or benzodiazepine to increase alertness one can take modafinil but daily intake is not recommended it can be used on as and when required basis nowadays lots of students do this and take for a long time but as a doctor I would not recommend that instead you can have activating antidepressant like bupropion which also increases concentration another option is atomoxetine revert with answers"
    },
    {
        "instruction": "hello doctor I am a 30 year old male I have been married for one year my problem is low sexual drive I do have morning erections but not regularly when I have sex one to two times a week I do not masturbate otherwise I masturbate two to three times a week unlike having sex I get enormous pleasure when masturbating when masturbating I withdraw for a few seconds when I am about to ejaculate so that I get a long session of masturbation and also a good climax when having sex I do not get the same pleasure when sliding my penis inside her I guess I have a low sexual drive from the past one and a half years I do not feel any arousal when I see her naked but when I watch a porn movie I get aroused sooner I consume himalayan gokshura capsules for vitality for the past one month apart from that no medications I am a strict non smoker and non alcoholic I do have some stress out of workplace and family issues I do not get enough sleep I did my circumcision when I was years old my penis is dry and I feel less sensitivity when having sex I normally ejaculate within five to ten minutes after insertion no medical conditions like seizure of fits but I feel tired at times I had been watching porn for the past several years could that be a reason for my low sexual desire or is it masturbation I had consulted a doctor in the icliniq she prescribed me bupron al 150 my for 15 days I understand that it is an antidepressant will it help to increase my libido are there any short term or long term side effects can I use this pill on a regular basis please help me to overcome this situation",
        "input": "",
        "output": "hi at the age of 30 the neurological illness diabetes and hypertension are not common so mostly the cause is anxiety and stress for erectile problems stress and worries can make a person distracted even while masturbation when a person watches a porn movie because of the visual content a person cannot have much distraction but when a person is doing masturbation or sex he may have distraction because of stress in addition to this stress and anxiety can cause low sexual desire financial issues work load at job daily hustles conflict with spouse repeated worry about failure in bed and partner satisfaction are the main reason for psychological erectile problems these are the sources of stress what you have to do is forget about the past failures and make a new beginning for initial four to five encounters in sex you should not go for penetration and just enjoy the foreplay spending more time in foreplay helps in holding erection for longer it also helps in identifying the sensitive areas for arousal in your partner the sensitive areas in female are neck nipple clitoris and anterior wall of vagina during foreplay you have to concentrate on these regions after four to five sexual encounters without penetration you can start intercourse and with prolonged foreplay take help from your partner for holding erection longer like oral sex and masturbation by your partner or whatever she is comfortable with if you are not confirmed about your morning erection then you can perform a bedside test like a paper test in this test you have to apply a strip of paper about am around your penis base while it is in the flaccid state it should be tight enough and use gum to stick both the ends of paper around the penis base when your penis gets an erection during the early morning the paper will be ruptured and this will be the positive finding that it gets normal morning erection if you are depressed then take a visit to a psychiatrist and get treated with antidepressants you can visit a good psychiatrist or sexologist in your city and undergo sexual counseling and therapy bupropion can help in increasing your libido continue it other drugs that can be used for the same are pramipexole cyproheptadine etc pramipexole can be started at a dose of 125 my three times a day dose can be increased to 25 my three times a day after one week I suggest you to continue bupropion and wait for one month if you do not find any improvement then change to pramipexole there is no need to worry about circumcision it can cause this abnormality or decrease sensation in penis glans more you ruminate about having a problem more will be the actual problems for anxiety purpose yoga and meditation will be helpful along with jogging or walking I hope this helps"
    },
    {
        "instruction": "hello doctor I want to know what this report means so I can list my questions I am concerned about the internal vascular nature of this report I am attaching my last three ultrasounds I am looking for your interpretation of the report and want to know if there is anything worrisome I have attached two of my previous reports for comparison",
        "input": "",
        "output": "hello welcome to icliniq com from your attached ultrasound reports I understand that you have a thyearoid swelling goiter with multiple tiny nodules for which you undergo regular followups I can also see that these nodules are quite stable and have not undergone any worrisome change nor have any cervical lymph nodes been found enlarged but you are presently concerned about the structure with internal vascularity which is a newer statement it is quite natural to be worried about such a finding but give me the pleasure of saying that it is only one of the four parathyearoid glands that are attached very close to the thyearoid the internal vascularity is only an identifying point of parathyearoids rather than any clue to an abnormality the size of the parathyearoid may raise suspicion as to whether it is enlarged such as in parathyearoid hyperplasia adenoma or carcinoma however parathyearoid hyperplasia is accompanied by a finding of calcification in the gland while carcinoma cancer is characterized by invasion into surrounding organs your report says which appears to be separated from as for parathyearoid adenoma please be assured that this disease manifests itself quite clearly in clinical and laboratory features such as abdominal pain due to the formation of gallstones renal stones bone pain abnormal calcium and phosphate levels and altered parathormone therefore considering all points I would like to assure you that internal vascularity is not a cause of worry and the parathyearoid even if it is marginally enlarged should also not create anxiety unless your doctor finds features of hyperparathyearoidism in your clinical or lab findings since I do not know your clinical or lab findings mentioned above I suggest that you may clarify the matter further with your respective doctor during your next scheduled visit I hope this helps"
    },
    {
        "instruction": "hello doctor I have just done my blood test including liver profile cholesterol profile thyearoid profile etc I have only one concern in the report which is high value of alanine transaminases liver profile two weeks back I have stomach infection with high gastric problem gas is passing as burn only and not from the back so I took antibiotics for this also I have an empty stomach gas problem sometimes that cause headache also I am attaching my report with this do I need any medicine or liv 52 is fine in my case I prefer herbal or homeopathy medicine please suggest",
        "input": "",
        "output": "hello welcome to icliniq com yes your liver enzymes are raised which requires evaluation of the cause most common causes of such liver derangement are alcohol viral hepatitis non alcoholic fatty liver disease and drugs however the rise is not very high still we should rule out possibilities like hepatitis and because they can later cause liver cirrhosis I would advise you to get the following investigations done hbsag surface antigen for hepatitis 2 anti hav hepatitis virus antibody for hepatitis 3 ultrasound abdomen a lot many times liver dysfunction is due to non alcoholic fatty liver disease nafld so if you have any evidence of fatty liver in ultrasound and your other tests are negative this rise is liver enzyme would be attributed to nafld for this you need to reduce your weight reduce fat in the diet and if required your doctor may prescribe you ursodeoxycholic acid for the same make sure that you do not take any pain killers without your doctor advice I hope this helps"
    },
    {
        "instruction": "hello doctor my son is years old and sometimes he has bloodshot eyes this allergy was started when he was one year old he has been diagnosed as vernal conjunctivitis",
        "input": "",
        "output": "hello I reviewed your history vernal conjunctivitis is a chronic condition and requires treatment for a long time it usually decreases in severity by 15 years of age the treatment mainly involves the use of antiallergic drugs like olopatadine with steroid eye drops in acute and severe cases since the treatment is required for a long time the treatment needs to be done under the supervision of an ophthalmologist hence I advise you to consult your eye doctor for examination and treatment accordingly"
    },
    {
        "instruction": "hello doctor I was doing crunches exercise three years ago something went wrong near my left side abdomen I mean the left side of belly button portion I feel a kind of knot sensation I cannot evacuate properly even if my stool is soft I cannot pass gas and urine comes slowly unless gas is fully evacuated I did an ultrasound scan and everything is fine no hernia nothing while I sleep I do not notice this knot kind of sensation but while I am sitting I can feel it doctor said it was a muscle catch and gave some medications but it did not work can you help me",
        "input": "",
        "output": "hello welcome to icliniq com I have read your query in detail and it seems as if you might be suffering from a femoral hernia though less common in men than an inguinal hernia it does cause the kind of symptoms you seem to be facing long term solution is obviously surgery but since we do not have enough information I will try to alleviate your symptoms rather than diagnose wear scrotal support this will lend strength to muscles in sitting and standing positions you can try an abdominal binder if pain or strain or knot is more above rather than below the abdomen avoid standing for more than five minutes in one go rest or sit as often as possible increase water intake to 10 12 glasses a day avoid eating high sugar foods to decrease gas or bloating follow up after 14 days with ultrasound abdomen and ray abdomen erect"
    },
    {
        "instruction": "hi doctor I am going to mention all of my issues together since I think they may be related to each other I have been suffering from lower back glue hip pain that radiates down my legs sometimes into my heels even for around five years this began after a hard fall onto my right buttock although weirdly now most of the pain is on the left side I have also had some foot issues metatarsal pain and now pain on the outer edge of the front of my feet I have not been diagnosed with a bunion but it is on its way there I have been prescribed insoles that help with the metatarsal pain but not the bunion pain when I initially presented with metatarsal pain the podiatrist also diagnosed me with tight hamstrings which I definitely notice also since then I have done all sorts of physiotherapies aimed at lessening the pain in my lower back hip as far as I can tell it is the si joint causing me issues the pain gets worse if I am static in any position for too long sitting standing laying down I recently decided to investigate further and had an mri scan which revealed no issues in my si joint but showed that my back is fairly straight as in not a very pronounced curve which is probably contributing to the pain in my lower back the orthopedic surgeon also mentioned that my lower three discs are somewhat degenerated and bulging a little too something that could eventually become a hernia but is not necessarily the cause of my pain right now so I do not have any straight answers so far my plan for the moment is to focus on strengthening my back my core is quite strong but I will continue to work on that too and working compression exercises for my lower back into my routine I think this may help to stop or reverse my bulging disc issue I have been doing more forward folds than backbends I practice yoga regularly and am incorporating more strength training into that routine so I am reversing that trend now after learning about my bulging discs I will also try to strengthen my glutes as I heard this can help with the pain having read all of this what can you recommend does my regime sound good I also have an appointment with a physiotherapist who specializes in backs near where I live but in the meantime I would like to hear as much as possible from outside sources about what their assessment and advice would be",
        "input": "",
        "output": "hello looking at the discs in the mri that you sent I do not think there is a cause of leg pain there degeneration of discs leads to overload and pain in the back with local radiation leg pain comes from disc pathology with entrapment of the adjacent nerve roots the second possibility is the si sacroiliac joint that you are saying is normal core and back strengthening will help always and I will recommend that you do more isometric of the spine and reduce forward flexion that causes the disc to bulge backward gluteal and hamstrings stretches are crucial finally try pregabalin 75 my twice a day for three weeks to see if the pain is relieved metatarsal pain is just an incidental issue that have happened together with leg and back pain"
    },
    {
        "instruction": "hello doctor my mother fell on her right arm a few days later she noticed a wound on the dorsum of the right arm but was not sure if it was from the fall she did not care for it nor treat it about a week later she started disinfecting and covering it but decided to visit a dermatologist as she was afraid it might be something else upon the looks of it the doctor wanted a biopsy as she said it could be cancerous too while waiting for the results the wound closed and decreased in size and signs of inflammation are gone today we got the results and it says hypodermic and dermis with hyperkeratosis severe dysplasia of the squamous epithelium chronic inflammatory changes in the dermis now I started reading to try and understand and what confuses me is the severe dysplasia of squamous epithelium is that carcinoma in situ in some literature they differentiate the two in others they claim it is the same I also came upon the fact that when there is an ulcer or inflammation reactive atypia and dysplasia may look the same hence the dysplasia may be from the inflammation how is that determined is it a wound that is in the stages of healing or is it precancerous what should be done in this case can we wait for one or two weeks to see if the crust will fall as in a healing wound and then perhaps have a biopsy on clean skin or should it be removed immediately with a suspicion that it might progress to cancer if it should be removed what is the time frame should it be done immediately I also talked to a surgeon friend who thinks if it is cut immediately it would cause a bigger wound which might be slow to heal again I have attached the progression of the wound",
        "input": "",
        "output": "hi I have seen the attachment this could be cancer however there is no harm in waiting for a week or 10 days and then perhaps go for an excision if it does not heal by then cutaneous sec squamous cell carcinoma is usually not very aggressive and in most cases excision surgery with a margin of normal skin is curative"
    },
    {
        "instruction": "hello doctor my son has had chronic constipation issues and this past week he was at the er three times two enemas were given and eventually they hospitalized him and they inserted an eg tube to flush out his bowels I am trying to figure out the time frame it takes for a four year old to become that backed up he came home saturday night had not had a bowel movement on that day nor he drank his normal amounts of fluids the next day he had a huge piece of stool come out with blood upon wiping immediately after he pooped his pants with stool that had much softer consistency not diarrhea then he passed another hard piece of stool at night monday night he passed a larger piece of stool once more and blood was noticed upon wiping tuesday morning he passed another large piece of stool and the toilet filled with blood and I took him to er I have all the summaries from the visits and ray results I am trying to figure out if constipation started prior to sunday or if he got constipated from sunday through tuesday I need an opinion on this matter as I am trying to figure out the behavioral aspect of his constipation he is currently taking three ex lax chews at am daily and 85 my miralax in 20 ounces of fluids every friday for one month",
        "input": "",
        "output": "hello I understand your concern after going through the ray report it shows on the ith no gross constipation noted on ith and 10th ray constipation noted with colon filled with stool but the actual problem has started from ith stool formation for years old child usually takes 24 to 48 hours depending upon diet pattern if low fiber intake and low water intake is there constipation can happen constipation can also occur secondary to local bowel inflammation"
    },
    {
        "instruction": "hello doctor I am 31 years old and weigh about 51 keg I am actually afraid to eat I took a liver function test my bilirubin total was 50 bilirubin direct 30 and bilirubin indirect 20 my triglycerides is 256 I feel nauseous all the time please suggest what to do I am taking pentate elpizyme syearup and liv 52",
        "input": "",
        "output": "hi symptoms you have mentioned may occur due to liver disease stomach problem or esophagus related for differentiation in these entities we need detail discussion by message or by phone apart from the discussion your bilirubin is elevated but the liver function test is incomplete we need more information g got sept all proteins it apt and in I need answers for the following questions you are afraid of eating all the time but why it is due to difficulty in swallowing or it is due to burning epigastrium pain in abdomen or vomiting what is the onset of these symptoms do you take alcohol dou you have constipation jaundice family history of constipation or similar illness advice continue pentate pantoprazole and domperidone 40 my half an hour before meals once a day avoid fatty meals take syearup gelusil my with each feed intake take syearup eva multivitamin my two times a day avoid milk for sometime especially do not take in the morning hours do regular exercise get done let liver function test with the above mentioned tests if there is abnormality then we will plan further tests provide details about question marked symptoms report back with the report and detailed information or can discuss by phone"
    },
    {
        "instruction": "hello doctor my relative aged 82 years is suffering from prostate cancer it was discovered one year ago surgery was done eight months ago and it is still spreading he is not diabetic will chemo might be fatal",
        "input": "",
        "output": "hi I have read through your query in detail please find my observations below it is important to know when the cancer spread was first detected if it has spread to involve other areas then it is likely to be stage cancer I have served in a cancer institute for years and have seen many patients like him getting chemotherapy to prolong life liver and kidney functions and general condition should be maintained during treatment radiation also helps many patients usually the survival of a patient with advanced stage cancer is not more than two years with good care and treatment this is an average and rarely patients might survive to three to five years chemotherapy and radiation therapy might help to extend the life of the patient and slow the disease progression but cannot cure cancer at the age of 82 years it is important to give him good nutrition and diet with proteins and vitamins pain relief is important for him and this is to be discussed with his doctor please see that he is comfortable hope this answers your question"
    },
    {
        "instruction": "hello doctor I have a migraine I have readjusted my eyeglasses prescription for headaches I feel sharp pains in my right and now started to feel like it is in my left ear as well please help",
        "input": "",
        "output": "hi if you would have presented to me as an outpatient I would have told you that your medical history is grossly inadequate to make any clinical impression migraine is unlikely to cause sharp ear pains it may be related to inner ear pressure abnormalities eustachian tube abnormalities or taj temporomandibular joint inflammation stress caused by wearing improper eye glasses can cause stress headache which can cause precipitation of even migraine episodes meanwhile please start taking tablet tryptomer amitriptyline 10 my once a day at bedtime along with that start mental relaxation exercises pranayama and yoga these things will likely help you please have an ent opinion also"
    },
    {
        "instruction": "hello doctor my father is a heart patient and also has a problem with high sugar but two weeks before his be level and sugar level dropped a lot and he started feeling very low with some kind of palpitation after some prescription his be level and sugar are normal but the problem of palpitation is still there to whom should I consult for him",
        "input": "",
        "output": "hello sorry to hear about your father when you say heart patient I assume he has had a blockage to the artery supplying the heart coronary artery disease or has had a heart attack myocardial infarction in diabetes management the duration of diabetes and the level of control in the past is very important for present management as well heart patients will be generally prescribed be blood pressure reduction tablets amlodipine losartan telmisartan cholesterol lowering tablets simvastatin atorvastatin blood thinner tablet aspirin clopidogrel and heart rate reduction tablet beta blockers atenolol nebivolol bisoprolol the cause of your father symptoms has to be found out low be can be caused by high heart rates and palpitation arrhythmia in such a scenario your father has to be reviewed by his cardiologist to see if there is a trigger like decreased blood supply ischemia or salt imbalance electrolyte abnormality and adjust the medications both be and heart rate medication a low sugar will usually raise heart rate and be but here the be had fallen so low sugar hypoglycemia may not be the cause of these symptoms one thing you might like to keep in mind is that if someone is on blocker his heart rate will not go up during hypoglycemia so the cause of low sugar remains unexplained a review of his diabetic management viz timing of diet intake dosage of insulin medications timing of medicines type of insulin have to be reviewed to find the cause a simple and common reason would be that he could have reduced his food intake or avoided it altogether due to his heart symptoms on that day resulting in low blood sugar now coming to his present symptom of palpitation as his sugar level is normal range as per your information it seems unlikely that his diabetes could be the cause of his palpitations so my advice is to recheck his blood sugar both fasting and post food two to three times to confirm the absence of low sugar and to review the heart condition and medication with his cardiologist a point of note is that if your father is quite elderly has been a long term diabetic has other co existing medical conditions like kidney dysfunction mobility issues it is better to go for a medium control of diabetes rather than very tight control of blood sugar levels I hope this helps"
    },
    {
        "instruction": "hello doctor just yesterday I discovered that my front tooth looks a bit black and then I decided to look behind that tooth I found out that there is a black spot between two teeth behind and I have not seen it before I was a bit shocked to find that out I am a student and cannot afford to visit dentist can you please consult on how to cure it without pulling out and visiting a dentist",
        "input": "",
        "output": "hello I understand your concern the most common cause of black spots on tooth is cavity or tooth decay unfortunately there is not any medicines or home remedy that could stop the progression or cure tooth decay this can only be done by a dental treatment tooth has three layers outer enamel denting and innermost never layer when decay starts in the enamel layer it does not show any symptoms other than visible black spot on tooth at this stage a simple tooth filling can be done but if left untreated it progress through denting and when reaches nerve layer it starts to give out pain this is when a simple filling cannot be done a root canal treatment and crown procedure will be the only option to save the tooth in that stage I can understand your situation but please visit the dentist and get a simple filling done as soon as possible to save that tooth treating at early stage will be a good decision financially meanwhile avoid stick and sugary foods and maintain a good oral hygiene to reduce the decay from rapidly progressing I hope this helps"
    },
    {
        "instruction": "hello doctor I used to have constipation issues last year and recently in the last two weeks it gets fixed but I think I have little wounds appearing that is my assumption I am taking soft stool from last week while taking out stool I feel a slight pain in that area is it serious please advice",
        "input": "",
        "output": "hello I can understand your concern for symptoms never attempt to take out stool instead it is advisable to use stool softener or laxatives the habit of taking stool out and constipation can develop anal fissure which is small tear on inner wall of lower part of anal canal constipation manual removal of the stool proctoscopy rectal examination anal fissure stool softener or laxative analgesic for anal pain anesthetic medication ointment for local application"
    },
    {
        "instruction": "hello doctor does every wisdom teeth start growing partially erupt or do I percent have something wrong with me my gum is half on my wisdom teeth which is now starting to grow are a bit swollen but the teeth does not look slanted or impacted so far it hurts a little though I just want to know if wisdom teeth always grow half erupted and then slowly fully erupted I cannot chew very hard or a lot because it will hurt there is nothing wrong with my gum it is just on the top of the teeth and swollen but besides that looking normal the teeth are on the right hand side bottom of my mouth and I brush my left hand side of my mouth a lot more than the right so it could be an infection I am 13 my wisdom teeth probably should not be growing yet my wisdom teeth on the bottom left side is also half erupted but does not hurt at all I do not know if it is swollen I am using numbing cream as of now",
        "input": "",
        "output": "hello most third molars or wisdom teeth grow half erupted or becomes impacted in most populations sometimes normally erupting teeth can cause pain and swelling this could probably be your second molar tooth we will have three molars on each side the age of eruption of wisdom tooth is 17 to 21 years whereas second molars erupt between 12 to 13 years this pain and gum swelling could mostly be due to its eruption this is quite normal you can do warm saline mouth rinses thrice daily to manage pain or can continue the same numbing cream to relieve the discomfort the gums over the erupting tooth will generally be loosely attached hence they attract food particles get trapped between the loose gums and the tooth thereby causing gum swelling do rinse your mouth after every meal to remove food deposits this should settle in a couple of days but if the swelling and pain are not coming down in two to three days you should visit the dentist and get the swelling examined I hope this helps"
    },
    {
        "instruction": "hello doctor I am 23 years old I am a hypothyearoid patient from my years I was taking medication till I was 17 years old then I could not continue with my medications and I stopped it for years one day suddenly I began to feel faint always even while I was sleeping sometimes I would feel fainting it would sweat a lot suddenly my muscles and bones started to pain a lot I could not go alone out of my house especially in the day time in the hot sun if I go then it would sweat a lot feel as if I was going to faint in some more time only if I come home and sit in the fan it will reduce a bit even after drinking a lot of water and eating glucose the feeling will not go I feel like I have only 10 percent energy in my body my pain would be more in the day time and after eating it would reduce so I get little energy in the night after eating all throughout the day I could not continue my life normally then I went to my endocrinologist she found that vitamin was low I corrected by eating heavy dose tablets and it came back to normal but my symptoms continued then I did yoga it reduced by 10 percent then I tested for vitamin b12 after five months it was 69 pig my then I took injections and corrected it but my symptoms reduced by 20 percent only still I cannot go out in the sun confidently I do not know what to do my parents are blaming me that I am simply telling a lie am I having any severe deficiency or disease please help me out I have discontinued my course due to this condition",
        "input": "",
        "output": "hi I have read through your query in detail please find my observations below if you have a history of hypothyearoidism and have not taken medicine for five years then it is important to review your thyearoid function tests again it is possible that you have again become hypothyearoid and it is essential to know your ash thyearoid stimulating hormone to and to you should also get clinically examined and if required then do a thyearoid ultrasound scan vitamin should be maintained at the normal level if it has come back to normal then you should continue eating foods rich in calcium like rage and milk vitamin 12 should also be taken care of it will help to know what is your present vitamin 12 level this should be in the mid range sometimes it can be at the lower limit of normal and this requires supplements it is important to know if you have any fear or anxiety concerning your health please eat well and also drink an adequate amount of water every day you are in growing age and should take 200 cal food every day include eggs fruits and green vegetables in your diet please spend 30 minutes in the morning sun from am to 30 am every day and this will generate vitamin from sunlight continue doing yoga and stay physically fit and mentally strong sometimes even electrolytes and blood sugar can get low and cause such symptoms it will help to get your serum calcium phosphorus sodium potassium and chloride done and also fasting and post prandial blood sugar test done these are important to know if your low energy problem is due to low electrolytes or sugar getting complete blood count hemoglobin with peripheral blood smear level is also important to know if you are having anemia leaving the course is not a good idea if you have any mental anxiety and stress then please consult a psychiatrist hypothyearoidism can cause laziness and low mood and this can be treated with medicines I hope this helps"
    },
    {
        "instruction": "hello doctor I am a master student currently writing a thesis as this is a stressful time for me my sleep is the first thing being affected for the past two to three weeks I have had sleepless nights restless sleep and waking up in the middle of the night averaging about two to three hours of proper sleep per night during that time I had been taking valerian root to help me sleep except recently it seems its potency has worn off or my body has become used to its effects a doctor prescribed me zimovane zopiclone for sleep but did not ask about prescriptions I am currently taking does zopiclone have any effects on birth control prescriptions particularly rigevidon",
        "input": "",
        "output": "hello zopiclone is a nonbenzodiazepine hypnotic agent helps in maintaining sleep long acting reduces the number of awakenings improves the quality of sleep and has minimal abuse potential the usual dose is 5 my 15 20 minutes before sleeping and should not be used for more than four weeks as such zopiclone has no metabolic interaction with birth control pills so you can continue to have them even on zopiclone however if you want to conceive then you should not take zopiclone as it can lead to withdrawal symptoms in neonates hence if on birth control pills you can continue to have zopiclone for about four weeks after which you should seek an opinion from a concerned psychiatrist burnout insomnia primary zopiclone 5 my sleep hygiene avoid stimulants at late night follow up after two weeks take oral medications continuously"
    },
    {
        "instruction": "hello doctor I have been diagnosed with multiple sclerosis I never traveled to a foreign country I have been unprotected from paint chemicals for over a year I use a mask that was not nosh approved the spray that I have been using is 341g a test shows that 36 pounds of chemicals have been inhaled like I was inhaler on drugs that is from the paint spray itself I would see things which were not there I experience numbness and tingliness in the right side of the face bottom of the right hand and right bottom foot I also have shortness of breath I highly believe this a case of multiple sclerosis symptom I know it is uncommon but can certain spray chemical give this symptom I do not want to be misdiagnosed I have got kids my health and life is depended on",
        "input": "",
        "output": "hello multiple sclerosis is an autoimmune disease in which an abnormal response of body immune system is directed against the nervous system brain spinal cord and optic nerves the immune system of the body mistakenly attacks the myelin sheath the protective coating around the nerves the cause of is still not known it is believed that several different factors may be involved mainly immune mediated but genetic and some environmental factors have a role although some studies have claimed to have a relation between is and some substances used in paints etc but not as spray substance otherwise also these studies are not giving a strong scientific basis these are simple reports that need to be confirmed further before reaching on conclusion the long contact with some paints can cause neurological symptoms and numbness but mostly it is reversible coming to your problem you have written I have been diagnosed with multiple sclerosis if it is by a competent specialist then I will not comment anything on the diagnosis what is mri and csi results anyway it can only be judged along with physical examination and signs and symptoms but some of the symptoms are fatigue progressively leading activity limitation numbness weakness walking difficulty vision problem urinary problem bowel problem cognitive emotional and depressive changes and respiratory problem if chest muscle gets weakened as you have apprehension about painting work so the best option for you is to search for some other job even if it is not proved that inhalation of painting is a cause of is"
    },
    {
        "instruction": "hello doctor I am 20 years old my height is 2 and weighs about 75 keg what are the yoga I could do to reduce weight how many days a week and for how many hours shall I practice yoga",
        "input": "",
        "output": "hello according to your height and weight your mi body mass index comes out to 30 24 which is considered to be a clear case of obesity for asian population according to the latest guidelines if you are really willing to lose weight then you just need to understand that weight gain or weight loss is simply due to a balance between calorie intake and calorie requirements the second most important point is there are no short cuts to weight loss the ideal recommended weight loss per week can be approximately two kilograms so you can expect approximately to 10 keg of weight loss in one month weight loss for the first two weeks is always easiest the main difficulty is in the second and third months plan and follow any weight loss strategy for a minimum of six months go for yoga a minimum of one hour per day and five days a week an ideal recommendation will be two hours of workout per day one hour can be given to yoga and another one hour can be reserved for jogging running walking dancing exercise or any other physical work out some practices which are useful for weight loss are jogging jumping spinal twists back swing hip twist forward and backward bending side bending parivrtta trikonasana stretch dynamic suryanamaskara chakki chalanasana bhunamanasana chapaati making dhanurasana swing salabhasana alternate bhujangasana and parvatasana navasana swing paschimottanasana stretch halasana alternate paschimottanasana and halasana cycling era pa uttanasana and dwi pa uttanasana side leg raising naukasana swing kapalbhati kriya gala neti kriya raghu shankha prakshalana vamana dhauti nazi suddhi pranayama bhramari and surya anuloma viloma it is not advisable to start with these practices without guidance especially in the beginning suryanamaskara is especially beneficial start with three rounds per session and keep adding one extra round every third day till you reach ten rounds per session dietary modification is a must for success you can follow different diet plans for example one week liquid only diet another week fruits only diet becoming very strict with one diet plan makes it difficult to follow go for food items which are bulky more volume but with less calories for example fruits and salads instead of an item which are have condensed calories and but less bulk like sweets all the information is relevant to you as long as you are not suffering from any other ailment it is worth to check your thyearoid status if you have not done it already"
    },
    {
        "instruction": "hello doctor kindly explain the treatment of periodontitis",
        "input": "",
        "output": "hello any history of previous braces treatment smoking history any systemic diseases under any long term medication usage I have gone through your op looks like you have a moderate form of generalized periodontitis is the inflammatory condition of the underlying bone and the associated structures it could be either because of local factors or due to systemic conditions a complete oral examination should be done to determine what is causing your generalized bone loss in oral cavity the most common local factors are calculus hardened yellow food deposits habits history and unstable bite this unstable bite could also be due to your wisdom teeth some of the systemic factors include nutritional deficiencies systemic diseases like diabetes mellitus genetic factors blood disorders immunocompromised diseases or if under any long term medication treatment depends on the cause treating the cause stops the progression of the disease if it is due to local factors scaling and polishing followed by lana laser assisted new attachment procedure will help long term maintenance including review appointments and oral prophylaxis should be done in periodical intervals please visit a periodontist dentist to identify the cause and to start with your treatment"
    },
    {
        "instruction": "hello doctor is pancreatitis curable is it treated as an outpatient or inpatient if as an oupatient what medicines are typically prescribed and what is the treatment plan if as an inpatient where is a good hospital to get treated",
        "input": "",
        "output": "hello yes there is treatment for pancreatitis in ayurveda but in your query only diagnosis is not sufficient depending upon your symptoms we diagnose the case according to ayurvedic view and then will give treatment generally all good and experienced ayurvedic doctors can treat your problem by the time for pain burning sensation and swelling you can use following medicines which are safe spicy food smoking alcohol gastric ulcer is shankha vat tab twice a day before food jeerakarishtam top twice a day after food with equal quantity of water avipattikar choorna top twice a day after food with warm water gulkand pravalyukta top at bed time follow simple non spicy veg diet"
    },
    {
        "instruction": "hi doctor this is about my 5 year old son just after a couple of months of his birth a light reddish spot appeared below his nose please see pictures now it has grown as dark brownish textured spot and appears to be growing with the body although it does not make any physical problem to him now he is quite conscious about it and tries to hide from everyone even after our counseling it is a kind of social stigma for him hence we want to get it removed please answer my queries does it has any future health risk is it possible to get it removed surgically or by medication if surgery is the only way can a child of 5 years age will bear the process will this removal be permanent or any other solution",
        "input": "",
        "output": "hi I looked into the pictures of your son and can understand your concern it is a simple nexus common mole regarding future health risk most of the common mole does not cause any problem except they may grow in size but very rarely they may get transformed into melanoma skin cancer treatment no medicines will clear it but yes it can be removed surgically the risk of it getting transformed into melanoma is not the indication to get it removed but it is a cosmetic indication in your son case yes he can withstand the surgery as it is done under local anesthesia with sedation it will not recur at that site once it is removed as mentioned only surgery can correct it but right now it is not strongly indicated unless he can cope up with it but as told there is a very small risk of it changing into melanoma actually most doctors would advise to watch for those changes sudden growth in size or changes in the color and if these changes are happening then go for the surgery but for him it is in the area of mustache so he may try to hide it from the world once he starts growing mustache and hence any changes in color of the mole might not be noticed so it is better you consider surgery now only I hope this helps"
    },
    {
        "instruction": "hi doctor we have a baby of months old I would like to mention the previous history here my wife does not have breast milk so she cannot feed it we are offering nanpro I to the baby she is very active and smiling all day doctor told to start solid to her with cow milk doctor offered a schedule as below give her mashed rice once a day and cow milk and nanpro as well but now we found that her weight is lost by 10 go compared to the last 15 days weight her weight as of now is 315 keg which was earlier 325 keg 15 days back my wife has reduced her nanpro almost all around 60 90 my per day is given to the baby and started feeding her with cow milk for the whole day from the last three days and from the last three days baby is having a very solid stool she also had pain while doing that she is also getting irritated for the past three days why we need your guidance is it correct to reduce nanpro while increasing cowmilk do we still need to continue nanpro how to deal with this solid stool which is giving her pain she does not have blood or something in the stool but she is having pain while doing it we are worried about her weight loss as well can you please guide us for her food so that it will suit her with weight gain and no pain",
        "input": "",
        "output": "hello your baby is now month old now you can give her food other than milk also but it should be offered in a way your baby will accept I mean to say you have to give semi solid food because your baby cannot chew enough to digest solid foods and some time is needed to get adjusted for both baby and mother this is the time when feeding difficulty starts so do not worry you can offer your baby semisolid foods like mashed rice in milk porridge made of rice rage etc mashed potato and banana add more milk to make it less thick you can offer food six to eight times in a day once or twice overnight milk for three to four times and semisolid foods rest of the schedule give in small quantities at each time gradually start introducing more solid food over the next four to five months about which milk to use you can use any type of milk usually what the family consumes add one spoon sugar to 10 spoon milk and feed with a spoon never use a feeding bottle if you have a habit of bottle feeding please stop it and never use again you can add ghee or butter to semisolid foods which will increase the calorie content of food and also make it tasty once your child starts accepting these things you can slowly come down on the quantity of milk and change the menu accordingly about formulas nanpro there is no harm using it but you have a lot of other options from homemade foods itself do not worry your baby will gain back the weight I hope I have addressed all your issues"
    },
    {
        "instruction": "hello doctor I am a 27 year old male with a sleeping disorder I have difficulty in falling asleep in the night and has difficulty in getting back to sleep after waking up in the middle of the night I need to masturbate in order to fall asleep I suffer delayed sleep phase disorder this has made it difficult for me to maintain a normal job during college time I did not use to sleep one night before exam because of fear of not getting up on time what is light therapy and chronotherapy how can they help I have daytime fatigue if there are any medicines which I can take for a short time please suggest I am facing this problem since last 10 years",
        "input": "",
        "output": "hello welcome to icliniq com sleep disorders are very common normally hygienic measures could be helpful to alleviate the symptoms also it could be a symptom of other disorders however in your particular situation that does not seem to be the case melatonin is effective in regulating the synchronization of the circadian rhythms of physiological functions like sleep timing of course the are pharmacological options that can be useful in acute cases or during a short time course like lorazepam 2 my lormetazepam my if that does not work please feel free to contact me again"
    },
    {
        "instruction": "hello doctor I am 37 years old I had a problem with bleeding in stool so I consulted a doctor and he said it is hemorrhoids he gave me sitcom 100 my for one month I have taken this medicine and blood is not coming now but I have constipation and I took organic psyllium but did not get any benefit please advise me on what should I take to get a normal stool and my 5 year old girl sometimes complaints for stomach pain I consulted the doctor but he gave only pain relief syearup but she did not have any benefit please recommend any test to know the actual problem",
        "input": "",
        "output": "hi in case of rectal bleeding there are two possibilities one is sous solitary rectal ulcer syndrome this is an ulcer formation in the rectum due to chronic constipation this causes bleed another one is hemorrhoids I think you have sous that can be easily treated by ispaghula and diet modification we do not do any investigation for this until constipation gets treated and it will not respond the problem of hemorrhoids is common in the adult age group constipation is among the one of the cause other risk factors are alcoholic liver disease and rectal carcinoma for constipation we give isabgol methylcellulose that is a bulk forming agent along with this you need to take a high fibre diet and plenty of water if you have hemorrhoids then in early stage exercise can benefit you there are two types of exercise one is to decrease your weight if it is excess more than 80 keg second is to do anal exercise in the form of anal contraction for five minutes every hour controlling constipation will also decrease your hemorrhoids regarding your daughter I think she had constipation you should note the duration of sitting in the toilet and that is more than five minutes in case of constipation and about straining during defecation or passing hard stool if she has constipation then she needs treatment her pain will subside after treatment for this she also does not require any investigation you should tell about her height and weight if it is abnormal then she requires investigations advice follow as per discussion for you provide details about your daughter give her tablet albendazole 400 once only review with details"
    },
    {
        "instruction": "hello doctor my front two teeth are not fixed and have broken edges because of a car accident but right now I feel like my lower front tooth are peeling I can feel a white powder type thing whenever I touch the tooth with my tongue I cannot bite from my upper front tooth plus after the trauma I could not take care of them properly because I feel too much pain whenever I brush I need your help please guide me on what to do how can I fix my problem I am very much tensed",
        "input": "",
        "output": "hello I understand your concern and have gone through your clinical picture please do not be tensed this can be treated white powder substance in your lower front tooth is called calculus food deposits or plaque that settles on the tooth gets calcified in the long run and becomes hardened calculus deposit although we do a proper brushing every day there are certain spots between teeth where the bristles fail to reach hence professional tooth cleaning scaling and polishing is always advised once in six months broken and irregular edges of your upper tooth can be fixed with a simple tooth colored aesthetic filling pain during brushing in the lower tooth could be from the impact and damage caused during the accident get an ray taken to check the status of tooth gums and its underlying bone and ligament blacks spots on the teeth are the initial stages of tooth decay get them filled at once before it advances and gives you pain visit your nearest dentist and get a dental examination done you will require scaling and polishing procedure to remove calculus composite fillings for an upper front tooth and lower left back molar x ray for your lower front tooth to check its health and stability I hope this helps"
    },
    {
        "instruction": "hi doctor I am a 35 year old male and have been experiencing a dull tight pain on the back of my testicles and in the spermatic cord sometimes it feels like a rough scraping inside my scrotum the pain is debilitating and I have had it for about six months now it started on the backside of my right testicle but now it has spread to the back of both testicles and I have pain going up from the scrotum I have had an ultrasound it scan mri taken antibiotics anti inflammatories and antidepressants and all tests are normal with a varicocele in the left but I still have pain when walking or sitting anytime something pushes into my scrotum when I stand still it is better and I cannot wear underwear or anything tight on my scrotum because of horrible pain also I have noticed that my testicles have started retracting up almost into my abdomen when having sex however I cannot have sex cause it hurts too much but this retracting is real tight and it has never happened before this year please help",
        "input": "",
        "output": "hi your history and clinical symptoms are suggestive of epididymo orchitis of both tes you told that you have undergone a number of investigations it would have been convenient for me if you had uploaded the same anyway you need a clinical examination too so you need to visit the office of your local urologist for management of the same another possibility is nerve entrapment syndrome as you have undergone groin hernia surgery on the left side but the possibility is less as you have bilateral symptoms and you had undergone surgery on the left side but you have to wear tight inner garments as that is the prerequisite for the treatment of epididymo orchitis"
    },
    {
        "instruction": "hello doctor I have a very sore throat and can barely talk or swallow it is very red and swollen with red streaks and blisters it hurts mostly on the left side and my left ear hurts as well my glands are very swollen to a point of protruding from my neck and are tender to touch I have a low fever going between and 100 my stomach is slightly upset as well I am 16 and weigh about 174 labs I have been exposed to streptococcal infection but have not had it since I was years old I have a doctor appointment next week so I am holding off going I did have a flu last week but was feeling better until I got this sore throat I am not sure if this is still from the flu or something else the first file is a picture from when the sore throat started two days ago and the second was from today",
        "input": "",
        "output": "hi I have seen the pictures your description and the images point to acute granular tonsillopharyngitis a bacterial throat infection probably due to streptococcus with low grade fever throat pain difficulty in speaking swallowing and enlarged tender lymph nodes you certainly need a course of antibiotics I personally do not think that you should wait for a week to start any medications for an antibiotic you will need a prescription from a doctor who examines you in person in case if you must wait then you can try the following conservative management in the meanwhile I can advise you to take an anti inflammatory medication like oral paracetamol 500 my twice daily after meals for five days along with antiseptic mouthwashes or gargles with chlorhexidine or betadine dilution of my in 50 my water and should not be swallowed three times a day before and after meals with voice rest and adequate hydration with fluids drink approximately two liters of water per day most throat infections would subside on their own without medications in eight to ten days you can expect a recovery in two to three days if you take an antibiotic along with the supportive medications that I have recommended to you I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 53 year old male with no previous medical history for the past two years I observed my semen to be slightly pinkish in color now I realized it was due to traces of blood but I did not pay much attention since the last two to three months I have been seeing blood in my ejaculate specifically if I have sex or masturbate on consecutive days the second day the amount of blood and redness is much more if I give a gap of 15 20 days then on the first day I do not see any blood but on the second day it is quite distinct I do not feel any sort of pain during or after sex or while masturbation I do not pass blood in the urine I do not feel any burning or itching sensation while ejaculating or urinating I have had no injury in my pelvic area or to my testicles I do not suffer from diabetes or hypertension I have been having sex and masturbation two to three times a month recently I took levofloxin 500 od for six days thinking if it was due to a urinary infection the antibiotic might help but it has not helped so far I have not consulted any clinician on the subject",
        "input": "",
        "output": "hello the condition you described is known as hematospermia which means blood in semen although it is considered a benign symptom in men but if for any person above 40 years of age the possibility of carcinoma should be ruled out in two third of the cases no cause is found and treatment is not indicated in many of the cases there is no intervention required but with increasing age chance of prostate tumor are high I request you to visit a urologist as soon as possible the purpose of visiting urologist is to rule out the possibility of prostate malignancy the other common cause of this condition is a sexually transmitted disease you did not describe anything else in association with blood in semen so the possibility is very low in case if you have any sexual exposure to some unknown or commercial sex worker in the recent past or you are having other symptoms of sexually transmitted disease it is wise to get physician consultation I hope this helps"
    },
    {
        "instruction": "hi doctor my upper incisor hurts whenever I touch it this morning when I woke up I was not feeling this pain but after I drank a cold juice I notice that it hurts I went into the bathroom and check if I see any hole but there is none I gargle with some warm salt water but it still does not stop I brushed my teeth but I cannot go up to where the gum is because it hurts when I eat food I do not have a problem with it but only when I touch it I feel pain I do not know what is causing this and I am wondering if it is my sinus but I know that I have tooth decay because when I eat certain food my molar and premolar hurts I have an appointment to see the dentist but it is not in the recent upcoming days",
        "input": "",
        "output": "hi I have read through your complaint and the relevant details pain on pressure is a clear sign of an infection deep in the roots of your upper incisors it could be mostly because of a forgotten trauma or assault you had in your childhood it is not necessarily because of tooth decay the vital part of the tooth is suffering pressure and causing the infection I advise you to visit the dentist on an emergency appointment immediately and you got to check with an ray to proceed with a root canal treatment in my opinion your appointment would be too late and you cannot be on paracetamol for so long there are a lot of chances for a bigger swelling or discoloration of the tooth it is not related to sinusitis as you think and the pain you get in premolar and molar region is the referred pain that you feel because of the upper incisors meanwhile try not to bite any hard object or food and gently brush with a soft bristle toothbrush thank you"
    },
    {
        "instruction": "hi doctor my mother is 76 years old and has alzheimer for the last five years along with ischemic heart disease hypothyearoidism and type diabetes recently she developed cold the doctor recommended foracort 400 inhaler twice a day and foracort 5 my respules through nebulizer once a day along with deriphyllin retard 300 at night is it safe to use the above three medicines considering that she experiences muscle spasms in the rib area from time to time",
        "input": "",
        "output": "hi thanks for your question I can understand your concern may I know her alzheimer's and i'd drugs and better not to take foracort budesonide and formoterol three times a day I will be happy to help you further wishing good health to your mother thanks"
    },
    {
        "instruction": "hello doctor I am getting an ulcer on the inner cheek of the mouth it disappears on the second day but again reappears after or days it is about 29th time I am getting the same place ulcer within three months",
        "input": "",
        "output": "hello it could be a common aphthous ulcer also know as canker sore it has various causative factors such as deficiency of vitamin hormonal imbalance psychological reasons such as stress some kind of allergy such as for food or paste or mouthwash accidental trauma injury caused by the sharp cusp of tooth and bacterial infection your problem could be any of the above to know the exact reason kindly get a clinical examination and blood report appropriate supplements will be suggested if the reason is either anemia or nutrition deficiency in case of constant poking of sharp tooth it will be either polished or filled meanwhile observe the following to avoid further pain and recurrence please avoid hot and spicy foods and take lots of water to keep yourself hydrated rinse your mouth after every meal or do saline mouth rinse thrice daily if the ulcer hurts a topical anesthetic like dolojel or hexigel can be applied over the ulcer with a clean finger visit your nearest dentist as soon as possible and get a complete oral examination done to identify the cause I hope this helps"
    },
    {
        "instruction": "hi doctor I am an active 30 year old female with health and generalized anxiety for the past days I have been experiencing heart palpitations sometimes it feels like a small flutter as if my heart misses a beat other times it feels like an intense pounding that lasts for hours I experienced these approximately years ago when I was first diagnosed but have not felt them in a long time so I am utterly terrified for reference I do not smoke or use drugs and I also workout 6 times a week cardio running and weight training I went to see a walk in clinic doctor who listened to my heart and said he thought it was all anxiety and suggested I take medication for my anxiety I had chest ray ekg and blood tests and everything was normal honestly I am just terrified that I am about to have a heart attack every single time I feel these palpitations can these palpitations really be caused by anxiety and should I be worried or just wait for them to pass I ran yesterday and today in spite of them and did not feel any palpitations while I was exercising I only seem to feel them at rest or when lying in bed please give me some peace of mind I am going out of my mind with worry every time I feel these",
        "input": "",
        "output": "hi I do not think from your symptoms that what you have said that you have terrified about to have a heart attack it is not as your symptoms happen at rest not during exertion to evaluate for palpitations you do hotter monitoring I think your symptoms mostly due to anxiety you maintain a diary and find out what are the things which disturb you or precipitate your anxiety advice for stress management note down and try to work out to correct it or ignore it walking for 30 minutes daily breathing exercises for 10 minutes twice daily do yoga for 30 minutes daily you are young so join any sporting activities you like you can listen to soft or romantic music spend quality time with your relatives and close friends share your problem with them take the help of a counselor to overcome anxiety you are suffering all these things will definitely give you relief review after two months"
    },
    {
        "instruction": "hello doctor my baby who is exclusively breastfed has just started her fifth month for the past four days she passes frothy liquid motion with little white like substance for a minimum seven times a day the consultant doctor examined her stool and said that she has got lactose intolerance he told me to stop breastfeeding and go with soya based milk powder for three months from now on should I stop breast feeding she is active and gaining weight",
        "input": "",
        "output": "hello I went through the details you have provided in the query lactose intolerance is the absence of lactose enzyme which helps to digest and break down sugars mainly lactose in the diet lactose intolerance is of two types primary secondary in primary lactose intolerance there will be deficiency of this enzyme permanently and will have to avoid for life time or needs enzyme replacement for life in secondary intolerance deficiency is only transient and will regain the enzyme in a few days this occurs mostly after episodes of gastroenteritis and needs to avoid lactose diet for a few days or weeks your child needs further evaluation to check if it is primary or secondary the reports you have sent are not clear the second one culture if positive will need treatment with antibiotics though breast milk contains lactose and not easily digested by lactose intolerant babies it is not advised to stop breast feeding as advantage of continuing breast feeding outweighs problems due to lactose intolerance though giving lactose free feeds reduces symptoms like loose motions and bloating my advice at this point is to continue breastfeeding but if loose stools are causing dehydration or weight loss in baby then go for lactose free formula and repeat stool examination and tests for lactose intolerance again since it might be transient only and might improve in about one to two weeks and if repeat testing is normal then normal breastfeeding can be given without any worry I hope this helps"
    },
    {
        "instruction": "hi doctor I have sharp pain in the right eye since yesterday evening also I wore a fresh pair contact lens last evening and I did not wear a contact lens for almost two months the pain started two hours after wearing contact lens and I went to a marriage function and there were many people with conjunctivitis there is mild swelling and redness of the right upper eyelid since today morning after I woke up but no watering and itching",
        "input": "",
        "output": "hello I reviewed your history and the photo attached to the question it seems like inflammatory swelling of the upper eyelid most commonly in the form of hordeolum I would like to treat this condition by the use of antibiotic eye drops like moxifloxacin eye drops and oral anti inflammatory drugs like aceclofenac warm compression applied over the eyelid will help in symptomatic relief the cornea appears to be clear however if you have symptoms like blurred vision you need to consult your eye doctor for examination and treatment under supervision the use of contact lenses should be stopped until the symptoms resolve and this generally takes three to five days hope this information is helpful for you"
    },
    {
        "instruction": "hello doctor the question I have is concerning the retina photographs that I have attached to this question from those can you tell if I suffer from a condition known as disc at risk or crowded optical disc I understand that it is possible for people with this condition to suffer from non arteritic anterior ischemic optic neuropathy naion when also taking ed medication I have had an eye test done but the person who did the test could see no problem with my eyes but seemed unaware of crowded disc or naion I am 60 years old not taking any medication and no previous history of eye problems or naion",
        "input": "",
        "output": "hello I reviewed your history and the photos of the retina attached to the question the funds picture does not appear like disc at risk and hence no need to worry about it in the funds photo the disc is showing is peripapillary atrophy surrounded by the tesselated background of the retina these changes are commonly seen in myopia people with a small disc with crowding of nerve fibers are at the risk of development of non arteritic ischemic optic neuropathy called naion the compression of the small capillaries at the optic disc because of overcrowding will result in ischemia resulting in naion in your case the funds picture the disc does not appear like a disc at risk hence no need to worry hope the information is helpful to you"
    },
    {
        "instruction": "hello doctor five weeks ago I fell down while mountain biking I went over the handlebars and hit my head and chest I was wearing a helmet and a chest protector and both of them had cracked as a result of the impact the helmet strap had strangulated my neck pretty hard ever since I have been continuously having sensation pressure at the place where the strap had impacted activities like turning my neck yawning laughing cause some pain over the past five weeks the symptoms have not improved I am very worried because I am afraid I might have to deal with this forever they did a it scan and said that it was normal should I ask for an mri could this be some kind of hernia",
        "input": "",
        "output": "hi sorry to hear about your injury since your it computed tomography scan is normal it is very unlikely that there is any bony or skeletal injury hence reducing the possibility of something permanent it appears that there is some soft tissue injury in the laryngopharyngeal region or a cartilaginous injury that is resolving very slowly this indicates an injury closer to the voice box region because of constant movements during speech laughter and swallowing delay recovery this may also explain why it is taking so long to heal completely in my opinion an mri magnetic resonance imaging is certainly indicated since there has been no improvement in symptoms for five weeks and to look for cartilaginous injury or soft tissue lesions such as a granuloma or hematoma following trauma in addition a video laryngoscope performed by an ent will help to evaluate the voice box and supporting apparatus internally for any injury specifically the inter arytenoid region a hernia in the neck or a laryngocele may be a possibility following neck injury but seems very unlikely in your case since there is no visible bulge in the neck which worsens on coughing etc there may be an internal laryngocele that may be picked up on video laryngoscope I hope this helps"
    },
    {
        "instruction": "hello doctor I am 24 years old I have an external and internal hemorrhoid I guess but I am not sure I have a lump near my anus and it hurts a lot when I sit and walk sometimes it bleeds as well there were two external hemorrhoids but one was gone by itself and one remained and it has been there for more than 15 months and it is still there I also noticed a color change near my butt area I have attached a video I want to know what actually it is and how can it be gone forever do I need surgery I do not want a surgery can it be cured by a home remedy",
        "input": "",
        "output": "hello did you attach any video here only pictures are available do you feel difficulty in passing stools any blood after stools does the area of lump itches or always seems to be wet it does not seem to be like a typical external hemorrhoid it needs a physical examination to confirm the diagnosis actually these are a collection of engorged small blood vessels and nearby soft tissue which occurs due to the pooling of blood due to prolonged constipation straining etc hemorrhoids can be avoided by encouraging more oral fluids avoiding constipation straining exercises especially abdomen fiber rich diet etc you most probably need to visit a general surgeon also you might just need a minor surgical procedure you no need to get worried you can get discharged in two to three days from the hospital I believe home remedies would not be helpful at this stage"
    },
    {
        "instruction": "hello doctor when I wake up every morning I feel the taste of blood in my mouth please suggest",
        "input": "",
        "output": "hi please check your mouth by looking into the mirror during brushing your teeth to know any bleeding site in your mouth and throat mild bleeding might occur if you have gum disease due to infection or vitamin deficiency please consult a dentist to get clinically evaluated please change and use a soft toothbrush sinus infection also causes symptoms including the taste of blood in the mouth every morning it will help to know if you are having any sinus infection which might be causing it if you are a smoker and have chronic cough then causes in the lungs including bronchitis will have to be included please get examined by an ent specialist and if required then consult a dentist please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements I hope this helps"
    },
    {
        "instruction": "hello doctor my father height is 161 am mother height is 152 am and my height is 141 am my birth weight 1 keg although I was born full term I had delayed growth since childhood and I attained puberty at the age of 15 no long term medication was taken no illnesses since childhood but crowded teeth and dental complications I sometimes have headaches also I just started hanging exercise since two months for 30 seconds twice a day I want to grow at least inches and most inches I started the magnetic kit of acupressure three months ago but no difference yet I will continue for a year at least I do not have facial growth I live in central africa is there any hope for three to four inches of height gain I would appreciate any advice",
        "input": "",
        "output": "hi I have read through your query in detail please find my observations below if the general adult height in your race is lesser than the world average then it is difficult to expect a normal height also your growth is delayed and therefore it might be slightly difficult for you anyways you can still try natural methods however you will continue to grow until you attain 21 years of age the bones stop growing at this age please continue taking a healthy and nutritious meal of 1800 cal daily and also take vitamin supplements include rich sources of protein like fruits vegetables and boiled eggs to give you required daily vitamins and minerals physical exercises help many people and you can extend your hanging exercises to about two to five minutes you can play basketball and do jumping exercises with skipping rope if you are still not 21 years then you can consult an endocrinologist and get examined and take medical treatment for increasing growth"
    },
    {
        "instruction": "hi doctor I have severe toothache and worm teeth please let me know the medicines I need to be used to cure it permanently",
        "input": "",
        "output": "hello I understand your concern unfortunately there is no medicine to cure tooth decay without dental treatment tooth has three layers outer enamel denting and innermost never layer when decay starts in the enamel layer it does not show any symptoms other than a visible black spot on the tooth at this stage a simple tooth filling can be done but if left untreated it progresses through the denting and when it reaches nerve layer it starts to give out the pain this is when a simple filling cannot be done a root canal treatment and crown procedure will be the only option to save the tooth taking painkillers will help control the pain but it does nothing to cure the decay it can only be manually treated by removing them please visit your dentist and start treatment immediately I hope this helps for further queries I would be happy to help good day"
    },
    {
        "instruction": "hello doctor I have been on femosten conti for several months and have changed from a different hit medication which was also the brand femosten but I cannot recall its name I commenced on the first medication to manage menopausal symptoms it has certainly helped with the symptoms especially the femosten conti I have noticed some spotting on occasion it is very minimal I wear panty liners so note any discharge or bleeding it is what I would describe as infrequent I am not sure if I should see my go about this",
        "input": "",
        "output": "hi thank for the query I can understand your concern femoston conti contains dydrogesterone and estradiol hemihydrate means combination of progesterone and estrogen to treat the symptoms of menopause usually prolonged use of hormone replacement therapy is not recommended if using for prolonged periods then regular general checkup is advised to diagnose any problems related to hormonal use irregular spotting after menopause should be considered seriously as sometimes it may indicate some problem usual causes are atrophic endometrium cervical erosion increased endometrial thickness etc hit is not advisable in case of unknown cause of pelvic bleed usually so please consult your gynecologist once get examined and go for pap smear test and ultrasound with this workup the possible cause of your problem can be identified and treated if symptoms of menopause are minimal then herbal extracts like astro are better with less side effects hope I have answered your question I will be happy to answer any further follow up questions take care increased endometrial thickness pap smear and ultrasound side effects increased endometrial thickness to be evaluated better to avoid prolonged use if needed"
    },
    {
        "instruction": "hi doctor I was diagnosed with dengue towards the end of last month I was hospitalized for five days I went through a lot during that period and since coming out of the hospital I have developed this phobia that I might have dengue again because my area is dengue prone with lots of mosquitoes whenever a mosquito bites me I get filled with this fear that I might have dengue again when I went to my doctor with this fear he told me dengue does not happen twice in the same season it can happen again in the next season but it cannot happen again this season I want to ask if this is true if it is true then what is the logic behind that can you please explain I am immensely afraid of the disease",
        "input": "",
        "output": "hello the fact that dengue cannot happen in the same season is true to some extent but not absolutely let me explain dengue is a viral infection caused by the bite of infected ages aegypti mosquito every mosquito bite will not lead to dengue fever as for infection to happen first the mosquito should be infected by the dengue virus dev by infection of the mosquito I mean the mosquito just serves as a vector or carrier for virus transfer to humans also every mosquito carrying the dengue virus would not lead to dengue fever shock etc some people just have subclinical asymptomatic infections too there are actually four types of dengue viruses numbered from to infection with one type followed by recovery confers immunity to that type of infection our body produces antibodies against the virus and protects us from further infection with time these antibodies fade away so immunity in dev is present but is short lived it can be said that the infection cannot occur in the same season but if an infection with another type say dev type followed by dev type occurs the body does not have antibodies which are protective against type as the body was previously infected by dev type this type of infection is more dangerous however in a season only one type of dev infection occurs usually I hope this helps"
    },
    {
        "instruction": "hello doctor I had a root canal done three months ago on tooth 19 I have not had a crown done yet due to financial reasons I went to a new dentist for tooth pain in that area and he said he could not help me because the rays showed the root canal was not finished I called my endodontist back and they basically refused to see me back and said they did complete the root canal and the reason they did not fill one of the roots was for post space well my rays have been reviewed by an oral surgeon and another endodontist in the meantime who have all concluded that the root canal does not look complete as one of the roots is not filled with the filling material that is used it was also determined that tooth 18 needed a root canal but was not going to be certain to work and I may end up losing that tooth for financial reasons I opted to have tooth 18 pulled five days ago in hopes of helping the severe tooth jaw and ear pain that I am having it did not work I am still having the pain and to complicate matters I now have bone exposure on the tongue side of where my tooth was extracted I saw the surgeon yesterday and he filed it down my headaches are ridiculous and of course I worry the infection is spreading to my head I have had three recent sinus surgeries and this does not feel the same I have been on amoxicillin for over a week now but my tooth pain in 19 has increased since the extraction do you have any suggestions I am currently taking amoxicillin and norco",
        "input": "",
        "output": "hi I have read through your complaint and the relevant details and also saw the ray you have attached tooth number 19 seems to have a good apical seal in the root fillings the first dentist was right in saying that there is a space prepared for the post fixture there is one cusp missing in the tooth hence the treatment plan was a post and core followed by a crown the pain is definitely not because of this root canal treated tooth the reason behind this is that only poorly cleaned prepared or poorly filled roots retain the bugs to stay within the roots while deteriorating the tooth and give pain in your case the root fillings are excellent since you told you are not able to get a crown due to financial reasons at the moment the treatment plan could have been changed maybe at least the post could have been fixed leaving the crown fabrication at the last in that case at least the tooth stays stronger for a while and does not break off when you bite hard food next regarding the tooth extracted area you have mentioned that the bone is exposed now I doubt if you have got dry socket not to be mistaken for infection due to improper healing of the gums over there this might be the reason for the severe pain secondly tooth number 20 also has decay on the sides which makes me to advise you to get another ray for that tooth the current ray does not show the complete tooth this particular tooth might also be the reason for pain please do not worry that the infection spreads to the head there is no such possibility for that right now either 18 dry socket or 20 decay has to be addressed to help you get rid of the pain continue taking amoxicillin as prescribed and for pain relief you can switch to ibuprofen 400 my orally eight hourly for two days provided you do not have asthma or gastritis problems else continue narco tablet for two more days hence I advise you to visit back to the dentist and get done with further checkups as I mentioned above periapical ray for tooth number 20 to rule out interproximal cares pulpits in 20 saline irrigation and zinc oxide eugenol dressing for dry socket in 18 gargle mouth with lukewarm saltwater thrice daily for three days to flush out debris from the gums and in the extracted socket in case it not healed yet follow up after three weeks"
    },
    {
        "instruction": "hello doctor I got blood tested for my thyearoid and I need help understanding the results do I have hypothyearoidism or hyperthyearoidism I have cold hands and feet eczema psoriasis on my nail sensitive eyes constipation gas bloating extreme lethargy depression and anxiety my blood test results free triiodothyearonine 5 5 5 pmol thyearotropin sensitive ash 48 hi 30 0 miu free thyearoxine free to 18 23 pmol l",
        "input": "",
        "output": "hi your results can be interpreted as follows your ash thyearoid stimulating hormone is surely high and the to and to levels are in the normal range there are two possibilities of such a report primary hypothyearoidism in this the ash is high and the others go low this is the most common type in this the thyearoid gland is under functioning the symptoms are usually as described by you now why is your to are normal it might be the case that you are in a very initial stage of dysfunction and might become frank with time if we treat it now the levels will come back to normal and you might not need further treatment secondary hyperthyearoidism in this case all the three readings go up which I see in your report the problem here is with the pituitary gland in the brain which stimulates the thyearoid gland to produce more so the fault is not with thyearoid gland at a primary level for this to confirm you will need a try thyearotropin releasing hormone level which is the stimulant of the thyearoid I would suggest you meet your endocrinologist and get the secondary aspect evaluated after that we can give you the right treatment and everything can be cured easily"
    },
    {
        "instruction": "hello doctor I was diagnosed with acute gastritis a few weeks ago there was no pain while taking the pills but now they are over the pain has started again the doctors said that I do not need to be on them anymore is it possible that the pain is related to gastritis",
        "input": "",
        "output": "hello acute gastritis pain usually subsides as the infection subsides is there any post prandial fullness early satiety burning or pain I hope there are no alarm symptoms like difficulty or pain during swallowing weight loss excessive vomiting or any family history of upper gi gastrointestinal malignancy at your age the above symptoms are highly unlikely at this stage according to recommendations you can either continue omeprazole 20 my twice daily or any other pi for four to six weeks or get yourself evaluated for pyloric antigen by non invasive means or get an initial upper gi endoscopy done to rule out peptic ulcer disease what I would suggest is to wait for some time and continue omeprazole 20 my twice daily or any other pi for four to six weeks if still continues you might need to get an pyloric screen test or upper gi endoscopy done you can also try some lifestyle modifications like eating smaller more frequent meals avoid high fat and capsaicin containing diets eat less spicy food stop smoking and alcohol if you do avoid aspirin or other pain medicines you can also limit your coffee intake as it may aggravate your symptoms I hope this helps"
    },
    {
        "instruction": "hello doctor I am a year old male with diabetes I am in relatively good health but I do have an infected toe I need antibiotics and anti inflammatory drugs please help",
        "input": "",
        "output": "hello it is great to know that you are generally in good shape except for the infected toe it is important to know if the infection started on its own or due to an injury if there is an ulcer on the sole side of the toe duration of the infection if the toe is swollen and red if there is pus and importantly are you in pain scenario now if the infection has started on its own if it had started on the side of the nail bed paronychia and of short duration then it is relatively straightforward you need antibiotics to cover the most common bacteria causing superficial skin infection penicillin family and anti inflammatory to reduce swelling and pain diclofenac group scenario if you had an ulcer on the underside of the toe and that has lead to an infection of the toe itself then it is something that needs specialist consultation for involvement of infection of the toe bone and the extent of the infection has to be assessed and if in need of powerful antibiotics oral or iv may have to be considered apart from the drainage of pus clearing of dead tissue from infection site and dressing of the wound if you do not feel pain then it is ominous because the extent of infection can be far greater than you think and it needs a surgical consultation at your nearby hospital finally if there had been an ulcer pressure relieving footwear might have to be considered to prevent the recurrence of ulcers I hope this helps"
    },
    {
        "instruction": "hello doctor I am 19 years old and I am experiencing problems with my periods for some time now three months back I had my period on regular date and experienced bleeding for and a half month I am experiencing similar problem of prolonged periods for about years now it happens once or twice per year I have been on short medications every time I had the problem also when I was 17 I did not have my periods for months and a local gynecologist prescribed me birth control pills for 28 days and I completed the course after which I was told that my prolactin level has raised up for which I was on medication for a month currently I am on an ayurvedic treatment and my last period lasted for days and with a normal bleeding but I am having a white vaginal discharge for a week or so now which is also a bit smelly and does not seem to be normal what should I do",
        "input": "",
        "output": "hi you have got vaginal infection if you need treatment then kindly follow up also for period problem is it controlled after taking ayurvedic medication"
    },
    {
        "instruction": "hello doctor does this lesion in my lower back pink appear to be worrisome for amelanotic melanoma it now appears flesh colored pictures attached",
        "input": "",
        "output": "hi welcome to icliniq com I have seen the pictures yes they are looking like melanoma signs of vascularization in the previous nexus is suggestive of melanoma kindly consult a local dermatologist as dermoscopic and histological examinations are required to confirm the diagnosis"
    },
    {
        "instruction": "hello doctor as per advise of doctor I have taken dapoxetine duralast 30 my before hour intercourse it did not work so can I take any other medicine or take higher composition of same medicine or two tablets before hour",
        "input": "",
        "output": "hello taking two tablets of dapoxetine might cause dizziness flushing of face nausea vomiting etc side effects but you can take two tablets that is 60 my prior to sex but if problem persists then better to consult your doctor again regular use of saris like paroxetine daily will help to delay the ejaculation time continue to take dapoxetine 30 on sos basis this will help in delaying the time"
    },
    {
        "instruction": "hello doctor I want to quit smoking but I cannot smoke so suggest me some medicine so that I can quit smoking",
        "input": "",
        "output": "hi I hope you are doing well I read your query and I am very proud that you have decided to take this great step first of all you need to understand that there is no medicine available which will make you quit smoking it is only you who can make it happen its not week or even month process it takes lot of time and courage I usually recommend following steps to my patient who wants to quit smoking set a date setting a date has a psychological effect and you can choose any memorable date your birthday your anniversary etc tell your family your friends and your colleagues discuss with them they are the one who will help you late on with the process prepare yourself for the upcoming problems you will face nicotine withdrawal and problems associated with that it will be cough constipation etc these are not serious but if you do not anticipate these such problems will discourage you from quitting and start smoking again try to find a friend or partner who also wants to quit people make it easier for each other remove smoking related products cigerrates ashtray from your house car workplace now in final step here comes a little role of doctor now you need to understand you have types of addictions physical I of nicotine and psychological I of act of smoking for physical addiction I would recommend nicotine patches and bubblegum whatever suits you better for psychological addiction you have to control yourself if you think that initially you cannot tolerate that you can use electronic cigerratte for a month or so and it will help you this is a workplan I can share with you which will help you in quitting smoking I would love to see you again and help you step by step in the process wherever you need me"
    },
    {
        "instruction": "hello doctor I am opening up a new subscription under you so that I can chat more easily I request you to follow our discussions from previous records to remind again this query is for my mother age 47 she is on her regular medicines for above mentioned conditions however recently her hemoglobin levels fell to 8 after consulting a doctor in my local area she is taking iron pills the problem is with her fluctuations in diabetes readings and haemoglobin levels I am attaching the recent conducted reports below blood sugar level he abc lipid profile urine culture thyearoid panel my query is to what can be done to improve her diabetes readings and hemoglobin levels it will be highly helpful if you elaborate the necessary steps to be taken including types of medicines that are to be taken",
        "input": "",
        "output": "hello I have seen the medicine list being taken by her of those drugs roxcef is an antibiotic to be given for a very limited period may be days or so bio strong is also not needed on continuous basis unless she has any specific neuropathy problems or any such complaints is there a to speak to you so that I can clarify a few things in one go for her diabetes I feel glycomet go once a day instead of voglibose containing tablet once a day with dynaglipt is enough rest of the medicines are to be continued"
    },
    {
        "instruction": "hello doctor I am years old male I have one weird problem when I take snap at afternoon I am feeling sick and sweaty and when I do not I am feeling normal what problem is this",
        "input": "",
        "output": "hello in afternoon especially after lunch one tends to feel sleepy as maximum blood is diverted to the git hence one may feel drowsy and lethargic and weaker but if you tide away this episode then endorphins take over and you may feel energetic and normal"
    },
    {
        "instruction": "hello doctor my tooth filling came out when eating food tonight there is a hole in the bottom of where the remains of the tooth are and I can see bright pink through it gums around the tooth are not swollen or inflamed there is no pain when touching them either how likely is it that I can wait it out till my insurance kicks",
        "input": "",
        "output": "hi I have read through your complaint and the relevant details do not worry because it is a root canal treated tooth there is no pain because during the root canal treatment the tooth pulp would have been cleaned thoroughly the pink color you see is the root filling material used since you have mentioned that your insurance starts from the est of the coming month you got to fill the hole where the filling was lost with some inert material the best choice would be sugarless chewing gum just chew one and pack it yourself with a blunt end of some spoon that can be easily grabbed at the kitchen drawers make sure you wash your mouth before you do this and also use cleaned spoons preferably disinfected in hot water for 15 minutes this can stay for a week time most probably when packed tight later on visit the dentist and get it filled with proper dental material I also advise you to get a crown for the root canal treated tooth as a next step through this you can get rid of the tooth filling breakage in case of heavy load the filling material has lost its strength as it stayed for 10 long years heavy chewing load ray to check any fractures of the tooth as a precaution follow up after three months"
    },
    {
        "instruction": "hello doctor I am suffering from allergy due to cold strong odor and old dust for the last about 35 years dependant to asthalin spray how to get rid of it",
        "input": "",
        "output": "hello welcome back to icliniq com it is nice to hear that you want to get rid of the asthalin spray and surely we can give a try you have been using the spray for quite a long time and your body is used to it so I will strongly suggest you not to discontinue it suddenly I advice you the following lifestyle modification and food supplements which can be very beneficial to you boosting your immune system drink lemon juice daily squeeze lemon in a glass of water and honey do not add honey if you are diabetic it is going to be winter soon and oranges will be available add one or two oranges daily to you diet lemon and oranges contain plenty of vitamin vitamin is very good for the immune system and it helps you to fight common infection and even cancer wear a mask to avoid dust this is one single measure which will help you to decrease the doses and frequency of asthalin use now a days washable mask in variety of colours are available for rs 20 30 common used by people riding motor bikes practice pranayam especially pal bhatti and anulom vilom these two asanas have direct beneficial effects for the respiratory system take two teaspoon chawanprash daily"
    },
    {
        "instruction": "hello doctor I am a female 30 years old questions how and why do I have all symptoms of ca radiculopathy confirmed by egg but not reflective of mri ca to normal what else if anything could cause ca radiculopathy in last digits per my imaging that would explain this medically what is your final assessment and why to date undergone much it and received facet injections at sites above and below acdf persistent neck pain into scapula and upper extremity unilateral hand numbness especially d4 d5 now with new weakness in opposite hand history background diagnostics former acdf at c5 labeled degenerative disk in mid late 20 resulted in great success post surgery several years later accident occurs results multiple levels damaged cervical spondylosis imaging reports mri findings no cord vertebral lesion and multi below above acdf ca herniation and degeneration and cord encroachment c5 ca bony overgrowth causes cord encroachment ca herniation degeneration but without any encroachment ca to unremarkable mydlo gram showed small extradural lesion at c5 with thecar sac compression a spur projecting from posterior border of ca small ventral defect egg left ue neuro exam weakness adm apb est do decreased sensation digits 4 clawing in ith digit der ncv left ulnar sensory nerve decreased conduction veloc wrist ith digit 42 polyphasic volition est do and adm no acute radiculopathy plexopathy peripheral neuropathy final abnormal test concluded chronic ca radiculopathy",
        "input": "",
        "output": "hi you do have chronic ca radiculopathy from your detailed description the reason for mismatch between nav egg findings and mri can be explained on the basis of a pre fixed or a post fixed brachial plexus where in the nerve exiting the c7 to inter space is actually carrying nerve fibres from the space below that will show up normal on mri the actual ca fibres are going out at a space above ie ca c7 or higher where they are getting compressed spur and compression exists at a higher level the second possibility is that there is arachnoiditis but that should show up on mri however I have not seen the mri myself and have to rely on the report the third explanation is possible injuries scarring at the time of acdf or after less likely as you would have known the temporal sequence of symptoms by apb you mean abductor and not abductor pollicus brevis that is median nerve appearance of new symptoms and persisting neck pain alert acdf suggests instability at another level which unfortunately can happen and is a collateral effect of fusion in spine get flexion extension rays and dynamic contrast mri"
    },
    {
        "instruction": "hello doctor about a month ago I had the worst outbreak of canker sores in my life I had 10 or 12 at once horribly painful and I could barely eat or drink over about two weeks they healed but I still have a few painless bumps on the top of my tongue and in the back of my mouth I will attach a photo of the bumps in the back of my mouth there are two on either side the bumps on my tongue are too far back to get a proper photo I tested positive for hav so I am mildly concerned about cancer brushing my teeth also causes a lot of pain to my gums occasionally they bleed a little I never had an issue with that before the canker sore outbreak",
        "input": "",
        "output": "hi I have read your complaint and the relevant details and also saw the picture you have attached since you have mentioned that the ulcers healed two weeks ago and still have few fresh ulcers now it could be recurrent aphthous mouth ulcers aphthous ulcers are usually painful but will not lead to cancerous lesions but there are small bursts in your palate which makes me think of viral ulcers as well you also have a history of hav human papilloma virus hence I advise you to take a blood test to rule out viral origin ulcers only then the treatment could be framed you have also mentioned that they are painless now so there is no need for topical ointments to get rid of the pain you should also know a fact that topical steroids should not be used for viral lesions so I request you to complete the blood check and then go ahead with the treatment from a nearby dentist accordingly regarding bleeding gums you have to undertake a complete professional cleaning by a dentist to flush out the dental plaque and chunky substances called calculus after that maintain good oral hygiene including flossing tongue cleaning and toothbrushing twice a day blood test avoid hot and spicy food take nutritious food rich in vitamins such as green veggies because ulcers could be associated with vitamin deficiencies follow up after three weeks"
    },
    {
        "instruction": "hello doctor I have been waking up from a racing heart accompanied by belching at night sometimes two or times a night at times the he has been in the 140s after I get up and belch a few times my heart rate returns to normal I have had my heart completely checked out along with a 30 day monitor and no problems have been found there I am wondering if herd could be causing this to happen it only happens at night while reclined or lying down for bed",
        "input": "",
        "output": "hi herd in itself cannot cause increase in heart rate however anxiety associated with herd can cause increase in heart rate so in my opinion you should see if you have anxiety there are no issues related to heart but if you have any anxiety you would need treatment for that I would recommend you to get hotter monitoring thyearoid profile done if done please share report with me if all normal my recommendations would be to discuss with your doctor to put you on propanolol which would keep your anxiety and pulse rate under control"
    },
    {
        "instruction": "hello doctor I flossed by a tooth where a filling almost came out and my tooth and gum have been hurting all night also have a tooth that is by this molar that fell or chipped out I do not know if it is an abscess or an exposed nerve in my molar that is right behind it took tylenol every hours twice it did not help used benzocaine on the area helped 20 do not feel comfortable using it at home",
        "input": "",
        "output": "hello is the pain sharp or dull any gum swelling if the pain is sharp lancinating and referring to the same side jaw temple ear or throat then this could be from the tooth with the chipped out filling most chipped out fillings expose the underlying nerve which causes severe pain ideally an ray is required to determine the depth of the cavity and to check for nerve involvement if the nerve is involved a root canal treatment and crown procedure will be done to save that tooth if the pain is from the gums and is dull in nature this could be an accidental gum injury due to flossing or there is a chance of the attempted food deposit to get deeply pushed into the gums causing this pain if this is the case a deep localized scaling should be performed under local anaesthesia to relieve any deeply wedged food deposit a clinical examination and ray is required to diagnose the cause of this pain I see that taking painkillers and topical anaesthetic in this situation were not much of help to you please visit your nearby dentist immediately and get the root cause identified meanwhile try warm saline mouth rinses and avoid hot spicy foods which may aggravate your pain"
    },
    {
        "instruction": "hello doctor I recently got a shoulder and neck ray for persistent back and neck pain the pain started a couple of years ago no medicines were taken so far my blood work and it abdomen are fine",
        "input": "",
        "output": "hi I have read through your query in detail please find my observations below the cervical spine ray ap anteroposterior and lateral views show the following there is straightening of the neck spine the alignment of the cervical spine is normal mild early degenerative changes are noted in the vertebral bodies of the cervical spine intervertebral disc spaces are normal in appearance except a minimal suspicious decrease in disc height c disc level anteriorly there is a small bridging osteophyte at ca anterosuperiorly is limbs vertebra rare possibility this is not a serious concern pre vertebral soft tissues are normal impression there is a possibility of neck muscle spasm and early degenerative changes in the neck spine left shoulder ray ap view shows normal shoulder joint the bones are aligned normally and left shoulder joint space is maintained the scapula lateral end of clavicle and head of humerus on the left side are normal I hope your query is answered the possibility of neck muscle spasm exists with early degenerative changes in neck spine pinching of nerves due to disc problems which might be seen only on mri cervical spine cannot be commented up on this ray further clinical neurological examination of neck spine might reveal any suspected causes for your symptoms orthopedic clinical examination of the left shoulder is also suggested to know any restriction of movements and whether any soft tissue structures like rotator cuff requires evaluation by an mri shoulder recommended physiotherapy for few weeks and if there is no improvement or if there is worsening then the concerned area is to be evaluated by mri scan there is no need of doing mri scan for both the regions mri scan of the cervical spine is more important in the view of muscle spasm and early degenerative changes please avoid sudden neck movements"
    },
    {
        "instruction": "hello doctor I have been sick off and on for about two months first my throat started hurting then my nose was stuffy that went on for about two weeks the doctor told me I probably had a cold a week later I got a stomach virus a week later that went away my throats started to hurt again a couple of days later the nose felt irritated the doctor suggested I had a sinus infection and gave me antibiotics I took my antibiotics for sinus infection but now it is all starting to happen again I know it is not allergies either because my allergies have never bothered me this bad and I am running fevers what is wrong with me I had mono infection a month before this sickness began do not tell me that mono will affect me for the rest of my life I just want all of this to end please help me",
        "input": "",
        "output": "hi I went through your summary sorry for your suffering my best guess probably you are suffering from herd gastroesophageal reflux disease before making that diagnosis I need few more information regarding your ailment any particular aggravating factors for your illness such as after food or drinks or following a heavy meal do you have any associated heart burn belching or digestion difficulty how long you are on ocp oral contraceptive medication recent stress work or studies because all these can cause gastro esophageal reflux disease herd that is acid in your stomach reflux back to the throat that sometimes causes a recurrent cold micking sinus infection you need to take antacids prokinetics and proton pump inhibitors stress or drug induced ugh copy upper gastro intestinal endoscopy herd pi proton pump inhibitors and prokinetics avoid stress avoid spicy food and heavy meal avoid drugs smoking and drinks"
    },
    {
        "instruction": "hello doctor I am completely desperate after treating yeast infections for years I made a lab test for whole bacterial microflora in my vagina the results are awful I do not have candid at all the results are gardnerella vaginalis prevotella bivia porphyearomonas spp 10 eubacterium spp 10 0 atopobium vagina 10 9 ureaplasma urealyticum and parvum 10 3 my doctor prescribed me the following treatment azithromycin first week first day second and third day 500 my the second week the same for gardnerella tinidazole two pills be for days actually og for one day he told me to take tinidazole on different days from azithromycin my husband also took pills for only one week azithromycin and tinidazole also we take probiotics and vitamins I also have fluomizin vaginal tablets for 12 days my worries are that after three days of azithromycin we took tinidazole but we felt awful after the second day we could not take the last because of vomiting diarrhea stomach and low back pain now I feel better and it is time for the second week of azithromycin can I take the last of tinidazole after azithromycin or just to let go I have some pain in the low back but this pain appeared two months ago and now I think I have pid or something really bad I think I have become infertile without knowing it this ureaplasma should be in me at least for four to five years for gardnerella I am not sure but I have always had some discharge so definitely things are old we want to have a baby and now things are not so good for us if I succeed in treating these infections can I get pregnant naturally or it is better to find medical help without losing time I am 32 years old doctors say nothing here actually my doctor told me if the treatment is successful we can try to conceive naturally but I think these bacteria have injured my reproductive system because of the long time untreated problem I am so sad I also had urine and blood tests everything is normal there my urine sediment is clear and ear is normal",
        "input": "",
        "output": "hello I would like to add a little information here is that pid pelvic inflammatory disease mostly is a subsequent result of sad sexually transmitted disease infection chlamydia and gonorrhea which actually travel upward along the reproductive tract and may lead to subfertility these prolonged infections can also cause subfertility but in very severe cases especially recurrent cases and if remain untreated as you have started treatment the infection has been cured so you should stop worrying now and start trying to conceive naturally the chances of getting pregnant spontaneously are quite bright and as you are 32 years now so you can try spontaneously for at least six months to one year before seeking help but if it is really concerning for you then there is no harm in seeking help earlier secondly yes you can take tinidazole after completing azithromycin course I hope this helps"
    },
    {
        "instruction": "hello doctor my right inner cheek is swollen this happened for the second time this month the swollen cheek falls between the teeth while talking or eating I am having pain too",
        "input": "",
        "output": "hi I have read through your complaint and the relevant details the swelling should be the reason for any tooth infection associated with the right lower back tooth region in the least case if that is ruled out during a dental consultation then it could be the infection in the salivary gland I say this because you have mentioned a history of swelling interferes with eating and talking usually salivary gland swellings affect both the sides of the cheek region and also below the tongue with or without pain you also got to check if you have dry mouth or dry eyes because salivary gland infections go in hand with these two symptoms in most of the cases mouth ulcer ointments might not work for this kind of pain hence I request you to visit your nearby dentist to get a complete oral check up done during your consultation if tooth infection is ruled out then the suspicion would be over the salivary glands also if you got any fever history please get that to the dentist attention meanwhile for pain relief please take tablet flexor ibuprofen and paracetamol thrice daily after meals for two days if you got any gastric irritation with this tablet please take capsule omen omeprazole delayed release 20 my half an hour before food along with the after food tablet bacterial or viral infections blood check to rule out viral origin ultrasound or computed tomography it scan to visualize salivary gland stones"
    },
    {
        "instruction": "hello doctor I have my mri pictures for back pain could you comment by looking at the pictures",
        "input": "",
        "output": "hello I have gone through your mri pictures and to me it looks quite pristine can you kindly tell me your age and a brief description of your symptoms the intensity of back pain on a scale of 10 is there any associated leg pain numbness weakness in your lower limbs paresthesias burning or electrical shock like sensations in limbs etc if you have already consulted a doctor who might have prescribed you this scan please send me his prescription paper so that I can see your exact neurology and other clinical findings I need all this information because normally we have to correlate the mri magnetic resonance imaging scans with patient clinical findings so that a diagnosis can be arrived at so if you can send me all these details I should be able to see them and advise you accordingly if you just want information on how these scans look like they appear fine to me with good disc heights and no obvious foramen compression of any nerve roots"
    },
    {
        "instruction": "hello doctor I am a 29 year old female I was just diagnosed with chronic urticaria I went to an allergic specialist for skin testing because my skin was so sensitive I reacted to everything they then did the last test on me everything came out class except for egg white wheat and oats being class and milk and hazelnut being class can these cause anaphylaxis how accurate are the last test I was put on an elimination diet but the hives are still there I occasionally get angioedema with it also can angiodema cause anaphylaxis as you can see I am so scared for my throat to close up that I am scared to eat anything I have only been eating a couple of things daily and live off that",
        "input": "",
        "output": "hello welcome to icliniq com last is a highly accurate test if the test is positive for a specific allergen it shows that you are sensitized to that particular allergen this means that you may mount an allergic response when you are exposed to that allergen however it does not mean that you will necessarily have an allergic reaction to that substance and nor does it mean that any reactions will be severe if the test is negative it means that one does not have the ability to mount an allergic reaction to that allergen and any symptoms one may be experiencing are probably not due to an allergic reaction to that substance however the results of the last need to be interpreted in conjunction with your clinical history g the presence of allergy to some or few allergens which may possibly be present either in the environment or food does not necessarily mean that they are responsible for the symptoms because if they are not even present in the environment or food of an individual then they are irrelevant in your case an elimination diet has not helped thus proving the fact that last test results should be carefully interpreted along with clinical history and does not necessarily mean that you will necessarily have an allergic reaction to the substance that you tested angioedema is frequently associated with urticaria pathogenesis is the same for both urticaria as well as angioedema the presence of angioedema does not always mean that it is a part of anaphylaxis angioedema can be a part of anaphylaxis in those individuals who have a severe allergic reaction to an allergen with high levels of antibodies circulating in the blood since you have only class and level antibodies therefore it is unlike that these antigens or allergens would cause anaphylaxis"
    },
    {
        "instruction": "hello doctor I had a negative c swab as a treatment I took two doses of fluconazole and metrogyl what can cause a yellow discharge from the penis I do excessive masturbation and had sex with two unprotected partners",
        "input": "",
        "output": "hello yellowish discharge from the penis along with a history of unprotected sexual intercourse points towards having contracted studs sexually transmitted disease the most common infection is that of gonorrhea and chlamydia which presents with complaints of painful micturition blood in urine pus discharge per urethra itching inflammation of prostate and testicles low grade fever sore throat body aches and flu like symptoms as well mode of transmission would be unprotected homosexual heterosexual contact with an infected partner and very close physical contact it can spread from hand to hand contact as well and from infected mother to the child as well in utero the treatment includes treating both gonorrhea and chlamydia as they are usually transmitted together for gonorrhea cipro or ciprofloxacin extended release 500 my single dose or levaquin levofloxacin 500 my single dose or sequin gatifloxacin 400 my single dose for chlamydia doxycycline 100 my two to three times a day for 1014 days or zithromax azithromycin 0 single dose or zithromax or pak azithromycin 500mg on day followed by one tablet 250 my once a day for four more days to prevent reinfection concurrently treat the partner as well precautions always have protected sex avoid unprotected and unnatural sexual activities once treated successfully the infection will not come back until contracted the new infection"
    },
    {
        "instruction": "hello doctor my year old boy has eczema in the head with itching it becomes pinkish sometimes while scratching please say some remedies",
        "input": "",
        "output": "hello this condition can be treated by siddha drugs this is known as kabala kuttam or a type of bala karapan the allergic symptoms are due to external or internal allergy for example cow milk wheat health powders horlicks etc soya powder shampoo hair oil hairpin cloths touching hair flowers kept on hair cool dry climate certain allergic foods etc if the baby is still feeding by mother milk then the mother milk might contain some allergen this allergen is produced in milk if the above mentioned allergic products are used by the mother first thing is to identify the allergen triggering factor avoiding the trigger will give a permanent cure the second thing is to treat the allergy by siddha drugs dhoorvathi thailam other name is arugam pul thailam or poduthalai thailam or nathan thailam buy any one oil apply on the scalp head wait for one hour then give a mild hot water bath apply daily for 60 days once the lesion is cured then apply this oil weekly two days in the remaining days you can use normal routine oils vallaarai ghritam give 10 drops in the morning 10 drops in the afternoon and 10 drops in the night continue for 60 days this drug cures skin problems in kids it also improves memory and gives immunity you may also get advice from nearby siddha pediatrician"
    },
    {
        "instruction": "hello doctor I barely turned 16 and my penis is only when flaccid and about when erect I suffer from hypospadias and I wonder if it will grow",
        "input": "",
        "output": "hello it takes a lot of courage to discuss problems related to genital and it feels good that you have that courage regarding your first query about the size of your penis as you told that in the flaccid state it measures and in erect state and that you are just 16 years of age I would like to assure you that you need not worry about the size of your organ as for your age it is appropriate and with age its size will increase it is similar to the average size of the penis that adolescent boys usually have at this age male sex hormone testosterone level begins to rise hence male secondary sexual characters begin to mature which includes the size of penis scrotum development of genital pubic and axillary hairs hoarse voice and masculinity as well so by your age your sex hormones have begun to increase hence your organ size will increase gradually with time along with your libido regarding hypospadias I would suggest you to consult a surgeon especially a urosurgeon as this anomaly requires surgical correction if you have not get it done till now with treatment it has no effect on sexual performance as well so you should not be too worried about all these conditions and seek an opinion from a surgeon as well"
    },
    {
        "instruction": "hello doctor I am having chest pains that are dull feeling in random parts of chest at random times throughout the day and night been having them for weeks now I have a newborn child months and I do not sleep lot because he does not either that has been going on for months the lack of sleep I am 34 years old with no health issues and no family history of heart disease or issues my doctor did an egg and said it was normal with an abnormality I went to a cardiologist and he did an egg and said it was normal but scheduled me for a echocardiogram and stress test to rule out anything am I just having anxiety which is what everyone keeps telling me or could it very well be heart related I am scared thank you for your assistance",
        "input": "",
        "output": "hello I passed carefully through your medical history and would like to explain that your egg seems to be within normal ranges nothing to worry or panic about the lack of sleep has played a role in exacerbating your clinical symptomatology anyways it is rationale to follow your doctor advise and pass through the recommended tests cardiac ultrasound and stress test"
    },
    {
        "instruction": "hello doctor I received propofol for my colonoscopy as it was administered my lips felt buzzy as though an electrical current was passing through them is this an allergic reaction thank you",
        "input": "",
        "output": "hi first of all you need not get anxious because of this buzzy feeling you went through after you were given propofol buzzy feel or electrical current feel is all part of the any general anaesthetic agent propofol is a very good medicine given by your physician for making you sleep during colonoscopy sometimes you do have this sort of buzzy"
    },
    {
        "instruction": "hello doctor I was wanting some more information about my sons blood test that was done yesterday there are a few results that were in the red the doctor called and left a voicemail today but only mentioned the chest ray that was done and not the bloodwork and were closed by the time I saw the missed call these are the results urobilinogen bacteria ur few all 168 unit creatinine 4 my do sed rate 12 my he abc 7k mcl my son is years old and the blood work was done because he has been sick for a month now and has had a consistent cough was seen in er for difficulty breathing and for the last two weeks has seemed somewhat lethargic he normally goes to asleep at 0830 and now has been falling asleep every night on his own between 0530 and 0630 and just has been laying in bed when he gets home from school any suggestions or help would be appreciated",
        "input": "",
        "output": "hi as your child is lethargic and not accepting well then child may be sick also regarding the reports urobilinogen may be seen in early phases of jaundice and bacteria simply me be due to urinary infection the abc count are low and which may also signify infection rest of the things are related to illness and may not pose any problem difficulty breathing with cough is a sign of infection or slams which may aggravate if not treated visit a doctor visit and doctor and review"
    },
    {
        "instruction": "hello doctor please can you look at this letter and report as they differ we have been told the following are metastases which we agree with liver met aortocaval node sub pleural nodule but the oncologist letter says possible peritoneal disease why did the it report not state peritoneal disease and once has rated this mets are under am if they are abated is this better so far irinotecan not worked what to do prognosis",
        "input": "",
        "output": "hello I can understand your situation at the moment but you have to accept the facts about your patient first thing is he has incurable disease he has undergone a major surgery in spite of treatment underlying disease is progressive and most important the disease is wide spread in the body in distant organs so the treatment options are very limited which have been tried already and beyond that the disease is not responding to the treatment given coming to your questions the aortocaval node is increased in size this is suggestive of peritoneal progression so oncologist can see it in it films it is not necessary that only radiologist findings to be final also there are adrenal metastasis only ablation of liver mets will not cure the disease as it is stage that means it is spread to other organs already so treatment of metastatic lesions will not cure primary disease irinotecan not worked suggests that it is chemoresistant malignancy so any palliative treatment will not work in future last thing about prognosis you have already been told by your primary oncophysician about it is stage disease now with no response to palliative chemotherapy so prognosis is very grave he is so lucky that in spite of such progressive disease he is asymptomatic at present but we cannot predict exactly when the things will go wrong and the period he will be alright so better to continue only symptomatic palliative care"
    },
    {
        "instruction": "hello doctor I was wondering if an anesthesiologist would mind getting interviewed I am writing a research paper and could not contact any anesthesiologist around me thank you for the help below are the questions I need an answer how many years have you been a part of this profession about how many times a month do you administer anesthesia to a pregnant mother in labor regarding the previous question what kind of anesthetic is used ga la or ra have you heard of transmitting the anesthetic agent through the placenta from mother to child is there any information you could provide for the above about how many times a month do you administer anesthesia to infants for surgery related procedures regarding the previous question what kind of anesthetic is used ga la or ra what kind of chemical compound is used in the hospitals anesthetic does this hospital use an anesthetic cocktail mixing drugs with anesthesia 10 what information can you provide about the issue of neurological degeneration in infants who have been exposed to anesthesia either during surgery or birthing what kind of introductory do you give your patients about the anesthesia they are about to receive 12 have you ever had a follow up with any infant patients later in life adolescent age 13 is there any more information that you believe could help me better understand this topic",
        "input": "",
        "output": "hi I am glad to answer your queries responses are by the question numbers I have been working as an anesthesiologist for the past years I would administer anesthesia for around 15 20 caesarean sections per month in my practice ra is the choice of anesthesia for the pregnant mother under going section when ra is contra indicated we do administer ga in this scenario we avoid opioids drugs since they cross the placental barrier which is can affect the baby I use induction drugs like propofol muscle relaxation with succinylcholine and vecuronium and maintenance with nitrous oxide and oxygen once the baby is delivered I give the opioids for the pain relief yes I am aware but I just follow my hospital team protocols opioids drugs like fentanyl pentazocine etc can affect the fetus neonate I am unaware of the effects of other anesthetic drugs on the fetus neonate I do not practice pediatric anesthesia not applicable thiopentone barbiturate fentanyl pentazocine opioids vecuronium muscle relaxant midazolam benzodiazepine propofol unclassified we do use cocktail mixtures 10 ketamine can cause severe neurological complications in the fetus neonate others I am not sure I have a pre anesthetic clinic in which I assess and choose the appropriate anesthesia I explain in detail about the anesthetic procedure complications if any finally I answer the clients queries and explain pre anesthetic instructions 12 no I have not"
    },
    {
        "instruction": "hello doctor I have an impacted tooth in the roof of my mouth and I do not have a top left canine what are my options to fill the gap a bridge or an implant or anything else not braces please and the fewer appointments are better",
        "input": "",
        "output": "hi first of all I need to know your age the treatment plan varies according to the age factor secondly the impacted tooth no matter where it is it should be 100 removed this is done to reduce the possibility of complications in the future it cannot even form a cyst abscess etc because it is prone to infections only after the removal and depending on the remaining space restoration options are considered if you are young then braces option will give you the best result because it does not involve grinding of teeth plus it gives you a permanent result even though the time frame is more for the treatment it is worth it next is the bridge option here there is grinding of teeth on either side of the gap reliable but why do you want to unnecessarily grind the teeth which might make your teeth sensitive when the bridge fails in the long run then you got to fix it again double expense implant is a good option this depends on how sound is your jaw bone and for canines it is mostly not considered because of the difficulty in imitating the natural aesthetics for a detailed and customized treatment plan please visit your dentist and discuss the best option that suits your age and the quality of bone"
    },
    {
        "instruction": "hello doctor for the last two days I have a ringing sound in my right ear I have not been exposed to loud music but for the last week are so I had itching and the day before the ringing started and my right ear was blocked so I cleared it with hydrogen peroxide but the ringing is not going away now I visited an ent doctor and he has given me a prescription and asked to wait for six days and then get a pta and impedance done I have a slight headache in my forehead and some tightness like feeling under the right ear I also have an impacted wisdom tooth I have attached the prescription",
        "input": "",
        "output": "hi what doctor has prescribed you is correct audiometry will see if you have any associated hearing loss and tympanometry will see if there is any middle ear infection that is causing hearing loss though the prescription is not attached wisdom tooth will cause radiating pain or fullness in the ears but not tinnitus please do not use hydrogen peroxide drops unless prescribed by an ent specialist because it is used to remove wax in ears if your external ear is clear then there is no point in using the drops pressure in the head can be there if you have sinusitis so do you have any cold or cough right now because that can also cause a middle ear infection"
    },
    {
        "instruction": "hello doctor I have been having depression symptoms hopelessness feeling worthless overwhelmed cannot focus on anything changes in sleep pattern loss of appetite suicidal thoughts isolation numb feel like everything is an effort cannot get out of bed and all that for the past six years but the thing is the low phase just last minimum of three days to one and a half week I have never been diagnosed with any mental health illnesses or taken any medications on other days I feel normal and hyper even it is just that when that low phase hit it hits hard like everything comes crashing down at once it is suffocating sometimes I feel like banging my head on the wall just to feel something and other times I would scratch myself to stop feeling too much it is intense so I want to know what that is actually because for someone to have depression the symptoms need to last for at least two weeks right but I am not it is just there it has been six years now but they just would not go away",
        "input": "",
        "output": "hello you are describing quite a lot of depressive symptoms that have been present episodically for six years it is true that for a diagnosis of clinical depression the symptoms need to persist for two weeks but with such a prolonged history sub threshold symptoms may be present it will help if you can maintain a mood diary to objectively chart your mood you report feeling normal or hyper on other days it will be helpful to have more information to ascertain what you mean by hyper have you experienced any manic or hypomanic symptoms it looks like you are having a mood disorder with more information we can classify further and you can be supported accordingly you also report headache and stomach ache but no physical causes were found these are probably functional somatic symptoms they are common in people with emotional problems like depression and anxiety good thing is you will get better with appropriate support have you discussed with your parents or close family member about your problems I will suggest having an open chat with them you can even show them this icliniq query you can consult your family member who can refer you to a psychiatrist for treatment of your mood problems you will be benefited from talking therapy or counseling in severe cases medication to help your mood can be prescribed self help measures are also beneficial start by eating sleeping and exercising regularly try to follow progressive muscle relaxation exercises and deep breathing exercises I hope this helps talking therapy sari selective serotonin reuptake inhibitors medication"
    },
    {
        "instruction": "hi doctor I am 36 years old female I got my precautionary health checkup done I have enclosed the report my internet search about the result indicates that I may have early stage leukemia cancer please advise",
        "input": "",
        "output": "hello I have gone through your report for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor five months ago my wife had a disc herniation surgery she was fine for the next two to three months but again she is getting the pain her doctor advised us to go for repeated mri we are yet to meet her doctor but I am looking forward to know what is going on I have attached the reports for your reference please help",
        "input": "",
        "output": "hi I have read through your query in detail please find my observations below revert back with the first mri scan to a radiologist online"
    },
    {
        "instruction": "hello doctor I am on psychiatric medication since two to three years but found no improvement I have started exercise such as walking yoga and pranayama and found some relief I become depressed more when I read about depression on internet my main issue now is loss of appetite headache when free or anxious and anxiety due to loss of appetite are these due to major depression or minor depression I am taking megapose plus one pill at bedtime I was very happy and loss of appetite also had cured at certain level but when I read in internet that major depression cannot be cured by exercise I become more depressed and problems again aroused please advise me about exercise for major depression can exercise cure major depression I am consuming whisky three pegs daily and I am having tobacco chewing habit I cannot sleep without drinking alcohol I want to withdraw drinking but due to sleep problem I am unable to stop I am suffering from stomach gas loose motions and also constipation I have attached my past medication prescriptions please help",
        "input": "",
        "output": "hello for further queries consult a psychiatrist online"
    },
    {
        "instruction": "hello doctor my mother is suffering from painful uterine fibroid she has also been diagnosed with hepatitis please advice us regarding the operation for this uterine fibroid",
        "input": "",
        "output": "hi we are here to help you the presence of multiple uterine fibroid causing pain or symptom warrants surgery to remove them presence of hepatitis will not hinder from surgery however following investigations should be performed before surgery she should receive vitamin 10 my injection once a day for three days prior to surgery and avoid taking painkiller revert back after the tests to an internal medicine physician online"
    },
    {
        "instruction": "hello doctor my father has night blindness and his overall vision is very bad he is taking some medication to keep his vision from degrading he has been given advise to try ocuvite lutein and I am not sure whether that is a good product for him I am not aware of the side effects associated with it I would like to know what we can do to keep his vision in a good state currently he is taking some blood thinning products such as aspirin please help",
        "input": "",
        "output": "hi I would like to have few details of him for a better diagnosis revert back with the pictures to an eye care ophthalmologist online"
    },
    {
        "instruction": "hello doctor I am 28 years old female 2006dlbcl treated with chop and radiation remission ever since last 15 years diarrhea got worse for last years they suspect autoimune",
        "input": "",
        "output": "hi looking at your clinical history and present symptoms my opinion is as follows chronic diarrhea is really difficult period patients with autoimmune disorders are very much prone to lymphoma and risk is always present previously probably you were not diagnosed with autoimmune disorder and dlbcl was possibly your first diagnosis females are at a higher risk of autoimmune disorder and can be present with localized or systemic manifestations infections would not usually present for this long and this amount of chronic diarrhea should be autoimmune rarely recurrent infection due to immune suppression secondary to chop therapy could be present investigations necessary are stool examination to rule out infections bacterial or parasitic also any presence of blood requires evaluation fecal fat estimation can be done and if positive points towards malnutrition colonoscopy to rule out ulcerative colitis or crowns disease autoimmune disorders biopsy is necessary for confirmation other causes could be irritable bowel syndrome if no cause is identified or malabsorption disorders possibility are rare at this age get a colonoscopy and endoscopy done if any ulcerations is seen biopsy needs to be taken based on biopsy further treatment is essential biopsy can help in identifying whether you require medical or surgical line of therapy do get a colonoscopy and stool examination done due to absence of reports I cannot comment further take a fiber rich diet increased risk of malabsorption and malnutrition is going to be present along with decreased body fluid volume take good amount of fluids along with a balanced diet avoid unnecessary medications and drug interactions can also cause diarrhea at present difficult to suspect this long"
    },
    {
        "instruction": "hello doctor I am a 28 year old male I got a lump in the right side of my neck before two weeks I am taking capsule cipmox 500 but it has not yet cured though it is not painful I am worried it never happened earlier please help",
        "input": "",
        "output": "hi we are here to help you for further doubts consult an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I am taking nextto forte and skizoril 12 my daily for the past three to four years I am under psychiatric medication for the past 10 years I was diagnosed with schizophrenia and add I have also been diagnosed to be suffering from hypertension and have been given nebimac my and thelma 40 for the past six months now my life is back on track and I have a good job in hand but I feel that my life is going on just because of the medicines and fear for the worst when I stop taking medicines I have had a talk with my doctor who said the dosage would be reduced gradually what would you advise regarding this",
        "input": "",
        "output": "hi if you are doing well with skizoril clozapine and nextto forte escitalopram I think you must continue with the same schizophrenia is a terrible psychiatric illness if it reoccurs then it will be difficult to manage skizoril 12 my is a minimal dose of the drug you can talk to your doctor about gradually reducing nextto forte for further information consult a psychotherapist online"
    },
    {
        "instruction": "hello doctor I was diagnosed with hypothyearoid 5 years back my doctor suggested me to take thyearox 25 daily I was using it and feel fine around a month back I had pain in my lower abdomen when I consult a different doctor it was diagnosed as kidney stone I told him my thyearoid history he examined my neck and advised me to discontinue the medicine for six weeks and check whether I develop any thyearoid symptoms in his opinion I did not have any thyearoid problem and so I am not taking the medicine now and when got it checked the levels are to 128 to 8 and ash 35 what to do now should I start thyearox 25 again or shift to new medicine please guide",
        "input": "",
        "output": "hello I need more information before I recommend what to do revert back with the asked details to an endocrinologist online"
    },
    {
        "instruction": "hello doctor almost a year ago when I was on holiday I had twitching in my right upper arm it appeared as a kind of jolt rapidly it came and went for over a week and finally went when I was on sunbed and it suddenly started five months later it appeared exactly in the same place for about two weeks some days it was not there and few days it used to be present but it is very annoying I visited a doctor and after assessment he said not to worry it would go in time and it is not a nasty disease and then it use to come and go in an interval of three or four months now for all this time I think I have been having an occasional twitch here and there which just seems to go like in my elbows or around my knee etc but I did have five or six jolts in the exact muscle on the other arm the other day now I do not have any weakness or atrophy I am sure my anxiety is making it worse when I look into internet I just want to know whether this is common should I worry about this I do not have any twitching at the moment please help",
        "input": "",
        "output": "hi I read your query and understand your concerns for further information consult a neurologist online"
    },
    {
        "instruction": "hello doctor I have white floating layers in my urine as you will see in the attached picture what are these I have symptoms such as frequent urination and burning sensation either during or after urination please help",
        "input": "",
        "output": "hi for further information consult a urologist online"
    },
    {
        "instruction": "hello doctor I am having pancreas enzymes such as amylase and lipase at high levels I am an alcoholic I do not have abdomen pain but I have little high cholesterol doctor advised me to stop the drink and maintain low fat diet will it reverse to normal if I stop drinking I have stopped drinking alcohol since the past one month but I am very anxious about the enzymes will they reverse to normal I am also having high uric acid and gout I am waiting for your valuable reply I have attached my reports for your reference kindly advise",
        "input": "",
        "output": "hi we are here to help you I have gone through the report for further doubts consult a medical gastroenterologist online"
    },
    {
        "instruction": "hello doctor I have interstitial cystitis why should one drink lots of water while taking phenazopyearidine",
        "input": "",
        "output": "hi for further information consult a urologist online"
    },
    {
        "instruction": "hello doctor I am a 26 year old male I had protected vaginal sex with a sex worker 15 days back however the condom broke and I ejaculated inside her I asked her whether she was hiv positive and she said no but I cannot trust her I have been having chills all over my body since yesterday I was told by the hiv helpline to do the dna per test on the 21st day what are the chances of me being hiv positive should I be worried about the chills I have never had such chills before especially in the legs and hands I am panic what should I do please suggest",
        "input": "",
        "output": "hello for further information consult a hiv aids specialist online"
    },
    {
        "instruction": "hello doctor I am a 35 year old male for the past two years I am suffering from muscle pain near ankle and also have muscle tightness in both feet while sleeping please help",
        "input": "",
        "output": "hi revert back after the tests to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor is it really possible to get pregnant without penetrating into vagina we did not have sex we rubbed the vagina and penis her period is late by two days is there any chance of getting pregnant",
        "input": "",
        "output": "hi for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hello doctor I am a 60 year old male who is overweight other than being overweight I am in relatively good health I am getting regular health checkup for every six months currently I am taking triamterene and hctz and simvastatin 20 my recently I had cold some respiratory discomfort chest congestion sneezing sore throat little if any fever and lots of coughing congestion is gone as is sneezing sore throat lingers there is an irritated spot on back of tongue it could be from sucking on too many cough drops tonsils and entire throat area is red and swollen ibuprofen relieves pain temporarily please give some thoughts or any suggestion initial symptoms of chest congestion appeared seven days ago please guide",
        "input": "",
        "output": "hi I have read your message meanwhile start with the following revert back after the investigations to an internal medicine physician online"
    },
    {
        "instruction": "hello doctor my father is 67 years old he is having mild psychiatric problem for the past 17 days in the middle around five days back the creatinine level increased from to 6 so an ultrasound was done and that showed blockage of urine due to enlarged prostate but urination was not completely blocked now the urologist has attached a catheter to pass out the urine and said that after 10 days laser surgery will be done to cut away the prostrate we are really in dilemma whether surgery is necessary or can it be cured by medication currently he is taking tamdura capsules one at night cecil 250 twice daily tranostat 40 my once daily and nefrozon twice daily his psychiatrist prescribed lopez my at bedtime and quan 50 my twice daily reports attached are blood test us scan and urine test report",
        "input": "",
        "output": "hi I have checked your reports for further clarification consult a urologist online"
    },
    {
        "instruction": "hi doctor I have a dark patch on my forehead which smells bad for this I have tried laser treatment as well but it did not work please help",
        "input": "",
        "output": "hi revert back with the information asked above to a dermatologist online"
    },
    {
        "instruction": "hi doctor my query is regarding my relative who is suffering from carcinoma of cervix I would kindly request you to advise us regarding the stage of cancer based on the biopsy mri and it scan report which I have attached here for your reference in her mri report there is a feature suggestive of carcinoma of the cervix with parametrial extension in it scan it gives an impression of bulky cervix with parametrial fat stranding along with a few subcentimeter sized parenchymal and subpleural nodes in the bilateral lower lobes I would like to know whether the above mentioned reports are sufficient to identify the stage of cancer she even advised to get vaginal examination done is a pet scan necessary in this case in order to get a clear view than it scan kindly guide us",
        "input": "",
        "output": "hi I would like to assure you that everything is going to be fine soon I have thoroughly gone through your case and the reports and can well understand your genuine concerns she has got cervical carcinoma it is a well differentiated type of adenocarcinoma that is an invasive cancer this is a less common type of cancer compared to the squamous carcinoma according to the staging systems devised for cervical cancers ajcc american joint committee on cancer tnm tumor lymph node and metastasis and fig international federation of gynecology and obstetrics the tumor in this patient had spread to the distant organs thus it shows the lung metastasis it falls into stage iv of the cervical cancer consult her treating physician for clinical correlation as it is very important since I do not have the complete case in front of me no need of pet scan in this case vagina is normal on mri of pelvis so no need to worry for vaginal examination for further queries consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor my roommate is in hospital with chest tightness and shortness of breath last week they ended up doing an angioplasty they had not given him the results of any of the tests they had done mostly just an ray and a sonogram they found blockage in the of the circumflex artery and the left anterior descending artery and put in a stent he went home the next day yesterday he started to have shortness of breath again and checked himself into the er at am he has been there ever since they did more rays and found nothing in his lungs and another sonogram for some reason they are refusing to do a it scan saying they would rather just do another angioplasty they said a it scan would not detect any clots I find this utterly absurd I think it is weird that they want to go in and put in another stent without further testing his troponin levels are also normal why do not they think a it is warranted before they do another angioplasty",
        "input": "",
        "output": "hi revert back with the asked details to a cardiologist online"
    },
    {
        "instruction": "hi doctor I got married 13 months back I had intercourse with my husband once immediately after marriage and then once again two months back I also had birth control pill twice unfortunately my husband died in an accident now everyone in my family forcing me to get second marriage if I do so will I get any health problems like pregnancy problems or hiv please guide me",
        "input": "",
        "output": "hi I have read and understood your problem for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hello doctor I have discoloration on my penis I do not have any pain it is just a dark red and seems like peeling it has been there since two days and there is mild swelling in that area I have got this for the first time please help",
        "input": "",
        "output": "hi revert back after ten days to a dermatologist online"
    },
    {
        "instruction": "hello doctor I have a really irritating itch around my groin area inner thigh and also in the abdomen area it has spread to my buttock area too I need help in solving this please help",
        "input": "",
        "output": "hi I need more information on your problem revert back with the asked details to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor my wife had a miscarriage at weeks it was our first baby evacuation was normal delivery after how long can we have sex she has completed her two periods please guide",
        "input": "",
        "output": "hello for further doubts consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor the molar on the left side of my mouth was filled last year and right now it hurts really bad I took tylenol and motrin but none of them help I cannot remember if I pulled out that molar a while ago or if it still needs to be pulled it is not really loose but I can move it around if I try to pull it out I am afraid that it will be my permanent tooth the pain started last week I do not know what to do I talked to my dentist and he said that he did not see anything wrong with it but for some reason the pain is still going I cannot sleep at night and it gives me ear pain",
        "input": "",
        "output": "hi I have read through your complaint and the relevant details firstly I would like to tell you that ear pain during night and the looseness you feel in the tooth are all the signs of a deeply infected tooth secondly it is not necessary to be for the same filled molar to give you trouble the pain might be from the same molar or could be due to a different tooth on the same side I would not be able to arrive at a correct diagnosis until at least I see a picture of your teeth in that row it seems you take pain killers for the same and there is nothing more I could prescribe considering your age the only way to immediate pain relief would be an active dental treatment for the affected tooth as soon as possible it cannot be cured just with pain killers or any other medications I advise you to see the dentist with an emergency appointment and look upon the issue if you do not address the issue then there are more chances of the tooth to undergo severe internal pressure and you might get a swelling next to the tooth thanks"
    },
    {
        "instruction": "hi doctor I recently visited the doctors as I was unable to catch my breath and was feeling strange the doctor performed a breath test which came back fine I had an egg and the doctor said that my egg showed possible left ventricle enlargement he then asked me to perform different breathing while he checked me with a stethoscope he said he could hear no blockages or other problems and that my blood pressure was slightly raised usually it is normal he said that I was suffering from anxiety and had a panic attack I have suffered from anxiety all my life when I asked about the enlargement he said my egg was borderline I am now worrying excessively about this and whether to have another egg just to be on the safe side I am fit eat a healthy diet and have not drunk since I was in my 20s I work out regularly since the age of 25 and I am now 40 I had this egg abroad as I was working away so I am wondering whether to have it checked back home I sometimes feel like I cannot take deep breaths when I am stressed but I do not feel this while exercising I have a very tight left shoulder and my left rib is sore near the top of my left breast near the armpit like a muscle aches that comes and goes I am quite an anxious person worrying about health issues particularly after losing my mother to breast cancer",
        "input": "",
        "output": "hello did you ever have chest pain or symptoms of excessive sweating with pain if your egg is fine then there are very fewer chances of you having a cardiac pathology left ventricular hypertrophy develops after prolonged hypertension in individuals but as you have said you have normal blood pressure so I do not think lvy should be there to relieve your anxiety you can undergo a stress echo or tit treadmill test to rule out inducible angina also you said you do not develop symptoms during exercise so I do not think stress echo or tit will come out positive"
    },
    {
        "instruction": "hi doctor I have taken I pill 72 hours within 18 hours of intercourse but still I got pregnant will it cause any bad effect on the baby during pregnancy or after delivery can I continue this pregnancy",
        "input": "",
        "output": "hi generally I pill emergency contraceptive pill does not cause any serious effects on pregnancy but you need to follow up with sonography at weeks and double market test at 12 weeks to make sure that everything is fine"
    },
    {
        "instruction": "hello doctor my complaint is a pain in the right pelvic area could you suggest what the images of my it film indicate there are some lesions on my bone what do they mean what should be the treatment I am currently on amlodipine valsartan 5 40 my",
        "input": "",
        "output": "hi thanks for writing into us and I have gone through the it scan images there is a lesion in the right intertrochanteric area and is showing characteristics of an osteoma and is almost always a benign condition one must look out for any severe pain and any abnormal bone growth in the area many osteomas might disappear with time and no active treatment is needed in cases when the pain is severe then surgery and bone curettage might help there is a likely area of excess calcium deposition and showing a white spot in the left iliac bone near the left sacroiliac joint area and is called a bone island a bone island is usually not treated however to confirm a bone island and to rule out other lesions a nuclear bone scan can help the thickening of the left anterior pararenal fascia is likely not significant the gall bladder is not well visualized"
    },
    {
        "instruction": "hi doctor I have noticed this black stain on my daughter teeth recently what could be the cause she has got her lower two teeth in months and upper at 10 months I started brushing her teeth a week ago",
        "input": "",
        "output": "hello I have gone through your attachment after watching the photograph there seems to be extrinsic stains these may be because of improper brushing food stains etc proper cleaning of teeth and cleaning of teeth after taking food will remove them if they are extrinsic food stains if not getting removed kindly visit a nearby dentist there may be another reason also for black stains or stains what kind of toothpaste do you use fluoridated or non fluoridated for any catch regarding cares it should be checked clinically drinking water fluoride levels also important to know"
    },
    {
        "instruction": "hi doctor I am 76 years old I do not feel thirsty thus I drink very little water for a long time I was advised to take more water but I am unable to take as I need to force myself to do so my urine used to be yellow three or four times a day whereas for the past 20 days it is always yellow in color and after urination when I flush the commode bright yellow color is appearing in the water I felt like checking up and got a kidney function test done I have the reports but there is no option to attach file however my urea is 27 blood urea nitrogen is 12 creatine is 9 and uric acid is 1 I am on medication for my diabetes and hypertension can you suggest what I need to do further on my condition what is the present state of my kidneys best regards",
        "input": "",
        "output": "hi I went through the case history and the reports I would like to know what kind of medication you are taking for hypertension and diabetics do you get a burning sensation while passing urine or fever kindly get back with the details thanks"
    },
    {
        "instruction": "hello doctor for the past week I had gotten a small round bump on my lower gum it is just in the corner at the lowest part of the gum so I have to pull my mouth open with my fingers just to see it does not hurt or bleed but it has not gone away and it has gotten a whitish color to it I also got the soreness on the tip of the tongue this morning I am quite careful with my teeth and brush or rinse regularly every day so I am confused to what may have caused this morning I woke up with a redness on the tip of my tongue too I wonder if it is because I have poked the bump with it just to feel wether it is still there I have switched to peroxyl mouthwash to see if this may solve it can you advise me on what this maybe I am a little worried",
        "input": "",
        "output": "hello it could be a common aphthous ulcer canker sore it has various causative factors it could be because of vitamin deficiencies hormonal changes psychological stress allergies accidental trauma or bacterial infection a clear clinical picture of the ulcer or bump will help to determine what is it and what caused it if that is an aphthous ulcer it may take a couple of weeks for it to resolve redness on the tip of the tongue could be due to constant rubbing of the bump or ulcerated area white tissue over that area could be healing tissues please do not disturb them meanwhile avoid hot and spicy foods do warm saline mouth rinses thrice daily rinse mouth after every meal drink lots of water and keep yourself hydrated at all times maintaining good oral hygiene and following the above said instructions will prevent further infection of the ulcer and promotes faster healing if required if it hurts a topical anesthetic like orajel can be applied over the ulcer with a clean finger I hope this helps good day"
    },
    {
        "instruction": "hello doctor other than a psychiatric condition such as delusional parasitosis are there any known real pathogens that can produce the sensation of loads of tiny insects residing and moving upon the skin that can spread or move throughout the body and causing intense itch if so please provide names",
        "input": "",
        "output": "hi for further doubts consult a microbiologist online"
    },
    {
        "instruction": "hi doctor I have had a terrible cough for weeks due to the flu I decided to try delsym 12 hour cough it helped immensely but the second day when I had it I noticed a bit of restlessness and light sensitivity I waited to take another dose and when I did take another dose I took half of the recommended dose for adults that was at 10 am last night now at almost am the next day and I am experiencing odd side effects sweaty palms a bit of confusion loss of attention and light sensitivity it feels like my eyes are dilated but does not appear they are every day I take 20 my of vyvanse and 300 my of wellbutrin",
        "input": "",
        "output": "hi sorry to hear about what you are going through basically from your history you might be suffering from what is known as serotonin syndrome it is a rare but possible condition that can occur when lisdexamfetamine vyvanse is taken together with dextromethorphan delsym it can also occur with lisdexamfetamine vyvanse and bupropion wellbutrin are taken together due to drug interactions but I assume you must have been taking them for a while now so it is not that the best advise for you is to stop delsym right away I would also advice you to consult the doctor who prescribed you the other two drugs to stop or reduce the dosage to rule out serotonin syndrome with them as well if you have any further questions please feel free to contact me"
    },
    {
        "instruction": "hi doctor every day I feel intense disgust for humanity and people I struggle with sadism and my last girlfriend broke up with me because that went too far it has always been a problem in relationships for me I hate society so much every time I see a person I want to torture them brutally every house I walk by I want to just kick the door down I just hate them all I do not even value my own life I am nothing I feel like I was just born for this born wrong born to be a problem I tried to fight it too and I failed no matter how much I tried to control it even when professionals were involved it overpowered me and ruined what little good was in my life I am no immediate danger of hurting people but I think one day I am going to really snap I have built up an intensive library of bad experiences with people and I do not think I can take much more people repulse me now is there any hope for people whose brains are as warped as mine I am 31 and I struggle to even hold down a job because I find I get emotionally exhausted doing things I do not actually want to do I also have a destructive temper so that causes trouble at work too what do I do I have been through the emotions you are only another psychiatrist so I do not know what I am expecting in reaching out again how can I break the cycle if therapy or medicines and psych wards have not helped me I have already tried taking my own life three times",
        "input": "",
        "output": "hi I can imagine how hard it is for you right now anger hatred past traumas and experiences consume us all in your case it has gone a little too far but the fact that you have reached out even after trying everything is enough for me to see hope and tell you that yes there is still something that can be done change is hard and it takes huge amounts of strength and struggle but if you have decided that you need to get out of this situation and you are willing to do anything for it then no one can stop you I would suggest you to first ask yourself how determined are you for a change if this is just another call to check if things can work and you yourself have doubts then surely you will fail and everything you try will fail as well if you decide that you will find a way out then no one can stop you I would suggest starting therapy sessions regularly with a psychotherapy expert if you cannot find one then you can opt for online therapy sessions with me first you need to vent out and learn to let go of past traumas it will be hard and will take time but until and unless you do that you cannot move forward once you are there that is when we can focus on building new perspective and living a good life again telling you it will be really hard but it is possible so find a local therapist or opt for a video consultation and we can talk I hope this helps take care"
    },
    {
        "instruction": "hello doctor I have a query and need your guidance and help I am 26 years old male as winters are very cold in my area I cought cold as I was riding my bike with no proper protection from winter I started coughing that night but I did not care it how ever increased I ate curd and smoked cigarette this made my cough worse so I took medication for it and my cough was gone in three days but not totally I started coughing thrice a day but as due to my business I had to travel I have not taken proper rest and given up smoking I smoked for years ord and ith year I smoked cigarettes a day average now I have given up totally my weight is stable I feel hungry a lot never smoked weed or reverse smoked I am non alcoholic no shortness of breath only cough is my issue and its dry and no mucus my cough is increased from day before yesterday as I was in ac couch of train and every single person near me was coughing very badly so I am taking monte la twice a day and ascoril thrice 10 my started from last night and it made it worse without medicine I was coughing twice or thrice day but now it is increased is it lung or throat cancer cause if I check on internet it makes me really sad and I really regret smoking so please help me and suggest me something what should I do I am in tears right now do not know what to do I just do not want to die now",
        "input": "",
        "output": "hello I would like to change the medicines you are on slightly first instead of monte la take allegra in the morning take it once a day only take alex lozenges whenever you feel cough sensation the lozenges have to be sucked and not swallowed take cherikoff is syearup thrice daily top drink plenty of warm water abstain from smoking take tablet antacid 40 my tablet twice daily before meals avoid dust and smoke if going in dust areas wear a mask most probably it will not be cancer take the above treatment and write to us after or days you will make good progress if within or days you do not find any progress then I suggest you take a course of clarithromycin 250 my tablet twice daily for days when you write to us next please take a picture of open throat and send us so that we can see the posterior pharyngeal wall for any nodule or congestion or hypertrophy also palpate your neck yourself and check for any swelling or lump do not worry and you will be fine soon have a peaceful and healthy mind do not smoke"
    },
    {
        "instruction": "hello doctor may I know if you have done urethroplasty in the distal penile urethra using the excision and primary anastomosis epa technique are you personally familiar with any such case if so was the surgery successful did the surgery cause penile curvature if so how many degrees did it had what was the structure length thanks",
        "input": "",
        "output": "hi I am a urologist and I have performed urethroplasties but excision and primary anastomosis is the procedure of choice only in short segment urethral strictures and they occur in the majority of traumatic urethral strictures that occur in the proximal urethra such a structure in distal urethra is rare however I had to do excision and primary anastomosis in an iatrogenic distal penile urethral injury wherein the surgeon had badly damaged distal penile urethra during an attempt to dilate the distal urethra I was called intraoperative the urethral plate was badly damaged in that case for only am I did excise that part and anastomosed end to end and the result was excellent and there was no postoperative chordee bending other than this case I have not done any era in distal urethra"
    },
    {
        "instruction": "hello doctor it usually pains in joints and happened for some years now I have shown to various doctors and was told that it is due to a low level of it do and cured by taking regular it do medicines recently I have noticed pains in my joints in leg hand elbow and foot the affected area becomes a little red with swelling and pain I had tested for uric acid and the level is under range though after the uric acid test my doctor suggested avoiding rich protein diet and also drink a lot of water currently I drink liters of water per day since with all this the pain has not completely settled and therefore I have done some more tests cop result 6 normal under and other reports ra quantitative serum and aso are normal with the increase of cop my doctor has suggested consulting rheumatologist for further advice hence I am requesting your advice",
        "input": "",
        "output": "hi I have gone through your query your symptoms typically match palindromic rheumatism it is an intermittent form of arthritis that can keep throwing joint pains and swelling intermittently initially cop done during an episode may have been high there is a 50 percent chance that it may become persistent and 50 percent it may remain this way only one test is missing which is an anti cop antibody kindly do that and let me know what it says as for the treatment I would suggest you maintain a diary of attacks if joint swelling is persisting for more than seven days then we need to start treatment or else if it goes off if you do not get another episode for a month then we shall wait hope the information was useful ear anti cop antibody and ana ifa"
    },
    {
        "instruction": "hi doctor I am a 49 year old woman and last month I was hospitalized with a necrotizing soft tissue infection on my thigh I had two debridement surgeries and was discharged after days I was treated with about iv antibiotics I do not remember them all I recall seeing vancomycin and penicillin I was told that the infection was not mesa but a slower moving bacteria they did not tell me what it was I was swabbed for mesa in my nose and butt before both surgeries and was told I did not have it for the last day of my stay I had a roommate who had a bad mesa infection on her butt and sometimes had diarrhea incontinence during dressing changes I had no physical contact with her but we had the same nurse I was discharged with a five day course of augmenting the wound has been healing very well and has not gotten infected but three weeks after discharge I got an abscess under my arm I went to an urgent care and was prescribed clindamycin and told to return in three days for drainage the abscess did not improve or get worse over the three days I got it drained and was prescribed augmenting and told to also continue the clindamycin that was a week ago and the wound is healing well they called today and said cultures show it was mesa and they prescribed bactrim and told me to stop the other antibiotics I am feeling devastated by this and wanting to understand why it happened could I have gotten it in the hospital I am concerned that it will not go away are those swabs at the hospital conclusive and mean for sure I did not have mesa a month ago I have never had any medical problems before and these experiences have been very frightening is there anything else I can do to prevent recurrence I have read about everything from bleach baths and hibiclens to antibiotics in the nose",
        "input": "",
        "output": "hi I am sorry for what you have had to go through as you previously did not have mesa strains it is possible that now you have hospital acquired strains in your blood it is a superbug and superdifficult to treat as it is resistant to drugs of choice so you have get culture and sensitivity test to find out which one is it sensitive to as you were told to stop other antibiotics and start bactrim this means the strain you have got is sensitive to bactrim if there is anything else you want to ask please feel free to contact me"
    },
    {
        "instruction": "hello doctor I have recently relocated to my workplace due to relocation I had to consume outside food for two months I had started growing skin rashes it was diagnosed as an allergy two medicines have been recommended by the doctor allegra 180 my and azithromycin 500 my I ate drumsticks today and I got the allergies back let me know please what all food should not be consumed what foods should I consume for regaining proper health that would not be allergic also whenever I keep my body heated the itching fades away but when it is becoming cold the allergy is back are there any tests to be carried out",
        "input": "",
        "output": "hello doctor certain cities are known for allergies some people who are genetically probing for allergy atop and hypersensitivity start showing symptoms in certain cities it is difficult to say what foods to avoid but I can give you some ideas about it there could be a food allergy or aeroallergy your place has a lot of ethnic trees and pollen related allergy the tests you must do are serum ice immunoglobulin if the levels are elevated that shows atop and thereafter you will have to do a skin prick testing or blood immunocap testing the latter two tests will clearly show us which substances can cause allergy in you if you desire you may get serum ice and one of the tests either skin prick or blood immunocap done together meanwhile keep away from plants and dust avoid smoke avoid air conditioner at home or workplace try to keep the temperature at an optimum level and not very cold drink plenty of water take a diary and note down whenever you eat or drink something different and if you get rashes or allergy keep your bed and weddings very clean change sheets frequently dust the sheets in the balcony or outside the house vacuum clean all crevices and corners in the house wash curtains frequently weddings curtains etc be washed in warm water soak them for two hours in warm water about 60 degrees these are known to harbor house dust mites please let us know the symptoms of your allergy like nasal or skin also let us know if the tablets recommended relieve you of the lesions if possible take a few pictures of the skin rashes and send to me"
    },
    {
        "instruction": "hello doctor ulcers are formed after getting a tooth extraction and have gotten worse and not gone away they have been there for a month I am worried it is oral cancer also my tongue is sensitive and my tongue is slightly white I also got white spots on the inside of my cheek and irritated red spot on my tongue and the roof of the mouth I was taking amoxicillin",
        "input": "",
        "output": "hi I have read through your complaint and the relevant details and also saw the pictures you have attached the oral ulcer at the corner of your mouth seems to be formed by some external irritating factors like a toothbrush hurt if that is the same area where tooth extraction was done it looks perfectly healed so the ulcer close by can also heal equally the red and white spots are nothing but oral ulcers that have recurred every now and then maybe that is why you say that it is there for more than a month also I find that you have done tongue piercing I suspect that is the reason for the red spot ulcers over the roof of your mouth this also is an indicator of difficulty in maintaining tongue hygiene which resulted in a white tongue oral ulcers can be treated by applying a small amount of dentogel 15 go on the affected area with clean fingers three to five times daily make sure you maintain good oral hygiene too recurrent mouth ulcers also refer to vitamin deficiencies for which please eat nutritious whole fruits and veggies instead of fried and fast food please do not relate it to cancer and get panicked once the rooting cause for oral ulcers are removed then it will heal normally and might not come back you will be fine blood check for vitamin deficiencies tongue cleanliness scraping tongue with blunt plastic tongue cleaner or with the back of the toothbrush head"
    },
    {
        "instruction": "hello doctor I have been watching porn since my 18 years and now I am 31 and got married recently I am getting an erection but after ejaculation I am unable to regain my erection and sometimes it goes down without even ejaculation please suggest so that I can have two to three times in the night and also suggest to me on the usage of tadafil 10 my and can this be used for a prolonged period as the effect of this medicine stay for 48 hours can this be used for a lifetime every alternative day what are the future problems with this medication",
        "input": "",
        "output": "hi good and satisfactory sex is never related to the frequency of intercourse in a day or duration of intercourse although these factors play an important role in sexual satisfaction but not the only factors it is the quality of sexual encounters that matter one can have a wonderful sexual life while having sex once a week on the other hand those having sex three times a day may not be happy with their sexual life so stop worrying about how to have sex two to three times a night it is not a competition in the fourth decade of life 30 39 years the level of testosterone hormone begins to decline progressively while it is most abundant in the late teenage and early adulthood as you cannot expect to have the libido of a 20 year old male if you think your sexual desire is gratified by having sex once a day then it is fine you need to improve the quality of sexual relationship by having lots of foreplay and imagination tadalafil can be used if you feel your erection is not persistent during sex but I think you are fine without it is usually not advisable to take tadalafil more than twice a week"
    },
    {
        "instruction": "hello doctor I am 43 years old from my 25 years of age I am suffering from burning epigastrium I erosive astral gastritis the endoscopy report shows erosion congestion my physician has suggested any of pi like pantroprazole 40 my od or rabeprazole 40 my od I simply wish to know is there any way out to cure it I am taking pips for years I am negative for pyloric",
        "input": "",
        "output": "hi along with chronic gastritis you seem to be having hypertension and might also have diabetes you must get your hba1c glycated hemoglobin levels done the chronic gastritis is basically of types environmental autoimmune and least common diffuse astral gastritis as you have reported above yours is an astral type the problem with astral type gastritis is that it is associated with increased acid output from the gastric glands and might lead to duodenal ulcers pi proton pump inhibitors are ion proton inhibitors they block acid secretion and hence are helpful in this type now the catch here is pyloric usually pyloric is harmful and causes destruction of gastric glands but in case of astral gastritis where the gastric glands are hypersecreting the destruction of these glands provides symptomatic relief in your case pyloric is negative and hence you are having these symptoms your symptoms will remain suppressed while you take pi and whenever you will stop pi there would be an exacerbation of these symptoms you should get yourself thoroughly investigated and other organic causes should be ruled out some lifestyle modifications you can try which I have already answered in this link here was a study performed in china where it was found that green tea reduced the risk of gastritis by 50 I hope your treating physician would have tried giving you sucralfate or gefarnate if not you can try the above either of the two also you should keep a check on your blood sugar levels and exercise regularly an hour of a brisk walk for five out of seven days in a week will definitely help"
    },
    {
        "instruction": "hi doctor I am a 26 year old female I experience pain during intercourse the moment the penis is inserted I feel my muscles contract and then it feels painful and due to this I am unable to have sex with my partner also I feel there is dryness in my vagina please help also I have genital herpes and I fear sex because I do not want to trigger the symptoms or eruptions again I take acivir for this",
        "input": "",
        "output": "hello you probably are suffering from a condition known as vaginismus it is characterized by involuntary spasm of pelvic muscles around the vagina making it almost impossible to penetrate the condition is usually related to conscious or unconscious anxieties about having sex sexual abuse during childhood sexual harassment and feelings of dislike and disgust towards sex and sexual partner are the issues commonly associated with it but it can occur in the absence of any such history another common cause of painful sex is pid pelvic inflammatory disease a condition caused by infection of internal reproductive organs signs and symptoms include painful sex abnormal vaginal discharge and chronic lower backache in case of vaginismus the patients are symptom free while not having sex I pain occurs only during sex the treatment includes relaxation techniques like systematic desensitization and progressive muscular relaxation the goal is to get comfortable with penetration here is what you can do first do kegel exercises by squeezing the same muscles you use to stop the flow of urine when urinating squeeze the muscles hold for two to ten seconds then relax the muscles do about 20 keels at a time you can do them as many times a day as you want to after a few days insert one finger up to about the first knuckle joint inside the vagina while doing the exercises use any lubricant while doing it start with one finger and work your way up to three you will feel the muscles of vagina contracting around your finger and you can always take your finger out if you are not comfortable this way you can teach your nervous system not to contract vaginal muscles while penetration"
    },
    {
        "instruction": "hello doctor is colchicine safe for breastfeeding mothers I have been prescribed colchicine for the treatment of my oral lichen plans condition however I am still nursing and breastfeeding my one year old child I am wondering if the medication is safe to consume given that I am still nursing my child if not is there any alternative treatment or medication that I can suggest to my oral medicine specialist also can I practice pump and dump if I want to continue nursing and yet continue with the medication assuming the dosage frequency is once a day I will nurse my child in the morning first before I consume colchicine then I express my milk and dump them through the day and only continue nursing my child six to eight hours after the last dosage in the morning is this do able",
        "input": "",
        "output": "hello regarding your treatment for oral lichen plans you need to take a topical corticosteroids and colchicine is an appropriate treatment for it I am posting here a study regarding the use of colchicine by a group of lactating mothers and you can see the results yourself the national transplantation pregnancy registry reports that 124 women with transplants have taken corticosteroids while breastfeeding 169 infants for periods as long as 48 months with no apparent infant harm so the gap you are giving in between the morning and day feeding is the best you need to give a gap of four hours maximum after the intake of the drug"
    },
    {
        "instruction": "hello doctor my year old son has been complaining of severe ear pain just right ear and occasionally says that he hears a sound in the same ear when he is abroad he has a nonstop cold phlegm and chest congestion but when he travels here he is absolutely fine he also suffers from nose blockage and struggles to breathe through his nose he breathes through this mouth only most of the time the doctors abroad suggested surgery to remove his adenoids however when he is here he is absolutely fine and the doctors are against surgery could you please suggest what is the solution for his suffering",
        "input": "",
        "output": "hi have you taken an adenoids ray can you upload the ray if you have taken it do you think there could be some allergen in his place abroad which could be causing allergy and nose block in your son does he take food properly is there any dust inside the house abroad any chance of pollen or house dust mites does he have any sneezing or running nose does he show any rashes over his body the ear pain is there only in the right ear and when only he stays abroad does your son have an ear problem here do you feel he has hearing loss from that ear have you covered his normal ear and checked the hearing from his affected ear let me know can you upload the relevant ray and blood tests what we are worried if the adenoids are causing ear block this can lead to compromised development as your son will have some hearing loss removal of adenoids will take care of this problem you may have to get some ear tests done meanwhile the allergy may aggregate the problem in when he is abroad and here it may not be aggravated but adenoids will not lessen in size even while in india"
    },
    {
        "instruction": "hello doctor I am facing constant tiredness fatigue lack of energy and weakness I had left the non vegetarian diet for a year or two but now I am consuming it I have recently treated for allergies and had a phase of amoebiasis I had to consume outside food for about two months recently due to relocation please suggest something I have done a urine and blood test yesterday there was a lot of over exertion due to relocation for the past two months",
        "input": "",
        "output": "hello I have seen your reports your urine and blood report are normal except for the presence of ketone bodies in urine which is usually absent in urine the reason for that usually are diabetes ketoacidosis starvation ketoacidosis etc check your random blood sugar level to rule out diabetes the increased metabolic activity also can also lead to the appearance of ketone bodies in urine so check hyperthyearoidism also by serum ash thyearoid stimulation hormone estimation which also can lead to weakness for weakness anemia and liver doses has been ruled out here through reports check for serum urea and creatinine to rule out kidney disease if you are drinking alcohol then provide history about that and finally you can check serum sodium potassium and calcium levels as well if all these are normal then over exertion due to the relocation can be the possibility for your tiredness for amoebiasis get treated by metronidazole I hope this helps"
    },
    {
        "instruction": "hello doctor I would really like to try led just as a matter of curiosity I am aware of all the risks and side effects as well as having no known history of mental illness in my family and I am a happy person with no depression or anything like that while I believe the risk for me personally to be very low I would still like to be safe hence my question do you think if I went to my go and told them what I wanted to do you think there is a chance of even getting pill of an antipsychotic to kill the effects in case things go downhill obviously I know the best thing is to not do it at all but if you had a patient come to you and ask you what would you say",
        "input": "",
        "output": "hello you have raised a very interesting query well done for seeking information on safety I see that you are keen on experimenting with led and knowing the risks involved you want to make an informed decision led trips psychdelic experiences by using street drugs are unpredictable and difficult to speculate the outcome hence it is not advisable to try it is highly unlikely your go or any other doctor will prescribe an antipsychotic prophylactically just incase you have a bad trip antipsychotics are powerful medication and can cause side effects on their own so needs to be used with caution when necessary after appropriate examination moreover if you develop any altered mental state that persists after using led you will need a proper medical evaluation"
    },
    {
        "instruction": "hello doctor I had braces and got them off and two tooth upper left last two had a gap my dentist said my filling also chipped from the removal and decided to redo the filling afterwards I experienced pain like sharp pain from eating hard things like chips grainy things that went into the grooves I went back and they fixed my bite by shaving some off that did not work so I went back and they redid the filling on the last back tooth because that is where I experienced the most pain I went home waited two weeks or so and had same pain when eating hard grainy things so I went back and they fixed the bite went back again after a few weeks because same issue came up they found natural tooth was an issue and said maybe I was getting down to the dentin they refilled those small spots I went home and had to go back in after a few weeks because I felt a few minor sensitive areas they fixed my bite by shaving some off again and of course that did not help so I went in again and this time they found two areas of the natural tooth and the filling was sensitive they think the filling was sensitive was maybe due to the shaving from previous appointment this time the following day it was way worse in terms of eating maybe it was the day after but running my fingernail on the tooth was sensitive my dentist said I may need an only or crown if this keeps happening I went to another dentist for second opinion and took rays as attached she said the filling looks good and it was done well and it is all smooth I wanted her to give me a second opinion and if I should get an only or crown she said part of my filling is close to the nerve I was surprised to hear that because the first time they did the filling it was far from the nerve so I don not know what happened maybe they redid it and drilled more she said even if I do an only or crown that with the temporary might not work and I can still be sensitive in which I would need a root canal I called my friend who is a dentist and she told me I should wait it out it is also possible the pulp horn can shrink and not be so close to the filling as it is pretty close she also does not suggest a crown because it is taking away healthy tooth structure and that if that did not work I would have to pay double as I would need a root canal when air goes on it is sensitive and sometimes when cold water goes on it is sensitive it was not like that before just seemed like it all got worse but then again I just got it done two days ago",
        "input": "",
        "output": "hello if only that particular tooth is being sensitive and no other then the best for you may be going through the root canal treatment the teeth may have been grinded down due to successive refilling and may now be very close to nerve sometimes using a strong toothpaste like go toothmousse helps in relieving this sensitivity completely by blocking all tubules so try it first apply some directly around and between those two teeth wait for five minutes then brush it off crown can be delayed till you can but just crown or inlay will not work without root canal treatment"
    },
    {
        "instruction": "hello doctor I started taking xyzal recommended to me by a friend for my bad seasonal allergies I took my first dose whole pill today and my skin got this red tint and felt hot and I had some hot flashes is this something that I should adjust to and can continue taking I have tried allegra zyeartec and claritin and benedryl none have done much for me the allergies I am having due to the pollen are causing sinus pressure and mucus that is traveling to my lungs the xyzal along with mucinex and sudafed seems to help with these symptoms is the xyzal safe for me",
        "input": "",
        "output": "hello xyzal is nothing but levocetrizine it is the leo isomer of cetirizine zyeartec the advantage of xyzal over zyeartec is that xyzal is effective over half the dosage of zyeartec and that the former produces less sleep the relief you find is more due to mucinex and sudafed mucinex acts to bring the tenacious mucous out by liquefying it and sudafed acts to decongest and reduce the vascularity of the area the main problem allergy which leads to sinus congestion and all these symptoms has to be addressed first we should do an allergy testing to find out what exactly is causing the allergy whether it is dust mite pollen or fungus subsequently you can take some avoidance precautions if that does not work then medicines like what you are taking and eventually if nothing works immunotherapy can be tried"
    },
    {
        "instruction": "hello doctor two weeks ago I had a scrotoplasty accompanied with this was liposuction around lower stomach and inside of thighs towards the groin to thicken the penis operation went well had general swelling and edema of the penis and scrotum with pain I have been taking anti inlfammatory tables antibacterial antibiotics and pain killers one of the symptoms I have had is pain in my penis when I stand it is like the blood rushes to that area and cause discomfort I then lie back down and the pain subsides based on this I have just been resting I noticed yesterday when feeling the scrotum that my left testicle has swollen I am guessing it is about two inches long by 5 inches wide in the shape of an egg it is not soar to touch but feels hard the scrotum or stiches do not show any signs or redness and the scrotum appears to be okay in color I have not had a fever or vomiting I have read different reports on line as to why this could be like fluids draining from liposuction into scrotum severe edema orchitis etc and advice would be appreciated",
        "input": "",
        "output": "hi first of all I would like to inform you that size mentioned by you is within normal range and it should not be called swelling unless there is gross difference from other side the average tests size is to am in length and to am in width now regarding feeling hard this is completely normal after scrotoplasty as there is mild deem of testicular skin along with tests itself this may take almost 6 weeks to completely disappear I feel this is normal complication of surgery as there is no fever no tenderness no redness sighs of inflammation I would like to inform you that keeping scrotal support and proper rest may help you in case this continues to remain in same stage sort aggravates with time it will be ideal to see your doctor and get examined regarding other symptoms related to pain at the tip of penis I feel this is due to clogging of secretions in urethra which creates problem in my opinion excess intake of water and fluids may help you"
    },
    {
        "instruction": "hello doctor I am going to be under general anesthesia in coming days for surgery I did let my pre op nurse know and wrote down all current medicines and supplements but have a question about supplements as I am not going to take them the night before anyways but just wanted insight the first is kratom I wanted her to know so the anesthesiologist could dose my pain medicines right during surgery second is phenibut a free amino acid would this would this have any effect on tolerance to the benzodiazepine they choose to administer",
        "input": "",
        "output": "hi you are taking drugs one of which is psychoactive compound kratom while other one is mind calming magnet phenibut if you are taking those drugs since long time then you may have some tolerance to opioids benzodiazepine other sedative anesthetic medicines so I would suggest you personally inform the anaesthesiologist regarding them so that he can make necessary adjustments in dose of anesthetic agents I just have added effects of these medicines on body kratom contains psychoactive compounds mitragynine c23h30n2o4 molecular weight 398 49 and hydoxymitragynine hmg it is used to treat chronic pain or opioid withdrawal although no scientific evidence supports this use the leaves are used for recreation and for self medicated opioid withdrawal treatment kratom toxic effects include dry mouth changes in urination nausea vomiting and weight loss serious complications such as seizures and coma have been reported the effects of kratom are dose dependent small doses produce cocaine like effects larger doses cause morphine like sedative effects kratom users report increased work capacity alertness sociability and sometimes increased sexual desire phenibut is a modified version of gamma aminobutyearic acid gala which is one of the inhibitor neurotransmitters in the brain it exhibits a relaxing effect and is also describe as producing a euphoriant dis inhibiting and calming state of mind"
    },
    {
        "instruction": "hello doctor I want to tell you that I have sensineural hearing loss and tinnitus according to my reports my doctor told me that I have mild sensineural hearing loss I am sending you reports I want to clear my doubts about sensineural hearing loss is my sensineural hearing loss progressive in future will my tinnitus cure of its own do I need any further testing like mri please check",
        "input": "",
        "output": "hi since how many days are you having hearing loss and tinnitus if it is since a few days you should try taking oral steroids your hearing loss can revert back mri or any other scan is not needed but you do let me know if your tinnitus and hearing loss is sudden in onset or not"
    },
    {
        "instruction": "hello doctor just wondering what type of impression I will need to get if I have to get crowns on last teeth like will it be a full top impression or can they do it off just those two teeth",
        "input": "",
        "output": "hi regarding the impression making the material is chosen depending on what it is being used for as you have already mentioned that the purpose is to fabricate crowns the best material to opt for is the rubber impression material elastomeric silicone impression materials the advantage of the material is the high accuracy of the details and it allows sufficient time for duplicating the teeth model talking about the number of teeth involved during an impression making usually it is the whole arch involving all the teeth that is the routine way of doing it but there are disposable sectional double impression trays available which help the dentist to make an impression in a particular region along with the opposing teeth the biggest plus with these trays are firstly preventing contamination because it is used only once and for a single patient secondly upper and lower teeth with the bite are registered in one impression hence time saving the maximum number of teeth involved in these kinds of impressions would be four to five but definitely not just two teeth I personally make double tray impressions on a routine basis for crown fabrications but it totally depends on the dentist well and wish to choose the technique according to his her skills and economic reasons"
    },
    {
        "instruction": "hello doctor the pet scan report says that the metabolic activity brain appears metastatic does this confirm that the patient has advance cancer",
        "input": "",
        "output": "hi revert with more details I need also pathological and treatment details usually if brain is involved with multiple lesions it is considered advanced malignancy"
    },
    {
        "instruction": "hello doctor my heart rate gets very high when I go to the doctor I get super nervous and I need to go to the dentist my teeth are getting worse but I am too scared because I know my heart rate will get high just wondering if you know what they will do",
        "input": "",
        "output": "hi you need not panic at all for a dental visit all that happens in your first consultation is that the dentist checks your oral status with a mouth mirror and a hook shaped instrument called explorer this is the point that most of the young people get scared of the instruments are not going to hurt you but used to check the tooth on its various surfaces as it is a hard tissue once you are thoroughly checked then if needed rays might be taken with complete protection these days ray techniques have gone digital for saving time and to comfort patients you just need to open your mouth the ray sensor captures the tooth and the pictures will be seen on the computer screen in seconds the treatment options will be explained to you in detail and the procedures are done only with your consent no dentist is going to prick you straight away with the needles so please do not worry about it in case where you have to get a filling done there is a rotary machine that sprays water that is used to drill the tooth and again this is super fast when you co operate if you are not liking that sound feel free to put on your favorite music with the headphones during the treatment also feel free with the dental team and ask all your doubts at once because the patient comfort comes in front of all exquisite treatments you will be fine"
    },
    {
        "instruction": "hi doctor I have a cracked tooth which I believe needs a root canal and a crown that I think went bad I am in excruciating pain I have been to emergency rooms they have given me clindamycin and vicodin for pain but it barely touches the pain I have been on antibiotics for two days I thought I would see some improvement but the swelling and pain are getting worse I have had a staphylococcus infection before is it possible that this could be one the infection was on the right side of my face I have been waiting for two months to get into my dentist",
        "input": "",
        "output": "hi I read your complaint and relevant details you have mentioned you got a swelling I just want to make sure if the swelling is confined close to the tooth or is it spreading the severe pain along with fever and swelling confirms that the infection has gone bad clindamycin is the only antibiotic that you are taking I recommend you to take metronidazole 400 my orally twice daily along with clindamycin for five days this will fight against another group of bacteria and reduce the swelling to an extent also continue with your pain killers as well tramadol works well for moderate to severe pain but in your case it does not sound so for immediate relief crush one tablet of ketorol it ketorolac tromethamine in half a glass of water and drink it straight away you will feel better in 15 minutes otherwise complete relief will be got only after the necessary dental treatment antibiotics are just add ons do not totally rely upon them"
    },
    {
        "instruction": "hello doctor I am 17 years old I had sex with my partner on the 24th day of the menstruation cycle I used today vaginal pill before intercourse on the next day I 25th day within 30 hours I also took I pill to be sure not to be pregnant now my period which was on due is still missing what are the chances of my pregnancy what should I do to terminate it if I am pregnant kindly help me out",
        "input": "",
        "output": "hello I have reviewed your query thoroughly I pill or emergency contraceptive pills have very minimal chance of failure if taken immediately after intercourse within 24 hours and chances of failure gradually increase after that even if taken within 72 hours there is about one to two percent chance of failure of an emergency pill or I pill in your case but we can be quite sure of its success if withdrawal bleeding occurred within four to five days after taking the pill confirming the shedding of layer of the endometrium based on the dates given by you today must be days following the date of the intercourse in that case to find out if you are pregnant you can get a serum beta hug human chorionic gonadotrophin testing done for the urine pregnancy tests to show the result if pregnant it must be at least 10 to 14 days following intercourse if you want to know urgently whether you are pregnant you can get serum beta hug testing if you can wait another week you can get a urine pregnancy testing which if positive must be followed up by ultrasound imaging only after then and after consulting an obstetrician should the abortion be planned under guidance furthermore if you are sexually active regularly it is better to choose other regular contraceptive methods after consulting an obstetrician and gynecologist instead of I pill I pills are meant to be taken only in case of unexpected accidental unprotected sex but not on a regular basis"
    },
    {
        "instruction": "hello doctor I am struggling with pinworm infection I took one dose of mebendazole 100 my and it helped two weeks later I took the recommended second dose and about three days after I started exhibiting symptoms again it is now a week after taking the second dose symptoms are not improving",
        "input": "",
        "output": "hello I have gone through your problem reinfection with pinworm is quite frequent mebendazole two doses are the standard way of treatment but in your case reinfection may have occurred because of remnant eggs please change your sheets on the bed and wash them thoroughly thoroughly wash the undergarments as they are the major source of remnant eggs of pinworm wash your hands properly avoid scratching in the anal region which you may be doing because of itching if there is a school going kid at your home please do inform the class teacher regarding this as other untreated kids may be another source another major thing to consider is whether you are definitely having pinworm infection or not in pinworm infection usually the eggs which are laid in the perinatal region and worms are not commonly released in stools the presence of eggs can be diagnosed with a simple tape test at your physician office if this is due to any other worm infection the required dose of mebendazole is different and what is taken by you will not be sufficient I suggest you get this clarified because what requires is a simple tape test and a stool examination for other ova or cysts"
    },
    {
        "instruction": "hello doctor I was diagnosed with is five years ago this month tests have identified high levels of blastocystis hominid in my stool as well as yeast and imbalance in gut flora I am traveling away and I am wondering what the best course of action for me is I have done comprehensive stool analysis and recent full blood test",
        "input": "",
        "output": "hi blastocystis hominid does not usually require treatment unless there is a co pathogen they were none found in your stool study or if the individual is immunosuppressed the other issue is your sofa short chain fatty acid and but the rate are a bit on the lower side how was your is irritable bowel syndrome with diarrhea diagnosed was it after a colonoscopy and checking celiac disease antigen as well as stool calprotectin level"
    },
    {
        "instruction": "hello doctor I was wondering if I need to be concerned or what is the probability if any would I have at developing a blood clot if I have no blood clotting genetic issues factor etc not on any hormones was on birth control pills for 12 years but been off for almost four years no recent surgery do not and have never smoked I am just going to be moving 12 hours away and someone I know developed a blood clot in their leg after a 12 hours drive and did not have any risk factors smoking hormones etc to their knowledge I got a little nervous about this possibility because I had a friend who died of a pe also should I take aspirin before the trip and wear compression socks or would that help I am a 31 year old female who only takes prenatal vitamins vitamin b12 100 mug chewable citalopram 10 my and occasional excedrin as needed thanks",
        "input": "",
        "output": "hi I can understand your concern before I can answer your question you mentioned that you are taking prenatal vitamins just curious if you are pregnant or plan to do so do you have previous unplanned or accidental abortions please let me know"
    },
    {
        "instruction": "hello doctor I need a consultation to decide on a health issue for the past four and a half years I have been suffering from menorrhagia and metrorrhagia due to a fibroid I tried ayurveda for three years and homeopathy for almost a year ayurveda did not work only with medication and they suggested to go take panchakarma treatment homeopathy started working for four months and the prolonged heavy bleeding stopped now the bleeding was there for almost five years on each and every day with few months stopped now and then at this juncture I just got an endometrium biopsy and an ultrasound to monitor the size of the fibroid my gynecologist suggested immediate hysterectomy to remove the uterus and my homeopathy doctor asked to try for three to four more months and if home treatment fails then go for surgery this gynecologist does not believe in any alternative systems I sent my reports to my ayurvedic doctor too and he said surgery is not needed the biopsy report says simple hyperplasia without atypia because of prolong non stop bleeding for years now I have anemia and went for infusion I need a second opinion on hysterectomy if it is needed or not in case if it is needed when can I go for it",
        "input": "",
        "output": "hi failure of conservative treatment and dropping your hemoglobin level to that extent indicates the urgency of surgery where is your recent abc report if your level of hemoglobin is less than go dl then you are at the risk of several diseases affecting the cardiovascular system"
    },
    {
        "instruction": "hello doctor I would like to have a natural abortion because I have no other choice what could you suggest to successfully achieve this goal I am currently taking anti depressants and be medicines",
        "input": "",
        "output": "hello welcome to icliniq com there is no acceptable or approved method to have a natural abortion if it happens on its own that would be a different issue but you doing something on your own to have an abortion is not at all recommended please do not brush away my opinion as something you have already heard or just because you are in a desperate state with no option having an abortion on your own at home has hazardous complications including heavy bleeding leftover fetus parts in the uterus resultant infection sepsis and sometimes even may result in death there would be nothing anybody can do if things go out of hand you have mentioned that you have no other choice I politely disagree with you and whatever the reason maybe it is not worth putting your life at risk please go to a doctor personally get medical attention personally if you cannot go on your own due to legal age or personal reasons open up to your parents or trusted guardian adults even if it may bring upon their anger or saddens them I am telling you again anything and I am willing to stress this upon you as many times anything is better than putting your precious life at risk do not do this on your own and please go meet a doctor and get medical attention ps you have mentioned that you are currently on antidepressants and blood pressure medication how long have you been diagnosed with hypertension I will be waiting for a reply from your side that you did not do this own and met a doctor take care"
    },
    {
        "instruction": "hello doctor I am a 21 year old male I have fordyce spots on my private areas and on the corners of my upper lip can you give me a cure my problem has remained consistent since the last seven to eight years it does not pain or itches or none of such problems I just feel upset whenever I look down at them and badly want to cure it when I touch the spots on the downside of my penis it feels like some kind of tight hard mass inside but it pains when I try to squeeze them out all in vain two three spots get bigger in size sometimes and remain so for quite a long time and some new spots also arise intermittently it is very awkward to see them feel the masses inside and these spots are only on the downside of my penis and not on the upper side and my be is normal as I last checked up some days ago I have no problem with sugar level or any cholesterol issue thanks",
        "input": "",
        "output": "hi fordyce spots are sebaceous glands it is a normal variant harmless I totally understand your frustration unfortunately this condition has limited treatment options and cure is difficult to assure cop carbon dioxide laser is one option it removes the spot but there can be potential for scarring another option is oral isotretinoin capsule isotretinoin is vitamin a derivative it is used in acne and it shrinks the sebaceous glands I am very sorry to say even with isotretinoin cure cannot be guaranteed"
    },
    {
        "instruction": "hello doctor I have been arm wrestling for close to seven years and with time I have noticed a couple of things about my wrist that are hindering my ability to have healthy progress in this sport the main issue is with wrist flexion my problem is that while doing the flexing motion of the wrist with a decent load on it cracks in some positions and I lose all my power in my right wrist I feel the crack around the ulnar styloid region and in my left wrist I can feel it around the scaphoid area the thing is that the thicker the handle of the weight is the better it feels on the wrist once it is past a certain thickness the cracking stops and I can train properly another thing that I notice is that if I try to flex my wrist with squeezed gripped it is like a pier that you squeeze then the motion is not smooth at all I can feel all sorts of cracks and it hurts the cracks are mainly around the scaphoid area in both wrists and it is less on the right do you believe that a chiropractor could fix this do you have any idea of what the problem might be please help",
        "input": "",
        "output": "hello I read your concern in my opinion the issue is with an excessive sheer force that you create when you flex your wrist is causing bone on bone rubbing and leading to those crack sounds depends on the concentration and loading of weight you feel it at different areas between the right and left wrist you can get a chiropractor consultation to mobilize the wrist and relieve muscle tension and then do stability exercises and load your forearm that should be safe the position of your wrist is always important as wrong positions tend to increase issues so be cautious do a lot of stretching exercises and icing to release tension as of now I hope this helps"
    },
    {
        "instruction": "hello doctor I was on a diet and I lost a lot of weight I used to be 57 keg and later I was only 38 keg I lost my period and I went to the hospital and they asked me to gain weight now I am 42 keg and still I did not get my period back",
        "input": "",
        "output": "hi now you have two factors that do not allow your periods as you said any sudden reduction of weight or even a sudden increase in weight can affect the control of the brain on these hormones which in turn control your ovulation you are still a young lady in early adolescence maybe you had your first periods few years ago it is only about the age of 19 21 years that your hypothalamo pituitary ovarian axis in short the circuit between your brain hormones and ovarian hormones becomes mature enough to have normal ovulation and hence normal periods you gave sudden stress on this circuit with sudden weight reduction which would have shifted the balance you need a minimum fat in the body to have normal hormones and normal cycles as ovaries breakdown fat deposits in the body to form hormones your target should be height in am 100 weight in keg I mean your weight should be 158 am 100 around 58 kgs you were never overweight advice do not go on binge eating no fasting have a regular controlled diet thrice a day reduce the high calorie diet junk food and red meat have a lot of proteins have regular exercise aerobics dance brisk walk and so on have a thyearoid profile and serum prolactin done in the early morning in an empty stomach just to confirm any other hormone problems wait for a month or two I bet your periods will come back if you still do not get the periods on your own you will need to evaluate you and start on a cycle of hormones for a month or two to artificially get the hormone train back on track which has got derailed now I hope this helps"
    },
    {
        "instruction": "hi doctor my wife is currently weeks pregnant on us the following have been found uterus is bulky well formed gestational sac with a living embryo is there yolk sac is seen cry 500 am heart rate of embryo 121 bum ovaries are normal in size as prescribed by the doctor she is taking duphaston thrice a day folic acid tablet once a day and normozyme syearup twice daily she is weighing 61 keg and her age is 27 years I want to know whether everything is alright and what does bulky uterus mean will it harmful for the embryo she had an anembryonic pregnancy eight months ago and had undergone and we are very much tensed as well as excited please suggest",
        "input": "",
        "output": "hi I see everything is absolutely fine nothing to worry about when the baby comes into the uterus the mother body has a lot of changes most important is the excessive blood flow throughout the body this is required as the baby is a fast growing life it needs a lot of energy to grow when blood flow to the uterus increases the size increases this is just the beginning the non pregnant uterus is only am long length of your finger which has to reach the level of her heart almost blood flow everywhere increases face blushes redness of skin all over excessive discharge from nose mouth stomach and so on as blood flow to these glands increases six weeks is the earliest baby heartbeat is seen so you do see a good sign yolk sac energy store for baby is seen is a good sign well formed sac means no bleeding and the attachment to the uterus is healthy all the signs are good she is on supportive medicines her age is perfect for pregnancy 19 35 years is a good time about the anembryonic previous pregnancy it is due to a genetic abnormality the best sperm meets the best egg at the right time and sits in the best place in the uterus to form the best baby any step wrong in this leads to a bad baby when you see baby heartbeat it means baby is genetically normal so do not worry about the past such abnormal pregnancies are accidents but accidents do not occur every time the journey of pregnancy 40 weeks is a long one there may be problems every pregnancy can have but have faith in god follow doctor orders and hope for a healthy baby and mother at the end should be your expectation do not think anything that happens is a bad sign positive thinking will allay your anxiety"
    },
    {
        "instruction": "hello doctor I am 32 years old I am currently facing ed and pe and reduced muscles and increase waist doctor advised for a total testosterone test and the result was 20 and he said it is really low for this age he advised for injections but is there any natural way to treat it",
        "input": "",
        "output": "hello androgen testosterone injection for the purpose of treating ed erectile dysfunction is acceptable but how long one can take the injection is the question if someone use it for years together then there will be some side effects but this is the definite therapy in siddha you can take agasthyar kuzhampu 100 my in the morning at am mixed with three arasam tree tender leaves ground with buttermilk this will cause diarrhea in some patients this is to be taken for continuous three days this drug can be taken every month for three months within the third month this siddha drug should give the result if not the drug to be changed but the agasthyar kuzhampu should be taken strictly from under a siddha doctor supervision for the remaining days orithal thaamarai chooranam lotus pollen thamarai magarantham poonaikkaali seed powder drumstick seed cashew nut are the best herbal to improve ed all these drugs together come in a single capsule as rathina purush so you can try agasthyar kuzhampu and rathina purush please continue for three months you will get a better improvement"
    },
    {
        "instruction": "hello doctor I had a capsule endoscopy done a few months back along with a colonoscopy and endoscopy I have symptoms of diarrhea constipation bloating gas and abdominal pain my gi doctor could not find anything significant except for acid reflux and diagnosed me with is I was reading the report of the capsule endoscopy and it said there was a my ulcer in the mid ileum found but of unknown clinical significance is this nothing to worry about my gi doctor never mentioned this finding to me can it be causing some symptoms I am experiencing",
        "input": "",
        "output": "hi your symptoms are suggestive of is only such ulcers are found incidentally mostly they have no value I would need to know if pyloric test was performed can you send me the report"
    },
    {
        "instruction": "hi doctor I have been diagnosed with sinusitis cold and ear infection for more than 10 days took antibiotics with ent doctor consultation I could see improvement in sinus pain cold but one ear still remains clogged finding difficulty in hearing when checked with doctor I was informed that the fluid has entered deep and need steroids to recover it I have been prescribed prednisolone my for 15 days with tablets per day for first five days then for another days and two for remaining days along with this steroid doctor have given clarinase and one more tablet named gases for preventing the stomach related issues as side effect of taking steroids my queries are is it fine to take such tablets while trying to conceive if not how many months I have to wait for conceiving is it the right treatment for clogged ears due to sinus what type of side effects can I expect due to this steriod",
        "input": "",
        "output": "hi if you are trying to get pregnant you must stop steroids because it has a harmful effects on the nervous and immune system of the fetus but do not panic because you have taken a small dose of steroids for a short period yes steroids are one of the best treatments for the collected secretions behind ear drum after sinusitis and common cold you can start trying to be pregnant the next few days from stopping steroids do not wait for side effects as the dose is small the period of treatment is short"
    },
    {
        "instruction": "hi doctor I am a mother of two children my daughter at the age of 21 started showing signs of depression she had to drop from university after six years of struggle and treatment she is on her way to recovery but even now she gets panic attacks and feels depressed and is unable to handle stress my son at exactly the same age 21 years started showing signs of depression my kids had a very normal childhood without any issues we are a normal healthy family my husband family has a history of mental health issues I have heard that at least one member from all our extended family branches had mental health problems my father in law was a patient of chronic depression all his life please let me know if depression is genetic and is it possible that my children problem is because of the genetic predisposition",
        "input": "",
        "output": "hello you have asked a very pertinent question as a parent I can understand your quest for answers for your children illness and treatment depression is usually caused by a combination of genetic and environmental factors if there is a positive family history a person is more vulnerable to develop depression especially when faced with environmental stressors epigenetics so to answer your question yes genetic predisposition could have played a part in your children developing depression but it may not be the only responsible factor it is positive that they have a normal childhood but any factors like academic pressure or peer relationships or social interactions or demands of growing up etc could have contributed to them feeling stressful which can then trigger depressive episodes with effective treatment depression can be very well managed and your children can live productive lives treatment involves a combination of medication psychological therapy like cut cognitive behavioral therapy and lifestyle changes regular exercise yoga and mindfulness meditation will be helpful I hope this helps"
    },
    {
        "instruction": "hello doctor I am a year old female I have been having some symptoms for two years it started with noticing some blood on the toilet paper went to my go and he said probably hemorrhoids nothing to worry about and then I started having diarrhea with blood on the toilet paper again then I had constipation with blood in stool I went to see a specialist that said I had a fissure then four months ago I started having too much diarrhea at least once a week and gas and borygmi after every single meal no matter what I ate I went to the specialist I did celiac test negative and my blood tests all look fine all my doctors said that I have nothing that it is probably stress but I am too worried how can I convince them to give me a colonoscopy",
        "input": "",
        "output": "hello I have gone through your query in detail a few details which could be helpful are have you lost weight do you have anemia or any abdominal pain have you had a fecal calprotectin done apparently your symptoms have been going on for close two years and specifically since you have had diarrhea with blood on toilet paper it is unlikely to be due to anal fissures anal fissures usually are precipitated by constipation and quite unlikely with diarrhea persisting diarrhea and bloating is more in keeping with symptoms of inflammatory bowel disease i'd especially since the celiac markets are negative anyways celiac disease is unlikely to cause blood with diarrhea on these grounds you can certainly insist on a colonoscopy"
    },
    {
        "instruction": "hello doctor my grandmother is 65 years old she has a problem with eye flashes for four years she complaints of getting lights in her eyes in various shapes like stars sparks and pictures of various colors she is left with only eyesight please recommend the best medicine and eye drops for this problem of eye flashes she is currently using ayurvedic eye drops she underwent laser treatment",
        "input": "",
        "output": "hi flashes are usually due to retinal problems like retinal tears or detachment floaters in diabetics can be due to blood in the vitreous these have to be treated with lasers retinal surgeries and or intravitreal avastin injections as she is left with only of vision these are the only options strict control of diabetes is a must please give the history of any eye surgeries past eye treatments present vision in both eyes kindly send pictures of old records for more details"
    },
    {
        "instruction": "hi doctor my mother is 47 years old firstly I want to tell you that at present my mother has a uterus tumor and kidney calculus last year her triglyceride was 402 cholesterol was 260 egg was normal and tit was showing negative but the doctor said that she has a minor blockage that the machine is not showing after that she was taking starpress al 100 rabiros 20 and ecospirin av 150 20 for one year now for the past two months she is taking starpress al 100 rabiros 20 and ecospirin av 150 but she is facing some problems during this time period approximately 18 months she often feels severe hurtburn and sometimes severe headache for this problem we consulted many times but the doctor does not do anything why does she this problem her tit was going to be done this year but that time her he was 10 do doctor asked her to consume juice and jaggery but nothing happened after that he gave biofer it and also consumed juice but her he is still the same 10 do if she consumes pomegranate juice and biofer it daily she gets loose motion that is why she left some dose of biofer it now she is not feeling any chest pain and because of these problems she wants to reduce ecosprin dose every three days she wants to quit it and wants to take ayurvedic treatment but the doctor is not allowing her to miss even a single dose and I also read from the internet that if we leave aspirin dose it may cause heart attack please suggest what to do",
        "input": "",
        "output": "hello I want to see the lipid profile egg electrocardiogram tit treadmill stress test and echocardiography report of your mother to guide you better but still I recommend you the following your mother is taking a high dose of aspirin I 150 my a component of ecosprin it may cause heartburn reduce it to 75 my another component is atorvastatin 20 my that is fine rabiros 20 my rabeprazole used for heartburn is fine reduce the intake of tea and coffee avoid spices in food for he hemoglobin eat healthily she is taking iron supplements that may also cause heartburn take iron supplement after two hours of rabiros 20 my to decrease heartburn take iron for three months and repeat abc complete blood count take all the medicines daily without interruption repeat the lipid profile after three months reduce weight adopt active lifestyle and do exercise I hope this helps"
    },
    {
        "instruction": "hi doctor I am 13 years old I get horrible stomach pains and my doctor thinks I have acid reflex my mom thinks because I have a hormonal imbalance that I am getting bad stomach cramps she thinks it is the hormones that are doing it but I do not think so I think it has to do with that it is so bad that sometimes I am breathing fast and it hurts really bad like I am getting stabbed I have joint pain in my hip and my knee and like every joint in my body crack sometimes and almost every day one of my knees feels like it needs to pop and it bothers me and I have to pop it and it feels better one day it felt like one of my tentacles blood vessels or something got tangled and my nervous system like overreacting or something and I was walking and it started hurting really bad and then it shot right down my leg and it was my nervous system I fell down because it hurts so bad that I could not walk on it so I laid down and it still hurt really bad it did not go away and so I crawled a little bit to a chair and it still hurts and then it just disappeared last night I crack my neck but it was like one that does not sound right I had neck pain and today and it is sharp neck pain in my cord for a second then it left if I am laying down and keep my butt and shoulder down my lower spine feels like grinding or cracking I know I have a lot of problems I had add hormonal imbalance",
        "input": "",
        "output": "hello well you have multiple problems I want to ask you a few things since how much time you are suffering from pain in the stomach what is the exact location of the pain above umbilicus or around the umbilicus or below that is there any association of meals with pain does pain associate with vomiting or loose stools is this pain occur during your periods menses or all the time what is your body weight I suggest taking capsule omeprazole 20 my empty stomach once daily in the morning tablet dicyclomine and paracetamol sos when required during pain if you do not get relieved then get an endoscopy and ultrasonography of abdomen done for the pain in hip and knee get an ray done first only then we can reach to any conclusion take some calcium preparation available in your country along with some multivitamin for pain in the neck get an ray cervical spine done ap anteroposterior and lateral view get following hormonal test done fish follicle stimulating hormone oh luteinizing hormone prolactin advice do morning walk and meditation take plenty of vegetables and fruits avoid spicy and junk foods"
    },
    {
        "instruction": "hi doctor I have pain in anus on touching I also notice blood in stools sometimes I have attached images please check and guide me thanks",
        "input": "",
        "output": "hi based on the images it looks that you have internal hemorrhoids or piles I would like to know the following since how long are you having these symptoms do you suffer from constipation is the blood fresh red or blackish revert with the asked details for better help"
    },
    {
        "instruction": "hello doctor I recently noticed white little lumps on the spots at the back of my throat one behind palatopharyngeal arch which is a red lump and another on the back of my throat each side with red bumps and white little things on them what is it I do not know how long I had it I do not drink or smoke is it cancer like throat cancer or mouth cancer I am a 27 year old female I have white sack looking things behind my tonsil as well with which look like blood vessels but anyway I am sending the picture I am scared please help",
        "input": "",
        "output": "hello I have seen the picture the red bumps with white little things on them at the back of the throat behind the palatopharyngeal arch are called lymphoid granules these are lymphoid tissues that are normally present however in you they seem to be slightly enlarged when enlarged and infected they are very congested red and may exude pus in your picture I cannot make out pus the enlargement without redness or pus may indicate chronic throat infection in case of chronic pharyngitis or tonsillitis you may be having these bumps for a long time however you may have suffered throat pain fever soreness difficulty in swallowing and painful swallowing intermittently they are not cancer the tonsils appear normal to me they do not have a smooth surface they have pits called crypts through which tonsillar secretions come out into the mouth when the pits are clogged then you may develop tonsilloliths or stones which may be painful and give globes feeling otherwise the tonsils look normal if you suffer from the intermittent symptoms I mentioned then perhaps this is a case of chronic tonsillopharyngitis where we can explore the option of surgically removing the tonsils from both sides to give you relief from the symptoms otherwise we need not bother"
    },
    {
        "instruction": "hello doctor I am years old I am a typical introvert person my problem is I procrastinate a lot sometimes because of social or workplace anxiety but sometimes just for nothing I have read many online blogs and watched motivational videos about it I can understand my problem and know what to do but when I think of taking the step I feel pressure inside that I cannot overcome and again I procrastinate maybe I need to awaken my willpower but do not know how I know there are many others like me and maybe it is normal for us but I really want to change myself what should I do",
        "input": "",
        "output": "hello procrastination is a common trait present in almost all humans you are insightful about your problem and its commendable that you are trying to address it and change yourself many people do not even recognize procrastination as a problem as you know people who are able to avoid procrastination are more productive what sort of career you are in how much is procrastination affecting your daily life is procrastination affecting both your personal and professional life sometimes when there are more routine and strict deadlines in office we tend to perform better and avoid procrastination I will suggest you write down and make a list of things you could have achieved in your life if procrastination was not an issue be objective and just make small points it should serve as a reminder and motivate you further to avoid procrastinating further break all work or goals into small multiple tasks do not aim too big even if you take just a few steps your mind will get a sense of achievement and you can gradually build up the momentum do not worry if you have bad days when you are not able to achieve much humans cannot be perfect all the time make sure your general lifestyle is good eat healthily sleep well and exercise regularly you mention some anxiety so try progressive muscle relaxation exercise and deep breathing exercises discuss with a trusted family member spouse or friend about your struggles and plan to overcome them they can help you stay motivated if there are any other problems like low mood excessive anxiety you can consult your family doctor locally you are welcome to contact us again if further advice is needed"
    },
    {
        "instruction": "hello doctor my father is a 73 year old male with the following diagnoses essential tremor congestive heart failure he has a pacemaker hypertension borderline diabetes arthritis in the hips depression moderate to severe and cognitive issues he received an epidural yesterday for pain in his hips and buttocks and my mother found his medication list and shared it with me I am somewhat alarmed about the anti depressants and opioid combinations in particular after doing some research on serotonin syndrome kindly evaluate his prescription",
        "input": "",
        "output": "hi looking at the age and co morbid conditions the polypharmacy multiple drugs is a must at the same time the clinician will assess monitor the patient for any serious side effects or drug incompatibility since your father has many geriatric complaints I feel all these drugs are required due to old age he may be having some trouble with kidney or liver functions most of the drug gets metabolized in the liver and excreted through the kidneys hence continuous monitoring is required as per the clinician advice I hope you are following the clinician advice regarding depression and pain in the hip the antidepressant drugs and analgesic are unavoidable please do not worry about its side effects like serotonin syndrome this is not seen in all the patients the symptoms of serotonin syndrome will be taken care of by other antihypertensive or cardiac drugs sometimes he develops diarrhea as I told earlier do not worry about the side effects these are not seen in all patients and these drugs are mandatory for your father he can avoid tyearamine rich foods example beer chocolate alcoholic beverages fermented foods cheese sore cream yogurt shrimp paste soy sauce soybean condiments teriyaki sauce tempeh miso soup sauerkraut kimchi etc the antidepressant drugs cause side effects only if more tyearamine rich food is consumed while under the medication I hope this helps"
    },
    {
        "instruction": "hello doctor how conclusive are three months negative hiv fourth generation duo test I did an unprotected vaginal and oral sex with a prostitute and have feet and leg burning pain prickling tingling in feet and hand fingers is there any test that tells I am 100 hiv free my doctor told me it can take up to five years to detect hiv but on the internet it says three months please clear my doubt when can I do the final test and what I do for my symptoms is there any other test for that is this neuropathy of hiv",
        "input": "",
        "output": "hello generally the hiv infection takes few days to years to produce the symptoms it is called as incubation period the incubation period is not fixed in hiv infection it is the time taken for the organism to establish itself within the human body as all of us know that hiv establishes when one immunity comes down so if someone is immunity is good enough he may not develop any symptoms even after hiv infection if the immunity had come down then the hiv infections will be expressed thus the clinical symptoms appear based on patients immunity similarly the few tests show positive only after the immunity has come down but there are some confirmation tests that tell about hiv even in the early stages the fourth generation hiv test is one among such tests thus we can come to the conclusion that you are hiv negative the peripheral neuropathy may be due to other causes definitely it is not due to hiv the first symptoms of hiv infections are continuous fever body weight loss and chronic diarrhea in advanced cases there will be white coating in tongue continuous sputum expulsion by cough and peripheral neuropathy I feel you no need to repeat the hiv test again if you still want do it after one year be prepare your mind that hiv is negative for you it is the confirmation test"
    },
    {
        "instruction": "hello doctor I think I might have glaucoma I have vomiting loss of consciousness and blurred vision 12 in the right eye and in the left eye all details are in the attached report I can send photos I am currently taking medicines for depression",
        "input": "",
        "output": "hi I have seen your attachments it seems like you have posterior uveitis there is a reaction in vitreous and also inflammation in the retina however vomiting and blackouts can be due to neurological deficits please get an mri brain and also followup with a neurologist in the meantime start timolol eye drop twice daily and moxifloxacin and dexamethasone eye drop four times a day"
    },
    {
        "instruction": "hello doctor I did a herbal cleanse which seemed to cause a blockage I worked with suppositories fleet laxative magnesium supplements senna docusate for temporary results my symptoms are straining excessively feeling of rectal blockage digital retrieval to relieve pressure feeling of incomplete evacuation intermittent pressure rectal area and dyschezia feel this can be the case even with soft stool I used miralax for eight days shortly thereafter I took 500 my magnesium capsules and benefiber the next day the stool was bulky good diameter and easy to pass I took the same supplements but for the next day the stool is fairly bulky with some strain I used the restroom four times to empty the rectum with straining later pressure cannot be moved so used suppository I am concerned about impaction but no blood or leakage I had a history of constipation but never like this before I am taking dilantin and levothyearoxine for several years",
        "input": "",
        "output": "hello from what I could make out from your description is that you have history of constipation but have a recent worsening possibly due to the cleanse you have a background of hypothyearoidism you have used a plethora of laxatives with some partial relief for your immediate relief I would recommend using safer laxatives like peg polyethylene glycol and stool softener under the guidance of a physician or a gastroenterologist you should also get your thyearoid profile checked as uncontrolled hypothyearoidism is a known cause of constipation do not strain excessively and use enema or suppositories if you feel impaction you may require a colonoscopy in case you have not had one recently I hope this helps"
    },
    {
        "instruction": "hi doctor I am 30 years old I have brca1 genetic mutation that is still undergoing more research as they are not sure of the exact risk yet my mom had breast cancer at the age of 56 and her cousin had the same at the age of 46 they were both positive to hormonal therapy another cousin had ovarian cancer at the age of 49 they are all cancer free now I have a fibrocystic breast and one fibroadenoma confirmed with a biopsy three years ago I had an ultrasound scan three months ago and found more cysts and nothing major to worry about I had another ultrasound a week ago as I felt a new little lump that lump turned out to be another cyst but the doctor found another lump she had not seen three months before it has regular borders and it is moveable but it has some vascularities she says it cannot be a cyst and could be a fibroadenoma but it has to be confirmed by a biopsy which I will have next week I know that sometimes triple negative breast cancer lumps can be mistaken for fibroadenoma but how likely is that chance I am feeling quite anxious and worried with a fibrocystic breast is it possible to have a fibroadenoma appear this fast or is it possible that an ultrasound would have missed it last time",
        "input": "",
        "output": "hi welcome to icliniq com since you have brca1 breast cancer type positive with a strong family history of breast cancer there is always a risk of developing cancer you need to have a regular followup ultrasound sometime may miss early changes since you have a high tendency of developing cancer you can undergo a complete mastectomy it is a tough decision for you but it is worth"
    },
    {
        "instruction": "hello doctor I think I have a problem with premature ejaculation for the past five to six months because of stress it lasts for only three to four minutes after almost 15 minutes of foreplay what is an ayurvedic medicine you can suggest for immediate results will it cause any side effects also how long I need to take such medicines",
        "input": "",
        "output": "hi for immediate result pde5 phosphodiesterase type inhibitor is the only option but it has its own side effects kindly share more details so we can find the cause of your issue there are many reasons for premature ejaculation stressful work night duties 24 hour jobs diabetes hypertension thyearoid issue has an effect on premature ejaculation keeping your blood sugar blood pressure and thyearoid hormones under control will help you long term antihypertensive and antipsychiatric medications frequent masturbation excess porn receiving less foreplay from partner or lack of knowledge regarding foreplay and female masturbation having an affair giving you a guilty feeling lack of exercise and obesity need to check fbi fasting blood sugar and pubs post prandial blood sugar to rule out diabetes check your be blood pressure free to ash thyearoid stimulating hormone for ruling out thyearoid issues kindly share details regarding the above reasons so we can work on understanding the cause and plan treatment accordingly"
    },
    {
        "instruction": "hello doctor one week ago I started feeling pain in the mouth in the left side last tooth the pain was so severe that I was unable to open mouth and also ulcer over that area was not visible to the doctor go he advised me to take becosules rubifol and zoon it for five days I started taking those medicines but I started feeling pain in the full left side teeth and jaw that extends towards the ear after searching over the net I came to know that it is a swelling of gum and something called gingivitis which may be the cause of my pain after I have gone to the dentist she advised me the following medicines augmenting 625 my ads for five days metrogyl 400 my ads for five days chymoral forte be for five days zerodol be for five days rantac 150 my od for five days I asked the dentist to reduce so much of medicine but she told me that you cannot modulate the antibiotics as it is a course plus she told me that your affected teeth I beneath the swollen gum needs to be surgically removed once you get back to normal I started taking these medicines leaving the above medicine advised by go except becosules now my queries are after one day I started vomiting and minor flecks of blood were also visible in the vomit now I want to know whether I am taking the right medicines and the right dosage whether any of the above medicines can be removed since I had gone to the dentist after full five days of ulcer medicines my jaw was not opening that time but from the next day I started reliving pain and gradually my jaw also started working and helps in chewing foods so can I reduce the dosage of the above medicines and leave zerodol as I think it is a pain killer and I do not have so much pain now I am scared of hearing surgical removal of my teeth so whether it is necessary to get it removed will I get back to normalcy after medicine whether removal is actually required in case of gingivitis any other suggestions",
        "input": "",
        "output": "hello I am sorry to hear about your problems the symptoms and line of treatment you have described points to be normal though you can take painkillers as per your requirement I advise you to not to stop the antacid rabeprazole and domperidone in many cases as they may help you prevent conditions like nausea and vomiting the blood appearing is alarming and the source of bleeding should be figured out notice if the blood is coming out along with pus of the tooth or not you may consult or call me in this regard it would be better if you send me a picture of the tooth and gums in questions to pinpoint the condition it is not always necessary to go for surgical procedures"
    },
    {
        "instruction": "hello doctor I am 40 and male do not smoke four years back hemoglobin was 18 rec normal hematocrit 50 normal now hemoglobin was 18 value was up to 17 rec normal 78 value up to and hematocrit at 50 platelets were 26 the doctor thinks I just run high but nervous would the counts be much higher all other values are normal should I worry about anything like polycythemia",
        "input": "",
        "output": "hello your hemoglobin level and red blood cells count are slight high the hematocrit level is within limit so you can have secondary polycythemia case drink lots of water at least 3 liter per day I suggest you investigate with serum ego estimation ekg and chest ray investigation for further work up your physical examination also should be done if all reports and physical evaluation is within limit then you may need not worry about that"
    },
    {
        "instruction": "hello doctor I am a 19 year old female in college and I have been struggling with my mood lately during the day I am super loud and happy but when I am alone or bored my mind wanders and I find myself get deeply sad I also sometimes get irritable and snap at people I do not know why I get sad or angry I also sleep all the time I am on lexapro for my anxiety I am worried with how fast my mood changes and how sometimes I think everyone likes me and then all of a sudden I think they do not what is going on and could it be some other mental illness",
        "input": "",
        "output": "hi I have gone through your query and I must say that it seems you are going through a tough time for most of the cases who are going through what you are going through exercising helps I would suggest you start engaging in some physical activity for your blood flow to increase in all parts of your body and help you remain energetic for a long time this will help you have an activity in the times you are alone and then make you tired to sleep and rest apart from this also try and find activities that you can do once you are back home so that you can substitute the quite and lonely time with doing a task which interests you I hope once you start practicing the above mentioned on a regular basis you will feel better all the best"
    },
    {
        "instruction": "hello doctor I am a professional rugby player who has recently broken and had my three front teeth removed I have had two implants fitted and currently have to wear a denture until I get the crown and bridge fitted I have been advised by one dentist to avoid playing rugby again as an impact could break my jaw bone however another dentist has said that the implants are meant to be resistant and with a professional gumshield the risk is not much higher than with normal teeth I would like to get some other opinions on my situation whether I should wait for a certain amount of time before playing again or if it is reasonable to consider playing immediately with a gumshield or if I should be very careful and consider playing altogether",
        "input": "",
        "output": "hello I understand your concern the normal healing time of bone is six to eight weeks however complete healing may take anywhere between three to six months in the case of implants it will take a minimum of three months for it to closely adapt to the surrounding bone and gain stability this is the most crucial phase in the entire treatment the amount of stability gained in this healing period determines the success rate and longevity of the implants temporary dentures made of acrylic may not create and actively transfer the chewing and other forces to the implant and hence suggested during this healing period any disturbances or accidental injuries to that area during this period can lead to failure of implants which is the most advanced option for replacement in this worst scenario we will have no other option other than giving a removable denture I understand your dedication and involvement towards your profession but please do consider the safety of your implants in which you have invested your time and money although you would be wearing a professional gum shield over the implants any accidental injuries could deliver the impact across your jaw bone thereby delaying or disturbing the healing process I hope this helps"
    },
    {
        "instruction": "hello doctor my daughter is years old and got a stroke for the first time that lasted for 25 minutes after eg we came to know that she had a partial seizure doctor prescribed her epilex chrono 200 is it fine she is complaining of occasional headaches for the past two years",
        "input": "",
        "output": "hi surely I would like to answer this with my best concerns but for that what actually happened during the event did she have involuntary movements like head turning uprolling of eyeballs frothing from the mouth and loss of consciousness seizure and stroke are entirely different things and their treatment is different please do not just mention stroke please tell what happened to her I shall interpret myself if it was a stroke or a seizure I hope you got it please ask a follow up question with the required information"
    },
    {
        "instruction": "hello doctor the right area of my tonsils are swollen in the swollen area there is a hole with like rice thing I do not know what it is I had a nose problem when I sleep where only one nose hole functioning well I also always snore at night the swollen area has been decreased a bit on my right neck I hope you can help me I am currently taking habbatus sauda",
        "input": "",
        "output": "hello based on your message I could understand that you have either tonsillitis or adenoids usually this problem gets solved as the child grows I mean your problem is persisting from your school days till now this is due to the chronic settlement of few bacteria in your throat which leads to the settlement of the same bacteria nearby lymph node right neck so please follow the following advice a use warm water and salt for gargling the throat every third hour continuously use alum small piece dissolve in warm water and do throat gargle before bedtime if you do not get alum no issues you can do with regular saltwater make a drink using five pieces of garlic with 150 my of boiled milk and honeny drink it twice daily if possible practice pranayama do not use cold items which are kept in the fridge karisaalai madakku thailam a siddha drug if you can get it this should be applied on your hair scalp daily half an hour before bath the same oil few drops to be applied on your tonsils with the help of earbuds this should be done daily three times if you follow these advice within one week you will get relief if you continue for three months you will get a complete and permanent cure"
    },
    {
        "instruction": "hello doctor my father has debt I am upset severely by that and I am 26 years now all are asking marriage questions believe me my ambition is to get into the politics or to do social service the relatives laugh if I tell this and I do not want to get into relationship I hate marriage and commitments because of all this I feel like dying and stressed out so much kindly help",
        "input": "",
        "output": "hi I can see that you are under a lot of stress to start with the debt I do not know the financial details and your social economic position so cannot comment on how you can come out of it but to start with you have to understand that this is your reality instead of getting upset about it try to sit and practically think of what you can possibly do to start with to help your father in this situation getting married does not mean that you cannot help your father or you have to abandon the responsibilities you feel you have regarding your family as a female I can understand your feelings it does happen in many cases that after marriage the in laws expect the female to just look after their family and not have involvement in her own family but times have changed now even I am a female and I do support my family even after marriage as much as I want the good things to do would be to communicate with your potential partner about how you expect your life to be clear with your partner that after marriage you will be taking care of your own family and not abandon them the relatives and society are just chatter do not get bothered with that getting married is not a bad thing everybody needs someone in their life as a partner make sure you find the right partner and you will realise that it is a good thing regarding social service I can see that you are altruism tech and you strive for higher good it is a very good thing but remember whenever you will try to do something which is not normal for the people around you they are going to laugh it is your choice whether you listen to it and get stressed or you ignore it and do what you want to work in politics or to do social work you do not need to postpone or ignore marriage you can start small do as much as you can in your position and then increase with time if you are not able to handle the stress I would suggest you to talk to a counselor"
    },
    {
        "instruction": "hi doctor I am a 17 year old female I am not getting my periods regularly and they occur once every three months and sometimes even six months I did not have sex ever still I am not getting my periods I started getting my periods in my eighth grade since then they have not been regular please do tell me the reason why am I not getting my periods regularly I consulted with two of the gynecologist they prescribed me some medicines which were having very bad side effects on me so I stopped taking them I still had to know that will I be able to get my periods regularly like every month and will it affect my future in any manner",
        "input": "",
        "output": "hi do not worry this is all normal now you are in a period of adolescence your hormonal levels are not fully mature by around 20 21 years of age you will have regular periods in a normal cycle you should ovulate around the 14 15th day of periods always 14 days after ovulation you will get periods in the initial few years the hormones controlling this ovulation are not fully normal or mature so you do not ovulate so the bleeding which occurs every three to six months is not real periods it may be light bleeding or heavy clots with pain or no pain at all I hope you have got thyearoid profile and serum prolactin done both in empty stomach early morning sample these hormones can affect ovulation even if not overweight try to reduce any mid body obesity around waist thighs and breast these fats can convert into hormones and affect ovulation do not bother for a scan at this age to control weight have regular aerobic exercise and brisk walking have regular dieting and high protein food no fasting no junk foods your weight should be height in am 100 for example 156 am 100 56 keg do not worry about future problems I hope this helps"
    },
    {
        "instruction": "hi doctor I and my partner had unprotected sex she is a virgin we tried intercourse three times and each time it was not even more than 15 seconds as she is a virgin she is getting huge pain when I insert into her vagina moreover as it is hurting her I not even inserted my organ completely into her vagina I have inserted only half of my penis and not more than that I have not even rubbed to and fro in her vagina and there is no chance of ejaculating inside her vagina I do not know exactly whether my precum existed or not because I thought that it will not cause any pregnancy but while going through on the internet the next day I found that precum may also contain a small amount of sperm which also cause pregnancy if they are alive moreover I washed my bud and shaft with soap before intercourse after reading the article the next day I was so scared that she may become pregnant so I asked her to take an I pill in less than 24 hours she took the pill between 23 hours after our intercourse she does not have a regular cycle of periods it varies each time and it was a day usually now I am afraid that her ovulation took place exactly on the same date of our intercourse I am also afraid that she may become pregnant will the pill work or will she become pregnant if it was exactly her ovulation date even if she took an emergency contraceptive pill can she become pregnant even with my precum without ejaculating inside her will the pill work for all cases she is experiencing vaginal dryness from the date of intercourse until today is that any symptom for anything or is it just the pills side effect please help",
        "input": "",
        "output": "hello I do not think you have to worry about this let me explain each one by one if periods are irregular you can never predict when ovulation is it is always 14 days before the periods so even if it is day cycle ovulation will be on the third or fourth day life of egg is only 24 hours then it dies emergency contraceptive is very effective if taken early earlier the better so even if the ovulation has occurred pills will not allow the pregnancy to settle dryness in the vagina could be due to lack of lubrication caused by any infection anxiety or due to hormones in the pills even if you did not have good foreplay her vagina will be dry being a virgin she is prone to have abarations or scratches in the vagina in the first act of sex it will resolve on its own seminal fluid is the clear white fluid before semen ejaculation it contains a high concentration of sperms it need not enter the vagina even if semen falls on the thighs it can swim up because of chemical attraction this fluid is formed only when you have the sexual arousal or touch sensation from the partner it is always better to have safe sex with a condom to avoid all these moments of anxiety if still you are anxious you have to wait until the date of periods and check urine for pregnancy"
    },
    {
        "instruction": "hi doctor for the past seven months I have been getting these reddish pink non itchy bumps on my skin they are round to oval and small to big when they first appear they were all over my arms abdomen back and on my thighs now they randomly show up here and there I had a large one in my elbow crease and it went away after a day or two now I have two small ones on my forearm and two larger ones on my back and one on my left lower abdomen every time I go to the doctor and they disappear some of them leave flat reddish like scar for a few weeks currently I am taking ativan and metoprolol but I was not on these medicines when this rash began what shall I do now",
        "input": "",
        "output": "hi I have read your query in detail and viewed the attached pictures and do understand your concern I need to get a few more details about your lesions you seem to be suffering from chronic urticaria it may be due to many things like chemicals dyes exertion insect bite perfumes packaged foods dietary protein allergens and may be idiopathic usually long term low dose treatment is required in the form of antihistamines example levocetirizine montelukast combination it consists of levocetirizine my and montelukast 10 my this can be taken twice daily in the morning and evening in severe cases your doctor may prescribe you a short course of oral corticosteroids use a medicated gentle cleansing lotion on your skin for bath like cetaphil cleansing lotion wear cotton clothes avoid allergens like pets dust etc if you find any causative factors such as any dietary substance dust exertion etc try to avoid it apply calamine lotion over affected areas revert back with the answers to a dermatologist online"
    },
    {
        "instruction": "hello doctor I have two concerns I have not had sex in over a month and I used a condom with a partner I have been on and off with over the last two years I have never had any sores from him and he never had a sore either my concerns are I have noticed this dark pigmentation in a few spots there is no pain burning or itching they do not appear to be raised it is just a dark pigmentation I did the vinegar test and they did not turn white although the vinegar really burned my vagina a gynecologist I went to did not comment about the dark pigmentation in two exams I have this red area near my vaginal opening that is slightly irritated I know that area has burned a lot with the vinegar so not sure if it is burned from that with both concerns do they look like herpes genital warts or sad please let me know and address all the questions thoroughly please also provide treatment options my lab test shows no chlamydia gonorrhea or trichomonas",
        "input": "",
        "output": "hello do not be worried just a dark pigmentation or red area is not of much significance in herpes usually there are a lot of painful eruptions which is not so in your case in warts there are irregular bumps which are again not so in your case just maintain genital hygiene do vaginal cytology for culture and sensitivity do blood for sugar herpes egg and ig immunoglobulin and and vdrl venereal disease research laboratory avoid soap dettol and touching apply locally an emollient apply locally a clotrimazole ointment review with reports"
    },
    {
        "instruction": "hello doctor I am a 19 year old male I have been to a few ophthalmologist about this and they seem to think it is benign but I want to get some other input on this if I widen my eyes and move my head around I can see shadows in my far peripheral vision moving as my head does and it seems that the shadows change and become different sizes as time goes on now I do have astigmatism in my right eye and from time to time I get aching almost gnawing pains that are with the movement of the eye and has happened in both at the same time before I find that it happens mostly when I am in a place with very weird or bright lighting or when I am looking at a bright screen in a weirdly lit room I suffer from anxiety and depression which is why I guess I am coming out to ask some more questions and I also have asperger's syndrome the aches radiate to my temple as well but as I have said I have been to doctors and they have dilated my pupils and looked at my retina and ocular nerves and told me they looked good so I honestly do not know what could be causing these weird shadows I have had them for quite a while and they also get bigger and more noticeable with head tilt like when I exercise or go running or do something very physical I currently take prozac 20 my and pantoprazole 10 my",
        "input": "",
        "output": "hello what you are describing is most probably breaks in the gel shaped part of the eye and is called floaters it is a normal and physiological condition that we see in patients that have refractive errors and have no significant consequences if these symptoms persist and are causing you discomfort look for an ophthalmologist that does a procedure called laser vitreolysis who could break them down into smaller bits so that you do not notice them that much and that is pretty much the only method of treatment"
    },
    {
        "instruction": "hello doctor I have a metal taste in the mouth hoarse voice and scratchy throat I am not on any medicines or vitamin supplements I have not changed my diet in any way and my dental hygiene is very good I am allergic to aspirin and have no health issues at all I also have two inner ear conditions both are somewhat rare in the right semicircular canal dehiscence and in the left patulous eustachian tube dysfunction what I want to know is whether I can fly take an airplane without getting ill and sustain further inner ear damage",
        "input": "",
        "output": "hello though the history you have given is insufficient to come to any conclusion about the possible causes I will give information about the common conditions which can have such symptoms the most common cause for scratchy throat with hoarse voice is routine throat infections such as acute pharyngotonsillitis or acute laryngitis which usually resolves with simple antibiotics and mouth gargles the next common cause which can present similarly is reflux laryngopharyngitis which is a type of acidity related disorder in this condition constant reflux of digestive acid into the throat causes injury to taste buds vocal cords and throat which leads to symptoms such as change of voice and change in taste in general people with reflux laryngopharyngitis will have symptoms such as burning sensation in chest repeated burping chest tightness dryness of throat etc regarding your inner ear conditions super semicircular canal dehiscence is a rare inner ear condition in this condition there will be giddiness and imbalance when exposed to loud noise and echoing of once own voice etc this condition usually does not get worsened by the change in environmental pressure so air travel would not be an issue in this condition in any case keep anti vertigo medications such as stemetil handy when you fly patulous eustachian tube is a condition involving the middle ear and nose my guess is because of the similarity in symptoms you have given in both the diagnoses I can say that if there is vertigo then it is superior canal dehiscence if there is no vertigo chances of patulous eustachian tube are high in any case people with patulous eustachian tube will have a certain degree of pressure symptoms in ear when they fly but most of the time it would not be very severe you can use simple saline nasal spray before boarding the flight and every two hours in the air to reduce symptoms"
    },
    {
        "instruction": "hello doctor I am a 32 year old female I had my second baby via section a couple of months after I started getting pelvic pain the pain is across my whole pelvic area and lower back and some times in my thighs too very similar to menstrual cramps occasionally I would get a sharp pain on either side of my pelvic area especially on the right side I also get pelvic cramps every time after sexual intercourse and occasional pain when I go to the toilet the pain is bearable and when it gets a little worse I can manage it by taking pain killers I get the pain almost every single day as well not just when I am on my period my periods have always been very heavy and painful from the beginning but have been able to keep it under control by taking the combined contraceptive pill gedarel 30 150 my and mefenamic acid which I have been taking for many years I have also been getting headaches and I am always very tired due to the lack of sleep I get from these pains during the night half the time I feel very stressed out because of the way I am feeling and it is not easy being a mom of two young children as well and having to manage with the pains etc I eventually visited the go and had some tests done such as smear tests infection swabs blood tests and an ultrasound scan everything was normal but the transvaginal ultrasound showed I have endometriosis and adenomyosis I was referred to a specialist gynecologist and although he has given me a course of action to follow for the next six months I felt that the appointment was a bit rushed and I had a lot of questions to ask regarding the two conditions I would really like to ask a few questions regarding the conditions as soon as possible because my next appointment is not for another six months and there are a few things I would like to know about how these two conditions will affect me in the long run I just need some answers for peace of mind nothing specific to me but more about the disease itself the doctor has advised to take the combined contraceptive pill for another six months without a break and to take pain killers as and when required the consultant also mentioned progesterone based methods but we had to rule that out as it causes hair loss and I have been through years of a form of alopecia and have just managed to get my hair back I have tried asking doctors online and have been conned by them because they have taken money from me and just copied and pasted answers from other places online which made me quite upset and furious hopefully someone from here can give me proper and professional answers these are the following questions I would like to ask what causes these two conditions I am aware that these two conditions cannot be 100 diagnosed via imaging methods and laparoscopy is the only method that provides a definitive diagnosis so how can a clinician be sure that they are treating me for the right condition and it is not something worse how will these conditions affect me in the long run if they begin the progress which out of the two endometriosis or adenomyosis is more severe and serious how will they affect my fertility and what would happen if I wanted to have another baby in the future will it be hard to get pregnant will it cause problems to either me or the baby is there an increased risk of miscarriages and preterm labor and if so how likely is this what if I were to come off the pill for whatever reason how can I manage these conditions are there any other methods or a form of lifestyle I can follow to help such as certain dietary intakes etc how can I prevent getting pain when I go to the toilet mainly passing stool and help with sleep any other information will be greatly appreciated also are there any online groups or support websites for these conditions",
        "input": "",
        "output": "hello welcome to iclniq com I have read your query both problems more or less will have the same effect in the long run it might affect you getting pregnant but if you get pregnant then symptoms of endometriosis subsided may be for ever it does not have any effects on pregnancy and baby no risk of preterm delivery or anything the permanent solution for this condition is the removal of uterus and ovary but not recommended if you have plans for further pregnancy of oral contraceptive pills can help you in disease suppression some gnrh gonadotropin releasing hormone injection are also available but they have side effects so not recommend for long term of pills can be taken for years if you miss of pills for two to three months or so then endometriosis should not return back immediately so any time if you want to stop it for a few months definitely you can do that talking about the sharp pelvic pain it could be because of fibrosis after cesarean section you can do some moderate exercise on a daily basis which can help you there are no specific dietary things which can help"
    },
    {
        "instruction": "hello doctor I have a headache back and right chest pain nausea vision blur and dizzy mri brain suggest supravermian archanoid cyst 1 am mri spine suggest straightening of the cervical spine scoliosis of the upper dorsal spine decreased la disc space with mild vertebral waist probably congenital right posterior lateral osteophytosis at the la and la level causing right neural foraminal narrowing please suggest",
        "input": "",
        "output": "hello welcome to icliniq com it is fine about the report please explain the symptoms that you are suffering from then I will explain about the report"
    },
    {
        "instruction": "hi doctor I have a crack that runs from my two front top teeth and it has a green color and is noticeable when I smile it is near the gum line but causes no pain do I need a dentist checkup",
        "input": "",
        "output": "hello yes you need to visit your dentist as early as possible those green lines are basically a form of calcified plaque or calculus in medical term and the reason behind their green color can be chromogenic bacteria these plaques are needed to be removed at the earliest otherwise they will become much more heavy in bulk and will degrade the underlying bone which is supporting your tooth and in advanced stages it may lead to tooth mobility gum recession and in severe cases it can even lead to loss of tooth but you do not have to worry about that cause your disease is already diagnosed what you need is oral prophylaxis and dental scaling from your dentist to get rid of those greenish lines post prophylaxis polishing is required I generally prescribe chlorhexidine 2 oral rinse or mouthwash twice daily for seven days nothing per mouth for 15 minutes after your rinse using this solution never swallow the solution in case of an allergic reaction to this drug avoid or stop the medication and visit your nearby dentist however allergic reactions to this medication are very rare as per my experience you also need to brush your tooth daily with a soft toothbrush and toothpaste and you must brush your tooth twice a day after breakfast and after dinner to maintain your oral hygiene calculus deposit clinical examination is required to asses probing depths around the teeth greenish to yellowish streak of calculus deposit over upper front teeth and lower teeth also oral prophylaxis and chlorhexidine 2 mouth rinse twice daily for seven days initially brush twice daily following meals follow up required after three weeks after completion of oral prophylaxis"
    },
    {
        "instruction": "hi doctor I am a 27 year old female I am getting acne since the age of 13 I have asthma no product has worked on my face I have sensitive oily skin kindly advice some solution",
        "input": "",
        "output": "hello I have read your query and I understand your concern revert back with the images to a dermatologist online"
    },
    {
        "instruction": "hi doctor I had sex 40 days back I feel burning sensation in penis for last month I had hiv test after 12 days of exposure and it was negative now I have severe throat pain and fever even after three days course of medication what to do please guide",
        "input": "",
        "output": "hi for further information consult an hiv aids specialist online"
    },
    {
        "instruction": "hi doctor I am a 45 year old male my weight is 96 keg and my height is 184 am my symptoms are breathlessness on exertion neck constriction while walking as well as on and off chest pain in the mornings that are unconnected with exertion I am also suffering from severe sleep apnea I had tit positive mets 3 minutes and it depression of 5 to my in inferolateral leads I underwent coronary angiography last week fortunately no significant blocks were found doctor said many small blocks are there which do not restrict the flow of blood the diagnoses are minor coronary atherosclerotic disease and systemic hypertension the report says only minor plaques in lda and lex does this mean angiogram is negative I mean normal if so are my symptoms non cardiac in nature can I ignore further chest pains or where should I go to treat them am I right in thinking that this report means I am unlikely to have a heart attack at least in near future what are the chances that these minor plaques may progress and become bigger or serious how will I know if and when the blocks become bigger since my stress test was already positive false positive is systemic hypertension the same as high be my be was only 130 80 at the hospital my home be machine often gives 150 160 90 how did they diagnose systemic hypertension being a wonderful doctor I need your help again today",
        "input": "",
        "output": "hi I am really thankful for your kind comments you have always been so nice and a health conscious person I want to assure you do not worry as everything is going to be fine soon I have thoroughly gone through your case and can well understand your genuine health concerns thanks for attaching the supporting documents attachments removed to protect patient identity for a thorough insight on the issue you had an unremarkable angiography it was a very good and a bold decision to go for a timely angiography I appreciate that you did as advised now at least we have got a direction to move on now I will reply every part of your query in the order"
    },
    {
        "instruction": "hi doctor my right arm is numb from the elbow to the wrist and sometime I feel like getting electric shock inside about 29 years ago I got my ca c5 lower disc removed I have neck and back pain too and for which I am taking lyearica now I had an mri and the report is as follows tight cervical spinal canal at c5 ca disc level and posterior disc herniation seen inventing the ventral aspect of the cord in c3 ca c5 and ca mild diffuse posterior disc bulges seen please guide me",
        "input": "",
        "output": "hi degenerative changes surgical decompression avoid lifting weight and use cervical collar revert back with mri report to a spine surgeon online"
    },
    {
        "instruction": "hi doctor my hug level is not doubling what can be the reason a week back it was 250 and now it is 423 is this abnormal please suggest",
        "input": "",
        "output": "hi if hug human chorionic gonadotropin report can be relied it indicates possibility of impending abortion miscarriage for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I have been bleeding heavily from my vagina for past five days it only happens when I either open my bowel or while urinating I put in a tampon to confirm that the bleeding is coming from my vagina and not from rectum when I am not using the bathroom there is no bleeding and no blood on underwear but as soon as I urinate and have a bowel movement I start to bleed it is not just spotting it is a heavy bright blood to sometimes dark heavy blood it reminds me of my heavy days on my periods I am nowhere close to my periods now I am taking birth control and have been getting my periods correctly each month this bleeding is not a consistent flow it only happens when I use the bathroom it is like I have blood pool above my vagina and the minute I push a little to pee or have a bowel movement it spills out I do not have period cramping but the pain will be like a dull achy to sometimes sharp pain especially when the blood comes out it radiates all over my pelvis ovaries stomach and back sometimes to my kidneys I did consult a gynaecologist earlier today he pressed on my stomach in which I had some discomfort he also did a vaginal exam and said there was a lot of mucus with blood when pressed inside I felt little discomfort he did a swab and sent it out to be checked for infection and prescribed me some antibiotics just in case it was an infection he also scheduled me an ultrasound for next week and wants me back in two weeks he told me to come back sooner if it gets worse he seemed quite concerned this evening I have started to become more dizzy and lightheaded could this be just an infection or something else I do not have itchy or burning vaginal symptoms that you get when you have an infection I am really worried about this I am scared of cancer now as I knew that the abnormal bleeding and pain are signs of reproductive cancer so I need a second opinion from another doctor while I am waiting for the results",
        "input": "",
        "output": "hi I believe this is the first episode of heavy intermenstrual bleeding or polymenorrhagia for you and during the mid cycle if the bleeding is not controlled and remains heavy causing anemia and dizziness as manifestation then to stop the bleed the best way would be to undertake a dilatation and curettage procedure through which can remove the endometrium and subject sample for histopathological exam to rule out any endometrial hyperplasia and accompanied atypia which may indicate towards an endometrial cancer depending on the reports at present wait and watch for excessive bleeding for few more days and if it does not reduce then review with er and get the ultrasound done sooner and further evaluation keep yourself well hydrated to maintain the blood volume and avoid dizziness episodes for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor this query is regarding my dad he has been limping for a year now he is a construction worker and about two years ago he accidentally fell down from the first floor he reassures me that his left leg limping is not due to the fall he had about 20 sessions of physical therapy he went to a pain specialist who injected him with steroid injections but that did not help the pain specialist also performed an electro test to see the response reaction in both feet the right one jumped and the left one did not he said he barely felt any sensation in his left leg his left leg is not responsive and he cannot carry it around we had an mri and consulted a neurosurgeon the neurosurgeon said that he is not to be operated on the result of his mri is as follows 47 years old with radiculopathy correlation is made with prior mri of the thoracic spine findings are mild spondylotic changes are seen within the cervical spine with disc desiccation multiple levels ca c3 there is a shallow central disc herniation impression on the thecar sac c3 ca no focal disc herniation or neurocompressive changes are seen ca c5 shallow central disc herniation impresses on the thecar sac c5 ca there is central disc herniation with effacement of the ventral csi ca shallow central disc herniation impresses on the thecar sac ca to no focal disc herniation or neurocompressive changes are seen vertebrae the vertebral bodies demonstrate normal height and marrow signal characteristics spinal cord there are multiple foi of abnormal to signal within the substance of the spinal cord one at the ca level and one at ca it is unclear whether this reflects myelomalacia versus the possibility of a demyelinating process clinical correlation as well as evaluation of the intracranial compartment with mri of the brain is recommended craniovertebral junction the craniovertebral junction is unremarkable mild prominence of the nasopharyngeal soft tissues is incidentally noted please correlate with direct clinical examination impression is multiple foi of abnormal to signal within the substance of the spinal cord as described these may be on the basis of myelomalacia however given the patient age the possibility of a demyelinating process is not excluded clinical correlation as well as evaluation of the brain with mri scanning is recommended mild spondylotic changes within the cervical spine with shallow central disc herniation at ca c3 ca c5 and ca levels slightly larger central disc herniation c5 ca with effacement of the ventral csi mild prominence of the nasopharyngeal soft tissue as I want an unbiased opinion please consider only the results and not the possible diagnosis my questions are what are the possible causes of these what are the outcomes in the future can anything be done to regenerate neural tissue and myelin finally how many herniated discs does he actually have",
        "input": "",
        "output": "hello for further information consult a neurologist online"
    },
    {
        "instruction": "hi doctor my month old baby boy has swelling in tibia bone he does not have any pain or irritation over the swelling he started standing by his months onwards what is the reason for this swelling",
        "input": "",
        "output": "hi revert back with the photos to an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hi doctor I have taken morning after pill after having unprotected sex on my est day of periods feeling vomiting sensation but there is no vomit happening please help me",
        "input": "",
        "output": "hello for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor my grandfather aged 85 years is having a lot of itching on his body the main areas are his arms and back there is a lot of inflammation at times and all of a sudden the inflammation increases and then goes down it appears in cycle he has been prescribed with the following medicines namely tablet tenzin my and momate cream he used these medicines for weeks it was good while he was using them but then again itching started slowly once he stopped using them please advice some other medicine as there is dryness in mouth when he uses these medicines thank you",
        "input": "",
        "output": "hello I have examined the pictures as well as carefully noted the details provided I understand your concerns and will do my best for further information consult a geriatrician online"
    },
    {
        "instruction": "hi doctor I have left sided crappy stomach pain and chest pain which is mostly located under breast near ribcage about two years ago I got streptococcal infection pneumonia and bronchitis at the same time in er they prescribed amoxicillin but it did not work for me as I am allergic to penicillin and amoxicillin that is the only time I can remember being in this pain three weeks back again I had streptococcal infection my doctor said that I might have flu and I am on azithromycin now I am wondering are stomach cramps chest pain back pain and labored breathing symptoms of flu please do the needful",
        "input": "",
        "output": "hi I have read your query and understood your health concern infection by streptococcus or viral complete blood count chest ray nasal and throat swab culture per for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I took a mucoram pill along with rhinocort spray then I had hyperventilating difficulty I could not swallow and I cannot balance myself and felt more tired and weak I feel that my brain became numb for a month after a month I am good now but still I feel some pressure and continuous pulse in my head all day my blood tests are all normal please help",
        "input": "",
        "output": "hi I read your question and I understand your concern allergies recent sore throat cold flu and seasonal variation pulmonary functions test allergen immunotherapy allergen sensitivity test peak flow meter fev1 forced expiratory volume in the first second allergic bronchitis sinusitis laryngitis pharyngitis asthma sinusitis decongestant mucolytics and home remedies avoid allergens pollen use humidifier and avoid beverages cold drinks and spices for further information consult a neurologist online"
    },
    {
        "instruction": "hi doctor I have had abnormal pap tests for the past four years now I am having really thick light brown mucus discharge almost daily the last one this morning was bigger than a quarter what could this be",
        "input": "",
        "output": "hi I understand your concern at the age of 29 years I would want to know what the abnormality in pap smear was I hope it is lil low grade squamous intro epithelial lesion or ascus atypical squamous cells of undetermined significance or only mild dysplasia any of these findings are suggestive of only some infection in the cervix creating some changes in the lining of the cervical canal this only warrants follow up and repeated pap smear evaluation these infections on the cervix can cause small ulcerations which would appear like a raw wound once the raw surface if formed the secretions from the underlying cervix increases just like in common cold secretion from the nostrils increase cervical secretions also increase the sudden appearance of excessive brown discharge can follow any local insult like recent sex or recent periods or local trauma by a tampon or even urinary infection but it is not to be worried about if it is been a year since last pap smear or at least six months have a repeated smear you may need local antibiotic treatment if the cervical erosion is significant and the abnormality you are experiencing in pap is more than what I mentioned then you may need excision of the ulcer with cryotherapy or electrotherapy or chemical but at this young age of 29 years and as the doctor has put you follow up for four years I bet you belong to low risk stage nothing to worry about just simple treatment of local medication will do"
    },
    {
        "instruction": "hi doctor my father had a surgery for cancer and subsequent chemoradiation on cheeks after that he developed a wound on right cheek which developed into a big hollow wound please help us",
        "input": "",
        "output": "hi for further information consult a surgical oncologist online"
    },
    {
        "instruction": "hello doctor my father is years old he is a patient having do cad cab it cod and sht now he has severe cough for more than 15 days and can see blood occasionally while spitting he is also undergoing dialysis twice in a week his present hemoglobin is 1 creatinine is 6 and urea is 81 I am worried whether it is cancer please help",
        "input": "",
        "output": "hi welcome to clinic com for further information consult a medical oncologist online"
    },
    {
        "instruction": "hi doctor I am having vision problem in my right eye I had corneal transplant done and no stitches have been removed my vision is opaque now is this possibly a rejection for the eye I am using prednisolone timolol antibiotic eye drops and euro 128 I am diabetic and also taking medicines for blood pressure cholesterol depression and prostate problem please help",
        "input": "",
        "output": "hi revert back with the photos to an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor my earlier ultrasound mentioned big head but my present ultrasound done in 36 weeks says big head with mild prominence of bilateral lateral ventricles my radiosonologist did confirm big head but on part of hydrocephalus she was not sure I have attached the report for your feedback",
        "input": "",
        "output": "hi I have checked the attachment mri brain revert back with brain mri to a paediatric surgeon online"
    },
    {
        "instruction": "hi doctor I am a 23 year old man I am working in a hospital cafeteria when I was washing a cart for coffee I saw a red spot I freaked and I became worried it was blood and I have a few cuts on my hand I did not wear gloves now any time I see red color I have phobia I am worried whether I will develop some infection please help",
        "input": "",
        "output": "hi revert back for doubts to a community medicine physician online"
    },
    {
        "instruction": "hi doctor my dad is without ventilator support since 40 days and his tracheotomy has also removed five days back without any life support system he is currently breathing by himself for last 8 days with saturation level 100 on air past four days he is able to keep his eyes open for few minutes and moving his pupils and following the moving objects my brother showed him pictures of family members and he is trying to look at the picture and recognize it he is trying to hold hand or other objects with his left hand when asked he has minor movement in his left leg as well but there is no movement on right hand or leg and occasionally he moves his neck I have attached a video showing his movements bedsores on side of the head and hip continues to be a point of concern as per your advice I had requested the treating doctor for mri however they only did a it scan and the same is attached for your reference I am also sharing the two it scans which they did two months back for comparison please advise on the below his left hand and leg getting stiff and he was given baclofen for the same is there other better medicine apart from changing position every 2 hours and applying candid powder on the affected area is there any medicine for curing bedsores do you see any chances of recovery from here what needs to be done next for reasonable improvement do you see any chances of him speaking soon below are his vital statuses serum sodium 129 serum potassium 8 serum chloride 98 serum creatinine 6 egfr 103 blood pressure 150 100 of saturation 100 maintaining without oxygen support for last 8 days pulse 75 90 blood sugar 230 to 265 after taking insulin comes down to 140 160 I have attached the list of medicines which he is taking for the past one week kindly guide us",
        "input": "",
        "output": "hi thank you for the detailed information I am happy to see your father improve gradually here is what I suggest for further information consult a neurosurgeon online"
    },
    {
        "instruction": "hi doctor I am using ocp for last 5 months in my last cycle I took active pills for days but took two cops each day from day19 to day along with this took an I pill on day18 of ocp cycle on ith day of pill free break got withdrawal bleeding I want to know when to start the next pack to remain protected without requiring any backup method can I start after day of last pill or day of withdrawal bleed or day of withdrawal bleed please let me know if day start and day start are same or not if in any cycle I take active pills for or 23 days to delay withdrawal bleed a little then take a break and start next pack on and or ord day of withdrawal bleed is it fine thank you in advance",
        "input": "",
        "output": "hi following are answer to your queries for further queries consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor my girlfriend was expecting her periods between ord and ith of last month we had protected sex on ord after hours she took an I pill then again on ith we had protected sex and after 10 hours she had another I pill now it is 12th and she has not had her periods but only spotting is there are there chances of pregnancy",
        "input": "",
        "output": "hello thanks for using this platform for further information consult a sexologist online"
    },
    {
        "instruction": "hi doctor my wife is 27 years old and 13 weeks pregnant now as per suggestion from doctor we went for a double marker test it is found that trisomy 21 it risk is 86 and doctor suggested for amniocentesis procedure now I am confused and do not know what to do my wife scared that the procedure is risky and painful please explain us about it",
        "input": "",
        "output": "hi for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I was diagnosed with asperger syndrome when I was 13 years of age I am now how does the dsm change that disorder",
        "input": "",
        "output": "hi asperger was previously regarded as a separate disorder but now it is categorized as a form of autism spectrum disorder and in dsm diagnostic and statistical manual of mental disorder and includes by the current dsm criteria individuals previously diagnosed with asperger syndrome would be diagnosed as having and without language or intellectual impairment this is because previously when asperger was introduced in 1994 it was distinguished from autistic disorders as there was no delay in language and general cognition but now it is put under autism spectrum disorders because there is no evidence of different response to treatment or of a distinct cause in asperger syndrome versus high functioning autism previously asperger was diagnosed only if they did not meet the criteria of autistic disorder so to resolve this confusion both were kept under the same umbrella of and for further information consult a general medicine physician online"
    },
    {
        "instruction": "hi doctor I am a 20 year old female and having modular acne for more than a year it looks very terrible and painful in my teen age I had pimples but of moderate type I have tried every possible treatments such as chemical peel and isotretinoin but nothing worked currently I am taking divya kayakalp which is an ayurveda tablet how can I get rid of this please help",
        "input": "",
        "output": "hi I can understand your concern seborrhea hormonal imbalance lipid profile liver function tests acne vulgaris follow up after five weeks to a dermatologist online"
    },
    {
        "instruction": "hi doctor around 12 years back my unsealing leg wound was cured by multiple skin grafting now after 12 years the wound opened up reason is unknown is it varicose I have attached the latest snaps",
        "input": "",
        "output": "hi can be due to weak immune system or malnutrition or chronic medical illness over tightening of sutures or poor suturing technique followed it can also be due to the suture material used in appropriate surgery site grafted smoking can be a cause can be due to obesity it could have caused because of premature post surgery exercise heavy lifting physical examination from a general surgeon is a must blood tests such as abc complete blood count and wound culture to be done check post prandial fasting blood sugar and glycated hemoglobin up fbi hba1c wound dehiscence good wound care and hygiene with appropriate dressing and cleaning as instructed by your doctor regular wound dressing antibiotics to be taken if the culture is positive for micro organisms revert back with the investigations to a general practitioner online"
    },
    {
        "instruction": "hello doctor I am suffering from chronic gouty arthritis it started ten plus years ago and now progressed to every joint in my body with multiple joint attacks at once I have contact pain in joints even if there is no attack the attacks jump from joint to joint nonstop I have seen many doctors they can only give me shots and prescription of indomethacin which is not working for me as it has been taken for more than 10 years I have changed my diet to exclude a lot of food and drinks with sugar purines citrus salt etc right now the pain is in my ankle knees and left arm shoulder rotator cuff elbow wrist thumb and neck I have been very depressed and go to bed in pain and wake up in pain daily my daily functions are limited",
        "input": "",
        "output": "hi I have gone through your history and it is a bit unusual for a 40 year old to have polyarticular gout that is involving a lot of joints firstly I would recommend you visit a rheumatologist near you to sort it out meanwhile first we should rule out if it is gout only or some other form of arthritis which are intermittent sorts like gout such as palindromic rheumatism I would like to know your last uric acid levels and if you have ever got rheumatoid factor of and anti cop anti cyclic citrullinated peptide done if it is gout then indomethacin is just going to help the attack you need to start on proper medications the treatment would be to start tablet zycolchine colchicine along with drugs like febuxostat or allopurinol 24 hour urine for uric acid rheumatoid factor anti cop antibody liver function tests kidney function tests palindromic rheumatism zycolchine high fluid intake consult a rheumatologist at the earliest"
    },
    {
        "instruction": "hi doctor my problem is I am not able to get fat doctor please help me to get fat",
        "input": "",
        "output": "hi with the details you gave I understand that you are an 18 year old girl who is slim and unable to increase weight also I see that your body mass index is 15 43 where as the weight that is desirable to you would be about 50 to 53 keg you are in your puberty and hence there will be growth spurt because of which the body energy would be used fast to put height and other bodily developments also this is the time your body sexually matures these might be the reasons why you are unable to put weight however I give you the following suggestions to help increase weight and bring it in normal range eat plenty of proteins soyabeans fish chicken take ghee in appropriate amounts you may use ghee as a cooking medium if you are not susceptible to pimples and acne ghee has great deal of energy in it and helps put weight eat adequate green leafy vegetables and minerals take spinach gooseberry fenugreek leaves palak leaves drink to litres of water daily drink 500 my of milk daily make sure the milk is not condensed skimmed milk is devoid of the fat you require the fat increase the amount of food you eat if you are eating meals make it spread out through the day keep your body in shape by exercising so that weight gain is healthy and not in appropriate places practice yoga and a daily workout regime concentrating more on weight gain exercises than cardio exercises help lose weight than gain if still not satisfied take protein powders soy or milk protein powders with good energy content search for protein powders for ladies for putting weight next do not worry unnecessarily about your weight this age one grows tremendously and so it might be difficult to put weight however within a few years your growth spurt will stop and you body metabolism will stabilize take the above measures and follow my advice it is important to keep oneself healthy and appreciate ones own body"
    },
    {
        "instruction": "hello doctor can I put lidocaine viscous oral topical solution qualitest in ear for pain",
        "input": "",
        "output": "hello please do not put lidocaine viscous into ear for pain first of all ear pain can be due to multiple reasons the causes of ear pain are as follows localized causes external ear pina ear canal middle ear cleft eustachian tube facial nerve mastoid cavity inner ear eighth nerve petrositis referred causes throat tonsillitis pharyngitis neck cervical spine disorders spondylosis oral cavity glossitis tootache tooth infection larynx laryngitis epiglottitis under each infections inflammations tumors malignancies non malignant growths hypersensitivities etc can result in ear ache referred earache is due to sharing of same nerve supply by the ear as well as the above said organs hence please do not treat earache on your own I will strongly suggest you consult an ent specialist doctor and follow his advise please provide us with details with regards to the following onset of ear ache duration nature of pain pricking dull aching throbbing any associated giddiness ear discharge headache nausea any throat pain nose block change of voice difficulty in swallowing any previous relevant history with regards to the ear or nose and throat which ear both ears you have fever any neck problems tooth ache artificial dentures next lidocaine viscous is for use on oro mucosal surfaces it is not for use inside the ear it will not get absorbed from intact skin surfaces like what you find in the outer ear where you are planning to apply the viscous top solution to relieve pain I suggest you try paracetamol 650 my tablet one tab sos not more than tablets per day however it is prudent to ascertain the exact cause for the earache and treat accordingly do contact us for any more queries on the subject"
    },
    {
        "instruction": "hi doctor my symptoms include a chest cold for approximately one month 12 pound weight loss nausea dry heaves excessive bowel movements shortness of breath muscle aches left side rib pain fatigue I had normal labs except mildly elevated alkaline phosphate my doctor is now running a all isoenzyme test do I have multiple myeloma am I too young what are my chances what else besides my liver could make that test elevated",
        "input": "",
        "output": "hi after reviewing your complaints and your blood investigation I can draw the following conclusions it is highly unlikely that you have multiple myeloma as your globulins in blood report are normal though it is a rare scenario before 40 years it can happen to people your case seems something else there is however abnormally low carbon dioxide level in your report this occurs because of hyperventilation anxiety some lung pathology more importantly your medication are the most likely reason for your anxiety sometimes these can cause diarrhea as well raised all can be from many causes liver uncommon if you do not have jaundice bone intestine and placenta being most common isoenzyme assay that your doctor is doing will help isolate the source to some extent given your age and your month old respiratory problem I would suspect a lung infection including tuberculosis to can also cause the left sided chest fatigue and weight loss pain itself can lead to hyperventilation moreover your all is only mildly raised which is against the diagnosis of multiple myeloma where it can be in thousands mildly raised all can be due to vitamin deficiency as well given you live in montana low sunlight please discuss with your doctor regarding need for a chest ray and possibility of to and vitamin supplementation do not worry the reason you might feel anxious is most probably your medications take a healthy balanced diet try some meditation as well"
    },
    {
        "instruction": "hello doctor my mother is 67 years old she has the following health issues type diabetes mellitus without complications high blood pressure disorder aneurysm fluid in the lungs hfpef heart failure with preserved ejection fraction atrial fibrillation irregular heartbeat collection of fluid in sac covering heart chest pain chronic left sided low back pain with left sided sciatica temporary loss of blood supply to brain low blood pressure from this year bladder infection currently her most upsetting symptoms are as follows doctors think that she might have to and so she is on to medicine as an empirical treatment severe shortness of breath even when lying on the bed temporary loss of vision currently she sees but not like before low blood pressure she is currently on sodium chloride serum very moody and frustrated and angry most of the time she used to be a very calm person before hallucinations not able to sleep her medications are shown in the attached picture along with the number of tablets per day and the total dosage could you please advise us about the medicines she is being given since she is very upset about it and we think she might not be able to complete the to treatment are there any medicines that have bad interactions or unnecessary",
        "input": "",
        "output": "hi welcome to icliniq com first of all stay calm and support her fully I understand it is tough to stay calm and there are too many medicines to take but she can do this all drugs are correct for the treatment to drugs are very important and one must complete the treatment rifampicin is the drug that might decrease the effect of other group of drugs for which we can increase the dose of other drugs do not take all the drugs altogether go slow keep a gap and keep record of all the blood tests and get them monthly checked to check their side effect on the body by keeping a check you can reach your goal and free of to"
    },
    {
        "instruction": "hi doctor I am a 20 year old male a few months ago I noticed a small lump on my skin directly on my tailbone I picked it and it formed into a small dent I did not think anything of it but for the past one week the same dent has become inflamed on the outer edge and extremely painful to touch I struggle to get up when I sit down as it is painful when I touch it after standing up it feels wet I have just asked my partner to look at it as I cannot see for myself and I gently opened my cheeks she told me that a thick white pus substance was coming out in large amounts I felt again and when I looked at my hands a small amount of white pus was on my nail whenever I have an infection in a scab my pus usually turns out to be a yellowish white or a yellow color so I am quite worried this color is not normal for me please help",
        "input": "",
        "output": "hi from your description you could be suffering from a pilonidal sinus or cyst color of pus yellow or white is not of great concern what can be concerning is a large amount of pus kindly try to quantify it may be in drops or teaspoon measures it is a disease of young men mostly hairy and sedentary lifestyles professional drivers also get it in higher proportions going to see a doctor at local surgery is a good decision the best way for pain relief is surgery to drain it properly and clean it can require to be completely removed in some complicated cases wash the area with soap and water daily try to avoid sitting for long periods in case you are worried about the possibility of cancer it is extremely rare in a pilonidal sinus this is a common problem and only a handful of cases have been reported in the world of some cancer developing in it that also after years of inflammation and without treatment but kindly confirm with your local doctor that it is in fact pilonidal sinus and not anything else"
    },
    {
        "instruction": "hello doctor I have pain in my left upper abdomen and feels like something is about to bulge out I smoke and drink too I feel quite congested and full at times and it has affected my activity too sometimes the pain radiates to the back and I have difficulty in breathing as well I am 2 in height but weighs around 10kg I had reactive arthritis with spondyloarthropathy when I was 17 years old and last year I was diagnosed with costochondritis sometimes I take etoricoxib 120 my",
        "input": "",
        "output": "hi your complaint of left sided pain in the abdomen and its running to the back can be suggestive of one of the following gastritis is the swelling or inflammation of the stomach the acid problems may be due to your obesity as your weight and mi are high 32 89 it may be due to high spicy food alcohol smoking especially in the empty stomach pain killers also can cause it pancreatitis is the inflammation of a deep seated gland called pancreas pain is set on after alcohol intake last for a couple of hours and runs to the back it can be accompanied by vomiting the type of arthritis that you have described can also be associated with some other organ problems but it is less likely what to do about it stop smoking stop taking alcohol at least till this issue has been resolved also I would like to know more about the type and amount you consume and frequency try to lose weight your weight as per your height should be 80 85 keg target for around one to two kilogram loss per week kindly elaborate more regarding your symptom of feeling quite congested and full at times and how exactly this has affected your activity regarding the fullness if you feel a tightness in the abdomen when did it start how has it increased or decreased over the last couple of months do you have regular bowel movements or are you constipated a jumbo plate of salad and drinking three to four liters of water per day will help also it will help reduce weight did you ever need to visit the emergency for this pain if yes what treatment was given please upload the records any investigations done like an ultrasound of abdomen or blood investigations if yes please follow up with the reports if no then I think you should get the following investigations ultrasound of abdomen blood investigations hemoglobin hematocrit hit total leukocyte count tac platelet count test plt ear erythrocyte sedimentation rate serum sodium potassium creatinine urea ast aspartate aminotransferase alt alanine aminotransferase all alkaline phosphatase bilirubin albumin amylase you may require an endoscopy later get back with these questions and investigations or follow up with your doctor in case of severe pain go to a good hospital rather than to stay home and take painkillers"
    },
    {
        "instruction": "hi doctor I had intercourse he did not ejaculate and took an I pill the next day I am suffering from pod and by doctor prescription I took meprate for seven days twice daily but still no sign of periods what can be the causes also after taking the I pill there is no withdrawal bleeding my last period was before two months and it is causing stress and I am overthinking please help",
        "input": "",
        "output": "hi do not worry you have nothing to worry about as you have pod polycystic ovarian disease your ovulation will not be on time as you mentioned that he did not ejaculate and you took I pill within 24 hours chances of pregnancy are very low meprate is a hormone pill that increases the inner lining of the uterus and when you suddenly stop it cause withdrawal bleeding usually you can wait up to 10 days after stopping because you had I pill and meprate your period would have got postponed so I would advise you to wait for periods till 10 days after the last day of meprate if still no periods just for confirmation get urine pregnancy tested I bet it will be negative then take any of the oral contraceptive pills like novelone or ovrel or dear 21 or diane 35 or intimacy plus twice a day for 10 days throw that extra last tab you will surely get periods within the next 10 days if you get periods in between just stop the pills in pod the inner lining of the uterus may not be thick enough so your periods will be light sometimes with pink discharge only so no withdrawal bleeding with meprate these pills will increase the thickness next time onwards never have unprotected sex to avoid these anxious moments I hope this helps"
    },
    {
        "instruction": "hello doctor I see a lump at the opening of the anus it is been there for over a week it is not much painful but it is uncomfortable while sitting I am a 25 year old male it never happened before and no current medications",
        "input": "",
        "output": "hello welcome to icliniq com I have seen the picture you have uploaded it appears to be thrombosed piles it takes a few days for it to settle down well but it is not anything sinister a few things would help to give relief take sit bath a large basin to be filled with warm water and a couple of spoons of common salt to be added and sit in it for 10 minutes twice a day take analgesic ibuprofen or paracetamol twice a day for five days laxatives fybogel for three days and laxido before bedtime for a week these would sort out the pain and discomfort you have higher chances of developing hemorrhoids piles in the long term do exercise regularly eat high fiber diet no restrictions in having nonvegetarian and reduce straining while opening bowels"
    },
    {
        "instruction": "hi doctor I am a 23 year old male I am currently in a relationship with a girl I would like to have sexual affair with her but I am shy I request some tips on how to have safe sex and how to approach the entire act I have searched the internet but it is more confusing secondly I want my partner to try out blowjob is it safe what precaution should I take and how can I lubricate my penis thank you in advance",
        "input": "",
        "output": "hello I appreciate your awareness regarding safe sex and seeking opinion for it for further information consult a sexologist online"
    },
    {
        "instruction": "hello doctor I want to fill the gap in four of my front teeth and reduce the size of two front teeth that seems large than others what are the safest options if I do not use braces please suggest",
        "input": "",
        "output": "hello you have two options laminate veneers which are more esthetic and durable but comparatively expensive composite veneers which are esthetic but less durable compared to laminates"
    },
    {
        "instruction": "hello doctor for the past seven months I have been having the following symptoms they have gotten progressively worse until the point where it is severely affecting my quality of life to where it is hard to function in a normal lifestyle I have this really irritated inflamed and damaged area of tissue on the right side of my throat the area is white and it is covering the bottom half of my vocal cords I taste blood and pus I have an earache in one ear the same side that the throat irritation is on I feel weak faint and dizzy my nostrils are blocked I do not have a runny nose I do not have a regular stopped up nose either when I blow my nose nothing comes out it just feels like the back of my nostrils are blocked I have a lot of trouble breathing which causes my heart to beat very fast I breathe through my mouth but it is not the same I have no heart condition and my pulse never raced before this started happening my blood pressure is fine I have tried nose sprays to open up my nose sinus congestion medications allergy medications I do not have any allergies when the symptoms first started they were not bad but only got progressively worse I went to my primary care physician I was put on antibiotics while I was on the antibiotics and for about a week after my symptoms disappeared but then they came back I went back to my primary care physician he said that since the antibiotics helped the first time maybe another weeks worth would make the symptoms go away permanently the same thing happened while I was on antibiotics and about a week after my symptoms disappeared but only to reappear again I went back to my primary care physician he said that he could not put me on any more antibiotics he did a blood test to see if I have an infection the blood test came back negative for infection he sent me to an ear nose and throat doctor the ear nose and throat doctor did a fiberoptic laryngoscope he found the severely irritated spot in my throat he said it was probably acid reflux he sent me to a gastroenterologist the gastroenterologist performed an upper endoscopy he did not see any signs of acid reflux except for the severely irritated spot in my throat I do not have any of the symptoms of acid reflux even before I started taking protonic he put me on protonic I have been on protonic for two months now the symptoms have only gotten worse all of the symptoms are hard to deal with but I could learn to live with most of them if I had to the main symptom that concerns me is that not being able to breathe good and my pulse racing as a result of that I have a lot of questions but my biggest question is what I can do about my nor being able to breathe well and my pulse racing I have a picture I can send you of my throat when the fiberoptic laryngoscope was done I can send you if you think it would help",
        "input": "",
        "output": "hi I went through your symptoms and pictures your fiber optic picture indeed shows some amount of changes of laryngopharyngeal reflux so even though you do not have acidity and reflux you still have some laryngeal reflux for which you will have to take a proton pump inhibitor tablet pantoprazole 20 my twice a day for one month the white area in your throat needs to be investigated by a throat swab for culture and sensitivity to know if it is actually a bacterial infection regarding nose block have the ent surgeon done a nasal endoscopy in your nose if yes what did he say if not done I will suggest go for a it computed tomography scan pins paranasal sinus axial and coronal view to be done to rule out sinusitis as if sinusitis is too much even then you have these symptoms I hope this helps"
    },
    {
        "instruction": "hello doctor I am 25 years old I have a year old and a year old kid after my son birth I have gained quite a bit of weight just a little over the obese range I say this because I do not know if it has anything to do with my problem I am writing because I am having trouble finding online information about my lower back pain behind the backbone it does not hurt all the time mainly there is constant pain while walking laying flat or when leaning forward without support also there is a real sharp pinch when my kids or spouse push on it either side I am not sure if this matters but once in a while when I stand from the couch there is a pinching pain in my lower front abdomen that goes away after a minute or two is there any idea you may have as to what is going on I have been dealing with my back for a year now and my spouse is starting to tell me to get it checked out I used to take only ibubrufen when I get headaches",
        "input": "",
        "output": "hi I am sorry to hear about your pain but I will try my best to help you from history the lower back pain may be related to mechanical or disc protrusion pied or some rare conditions like a kidney stone or pelvic inflammatory disease mechanical and pied prolapsed herniated or extruded intervertebral disc can be differentiated by a dragging pain to one of your legs in pied dragging pain is common you may need an ray of your lower back this pain is not related to an epidural but as there is a pinching pain in front of the abdomen other causes should be ruled which is addressed with an ultrasound as per your age pied is a common symptom that is addressed initially with conservative management the diagnosis is confirmed with an mri if it is pied need not take bed rest you can do your daily activities if pain reduces completely then start physiotherapy back strengthening exercises"
    },
    {
        "instruction": "hello doctor I have some scars on my legs from when I was a younger kid so when I was younger I fell and bruised and got scars sometimes I would scratch my scars and over time the scars become dark and they look ugly and since then I do not wear shorts or clothes that show my legs is there anything I could try to fade the scars or lighten them",
        "input": "",
        "output": "hello welcome to icliniq com first of all your scratching induced issues over the skin are not scars rather they are marks that too over a background of another mild skin condition that you seem to have scars are aberrations in the skin texture irrespective of the color change what you have is background of a mild skin condition called macular amyloidosis ma you may see light brown colored speckled pigmentation in coalescing patches over your leg shins these arise spontaneously mostly without any cause although friction contributes to it in terms of making it worsen and darker so do not scratch any further few marks these are the smaller spot like darker brown colored discrete and are a few in number a result of the healing of the skin over your pointed scratched areas now ma does not have a permanent treatment and also often does not need it may also affect the upper back and upper arms just have a look sometimes it tends to run in families moisturization with cetaphil dam lotion after bath and before sleeping tends to reduce the associated dryness itching as well as roughness of those areas but many times especially in girls and women ma is associated with thyearoid dysfunction so please get your serum ash thyearoid stimulating hormone blood test done for the brown marks that are bothering you will require a depigmenting cream to be applied in the night just over the spots and a broad spectrum sunscreen with spy 50 sun protection factor in the day time on the entire legs daily I believe cetaphil uva uv sunscreen or anthelios xl spy 60 or avenge sunscreen may be available to you over the counter use them daily over the entire legs and first coat to be applied at least half an hour before going out now I would not be able to tell you which depigmenting skin lightening creams are available in your place but you can check with your local pharmacist you could select from a range of combination creams that often contain varying proportions of hydroquinone koji acid glycolic acid arbutin azelaic acid mild steroid tretinoin vitamin or etc although it would be ideal that you get a prescription cream from your dermatologist till then you may for the short time 15 30 days only use one of these creams to be used as spot therapy only over the dark spots in minuscule quantities that too strictly at night and discontinue using it if it causes excessive redness peeling irritation etc additionally take some good oral anti oxidant capsule daily for two to three months for best management please revert back with the answers to my following queries do you have similar pigmentation over the back please send pictures in your response does your mother or other family members have a similar problem get your serum ash levels checked and let us know the value contact the pharmacist and try to procure and use the sunscreen and night cream in your response please tell us the brand that you procured and the contents of the skin whitening cream so that we could further advise you about its use and safety I hope this helps serum ash levels blood test to be given in a fasting state"
    },
    {
        "instruction": "hello doctor one week ago I had intercourse on my third day of the period and after approximately 30 hours of that I have taken an I pill from the next day of taking the pill I had severe back pain and lower abdomen pain which continues for one week and after one week I started bleeding and right now do not know why I am still bleeding is it my period that came again",
        "input": "",
        "output": "hello I read your message can you tell me in detail about your periods date of intercourse date of taking I pill and date on which bleeding started after I pill bleeding is expected for a few days but you said you got bleeding twice so please tell me all the dates so that I can conclude properly"
    },
    {
        "instruction": "hello doctor I have been having a little bit of jaw pain from time to time and also a dull pain in different teeth at different times I suffer from bruxism and have a custom dental night guard but for the last month I am feeling pain as if I am grinding at night the dental guard split in half but it still fits perfectly the infrequent systems started before this split what could be happening I try to be conscious not to clench or grind during the day but two weeks ago the dull pain in my molars required me to take anvil what could be happening I hope it is not wearing my teeth further I am more concerned with this than the pain",
        "input": "",
        "output": "hello I understand your concern this could be a temporomandibular joint taj issue temporo mandibular joint is the jaw joint between the upper jaw and the lower jaw and involves multiple and complex structures like a disc between two jaws chewing muscles and the joining bone structure a complete taj and dental evaluation should be done to determine what is causing your jaw pain and bruxism is not a condition but one of the main symptoms of a taj disorder it could be because of tensed chewing muscles disparity in the disc changes in jaw bone structure other than taj issues it could be due to psychological stress misaligned teeth multiple dental treatments recent dental injury or infection visit a taj specialist to identify the cause initially a splint similar to your night guard called deprogrammed appliance will be suggested as a diagnostic appliance to identify the cause once the cause is determined the treatment depends on it I hope this helps"
    },
    {
        "instruction": "hello doctor I have extreme fear of leukemia after hearing about it through my friend I read on the internet that leukemia causes bleeding gums the next day I noticed blood from my gums and was extremely scared after a lot of tension I showed elevated abc of 1800 I was sure that I had leukemia however I waited for two and a half months and repeated the abc it is 10400 why is my abc not getting low the only symptom I have is my gingivitis I do not understand what is wrong with me I also read that cancer causes gingivitis I am attaching my two abc reports please help to get rid of this tension",
        "input": "",
        "output": "hello I have seen your reports can you tell a few things like do you have any fever or night sweats any bleeding from anywhere else yes leukemia cause gum bleeds but it is not the most common cause usually the cause of gum bleeds is gingivitis or poor dental hygiene or vigorous brushing as the reports are generated by an automatic counter there is a chance of variation in abc complete blood count if it is not abnormal there is no need to worry I would advise you to repeat abc along with peripheral smear if it is normal no need worry usually in leukemia you will have low platelets and very high abc count as per the above reports it is not suggesting any serious problem I would be happy to help if you have any further questions"
    },
    {
        "instruction": "hello doctor for the past week I have been experiencing a scratchy feeling on just the left side of my throat right below my adams apple region now it feels as though whatever it is has transformed into a feeling of paralysis from my voice box up to behind my left nasal passage I am also experiencing shortness of breath",
        "input": "",
        "output": "hello can you send me a picture of your throat clear one I want to see if your posterior pharyngeal wall or tonsils are infected are you a diabetic what problem do you have in your nose is it like a nose block shortness of breath can be due to nose block as well do you have any posterior nasal drip any coarseness of voice or cough while eating or drinking these symptoms are suggestive of vocal cord paralysis do you consume alcohol or do you smoke any problem of acid reflux"
    },
    {
        "instruction": "hello doctor an 18 year old female lying in bed with no stimulus like to and has a laughing fit she cannot stop laughing then could not breathe so she had a panic attack and began crying she has had similar situations about once per year for the last four to five years can this be a elastic seizure she is underinsured and would like to do nothing but if it is likely something dangerous causing it she will have to see someone medications depo shot three months for birth control vyvanse lisdexamfetamine for add taken in the past sometimes prescribed as high as 90 my per day she is not taking now as she has graduated high school and does not think she needs it when not in school",
        "input": "",
        "output": "hello I would like to know if she has strange behavior during all the time fluctuations in her mood sometimes cries and sometimes feels euphoric if she stays alone time after time feeling depressive and other times trying to attract the other attention being euphoric and impulsive in such a case I would think about a psychiatric disorder otherwise I would recommend performing an eg electroencephalogram in order to exclude possible elastic seizures a brain mri magnetic resonance imaging would be necessary too I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 64 year old female operated cancer breast and cancer rectum I completed the treatment for breast cancer I underwent neoadjuvant cart and anterior resection with covering ileostomy for cancer rectum I completed adjutant chemotherapy and ileostomy closure done my it thorax shows multiple enlarged left retro pectoral nodes",
        "input": "",
        "output": "hello as per your reports your mammography is normal it computed tomography shows retroperitoneal lymph nodes and multiple hypodense lesions chances for breast cancer recurring after 10 years are usually unlikely what can you tell about your baseline stage of cancer breast and cancer rectum as serum sea levels are normal there is discordant radiology and serological picture I would like to view it films and if previous it films are available the it is definitely abnormal liver lesions can be simple cysts too if that is the case I would not give much importance to retroperitoneal nodes and just advise you to be in close follow up may be repeat sea and it after three months there are no definite guidelines for this type of situation and the plan of action depends on experience and clinical judgment regards how likely is the recurrence if symptomatic I would advise you to follow up most likely the picture looks like recurrence of cancer rectum but as treatment was completed more than three years ago recurrence this late is not common and chances of different diagnosis like to tuberculosis or invective cause can also be there"
    },
    {
        "instruction": "hi doctor I have a dry red small area on my face for years now I went to my dermatologist and he told me to buy a cream I do not remember the name it worked for a while but after it stopped working the redness gets redder when it is hot I sweat on my face or if I scratch it does not itch at all nor have any other redness anywhere I had dandruff but I am using dandruff shampoos for years now and do not have anymore I have another thing to say I have a small lump on my thumb it has been there for one year but these days I smashed it a little and it got bigger when I press on it hurts and it does not look like a wart what can I do for these issues I will upload the photos please help",
        "input": "",
        "output": "hi I have seen the photos attahment removed to protect patient identity it is not clear I want to know about your age exact morphology site of rash any disease present or treatment taken and diagnosis made for either of the lesions please send clear photos of both the lesions and all details and any other lesions if present I will try to help you it may be allergy or infection or else"
    },
    {
        "instruction": "hello doctor my father recently had a heart attack and a stroke then had two heart valves repaired and they want to put a stent in his list of medications does not seem to make sense and although he loves his cardiologist I do not think he is paying enough attention I am in the medical field and although I am not a pharmacist or an d I know a little bit about adverse drug reactions tell me if this makes sense to you metoprolol tartrate 25 my half pill twice a day potassium chloride 20 me once daily losartan potassium 25 my once daily warfarin sodium my once daily atorvastatin 20 my digoxin 25 mug once daily and furosemide 40 my once daily I need to know if these medications are fine to take all in one day and if so I would like to split them into two times a day according to the reactions I feel that so many medications doing the same thing is redundant and unnecessary and causing problems please help me",
        "input": "",
        "output": "hi let us evaluate all medications your father is receiving diagnosis valvotomy cad with mi coronary artery disease with myocardial infarction and ca cerebrovascular accident recovered tablet metoprolol is essential in patients with heart attacks as it slows the heart and keeps it healthy so we cannot omit that the dose is already very low and so we cannot reduce it further tablet losartan again essential in people with heart attacks it is a disease modifying drug the dose is already less and cannot be reduced but yes the timing can be changed to alternate with metoprolol one in the morning and one in the evening the danger is giving potassium tablet losartan and digoxin and can cause increased potassium levels and giving more potassium is highly dangerous the doctor might have given for some time but it has to be stopped now warfarin is given for stroke prevention my is a minimal dose it cannot be removed as stroke prevention is essential timing can be made flexible atorvastatin is for heart attack prevention ideally can be taken at bedtime frusemide is a diuretic there is no specific reason to give this in your case the only issue I can think of is because of the valve surgeries they want to keep blood volume low this can be discussed and removed ideally can be given in the morning about aspirin it should not be given when you are giving warfarin remove it if it is still on if the blood becomes very thin then there are chances of brain hemorrhages I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 40 year old male I have perforated right ear for the past 20 years and get discharges on various occasions and treated every time but I have no discharges for the last three years as a routine checkup I am asked for a it scan and the findings are as follows right sided mastoid air cells are partially sclerosed with reduction pneumatization however no collection is seen at present in mastoid air cell or middle ear cavity right maxillary small retention cyst mild dna with nasal septal spur I have no problem in the ear except a tension pull in nerves veins around the right ear while moving my head to and fro I am currently taking antibiotics and montelukast my lab report shows abc 9600 see you my neutrophils 74 lymphocytes 18 monocytes 01 eosinophils 07 basophils ear first hour 06 my",
        "input": "",
        "output": "hi you have right sided chronic otitis media which is a common type of chronic middle ear infection it is common to have recurrent ear discharge in this condition because of the perforated eardrum since your ear is dry for three years you need not worry much as far as it computed tomography findings are concerned sclerosis of the mastoid is common in patients with perforation of eardrum with earlier infections it is absolutely normal in you to have these findings there is nothing to worry about maxillary retention cyst is a common incidental finding in routine it scan and not a problem to worry about if you do not have nose related problems dna with spur if asymptomatic like nose block is also a common incidental finding and can be present in many normal individuals so your it scan report can be considered normal for all practical purposes"
    },
    {
        "instruction": "hello doctor my pubic area is white flaky and dry I was prescribed a lotion last month for folliculitis bumps and it went away now this problem persists I got tested for sad two months ago everything was fine",
        "input": "",
        "output": "hi it is not clear about your age the exact morphology duration symptoms treatment taken etc can you please send the photos and details so that we can get the real picture of the rash it is good that you have been tested negative for studs sexually transmitted diseases it is not clear what lotion was prescribed I consider it may be for scabies or calamine lotion both can cause dryness and flaky use gentle soaps or cleansers like cetaphil to wash the area if the area is already shaven you can apply moisturizer cream or lotion stop applying the lotion given which might be causing you this or maybe due to other conditions it is unlikely to be any sad so you can relax and be free of any anxiety take antihistamine tablets like cetirizine if any itching or allergy please get back to me with details and photos for a more correct assessment of the situation and management"
    },
    {
        "instruction": "hello doctor I am a year old female I get random chest pain either on the left side or on the right side that is painful to touch there are some instances when it feels like my chest is going to collapse this feeling lasts for a second or two almost like a lightning bolt has shocked me there are other times where I feel like something is pinching or pressing on my left or right side of the chest I have been diagnosed with costochondritis and herd and prescribed anti inflammatory pills plus omeprazole I also have high blood pressure and high cholesterol for which I take losartan 25 my hydrocholorithazide 25 my and fenofibrate 145 my once daily I had an ekg done and that turned out normal I went to the clinic two weeks ago as I had pain in the middle of my chest that lasted less than a minute I had an ekg done again and it turned out abnormal my blood pressure was elevated at 130 100 mhg and I was having an anxiety attack although ekg was abnormal blood tests came out normal and troponin was negative I am totally freaking out doctor says that I am fine but I should see a cardiologist to rule out heart problems I am worried because several months ago my ekg was perfectly fine but now it is abnormal please help",
        "input": "",
        "output": "hello I understand your concern your troponin was normal this is good because that was not heart attack regarding your egg electrocardiogram I do not know what was the abnormality I want to see your egg to guide you accordingly one thing I would stress that please reduce your weight as obesity is the most to many unwelcomed diseases obesity is a field in which cardiac diseases grow only reducing weight will solve many of your symptoms and worries regarding your chest pain it is atypical and does not seem to be related to the heart take painkillers when you have pain"
    },
    {
        "instruction": "hello doctor I am 19 years old and weighs about 65 keg I am suffering from masturbation effects like leg pain fatigue night fall body weakness and weak memory I also think that my hair are getting thin and I lost my few hairs from the top of my head I masturbate for the last seven years in the beginning I do excess masturbation like four to five times a day but now I controlled it and I usually do once or twice a week I tried a lot to stop it but cannot stop it I need your help please suggest me some medicine to recover from the side effects of it can I take shilajit and ashwagandha both or not and in which dose I should take it please give me some suggestion to gain my memory power",
        "input": "",
        "output": "hello this is not abnormal in this age please take the following drugs rathina purush capsule one in the morning and one at night with a cup of milk gnanavalli capsules one in the morning and two in the evening these drugs are available in siddha and ayurveda pharma these are the two major drugs for your issues you may contact local ayurvedic medical shops to get it shilajit and ashwagandha these two are supplementary and very useful you can take shilajit one in the morning one after lunch and one in the evening ashwagantha legium is better go in the morning go after lunch and go after dinner all these four drugs are to be taken after food for three months they rejuvenate you and boost your energy level also your memory will be improved you can consume more dry grapes grape juice pomegranate juice and add more curd or buttermilk in your diet you need to apply brahma hair oil to hair and wait for 30 minutes then take a bath this should be done every alternate day in the morning this is to maintain normal body temperature"
    },
    {
        "instruction": "hi doctor I have skin allergy on feet black patches on periphery of feet lack of moisture in those areas causing wide open cracks and even the flesh are exposed outside I have attached the pictures for your reference kindly guide thank you",
        "input": "",
        "output": "hello follow up after 21 days to a dermatologist online"
    },
    {
        "instruction": "hi doctor I had a protected sex with escort 15 days ago we did not keep it simple stupid or do anything without a condom today I noticed a bump next to my scrotum that looks like a wart I cannot remember whether it was there before I just noticed it today and it seems to burn it terrifies me that it may be a genital wart but it is tucked away behind the scrotum where there was never any contact so I am hopeful that it is something else no tests are performed yet my last sad was nearly years ago and came back negative please help me",
        "input": "",
        "output": "hello I went through your query and picture and honestly it does not seem to be anything related to sexually transmittable disease it is not a wart too you did not mention whether it is painful or exhibiting any other symptoms and the consistency of lesion so it is impossible to make a diagnosis only with the picture of a raised nodule without close inspection and palpation for further information consult a hiv aids specialist online"
    },
    {
        "instruction": "hello doctor my wife is 18 weeks pregnant last night we went out for dinner and she ordered a shrimp cocktail the shrimp seems a bit off and so she only ate or then we returned them she also felt a little unwell the next morning but she had no fever her temperature was 34 degree celsius we have heard horror stories about listeria and pregnancy in addition to other things with eating fish and shrimp could this be a problem should we go and see our doctor are there any tests she can do to see if she caught anything if so what are the risks to the baby anything else you think we should know about or do please advice us thank you in advance",
        "input": "",
        "output": "hi I went through your query for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor when I wake up in the morning I have watery eyes eyelid swelling and redness the symptoms get clear in some half an hour to a maximum of hours and then it remains fine the entire day please help with this",
        "input": "",
        "output": "hi revert back with the photographs to an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor I am using artificial tear drops during the day and an artificial tear gel in the night before going to bed for dry eyes in most of the days I feel a lot better however one day or another I have the same symptoms or watery eyes and redness and minor blurred vision this happens with the left eye however I also have redness on the other one these symptoms started very mildly and then started to get worse currently I am using risperidone some things I would like you to know are I have been spending 9 hours in front of my computer in the last 4 years I also use my smartphone to play games and read emails I feel a lot better when I spend only 3 hours on the computer on the previous day I also have mild redness during the day if I am at a computer screen for 2 hours without interruption I have been diagnosed with rhinitis too my questions are can my problem be caused by a cumulative and excessive computer exposure without often breaks and for the last 4 years if yes what is your recommendation for improving I am finishing my pod in thesis and I would like to use the computer if not what else could be the cause of my dry eyes also the last time when I had conjunctivitis an optometrist detected a spot in my cornea on a slit lamp examination and 10 hours later I was diagnosed with a corneal infiltrate due to an eye infection by a general doctor can corneal infiltrates show as spots on a slit lamp examination is it possible that I have these symptoms much more intense on the left eye I have a higher uncorrected eye myopia and astigmatism in the same",
        "input": "",
        "output": "hi it is very good to know that you have improved drastically for further information consult an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor my son has a large soft lump on the penis partially covered by pubic hair it has a blister like appearance but it is not he says it is tender to touch what is this and should we do anything about it also there does not appear to be any liquid coming from it please help",
        "input": "",
        "output": "hello I have gone through your case history and would help you as best as possible to get your son out of the problem that is bothering I have had several patients with similar complaints during my practice our best wishes to you and your son for his early recovery revert back with the photographs to a dermatologist online"
    },
    {
        "instruction": "hi doctor I am years old it has been years since I got married and have one daughter aged years my main concern is my wife is not getting pregnant she is undergoing gynecology checkup all her test reports are normal I am much tensed at this moment I think my sperm count is low and not thick because years back suddenly I realized my penis not getting hard too much and also not able to have intercourse for more than two minutes I searched on internet and found a pill called vigour 300 I ordered and took as described it really worked and I started taking this pill every time while having intercourse I had 10 packs consists of 100 pills then again used another 10 pack of vigour 800 now my sex capacity is normal but still I am not able to get my wife pregnant I observed that my sperm color has changed from white to yellow and quantity is very minimum but not thick as before I really want to get my wife pregnant please suggest some measures thank you",
        "input": "",
        "output": "hello revert back with the reports after 14 days to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I used contact lens for more than 12 hours and also applied eye drops twice during that time my left eye had slight pain but I ignored it next morning left eye looks dilated and off center what to do",
        "input": "",
        "output": "hello for further information consult an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor my son is year old four days before he had stomach pain and loose motion he passed loose motion for about 3 times a day we gave him anafortan syearup for stomach pain next day he felt better today again he has light stomach pain and went potty but not too loose I again I have given him anafortan syearup our family doctor is out of station I do not want him to miss his school please suggest me what should I do can I give him pecef 50 my or could you suggest any medicine",
        "input": "",
        "output": "hello welcome to clinic com I have thoroughly gone through your case and can well understand your genuine health concerns revert back with the test reports to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am 30 years old I am 26 weeks pregnant my baby remained breech so far but a few days back got cephalic my sonographer said baby is female but she got mild enlarged clitoris then I went to my regular doctor and she rejected it she said that at this level and in this situation gender appears the same so do not believe in it can you tell me whom should I believe",
        "input": "",
        "output": "hello I understand your concern for further information consult a fetal medicine specialist online"
    },
    {
        "instruction": "hi doctor my diabetes started as gestational diabetes around seven years back I am taking novorapid 24 units three times a day and lantus 30 units at night daily but my blood sugar levels are not at all coming down previously I took tablet zoryl my and I am using these insulin for the past six months but there is no improvement in my sugar levels also my hba1c is greater than please help",
        "input": "",
        "output": "hi for further information consult an endocrinologist online"
    },
    {
        "instruction": "hi doctor I have been suffering from some kind of derealization or something for the past five years it seems to be related to a bunch of vitamins I took to treat autism anyway I seem to be suffering from some kind of grounding disorder that has a lot to do with the kinds of principles that lawrence barsalou is always writing about also I really miss being an ocd control freak who likes to do everything the old fashion way and has the entire future planned out to the tiniest detail I felt a lot more productive that way I think the best way to treat all this is with medication and cognitive behavioral therapy currently I am having adderall and prozac",
        "input": "",
        "output": "hi I can understand your feelings of detachment treatment for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am a 48 years old male I do not have diabetes or hypertension I had on and off pain in the scrotum for two months I felt better after I had a course of doxycycline for seven days but one day I ran to catch a bus and at that time I felt some pain again I am experiencing the on and off pain but this time the pain is restricted to the area in the left scrotum my general surgeon advised me ofloxacin for a week and then I had doppler urine and blood examination my high resolution color doppler ultrasound findings are as follows left tests 40 21 29 my normal in size and echotexture there is no mass or lesion or calcification seen right tests 46 19 26 my normal in size and echotexture there is no mass lesion or calcification seen epididymis is normal in size and echotexture right 10 and left 9 there is no evidence of hydrocele and varicocele is it torsion and detorsion will doppler show that also advise further investigations please guide me thanks",
        "input": "",
        "output": "hi revert back with the investigation reports to a urologist online"
    },
    {
        "instruction": "hello doctor I am 43 years old I do not smoke or drink but my food habits are not very good recently I got my blood checked for apo apo a and the ratio was really bad at 6 the triglyceride is around 474 and this rose from 270 around three months back my hel is 26 lil 16 and to 237 let me explain that my last 60 days diet which was really high on rice and oil I also had a lot of cashew nuts in the last 30 days before this checkup fasting sugar is 14 and postprandial 170 may I know whether I need to start taking any medication or this can be taken care of by exercise my last three years blood report has been showing elevated reports of lil around 180 and my to has been around 270 I have always maintained my blood glucose level within the normal range but this time it has overshot 14 my be has always been bang on 120 80 mhg please advice",
        "input": "",
        "output": "hi we are here to help you revert back after the repeat test to a cardiologist online"
    },
    {
        "instruction": "hi doctor I had unprotected sex with my boyfriend who is on steroids I read that steroids will make sperm weak swimmers is that true also after the unprotected sex I took plan one step immediately what is the possibility of getting pregnant what are the early symptoms of pregnancy and when do they start",
        "input": "",
        "output": "hi we are here to help you for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am pregnant with ma twins we have been told that one twin has a reversed a wave what possible outcomes can this have for the twin please explain thanks",
        "input": "",
        "output": "hi I went through your query and I totally understand your situation for further doubts consult a fetal medicine specialist online"
    },
    {
        "instruction": "hi doctor I am a 20 year old male my height is 3 and weight is 180 pounds I am having problems with my whole skeletal system my right knee snaps when I extend my leg and my left hip has some pain my left foot appears longer from heal to big toe and my right leg appears longer from the knee to the ground I have been diagnosed with minor scoliosis and one shoulder appears higher than the other I have minor neck pain plus my calf muscles get so tight and they hurt",
        "input": "",
        "output": "hi revert back with the asked details to a chiropractor online"
    },
    {
        "instruction": "hi doctor I am a 38 year old male my height is feet height and weight is 90 keg I have been a hypertensive for the past ten years my fasting sugar generally comes in the range of 100 to 130 up 140 to 170 and arc level is should I start medicine for this for hypertension I am taking loser in the morning and amtas at night all other tests such as lipid kit let thyearoid etc are normal",
        "input": "",
        "output": "hello your levels are indicating that you are diabetic but the values are not that high enough to start on medications I recommend you to start diabetic diet and exercise regularly also repeat your fasting blood sugar fbi postprandial blood sugar pubs and hba1c glycated hemoglobin after three months diet to be followed exercise to be followed revert back with sugar reports after three months to a diabetologist online"
    },
    {
        "instruction": "hi doctor I had a mole removed from my leg the pathology laboratory has sent my sample to another laboratory for second opinion why would they do that",
        "input": "",
        "output": "hi for further clarification consult a pathologist online"
    },
    {
        "instruction": "hi doctor I have one rib out of its place I think it is third or fourth one next to my sternum once a doctor put it back but it has slipped out again can you guide me through this",
        "input": "",
        "output": "hi for further information consult a chiropractor online"
    },
    {
        "instruction": "hello doctor my daughter is 21 years old and is very thin her weight is only keg and height is 4 since her birth she is of low weight and does not have any medical problems kindly advice some treatment plan that would help her to increase her weight how long will it take for her to gain weight with medicines kindly suggest few weight gaining products suitable for her",
        "input": "",
        "output": "hello other options for her are revert back for further details to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am a 70 year old female my weight is 60 keg I am a known case of niddm I am on glimepiride my bid and repaglinide bid but my fbi is 271 and pubs is 457 is there any solution to lower my sugar without insulin for me insulin was already prescribed but still I have not started",
        "input": "",
        "output": "hello for further information consult a diabetologist online"
    },
    {
        "instruction": "hello doctor my mother age 59 had an ischemic attack recently trop test positive cpu mb elevated she has had a bev for her mitral stenosis two years back she is currently in the icu on medicinal therapy anti thrombotics she underwent an angiogram yesterday report and video attached her ca is 100 percent chronically occluded lda and lex have 70 percent and 90 percent occlusion respectively I have the following questions what the chance that angioplasty can help the total occlusion in her lex will a newer technology like rotablator ivus increase chances of clearing the totally occluded artery we are in a center that does not have surgical facilities so a bypass surgery will require shifting her to a another hospital how safe is it to do angioplasty in this situation and would you consider it risky to shift her to a bigger city that will involve 5 hours of road travel after which we can wait followed by a 5 hour long flight",
        "input": "",
        "output": "hello I am sorry to hear about your mother poor health condition there is a very good chance that angioplasty can help with the 100 blockage alongside a stent she is still young if she can adhere to lifestyle modifications and medications it will help rotablator or ives can definitely help with clearing the clogged arteries although they also will require tenting because the site of the clogged arteries have become weak and will require tenting as support in situations like this I advise angiography for my patient the recovery period is shorter and patients are able to live a quality life with modification of lifestyle and medication it is not safe for her to undergo the stress of traveling at this time"
    },
    {
        "instruction": "hi doctor I am 17 years old I was born with polycystic kidney disease when I was 14 I was diagnosed as I was having severe chest pain and dizzy spells I am currently four months postpartum since my son was born I have not been able to use the bathroom as frequently as most it never caused me pain or anything up until about a week ago for the past one week I pee once a day I feel the urge to pee all the time but I cannot no matter how hard I try the pain is entirely unbearable at this point I drink plenty of water a day I have even tried cranberry juice but nothing has helped I have put off going to the hospital for the fear of being admitted but I cannot any longer I want a professional opinion do you think I need to suck it up and go to the er or is there anything I am not doing that you think might help please guide",
        "input": "",
        "output": "hello since you are a patient of polycystic kidney disease you will be more prone for urinary tract infections urinary stones or cysts which could burst and form clots which can result in obstruction one cannot be sure unless you get a sonography done since you say you get urges for urinating and you cannot pass I think you should go to emergency room er and get yourself checked I would advise you to get a complete blood count serum creatinine urine routine and sonography try to keep a chart of the amount of urine you pass and fluids you drink daily and a daily weight chart let me know the laboratory reports for pain use safe painkillers like paracetamol and tramadol revert back after the tests to a nephrologist online"
    },
    {
        "instruction": "hi doctor my mother is having metastatic carcinoma and went through radiotherapy now she has got severe diarrhea swelling in face and do not like to eat food please help",
        "input": "",
        "output": "hello revert back after investigations to a radiation oncologist online"
    },
    {
        "instruction": "hi doctor please find the attached echo reports of my 18 days old baby boy please review and give your feedback thank you",
        "input": "",
        "output": "hi I have gone through the echocardiogram reports normal breastfeeding and monitoring of symptoms keep close contact with pediatricians for further clarification consult a paediatrician online"
    },
    {
        "instruction": "hello doctor I am suffering from tooth decay of my third molar should I go for extraction or is there any way to save my tooth",
        "input": "",
        "output": "hello I understand your concern and I have studied your ray the tooth is divided into the crown part and the root part the tooth structure till the bone level from top is called the crown and beyond that is root more than one half of the crown part is decayed and the decay had started penetrating the root part too if you notice the ray you could see the infection penetrated the root and weakened the adjacent bone too the gap between the root and bone on the left side of ray the infection has engulfed one of the roots completely the ideal treatment for this tooth is removal I extraction if the same scenario occurred in a tooth other than the wisdom tooth I the third molar I would have definitely advised you to save the tooth the reasons for advising extraction the wisdom tooth is highly unstable and there are more chances of secondary infection even after a good root canal treatment it carries out less than of chewing extracting it will not make much difference to your chewing efficiency oral hygiene maintenance in the wisdom tooth area is highly challenging which caused your decay in the first place our brush does not reach that far any treatment like fillings and root canal treatment in wisdom tooth may lead to jaw issues in the future because of its unstable nature I hope this helps"
    },
    {
        "instruction": "hello doctor what causes acne scarring what ingredients should people be looking for to diminish them in the products they use is scarring more difficult to get rid of on darker skin tones if so please explain why is it possible to achieve complete removal of this without getting something like a chemical peel how effective are peels and other cosmetic procedures for this issue which procedures would you say are the most effective for people who do not want to undergo a cosmetic procedure what are some things they can do on their own to help sunscreen is there any way to prevent scarring from occurring if so please explain",
        "input": "",
        "output": "hello during severe active acne inflammatory process leads to scarring if it is not properly treated or treated late during course of acne so treatment of acne is very important both early and according to recommendations because inflammation leads to destruction of collagen fires in skin resulting in scar formation people should use products that contain collagen hyaluronic acid elastic the natural ingredients present in our skin and maintain its contour and give it even surface scarring can be more difficult to treat in darker skin type because of heavy melanin pigmentation present naturally in their skin which also take part in inflammatory process occurring during acne once scarring occur it is not possible that it get improved on its own or without any treatment different options available for scars are topical gels and chemical peeling apart from that cop fractional laser is also available to get rid of it chemical peeling is a method by which skin is stimulated to produce more collagen and making the skin scar free and improving its texture the more effective treatment is fractional laser that helps in stimulating fibroblasts increasing collagen production and improving acne scars people can use topical gels containing collagen if they do not want to undergo procedures sunscreen do not have much role to play for prevention of scarring early and proper treatment of acne is needed oral retinoids are recommended to prevent scarring"
    },
    {
        "instruction": "hello doctor I am 24 years old student recently during a sexual intercourse I felt an acute pain after which I suddenly stopped the next day I had swelling all around my penis it seems like the foreskin has swollen I was a bit worried so I visited the go here who advised me to take anti bacterial anti fungal and anti inflammatory medicines the dosage is over but the swelling still persists the penis and genital area feels itchy at times and sometimes has a foul smell too the medications recommend by the go were as follows co amoxiclav 500 125 aciclovir ibuprofen 400 my I have a regular partner with whom I indulge in sexual intercourse is this a classic case of balanitis please tell me what to do",
        "input": "",
        "output": "hello the foreskin of your glans is edematous and little inflammatory this condition may be due to vigorous sexual activity against the dry vagina or may be due to local infection possibility of balanoposthitis so you may check blood sugar levels complete blood picture wear soft cotton related innerwear apply clotrimazole plus betamethazone gel locally twice a day for five days use tablet fluconazole 150 my once a week for five weeks if no improvement get it done local swab culture and microscope but do not worry it is a simple condition it may subside within one to two weeks take care"
    },
    {
        "instruction": "hello doctor my grandfather is feeling chest pain and high be since last days we admitted him to the hospital and according to the doctor he had a mild heart attack we want a second opinion about his health condition and further treatment I will attach the reports",
        "input": "",
        "output": "hello heart attack in your grandfather case is diagnosed on the basis of comb and qualitative troponin tests comb is not specific test to diagnose heart attack and it may come positive in many other conditions same is the case with qualitative troponin test yes but if there is no kidney problem no severe infection in body and patient has chest discomfort then we can say its heart attack egg may help in making diagnosis as well echocardiography is overall normal to diagnose heart attack best tests are egg and quantitative troponin I test if your grandfather still has chest pain I would advise go directly for angiography and then angioplasty if indicated on angiography if your father has no chest pain then go for a test called stress echocardiography or myocardial perfusion imaging and if positive for changes consistent with heart attack then angioplasty please note in some cases angioplasty is preferred and in some cases bypass is preferred that is decided on many factors including angiography report patient overall condition and patients wish in some cases of very frail old peoples only medical treatment is preferred and no angioplasty or bypass is attempted this also depends upon overall condition of the patient and angiography report in any case whether angioplasty bypass or only medical treatment medicines are continued throughout life keeping in view contraindications and side effects of medicines please tell about overall health of your grandfather any other diseases he is suffering from such as kidney diseases lung problems walking issues etc also show me his egg and other reports if already done when overall picture scenario of patient is in mind then I can guide you properly for further management"
    },
    {
        "instruction": "hello doctor last saturday my partner while temporarily at his mother home got sick then following day evening he was diagnosed with gastrointestinal bacterial infection most likely from coli bacteria by a home visit doctor service who gave him something for his symptoms next day no more vomiting but still other symptoms are present and the next day most symptoms eased or gone except gastritis and diarrhea and since yesterday all symptoms are gone my question is how long number of days after his recovery it is safe for him to return home so his body is no longer contagious as we have not seen each other in person since he stayed at his mother home I do not want to afford the risk of being exposed to this infection",
        "input": "",
        "output": "hello it is a classical food related infection it is gastroenteritis if those symptoms of stooling and vomiting have subsided then he is free you are safe with him if there are no more symptoms he is no longer contagious if you both keep good personal hygiene if there is not contamination of your food or water and there will not be any infections wash your hands with soap and water after using the toilet keep the environment clean these measures will prevent germs from your environment"
    },
    {
        "instruction": "hello doctor I am 42 years old single parent with two kids aged 15 and 10 the last 19 years I have had several stress related in my view ailments history erratic bowel syndrome 19 years back corrected now polycystic ovaries corrected now was on metformin for one year severe migraines twice a week that lasted 3 days corrected now hyperthyearoidism which got over corrected to hypothyearoidism and therefore medication was stopped was on eltroxin 25 mug I was diagnosed with be issues and chest pain years back I was on lonzaep for anxiety and prothiaden 50 my a day ten 25 my for be had a c for continuous periods biopsy was clear ten was stopped and nebistar my once a day was initiated by my cardiologist along with 20 my telmisartan I was also diagnosed with arterial stiffness persiscope cardiovascular analysis report enclosed I experienced alopecia and lost almost all my hair I got it back after treatment the cardiologist increased thelma to twice daily 20 my along with nebistar my recently my concerns and questions the be continues to fluctuate going as high as 170 10 and then dropping very suddenly to very low be rises typically in the evenings while it is very low at night I understand that this is the case naturally while I understand the concept of be fluctuating all day and looking at the average I am worried that when it is very low I am probably aggravating the situation by taking a medicine to low it further app reports taken all these years are enclosed when the be is high mostly I have chest discomfort and pain in the chest for 4 days and then subsides on its own I am concerned that my arteries are inflamed please see reports on high sensitivity reactive protein when I had continuous migraine and chest pain I went in for a coronary angio and a brain mri reports enclosed acute ischemic foi is there a correlation my cardiologist was concerned about my echo tests and the be shooting up very quickly during the stress test can you explain what the test implies and the connection between the inflammation and these tests results my stress levels overall are definitely better I am consulting a psychotherapist for the last years practising yoga however the be seems to have shot up again the last few weeks is it because of the extreme winters I am undergoing a stressful situation at the moment on the whole I would like to know if I am at risk of a stroke if yes what is the probability is there inflammation if so how bad is it how can I control reverse it why does the chest pain persist the pain is usually followed along with high be when I particularly have a heavy session in psychotherapy or overthink some issues what do I do when the be reaches dangerous levels like 170 10 are there any drugs that I should avoid what are the safe supplements that I can have for magnesium I am taking omega supplements are there any follow on tests and medications that you recommend I got a full health check done four months back and kidney tumors etc have been ruled out happy to share additional reports in case needed",
        "input": "",
        "output": "hello I would largely comment from cardiac point of view so overall other than be your cardiac status is normal your heart function is normal and no rwma your blood vessels were clean on it coronary angiography so I do not think there is anything to worry from cardiac perspective regarding chest pain if be is elevated then it can cause some strain over the heart and cause chest pain but it would be limited to time during which be is elevated now considering that you did not have any chest pain during stress test and be was elevated during stress test pain is probably unrelated to be or heart if you are having any ventricular ectopic or extra beats then it can cause some dull ache in chest now other aspect is be you have tendency for be elevation due to your genetic make up which is part of cos etc how much do you weigh also your psychological issues tend to worsen be may rise during exercising and considering your high be tendency it may excessively rise during exercising other factors which can worsen be is stress high salt intake like pickles nsaids like brufen or other pain killers migraine medicines or even any pain can worsen be so avoid pain killers other than paracetamol or tramadol plenty of fruits have low salt diet regular exercises try to keep weight under control if be elevates then you may have an additional dose of telmisartan maximum you may up to 80 my in a day also while taking be readings you should keep your arm relaxed take 3 readings at a time and take be after rest of 10 min if be is rising persistently in the evening then additional dose of telmisartan may be added in the afternoon hours before the expected be rise your average in last abpm was fine and occasional high readings are not worrisome regarding inflammation best way to settle inflammation is healthy lifestyle like avoiding fatty oily and high calorie diet having regular exercises like brisk walking or running according to capacity also you should get your lipid profile done and stations like rosuvastatin prescribed to settle this inflammation dinner should be light now regarding your stroke risk it is better to get a neurologist opinion the changes may be related to inadequate be in the past but you should also obtain carotid artery doppler for source of emboli also transesophageal echo should be obtained to rule out possibility of patent formanen oval as a source of emboli"
    },
    {
        "instruction": "hello doctor I am a 23 year old male two years ago I had intense palpitations and I was diagnosed with anxiety disorder I had panic attacks but then I was able to recover by myself from a few days I had two panic attacks and I am afraid if this is anxiety or if my diagnosis was wrong as if I had some serious health issues I worry that I have a heart problem even if someone touches my chest I feel uncomfortable I do not think a lot I try to calm myself but somehow I am not able to calm myself no matter what I try the main problem now is my anger I suddenly feel so much angry on very stupid things like I am walking on a road and a car blows horn continuously I feel very irritated and angry if my girlfriend does not pick my call I get so much angry and it is not normal if I try to control my anger I feel numbness and hand shakes I even have palpitations this is very worrying for me as I think this is very serious this time my heart palpitations go away only when I am in deep sleep or when I am doing something so deeply without noticing anything I had palpitations two days before my exams I tried calming technique but it did not went away but when I was in the examination center when I started writing my answers I was so deeply busy in writing that my palpitations go away and then after the exam I was fine but anger is ruining my life I want to change the way I am please help I am currently taking sertraline and beta blockers",
        "input": "",
        "output": "hello panic attacks often mic a heart attack in fact one of the common differential diagnosis for panic attack is cardiac arrest if it is happening often it is advisable to get an egg electrocardiogram done please tell me from last how many days are you taking anti anxiety medications secondly I would advise you to start cognitive behavior therapy anxiety is caused by negative thoughts called cognitive distortions these can be improved with various techniques used in the therapy once you learn how to cope up with these negative thoughts you will be able to control your anxiety find a local therapist or you can opt for online therapy via video consultation the relaxation techniques such as box breathing and progressive muscle relaxation help in long term efficacy I hope this helps"
    },
    {
        "instruction": "hello doctor ten years ago I had a molar break nearly in half at that time I tried to do the correct thing I went to a clinic and had a temporary filling I switched jobs within a few months acquired actual dental insurance and went to a clinic I got my teeth cleaned a couple of fillings and set up for a root canal on my broken tooth during and after the root canal I was out of it I have severe taj and had to be medicated it was not until a few days later when I received the bill that I even realized the procedure did not include the cost of a crown so I have not had my crown as it was expensive there is not an excuse that is acceptable but the fact remains that I have not done anything about this for a decade between that time and now I have switched jobs and no longer have any provided insurance I stopped chewing on one side of my mouth a few years ago my broken tooth has died and fallen out a piece at a time there is about a quarter left the teeth next to it are in bad shape my gums are swollen and surely infected I am aware of the liveliness of deeper infection I have zero dental insurance and minimal health insurance I am highly anxious in general and suffer from irrational fears for reasons I cannot explain I am terrified of visiting doctors and especially dentists no offense I also have very little in the way of expendable income and I cannot afford to hop from doctor to doctor paying each along the way I have no clue where to start but I know I need to I just have no one to ask I am scared what do I do can I get to see my general physician about this I know they will have to refer me but going straight to a dentist will surely cost a great deal more I need step one and I do not know what it is",
        "input": "",
        "output": "hello you need to show to a dentist itself as the teeth is broken and only a quarter of actual size should be removed the tooth next to this which has cavity should also be filled or maybe would require root canal treatment you can delay the crown placement if you do not have money for otherwise just extracting or pulling out those infected teeth will give you much relief and it would be cheaper also than trying to restore it use saline or betadine gargle for at least twice a day after food for a month to reduce the gum infection I can prescribe you antibiotics but I do not know whether you will be able to buy them there without a prescription amoxicillin 500 my thrice for five days would reduce the underlying infection and give you relief for a month or so stop if you have any allergic reaction you can take some painkillers and antacids if required as a last resort if you do not have any money for the treatment and also do not have insurance just use betadine gargle and try to buy the above antibiotic and use it for five days then when you have money show to a dentist and get those teeth pulled out or restored maintain proper hygiene so that at least other teeth do not get infected use warm saline gargling as much as possible and for as long as possible I hope this helps"
    },
    {
        "instruction": "hi doctor I have recently noticed that I have been having a pattern of symptoms since I was a teen which have gotten worse in recent years I have extreme lows and highs unstable relationships and anger control issues I have noticed that I do not react to bad news the way people around me do I tend to scream harm myself and substance abuse I have been to my go twice and both times they have said they cannot refer me to a psychiatrist because my symptoms are not severe enough I feel like I have a personality disorder but I want to have a diagnosis this is proving impossible for me can you shed some light on this",
        "input": "",
        "output": "hello you are reporting symptoms like mood fluctuations unstable relationships anger control issues self harm substance abuse etc I can understand why you feel like having a personality disorder but these symptoms can also happen in people without personality disorders you may be probably having traits but whether you will reach the threshold for referral to specialist mental health team psychiatrist will be best judged by your go based on your history and clinical presentation I will advise you to maintain a log of your symptoms on a regular basis like a diary record significant events like self harm episodes you can use a mood diary online and share it with your go during your next review I note that you are on prozac fluoxetine for just over a month you should be able to see therapeutic response by around weeks if there is no significant improvement request a review also you will benefit by having some talking therapy if you have not already had it you can request your go or self refer to the local apt service improving access to psychological therapies you will be seeing a therapist with whom you can discuss further about your concerns and they will feedback into the system about any recommendations if at anytime you are not able to cope or manage the situation speak to a trusted family member friend and contact emergency services"
    },
    {
        "instruction": "hi doctor I have severe razor bumps and want to get rid of them asap when I first started shaving I did not know the proper way to do it and scars where left over the years and razor bumps and sometimes ingrown hairs I got tested for herpes because that is what I thought it was after a while but the test came back negative I started waxing and she told me to exfoliate down there twice a week I have done that and still no results I do not even want to get waxed because it is very embarrassing having to show an ugly scared vagina please help",
        "input": "",
        "output": "hi I saw the picture it is very common because of the allergy secondary to shaving also happens after waxing anyways try to avoid shaving as much as possible if it is troubling you a lot then you can go for laser permanent hair removal for now I am prescribing you few creams start using it within a month it will decrease we will take a follow up after a month and according to the response we will decide the further treatment plan shaving waxing acneiform eruption keratosis pilaris retina a 025 cream apply in the morning after bath"
    },
    {
        "instruction": "hi doctor I was diagnosed with hypothyearoidism five years ago and currently taking 100 my of synthroid my most recent lab work showed that I am now at hyperthyearoid levels in the past I tried reduced levels of synthroid but felt terrible I was diagnosed with peripheral neuropathy about 15 years ago with tingling and burning in the face and limbs my neurologist looked for is due to my sister having the disease the neurologist said only to contact him if it got worse I used to get two or three episodes per year mostly during stress or period of fatigue in the last six months or so I have almost constant tingling in my face feet and arms and numbness on the sole of my foot burning is off and on some days worse than others I mentioned it to my go at an appointment about one month ago but he said it was nothing to worry about researched that thyearoid problems can cause tingling burning and numbness could this be from thyearoid usually I would push my go but my husband was recently diagnosed with late onset is five months ago and I feel doctors will think I am a hypochondriac I am planning to visit my doctor after the holidays but my husband had his attack recently and I am focused on his issues I am just curious if I should be worried please help",
        "input": "",
        "output": "hi there are two issues involved thyearoid problem and the other one is if you have is about thyearoid you are taking 100 mug not 100mg synthroid since long my suggestion is to look for thyearoid levels and consider tapering slowly over six months you can discuss with your doctor for the same next are your tingling and numbness it could be because of diabetes I am not sure if you have diabetes if yes reasonable control of sugar is required if you are not tested for diabetes then get tested for the same as you have hypothyearoidism there is a good chance that you may also have diabetes tingling and numbness can also be because of vitamin b12 deficiency check for levels of the same as it can be easily corrected with supplements multiple sclerosis can be diagnosed clinically and by specific laboratory tests if your doctor has already done it and assured that you do not have it then no need to worry you have fear and anxiety about getting the same as you have a family history and your husband is also diagnosed with it recently if you have any weakness in legs or hands blurring of vision and paresthesia in extremities then consult your doctor thanks"
    },
    {
        "instruction": "hi doctor can fluctuate blood pressure cause elevated abc I got sick with chronic idiopathic urticaria and started mtx my rheumatologist diagnosed me with seronegative ra and stopped mtx did vectra da test and scored 42 moderate for ra disease I was supposed to start remicade this thursday but my blood pressure started fluctuating as high as 189 108 mhg to 138 83 mhg with low he as low as 43 at rest in er they checked heart lungs and kidneys they referred me to a cardiologist and she added a new medicine edarbi 40 my but said abc is 20 with polls 93 and lymph 5 I was referred to a hematologist he said that it looks to be some bone marrow abnormalities and suggested more extensive blood tests to see if reactive effect to inflammation or blood disease or cancer the other symptoms are weakness fatigue and intermittent slight shortness of breath but I suspected all was due to pressure or heart rate issue fever chills and body ache lasted for one day I was fine after I took 500 my naproxen there is no cold symptom with fever I saw my rheumatologist and she said it is not ra related based on high polls cop ranged from 2 to 17 earlier that is before two years and now almost at its lowest at does this look like a body reacting to inflammation or pressure or heart rate also I have intermittent pain in lower left abdominal area I do not see my hematologist for follow up until next month and cannot start remicade until I get it figured out",
        "input": "",
        "output": "hi thank you for providing a detailed history to answer your first query there is no direct correlation between fluctuating be and the increase in cell counts cop is usually elevated in ra rheumatoid arthritis disease which is a common finding reflecting the body reaction to inflammatory or autoimmune disorders like ra though your be is now controlled to some extent the low pulse rate could be because of systolic my nebivolol you need a review with your cardiologist for the same also looking at your non specific symptoms like weakness fatigue intermittent shortness of breath fever chills along with elevated differential white cell counts it is advisable to have bone marrow examination done to rule out hematological malignancy I am not convinced with your or of 98 have you checked it correctly please update thank you bone marrow aspiration review with cardiologist and hematologist"
    },
    {
        "instruction": "hi doctor I am a year old male is there any treatment in ayurveda for pancreatitis I had six recurrent pancreatic attacks in the last three years please help",
        "input": "",
        "output": "hi as you are aware there are many reasons for repeated pancreatitis that including alcohol consumption some viral infections autoimmune etc you can discuss the following drugs with an ayurvedic physician nearby and use with consent karisalai karpam tablet or heptowin tablets morning noon evening after food this is pure herbal kaasukatti tablets pills morning noon evening after food this tablet is chewable or can swallow with water this is also pure herbal bantha chendooram 100 my mix with honey and drink twice a day morning and evening after food this is prepared from magnet and herbal all these drugs should be consumed for six months you feel the difference within 20 days of the first dose continue for six months and can stop it if your pancreatitis is due to autoimmune cause then you need to take the following additional two tablets rasaganthi mezhugu capsule one capsule morning and one evening after food poorna chandrodayam tablet one tablet morning and one at evening after food these two drugs help reduce the autoimmunity in your body and improve your immunity at high we follow these drugs in our practice these drugs also should be continued for three months and then can leave a gap of one month again one month therapy then one month gap once you start you will get the improvement within a week while taking these drugs if you have any doubt please feel free to contact me thank you"
    },
    {
        "instruction": "hi doctor my 18 year old daughter has cutaneous vasculitis mainly covers her lower legs according to the er doctor and family doctor as of weeks ago she is so miserable I have had to keep her home from school and let her put her feet up when she goes to school or is on her feet for any length of time she ends up in pain she cries and tells me her legs hurt and burn poorly she feels nauseated and complains of stomach pain regularly and tired today she became weak as she could hardly go from one room to the next she seemed as if she was going to drop or pass out as usual I brought her to the er again where she was told it was not an emergency and there is nothing they can do she needs to wait until a rheumatologist can see her which is still a week away is there anything I can do to make her more comfortable or is this normal for her to feel this way with vasculitis",
        "input": "",
        "output": "hi I have gone through your history it seems a bit weird that no one is starting the treatment yet firstly with vasculitis one needs to see if it is limited only to the skin or the internal organs as well we need to see her blood routine urine routine and a chest ray before concluding it is only limited to the skin secondly if you can then please get her tested for ana antinuclear antibody and anna anti neutrophil cytoplasmic antibody these are the mandatory test for vasculitis will only respond to steroids I am not sure if you can get your hands on it unless your go suggests but meanwhile give her some anti inflammatory like naprosyn naproxen only after making sure that her renal function tests are normal I hope the information is useful do let me know for more queries"
    },
    {
        "instruction": "hi doctor I am having a mild tender bump or a lump or a kind of knot deep under the skin on the deltoid muscle it is very hard to tell if it is moving under the skin it has been there for three years I have not noticed any significant growth in the last three years I am quite scared after reading about sarcomas I am 20 years old please help",
        "input": "",
        "output": "hi I can understand the anxiety you would be suffering from after suspecting that it is a sarcoma here is what I can suggest to you sarcoma is an uncommon cause of such lumps and much more common are some harmless cysts and lipomas malignant tumors like sarcoma generally do not stay the same size for three years most malignant sarcoma in limbs are not associated with pain however there is only one way to find out for sure and that is doing some tests on this lump you have not mentioned the size of the lump if it is small for about 2 am in diameter then it may be possible to take it out and test for malignant cells thoroughly if it is larger then an mri scan and a needle core biopsy can be done to decide the treatment whether it can directly be taken out or not will be decided by the size and exact location of the lump please send a picture with a scale measure by the side of the lump if you want to follow up much more commonly however it is a cyst that can be easily taken out without any ill effects to know if it is a cyst or not your doctor needs to examine you and maybe do an ray of the limb and an ultrasound examination of the site but only if required for now do not worry just see a good surgeon most likely it is a lipoma or a cyst and not a tumor"
    },
    {
        "instruction": "hello doctor I am a 29 year old female I suffered from abscess when I was eight and a half months pregnant after three months it was diagnosed as fistula and gone under fistulotomy operation since the past few months I feel some wetness in the perianal area and today I saw a blood spot on the tissue also I feel itchy and I am not sure if the anus is completely cured after surgery please help me",
        "input": "",
        "output": "hi after reviewing the information shared and your pictures a few things come to mind wetness in the perianal area and itching are because of the small amount of seepage of stools around the anus this stool causes irritation to the skin around the anus which causes the itch also the irritation can erode the skin and cause a blood drop to appear I would like to know a bit more regarding your problem did you have any pain along with the blood spot or any pain after stools how frequent is this problem of itching did you ever feel a small amount of stool or gas passed without your control while coughing or laughing hard when did it start happening did it start happening any time soon or was it there all along after surgery has it changed over time was it a normal delivery was anything done to assist the delivery was there any complication at the time of delivery of baby from the picture I can think of two possibilities there is a defect in your anal sphincter the contracting muscle although to be sure a thorough examination is required along with an ultrasound called trust transanal ultrasound a special type done from inside the anus in this case the trouble would be there all along after surgery so you may be right that it did not heal properly there might be a new fistula in ano developing just in front of the anal opening and behind the vaginal opening in this case it would have started troubling for a couple of months if it was painful for you to pass stools or associated with pain after passing stools then it could be an anal fissure my advice as follows do sit bath take lukewarm water in a tub and put a half teaspoon of ordinary salt in it now sit in this water and try to make the water clean and sooth your anal region sit for around 15 minutes three to four times every day try to do it at least twice per day it will decrease itching avoid constipation with a large platter of salad sprouts or sat isabgol spoonful three times per day take to liters of water measured by a bottle every day do exercises for building pelvic muscles and improving the tone or control of anal sphincter it is best to discuss all the above with your local doctor who can examine you in person as a definite diagnosis is unlikely without examination if there is a defect seen on trust and weakness of sphincter some surgical repair may be possible otherwise exercises can help kindly get back with the queries and follow up on icliniq thank you"
    },
    {
        "instruction": "hi doctor my husband was just diagnosed with congestive heart failure with 25 ejection fraction they also found an artery 100 blocked but his own body made another vein and they discovered it is viable so no bypass surgery is needed they also discovered his mitral valve is stiffened and not working he has some kidney damage also we are going to have a scope done and I guess that will determine how to fix the mitral valve will they do another test to determine the cause he has told them he used some steroids during his bodybuilding days and he drinks occasionally but he drinks every night and has used mild steroids up until this happened they are going to do a test that would determine how it was caused could it be due to a virus or abuse I am just trying to be educated before we go to the next visit my husband is not always honest with the doctors",
        "input": "",
        "output": "hi thanks for the query madam good to know you are worried about your husband yes alcohol and steroids do cause harm to the heart make sure your husband never uses these suicidal drugs again as now he has an ejection fraction of only 25 coming to the mitral valve it depends upon how much it has narrowed if severe narrow then options are either surgery to change the valve or percutaneous mitral balloon valvotomy pmbv in which the mitral valve is widened by inflating balloon in the valve if not severely narrowed then only medicines of heart failure are sufficient for your husband comply with the doctor advice and medicines have vaccination against influenza done yearly and also pneumonia five yearly if ef is 25 and not improving then have a device installed in the heart called ice implantable cardioverter defibrillator to save from sudden cardiac arrest"
    },
    {
        "instruction": "hello doctor this query is regarding my and a half year old son he was born at 36 weeks and progressed normally at around years of age he used to get frequent bouts of running nose and cough he was hospitalized for lower respiratory tract infection at 7 years and had febrile convulsions at 9 due to stomach infection he still continued getting bouts of cold cough and fever approximately every month he began going to school and his frequency of falling ill increased now he is on a nebulizer taking budecort 5 my respule twice a day along with lazing dry syearup as suggested by his pediatrician he weighs 15 keg plus advise if these respules are safe for him we could not take him out if it is cold or rainy and even the ac does not suit him he has been advised not to have milk and milk products like cheese paneer etc as a result he is not putting on weight what is the permanent solution for his health problem will he improve is there any other treatment is homeopathy safe how do I increase his immunity as he falls quickly to changing weather conditions I would be extremely grateful to you as this is causing me a lot of worries thank you",
        "input": "",
        "output": "hello thanks for writing your query to me I can understand that you are very much concerned about the health of your son from your history description it seems that your son has bronchial asthma usually occurs from exposure to the allergens in our surrounding environment the main treatment of asthma is inhaler medicines like budecort inhaler 200 instead of giving him daily twice nebulizer I will recommend you to start him on budecort inhaler via zerostat vt spacer two puffs twice daily followed by gargling with water and levolin inhaler two puffs as required in an emergency on a long term basis inhaler medicines are not as harmful as they are having fewer side effects than tablets and syearups also as they act at the site of action a very minimal dose of medicine is required try to find out the allergens in his surroundings and avoid them as much as possible there is no need to deprive him of dairy products such as milk cheese or paneer unless he cannot tolerate them he needs to give it as it is the most important source of calcium and required for weight gain nebulization with budecort is only to be given when he is unable to take inhaler by mouth do not forget to rinse the mouth with water after taking inhaler or nebulizer no other therapy is better for optimal control of asthma as there is no cure for it homeotherapy also cannot cure asthma in the long run as there is no scientific evidence for it I hope everything is clear to you now"
    },
    {
        "instruction": "hello doctor my husband uses diclofenac solution topical for his neck pain I am 28 weeks pregnant he also uses a neck pillow after applying it will it affect my unborn baby how long will it take for the solution to be fully absorbed in his body I am scared that the diclofenac solution will be absorbed in my body and will hurt the baby also if we have sex and he touches that hand in my vagina will the diclofenac solution spread into my body should I be worried please give me some advice as I am scared",
        "input": "",
        "output": "hi you are in the last trimester 9 month of pregnancy most of the organs in the fetus might have developed and now it is growing thus care should be taken in food and lifestyle the rate of absorption of diclofenac solution into blood from skin is very less even if you apply the solution on your own body skin for long hours the absorption will be less if it is absorbed it stays in the blood for hours at the end of hours 50 of the drug from the blood gets excreted through urine remaining 25 will get excreted in fourth hour remaining 12 gets excreted in sixth hour it means if the solution reaches blood at am it gets completely excreted at am note the point that the external solution does not get absorbed through skin into blood thus need not to worry be careful with your vagina or oral because the vagina or oral is made by mucus membrane containing rich minute blood vessels vagina is different from skin in vaigna the absorption rate is higher and the diclofenac drug may reaches the blood better to avoid direct applying of diclofenac solution to vagina or nearby vagina or touching hands solution to vagina this carries some less risk to fetus if the solution is less no issues if the solution applied is more then little amount enters into your blood if more drug reaches fetus it inhibits prostaglandins in fetus heart which lead to unwanted problems in the heart you can involve in sexual activity then your husband can apply the drug or wash the hands with soap thoroughly before involving in sex I hope you could understand what I want to say"
    },
    {
        "instruction": "hello doctor I am married 41 years old I have kids for the last six months I am having erection problems I cannot even penetrate due to this I fear of nights I cannot face my partner kindly give a solution to my problem",
        "input": "",
        "output": "hi I am not sure whether you have diabetes or hypertension or any other diseases whether you are taking drugs allopathy or herbal for any other diseases if so we need to look the side effects of those drugs diabetes patients gets diabetic neuropathy thus there might be a chance for reduction in erection there are many other possible reasons as follows after 40 if the male hormone is reduced more sathwik pure vegetarian diets reduce the sexual hormones atherosclerosis to penile artery this is due to cholesterol sedimentation to the artery which supplies blood to penis arterial thickening of penile artery psychological depression related to work career economy family etc this has very strong influence on the erection any trauma hitting on the penis or back side of hip this will affect the neurons to rue out the cause and further treatment you need to consult a doctor in personally directly any psychiatrist or urologist or andrologist are the better choice to consult you may also try the following advice drink badham milk or eat badham nuts every day there is a risk of increasing cholesterol at this age eat cashew nuts one daily here is a risk of increasing cholesterol at this age do pranayama or mediation to keep the mind free go to picnic with family the new environments can remove the psychological depression try to solve other psychological problems if any rathina purush capsules one capsule morning and one at evening before food this can be continued for one month within one month if you get some effect then continue it for a total of months and stop it if there is no improvement within one month then no need to continue this drug after evaluating the cause then only we can take further drug therapy to evaluate the cause approach nearby clinician I mentioned earlier they do doppler or us to find the cause the above said physicians deal such cases daily you need not worry about it"
    },
    {
        "instruction": "hello doctor suffering from mild is since last four years noticed a tender lump beneath skin near anus three years ago swells and shrinks itself mild throbbing and pale yellow fluid discharge from anus when pressed during swelling proctoscopy was done in a piles hospital the doctor said no piles fissure and fistula mri was done in another hospital 17 my to hyperintense linear tract with no abscess no overt fluid signal as well the doctor said nothing and discharged me what is this tender lump I am a healthy 35 years old male working in a office",
        "input": "",
        "output": "hi after reviewing the information shared and your pictures it appears you are suffering from fistula in ano tubular interconnection between anal canal and outside skin near the anal opening the swelling you are talking about is called perianal abscess it is a swelling because of infection of some anal glands around 30 40 perineal abscesses are associated with a fistula in your case having a couple of good quality pictures of the anal region can help in suggesting further treatment your mri report reported presence of around am size fistula with no abscess at the time of imaging and no higher up extension this is a good prognosis type it will need either of two things there are many treatments possible but for you I would suggest these thread insertion in the fistula a tightening it every week this treatment is called cutting sexton you can use shar sutra or silk thread surgery to take the fistula out and let the area heal by itself over time weeks this can lead to loss of incontinence as well control on stool holding what to do now you need to followup with a surgeon to do any one of the above two suggested treatments do sit bath take lukewarm water in a tub put a half a teaspoon of ordinary salt in it now sit in this water and try to make the water clean and sooth your anal region sit for around 15 min to times everyday try to do at least twice per day it will decrease itching and help to heal the fissure as reported by you in your info provided avoid constipation with a large platter of salad sprouts or sat isabgol teaspoon three times per day take to litres of water measured by a bottle measuring cup everyday in case you need more information and help regarding what to choose and why kindly followup with a couple of good quality pictures of the fistula site or discuss it with your local doctor"
    },
    {
        "instruction": "hi doctor I had ligament reconstruction on my ankle months ago the surgery went well and my stability is back to normal however when my surgeon did the athroscopy he noticed mild damage to the joint however he said that this should heal by itself I saw my surgeon weeks ago as I have still been getting a lot of pain where the ankle joint is since seeing him I have been getting bruising over the joint with no injury and I currently cannot bare any weight on the ankle when I saw him he recommended more physiotherapy and said that the main reason was likely to be linked to the surgery I had and it should go away within time I am currently using codamol to manage the pain as normal pain relief is not helping I would just like to know if there could be any other reasons why I could be getting this joint pain and if it is worth me arranging to see my surgeon again if it carries on after giving more physiotherapy a try I am 18 64 keg and 7",
        "input": "",
        "output": "hi welcome to iclinq com after reviewing your information provided and the picture there are two concerning things are you trying not to move the leg at all could be a cause of one sided cold foot are you getting this bruise after resting the ankle on the side of bruising in that case it could be a pressure sore developing here also physiotherapy will help I think you should continue with physiotherapy as advised by your doctor physiotherapy can help in the following manner reducing pain of movement and strengthening muscles for weight bearing maintaining full movement of the joint improving the circulation and helping with this kind of pressure sore development and also cold foot regarding other causes of pain discuss it with the surgeon who did the arthroscopy depends on the findings definitely see your surgeon till you are able to bear weight and do your daily life activities well if you have cold and painful sensation in both feet or arms or a family history of such problems discuss with your go the possibility of vasculitis be very careful with the codamol it can be habit forming you should not be requiring or using this medication for a long term hot fomentation can help reduce the pain as well please discuss with your physiotherapist or orthopedic surgeon"
    },
    {
        "instruction": "hello doctor I woke up this morning to see a small red line or vein on the top of my left breast I had a breast check up and mammogram months ago which was clear is this normal what is it",
        "input": "",
        "output": "hello this does not appear worrisome to me this appears like erythematous lesion due to inflammation this has probably occurred due to some trauma like due to pressure of folds in clothing or bed sheet or lying over the chest also rule out possibility of some bite or nail scratching if this is generalized and also present on the other body parts then may be related to some infection so usually such single visible vein is not significant it should settle in a day or two but if continues to persist or increase in number or any other symptoms like swelling pain fever appears then will need examination or investigations at present does not appear significant or serious issue hope this helps you and get back if you have any doubts"
    },
    {
        "instruction": "hello doctor I have a very personal and sensitive issue I have horrible breath I do have gum disease but my cleaning which consists of flossing several times a day using a miniature brush to brush between teeth and using tongue scrapper several times a day I occasionally oil pull as well can part of my issue be due to a deficiency of some sort any kind of advice would sincerely be appreciated this issue is significantly affecting my life",
        "input": "",
        "output": "hello I just read your query see the main cause behind bad odor from mouth is due to bacteria present in mouth there are present several bacteria in our mouth the bacteria when come in contact with food particles release sulfur compounds which ultimately cause bad breath also you have been suffering from gum disease which exaggerate this problem along with all your oral hygiene measures and treatment add these measures in your daily regimen and these will help you a lot after every meal chew some roasted fennel seeds they will freshen your breath you can also chew fennel seeds and rinse together to increase good bacteria take one serving of curd once a day preferably in the morning or afternoon you can opt out for fat free curd if you do not want to go for curd made from full fat milk you can also chew fresh parsley leaves after meal to combat bad breath apples pine apple orange and free tea also helpful in reducing bad breath so you can also add all these in your food regimen they will help you in combat bad breath you can also use this home made mouth wash three to four times in a week take two teaspoons of baking soda and add it in a cup of lukewarm water mix it well swish it around for some time and then spit it out it is also useful in your problem and easy to do whenever you are going outside or in a meeting keep some chewing gums along with you which have peppermint zinc etc as their ingredient they quickly freshen your breath in a few seconds avoid alcohol cold drinks onion garlic and smoking if you do because all these things increase the problem of bad breath drink plenty of water because it is helpful in flushing out your mouth change your toothbrush very often basil cilantro and mint are also helpful in neutralizing your bad odor from mouth you can also chew them after meal these plants are easy to grow at home so you can grow them at home and use easily cardamom cloves and cinnamon are some commonly available spices and you can keep them in your mouth and chew them slowly they are also helpful in reducing bad breath"
    },
    {
        "instruction": "hello doctor I am a 19 year old female almost every time I stand up or sit up I get extremely dizzy and lose all eyesight and everything looks like a to that lost signal I also lose most of my hearing and there is also ringing noises in my ear after a few minutes I can see again but I get about 20 seconds of an excruciating migraine I usually have to hold on to something because I almost always lose balance there have also been a few episodes while just sitting down I get blackouts it is just the same as described in the ones when I get while I stand up but about 20 times longer and I constantly fall and cannot stand or see absolutely anything in those cases that episode lasts for about half an hour I have had the constant spells when I stand up a few times daily at least for the past couple of years and thought they would decrease by now but the bad spells that I get have become more frequent in the past few months once every two weeks or so I have not had any injuries in the past few years so I have no clue what could be going on it is starting to really concern me also when I am exposed to the color white or yellow my color in my vision changes and I start to see different colors I have no idea if that is related but I have had those for years",
        "input": "",
        "output": "hello frequent chronic headaches are most commonly due to migraine headache chronic tension headache migraine headaches are usually unilateral associated with throbbing vomiting sensations photophobia and phonophobia chronic tension headaches usually present with heaviness in head band like sensation over the head with sleeping difficulties important here is to differentiate between the two a clinical examination especially neurological examination funds examination are must to rule out any other neurological problem which might also require neuroimaging you should see your doctor he will classify the headache and if it is migrainous treatment would be with drugs like flunarizine propanolol amitryptyline tension headaches are treated with amitryptilline escitalopram with behavioral modification treatment I hope this helps"
    },
    {
        "instruction": "hi doctor I am using a treatment on my acne called epiduo which was prescribed by my doctor my skin has very bad hyperpigmentation and acne I have been using the treatment for three days and on the second day it itched and burnt a little and I thought it was just working and all was fine but on the third night I put it on and my skin began to burn terribly and it was unbearable it blocked me from breathing and I nearly passed out I did not wash it off because I found when I did that on the second night it made it worse and when I woke up today I had terrible chemical burns all over my face my hyperpigmentation and acne had become worse and it is causing immense pain and discomfort and it really does look terrible it is similar to the worst kind of sunburn ever and the skin is plastered and dry too I do not know what I can do is there some sort of treatment I can do in a cosmetic skin clinic or something I can use on the burns and the acne and the hyperpigmentation",
        "input": "",
        "output": "hello you have developed contact dermatitis to this epiduo adapalene and benzoyl peroxide which you were using for treatment of acne now your skin has two problems it needs to be treated in two steps first we have to treat contact dermatitis do not use epiduo now wash your face with mild soap and water take tablet azithromycin 250 my twice daily for the first three days then on alternate days for three weeks apply sunblock of spy 60 sun protection factor from morning till evening use good moisturizer four to five times a day when your skin improves from this contact I burned condition then step two of treating acne and leftover pigmentation will be done contact dermatitis and acne vulgaris apply a sunblock of spy 60 take azithromycin 250 my be for the first three days then on alternate days for three weeks apply moistuerzer four to five times a day wash face with mild soap and water avoid using dettol and other irritant avoid scratching or pricking up the leison follow up at three weeks"
    },
    {
        "instruction": "hello doctor I am a 24 year old female I had preeclampsia with both pregnancies as well as kidney infections during pregnancy I have a history of ti as well my creatinine was up to 67 in all of my kidney infections few months back I had a partial hysterectomy in which my left ureter was cut and not noticed and I was closed back up I returned to the er six days after my hysterectomy and was taken to emergency surgery because my left kidney was enlarged and not draining I had a stent placed which remained for six weeks my creatinine was 7 I had bloodwork done after my stent was removed and my creatinine was I had another kidney infection in four months my blood pressure has been increasing since then and I had to go to the er because my blood pressure was about 146 121 mhg I am now on blood pressure medication and my blood work shows my creatinine at 2 I had a renal scan done that came back normal is it possible that I had cod or are there any other explanations for my raised blood pressure flank pain and increased creatinine I am currently taking adderall 15mg two times a day macrobid after sex lisinopril",
        "input": "",
        "output": "hello in preeclampsia or eclampsia patients may present with albuminuria this may lead to progress to chronic kidney disease your urine examination report also showing plenty of rec red blood corpuscles but not mentioned what is rec morphology in microscope in case of renal problems morphology is changed but if morphology is intact means it is lower urinary tract infection also check for ti urinary tract infection for your husband there is a chance of repeated urinary tract infection please review with urine culture report if unnecessary raising of serum creatinine may a need kidney biopsy control your blood pressure which may lead to proteinuria and renal problems"
    },
    {
        "instruction": "hello doctor I am an 18 year old female who has for the past months been experiencing that my memory is degrading badly I have always had a memory that was fair enough I do have much stress and I do have social anxiety I do not sleep that well but that was never a problem before I sleep around 7 hours on school week and hours on a holiday I do take some medications for my add and I am aware there are some side effects to that medicine I could not even remember a friend name that I recently met for some split seconds then after some thinking I could finally remember it I can remember certain situations that were very important I could remember something from years ago but not weeks ago and I do feel like my memory gets better after I eat food but it feels like it is getting worse as time passes I did as a child had to do mind memory games at school but I felt like I could still remember basic information or situations that happened some days prior but now I cannot even remember what I did days ago is there something wrong with me I am showing early signs of dementia or I am just overreacting",
        "input": "",
        "output": "hi I appreciate that you approached for counseling I am not sure whether you are diagnosed with add or not also please do mention medicines you are taking based on given information it seems that you are experiencing attention problems due to stressful events and preoccupations in your daily work also lack of quality sleep may effect concentration that leads to recalling problems you need thorough assessment for that apparently it is related to anxiousness and stress factors dementia occurs in later age of life and you are too young for that you might need help for anxiety management and stress management also if you are diagnosed with add then another detailed assessment is required"
    },
    {
        "instruction": "hello doctor I am 42 years old I had a heart attack 12 years ago and now have three stents by the way I have no family history of heart disease high blood pressure cholesterol and anything of that nature I am a disabled military veteran and am 40 disabled as a result of being exposed to lead and asbestos during my time in service I am drawing disability for chronic or acute sinusitis and migraine headaches it is my contention that my heart complications are a result of being under those same conditions while in the service I had not had any health issues nor any family history of heart issues leading up to these complications this is a battle I have been fighting for nearly ten years I have provided case studies online articles and most recently feedback from a cardiologist that stated that there has been findings that there is a correlation between lead and asbestos exposure and heart disease even when I was able to obtain that particular feedback they are now requiring additional documentation I am reaching out to you in an effort to get an open and honest opinion the veterans administration is asking the following is there a greater than 50 chance that my exposure to lead and asbestos during my service time could have lead to my heart disease and heart attack I have also included some articles below that back up the correlation between the two",
        "input": "",
        "output": "hello it saddens me to hear of the whole difficulties you have gone through in the past years I must recommend you for staying strong in the face of all these difficulties I have thoroughly gone through all your detailed explanation and here is my view although I have not had clinical experience of a patient with such complications I have thoroughly researched to find enough evidence to bring me to the conclusion that lead poisoning can lead to heart diseases and stroke but no much evidence of asbestos causing cardiovascular diseases these below are my findings in a study that involved 60 participants it was concluded that lead poisoning was associated with cardiovascular events most commonly but not limited to hypertension especially in lead blood levels below dl another article also detailed the complications of lead poisoning to the cardiovascular system although the mechanism is unknown a study by the harvard school of public health hsph also detailed the effects of bone lead to increase cardiovascular complications in my conclusion there is more than 50 chance of a cardiovascular complication due to lead poisoning although they might argue the fact that only a few cases have been reported I feel strongly that more than 50 of it caused your heart complications your level of lead exposure will help your case"
    },
    {
        "instruction": "hello doctor I am feeling very stressed for some issues I am having a feeling of guilt and fear how to cope with it",
        "input": "",
        "output": "hello you have reported feeling stressed for the past days due to some issues were you completely normal before days it is common to feel stressed when faced with difficult life circumstances you can follow these strategies to manage stress till you get better it is very important not to isolate yourself during this period try to open up and talk to a trusted family member or friend so that they can support you if you are feeling low you will want to avoid meeting other people but try to make an effort to go out and see others exercise regularly go for walks play sports these will release natural endorphins in your body and help to improve your mood eat regularly and sleep well avoid using alcohol or any other drugs these will just numb you temporarily and will not help in the long term try meditation to calm yourself try to keep yourself occupied by continuing with your regular work distract yourself during leisure time by listening to nice music watching movies etc follow sleep hygiene measures try to sleep for atleast 8 hours daily try progressive muscle relaxation exercises and deep breathing exercises try not to worry about things beyond your control is there anything in particular which makes you feel guilty and fearful is it related to any recent stressor if you are continuing to feel stressed and not able to cope visit your doctor locally for an assessment remember it takes some days to feel back in control"
    },
    {
        "instruction": "hi doctor I would like to get a second opinion on my dentist plan to fix my missing teeth I am missing my upper lateral incisors since birth and have had a temporary resign bonded bridge since I was 17 I am now ready to take the step to a more permanent solution my two options are a bridge or implants after my rays and mri scan it became apparent that I do not have enough bone for implants and I would need a bone graft since I would need at least my for each side my dentist told me that there was a chance it might not take and I would need another surgery the position of the roots of the adjacent teeth are not a problem there is enough space to place the implants just not enough bone initially he did say he would prefer to do the implants since it is a better solution for long term when my dentist asked the opinion of another dentist in the office he said that the bridge would be a better solution so I would not have to go through multiple surgeries and it would be done sooner the bridge is indeed a quicker solution but I am not very keen on having parts of my teeth removed for the bridge it will also need replacing at some point and if the underlying teeth have a problem the whole bridge needs to be replaced both my sister and mother have a bridge they are also missing their upper lateral incisors and I am not impressed with either results these were placed by different dentists I am fine with the process taking a little longer and being more expensive if it means it will give me a more natural smile but I am also afraid that I will be going through surgery for something that might not even take my dentist now does not want to express his opinion anymore and just keeps giving me the pros and cons any insights would be greatly appreciated",
        "input": "",
        "output": "hi in my view even though I do not have any pictures or ray I believe it is better for you to get bridges you can get costly zirconium bridges which are highly aesthetic and looks exactly like natural teeth get those side teeth root canal treated to prevent future sensitivity or pain this will give you a highly satisfactory result in my view implants need much bone support and as your lateral incisors are congenitally missing the bone at the region will be very thin and any bone graft is bound to fail in 50 cases for more details send pictures if possible"
    },
    {
        "instruction": "hi doctor I have been suffering lately from pain in my big toe joint it is very severe that I could not sleep two nights when I ran out of painkillers I thought it might be a gout attack because I do have gout though my uric acid levels are mostly high I do not really watch what I eat my triggers for gouty attacks happen to be rapid weight loss it was actually the cause I had gout in the first place I lost 40 keg in a few months when I was 18 so if I count the attacks I had since the first time years ago perhaps only six times three times my right big toe and three times my left ankle all when I was not eating well and lost a lot of weight the last attack was a year ago but it has never been too severe and the most painful period will last for hours in one single night I cannot step on it and eventually it will go away gradually but this time it is too intense especially if I try to sleep I will sleep in minutes and the moment I move my toe while asleep I wake up with an extreme pain like someone stabbing my foot with a knife and cut it through from the big toe joint through the upper foot I even cried as I felt helpless with extreme pain that will not let me rest and it has been a week now and the pain is not going down with medication the moment I finished my voltaren 50 my in four days I thought it is much better now but it came back like a demon the problem is that I am confused and cannot run into all options of diagnoses due to financial situation I went today to a hospital the orthopedic was full could not get an appointment urgently so it was a general doctor he did not know for sure what is going on he suspected gout so he made blood test and uric acid was 326 umol which is the best I have ever had as he still not sure he advised to do an ray and the result he said as normal so he gave me strong painkillers and allopurinol which I did not use as my uric acid is fine and told me to see how it goes for two weeks in my ray see I noticed there is a slight difference in distance between the bones of the toes and the foot the big toe is a bit closer to the bone comparing with the other toes I do not know if this has anything to do but I want you to double check I have attached the photo taken to give you more information the pain is so intense if I am out of medication the big toe flexes up or down but up is more difficult than down and also upon stepping on it so I have to walk stepping half side of my foot avoiding landing on the big toe base of course I apply ice water almost every three hours to feel ease and also pain upon touch from the outer side of the joint to the left also you can see clear swelling and color change of the skin in the photo I am totally confused because I happen to make many mistakes that might cause different problems to my joint I am not sure which one triggered it or the cause of it I lost a lot of weight in a short period of time I was recently last month on a ketogenic diet low carbohydrate high fat in which there is a debate that it might be problem for gout sufferers I have also increased my volume and intensity of the workout due to the extra energy felt when I was veto adapted I usually stop exercising when I feel I spent a lot of hours not because I was tired so perhaps that caused a lot of stress on my body my daily workout was something like 90 minutes weight lifting in the gym and 45 minutes running and maybe 30 minutes walking to the gym if we count this as well I remember running in barefoot too I changed my shoes just a week before the pain and I chose a good quality running shoe I chose a fit one not painful or even uncomfortable but I thought because it is filled with cushioning and felt light and good I have not even known that there could be a problem until last night I read some articles against tight fit shoes especially for those with gout so I am really confused about the problem am I suffering from gout or sesamoiditis or tendinitis or turf toe I need you to guide me what should I do will I need to do an mri or it or bone scan which one will confirm everything",
        "input": "",
        "output": "hello for further information consult an orthopaedician and traumatologist online"
    },
    {
        "instruction": "hello doctor I have a lipoma in my arm is there any cure",
        "input": "",
        "output": "helio I have gone through your query and understood your concerns lipomas are painless swellings for lipoma the best treatment is surgical excision and as it is not a big surgery you can go for it consult a general surgeon online regarding the surgical removal of the swelling"
    },
    {
        "instruction": "hi doctor in my right upper arm I have a lipoma which grows slowly from three years now I have two new lipomas in the same upper arm there is no pain as such is it normal",
        "input": "",
        "output": "hello firstly I want to ask you whether the diagnosis of lipoma was made by a doctor because swellings may be of several types my advice is to visit a surgeon for an examination in person the doctor will be able to tell you the best whether you need a biopsy or excision of the lesion or whether no active management is needed it is difficult to comment without examination hope this helps for further queries consult a general surgeon online"
    },
    {
        "instruction": "hi doctor I am a 20 year old male healthy and active all my life I have multiple lipomas that do not bother me except for their appearance and having to explain to people what these bumps on my body are whenever I take my shirt off doctors say all I can do is have them surgically removed but that would lead to many scars frankly it does not bother me that much to undergo an elective surgery what advice would a chiropractor give for my condition",
        "input": "",
        "output": "hi for further information consult a chiropractor online"
    },
    {
        "instruction": "hello doctor I was diagnosed with palmer erythema last year I am 28 years old however I started drinking moderately from 16 20 then stayed sober for a year and a half however started drinking again at and have been more of a binge drinker consuming on average of 20 50 drinks a week over the last years I never drank everyday usually 10 one day during the week but would drink lot on friday annd saturdays since my pe diagnosis I have had my liver enzymes checked times along with abc and autoimmune diseases and just about every kind of blood work that could cause along with an ultrasound and everything has came back normal except my cholesterol and triglycerides were a high since I have gotten my triglycerides in healthy range but cholesterol is still a little high my question is how accurate is all of this in detecting liver damage I do not have any symptoms of disease except the red palms and should I be concerned since I am now sober as I have talked to several people in the cirrhosis and fatty liver disease community and it definitely scared the heck out of me how dangerous alcohol really is so I am just hoping to get some advice and if there is anything else I can do to be certain or what is your opinion on my story definitely never drinking again and totally not worth the risk of developing some kind of liver disease",
        "input": "",
        "output": "hello do not worry you may have anxiety more than disease itself for raised total cholesterol you may take low cholesterol diet with regular exercise quitting of alcohol may be useful get it done ultrasound abdomen and liver scan avoid alcohol intake use tablet pantoprazole before breakfast for one week eat green leafy vegetables do yoga and meditation be happy and do not worry if cholesterol is still high then you may take antihyperlipidemic drugs please consult your physician he will examine and treat you accordingly take care"
    },
    {
        "instruction": "hello doctor I am a 26 year old female with no significant health history I have anxiety and I had hyperthyearoidism in the past I have had an itchy rash for over three months it started as a small patch behind my left knee it happened after having a ring shaped rash on my left thigh I was treated for that with antifungal cream and it went away this new rash is completely different I am extremely itchy to the point it is interfering with my life there is no obvious rash unless I have already scratched that area I then get a bunch of small skin colored bumps also after scratching I often get petechiae and bruising the itch is everywhere but my face I have been waking up wet from sweating even though my bedroom is fairly cold at night a few times I have checked I had a small fever of around 1 my doctor puts me on antihistamines benadryl at night claritin during the day and steroid cream it has not worked she recently wrote me a prescription for prednisone but I am worried that a skin allergy just is not what I have I am currently taking effexor 75 my klonopin 5 my when needed",
        "input": "",
        "output": "hi you do have a bright red colored rash over the legs such rashes occur mostly as a response to allergies now allergies can be because of food artificial colors or even at times because of insect bites the petechial patch on the shin is nothing but a result of excessive scratching of the skin you must use a good preservative free hydrating moisturizer cetaphil restoraderm in the morning if the itching is severe enough there is no harm in taking a short course of prednisolone most importantly get your blood workup complete blood count done you can get back to me after the blood work is done"
    },
    {
        "instruction": "hi doctor I am 39 years old I have a very bad red itchy weeping scaly butterfly rash on my face which my doctor says is rosacea but it has responded to no treatments except steroid cream so far I also have excessive watering itching and swelling of my eyes ocular rosacea not sure if there is a connection but my periods have become unusually light during the last year could I have something more than just rosacea do you think I am currently being tested for lupus but would there be other possibilities for what could be causing this",
        "input": "",
        "output": "hi from the photos it looks like rosacea however the possibility of lupus and allergies to sun exposure can not be ruled out you should check out for lupus steroids are not given in rosacea as initially it may give a good improvement but as the times goes by you will be completely dependent on them topical steroids cause skin atrophy and hoards of other problems which is more or less permanent so I will suggest you stay away from them topical metronidazole gel at night with a good sunscreen as rosacea worsens with sun exposure will give results rosacea is a chronic condition and will stay for a long time you will have to manage it well it some times shows signs of flare ups and downs generally as a response to anxiety stress excitement and prolonged sun exposure minimize sun exposure use sunscreen meticulously daily no cosmetics on the face follow up after the use of said medications in 15 days time"
    },
    {
        "instruction": "hello doctor I have been to four different hospitals over within a year multiple times due to health anxiety and fear of heart failure heart attack etc I am dealing with a lot of muscle tension all my muscles are tight and I am always checking my heart rate constantly for some reason at times like standing walking or in the shower my heart feels like it is beating harder than normal and faster at times I am not sure if a tight chest makes heart beats feel more intense or if there is a problem I have had ekg chest rays and blood work to rule out serious heart conditions everything was fine except blood pressure I have been really stressed scared and constantly on edge so they think my blood pressure is due to stress as I was having a panic attack when it was taken and when I was relaxed it started going down I am extremely scared to do anything because my chest neck and back is so tight and when I feel my heart beat fast things get tighter spasm and lock up what is going on what is the remedy to this is this really anxiety can the muscle tension make my heartbeat feel stronger than normal",
        "input": "",
        "output": "hello your symptoms seem to be due to anxiety if all your workup is normal there is nothing to worry about I advise you to eat healthily avoid fast foods alcohol etc do regular exercise flush all the worries out of your life there is nothing to worry about always chill you have your life and you have to make full of it always care for life as it is precious so you are too take part in healthy activities if these measures does not solve the problem pay a visit to the psychologist in my opinion you are fit and healthy and nothing to worry"
    },
    {
        "instruction": "hello doctor I am a year old male I do no substance abuse alcohol and smoking I have a painful post auricular lymph node swelling for four days yesterday evening one more post auricular lymph node was noticed which is swollen sudden in onset and painless I am taking antibiotics augmenting duo amoxicillin and clavulanic acid and painkillers for three days I am worried because one more lymph node started swelling and I even worried about cancer please help blood test was done lymphocytes and neutrophils 30 rest all values are normal",
        "input": "",
        "output": "hi your complaint is suggestive of some ear or scalp infection as it is painful please send a picture of the lesion as it is possible that what you think is the painful lymph node is actually folliculitis and the painless thing is actually the real lymph node in that case the antibiotics that you are currently taking are appropriate the dose should be augmenting duo 625 amoxicillin 500mg and clavulanic acid 125 my twice a day for five days do not stop before five days take tablet combiflam ibrufen 400mg and paracetamol 325mg twice a day for two to three days regarding the risk of cancer size of the painless lymph node is a very important parameter in deciding further investigation if the size is more than 5 am then fac fine needle aspiration cytology of the lymph node is usually recommended this test needs to be done if after taking the above mentioned treatment for five days the swellings continue to persist gram stain and culture of any discharge acute lymphadenitis lymphoma folliculitis continue antibiotics to complete total of five days painkillers as required hot and cold fomentation maintain scalp hygiene followup is must if the swelling persists more than a week follow up with pictures both before medicines and after a week"
    },
    {
        "instruction": "hello doctor why do men get wrinkles in their foreheads with age is it more lifestyle or genetic is it possible to tell if it is more than the other are men more or less likely to get forehead wrinkles compared to women why or why not what can men do to prevent forehead wrinkles is there anything they can do to reverse them once they show up that does not require surgery do facial muscle exercises I face yoga work what surgical options to men have and when might they consider it are forehead wrinkles a sign of an underlying health problem or cause for concern",
        "input": "",
        "output": "hello forehead wrinkles are signs of aging process men get wrinkles due to decrease formation of new collagen and destruction of already existing collagen and elastic proteins in our skin wrinkles can be inherited if one gets it early but in majority people they become prominent with aging and ultraviolet radiation has the major role to play in this uv ultraviolet radiation boosts the process of collagen degradation through the formation of reactive oxygen species men get more forehead wrinkles because in females estrogen has a somewhat protective role men are more exposed to sunlight and women have more fat layer beneath the skin that gives good contouring to the skin prevention of forehead wrinkles is partially possible because they are part of the normal age process protection from sunlight is very important in this regard treatment of forehead wrinkles can be invasive or noninvasive in non invasive procedures hifu high intensity focused ultrasound is very famous nowadays in this high intensity focused ultrasound waves are given to wrinkle area and it stimulates collagen formation invasive methods are botox injection surgical correction requires fillers to be inserted"
    },
    {
        "instruction": "hello doctor I think I have tonsil stones I have little white things in my tonsil pockets when I cough them up or manage to get them out they are whitish or yellowish hard clumps I have mild sore throats all the time bad breath I brush my teeth constantly and I make sure I do not eat food that makes breath smell bad and I get earaches it constantly feels like food or something is stuck in my throat and it is really annoying should I go see a doctor about this or is there any way I can get rid of them at home",
        "input": "",
        "output": "hello you suffer from tonsilloliths tonsils which are lymphoid organs in the throat produce secretions through the crypts in them in a few people these secretions calcify and become stones called tonsilloliths in a vast majority of people it stays asymptomatic however in a few like you they produce symptoms such as food stuck in the throat and mild ache the presence of these stones causes stasis of secretions in the crypts which otherwise freely flow into the mouth the stasis causes the development of bacterial colonies which result in halitosis bad breath and associated throat ache the tonsils act as a source of infection to the ears as the bacteria rises up along the eustachian tube that connects back of the nose to the ears on each side sometimes a remnant of adenoids could also be causing the ear issue if this problem has been there for more than three to four months I suggest you go ahead and get your tonsils removed the procedure is called a tonsillectomy before that we would like to take a radiograph of your nasopharynx to rule out adenoids enlargement adenoids usually regress by 10 years of age but in some it remains longer and causes problems of mouth breathing ear block snoring and ear infections if adenoids are enlarged they also can be removed along with tonsils in the same setting adenotonsillectomy if you ask me the merits and demerits of the procedure in your case the merits clearly outweigh the demerits these lymphoid organs in you have turned more harmful than protective the tonsils are causing you bad breath foreign body feeling in the throat along with tonsillar stones the tonsils or the adenoids are causing you the ear ache as well post operatively you may face mild pain for two days and you can resume your work or college in three to four days time in my set up we do this operation on day care basis we use radio frequency ablation for removing the tonsils which is one of the most recent advances in the field of ent surgery medically the problem can be managed but recurrence are the norm you may gargle the throat using chlorhexidine dilution or betadine dilution multiple times a day drink plenty of fluids treat an acute infection on a case by case basis using appropriate antibiotics and avoid cold spicy food items that may irritate the mucosa however a permanent solution for the problem will be evasive unless and until you rid yourself of the tonsils I hope this helps ray of nasopharynx soft tissue lateral view for adenoids serum ice throat swab for culture and sensitivity"
    },
    {
        "instruction": "hello doctor I am 45 years now and still not blessed with a child due to late marriage this is my third year after marriage I get my periods regularly but this month I got my period as usual on the correct date and after one week again I got my period with lot of clots is this sign of menopause or all the cysts are coming out please advise how to become a mother in my case",
        "input": "",
        "output": "hello doctor welcome to icliniq com age is an important factor in getting conception of an embryo the best healthy ovum are usually released during the early years of life thus during a late age we might have an unhealthy ovum so if you are trying to conceive you approach a gynecologist to check the status of your uterus endometrium ovary ovum and hormonal levels if there is something wrong we can specifically give the treatments mostly in this age menopause is possible other things such as fibroid uterus should be ruled out through an ultrasonogram if menopausal attained then the estrogen progesterone level in the blood will be in the lower level I suggest you go for a lab investigation to rule out the cause in allopathy system you may try for in vitro fertilization techniques for conceiving in ayurveda take tablet alles compounds two in the morning two in the afternoon and two in the evening after food continue this tablet for three months if you do not have fibroid uterus and menopause you will get conceived if a fibroid is there we can treat with other drugs or do surgery to remove the fibroid if menopause attained then no hope for natural conception invitro fertilization may be helpful simultaneously the semen analysis to your husband to be done if a couple gets their kid at the age of 47 by the time they reach 70 years their child enters college this is how late marriages affects the care of the next generation"
    },
    {
        "instruction": "hello doctor I had septoplasty and turbinoplasty 16 days ago after the surgery they asked me to come back after two days for packs removal then after two days I went to the hospital other doctor look after me and he just removed one pack even I asked him to remove the packs on both sides but he refused it I then came back home after two days I cannot able to eat or even drink anything as my mouth smells very foul and the whole nose got swelled then after seven days I revisit a doctor then the doctor who did the surgery on me looked inside my nose and pulled out the pack hardly then after this my nose shape changed badly and I cannot breathe normally now what I can do now",
        "input": "",
        "output": "hello I understand you underwent septoplasty and turbinoplasty and you have not completely recovered after septoplasty post operatively it takes about two to three months for complete healing and recovery you must put solspre nasal spray two puffs four times daily for about a month in either nostril if there is excessive dryness you must also instill 5 menthol paraffin nasal drops three drops in each nostril thrice daily the room where you stay must be adequately humidified and should have moisture you must drink plenty of water and take healthy foods you must go for weekly reviews with the ent surgeon who can look into the nose and see if the healing is good if not you may require suction clearance of the nasal cavities any clots or crusts may be causing the nasal blockage for you if after two months also you are not feeling any improvement kindly contact us we can reassess the problem and get you the best treatment"
    },
    {
        "instruction": "hi doctor I went to an optometrist and diagnosed with something like below retinal exam showed od temporal area of pigmentation old carpe is tropical hole with area of retinal elevation I have attached the optomaps can you please tell me how serious is this does it need surgery",
        "input": "",
        "output": "hello I have gone through your optomap the first left eye one seems fine the second one right eye on your left hand side has a few changes it is a bit tricky to make assumptions based on images but are you referring to the retinal elevation and hole and carpe on to the left hand side there are a multitude of options to treat such a disease some doctors with such a finding might say that it is a small hole and localized elevation and especially if you yourself have no symptoms like flashing light or floating objects might ask you to simply follow up with them and recommend observation others may recommend that you get laser or surgery done more so in case you have symptoms as mentioned above and if you have had any such incidents in your other eye or have risk factors like a high power so in summary I can say that it mainly depends on the progress your symptoms and the risk factors I can assure you that observation for a retinal problem like yours can be done because it is not involving the center part macula but the doctor may opt to treat with a laser depending on the progress of the condition once again it depends on your progress risk factors and symptoms"
    },
    {
        "instruction": "hello doctor I have hypothyearoid and pod I am taking eltroxin 100 mug I have been put on devilry tablets a few times to regularize periods I am looking for a permanent cure for pod I read from your posts that kalarchi choornam is effective can I take them along with thyearoid eltroxin tablets or will there be any interaction what is your suggested treatment for my pod",
        "input": "",
        "output": "hello you have hypothyearoidism and pod polycystic ovarian disease you are not trying to get pregnant now so it is time to take strict siddha medications to get a complete cure from pod I advise you to continue eltroxin tablet during your regular visit the physician will regulate its dose based on hormonal values so you no need to worry about that in many people siddha drug renders the possibility of reducing eltroxin dose for pod please follow the following medical advice a kumar legium van kumar legium take go one spoon in the morning and evening before food or alles compounds two tablets in the morning and two in the evening after food tablet chithira moola kuligai one tablet in the morning and one in the night after food kalarchi chooranam 5 go in the morning and evening after food with hot water or milk if you do not get this drug in the market you can prepare as follows kalarchi bonduc nut seed remove outer shell and use only the inner kernel 100 go black pepper 10 go asafoetida fried 10 go keep these in a pixie jar and make a powder the drug is ready store in a container alai vembathi thailam or kalingaathi thailam both or same my daily during the night before bed after some days you can increase its dose a few drops continue all these drugs within three months you will get periods then also during menstrual bleeding days stop all drugs again start from day fifth of the bleeding day continue for six months your uterus and ovary will become normal suppose if you do not get bleeding but only few spots then consider it as the bleeding if you do not get even a spot then do not worry you continue these drugs for six months tender arasam leaf peepal tree collect the tender leaves grind three leaves and mix with milk like milkshake consume this in the morning continue this daily morning until you become normal if you get more tender leaves at a time dry them and powder it then take go and mix in milk if you do not like milk then use buttermilk or water this is another important home remedy for pod"
    },
    {
        "instruction": "hello doctor I have had many years of health problems including severe joint pain inability to lose weight chronic fatigue transient pains and abdominal pains that seem to come and go in cycles sometimes lasting for days or even months I have a medical phobia so have not been to the doctor unless it was an emergency but over 20 years ago I ended up going to the er and had several tests I was told I had lupus osteoarthritis cos and thyearoid issues I have tried to treat myself and pain naturally over the years with a healthy lifestyle and natural aids but the pain finally became so bad over the last couple of years that I have gone to some appointments I was referred to a rhuematologist that did blood work and said I was fine except low vitamin I told the new doctor about the early diagnosis and she said it was probably wrong but she would run blood test anyway when the test results came back she said I did not have an autoimmune problem and I was fine except that I had low vitamin I have a copy of the test results that look like there are some problems to me and based on her reviews and my personal experience with my health I would very much like a second opinion I am taking xanax when needed some tests are attached I have also had an mri that showed osteitis pubis fatty liver and mild bladder inflammation",
        "input": "",
        "output": "hello I have gone through your history and blood reports I found a few abnormalities which I would like to ask a few more details on and also some more questions pertaining to your problem which would help us reach a conclusive diagnosis do you experience any dry eyes or dry mouth when the pain comes is it more in the nights or day do you experience fatigue in the morning hours as well any recent mood changes with irritability any history of forgetfulness as for the blood test major abnormalities I found were low vitamin positive ana but the titer is very low and further end is negative which excludes an autoimmune cause but your cop reactive protein is a bit high at the last report so there was an infection going on that time or any other symptom as your last cop was mostly normal as of now I do not think you have lupus my diagnosis is going towards fibromyalgia but would like to confirm after knowing these further queries only"
    },
    {
        "instruction": "hello doctor I saw an ophthalmologist for what I thought was a pink eye infection the following issues were addressed acute sudden onset inflammation of the conjunctive the membrane that covers the white part of the eye causing the white part of the eye to become red and irritated with the formation of little bumps inside of the inner eyelid and misalignment of the eyelashes which rub against the eyeball causing irritation his diagnosis was some type of scleritis he wrote a prescription for drops with an antibiotic and told me to give it a few weeks to clear up and nothing serious within a month there was little marked improvement so I went to see him again he was amazed that there was no improvement and laughed he said all of my patients get better with this medicine except you should probably check with the pharmacy and see if this was a bad batch maybe it got too hot on the truck I was literally taken back he took me off of that medicine and told me to get over the counter drops similar to no more tears I did and used for one more week with no improvement I called his nurse at his office and he prescribed prednisolone acetate drops which did seem to eliminate the white blisters on the white of my eye however my eye started to hurt as if someone was stabbing it with a needle over and over at random times by the next day morning I lost a part of my vision in my left eye it was as if someone smeared my lens with vaseline blurry and looked like I was looking through frosted glass and also painful I called his office and he was on vacation so they referred me to the physician on call at another facility the doctor was shocked that this had gone on for so long he was afraid my vision was in danger because of nontreatment he diagnosed me with dendritic keratitis and shingles of the eye cornea he did not want me going back to the previous doctor I have been with him since trying to get this fixed he prescribed me the shingles medicine valtrex the shingles in the eye are getting better now but the damage which could have been prevented has taken its toll my left eye is left with a smear laziness fog or frost vision which makes it impossible to focus especially with both eyes open I asked him about a possible cornea transplant and he said the damage was likely too deep in the eye to make a difference in fact that could even make it worse is this true I now see two blurry red light traffic signals covered in frost or haze he said the haze would be permanent my wife and I are almost retired and wanted to travel before this happened please let me know what I can do in this matter or any surgical recommendations the prognosis for full recovery was bleak when talking to another doctor",
        "input": "",
        "output": "hello after going through your history I understand that you have two concerns firstly what has gone wrong and the second is how to fix it from what you have mentioned in your query I can tell that you have at least two problems interfering with your vision corneal scarring due to the viral infection of the cornea this is an end stage and can be corrected using a corneal transplant although the information you have provided is quite detailed it would be useful to have a photo of your cornea the round black part of your eye this is to check for corneal ulcers or scarring optic disc damage or glaucoma I think this may be present as well it is a common side effect of long term prednisone and probably why your second doctor said that a corneal transplant will make this worse as the problem is too deep in the eye once again although your description is detailed glaucoma cannot be ruled out by this limited information please send a photo of your doctors reports or at least the intraocular pressure readings coming to the cure corneal scarring can be cured with a corneal transplant but I am afraid if you have glaucoma there is no way to get back the vision you lost all we can hope to achieve is not to let further damage to the disc happen I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 50 year old male I was having photosensitivity not too bad went to a dermatologist had a blood test and tested positive for ana 160 I was getting eczema on my hands and feet with the sun at the beach tiny little itchy blisters but my forearms and calves start to itch with a very slight rash I was told I essentially had very dry skin he was not even going to order a blood test but did it just to make sure of blood count I showed him a picture of a slight rash the ana then tested positive I have to go see a rheumatologist now I do not have any other symptoms of joint pain etc I am pretty healthy I work out five times a week I take atorvastatin for cholesterol baby asprin ezetimibe and vitamin I also have a vitamin deficiency I also had a physical four months ago and everything else was fine with the blood work everyone told me not to worry that there are a lot of false positives I can have an early stage of something and it needs to be monitored but what am I most likely realistically looking at how quickly does this get assigned",
        "input": "",
        "output": "hello according to history it looks more like the skin is the only one troubling you I would like to ask you a few more queries did your rash resolve after the sun exposure was removed do you experience it on a daily basis when exposed to the sun or was it just due to prolonged exposure how about your other blood test like complete blood count ear erythrocyte sedimentation rate and liver function test yes it is true that ana antinuclear antibody can be a false positive in a lot of people but we need to be sure that it is not the start of a disease so only ana does not give us answers we need to see if it is causing inflammation in the blood which will be clear from other tests as per history it sounds more like a polymorphous light eruption which usually should improve itself but yes if your skin is sensitive you should avoid getting prolonged exposures like tat as they can be harmful to the skin"
    },
    {
        "instruction": "hello doctor what do parents need to know about keeping their children safe around water this summer how to stay safe at a pool in the water and around the pool area how to stay safe at a beach in the water and on the shore what are possible signs of distress or danger parents should look for extreme exhaustion coughing heavy breathing what is dry drowning and what to look for most important points parents should teach their kids about water safety",
        "input": "",
        "output": "hello staying safe in and around the pool avoid taking children between the age of months to years near pools as they may go unnoticed into the pool and may drown if at all you do take children to the pools make sure they have their floats and other safety equipment on at all times even when out of the pool make sure children do not drink the water of the pool staying safe in and around a beach all of the above tips plus be careful of children eating sand watch out for sea urchins crabs and insects that may bite the children carry enough water with you and advice the children to drink plenty of water so as to prevent dehydration on a hot sunny day at the beach warning signs breathlessness fainting drowsiness convulsion dry drowning is when water enters the child nose and upper respiratory airway but does not enter the lungs due to spasm of the upper respiratory tract watch out for breathlessness chest pain and irritability in this case"
    },
    {
        "instruction": "hello doctor what are the benefits of natural remedies for chapped lips can almond oil cumber lemon juice conut oil a humidifier sugar and honey green tea bags and olive oil be used as natural remedies for chapped lips I would like to know the skincare expert view please suggest",
        "input": "",
        "output": "hello for chopping of lips the following can be used conut oil has a good emollient effect and forms a barrier over the lips that prevent further chopping it can be used two to three times a day olive oil is another option to treat chapped lips and help in retaining the moisture within the lips preventing further damage it is used after washing and taking a bath rose petals and rose water another important remedy for chapped lips it has antioxidants properties and due to its fragrance it is cosmetically acceptable it can be applied three to four times a day lemon juice is full of vitamin that is ascorbic acid and being a very good antioxidants it is very important in treatment of chapped lips it can be used by mixing in few drops of water aloe vera is another very important home remedy for treatment of chapped lips it can be used along with vaseline vaseline petroleum jelly is a very good and cheap method for the treatment of chapped lips it gives good protection and provide a barrier and retain moisture almond oil and shea butter both can be used for the treatment of chapped lips honey has a lot of benefits for skin apart from wound healing and its antiinflammatory properties it has hydrating and moisture retention qualities which makes it excellent for treating chapped lips it can be applied twice a day green tea bags can also be used because their ingredients have antioxidants properties and helpful in improving the chopping"
    },
    {
        "instruction": "hello doctor I am years old from the last few days I am suffering from herd I feel something is stuck in my throat and even if I take water this feeling never goes also I feel a loud sound in my stomach before and after lunch and formations of gas I took reblet eristozyme tables and sacral antacids but did not work please suggest me remedy so that I can get received from herd and the feeling in esophagus",
        "input": "",
        "output": "hi not sure whether the diagnosis of herd gastric esophageal reflux disease is made by you or your physician by looking at the symptoms it looks like there is increased gastric acid secretion which is giving you the sensation of bloating diagnosis of herd is made if you feel that the gastric acid is regurgitating back and you feel soreness in your mouth especially when lying down this is because of the relaxation of lower esophageal sphincter pressure as a result acid is regurgitating into the esophagus I suggest you to modify your lifestyle as mentioned below avoid spicy and acidic foods avoid going to bed immediately after food a gap of at least one to one and a half hours is recommended elevate the head end of the bed to about 30 degrees while sleeping avoid smoking and alcohol if you do so take small feeds or meals and avoid fatty foods and large meals avoid coffee tea cold beverages like cola etc for a few days continue tablet lansoprazole or pantoprazole 40 my twice daily for a month no need to take domperidone along with these you can take antacids as and when required but not more than 20 my per day if symptoms do not resolve after 30 days give a try for pyloric kit lansoprazole amoxicillin and clarithromycin for 14 days it is readily available with chemists if the problem still persists you need to undergo endoscopy to find out the reasons for persistent symptoms and may require surgical intervention I hope this helps"
    },
    {
        "instruction": "hello doctor my father is 70 years old he has some dental problem and that is filled with pus and blood local dentist checked it but the treatment does not provide complete solution it occurs again and again please check the picture and tell me what it is it cancerous is it curable please guide",
        "input": "",
        "output": "hi a localized radiograph of that region inadequate oral hygiene maintenance deep scaling and radiograph revert back with the radiograph to an endodontist online"
    },
    {
        "instruction": "hello doctor I have already put my query to a neurologist still I would like to get opinion from you as well my son is 5 years old he has been diagnosed with benign childhood epilepsy his mri and it were normal there are epileptic form of discharge he spikes from right occipital lobe usually he will be conscious and feel involuntary movements in left leg in severe case he will lose balance and fall down this will happen once in a week we consulted a neurologist and epileptologist here in my place they prescribed him topamac 50 my twice a day and lobazam 10 my for three months I am concerned about the long term usage of lobazam will it cause any serious side effect now with medication he is fine and attends kindergarten school please do reply about my concern",
        "input": "",
        "output": "hi I went through your query I can understand your concern about long term effects of antiepileptic medications so in reply to your query I would like to make suggestions for your son as follows treatment of many types of childhood epilepsy requires long term antiepileptic medications sometimes for years together hence your doctor a neurologist always has to judge the minimum dose that is adequate to prevent seizures and also to take care that the dose does not cause side effects dose of most of the drugs in children is decided by weight and not by age at present I assume that your son weight is around 14 15 keg and the second is please make sure that your son is taking plenty of liquids during the day to avoid a remote risk of developing renal stone renal stone is not common but a possible side effect with topiramate please take all possible measures to avoid factors that may precipitate seizures such as avoidance of physical or mental strain avoidance of excessive hunger control of fever with proper medications and tepid sponging etc please make sure that all the antiepileptic medications have side effects so it is usually the best option to choose proper medications that control seizures as well as do not cause side effects at present I would agree with your neurologist opinion however a neurologist is usually the best expert to manage childhood epilepsy for further information consult a paediatrician online"
    },
    {
        "instruction": "hi doctor does ma show arterioles does cat show small vessels can spent tell microvasculitis from vasospasm in microvessel do arterioles and capillaries feel pain",
        "input": "",
        "output": "hi I have read through your query in detail please find my observations below for further information consult an interventional radiologist online"
    },
    {
        "instruction": "hi doctor I am a 19 years old female I have noticed that one of my clavicle is longer than the other my left shoulder is slightly broader than the right shoulder every now and then I am experiencing pain in my left shoulder my waist on the left is bigger than my right side as if I have lopsided curves as well as my breast is bigger on the left than the right my posture looks good and my spine looks normal I have tried looking into scoliosis but was told nothing wrong with me is this a growth problem",
        "input": "",
        "output": "hi for further doubts consult a chiropractor online"
    },
    {
        "instruction": "hi doctor my last us report showed intrauterine pregnancy with my gestation sac no fetal and yolk sac last week I had brown discharge with mild lower abdominal pain and was prescribed austen 200 my oral now I am feeling the pain frequently in the right lower abdomen with mild bleeding and pain it is less when I lie on bed what to do",
        "input": "",
        "output": "hello I have read through your question and understand your concerns I think it is threatened abortion you should take bed rest along with tablet austen 200 my twice daily progesterone for two weeks and mbryosafe sachet once daily arginine I think it will help you and give you better prognosis ultrasound is required after two weeks for evaluation for further information consult a fetal medicine specialist online"
    },
    {
        "instruction": "hi doctor I am trying to conceive for over a year now but unsuccessful I went to a gynecologist and he told me that I have no eggs maturing in my ovary and was given clomid 50 my eggs did not mature and it only grows up to 10 my he asked me to come again to try I treatments he mentioned that my uterine lining is thin my cycle is regular for the past months I have 30 days cycle but I realize that my period is getting shorter and lighter during my ovulation I use ovulation predictor kit to track the test line gets dark between 15 16th day but the test line never gets darker than the control lines so I assume it as negative please help",
        "input": "",
        "output": "hi revert back with the investigation reports to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor my blood pressure is 145 95 how can I cure it through home remedies please suggest",
        "input": "",
        "output": "hi I have gone through your query for further information consult a general medicine physician online"
    },
    {
        "instruction": "hi doctor I underwent a comprehensive health checkup recently and it revealed multiple small nodules in both my lungs from the high resolution it scan presently I have sporadic recurring breathlessness during late evenings now I am taking osteopenia medication calcium and calcinase nasal spray the it scan report is attached for your reference please advise the next course of action",
        "input": "",
        "output": "hello for further information consult a pulmonologist online"
    },
    {
        "instruction": "hello doctor I would like to know how does our skin change through the decades how our skin changes in our 20s 30s 40s and beyond also looking for tips on how to care for our skin what products we should be used for certain problems when should we start acid toning how about retinal products",
        "input": "",
        "output": "hi our skin undergoes aging process continuously there are two types of aging going on in an individual intrinsic aging that is inherited in our genes and the other is extrinsic aging that is due to environmental factors most importantly the sunlight with aging the following things happen across the decades collagen in our skin becomes less resulting in wrinkles the process of degeneration of collagen gets aggravated by the exposure to sunlight due to the formation of reactive oxygen species natural moisturizing factor and hydration of skin get low and skin becomes more dry and scaly hair follicles in our skin and sebaceous glands also become less with time resulting in few hairs on the body elastic tissue becomes less in the skin resulting in crows feet fine lines and sagging of skin sunlight exposure and extrinsic aging lead to melanin synthesis and freckles lentigines formation on exposed areas skincare protection from sunlight is advised a good sunblock of spy 60 sun protection factor should be used vitamin cream can be used plenty of water should be taken consuming fresh fruits and vegetables with antioxidants properties are very important acid toning can be started around 30 years of age when skin requires rejuvenation topical retinoids are very important in skin rejuvenation they decrease wrinkles they increase collagen synthesis and give glow and decrease fine lines from the skin"
    },
    {
        "instruction": "hello doctor I want to know about going off birth control what are the five to ten most common physical and emotional changes women can expect when they discontinue hormonal birth control use will these changes differ depending on the type of birth control and how long you have been on it how so what are some myths people tend to believe about going off birth control can you debunk these any last words of advice for women nervous about going off birth control",
        "input": "",
        "output": "hello welcome to icliniq com there could be many effects if a woman has been on any specific birth control pills like mood variations fear of conception if not willing to conceive anxiety irregular periods skin dryness soft breast dry hairs less libido angry behavior etc if the body has been on one particular hormone then it gets used to it and after quitting the body reacts and those could be withdrawal symptoms or gradually the body original physiology comes out those who are habitual for contraceptive pills can have a strong fear of having conception or minor symptoms whatever they feel could report to their treating doctor woman who just wants to or already get rid of pills should have better physical and recreational activities and try to avoid withdrawal symptoms by making themselves busy"
    },
    {
        "instruction": "hi doctor my age is 35 I have black patches on my face and pores on the cheek black patches first occurred years ago for the first time how to remove them and get a fair skin please suggest",
        "input": "",
        "output": "hello I have read your query postinflammatory uv rays sun damage start applying anti pigmentary medications like koji acid kojivit or hydroquinine h lite in the night only to the black patches for two weeks along with a sunscreen of spy 26 and above in the morning to your full face three to four times like at am am and am sunscreen can be continued for a long duration for further information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor I got some white patch with rashes I feel it sometime itchy it is the same for last two weeks neither increasing nor decreasing applied face cream and cow ghee I have attached the photos for your reference",
        "input": "",
        "output": "hi I have gone through the information provided sun exposure friction sweat sunburn eczema fungal infection sunburn sun protection for further information consult a dermatologist online"
    },
    {
        "instruction": "hello doctor six years ago I noticed that I have color blindness can this be corrected or will it remain forever if correction is possible then how can it be",
        "input": "",
        "output": "hello for further doubts consult an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor I got facial pain headaches popping sound while opening jaw pressure and sometimes neck pain as well I got patchy mucosal thickening of ethmoid sinuses from a it scan I have attached my dental ray are my symptoms due to sinuses or do I have tad of right mandible most of my symptoms are on my right side of the face I am having this issue since a year please help",
        "input": "",
        "output": "hi revert back with the details to a dentist online"
    },
    {
        "instruction": "hello doctor what is the value of bile salt and bile pigment if a person has jaundice",
        "input": "",
        "output": "hi for further information consult a family physician online"
    },
    {
        "instruction": "hi doctor there are red spots on the back of my hands close to the thumbs I do not feel any itching pain or any other unusual conditions it is just redness it is present under the skin and looks like bruising I do not know if it is caused by sun exposure or something else I first noticed it three months back at present I am taking vitamin complex tablet and vitamin tablet please help",
        "input": "",
        "output": "hello I have examined your photographs attachments removed to protect patient identity and your history details for further information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor I am experiencing seminal leak and pain in left tests on excitement without sex situation worsens when excited after exercising this seminal discharge is causing anxiety and pain I am having this problem since last 10 years please help",
        "input": "",
        "output": "hi I have read and understood your problem revert back after the investigations to an andrologist online"
    },
    {
        "instruction": "hello doctor I am having feelings such as hopelessness nervousness and shortness of breath my egg and lipids are fine and my physician advised no problem with my heart and breath he says it is due to depression and anxiety I have some vertigo sometimes I feel less control over my body restless sleepy feeling and yawning negative thinking depressed mood and not interested in anything kindly suggest suitable medicine already I am taking stalopam 10 be alprax 25 be fluoxetine 20 od and trivia when feeling excessive nervousness also I am taking olmetime 20 od for be and actor ez od for cholesterol are these medicines and their dosage are fine as per my symptoms or should I change them kindly help me",
        "input": "",
        "output": "hello for further information consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor I have cos hypothyearoidism and pituitary cushing disease I am taking yasmin glucophage 850 my and to 150 my as I have to take metyearapone for cushing my doctor recommended stopping yasmin but if I stop it I do not have period for months and I get acne all over my body what can I use instead of yasmin in order to control cos can I get it cured by removing ovaries",
        "input": "",
        "output": "hello metyearapone metopirone is an orphan medication that holds the fda approval food and drug administration for the diagnosis of cushing syndrome and is occasionally used off label for short term treatment of cushing syndrome prior to surgery metyearapone prevents cortisol synthesis by inhibiting hydroxylase the enzyme responsible for the conversion of deoxycortisol to cortisol the restricted access and adverse reactions of metyearapone are associated with increased androgen and mineralocorticoid production which limits the use of this medication for the treatment of cushing syndrome it can cause a negative feedback increase of act adrenocorticotropic hormone leading to acne hirsutism excessive male pattern hair growth hyperkalemia however yasmin drospirenone and ethinyl estradiol is a low dose sequential pill which has been given to regularize your cycles they really do not actually affect the cortisol levels due to cushing and not really interact with metyearapone either it is often associated with weight gain so for that you may opt for dinette 35 combination of ethinyl estradiol and cyproterone acetate tablet monthly for next months to regularize cycles and balance hormones there is no need at all for ophorectomy for cos polycystic ovarian syndrome it is never indicated it can be controlled by medication as advised and revised now for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hello doctor I am 26 years old I have never had any problems with my eyes I had a perfect vision but from yesterday morning I feel blurred vision in my right eye I am an informatician so I am in front of a screen every day for almost 10 15 years and I do not have pain in my eyes when I use it for past one month I am taking rhinocort for my nose please help me",
        "input": "",
        "output": "hello I reviewed your history computer screen vision testing refractive error dry eyes artificial tears avoid continuous use of computers or laptops revert back after a month with the reports to an eye care ophthalmologist online"
    },
    {
        "instruction": "hi doctor I can run slowly and do aerobic exercise for 45 minutes but if I try anaerobic workout I get tired very soon and feel very thirsty I have this problem since four years I have the ability to fast for three days or drink only water but when it comes to anaerobic workout like push up or a sprint I am unable to do during anaerobic workout I get the feeling of accumulation of glucose in my muscle to do anaerobic exercise I need to drink lots of water when I begin to do my muscle stretching exercise after a running session of 45 minutes my heart beat rises and I get a feeling of breathlessness few months back I consulted a doctor and he told me that I am suffering from glycogen storage disease I would like to know which type is it kindly help me with the solution",
        "input": "",
        "output": "hello revert back with the answers to a diabetologist online"
    },
    {
        "instruction": "hi doctor my mother is 65 years old she got tested for hemoglobin and fasting blood sugar the results are 20 do and 123 my do respectively the hemoglobin level is alarming three years ago she had same hemoglobin level she was admitted for a week and two units of blood were transfused what to do now please guide",
        "input": "",
        "output": "hi I can understand your concerns follow up with further information to a general medicine physician online"
    },
    {
        "instruction": "hello doctor I am 25 years old I am feet tall and my weight is 86 keg basically my entire problem starts at night while lying down three to four years back I had mild pain while lying down I feel acute pain or some tingling in my left chest sometime it goes down around my body when I am about to get sleep I feel short of breath then I had to wake up and sit for a while and also my nostrils are too often blocked for few days I had levocetirizine and currently just using nasal drops consulted many doctors over the years as per the doctors I have nasal muscle swollen or increased which is blocking the way I had undergone some tests of heart egg and took chest ray everything was pretty normal but from last 4 days my nights are hell I could not sleep at all I am a smoker half cigarette per day and drinks alcohol twice a week please tell me which doctor to consult is it something serious",
        "input": "",
        "output": "hello I have checked your ray reports you have deflected nasal septum with shaped deformity of the septal bone and cartilage due to this reason you are getting sleep apnea breathless nights that makes you to wake up and sit for a while to catch the breath"
    },
    {
        "instruction": "hi doctor I have done a blood test before months and was diagnosed with celiac disease I already have thyearoid problem which is controlled right now with thyearoxine the issue is followed by a gluten free diet I cannot see any progress I am still losing weight my skin is pale and dry I also have abdominal pain cramps vomiting and constipation I am currently taking thyearoxine 150 uq movicol multivitamin and vitamin when I first did the blood test my ana result was positive titer of 1280 and he suspected fatty liver now when I repeated it the result remains the same my doctor is away and I cannot reach him do I need to worry",
        "input": "",
        "output": "hi your issues are found as a consequence of thyearoid disease and celiac disease this is how the natural course of the disease is"
    },
    {
        "instruction": "hello doctor what are the signs of having an inferiority complex what is it why do some people have it what are some signs someone may have an inferiority complex",
        "input": "",
        "output": "hello inferiority or superiority complex is a term derived from a psychoanalytic perspective in psychology it is an underlying feeling in a person that one is inferior to others and is inadequate to flourish in life areas inferiority complex is developed in people who have negative past experiences such as those who faced criticisms during their childhood from immediate family members from peers friends or other people around in their social circle another factor could be the negative thinking style such as those having a personality trait of neuroticism may extract negativity from their environment which may lead to an inferiority complex there are some signs that indicate someone might have an inferiority complex which includes extremely submissive behavior lack of self confidence people pleasing behaviors arrogant attitude show off regarding their possessions authoritative behavior at inappropriate places where an individual is not expected to behave in such a way such individuals communication and behavior let you feel that they think negatively about people around them for instance other people always try to make one inferior"
    },
    {
        "instruction": "hi doctor my wife has done a pa a screen test and results are 9 and hug level 65 she is 12 weeks pregnant please advise regarding the same thank you",
        "input": "",
        "output": "hello revert back with the complete reports to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I have red circular lesions on lower extremities currently I am taking amlodipine 10 my qd benazepril 20 my and clonidine 2 my I have not yet taken any tests kindly suggest what can it be",
        "input": "",
        "output": "hi kindly revert back with the pictures and answers to a dermatologist online"
    },
    {
        "instruction": "hello doctor as bisexuality is defined as attraction to both men and women however many men who feel that way tend to not identify as that please explain why this is and why bisexuality among men has been so stigmatized in the past and why it has not seemed to improve even as people become more accepting of homosexuality",
        "input": "",
        "output": "hello bisexuality is common and a lot of men and women have bisexual orientation at some point in their lives this does not mean that a person will have homosexual relationship with same sex partner a person who is happily married might have liking for same sex too but this has been stigmatized in the past and because of cultural beliefs people never thought of accepting this in public since birth an individual is conditioned to behave in a particular manner like boys are supposed to be more active in competitive sports they are encouraged to be masculine while girls are supposed to be delicate sophisticated in most countries and most cultures if a boy behaves like girls he faces many issues like other peers make fun of him this conditioning is the basis of sexual orientation too boys are supposed to have girlfriends and girls have boyfriends homosexuality was considered as sin and even a lot of countries still consider homosexuality a crime and is stigmatized even these days media and the internet are working to reduce the stigma but in society people make fun of homosexuals especially of men this is the reason things are improving but still people do not look at bisexuality with good intentions"
    },
    {
        "instruction": "hello doctor can I swim while wearing a contact lens I am looking to connect with an eye doctor who can give advice or insight on this",
        "input": "",
        "output": "hello contact lenses should never be used while swimming contact lenses should never come in contact with water and patients are educated to never use water to clean or store lenses some people feel that wearing lenses underwater can help them see better this thought could perhaps have come in the mind of a professional swimmer or coach but unfortunately wearing contact lenses will not improve vision underwater the reason for this being that the eye is designed to work on the basis of a difference in the refractive index to put it in a simple way the difference in the refractive index between the eye and air is large hence vision is clear whereas the difference in refractive index is very small between our eye and water thus leading to blurred vision the only way to see clearly underwater is by using watertight swimming goggles which have a layer of air in front of the eye thus bringing back the difference in the refractive index swimmers with the refractive error may use contact lenses with their swimming goggles coming to the harmful effects of contact lens usage in water the most important being bacterial infections of the cornea called keratitis the commonest organism being pseudomonas is a very prolific bacteria this organism is the bane of every ophthalmologist thanks to a special trait it exhibits of boring through an intact and healthy cornea setting up deep seated hard to cure diseases the most characteristic organism seen would be acanthamoeba this organism is ubiquitous and infects untreated swimming pools and many natural water sources like rivers tanks lakes etc in which people swim in during hiking and outdoor activities all causes of such a corneal ulcer will need emergency hospital admission and treatment with intensive monitoring for signs of recovery if at all you are interested in wearing lenses while swimming the best option would be to use daily disposable lenses which can be disposed after swimming rigid lenses mostly will slip off the eye while swimming soft lenses usually are retained in the eye but will absorb most of the bacteria chemicals like chlorine etc used for treating the water this can set up a lot of inflammation and cause redness irritation and blurred vision to conclude I would say that wearing lenses underwater will not help you see well this blurring underwater can be overcome by wearing swimming goggles but not by contact lenses contact lens use while swimming will only cause serious eye problems and is to be best avoided"
    },
    {
        "instruction": "hello doctor I would like to know the benefits of using mineral sunscreen what is a mineral sunscreen how does mineral sunscreen differ from the chemical kind what are the biggest benefits of using mineral sunscreen what should you look for in a mineral sunscreen if you want to ensure you are getting a formula that is going to be both protective and cosmetically elegant",
        "input": "",
        "output": "hello sunscreen are agents that give protection to the skin against harmful ultraviolet radiation of the sun especially uv ultraviolet radiation that is more harmful sunscreen are of two types physical sunscreen and chemical sunscreen or sunblocks mineral sunscreen is another name for physical sunscreen physical sunscreen physically blocks sun ultraviolet radiations and chemical sunscreen absorbs uv radiations and chemically disperse them physical sunscreen are zinc oxide titanium oxide and iron oxide they are cosmetically unfavorable because they have to be applied thickly and evenly so they are visible on the applied skin whereas chemical sunscreen like octocrylene etc are not visible mineral sunscreen gives better protection than chemical ones they reflect the uv light whereas chemical sunscreen absorbs light and has more chance of photoallergy and contact dermatitis mineral sunscreen are better in this regard various cosmetics are using these mineral sunblock ingredients"
    },
    {
        "instruction": "hello doctor I am worried that I may have come in contact with herpes I woke up this morning with a small cut like marking on the corner of my mouth my top lip has a red patchy spot on the inside of the lip last night I drank a ton of alcohol smoked multiple cigarettes and took ecstasy is the symptom possible from that",
        "input": "",
        "output": "hello I understand your concern drugs like alcohol ecstasy and cigarettes reduce saliva secretion and blood flow to our mouth lips and gums a dehydrated oral cavity is prone to mouth ulcer cancer sores and the lips tend to get chapped and cracked this could be a simple mouth ulcer from dry mouth caused by heat due to multiple cigarette smoking or could also be an hav herpes simplex virus infection herpes simplex infection of lips spreads through saliva by personal or intimate contact sharing cigarettes or drinks with the infected person a clear picture of the ulcer and lip sore will help to diagnose it please visit a dentist immediately and get the ulcers examined watch for signs of fever stinging or burning of the ulcer mucosa and gums treatment is symptomatic if it is a simple mouth ulcer a topical anesthetic will help control the pain and burning sensation if present after an initial examination if the doctor suspects hav infection he will advise you to get a series of lab tests for confirmation meanwhile keep yourself hydrated at all times and maintain good oral hygiene to prevent further infection of the mouth ulcer I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 25 year old male I have had muscle twitches all around my body but primarily in my legs for three months I had the same twitches last year which lasted about a month the twitches seemed to subside shortly after I had an egg done as I was petrified and convinced that it could be als or mnd this time round with the twitches which started again almost exactly a year later I did not have another egg as my doctor did not seem it necessary but instead referred me to a neurologist which deals with als patients he did only a physical examination and test and did not have any concerns at all he also looked at my egg results and agreed they all read fine and showed benign muscle fasciculations the twitches seem to have started again more frequently the past couple of days and I have scared myself by reading als blogs on the internet where people say that they first started with muscle twitches that progressed into als do you think I should be worried about als do you think I have had my egg conducted too soon to rule out als",
        "input": "",
        "output": "hi I have gone through your history and events I wish to know more about muscle twisting which parts of the body are affected are those twisting and painful is there any stiffness in limbs is your illness affecting your activities of daily living or occupation"
    },
    {
        "instruction": "hello doctor I am 57 years old with extreme fatigue achy joints in hands and feet especially during the first hours in the morning or after resting I have psoriasis in hand elbow leg and behind one ear and vitiligo over 80 of my body I get random low grade fevers and develop rashes when in sun and at times I will have the butterfly rash on my face I did not get a follow up appointment with my rheumatologist until next month any recommendations with what I should ask or discuss would be greatly appreciated I have attached my most recent labs and concerned with the results of the dna is all other lab reports are normal and negative is lupus a possibility I am currently taking prednisone 10 my synthroid 125 advair 100 50 and zyeartec 10mg",
        "input": "",
        "output": "hello I have gone through your reports considering the symptoms and medications you are taking I would like to know a few more details how is the sleep pattern do you get enough sleep or is it disturbed any early morning fatigue any dryness of eyes or mouth do you experience any joint swellings any recent history of irritability any forgetfulness which has developed recently as per the investigations and ongoing treatment my suggestions would be didna has not much relevance in your case it looks like a false positive value mainly cause ana is negative and ear and cop are normal you are on too high dose of prednisolone which is not good for bones and psoriasis as well we need to cut down on the dosing methotrexate may be a good option as psoriasis can cause a lot of joint pains itself which will get better with it also it is a good drug for removing steroids"
    },
    {
        "instruction": "hello doctor I am 28 years old I have an issue with keeping my body clean my body is constantly dirty in the sense that if I use my fingernails to scrub any part of my body after soaking in water for some time I always get light or dark greyish gung under them more so if I soak in a moisturizing bath soak having a simple shower and using a loofah just does not get me clean I can have showers every day after a bath and scrub but by day three I actually feel like I am not clean again if I use my fingernails gung comes off of my body again it is a real pain to have to soak twice a week and use fingernails and then exfoliate I moisturize using aveeno lotion after bath I am very overweight and suffer from hirsutism maybe that has something to do with it can anything be done about this where a simple daily shower is enough to get me properly clean",
        "input": "",
        "output": "hello welcome to icliniq com yes overweight and obesity can lead to such problem because our sebaceous glands get bigger and too making more serum and you feel like being dirty all the time I will suggest you to first try to decrease your weight within limits it will be very helpful not only better for your health but also for your skin that is why in obese person skin infections are very common secondly sweating also increases especially is skin folds where dirt extra gather easily so you see the ultimate solution is weight loss apart from that use olive oil massage for the body before washing and use simple mild soap for bathing I hope this helps"
    },
    {
        "instruction": "hi doctor I was diagnosed with cos when I was 17 years old and from there on I was taking diane 35 to regulate my periods I was having three months gap between periods and sometimes was regular before treatment now I am 25 years old married and trying to conceive so I had stopped diane 35 last month since then we tried naturally for a few months but it did not work out so we started with treatments the doctor initially put me on ovacare my and other vitamin tablets using which I got my periods on time this continued for a month next she put me on ovacare and endothik and post 15 days I was put on duphaston this too did not help to conceive next my follicle study was done I was checked on the 12th day where my follicle was not that matured and et was just I was called on 15th day which showed my follicle in the left ovary was 19 my and et was 10 my the doctor gave me an hug trigger injection I was asked to try in this period so I and my husband had contact from 14th 15th 17th day and also 18th day I was called on the 18th day which revealed that my follicle had ruptured and it was a fresh one since it has some fluid around it so since it is confirmed ovulation I expected my temperature to rise I had not checked my but before but when I did it on 20th day it showed a temperature of 36 celsius this is way too less right with hug shot and ovulation confirmation I taught it would rise is there some issue here I am given duphaston and embryo safe sachets to be taken please advise if this cycle too I do not have any chance",
        "input": "",
        "output": "hello the chance of pregnancy in the ovulatory cycle is around 25 30 as ovulation was confirmed you have some chance rise in basal body temperature is an unreliable predictor of ovulation and once you had confirmed ovulation by a more reliable test ultrasound there was no need to check bt your body temperature does not give any information regarding the quality of ovulation and there is no need to assign any significance to body temperature in your case as I already told you have around 25 30 chance in each ovulatory cycle and there is no reason to lose hope just get your husband semen analysis done if not already done as normal semen is equally important for pregnancy to happen"
    },
    {
        "instruction": "hello doctor I would like to discuss about one of my family members he is a teenager and he is 14 years old I want to discuss his up and down moods is it just because he is a teen his mood is very strange I think so when he is really happy or high I call it he does stuff like he has enough energy to last forever and he has these ambitious plans and ideas he wants to do when he is like I say he is losing touch of reality cause he says he sees stuff that are not there and sometimes he feels like a religious person like god and sometimes there are voices in his head to tell him to jump off the bridge for fun or something like that and I know off these episodes only last about a day or two or even a week but I know he has depression but anyways when he is depressed he tends to have no energy at all to do anything at all and he is always tired and he becomes suicidal what in your opinion he has please tell me the cause I know he is depressed but why does he tend to be high",
        "input": "",
        "output": "hi as per your history I find that the patient sometimes is high and sometimes depressed though some more details about the symptoms are required however I may say that the patient is suffering from bipolar affective disorder as the name suggests it has two poles the first pole is depression which is very common where the patient feels sad has decreased energy and pleasure and can have suicidal ideas the second pole being mania where the patient appears high they talk continuously talk high things about themselves highly energetic sometimes they have psychosis associated when they hear some unusual voices in their ears called hallucinations this condition requires urgent psychiatric intervention"
    },
    {
        "instruction": "hello doctor I am 29 years old my spa is 93 no change in urination pattern I have a dull pain in the groin hips thighs rectum and perineum I masturbate frequently from the age of 15 I suffer ed for two weeks",
        "input": "",
        "output": "hello ed erectile dysfunction is the most common problem nowadays it is curable your spa prostate specific antigen is absolutely normal ed can be psychological or organic psychological causes are stress anxiety and other life problems since you had good erections before I think you have a psychological cause of ed you should try behavioral therapy yoga and exercise to reduce stress strictly avoid smoking and alcohol I am giving pain killers for pain if things do not improve then contact a urologist I hope this helps tablet voveran so diclofenac 75 my in the morning and evening for five days tablet pan 40 pantoprazole in the morning for five days"
    },
    {
        "instruction": "hello doctor I am a 27 year old female I have been on depo proverb for six years I am not taking any other medications lately I have been experiencing severe mood swings and have not been myself one minute I am dancing around the room and could not be happier the next I am either crying or very angry normally I do not cry and I am usually pretty laid back I have also been getting dizzy mostly when I stand up or walk up the stairs I have trouble sleeping and or sleeping too much I am hungry all the time however when I do eat I feel nausea I have done some research and have found that these symptoms are both common with the injection and also with pregnancy how do I tell if these are pregnancy symptoms or if it is because of the depo shot I did miss my last shot three months ago last month I took a home pregnancy test it came back negative will a home test be enough to tell if I am pregnant or not",
        "input": "",
        "output": "hi the home pregnancy test is fairly sensitive and very unlikely to miss pregnancy except in very early pregnancy if you suspect pregnancy strongly you can repeat a home pregnancy test again after a week if period does not start most of your symptoms can be either due to indigestion or hormonal imbalance hypothyearoidism or estrogen deficiency you can take antacids pantoprazole for three to four days and see if symptoms resolve if your symptoms do not resolve and pregnancy test comes negative you can do ash thyearoid stimulating hormone test to rule out hypothyearoidism as you have taken depot for a long time estrogen deficiency is likely which can cause all of your symptoms if possible shift to oral pills for contraception for a few months to avoid the same I hope this helps"
    },
    {
        "instruction": "hello doctor recently prescribed by arn low dose of station but prefer trying diet limited to 200 my cholesterol with average daily of 100 my plus revise days a week to lower with supplements instead I am 64 do not smoke do not drink trying to lose 20 labs female at 243 total with 58 hel is station necessary or other testing like stress test",
        "input": "",
        "output": "hello when patients present to me in the hospital with a similar presentation considering your age family history I commence them on stations initially you should use stations for atleast a month or two before trying out the option of diet or other natural methods at your age it is slower to loose weight so yes it is necessary that you use stations for atleast the first to months till your total cholesterol has dropped to atleast 200 my dl before continuing with diet and supplement perhaps stations rarely have side effects you do not need stress test now it is mostly indicated when you are having symptoms such as shortness of breath chest pain etc for now it is not necessary I advise you take the station for a couple of weeks first you can switch to diet and supplement once your total cholesterol is below 200 my dl also continue with all other medications as prescribed hopefully you will be fine best regards"
    },
    {
        "instruction": "hello doctor I got fillings done a while back that were causing me no pain whatsoever or sensitivity so I found a new dentist got the filling done and by week the fillings on the left top were causing me more severe pain than week and my bite was off no matter how many times she adjusted it there was only tooth touching and being damaged dentist is denying she did anything says there is no infection I finally went to the er and dentist visits later and I had an abscess lanced on the roof of my mouth and need a root canal on a tooth that had a short cavity in the first place by the dentist the pain goes away with antibiotics and I have been doing alright for the past months except pain when eating on the effected side now all of sudden the top molars on the left where the infection was there are red around them and pain when pressure is applied mind that when I bite down on top left second to the back molar is the only tooth touching anything all the others are not touching each other no matter how hard I try since my dental work and I am scared I am getting an infection again",
        "input": "",
        "output": "hello the problem with cavities are either you will find out about it when you start getting severe pain or if some dentists points it out in your case occlusal corrections could have been done more accurately to find out which tooth is having the high point and reduce it appropriately if there is an abscess get root canal treatment done I need to see rays and pictures to give you any definitive diagnosis and treatment plan"
    },
    {
        "instruction": "hello doctor please find the eye report of my year old son he is not getting much issues in walking in long distance reading and in anything but in the eye test report he got and 5 spherical numbers in the eyes is it a very serious number I am very tensed as I thought is a very big number for a child will the number increase if he wears glasses constantly how this much number came as we did his eye checkup at the time of birth as well as at the age of please assist as we are very tensed for his glasses and number",
        "input": "",
        "output": "hello I have gone through your attached photo there are both spherical and cylindrical powers in both of his eyes this power is large for a year old boy and I understand your concern regarding the cause the given age I will say that this power probably has to do with the pattern of his eye growth it is a bit longer than normal usually the most intelligent people who are bit more mature than the rest have to develop such a thing another important cause is seeing things by holding them very close for example phone books etc near work increases myopia but nobody can exactly predict what the cause could be regarding progression even if he wears the glasses regularly there could be variations in his power as I said this power is due to the lengthening of the eyeball and the eyeballs keep growing as he grows this is the reason why your doctor would have called you back for a follow up every six months or every year wearing glasses constantly helps in preventing complications like cross eyes squint and amblyopia lazy eye amblyopia is a condition where due to weakness of the visual nerve and brain vision centers the patient can no longer see the smallest letters even with the maximum power this can hamper his chances of getting into a few jobs like armed forces etc so the best course of action would be stop seeing things from close by avoid mobile phones computers and read books from as far away as possible do not rub the eyes this can increase the cylinder power wear glasses constantly to prevent complications like squint and amblyopia do not miss follow ups and consult your ophthalmologist in case of a sudden dip in vision I hope this helps"
    },
    {
        "instruction": "hello doctor I am 38 years old and my wife is 36 years old we are married for the last two years and trying for a baby for the last one year almost by our gynecologist advise we underwent an I cycle which resulted in missed abortion at seven weeks due to no growth of fetus after five weeks done and karyotype of abortion showed a chromosomal abnormality remarks as below aborted fetus karyotype 69 ex banded metaphase shows triploidy wife condition a age 36 years no issue yet has a subserous uterus fibroid of size 68 62 my and bulky uterus had thyearoid and she takes thyearoxin 50 my every day last ash is 48 sugar is under control and tac is normal in childhood she had one occurrence of epilepsy husband condition a age 38 years nonsmoker and non drinker semen analysis result is normal fertile specimen shaving a bit high uric acid in the last one year under medicine karyotyping results of partners husband 46 xy banded metaphase shows normal karyotype wife 46 ex high frequency of banded metaphase shows telomeric association of chromosomes 3 16 my questions are is it possible that after fibroid removal she can conceive a baby in a normal way can there be any bad effect on baby health physical and mental due to the dna abnormality found in her report",
        "input": "",
        "output": "hello welcome to icliniq com as far as the subserous nature of the fibroid is concerned which is around 7cm am it per se is not going to have an effect or cause hindrance in conception but it is likely that it can cause problems during the pregnancy and in the late third trimester due to abdominal pain so it is advisable that it should be removed anyways as the size is a concern here and can cause incoordinate uterine contractions during labor later and also chances are that it would further grow under estrogen effect hence better get it removed as the fetus showed triploidy banded metaphase which as per the mother report she has high chances of replication of similar results in future pregnancies as well which may not be compatible with life and likely missed abortions may occur in future hence it is suggested that both of you should try for an if in vitro fertilization with ovum and sperm harvesting and in vitro fertilization of the egg by your sperm and subjecting the embryos to preimplantation genetic screening with fish fluorescence in situ hybridization technique or per polymerase chain reaction or comparative genomic hybridization cgh before selecting the embryo for transplanting into the uterus though the frequency of banded metaphase telomeric association is high for 3 16 and chromosome the chances of the fetus getting triploidy are very high another best option for you as a couple would be to opt for a donor egg from another woman which can be fertilized in vitro by your sperm and then the embryo after pre implantation genetic screening can be implanted in your wife womb to improve the chances of having a healthy conception I hope this helps"
    },
    {
        "instruction": "hello doctor I am suffering from a disease called uveitis and I visit a doctor every six to seven months for injecting kenacort 40 my on each eye when needed or when the inflammation starts again I want to know that when this procedure is going to end or will I have to go for injections for my entire life I want to know that if I travel to some countries the vision loss occurs sometimes or the effect of injection comes to an end can this injection be injected anywhere around the world please guide what would be the procedure for that I am currently taking deltacortril and cellcept",
        "input": "",
        "output": "hello I understand that you are suffering from uveitis and are on antiglaucoma drops and previously were on immune suppressive tablets I feel that you may be suffering from an underlying disease that is hampering your immune system we call these as autoimmune disorders the ideal solution to these problems in general would be to find out the cause for this immune disorder and treat it this can be done using blood tests for substances called antibodies ab following which specific treatment can be instituted injection kenocort triamcinolone is an emergency measure employed in case of severe cases not responding to treatment these injections cannot be given on a regular basis as they cause complications like cataract and worsening of glaucoma kenocort injection is available in most places around the world but the guidelines for doctors in different countries may vary and some may not choose to perform this procedure in view of the side effects if you would like to know more kindly attach your blood tests and doctor reports"
    },
    {
        "instruction": "hi doctor I am concerned about the health of my nephew who has got brain injury during his birth in the past he had ha supplements and used to do exercise I need your consult regarding the extent of injury effects solutions and medication please guide",
        "input": "",
        "output": "hi revert back with the asked details to a neurologist online"
    },
    {
        "instruction": "hello doctor I had seven teeth extracted today just the roots anyway over two of the teeth the dentist said there was an infection I did not get any antibiotics but she cleaned the area after there is a lot of swelling in that area and the gums are real red and like an ulcer but not much pain is this normal how do I know if it is infected or dry socket or anything else it could be",
        "input": "",
        "output": "hi I have seen the photos nothing to worry about for the swelling give cold pack from the outside of the extraction area do not spit or rinse the mouth for a day drink lots of water to keep yourself hydrated do not suck anything such as ice cubes using a straw to have liquid etc because it will lead to dislodgement of the blood clot do not see the extraction site every time it will heal in seven to ten days after 24 hours of extraction rinse your mouth with lukewarm saline water three to four times a day it will help in healing do not smoke or chew tobacco do not drink alcohol or sodas have semi solid food for two to three days dry socket is caused by the dislodgement of the blood clot from the extraction socket in your case white color film is there that clot is covering the socket wait for one more day if the swelling does not reduce consult your dentist if you could provide me your age gender and medical history I will be able to advise on medication as well"
    },
    {
        "instruction": "hello doctor I am trying to understand my recent prescription I received and no longer can contact the doctor od 75 50 x070 os 75 50 x010 these are computer reading glasses is it normal if things are blurry at a distance even three feet starts to look weird on reading online I read this as slightly farsighted with slight nearsighted astigmatism in both eyes how is that possible",
        "input": "",
        "output": "hello welcome to icliniq com in the prescription you have mentioned there are two components the spherical 75 and the cylindrical 5 at axes 70 10 respectively the important thing to note here is that reading glasses per se are given to people above 40 years of age in your case I feel that this power is probably your distance correction the doctor might have felt that they may be a bit cumbersome to wear all the time and would have given a small magnitude of power and probably have told you only to put them on during intense visual activities like watching computers reading books etc an accurate way to say whether these were meant for distance or for reading is to recall how you were tested at the doctor office in the first place suppose they made you sit at a distance and asked you to read out the letters on a screen then these are distance vision glasses if they had tested the power by giving you a book in your hand and asked you to read it then these would be reading glasses so coming back to your question firstly reading glasses are meant only for distances around am from you for the books and around 100 am for the computers and you would not be able to see beyond this second the far sighted power of 75 is determined by the length of your eyeball in case of far sightedness the eyeballs are shorter compared to normal and in near sightedness they are longer the astigmatic power is determined by the curvature of your cornea in your case myopic astigmatism the corneas are steeper at axes of 70 and 10 degrees respectively compared to the rest of the cornea in hypermetropic astigmatism they are flatter in that particular meridian compared to the rest of the cornea I hope this helps"
    },
    {
        "instruction": "hello doctor I take sompraz d20 on an empty stomach every day I also take libotryp at night for stomach to for the last one year I have pain in my lower teeth while eating anything one year ago a small cavity was also detected for which I underwent airbrushing and filling I suspect that the filling came out from my lower teeth yesterday I have this tooth sensitivity for the last 15 days it pains a lot when I eat otherwise it is fine I also take duonase nasal spray two times also for dry eyes I take I dew is eye drops my recent vitamin is 25 48 no my suggest me any gel or cream to cure this cavity also I am highly sensitive and allergic to smell so please prescribe me gel or cream accordingly",
        "input": "",
        "output": "hi welcome to icliniq com see the first thing that I need to know is that is whether the pain is present in a single tooth or multiple teeth as you mentioned in your question that the filling has come out so please make it clear that is the tooth that has lost filling is painful alone or more teeth also please click the picture of your teeth that are painful and upload please revert back with the answer"
    },
    {
        "instruction": "hello doctor I am 23 years old male I have had thyearoid issues since a young child after a few years they concluded it was thyearoiditis currently I take eutirox 75 my and have for about a year before that I took 50 my ever since 8 months I am not sure about the timeframe I have had issues with extreme sweating under armpits for example I am in a 2c room and start sweating insanely I go outside lay on the hot sun and I stop sweating minutes after putting on a shirt there are considerable sweat marks on my armpits 10 minutes after it is a huge sweat mark it is also irregular some days it is crazy other days not so much I have never had issues with sweat ever on the right side of my head I now have white hair that definitely were not there a year ago even months ago it was just hairs attached are my lab results the doctor said it was normal however during the conversation I said my breakfast was a couple eggs sometimes pancakes and fresh juice he replied it should be milk and bread so I have began looking for another doctor for that reason what can I do to find the best doctor and would it be ok for me to go back to eutirox 50 my while I look for a new doctor or can this cause a serious issue ray resume says the following translated by me thyearoid with normal dimensions right lobe measuring 14 50x13mm and the left lobe 13 53 12mm with lobutlated shape its ecostructure is diffusely heterogeneous with multiple areas hipoecogenic poorly defined aspects to which is associated the increase of vascularisation on the doppler color study changes compatible with thyearoiditis near the inferior pole of the left lobe some reactive ganglionic can be observed the biggest measuring about my",
        "input": "",
        "output": "hi you are sweating due to the increased dose of eutirox and that is perfectly normal and expected in a person with thyearoiditis being treated with medication this only means that you are being correctly treated with respect to your thyearoid function the few white hair that you noted could be due to stress that you have in your day to day life or simply without any reason they can occur they have nothing to do with your thyearoid function your breakfast is good but maybe the doctor meant to decrease the calories I do not see anything that should make you search another doctor but ofcourse it is your right to do so if you wish try to live a stress free life and you will find many of your symptoms resolving"
    },
    {
        "instruction": "hello doctor I am 30 years old I was diagnosed with non ulcer dyspepsia seven years back was treated with probiotics and it helped a little bit now my complaint is frequent flatulence foul smelling and irregular bowel movements sit to times daily with only episode of almost complete defecation and others scant and incomplete history of frequent flatulence for years acute gastritis after heavy alcohol intake 4 times by last year managed with antacids my dietary habits are irregular timings with missed diets 4 times a week I smoke occasionally history of alcohol intake 180 my hard liquor days a week for years 6 days a week for an year 300 my 6 days a week for an year I have no other medical co morbidities or past surgeries ocd for 5years being treated with saris fluvoxamine for years and escitalopram for the past 10 months pips for 10 days times in years family history nothing significant did a fibroscan liver let and us abdomen 10 months back and were normal let every three months since then were normal now may I please know what will be the solution for my current complaints",
        "input": "",
        "output": "hi it looks like is symptoms you need medicine along with some lifestyle changes continue escitalopram and isabgol take tablet rifagut 50 my twice daily tablet normaxin twice daily tablet esomac 40 my once daily before breakfast tablet folvite my once daily"
    },
    {
        "instruction": "hi doctor I am 24 years old having pod and thyearoid from past years as well as my weight has increased to 65 keg from 50 keg within these three years my height is 9 it I am suffering lot to reduce my weight and it is not happening now I am planning to conceive please suggest me medication to reduce my weight as well as to conceive",
        "input": "",
        "output": "hi thyearoid and pod both affect fertility so need precautions investigations on regular basis if needed treatment and dose adjustments accordingly thyearoid abnormalities can affect fertility periods flow regularity can cause miscarriages increases risks of congenital anomalies in fetus etc so have regular consultations and check of thyearoid levels so can have dose adjustments polycystic ovaries can disturb periods scanty irregular can give abnormal hair growth sudden weight gain disturb insulin levels that increases risks of having diabetes as well as disturb metabolism main factor that will help is weight reduction or balanced weight and mi by daily exercise yoga and walk can take help of instructor have balanced diet with less sugar oil spice and salt can adjust with dietician to guide for balanced diet have folic acid daily and sex in fertile period of cycle you can have tablet glucophage 500 my twice daily after food and if feels low sugar levels then better start with lesser dose to regulate periods for cycles in addition to weight reduction folic acid and glucophage can be taken with combined oral contraceptive pills to regulate cycles husband general health also needs attention should quit smoking or any other recreational drug after months start sex in fertile period of cycle have complete treatment for any health issue you or partner have send me recent transvaginal scan and blood tests on day of periods testosterone progesterone insulin prolactin fish and oh thyearoid function test if conceived continue glucophage in whole first trimester and then discuss here or with treating doctor"
    },
    {
        "instruction": "hello doctor I got cervical neuropathy 10 days back got mri days back on bed rest analgesic got depomedrol 80 my shot pregabalin methycobalamine and oral medrol have not got any muscular weakness or um signs mild parasthesia in thumb and index finger of right hand pain has decreased by around 30 40 percent since it started 10 days back and I am not taking any nsaids for last days I have got a few concerns do these changes occur at this age 43 years how bad are the degenerative changes any need of surgical intervention how much time usually it takes for complete resolution of acute episode is it going to be a trouble in future as well I mean repeat episodes or further complications what should be the life style changes after resolution of acute episode you know the nature of a pediatricians job if at all surgery is required in future further canal stenosis causing cord compression how risky is the surgery and how are the results",
        "input": "",
        "output": "hi I have gone through your medical history and the attached reports in detail it does not seem to be a serious matter at present yes neuropathies are common at this age usually it takes around to weeks for an acute episode to resolve depending on the symptoms if proper care is taken avoiding use of pillow avoiding lifting heavy weights neck exercises usually symptoms do not recur at present there is no need of surgery you are doing pretty well and recovering fast use cervical soft collar and take analgesic for atleast 10 days get a repeat mri after months well decompression surgery is risky and has side effects and should better be avoided"
    },
    {
        "instruction": "hi doctor recently been concerned about a carbon monoxide leak in my pick up recently after a hour interstate drive I stopped and did a carboxyhemoglobin blood test the results came back at 3 I felt that was on the high side of normal so I took it to another exhaust place he claimed it had a small leak and repaired it so this past week we took it on another hour drive this time my wife and I both tested again mine came back at and the wifes at 8 is this normal after driving this distance or should I be concerned",
        "input": "",
        "output": "hi welcome to icliniq com carboxyhemoglobin level is raised by various reasons and the inhalation of carbon monoxide is one of the reason our body has many mechanism to increase carboxyhemoglobin level for you and your wife the level is normal and nothing to worry lab to lab variation intro instrumental variation human physiological variations are the reason for different values at different time points in case of carbon monoxide poisoning breathing difficulties bluish discoloration of body blood are commonly seen in such case just inhalation of fresh air can be helpful in such cases the carboxyhemoglobin level is higher than your levels so I suggest to leave the worry go for brisk walking in fresh air daily and practice pranayama to balance the carboxyhemoglobin levels if you want to repeat the blood test can be done after some days if the value is not doubled below the doubled level then it is normal if values are doubled or more only then it is the toxic influence"
    },
    {
        "instruction": "hello doctor since I came off the pill 14 months ago I have had lots of issues black brown smelly spotting irregular periods severe pain severe fatigue been to the emergency department many times with different issues stomach bleeding severe stomach pains lightheadedness back and neck ache etc I developed a headache about months ago mri showed a pituitary microadenoma have been to endocrinologist but he has ruled out hormonal reasons and sent me away saying another mri will be done in months and have referred me to a fertility specialist I cannot live like this severe stomach issues cannot eat properly diarrhea severe headaches weeks leading up to periods have lost keg within months severe fatigue no energy for anything palpitations any exercise makes me very lightheaded someone please help",
        "input": "",
        "output": "hi in your description you have mentioned lots of issues that needs to be investigated and sorted out in detail individually microadenoma and hormonal imbalance are two separate issues actually those can cause different symptoms need different investigations precautions and treatments it would be better if you could send me your detailed reports adenoma related issues need to be consulted with endocrinologist on regular basis for rest of the medical issues need to be consult with consultant general physician to sort out for every symptom have some counseling sessions with pshychaitrist to help feel emotionally balanced for irregular periods have transvaginal scan and blood tests on day of periods testosterone progesterone prolactin insulin fish and oh thyearoid function tests high vaginal swab cervical smear collect all laboratory tests and discuss here have combined oral contraceptive pills for cycles to have hormonal support and regulate periods after collection of swab from vagina have injection ceftriaxone 500 my intramuscular once azithromycin go per oral once tablet doxycycline 100 my twice daily and tablet metronidazole 400 my hourly for 14 days have balanced diet weight and mi complete treatment of any health issue you have daily walk exercise and yoga have recreational activities and quit recreational drugs have cold milk at bed time and after waking up before breakfast"
    },
    {
        "instruction": "hello doctor I recently bought new glasses with a different prescription but I genuinely feel no difference between my glasses I have tested it at in daylight and also during night time numerous times I just see the same I tried to look for the cause myself but it came to a dead end thanks for taking the time I have put the prescription changes down below for some more details right eye left eye spy 50 spy 50 cal 50 axis 175 vis 85 vis 85 after eight months right eye left eye spy 0 spy 25 cal 50 cal 75 axis 175 axis 175 vis 80 vis 78",
        "input": "",
        "output": "hello welcome to icilniq com from your attached prescription I can tell you that there is a very definite change in the power of your glasses and also in the amount of how much you can see the best to make that difference stand out that you can do yourself is to cover each eye and look through the other ideally at an object or letter just visible to normal people around six meters or 20 feet away you can also try this in different levels of light just as you have compared before the impression I get from your prescription is that while your myopia has increased in both the eyes there has been some decrease in the amount of vision in both your eyes that is to say that the power has increased and the amount you see has come down as always testing of glasses is a subjective assessment and varies depending on your suggestion and the optometrist performing the test in case you are not happy with your current glasses you can always return to the same place for a re check I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 30 year old male a few days ago I had safe sex with a condom now I have two red dots on my penis it also hurts when I urinate when I pull down the foreskin there is a whitish discharge I am pretty sure I have caught some type of sad I am freaking out and do not know what to do can anyone help me I want to know what this is I have attached the pictures",
        "input": "",
        "output": "hello I understand that you are worried this looks like herpes but to be sure I will need a few more details after how many days of the event did you notice these spots do you have any burning sensation are there any spots on the scrotum lips etc are you allergic to any medicine is there any swelling in the groin area have you used any medication till you send these answers apply back mupirocin cream twice a day once you send the details we can prescribe you oral medication"
    },
    {
        "instruction": "hello doctor I am having spherical and and 5 cylindrical power in my eyes I have a border line eye pressure doctor said I cannot take laser or ice surgery but can have relax smile for that power but it also needs some cornea tissues which is a risk factor for glaucoma I do not know what to do now which treatment is better for me and the doctor just gave normal lubricant drops is there any treatment for me for refractive surgery by controlling eye pressure",
        "input": "",
        "output": "hi how much is your eye pressure did the doctor measure it with an instrument that puffs out air at you or was it a blue light instrument that he used to touch your eye with from what you have told me I understand that you are interested in refractive surgery but the doctor refused to operate on you saying your pressures are high and that your power is too high for lasik it is true that your power is on the higher end of the patients we usually consider for surgery so doing lasik and park photorefractive keratectomy is not possible on the eye with 9d but can be done on the eye with and 5d putting an ice implantable contact lens in your eye might increase your eye pressure so I will not recommend that relax smile can be tried in both your eyes if the surgeon is confident I am guessing that he would have asked you to come for a follow up to re check pressures if the pressures were too high he would have asked for visual fields and a few other tests for glaucoma in either case it all depends on the surgeon experience and your eye pressures if you can tell me about your eye pressure and your vision in each eye with 9d and 1 5d I could help you better"
    },
    {
        "instruction": "hello doctor my question is regarding post surgery care in heart related ailments how is the monitoring done how often does re admission occur how to prevent this",
        "input": "",
        "output": "hello regarding the care of non cardiac surgeries in cardiac patients if you are suffering from cardiac problems such as previous heart attack heart failure any cardiac valve problem you have to take cardiac fitness before surgery if fit then go for surgery after the surgery you can take rest as advised by your surgeon if the cardiac issue is stable there is no need to reassess the cardiac problem if cardiac problems such as heart failure worsens then you may need echocardiography and other related investigations regarding medicines ask your surgeon not to prescribe you medicines that have a high amount of sodium which may worsen your cardiac or hypertensive problems you may take a low sodium diet and may start light exercise according to your surgeon regarding cardiac surgery for pain relief you may take a pain killer for wound related pain gradually increase level of activity unto six to eight weeks you may drive then also eat a low sodium diet do not eat up to full stomach eat small amounts multiple times per day readmission depends upon complications that may develop such as wound infection heart failure heart attack due to blockage of the grafted vessels after bypass surgery if a heart valve is implanted it may get stuck and it causes sudden worsening of symptoms some times bleeding may occur due to unmonitored blood thinners to avoid do not stop medicines on your own keep monitoring clotting profile in case blood thinner such as warfarin is prescribed take a low sodium diet avoid excessive exertion just after surgery I hope this helps"
    },
    {
        "instruction": "hello doctor I am 30 years old I have always been a bit clumsy and a slow learner I easily get lost in details given to me and go completely blank I had a hard time understanding maths but I do alright in languages as time passes I have become increasingly clumsy and have poor eye muscle coordination this is making me frustrated at myself what could be the reason",
        "input": "",
        "output": "hi I can only answer in broad terms as there so many things that could lead to the symptoms you are describing then I can put you in the direction medically you should follow going forward the fact that you note you have always been a clumsy person and it worsening now indicates that your problem has been a chronic long term one that seems to be progressively with time you mention you were a slow learner and that you are still having cognitive thinking learning memory up unto this day shows me you that there is definitely something wrong and needs to be medically investigated some unknown uninvestigated cognitive problem since early childhood has been missed and caused serious harm to your life and it is not your fault you were a child and it is the clear responsibility of the adults in your life to note the problems and take them further there is an entire range of things that could be causing your symptoms from undetected poor hearing vision or a specific learning disability or attention deficit hyperactivity disorder but also including a huge range of psychiatric neurological and neuropsychiatric symptoms then the fact that your neurological motor or sensory functioning poor eye muscle coordination has been affected and your feeling clumsy has also been since childhood that difficulty been chronically clumsy from childhood to adulthood and was never investigated further should be not an acceptable way of schooling or raising children so the bottom line is that now you need to take control and investigate these symptoms kindest rest further to at least know the cause of serious problems the doctor I would send you to first is a neurologist or a neuropsychiatrist they can examine you for the right medical investigations like blood tests of rays and it scans etc they should be able to put a possible diagnosis together and all of these symptoms can be explained and understood consult a neurologist as soon as possible follow up according to neurologist advise"
    },
    {
        "instruction": "hello doctor I am 26 years old for the last 10 years I am suffering from very weak hand grip strength at the age of 16 it started and grip strength was negligible for like four years then I started working out with hand rippers and the condition has improved a lot there is no pain or numbness but still at times I feel my gripping strength is very weak and when I perform exercise it improves for the time being as I can feel the blood rushing inside the hands my query is that does masturbation has any link with this because I have noticed often that after performing the act the situation starts getting worse as in there is very less blood flow in hands and I feel very low gripping strength I have no issue in lifting weights eg bench press and there is no pain while doing any kind of lifts please guide me on my condition",
        "input": "",
        "output": "hello there is no link between masturbation and handgrip weakness the cause of your hand grip weakness needs to evaluate further you need an in person neurologist consultation face to face because we need to examine your strength reflexes sensations of your hands is the weakness is more on the right or left do legs are involved or not after a thorough physical examination only we can advise mri magnetic resonance imaging cervical spine or nerve conduction study but as a neurologist I can definitely guide you that there is no link between masturbation and hand weakness"
    },
    {
        "instruction": "hello doctor we are a bit concerned about our week daughter the labor was a very traumatic experience with having to be induced and trying natural labor which failed due to her turning on her back at the last minute so we had to go to the theatre to have a forceps delivery which also failed and we ended up having an emergency section we know due to the birth trauma she has suffered damage to her neck muscles and can only look to her right and finds it very difficult and painful to turn her head we are currently visiting the physiotherapist to help her neck which we have been told it can take a long time to repair but the other things we are concerned about are the way she looks at objects I curtains and light fittings and bursts out screaming also she will be sleeping peacefully and all of a sudden jump out of her arms and legs in the air and screams and cries until she is blue in the face also while she is sleeping or napping she grunts and makes very strange noises could there be anything in the hospital doctors or midwives have missed as it is very stressful watching her like this",
        "input": "",
        "output": "hello welcome to icliniq com I got your concern well based on your history I can say that due to birth trauma and subsequent consequences she may have airway obstruction due to secretions reflux or abnormal neck position can cause these symptoms I advise you to monitor her pulse oximeter saturation 24 hours and not how many times it goes less than 90 due to abnormal neck position and pain she may find it difficult to see around please continue physiotherapy and follow her and if the pain is more you can give paracetamol for pain relief make symptoms diary and take videos of the event which may help the pediatrician to look for any problem the way she is screaming suddenly it is possible that it is startle reflex but please take video and show it to the pediatrician"
    },
    {
        "instruction": "hello doctor diffusion weighted images add maps and postcontrast sequences were also performed findings there is mild cerebral volume loss and ex vacuo dilatation of ventricular system there are scattered punctuate foi of increased signal intensity within the periventricular and deep subcortical white matter on the to flair sequences which are nonspecific however they are most likely secondary to chronic small vessel disease there is no evidence of restricted diffusion to suggest an acute infact midline shift or mass effect there are no blood products on the gradient echo images normal intracranial flow voids are seen the visualized paranasal sinuses are clear there is no pathologic enhancement identified degenerative changes are noted within the upper cervical spine impression no acute intracranial process mild cerebral atrophy and mild chronic small vessel disease no pathologic enhancement identified what should I do and how concerned should I be I am 70 years old and my be and cholesterol are controlled how concerned should I be",
        "input": "",
        "output": "hello your mri shows mild cerebral atrophy with some small vessel disease changes I would like to know about your memory speech gait and urinary symptoms are there any abnormalities these changes are much common at the age of 70 but still you have to take some precautions life style modifications like regular sleep and healthy foods like low sugar low fat high fiber and protein will do exercise 45 minutes regularly it is good that your be and cholesterol are under control keep a watch on it check your blood sugar at least yearly and if raised then control it do regular meditation and yoga"
    },
    {
        "instruction": "hello doctor I am a 19 year old medical student this year I lost my right tests to testicular torsion resulting from late diagnosis as a precautionary measure a contralateral orchidopexy was also done this involving a part so intimately connected to me shattered me a lot and I am recovering slowly from that mental trauma besides the fear of a retorsion in the left one and its subsequent loss keeps lingering I am also concerned about orchidectomy impacts on my fertility and hormonal levels can you please allay my fears also my surgeon report says the left scrotum was exposed left tests exposed very mild hydrocele version of sac done using 0 monofilament suture left lateral wall of tests fixed with 0 monofilament suture at two points skin closed is this fine why was the sac everted and what about the hydrocele I have heard the 0 monofilament used was absorbable if so then how can those two sutures on the left tests prevent it from further torsion will there be some tissue formation eventually that will hold the tests in place or is it because by then the tests will get naturally attached to gubernaculum as I presume the sutures were made into tunic albuginea however I read somewhere that this might have impact on sperm production is it true lastly can I by any means ascertain whether my left buddy is fine at home by physical examination does the presence cremasteric reflex always rule out a possibility of necrosed tests",
        "input": "",
        "output": "hello welcome to icliniq com first of all relax and do not worry at all we had done orchidectomy due to torsion in many patients they are absolutely fine and doing well physically as well as mentally having one tests remaining is perfectly fine you will have no problem regarding sperm production or testosterone levels your left tests can produce enough sperms for fertilization only one sperm is required for fertilization the surgeon has done a perfectly good job in the right tests version of the sac was done for hydrocele so that in future you do not develop hydrocele also fixation with 0 monocryl is perfect it just requires fixation at two points so that is cannot twist in the future if suture are absorbable also no problem as it will cause fibrosis at the suture site so your tests remains fixed in the correct position so do not worry everything is fine"
    },
    {
        "instruction": "hi doctor I am a 24 year old female I am married for about months my weight is keg and height is 4 I conceived in the very first month but unfortunately I had a miscarriage after 10 weeks and had and till then I am trying to get pregnant but having a problem in it my gynecologist suggested me hormonal test but I could not understand its result please explain to me the report and help me to find out the actual reason for infertility according to the test report to 7 no my to 2 no do ash 0 miu my oh 8 iu fish 6 iu prolactin 6 no my progesterone 5 no my testosterone 2ng my menstrual cycle is of about 31 32 days and last time I had periods within 28 days I am using clomid and ovafin from the last three months in two to seven days of menstruation but I have not conceived yet along with infertility I am suffering from vaginal farts weight increase facial acne mood swings and headache I am very stressed please guide me and tell me the reason for infertility",
        "input": "",
        "output": "hi all of your test reports are normal you are trying for pregnancy just from last seven to eight months kindly give yourself some time and you can get pregnant naturally as your periods are regular in my opinion you do not need ovulation induction medicines like clomid in fact you do not need any medicine right now just continue folic acid tablets and continue trying naturally you should get pregnant naturally if there was any infection after last dilation and curettage you can get your tubes checked by hug hysterosalpingography to be sure that everything is normal you can do that test after trying naturally without medicines for three months I hope this helps"
    },
    {
        "instruction": "hi doctor I have dysautonomia I wanted to get that out of the way at first I also have bad anxiety and depression which may affect how I feel I also had a heart catheterization years ago for rvot I wore a monitor for two weeks a couple of weeks ago and I just got the results and I have no clue how to read them and waiting for the doctor to get back with me here what it said on the site that he wrote out 15 days of monitoring analyzed 13 symptomatic and 34 asymptomatic strips submitted all symptoms primarily of lightheadedness with one or two chest pain and soa all strips show sinus rhythm with rates between 39 bum and 174 bum one o skipped beat correlates with rse with pvc symptoms of lightheadedness and dizziness generally occur with sinus tachycardia I have always dealt with tachycardia for almost a year I had almost a normal heart rate than some bradycardia it was weird like he totally reversed it now it is back obviously fainting and whatnot again I think I get some of what he is saying but not all please help I am currently on clonazepam gabapentin prilosec adderall and pail",
        "input": "",
        "output": "hello I have read through in detail all your explanations and I understand what you are going through dysautonomia is a condition that affects the autonomic nervous system this is the system that transmits information to organs like bladder heart blood vessels etc it can be associated with symptoms such as bradycardia tachycardia etc your test result shows that severe bradycardia was recorded while tachycardia was recorded which was accompanied with dizziness and lightheadedness this test gives the possibility of root right ventricular outflow tract with premature ventricular complex pvc in this kind of situation I prescribe beta blockers for my patients I advise you to avoid anything that contains caffeine if there is no improvement in due time catheter ablation can be considered idiopathic inherited heart disease"
    },
    {
        "instruction": "hello doctor I am a 62 year old female I was diagnosed with collagenous colitis following colonoscopy biopsies I started on entocort three days later I have severe swelling in feet and ankles I am fatigued the next day on the seventh day I had swelling of lips and a strange feeling in the throat I called the doctor and he stopped the medication my blood report shows hemoglobin 6 do rec 38 million m3 iron saturation fecal stool sample postive I went to the er I was given two units of blood my hemoglobin raised to 5 the next day I was discharged endoscopy was performed and my biopsy report is negative I had minor stomach inflammation my next bloodwork shows hemoglobin 1 do rec 05 million m3 iron 51 saturation 12 vitamin b12 648 immunoglobulin a and are pretty low gastroenterologist says need to do small cap endoscopy to see if there is bleeding in the small intestine my new stool sample results are not back yet but stools have not been dark what other tests need to be done to determine the cause of anemia list the possible that medication caused anemia since I had such a severe reaction current medications no prescription only supplements vitamin do coq 10 methyl b12 and curcumin",
        "input": "",
        "output": "hi entocort budesonide is a corticosteroids it is very unlikely to cause anemia especially to the extent that you had what was your hemoglobin prior to the colonoscopy if it was near normal and then dropped to 6 that would be a huge drop if you had gastrointestinal bleeding leading to such a huge drop in hemoglobin in a short span of time I would expect that you would have noticed the blood in your stool minor bleeding over longer periods can lead to anemia and in those cases serum ferritin a storage form of iron would be low acute blood loss anemia usually does not cause serum ferritin to drop did you have a serum ferritin level done along with your other iron studies if the serum ferritin is less than 15 it is almost definitely iron deficiency iron deficiency is either due to dietary reasons or blood loss dietary iron deficiency is rare in developed countries so blood loss has to be ruled out if no obvious reason is identified on upper gi endoscopy or colonoscopy then small bowel pathology has to be ruled out by capsule endoscopy other reasons for a rapid drop in hemoglobin would be hemolysis where the red blood cells are destroyed for various reasons this would be diagnosed by tests like peripheral blood smear serum haptoglobin direct and indirect bilirubin direct coomb test lah lactic acid dehydrogenase please attach any reports you have with you that may help me give you a better answer"
    },
    {
        "instruction": "hello doctor I tested negative for ana but positive for anti dsdna my go diagnosed me with ankylosing spondylitis when I have many symptoms of lupus just not the rash my sister also has lupus and did not test positive for ana she has seronegative lupus I am under the impression that anti dsdna has nothing to do with ankylosing spondylitis is that correct I am currently taking gabapentin tizanidine naproxen levothyearoxine",
        "input": "",
        "output": "hi you are right anti didna antibodies are specific for she systemic lupus erythematosus especially if the titers are high ankylosing spondylitis does not give you any kind of antibodies anti smith antibodies are the most highly specific antibodies for lupus but only a small percentage of people with lupus have them did you get that test but it is strange that your ana antinuclear antibody was negative anti didna is a type of ana I believe it is a false positive a normal sedimentation rate essentially rules out inflammatory pathology lupus is an inflammatory disease to begin with we need to know more about your symptoms she is diagnosed based on the symptoms and signs along with laboratory tests it is not diagnosed just on the basis of an antibody test you can get false positive tests positive test in the absence of disease so please get back to me with details of your symptoms based on the information you gave I do not think you have lupus there are no blood tests that can diagnose ankylosing spondylitis as ha b27 is more common in people with as but it is not diagnostic as diagnosis needs clinical and radiological criteria I hope this helps"
    },
    {
        "instruction": "hello doctor I have trouble sleeping but when I do get the chance to sleep I often wake up still feeling exhausted my thoughts keep me up at night and as a result I am always thinking about tomorrow or worrying",
        "input": "",
        "output": "hi most causes of sleeplessness are due to wrong habits and the good news is that it is easy to cure them you should have a natural circadian rhythm try to go to sleep and get up at the same time every day and wake at the same time do not take coffee or tea after am milk can be taken cover the windows and doors with curtains and avoid light avoid watching to lying in bed and avoid mobile phones do exercise walk for 45 minutes after dinner take a bath after that I hope this helps"
    },
    {
        "instruction": "hi doctor my 19 year old brother was suffering from ocd and it started kicking back in for the past 20 days he basically has a checking problem he is currently a freshman at a university and was doing well for the first two months last month he went back home and was returning back to the university and that is when he started feeling homesick during the journey he felt for a moment that he going back to an unsafe place this feeling was because of a crime movie that was shot in the city his university is in that made him feel uncomfortable and at the same time the results of his mid term were told to him and he misinterpreted them and thought he scored less but the real scores were very good and he did the best among his class but he was affected by all these thoughts throughout the journey and right now he fights homesickness and is scared about the place he lives in and also checks continuously if he is able to understand what he is being taught in the class rather than listening to the class I am scared for him and his future",
        "input": "",
        "output": "hi his current symptoms are also probably due to ocd obsessive compulsive disorder he has fear due to a crime scene of a movie and is feeling very homesick this is happening because of severe anxiety due to ocd if he has never consulted a psychiatrist then he should visit for evaluation fluoxetine or fluvoxamine which are sari selective serotonin reuptake inhibitor drugs are the drug of choice for severe ocd the drugs help to control ocd symptoms in about four to six weeks for very severe symptoms low dose antipsychotics can also be used visit a psychiatrist for help"
    },
    {
        "instruction": "hello doctor I am 24 years old I had my kidney stone removed a year ago for causing mild hydronephrosis at my right kidney during the treatment I was exposed to full of radiation abdominal it scan lithotripsy fluoroscope and another fluoroscope during stent insertion I am not sure how the doctor manages the radiation I did my treatment abroad and it is not really a well developed country he might not even care bout it I studied some about radiation when I was in dental school so I am very scared of the side effects so if I am to have another case of hydronephrosis should I just remove the kidney rather than undergoing such radiation which may cause me high risk of future cancer because as you can see I am still so young and I just started my career what do you suggest do the pros outweigh the cons or vice versa is there another less risky treatment in terms of radiation how about invasive treatment is the risk higher aside from the slow healing and I am serious about the removal if indeed it has lower radiation risk even though I know kidney is very important please suggest",
        "input": "",
        "output": "hello there are enough studies and literature which prove that though there is radiation exposure during it computed tomography scan in the removal of kidney stone it is in low dose and chances of cancer do not increase so do not worry about that I do not think removing kidney to escape from radiation exposure is a good option you should not think of that if there is again stone formation then there is a treatment called ultrasound guided lithotripsy eswl which can break your stone from outside without any radiation exposure so you can do eswl extracorporeal shock wave lithotripsy if required later but no need to remove the kidney"
    },
    {
        "instruction": "hello doctor I have been having off and on ear pressure in my right ear and have some cold symptoms the last 5 weeks chillish runny nose body aches etc my kids have battled the cold as I have my office I noticed my right submandinbular lymph node was slightly swollen I went to my go and he prescribed antibiotics which has not helped I have had sinus issues in the past I noticed that my right tonsil is bigger than the other which is the side of the pressure and lymph node can a viral illness cause one sided swelling could this be tonsil cancer I go to the dentist every six months whom I assume checks out my tonsils I am concerned it is one sided my throat has not really been that sore",
        "input": "",
        "output": "hello I went through the pictures it seems you have inflamed tonsils one side does appear to be larger and more red than the other it does not mean you got tonsil cancer it is a routine infection that needs strong antibiotics the symptoms with regards ear swollen node etc all signify infection how many days amoxicillin course has been completed what dosage did you take did you take any gargles along with the antibiotics any nasal or oral decongestant any nasal sprays did the go check the insides of the ear using an otoscope usually when one has tonsillitis or pharyngitis the pain gets radiated to the ear and sometimes the infection also passes into the ear through the eustachian tube causing fullness and swelling inside the ear the nearest nodes also get swollen when the infection is severe I would suggest you take a course of clarithromycin appropriate for your weight for days and take betadine or benzydamine gargles take otrivin nasal spray for five days and steam inhalation if the infection is not subsiding and the nodes are increasing in size you may need some blood tests and possibly intravenous antibiotics do you smoke or drink what sort of a diet do you consume is there any fever or weakness alongside"
    },
    {
        "instruction": "hello doctor would dry eyes cause cloudy vision with little nonmoving black dots this is my normal vision and every once in a while I can see perfectly the eye doctor said everything in the eye looks perfect I have noticed when I sleep one eyelid does not close all the way but this is the vision in both eyes I did have a vitrectomy in one eye and the other is still in need of cataract surgery",
        "input": "",
        "output": "hi yes dry eyes can cause blurring of vision as you said you feel your one eye is not closed properly while sleeping so there is a greater chance of getting cornea dry and can lead to exposure keratopathy but you have not mentioned any history of stroke or bell palsy did you have any did your doctor notice that you are unable to close one eye properly your mi body mass index is also high so with obesity there is a condition related to floppy eyelid in which eyelids are more elastic and get averted while sleeping that can also cause dry eyes you said you had vitrectomy in one eye please explain why was that advised are you having diabetic retinopathy or you had a vitreous hemorrhage or retinal detachment or you had similar black spots in that eye too these black spots in vision may also be due to vitreous liquefaction and condensation which is age related problem jelly in the back of your eye starts becoming liquid after 50 years of age so you can use artificial tear drops or dry eye and the eye you feel does not close properly you can also patch your eye while sleeping with simple tape so that your cornea does not get dry out your eye doctor is doing a great job he has examined your eyes so he knows better and he will do the best you can discuss with him if anything missed like if you have not told him about incomplete closure of the eye during sleep"
    },
    {
        "instruction": "hi doctor I have an 18 month old daughter my daughter has had trouble with her bowels since she was months old she finds it impossible to do a normal stool she strains and screams to the point she falls asleep from exhaustion and still does not pass stool she does have a regular bowel movement but she is in constant pain while doing it her stool has got to the point of having blood in it I have taken her to numerous doctors and tried just about everything possible to help her current specialist has given her the same medicine which I have stated does not work it does not matter what the dosage is I have contacted him to tell him it does not work and he has just said to change her to another type of laxative laxatives do not work for her I feel it is something more serious so I was just wondering if you could take the time out to give me some advice on what I could do or what might be wrong with my daughter I cannot handle watching her be in pain anymore",
        "input": "",
        "output": "hi she has chronic constipation as you have noticed blood she also may have fissure in anus due to which she has extreme pain give her lots of water and a high fiber diet dry fig milkshake dates and prunes in any form help a lot give either one of them every day along with fruits and vegetables you can try lactulose suppository for a few days which may prove more effective than syearup secondly make her sit in a tub of lukewarm water with few drops of salon put on it this is called a sit bath which will help if there is fissure wound due to peeling of skin in the anal area do this three times a day also encourage her to pass stools immediately after every meal as it is the ideal time to try when bowels are in action for the digestion of food if you do not find any improvement in five to seven days please consult a pediatric surgeon to check the fissure and investigate further"
    },
    {
        "instruction": "hello doctor I am a 30 year old female I do not have any medical issues that could associate with my problem about a month ago I woke up to pain and stiffness in my neck and shoulders I figured I just slept wrong or something little like that but every single night since then I have been woken up by the pain during nights I cannot lay in any position where I put pressure on them and it only happens at night or while resting or laying down for more than an hour it started with just my neck and shoulders but gradually it has turned into pain and stiffness in my neck shoulders elbows hands which includes swelling in my fingers hips and now my knees it only happens when I lay down for long periods and gradually disappears during the day with movement and activities it is also disrupting my sleep every night in which I barely get for three to four hours altogether I have tried taking naproxen before laying down for the night and using a heating pad at night to avoid these issues but it is not helping my question is what is wrong with me and how can I reduce or stop the pain and stiffness",
        "input": "",
        "output": "hello the symptoms you have explained points towards arthritis it can be osteoarthritis or rheumatoid arthritis depending on the joints involved and the duration of morning stiffness usually in rheumatoid arthritis morning stiffness remains for more than 45 minutes and joints of the hands involved are middle joint and the joint which connects your finger with hand osteoarthritis morning stiffness relieves in less than 30 minutes in the morning and the joint involved are the distal joints of your fingers the tests which you can go for to confirm are a rheumatoid factor cop reactive protein ray of the joints the medications which can be used to relieve the symptoms are nsaids non asteroidal antiinflammatory drugs steroids to relieve the inflammation and dmards disease modifying antirheumatic drugs like methotrexate sulphasalazine etc surgery is another option here which you can talk to your doctor after confirmation of the diagnosis I hope this helps ray of the joints cop rheumatoid factor osteoarthritis gout"
    },
    {
        "instruction": "hi doctor I am 34 years old I have had pain in both of my legs when sitting for about 12 years the pain starts 15 minutes after sitting and it is pretty bad there are itchy and burning pain between my calves and ankles and it feels like my legs are squeezed in this area at the same time there is dull and a kind of bursting pain in the feet and dull and itchy pain in the back and the middle of upper legs nothing in the buttocks sometimes there are tingling sensation starting in the middle of upper downwards it feels like I need to raise my feet a little bit from the floor and move them all the time there was minor varicose vein removed on my right leg no more visible veins there since then and you can see the vein on my left leg but they are not varicose when I stand up it feels like 70 90 of the pain is gone there is no pain when I walk also there is a tingling sensation when I lay down and bend my knees so I feel these sensations from knees downwards it feels like there is a problem with circulation but why it starts straight away after sitting I know some people who have pretty bad veins on legs but they do not have that bad pain like me it drives me crazy please suggest",
        "input": "",
        "output": "hi leg pain can have so many causes but from your history of aching after sitting suggest a possibility of dot deep vein thrombosis dot is the formation of a blood clot in a deep leg vein blood vessel the pain is typically a burning or cramping sensation immobility is one of the cause of this immobility results in slow blood flow from the leg to the heart slow blood are more likely to clot than normal now you have to consult a surgeon immediately and do a doppler study of both legs to check the blood flow they will provide you with medicines"
    },
    {
        "instruction": "hello doctor for a while now I have had a terrible odor that comes out my mouth and nose the odor is somewhat subtle whenever I am not around a fan ac etc but whenever I am around one of those the smell seems to spread all around me I am positive the smell is coming from inside my stomach I have realized a lot about leaky gut and candid but neither one mentions a smell my diet before has been poor lots of packaged sugary foods but I have always been a healthy weight I feel terrible riding in a vehicle with others I will sometimes hold my breath to try and stop the smell but it does not work most of the time my symptoms started when I was a working nightshift job stress might have been a factor although I did not feel like I was I have not worked there for almost six months and my condition has worsened could the amount of sugar I consumed destroyed my stomach lining I also heard when candid is starved it digs into the lining and essentially makes holes which can cause food to leak could this be the source of the smell I am currently taking probiotics",
        "input": "",
        "output": "hi welcome to icliniq com there is nothing like leaking gut in the medical dictionary the bad breath you are experiencing in medical terms is called halitosis it is majorly because of poorly kept oral hygiene it could be an indicator of gum infection tooth decay smoking alcohol etc sometimes it is because of organized infection of tonsils my suggestion is to consult a dentist first to find out the cause as in the majority of patients it is related to the oral cavity the remedy is simple maintain good oral hygiene by brushing twice daily in your case after every feed do regular flossing avoid smoking and alcohol if you do so you can use flavored mouthwashes regularly which are easily available with chemists"
    },
    {
        "instruction": "hello doctor I was diagnosed with an anxiety disorder and was given trintellix 10 my I took it for two weeks it helped with anxiety attacks but made me nervous about every emotion or feeling I felt my mother has bipolar disorder and health anxiety and I think I have health anxiety too I am worried that I might get bipolar disorder so I was constantly checking when on trintellix for any signs of mania even though I have never had any manic episodes I also would shake and have a racing heart so I would get so scared which was causing me nervousness I could not even judge if the drug was working my doctor switched me to cipralex but I am afraid to take it and the same thing happens to me I also have intrusive thoughts sometimes and I feel stuck not sure what to do or what medication would be my best bet I am also on clonazepam 5 at night to help me sleep",
        "input": "",
        "output": "hello it looks like you are experiencing significant anxiety I note that you are weaning off trintellix 10 my and are you are in a dilemma about starting cipralex escitalopram due to concerns about side effects like developing mania since your anxiety appears quite significant it is best managed by a combination of medication and psychological therapy like cut cognitive behavioral therapy cipralex is an effective medication in this situation remember that it will take at least two weeks for your body to get used to the medication and in this period some may experience nervousness agitation etc it generally settles down and you will see full therapeutic benefit from around four to six weeks so medication is worth a try and have regular follow up reviews with your psychiatrist as advised you can take cipralex long term till anxiety is better clonazepam 5 my is meant to be taken for the short term only ideally less than four weeks to prevent developing dependence in addition to medication consider cut to develop psychological strategies to manage anxiety regular exercise also helps maintain a good sleep schedule avoid alcohol and caffeinated drinks I hope this helps"
    },
    {
        "instruction": "hello doctor my father is 61 years old known case of cod with hypertension he has been on dialysis for a couple of weeks sum total of ten dialysis have been done out of which one dialysis was done using an online hemodiafiltration technique his creatinine has subsequently reduced from 6 to 5 however he had pneumonia patch in the right lung and took antibiotics and has recovered from that but he has been coughing quite a lot with only secretions coming out and no sputum there is some fluid in his lungs for which he has been advised to go for edf and mild pericardial effusion aft for to is negative can you please suggest what can be the cause of severe coughing shortness of breath and the treatment for the same if needed I can send out the ray to you for evaluation he is currently on flavedon minipress al metolar or torsemide 40 vitamins and calcium tablets his lab report shows tac is raised to 12 which was earlier please help",
        "input": "",
        "output": "hi welcome to icliniq com there could be a few causes for the wet cough with phlegm despite taking antibiotics for pneumonia the opacity in the lung takes a few weeks to completely disappear the cough in such a case can last for a month if the patient has no fever I will not worry chef congestive heart failure is also one of the causes in elderly patients in addition to environmental factors I would advise you to continue supporting treatment for cough as advised by your doctor if there is fever in such a case you must report back to the doctor to rule out any other cause if the ray reviled plural effusion then probably other continuation like to tuberculosis etc should be considered you can send me the chest ray to comment better I hope this helps"
    },
    {
        "instruction": "hello doctor only when I wake up I feel ear ache pain also pressure in my left ear it only happens when I have been sleeping on the left ear the ear ache pain lingers for minutes or so and fades away it started months ago but seemed to go away for month but now I have had it again for the last days I did try and used some cortisone cream in the ear canal before the pain went away last time but not sure if this was just a coincidence my doctor has examined the ear and said it looks normal with no middle ear infection",
        "input": "",
        "output": "hi it is a rare case which I saw few times it is caused by warming the auricle while sleeping on it use corticosteroids and antibiotic cream when needed do not apply water for your ear during the time of pain"
    },
    {
        "instruction": "hello doctor what do these tests results mean esophageal mobility failed 30 weak 40 ineffective 70 egg outflow obstruction median rip 19 I am having acid reflux and taking medications for herd",
        "input": "",
        "output": "hi can you send across the endoscopy report looks more like egg outflow obstruction than achalasia cardiac anti reflux surgery alone will not help may need myotomy too will give a definite comment once I see the pending reports"
    },
    {
        "instruction": "hello doctor I have had very bad dark circles under my eyes since I was around or years old and went to a dermatologist about it once which said they had something to do with a vein but was not sure how to help I was wondering if you could shed some light on this I am 28 years old now and still have the dark circles which makes me look bad and would like to find the best solution to make them go away",
        "input": "",
        "output": "hi this is tear through deformity you can try dermal fillers for this visit your nearest dermatologist it will give better result do not worry it will go do you have any addiction reduce your stress take proper hour continuous sleep eat healthy food take care send your photos after taking treatment"
    },
    {
        "instruction": "hi doctor my years old son is suffering from stomach pain from the last eight to nine days he mostly complain about that in the evening time or after mid night if I massage his stomach he feels relaxed he underwent an ultrasound along with appendix and some other blood tests including to all reports are fine no complaint of loose motion he is feeling down from a couple of days and not eating properly suddenly he starts to complain of pain in the stomach but the pain does not remain all day even in the school he sits with his head down in free time please advise me on what is the problem and remedies for the cure he is currently taking duphalac drotin is zentel and metrogyl",
        "input": "",
        "output": "hi I have seen the reports the on and off stomach pain is due to constipation the scan report says few fecaliths are present which means hard stools that are not cleared I feel this is the reason encourage him to take lots of fruits and vegetables along with dry fruits like dates prunes dry figs etc which will help to make the stool soft he has to drink lots of water avoid junk foods wheat and maid products he is already taking duphalac which will take about a weeks time to act also to clear the fecaliths please show him to a pediatric surgeon once those are cleared and constipation is treated he may feel comfortable"
    },
    {
        "instruction": "hello doctor I have hashimoto thyearoiditis and I felt like a lump in my lower throat the doctor did a physical examination and noticed two nodules and sent me for an ultrasound the result came back that the thyearoid as a whole was hyperemic and heterotrophic in the background appearance the left lobe contained two nodules for which he then sent me to an ent to do an fob right now usual symptoms of hypothyearoidism are present like extreme fatigue dry hair but in the last couple of weeks I have not been able to sleep on my back or side or put my chin down as it feels like the air is restricted my question is what does this sound typical of thyearoid cancer or a goiter I am not an over reactor I just wish I had more information or know the prognosis of cases that were similar to mine does this sound at a higher risk of cancer or more like a goiter and if I am already on thyearoid medication what can they do to treat it",
        "input": "",
        "output": "hello welcome to icliniq com I had gone through all the data posted from the details posted it appears as autoimmune hypothyearoidism hashimotos kindly tell us the thyearoid blood reports to know the control do you hear any sound while breathing stridor which indicates pressure on trachea breathlessness on lying back or on the side is unlikely due to thyearoid unless it has retrosternal extension significantly which needs to be decided by clinical examination do you get breathlessness while taking the stairs since how long do you have hashimotos since how long you have noticed the increase in the size of swelling do you have a family history of thyearoid cancer for definitive distinction of benign is malignant fac fine needle aspiration cytology is important if we have any doubt on fac we go ahead and do thyearoidectomy and send thyearoid tissue for histopathology examination which is the most confirmatory test ultrasound is not so sensitive to differentiate benign is malignant so kindly wait for the fac report kindly get a complete physical examination in view of symptoms of shortness of breath before attributing those to thyearoid problems kindly review with further details so that I can help you better"
    },
    {
        "instruction": "hi doctor I have been experiencing some very unusual problems at the moment and I am getting a bit concerned about them I have not gone to my doctor about it yet it is hard to explain but I will try it is as if the connections between my hands and my brain become muddled and I have trouble telling which part of my fingers or hands is being stimulated it all kind of blurs into one numb sensation my hands feel heavy and become harder to move as if I am trying to move them through a viscous fluid this weird experience has been happening mainly when I am at work and when I am stressed but I am noticing it now slightly as well while typing this it is a really bizarre feeling and it can extend through my arms and my legs when it gets really bad I also have a constant tinnitus but I only notice it at night when trying to sleep or if I am in silence I also feel that my heartbeat has started to become irregular and I always feel tired and dizzy at the moment I went to my doctor about the dizziness about months ago and got a blood test done and that was fine but he said my blood pressure was slightly high for my age two years ago I very stupidly took a legal high bk 2cb and I had a full blown visual and auditory trip that lasted about 18 hours once it wore off I was fine but then about weeks later I started to have visual problems I had really bad after images and reality just looked very strange to me especially when looking at other people these visual symptoms seemed to have faded now but I still have brain fog and after images I am just messaging because I am concerned about the problems I am having with my sense of my hands in particular and I am wondering if it has anything to do with the stupid mistake I made years ago when taking that drug",
        "input": "",
        "output": "hello the sensation in your hand can be because of compression of the nerve at elbow while typing but it is unlikely to spread to your legs stress anxiety can cause such symptoms tinnitus at night when it is very quiet outside is common and normal phenomenon but when it is present when you are in a noisy environment that is abnormal dizziness and tiredness may be a part of your stress slightly high blood pressure will require regular blood pressure checks and there is nothing to worry about on that front drug effect does not last for years if you have taken it for a very long time the it can cause psychiatric problems but I do not think your problems are related to that I would suggest you take a psychiatric consultation because I do not feel it is a neurological problem and there is nothing to worry about"
    },
    {
        "instruction": "hello doctor what will my doctor exactly do while examination when I tell him I am having erection problems",
        "input": "",
        "output": "hi it depends on what all positive findings you give while giving history for example the doctor will ask you for diabetes high blood pressure any regular medicine intake psychiatric medicines low hemoglobin symptoms etc these diseases usually cause ed erection dysfunction as a secondary cause then depending on what comes out of the conversation the check up will consist of general body workup for the ed part the doctor will surely look for a local problem the size and consistency of tests the shape and size of the penis he will then try to check for erection as a reflex on touching and will also check for skin retraction the next step can be a stamp test or a penile doppler where the blood supply of the organ will be checked there can also be a nerve conduction test done if the doctor thinks that the nerve supply is deficient I hope this helps"
    },
    {
        "instruction": "hello doctor I am a 19 year old male I am active and never had any serious condition of unhealthiness as a part of the ongoing project I had to work for almost 14 days in burning hot sun when I returned home I identified white spots on my face and quickly searched the internet for a narrow down of the condition thanks to this site I have identified it as tina versicolor and used an ot clotrimazole ointment and it faded away in less than a week just after that my friends pointed out a rash on my neck and I thought it was probably the same as my previous infection it was white in color and looked like a fungal infection with four small patches and so I applied the same cream unfortunately I could observe no change and kept trying home remedies like turmeric and honey paste etc it has now come to look black and dry as in the attached image there is no sensation whatsoever at all I only know it is there when I place my hand over it please can you help me identify what it is I have already looked at a lot of conditions and was unable to match it with mine it is been almost six months and it looks like one has faded and the other three have mated",
        "input": "",
        "output": "hi I have seen the pictures the condition in the picture is not tina versicolor at the moment this is skin thickening as a result of allergy to sun exposure this is quiet common in the neck area you must use a good quality sunscreen till the allergy resolves completely as such it is not something you should get scared for as most of the sun allergies resolve on their own sun allergies mild topical steroid cream like desonide cream application at night only over the patch for not more that 14 days spy 50 sunscreen every three to four hours throughout the day time eat lots of carrots and paya as they have beta carotene which will protect you from sun allergies internally follow up after seven days for assessing the improvement of the treatment"
    },
    {
        "instruction": "hello doctor my friend gets frequent fever and weak bone problems she is not able to gain weight and strong bones she belongs to a poor family though she has been visiting many ayurvedic homeopathic my no one is able to figure out the exact reason there might be chances of bone cancer she had already spent lots of money and now she is losing hope please help",
        "input": "",
        "output": "hi it seems from what you have mentioned that your friend is a 30 year old lady with frequent episodes of fever and bone pain assuming that the bone problems you mentioned are bone pains at multiple locations if she is indeed only 70 labs then it is likely that she is cachexic this along with the frequent fevers gives us a major red flag for two serious conditions that she might have tuberculosis to or tumor anywhere in the body let us discuss these two possibilities tuberculosis is endemic and is more common than we think most individuals already have the bacteria in them and the disease occurs when their immunity reduces long standing low grade fevers loss of appetite and weight history of contact with someone who had active to and low socioeconomic living conditions are quite likely to cause to while to most commonly involves the lungs causing a chronic cough to can affect almost any system in the body one may have musculoskeletal to involving the spine joints and any of the bones if your friend bone pains are related to she should have pain at only a few locations in her body unless she is immunocompromised tumors or cancer anywhere in the body can cause loss of appetite and weight low grade fevers may occur in some tumors while the spread of tumor tissue to bones will lead to bone pains and pathological fractures tumors arising from the bones are a definite possibility finally besides to and tumors there are other rarer causes cachexia and bone pains these include nutritional deficiency disorders like osteomalacia hiv infection certain medications that reduce immunity etc it might be a good idea for her to take pictures of all the tests that she has undergone and also any rays or imaging that she may have got done till now you may upload these on this platform and we could discuss her issues further I understand she may be losing hope from any medical intervention and such disease related depression is quite common if she has consulted only ayurvedic doctors till now it may be prudent to take opinions from allopathic doctors it is quite possible that her diagnosis may have been missed lastly I would sincerely suggest that you take at least verbal consent from her before discussing the specifics of her case on this platform I hope this helps tuberculosis malignancy"
    },
    {
        "instruction": "hello doctor I am a 25 years male before two months back I got into a very fearful situation and I felt panicked at that time I consulted a psychiatrist and he gave me clonezopam propranolol and anti depressants after using it for seven to ten days I stopped them by knowing that they are addictive and after stopping I felt new kind of problems such as heart palpitations whenever I try to sleep in the day time and I get irregular sleep at night feeling anxious for many days I kept tolerating them after many days now the symptoms have diminished but still I get palpitations whenever I try to sleep then I took medhavati for 12 14 days my sleeping time at night somewhat increased but I did not use to get a refreshed sleep I consulted a general doctor he told me it is just a phobia and gave me stalopam clonezepam and escitalopram for 15 days and multivitamin tablets then I consulted an ayurvedic specialist he gave manasamitra vatakam stresswin and saraswatiristam please help me whether I should take these ayurvedic medicines or take antidepressants for 15 days are manasamitra and saraswatiristam safe for me and do not have side effects and what time does it take to show effects and for much duration should I take them now I am almost fine but unable to sleep at daytime due to palpitations and getting some negative fearful thoughts at some times does manasamitra increase serotonin in the brain and give enthusiasm I am thinking of going for allopathy for 15 days or will ayurveda medicines show early results please help",
        "input": "",
        "output": "hello I could understand how much confusion you experience and your mental pain so far fewer studies have been done if we combine allopathy drugs with ayurveda or siddha drugs in your case I feel you should continue the allopathy drugs for 15 days or above as per physicians instruction I feel you can also have propranolol to reduce the palpitation you can continue the allopathy drugs for particular days in order to avoid the addiction the gradual stepwise dose reduction of tablets should be followed for example from day 16th onwards half tablet to be continued for next one week then every alternate days half tablet for next one week then every ith day half a tablet for next week then stop it this can be done with the advice of the physician few research in animals has proved that manasamitra tablet could increase serotonin levels but not 100 guarantee given many clinical sharing concludes that these three ayurvedic drugs are useful if the patient starts the therapy in the early stage of the disease and also good for long term treatment hence in your case adding these drugs will surely have some beneficial role you do not stop these ayurvedic drugs continue it for the next six months you join for a regular yoga class or training class daily continuously for the next six months in my experience after six months you can stop all medications including ayurveda and can run the best life only with yoga practice yoga practice at home is free of cost many people got miracle relief from anxiety depression and can focus on the studies or business or particular work with good sleep and good diet you find out your interested hobby be it plants pets color fishes walking playing picnic temples etc focus on these you will come out of the stressful anxiety I hope this helps"
    },
    {
        "instruction": "hello doctor my grandmother had a big goiter that she did not get it removed later she got a large cyst on the ovary I mean keg when she removed it she found out she had ovarian cancer she removed it and is healthy today now I am terrified that this is hereditary what do you think I am so scared for my mother the doctor told my grandmother to remove the goiter a lot of times it was huge and she had hyperthyearoidism I have read somewhere that there might be a link to hyperthyearoidism and ovarian cancer I think that the body is trying to tell something when she got all this stuff my grandmother was smoking for almost 30 years before she got this and was when she was diagnosed do you think it is hereditary she is the only one in the family with this type of cancer no breast cancer known in the family my mother was on a check before a few days but she is and has irregular bleeding and has an appointment with a specialist next month I am terrified my grandmother had an early menopause and the doctor thinks the same is going on with my mother if she got the menopause from my mother I think she also can get the cancer but it is very normal to get the menopause on the same age as your mother is it my mother is years has kids never tried a smoke do you think she is in danger I also have ocd and terrifying thoughts all the time",
        "input": "",
        "output": "hello first it is perfectly normal if your grandmother had and now your mother is started having premenopausal irregular cycles at age of there is no harm in having menopause at this age and studies have concluded that early menopause protects from breast and ovarian cancers second since your grandmother had ovarian cancer then here are a few questions what was the age of your grandmother when it was diagnosed what was the histological type and grade of the tumor has she underwent screening for other cancers that are common in this age group and your complete family history with cancer history in family members the use of hormonal replacement therapy or other erogenous hormones third thing is that being concerned sometimes over concerned about the health of family member should not be considered as ocd or any other disorder until and unless the thoughts makes you sick one suggestion that I can give to you to relieve of your anxiety is that you should take advice of a medic if in doubt rather than ruminating on thoughts of impending doom and last thyearoid swelling can be tackled with a simple surgery so convince your go"
    },
    {
        "instruction": "hello doctor in the past several months I was diagnosed with anterior uveitis in my right eye several weeks later I was also diagnosed in my left eye in addition I experienced some achilles heel tendinitis and back pain I completed the week treatment program dilating drops for the first week and slow recession of steroid drops and about weeks later symptoms began reappearing in the left eye followed by the right I began another round of steroid drops in both eyes and slowly tapered the consistency I am down to drops per day and I have begun experiencing severe back pain which had previously quieted down also in the past weeks I have had a pityeariasis rose attack the and attack in 4 years I was also treated for bacterial vaginosis a few weeks ago and prescribed antibiotics it seems to me that everything is connected but I tested negative for inflammation in my blood and no doctor has been able to link everything or look at all my symptoms as a whole any help or input is greatly appreciated",
        "input": "",
        "output": "hello it seems from the history that you are having recurrent attacks of uveitis is an inflammatory disease of the eye and it can be because of infections allergies systemic diseases skin diseases like pityeariasis can be seen associated with uveitis however there is no definitive relationship between vaginosis and uveitis back pain because of arthritis is a common association with uveitis the treatment for uveitis is by steroids and cycloplegic dilating stops as you are taking now and you can continue same treatment since the episodes of uveitis are recurrent I advice for a systemic evaluation the common tests need to be done are complete blood count ear cop since you are having backpain we need to rule out arthritis and spondylitis as a underlying cause hence you require ray of spine and ra factor there is definitive and proven link between back pain and uveitis hence I advice you to get evaluation done to rule out spondylitis and arthritis"
    },
    {
        "instruction": "hello doctor I am years old and weighs about 86 keg my whole body hurts I got pain all over the body pain in legs and hands pain is persistent all the time mostly in the lower feet and hand I am having pain for the past three months I just had an appointment with my doctor he ordered some blood work and told me everything is fine and he told me to see the rheumatologist once for my peace of mind I have attached my report do you see anything abnormal in my blood report what is the cause of my body pain is anything wrong with my body do I have any underlying conditions such as leukemia lymphoma or any other cancer do I have any liver disease or thyearoid disease that can lead me to pain before three months I did a blood test and my rheumatoid factor was 1 iu my and now it is iu my why it is going up with a short duration of time what do I need to do I am eating healthy and getting good sleep but I am not losing weight my vitamin level is 40ng my and I am taking vitamin b12 I am taking vitamin for almost one year I taking 400 iu for five days a week please explain in detail the treatment plan",
        "input": "",
        "output": "hello well I have gone through your history and the reports attached all the reports are normal I could not find the reports of liver function tests there but I suppose your doctor had already looked into it do not worry you do not have any cancers at the current time if any cancer would cause pain it surely would have affected your blood counts as well as for rheumatoid factor or can be lab variation or instrument variation but as long as you do not have joint swellings or pain it is insignificant my diagnosis for pain would go for fibromyalgia it is more of a diagnosis of exclusion and one only considers it after ruling out the other causes which they have done so far I will give you a link you can go through it and let me know if your symptoms match this as treatment will depend on your being convinced about the diagnosis I hope this helps fibromyalgia"
    },
    {
        "instruction": "hello doctor I had sex with my partner we used the condom but at the end we found it broken but according to him nothing slipped inside but for safety I took I pill within two hours after this I got bleeding within six days of I pill intake and it lasted for five days and was the same as regular periods so based on this I was expecting my second period on 16 the of this month but till date I have not got my second periods during this period several times I did a home pregnancy test and all found negative till today I did not get my period what is happening inside me what is the expected date that I can get my periods is this a sign of pregnancy should I do the test again please help",
        "input": "",
        "output": "hi after having sex five days later you got your periods this indicates that 100 you are not pregnant now the delay in your next periods is due to the effect of I pill but there is no need to worry no need to do any further pregnancy test as there is no chance of pregnancy just wait for one or two weeks and you will have your normal periods"
    },
    {
        "instruction": "hello doctor I would like to send you my daughter egg for evaluation this was taken at the er I think she had heartburn we are now concerned about the abnormal report",
        "input": "",
        "output": "hi I have seen the egg of your daughter she has a condition called right bundle branch block a right bundle branch block rbb is a heart block in the electrical conduction system our heart is divided into four chambers upper two are called aria and the lower two are called ventricle every heartbeat starts from the sino atrial node in the right aria called pacemaker of the heart and is conducted to ventricles through bundle branches arising from bundle of his in the ventricle the right bundle branch supplies the right ventricle while the left bundle branch supplies the left bundle during a right bundle branch block the right ventricle is not directly activated by impulses traveling through the right bundle branch the left ventricle however is still normally activated by the left bundle branch though in 85 of adult population rbb is a normal finding yet as your daughter is in the pediatric age group it can be because of atrial septal defect also a detailed history is required before concluding if its atrial septal defect or not you have not mentioned her symptoms does she had breathlessness especially while playing does she have chest pain any history of recurrent chest infections in her childhood why was she taken to er does she have gastritis or acid peptic disorder or heartburn previously does she ever had heart palpitation is she over fatigued as compared to her friend in doing the same amount of work I need answers to the above questions before giving a further advice right bundle branch block atrial septal defect follow up with a detailed history"
    },
    {
        "instruction": "hello doctor I had a boil on my lower leg last month it was paining and in five days it was filled with pus doctor advised it hoping and after that I took amoxiclav 625 twice daily for three days and keep on dressing after 15 days another one appeared on the upper side of the knee on the same leg I used black tape atropa and it popped in five days on the fifth day another appeared on the same leg and I took amoxiclav 625 for five days twice daily it popped yesterday and today is the fifth day of medicine now today I am feeling another coming near it what should I do please suggest should I use mupirocin on it three to four times a day should I continue amoxiclav more please guide me if anything else should I do including any home remedy I can not bear more pain and I do not want to take medicine any longer",
        "input": "",
        "output": "hi from your history I would say you are suffering from folliculitis I bacterial infection since you have recurrent episodes I would suggest you to get pus culture sensitivity done so that specific antibiotics can be decided secondly complete your seven days course of amoxclav 625 amoxicillin and clavulanic acid do not burst boils there is no need for dressing yes you can use mupirocin ointment two to three times a day or fusidic acid cream fucidin cream can be used if possible please send an image and revert back"
    },
    {
        "instruction": "hello doctor I am a 31 year old male I am suffering from muscle pain for more than four years it has just become worse and I could not get a diagnosis until now it started as an ankle and calf pain four years ago and slowly progressed upward at present I experience severe bilateral pain in the calf muscles and ankle a bit lesser pain in the posterior thighs fluctuating back pain dull aching pain in posterior shoulder muscles I need a pain killer all the time as I cannot take the pain for an hour with out pain killers currently I am on tramadol for peptic ulcer issues I take nsaids my other symptoms include frequent neck stiffness especially during mornings frequents headaches pulsatile tinnitus and jaw pain usually accompanies headache I sleep for 14 hours and still feel tired I have frequent palpitation like panic attacks fatigue concentration issues lots of floaters tinnitus herd all my blood workups are normal except vitamin do which is low and my to was way high hence my doctor thought I am having diabetes even though my fbi ribs were normal he also thought it as diabetic neuropathy but my hba1c is normal and it does not explain the symptoms other than the leg pain all rays were normal mri of the lower back was normal bone scan is normal egg mav are normal doppler of extremities and heart are normal my life has become devastating it has hugely impacted my daily life I cannot work take care of my family or be a normal person for one day I have seen many doctors but all tests blood workups are normal what could be wrong with me how can I get myself diagnosed",
        "input": "",
        "output": "hello I have gone through the complaints with chronic muscular pain fatigue to be your main symptoms do you have any urinary problems like pain during passing urine frequency urgency do you have any history of weakness in the muscles in the form of difficulty in walking climbing stairs and performing daily activity history of recurring fevers presence of lymph nodes memory problems unrefreshing sleep unexplained muscle pain and extreme exhaustion associated with all normal investigations go with a functional syndrome by name chronic fatigue syndrome or fibromyalgia"
    },
    {
        "instruction": "hi doctor I had unprotected intercourse with my fiance in the first week of last month and she had unwanted 72 within hours the month end she had little spotting is that an issue her period was expected on the same day but she did not get bleeding I did not discharge the semen inside her is she pregnant",
        "input": "",
        "output": "hi thanks for your query on this platform for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I got skin color bumps all over my body which are getting darker after going away I have attached the photos please help",
        "input": "",
        "output": "hello I have examined the pictures attachments removed to protect patient identity and noted your details the description matches closely that of superficial folliculitis which is a low grade bacterial infection of the hair follicles and is recurrent in nature for someone attending with me in my clinic and having a similar profile I would have taken full history and conducted local and general physical examination and would have suggested the following measures it is expected that with above measures there should be improvement within a week or so it would be good to keep me updated so that I can guide you through the recovery process for further information consult a dermatologist online"
    },
    {
        "instruction": "hello doctor my wife is 31 years and she is in her sixth month of pregnancy for past one week she is feeling mild pain in her left thigh region near to lower abdomen yesterday she experienced sporadically sharp pain especially while she got up from chair in office and difficulty while walking today also similar situation this weekend we plan to travel by train what precautions need to be taken kindly advice",
        "input": "",
        "output": "hi for further doubts consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hello doctor I have vitamin deficiency my treatment and supplement is going on I feel too much weakness and lethargy I cannot close my hands completely my hands pain while closing there is numbness and tingling in fingers all the time it is more in the night and when I get up light objects get dropped from my hands I am having these problems since two months currently I am having prise do meganeuron od plus d100cal oxetol or 150 lupirtin tablet pregabalin since there was no effect with the treatment I am advised to consult a neurologist please help",
        "input": "",
        "output": "hello revert back after the investigations to an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I am married for ten months I had a miscarriage of 10 weeks baby now again I expect five weeks of pregnancy at my first miscarriage checkup the doctor said that I have a fibroid of 2 am within the uterus at the intermural side also at that time my torch test was positive and were positive and I took medicines will I have a safe pregnancy this time what can I do please suggest",
        "input": "",
        "output": "hello there are two things one is to have a pregnancy and the second is the growth of the pregnancy both are different and require different approaches in the treatment point of view as you said there were and positive if it was egg immunoglobulin positive then you need not worry it suggests the past infection but as you have taken tablets and completed the course no need to worry you said that you have a fibroid around 2 am intramural it is true that fibroid can increase the chance of abortion but it is also true many pregnancies with fibroid goes up to the term without any complications and have delivered the baby normally so continue the treatment prescribed by your doctor take maximum rest avoid heavy weight lifting intercourse jerky work and work while bending and hopefully you will have a normal pregnancy"
    },
    {
        "instruction": "hi doctor I noticed that the upper lid of my eye is swollen it does not have the signs of inflammation but rather the lid is being like edematous it is itchy in the night can it be normal again what is it and what should I do",
        "input": "",
        "output": "hi revert back after days for follow up to a dermatologist online"
    },
    {
        "instruction": "hi doctor my mother is 83 years old she is suffering from hypertension she is taking tazloc 40 my be since six to seven years of late she cannot walk on her own please advice",
        "input": "",
        "output": "hi revert back with the investigation reports to an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I have attached the blood reports medical reports and doctor prescription of the patient doctor advised for the operation I would require you to please review the attached document and provide your feedback thank you",
        "input": "",
        "output": "hi I have thoroughly gone through your case attached reports and can well understand your genuine health concerns you have normal thyearoid profile means gland is working normal and no issue with it your complete blood count is fine meaning there is no issue with your blood kidneys are working normal mri is not normal it shows a fistula and needs proper management as directed by your doctor your physician is right on a decision for surgery as there is a fistula in the sphincter of anus and is causing issues right now if left untreated then it can damage the sphincter of the anus and that may lead to permanent loss of control on stools it is very miserable condition that needs to be corrected in the first place right now please follow the instructions of your physician for further clarification consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor my wife who is 40 years old has hemoglobin level of which iron or other supplement should she take immediately she regularly feels quite tired she had the same issues during her college days too also can iron tablets cause constipation if yes kindly suggest remedial measures please guide",
        "input": "",
        "output": "hi revert back after the tests to an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor one of my colleagues was diagnosed with measles I had measles in my childhood but my doubt is whether it can spread to my months old granddaughter through me will I transmit the infection",
        "input": "",
        "output": "hi for further doubts consult a preventive medicine physician online"
    },
    {
        "instruction": "hi doctor I am a 32 year old male I have a very small topical cut on my penis where the shaft ends it does not pain normally but pains on stretching it happened last month once and went away now it recurred while having sex I am not on any medication",
        "input": "",
        "output": "hi please send the good quality photographs of the lesion for better help revert back with the photographs to a dermatologist online"
    },
    {
        "instruction": "hello doctor I want a medical opinion for my mother who is diabetic for the last 26 years please guide",
        "input": "",
        "output": "hi revert back with the reports and details asked to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor for the past few weeks I have had severe vaginal itching it goes on all night and sometimes during the day I have not slept properly for the past few weeks I have not experienced this level of itching before and for such a long time once this started I used lactacyd to alleviate the itch but that has not worked please help me before I go out of my mind",
        "input": "",
        "output": "hi for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I took a drug test and it came out negative I am on oxycodone my gabapentin methocarbamol and lisinopril how could it come out negative while taking these drugs I drink a lot of water is this the cause how does this happen please help",
        "input": "",
        "output": "hi for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I would like to ask about medicine called tebonin konzent 240 is it good for memory power can I take it in the age of 20 need some advice from your side thanks",
        "input": "",
        "output": "hi for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I have burning sensation while urinating and a frequent urge to urinate can it be due to sexual contact I am a year old male",
        "input": "",
        "output": "hi these symptoms are classical of urinary tract infection cystitis prostatitis or urethritis yes they can be acquired by sexual contact please get a urine culture and sensitivity done along with ultrasound abdomen because stones in lower ureter can cause these symptoms you can start on a good antibiotic like levofloxacin 500 my once daily in the morning till you get culture report revert back after the tests to a urologist online"
    },
    {
        "instruction": "hi doctor I am getting allergy once in three to four days which causes rashes and swelling on the body I take cetirizine to control the allergy the allergy is mostly due to unknown factors although it could be because of cloth material I am wearing or bed sheets is there anything I can do to understand the cause of allergy to avoid its recurrence I have been taking cetirizine for years does that have any notable side effect",
        "input": "",
        "output": "hi I have read your query in detail and do understand your concern it is very difficult to narrow down to one or more causative factors there are many tests available like patch testing or immunoassays to point out the allergy causing antigens but practically they are not much useful however if there is any family history of autoimmune disorders like thyearoid you may get a thyearoid profile done chronic idiopathic urticaria you can continue with cetirizine alternatively you may take loratadine 10 my or hydroxyzine 25 my at night the side effects are quite rare especially if the dose is taken after a variable gap of few days you may apply calamine lotion as a soothing agent for further information consult a dermatologist online"
    },
    {
        "instruction": "hello doctor I am 50 years old I have done my sugar test last week which showed high blood sugar value and high cholesterol my doctor advised me to test because I had irritation while urinating my doctor prescribed me to take cumet so tablets my weight is 85 keg and height 8 feet I have few questions regarding this is this sugar value bad is drinking alcohol responsible for high blood sugar which fruits and meals can I take to control my blood sugar should I reduce my weight my cholesterol level is little bit high can you suggest a diet for that is oats good for controlling blood sugar I have attached my blood reports for your reference please help",
        "input": "",
        "output": "hi I have gone through your complaint and seen your reports yes drinking alcohol raises blood sugar you should take 6 portions of fruit or vegetables each day you can eat citrus fruits like orange sweet lemon or other fruits like cup pieces of paya pineapple water melon and apple daily you should avoid mango grape date and sugarcane take adequate amount of salad containing tomatoes cumber and green leafy vegetables daily use green leafy vegetables in soup or salad take adequate intake of beans and nuts you can use artificial sweeteners up to certain extent you must restrict your carbohydrate intake avoid rice processed flour potato and sweet potato avoid alcohol smoking sweets and cold drinks try to incorporate whole wheat in diet oats are good in controlling sugar you must carry out moderate exercise 20 minutes per day for five days a week obesity alcohol hba1c blood sugar diabetes mellitus for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor my mother is 2 and she weighs keg she is suffering from severe hair loss she had ferritin test and the level is 29 10 her hemoglobin level is normal please give me suggestion about this doctor",
        "input": "",
        "output": "hello for more information consult a dermatologist online"
    },
    {
        "instruction": "hi doctor I am unmarried and 32 years old I am having pod one of my friends suggested me recently to donate eggs I would like to ask is there any sort of side effects to my ovary will the hormone injections cause some side effects to my body or any damage to my pelvic organs will it affect my menses or in getting pregnant in future please help me",
        "input": "",
        "output": "hello for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I took medication for pimples I had some allergy and so stopped them now sometimes I have multiple rashes near neck and hands only in evening it also itches all my blood tests are normal currently I am taking allegra please help",
        "input": "",
        "output": "hello revert back with the above information to a dermatologist online"
    },
    {
        "instruction": "hi doctor I am a 34 year old female my issues are weight loss memory loss and body pain I had medication for depression before two years my vitamin do level is 34 currently I am taking ashwagandhadi liv on and amlapitta",
        "input": "",
        "output": "hi for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I want to increase my breast size without going for an implantation please recommend a safe and effective medicine for my problem",
        "input": "",
        "output": "hi I have read and understood your problem for further doubts consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hello doctor I am a 34 year old male I do not have any diseases or ailments I am married for 10 years with two children my wife is 34 years old with no diseases I am suffering from pe for the past 12 months and use ot desensitizing lidocaine spray which has wonderfully worked until now I never had erection issues and the intercourse totally satisfied me and my partner but now I am losing erection when sprayed we are a healthy loving couple with zero habits no smoke alcohol I saw a sexologist who advised so profile duralast 30 lox jelly I want to hold on for a month before getting the complete hormonal and semen tests is this pointing towards andropause do you suggest I get the tests done please advise",
        "input": "",
        "output": "hello welcome to icliniq com I do not get what so profile is in most cases it is not hormonal so I would never suggest my patients to go for it for providing you the proper treatment I need to know the answers to the following questions what is your age how long you had been in physical relationship any sexual encounter with commercial sex workers any history of diabetes and hypertension is the condition persistent or deteriorating with time is the condition remain constant with other sexual partners if any smoking alcoholic hyperlipidemia on any medications or hormonal therapy any marked curvature in the penis any history of trauma surgery or neurological disorder do you have any of these following features persistent low mood loss of interest in work low energy lack of concentration disturbed sleep ideas of hopelessness helpless guilt or suicide change in appetite headache forgetfulness excessive sweating or shakiness of hands I look forward to hearing from you soon in order to find out the proper cause and thus to provide a proper treatment"
    },
    {
        "instruction": "hi doctor I have breathing difficulties I had a spirometry test that showed a restrictive disorder I recently had a it scan and waiting to see my specialist in the end of the month I was wondering what could indicate this type of problem I can attach my it scan I am currently taking plaquenil to help urticaria",
        "input": "",
        "output": "hi welcome to icliniq com I have seen your reports the it computed tomography scan which you attached is showing ground glass with mild reticular changes in your basal regions and from the history which you gave it could be an interstitial lung disease restrictive pattern in spirometry and go in it chest and in the next visit I would advise you to go for a dclo diffusing capacity for carbon monoxide and serum ice immunoglobulin levels"
    },
    {
        "instruction": "hello doctor I am 30 years old I have swollen glands in my neck which have been there for at least two to three years I had a previous ultrasound for it which showed signs of reactive lymph nodes I recently visited my go as I felt swollen glands in my inguinal area for nine to ten months I feel fit and fine otherwise with no other symptoms the go said he was not very concerned but decided to send me to a hematologist who examined me and he said there are multiple lymph nodes in the neck and inguinal area but they are subcentimetric the blood was all normal apart of mild neutropenia he said he does not feel it would be something significant but he booked me for it neck thorax abdomen and pelvis I would appreciate your opinion",
        "input": "",
        "output": "hello I read your concern you have swollen lymph nodes for many months so it is advisable to investigate with histopathology examination of enlarged node to rule out the underlying cause for that biopsy has to be taken and send it for a histopathology examination it computed tomography scan is also beneficial and you might not worry about radiation if a it scan mandatory to perform however I recommend to investigate with biopsy for histopathology examination as well for primary work up I hope this helps"
    },
    {
        "instruction": "hello doctor what is the treatment of mania",
        "input": "",
        "output": "hi the treatment option for mania is many including antipsychotic such as arpizole and other antipsychotic and mood stabilizing drug such as sodium valproate or lithium and or carbamazepine the choice of drug depends upon the patients choice and side effects profile of drug so please let me know exactly what you want"
    },
    {
        "instruction": "hi doctor about months ago I had kidney stones with pain under my rib cage and swelling the kidney stones are gone but the pain and swelling under my ribs came back one month ago with constipation I did a it scan without ivcm everything is normal except a mild left basal pleural thickening noted please advise",
        "input": "",
        "output": "hello we are here to help you it seems you are suffering from muscular pain the muscular chest pain aggravates with movement it is dull diffuse and continuous in nature this can result from incorrect posture during the night while you were sleeping however in case you have any pain in the upper part of the abdomen or you had consumed alcohol in case last night you would require to get an ultrasound abdomen to rule out any evidence of gall bladder stones or alcohol induced pancreatitis for muscular pain you should do hot fomentation over the involved area to times a day you should apply diclofenac gel locally over the involved area to take anti inflammatory and analgesic pain killer like ibuprofen etoricoxib if the pain is very severe share my opinion with your doctor before acting upon it"
    },
    {
        "instruction": "hello doctor I have these big changes in my mood and activity levels I will swing from feelings of euphoria and lots of energy during this time I am extremely aggitated my thoughts race and I feel as if I do not need much sleep but I will then crash to an extremely depressive state where I will binge eat I loose all my motivation I cannot think or make decisions I also am often very anxious and I have bursts of extreme anger",
        "input": "",
        "output": "hello in order to make an accurate diagnosis some more detailed information is required about your symptoms such as when did it begin how long do they last what exactly you feel in depression have you taken any medicines for it previously is there any family history of similar symptoms what situations trigger these episodes"
    },
    {
        "instruction": "hello doctor I am a 25 year old male my bum is 31 during physical and mental exhaustion but my bum is high of about 178 during hyperventilation and has pointless frustration my bum from rest to stand increases by at least 30 points but averages a 50 point increase my resting bum is 40 and upon standing it increases to 90 and peaks up to 10 I had done an echo cardiogram and ekg I feel light headed upon standing along with sudden pulsation headache and muscle spasms I feel blackout syncope and fainting I had spontaneous jolt breathless palpitations flutters fatigue chills and skin rash on the back of hands my mental disturbances include confusion inability to maintain thoughts I also feel pointless random irritability ankle pain random lapse of balance throbbing extremities vibrating vision burning sensation social anxiety depression irritating bowl movements no appetite and chest discomfort I wast told to mention the possibility of autonomic dysfunction as its often times overlooked",
        "input": "",
        "output": "hello the symptoms you have been suffering from seem to point to a number of possibilities one would initially suspect a cardiac abnormality given the drastic fluctuations in your pulse rate but that would show up on an egg or echo tests since your egg and echo tests are normal I would advise you to get some blood work done like a serum electrolytes test to see if there is any hyponatremia or hyperkalemia also a urine test for 24 hours urinary collection of catecholamines both of these tests would indicate a disorder of the adrenal gland addison disease with the electrolyte abnormalities or phaeochromocytoma diagnosed by the 24 hours urinary catecholamines please get these tests done as both these probable conditions if present need to be treated sooner rather than later I hope this helps 24 hours urinary catecholamines serum electrolytes addison disease adrenal insufficiency phaeochromocytoma"
    },
    {
        "instruction": "hello doctor yesterday I woke up with a mildly swollen and bloodshot left eye which just got worse through the day I was fine the previous day today I woke up and my eye has become doubled in size accompanied by temperatures headache chills and mild sore throat I went to the doctor and explained my symptoms including that at work my colleague had recently been off with glandular fever he checked my eyes gave me drops and sent me on my way my eye is not better despite doing the drops every two hours as instructed I still have all the other symptoms and none are calming down my right eye is still absolutely fine so after two days of swollen and watery eyes I cannot believe this is due to conjunctivitis I should also add I had glandular fever when I was 16 years old please advise",
        "input": "",
        "output": "hello welcome to icliniq com according to the history and the photo you attached there is mild lid edema conjunctival chemosis and confession seen there is also a history of glandular fever to your friend my top of the differential diagnosis would be pharyngoconjunctival fever it is caused by an adenoviral commonly type and causes sore throat fever conjunctivitis that manifest as watering photophobia and swelling in some cases there may be rash it is a self limited disease it can take one to three weeks only symptomatic treatment is given for prompt relief apply cold compresses two to three times daily topical vasoconstrictor gives rapid improvement artificial tear drops give some relief prophylactic antibiotic drops are given to avoid any bacterial infection sometimes oral anti allergic or antihistamine is helpful if there is itching you will get this with your doctor prescription so do not worry it will be alright what you have to do is to protect everyone else it is a viral disease and a contagious one so your family kids and colleagues can get this from you so take care of the clothing towels etc so that the rest of the people be safe"
    },
    {
        "instruction": "hello doctor I am a 20 year old female I am pregnant and suffering from depression and my main trigger is lack of sleep and tiredness I am aware that I am having a child I am signing up for sleepless nights so my main concern is antidepressants and the effect they might have while breastfeeding",
        "input": "",
        "output": "hi I have read your post thoroughly and I have to tell you that depression during pregnancy must be dealt with carefully pregnancy itself causes mood swings and there are episodes of depression as a consequence of hormonal fluctuation the best ways to deal with this during pregnancy vary from patient to patient depending on their level of depression provided your history with this and the suicidal attempts you may need to be on antidepressants which even though are generally considered unsafe for the fetus a few are of pregnancy safety category meaning category drugs may be given when benefits outweigh the risks in your case needless to say these are prescription medications and I recommend you to see a psychiatrist who can evaluate your present situation and decide on that please note that if you ever feel like you need medication during pregnancy do not hesitate to consider the safer options because harboring something like depression can make it worse and cause more harm to the fetus than the drug itself I hope this is helpful"
    },
    {
        "instruction": "hello doctor my mother is years old she is suffering from diabetes and high be her be remains 140 90 mhg she is taking the following medicines in the morning telmisat 40 one tablet thyox 25 my one tablet during lunchtime jalra 50 my one tablet before food zoryl my forte one tablet during food during dinner time jalra 50 my one tablet before food zoryl my forte one tablet during food alas 10 one tablet telmisat 40 one tablet metolar50 one tablet the recent lab report shows fasting glucose 137 my do post prandial glucose 189 my do urine report shows albumin 184 my creatinine 2 l albumin to or 836 my go mitral test 184 my urine analysis shows protein albumin present cystatin serum 51 my more details about the presenting complaint she is suffering from high blood pressure and diabetics despite taking medicines diabetics is not lowering also sometimes swelling appears in the legs",
        "input": "",
        "output": "hello your mother as you said is hypertensive and diabetic she is on glimepiride vildagliptin antidiabetics and atorvastatin metoprolol as station and antihypertensive her be blood pressure is in under control as per her age and blood sugar is raised moderately I would advise to start her on insulin the dose all depending on her weight and blood sugar level if she is not fine with insulin I would advise to increase the dose of antidiabetic drugs after consulting your family physician her kidneys and eyes are fine please take care of her feet by doing a regular examination of feet increase her daily activity by daily walks and avoid lifts diet should be strict avoid non vegetarian rice and fried foods"
    },
    {
        "instruction": "hello doctor I have an eye infection for six months initially it started with the left side under eye and now it is with both the eyes currently my right eyelid and both under eyes has swelled whenever I touch or rub my eyes also I get itching sensation I have stopped using all eye cosmetics since then every doctor I have consulted says it is dust allergy and gives different eye drops tablets and ointments and says to use it until one month continuously I have used precisely as each doctor suggested till date but still could not get rid of my eye infection even now my eyelids and under eyes are swollen please explain to me why is this happening for the past six months and please help me to get rid of this suffering",
        "input": "",
        "output": "hello unfortunately allergy is not a disease as much as it is a reaction to some factors the purpose of any eye drop that we use as ophthalmologist can recommend is merely to suppress that reaction the main treatment would be to detect the factor that is causing this condition and escape it in order to do so you will have to go in your memory six months back and find out what new factor has been introduced into your life another option would be to undergo an allergy test and find out what are the main factors you have an allergy to it would of course help me more to visualize the changes that you currently have in the eyes you can upload several good quality photos of your eyelids and invert them so that I can see the conjunctive the inner layer of the eyelids it is very important to inform me whether you have any other symptoms such as sneezing dry cough or any other symptoms that started at the same time with the changes in your eyes"
    },
    {
        "instruction": "hello doctor I have been using amir magic cream for about four years and I just totally stopped this year I got itchy very dry red and flare up skin in my face neck and underarms I noticed that every time I stopped using it my skin became dry and itchy but when I started to apply the cream again my skin became clear and bright again I read bad reviews about this cream online we are all suffering the same outcome sometimes I am tempted to buy the cream again just to have my clear skin back but I know I have to use it for the rest of my life do you think that the cream that I was using for a long time had steroids am I also one of the sufferers with the so called topical steroid withdrawal it has been two months since I have this dry and itchy skin please help me",
        "input": "",
        "output": "hello welcome to icliniq com you should not use it further as it is clearly causing damage and problem to your skin the manufacturer does not write steroids in its composition but the whitening creams available in the market do contain harmful ingredients always use the product prescribed by the dermatologist it will take time to better your skin and hope for the best steroids steroid induced contact dermatitis steroid induced rosacea use good sunblock of spy 60 apply metronidazole gel 75 over face once a day mix it with cold cream if it irritates your skin use petroleum jelly four to five times a day maintain good hygiene of the area wash with soap and water avoid using dettol and other irritant please follow up at three weeks with pictures attached"
    },
    {
        "instruction": "hello doctor my wife is 23 years old she is the mother of one daughter and is a little obese and she wants to reduce the weight she has tried many exercises and diet plans but all failed her height is 1 and her weight is 80 keg please suggest her to reduce the weight",
        "input": "",
        "output": "hi compared to your wife height her weight is high she has to maintain her weight below 62 keg first of all we have to find whether there is any underlying cause for this do thyearoid function tests to rule out thyearoid disease do us ultrasound to rule out pod polycystic ovary disease these are the most common disease that causes an increase in weight regular use of steroids can also increase weight do the tests and review them with results if you do not have any of the above we can reduce the weight just by regular diet do follow up to get a complete weight reduction diet chart"
    },
    {
        "instruction": "hello doctor I recently met a neurologist as I was experiencing jerks for atleast 6 times during sleep and also during day time when I used to feel as if I have received a current shock with family history of epilepsy he wanted me to take eg and an mri in the mri he noticed white patch like matter in the brain and wanted to repeat the mri with contrast the area did not enhance post contrast hence he suspected it to be either demyelination or low grade glioma since the terms scared us we took a second consultation with the family neurologist who was again doubtful of what it is finally suspects it to be either focal vasogenic edema in cerebellar hemisphere the report has also has these statements non enhancing medusa like branching magnetic susceptibility effects within this area and thrombosed developmental venous anomaly they have asked me to wait for three months and repeat the mri to see the growth and then come to a conclusion of what exactly it is I get severe headaches and it reduces only after I vomit I feel week in my hands also my parents are ignoring the symptoms I tell them as they think it is my imagination so they are not letting me to get a consultation again please advice",
        "input": "",
        "output": "hi if you are getting frequent headaches and vomiting please consult a neurologist neurosurgeon at the earliest watch for visual symptoms like blurring or double vision we might be dealing with two different problems here like epilepsy and an incidental finding of dva if you could have provided films I could have had a look somebody has to see your eyes to look of you have any raised pressure in the brain right now you can start on tablet amitryptilln 10 my at night one tablet diamox 250 my thrice a day you may experience paresthesias as a sideeffect do not worry they will go off take plenty of conut water if raised intracranial tension is detected"
    },
    {
        "instruction": "hello doctor my eyesight is decreasing every year and now it is in both eyes how can I cure it and will it be sign of blind soon",
        "input": "",
        "output": "hi welcome to icliniq com I have gone through what you have mentioned in your query it is quite a common sight here to see people as young as you with a power of to so there is nothing serious in this you have mentioned that your power is but you have not mentioned how much you are able to see with it is usually mentioned as a fraction of example 9 12 and so on by is considered as normal and for most practical purpose 9 is also fine solutions you have although there are no treatments to cure your power you can get lasik park smile surgery done to get rid of glasses we usually recommend a period of stable of power for atleast months before you can make this move else you can opt for contact lenses though they do not treat your power they offer cosmetic benefit complications that you may get now coming to the problems that people with high powers face retinal detachment amblyopia retinal problems including bleeding the only way to avoid these is to see your ophthalmologist atleast once a year where we will be putting in drops to check your retina the problem that you are facing is a challenging one but with proper follow up you will be able to avoid most of the problems that I have mentioned and be able to lead a productive life"
    },
    {
        "instruction": "hello doctor I am 18 years old and I am in the computer field and have myopia 10 and cataract in both eyes will it get stable with time or are there any chances that I can go blind I am in depression thinking about I might go blind",
        "input": "",
        "output": "hi I will first of all say that myopia is correctable and cataracts are curable so there is no need to worry about blindness as long as you are attending your follow ups regularly you have mentioned that your power is 10 but I want to ask you how much your vision is with the 10d it is usually written as a fraction ex 12 etc if your visual acuity is above 9 your eye sight is as good as normal and there will cause you problems with your work in case it is anywhere less than 12 means your cataracts are in the stage to be operated or your high power has cause a few degenerative changes in your retina unfortunately your eyesight cannot be improved further is you have the latter but in case of the former you have no reason to worry like I have told you cataracts are curable and after the surgery as we would have put in a intraocular lens inside your eye you will not need to wear any glasses either you can enjoy spectacle free good vision for the rest of your life there are no home remedies or special diets that can make the cataracts or a power of 10d come to zero if you can scan and send me your doctor notes I can give you more clarity as to what is exactly going on congenital scan fundoscopy scan oct macula"
    },
    {
        "instruction": "hello doctor my crown has become loose as there is decay inside the crown and around half the edge but not visible I was told that tooth is stable underneath I saw one endodontist who said to rule out implant and he would do root canal but bone and gum are less than ideal and 50 chances are there that it will work he also did not clear all the decay did not take the crown off but drills straight through a wobbly decayed tooth underneath crown did not do the post or crown there is a long standing chronic access at root for years current root canal was done years ago I do not have any other molars left in lower I am in shocked sad anxious and 60 years old I feel tempted to go to an unknown dentist just to see if he could do a hemisection as the endodontist I talk to no longer do them as implants are available and semis tend not to last long does anyone reading this please see any hope for this tooth I chew on it and have no sensitivity and no pain no symptoms at all there is gum recession I have complained to dentist about for the last couple of years I am concerned I will regret not trying to save this tooth if at all possible also told to see prosthodontist to ensure a crown could be made if I get the retreatment I have two tracks I am pursuing I will see an oral surgeon tomorrow to rule out implant and then see prosthodontist I am attaching rays concerned in this decision making process about any further damage being done to gum and or bone impeccable hygiene history",
        "input": "",
        "output": "hello seeing the recent rays it is obvious that the distal root has abscess and should be removed hemisection might be a good idea but it alone cannot withstand the biting force and if you can afford then go for a molar implant behind this tooth so that you will get one extra molar to chew on a hemisection to retain the menial root of this tooth along with another implant behind it will give adequate tooth structure to have a normal biting force if you cannot afford both then go for extraction of this abscessed tooth and an implant as hemisection alone is not strong unless it has more support behind it"
    },
    {
        "instruction": "hello doctor I am suffering from low platelet count low hemoglobin burning back pain shoulder pain arm pain forearm pain breathing problems abdominal pain morning stiffness foot and hand pain I feel tired eyes pain and burning headache pallor and frequent urination my burning pain in the back gets worse while doing some household activities can you please help me with what is going on with me I am currently taking naproxen 250 vitamin b12 injection and vitamin do capsule",
        "input": "",
        "output": "hello the shoulder pain arm pain like symptoms could be because of low vitamin b12 levels so you can complete the course of b12 injection for breathing issue however you need to investigate with spirometry and chest ray additionally I have observed that your hemoglobin level and platelet counts are low persistently for the past two to three months so kindly consult a nearby hematologist for a detailed evaluation of low platelet count some autoimmune thrombocytopenia like cause needs to be searched as per provided history for that primarily ana antinuclear antibody investigation has to be done I hope this helps"
    },
    {
        "instruction": "hi doctor I am a year old female and a working professional I mostly work in night shifts and graveyard shifts am 12 am I have had thick hair in the past but since the past four years my hair kept thinning and I now see little signs of baldness on the crown of my head I have recently visited one of the doctor and she suggested few tests such as thyearoid hiv hepatitis etc everything seemed normal but she noticed that I had vitamin b12 deficiency and recommended pop treatment for my hair where she would inject my own blood into the pores of my skull crown for about six months so it would be six sessions and she said that would help I am really scared to get that done as I want to know if there would be any complications or side effects in future after going for pop I also have to accept that my hair has thinned out drastically and I want to do anything that would definitely help me",
        "input": "",
        "output": "hi in addition to thyearoid test also get a hemoglobin blood test done if the hemoglobin is below normal you will have to take iron supplements in addition to vitamin b12 supplements also take biotin and zinc supplements lifestyle changes are also required which is difficult in your situation due to your job timings eat healthy foods like vegetables and fruits drink plenty of water have at least eight hours of sleep you can use minoxidil lotion my twice a day applied over the scalp for a month then can increase the concentration to 10 minoxidil once a day for two more months check for any allergies though after applying"
    },
    {
        "instruction": "hi doctor we are trying for a baby for three months I have been facing a couple of issues I feel the symptoms of periods within 18 to 20 days of my previous cycle my regular cycle was between 25 to 28 days before I was taking folvite folic acid tablet but started using iron tablets for two months please let me know what could be the cause or is this normal",
        "input": "",
        "output": "hi welcome to icliniq com the feeling of symptoms like periods but not actually having bleeding could be due to ovulation pain what is called in medical terms is mittelschmerz pain if your cycles are ovulatory all the more good try for conception in the middle of your cycle days say in 25 28 day cycle 18 days do not worry if three months are gone give a fair trial for six months before undergoing any investigations folic acid to continue till you conceive it will prevent neural tube defects in the baby"
    },
    {
        "instruction": "hello doctor I have been recently diagnosed with postural orthostatic tachycardia by my family doctor I have been experiencing lightheadedness fainted a few times after standing my be is really high 186 102 mhg on average with a normal pulse while lying down then as soon as I sit or stand up my be drops quite low 104 75 mhg on average I have also been experiencing severe fatigue my whole body just aches all the time and I constantly feel short of breath and get chest tightness and on and off pains I have reoccurring tremors in my left arm and fingertip numbness I become very foggy minded usually at night and I get words mixed and my speech gets slurred and stuttered the worst most uncomfortable feelings I have is shortness of breath and have difficulty trying to breathe I cannot sleep feeling like this I have a month old baby to take care of but I need some advice on getting at least some temporary relief with my breathing and chest pains until I see the cardiologist please help I am currently taking celexa 40 my at night for depression",
        "input": "",
        "output": "hi welcome to icliniq com it is postural orthostatic hypotension I a significant drop of blood pressure which is causing fainting and giddy kind of symptoms to prevent this avoid sudden movements like while getting up from the bed sit with the legs hanging on the side for a while then get up while feeling faint just lie down on the floor do not try to control and stand surely you will fall second thing your resting be blood pressure is high it needs to be controlled as early as possible it looks like gestational hypertension after pregnancy chest tightness and breathing difficulty are due to resting high be take tablet amlodipine my once daily until you see any cardiologist and avoid sudden movements"
    },
    {
        "instruction": "hi doctor I am the mother of a 15 year old girl who was adopted she has no family history and no medical history she started experiencing back pain in her lower central back the pain felt like sharp jabs at sometimes and dull at others this pain progressed to the hips and shooting pains down both legs she was seen by her regular pediatrician who sent her to get an ray of her lumbar spine the test was clear her doctor recommended physical therapy after starting physical therapy she was sent to a podiatrist to see if her flat feet were the problem they were determined not to be she has now been doing physical therapy for about three weeks and nothing seems to help she recently experienced an episode where she was sitting reading in class when all of a sudden her whole left side jabbed and got spasmed she felt the pain the whole afternoon as it felt like all her muscles were pulled she also experienced sudden vision deterioration and has just gotten glass for that could you please tell us what you think this could be",
        "input": "",
        "output": "hello I had gone through all the data that you have posted I can understand your concern being a mother of 15 year old and facing all this I will try to help in my way the first thing is complete detailed neurological examination is very important in this case due to the presence of a back problem with sensory symptoms for some time and sudden vision deterioration goes in favor of multiple sclerosis is if the clinical examination reveals some abnormalities kindly go ahead for mri magnetic resonance imaging spine along with the brain in is it is common to have such episodes and more on extending the neck and weakness if any may worse with bath in hot water other possibilities include dyselectrolytemia sciatica so kindly consult a neurologist for a detailed neurological examination and discuss possibilities with him and let him decide on further evaluation"
    },
    {
        "instruction": "hello doctor my son is months old his weight is now 3 keg he is premature with birthweight 3 keg I could not breastfeed him he was on silmilac after every feed he used to poop on his second vaccination he started getting loose motions he had almost for weeks he was then shifted to isomil and neogain after that his motion frequency reduced but it was pasty in between he had blood in motions they looked like pepper and episodes of spots of blood from next month he became constipated using neopeptine drops three times a day and colic aid he went motion once a day last week he did not go motion at all for days and had to use enema to remove the doctor suggested to use can lo lac very next day he got high fever white watery stools and dehydrated and was admitted to hospital he was given neusobee in the hospital he started going green watery motions flushed face and rash all over body am was stopped and nestum was given he started going pasty yellow stools can neogain be given how will he have enough calcium since he does not take milk amino acid am is not available in market here the doctor advised him to give rice and bread I am afraid to give him any feed since his gut is damaged what to be given he is also anemic and he came out of hospital with a sore throat he was on antibiotics montox in 20 for days and probiotics and drops to be continued for 10 days",
        "input": "",
        "output": "hello I have gone through the elaborate history you have given you did not mention how you were feeding the baby meaning whether it was bottle feeding or spoon feeding generally if a baby is bottle fed there are high chances of infection due to contamination good hygiene should be maintained it is very unfortunate that the baby did not have breastfeeding the reason for frequent gi infection could be contamination and lactose intolerance you have changed formula feeds very frequently which should not have been done either you should go with a lactose formula like can or lactogen or a lactose free formula like nusobee or zero lac continue the one which the baby is compatible with as far as complimentary feeding is concerned that is rice you need to start it once baby is months old do not worry that the baby gut is damaged it repairs itself and adapts to the food or diet we give but takes some time start with liquids or soups later increase the consistency"
    },
    {
        "instruction": "hi doctor I am in sexual relationship with my wife since marriage for the past 100 days yesterday we both tested and identified that she is hiv positive and I am negative is there a high chance that the unprotected vaginal sex with hiv positive woman will result in hiv will it get cured in hiv window period am I safe if I am negative what I will do for pregnancy and kids in future if I become positive what I will do for the same above",
        "input": "",
        "output": "hi for further information consult a hiv aids specialist online"
    },
    {
        "instruction": "hi doctor I am married and have a child of two years I am five weeks pregnant now and I want to abort is it possible with pills or should I go for surgical abortion",
        "input": "",
        "output": "hello I understand your concern here completely for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hello doctor I have type diabetes I am 29 years old my height is 7 and weight is 58 keg 34 days back I gave blood tests my fasting blood sugar was 313 postprandial 599 hba1c 14 to 109 to 12 30 vitamin 6 and ash 29 after five days I consulted a doctor and he gave me medicines and asked me to get back for a checkup after having them the medicines he suggested were cobadex cos isryl m1 glyciphage so 500 my and teneligliptin tablets 20 my then again three days later my fasting blood sugar 89 postprandial 195 lipid profile total cholesterol 186 triglycerides 252 hel cholesterol 46 lil cholesterol 90 cholesterol hel ratio vldl cholesterol 50 and total lipids 624 then I took these medicines and took a test again after 17 days the result was blood sugar fasting 100 30 and postprandial 136 20 now I stopped medicines please advise me what should I do how do I increase my weight without affecting my diabetes what type of diet should I take please guide",
        "input": "",
        "output": "hello coming to your diabetic diet for further information consult a diabetologist online"
    },
    {
        "instruction": "hello doctor a little over two years ago I experienced some stress in my life that resulted in a high level of anxiety and depression I was prescribed pail and took it for one year at the time I was also taking divan and atenolol for hypertension pantoprazole for reflux and simvastatin for high cholesterol one positive side effect of the stress was that I lost 25 labs and went from 195 labs to 170 labs I also started to eat more healthy foods and started to exercise regularly one effect of my anxiety and depression is that I would awaken frequently during the night and morning between am and am and feel very agitated and get panic with upsetting thoughts over the past year or so I have managed to improve my condition with counseling meditation etc I am also no longer taking any medicine since my health dramatically improved I am at the point where I am doing well but still awaken very early about or am no matter when I go to bed I feel very anxious and my heart starts to pound I used to have bad thoughts but I have managed those and now just feel the physical feelings the thoughts diminish gradually throughout the day and seem to end at about am I am wondering whether I have a cortisol or adrenaline problem what are your thoughts regarding the same please guide",
        "input": "",
        "output": "hi have a thyearoid function test done first for given weight loss and heart pounding you should also consider seeing a primary care physician pop and have an electrocardiogram ekg done revert back with the details asked and to an endocrinologist online"
    },
    {
        "instruction": "hello doctor my years old baby is not yet walking properly while walking her body shakes and she fell down I started doing massage using ayurveda please suggest any remedy for my baby",
        "input": "",
        "output": "hi do not worry I read your query and understood your concern for further information consult an ayurveda specialist online"
    },
    {
        "instruction": "hi doctor I am 36 years old I cannot communicate with other people they say my conversation is weak boring and serious all the time I want to be a normal guy please guide",
        "input": "",
        "output": "hi for further information consult a psychologist counsellor online"
    },
    {
        "instruction": "hi doctor we had sex before days of her period she had a pill after 64 hours she got her periods but it has been continuing for six days what is the chance of pregnancy please help",
        "input": "",
        "output": "hello for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor I am 21 years old I am suffering from pimples and their dark spots what happens is one or two pimples appear and vanish in two to four days leaving dark spots behind the same thing repeats again and again now there is a lot of dark spots in my face I do not use oil in my hair and also avoid oily foods pimples contain something whitish what should I do please suggest",
        "input": "",
        "output": "hello I can understand your concern you need to take proper medicine for the treatment of pimples so that dark spots will not appear seborrhea or hormonal imbalance acne vulgaris with post inflammatory hyperpigmentation revert back after six weeks to a dermatologist online"
    },
    {
        "instruction": "hi doctor I am taking the following psychiatric medications oleptal it 300 0 encorate chrono 300 0 zipsydon 80 0 flunil 60 0 zapiz 5 provanol 10 and waklert 150 0 I feel lazy and have low libido tented forte is not working for me please modify my dosage so that I do not feel lazy and also recommend some libido improving medicine also I had epileptic fit last year due to excess of bupropion so 450 but since then I have no fit my main problem is laziness so please adjust the dose accordingly thank you",
        "input": "",
        "output": "hello for further information consult a psychiatrist online"
    },
    {
        "instruction": "hi doctor I am suffering from crohn disease and would like to try nutrigain please advice if there are any side effects",
        "input": "",
        "output": "hello for further information consult a medical gastroenterologist online"
    },
    {
        "instruction": "hi doctor I am 25 years old I was diagnosed with vaginal yeast infection a week ago and immediately started my medication it includes oral gel and vaginal pessaries it was six days long course even though the symptoms vanished in less than a day I did not stop taking the medication today my boyfriend came back who generally stays abroad due to work the sex was painful and uncomfortable hence scared and I did not go ahead with it this is the first time I am facing problem down there I drink more than liters of water every day and avoid using common toilet as I live alone no family member sharing my house toilet as well a gynecologist did an internal checkup and found some white cottage cheesy colored discharge inside none of it ever came out in the panty is there any reason to alarm",
        "input": "",
        "output": "hi normally treatment for vaginal yeast infection is given to both patient and sexual partner to prevent reinfection so your partner also needs to take treatment simultaneously what you can do now is you both can take tablet foran 150 my fluconazole single dose to prevent recurrence regarding your symptoms those are likely to be due to inadequate lubrication you can increase amount of foreplay to increase lubrication if it still hurts then use some lubricant like paraffin oil for further information consult an obstetrician and gynaecologist online"
    },
    {
        "instruction": "hi doctor my present ultrasound is showing mild hydrocephalus with breech presentation 36 weeks dilated 13 my ventricle no genetic disorder reported earlier done in second trimester all the previous ultrasound showed normal and sound growth of fetus reports attached for your reference thank you",
        "input": "",
        "output": "hello antenatal infection mri brain and spine ultrasound abdomen and ad echo echocardiogram of the heart karyotype surgery if required revert back after mri to a paediatric surgeon online"
    },
    {
        "instruction": "hi doctor four days ago I visited a tattoo shop it is a small one and I think he will do only temporary ones suddenly I got a hit on the backside of my right thumb I stopped him as he did not change the needle little piercing was done till my epidermis of skin I am scared what should I do now",
        "input": "",
        "output": "hi for further doubts consult a hiv aids specialist online"
    },
    {
        "instruction": "hello doctor I am suffering from vocal folds swelling I feel my voice is too low local ent specialist advised me to take steam through mouth please help me out",
        "input": "",
        "output": "hi take plenty of fluid intake orally take absolute voice rest have steam inhalation take capsule rabeprazole 20 my once a day avoid spicy and fried foods avoid frequent throat cleaning avoid shouting screaming whispering and lengthy conversation for further information consult an ent otolaryngologist online"
    },
    {
        "instruction": "hi doctor I am having indigestion and vomiting since one month it is not frequent but twice or thrice in a week when I am having my dinner after eating half of the meals I feel some air in my stomach and suddenly vomit everything I am having this issue in the morning too when I wake up I feel my stomach is full indigestion is also there please suggest me some medicine thank you",
        "input": "",
        "output": "hello it is usually due to changes in the oh of the stomach and changed secretions including hydrochloric acid go for some tests and upload the reports other causes may be a gross pathology of the gastrointestinal tract most probably in the upper gi tract for that an endoscopic examination is mandatory to rule it out h pyloric helicobacter pyloric screening test esophagogastroduodenoscopy end you need to consult a gastroenterologist for thorough evaluation and management he will go for end ask your physician for prescription of dexilant dexlansoprazole twice before meals and itopride thrice a day before meals take citrucel methylcellulose dietary fiber supplement with plenty of water take bland diet and avoid spicy hot and sour meals fast and fried food revert back with the investigation reports to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I am 32 weeks pregnant I am having pain on the right side of my face I have one half erupted wisdom tooth could it be the reason",
        "input": "",
        "output": "hi for further information consult a dentist online"
    },
    {
        "instruction": "hi doctor I am a 69 year old retired internist I am not taking any regular medication other than aspirin 325 my I have no known allergies and have never smoked I do not have any medical history of thyearoid disease autoimmune diseases or paget disease around four to five weeks back I noted the onset of an intermittent occasional episode of either a high pitched ringing sound in the right ear or low pitched humming in the left ear I do not recall if they occurred at the same time although they might have each episode lasted for 10 to 20 seconds before abating spontaneously there was no associated vertigo or hearing changes last evening I noted the onset of the ringing noise in the right ear remained for 20 seconds as it began to abate the lower pitched humming noise began in the left ear and has remained since this was associated with a sensation of fullness pressure and slight muffled hearing in my left ear the humming is constant and non pulsatile it is not positional and there is no vertigo I do have a history of taj disorder and it seems that when I open my jaw fully the noise increases in volume I also noted last evening when I yawned deeply the right ear ringing noise appeared for a few seconds at times the humming noise reduces in intensity spontaneously for a few seconds this morning I also noted some fullness in my right ear with a crackling noise when swallowing I recently had an acute sinusitis that resolved after five weeks although there was no ear involvement I have been under stress and have not been sleeping well I have checked my blood pressure at various times during this episode all results are quite normal I had a complete physical examination two weeks ago with full blood panels all were quite normal please help",
        "input": "",
        "output": "hello what you are suffering from is known as tinnitus it is not a disease itself rather a symptom due to various underlying causes like age related hypertension impacted wax fluid in middle ear patulous eustachian tube tmjd temperomandibular joint disorder hyperthyearoidism etc but as you have mentioned you are not suffering from any hearing loss vertigo and your blood pressure is also within normal limit and considering the characteristics of tinnitus it is mostly due to eustachian tube defect aspirin intake also causes and aggravates tinnitus so first do not worry and do a valsalva maneuver 20 to 30 times a day the procedure of which you can get in youtube then take steam three times a day get a pta pure tone audiometry and a tympanogram pta tympanogram end eustachian tube dysfunction valsalva maneuver steam inhalation mecobalamin methylcobalamin 5 my once daily ginkgo biloba one capsule once a day revert back with the investigation reports to an ent otolaryngologist online"
    },
    {
        "instruction": "hi doctor I have right arm elbow pain for few days now I play table tennis and cricket I got the pain after playing to for longer duration do you suggest me to take ray please guide with some medication",
        "input": "",
        "output": "hi for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hi doctor I have several spots on my penis from my childhood sometimes when I masturbate few times in a day it gets rip and start to hurt as I am going to be married soon I would like to get rid of these first",
        "input": "",
        "output": "hi before giving you a solution I would like to get answer for the following questions revert back with the answers to a dermatologist online"
    },
    {
        "instruction": "hi doctor my father is an alcoholic he has not been eating for the last 15 days he is now suffering from insomnia he is able to see abnormal things like people standing near to him he has lost weight he is having heavy sweat at night on the forehead his tongue twists and has shivering hands his height is 8 and weight is 62 keg what is the problem with him now",
        "input": "",
        "output": "hi sorry for your father condition if I am your doctor then I would like to treat you in the following way for further information consult an internal medicine physician online"
    },
    {
        "instruction": "hello doctor I am 31 years old I have two small affected areas on my penis head and it is not going away they get dry as they regrow and sometimes I peel off the dry part using a nail cutter I am really concerned about this it is not smooth as it used to be I am going to attach photos for your reference",
        "input": "",
        "output": "hi I have read your question and I have also reviewed the images these are most likely warts or condyloma acuminata which is an infection caused by human papilloma virus hav the infection is usually acquired by sexual contact with an infected sexual partner are you sexually active hav infection human papilloma virus genital warts electrocautery or radiofrequency ablation revert back with the detailed history to a dermatologist online"
    },
    {
        "instruction": "hello doctor I am currently seeking help and I do not know how to go about it I am a 17 year old ex mental patient I stayed in rehabilitation center multiple times and due to it causing health problems I have been off all medicines for the past three months it went out of hand now with my paranoia I am not sleeping at all and when I do they are only short naps during the day when it is light outside the dark and night terrify me I have bad depression and serious anxiety I am still waiting for a diagnosis for me at night time seeing and hearing becomes so bad I am physically breaking down and emotionally unstable till the sun comes up and I really need help I have not had proper sleep for a month if I do manage to sleep my sleep paralysis is worse than ever I am so scared to see and hear things I am deathly anxious jumpy and constantly reduced to tears this cannot go on and I do not know what to do I fear to tell my mother as she will over panic and take me to rehabilitation center again I do not feel suicidal currently so no use for rehab at the moment I just need to know the problem and solution should I seek out more serious help please help me",
        "input": "",
        "output": "hi I see that you are facing many issues at the moment it must be very difficult for you to deal with all these at once and you are still holding on bravely it is certainly very courageous of you as you are seeing and hearing things and you have mentioned that you are also having paranoid thoughts these symptoms point towards a diagnosis of paranoid schizophrenia you have also not been taking any medicines for the past three months and it may have worsened the condition the auditory and visual hallucinations that you are having are results of imbalances in the neurotransmitters which are chemicals in our brain helping us to think and function the medications normalize their levels and help you focus on necessary tasks since you have been diagnosed with borderline personality disorder bpd depression and anxiety disorder it will be very helpful for you to start medications for the symptoms you have mentioned in your query for that you must consult either your go or psychiatrist directly in your condition the role of counseling will be amplified only once you are able to do away with the paranoid thoughts and hallucinations schizophrenia bpd depression anxiety disorder prescribed medicines cognitive behavior therapy meditation for further information consult a psychologist counsellor online"
    },
    {
        "instruction": "hi doctor I fell on a wooden set of stairs last night and landed mostly on my right lower back from the morning I feel like someone is squeezing my kidney every time I move the pain is even more severe when I move my right leg I do not see any blood in my urine and I do not want to go all the way to the er for them to tell me nothing is wrong what shall I do my leg does not hurt but I can still feel the pain when I am not moving my leg but it increases dramatically when I do my pain is only on my lower right back please help",
        "input": "",
        "output": "hi I feel sorry to hear this muscle injury bone injury ideal tuberosity or coccyx injury ray pelvis anteroposterior view take painkillers and muscle relaxants like a combination of diclofenac paracetamol and chlorzoxazone along with pantoprazole do not take these medications if you are in early pregnancy consult your doctor discuss with him her and take the medicine with consent revert back after three days to an internal medicine physician online"
    },
    {
        "instruction": "hi doctor my mother is 57 years old she has red patches and dark spots in the bottom of the foot it itches most of the time many doctors we have consulted but no positive result from their treatment please suggest the best medication",
        "input": "",
        "output": "hi revert back with the details to a dermatologist online"
    },
    {
        "instruction": "hi doctor my 18 month old daughter has had problems since birth and I am desperate for a second opinion the history is complicated trying to explain the symptoms but I will do my best it was detected polyhydramnios in pregnancy my daughter born at 36 weeks days through emergency section due to pre eclampsia her weight was 3070g no tube passed three times due to polyhydramnios we went home on day two readmitted on day five for phototherapy till months of age several visits with health visitor and go for colic like symptoms and constipation she will scream in pain which opening her bowel and only opening her bowels every four to five days over this time they tried colief infacol lactulose glycerin suppositories ranitidine gaviscon and domperidone nine different formulas and we also tried all common natural remedies for reflux like keeping upright after feeding etc no alleviation of symptoms at all with exception of glycerin suppositories which did seem to help the constipation in months pediatric consultant suggests functional constipation and recommends higher dose of lactulose and movicol for 16 weeks he suggested that we are giving her too many glycerin suppositories and that is making her dependent on glycerin to open her bowels and so glycerin was stopped we delayed weaning whilst waiting for appointment at this point her symptoms completely changed to intermittent diarrhea and constipation bowel frequency increased to once a day colic like pain and she does not start vomiting until the consistency of the food moves up to a more solid consistency the laxatives made absolutely no difference in her 10 months of age the constipation has turned to diarrhea the doctor is happy that it was functional constipation and discharged her at months she had first acute episode of chronic diarrhea and forceful vomiting lasted for 16 days which coincides with the introduction of cow milk during 14 months of age she was introduced to solid food chronic forceful vomiting which does not seem to follow any pattern a food diary is followed for several weeks and there does not seem to be any consistent non ice allergy as a cause during her 14 months of age we had an appointment with dietician and switched from normal formula to pepsi and then neocate her chronic wheeze disappears overnight but chronic vomiting continues she troubleshoot overfeeding as a cause we are feeding her more as she is vomiting when we did not substitute the feeds she lost weight so if she vomited a feed we gave her another one hour later we fed her small quantities throughout the day to try and prevent vomiting again in 15 months consulted her dietician and he suggested definite non ice cow milk protein allergy and to try trial and error with other three common allergies soy wheat and dairy so then for a month we followed strict elimination of those three this month she had only neocate liquid diet plus corn snacks organix and one paella meal symptoms improved but sporadic forceful vomiting remains she tolerated only one baby paella meal well which is overcooked rice very mushy consistency now again we attempted to challenge the three foods back in and move beyond this one meal all attempts were failed her reaction to us seems to be much more about the consistency of the food rather than what the food is she can tolerate a large amount of breadcrumbs but cannot tolerate a piece of toast we continue with food diary and there really is no clear pattern which isolates one food again in her 17 months age when we consulted her dietician he was unsure whether the symptoms fit flies at all and suggests gastro referral then she had second acute episode we went a and on day five and was sent home with suggestion of gastroenteritis chronic vomiting and diarrhea lasted 15 days she lost 10 of her body weight sent home on neocate as the only diet but there is no evidence of gagging choking or problem swallowing no fussing or wriggling during feeding four months back her weight was 12 keg and now 10 keg her barium ray showed mild malrotation but at met it was decided this was not explanation of symptoms we have recently tried omeprazole to rule out severe reflux and it made no change genetic blood tests kidney and abdominal ultrasound were normal for us her symptoms now are identical to what they were like before the onset of weaning again she is suffering from intermittent colic pain and constipation but there is no vomiting she is not sleeping well at all we have increased her water intake and added lactulose and the stools are no longer hard but she still seems uncomfortable stools are very dark green we have tried a couple of solids she prefers crunchy food she tolerates corn based crisps as they basically dissolve into crumbs into your mouth we tried peas grapes and she passed all of the peas grapes and beans completely undigested in her feces without solids she does not sleep well at all because the neocate just does not fill her up for long enough and so she is screaming all night because she is hungry so we tried a few solids and she is still screaming half the night with colic like pain she is clearly in pain because she is absolutely screaming she is pretty inconsolable but the only thing that does relieve it is sucking on something like a bottle of water she is waking up about every 20 to 30 minutes throughout the night during the day she still has this colic like symptoms and she is tired and clingy and uninterested in playing she does tend to have one to two hours a day of good time where she will play happily one month back we had consultation with slt her elder sister is under slt",
        "input": "",
        "output": "hi hirschsprung disease cmpa barium enema study continue on same diet till further plan revert back with the previous investigation reports to a paediatrician online"
    },
    {
        "instruction": "hi doctor I have a reddish rash on my inner thigh since months I have attached a picture for your reference it is annoying me a lot please help",
        "input": "",
        "output": "hi I have reviewed the attached photographs attachments removed to protect patient identity according to me you are affected by ringworm infection I would recommend you to take tablet terbinafine 250 my once daily and apply sertaconazole cream on the affected area twice daily continue this for three weeks and revert back you will definitely notice some improvement but do not stop the medicine on your own as recurrence is the most common issue with this condition for itching take tablet levocetirizine my once or twice daily depending on the intensity of itching besides this keep the area as dry as possible avoid sharing of soap and towel wear loose cotton clothes and stay in cool and airy environment ringworm tina cruris revert back after three weeks to a dermatologist online"
    }
]