[{
  "instruction": "My daughter ( F, 18 y\/o, 5'5', 165lbs) has been feeling poorly for a 6-8 months. She had COVID a couple of months ago and symptoms have are much worse in the last month or so. Symptoms seem POTS-like. She feels light headed, breathless, dizzy, HR goes from ~65 lying down to ~155-160 on standing. Today she tells me HR has been around 170 all day and she feels really lousy. (She using an OTC pulse ox to measure.) She has a cardiology appt but not until March and a PCP appt but not until April since she's at school and it's a new provider. What to do? Is this a on call nurse sort of issue? Or a trip to the ED? Or wait till tomorrow and try for an early appt? Try a couple of Valsalvas? Wait it out until her cardio appt? Or? She's away at school if Boston, what to do? Thank you",
  "input": "",
  "output": "If she actually has a HR of 170 that is accurate, ongoing and persistent, she needs to be seen in the ED immediately."
},
{
  "instruction": "Im a 37 y.o. transgender man with pre-diabetes and high cholesterol\/triglycerides. I had chest pain and dizziness several months ago and went to cardiology for tests. Stress echo was normal, though the symptoms were still made worse with the exercise. I was sent for a CT scan with contrast. No blockages or abnormalities. They did find a small hiatal hernia. I asked if that could cause chest pain and they reluctantly admitted that it could. I say reluctantly because despite my results being normal, she wanted to put me on a stronger statin. Ive been on statins for years and it has impaired my glucose tolerance. Rather than go on Metformin, I opted to go on strict low carb diet, monitor my glucose and lots of walking. Ive done that for two years and Im almost back in to anormal A1C. Ive worked very hard. I also switched from Simvastatin to Pravastatin. The latter has some preliminary findings suggesting it doesn't effect glucose tolerance as strongly. One of the worst statins for this...is Crestor. The cardiac nurse is convinced that I need to be on it. So I tried it for a month and surprise - my glucose is impaired again. (Morning was usually 160 at worst, two days ago it was 300. My diet has not changed.) I said no thanks to the Crestor and asked to be put back on Pravastatin. Nurse was really pushing back saying its still worth the risk because my cholesterol was too high on the Pravastin. I agreed to double my dose of it until we sort out this dispute. I get a call today from the cardiologist resident who was approached by the RN about my refusal to take Crestor. I get the same spiel about how its worth the risk. I explain patiently that A) I show no signs of heart disease. B)that my chest pain was very likely the hiatal hernia (which will be addressed separately)C) That although I understand their logic, I have worked very hard to keep my Diabetes controlled without Metformin. The common side effects of which (fecal incontinence and nausea) Ive seen with my sister and would very much like to avoid. Cardio Resident says she will \"consult Endocrinology but they will likely say the same thing\". Add to this that Im on Testosterone Cypionate , which she says can cause the triglycerides to read high. I told her to make sure she mentions this when she talks to the Endo. I feel like I am being forced onto a medication that I dont consent to. Here are my questions: 1) could Testosterone cypionate cause a false high reading of triglycerides on a blood test? 2) Am I being foolish in my refusal of the more aggressive statin? 3)Are there other options I am not seeing?",
  "input": "",
  "output": "How high is your cholesterol? Since youre only 37 and they are pushing statins pretty hard, I would assume that your cholesterol sucks and you almost certainly should be on atorvastatin or rosuvastatin if it is being recommended by two cardiology providers. Small hiatal hernias do not generally cause chest pain, and for sure do not cause dizziness. If your chest pain was worse with exercise, its concerning for micro vascular disease, with a normal CT.Overall while statins do increase glucose intolerance, they overall have a net benefit in decreasing risk of heart attack and stroke. While your glucose numbers may change, its less about the glucose numbers and more about reducing downstream effects.It is kind of silly frankly to avoid metformin without knowing if youll have GI side effects or not. You likely will unfortunately need metformin in the future, statin or not, and if you dont tolerate metformin there are other alternatives out there such as GLP-1 agonists and SGLT-2 inhibitors that also help with cardiovascular risk."
},
{
  "instruction": "Male 35 physically active no issues before non smokerRecently my entire body swelled up like edema was in the hospital CK level super high but leveled out and started attacking itself over the last year I've gone to every doctor possible. My body is losing skeletal muscle mass and spams for the last year with no clear answers. I'm swimming in all my clothes and no matter what I do nothing helps. Excessive exhaustion and sweating as well.Went to cardiologist but she was vague on my test and scheduled a ct was wondering if anyone had suggestions after echo and ekg were negativeI've been to go a rheumatologist, neurologist, etc and no one has answers for what's going onThis is the latest from my cardiologist but if anyone else has ideas pleaseRAC sign is present, suggestive of anomalous coronary circulation with retroaortic course.",
  "input": "",
  "output": "Wish you the best, really with this the only way anybody could provide any sort of advice would be a review of complete medical records and all lab findings"
},
{
  "instruction": "Appreciate it al labs have come back completely negative only thing that's been consistently elevated but wasn't that much of a concern was CK levels everything else you could think of from any type of test normal",
  "input": "",
  "output": "again, really need complete work up and medical notes to provide any insight here"
},
{
  "instruction": "32F, 130-140lbs, have asthma and history of postpartum preeclampsia. Former cigarette smoker, currently vapes nicotine.ECG in comments.Ive been feeling huge thumps in my chest, several times a minute. Called 911 a few days ago because I wasnt sure if I was going to keel over, have never felt this before, and was scared. EMT thought I was in AFIB. ER doctor says no, just PVCs and to reduce my stress, stop vaping and limit caffeine. That these are harmless and I dont need to worry.Sometimes I feel lightly dizzy when it happens. I notice them when Im falling asleep. I notice them just sitting here, and the last few minutes, Ive been feeling big thumps pretty much every 15-20 seconds. Theres no way thats normal right?Can someone tell me if I need to ask my PCP for a referral to cardiology? Or tell me what youre seeing? This is truthfully scary to me and so uncomfortable.",
  "input": "",
  "output": "Normal sinus rhythm with a PVC. Not concerning."
},
{
  "instruction": "33F 144lb 55 ex-smoker x13yrs quit 2018 non-drinker Dx GPA with kidney\/sinus\/joint\/skin involvement 2002, CKD2, chronic migraine with aura, SVT ablation 2017 dual AV node, sepsis 2018 from PID due to improperly placed IUD, dysautonomia (dx recently from tilt table test), Sjogrens, hospitalized in November for hypoglycaemia (glucose 2.7) still being worked up by endo but symptoms resolved after Rituxan so they are thinking autoimmune hypoglycaemia  Im not going to list everything because its just depressing and not relevant. Basically a big mix of autoimmune disorders and premature degenerative conditions related to treatment for GPA Currently taking ..Rituxan infusions every 6 months, next one in a couple of weeksPlaquenilLipitorZoloftWellbutrinGabapentinCyclobenzabrineEltroxinVyvanseZopicloneDomperidoneZofranTopiramateOxycodoneTriptans for migrainesSome PRNs Im forgettingSo I just want to know if this ECG is normal. Ive never gotten any alerts for Afib on my Apple Watch before and today during a particularly brutal migraine with lots of dry heaving, I got a few alerts (this ecg isnt of the Afib ones). If you move the sensor, you can get different lead ECG readings (according to my cardiology nurse). I placed the sensor over V2 (I had to look that up) to get this reading and the big dip after the QRS complex (also had to look that up) looks off to me when I compare it to the normal image on Google. Is this something I should be concerned about? Migraine has started to abate but I feel weird. Heart was pounding in throat the whole time, especially when on my side. Some shortness of breath. Mostly feeling better now.Thanks for your time, help (hopefully) putting my mind at ease and teaching me something in the process :)Edit - also, not sure if relevant but I got my 5th COVID vaccine (the bivalent Pfizer one) on Mondayhttps:\/\/i.imgur.com\/mA1T0Vz.jpg",
  "input": "",
  "output": "EKG interpretation requires a very comprehensive understanding of cardiac electrophysiology, anatomy, and pathological processes, including the mechanisms that various arrhythmias, ischemia, and, in your particular case, previous procedures\/ablations have on these functions. Without attempting to delve into the \"why's and how's\" of what these very complex squiggles mean, the short answer to your question is yes: inverted T waves in lead V2 can be completely normal in many individuals (that \"dip\" you're referring to after the QRS is the T-wave, and inverted just means that it's flipped upside down)."
},
{
  "instruction": "Thank you so much for the education :)",
  "input": "",
  "output": "Did you place the back of the watch on your chest (in the V2 lead position) and then touch the crown with your finger to get this? If so, then the inverted T wave you are concerned about would not be a valid finding. The voltages in the precordial (V) leads in a 12 lead EKG are measured in relation to the average of the 4 limb leads, not just one arm which the watch is doing. EKG tracings from Apple Watches are good for determining heart rhythms but not much else."
},
{
  "instruction": "Thats exactly what I did. I was told you could use it on that area and even on the ankle to replicate different ECG (EKG?) leads. Thank you for the info!! Phew!",
  "input": "",
  "output": "It would be theoretically possible to get a tracing with accurate wave morphology between 2 limbs with an Apple Watch, but it could be inverted if the polarity is switched. Please dont try this though, it can only serve to stress you out more. As long as the watch says sinus rhythm, you are probably good. Ask your physician for a standard EKG is you are concerned."
},
{
  "instruction": "I appreciate you geeking out with me explaining the technology moreI find all of this stuff so fascinating. I got 6 Afib alerts today but I read there are a lot of false positives, especially with younger people. Will go get a full 12 lead to make sure. Thanks again!",
  "input": "",
  "output": "Did the watch say an EKG tracing you performed showed afib or was it from monitoring from the heart rate sensor?"
},
{
  "instruction": "An EKG I performed while having palpitations showed Afib, which is why I started trying to get different lead readings  was trying to see if it was a fluke or not and get as much info for cardio if necessary (Holters suck). Didnt happen consistently when performing recordings back to backsome would say it detected Afib and others sinus.",
  "input": "",
  "output": "Thats a bit concerning. Be sure to show those EKG tracings to your cardiologist.Many of the medications you list can can affect heart rhythm and interact with each other. The Vyvanse particularly would not be good to take if there is a question of atrial fibrillation."
},
{
  "instruction": "I think its long QT? Something QT? Pharmacist mentioned that I was on a lot that increased that risk so Ive been careful with the domperidone and zofran but I had to take both today. In your opinion, are there any meds you would cut? Other than the Oxycodone - I have a plan for that. I know you dont know my full medical history but I would love to eliminate some of these meds. Are there any redundant ones? Ones that work against another one? I wont take what you say as medical advice and discontinue meds or anything - just curious what another doctor would say. Appreciate it!Edit - and stopping Vyvanse for now until I talk to cardio is probably the best. I dont take it every day anyways",
  "input": "",
  "output": "No way I can address something this complex and nuanced in this forum. Please discuss this with your personal physician."
},
{
  "instruction": "Thank you for the advice! We havent thought about pheochromocytoma. It does seem to line up. How does that get diagnosed? The website I was reading just a minute ago said a 24-hour urine test which she did when her GI doctor wanted to test for carcinoid syndrome\/neuroendocrine tumors with a 5-HIAA urine test. I think they were only testing 5-HIAA though and not anything else so not sure if thats what they test for when checking for pheochromocytoma. Shes also had a kidney ultrasound and two abdominal (including kidneys) CT scans with contrast. Would they have shown up on those or is it one of those things they have to be specifically looking for?Shes reached out for therapy. She actually is a counselor herself so we tend to think she had the proper coping skills herself but as time has gone on with this, she has reached out to former colleagues, specifically to try to schedule EMDR therapy which has been very helpful for her in the past.The tricky part with it being related to anything COVID-related is she's never actually tested positive for COVID. So we don't know that she's had it even though when she searches for others dealing with her symptoms on reddit, it often takes her to posts in the covid longhaulers subreddit.",
  "input": "",
  "output": "5-HIAA testing is for carcinoid syndrome, not pheo"
},
{
  "instruction": "I would test Seum Copper levels and Zinc. Copper deficiency can cause peripheral neuropathy, histamine intolerance (copper is a cofactor of DAO), dysautonomia (copper is a cofactor of DBH, required to convert dopamine to norepinephrine), EKG abnormalities.Copper deficiency can be caused by zinc toxicity, and zinc has become a very popular supplement \"to prevent\" COVID. Too much zinc supplementation without Copper can lead to copper deficiency.We havent looked into that. She doesnt take any zinc supplements so were not sure what would cause her to have copper deficiency or zinc toxicity. Well write it down to mention to her PCP at her next appointment.She has been checked for carcinoid syndrome. Her GI doctor suggested it and she had both the CgA blood test and 24-hour urine 5-HIAA test that luckily both came back in normal range.",
  "input": "",
  "output": "I agree with another poster - she needs to have a PCP that can consolidate her information and testing to help you guide where to go next. I think you keeping this list is fantastic to help you advocate for yourselves.There are a few things here:The white plaques found on the colonoscopy Spring 2021 is of very high interest especially given that the cause was not determined. Was it ever biopsied? It may be worth another repeat C-scope because it sounds like the most recent direct visualization was an EGD. Low grade colitis from inflammatory bowel disease doesnt always show up on a CT scan.I also think her autoimmune workup is incomplete from the blood work listed. In addition to this, viral illnesses (such as the one she had in 2019 that may or may not have been COVID) often can trigger the beginning of an autoimmune condition. The blood work ANA and RF is by no means comprehensive. Why was an RF checked? Was she having joint pain as well? With a family history, autoimmune conditions are very high on my listnose symptoms, lung symptoms, microscopic hematuria, peripheral nervous system issues beings up differentials including: GPA (granulomatosis with polyangitis previously known as Wegeners Granulomatosis) and Anti-GBM (Goodpasture) Disease which are autoimmune vasculitisI would recommend checking for vasculitis: ESR, CRP, C3\/4, ANCA, Anti-GBM, cryoglobulinsOther autoimmune conditions can manifest with GI issues too - there is a lot of overlap. Whether she has joint pain or not, I would check CCP, HLA B27, Sjogren panelSystemic scleroderma is a possibility too which would include Anti-Scl70 labsIf she has joint pain, a synovial ultrasound of the hands \/ feet may find active joint or tendon inflammation which would support an inflammatory condition as well.I hope this information can help bring your wife some answers and hopefully treatment"
},
{
  "instruction": "I greatly appreciate this response as its extremely informative!The white plaques were never followed up on unfortunately. Her blood in her stool cleared up shortly after so she let it go.I definitely agree with you on the autoimmune thoughts. I had no idea there were so much more to test for. What kind of specialist would she see who would run those kinds of tests and how does she approach it with that doctor? Just tell them she wants to be tested for everything?",
  "input": "",
  "output": "A lot of those blood tests I mentioned any primary can order as well as the synovial ultrasound.Its hard to approach an MD about specific tests but I think its worth asking. It just depends on how you think your doctor is. I have patients ask me for specific tests pretty often and we just make a joint decision on if its worth it in shared decision making.As for which specialty? rheumatology and GI would be the ones in my opinion."
},
{
  "instruction": "Hey. I am male 24 Height 5:10 and weigh 87 kg. I don't drink or smoke. For a few months i have been suffering from left sided chest pain that radiates to my left arm and back. I also suffer from shortness of breath at times. I decided to get my lipid profile done and my cholesterol levels came back very high. I then decided to get Echo Cardiogram and Exercise Tolerance Test and some other blood work. Can you take a look at my reports. Thankshttps:\/\/imgur.com\/a\/SiBOG1Phttps:\/\/imgur.com\/a\/yKBhqsFhttps:\/\/imgur.com\/a\/aK6RuWchttps:\/\/imgur.com\/a\/IWwMi1vhttps:\/\/imgur.com\/a\/UaEOvP2",
  "input": "",
  "output": "The point of getting testing like this done is to go over it with a medical professional who can then make recommendations. The echo and stress test are normal, your cholesterol is too high. I'd suggest that you find a primary care doctor."
},
{
  "instruction": "I did. Was recommended to start statins but i am yet to start those. I wan't to see if the levels could be brought down by lifestyle and diet changes first. I just can't figure out why im experiencing the chest pain.",
  "input": "",
  "output": "That's a good thing to talk to your PCP about. GERD is a common cause of non-cardiac chest pain."
},
{
  "instruction": "35 yo female 5'7\" (170 cm) 180lbs (81.6kg) Caucasian and Native American I have previously had high blood pressure, but as of the last year or so my blood pressure has become very LOW for undetermined reasons, with my most recent reading being 101\/60Primary symptoms: Decreasing general health for the past ~3 years, primarily presenting as severe fatigue, syncope + nausea when overheated or standing up too quickly, needing a minimum of 10-12 hours of sleep every night to feel rested, general malaise.I have asthma, ADD, MDD. Drink occasionally; previous occasional smoker but quit ~5 years ago. Same for recreational drugs -- on occasion when I was younger, but none for at least 5 years. I had previously been diagnosed with Rheumatic Fever in 2015, which seems VERY relevant here, but every doctor I've tried to discuss it with brushes it off when I mention it.So, last month I finally got a referral to a cardiologist, after years of trying to get one, and I was given a heart monitor to wear at home for two weeks, and then on Dec 23rd I had an echocardiogram ultrasound done. After trying and failing to get ahold of them by phone, Friday I FINALLY received a letter in the mail with my results. The front page of that letter states that all my tests were normal, and no follow-up is needed.THEN, that same letter goes on to detail in the next few pages that I have a small left ventricle, sinus tachycardia with an average heartbeat ranging from 90-150 bpm, paradoxical septal motion, mild pulmonary valve regurgitation, a thickened mitral valve, mild mitral valve regurgitation, trivial tricuspid valve regurgitation, and then it states that my \"right ventricular systolic pressure could not be estimated due to inability to detect peak tricuspid regurgitation\" and that my pulmonary valve stats were also inconclusive due to \"poor visualization\".The \"inconclusives\" I suppose could go either way, and I don't know if those are something I should try to get more testing for to clear up or not. But the rest definitely does not sound \"normal\" to me, and based on a quick Google search most of those things seem to be more common in someone who has had previous cardiac surgery, which I have not, and\/or they usually go hand-in-hand with severe pulmonary hypertension, and as previously mentioned, my blood pressure has been consistently LOW, to the point of being almost abnormally so, for at least the past year.So, is there anyone who can confirm that all those abnormalities could be found, while still falling within the \"normal\" range of test results? Am I just reading too much into this, or am I right in thinking that my cardiologist didn't do his job properly, and a second opinion is needed?Update: Wow this really took off way more than I expected! I went to bed early last night, was busy with other stuff this morning, and then I'm American, so I have been thoroughly distracted by the absolute shitshow going on in DC ever since..., so I haven't logged on to Reddit to check back on responses until just now. Thank you to everyone for what looks like some very educated replies; I'm working my way through them and will try to respond more thoroughly tomorrow after a good night's (hopefully) sleep!",
  "input": "",
  "output": "Nearly all of the things youve described are seen on essentially every echo report. Trivial and trace and mild regurgitation are seen in one or more valves of (what I estimate to be) the vast majority of healthy people. The regurgitation is only really abnormal if its significant (moderate or severe). Its important to mention any at all, though, so the previous report can be compared to any future ones (among other reasons). The reason theres a lot of could not assess...poor visualization all over the report is because this was a transthoracic echo. If they need better visualization of those structures, they would need to do a transesophageal echo which is a really not-fun procedure which requires you to be sedated, and is usually reserved for people with high suspicion for infective endocarditis or severe cardiac disease involving the poorly visualized structures.The rest of the findings could be related to pulmonary arterial HTN, which youve already mentioned. PAH is not the same as hypertension in general. The lung circulation is separate from the systemic circulation (though obviously the two are connected) and PAH is usually due to changes in the lung structure or function. For example, COPD, pulmonary fibrosis (scarring in the lungs), or - my attendings personal favorite underdog in the world of heart\/lung issues - sleep apnea.The full report of any diagnostic study, like an echo, is always going to have something that doesnt sound completely normal in it - the wonderful world of incidental findings. Thats why its important to go by what the cardiologist or other ordering physician interprets from the echo. Its also why every diagnostic report has a disclaimer along the lines of correlate with clinical findings. In the context of your presentation, the echo that you had done was essentially normal. Its what my own echo report said despite results that could have been used to diagnose someone with heart failure with reduced ejection fraction had they been a 68 year old with blood pressure of 155\/100 for the past 25 years, extra heart sounds, and shortness of breath.Your echo was done, I presume, to look for rheumatic heart disease in the context of your clinical findings (which could be consistent with that, though its rare to get this from only having rheumatic fever once). These findings arent really consistent with RHD. The mitral valve is slightly thickened, which may be the result of the rheumatic fever, but the report does not show mitral stenosis (the expected consequence of RHD).What Id recommend doing is writing down the findings youve seen on the report, including your concerns about what they could mean, and other good questions youve asked in your post here (like about pulmonary artery hypertension, and the poor visualization of certain structures on the echo and how important these inconclusive findings would be to a diagnosis) and take them with you to the next appointment. Because your cardiologist has a more complete picture of your clinical presentation and other health info, they are the best person to help guide you through the report, why they do not feel this echo has shown the underlying problem, and the next steps to take.Best of luck to you, and thank you for the question! Echo reports are always confusing and concerning to many who arent aware that many of the abnormal findings are often normal variants, so this is a great post to discuss that with."
},
{
  "instruction": "Sorry for such a late reply, but the past few days have been a bit busy for me. Thank you for such a detailed response!So, the echo actually wasn't done specifically to look for Rheumatic heart disease -- that's just something I thought might be relevant or related to the problems I've been having. It was primarily done because I've been having these periodic attacks of such severe fatigue I can barely get out of bed, and when I do manage to get myself upright, I get out of breath and heart-poundy with even the slightest exertion, and am just generally extremely weak and disoriented -- I can't lift my arm over my head for more than a couple seconds, can't stay standing very long without sitting or leaning heavily on something, etc... and if I try to fight it and actually KEEP myself upright and moving around for more than a minute or two -- ie, to take a shower -- it quickly progresses to my heart feeling like it's gonna pound out of my chest, then nausea + room violently spinning, very rapidly followed by syncope. I'm not sure if it's full or partial syncope because I'm not sure if only being \"out\" for a few seconds or so qualifies as full syncope or just partial -- but I definitely black out briefly and collapse, and then spend awhile feeling violently sick and dizzy and shaky (and cold-sweaty) after I come back to. These \"attacks\" (episodes? Not really sure what to call them) come and go, but when they happen, they generally last about a week (roughly 3-4 days of being really bad, then another 3-4 days of recovery before I'm relatively back to normal again.) I've figured out that my Adderall prescription seemed to be a primary trigger for these attacks, so I've recently quit taking that altogether, and I'm hoping that will drastically reduce the attacks... but they've definitely happened at other times even without any triggers that I've been able to pinpoint, so it's not the Adderall that was CAUSING it (also it didn't happen every time I took the Adderall, which is why it took awhile to pinpoint that being a huge trigger) -- there's something underlying that's going on, and the Adderall just seemed to trigger whatever that \"something\" is. But I'm not sure what it is that triggers them other times.So, my cardiology workup was primarily to try to figure out what the hell is going on with me as far as all that. I was honestly really hoping the answers here would be along the lines of \"yes, something DEFINITELY got overlooked or mixed up, you need to call and insist on a follow-up appointment and let your doctor know he effed up and x, y, and z needs to be immediately looked into further\". I mean I'm not looking for a malpractice suit or anything, I understand mistakes can happen... but I just really wanted to hear that it WAS a mistake, because I'm SO. FED. UP. with these goddamn symptoms.I have been in and out of doctor appointments CONSTANTLY for three years now. And I haven't been able to work for those three years because jobs just fire me for having to call in too often. And despite three years of endless appointments and efforts, I feel like I'm still no closer to having any answers... so I was REALLY hoping this would finally provide some. I would rather have an upsetting diagnosis at this point, than continue having NO diagnosis at all. Knowing what IS wrong would be so much more useful than just knowing one more thing that isn't -- once I know what IS wrong, I can actually get a treatment plan going for it, and maybe I can finally start getting my life back on track. I used to be super active -- worked full-time in a restaurant, on my feet running around 40 hours a week; spent my free time riding bikes, hiking, and gardening, as much as possible... and now I can barely do any of that. Very short hikes, small amounts of gardening... but none of the rest. I want my life back.Or worst case scenario, with a diagnosis I could at least apply for disability, if getting my life back isn't an option, and have some meager bit of income again, anyway. I could start processing the fact that getting my life back close to where it was before just isn't gonna happen, and deal with that, instead of holding out some hope of being able to be \"fixed\" -- at least somewhat -- once I finally know what's wrong. With answers, I could at least do SOMETHING. With no answers, my life just stays in this shitty limbo indefinitely. And I really, really thought this was going to be what finally gave me some answers. It 100% FEELS like it's my heart that's the root of my problems... and I was even about 2\/3rds through one of the attack weeks when I had the echo done, so I thought for sure it would show something while I was right in the midst of it, especially. So I just can't wrap my head around how everything could be \"basically normal.\"I suppose that all wasn't exactly clear in my \"symptoms\" summary -- I was just trying to rush through and get to the echo results, and didn't really feel like typing out the whole story -- so I just figured \"fatigue\/syncope\/malaise\" would cover the gist of it.I do really appreciate your response, though... I just wish it was what I actually wanted to hear. I just don't know how much more I can take of hearing \"nothing seems to be wrong\" when something is so obviously, seriously wrong. I know it's not psychosomatic; any doctor who tried to tell me it's \"anxiety and\/or depression\" would probably find themself in possession of a brand new, shiny, second asshole by the time I was done with them... but this never-ending lack of answers does sometimes make me wonder if I'm going crazy. It feels like I'm being gaslit -- but by medical science, not by a person.",
  "input": "",
  "output": "Hello. I'm not a native English speaker so the terms \"mild\" or \"moderate\" got me a little confused at first. The medical student and the cardiologist gave a very good explanation as to why those are really normal findings, those are normal findings in my country as well. Still heart rate isn't normal, and symptoms persist so there is still a problem. Now we now it isn't in the heart. I also think that the rheumatoid fever isn't something to be worried of there was only one event, the echocardiogram findings demonstrate mitral valve thicken but not an stenosis, I agree with the rest and think that is not a problem. There are not-doctors that are thinking about POTS\/dysautonomy, I came here to tell them they are not crazy, I also suspect that. However dysautonomy is diagnosed by discarding other illnesses, and with only the findings of an echocardiogram it cannot be diagnosed. I would ask with internal medicine for a second opinion and more tests, first you have to discard hypothyroidism (not likely), adrenal dysfunction and endocrine dysfunctions. The recommendations to better your symptoms are drinking more water, change positions slowly: if you are in crouch position stand up as slowly as you can, from laying down sit before you stand up. Try doing some non impact exercise (not a good idea: weight lifting, running, crossfit). Hope you get better and find some answers. Stay safe"
},
{
  "instruction": "48 year old female 54 normal weight female. Went to the ER for chest pains on the left side that were consistent for about two months and have since subsided in the ER had a normal chest CAT scan with contrast. Low anion Gap. I was just looking back at bloodwork from ER visit in December and noticed Anion Gap was 1\/mol\/L but Albumin was normal 3.9 and total protein normal 7.2. The Dr didn't mention this to me. And just saw this now. So worried about Multiple Myeloma now. My sodium was low 131 and SGPT (ALT) was low 12. The only thing they mentioned was elevated Hgb 15.5 and Het 46.3% but said nothing to worry about. Can anyone give their opinion. Ive also been to the gastroenterologist and cardiologist, upper endoscopy and colonoscopy normal and all cardiology tests were clear just showed some palpitations upon exertion.",
  "input": "",
  "output": "Multiple myeloma usually has high calcium, kidney disease, anemia (low blood count) and bone disease. You mentioned none of those. Low anion gap is hardly used in the emergency setting, and usually will need retesting if blood to see if it was a one time occurrence."
},
{
  "instruction": "Thank you for the response. Several months ago I did have elevated calcium but have been retested two times and calcium was normal. I was taking a lot of gas x and alka seltzer for the chest pain that I had gone in for.Also had bloodwork three weeks prior and anion gap and albumin and globulin were normal. Would that change so fast?",
  "input": "",
  "output": "Anion gap is calculated by (sodium + potassium) - (bicarbonate and chloride). Most of the time when it is reported as low it is because there is slight variation in these factors from any random blood sample leading it to be falsely low. This is why they usually repeat it, and usually it normalizes."
},
{
  "instruction": "8F, 78lbs, no medication. She was in the hospital for a long time but they discharged her. She is still in pain, please help. I attached the notes of her discharge.The patient is an 8-year-old white female with five weeks of fever, rash, arthralgias. Last month, the patient noted foot pain involving both left and right feet, as well as a blotchy pink rash on the leg that proceeded to spread to the trunk and then arms and then face during that week. The patient had low-grade fevers with temps to a max of 101. This has progressed to the week prior to admission higher fevers with T-max of 103.5. The patient has endorsed muscle pain, particularly in the right leg and arm, and PMD had seen the patient this week noted right knee and right index finger swelling. There is no noted weight change over this time period. No noted diarrhea or swollen nodes. The rash the patient described the week prior had an acute abrupt onset and 5-10 minutes later would dissipate.Rheumatology was consulted on the patient from admission. Lab studies were sent to rule-out an infectious etiology for rash. Strep culture was negative. EKG was also performed to rule-out a prolonged PR interval. EKG was within normal limits. A DNase B antibody was 547 and an ASO titer was 300. While results were elevated, the patient did no meet clinical criteria for rheumatic fever and diagnosis that was most likely entertained was systemic JIA. Further lab work included an ANA which was negative, rheumatoid factor which was negative, a CRP on admission was 8.6 mg\/dL with an ESR about 80. CK and aldolase were within normal limits. Ferritin was elevated at 663. LDH was within normal limits. CBC was reassuring with normal white counts, hemoglobin and platelets; findings nonsuggestive of leukemia. Hepatic panel within normal limits. A chest x-ray was done to rule-out mediastinal mass, and that was negative. From an infectious standpoint, Parvo, CMV, EBV were all negative. Clinically the patient was noted to have a salmon-colored transient rash that would come and go throughout the hospitalization lasting a matter of minutes. No definite arthritis on examination. Oncology was consulted given the history of arthritis and fevers. It was felt in the setting of normal cell lines in evaluating a smear, which revealed no blasts, no indication of hepatomegaly or splenomegaly and uric acid and LDH within normal limits and x-ray that was normal, they felt that further oncologic evaluation was not indicated and a bone marrow was not indicated at that time. Cardiology was also officially consulted because the patient had a 2\/6 ejection murmur on the exam. Cardiology felt the murmur was a flow murmur and evaluated the EKG, which they read as within normal limits, and decided an echo was not indicated to rule-out valvular disease in the setting of the rash and arthritis in an attempt to workup acute rheumatic fever.",
  "input": "",
  "output": "Internal medicine doc here but in my differential is Adult Onset Stills Disease which can still present in children and Rocky Mountain Spotted Fever. The salmon colored rash lasting a few minutes is textbook for Adult Onset Stills Disease.I'm assuming she had blood cultures done at one or multiple points during her admission. Did she have a procalcitonin tested? Did she receive any antibiotics? Any steroids like solumedrol, prednisone etc? Does she still have joint pain? Does this rash show up only during febrile episodes? Any auto immune conditions in the family like lupus, rheumatoid arthritis, hashimotos?"
},
{
  "instruction": "NAD. My son has Adult onset stills disease, also considered SJIA when in a child under 16. His symptoms were rash (with fever) that could disappear when the fever went down. Muscle aches, joint pain. Enlarged spleen, liver. Elevated CRP, ESR, ASO, and Ferritin. Liver enzymes elevated from the swelling. He is on high dose prednisone and biologic injections. Hospitalized for 3 weeks.Its rare op, but your sisters case seems so similar. It needs aggressive treatment early on for the best chance of success\/possible remission",
  "input": "",
  "output": "Yes, the evanescent nature of the rash in this context twigged me to Still's as well. There is a known juvenile onset form that falls under \"SoJIA\" (Systemic-onset Juvenile Idiopathic Arthritis), considered a version of Still's.OP, this sounds exactly like a form of arthritis to a clinician who takes care of children. I agree that what comes to mind for your mother as \"arthritis\" is likely too limited, and that definition might need to be expanded in her mind. Could you look at this, and maybe share it with her? https:\/\/www.arthritis.org\/diseases\/systemic-juvenile-idiopathic-arthritisAbout a third of the way down that page is the SYMPTOMS section, with subsections on Fever, Rash, and Joint Pain. Please read it and see if it rings a bell. Best wishes."
},
{
  "instruction": "27, female, 5ft 8, 190lbs, folic acid & vitamin D supplement medications.I am 16 weeks pregnant and have Wolff Parkinson White syndrome. I was diagnosed in 2012 but have been asymptomatic for around 8 years now. Today I was at maternity and was checked by cardiology where WPW presented itself again on my ECG. I had an 2 ablation attempts in 2012 & 2013 where they werent able to get the extra pathway.How will this affect my pregnancy and delivery options?",
  "input": "",
  "output": "It depends on if you have arrhythmias. Have you ever had atrial fibrillation? Did they ever do an exercise stress test?Most of the time it won't effect pregnancy but if you have ever had atrial fibrillation the risk of degrading to a ventricular arrhythmia will be increased in pregnancy.Talk with your cardiologist, it may be beneficial to start a beta blocker depending on your history."
},
{
  "instruction": "I'm not sure what details are most important here, so I'll try to sum things up clearly. I need to determine if I should pay for a private autopsy, the problem is money is tight. However, if it's likely someone messed up, I want to take action. This hospital has something of a reputation when it comes to problems with infections, and previously they messed up on a friend of mine, their mistake nearly led to the amputation of her arm. Luckily that time they caught their mistake, and the $250,000 medical bill wasn't placed on my friend.Male665'10\"215 lbhad been on 5mg oxycontin for a bruised rib, took something like 30mg total a dayRough timeline:Day 1 he went to the ER for an infected toe. They referred him to another ER because the infection had spread to the bone and they needed to amputate. His GP said he had no diabetes. He may have had a case of bronchitis.Day 2 he's dealing with bad conditions at the hospital where his surgery will take place due to overcrowding in the non-covid section of the hospital while they give him antibiotics prior to surgery.Day 3 surgery takes place, surgeon reports everything went quickly and smoothly. Dad texts me after, saying everything went well. I talked with him and he sounded tired, but didn't seem out of the ordinary post-op.~14 hours later, a nurse says he was talking with my dad, he was joking with the nurse and the nurse \"got his pain level down\" and continued his rounds. An hour after this, my dad starts to gasp for breath, starts coding and they move him to the cardiology section where he passed.Some possible weirdness:The surgeon led me to believe there would be an autopsy, though he never directly stated there would be one, as he said my dad was relatively young and the surgeon didn't know what could have gone wrong. However, the surgeon had either already signed off on no-autopsy or did shortly thereafter. Going back to our conversation, the surgeon never said \"there will be an autopsy\" he just said \"the coroner will have to tell us what happened\" or something along those lines.I waited for a couple of days to hear back the results, but the hospital then lost my dad and the stuff he had brought in with him, they lost him for something like 4 or 5 days, with us calling every day after the 2nd day after his passing trying to find him and his phone so we could get his contacts and notify people. We still don't have his phone, so we haven't been able to notify all of his friends as the majority of their contact info is in his phone and we don't have it yet.",
  "input": "",
  "output": "First off, let me say I am very sorry for your loss.All the following assumes you live in the US:I believe the specifics varies by state\/county, but any unexpected death (with or without surgery) is by default a coroner's case. This means, someone at the hospital (doctor or nurse) is legally obligated to call the county coroner and report the death. The coroner has the discretion to order an autopsy, i.e. say yes or no they believe one should be done. In this situation, I would think they definitely would, and the body would be transferred to the coroner's office to do it. Even if the coroner says no, they don't require one, the attending doc of the patient can request an autopsy (to be done by the hospital.)I guess in your shoes I would do the following:Contact the surgeon and ask if the case was reported to the coroner. If not, why not. If they did call, what did they say about an autopsy.Then ask how you go about arranging a private autopsy. The surgeon might not know, but should be able to get you in contact with people in the hospital who can help you find out.Any respectable surgeon would want to know what happened just as much as you do. If you find him being evasive on the subject or refusing to return your calls, contact the hospital administration. Admins know medical legal risk and this is absolutely a red flag in that regard."
},
{
  "instruction": "I have had an experience in a hospital like this, as the mom of a patient. The procedure was absolutely botched and we did not find out til later from a nurse who didnt realize they hadnt told us the entire truth. It changed the procedure for pyxis picks in our local hospital, because they picked the wrong medication and it went through two nurses and a pediatrician and was administered to my newborn, premature son.Every business is going to protect its own interests, and I consider doctors a business entity as well as the practices and hospitals. Mistakes are understandable but for a mistake to make it through 3 medical professionals and not be caught til hours after the fact is inexcusable.All this to say, mistakes happen and even on a big scale. I wouldnt think it uncommon for this sort of thing to happen.",
  "input": "",
  "output": "Interesting assuming your flair is correct and you are not in medicine it seems more likely there was a miscommunication. I've seen bad outcomes but i have never seen or been involved in a \"coverup.\" In PACU Im on the phone with the family\/proxy immediately informing them of even relatively mild complications like blood loss requiring transfusion (1-2 units not MTP).At least in general surgery, the patient\/their PCP will see what was done on post-op imaging. You can't hide from radiology!"
},
{
  "instruction": "irst off, I know the pain of losing a parent and Im terribly sorry.Second, NAD, but my field of work happens to be in medical malpractice, specifically investigating licensed medical professionals.Malpractice is generally defined as medical negligence, but this comes in many forms.What I would do is request any and all medical records IF you can legally. Or whoever can, they need to and are allowed under HIPAA. The records we see from doctors are very general, they are required to log and note just about everything and a lot of detailed notes youll never see unless requested.It appears if any negligence happened it was after his passing. The fact that they lost him is NOT ok.Id also be curious to see what medication he received after surgery or in the hours before his passing. Incorrect dosage or medication is a lot more common than people think.Anyway a malpractice attorney may not be the best route yetThey would have a coroner examine the body and can sometimes determine cause of death without an autopsy hasnt a cause of death been given to your family yet?If they cannot determine cause an autopsy would be performed and the family has to consent.The family also has every right to request one, but you may have to pay for it.I would gather that information for sure and any and all medical records",
  "input": "",
  "output": "This very sudden event does not sound like a surgical complication. It sounds more like a pulmonary embolus or heart attack, possibly an acute allergic reaction. WITHOUT RECORDS I CANNOT CLAIM THIS AS FACT. Edit: I just noticed you mentioned they moved him to the cardiology floor. A cardiac event seems more likely.You can request a copy of his medical records if you want to know more.Pulmonary embolism was my first thought as well, but of course its my first thought regardless of the situation because, well, gotta CT somethin.Sorry for your loss OP. I hope you are able to find peace within all of this."
},
{
  "instruction": "In my hospital, the surgeon has no decision making in a coroners case. A mandatory coroners case is if a patient dies within 24 hours of admission. Furthermore, if any patient dies in my hospital, the charge RN or patients RN calls 1) the coroners office. 2) organ donation. 3). The family, and 4) the funeral home or cremation. The surgeon has nothing to do with the decision of a coroners case, the coroner decides. If the coroner decides no autopsy is warranted, the family may have there own independent autopsy completed at their own expense. Your fathers surgeon signed off because your father was no longer his patient. I hope this helps, and I am truly sorry about your father.",
  "input": "",
  "output": "Saying that hospital staff killed your dad is a bit of a stretch, but you do deserve an autopsy like you asked for.Reaching out to get records from the hospital and getting a lawyer could help. You could also reach out to the medical examiners office and see if theyre even aware of this case, if they havent heard of it, or if they rejected it."
},
{
  "instruction": "Is there a way to get a coroner to do it? The county coroner said they won't since the surgeon signed off on it, so as far as I'm aware I need to get a private autopsy done, which is a pretty large financial burden at around $7,000. I'll absolutely pay for it if it's at all likely that they messed up. I can't stand the thought that they could face no repercussions for any mistakes they made.",
  "input": "",
  "output": "Its really hard to connect a sudden event like this to a relatively benign surgery i.e. toe amputation. I cant envision a scenario where the surgery was a direct cause of his death. If it was a PE and he wasnt getting SQ heparin in the hospital, maybe you have a case, but even that might be a stretch. The vast majority of deaths in the hospital were beyond anyones control, but of course there are exceptions. Despite popular belief, its hard to kill people.I think it's most likely that they didn't make any mistake that caused this death, especially with just an amp of a digit, but I would think this definitely would deserve an autopsy. He probably had a PE, STEMI, something catastrophic either unrelated to the surgery or a very unfortunate complication of the surgery, and was in a part of the hospital for very non-acute patients that don't really need much monitoring when it happened."
},
{
  "instruction": "Im a 32 year old male, smoked tobacco from 18-22 and switched to vaping, regular use of marijuana and no other drug use since age 22, I used to abuse cocaine. Went to the ER twice, once for a short lived but stabbing center chest pain, other visit I was sitting watching videos and my heart started pounding out of my chest and reach 150-160bpm, but absent of pain, both times EKG and X-ray were explained as unremarkable and was given an ER diagnosis of palpitations\/anxiety. I went to my PCP yesterday and he asked if any of the ER staff mentioned a incomplete RBBB. I told him they did not, I reached out to ER doctor and he said the computer read out printed an incomplete RBBB on the paper but upon human examination it wasnt the case and was likely caused by me being underweight. My PCP said this is highly unlikely and ordered a chemical stress test and a cardiology appointment for May 5th, I trust my PCP but hes new to me so I dont know him very well. Can an EKG false read a RBBB or is my PCP correct to be suspicious? If I do have an Incomplete RBBB what does that mean for someone my age? Waiting on the next appointment is giving me anxiety and just want to understand more about whats happening. Thank you in advance for your help! I have a family history of stroke but not cardiac failure.",
  "input": "",
  "output": "An incomplete RBBB is generally a benign and incidental finding. I would not worry about it at all. I often dont mention it to patients if I see it on their EKG because it doesnt really meaningfully increase risk of anything nor does it typically indicate underlying cardiac disease. Think if it as simply just being the way your heart is wired."
},
{
  "instruction": "34F, Canada, Cushings Disease with associated type 2 diabetes, hypertension, etc.One week ago I underwent a transsphenoidal pituitary adenoma resection. Midway through the surgery my heart stopped and they had to give me CPR. Not sure how long I was out for (the doctor said I was back before he had time to get the life-saving medications). My heart stopped again right at the end of the surgery. I woke up from anesthesia having my chest x-rayed and being asked a bunch of questions to see if I had any neurological damage.X-ray showed no fractures and ECGs were normal. The cardiology team didnt really know what happened and just said something about a vasovagal response with asystole. They discharged me from their care. I ended up developing diabetes insipidus so I spent 5 days in hospital.My chest still hurts something fierce. The headaches, fatigue and the hormonal rollercoaster from the tumour being removed is a walk in the park in comparison.Is the pain just muscular if the X-rays were clear? How long can I expect this to last? I feel like I cant take deep breaths or move my arms without pain. I complain but Im very grateful to the doctors who saved me!Should I be cautious going under general anesthesia in the future or was this just a freak thing?Thank you!",
  "input": "",
  "output": "That certainly sounds like a challenging case.You should review what happened with the anesthesiologist as they can provide the necessary context and course of events to what happened. Having the anesthetic record available will also be invaluable.Also, brain surgery carries additional risks, with significant pauses in heart rate being due to several different mechanisms. Most likely, this will not be an issue in other surgeries. However, it is impossible to know without more information.As for your chest pain, while broken ribs can happen, there can also be pain in the joints as well as muscles and other tissues. The soreness should eventually get better in the next week or so."
},
{
  "instruction": "Thank you! Yes all the doctors seem a bit mystified by it. I have follow-ups with the surgeons in a couple weeks so I will get more details. I admit to feeling a bit freaked out by the experience. And the chest pain has been killer.",
  "input": "",
  "output": "Broken ribs are notoriously hard to see on X-rays  were looking more for breaks that are also very out of place, or a collapsed lung from the fracture. So you could very well have a broken rib that wasnt seen."
},
{
  "instruction": "26F. 510, 150lbs. Non smoker, exercise 2x per week.I had an episode a few weeks ago where I felt lightheaded for about 15 minutes. I also had heart palpitations and feel very anxious (heart palpitations started after light headedness). This improved with deep breaths. I havent had an episode like this previously but have in the past felt heart palpitations when stressed.I spoke to a doctor at the time who sent me to the ER. I had blood tests, 2 ECGs, blood pressure tests and an X-ray which were all normal, but was sent to cardiology as a follow up.I have also since spoke with a GP who said they likely think my symptoms were a panic attack as I do suffer from anxiety and health anxiety. That said, I still have to see a cardiologist to confirm.I have my appointment tomorrow and Im very anxious about it. What will happen? Whats the likeliness of needing further tests and what would they be? Im worried about having to do a lot of follow up tests as Im travelling soon and need to be fit to travel",
  "input": "",
  "output": "They might just talk to you about your symptoms and what happened. Family heart disease history. Might have you wear a heart monitor to catch any arrhythmias that might happen if\/when you feel lightheaded etc. or do an echocardiogram but I say might given that you only had one episode and all blood work \/ ekg are normal."
},
{
  "instruction": "Gender: Male. Age: 21. Weight: 160. Diagnosed with asthma.Some months ago, I went into the emergency room for heart palpitations. I am prone to heart palpitations during anxiety, but those are caused by tachycardia. They feel like a fluttering in my chest. These heart palpitations feel like my heart stops and then THUDS into my chest. When I went into the emergency room, they were relatively infrequent. I was referred to a cardiologist.During my cardiology appointment, the doctor told me that I had a heart murmur. He ordered an echocardiogram, an MCOT monitor and a stress test. The echocardiogram came back negative for any abnormalities and I have four days left on my MCOT monitor (which is like a monitor that sits on a patch above my heart and monitors my heart rhythm 24\/7). I never had the stress test done.Since that appointment, I've had these beats relatively infrequently. Maybe four times a night tops.Starting last night, I began to have them much more frequently. Much more frequently. And it is only one PM and it's happening maybe two or three times already. My question iswhen are these skipped beats concerning? When should I be worried about dying? Should I go to an emergency room?",
  "input": "",
  "output": "There honestly isn't any indication to go into the ER if you're wearing the MCOT monitor. While you have it on, detection of an arrhythmia is automatically transmitted to a central surveillance station for further analysis and possible intervention. If something concerning or life threatening was going on, someone would call you about it immediately."
},
{
  "instruction": "Wellthe people monitoring the data have made it clear that MCOT isn't an emergency service and that all of the information from the monitor is being sent to my cardiologistwho isn't at work until tomorrow. So my thoughts are that he hasn't even seen any of my data since this has started. I just had another skipped beat. They're happening very frequently.The site says that they will only contact me if specifically requested by my physician, who isn't working weekends. I'm quite scared because these beats are happening much more frequently than normal.",
  "input": "",
  "output": "Are you having any other symptoms with the skipped beats? Like chest pain, shortness of breath, lightheadedness\/dizziness, vision changes, or numbness\/weakness\/tingling anywhere, that's any different from your baseline? If so, then those would be indications to present to an ER."
},
{
  "instruction": "Whenever I have the skipped beat sensations, there's like an anxious feeling in my chest and sort of a feeling like my body is heavy. It is the same sensation that I get during panic attacks but much less severe. The sensation never lasts. It goes away immediately after the beat. I'm terrified these fuckers are going to kill me. I have no idea why all of a sudden these are happening so frequently.",
  "input": "",
  "output": "It sounds like PVCs (premature ventricular contractions) which feel weird but arent life threatening."
},
{
  "instruction": "Thank you so much! I was told I had a blockage of some kind? I cant remember exactly what its called now. Essentially the 2 parts of my heart arent in sync with each other. Thats why I got the heart monitor. Is that something to worry about?",
  "input": "",
  "output": "CMS\/HCC is just a designation for billing stuff (CMS = Center for Medicare\/Medicaid Services).\"Ambulatory referral\" - referral to an outpatient cardiologist (not being sent to see them urgently in the hospital)Syncope is the medical term for fainting, or becoming unconscious.The optic disc is a spot in the back of your eye where we can see the nerve that gets information from your eye and brings it to the brain. \"Anomaly\" just means that something looks funny (since they don't say anything else here, I can't say how it looks funny).In short, for your passing out or possible seizures, they're sending you to see a cardiologist to make sure it isn't your heart. For the funny thing they saw in the back of your eye, they're having you see an ophthalmologist. Sounds like all of this is a very reasonable workup for your issues.Hard to say with that general explanation - it'd be more helpful if you have the medical name of the condition."
},
{
  "instruction": "I believe its a first degree atrioventricular block.",
  "input": "",
  "output": "Based on his username the original respondent is the best to answer this question though."
},
{
  "instruction": "27F. 213 pounds.Preexisting conditions: pcos, endometriosis, factor V, anxiety, depression, and under active thyroid Medications: propanol 40mg, levothyroxineLast year I started having random heart palpitations. I went to the ER. I had an ekg. In the ER they determined I was normal so they gave me a referral to cardiology. Since then Ive had a 30 day heart monitor, echo, and a stress test. Im told that all the results read normal and Its probably anxiety playing a part.On Friday I had a weird sensation happen. Its happened a handful of times and I mainly feel it at nighttime while laying down. It is in the middle of my chest and its a cross between a flutter and a spasm. Like it gets tight for a second. It makes me cough and I breathe in to get it to stop. I can also slightly feel them in my lower neck beating. I also woke up this morning a little weak in that area. It freaks me out.I have some slight occasional pinching just like I do with the other palpitations (Im told that can be normal ) but Im not in pain. I dont have a headache. My blood sugar is normal. My bpm is normal. My blood pressure is a little lower than where it usually sits but its still in the range.Im seeing a NP on Monday but I wanted to ask if anyone has experienced this or knows what it might be before I get told its just anxiety again.Disclaimer: Im not saying it cant be anxiety but every time I go to the doctor EVERYTHING under the sun is anxiety and its hard to get past that diagnoses when you feel like something is off",
  "input": "",
  "output": "The workup youve had is incredibly thorough and it couldnt find anything pathological. Short of a heart attack (which is almost impossible at your age) there wouldnt be any significant changes to your cardiac physiology since that battery of tests was done.Anxiety is by far the most likely cause.From the sounds of it, it is probably anxiety."
},
{
  "instruction": "I (24F) had an ekg done yesterday to investigate consistently high blood pressure (around 140\/85 or higher) and both high (122bpm) and low (53bpm) heart rates. The ekg showed that I have a heart block and they explained that my heart is skipping beats and part of it is beating slower? They seemed pretty concerned and asked if I had any chest pain or dizziness, which I said no - but that I am almost constantly nauseated and tired.I have a lifelong history with nausea and fainting that Ive learned to control by avoiding triggers like heat, cardio, or becoming overwhelmed emotionally. They said since Ive been experiencing symptoms for so long, its probably not immediately life threatening and sent me home. But they insisted that I go to the ER if I feel like Im going to faint at any point and I was given an urgent referral to cardiology. How concerned should I be?Stats: 24F; very rarely drink, no cigarettes, no vaping, daily weed; Diagnosed with bipolar, adhd, and anxiety; Currently taking Trileptal 675mg and lexapro 10mg",
  "input": "",
  "output": "There are many types of heart block of various degrees of seriousness. It's not possible to say from this info what you have"
},
{
  "instruction": "Depends on the type of block you have. Is it a first or second degree, Mobitz or Wenkebach?For a third degree, you'd've had to stay in the hospital, I guess.",
  "input": "",
  "output": "Or bundle branch or fascicular."
},
{
  "instruction": "I'm a 19 female, no drinks no drugs no smoke, \"loose ligament syndrome\"(modern day gHSD and hEDS, basically hypermobility spectrum disorders) runs down the matrilineal line. I couldn't inherit the diagnosis because diagnostic process changed, but same symptoms. Because of that, I'm very sedentary- chronic pain and bad joints makes even walking difficult to do for any extended period of time.Because of the loose ligament syndrome thing, I was supposed to have seen a cardiologist a while ago(if it's hEDS, increased risk of aortal dilation). On top of that, just learned maternal grandmother is also medicated for high cholesterol and bp, and had a heart murmur.I just scheduled a doctor's appointment for the 18th of February- just with my gp for a physical, and I'll go from there. Scheduled it after I went to an urgent care for something unrelated and they took my bpm three times(137, then 111 laying down, then 102 as they had me meditate for a minute). I have tons of symptoms that I just attributed to an autonomic condition like pots or something, and didn't bother treating because \"it's not fatal\"- common mentality in my family. However, these symptoms all also apply to cardiac issues. Things like chest pain spreading to shoulder blades + neck, feeling like a lump in my neck during hot shower + palpitations, blood pooling in my feet, breathlessness, dizziness, cold hands and feet, etc etc. I'm also wearing a Fitbit to help give general metrics(I know Fitbits aren't concise) to the gp.Anyways, because of these symptoms, I'm concerned that my gp will hear this and send me to the er (the gp office is connected to a hospital), rather than referring me to cardiology. These are all symptoms I've dealt with for months if not years. Not entirely afraid of that, I just like knowing what to expect and am trying to mentally map out possibilities.I'm curious to know at what point a doctor decides to refer a patient vs send them to the er? Especially if it's something the patient has been dealing with for a while(like in my case), vs something brand new?Update: nevermind had a heart event and I'm at the er now. So, fun reminder to go to the er when the internet tells you to, rather than waiting it out.",
  "input": "",
  "output": "As an ER doc, I can hopefully help map out the in's and out's of what \"should\" dictate a referral to a specialist vs. what constitutes the need for a recommendation to go to the ER.The answer is...you ready for this?...If the presentation is...an emergency. Poof. Mind blown...\"You condescending asshole!\" I hear you saying to yourself. But, no, seriously, this is power to you. IF your PCP, for some odd and unnecessary reason, says, \"Based on your symptoms, you need to go to the ER. NOW!\" Calmly tell him, or her, \"But, I thought that dark and scary soul-sucking hell-hole was only for emergencies. Yet, I've had these symptoms for months. Why is this suddenly so emergent? Please just refer me to a cardiologist who can help me with my chronic cardiac issues.\" Then, feel free to bat your eyelashes, if you so choose, as they sit in the cesspool of being completely and totally wrecked by reason."
},
{
  "instruction": "Yeah I put an update at the bottom, I'm at the ER after a cardiac event",
  "input": "",
  "output": "Ahhh dang. At the very least, I hope you get feeling better soon!"
},
{
  "instruction": "My mother has undergone an MRI brain without contract as she was suffering from double vision, major headaches, fatigue, imbalance, and frequent of coordination. The MRI scan consequently showed a small 7x4 mm nonspecific focal area of white matter high signal change seen on T2 and FLAIR sequences in the left centrum semiovale. The neurologist then advised to undergo a CT contrast scan alongside a lipid panel test to infer on the MRI findings.As per the CT scan, below were the findings:Atherosclerotic changesOcclusion of the right vertebral artery at the origin, partial visualization of the cervical segment, retrograde filling of the distal V4 segment and PICASignificant narrowing of the left PCA distal P2 and P3 segmentMild narrowing of the proximal right ICA about 40%.Right A1 segment is congenitally absent, the rest of the right ACA is hypoplasticThe lipid panel test showed the following:Lipid panel-LDL 3.34, total cholesterol 5.61Momentarily, the neurologist has requested a HBA1C and liver function exam, in addition to the echocardiogram and a 24-hour blood pressure monitoring from cardiology standpoint. He has concluded that the previous MRI reported a lesion suggestive of old ischemic infarct.I am looking for advice regarding the next viable steps as the healthcare from the country I am currently in is not up to par\/adequate. I am extremely distressed and worried about this case as my father has suffered from a hemorrhagic brain stroke 12 years ago and cannot lose another parent as a result of a medical condition. I am the sole carer of both my parents who works 10 hours a day. Please advise me.",
  "input": "",
  "output": "It is not uncommon to have small, old infarcts as people get older.The important thing to do if these are seen is secondary prevention, meaning modifying risk factors to prevent future infarcts. This sounds like it is already taking place through the measurement of her HbA1c and lipid profile.As to whether anything is done about the existing vessel narrowing will depend on her particular case and where in the world you are and should be discussed with her team."
},
{
  "instruction": "Thank you for your reply. Greatly appreciated. Could I just ask in regards to the occlusion of the right vertebral artery and the 40% narrowing of the ICA - how dangerous\/worrisome are those findings and should we opt for any surgical intervention?The neurologist has suggested to get her on Lipitor 20mg daily for 3 months and an anti platelet treatment (although she took aspirin before and had a huge drop in ferritin levels equating to 2.7 and edema, which led to her having to get iron infusions). The neurologist hence recommended plavix as an alternative.",
  "input": "",
  "output": "This will again depend on local practice and your mothers wider medical history and functional status.As an example, in my region we wouldnt consider it unless stenosis was greater than 50% and even then, the vertebral arteries are very difficult to access safely and generally only consider thrombectomy of small vessels in the acute phase."
},
{
  "instruction": "In regards to medical history, my mother has been extremely healthy, no smoking or drinking, and no other medical issues. However, it is essential to note that her father and sibling have passed away from a heart attack, and two others have undergone open heart surgery.So, from my understanding, operating on the vertebral artery is extremely dangerous, and for any other stent operations regarding intracranial and extra cranial arteries, the stenosis should be larger than 50%? But what is the likelihood of her ICA percentage growing to 50% and in how long? Considering she suffered from an transient ischemic attack recently reflecting in the MRI, how would you assess this case?",
  "input": "",
  "output": "The number of 50% is an example of what we would use in my local practice - it does not necessarily represent the targets in your area\/situation. That is a much more nuanced question that can only be answered by your team."
},
{
  "instruction": "Hello, Im posting on behalf of my 76 year old father. He had double bypass surgery back in 1995. Other chronic conditions include Afib, medically managed cholesterol, and he is a regular drinker (mainly beer and wine). His medications include Metoprolol 50 mg, Xaralto, Lipitor 40 mg, Lavazo 4000 mg, baby Aspirin, Coq10, and D3. He has dealt with very swollen feet for years and always has a dry cough. He is not short of breath or wheezy at all. In fact he is quite active, he walks about 3-4x a week, lifts with a personal trainer 2x a week, does Pilates reformer once a week, and yoga\/stretching lesson once a week. He has gone to Cleveland Clinic for a full physical every year and they feel that everything is managed from a cardiology perspective. They cannot treat his Afib via electric shock for whatever physiological reason, and he doesnt want to undergo a major surgery. According to his Apple Watch, his resting heart rate is 45 for the past 13 weeks. He had a vascular doppler of his lower extremities and they found that his veins are larger than normal but no blockages. His lab work has not shown signs of kidney problems. What is most concerning to me, is that no one ever seems to be concerned about his cough. My dad is convinced its allergies but he wont take an allergy pill because it makes him tired and wont see an allergist. I would love an opinion about his very swollen feet (picture below in comment) and persistent cough. I feel like it is abnormal and we shouldnt be taking everythings fine and managed for an acceptable answer. I think that it is a symptom of something else happening in his body. What do you think it could be and do you think he should go get a second opinion? If so, where?",
  "input": "",
  "output": "Sounds like congestive heart failure. He should see a doctor asap."
},
{
  "instruction": "Left Ventricle: The ventricular size is normal. There is no left ventricular hypertrophy. Global LV systolic function is normal. The left ventricular ejection fraction is 70 %. LV diastolic filling parameters are c\/w normal diastolic function.Right Ventricle: The right ventricular size is normal. Global RV systolic function is normal.Left Atrium: The left atrium is normal in size.Summary and Conclusions:No previous studies for comparison.Normal LV size and systolic function. LVEF= 70%. Normal LV filling pressures.Normal RV size and systolic function.Normal biatrial size.MEASUREMENTS AND CALCULATIONS:Left Ventricle: Normal Aorta\/Left Atrium: Normal IVSd: 0.6 cm (0.7-1.1) LV FS: 40 % (>25%) RA Area A4C: 11.8 cm2 (<18) LV EF (Biplane) 70 %. (54-74) Right Ventricle: LV Mass 66 g (67-162) RVd A4C: 2.8 cm (2.5-4.2) LV RWT 0.40 (<0.43) TAPSE: 15 mm (>16) LV EDV 2D: 44.5 (56-155) IVC Diameter: 1.8 cm LV ESV 2D: 13.4 (19-58) LV EDV index: 31 ml\/m2 (35-75) LV ESV index: 9 ml\/m2 (12-30)",
  "input": "",
  "output": "Cardiologists take a broad approach to reading an echocardiogram, not just looking to see what measurements fall within a range. Your cardiologist is the best person to tell you if your echo is normal or not.This is a normal study"
},
{
  "instruction": "Please can I have some help identifying exactly what material has caused a nasty skin reaction in my 5 yr old? (Female, Caucasian, no health issues but has had other topical reactions in past)She had a tonsillectomy a few days ago and her skin has reacted to the sponge backing on the electrodes they stuck to her chest during surgery. (I know it's only the sponges, as the welts are in perfect circles)I've identified the electrodes as Ambu WhiteSensor 4535M https:\/\/www.ambu.co.uk\/cardiology\/ecg-electrodes\/product\/ambu-whitesensor-4535mThe data sheet says the sponge is material is \"polyester polyurethane reticulated\". Google tells me these are two different materials? Is there a common name for this stuff that doctors use, and is it a common medical material that I need to look out for in future?",
  "input": "",
  "output": "Acrylate allergy is most likely followed by nickel next."
},
{
  "instruction": "65M, 5'9\", 140lbs, Asian \/ Chinese, NYC, no medications <-- My Dad's InfoI'm in a stressful medical situation right now, and need some help \/ advise. My dad had an emergency aortic valve and ascending aorta replacement 5 days ago due to aortic dissection 7 days ago. He was in the OR for ~11 hours because they first attempted to repair a part of the ascending aorta, took him off bypass, saw that things weren't going well, then put him back on bypass again to do a more aggressive procedure of replacing the aortic valve and the ascending aorta including the arch, so it was a very long amt of time on bypass.Yesterday he was moved from the Cardiothoracic ICU and into a normal hospital wing due to a bed shortage in the ICU. I've noticed since he came out of surgery that he has a facial muscular abnormality on his left side (his left mouth is slanted up) and is having difficulty speaking\/writing (he is slow to utter syllables, is misspelling very easy English and Chinese words, can't pronounce English and Mandarin words to the point where it is not possible to have a conversation with him without both my mom and I guessing while he attempts to partially speak \/ write). The cardiology team told me yesterday that they don't think they need to bring neurology in to examine him because it may all be normal effects of the bypass. I am really worried there may be signs of a stroke (he can't read\/write properly and his mouth is crooked) and I am wondering why nobody at my dad's hospital is concerned with a neuro eval. What do you think - should I push back more for a neuro eval or is this normal?",
  "input": "",
  "output": "I'm a neurosurgeon so I'm kinda talking out of turn but....I did rotate thru CT surgery as an intern long ago, so maybe it's still valid.Have they done a CT or MRI of his brain? If yes and it's normal, rest easy. A negative imaging study (especially MRI) rules out a stroke, which means there's little for neurology to do, other than diagnose \"encephalopathy after surgery\/bypass.\" However, if they've done no imaging, I'd consider that odd. My ICU has a low threshold to get a neurology consult and imaging, and someone having language issues and a facial droop for 5 days after heart surgery would certainly trigger it."
},
{
  "instruction": "No, they have not done imaging of the brain yet. If this were your family member, would you advocate for CT or MRI? Thank you so much for replying to me so quckly.",
  "input": "",
  "output": "I think a CT is a reasonable step. Quick look to rule out something concerning like a bleed or a stroke."
},
{
  "instruction": "Thank you so much for your help. Using info and confidence from this thread, I was able to push\/advocate with the hospital over the last few days to have the surgeon finally order a CT scan and....blood clot in the frontal lobe. A stroke team then confirmed an embolic stroke immediately. He will need to have another procedure to remove fluid around the heart.It suprises me that if I had not pushed for brain imaging, my father would have been discharged as if nothing was wrong. I can see why having family\/children may sometimes be the difference between good care and terrible care. It feels good to have a baseline data point and it sounds like aspirin + therapy are the only treatment that we can seek after his condition hopefully stabilizes (low blood oxygen levels, fluid in heart and lungs is in hard to reach places, etc.).The power of Reddit continues to shine. I am grateful for this community.",
  "input": "",
  "output": "Glad you pushed and got some answers. Heart surgery puts people at risk of both bleeding strokes (because the blood is thinned during surgery) and well as embolic strokes (because things can flick off arteries, valves, and even repair devices like aortic repair grafts). It's important to differentiate between the two, since a bleeding stroke is a contraindication to many\/most post op blood thinners.I hope your dad's recovery goes smoothly. He might ultimately be a candidate for inpatient rehab, which can definitely accelerate recovery after a stroke. It's usually done at a different facility than where the surgery was done. The physical, occupational and speech therapists that work with him now will let you and the surgeon know if he's an appropriate candidate for it."
},
{
  "instruction": "Female 35 \/ 55 \/ 195 poundsI attended my physical today and my doctor said that I have a heart murmur. This hasnt ever happened to me. She told me not to worry but now I have a cardiology appointment. I have severe health anxiety. She said its likely from anxiety or a small leak? - she said since I dont get out of breath its unlikely its serous?",
  "input": "",
  "output": "Everyone here will tell you the same thing your doctor told you.Take a deep breath, Relax and wait for the next appointment. No one can tell you any different without examining you."
},
{
  "instruction": "Sex - FemaleLocation - EnglandPre-existing conditions - Chiari Malformation with Syrinx, IIHSurgeries in previous 12 months - Stents fitted to transverse sinus & ICP monitorMedications - Aspirin, Antenolol, Acetazolamide and progesterone only pill (to stop cycles, I am sterilised so not used as birth control).Issue - Hi. I am currently waiting an appointment with cardiology following a trip to A&E with tightening pains in the chest when experiencing a double heart beat. This was evident on the ECG the hospital took and appeared similar to the ones taken with my Apple Watch. It has been queried if it may be bigeminy(?). Ive attached an image in the comments from today. The episodes are becoming more frequent and happening for longer periods. I dont want to bother our already busy hospitals when these happen just to have an ECG and be sent away to wait the referral. Can anyone suggest anything I can try to stop this happening? I dont drink given my pre-existing conditions, have never smoked and Ive cut out caffeine already with no results. Thank youETA - Ive taken blood pressure when these are happening and readings are totally normal, reading with picture in comments was 114\/66",
  "input": "",
  "output": "Looks like classic premature atrial contractions (PAC). Can happen in times of high stress. Usually benign, sometimes in the setting of new arrhythmia. Beta blockers can reduce occurrence so maybe cardiology might want to discuss atenolol dose.Sounds like you might getting into a cycle that precedes panic attacks which makes people feel like they are having a heart attack eg short of breath, chest pain. Then fear of a similar episode happening again causes stress and then you cycle right back into stress induced PACs. Breathing exercises are golden when you feel youre about to enter one of these cycles. In through the nose 4 seconds, out through the mouth for 6 seconds. Do this at least 4 times and focus on breathing.See what cardiology has to say. Very unlikely anything serious."
},
{
  "instruction": "22F. 115lbs. 5'2. History of gallbladder removal. History of lupus. I take aderall for ADHD and hydroxychloroquine for my lupus, as well as birth control.EDIT: Heres the full reportI saw a cardiologist a month ago and wore a heart monitor for 2 weeks and had an echo done. I went in because I have a consistently high heart. The heart monitor didn't show anything concerning according to cardiology and I was diagnosed with inappropriate sinus tachycardia. Well, I got my report back.Everything was normal besides two things that I read on the report:Trace mitral valve regurgitation.IVC is dilated at 2.5 cm.This freaks me out a bit because my doctor didn't mention any of this to me and he won't respond. On the 2D measurements, the only abnormal measurement was my LA which was 2.8 (reference range 3.0-4.0 cm).The reports from the mitral valve stated:Regurgitation: TracePeak E: 0.9 (0.6-1.3 m\/s)Peak A: 0.5 (<0.7 m\/s)E\/A Ratio: 1.8 (0.75-1.5)The only other measurements that were high were my Pulmonic Valve:Peak Vel: 1.1 (0.6-0.9 m\/s)Peak Grad: 4.5 (<=3 mmHg)I am really freaking out. How concerning is this? Is the dilation, regurgitation, and high values concerning?",
  "input": "",
  "output": "A lot of good answers here, I'll just confirm what the others have said. Pretty much all the answers I read are correct. It's not uncommon for our heart valves to have a tiny bit of leak (regurgitation), it's nothing to worry about. As far as the IVC. It's a touch on the large side but it could just be a normal variant. It could also mean that you are very well hydrated and there just happens to be a lot of fluid in your veins making it look nice and plump."
},
{
  "instruction": "Thank you so very much for this. It is very much appreciated. I had assumed that my doctor wouldve told me if it was concerning but I just wanted to double check. I do have very plump veins which makes blood work easy for me lol.The hydration would make sense as I hound down so much water throughout the day (close to 90 oz). I was over hydrating too much and ended up depleting my electrolytes so now I add electrolyte drops to my water.Again, thank you so much for taking the time to respond and fantastic username.",
  "input": "",
  "output": "I'd interpret this as basically not concerning. IVC of 2.5cm by itself can be normal in adults as long as there's good compressibility and respirophasic variation (not commented on, but given lack of tricuspid regurgitation and normal right heart function, would highly doubt any abnormalities). Most likely, this just means you were well hydrated at the time of the study.Regarding the mitral regurgitation, trace amounts of regurgitation across the mitral and tricuspid valves can occur in otherwise healthy adults without any significant pathology or cause for concern. Given that the rest of the report shows normal systolic and diastolic function, I'd be really surprised if the regurgitation they describe is significant or would cause any symptoms."
},
{
  "instruction": "My (74F) mom will likely be diagnosed with Alzheimer's later this month by the neurologist when we go for a follow-up after an inpatient stay for delirium. She is currently in a memory care facility. She has DM, OSA, and CHF with an implanted defibrillator. As I step in to manage her appointments I was wondering if she needs to see all her various specialists still. She will be seen by a Geriatrician for primary care, and I assume Cardiology would still be needed due to the defibrillator. But would she still need endocrinology and a dietician for the DM? What about Neurology and Psychiatry after the diagnosis? I got the impression from the Hospitalist that no treatment would be coming for Alzheimer's. Her DM and OSA have always been poorly controlled due to her non-compliance. I don't want her to get worse, but I'm also wanting to be as efficient as possible with the appointments since I'm on my own.",
  "input": "",
  "output": "When quality of life starts to decline, it is important to look at quality vs. quantity of life. If you want her to live as long as possible then yes she needs to continue to see her specialists unless they say it isn't necessary.If her goals are just peace, dignity and comfort rather than trying to extend life then focus on this instead. Her geriatrician can help with this."
},
{
  "instruction": "I have pasted the findings of my regular echo below (The tricuspid regurgitation is new) I apologize for the formatting. It wouldnt allow photos.I am a 31 y\/o female and just had my yearly follow-up with cardiology. Suddenly my doctor says she is very concerned about my MVP due to my age, and scheduled the esophageal echo.Naturally, I am terrified. I have a four year old, and Im supposed to be getting married. I have issues with anesthesia and Ive been a mess at work all day at the thought of having heart surgery - or possibly not waking up.How serious DOES this sound? I believe a doctor when they say theyre concerned. But Im freaking out right now. Normal left ventricular size and systolic function with an estimated EF 55%. Mild left atrial enlargement. The mitral valve is thickened and the anterior mitral valve leaflet is elongated. There is bileaflet mitral valve prolapse and an associated eccentric jet of moderate mitral insufficiency. There is mild tricuspid valve regurgitation. Dilated IVC without respiratory variation consistent with elevated right atrial pressure 15 mmHg. Estimated PA systolic pressure at the upper limits of normal 34 mmHg. Given decline in LV systolic function (previously 65%) and technically difficult images with difficult to view mitral insufficiency, will discuss with the patient moving forward with a TEE.-Left ventricle cavity size appears normal. Left ventricular systolic function is normal with an ejection fraction of 55%.-Left atrium cavity size is mildly dilated.-Right ventricle cavity size appears normal. -Systolic function is normal.-Right atrium cavity size is normal.-The aortic valve is probably tricuspid. The leaflets exhibit normal excursion. There is no regurgitation.-The mitral valve is thickened and the anterior mitral valve leaflet is elongated. There is bileaflet mitral valve prolapse and an associated eccentric jet of moderate mitral insufficiency.-There is mild tricuspid regurgitation. RVSP is 34 mmHg.-The pulmonic valve was not well visualized.-The aortic root at the Sinuses of Valsalva appears normal in size.-The inferior vena cava demonstrates a diameter of >21 mm and collapses <50%; therefore, the right atrial pressure is estimated at 15 mmHg.-There is no pericardial effusion",
  "input": "",
  "output": "Sounds like the initial problem here is that they can't get good enough images of your mitral valve, so that's why the doctor is suggesting the TEE (trans-esophageal echocardiogram). This will require sedation (usually moderate sedation, like getting your wisdom teeth out). This is a very safe procedure, so I'd suggest it as a good next step to get all the important information your doctor needs."
},
{
  "instruction": "3f 3ft tall 34lbs No medications Medical history: Uncomplicated pregnancy and no complications during delivery (vaginal) VSD and heart murmur present at birth but resolved on its own and was cleared by cardiology at age 2 She does have sensory issues and possibly autism were awaiting evaluation.We play doctor a lot because going to the Dr has always been something shes had a hard time with and when I was checking her mouth I noticed she had some red dots on the inside of her cheeks. While I dont believe it to be anything worrisome I wanted to just check. I got the best pictures I could of the red dots I saw. Theres a single one on one side and about 6 on the other side. I tried asking her if anything hurt like her mouth or throat but she didnt respond and is not always able to communicate clearlyI just noticed it today, so I am unsure about the duration and how long its actually been there.",
  "input": "",
  "output": "Likely from normal trauma"
},
{
  "instruction": "42F, obese, hypertensive but controlled on meds, normal cholesterol but low HDL, arthritis, recent ankle reconstruction (July and October), seasonal allergies, depression\/anxiety.Following a bout of awful GI issues for a week in December, I developed noticeable PVCs. They have progressively gotten more frequent, so I saw my PCP in January. She referred me to cardiology following a normal CBC and MBP.I had a two-day chemical stress test and echocardiogram yesterday and today. I finished around 0900 today and by 1330 I was scheduled for an emergency heart cath tomorrow.I never spoke to the cardiologist, only his nurse. She said he was incredibly concerned about the results of my tests, but didnt elaborate. I was in shock and didnt even think to ask why he was concerned.The results were uploaded to the My Chart app and I tried to read them, but its all foreign to me.Lexiscan reportEcho reportWould anyone be willing to help me understand this?",
  "input": "",
  "output": "The reversible defect on the \"lexiscan report\" is showing that after injection of a drug to simulate the effects of exercise on your heart, there is an area of the heart that doesn't appear to be getting enough blood flow. The concern would be that there is a narrowed coronary artery in this area.These findings are not always accurate but warrant a coronary angiogram, where a small thin tube is threaded up into an artery usually in the wrist, to get a better look at the blood vessels and find if there is narrowing. If there is coronary artery disease, the options would be medical management, a cardiac stent, or recommendations for surgery.I'm reassured that you seem to have normal heart function and currently have no symptoms, and don't have diabetes which can cause some difficult-to-treat coronary lesions. \"Incredibly concerned\" is an unfortunate word choice, positive stress tests are a very frequent occurrence and you are stable. Don't get ahead of yourself you will know more after the cath about whether there is a problem and what to do about it."
},
{
  "instruction": "31M,169cm,95kgI want to ask. previously I had taken aspirin and clopidogrel as instructed by the cardiology clinic. at the same time I had an appointment with a gastroenterologist because of a stomach acid problem and the gastro doctor told me to stop Clopidogrel. When I take Aspirin and Clopidogrel Blood test like Red blood cell Hemoglobin Haematocrit is high and it was abnormal last month. My question, If I stop clopidogrel on the instructions of the gastro doctor will it cause 3 types of blood readings to increase more in the future",
  "input": "",
  "output": "Clopidogrel and aspirin do not affect your red blood cell or hematocrit that being said you should speak with your cardiologist before stopping those medications"
},
{
  "instruction": "40\/F 5'7 175 lbs: gerd, anxiety, bile reflux, asthma, allergies. Cardiology concerns- calcium score of 149, ldl 191, total cholesterol 281, family history of heart disease at a young age.My cardiologist just prescribed Rosuvastatin 40mg. The bottle says not to take within 2 hours of magnesium or aluminum antacids. Does that include esomeprazole magnesium? I usually take all my morning medications (esomeprazole, zyrtec, fluoxetine, vitamins) together- do I need to wait 2 hrs to take the statin?",
  "input": "",
  "output": "No your esomeprazole should be fine"
},
{
  "instruction": "My father was in his late 40s and went on a walk. He was 160 lbs and 54 and vegetarian, didnt drink or smoke, and exercised pretty regularly. He called my mom and told her he couldnt breathe. She drove to him and got there within two minutes (he wasnt too far from our house). When she got there he was unresponsive and another passerby had started cpr and called 911. He revived before the paramedics got there and was able to talk to my mom. He even called her on the way to the hospital in the ambulance and told her he got there. As soon as he got there he lost his pulse. They did cpr on him and tried to revive him for an hour before they called his death. Im very lost. How could he have been revived on the sidewalk but not in the hospital. I thought cardiac events were treatable if they were caught within the first few minutes. He had calcium deposits on his heart and had tested positive for covid two weeks prior. Any insight would be greatly appreciated as Im looking for some understanding and closure.Edit: thank you all for your comments. Ive read all of them and really appreciate the insights you all have given into what could have happened. Im talking to a doctor about getting a cardiology consult for my siblings and I to make sure there arent genetic\/other issues. Im also making sure my family will get the updated covid booster shots. My dad was pretty religious and we therefore cremated him as soon as possible, because thats what he would have wanted, and tbh I value fulfilling his last wishes more than an autopsy at this time. Ive also gotten my mom and siblings into grief counseling and am looking into options myself. Thank you again for all your kind words.",
  "input": "",
  "output": "Hi. I am very sorry for your loss.Some cardiac arrest cases do happen in healthier individuals and can be fatal. Not all cardiac arrest cases are treatable even in an emergency.It's normal to feel lost right now, but you will get through this. Grief counseling may be helpful in your situation for closure."
},
{
  "instruction": "OP, Im NAD but my dad passed suddenly and unexpectedly from cardiac arrest 10 months ago as well. He was 66, and had received a clean bill of health from his doctor 2 weeks prior. I just want to say, I am so incredibly sorry for your loss. I know how youre feeling. Grief is such an incredibly tough journey, one that Im still in. The first few months are the hardest, I got into grief counseling immediately and talking about my dad to someone really helped me. Just know that everything youre feeling is ok, and its good to ask questions. My thoughts are with you and your family.sacca:OP, I'm NAD, but as a hospice volunteer, many hospice organizations offer grief counseling services even if the person was not involved in their hospice program. These sorts of orgainzations might be a place to start for grief counseling.Grief is different for everyone, and for many it's like a roller coaster that eventually levels out, but the ride is uncomparable to anyone elses - give yourself time and space especailly now. I lost both my parents a little suddenly (they were in their 80s, but not much warning) and for me, years later, the roller coaster has become much flatter, with more tender memories than anything else.Another person: Adding to the story chain for OP.When I was 27, I had a massive widow maker heart attack in my larger artery (LAD). I was only 27.I didn't know I had a blood clot in my heart, because I didn't know I had a clotting disorder. The LAD was 98% clotted. Sometimes there's more silent things happening in our bodies.I'm really sorry for your loss OP.",
  "input": "",
  "output": "Im sorry for your loss. Without an autopsy or knowing your family history its impossible to know. He could have had a pulmonary embolism or myocarditis leading to ventricular arrhythmia as a result of his COVID. He could have a genetic syndrome such as Brugada or ARVC or the like. He could have suffered a massive heart attack though thats probably least likely."
},
{
  "instruction": "Cardiac incidents are complicated. You mention that he had plaque (calsium deposit) in his heart, which can cause heart attacks, he might have been revived at first and then suffered another attack later causing him to pass away. Having plaques in the arteries of the heart is one of the main causes of heart attacks, and if a piece of this build up breaks off a blood cloth might form around it, blocking the blood flow to the heart starving it for oxygen which is a potentially life threatening condition.That's a question better fit for a Cardiologist, as an EMT it's a little outside my job description to know the fine details about the tests. I know they use duplex ultrasonography which is an imaging tool that uses sound waves to check the flow of blood in the veins. It can detect blood clots and blockages in the deep veins. But I'm not sure how much\/little build up there has to be for it to detect it. They also use a blood screening called \"D-dimer\" which is a substance that is released when a blood clot breaks up. Again, I'm not sure how sensitive the test is.",
  "input": "",
  "output": "Im sorry this happened to you. My father died In A similar manner, playing tennis. He was in great health, it was a terrible shock to our family and left me fatherless at a young age. Your father likely had a cardiac arrhythmia, it could be related to the Covid virus as it can settle on your heart. If there is no cause of death found at the autopsy it will fall under the category of sudden cardiac death. Resuscitation is not like in the movies and has a low likelihood of good outcomes especially in the field (outside of the hospital). Sometimes despite everyones best efforts people still pass, do not blame yourself or anyone else as these are just acts of nature or God."
},
{
  "instruction": "I (22F) found out I have a pulmonary embolism on november 2nd. It is in the posterior basilar segmental pulmonary artery of the right lower lobe. Its acute (d-dimer at 1,170), I wasnt really concerned honestly. I have been in and out of hospitals my whole life (Im not very lucky when it comes to my health) and ive gotten to the point that I dont stress out whenever I get diagnosed with something new. The ER doctor suspects it was caused by my BCP (combined) along with post-covid stuff (I had covid in july\/august of this year).I work as a phlebotomist and recently added an MA type position to my job role at a preventive cardiology office. So I am in the medical field but I dont know a lot about medical stuff - moreso just what I learn from patient situations and what I hear around the office.The first day back at work, a lot of co-workers were extremely concerned and worried about me, some said things like im so glad youre alive!. I appreciated all of the kind words from everyone but it got me a little nervous about how serious this is??Should I take this more seriously? And be more aware of my symptoms? I can take my vitals daily at work and do little things like that. I am so lucky that this happened while working at a cardiology office as the doctors there are keeping an eye on me and basically just told me to monitor my d-dimer at the office and refill my own prescription for eliquis etc etc. Obviously giving them the blood work results if there is anything concerning.The only thing I have changed in my life is that Im constantly wearing a mask in public as I really dont want to risk getting sick right now. When I started eliquis while I was in the 2 weeks of 10mg twice daily, I sneezed and got a nose bleed (I havent had a nose bleed in a good 10+ years so thats not normal for me), so I really dont want to be constantly coughing or sneezing. I used to try to wear a mask out in public whenever I remembered to bring a mask with me and I avoided large crowds as I am immunocompromised anyway, but I wasnt extremely strict with it. Ive also been wearing compression socks since I started this recent BCP.Should I be more careful in other places? Is this something I should be really worried about? I feel like Im doing enough but the comments I get whenever I mention my PE to someone kind of scare me.Medical info : 22 Female 5ft8 ~155lbs White. Diagnosed with psoriatic arthritis at age 2 (arthritis, psoriasis, and uveitis). PCOS, endometriosis, and a septate uterus (the main reason Im on BC). Hypermobility (probable EDS). Frequent concussions (recently got a referral to see a neurologist for this). Guillan-barr episode in October 2020 due to an insect bite on my neck. Paralyzed from the neck down, was in the ICU for a week for precautionary reasons but never needed a ventilator. GB isnt reoccurring and not on any medications for it. ADHD (along with depression and anxiety) and PTSD.Humira bi-weekly for uveitis. Eliquis 5mg twice daily. Falmina (BCP). Prazosin for PTSD (nightmares). Cymbalta for depression. Vyvanse for ADHD (not taking currently due to concussion and PE. Vyvanse makes me extremely tired and Im already tired from my PE so I dont want to make myself even more tired). Pred-forte eye drops for uveitis (SIG changes constantly, currently on twice daily in both eyes).Extremely light drinker (last drink I had was sometime in September). Occasional marijuana use for humira side effects and pain (~4 nights a month).",
  "input": "",
  "output": "PEs are like car wrecks. Some are horrible and kill you instantly, more often they are a semi big deal, and a lot of the time they happen and are lame but you werent really at risk of dying on the spot. But regardless, if you tell someone youre in a wreck theyll gasp and ask if you were ok.Sounds like you had a small subsegmental PE which as you said couldve been provoked by your medication. Take your eliquis which will prevent new clot formation and your old clot will dissolve with time"
},
{
  "instruction": "male\/ 37 years old\/ 230lbs\/ 6 feet tall\/ non-smokerI've had chest pain since my late-20s. For about 12 years, I've had high cholesterol due to a rather poor diet. My total cholesterol is \"borderline\" high according to the ranges, at around 230 mg\/dL, my LDL is usually around 160 mg\/dL and my HDL is around 50 mg\/dL. My blood pressure is always pretty good at around 115\/78.Due to the chest pain not going away, I was sent to a cardiologist who did a whole cardiology workout: echocardiogram, loop monitor, EKG and a calcium CT scoring test. Everything came back fine and my calcium score then was \"Zero\" , which the cardiologist said is a perfect exam.Since then, I've been diagnosed with a hiatal hernia and anxiety. I've started Zoloft, which has made my chest pain 85% better. I still get it at times, and my doctors are convinced it's my hiatal hernia creating pressure in my chest and\/or pushing on my vagus nerve.Fast forward 6-7 years to today, I just really started getting my diet in gear about 2 weeks ago but just at that time before I started, I wanted to get a baseline blood work to compare. My cholesterol was the same as it usually was for the last 12 years but my primary care physician said my C Reactive Protein is 5.5 mg\/L , whereas when I had it drawn years ago , it was around 3.0 mg\/L. He said \"you really need to focus on lowering your cholesterol. That CRP could be due to your arteries starting to narrow and atherosclerosis starting to happen.\". Would the calcium score test from 6 years ago change that much in that time?I am not \"fat\" and have really wide shoulders so I carry my weight differently but I know I should definitely lose weight and eat better, which I definitely have been. Hearing that my CRP is now high, I am worried that there is now narrowing in my heart. Should I go back to my cardiologist and see if I can have a repeat calcium scoring test or even a CTCA?",
  "input": "",
  "output": "More than anything you need treatment for your cholesterol. Are you on a statin? Poor diet does not by itself lead to an LDL of 160 in a 37 year old."
},
{
  "instruction": "thank you. I am not on a statin. My doctor said given the fact that I got my LDL down to 118 a few years ago when I tried eating more fish (salmon), he said I can do try the diet route again if I stick to it. He also knows I don't exercise much due to the pressure I feel from the hiatal hernia.",
  "input": "",
  "output": "It is worth considering. While you are young your elevated lipids and hsCRP are enough to at least consider it"
},
{
  "instruction": "79M approx.. 6 195 lbs. asthma (we have no idea what meds he is on or prescribed at ER)My FIL (79M) was taken via ambulance to a small local community hospital on Tuesday and diagnosed in the ER with having had a TIA due to Afib. Heart issues is something that was unknown to them previously so he was not previously on any meds for that. My husband got up there in time to interact with the doctor at discharge and specifically heard the doctor tell FIL and MIL that he needed to take the meds he was being prescribed and see cardiology and neurology as soon as possible. This was a small local community hospital outside of San Diego but they are in an area with a large senior population where they probably see this a lot. My husband felt the instructions were clear and relayed succinctly.Because my own father has a long and fantastic experience with both cardiology and neurology at the large very well respected university medical center my husband asked me if I could make appointments for his father there as we figured inlaws were overwhelmed among other issues. I was surprisingly able to secure him appointments for this Monday and Tuesday respectively (6 days post ER visit). Husband told MIL that evening that appointments were secured for FIL at the university hospital.Now today my husband learns that MIL took FIL to their GP yesterday (day after he was released and before specialist visits) to their GP (whom my husband refers to as Dr. Quack due to his negligent care of his aunt resulting in her subsequent death due to melanoma so we may be biased here and this is why we are asking) told him he didnt need coumadin that he was just stressed and he just needed some Xanax to relax. So FIL told my husband today that he stopped the meds that ER doc overprescribed and am just taking the Xanax. I FEEL GREAT! FTR we have no idea what the other meds were and now they wont tell us.MIL is exploding at my husband and accusing him of a lot of wildly ridiculous things and FIL is trying to keep the peace and just shutting down. As a bit of background there are A LOT of issues with MIL and her behavior and this is pretty standard. Husbands basic rule is that we just need to prevent her from harming others and just tune her out otherwise. So our question is will this change of meds harm FIL and husband needs to intervene more strongly or is this something standard? TIATLDR: is it medically acceptable for a GP to remove someone from blood thinner (Coumadin?) less than 48 hours after a TIA and replace with Xanax even before they have seen cardiology or neurology?Edited to clarify timing",
  "input": "",
  "output": "Everything here is just odd. No way of knowing what's what without the hospital records. Please be sure to take them with you to the neurologist and cardiologist."
},
{
  "instruction": "Thank you for responding. Right now they are saying he is not going to cardiology and neurology because GP told him he doesn't need it. (again husband and I do NOT trust this GP and believe the ER). Husband had me call the university and make sure the appointments cannot be cancelled unless they call my husband's number. Our question is will he be fine like this until Monday or should husband intervene with the nuclear option and go collect FIL when MIL is out and take him to urgent care?",
  "input": "",
  "output": "Unless FIL is cognitively incompetent, they should be able to make their own decisions. They have all the information from the ER and GP to go on. This is a complicated situation and your question is not answerable without more detailed\/nuanced information and discussion of pros\/cons. Being on Coumadin is either a necessity or a huge liability (quite often both) depending on factors we do not know here on Reddit."
},
{
  "instruction": "34 female 5'9\" 230lbsNon drinker, light smoker but almost completely quit since the heart problems started. Had covid 6 weeks ago with no complications. No history of heart problems or high BP.It started less than 2 weeks ago with drops and spikes ranging from 90\/60 to 180\/110Now it's sustained high BP and elevated HR. I did go to the ER Monday just to make sure it wasn't something acute as there is accompanying chest pain but the entire time I was at the ER my BP was very low as was my HR.I have a cardiology appointment next Friday but every day since Monday I've been waking up with systolic in the 150s. I feel physically panicked all the time and it's starting to affect my sleep. I've already doubled my propranolol from 40 to 80, I take klonopin and prazosin daily as well, and I've added clonidine and antihistamines to also try to keep it lowered. Even taking all of those at once it barely makes a difference.I have a good life right now i can't think of any stressors other than being in love, but I feel like I can't do anything or be there for anyone because my body is fucking panicking 24-7 nowI can't do this much longer. It's obviously not an emergency but I feel awful not at all being in control of my body. It's like something flipped the fight or flight switch and it's stuck on high. This does not reflect my mental state at all.",
  "input": "",
  "output": "How regularly are you taking the clonidine? That frequently causes rebound hypertension."
},
{
  "instruction": "Age: 8Height\/weight: Average, not sure exactly but last i was told, she's within normal rangeFemaleCaucasian\/ HispanicNo previous medical history, no prior surgeriesnon-smoking householdWe all had covid in December 26th. It was rough but we all recovered. Me and my husband were vaccinated. My kids weren't because their clinic wasn't providing the vaccines yet.I'm going to try to be thorough as possible because it's just so much going on with her and i don't know where to start and her symptoms are all over the place... Last summer she was in someone's house that had a rabbit. The rabbit was filthy and it scratched the top part of her hand. Her hand began looking infected because even though i washed it and put neosporin on it, kids are kids and she couldn't keep it clean and soon it began looking red. She got a fever roughly around that time and was complaining of headaches and that her \"throat feels tight\". I took her to her clinic and they drew blood to test her for \"rabbit scratch fever\" It came back negative..They figured she just caught a virus and nothing became of it. The scratch eventually healed with an ointment they gave her. That same summer she..again...being a kid, didn't listen to me and was rolling in grass in her grandmother's yard which we have found ticks in. She ended up with a tick in her head which by the time we noticed it amongst her hair was engorged. I pried it off her. My daughter again, began complaining of headaches and her body hurting, \"tight\" throat. I took her to the ER and had her get tested for lyme disease it came back negative..It's now almost a year later and her headaches \"tight throat\" and body pain just come and go sporadically. I would chalk it up to growing pains which is what everyone was telling me. Her doctor never seems concerned...But sometimes the headaches are so intense she will cry and lay down and ask for a cold towel for her head...she's 8. And now on top of it all she's got new symptoms. She came to me about a week ago saying her butt felt weird like it had \"dots\". I tell her to show me and all over her butt and upper thigh area she is covered in what look to be pimples. Its so odd. My mind automatically went to \"bed bugs!\" So i checked the beds from top to bottom but found nothing. She still has trouble sleeping some nights and comes to sleep on our bed so if it was bed bugs why is she the only one with the dots? I'm checking her daily and it's as if she's got a new \"pimple\" everyday...again, she's 8...wth..Another new symptom she has is she's been getting heart palpitations. One minute she's playing on the floor or on the sofa, and the next she will come to me saying her heart is beating rapidly. I put my head on her heart and i feel her heart beating quickly. It scares her and i have to scoop her up and hold her for a while. She has also started hypervenilating when she's upset. Something she's NEVER done in her life. We aren't strict with her and she's a happy child, why would she start doing that? She says she can't help it.I took her to her doctor roughly two-three weeks ago because i had enough, i told her doctor everything from the summer to now. From the body pain to the heart pain and showed him her butt pimples and asked him to please help because we are at our wits end. He checked her out and said her heart sounds fine to him. He also was dismissive towards her skin problem. He did however notice the lymph nodes around her neck were really swollen. He ordered her to get blood work done and it came back last week. She has covid anti-bodies in her blood. She tested negative again for lyme (im guessing he just wanted to double check in case the other one was a false negative) and showed what he thinks might be her in \"Recovering\" state of cat scratch fever? ...ok? We have cats so i guess that's possible. He sounded so unsure with himself. Sighing a lot and kept going \"eh...i don't really know what to tell you...\" and stumped with her blood work. He sent her a prescription for Azithromycin just to be safe. She has to take this every day after dinner.Thing is, she's still complaining about her various symptoms. And it's been days since she got the medicine and now she's more frequently telling me her hearts beating quickly. So im afraid to continue giving her the medicine in case that's whats causing the palpitations. I have sent various messages to her doctor two days ago but he isn't calling me back. I'm tired of waiting for him and already went ahead and made her an appointment for both pediatric cardiology and dermatology. I also found a new pediatrician because i've had it with this guy. Both appointments are next week. But until then i'm just a bundle of nerves. I hate when she comes to me saying her heart hurts or her head hurts. Can anyone here please tell me whats wrong with my baby girl?Edit: were at the ER now. She started complaining of heart pain and palpitations and Im done waiting. Will update depending on what they say",
  "input": "",
  "output": "Time for a new doctor. Its not typical for 8 year olds to get heart palpitations"
},
{
  "instruction": "Yes, but I was just told by a pediatric cardiologist that this is happening with children who had Covid and were t vaccinated. Im going through similar with my 8 year old.Edit: werent vaccinated, not were.The reason I stated what I did and kind of barged in here to comment was just to bring light to this issue.Theyre monitoring her for now. They had to her a holter monitor for a few days, then some testing. She was fainting and her lips were turning blue when she would have her palpitations. I also have them and get dizzy but never blue finger tips or blue lips.I hope all ends up okay. I know how scary this is for both of you.",
  "input": "",
  "output": "How long does it last? If it lasts 15+ minutes, it might be worth your peace of mind to get her on a monitor in the ER. If its only a few minutes then she probably needs a holter monitor or evaluation with a pediatric cardiologist."
},
{
  "instruction": "29F, non-smoker with history of NSVT. Diagnosed in 2011. NSVT was then changed to PSVT in patient records without my knowledge until recently.Diagnosis would present with palps, lightheadedness and tunnel vision. It occurs randomly with no clear trigger.I had a new holter applied for rapid pounding heart with dizziness and angina.Holter findings were reported normal with low burden PVC and sinus tachycardia. (sinus tachycardia is expected culprit for rapid heart and associated symptoms)However, VT was also noted?https:\/\/imgur.com\/a\/S2rMmmEThe comment states AIVR. And Im just curious if this is actually AIVR or PSVT? Or something else entirely.I do have an appointment with Cardiology in a few weeks.",
  "input": "",
  "output": "Characterized as AIVR because rate is <110 with widened QRS.PSVT is usually in the setting of tachycardia so rate goes from normal to very high. Had a few more beats (like those shown) at a faster rate happened, it may have been called PSVT."
},
{
  "instruction": "That makes sense, thank you!Do you know if PSVT and AIVR have a habit of appearing hand in hand?",
  "input": "",
  "output": "Not typically. My best guess is this was a small run of soon to be PVST that corrected before becoming tachycardic."
},
{
  "instruction": "29M 62 181lbs Hypertension (20mg olmesartan qd) and recently recovered from mild COVID infection, otherwise no significant medical hx. I do also take melatonin nightly and use an occasional ginger root supplement.I was on a beach trip over the weekend and we stopped to grab some brunch around 10am before my girlfriend and I drove back home. I drank a cup of coffee at brunch, and felt a skipped beat kind of feeling, so I took an Apple Watch ECG. To my surprise, I noticed that I was popping anywhere from 2-10 PVCs\/minute, which I have no history of.I rode it out on the way home and tried to forget about it. I took a few more random Apple Watch ECGs, and the frequent PVCs have been consistent all day. Finally a little after we got home, I decided to go to urgent care just to get seen. They did an ECG, which didnt capture any PVCs on the 10 second strip of lead II. But the NP said she auscultated a few after they took the ECG. Confirmed on my Apple Watch theyre still happening.The NP basically told me shed give me a cardiology referral and to do nothing in the meantime, but to go to the ER immediately if I started having any chest pain or SOB. She basically said that there was nothing she could do in the urgent care setting and that I need a further cardiology work up.Is this solid advice? Am I safe? Or do I need to go to the ER? Besides the initial skipped beat feeling, I havent been symptomatic at all.I will also say, I had a good bit of alcohol this weekend, more so than usual. Could it be alcohol and caffeine?12 lead ECG from urgent careApple Watch strip with PVCs",
  "input": "",
  "output": "Yup wait to follow up with cardiologist. ER if SOB or chest pain. Caffeine and alcohol can certainly contribute"
},
{
  "instruction": "40M 5'8 160 pounds. As part of my team of doctors (3 cardiologists, primary care doc, endocrinologist, neurologist, etc.), we've been hunting down some autonomic issues that I have been having. I haven't had blood work in a couple of years because I have been pending Disability since last year and had a work injury the year before that. My autonomic issues worsened over that time.If TLDR, can a Cardiology office request the same type\/amount of blood work as a primary care doc, for instance?I don't have a primary care doctor presently because I had a good one and he moved away back to his home state a while ago. Most primary care doctors are unfamiliar with specific autonomic dysfunction conditions, so my third cardiologist is the specialist in autonomic issues. They want to do blood work. Of course, I'm asking their office what kind of blood work they can do, as well. But since it may be days before they can get around to that general question, this is a two-part question:I'm wondering if any doc can explain the difference between which offices (primary care, cardiology, endocrinology, etc.) can do what types of blood work and if they are 'limited' in what types they can request.Also, is that that limitation solely based on the provider themselves being medically unable to request beyond specific blood work related to their specialty or is it just because they're not familiar with other blood values? For instance, I asked my neurologist one time about blood work values from a cardiology tilt table test and he said he \"didn't know how to read those blood gas levels\". So that told me that of course that's not his specialty, and I knew that, but he was the one who asked about blood work to begin with.",
  "input": "",
  "output": "Any doctor can order any kind of blood work, but the limitation as you've found is the ability to properly interpret it."
},
{
  "instruction": "Im 20F with a long standing family history of heart failure. Ive had intermittent chest pains due to chronic Tachycardia but last night it was unbearable and I went to the ER because I thought I might be having a heart attack. I waited approximately 2 hours after initial onset to leave work bc another manager needed to be present. My mistake but I eventually shut down the store out of fear and went. My ECG was flagged abnormal for nonspecific T wave abnormalities on the inferior leads. But thats always on my ECG. However the hr recorded was 72. My avg resting hr is 98. Could I have had a cardiac event that ended before I got to the hospital? negative D Dimer low average Lactase and high PT (12) and PTT (54) INR 1.1. Chest X Ray clear. Should I push for a cardiology referral given family history? or was it likely a fluke?",
  "input": "",
  "output": ">Should I push for a cardiology referral given family history?No, they would probably decline the referral given your normal investigations.>Could I have had a cardiac event that ended before I got to the hospital?Incredibly unlikely.Also:>Ive had intermittent chest pains due to chronic TachycardiaI doubt these two things are related."
},
{
  "instruction": "34, male, 5'9\", 260lbsnon-smoker, rarely consumes alcohol (1 or 2 a month, if at all), tried a friend's THC vape once, no other recreational drug use.medications: effexor 150mg, concerta 54mg, advair 2 puffs daily, albuterol rescue inhaler as neededhealth conditions: anxiety, depression, ADHD, moderate asthma (all very well controlled on current meds)medical history: knee surgery 2012, initial 2 COVID vaccines March and April 2021 + booster November 2012, had COVID February 2022.Background of Current IssueHad a mild case of COVID-19 in February. Main symptoms were swollen lymph nodes on the left side on my neck and armpit and frequent heart palpitations.Symptoms went away until April, when I started having sudden heart palpitations randomly throughout the day. When the palpitations end, my the same neck and armpit lymph nodes swell up painfully for several hours.Symptoms got bad enough that I thought I was dying and went to the ER. Not dying, just something that can happen post-covid. Minor abnormalities on ECG, Doctor explained why they weren't concerning in my case.After a couple months of reducing caffeine intake as much as possible ( about 2 cups of coffee before work, no more canned coffees or caffeinated tea at work), it seemed to have gone away.About two days ago, it came back. Didn't recognize the symptoms for what they were and went to the ER again. Slightly different abnormal but not concerning ECG. Blood pressure was high, went back down to normal by the time I was discharged. Negative COVID-19 test. Same left side lymph nodes painfully swollen.My Question for AskDocs:I plan to see a cardiologist about the heart palpitations since they have been so frequent after coming back.Is there any other specialty that might be able to help me? Or would making sure my heart is okay be enough?",
  "input": "",
  "output": "Cardiology will handle the palpitations.Without seeing your ekgs I can't tell you much more. There are many causes of palpitations, if the ER discharged you then the palpitations we're probably due to PACs or PVCs which can be treated by your PCP or cardiologist to reduce your symptoms, but like I said, can't say much more without the ekgs or more info."
},
{
  "instruction": "Age: 21. Weight: 160. Gender: male. Height: 5'7\". Diagnosed with asthma.I had a cardiology appointment today. I was told that I had a heart murmur and I had a bunch of tests scheduled..the soonest being A WEEK OUT. With my echo being months out. Seems like a heart murmur could easily kill me. What's up.",
  "input": "",
  "output": "Many heart murmurs are caused by non-life threatening things. Unless you are having signs or symptoms of life threatening things (passing out, chest pain, severe shortness of breath, etc) doctors will investigate things in an outpatient setting. For example, most cancer work ups (arguably more life-threatening) are done in an outpatient setting."
},
{
  "instruction": "Mandatory info: 30M, 6'3\", 185lbs, white, near syncope with heart pains for the past week, EKG abnormality. Don't smoke or use any recreational drugs, have used Ambien (5-10mg) to treat insomnia intermittently for the past 3 years. No preexisting conditions.Last week I had back-to-back instances of severe chest pain, followed by a hot flash \/ sweating and dizziness that persisted for about 60s. This occurred at the airport, and resulted in me getting transferred to the ED for evaluation. Paramedics conducted a few EKGs, and I heard them say there appeared something anomalous with \"B3\". At the ED, had an additional EKG, chest x-ray, and ultrasound with no acute findings. No bloodwork done. Cleared to fly, completed my work travel, returned home with a PCP appointment scheduled for this morning. The intermittent pain \/ palpitations \/ weakness \/ dizziness has persisted since the first episode.At PCP visit today, another EKG was done and compared to my past EKGs done at that office. My primary found an anomaly in Lead 3 (which I assume is what I misheard the medics identify), and ordered bloodwork (troponin and lipid panel, amongst others). Gave me an urgent referral for cardiology, wants me to get a Holter monitor and stress test at a minimum.My question for all you wonderful people: what is the pathophysiology that leads to an anomalous Lead 3 finding on an EKG? How worried should I be?",
  "input": "",
  "output": "Impossible to say without seeing the ECG and exploring. Lead 3 (in conjunction with others) corresponds to the inferior portion of the heart. But there are many things that could be showing in this lead on your ECG."
},
{
  "instruction": "F30. Ive had these transient episodes of PSVT for some years now, following an Epstein Barr infection when I was 22. Ive had a cardiology referral before, with a 3 day monitor. It caught nothing, so they diagnosed me with Anxiety and sent me away with a low dose of Propanolol if I wanted it.These heart episodes are making my life a living hell. They are destroying my relationships and my ability to function in my daily life. I used to work, but now I dont. Ive had to give up my job because I couldnt cope with the interrupted sleep (they specifically wake me up from a sound sleep, usually around 3am). This is obviously very frustrating for both myself and my partner.Went to ER with chest pain after the last episode, and the ER doc wanted to get me a 21 day heart monitor - which would definitely catch it as my episodes appear in clusters, a few times a month. There appears to be a hormonal component to it.Ive completely cut out caffeine but the effect that has had on it has been minimal.Now, the NHS is saying that they will refer me to cardiology when my anemia is sorted. But, its never sorted - at least, not without iron infusion therapy (I have IBS and dont tolerate oral tablets well).I did have an iron infusion months ago, which picked my Hb levels to no longer anemic - but didnt get the referral then either. On the contrary, I heard nothing from my GP, for months, and now Im back to being anemic again - its so hard to maintain my iron levels without routine IV iron, and the only time I get it is if Im in hospital for another reason (last time was Gynae related).Im beginning to lose hope that this will ever be resolved and worry that Im just going to drop dead of an unidentified cardiology issue.Is there any way I can get the cardiology appointment and have my cardiologist take me seriously instead of attributing it to anemia like last time, because my resting HR is 60bpm, these SVT episodes are a very distinct and immediate jump to a hr of about 170-200bpm, and they arent anxiety related at all. They also definitely arent anemia related because even when I am no longer anemic, I still get them. Twice monthly, around the times I ovulate and right before my period. Predictable as clockwork.I just want them to stop because they make me afraid to sleep at night and as a result I have developed pretty terrible insomnia, and depression due to the constant fear of wondering if something is severely wrong with me.",
  "input": "",
  "output": "I dont understand why you had to give up your job if they only happen twice a month like you say? Do the beta blockers work?"
},
{
  "instruction": "I was training as a student nurse, but the stress from this has been too much for me to cope with tbh.Im reluctant to take BB because my resting heart rate sits at 60bpm, and tbh theres nothing wrong with my resting hr. I would prefer to have an ablation than take daily unnecessary medication for the rest of my life?",
  "input": "",
  "output": "Im sure the cardiologist assessed your pulse before giving you beta blockers, have you tried them?"
},
{
  "instruction": "That was when I was 25, and Im 30 now, so its been a while since my last cardiology review (during which time these episodes have gotten more frequent and last longer) and the cardiologist hadnt ever actually seen an ecg tracing of this issue, which I think is a pretty important piece of diagnostic information. Id personally advocate for my patients that abnormal ecgs are reviewed, so why not mine?Ill ask my GP about trying a low dose BB, but I dont expect it to do a great deal other than lower my BP a smidgen.",
  "input": "",
  "output": "Id be surprised if a cardiologist ordered a 3 day monitor without reviewing an ECG first.If I was you Id go back and take the beta blockers, give them a go. If they fail then go back and say I did what you said doc whats the next steps. The outcome will either be finding a treatment that works in primary care or youll be referred back to cardiology."
},
{
  "instruction": "I have also been having infrequent runs of (possibly) SVT, which also seem to be hormone related, although Sods Law they have never appeared when hooked up to hospital machines, only a 6 lead home device.I also have a resting HR of 50-60 but have found beta blockers insanely useful. I take a super low dose of bisoprolol and it seems to be just enough to stop my heart going into these fast rhythms but not so much that my heart feels too slow. I was sceptical at first too, but Im glad I gave it a go. I drink a tin of coke each day and take stimulant medication and I will only get a brief run of SVT once in a blue moon. Whenever Ive stopped the beta blocker the issue has come back so it must be doing something.I hope you manage to get to the bottom of things and find a solution!",
  "input": "",
  "output": "Meds are helpful as mentioned and usually pretty well-tolerated unless you have AV block or hypotension.Depending on frequency, length of the episodes and preference cardiologists generally use either chronic preventive therapy with a beta-blocker or calcium channel blocker, or pill-in-the-pocket with flecainide or beta-blocker. If you have a favorite vagal maneuver those can sometimes work too.These are very rarely life-threatening. Ablation is effective but can't help you negotiate the NHS system. Fixing the iron deficiency will also help. Our hematologists do have some patients with chronic iron deficiency anemia who can't catch up with oral supplements who have scheduled IV infusions, but only after every possible source of ongoing blood loss or iron malabsoprtion is addressed (celiac, heavy menses etc)."
},
{
  "instruction": "40M 5'18 160 pounds. Over the past few years, some weird symptoms either developed or got worse. I was lightheaded back in 2018 and a neurologist found nothing wrong with me. Late December, symptoms sent me to the ER with elevated blood pressure, white blood cell counts at 14.5, stomach and intestinal pain, rapid heartbeat, etc. My heart rate and blood pressure rapidly fluctuate. My heart rate varies by at least 20 beats per minute from the base line. So I'm sitting and the base is 70, it will go 72, 75, 78, 80, 82, 85, 87, 90...88, 86, 84, 83, 0, 78, 75, 72, 70 and sometimes do that whole course twice in a minute. I am not known to have ever had Covid and I am presently fully vaccinated, as well.Over the past few years, I've been seen by primary care, neurology, gastroenterology, endocrinology, had head\/abdominal scans with nothing noted, saw 3 cardiologists, wore 2 Holters for a month, had lots of blood work and such. Stress Echo via treadmill showed a healthy and strong heart.Diagnosis of Postural Orthostatic Tachycardia Syndrome by primary care, neurology and cardiology. Dysautonomia\/autonomic dysfunction got thrown vaguely into the mix, as well. Tilt table test would have been negative for POTS. I didn't faint or have the rapid rise in heart rate. They gave my sublingual nitroglycerin and I fainted within a short time. BP went down to 97\/56 and pulse to 40, possibly only because of the nitro. I am lightheaded 24\/7. Even just lying on the bed at night, I feel little sharp \"zaps\" of lightheadedness. I'm familiar with BPPV and it's not that. The POTS no longer applies - I am rarely tachycardic. Also, my blood pressure is now more so low on a daily basis. For instance, earlier today it was 99\/57 after a meal that was quite heavy in salt. I seem to always crave salt and can't seem to get enough of it. I am completely exhausted every day, have no energy and my entire body is hyperreflexic.I have hundreds of tiny little red bumps all over my upper and lower back and the backs of my arms. They do not itch. Back in 2020 an EGD showed an inflamed stomach lining with negative biospies. 6 months of Prisolec 40mg twice daily at that time didn't help. He put me back on the 40mg twice daily again. It was after that point that I ended up chasing the POTS\/autonomic dysfunction stuff and had not seen the gastro doc since because I later lost my job due to a work injury. I just saw my gastro doc again recently. After reviewing my symptoms, he asked if I have ever seen an allergist. Then when I told him about the horrific lower colon pain that I get at times, constipation on average of 2-3 days at a time due to inflammation preventing a bowel movement, the feeling of inflammation and severe burning\/clawing pain for hours even after a bowel movement and such...he feels that I may have something else going on in my colon. He brought up Crohn's and said it was sneaky sometimes. I showed him photos of my pie crust-like tongue that seems to swell at times and I get canker sores in various areas of the mouth and have for a long time. I showed him a photo that looked like I was pregnant - considerable lower colon swelling and abdominal bloating. Also, what makes me think some of my other symptoms like the low blood pressure and such may be related is because when I press on my lower colon area or rub it, my ears immediately ring and at times I get nauseous. There's no way that's a coincidence given how often it happens.I'm always hungry for big meals even after I just ate a big meal recently. I get considerable postprandial hypotension. I haven't worked in 2 years, pending Disability. Gastro doc requested CBC, Comprehensive Metabolic and Thyroid\/TSH panels. All within normal range except the thyroid panel:T3 UPTAKE 24 Reference Range: 22-35 %T4 (THYROXINE), TOTAL 10.9 High Reference Range: 4.9-10.5 mcg\/dLFREE T4 INDEX (T7) 2.6 Reference Range: 1.4-3.8TSH 2.25 Reference Range: 0.40-4.50 mIU\/LThe only flag was the T4 Thyroxine and it's only 0.4mcg\/dL higher than the highest normal reference range. All other blood work was fine. This reference range seems normal and also what is 'normal' seems to vary considerably depending on what source you compare it against.Severe burning\/clawing sensation in the lower colon just below the navel. Worse at night, but moderate pain 24\/7. Full-body malaise, jitteriness and rare spikes in blood pressure with full-body tremors as if freezing cold for 15-20 minutes. I get even more colon pain during this time and at times feel feverish. I have had unexplained blood pooling in my hands and feet since I was a teenager. Heavy nausea immediately after lightly pressing or lightly rubbing the lower colon area below the belly and middle abdomen. No vomiting. Frequent bright yellow or greenish stools with some worm-like mucus in them. No visible bleeding. Upper body jolt-like 'tics' that feel at times as if they are originating from the lower abdominal area and cause my upper body to jump randomly in certain movements. With the lightheadedness, it feels like even when I'm sitting or lying down an djust move one arm or leg, I get a brain \"zap\" of lightheadedness. What in the world could cause that?I'm trying to get a colonoscopy to see for sure. Due to low income, the Colorectal Cancer Alliance has me on a list for funding for a colonoscopy locally when it becomes available, quoting possibly in February when more programs open.What are my chances of Crohn's\/IBD with the above issues going on? Could it also be the cause of my blood pressure and heart rate fluctuations? I'm puzzled at the normal white blood cell counts given that my lower colon was absolutely hurting\/inflamed during the blood draw.",
  "input": "",
  "output": "There's nothing here that suggests IBD, though that doesn't mean you can't have it.It's possible that you have IBD but your symptoms are pretty vague and not classically IBD"
},
{
  "instruction": "28YO female, healthy and an avid lifter. Referred to cardiology for heart palpitations and fast heart rate. Placed on 7 day heart monitor. Was told that I am in ST majority of the day. There were some skipped beats as well. Placed on toporol for management. Cardiologist said borderline concerned, due to how high my HR is. Said if it gets worse, things would change. These strips are from the Holter monitor report.",
  "input": "",
  "output": "ST = Sinus Tachycardia. It means the heart is working down the normal electrical system, but its going faster than normal. Often there is an underlying cause (and not a primary problem with the heart), but sometimes peoples hearts just go fast and we need to slow them down with medications like your toprol."
},
{
  "instruction": "Age: 36 years old Gender: Female Height: 5'4\" Weight 160lbs Location: USA Smoking: Never Meds: xyzal 5 mg daily for chronic idiopathic urticaria and angioedema 200mg Zoloft (serteraline)I recently gave birth. I had pre-eclampsia with high blood pressure, protein in my urine, headache and chest pain. I was given an ECG, EKG, and chest x-ray while in the hospital. I was discharged a couple days later and they put a zio heart monitor on me for 2 weeks.This past Friday I had a follow up appointment with a cardiologist after my monitor results, the other tests, and one more ECG. The cardiologist told me (in a relatively relaxed and casual way) that I have a long QT interval and that can increase the risk of sudden cardiac death. She referred me to a geneticist who I'm waiting on for an appointment.At the time my brain stopped working when she said death but now I'm trying to gauge what is.me.being overly health anxious and what is justified worry. I am emailing the doctor but I suspect it willl take awhile for a response since it is the weekend.But given that I have no history of drinking, smoking, drugs, eating disorders, or any vitamin imbalances. How worried should I be?? Like should ainbe saying my goodbyes?! Or do I just ignore it and my life will be relatively normal??? I haven't had any fainting spells and I don't THINK either side of .y family has a history of SCD. But on both sides there is cardio history -- my maternal grandfather died of a heart attack and my maternal uncle has had a couple I think? My paternal uncle has had a heart attack and I think my paternal grandfather died from one as well? But that one I am really unsure about.Is this the sort of thing that everyone has and is NBD?? Or is this the sort of thing where I need to 100% commit to completely devoting myself to Cheerios and heart healthy choices if I want to live???I really appreciate any help or advice you can give. I really know SO LITTLE about cardiology it's like I don't even know what I don't know.",
  "input": "",
  "output": "I'm sorry you're going through this. I don't think you need to say you're goodbyes at this point. There are varying degrees of prolonged QT intervals. Without actually knowing how prolonged it is it's hard to really guess. Depending on how prolonged it is it may be nothing to worry about but it sounds like you're in good hands with seeing a cardiologist and moving forward with workup."
},
{
  "instruction": "Thank you for your reply.I feel so ignorant about how hearts work I feel like my brain can't even comprehend the risk or understand. I'm not a particularly stupid person but this is all just beyond my capacity.",
  "input": "",
  "output": "Don't feel that way! It's a complex organ and no one would expect you to fully understand. You should reach out to your cardiologist and just see if they can explain it better to you, that may be helpful before seeing the geneticist and answer some of your questions."
},
{
  "instruction": "F49, 55, 143 lbsI had a severe allergic reaction and I almost died on Tuesday. I got stung 2-3 times by a yellow jacket while cutting the grass. I came inside to get some Benadryl and saw all these black spots (probably 4 minutes later). Then I was profusely diaphoretic, dry heaves, had copious amount of phlegm from my mouth and nose, couldnt breathe, weakness and was blacking out. It was so so fast.My husband (hero #1) happened to be coming from the airport so he called 911 and My 13 year old gave me one of her epipens in the thigh (she is anaphylactic to shellfish and buckwheat). First responders came (maybe 4.5 minutes) and I couldnt open my eyes, they put me on a blood pressure monitor and then it was alarming, so they turned the alarm off. Then advanced life support I think or Ems literally picked me up and ran me out to the ambulance. I think I blacked out and woke up and I barely remember the ambulance ride with sirens and lights and them laying on the horn. I could hear them saying we got gotta get her pressure up, we got nothing here. I remember trying to talk to them and my tongue wouldn't work. When I was conscious and realized the lights and sirens were on, i saw the seriousness. When I heard them say ETA 3-5 and BP of 40\/20 - I 'm like , that's not compatible with life. The paramedics worked on me the entire time. At hospital had me in a trauma room and called all staff over loudspeaker. Thankfully they got my pressure up and gave me another epipen and steroids and Benadryl. The epipen and lack of blood flow gave me some cardiac issues and Im following up with cardiology.That said, I dont feel right. Im weak. I keep waking up with nightmares about not being able to breathe and I keep replaying the incident in my head. I have little appetite. Do you think I would benefit from some counseling? Did I almost die? I feel like I certainly came close. Would I be a candidate for venom therapy? I feel like this if my only chance at a normal life.Is there any way I have some sort of Mast Cell Disorder for this to come on so suddenly?",
  "input": "",
  "output": "Sounds like a pretty traumatic experience and I'm sorry you had to go through that. It is normal not to feel completely yourself this quickly after such an event, and it may take some time to feel back to normal again.Medically, it is good that you have recovered. I must emphasize you need to have an epi-pen with you at all times in the event you do have another sting at some point. The strength will come back. It's hard to tell how bad off you are, but can say a BP of 40\/20 is pretty bad.Counseling is up to you. It sounds like you are having an acute stress reaction to a traumatic experience (think PTSD, but happening essentially immediately after). This may improve on its own, or may need some help to get through."
},
{
  "instruction": "Sorry to hear about how much has happened to you in such quick progression  I can imagine it was and continues to be very jarringBased on your description and recollection of the events, you went into severe anaphylactic shock which likely would have been fatal had your husband\/daughter\/EMS not been around. Will reiterate what has been said already to keep an epipen on you at all times moving forwardOnly other thing Id add to whats been said is you likely may be a candidate for venom therapy. However, it sounds like theres still quite a few things going on so take it one day at a time. Once everything else has settled, you may want to consider connecting with an allergist to receive venom testing  in Canada the 5 main sting tests we do are on honeybees, wasps, yellow hornets, yellowjackets, and white faced hornets. If you test positive for a stinging insect, venom immunotherapy can be 98% effective for the rest of your lifetime. That being said, its not cheap, and it can take 3-5 years of injections at the very leastWishing you all the best in your recovery!",
  "input": "",
  "output": "In reference to your last sentence - your mast cells must work normally for you to get anaphylactic shock in the first place, the issue is that your immune system is sensitised to the venom in the sting. Given that there is no definite way that you can guarantee avoidance of the same allergen in the future you should be referred to an immunologist for consideration of a desensitisation program"
},
{
  "instruction": "Could a Physician clarify as to why Cardiology have told GP to omit Ramipril until blood tests and ECG have taken place.34 year old male BP 160\/110 (Schizophrenia\/Meds Olanzapine\/Valproic Acid\/Citalopram)GP prescribed Ramipril 1.25mg, he started to take though 6 days later a call from the surgery saying omit Ramipril until above has been done. Booked for 2 weeks time, but has left (my son) with no BP moderation. Very worried as seems so high!",
  "input": "",
  "output": "Your doctor will likely be able to answer this question in much more detail, but often before starting an ACE inhibitor (which ramipril is one) it's important to make sure a patient has normal\/stable kidney function and potassium. A blood pressure of 160\/110 isn't imminently dangerous, no reason to make hasty decisions."
},
{
  "instruction": "Im a 40(F), 410 and 113 pounds. I was diagnosed with hypertension in 2018, its been u fee control with Lisinopril HCTZ 20-12.5 with no issues. I was diagnosed with ADHD in December 2019 and put on methylphenidate 20 mg(2 in the morning and 1 at 1:00 pm). I always checked my blood pressure around lunch to make sure it was t too high, I never had an issue. I was diagnosed with Hashimotos last October and started seeing a functional medicine doctor last December. I was put on NP Thyroid 30 mg, moved up to 60, then doubled to 120 by June. I have had labs drawn every 3 months since December. I felt really good until around the beginning of August. My TSH was <.02 but T3 and T4 were in range so she reduced my medication to 105 mg a day.Since I was checking my BP for it being to high, I didnt realize it was going down. I happened to miss my afternoon dose of the methylphenidate and my nephrologist commented is was a little low. This was the last week of August. I had some scans done by my cardiologist the next week. I mentioned my fatigue and she suggested I stop the methylphenidate for a few days to see if that helped and to follow up with her in 2 weeks. The next few days my BP just completely went down, I ended up in the ER twice because of it. The did CT scans the first time I went and I had kidney stones. The second time I went, they though it was a kidney infection. I went back in the methylphenidate because it kept my BP up. I followed up with my cardiologist. She said everything was fine cardiology wise and to continue to take the methylphenidate without the lisinopril until I could find out the cause for the drop.At this point a reached out to my thyroid doctor to see if anything thyroid related could cause this and she said no because usually signs of over medication is high blood pressure. She said to let her know what the urologist and nephrologist said.I made an appointment with my urologist and he did a cystoscopy and ureteroscopy based off the CT from the ER visit but he found nothing wrong and no stones. The nephrologist also found nothing wrong.So last Wednesday, I finally get her to run my TSH, Free T3 and Free T4. I got the results back yesterday. My T4 is in range. TSH is <.01. T3 is 5.3. I ask about T3 thyrotoxicosis and again she says that would cause high BP. She wants me to not take my thyroid meds for 2 days then go down to 90 mg.This has been going on for 2 months. The constant up and down with my BP has me struggling. My vision is getting blurry. Im exhausted. Do I wait it out to see if what she says or should I go to the ER?",
  "input": "",
  "output": "With hyperthyroidism, hypertension is definitely more common, but this is not always the case. In acute crises of hyperthyroidism, blood pressure can also be lowered, particularly diastolic. In general, I'm pretty sure the problem here is the interaction between the various medications you are taking. The thyroid medication is largely overdosed considering that TSH value, and has been increased quite randomly over the various months. Also, I am not a fan of NP thyroid, since adjusting the dosage is difficult with that medication. Until the TSH is in range, we can't be 100% sure thyroid is not responsible. Look for an endocrinologist."
},
{
  "instruction": "Thank you. I was taking Jaimiess birth control until mid-July. The functional medicine doctor kept suggesting I get off of it to help get my hormone levels up since I was only on it to lighten my periods. From what I read, the estrogen acts as an inhibitor for the thyroid medicine, which would explain why the dosage needed to be increased so much before it started working. Then I went off the birth control and the thyroid meds just went wild. I asked her if that could possibly be a factor but she said no. I am now also wondering if my hypertension was caused by the birth control. Hypertension runs in my family so I just assumed that was the reason. I had no idea birth control could cause that. Im looking for an endocrinologist but the 6 Ive called, with good reviews, are at least 3 months out. Im debating if I should go back on the pill so I can get my BP back up for now, then come off of it under the supervision of an endocrinologist. My cardiologist said, shed rather it be high(obviously not too high) that can brought down with meds, than it be too low. I just know I cannot continue with the methylphenidate like I have. Again, thank you for your response.",
  "input": "",
  "output": "Estrogen has an effect on thyroid function by altering the hormone-binding protein, but generally the problem is when you stop therapy or go through menopause. It is also true that the pill can increase blood pressure, but not so much that you go from hypertension to hypotension. The effect of the pill is modest. I think if therapies are the culprits, it depends more on the triad thyroid hormone-antihypertensive - ADHD meds . I don't think it's a good idea to start hormone therapy again just to control blood pressure, honestly."
},
{
  "instruction": "My son 3 years old recently diagnosed with autism. He was sitting near me suddenly he started to cry but with very low energy. I looked at him and his face was blue. I quickly grabbed him and he fainted I put some cold water on his face and ran to the balcony to get some fresh air. Then his face turned to very white and he started to open his eyes then he fainted again, on my way out of the building he woke up and slowly got some energy back. I arrived at the ER Almost 30 minutes after this happened, they did blood gases tests and blood counts then after an hour they said all is good but I need to see a cardiology to make sure nothing is wrong with his heart. I took a look at the test results and I think there is something wrong and the tests were not ok. I uploaded a screenshot of the tests. TAM KAN SAYIMI = FULL BLOOD COUNT (Count or percentage) KAN GAZLERI = BLOOD GASES. What should I do now? TestsEdit: Now (after 7 hours in the ER) they gave him the 3rd \"fever shot\" in his serum. The heartbeat is now stable in 160s after being stable at 180s but it sky rocketed twice to 241 and 250 bpm and when he cries it goes to 200s until he comes doen. They say it may be a flu infection.",
  "input": "",
  "output": "I believe one of those is chloride. It's a hair above reference range and is fine.The other two are oxygenated vs. deoxygenated hemoglobin. They appear to be applying arterial reference range values to a venous sample, making them look very aberrant. These are also fine.Lactate being slightly elevated is super common in kids also. Nursing often struggle to get good samples with limited tourniquet use, and the lactate is frequently a tad elevated."
},
{
  "instruction": "Looking for clarification, are you recommending a tighter tourniquet to ensure a more accurate lactate level? I am a nurse...",
  "input": "",
  "output": "No. Limiting tourniquet use as much a possible is best for lactate."
},
{
  "instruction": "Okay thats traditionally been my understanding. I just wanted to make sure there wasnt some other thought process. Thank you.",
  "input": "",
  "output": "No. Nothing in these labs is spooky.Has he had any gastrointestinal symptoms?\"Toddler doing weird shit and passing out\" is sometimes from intussusception, and we have a low threshold to do US looking for this."
},
{
  "instruction": "37F, 5'7, 128lbs, Caucasian. Primary complaint is increased resting heart rate, palpitations at night that wake me as I'm trying to fall asleep and fatigue.Symptoms started 06\/15\/2022 with one severe episode of diarrhea. After that I was feeling very fatigued. On 06\/22\/2022 I was very dizzy and almost fainted, my heart rate was elevated (120-140) and I had tingling\/numbness in my hands and feet. Went to the ED. Only thing they found was a Potassium of 2.6, they said my ECG was \"inline with my low Potassium\". They gave me IV Potassium, Magnesium and saline. Got my Potassium up to 3.8 and sent me home.Three days later I had a similar episode and went back to the ER (I thought maybe my Potassium was low again or that maybe it was my heart). They did another ECG and said my heart was fine. Potassium was fine. No other abnormalities. ER doc said maybe viral or Thyroid.In the weeks after my ER visit I was still feeling very weak and my heart rate was still elevated (80's laying, 90's sitting, 110 standing). I was still dizzy. My stomach was destroyed, I couldn't eat without getting severe reflux and I just wasn't hungry. I thought it could be POTS. My symptoms were worse in the morning and in the evenings I felt almost normal.Symptoms slowly started to improve as I started breathing\/meditation exercises and started getting back into training and eating. (I lost almost 10 pounds during this because I just couldn't eat).I then started to experience adrenaline surges where my heart would race, I would feel very jittery, nauseous and I would have to pee many times. At first the surges happened only in the morning, but later started happening at night. Only one a day. The surges would leave me very tired. I had very poor exercise tolerance.I saw my PCP and we ran many tests, CBC, BMP, Full Thyroid Panel, T3 and antibodies, H.Pylori, AM cortisol, Catecholamines, PTH, Heavy metals, MTHFR, DHEA serum, ACTH plasma, celiac panel, Homocysteine, CRP, 25 hour Urine Catecholamines and Metanephrines, Folate RBC and serum and B12. The only \"abnormal\" tests are below:Alkaline Phosphatase low 32 (this has always been low for me).High epinephrine 67 (I was having a \"surge\" that morning, I am not afraid of blood draws).Heterozygous C665C MTHFRHigh am Cortisol 21.2 (I was having a \"surge\" that morning, I am not afraid of blood draws).DHEA 686 (she said it was normal but it seems high for me based on my age).24 hour urine Normetanephrine 122 lowFolate RBC 1248 (for context)Folate serum >20 (for context)B12 852 (for context)Background information: When this all started, my husband and I were trying to conceive and I had been taking 800mcg of Methylfolate to prevent neural tube defects since May. The day I ended up in the ER was the day I got my period. I thought that maybe, based on my MTHFR mutation, I had a bad reaction\/poor tolerance to the Methylfolate so I stopped taking it 2 weeks ago. My symptoms seemed to align with too much Methylfolate, based on other peoples reports.My biggest complaint now is the palpitations at night. I keep getting jolted awake several times as I am falling asleep. This lasts an hour until I fall asleep until morning. Palpitations are felt when I am lying on my side and sometimes when I lie flat on my back. I have headaches off and on and still feel like something isn't right, like my body cannot relax. I also get this feeling of pressure in my head. I don't have any shortness of breath except for when I am jolted awake at night.I am not an anxious person thought I am certain these issues have caused worries. I am active (strength training three times a week, assault bike workouts and lots of walking\/hiking\/paddleboarding). I do Olympic lifting for fun but haven't gotten back to that yet. I eat paleo-ish, low carb, Weston A. Price though I am trying to incorporate more carbs into my diet. I take Magnesium Glycinate at night, probiotics, Vitamin D and Cod Liver Oil. I practice good sleep hygiene. I don't lead a stressful life. I have a cardiology appointment at the end of August.Any input would be greatly appreciated as I have already spent so much money on all this, I need to be efficient with my resources.Im thinking that something really messed me up, maybe the Methylfolate combined with a stomach bug? I had COVID in January, maybe that has something to do with it. Will this likely resolve on its own?Thanks in advance!",
  "input": "",
  "output": "I dont think methyl folate has anything to do with your symptoms. My hypothesis is that the first occurrence sensitised you and made you more introspective. Fear of something can cause tachycardia and introspection can make you notice your heart beat, where you previously wouldnt have noticed it.Relaxation exercises, especially breathing exercises and a distraction from your own thoughts via audio book or podcast might be helpful. 24h ECG could objectify your symptoms, but Im not sure thats a good idea. Maybe try it for a week or so and get back to me, if it doesnt help? Cant promise Ill immediately respond, but I check up on Reddit regularly :)"
},
{
  "instruction": "Fair enough. I am and have been meditating and doing breathwork. I will continue. Any hypothesis on why the first occurrence happened in the first place?",
  "input": "",
  "output": "Hm, maybe its not really anything about your body changing, but your perception of it having changed. Concentrate on your belly button, for example. Normally, we dont really consciously feel the pulse there, but if you concentrate on it long enough, it will feel really strong. Its there all the time, but we only notice it, if we actively look for it."
},
{
  "instruction": "I understand what you are saying, I just don't know that it's true. But, I will go with that theory and see what happens. Thank you for taking the time to reply to my post.",
  "input": "",
  "output": "Neither of us know if its true. I only have your explanation of everything happening to you, there is no blood work, no images, no test results available to me here. Im trying to give you a direction to work in and my opinion based on the information given. There is a reason this isnt designed as an actual treatment or doctors visit, here :) That said, I hope you get well soon!"
},
{
  "instruction": "Well, here's my week update. I am definitely continuing to feel better. I told myself that whatever seems to be happening to me is not something that I need to worry about. I am continuing to do my breathing\/meditation exercises 1-3 times a day. I am exercising daily (strength training, pushing the sled and riding the assault bike, usually 10 minute TABATA). I drink water with liquid IV daily, am eating well and sleeping well. I sauna every other day. My resting heart rate is still consistently elevated, about 100 - 110 standing. I used to be around the 70 range standing. I've only had one adrenaline surge in the last week. I do think that changing my state of mind has helped me avoid any extra stress but I do still feel like im not my usual energetic self. Like my body is working harder.",
  "input": "",
  "output": "First of all,thats great to hear. In addition to that, a physical stress response, where your body constantly readies for fight or flight will sap energy from you. Are your palpitations still there?Your cardiology appointment isnt far now, that will hopefully help with stress, too, or maybe allow for more specific advice."
},
{
  "instruction": "I'm(M17) 176cm(5'9) and 48kg(105 lb), my BMI is 15.5 and I'm REALLY skinny, everytime somebody sees me they get either scared or concerned, and at the beginning i said i was fine but now I really feel like I need help. We contacted many different doctors in my city(I live in Italy) and nobody knows what my problem is.. we(my family and I) did many exams looking for problems with metabolism and we got nothing, we were thinking to get my self hospitalized (as you know, it's free in Italy xD) but they asked us a kind of \"hint\" of what medical department(like \"cardiology\" i don't know if it's correct in English) i should go in, and our doctor told us he'd inform himself but didn't tell us anything.So my questions are, what could be my problem, what department should I get hospitalized in and in general what should I do?Any answer is appreciated and I'll try to answer every question",
  "input": "",
  "output": "\"You're not eating enough food\" is the answer about 98% of the time."
},
{
  "instruction": "Add a couple of glasses of sustagen\/ensure and a few spoonfuls of peanut butter to your daily intake (in addition to everything you already eat), if you still havent gained any weight after a few months then I would see a gastroenterologist to check for malabsorption.Well, I'm not the 98% I eat enought I'm quantity and i get all the nutrients i would need, yet i can't gain any weight nor muscle. We've been struggling with his problem for a while and it's getting always worse.. i grew 10cm in about 1 year and a half while not gaining any weight, i actually lost weight. I get it that many people jump to that conclusion, but I'm 100% sure it's not that",
  "input": "",
  "output": "How many calories per day are you eating?What brand of food scale are you using?"
},
{
  "instruction": "Don't know exactly, but I can estimate about 2.6k calories a day, altough some days it may be Less and some a lot more",
  "input": "",
  "output": "Also, you can't say it's \"100% not that\" when you haven't ever measured your calorie intake.It's like saying your checking account is getting lower and lower and you don't know why, but you've also not looked at the math for your income vs. expenditures.\"You're not earning enough money for how much you spend.\"Nah, can't be that! I'm certain.\"Have you actually looked at you budget?\"Nope.Unless you have some malabsorption disorder where you can't absorb nutrients (these people have constant diarrhea, gas, belly pain, and even oil in their stool), you just aren't eating enough calories.That's not enough.Young men, especially active young men, typically need 3,000-4,000 kcal to gain weight.Anything in the low or mid 2,000s isn't going to cause weight gain.This isn't a medical mystery. Eat more food and workout. You need r\/gainit, not an inpatient stay (assuming no eating disorder)."
},
{
  "instruction": "Yes, but I don't think it should cause this much weight loss either, as well as the fast loss of muscle.I'll try eating even more as you told me.. even tho I'm still skeptical about it, as me and my brother eat pretty much the same things yet he's alright(skinny but not on the same level as me)",
  "input": "",
  "output": "That's literally the only answer. If you've been evaluated for metabolic disorders, malignancy, etc, the only thing that will make you gain weight is eating more calories.Even moreTo clarify, mid 2,000s is not a lot of food for a teenage boy. If that's an accurate estimate at all, is not surprising you're not gaining weight. You're not eating a lot to start with.Eating the same amount of food won't make you gain weightEating less food won't make you gain weight.You must eat more food."
},
{
  "instruction": "If I feel heart flutters about once a day, and cardiology tests come back normal, at what point do I need a medicine to prevent strokes? In other words, when, if ever, would it be time to go on Plavix or Eliquis?(Female, 55, no drugs, overweight, normal blood pressure, normal cholesterol)",
  "input": "",
  "output": "The sensation of flutters versus having atrial flutter \/ fibrillation is different. Unless you actually were diagnosed with it, you do not need medicine for stroke prevention."
},
{
  "instruction": "35F, 145lbs, 511 dont smoke, drink rarely. Generally consider myself healthy, however mid last year I underwent double jaw surgery and have since not taken part in any form of exercise and feel very unfit, but I still eat a well balance diet for the most part!After surgery however I lost over 20lbs in around 2 months and then gained it all back in the following 4 I had a hard time psychologically during recovery for a plethora of varied reasons and also unexpectedly became a carer for a relative who developed dementia whilst I was still recovering, this took a toll on mental health and I fell into a bit of a depression, I was prescribed Sertraline 50mg in late September 2022 however my mental health has VASTLY improved, it is my physical health that is bothersome.I also have a history of IBS and GERD (diagnosed over 10 years ago so is my normal but has slowly gotten a little worse over time).I reached out with no urgency to doctors for a health check as my generally sense of physical health felt at an all time low. I wanted to reassess IBS and GERD with focus on regular urgent diarrhoea (occasionally up to 6x a day), and regular nausea. Additionally I find myself easily very short of breath, dizzy and nauseous, and ultimately I feel weak. The disconcerting feeling this brings means I avoid any physical activity (historically I have enjoyed being more active). I noted that my heart rate has been falling lower and lower in the last 8 months since surgery and I am not physically fit at the moment. I feel slow. Maybe I am just getting old I was given a battery of tests and most of my bloods are generally fine, I have some deficiencies eg. Folate (which I queried as I dont drink and enjoy my greens) but was advised that some people are built different and need more vits or nutrients than others and I just need to take supplements  I assume this may cause some of my symptoms such as diarrhoea?I also had a 24hr Holter monitor and results came through yesterday. I havent seen them but doc noted 357 counts of bradycardia with lows of 37bpm. Coupled with my nausea and dizziness, I have an urgent referral to cardiology (although that still means in 3 months).However when I read up on Bradycardia, it doesnt seem to be a concerning issue? I dont have the full results but is it only the coupling of my nausea etc that makes it more concerning. Unsure if relevant, but despite low heart rate I often have slightly high blood pressure.Tldr: is bradycardia with nausea and dizziness worthy of urgent cardiology referral? Can heart issues cause additional symptoms such as regular diarrhoea?Also not sure if relevant, but I had a persistent rash and redness and deep itch in left breast for last 2 months, ultrasound shows I have lots of benign cysts and a fibroadenoma, they (radiologist and consultant) seemed unconcerned but did biopsy due to my age and I will get results soon, the lack of concern from consultant means I have little concern also (my mother has fibroadenomas that have never caused any issues), but thought I would add everything that ails me! Ha! In case there is some magical connection to it all.Thanks!",
  "input": "",
  "output": "What is your normal heart rate? Was it sinus bradycardia? How long were these episodes in duration?. Also would be helpful to know any medications other than the SSRI and whether you have sleep apnea, have had Lyme or chagas disease or are hypothyroid.To he honest I would also be surprised if it is sinus bradycardia that it is causing your symptoms rather than vice versa. Nausea and bowel movements are an excellent way to temporarily lower your heart rate. Most often it is just a normal variant, and if it is sinus bradycardia almost never requires a pacemaker. Wouldnt get too overwrought.The downside is i there is no magical connection here to any issue other than maybe being a symptom of nausea, which isnt that magical."
},
{
  "instruction": "Thanks for response! I take no other medication, however I did take antibiotics and omeprazole briefly post surgery last year. I cannot see the detailed results,",
  "input": "",
  "output": "okay then what i said above i guess."
},
{
  "instruction": "I have zero other health issue than those noted in my post, when I was very young I had migraines and I have always had dodgy joints (again Im getting older and runs in the family) and that is about it.I have never had any ailments you noted. When first diagnosed with IBS I was given lansoprazole in case I had an ulcer. But generally I have been in good health most of my life and taken little medication. Its just a bit cloudy all at once now I have reached my mid 30s  Blood tests historically are fine only regular things to note: I consistently have high bilirubin in liver blood tests but as the rest are fine this is usually noted as Gilberts syndrome? And again, not an issue. Cholesterol is teetering on high side but still currently in normal range. High but normal MCV in last few blood tests (~100)Im more concerned that I am not in need of an urgent referral and wasting time? But secondarily would like to know why I feel so rotten, and if it could relate to heart at all? It would be great if I could actually see the results and notes - I should call and ask for them and see if they will share!",
  "input": "",
  "output": "I suspect that this is not cardiac related and it is incidental. But with your symptom of dizziness and bradycardia and your GP's concern followup is prudent and not a waste of time. \"urgent\" and \"three months\" don't seem to belong together.You certainly have symptomatic gastrointestinal disease, diagnosed IBS but some of the symptoms sounds like gastroparesis. I would continue to followup with gastroenterology for workup and treatment."
},
{
  "instruction": "Hey guys,Today I had a pulmonary function test performed and results are mostly normal, which I expected. The only abnormal result is my FEF25-75%. The final value was 2.04, 64% of the expected reference value.I didn't have a bronchio dilator test performed due to palpitations, which I take beta-blockers for. Still being studied in cardiology.I didn't expect much to come out of this, because my GP suspects it might be exercise induced asthma. I wasn't feeling particularly bad when I had the test performed either.I experience chest tightness, wheezing, sob, air-way burning feeling and it hurts when I try to take a deep breathe. If I talk too much or laugh, I also get chest pain and cough.I have been prescribed Atrovent\/Ipratropium bromide and it's so far the only thing that has helped me. It has taken me from barely being able to walk 40-50min, to walking 40-90min (usually 40-60) depending on the day without collapsing.",
  "input": "",
  "output": "The FEF25-75 is the forced expiratory flow throughout the middle of your expiration. When we fully exhale our lungs are left with some air leftover (called residual volume, or RV on your PFT). This RV is there because as we exhale our small airways close down as the intrathoracic pressure rises above the intra-bronchiolar pressure -- it's a normal part of expiration. A lower FEF25-75 is thought to reflect early small airway closure, which could be a component of asthma (as asthma affects small airways).You'll notice I use a bunch of hedgy language (lots of \"could\" and \"thought to\"). PFT guidelines recommend against using FEF25-75 to diagnose or treat anything. The data just isn't very strong. The American Thoracic Society recommends not even putting the FEF25-75 on the PFT report. All that said, the FEF25-75 isn't entirely worthless, it just has to be interpreted with caution. If you have the right symptoms, a reduced FEF25-75, and a positive clinical response to bronchodilators it can be very reasonable to suspect asthma.If you have a great response to the inhaler, great, there's your answer. If not, it would be a reasonable time to seek an evaluation by a pulmonologist. Your goal should be feeling normal. All-too-often asthmatics will talk about having daily symptoms, which is a real shame. They either need more aggressive treatment or a different diagnosis altogether."
},
{
  "instruction": "23F, 51 and 115 pounds, Asian. depression, anxiety, ptsd, adhd, taking 20mg adderall, 57.5mg paroxetine, 50mg welbutrin. i drank weekly in college but since ive left, i barely have. no weed either.I crashed my car a while back into a pole, but I have no idea how it happened - my memory is blank from me just driving on the road to me being in front of a pole, where i tried to break before i crashed. i dont know why theres a gap in the memory, but my pcp is suggesting i may have passed out or have had absence seizures, but she feels its neurological and not cardiological which is why Im seeing a neurologist in a week. i am just wondering if there are any ideas of what it could be \/ if i have any disorder. i know i didnt fall asleep as i have a pretty routine sleep schedule, but i just want any ideas of what could have happened to soothe my nerves. the car crash left me with a broken ankle and a friction burn, but nothing else. thank you in advance.",
  "input": "",
  "output": "You need to be evaluated for potential seizures - that's why you're scheduled to see a neurologist. If nothing found there, probably worth getting some kind of cardiac workup."
},
{
  "instruction": "Age: 28Sex: Non-binary\/Female (she\/they with a uterus)Height: 59Weight: 145Race: White\/EuropeanDuration of complaint: N\/A, 3-weeksLocation: New England USAAny existing relevant medical issues: Depression and anxietyCurrent medications: Wellbutrin (daily 150mg), Xanax (as needed, usually ~0.25mg\/month)Hi Docs,This is a question about my spouse (she\/they) in their late 20s and physically healthy. She has a panic disorder thats especially bad in medical settingse.g., took 0.5mg Xanax before their recent echocardiogram, but was still hyperventilating and crying throughout.Three weeks ago she was having some chest tightness, which we thought was from a workout we did the prior day, but wanted to go to urgent care just in case. Urgent care gave her an EKG (her first one), which had an inverted T wave in one lead (EditI think it was actually in two leads, EKG reveals sinus tachycardia at a rate of 117, T wave inversions inferiorly and laterally.). Along with the tachycardia (which always happens in medical offices, but goes back down to ~70bpm after) and they sent us (in our car, not ambulance) to the ER.ER did blood panel CBC\/diff, some hormones, D-dimer in case clot, etc, all looked normal except for neutrophils at 82% (reference 48-76), then checked for fluid in the heart cavity with an ultrasound. ER wasnt concerned and sent us home with a cardiology f\/u.Cardiology NP was worried about potential inflammation (e.g. myocarditis, as Ive heard has been a more common than usual in young women lately from covid, which we dont think weve had yet) so did an echo and a few more blood tests, including a sediment test, all of which looked normal.No chest pain or tightness or swelling other complaints since the ER incident.I dont have the full EKG, but herere the values they released to us from one lead:PR interval: 123ms QRS: 78ms QT: 318ms QTC: 443ms P Axis: 65 degrees R Axis: 69 degrees T Axis: -4 axis (was -36 at previous visit)Cardiology NP is concerned about the inverted T wave and wanted a cardiac MRI after the echocardiogram, but to me the T wave seems like an unconcerning variation in the absence of other symptoms. If I was the patient Id be fine with the MRI but, given how psychologically difficult an MRI would be for my spouse, Im not sure its necessary and want to encourage her to talk to her primary care doctor about her options.Based on the (of course incomplete) picture Im giving here, does my interpretation sound reasonable, or am I missing something?Thank you!",
  "input": "",
  "output": "Inverted T-waves in V1 and V2 are normal."
},
{
  "instruction": "Thank you! Yeah I just went back into the ER notes to check. It looks like it was two leads, not sure which ones (Thinking back, I think they circled the top right cornerlead 4?)From the ER Chart: EKG reveals sinus tachycardia at a rate of 117, T wave inversions inferiorly and laterally.",
  "input": "",
  "output": "Would need to be able to see the EKG to tell more info.Are they still having symptoms?Could provide more info with: Troponin lab value D dimer lab Echo report"
},
{
  "instruction": "Thanks for the responseAh, that makes sensebummer that they dont provide the full EKG, I shouldve taken a picture. Ill update this post if I somehow get it.Theyre not having any symptoms anymore, aside from the anxiety.Troponin is <6 ng\/L. D-dimer is <270 ng\/mL.Echo summary: The left ventricular cavity size and wall thickness are normal. Left ventricular systolic function is normal. There are no segmental left ventricular wall motion abnormalities noted. The estimated ejection fraction is 60% The right ventricular size is normal. The right ventricular systolic function is normal. Normal valve structure and function.Reason for exam: eval in ED with CP x 4 days, EKG showed TWI inferolateral leads, trop <6, Dimer wnl, no history of Covid. Persistent tachycardia. Abnormal EKG Palpitations",
  "input": "",
  "output": "Thank you. So labs and the echo are normal. TWI is not an indication for cardiac MRI. TWI in inferolateral leads can even be due to things like lead misplacement.I think it would be in your partners best interest to ask the ordering NP how the cardiac MRI would impact their care. If it's positive for myocarditis, what will they do to treat it? (The answer is probably nothing). If it is negative for myocarditis, what will they do to treat it? (Also nothing) Secondly, it could be in their best interest to discuss this test and their care with a physician.Gotta give you a disclaimer: My assessment and recommendations are based on the information provided and I have not seen the EKG, taken a history from the patient, or performed a physical exam. I don't want to sow mistrust and am not attempting to disagree with other medical personnel, since the ordering NP has performed all of these assessments."
},
{
  "instruction": "40M, 5'10\", 210 lbs, Caucasian, California.5mg Bisoprolol for arrhythmia, 160mg fenofibrate for high trigs, 300mg gapapentin for chronic thoracic spinal painHello. I'll try to keep this as short as possible as I know you're all busy.TL:DR - https:\/\/imgur.com\/a\/m5lprmBWondering if anyone can offer an opinion on this ECG from my implanted loop recorder. The loop recorder was inserted 1.5 years ago to investigate a an episode of sustained arrhythmia + syncope. I have a history of AVRT (ablated in 2006, possibly WPW, but that wasn't made fully clear to me). It seems something didn't go quite right during the ablation and the AVRT was eliminated but I developed frequent PVCs that were not present before the procedure. I have some documented NSVT from holter monitors and 30 day loop recorders over the past 10 years.My loop recorder seems to not be programmed to detect much of anything on its own. I think I would have to literally be in v-fib for it to automatically flag an event for review. After about a year of it literally capturing nothing despite having symptoms, I requested a patient trigger device that I can use to force the device to record and upload an event. Since I have started using the trigger, I have been able to capture several episodes such as this: https:\/\/imgur.com\/a\/m5lprmBWhen I look at this, my untrained sees a salvo of PVCs, which I guess technically defines NSVT. I have asked my doctor for an opinion on these events and every time his response is basically \"Doesn't look like anything to me\".What he doesn't seem to understand or appreciate is I find these episodes to be physically very uncomfortable and honestly, highly distressing, like hand over heart, feeling like I'm going to die sort of vibes. I admit that's probably a bit dramatic and an overreaction, but my cardiac history and long road to a diagnosis has trained me to think this way. Additionally, I am dealing with Kaiser Permanente in California and unfortunately, they have a rather abysmal reputation for cardiology and electrophysiology is basically non-existent.I realize there's people out there that have PVCs and other palpitations and barely notice them, but for some reason when I experience them, its like I'm getting punched in the chest.My hope is that someone out there can give me a reason why I should NOT be worried about these events. My doctor seems to be very, very, unconcerned by them, and maybe he's right to think that, but an explanation would be nice and if there's a way to be less frightened by these episodes, I think that should be considered therapeutic and part of the plan for care in this situation.Thanks for reading.",
  "input": "",
  "output": "So first things first I dont see clear P waves and you seem to be slightly irregular. Do you have a history of AFib? Secondly the beats that you point out are wide but also irregular. This makes it less likely that they are PVCs\/NSVT and more likely to be AFib with aberrant conduction if you have AFib to begin with. Since you have AVRT and have had ablation, its not unusual to have some aberrancy when the rate changes since you have an abnormal electrical conduction system thats also been burned. While this isnt life threatening in any way, increasing your bisoprolol dose would probably help keep the rates better controlled and decrease your symptoms. You can also get a cardioversion\/ablation if you are actually in AFib"
},
{
  "instruction": "No history of AFib.I think the lack of visible p waves may have more to do with how the ecg is rendered with this recorder (very small), plus this is a screenshot of the report's summary, so maybe the actual report renders the morphology with better detail (I don't ever have access to that). For comparison, I have a 6 lead Kardia ecg device that is much clearer and shows clear p waves.This isn't the first time I've gotten a recommendation to increase the bisoprolol dosage but im a bit concerned about the long term side effects of that. I've already been on it for over a decade and I'm 40 now. However, after this recent episode, I think it's probably best for my sanity.Follow-up question. Does your opinion change knowing that I have never been diagnosed with afib, despite several doctors reviewing my strips in the past?",
  "input": "",
  "output": "I think the answer no matter what is to increase bisoprolol."
},
{
  "instruction": "Now I am off them in the past few weeks I have noticed mild chest pain and fluid retention in my legs. I have always carried weight in my legs but recently I have been needing to pee quickly after lying down at night. I can speed the process up by lying on the ground and putting my legs up against the wall to let it drain down them. I always get a lot of fluid when I pee when I do this, lots more that I should do. I know fluid retention can be dangerous with heart problems and Im getting quite concerned. I have a GP phone appointment next Friday but Im concerned Im not pushing for the right things fast enough.I also suffer from what I have always assumed was IBSI have been tested for Celiac, thyroid problems, absorption levels and all the standard things you would be tested for on the NHSI know that the heart problems could be caused by the low levels in my blood, but what is causing my levels to be low in the first place. Im really worried and really at a loss. Thanks",
  "input": "",
  "output": "The history isnt convincing for anything heart failure related causing your fluid retention.What is far more likely is that its a side effect of your contraceptive pill. Fluid retention is listed as a common or very common side effect of your particular medication."
},
{
  "instruction": "The history isnt convincing for anything heart failure related causing your fluid retention.What is far more likely is that its a side effect of your contraceptive pill. Fluid retention is listed as a common or very common side effect of your particular medication.",
  "input": "",
  "output": "Often, but not always. Your physiology changes over time so sometimes you may start to see side effects that you previously didnt."
},
{
  "instruction": "Cross from \/AskCardiologyDetails to previously deleted post, dad had heart attack but refuses medical adviceI previously posted and deleted due to lack of details. My dad (56M) had a cardiac event two weeks ago that he refused to explain. Yesterday he invited me to dinner to explain his situation. He looks TERRIBLE, he is gray with the blackest bags under his eyes. He explained he was working out and suddenly had SVT bad enough to where he lost feeling in his body, his left arm turned blue and he collapsed (didnt lose consciousness) and couldnt get up for a couple hours. As a nurse, he 100% believes he had a heart attack. He stated he has been feeling ill for 6 months, had this event, and has not felt normal since. His cholesterol and triglycerides are insanely high and he knows he has hereditary atherosclerosis. He is very anti-doctor\/pharmaceutical and is relying on a diet of nitrous oxide-rich foods and Willow bark to clear is arteries of plaque. He looks like a corpse and Im afraid he will die soon without medical attention. If he did have a heart attack, whats his outlook without treatment?Edit: he is not on any medications, works out twice a day, his father had triple bypass at 70.",
  "input": "",
  "output": "Ok man, I'll be pretty straightforward - lack of attention to this could kill your father.The thing you worry about after a heart attack is that part of the heart muscle doesn't work well. You can get heart failure pretty easily when one wall of the heart isn't contracting. If he looks bad to you, keep gently encouraging him to get checked out. Use words like \"I'm worried about you\" and \"I don't want to lose you.\" Don't push. Encourage and focus on your concern for him.It isn't clear it was a heart attack, but something bad happened. An arrhythmia, exacerbation of undiagnosed heart failure, a heart attack, some other vascular event are all on the table and need proper testing to sort out."
},
{
  "instruction": "hanks for your response, I did ask that he see a doctor but he is very stubborn and just accepts if its my time then oh well. So Im not expecting much here unfortunately.",
  "input": "",
  "output": "Ugh. Im sorry. So hard to watch a parent do that. Be persistent. Enlist other family members. Avoidant behavior is very common. Especially for healthcare workers."
},
{
  "instruction": "Im 34, female, 5 ft. And currently depending on the day between 209 and 223 lbs ( its weird, Ill get to that.)Day 1 Normal bp: 90\/60. Weight 184 pounds 5\/29\/21.So back in June, I was working in a facility housing homeless individuals. During my shift, I smelled what I thought it was an electrical fire or fumes coming through or exhaust system. I discovered that folks were either cooking or smoking methamphetamine in the facility, but couldnt do more then create an incident report and narrow down where this happened.I coughed a bit, Had a headache, went outside to clear my head. Didnt think anything of it. By the end of my shift It felt weird to breathe. Like I was stuffed up. Within 48 hours I was wheezing coughing and very fatigued. COVID negative. Started azithromycin and prednisone 7 day taper.By day 4 post incident I could feel It wasnt helping. Went to the hospital. 02 was in the high 70s, I was coughing so hard. Confused. BP elevated for me 120\/70s. Admitted for 4 days. 3 COVID tests (2 pcr, 1 rapid) negative. No fever this whole time. Nothing came up in sputum tests or blood work other than what they explained as inflammation.According to docs notes: patient was admitted to the hospital originally for suspicious of pneumonia based on the chest x-ray reading. In speaking to the patient, her symptom is more consistent with a asthma\/COPD attack and lack the usual signs symptoms of infectious pneumonia including fever, productive cough, leukocytosis, and known sick contact. Instead, her symptom was brought about by inhaling smoke at her workplace. Patient has a history of childhood asthma for which she managed at home with rescue inhaler, patient did not have any asthma issues as an adult until exposure at her work.Therefore, after admission, she was treated for an asthma\/COPD exacerbation. Antibiotics initiated on admission ( levaquin, azithromycin)to a more appropriate diagnosis. She responded well to bronchodilators, nebulizer, and oral steroid. So I finish the azithromycin, prednisone and have duoneb, and albuterol to help.CT scan showed glass opacities, right side of lungs was worse. 5th PCR test negative for COVID.06\/13-I go back to the doctor 6\/13. I feel worse. They tell me to give it time.06\/24- return to work on light duty. No more than 4 hours a day of walking.07\/03-7\/23- doctors are still saying give it time. My lungs sound clear. I quit my job with the county to work from home.07\/29- go into urgent care because I feel like I cant breathe. Exacerbation of symptoms. They talk about referral to pulmonologist but nothing yet. More prednisone dosepak7\/30-8\/15- using flutter, spirometer, albuterol and duoneb still as directed. Flutter\/ spirometer every hour. Albuterol every 8 hours.Hospital admission 8\/16-8\/21 doctors notes*Called by nursing due to worsening hypoxia. Patient was admitted for presumed asthma exacerbation with high suspicion for COVID-19 infection. She was initially on room air with SPO2 of 90%. Since her admission, her oxygen needs has been gradually increasing. She is currently on 15 LPM oxygen mask with SPO2 95%. She is becoming more tachypneic with respiratory rate up to 36.Due to lactic acidosis of 3.9 on presentation, patient was started on normal saline at 125 mL\/h. She was also started on dexamethasone for presumed asthma exacerbation with possible COVID-19 infection. She is on albuterol MDI inhaler every 4 hours and every 2 hours as needed.Vital signs: Temperature 98.7, pulse of 107, respiratory rate 36, blood pressure 114\/74, SPO2 95% on oxymask.On physical exam, patient is alert and oriented. She shows signs of mild respiratory distress with increased work of breathing and tachypnea. She has decreased breath sounds with mild crackles expiratory right greater than the left. No active wheezing.Laboratory studies show white count of 18.3, hemoglobin 14.7, platelets 277. Chemistry panel within normal limits with potassium of 3.9. Magnesium low at 1.7. Lactic acid improving to 2.2 from 3.9. Procalcitonin less than 0.05. D-dimer 0.41.CTA with PE protocol per my review shows no filling defects consistent with pulmonary embolism. There are mild diffuse patchy interstitial bilaterally concerning for COVID-19 infection versus asthma related pneumonitis. No pleural effusions or focal consolidations.Acute hypoxemic respiratory failureLactic acidosisHigh suspicion for COVID-19 infection. Progressive worsening with administration of IV fluids. Improving lactic acid.Plan: -Discontinue IV fluids. -Furosemide 40 mg IV once. -Continue dexamethasone 6 mg by mouth daily for 10 days. -Continue albuterol scheduled and as needed. -Magnesium sulfate 4 g IV once to assist with treatment of possible asthma exacerbation. -Check ABG. -Continue levofloxacin. -Follow-up COVID-19 testing results. Continue precautions for now. -Escalate to high flow oxygen to decrease work of breathing.Patient is critically ill. The patient continues to have: Acute hypoxemic respiratory failure the vital organ system that is affected is the: Respiratory system If untreated there is a high chance of deterioration into: Respiratory failure, cardiac arrest, and eventually death. The critical care that I am providing today is: I performed an extensive data review and discussed care with patient. I have stopped IV fluids and started diuresis with furosemide 40 mg IV. I started magnesium sulfate IV for treatment of presumed asthma exacerbation. I have escalated oxygen needs to high flow oxygen.I get discharged from this hospital stay with 2L oxygen constantly. I get to see my doctor for follow up 9\/8. They tell me again to get better first. Then well look at respiratory therapy and pulmonologist and physical therapy long term. I talk to them about my weight gain and my puffy face. They say its common with steroids. I can self monitor for oxygen use.9\/17 develop vertigo, confusion, nausea and vomiting. Diagnosed with colitis. COVID negative. Urgent care visit. No longer on oxygen but still exhausted.9\/25- diagnosis sinusitis, vertigo from left ear infection. Lungs clear. COVID negative10\/5- vertigo doesnt go away. Given meclizine. COVID negative10\/17- patient noted to have slightly elevated blood pressure likely circumstantial secondary to presenting complaint (152\/90). Referred to primary care physician for further evaluation.Medical Decision Making: CT temporal bones show some fluid within the left mastoid. Slight elevation of white count. Patient also has an abnormal dilatation of the right lateral ventricle on CT of her head. This is concerning in light of her ongoing nausea vomiting and vertigo over the last several weeks. Discussed with pharmacy and placed on antibiotics to cover for possible mastoiditis and discussed with hospitalist for admission for further evaluation and treatment of this ongoing vertigo and abnormal CT head. Admitted in guarded condition.10\/17- COVID positive. Test results received after discharge. 10\/18. 10\/21 tests negative for COVIDWeight gain from June to October 21 is from 184 pounds to 222.October 27- pcp follow up after quarantine. Currently 231 pounds. BP is 148\/86.Doc notes History of Pneumonia, RecurrentRecurrent pneumonias with recurrent hospitalizations Exposure to methamphetamine at work at shelter - ended up with ground glass opacities on imaging. Tested multiple times for covid, negative at that time. Has had persistent fatigue, lightheadedness, loss of energy Positive for Covid 10 days agoWeight GainGained 30 pounds since September. Has had recurrent doses of steroids with recent infections. Orthopnea Has had decreased appetite and is not eating much at all. When she does eat a lot, feels need to vomit.HypoxiaDesaturations throughout hospitalizations, was discharged on home oxygen which she was able to wean down, but does still have hypoxia when she sleeps and exertion. Concerned for sleep apnea.VertigoRecurrent episodes of vertigo especially after recent illnesses Reports that she is occasionally awoken by vertigo and hot flash symptoms. Repeat evaluations for the same - does have history of CP, recent finding of R ventricle enlargement on MRI. Some benefit with Meclizine, but has had abnormal associated symptoms including confusion, word finding difficulty. Continued to say istory of pneumonia, recurrent Suspicion for initial covid infection with negative test causing initial ground glass opacities As these are consistent with many other etiologies and she has significant other symptoms (fatigue, weight gain, hair loss, vertigo with normal TSH) will consider other etiologies ANA, RF, anti-CCP for evaluationWeight gain TSH normal in the past, so has never reflexed to T4 and T3 - will measure these Autoimmune evaluation as elsewhereHypoxia Pulmonology evaluation,possible covid long-hauler symptoms, possible other causes of groundglass opacities Sleep study and general PFTsCurrently taking : Claritin albuterol Flonase every day. Meclizine as needed. I think they help.I KNOW THIS IS A LOT. I m sorry thank you for even reading this but I wanted to be thorough.How can I advocate for myself further? What can I ask about? Any additional testing you would suggest? I dont feel like a person anymore. If I eat, clean my kitchen and walk the kids to school it takes everything I have.",
  "input": "",
  "output": "This is a hell of a history. From the right ventricular dilatation, hypoxia, and continued GGOs on CT scan Id say that the cause is probably the lungs. The pulmonologist is going to be your best friend here. PFTs are going to be helpful"
},
{
  "instruction": "Ruptured calcaneofibular ligament and ?fracture of the anterior process of the calcaneus I am a little unsure of where that exactly is on the ankle after looking at multiple diagrams, doctors werent helpful enough in explaining it.- backstory if youre interested:Ill try and keep this short, history of ankle injuries in the past, never quite this bad on that ankle (other one has had reconstructive surgery).I am a 24yo Female who works in emergency as a critical care RN.Rolled the ankle after stepping on a hockey ball 2.5 weeks ago. First 3 days was horrendous, then the pain settled and all I needed was Panadol once a day.XR on day 1 said no fractures. Went home and played another game of hockey a week later (with some pain after of course).US at week 1 said fully ruptured ligament and small ossicle 2.8mm indicating a possible fracture. Recommended CT.CT at 2 weeks showed possible cortical fracture at anterior process of calcaneus.Now Ive had ligament damage in the past, on the other ankle, and this feels relatively minor in comparison.Im being told by an orthopaedic surgeon that I need to be in a moon boot. I am ambulating fine on flat ground with rigid strapping tape on to replace the broken ligament.Its relatively painless to poke around the ankle area. Im not sure I even understand exactly where this supposed fracture is.Im worried by going in a boot when Im coping so well, will hinder my recovery and extend the time itll take me to get back to sport.I can attach some paperwork in the comments.Whats your opinions? Is it possible theres no fracture?",
  "input": "",
  "output": "Usual disclaimer: no one can provide specific medical advice for a person or condition without an in-person interview and physical examination, and a review of the available medical records and recent and past testing. This comment is for general information purposes only, and not intended to provide medical advice. No physician-patient relationship is implied or established.The anterior process of the calcaneus is deep inside the foot, and thus fractures do not always produce tenderness, as you cannot palpate it directly. I assume that when you say \"no bone pain\", this is what you are talking about.Fractures of the anterior process can be occult, not seen on plain x-ray due to the overlap of bones in the area, and sometimes CT or MRI are needed to confirm.I am a little surprised at you posting here, as you are a registered nurse who has access to emergency physicians and have already seen an orthopedic specialist for consultation. The opinion of your orthopedic specialist is that you have a fracture, and the treatment recommended is immobilization. No one who has neither examined you nor had access to your imaging studies will be able to give you better advice.The rationale behind immobilization of such fractures is simple: the foot has many bones that articulate (touch and move) with each other. Broken bones that do not heal well will cause permanent pain and debility due to interruption of the way the bones can move in relation to each other.If you want a second opinion, then see another foot specialist, bring them all of the imaging tests on DVD (reports are of limited use in these situations)."
},
{
  "instruction": "Height: 1.8m (5' 11\")Weight: 64kg (141lbs)Race: CaucasianLocation: Seattle, WA, USA (German born, Berlin)Vices: occasional vaping with very weak nicotine content, no drinking, no illicit drugs, chronic pain patient (fentanyl patches, 50 microgram)Current physical conditions: pituitary macroadenoma, adrenal cortext carcinoma, and a ton of implants and artificial bones. I cannot afford treatment for either and my insurance, medicaid, will not pay for removal of either or even treatments since my treatment is HCG, which comes from only fertility clinic pharmacies, and medicaid doesn't cover and fertility treatments for menCurrent mental health conditions: PTSD, bipolar, BPD, ADHD, generalized anxiety, and recently depression. All are treated quite effectivelyMedications (total daily doses): 50microgram fentanyl patches, 6mg prazosin, 12mg tizanadine, 7.5mg mirtazipine, 2700mg gabapentin, 2mg clonidine, up to 150mg hydroxyzine, 80mg Latuda, 200mg Lamotrigine, 40mg viibryd, 10mg melatonin, 8mg ondansetronEmergency Usage Only Medications: Hospital only: 100mg dex, 20mg morphine, 4mg lorazepam all IV for cluster headaches; Personal use: 50mg IM dex for cluster headaches, epi-pen for food allergiesWARNING: This will be long. I deeply apologise, but I feel like I need to be very specific and include context to get an accurate answer, if one even exists.----------------------------------------------CONTEXT:I want to start this off by saying I don't particularly believe in homeopathy, certain Eastern medicine, religion (I'm agnostic, borderline atheist), or the paranormal. I do many things for work, taking whatever pays me, but I have spent the majority of my career as a data architect in medical research. I believe in what can be proven, but I also acknowledge we can't prove absolutely everything to be true or false and that the sciences are ever changing and ever growing. I would also note that my life have been a very challenging one and I seem to have the single worst luck of anyone I've ever personally met. I've been very stressed and it has gotten significantly worse of late, though I've been told that I'm handling it quite well. Of course, I also acknowledge that there's plenty of people who've lived much worse lives. I'm not trying to play the victim or be arrogant.----------------------------------------------IMPORTANT LEAD IN:I went to bed last night around 23:00. I woke up an hour or so later to the sounds of small booms outside the front of my house. I initially thought I'd imagined it, but I rolled over and say all 3 of my cats with their faces pressed against the window screen, ears perked up. The sounds actually happened. A few moments later, I heard out smartlock on the front door unlock followed by the door opening and closing. Aside from internal doors, the front door is the only \"normal\" door to the house. the others are sliding doors that were all locked and barred and sound completely different when opened and closed. My roommate was asleep in his room and had been for hours. Nobody else lives here. Once again, I thought I imagined it, but the cats had all left my room and run downstairs to the door, which is what they do when someone comes over or gets home from work, errands, or whatever. I then head a set of male and female voices coming from downstairs. I grabbed a replica Master Sword (from The Legend of Zelda game series my roommate gave me a few years back) and went to my roommate. I tried to wake him up repeatedly, but he just mumbled something inaudible and rolled away over and over. So I went downstairs quietly. I spent 15-20 minutes walking around the house, following the voices, but never found anything. One of my cats, Needles, kept running off towards the voices then coming back to yell at me to follow him to them, which is what he does whenever someone comes home and I don't instantly go see them, but I never could find them. He's an utter attention whore. After that, I gave up and went back upstairs. Within 5 minutes I heard the door open and close again and the voices stopped. I don't have the greatest hearing in the world and never got close enough to make out what they were saying. I checked my Nest doorbell camera and at no point did anyone walk past the door. It is always recording and saved online for 5 days and, with the way it's positioned, it couldn't possibly fail to see someone come in or leave. I checked my smart lock app to see how it was unlocked and it said it was unlocked using a key by a user named \"error\". To clarify, the account's username that opened it was not literally \"error\", but rather that the app produced an error trying to identify the user. There are no physical keys to our house. It's entirely electronic and only myself and my roommate have the access codes.I have no explanation for what happened. I was wide awake for it all. The cats saw it. My smartlock confirms it. It definitely happened.----------------------------------------------THE REAL ISSUE:After that all happened I went back to sleep. It generally takes me hours to fall asleep, however that's not what happened last night. I always fall asleep with the TV on for noise, but turned down. South Park is what I had on last night and throughout the course of the night, I could clearly identify the voices and episodes as they came and went, even during the \"dreams\" I'm about to talk about, but NOT during the dream at the end of my story. That's a VERY important thing to note. After maybe 30 minute I felt like I was asleep, but I wasn't. I could feel my sheets, feel my head and arms on the pillow, move around, and feel my cat against my leg. That said, I started \"dreaming\" as if I was asleep. I'd note now that I've only ever had 1 lucid dream before and it was right after my long-term secret fiance had left me. It was stressful cause I simply came home to an empty house one day. I hadn't heard a word from him all day and all that was left was a quit-claim, signed and notarized, leaving the house entirely to me and taking his name off it and a hand-written note saying \"I'll always love you. I'm sorry\". Never heard from him again. He was my world even though he wouldn't allow anyone to know we were together cause he desperately wanted to be \"straight\". I cried myself to sleep for quite literally years, though over time it became a silent cry. I've been told the stress caused the lucid dream. I have countless wonderful stories about him, but he did give me me a strong case of PTSD, which I already had to deal with from an extremely abusive father.Back to the story now. During this \"dream\" I found myself on a cement platform in a park with a table and two chairs in front of me, underneath a pavilion. There were lots of oak trees, azaleas, and camellias, like a park would look like where I grew up in New Orleans. A cup of my favourite tea was waiting for me. An middle-to-late aged woman was sitting at the table in a white pants-suit. She had blue eyes and gray hair. She introduced herself as \"death\" and asked me to sit and chat with her for a while. She discussed my life with me and asked me many questions. She knew things about me that I didn't even realize myself. My memory of it is hazy, however. The \"dream\" lasted 30-45 minutes. During the \"dream\" I was able to freely move my \"sleeping\" physical body. Movement would cause a strange type of interference with the dream that I cannot really describe, but as soon as I stopped moving it went back to being incredibly vivid. At one point I sat up entirely, walked to my desk, and scooped up one of my other cats, and brought him back to bed and wrapped my arms around him. I felt entirely real. I had fully control over my body and words through the entire \"dream\". At some point in the dream she asked me to stop moving around cause it made her \"presence\" more difficult and she insisted I trust her that it was real. Over the next 7 hours I had 7 more nearly identical \"dreams\". Each dream was roughly the same, but the scenery and other person changed. Each \"person\" I talked to presented themselves as some kind of aspect of life. The ones I remember were: Death, Joy, Lust, Love, Pain, and Plague. I'm struggling to recalled specifics about the conversations, but they all insisted it was real and that I was safe. Each discussion was different and revolved around the aspect of life they claimed to be.I woke up completely after that and was confused, scared, and for some reason, relieved. It felt like everything was going to be ok. I've only experienced that feeling one other time. In December 2016, I was run over, intentionally, by a woman in an SUV while I was crossing the road on my motorcycle. She ran her light with the goal of killing me cause she was enraged by the pride flag sticker on the back of my motorcycle. It's a long story that I've shared many times, but this is already long so I'll skip most of it. The force of the impact sent me flying 30 feet and I slammed into an oak tree and the majority of my body was either broken of entirely shattered and I damn well knew it. In relatively short order, I grew cold from my chest and it spread throughout my body and I knew what was happening. I was about to die. I suddenly felt this massive calming wave overtake me and felt like nothing could ever be wrong and everything is ok. I blacked out shortly later and when I woke up again, I was looking at EMTs and a nurse who'd been attempting to revive me. I had been dead for around 5 minutes and had been kept alive by the person who was driving behind me and just so happened to be an ER nurse heading to work at the hospital less than a mile away.Back to the story again, I was awake for around an hour after all those experiences and ended up falling back asleep. This time, however, I had a regular dream, technically a nightmare, which is normal for me. I suffer from night terrors that are truly horrible and take 6mg of prazosin at night to prevent them. I still get them from time to time, but the overwhelming majority of my dreams are standard issue nightmares. I rarely have any positive dreams.As a reminder, I'd mentioned earlier that I had South Park on throughout the night. During the bizarre \"dreams\", I could hear the voices and episode as they came and went and even laughed at a particularly funny scene and told the \"aspect\" I was currently talking to about it when it happened. In my last dream of the night, the standard-issue nightmare, I could NOT hear the TV, could NOT control my body, and was completely asleep. I'm not sure what that means overall, but I feel like it's a VERY important detail.----------------------------------------------THE QUESTION:Quite simply, what in the absolute hell happened to me last night?! I don't know what to make of any of it. As I said, I'm not spiritual or religious in any way, but this is causing extreme level of conflict and concern within me. Furthermore, I've been around a lot of dying people, I live with a doctor and dated him for the last 6 years (we broke up a few months back, but still live together), I've dated other doctors, I spend a ton of time at doc appointments and in hospitals, and I myself work as a data architect in medical research most of the time. I'm very aware that when people are nearing the end of their lives, most (60%, if I remember right) will hallucinate loved ones, angels, or even demons, and have long conversations with them over and over. In my experience, and to best of my knowledge, this usually happens within a few days preceding their death, but can happen as far as a few months in advance. Is that what I just experienced? I certainly have serious conditions, but I'm otherwise perfectly healthy. Other than my migraines, cluster headaches, and chronic pain I feel perfectly fine. I've had the migraines and clusters since I was a kid and the chronic pain since I was run over and nearly murdered. Nothing new has come up. I have been much more depressed and anxious about life lately as I've had awful dating experiences, am struggling horribly to land a new job, and the end of my lease is coming up soon and I will have nowhere to live, but I feel like I'm handling it well.I'm exceptionally worried about what happened last night. I want to see a doctor about it, but I have absolutely no clue who I'd go to. I know there's \"doctors\" who study dream analysis, but I talked to my ex about it, the doctor I live with, and we both feel like that's psuedo-science and doesn't carry any real validity. Because I'm currently laid off, aren't receiving unemployment, and am only earning money by doing freelance and contract work, I have to use medicaid for insurance. There's no available therapists or psychiatrists I can go to cause I can't afford their cash rates and the ones who accept medicaid are seriously booked up and have multi-year long wait lists. I'm on all of the wait lists, but I'm definitely not gonna hear back anytime soon. I can't afford cancer treatments either and medicaid won't pay for them.My mother insists all of it was a dream and I didn't wake up at any point through all of this. That's 100% false. I damn well know when I was awake and what I experienced. I have proof from the cats seeing and hearing what I did and the history on my door lock. I talked to a friend studying psych and he suggested I could be schizophrenic, but he's not a doctor or even a therapist and I was diagnosed as schizo year ago and treated for it, which worked, but when I moved to WA and found a much better psychiatrist, she vehemently disagreed, changed me to my current diagnosis and changed my medications which work far better, so I'm inclined to believe she was right. My psychiatrist in Louisiana was not on good terms with the board and was wildly aggressive with diagnosis and treatment for all her patients. Her results were remarkable, but her methods were HIGHLY questionable and she was quick to prescribe controlled meds. She had me on lorazepam and adderall while I was also on 50mg of Percoset daily from my neurologist. I absolutely never had any problems, complications, or side effects because of this and it was actually extremely helpful in helping me hold down a job and be a functional adult, but it's generally not appropriate to do. I desperately need my ADHD treated to hold down a job, but the state of WA will not allow you to be on more than 1 controlled medication at a time. I understand, but it makes life extremely difficult for me and I think it's completely unfair to make me choose between living in intense pain or being able to focus for more than 5 minutes at a time. Writing this post has taken me over 3 hours cause I keep walking away and doing other things.Anyway, any advice would be amazing. thank you for reading and I'm sorry for the length.TL;DRHad a series of \"dreams\" last night that didn't work like any dream I've ever had where I could freely move my physical body, which upset the \"people\" I was talking to in the \"dreams\". During the series of \"dreams\" I met personified aspects of life itself, like love, death, regret, plague, etc that held conversations with me about my life. A while after the series of \"dreams\" ended, I ended up going back to sleep and having a normal nightmare where I couldn't control my sleeping, physical body and things were normal. Now I'm wondering if that's my version of dying people hallucinating loved ones and I don't know what to do or what kind of doctor to see about it.That said, please, PLEASE read the full post. There's way more to this and the TLDR makes me sound like a lunatic. I spend a lot of time carefully writing it up and explaining everything, like the insanely critical context the TLDR is missing, please read it.",
  "input": "",
  "output": "Sounds like lucid dreams. I dont want to Monday morning quarterback your doctors but thats a dizzying (literally) array of psychoactive medications you have all mixing together that probably played some role too."
},
{
  "instruction": "Hi docs! Im currently in the neurology critical care unit with an aunt (78F) who was flown from our local hospital to this one. We knew that it was a smaller bleed, but not much else. Im the one that will be asking questions on behalf of her children (who are with me) so that we can fully understand whats going on. What are the questions that I should ask in order to get the most explanation all around?",
  "input": "",
  "output": "I'm so sorry your family is going through this. I'm board-certified in both emergency medicine as well as critical care. Going to need a little more information in order to help tailor the appropriate questions to ask. What information have you received so far about your aunt's current situation, and what is her current condition (e.g. is she on a ventilator, acting appropriately, etc.)? Have the docs given any updates on her prognosis and\/or next steps, medically?"
},
{
  "instruction": "Thank you so much. No information other than that she was resting and that the bleed was small. They said that they would try their best, but wouldnt guarantee anything. Thats all the doctor told her son. :\/",
  "input": "",
  "output": "Well, that's certainly not very helpful or enlightening at all :\/ Idk your aunt's medical history, how the bleed occurred, or what intervention's her medical team has already performed so far. However, it's reassuring that the bleed is reportedly small. Important things that would be good to ask would be:-What interventions have been performed so far, and why? Also, which interventions\/procedures can be expected in the future? -How severe is the bleed, and what deficits can be expected following recovery vs. what are the chances of a full recovery (note, they likely won't commit to a specific answer to this question, because there's no good way to predict patient outcome, but notifies the care team that you're actively involved in the patient's care and want to be kept in the loop)? -What does the recovery time\/process look like if\/when her bleed improves? -Are there any additional co-complications going on? -is there any specialized care that is going to be required following recovery? -How often can we expect patient updates from the doc in the future? -Does the providing physician have any specific concerns of their own that we should be aware of?Additionally, it's probably worth asking what support is provided by the hospital that's available for friends\/family of the patient. If you have any additional information to share, please post here so that specific questions can be appropriately addressed."
},
{
  "instruction": "I chose his CRNP because I was having chest pains and I already knew that I was hypertensive. I'm an advanced EMT and although my scope is nowhere near a CRNP, I can still diagnose myself for what is critical and what is not.This woman is under half of my age. I'm not comfortable with someone fresh out of medical school. She told me that I had to go to the ER. I paid $140 for an office visit for her to tell me that I had to go to the ER, after taking my blood pressure. I already knew that I was hypertensive and they told me over the phone to come in to get some kind of high blood pressure medicine.I told her that and she told me that I needed an EKG and a CBC workup. She told me they could do that at on-site, but without insurance, it would run me around $1,400... and it had to be paid, NOW. Words fail me here. All of this could have been told to me on the phone.I told her that I couldn't afford that out of pocket. She told me that I was going to be sent home... without any medicine. I said, \"Let's review here... It's such an emergency that I have to go to the ER or pay for tests now, but you can send me home without medicince???\" Unbelievable. I left, had to pay my $140, and went home with no medicine. I got home, at square one again, and was $140 poorer.The social worker called me later that day and she was also an EMT. I told her what I just typed. She emailed the doctor and a few hours later, I was prescribed some amlodipine that could be picked up immediately at my pharmacy.I received better care from a social worker that I paid nothing, than from a CRNP that I had to pay for... amazing. The CRNP obviously didn't even go to the doctor for consult.",
  "input": "",
  "output": "I'm not comfortable with someone fresh out of medical school.NPs do not go to medical school. They are knowledgeable and can treat common illnesses, but they are not medical doctors.Are you located in the US? Do you not have insurance?"
},
{
  "instruction": "What kind of school do they go to, then? I assumed that they went to some kind of medical school, since their scope is higher than a registered nurse.I am in the US and I just got insurance.",
  "input": "",
  "output": "What exactly is your question? Any given decision to see an MD vs an APP is a balance of complexity and access."
},
{
  "instruction": "31F, went to the ER due to stomach pain and uncontrollable shivering. She was admitted to the ICU and had extremely low blood sugar, hypothermia, hyperkalemia, blood in the stool, gram positive cocci in pairs and chains, anemia, and she had been previously diagnosed with endometriosis. They found cysts in the liver, hypodensity in the left side of the brain and have been taking several tests. ER gave her 3 blood transfusions for the anemia and she now has a swollen back, legs, hands, and feet. She is still anemic even after the 3 blood transfusions. She has undergone multiple MRI, ultrasounds, CAT scans, and blood works but they aren't sure what is causing everything.Her vitals at admission were:K 5.9Hgb 5.5Glucose 17Temp 94.5WBC 5700She started antibiotics yesterday morning and her second ecg was normal. She was taking oxycodone for pain but is now on morphine and lidocaine. Doctors said that she had a reaction to her 3rd blood transfusion and her heart rate went up and blood pressure went down. She is now on medication for that. She has not been allowed any food or water today after the reaction. An MRI found that she has lesions in her brain but the nuero surgery consultant said they were not going to do any procedure.Has anyone had experience with something similar and what was the diagnosis?",
  "input": "",
  "output": "While I have lots of experience with patients like her, I dont think theres much that can be said over the internet to help. She has a severe critical illness with what sounds like septic shock. The best people to answer your questions is the team of doctor taking care of your sister."
},
{
  "instruction": "Im 30 years old and after a very long and defeating search for a doctor willing to listen, I was finally diagnosed with Nutcracker Syndrome. I have surgery in 1 month, but I am in debilitating pain. Im a critical care nurse of 8 years and no stranger to the difficulties with pain management faced and felt by both physicians and patients. What I was baffled by was the extreme amount of gaslighting I faced as I tried to get this syndrome ruled in\/out. Ive fought for months to NOT end up in this position (stuck in pain) by advocating for myself yet listening to each physicians advice, and trying to be a good patient and human being.I was in pain management but left the clinic because the doctor wasnt willing to work with me in any way. I was given Meloxicam, Gabapentin, and one 5mg Norco per day. Only the Norco would do much of anything. I had an appointment set up with a new clinic before I left, but its not till Dec. 12th and my pain has gotten MUCH worse even in the last week. I will also still have to wait the 2 weeks to actually get any medication (as far as i understand).My surgeon cannot prescribe me anything, and I see a PCP who uses holistic and traditional medicene (basically started me on tons of supplements) and really seemed to help me, its pricey but worth it as they are also more available. BUT, they cannot prescribe pain medication as they are a cash pay direct care practice. Ive called other pain clinics and they cant get me in until even later dates, Ive texted every doctor Ive worked with and their leads have fallen through. Meanwhile, the pain is so horrible I can hardly eat or move, and getting worse by the day. I went to the ED out of desperation a couple days ago and the doctor was kind and gave me 14 Norco 5s which help the pain a bit for about 2-3 hours. But I desperately need something stronger and more permanent (obviously).As far as options, My surgeon suggested going back to the ER for more pain meds (which was weird) or my PCP though he knows they cant prescribe those meds. The ER doctor suggested a new PCP which Im considering but Ive had good support with my current one and feel they are far more accessible, especially considering something new happens each week it seems like (strep B UTIs, hypothyroidism, gallbladder and liver issues, you name it). Plus idk if anyone would feel comfortable writing me opiates on a new patient visit.Is it even worth trying a new PCP? Would it be pointless to keep both my current PCP and see a new traditional PCP that could help with pain ? Or should I switch altogether? When my current pain meds run out I WILL have to go back to the ED because it gets that bad and Im no wimp. Its a solid 7-8\/10 WITH the Norco on board. Would a second ED physician even consider writing Another script?Should I try and speak to the actual doctor I will be seeing Dec 12 about my hopeless situation or insist that the nurse tell him about it?Im really at a loss, Im in Indiana so medical marijuana isnt an option. I would appreciate any advice, leads, anything. I feel like Ive been failed for a year straight, and I was hoping I would be taken more seriously as someone whose also in healthcare, but its sadly not been the case. TIA",
  "input": "",
  "output": "I'm sorry OP, this is awful. Not familiar with the health care system where you live and why your PCP can't prescribe opioids, but can you see them for help navigating how to have this addressed? I agree it looks bad if you start seeing a new PCP or go back to ED but perhaps letters from your current PCP explaining the situation would be helpful?"
},
{
  "instruction": "Thats a good thought, I have asked them to call the pain management place I have an appointment at the attempt to get me in sooner. I will see if they will do that as well :) Nothing can hurt at this point. And thanks for the validation because honestly, Ive started questioning if its really all that bad (though I know it is).Its crazy what a year of being chronically ill can do to the mind, even someone familiar with the healthcare system (Im in the U.S.). A lot of doctors here would love to be able to help me out but legally cant, or if they can would have to fear for their license (presumably).The ED giving me the small script they did was even kinda going out on a limb. It all comes down to the fact that not many doctors arent familiar with nutcracker syndrome because its rare, and the extreme pain isnt a well known fact about it. So it makes me seem as if Im drug seeking, but one look at my background and its clear theres not history of anything whatsoever.I mean i worked in ICU for 8 years around every narcotic imaginable, and still could be if I wasnt this sick. And I was charge nurse of a high acuity unit. The doctors Ive worked with have helped me alot in this process but their hands are tied on the opiate thing.",
  "input": "",
  "output": "I'm not familiar with the syndrome but it's not hard to look it up. It's very sad that because of the opioid abuse pandemic we've gone so far the other way that people can't get adequate pain relief for appropriate indications.Good luck, and I hope the surgery is effective!"
},
{
  "instruction": "I had an awful IUD experience, involving vomiting and fainting as a result of the pain level. I would rate my IUD insertion worse than passing a kidney stone or breaking bones. Im not alone with this experience. If you search IUD on TikTok or other female-dominated subreddits, youll see an abundance of women\/ teenage girls who have also described the IUD pain as the worst pain in their life. Ive noticed a trend of increased pain particularly among nulliparous women.The Intensity of pain doesnt seem to be acknowledged by many medical providers though, as many patients are told it will be a slight pinch and arent properly informed about the pain involved. As a result, many of us did not properly prepare for the persisting pain by arranging a ride home from the appointment, a day off from work\/school, or mental preparation for pain. Many providers both seem to acknowledge that extreme reactions to the insertion are normal, but the pain isnt enough to warrant preparation or pain medicationsI played rugby, basketball, football, and softball. Ive had many broken bones and torn ACLs. Ive also passed kidney stone. The IUD insertion pain was by far worse and longer than any of the aforementioned pain events. If I was offered pain medicine for all those events, why is nothing given for IUD insertions to reduce the associated pain and discomfort? Is there a specific reason?Edit- I should mention Im directing this question to medical professionals in the US.Edit 2- Ill admit I havent looked into any of the studies about this. We had one doctor chime in that studies show that extreme pain is not the norm, but the trend Im seeing in person and across social media appears contradictory to those findings. Would any medical professionals be willing to share the specific studies that are being referenced for care? Im a PhD student in a different area of public health research, but I wouldnt mind doing some critical review of the publications while I have the time. Update: so far I've only found a few relevant articles in my Uni's database. Most are about a decade or older and have really small sample sizes, like n=40 or less. The more recent articles are recognizing the pain of insertion as an issue, but I'm not finding a lot of resources so far. If anyone has a specific research study they reference when learning, I'd be thrilled to look at it.Edit 3 -I started to search for articles. This is the first abstract I found:\"Concerns about pain during IUD insertion are a major barrier to use of IUDs among adolescent and young adult patients who may otherwise be interested in this method. Although few studies of pain control options have been conducted in this population, available data suggest that several pharmacologic interventions discussed in this chapter may be beneficial. Pre-procedure naproxen, ketorolac, or tramadol can help to reduce post-procedure discomfort. Paracervical nerve blockage with lidocaine-based anesthetics, topical lidocaine spray, or EMLA cream also appears to reduce pain with IUD insertion. Intravaginal 2% lidocaine gel may reduce pain with tenaculum and speculum placement. This chapter will discuss the complex nature of pain in gynecological procedures, including IUD placement, and the impact of anxiety and fear on pain perception. It will also review clinical guidelines to assist with pain control during procedures and describe evidence-based pharmacological pain control modalities that can be used during IUD procedures.\" Optimizing IUD Delivery for Adolescents and Young AdultsTho I don't have full access to the text, this abstract is making it apparent that pain management is a valid concern and there are options. Can doctors weigh in more on those options? If it is indeed a recognized problem in the medical community, why aren't these options considered?Update 4: I have 26 peer-reviewed articles to review. Slamming a coffee and Ill get you my quick-and-dirty lit review asap.",
  "input": "",
  "output": "I don't do IUD insertions, but pain management should be discussed and offered.I don't care what the studies say. Sometimes you just need to be a human and empathize with other humans. Medicine is as much an art as it is science."
},
{
  "instruction": "Im a 26F, 173lbs, 57 I have SLE Lupus, Ehlers Danlos Syndrome, and Idiopathic inter cranial hydrocephalus.I just had a CT W\/O of the brain and neck yesterday. Reason for this was because Ive been having terrible headaches lately. I received a message today stating THIS REPORT CONTAINS FINDINGS THAT MAY BE CRITICAL TO PATIENT CARE.Impressions:Hyperdensity seen in the right frontal along anterior aspect of the right superior frontal sulcus concerning for focus of subarachnoid hemorrhage. Sorry for the all caps I just copied and paste. What does this mean? Thank you for your help",
  "input": "",
  "output": "Physician, Emergency Medicine | ModeratorAgree 100% with \/u\/sspwnage. Closing this thread as there is no other message that needs to be said other than call 911 or go immediately to the ER (and tell them your CT scan yesterday showed bleeding in the brain). I am a little surprised no physician called to tell you about this which I assume is just an oversight.PhysicianYou need to go to the emergency room ASAP. That CT is showing you are having bleeding in the brain. This is probably the cause of your headaches but they will need to run more tests. Seriously drop what you are doing and go, brain bleeds need to be monitored and seen by a neurosurgeon ASAP."
},
{
  "instruction": "Hi there. Female, 20yo with Panic Disorder, GAD, MDD, BPD, the works. Hate it.Anyways, I've had psychiatrists keep me on Prozac 40mg most of my life and it's been the most comfortable. A numbing experience, but it did the job. Years ago, I tried Wellbutrin but at the time I had COVID (which actually amped my anxiety) and thought my anxiety getting worse was due to Wellbutrin, so I was taken off. Back to prozac for 2 more years. Recently, I got off it again and got on Wellbutrin 150mg due to sexual side effects and hoping it'd help my anxiety.It did not. In fact, it made anxiety worse and I've had awful panic attacks, physical symptoms that have been cleared by my GP after tests showed nothing was physically wrong.Talked to the psych, and he said \"Ok well I can cross taper you from Wellbutrin slowly back to Prozac.\".I swear I keep hearing never to take those together, and even my past psych wanted me to be off prozac completely before getting on Wellbutrin years ago.Note I have horrible health anxiety and dread feeling any negative physical symptoms (to the point I annoy my GP about it) and it's starting to make me feel helpless. I'm constantly bothering people and terrified of dying, and just... Feel like a waste of time to my doctor, a waste of resources to my nearby hospital when a panic attack gets so unbearable it feels like I'm fucking dying, and a bother to my loved ones even though they try to be helpful and reassure me I'm not dying.Last night was possibly the worst panic attack since I've been on Wellbutrin, even worse than Prozac PAs. Basically I was eating soft stick candy, swallowed a whole piece because I have a bad habit of not chewing my food, felt like it was stuck in my throat, tried coughing\/throwing it up, began to panic when my throat started feeling weird after trying to force myself to throw up, and panic ensued. Fiance checked, nothing was in my throat and turns out it was probably a phantom feeling in my throat.But anyways, about the medication.So... I've agreed to do a cross taper and lower to 100mg for 2 weeks before adding in Prozac 20mg if I felt ok.Is this ok?Also, secondary question.What do you think of patients who suffer from these things? I'll be completely honest... I genuinely feel like a horrible person for wasting the time of people who help others that really need it.I had gone to an Urgent care when I started experiencing really bad breathlessness and a nurse came in to talk to me, I told them what I was feeling and mentioned it felt worse than most of my panic attacks. She asked me if I had a history of anxiety, answered yes, and she did my vitals and left. Later a doctor came in to check on me, nurse pulled her back outside and I had heard her say \"No no, she's having a Panic attack\" and their voices became more muffled as they walked away.It just... Kinda confirmed what I was already feeling and connected with other experiences of having gone to hospitals feeling absolutely shitty, with doctors recognizing me and seeming annoyed, or seeing my GP look at me with.. I dunno, not really pity, but something else that just makes me feel like I'm disappointing him, and it's not his fault... It just sort of destroys me, because every time he clears me of any physical illness, he just reminds me to find a suitable therapist and combine it with my medications, despite me knowing and not telling him most therapists around me have a year long waiting list and the ones I tried that DID hear me out... Well, didn't help at all. One I tried recently missed appointments constantly, telling me to wait until next week... for 4 weeks straight. And when I finally saw her, I wanted nothing more than to just spill the beans and vent and try and work through recent trauma with just a really horrible and abusive friendship that I'd managed to cut off, and...She said that before that, we had paperwork to fill out for the next 2 sessions. Not homework or therapy paperwork, mind you, paperwork paperwork.It's just... A helpless feeling. I feel like a bother to most doctors having the anxiety I have. I want to get to a therapy asap to stop having these obsessive thoughts about my health, and in turn, let you guys do what you do best, y'know?I'm really sorry to bother you all here. I guess I want some insight? Validation? Criticism? Confirmation of whether or not it's a huge inconvenience\/nuisance for you all? I'm not sure... Any answer on the second half is welcome. Thanks, and again, sorry.",
  "input": "",
  "output": "Physician - PsychiatryProzac and Wellbutrin are very often prescribed in combination and is perfectly safe.You need to chew before you swallow your food. Basic skills of life here. There's a reason we have teeth. Please use them.There's nothing inherently wrong with you seeking medical reassurance when you're anxious about something, but also understand that medical resources are limited and healthcare workers are burnt out and very overworked. If someone comes in for the 4th or 5th time with anxiety symptoms that are similar to the past 4-5 times, it's human nature for the doctors to automatically assume it's anxiety again, which is neither medically urgent nor emergent. It becomes harder and harder for the doctor to justify medical workups when the cause seems very obvious.Having experienced anxiety symptoms for so long and so often, you can learn to recognize when it's anxiety vs something new that would feel different. You can learn how to start taking an active part in recognizing triggers of your anxiety and learning to avoid triggers (i.e. CHEWING your food) or de-escalate your symptoms before they become severe. As a psychiatrist, I'm acutely aware of how difficult is to find a therapist who can take insurance within a reasonable wait list (you should still get on those wait lists, it'll be your turn eventually). In the meantime, you can look into online Cognitive Behavioral Therapy (CBT) courses you can do on your own from home. It's not as effective and personalized as working with your own therapist, but it can get you to start learning the basic skills and concepts and start practicing those skills while you're waiting for a therapist. Therapy will be essential for long-term control of your symptoms. Meds alone will never be enough."
},
{
  "instruction": "This is... An incredibly well thought out and insightful comment :')Yeah the chewing the food part was definitely my own fault, even my parents point out I eat way too fast and it's always been a terrible habit to break out of, something in my brain, whenever I try to chew, just says \"Stop it, it's food, get it in before it's gone\" so I'm genuinely trying to slow down but slip up like yesterday.The medical reassurance thing has sparked up pretty recently and I'll try my best to at least limit the urges to go. The problem is that even though I've had countless panic attacks, something new ALWAYS pops up. A different symptom that just freaks me out every time, jumps up out of nowhere, and automatically is flagged as \"This is new. Panic, you're dying.\" Just when I get used to one symptom, another pops up. Like the breathlessness, which was never really a symptom until recently. Something I noticed after I'd gone to the doctor and got cleared was that trying to tell myself \"You're fine, it's new, but nothing is wrong with your lungs and heart, just distract yourself.\" Tada, as soon as I'm not thinking about it, it goes away, and as soon as I think \"Hey, look at that! It went away!\" It comes right back because I focus on it, even if it's positive. But at least I got that down, trying to tell myself as long as I'm breathing and not unconscious I don't need to go to a hospital.About the CBT online courses, I had no idea that existed. Usually I'd only take DBT for years and not CBT even though I thought it would help more (but therapists kept saying \"well you have BPD so let's focus on DBT\" even though... I graduated it.)I usually assumed I NEEDED a person to have CBT therapy with, so is there a specific site you'd recommend? I'm genuinely kinda excited at the prospect of it being online.",
  "input": "",
  "output": "One suggestion I have is for your to start keeping a list of the symptoms you have when you have anxiety\/panic, and also checking out descriptions of anxiety symptoms from REPUTABLE medical websites like WebMD, MDConsult, Stanford Health, Massachusetts General Hospital, Johns Hopkins Health, etc, and generate a master list. When you have a new symptom, check it against the master list to see if it's considered a common anxiety symptom, and if it isn't THEN go get a medical workup.You can do a Google search for online CBT classes (be aware these are not usually Free, and if they are, there's usually a catch). Here are a few with good reputations:https:\/\/cbtonline.com\/https:\/\/www.beatingtheblues.co.uk\/private-patients\/https:\/\/cogbtherapy.com\/free-online-cbt-workbook (this is free, no catch, but very basic)"
},
{
  "instruction": "This is amazing. I've never considered a master list and I'll get on that right away. I kinda wanna make a physical and digital one and make them both look nice, so it seems I've got a new art project :DAlso the free online CBT workbook seems best while I look for a CBT therapist or at least get into the therapy waiting list from the psychiatric hospital nearby I get medications from. I apologize for being a little difficult, but here's my question:Concerning symptoms in general, what if it's a new symptom that feels particularly severe or a general symptom from before that feels significantly more severe than usual?Usually I start to panic once let's say... I have dizziness, and suddenly that dizziness morphs into lightheadedness and a feeling faint sensation. Luckily I've been able to tell myself \"just lie down, this is probably anxiety\" but that was waaaay before, with my health anxiety ramping up again I'm afraid of just freaking out once something comes up and I forget in the moment.Although, I do guess that comes with the territory of learning my symptoms. But like I said, if a symptom is extremely severe, I should probably check with other things like accompaniment of other symptoms that are new and not anxiety related, or if something happened to spark the symptom right? I'm really sorry, I just wanna make sure I know when to panic and when not to, although I realize that's also something I'll need to work on, controlling panic.",
  "input": "",
  "output": "I encourage you to read up on Box Breathing techniques. When someone gets stressed or anxiety, its easy to start hyperventilating, and hyperventilating can induce anxiety symptoms. So learning how to control your breathing can go a long way towards getting anxiety and panic symptoms under control. As soon as you notice that youre feeling anxious, take yourself away from the trigger and go find a quiet private place, preferably dark, and take 5-10 minutes to do the Box Breathing technique. Most anxiety symptoms will go down by doing that and youll be able to better differentiate where youre having anxiety or an actual new concerning symptom.https:\/\/www.webmd.com\/balance\/what-is-box-breathingI also would suggest you find some guided progressive muscle relaxation videos on YouTube and start learning that skill. Its incredibly effective at calming anxiety attacks. If you can successfully complete a whole session, youre probably not going to feel much anxiety afterwards."
},
{
  "instruction": "Hey! Im a 33F. 59, 215lbs. Diagnosed with arthritis in my back in 2020. No daily medications normally. ER just started me on prednisone 60mg daily, metaxalone 800mg TID and diclofenac 75mg BID. I have had chronic back pain for years now. I work as a nurse and as you all know the constant pulling and lifting of patients is hard on the back. I did some dumb things as a new grad working short in long term care and ended up with lots of back pain. I went in 2020 to have it evaluated. My NP did an X-ray and it just showed arthritis. She ordered PT but at that time I was working a covid unit and they started mandatory extra shifts and I wasnt able to schedule the PT. About 6 months ago I started having issues where when I would go to stand up my back would catch and Id be stuck bent over for several minutes until it loosened up. I kept saying I was going to schedule an appointment but never did. (I know, I know. ) At work the other night my toes\/foot went numb. I ended up going to the ED. They did a CT scan of my lumbar spine and told me I had bulging discs. When the ER NP came in, he told me I had 4 bulging discs in my lumbar spine and he felt they were causing nerve compression which was causing my numbness\/tingling. He said I was at risk of herniating and put me on a 10 lb weight restriction until I follow up with primary care for a MRI. (They are a small ED and have no MRI available.) The CT report just came through on MyChart and it says I have bulges at L4-L5 and L5-S1. So am I understanding that that would only be 2 bulging discs? Im thinking my husband and I maybe just misunderstood him when he came in. This is a different side of nursing for me and Im not too sure about the risks and such with disc issues. Is the risk of herniating really high? My job wont put me on light duty because it didnt happen there and they just told me to ask for help with transfers\/boosts. I work on a very heavy floor thats not considered ICU but they still call it critical care. Its lots of post ops and amputations. It tends to require a lot of lifting and pulling. Im just feeling really anxious about work and I guess am just looking for reassurance\/ guidance. Interestingly enough two days before my foot went numb I was having nerve pain going across my shoulders and radiating down my arms. So Im sure Ive got stuff going on higher up as well. I was able to get a PCP follow up on Wednesday so Im hoping to get more information there.Also- is it common for the numbness tingling to come and go? Im assuming its the meds helping? Because at first it was continuous. Now sometimes it travels up my leg into my thigh but It wont last very long. Maybe an hour or so and then goes away.Sorry for the novel- thank you if youve gotten this far.",
  "input": "",
  "output": "I question everything this ER NP has told you. You're correct, if your report says L4-L5 and L5-S1 that's two discs. Not sure why they said that those disc bulges are causing the pain. It's well known that imaging findings in back pain, particularly minor and common findings of disc degeneration, do not correlate well with back pain. That is to say, imaging findings like yours are not necessarily the pain generator. Was a physical exam done with a lower extremity Neuro exam?"
},
{
  "instruction": "The NP, MD and nurse never once looked at my foot. I was at work when it started. Im a vascular nurse so I checked pulses and my other nurse friend did a very quick assessment for weakness but it was fine. At the ED they all just kept telling me it was sciatica, which Ive had before but its never made anything go numb. Then once the CT came back they said it was nerve compression from the bulging discs.",
  "input": "",
  "output": "Hopefully your primary care doc will actually do a physical exam.I'd caution you against recommending things based off of what you've seen. That's unsafe, inaccurate and bad practice."
},
{
  "instruction": "This post is about my dad, who is about to leave the hospital after a 2 night stay.Age: 55Sex: MHeight: 5'8\"Weight: ~180-200Race: whiteDuration of complaint: 5 daysLocation\/issue: Esophageal tear, 4 stomach ulcersAny existing relevant medical issues: T2 diabetes, high BP, GERD, alcoholic for ~25-30 years, anxiety, compressed ulnar nerve due to bulging cervical discs - lots of back pain and numbness in armCurrent medications: metformin, no BP meds (had a bad rxn), alprazolam, venlafaxine, there are others I can't remember but they're not super relevant to my concernI'll be brief here, but can answer questions if needed. I don't live near my parents so I'm hearing everything from my mom.Wednesday: Dad isn't feeling great, but that's not uncommon due to the alcoholism-diabetes combo and current back pain. Mom and dad go to the gas station, dad goes to the bathroom, employee informs mom that dad has passed out in the bathroom. They call the ambulance, blood sugar is 54, he's given glucose, and feels better. Refuses to go to hospital, mom takes him home.They walk inside, he feels lightheaded again and vomits multiple times. Mom goes to get a towel and he then passes out and begins to aspirate vomit. Mom sits him up and slaps his back until he can breathe again. Brief comedy break- he says \"wow! I feel better!\" He goes to the bathroom and is bleeding a lot from his rectum. Refuses again to go to the hospital (he's an ornery fellow, but it's understandable because he doesn't have insurance).Thursday: He goes to his PCP Thursday morning and PCP says he has lost up to 1\/3 of his blood and needs to go to the hospital. Dad refuses again. No major events occur the rest of the day.Friday: Dad tells mom he's feeling alright, he eats some food, seems normal. She goes to work. She returns and I'm not sure what exactly happened, but he begins bleeding profusely from the rectum again and goes to the hospital Friday evening.Drs can't identify the source of bleeding and are thinking diverticulitis. He continues to bleed and is given 5 pints of blood over the course of the evening\/overnight. They prep him for colonoscopy in the morning. Drs tell mom situation is critical and to be prepared for the worst.Saturday: Dad doesn't respond well to the barium so they do endoscopy through the mouth instead and find an esophageal tear and 4 stomach ulcers. The esophageal tear finally resolves on its own so they didn't do any repair. Rectal bleeding largely subsides but there is still some with every BM. They plan to do a colonoscopy later. Hemoglobin was 9 at intake, now is 7.6. He's on a magnesium drip and gets another pint of blood for a total of 6 pints. Saturday night is not too eventful. Blood pressure is low despite typically high BP.Sunday: Bleeding has mostly subsided. Hemoglobin is still very low. BP still low. GI doctor no longer wants to do colonoscopy and says dad can go home. Floor Dr and nurse think he should stay. Dad is worried about medical bills and claims the hospital is \"trying to kill him\" so has opted to go home.I have two questions- should he really be going home?? And given he is a physically dependent alcoholic, should he be given alcohol or no? Mom says he was not given alcohol during his stay and did not have any seizures or severe withdrawal symptoms. Last time he had alcohol was probably sometime Friday morning or afternoon. I know quitting alcohol cold turkey is very dangerous so I'm surprised he has been mostly ok in that regard. He's anxious, irritable, and paranoid that the hospital is killing him, but otherwise not terrible. Is he over the hump after 2 days cold turkey? Should my family remove all alcohol from the house and keep him dry? Supervised small doses?I'm surprised he's allowed to discharge himself so soon after nearly dying, when his stats are still bad and his doctors don't even agree. My family hasn't been given much information and don't know how best to take care of him at home. He can be quite the asshole and doesn't listen to anyone (even his doctor) so restricting alcohol or anything else would be difficult.I'd appreciate any advice on home care, what to look out for, and especially what to do about alcohol. For reference his intake varies a lot but sometimes it's as high as a whole 750mL bottle of rum in one day. Supposedly it has been \"less\" lately due to acid reflux.Edit Sunday Aug 7th: his hemoglobin had gone up, but dropped back to 7.7 and there's a small amount of blood in his stool. So he's still at the hospital for now.",
  "input": "",
  "output": "Glad that he is staying in the hospital.He should strongly consider medications such as naltrexone (oral or intramuscular injections that last for 30 days) or acamprosate which can reduce alcohol cravings. This is the type of medication he should get a prescription for once he is discharged. Once he is home, remove any triggers he might have at home.Wish you and your dad the best"
},
{
  "instruction": "My son (19M) 6'1\" 210lbs who lives approx. 2 hours away at university. No relevant health history besides depression. No routine meds. Doesn't smoke or drink. Yesterday, around 18:00 apparently, he took 50 500mg acetaminophen tablets in a suicide attempt. I was notified at around 02:00 this morning by my ex-wife. I immediately called 911 and notified them of the situation. Ultimately he was taken to the ER a little after 03:00. I have been unable to speak with him due to being Baker Acted. My ex-wife was able to find out that they'd given him something to induce vomiting. My question is roughly 9 hours after ingestion he should definitely be receiving Acetadote, right? I'm not saying that he he isn't, but it wasn't mentioned apparently. It has been quite sometime since I've worked in critical care (RN), but we would have definitely put him on Acetadote. Am I safe in assuming this is the case? Also, in an otherwise healthy young man, what, if any, longterm complications might we be looking at? Thanks in advance for any help.",
  "input": "",
  "output": "No long term complications if he recovers from this, which he should if the timing is correct. There's only 2 ways these go 1) liver failure or 2) complete recovery. He should be early enough in his overdose to be treated."
},
{
  "instruction": "My sister (30, Hispanic, 5'3\", about 250 lbs) has several medical conditions and a long history of undiagnosed neurological symptoms.Two or three years ago, she started having numbness and weakness in her hands and feet and sometimes arms and legs that got much worse in the heat. She was having a couple of other symptoms at the time (can't remember, but I think one was having trouble seeing out of one eye) that made us wonder if she might need to be screened for M.S., but she didn't have insurance at the time and it resolved after a couple of months, so she never got it checked.Last year in June, she started having multiple grand mal and absence seizures per day, including episodes of stat ep, and an EEG confirmed temporal lobe epilepsy. She also had periods of disorientation with no obvious seizure activity. She tried several medications and they finally settled on max dose Depakote. She has not had a seizure in six months that she knows of.Two or three months ago she suddenly developed the inability to tell if her bladder was full and she also had sudden full releases of her bladder. This has been improved with medication.On June 8th, she went to the ER for a severe headache. She was diagnosed with cervicogenic headache caused by muscle spasms in her back and neck (new onset).On June 29th, the ER gave her a steroid injection (for asthma) in the front of her left thigh and her thigh immediately went numb. It remained numb until this past Monday, when she developed severe pain in her thigh with difficulty walking and bearing weight on that leg. There was no redness, swelling, or other obvious indication of infection or blood clot. Her PCP said it was likely femoral nerve entrapment as a result of the injection and that it would likely resolve over time.Last night (Thursday), just before 5 pm, she had a sudden onset of left sided numbness in her face, neck, left arm, and left leg. She could no longer feel the nerve pain in her thigh at all. She also had blurry vision in both eyes. The paramedics noticed slurred speech, word finding problems, and facial droop. She was able to make it to the stretcher with help. By the time that she got the ER (level 2 stroke center), her entire left side was paralyzed and she had zero sensation on that side. Whenever she tried to lift her left leg, visible muscle spasms were present in her thigh. She also could not feel her pubic region at all and had great difficulty urinating. At no point did she have a headache. She said she had no lapse in memory and does not believe she had a seizure (her SO was with her also). Her blood pressure and blood glucose were normal. Head CT and MRI did not show signs of either a hemorrhagic or ischemic stroke. After a couple of hours, she showed slight improvement - able to slightly lift her affected arm and leg, although she still has no sensation. The facial droop and slurred speech had mostly resolved, but she was still having word finding problems. She was told it was likely a TIA caused by her Nexplanon and that it would be completely resolved by morning. They said if it wasn't a TIA, it could either be an unusual presentation of a seizure or a psychiatric condition (she has depression, anxiety, PTSD, and ADHD, all controlled). She was admitted to the step down unit for observation. They said they could not give her any of her medications until the hospitalist approved them.This morning (Friday) my sister had recurrence of the left sided numbness and could no longer move her arm and leg. The hospitalist was surprised to find that the symptoms had not resolved. The hospitalist said it was likely not a TIA and that they would be looking for other causes, like M.S. The symptoms slowly began to improve again, then the numbness returned along with the paralysis. This has improved slightly again. She had a repeat head MRI and CT, an echo, and a carotid ultrasound, all normal. She was assessed by speech therapy (normal) and PT\/OT, who found severe deficiencies and recommended inpatient rehab. At no point throughout the day was she given any of her regular medications, including her Depakote, which is critical for her. The nurse didn't answer any of her call lights all day, and she sat in her own urine for hours, tried desperately to hold her bowels because he was so irritated every time she called that she was afraid to use her call light.Her case worker informed her that both local inpatient rehabilitation centers denied her admission because she didn't meet the criteria based on the neurologist's diagnosis (which we had not yet been updated on). Finally the neurologist came and did a super quick assessment. My sister could lift her left arm about three inches off the bed and her left leg about two inches, and still had almost no sensation. She still could not walk or bear weight at all. The neurologist said that they had ruled out all emergent causes and that it was probably a manifestation of conversion disorder and that it would go away in a few weeks. She will be discharged tomorrow and given a referral for home health.After the neurologist left, my sister started crying. She felt dismissed and judged and crazy and she started wondering if she was faking the whole thing. I reassured her that what she was feeling was real and that I believed her 100%. I called the patient advocate, but they were gone for the weekend. I contacted the house supervisor and requested either a different neurologist or a transfer to another hospital. She said she would talk to the neurologist to see what he was thinking. After they talked, they basically denied both requests, as well as a request for inpatient rehab or PT, and said she would still be discharged tomorrow.There are stairs that lead up to her mobile home. Her SO is not strong enough to assist her with the at home care she needs until home health comes through and she will clearly need significant around the clock care. She will not be adequately cared for at home.I'm not sure if we should just do the best we can until she can contact her regular neurologist on Monday (there is no after hours emergency line), or if we should check her out tonight and take her to an academic hospital for a second opinion and further testing. Our closest major cities are Shreveport, LA (1 hr), Little Rock, AR (2.5 hr), and Dallas, TX (2.75 hr). Any advice would be extremely helpful.This is what I know about her medical history:Hard of hearing Temporal lobe epilepsy (June 2021), last known seizure 6 months ago Cervicogenic headache due to neck\/back spasms (June 8) Asthma Unstable SVT (frequent episodes for awhile, but no episodes in a few years) Fibromyalgia Left leg - possible femoral nerve entrapment (June 29) Rectal abscess surgery (Feb 8) ADHD Depression Anxiety PTSD Chronic\/frequent laryngitis? (sore throat, loss of voice, and fever every two to four weeks for at least a year, not diagnosed) Upper back pain\/vomiting when eating (April) Severe sleep apnea - hasn't received CPAP machine yet Urinary incontinence Non-alcoholic fatty liver disease Chronic rib pain - both sides, since teenager Enlarged spleen (Dec 2020) Hypertension Hyperlipidemia COVID (2020) PCOS Acid refluxThese are the medications I'm aware of:Ozempic (for weight loss) Metformin (for weight loss) Cymbalta Depakote Albuterol Gabapentin Oxybutynin Indomethacin Trelegy Singulair NexplanonShe rarely drinks alcohol - causes back and shoulder pain. She does not smoke cigarettes. She has her medical marijuana card for epilepsy, but rarely used it until this week, when she began smoking frequently to try to control the leg pain.Please let me know if you have any questions.",
  "input": "",
  "output": "I hate to be that physician but in the absence of any actual findings on multiple MRI, ECHOs, Carotid US, sometimes conversion disorder may be more likely than a rare esoteric disease. That being said, what led you away from conversion disorder?"
},
{
  "instruction": "Thank you for responding. I thought that required a pretty significant stressor. The only thing that's come up in the past couple of weeks is the nerve injury. Nothing else has really been stressful lately and her mental health has been under control. The altered mental status and muscle spasms left me with the injection that it is medical in nature. Also her history of neurological issues presenting over the past three years. I was thinking Todd Paralysis or MS might be more likely. They didn't do a spinal MRI, a spinal tap, or nerve conduction studies. Not sure if it was necessary or not.",
  "input": "",
  "output": "Conversion disorder does not require a significant stressor to be present, although significant is a relative term in itself. That being said, an extensive work-up would include MRIs with\/without contrast of brain, cervical spine, thoracic spine, lumbar spine +\/- lumbar puncture. If this has all been done and negative, it is more likely conversion then a obscure neurological disease although the latter in itself is difficult to rule out."
},
{
  "instruction": "Given the timeline Ive described, would it be reasonable to assume the relationship between Covid and these complications?Would it be reasonable to assume the relationship between MI and demand ischemia?Interestingly, the transfer hospital did not initiate treatment for COVID-19. Could this have changed the trajectory of the case?",
  "input": "",
  "output": "Sounds like the likely timeline is COVID infection --> demand ischemia, MI. Given the situation, it sounds like the transfer hospital and receiving hospital appropriately triaged the issues and treated the most life-threatening issue (the acute MI) first.This patient had a lot of risk factors for getting very sick with any infection, not just COVID. Going without clopidogrel likely also helped precipitate the MI, though no one will be able to say to what extent.I don't think that initiating COVID treatment at time of presentation would have made much difference."
},
{
  "instruction": "Hello all... I am a white 33yr old male, 5'9 180lbs no meds taken currently. This is the second time I have had cellulitis in two months. I was wondering if sea moss was beneficial in any way to help the healing process as well as make it faster it's extremely painful and I have it on both of my feet in lower legs I'm afraid to go to the hospital because of the area that I live in they are too quick to judge and stereotype you and I have extreme anxiety going to the hospital so is there anything that I can do to get this healed and taken care of as quickly as possible please any and all comments ideas and suggestions are welcome and will not be criticized or Taken the wrong way",
  "input": "",
  "output": "If on both legs not likely to be cellulitis.Please include one of preferably more of the pictures in your post as an imgur.com or imbb.com link. It makes it easier to help with something when it can be examined visually."
},
{
  "instruction": "My dad (52M, no prior health issues except mildly high blood pressure, on a blood pressure med) is currently hospitalized for a pneumothorax after an injury. He broke several ribs, and one of them pierced his lung. The pneumothorax was small, so we assumed hed heal fine on his own, but yesterday he had to be transferred to the critical care unit because he had developed AFib in his sleep. Once his heart rate was stabilized, they put in a chest tube, because X-rays showed air and fluid. Hes been draining a lot of blood and fluids from the tube.They arent sure if the AFib was caused by the collapsed lung, but he has no history of irregular heartbeat or heart problems. Is this common after a pneumothorax?",
  "input": "",
  "output": "Essentially, anyone can develop atrial fibrillation at any time for numerous reasons including you and I. That being said, the stressors on his body could have induced a state conducive to this, or it is possible that these are 2 separate problems that happen to occur around the same time, ie a person with a stroke who also has a UTI. One would not have necessarily induced the other in this case."
},
{
  "instruction": "Please take the time to read this. I am extremely sick and not sure if I am going to survive much longer.31M. 5'8\"; 125LB; Caucasian; trouble breathing\/abdominal pressure; 7 year duration; condition undiagnosed - separate diagnosis of reactive hypoglycemia; current medication (Acarbose 50mg every meal); ZERO drugs\/drinking\/smoking\/vaping\/caffeine;My name is Jason Otto. I've been so sick for so long I don't care about online anonymity anymore. Here's a pic of me to prove I'm not making this up:https:\/\/ibb.co\/1vHzn3xI am extremely messed up. I have been unable to work for the last 8 years and savings have nearly run out. I am now homeless (living out of my car). I have traveled the United States in search of help and I am currently at Harvard. I thought I would get help here but it's more of the same: condescending doctors who take very little time to even talk to the patient and figure out what's wrong. I don't know where else to turn.I am currently looking for a doctor that gives a shit about his\/her patients. I'm looking with someone with integrity. I am willing to travel anywhere in the country and can be there within 24 hours. Most dismiss me after the usual 20 minute appointment and tell me nothing else can be done. There is no brainstorming, no critical thinking, no followup, nothing. I don't think that these people understand how serious this situation is. I cannot work, I can barely get out of bed (now my car-seat) in the morning, my cognition is in the toilet and I am unable to function in daily life. I am a vegetable.My problems began in April 2013. I had been having gastritis for a good 6 months and was treated unsuccessfully by several GI docs and their PPIs and H2 blockers. Out of desperation, I went to a chiropractor at the recommendation of a friend. He said he sees all sorts of weird stuff and he will ACTUALLY LISTEN TO YOU. Sold.I see this guy and he thinks my gastritis is due to a hiatal hernia. I now know that this can be seen on an xray and that he was completely full of shit, but I was desperate so just told him to \"fix me please\". Desperation breeds bad decision making, and without family support I didn't think twice about it.He said he could manipulate it back into place and laid me down on the table, stuck his fingers in exceptionally hard, deep into my abdomen, just under my ribs, about an inch below my xiphoid process, and pushed in and pulled down toward my naval very forcefully.I feel like he moved something out of place.Since then I have had trouble breathing, eating, and feel like I'm constantly being hit in the stomach. I feel like the life is being sucked out of me. It's hard for me to move, it's hard for me to think, refreshing sleep is next to impossible, and I feel like I'm stuck in overdrive all the time because I am so uncomfortable that I cannot calm down. Something feels out of place in my abdomen, almost like it was shifted downward, and no one can seem to tell me what it is or how to treat it.I've had CTs, MRIs, xrays, and many other tests. GI has been ruled out with extensive testing (EGD, barium swallow studies, gastric emptying scans, etc.) It feels like it is outside of my GI tract, almost as if my liver has been displaced. When you go to a doctor and say you are having problems in the epigastric area, you are referred to a GI. GI has been ruled out, and there is nothing wrong. It feels like it's some sort of organ or something else that has been forcefully moved. I feel like I'm in hell in my own body.I struggle to focus because I feel the need to constantly lay down. It's like being hit in the stomach and needing to sit there for a moment to just relax and catch your breath, but the feeling is constant and never goes away. This has crippled me and I cannot do simple things like reading books.If anyone has any idea on what this could be, or has any recommendation on where to go or who to see, PLEASE let me know. I'm someone who always repays the favor, and if you can point me in the right direction or help me in any way, I will more than make it up to you.I used to be a somebody, and now I'm rotting away in my vehicle. I've lost 40 pounds because the thought of food makes me sick, and I cannot find relief.Thank you.-MAlso, THERE IS NO PAIN. I need to make that clear. It's pressure\/tension that is constant and I do not feel pain with this at all.I also feel a beating heartbeat in the area, like my heart is pushing against it. The heartbeat is pronounced.Here is a link to an image I uploaded showing the area (under xiphoid process, near liver and diaphragm): https:\/\/ibb.co\/ByrJ4xSScan list:CT chest, abdomen; MRI chest, pelvis, abdomen; xray chest, pelvis, abdomen; Abdominal ultrasound; Echo, stress test; Tons of blood workEGD; Barium Swallow Study; Colonoscopy; Gastric Emptying Scan; Capsule Endoscopy; Pillcam",
  "input": "",
  "output": "This is now getting filled with bad advice and advertising. I think good suggestions that will come up have come up, and the discussion is over."
},
{
  "instruction": "Since you're already in the neighborhood, have you tried this group? https:\/\/undiagnosed.hms.harvard.edu\/",
  "input": "",
  "output": "UDN is a good thought, and I think worth looking into. I hope this suggestion gets upvoted more. They have great success stories and are run by great people. It also illustrates that \"I am at Harvard for medical care\" can mean a bunch of different hospitals, clinics, and doctors, who all have varying expertise and areas of focus.However, a couple things to point out:It's a research study, so not the same as \"having a doctor.\" You also need a study recommendation letter from a health care provider.\"We cannot accept all applicants.\" Eligible participants \"have at least one objective finding.\" I honestly don't know how they define that, e.g. is weight loss objective enough?\"After all of the necessary information is received... it typically takes 6-8 weeks... to decide whether to accept....\"They have about 12 clinical sites across the US, not just Boston.Not trying to dissuade OP. If it were me, I would absolutely be looking at UDN. Let them decide whether you're eligible or not. I'm just trying to provide perspective about what to expect."
},
{
  "instruction": "Thanks!It does seem structural but I'm having a hard time getting anyone to believe me. Most docs don't even want to hear my history of how this happened. They're on auto-pilot and seem to just want to know what the symptoms are.I'll look into sympathetic nerve damage.",
  "input": "",
  "output": "Posts by unflaired users that claim legitimacy by virtue of professional medical experience are not allowed.If you are a medical professional who wishes to become a verified contributor to this subreddit, please message the moderators with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!We do not accept digital forms of identification."
},
{
  "instruction": "Thanks I added that to my list of things to look into and will be following up with someone on Monday to hopefully evaluate it. I have a list of everything that everyone on here has said and I'm going to bring it to the attention of the next doctor I find.",
  "input": "",
  "output": "To be honest I wonder if you had some traumatic injury to the celiac plexus. This sounds like a neuropathic pain secondary to the chiropractic manipulation. This is a very unusual story you give, so I can't say I have a strong hunch what is going on, but this seems like a reasonable thought. I'm sorry you've ended up in this predicament. You may consider seeing a pain specialist for discussion about a very particular procedure of a type of nerve block."
},
{
  "instruction": "I've been thinking the same, and am trying to find out how to know for sure. I'm told that x-rays show the diaphragm, as well as CT scans, but nothing is ever mentioned. I've had an ultrasound of the abdomen as well which I was told would show something if there was a problem, but nothing is coming up.",
  "input": "",
  "output": "Just so you know, x-rays show the diaphragm so-so, but not great. CT would certainly show more detail. Earlier you stated a hiatal hernia \"can be seen on an xray,\" which is true in the sense that an obvious one would show up, but not all would show up.Likewise, an ultrasound of the abdomen could in theory show some diaphragm abnormalities, but that's not often what the sonographer and radiologist will be looking at most closely."
},
{
  "instruction": "t that's not often what the sonographer and radioloThank you.I have had a lot of imaging, including CTs, over the past several years. Do you think a second opinion from a radiologist would be a good idea? Usually you get an order from a doctor and the radiologist does and reads the scan, but are there options for people who just want a radiologist to look over old testing? Can I pay someone to look at old tests?",
  "input": "",
  "output": "In general, radiologists definitely look at old scans, and that could be considered a second opinion. This pretty much means the patient has to bring the images on CDs.However, when this happens, it involves a \"front line\" non-radiology doctor (medicine, ortho, neuro, etc.) who sees the patient and usually is ordering a new scan and wants to know how today's MRI of the hip compares to the 2015 scan from Far Across The Country Clinic, LLC. Rarely the front line doc might have old scans only and just want his\/her local radiologist to take a look as a courtesy.I have never run across exactly the 2nd part of what you're suggesting: patient directly sees\/pays a radiologist to review stuff (with no front line doc involved). This probably exists somewhere in the world, but it has a sort of \"boutique\" feel to it."
},
{
  "instruction": "Hi Docs & Medical Community -Coming to you all hear with some saddening news. It's been approximatley six weeks since my partner \"attempted\" suicide via hanging, and I have had extremely limited information on his current condition due to a variety of factors. These include being a non family-member, and his remaining family being very difficult to work with, less than caring of his current condition, and not being the ideal parents. The background for these are for another subreddit, but I'm happy to divulge any information if you all need more. I will try to be as analytical and non-emotional as I can in this post, as I'm only attempting to gather information from those directly involved in the field, as opposed to my resources of compiling random pages on the internet. Hope you all can help, and if you need any information please ping me.For security reasons, this is a throwaway, but I will be checking the post on my main account routinely and can log back in to answer any questions you all may have. Thank you very much for your help.I made an original post on r\/TrueOffMyChest yesterday, that you can find here. It may have some information that may be relevant, although focuses more on my emotional state and less on the actual medical facts.---Patient Information: USA, 25M, 6'0\", 192, White, Attempted Suicide Via Hanging - Hypoxic Brain Injury. No exisiting medical issues - daily workouts w\/ weightlifting and cardio, very diet and food aware. Current medications include 20mg daily Wellbutrin, started 2-3wks before event happened. Prior to Wellbutrin, 20mg of Prozac daily. Casual smoker (vape-nicotine) and regular alcohol intake (2-3 drinks\/mo). No recreational drugs. Past history of mild depression and anxiety, routine therapy. Zero previous suicide attempts or thoughts at self-harm.---The last several weeks have been quite stressful and devastating as you can imagine. There's a lot more to the information-specific side of the story, but the long story short is an abusive, neglectful, and incredibly religious mother, who has cut off her son. She is unwilling to call the hospital for daily updates, and obviously they can't release any information to myself or his friends, as we're not family. We have been able to get some limited information through friends of friends - my partner was a graduate school student in biology, and has many friends who know some individuals who work at the specific hospital he's at and were able to nail down some information. With the exception of yesterday's update, in which my partner's best friend drove to the hospital and used one of his friends there to squeeze some actual information (I'm not sure that's legal, but we are totally in the dark and the only person who has information will not share for her own greed), we know nothing concrete.The information yesterday was helpful in a way. For my full emotions, I can't say I'm any better, but from a purely medical standpoint I'd like some help deciphering it. Again, I understand this is a sticky situation involving HIPPA and legality, so want to be clear that I am not advocating for any unethical or illegal reporting standards. I fully understand the rationale and logistics behind HIPPA and it's protection laws. I hope, from a personal perspective, you all can see how we had to do what we did in order just to learn SOMETHING. I am not a judgemental person, but his mother is subjectively awful for her behavior in the past and now, withholding information and not even picking up half of the hospitals calls regarding updates about her own son. We just have to work with what we have.The reason I bring this up at all is due to the fact I want to stress the 'concrete' nature of the status update yesterday - while all of our other updates have had questionting validity due to them being passed through multiple sets of ears and open to interpetation, this one came directly from the source. Anyways, I will attempt to construe a timeline below:Mid-Feburary: Initial incident occured. I discovered my partner hanging by a constructed noose in his bedroom. While I don't know how long he was cut from oxygen, I know that it was >4min and <11min. If it was closer to 4, I'd assume he'd be awake by now. If it was closer to 11, I figured he may be confirmed brain dead and\/or medically dead at this point.I called 911 and began CPR immediatley. 911 was quick response, and from call time to arrival was no more than 3-4 minutes. In this 3-4 minute period, I opened his airway and performed CPR while simeltaneously on the phone. I did not detect a pulse nor breathing, and once the EMTs arrived, they relocated me into another room for comfort & questioning while attending to him in the field. They shocked his heart back from AFIB, and I do not remember them confirming if they restarted his pulse.Late-Feburary: 13 days after event. I have no information. I am called by my attorney (who I called to be safe and attempt to find out more info) to see if he knows anyone who can get any contact update. I have contacted his mother by now who has expressed her disgust for her son and says he is an \"unforgiveable sinner\" and wishes not to be contacted by me anymore. When my attorney calls, he gives me no information other than \"no brain activity.\" I immediatley assume brain death, and am disheartened (to say the least) at this news. I assume at this point that it is irreversible and he will not wake up.Early-March: Limbo period of no information update. My attorney can only guarentee me that he will have any information if she dies - in which case I will be informed.Through grapvine comprised of partner's close friends, limited information is listed that he has been transferred to a highly-rated neurosurgery hospital, and has been moved from \"Critical\" to \"Critical-Stable\". His body is improving, but no update on his brain status and activity. No one knows who authorized the transfer, or if it was done by the State or a hospital administration decision. His mother does not answer my request for comment. Brain activity has gone from \"no brain activity\" to \"little to no brain activity\" if that makes a difference - it did not to me, at least not at the time.Late-March\/Present: Partner's best friend made the state-crossing drive to his current hospital, which as of yesterday, he is still at and not reported medically dead. Source-based information was relayed as follows: Still in \"Critical-Stable\" condition, with significant brainstem activity. They would not say if it was a persistent or permanent vegetative state, rather they listed it as a \"medically-induced coma to allow the brain to heal.\" They implied that they COULD wake him up if he wanted, but they were holding off to see if he would have a better response. I'm unclear on what that means. They could not give him an exact date on when he was moved from one \"level\" of inactivity or trauma to the other, so I cannot confirm that. They said his OFFICIAL condition was \"Stable, but Unresponsive\" which could mean a number of things. I am optimistic that they have taken away the notion of a sudden brain death, but am trying not to a) get my hopes up, and b) speculate on anything that was not explicitly confirmed.In addition to those updates, they said his vitals were normal, and he had sleep\/wake cycles, but no voluntary response to stimulation. Whether this is due to a brain injury or the medically-induced coma or some combination of the two is unknown. While he is still on a ventilator, it was reported that it is no longer breathing FOR him, simply assisting him in his breath. His heart was put on bypass, but is pumping on it's own at the moment. This is the last update I have.---So, here we are. This is a lot of words. I want to state - I don't know how to feel. I'm not writing this post for someone to sit here and tell me it's going to be okay. I know, logically, there is a very small percent change (<5%, if not smaller) of him ever waking up, and a fraction of that small chance of him being \"normal\" in the sense that he was.My intention with this post is to try and get some real life experience from those who have seen something similar or have an area of expertise in this field. I've read a LOT of things on the internet, some of which make sense, some of which don't, and some of which conflict each other.IF YOU HAVE ANY ADDITIONAL QUESTIONS OR NEED ANY MORE INFORMATION, PLEASE LET ME KNOW. WILL UPDATE AS SOON AS I CAN.---I'm not religious, but ask all of you to send some good thoughts his way. You never know. I know that there are a thousand possibilities of varying severity through this outcome. I'm hoping it's the one that he's happy with.",
  "input": "",
  "output": "Thats a very sad and difficult situation, Im so sorry.Im not sure we can help a lot with all this second hand information.The fact that he has a wake\/sleep rhythm and triggers the ventilator means that hes not brain dead. The first fact means hes probably moving to (at least) a persistent vegetative state.The chances that he recovers without important disability are slim. Its very hard to predict if this remains in the range of persistent vegetative state or if more consciousness will recover. A next step would be if meaningful communication would be possible.An MRI, EEG and the results of a neurological exam will help inform prognosis, but there still will be significant uncertainty."
},
{
  "instruction": "Age 40 Sex MHeight 6'1 Weight 190 Race W Duration of complaint Week Location Left index Any existing relevant medical issues PsA Current medications Biologic Include a photo if relevantLast weekend when planting a very large agave\/century plant, I got three spines in my left index finger. Two I got out (but they hurt for days after -irritant\/poisonous?). The third I felt a stick but didn't see a mark and couldn't find anything to remove. All week the finger has been warm, red, stiff, and a bit swollen. No change in a week, though now the first joint is a bit painful when pushing on it. I've got PSA, so used to having stiff hands, but this is a little different.I've held a very bright flashlight to it and cannot see any foreign body under the skin.For sure had DTAP 8yrs ago when my first was born. Not sure since.Go to the GP? Let it ride? If the doc, do they just throw oral antibiotics at it, or is there something more effective?",
  "input": "",
  "output": "Missing critical elements of history and no images. You may have an infection and you should seek care. Infections in the hand can be serious."
},
{
  "instruction": "29F, 5'2, 80 something lbs, end stage liver failure etc.This one might be long, but I appreciate any kind of advice or input. I'm concerned my sister has been kind of pushed to the side since COVID19 and she's currently in critical, critical condition despite having been discharged. My family is confused on what to do, how to help her, especially since she's been denied a liver transplant. But anyways, here it goes:On March 5th my sister was found collapsed on her bathroom floor, she was completely yellow. Her boyfriend rushed her to the ER, where he was told to call family (us) because she wouldn't make it. From there she was transferred to a larger hospital, placed in surgical ICU and had a team immediately on her case. At this point her liver was failing, and she had an infection but they didn't know the source nor the bacteria causing it. She couldn't breathe on her own etc. Over the next week they threw all the antibiotics at her hoping something would stick, put a tube in her stomach to drain fluid that had built up around her bladder, put her on 24\/7 dialysis since her kidneys began to fail, so many tests ran, I unfortunately can't recall all the details right now but if there are any specific questions I can likely answer.It was very touch and go for a while but her fever had gone away despite never finding out the source of infection. She was tolerating the dialysis and the last day I saw her she looked like she was doing a little bit better. Then COVID-19 hit my state and we were no longer allowed to visit her. Phone updates from the RN told us she was doing better, but they never had any specific information on what specific doctor's were saying, questions we had just weren't getting answered and my sister was unable to tell us what was going on. Within one week, we were told she was well enough to go down to general, despite previously being told she would go down to regular ICU first, and be in the hospital for at the very least a total of 6 weeks. She could breathe (not very well) on her own at this point and could communicate, so the hospital was no longer relaying information to us despite her not being in good enough condition to actually understand what was going on and couldn't remember what doctor's were saying to her. The next day we get a call that she's getting a port placed for out patient dialysis, and she was discharged that same day.We knew she wouldn't be 100% obviously but thought she would be better than she is. She comes home and can't walk, can't breathe very well at all, is completely yellow, is in constant pain and honestly looks like she won't be able to make it much longer. We don't know if she can survive with this liver, she was denied a transplant (whole 'nother story) and despite getting outpatient dialysis she looks worse and worse. She was told she was getting a home care nurse, they aren't coming now. She was supposed to originally be getting PT, they won't come out anymore (honestly don't think she's at that point now anyways). I'm trying to facilitate the care she needs and I'm trying to get her appointments set up but all doctors are only doing video call (completely understand). I'm just so scattered right now and have no idea why she was discharged. Should I take her back? Will they even be able to do anything? I don't understand and I'm just looking for any kind of advice I can get.Edit: The liver failure was precipitated by alcohol abuse and exasperated by the sepsis from her bladder infection. The last we had heard from the transplant team was that she was considered a good candidate (after 3 interviews) despite the alcohol abuse. We got a letter in the mail yesterday stating the denial. I am not trying to negate from the alcohol abuse, that was the reason her liver failed. Just that she also had a lot else going on that led to the condition she is in.",
  "input": "",
  "output": "Posts by unflaired users that claim legitimacy by virtue of professional medical experience are not allowed.If you are a medical professional who wishes to become a verified contributor to this subreddit, please message the moderators with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!We do not accept digital forms of identification."
},
{
  "instruction": "Ineligible? Its probably the alcohol. Transplant has very strict regulations. I cant believe any transplant team would say shes a good candidate if she lost her liver due to alcohol abuse. Just like with cigarette smokers. You have to quit and show at least 6 months to a year smoke free before you can even get on the list. Its a long process.I had to wait five years after my stomach cancer to get my transplant. So I did my best to follow my diet and restrictions set forth by my nephrologist and dialysis center.Im only speculating, about your situation. Im sorry if any of this sounds harsh.It took 3 years of waiting on the list and finally as my health took a turn for the worse, my ex donated his kidney to me 15 months ago.If she will not comply with the program, theres no reason to transplant a healthy organ in a person who wont stop those destructive behaviors. The restrictions\/rules are there for a reason. I had So many moments of pure anger, crying, frustration and hopelessness. But thats normal considering the situation.I AGREE, she needs to be hospitalized. Her dialysis center should be advocating for her. Find out who is the social worker for her clinic and contact them ASAP.Also, did you know that for a liver - you can donate just a portion - it doesnt need to be the entire organ for a successful transplant. You (family) could still get tested while you work with the transplant team to make her eligible.My mom has cirrhosis of the liver & she too was ineligible because she was a heavy smoker and soda drinker. She wouldnt quit. Shes outlived all the doctors predictions. But shes suffered tremendously. I finally got her and my dad to quit about five years ago. Shes still too afraid to have transplant, shes set in her ways. So everyday is sheer hell at this point. Im terrified for her with COVID-19. One person has already died at her assisted facility living.Heres my take on part of the reason she was worse after she came home is most likely the dialysis. Its a new thing for her body. It has to adjust to it slowly over the next few months. Depends on how bad she is. It wrecks havoc on your body. You can have extreme lethargy, dizziness, headaches, nausea and cramping.She has End Stage Liver Disease. She is living with terminal illness. The only real thing besides humor & my kids that helped me cope was educating myself. About my disease, dialysis etc.I am so sorry this is happening. Wishing you both the best in the future to come.",
  "input": "",
  "output": "It's hard to tell you what's happening or what to do without more detailed info, although I completely understand that you do not have this information, and this is all exacerbated by the current isolation requirements. If I were you I would be focused on finding someone to talk to who can explain things better to you or her medical power of attorney (which, by the way she should definitely have at this point). Does she have a follow-up appointment with a liver doctor within the next week?What medical problems did your sister have prior to March 5th when she was found down in the bathroom? Do you understand what is the primary source of her liver failure? Most common things are alcohol abuse, hepatitis C, or toxicity from a Tylenol overdose... others have what's called \"cryptogenic\" liver disease which means \"it's a mystery\" but these cases usually don't present as rapidly and dramatically. Sometimes even young healthy patients just have really bad luck and get a bad viral hepatitis that leads to fulminant hepatic failure in a very short time span.Reasons for being denied a spot on the transplant list generally fall into one of three categories: 1 - not sick enough yet, 2 - too sick or has other serious other problems that mean even with a transplanted liver she would not survive long enough to benefit from the very scarce resource of a liver donation, and 3 - not eligible due to history of current or recent alcohol or drug abuse.From what you describe it sounds like she was reasonably healthy and has had a sudden dramatic decline in her health which included an ICU stay with multi-organ failure (liver, kidneys). Then at some point she had somewhat \"stabilized\" enough, although remained in overall poor health due to her illness. At this point she was discharged home with home health, outpatient dialysis, and PT for rehab, but given the current worldwide situation those services are not being very reliable. Pain, weakness, and some shortness of breath are honestly part of her disease and may not (by themselves) warrant re-admission to a hospital... depends on the severity and whether there is any intervention that could be done in a hospital setting to improve her. Perhaps she should have been discharged to a skilled nursing facility, but these have specific requirements which she may not have met. I can speculate all day but without detailed information it is hard to give good answers.I'm sorry for what you and your family are going through - both the fear of your sister's declining health as well as the uncertainty and confusion you are dealing with. I know it must be very frustrating. Like I said above, the most important thing is getting more info. And if she truly is getting sicker and looking worse at home them take her back to the hospital ER. They may or may not readmit her, but at least she would be evaluated and you'd have a chance to talk with someone about her situation."
},
{
  "instruction": "Thank you so much for this thoughtful reply, I'll try to clarify on some of the things you mentioned. I'll try to be as concise as possible.The cause for the liver failure is alcohol abuse, unfortunately.2 weeks prior to March 5th I saw my sister and she looked healthy. She had been complaining about UTI pain and she told me she saw a doctor and got antibiotics, I told her she needed to go back if she's in pain still since it could spread to her kidneys and she said she would. She never did either of those things, so that bladder infection I'm sure, is a result of a long standing infection. She didn't look jaundice two weeks prior, she has always been a drinker, however until this happened unfortunately I don't think anyone (in the family) knew just how bad it got. Apparently she was drinking very very heavily the week\/2 weeks prior to collapsing. We didn't hear much from her the week prior to the hospital, her boyfriend told us she was trying to kick alcohol and wasn't feeling well. I honestly can't tell you exactly how things got to the point that they did, as she was living with her boyfriend at the time. I certainly have my own questions as to why it took her collapsing on the floor yellow as you wouldn't believe for him to get her to the hospital... But that's another story and something I'm trying to think about right now.I'm guessing her reason for not getting a spot on the transplant list is either due to your #2 or #3. We were assured when they first started speaking to us that alcoholics are eligible for liver transplants if they feel they are a good candidate, and they thought she was. We went through 3 separate interviews. We just got the news she was denied via letter in the mail just yesterday.She has a follow-up appointment via video call with a liver doctor on Wednesday.I've talked to my mom today about how we need to set up a POA. We didn't think she was going to make it while she was in the hospital\/when we could still visit, so while my mom was acting as her advocate, nothing legal has been set up yet. I agree, that needs to be done asap.I forgot a couple things in my original post about how she was considered to have sepsis due to the infection, and she had aspiration pneumonia. Not sure if that's relevant at this point. I'm just taking with my mom rn were trying to make sure we're including as much info as we can remember.Your summary sounds very much on point, and that's kind of where I'm at. Do we take her to the ER? Do we wait until her video call on Wednesday? I can't figure out why she was discharged, and I don't feel like we were armed with enough information about her current condition before she was discharged and were confused on what to expect, what were working with, etc. She's currently in a lot of pain, she's not very alert today, she does have dialysis tomorrow. I'm just so confused lol.Thank you for your help, I'm trying to prepare for what my next move is going to be, everything has been so confusing having COVID19 thrown ontop of all of this. I do feel like this lack of communication wouldn't have happened before all of this, and it's just been confusing trying to figure it all out. She came back to us very very sick, and I just have so many questions.",
  "input": "",
  "output": "Sorry that you and your sister are in this situation, but for this extra information and the long standing alcohol dependency\/usage, it sounds like she was denied on that basis. Yes, there are circumstances that can alcoholics can get listed but transplants are reserved for candidates that can make use of their own life and the life of the person whose liver is being transplanted. In other words, it isn't just her life that they are considering. The decision to offer or deny someone a transplant is not a light decision, it involves a whole committee that looks at all aspects of the patient being considered. They look at the usual age, sex and medical history, but also socioencomic history, psychiatric, social structure and support. They usually require a certain number of months of sobriety and vigorous compliance to AA, follow-ups, medications, etc before they can seriously consider any candidate as there is nothing worse than transplanting someone, and that person end up going back to old habits, get lost to follow-up and wasting a healthy transplant that could have gone to someone else. However, just because she was denied now, does not mean she cannot become eligible later.Long standing alcohol consumption can lead to eventual liver failure, and any binges on top of that can throw someone into fulminant hepatic failure and the resultant complications, which sounds like the situation your sister is going through.Unfortunately, she is very, very, very sick and her condition is unlikely to improve dramatically, and she will have more setbacks along the way or she may have an abrupt decline, even while waiting for a transplant. Failed livers have a very high chance of more bad things happening, even with the best therapies and intent. If she is not doing well, such as she is having increased confusion, or unable to be aroused, fevers, gastrointestinal bleeding, I would bring her back to the ER where they evaluated her for transplant (the large hospital, sounds like an academic hospital), if you can. If she cannot make it to the hospital where the transplant evaluation is possible, the closest ER will do, they can stabilize her and decide what to do once she is stable.Hoping for the best! Let us know if you have any more questions."
},
{
  "instruction": "Not the OP but have seen plenty of cases of 'young' alcoholics with severe or fulminant liver failure. I've also seen plenty of much older alcoholics who don't develop any of the usually associated diseases. It's a bit unpredictable but generally someone who develops severe disease at a young age will have been drinking a very significant amount over a sustained period of time. And some people are particularly vulnerable to disease unfortunately.",
  "input": "",
  "output": "The degree of liver damage related to alcohol can definitely vary person to person, and probably has a genetic component to it. Just like some people can smoke their whole life and not get lung cancer, some people can drink and not develop cirrhosis (I don't recommend anyone try this). Those cases are the exception to the rule. Smoking and alcohol generally have a dose dependent insult to the respective organs.But definitely have seen early 20s in full liver failure and die, related to alcohol. Some might argue that the developing liver during childhood are more prone to alcohol-related damage.Wow you and your family are really having a terrible month. You seem very calm and reasoned despite the fear and chaos going on. In any family facing these kinds of ordeals it is always very helpful to have someone like you who can rationally absorb information and help others understand.Things that you should \"go to the ER now\" for would be an altered mental status to the point of near unconsciousness even when you try and speak to her, unbearable pain that is worsening, fevers, significant breathing difficulty (a very rapid respiratory rate like 30+ times per minute or otherwise looks like she is \"getting tired\" of breathing), a rapid expansion of her swollen belly, or if she cannot do simple tasks of daily living like drinking water or using the restroom on her own. If she is not quite that bad I think it is likely safe to take her to dialysis tomorrow. The dialysis nurses will have a keen eye for patients who are too sick to be at the outpatient center, if they don't seem particularly concerned about her and she tolerates dialysis well then I think she can go back home and await the hepatology appointment \/ video call on Wednesday. Hopefully you will have much more information after that and can then come up with a plan for the future.Patients with alcoholic liver disease do indeed received transplants all the time. Just because she was not a candidate once does not necessarily mean she never will be. For liver failure caused by alcohol or drug abuse, most donor networks will require abstinence for some period of time (usually several months at a minimum)... but it also sounds like she needs quite a bit of \"medical optimization\" before she would be well enough to undergo a liver transplant anyway. She needs to recuperate and heal from her infection more and keep taking all the liver failure medications they prescribe. They may also be waiting for her kidneys to hopefully recover some. Hopefully in another week or two she is feeling a bit better and stronger... once she is able to she should strongly consider some kind of addiction recovery program (there are many free ones as well as ones covered by most insurance companies).My very best to her and your family."
},
{
  "instruction": "Father, white male, 73 Approx 170, 58 Date of onset 2015My father is currently in a nursing home with the diagnosis of dementia. What is odd about this is that the dementia was sudden onset. The first thing that happened was that my father had an episode they called syncope in December of 2015. He fell down and according to my mother he appeared to seize up. My father is a poor historian since all this and my mother as well so I have to relay this as my memory serves and as she told me so some pieces are missing and some things may be confused.After the syncope episode he did go to the hospital. I am not sure what treatment he started at that time. I believe he had a work up for stroke and seizures and it was negative. In the subsequent months\/years my father began to become obsessed with checking his blood pressure. BP readings were not abnormal at this time but he was convinced something was wrong with him. In the medical records it was documented that my father stated something is wrong. That was the last time my father was ever somewhat normal. He lost interest in his usual interests. He appeared quiet and withdrawn. I believe at this time he was taking medication for high blood pressure, prostate medication, cholesterols meds, and Zoloft.My father deteriorated badly enough that he was especially confused one night. My mother and I were concerned enough to take him to the ER. He had severe hyponatremia. I believe his sodium was in the critical range. He had a long hospital course. I believe the hospital corrected the hyponatremia carefully and slowly and I do not find fault with them over this. During the hospital stay my dads heart went bradycardic and he coded. He had to receive a pace maker.After they corrected the sodium my dad never came out of the confusion. He underwent so many work ups to see why he was experiencing the confusion. All the scans, PET scan, blood tests were negative for anything that would explain the confusion.My dad came home with the pacemaker and remained confused. He remained with a flat affect. Loss of interest in hobbies. Diagnosed with dementia at this point. The doctors couldnt explain why a sudden onset of dementia but said this wasnt the usual presentation.Sometime after this my dad had an episode of status epilepticus and went to the hospital. He was placed on a seizure medication at this time. I dont know which one but I can tell you that after he began seizure treatment his personality returned. He improved somewhat.After this he began to deteriorate to the point of not being able to use the restroom in his own. He started wearing diapers. He became bedridden. My mother decided to place him in a nursing home. He recognizes family but isnt oriented to time and space. I do know he began mirtazapine around this time. I was hopeful this would improve his condition if it were not truly dementia. I believe its been about a year since and my dad remains confused. Hes still wheelchair bound.I read promising studies regarding mirtazipine but as time goes on Im not hopeful he doesnt have dementia. Im posting this in hopes anyone can provide any insight over my dads case. My hopes are that he had pseudo dementia.Ill add that all of his care was provided by the VA. We never accused them of any wrong doing. His primary care doctor and neurologist no longer work at the hospital. They asked us repeatedly if my dad was an alcoholic. We would ask why he seemingly developed dementia overnight and they would ask us if he were an alcoholic. My dad was a heavy drinker at times but we didnt feel like alcohol contributed to anything so said no. I know from working in GI that if someone is an alcoholic its hard to hide from a proper work up. Its possible my dad drank more than I knew and its possible that he truly did have dementia but hid it. I guess my question is does this sound like true dementia? Is there anything else that can be ruled out?",
  "input": "",
  "output": "You say sudden, but it sounds like this has been slowly progressive now for almost 6 years, not overnight. That's a fairly typical course for Alzheimer's disease, with initial loss of memory, later urinary incontinence and more global confusion, and later loss of mobility and total impairment. Pseudodementia has particular findings on assessment that indicate for or against; one element is depression. Your father has been on antidepressants, but it's not really clear, at least to me, what depressive symptoms he has had other apathy and loss of affect.But other things don't fit. Neither pseudodementia nor Alzheimer's dementia present with seizures. Severe hyponatremia can, but that would need a workup and cause. Sometimes the cause is brain injury causing syndrome of inappropriate antidiuretic hormone (SIADH), which lowers sodium, which can cause seizures, but it's still not obvious why the first episode of syncope. Eventually severe bradycardia requiring a pacemaker, but not initially?Timing and type of head imaging makes a difference. With the the triad of dementia, incontinence, and now loss of mobility, has there been any discussion of normal pressure hydrocephalus? It would usually be picked up, or at least suspicion identified on CT at some point, but it partially fits and should at least have been ruled out."
},
{
  "instruction": "Based on the history you give I would be very surprised if he had not had imaging of his head either CT or MRI and this would certainly have identified if normal pressure hydrocephalus was the cause of his symptoms and this is important to rule out as if identified early it is treatable.It does actually sound pretty good for a history of dementia and I was unclear from your history whether he had in fact had a stroke as this can sometimes lead to a form of dementia known as vascular dementia which is common but presents slightly differently to the more common Alzheimers dementia. In vascular dementia the progression of symptoms tends to be step wise with sudden deteriorations followed by a plateauing of symptoms and then further sudden decline. In Alzheimers the decline tends to be more of a slow and subtle deterioration. You can actually develop seizures with Alzheimers disease which can develop relatively early in the disease but they can be treated with anti epileptics.Dementia cannot explain the hyponatraemia though; however from the history there are 2 common causes for hyponatraemia. Firstly your father was being treated for hypertension and quite a few of the medications used to treat high blood pressure can cause hyponatraemia. This increases if people are on multiple agents to reduce blood pressure and diuretics tend to be the worst but ACEi and ARBs also cause it. Secondly there seems to be some suggestion of alcohol use and at times you say your father was a heavy drinker. Alcohol particularly if drinking over recommended safe limits can also cause hyponatraemia as well as seizures. It is also a risk factor for developing Alzheimers disease and can actually cause a rarer form of dementia known as wernicke-korsakoff syndrome; although from the description you give I suspect this is unlikely to be the cause.",
  "input": "",
  "output": "Its not uncommon for people to say what youre saying, which is they are shocked at how rapidly a person can deteriorate. I hear it all. The. Time. And its totally understandable.The reality is he was slowly deteriorating before that episode, and you didnt notice it. People with early dementia are good st hiding it. We as doctors get used to picking up on the small signs but family doesnt always realize it. Ask them to recall something very specific, and they cant. But they keep light happy conversation very well. And they always seem happy and they say things are going well. In reality they dont remember much.Then something happens. They get sick with whatever and family is shocked at how it becomes full blown dementia. This is classic presentation for a UTI in the elderly. Something that little can make them completely confused.I suspect that was going on for him. You said he had a heart attack, his brain may have not gotten enough oxygen for a short but also, and that can cause permanent damage. You touched on sodium, Im sure you know correcting that has potential downsides as well.Regardless of what caused it, it is what it is now. Outside of it being one of his medications causing it, I suspect theres nothing you can do. Theres some medications they use to treat it, Im not familiar with them.Sorry youre dealing with this. Its hard to watch someone slowly slip away. Make sure youre taking care of yourself, a therapist can help often. And reading up on how to deal with dementia patients is helpful also, theres lots of small things to do that make both of your time together better"
},
{
  "instruction": "What are permanent treatments for sleep apnea? Due to the fact that obstructive sleep apnea is the result of anatomical characteristics, the question of a permanent cure is complicated to answer. You can definitely do a home sleep apnea test to be sure if you have it or not. Ongoing, sleep apnea may be treated by a CPAP machine or an oral appliance. A CPAP is worn nightly and works by opening up the airway with air pressure. CPAP is effective for the treatment of sleep apnea, but many patients find it difficult or impossible to tolerate. Continuous Positive Airway Pressure machines are machines in which doctors give the nasal mask to the patients that provides continuous air pressure, which opens the blockage in the passage that was causing obstructive sleep apnea. As a result, the patients can easily breathe, and they dont feel any breathing sensation or apnea. Due to this, the patient sleeps well with no snoring, and they wake up fresh in the morning. So this treatment is a very important treatment; however, patients first dont understand this, but once they start using it, they start noticing some changes. They feel active because earlier the sleep, which was not complete or used to be in fragments, you were waking up in between, and you were not aware of it, but now that sleep is complete, the patients feel much better. In addition, if people say that they will ignore it and say they dont need these machines, they will bring complications. Because if you are short of breath and there is less oxygen supply of blood to the organs of the body. There is the possibility of having a heart attack very much; if one has diabetes, then it may get uncontrolled; if someone has BP, then it may get uncontrolled, there is a chance of stroke. Also, the other life-threatening disease may get fatal because of obstructive sleep apnea. So it is very important to identify obstructive sleep apnea, get it diagnosed, get treatment, and, if needed, use a CPAP machine, which is very important for your life. So if you do these things along with lifestyle modification like early dinner. Few exercises can be done, such as walking, working on weight reduction and looking at your health benefits to reduce the use of CPAP machines. In this video, our SimpliHealth expert, Dr. Preeti Sharma Senior consultant Pulmonology and Critical Care at Apollo clinic Chandigarh explains the diagnosis and treatment of obstructive sleep apnea. https:\/\/www.youtube.com\/watch?v=-GhgspGvrQY",
  "input": "",
  "output": "There isn't a permanent treatment for OSA. There are many treatments for OSA with various indications and various treatment success. CPAP is the most widely applicable with the most consistently positive outcomes. Oral appliances can improve symptoms and in some people normalize their overnight obstructive events, but doesn't have as good long term outcomes as CPAP. Some people may benefit from a surgery where their jaw is moved forward, but it only applies to certain people when their jaw is set very posteriorly. There are also hypoglossal nerve stimulators, but are effective in only certain instances of OSA in which the airway closes in a certain pattern."
},
{
  "instruction": "My son is 5 weeks old, I am not sure of his height right now but he weighs 9lbs 4oz. his medical history is complex and I believe it is valuable information so I will start with that..When my son was exactly 1 week old we went to his first pediatrician appointment, they noticed he was looking a bit yellow so they did a bilirubin test the levels came back critically high (21). We were immediately brought back to the hospital and they started him on bili lights however they never tested his bilirubin before we discharged from the hospital I had him at, so we truly dont know how long his levels were that bad. We are RH incompatible so I am certain thats probably what caused the really high biliWhile hospitalized for the bilirubin, we quickly noticed our son was having problems breathing. He was holding his breath for pretty long periods of time. A nurse told us at one point that his respiration rate was only 14.. he was having desaturations and bradycardia with this so he was quickly life flighted to a hospital that was better equipped for this situation. Our son spent 1 night in the NICU and then 9 days in the special care unit. It took him EXACTLY 48 hours to have another breathing episode at this hospital. He was life flighted at 10 pm and then 48 hours later at exactly 10 pm he started having issues again. They did a 1 hour EEG and told us there was nothing substantial And that they didnt find it necessary to do a 24 hour EEG. they decided to try Pepcid 0.2mg because they started to think this was reflux related. At the same time they started the Pepcid he stopped having these breathing episodes. They did not run any further testing and just stated that he was having reflux and was holding his breath because of the acid coming up.My son is now 5 weeks old. We were home for less than 2 weeks and we are now hospitalized again. On Wednesday around 3:30pm our son had what looked to be seizures. His eyes were looking to the left, they were sort of vibrating rhythmically in small side to side movements (not across the entire eye. They stayed looking to the left but kind of vibrated??), and he was unresponsive. We snapped in his face and tapped on him, talked to him and everything and he just was not responsive. He ended up doing this 3 times back to back. Each episode would last about 30 seconds with a 1-3 minute break between each of them. We took a video of it and showed it to our pediatrician who immediately told us with certainty that our son was having seizures. He was admitted to the hospital that night.. they did blood work and did find his electrolytes slightly out of normal ranges, however just a few hours later when they repeated the labs he was back to a healthy range and I was told that couldve happened because of the IV fluids he was on..Once again, our pediatrician made the call to send him out to a better equipped hospital. They sent him to a childrens mercy he was there for 24 hours on an EEG which they did not find anything on.. they told me hes not having seizures and that this movement is normal Im sorry but I truly dont think this is normal. Ive never seen a baby do this and our pediatrician found it alarming enough to send him out to childrens.. our pediatrician has 30 years of experience. Hes a smart guyChildrens mercy discharged us with no answers. We begged them to run more tests or consult with a neonatologist and they refused we left that hospital and went to another one in the area that is well known for their high quality PICU & NICU. we went in and showed them the video.. the nurologist that watched the video said he also does not think this is seizures, however he doesnt think its normal.. right now the plan is to do an MRI tomorrow. In the past he has only had CT scans done, but nothing was found on them..I am absolutely desperate. Our kid is being life flighted twice in his first month of life, and hes spent nearly half of his life in the hospital at this point something is wrong, and no one knows what direction to point us in I asked about the eye movement possibly being related to a balance issue or an issue with his ears and they told me no.. Ive asked if reflux could cause it and theyve told me no Ive asked what could cause it and they give me broad answers I need a direction to go with this. Neurologists dont seem to be finding anything. Could this be a cardiac problem?? Does anyone have any advice on what to ask for if the MRI Comes back normal? Our son needs help. He is miserable. He doesnt sleep, hes not eating very well he gets hungry every two hours and I dont even think hes getting enough milk because he falls asleep every time hes eating and wakes up so upset because hes starving he doesnt let me put him down. I am not being dramatic when I say I have to hold him all day and all night. He will not sleep unless someone is holding him, and usually that someone has to be me. I need help something is wrong and I cant keep doing this. I dont have the energy in me to keep fighting with these doctors.. please help",
  "input": "",
  "output": "Were seizure like episodes actually captured on EEG? Did he do the weird stuff while the leads were actually on? It's possible to have seizures, but have a normal EEG if you're not actively seizing.However, not all abnormal movements are seizures."
},
{
  "instruction": "24F 57, 190lbs Meds: Lexapro, Buspar, Zyxal, Allegra, Pepcid, metoprolol tartrate, NuvaringPMH: postural orthostatic tachycardia syndrome, mast cell activation syndrome, hypermobile Ehler Danlos syndrome, and Celiac diseaseOther background: moved to NYC over the summer, works in cardiac surgery and critical careBefore the past few weeks, I had symptoms well under control with meds and lifestyle.3 weeks ago, I woke up out of the blue with itchy, raised hives all over my entire body. I went to urgent care and got a 5 day run of prednisone and steroid cream. Hives continued to fade and pop up all over. A week later, I went to my allergist. She gave me hydroxyzine to manage itching. A few days before it started, I had gotten my flu shot and COVID booster (Pfizer). She said maybe it was a hypersensitivity reaction to one of the vaccines, and that wouldnt last more than a few weeks. We couldnt come up with another trigger other than maybe environmental due to the apartments heat kicking in or the weather changing to cold.After seeing her, things worsened. The hives have been terrible still. Ive been getting pain, hives, and swelling in my small joints (fingers, wrists, ankles). Today, my face started swelling too. I have no idea if its still a vaccine reaction, a new allergen, or something else. Its getting harder to manage and no new ideas from my drs. Any ideas?",
  "input": "",
  "output": "If you have urticaria, this is acute urticaria. They can both be managed the same way.Finding a \"cause\" for most urticaria in most patients is not a reasonable expectation. Laboratory and other evaluation is not evidence based. Following the evidence-based treatment approach in Figure 2 will greatly improve most patients: https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/all.13397"
},
{
  "instruction": "Gender - male Age - 54 Weight - 165lbs Height - 5'11So my father has been a heavy alcoholic and smoker for 40+ years but im concerned about his health. About 15 years ago he went to the doctors to get some tests done and his doctor literally said to him \"I don't know how you are standing here in front of me\", He also had a blood pressure of over 200 and his blood pressure is still at around that level today.But a few months ago he felt really dizzy to the point where He got a doctor's appointment, Then at the doctor's they did a ECG on his heart and said that he must of had a silent heart attack. They also took his blood pressure and it was 260\/180.But my father still drinks and smokes like crazy, He did take tablets to lower blood pressure but he still doesn't care.Seriously, How the hell could he still be alive when he has been living with critical blood pressure of over 200 for at least 15 years? Cause apparently if you have a blood pressure of over 180\/120 then you have a 80 percent chance of dying within 1 year.Now I love my father but I think he is a ticking time bomb and im worried",
  "input": "",
  "output": "The body can adapt to a lot of things, seems that your dad is lucky. Not sure what type of advice youre looking for, seems that you know the answers. He should stop drinking and smoking and take his blood pressure medication because youre right, he is a ticking time bomb, he could suffer a brain hemorrhage or a heart attack at any moment, or even start to develop symptoms of lungs, heart and liver conditions."
},
{
  "instruction": "He's also not vaccinated against covid although I think he caught covid a few months ago because he was pretty Ill (He just couldn't be bothered taking a test tho). He has also never got a vaccine in his life (Apparently) and he was offered to get his covid\/flu vaccine but he just doesn't want tohe is a heavy smoker and alcoholic (Does it everyday), He also use to do alot of other drugs back in his early day (I.e coke, ketamin, Ecstasy etc) but even his doctor said to him 15 years ago that he should be dead.Now I know that things such as heart attacks, Strokes etc doesn't seem to run in my family luckily and both of my grandparents (his parents) are still alive, my great grandparents (His grandparents) also lived to thier late 90s so maybe genetics plays a role here but still, I thought him having that silent heart attack a few months ago would of motivated him into getting his shit together but it hasn'tAlso, The doctor's gave him folic acid tablets to treat his blood pressure (Which I don't really understand). He also went for a scan the other day on his heart but they lost his scan results",
  "input": "",
  "output": "Folic acid is known to help reduce the risk of having a stroke. It looks like you cant do much else if your dad doesnt want to help himself a bit. Genetics might be doing their part here, theres really no way of knowing for sure why he hasnt any other complications, but thats a good thing :)"
},
{
  "instruction": "(EDIT Below Original Post ) I kinda wrote all of this in a rush this morning after talking to his critical care doctor and surprised to see how many have responded, thank you again, It really means so much.I been staying with him for 99% of the time in the hospital. I went home for one day out of 35 days.He was having issues all of this year, mostly without not being able to eat. We went to ER early June and test results came back okay (or so we were told)He became really sick and malnourished so we took him to ER again in Sept and they performed a CAT Scan. They found a Mass.Biopsy of the Mass diagnosed it as Stage 4 Lung Cancer and now he's been in the hospital for over 5 weeks.He had a cardiac arrest which lead to him being put on life support but they carried on with doing radiation to treat the mass and shrink itHe has SVC Syndrome, Pleural effusion (chest tube) Gastrointestinal tube present (Possibly getting a G-J) , HCC Lung Cancer and AFIB ( Atrial Flutter)Medications: (TBE) He's been\/are onFor Pain: Morphine , fentanyl , Versed,Blood Thinners: Heparin, Zerelto, LovenoxBlood Pressures: Levophed, MidodrineDiuretics: Lasiks (oral)Lasiks (IV) 10mg to 20mg back to 10mg.Spironolactone (current)I really don't know what to do. They want us to tour LTAC facilities and we're scheduled to meet Palliative Care later on today..Chemo is an option but he might be too weak to do so..Idk if we should transfer hospitals to get second opinions or what.there isn't much I can do besides this. Being supportive and smiling.. Reaching out to people for help\/opinions...This feeling of uselessness is overwhelming..EDITED (Additional information): Thank you for all the replies and upvotes... It means a ton. He's responsive and understands what's going on. We're able to communicate with him and he does mouth out his concerns. Even tho he hasn't really had significant improvement, He hasn't been getting worse and has been maintaining stability and he's doing a lot better than when he was first admitted into the hospital. I've understood for a while that his cancer isn't curable from a medical standpoint and that it's only possible to maintain it through treatment. He's expressed that no matter how small the chance is, he wants to continue fighting. We've had this talk several times throughout the years. Even now he expresses this. Which is why I'm trying to explore every realm of possibility. They trached him and He's been on Spontaneous mode (his respirator) for almost a week, and they did take him off the vent for 2-4 hours a day to get him used to breathing on his own. His diaphragm is really weak and he gets really anxious whenever this happens because of how different it feels but his vitals and oxygen levels always seem okay. He says he isn't in any pain, he just gets frustrated & anxious at times but that's understandable. He's just fighting really hard, we all are. We have an amazing support system from friends and family and there's a lot of people rooting for him. I just want him to have a 2nd chance at life and be able to live whatever time he has left to the fullest. I have access to some of his records through MyChart but the daily notes that nurses and docs input isn't all there. I wish I had more information to provide you all. https:\/\/i.imgur.com\/rea1isQ.png",
  "input": "",
  "output": "Sorry to hear.(HCC stands for hepatocellular carcinoma, a kind of liver cancer. It can metastasize to the lung, which can be a cause for confusion. Or perhaps he has a lung cancer and the acronym you were provided isnt quite right. Probably not of much consequence to the following discussion.)If there is talk of LTAC and he is on versed, I am guessing he is still requiring mechanical ventilation?One cannot be precise without seeing all the data but the typical prognosis with this general picture is very poor. If someone is ill enough to die while in the hospital while receiving optimal care, the odds of complete recovery after resuscitation are low (in the neighborhood of 10%). In those who go to LTAC on a chronic ventilator, only a minority ever come off the vent (~30%), and there is a high short-term mortality in these patients even when stage IV cancer isnt in the mix. Stage IV cancer of any kind, with very very rare exception (some testicular cancer, etc), is not curable.Meeting with palliative care seems like a very good next step. If they do not suggest it themselves, I would ask for a family meeting with the palliative care docs, ICU docs, oncology and radiation oncology docs all in the room together. This is often the best way to get a complete picture of the current medical issues.If he is not currently able to make decisions for himself, as I suspect from information provided he is not, the main question for you and your family is: what is the minimum quality of life he would accept? Some would say that unless current therapies have a good chance of returning them to independent living with intact cognition, they would not want to be maintained alive by machines or treatments. Some would say that if they can think but require complete assistance, that would be enough. Some would say even being maintained in a state in which they have no awareness of the outside world is acceptable.The main question for his doctors is: what are the chances his current treatments will get him to that minimum qualify of life, whatever it is for him? If the treatments and supports offered have little chance of returning him to a state he would find acceptable, then one could view his current therapies as prolonging a state of suffering.Sorry again for what your family is going through."
},
{
  "instruction": "Very well said.I want add that if you look at the data for people who go to LTAC and are successfully liberated from the ventilator, and are alive and independent at 1 year... It's somewhere between 5-10 percent. It's a long road to get there, even without metastatic cancer.Something I'd like to add about the quality of life comment that I think is important to share with family members... Everyone has a quality of life minimum that they would accept. It's our jobs to tell the people we love what that minimum is while we are alive and healthy so that our love ones know what our wishes are. If (when) something happens to us, it's up to our love ones to state the decision we've previously made. There's always going to be emotions during this tough time, but guilt or regret should not be one of them.In Healthcare we commonly refer to the surrogate or next of kin as the \"decision maker\", but really the decision maker is always the patient. The surrogate is the party that speaks for the patient when they are unable to and brings the patients desires to light.",
  "input": "",
  "output": "HCC stands for hepatocellular carcinomaIn EPIC, a lot of diagnoses in the problem list are labeled with (HCC) after their name, like \"Acute heart failure with reduced ejection fraction (HCC)\". I have no idea what it means, but this is probably where OP got it from, and the pt probably doesn't have hepatocellular carcinoma.Edit: Just looked at OP's screenshot and you can see what I was talking about.Yes. Probably means the word salad pointed out by the other poster just before you. Never heard in a clinical context. Reason #649263 that epic sucks."
},
{
  "instruction": "HCCs are a method used in coding to show how \"sick\" a person is. It's used for Medicare reimbursement calculations for payers (insurance), incentive programs, etc. It's part of Risk Adjustment. Heirarchical condition code....or something like that. I can't even remember right now and I'm a certified Risk Adjustment coder.",
  "input": "",
  "output": "Is there any good reason that this stuff is exposed to actual healthcare workers?"
},
{
  "instruction": "Another aspect to note is that patients who see palliative care earlier have a much better prognosis - longer survival times and higher quality of life scores.",
  "input": "",
  "output": "Pulmonologist here. I am also the medical director of a hospice for the last 15 years. First, I am very sorry for the difficulty that you, your father, and your family are having to deal with. As a physician, and particularly in doing pulmonary\/critical care as well as hospice, I have tried to help people through these tough situations for most of my career. Each case is individual and each patient is an individual with their own beliefs and values and dreams.Over the years, I've spoken to many dying patients and their families about their illness, and what I've tried to do is to give them the perspective of a physician in order that they can then use their own values and beliefs within the framework of a physician's perspective...using what we know and applying their own perspective.As a physician, my perspective on your father is that he is dying. Please don't take that as callous...it is not meant that way. Most people think of dying as a moment...and it certainly can be...car wreck, heart attack, massive stroke... those thinks can take a life in the blink of an eye. However, for many, if not most, people...dying is a process. It can be several hours or several weeks...or longer It begins when you know that nothing else can be done for the patient and all you are trying to do is maintain, and despite your best efforts, the trend is that the patient continues to decline. All patient's have good days and they have bad days, but for a dying patient, when you average it out, the trend is that they continue to worsen.It's at this point that I think it's important to find out what kind of death your father really wants. That can sound very brutal to some people...but remember, we're physicians and we experience this life and death everyday, and we see patients who die peacefully and comfortably and we see patient's who die alone and in horrible circumstances. With those experiences in mind and with our practicality, we begin to think about what we would want for ourselves. Ask any physician or nurse friend of yours...chances are they've thought about it a lot...far more than other people. They tend to know exactly how far they're willing to go before they just want comfort.From your post, you've spoken to your Dad about his care:He's expressed that no matter how small the chance is, he wants to continue fighting. We've had this talk serveral times throughout the years. Even now he expresses this. Which is why I'm trying to explore every realm of possibility.When he says \"chance,\" what does he mean? Chance of a cure?...chance to go back home?...chance to get a little better and be off the ventilator? In other words, you need to know what his goals are. If his goal is cure, there is no chance. If his goal is going home to the way his life had been...there probably is little chance of that either, though there may be a chance to go home...I don't have enough information. But first, find out which of his goals are potentially achievable with his doctors. Once you know what goals are potentially achievable for your father, you and his doctors can talk about what would have to happen to achieve those goals.Eventually...at some point however, because of the nature of our existence, none of those goals will be achievable, and at that point it is reasonable to give your father permission to let go and to seek comfort in the final moments, days, or weeks of his life. I say that because many patients continue to fight because they think that's what they're suppose to do or because they think they'll be letting down their family if they let go. They endure unnecessary suffering because no one has offered them a path of comfort and acceptance or because they made a vow to fight on and they don't want to renege on a promise they made to someone.We all eventually die. Some of us will never know what hit us because it comes too quickly. For those of us who are struck with a terminal illness like cancer, the only benefit is that we may have enough time to get our personal affairs in order and make peace while having some control over the dying process. As a physician, I know how I'd want to die, however, I don't try to push that on any of my patients. There are definitely patients who don't want to do much at all and just want to enjoy what life they have left. There are other patients who can't die in peace without trying everything including investigational treatments. I respect them all but as a physician I have to make sure that they are making those decisions knowing all the facts and the possibilities and risks.Start by talking to your father about his goals and discussing those goals with your father and his doctors. Give your father permission to do what he wants whether it's letting go or fighting to his last breath. And make sure that in the end, his comfort and wishes guide what decisions you may have to make in his stead. I hope this helped a bit. As best as I can on a reddit post, I'd like to give you, your father, and your family a big hug and my wishes that you all will be comforted in the days ahead."
},
{
  "instruction": "Thank you for the supportive information. I really appreciate the time you took to type this out.He's responsive and understands what's going on. We're able to communicate with him and he does mouth out his concerns. Even tho he hasn't really had significant improvement, He hasn't been getting worse and has been maintaining stability and he's doing alot better than when he was first admitted into the hospital. I've understood for a while that his cancer isn't curable from a medical standpoint and that it's only possible to maintain it through treatment.He's expressed that no matter how small the chance is, he wants to continue fighting. We've had this talk serveral times throughout the years. Even now he expresses this. Which is why I'm trying to explore every realm of possibility.They trached him and He's been on Spontaneous mode (his respirator) for almost a week, and they did take him off the vent for 2-4 hours a day to get him used to breathe on his own. His diaphragm is really weak and he gets really anxious whenever this happens because of how different it feels but his vitals and oxygen levels always seem okay.He says he isn't in any pain, he just gets frustrated & anxious at times but that's understandable. He's just fighting really hard, we all are. We have an amazing support system from friends and family and there's alot of people rooting for him. I just want him to have a 2nd chance at life and be able to live whatever time he has left to the fullest.I have access to some of his records through MyChart but the daily notes that nurses and docs input isn't all there. I wish I had more information to provide you all.https:\/\/i.imgur.com\/rea1isQ.pngI kinda wrote all of this in a rush this morning after talking to his critical care doctor and surprised to see how many over responded, thank you again, It really means so much.",
  "input": "",
  "output": "I'm sorry you are going through this.Your father is going to die. I'm no oncologist, but this seems like he won't get into a situation where he can be treated with chemo or other targeted therapy (I assume they looked at that through his biopsy).A second option can help informing treatment decisions and with accepting this terrible news, but looking how to make sure your father is comfortable for the coming period seems like a good idea."
},
{
  "instruction": "Hi all, I'm looking for some assistance for what my next steps are, as I'm just a grad student and not a medical professional.TLDR: 48\/F with late stage liver failure and diabetes. Estimated 3-6 months to live. She suddenly is not lucid after stopping most treatment and starting an SSRI. I want to know if this sounds like encephalopathy, and if it does, can it be caused by these treatments?My mom (48\/F\/caucasian) is currently in the hospital for late stage liver failure. The current prognosis is that 10% is functioning, which is complicated by her diabetes. Last month she was in the hospital with 20% liver function, and had a second toe removed (the first was amputated in 2019).I brought her back in after my dad called complaining about how she can no longer stand, speak coherently, stop crying, and was in constant pain, which we were told was encephalopathy. Since she was removed from the ICU, a family member has been here for the entirety of visitation hours everyday to help her eat, get to the bathroom, etc, so we have witnessed this whole process. After a week or so of treatment with diuretics, she was lucid, starting walking, ate all of her food plus snacks, etc, though still in pain. She was able to verbalize that.Due to the IV teatments they were giving her, she accumulated 40 lbs of fluids in her legs and and abdomen, which they said couldn't drain due to her hemoglobin levels\/blood pressure. It started weeping from her legs as a yellow liquid, and eventually she developed dozens of sores on her leg bandages and the legs swelled to 3x their regular size. She was in excruciating pain plus itching, which from what I've read to pretty standard. That all said, she was still able to verbalize this and was lucid.5 days ago, she was told by the hospitalist that there is nothing they can do, and instead of palliative care, she should now be in hospice care. She was incredibly upset by this, but was still lucid. At that time, the palliative care doctor prescribed her an SSRI (not sure which one, they would not tell me) and the hospitalist stopped all other treatment other than blood pressure medicine, insulin before meals, oxycodone upon request, and benedryl for itching upon request.The timeline since then is as follows:Friday, she started receiving the SSRI. She was still lucid, calling people, and complaining of pain.Saturday, she stopped eating, speaking, or drinking anything. She just lays in bed, and if you ask her a question she stares blankly at you. She will nod sometimes to questions. She ate very little, and only when urged to.Sunday, she was about the same. Barely ate and doesn't speak at all.Today, Monday 3\/15: she is still the same, and hadn't had any sort of fluid since the previous family member left at 6p the day before and I arrived this morning. She has had no bowel movements in 24 hours. The palliative care representative prescribed ritalin to make her more alert, but it hasn't done anything. We are currently working on transferring her to a hospice care facility.She looks like someone on a heavy dose of oxycodone, but she hasn't had any in days. All she does is stare at us and occasionally eat a piece of candy when prompted. I asked the hospitalist what could cause this so suddenly, but he said there's nothing they can do, as it is not encephalopathy. He referred me to hospice and would give no other information.All of that long background is to say this: this doesn't look like how her encephalopathy manifested before (crying, pain, etc). Is it possible for it show up differently? The only new medication introduced last week was an SSRI, but since she only started it Friday, it seems weird that it would have an immediate effect like that, since I would think that it takes some time for it to get to the liver and metabolize (or not metabolize) and cause a rise in her toxin levels. I have also always been told that it takes weeks for SSRIs to be effective, but I don't know how that changes in cirrhosis patients. If this is not encephalopathy, but what is causing this sudden change?I want to make sure she is receiving proper care, as I'm not able to clean much from her doctors and she is not lucid. Thank you for any guidance on this situation!Here are the papers I read regarding this, in case that is important:2015, Issues in the endstage liver disease patient for which palliative care could be helpful2017, Psychotropic drugs and liver disease: A critical review of pharmacokinetics and liver toxicityNote:I don't know her current numbers, as they messed up her labs this morning and apparently don't redo them when that happens.",
  "input": "",
  "output": "I imagine this is one of the toughest times you and your family have ever had to go through. Please don't neglect yourselves whilst looking after your mother and seek appropriate support, particularly psychological, as necessary.I am a psychiatrist, so I will try to answer your query regarding the SSRI. I'm afraid my internal medicine knowledge isn't up to date enough to help with much else here.All SSRIs are hepatically metabolised. They can therefore accumulate over long periods of time, so they must be used cautiously in liver impairment, and SSRIs with long half lives should be avoided. Of the SSRI family, citalopram \/ escitalopram have the least known effect on hepatic enzymes and are typically the SSRI of choice. Some specialists may prefer paroxetine, due to it having the shortest half life. Whichever is chosen, the general rule is to start low and go slow. I trust your mother's doctors have stuck with this rule. In which case, I suspect there has not been enough time for the new SSRI to accumulate to sufficient levels to be responsible for her acute deterioration, particularly if her deterioration began after just one or two doses.However, even if the SSRI isn't doing any harm, we need to ask ourselves, is it doing her any good? In the state that you have described her to be in, especially since the deterioration, I would struggle to justify continuing the SSRI. At this stage, I would argue the potential harm outweighs the potential benefits. And who knows, I might be wrong about the SSRI not being responsible; if it gets discontinued and your mother starts perking up, then all the better.Sorry to hear about this awful situation, do take care."
},
{
  "instruction": "You seem to have knowledge about how SSRIs work, wondering if you'd take a look at my post, possibly had SSRI-related damage happen to me. https:\/\/www.reddit.com\/r\/antidepressants\/comments\/raqwkk\/my_life_has_been_upended_and_i_dont_know_what_to\/",
  "input": "",
  "output": "I'm sorry to hear you and your family are going through this. I agree with her physicians that unfortunately it does sound as though your mother is approaching the end of her life and palliative\/hospice type care is appropriate.Given your description, I suspect that her current condition is likely caused by hepatic encephalopathy, where toxins like ammonia build up in the body as they are unable to be processed by the failing liver. The treatment for this is usually medications that promote frequent bowel movements, like lactulose or other laxatives, as the bowel is the only other route by which these toxins can be removed.Hospice care should be focused on your mother's values and what's important to her. If you feel that it would be important to your mother to be more awake and with it during this time, it would be reasonable to ask her physicians whether medications to treat encephalopathy could be restarted. However, the counter argument is that by being more awake, your mother may also be less comfortable, the avoidance of which is another goal of end of life care. It could be that this is why her physicians have felt that holding these medications to promote her being less aware is best for her at this time. This is a conversation you should have with her palliative care doctors and together figure out what is the best way to care for her. Again, I'm very sorry and hope this helps."
},
{
  "instruction": "9 weeks ago i got pain on my right side under my rib cage. shortly after that nausea, bloating, and indigestion started. then my bowl movements were unpredictable and of all different types (loose... dark... normal... soft... constipation...) then dry heaving started.i have had a hell of a time getting treatment because im not critical enough during this covid19 crap. through multiple urgent care visits i finally got one to take urine and blood samples. they also got me an ultrasound and a telemed appt with a gastroenterologist.the urine was normal, but i was slightly dehydrated. not surprising given i was so nauseous drinking water was difficult. blood test was also normal except for a slightly low RBC count\/low iron. the ultrasound showed no evidence of gallbladder problem, but did reveal some potential (likely benign) tumors in my liver. those apparently are completely incidental, and not urgent to diagnose immediately, but i do need to get a CT scan on them once covid restrictions lighten up.this past weekend vomiting returned for a few hours. i also developed a mild fever, and then chills with low body temp. i was also salivating uncontrollably. i had to chew gum to get the salvation to stop. it was weird af.i can only eat small portions of easy to digest food. like grapes and cream of wheat. complex foods or larger portions usually throw me into severe nausea\/belching\/etc. I've lost around 6lbs this far.i'm waiting for a h. pylori stool sample test to come back in the next 48hrs. at this point im praying its positive so i can get an answer and some relief.is this normal? 9 weeks feels really long. every time i think im improving it hits me and gets bad again. do i sound like im describing an ulcer? and if so does it seem like the bacterial type? can it really take this long to heal? i called the gastroenterologist and im trying to get a follow up appt soon. i realize this is the internet and is not a substitute for true medical care. im just having lots of anxiety and would love some opinions. 9 weeks of constant nausea starts to fuck with your head.note - I've been on anti nausea and proton pump inhibitors for 4 weeks. i take no other meds including nsaids. there's also no history of cancer\/ulcers im my family. im also a middle aged male (early 40s). i have no major health issues, injuries, or surgeries. im an avid fitness freak. seasonal allergies, mild rosacea, and depression are my only real health problems to date.any thoughts appreciated. im in hell. getting help during covid is slow. im miserable and have a hard time living daily life.",
  "input": "",
  "output": "Most people with changes in their stools between constipation and diarrhea have irritable bowel syndrome. There are related conditions like sphincter of Oddi dysfunction or biliary dyskinesia that also cause RUQ pain and can sometimes affect stool consistency.H. pylori would be unusual with your symptoms, but it can present in many different ways. It doesn't typically cause diarrhea or other stool changes (unless it bleeds, but that's usually pretty obvious). Furthermore, if you get a stool test for H. pylori, and it's positive, that doesn't mean it causes your symptoms. Many people are asymptomatic. It really takes an endoscopy that shows significant gastritis or an ulcer to make a clear association between your symptoms and the effect of the bacteria.Your liver findings are probably not related. We see incidental liver lesions on ultrasounds all the time. But sounds like your doctors aren't too worried. I agree a CT down the road is a good idea. These are usually benign things, like hemangiomas, but worth getting a more clear diagnosis for these just in case.Other things to consider with nausea \/ belching with higher calorie foods is gastroparesis, which is where your stomach doesn't empty properly.I know it will be hard to get much workup now, but that's really the only way to narrow this stuff down. The tests we typically do are things like endoscopy (probably of most importance in your case), gall bladder scans, and gastric emptying scans."
},
{
  "instruction": "thanks for this reply. i should have been clearer. i have had \"looser stool\" than normal at times. but not diarrhea. i don't believe I've had diarrhea even once so far. not sure if that natters or not. my most recent one (sry this is so gross) was small and seemed to be covered in a whitish substance. maybe mucus from excess production in stomach?also thx for the heads up that a positive pylori test doesn't mean that's the cause. frustrating, but good to know nonetheless.",
  "input": "",
  "output": "Loose stools would lean towards IBS as well. But its a pretty nonspecific symptom and doesnt narrow things down a ton. :-("
},
{
  "instruction": "There are some parasites that can cause liver cysts and start giving you all sorts if weird symptoms. Did you travel anywhere before symptoms began where you walked barefoot on soil\/sand or drank water from a source you dont usually drink from?",
  "input": "",
  "output": "People sure do love parasites around here. Unlikely the explanation for OP.From your comment below:Entamoeba - This causes colitis, which is bloody diarrhea, not alternating stools and RUQ pain like OP describes.Liver flukes - Almost always asymptomatic. But, easy to check for with a stool O&P like you suggest.Cystic echinococcus - OP had a liver ultrasound. CE would show a bunch of cysts, and should be apparent to the radiologist."
},
{
  "instruction": "From what I've learned from House MD, it's definitely either sarcoidosis or lupus.Also, you get an upvote for your username.",
  "input": "",
  "output": "TuberculosarcoidolupusCANCER."
},
{
  "instruction": "I was reading this tweet thread from Dr. Monica Gandhi about molnupiravirhttps:\/\/twitter.com\/MonicaGandhi9\/status\/1415093950000422912Molnupiravir was not developed for SARS-CoV-2- originally thought of as a broad-spectrum antiviral because it is a \"nucleoside analogs\". We use those a lot in HIV but they basically inhibit the virus from replicating because this compound interrupts the process of copyingwhich led me to this article in Business Insiderhttps:\/\/www.bloomberg.com\/news\/features\/2021-03-25\/merck-mrk-molnupiravir-pill-could-change-the-fight-against-covidThe first antiviral approved in the U.S. was idoxuridine, a herpes treatment regulators green-lit in 1963, generations after the discovery of antibiotics. Its among a widely used class of drugs called nucleoside analoguessynthetic versions of nucleosides, critical building blocks of DNA and its counterpart, RNA, the messenger molecule that delivers instructions to a cells protein-making factories. Nucleoside analogues prevent viruses from replicating, or from replicating effectively, inside cells.When they do invest, they have much more incentive to focus on chronic diseases than acute ones, which entail inherently shorter treatmentand revenuewindows. If you look at what drugs have been developed against viruses, you have HIV, you have hep C, you have herpes. Those are all chronic infections. That means longer-term therapy,And so here I am, my High School Biology in mind, wondering how if day to day my cells are dividing and so need to replicate DNA, how providing a drug that inhibits replication is safe, especially for chronic diseases where the drug is taken on a daily basis for well, the long term.For the care and feeding of the automod:I am a 60 year old male, non-smoking, and this question has recurred off and on for a few years now, mostly in by frontal lobe I believe, though friends insist that that is located in my rectum",
  "input": "",
  "output": "Antivirals like acyclovir and similar nucleoside analogues act only on the cellular machinery within viruses, but not the cellular machinery in human cells. You are right that both viruses and human cells replicate DNA, but they do it in a different way. Some antivirals work on viral DNA polymerase, some work on viral reverse transcriptase, and some probably do something else that I don't know about."
},
{
  "instruction": "I 34(F) have been seeing a dermatologist over the course of several years, unfortunately Im in a healthcare system that is hit and miss with varying levels of doctors. Its also a healthcare system with a different first language to mine.I have been diagnosed with rosacea and seborrheic dermatitis. My skin goes from angry inflamed redness to dry and flakey.Initially I was advised to use steroids on the redness inflamed areas and to moisturise 2-3 times a day. To be honest, this doesnt work. Im using steroids weekly. I saw a good dermatologist who prescribed elidel cream which is ok, though it has not really worked well enough to prevent flare ups.Since then I was prescribed skinoren (which burns), told to wear sunscreen with multiple application daily and to start tacrolimus ointment. Avoid stress (Im a mum of 2 very small children and a critical care practitioner, so easier said than done).One dermatologist told me to stop steroids on my face as I had ?lines as a result of long term use. So should I completely stop?I cannot start tetralysal as Im breastfeeding.Are my options limited without oral medication? Will the results be worth me weaning?Im feeling pretty miserable as a woman when I can no longer wear make up without significant flare up and people asking what happened to your face?Advice is conflicting, often superficial and although I understand its chronic, will I ever have good enough skin to feel my normal self again? I only developed this in the past 6-8 years.Obligatory: BMI 20, non smoker, enjoy a glass of wine regularly. No other medical conditions or medication.",
  "input": "",
  "output": "Topical corticosteroids are inappropriate for long-term use. Pimecrolimus is much safer for long-term use and tacrolimus is more potent than pimecrolimus. Many who use azelaic acid use too much quantity and get irritation. Much smaller quantities are appropriate. Adding additional agents such as topical ivermectin and metronidazole may additionally help for rosacea, as could imidazole antifungal agents and similar for seborrheic dermatitis."
},
{
  "instruction": "33F, recently diagnosed with PCOS \/ insulin resistance, high TST, low cortisol.Im at a pretty critical point in getting my hormones fixed and after my appointment today I was notified that if I want to continue seeing the doctor that I see, there is a $100 fee per month to continue under her care. I see her three times a year but they want $1200 to ensure a spot to see her. They were very clear this was not insurance related and would be my responsibility...seems shady?? Hoping some medical professionals can explain it to me if its legitimate since, as it stands, it sounds very questionable. I want to understand.",
  "input": "",
  "output": "A physician can charge out of pocket whatever they want, not shady. Billing insurance is totally separate. This is a concierge model of healthcare that typically gives a patient more reliable access to their doctor (and is typically more expensive than other doctors). I suggest you find a different doctor that fits you situation better."
},
{
  "instruction": "26F 56 120 lb No medications Non smoker No known medical issues Migraine symptoms approximately 1x\/week for the last 4 weeksSo I did an MRA on Friday afternoon and the technicians gave me the results in a CD without any explanation. I didnt have a chance to speak with my neurologist. My boyfriend, who is a senior neuroscience biomedical engineering PhD student and has seen many brain scans before, immediately pointed out a strange deformity in my MRA. On the saggital view in the top middle of the brain close to the motor area there is a bump. His first thought was subdural meningioma. It was dark in the MRA image so he thinks it may not be a tumor because it isnt highly vascularized. Could it be a chat? Could it be a meningjoma covered by a subdural hematoma?Background - about 4 weeks ago I started having migraine symptoms basically for the first time. Nausea, dizziness, feeling out of breath while exercising even though I am a relatively fit person...and I had 3 episodes of mild throbbing pain on the side of my head. So I went to see a neurologist who recommended a MRA\/MRI.He tried to book it before Id be set to go out of the country on holiday for 3 weeks - all the way from US to a beach in Thailand with possibly limited access to medical care. We only booked the MRA because the most urgent goal was to make sure it was not an aneurysm.I had yet another episode today - lots of nausea and feeling sort of dizzy and hard to balance at times. And I have my flight tomorrow early morning ... 30+ hours!The main question here is - how likely would it be for my situation to be dangerous enough that I should not get on a 30+ hour multi-flight trip? Any counter-indications towards flying that I may want to be aware of given my symptoms and this MRA result? The problem is that I cant speak to my neurologist until Monday morning - by then Id already be in Thailand (or sick \/ critically unwell due to the flight?).Any help would be greatly appreciated!! Im ok with flying as long as I can be reasonably sure that I am not putting myself at risk by doing so.",
  "input": "",
  "output": "Unfortunately, Without the images or report, it would be impossible for anyone to give advice here. Can you call your doctor or the doctor on call before you leave?"
},
{
  "instruction": "Definitely call the Dr on call now.",
  "input": "",
  "output": "Your symptoms would not match anything you described may or may not be on your MRA images. That being said besides vascular anomalies nothing else can be commented on in an MRA. So seeing dark or light things outside of the vessels does not mean anything, that's what the MRI is for."
},
{
  "instruction": "My mom was diagnosed with Diverticulitis\/Ischemic colitis on Saturday. I picked up an Rx for her and it said take every 6 hours.Yesterday, I called urgent care to see if taking it every 8 hours was a possibility, as my mother has moderate dementia and it's difficult to get her up in the middle of the night. They said no...has to be 6 hours, but I don't have to wake her up in the middle of the night.This makes no sense to me; if it's not allowed to switch to 8 hours, then it means it's critical to take it every 6...which means I have to wake her.I already have sleep issues, and waking her at 3am every night is going to be a whole ordeal and struggle. Sure, I'd love for her to sleep through the night, but I don't see how they can say I don't have to wake her. It doesn't make sense.I just want to do the right thing. Can someone give me guidance? Thanks!!Edit: I actually called the pharmacy first, before reaching out to the urgent care: they said they could not provide guidance.",
  "input": "",
  "output": "It is rarely necessary to dose flagyl more than every 8-12 hours, this is sufficient for the large majority of indications as it maintains adequate blood levels. I don't typically give it more frequently than this and work in an ICU with very sick patients. Every 8 hours is a reasonable compromise. There is another medicine called augmentin that is used for diverticulitis and is twice a day.The general push recently has been to not use antibiotics for diverticulitis, though with your mother's age it is still appropriate to prescribe these. But in any event wouldn't get overly concerned about the flagyl dosing interval provided she is getting it more often than every 8 to 12 hours.Remember I do not know your mother's specific situation, so this is not meant to supplant the information from your providers, just that without any other details a less frequent dose of flagyl is adequate."
},
{
  "instruction": "Thanks so much for this. I called her doctor and we'll see them on Friday. Thanks to your prompting, I asked if they would like to make any changes. They haven't yet...maybe because she already started...? Thanks again!!!This was an urgent care so she probably was not seen by an actual physician.",
  "input": "",
  "output": "I think interrupting the night sleep of an elderly infected woman seems a bit of an odd choice even in the hospital.Give her one dose right when she wakes up, and one dose right when goes to sleep. Then space the others as evenly during the day as possible. (So for example, she goes to sleep at around 21:00 and awakes at 7:00 her doses should be at: 7:00-11:30-16:30-21:00).On the other hand, the active metabolite of metronidazole (flagyl) has a half-life of 9-19 hours. So taking it more than thrice daily is also odd."
},
{
  "instruction": "Thank you much. It's 250mg. I called her GI doc to update them and to see if they want to do any changes, and they scheduled to see her on Friday She was seen in an urgent care so probably these were not prescribed by a physician",
  "input": "",
  "output": "Fair enough, in my country every antibiotic has to be run through an MD (we don't really have DOs), so I assumed the same."
},
{
  "instruction": "[16M] So 2 days ago i felt pain on my right eyelid, the pain is like bruise, I don't really care about it. The next day the pain wasn't gone, so I checked \"Inside\" of my eyelid and it's more red than the left side, now i am worried about this. My current hospital only accepts critical\/emergency cases so I can't go there for now. What should I do about it? Is it bleeding inside?Edit : Nearby pharmacist says it's an infection\/allergy and gave me eyedrop \"DexOph\", could this help me?",
  "input": "",
  "output": "Ophthalmologist here. The picture isnt great, but it looks pretty normal to me. I wouldnt just use Dexoph without seeing an ophthalmologist. Dexoph is dexamethasone which is a steroid. Unregulated use of steroid eye drops can lead to both premature cataracts and glaucoma.You should go see an ophthalmologist.Edit: can you upload a higher pixel picture of the affected eye along with a picture of the normal eye for comparison?"
},
{
  "instruction": "Female, 50, 5 5, 215 pounds, never smoked, seizures, chronic stomach issues like abdominal migraine and ileuses, breast cancer.I have lifelong chronic digestive issues, stemming from a major exploratory surgery when I was 5 years old. About 20 years ago, I started having major issues requiring hospitalization with NG tubes and all kinds of other fun stuff because of the adhesions from the 1974 surgery hardening and choking my intestines.Starting in 2006, after many other things failed, doctors treated both the pain and the hyperactive bowels using Dilaudid. Over the past 13 years, my tolerance has increased, through absolutely nothing but closely monitored physician prescriptions and instructions. Through all of these years, I have taken some hefty narcotics for about one week every month, and not at all the other three weeks. I have thanked God a thousand times that I don't appear prone to any type of addiction (Never smoked, drink a couple of times a year, no illegal drugs whatsoever, couldn't care less about gambling, etc. My worst vice is Amazon.)Between this and absorption\/metabolic condition, I get extremely little relief from the highest oral dosage that my PCP is comfortable with: 8mg every 6 hours.I'm currently in breast cancer treatment, halfway through Herceptin infusions that are supposed to continue through September. From the very beginning, Herceptin gave me diarrhea, and it has worsened to date to the point that I am in the hospital about one out of every three weeks because such severe diarrhea that I am dehydrated, critically low on magnesium, excruciating cramps because it flares my chronic condition, and you can imagine the rest.Two weeks ago I went to the emergency room with the usual symptoms, was given my now usual dose of two milligrams IV Dilaudid immediately followed by 1 mg every 3 hours for the next 8 days inpatient. Normally, they start tapering off by spreading out doses around day 4 and I am home and much more comfortable by day 8. This time, however, they noticed significant thickening of my colon on a CT scan, so on day six, when the Dilaudid had just calmed my bowels and decreased my pain, they had me do colonoscopy prep, which not surprising brought excruciating pain back with 18 hours of non-stop diarrhea.SO... hospitalist has access to 13 years of hospital records outlining the progression of all of this, has recent records showing mastectomy, Herceptin, labs consistent with six months of diarrhea... yet still harangued me the entire visit, accusing me of being there basically faking it for the Dilaudid. I could never keep him focused enough on my actual issues to get any help from him or get any questions answered because he was so convinced that there was no illness, only addiction. He claimed he read my records. I couldn't get him to call any of my other doctors. I couldn't get him to look at the December prescription bottle the nurses took from my purse and locked up that was still half full. The day of the colonoscopy, for the first time in my life, I told them I was a 9 on a scale of 1 to 10 in pain ... I'm very conservative with those numbers. Asked if I could have just one dose of 2mg of Dilaudid to get me back on track and was denied. Then he started the discharge process that day... with renewed diarrhea every couple of hours and 9 on the pain scale AND no tapering of Dilaudid. Being on Medicare (disability on the first try, approved in 2017 in less than 90 days due to the severity of illness), I threatened to report him because I didn't believe I was ready for discharge, and he told me with hostility that I could stay one more day but then I was out.I was discharged with the same level of diarrhea I went in with, more pain that I went in with, and spent three lovely days in bed crying my way through Dilaudid withdrawal. All caused by a doctor who lectured me for 4 days on the opioid epidemic. I can't imagine how many people would have become addicted in my situation instead of just gutting out the withdrawal.How do I get this to stop? Isn't there any overarching agency or physician type or anything I can do to have it documented once and for all that there has never been an addiction problem and that there is a room full of files documenting the illness and the reason for the medication?I'm seriously considering stopping life-saving breast cancer medication because on top of all of the pain and diarrhea, I can't face another week like the week he put me through. This wasn't my first experience with a doctor so obsessed with this notion, but it was by far the worst.What the hell are people with decades of documentation, debilitating chronic illness, and zero evidence of any addiction at any time supposed to do?",
  "input": "",
  "output": "I read it somewhere in this but you need to 1) go to a pain clinic and 2) have a medication contract that may even cover pain crisisDilaudid isn't a great chronic opiod and ideally you should be switched to methadone or buprenorphine, but again, that's something that should be discussed at the pain clinic.Also, I would reexplore with a GI your hyperactive bowels and see if you can find an alternative to opioids for it's management."
},
{
  "instruction": "Awaiting my follow up appointment after questionable minimal supravermian atrophy that was found on my brain MRI last week. Im unable to find valuable information with the phrase supravermian atrophy online. Im hoping someone can shed some light on what a finding like this could possibly be related to. Im too impatient to wait until my follow-up to learn more about it.27F, 5 8, 138 lbs, European ancestry. I work full-time as a critical care RN in a peds ICU. History of gangrenous appendicitis age 5, Guillain barre related to a suspected tick-borne pathogen age 8, asthma (controlled by corticosteroids,) anxiety (relieved with PRN benzos,) vasovagal syncope episodes during ovulation since the age 16. I spent my early childhood on military bases with known toxic contamination (Fort McClellan, Fort Bragg.) I dont do drugs, I drink maybe 1-2 times a month. PALB2 & CHEK2 gene mutations. Dad was diagnosed with stage IV Glioblastoma, age 48. Paternal uncle died of a brain tumor age 3. Paternal aunt had endometrial cancer at 27. Mom has history of substance abuse, Sjogrens, rheumatoid arthritis. Maternal grandpa received a heart transplant (acquired heart disease,) maternal grandma and aunt had ductal cell carcinoma (after menopause.) I was out of work for over a month due to an intermittent fever ranging 99-103. No pathogens detected in my pancultures. Blood work was normal: CBC, BMP, TSH, HIV, Syphilis, B12, Vit-D, thiamine, folate. In the past year Ive had the following symptoms: fatigue (I could sleep 16 hours a day if I was able,) dizziness, occasional double vision, compulsive sighing\/feeling out of breath, itchy\/burning armpits, twitching throughout my body, headaches (~3\/week,) cold hands and feet, high blood pressure, stress and urge incontinence (especially around ovulation,) severe abdominal pain right before a bowel movement, sometimes I pass out from the pain. Ive noticed changes in my speech: fluency, long pauses between words, losing track of sentences. I cant hear people or retain information unless Im staring directly at them, and I have worsening sound sensitivity. My memory has suffered. I will quickly lose new information and have difficulty recalling information on the spot. I find bruises on myself because Im clunky and clumsy.I want to feel young, healthy, and happy. Please help.",
  "input": "",
  "output": "Can you post the full MRI report? I too have trouble understanding what that term means; the vermis is a part of the cerebellum, but the space above it (supravermian) in my experience refers to a space containing CSF, not brain tissue."
},
{
  "instruction": "Hi so I (23f) have had a sudden onset of joint pain mostly in my hands and arms. It may have been more gradual than I noticed, but this week has been very brutal! Its like my finger joints are just VERY achey and my elbows are also in pain fairly frequently (mostly when my elbows are bent).I work on a computer all day, but am not a typist. I am usually working on excel spreadsheets doing data analysis which I guess I never thought of as typing as its more of a critical thinking thing as my main task. That being said my hands are on a keyboard for the majority of the day.Now my FIL had surgery for carpal tunnel syndrome last year, and it feels like exactly what he described and I am panicking a bit bc I didnt really think that I was a candidate for having this issue so early on in my life! Is it possible that I have carpal tunnel syndrome? What else could it be?Im just scared of the financial ramifications an issue like this may have (Im broke as shit!! But I do have insurance!), but I obviously want to take care of it ASAP instead of letting it get worse. What should my course of action be\/how long should I wait before getting it checked out in person?Thanks in advance for your time!ETA: not sure if this is relevant to this issue, but I am in relatively good health. I am overweight but have lost around 50 pounds since the beginning of the year and am well on my way to a healthy weight. I eat mostly cleanly and walk a lot. I used to be an avid weightlifter but have not gotten back into it after a knee injury in 2018 (big part of how I became overweight... lack of movement & depression from losing my job & other stresses due to my injury). I also was a 4 sport athlete in high school: softball, swimming, track & field (discus & shot put), and volleyball. I dont know if any of this is helpful but if it could be a contributing factor I thought I would mention it.",
  "input": "",
  "output": "Yes, it's possible for you to have carpal tunnel- it just really depends on your level of activity with hands.You aren't locked into surgery. I'd start with getting an ergonomic setup for yourself and taking frequent breaks from typing. I would also look into getting a wrist brace to sleep with at night, and begin using that for a week or two and seeing if you improve. Chances are if you take early action you won't need surgery for quite some time- if ever."
},
{
  "instruction": "Wow, that is great news! Will that help with the elbow pain as well? Also do I still need to see a specialist or set something up with my primary care physician?",
  "input": "",
  "output": "It can help with the elbow as well, yes.If you end up seeing a doctor they will tell you what I just did. I'd say hold off and start with what was mentioned unless it progresses significantly or it starts actively impacting your ability to function."
},
{
  "instruction": "Hey, for the past year or so I've been smoking socially (about twice a month). I know that death\/critical care rates are much higher for smokers, but I haven't smoked in about a month and don't plan to start again so where does that put me? I'm an otherwise healthy, moderately fit 18 year old. I know info isn't available for covid19, so if you know this regarding respiratory infections in general let me know, anything is helpful",
  "input": "",
  "output": "Puts you somewhere between the smokers and the non-smokers, closer to the non-smoker side of things. Good on you for planning not to smoke again. That's about the best thing you can do."
},
{
  "instruction": "Age: 30sSex: MaleHeight : 5Ft 8inWeight: 180Race: LatinoDuration of complaint: 5 months+Location: Texas, US. Abdominal pain, blood in stool.Medical Issue: Had recurring blood in stool that increased in intensity and frequency. Saw doctor and prescribed Cipro after which frequency of bowel movements and amount of blood increased. Given prednisone which seemed to increase amount of blood in stool. Had CT scan of abdomen which revealed hepatic mass lesions. Primary care doctor advised and arranged for admission to emergency room for an MRI of the abdomen. ER doctor however reviewed scans from CT and believed they were cysts and wouldn't proceed with MRI. ER doctor emphasized need for colonoscopy first which I have scheduled for 31st, but he worries that is too far away. For reference it took me 6 weeks to get the CT scan. I didn't get a referral\/authorization for an MRI from my primary care doctor. ER doctor told me to return on Monday and that I may possibly be scheduled for colonoscopy through their hospital. How critical is all this? I'm worried as I now have to wait the weekend at minimum, but likely will have additional weeks of waiting for paperwork\/insurance authorization\/scheduling before I can get these procedures.",
  "input": "",
  "output": "You didnt mention any blood test results (e.g. liver function test).Also, did the imaging study not reveal anything in your GI tract?Either way, yes you should undergo a colonoscopy as soon as possible. The results of the colonoscopy will inform further management decisions.If you feel like fainting, or experience any symptoms that you consider to be drastic, go to the ER.Best wishes."
},
{
  "instruction": "Sorry in advance for the formatting. My mother is the patient. She is a 62 year old female, 52, ~140 lbs, a caucasian, and she has several issues with chronic pain\/osteoporosis\/degenerative disc disease\/some nerve issues\/arthritis that her doctor has prescribed a 12.5 mcg fentanyl patch for that she changes every two or three days. She was on a higher dose when she started using the patches but she did not like the side effects, so her doctor cut the fentanyl dose in half to 12.5 mcg. She is taking lexapro, wellbutrin, a blood pressure medication (I think bystolic), montekulast, and possibly a diuretic (unsure if shes still taking that) daily. As needed, she is prescribed voltaren gel and voltaren pills, Valium, and norco (hydrocodone 10\/325). She has some additional health issues that arent relevant to my concerns (high bp, asthma, primary lymphedema, some allergies. Dementia runs in her family, but the people who have had it have all been very sharp until their early 80s.Since she has been on the fentanyl patch for a few months now, my fatherwho is a physician himselfand I (who live with her) have noticed some very concerning things. We all see the same physician, so he knows all of us and our character. I would like to tell the doctor about these concerns using a letter, but Im not sure if Im being too wordy or if I should contact him another way. Please give me your constructive criticism as to how I can effectively communicate with him so these concerns get addressed. Heres what I have written:Dr. Doctor,I am writing out of concern for my mother, [major_bummers mom] (DOB XX\/XX\/XXXX). I am aware that I have no power regarding my mothers care and no right to her personal health information. However, as a daughter, I have some concerns regarding my mothers current usage of the fentanyl patches you prescribe her. I wanted to reach out to you about them personally because I dont think she has the mental ability to realize how much of a toll these patches have taken on her. I realize not all of these concerns I have about her cognitive ability\/memory\/ability to preform daily functions could be attributed to her use of the fentanyl patches, but the timing leads me to think it is the cause.My father and I noticed that about two weeks after my mother began using the fentanyl patches, her overall productivity became much less than normal. She is now spending her days sleeping as much as she can (10 hrs per night with a 3-4 hr nap) and gets a significantly less amount of work done compared to before she started using the patches. She says she thinks her pain is under better control with the patch, but her avoidance of physical activity and her daily complaints of increasing or new pains tell me it is not working as well as originally hoped.My mother has seemed to slowly lose her critical thinking skills, her ability to remember things, and speak\/think at her normal speed. She was the type of person to remember where everything in the house is, even years after it was put somewhere, but now she has started to lose things such as everyday items, important documents\/records, and even her own controlled medications. (She normally hides them so she has to think about where they are before taking a narcotic, but recently she forgot where she put all of her scheduled medications and had my dad and I flipping the house upside down looking for them for about 6 hours. She also separated one fentanyl patch from the others and has been saying she has been unable to find it for days, making me wonder if she actually put two on.) Along with my concerns about her memory is that in the past month and a half or so, she has started remembering things that have never happened\/things shes made up in her head and has been unintentionally giving my father and I completely false information, which has caused a lot of frustration within the family. She will become unnecessarily upset with us as she genuinely doesnt realize some of her memories are extremely inaccurate or have never been real. Usually, this results in an argument with her until she either gives up or understands our explanations as to how and why what she remembered couldnt have happened. She often asks the same basic question (such as are you going to work today?) several times per day because she doesnt remember the answer from the first three times shes asked. Her accounts of something that weve both seen are usually inaccurate.On bad days, her speech is sometimes very slowalmost incomprehensibleand my dad and I have to either work on completing her sentences for her or ask her to form a complete thought\/statement before speaking. I dont feel like the person Im talking to is my mother and is instead someone that is either mentally handicapped, drunk and drowsy, or demented. She often seems mentally absent or half asleep when I am trying to have a normal conversation with her, even with no distractions.Lastly, my biggest concern is that her ability to react to things has slowed down substantially since she began having a strong opiate in her system on a constant basis. When I have the opportunity, I ask\/offer to drive her places because she is a danger to herself and others behind the wheel. She has made a habit of going below the speed limit and stopping at places she has the right-of-way to be a safer driver, in her words. This is a woman that used to love to drive fast cars on racetracks. She has started to slam on the brakes when she approaches a stopping point because she does not slow down in time to stop properly\/safely. It seems that her situational awareness has taken a nosedive since she started using the patches. If she were to cause an accident, which she has almost done on many occasions since starting the fentanyl patch, a police officer would absolutely see she is driving while incapacitated\/under the influence of a drug.It pains me to see my mother like this and hope you understand my concerns. I am grateful for your time reading this letter and hope you will keep my observations in mind when proceeding with my mothers care. My family and I very much appreciate all that you have done for us. If you need further detail or have any questions, please dont hesitate to give me a call.Sincerely,Major_bummerEdit: added some additional health information and fixed grammar",
  "input": "",
  "output": "Make it shorter and send it. The goal of pain management (in patients without terminal illness) isnt to completely eliminate pain or get people on government disability. Its to get their pain to a level that is tolerable enough for them to main functionality (keep being employed, for example). Sounds like your mom is on too many narcotics. Based on the problems you told me (all musculoskeletal), she probably needs to be tapered off narcotics completely."
},
{
  "instruction": "Would a bulleted list be more appropriate for a busy doctor?She has been on narcotics for years as her spine is not in good shape at all (we almost went overseas for better spine surgery technology but couldnt afford it) so I doubt shell get off of the narcotics entirely anytime soon. Shes one of the few patients with enough pain that she qualifies for disability and deserves a relatively strong opiate, but not as strong as fentanyl. I still feel like she was doing better mentally taking more hydrocodone daily instead of using a constantly releasing fentanyl patch. Granted I wasnt in the room when he initially prescribed the fentanyl patches, but it seems like a huge leap to go from 3 hydrocodone per day to fentanyl without trying something like an extended release opiate that isnt as strong as fentanyl + comes with less risks. I know shes tried things like gabapentin and lyrica before but her body didnt like them too much and she reacted to them strongly.",
  "input": "",
  "output": "There is no evidence that opioids work any better than over the counter meds for chronic, non-cancer-related musculoskeletal pain, so your assertion that she deserves a strong opioid is specious at best. Fentanyl is no better or worse than long-acting opioids, it is the dose that is most important. Regardless, her current situation is not acceptable (being zonked all day long) and I would argue that you have an obligation to notify their prescriber."
},
{
  "instruction": "Age 16Female110lbs, maybe lessRussiaHello doctors,Our relative was hit by a car. We don't know many details at this time except that she is out of critical condition, but still unconscious.The reason for posting is because it's Russia and for most part, doctors don't really care for their patients, especially if it's a public hospital.Can someone please tell me what are some of the must be done tests, scans, blood work after an accident.Thank you",
  "input": "",
  "output": "It's impossible to know without knowing how exactly they were injured. I would assume that if she is unconscious, they would do some kind of imaging of her brain to make sure there isn't any bleeding in there."
},
{
  "instruction": "For example, this morning we had a 63 yo patient that had been sinus tach since her admission a day or two ago. She was alert but not fully oriented during morning rounds. This morning, over the course of an hour, she slowly went from 115 to the 40s. She ended up bradying down and a code was called. There was a short run of vtach right before we started coding her. She ended up regaining spontaneous circulation and was moved from step down to ICU.As far as her history, I barely saw her chart. I know she was suffering from c diff and chest pain. There was critical care protocol for fentanyl and propofol but other than that I have no idea.Is this something related to electrolytes? Cardiac issues? Need more information? Her ekg strips were normal sinus tach prior to the event. Ive also seen this in other patients that were DNR where they just Bradyd to asystole. Any insight is appreciated.",
  "input": "",
  "output": "Definitely need more info. Bradying down essentially just means someone is dying. So for that patient in the ICU I'm gonna assume she has lots of possible reasons to die. Electrolytes absolutely, acid\/base yes, hypoxia, hypotension, MI, PE etc etc. The list is literally endless. Brady codes are the most frequent ones I have seen usually."
},
{
  "instruction": "I'm trying to understand a current family situation where I believe doctors are being hasty with care.My brother in law, about 30 years old 6ft 250lbs, is currently in the hospital for acute pancreatitis due to alcoholism which stressed the one kidney he had (genetic one kidney). He's currently sedated on vent, dialysis crrt, and insulin drip. He was admitted a week ago after he called an ambulance. With only symptoms being nausea and stomach pain. Since being admitted he was bumped down to 30% oxygen with breathing therapy, 5.0 PEEP, and his vitals and blood work were all in normal ranges for an adult male. Then they lessened his sedation and he was responsive. Hand squeezing and pointing. However other blood work and vitals dipped a bit after he had breathing trouble from bile due to pancreatitis.Additional: I think initial intubation was due to shock\/hyperventilation upon admission or lung infection? Doctors have said all organs are viable. Torso MRI showed a good gallbladder, liver, and lungs without liquid. Family told they should not worry about organ donation yet(family match donation to improve health). Organs are not necrotic.I'm not trying to decide if my BIL needs a DNR. That's not my choice to make. I'm just curious how doctors factor offering it or when it's needed.TLDR; So, why would a doctor recommend a DNR for such a young patient that could seemingly recover? When do you consider patients to be at a point of no return? Is it standard to ask any critical patients to sign a DNR? Do Doctors weigh stats before offering or just their judgement?If you were this patient would you ask for a DNR?",
  "input": "",
  "output": "Your BIL is critically unwell and requiring multiple organ support. He has de-facto multi-organ failure because his kidneys are needing dialysis, his blood pressure is being supported by drugs and he is being ventilated for what sounds like ARDS.The DNAR is if these things stop working, so he does not undergo futile CPR. If he recovers and leaves ICU theyll tear that DNAR up (or you can ask them to), but it wont affect the quality of his care to have one in place.Currently -depending on where you are- he isnt a transplant candidate due to the alcohol, as well as being critically ill."
},
{
  "instruction": "Absolutely this. DNR is NOT the same thing as comfort care or withdrawing life sustaining treatments. Them asking about a DNR in this case probably means they think he is unlikely to survive or have a good outcome from CPR. But its important for everyone to consider what they would want done if they were to have a catastrophic health event, regardless of their current health.Okay but studies have shown that a DNR can result in lower quality of care, and typically do. In the BIL's case, although he is critical, he is responsive, and has only been in the hospital for a week. He has made significant recoveries like oxygen levels being reduced and other blood work levels being stabilized to healthy amounts.We are being told both organs have capacity to recover or with the kidney some function. They aren't necrotic. Couldn't he still qualify from a family member match willing to donate? Doctors have not moved towards that idea either.I guess my question is- how does a doctor stack the odds like that? Yes, on paper he has three machines doing organ functions. But is there not potential for recovery? If the oxygen intubation progresses with therapy, he could also remove feeding tube. There is also potential for getting pancreatitis managed, and kidney support with regular dialysis treatments or donation.Does a doctor weigh statistics or is it just judgement? And what helps them make that judgement? Because I feel like someone with the potential to recover, who is pretty young, would not be a candidate for a DNR.Now if there was a clearer document that outlined CPR in a worst case scenario then yes I see that. But signing a generic DNR with chances of recovery and treatment options seems very pessimistic. Especially given that BIL has a condition that can cause asphyxia and there have been cases where DNRs do result in vent being removed.",
  "input": "",
  "output": "Simple answer is at the moment none of his organs need replacing- or rather theyre broken in a way a transplant wont fix. An organ isnt like a broken gear, the whole system needs to work for the organ to work.And nobody is taking him off life support prematurely due to a DNAR. Its simply stating if his heart stopped beating that would be the end of treatment. irrespective of age, if he reaches that point he isnt surviving in his current condition.As previously mentioned, if he continues to make progress forwards then theyll tear up the DNAR anyway, but at the moment your BIL is not somebody I would expect to survive chest compressions- it would be another organ not working, without the ability to support it or replace it to ensure survival."
},
{
  "instruction": "When you sign a DNR it isnt just a genetic DNR. There are different sections to it. It asks if you are ok being on a vent if needed. It asks if you are ok having a feeding tube if needed.You can be ok with life support, just not CPR if it comes down to it.",
  "input": "",
  "output": "This is a difficult question to answer without knowing the full clinical picture. What is his day to day ventilation settings? Just because he is down to 30% doesn't meet his PEEP is down. How has his spontaneous breathing trials go? What does his CXR show? What do you mean the blood work is great? What are his I\/Os? How is his kidney function?"
},
{
  "instruction": "He's got a feeding tube because he's been sedated. But he's had bowel movements. Constant IV hydration drip but no urine in catheter.They had been doing breathing therapy with him that is when they lowered his sedation and oxygen. He seemed to be doing better with 30% and then bile in the tube then his condition worsened. He's now at 50% again. They have done several torso scans but they haven't given details on the scans diagnostics.That's most of what I have based on what I've been given. They said his kidney and pancreas are not necrotic. He did have an infection in his lungs when he was admitted but they cleared out several days ago. However since he had bile with the intubation he has liquid in the lungs again.",
  "input": "",
  "output": "There's far too many details still being missed here to state that his care is hasty. You have an individual who has one kidney on continuous dialysis while having low blood pressure. He is making no urine at all. For some reason, he was intubated for pancreatitis, so I assume it was because of ARDs. He sounds critically ill."
},
{
  "instruction": "To clarify, just because the organs aren't necrotic doesn't mean they are functioning. Also organ donation has nothing to do with DNR. The appropriateness of someone to donate only comes after they have died or are literally about to. In the US people self-declare at the DMV so the organ donation services already know their intent in most cases.He has multisystem organ failure, plus underlying conditions which will make his recovery harder than someone without those (alcoholism, solitary kidney) based on what you have written, so it is absolutely imperative to find out what his wishes might be regarding code status. In the absence of any clear directives from the patient in the past, the family is asked to predict what the patient would choose for themself if they were able to sit in on the discussion and weigh in--basing this off of past comments, how they engaged (or avoided) healthcare interventions on their own, etc.I suggest that his designated healthcare agent and any other family present, have a care conference with the intensivist. This is a time set aside in a nearby conference room, not at the bedside or in the hall. Include one of his nurses if possible, any specialists who can make it (often harder to arrange) and then the unit's social worker\/case manager. The purpose is to outline exactly where he is on his trajectory, what the major challenges are, what the expected chances of recovery appear to be at this point, and then a discussion of next steps. Find out more about why the doctor was recommending DNR. Hear what they have to say about this based on their experience. It might be because they don't feel he will likely be resuscitated if they make attempts, therefore, to attempt shocks and compressions would be futile. If they feel it would be futile, then it would represent only harm to the patient and not comfort or cure. I cannot predict what they are thinking so you need to find out, but this has been my experience from working in ICU as an RN and Care Manager.If he cannot be weaned off of the vent shortly, he will need a trach and a PEG (feeding tube in his side). If he stabilizes enough to be discharged from ICU (off of CRRT, off of high vent settings, off of any vasopressors that are stabilizing his BP, only on X number of antibiotics, etc) then he will meet criteria to transfer to a ventilator rehabilitation hospital or LTACH (long term acute care hospital).If this happens, it is a long slog. Is it something he would want? Also, he might not survive it and could have a downturn at any time, heading back to the hospital. Knowing this, is this something the family would predict HE would want? If so, you have your answer. If not, then it is appropriate to consult hospice to make him comfortable. Another service to consult if you have it available is Palliative Care. In many hospitals they are consulted for complex cases like this who are taking a long time to recover. They are particularly helpful to the patient to improve quality of life while recovering, as well as provide support and guidance to family.At the end of this long post, I offer you two things. One-you are in my thoughts. I know how difficult this is and you are on a crash course of learning right now. Two, please use this resource that many families in your position find extremely helpful--patients let us know so often this has helped them in cases like yours: Hard Choices for Loving People booklet",
  "input": "",
  "output": "If this was me I would want a DNR and a DNI signed. More importantly, I would want a MOLST form singed indicating exactly the care that I would want, the care that I don't want, and for how long. That is to say, give me antibiotics for one week and see how I do, if nothing's happening then stop all unnecessary treatments.What I like to see in patients is an end goal. What happens far too often, is patients will sit in an ICU for an extended period of time deconditioning and not getting better, but family does not want to do anything for fear of making the situation worse or feeling like they are murdering a family member by taking away care. Recognize that his pancreas is not well at all. His kidneys are not well at all. His liver is not well at all. Assumedly, his lungs aren't either.Let's say he is extubated. Now we have a burnt pancreas. And kidney. And liver. If you are this young and have liver dysfunction or failure, that's a life of slowly getting sicker and sicker until you can possibly but probably not get a liver transplant in the future. It's painful. If his kidneys are truly shot and he requires dialysis in the future, that's 50 years of spending 3 days a week going to get dialysis and sitting there having your blood cycled over and over for hours, just to go home and not feel well. Then you do it again. Then you do it again. That's a lot of stress for a 30-year-old. A 30-year-old that already has alcoholism. If your pancreas is constantly becoming inflamed, diabetes maybe in the future or at least insulin dependence. A 30-year-old diabetic will have a low quality of life.DNR and DNIs are to preserve a patient's dignity thinking about the long-term consequences to their health and quality of life. The idea that saving people is enough, is not enough. By stating do not resuscitate, You're saying to give a chance, but don't take it farther than he would like given all that has happened, and will happen in the future.The doctor sees this all the time. The doctor sees a family that holds on to hope that everything will be okay because their family member is \" a fighter, \" but neglects to see that the patient has already fought 25 rounds and has been knocked out three times. And also neglects to see that, if they come out of the fight, they essentially will have an agonizing future for the rest of their life."
},
{
  "instruction": "Hello Reddit,My younger brother was 27, Male, maybe 6 foot and 375 pounds, half white\/asian, no drugs, no smoking, extremely rarely drinking (like less than once a month).I don't recall what his early symptoms were but I found a virtual chat that said he may of had \"uncomplicated cystitis\" and had antibiotics prescribed for it. He saw a urologist and eventually had a nephrostomy tube, then had surgery later and was noted with a failed kidney. They were unable to remove it due to his weight and having hemorrhage concerns, at least that was my understanding, and that's it for a his existing medical condition, with an exception.I'm first wondering how he developed this condition to begin with. Would the failed kidney have caused the infection? I wish I had the full records so I could paint a better picture, but ultimately I can only guess that his high blood pressure was a cause, plus having a high stress job.Ever since all this, he had to urinate every like hour and this caused issues with work and sleep. I really don't understand why this kept happening and nothing was given to him for it. Would having a failed kidney cause that? This started back at the end of 2020 and the tube and surgery may have been in Q2\/3? I now can't remember what happened first.From that I'm mostly wondering about the reason for frequent urination and if he would have got infected some other way outside of high blood pressure. He almost never leaves the house, and I fear he'd only get sick if a family member came home with something.Fast forward to the bulk of my reason to post. On January 13, 2023 he mentioned some nasal congestion and some body aches. He didn't seem to get better on the 14th so I asked if he wanted to see a doctor and he said not yet. This eventually came with some headaches so we tried to go to an urgent care but the wait times were 3+ hours so we figured try a Teladoc (98point6 for this call) and get an appointment later. He mentions a head ache lasting 4-5 days, dull\/sharp pains in waves from front to back, also going behind his eyes. He was taking ibuprofen, and was asked about a fever and he said he wasn't sure but his head seems warmer compared to his body. They basically said to take Afrin and Excedrin and go to urgent care if things don't get better. When he went to take the afrin that night, he blew his nose and had a nose bleed, and per our father he had nose bleeds from time to time, but not that super often.Come January 19 I take him to urgent care and I do have his visit summary. Blood pressure 174\/89 (why the fuck didn't anyone talk about this), temporal temperature of 98.1 (maybe the medication lowered it?), pulse 90, respiration 18, oxygen saturation 97. They gave him Toradol and sent him home. I feel like a fucking asshole that I wasn't in there with him, I had to drop him off and attend a work meeting that I should of canceled, and our mother picked him up. This is all very local, like within 15 minute drives.He doesn't seem to get better and on the 22nd he talks about some vision issues so I immediately take him to the nearest ER, which is a satellite and not attached to a large hospital. He goes to a back room almost immediately after checking in - alone, and again I feel like a fucking loser as I should of gone there with him to help explain everything - who knows exactly what he said since he was dealing with headaches. I did come back and talk to one of the nurses, but that didn't seem to change anything they expected.He had the following lab tests done, CBC With Diff, CG4 PANEL POC, Comprehensive Metabolic Panel Poc, PCR Influenza A & B and Covid 19 (POCT). Also had a CT Head W\/O Contrast and EKG. Done today was just the CG4 and Comprehensive Metabolic, guess the CBC was still processing? I don't recall any notes on this, and his MyChart is closed.They didn't seem to find anything, even though he had a 171\/105 blood pressure, they did ask if he had history and I didn't have a full answer, but said it wouldn't be surprising since the rest of the family has medication for it, but he didn't have a primary care doctor to prescribe it. He had trouble finding one since COVID and it really pisses me off that I didn't help him find one somehow. He also had 100.1 temperature.They gave him .9% NaCl (NS), tylenol, benadryl, toradol and reglan, and sent him home.The next day I don't remember exactly what triggered this, maybe balance, but we took him to the ER attached to the hospital and the doctor almost immediately said he wasn't going home that night, he saw something. They put him in a gown and my brother was shivering mad, and he normally likes it cold. Sometime that night I believe he got a room and had some tests, and they said he had meningitis, and shortly after was uncertain of contagious so the room was adjusted and we had to wear N95 masks and a face shield \/ gown. This went for maybe 2-3 days, and it bothers me so much because this was the most critical time that I could of had talking to my brother and I minimized my time like a coward and asshole. I believe our mother was there the whole time though.After that 2-3 days it was cleared for bacterial and said likely viral (they never said what he had) and the additional PPE was stopped. I remember he texted me to bring apple juice, yogurt, and fruit cups, which I did, but asked if it was okay because I thought hospitals didn't want outside food. They said it was okay as long as it conformed to a low sodium diet, which those did.During this I know he had a lumbar puncture, which is likely how they found the meningitis, and had a CT\/MRI that they said was clear. Then suddenly the next day he developed delirium. He was able to answer our questions and knew who we were, but it was like he was living in a video game or something. He'd also spring up very quickly pulling wires to urinate (and frequently) which caused concerns for the monitoring and fall prevention, since he was a little wobbly and I think bumped his side one day because of the bar being down for the accessibility access for the toilet.The doctors believed the delirium was due to his lowered sodium levels, which could have been to the frequent urination and low sodium diet. He was drinking a ton of Gatorade at home back home, probably around the 16th I was buying him multi-packs as I felt those helped me recover. Eventually they put him on a EEG and because of the frequent getting up and sometimes he'd just try to rip the things off, they restrained him. I wasn't there when it happened but our mom was there and it sounded a little traumatic, like saying \"why are you doing this mommy, and then attempting to bite her\". Not sure if that's exactly what happened but he was restrained. Either at that point or shortly after he did have a nurse assigned to be next to him 24\/7 to monitor, and help him pee as he'd be responsive if he had to go and the nurses asked.During this delirium he'd talk about random stuff, sounded like he was in a game, he couldn't explain where he was, but he was still answering questions. Everyday I visited I'd ask if he knew who I was and he'd start by laughing and saying of course, and I had to be more specific with him and he'd confirm my name and that I'm his brother. During this time we had a family member with him 24\/7, but would occasionally talk to him, I know I'd hold his hand and he'd squeeze back, but we'd end up sitting to the side talking to each or reading a book, etc.Finally on the 30th I was coming in to swap out with our father, who said that my brother was a bit quieter today, maybe he was finally getting some much needed sleep as it seemed like he wasn't getting any. I also noticed that he had an oxygen tube under his nose, which wasn't there before. I didn't want to wake him so I didn't do much, and this was the first day I decided to pop up my switch and play some yoshi crafted world, and I kept one ear bud out just in case.I know he had a lumbar puncture done either before I came or just as I came, and an MRI earlier (might have been the previous day, it's becoming a blur now and I hate it) and the neurologist said they see a lesion, and it looked like one of the quadrants of the brain. I honestly can't remember but it felt like a sizable portion. I also looked at the EEG from time to time as I assume they were looking for seizures and I swear I saw alerts on the machine detecting them.This was the first time that I was going to pull the all nighter, and it was normally our mother that would do that and I offered to stay but she wanted to get some rest which I understood. A bit after I was there I noticed they swapped the tube with an oxygen mask, and I regret to this day that I did not look at that monitor better, seeing if oxygen was dropping, etc. There was a nurse there but I don't know how well they were watching, I swear one of the guys before was on his phone most of the time. I remember there was a night shift change, and I don't recall how long after before the most traumatic part happens. I did ask if my brother snored normally to our parents, as I never really heard him sleep and our father said yes, and he should get a sleep study done. It reminded me of our father's sleep apnea when napping on the couch during movie night. I don't remember how long this went on for, but I think they adjusted the bed height or something, don't remember... yet another thing to add to my list of regrets.That night after playing a bit I remember my arms getting tired so I pulled the little side table near me to prop my switch up on so I could just use the remotes, and all of a sudden a bunch of nurses come rushing into the room and one of the nurses checks his neck and says no pulse, then a code blue is called. I am escorted out of the room and just panicking. I don't remember hearing the monitor beeping prior (remember 1 ear bud and I had the volume at like 1 tick), and I don't recall him snoring just before either. For all I know the sensors were faulted and he was out for awhile, I have no idea how immediate it was, or if maybe the table pulled\/squeezed the oxygen tube (this all happened in like 10 seconds). I know that his monitor was beeping a lot earlier due to his blood pressure, and I don't know if they gave him medication, but I don't remember that monitor beeping at all that day. Maybe the last nurse silenced it? I don't know. I also don't know how well the nurse was watching. One of the nurses in the morning\/afternoon was great and I know she was looking at his face and the monitor with great focus, and I fear the night nurses not so much. I know the nurse that night was from newborns, and just helping out.I don't understand why or how he code blued, how quick it was, or anything, but I know it took them over 20 minutes to bring him back and he was on a ventilator. They did the 24 hour thermal treatment of going cold then normal, and after that for the next few days they'd do an eye test and pain test with no responses. On February 1 they did some test with a dye to see blood movement in the brain and I saw the results that night saying there was little blood flow but not clinically brain dead. I had a spark of hope but knew I wasn't a doctor. The next day we talked to the neurologist and confirmed that he was indeed brain dead and I felt like I lost my brother for the 3rd time in that hospital. Once during delirium, then the cardiac arrest, and now. We had to decide when to pull the life support, and I watched him officially die, for what felt like the 4th time.Having to find the courage to join our father for the funeral arrangements, then the funeral which was a visitation before cremation, then picking up the urn a week later, it's been waves of trauma and it still feels like yesterday a month later. Everyday I've gone home to see my parents, and touch the urn and cry. I don't understand why he's in there and not at our house playing video games with his friends.I don't understand how he got sick to begin with, he moved in with me back in May and I tried to make things as comfortable for him as possible. This was his first winter with me and I think this house is a bit drier than the parents he lived with, but I wouldn't think that'd cause the issue. He almost never leaves, he works from home and plays games. If he caught anything it'd be from me, and I know I got sick at the end of June with COVID and he caught that from me, what a fucking loser I am. I did another trade show in September and got sick, not sure if he got it then, he didn't report time off to work (and he tries to take every time off he can).I don't understand why the teladoc didn't ask other questions, or the urgent care to find anything. Then later the first ER only commented on the high blood pressure, and it wasn't until the second ER that they knew something was up.Why did he get delirium, why did they let sodium levels drop? What was going on with the oxygen? With the monitoring he had, how did they let a cardiac arrest happen?I have so many questions and it pains me knowing that even if I get knew, it doesn't change that my baby brother is gone. We had so many plans this year, such as cooking better for ourselves, working out to lose weight, and most critically spending more time outside of his room to try new things like restaurants and take vacations. The last vacation I had with him was 2007, and he was in Hawaii with the parents in 2008 where I was rejected from going because I didn't have a job after high school.Before his delirium I remember one big ask, which was to get a hug, and that he was ready and wanting to go on adventures with me. I hadn't seen my brother much outside of a quick dinner talk from time to time, and when he moved in I was glad to be bonding with him again, and we didn't even get 1 year. We had so many plans, and the world robbed him of that.During the visitation I played the Halo song \"Never Forget\". He was a big Halo fan and that song always gave me the feels. I hugged his cold body for that entire song, wishing I could give him more.This is a long post and I apologize, I just needed to write, and I wonder if anyone knows what may have caused things. I fear that my lack of knowledge and experience failed to get him to the ER sooner, but it didn't seem like that even helped, they may have just done the same as they did on the first visit and turned him around.I failed to protect you brother, I am so sorry. This world is just not fair and you deserved so much more. You were the nicest person anyone would of met and you made those around you happier. I miss you so much brother, and I love you even more.I will see you again one day.",
  "input": "",
  "output": "I'm sorry for your loss.Delirium can be caused by many factors including infections, metabolic imbalances, medications, and underlying medical conditions. In your brother's case, the low sodium levels may have played a role, but it is also possible that there were other contributing factors such as an underlying infection or a reaction to medications.His low sodium could be due to frequent urination, or due to his low sodium diet, or it could be due to an underlying medical condition such as adrenal insufficiency or kidney disease.Don't know about the oxygen - but, changes in oxygen levels can occur due to changes in respiratory function, changes in blood pressure, or changes in heart function.The fact that he was on monitoring does not guarantee that a cardiac arrest could not occur. It is possible that the cardiac arrest was due to an underlying medical condition or a sudden event such as an arrhythmia. But, ultimately I don't know."
},
{
  "instruction": "Im not sure if this is the appropriate place to post, Ill delete if not.33F, Current diagnoses: anemia, bulging discs, arthritis. Im on slow release iron and vitamin B12 daily and mobic and skelaxin PRN. I see a PCP regularly. Ive always been an anxious person but lately its been significantly worse. I lost my sister at the end of 2021, she was at home recovering from covid and died unexpectedly. It was a very traumatic experience, I watched the paramedics perform CPR on her. Im also a nurse, worked a covid unit the first 2 years of the pandemic. Ive got a lot of negative feelings from that as well, like most hcw. I find myself crying more often than not. I find myself unable to sleep because Im reliving the night my sister died and the days that followed. Its not just when Im asleep though. Itll hit me when Im driving or at the store, just these intrusive memories replaying and I cant make them stop.I work third shift, I come home and stand next to my husband because Im convinced hes not breathing. I have to watch his chest rise and fall several times before I believe hes ok. I panic if he doesnt respond to a text, I almost left work one night because I was freaking out convinced he was dead, he was home with covid and had just fallen asleep.I now work a unit thats not technically critical care but our patients are very sick. (Post op, pressors, a lines ) I often feel so heavy in my chest by the end of the night sometimes until I get home because Im so anxious that I have forgotten something or done something wrong.When I did my physical I did discuss my grief with my PCP but told her I felt like I was ok. I do this thing were I like to say Im ok even though I know Im not. Its getting to a point though its obviously interfering with my life. Im just not sure who to turn to. Ive never sought care for my mental health so I was going to go through my employers EAP but its so overwhelming. Theres therapists, social workers all kinds of options. But theres no psychiatrists available. I dont really know if theres a reason I should be seeking one or if I should just start with a therapist. I think I just feel overwhelmed by all of it and need help in which direction I should go.If youve read all of my ramblings I greatly appreciate it. Any and all advice is welcomed. Thank you all for your time!",
  "input": "",
  "output": "I think you would benefit the most from having both psychological and pharmacological therapy together.It sounds like you're in a different country than mine, and your healthcare system may be slightly different, but I hope this largely applies.I think your first step ought to be going back to your primary care doctor and telling them what you've written here.Your primary care doctor should be able to signpost you towards the appropriate psychological service, who can do their own assessment and determine what type of psychological therapy is best suited for your needs.At the same time, I think you would benefit also from pharmacological therapy, but it's not necessary for you to see a psychiatrist immediately. Your primary care doctor is trained to assess and prescribe treatment for common and uncomplicated psychiatric conditions. If it later becomes clear that your illness is more complex than it first appeared, or if you don't respond to the first or second-line treatments, you could explore getting a referral to see a psychiatrist then.You should also look into seeing your employer's occupational health service, who can, I hope, help support you in your work and make any necessary adjustments. I would strongly recommend discussing your health with them especially if your mental state starts interfering with your ability to work.I hope things start getting easier for you soon."
},
{
  "instruction": "What type of medical tests should I ask my doctor to perform to look at underlying medical issues or deficiencies that might be responsible for my hair loss. I have complained in the past and she only looked at iron.Im a 34F who has lost probably 60% of my hair over the past 3 years. I have no history or family members with hair loss. I am east European with light brown, fair hair. However, I have always been complimented with how full, soft, lush my hair is. Hair loss is all over rather than patterned.",
  "input": "",
  "output": "This post has very little information about your general health, no information about your medications, inadequate information about the alopecia distribution, and no quality images of your scalp. Meaningful comment is not appropriate."
},
{
  "instruction": "No medications (aside from Advil as needed), not considered alopecia, images wouldnt be relevant considering to the average person, it just looks like I have thin hair, but I know what it was beforehand and the loss I experience showering daily.I have always had perfect health. Also, I have a very clean diet, eat white meat or fish daily, lots of organic produce, avoid fast food or junk food (besides chocolate). Dont smoke, drink maybe 2 glasses of wine per month. Active lifestyle.I do still experience cystic acne as an adult, and have oily skin.",
  "input": "",
  "output": "Hair loss is alopecia. If you choose not to share relevant information, meaningful comment is not appropriate."
},
{
  "instruction": "This response is a bit harsh, and repetitive. Perhaps you could assist the OP by describing what YOU consider to be meaningful and relevant, as it appears she is trying. Also, you are the one with the degree.",
  "input": "",
  "output": "Good suggestion. I need precise information on the anatomic distribution of the hair loss. Additionally, I need information on the appearance of the scalp and the hair follicle appearance in involved and uninvolved areas."
},
{
  "instruction": "26F, 57, 177lbs SLE Lupus, Ehlers Danlos syndrome, and pseudo tumor cerebriThis is the first post and I took the advice given and got medical help. Well the ER didnt do anything but, give me fluids they did another CT with contrast and told me the findings were most likely old. Plus I take blood thinners already and I should be fine ( I take blood thinners because I have a stent in my brain and I had heart surgery long story). The new CT showed  IMPRESSION:Tiny sliver of hyperdensity seen in the right frontal lobe along anterior aspect of the right superior frontal sulcus concerning for focus of subarachnoid hemorrhage.Proximal Jugular Veins: Diminutive on the right, normal on the left.I also got in contact with the on call doctor since my neurosurgeon is on vacation and he said the location of hemorrhage isnt concerning. Plus if all I have is an headache I should be fine. Just to note he did see the ct report or films.So I just want to be sure Im make a good decision to not do anything. I still have a terrible headache accompanied with nausea that doesnt seem to go away. My mom is worried and keeps insisting I need to take this seriously.I hope this is legible its hard to type with a terrible headache. Thanks again I appreciate you guys",
  "input": "",
  "output": "you're on a blood thinner and they said its okay to continue while you have a hemorrhage? what?! did you have an angiogram? i don't understand this. do you have a cereberal venous thrombus?Physician\/NeurosurgeonWe get a huge number of consults for hemorrhage that are almost certainly not hemorrhages on our review. If a neurosurgeon already consulted and said this is nothing then that is reasonably likely to be true. It could be artifact, calcification, post-op change from a prior procedure, or any number of other things. I think OP should track down the on-call neurosurgeon again and get a better explanation.Physician, Emergency Medicine | Moderatorone would assume a radiologist would be a little more careful in hedging if they werent sure. lord knows they hedge when they need toPhysician\/NeurosurgeonThat is a poor assumption. They call surface SAH all the time that arent. There is a lot of volume averaging on the hemispheric convexities and it makes little light spots appear pretty regularly."
},
{
  "instruction": "Is this standard practice? Hematology question.Female, 50, Arizona. Too many ailments to list.I've been anemic for at least a couple of years. One of my Dr's asked me who was managing my anemia. Ummm, nobody? So she referred me to a hematologist. The next day, I received a seemingly random text from a cancer center. The Dr she referred me to is both an oncologist and hematologist. Thus the cancer center wanting to schedule me an appointment.",
  "input": "",
  "output": "Nope thats normal. Hematology and oncology often are done in the same fellowship. Doesnt mean you have cancer at all54ReplyShare"
},
{
  "instruction": "Assistance for interpreting Ultrasound, Chemistry, Hematology, and Urinalysis resultsGood day everyone!! May i ask for assistance with interpreting\/reading may mom's results (shown in pictures above) and her potential ailment, we're really suffering financially these past few days, i'm very sorry and thank you for those who would help!! Gender: F Age: 60",
  "input": "",
  "output": "Who ordered the tests for her? They need to be the one to interpret the tests because they know what they are looking for. Tests in isolation with no context really arent useful. The lab that processes tests also have parameters that are normal based on the sample processing, and none are listed."
},
{
  "instruction": "PLEASE help me figure out why my legs\/feet are cyanotic and can't get oxygen when sitting down. No quality of life and at risk of further permanent damage. Every specialist and hospital is baffled :( Pic inside.'ve posted here before in the past (now deleted), but that was over a year ago. I got a lot of great suggestions and every one of them has now been ruled out.History:30 year old white female, thin, non-drinker, vapes nicotine, no drugs or medsHealth issues prior to this situation: POTS, heart arrhythmias, and EDSA year ago, after my post, I was hospitalized with a vast array of neurological symptoms. To make a long story short, I ended up having a severe B12 deficiency that went unnoticed for 2 years. Low serum B12, extremely high homocysteine and MMA.After getting on the B12 injections, all of my initial symptoms have resolved, except this leg thing which I've never been told is related to the deficiency and idk if it is.Leg Issue:Feet PictureDuration: 15 monthsOnset: Began with some numbness in my toes and transient foot pain when walking, also difficult to walk as if I couldn't feel where my feet were (although sensation was intact). Coloration starts looking funny. A month later, I was sitting at my desk working for about 4 hours and looked down and my feet\/calves looked like corpse limbs. Saw a vascular surgeon and had a terrible result on ankle brachial index test. He had me admitted to a major hospital and warned me of risk of double amputation. After release from hospital with no answers, I saw about a million specialists.Symptoms: when in a dependent position (sitting, essentially), it takes about 10 minutes for my feet\/calves to start turning colors. They became ice cold to the touch, mottled, dark purple\/blue (and sometimes blackish), and there is no detectable pulse in the feet or ankles on doppler or otherwise during this state. The longer I sit, the worse they get. It also has begun to spread higher and higher, if I sit too long it will now go all the way up to my thighs. It is not painful when sitting, they simply feel freezing cold. When I stand up to walk, they are moderately painful (not nerve pain, achey), and walking is clumsy and difficult for a bit. Occasionally, they will become hot, swollen, and bright red but there is no identifiable trigger for this. It happens rarely and isn't related to sitting or elevating them, unsure if this is even related. This cyanosis issue has caused muscle and nerve damage in my feet. Also, lack of toenail growth and yellow thick toenail color.What helps: elevation, when I elevate them, eventually the color will return to normal (pale) and the temperature usually stays cold. Walking also can help the blood flow return to normal. That's it. Soaks in warm water will help the warmth return, but does not solve anything else.What we've ruled out and tests done:Raynaud's syndromeCardiac causesPAD - MRI of both legs showed no atherosclerosis or other signs of PAD. Doctor mentioned \"the veins in that area are very narrow but no other findings\". He didn't write that on the report and MRI was marked as normal.I had 2 venous doppler exams. Both were done while my legs were elevated and in their good state. Both exams were normal. I expressed again, when elevated they have good blood flow, can they please do the test while my legs are dependent? They said it isn't possible.POTS Blood Pooling - It's not blood pooling, it's a lack of blood flow or a lack of oxygenated bloodBurger's syndromeAll autoimmune conditionsHematologic conditionsDependent acrocyanosis caused by POTSPretty much everything else that I'm sure I'm forgetting hereWorking Diagnoses: PVD of unknown cause, Venous Insufficiency of Legs (Don't know how they got to any of these conclusions but they are also just guesses at Doctor's admission)Other Factors: I do have motor (distal axonal) neuropathy throughout my body, caused by the b12 deficiency, however I have been told this is not related, and the neuropathy is also present in my arms and hands which have no issues in dependent positions.So for one year now under advice of my doctors, I have my feet elevated pretty much at all times. I can not sit on a couch with someone, I can't sit at a desk to work, I can't sit ever. This is affecting all areas of my life, I am babying my feet and legs all day long. I can't do normal things without being able to sit like a normal person.I am out of options, and completely desperate to save my feet. They are already muscle atrophied and partially paralyzed. They are very painful at night when I'm lying in bed (but not usually during the day).Summation: Cyanotic, cold, pulseless feet and calves when sitting. Every time. Will spread up my entire legs if I sit long enough. Clinical damage to muscles and nerves in affected area. MRI and venous doppler are normal. Feet are fine when I'm standing, walking around, or have them elevated. There are NO triggers to this except sitting. (Not triggered by temperature, stress, foods, anything but sitting). There is NOTHING that alleviates this situation except for elevation or walking.I have no idea what is happening but I can not live like this anymore. I have no quality of life. No doctor can give me any answer.I have lost all faith in solving this, but maybe a reddit miracle can happen. You never know. If you read this far, thanks for reading.",
  "input": "",
  "output": "How was Buerger disease ruled out? Biopsy?This is clearly severe peripheral arterial or venular disease - either medium vessel or small vessel.You ABSOLUTELY should not be using any nicotine products. This is in all likelihood driving the process."
},
{
  "instruction": "Thank you so much for replying.I don't actually remember how they ruled it out, but I brought it up to multiple specialists who had various reasons why it wasn't. But even still, I did quit vaping\/nicotine for 9 months during this and the condition continued to worsen. I started using my vape lightly again recently, but I will stop 100%.Is it possibly reversible if I stop immediately? (I'm stopping regardless after reading your message).And just one more question, I also thought obvious PAD but they say it's ruled out because no atherosclerosis and normal doppler. Is that inaccurate?",
  "input": "",
  "output": "You can still have an inflammatory\/autoimmune process causing similar symptoms.I dont know what workup youve had, but ruling out all autoimmune conditions is a pretty significant claim, though with the right lab work you can estimate a likelihood.Id consider some of the vasculitides\/rheumatic conditions such as anti phospholipid syndrome, cryoglobulunemic vasculitis, etc. they often come with other manifestations but there is obviously not a full history and physical exam above.Many of these are associated with autoimmune diseases such as lupus, but they are not pathognomonic by any means.Have they done a biopsy?"
},
{
  "instruction": "No biopsy due to concerns about infection\/wound not healing with the blood flow issues.You're right, I have no idea if they truly ruled out all autoimmune diseases. But I did have significant testing for it. The main hospital did all their own testing and when I was negative for everything, the doctor worked with Mayo Clinic and used their full autoimmune testing panel or whatever and was still negative for everything.I do remember some reasons coming up: no inflammation markers, negative ANA multiple times, 3 rheumatologists cleared me and told me it was vascular not rheumatological in origin. I was tested for and all the types of vasculitis (without biopsy just blood work).And these are some of the reasons I can remember for saying no to Buerger's:- My symptoms only come on in the dependent position and at no other time, all their tests showed no blockages or clogging or weird patterns of veins, no claudication, no blood clots, no change in symptoms when exposed to cold, and I think some more stuff. I know my vascular surgeon sent images and case history to some massive network of vascular specialists and the consensus was that it was not buergers (but again, who knows).My neurologist is absolutely convinced that I have Marfan syndrome but I did not get the genetic testing for it yet. And I'm not aware if that can cause this but it's the only other thing I can think of.EDIT: I just went through my mega document of all my labs and tests, and anti phospholipid syndrome could fit, because I do have a history of blood clots and also recurrent miscarriages (5 by the time I was 29). I am trying to find the exact lab names of the tests for this right now to confirm (that's always hard lol). (I found the names, I was tested for aCL IgG and IgM antibodies and results say<10 GPL<10 MPLThey also looked at regular IgA = 288.9, IgM = 50There's a bunch of other IgA and IgM and IgG tests in there too with other words in front of them that I don't understand but all seem normal.",
  "input": "",
  "output": "Did they do lupus anticoagulant (LA) or anti-beta2 glycoprotein 1 (a(beta)2GPI) with those antibody tests? It sounds likely that those will have been covered in the workup described. If so then its unlikely to be anti phospholipid syndrome, at least from initial workup. Given the description of symptoms there is still a possibility of antibodies to other things such as anti prothrombin, anti-annexin, anti-phosphatidylserine, etc, but the clinical correlation is weak at this time and testing is not routinely performed since there is much uncertainty about their significance. It may be something a rheumatologist could speak to in more detail.One of the key criteria with testing though is that testing should occur within a short period of time from any event such as blood clots or miscarriage if I remember correctly. If it is not done within a short period of time it may not show up on testing (I dont routinely deal with APS so I dont know the timing recommendations). I could not say if the current cutaneous and vascular manifestations would be included, but a rheumatologist may be able advise further.I do agree it is worth another follow up and discussion with a rheumatologist again to discuss the possibility of the diagnoses in this thread, multiple good differentials on the list from other physicians as well. It sounds like youve already had an extensive workup, but at the end of the day if you have a progressive pathology and no answers, you have to keep searching and discussing it. Best of luck."
},
{
  "instruction": "Huh, that's very interesting.I was told they tested for all lupus stuff but I don't see LA or the other antibody tests in my records, unless they're using different acronyms for it or something. They did do a bunch of prothrombin tests which were normal.Thank you so much for your help here. I think I need to go to a different state to see a rheumatologist, I've seen all the best where I live and after looking at my labs they tell me they can't do anything for me. But I'll keep trying.",
  "input": "",
  "output": "Lupus anticoagulant is actually not associated with lupus, rather it is associated with APS, as is the anti beta 2 one mentioned previously.They are part of the testing for the Sapporo criteria in APS diagnosis."
},
{
  "instruction": "Did they ever do an angiogram while you were symptomatic? Or a mri or Ct with contrast while you had active symptoms?",
  "input": "",
  "output": "The problem with the studies you received such as the MRI and CTA is they dont have the resolution to see smaller blood vessels. This would require a biopsy. Some medium and small vessel diseases respond to immune suppression with steroids etc, the treatment for Buergers is not smoking. Others such as livedoid vasculopathy (a vein disease) require anticoagulation.So again not vaping is essential to save your legs. Wouldnt recommend other nicotine containing products such as patch or gum, but bupropion and varenicline are effective smoking cessation aids.Personally if smoking cessation isnt effective and the symptoms progress I would want the biopsy despite the admittedly very high wound healing risk. There may be a proximal area with less advanced disease that is amenable, and your symptoms are end-stage.Can PM me if you have specific questions."
},
{
  "instruction": "Thank you so much.I did not have that spinal reflex test done. And I understand now about the biopsy. I am quitting cold turkey, I don't react well to bupropion or most medications honestly.I will ask for the biopsy and I do have a referral right now to a new hematologist, only problem is all the new specialists I see just keep telling me everything has already been ruled out. I'll still go though of course!",
  "input": "",
  "output": "Uh ignore the spinal reflex part, that is a lame joke"
},
{
  "instruction": "LOL and I was sitting here googling that, confused as hell. So now you've made me laugh and you've terrified me with the end-stage comment :OI guess it's time to submit my application for Dignitas. Can you pls write me my physician recommendation? It would also be lovely if you could attend my death, Switzerland is beautiful. (and maybe write a eulogy about me too, I think you'd be very good at that)",
  "input": "",
  "output": "No no end-stage vascular disease not end-stage you.Stop vaping (done). Advocate for a biopsy in an area that has a little better blood flow but might provide an adequate specimen. Followup with the specialists and try your best to stay positive even though it's a shitty situation."
},
{
  "instruction": "Hematology questions. (mother with acquired aplastic anemia)Obligatory info so the bot doesn't eat me: 69F , 5'3 \", 185lb , White , USA , Former smoker but 20 years totally off, no drinking or illicit drugs, full list of prescriptions is further down the post, duration of about 6 months (2 pre-diagnosis, 4 post-diagnosis) location of complaint is... blood?First, thanks for looking. I know my questions here are going to be weird and kind of specific. My mother was diagnosed with acquired severe aplastic anemia this past July. For those who don't know it is a disease of bone marrow failure which means the creation of different types of blood cells is severely limited.I'll try to be short about it - my mom had increasing weakness and bruising until ending up in the ER with Hgb of 4.6, platelets of 4, WBC 3.2, ANC 1, ALC 2; she spent a week in the hospital where they did a bone marrow biopsy and a million other tests to figure out the cause. (previous to this she had no other health issues)July 12th she was diagnosed with aplastic anemia, with bone marrow cellularity of 20%, reticulocytes between 0.02-0.03 (range 0.018 - 0.158 x10E+12\/L), very tiny PNH clone (<1%) was given a PICC line and started horse ATG on July 14th in combination with cyclosporine 600mg + Promacta 150mg. Had almost no issues with the ATG treatment but became refractory to platelets pretty quickly and thankfully HLA matched ones were found. She was released once they found the appropriate dosing for the cyclosporine to not be at toxic levels.My mom is still going twice a week to the heme\/onc clinic for blood tests and receiving blood if Hgb dips below 8 (approximately every 3\/4 weeks) and platelets if they dip below 20 (approximately every 7-11 days). The tests are monitoring the need for transfusions, monitoring for blood cell lineage response, as well as checking for liver and kidney function.Currently taking 125mg x2 a day of Cyclosporine, 150mg Promacta, 20mg prednisone, along with 400mg acyclovir, levofloxacin, fluconazole, B12, Folic Acid, Vitamin D3\/Calcium, 20mg x 2 Famotidine and 25mg metoprolol (for heart palpitations, the only med she was on previous to this) I'm sorry I don't remember offhand the exact dosings of the preventative antimicrobials and for the vitamins.I was asked to post the full lab values, so I am only going to post the most recent ones which were taken 11\/29.Of note: Last blood transfusion 11\/11, last platelet transfusion 11\/26 (HLA matched, I guess they work really well)ComponentYour ValueStandard RangeFlagWBC3.8 X10E+09\/L3.8 - 10.6 X10E+09\/LRBC2.44 X10E+12\/L3.73 - 4.89 X10E+12\/LLHgb8.2 g\/dL11.6 - 14.6 g\/dLLHematocrit(HCT)23.2 %34.1 - 43.3 %LMCV95.0 fL82.6 - 97.4 fLMCH33.7 pg27.8 - 33.4 pgHMCHC35.5 g\/dL32.7 - 35.5 g\/dLRDW25.9 %11.8 - 15.2 % HPlatelets143 X10E+09\/L156 - 369 X10E+09\/LLMean Platelet Volume8.1 fL6.8 - 10.4 fLNEUTROPHILS %46.1 %44 - 77 %LYMPHS %44.6 %13 - 44 %HMONOS %8.8 %4 - 13 %EOS %0.1 %0 - 6 %BASO %0.4 %0 - 1 %ABS Neutrophils1.8 X10E+09\/L2.24 - 7.68 X10E+09\/LLABS Lymphocytes1.7 X10E+09\/L0.80 - 3.65 X10E+09\/LABS Monocytes0.3 X10E+09\/L0.30 - 0.90 X10E+09\/LABSOLUTE EOS0.0 X10E+09\/L0.00 - 0.40 X10E+09\/LABS Basophils0.0 X10E+09\/L0.00 - 0.06 X10E+09\/LTYPE OF DIFFERENTIAL | Auto diff performed RBC Morphology 1+ PolychromasiaOnto the questionsAfter all that, my questions are mainly about what certain things in the blood values mean and also things I have heard from other patients with this disease that I want to confirm if they are real or not. There isn't really time to discuss any of this when my mom sees the hematologist at the clinic and I don't want to be a bother acting like I know anything about blood or medicine and asking a million dumb questions.1.) What does +1 polychromasia mean here? From what I understand it's off-color red blood cells, usually very young ones. It has shown up on almost every CBC since treatment began.2.) What does the elevated RDW mean here? It has been elevated since treatment.3.) How does getting transfusions of red blood cells affect these numbers? I asked once about the most recent reticulocyte count (3.2%, ARC 0.084 x10E+12\/L) hoping that it was indicating some response to the immune suppression, but was told that donor blood will also have reticulocytes in it so the count doesn't matter.4.) Things such as nucleated red blood cells and ovalocytes have also occasionally popped up on the reports alongside the polychromasia. What do they mean in this context?5.) Is it correct to understand that on diagnosis her bone marrow could only make enough cells for a Hgb of 4.6, but that it may have improved since then, but still be under the transfusion threshold? (ie if it improved to 6.5 or so but they wouldn't know if she continues to get transfused <8)6.) My mother's doctor is a hematologist\/oncologist but does not seem to have any specialty in treating aplastic anemia, tho he seems to be doing things mostly right. I have been trying to find someone in the city that does have some specialty in aplastic anemia but it has been very hard. I have been through the AAMDSIF listings for her city and not come up with much. I am surprised because there is a major medical school and center there with a full heme\/onc division and also sections for benign hematology and rare blood diseases. Is it weird to try and contact these sections for help finding a hematologist with an interest or specialty in treating this?I think that's all I have for now - feel free to ask for any more information needed, I've got piles of it. If you're wondering why I'm so rabid about this, my father had leukemia and I was too young to understand why they were doing the things to him they did, or why they didn't do other things, and it seemed like he was adrift in a sea of complicated medical situations and opinions and unusual symptoms. This time, I want to know as much as possible, to be able to advocate and educate. I am also very interested in medicine and anatomy (but I'm too dumb for something like medical school, so it's just a weird special interest)",
  "input": "",
  "output": "Agree with answers from \/u\/Spicy_Antigen.Regarding her doctor, he certainly has treated aplastic anemia before. I don't know if there are really enough aplastic anemia patient for any hematologist to have a \"specialty\" in it. If you want a second opinion, I'd reach out to the major medical center in her city."
},
{
  "instruction": "Iron vs Iron Saturation? [Hematology]Can anyone explain the practical difference between these two test values (not just the technical definition), and what it would mean if someone had normal Iron but low Iron Saturation?i.e. How could the saturation end up low but the iron level itself stay normal, physiologically?The numbers are 63 mcg and 18%, respectively, in case you're wondering, with the range listed at 50->180 for Iron and 20->48% for the Iron sat.tyvm!Age: 30, Height: 180cm, Sex: M, Non Smoker",
  "input": "",
  "output": "It's not easy to ELI5 this. Iron level basically just measures the amount of \"free\" iron released by your body into your bloodstream at the very second that your blood was drawn. It will change from hour to hour and day to day. The iron level is basically meaningless because it doesn't tell you anything about how much iron you actually have in your body. For example, your body needs a certain amount of iron in your blood at any given point. Even if you're iron deficient, you could have 63 on your lab and you could be iron overloaded, and it could still be 63 on your lab.The iron sat tells you indirectly how much iron is stored in your body. A low saturation means your body stores are low."
},
{
  "instruction": "What can these blood tests indicate? (Infectious doctors? hematology doctors? Nuerologists? )Male, 28, 68 kg, 183 cm. White. Sweden. Previously diagnosed with Lyme Disease. One major event of disease progression was food poisoning from eating raw fish.Symptomatic presentation:Numbness in body and limbs, and in skinDecreased body awarenessAnhedoniaDecreased sense of smellDecreased sense of touchDecreased hearing quality, level and resolutionLost access to brain areas and higher functionsBrain fogShort term memory affectedAffected bodily, space and time perceptionTingling in skinFloaters in eyesWeight lossMuscle lossDepersonalizationDerealizationAn altered mental state described as a conscious comaChronic fatigueNauseaSexual dysfunction, loss of sexuality, anorgasmiaGeneral weaknessVery dry skinNot able to have a feverTESTS DONE IN JUNE: VEGF-A 114 pg\/ml, reference: >42,6 pg\/ml. Candida glabrata 1,6 x 10^6 KBE \/ g Stool, reference <1.0 x 10^3 (<----*>Streptococcus Sp. ELISPOT 4.1 (ref > 3).**[**U75] ASO (streptolizyna)  255,03 u\/ml < 200.Tryptophan Metabolism in urineSerotonin PathwayKynurenine Pathway IgG subcategory Type 4 1, 14 g\/l, 0,004-0,86 Zonulin 71,88 ng\/ml <55 Lactate \/ pyruvate 13,7 Quotient <12,9 Adrenaline 6,20 ug\/g Crea 2,0 - 5,5 Dopamine 126,81 ug\/g Crea 130 - 240Histamine in stool 1419,7 ng\/ml <959Blod Analysis Cabinet of Medical AnalystBabesia sp 2.9% (out of 500 assessed erythrocytes) other detected co-infections: - Bartonella spFound in the analyzed fields of view: Pathological erythrocytes: anisocytosis (defense mechanism?)misshapen blood cells: - ovalocytes, lacrimocytes, dacrocytes - it may indicate an infection of the haematopoietic systemInternal cell structures : rod-shaped, branched, ring-shaped, grainy, - may indicate a multispecies parasitic infection",
  "input": "",
  "output": "Thats a rather eccentric collection of lab results. What kind of doctor ordered these?"
},
{
  "instruction": "Infectious disease specialists.",
  "input": "",
  "output": "Oncology? You don't mention a history of cancer"
},
{
  "instruction": "My bad. It wasn't specialist in oncology. The doctor works and conducts research with supportive therapies for cancer, hyperthermia.Only labs that are off are being posted of course. 50+ more tests have been done. Including 2 MRIs of the brain and spine.",
  "input": "",
  "output": "These labs suggest your doctor(s) are not practicing modern, evidence-based medicine."
},
{
  "instruction": "Some discussion on liver lesions? Hi guys!So I went to the ER a week ago with pain in RUQ after lager. The doctors thought it was gallstones or gastritis and wanted an ultrasound - it came back with a 5.4cm lesion on my liver. I then went for an MRI, the ER doc said it didnt look benign or a cyst and wanted to admit me for more investigation. I also had a CT scan and they don't have much information on it. My bloods are normal also. My symtpoms include; extreme fatigue, right shoulder pain, stomach bloating, 8 weeks PV bleeding with black blood(they are investigating this too), and severe itching on legs. I know due to my age its most likely not cancerous as I'm only 26. But there is cancer in the family too. I was meant to be there for a biopsy this morning but the consultant (gastro) wanted to cancel it and get a second opinion on my scans from a hematology clinic before a biopsy.I just wanted to bounce this off people for your thoughts. I'm not asking for anyone to diagnose me as I know its up to the medical professionals. But I just want to see what people think",
  "input": "",
  "output": "Much more information needed here - I'd suggest posting the radiologist report from all the imaging, all bloodwork results, etc."
},
{
  "instruction": "37M - MRI of Cervical Spine - \"Diffusely low signal\"Hi there,Having some MRIs done for some nerve issue i'm experiencing. Cervical spine MRI showed up fairly normal but I'm not entirely sure what this means.\"Diffusely low signal intensity marrow likely represents hematopoietic marrow. Hematological correlation is suggested.\"",
  "input": "",
  "output": "Usually adults have fatty bone marrow. Hematopoietic bone marrow can be an indirect sign of hematologic conditions. Hence the hematological correlation to make sure."
},
{
  "instruction": "Thank you kindly. Hematopoietic is just various types of blood?",
  "input": "",
  "output": "Hematopoietic cells are the cells in our bone marrow that produce the blood cells"
},
{
  "instruction": "68M Recurrent right sided nosebleeds resistant to treatment followed by respiratory infectionMy dad is a 68 year old Mexican (mestizo) male. At the time of his first nosebleed, he was diagnosed with diabetes, high cholesterol, and prehypertension. He's 5'6\" and weights 180 pounds. He rarely drinks and doesn't smoke or use recreational drugs. He's prescribed metformin, insulin, aspirin, and lovastatin but refuses to use the last two. He also has arthritis in his elbows, for which his doctor tells him to use ibuprofen as needed. I don't know his cholesterol levels or A1C.About two weeks ago now, had a nosebleed (limited to the right nostril) for the first time in over 30 years while he was cleaning the garage. We asked him if he accidentally hit himself, scratched his nose, or sneezed but he insisted that it just started out of nowhere. Initially he was able to stop the bleeding but later that same day the bleeding resumed while he was moving some boxes (15-35lbs). We were unable to stop the bleeding and he went to the emergency room where they tried to stop the bleeding with Tranexamic acid and, after that failed, cocaine hydrochloride before ultimately applying an anterior nasal packing. His blood pressure was checked and it was high 143\/83 but the doctor said it could be due to the stress of the situation and didn't warrant immediate treatment (side info, he had a heart rate of 85, low 60s seems to be normal for him). He was told to go back in two days to remove it and cauterize the affected area. He was also prescribed cephalexin (I'm assuming to prevent opportunistic infections). Apart from the nosebleed, he seemed fine. He was a little shook from the experience but was feeling good. No other symptoms.Two days later he went to get the nasal packing removed and the doctor determined nothing needed to be cauterized. My dad was told to be careful for a few days and to schedule an appointment with his PCP, which he did. He has that appointment later today. Two days after getting the nasal packing removed, he woke up with a bloody nose that he was unable to stop. He went to the ER again where they ended up cauterizing his nose. He had some minor discomfort from the procedure but was fine otherwise. He was also referred to an ENT doctor and was able to schedule an appointment, but it's a month from now.Since then, he's experienced 1 more severe nosebleeding episode. He went to the ER and got it treated with lidocaine and since his blood pressure was higher 153\/89, he was prescribed blood pressure medication (something starting with an an L -- I don't have the documents on hand). He was also given a nose clip and finally had some lab work done (cbc, complete metabolic panel, and prothrombin time test -- those results will probably be discussed today). He's since experienced two minor nosebleeding episodes that have been effectively treated at home. In addition, starting the day his nasal pack was removed he started experiencing symptoms of what appears to be a respiratory infection. This will be explained in the next paragraph.The day my dad got his nasal pack removed, he complained of discomfort in the nose and sinuses. Some discomfort was to be expected but the day after he started developing a sore throat which eventually progressed to a dry cough, headache, coughing fits and nocturnal fever (no thermometer available to record temperature). He went to urgent care which prescribed him prednisone and azithromycin. It's been two days since and there's been no change on his condition on that front. The illness appears to be communicable since my mom started displaying symptoms about 4 days after my dad. It's possible that he caught the bug during Easter since we had a small gathering (<8 people) though no one else was displaying symptoms at the time or has displayed symptoms since. My dad has been tested for both covid and the flu, for which he has tested negative. It's also possible he caught it while seeking treatment for his nosebleed due to the area of treatment but I'm wondering if the two could be interrelated.It's concerning that after having no nosebleed or symptomatic medical issues for so long (other than the diabetes), one would present so abruptly and severely without any physical trauma or changes in medicine or lifestyle habits. My questions would be what would be some of the most likely causes of nosebleeds in someone with his medical history (hypertension seems to be a big one)? His visit with the PCP is today. What would be some good things to bring up or ask about in his upcoming visit that his doctor might overlook but could be important?",
  "input": "",
  "output": "Hypertension does not cause nosebleeds, not does it prolong them. Except very rarely and dramatically they are not from an artery.The most common cause is actually nosepicking, so grill him more about this. Dry air, a cold, allergies and exposure to dust in his garage are other likely causes. Once you start getting them they tend to persist for a while. He is not on a blood thinner.While waiting for ENT he can use saline nasal spray to keep it moist, use a humidifier at night, and learn how to apply effective pressure to stop the bleeding."
},
{
  "instruction": "I guess one of the possible causes they explored during his first visit was nosebleed due to hypertensive crisis but yeah, it doesn't seem like the doctors think hypertension was the cause of his nosebleedsThe dust in the garage does seem like a likely culprit considering it had been two years since it had last been cleaned out. It's just alarming that a man that hasn't experienced a nosebleed in decades would suddenly have recurrent nosebleeds but it sounds like it's not too out of the ordinary to experience them in succession like that, so that's reassuringI'm sure his PCP will grill him about picking or rubbing his nose since he has a habit of doing that, though one would hope he'd be following the doctors' instructions to not touch the area after the first nosebleedWe'll get him a humidifier. Hopefully his visit with the PCP will provide answers or more specific questions",
  "input": "",
  "output": "It's usually from irritation in an area called Kiesselbach's plexus in the front of the nose. The ENT can cauterize this, usually helps. Noses bleed, it is very rarely a sign of cancer or hematologic disease.Rarely the sinus packing can cause a sinus infection. His symptoms sound more like a viral URI with the dry cough and sore throat plus infecting your mother."
},
{
  "instruction": "1: It really seems like he should have been diagnosed and started treatment for MDS after the bone marrow biopsy\/aspiration in July 2021, not 11 months later given the fact he has tried so many therapies for ITP with no response. It also notes that patients \"typically have mild-moderate thrombocytopenia.\" He has always been below 50K, surely that's not moderate?What is your opinion on his history\/diagnosis?2: I believe the nurses screwed up with premedicating him for his tranfusions during his last hospital visit. He had negative reactions on the two days I know they deviated from what is clearly on his chart AND on the request from his hematologist\/oncologist which tells them what medication he needs when. Then, units aren't even ordered for the following two days, a man who is recorded as transfusion-dependent in his chart. Prior to his hospital visit, the premeds were followed almost exactly with no negative reaction, and after noticing his head bleed, the nurse followed the premeds exactly with no negative reaction. I am going off of his medical history acquired from the hospital which notes exactly when the medication is administered (not being confused with when they charted it). His cause of death is noted as acute respiratory failure due to PNA, but its only because we took him off the oxygen due to the head bleed which I believe they caused.Am I looking at this wrong? Did they mess up?THANK YOUI know, it's a long one. I really appreciate it if you took the time to read through it and give your thoughts and opinions.I know he had a rough disease, and I believe I could accept his death, but something in these hospital notes stinks...",
  "input": "",
  "output": "Having treated many patients like this, these cases are often very difficult to manage. They sent off clonal hematopoiesis of indeterminate potential (CHIP) which is helpful in identifying mutations that may be causing cell abnormalities in MDS and sometimes garners targetable mutations eg IGH, del5q, ringed sideroblasts. However many of these we do not have detailed data given rarity so their effects on treatment are still unclear. In February 2023, that loss of chromosome 7 confers a very very poor prognosis along with refractory thrombocytopenia. I believe getting palliative care involved at this point may have been warranted. I do not believe any treatment wouldve changed his course by this time.I dont think a mistake was made by not treating him since signs of transformation to AML were not evident on the marrow from 2021. A score we use to predict transformation would also predict that prognosis was good with low chance of AML transformation in the next 10 yrs. Your father also has an extensive cardiac history and the drugs we use to treat MDS to AML have significant side effects including heart failure which Ive seen happen before from anthracycline. He had too many comorbidities so Vidaza was appropriate when it was given which is used to treat AML. Wed classify him as medically unfit but not frail and these patients are typically very hard to treat. Patients also become refractory to transfusions over time because their body starts making antibodies towards platelets. I do not think the mix up with premeds made a difference.Watching a loved one die from a hematologic malignancy is not easy, especially MDS. Please make sure you take care of yourself as well. I am very sorry for your loss. You did the right thing letting him go like you did. There was no meaningful way out of his situation where he would go on living a quality life. Please know that his medical team did everything they could."
},
{
  "instruction": "Hey yall My kiddo (3M, approx 42 pounds, 3.5 feet tall) (daily meds are nexium, senna, zyrtec, tenex, atarax, melatonin) got referred to hematology and I'm drawing a blank on what questions to ask. He had a blood smear that had \"abnormal lymphocytes\" and a high level of lymphocytes. He started seeing Immunology a few months ago because he's always had frequent infections and fevers just about daily for most of his life. Immunology doesn't have any diagnosis, but are thinking of referring him to rheumatology. Im just not really sure what questions to ask or what to say really. If there's a better sub for this, please point me in the right direction. Thanks y'all!",
  "input": "",
  "output": "Where does it say \"abnormal lymphocytes\"? That's unusual language. \"Atypical\" lymphocytes are seen with viral infections, classically mono. If the blood smear was the reason for referral, I would ask what the results mean. If the answer isn't clear, keep asking until you understand. They will tell you the differential diagnosis for the findings and what additional tests they recommend. There might be none.Frequent infections are the rule in childhood, not some weird immune deficiency. Is he really having fevers every single day for 3 years? Also, one of the most common findings with immune deficiencies is poor growth and your son is a tank :) Rheumatologic conditions in preschoolers often come with poor growth, rash, joint swelling, and very abnormal blood tests. But they can be more subtle and I can't say on the internet if that's a possibility in your case."
},
{
  "instruction": "i meant atypical, im sorry! it was in the notes for the test result.He has fever just about every day, if its not fever, its right under fever (99.9-100.3) but most days its 100.4 or higher. He usually gets sick 1-3 times a month, and he stays sick and his pediatrician says thats too much especially for a kiddo not in day care or anything like that. Hes been hospitalized a few times and they havent been able to figure out what causes it. This is something weve been dealing with pretty much since he was born.",
  "input": "",
  "output": "Has he ever had a CRP or ferritin? What was the total WBC and neutrophils on the blood count?I think hematology is unlikely to solve this for you. Between immuno and rheum they may have some recommended tests for uncommon causes of recurrent fevers."
},
{
  "instruction": "3F with persistent nosebleeds, referred to hematologyMy daughter 3F has had persistent nosebleeds since she was 18m. We had a blood draw the other day for Von Willebrand screen and her Ag%, factor activity, and factor VIII numbers were normal. However, the lab still did show high Prothrombin time, INR, and aPTT. However, I have no clue what that means. We've been referred to pediatric hematology but the first appointment isn't until April. Can someone give me a run down of what these kinds of results potentially mean? Should I look for a hematologist with an earlier appointment?",
  "input": "",
  "output": "Could be platelet aggregation\/functional disorder, a possible other factor deficiency like prothrombin, fibrinogen, factor V, or factor X or an acquired factor inhibitor (less likely at that age). These would all affect both PT and PTT times.We worry most about these folks with procedures or when she hits puberty and starts having menses. Its good that she is getting checked out by hematology. There is no urgency unless youre noticing other signs of spontaneous bleeding like bloody stools, large spontaneous bruises or joint swelling (common place to bleed for hemophiliacs)."
},
{
  "instruction": "Low MPV?Hey, just a quick question! My son (3M, 42lbs, 43 inches, daily meds are Tenex, Atarax, Nexium, Senna, Cetrizine, Albuterol) has always had a low MPV on every CBC since birth and I was just wondering if that meant anything. I know theres a lot of components when it comes to blood, but Im just curious about that one thing. He does have a hematology appointment coming up next month, I just wanted to know what yall thought.",
  "input": "",
  "output": "Low MPV (mean platelet volume) usually doesnt mean much. We worry moreso when they are enlarged. If MPV is actually low <7, it can indicate problem with production but we very rarely see this. Reduced production can happen for any number of reasons eg infection, medication effects or reduced bone marrow production. Usually we would review a blood smear to see exactly whats going on and heme can do this."
},
{
  "instruction": "any heme docs who can interpret this CBC?24M, 5'10, 200 lbs, East-Asian.Elevated BP (usually around 140\/90), No alcohol use, no drug use. not on any medications. Not diagnosed with any conditions. Family history of DM2, High Blood Pressure.No complaint and no symptoms of any kind, but I recently went to my PCP to get a checkup due to an older sibling being diagnosed with DM2 recently. The physician ordered a CBC with differential\/platelet and CMP. CMP results were completetly normal, but many markers for the CBC were off from the reference values.I asked my PCP the significance of the results and he told me that he's not quite sure. Then, to make sure that the results are not due to lab error, he had me take a second blood test about 3 weeks after the results of the previous one. The test this time included Iron and TIBC as well as Ferritin. Results basically came back identical to the results of the first test.He basically asked me to schedule a visit with hematology because he's not sure how to interpret the results. I just scheduled a visit with a hematology group near me but it'll be mid august before i can see them. Seen as I just need someone to interpret my CBC results, i figured it might be quicker if one of the docs here on reddit can do a quick reading so i can have peace of mindThe results the second test (with comparision to the values of the initial test) are as follows:https:\/\/imgur.com\/a\/gxgM99T",
  "input": "",
  "output": "Low MCV like this with normal hemoglobin is likely a hemoglobinopathy like thalassemia. Could also be something like spherocytosis. Hematology should look at a blood smear, maybe run hemoglobin electrophoresis and can give you a more definite answer as to what is going on. Your RDW being elevated suggests that you're churning out new cells or possibly have a vitamin deficiency. Lots to discuss with hematology here but nothing that is ominous or emergent. Normal ferritin suggests that you aren't iron deficient which was tested because of low MCV."
},
{
  "instruction": "Should I be concerned with repeated abnormal CBC labs?For some background, Im a 35 year old female, relatively healthy, normal BMI, no major health events, Ive never smoked cigarettes, rarely drink, not taking any medications.During my most recent physical (3\/23), my practitioner was slightly concerned about my CBC lab results from 2020. At that time, my platelets were low (81 103\/uLtheir standard range is between 140-400 103\/uL), but all other values were within normal range.After the physical, I had my labs drawn and everything was normal with the exception of my platelet count. The platelet count was inconclusive and there was a note stating that they were unable to give numerical value for the platelet count. My practitioner messaged me and said that she had never seen this before and advised me to have my labs redone. She also advised the nurse to collect my new sample in a sodium citrate tube.I had my labs redrawn last Friday (4\/14), and as of yesterday I had not received my results. I typically get these results back in 1-2 days, so I decided to contact my physicians office. A nurse promptly replied and told me that my blood sample had spoiled before it made it to the main lab for processing, and that I needed to come back to redo the test.This morning a woke up to a message in my patient portal stating that the blood sample did not spoil, and hematology assumed that there was essentially an abnormality with the sample.Im going back to have my labs redrawn this morning.Im not quite sure what to make of all of this? Ive been trying not to dwell on it, but Im becoming concerned after all of these failed attempts to obtain my platelet count. I would greatly appreciate any suggestions or guidance!",
  "input": "",
  "output": "Was the low sample done in the new tube your PCP suggested? If not, she is correct in suggesting it get drawn in that tube. Sometimes the chemical in the normal CBC tube interacts with the platelets and gives a falsely low number."
},
{
  "instruction": "Basically Im just a little nervous about all this, (Leukemia, Pulmonary Arterial Hypertension are my main concerns ). Can anyone offer any guidance or insight into these findings and help me understand my questions better? Thank you for reading this novel, I truly appreciate any help or guidance anyone could give me.",
  "input": "",
  "output": "Do you snore? Now you say you are sleeping better, are you having fewer of these nocturnal episodes?**Lab \/ Test results ** are normal. Almost completely normal. While the \"normal ranges\" for our lab tests may not match your bodies, being within 10-25% and stable is completely normal (for you). I do not see any abnormalities at all here really. Your ECG may show slightly tall P waves (maybe MAYBE slightly taller in May if I squint) but an ECG is not accurate enough to that degree. Also, there are other areas of the ECG with some variability, this likely means the positioning of the leads from May does not exactly match that of the prior."
},
{
  "instruction": "HANK YOU SO MUCH! What you said, I think you may have figured it out. Last year, I started grinding my teeth at night. I would wake up in the middle of the night because I would slam my teeth together, and started to develop TMJ pain. So, I had a custom night guard made, but then I found I would it would keep my lips slightly parted while I slept, which dried my mouth and throat while I slept. So, I bought a velcro anti-snoring head strap (https:\/\/www.amazon.com\/gp\/product\/B081NJT3YF\/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&psc=1 but an older model) but in order for it to keep my mouth shut, I had to get it pretty snug, which I now think may have been pressing on my airway.The last week or so, I've been only attaching it partially (the part on the front part of my jaw, and wearing a sleep mask to keep out light, which helps keep it from riding forward\/backward and falling off my head, and I haven't had any significant episodes since. A little chest pain here and there, and a sensitivity to any form of anxiety or overstimulation (I think my body might just be in a very hypersensitive healing state right now to encourage rest, I was only getting about 4 hours of sleep during those episodes, and waking up several times a night).I am waiting on old ECG's from 10+ years ago, so if it shows the taller P-Waves, I guess it might just normal for me, probably precipitated by the head- strap airway obstruction. I've always had chemical sensitivities that manifest as chest-tightness\/shortness of breath. I've had many doctors since childhood tell me that I might be considered borderline asthmatic, but I am a minimalist when it comes to pharmaceutical interventions unless I cannot get around it with diet\/exercise\/lifestyle changes.I will still go ahead with my doctors appointments for due diligence, but I think you have solved it and helped ease my anxiety enormously. Thank you again! : )",
  "input": "",
  "output": "That is very interesting! But yes that was interesting when you said you were sleeping better now. Demonstrating that you can tell when something is better. I would not worry about the old ECGs, I would not have really called that R Atrial Enlargement, it is mostly normal.Happy to help!"
},
{
  "instruction": "What does this mean? Need a set of eyesHi, I went to hematology\/oncology for low WBC count that resolved on its own and I have had lymphnodes that are palpable in my neck for years which have already been checked by another oncologist\/surgeon\/2 GPs and they werent concerned. However the recent DR I seen took an ACE test and I was elevated. I waited 6 months went to another doctor to re-test and it was at 136 while the cut off was 80 at this particular lab. Im very concerned and I have an appointment with a pulmonologist in a week. I have been stressing because Google says that high ace levels either indicate Sarcoidosis or Lymphoma. Does ACE levels mean malignancy? Google has such limited information on ACE levels and I need some knowledge. Im very concerned with Lymphoma.",
  "input": "",
  "output": "Usually concerned about sarcoidosis more than lymphoma with a high ACE level. They both can be co-diagnosed but this is a very rare phenomena. Pulmonologist is exactly who you need to see next as the lungs are most affected in sarcoidosis. Given prior work up, Id have low suspicion for malignancy."
},
{
  "instruction": "Please help me understand this. Scared19, Male, 60, 180 lbs, Usually healthy, Works-out 5 days a weekHi there, I went to hematology for a low WBC count and while there I mentioned to them that I have had palpable lymph-nodes in my neck for 3.5 years and I have already been checked previously by 4 doctors including a pediatric oncologist and had multiple ultrasounds which suggest its non-concerning. However, she took an ACE level test and it came back elevated and she said something along the lines Youre ACE levels came back elevated and it could suggest sarcoidosis and if youre concerned go to a GP and get it measured again  ANYWAYS! I didnt think much of it and let it be for 6 months & I went to a Nurse Practitioner to repeat my CBC out of curiosity which showed everything was normal and my WBC was 5.6 which was great. I also asked for the ACE level test to be re-measured and they didnt know what that even was. They had me come back after they researched it and then they took a small vile of blood. They sent it off and it came back high at a 135 and cut off for that lab was 80. I am freaking out because he contacted the hematologist doc and they said I should go to a pulmonologist. I feel perfectly healthy and better than I ever have. I am freaking out because google keeps saying ACE levels being high indicates: Lymphoma, Multiple Myeloma AND Lung cancer. I am absolutely plummeting right now and nothing makes sense to me. Please give me some advice OR knowledge. Its hard to find stuff online speaking about ACE levels.",
  "input": "",
  "output": "ACE level is a very nonspecific test. It is not recommended for exactly this reason. Positive tests have <25% chance of having sarcoid, especially if they aren't sent for a good reason.I would followup to make sure but this is a good example of why we don't just send off a bunch of tests for no good reason - you end up with anxiety and chasing down a number of things that are not real."
},
{
  "instruction": "okay thanks. ill meet up with a pulmonologist most likely. how likely would something malignant cause this?",
  "input": "",
  "output": "Very unlikely. We dont use it as a test to look for malignancy."
},
{
  "instruction": "okay thanks for the responses. my NP i seen doesnt even know what the ACE levels mean and has no knowledge on it. think i should go back and see my actual GP? or is this something i can just let be elevated",
  "input": "",
  "output": "I would be hard-pressed to know how to deal with this nonspecific test without seeing you and your lab records and getting a full medical history. So again I would followup. Depending on the level of suspicion a chest x-ray, chest CT or even biopsy might be warranted.It is generally more productive to wait until there are some symptoms but I can't reassure you that you definitely don't have sarcoid or a different autoimmune disease. It does not seem like you have cancer based on the lymph node surveillance"
},
{
  "instruction": "Scared to death - Possibly cancer (leukemia\/lymphoma)Hi, my husband is a 26-year-old M. He is 510 and weighs 190 pounds. No medical history beside hypothyroidism and takes 100 mcg of Levothryoxine. His mother has hypothryoroidism and his brother had a condition as a small child where his body attacked the collagen in his skin (scleordermia??). He had Covid in June and recovered in 3-4 days. He had routine blood work done because he has never had blood work done, and I encouraged him to do that. He works out regularly, and never gets sick. He does not have enlarged lymph nodes, no night sweats, no pain, or fatigue, weight loss, ect.He initially received a call from a local family doctor towards the end of January about abnormal blood work. His neutrophils were coming in at 0.1 as well as low WBC and high lymphocytes, and they wanted us to follow up with hematology\/oncology. We were told that this blood work did have a bad blood smear that could affect the results. We found a hematologist\/oncologist with a major hospital nearby and the lab work down below has been done by her office.We met with her today, and she said that his lab work on the 1st was not significant, and she would have not accepted him as a client had this been his initial labs. However, since he had the initial 0.1 neutrophils with the other small practice, she took him on. She said the blood work was not too off on the 1st, but that she wanted repeat lab work done. The CBC from the 14th was done after our appointment. She said during our appointment that if the lab work looked similar or was trending outside of the ranges more so then she wanted to do a bone marrow biopsy.We are scared shitless, and this has flipped our world upside down. Any insight or advice would be greatly appreciated. What is your take from these test results? Has anyone experienced this and its not been something as serious as cancer? Thank you in advance.February 14th 2023L : WBC (3.6-10.6) : 2.7RBC (4.5-5.9) : 5.17Hemoglobin (13.5-17.5) : 14.8Hematocrit (41-53) : 43.4%MCV (80-100) : 83.9MCH (26-34) : 28.6MCHC (32-36) : 34.1RDW SD (36.7-47.2) : 37.9RDW (11.3-15.6) : 12.4Platelets (150-400) : 236MPV (8.6-12.4) : 9.9L : Neutrophil % Auto (42-72) : 34.6%H : Lymphocytes % Auto (18-45) : 50.4%Monocyte % Auto (2-12) : 10.9%Eosinophil % Auto (0-5) : 2.6%Basophil % Auto (0-2) : 1.1%Immature Granulocytes (0-0.5) : 0.4%L : Neutrophil, Abs (1.8-6.8) : 1Lymphocytes, Abs (1.2-3.4) : 1.4Monocytes, Abs (0.2-0.9) : 0.3Eosinophil, Abs (0-0.5) : 0.1Basophil, Abs (0-0.1) : 0Immature Granulocyte, Abs (0-0.04) : 0Feburary 1st 2023L : WBC (3.6-10.6) : 3.1RBC (4.5-5.9) : 4.9Hemoglobin (13.5-17.5) : 14.1L : Hematocrit (41-53) : 40.8MCV (80-100) : 83.3MCH (26-34) : 28.8MCHC (32-36) : 34.6RDW SD (36.7-47.2) : 37.1RDW (11.3-15.6) : 12.2%Platelets (150-400) : 235MPV (8.6-12.4) : 9.7Neutrophil % Auto (42-72) 42.9%H : Lymphocytes % Auto (18-45) : 45.2%Monocyte % Auto (2-12) : 8.7%Eosinophil % Auto (0-5) : 2.2%Basophil % Auto (0-2) : 1%Immature Granulocytes (0-0.5) : NoneL : Neutrophil, Abs (1.8-6.8) : 1.3Lymphocytes, Abs (1.2-3.4) : 1.4Monocytes, Abs (0.2-0.9) : 0.3Eosinophil, Abs (0-0.5) : 0.1Basophil, Abs (0-0.1) : 0Immature Granulocyte, Abs (0-0.04) : 0February 1st 2023CMP All within normal limits.02\/01\/23 Pathology review blood smear report : Surgical Pathology ReportFinal Diagnosis : Neutropenia, rare circulating plasma cells  The concurrent flow cytometric analysis is negative for abnormal lymphocyte population  There are no significant hemolytic changes, dysplastic changes, or circulating blastsHistologic EvaluationPeripheral Blood MorphologyLeukocyte differential : Cells counted (100) : Bands\/segmented neutrophil 54, eosinophil 1, basophil 0, monocyte 7, lymphocyte 37, plasma cell 1.Leukocytes : Neutropenia. Neutrophils are mostly mature and without dyspoiesis. Lymphocytes are mature and without over atypia. Occasional circulate plasma cells are present.Erythrocytes : Adequate with normal morphologyPlatelets : Adequate with normal morphology02\/01\/23 Leukemia\/lymphoma phenotyping report by Flow Cytometry ReportComment : There is no evidence for increased blasts, increased plasma cells or abnormal lymphoid population. A negative flow cytometry does not exclude malignancy.Leukocyte DifferentialCD45 Dim Area : 1%Lymphoid Area : 59%-T Cells : 78%----CD4:CD8 ratio 1.5NK Cells : 12%B Cells : 8%----Kappa : Lambda ration 1.8Monocytoid Area : 3%--The monocytoid population has typical antigen expressionMyeloid area : 34%--The Myeloid population has typical antigen expressionANA Hep2 IFA w\/ Reflex ENAANA IFA Screen : NegativeCMt1 : ANA IFA : NegativeFolate Level : 11.4Hep B Surface AntigenHep Bs Ag : NonreactiveCMT : Hepatitis B Surface AgHep B Core Antibody (Total) (ARUP)Hepatitis B Core Ab TotalHep B Core Ab Total : NonreactiveVitamin B12 Level (345-1485)  427HIV Av\/Ab Combo  ScreenHIV  Ag\/Ab Combo by CMIA : NonreactiveHep B Surface AntibodyHep B Surface Ab : NonreactiveESR, Westergren (0-15)  5TSH : (0.46-4.88)  2.54Hep C AntibodyNonreactiveHCV Signal to Cutoff Ratio : 0.05LDH (125-265) : 139",
  "input": "",
  "output": "This is a slight neutropenia, without symptoms and with these blood tests the likelihood of leukemia is incredibly low.Also, this is not a lymphoma."
},
{
  "instruction": "Hi, thank you for your response. Based on the work above what makes you rule out lymphoma? Once again thank you!",
  "input": "",
  "output": "From history: No enlarged glands, no night sweat,no weight loss and no fatigue. No description of splenomegaly or hepatomegaly.From differential: No clonal phenotype, no abnormal peripheral lymphocytes. No blasts.From biochemistry: Normal LDH, normal ESR, no anemia.Basically, none of the warning signs for lymphoma, neutropenia isn't even common in a lymphoma unless there is lymphocytosis or infiltration of the marrow. And ALL infiltration of the marrow should give more symptoms.Edit: I understand this is stressful, so I'm not trying to dismiss you, but I am trying to calm you."
},
{
  "instruction": "Would a cbc with differential show blasts if they are present? I got a cbc recently and it didn't even have a line item for blasts. Just neutrophil, lymphocyte, monocyte, eosonophil and basophil?",
  "input": "",
  "output": "The standard is to report blasts if they are present."
},
{
  "instruction": "Would an automated cbc report as well?",
  "input": "",
  "output": "You can really never know, sometimes it counts them as lymphocytes"
},
{
  "instruction": "What could it be?16 year old male , 61, 105 lb, doesnt take meds, balanced diet, teenager so not a ton of exercise. Complains a lot about bone pain (legs and arms) and is always tired. Referred to hematology after standard labs, these are all labs the Hematologist pulled.These are the labs: Cd8% Tcells : 14 Cd8 absolute :204 Cd 16 + cd 56 (nk cells) : 64 Bilirubin direct: .30 Neutrophils : 28.6 Lymphocytes: 57.1 Monocytes 8.2 Basophils : 4.1 Absolute neutrophils : .9 Manuel nrbc : 2.0 Igm : 37 Wbc: 3.0 Mcv : 79.5 Mch: 25.5 Mchc : 32.2 Rdw: 16.6 Mpv:10.7 ANC .9 Segs % 28.6 Iron 223 Calculated TIBC 438 Iron saturation 51 Creatine .66 Ferritin 8",
  "input": "",
  "output": "Hard to say. Lots of info missing but cd8 cells are low. Absolute neutrophils are mildly decreased. Possible signs of iron deficiency.Guessing some sort of immunodeficiency. Best evaluated by both heme and immunology."
},
{
  "instruction": "26, F. Slightly elevated RBC and high absolute lymphocytes.I [26,F] just got blood work done yesterday - routine chemistry and hematology tests. I weigh 120 lbs and Im 54. I do not smoke but used to vape. Everything under the routine chemistry test came back normal. My RBC shows as high (5.17). The reference range is 3.80-5.10. My lymphocytes were also high (4301 cells\/mcL). The reference range for this is 850-3900 cells\/mcL. My wbc, MCH, MCV, neutrophils, hemoglobin, and hematocrit are all normal.I got cbc tests done a year ago and they came back normal. I was sick all last week with either a cold or the flu. The doctor said my throat looked red. He used the stethoscope to listen to my heart and lungs and said everything sounded good. Could being sick last week cause the RBC and lymphocytes to be high? I have pretty bad health anxiety. Doctor didnt call me with the results yet but I can see them online.",
  "input": "",
  "output": "High lymphocytes are likely from infection. RBC count is only ever so slightly high and normal by most standards. Nothing to worry about. Simply being dehydrated could also cause both counts to be falsely elevated."
},
{
  "instruction": "Hematology investigation; can anyone please translate?Age: 36Gender: MaleWeight: 88kgs, Height, 175cmsLocation: CanadaEthnicity: SE AsianMeds: 40mg Pantaprazole 2x a dayAbout 2 weeks ago I posted asking what the docs here thoughts my hematology panel results meant (post below)https:\/\/www.reddit.com\/r\/AskDocs\/comments\/dis3kq\/can_someone_decipher_my_hematology_panel\/Following the results, my GP sent me to get a hematology investigation done. Below are the results.results: https:\/\/imgur.com\/EINgINCCurrently my GP is away, but I will follow up in a week or so. In the meantime, would any docs here be kind enough to shed some light on what the terms mean?",
  "input": "",
  "output": "Homozygous Hb E likely fully explains your CBC which has a pretty low MCV (ie your cells are small) but otherwise is normal. This in and of itself should not cause any real problems, though as noted there could be implications if you plan on having children. The most common scenario would be if a child inherits HbE from you and a beta thalassemia mutation from mom, which could result in the child having a form of thalassemia.A single alpha thalassemia gene deletion = you have 3 out of 4 functioning alpha hemoglobin chains. This also has no real significance in and of itself - people who have this and nothing else (including no HbE) would have totally normal labs. Again, your MCV is low because of the HbE and not the single alpha deletion.Hope htis helps."
},
{
  "instruction": "reading my hematology results does it look like anemia?im female, 20 years old and i have graves disease, recently getting these results back im wondering if any of them point to anemia.(Hematology WBC 5.3 4.0 - 11.0 x E9\/L RBC LO 3.96 4.00 - 5.10 x E12\/L Hemoglobin 126 120 - 160 g\/L Hematocrit LO 0.348 0.350 - 0.450 L\/L MCV 88 80 - 100 fL MCH 31.8 27.5 - 33.0 pg MCHC HI 362 305 - 360 g\/L RDW 12.0 11.5 - 14.5 % Platelet Count)",
  "input": "",
  "output": "No. By definition it's not anemia."
},
{
  "instruction": "15 y\/o male, R arm swellingHello doctors of Reddit,My brother is a 15 yo male with 1 week of R arm swelling and mild\/dull pain on shoulder abduction . He is an avid basketball player who trains very hard and he uses his right arm to shoot the ball. 3 days prior to onset of swelling someone hit him hard on the right shoulder. He didnt think much of it, but has mild ecchymosis on the shoulder.1 day after symptom onset he went to the ER. Ultrasound negative for DVT and echogenic material. CT scan of arm and chest negative for blood clots and mass. CT scan did not see a cervical rib but noted minor thoracic inlet narrowing. CBC normal PT\/INR normal CPK elevated D dimer positive (ER physicians were unconcerned due to imaging) Protein C\/S normal factor Leiden V normal Normal radial pulseHe was sent home with hematology and vascular surgeon follow up. The ER physicians suspect this is an overuse injury causing some type of impingement that resulted in the swelling of the arm.So far his arm circumference has dropped by 1 inch and his arm feels less tight, as in you can pinch the fat, which was difficult to do before. His pain has improved. We will follow up with the specialists but also a sports medicine doctor.Could this really be an overuse injury? Can such an injury really cause the whole arm to swell?Thank you all.",
  "input": "",
  "output": "Holy shit at that ER work up. Seems.. thorough.Could be the bruise or a muscle strain causing swelling as well"
},
{
  "instruction": "Protein electrophoresis and Lambda\/Kappa Chain ResultsHello guys,Context: 23 year old M with most likely beta thallessemia based on other results who also presented with elevated wbc of 13.9 and lymphocytes of 5100. Doctor did some thalassemia and protein electrophoresis tests to confirm thalassemia.Thalassemia results came back consistent with beta thalassemia however my doctor does not know how to interpret the SPEP results and will send me the hematology. Wanted some input before my hematology appointmentProtein: 8.2 H (reference 6.1-8.1)Beta 2 Globulin: 0.7 H (ref 0.2 - 0.5)Kappa: 444 H (ref 176-443)Lambda: 269 H (ref 91-240)Kappa\/Lambda ratio: 1.65 ( ref 1.29-2.55)CMP: WNLCBC: besides the ones listed above and other values typically associated with beta thalassemia is WNLSymptoms\/Problems: noneAny inputs would be appreciated. Thank you!",
  "input": "",
  "output": "Could be consistent w\/ beta thalassemia, which affects hemoglobin (the protein in RBC responsible for carrying oxygen) and this can lead to anemia. The elevated beta-2 globulin might be the body's response to increased red blood cell breakdown, common in beta thalassemia. But the SPEP test isn't the main diagnostic tool for beta thalassemia; other tests like hemoglobin electrophoresis and genetic testing are more specific."
},
{
  "instruction": "please help. 2 low wbc in a row, now seeing hematologyMy husband. Male, 48. Healthy.First wbc 3.5, no differential was done. Everything else normal.3 weeks later wbc 2.8 and neutrophils 1.4 with 1.5 being the lowest level for norm. Says 50.4%. All other levels still normal, monocytes normal but higher end. 0 immature granulocytes.Doctor said he knows we are scared, but really, really doesn't think it's cancer. Thinks most likely was fighting some kind of virus, but sending to hematology to be sure. Also has 2 immediate family members with rheumatoid arthritis.I'm very scared.",
  "input": "",
  "output": "When just the WBC is low, your doctor is right, it's usually recovery from an infection. Cancer tends to cause more than one type of blood cell to be low, which doesn't seem to be the case."
},
{
  "instruction": "Asking on behalf of my sister. Liver lab levels insane, among other strange things.Because the leukemia\/lymphoma lab is taking forever to come back yet we have a ton others, her pcp isnt giving her much more info. Wonky highs and lows.36F, overall healthy, non-drinker and never smoked. Had 2 successful pregnancies and birth. Eats and maintains healthy diet and exercise. 57 145. All vaccines.3 weeks ago she started feeling achey. No upper respiratory stuff but general aches, fatigue and headache. Took several covid tests and negative. Ended up going to Hawaii where she thought she actually had covid there and those were also negative. She was complaining of the same thing. At one point, thought it was sun poisoning. Shes seemed to get worse and worse. A week later, which was 2 days after returning home she went to the ER for what she thought was severe dehydration. It wasnt that but they werent sure what it was. Said to see her pcp.ER doc did a handful of labs. Initially told her to see her pcp for follow up labs for mono or leukemia. Her joints ache, a weird floaty face feeling, no fever, no upper respiratory, majority of joint pain is in her legs and toes feel strange. Headaches here and there. Otherwise, she feels okay. No notice of brushing, bloody noses, rapid weight loss.Labs below. If a number is in here more than once its because it was the second lab test when increased. Nothing of concern went down, but only up. Only test we are waiting on, of course, is the leukemia one. Mono all came back negative and no antibodies.Sediment rate 4 - normal, Smudge cells - mild, C reactive - higher at 12, Polychrom, platelet morph and others in category this tests were all few or normal, WBC 8.02, Rbc 5.1, Hemagblobin 14, Hematrocit 41, MCV 83, Mch 29, Mchc 35, Rdw sd. 40, Mpv 9 - low., Nrbc 0 , Neutrophils 23.5% low, Lymphocyte 70% high, Mono 3.9%, Eos 1.0 % bordering, Baso 1.2%, Ig .1, Neutrophil # 1.8, Lymphocyte # 5.64, Mono # .08, Eos .08, Baso # 10,Edited and added below AST -57, ALT 61,Others I missed: Anion gap 2, Globulin 3.5, Albumin\/gobulin ratio 1All plasma levels seem in range besides glucose bordering high.Can anyone share if youve seen a blood work up look like this? The overall sickness has been going on for 3 weeks now and is increasingly getting worse.If its not CLL like our minds are nervously going towards, do you recommend she ask for a referral to hematology or rheumatology? Weve heard a virus already thrown in there and Im just wondering what virus out there does this to your body bc even tho Im not a dr her liver numbers arent ideal with some other markers showing some poor function Any comment to give insight would be great! Thanks.",
  "input": "",
  "output": "Where are the liver labs? And how did CLL get brought up?"
},
{
  "instruction": "CLL was brought up bc of the higher absolute lympho count and the moderated smudge cell. The ER doc wrote it on discharge to pcp.",
  "input": "",
  "output": "I'm a ED physician, and this...sounds unusual. In CLL, the white count should be significantly elevated which in this case, it is not. Furthermore, the presence of smudge cells is not necessarily indicative of CLL. I be surprised if this was CLL. This is likely some sort of viral infection if I had to guess."
},
{
  "instruction": "Post-Stroke Pneumovax?47f, hx of PCOS and gerd, overweight.I had an ischemic cerebellar\/medullary stroke in 2021. It occurred 3 days after my second Pfizer vax, but no providers have really considered a link other than hematology, who saw me once and ruled out clotting disorders. He thought there could be a correlation, but said that there was no existing evidence. They never found a real cause. I was Covid negative at the time of my stroke but had a moderate case in April of 2020, so it had been 10+months. My cholesterol was elevated at the time of the stroke, so Ive been on a statin since then, and its remained in the normal range.Im an RN and am definitely pro-vaccine and pro-science, but Ive been hesitant to get my Covid boosters since the stroke. Also, I have Kaiser and my stroke has triggered a recommendation for the pneumonia vaccine. My own PCP wont advise me. When I asked her the risks of the pneumonia vaccine and named my fear of further stroke, she told me to speak to my family.Has anyone seen any discussion or research regarding this, or can anyone offer recommendation regarding both the boosters and other vax? Thanks so muchDont inbox me if youre an anti vaxxer because Im not interested",
  "input": "",
  "output": "In massive datasets there has been no correlation between Pfizer and stroke, although there has been risk of cavernous sinus thrombosis with the AstraZeneca vaccine.Pneumococcal vaccination hasnt had quite the sudden pileup of data, but thats been studied and no link to strokes.Prior COVID infection raises cardiovascular and cerebrovascular risks even up to a year later, even after mild illness. That and bad luck are the most likely culprits for you."
},
{
  "instruction": "Are promyelocytes showing on blood test normal?M 27, 6'1'', 150 pounds. I recently had bloodwork done due to low energy levels\/pale skin. RBC was 4.0 and WBC was 3.4, both low but I guess not far enough outside the range to be a red flag yet. Hematology is having me retest in 4 weeks.What is concerning me is I have promyelocytes of 0.06 when this should be at zero, and everything I've read says this is never a good sign. My doctor and hematology didn't mention this at all in their notes, should I be concerned?Really appreciate the help.EOSINOPHILS,MANUAL COUNT0.16 x1000\/mcLBASOPHILS, MANUAL COUNT0.03 x1000\/mcLPROMYELOCYTES, MANUAL COUNT0.06 x1000\/mcL",
  "input": "",
  "output": "Best to call your GP and discuss this. Those cells are usually indeed found in the bone marrow instead, not in the blood."
},
{
  "instruction": "High eosinophils anxiety or underlying issue?Age : 24Sex : MaleHeight : 61Weight : 190Race : CaucasianDuration of complaint : unknown how long persisted under radar.Location : North America \/ SoutheastAny existing relevant medical issues : none.Current medications : propranolol.Hey everyone, for any with experience in hematology, I went to the doc a month ago for routine work and a check up. After a blood test returned, it appeared that everything was normal, nearly in perfect ranges, with the exception of my eosinophil count.Normal ranges are between 0-500 per x value and comprise 0-6% roughly of all white blood cells. My white blood cell count alone was practically perfect (middle of range, if not slightly favoring lower end) and all individual white blood cells were in optimal ranges, however my eos was rated at 1500, nearly 3x the standard, and at 19%.For some context, I had just gotten back from a trip in California where I had a fairly massive reaction to poison ivy or oak or sumac, it covered a significant portion of my legs (60%) and it was streaked on my torso and my arms. I also, not even a week before, had been ill or had an allergic reaction to something in a house I stayed in that is suspected to have some mold in it and cats which im Allergic to. I was sick for probably 3 days.I have my second blood test tomorrow and am a bit stressed by this. Any direction, advice, anecdotal evidence etc is appreciated.",
  "input": "",
  "output": "Almost certainly due to your exposure to the plant."
},
{
  "instruction": "Worried about a blood cancer but doctors aren't? Petechiae that come and go?25M, 6'0, White, 175lbs. Manual Labor Job, lifted weights until june 6th (mostly due to workload) No alcohol\/smoking, only THC gummies. USA(Prior Health Concerns)-Rosacea-Late Dec 2020 I tested negative for covid, unbearable stomach pain\/bloating whenever I ate. Lost 11lbs over 7 days until I could finally eat again. Saw GastroEnter early Jan '21. Gastroscopy, upper endo, colonoscopy. All biopsied, no inflammation. No blood in stool. Total mystery to them that resolved and never came back. Had remnant pains the next few months, tingles\/tickles around torso, all resolved in time with no medications\/treatments.-August 2nd, had knot under left armpit for two months ultrasounded, ruled benign, not pathologically enlarged(Current Health Issues)I've had issues the last few months. My hands felt cold\/stiff in the fingers, no pain. This lasted only a few days before going away, (June 1st). GP said Raynaud's. Almost as soon as the finger issues stopped, I went to the ENT for a migratory feeling of fullness in my throat for multiple weeks that turned out to be acid reflux, and issue I have had off and on for the last handfuls of years (Maybe once a year), but never like this. I'm on omeprazole 20mg daily and that has been resolved. Back issues (now believed by trial\/error to be caused by highly acidic food (Homemade hot sauces) have all but recently resolved. Migratory from spine to flanks, almost always symmetrical radiating irritation\/tightness. Only two instances of sharp pains when eating spicy\/acidic food, so I associate that with the acid reflux. These back issues never affected my mobility, and only ever had an issue like this when I had the moderna vaccines (Which kicked my ass for three days each)My biggest concerns have been my blood work. Initially my doctor was worried about my platelets on June 6th. (Still had back issues). I was on a plant based diet, and he recommended I go off it because he has no experience with it until we see what's happening. I resumed a traditional diet until follow up bloods and peripheral smear on June 22nd. Almost everything bounced back into normal range, or at the very least recovered significantly. No concerns on his end other than slightly low wbc, peripheral smear great. I felt better, and resumed a plant based diet until I felt started to have back\/hand issues again.Aug 2nd - I also noticed some flat individual dots on my trunk\/legs. Only about 5 at the time. Some of which are raised. He said they are petechiae, never go away, and that was that. Two of which I vaguely remember noticing a few years ago but cannot be certain. More bloodwork and smear done. Both smear results are of no concern to GP or hematologist (Facility requires all bloodwork reviewed by Hematology across the street as per policy)The last handful of days I noticed a cluster under my left armpit of petechiae, which had mostly faded before returning again today, but not as prominent. I have a hematology appointment on the 15th. Both doctors are not concerned of Leukemia, but Hematologist is still interested to see what's up and GP said all his resources are exhausted.I have no organ enlargements\/lymph node enlargement\/no fatigue\/nightsweats\/weight loss. No inflammatory markers, healthy kidneys\/liver\/spleen. No reduction in appetite (Quite the opposite) Only Low wbc and mild hand symptoms that come and go that had remedied when returning to traditional diet but dropped since returning to plant based. The last three days I have noticed minor \"tickles\" around my body. I wouldn't say itching. Similar to the tingles I would get when I had my stomach issues about 3 years ago. None of my symptoms ever got worse at night, quite the opposite.(Questions)Would cancer symptoms wane and reoccur? Would my bloods have recovered so fast if I it was? I honestly don't know what to think at this point. I feel like by now if it was leukemia it would have been caught in the blood smears or my conditions would have worsened, not (mostly) resolved?I understand my WBC is low, but would it be considered pathologically so? All abnormal labs are posted, everything else fell into normal rangeshttps:\/\/imgur.com\/FZEIlnE (Bloodwork)https:\/\/imgur.com\/Lhw9UC1 (Petechiae)",
  "input": "",
  "output": "Blood smears are diagnostic for blood cancers. If theyre normal, you dont have blood cancer."
},
{
  "instruction": "Worried about a blood cancer but doctors aren't? Petechiae that come and go?25M, 6'0, White, 175lbs. Manual Labor Job, lifted weights until june 6th (mostly due to workload) No alcohol\/smoking, only THC gummies. USA(Prior Health Concerns)-Rosacea-Late Dec 2020 I tested negative for covid, unbearable stomach pain\/bloating whenever I ate. Lost 11lbs over 7 days until I could finally eat again. Saw GastroEnter early Jan '21. Gastroscopy, upper endo, colonoscopy. All biopsied, no inflammation. No blood in stool. Total mystery to them that resolved and never came back. Had remnant pains the next few months, tingles\/tickles around torso, all resolved in time with no medications\/treatments.-August 2nd, had knot under left armpit for two months ultrasounded, ruled benign, not pathologically enlarged(Current Health Issues)I've had issues the last few months. My hands felt cold\/stiff in the fingers, no pain. This lasted only a few days before going away, (June 1st). GP said Raynaud's. Almost as soon as the finger issues stopped, I went to the ENT for a migratory feeling of fullness in my throat for multiple weeks that turned out to be acid reflux, and issue I have had off and on for the last handfuls of years (Maybe once a year), but never like this. I'm on omeprazole 20mg daily and that has been resolved. Back issues (now believed by trial\/error to be caused by highly acidic food (Homemade hot sauces) have all but recently resolved. Migratory from spine to flanks, almost always symmetrical radiating irritation\/tightness. Only two instances of sharp pains when eating spicy\/acidic food, so I associate that with the acid reflux. These back issues never affected my mobility, and only ever had an issue like this when I had the moderna vaccines (Which kicked my ass for three days each)My biggest concerns have been my blood work. Initially my doctor was worried about my platelets on June 6th. (Still had back issues). I was on a plant based diet, and he recommended I go off it because he has no experience with it until we see what's happening. I resumed a traditional diet until follow up bloods and peripheral smear on June 22nd. Almost everything bounced back into normal range, or at the very least recovered significantly. No concerns on his end other than slightly low wbc, peripheral smear great. I felt better, and resumed a plant based diet until I felt started to have back\/hand issues again.Aug 2nd - I also noticed some flat individual dots on my trunk\/legs. Only about 5 at the time. Some of which are raised. He said they are petechiae, never go away, and that was that. Two of which I vaguely remember noticing a few years ago but cannot be certain. More bloodwork and smear done. Both smear results are of no concern to GP or hematologist (Facility requires all bloodwork reviewed by Hematology across the street as per policy)The last handful of days I noticed a cluster under my left armpit of petechiae, which had mostly faded before returning again today, but not as prominent. I have a hematology appointment on the 15th. Both doctors are not concerned of Leukemia, but Hematologist is still interested to see what's up and GP said all his resources are exhausted.I have no organ enlargements\/lymph node enlargement\/no fatigue\/nightsweats\/weight loss. No inflammatory markers, healthy kidneys\/liver\/spleen. No reduction in appetite (Quite the opposite) Only Low wbc and mild hand symptoms that come and go that had remedied when returning to traditional diet but dropped since returning to plant based. The last three days I have noticed minor \"tickles\" around my body. I wouldn't say itching. Similar to the tingles I would get when I had my stomach issues about 3 years ago. None of my symptoms ever got worse at night, quite the opposite.(Questions)Would cancer symptoms wane and reoccur? Would my bloods have recovered so fast if I it was? I honestly don't know what to think at this point. I feel like by now if it was leukemia it would have been caught in the blood smears or my conditions would have worsened, not (mostly) resolved?I understand my WBC is low, but would it be considered pathologically so? All abnormal labs are posted, everything else fell into normal rangeshttps:\/\/imgur.com\/FZEIlnE (Bloodwork)https:\/\/imgur.com\/Lhw9UC1 (Petechiae)",
  "input": "",
  "output": "Blood smears are diagnostic for blood cancers. If theyre normal, you dont have blood cancer."
},
{
  "instruction": "Can MCV go up by a few points over a month, still in normal range - should we be concerned? All levels listedMale -48 (my husband)WhiteWeight 163No signs\/symptomsCan an MCV increase in one month by 3 points?Been seeing doctor since April 2022 for low WBC and neutrophils. Everything else was normal. (found on routine bloodwork)Followed by hematology. They aren't all that concerned, but I have a question.This latest test (50 days after last one) his WBC went back up to 4.3 (previous low 2.8) and neutrophils are 2.5 (previous low 1.4).Of course now I see that his MCV went up to 95.8 from 92,8, before that 93.8 (still normal, ref high is 100)MCH stayed same at 32.5 (norm)MCHC went down from 34.5 to 33.6 (normal, ref low is 31)RDW 12.6 stayed same (norm)RBC went from 4.64 to 4.53 (still normal, ref low is 4.2)Hemoglobin went from 14.9 to14.6 (still norm, ref low is 13)Platelets, all other counts normal for him.Normal B12, Folate normal at 29.4Are these counts any cause for concern? Can they go up and down within range?He's had 4 blood tests within 3 months so I can see the fluctuations. Also to note, he's having heel pain\/inflammation starting last week (from running we think). They did test for RA due to strong family history (dad and brother) but negative. Although doctor said that doesn't mean he's not developing it.And he has been eating a lot less healthy this month and gained some weight.",
  "input": "",
  "output": "This change is within normal lab variation. Nothing to worry about."
},
{
  "instruction": "Worsening Breath hunger with normal blood panel resultsMy doctor doesnt seem to think theres a problem here. Does anyone have an idea why I find it so hard to breath? Walking up the stairs is becoming more and more difficult. Im 33\/f (I hope this makes sense, its translated from German)Material submitted: Whole blood or supplement, EDTA blood, GlucoExactinvestigationresultDimension reference areagraphicprevious valueCLINICAL CHEMICAL TESTSglucose10560-100The multiplication of the measurement result by a factor of 1.16 required for the GlucoExact tube was already 60-100 mg\/dl (3.3-5.6 mmol) normal fasting glucose: 100-125 mg\/dl (5.6-6.9 mmol) abnormal fasting glucose: >126 mmol\/l) Diabetes mellitus (guidelines of the DDG from 10\/2004, confirmed in Diabetologie 2010; 5: 109-112)performed.mg\/dl (>7.0GOT (ASAT) GT29160.7<0.9Creatinine (Jaff)GFR (calculated, according to CKD-EPI)11460min\/1.73m2COFIRON BUDGETferritin13-150LIPOS METABOLISM\/ATHEROSCLEROSIS RISK DIAGNOSTICS45-23075cholesterol134triglycerides62mg\/day20-150HDL cholesterol51mg\/day48-83LDL cholesterolmg\/day10-155LDL target values according to the ESC\/EAS guideline: Diagnosis and therapy of dyslipidemia (2019 version): In the case of a low cardiovascular risk, an LDL cholesterol target value of <116 mg\/dl (<3.0 mmol) should be set, and in the case of a moderately increased cardiovascular risk of <100 mg\/dl (<2.6 mmol\/l) should be aimed for. If the cardiovascular risk is high, the LDL. Cholesterol maintained at less than 50% of baseline and at least <70 mg\/dl (<1.8 mmol\/l) and very highcardiovascular to be sustained to less than 50% of baseline and at least to <55 mg\/dL (<1.4 mmol\/L).non-HDL8314-185Secondary non-HDL target values according to the ESC\/EAS guideline: Diagnosis and therapy of dyslipidemia (2019 version): with a moderately increased cardiovascular risk <130 mg\/dl (<3.4 mmol\/l), with a high cardiovascular risk <100 mg\/dl dl (<2.6 mmol). at very high cardiovascular risk <85 mg\/dl (<2.2 mmol).VITAMIN DIAGNOSTICSVitamin B12197-771 1.8-9.0folic acidTHYROID DIAGNOSTICS TSH basal value1.250.4-4.0TSH in the reference range as an indication of a euthyroid SD functional position (assuming an intact HVL axis). Please note the changed reference range.Page 1\/2amedes MVZ 1. Laboratory. and Microbiology Leipziger Chaussee 1911 06112 Halle\/Saale Tel.:0345\/44507-100 FAX:44507210amedeswithdrawal inputSurnamePIKE EMMAborn05\/20\/1989 (933 years)Payer checkout investigationYour number 7014147367 barcode number701414736707\/26\/2022 07\/26\/2022final resultlab noYPWG26 5414resultDimension reference areagraphicprevious valueHEMATOLOGICAL DIAGNOSTICSSMALL BLOOD COUNT5.44.0-9.0leukocyteserythrocyte hemoglobin4.2TA39-5313.0120-16.0hematocrit MCV3836-4789.880-9630.728-32MCHC34.230-36platelets150-400Commentary on findings: [1] Please note the changed reference range.This finding was medically validated by Dr. Biro, F for Laboratory Medicine",
  "input": "",
  "output": "While your blood tests are normal, there isnt much of any investigation for shortness of breath (aside from demonstrating that youre not anemic). A typical workup for shortness of breath will include chest imaging (usually starting with a chest x-ray) and pulmonary function testing (breathing tests). If you doctor isnt comfortable working up your symptoms its always reasonable to ask about a referral to a pulmonologist."
},
{
  "instruction": "27F immunocompromised and sick for two weeks. Getting worse. Rheumatologist is out of town and ER doctor sent me home pending blood test results that are still processing. Insight?Demographics: 27 female. Height 5ft 6in, weight 190lbs. Married.Conditions: rheumatoid arthritis and lupus; SVT.Meds: 2000mg sulfasalazine, 400mg plaquenil, 200mg Cimzia injection every two weeks.Non-smoker, no alcohol, no caffeine.Duration of complaint: 2weeksI have four doses of pfizer covid vaccine.Currently negative for covid.Two weeks ago before my scheduled Cimzia injection I spiked a low-grade fever. It was about 37.8c. Since then, my temperatures have been 37.5c to 38.5c. Acetaminophen will not bring my temperature down. It initially started with fatigue and headache and fever.Last week I began to get a sore throat, sweating, clamminess, chills, mild sinus pressure, confusion, shortness of breath, and a slight cough.I went in for monthly rheumatology bloodwork on 7\/28. Ill attach the results. Mildly decreased WBC and Neutrophils.On 7\/29 I went to the emergency room as my primary doctor instructed me to because I was not improving. Many cultures were taken. WBC further decreased and neutrophils were more than half of the previous day. There is a WBC Morphology pending pathologist review.Sepsis cultures have not shown any growth over the day.X-ray of chest showed no abnormality.Im confused as to what could be causing this. The ER doctor also said he was confused and it could be a medication or a nasty virus (was not tested for these) and that I have neutropenia and I am quite immune compromised but left it at that.Today, 7\/30, I have had more difficulty breathing, particularly with movement or talking. Im coughing green\/yellow thick mucus. More fatigue. My lungs feel heavy.Im thinking of heading back to the ER tomorrow if symptoms get worse, but Im not sure it will do any good for me or provide me with more.Is there any insights?Ive reached out to my rheumatologists receptionist as well as my primary doctor. However, Monday here is a holiday so the offices are closed. The earliest I could see my primary is on Tuesday, and Im not sure how much further it will progress by then.here is the link to my imgur albumI understand that some of the blood work with the hematology panel is still pending.Also, what does it mean with the WBC morphology Reviewed by technologist Sent to Pathologist for review?",
  "input": "",
  "output": "I wouldn't wait a day more. Go to the ER. In my opinion you should be started on broad spectrum antibiotics asap, while waiting for results."
},
{
  "instruction": "Any other possible causes of low WBC count? am hispanic 23F, 5'1, 105 lbs.Symptoms: some fatigue, occasional night sweats (maybe 1-2x\/every 2wks for ~4-5 mo) that are drenching and wake me up, palpable non-tender L posterior auricular lymph node, submental, and R posterior cervical lymph nodes (but have been told by a otolaryngologist in a class these are probably just shotty\/only palpable because I am thin), I mainly just saw a doctor to establish care after moving and for a physical because it had been a while.Medical hx: childhood asthma, internal hemorrhoids ongoing on\/off for 4 yrs dx by colonoscopy, iron deficiency without anemia 2 yrs ago (likely d\/t vegetarian diet)Current medication is Nuvaring. I drink max 2 drinks\/wk, I do not smoke, and I do not use any drugs.Lab results:-CBC w\/Diff: Repeated 3x over 2 months, same results. Results here of manual diff:WBC 3.1 10e3\/uL 3.9 - 11.2 10e3\/uL LRBC 4.9 10e6\/uL 3.7 - 5.2 10e6\/uLHemoglobin 12.1 g\/dL 11.3 - 15.1 g\/dLHematocrit 38 % 34 - 45 %MCH 24.8 pg 25.7 - 34.1 pg LMCHC 32 g\/dL 32 - 36 g\/dLMCV 78 fl 79 - 98 fl LRDW 13.7 % 11.0 - 14.9 %Platelet Count 180 10e3\/uL 165 - 366 10e3\/uLMPV 12.2 fl 9.0 - 11.8 fl HAutomated Nucleated RBC 0 %\/100 WBCBand Neutrophil % 1 % 0 - 1 %Segmented Neutrophil % 43 % 43 - 74 %Lymphocyte % 49 % 17 - 46 % HMonocyte % 6 % 4 - 13 %Eosinophil % 1 % 0 - 6 %Basophil % 0 % 0 - 1 %Absolute Neutrophil (Segs and Bands) 1.36 10e3\/uL 1.90 - 7.80 10e3\/uL LAbsolute Lymphocyte 1.52 10e3\/uL 0.90 - 3.20 10e3\/uLAbsolute Monocyte 0.19 10e3\/uL 0.26 - 0.86 10e3\/uL LAbsolute Eosinophil 0.03 10e3\/uL 0.03 - 0.52 10e3\/uLAbsolute Basophil 0.00 10e3\/uL 0.01 - 0.10 10e3\/uL LRBC Morphology Comment Present RBC: Manual smear Review PerformedPoikilocytosis 1+ AOvalocytes Present ATarget Cells Present A-Other labs:normal CMP, negative ANA screen, negative rheumatoid factor, normal Vitamin D, normal B12, normal Folate, negative for hep B & hep C, negative TB skinMy question:My Dr. did an e-consult with hematology, and they were dismissive I think because I am young and relatively healthy and all of the above possible explanations were negative\/normal. They said that it was likely just low WBC due to genetic variation. I have never had a low WBC count in the past (last cbc w\/diff in 2020 was normal) and no one in my family has a low WBC count. I understand that it still could potentially be a \"normal\"\/ genetic variant low wbc count, but are there any possible explanations for my results that have not been explored above and should I push to investigate or should I just wait and see if I start getting infections or other symptoms like they said I should? I am a student in a healthcare field and could just be over-analyzing and worried for no reason!",
  "input": "",
  "output": "I wouldn't pursue anything further with this if you don't have frequent infections or any other symptoms. Some people just run on the lower end, and that's fine."
},
{
  "instruction": "29F. Low wbc and neutropenia. Referred to hematology. Stressed because it takes time to see specialistI just need some peace of mind, something that can calm me down my pcp called me after my cbc test and said that they want to refer me to Hematologist just to make sure they dont miss anything. The soonest appointment for hematologist is in the end of January! I dont know what to do because all I can think of is Cancer or HIV because what else can explain my low wbc 2.9k\/UL (3.9-12 standard range) and neutrophils 34.8% (40-70%) high lymphocytes 52.4% (25-45%) and high basophil 2.1 (0-2%) I am absolutely terrified and cant wait that long to find out whats causing it Can PCP run other tests in a mean time?",
  "input": "",
  "output": "What else could cause it? A viral illness. Nutritional deficiencies. Drug induced neutropenia. Benign ethnic neutropenia. There's many potential causes besides what you jumped to. There are some tests your doctor could do, like a peripheral blood smear, folate and B12, some liver function testing and some screening panels depending on clinical suspicion from history and exam. Many of these may have been done or deemed not necessary."
},
{
  "instruction": "Hereditary iron deficiency?Profile: 25, female, 58, 175lbs, active, Caucasian-Mediterranean, Complaint: -extreme fatigue despite adequate sleep -dizzy\/ fainting spells -poor circulation -blood pressure and blood sugar fluctuations -severe brain fog -dissociative episodes -debilitating anxiety\/ depression Has been going on for the past 5 years and steadily getting worse.Recent labs: Hemoglobin A1C: 5.6 Glucose fasting: 5.0 mmol\/L Ferritin: 40 ug\/L Hematology profile normal, electrolytes normal, kidney\/ liver function tests (urine & blood) normal, B12: high 836 pmol\/L Cholesterol: 4.82 mmol\/L LDL: 3.01 mmol\/L HDL: 1.51 mmol\/L Non HDL: 3.31 mmol\/LHello! So I (25F), my mother (50), and my grandma (74) all have iron deficiency. We all have no underlying illnesses, except that grandma and I are subclinical hypothyroid. No kidney or liver issues. No other inflammatory diseases, crohns, celiacs, etc.Recently I found out that ferritin is optimal at >100 ug\/L. Pretty pissed because 5 months ago it was 54 and I was told it was normal and now its 40. all of my symptoms align with iron deficiency.Can anyone shed some light as to what the root of this may be? Is it possible its just hereditary?Thanks in advance for any responses.",
  "input": "",
  "output": "Well, you all (presumably) menstruate. So you lose iron monthly. That can cause iron deficiency."
},
{
  "instruction": "Yes. Thats what we assumed it is.. but it seems odd as we all eat meat. I know that certain foods like dairy can block iron absorption though.",
  "input": "",
  "output": "It's not uncommon at all. Many people who menstruate are iron deficient"
},
{
  "instruction": "Elevated liver enzymesI am a 29 YO male, 510, non-smoker (occasional marijuana smoker), there has been no symptoms or duration.So I made a doctor app because of high blood pressure, she sent me for bloodwork and the results showed elevated liver enzymes AL-something was 129 when normal is 9-65. After numerous questions it was noted that I chronically used extra strength liquid gel Advil 400mg (took 2-3 a day for a long time due to chronic neck pain). The doctor said this COULD be it but had to rule everything out and advised to immediately stop taking Advil. This was Monday June 20th. Extra bloodwork was taken (HIV, Hepatitis) but results only came back stating my enzyme levels got worse, now 165. So I got my third set of bloodwork today for more in-depth bloodwork under hematology. The doctor is still saying that she THINKS it COULD be the Advil use but they dont know for sure whats causing it or why its getting worse. I also have a ultrasound scheduled for July 11th.Im trying to remain calm but why is this suddenly happening when Ive NEVER been sick like this, I dont have pain in my liver, I dont have yellow eyes or skin (which the doctor asked). If it wasnt for routine bloodwork catching it I would never even know. The doctor says its still mild and its good we caught it when we did but we got to figure out whats causing it. She mentioned something about auto immune disease or gastro also but my mind is going to the darkest depths.. cancer. I have this sinking feeling like Im dying now. Please any insight or input. I know you guys wont have answers for me from a simple Reddit post but anything.",
  "input": "",
  "output": "Many causes. Looks like good appropriate workup is being done. If you're overweight, fatty liver is a possible cause"
},
{
  "instruction": "Referred to hematologist at a cancer center for chronic leukopenia, thrombocytopenia, and anemia, wondering if my bloodwork could be indicative of anything serious?TLDR; I'm wondering if my bloodwork could be indicative of any serious issues besides iron deficiency anemia. Screenshots of my results are at the link at the bottom.23F, 52, 113lbs, dont smoke, rarely drink. I take Vitamin D3 supplements.I have iron deficiency anemia. Im a lacto-ovo vegetarian, so Ive always assumed that my anemia is related to my vegetarianism. Last April, I was prescribed iron supplements by my doctor. I took them for awhile and my iron levels had improved as of October and I wasnt anemic anymore. Around the same time I started slacking off taking my supplements (havent taken many since October) and as of last weeks bloodwood, Im anemic again. Im not surprised about that. My physician said she was going to refer me to hematologist to see what their recommendations would be as far whether supplementation alone is fine or if they'd suggest an iron infusion.The past three times Ive had my bloodwork done Ive noticed that my WBC and platelet count was low and would think Huh thats weird, but assumed it had something to do with my anemia. The doctor never mentioned a problem with it so I figured it wasnt really anything to worry about. At the end of our appointment I asked if my anemia is related to my vegetarianism or if its hereditary. She said she wasnt sure because of my low WBC and platelet count, so thats why shes sending me to the hematologist so they can look into it further. This was slightly off-putting to me because I expected the answer to be my vegetarianism because thats what Ive always assumed. It possibly being related to another underlying issue has been bothering me a little bit. On the appointment details, she noted: Thrombocytopenia (chronic), Leukopenia (chronic), and iron deficiency anemia secondary to inadequate dietary iron intake.Fast forward to today and I get an update from my doctors office that theyre still in the process of making the referral to the hematologist. They let me know the referral request was sent to our local cancer center. Normally, I dont really worry about stuff like this unless given reason to worry. Im aware that hematologists often work at cancer centers so Im assuming thats why she referred me there. It just has me slightly on edge because my dad goes there for his chemotherapy. The type of cancer he has isnt hereditary, but its still a little concerning to get referred to the same place where your dad got diagnosed with cancer and is getting treatment. My grandma has leukemia and also goes there to have it monitored. Im not sure if hers is hereditary or not.When I was researching leukopenia a little bit more and its possible causes, another thing thats bothered me a little bit is that I dont really see much of a link to iron deficiency anemia like I originally thought. So I'm not sure what could be causing it. I saw that low B12 can, but my B12 levels were checked last year and they were pretty good. My WBC was even on the low side then. Other details is that Im African American on my moms side and Mexican on my dads. I haven't had folate or copper tested, so maybe a deficiency? I also recently found out that my paternal great grandfather was a hemophiliac. Several people in my family have had cancer.Anyway, heres my recent bloodwork. I was wondering if anyone has any input on what this could mean to put my mind at ease while I wait for my hematology appointment.https:\/\/imgur.com\/a\/63OzoXP",
  "input": "",
  "output": "Your physician did the exact correct thing to refer you to hematology. The low platelets and white blood cells could be from many things. I agree that anemia is most certainly from iron deficiency. Given your ethnicity, low WBCs can sometimes be familial and we do see this more in the Black and Hispanic population. I am unsure why your platelets are low and this needs to be worked up. Leukemia is not hereditary. Hemophilia is hereditary and sometimes acquired but usually the former. Please let hematology know about this family history. You may also want to ask your mother if there is any history of sickle cell in her family given race.There is testing that can be done for folate and b12 deficiency but these levels (even when low) rarely affect WBC or platelet count. Based on your labs, there isn't anything that screams something ominous like cancer. Maybe autoimmune if anything as we see chronic non-life threatening low cell counts in these patients often"
},
{
  "instruction": "32F, Fatigue, Migraines, Mild Bradycardia, Mild Anemia,Hi Reddit,My girlfriend has chronic fatigue, migraines, weakness, dizziness, and occasional stomach pains which cause her to be unable to work or leave the home somewhere around 1 in 4 days. She has been to several doctors who all use a very compartmentalized approach that simply finds nothing. Getting her to go to more doctors is a challenge, partly because of the fatigue but also because it seems to go nowhere (and I can't blame her). Here's the medical history as we've found it so far:Basic InfoWhite female32 years oldBorn Russia living in United States5'2\", 95 lbs.No tobacco, vape user, moderate drinkerLittle useful family historySymptomsMigraines and other headaches, 1-2x\/wk, varying in response to NSAIDs and triptans (sometimes helps, sometimes doesn't)Often feels dizzy or says room goes black when she \"stands up too fast\"Can also black out under substantial stressCold hands\/feet that she sometimes complains are numbLast year had several instances of extremely severe stomach pain, once resulting in hospitalization (has no reoccurred this year), no cause foundFatigue 3-5x\/month severe enough to not leave home even without complaints of headacheDepression, PTSD-like symptoms from childhood traumaRecently measured heart rate of 57 bpm in eveningDiagnostics AttemptedHead and abdomen CT & MRI, negativeColonoscopy, Dx: gastritis, recommended treat with PPI and dietBloodwork, positive results: mild anemia (says all bloodwork since childhood was same), mild vitamin D defBloodwork, negative results: CBC and other basic hematology, thyroid issues, Lyme diseaseRx \/ TreatmentNexplanon implant (~2 years)J&J corona vax, 3\/2020, no boost (previous infection: Delta)Bupropion + psychotherapy for depressionVitamin DIbuprofen and\/or triptans for migrainesAdd'l InfoOften has trouble sleeping at night, ends up sleeping in morning until early afternoonDiet could be better (eats at random times, often not the healthiest foods)Does not exercise (dislikes running, weight lifting, outdoor activities in sun\/heat)Stress seems to trigger episodes but can happen even without stress triggerAnyone have any idea what to try next for diagnostics? The reading of 57 bpm is a newer symptom and was contemporaneous with the cold\/numb extremities, so perhaps some kind of cardiology workup? Having a partner that is constantly sick with no idea what's going on is stressing us and our relationship, but more importantly worries me that something significant may be being missed.",
  "input": "",
  "output": "HR of 57 is normal.I know you said doctors have used a very compartmentalised approach, but I would actually use the term thorough.Incredibly so. While I appreciate how frustrating it can be for all of these things to come back negative, it is reassuring that theres no gross medical abnormality.The tests she has had are all incredibly sensitive and have even been repeated in different modalities, so the chance something has been missed is slim to none.I strongly suspect that what youre seeing is the effects of a functional disorder. With a functional disorder, there is no physical pathology resulting in symptoms. Rather, the symptoms are a manifestation of psychological trauma and\/or psychiatric issues; two things that we know your partner unfortunately has.It is important to note that these symptoms are incredible real for the individual, even in the absence of physical pathology. This is not faking in any way.Your partners history is highly typical of this: general, multi-system symptoms with normal investigations.The management of these conditions is challenging. When theres a physical pathology, we can target it. When there isnt, theres nothing physical for us to target.That leaves us with the non-physical targets, which in this case is psychology\/psychiatry. The most effective treatment for functional disorders with a known mental health history is treatment of said mental health history through a combination of medical and talking therapies."
},
{
  "instruction": "Psoriatic Arthritis and Taking Methotrexate: Blood Work Comments[31][F], 5'2\" 90 lbs, white and Hispanic, biologic taken, no longer taking Methotrexate with psoriatic arthritis. No drinking or smoking.My rheumatologist is taking me off Methotrexate due to my blood work, in conjunction with me feeling absolutely awful.Can a doctor please explain why those comments on the two blood results were written? Is it that serious? Meaning--my doctor wants me to take a repeat. What is concerning?I attached the photos w\/ Imgur:https:\/\/imgur.com\/a\/FDmJ7A0\"RBC01 3.49 Low 3.62 07\/23\/2021 x10E6\/uL 3.77-5.28 Macrocytes present. Anisocytosis present.\"\" Neutrophils (Absolute) 01 1.0 Low \"\" Alkaline Phosphatase01 128 High 76* 07\/23\/2021 IU\/L 44-121 AST (SGOT) 01 70 High 29 07\/23\/2021 IU\/L 0-4 \": Hematology Comments: Verified by microscopic examination\"",
  "input": "",
  "output": "Youve got a macrocytic anemia, likely due to the methotrexate causing a folate deficiency basically the blood cells are bigger than normal and not developing properly.The anisocytosis just means you have a variety of different sized RBCs, meaning its likely that you are within 90 days of when the assumed folate deficiency started - blood cells live on average about 90 days so you either have a mild deficiency or its somewhat new.Neutrophils can be low for many reasons, its not at a super worrisome level but couple with the anemia its likely partially due to one of the multiple mechanisms of immune suppression from methotrexate.Alk phos\/ALT\/AST are liver function tests, its just saying theyre slightly elevated. Overall not super worrisome levels but again likely due to cytotoxic effects from methotrexate.Its more so they dont want you to GET bad rather than the labs ARE bad. They are borderline right now but when you have a known drug causing it, you want to stop it sooner than later. They are likely just recheckingnit to make sure they dont need to do further intervention to prevent worsening effects and ensure your body is recovering before they would try an alternative therapy or restart the current therapy if absolutely needed.Definitely a conversation to have with them for more details, not a rheumatologist so I dont know all the cytotoxic effects of methotrexate off the top of my head."
},
{
  "instruction": "Persistent elevated platelets35F, I have had platelet counts consistently ~500 for the past several months, on multiple repeat test. No other abnormalities on CBC. I have seen a hematologist and done several followup tests: no iron deficiency, no JAK2, CALR, MPL or BCR-ABL mutations. I had an abdominal ultrasound which showed normal spleen (incidentally found some gallstones). I take Wellbutrin 150mg and Lamotrigine 200mg. My last normal platelet count was in 2017, at 375.My question is like....do I need to pursue this further, and how? My hematologist wants to do a bone marrow biopsy but is unclear on what she expects it might find given my other results. My primary care doctor seems completely unconcerned (I checked back in after hematology and he just said \"I think that is all.\") I, of course, have done a thorough google and read all about the association with cancer, and given that no more benign cause has come up I've gotten pretty worried, but I don't know how much that's something I need to think about at my age\/without any other specific symptoms. Can you just have higher platelets for no reason, or is it something I need to keep looking into?",
  "input": "",
  "output": "Hematology could go either way - biopsy or no biopsy. Without symptoms, many would opt for no biopsy and monitor. Some would be more aggressive and do the biopsy because 10% of those with thrombocytosis secondary to a myeloproliferative disorder lack mutations. So theyd essentially be looking for an MPN. You could go either way and set a limit eg do a bone marrow if they keep rising or hit a certain number, you develop symptoms or other cell counts are abnormal."
},
{
  "instruction": "Thanks for this! My hematologist wants to do the biposy, but the only thing she's talking about finding at this point is essential thrombocytosis, and if I had that we would just be doing regular labs to monitor it since I'm young and low risk. I'm already doing labs frequently to monitor the unexplained result, so for my money I'd rather put it off unless something more suspicious does come up. Glad to hear that's not insane",
  "input": "",
  "output": "Just want to say that this advice shouldnt be substituted for your hematologists recommendations. Id discuss some of the suggestions mentioned and see if she is amenable to monitoring. She may have more information than I do about your situation as well eg low cell counts etc. that I am not privy to and this may change course of care."
},
{
  "instruction": "Recurring severe petechiae on 5f, multiple doctors confusedMy daughter 5F Caucasian. No significant medical history. She has had recurring petechiae on her elbows and occasionally knees for approximately 3 months. She is otherwise very healthy and full of energy. The petechiae occur mostly while she is at school, always on predominantly left elbow with occasional right elbow and knees. They do not occur every single school day, but most days with varying severity.She has visited multiple GPs and a pediatric hematology specialist; none of these have been able to find an explanation. She has had multiple complete blood counts, clotting factor tests, and other bloodwork taken. Platelets, red blood cells, white blood cells completely within good normal ranges. All other tests returned completely normal findings aside from marginally low ferritin and fibrinogen. The hematologist said neither of these were of concern to her.Some images of the petechiae on various days recently:https:\/\/imgur.com\/a\/OHKjDtlAny ideas would be very much appreciated.EDIT: Sorry, I forgot to include this information! They are non blanching and totally flat. Non itchy. They go away within about 24 to 48 hours, only for new ones to appear.The doctors have generally identified them as petechiae, but can't determine a cause.",
  "input": "",
  "output": "Sometimes skin biopsy can help with to diagnose conditions such as this.They looks raised and scaly. Can you run your finger over them with your eyes closed and feel them?Petechiae are generally considered to be less than 2 mm, and these are larger than that. I wouldn't describe it as petechial. Maybe purpura, but I can't tell if it's blanching.Does it itch?Pediatric psoriasis can look similar to this and occur on the extensor surfaces."
},
{
  "instruction": "Sorry, I forgot to include this information! They are non itchy and non blanching.",
  "input": "",
  "output": "Are they flat, or can you feel them.They're totally flat; not raised or bumpy."
},
{
  "instruction": "Iron\/vitamin D low even when supplementing?26F, 133lbs, 56 Non-smoker, no recreational or pharmaceutical drugs.I recently had my ferritin retested as Im supplementing to raise my levels. Around a year ago it was 44 (ug\/L) and now after taking supplements every other day its gone down to 26. My vitamin D (I take between 2000 to 4000 daily depending on the weather) is the exact same at 92 (nmol\/L).Additionally looking at my blood work results my TSH went from 2.62 mIU\/L to 1.29. My hematology\/differentials are also all on the lower side and my MCH was flagged by the lab.All this being said, my doctor assured me my bloodwork is fine (I dont feel fine hence the bloodwork). Hoping to gain some insight into what could be causing this please.",
  "input": "",
  "output": "Make sure you take Iron with OJ\/Vitamin C and Vitamin D with food."
},
{
  "instruction": "I do both these things!",
  "input": "",
  "output": "Hey there. Lots to unpack so I'm gonna do this in bullet points.You didn't post your hemoglobin. Your hemoglobin should be going up with iron supplementation. Ferritin too, but I guess as an interested third party I wonder what it is, and what it was.your differentials are allowed to be all over the place, it's just the population breakdown of your white blood cells. It's constantly in flux as cells die and are born. I suggest paying less attention to this.your TSH is still within normal. Secondly a low TSH generally means your thyroid is not needing any more stimulation. I suggest paying less attention to this.vitamin d can be supplemented more aggressively I suppose. It is near normal.MCH is a completely and totally irrelevant lab valueI'm not really sure what symptoms you're having. From where I sit this feels like we're treating numbers that are irrelevant. I'd humbly suggest you stop looking at the labs so closely as I don't think they're holding the answers you seek. I'm not saying that your symptoms are irrelevant, but I am saying that these tests hold no explanation for any symptomatology."
},
{
  "instruction": "Sorry about that - hemoglobin was 126 g\/L exactly a year ago, 124 g\/L now.Happy to expand on the rest. I deal with near constant fatigue and hormonal issues like hair loss, hirsutism, abdominal pain, and digestive issues.",
  "input": "",
  "output": "Awesome, thanks for posting. Unfortunately, your symptoms are not very specific for one thing. This means they can be explained by a lot of different conditions. That's what makes them so frustrating-- they're not obvious and that can sometimes get your team challenged. I think that's sometimes why young otherwise healthy women get told it's anxiety. I'm sorry in advance if that's happened. You mention hair loss, abdominal pain, and digestive issues. These together make me think about vitamin deficiencies and malabsorption syndromes. Hair loss alone can also be autoimmune in nature. You'd need to expand more on the GI issues for me to say something meaningful. I think all my recommendations are going to be low quality because I can't have a sit down session to discuss all your symptoms at length (eg what type of GI symptoms, any other autoimmune symptoms).Most vitamins are not on routine labs, and you need to test specific vitamin levels based on the disease you suspect is afoot (which is why we usually start with the history of the disease before we go to look at labs). Do you have any history of abnormal eating patterns, like eating disorders in your past (or present)? If so, that's where to start. If not, I think we might need to go down the route of testing for malabsorption. Fat in the stool (steatorrhea, you can google that, NSFW obvs) is usually a good clue for malabsorption to start with. There are some skin rashes that people get from certain malabsorptions as well, so it might be worth doing a skin check.As a random doc on a computer I'd probably send you to a GI doc to discuss your gi issues at length and evaluate for malabsorption. Even if we are sure that's the issue, though, there are still many conditions that can cause it. If it's not the issue (and again, sorry, these symptoms are not too specific so sometimes a lot of trial and error is involved) it may be worth discussing with a rheumatologist. Your primary doctor can also evaluate generally for rheumatic diseases.On the note of your primary doc, it sounds like you may not have a working relationship. I'm an advocate of switching docs until you find one who seems to be listening and has good open lines of communication with you.Iron itself is kinda a tricky one to get right. Bodies generally don't love iron (in fact we make a concerted effort to not absorb it). You could try taking your dose every 48 hours as one trick (when your body sees oral iron daily it gets more resistant to iron absorption). However, I don't know that is the answer for any of your issues, which is why I first suggested against looking at these labs too closely.Sorry to be long winded - internal medicine people usually are. As a first step, I'd go to a GI specialist to discuss these gi symptoms, stomach pain, and hair loss together as a possible malabsorption phenomenon."
},
{
  "instruction": "24F, feeling very sick after accidentally inhaling a lot of fumes from rotten potatoes. Could I have solanine poisoning?24F, 56, 111 pounds, Caucasian, never smoked, almost never drink, no recreational drugs, located in Charleston, SC. History of Ehlers-Danlos Syndrome type III along with a number of comorbidities, including cardiovascular and gastrointestinal issues. More details on medical history at end of post.There has been a smell coming from my pantry for the last several days that I havent been able to identify. Today, I opened the door and just got hit with this wall of fumes, and I decided enough was enough. I spent about half an hour tearing it apart and smelling every single thing in it. By the time I identified the potatoes and threw them out, I was feeling pretty terrible. My head kills, Im super nauseous, and Im having chest pains.I looked it up online and read that rotten potato fumes can be extremely toxic, but its hard to tell if Im feeling awful because of toxins or because the smell and activity triggered flares of my pre-existing conditions (see below). Its not uncommon for me to experience chest pains just from walking around the kitchen for a while, and I have a headache and nausea for the better part of most days as it is. It feels worse than normal, but not so much worse that it couldnt be a heightened version of the regular stuff.That being said, I have been experiencing some other unexplained symptoms over the last few weeks that I wonder might have been caused by inhaling the fumes before they were as noticeable. Ive been experiencing random spikes in temperature (99.6-100) that last for about 12-18 hours, go away, and then pop back up again a few days later. Ive also lost weight (from 122 to 111 in less than a month) with no changes in diet, and Ive had pretty bad diarrhea and abdominal pain too (mostly upper right, but it kinda moves around). Ive also had really bad dry eyes and dry mouth. (My rheumatologist has suspected Sjogrens for a while and ordered a lip biopsy recently, so thats happening soon.) I also have had a sore throat (kinda burns, probably related to dry mouth) and swollen glands.I have an unrelated diagnostic laparoscopy scheduled for next month, and theyre going to test me for covid before that. I dont think I have covid, and neither does my doctor. Mostly because the fever has been so off-and-on, and Ive had no cough at all. But Ill be tested in the next few weeks regardless.I just dont know how to tell whether the worsened symptoms Im experiencing should be worrying me or not. I sent a message to my doctor, but the office doesnt open for several hours, and she probably wont see my message until the end of the work day anyway (thats the time of day she usually sends me messages). If theres a chance Im experiencing poisoning, what steps should I take to manage it until I hear from my doctor?Health issues: EDS (type III), POTS, mitral valve prolapse, MCAS, pernicious anemia, gastroparesis, IBD, GERD, interstitial cystitis, idiopathic hypersomnolence, small fiber neuropathy, cervical instability, scoliosis, kyphosis, tortuous colon, vestibular adenitis (two past surgeries for this), and unexplained eosinophilia (pending hematology referral). Suspected esophageal dysmotility (doctor wanted to do a manometry, but I declined because it sounds awful, so this is unconfirmed). Suspected endometriosis (pending laparoscopy). Suspected Sjogrens (pending lip biopsy).Meds:Ditropan (10 mg\/day), Metoprolol (75 mg\/day), Nexium (80 mg\/day), Sunosi (150 mg\/day), B12 (1000 mg\/day), Nexplanon birth control implantI have had no recent changes in meds apart from my cardiologist upping my metoprolol from 50 to 75 mg\/day because Ive been dealing with shortness of breath, presyncope, and chest pains more often than normal lately due to inactivity (thanks, quarantine).Any advice would be greatly appreciated. Thank you!",
  "input": "",
  "output": "You didnt ingest these? Typically large amounts in children of old potatoes could cause GI symptoms and some central nervous system issues. I would be surprised if the smell alone caused your symptoms and I doubt its connection to your undulating fevers. I am doubtful your symptoms are directly caused by the cleaning and smell. Perhaps it was irritating and triggering nausea, but without ingestion youre unlikely to be poisoned from potatoes."
},
{
  "instruction": "NAD but I've worked in potato warehouses for many years, and also spent days shovelling out rotten potatoes in enclosed spaces.. I've never had an issue so I found it kind of weird to have these symptoms without ingestionWhen were you near the rotten potatoes? At the beginning you said it was in the last few days but later on it said the last few weeks.Temperatures above 98.6 and below 100.4 are considered mild fevers. Ive had one for a few months now. Your temperature is nothing to worry about unless it goes to 103 or above or if it lasts longer than a week.Symptoms of solanine poisoning are mainly gastrointestinal and neurological. Symptoms usually appear in 8-12 hours and go away in 24-72 hours. It is also only considered to be toxic if it is ingested through food or drink.",
  "input": "",
  "output": "Temperatures below 100.4 are normal and not considered mild fevers. You are not having a mild fever for months, youre having a normal body temperature.Anything above 100.4 is considered a fever"
},
{
  "instruction": "This is just a question but my normal temp is 97.6. Would 100.4 not be considered a fever? Or does that 100.4 go from possible normal temps and not the average body temp? Usually if my body is 3 degrees warmer than normal I don't feel well etc.",
  "input": "",
  "output": "Hi friend, no that wouldn't be considered a fever. The body has a much greater range of normal temperature in general than people who use the empiric system believe. \"98.6\" is actually the direct translation of 37 C into fahrenheit. In celsius, (which is how medicine measures temperatures, even in the USA), fever starts at 38 degrees. That directly translates to 100.4. (That's why a temp of 99 is not actually a fever.) Though it appears higher than the 98.6 we're used to hearing, it's actually well within normal limits.The usual frame I'm used to is 36.5-38 as sort of the guidelines. Your temperature of 97.6 translates to 36.4444. My guess for that is just that temperatures taken outside the body can be less accurate. That's not a concerningly low temp to me; basically you fit well within the normal standards and you would not qualify as having a fever until you reached 38 (or 100.4)"
},
{
  "instruction": "High Hematocrit with Low iron. Should I see hematology ASAP or continue further investigations?Hematocrit peaked at 47.5 this year. (Normal high range is 44)Currently Ferritin is 9. (Normal range 16-165)37f. Af Am. 59. 140lbs.Problems.Persistent headache. Severe abdominal pain. Raynauds without spasm - hands stay cold. Severe chest pain. Abnormal EKG (compared to previous) w\/t wave inversions. Intermittent claudication with 0.7 ABI post exercise. Paresthesias. Sudden high blood pressure since my hematocrit went out of range. Fatigue. Night sweats. Sudden high blood pressure when hematocrit went up to 46. 12 yrs ago, retinal detachment left and tears\/holes both eyes retina surgeon can be signs of microvascular\/hematology issues.Meds.Continuous BCP 12 years bc of heavy bleeding. Amlodopine off label for poor circulation in legs\/hands.Saw a hematologist and they declined to test for JAK2 mutation for polycythemia Vera because hematocrit wasnt that high and EPO was low normal 3.2.Unlikely sleep apnea. Live at 100ft above sea level. Dont smoke. Changed houses since hematocrit started climbing years ago, so carbon monoxide unlikely. Drink a gallon of water daily. 3 cardiologists say I do not have a heart or cardiopulmonary problem. Entire body has been imaged neck down for large vessel blockages. Neurologist did EMG and entire spine has been imaged for paresthesias. All normal.Should I continue the endless investigations? I have GI, rheumatology appts scheduled.See hematology ASAP?Take an iron supplement and see if I feel better?",
  "input": "",
  "output": "I dont think you need workup at all"
},
{
  "instruction": "Why is that? Does anything need to be done about my ferritin levels?Im at Stage 3 iron deficiency.https:\/\/maryannjacobsen.com\/wp-content\/uploads\/2021\/02\/Stages-of-iron-deficiency.png",
  "input": "",
  "output": "I mean you need iron but there's no workup needed for your blood count"
},
{
  "instruction": "My hematocrit is 10% over the expected high range for African American women. So the equivalent in a white male would be 55 range.https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4578165\/table\/T2\/?report=objectonlyAt what percentage over the norm for my gender and race does it need workup?Or is the white male range the standard that has to be used for everyone?",
  "input": "",
  "output": "What's your hemoglobin? That isn't an abnormal hematocrit"
},
{
  "instruction": "15+ also above the 97.5 percentile for my gender and race according to the US National Institutes of Health.https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4578165\/table\/T2\/?report=objectonlyIm asking. If doctors dont trust the national institutes of health guidelines, what is the guideline I should expect them to use for abnormal?Do I need to be in the white male range for abnormal?Do I need to take iron supplements to pop my red blood cell counts into the abnormal for a white male range?",
  "input": "",
  "output": "Just fyi there's no such thing as a NIH guideline. You're just quoting a table in a very low impact journal. Pubmed is the central database where most publications are stored. Usually when a publication only makes it to a low impact journal, that's because there are significant flaws in the study.Every lab that runs these tests have slightly different results and their own reference range.It's somewhat futile to go on a endless journey for mildly abnormal tests because unless there's major clinical consequences, chances are it's nothing. As you said yourself, you're above the 97.5% but that means 2.5% of the population has hemoglobins higher than that which is you.Anyway good luck"
},
{
  "instruction": "Is this some kind of blood cancer?25.Male.HIV undetectable. My HIV provider is very concerned regarding abnormalities found repeatedly on my labs since the start of the year. Previously, my CD4 Poz Lymph usually stayed in the 30s range. However this past year, that range has consistently been dropping. First 22; then 19, and 16... Since last summer, I have had a full workup related to abdominal pain, migraines and muscle weakness\/discomfort and current severe rectal pain. My provider has expressed her concern regarding this and has now referred me out for a hematology\/oncology consult. There is a history of blood disorders including blood related cancers on my dads side of the family. Can you give me any insight or advice on what I may be dealing with here? It would be greatly appreciated. Thank you.",
  "input": "",
  "output": "This is a murky situation because both resurgence of HIV as well as other infections could cause high lymphocytes. If HIV is still negative then Id worry more about another underlying viral infection. If lymphs remain high and keep going up then Id ask for hematology consult. Your ID doc might want to send off flow cytometry to rule out any ominous diagnoses in the meantime. I wouldnt be too concerned about percentage of CD4 cells. Just worry about absolute count which is fine. High lymphs is nothing concerning unless it keeps going up on repeat."
},
{
  "instruction": "How concerned should I be regarding leukemia, lymphoma or some other blood related cancer",
  "input": "",
  "output": "Id have absolutely no concern for these things with these labs"
},
{
  "instruction": "Just had new panel taken yesterday that just came back via Labcorp. Numbers are still wonky. Being referred to hematologist . Confused and terrified",
  "input": "",
  "output": "No reason to be terrified. Your lymphs might be high but they arent going up. Numbers are seemingly almost the exact same as last time within deviation. Heme will likely send flow cytometry off but your ID doc couldve done this to get the ball rolling. Still doesnt seem like anything ominous. Bad things come with really bad labs, multiple cell lines affected and usually metabolic abnormalities."
},
{
  "instruction": "Is this Lymphoma\/ some type of Blood cancer25.Male.HIV undetectable. My HIV provider is very concerned regarding abnormalities found repeatedly on my labs since the start of the year. Previously, my CD4 Poz Lymph usually stayed in the 30s range. However this past year, that range has consistently been dropping. First 22; then 19, and 16... Since last summer, I have had a full workup related to abdominal pain, migraines and muscle weakness\/discomfort and current severe rectal pain. My provider has expressed her concern regarding this and has now referred me out for a hematology\/oncology consult. There is a history of blood disorders including blood related cancers on my dads side of the family. Can you give me any insight or advice on what I may be dealing with here? It would be greatly appreciated. Thank you.",
  "input": "",
  "output": "See what the haematologists say but I wouldnt be particularly concerned if your CD4% is lower, because your absolute lymphocyte count is high. When your lymphocyte count comes down your CD4 % will increase. I dont know why your lymphocyte count is (a bit) higher than normal, but its not usually anything concerning.The most important thing is that you are continuously undetectable on HIV viral load."
},
{
  "instruction": "Help with CBC results?Im a 30y\/o white female, 52, 138lbs. I used to stay very active, workout consistently. I never drink or smoke, and the only meds Im on is Fluoxetine 60mg for clinical OCD diagnosed several years ago.For the past 8 months I have had severe fatigue, breathlessness, irritability, exercise intolerance, sleep disturbances, heart palpitations and it seems I am constantly ill from flus or colds.Bloodwork initially showed low ferritin so we assumed it was that and did iron infusions. My b12, folate and T4 and Vitamin D were all normal. My reticulocyte count was quite low previous to the infusions and after treatment, its still low. From what my doctor understands, the absolute reticulocyte count should have risen substantially (even elevated) in response to the iron infusions as it would help my bone marrow get stimulated to make more red blood cells.Why would this be? My doctor is sending me to Hematology Oncology because she doesnt like the blood work results either, but my appointment is 2 months out due to living in a remote region of the country (US). Can anyone help me decipher what all this means? (I will put link to pic of labs)",
  "input": "",
  "output": "What date did you get an iron infusion."
},
{
  "instruction": "I got the 2 dose formulation. Once on 9\/23 and again on 9\/28",
  "input": "",
  "output": "This seems like pretty acceptable\/normal lab variations then for such a short interval between lab testing and iron treatment."
},
{
  "instruction": "What are your thoughts as to the Retic count being low?",
  "input": "",
  "output": "I think it's likely appropriate given the timing. But, I'm not the specialist. I wouldn't stress"
},
{
  "instruction": "So sick Im afraid Ill die35F, white, 5'4\" was generally healthy except for Ehlers Danlos and trauma-related mental health (being addressed) Was bitten several times by a mouse (no rash) and a month later, soon after having an operation of tubal ligation and IUD replacement (to stop periods) began having sporadic fevers. Thought it was due to surgical wound, took antibiotics, sporadic fevers continued. My surgical wounds are healing very slowly as in 6-8 weeks. This was October. December, elevated temp ranging from 99-101 every day. Shortness of breath, but chest CT showed healthy lungs. Nausea and weight loss but abdominal CT showed no problems. Persistent need to cough and clear throat and difficulty doing so, having to cough for a minute to clear it enough to talk.No one knows whats wrong. I now feel like Im dying. I dont say that to be cute, I feel like I need someone to watch me and Im scared. I have a hematology appt but its at the end of March and who knows if they can help me either.POSITIVE TESTS: mycoplasma hominis, ureaplasma urealyticum, SED rate 44 mm\/hr and D-DIMER abnormal at 321 ng\/mLIm taking doxycycline and am 2 days in and feel nothing.Negative tests done: CT scan of chest with contrast, ie no blood clots, Covid, CBC with platelet, mono, blood cx aer & an, urinalysis, panel hepatic function, lipase, cbc w pits\/auto diff, chemistry labs, protein total serum, serum electrophoresis, TB test, ck total, rheumatoid factor, hiv, lactate, hs C-reactive protein, and sed rate ESR. All mostly within range.Help.EDIT some have said to add my meds, Im on a lot dont judge lolLexapro, Wellbutrin, Vraylar, Nuvigil, Provigil, Xywav, Glyco-whatever (the sweating pill), prazosin for nightmares, topamax, vit D, levothyroxine (thyroid just checked and normal), fiber, linzess, and I receive ketamine\/lidocaine infusions but those started post-fevers",
  "input": "",
  "output": "Need clarification, the organisms that you listed, were they wound cultures, blood culture, sputum cultures?If wound cultures, were they superficial, deep, or tissue (in that they took a chunk of tissue to culture)D-dimer and ESR will both be elevated in infectious processes, although it would be odd for CRP to be normal"
},
{
  "instruction": "They were all blood tests! No wound cultures or sputum cultures",
  "input": "",
  "output": "Blood cultures? I'm still unsure how they got these organisms"
},
{
  "instruction": "Oooo are you talking about the mycoplasma hominis? That was a vaginal swab (embarrassing)",
  "input": "",
  "output": "Same with ureaplasma?Ok just wanted to check this wasn't in the blood or something, but given location this is not a big deal and likely normal Flora.Sorry unfortunately I don't have much to offer, but at least you can be assured these organisms are likely not related to what's going on.A lot of things don't really add up in your post. You say you're \"generally healthy\" but you're on over 13 medications. What's the Topamax for? Migraines or seizures? How about the cariprazine? Were any of these medications started recently? Glycopyrrolate that I am assuming you're taking as well as Topamax can cause elevated body temperatures and the combination of the both of them might be the cause of your symptoms."
},
{
  "instruction": "Topimax for weight loss, Vraylar+Lexapro+Wellbutrin for depression\/anxiety\/ptsd. When I said I was healthy I meant physically healthy? Guess I shouldve said fat. I do have narcolepsy, I forgot to say that but I view it as so separate. But ty for the info about the glyco and topamax! Ill bring that up with my doc and see if maybe that has to do with it. No new meds, latest one was Xywav in the summer.",
  "input": "",
  "output": "While Topiramate does induce weight loss it's not usually my first choice. In addition, it's usually contraindicated in people with mental health disorders and is known to increase the risk of suicide. It also causes drowsiness and you already have narcolepsy. Given the interraction with the glycopyrrolate as well I'd discuss with your physician about transitioning to another agent such as a GLP1 agonist if the goal is really just weight loss."
},
{
  "instruction": "Platelets count of 2000, but sent home?I was in the emergency room for bruising and petechiae. They checked my blood and everything came back within normal range except my platelets which came back at 2. They said I need to see an expert so they sent me home and told me to follow up with hematology tomorrow. They gave me 40 mg of dexamethasone. When I was there they made it seem like no big deal, but now when Im researching it Im a bit concerned. Other stories say people were immediately hospitalized for levels of 5-10 and efforts were made to quickly increase their levels. Now I cant sleep because Im so worried and cant find any real answers. Should I be concerned that they sent me home? Is 2 a level that will cause me to die in my sleep or something?25 female 53 150 lbs Regularly Prescribed 150 mg lamictal and 50 mg Vyvanse Dont smoke or use any recreational drugs Only other health problem is possible PCOS (based on polycystic appearing ovaries and low SHBG) I also currently have a cold if thats relevant? COVID test negative.",
  "input": "",
  "output": "uhh... yeah not sure why they would've sent you home. Was it a community hospital? Is there a university hospital nearby?"
},
{
  "instruction": "Yes, a community hospital. How would I go about transferring to a university hospital? Just call them and tell them whats going on?",
  "input": "",
  "output": "Or just go to another ED? Your platelet is 2,000 right?"
},
{
  "instruction": "Yeah its 2 and the rage is 140-150 so Im pretty sure that translates to 2,000. Will a different ER do anything different? Even if its the same hospital network?I have an appointment with the hematologist around noon. Theyre being pretty casual about this. Should I push to be kept? Or to have them intervene some how like a transfusion?",
  "input": "",
  "output": "Just meet with them at noon"
},
{
  "instruction": "Hypoferritinemia?Im 23 F. 53 and 125 pounds.I have severe gastroparesis (gj tube because of it), IBS, endometriosis, and now hypoferritinemia without anemia as well.I got a letter in the mail from my doctor saying hematology thinks I have hypoferritinemia without anemia due to a combination of malabsorption and losing a lot of blood from endometriosis issues. Im constantly dizzy and my joint pain baseline is never below a 7 anymore. They said it could possibly be because of this, but they arent sure.Other than a letter that said my ferritin levels were 4 & I also had low folate levels, so I was to schedule an iron infusion appointment a few weeks out, I havent heard anything else.My biggest questions are is this something that would likely be chronic, or fixed with a single iron infusion? & is there anything I can do to help correct this?",
  "input": "",
  "output": "If you have a GJ and bowel problems you'll probably have ongoing absorption problems anyway.Have you considered trying to stop the periods with contraception so you're not losing more blood at least? You should avoid the pill if absorption is an issue but depot, implant and coils would be good options."
},
{
  "instruction": "Ive used the pill for 12 years to try and limit periods, but Ive always bled through it anyway. My gyn is hesitant about using any other hormonal birth control because of how rapidly the endometriosis grows back after being removed. They didnt want to use any IUDs because of level of cramping I already get. They said at this point my options are to either keep taking the pill and hope it helps or get pregnant and hope that helps.Ive been on over 20 medications for a year to try and help my symptoms, but I see no improvement from any of them whatsoever except sometimes the dissolving zofran helps my nausea. I dont know if this is another sign of an absorption issue.",
  "input": "",
  "output": "I'm surprised they are happy with the pill given your presumed absorption problems. A method that prevents ovulation eg the depot would be ideal and will make endometriosis better."
},
{
  "instruction": "2.5 year olds bloodwork. Concerned.My 2.5 year old daughter has been refusing food, tired and constipsted. I get picky eating is a thing but this is beyond picky. Shes losing weight. Her doctor didnt seem concerned but there are levels on her chart that are totally abnormal and Im at a loss as to what I can do.WBC Learn more about this 5.96 103\/uL WBC Date: May 21, 2021 08:49 a.m. PDT Reference Range:4.80 103\/uL - 13.50 103\/uLRBC Learn more about this 5.07 106\/uL RBC Date: May 21, 2021 08:49 a.m. PDT Reference Range:3.70 106\/uL - 5.40 106\/uLHemoglobin Learn more about this 13.7 g\/dL Hemoglobin Date: May 21, 2021 08:49 a.m. PDT Reference Range:10.5 g\/dL - 16.0 g\/dLHematocrit Learn more about this 40.0 % Hematocrit Date: May 21, 2021 08:49 a.m. PDT Reference Range:29.0 % - 48.0 %MCV Learn more about this 78.9 fL MCV Date: May 21, 2021 08:49 a.m. PDT Reference Range:74.0 fL - 99.0 fLMCH Learn more about this 27.0 pg MCH Date: May 21, 2021 08:49 a.m. PDT Reference Range:25.0 pg - 32.2 pgMCHC Learn more about this 34.3 g\/dL MCHC Date: May 21, 2021 08:49 a.m. PDT Reference Range:31.0 g\/dL - 37.0 g\/dLRDW Learn more about this 12.3 % RDW Date: May 21, 2021 08:49 a.m. PDT Reference Range:11.6 % - 14.4 %Platelets Learn more about this 370 103\/uL Platelets Date: May 21, 2021 08:49 a.m. PDT Reference Range:150 103\/uL - 450 103\/uLMPV Learn more about this 8.4 fL MPV Date: May 21, 2021 08:49 a.m. PDT Reference Range:7.3 fL - 12.4 fLNeutrophil % Auto Learn more about this 33.8 % Neutrophil % Auto Date: May 21, 2021 08:49 a.m. PDT Reference Range:33.6 % - 77.5 %Lymphocyte % Auto Learn more about this 57.7 % Lymphocyte % Auto Date: May 21, 2021 08:49 a.m. PDT Reference Range:10.0 % - 59.0 %Monocyte % Auto Learn more about this 7.6 % Monocyte % Auto Date: May 21, 2021 08:49 a.m. PDT Reference Range:4.0 % - 12.5 %Eosinophil % Auto Learn more about this 0.70 % (Low) Eosinophil % Auto Date: May 21, 2021 08:49 a.m. PDT Reference Range:1.00 % - 4.00 %Basophil % Auto Learn more about this 0.2 % Basophil % Auto Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.0 % - 1.0 %Imm. Granulocyte % Learn more about this 0.0 % Imm. Granulocyte % Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.0 % - 0.4 %Neutro Absolute Learn more about this 2.02 103\/uL Neutro Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:1.50 103\/uL - 8.60 103\/uLLymph Absolute Learn more about this 3.44 103\/uL Lymph Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:1.00 103\/uL - 7.30 103\/uLMono Absolute Learn more about this 0.45 103\/uL Mono Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.00 103\/uL - 1.20 103\/uLEos Absolute Learn more about this 0.04 103\/uL Eos Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.00 103\/uL - 0.50 103\/uLBaso Absolute Learn more about this < 0.04 103\/uL Baso Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.00 103\/uL - 2.80 103\/uLRetic Count.LC Learn more about this 1.3 % Retic Count.LC Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.6-2.6Imm. Granulocyte Absolute Learn more about this < 0.04 103\/uL Imm. Granulocyte Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.00 103\/uL - 0.10 103\/uLMiscellaneous Hematology Sed Rate Learn more about this 16 Sed Rate Date: May 21, 2021 08:49 a.m. PDT Reference Range:0 - 20 Routine ChemistrySodium Learn more about this 137 mmol\/L Sodium Date: May 21, 2021 08:49 a.m. PDT Reference Range:137 mmol\/L - 145 mmol\/LPotassium Lvl Learn more about this 4.2 mmol\/L Potassium Lvl Date: May 21, 2021 08:49 a.m. PDT Reference Range:3.5 mmol\/L - 5.1 mmol\/LChloride Learn more about this 102 mmol\/L Chloride Date: May 21, 2021 08:49 a.m. PDT Reference Range:98 mmol\/L - 107 mmol\/LCO2 Learn more about this 21 mmol\/L (Low) CO2 Date: May 21, 2021 08:49 a.m. PDT Reference Range:22 mmol\/L - 30 mmol\/LAGAP Learn more about this 14 mmol\/L AGAP Date: May 21, 2021 08:49 a.m. PDT Reference Range:7 mmol\/L - 16 mmol\/LBUN Learn more about this 16 mg\/dL BUN Date: May 21, 2021 08:49 a.m. PDT Reference Range:7 mg\/dL - 17 mg\/dLCreatinine Level Learn more about this 0.30 mg\/dL Creatinine Level Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.20 mg\/dL - 0.70 mg\/dLBUN\/Creat Ratio Learn more about this 53.3 ratio (High) BUN\/Creat Ratio Date: May 21, 2021 08:49 a.m. PDT Reference Range:6.0 ratio - 20.0 ratioGlucose Lvl Learn more about this 88 mg\/dL Glucose Lvl Date: May 21, 2021 08:49 a.m. PDT Reference Range:74 mg\/dL - 106 mg\/dLCalcium Learn more about this 10.4 mg\/dL (High) Calcium Date: May 21, 2021 08:49 a.m. PDT Reference Range:8.4 mg\/dL - 10.2 mg\/dLProtein Total Learn more about this 7.7 g\/dL Protein Total Date: May 21, 2021 08:49 a.m. PDT Reference Range:6.3 g\/dL - 8.2 g\/dLAlbumin Learn more about this 4.8 g\/dL Albumin Date: May 21, 2021 08:49 a.m. PDT Reference Range:3.5 g\/dL - 5.0 g\/dLA\/G Ratio Learn more about this 1.7 ratio A\/G Ratio Date: May 21, 2021 08:49 a.m. PDT Reference Range:1.0 ratio - 2.2 ratioBilirubin Total Learn more about this 0.30 mg\/dL Bilirubin Total Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.20 mg\/dL - 1.30 mg\/dLBilirubin Direct Learn more about this 0.0 mg\/dL Bilirubin Direct Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.0 mg\/dL - 0.3 mg\/dLAmylase Lvl Learn more about this 68 U\/L Amylase Lvl Date: May 21, 2021 08:49 a.m. PDT Reference Range:30 U\/L - 110 U\/LLipase Lvl Learn more about this 55 U\/L Lipase Lvl Date: May 21, 2021 08:49 a.m. PDT Reference Range:23 U\/L - 300 U\/LAlk Phos Learn more about this 215 U\/L (High) Alk Phos Date: May 21, 2021 08:49 a.m. PDT Reference Range:38 U\/L - 126 U\/LALT Learn more about this 19 U\/L ALT Date: May 21, 2021 08:49 a.m. PDT Reference Range:0 U\/L - 34 U\/LAST Learn more about this 57 U\/L (High) AST Date: May 21, 2021 08:49 a.m. PDT Reference Range:14 U\/L - 36 U\/LCRP Learn more about this < 0.5 mg\/dL CRP Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.0 mg\/dL - 0.9 mg\/dLGlobulin Learn more about this 2.9 g\/dL Globulin Date: May 21, 2021 08:49 a.m. PDT Reference Range:2.2 g\/dL - 3.7 g\/dLImmunology\/Serology Mono Screen Learn more about this Negative Mono Screen Date: May 21, 2021 08:49 a.m. PDT Reference Range:Negative",
  "input": "",
  "output": "All these results look very normal, with the exception of a mildly elevated AST and Alk phos (most likely from a virus). Nothing here gives much of an idea what may be going on.Children can also have elevated Alk Phos from simply growing, so absolutely no worries there. Agree about the AST potentially being viral in origin. At my place we'd recheck that (by itself) in a few months but not worry about it in the meantime."
},
{
  "instruction": "Husband with osteonecrosis and little game plan besides narcotics- is he being managed appropriately?Just a HUGE thanks in advance to anybody who responds. I'm a talker and I'm livid right now, so I'm trying to keep this just to necessities but may fail and leave out key details and\/or talk about things that aren't necessary. To preface- I come from a \"medical family\" but it's primarily neuro and psych rather than ortho. I devour medical literature, podcasts, etc, have worked as nursing staff in psych and derm, just got my master's in health sciences, and am planning to apply to med school this cycle- so basically, please feel free to talk to me in technical terms, link to articles, etc as appropriate.Now onto the issue.Husband is 28M, 5'8.5\", 225lbs, white, occasionally smokes cigars (maybe a cigar or two a year?), and drinks moderately (down from heavy drinking a few years ago as part of work culture). About 5 weeks ago was diagnosed with osteonecrosis in both femoral heads. Started having pain just in his right hip in May, but really started to notice in June as it was limiting mobility. Got to the point in July where he couldn't go up and down the stairs- I was gone and he was texting me he had to army crawl back up the stairs to bed. Initially, he got an x-ray which had some \"fringe\" or something to that effect (I wasn't in the appointment so I don't really know what was said about it) but was concerning for possible osteonecrosis and MRI was recommended. While waiting, he went to PT, and the PT thought perhaps bursitis if not ON, but the pain kept worsening. Got an MRI at the end of August which showed osteonecrosis in both hips involving over 50% of both femoral heads. Right side had marked edema extending into the femoral neck and noted a \"mild asphericity of the head consistent with mild depression,\" subchondral fluid cleft, and diffusive mildly thinned cartilage. Left side had edema as well extending into the neck.Husband was referred to ortho, which in itself was a headache as PCP had to send that referral FOUR times. As we're waiting, his pain is getting worse to the point where he was using a cane and then progressed to needing a full set of crutches. If you could see his gait- it's just awful and was placing stress on other joints and was leading to back pain too. PCP started him on Celebrex 1000mg QAM for two weeks and then 500mg QAM after as well as gabapentin (titrated up to 900mg QHS). Got several labs drawn to check for a cause- including autoimmune labs- and the only abnormality was low vitamin D (15 ng\/mL), so he was also started on OTC D3 5000IU daily and a prescription weekly dose of D2 (I can't remember the dosing). . The Celebrex seemed to help him the most, but after about a week on that, it was still only \"barely\" helping. As time went on waiting for ortho, the way he described the pain and sensation also changed, with more \"grinding\" pain.In what I've been able to read, it seems there are treatments that can help the pain (narcotics, staying off the joint, fluid aspiration for edema) and may treat earlier stages of disease (eg, core decompression, treating underlying cause to get blood flow back to the bone), but once the femoral head collapses, hip replacement becomes standard of care.When we were finally able to meet with ortho, the doc, while personable and nice, didn't really give us a lot of info. He didn't stage the disease at time of MRI, but kept saying \"mild.\" This annoys me because with the amount of pain he is in and asphericity of the femoral head, I wouldn't classify anything he's experiencing as \"mild\" myself, and surely not \"caught early\/in early disease stage.\" We tried to impress the pain aspect and how limited his mobility is because of the pain. Doc kept hinting at \"something stronger\" to manage the pain and said we could schedule for aspiration for the edema. Also mentioned that he needed to stay off the joint as much as possible and should be using the crutches for any walking. Husband is terrified of needles (aspiration is done fully conscious and may need to be done every week or two to control pain from the edema), and with a history of SUDs in his family, being on narcotics for longer than a few days is also terrifying and he prefers not to. We asked about hip replacement, and he seemed not to want to do it, citing Husband's age. ORtho requested workup for potential coagulation disorder because we could \"save the hips\" if this was caused by a treatable clotting disorder, and he referred to hematology. No further discussion about replacement or why he didn't want to pursue it- just the age and potential for a clotting disorder.Neither one of us was thrilled with this. I wasn't convinced that restoring blood flow would magically re-shape his femoral head, especially with how he is now describing grinding pain. His half sister also does have a clotting disorder, but it's Factor V deficiency, so it's that she doesn't clot appropriately. But fine. Took them a week to get the referral to hematology, and a few days later, we have to call hematology and essentially was told he is a \"low priority\" patient and they wouldn't see him (they were rude, but I do get it because oncology patients need to take priority). Ortho refused to order the tests because \"we don't really order tests\" and said they'd send it to PCP. No follow-up scheduled with ortho until after the coag tests. This was about two weeks ago.About 10 days ago, his pain advanced so much that he finally did call in to the ortho clinic to as he was unable to sleep he was in so much pain. I picked up a script for 5mg oxycodone for him, and he's been taking this before bed reliably since and sometimes needs it during the day due to the pain. He hates it, and it barely touches the pain anyway. He called again last week because he is still in so much pain and essentially demanded to see the surgeon himself so we can get real answers about how we are not just going to \"manage\" the pain but resolve it. Thankfully, we see the surgeon tomorrow.Anyway, so today, we were able to meet with his PCP via telemedicine (he couldn't get to the actual hospital due to his limited mobility right now and still make it to the ortho appointment tomorrow). His PCP essentially said they a) weren't going to order any of the coag tests ortho wanted (they didn't have any notes from ortho and \"it isn't standard of care\") and if they wanted coag tests, they'd have to order themselves, and b) my husband \"needs\" to be more active, going to PT, walking, swimming if he can't put weight on it (note: the only pools here this time of year are at expensive gyms we cannot afford to go to), etc. My husband literally cannot do that. If he goes up and down the stairs more than once in a day, he's knocked on his ass in pain for the next 24 hours. He tried to impress this upon her, but she just kept saying how he needs to move it to avoid muscle atrophy, and if he can't, then the pain isn't managed appropriately. I don't disagree about his pain- it's not managed well at all- but her solution was to increase the gabapentin which tbh I don't think is helping him at all anyway. The bit about moving the joint more though directly goes against everything I've read about the disease, what the ortho told us, and what he experiences- he can manage his pain by being totally 100% sedentary, but that's not a lifestyle he wants (nor what is good long-term).So, wonderful docs of reddit, is he being managed appropriately so far? Is there something more I can do to ensure he has good care? I don't go into telemed visits with him since he takes him on headphones, but I do have to go with him when he goes in to the clinic since he cannot get around with me. I asked my older sis to send me some of the info on UpToDate so I can read more about what is actual standard of care. I cannot for the life of me feel good about it, and I feel like nobody is listening to him and his pain and what HE wants (solution, not management). Our world has radically shifted very rapidly, as he cannot do much at all or engage in hobbies or household chores or even the fun parts of a relationship most of the time. We are seeing a therapist to help manage it, even, but all the medical teams seem to be doing is throwing narcotics and giving him mixed messages and refusing to actually give us real insight into the disease process or why they don't want to resolve it. And yeah, I'm really mad about it all.Thanks again to anybody that can give me any insight into this.",
  "input": "",
  "output": "Osteonecrosis \/ avascular necrosis of the hip, it can be bad. I kinda agree with the ortho - be as reluctant as possible with a hip prosthesis. I don't like the term \"hip replacement\", cause it makes it sound like you change the hip with an equivalent. It's not. A metal prosthesis has a limited life span - 10 - 20 years. Given enough time, the prosthesis will eventually fail. He's young, so he'll be doomed to have a failure while still in prime age. Then he'll have a bigger problem, since replacing a replacement is a much bigger surgery, sometimes it may not be possible at all, and there's a chance he'll have to remove a hip joint altogether while still only 40-some years old.There's a chance his osteonecrosis may dwindle, without completely destroying the femoral head. Sometimes it just leaves a small irregularity in the top joint surface, and it can be usable. I often see that the \"acute\" inflammation like necrosis dies out. It would be wise to wait and see how things progress. Hopefully, he can have pain relief with medications temporarily.So, I think the treatment right now seems wise. You want the problem to be solved right now with a hip replacement, but the ortho know that will bite you back in a few decades. When he says it's mild, he's probably referring to how it looks on xray, and mild there is a good thing."
},
{
  "instruction": "hanks for the reply. We know he would need another replacement in his life time (or multiple replacements of the hardware) if he were to have it replaced now, although the rate of failure of that THA is what is unknown to me and what nobody seems to have discussed with us. My best friends mother had bilateral THA in her teens and is in her 50s now with an additional 3 replacements, and is still healthy, so I may have some rose colored glasses with the n=1 sample size there. I think I will look up the data about revisions.I worry so much because I see his QOL just deteriorating in front of me. He doesnt want to die, but I know he doesnt want to live like this. Not just the pain but being unable to do what he finds meaningful. Pain management is great when theres a positive end in sight, but if its going to be a long-term that has a very high likelihood of ending in THA anyway, I cant imagine he would want to live like that. The trajectory hasnt been good so far, and Im somebody that needs hard data and numbers to reconcile any differences between patterns I see and what I am told might happen. As a radiologist, you may not have an answer, but how often do you see patients actually improving without hip prosthesis once their MRI looks like my husbands (or, can be described like my husbands)? Do you get to know who is symptomatic and how symptomatic? Previously I was trying to find studies or case studies and just couldnt find anything promising myself, and I was also focused on the quality of his pain, since there seems to be a different type of pain now.Along the same vein, how often is common to repeat images while waiting? How quickly have you seen deterioration? Its only been 5 weeks since the MRI and just shy of 3 months since the X-ray, but I am worried about how its progressing and wondering if it may not be as early or mild now as it was then.",
  "input": "",
  "output": "how often do you see patients actually improving without hip prosthesis once their MRI looks like my husbands (or, can be described like my husbands)Don't have an exact number, but it's not uncommon to improve, and I'm often amazed of how well some seemingly terrible looking hips can end up, given time. Conditions with bone marrow edema are generally painful. I believe bone marrow edema in itself is causing much of the pain. The edema will usually \/ eventually resolve in time. A few months at least. Sometimes more than half a year. When \/ if the edema is gone, remaining pain will often depend on how damaged the joint surfaces are, and degree of osteoarthritis. From the description you quoted, it's not too damaged now. \"Mild depression of the joint surface, mild cartilage thinning\", I have an image in my head how that looks, and it's not too bad. As long as the joint surface isn't completely destroyed - and it isn't on those exams he's taken - there is a chance yet he could avoid THA.There is a chance it may develop into further joint destruction, but can only wait and see for that. Follow-up MRI 3-6 months after the first, maybe, depends on the clinical situation. Regular xray is often enough to assess damage to the joint surface.Also - while I'm not really questioning the diagnosis he's given, there are different conditions that causes bone marrow edema in the femoral head. \"Transient migratory osteoporosis\" is self limiting, and possible to mix up with osteonecrosis."
},
{
  "instruction": "Help with hematology analysisIm a male 39 years old, 78 kg, 173 cm. I use CBD for anxiety daily, no other medication. My MCV seems to be a bit high in the analysis.MCV 98.1 Hemoglobin 9.3 mmol\/l Erithrocytes 4.8 \/ pl Hematocrit 0.47 l\/l Thrombocytes 214 NL Leukocytes 6.4 NLAll other parameters, including thyroid TSA and liver ALAT are good, also glucoses, glycosilated hg, cholesterol and triglycerides are good. I drink almost daily, but no more that a couple of beers, smoke socially, and dont do other drugs. Red meat consumption is very low but Im not vegetarian. My diet is (I think) good, but probably too much bread. Should I worry about the MCV? What does it mean? What could be the consequences?Edit: I should also say that I do boxing 2\/3 times a week, and bike 10km 5 days a week.",
  "input": "",
  "output": "The most likely cause is your alcohol use. Alcohol is a well known cause of macrocytosis.Other possible etiologies include B12 deficiency (worth checking a B12 level but unlikely in your case), hemolytic anemia (very unlikely in your case as your hemoglobin is normal), liver disease, certain bone marrow disorders such as genetic conditions or MDS (those are very unlikely in your case).The macrocytosis itself is not concerning but it does mean that you have significant alcohol use. I would try to cut down.It's helps determine the cause of your anemia (low hemoglobin). You shouldn't worry, but you should follow up with your doctor to go through the next steps to work up your anemia with a high MCV. This is a common thing that has a pretty well trod diagnostic pathway that you and your doctor can work through"
},
{
  "instruction": "Diagnosed with Chronic Myeloid Leukemia in November, fired from oncology office, 2 months without chemon September went to the ER for feeling under the weather and some blood work came back abnormal and I was referred to a hematology oncologist a month later. Went in and did the biopsy and everything. The doctor said that she calculated the risk from all the numbers and I'm in the intermediate risk stage but hopefully with the oral chemo for life, I should be able to keep it from turning into AML or the least, extend the quality of life.Come to find out that the doctor I was rushed in to see was actually a traveling doctor and she'd be leaving at the end of November. I then was forced to see a male doctor in the practice instead of the other female due to scheduling conflicts and bad weather. I felt very uncomfortable with the doctors bedside manner, the way he implied that I somehow forced a surgeon to take my thyroid out instead of trying medications first, didn't let me talk and explain that I was experiencing bad side effects from the chemo and also experiencing pain. This all happened and came to a head in March.He basically said that I was seeking drugs and that he wouldn't make any changes to my treatment (which was Bosulif 400mg\/once a day). I was given a prescription and 5 refills. I then tried to speak to the director about being switched back to the female doctor and she said that the male Dr wouldn't sign off on that and if I was unhappy with the decision I can seek treatment elsewhere.I got my last refill in February and so have been off chemo since Feb 22nd. I tried to get into another oncology office but after the previous cancer center sent over my records, I've been told 4 times now that they have the referral and will contact me by end of day or the next day, for the last 3ish weeks.I can feel the pain in my thighs, hip\/pelvic bone is growing and starting to get to effecting my daily routine.Does anyone have any advice on what I can do from here?Edit in case it's relevant: I also have Addisons and Graves Disease (well I had my thyroid taken out last June), Idiopathic Intracranial Hypertension, Thyroid Eye Disease, Ulcers, Gastritis, and gastroperisis.",
  "input": "",
  "output": "So what you have been taking is a -tinib drug which inhibits\/blocks a growth hormone receptor (called tyrosine kinase). It really isn't classified as chemotherapy. That said, I would see a primary care doctor for now, to have the prescription renewed, while you wait to establish with a new oncologist."
},
{
  "instruction": "Ah, okay, was oddly explained to me in the beginning.But, I have gone to my primary care and they basically said that they can't prescribe the medication or treat the leukemia and that I need to try to work with the cancer center to find a new oncologist office. I've reached out to a few and had my referrals sent over but the days are just passing and no calls though a few have confirmed receiving the referrals.",
  "input": "",
  "output": "This is odd. I fail to see why a MD\/DO would not prescribe at least 30 days of this medication. It isn't really a chemo drug and most physicians learn about it in medical school."
},
{
  "instruction": "Donating Blood with Fatty Liver \/ NASH42 White Male, 510, 181 PoundsMedications: Wellbutrin, Pepcid, Prilosec, AdderallI currently have Fatty Liver \/ NASH with F2 Fibrosis. I keep seeing things asking for blood donors due to a current shortage, but my local blood bank lists \"Liver Disease\" as a disqualifying condition.Over the past 7 months, I've lost 50 pounds due to diet and daily exercise. At my last hematology visit, all of my liver blood tests were in the \"normal\" range. So is there really a reason that I shouldn't give blood? Or do they really mean that cirrhosis is the disqualifier for blood donation?",
  "input": "",
  "output": "Fatty liver is not an exclusion to blood donation. When they list \"liver disease\", they mean problems that can be transmitted via the donated blood products. That means viruses, like hepatitis B or C. Cirrhosis does not exclude anyone from donating blood, but the person may be taking medications or have abnormal blood counts or have abnormal vital signs that would prevent the donation."
},
{
  "instruction": "Juvenile Xanthogranuloma22m with two skin lesions that were biopsied and turned out to be \"Juvenile Xanthogranuloma\" (adult type).The PA who did the biopsy didn't seem too concerned. I'm a little confused as it seems that it normally happens to infants and I can't find much other information about this online except in medical journals.Some research says it's rare, while other research says as many as 1% of children can be affected and that it's usually underdiagnosed. One study says the average dermatologist sees 1-2 cases per year, which doesn't seem too rare to me. It seems that 10-20% of cases occur in the third decade of life (people my age).I am also slightly concerned about an association between multiple juvenile xanthogranuloma and \"hematologic malignancies.\"What has been your experience with this as a dermatologist\/GP\/etc.? Is this rare? Do you ever see it in adults in their early 20s or teenagers? Would having two lesions count as \"multiple JXG\"? Do I need to be getting bloodwork done? It's been months since they first appeared and no other ones have appeared.These developed after I got the COVID vax's. Apparently JXG results from a \"proliferation of histiocytes\". Could this be due to the immune response caused by the vax? I have not found anything about this link in VAERS.",
  "input": "",
  "output": "2=multipleThese are very uncommon in adults. Feel free to have a thorough investigation if you feel it is needed. The yield is very low.Your theory on pathogenesis is interesting and unprovable."
},
{
  "instruction": "Polycythemia Vera?For the last ~10 years, I've had multiple CBCs done and regularly had slightly elevated hemoglobin and HCT%. My pediatrician and then primary care (until about age 25) never thought twice about it, as they were at the very top range of normal. Then, when I switched doctors in 2019 due to a move, I had a CBC done and my current PCP is much more concerned.The last three CBCs showed: Hemoglobin: 17.4, 17.5, 17.5 HCT%: 49.6, 49.4, 49.8, all taken within the last year. All other labs are normal (RBC slightly elevated too, understandably). I even have a CBC from 2011 with HGB 17.5 and HCT 49%, and 2016 at 17.4 and 50% respectively. The institution they were taken at consider those within normal ranges (though at the upper bound). The most common JAK2 mutation is negative, and so is the EPO testing (as in its normal). I don't have any noticeable symptoms, other than some occasional moderate fatigue and malaise that may or may not be related.I was referred to hematology and the doctor was moderately concerned. She would like to order additional gene mutation testing for less common mutations, and some other more basic labs. The former of which is likely to be pretty expensive. She also was clear in saying that PV is technically cancer, and could lead to stroke etcetc. I am what I would consider highly medically literate, but still found the latter comments fairly scary. At the same time, she mentioned dehydration and sleep apnea as other causes. I find both to be somewhat unlikely given that a. being dehydrated at every blood test seems unlikely and b. i don't snore (though i know you can still have sleep apnear regardless, its far more rare).My real question is: from all of my research, the lab values I'm seeing are really just above normal and may even be within normal ranges at some institutions. To what extent is it worth continuing to pursue the root cause? What do I have to worry about most? If one of those other gene mutations comes back positive, what's my prognosis?",
  "input": "",
  "output": "I would defer to your hematologist for a real discussion, but your hematocrit at or below 50% is pretty non-concerning for primary polycythemia vera. Based on my reading you wouldn't even phlebotomize unless you HCT is >54%. There are plenty of other causes of secondary polycythemia beyond sleep apnea, including just simply having a higher than normal hematocrit.But to be sure, take your hematologists recommendations are far higher value than my thoughts. I deal with the secondary causes a lot more that primary PV."
},
{
  "instruction": "This makes a lot of sense to me, appreciate you answering. I agree and defer mostly to the hematologist.It becomes a challenging question when the labs that were ordered (myeloid NGS panel) are quoted at $1K+ and I have to decide if I want to follow through on that.",
  "input": "",
  "output": "A good question to your hematologist is what she's going to do with a positive result. If there would be a treatment that would significantly reduce your risks and improve your life, the $1000 might be worth it. If she would just monitor your blood counts the testing might not be worthwhile. agree with the original physician response.Just wanted to comment on whether or not to do NGS for $1k. I think this is a little excessive if only for high Hgb. Id maybe try CALR mutation first. This is the second most common cause of high Hgb or platelets. Maybe do MPL. Also how are your platelets? And do you smoke by any chance or live at a high altitude?While PV can transition into a cancer, it is also easily controlled with things like hydroxyurea and therapeutic phlebotomy to keep your Hct down. Its not as scary as say full blown myeloid leukemia. Its something that is treatable.Just my 2 cents as someone who works in the field. Maybe bring these issues or questions up the next time you speak with your hematologist. I think the Pulm MD above also had a good thought about if any of these mutations come back positive, what does it do for your future monitoring and treatment?"
},
{
  "instruction": "Elevated white blood countAge: 41 Height: 5' Weight: 175 Conditions: hidradenitisHi. I've sat chronically at 12 as my white blood count for several years. I've had issues with fatigue and feeling weak but it's recently increased with the addition of excessive sweating while asleep and at times during the day. my gp sent me for a routine workup where I have spiked to 15 without any illness(ie no colds etc). She repeated the test the following week and I was at 15.66. She's referred me to hematology. I'm overweight and do smoke a half a pack a day. I've been a chef for 20 years so I'm very active despite these lingering habits(sober now for 6 years). So I'm curious what to expect at the appointment if it's even necessary or if I just need to change my lifestyle? Thanks very much",
  "input": "",
  "output": "Smoking, overweight and hidradenitis could all contribute to an elevated white blood cell count. The sweating stuff is non specific, only sustained drenching night sweats are particularly concerning, and they are not subtle at all. Do you have the differential on the CBC?"
},
{
  "instruction": "I don't, she hadn't uploaded my tests to my portal. She's been my gp for a few years so she knows my conditions etc. The night sweats only cause me to pause because I haven't had them like this since before I quit abusing alcohol. I guess I'm just wondering if I actually need to see a hematologist or if it's something I can try to manage on my own? She ordered a chest x-ray as well, I have no idea what that has to do with any of it!",
  "input": "",
  "output": "The Hematologist can at least look at your differential, maybe do a couple tests to rule out uncommon chronic leukemias and similar disorders and give you the all clear so the matter doesnt need to be addressed again. If youve got an appt, may as well go to it at this point. 15 is high enough that we wouldnt resent having to see you hehe. Now if you were sent when it was 12, that would suck, and we get a lot of those referrals as well. Its reasonable to get a once over by a blood doctor for a WBC if 15, but most likely to be fine from that perspective."
},
{
  "instruction": "M-Spike. How concerned should I be?My allergy doctor somehow decided to test me for some antibodies & some other things due to some unusual symptoms and I had an M-Spike result. She was quite concerned.Specifically, the test was \"Protein Immunofix Electrophoresis, Serum Details\" and the result was \"abnormal band identified as monoclonal IgG kappa.\"I went to my primary care provider who ordered some follow-up tests, which I just got back. The results are in the table below. Most are normal, but the first one is presumably a repeat test (and same result) of the igG kappa.On Wednesday I'm meeting with a Hematology\/Medical Oncology doctor. In the meantime I'm wondering if I should be losing sleep over this. Because I am.I'm 50 yrs old, 5' 9\", 150 lbs., male, I take pepcid, non-smoker. I've been having some strange symptoms for five years (balance, adult onset scoliosis, right sided fatigue, bone pain on the right side).Thank you.",
  "input": "",
  "output": "Note: I am not a hematologistLooks like monoclonal gammopathy of uncertain significance (MGUS). A small percentage of people with this condition will progress each year to a low-grade malignancy called smoldering multiple myeloma or to overt multiple myeloma. Some people may develop other malignancy of the plasma cells (mature B cells that produce memory antibodies). Most people are simply monitored for rising amounts of the monoclonal protein over many years, and don't require treatment.Monoclonal proteins may be associated with elevated Factor VIII, which can predispose patients to blood clots. If you have a history of DVT or pulmonary embolism, the presence of these proteins could be a reason to consider ongoing anticoagulation medication long-term. If you haven't had a blood clot, it may be a reason to consider DVT prophylaxis when in high-risk situations, such as surgery or long periods of travel or prolonged bedrest.Your hematologist will probably tell you to have blood tests periodically to monitor the level of monoclonal protein. Based on the data that you gave, it doesn't look like you have a large amount of abnormal protein, so you are unlikely to require treatment."
},
{
  "instruction": "I have experienced a change in bowl habits and I have been seen by a gastroenterology who diagnosed me with IBS. My primary recently ran a total bilirubin test and found my direct bilirubin was elevated (direct = 0.3 indirect = 2.0. He wants me to see a hematologist. Is this common?Hello and thank you for reading. I am a 25 year old male, no prior medical history, non smoker, non drinker, very active (run 20 miles a week). I started to have increased bowl movements (5-7 a day on bad days), very lose stools. Its been pretty frustrating. I made an appointment with my GP, he ran standard blood work (CMP\/CBC) and the only thing there was elevated bilirubin of 2.0 which he said was just Gilbert's syndrome.. He referred me to gastroenterology.The gastroenterologist ran a C-reactive test, calprotectin stool test, whatever the celiac marker test is, and all were normal. His assessment was that it is IBS and no treatment is needed. I went back to my GP per a followup. He felt it was worth doing an ultrasound of my abdomen and a total bilirubin test. Ultrasound was normal, bilirubin test was 2.0 indirect and 0.3 direct. The normal direct is suppose to be < 0.2.The direct bilirubin test was done on November 4th. I'd seen the results and assumed they were not remarkable. On November 22nd, I get the following e-message from his RMA:\"Your recent labs indicate your direct bilirubin is high which could indicate hemolyis. You need to follow up with hematology as soon as possible. Feel free to contact us as soon as possible\"I was pretty irked to get this message 20 days after I'd already seen the lab results myself. I also felt like more context would be helpful on what as soon as possible meant... does it mean in the next few days or next few weeks or next few months...Ultimately, all I was wanting to know is if this is common practice for that lab result... could that elevation of direct bilirubin be related to Gilbert's? I appreciate the insight.",
  "input": "",
  "output": "It's probably going to be Gilbert's. But who knows, sometimes it's not."
},
{
  "instruction": "Thank you for your time and thoughts. I imagine that is what it will be and perhaps he is just being thorough. It struck me as odd that he wanted me to see a hematologist. What are the most common other things one would be concerned about if it isn't gilberts? His RMA wrote about hemolysis concern given the very mildly elevated direct bilirubin, but wouldn't I have abnormal rbc (anemia) blood work if that was happening.I haven't been able to hear back again given the holidays and have been a bit worried by the message.",
  "input": "",
  "output": "Hemolysis is the only other common thing"
},
{
  "instruction": "6F, 50lbs, 3 11 Melatonin supplement at night (.03mg), probiotics Medical history (not sure if its relevant) - she was diagnosed with neutropenia when she was 2. Saw hematology for a period of time because they suspected cyclic neutropenia (her levels fluctuated over 6 weeks of finger pokes), but since she was healthy, and didnt seem to have other symptoms, they did not want to do a spinal tap. The few times shes had bloodwork since, her levels have been within normal range. So possible neutropenia of childhood. I recently invested in a personal ECG device (Wellue Pulsebit EX) for me to keep track of my own arrhythmias. But I used it on her, and got irregular heartbeat results. The AI analysis describes it as PACs\/supraventricular tachycardia, though Ive tested her 8 times in the last 2 days at differing times and four of them have come up as this and one came up with PVCs (so 5 out of 8 were irregular). I am curious if this is something I should speak with her doctor about, or is this because the device is not taking her young age into consideration. I looked up PACs in young children and while it says some are normal, if they are more frequent then they should be investigated further. Im trying not to worry myself silly, but I would definitely appreciate any insight. Thank you! Im going to comment with a photo of one of the readings, since I cant figure out how to add a photo and text to this post.",
  "input": "",
  "output": "These are not approved for children. Do not use them on her.Children have very different hearts than adults. Their heart rates are generally higher. It is generally not recommended to routinely screen asymptomatic children with monitoring devices like this. The thought process is that it generally leads to a lot of anxiety (as you've probably noticed) and unnecessary testing without actually saving very many lives. If she passes out, bring her to a doctor to have her assessed by machines designed for interpretation of children's hearts."
},
{
  "instruction": "Iron Deficiency with normal-\"high\"- hematocrit, rbc and hemoglobin ?Hey guys,25M, 184cm, 95kg, white, diagnosed depression\/anxiety on lexapro 10mg, don't drink\/no smoking, ex recreational drug user.For reference: I recently had a comprehensive blood panel that revealed:Ferritin 19.3 ug\/l (30 - 300 ug\/l)Transferrin Saturation 11.7% (16 - 45 %)Hematocrit 49 % (40 - 53 %)RBC 5.7 T\/L (4.5 - 5.9)hemoglobin 17.2 g\/dl (13.5 - 17.5My GP says you won't have symptoms of Iron deficiency unless it shows in hematologic parameters (hematocrit, hemaglobin, rbc, ...). Is this true?Many thanks in advance!",
  "input": "",
  "output": "This is generally true. However, as a male you shouldn't be iron deficient. At the minimum get tested for h pylori and celiac."
},
{
  "instruction": "35m, obese, do I have cirrhosis?I am a 35 y\/o male. Diagnosed with nafld very young, back in 2007. I don't drink, or smoke, my diet is pretty shit. My weight usually hovers around the 300 mark. My AST has always been normal and my ALT has usually been elevated. When I lost weight in 2017-2019 my enzymes fell to within normal range for the first time in forever. My last ultrasound was in 2016 and it showed fatty liver.Since 2019, I have gained a significant amount of weight, getting to my heaviest ever at 350 lbs. 6 months ago, I had labs drawn and they were AST 49 ALT 140. Everything else was normal expect for my wbc, 13, and crp at 20! These have been elevated since I was in my teen, have seen oncologist, hematology, etc. Never able to find a cause.My question is, is it too late now? Have I finally don't irreparable damage by gaining this weight back?I don't have any follow up testing scheduled at this time. My triglycerides are normal, etc. Seems odd to me.",
  "input": "",
  "output": "Cirrhosis isnt a diagnosis made by AST and ALT levels. Get an abdominal ultrasound, or CT to look at the liver. You may need a biopsy at some point to characterize the degree of non alcoholic liver disease. I doubt you have cirrhosis but more of fatty liver that could definitely progress to cirrhosis.Try to lose weight, exercise, eat healthyBest of luck"
},
{
  "instruction": "Would those number be something to worry about in this setting? My AST and ALT?",
  "input": "",
  "output": "Lose weight. Lots of it. Any damage as of now is still reversible. Later, not so much"
},
{
  "instruction": "Do you agree with the diagnosis of Aplastic Anemia? Or at least does it seem likely\/feasible? I know that is very difficult to answer on such limited information.Is the current treatment plan of observing a good one? Based on my reading online (again, not always reliable) it often talks about the dangers of not treating Aplastic Anemia. Thank you for taking the time to read through this, and for providing input.",
  "input": "",
  "output": "Theres hypoplasia. Dont think Id call it aplasia. Not so stoked that things are going down. I think the second opinion is reasonable. Id check counts monthly, not every 3 months, at least for a while. Something aint totally right here. But I dont think Id call it aplastic anemia at this point."
},
{
  "instruction": "Papilllary thyroid cancer- RAI or notI'm a 30 F,Height 5'10, weight 139, caucasianPapillary thyroid cancer, total thyroidectomy with central neck disscection March 1st 2022Pathology showed classical papillary thyroid cancer, hematological invasion: No, Extrathyroidal invasion: No, lymph node invasion: yes, biggest 0.7 cm, 6 lymph nodes with many having psamomma bodies( did not detail in report). Should I get RAI? I can't self diagnose but im in intermediate category. No genetic testing because my cancer is not genetic?Do you think RAI is appropriate for me? I'm scared go getting a second cancer, salivary glands going and having bad teeth, etc.No known history of radiation exposure or family historyNon-smoker, Non-drinker, Non-recreational drug user- not really relevant",
  "input": "",
  "output": "This decision depends on a number of factors to include number of nodes, size of primary lesion, etc. Based on your description, it sounds like you had a number of nodes that had papillary thyroid carcnioma. which would put you within the intermediate risk group based on the american thyroid association below (I've highlighted the pertinent criteria:ATA intermediate risk (520%) category includes patients with: (i) microscopic invasion of tumor into the perithyroidal soft tissues; (ii) aggressive histology (e.g. tall cell, hobnail variant, columnar cell carcinoma); (iii) PTC with vascular invasion; (iv) clinical N1 or >5 pathologic N1 with all N1 <3 cm in largest dimension; (v) multifocal papillary microcarcinoma with microscopic invasion of tumor into the perithyroidal soft tissues and BRAFV600E mutation (if known); tumour larger than 1 cm with BRAF v600E mutation could confer an intermediate risk of recurrence but has not been proven yet, based on a prospective study.In these cases, it can go either way based on discussion with your endocrinologist. Some will monitor thyroglobulin levels and obtain serial ultrasound, some will recommend RAI. In young patients (<45 years) there isn't a lot of great evidence to say RAI improves survival in those with small central compartment nodes.The decision all depends though on your specific risk factors and various other aspects of health that are outside the realm of feasible determination just through an internet post. Work with your endocrine provider, discuss risks, benefits of each; and you can likely come to decision as to what is best for you."
},
{
  "instruction": "Bloodwork check pleaseAge: 28, sex: female, height: 51, weight: 105 lbsplease advise on this bloodwork. My doc said its fine but Im unsure. Cuz it looks not fine. I attached previous tests for comparison.Automated Hematology WBC 13.6 x103\/mcL (High) Date: Feb 22, 2023 10:46 a.m. EST Reference Range:4.5 x103\/mcL - 11.0 x103\/mcL7.2 x103\/mcL Date: Jun 23, 2022 10:52 a.m. EDT Reference Range:4.5 x103\/mcL - 11.0 x103\/mcL8.6 x103\/mcL Date: Dec 14, 2021 09:48 a.m. EST Reference Range:4.5 x103\/mcL - 11.0 x103\/mcLNeutro Auto 76.8 % (High) Neutro Auto Date: Feb 22, 2023 10:46 a.m. EST Reference Range:42.0 % - 72.0 %56.2 % Date: Jun 23, 2022 10:52 a.m. EDT Reference Range:42.0 % - 72.0 %48.8 % Date: Dec 14, 2021 09:48 a.m. EST Reference Range:42.0 % - 72.0 %Lymph Auto 17.9 % (Low) Lymph Auto Date: Feb 22, 2023 10:46 a.m. EST Reference Range:25.0 % - 45.0 %36.0 % Date: Jun 23, 2022 10:52 a.m. EDT Reference Range:25.0 % - 45.0 %44.1 % Date: Dec 14, 2021 09:48 a.m. EST Reference Range:25.0 % - 45.0 %Neutro Absolute 10.41 x103\/mcL (High) Date: Feb 22, 2023 10:46 a.m. EST Reference Range:1.40 x103\/mcL - 6.50 x103\/mcL4000 IntlUnit\/L Date: Jun 23, 2022 10:52 a.m. EDT Reference Range:1400 IntlUnit\/L - 6500 IntlUnit\/L4200 IntlUnit\/L Date: Dec 14, 2021 09:48 a.m. EST Reference Range:1400 IntlUnit\/L - 6500 IntlUnit\/LBUN 6 mg\/dL (Low) Date: Feb 22, 2023 10:46 a.m. EST Reference Range:8 mg\/dL - 21 mg\/dL9 mg\/dL Date: Jun 23, 2022 10:52 a.m. EDT Reference Range:8 mg\/dL - 21 mg\/dL10 mg\/dL Date: Dec 14, 2021 09:48 a.m. EST Reference Range:8 mg\/dL - 21 mg\/dLBUN\/Creat Ratio 7.5 mg\/dL (Low) Date: Feb 22, 2023 10:46 a.m. EST Reference Range:10.0 mg\/dL - 20.0 mg\/dL11 Date: Jun 23, 2022 10:52 a.m. EDT Reference Range:10 - 2014 Date: Dec 14, 2021 09:48 a.m. EST Reference Range:10 - 20",
  "input": "",
  "output": "Do you have any symptoms? Your BUN will be slightly low because you're a small person. Your WBC and neutrophils are slightly high, which is consistent with an acute infection or inflammation, but difficult to comment without context."
},
{
  "instruction": "3 year old male with unilateral swollen cervical lymph node, urgent?About 5 days ago I noticed that a lymph node on the right side of my sons neck was quite enlarged. When I palpate, it doesnt seem to hurt him, it is not mobile and feels more rubbery\/hard. I would estimate it is 2-3cm across. He had Impetigo 2-3 weeks ago but it has been resolved for a week and he didnt have swollen lymph nodes at the time. He does not have any symptoms of illness currently and there is no one in the home sick. He is eating well, no recent weight loss. Is this something that should be evaluated within the next few days or is it fair to watch for 2-3 weeks to see if the lymph node goes back to the usual size? My son is 30 pounds, has controlled epilepsy and takes Keppra. He was followed by hematology for 1 year previously due to unexplained neutropenia. Has not had blood work in 8 months.",
  "input": "",
  "output": "It likely won't return to its previous size, but will likely shrink down near that on the next few months (not weeks), if it doesn't or your concerned then make a non-urgent appointment with his doctor"
},
{
  "instruction": "Do platelet transfusions require the same compatibility requirements of blood transfusions?My son is a 7 week old male. When he was 4 days old he needed a platelet transfusion. His blood type is O- and the donor was B+. From what I understand, an O- blood type can only receive O- donor blood. But what about platelet transfusions? His chart labeled the transfusion \" Pheresed Platelets.\" He was in the NICU during this time and I don't really remember why he needed a platelet transfusion. He had two blood transfusions because his hemoglobin was 3.7 at birth but I don't see any tests results for platelets in his chart until the day after his platelet transfusion so I'm not sure if they were low before. I can bring this question up at his next doctor's appointment but I just wanted to get a sense first if it's normal\/ok to give platelet transfusions from a B+ donor to an O- recipient.If we call platelet transfusion day Day 1 then his platelet levels were as follows:-Day 2: 58-Day 4: 40 and later 43-Day 5: 46-Day 6: 49-Day 9: 127They eventually got up into the 200s and most recently was in the 500s. We are working with hematology right now but I just thought I'd share the results in case it's pertinent.",
  "input": "",
  "output": "Nope.It is preferred but not as big as a concern"
},
{
  "instruction": "Would viral pneumonia cause a WBC of >80k?24F, 55, 135lbs, USA, no alcohol or drugs, relevant pmh: aplastic anemia and pnh, meds: soliris, cyclosporine, promacta.Last week I tested positive for flu B and strep throat, was prescribed amoxicillin and tamiflu. I initially felt better, but then all of a sudden felt worse. My fever returned (highest was 102.4), wet cough, SOB, and severe fatigue. Went to urgent care earlier today and the dr did blood work and chest X-ray, and was diagnosed with viral pneumonia. However, he told me that my WBC was over 80k, but was not specific with the differential, which is obviously not normal for me. He said it could just be the way my body is responding to the infection. Is this normal or should I reach out to my hematologist? I know I probably should have went to the ER given my medical history, but didnt want to put more of a strain on healthcare if I didnt have to. Thanks for the help!",
  "input": "",
  "output": "No, Thats a really really high WBC count and would be very atypical for a regular viral pneumonia. With your history of aplastic anemia especially you definitely need further evaluation urgently.That person has some sort of hematologic\/oncologic process going on until proven otherwise.I would start with just repeating the CBC though."
},
{
  "instruction": "Fingers, Toes turning black and rotting off. Desperate for answers! Also hematology and rheumatology blood results and symptoms that no doctors can explain. can't embed images here, so I made a pdf with all text, pictures, and labs. https:\/\/www.scribd.com\/document\/511582218\/askdocs-pdf?secret_password=VqmaLuJA0tGw5bGE5xYp It will be much easier to read the whole thing there, with the images embedded, but I will copy the text here.36F, 55, 115 lb, white.  Primary complaint = fingers and toes turning black and rotten (pictures included).  Existing issues = random red cell destruction without cause, random platelet destruction without cause, swellings and rashes (labs and pictures included).  Medications = iron supplement.  Occasional Claritin, Advil, Prednisone.  No medication right now.  No recreational drugs or smoking.  Rare\/light alcohol (an occasional drink on holidays or weddings)  Rotten Fingers.My left thumb got a blood blister so I put Neosporin and gauze on it.  The pain became so intense that I went 72 hours without sleep.  I went to urgent care, who removed the bandage.  The thumb was very swollen and the top third was black and crusty.  (picture)They sent me to the Emergency Room, where they removed the upper half of the thumb.  The pain completely went away, it was just a little sore and itchy.But a few days later, all the other fingers and 8 of the toes started turning black.(pictures)Thats the hand with the original bad thumb.  The pinkie has a blood blister, the index and ring fingers are turning black and crusting at the very top under the nail, and the middle finger is just inky blue\/black without any crustiness or blisters.  The left picture was taken a day after the right one.  Right Hand:  no crustiness or blisters.  The fingers are just dark.  The index finger is getting kind of gooey (last picture).(pictures)Toes look blacker than fingers but not crusty.  All but the two smallest toes on right foot are turning black.The ER doctors were very kind but nobody knew why my thumb turned black and rotten.  Now here are all the other weird symptoms and bloodtests that doctors cant explain.  None of it seemed like a big deal untl fingers started rotting.  2. Rotting BloodFor years my annual bloodwork showed I was anemic.  For example(picture)But I had no symptoms of anemia other than feeling cold, so my NP said being anemic was just my normal and prescribed an iron supplement.Two or three times a year, I would get symptoms of extreme exhaustion that would last a few weeks.  Most of the time, I felt healthy. But for those weeks, I would sleep the entire weekend, wake up Monday, stumble brain dead through the workday, then get home and fall right back asleep.  After a few weeks, Id start to get better.  For years, my NP said it was nothing, just a virus.  But I never felt sick, just exhausted.  Then a doctor saw me while it was happening.  As soon as she saw me, she took my vitals, looked at my eyes, and said, this isnt all in your head.  We need to take your blood.  Here were those blood results(picture)It turns out that the exhaustion is because my blood starts rotting a few times a year.  I went to hematology.  They tested me for every possible cause of blood destruction.  But everything was normal.Tests included DAT\/Coombs negative, PNH w\/ FLAER no flow cytometric evidence of paroxysmal nocturnal hemoglobinuria No evidence of aberrant loss of GPI-linked markers tested in erythroid or leukocyte populations. Anti-CD45, glycophorin A, CD59, CD24, CD15, CD64, and FLAER tested. Complement: C3C, C4C normal, CH50 high (>60). Cold hemagluttinins: none detected, G6PD - high (>21.00). No hereditary spherocytosis or elliptocytosis. Infections negative.  Blood cultures normal.I can post the tests if anyone needs to see them.3. Bruises and Rotting PlateletsNormally I dont bruise any more than most people.   But once in a while, I get bruises everywhere.  My bra, underwear, and socks all leave big bruises.  Theyre painless and go away in a couple weeks so I never worried about it.  But when a doctor saw and tested, it turned out there were almost no platelets.  The picture shows the bruising left by a loose sock.  My whole shins were just big bruises that followed the pattern of the sock elastic.(picture)In a few weeks they were back up to 40 and the bruises were gone.  Hematologist found no reason for platelets to suddenly drop like this.  They checked for cancers and even took bone marrow but no answers.(picture)All the bone marrow tests like fish and genetics were normal.  4. Symptoms that Seem Autoimmune but Have No Rheumatologic Cause.  Sometimes I get rashes and swellings that doctors think is autoimmune(pictures)Rheumatology has tested EVERYTHING again and again.  Sedimentation rate, ferritin, and CRP are always high.  But nothing else is usually abnormal.(pictures)They biopsied some of the rashes and purpuras (which I dont have pictures of, theyre just little painless red spots that sometimes break out on my legs).  They all showed the same thing, leukocyto elastic vasculitis.  Heres one.(picture)But every other type of test for vasculitis has been negative.   Nobody has explained why someone healthy and pretty young like me should have chronic venous insufficiency either.I have only had one round of tests where there were any abnormal autoimmune results:(picture)But these things were only abnormal that ONE TIME.  Rheumatology has re-tested them so many more times and they are always normal.  They have tested for every other autoimmune disease and they are all normal.  The only rheumatology tests that are often abnormal are sediment rate, creactive, and ferritin being high.   Ddimer and visc is sometimes high but not usually.  PT, INR, and ptt are sometimes high too.  (picture)They dont think its cryoglobinemia because it was only positive once and negative a lot more times.  Also, my C4 was always high or normal and my C3 was always normal, even in the test where there was cryoglobulin.  (picture)The only other thing off on the bloodwork is subclinical hypothyroid.   TSH is high, but T3 and 4 are low normal.  I have no symptoms of  hypothyroid other than being cold.  And the cold could be from anemia.Please, does anybody know what this all means?I had accepted the lack of answers when it was just random blood rotting, swelling, and rashes.  I know the doctors tried hard.  I could live with all that stuff.  But these black fingers, I cant live with it.  It hurts too much.It feels like someone as healthy as me shouldnt have all these symptoms unless its connected somehow.  But nobody knows how.  Rheumatology thinks the rotten blood is not autoimmune because Coombs and other autoimmune tests are always normal.  But hematology says if its not autoimmune, then theres no other answers.  So far, I have no autoimmune diagnoses but doctors still act like I have something autoimmune.Monday I will see my NP and can ask for any tests anybody recommends.IS THERE ANYTHING I CAN DO FOR THE FINGERS AND TOES?  TO MAKE THE BLACK GO AWAY OR MAKE THEM STOP HURTING?I already tried asking a pain forum for tips, but I got a nasty message (Your complaining about 2 weeks of hurt fingers!  Do you understand that we have pain that is severe, intractable and forever*?*  I have ddd and a herniated L5-S1 disc.  I am in 10\/10 agony beyond your imagination.  Your hurty finger is a joke.  Suck it up buttercup) so I deleted it and wont ask for help from patients again.I hope doctors will be more understanding. I get it, that there are other people who have it much, much worse.   But I dont have chronic pain so I never developed a high pain tolerance.  Typing this is killing me. Ive had a broken bones, a vaginal delivery, wisdom tooth surgery, and swollen joints, but none of those hurt that bad.  When Ive broken a bone, its only been blindingly painful for ten or fifteen minutes, then it settles down.  Then a few days of throbbing and aching thats relieved with rest and Advil.  This is the first time Ive had pain that Advil cant relieve and that doesnt settle down with time or rest.  I know other people with bad backs or arthritis have it worse.  I dont need to be told that.  But for me, this is too much.  What can cause this?The doctors seem confident that its not just psychological.But I cant shake the fact that I get more symptoms when Im sad or stressed.  I dont have any chronic mental illnesses, but I go through short periods of feeling down or anxious.  At the hospital, I held it together when they took off the black thumb.  I told myself that it was ok, that the pain was finally gone, that half a thumb isnt that important, that its my non-dominant hand, that I dont need a full left thumb to type or do most activities.  When I got home, I was so happy to be pain free and I had so much to catch up on, I just didnt think about it.  But then I looked at the discharge paperwork and saw that under Reason For Visit, they wrote GANGRENE, WET.  I knew that the thumb wasnt good, but seeing it called GANGRENE made me feel so repulsive and sad.  I spent 10 or 15 minutes just crying.  It was right after that little breakdown that all the other fingers started hurting and turning black.  Could all that crying have caused it?Theres also an odd discrepancy.  My black fingers hurt so much but my black toes dont hurt at all.  How is that possible unless the pain is all in my head?I am desperate for answers or relief if anyone can help.  Thank you to anyone who has read this far.TL-DR:  What causes rotting fingers, rotting blood, rotting platelets, leukocyto elastic vasculitis, swelling, rashes, purpuras, and maybe subclinical hypothyroidism but without showing up on normal blood tests for autoimmune or other diseases?",
  "input": "",
  "output": "This is beyond the scope of all but the most seasoned hematologists and rheumatologists. It MUST be rheumatologic or a bone marrow disorder, nothing else fits all the symptoms. You should be referred out to Mayo Clinic or Johns Hopkins or something. I would say the rapid progressions warrants an inpatient workup until a cause or treatment can be found. If those fingers\/toes get infected you could get septic pretty quick.Some type of small vessel vasculitis fits best, but theyve tested for all the obvious culprits so its hard to say why nothing has been found yet. Its definitely not in your head, but its no surprise that stress makes the symptoms worse. Stress makes a lot of things worse.I wish I could offer you more, but this definitely isnt my field of practice. Hopefully someone else has some ideas.Agreed agreed. This needs an inpatient work-up in a big academic center. We had a similar case on my MICU rotation in residency and he was getting continuous plasmapheresis while we tried to figure out what the cause was."
},
{
  "instruction": "Are there any hematologist\/rheumatologist crossover doctors? Like a single doctor who specializes in autoimmune hematology? It feels like rheumatology and hematology pass me back and forth and like both of them think I'm the other specialist's problem.",
  "input": "",
  "output": "Not that Im aware of unfortunately. The problem is they are both at dead ends and think the other specialty will be able to help. Which is why you need your case elevated to the next level"
},
{
  "instruction": "Why wouldnt you suspect infectious disease? Could there be local infectious disease or insect\/animal bites that are common? In California we have Valley Fever which is not know outside of certain areas. Could a local infectious agent not well known be an avenue to look down? Some resistant bacteria?",
  "input": "",
  "output": "Theres no infection Im aware of that causes your fingers and toes to necrose. The only way that happens from an infection is when someone is in septic shock and the vaso pressors they need to stay alive cause their small vessels to spasm shut"
},
{
  "instruction": "So when is a black finger just Raynaud's and when is it gangrene? The right index finger isn't squishy, but the skin is breaking down and it's oozing something smelly.",
  "input": "",
  "output": "OP, this is an indication that the tissue has died and has become necrotic. This tissue needs to be removed urgently. I am very concerned that an infection of this tissue could become systemic and fatal, potentially in hours.This is a definite indication to immediately head to an emergency room.I am so sorry you are going through this, but you need to be admitted and likely get surgery so that this does not become immediately life threatening.PLEASE DO NOT WAIT UNTIL YOUR APPOINTMENT IN AM"
},
{
  "instruction": "EGD Path results32F, symptoms of weight loss, nausea, loss of appetite. Also have LLQ pain. Low platelets, WBC, hemoglobin. Had 2 BMBX in last year that confirmed hypocellularity of bone marrow, no official diagnosis of aplastic anemia or hypoplastic MDSyet. Monitoring blood levels monthly with Hematology. CT CAP showed what turned out to be an ulcer in pelvis, diagnosed via pelvic ultrasound. No further concern and no masses found. Spleen is slightly enlarged but Hematology not concerned.My PCP referred me to GI last year June. GI wouldnt see me until heme\/onc cleared me for any cancer. Saw GI end of Nov and had an EGD+colonoscopy yesterday Mar 6.They scheduled a followup in 7 weeks (!) to discuss biopsy results, which I just got a few minutes ago. Any thoughts? Seems like: take a Tums and suck it up? Wasnt really expecting GI to find much but curious what this all means, if anything really. Thanks.Microscopic examination reveals duodenal mucosa with blunted villous architecture, acute and chronic inflammation within the lamina propria and overlying mucosa, Brunner's gland hyperplasia and foveolar metaplasia. Focal reactive epithelial atypia is identified. No evidence of dysplasia or malignancy is identified.Microscopic examination reveals gastric antral mucosa with a chronic inflammatory infiltrate within the superficial lamina propria including clusters of plasma cells. No evidence of Helicobacter pylori, dysplasia or malignancy is identified.",
  "input": "",
  "output": "Some inflammation or other changes in the tissues of your digestive system, but they don't indicate any serious conditions like cancer or dysplasia (abnormal growth of cells)."
},
{
  "instruction": "is this iron overload? high iron levels abnormal bloodwork32 year old female, white, smoker, 5'9, 125 poundsOver the last few months I have had my iron tested a few times first time iron saturation was 87% now it it 95% (added pics in comments). My diet has been liquids due to health issues. I have consumed 6.5mg to 7mg of iron daily and guarantee it's not more because I'm not on a regular diet. I take 2 ensure drinks, mainly fruit juices, water, gatorade, and occasionally tomato soup or chicken broth. No way have I consumed a dangerous amount of iron. I also have pain in my right upper quadrant that has been going on for months. Last ct scan was \"normal\" even though it showed mild liver edema. Also have had low platelets 72 to 97 and low wbc 3.1 as well. Hematology appointment set this week. But anyways I would love opinions on this.",
  "input": "",
  "output": "I think your hematologist will be able to answer your questions better than any of us online. We dont know you, your medical history, your family history, or other relevant workup, and we cant examine you.Its possible theres an underlying chronic disease or inflammation is leading to the low TIBC and high ferritin, but the range of possibilities is so broad that itd be irresponsible for us to start guessing based on this limited information."
},
{
  "instruction": "Reasons why OB wouldnt follow MFM or HEM recommendations?Trying to wrap my head around what is going on with my provider.Had two uncomplicated pregnancies (shoulder distocia in first, scheduled c section second). I am currently 17W and this pregnancy is going well thanks to some info\/changed approach.Unfortunately, my husband and I suffered 5 consecutive losses after these pregnancies before this one. OB was not supportive when I kept asking and saying I was concerned. Went to specialist after not getting answers\/support.It was discovered I have Factor V Leiden clotting disorder and 2 other borderline clothing disorders. Met with hematology who had me start lovenox in current pregnancy. Lab reults showing clotting disorder as well as notes CC to OB.OB is not supportive of me staying on lovenox (despite being currently managed by HEM)Additionally, she is arguing about my due date. Despite myself, MFM and other radiology imaging aligning (actually even measuring ahead of my calculations) whereas the uktrasounds she has performed are substantially off. Like over a week behind. I brought this up to my MFM and said its either user or equipment issue. And that they would speak with OB about correcting due date.This is important because I need to stop lovenox and transition to heparin before I go into spontaneous delivery.Again, she is refusing to acknowledge the MFM and change my due date to the correct due date.I dont even know what to say - I know people change physicians all the time but I have built what h thought was a good relationship with this provider and Im literally bothered by the contentious nature of this.Why short of ego would this provider not want to listen to MFM and HEM?I am in the northeast fyi",
  "input": "",
  "output": "I cant say what the provider is thinking, but honestly this is causing you enough stress that it would be worth considering a change in provider.Agree with above comment. Switch OBs. This is unacceptable."
},
{
  "instruction": "Do labs ever actually determine EBV reactivation? TL;DR I'm tired of being tired.My OBGYN doesn't know what to do with these results but refer me to an MD who is also a Naturopath.I've had daily fatigue and elevated lymphocytes for nearly 3 years. Initially, my PCP sent me to Hematology and now over to my OBGYN. Hematology increased my iron but when fatigue continued for months after, my OB ordered hormone, thyroid, and EBV panels..Hormone and Thyroid resulted in normal values. CBC done in late January: lymphocytes % =50.6, Neutrophils % =37. EBV panel (February): EBV Ab IgM to Capsid U\/mL Value <36.00, EBV Ab IgG to Capsid U\/mL Value 393.00, EBV Ab IgG to Nuclear Antigen U\/mL Value <18.00. NOTE: Suggestive of a recent Epstein-Barr virus infection.No illness between mid 2019 and these results. Not even a cold. Definitely not mono (had that aged 15)Am I wasting my time going to see a naturopathy-focused MD?",
  "input": "",
  "output": "EBV DNA would be the test that would detect EBV reactivation (that term is probably not a great one, but at the moment Im at a loss for a better one). Its ironically the one doctors check the least often, probably because they dont understand what they are checking for. EBV IgM, if positive, is certainly compatible with recent infection. The IgGs are all variably positive in different patients, to the extent that I place zero value in them. Transplant physicians have a legitimate use for them, but otherwise in my humble opinion they are checked inappropriately > 95% of the time, including in your case.The pretest probability that fatigue in a previously infected patient is due to EBV reactivation is extremely low.Hope that helps. Maybe an ID doc can weigh in better.Regarding seeing a naturopath, I would say if insurance covers the services\/treatments they recommend thats a hint they are legit. If its out of pocket to a large extent, Id personally steer clear, but thats an individual decision. Its not medicine, so I really have no authority to judge there.Whats your absolute lymphocyte count?"
},
{
  "instruction": "Can you give me some guage on these iron and blood results?Background. I've had elevated platelets on and off for almost 20 years. They've never been enough to cause further testing. This past fall they were elevated again ( I think they were around 540?) so my doctor sent me to the cancer and hematology center (terrifying) for further testing.Here are my results:Iron - 45ug\/d L50-212 LUIBC - 341ug\/dL 155-355Iron % Saturation - 12% 20-50 LRed Blood Cell Distribution Width - 15.2% 12.1-14.6 HPlatelet Count - *403x1000\/UL133-382 HFERRITIN - 30ng\/m l6-200Before this test, I had a previous test on my first visit with the hematology doc.My iron was 71 at that time. He put me on elemental iron supplements but I couldn't find them so I took normal iron supplements. He had me on them once every other day. After the second test where my iron was 45, I found the elemental iron and he said to take them every day.Another note that might not be of importance, I was on my heavy period during the second blood test.I'm going back tomorrow but I have a serious, serious case of health anxiety. I have trouble gauging what I should absolutely lose my mind over or what I should just be like, \"oh, I'm anemic.\"I have other lab results related to these but they all came back normal. I can provide those if needed though.When I had my baby 10 years ago, I had to have an iron infusion. But I've never had low iron show up on tests at any other time. Though, I've had the fairly high platelets come and go.Other info about me, if needed: I'm 42, female, obese, asthmatic, type 2 diabetic on metformin (fairly well controlled as I try to eat pretty healthy and am starting to exercise more), PCOS insulin resistance, and take the following meds:MetformingSingulairLexaproBuproprion (sp)Buspironexanax - as neededFerris Sulfate Iron supplement 65 mg 1x a dayOTC - benadrylMy anxiety has me positive I either have leukemia or that I'm bleeding internally from other type of cancer.If my results come back tomorrow and my iron is still low, is that really bad news? Does that mean they're going to need to check for internal bleeding or cancer? What is an really bad iron level? Can you help me find some relevancy?I appreciate you so much!",
  "input": "",
  "output": "You haven't included all your results, which isn't helpful. What you have included suggests iron deficiency. Serum iron is a poor marker of iron deficiency and other labs are used to help sort out what's happening. This looks like iron deficiency. You mention anemia, which the labs you included don't inform about. Anemia is low hemoglobin. This all looks like iron deficiency. Menstruation is the common cause."
},
{
  "instruction": "Does this look like Multiple Myeloma?My hubby is 78 male with history of anemia, heart disease and ckd. Nonsmoker. 5'9\", 178lbs. On torsemide, eliquis, carvedilol, entresto. Cardiologist referred him to hematologist and the abnormal results of lab work are: FLC ratio 0.20 Kappa 3.07 Lambda 15.47 Pt\/INR 17.6 1.6 (eliquis likely) RBC 3.19 Hgb 10.1 Hct 31.9 Rdw 15.3 Lymphocytes 17.1I'm a nurse and these look concerning to me, but hematology is not my area. Thank you",
  "input": "",
  "output": "Need more information. Light chain ratio isnt used by itself to diagnose MM. Would need immunoglobulin levels and immunoelectrophoresis looking for a monoclonal antibody. Really hard to tell. Anemia and abnormal light chain ratio could be from CKD. More testing needs to be done to help bring clarity to whats going on."
},
{
  "instruction": "Thank you. I think there are more lab results in progress. Some had to be sent out and we won't have results for about a week.",
  "input": "",
  "output": "Some take a while, especially electrophoresis. Feel free to come back and post with more results."
},
{
  "instruction": "Monoclonal protein 1.76 Beta globulin 1.66 Still waiting on the rest.",
  "input": "",
  "output": "So he has a monoclonal protein and its above 1.5. Im hoping its IgG. Now the trick is figuring out if his anemia and kidney issues are from myeloma or heart disease and poor perfusion. This will determine if he needs treatment or not. Agree with other person on this thread to make sure you test for amyloid. If he has a bone marrow (which he definitely should) then make sure they get a Congo red stain. Make sure you ask for this because many will not request path to look. This is not trivial as patients with amyloid secondary to light chain deposition respond amazingly well to daratumumab. Good news is myeloma is very very treatable these days. His b2 microglobulin is low which is a good prognostic sign."
},
{
  "instruction": "I keep thinking amyloidosis but, his brother had MM. Entire family has heart disease and I'm thinking that they may all need to be tested.",
  "input": "",
  "output": "MM isnt typically genetic. Familial cases make up 0.3% of diagnoses. Amyloidosis can be familial but is not the same as AL amyloidosis associated with myeloma. If your husband by any chance served in Vietnam, agent orange exposure also increases risk of developing MM.Your husband likely has IgA myeloma given how high is IgA levels are, which is the second most common form. A bone marrow will help make the diagnosis formal. He likely isnt feeling well from either the myeloma or a possible opportunistic infection in the setting of immune dysfunction from the myeloma.He should be seen sooner than February or at least have a bone marrow done before this time. Someone should be following up sooner with these numbers.If interested, there is also a website run by a physician with myeloma that tracks labs and has physicians from all over weigh in on care. Its free and worth looking into if you are not close to a large academic center."
},
{
  "instruction": "35\/F, nervous about upcoming appt...35 female, been dealing with a whole slew of issues for 3 years now. I am being seen at hematology\/oncology for ongoing anemia. Was diagnosed with alpha thalassemia. Was also told I may have a slow growing lymphoma. Because of that, I had a bone marrow biopsy 3 years ago. No lymphoma shown, but was told it was only a 50\/50 chance. Basically if it was in my bones. Doctor ordered a PET scan but my insurance said no. Been going back and forth trying to push for more testing but the doctors don't seem to want to do much of anything to help me. Blood work is almost normal, but symptoms are ongoing. Night sweats, low fevers at night, bone pain, fatigue. I have a ping pong sized lump on the back of my head. Brought it up to one of the doctors and they shrugged and said \"no idea why you'd have a lump there.\" And left it at that. I've asked for a biopsy of other lumps with no luck.My next appt is this week. I have a hard time advocating for myself and pushing for further tests. I get told no and shut down.Any tips for voicing my concerns better? I hate feeling like this and I hate feeling so defeated after all my appointments.",
  "input": "",
  "output": "Very unlikely to be even slow growing lymphoma. Everyone is dealing with a whole slew of issues, honestly. Live life. Please dont look further for a disease. Youve done your due diligence."
},
{
  "instruction": "Palpable Lymphnode for years no pain19, Male, 60, Very active and healthyHi there, 3 years ago I have noticed this lymphnode on the left side of my neck and when I turn my head to the other direction it feels huge. I have been to my GP and bloodwork was fine, he sent me to a surgeon who refused to do a biopsy and he sent to an infectious disease doctor who took LOADS of blood and it came back all good- I went back to the surgeon and he got tired of me and I pushed for hematology\/oncology & he finally referred me there. When I went to the appointment she said she wasnt really worried and my blood was fine again. I have had 3 ultrasounds on it and it doesnt really seem to be getting bigger. Even after these 3 years it hasnt changed in size at all. Recently though I had a cold and a bunch of lymphnodes around it back enlarged and painful. They all went away but I was feeling this lymphnode again and its freaking me out. Its way bigger than my other nodes and it feels so hard. Im so irritated I never got a biopsy for it. Should I be concerned over lymphoma or no? Should I go back to the doctor? Please give me thoughts",
  "input": "",
  "output": "Should I be concerned over lymphoma or no?You've had 4 physicians, multiple US, and blood work suggesting its fine. I'm not sure what else a physician over the internet is going to tell you at this point.Im so irritated I never got a biopsy for itWhy? Would you be irritated if it came back normal but you had a complication from the biopsy that you are still dealing with today? Would you be satisfied knowing the biopsy was normal, but there is a chance for a false negative?its freaking me outI think the bigger issue here is your anxiety. It does not sound well managed. This will lead you to never be satisfied regardless of what you do or have done. I would suggest your seek mental health therapy\/counseling for this."
},
{
  "instruction": "doc referring, can't figure out what's wrong, 32f 230lbs partial hysterectomy (have ovaries) in 2017 due to endo. Recently diagnosed PCOS after internal ultrasound. Massive weight gain within past year (80lbs) despite 900 cal diet and intermittent fasting. Whole body swelling, constant pain in feet, legs, back and pelvis area. I've had a slew of lab tests done and my doctor cannot figure out what is wrong. They are referring me to Hematology. They \"don't want me to worry\" so I'm getting half assed explanations. I'm frustrated and I really feel like my body is just giving up. My WBC has been elevated for over a year. I have attached pictures of my lab results. I have upcoming appointments for Hematology, a chest xray, CT scan of pelvis and Neurologist (daily headaches and vision issues) What would the point of a chest xray be if I'm not having difficulty breathing? Every time I ask for explanations they just skirt around it without giving me actual answers. I know speculation is not good but I would rather have an idea of what COULD be happening. https:\/\/imgur.com\/a\/sVjWCD9",
  "input": "",
  "output": "Have they ever ruled out hypercortisolism with a suppression test ? I can't find in your tests cortisol and ACTH values either"
},
{
  "instruction": "I don't believe so, that doesn't sound familiar. Is this something I should speak with Hematology about once I see them?",
  "input": "",
  "output": "It's an endocrine disorder that would fit most of your symptoms (and also the high WBC count)"
},
{
  "instruction": "Wow, after looking at this I have SO many of the symptoms. I've been living with unbearable stress for about 2 1\/2 years, it's caused crippling anxiety and I feel like I'm about to pop. I don't know if major stress could cause this or add to it. I'm calling my doctor now to see how I can have this testing done. Thank you so so much.",
  "input": "",
  "output": "Let me know if you have updates. The first step is a simple blood test (performed in the morning around 8AM), to measure Cortisol and ACTH."
},
{
  "instruction": "Just curious, why 8am? Is it tied to when most people get up or does it have to do with circadian rhythms and such?",
  "input": "",
  "output": "The reference values are based on that time, when there should be the physiological peak of cortisol. Hormones fluctuate a lot during the day, cortisol more than others, so a simple blood draw is usually not enough to get a diagnosis. Performing it at the right time helps a bit, knowing that it should be at its highest level of the day ( the lowest is around midnight )"
},
{
  "instruction": "I think the question is more so of \"how does the body know what time it is?\". If someone sleeps 11 am to 7 pm, it would be really interesting for cortisol to still be highest at 8 am.",
  "input": "",
  "output": "That is a great question. People with insomnia or who work night shifts might have altered cyclesI might be misremembering, and of course would defer to you (you being an endorcrinologist..), but I feel that I remember reading in medical school about the cortisol cycle being the least affected by behavioral changes in sleep-wake of most the diurnal cycles."
},
{
  "instruction": "I'm not sure, the second picture of my lab results has a TSH free line but it doesn't look out of range (that I can tell)",
  "input": "",
  "output": "Your TSH is fine, 0.7 is a good value"
},
{
  "instruction": "I don't know how to edit my post and not sure this info would be relevant but I'm always hot, constantly sweating. My temperature is usually around 99f. Also, both of my armpits are swollen, some days it hurts to even move my arms. The only time I've experienced something like that was after receiving my 2nd dose of Moderna and I was told it was swollen lymph nodes.",
  "input": "",
  "output": "Is it possible youre night eating?If you were eating a strict 900 kcal diet I have a hard time imagining you would be maintaining that weight.Do you take ambien by chance?Also why exactly are you referred to heme? You posted a mountain of labs and no one here will review them all for free, do you know what labs exactly are abnormal they were concerned with?"
},
{
  "instruction": "Mystery left abdominal painUpdate about 160 days later: mystery solved Had colonoscopy+EGD and emptying study. All that was found was mild gastroparesis. Two days ago I had a diagnostic laparoscopy and surgeon found deep endometriosis behind my uterus. Also found a large nodule of endometriosis higher up on my left abdominal wall, which explains the pain. Will have it removed in a few months and should be pain free.Original post: 32F 5'6\" 125lbs I have had left abdominal pain for about 3+ years now. It is directly left of my belly button. Most of the time, it's very dull and barely noticeable. However, a few days before my period it starts to intensify. Then during my period it is intense, to the point where my daily activities are limited. It has been getting worse over the months\/years.The pain feels kind of like a pulled muscle, and when I move\/sneeze\/cough, it is extreme. The only thing I can relate it to is a labor contraction. When I move or stand up straight, also extreme. If I hit a bump driving in my car, extreme pain. Then after about a week, it fades away to a duller pain until it comes back more fiercely next month.I began the process of exploring this pain with my OB\/GYN in 2019 and at the time it began, I had already had two miscarriages. I've had several pelvic ultrasounds and all were normal. We started the discussion of endometriosis and had some appointments set up with a surgeon for a consult on the laparoscopic surgery needed to diagnose it...and then he pandemic hit. My appointment got bumped, and bumped again, and then I got pregnant with my son who was born early 2021. I had no pain while pregnant and the pain didn't return until my period did.Early this year (2022), I saw my doctor again for the pain, loss of appetite, weight loss (now at about 35lbs lost in 2022), nausea. They did several blood tests and my WBC, RBC, and platelets all came in low. I was referred to hematology\/oncology where we did bone marrow biopsies and several other tests. No cancer was found, but it appears my bone marrow might be in the early stages of failure, perhaps developing aplastic anemia. I get my blood counts monitored each month and they have been low, but stable, so no action required at this time. Hematology also did another pelvic ultrasound and a CT scan of chest\/abdomen\/pelvis. My spleen is slightly (barely) enlarged, otherwise everything is normal. No masses found.Now that hematology has done their thing, GI will finally see me. I saw them last week and am scheduled for an EGD and colonoscopy early Jan 2023.The doctors are reluctant to explore endometriosis at this point. Their reasons are: I had a \"successful pregnancy\", they do not want to do the surgery because of my blood counts being low (too risky I guess), and there really isn't much they can do if it's endometriosis anyways. They had me try an oral contraceptive for a few months and that did not help.Any ideas on what this could be? What questions I need to be asking? What other tests to request? Im at a loss and growing weary of spending money on all these tests that are coming back negative.",
  "input": "",
  "output": "Have you been checked for an umbilical hernia? either by imaging or by a general surgeon?"
},
{
  "instruction": "I have not met with a general surgeon. My CT scan of chest\/abdomen\/pelvis didn't show anything, which I'm not sure if it would or not. I brought up a hernia to my PCP because I had read an article about how hernias in females are often harder to diagnose and she felt my stomach and said she didn't think it was that. I will bring it up again.ETA: Wouldn't I have been in excruciating pain throughout pregnancy with a hernia, especially toward the end? I didn't have the abdominal pain at all during pregnancy. Just curious!",
  "input": "",
  "output": "My CT scan of chest\/abdomen\/pelvis didn't show anythingIn my experience, radiologists often do not report simple fat containing hernias, so I always look at the CT images myself to see if there is actually a hernia that just wasn't commented on by the radiologistread an article about how hernias in females are often harder to diagnoseyou are probably referring to inguinal hernias not umbilical hernias. Maybe you could ask for a referral to a general surgeon depending on what ur pcp saysWouldn't I have been in excruciating pain throughout pregnancy with a hernia,No. Hernias can cause pain but many of them do not. And women very frequently get umbilical hernias during pregnancy. So thats why your history of pregnancy and now periumbilical pain made me think possible hernia."
},
{
  "instruction": "Is this hematology panel indicative of chronic lymphocytic leukemia in a 61yo female?HematologyWBCA134.0-10.010*9\/LRBC4.463.50-5.0010*12\/LHemoglobin140115-155g\/LHematocrit0.40.35-0.45L\/LMCV9182-98flMCH31.427.5-33.5pgMCHC347300-370g\/LRDW1311.5-14.5%Platelet Count270150-40010*9\/LDifferentialNeutrophils4.12.0-7.510*9\/LLymphocytesA7.91.0-4.010*9\/LMonocytes0.70.1-0.810*9\/LEosinophils0.20.0-0.710*9\/LBasophils0.10.0-0.210*9\/LGranulocytes Immature00.0-0.110*9\/LWBC MorphologySMUDGE CELLS presentRBC MorphologySTOMATOCYTES presentHematology CommentsResults are pending ...Recent screening torso MRI:Potential mild cardiomegaly. Note that this is not a study accurate for cardiac evaluation. Possibility of left ventricular hypertrophy is raised. Please correlate clinically and with dedicated echocardiogram or MR imaging as required.An increased number of lymph nodes at both axilla and hila although these are still measuring within normal sizeA mild degree of edema at the lower gastroesophageal junction, may indicate chronic gastroesophageal reflux disease. Mucosal details are not available.Both kidneys have focal areas of volume loss; this is worse on the left and may indicate scar tissue, sonographic evaluation for any underlying pathology would be beneficial. Is there any concern for embolic events?Multilevel degenerative disc disease, described above. There is also likely bilateral L5 spondylolysis with potential for malalignment in addition to the scoliosis.There is a nonspecific bone lesion at the posterior left femoral head, a somewhat similar configuration focus at bilateral posterior pubic bodies. These potentially may be compatible with erosions or subchondral cyst formation, Recommend nonurgent radiographic correlation.Borderline prominent spleen correlate clinically.A small segment 7 cystic lesion can be assessed with nonemergent ultrasound. Possibly septated hepatic cyst, hemangioma or less likely cystadenoma. Reported using speech recognition.",
  "input": "",
  "output": "Not really. White count is only 13"
},
{
  "instruction": "Was the presence of smudge cells that tripped me up, but maybe that can be normal? Right now she's been having chest pain and I highly suspect CAD but without a positive ECG or elevated troponin they won't do anything further.",
  "input": "",
  "output": "CLL typically has white counts in the hundreds, not 13.Without more details on the chest pain I cant really comment"
},
{
  "instruction": "Please, please help...no one can figure out whats wrong and at my wits endI've posted here before and no one ever seems to answer but I'm getting so sick that I'm basically bed bound from pain.I'm a 32 yo woman, overweight at 280 lbs, diagnosed with Sjogren's, PCOS, and on these medicines:Metoprolol for tachycardia I've had since childhood Metformin for PCOS Spironolactone for low potassium I've had since childhood (used to have constant racing heart and passed out a lot as a kid because of low potassium) as well as PCOS Nuvigil for chronic fatigue Pilocarpine for Sjogren's dryness Doxepin for ribcage pain Rosuvastatin for high cholesterol Low dose naltrexone 3mg for chronic pain Trintellix for depressionA few years ago, like 5 years now, I was healthy and 125 lbs. Then I had my 2nd child, was about 180 after she was born, and developed PCOS. I could not lose weight and gained a little more and got to about 225.In Dec 2019, my psychiatrist put me on Trileptal for mood stability. About a month later, I started to develop pitting edema and severe low ribcage pain and then had absolutely zero appetite whatsoever. I went to the ER with grade 4 edema, severe low rib pain, and blood in my urine and bloody vaginal discharge. No sign of infection, no excess protein, nothing really out of the ordinary aside from GFR that would dip into the 50s before sometimes coming up again and blood. I did get low iron and potassium, needed iv potassium several times, but they could find nothing to easily explain symptoms. This goes on for nearly a year...I got up to 325 lbs even though I could barely eat or get out of bed. I truly thought I would die.I stopped taking my medicine when I couldn't eat, and noticed I felt worse after taking it again. I also felt worse if I exercised. So I stopped Trileptal and rested for about a month and slowly seemed to recover. Then my OBGYN found uterine polyps and I had surgery to remove them. The next month, my gallbladder was removed. The next month, I had surgery to \"fix\" my urethra since they thought maybe I was having urinary problems stemming from that.But I got better and tried to be okay mentally with the constant dismissals I got from so damn many docs before I finally got some help. It was extremely difficult and I suffered with health anxiety because of it but have done great with therapy. I even managed to get my weight down to 235 after starting exercise after being sure my kidneys were fine again at a consistent GFR over 110.Then a month ago, I got a very bad case of flu. The lower rib pain came back bad. I dismissed it as flu. Recovered from it, then had several days where every muscle in my body felt like it had been lifting heavy weights for days. Everything hurt, and doc said maybe mild myositis from flu. Then I noticed urinary changes. I normally have frequent urination, going a few times a night and usually at least every hour or more. No one can find a cause though. But suddenly not going at night at all and only going like 3 times in the day. Started having white flecks in urine sometimes and strong odor. Then urinalysis started showing blood in urine consistently. Then sharp pains in urethra all the way to anus at times, which I'd had before as well. I have brown vaginal discharge too. A few days ago, I couldn't pee at all and was sent to the er. They can find no reason for my symptoms...nothing on ct, no bacteria in culture, no stones, no nothing. No one knows, but I had to have a foley catheter inserted (was very painful like stabbing) because I had retention and could not pee. Was sent home with it and had it removed next day and I was able to pee again but then developed pitting edema. It's currently grade 1. No cause can be found.I will add in case it is relevant, just before the flu, my pcm referred me to neurology for mris of head and spine and nerve conduction test. I've been having nerve pain for several months. Buzzing, tingling, numbness, shocks, in various places for sustained periods and sometimes just sudden and then goes away. She was thinking the lower rib cage pain may actually be nerve pain since it feels burning at times like the burning headaches in the base of my skull and my neck. My thyroid is sometimes hypo but usually fine, my b12 and magnesium are normal, and I do not have any markers of diabetes other than just being fat currently. My grandma has MS, which she believes was healed by Jesus, but I know enough about it to know that's what she's trying to rule out I'm pretty sure.Can anyone, please , give me some insight about what might be wrong with me? I'm in so much pain with the gnawing, burning pain in the bottom of my ribcage and the electric shock pains in my urethra and anus, and I am so scared of the fact I've got urinary bleeding, vaginal bleeding, and putting edema but no one knows what's up. I've seen rheumatology, nephrology, urology, obgyn, even was sent to a hematology oncologist as a hail-mary.I stay away from Googleing anything because for one, I have too many symptoms to easily fit in a search bar, and I know there's no good coming out of looking at it anyway. I have gotten better care since changing hospital systems after last time this happened, the urologist I saw kept insisting the blood in my urine was from my vagina even though I still had blood in my urine after a catheter was used to sample, and I e just had a really hard time getting docs to push to figure out what's wrong. It feels like since I don't appear to be imminently dying, and they dismiss my pain and exhaustion, no one sees a point in helping.So sorry for the long post but I'm just trying to give as much context as I can. Please let me know if you have any questions as I'm happy to answer.",
  "input": "",
  "output": "In the absence of objective findings on imaging and testing, it is possible that weight in itself can cause the multi-system problems that you have. Obesity unfortunately affects numerous organ systems in subtle ways initially."
},
{
  "instruction": "Can someone decipher my hematology panel?Age: 36Gender: MaleWeight: 88kgs, Height, 175cmsLocation: CanadaEthnicity: SE AsianMeds: 40mg Pantaprazole 2x a dayGot some bw done recently for stomach pains, crazy ACID reflux nausea, bloating and right sided flank pain. Seeing my GP on Sunday, but wanted some ideas in the mean time.Image at link below:https:\/\/imgur.com\/GaF9PCg",
  "input": "",
  "output": "To me it looks like iron deficiency"
},
{
  "instruction": "Thanks. That's kind of what I gathered from my uneducated Googling, but I just don't have any fatigue, brittle nails, hair etc. The only symptoms of worry (which started this whole thing) have been crazy acid reflux, nausea , bloatedness, abdominal aches and pains and sharp flank pains.",
  "input": "",
  "output": "The deficiency isnt big enough yet to affect your hb more something to be aware ofThe other symptoms sounds like something else. Consider this probable iron deficiency as an accidental find during tests"
},
{
  "instruction": "Multiple diagnostic tests and still no answers.Hi there! I am just looking for any answer, preferably from someone who has a background in hematology? I am a 29 year old female, and was hospitalized for an unknown illness in April (fever, chills, all over body aches). The doctors ran many tests (HIV, mono, Covid, Flu, RSV, blood cultures, abdominal CT, pelvic exam, pelvic ultrasound, CBC tests, etc.) and still were not able to find what was causing my symptoms. I worked with an internal medicine specialist after my hospitalization because I continued to get sick and have fevers every couple of weeks until July. She ended up testing me for many infectious diseases and they were negative (with the exception of EBV, but this didn't look like something new). Also tested me for an ANA marker (negative). Her biggest concern were my elevated platelets and WBC. She noticed these had been elevated for >6 months. I had a peripheral blood smear and saw slight leukocytosis with left-shifted neutrophilia and monocytosis, slight thrombocytosis with normal platelet morphology. No abnormal circulating cell populations identified.She referred me to a hematologist who I have been working with but still no answers. The hematologist tested me for a JAK2 mutation (negative), CALR mutation (negative), BCR-ABL (negative), and redid my CBC count. She had been thinking potentially essential thrombocythemia (ET). This time my reticulocytes are elevated and my circulating antibodies are elevated. I do not have an iron deficiency. My WBC and platelets continue to be elevated and they ran another peripheral blood smear with similar findings. Everything seems to point to \"favor reactive\/inflammatory\". However, in looking through my historical lab reports, we can see this blood work has actually been a pattern for the past 9 years! I have begged her to do a bone marrow biopsy just to triple check for ET or other MPNs because it seems that about 50% of patients with ET have no genetic mutation but she said no. I just feel like I need to know why my bone marrow is pumping out immature blood cells and extras of others. Now she's referring me to a rheumatologist and I don't understand why except that I may have chronic inflammation. I have no joint\/muscle\/bone pain, my ANA marker test was negative. Could it potentially be something like autoimmune hemolytic anemia since my reticulocytes are elevated and antibodies?I'm just so tired of being dismissed by doctors over the years and not having answers. I am so exhausted all the time. I just want someone else to give me another opinion or potential ideas for new avenues to explore. I am following up with the hematologist in January and have an appointment with a rheumatologist that same week, hoping to get in earlier if someone cancels.Thank you so much in advance.",
  "input": "",
  "output": "Were you tested for a mutation in a gene called MPL?Does your peripheral blood still show a left shift, or has that resolved?"
},
{
  "instruction": "Hi! I wasnt tested for an MPL mutation, just CALR, JAK2, and BCR-ABL. The left shift was still there in my last blood test in late September. Not sure if it has been a left shift the whole time but in my past records (over 9 yes) my WBC is almost always elevated in addition to my platelets.",
  "input": "",
  "output": "You might try asking for a MPL mutation test (can be done from DNA extracted from your peripheral blood or bone marrow aspirate). Also, do you know if your CALR test was done by PCR and electrophoresis, or sequencing (i.e., next generation sequencing, NGS)? The PCR + electrophoresis method can usually identify but not characterize atypical mutations (i.e., not type 1 or type 2), whereas NGS can identify and characterize any mutations. Only about 1\/8 of essential thrombocythemias are \"triple negative\" (lacking mutations in JAK2, CALR, and MPL).Another angle would be trying again to get a bone marrow biopsy and see what that shows."
},
{
  "instruction": "What are your thoughts on the left shift?",
  "input": "",
  "output": "That's nonspecific. Causes could range from an infectious process, an autoimmune process, a malignant process, or none of the above."
},
{
  "instruction": "Oh okay I see. Thank you! Did you see my other comment about the CALR test type?",
  "input": "",
  "output": "Yeah -- so it's almost certain you don't have a classic CALR mutation (type 1 or type 2) but some small possibility remains you have an atypical one.If you end up getting a bone marrow biopsy done by someone (you can always ask the rheumatologist to order one and see what they say), you can always try to get a comprehensive NGS panel done on the resulting sample. Depending on who your healthcare system contracts with, this is usually a 50-75 gene panel that would include JAK2, CALR, and MPL, as well as various other genes commonly mutated in myeloid malignancies. It could still be negative, though -- about 1\/4 to 1\/3 of the NGS panel cases I sign out are negative. Hopefully this is something your insurance would pay for, as this is a very pricy test."
},
{
  "instruction": "Do I have hepatitis b? [Lab Results]Hi there, I just recently started going to the VA and they did a lot of blood test on me. I will l double check with my PCP but to be frank, I would like a second opinion either way.Does the below indicate that I am positive for hep b, and it seems as though I've contracted it within the last 6 months. Is this accurate?Mandatory stats: 36M, 5'10\", 230lbs, white, no existing medical issues with STDs except I have HPV, no medication, moderate drinker, smoke cannabis moderately. USA.Lab Test: Hepatitis PanelLab Type: Chemistry\/HematologyOrdering Provider: [REDACTED]Ordering Location: [REDACTED]Specimen: Serum (substance)Date\/Time Collected: 30 Sep 2022 @ 1305Collected Location: [REDACTED]-------------------------------------------------------------------------Test Name: HEPATITIS B SURFACE AbResult: POSITIVE Units: --Reference Range: Interpretation: Never infected with the virus (consider giving vaccine)HEPATITIS B SURFACE Ag - negativeHEPATITIS B CORE TOTAL - negativeHEPATITIS B CORE IgM --- negativeHEPATITIS B SURFACE Ab - negativeInfection likely took place over the last six months and is still active.HEPATITIS B SURFACE Ag - POSITIVEHEPATITIS B CORE TOTAL - POSITIVEHEPATITIS B CORE IgM --- POSITIVEHEPATITIS B SURFACE Ab - negativeInfection likely took place over the past six months and is in theprocess of clearing.  A false-positive is another possibility(HIV-positive people with this particular test result should have theirHBV viral load checked).HEPATITIS B SURFACE Ag - negativeHEPATITIS B CORE TOTAL - POSITIVEHEPATITIS B CORE IgM --- POSITIVEHEPATITIS B SURFACE Ab - negativeInfection likely took place more than six months ago and has beensuccessfully controlled by the immune system.HEPATITIS B SURFACE Ag - negativeHEPATITIS B CORE TOTAL - POSITIVEHEPATITIS B CORE IgM --- negativeHEPATITIS B SURFACE Ab - POSITIVEThe vaccine was successfully given to prevent HBV infection.HEPATITIS B SURFACE Ag - negativeHEPATITIS B CORE TOTAL - negativeHEPATITIS B CORE IgM --- negativeHEPATITIS B SURFACE Ab - POSITIVEChronic HBV InfectionHEPATITIS B SURFACE Ag - POSITIVEHEPATITIS B CORE TOTAL - POSITIVEHEPATITIS B CORE IgM --- negativeHEPATITIS B SURFACE Ab - negative Performing Location: [REDACTED]Status: Final----------------------Test Name: HEPATITIS B CORE TOTALResult: NEGATIVE Units: --Reference Range: Interpretation: -- Performing Location: [REDACTED]Status: Final----------------------Test Name: HEPATITIS B CORE IgMResult: --Units: --Reference Range: Interpretation: -- Performing Location: [REDACTED]Status: Pending----------------------Test Name: HEPATITIS B SURFACE AgResult: NEGATIVE Units: --Reference Range: Interpretation: -- Performing Location: [REDACTED]Status: Final=========================================================================",
  "input": "",
  "output": "Vaccinated and immune"
},
{
  "instruction": "Nutritional advice regarding protein shakes\/liquid dietHi guys! Im not really sure if this is the right place to post this, but I figured its worth a shot:) Im 22 female, 53 and about 220lbs (yes Im overweight, yes Im working on it, Ive lost 20lbs in the last 4 or so months) with autism and ARFID, I was also recently diagnosed with PCOS. Im currently only taking yaz birth control. Ive struggled with eating\/wanting to eat since high school, and typically I only eat once a day because Im either not hungry or the thought of eating makes me feel sick. Recently, since I was diagnosed with pcos, Ive been placed on birth control. Ive noticed that I get hungrier faster than I used to, which isnt necessarily a bad thing. The issue is within an hour of eating, Im starving again. Ive just constantly felt empty but because im so hungry, I feel sick and cant eat, which obviously makes everything worse. My question is, since I dont have a nutritionist atm, and I have to go to the store Tuesday for groceries, if you guys had any recommendations on protein shakes or simple snacks that are super filling\/cheap that I can get until I can work with someone on my diet? Im just so tired of feeling like this lmao",
  "input": "",
  "output": "Your weight and PCOS put you at risk for diabetes. Talk to your doctor about adding metformin to your regimen. Get screened for diabetes. In the meantime high protein\/low carb diet will help, but dont do it for too long."
},
{
  "instruction": "How many nutritional supplement drinks is it safe or wise to drink in a day?In the past several months I have experienced a significant (and possibly severe) reduction in my appetite. I'm just not hungry, and I can't force myself to eat without feeling sick. Which more often than not leads to me not eating for several days, usually without even realizing it. I also can't sleep at night.. yay me. But that's not what I am addressing here.I had someone tell me since I'm not eating as much as I should, I should drink those Ensure shakes to make up for some of the nutrients I am not getting. What I want to know is how many should I be drinking each day? Just one? I also got myself fruit and spinach and stuff to make some healthy smoothies. I'm trying to plan good meals to eat, but my lack of appetite is making that harder than it probably should be.Diagnosed: ADHD, low blood sugar, asthma, and depression Current meds: Singulair for asthma Female, 5'6\", 130lbs",
  "input": "",
  "output": "They're designed nutritionally balanced so you just need to match the calories you need."
},
{
  "instruction": "Could lack of nutrition explain my (86F) Grandmother's poor health?I hope this is a relevant place to post this, I'm not sure which sub is best, but any opinions would be extremely welcome. Sorry for the long post.My Grandmother is 86 years old, lives in the UK and in the past 4 years has seen a tremendous downturn in her health and wellbeing. She suffererd a broken ankle 4 years ago abroad, and was put on a plane for a 9 hour flight home despite this so she could be treated for free in the UK. Shortly after she fell in the bathroom and hit her head, and her health has never even close to recovered since. Doctors have done every test they're willing to do on the NHS and they never find anything wrong.Those events certainly marked the start of her decline, but she is now getting much worse. She has no energy, often doesn't get out of bed, and is extremely unsteady on her feet. She describes this as being like a massive head rush where her legs simply give out every time she stands up. She can't cope with any situation outside of the absolute normal, is getting confused all the time but not in a way that reminds me of dementia. It's more that she simply doesn't seem to be able to think clearly or quickly. Her actual memory is generally ok. She is on Bisoprolol for a heart condition, and otherwise just vitamins.I do her shopping for her every week, and it's a constant argument. She wants me to buy enough food for MAYBE 2 days at most every week. I buy her more but it often just gets put in the freezer or goes out of date. She insists she eats plenty, but I simply can't see this being true. She weighs about 6.5 stone and hasn't got an ounce of fat on her body, she is scared to drink because of having to get to the toilet also.I don't live with her so I can't say for sure how much she eats, but it's can't be much at all. A brioche roll in the morning, a cake or something in the afternoon at most, abd no more than half a small ready meal on the evening, but again, I only buy her maybe 3 days worth of meals at most and they're often uneaten.She is beyond frustrated that she is just getting worse and worse, but I can't help but think the answer may be as simple as she is almost always nearly starving. She is a very stubborn person and refuses to even try to just eat more, or even try to sip a nutrient rich shake or something just to see if it helps. She talks like a person with a weight disorder to be perfectly honest.I appreciate that most of this stuff sounds like she's just old, but she's declining so rapidly, I just want to try anything that gets her even a small amount of quality of life back. I hope this is somewhere within the accepted rules of the sub, any opinions would be appreciated. Thanks.",
  "input": "",
  "output": "Fractures are a huge risk factor for older people, and her story is not uncommon. While her poor food intake might make the decline worse, the relationship might be the other way around: she's feeling poorly and therefore has lost her appetite.I'd recommend you have a chat with her and her doctor first, where you bring up your concerns. It's also not uncommon for older people to be reluctant to discuss these kinds of issues with their doctors and family members to avoid \"being a bother\" or feeling like a burden. The issue is that those little things pile up quickly, and if they aren't taken care of, they become bigger problems. It might be best then of you bring them up, but keep in mind that she might be embarrassed. I am concerned about the dosage of her bisoprolol, as the feeling of her legs suddenly giving out might be a sign that she needs a lower dose or perhaps a different medication all together, but if she hasn't mentioned it to her GP then they wouldn't be aware of it. It might also be time to discuss perhaps getting a carer for a few hours every day, to ensure she's eating and reduce her risk of falling or getting UTIs from avoiding the toilet.It is important to remember that your gran is an adult, and so long as her mind is still all there, she can make her own decisions, even when neither you nor her doctor agree with her. Losing whatever control she has over her life, be that over her food or her medical care, could have a much bigger impact to her wellbeing than what you're perceiving from her intake right now, so all of these conversations need to be approached tactfully and keeping her as the decision maker."
},
{
  "instruction": "Are 'superfood' nutrition supplements sufficient to keep my body from going into a nutritional deficit?27M. Occasional tobacco smoker. 5 foot 7.5 inches. Exercise regularly.Obviously, it's best to maintain a diverse and healthy diet filled with vegetables, fruits, meats, grains, nuts, etc.I'm well aware of that, but I've got a ton of other stuff in life going on that I'm trying to focus on, and diet is currently not my top priority. That being said, if I'm going to maintain a \"minimally effective\" dose of nutrients towards my diet - is taking a superfood supplement enough to stave off diseases, etc? Or would this be throwing a tiny bandaid over a gash?I eat mostly healthy foods, rice, meat, oatmeal, frozen fruits etc, but sometimes I just don't make the effort to eat enough fruits and vegetables. Mainly, there is a lack of diversity in the fruits I eat. I've heard that in general, you should try to eat diversely so you don't miss any crucial nutrients.Is supplementing with a nutritional powder like Green Vibrance from Vibrant Health or Vital Reds sufficient if I have somewhat of a healthy, but repetitive diet?",
  "input": "",
  "output": "With a good balanced diet (which you clearly have) there is absolutely nothing to be gained from vitamin supplements.The supplements are at best less effective than a regular diet, and have potential for harm. You should avoid using them unless recommended by a physician.The point of a good diet is less that there are definite nutrients needed and more that eating a variety of foods with non-caloric bulk reduces risk of weight gain and metabolic syndrome. Theres no evidence that supplements of specific vitamins are good for you without specific deficiency; theres no evidence for superfood supplements and very little to justify the super in so-called superfoods.Eating a perfect diet every day is not practically achievable for most people. Eating a good diet mostly is whats important."
},
{
  "instruction": "Nutrition questionI've been really good about monitoring calories, saturated fats, etc for a while and have lost quite a bit of weight. Is it wrong to splurge for a single night? I'll be having pizza with my folks and don't want to mess with my overall health.",
  "input": "",
  "output": "I am not in the slightest concerned about you eating pizza for the evening. What worries me is the general context here, what is your relationship with food like? How much do you weigh and how quickly are you losing weight? If you're counting calories, how many do you eat in a day?"
},
{
  "instruction": "I keep getting quad cramps above the knee every time i go hiking. Is this a nutrition issue or just overall shape?Want to preface this by saying i plan to see a dr or even nutritionist next week. However right now I'm on a hiking trip, so just kind of hoping for any quick advice.I'm 30M in good shape and health, but cardio has never been huge for me. Lately I've been doing spin a few times a week trying to change that habit. I've been hiking for a few years and never had any issues until the past year or so. All of a sudden every single hike i do, once it starts to get challenging i get bad cramps in both my quads right above the knee on the inner side.I've been trying to totally change my hydration habits, drinking a lot before and during the hike. Gatorade before and during, even tried supplementing with those emergency electrolyte packs. No change.I know it's a long shot but anyone ever had this start to happen and figure out how to fix? Or is it just getting in better shape?",
  "input": "",
  "output": "Lack of calcium or potassium and dehydration is the most common cause- I dont think this needs a doctor but do take more than just a light supplement. A banana is actually perfect for preventing cramps."
},
{
  "instruction": "Internist advised to go to hospital for nutrition but when?Hello,22year old female who has been vomiting for the past 13 days. Was referred to an internist. He has referred me to a gastroenterologist.The internist was concerned about my nutrition intake and told me I may have to go to the hospital for some type of supplemental nutrition. I asked him when but he was vague about it, and said I would feel shitty.Well, Ive felt shitty for a while, and was wondering at one point I would need to go for some type of supplemental nutrition. Have been vomiting all food for 13 days, and some fluids. Have lost weight (do not have a scale), but clothes are loose, and I track my calories and last week averaged 150 cals and this week averaged 300.I did have to pick up a prescription today and discussed it with the pharmacist who advised me to go, but I was hoping I could also get a doctors opinion since I would prefer not to go to the hospital if I do not have to.Thanks!",
  "input": "",
  "output": "I would go today. 300 calories a day is not sustainable and your *body will be taking damage from that."
},
{
  "instruction": "(1) In general hypoechoic lesion worst than hyperechoic?(2) I've been taking supplements such as Vit-D (2000IU almost 4 times a week), NAC and Zinc (once in a while) to avoid Covid based on what i've read. I also take whey protein\/collagen at times for recovery after the run\/weights. I've been reading taking too much protein or anti-oxidants can also cause cancer? Please comment if anti-oxidants can actually cause reverse damage?(3) I know ultrasound is safe in general, but what are your comments\/thoughts on heat on the organs if i go for scan once every year. The radiologist scanned 15 minutes on my liver which was bit too much IMO(4) Would you recommend me to go for MRI? I know MRI are safe (no radiation), but again those Radio Frequency, no one knows how it impacts us in the long run?As you can read, i am anxious and hypochondriac. Would love to read your thoughts and comments.PS - Scan if you want to see https:\/\/imgur.com\/a\/GofAWbX",
  "input": "",
  "output": "Hypoechoic is generally better and a cyst, but it depends on the actual look and situation. Hemangiomas are benign.Antioxidants seem to help, but there's not enough knowledge to say how much. (Maybe my own knowledge). That being said, antioxidants don't negate bad habits like smoking, alcohol, etc. Better diets and habits are the main way to reverse damage. There's a lot of literature easily found regarding epithelial oxidative injury. Too much anything seems to be bad. Water, protein, oxygen, etc etc.Ultrasound is considered safe. It is used on babies' brains if that helps you feel better.You should get an MRI if the impression on your scan says that the lesions need that kind of evaluation."
},
{
  "instruction": "How quickly can you develop nutrition-based anemia?Thanks to lockdown and a breakup, something I thought never possible happened--I (28\/F) began relapsing into anorexia, which I recovered from several years ago. For the past month, my diet has cratered, generally hitting 700-1000 calories a day. What I do eat is horrible--popcorn, Clif bars, and protein shakes. That's it--no other foods. Needless to say, I have lost a significant amount of weight, and I was thin to begin with. (For reference, I'm 5'2 and am 99 lb now--I was about 105 before).I run for 30 min 4x a week. Lately it has become harder and harder; my heart rate skyrockets, and I tire quickly. Is it possible for anemia to have set in due to poor diet already? I've struggled with that in the past due to the ED, with similar symptoms.(To be clear, I *know* I have to address my eating disorder; I am not so naive as to reduce the problem here to just anemia. I've done this rodeo before; I've already hit the weight I said I would stop at, and of course I am still restricting, because that's just how EDs work. I am seeking therapeutic help.)",
  "input": "",
  "output": "It will be hard to tell you that and honestly probably easier to just get your labs checked. In theory, yes, it can happen but it would require a lot of conditional circumstances existing prior to this month to tip you over. In reality, probably not:You need to be iron deficient prior to this month so that your body can't make adequate RBCs this monthYour blood cells typically last up to 120 days, so you shouldn't drop significantly in a single month under normal circumstances even if iron deficientYou are female and if menstruating, that could be a source but usually it isn't enough in a single month (unless you were anemic to begin with or severely iron deficient to begin with or heavy menses)Honestly, your fatigue, heart rate, exercise intolerance is probably due to your inadequate caloric intake and your body trying to preserve energy (and breaking down your body fat\/muscle)"
},
{
  "instruction": "Anemia isnt the only potential issue here. All your cells in your body need food for energy. If you are using much more energy then you are putting in to your body, you're gonna run out of energy. You're starving yourself. Like when someone is ill from starvation. Just slightly slower.",
  "input": "",
  "output": "Possible, but it's more likely that there are other factors contributing to your easy fatigue, such as dehydration and overall lack of metabolic fuel due to your restricting. While you're seeking help, I think it would be advisable to cut down on your exercise regime as well."
},
{
  "instruction": "Nutritional Advice33F, currently 150 lbs, 5'6\", white. Previous diagnoses: PCOS, migraines with aura, acid reflux, several skin allergies. Medication: None currently. Alcohol: 1-2 glass of red wine per week, no recreational drugs.TL;DR: How the hell is one supposed to eat 18 mg of iron daily?Very bad choices led me to gain a lot of weight in my 20s, got to be a max of ~220 lbs by the end of 2018. GP told me I needed to lose weight, so I did. I started eating healthier and exercising more. For the past 4 months I've been eating below 1400 calories on average. I'm still losing weight, but I started to feel very tired in general, and get easily out of breath while exercising. GP send my to take a blood panel 2 months ago. Results came back and he said I was ok but said that since CBC values came considerably lower than the last few times, I needed to eat more iron rich foods. Since I'm already logging the foods with an app that tells me the nutrients, he said I should aim on getting 18 mg of iron daily, and explained all the ways of maxing iron absorption (vitamin C with heme iron, avoid dairy in same meal, etc).So it's been 6 weeks since I started paying attention to the iron. I use a digital scale, and verified sources (like USDA) to check iron amounts on every food. I still have severe issues trying to reach that daily amount. It seems like the only days I'm able to reach it is when I ether eat beef liver, mussels or a huge amount of spinach. I love spinach, but I don't really enjoy liver or mussels so I have to find ways to have them. Beans, lentils and seeds are good, but I can't have too many since I'm still losing weight. The days I have those with some eggs, I still can't reach 10 mg of iron.Past 2 to 3 weeks have been worse, I feel even more fatigued and dizzy than before. I think because of the pandemic measures in my country, my GP's office have stopped answering phones. I left a voice message but haven't hear back from them yet.So question is.. how do people do it? It seems an insane amount to get daily.If it matters, here's my last BP:Hc: 36%Hb: 11.9 g\/dLRBC: 3.880.000 \/mm3Colour Index: 79.33%MCV: 92.78 \/um3MCH: 30.67 pgMCHC: 33.06 g\/dLI would greatly appreciate any input on how to improve my nutrition",
  "input": "",
  "output": "Hmm, based on those results your hemoglobin is low, however the pattern doesn't really look like iron deficiency. With the PCOS do you have a lot of bleeding? It could be that your body is just unable to keep up with the blood loss. You might ask your doctor to check your iron levels to be sure. I think the amount of iron you are eating is probably okay based on the results you posted. If you want to try to get more, you could try an iron supplement, but if you do start at a fairly low dose and go up gradually because it can cause some stomach upset. If you can't find iron supplements, you could try prenatal vitamins which tend to be well balanced and have high levels of iron. It's hard to tell just from the parameters you posted, but I would also be concerned about your vitamin B12 levels. Make sure you are getting the recommended dose of B12, and consider adding a B12 supplement. If you are still having trouble after a couple weeks of this, and your hemoglobin remains low, you should probably have your iron and B12 levels checked. (for the sake of clarity, we usually don't actually check B12, we check some other chemicals in the B12 pathway)"
},
{
  "instruction": "I have not noted an increase in bleeding. I also go yearly to my gyno, last time I did a check was on January, PAP smear was normal, and last TV ultrasound showed normal follicles, gyno said she thinks losing weight might have helped.I haven't had my B12 checked, but the app to track nutrients tells me I'm almost always good on B12 levels.I'll see if I can find the supplements you suggested, and start from that. I don't see being able to take a blood sample again soon because of the COVID situation here, since only emergency appointments are allowed.Thanks a lot for your time and answer and have a lovely day!",
  "input": "",
  "output": "The amount of B12 you're eating might be good for maintenance (to keep your level stable), but if you are low, you might need more. Especially if you have Had a poor diet in the past, the levels stored in your body might be low"
},
{
  "instruction": "Child Weight\/NutritionMy son is 4 years old and one month. He's 39.36 inches tall and weighs 40 pounds even. According to bmi he is obese. I am asking what would be good numbers of calories and nutrients to feed him? He's very active so I'm not concerned about excercise. Also his pediatrician says his weights fine and that bmi's don't always work right for children, is that accurate? Should I just not worry because a growth spurts close? I'm prone to worrying when there's no problem so maybe the doctors right? The only reason I'm even doubting the doctor is because he is, at a guess 375-400 pounds, and I worry he is more okay with obesity than he should be. My son was 9 ppunds and 8.9 ounces at birth, caucasian, non-Hispanic. If that's relevantEdited to add: He has just gotten over pneumonia twice and has low IGG, we are seeing an immunologist soon to figure out why. So taking him places to figure out calories and nutrients isn't really possible right now because we are staying inside. Just hoping for advice until I can take him out, thank you :)",
  "input": "",
  "output": "Obesity at his age is highly associated with adult obesity, but far easier to fix now than later. Some kids slim down but many do not.Easiest solution is to meet with a registered dietician (NOT a nutritionist). They can help you plan meals so he has the right number of calories \/ balance of nutrients.That being said, the easiest (and one of the more effective) ways to slow weight gain is elimination of all liquid calories, even milk. Only water to drink."
},
{
  "instruction": "I'm probably not going to make an appointment with a dietitian right now because of the coronavirus and my son also has a weakend immune system which I probably should have mentioned, so any ballparks would be helpful until I can get in. We have been cutting out calorie drinks besides milk at breakfast and juice with dinner. The confusing thing for me is he really doesn't snack, maybe he was just having way too much juice before. Thank you!",
  "input": "",
  "output": "You can do a phone appointment with an RD."
},
{
  "instruction": "What will happen to someone (29F) drinking only one 330 Calorie nutrition shake a day?A friend has been having a mysterious, very serious neck\/jaw issue for the last two years, rendering her unable to eat solid food. She has been to many doctors, who were all unable to diagnose or treat the issue.She often lives on Kate Farms nutrition shakes, which have 330 Calories each. She would usually drink 4-5 a day, plus whatever else she felt able to swallow. Recently however, in particular after restarting taking her antidepressant medication, the feeling of choking on anything she tries to drink has worsened  she describes it being possible to drink a shake in the morning after waking up, but getting more and more difficult throughout the day.She reports that she has only had an average of one a day for the last 3 or 4 days. There's no sign that it's getting better, and she is feeling resistant to trying to drink more of them because it is so physically unpleasant\/scary to do so. I'd like to present her with some solid information about the progression of malnutrition  what kind of symptom timeline can she expect if she stays at this extremely low Calorie intake?She is already obviously very low-energy and depressed. I'm looking for concrete info on how many days of 1 shake\/day average it will take before other serious physical symptoms of malnutrition emerge.Thanks!Age: 29Sex: FemaleHeight: 5'4\"Weight: ~130, reports losing 50lbs from normal weight a year agoRace: ChineseLocation: Eastern US",
  "input": "",
  "output": "They will die. This is not enough food to live. She needs to go to the hospital."
},
{
  "instruction": "Flu-like ache but definitely not the flu. Could it be linked to a nutritional deficiency?32 F.Height 5' 11. Weight 145lbs.Vegan diet, health-conscious, mildly-moderately active.I've basically had fatigue and consistent mild pain since I was a teenager (my doctor put it down to depression). But this has continued into adulthood and I'm becoming determined to get to the bottom of it.But for the past couple of weeks I've been having this really weird sensation of a deep ache and tightness throughout my body, like it's in my bones and my joints. The closest thing I can describe it as is that it's similar to when you have body aches with the flu, but not nearly that bad. It's quite mild, but I feel like I can feel it throughout my chest\/back\/ribs, in my arms and hands, and occasionally in my legs. It's not debilitating, it's just weird and a little uncomfortable. It's not consistent either, it sort of comes in little waves\/pulses. I get a deep pain in my leg bones sometimes when the weather is very hot or very cold, and it's a similar ache to that but again not as severe, just a similar 'deep'ness.Have you heard of this before?!I'm looking into getting some tests done to see if I have a chronic deficiency. Last time I was tested I was told I don't have anaemia, but I'm also interested in vitamin B12 and D deficiencies. Also considering getting the genetic sequencing test to look for MTHFR mutation, because from my own research it seems that a lot of my symptoms link up with this.Is there anything else I should get tested for?I typically eat a very healthy, balanced diet. I get plenty of protein, supplement with a good quality B12, take vitamin D drops in winter, occasionally take Floradix for iron if I know I haven't eaten much iron that day. Occasionally I take K2 and hemp seed oil for omega 3-6-9.",
  "input": "",
  "output": "With vague non-specific body aches like that, a doctor can help elucidate a more thorough and specific history and exam. Not sure how long ago the last set of labs were and what exactly the hemoglobin and MCV values were, Id start with repeating routine labs like CBC and CMP, maybe a CK to check for muscle breakdown. TSH and vitamin D levels would not be unreasonable. The presence or lack of anemia on repeat testing can guide whether or not a B12 or homocysteine should be checked. Not sure why one would bypass these cheaper and possibly indicated tests for an expensive test for a gene variant that wouldnt change management without starting with routine labs and going from there.If one were truly concerned about malabsorption from diet, then consider celiacs testing and ruling out IBD if there are other GI issues."
},
{
  "instruction": "Nutritional Advice needed\/AlcoholismThis is kinda a weird one, and I'm not sure if it belongs here or some more niche subreddit.I am 25 years old, an alcoholic, I drink approximately 300mL of vodka every day or every other day. I have generally healthy eating habits, avoid pasta, carbs, eat primarily meat, vegetables, kefir, cottage cheese, low carb wraps, etc.. I do not drink anything containing sugar barring clear liquors. I have a family history of high blood pressure, which mine is manageable and better than most of my family. I think all things considered, barring my weight and alcoholism, I am relatively healthy, although I know I won't be forever with some of my habits.Through my insurance, I get gym memberships to basically everywhere for free, and just learned about this, and have been taking advantage of it. I'm not used to prolonged goal-oriented activity, and haven't been since maybe highschool track and field, though I went to the gym in college as well to a lesser degree. I didn't get a car until last year, and my exercise then consisted of a two mile commute by foot to work. I have hovered around the same weight for a long time, about three years maybe.I understand that alcohol has caloric content, which may impede my physical development as well as eat into my daily intake calorically.My big questions are as follows: Does it [alcohol] impede muscle recovery to your knowledge?If I exercise when I still hurt from a prior day's exercise, is that a bad thing? I want to go to the gym literally every available bit of off time I can spare, but I know overdoing things can cause bad effects depending on what they are. I'm not like, in agony, just tight in my legs and other places.I want to work on my alcoholism, but I've been very focused on dieting and exercise lately, and working in a pushy sales job during the holiday season means I got a lot on my plate in addition to those and I can't just fix everything at once I guess.",
  "input": "",
  "output": "This question is the quintessential rearranging deck chairs on the Titanic. Instead of dealing with the alcoholism you quibble over other issues.Please find a drug and alcohol therapist, preferably someone who specializes in motivational enhancement therapy. Having seen a friend in his 40s go through fulminant liver failure from alcohol use, I can attest that it ain't pretty. His liver is still shitty but he's functional, but his brain is toast..."
},
{
  "instruction": "Kidney stones training nutrition adviceThree weeks ago I've got my first kidney stone experience, and it wasn't pleasant. I just expelled it recently and went back to the hospital to do one more check up and also to give the stone to them in order to determine what kind of stone it is... After the check up they told me the stone went out and I was ok. But apparently I have another small one forming in my other kidney. They said it's small and even if it started moving I'll probably just expel it without any problems or pain, but I need to be careful on not making it grow bigger so I should drink plenty of water. So far so good.Now my problem is; I'm underweight and I've got a sedentary job, and I'm starting an intensive six months program at the gym to build muscle mass. This program include a very strict diet plan and the consumption of protein whey powder and creatine. I read in many forums that protein powder and creatine are not ideal for subjects with kidney stones history. And when I asked the doctor after my check up he just said \"doesn't matter what you eat, just drink a lot of water\". Now, I'm not an expert, but I do believe that what you eat does matter...I'm asking for advice here because I cannot see a specialist at the moment. I was wondering if taking protein powder and creatine wont have any negative effect on the formation of other stones as long as I drink plenty of water, or if I should avoid them...And if I should avoid them, are there any substitutes I can take?To give some context. I'm male, 32 years old, 187 cm and 69 kilos, never had kidney stones before, never took creatine before, I took some protein whey powder for about 40 days one year ago. I'm not under medications. I don't have any history of diseases.Any advice is really much appreciated.",
  "input": "",
  "output": "If you can drink enough water, you can consume a bit more protein (not too much more; up to 60-65g is ok. More is not helpful and is wasted, unless you're training for the Olympics) without problems. Generally, taking more creatine won't help....it gets digested, and is no different than any other (much cheaper) protein. The issue is that the amount of water you need to drink to markedly reduce kidney stone formation is a lot...at least 2.5 liters a day. Most people don't manage to make it to 2 liters a day unless they force themselves to drink more water. It helps if you add a bit of flavoring (e.g lemon flavor) to it. Especially if you exercise a lot, you will need to drink even more. How much more? If your urine is totally colorless (not yellow), you're drinking enough. You can do your weight training and eat a bit more protein with no problem, but generally, one will not see any additional muscle increase by eating much more protein (more than 60 g or 65g per day). So eating 100 g of protein per day will not increase your muscle mass, and will increase the risk of kidney stones. All the protein whey powder and creatine are more psychological...you can get the same benefits by eating a couple of extra egg whites per day."
},
{
  "instruction": "My arms fall asleep daily while sleeping and usually when using armrests in planes. Do I need to consult my physician on this?Hi there. I'm 28F 5'8\" 160lbs white, and generally very healthy and active. I have no major medical conditions, good nutrition, don't drink alcohol, workout several times per week (yoga, lifting, indoor climbing). I take hormonal BC to avoid painful periods (been on it for more than a year) and I started taking a long-term antibiotic for a skin issue a week ago (yes I'm aware they interfere).I've noticed that almost every day while sleeping lately, I wake up at some point with some of my fingers numb and prickly up to my entire arm being limp (where it flops around, can't move it, and have to \"shake it back to life\" so to speak). I remember this happening occasionally as a kid, as well, so it's not a new development. I take several work trips per year that involve flights and I tend to get a similar problem sometimes when using the armrests in planes.I'd say it mostly happens in my right arm (dominant) but I think it happens in the left arm sometimes, as well. I'm a bit alarmed that this seems to be happening so often. I'm guessing my brain wakes me up when this starts to happen so it can't be that long that it happens but I can't be sure, obviously. I'm just concerned that it may at some point cause damage if this keeps happening.I have a memory foam type of mattress, so I'm wondering if a different type of mattress would help? A side sleeping pillow? Maybe it could somehow be nutrition related?Any advice is appreciated, thank you!",
  "input": "",
  "output": "Usual disclaimer: no one can provide specific medical advice for a person or condition without an in-person interview and physical examination, and a review of the available medical records and recent and past testing. This comment is for general information purposes only, and not intended to provide medical advice. No physician-patient relationship is implied or established.Most commonly, the sensation of a limb \"falling asleep\" is from an issue with a peripheral nerve, and not (as is commonly believed) from an issue of blood circulation.Some people (and I am one) are more susceptible to this phenomenon, but it can happen to anyone. When a nerve is compressed, it will stop functioning temporarily.There are places in your body that are more susceptible to this - generally where a nerve is running close to a bone, and where there is little flesh surrounding the nerve that might diffuse the pressure.One nerve that is very susceptible to compression or injury is the ulnar nerve, commonly known as the \"funny bone\". If you let your arm dangle at your side with the palm facing forward, the \"funny bone\" is at the back of the elbow, just above and towards the middle of the body from the bony lump you feel behind your elbow.A sudden blow to this area often produces a sudden sting \/ burning sensation that radiates down to the hand (this event is the reason behind the name \"funny bone\"). However, prolonged pressure on the area will also produce symptoms, and is the most likely cause of numbness and tingling in the hand and fingers while leaning on the elbow.Typically, the sensation of the pinky and ring fingers is the most affected, as well as the same side of the hand and forearm as those fingers.The solution that I have worked out for myself is simply to avoid leaning on that part of the elbow. Place the forearm on the armrest instead, or lean on the outside of the elbow, not the inside.This is not, of course, the only place that is affected by nerve compressing. Many people, when sleeping, have their arms under their head and \/ or pillow, or even under their body. Using trial and errors, you can probably find a sleeping position that will minimize the chance your limbs will \"fall asleep\"."
},
{
  "instruction": "2 year old admitted to hospital, unresponsiveLatest update (since coming back to the US after private hospital was unable to treat him in February, and he was having retractions): For future parents that might be in a similar situation and trying to find answers, I thought I would share what we have learned since coming back to the US.While in the hospital, the doctor kept saying he was unconscious because of inflammation. However, as I was trying to gather medical information, his theory at the time was sepsis. He did have a UTI a month or two earlier that we struggled to find antibiotics to treat (although he seemed to respond well and quickly when our pediatrician prescribed Augmentin).Our pediatrician here suspects encephalitis because he was fully up to date on vaccines (including pneumococcal), and the timeline was so fast from a cold to eyes fluttering open but not responding to pain or voices. Hopefully we will never know, because the most likely way to be able to correctly diagnose what happened is that it happens again while in an area with better ability to treat and test.That being said, information that would have been nice to have included a blood culture and a brain scan (according to our pediatrician here). Our pediatrician at the hospital where he was admitted did not have the ability to do either of these, and I still think it was our best option, but I wish I had known that the hospital was so limited because I wish I had at least had the opportunity to consider medical evacuation. I truly believe his pediatrician at the time was doing the best he could, and quite frankly, I still completely believe he saved his life, but I have learned that there are cultural differences. Doctors in some cultures may not be as forthcoming as would be expected in Europe and the US.Although to say, he is fine now. Because of the mystery surrounding the diagnosis in December, we don't really know how likely another similar episode is. However, now he seems like a perfectly healthy, developmental normal, energetic and talkative 2 year old boy! And we have learned to ask A LOT more questions about medical care before moving overseas ;)Update: His primary care just came in. He believes it is a combination of factors. Firstly, he is fighting a virus. Secondly, his glucose level was low and he was dehydrated at admission. He anticipates sending us home maybe tomorrow. For right now, he said he just needs IV nutrition and fluids, and time for his body to kick whatever the virus is that he's fighting.My son, 2 year old male, 12 kg, 85 cm, was admitted to the hospital about 9 hours ago. Our whole family has had a virus. Both he and my daughter received IV nutrition day 36 hours ago. My daughter recovered yesterday almost completely, but my son slept all day. I think it's been several days since he stood on his own. I brought him to the hospital, anticipating needing another round of saline, vitamins, and glucose.As I was transporting him, though, it became apparent that he was even sicker than I realized. He was completely limp, and failed to respond in any way to checking his glucose levels. His eyes would flutter open and sometimes hed briefly make eye contact, but he didn't respond to his name.He has been admitted at least overnight. His glucose and electrolytes were low, as well his leukocytes. One of his liver enzymes was also high (I believe AST...whichever one, it was 42). His urinalysis came back with ammonium urate, mucus, and acetone (according to Google Translate...I am a beginner in the language here, and the doctors and nurses don't speak English, so everything I know is through Google Translate). His O2 was also a little low (94), so he is on oxygen. They have given him glucose and electrolytes and vitamins, as well as an antibiotic.Can anyone explain why he became unresponsive? His BMI was perfectly healthy. I thought fat was able to sustain through sickness like this until able to eat again, and not only that, he had IVs yesterday of vitamins, saline, and glucose. Is he going to be ok? How long is the road to recovery likely going to last? Any theories as to what's going on?I'll also attach a copy of the urinalysis, translated. I don't have a copy of the blood work, though.Edited to add: He has since woken up for brief periods. Maybe 4 hours or so on IVs, he woke up and asked to nurse. He also fought the nurse and doctor while having his nose aspirated... the doctor, nurse, and I all had to hold him. He fell asleep shortly after that, and has not woken up since.",
  "input": "",
  "output": "There's not nearly enough info to say why he's unresponsive. I know youre stressed and looking for answers but you won't find them here."
},
{
  "instruction": "Can adolescent anorexia have long term effects? Does it have long term effects if it occurs during puberty?26m. No known health conditions. From upstate NY.Ive struggled with my weight my entire life. At birth I was 9lbs. By the time I was 12, I was clocking in around 190 lbs. By the time I was 15, I was well over 200lbs.When I was 15, I had multiple surgeries on my feet. I had arthritis, and flat feet. I had 5 back to back surgeries to correct it. They put me on a ton of pain meds from 15-17. As a result, my appetite was severely suppressed during those 2 years. I remember losing a ton of weight, and people started to notice. I barely ate, due to the low appetite from the pain meds. I remember being 15, and thinking Wow. This was easier than I thought. This led to some pretty terrible choices. Throughout puberty, you probably couldve defined me as a textbook anorexic. I barely ate, and the weight just fell off. I really didnt notice how bad it was until I was 20. I was 20 years old and severely underweight. I was skin and bonesToday, I dont deal with it at all. Im 511 and weigh around 170-175. I dont really check. I eat well, and long distance cycle 3-4 times a week. I do strength training a couple of times a week. Not as much as I should, but I try. I watch what I eat, but definitely consume at least 2000 calories a day. Theres no question about that.But the more and more I read up on this, the more I fear how the prescription pain meds, and anorexia was detrimental to my growth during puberty. Thats such an important time for human beings, and I fear what long term effects my poor decisions caused.Can adolescent anorexia and drug use have detrimental effects during puberty? Maybe Im just paranoid. I fear it stunted my body. I fear I didnt give my body the proper chance to grow and mature",
  "input": "",
  "output": "Most boys are done growing by 16. You were likely close to your adult height regardless by age 15."
},
{
  "instruction": "I already take calcium\/vitD combination tablets since my anti hormonal treatment started and got worse despite it. I asked my oncologist about vitamin K and she waved it off saying she had never heard of it. So I'd have to look into evidence for that if I want to have mine measured and supplemented I think. Hadn't heard about the combination with vitamine C either. Here they're just like 'oh the calcium and vitamin D don't do enough? Well guess we'll bombard with bisfosfonates then'",
  "input": "",
  "output": "Possibly. But it can be significantly improved with strength training and good nutrition.It's not clearly wrong. It's a medical fact.\"Boys tend to show the first physical changes of puberty between the ages of 10 and 16. They tend to grow most quickly between ages 12 and 15. The growth spurt of boys is, on average, about 2 years later than that of girls. By age 16, most boys have stopped growing, but their muscles will continue to develop.\"https:\/\/kidshealth.org\/en\/parents\/growth-13-to-18.html#:~:text=Changes%20in%20Boys&text=They%20tend%20to%20grow%20most,muscles%20will%20continue%20to%20develop.I didn't say ALL boys stop growing at 16.Most resources say 16. Some say 16-18.Most boys are NOT still growing into their 20s.Everybody has anecdotes about somebody they know that grew 4 inches in university. Those are mostly exaggerated, and\/or outliers.Your anecdotes about your friends getting taller doesn't change what happens for \"most\" boys."
},
{
  "instruction": "It is just quite frankly wrong, every countries education system and reliable sources all say boys stop growing at about 19-21",
  "input": "",
  "output": "No, they don't.https:\/\/www.google.com\/search?q=average+age+boys+stop+growing&oq=average&aqs=chrome.0.69i59j69i57j35i39j0i512l2j0i433i512j0i433i457i512j0i402j0i271l3.1317j0j4&client=ms-android-oneplus-rvo3&sourceid=chrome-mobile&ie=UTF-8#ip=1You can easily see differently by simply googling this.Most resources say 16. Some say 16-18.Most boys do not continue to grow past 19. Some do. Most do not.This is why male growth charts norms plateau at 16-17 years, but weight continues upward.It might be commonly said to be 19-21 in your country's education system, but that's not accurate.If you're able to find a source that says it's typical to keep growing into your 20s, there 100 others that say it's not.This is common pediatric knowledge.You think you're right here, because lay people have told you this while growing up, but it's not medically accurate."
},
{
  "instruction": "Is it unreasonable to try to ask for IV foods, or is this feasible? How else can I stop withering away? Please help.Im not sure what the technical term for IV food is, but here we go:Basic info: Male, white, 33 y.o., 6 foot, down from 190 lbs to 129 lbs. Im in the U.S. and do have insurance.Background info: for the past four years, I have had increasingly bad health issues that doctors cannot diagnose. It started with joints that felt like they were tearing spontaneously and not healing (which makes them to where I have no strength or movement) and it is literally almost every joint in my body. Then it became muscles and other soft tissue that seems to be contracting out of nowhere, and I am losing all range of motion. Then, I have other health issues that pop up and never seem to heal. Examples are erosive gastritis for the past 2 years that wont heal with medicine and prohibits much of what I eat, eyes that were hurt after being outside for 30 minutes and have now made it to where I cannot tolerate light or screens without searing pain, and weird things like that. I have seen so many specialists, and they are all baffled, think something is seriously wrong, but say they cant help. Extensive bloodwork has shown nothing but a TPO antibody, but normal thyroid levels.My main question: with my joint problems, I have not been able to close my jaw for almost a year, which means I havent been able to eat solid food in almost a year. Then, my erosive gastritis limits most high calorie foods from my diet. I stuff my mouth with the foods that I can eat, and if I try really hard, I still struggle to get 1500 cal a day. I have tried everything I personally have control over, but it is just not possible to get enough, and my nutrients are low and making it to where I can hardly stay awake. I have asked doctors if there would be any way that I could get IV food so I can get enough nutrition to, at the bare minimum, not keep getting worse and worse. Ideally, I would be able to get enough to gain weight so I can maybe improve my muscle mass. However, I mentioned this to a doctor and was laughed at like it was the dumbest question on earth. When I say laughed at, he literally said oh my god and rolled his eyes.Is this a crazy request? Is this a feasible option? If you have ANY suggestions, please help. I hate to sound dramatic, but my entire family thinks Im dying, and I feel Im on my way there as well. My stomach and colon have been torn up from all the medicines that have been tried, and I am all out of ideas.",
  "input": "",
  "output": "If you cant tolerate enough oral intake for nutrition then an appropriate next step would be consideration for a feeding tube of some sort. Either into your stomach or small intestine.IV nutrition is inferior and prone to a lot of problems (also super expensive and hard to get insurance approval). Its not typically used unless you absolutely cant use the intestines for one reason or another."
},
{
  "instruction": "Before they would consider IV nutrition, they would exhaust all the other ways of feeding you.IV nutrition comes with significant risks. If there is zero other way to tolerate food, it's better than starvation, but putting things in your intestines for nutrition is the safest and best in most situations",
  "input": "",
  "output": "I also agree. You are not a candidate for IV nutrition. So presumably a gastroenterologist diagnosed you with erosive gastritis after an endoscopy? What was the treatment plan for that diagnosis?Putting this all together: unhealing joint injuries, muscles contracting, light intolerance, stomach and colon torn up, and extensive normal testing raises the possibility of a somatic symptom disorder."
},
{
  "instruction": "Yes, I was diagnosed with an endoscopy, and I believe there were erosions in 3 places. At first I was on sucralfate 3x daily, Pantaprazole 1x daily, and dicyclomine 3x daily. That hasnt worked, so Im now on Pantaprazole 2x daily, sucralfate as needed, and dicyclomine 1x daily. That might change, however, as I have sought out a new gastro after the last one dismissed me passing a lot of blood in my stool and colon pain (likely from a large amount of antibiotics I had been prescribed).My symptoms have been strange, and I dont at all understand them. On MRIs they have seen torn ligaments, but there were no reasons for it to be torn; they have seen inflammation in my eyes, but there was no reason for it to be inflamed; and they can feel the popping\/tightened muscles and described them as being constantly kicked on. But, the bloodwork comes back fine; the silver lining is that maybe Ill get something named after me?",
  "input": "",
  "output": "There's a lot that remains unanswered so it's hard to say anything with certainty. I agree with my colleague - IV nutrition is reserved for people with no gut, or a biologically nonfunctional gut.However, if erosive gastritis is the issue preventing you from eating, and you have lost that much weight in 6-12 months, you may be a candidate for a feeding tube placed in your small intestine, past the level of your stomach.I don't understand why the gastritis has been this refractory to treatment (it is usually fairly simple to treat). In general the answer would be fixing the stomach problem. But a feeding tube could be used here while trying to solve the medical issues."
},
{
  "instruction": "can i still grow taller? (16f)it's my biggest insecurity to the point i feel like taking my life over it, i know it sounds like i'm exaggerating but it's just been so bad for the last few years. i don't even want to leave the house over it most times.i'm 16, 5\"2, 40kg. i had a really bad eating disorder for the last few years and i'm barely eating 600\/700 calories a day. i know this is making me malnourished and probably is a reason why i didn't grow that much. but i will put in the effort to recover if it means i'll grow taller. my parents are 5\"0 and 5\"9. i want to be at least 5\"4 which is only two inches but it seems impossible. i just really want to know if i can grow still because it's eating me up alive.",
  "input": "",
  "output": "5'2\" is an extremely normal height. I'm sorry to hear about your eating disorder but you're a completely normal height"
},
{
  "instruction": "Any fitness\/wellness tips for a 29F, 4'11'', 177 pound jogger?I recently started jogging. I'm up to jogging 2 miles on a treadmill slowly and consistently at 3.5 mph speed. Did it the other day, did it again today. I'm strength training a bit, too.. I can plank for 70 seconds. I'm doing about 65 pounds on 5 rep X 5 set chest press machine routine. I can lat pull down over 100 pounds, and I can shoulder press 55 pounds on the 5 X 5's. I lost 25 pounds in the last year, but it is going so slowly. I bought a scale, and now when I look often, I just feel like I have plateaued. Any tips? Am I doing the right thing here with my routine? Will I ever lose more weight? I JUST now am getting down from stage 2 to stage 1 obesity, almost. Is there something that's supposed to be happening at this point? My blood sugar is now normal, although cholesterol was a bit high at my yearly checkup for the second year in a row.",
  "input": "",
  "output": "Plateaus are common in weight loss. It'll pass with time. Keep track of nutrition, continue exercise. Look at the positives. You're down 25lbs and are increasing your activity in a meaningful way."
},
{
  "instruction": "Blood work off after MTX. Should I hold the next dose until Rheum consult?30F non-smoker 147 lb 5ft 2in tall, years long history of rheumatoid symptoms and indicative blood work. My degree is in clinical nutrition which means unfortunately I understand the basics of my blood work but am not sure what to do with it. My rheumatologist is out for a week.After 7 weeks of 10 mg oral methotrexate weekly with absolutely no contraindicated medications (sulfa, alcohol, etc) my blood work has come back. I'm just hoping for clarification on if these results are expected with methotrexate, or if I may want to hold a dose until Rheumatology is back in office next week.Creatinine has dropped to 0.51 and was 0.70 prior to treatment. BUN has risen to 24 and was 17 prior to treatment. CRP at 1.4, was 1.3 prior to treatment.If I can ask for any input just to ease my mind, I'd really appreciate it!",
  "input": "",
  "output": "I would not worry about these labs. They are inconsequentially different from prior.For your information - Creatinine is a measure of how well the kidneys are working. We worry more about kidney injury when it is high. BUN is not as specific and should be interpreted in the context of your creatinine. Your CRP is basically unchanged.Your rheumatologist would likely go more based off your symptoms in adjusting your meds, they are probably monitoring side effects of methotrexate so looking at blood counts for signs of low counts and liver function tests. Methotrexate is cleared through the kidneys so if there was a major change in your creatinine it may prompt a dose change. CRP and ESR are inflammatory markers that will be trended.Hope this helps!"
},
{
  "instruction": "Nutritional RecommendationsHi, are there any nutritional recommendations for cancer patients? As a caregiver, I am specifically looking into any protein powders to help my dad fight weight loss. Thank you.",
  "input": "",
  "output": "There are multiple factors that go into creating a nutritional plan, ranging from lab values such as kidney function, to muscle mass, desire to eat, ability to eat, etc. Id recommend speaking with a nutritionist as they are typically even more knowledgeable than physicians for nutritional advice. It should be covered under palliative\/supportive care for the cancer. Youll want to consult them anyway depending on the state your dad is in physically as this point to ensure he doesnt have any nutritional deficiencies specific to the cancer he is fighting (e.g. GI cancers scan affect absorption of vitamins, minerals, fats, etc).Realistically if youre just looking for a caloric supplement, any of a number of protein drinks, such as ensure, will work. It will really come down to whether hes willing to drink them, find a flavor or brand he can tolerate and dont be afraid to switch it up for variety"
},
{
  "instruction": "Failure to thrive, possible causes to consider?Kiddo born last week of October 2022 at 39+1 (vaginal birth via induction) weighed 5lb 9 oz, looked quite small for the weight and had short, withered looking legs and a disproportionately small butt. At 5 months, weighted 12lb 5.5 oz. Has consistently been 0.5 percentile although recently scraped up tp 0.6. Legs have filled out and lengthened, butt is more or a normal size. kid has been hitting motor and social developmentsl markers very well, but is deemed failure to thrive. Baby is breastfed, milk supply not the problem. Bottle is offered after every nursing, but not forced by parents, as this leads to vomiting.Mother 42 at delivery, pregnancy the result of IVF with a PG tested embryo. IUGR was first diagnosed in the second trimester, amnio and weekly placenta monitoring followed. Amnio revealed a microdeletion of unknown significance on 6p which was at length deemed unlikely to be the cause of anything by maternal fetal medicine genetic specialists - even before testing revealed the microdeletion to be inherited from the father, who has no disadvantages or disability.Mother contracted Covid in the early\/mid second trimester, was fully vaccinated and fully recovered in 1-2 weeks. Mother struggled to eat during the pregnancy and after birth weighed 10lb less than she had when the embryo was transferred. Mother took diclegis, tums and omeprazole daily throughout the pregnancy to manage nausea. Mother had a UTI from week 10-20 that took 3 treatments to clear. Both the covid and the nausea were dismissed as a cause of the IUGR by both the OB and the Maternal Fetal Medicine Doctors.Currently waiting on a referral to genetics at a local hospital to investigate the possibility of skeletal dysplasia. The only visible symptom for dwarfism is a very, very slightly protruding forehead. Head circumference has always been in the 50th perventile despite the little body.So.What could be causing this, or have caused it? The final opinion from the Doctors at the MFM clinic was \"Hes just a little guy.\" For the sake of assuaging parental guilt, it would be good to know how likely it is that the inability to eat could have contributed to the problem.",
  "input": "",
  "output": "If the child is growing along a percentile curve and staying on that curve, technically this is \"failure to thrive\" (also known as growth faltering) but my concern is generally low. If they're gaining weight at a lower amount than they should be or crossing percentile lines, that's where we really get concerned. How does his weight for length curve look?"
},
{
  "instruction": "Thank you for responding!Weight for length curve doesn't look great, even to a layperson like me.I do think the numbers here are can in part be explained by the fact that the legs that were withered and disproportionately short at birth seem a lot more proportionate to overall body length at current time. Based on photos, I would guess that this was a visible change by 6 weeks. IUGR diagnosis was asymmetric, with normal enough head and torso with shorter arms and significantly shorter legs (legs measured for 32 weeks at last growth scan prior to birth).So ... leg length caught up a little, but weight did not rise at the same rate.WHO Boys 0-2 Percentile goes:43 at birth1.9 at 1 months3.3 at 2 months1.8 at 3 months0.96 at 4 monthsCDC Boys 0-36 months Percentile goes:60 at birth2.5 at 1 months3.4 at 2 months2.2 at 3 months1.2 at 4 months",
  "input": "",
  "output": "These percentiles that you record here are for weight-for-length? Then yes, I'd agree that this needs to be worked up further.Given that all this has been post birth, this isn't from any kind of nutritional deficiency during pregnancy"
},
{
  "instruction": "I [22F] am prediabetic and prehypertensive and my doctor hasn't been helpfulHi all! I am looking for some guidance here. The stats I provide are also from a DEXA scan I did just this week as a participant in a longitudinal study on my campus:22F;166.4 lb;5'8\";27.7% body fat;54.95 kg muscle mass (the form says \"muscle mass\" and idk if that's just lean body mass or muscle mass);1.055 g\/cm3 bone density.Doing the DEXA scan and talking through it with the researchers was helpful because it put my weight into better perspective than just comparing it to my BMI.Summer 2021, I went for my first physical assessment living in the US and here were blood results:my A1c came back at 5.7;lipid panel all borderline high at 206mg\/dL for cholesterol, 124 for LDL, 76 for HDL, but 62 for triglyceride;my blood pressure is consistently around 120s\/80, including this week;my pulse is consistently in the 50s bpm, including this week at 55;I have mild anemia and take 65mg of iron daily. Over the past year my iron levels are back in normal range.I know of a family history of anemia, hypertension (my maternal uncle was also diagnosed in his 20s despite being seemingly physically healthy) and high cholesterol, but have no idea about diabetes.I freaked out at the blood work, and bombarded my doctor with questions including if I needed medication or if I should start monitoring my blood glucose. He gave the vaguest answers, saying there's no need for medication or monitoring at this time, just that I should change my diet and listed generic things I should eat that included a lot of tubers (huh?). I started monitoring my blood glucose anyway and scavenged reddit to learn what others do, but fell into a depression last year and only started picking up my discipline regarding my eating last December. I'd still been exercising throughout, though.I have a history of challenges with disordered eating behaviors and I have been working to address that and making good strides to recognize my triggers. I was overweight all my life and never learned what balanced nutrition or good regular activity looked like. I've been figuring that out for myself at college. For the past 4 years, I have been exercising pretty consistently 3-4 times\/week for 45-60mins. I walk a lot, and have in the past six months increased cooking for myself to increase the protein (really just chicken, lentils, and beans lol) and green vegetables on my plate. I have been substituting rice with green banana (I don't really eat Western food) and have been successful at learning how to intuitively eat as a part of addressing my disordered eating habits.I am confident I can continue to improve my wellness habits, but need guidance on addressing my pre diabetes and prehypertension. I am awaiting bloodwork from the study at my school in a few days to see where my A1c and lipid panel's are nearly two years later. But I don't want to develop full blown diabetes and hypertension if there are things I can do now in the \"pre\" ranges to nip them in the bud.I have scheduled another physical assessment w my primary doctor in two weeks, where we will repeat those tests. I want to advocate better for myself given his last feedback. Should I ask to be put on metformin? What should I continue to do about being pre-hypertensive?I don't want to ignore my issues and don't want to be hard on myself about them either. I just want to know what I should do to live better and keep myself as well as possible. Thanks!",
  "input": "",
  "output": "Relax.You BP 120\/80 is normal.. and even the HbA1c is also not at a pre-diabetes level which is usually considered at > 6.0Keep exercising regularly and eat a balanced diet (which you already seem to be doing).. your cholesterol is also something that I would not worry about at this stage..no medical intervention is necessary at this time... lifestyle modification is sufficient."
},
{
  "instruction": "What do these results mean?24F, 176cm 46kg. I have hypermobile ehlers danlos & likely gastroparesis, my stomach shut down just over a year ago & I rely solely on a nasojejunal tube for nutrition, hydration and medication. I've gained 8kg from my most unwell point, but my weight has been going on a bit slowly & my blood sugars are constantly low despite feeds. I've also had issues on & off with my liver and recurrent kidney and bladder infections.I had an ultrasound followed by an MRI last year, but I didn't see the results until I called the hospital & requested the results a few months ago. It seemed to suggest nutcracker syndrome, which I know can be related to SMAS. But I've also heard MALS? I don't understand the results, and no doctor has ever even told me them, let alone explained them to me.'Ultrasound: The left renal vein was not clearly visualised crossing anterior to the aorta, and the left gonadal vein appeared dilated with reversal of flow heading downwards into the pelvis. The appearances raise the possibility of nutcracker syndrome.MRI: The aortic-SMA angle is somewhat reduced, assessed at between 17 and 30 degrees on the low quality reformatted images (normal range 38 to 65 degrees).'What does this all mean?",
  "input": "",
  "output": "Basically there isnt enough fat between your superior mesenteric and aorta to prevent the SMA from crushing your left renal vein and duodenum (beginning portion of GI tract). I have attached a nice diagram below.Your BMI is 15 which is waaay underweight. I understand how hard it is for you to gain weight without a functioning GI tract but weight gain can help decompress structures through fat pad support. There are also surgical options but many will have you try to gain weight before offering surgery. Its often a multidisciplinary team approach in treatment. GI or vascular surgery would be most appropriate to consult about options."
},
{
  "instruction": "Thank you! Is it 'normal' given my weight & general health, or can this be a separate condition\/issue entirely? Is it something I need to raise with my gastro even though they've ignored it?",
  "input": "",
  "output": "Its not normal. Just low weight worsens it. Whoever ordered the imaging should be the one to make the next referral."
},
{
  "instruction": "Pregnant with a pre-existing umbilical hernia. I don't know much yet, and I have questions.Age\/sex: 29F | Height: 5ft 0in | Weight: 117 lbs (~105lbs before pregnancy) | Race: whiteI am 16 weeks pregnant with my first child. I live in the US.Yesterday, I had my 16wk OB appointment. We measured baby's HR at 140bpm, woo! But I have also been referred to a surgeon regarding my umbilical hernia, which, to my knowledge and limited understanding, I got in infancy (my mom watched my bellybutton \"pop out\" during a screaming fit). Yesterday, before the OB measured baby's HR, I told her about my \"outtie\" belly button and how it's already doubled in size since pregnancy; also about a day last week when I scraped a bathroom stall door against my bellybutton while opening it, which immediately caused sharp, downward shooting pains and overall abdominal discomfort that lasted for the rest of the day. She kind of wrote it off (\"bellybuttons sometimes get sensitive during pregnancy\"), until I laid down for her to get the heartbeat. She then looked closely at my bellybutton and asked me to do a sit up, then mentioned that she would be referring me to general surgery for an umbilical hernia. I asked her what the medical implications of an umbilical hernia with pregnancy would be, and she just said, \"a lot of pain that we can't do anything about.\"So that was scary, and made me question why even see a surgeon now? Just to confirm it's a hernia? But then I did some googling, and have further confused and worried myself.My consultation with the surgeon isn't for another month, coincidentally the same day as my 20 week ultrasound._________________________________Here's some more info about my experience that might be relevant:-My bellybutton has always been sensitive, even as an adult. It was much bigger as a kid and got smaller as a I grew up, but definitely still an \"outtie.\" When I was a kid, I remember it filling up and getting \"hard\" when I had gas. I would \"pop\" it and it would \"deflate.\" That stopped happening by the time I was like 7 y\/o.-I have struggled with constipation on and off throughout the years, but I wouldn't say it's generally \"severe.\" I have had occasions when I'd go 4-6 days without a BM where it seemed like nothing helped, but overall, if I pay attention to lifestyle\/proper nutrition, I don't go more than 1-2 days without a full BM.-Only today have I noticed a bulging under my bellybutton. And it's only when I lean back far enough so the rest of my belly\/organs\/fat go down so I can see it. I've never noticed this before, and I assume it's due to the pregnancy.-I've always had a pretty strong core with visible muscle tone and minimal stomach fat._________________________________I would really appreciate any comments\/information about what to expect, what possible outcomes are, other experiences, etc. But some of my specific questions are:-Does this pretty much guarantee I'll need a C-section delivery? (to avoid the strain of pushing)-Is it possible to not need surgery at all-- neither during pregnancy nor after?-Will a CT scan be necessary?-Will I inevitably be in a lot of pain?-What would make a surgery necessary while pregnant? (I understand there is also an option of having the hernia surgery at the same time as C-section)-What, if anything, should I look out for before my consultation that would constitute an emergency?________________________________________I think that's all, I'll edit if I think of something else I should add.Thank you so much in advance!",
  "input": "",
  "output": "-Does this pretty much guarantee I'll need a C-section delivery? (to avoid the strain of pushing)No, I don't believe so. I'm not ob\/gyn but a general surgeon, so I could be wrong on the indications for a c section.-Is it possible to not need surgery at all-- neither during pregnancy nor after?Depends on if you want it fixed, if its causing you pain, etc. Not mandatory in all cases.-Will a CT scan be necessary?No, usually not unless the surgeon is unsure of something, and a CT is contra-indicated in pregnancy.-Will I inevitably be in a lot of pain?No. Some hernias cause pain, others do not.-What would make a surgery necessary while pregnant? (I understand there is also an option of having the hernia surgery at the same time as C-section)Incarceration or strangulation.-What, if anything, should I look out for before my consultation that would constitute an emergency?hard, very painful lump at your belly button that you cannot push back it and it continues to become more and more painful."
},
{
  "instruction": "Scared about abnormal CBC results, history of anorexia25F, 5'0, ~105lbsHistory of anorexia and childhood asthma (used a nebulizer as a little kid, no need for inhaler\/treatment now)Abnormal lab results: https:\/\/imgur.com\/a\/Mcg5s0kI see my PCP every couple of months at her request since I have struggled with a restrictive eating disorder since I was 13. As part of my semi-regular appointments she runs what I think are fairly comprehensive labs (I only included pics of abnormal results but she also runs thyroid, estrogen, etc.). My vitamin B12 is also slightly high (1,316 pg\/mL).Im mostly concerned that my absolute lymphocyte count has been steadily declining since last year  when I first started seeing my doctor in March 2022 it was 1.26 L and in March 2023 it was 0.79 L. There are a few other results like hematocrit and mean corpuscular volume that are elevated, but those at least seem to be closer to the reference ranges. I know a small elevation\/drop can be normal since were not robots, but the decrease in lymphocyte count seems pretty dramatic.My doctor didnt call\/comment on my most recent labs, so I sent her a message online asking about the lymphocyte count. Her response was that a slightly lowered lymphocyte count isnt uncommon\/could be due to nutrition and we could recheck at my next appointment. However, Ive actually been doing much better with nutrition since around December 2022 and am at a stable weight with normal thyroid\/estrogen levels, so Im not sure that malnutrition would be a likely cause.Ive been waking up slightly sweaty\/clammy in the middle of the night, usually a few nights per week. Ive experienced this before to a much greater extent in residential treatment for my eating disorder when I was going through refeeding and experiencing hypermetabolism, but that is definitely not the case now as my weight and food intake are adequate (confirmed by RD).I have a small lump on one side of my neck that my PCP ordered an ultrasound for in November 2022  result was normal enlarged lymph node, no biopsy recommended. It hasnt changed\/grown, but I recently noticed another small lump on the other side of my neck. The lymph nodes just under my jawbone feel slightly swollen as of this weekend, but Im not sure whether to chalk that up to stress about this whole thing.Does my doctors suggestion to wait a few months until my next appointment to recheck the lymphocyte\/other levels sound reasonable? Im worried that it will keep declining, or that it could signal a larger issue in connection with the other signs\/symptoms. Thought about seeking a second opinion with a specialist, but Im having trouble figuring out how that will work with my insurance.Thank you for your time and advice.",
  "input": "",
  "output": "This isn't at all concerning. I agree with your doctor."
},
{
  "instruction": "Thank you so much, that helps me feel less worried about it. I know I'm a not a doctor and my current PCP has been great, but it's hard not to stress out sometimes.Really appreciate the time you and all the other doctors put into helping others out on here!",
  "input": "",
  "output": "I agree with your doctor's suggestion. This wouldn't concern me."
},
{
  "instruction": "How long can formula milk be run through an IV without spoiling?6 months old male Continuous feedI asked in r\/nursing when milk goes bad and they immediately closed it and said ask a doctor for medical advice so here I am.Our son was in hospital for 5 months on continuous feed 20 hours a day in 4 hour chunks. We've continued that cadence now he's home and he's currently getting 180ml every 4 hours for 20 hours with a 4 hour break, but we now have a student nurse who watches him during the night while she studies. She's feeding him 360ml in 8 hour chunks which we were under the impression would be a bad idea as formula at room temperature for this long would spoil - is that correct?When I Google it it says formula can't be at room temp for longer than 2 hours which would mean he's been fed incorrectly since birth so just looking for a bit of clarity on how long you would run a continuous feed for in hospital before swapping the bags out so that we're not feeding him bad milk.",
  "input": "",
  "output": "What is the actual material you are feeding? Is it formula, tube feeds or other types of nutrition?Is it going to his stomach via a tube? Or in an IV?Lots of inconsistencies in the post. Regardless best person to ask is the manufacturer of the feeds."
},
{
  "instruction": "Please forgive my ignorance, this is genuine confusion and not sarcasm or anything like that but I'm really not understanding how anything is relevant behind the time at which formula milk goes bad at room temperature. Whether he's fed 10ml an hour or 1 liter an hour into his stomach or his bowel, the fact would remain that the rate at which milk would spoil at room temperature would be a constant - I'm having difficulty understanding why the answer is not straightforward that 'formula cannot sit unused at room temperature for xyz hours' as an example. Nothing unique to him or his situation would make milk sat at room temperature last longer - at least that I can think of - but if I am being ignorant to something that changes everything then please tell me so I can learn.Right now in my head I'm having trouble getting away from the concept of whether I eat chicken in 2 bites or 17 or whether I put it in a blender or I eat it fried, it would still be unfit for consumption if it were first left out for a period of time. And given that we believe the nurse is doing something we've been told is bad, it wouldn't make sense to ask her because she wouldn't contradict herself. It makes more sense to me to look for a consensus from different professionals.For his feed, that's my bad referring to it as an IV, it's in a bag that hangs up on a pole and is administered slowly over 4 hours at 45ml per hour. We give him 180ml and change the bag every 4 hours. The line runs through a kangaroo thing that pumps it into his bowel through a J port in a button on his chest. Instead of 180ml at 45 per hour for 4 hours the night nurse is feeding him 360ml in the bag over 8 hours at the same rate so just doubling the contents of the bag and leaving the bag at room temperature for 8 hours while it is administered into him",
  "input": "",
  "output": "It's not milk though is it? It's some type of tube feeding. Look at the bottle, and then look on the company website.For example, Vital AF, a common tube feed formulation used in my hospital can hang unrefrigerated for 48 hours per the company website.https:\/\/www.abbottnutrition.com\/our-products\/vital-af-1_2-cal"
},
{
  "instruction": "How do you know if you're nutritionally deficient in some way?Male. Late 20s. Non smoker. Non drug user. Non drinker.So I have a fairly basic diet. I eat a reasonably healthy mix of meat veg and fruit every day. But it is basically the same things every day. So unless there is a major health issue as a symptom is there a way to know if there's something else I need to be eating?For example I can't eat fish\/ seafood. Is there a symptom that I should mindful of that means I'm missing something from my diet that fish\/ seafood would normally provide?",
  "input": "",
  "output": "Usual disclaimer: no one can provide specific medical advice for a person or condition without an in-person interview and physical examination, and a review of the available medical records and recent and past testing. This comment is for general information purposes only, and not intended to provide medical advice. No physician-patient relationship is implied or established.True nutritional deficiencies are almost unheard of in modern first-world countries. They are either the result of very restrictive diets, or of medical conditions that cause problems with the absorption of nutrients, such as inflammatory bowel disease or celiac disease, or surgery of the gastrointestinal system, such as bariatric surgery (weight-loss surgery) or removal of parts of the small intestine (usually due to injuries like getting stabbed or shot in the abdomen).As an aside, there is an \"epidemic\" of vitamin D deficiency currently. I use the quotation marks, as this is a controversial issue. By some measures, up to 60% of people in the United States are \"deficient\" in vitamin D. However, it is possible that the values that are considered to be sufficient are just wrong. For an interesting discussion of how this came to be you can read this interesting article about the physician who more-or-less singlehandedly creates the modern idea of vitamin D deficiency.https:\/\/www.nytimes.com\/2018\/08\/18\/business\/vitamin-d-michael-holick.htmlIt should be noted that there are studies that associate vitamin D deficiency with worse outcomes of various illnesses, including COVID-19, but that large studies of vitamin D supplementation have never shown any benefits whatsoever.Finally, and to me mysteriously, despite the \"epidemic\" of vitamin D deficiency, children are oddly spared the effects: vitamin D deficiency in children produces a specific syndrome called rickets, which is very nasty, but somehow, there is essentially no rickets in the United States. The only case I ever saw was a well-meaning but utterly misguided family feeding their newborn infant home-made vegan formula."
},
{
  "instruction": "Can I survive only on smoothies and fruit bowls if I make them nutritionally complete?Alright so heres the deal. Im 20, female, 119 lbs and 54. I was diagnosed with gastroparesis and IBS when I was 16 and Ive been trying to keep my symptoms at bay. However lately Ive struggled a lot with very intense pain after eating and a lot of bloating, especially when I eat at night. Whenever I eat after like 4 I have trouble sleeping because of the pain, that is if I dont throw up immediately afterwards. I started to realize that the problem goes away if I consume smoothies or smoothie bowls instead of my normal meals. I always have oatmeal for breakfast and I usually dont have an issue with it, I do become full super quickly though. I decided to replace my lunch and dinner with one big smoothie. The smoothie contains: -Spinach or kale -About 1.5 cups of fruit -Coconut oil or sugar free peanut butter -Vegan protein powder -Fortified Almond milk -Cauliflower, Celery or other miscellaneous vegetables.The smoothie is either liquid or thick and topped with more fruit, some light granola and extra nut butter. It would be my one meal aside from my daily bowl of oatmeal which is also topped with berries, nut butter and a little bit of honey. Although sometimes I have eggs for breakfast instead.In addition I take a B complex vitamin, omega 3, vitamin D and Iron supplements. I want to know if this is sustainable and something I can do long term, I honestly cannot stand the pain food causes me anymore and I figure liquid food is better than no food. Im treatment resistant and Ive been on medication for both of my conditions, somehow after I started treatment my symptoms got worse so I had to stop. I appreciate any advice you can provide.",
  "input": "",
  "output": "sure. You can survive on a blended up vegan diet if you want.Just be sure you're hitting reasonable amounts of fat and protein, and supplement B12. Pay attention to your iron intake, may need supplementation too."
},
{
  "instruction": "Wouldnt talking to a dietitian help or even be a good idea for anyone considering something like this? Or is that not in line with what a dietician would normally advise on?",
  "input": "",
  "output": "She can if she wants. If she's not familiar with vegan diets, it could be a good idea.The intake of protein, fats and other micros could become a problem. Remember a healthy diet is first, balanced and second, a diet you can stick to."
},
{
  "instruction": "What does a toddler really need nutritionally?My husband and I have 3 children. We have always had good eaters but my youngest (2 years) is becoming rather picky. I personally believe she is still eating enough and realize this is just a pretty common childhood thing. My poor poor husband is worried sick. I think this man legit thinks she will starve if he doesn't just get her to eat something and often results in caving to more snack foods, making this whole thing worse.To give you an idea of what she is currently eatingBreakfast - a full bowl of Oatmeal, banana, cup of milk. Lunch - about a quarter (plus a few bites more) of a peanut butter and jelly sandwich, bowl of applesauce, cup of water She will snack on some plain animal crackers or cheerios throughout the day Dinner - usually a small bowl of noodles and a cup of milk. Definitely her smallest meal of the day. I usually will still give her a small bowl of ice cream or a slice of pie if we have it. And I'm talking age appropriate portions. All within reason.I realize she's heavy on carbs and in an ideal world we could get more fresh foods in. I think it will all happen in time but this man really is scared for his daughter. Please help me calm him down and let me know if she will survive to adulthood on this pretty standard kids diet?",
  "input": "",
  "output": "She'll be just fine. Toddlers are often snackers, and they get in a lot more calories than you'd think through this. As long as she's growing, I wouldn't be too concerned. You can always bring her in and discuss further with her pediatrician if you think your husband needs to hear it directly from them."
},
{
  "instruction": "I (f21) have been losing my hair and I think its a nutritional issueMy hair used to be super thick when I was younger. As I got older, I would shed like crazy. Id be in the shower and pull out chunks of hair. My part is getting wider and it has mini parts so my big part is shaped like a stitch or spine. What kind of foods could help me grow my hair back, if possible?",
  "input": "",
  "output": "This post is missing much of the helpful required information for this subreddit and contains no medically-precise information about the distribution of hair loss and medically-precise description of the findings of the scalp examination. Providing an opinion is not possible. Seek dermatology care."
},
{
  "instruction": "Where to start for a good nutrition deficiency and gastro health testing29 6'1\" 200 lbs white male Fatigue last couple of yearsHey everyone. Thanks in advance for any help! I have maxed out my deductible this year for unrelated arm surgery and am looking to make sure I get the most of medical assistance that I have kinda been putting off. For the last couple of years I have felt fairly fatigued and cloudy from day to day and generally held a bit of a fog. I am in great shape physically but my diet is not the best due to very little fruits and vegetables. I was wondering about a good place to start to get a nutrition deficiency test? I would like to do a comprehensive one if possible. This has been something that I have been meaning to check off regardless of if it is the best place to start for concerns around fatigue. I have also noticed frequent black specs that look like coffee grinds in my stool. I got a take home test done with a general physician with negative results. Does this mean I simply do not need to worry about this concern anymore? I was picturing a situation where I might be able to combine the concerns and see a gastro health doctor and have a general look at my overall nutritional picture?On a side note hangovers have been getting really bad for me recently and usually lasting two days.In addition to this, I am open to suggestions on any general medical checkups that would be advised to get an idea of my health prior to the end of the year and having to pay out of pocket next year. Thanks for any help. It is appreciated!",
  "input": "",
  "output": "Why get a nutrition test when you know the problem already: you need to eat more fruits and vegetables.Why are you still getting hangovers? You're 29 dude. Drink a glass of water between every drink and stop drinking so much that you get hungover. Alcohol is a literal poison. It's fun in moderation, but if you're getting hangovers for days, you aren't drinking in moderation."
},
{
  "instruction": "Nutrition Response Testing21M 165lbs 5'10 I think this is not scientific or accurate but am looking for other opinions. The idea that the body responds differently depending what bottled supplement or substance someone is holding doesn't make sense to me at all. I haven't been able to find any detailed explanation online about the rationale behind this. Still, nutrition response testing is quite widespread and used by many doctors, which is difficult to understand. Do they legitimately believe it works or are they just trying to appeal to more clients\/make more money? The fact that Freddie Ulan(founder of nutrition response testing) is a known scientologist is also a red flag to me. My mom is convinced that this works and wants to take me. What are your thoughts?",
  "input": "",
  "output": "Removed under rule 7. Please do not post pseudoscience\/pseudomedicine or other non-medical interventions in this subreddit."
},
{
  "instruction": "Pediatric: Cannabis vs Opiods for pain management?My step-son (13M, 238lbs, 6'3) fractured the growth plate on the back of his ankle today. We were given hydrocodone but he has gotten very agitated\/rage-y on painkillers before.Also, there is a history of opioid abuse\/addiction on one parent's side and general substance abuse\/addiction on the other so we're all very skeptical to give him anything. Two of us parents have used medical marijuana as a replacement for pain medication effectively.Which would be considered the lesser of two evils here? Either way we would mostly be giving it to him once a day to help him sleep.",
  "input": "",
  "output": "Besides hydrocodone. Is he on any nsaids? (Ibuprofen,naproxen,etc) I assume the hydrocodone is in combo with acetaminophen. Cannabis has and is used for some pain control but it really depends on the legality in your state\/country."
},
{
  "instruction": "Yes, we are alternating ibuprofen and Tylenol every few hours throughout the day which is why the main concern is him getting some rest at night. Delta 8 and 9 are legal in our state. I'm mainly worried about the whole brain still developing at his age thing.",
  "input": "",
  "output": "if his pain is bad enough he could get a nerve block with a catheter. would make the pain basically gone and he could keep it pretty numb for 3-5 days till a lot of the inflammation is down.You could try paracetamol and ibuprofen first. If his pain is uncontrolled with that then chat to his doctor about your concerns. Opiates can be entirely appropriate for acute pain. Im not sure of the evidence for cannabis for acute pain, especially in children."
},
{
  "instruction": "My pediatric urologist wants to put my child under general anasthetics at 6 monthsI am worried about negative impacts this might have on brain development is it possible to have a successful surgery done at 3 years old instead?",
  "input": "",
  "output": "3 year old kids get extremely stressed about surgery and will remember both the period before and the pain afterwards. It can be very traumatizing for them.A 6 month old will have no clue what's happening and won't remember.The available evidence suggests that a one off exposure to a general anaesthetic will not have long term implications for neurodevelopment. However your concerns are very valid and you should discuss it further with your paediatrician."
},
{
  "instruction": "This! When my kid was 6 months old all he needed to feel better was to nurse. At 3 nothing worked!",
  "input": "",
  "output": "It depends on what surgery your child is having on whether it can be delayed that much. What is it?"
},
{
  "instruction": "Chordee",
  "input": "",
  "output": "He'll be more uncomfortable after surgery at age 3 than at age 6 mo, but there's really not a solid indication to fix that early. For things like undescended testicles, those should be done sooner."
},
{
  "instruction": "Was this inappropriate?26M. I recently had a flashback to when I was 15.5 y\/o and had regular visits with my pediatric endo. I only have TID, no other autoimmune disorders but my pediatric endo always checked my testicle size during every 3-6 month checkup. Is this appropriate? I'm trying to figure out if this is the norm",
  "input": "",
  "output": "Most pediatric endocrinologists check the testicles to see the volume and stage sexuality maturity.Endocrinologists also are heavily focused on hormones, so its well within their training to make sure youre testicles were growing appropriately.What's TID? What were you seeing an endocrinologist for?"
},
{
  "instruction": "Sorry, type 1 diabetes",
  "input": "",
  "output": "Well apparently high sugar levels can damage your testes, so perhaps? Hard to say"
},
{
  "instruction": "Possible seborrheic dermatitis?Pediatric patient 10M, height 4ft, 80lbs, white\/black, healthy and has no medical issues, no meds, etc. I was thinking it was just a serious case of dry scalp as it was starting to peel. He's been itching it quite a bit while at school. I mentioned this to the pediatrician and was told to use selenium sulfide (Head & Shoulders), so that is why the scab appears that greenish\/blue color. It is raised pretty high. My concern is if he keeps scratching it could lead to an infection. Does this appear to be seborrheic dermatitis? if not what else could it be? Thank you.",
  "input": "",
  "output": "1 marginal quality image. Seborrheic dermatitis could appear this way as could psoriasis, tinea capitis and many other conditions."
},
{
  "instruction": "Thanks, Doc. It definitely could be tinea capitis. I'll keep treating it with selenium sulfide until my appt with the pediatrician next week.",
  "input": "",
  "output": "You might consider dampening the scalp, using a salicylic acid shampoo and let it stay in place 5-10 minutes, then rinse it off. This may loosen the scale."
},
{
  "instruction": "Thank you, Doc. So salicylic acid should work better than selenium sulfide? Selsun Blue and Head and Shoulders have both.Correct, I have been rubbing it in gently and washing it out after 10 minutes.",
  "input": "",
  "output": "There is no evidence that one active ingredient in these shampoos works better than another for seborrheic dermatitis. I was making a suggestion to help remove the adherent scale."
},
{
  "instruction": "Pediatric neurology help. Sudden onset Anisocoria (1.3mm) in 3 siblingsMy 4.5, 2.5, and 6 week old all have Anisocoria. The first 2 measure 1.3mm difference, the third has not been seen.My 4.5 year old was referred after he didnt pass the vision screen at pediatrician (they turn off lights and the kids look in the box with birds chirping.) My 2.5 year old failed same test and was referred. It is noticeable by naked eye with the 6 week old. The older two have previously passed the eye test in years prior. This is the first appointment for both that they failed.My 4.5 year old went to a pediatric eye doctor and he said he couldnt find any other issues. He said he has seen it come and go in kids and even switch eyes. I cant find anything like that on Google. Nothing about it being genetic. He said 1 in 10,000 chance that its a neurological issue because no other symptoms present. My 2.5 year old will go on 10\/20. My 4.5 year old will go for follow up on 10\/31.I dont know what other actions to take. It is unsettling this popped up in all of them with no answers.",
  "input": "",
  "output": "I'm not an opthalmologist, but if three children in the same household developed this as a sudden onset issue in the same time period it seems reasonable to consider an environmental trigger or exposure. New medicines in the house?"
},
{
  "instruction": "My 10 year old had an allergic reaction Sunday night and still has welts. Is it normal for his body to heal like this?My 10 year old son had an allergic reaction while asleep Sunday night and woke up with his trunk covered in welts. He was taken to his pediatrician and prescribed 4mg Dexamethasone, 2 tabs first day and 2 two days after.His only known allergy are peanuts (severe).He is still getting new welt outbreaks and does not seem to be getting better, but physically feels fine minus the itching.Thanks for your help.",
  "input": "",
  "output": "The most common causes of hives in a pediatric population is actually a viral illness. If you don't think he's having other allergic symptoms, this could be the culprit."
},
{
  "instruction": "5.5 Year Old Severe ConstipationTLDR: 5.5 year old is severely constipated, complaining of major stomach pain, trouble swallowing, and nausea. Shes waking up through the night coughing and crying in pain. Doctors are suggesting 5 cap fulls of miralax and 2 ex-lax a day - Im concerned this is not good for her. Thoughts?Hello! I feel like Im new to the constipation world, but weve honestly dealt with it for awhile now without me knowing how bad this is. My daughter is now 5.5 and we are about 5 months into a severe constipation epsiode. Its taken doctors awhile to help figure out how bad this is, but here we are. Shes struggled with constipation on and off ever since she was born (at 4 months old she would pass stool the size of hard boiled eggs), but I didnt know how bad it truly is. She has always pooped once or twice a day for most of her life, its just the consistency and size of the stool that I was ill-informed about. Here is where we are at now: Since November, she has been complaining that as soon as she eats or drinks, her throat feels tight, feels that shes going to throw up, and her stomach hurts so bad. Ive taken her to the ER twice, doctors at least once a week, and have had multiple X-rays. The X-rays consistently show tons of stool. We officially started doing a clean out method about 2.5 weeks ago doing mirilax, milk of magnesia, and ex-lax. Shes been pooping 5 or more times a day, passing lots of ribbon size or huge logs. But her complaints are continuing and shes eating less and less. She is not afraid of pooping and has no problem making it to the bathroom which is good. Weve missed a lot of school (kindergarten) for this and shes only 35 poundsI cant imagine what this is doing to her long term. The X-ray 2 days ago showed that shes still completely backed up right at the exit of her stomach, her stomach isnt digesting her food well, and her stomach is extended. The pediatric GI suggested to do 5 mirilax cap fulls a day and 2 ex-lax still, for up to 3 months. I just dont feel like this is safe for her, how little she is, how little shes eating, and how much pain this is causing her. Im no doctor, which is why Im turning here. Of course the stomach aches are now worse and shes in tears on and off all day. I, personally, have IBS with diarrhea so I have no experience on how to deal with this and asking for all the tips. We have been dairy free for a month, and Im not yet going to try gluten free because I do want her tested. We have only been talking to a pediatric GI on the phone through our regular doctor because her appointment is still a month and a half away (we had to wait almost 2.5 months to get in), so further testing hasnt started yet as to why we are in this mess.",
  "input": "",
  "output": "I would agree 100% with the pediatric GI given what you say here. Long-term constipation like this causes her bowels to dilate (become larger) at baseline. That distension causes her to have less sensation of when she needs to go. Those nerves in her gut can retrain themselves, but it takes months, so it's important that she get fully cleaned out and stay that way while the retraining happens.If the dairy-free diet is helping, you can continue, but if you don't see a huge difference, it's fine to re-introduce dairy. Most pediatric constipation isn't due to a food intolerance.https:\/\/www.healthychildren.org\/English\/health-issues\/conditions\/abdominal\/Pages\/Constipation.aspx"
},
{
  "instruction": "Pediatrics, please!Hello! Worried Mom here.Patient is 5 years old (almost 6). He weighs 35ish pounds and is in the 90th percentile for height. He is a picky eater, but there has been no loss of appetite.His symptoms are diarrhea. I believe this is from lactose intolerance (his dad has the same issue) because the worst episodes are after he consumes anything that could contain lactose.What I am concerned about are the dark circles beneath his eyes that have developed lately. These two symptoms (diarrhea and the dark circles) pull up neuroblastoma when I Google (I know, no Googling). I had a friend whose child had this so it hits a little closer to home, but I know its rare.He has an appointment Monday. Should I push for tests? Or is it probably just lactose intolerance and allergies\/lack of sleep and I am just freaking out as a Mom?I do have health anxiety that is being dealt with by a professional- counselor and medication - but every time my children are sick I always jump to cancer.Thanks for any advice!",
  "input": "",
  "output": "More concerning that he's not hydrated well, or very tired. Neuroblastoma, just...no. Not up high on the differential at all."
},
{
  "instruction": "What to expect from a pediatric UTI examFemale Age 5 Weight 42 lbs Symptoms started this morning Occasional burning sensation when urinating Frequent urge to urinate No current medications Exam scheduled for tomorrow morningJust wondering what to expect by the exam. Mostly which areas will be examined and the manner in which it is done. I want to be able to protect my daughter and be able to spot any predatory behaviors.",
  "input": "",
  "output": "I'm assuming you're asking whether a genital exam will happen. May depend on the physician. Some girls that age will complain of \"burning\" with urination and not have a UTI, but instead have a yeast infection or vaginal irritation that is causing the symptoms, so I do often do a genital exam unless they have symptoms like fever that make me more certain about a UTI.Genital exam in a prepubescent female would consist of often getting into a frog-leg or \"butterfly\" position while lying down or sitting back. The doctor may spread the labia majora slightly to get a view of the urethra and assess for redness or discharge. There should be no touching of other structures.If you don't feel safe with your pediatrician, time to find a new doctor. A good doctor should always welcome you asking questions and asking for an explanation before they do an exam."
},
{
  "instruction": "Thank you for the very helpful reply! Im glad you specified what the exam would consist of that was exactly the response I was looking for.Its not so much that I dont feel hes safe or a good doctor, more that I want to be aware. I feel that asking someone involved in the situation with more knowledge than I puts them in a position of power where they could just claim what theyre doing is normal.But again its less the doctor and more about me being suspicious, paranoid, and protective.",
  "input": "",
  "output": "No problem!"
},
{
  "instruction": "Pediatric impetigo or something else?Age: 5Weight: 43 lbsRelevant health background: Hes very picky with eating due to some sensory aversions, so he ends up eating a bit of a lopsided diet and barely eats any proteins. He takes multivitamins with iron and no other regular medications. We are in the US, and he is up to date on his vaccines.Maybe relevant maybe not: We live in an area that has brown recluse and black widow spiders. I havent personally seen any. This also began his very first week of Kindergarten. A cough accompanied it, but to be honest my son has a cough 80% of his life.TIMELINESept 2 - My son comes home from Kindergarten and tells me he has a bug bite and his leg hurts. I dont think anything of it, were driving when he tells me this so I dont immediately look.That evening, I see it when giving him a bath. It looks like a bug bite. I put a bandaid on it.Sept 3 - The bug bite is irritating him. Hes scratching at it, I replace the bandaid and give him neosporin.Sept 4 - When I remove the bandaid, the wound has grown considerably. This is the first time I take a photo. Now Im wondering if this was a spider bite. I put some neosporin on and leave it without a bandage Photo: https:\/\/imgur.com\/a\/rB1KJ7BSept 5 - The next day, it looks a bit larger, and with some dots surrounding it. https:\/\/imgur.com\/a\/QdcVImZSept 6 - No change, didnt photographSept 7 - We go to the zoo and he immediately begins complaining about his legs being soooo tired. He was excited to go to the zoo so this was unusual. He whined the whole time and insisted on being carried (hes 5, this is not typical). When we get in the car, he immediately falls asleep. This is important because he had not napped in THREE YEARS. He dropped his naps when he was 2 and never napped since. When we get home, his legs look a lot worse. Not only that, the little bumps around the area have begun popping up all down his back, shoulders, everywhere. https:\/\/imgur.com\/a\/bbCGtFVSept 8 - We visit his pediatrician. He takes one look and diagnosis impetigo. Hes very confident in this. Prescribes topical antibiotic and oral antibiotic for a week. Said he was fine to return to school as long as the wounds werent weeping.Sept 9-16 - The rapid progression stops almost immediately and it begins to heal after about 48 hours on antibiotics. Things are looking good! All my fears of flesh eating bacteria and so on start to go awaySept 21 - Another small sore pops up on the same leg, near his hip. Im immediately suspicious of it, and dont want it to progress, so we go back to the pediatrician the same day.She says it doesnt look anything like the others, and to just keep using the antibiotic ointment, but to add a daily bleach bath (1\/4 cup bleach in a tub of water) to help ward off the bacteria living on the skin. She says impetigo is just staph or strep that found its way into a wound and is irritating it, so we just need to keep his skin clean. So we start that.MAYBE RELEVANT - She notes his tonsils are large and does a rapid swab for strep, which is negativeSept 28ish - He has a scrape. Its on the OTHER leg. Hes adamant that he fell and scratched it. We believe him and leave it alone.Oct 1 - Its considerably larger but he also keeps scratching it so were not sure what to think.Oct 2 - We took a walk today and he began complaining that his legs are sooo tired (I cannot stress enough what a hyper boy he is his legs are NOT tired). We go home and that other leg looks IDENTICAL to how the original looked. I go to the urgent care and insist on a skin swab, which they do but since theres no pus, they cannot guarantee accurate results. They prescribe 10 days of Cephalexin but say theyre just not convinced its bacterial. They said it just doesnt look like anything they can readily name.https:\/\/imgur.com\/a\/cObh69dI am worried because it seems to be jumping around his body, made worse by walking\/warmth, and hurting his legs more than topical wounds should. I also cant shake that the cough is still there.I also feel dismissed when I repeatedly ask if the cough and exhaustion could be related to his wounds.What do YOU think?",
  "input": "",
  "output": "Cephalexin is unlikely to be successful at treating a Staphylococcal impetigo. Treating that requires either Bactrim or clindamycin."
},
{
  "instruction": "So do you feel it looks\/sounds like impetigo? If it is, would the swab they took today tell me what bacteria its originating from?",
  "input": "",
  "output": "The photos remind me of a bullous impetigo in which the bullae have opened. A culture of the affected skin without fluid from an intact bulla would not show this; the diagnosis is a visual one. Non-bulbous impetigo is Streptococcal, but bullous impetigo is Staphylococcal and one must always treat for MRSA."
},
{
  "instruction": "(Almost) 4yo Boy, Many Symptoms, No AnswersBorn 3\/2019.Waking up at night from a dead sleep with leg pain for nearly a year now. Happens once or twice a month usually. Right leg more frequently. Chalked up to growing pains. When he wakes up, give him Tylenol, get the heating pad out and wrap his legs. Rub his back and he falls asleep. Seems fine in the morning. Sometimes has complained of pain during the day, but could be a ploy for medicine. Points to his shins, knees, and thighs as sources of pain.Complains of headaches occasionally (I've never even heard the word, \"headache\" come out of his older brother's mouth). Goes away with Tylenol.Was vomiting a lot last year. I started tracking and the average was 1.5x a month. No fever or other symptoms; would complain of nausea, boot, then be back to normal within an hour. Went to pediatrician on 8\/19\/22, she recommended we go to the ER because we could get all testing done rapidly and at once. Went to ER, had bloodwork done (normal at the time, no cancer markers), was diagnosed with cyclical vomiting syndrome. Debated on whether to do a CAT scan or MRI, opted to not. Has only vomited 1x since then, was this past October. Not much nausea or vomiting since.Swollen lymph node in armpit and back of neck, both on left side. Just discovered armpit one today. Neck node has been enlarged for over six months. No biopsy, superficial exams by multiple doctors, all advise this is normal and not a concern. Soft, movable, and less than 2cm in size. Hasn't grown.He often just looks pale compared to the rest of the family (we are white, British decent), but could be chalked up to recent rainy weather and being stuck indoors for winter. He also seems thinner than the rest of us, just bonier than his older brother was. Always craves sweets. Weight and height are good, around 70th percentile.I found swelling in the back of his knee four weeks ago. Right posterior, left of the popliteal fossa, about the size of an avocado pit. Puffy, not hard. Took him to the pedi two weeks ago, and she said likely a cyst, but referred me to an orthopedic surgeon for further evaluation. Have appointment this Friday to get it checked (she said probably an ultrasound). She also checked him for a wet cough that he's had for over two months. Said she heard crackling in his lungs, prescribed inhaler, doesn't seem to be helping, will have a follow up next week to check his lungs again. Cough is annoying, but not really impacting day-to-day activities. Still very active and happy kid.Went on a long walk today and he woke up again with knee pain, said only right one hurts. Did the usual late-night treatment and now he's asleep.I am debating on whether to take him to the ER again. Our firstborn was healthy as a horse, never in the ER and sick with typical symptoms. I don't want to be too overzealous with an appointment coming up, but all of these symptoms just have my mom radar screaming there's something really wrong with him. I assume the ortho won't do another blood panel at the time, so it'll be a referral if they find something wrong. I just don't know if I want to keep dragging out discovery appointments for the next few weeks vs. going to the ER and asking for the gamut of tests.Any feedback at all is appreciated. We have a PPO and are financially stable, so cost isn't an issue.",
  "input": "",
  "output": "I've usually noticed that when your mom radar is screaming, it's better to take your kid to the ER. The symptoms you have mentioned could be due to a viral infection, but I'm still perplexed as to why the doctors decided against the CT or MRI and did they perform abdominal Ultrasound?. Also , cyclic vomiting syndrome can cause dehydration, lethargy , pallor, and muscle weakness. I hope he's taking his fluids well."
},
{
  "instruction": "The ER doc and a random physician's assistant both advised against the CT (radiation unnecessary) and MRI (would require sedation) because it would be invasive and likely unnecessary given the results of the blood panel we got this past August. He already had the swollen neck lymph node by that point, but it was dismissed as normal. No one spoke of an abdominal ultrasound at all.He hasn't had a vomiting episode in a while, which I'm grateful for, but he is a very finicky eater. Often says he's not hungry or full, but I try not to stress because his weight and height have been increasing on the right trajectory and he's at the 70th percentile.The tone I perceive from doctors is that I'm overreacting because this is my \"baby\" and there's nothing wrong with him, but it's just such a stark contrast to his older brother. I think I'm pretty laid back overall as a mom, but this has me questioning myself. Thanks for the two cents.",
  "input": "",
  "output": "You are welcome. Usually, CVS is triggered by a stressor or a food . Has your pedi advised you to keep a diary to identify it ?"
},
{
  "instruction": "Nope, same deal, no mention of keeping a diary. I was essentially told that he'd probably grow out of it, not to worry if he wasnt losing weight. Based on your matrix, I would define it as mild now. He recovers fast and the issues were really confined to early\/mid 2022.",
  "input": "",
  "output": "Maybe he was under some kind of stress at that time , you never know with young kids. But it's good that it's resolved now. The enlarged lymph nodes , in my opinion , need to be investigated, most probably it's due to a viral or bacterial infection, and there's no harm in repeating tests so if antibiotics are needed , they can be given at the right time."
},
{
  "instruction": "I'm just a layperson, but I feel like if it was me I'd 100% rather random people\/doctors think I'm crazy than my child feel like I don't hear them\/don't care that they're complaining of pain or sickness.",
  "input": "",
  "output": "It's a very helpful matrix for cyclical vomiting syndrome. Though it's more relevant to the doctor treating the patient , I think it also provides good information to the patient or on your case parents."
},
{
  "instruction": "We were prescribed Topiramate, but I haven't had to use it since October 2022.",
  "input": "",
  "output": "Topiramate has a very good response in pediatric CVS."
},
{
  "instruction": "I have really appreciated your responses so far! Do you have any thoughts about the knee swelling\/cyst and night pains?",
  "input": "",
  "output": "Night pains could be growing pains, or it could be the popliteal cyst or lymph node compressing a nerve. Usually, with an enlarged popliteal lymph node \/ cyst and neck ( cervical ) lymph node , I'll go for complete blood work and monospot test ( to detect mononucleosis\/ Epstein Barr Virus ). Chronic bacterial and viral infection can lead to the enlargement of lymph nodes in kids ( also called lymphadenopathy ). It also happens in upper respiratory infection ( and if your pedi wants to explore further , I think they should go for a chest X-ray). Another thing that I'll always do will be the abdominal palpation to rule out enlarged spleen. In your kid's case , I'm still leaning towards the infection because he's otherwise healthy."
},
{
  "instruction": "He was home for most of the covid lockdown years (we were in California and very restricted), so he was never sick or exposed to immune stressors for over two years. It seems like since he started daycare in late 2021 it's been nonstop illness. We've had head colds, stomach viruses, covid, flu, roseola, hand foot mouth, etc, you name it. Would this onslaught of viruses cause lymphadenopathy? Could it cause unexplained vomiting too? The vomiting occurred without fever and far enough from the stomach viruses and roseola to not be linked, I think.We decided to skip the ER and will see his pediatrician this week. I'll ask about the spleen\/mono and push for more tests to explain the swelling nodes. Thank you so much for at least putting me at ease regarding worst case scenarios. Let me know if you'd like an update after we get results. I have no idea why you were so helpful to an internet stranger, but I sure do appreciate it!",
  "input": "",
  "output": "Thank you so much for your appreciation. As a physician , it is my duty to help a patient in any way I can. You are right about the non exposure of viruses during lock down, because kids didn't have the opportunity to develop any immunity to them, and hence, the flu is more severe than before. I'll definitely appreciate an update, and I hope everything will turn out alright.Different physician, but I am not concerned about the leg pain. The lymph nodes need to be investigated at some point soon, but not necessarily tonight. You relate reassuring characteristics about them.The big tell for leg pain is whether they want them rubbed or not. Pathologic leg pains don't get better with touch, and kids flinch away: tumors, fractures, arthritis, osteomyelitic infection, chronic inflammation, all of that is not something that gets better with being rubbed. I don't think I've ever seen something worrisome in the legs causing pain that was better with rubbing."
},
{
  "instruction": "This is so very heartening to hear! I opted to skip the ER today. Will see pediatrician this week to re-examine the cough\/lymph nodes. I'll wait for the ortho appointment this Friday. He definitely wants those legs rubbed!",
  "input": "",
  "output": "I will be thinking of you and hoping for the best. Please let us know how it works out."
},
{
  "instruction": "Thank you, will do! Did you happen to see the comment above about Celiac Disease? My mother has it, I do not, but I do have issues with carbs in general. Would a sensitivity like that account for the leg pain and immune response? Vomiting and paleness?",
  "input": "",
  "output": "Celiac can certainly present in a variety of ways. We used to look for a very limited constellation of symptoms, but then it became recognized that -- for example -- it can come with constipation, not just diarrhea.My comment was intended to be reassuring about pathology in the legs themselves. I think what you related is reassuring from that perspective. Whether he could have cramping from an electrolyte imbalance or nutritional deficiency secondary to celiac disease? It should be possible. Thankfully there is relatively definitive testing to rule in or out.I hope you get some answers for your little tyke soon."
},
{
  "instruction": "ENT surgeons - would you do pediatric supraglottoplasty and\/or remove adenoids?My baby is almost 5 months old, scheduled next week for endoscopy & bronchoscopy - the ent surgeon wants blanket consent going in for supraglottoplasty and removal of adenoids if indicated.On sleep study around 2.5 months ago, baby had a significant number of hypopneas (approx 27 times per hour) and 5 apneas (total) without a decline in O2 sats for either. Oxygen and carbon dioxide levels remained stable\/good throughout duration of study. (Baby was not on supplemental oxygen during the study.)Baby has no noisy breathing, no feeding concerns (weight has gone from < 1 percentile at birth to currently 7th percentile) and is hitting all developmental milestones.Baby was IUGR, born at 5.5 lbs at 38 weeks. Released from hospital on day 3. Baby had trouble holding o2 sats at 2 weeks old, and was put on oxygen. Has remained on .5 liter since. A pulmonologist and the ENT doing the procedures both said the baby could come off of oxygen based on the sleep study, however the pulmonologist who initiated oxygen treatment in the hospital wants to continue until after the procedure.Since the study, baby is sometimes off of oxygen during the day and o2 levels hold stable. I also see significantly less startle during sleep. In my opinion, his condition is improving, and if I understand correctly a high number of babies outgrow apnea and laryngomalacia (what theyre looking for, not currently diagnosed).Looking for outside thoughts on this before deciding how to proceed.",
  "input": "",
  "output": "There's not enough information to definitively say what the correct course is, and we can't look at any further evaluation that has been done. Your child has severe sleep apnea based on the reported AHI, has an oxygen requirement, and by definition had failure to thrive while being <5th percentile for weight. One thing not commented on in this post at all is how feeding has been going, if there is tiring during feeding, desaturations during feeding, and how noisy the baby is when agitated and how noisy when sleeping. These can also all point to whether laryngomalacia is a potential cause.These all indicate at the very least that an evaluation of the airway is necessary, and it is reasonable if there are significant issues to correct those issues and minimize the need for further procedures."
},
{
  "instruction": "Thank you for replying!I tried to address some of those things in my post. It sounds like I wasnt clear, so Ill try again.Ive been told by 2 different doctors that he no longer has an oxygen requirement, however the initial doctor who began the oxygen wants to keep him on it until the scopes.Baby is not failure to thrive. He was born less than 1 percentile due to IUGR. He is currently in the 7 percentile. He has been growing and gaining weight consistently along his curve. Weve seen GI and several nutritionists and feeding specialists (the specialists here see in co-managing groups) and everyone is very happy with how he is feeding and how he is gaining.He does not have, and has not had, any feeding issues. No tiring during feeds. No sweating. No desats during feeds. He has a bit of reflux, which GI said is normal and needs no treatment.There is no noisy breathing when agitated. He is not noisy during sleep.The impression Ive gotten is that laryngomalacia is being looked at as a possibility due to apnea. I also understand that typically oxygen drops during these events, and his did not. I think I was seeking some opinion on this in my post, though I wasnt clear. Can apnea be the only symptom of laryngomalacia requiring treatment?I absolutely think the scopes are necessary. Im totally on board with looking. I think this is why Im feeling challenged in giving blanket consent to cutting going in, though. To me, based on the research Ive done, it doesnt sound like he has other symptoms of laryngomalacia.I was hoping I might get additional insight here, and perhaps even find other pathways to research and explore. I appreciate you taking time to respond!",
  "input": "",
  "output": "Generally laryngomalacia is associated principally with noisy breathing and feeding difficulties. It is possible to have severe enough laryngomalacia that the loss of tone is resulting in the apneas\/cessations of breathing, this would be called sleep-dependent laryngomalacia which is becoming increasingly recognized in the last few years.The true fact of the matter is there is a 5 month old with severe sleep apnea who is working on growing. Sleep apnea has significant impact on children and can impair development.It is also unclear if a scope examination has been done while the baby is awake (through the nose) to see if there is any evidence of laryngomalacia as this can often be apparent at bedside as well. The caveat to this would be sleep dependent laryngomalacia wouldn't be (because baby isn't asleep)When I was at a children's hospital and worked with some people that did blanket consents like that, it didn't always mean that the surgery would be performed, only if there were findings concerning enough to warrant the intervention. You have the option to talk to the surgeon and ask they call you before performing the procedure or discussing what they find. I've done that with plenty of folks. That being said, a supraglottoplasty is very well tolerated overall and those kids do tend to do much better."
},
{
  "instruction": "Dr.'s office is closed but I plan to call them tomorrow to verify... but I'm curious. My kiddo, 9F 29kg was prescribed pills instead of suspension because there is a shortage here, but it seems like she was prescribed an adult dose- 875mg every 12 hours, which works out to just over 60mg per kg per day. This seems to be roughly double the recommendation for children under 12.... source here: https:\/\/www.drugs.com\/dosage\/amoxicillin.html#Usual_Pediatric_Dose_for_Tonsillitis_PharyngitisThe diagnosis is scarlet fever, rapid strep test came back positive. I'm considering giving her half a pill tonight, or maybe just waiting until tomorrow when I can verify dosing with the doc. Do I have other options? Is there a better site for dosing information? I don't want to be the stereotypical \"dr Google\" but I know how EHR's work and I wonder if the system goofed when the med was switched from pediatric suspension to pill form, and I don't want to give my kid unnecessary diarrhea or whatever other nasty side effects might come from too strong a dose.",
  "input": "",
  "output": "They may have missed that we max out the dose of amoxicillin at 500mg twice daily or 1000mg once daily. I think it's fine for her to take a single dose of the 875mg tonight, then call them in the AM to see if you can get 500mg tablets instead.https:\/\/www.cdc.gov\/groupastrep\/diseases-hcp\/scarlet-fever.html"
},
{
  "instruction": "Please can anyone tell me what is in the predmed given before UK pediatric surgery -to help calm and sedate my 5yr old before GA. Thank youAgeSexHeightWeightRaceDuration of complaintLocationAny existing relevant medical issuesCurrent medicationsInclude a photo if relevant",
  "input": "",
  "output": "I'm not in the UK but in Germany, yet I doubt the colleagues use vastly different medicines.We typically use the short-acting benzodiazepine Midazolam, which is also available as a sirup (ideal for kids). Alternatively, Clonidin can be used."
},
{
  "instruction": "Can I still visit a pediatric doctor although i am 2121F. Height: 159 cm. Weight: 47kgs. South Asian. Although i am 21 i literally look like a 12 year old. I look very skinny and petite. I almost always have been since age 7-8. I won't say i eat the healthiest diet in the sense i most of the time remove onions and tomatoes out, other than that I eat ample amount of food. I literally am not gaining any body mass other than my tummy lol. I have a very thin and petite body frame. I was thinking of approaching a pediatric doctor unless it didn't improve till 18\/19 but then COVID hit, can I still visit one, or that won't be appropriate given I am 21 now. Or should I visit some other doctor?PS.: I also got my thyroid levels checked and it were normal. What could be the cause? Where do I start from",
  "input": "",
  "output": "If you have a pediatrician as your primary care doctor, they may continue to see you until some point. If you dont have one, setting up with a pediatrician makes no sense and most would decline to start with you. Size and appearance are not the distinction between pediatric and adult medicineas pediatricians are fond of saying, kids are not just small adults. You should see an internal medicine or family medicine doctor.Your BMI is within the healthy range. Are your parents and other relatives thin? If so, without any symptoms its very likely just genetics."
},
{
  "instruction": "Was I molested by my pediatrician? \/ Is this normal for a pediatric exam?This is going to be all over the place so I'm sorry for that.All I remember was being 14 and being at the pediatricians. I kept saying no. My Mom was in the room and kept saying yes. So my underwear was down and my knees were bent and I was sobbing and my male pediatrician spread my labia just to \"look\" (with his hands). I was sobbing and saying no and I was ignored.I've talked to various crisis types of hotlines including RAINN and personally found them of no help.",
  "input": "",
  "output": "An external genital exam is part of a normal physical exam in child. I seriously doubt your pediatrician was doing this exam for some sexual purpose. However, I wouldn't force an exam like this on a crying kid, particularly an older kid with a sense of agency, unless it was medically necessary.Many pediatricians will limit their external GU exam on older girls to simply looking externally at labia, to assess pubarche. Doing an external while spreading labia is less common a \"check up\", unless there's a specific complaint like discharge, itching, rash, whatever. On the other hand, boy will typically have their testicles palpated looking for masses, hernias, varicocele, and assessing normal testicular development.Nobody here can say if the specifics of what your pediatrician were definitely appropriate in the circumstances, but an external GU exam isn't uncommon, and isn't \"molestation\" in and of itself. But it's something where assent from a 14 y\/o girl should be obtained."
},
{
  "instruction": "Sorry in advance for the long post!My 8 year old son has had significant trouble with bowel training since initiation of potty training in general. What I believe started as an aversion to pooping due to distraction or not wanting to miss out on anything exciting while he was on the toilet, evolved into chronic constipation and an aversion secondary to pain. This was initially treated with Miralax and pushing fluids. However, he continued to have various amounts of poop in his underwear on almost a daily basis, and struggled with having regular bowel movements, alternating between small pebbles to impossibly large logsBecause he spends half of his time with his father and half with myself, there have been some inconsistencies in addressing this. I recently had a long discussion with his father and we decided to give an impaction appropriate dose of Miralax to encourage complete emptying and then start on a consistent maintenance dose at both houses. Admittedly, we had both dropped the ball on this. My concern now is that my son has recently had a couple of episodes of full on incontinence while out running errands. When I talked to him about always letting me know he has to go so we can find a restroom, he explained that he does not feel and urge to go, and only realizes what has happened when he feels it in his pants. I recognize that prolonged constipation can decrease urge sensation and believe this is what has happened. I do think this is still a tiny bit related to not wanting to stop what hes doing and sit on the toilet for the appropriate amount of time to have a big poop. All of that background is basically to ask, should I seek out a pediatric GI specialist? Or is this something that can be solved by going back to the potty training basics (timed toileting and having him sit on the toilet for a while). Is Miralax an appropriate choice for his age\/symptoms? Does this warrant a consult with a therapist? Of note, I am aware that some of these symptoms can be a trauma response, however I am very confident that is not the case with him. Despite our divorce, my ex remains a caring father to both of our children, and neither child is left in the care of any suspicious characters. Any guidance would be greatly appreciated!",
  "input": "",
  "output": "Probably appropriate to see a peds GI at this point. The starting outcome will likely be Miralax and timed toileting, but it's good to make sure nothing else is going missed."
},
{
  "instruction": "what to expect at pediatrics?16yo female. went to the doctors complaining about stomach issues, they took my bloods and done a checkup and nothing came back wrong.they made an appointment in the hospital for the pediatrician and im quite nervous.",
  "input": "",
  "output": "A talk with you and your parent, and a physical exam. Any particular thing youre worried about?"
},
{
  "instruction": "Pediatric lower back painMy son broke his hip 4 months ago. He was non weight bearing for over 2 months. His doctor released him 2 weeks ago. His PT said his left side is super weak and lost muscle mass. He has a slight limp which the doctor said would get better with time. My question is, when he tries to run eventually his lower back starts to hurt. Could this be just from weak hip\/ back muscles or some kind of muscle imbalance throwing things off? We are keeping a look out for hip AVN but OS told us that would cause hip pain and groin pain, not back pain. Any insight be help.Please",
  "input": "",
  "output": "Could certainly be the weakness in his leg altering his biomechanics. That said, how did he break his hip? If there is any concern for a back injury that went unnoticed, discuss with his doctor."
},
{
  "instruction": "We had a sledding accident. Im pretty sure they did a full trauma work up at the hospital. All sorts of X-rays. Couldnt they have seen something then? It all started after he started trying to run and stuff, which is why it makes me think its muscular imbalance?",
  "input": "",
  "output": "Yes, I'd be very surprised if they didn't catch something more serious. The back pain should improve as his gait and running stride normalize, which PT can help with."
},
{
  "instruction": "Good sub for pediatrics?The sub r\/pediatrics isnt for medical questions. Im trying to find one thats appropriate.Ive got a sick four year old who has been fighting a sinus \/ ear infection for weeks, even after seeing four different doctors. So Im looking for a group with some potential SMEs or at least other parents who have been down this road.",
  "input": "",
  "output": "Yes, there are a number of pediatricians, peds-EM docs, and a neonatal NP active on this sub."
},
{
  "instruction": "Worried about my dads cardiac cath resultsMy father is a stubborn mule of a man, and I need to know if Im right in pushing this issue until he gets the care he needs. I am a pediatric ICU nurse, so adults are not my thing.My dads history: 63yo male, normal BMI, moderate physical activity 5 days a week, former smoker x 30+ years (quit in 2017 when my son was born). He takes Repatha, losartan, baby aspirin, and ambien (he works nightshift & sleeps during the day). Generally healthy and active, only pmhx is high cholesterol (we are Cuban and he eats a very high fat diet and a lot of red meat), and two stents placed in 2017. Extremely extensive family cardiac history as follows (this is tough to keep track of so bear with me):His father: quadruple bypass, 5 TIAs then full carotid blockage, heart attack = died in 10\/2014His mother: quadruple bypass, years later had MI & stroke = died 4\/28\/2008Brother #1: quintuple bypass in his 40s... died of heart attack in his sleep 5\/2019 @ age 58Brother #2: stent in his 40sSister: MI (widow maker) & triple bypass 4\/2019Brother #3: 3\/2023 bilateral carotid 90% blockages, persistent A-fib.And those are just his immediate family. That history extends to every branch of uncles & cousins as well. They should give us a discount for buy two get two bypass at this point.My dad recently went for his annual cardiac appt and failed his stress test (he was unable to complete it) so they had him go for a cath. That revealed 100% blockages in several areas (diagram drawn by his doc here: https:\/\/imgur.com\/a\/0adwYqA ) but they didnt perform any interventions. The doc said theyd have to compare this cath to the one he had in 2017 to see the changes and decide how to proceed, but that he felt ok just watching things for now. His next appt is in June, and my dad seems to think all is well. He said oh it went fine, they told me my body made other pathways for the blood to flow. Ugh.I am alarmed. Cardiac isnt my specialty, but wouldnt this warrant a double bypass? Isnt his personal and family history enough to be more proactive with intervention? I was very close with my uncle and he passed away in his sleep just months after a normal cardiac exam. I dont want the same to happen to my dad, and Im concerned that hes heading towards a major event. Any insight? Am I right to want to push him to follow up on this immediately? Thank you.",
  "input": "",
  "output": "So obviously your dad has significant coronary artery disease. The family history at this point (which is ridiculously extensive) doesn't really matter since we know his anatomy.It looks like his left main coronary artery and left anterior descending artery (LAD) are open. His right coronary artery is blocked but past this it presumably backfills from the LAD through enlarged (collateral) vessels that wrap around the apex of the heart. This is why he had a positive stress test - with enough exertion the oxygen demand is too high for the left side to keep up.Almost all of the benefit for a coronary bypass procedure is with patients who have significant narrowing of the left main coronary artery or both of the immediate downstream arteries. These feed a large portion of the heart muscle, and not just your dad but anyone does poorly if they are blocked.However when these are open, which is the case here, the benefit is less clear and this is doubly true in the absence of significant symptoms. A left sided graft may not even stay patent in this setting, since there is competitive flow down the LAD. We would not usually do a bypass just for right coronary disease, the benefits do not appear to outweigh the risks in this scenario.The other blockages are being backfilled by the open arteries, and unless he develops new symptoms then medical management is at least as effective and safer. It isn't that the blockages aren't a concern, it is whether bypassing them is beneficial. In this case if it were my dad I would prefer aggressive medical management and lifestyle changes as much as possible."
},
{
  "instruction": "This is an incredibly thorough reply, thank you for taking the time to explain all of that. My clinical brain cant function because all I can think about is getting another phone call and it being about him.So if Im understanding correctly, it sounds like the collateral vessels are more effective than I assumed. Hes a pretty active guy, is there danger if the left side cant meet the metabolic demands of the heart during exertion? Any risk of right sided ischemia?Ill be joining him at his appointment to take notes and make sure hes compliant with those lifestyle changes. He still thinks this is all routine and not a big deal. Your reply is helping me catch my breath a bit, so thank you again.",
  "input": "",
  "output": "Yes the collaterals are presumably well-developed. The danger from over exerting himself through exercise isnt of much concern, he would be symptom limited well before there was irreversible damage. Other issues like sepsis could put some strain on the heart but unlikely to cause any sizable infarct.He needs to really maximize the medical management - strict risk factor control with high-intensity lipid lowering therapy (doesnt matter if cholesterol is high) and tight monitoring of blood pressure. If there is a hint of diabetes one of the newer agents also would be good.The medicines actually work quite well combined with lifestyle changes. CABG and stent are more bailout procedures if a lot of heart muscle is threatened by very narrow arteries, which is not the case here."
},
{
  "instruction": "Pediatric low Creat level - Doctor ignoringMy 3 year old daughter went in for her check up\/blood work, and has a .3 level of Creat and and 240 alphosi test results. The doctor is entirely unconcerned about this, but what Im reading on line makes me worried. Should I be concerned? If yes, what are immediate next steps I can take.Thank you in advance, Worried Parent",
  "input": "",
  "output": "I cannot think of a situation in which a low creatinine in an otherwise healthy child would worry me."
},
{
  "instruction": "Is there anything to be concerned about with the high level of the alkphosi?",
  "input": "",
  "output": "Probably not, but thats something to ask the pediatrician"
},
{
  "instruction": "NAD but I understand that higher alkphos in children is considered normal because of bone growth. Could be the kiddo just had a growth spurt. Alkphos is an enzyme found in bones, liver,kidneys, digestive tract. Def talk to your pediatrician so they can ease your worries.",
  "input": "",
  "output": "Those are both normal results for a patient her age. The doctor is ignoring them because your lab likely has a reference range that's for adults, not kidsThe creatinine level roughly reflects the muscle mass. Normal for kids is always low. If it's \"normal\" for a kid, I look twice and think about things.High alk phos (alkaline phosphatase) level in kids is almost invariably correlated with a low Vitamin D level. It's more typical these days to have a low Vitamin D than not, at least for kids. Maybe it's all the sunscreen plus much less non-screen time. Fewer sunburns but lower sunshine. I don't know that we have good guidelines for what to do with vitamin D levels these days, but if you wanted to pursue something, that would be it. Or give her a multivitamin with at least 400 IU of Vitamin D and consider rechecking in the spring.I'm curious, though -- we usually don't check these labs as part of routine blood work. There's the CBC or hemoglobin level, and lead, and then lipids and diabetes (but only for children at particularly high risk). Do you know what the physician was looking for, or why they were checking extra things?"
},
{
  "instruction": "Dont worry- I totally believe in them and support vaccination.Im an infant\/toddler nanny, and have been working with them for over 20 years. Today I encountered something new.The Little One I take care of (18 month F) got a couple of shots today. The pediatrician advised her parents not to use Motrin or Tylenol for fever or discomfort unless her temp goes over 103.5 or she absolutely cant sleep. The reason given was having a fever and letting it do its thing means she will have a greater immune response from the vaccines. (These were standard 18 month shots- not the COVID vax, for what its worth. She has gotten the first 2 COVID shots- waiting on the 3rd next month.)I have never heard this before. Can anyone weigh in on this? Sounds crazy to me, but Im not a doc.",
  "input": "",
  "output": "Current data is a bit conflicting from studies Ive read, but I generally caution against prophylactic use of antipyretics because there is some evidence that it blunts the immune response.Use of antipyretics about 4-6 hours post-vaccine have shown mixed results in terms of immune response but generally patients still gain immunity. Id rather have a happy patient and family that returns for all vaccines than tell them not to give Tylenol\/ibuprofen. I try to make sure they wait 4-6 hours though before the first dose if it is needed. We have multiple doses of most childhood vaccines, so its likely there wont be an issue with immunity, even with Tylenol\/ibuprofen post vaccine."
},
{
  "instruction": "Thank you so much. Ive just never heard this before, and Im always open to learning! We obviously want her to get the best results she can from them, but we also dont want her to be needlessly uncomfortable. She made it through to nap time comforted with snuggles and her favorite lunch, and we plan on letting her play in the tub this afternoon to soak the bandaids off her legs.Thats another question- is there a legit reason to put bandaids on after shots? Ive never seen more than the tiniest drop of blood on a bandaid after a child gets a vaccine, but they are so hard on their legs. They stick super hard, and she tends to get little welts where the bandaids were. She also cries now anytime she sees bandaids bc they hurt so much to take off.Are they needed? Is it to prevent infection? To put pressure on the injection site? We would MUCH rather just have the tiny drop of blood on her pants than go through this every time- but if theres a legit reason Id love to know about it.Thanks for taking the time to give an answer. Its much appreciated!",
  "input": "",
  "output": "No, no good reason for the bandaids other than the drop of blood and to prevent them from messing with the area immediately after.It's not evidence based. https:\/\/journals.lww.com\/ebp\/Fulltext\/2021\/03000\/Does_premedication_with_ibuprofen_affect_the.19.aspxThose meds can reduce immune response but not uniformly and the immune response is still enough to be protective at minimum. There's no basis for that fever number that she picked. Delayed acetaminophen or ibuprofen given after the vaccine rather than with the vaccine appear to have a lesser effect."
},
{
  "instruction": "Just to clarify your last sentence- does delaying the dose lessen the effect of the med I terms of comfort\/fever reduction? Or lessen the effect of how the vaccine impacts the immune system?We try to use other methods of soothing her in general when we can, but sometimes shes uncomfortable enough that it seems warranted. (We went with her favorite lunch and lots of snuggles between the shots and nap, and are planning on letting her play in a warm bath after nap if she wants.)Thank you for weighing in. I appreciate it!",
  "input": "",
  "output": "I think there was a trend to lessening the effect on the immune response, but again, the immune response was still adequate regardless. I'd give my kid the tylenol after a vaccine. In my local children's hospital they do as well. I find the evidence saying not to give it is weak and mostly refers to giving it at the time of vaccination"
},
{
  "instruction": "Thanks!Edit: added question to the top.",
  "input": "",
  "output": "Benzoyl peroxide is a rare allergen but a common irritant and can cause irritant contact dermatitis. As long as the latter does not occur, it is an excellent biocide."
},
{
  "instruction": "Thank you. Would you have insight into how often benzoyl peroxide wash would typically be used in a situation like ours?",
  "input": "",
  "output": "No examination details or images included, so no comment appropriate."
},
{
  "instruction": "I hope this works for photos. Ive never used Imgur or posted a photo on Reddit before. The labeled photos are from tonight when the dots have pretty much dried up and are the best they get after a bleach bath. The other two are of times when the folliculitis is more flared up. Let me know if there is anything else for a physical exam you would want. Thanks!Edit: looks like the photos require being over 18 to view. Two are of his bottom, this is probably why, though I censored what was necessary.",
  "input": "",
  "output": "Mild folliculitis present. Using the benzoyl peroxide wash a few times a week may maximize efficacy and minimize irritation."
},
{
  "instruction": "Would you indulge another question? Just curious if selsun blue would be a viable option as an occasional body wash for my sons situation given its anti-fungal properties. (Im thinking the benzoyl peroxide will be sufficient, but just curious.)",
  "input": "",
  "output": "Selenium sulfide is an antifungal agent but does not have antibacterial activity as far as I know. Not a good choice."
},
{
  "instruction": "3 months later, doctors hypothesize TTPm seeking medical advice for my mother. She has her internal med and cardiologist following. She is now seeing a hematologist. We are interested in any additional advice or suggestions that can help with her diagnosis.My mother (62F) has a history of RA. She contracted COVID four times. Once was before she received the vaccine and three times after. It is our understanding that her medication caused the vaccine to be ineffective. With each COVID diagnosis, she received the antibody infusion.My mother was then diagnosed with AFib. She took Eloquist for over one year and had an ablation in October. In November, she had a watchman placed, was taken off of Eloquist, and began taking Plavix. She also takes 80mg ASA.After one week, she began to develop spots around her ankles that resembled petechiae. Her doctor advised her to continue Plavix. The spots then became larger and spread above her knee. After 1.5 weeks of taking the medication, she discontinued Plavix and began Brilinta bid.The spots started to look more solid, and one week after switching medication, the doctor advised her to cut back on Brilinta to qd.The sores on her legs were somewhat better off and on, but during this time, they spread as high as navel. The cardiologist advised her to discontinue Brilinta and resume Eloquist. She also took a round of Augmentin which caused her legs to look better.Since that time, the spots have remained on her legs, and after days in which she is walking quite a bit, the spots sometimes become solid and encompass the entirety of her lower legs.She has now been off of blood thinner for two weeks. Seeing little to no progress, her cardiologist and internal med doctor have now referred her to a hematologist to assess for TTP.After the watchman placement, my mother has routinely had labs drawn each week. She has also had a platelet function analysis. Labs have remained WNL.She has recently started seeing the hematologist. He ordered additional lab work in which the results should be back at the beginning of the coming week. He explained to my mother that she seems to be healthier than most patients who have been diagnosed with TTP although some of her symptoms seem to correlate with that of TTP as well as another disorder that is typically only diagnosed amongst pediatric patients.The hematologist also explained that recently, he has observed many different disorders and symptoms that were not observed prior to COVID, and considering that my mother had COVID four times, this could be one of those occurances.Im curious as to if any of you have recommendations or if any of you have encountered anything similar. Any suggestions are greatly appreciated. Thank you so much in advance for your help!",
  "input": "",
  "output": "It would be helpful for you to post the labs results but if her cbc is normal as you're pointing out above then it's extremely unlikely for this to be TTPThe pictures you showed look like a vasculitis"
},
{
  "instruction": "6 year old re-cauterized day 5 post tonsillectomyMy 6 year old had her tonsils and adenoids taken out on April 6th, she was what I thought, healing well. In good spirits, never complaining of anything more than  a little pain . Popsicles nonstop, ice cream too. Tuesday night, after a full 5 days post operation, she wakes up and starts vomiting blood. We panic, call 911, go the nearest pediatric hospital. They tell us well have to recauterize. Cue second round of fear for the night. I couldnt imagine putting her through anesthesia again in less than a week. Thankfully it went well, and the left side had active bleeding in one spot which they cauterized and the right side had some tiny vessels that the doctor recauterized too. They kept her for another 8 hours for observation and she was doing well. I guess now were all so traumatized, including her, that it could happen again. She hates the taste of Tylenol but pediatrician warned about Motrin possibly triggering the bleeding. Of course, she prefers Motrin. Im writing this terrified of it recurring and praying it wont.Im so terrified of her hemorrhaging again and I dont know how to calm myself. I was told it would be rare to happen again but it was rare to even happen the first time. Were officially 7 days post initial procedure and Im wondering at how many days post op can i be confident that shes healed?Any possible words of encouragement or advice would be so very appreciated.",
  "input": "",
  "output": "Its not that uncommon after tonsillectomy actually, I agree unlikely to recur and should be ok. Did they check her blood counts to know how much she had bled?"
},
{
  "instruction": "Ive got her lab results with me but unsure of what its telling me.",
  "input": "",
  "output": "Fairly common , frankly not a big deal that is just bad luck. Rate of postoperative bleed is 1%, so chance it happens again very rare.You can get a rebleed at 7-10 days but rare. After that it becomes extremely unlikely"
},
{
  "instruction": "Thanks for your comment. The pediatricians drilled it in our heads that it was rare that it happened in the first place, even at 5 days. But I cant help but shake the feeling that even though its rare to happen again, we were already one of the rare ones it happened to the first time around. They made it seem as its way more unlikely for it to happen to children and more common in adults. When we saw her vomiting fresh blood we thought we were going to lose her.Will the recauterization of the spot where they found her active bleeding (noted as left superior tonsillar fossa) reset the clock on healing the whole area? Diffuse oozing in the right, clots bilaterally were also listed on our discharge papers.",
  "input": "",
  "output": "In 25 years of practicing ENT Ive only seen one re-bleed.The cautery sets the clock back just in that one specific spot. Theres no evidence postop bleeding is more common in adults, thats an old wives tale.Big picture here, this was a small setback your child will be fine."
},
{
  "instruction": "11 month old with fatty liver11 month Male Multivitamin with iron 6 weeks premature Uncircumcised 29 inches 24.5 lbsOn March 30 he woke up with a fever. We headed to urgent care and they diagnosed him with UTI. Got a call from them a week later saying to follow up with his pediatrician. While there she said his bacteria numbers werent high enough to indicate a UTI but its possible we just caught it super early. She said she was going to do research and possibly want further testing. She ended ordering a renal ultrasound. The findings of the ultrasound indicated that his renal system is unremarkable! But his liver is showing echogenicity and fatty infiltration of the liver. What could cause this? Should I be worried about it?",
  "input": "",
  "output": "Some infants have fatty liver on US or CT scans done for other reasons, as in your case. There's no consensus on what to do in this situation, but I tend to just follow it, because it often goes away. We think it's often a consequence of fetal environment, and has some association with maternal obesity, maternal gestational diabetes, and also seems to happen more often to preterm babies. But overall, the problem hasn't been well studied. In the setting of a recent infection, there's also a decent chance it's a consequence of the immune response (although it's usually from a gastroenteritis with things like adenovirus, not a UTI).These cases come to my clinic every now and then and most of the time it resolves. I usually do two things: repeat the ultrasound in a few months, and get a blood test (called a CMP) to look at the liver numbers.We don't know how this relates to long term risk for fatty liver, which has more significant health consequences. Some people have genetic causes for fatty liver, and it can start at a young age, but this is fairly rare, and not the cause of fatty liver in infants in most cases. Either way, it's worth keeping tabs on it to see if it goes away over time."
},
{
  "instruction": "Should I look into dietary changes? He breastfeeds 5+ times a day and has a meal 3x a day. The meals typically consist of a protein, fruit\/veggie and some form of starch (sweet potato, wild rice, veggie pasta). He drinks probably 1 cup of water a day.",
  "input": "",
  "output": "Likely not necessary in the short term. But I would still discuss with a pediatric gastroenterologist."
},
{
  "instruction": "Please help me understand this. Scared19, Male, 60, 180 lbs, Usually healthy, Works-out 5 days a weekHi there, I went to hematology for a low WBC count and while there I mentioned to them that I have had palpable lymph-nodes in my neck for 3.5 years and I have already been checked previously by 4 doctors including a pediatric oncologist and had multiple ultrasounds which suggest its non-concerning. However, she took an ACE level test and it came back elevated and she said something along the lines Youre ACE levels came back elevated and it could suggest sarcoidosis and if youre concerned go to a GP and get it measured again  ANYWAYS! I didnt think much of it and let it be for 6 months & I went to a Nurse Practitioner to repeat my CBC out of curiosity which showed everything was normal and my WBC was 5.6 which was great. I also asked for the ACE level test to be re-measured and they didnt know what that even was. They had me come back after they researched it and then they took a small vile of blood. They sent it off and it came back high at a 135 and cut off for that lab was 80. I am freaking out because he contacted the hematologist doc and they said I should go to a pulmonologist. I feel perfectly healthy and better than I ever have. I am freaking out because google keeps saying ACE levels being high indicates: Lymphoma, Multiple Myeloma AND Lung cancer. I am absolutely plummeting right now and nothing makes sense to me. Please give me some advice OR knowledge. Its hard to find stuff online speaking about ACE levels.",
  "input": "",
  "output": "ACE level is a very nonspecific test. It is not recommended for exactly this reason. Positive tests have <25% chance of having sarcoid, especially if they aren't sent for a good reason.I would followup to make sure but this is a good example of why we don't just send off a bunch of tests for no good reason - you end up with anxiety and chasing down a number of things that are not real."
},
{
  "instruction": "okay thanks. ill meet up with a pulmonologist most likely. how likely would something malignant cause this?",
  "input": "",
  "output": "Very unlikely. We dont use it as a test to look for malignancy."
},
{
  "instruction": "okay thanks for the responses. my NP i seen doesnt even know what the ACE levels mean and has no knowledge on it. think i should go back and see my actual GP? or is this something i can just let be elevated",
  "input": "",
  "output": "I would be hard-pressed to know how to deal with this nonspecific test without seeing you and your lab records and getting a full medical history. So again I would followup. Depending on the level of suspicion a chest x-ray, chest CT or even biopsy might be warranted.It is generally more productive to wait until there are some symptoms but I can't reassure you that you definitely don't have sarcoid or a different autoimmune disease. It does not seem like you have cancer based on the lymph node surveillance"
},
{
  "instruction": "what is this rash on my toddler1.5 year old, male, 24 pounds,I just noticed this rash on both my sons feet legs and bum. theres been no change in detergent, or soap. Hes recently been on antibiotics for an ear infection but broke out in a full body rash on day three of amoxicillin. so they switched him to azithromycin and same thing happened. hes been on cipro\/ dex. drops since wednesday. what the heck is going on. why is he covered in rashes? he doesnt seem to notice. acting fine, no fever, not itching. Any ideas? Picsedit: sorry the pic kind of sucks but 1. hes a toddler and does not sit still 2. the flash dulls the color of the rash",
  "input": "",
  "output": "Does this rash cover his whole body? It looks like Roseola to me, which is a very common viral infection in pediatric patients."
},
{
  "instruction": "no not this time. but the other 2 times it did. googling roseola - thats exactly what his rashes have looked like.i had brought him in to ER with a fever of 39.7 (went to 40.5) and lethargy, which is when they said he had quite a bad ear infection (membrane retracted with ++ pus) he hasnt been tugging on his ear or anything. could that have been an accidental finding and the fever was actually the roseola? i understand its hard to say over the internet but thought id ask",
  "input": "",
  "output": "Exactly. We see this in the ER all the time. Roseola is infamous for making the ear drums look infected when they're actually not. I suspect his fever was from the Roseola, and he was falsely diagnosed with an ear infection at that time given his constellation of symptoms. The rash infamously comes after the fever breaks. It's not itchy or uncomfortable for the child."
},
{
  "instruction": "that is so interesting!!! a coworker actually suggested this but i basically brushed it off, but it makes sense! so maybe hes not allergic to penicillin and azithro after all.its been about a week with on and off rashes. is that normal? i keep taking him back to the doctor thinking its the meds",
  "input": "",
  "output": "I highly doubt he's truly allergic to either :)"
},
{
  "instruction": "Good to know!! he doesnt seem bothered by the rash at all! He does still have a bit of a rash though and its been like 7 days since it first showed up. its kind of comes and goes tho is that normal for roseola?",
  "input": "",
  "output": "Hand foot mouth is a possibility too.As an ER pediatrician, I ignore whatever urgent care diagnosis was given regarding ears. They usually suck at examining them, and think every flushed ear drum in a kid with fever\/crying is infected. That, or frequently find that they're outright liars, and couldn't have possibly seen the TM, because of the enormous amount of wax (or even foreign bodies) that is in the way. The people doing these evaluations and making these diagnoses are almost never pediatricians, and usually aren't even physicians."
},
{
  "instruction": "Advised by nurse line to give my 3 month old a glycerin suppository?Male. 3 months. 15 pounds.possibly milk dairy allergy. He usually goes 1 to 2 times a day but hasnt gone in 4 days. He is exclusively breastfeed. I started a probiotic 5 days ago that I discontinued since he hasnt gone. He has been having diarrhea for weeks everyday so this is a big change. Hes been passing gas and fussy starting today whenever he passes gas.I called our pediatrician hotline and was told to use 1\/4th if a suppository for him. Im a little hesitant but cant get in touch with his doctor until Monday.",
  "input": "",
  "output": "Exclusively breastfed infants can go up to 9 days between poos. If he is eating, not vomiting and passing wind I dont know why you would give him a suppository"
},
{
  "instruction": "why does everything feel fake?history: im 16M, have no existing medical issues, nor am i using any medications, and i dont smoke, drink, or do drugs.occurrences: this has been getting progressively worse the past month, at first it was only something i could notice but it never really bothered me, but now it makes taking tests, reading (even this), and programming really difficult without full concentration. it kindof comes in waves where i can read whole chapters with no problem to having to re read a sentence multiple times to understand it (this happened in my ism test where i got stuck on a really easy problem because it felt like whenever i read one part of it, part before it disappeared). sometimes it gets so bad to where i get dizzy spells in the middle of class, and other times when im about to sleep it feels like im \"slipping\" and jump up (not the kind where you feel like your falling in a dream and wake up). also the past few days its kindof always been on very slightly.when it gets bad it feels like passing out without actually passing out, you know how you technically CAN see, but dont really understand anything? it feels like that, or like those pictures where you cant identify anything, or waking up suddenly from a deep dream, and my mind goes blank and i feel like im \"spiraling\", and it feels like im about to fall through the world? i dunno how to explain it, but i usually get jumpscared by it and it brings me back to normal, but if i focus i can point things out and describe things. another way i can describe it is it feels like im looking through my peripheral vision at all times, theres a certain lack of clarity to what everything looks like, and sometimes when im reading it feels like im being sucked into the monitor, if i really focus i can read, but it feels trying to read on a rocky boat, yeah i CAN do it, but im not really understanding it because im too focused on reading the words. sorry if im explaining this poorly, i dont really know what it is or whats causing it, im thinking its a mix of brain fog and anxiety? i wouldnt say im an anxous person but idk, and it feels kindof similar to the brain fog i get when i drink coffee, and ideas would be apreciated!",
  "input": "",
  "output": "Needs detailed in person. Pediatric psychiatric evaluation."
},
{
  "instruction": "3 months later, doctors hypothesize TTPIm seeking medical advice for my mother. She has her internal med and cardiologist following. She is now seeing a hematologist. We are interested in any additional advice or suggestions that can help with her diagnosis.My mother (62F) has a history of RA. She contracted COVID four times. Once was before she received the vaccine and three times after. It is our understanding that her medication caused the vaccine to be ineffective. With each COVID diagnosis, she received the antibody infusion.My mother was then diagnosed with AFib. She took Eloquist for over one year and had an ablation in October. In November, she had a watchman placed, was taken off of Eloquist, and began taking Plavix. She also takes 80mg ASA.After one week, she began to develop spots around her ankles that resembled petechiae. Her doctor advised her to continue Plavix. The spots then became larger and spread above her knee. After 1.5 weeks of taking the medication, she discontinued Plavix and began Brilinta bid.The spots started to look more solid, and one week after switching medication, the doctor advised her to cut back on Brilinta to qd.The sores on her legs were somewhat better off and on, but during this time, they spread as high as navel. The cardiologist advised her to discontinue Brilinta and resume Eloquist. She also took a round of Augmentin which caused her legs to look better.Since that time, the spots have remained on her legs, and after days in which she is walking quite a bit, the spots sometimes become solid and encompass the entirety of her lower legs.She has now been off of blood thinner for two weeks. Seeing little to no progress, her cardiologist and internal med doctor have now referred her to a hematologist to assess for TTP.After the watchman placement, my mother has routinely had labs drawn each week. She has also had a platelet function analysis. Labs have remained WNL.She has recently started seeing the hematologist. He ordered additional lab work in which the results should be back at the beginning of the coming week. He explained to my mother that she seems to be healthier than most patients who have been diagnosed with TTP although some of her symptoms seem to correlate with that of TTP as well as another disorder that is typically only diagnosed amongst pediatric patients.The hematologist also explained that recently, he has observed many different disorders and symptoms that were not observed prior to COVID, and considering that my mother had COVID four times, this could be one of those occurances.Im curious as to if any of you have recommendations or if any of you have encountered anything similar. Any suggestions are greatly appreciated. Thank you so much in advance for your help!",
  "input": "",
  "output": "It would be helpful for you to post the labs results but if her cbc is normal as you're pointing out above then it's extremely unlikely for this to be TTPThe pictures you showed look like a vasculitis"
},
{
  "instruction": "Low alkaline phosphatase and low ALT(SGPT)My Child, 6 years old,18kg, male, kept complaining about sore legs (mostly around knees) for the last 4-5 years. Talked to our Gp about it few times only to be told is due to growth.It could happen all of sudden and last for a week every day or evening and then he is ok for few more weeks and then starts again. We also had months of no pain too. It is very irregular.Pain stops only after giving him pain medication along with massage.Sometimes is so bad that he is shaking from pain.We also went abroad to an private orthopedic pediatrician. Checked him and also said is probably due to growth and that is very common.Few weeks ago had another episode. He would also wake up during the night because of this pain just like before. Decided to se our gp again and asked for a referral to a specialist. It will most likely take months to get an appointment. In the mean time we did some blood tests.Results came and I'm scared. Google gives me the worst scenario for low alkaline phos. And low ALT (SGPT). I will see our gp in few days but im very concerned. Should i be that worried? He also has low eosinophils and low (0) Basophils.What other blood tests should we ask to do until we get the specialist appointment.",
  "input": "",
  "output": "The low alkaline phosphatase and low ALT (SGPT) levels may suggest an underlying inflammatory process, perhaps JIA.I recommend a referral to a pediatric rheumatologist.The low eosinophil count may be related to his immune system response to inflammation."
},
{
  "instruction": "Thank you for your answer. I called the gp to talk about the results until I see her next week. Shes telling me results are ok and should not be worried at all. She is actually telling me that low reading of alk phosphatase and Alt is no concern and would have been a problem if it was high.I kept insisting by telling her that it must be a reason for these to be low. She did not know what to say.I will insist for a referral anyway which will take months? but should i be asking for another set of blood tests in the meantime but this time to check magnesium, zinc and b6 or b12? Could this be a cause for his pains?",
  "input": "",
  "output": "High levels can indicate liver or bone issues, yes, but low levels could still warrant further investigation, especially if your child is experiencing ongoing pain.Nutrient deficiencies, while they can cause muscle and joint pain, are only one of many potential causes"
},
{
  "instruction": "Could her delayed growth be a byproduct of the IUGR? Or is it more likely shes just not taking in enough calories per feed? Additionally, are there any questions that youd recommend I ask the pediatric GI doc? Thanks so much!",
  "input": "",
  "output": "Both. IUGR babies are prone to have poor growth. Most continue to have slow growth in the months after birth, often leading to GI interventions such as increasing nutrient density of formula. This is to make up for the nutrient deficit present that an average infant's daily intake typically cannot surpass on its own.While the vast majority (80%) of IUGR and\/or SGA (small for gestational age) do catch-up to reach sizes comparable to other children, this typically takes about two years. Many factors affect growth and stature, including any medical problems that led to her being small. For instance, this nutrient deficit and propensity to growth failure tend to be worse in infants who were also preterm (at 37+1 weeks, your daughter was born just two days further along than what we would consider \"late preterm\").The main things you can control and monitor at this point are her nutritional intake and feeding habits. For now, the baby's goal is to be improving in her percentiles, not worsening. I recommend working with the GI team on this goal. They will likely have you see a pediatric dietitian as well to help figure out how many calories she should be getting.Don't despair - this is more common than you would think. It doesn't mean you're doing anything wrong. You are working very hard and doing everything you can right now. Getting more hands on deck by bringing in a specialist's perspective only means more people in your daughter's corner trying to get her growing better.Most babies born with IUGR do catch up their growth by this age, so I agree with your pediatrician's concern. Increasing the concentration (\"fortifying\") her formula is a great first step, but it's worth seeing the pediatric GI to make sure there isn't something else going on. I'd suggest keeping track of about how much she eats in a 24-hour period as well, so the doctor can assess whether she's getting enough calories."
},
{
  "instruction": "Pediatric question: For an 8mo baby with hypotonia and delayed gross motor milestones, how much could diagnosing the cause impact the PT\/OT she is already receiving?We are talking about an IUGR baby who was born 0.03rd percentile at 38 weeks and is now 13th percentile weight, still has low BMI and diagnosed at 6mo with overall hypotonia. Currently working with PT in person weekly and OT via video-chat weekly.Skills being worked on in PT\/OT include:rolling front to back (emerging, working on efficiency)rolling back to front (she never does this unassisted)weight-bearing on elbows in tummy time (often lifts arms and arches back)weight-bearing on hands in tripod sitting positionshifting weight and reaching while in prone\/various seated posesbuilding lower abdominal strength with targeted exercisessensory brushing and joint compressionsimproving one and two hand grabsreconditioning oral aversion (from extensive craniosacral mouth work and tongue tie revision w\/ post-surgical exercises around 4-5 months old)eating solid foods (baby will touch foods, but never bring to mouth, accepts spoon feeding enthusiastically)neck and shoulder stretches for mild torticollisIm probably leaving something out, but this is an idea of our therapy focus. We live in an area with only one pediatric neurology practice, so we cannot begin to diagnose or rule out anything until our scheduled visit in 2 months.My questions are: Is the therapy we are doing appropriate regardless of diagnosis? How could delaying diagnosis until 10 months (or later) affect her long term outcomes? Would there be any reason for us to travel out of state to a larger facility if we could be seen sooner (on our own dime, eight hours away)?TLDR: Is diagnosis of the cause of mild to moderate infant hypotonia urgent when PT\/OT is already underway?",
  "input": "",
  "output": "A proper pediatric neurological evaluation will better guide PT\/OT, as well as if any other necessary treatments if the underlying cause is treatable."
},
{
  "instruction": "UTI or Kidney Infection?My daughter 14F, 57, 150lbs, was diagnosed with a UTI at the ER on Thursday afternoon. It caused her to have hot\/cold flushes and high HR, which is what brought us to the ER. She has been taking antibiotics twice per day, starting Thursday afternoon. NITROFURANTOIN MONO-MCR 100 MG CAPSULE. She has horseshoe kidney, which is why Im worried. Pediatric nephrology sent her urine from the ED for more tests and they came back this morning to MyChart.Urine Culture Your Value 20,000-29,000 cfu\/ml Enterococcus faecalis Flag AUrine Culture Your Value 10,000-19,000 cfu\/ml Mixed Contaminants X2Friday night she felt awful and had shakes for an hour. We called the Capital Blue nurse hotline and she said that its just my daughters body fighting the infection and she needs more time for the antibiotics to kick in.Its now Sunday afternoon and she is feeling bad again with a low fever (she didnt have a fever before). She doesnt feel well enough to get up and shower.Is there anyone who can offer help until we can call the nephrologist Monday morning?The ER doc dismissed her high HR and hot\/cold body flushed as a panic attack, so now when she starts to feel bad she starts to panic. She has finals tomorrow and has an after school commitment starting this week. I need to figure out what is wrong and help her feel better.",
  "input": "",
  "output": "Is her temperature over 100.4?Macrobid (nitrofurantoin) will treat enterococcus very well. However macrobid will not treat kidney infections, only bladder infections. If her temperature was truly >100.4 she may need another antibiotic. You can wait till tomorrow to call your nephrologist to check in."
},
{
  "instruction": "Is a prolonged QT wave on one EKG significant? (Pill overdose)Could my incident of one abnormal EKG I received as a teenager following pill overdose need to be reported to docs 10+ years later\/in the future?Or if since then I have had 2 other EKGs and a 48-hour holter monitor and only found tachycardia, am I clear? The specific abnormality was a \"borderline prolonged QT wave, poss \/ positive for RVH.\" Context and other lesser abnormalities to follow.I am currently 29F with sinus tachycardia, fibromyalgia, bipolar disorder. I requested hospital records of my pediatric suicide attempt because my parents and current psychiatrist are not sharing consistent information with me about my diagnosis(es) and prior care, and I would like to get more help. I was never told that I had particular diagnostic tests run or that any came back abnormal, and I want to know whether these should be chalked up to error\/a fluke\/exclusive to that overdose, or whether it's something I should've reported to my doctor when my tachycardia was being investigated or should report in my future medical histories or if I were to have more concerning cardiovascular complications.As a 14-year-old, I attempted suicide by ingesting 50 ibuprofen and an unknown # of Sonata, best estimate ~10 pills. The ibuprofen # could be higher technically, since I was still taking it when I lost memory\/began to hallucinate. The tox screen was also positive for caffeine.14 F 110 lbs, 5'3\", on 0.5 mg Risperdal, 25 mg Zoloft, unknown if any particular mental disorder diagnosis was made at that time, \"asthma,\" white, no drug\/alcohol use.I was taken to a hospital and an EKG, head CT, and labwork were done ~4 hrs after ingestion. I presented with normal exam\/vitals\/labwork in the first 6 hours except for visual and auditory hallucinations and ataxic gait. After about 4 hours I was transferred to the children's hospital ER. While the initial ER noted no new symptoms and stated my EKG was normal, I did see that shortly before I was transferred my BP went from 115\/80 -> 114\/55.Cardiac Consult:The children's hospital notes by 2 different care team providers state that my EKG by the outside hospital had a borderline prolonged QT and poss \/ positive for RVH. They repeated my EKG 7 days later, and the consulting cardiologist said they were happy to report this present EKG came back completely normal. He did state that I was \"admitted to [the] eating disorder program,\" so I hope misunderstanding why the EKG was being performed wouldn't affect his conclusion? He also offered to do an exercise treadmill test if they desired. Another note by a care team provider said they recommended I do an outpatient stress test after discharge, but I don't believe my parents ever had it done.Other noted abnormalities post-ER EKG after I was transferred to children's:1\/6 systolic murmur, diastolic BP was hypotensive for 12 hrs (98\/38, 101\/35, 94\/45, for example), bpm was 70 - 130, 2+ pulses on extremities, somnolence - at one point only arousable with painful stimuli and then immediately falling back to sleep - and a lot of vomiting later on. Seems like I went back to baseline by about 18 hrs post-ingestion.I think my parents and doctors were so worried about my mental state that they didn't even touch on the physical symptoms. Do I need to consider them at all? Or is it fair to assume that the EKG was a result of the overdose or emergency situation, but that it wouldn't have any long-term ramifications?Throwaway due to sensitive details.",
  "input": "",
  "output": "An abnormality on an EKG one time in the context of a medication overdose is not worrisome, especially as it normalized later. This is an expected consequence of the medication overdose, as were your symptoms."
},
{
  "instruction": "Im not going to lie -- between these heart rate numbers, her complaining about \"heart pain\" when she was younger, and otherwise being healthy and on-target (if slightly smaller than average) for height\/weight\/BMI...Im concerned. But I'm not a medical doctor. So here are my questions to those of you that are:Should I be concerned? If so, how concerned should I be?If this is concerning, what steps need to be taken? Do we need to take her back to her primary doctor and get a referral to a pediatric cardiologist? Should we insist that she be allowed to (as needed) walk during runs in cheerleading practice \/ school?Aditional Info and DetailsMy little sister does pee-wee cheerleading, and they start every practice by running 2 laps around a football field, which is ~1\/2 mile (i.e., ~0.8 km). She is not quite \"sprinting\", but is running the whole time at (Id guess) 80-90% of her maximum running speed (with no walking breaks). When she ran it earlier tonight, at the end of the 2nd lap her Fitbit watch said her heart rate was 213 beats per minute. Her heart felt like it was literally beating of her chest, and she said that she felt like she was about ready to pass out.From what I could find online, 213 BPM for a 10-11 year old girl could be dangerously close to her maximum heart rate, though (especially at that age) maximum heart rate is somewhat variable.Ive also measured her resting heart rate a few times (e.g., after sitting down watching tv for 30+ minutes) and it has been in the 100-110 BPM range, which from what I could find online is not unheard of, but is pushing the upper limit of \"normal\". These measurements were in the evening (close to bedtime, before taking the 50 mg trazodone). I ran the numbers and, at this point, all the vyvanse from her morning dose has been converted into dextroamphetamine, which (on average) has gone through ~1 half-life (~50% has been metabolized, assuming a 1:1 metabolic conversion for Vyvanse --> dextroamphetamine).Note: to check the Fitbit's accuracy, one of these times I also measured her heart rate manually using my (surprisingly effective) homemade double-walled stethoscope. Over a 30-second interval, the fitbit pegged her at between 99-102 BPM, and I counted 50 heartbeats (meaning 100 BPM), so the measurements it takes seem accurate.She isnt the most \"active\" person -- left to her own she would sit and watch TV and play on a tablet all day -- but between cheer (3x 2-hours practices + 1 game every week), dance (2x 1-hour classes every week) and school (PE, recess) she gets at least an hour or 2 most days whether she likes it or not. And she certainly isn't overweight -- this growth chart suggests she is in the ~30th percentile for weight and ~25th percentile for height. This BMI calculator for girls puts her BMI at the 53.6 percentile (z=+0.09).",
  "input": "",
  "output": "Agree with \/u\/muchtwojaded. Normal resting heart rate for her age\/size, and the >200 HR with exercise isn't concerning to me. Sounds like she gets a good amount of healthy exercise, more than many kids her age.Nothing here sounds dangerous. If she's not complaining of symptoms with exercise, I wouldn't do any kind of workup."
},
{
  "instruction": "Is it PPA or is there something wrong with my 9 week old son?I want to mention that Im not a FTM. This is my second baby. My first didnt sleep consistently through the night until 2.5. But I really feel like this isnt normal and no one is taking me seriously.Around 2 weeks he started refusing to sleep on his back. Weve had to resort to bedsharing(not what I want to be doing) and he still will only sleep in 30-60 min max increments. He breathes through his mouth a lot. And sounds like a pug when he breathes sometimes. He will stop breathing for a few seconds and then wake himself up with coughing\/gagging noises. He frequently gags\/chokes when breastfeeding as well. My pediatrician thinks the breathing is normal and that hes working us by crying when we put him to sleep on his own (told us to keep putting him on his back in his crib and hell figure it out. But he screams immediately).Hes had his tongue and lip tie removed a month ago. Chiropractor appointments. Hes on reflux meds. And Ive been dairy and soy free (was having green mucousy diapers) for 2 months. All of this has greatly improved his colic\/fussiness- hes usually happy now. But not his sleep.My last resort is maybe an pediatric ENT. But idk what they would even do. Everyone keeps telling me his breathing is normal but I just have a feeling its not. I dont want to waste anyones time.Ill link a video of him breathing and screenshot of his owlet sock showing oxygen lvl and how frequently hes waking (orange is awake). I really really appreciate any advice.",
  "input": "",
  "output": "See the pediatric ENT.The breathing sounds to me like he may have a \"floppy\" airway and could have a condition called laryngomalacia or tracheomalacia. It's fairly common, often does not require medical intervention, and typically improves with age, but you should have him evaluated particularly given the nighttime coughing and awakenings, which are likely because of the condition causing temporary drops in oxygen (as you saw on the owlet) resulting in the body's response of cough\/awakening to bring oxygen back up. The pediatric ENT can use different techniques to determine whether this (or another) condition is present and responsible for the symptoms.Interestingly, children with this condition are sometimes recommended to sleep on their stomachs as it helps relieve the upper airway obstruction caused by the floppy larynx and\/or trachea, so by refusing to sleep on his back, your son might just be telling you what his airway needs right now. The ENT will provide guidance on how your child should best sleep as well as any other recommended modifications to help with the condition.If bedsharing, practice safer co-sleeping techniques as much as possible as described here. Most important is firm mattress, no pillow\/blankets present that could possibly obstruct the face during sleep, no smoking, drinking, or siblings."
},
{
  "instruction": "NAD, but came here to say my child had Laryngomalacia as an infant. He was a squeaky breather but ceased showing signs at 18 months. I hope you get answers soon, OP.",
  "input": "",
  "output": "Do not take your baby to a chiropractor. Chiropractors are not medical professionals, and they are especially not pediatric professionals. They are at best harmless and at worst lethal.I am not a pediatrician, I have no idea how reliable or useful Owlet monitoring is (I suspect not very), and that minimal video doesn't sound concerning to mebut I can barely hear and I am again not a pediatrician.This is something to discuss with your baby's pediatrician. If the doctor involved is not concerned, it's probably okay. If you're still very concerned, you could try getting a second opinion from another pediatrician, including bringing all of this information."
},
{
  "instruction": "Can I ask my doctor to request pharmacare to cover Zofran?26F, 195 lbs, white, current meds are Mirena IUD, cipralex, wellbutrin, and pantoprazole. Current diagnosis of IBS.For the last four years or so have been dealing with awful and disruptive GI problems. Rectal bleeding, diarrhea, distention, nausea, vomiting, pain etc. Blood work has only ever shown anemia, which I've dealt with before, and calprotectin, fecal occult, and scopes have all been given, only finding is enlarged internal hemorrhoids but not so large to warrant a banding procedure.I saw my doctor today as nausea and vomiting were controlled by pantoprazole for almost a year, but nausea and vomiting has worsened, and I've been having increased pain localized to LRQ that will stop me in my tracks, and feels like a rolling intense cramp, or intense pressure. She wrote me a prescription for Zofran, and it was $272 for 90 tablets. I have provincial coverage, but since I'm not a pediatric patient or undergoing chemo or radiation I'm not eligible for coverage.Could I ask my doctor to petition pharmacare to get me coverage and explain that I've already been on meds that have failed to control problems? How likely is it that can be covered",
  "input": "",
  "output": "Zofran has been off patent for a little while now, ask for the generic, it should be at least half that price"
},
{
  "instruction": "I did get the generic , don't know what I would have done if got the name brand",
  "input": "",
  "output": "Yea right, interesting. 10 wafers generic in australia is around $14 so youre still getting a solid premium over there"
},
{
  "instruction": "1 year old sudden loss of visionOn Thursday, my 15 month olds babysitter noticed that she wasnt making eye contact like normal. At home, I noticed the same thing. Normally, if I look at her and smile she smiles back. But it looked like she was looking right past me. Along with that, she was not tracking objects with her eyes.I took her to the pediatrician on Friday who was concerned and wanted her to see an ophthalmologist right away. So we did that, she had a full eye exam with her eyes dilated and there was nothing wrong (like far sightedness or strabismus etc) with her eyes. The ophthalmologist was concerned too and called a neurologist who wanted us to go to the ER so we could be admitted into neurology over the weekend.The ER did a lot of blood work, a spinal tap for fluid (I cant remember the name- Im sorry.) and the doctors there just generally said they were stumped.We are on day 2 of being in the pediatric neurology unit. Shes having an EEG done for 24 hours and hopefully an MRI today. The neurologist says hes fairly confident she isnt having seizures but wants to cover everything.I hope one or both of those things gives us an answer but in the mean time all I have to do is think. What could possibly have caused this loss of vision seemingly overnight? She responds to sounds but not objects. Shes had hundreds of lights (from nurses doctors etc) flashed right in her eyes and she does nothing like youd expect. They shined a light in my eyes to show me how abnormal it was that she did nothing because I instinctively moved my eyes.Also... no falls, no high fevers, no recent illness, her birth was normal, shes developmentally normal.Does anyone have any idea of what this could be?",
  "input": "",
  "output": "Sorry to hear about your daughter. It is hard to know the cause without all the test results at the current time, especially the MRI, as this seems to be something less common. If she looks well in other aspects (except for the vision loss), and has already been evaluated by a pediatrician, ophthalmologist, and a pediatric neurologist, you are doing everything you can, and it seems that everything necessary is being done. Vision requires normal eyes, normal optic nerves connecting the eyes to the brain, and normal function of the visual cortex of the brain, and of course normal response to vision requires good function of the rest of the brain. Generally most problems affecting the eyes affect only one eye at a time, and can be seen by the ophthalmologist (either anterior chamber problems such as cataracts or posterior chamber issues such as retinoblastoma). Problems affecting the optic nerves (e.g optic neuritis) are more often seen in older kids (e.g with multiple sclerosis) and are very rare at 15 months. Rarely, there can be problems near where the optic nerves come together just behind the eyes (optic chiasma) when masses (eg. craniopharyngioma)\/cysts push on them and can cause visual loss. It is also rare for things to affect the visual cortex of the brain. I suspect that the MRI will be of help. If it does find something, it might need other specialists (e.g. neurosurgeon) to provide further information on management."
},
{
  "instruction": "Are there different sized tools for transvaginal ultrasound?Female, Canada, 27.I think I'm expecting to get a transvaginal ultrasound sound done today, my first ever. Problem is that although I'm an adult, my body has stunted growth and I also barely have any experience putting something in there. I've only put something in there long ago that's really small and the last was like 2 days ago when I had my pap exam. She used the pediatric sized tool and even that was on the painful side. So I'm really nervous about the upcoming one because I'm worried it will damage me if they don't see where to stop at. Will they be able to see where to stop the end of it and do they've different sized ones?",
  "input": "",
  "output": "The probes used for transvaginal ultrasound aren't that big, and are smaller diameter than a pediatric speculum like you would have had used for the Pap smear. Another thing you can do if you're comfortable with it is ask to insert the probe yourself, since it's more comfortable for many people."
},
{
  "instruction": "13 year old athlete EKG results - Sinus bradycardia and Intraventricular conduction delayMy 13 year old is 5'11, 188lbs, was complaining of chest pain on the 29th that every time he took a deep breath it hurt. No pain when breathing normally, pain located almost directly in the middle of his sternum and a little to the left. He does play sports year-round - Football and wrestling. I cannot get an appointment until Monday with a cardiologist and I am having a hard time understanding what this means!",
  "input": "",
  "output": "Would need to see the actual ECG. This may be the auto-interptetation by the machine. They are notoriously wrong."
},
{
  "instruction": "1 year old Male, question about delayed passage of meconium as a newbornMy son (1yoM) has had chronic constipation since early infancy, beginning when he was exclusively breastfed. After no success with dietary remedies, ped prescribed Miralax, which has significantly improved his constipation. But it has not gone away, so ped had a barium enema performed. This test was normal, but he was referred to pediatric GI since the constipation has remained, and GI said that Hirschprung's is not ruled out and is wanting to conduct further testing.My question - part of why they're suspicious of Hirschprung's is that my son did not pass any meconium\/poop at all from the time he was born until he was 4 days old. I understand this is very delayed passage of meconium. However, he was an out of hospital birth, and my mom, who was present at the birth, is sure that meconium was passed during delivery, because she said the amniotic fluid coming out as he was born was brown. The midwives never mentioned this. Obviously my mom is no medical professional, but I don't want to be raising false alarms with the doctors by reporting that he did not pass meconium if in fact he did during labor.So - if he passed meconium during labor, and then did not poop at all for four days, then passed a large volume of meconium, would this be considered normal, or still qualify as a risk factor for Hirschprung's? I've struggled to get a clear answer from his doctors, and I want to be sure that he isn't getting more testing than he needs due to me misreporting information.",
  "input": "",
  "output": "Even if he did pass it during delivery, not having further meconium passage within the first 4 days after birth is abnormal. Sounds like further workup would be warranted."
},
{
  "instruction": "displaced acute supracondylar humeral fracture with dorsal and radial displacement - 1\/16\/23My daughter fell off the monkey bars today. She landed on her back and elbow. I could immediately tell it dislocated. I called rescuer and they put a splint. I took her to the ER and they did X-rays. Based on the X-rays they said she had a displaced acute supracondylar humeral fracture with dorsal and radial displacement - the pediatric orthopedic was not available to come in but the PA said she spoke to him on the phone and they determined she needed surgery. I really dont want her to have surgery unless its absolutely necessary. Shes only 5 years old. Please help. Id like another opinion. Is there another non-surgical option? We were admitted and will stay the night in the hospital.",
  "input": "",
  "output": "She absolutely needs surgery. Its a very small surgery in the realm of orthopaedics. It will be 2 or 3 pins placed through the skin and then a cast or splint applied. Theyll be able to take the pins out in the office after it heals. The only type of supracondylar fracture thats amenable to non-operative treatment are those that are non-displaced. If you elect for non-operative treatment for this fracture pattern, your daughter will have permanent, long-term elbow dysfunction."
},
{
  "instruction": "I (23F) keep sleeping through my doctors appointments due to a sleep disorder.Caucasian, 95lbs, 54. Diagnosed PTSD, Anxiety, Depression, Essential Tremor, Hypoglycemia. Taking 150mg Oxcarbazepine 2x\/Day, .5mg Clonazepam 1x\/Day. Vape nicotine and cannabis.Im currently dealing with several medical issues but am unable to get them treated\/diagnosed because I sleep all day, every day. The sleep issues have been ongoing and worsening over the past decade.I sleep 16+ hours every day, cannot sleep at night, nothing and no one has been able to wake me up (incl. medical professionals in a hospital setting, my partner, assorted alarms, resetting my sleep schedule, etc)I had an appointment with my PCP on the 26th at 8 AM that I had to pull an all nighter for to be able to go to. I got an abnormal EKG reading and needed labs. They proceeded to try to draw blood..but my veins are tiny (they used pediatric needles) and kept collapsing, so they requested I come back today (the 28th) at 10 AM, extra hydrated and rested (they said my not sleeping couldve been partially to blame for labs difficulty).Well, thats about 2 hours past my bodys chosen bedtime, so I accidentally fell asleep (and woke up at 8 PM today).Everyones getting frustrated with how many appointments Ive missed (myself included). If I continue to miss appointments (especially therapy) I could be labeled as non-compliant, which could royally fuck everything up.How can I make my appointments? How can I treat my condition myself enough so that Im able to get professional care (for this and other issues)? At the very least, how can I show\/prove that Im invested in my care despite my repeated missed appointments?",
  "input": "",
  "output": "Taking a sedative (clonazepam) whilst also smoking a sedative (cannabis) certainly wont help you to not fall asleep."
},
{
  "instruction": "[26][F] I have moved to a new state and have WA State Health Insurance. Questions about choosing my PCP.I previously had a PCP who helped with various issues but mainly helped me with my medication management for my mental health issues. We have found what works for me (see 'Current Medications' below) but I want to have a PCP that is versed with medication for mental health issues in case changes are needed to be made (It took many years, several doctors, and many different medications to come to my current Rx and I am very thankful to my previous doctor for helping me get to such a point). But I also am 26 and am more aware of my women health needs and want to be sure I'm addressing those and staying healthy. I also have an IUD that needs removal soon, at which I will likely get another inserted.I was assigned a doctor that works at a \"Pediatrics Associates\" place with the credentials (MSN, ARNP, NP-C). I am confused as to why I was assigned to go somewhere for pediatrics, as it was my understanding that it was for children, though I am not discounting my assigned PCP's credentials. I looked into other PCPs that were on the directory and found an MD in Family Medicine and Obstetrics. Seeing this doctor would be a further drive for me but it intrigues me since I have never been to an OBGYN. Since I am getting older and leaning more into health women's health, should I request to begin seeing this PCP instead? -- Note that requests for doctor changes are allowed. -- or does the assigned doctor seem to have plenty credential\/ knowledge for me to establish care?Hope this doesn't seem undermining at all, I just want to make sure I'm making a good decision since I will likely establish long term care with my next doctor!TIA :)Height: 5'4\"Weight: 110-120 lbRace: Asian AmericanPrimary Concerns: Vaginal Health & Mental HealthExisting Medical Issues: Diagnosed ADHD, MDD, GAD. Prone to overproduction of yeast leading to BV or Yeast InfectionsCurrent Medications: Venlafaxine 150 mg, Vyvanse 60 mgOccasional drinks weekly. No smoking. No drugs.",
  "input": "",
  "output": "Yeah, no idea why you would have been assigned someone who works in a pediatric office. I'd switch to the family medicine MD."
},
{
  "instruction": "Childs swollen elbow normal?4.5 years old 37lbs 43in.My daughter fell and hurt her left arm on Sunday evening. We took her to urgent care early Monday morning. Got X-rays and there are no fractures. They determined it was a Nursemaids Elbow and tried a few times to reset it, but they werent sure they were successful because she was resisting, even though we were (safely) restraining her (the absolute worst worst WORST for my heart omg).They told us that we should bring her to an pediatric orthopedic doctor today if she wasnt using it by the end of the day (yesterday, Monday).I did notice her using it a little bit more, though not much. She complained it hurt for the rest of the day (when she went to wash her hands and used it to push down on the soap dispenser, she screamed out in pain).Today she woke up and I noticed its a bit more swollen than her other elbow. Shes still complaining that it hurts and is using her other hand to hold her arm close to her body, but she turned a page in a book with it as I typed this, which is way more than shes done in the past day and a half.Im not sure if its just from being a bit manhandled by two different doctors trying to reset her elbow yesterday, and so we should let it be, or if its worse and I should take her to the orthopedic doctor this morning.",
  "input": "",
  "output": "I would definitely take her to get checked by the pediatric Ortho. The injury is not consistent with nursemaids and these are typically very easily reduced. Worth a second look for sure."
},
{
  "instruction": "Could they have seen it in an X-ray? They didnt show us the X-ray, but said there were no fractures.",
  "input": "",
  "output": "The elbow can be tricky in kids. Sometimes they hide fractures very well there and we may not see them initially on x-ray."
},
{
  "instruction": "Pediatric Dentist ? 5yo needs dental work.My son 5M 55lbs no medications or health concerns besides this one.Hoping theres a pediatric dentist on here? My son has a tooth thats got an abscess on the gum above it. That tooth has to be pulled and he also needs a crown on another tooth that has a bad cavity. He doesnt do well at the dentist and they suggested IV sedation for him.They do this in their office (pediatric dentist plus dentist anesthesiologist) which I found unsettling and wanted to know if thats normal? Is this general anesthesia like where hed be intubated? I always thought that needed to be done in a hospital setting.I already feel like the worlds worst mother so I know its my fault for letting his teeth get so bad. So adding this anxiety to my guilt. Just worried about his safety and if an emergency should arise we wouldnt already be in a hospital.My next question is that they didnt schedule it until mid October and thats over a month and a half wait with an abscessed tooth. Im afraid its going to get much worse in that time. They prescribed an antibiotic but Is there anything I can do at home to keep it from getting worse?If anyone has any advice for this terrified mom I would truly appreciate it.",
  "input": "",
  "output": "You probably won't find a pediatric dentist on here (this is AskDocs, not AskDentists).IV sedation isn't the same as full general anesthesia where he'd be intubated. They'll use IV medication to calm him down and make him sleepy, but he'll still be breathing on his own. WIth proper monitoring (cardiorespiratory monitor, O2 saturations, etc) this is very safe. Similar to the sedation that's given for many people to get their wisdom teeth removed.Besides ensuring good brushing and taking the antibiotic, not much you can do to keep this from getting worse. Stuff happens, don't beat yourself up."
},
{
  "instruction": "My 6 year old is sick every other week. I need advice.I need advice! My 6 year old is in kindergarten and has had strep, pink eye, and bronchitis every other week! He's well for a week then gets hit with a new fever, and sick again. I am not sure what to do. Care is the worst around us and we are on a waiting list for a pediatric ENT for possibly getting his adenoids out. Anything I may be missing or what I can do? It breaks me how sick he is all the time and the amount of school he keeps missing.",
  "input": "",
  "output": "How are his growth and development? Every child has been getting sick constantly for about 9 months, so probably he is just like every other child. But without any information no one can say."
},
{
  "instruction": "Low alkaline phosphatase and low ALT(SGPT)My Child, 6 years old,18kg, male, kept complaining about sore legs (mostly around knees) for the last 4-5 years. Talked to our Gp about it few times only to be told is due to growth.It could happen all of sudden and last for a week every day or evening and then he is ok for few more weeks and then starts again. We also had months of no pain too. It is very irregular.Pain stops only after giving him pain medication along with massage.Sometimes is so bad that he is shaking from pain.We also went abroad to an private orthopedic pediatrician. Checked him and also said is probably due to growth and that is very common.Few weeks ago had another episode. He would also wake up during the night because of this pain just like before. Decided to se our gp again and asked for a referral to a specialist. It will most likely take months to get an appointment. In the mean time we did some blood tests.Results came and I'm scared. Google gives me the worst scenario for low alkaline phos. And low ALT (SGPT). I will see our gp in few days but im very concerned. Should i be that worried? He also has low eosinophils and low (0) Basophils.What other blood tests should we ask to do until we get the specialist appointment.Thank you!",
  "input": "",
  "output": "The low alkaline phosphatase and low ALT (SGPT) levels may suggest an underlying inflammatory process, perhaps JIA.I recommend a referral to a pediatric rheumatologist.The low eosinophil count may be related to his immune system response to inflammation."
},
{
  "instruction": "Thank you for your answer. I called the gp to talk about the results until I see her next week. Shes telling me results are ok and should not be worried at all. She is actually telling me that low reading of alk phosphatase and Alt is no concern and would have been a problem if it was high.I kept insisting by telling her that it must be a reason for these to be low. She did not know what to say.I will insist for a referral anyway which will take months? but should i be asking for another set of blood tests in the meantime but this time to check magnesium, zinc and b6 or b12? Could this be a cause for his pains?",
  "input": "",
  "output": "High levels can indicate liver or bone issues, yes, but low levels could still warrant further investigation, especially if your child is experiencing ongoing pain.Nutrient deficiencies, while they can cause muscle and joint pain, are only one of many potential causes"
},
{
  "instruction": "21 year old female with GI issues for years but they keep getting progressively worseI cant remember if I always had these issues, but I remember being 12 years old and starting to have very consistent diarrhea. All throughout middle school and high school I had mostly diarrhea BMs, with a few episodes of constipation. I always assumed it was how my family ate. Around 18 it got worse. I started to become constantly nauseous and lost over 50 pounds from throwing up and diarrhea. I went to the doctor but they told me change my diet. Since moving out last year and making changes to my diet to be healthier and adding more probiotics and fibers, nothing has changed and it feels like its getting worse. Now I have constant painful gas that bubbles in my stomach and honestly smells so bad. Im embarrassed to leave the house most days in fear my coworkers will notice. My joints have started to have unbearable pain, mostly in my hands and hips. I get sick once a month and it leaves me bedridden at least one day. I feel like my body is falling apart on me.I drink lots of water and try to keep my diet to standard to help my stomach, but Im not sure what else to do. I recently aged out of pediatrics and am unable to find any doctor near me that both accepts new patients and takes my insurance. I just feel so lostIve never had a diagnosis before other than for mental illnesses. Ive considered it being stress, and while it does get worse when Im stressed, its always like this no matter what my mental state is.For family history, we have no diagnosis of IBS or Crohns, but my mother had really bad undiagnosed stomach issues and died from breast cancer. All the women in my family have had breast cancer. My sister has diagnosed rheumatoid arthritis (she is 30, was diagnosed at 26)",
  "input": "",
  "output": "Have you been tested for celiac disease? You should see a GI doctor if your PCP isn't doing any meaningful work-up. There are many possible causes"
},
{
  "instruction": "Is antibiotic resistance some thing I have to worry about?I have a daughter who is four years old. She has no pertinent or obvious health problems, except for a lingering cough she had for about eight months after we had Covid last year. She is almost 4 feet tall and about 55 pounds. She has been having recurring vaginal discharge for over a year now. She has been on amoxicillin, Cefdinir, and keflex. Finally, after so long of not having any answers, they finally sent her to a pediatric gynecologist. She did an internal swab and found the strep bacteria. But, after a phone call with her, she told me that all of the antibiotics she has taken so far should have killed the bacteria. Each time she took antibiotics it was for 10 days.She prescribed her another, fourth kind of antibiotic, and said that if this doesnt kill it, that she will have to have a check up inside her vagina under sedation. I am not against this procedure, but now I have become a little worried about antibiotic resistance. If these previous antibiotics were supposed to kill the bacteria and she took them for 10 days, is this a bad sign? Or is it really possible that these three different kinds of antibiotics that she took for 10 days each didnt really kill the bacteria? Id love another doctors opinion on the matter.",
  "input": "",
  "output": "It's probably fine.It's not clear to me she has an infection that needs antibiotics."
},
{
  "instruction": "Would a swab that shows strep not indicate antibiotics?",
  "input": "",
  "output": "If you swab a human's orifice, it will grow bacteria.Whether that bacteria is the cause of an infectious pathology is a different question.Are you talking about group A or group B strep?"
},
{
  "instruction": "Any pediatric GIs who are familiar with intussusception? Or something that presents as such symptomatically?Any pediatric GIs who are familiar with intussusception?My 15month old son who was full term at birth was diagnosed with a small bowel intussusception when my husband and I brought him to the emergency room yesterday, 12\/21\/2022. The ultrasound report read, There is a 1.1 x 0.9 cm small bowel small bowel intussusception in the left hemiabdomen near the umbilicus. No evidence of ileocolic intussusception in the right lower quadrant. No free fluid in the abdomen or pelvis.After this was found on ultrasound, after 2 hours, an ultrasound was repeated, and the intussusception was gone.I have to say I wasnt surprised by this diagnosis, and I am GLAD that it was found on ultrasound.Since my son was six weeks old, he has experienced what I intuitively thought was GI distress. He would scream inconsolably, turn red in the face, and grunt as if he were trying to bear down. This wasnt infrequent; it was all happening all the time. Every week we would visit the pediatrician and an urgent care 1-3 times. At these visits, they would tell my husband and me that it was colic or gas or fussiness. We tried different formulas with cutting everything out of my diet because he was getting breastmilk too. We tried gas drops, bicycles, probiotics, and the colic holds we were shown. You name it; we tried it.After six months of torture for my little guy, I finally said ENOUGH was ENOUGH, and I brought him to the emergency room. The imaging at the emergency room showed that he had a lot of gas in his abdomen, and it was recommended that we try a hypoallergenic formula. (Before this, my son was getting breastmilk supplemented with formula.) We switched to Similac alimentum. Once we discovered that all of the formula we had given our little guy was recalled, we changed to Nutramigen. Since being on the hypoallergenic formula, the CONSTANT crying and screaming had subsided but hadnt completely gone away.He would have bouts of inconsolable screaming that would last 20 minutes, and then he would calm down. Sometimes he would have bouts of screaming that would last 20 minutes, calm, and then crescendo into more extended periods of crying with bearing down, turning red in the face, shaking, and vomiting.With that said, I am looking for some guidance. Has any pediatric GI seen or heard of small bowel intussusception reoccurring for this time? The Emergency Room doctor said he couldnt answer this question because he sees the acute visit of patients. He recommended that we follow up with a pediatric GI surgeon and our pediatrician.I spoke with the pediatric GI Nurse Practitioner, and she said they do not perform surgeries on small bowl intussusceptions. She said that they only perform surgeries on small to large bowl intussusceptions. She also said that this should subside when he is 5 -- she said this as if I could look forward to relief for him in 3 1\/2 years!!The pediatric GI Nurse Practitioner and the Emergency Room Physician told me that I should bring him to the ED anytime he presented the way he did when I brought him in when he was diagnosed. This cant is the answer. This is not sustainable for us or our child. Since he was 15 months old, we have brought him into the ED, pediatricians office, and urgent care countless times for the same issues. It just so happens that they FOUND the cause THIS time.I would like to know if anyone has guidance or familiarity with this. Some questions I have are, has anyone ever seen a re-occurring intussusception? If this is re-occurring, is our only option to keep bringing him to the ED? Could something else be missing? Who else should I talk to? What else should I do?I am so frustrated with all the conflicting information and advice I have been given over the last 15 months. I feel so discouraged and not heard.I am so worried and heartbroken seeing my son constantly go through this.Any suggestions would be helpful. I am following up with our pediatrician, and hopefully, they will FINALLY put in a referral to a pediatric GI. I am a registered nurse, so I have a general background in the medical field.",
  "input": "",
  "output": "Transient small bowel intuss is a common finding in kids with belly pain or GI distress.No, it essentially never needs intervention.Kids get it all the time when they have stomach bugs. You just don't have an ultrasound on their belly the whole time.This may or may not be related to his prior issues of belly pain at all.A possible, but unlikely possibility is some sort of pathologic lead point that causes recurrent intuss. Like a Mekels, a real bad Peyer's patch, vascular anomaly, or even less commonly malignancy. I know of these being implicated more so for recurrent ileocecal intuss, but I suppose there's no reason they can't occur higher up.I think referral to peds GI is appropriate.Another possibility is Deitls crisis. It's recurrent, transient UPJ obstruction that causes episodes of pain, similar to intuss. It's rare, but also underdiagnosed, because nobody fucking knows about it. Small kids that have it are actually experiencing renal colic, but can't communicate it, and are presumed to have actually have abdominal pain. It's something to consider in the child with chronic episodic belly pain that self resolves and has no other symptoms."
},
{
  "instruction": "Pediatric Psych patient dosage9 F Caucasian 93 lbs 4ft 6?My daughter was prescribed Lexapro 5 mg and everything I'm reading online says it's not for children under 12. I reached out to her pediatrician and he says to contact them because it's their expertise. I've been trying but am not getting through. In the mean time, is this something I should hold off on giving her or is the dosage small enough?",
  "input": "",
  "output": "Its likely safe but there is limited evidence to show efficacy (limited number of trials). Id hold off until you speak to psych, 1-2 days while you wait to speak to a psychiatrist for more clarification wont make a difference. It takes 6 weeks of consistent use before you really start to see much in the way of improvement to begin with, for most patients."
},
{
  "instruction": "Thank you for your reply! She was given it starting on Saturday and seemed to do fine. I did end up getting through to someone and they said it was fine to give because she had been monitored while on it. I can't find any info as to why it's not recommended for children under 12 but they seem to find it appropriate, so I'm going to assume it should be?",
  "input": "",
  "output": "They dont recommend against it. Its just the lack of evidence and a strong benefit\/risk analysis that prevents them from recommending it in patients under 12 at this point."
},
{
  "instruction": "(Pediatrics) 24 month old white female with discordant bone age. 31\" tall, 21 pounds. No meds, no surgeries.(Pediatrics) 24 month old white female with possible short stature. 31\" tall, 21 pounds. No meds, no surgeries.My 2 year old hasn't been getting very tall as she's gotten older. She's dropped to the first percentile for height. Her first pediatrician wasn't overly concerned, but we saw a new pediatrician and she was concerned and had her x-rayed. I got the report back, but the doctor is out of the office so I won't be able to talk to her until next week.The radiology report says:FINDINGS: A single radiograph of the hand was provided for evaluation of bone age. The patient's chronological age is 24 months. The hand bone age according to the tables of Greulich and Pyle is approximately 2 years. The wrist bone age most closely approaches that of 1 year and 3 months. The standard deviation for the patient's chronological age is 4.64 months. No structural abnormalities are identified.IMPRESSION:Discordant bone age between the hand and wrist, but both are within 2 standard deviations of chronological age per the age and gender matched standards of Greulich and Pyle.Is the discrepancy worrisome?https:\/\/flic.kr\/p\/2nS9y6S",
  "input": "",
  "output": "Worrisome probably isnt the right term. It isnt indicative of anything dangerous.It can sometimes indicate a hormonal issue that requires endocrine referral.But will also say that pediatric endocrinologists and radiologist often disagree on bone ages.Bone ages are pretty subjective. Basically they x-ray the hand in a specific way and then compare it to a book with known bone ages and say eh, I think it looks like this one the most."
},
{
  "instruction": "Disagree in what way? Just generally, or does one group tend to say bone age is more\/less advanced than the other?",
  "input": "",
  "output": "Just generally. I dont do bone ages but have heard a few endocrinologists say I never listen to radiologys reads on bone ages. Then they proceed to do it themselves."
},
{
  "instruction": "6 year old with hallucinations currently hospitilized. Is this autoimmune encephalopathy?Age: 6Sex: MaleLocation: New England, USAMy child has been in the hospital over the last week for suspected autoimmune encephalitis. I brought him to the ER on 4\/11 per instruction from his pediatrician due to visual hallucinations. He was admitted after neurology came to the ER for a consult. The hallucinations have not been improving with treatment as of yet (4 days of IV steroids & 1 day of IV IG, see below for more specifics). I've been advised 90% of the labs will take a couple of weeks to get back. Is there anything else we should be considering? He's the happiest kid, he absolutely loves school and his friends and teachers and he can't wait to go home. He knows what he's seeing isn't real and I wish I could make it go away. Any insight\/advice would be so appreciated. He's been a trooper throughout this process but it's not easy wondering every day what is going on. I can provide additional information if needed\/requested.Assessment\/Plan: Child is a 6 y.o. 5 m.o. male with PMH of hypnagogic hallucinations and asthma who presents for evaluation of 2 days of daytime hallucinations. Given acute onset of worsening visual hallucinations that started with nighttime awakenings on 4\/7 and then progressed to daytime visual hallucinations on 4\/10, we are concerned for autoimmune encephalitis. LTM EEG with left parasagittal and temporal spike wave epileptiform discharges, suggestive of underlying brain irritability. However, patient is very well appearing with no other classic features of autoimmune encephalitis- no encephalopathy, no weakness, no abnormal movements. Given that he is very well appearing and is not demonstrating significant decline from day to day, we will plan to first obtain CSF and brain MRI with contrast prior to starting immunosuppression. If CSF is bland, we would likely still recommend treating with immunosuppression given clinical concern and patient meeting diagnostic criteria for autoimmune encephalitis.EEG is abnormal but no definite seizures. Frequent and sleep activated left temporal and parasagittal spike and wave epileptiform discharges. Brain MRI normal. LP overall bland with 1 nucleated cell in tube 1, 2 nucleated cells in tube 2. Other labs pending but does have ANA positive at 1:320.Has been on IV steroids since 4\/14 with no improvement in visual hallucinations. Will plan to continue steroids for total 5-day course and discuss case with our neuroimmunology colleagues. (This plan changed after neuroimmunology consult, began tapering steroids after 4th day to begin IV IG)Treatment:s\/p 4-days of high dose IV methylprednisolone (30mg\/kg daily)prednisone taper: 1mg\/kg (max 60mg) prednisone tapering over 6 weeks (can roughly cut in half every 7 days) Week 1: 30mg daily Week 2: 15mg daily Week 3: 10mg daily Week 4: 5mg daily Offstart IVIG today for 2-days- IVIG 2g\/kg divided over 2 days. Started on 4\/17 treatment was well-toleratedResulted workup:EEG abnormal with frequent abundant spike wave epileptiform dischargesEEG continued to demonstrate frequent abundant left parasagittal and temporal spike wave epileptiform discharges -EEG from 4\/12 -Frequent to abundant left parasagittal spike wave epileptiform discharges that occurred both independently and in brief 1-3 Hz runs lasting <10 seconds (BIRDS) -Occasional to abundant left temporal spike wave epileptiform discharges that occurred both independently and in brief 1-1.5 Hz runs lasting <10 seconds (BIRDS)quick brain MRI normalsedated brain MRI with contrast normal, incidental finding of likely arachnoid cystReassuring CBCd, BMP\/Mg\/Phos, LFT'sESR and CRP normalTSH elevated to 7.44, free T4 normal at 1.1B12 and folate normalRPR non-reactiveRhinovirus positiveCeruloplasmin normalUrine tox negativeUA normalANA positive 1:320, speckledSerum copper within normal rangeCSF opening pressure 15CSF cell count and total protein normalAnti-TPO antibodies negativeHIV 1\/2 negativeCollected and pending: [] CSF culture [] CSF HSV PCR, CSF VZV PCR, CSF VZV IgM [] CSF oligoclonal bands, IgG index, beta-2 microglobulin, flow cytometry, cytology [] CSF autoimmune encephalopathy panel [] CSF anti-Glycine-R antibody [] Serum Glycine Receptor IgG [] Myelin oligodendrocyte glycoprotein [] 24 hour urine copper [] 24 hour urine porphyrins [] Double stranded DNA antibodies [] Antiphospholipid antibody panel [] Thyroglobulin antibody [] Serum MaTa Autoantibody test [] SPEP panel [] MS profile, serum and CXF [] IgG index\/synthesis rate, serum and CSF [] EBV serology [] VZV IgG, IgM [] HSV PCR, HSV type 1,2 antibody [] Serum encephalopathy panel [] Mycoplasma IgM, IgG [] Lyme screen with reflex to immunoblot [] HSV PCR, serumMENTAL STATUS EXAM: Appearance: appropriately dressed Behavior: cooperative, eye contact good and pleasant Psychomotor Activity: normal Musculoskeletal: moves all extremities; no abnormal movements Station\/Gait: normal Speech: regular rate, regular rhythm and regular volume Language: normal comprehension Mood: happy Affect: full range Thought Process: logical, linear and goal-directed Associations: no loosening of associations Thought Content: no delusions and no obsessions Perceptions\/Experiences: visual hallucinations Orientation\/Sensorium: alert Memory: immediate recall intact. Attention\/Concentration: intact to observationImpression: Child is a cheerful and pleasant 6 yo boy, from X attending Kindergarten at X. He has a hx of mild OSA, hypogogic\/hypnopompic hallucinations since early on, asthma, no prior past psychiatric history, presenting for worsening hallucinations since 4\/10, admitted for medical work up on etiology. Psychiatry consulted for diagnostic clarification, support and medication management.4\/14\/23: Patient continues to be calm and cooperative, behaviorally appropriate for a 6-year-old boy. Continues to experience visual hallucinations, yesterday night described as \"monsters,\" which patient is understandably afraid of. Most of patient's hallucinations are visual, vivid, and neutral with minimal emotional involvement. No auditory hallucinations. No clear seizure activity on EEG, other than minor blinking, clinical signs of seizure disorder not noted on physical exam. Pt age, onset, and symptoms are not typical of a primary psychotic disorder or normal development. We agree with pediatric neurology and primary team that the origin of hallucinations are organic. No emotional or behavioral dysregulation. Thus, we do not recommend scheduled psychotropic medications at this time. Pediatric neurology assess patient has underlying brain irritability from EEG findings (left parasagittal and temporal spike wave epileptiform discharges), likely secondary to encephalitis, as opposed to seizure disorder.",
  "input": "",
  "output": "What were the CSF cell counts, protein, and glucose?"
},
{
  "instruction": "3y(f) Seeing Pediatric Pulmonologist - What to Expect and Genetic TestingMy (37F) daughter (3F) will be seeing a pediatric pulmonologist next week for suspected asthma. Her pediatrician has diagnosed it as \"mild or intermittent\" but from my observations, it is not mild and is getting worse. It was thought she had recurrent croup but we now suspect those croup episodes have actually been asthma attacks\/flares. They only occur during viral illness, but each time she is sick she ends up in respiratory distress and needs an ER\/hospital visit. She is prescribed albuterol, flovent, and decadron. Pediatrician agreed to allow us to only use flovent at onset of illness so it is not daily use.I don't know if there will be genetic testing performed, but I did sign a form agreeing to genetic testing.My question is, should I be thinking this is something beyond asthma and possibly genetic? Should I push for imaging and\/or genetic testing?",
  "input": "",
  "output": "Peds ER doctor here, sounds very much like asthma. No, genetic testing is not done routinely at all, i suspect they make everyone sign that form before coming in so that they can streamline the process if they need to test patients for anything."
},
{
  "instruction": "Pediatric Abilify weaning schedule?Hi Reddit Docs, My 8yo (9 in April) son has been on Abilify for about a year, up to 15mg. Long story short we dont feel that it is making a difference and in fact hes getting worse, more physical\/aggressive, even violent at times. Especially since we added clonidine again. (In addition hes being treated by a physician who specializes in ADHD, not a psychiatrist. He was diagnosed by a psychologist with ADHD, depression, and motor coordination development disorder. I had to see this Dr because he was diagnosed during the height of the pandemic and no psychiatrist was available. Basically threw different combinations of Vyvanse, guanfacine, clonidine, and Adderrall at him, hes currently on Adzenys, Abilify and just came off clonidine. Finally got him some Lexapro a few months ago and his baseline mood has improved but the outbursts are worse. Ive been trying again to get a psychiatrist with no luck. I currently have an emergency intake visit scheduled in 4 days with a social worker who is supposedly going to get us a faster referral visit.) What is the recommended taper schedule to come off the Abilify? Wanting to make sure current provider is giving us accurate info. Thank you!",
  "input": "",
  "output": "I am not sure what the guidelines for treating children are where you reside but to me this seems like a hodgepodge of medication. I would personally be very concerned to write out so many medications (some of which counteract each other).My first question would be what was the main problem with your son before he got medicated? Why did you seek help? Is there family history of psychiatric illness?The tapering really depends on the patient and the symptoms experienced. One could recommend to reduce 5mg every week (so 15mg, 10mg and finally 5mg before stopping). This can be further adjusted depending on any side effects. This can be also adjusted more finely if you have an oral solution instead of tablets."
},
{
  "instruction": "Pediatric4 y\/o female, turning 5 next month. No significant PMH. Complaining of pin point pain around umbilical area that hurts more when I breathe in and out. Also complaining of GERD symptoms described it perfectly without knowing obviously when I eat my food and drink too, it goes down to my belly and then comes back up and I have to swallow it again.Started complaining of both these symptoms over the last 24 hours.No bulge can be noticed or palpated, even when coughing or taking deep breaths.What could this be?",
  "input": "",
  "output": "Gastric or duodenal ulcer, GERD, constipation. Would talk to pediatrician about it. Can do a trial with famotidine if it sounds like reflux to them with a more thorough history. If its a one off episode its unlikely to be anything to worry about if it self resolves. Look for food triggers and anything that helps or makes it worse in the mean time."
},
{
  "instruction": "Pediatric burnsMy daughter is 4 years old and was burned with hot water earlier today. She was taken to our local emergency room within about 20 minutes of the accident. The burns are on her chest\/belly area covering approximately 65% of the front. The doctor did not specify but I believe it's 2nd degree burns as the top layer skin has came off. The er gave hycet plus gave her a prescription for hycet and silvadene cream. They gave some thin blue towels of hold over the burn area with instructions to not begin the cream or put anything else on it until it stops leaking fluid from the burn. Now she has blue towel fuzz stuck to the burn area and I was told not to wet the wound nor cover with anything else. I don't want to go against the er doctors instructions but I just have a bad feeling that this is going to end up infected. Do these instructions sound correct? Is there anything else I should be doing? Given the burn is on her chest I'm not sure I'm allowed to include a photo but if the mods allow it.",
  "input": "",
  "output": "This burn would likely meet criteria for inpatient management based on the described size and severity of the burn. Im surprised they would send you home. You should be able to lightly rinse the fibers off but every time you rinse it and if you have any abrasion, you risk destroying the epithelialization of new skin. There is a balance between dressing changes and allowing time for healing. Additionally moisture can increase the risk of infection. Generally speaking the fuzz is likely harmless, so you would have to use your judgement as to whether it needs to be removed based on the amount attached and any soiling or other factors present.If there is a significant amount, Id recommend a return to the emergency room for further management and discuss admission to the inpatient service or transfer to a burn center for further care. Burns often require more significant care than just the initial skin damage, especially if a significant portion of the trunk has been burned. In pediatric patients it is even more imperative to get proper care to ensure proper healing and limit future difficulties secondary to poor healing.They can be managed at home for minor burns, but if you are not comfortable with the care and it has not been described in enough detail that you feel comfortable, return to the ED. Your child will thank you in the future if you get proper care now. Its unfortunate that this may require an additional trip to the emergency room, but I wish you the best and hope your child has a speedy recovery.You may wish to try a different emergency room for a second opinion if you did not feel like you received adequate care at the first one."
},
{
  "instruction": "Pediatric lupus?My 11 y\/o daughter had three weeks of low grade fever, headache, body ache, fatigue, nausea and low appetite. Multiple negative tests - covid (including antibody), mono, strep, flu, RSV. Had a positive urinalysis for bacteria and blood - did a round of Bactrim but the symptoms remained. Current meds for asthma - symbicort, xopenex as needed, singular.Doc ran some more blood tests - looks like some were autoimmune tests. Can I get some interpretation of these ANA titer results? Recommend seeing a pediatric rheumatologist?",
  "input": "",
  "output": "That's quite a high ANA titer (means very positive). Time to see a peds rheum.This is not the place to push Lyme pseudo-medicine."
},
{
  "instruction": "Definitely in a tick borne illness area - Lyme tests are in these results too - but she was only reactive on one of the bands. I think that means shes negative?",
  "input": "",
  "output": "That means she's negative. Please don't listen to the internet panic about Lyme disease. It's easy to test for and straightforward to treat."
},
{
  "instruction": "Pediatric Wellness Exam around PubertyI am trying to find a new pediatrician for my daughter (11y\/f). We went to a local female pediatrician, who was nice, albeit a little rushed and pushy. We talked for a little while, and the pediatrician did ask if she had her period yet or not. She has not. Upon physical examination, with little notice (hey I'm going to do this, and then did it) the doctor pulled up my daughter's shirt and bra, and then pulled up her pants at the waistband to look at her vaginal area. My daughter was struggling to not let her do this and is now traumatized by the interaction and felt like she could have given a little more warning. I know that physicians are very busy and have many patients to see, but I feel like I've failed to protect my daughter from this. I would think a conversation asking if she is developing breast tissue or pubic hair would have been just as efficient without stressing my child. Or even saying what she is going to do before doing that kind of exam. Is this a normal practice on a wellness exam? My daughter will not be returning to this doctor.",
  "input": "",
  "output": "It is normal practice to check these areas, yes. Sounds like the doctor could have explained the process a bit better. At this age, I generally talk to the patient about what I'm going to do and why, then ask for their assent before proceeding."
},
{
  "instruction": "7yo old with Hashimotos and Lichen SclerosisMy apologies for such a vague request but Im searching for any answers of how these two are connected or if we should be traveling out of state for second opinions. My daughter was diagnosed in the past year with both conditions. We live in the US (Nevada). She currently sees a pediatric endocrinologist and a pediatric urologist (we do not have a pediatric gynecologist where I live and our pediatric dermatologist is a male and my daughter wasnt comfortable seeing him).My issue is that everywhere we take her they comment on how rare her conditions are or how they havent treated it before. To me, that doesnt mean they are incompetent or she is receiving poor treatment, I just wonder if there are people who do treat these conditions more frequently and if it is worth our time to seek second opinions.Definitely not rich, but could most likely cover basic assessments if need be.Thank you in advance!",
  "input": "",
  "output": "If someone has one autoimmune condition, they are at increased risk of developing other autoimmune conditions. These are both autoimmune conditions but unrelated except for the autoimmune diathesis. No comment on the thyroid disease, but skin biopsy results are definitive and treatment of lichen sclerosus is usually straightforward."
},
{
  "instruction": "For my son.Age: 8 months old Weight and height: 20 pounds and 2 foot No medications being taken No smoking No current medical issues Location of complaint: headIll start with saying we took him immediately to the ER and got seen by a neurosurgeon at a pediatric hospital afterwards. They said he was good to go after observing him for a few hours and said his CT scan was clear of any bleeding or fractures by both the ER and neurosurgeon at at the pediatric hospital.I was at work and my wife called me and told my son fell back off of the couch, which is about a foot and half up off the floor (which is hard tile, there is a rug there as well about a quarter of an inch thick if that.)She picked him up and then said he was crying but then he stopped and his eyes rolled to the back of his head, he started bubbling at his mouth and got stiff. Wasnt responding to anything. I work at the hospital where we brought him into the ED at and I saw him, I was moving him but he wasnt responding either so they called in a code and gave him 2.5mg diastate to help him out. After they gave him that, I saw him start moving and making noises. Afterwards they took a CT scan on him which, at that point, I was informed by one of the doctors there it was clear from any fractures or bleeds. However, I was also told that since there wasnt a radiologist there the doctor told me she couldnt say for sure. At this point, they send us to the pediatric hospital where he was seen by the neurosurgeon, who told us she didnt see anything either and it looked clear to her as well. Afterwards we were three from about 10:30-5:00 pm. During the time we waited he fell asleep and ate like normal, didnt throw up or anything. Neurosurgeon came back and did some other tests, he grabbed some keys she had and played with them like he normally does with things. From there, they discharged us and said to watch him over the next 48 hours for any changes in behavior or anything out the norm. Neurosurgeon stated she doesnt think he had a seizure but doesnt know for sure since the scan was done about 20-25 minutes after he arrived and wasnt sure if it was done too early. For a bit of a better timeline of events, he fell about 8:59 a.m. and arrived at the hospital about 9:05 a.mSo after we got home hes been completely normal. Even today hes been fine. He has a regular check up in about two weeks but I want to do a follow up and wanted your alls advice due to the fact of how he was immediately after the fall, since that seemed to be the part that had most of the providers a little stumped. I did on searching on google (I know) to see if I could find anything similar to the situation but found nothing that seemed similar to it. They way a nurse and the neurosurgeon explained what it was, that it couldve been he had response to the trauma of the pain and that his was reaction was what made him go into that state. I apologize for the long read but there was no short version that had enough info. But, if theres a question that anyone needs answered for more context please let me know.",
  "input": "",
  "output": "t's hard to say if he seized or not. Seizure after head injury isn't super rare. You can have seizure in absence of bleeds or fractures. The timing or findings of the CT has no bearing on whether he seized.He may have been concussed. Concussion is a clinical diagnosis, and is not something that is diagnosed by imaging.I frankly would be shocked if he had seizures or concussion from the fall, as described. I've seen >100 babies with falls like this, none have had serious injury.I've seen many infants and toddlers with falls from 2nd story window\/balconies. I don't recall any ever having serious head injury.But yeah, likely either a weird pain response, or concussion. Or there is more to this story than an 18\" fall onto carpeted floor."
},
{
  "instruction": "Trans (FTM) invasive exam at endocrinology visit *repost **is this common practice??4 years ago i had visited a pediatric endocrinologist for my first dose of T after 2 years of therapy. i had done everything i needed to, i was excited, i was desperate the endocrinologist did everything routine blood tests, usual physical examinations during the physical, it was quite apparent that i did have excess hair and signs of hyperandrogenism. the blood work even indicated that my cholesterol was high. the day of my follow-up he had asked me to wear a gown so he can check down there i dont remember ever getting a reason why but he did let my mom stay in the room and brought a chaperone. i was desperate so i let him do it. it haunted me for a while.4 years later. i had learned that that examination apparently isnt routine via my friends and this examination was never reported in any of my records so i decided to give him a call about it to express my concerns. he told me that people who have hyperandrogenism, their clit grows so he wanted to check for signs of that and anything that can indicate for signs of a tumor, that is causing it so that he would order a CT scan if he suspected iti still dont know how a physical examination can make that clear but i felt pressured today so i just agreed just like i did 4 years ago he even admitted to checking several patients clits for a baseline for T but he said he doesnt do it anymore because its uncomfortable or has a (female) nurse do it if he feels its necessary.i still dont have an answer im afraid i gave consent that day under false pretenses i feel strange just leaving this alone even though i dont think he had any ill intentions.should i ask for another opinion? or am i making this a bigger problem than it is?",
  "input": "",
  "output": "Sounds like they were assessing for clitoromegaly and they werent very sensitive to your needs or reading the room. I dont think this is common for FTM physical exams, especially when youre displaying signs of hyperandrogenism.What I can say is that my guess is a pediatric endocrinologist is definitely more likely to assess genitalia because they are the ones that first pick up on hormonal imbalances caused by tumors or abnormal genitalia so it may actually be within their scope. I think they were being thorough during a time when trans care was evolving given that they brought a chaperone. If they did a full pelvic exam then that would certainly raise some red flags.I think your being uncomfortable was warranted and I dont think what they did is standard practice. However, Im not sure Id pursue it anymore given that a genitalia exam in some cases might be appropriate. Again, if penetration occurred then Id be more worried. Today, this would typically be monitored by a Gyn as part of a multidisciplinary team."
},
{
  "instruction": "What exactly do percentiles mean for pediatrics?I took my two year old for his appointment today he weighed 32.2 lbs\/90th percentile and his height was 34.5\/63rd percentile.I know this might sound bad, but does this mean my child is on the short and chunky side? Only asking because I didnt mention his diet and the doctor never brought it up except to cut out juices and switch to 2% or 1% milk for him.. but didnt seem concerned with his weight and said his teeth were great.I shouldve asked, but my son was trying to get into everything, it got hectic and it completely slipped my mind to ask",
  "input": "",
  "output": "He's on the heavier side for kids his age. He's still taller than average, though, so in general he's just a bigger than average 2yo.Switching to low-fat milk and avoiding sugary beverages are standard things that we suggest at this age, so I wouldn't read into the pediatrician talking about those. That's the recommendation for every kid!"
},
{
  "instruction": "The only time percentiles posed a problem for my kiddos was when they were used to detect a head growth problem in one of my kiddos  extra imaging was requested and there was an actual reason for the extreme jump off of the datum points off of the growth curve.Would it be fair to suggest that growth curves and percentiles are used to detect changes in growth?",
  "input": "",
  "output": "Yes, that's a good way to explain it. When we're watching from visit to visit, we're looking at the trend in percentile over time.50th percentile would be exactly average, 90% percentile means in a room of 100 kids his age hes heavier than 90 of them."
},
{
  "instruction": "low neutrophils high lymphocytes pediatricMy son is 3 years old. Got a ton of blood work for his weight I guess. He's 27lbs. He has high energy and no concerns other than occasional constipation. The blood work came back with low neutrophils 21% and high lymphocytes 71% (which has me sick to my stomach thanks to Google. WBC, RBC and hemoglobin is normal. Hematocrit is low 32.9% with the range min of 34%. His neutrophils absolute is 1.56 which is in range but on the low end of the range that says the min is 1.50. Lymphocytes absolute is in range. All morphology is normal. His ferritin is low at 23 with the standard low being 36. Everything else is normal. They did a lipid panel which I didn't have him fast as no one informed me. And his triglycerides were pretty high at 238mg\/dl. He had half a sugar cookie an hour before and I was feeding the other half during his blood draw to distract him. VLDL was high at 48mg. Everything was normal on lipid. Carbon dioxide was low at 17.0mm.",
  "input": "",
  "output": "First off keep in mind the percentages always have to add up to 100. So either the neutrophils are low because the lymphocytes are high, or the lymphocytes look high because the neutrophils are low. So he's got one problem, not two. Based on the other values my guess is that it's probably the low neutrophils but I'd have to see the absolute numbers.His iron is a little low but otherwise everything else is normal. Do you have a hard time getting him to eat meat? Because it's likely just dietary.In general, I really recommend against googling labs because it always comes up with scary stuff. Those aren't cancer values if that's what you're worried about. Could be he's fighting off an infection, could be related to a malabsorption issue or dietary deficiency, could just be normal for him.If it were my patient or my child I would think it's not likely a big deal, but would want to recheck at some point in the next few months to see if it changes. Keeping in mind I'm a family doctor and not a pediatrician, so they may have a slightly different plan."
},
{
  "instruction": "Neutrophils Absolute Your Value 1.56 103\/uL Standard Range 1.50 - 8.50 103\/uL Lymphocytes Absolute Your Value 5.26 103\/uL Standard Range 2.70 - 10.50 103\/uL Monocytes Absolute Your Value 0.44 103\/uL Standard Range 0.10 - 1.10 103\/uL Eosinophils Absolute Your Value 0.15 103\/uL Standard Range 0.00 - 0.90 103\/uL Basophil Absolute Your Value 0.00 103\/uL Standard Range 0.00 - 0.20 103\/uL Bands Absolute Your Value 0.00 103\/uL Standard Range 0.00 - 2.10 103\/uL",
  "input": "",
  "output": "Honestly that doesn't really look awful. Mild neutropenia. Not particularly scary."
},
{
  "instruction": "Ascites 4 weeks post-op, acute renal failureUpdate: Over 5L of fluid was drained from my dads abdomen today. The fluid was high in creatinine and consistent with urine. He initially felt much better, but then started experiencing extreme pain, likely from muscle spasms due to the drastic change in his body over the course if only 2 hours. His O2 dropped to 86 due to the pain. He is now medicated for pain and sleeping on and off. We are hoping that his status will improve over the next few days. Thank you to everyone that commented.70M, 6ft even, 205 lbs, Barrett's esophagus, eczemaHistory of heavy smoking decades ago that was reduced to once or twice per day in the 1980s. Uses edibles\/microdosing to manage anxiety and depression.Regular medications include acid reducers for well-monitored esophagus and fish oils and supplements for controlled eczema. Very active lifestyle for age including managing half acre yard, frequent 15 to 20 mile bike rides when weather permits, strength training at gym multiple times per week.January 12th, dad underwent robot assisted prostate removal. Lymph nodes were clear and there was one area where cancer had spread one millimeter into outside tissues. No radiation is recommended at this time. He was disharged home with a catheter. The catheter was removed one week later, but about 18 hours after it was removed, he was having trouble urinating and developed severe pain. He went to the ER cathed again. He was determined to have continued swelling in his urethra.A few days later, a cystogram with his surgeon revealed a small tear in his bladder where his bladder and urethra meet. His surgeon said that he expects the tear to heal on its own.My dad was admitted to the ER today for increasing discomfort in his abdominal area with pain and diarrhea. When I showed up, I noticed that his abdomen was visibly distended. CT confirmed ascites. Nothing else to note other than a 2 mm calcification in a kidney and cirrhosis. He is a recovered alcoholic that hasn't touched alcohol in 37 years. Labs shows some RBCs and WBCs in his urine. Also indicated acute kidney failure. BUN 56 mg\/dL, creatinine 4.54 mg\/dL, eGFR-Cr 13 mL\/min\/1.73m2.It is a lymphatic leak? Maybe urine leak caused it? If so, what next?",
  "input": "",
  "output": "In a patient with cirrhosis and new onset renal failure with swelling by the prostatic urethra, your dad appears to be at risk for urinary retention because of how much inflammation and swelling there is by the pelvis at the neck of the urethra. A simple noninvasive bladder scan can be done at the urologist's office after he voids or is allowed to empty his bladder completely , called a \"post void residual\". If there is more than 300-450 cc (every doc has their own cutoff) after a reasonable attempt to empty every last drop, he is considered to have urinary retention. This can cause urine to flow backwards and cause backpressure into the kidneys, effectively causing hydronephrosis (which can be picked up on a renal ultrasound (ultrasound of kidneys), or CT scan of the abdomen. Obstructive uropathy is this condition and can be source of renal failureAlso, ascites is not uncommon in decompensated cirrhosis. Make sure your dad is on a low salt diet. Also it is important to check a Complete metabolic panel or hepatic function panel to see his albumin level. Low albumin can contribute to ascites. Your dad could be in what we call hepatorenal syndrome if his cirrhosis is not under control and can lead to renal failure and death."
},
{
  "instruction": "What would cause someone to spiral into acsites when they have not touched alcohol in 37 years? He quit drinking when he was only 33 years old and hasn't had a drop since. He has never had any issues with his liver before.I will put his CT impressions, but I don't recall seeing anything about hydronephrosis.",
  "input": "",
  "output": "low albumin levels coupled with changes in portal pressure can cause this too, as can increased salt in diet or from IV fluids he had received during surgery. You mentioned the CT had findings of cirrhosis. Cirrhosis physiology is complex and would need complete liver function panel, INR, Tbili, serum albumin, Na levels to fully evaluate severity"
},
{
  "instruction": "Thank you. I just got off the phone with his surgeon, and we were able to talk for about 30 minutes. He feels that there is a continued bladder leak and that we are likely to find that the fluid collection is high in creatinine. They are putting a drain in tomorrow and they'll test the fluid. If this is the case, his kidney function is likely not as poor as it appears, as his body is reabsorbing creatinine through his peritoneum. I did ask him to run a liver panel out of an abundance of caution and he agreed.",
  "input": "",
  "output": "If that's the case, then this is a Urinoma I believe. Still though a creatinine of 4.54 and BUN of 56 is quite high but you're dad's urologist is right that creatinine can be inflated in this rare but unique scenario. BUN would be expectedly a bit higher if his creatinine were that high but not always. Cystatin C measurement can be another surrogate used to indirectly measure his true GFR. That hole wont repair itself unless the urologist diverts the urine elsewhere and hence the drain is needed. Bladder wont heal if there's continuous flow of any liquid, in this case urine, through the hole."
},
{
  "instruction": "Thank you for your input. I feel significantly more at ease. Hopefully, this is truely just the continued leakage. When my dad's labs came through electronically, I was initally shocked and alarmed. Now I feel cautiously optimistic.His urologist us going to mess with catheter sizing and try to inflate the balloon a bit more to put a bit of a stretch and seal up that leak. He'll give it two more weeks to see if the fistula can repair itself before going in for a corrective surgery.",
  "input": "",
  "output": "I'd be worried about a bladder leak given the bladder injury. Need to aspirate and sample that fluid before writing it off as simple ascities, imho."
},
{
  "instruction": "They are putting a drain in tomorrow morning, so we will find out what thr fluid is then. I feel extremely frustrated right now that there isn't more of a sense of urgency.",
  "input": "",
  "output": "Either the fluid is persistent leak from the tear which seems somewhat likely. The other possibility is obviously cirrhosis with ascites. As a prior heavy alcohol user, long-term smoker likely some degree of poor lifestyle habits (ie dietary) and his age he has more than enough risk factors to develop cirrhosis.Either way, sampling the fluid will give the necessary info"
},
{
  "instruction": "My husbands diagnosis. Please help. I posted a few months ago about this and you were all so helpful.Pt: 41 y\/o male, former marine, non smoker, very occasional drinker, 170 lbs 60.My husbands official diagnosis is Metastatic renal cell carcinoma, which spread to his lungs. They went in and took the tumor off the kidney (he has horseshoe kidney so he only technically has one) and he was very optimistic about getting it all from that area. Said his body encapsulated the tumor and they didnt see anything else on his kidney. They said there were nodes in his lungs, but that they werent treating and just want to keep an eye on until mid December, then talk about what to do if they grow. The problem is, he is weak and is having trouble breathing.No chemo, no radiation, no immunotherapy yet or maybe at all. Is this normal?His lymph nodes have been so swollen I can see them under his collar bone, and in his neck. Im worried. Is metastatic a automatic stage 4 diagnosis?Is his prognosis good? His oncologist and doctor seem to think so, but they wont really speak on anything early on. They said we would meet in December and talk more then. What do I do now?My husband isnt able to work, and is taking time off from getting his degree. He can barely walk around without being winded. I have picked up extra shifts at work, so I dont get to see him and how hes doing. I just want to know if I should trust what they are telling us, or ask for them to check him again since hes so weak. Help? Im losing my mind.Thank you. I appreciate you all so very much.",
  "input": "",
  "output": "Dont wait, call the oncology office now and let them know these concerns, they may need to start other treatments sooner.See a palliative care doctor ASAP. They are experts in cancer pain. Some cancer treatment centers also have anesthesiologists or rehab doctors who are experts in cancer pain.Oncologists are experts in the extreme complexities of treating cancers. There is a lot more to having cancer, and it's best to have an interdisciplinary team."
},
{
  "instruction": "He definitely needs to be checked out sooner rather than later, so if the oncologists cant see him urgently then he should still see primary care, or failing that, go to ED where they can check him over and perhaps even do a CT to establish whats going on with his nodes \/ progression.",
  "input": "",
  "output": "Yea an ER doc can check to make Sure he hasnt developed a PE (blood clot in the lungs) which is common and cancer and causes shortness of breath. The CT will also see if the cancer is bigger. Just be sure to go to an ED thats affiliated with his oncologist so they can see the images"
},
{
  "instruction": "Pts horseshoe kidney would handle it better than an. NSAID for, say, minor pain. But metastasizing cancer pain is of a much higher order. Hell be initially given Norco, probably transition to higher-order opiates via a learned palliative oncology Al pain specialist.",
  "input": "",
  "output": "That is an outrageously inappropriate pain regimen for a young person with advanced cancer."
},
{
  "instruction": "I agree. I was shocked. Its hard as his wife to watch him suffer. The man never complains, and if he says in hurts, it hurts.",
  "input": "",
  "output": "I'm seeing a lot more tylenol\/NSAID management for post operative patients (c-sections, hernias, hysterectomies, etc). However we always give narcs for breakthrough. The cancer patients are the exception, particularly the stage 4 ones. They still get non narcotic pain alternatives but that's in combination with narcs."
},
{
  "instruction": "Based on all of your comments it truly sounds like its time for a second opinion. Your current oncologist doesnt sound effective nor compassionate and you and your husband deserve a doctor who will listen to your concerns, treat symptoms, and treat his cancer rather than wait another few weeks which could be crucial",
  "input": "",
  "output": "Im a urologist and I've treated cancer like this.So he should definitely be in some type of therapy if he has metastatic renal cell cancer. Typically this is immunotherapy which is typically not too hard on the body (this is significantly easier than something like chemo). There are many medications out there that all have pretty good effects on cancer. It sounds like your husband had a cytoreductive nephrectomy\" where the kidney is taken out even though we know the cancer is spread. The goal is to just get as much cancer out as possible. Typically if there is remaining cancer (in the lungs for example) we then give immunotherapy however you do need to wait about 6 weeks after surgery for recovery. I'm not sure where he is on his recovery from surgery. Bottom line, I would talk to your oncologist about starting treatment, especially immunotherapy.Yes stage 4 = metastatic cancer. This is true of essentially all cancers.i will be blunt his prognosis is not good. With appropriate treatment his chance of living another 5 years is probably ~20%. This doesn't mean he'll die tomorrow but his time is limitedMore worrying is how young he is - 41 is incredibly young. You mentioned he is a veteran - he should see someone asap at the VA. If he had any exposure during combat he may be able to have all his medical bills covered. This is incredibly long and bureaucratic process but would be something I'd strongly suggest looking into.I am sorry but I hope this helps"
},
{
  "instruction": "It helps me, as you are being honest and upfront and thats what I need.So theres really not a good chance hes going to walk away from this? If you personally had to put time on it, can you tell me about how long?Thank you for that well thought out and honest reply. His doctors told him that he was going to be fine, but everything I have read online (I know Dr google isnt good, but I have scoured so many articles)Maybe thats why they want to wait until December? He is recovering very slowly. Hes also in a ton of pain and nothing I do helps. His doctors wont prescribe things as they claim its too hard to get around the red tape. I dont understand. Im treating him with edible THC as well as CBD because he wasnt eating. I was honest with them about this, and they didnt seem to see a problem with it.My heart is broken, but thank you for telling me your opinion here. It means a lot.",
  "input": "",
  "output": "Cancer related pain is one of the major indications for opioid pain meds. Im not sure what red tape these doctors are on about. I think its time for a second opinion."
},
{
  "instruction": "NAD, but both of my parents had metastatic lung cancer. There was literally zero red tape in getting them pain meds. My father passed 7 years ago, and was getting fentanyl patches, morphine, and Norco. My mom just passed 3 months ago and she had morphine and OxyContin. Your husbands pain should be treated.",
  "input": "",
  "output": "Is he getting medical care through the military or civilian hospitals? There's a huge difference in quality as well as the fact that you cannot sue if a practitioner has dropped the ball."
},
{
  "instruction": "If he has a positive Virchow node, they need to see him like right now",
  "input": "",
  "output": "This is all (unfortunately) correct except OPs husband didn't get cytoreductive radical nephrectomy but partial nephrectomy, due to having only one kidney to start with."
},
{
  "instruction": "That doesnt sound good.",
  "input": "",
  "output": "Yes, this partThey said there were nodes in his lungs, but that they werent treating and just want to keep an eye on until mid December, then talk about what to do if they grow. The problem is, he is weak and is having trouble breathing.doesn't sound good at all. Sounds like his metastases are growing pretty fast when he's already noticing bulging from lymph nodes and trouble breathing from lung metastases. But we don't really have enough information to make this determination right now. Missing information:The exact histopathology (is it clear cell renal cell carcinoma or something more exotic?)Imaging reportsThe date of imaging and surgery to get a feeling for the timeline and progression dynamicsWhy his treating physicians said that \"his body encapsulated the tumor\" when they also said he has lung metastases, and why they didn't indicate systemic therapy and why they seemed to think his prognosis is good.Taking the most likely case based on incomplete information: In metastatic classic clear cell renal cell carcinoma, no chemotherapy is indicated ever, because chemotherapeutic agents don't help, which has been tried and demonstrated over and over. Effective medications are immunotherapy (checkpoint inhibitor antibodies like pembrolizumab), TKIs (tyrosin kinase inhibitors that can be taken orally, like sunitinib, pazopanib, cabozantinib or axitinib) and as probably less effective alternatives medications that inhibit vascular growth (e.g. bevacizumab or lenvatinib) or mTOR-inhibitors (e.g. temsirolimus).What's indicated precipitates on your husband's other medications, comorbidities, performance status (overall health) and other stuff.Also, in oligometastatic renal cell carcinoma, locally ablative therapies can be used to kill all the metastases you can detect at the moment, for example radiosurgery, microwave ablation etc., but your husband's case doesn't sound like that from the very limited information we got.Edit: As \/u\/Porencephaly already wrote, your next step is to contact his oncologist's office. They need to determine what the problem is right now (maybe it's even an infection and not metastatic progression) probably with new CT imaging and formulate a plan of action.His trouble breathing could be due to anemia, or a number of infections, or heart problems, or lymph node metastases compressing blood vessels or a bronchus, or pleural effusion, or whatever else... this is all more probable than trouble breathing due to lung metastases themselves, which surpisingly rarely are symptomatic in this way."
},
{
  "instruction": "Thank you!! Ill get him in ASAP!",
  "input": "",
  "output": "Heme\/Onc fellow here, agree with everything youve said.Ill add my two cents and say that in addition to immunotherapy, VEGF inhibitors such as axitinib, cabozantinib, and lenvatinib are options as well. Many of the first-line treatment regimens are a combination of immunotherapy (either pembrolizumab or nivolumab) + one of the VEGF inhibitors. Combination immunotherapy (ipilimumab+nivolumab) is also an option as well for many patients. If someone has non-clear cell histology, the preferred regimens change a bit (and clinical trial is much preferred) but a lot of the same treatments are used.For someone who has a large burden of disease and is symptomatic from it, a combo of VEGF inhibitor + immunotherapy might be better than immunotherapy alone, just because the response rate is faster. But ultimately the choice depends a lot on factors like what other medical conditions someone has and what side effects theyre willing to tolerate, because we dont have any head-to-head trials showing that one regimen is better than the other."
},
{
  "instruction": "Seeking information regarding dads renal cell carcinoma. Any urologists here?My dad has been having serious issues with vomiting, nausea, and weight loss. They ended up doing abdominal CT because colonoscopy and upper GI scope were normal. There was an incidental finding of a 2 cm heterogenous(I think???) lesion on one kidney. Per radiology report, it says renal cell carcinoma until proven otherwise.Today we saw the urological surgeon who said due to size of tumor and my dads age, hes a candidate for ablation and theyll give him a referral.The appointment was very rushed and I (29 F) went in with my dad because he has a history of TBI and has a hard time remembering\/relaying medical info. We basically were just told that its cancer (which I figured from reading rad report) and that it can be ablated very quickly and the doctor then basically told my dad to drop his pants for a prostate exam so I made a swift exit.My questions lie in whether more imaging needs to be done on my dad to make sure theres not other cancer somewhere? The doc said most likely stage one but theyve only done the abd CT and nothing else?? I understand its a small tumor but does that automatically mean theres no metastasis?? I dont understand how they know that its only stage I without additional testing or imaging? Can anyone give me insight here about this process?We will be following up with that physician where I will be asking for clarification. It was such a whirlwind of an appt and I just didnt feel prepared to ask necessary questions.",
  "input": "",
  "output": "From the information provided, this is not standard of care - but giving us the image files (upload to e.g. dicomlibrary and CT report would be very helpful.Here is NCCN's very helpful patient guideline for kidney cancer.A suspicious 2 cm lesion on a kidney often, but not always is renal cell carcinoma. A 2 cm renal cell carcinoma that's confined to the kidney is usually pretty harmless and very unlikely to relapse or metastasize.The problem is that 1) staging is incomplete and 2) you won't have histology going along with this to confirm that it is indeed renal cell carcinoma and 3) your father has concerning symptoms that are as of yet unexplained.Initial evaluation and staging vitally includes comprehensive labs (CBC, metabolic panel, LDH), abdominal CT with and without contrast, chest CT (or at least, but that's discouraged in the guidelines, chest X-ray) and a thorough physical examination and history.If there are any alarming signs on history or examination, additional imaging must be done. I'd consider vomiting, nausea and weight loss to be alarming. At least brain imaging (preferably MRI) should be done to exclude brain metastases imho.Also, when not performing a partial nephrectomy, which would be preferable to ablation if possible, an initial core needle biopsy to secure histologic diagnosis is recommended. Otherwise you won't ever know what kind of 2 cm mass they burned. The NCCN guidelines stateBiopsy of small lesions confirms a diagnosis of malignancy for surveillance, cryosurgery, and radiofrequency ablation strategies. Ablative techniques may require multiple treatments to achieve the same local oncologic outcomes as conventional surgery."
},
{
  "instruction": "Distended abdomen, fatty liver, enlarged spleen and left renal fullness?Hi everyone!Just wondering if anyone has any ideas as even my GP seems to be stumped!I'm female, 32, MODY diabetes on insulin and high blood pressure (on nifedipine). Have a history of colon polyps but most recent colonoscopy in June was clear.The last few months I've been struggling with swelling in my stomach (photo) I look heavily pregnant and it is so uncomfortable, and the few weeks I've started having pain around my right rib area and into my back. Also have extreme fatigue.2 different GPs examined me and both were certain it was fluid so referred me for ultrasounds.I had these last week and had the results today - there is no fluid! The ultrasound did confirm moderate fatty liver, an enlarged spleen and left renal fullness.GP has referred me to haematology to look into the spleen, but said the fatty liver is only moderate and wouldn't cause the pain etc. He also doesn't know what the left renal fullness means but I do have a repeat enal ultrasound tomorrow.Full blood count was normal, kidney function came back normal but GFR had dropped from 85 in April to 62 last week, ALT on liver function only slightly raised to 62, cholesteral high at 6.3 with triglycerides at 7.3mmol.Anybody have any ideas at all as to what could be causing the swelling etc?Thanks - sorry it was such a long post!",
  "input": "",
  "output": "An ultrasound cant tell the difference between fat and fibrosis. Your labs and imaging findings of enlarged spleen are concerning for possible liver disease. You should see a gastroenterologist for further work up."
},
{
  "instruction": "Dont you think a gynecological exam is warranted?",
  "input": "",
  "output": "I honestly dont know if abdominal fullness is a reason for a gyn exam. I wouldnt think so though if youre not having other symptoms (bleeding), but not my area of expertise"
},
{
  "instruction": "That's doodoo. If fibrosis is significant, US can easily tell the difference between cirrhosis and fatty liver.",
  "input": "",
  "output": "An ultrasound can show other signs of cirrhosis and can give an idea if a liver is cirrhotic appearing but it doesnt actually measure fibrosis\/scar tissue. Sono it doesnt show fibrosis. Youd need a biopsy or fibroscan for that. Or an mri with elastography. 97wrongggggff"
},
{
  "instruction": "You said if it can tell the difference. Measure is another thing. Ultrasound can tell the difference between a fatty liver and a highly fibrotic one\/cirrhotic. But yeah, it can't measure the amount. Unless you do an ultrasound fibroscan. In that case. Ultrasound can measure the amount ",
  "input": "",
  "output": "You can have an ultrasound that just shows fat and that liver can definitely be a cirrhotic liver even if the ultrasound doesnt call it. Thats my point."
},
{
  "instruction": "My sebum creatinine level is 5.7 and I want to reduce it by following a renal diet. Is it possible?I am 23F, 55kgs and 5'1. I had high creatinine level of 17, then went through dialysis for 2 sessions and reduced it to 5.7. I do not want to go through dialysis again as it made me feel very weak and made me vomit blood and feel sick. Instead of dialysis, I want to follow the renal low protein diet and take my meds (ketosteril, iron supplements because of my low haemoglobin and antacids). Is it possible to reduce creatinine by this margin without dialysis?",
  "input": "",
  "output": "I suspect the answer is no, but it's a better question for your kidney doctor. My understanding is that the renal diet won't restore renal function, but reduces the amount of things that don't dialyze well (certain dietary proteins, phosphorus, etc). If you have been started on dialysis I suspect that your kidneys have failed. Your kidney doctor is the one tell give you prognosis if there is a chance of you regaining kidney function or if dialysis would be a long-term thing.I would strongly caution against trying this on your own or skipping dialysis sessions without first discussing with your kidney doctor. It's very possible that dialysis is literally keeping you alive.I'm sorry but this needs more info."
},
{
  "instruction": "I'm willing to give any info. What should I add?",
  "input": "",
  "output": "I'd add the history: what doctor did you see, why was your creatinin so high\/what was the reason for your kidney failure, did they tell you doing dialysis twice was enough? This post is very confusing"
},
{
  "instruction": "Would bladder or ovaries be checked on a CT scan for renal stones?A few months ago I (24f) was in the ER for gross hematuria and the doctors there did a CT scan, suspecting renal stones. Nothing showed up, and its now suspected to be related to my endometriosis as its having a cyclic presentation around my period.The doctors also noted a 4 cm ovarian cyst on my right ovary, which makes me think that the CT scan wasnt just focused on the kidneys.Anyway, all this to say: Im pretty sure the gross hematuria is from bladder endometriosis (which my doctors believe it to be), but Im a bit worried its something more serious like a tumor or large cyst. Would my earlier CT scan rule out these possibilities, or should I maybe make an appointment to do more imaging?",
  "input": "",
  "output": "Would have been seen on the CT."
},
{
  "instruction": "Potential Renal neoplastyWent to er for massive dehydration and what I thought was a intestinal blockage. That issue resolved itself but during CT scan for blockages, etc, noticed something on my kidney.\"Indeterminate lesion in the lower pole of the left kidney measuring 1.7 x 1.5 cm. This is suspicious for a possible renal neoplasm. A follow-up non emergent dedicated pre and post-contrast renal CT would be recommended to further evaluate.\"Not asking for medical advice, going to get it further checked asap, but anyone with experience here - how concerned should I be? It's the weekend and I can't call pcp and I'm trying to keep my wife from panicking, honestly. The er doc seemed fairly concerned.",
  "input": "",
  "output": "Based on CT results it's literally indeterminate. You need further imaging which will likely happen rather quickly."
},
{
  "instruction": "potential kidney\/renal issues? or maybe something else?Hi,I really need so advice, I'm 27 male from UK, bmi within range, slim\/average build,Over a year ago now I had a dull ache in my right mid back side which radiated down my flank.I saw my Dr who did a urine sample and a ultrasound, both were fine.. a year ago, however the pain has still persisted.I've gone back and forth to the Dr's who are now being quite stubborn and won't do anything else apart from constant urine tests which come back normal, they won't assist or try other avenues.This pain has continued to plague me, sometimes I have zero pain, live normally, and a hour or so later or the next day I could get the pain back which feels like a deep ache, (like I've been kicked in the testes) this hasn't got any better by itself for a year. And now it's starting to worry me as now when the pain happens, I now get a tender testicle on my right side.At first I thought maybe my underwear are a bit tight, so I've spent a lot of time not wearing underwear to give them space, it's made no difference, as soon as that back pain starts it moves down my flank, and eventually in my testicle where the pain can last 1hr to 5hrs and if like magic completely disappears until the next episode which is usually that same day or the next.I dont know where else to turn, I'm considering going private for gp , who could push me back onto the nhs and refer me. Bypassing my nhs gp. I'm starting to be concerned it could be something more serious which is not being detected and could get worse.I just want the pain to go.The pain severity out of 10 can range from a 2, to a 8, it makes me feel nauseated if it's bad.Thanks in advance.",
  "input": "",
  "output": "Sounds like a ventil stone in the right ureter, can be seen easily with a native CT scan of abdomen\/pelvis.The ultrasounds and urine analysis were done to rule out the most common causes which are hydronephrosis and pyelonephritis.A ventil ureter stone doesn't always cause a hydronephrosis to be seen in the ultrasound. And a microhematurie although is present in most cases of urolithiasis but not always.The next logical step is a native CT scan. Book an appointment with your urologist"
},
{
  "instruction": "Thank you this sounds similar, I will have to ask my Gp as in the UK we can't book direct with specialists, you need a gp to do so if they feel it's necessary.I cant find anything on ventil stones, but have found a lot of info on ureter stones which sounds very similar. Thanks again",
  "input": "",
  "output": "Ventil stones are rare, i have only 2-3 cases per year. I don't know if the name in english is same as in german, we call them ventil stones because they act as a ventil or imagine as a Gate, the ventil stone moves a bit=blocks urinary tract causing hydronephrosis and massive pain, then a bit later this stone moves again and opens the way so to say and then urine flows normally and hydronephrosis dissappear so pain goes away. The native CT scan can 100% detect it. If you experience fever with the pain you rush to the Er, otherwise go to your gp as you said."
},
{
  "instruction": "I have a secret IUD and need to undergo a non-invasive pelvic ultrasound, will it be detected?Hi! I'm a 22 year old woman who lives in a conservative Muslim society and I need to undergo a pelvic ultrasound to test for PCOS. I secretly got an IUD while living abroad, never thought I would have to move back to my home country so wasn't prepared for this situation. My mother accompanies me wherever I go because I'm never allowed out of the house alone.I recently had my blood checked and the test report includes: levels of FSH, LH, estradiol, progesterone, testosterone, renal function tests, liver function tests and a lipid profile. Can a doctor come to a conclusion about whether I have PCOS based off my hormone levels, or is an ultrasound mandatory?",
  "input": "",
  "output": "Yes, they will 100% see it on an ultrasound.Often the hormone results are all theyll need for the diagnosis, but in some cases doctors will recommend the ultrasound to get information on the size and appearance of the ovaries. Its possible to decline to get the ultrasound. If you really dont want one, the doctor may be okay with skipping it.Or is there a way you can go to the ultrasound with another family member who you trust to know about the IUD?"
},
{
  "instruction": "Could they slip a written note to the tech or doctor to not verbally mention the IUD in front of mom?",
  "input": "",
  "output": "In conservative Muslim countries, it's not uncommon for doctors to share information about adult children with their parents. It would not be safe to send this type of note\/email and risk it being shared with the parents.Read more here. (Excerpt from \"Factors influencing sexual and reproductive health of Muslim women: a systematic review\" below)\" Unmarried women seemed to be concerned with healthcare providers informing family members about their visits and expressed worries regarding providers sharing information discussed during consultations. For some single women, family members often accompanied them during health visits, making it impossible for them to discuss any issues privately.A study in Egypt revealed that although patient records were stored securely in filing cabinets in the family planning clinics, a number of healthcare providers stated that they allowed family members to view womens health records. In addition to providers lack of respect for confidentiality, another contributing factor is that in the Egyptian family health model, womens medical records are a part of the combined family health records and could be easily accessed by any family member \""
},
{
  "instruction": "Thank you so much for your answer! I was not aware of this!",
  "input": "",
  "output": "#1. PCOS can be diagnosed by simply having irregular or absent cycles plus excess hair growth. Ultrasound is definitely not necessary. #2. Unfortunately, if a pelvic ultrasound is done the IUD will be quite obvious."
},
{
  "instruction": "NAD, but is it possible for you to call your doctor on your own? Explain the situation, I'm not sure if that is feasible where you are or not, but they really do need accurate medical history",
  "input": "",
  "output": "You don't need an ultrasound to diagnose PCOS. It's clinical history + exam + hormone levels.If you have a hormonal IUD, though, this can affect diagnosis and treatment plan. Hormonal contraceptives are the first line treatment for PCOS, anyway."
},
{
  "instruction": "In Australia you wouldn't need it because you already meet criteria. That being said the treatment doesn't really change wether you label it as PCOS or not - it's to go on hormonal contraceptives.",
  "input": "",
  "output": "In your case, you still don't need the ultrasound tbh. You need clinical OR laboratory signs of hyperandrogenism (in your case, hirsutism) Coupled with absent periods, you have two features. As long as they don't suspect another etiology (which can be tested for via blood), you can be diagnosed."
},
{
  "instruction": "Sorry to piggyback this comment but just out of curiosity, can PCOS ever be a possible diagnosis even if hormonal blood test results indicate otherwise? I have always some of the physical symptoms (long periods, cystic acne, mild hirsutism), and my consultant gynaecologist diagnosed me with having PCOS after observing that my ovaries were enlarged and pearly during a laparoscopy to excise endometriosis. But bloods I had taken when I was much younger, and further bloods I had taken 2-3 years after this surgery showed that my androgen & testosterone levels were within normal ranges, so my GPs opinion is that I dont have it (regardless of my consultants observations). Ive never quite known what to make of this difference in opinions. Any thoughts?",
  "input": "",
  "output": "Yes, if hormonal blood tests are normal and there's no obvious signs of hyperandrogenism (in your case, the hirsutism seems subtle), then that's when ultrasound comes into play. Your GYN did a laparascopy and visualized the ovaries directly, which would replace the ultrasound in this case. Also, women with PCOS tend to have skipped or absent periods, not prolonged periods. So, I can see why your GP would be skeptical."
},
{
  "instruction": "MRI Renal ResultsAbdominal Wall: Umbilical defect approximately 9mm TRVCan someone explain this to me? Is this a hernia, if so how is this possible?Also originally I received the mri for a renal mass that was first discovered in 2017 of 3.6 cm and on my recent MRI exam is now 1.1 cm? Does this mean it could still be cancerous or most likely benign?",
  "input": "",
  "output": "Tiny (presumably fat-containing) umbilical hernia which is so common that half the time we don't mention it.Can't conclude anything about the renal lesion without the full description. If it's one complete thing that has decreased in size, then yes it's benign. If there was a 3.6 cm cystic lesion that has gotten smaller but now has suspicious features, that's a different story."
},
{
  "instruction": "Respiratory rate while sleeping?Age: 26 Gender: Male Weight: 170 lbs Height: 510I do not smoke or drink.Hello! I have been monitoring my sleep with my apple watch and have seen my respiratory rate be pretty low which from what Ive seen isnt good.Occasionally I see it between 10-11 and apparently last night at 9.5?I dont know if you guys can offer if the apple watch is even a good indicator or accurate. Which is why I rather ask yall.Thank you for helping, wishing you the best.",
  "input": "",
  "output": "That's normal"
},
{
  "instruction": "Thank you so much!At what point would you consider it to be abnormal? I obviously have no knowledge other than the vagueness I see which is 12-20.",
  "input": "",
  "output": "It's more abnormal to be tracking your resp rate while asleep."
},
{
  "instruction": "68M Recurrent right sided nosebleeds resistant to treatment followed by respiratory infectionMy dad is a 68 year old Mexican (mestizo) male. At the time of his first nosebleed, he was diagnosed with diabetes, high cholesterol, and prehypertension. He's 5'6\" and weights 180 pounds. He rarely drinks and doesn't smoke or use recreational drugs. He's prescribed metformin, insulin, aspirin, and lovastatin but refuses to use the last two. He also has arthritis in his elbows, for which his doctor tells him to use ibuprofen as needed. I don't know his cholesterol levels or A1C.About two weeks ago now, had a nosebleed (limited to the right nostril) for the first time in over 30 years while he was cleaning the garage. We asked him if he accidentally hit himself, scratched his nose, or sneezed but he insisted that it just started out of nowhere. Initially he was able to stop the bleeding but later that same day the bleeding resumed while he was moving some boxes (15-35lbs). We were unable to stop the bleeding and he went to the emergency room where they tried to stop the bleeding with Tranexamic acid and, after that failed, cocaine hydrochloride before ultimately applying an anterior nasal packing. His blood pressure was checked and it was high 143\/83 but the doctor said it could be due to the stress of the situation and didn't warrant immediate treatment (side info, he had a heart rate of 85, low 60s seems to be normal for him). He was told to go back in two days to remove it and cauterize the affected area. He was also prescribed cephalexin (I'm assuming to prevent opportunistic infections). Apart from the nosebleed, he seemed fine. He was a little shook from the experience but was feeling good. No other symptoms.Two days later he went to get the nasal packing removed and the doctor determined nothing needed to be cauterized. My dad was told to be careful for a few days and to schedule an appointment with his PCP, which he did. He has that appointment later today. Two days after getting the nasal packing removed, he woke up with a bloody nose that he was unable to stop. He went to the ER again where they ended up cauterizing his nose. He had some minor discomfort from the procedure but was fine otherwise. He was also referred to an ENT doctor and was able to schedule an appointment, but it's a month from now.Since then, he's experienced 1 more severe nosebleeding episode. He went to the ER and got it treated with lidocaine and since his blood pressure was higher 153\/89, he was prescribed blood pressure medication (something starting with an an L -- I don't have the documents on hand). He was also given a nose clip and finally had some lab work done (cbc, complete metabolic panel, and prothrombin time test -- those results will probably be discussed today). He's since experienced two minor nosebleeding episodes that have been effectively treated at home. In addition, starting the day his nasal pack was removed he started experiencing symptoms of what appears to be a respiratory infection. This will be explained in the next paragraph.The day my dad got his nasal pack removed, he complained of discomfort in the nose and sinuses. Some discomfort was to be expected but the day after he started developing a sore throat which eventually progressed to a dry cough, headache, coughing fits and nocturnal fever (no thermometer available to record temperature). He went to urgent care which prescribed him prednisone and azithromycin. It's been two days since and there's been no change on his condition on that front. The illness appears to be communicable since my mom started displaying symptoms about 4 days after my dad. It's possible that he caught the bug during Easter since we had a small gathering (<8 people) though no one else was displaying symptoms at the time or has displayed symptoms since. My dad has been tested for both covid and the flu, for which he has tested negative. It's also possible he caught it while seeking treatment for his nosebleed due to the area of treatment but I'm wondering if the two could be interrelated.It's concerning that after having no nosebleed or symptomatic medical issues for so long (other than the diabetes), one would present so abruptly and severely without any physical trauma or changes in medicine or lifestyle habits. My questions would be what would be some of the most likely causes of nosebleeds in someone with his medical history (hypertension seems to be a big one)? His visit with the PCP is today. What would be some good things to bring up or ask about in his upcoming visit that his doctor might overlook but could be important?",
  "input": "",
  "output": "Hypertension does not cause nosebleeds, not does it prolong them. Except very rarely and dramatically they are not from an artery.The most common cause is actually nosepicking, so grill him more about this. Dry air, a cold, allergies and exposure to dust in his garage are other likely causes. Once you start getting them they tend to persist for a while. He is not on a blood thinner.While waiting for ENT he can use saline nasal spray to keep it moist, use a humidifier at night, and learn how to apply effective pressure to stop the bleeding."
},
{
  "instruction": "I guess one of the possible causes they explored during his first visit was nosebleed due to hypertensive crisis but yeah, it doesn't seem like the doctors think hypertension was the cause of his nosebleedsThe dust in the garage does seem like a likely culprit considering it had been two years since it had last been cleaned out. It's just alarming that a man that hasn't experienced a nosebleed in decades would suddenly have recurrent nosebleeds but it sounds like it's not too out of the ordinary to experience them in succession like that, so that's reassuringI'm sure his PCP will grill him about picking or rubbing his nose since he has a habit of doing that, though one would hope he'd be following the doctors' instructions to not touch the area after the first nosebleedWe'll get him a humidifier. Hopefully his visit with the PCP will provide answers or more specific questions",
  "input": "",
  "output": "It's usually from irritation in an area called Kiesselbach's plexus in the front of the nose. The ENT can cauterize this, usually helps. Noses bleed, it is very rarely a sign of cancer or hematologic disease.Rarely the sinus packing can cause a sinus infection. His symptoms sound more like a viral URI with the dry cough and sore throat plus infecting your mother."
},
{
  "instruction": "Myasthenia gravis and respiratory infectionHi my first language is not english so please excuse any mistakes. I (24f) have Myasthenia gravis and even though I take several immunosuppressants such as Prednisolon, Azathioprin and weekly Efgartigimod alfa infusions my symptoms are quite severe.I had multiple myasthenic crises the last few months. The last time I was in the hospital was this January because my symptoms worsened due to a covid infection and I was treated with intravenous immunoglobulins and nirmatrelvir\/ritonavir. I was released 10 days ago.Two days ago I started to notice that I have symptoms of a respiratory infection (coughing, runny nose, sore throat, breathing is difficult and so on) and the symptoms of my MG worsened too. I am really afraid to call my doctors because they work at the hospital and when my symptoms get worse they admit me to the hospital. I can't stand hospitals anymore. I had several plasmapheresises, was intubated, had a feeding tube, a thymectomy and so on. I am very thankful for all their efforts and they saved my life several times but everything in me has the urge to be as far away from the hospital as possible...Do you think I should be admitted again or is there any possible solution to treat this at home? And if I contact my doctors would it be irresponsible of them to treat me at home?",
  "input": "",
  "output": "Sorry, but I dont think your question can be answered over the internet. The decision to treat for an MG flair requires a thorough physical exam. It may be worthwhile to note that MG can be very difficult to treat, and its reasonable for your doctor to be conservative and bring you into the hospital. If left untreated it can be rapidly fatal, especially if youre at home."
},
{
  "instruction": "(26F) If a breathing pattern disorder is corrected (respiratory alkalosis\/chronic hyperventilation), how long does it take for serum bicarbonate to return to normal levels?I developed chronic hyperventilation due to tachycardia. Sustained low CO2 dropped my bicarbonate levels. My heart rate is now under control and breathing pattern disorder in the process of being corrected. How long can I expect it to take for my bicarbonate levels to return to a normal range?",
  "input": "",
  "output": "Bicarbonate levels will usually normalise within days once CO2 levels are corrected. The kidneys are very good at what they do - I wouldnt worry too much about your bicarb levels if all else is well\/improving."
},
{
  "instruction": "Viral respiratory infection fever not getting better.22M, 5'10, 157 lbs, no drug use, no known health conditions or allergies. I got sick early in the morning on January 7th around 1 AM or so. Instantly got hit with fever, cough, sore throat, headache. Jan 9th I developed severe ear pain and pressure as well as ringing and echoing. NP looked and said it was an ear infection and prescribed amoxicillin. On January 7th my fever peaked at around 101.5-102. I took Tylenol to reduce it and it worked well. On the days after that my fever fluctuates from around 99.5 F to 100.5-101 F. It hasn't gone down from there. Doctor's office didn't detect fever today but they were using a forehead thermometer. At home my thermometer once again showed 99.5 which has now increased to 101 in the evening. My oxygen levels, HR, and BP were all fine. I cough a lot with mucus and sometimes it hurts but nothing crazy. Should I be worried? How long does fever typically last and when should I seek out help? I took a covid test today and should be getting results tomorrow as well.",
  "input": "",
  "output": "That's fine. Nothing to worry about"
},
{
  "instruction": "M19 70 kg . Possible influenza but no respiratory problems.Hi . So my sister got influenza, and got diagnosed. And then I got the fever and the dizziness.So here are my concerns. I a barely coughing (I had like 10 painful coughs the whole day) but other than that I am breathing fine. I am feeling kind of itchyich in my trachea but nothing more.I am also concerned by my dizziness that comes and goes for 5 seconds.Thoughts?",
  "input": "",
  "output": "Im not sure I follow your question. Influenza has a spectrum of symptoms. Sounds like you have influenza."
},
{
  "instruction": "How do you clinically distinguish a Viral Upper Respiratory Tract Illness from a Bacterial one?Medical student here, year 2Well I've been reading about respiratory pathogens and found out that while viruses are the most common cause for these, bacterial infections can have terrible sequelae when not treated (RHD), so how does a doctor clinically determine if the person presenting to them has Viral or bacterial infection so that right measures can be taken?I'm assuming throat swabs for every single person wouldn't be very economical and just or would they be?",
  "input": "",
  "output": "Usual disclaimer: no one can provide specific medical advice for a person or condition without an in-person interview and physical examination, and a review of the available medical records and recent and past testing. This comment is for general information purposes only, and not intended to provide medical advice. No physician-patient relationship is implied or established.Streptococcal pharyngitis is a fairly distinct clinical syndrome compared to a garden variety viral respiratory infection. Classically, the symptoms are severe sore throat and fever, and the signs are exudative tonsillitis and tender anterior cervical lymphadenopathy. While sore throat is common in viral infection, exudative tonsillitis is less so, and viral syndromes are often accompanied by cough and coryza, which strep infections do not produce.These distinctions are codified in the Modified Centor Criteria, which can give you a pretest probability for the presence of strep throat, and guide your testing and treatment decisions. Here is a link to a calculator that can help you.https:\/\/www.mdcalc.com\/calc\/104\/centor-score-modified-mcisaac-strep-pharyngitisBacterial infections of the respiratory tract typically refer to pharyngitis, tracheitis, sinusitis, or pneumonia depending where along the tract you are worried about. Each will have their own physical exam findings, risk factors and severity that over time, you learn to distinguish.Since you're mentioning throat swabs, testing for EBV, flu, RSV, COVID, or Group A Strep can quickly be done with rapid point-of-care testing if they have risk factors (we can use clinical decision making tools like Centor criteria to help us as well)."
},
{
  "instruction": "Are there these associations like, if pharyngitis is bacterial in etiology the person most likely presents with fever, while viruses produce a runny nose, are any such associations there and are these correct?",
  "input": "",
  "output": "Not that simple. Viral infections can also cause fever. Runny nose tends to be more viral than bacterial."
},
{
  "instruction": "M25 215lb viral respiratory infection and low body tempHello Im M25 and weigh 215 lb. I have been recently (yesterday)diagnosed with a viral respiratory infection and have been experiencing mostly coughing (for a week) and sinus drainage; however, my body temperature has remained consistently lower than normal. Im typically at 98.6 F but Im currently approximately at 96.4. Im using a thermometer under my tongue. Is this drop in body temperature normal?",
  "input": "",
  "output": "This does not sound concerning. Try a blanket."
},
{
  "instruction": "Thank you for your comment. What worries me is that Im wearing a jacket and am using a blanket in bed right now.",
  "input": "",
  "output": "Throw away your thermometer for an easier life."
},
{
  "instruction": "Can you get an outer ear infection from upper respiratory illness?~2.5 weeks ago I caught a mild illness  sore throat with swollen lymph nodes on left side only. Negative COVID tests.My left ear felt a little clogged afterwards but seemed to be improving.Yesterday, it rebelled. Lots of pain inside, worse today. Jaws a bit sore too and sometimes the pain spikes when I turn my head left.Diagnosed with outer ear infection, prescribed Ciprodex drops.After curiously reading up on it (only had an inner & middle one before), Im feeling confused and wondering if this makes sense.- How does a throat illness\/infection end up in your outer ear? Are they unrelated?- Can you get an outer ear infection if your ear hasnt been wet recently?- If it isnt an outer ear infection, will the drops still work?Most of what I read talked about swimmers ear and there being water involved, but embarrassingly between the illness and some other stuff I havent showered in like 2 weeks so it's been dry.I've had past vestibular issues so am extra concerned about addressing this right\/quickly so it doesn't start causing other trouble.Thanks!",
  "input": "",
  "output": "This is a common thing that gets referred to me, and as an ENT this issue slowly kills me inside. Differentiating between an outer and middle ear infection should be quite simple.If you can answer yes to the following questions, then you may have an outer ear infection (aka otitis externa):Is there white\/yellow\/brown\/red stuff draining from my ear?Does the physical ear hurt when I pull on it or press on it?Did it hurt when they stuck the otoscope in my ear canal (more than it may usually if you have sensitive ears)?When they examined the ear, did they see redness, inflammation, drainage in the ear canal itself?If no, then you don't have an external ear infection.If you have a middle ear infection and they gave you drops, the only time this is useful is if you have a hole in your eardrum, and this will often also lead to drainage from the ear.A middle ear infection can be quite painful as well, but you shouldn't be able to really touch the pain in the same way.What is very common post-cold and what you may likely have is Eustachian tube dysfunction. This can result in fluid in the middle ear space, but doesn't necessarily mean an infection. This is treated from the nose side with either short course afrin, sudafed, oral steroid (low dose, short course), Flonase, saline irrigations, or any combination of the above.This all comes with the obvious caveat that I have not examined you and cannot specifically comment on your case or rule out an otitis externa, otitis media, or whatever else."
},
{
  "instruction": "can cutting off sugar cure an upper respiratory infection?20F, 5'4, 116 lbs., do not drink, do not smoke\/drink\/use drugs, USAI got sick around October 29, 2022, after going to the doctor, I was prescribed a 10-day antibiotic dose that was finished around November 11. Although my harsh symptoms were gone afterward, such as tiredness, body ache, and congestion, all of a sudden after the antibiotics I got this harsh cough that was productive with green mucus. The cough was not a dry cough like I had before\/during my antibiotics but rather came from my chest and is very loud. I have trouble breathing with this cough. Knowing its been around 40 days and I haven't stopped coughing so much so my back is killing me from the constant coughing, 4 days ago I went to the doctor. He basically told me to cut off sugar from my diet, no junk food, and eat only vegetables and soup for 20 days and I should feel better. (I was a little confused about this suggestion because he never asked about my diet beforehand, previously, I didn't eat junk food every day and I include veggies and fruit in almost every meal. I am quite active and have been consistently healthy.) I was not prescribed anything that can help my mucus but was prescribed cough syrup and an inhaler.I am not sure if a change in diet is a solution and I'm wondering if I should ask for a chest x-ray because I have difficulty breathing.Also this doctor didn't even check my breathing until I had asked him to. He said my lungs sounded fine but did hear mucus in my bronchi.Side note: after finishing my antibiotics I took probiotic pills and drank kombucha, could that have caused this?",
  "input": "",
  "output": "Generally speaking, eating less sugar and increasing plant-based food is a good thing for your health; but you shouldnt expect this change to make any real difference with an acute infection. I expect in 20 days youre going to feel a lot better regardless of a change in your diet."
},
{
  "instruction": "My (35m) heartrate is not going down after recovering from a respiratory virus.I'm 35, male, 5'11 and 215lbs. I was fighting a respiratory virus for the last 2 weeks. My symptoms are basically gone at this point, but my RHR has not recovered. It is normally around 62bpm and has been stuck around 92bpm for the last few days. I understand that it can be elevated while fighting an illness, but I expected it to return to normal as I got better. I do not drink caffeine, alcohol, or take any medications that could raise it. I have an appointment to get a Holter monitor for an unrelated sinus arrhythmia in a couple weeks and I'm concerned it might skew the results. The only thing I can think of is I haven't been eating much in the last couple weeks due to a sensitive stomach so I don't know if the lack of nutrients might be causing something to be going on. I've been drinking lots of water as well.",
  "input": "",
  "output": "Give it a few months to reset"
},
{
  "instruction": "26F - little streaks and spots of blood in phlegm but no symptomatic respiratory\/sinus\/throat illness and no coughing26FWhen I brush my teeth, I suck the mucus in my throat out into my mouth and spit into the sink. For the past few days, I've noticed bright red spots and streaks within the mucus. Not too much but it's there. I have had no recent infections or illnesses. No recent coughing or sore throat either. Everything sinus or respiratory has been normal. I used to vape and smoke between 18-23 years of age, and the volume of air I can take in during a deep inhale has shortened as a result of the smoking\/vaping based on my subjective, highly inconclusive observations.Have been experiencing noticeable and moderate ongoing fatigue as well.",
  "input": "",
  "output": "Not concerning. Congratulations on being nicotine free though! your body thanks you."
},
{
  "instruction": "My disease may have caused respiratory involvement.Hello, I am 28 years old male 165cm 22kg Malay. I have been diagnosed with rare disease named Congenital Fiber Type Disproportion Myopathy in 2010. I also suffered Combined Scoliosis and Lordosis and has to use wheelchair. The scoliosis made my left lung smaller than my right lung. I refused spine surgery as I deemed the risks outweighed the benefits. I discontinued medical checkup in 2011 as there's no other treatment available. My skeletal muscles is progressively weaken over the years. Since last month after recovered from a flu, I've been having daytime sleepiness despite 7-9 hours of sleep. I also frequently woke up from a dream with a headache. Rarely, I woke up choked or gasping for air. I also has multiple awakening at night. My Gp prescribed me with 0.25mg Alprazolam few days ago to help me sleep better. I did get uninterrupted sleep, but it did not help with daytime sleepiness. I stopped Alprazolam after I read about the withdrawal symptom. I planned to schedule an appointment with sleep specialist. I'm afraid my disease has respiratory involvement.",
  "input": "",
  "output": "Your post raises concern for chronic hypercapnic respiratory failure  basically you skeletal disease causing chest wall restriction leading to hypoventilation. A benzo (such as alprazolam) would acutely worsen this, not surprised things got worse. Strongly recommend you see a pulmonologist asap. You probably need something like nocturnal BIPAP to blow off CO2 and improve your symptoms."
},
{
  "instruction": "Can someone explain \"respiratory failure\" to me?30F, persistent pneumonia and shortness of breath. Sp02 sits at around 88 but as low as 50 on exertion.I have been treated at an outpatient clinic and visited by nurses daily, I have been given oxygen to use at home. My doctor said I have respiratory failure but I am unsure if this is just a general term, or if it means my lungs are dying, or something else?The term \"failure\" makes it seem serious\/life threatening but I have not had anything explained to me.Should I be worried?",
  "input": "",
  "output": "Respiratory failure usually has a different meaning than being used here - what's the clinical situation causing this?Respiratory failure is often technically defined as either low oxygen levels or high carbon dioxide levels due to your lungs not working as well as they should. You can have acute respiratory failure, like if you get pneumonia or have an asthma attack; you can also have more chronic respiratory failure where your lungs dont work as well in generallike with emphysema.Its hard to know whats going on in your exact condition and what the prognosis is without more informationbest thing to do is ask your doc.In your case respiratory failure is defined by your need for oxygen -- chronic hypoxic respiratory failure. \"Failure\" in this situation means your lungs aren't working well enough on their own to sustain your life, so you need the oxygen. If your lungs weren't failing you wouldn't need oxygen.Should I be worried?That's a very common question on this sub, and often it's not answerable over the internet. In your case I'd certainly be worried. It sounds like you are quite young for having developed chronic respiratory failure, and it doesn't sound like you have a clear diagnosis (probably meaning there isn't a clear treatment plan going forward). You should keep asking questions to your doctors until you get answers; and if you haven't seen a pulmonologist yet you should seek one out ASAP. \"Persistent pneumonia\" isn't a diagnosis."
},
{
  "instruction": "27F Overweight  dizzy, nauseous, weak, sleepy, and seeing some black spots from time to time  respiratory acidosis?It's been a month since I've been having these weird symptoms  headaches, dizziness, nausea, weakness (specially on the legs), faintness. I feel confused some times as well.I also have bad GI problems such as bad absorption, diarrea, and\/or constipation depending on the date.After 5 trips to the ER with pain on the left part of my chest, and confirming that my heart was fine, all I got diagnosed with was anxiety and POTS.But today I did some blood tests and my Bicarbonate levels were low (20; normal range is 22-29).Could I have respiratory acidosis although my oxygen levels are 95% and up?Or is this more a metabolic thing?I do feel like I can't breathe properly recently.",
  "input": "",
  "output": "Your bicarbonate level is fine. It was maybe outside of the lab reference range, but it's nothing to worry about at all"
},
{
  "instruction": "Sorry for doubting, but  Are you 100% sure? I have my doctor's appointment on Monday. I just want to know if this is something treatable, or if I should go to the ER.",
  "input": "",
  "output": "Yeah it's fine, not at all urgent."
},
{
  "instruction": "I don't have kidney problems that I know of.But do you think my lungs are alright? Could it wait till Monday to check? I feel I can't breathe properly, but just because I'm terrified of not breathing properly.",
  "input": "",
  "output": "Youve been to the ER 5 times. I would assume they checked your oxygen levels and someone listened to your lungs."
},
{
  "instruction": "Yes, they have listened to my lungs several times, but they have never said anything bad there. My oxygen levels are always 95%+.I just had an abdominal ultrasound scan and aside from some fat in my liver and some bile salt in my vesicle, they didn't find anything. No comment on any acid in my stomach whatsoever.I also had a chest X-ray plaque and they didn't say anything bad was going on in my lungs.I have high uric acid  9.0 (limit is 5.7).Is it safe for me to sleep today and tomorrow and wait till my Monday appointment?",
  "input": "",
  "output": "Do you have kidney problems? Did anyone suggest baking soda or tums? Do you eat a lot of meat?"
},
{
  "instruction": "Getting circumcised. What else can I say was done at work as an excuse?EDIT: Wow thanks for all the replies!TLDR: whats a fairly minor procedure with a ~2 week recovery time that I can say I had done instead of a circumcision?  Im a 34 year old male and I have to get circumcised for medical reasons (phimosis and frenuloplasty that didnt work)I have a physical job as a Paramedic, so will be on alternate duties in the office for a couple weeks. Ive done so before with a busted ankle.However Ill be working around people who are medically trained to various levels, and theres always ice breaker conversations about how you ended up in alternate duties. Well Id rather not tell Carol from accounts about my dong, so is there another procedure I could say I had done that isnt as embarrassing?I could say its none of your business or similar, but that might make things awkward and probably make it obvious its dick related.Im thinking of saying an inguinal hernia repair? Seems like a similar recovery time, a bit tender below the belt kinda thing??Any other ideas?Thanks docs!",
  "input": "",
  "output": "Tell people you had macropenis and that you had to have a surgical reduction, since it was just too big."
},
{
  "instruction": "Doesn't HIPPA protect him from having to tell his work anything more than that it's a medical issue",
  "input": "",
  "output": "No, thats not HIPAA. HIPAA prevents healthcare providers from telling anyone at work if they ask. Your employer does have limited rights to information for sick leave and I think most privacy is under the ADA."
},
{
  "instruction": "Yes, that you're having surgery not what the surgery is for.The point was that their job has no right to ask specifics",
  "input": "",
  "output": "No. HIPAA is concerned with covered healthcare entities not disclosing your medical information to other people without your information. It doesn't address your coworkers asking about your surgeries."
},
{
  "instruction": "O I get that but that not the fkn point I'm trying to make.",
  "input": "",
  "output": "HIPAA does NOT protect him from his employer asking about medical conditions. This is more of an ADA issue if anything.HIPAA has nothing at all to do with this situation."
},
{
  "instruction": "It does if they call my doctor to ask. Hippa protect any thing about my health being shared",
  "input": "",
  "output": "HIPAA says your doctor can't disclose that info. It doesn't say they can't call and ask.I can call and ask your doctor. If he tells me, he's committed a HIPAA violation. Not me.HIPAA has nothing to do with OP's responsibility (or lack thereof) to disclose medical information to his employer. Neither are HIPAA bound entities."
},
{
  "instruction": "Inguinal hernia seems like a good excuse. Same region, common in men, not very invasive surgery similar to circumcision",
  "input": "",
  "output": "No, OP doesnt need an explanation, they said as much. But OP also said they would rather have a simple excuse on hand that doesnt raise any eyebrows rather than tell someone its none of their business and invite scrutiny. Some people are more comfortable with that than others."
},
{
  "instruction": "I'm not sure, my dad had one and was advised no heavy lifting for six weeks post op",
  "input": "",
  "output": "I would say testicular torsionNo guy is asking any questions after that"
},
{
  "instruction": "I disagree. If I didnt already know what it was, Id definitely ask what it is haha",
  "input": "",
  "output": "I think hernia is fine"
},
{
  "instruction": "One of my sons had to have surgical repair for penoscrotal webbing, sounds somewhat similar, and I also didnt feel comfortable blasting private details about that around casually. we made similar jokes about it being a penis reduction. But usually I just said he had a urological surgery\/procedure and left it at that. If some asshole really tries to pry about details after that then they deserve the nunya response. Edited to add- he was about a year old when he had surgery, so different in that regard but still not comfortable telling people details about my babys private part situation",
  "input": "",
  "output": "Hernia repair is fine.However honestly if it was me, I would just be up front about it.You're having a medical procedure to correct a problem with your health, and your coworkers are healthcare workers.If carol from accounting gets nosey, just offer to show her before and after photos! (But don't really, because you would totally get in trouble.)"
},
{
  "instruction": "Dont tell them you are getting circumcised. Medical co-workers can be the worst.",
  "input": "",
  "output": "Thats your approach which is fine. But OP made it clear theyd be more comfortable if they just had an easy excuse that doesnt raise eyebrows. OP shouldnt have to explain themselves, but not everyone is comfortable with that.Id go with hernia.Is there a reason why you have to give the info in the first place?\"I'm on alternate duties for medical reasons\" should be more than enough for anyone who isn't your doctor. Honestly \"I'm on alternate duties\" with no further details whatsoever is a complete sentence already.You can say hernia repair if you want, not saying you can't, but it's a bit bizarre to me that you've been put in a position where you feel like you have to reveal more than you wanted to or make something up just for an ice breaker with Carol from Accounting. An ice breaker should be, like, \"what tv shows are you watching recently\" or \"what's your favourite meal\"! Not \"please explain something potentially very personal\"."
},
{
  "instruction": "NAD ... Tell'em you had a hysterectomy, and then grin and walk away.I get that you'll need to say something because people are like that. But it's not up to you to tell. I, personally, head for \"humor\" to shut it down.",
  "input": "",
  "output": "Since this has nothing of an actual repercussion medically, you could try saying something in line of abscess drainage or an excision of lipoma\/sebaceous cyst, etc.,"
},
{
  "instruction": "Honestly, just say that you had to have a procedure done that you'd rather not talk about. I work in the medical field too and I have never had anyone push after saying that.",
  "input": "",
  "output": "Vasectomy, cord lipoma removal.Where I am, hernia repair earns you 4-6 weeks of light duties."
},
{
  "instruction": "respiratory\/co2\/bipap\/desatrespiratory\/co2 retention\/bipap\/desatsHello everyoneI am a caregiver to my 47y male [5'11 155lbs, Caucasian, no alvohil quit smoking in 2020 after 22 years of cigarettes and lots of cannabis, on 60mg sildenafil 3x a day; inhaled treprostinal, b1, Folic acid, vit d, calcium, o2 and temporarily prednisone after hospital] partner with CHF, pulm hypertension, and copd emphysema. DX in 2018. Was put on 3L of o2 24\/7 in 2020 and then May of this year began having frightening symptoms which turned out to be CO2 retention. He's been to the hospital 3x in 5 weeks, been intubated once and on hospital bipap twice. We have our own bipap bit it's part of the philips recall so until we became aware of this co2 problem, we weren't using it. The dr recommended we do as it was riskier without it.However everytime I would put him on it, he would desat 10-15% and hold there. I thought it was the machine, the mask, the toxic fumes from the recall, etc. I have now rented a machine, have a new mask, and when he got out of the hospital o2 sats were good while on it. However its now been 2 weeks, although using it every day and trying to keep him out of the hospital his CO2 has built back up judging by his symptoms.Been trying to use the bipap anyway and just fight to keep o2 sats up, had a mask leak the other day , finally got the new part and it doesn't seem to be leaking anymore but still he desats 30%, it seems like it takes some time (hr , hr and a half) to burn off the first layer of co2 before he can stabilize o2 sats so just been trying to get him over that hump.When o2% drops it seems to get stuck like airway is closed or diaphragm paralyzed! If I crank the o2, sometimes it works to help his sats cycle up, but mostly not. I haven't been able to keep Bipap on more than hhr at a time the last day as it drops under 80, and a couple times under 70. Trying to do some research and my theory was a bronchospasm but his inhalers (prosir snd combivent) and\/or breathing treatment of a Ipratropium bromide\/albuterol seem to make his sats worse than before use.Last night it cycled down to mid 70s on the bipap for the 5th or 6th time but wouldn't come up and I pulled him off, put him back on the cannula. However the spasm continued once he was off it, no matter how much I cranked the o2, it would cycle down to 70s or low 80s and sit there awhile. Then it might cycle up but fall right back down. He was making efforted breaths, with a high respiratory rate. Took ages before this cycle stopped and his o2 sats stabilized in 90s.My question is does this sound like a bronchospasm? Hypopnea? Paralyzed diaphragm? Just recently got a wellue o2 ring and have noticed so me drops to 78% out of nowhere, when he's just sitting and it will hold there for 10-30 seconds and then go up. I've actually noticed on the chart a couple days ago, it happened 3x, almost exactly 10 minutes apart while on bipap so was wondering if it was related to the heart cycle. Don't know if these events are even related\/the same thing.Any insights? I can't keep him on the bipap\/can't get out the co2 when I can't keep his o2 up!! I was gonna leave in the cannula and just hold the bipap mask up to his face tonight so it's easy to remove if o2 starts falling but still may help trigger some deep exhales to blow off co2? Is this a good idea or not? To kind of spot treat without strapping everything on that's difficult to get off, switch over to cannula if sats drop?I'm at the end of my rope, haven't slept more than 1 hr increments for months, i really don't want him going hmback to the hospital they always seem to break something else on him!! The drs cant understand the anount of damage to his lungs for his age\/history. Are there diaphragm exercises to strengthen? Does it sound like a spasm? Any theories or information helps!",
  "input": "",
  "output": "Most likely the oxygen supply is decreased due to high pressures inside the mask during inspiration. Do you have a second oxygen supply and nasal cannula? If so, put on a nasal cannula under the BiPAP mask and run it at 8-15 L\/min. This will help provide a higher amount of oxygen during inspiration."
},
{
  "instruction": "Yeah one of the doctors suggested that, we did try that a couple weeks ago and it didn't help, we didn't have a proper dual ventilation setup so the mask didn't seal as the cannula was in the way. When his CO2 is low he's able to stay above the 90s, even a few days ago when it was high but not too high, as long as I held the mask on when there was a leak he was staying in the 90s but given that this happens desat after the BiPAP is off I feel like there's some other explanation like his lungs are freaking out",
  "input": "",
  "output": "I have to disagree. I would try to find a dual ventilation setup to try."
},
{
  "instruction": "I will try anything but respectfully how do you account for the desat cycle to 70s for an hr and a half after thr bipap is off?",
  "input": "",
  "output": "Could be entirely unrelated to the desaturation when putting the BiPAP on."
},
{
  "instruction": "Yeah I'm wondering that, bc it just happened, just not as long or as low and he hasn't had the bipap on for 12 hrs. I'm wondering if the bipap exacerbates it but there's another issue like diaphragm or bronchospasm.",
  "input": "",
  "output": "I wouldn't think bipap would exacerbate it. I do think there's likely another reason for his desats, like bronchospasm. Not likely a diaphragm problem. Follow up with his doctor."
},
{
  "instruction": "If it is a broncospasm should the Ipratropium bromide\/albuterol nebulizer treatment and\/or proair albuterol inhaler and\/or combivent inhaler (Ipratropium bromide\/salbutamol) make it better or worse? I've read some conflicting things and the neb used to help his o2 sats , I would use it before bipap but now with the heavy co2 , all those treatments seem to make his sats worse by 5%+.",
  "input": "",
  "output": "It should make it better. It sounds like he's needs to see a doctor"
},
{
  "instruction": "I (63m) was diagnosed with ALS about 8 weeks ago. Needless to say, this has been a devastating diagnosis for me and for my spouse. Symptoms started 2 years ago with diffuse cramping, and minor dyspnea upon exertion. The cramping continued, then I developed more dyspnea, and then fine motor skill weakness in left>right hand. An EMG in March of this year showed major motor neuron issues, and the suspected MND was confirmed as ALS by two specialists. I am 5'9, 170 lb. I am on riluzole and Relyvrio, still waiting on the Radicava because the fucking insurance company is taking its sweet time and would probably prefer that I die in the meantime so that they don't have to pay for it. Here's my issue: my main symptom, which has slowly progressed, then more quickly starting in Feb of this year, is respiratory muscle weakness (diaphragm and chest wall muscles). I cannot breathe lying flat, and have to use a BiPap machine at night or I get hypercapnia. I am increasingly fatigued during the day, and often short of breath even just moving around the house or doing simple chores. I can walk a mile slowly, but have to take a break halfway, and it's taxing. I understand from my voluminous reading about this shitty disease that most people die from respiratory failure at the end, and that that is usually the last set of symptoms they get. Respiratory muscle weakness is more rare as a presenting symptom. Given that it's really the first major problem I am having, my fear is that it's going to be the thing that takes me out, and that it could happen rather quickly. I am trying to get my affairs in order, have an advanced directive on file with my PCP and am doing all other estate planning and power of attorney, etc., as fast as I can. I do not want tracheostomy or gastrostomy under any circumstances, I do not want to simply exist hooked up to machines. Quality of life is paramount, and my spouse has agreed to all of my wishes. We do not have children. How will it end when it ends? I am still relatively mobile and can use my limbs and hands, no real issues with voice or swallowing. I imagine that at some point I will simply not be able to breathe any more without the NIV, and that even that will not work at some point. What I am unsure of is what it looks like getting to that point, and what happens when I simply can't breathe any more and an NIV doesn't work. I want to go quietly and easily, without struggle. Do I state that I want continuous deep sedation at some point, and if so, when? Any guidance or feedback at all is welcome.",
  "input": "",
  "output": "One of the worst diseases. I'm so sorry OP.I can promise you that there is no reason you should in any way be suffering physically at the end of life. You will not stop receiving treatment. We cannot treat ALS but we can treat pain, shortness of breath and anxiety\/fear very very effectively. Your ALS neurologist or pulmonologist should be able to put you in touch with a hospice program and I think talking to them may reassure you.Opiates for instance are almost always successful at relieving shortness of breath and pain. Benzodiazepines are sometimes used for anxiety. These are given in doses of whatever you need to be comfortable. With a good hospice plan you should have nothing to worry about as far as untreated symptoms.The setting is also a consideration. Home hospice can be challenging mostly from a care standpoint. Often patients with ALS already have in place a high level of care at home and can stay there with a few hours a day of hospice nursing. If the nursing needs are significant or can't be met, the other option is to choose to do what is called inpatient hospice. This is in a setting that is more like a hotel than a hospital, visitation restrictions are (in general) quite relaxed, and there is 24 hour nursing care. They are very focused on quality end of life treatment.You are dealing with your own mortality and grief. This is more than enough. What you shouldn't be fearful of is feelings of pain or shortness of breath. I suggest meeting with the hospice people in the near future even if you are not yet ready for this. They can answer questions and plan about how you want this to be done."
},
{
  "instruction": "Upper respiratory culture came back and the results are confusing.I am a 33 year old female. Weight: 160 Height: 53 Medications: Modafinil Smoking: Yes, about a pack a day.Was seen at walk in clinic on the 9th of October for what appears to be a Virus. Swollen lymph node on the left side of my face, under my jaw and just to the left of my chin. Sore throat, dry cough, lethargy, headache, muscle pain, and fever that sticks around 101 and comes down occasionally. OTC wasnt really helping. On the fourth day of this now. Chest discomfort started today.Covid pcr came back negative. Rapid strep test came back negative.My upper respiratory culture came back today and these results are what is confusing me. I cannot get a hold of anyone at the clinic who can tell me something so attempting to get an idea of if I should continue to call or if its nothing.This is the only information on the culture.TEST: Upper Respiratory Culture1COLLECTED DATE\/TIME: 10\/9\/22 8:30 PMFINAL REPORT: MANY MIXED RESPIRATORY FLORAINTERPRETIVE DATA: 1ALI Microbiology uses MALDI-TOF mass spectrometry on the Bruker Microflex as its primary method for identifying bacteria and yeast. This test was developed and its performance characteristics determined by ALI. It has not been cleared or approved by the FDA. The laboratory is regulated under CLIA as qualified to perform high-complexity testing. This test is used for clinical purposes. It should not be regarded as investigational or for research.",
  "input": "",
  "output": "Usual disclaimer: no one can provide specific medical advice for a person or condition without an in-person interview and physical examination, and a review of the available medical records and recent and past testing. This comment is for general information purposes only, and not intended to provide medical advice. No physician-patient relationship is implied or established.MANY MIXED RESPIRATORY FLORAThis simply means that the bacteria found in your culture are typical bacteria found in everyone. No predominant pathogen (disease-causing organism) was found.Generally speaking, respiratory cultures of outpatients are not useful. Rarely do they produce actionable information."
},
{
  "instruction": "My asthma is so badly controlled and my specialist isnt giving me other options, is there anything else I can try?Im 28F and Ive tried so many different asthma treatments and I constantly sound like this https:\/\/imgur.com\/a\/RkAF2MC , right now Im having no real bad coughing fits or terrible difficulty breathing, it gets worse but I really dont know what else I can do to just breath normal. This is what Ive tried with my pulmonologistVentolin Symbicort Spirivia Montelukast Xolair (stopped this bc side effects were bad) Dupixent (taking bi weekly)I take prednisone probably once a month at this stage.Ive seen an allergist and use all hypoallergenic products\/bedding etc. I have an air purifier in my room. I wear a mask out doors because of air pollution in the city. Ive tried taking anti histamines and they dont make any difference.I dont or never haved smoked. I try to keep active and live a healthy lifestyle for the most part.What else can I do? My doctors not really giving me any more optionsHonestly all tips or advice is welcome.",
  "input": "",
  "output": "Asthma mimics need to be ruled out (vocal cord dysfunction, tracheobronchomalacia, ABPA, etc). If all else fails there may be some benefit from bronchial thermoplasty (but the overall benefit is somewhat unclear)."
},
{
  "instruction": "Add Chrug strauss syndrome to the list too",
  "input": "",
  "output": "Sarcoidosis as well. Basically needs a full cardiac, pulmonary, and upper airway workup if youre failing this many treatments. I presume they had one if an allergist got Xolair approved, but you never know."
},
{
  "instruction": "How does diaphragmatic breathing differ from typical respiration in an individual without underlying respiratory conditions?To my understanding, the lungs expand and contract as a function of the diaphragm\/transverse abdominals contracting, as well as the contracting of the inner\/outer intercostal muscles. As a musician who plays brass instruments, there is this phrase, \"Breathe with your diaphragm\" that gets passed around quite often, but I never really felt like I fully understood what that means from an anatomical standpoint, because wouldn't that imply that it's possible to breathe without the diaphragm, or that an otherwise normal breath is done without the diaphragm?I am aware of diaphragmatic breathing as a form of physical therapy for individuals with chronic obstructive pulmonary disease, but what benefits, if any, would it offer for an individual without such medical issues?Follow-up, would such exercises expand an individual's vital capacity\/is it possible? I believe a person's TLC cannot be changed. All in all, there is a lot of information about breathing in the world of music education that is shared and taught without citation or concrete scientific basis and I wanted to get to the bottom of it all. Thanks!",
  "input": "",
  "output": "I am not in the world of music but you are correct. Inhalation is done with the diaphragm and accessory muscles as needed. I would guess that breathing with your diaphragm is more of a cue to take a solid expanded chest, stomach out breath as opposed to a weak, chest only inhalation. Again, basically a cue to get maximal amount of air in your lungs.And yeah I think it would be a stretch to say that exercising can increase total lung capacity. Maybe, but I cant imagine it is in any appreciable way."
},
{
  "instruction": "Does routine respiratory flora mean Im strep free?Age: 48Sex: femaleHeight: 5 8Weight: 150Race: whiteDuration of complaint: weekLocation: throatAny existing relevant medical issues: StrepCurrent medications: noneInclude a photo if relevantI was treated for strep but still felt a little sick so I asked for a other culture. The results came back routine respiratory flora. I cant get anyone at One Medical to respond\/explain so I thought Id check here and see if that means Im ok or if something else is going on.",
  "input": "",
  "output": "It means you have the normal bacteria that grow in your mouth. As for whether or not you are improving from strep throat, the culture has no bearing on that."
},
{
  "instruction": "please help, ive been having weird respiratory problems for 10 days and idk whats going on.25f smoker hi, for 10 days ive been coughing up THICK GREEN phelgm and\/or blowing it out of my nose, especially at night. i wake up every 2 hours unable to breath until i clear it out. my throat is also sore at night but just from the phelgm irritation. its so much phelgm i go through 2 boxes of tissues a day. the first day i was sneezing a lot and then my nose was running for a few days and now the last couple days it seems worse, as its turned into a lot more coughing\/occasional wheezing even in the day time. i have a post nasal drip too. sometimes my nose feels clogged and sometimes it feels dry. the mucus production has only increased with time. during the day its not very bad but at night its hell and the mucus is much darker and thicker. im only relatively comfortable if im completely standing. weirdly enough i have no other symptoms like fever or pain. just various respiratory issues. im worried i may have a bacterial infection because it has only gotten worse. what could this be? please helpEDIT: went to urgent care, had bacterial infection, on antibiotics now",
  "input": "",
  "output": "You are having a bad cold my friend, sounds like it might have progressed to sinusitis. This will get better on its own, use decongestants at night, aspirin and lozenges for throat pain."
},
{
  "instruction": "Can anyone recommend some blood pressure medicines that dont cause respiratory issues?Im 25, Male, 6 and weigh 180lbs. Ive been taking Metoprolol since I was 13. I wasnt overweight, no heart defects or anything, just a genetic issue. My usual blood pressure without medication is 150\/100. 25mg of Metoprolol ER brings it down to 120\/80, and when Ive taken it in the past, 10mg of Lisinopril brings it down to 110\/70.Ive always had bad allergies and congestion issues, and recently theyve been getting worse. Im seeing an ENT soon, but before then, I also have an appointment with my primary doctor. I suffer from pretty bad post-nasal drip which causes me to constantly clear my throat. Through research, Ive found that Beta blockers, as well as ACE inhibitors, are prone to cause asthma symptoms, congestion issues, and dry cough. Since my congestion and post nasal drip have become more problematic, Im looking to eliminate anything that might be contributing. Since there are so many different blood pressure medicines, I thought Id ask for some recommendations that are less prone to cause those side effects. So far Im leaning toward Losartan, and Ill be discussing these changes with my doctor this week. Thanks!",
  "input": "",
  "output": "Beta blockers can cause bronchoconstriction in people with asthma. You havent mentioned asthma, just congestion. Those are unrelated problems.ACE inhibitors like lisinopril increase bradykinin, which can produce a dry cough. Again, unrelated to post-nasal drip or congestion.Calcium channel blockers like amlodipine are often first line and dont have any respiratory effects, and ARBs like losartan dont increase bradykinin, so thats reasonable, but it doesnt sound too likely that your problems are related to medications."
},
{
  "instruction": "I previously had an inhaler because I was waking up in the middle of the night not breathing. Did a sleep study and no apnea. I also go through episodes where I feel like theres so much mucus in my throat I cant breathe, but I always attributed that to anxiety.",
  "input": "",
  "output": "At that dose, metoprolol specifically is selective for the receptors in the heart and should not affect your lungs at all. At doses above 100mg\/day is when I'd be concerned. (Other beta-blockers vary in their effect on asthma but metoprolol is a better one).As for Lisinopril I echo what the physician above said. It only causes dry cough and that would usually appear very early on when you take it. No effect on congestion.I personally had bad post nasal drip and congestion. Seeing a specialist helped so I'd suggest waiting for the ENT appointment."
},
{
  "instruction": "Can someone be more prone to respiratory infections?Almost every year without fail, I get an upper respiratory infection. Every spring it starts out seemingly as allergies, an itchy nose and throat, sneezing, etc. then it slowly makes its way down and I get a respiratory infection. I dont know why but it just always happens without fail. One year it got so bad that I started to have fluid buildup in my lungs and had to have a lot of antibiotics. This year its quickly getting bad but I just moved recently so I dont have a doctor, barely productive cough that tastes like blood\/nasty and some chest heaviness along with fatigue and a hoarse voice\/white spots on tonsils.No one else seems to have problems like this, so I was wondering if some people are just more prone to stuff like this? Ive gotten them constantly no matter what environment Im in, and it always quickly gets really bad. Even during my childhood I got them really bad, and I had RSV as a kid. Usually I dont get any answers, its just yeah you have an infection, heres antibiotics.Other than this Im a completely healthy 21 year old female, no existing conditions and no medications other than melatonin.",
  "input": "",
  "output": "Note: I am not a pulmonologist.Having had pneumonia in the past, you are more vulnerable to getting pneumonia recurrently. You might want to consult a pulmonologist to see if there's something else going on. Asthma, chronic bronchitis, reactive airways disease, and a few other less common causes of seasonal\/recurrent respiratory illness might underlie your problem. Also, because you've had recurrent respiratory illnesses, you should get annual flushots and update other immunizations. If you smoke or vape, the best thing you could do is quit. Inhaled substances are not prudent if you are prone to respiratory illnesses."
},
{
  "instruction": "Morphine and breastfeeding21f, in Ontario Canada, breastfeeding a 8 month old. Is there any safe amount of morphine I can take for pain while breastfeeding?",
  "input": "",
  "output": "Morphine is generally safe and has low transfer through breast milk.However, make sure youve maxed out your Tylenol first. 650 mg every six hours can go a long way towards pain relief."
},
{
  "instruction": "Thank you for this! Is 650every six hours the max dose for Tylenol? I do not want to take narcotics but sometimes it seems like the only wait to get the pain to a point I can function.",
  "input": "",
  "output": "Max dose is 1000 mg every six hours, but I think you have diminishing returns after 650 mg. Plus, wouldnt go too much higher with breast feeding."
},
{
  "instruction": "Can I wait this out? I dont want to go to urgent care35F 140lbs. Been having what I assume is an upper respiratory type infection for like 3 days. Coughing up green mucus, from sinuses too. Its thick and sticky. Taking mucinex daily and drinking a lot of water. No fever.My husband insists I go to urgent care because of the green thick mucus situation. I have no fever, can I just wait this out and see if it gets worse in a few days? I dont want to be put on antibiotics by a doctor if its just a virus.",
  "input": "",
  "output": "If only 3 days in and not having fever or really bad facial pain, I have no reason to think that you have a sinus infection instead of just a viral upper respiratory infection. I don't think urgent care is warranted in this situation."
},
{
  "instruction": "No bad facial pain. Just coughing up mucus from the chest. Im assuming from dripping down my throat",
  "input": "",
  "output": "Yep, sounds like a nasty virus. Hydration is going to be key."
},
{
  "instruction": "Ongoing respiratory issuesLast week I started coming down with what felt like a cold. But my chest was aching very bad (under left breast and into back) and was having a hard time breathing. Gave it a few days to sort itself out but it got worse, ended up in the urgent care with a fever, cough , chest pains. Was coughing up brown, green and blood tinged mucus. Did X-ray.. doctor said they saw bronchial cuffing but radiologist stayed X-ray was all clear (confusing..) doc put me on a zpac and Im on day 3 of 5. Im still having chest pain, low grade fever and coughing up blood, and green mucous. I am a smoker and noticed after I smoke I feel horrible with chest pains and sweating.. going to ride it out another day if I am still unwell tomorrow should I go to er for another chest X-ray? Nervous about lung issues\/as a ct scan awhile back showed partially collapsed lung and lung nodules. I dont feel that the antibiotic has been helping Much. Im a 27yo female so I feel Im sort of young for any serious issues",
  "input": "",
  "output": "Another chest x-ray this soon is probably not going to show anything different. Infections take time to clear, at this point I would recommend continuing the antibiotic and waiting. If your symptoms haven't started to improve after the last day of the antibiotic, then consider going back in for a reassessment. Also, smoking really diminishes the lungs ability to fight infections. I would recommend quitting smoking."
},
{
  "instruction": "My neighbor (36M) dropped dead in front of me. I failed to resuscitate him. Hoping to get better understanding of his cause of death.This happened a month ago and Im sorry if this isnt the right place but it was a traumatic event for me and I think having some potential logical explanations might help me move on.My neighbor (who I didnt know at all really) was a 36 year old male, slightly overweight. He worked construction I believe. I was out front of my house when his truck drove down and he kind of pulled into his parking space a bit erratically but I didnt think much of it and was busy with my daughters. After what felt like a couple minutes (but was actually 12 mins according to my security camera), another neighbor screamed and said hes not breathing and asked me for help. I called 911 and immediately helped get him out of his truck and onto his back. He was blue. Me and another man took turns doing chest compressions until rescue arrived. They were able to get a pulse back but he ended up dying a week later.He and his wife had a brand new baby. They dont speak English and so when I asked her what had happened she told me as best she could that it was not a heart attack. That it was respiratory arrest. That he had a form of syncope.I actually have syncope myself (neurocardiogenic syncope and take beta blockers) and didnt want to ask any further questions. Just wondering how such a young guy can go from driving one second to just not breathing the next. As far as I know, my doctors have never told me I might just faint one day and stop breathing as a result. Im guessing this is a different kind of syncope. Just wondering if anyone knows of any possible reasons?Edit: I wasnt expecting so many responses and am so grateful. There are so many potential causes of death I hadnt thought of. Its really moving hearing so many doctors and paramedics share their own stories of losing patients and the emotional ramifications. Thank you. Im going to absolutely pursue counseling.Ive had a couple people message me about his widow and baby. I wanted to update that Ive been doing my best to help them. I got a fair amount of baby gear donated and my husband and I bought her enough groceries for a month as well as a $200 gift card to the grocery store. I also printed photos (which I got from her sister) of him and his baby on archival quality paper and framed them as a gift for them. They were already struggling before he died and both out of work. It seems like since his death, a lot of family has arrived to help her out too.And lastly, it wasnt covid (luckily). Its been a month and I already tested negative.",
  "input": "",
  "output": "Just chiming in to reinforce what has been said. We can't tell you exactly what happened, because we can't know without a lot more information. However, we can say a few things.Seeing someone die is always a hard thing to deal with. The first death we all saw in our careers stay with us, even when doing CPR becomes a routine thing, and if you ask the majority of us we'll be able to tell you what happened in detail, even after quite a few years. It does get easier though, once you realise that the person you were trying to resuscitate needed resuscitation in the first place; they were dying without your intervention and you did all you could to try and change the outcome from what was already going on. In your specific case, the fact that you kept pumping his blood for him well enough for paramedics to get a return to circulation means you did a good job of it.You should consider talking to a counselor about this. It is definitely a big thing to process, and it's normal to struggle with it. We usually get a debrief from our seniors after a death, and getting to talk it over with someone who can help you unpack it all is quite helpful.Also, know that there are various different kinds of syncope, and the kind you have doesn't cause an increase in your risk of sudden death."
},
{
  "instruction": "I cant like this enough.I havent been authorized by the mods of this sub, but I want you to know that every death is a tragedy to medical professionals. Regardless if youre prepared for it or not, its hard to deal with losing someone. Even if you know your patient is terminal, it still hurts to have it end in death.You did everything you could, and MORE than most would do.Im so sorry you had this experience, but please know that you reacted stronger and better than a huge majority of people would.",
  "input": "",
  "output": "every death is a tragedy to medical professionals. Regardless if youre prepared for it or not, its hard to deal with losing someone. Even if you know your patient is terminal, it still hurts to have it end in death.Truth. As an oncologist, I have just grown numb to losing a patient. It still feels like a stab in my heart every time."
},
{
  "instruction": "Hey man, just wanted to let you know that youre a great person for venturing into such a difficult field. Take care of yourself.",
  "input": "",
  "output": "Thank you"
},
{
  "instruction": "That's totally how I felt reading this. OP, you did amazing. I knocked myself out at work last year and all people could do was run around screaming. You were nervous but composed and did an amazing thing keeping him as best as you could until the paramedics arrived.OP, I am really proud of you, not only for your quick action but also for your caring. We can't save everyone but the people who try make me proud to be human.",
  "input": "",
  "output": "Know that you did everything that you could. Don't feel guilty. He might've had cardiac issues that resulted in cardiac arrest. Likewise, things such as OD cannot be ruled out either.When I was a resident, events like this often triggered me to have a meltdown. I'd feel guilty. Why couldn't I have saved that man or woman during that code blue? At the end of the day, we have to realize that death is a part of life. Of course, I learned this over time as a young doctor. Sometimes we cannot resuscitate an individual no matter how hard we try even if there is a crash cart with all the emergency supplies right next to us."
},
{
  "instruction": "I go to therapy once a week for a different reason, but the one thing that helps with closure with traumatic instances is EMDR. Its like what op said, but instead of writing the event out, you work with a therapist and say the event until you feel safer. I always hold these things in my hand, as we go through the event little by little, hell ask me one to ten how do I feel (about what I just talked about) and tell me to just focus on that and well do a set. The thing in my hand (dont know what its called) will start vibrating in my hands (think like hand held massagers that were popular in the 90s ish. Its not big, but it buzzes and vibrates in your hand. Does that make sense?) Its so soothing, and I always feel like I am slightly floating and turning. Absolutely not in a way you would high. Then he would stop and ask what I notice now? I would explain the next part and repeat. When we had to stop for the day (or week, depending how often you went) he would ask 1-10 how I was feeling, do a set and I would gently open my eyes. We would do this until I felt comfortable enough to feel like the incident was more safe in my mind.ETA: I forgot to mention, in the beginning of the session, he would show me a list of emotions and ask which one could best describe my feelings of the event at that moment. Then ask 1-10 of my emotion. We would then do a set before he asked me what I noticed from the event.Every appointment, he would ask if I felt like processing that session. Sometimes you need a break, and thats okay. You still have someone to share anything you feel comfortable sharing who is a third party. He also started the processesing session showing me emotions, asking how I felt 1-10 and I could share starting with the beginning from last session, or where I left off. The whole point is to talk about the event on your terms and process how you need to.",
  "input": "",
  "output": "Realized I havent let myself process what happened.It will take time; don't be afraid to seek help from a therapist. Just know that you did everything right. Thank you.I just wanted to thank you for doing CPR on this guy. You did a good job, it's so important that people try to resuscitate a patient in this situation. Sometimes it wont work depending on the underlying disease. But that's not your fault. You guys did the right thing!"
},
{
  "instruction": "NAD, Im a 911 dispatcher. The fact that EMS was able to get a pulse back means you and your neighbor did the right things and did your absolute best to give him a fighting chance. Unfortunately, sometimes no matter what you do, its not enough and its too late. So many times, cardiac arrest calls we take end with EMS doing CPR until getting to the hospital, and the hospital calling it shortly after. Perhaps your quick action gave his family time to see him a last time and say goodbye. I hope you find peace and comfort... and even just a few sessions of therapy can provide such a huge benefit toward professing things like this.",
  "input": "",
  "output": "Echoing all that was said here.First off, thank you for trying to help. These kind acts keep society alive despite political posturing and divisiveness in social media.As hard as it is to imagine and as difficult it is to go about your routine, inaction would be far more paralyzing. You did everything that you could in his time of need. I have had similar instances in my career in the ED and this same message was relayed to me early in my career: We can only do everything we can do and nothing more. At the end of the day, you gave him a chance. If no one did anything, he would have died. You gave him a chance.I cant speak to exactly what happened, but respiratory arrest is essentially saying that he stopped breathing. That could imply severe asthma, anaphylaxis\/allergic reaction or even cardiac arrest (eg, I had a 42 yo MI in a patient just today). Or pulmonary hypertension.I wouldnt rule out overdose. Narcotic addiction has almost never been higher and is one of the leading cause of death of young people. I pulled someone out of their car unresponsive, cyanotic last week for the exact same reason.I trained in one of the most severe areas of narcotics in the US, Kensington in Philly. Its everywhere and a daily occurance. An opioid addicts life has been replaced with daily struggle to obtain narcotics or suffer debilitating withdrawal that few ever want to experience in their lives ever again. Its said that alcohol withdrawal can kill you; narcotic withdrawal makes you wish you were dead.Fortunately, there is help. Suboxone and other treatments can help to replace their addiction with an extremely safe and effective alternative. Its unfortunate that this happened and likely could have been well known by the family. I have had this converation far too often in my career. Parents who performed CPR on their child as they were holding their grandchild in their lap on christmas morning, the daughter who could no longer struggle and overdosed on every pill in the house and the 15 year old who is going to gift of life after found in the rear of the bus. Family are expecting that someday that they will get a phonecall - they just dont know when.The carfentanyl that is used in place of heroin is deadly for anyone who cant fight their addiction and relapse, only to find that the ford taurus of narcotics was replaced with a tractor-trailer. And its often too late. Methadone can be used, and maybe used by some on the street or for pain control, but its hallmark is that your breathing is stopped often before pain control. And it has some of these cardiac effects that were mentioned regarding hydroxychloroquine.Narcan is a medication that is widely utilized. It reverses their apnea (lack of breathing\/respiratory arrest). But its temporary. Sometimes ingestions can rebound and the effects can wear offI trust that you did everything you can.If this continues to haunt you, in addition to asking your family doctor for a referral to someone to speak to regarding your experience, ask for a prescription for narcan. Even our local libraries carry some. Keep some in your bag. Speak out, see if there are groups in your area that you can support financially or otherwise. Reach out to the family that was involved. Addiction is often a genetic process. Finally, if you have your own kids, be aware that opioid addiction can happen...especially those with addiction tendencies. It can happen with as few as 12 pills.Best of luck. And again - thank you for all that you do!"
},
{
  "instruction": "Its said that alcohol withdrawal can kill youHow can it kill you? That's insane!It can happen with as few as 12 pills.It's seriously that addictive? I was on codeine cough syrup for three months and I had no problem putting the bottle away when my cough was gone. Maybe it helped that I genuinely hated every single thing about it except for the cough relief.",
  "input": "",
  "output": "How can it kill you? That's insane!Since you don't appear to have gotten an answer. Two main ways. Alcohol withdrawal can cause seizures, which can be deadly, and alcohol withdrawal can cause something called delirium tremens. Delirium tremens is more of a form of withdrawal characterized by quick and varying changes in someones heart rate and blood pressure in such a way that it can kill (through irregular heart rate called arrhythmias) or a person can become unable to \"protect their airway\" so to speak and choke.Alcohol withdrawal isn't a pretty thing. BUT the good and bad news is that it varies a lot from person to person.https:\/\/emedicine.medscape.com\/article\/166032-overview"
},
{
  "instruction": "I'm not a doctor so I can't say much on what happened but I went through something similar.An elderly man that walked past my house every day to go to church collapsed in front of my house. I have no idea how long he was there. But I heard a woman screaming for help so I went outside to look. He had no pulse. I gave him chest compressions until ambulance arrived but i knew he was already gone. I could hear air going in and out of his lungs from the chest compressions. I'll never forget that sound and how sad I felt doing it to him when I knew he was gone and feeling his ribs crack. This was 5+ years ago and I still remember it like it was yesterday. I still wonder if i had looked out my window sooner if he would have survived and wonder how long he was there before the woman saw him. I also remember how the fire fighters arrived first and stood around me and told me to keep going rather than take over. It was definitely traumatic.I feel so sorry for your neighbors family. So young and so much life ahead to live.Life really sucks sometimes.I will always remember the experience and it was hard to process at the time but it did get better as time went on.",
  "input": "",
  "output": "This probably doesnt really add anything, but I just want to reiterate, THANK YOU. You did something that is incredibly hard both physically and emotionally. You kept your cool and did what needed to be done, and what each of us hope that someone would do for us or our loved ones. The causes of suddenly death make a long list, and include things like congenital or acquired arrhythmias, vascular issues including aneurysm rupture or clot in the brain or lungs, and among many many others drug overdose which is sadly probably the leading cause in this age group these days. Im sorry that we cant really give you an answer here. As others have said, please seek help if you need it to process this event. Its a trauma and not something that many people have experienced. Remember that you did everything right, there is likely little that would have changed the outcome, and that you helped give his family a week to say goodbye."
},
{
  "instruction": "To respiratory physicians: is length of time of holding breath an indication of lung capacity?Im a 24M, light smoker, on no meds, weighing 71kg at 175cm.For a smoker who is hypersensitive to the effects of smoking on his body, I am often testing my lungs, usually while exercising (swimming), to see how long I am able to hold my breath. Am I making a false conclusion when I see that my ability to hold a longer\/shorter breath correlates to better\/worse lung health?Side note: Ive heard that lung capacity can only deteriorate, and is rather stubborn in improving, or all together impossible.. so what gives?Ps: if there is a better sub to ask this question, please do suggest it!",
  "input": "",
  "output": "The other comments here are correct that breath holding time is not an accurate reflection of total lung capacity (TLC).But to unpack your question a little further, TLC is just one of many variables important in lung health. Chronic lung disease from smoking is predominantly obstructive (COPD), which is measured by a decrease in the forced expiratory volume in 1 second (FEV1), often also expressed as a ratio to the forced vital capacity (FVC), or the total amount of air you can blow out at once.If anything, smokers tend to increase their total lung capacity as their disease progresses because they are trapping air, unable to blow it out."
},
{
  "instruction": "Respiratory sinus arrhythmia or sinus pause ?? EKG (sorta) included20M, 52, 150lbs, hypothyroidism, anxiety disorder, depression, .5mg Xanax, 25mgc levothyroxine, 12.5mg metoprolol 2x dailyHi again !! So I have one of those at home 1-lead ekgs and whenever I do one and take a deep breath I notice my heart rate slows down and it looks like it skips a beat...... can anyone tell me what this is ?? I have a lot of anxiety around my heart and bought the ekg to monitor my heart rate and I know these things arent 100% accurate but this is worrying me. Sorry if this is asking a lot but im not seeing my cardiologist for a couple weeks so could someone tell me what this looks like ? https:\/\/imgur.com\/gallery\/wjuAjvy",
  "input": "",
  "output": "100% normal - this is respiratory sinus arrhythmia. Stop checking."
},
{
  "instruction": "Update to Previous Post Regarding Cough Up Blood After Workout. Results Were SurprisingAge: 31Sex: MHeight: 6'6\"Weight: 250 AthleticRace: White\/CaucasianDuration: 4 1\/2 MonthsLocation: Lungs\/Upper Respiratory, Upper G\/ICurrent Diagnosis: Stage 4 Aggressive Gastro-Intestinal CancerCurrent Meds: Pain Killers, DiureticsAs needed Meds: Lidocaine Patches, Anti-Nausea, Melatonin sleep aidOriginal: https:\/\/www.reddit.com\/r\/AskDocs\/comments\/c2ls61\/chronic_cough_and_now_coughing_up_blood_after\/?utm_medium=android_app&utm_source=shareSo after spending some time at an Urgent Care, getting some scans lined up and trying to be patient, I woke up one morning to pain and compression over my chest. Urgent Care Docs had advised me that any escalation of symptoms should mean I go to the Emergency Room. Once there they almost immediately checked me into the ICU for observation and began running every test you could name. For the next 4\/5 days I did just an unreal number of scans, 2 biopsies, and they drew enough blood to fill a small pool. Pain escalated daily while there so finding a solution was a running theme. So after a lot of trails here's what they found:Current: Stage 4 Aggressive Metastatic Gastrointestinal Cancer ( Adenocarcinoma )Previous: Disseminated Intravascular CoagulationAfter doing a Lymph Node & Bone Marrow Biopsy they found my marrow filled to capacity with dead cancer cells. This pointed them in the right direction. My platelets were crashing daily (20,000 at admission) and I've got inflamed lymph nodes throughout my chest cavity which is one source of my (significant and at time escalating) pain. Its infiltrated my lungs and several vertebrae along my spine (causing vertebrae to show signs of Osteopenia) . Weirdly enough there's no noticeable tumor\/mass\/lump they can trace it back to. It's kind of just spread throughout (described as Adenocarcinoma) , though they were finally able to locate a small ulcer in my stomach that allowed them to finally be able to classify it. I've currently just completed my 3rd (now weekly) round of chemo (we started asap when other options such as clinical trials were deemed a non-option) and we've been able to stabilize a number of things (blood factors such as platelets, hemoglobin and the like) along the way. Many of my blood counts are still in the trash so clinical trails are not currently an option. In early stages of my 3 weeks hospital visit I was in a state called **DIC (**Disseminated Intravascular Coagulation) which caused me to act like something akin to a blood squirt gun if i bled. Essentialy it screws with you clotting factors and any bleeding event is an issue. Any procedure became an issue and many my numbers were artifically raised in order to attempt anything that would cause me to bleed. Fortunately after a week of treatments and what felt like several wheel barrows of infusions we kicked my body out of D.I.C and am more or less clotting normally. Fun story: early one morning after the vampires took their daily does of my blood a CNA came in to do a routine vitals check. This particular morning they took 2 unique sets of blood samples plus a rather large sample for testing against infectious disease. This was also kind of at the height of my \"he's not clotting\" phase. During the blood pressure check it popped open all the fresh holes in my arm, causing them to bleed and freaked\/surprised the CNA. Made me laugh. (end of story). Immunotherapy is what my Oncologist are banking on right now so crossing my fingers. Chemo is causing reasonable progress (numbers are low but stable) so we're staying the course for now. My personal mid->long term goal is to find an alternative to opiates for pain management (who the hell knows why a person tolerates opiates for a buzz cause constipation sucks!!!) so looking at alternatives (THC pills potentially or preferably resolving the issue that's causing me pain) I've been discharged from the hospital after 3 weeks so now I'm working to find a routine that works. Losing weight so a short term goal is stopping that (I'm rather tall and (was) muscular so my bodies nuking whatever calories I put in and I'm not putting in a lot due to general nausea, but smoothies have been my friend. Please let me know if you have any questions or advice.. I'll answer what I can and absorb what reasonable advice I read.",
  "input": "",
  "output": "Man, that was not high on my list of possibilities after your original description. Sorry to hear. Give it hell."
},
{
  "instruction": "Fortunately I do, and they've been a tremendous help. Would have been very difficult without their aid. However , things have mellowed out enough, now that I've been discharged, that most everyone has been able to return to their routines, which is nice. Their support was invaluable but I was eager to get everyone back to their normal lives as well for their own sakes and health.",
  "input": "",
  "output": "Thanks for the update, OP, though I wish it were better news.I will leave this up for now as OP has a specific follow up question regarding pain and symptom management. However, if this thread becomes off topic (including an excess of well wishing in relation to actual advice being given), we will lock it.We all want OP to do well. Stay on topic so we don't bury good advice that may come forward."
},
{
  "instruction": "My significant other's health has sharply deteriorated and after months we have no idea what it is.Hello. My (24F) boyfriend, Paul (29M), and I are fairly active. We go on road trips every year with our main stops being prime hiking spots. Paul is 5'7'' and 230 pounds. Due to his southeast asian\/pacific genetics, his entire family is on the heavier side, but Paul is just as active as I am and eats well.Recently, we have gone long distance. Paul returned to live with his parents due to the pandemic while I stayed where I was. I visited him in June 2021. At this point, Paul had few symptoms, but some new minor health issues. We went hiking around Lake Tahoe and Paul was a little more out of breath than usual. He hasn't needed to use his inhaler since he was a kid, and he had to use it on this trip. We attributed this to recent wildfires in the area and poor air quality.However, Paul's health continued to sharply deteriorate. We went to Edinburgh, Scotland, in July. While hiking Arthur's Seat, Paul had to use his inhaler so many times he emptied it out. He could not get it refilled as we were out of the country. Until the end of the trip, Paul's breathing became more and more labored and he developed a persistent cough.I did not visit Paul August-November 2021. We spoke on the phone and Skyped regularly. During this time, Paul would sometimes leave the call or mute for a few minutes. He'd come back and apologize, saying he'd had to cough pretty violently and didn't want me to hear. I was concerned. I overheard one wracking, moaning coughing session and knew it was not just asthma or an irritated throat. By October 2021, the air quality in his area had greatly improved.I persuaded Paul to visit his general practitioner. His GP dismissed all of his concerns and cited Paul's being fat and asthmatic as the source of his issues, and that the issues would disappear with rest and exercise. I had to fight doctors for years to get them to take my chronic pelvic pain seriously, and was finally diagnosed with an ovarian cyst that was 8mm long and about to burst, so I have experience with self advocacy in the medical space. I helped Paul see new doctors.In mid-October 2021, Paul developed abdominal edema. Paul's feet, legs, and lower stomach were swelling up like crazy. He gained 40 pounds. He could barely move at all, even to go to the bathroom. He couldn't sleep lying down without suffocating, which only worsened his exhaustion. He went to the doctor again and was prescribed diuretics. The diuretics helped with the swelling and extra weight and within 2 weeks he was back to his regular weight, but the coughing and weakness persisted.About a month after regularly taking diuretics (November), Paul started feeling intense nausea on a weekly basis. This nausea would prompt coughing fits. Paul couldn't eat or focus while nauseated. Our calls became more and more infrequent as Paul's nausea and headaches grew. He told me sometimes the nausea would get so bad that he would vomit. There were no patterns to the vomiting--it didn't happen at a certain time of day or after meals. Sometimes it was foamy. He got a CT scan to look at his gall bladder and all results were within normal ranges. Blood tests, including labs for liver function, all came back normal. His doctor referred him to a gastroenterologist for more testing, but due to increases in COVID-19 cases, they haven't even processed his file, let alone scheduled appointments, which would be months out. A nurse anticipated he wouldn't be able to go in until February 2022, but at his rate of decline, this has me concerned for his mental wellbeing and life quality.This week, in late December 2021, I visited him and his family for Christmas. I had heard from Paul about his issues and was following closely with his medical updates, but seeing it firsthand was another thing altogether. I have never seen human suffering and sickness like this up close or cared for another human being in such an intimate way.Every single day, he has intense coughing fits and bouts of nausea where he makes vocalizations and gags, usually every few hours. At least once a day, these coughing fits are so bad that he spends 5-30 minutes vomiting in the sink. The vomiting has increased drastically. After this, the nausea alleviates, but Paul feels exhausted and has migraines. He barely eats. He barely sleeps.Today, he had three different nausea\/coughing bouts that induced vomiting. One developed rapidly and he threw up in a restaurant bathroom. The last one, which just happened this evening as of writing this post, also caught him by surprise, and he vomited in the kitchen sink. The vomiting was so physically taxing that his nose bled profusely and he lost control of his bowels and peed himself. He was not strong enough to make it down the hall to the bathroom. Eventually, I assisted him into the shower. I am writing this before bed, and he is still coughing, and has a migraine. He hasn't gotten up from where he sat after taking the shower.I would appreciate any medical advice about what might be causing what Paul is going through, as well as tips for how to navigate the medical system to ensure this gets treated in the best way possible. I would like to reiterate that while neither of us are marathon running body builders, Paul (before all of this) was physically active and monitored his eating habits. He was also mentally active and had returned to school to pursue a degree in a new field. We both have families that are reasonably well off and are good support systems.Paul is one tough puppy, and reassures me that it \"isn't so bad,\" but after seeing it firsthand, I know this is not something that can continue the way it is. I am extremely worried, and caring for him is beginning to wear on me mentally. Sometimes I feel sympathy nausea when I hear the noises he makes in the bathroom.Please help in any way possible. I appreciate any and every tip, and can provide additional information if needed. Thank you very much.UPDATE 12\/26:We went to the ER at 4 AM right after Christmas. Luckily, it was almost completely empty. I was not allowed to go back with him, so for the entire five hours I was sitting in the waiting room, I was only ever accompanied by one or two other people at a time.Paul's shortness of breath, fatigue, and wracking coughs got him seen quickly. He texted me updates as things progressed. He got every test I wrote down from these comments--BNP test, pulmonary work, chest x rays, GI work. An echocardigram is scheduled for next week.They found out right away that Paul's BNP results were seven times higher than usual. They said this was indicative of heart failure. They also tested Paul for COVID 19. He tested negative, but did test indicating he had some kind of viral illness.Paul's doctor concluded that he was suffering from chronic RSV that was made worse by poor genetics, asthma, and obesity. Paul did confirm he had what felt like a respiratory illness in Scotland in June, then after going to a wedding in October, then this week when he got severely ill and we found out his mother had a cold.There is no cure for RSV, but a vaccine has reached human trials. The only things Paul can do to alleviate his own suffering and avoid a heart attack is to make significant lifestyle changes and live like an immunocompromised person. I believe in his ability to achieve the former, but the latter is more difficult because of his emotionally overattached mother who brings the entire extended family out for lunches, movie nights, shopping, etc. several times a week. I'm concerned she won't take it seriously or will be in denial to avoid feeling responsible and will therefore continue to expose Paul to colds that could kill him.Paul is currently resting. He was given medication for his nausea and a new inhaler. He is doing better but still coughing. We have already started on his new food regimen. I am hoping for the best, but the pandemic has proved that people rarely take precautions for others' goodwill. Thank you for all your support. Paul might never have gone to the ER if I hadn't visited and reached out to this community.",
  "input": "",
  "output": "He needs to go to the emergency department. It sounds like he has some sort of heart failure causing the shortness of breath and swelling. The nausea and vomiting could be anything, though Id be concerned about electrolyte abnormalities or increased intracranial pressure. Heart failure can cause it too but not this severe Id imagineDont have a great answer tying them together thoughThis was pretty much exactly my thought process as well. Hard to tie all of these symptoms together until we start a work up, which should definitely include an Echocardiogram. Go to the emergency department to get started, then will probably need to stay in the hospital until a diagnosis and care plan is made, as well as symptomatic improvement."
},
{
  "instruction": "What about ruling out lung cancer? You dont have to be a smoker or old to get lung cancer and unfortunately Asian\/Pacific islanders are at higher risk?",
  "input": "",
  "output": "Lung cancer is almost unheard of in your 20s. Also none of the symptoms other than cough fit"
},
{
  "instruction": "Disclaimer: Not a doctor.With Paul's history of being active outdoors(I also wonder if he has any pets?), I also wonder if the hospital should be checking for Lyme Disease? Depending on his other symptoms not sure how high up it would be on the differential?I know that coughing is pretty rare in it, but from the sounds of it whatever he's had has been going on for a prolonged period of time, and it kind of sounds similar to this patients story, but also maybe not entirely?I guess it could be something for the OP to ask the doctor about that they're talking with.",
  "input": "",
  "output": "It is something I thought about though I dont know Lyme prevalence in the UK and more importantly Lyme is more associated with heart block than with heart failure. Something worth thinking about though"
},
{
  "instruction": "When you look at intracranial pressure, how does that affect how someone breathes?I know it makes you work harder to breathe but not why.",
  "input": "",
  "output": "Theres the Cushing reflex which makes you breathe shallower but Im not 100% sure the nausea\/vomiting and breathing troubles are relatedGood lord this is a hospital visit.As a physician these symptoms would spark a large battery of tests in my primary care office, but it sounds late for that. He needs to try a hospital. Make sure he tells them exactly what you wrote here."
},
{
  "instruction": "I dont mean to be rude with this question but I know as someone with chronic illnesses I am generally reluctant to go to the ED when they flare up because of the whole history of being told theres nothing doctors can do for me, or its just because Im fat, anxious, whatever. If hes been dismissed by doctors before what should he say now to make sure he actually gets the care he needs?",
  "input": "",
  "output": "Its always hard to say what another doctor saw or thought when someone got care. Miscommunication between providers and patients are extremely common with chronic illness. With flares of chronic illnesses there is often not much that can be done outside of the norm, and brief emergency care is frequently not enough to solve the flare but hospital care is frequently not indicated, which can make one feel very much dismissed.In this case, OPs BF has several huge red flags that suggest he should go to the emergency room for evaluation.Severe worsening nausea and headachesLoss of bowel\/bladder controlProgressive coughing and shortness of breathFluid buildup requiring diuretics (this is VERY unusual and requires a significant evaluation that I dont see written about here)"
},
{
  "instruction": "How can we determine which ER around us is the best\/most advanced? Paul's insurance is considered good (Kaiser Permanente) but his doctors barely listen to him, infrequently order tests, and weren't overly concerned\/in emergency mode over the fluid buildup.",
  "input": "",
  "output": "If he is a Kaiser insured patient he will only be able to seek care at Kaiser facilities. This is a situation of the squeaky wheel getting the grease. He needs to go to the biggest Kaiser in the area and be on his doctors ass every single day until he gets help."
},
{
  "instruction": "There is a Kaiser ER near us. Hopefully they listen.",
  "input": "",
  "output": "Kaiser is generally a good system, but weird things can be harder to diagnose in the system because they are much more conservative in general with testing"
},
{
  "instruction": "Ideally it should be an academic \/ teaching hospital. They're more used to seeing unusual cases and thinking outside of the box.",
  "input": "",
  "output": "This will not be possible with Kaiser insurance, they will simply send him to a Kaiser hospital from the academic hospital ER, and he will get a large bill for it"
},
{
  "instruction": "Im with Kaiser and Ive gone directly to the ER for an emergency by ambulance. I just paid my co pay.",
  "input": "",
  "output": "It can happen, but you cannot be admitted to a non-Kaiser hospital unless you are too unstable for transfer or the Kaiser is on diversion for some reason."
},
{
  "instruction": "I agree. He should go straight to the most advanced ER\/hospital local to him. A lot of things are probably going on.Once the more acute and scary things are sorted out I'd look into a sleep study to find out if he has sleep apnea since it can cause a cascade of serious problems.Also I do not mean to sound insensitive (and of course doing this is a very personal decision) but if obesity is a big problem for him he may want to consider weight loss surgery after he recovers from whatever is going on now. I was obese my entire life, once my health started failing I had gastric bypass surgery and I can't tell you how much it has helped me and probably saved my life.",
  "input": "",
  "output": "I agree he needs urgent evaluation with his worsening symptoms. The differential is broad for his various symptoms and will likely need cardiac, pulmonary and GI workup."
},
{
  "instruction": "The most important part is that - while you may have a list and such, an ER visit isnt going to find the exact diagnosis right there and perform all those tests at your request. The goal of this visit is going to be to assess for any acute abnormalities OR to get him admitted to an internal medicine team that can take the time to work these things out.",
  "input": "",
  "output": "Posts by unflaired users that claim or strongly imply legitimacy by virtue of professional medical experience are not allowed.If you are a medical professional who wishes to become a verified contributor to this subreddit, please message the moderators with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!We do not accept digital forms of identification."
},
{
  "instruction": "As the physicians here have responded, go to ERnow. And please update! Very curious to hear his outcomes. Best of luck to you",
  "input": "",
  "output": "Does he use drugs, specifically marijuana?Food allergies? It would be a bit drastic, and may not explain the swelling, but you can develop them at any time.A bit young for cancers, but maybe he is genetically predisposed, getting at least a CT scan with contrast of his abdomen would be good.This is concerning for his heart too, as mentioned.He needs quick workup, as mentioned. Worrisome is not eating and what his electrolytes are like.Not that being obese is the sole cause of his symptoms, but he should lose weight. Almost every physician you will run into will say this as it is important for his health, just as they would tell him to stop smoking if he was smoking."
},
{
  "instruction": "He doesn't use drugs and has no known food allergies. He was able to eat breakfast today, and so far it hasn't come back up, though he is coughing. I feel overwhelmed by these responses but appreciative. I'm worried about going to the ER because our area is having a huge COVID surge and hospitals are at capacity. Is it safe to wait? Where is best to go?",
  "input": "",
  "output": "As tough as it is right now, you might have to take him for emergency care. If he is coughing\/vomiting so much that he loses control of bodily functions and is unable to eat and generally take care of himself, he should be seen sooner rather than later.Are the headaches coming before or just after the other symptoms? Bad migraines can present with nausea and vomiting, and sometimes neurological complaints, as well.It's hard to tell more without seeing full labs and imaging, again, pointing to getting some answers quicker by going to an ER."
},
{
  "instruction": "They were probably wondering if cannabis hypermesis syndrome could be contributing to ten vomiting",
  "input": "",
  "output": "Yes, cannabis hyperemesis syndrome, or cyclical vomiting syndrome, as mentioned. Usually people who have been smoking daily for while, 10-15 years, but can happen with less."
},
{
  "instruction": "[25m 175lb 61] Post-Concussion Respiratory IssueI suffered a mild to severe concussion on Dec 10th after flipping my car. Jan 13th I began to get sick. I mention this because I know it affects the immune system.So, 1\/13; It started with a sore throat & a lump by my adams apple. For the first week It progressed to wheezing, headaches, extreme fatigue and as much mucus and snot that the body can produce. By Jan 22nd I felt better, but the mucus and sinus pressure was still there. Today is Jan 28th. The past 4 days Ive had mucus that began as lime green color the first two days, and the past 2 days (including today) has been the color of an egg yolk. I also coughed up blood a little while ago today. I have never had a sickness last me this long. Not even covid. Im concerned. What should I do?",
  "input": "",
  "output": "It sounds like you have an upper respiratory tract infection.It could be that your symptoms resolved and you got a second infection.It could be that you've got a bit of congestion or post nasal drip. You can treat this with a mucolytic agent that can help the body break down and clear the mucous.It could be that you've developed a bacterial infection that is taking longer to clear and may require some antibiotics.It is likely that these symptoms have nothing to do with your car accident.Given how long your symptoms have been going for, I'd suggest seeing your GP or PCP for further treatment options."
},
{
  "instruction": "Undiagnosed respiratory illness.32M177cm77kgEuropean whiteI've had an ongoing illness with no diagnosis for 2 years. Main symptoms are respiratory; sore chest, flu-like symptoms, no energy, coughing up blood and mucous, shortness of breath, exhaustion at the slightest of exertion. Numb nose, inflammation all in nose.I've had a CT scan abdominal and there was nothing too abnormal. One thing stated was large lung volume, but no signs of COPD, fibrosis. I also did genetic test with Ancestry which stated I have a significantly increased risk (although stated it could be a mistake) for lung diseases. I would like to know is there any clinical significance to increased lung volumes with no other symptoms? It's just something I am curious of but can't find answers online, like is it a precursor to getting COPD or something. Can someone explain if it means anything?At this stage due to the CT abdo scan coming back mostly normal, I am beginning to suspect some sort of nasal infection, but I would like someone explain to me what increased lung volume could mean, so I can move forward and narrow down my illness and eliminate all other possibilities whilst also understanding what it means.",
  "input": "",
  "output": "There's honestly no real clinical significance to just noting large lung volumes."
},
{
  "instruction": "For 19 days, My wife has had fever and muscle soreness to where I have to help her stand up and get out of bed. She is convinced she is dying. Please help.We have been to the clinic twice since this started but since she has no respiratory problems they did not test for covid. She had a chest x-rayMe and our 1 year old are fine. Wife did not get the flu shot this year so we think it might be related but for 19 days seems outrageous.She has been prescribed antibiotics and tamiflu which she finished two days ago.She gets fevers around 2pm and closer to bed time around 9pm. They've been around 102 on average and peaking at 102.9 a few days ago.We're scared because this hasn't let up for 19 days. Are there side effects if your body stays at fever temperature for long periods of time?Is 19 days unheard of for the flu?? Is it likely something else?31 F 5'9 188 lbs. Caucasian.Taking Tylenol regularly to fight fever and achesUpdate: Wife is in hospital. Thank you for the help.I can't be with her yet. All of our normal sitters and family are either out of town, unavailable or also sick.They would not let us bring the baby in so I'm just home waiting for info. She is at least in good hands.",
  "input": "",
  "output": "She'd almost certainly have a headache though and I see no mention of that."
},
{
  "instruction": "Headache can sometimes manifest as neck pain if its referred pain, I just wouldnt rule out.",
  "input": "",
  "output": "Right, but I've never heard of neck pain without headache. It's referred from the meninges so it'd be very strange to present like that. It's always possible but the likelihood is maybe < 1%? Additionally, symptoms typically start improving within 7-10 days.Any answer on the mono testing? If shes never had mono it can be pretty brutal. Comes with neck pain and fevers for sure."
},
{
  "instruction": "How severe is the neck pain? Look up Kernigs sign. Its a maneuver you can do to test for meningitis. Meningitis is the inflammation of the lining of the spinal cord and meninges in the brain. It can be caused by both virus or bacteria. Shed be positive if she has extreme pain and cant extend past 90. If thats positive, you need to call the doctor\/ED. Also, meningitis can cause a pinpoint rash. If shes darker skinned, you could see it more easily on the palms and soles of the feet. Rashes May also appear with prolonged fever. You can do the tumbler test where you take a clear glass and press it against the rash. If redness goes away when pressed, then its negative. If you can see the rash still through the glass, then its positive. Its sounding more like Mono. If possible, see if the doctor can test. Mono needs to run its course, but it can have some complications. One of them in enlarged spleen, so no sports and if she has sudden upper left abdominal pain go straight to the ER. It also can cause liver issues, so watch out for jaundice which is yellowing if the skin. I hope she starts feeling better soon OP!",
  "input": "",
  "output": "I'd be careful about posting medical advice like you are without fact checking.Kernig's is actually a pretty bad test for meningitis. It has a sensitivity of only 5% and a PPV of 27%. That's pretty awful. I also wouldn't recommend for untrained people to test it on themselves or their loved ones.Not all types of meningitis causes a rash. I believe you're referring to meningococcemia. I think this diagnosis is extremely unlikely as she has been having symptoms for 19 days. She would be dead by now. Symptoms of meningococcemia progress very rapidly. Also, the tumbler test is also a pretty bad test and all it does it to be able to differentiate petechiae from other blanchable rashes. It's not specific to meningococcemia and can also just be done with a finger.\"Prolonged fever\" do not cause rash. I am not sure what you are referring to here. Yes, a lot of diseases that can cause fever are also associated with rashes but it's not the fever itself that leads to a rash.I don't think Mono is likely here. While some of the symptoms would match, it would be unlikely to have persistent fevers for 19 days with simple mono.OP, I believe that at this point a visit to the hospital is warranted if your wife is as impaired as you are describing it."
},
{
  "instruction": "THIS. NAD but same symptoms I had and it was sepsis. I was also sent home from doctor\/ER twice before they realized it. Need to have blood taken for dx (in my case anyway).",
  "input": "",
  "output": "Please read our rule on claiming credentials"
},
{
  "instruction": "I wouldnt worry about COVID right now. As your wife is probably septic and requires urgent care to live and prevent death.Spesis KillsSorry to sound blunt please update us",
  "input": "",
  "output": "This is your final warning on claiming credentials without verification."
},
{
  "instruction": "Ok. Can you please send me the information so I can send through my information. Kind regards Rachelle. Sorry I have never done this before.",
  "input": "",
  "output": "Posts by unflaired users that claim legitimacy by virtue of professional medical experience are not allowed.If you are a medical professional who wishes to become a verified contributor to this subreddit, please message the moderators with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!We do not accept digital forms of identification."
},
{
  "instruction": "Exactly. Ive seen a couple cases like this. Id still recommend for OP to have her checked in the ED. Would rather not miss another explanation such as underlying infection and like others have mentioned possibly sepsis. Id suspect an infectious source will need to be ruled out first as it can then be treated with antibiotics and is more lethal. If nothing is identified from labs\/imaging maybe further pursue labs to rule out rheumatoid arthritis.",
  "input": "",
  "output": "This sounds like it could be mono. It's possible she's septic from various sources but I'd think they would have been ruled out by the clinic you went to.Has she been getting worse or does it seem like she was bad at first and has stayed at that level?What does she doe for work? Has she had any sick contacts?"
},
{
  "instruction": "Can the flu be misdiagnosed as an upper respiratory infection?M14Height: 5'3\"Weight: 145 lbsRace: WhiteComplaint: Very flu like symptoms; fever, aching body, being hot cold hot cold, chills, dry cough, the whole nine yards. Doctor did 15 minute flu test (nose swab) that came back negative and prescribed an inhaler and cough syrup for an upper respiratory infection.Existing medical issues: None to my knowledgeCurrent medicine and doses: Prescribed Fluticasone nasal spray; 2 sprays in each nostril and Poly-tussin liquidSmoke? No but secondhand smoke from parentsDrink? NoRecreational Drugs? NoAny help is greatly appreciated. I am happy to answer any questions.tl;dr Flu symtoms, got diagnosed with upper respiratory infection. Doesn't sound right.",
  "input": "",
  "output": "Flu technically is an upper respiratory infection (in general, though it can cause lower respiratory infections). The false negative rates of the rapid flu swab are pretty low, so while it is theoretically possible, I would just assume that it's true that you do not have the flu. The flu is just one of many, many related illnesses that all act similarly. Our rapid nasal swabs only test for that one specific virus (influenza), but there are tons of other viruses that we cannot rapidly test for and which could cause similar symptoms. You could have parainfluenza, human metapneumovirus, RSV, etc.The treatment is the same for all of them, inhaler, cough syrup, Tylenol\/ibuprofen\/naproxen and time."
},
{
  "instruction": "Ok. Thank you for answering! I do have a question though. How long should I stay out of school? I was planning to not go tomorrow, and have a doctors excuse to go back on the 5th. Is that good or should I stay out longer. A lot of kids have influenza but go anyway and the school won't shut down to prevent infections. On a sort of related note, I had RSV as a baby and have had bad lung function ever since I can remember.",
  "input": "",
  "output": "Just stay out of school until you're feeling better. The 5th sounds reasonable to return. Ideally people would not be in school when they're sick, but the reality is if you're in school you're going to get sick in the winter. Lots of babies have RSV, I don't know that it predisposes you to having it more as a teenager."
},
{
  "instruction": "My dad had an upper respiratory infection and now I am nervous from being around him.Age: 44Sex: MHeight: 6'3Weight: 202lbsRace: WhiteDuration of complaint: NALocation: TennesseeAny existing relevant medical issues: NoCurrent medications: NAMy dad and sister went on a vacation trip to Peru roughly two weeks ago. About a week after returning from the trip he developed runny nose, chest congestion, probably a fever (never took his temp), and a bad cough. He is in his late 60s and already has a weakened immune system from a bone marrow transplant he had a few years ago, so he just chalked it up to the common rhinovirus cold that he seems to get every year. I went to visit him this past weekend (about a week after his symptoms started). He didn't have a fever or anything, but had a pretty bad cough the entire time I was there. All in all, he was healthy and out doing stuff the entire weekend. However, with so much coronavirus in the news, now I find myself contemplating whether or not its POSSIBLE he had it (I havent seen Peru in the news, but ya never know) and if I now possibly have it (I am currently observing no symptoms and was at his house from Friday to Sunday morning). He was not observing very good hygiene protocol with his coughs, and I had to chastise him numerous times for coughing into his hands or not covering up at all. Again, he had zero symptoms at time of visit other than a lingering cough. I guess my question is, should I be dedicating any real estate in my mind right now to worrying about this corona virus? It should be noted that my sister was in close proximity with my dad the entirety of the trip as well as a week after the trip when he started getting symptoms, and she has shown zero signs of anything. With all this panic in the news, I just find myself silently listening or observing my body for the onset of symptoms and its interfering with my daily life.",
  "input": "",
  "output": "You do not need to worry about 2019-nCov at all. There have only been 2 imported cases in Brazil and 1 imported case in Ecuador in all of Latin America. Even if there had been cases in Peru, the odds of him coming into contact with it would be very slim, and the Futher odds of you being at any sort of risk would be neglegible.Stop panicking about this, and get your flu shot every year."
},
{
  "instruction": "81 y\/o female- respiratory distressMy grandmother got pneumonia this time last year. Currently she is achy, having trouble speaking, her throat hurts very bad. We went to the Doctor a few days ago, they took an X-ray of her lungs and said there was one area with fluid they wanted to keep an eye on but werent too worrisome. Today I call her and she can barely speak and is wheezing while breathing. Do we need to go to the emergency room?",
  "input": "",
  "output": "Yup"
},
{
  "instruction": "Post-Respiratory Illness - Cardio -- persistent elevated heart rateI have been sick with a respiratory illness for several weeks. I tested negative for the flu, the doc didn't think it was COVID-19 and would not test me. I have been on several antibiotics and I take the last dose tomorrow. It was mostly chest tightness and inflammation. I felt better today so I went for a run. I shortened the distance and intensity by half.About an hour after my run, my heart rate spiked to 99 bpm and my hands began trembling . It's varied this evening between 80-120 bpm all night at rest. My baseline is around 66 bpm. I have tested my temperature several times - no fever.Could this be something serious? It has me a bit concerned. Thank you41M5\"10180 lbsSmoke (occasionally)Duration - 6 hours",
  "input": "",
  "output": "No way for us on here to tell you wholeheartedly whether this is serious or not. If it is bothering you then it is serious. Does this typically happen when you run? Cause I know for a fact when I run my heart rate shoots up as well. Very normal for this during physical activity. I would recommend stopping smoking if you are worried of respiratory illness."
},
{
  "instruction": "Acute Respiratory Failure from strong scentsAge27SexMaleHeight194cmWeight104kg 14% BodyfatRaceCaucasian, Irish\/DanishDuration of complaintLifelongLocation (Geographic and on body)Ontario Canada. Lungs, esophagus?Any existing relevant medical issues (if any)AsthmaticCurrent medications (if any)Salbutamol Turbuhaler, Ventolin, FloventInclude a photo if relevant (skin condition for example)N\/AThis question is going to be short, and concise; with examples.When a strong smell is present, my airway cuts out completely. I have theorized that it it may have something to do with what I call \"thick air\".Examples: Diesel exhaust scent, frying greasy or oily things, the smell of certain algae (like near a pond), occasionally with foul smells (this will seem odd, but it's innocent in my exposure((a day old corpse, animal or otherwise)).It's not particularly tied to smoke, cigarette smoke does not bother me, and I use an E-Cigarette. This has been something I've dealt with my entire life. It is quite painful when my airways suddenly close, and I can only breathe again when I place a cloth over my mouth (if the scent is still present) or move to fresh air. My doctor has told me he thinks it's something called laryngospasm, but this doesn't seem exclusively correct, as from my understanding, this is caused by your vocal chords... and that doesn't quite make sense to me.Edit: I should mention that once I am able to breathe, I typically uncontrollably cough, and sometimes vomit because of my coughs.",
  "input": "",
  "output": "Throat tension, hoarseness, and\/or voice changes shortly before, during, or shortly after these episodes?My first thought is along the lines of your docs. Look up vocal cord dysfunction or paradoxical vocal cord motion and see how well that matches your experience.(Edit: also, Id not consider this acute respiratory failure unless you became hypoxemic\/needed supplemental oxygen or needed to be mechanically ventilated in some way. These things can happen due to vocal cord dysfunction in fairly severe cases of it)"
},
{
  "instruction": "Tension and Hoarseness, definitely. My voice becomes gravely and it tends to hurt to speak.Only one instance a few weeks ago, I couldn't get fresh air and from what I've been told, I blacked out. That was strangely because of some smells from a Kernels popcorn stand.I apologize for the mis-identified title. I understand the difference now. Thank you for your response!",
  "input": "",
  "output": "I see laryngospasm occasionally in my clinical practice, and one is usually unable to breath to the point of turning blue. It occurs when a physical substance tickles your vocal cords: saliva, blood, water while drowning, etc.. not generally fumes. Rarely lasts more then a minute.What you're describing sounds closer to bronchospasm for which you're at high risk: asthma, smoker (yes I know it's e-cig... It doesn't make it harmless : https:\/\/www.ncbi.nlm.nih.gov\/m\/pubmed\/29847989\/). My advise is to get better control of your asthma depending on the frequency of these symptoms and, well, you know this is coming: stop smoking. For standard cigarettes smokers, it can take 2 months for your body hyperreactivity to return to normal, not sure what the data says for e-cigs."
},
{
  "instruction": "How can I avoid respiratory problems with the flu shot?I know the importance of getting my flu shot, so I intend to get it. However, I always get breathing problems accompanied by dizziness and fatigue for a couple days after getting my shot. It presents the day after the shot, not the day of, so I don't think it's an allergic reaction. I guess it's just my immune system freaking out. Anyways, is there a way to avoid the respiratory issues, or should I just get my shot on a Friday so I can let everything play out over the weekend?22F, 5'2, 120lbs, no meds, generally healthyThanks!",
  "input": "",
  "output": "This could be an allergic reaction, although it doesn't sound typical. It's worth discussing with your doctor before getting the shot. Some people shouldn't get the flu shot, it's possible you're one of them.If it's not an allergic reaction then I don't have a good alternative explanation. I would suggest Tylenol and rest."
},
{
  "instruction": "If it's an allergic reaction, do you think taking Benadryl would work?",
  "input": "",
  "output": "Maybe, but then you would be even more tired. Better to know for sure than guess."
},
{
  "instruction": "UPDATE: [26F] recommended for termination of pregnancy in a country where I don't speak the languageOriginal post here: https:\/\/www.reddit.com\/r\/AskDocs\/comments\/ici7ez\/26f_recommended_for_termination_of_pregnancy_in_a\/First of all I want to say thank you, thank you, thank you not only to the physicians who responded but also to everyone who upvoted and comment-bumped me for visibility. Obviously the physician responses helped on the medical end, but the simple comment bumps helped so much emotionally. I'm in this country without family (except for my husband and toddler) and sometimes it honestly gets really lonely so having even the tiniest bit of online support meant the world to me. I even want to thank the user who posted anti-semitic comments because your comment specifically helped this hella Jewish woman connect with other Jewish women on this forum who offered hands-on support, validation, and rescoures.I had a meeting with the specialists in the termination committee today and they diagnosed the pregnancy with cystic hygroma in addition to other serious physical (nasal, respiratory, heart) malformations that would make the fetus 100% incompatible with life. They made it pretty dang clear that I could basically miscarry at any moment, which sounds about right to me as a layman given all this info. We asked about genetic testing\/probability of this happening again and they said it's very unlikely, the occurrence of this situation is less than one percent overall. So I've decided to forgo any additional testing like CVS or amniocentesis as a chromosomal defect would just be another issue on the list and not a defining factor in my choice.So unless nature takes it course, I'm scheduled for an inpatient termination this coming Monday. I can't really find anything online about inpatient terminations, but they gave me the choice and explained that the outpatient procedure would be started with dilation by osmotic dilators and move quickly while the inpatient procedure would use slow, supervised dilation with less trauma over 48 hours. I'm not 100% sure if they meant physical trauma or emotional trauma, as they mentioned some people find it very uncomfortable and impeding (especially with childcare) to do the outpatient dilation and return to the hospital for the procedure. I'd read about osmotic dilation earlier and it really freaked me out so I was super happy to have this previously unknown option offered.I'm feeling a lot more secure after hearing from everyone in this community, my doctor, and today's specialists. I never in a million years thought I'd be terminating a wanted pregnancy for any reason but I still have thousands and thousands of chances to have another baby just waiting in my ovaries so I'm going to focus on that and also on my toddler who is already my whole world. And I'm thankful in that I've experienced this and can hopefully help women who are in this situation in the future. Thanks everybody!*Edit just to add that all the doctors and social workers on the committee and at the hospital we went to spoke near perfect English which was a great relief for me and we did not have to spend money we don't have on an interpreter.*Later edit to update that the genetic blood test came back early and indicated 1:5 for down syndrome and trisomy 18.",
  "input": "",
  "output": "I'm glad you got the answers you needed.Regarding the inpatient termination if you are wanting clarification I think it would be which route are you going:will you receive osmotic and\/or chemical dilators and then go on to have an evacuation procedure?will you receive osmotic and\/or chemical dilators and then go on to have an induced delivery? Just an fyi with this, people not infrequently require manual removal of the placenta, so they end up having the 'evacuation' portion anyhow (but it would just be the placenta).Both are safe. Some \"feel better\" about the second option because they feel like they are just inducing labor rather than actually \"terminating\". Fetuses in general, but especially a compromised one, have high rates of passing before delivery anyhow though.Also, you could choose to have genetic testing of any remains (and not do CVS or amniocentesis). But it is one of those things where it's optional and it may not truly change anything for you. This being said, many people like having a more solid answer.Good luck with everything. You have very good odds of having normal babies in the future."
},
{
  "instruction": "From what I understand, I'd be going route 1 with chemical dilators and then the evac. The chemical dilators seems to be their reason for inpatient treatment though and honestly I'm fine with 1 or 2 in that case. Something about the osmotic course just innately makes me uncomfortable. Buuuut if I'm being super duper honest, I'm fine with anything inpatient because I just want the time and space to decompress about it all without the stress of toddler, chores, work, etc. But yes we asked about genetic testing of the remains too but the specialists said they'd only show \"academic\" results and nothing impactful after the fact or for the future. My husband and I are both just really onwards and upwards kind of people so if the doctors don't need it after the fact and say everything's okay, then it's okay for us. I wish I had the rescoures to gild your posts for the rest of forever, you really deserve it! I'm so truly thankful for all of your responses you have no idea.*Edit to add that I did however have the basic chromosomal blood test done that goes hand in hand with the nuchal translucency, so if anything comes back abnormal with that I will of course satisfy any curiosity with an update here!",
  "input": "",
  "output": "I did however have the basic chromosomal blood test doneThat test is pretty accurate so that should likely give you the information you need. Good luck with everything."
},
{
  "instruction": "NAD, but a nurse and in general was worried for you! Glad to see your update! Im sorry you are feeling so isolated, but glad you found resources! Hang in there.",
  "input": "",
  "output": "I'm locking your thread since you don't seem to have additional questions. Thank you for the update though, and we wish you all the best."
},
{
  "instruction": "30F, 55kg, 160cm, Asian, Singapore, upper respiratory tract infectionLong story short, somebody i know was diagnosed with upper respiratory tract infection bu a licensed doctor, 2 night ago. Her symptoms were cough, fever (38 degrees), headache and muscle aches. No runny nose. She refused all the medication provided by the doctor. The doctor gave her 1 day sick leave.Last night, about 24hrs after the initial diagnosis, she claimed that she has been hospitalised for her illness. Is this possible? Isn't \"upper respiratory infection\" just a fancy term for a common cold?",
  "input": "",
  "output": "We will not be able to tell you if your acquaintance was hospitalized, as that seems to be your question."
},
{
  "instruction": "Alkaline \"medicine water\" healing reflux, colitis and upper respiratory infections.In my country (Hungary) we have this medicine water called Salvus which is drawn from a thermal bath. It has bold claim such as healing GERD, colitis, upper respiratory infections while also treating diabetes and peptic ulcers.I 31M have GERD and my doctor switched me off of PPI's to Salvus water and a low dose of famotidine. Since then I have pretty much non-stop diarrhea and my heartburn got much worse.My question, based on the ingredients, is this medicine water bullshit?Ingredients (mg\/l):- Sodium: 5800- Lithium: 2.0- Chlorid: 2020- Bromide: 13.9- Iodide: 2.08- Fluoride: 3.0- Hydrogen-carbonate: 12810",
  "input": "",
  "output": "Surprised a doctor is scamming you. Is it a real doctor? Alkaline water is a scam. Go back on the PPI."
},
{
  "instruction": "Heart rate increases every time I inhale. Respiratory sinus arrhythmia.Male, 27. 70kg. Relatively healthy, I do running and hit the gym.Is it normal? Does everyone have this?",
  "input": "",
  "output": "Very normal. Nothing to worry about."
},
{
  "instruction": "Respiratory restrictive pattern, unknown cause please help.I am 21 years old male.I have started having bad shortness of breath the past 4 months. I have seen so many doctors and this is the results so far.The originally test to prove there is something going on is the respiratory function test, I cant interpret all the results but the pulmologist said my breathing shows a restrictive pattern with 65% of expected lung capacity and velocity. This test has been repeated every month with similar results. Gas transfer was 95-100% not indicating lung disease.Got a ct scan of chest with dye to rule out lung disease or to see if anything else is on my lungs but it came back clear other than enlarged thymus gland.They thought it might be respritory muscle weakness although the neurologist said unlikely as when I am lying down the respiratory test shows similar results as to standing.Cardiac possibilities cleared by cardiologist.The cardiologist, pulmologist and neurologist are at a loss and have determined to just hope it doesnt get worse. Please help.",
  "input": "",
  "output": "Restrictive pattern on PFTs essentially fall into three categories, unfortunately you've had them all investigated. It can be the lungs themselves (i.e. fibrosis, or stiff lungs), chest wall noncompliance (think of terrible scoliosis, severe obesity, etc), or neuromuscular disease. The first two are typically pretty easy to diagnose, neuromuscular disease can be very difficult. There is no gold standard for how to determine if restriction is related to neuromuscular disease, but the sitting\/supine spirometry is often done as one piece of data (as it appears you have done).Have you done a MIP\/MEP (maximal inspiratory pressure and maximal expiratory pressure)? A low MIP tends to indicate diaphragmatic problems, and a low MEP indicates problems with chest wall strength. Like the sitting\/supine spirometry, these must be interpreted with caution, as they are not truly gold standard for anything.If all else fails, there is always the Cardiopulmonary Exercise Test (CPET). It's basically a test that measures your heart and lung function through maximal exercise to determine where exercise intolerance may be coming from. It's not always available in all places and can be very difficult to interpret.All in all, with your story I would put my money on a neuromuscular issue. I think the neurologist ruling it out based on the positional spirometry alone is premature. Bring up the MIP\/MEP and CPET to your pulmonologist and see what he\/she thinks.Mind if I ask where you are being evaluated? You would likely benefit from going to a tertiary care center, such as affiliated with an academic or university medical center. Depending on where you are located I could suggest some places to find docs who'd be interested in you."
},
{
  "instruction": "Can visual processing issues stem from 1) respiratory infection or 2) stress and anxiety?I am 30F, relatively active lifestyle, diagnosed with ADHD and treating it using Vyvanse and regular therapy.I am on the tail end of a two-week cold. Still have a bit of congestion and fatigue but no sore throat or cough etc.Something I've noticed over the past couple weeks\/in the past is that I feel like I have difficulty processing visual information. E.g. if I'm walking in a forest, the amount of visual information seems overwhelming. I can't really \"see\" what's in front of my unless I really stop and focus on one thing at a time.My last eye tests showed I had 20\/20 vision and I have no issues reading on screens or seeing things far away, it's just that when I'm presented with a lot of visual information, I have issues processing it all.I've also notice this happen in the past when I've had depressive episodes. Does this sound like an actual issue with my eyes, or could it be linked to my mental state?",
  "input": "",
  "output": "Simple answer is yes. Fatigue and illness affect sensory processing and cognition, usually transiently. That's a good thing, since it forces you to rest, slow down, let your body recover. The more complicated question is whether there's something different about your experiences as compared to people without neurodivergent states.Your description suggests that you might have visual snow, though maybe you are just overwhelmed with information during higher stress?"
},
{
  "instruction": "Muscle, Respiratory, Heart, and Mobility problems: Is this just obesity or something more?I am 29 y\/o , 6ft even, and probably 400lbs easy, probably more, i can't afford a scale so idk.For about a year up until March when my job shut down for 7 weeks, i was very capable of doing the physically demanding work at the Auto Plant i worked at.. I was not fit, but it was doable for me. During shutdown from Covid, I started to notice that moving became harder and harder. My lower back would struggle to stay up and that caused breathing to get harder, which caused the heart rate to skyrocket. It eventually progressed to the point of complete muscle failure after about 50 feet of walking.When I got back to my job, I collapsed in front of my supervisor and his boss. Everybody freaked out and I was forced to go home and get tested for Covid 19. It was negative. Even when coming back after a few days out, however, I still could not walk more than 50 feet without sitting and gasping for air with the muscles in my back completely giving out causing collapse.Now I cannot even mow my lawn completely without resting 3 times. It is a tiny lawn that my roommate mows in about 10 minutes. It takes me 30-40 minutes with resting.I cannot walk 50 feet without gasping for air, I have regular heart palpitations, there are huge numb patches in my legs (oval shaped, upper thigh above the knee on the front of the leg), I cannot sleep more than 40 minutes to an hour at a time, and when walking I feel like I ran a marathon when it is only trivial distances. (heart rate, breathing troubles, back and leg muscle failure)Lastly, this morning at 4:30 am up until about 8:00am, I had these horrible feelings of doom, despair, anxiety, and panic, all wrapped up into one horrific attack for those many hours. Along with this, my heart rate was so high I literally almost called 911 many times.In the opinion of the people in this thread, are my issues likely 100% obesity related, or could there be something neurological going on in my back and legs as well? I dont know when the numb patches in each leg started.I'm scared of death, so I'm making what life changes I can (eating better, cutting caffeine down to reasonable levels of moderation, etc) but this is preventing me from functioning as a human being. I do not have insurance so I dont know what to do. I probably need to see a cardiologist, neurologist, or some sort of skilled orthopedic person. Please help, reddit. I dont want to die. I have dreams of owning my own I.T. business for security consulting.If more information would help, please please please ask and I will be 100% open about everything. I'm trying to change my life and contribute to society. I'm hoping to not have to go on disability or anything like that. My father was upper executive branch of a major telecommunications company so I hope to do something that would make him proud as he watches me from the heavens.",
  "input": "",
  "output": "Do you smoke?Obesity can cause a great deal of damage. Think how much more your heart has to pump. Think of your belly compressing your lungs decreasing how much they expand making it difficult to breath. Think of the extra weight your back has to carry. These are just a few things. I know this sounds tough and maybe harsh but Im saying it because Im confident you can make changes. Youre young and if you put in the work, you can definitely make changes. There are many free resources online.From the sounds of it, you might be having some heart failure symptoms. Do you have any swelling in your legs? I say find a PCP. Get worked up and get the studies you need. Maybe start off with an EKG and some labs and go from there. You might need an ultrasound of your heart if your PCP recommends it.Biggest recommendation I can make is lose weight by changing your diet. Preferably something you can live with whether its intermittent fasting or the Mediterranean diet or whatever.You got this"
},
{
  "instruction": "I do not smoke, and actually had an EKG at the Emergency Room today which came back normal. Could a normal EKG mean heart failure is off the table? Your positive words mean the world to me, friend.",
  "input": "",
  "output": "Well, heart failure is a clinical diagnosis. An EKG may help but doesnt give you the answer. For example the EKG can tell you there might have been a heart attack or signs of decreased oxygen or clue you in that one side of the heart is enlarged but thats about it.We usually use a combination of symptoms and labs to say someone has heart failure. Again, your PCP will be able to help. Again there are a few diet threads on here were guys your size have dropped a bit of weight."
},
{
  "instruction": "Here is an image of what they actually did test wise https:\/\/i.imgur.com\/7fMucgv.png. I have covered all identifying information as well as the weight because I am embarrassed. They checked my blood for Diabetes i guess and said that while my pancreas is compensating and I'm not even pre-diabetic, I do need to stick to the positive life changes I've implemented. If you have time to look at that image, would any of those tests have revealed the existence of Heart Failure?",
  "input": "",
  "output": "No. A proBNP would be helpful and if youve had recent leg swelling that would also be helpful. Otherwise seems like everything looks good from this numbers"
},
{
  "instruction": "51F (pulmonary) under what circumstances should I take mom to the ER? She has chronic respiratory failure - hypoxia of unknown origin being worked up - but over past 3 days she's gotten worse51F, 59, very thin, getting thinner fast, white, USA. non-smoker, non-drinker; no prescriptions. On supplemental oxygen for chronic respiratory failure - hypoxia. Undergoing workup to figure out whats wrong but its taking taking forever. (This is for my mom.) (x-post)Very long story short: formerly vibrantly healthy moms been deteriorating since January. Shes lost over 25lbs since then, has been having daily oxygen desaturations down to as low as 80 whenever she started walking for months and is now on supplemental oxygen. Exhaustive pulmonary testing (including RHC and shunt studies) and cardiac testing (echo with bubble study) all inexplicably normal. The doctors are puzzled, as you can imagine. She looks awful. She does have a few \"good\" hours in the morning, but it slowly diminished til afternoons she crashed. As of now, \"good\" morning hours aren't lasting as long and she's crashing earlier in the day when she hits a wall, becomes totally sapped of energy, becomes very weak.At first her oxygen only went down when she was up and about and moving, down as low as 80, thats when she got the order for supplemental oxygen. But past 3 days, it's going down much more often, even at rest. (But it IS intermittent, not constant.)Heres why Im here today seeking advice: What would be a scenario that would mean we should take her to the ER? As of the past 3 days shes feeling worse, now has oxygen desats at rest, and it also is dipping down more and more often than ever before, and something very new - her heart rate keeps dipping a few times a day down into the 50s and occasional 40s (not necessarily when her oxygen is low - sometimes yes thats the case, sometimes when shes on oxygen it happens too. In the past few evenings shes been having severe shortness of breath even when her oxygen is at 100. Although shes been ill for months w\/no answers yet, these worsening signs and symptoms have only been happening for about 3 days.Blessed to live in a city with a nationally known excellent medical center. The head of one of the lung hospital lung centers shes been seeing wants her to come back in to see him again for further investigation since the last study (shunt) was normal and they still dont know whats wrong (what the hell else can they test for???), but that conversation with him was last Thursday, before things suddenly got even worse on Friday til now - and who knows when that appt will happen. He's in high demand of course.In the meantime were in a holding pattern, so please can someone give advice on if there are certain signs or symptoms that would trigger us to take her to the ER?",
  "input": "",
  "output": "The desaturations at rest are concerning, it would be reasonable to take her into the emergency room now. Given your post it seems that she would have very poor reserves, so if things worsen even a little bit she may have profound effects.Another option is to get ahold of her pulmonologist or the person whom is on call for the clinic. He\/she would be able to give a more informed opinion based on her unique situation."
},
{
  "instruction": "Thank you so much. I begged her to let me take her to the ER last night, it was pretty bad - but she refused - she said she'd \"feel stupid\" since her oxygen\/heart rate go back up to normal in between the bad episodes and she \"doesn't want to waste their time.\" With your advice I think she will listen (she appreciates my asking things here).With her permission I reached out to her regular long-time pulmonologist via her patient portal to ask if she should come in to see him soon. I did mention the low heart rate in that message. Hopefully will hear back soon. If her heart rate goes down that low again I'll remind her of an actual physician's advice (thank you thank you!) and she will listen.",
  "input": "",
  "output": "Assure your mother that she's not wasting anyone's time! Also, it's not her job to know if something is an emergency, s it's okay to go the ER and find out everything is fine."
},
{
  "instruction": "I have an upper respiratory infection. Been to the doctor for it. When will it end? It's been 8 days now.25f, 120lb, white, asthmaticI was tested twice for COVID and both came back negative. When it got worse the doctor gave me 4 days of steroids to take, cough medicine, and mucinex.Day 1-3: bad congestion, fatigue, sore throat, voice loss Day 4-7: began coughing. Had to increase use of my rescue inhaler Day 8: began to cough up disgusting green phlegm.Does the green phlegm mean I'm near the end? Or that I should go back in?",
  "input": "",
  "output": "Probably just a viral cold that needs to run its course which is usually 10 days - 2 weeks. I would add some Sudafed\/flonase for your congestion. Hopefully you start feeling better soon."
},
{
  "instruction": "38 yr old femaleHistory of bronchitis\/pneumoniaI was recently babysitting my nephews who were unknowingly sick with an upper respiratory infection both have been tested for coronavirus several times coming back negative. However, in the meantime I got the upper respiratory infection also. Unfortunately, I have a very long, bad history of bronchitis\/pneumonia with a hospital stay of two weeks in 2019 with double pneumonia and only an inch of air flow. So my question is how long does congestion last before I should be concerned? I've had this cold since last weekend. I'm on amoxicillin, my inhaler, Albuterol, nose spray etc. But still congested and wheezing but no fever or chest tightness. The congestion however has not improved should I be concerned?",
  "input": "",
  "output": "Assume you've got tested?Most URTIs are viral so I'm not surprised if its not improving quickly with antibiotics, likely they will do nothing."
},
{
  "instruction": "I haven't been tested because my nephews came back negative and they were the only people I've seen. Also, if I'm not improving on antibiotics what do you suggest? Er visit PCP visit? Just wait it out? My chest congestion and wheeze is bad but I'm not running a fever, no chest tightness, I'm not getting worse but at the same time I'm not improving.",
  "input": "",
  "output": "You need to isolate and test regardless.No, congestion is normal with a viral URTI and doesn't usually need a doctors visit, you can self manage at home. If it is not improving over time or worsening yes definitely."
},
{
  "instruction": "what is wrong with me? respiratory problems and oedema doctors baffled need ideashi I know this is a long shot and I'm not looking for a replacement for a diagnosis by a \"real life\" doctor - I have been having a long series of tests and scans etc etc and been in and out of hospital for months. It's just a matter of curiosity really.I became ill with what I thought was asthma in roughly june last year. It started with terrible chest pain that I woke up with and called an ambulance when I was no better after 4 hours. The pain was roughly central and felt like I'd been kicked by a horse and I was very short of breath. In hospital my O2 was measured at 71% which they blamed on my smoking habit. I had an x ray and ecg and everything seemed fine.I went home and continued to have terrible breathing problems which I thought was asthma for about a month before I was referred to minor injuries by my GP. They did an x ray and freaked out and got all the students to listen to them tapping my chest because one side was almost completely full of fluid. I got rushed to hospital in an ambulance and admitted. I had a chest drain put in and then had to go to a specialist hospital to have a heart drain put in as I had fluid on both lungs and around my heart. After a couple of weeks I was allowed to go home.Unfortunately the problem has persisted and I've been in hospital 3 times now, with my chest no better. I also had a.broken rib which I think was the result of coughing after I caught a cold at christmas. That's healed up now but I still have swollen legs and a swollen tummy and trouble breathing that has me gasping after a few steps. I'm on a diuretic for the swelling and it's been increased twice.I've had all sorts of scans, x rays, blood tests, ecgs, and most recently had a broncoscopy with a fine needle aspiration biopsy of swollen lymph nodes in my lungs. None of the tests have shown anything and the consultant says he is baffled and they are going to have a meeting about me. I have to go back in to hospital soon for a few days to have my chest drained and a thoracoscopy (?) - camera between my ribs and a biopsy.I've given up smoking but it hasn't helped. My O2 isn't as bad as it was in june\/july though - tends to be high 80s or low 90s. I also hit menopause at the exact same time that my health took a nosedive and haven't had a period since june '22. I was also diagnosed with diabetes type 2 and high cholesterol when I was hospitalised in august and have been taking medication for that.So far tests have been negative for cancer but he says it can't be entirely ruled out.Does anyone have any insight at all or any ideas as to what might be wrong with me?age 51sex femalerace whiteweight 230lbslocation ukdiagnoses: schizoaffective, type 2 diabetes, asthma, high cholesterol, bilateral pleural effusion and cardiac effusionmeds: furosemide (? diuretic tablets), statin, a tablet for diabetes that is supposed to increase insulin after meals, folic acid, salbutamol inhaler. Supposed to be taking metformin but it makes me have an upset tummy and I found that difficult as I am living in a hotel at the moment and don't want to have an accident so I haven't been taking it. Up until august last year I was on paliperidone injections 75mg (invega) for schizoaffective disorder but they stopped those in case it was making me ill.",
  "input": "",
  "output": "I would have a CT scan of the chest and abdomen to get a more detailed image of the fluid collections and any other abnormalities. I would get a culture of the fluid obtained during the thoracoscopy procedure to determine if there is an underlying infection, and then a biopsy of the pleural and pericardial tissues to determine the cause of the effusions.Shortness of breath, swelling, and fluid accumulation can be symptoms of congestive heart failure. Your history of high cholesterol and type 2 diabetes increase your risk for this condition."
},
{
  "instruction": "Can I fly on a plane with weakness of respiratory muscles?(neuromuscular disease)Male, 24 years old. Live in Canada. 100kg, 200 Cm tall.I have an unknown neuromuscular disease that weakens my diaphragm, throat and skeletal muscles, and affects my cognition. I also have Ehlers-Danlos Syndrome.I want to know if my daytime oxygen is normal, and my Co2 levels are normal, is it safe to fly in a pressurized cabin on a plane? It's quite hard to breathe at times but I had a sleep study a couple weeks ago and it was fine.",
  "input": "",
  "output": "Can't answer that over the internet with the limited information. Would recommend talking to your doctor about a test called a High Altitude Simulation Test (HAST), where they used oxygen blenders to simulate a lower pressure with a lower partial pressure of oxygen. A lot of airline companies require it for people with lung disease to fly."
},
{
  "instruction": "Is a low respiratory rate a problem? (Bradypnea)Is a resting respiratory rate of 5-6 breaths per minute indicative of a problem? Online it seems there are some sites (non medical...) which think a low breath rate is healthy. But on medical sites I find references to the medical problem of bradypnea.40M, caucasian, 178cm, 90kg, drink alcohol. Resting heart rate of approx 55-60BPM. Blood pressure normal to slightly elevated.Existing conditions: anemia - taking iron supplement. Possible IBS. Have done little exercise over the past 12-18 months due to fatigue caused by anemia.",
  "input": "",
  "output": "low RR with self measurement without other symptoms is not a problem."
},
{
  "instruction": "COVID-19 FAQ #2Updated 6th AprilThe below comes from multiple sources as well as the direct experiences of myself and my colleagues.If you would like more information I highly recommend this free e-book written by two German physicians, it is available in multiple languages and is very up to date: https:\/\/covidreference.comIs it really as bad as they say?Yes. This is the most serious public health crisis of the last hundred years. By the time this is over many thousands will have died before their time. Do not underestimate the effect this will have on global societyThese are my symptoms, do I have COVID-19?Right now (assuming you live in an endemic country) any infective symptoms are COVID-19 until proven otherwise. Such symptoms may include any or all of:FeverCough (productive or dry)FatigueMuscle aches (particularly chest pain)Sore throatSwollen glandsLoss of sense of taste or smellDiarrhoeaThis is not an exhaustive list. Take home message: if youre not sure assume you have it and quarantine appropriately.When should I seek medical attention?Any breathing difficulties should be discussed with a doctor. This may be breathlessness at rest or on exertion, such as climbing the stairs. If youre struggling to do the things you normally do then seek assessment.You should have a low threshold for seeking assessment if you are at high risk of exposure, for example if youre a healthcare worker.I have no symptoms, should I stay at home?Yes.At this moment you must stay at home. You must only go to work if your job is essential for the running of the country or your local health service (although I accept not every country has introduced income support for those who have to stay at home.Dont see anyone socially unless you live together.If you do go out for work or supplies then stay at least 2m away from other people. Do not touch each other. Wash your hands religiously.What treatments are there?So far nothing.Either you get it and your recover, or you develop ARDS, in which case you will need to be admitted to ICU and ventilated.Chloroquine\/hydroxychloroqine inhibits the ACE2 receptor in your cells, this is the path the virus takes you infect you. There is, to my knowledge, no published data at this time suggesting that it makes any difference.There are multiple trials into antiviral medications but again nothing has been published to my knowledge (please correct me if Im wrong).Am I high risk?The majority of people who get C-19 will have a mild disease. A minority will develop severe disease that requires ventilation and may lead to death.The biggest risk factor for developing severe C-19 is age. Below the age of 50 the disease is rarely severe. In children it is almost always mild. The groups most at risk are the over 70s and over 80s.As mentioned earlier there is some suggestion that higher viral exposure (such as experienced by healthcare workers) may lead to a more severe disease course.In terms of other medical problems some people should take extra precautions. Those receiving cancer treatment or taking immunosuppressants are at greater risk. Asthma seems to convey greater risk but mainly among those with more severe disease (such as those on biologic treatments, daily prednisone or those who have previously been admitted to intensive care).Men seem to be at higher risk of severe disease. We dont know why.Other conditions may have implications. If you are curious about your personal risk due to a comorbidity there is lots of useful information on patients charity websites, for example asthma UK.I have elderly relatives, what should I do?Everything you can do to facilitate them staying at home away from others. If you live with them avoid them as much as possible.Talk to them now about what they would want if they got COVID and got sick with it. Would they want an ventilator? Would they want ICU? Over here hospital inpatients arent being allowed visitors. Admission may mean dying alone, on an intensive care unit with no one allowed to see you. Its a hard discussion but better that everyone knows what everyone wants now.What is it?COVID-19 means coronavirus disease 19 (as it was first reported to the WHO on NYE in 2019). It is caused by the SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2).Why is it spreading so fast?COVID-19 is very contagious. Current data suggests an R0 (that is the number of people an infected person will go onto infect) of 2.5-3. By comparison your average seasonal flu with have an R0 of about 1.3. To put this into perspective, if you start with 10 people infected with seasonal flu, over ten infection cycles youll end up with about 138 infected people. With COVID-19 over the same ten cycles youll end up with tens of thousands to hundreds of thousands of infected people. Bear in mind this is not what is going to happen, only what could happen if the a disease was left to spread without effort to slow it. Public health measures to contain it can massively reduce the actual transmission rate.Can I find out if Ive had it already?Right now no. There is a test in development.What can I do to minimise my risk?Wash your hands. Regularly. Avoid large gatherings. Follow local rules and guidance. If you have symptoms then stay away from other people.To my knowledge there is no evidence that wearing a surgical mask in public will be of any benefit.Should I stop taking my medication?There have been media reports that people taking certain types of mediation, specifically ACE inhibitors\/A2RBs (eg ramipril\/losartan) or NSAIDs (eg ibuprofen) are at higher risk of catching or complications of COVID. To my knowledge there is no good data to support this. You should continue to take your medication as normal unless instructed otherwise by your doctor.Is tickle in throat same as a dry cough? Two days ago I woke up with chills, diarrhea and pounding headache. Headache is gone but now have tickle in throat that makes me want to cough. Could that be corona virus??",
  "input": "",
  "output": "If you aren't coughing, you don't have a cough, do you? You could still have the coronavirus, infections can have very variable symptoms."
},
{
  "instruction": "Are you no longer contagious when your symptoms disappear?Ive tried reading through the comments but couldnt find any direct answer. A friend of mine was in contact with someone who tested positive and Im worried. He said his symptoms were gone after two weeks of being sick but he got tested the week they hung out and got the results two days after the handout.",
  "input": "",
  "output": "Not thought to be, but not confirmed.We are recommending you wait until at least 72 hours after your symptoms have resolved to end self-isolation (and symptoms resolving while you're still having tylenol around the clock doesn't count)"
},
{
  "instruction": "NYC, immuno-compromised. Delay medical appt's? Better or worse?",
  "input": "",
  "output": "Depends if time critical or routine"
},
{
  "instruction": "Ive been sick with some Covid19-like symptoms for 25 days now and Im 90% better now. I cant get tested where I am but my GP and I have been assuming thats what it is so Ive been isolated and all that good stuff.My question is, if my respiratory infection was by some chance NOT Covid19, am I now at increased risk of complication if I do contract it now that Ive just experienced pneumonia or something like it?",
  "input": "",
  "output": "No"
},
{
  "instruction": "Would a motorcycle helmet protect against virus? I know I'll look silly, but I don't want to buy face masks so that they are saved for the healthcare professionals.",
  "input": "",
  "output": "No"
},
{
  "instruction": "If you have a cough, but no fever or fatigue, are you okay? Can allergies cause a sore\/itchy throat AND a cough?",
  "input": "",
  "output": "Any cough right now is covid until proven otherwise."
},
{
  "instruction": "What should you do if you develop the symptoms? They're so generic, and the hospitals are being overwhelmed, plus it IS allergy season. Advice online seems to suggest you should only seek treatment if you have a pre-existing condition, or one of the more serious signs like shortness of breath. However, my whole city went under a 2-week quarantine starting a week ago after a woman had a coughing fit in a store in a neighboring county, and she did test positive! I don't know any other details of the case though. Right now I'm worried if someone even so much as clears their throat near me. I haven't gone out since the quarantine stated, but my mother (who I live with) has been going to work (she's only one of like 4 or 6 people who are, and she has to go to work because she can't take all her paperwork home with her, its just too much), and she claims the idiot locals are completely disregarding the quarantine even though we HAVE had at least four confirmed cases in this city alone! This has made me really paranoid. The local community isn't exactly known for being healthy, and the whole city seems to be overrun with Trump supporters too which doesn't bode well with him denying its a problem.",
  "input": "",
  "output": "If you develop symptoms you stay at home. If you develop breathing difficulties you seek medical assessment - follow local protocols."
},
{
  "instruction": "Are swollen lymph nodes involved with the virus at all? I woke up today with VERY swollen and sore lymph nodes on my neck underneath my jaw, both sides.",
  "input": "",
  "output": "Not typically, but possible"
},
{
  "instruction": "Where are they at with antibody tests? Internet says they exist but are hard to get.",
  "input": "",
  "output": "Lots of companies are touting these but to my knowledge none have been proven to be reliable yet."
},
{
  "instruction": "I have been experiencing fatigue lately: my RHR is higher (~55 instead of ~45-50); I get really tired when I try to run, even though I am a runner that does 50 mpw; I feel dizzy for a few seconds when I stand; etc. I have felt fatigued for the past 5-10 days and none of the other symptoms of COVID-19 have appeared. I think the fatigue is potentially from not being as hydrated as usual, the weather getting warmer, or my different eating habits with this whole quarantine situation.However, I am worried that it could be COVID-19. I am wondering what the actual chances of this being COVID-19 are; how many people actually only get fatigue without any of the other symptoms? I get the FAQ states any of the symptoms should be conservatively assumed to be COVID-19 but I am looking for a more statistical response. Thank you!",
  "input": "",
  "output": "Sorry I am unable to give a statistical response based on your vague set of symptoms."
},
{
  "instruction": "Do the fevers fluctuate? I've been tested and will get my results with 24 hours. I've been exposed to a covid + person and have had fatigue, mild cough, body soreness (as if I worked out). My normal temperature is around 97.4 it raised to 99.8, 100.5, and the back to 98.5 .",
  "input": "",
  "output": "Yes. Sounds like possible covid."
},
{
  "instruction": "My wife tested positive for COVID-19 several weeks ago and has now had a fever for over a month, while I am asymptomatic. We have been quarantined for the entire month and have not left our house. Her doctor recently gave her antibiotics as she believes my wife has a secondary infection that is causing the fever to linger. Is it safe for me to see family (while maintaining 6 ft\/mask\/etc of course)?Edit: My family has also been self-quarantined, they are relocating to their vacation home which is close to me.",
  "input": "",
  "output": "We are still treating people as infectious if they have a fever so you should continue to quarantine. You cant prove that your wife isnt infectious or that you arent asymptomatically carrying it. Check your local guidance on whether you should be socialising with others regardless of your Coronavirus status."
},
{
  "instruction": "There has been some mention of pinkeye being a possible symptom of the virus. Is there any potential truth to this or is that likely a symptom of something unrelated?",
  "input": "",
  "output": "Not to my knowledge"
},
{
  "instruction": "31F, ~125 lbs in NYC (a hard-hit neighborhood in Brooklyn). Pre-existing conditions: classical EDS (with ID'd genetic mutation) and mild dysautonomia. In 2018 I had a very bad case of mono and by early 2020 was just getting over the fatigue from it.I've been sick with suspected covid-19 for almost a month now and just can't seem to get 100% over it. Week 2 was the worst, couldn't eat and lost almost 10 pounds (was originally at 130 lbs and now starting to gain a little of it back) and had chest pain. I had ordered a pulse oximeter, which arrived halfway through Week 3. Readings are mostly normal, it once dipped to 94 briefly. Have had persistent low-grade 100-degree fever (99.5-100.3) that lessens a little at night and worsens in the afternoon, comes with chills and sweats. Pretty fatigued and get winded doing normal things in my apartment like cooking (I live alone.) I have swollen lymph nodes (two that have bugged me since the mono that swell with any infection since then, one on the back of my head and one in my thigh [?!], other lymph nodes affected through this were the ones in my armpits and groin).After 4 weeks of fever, my PCP asked me to come in for a physical and bloodwork. Lungs sounded fine, temp measured 99.4 in the office (morning), throat was red, lymph nodes in armpits were felt by her but didn't seem unusually large. Metabolic panel and CBC came back normal -- not even elevated white blood cell count. Dr was a little concerned about the buggy lymph node in my thigh and said it should be imaged when the pandemic is over....but that will probably be months from now. I was diagnosed with \"fever of unknown origin.\" Tylenol and Aleve relieve some discomfort, but don't bring the low-grade fever down. It just likes to stay put at about 100. (I normally run in the 97s-98s.)I am starting to worry about lymphoma because of that lymph node. It was imaged (ultrasound) when it first appeared in 2018 and was deemed large but noncancerous. Since then I've caught some more bugs than usual but attributed that to recovering from mono and a particularly bad cold\/flu season in the city.My PCP is getting harder and harder to reach since she is now working in the ER to help those that are in dire need of help, and I don't want to bother her too much since I'm not dying...I'm just mildly ill and not getting better.Are there cases of mild covid19 that just seem to linger on and on and on like this? I had some friends who had mild cases around the same time as me and recovered in 2 weeks and are completely better now. I'm nearing 5 weeks and still sick. Is this just how covid19 is in some people, or do I need to be worried about cancer? I'm sorry, just really scared and won't be able to get regular\/thorough medical help for the time being.",
  "input": "",
  "output": "Most likely prolonged recovery. Lymphoma very very unlikely, but review with your primary doctor when theyre back open."
},
{
  "instruction": "Does anyone know if taking antibiotics for a bacterial infection while potentially being infected with coronavirus is dangerous?Ive had a fever the last couple days with sever headaches, however I dont fit the criteria for testing where I live. This morning I noticed what seems to be a times flare up on my left foot. A couple hours later and my toe has swollen and there is a redness spreading slowly up my foot. I spoke to a doctor over the phone and mentioned the fever, and gave my other symptoms. The doctor prescribed me with some antibiotics for my foot and said theyll fax to the pharmacy for me.Im just worried that the antibiotics would be detrimental to my immune system if I do have covid-19.",
  "input": "",
  "output": "No benefit but doesnt seem to worsen things either. Current agreement is to give antibiotics if any suggestion of a bacterial infection instead of\/in addition to COVID."
},
{
  "instruction": "I and my mother just came back from England 10 days ago (flew to Romania). We're in self-isolation, haven't gone out even for shopping. When we were at the border the doctor told us to call our GP or 112 (emergency number) if we get symptoms. I have just heard Mom properly cough, very loudly and persistently, and it lasted a while. The airport and plane were very crowded so I wouldn't be surprised if we have it. Mom doesn't want to call our GP because she is afraid of a hospital quarantine. 112 seems a bit drastic for some coughing. There's a national covid19 information hotline. Should I call them? Should I just talk to her and we agree to continue self-isolating for a month beyond the government enforced period? If I am honest, I'm kind of scared of a hospital quarantine too because I feel like it might make her (and maybe me) worse. I'd much rather just self-isolate at home, but I feel like if we don't know she\/I are positive she'll really want to go out grocery shopping and stuff. She's also probably going to want to meet with my Dad (who is 64, has diabetes, hypertension, liver problems, is overweight and has had a benging tumor in his intestine for which he's been operated). She's 49 and I'm 17. Should I not call anybody and just talk to her? Call the hotline? Call 112?",
  "input": "",
  "output": "I dont know what measures Romainia is taking but I would encourage you to follow all local guidance. If the cough lasts more than an hour then call."
},
{
  "instruction": "I heard her, she had breaks but it was very very loud and it was about an hour, she was trying to silence it and go to sleep. Im not sure how seriously they mean call 112 though. Ill call the information hotline in the morning and see what they say.",
  "input": "",
  "output": "There is a strong chance she has covid. Follow all local guidelines"
},
{
  "instruction": "I'm trying to find an answer to this because the CDC released conflicting information.How much benefit is there to cloth\/homemade masks? My understanding is they don't help much, they don't block coronavirus, and if anything they increase risk because people are constantly touching\/removing\/adjusting them.Surely there isn't much benefit in wearing a homemade mask at work if I have to remove it for lunch and then put it back on. I'm just touching my face more.",
  "input": "",
  "output": "The benefit of the public wearing masks is really going to be in prevention of transmission from folks that are asymptomatic but spreading the virus. You could be spreading it right now. Please wear a mask so that you don't get others sick. We don't know exactly how much benefit this will have, but it's a simple enough thing to ask people to do.You shouldn't be touching your face at all when removing a cloth mask."
},
{
  "instruction": "An article mentioned that hypertension is a significant risk factor.Does this refer to untreated hypertension or treated, or both?If someone had hypertension that has been successfully treated for years or decades, is it still a risk factor?",
  "input": "",
  "output": "Hypertension seems to be a risk factor. Whether that is because of the hypertension itself or because of the associated micro and macrovascular damage cause by untreated hypertension we do not know."
},
{
  "instruction": "Allergy season is coming up, which means sneezes and sniffles. Currently I take a steroidal nose spray to cope, I also have access to non-steroidals if needed. Will a steroid nose spray have any negative affects vis-a-vis covid19? I do not have it, but dont want to make things more difficult than it needs to be.",
  "input": "",
  "output": "Nasal steroids safe to continue"
},
{
  "instruction": "I keep hearing \"I had the virus back in November!\"In November of 2019, there wasn't a surge of deaths and hospitals becoming inundated with ill people.The virus didn't just decide to start becoming highly contagious in March 2020.I find it hard to believe these people actually did have it already months ago.",
  "input": "",
  "output": "Unless these people were living in Wuhan then it is phenomenally unlikely they had covid in November."
},
{
  "instruction": "Someone told me it was a matter of controversy that COVID-19 is transmitted via breath.Is that controversial like it is controversial to say that smoking causing lung cancer? :-).",
  "input": "",
  "output": "Theyre talking nonsense"
},
{
  "instruction": "What is a good source of news about the progress of the pandemic?I tried MedCram on youtube, but it goes off on tangents.People keep recommending web sites teenagers built.I would like a news source that would tell me the numbers, the trends, what has been learned, and what the recommendations are.",
  "input": "",
  "output": "In terms of hard stats on numbers of cases\/deaths etc http:\/\/worldometers.infoIn terms of everything else the ebook listed at the top of the FAQ"
},
{
  "instruction": "Can someone who was sick in Feb with what they thought was the flu, now test positive for Covid-19?Or in other words, is the virus similar to Hep-C where you can still test positive weeks after recovery because of antibodies?",
  "input": "",
  "output": "There is no reliable antibody test yet available.Once one exists it should be able to confirm exposure within the last year, perhaps longer. The immune response still not fully understood."
},
{
  "instruction": "Age 23. Female. North Colorado. 55. Maybe 105 pounds. I have Ehlers Danlos Syndrome with Vascular Complications, Gastroparesis, and an AVM in my dueduom that bleeds periodically ( started bleeding again yesterday) (currently anemic because of this). My father recently told my family that he tested for antibodies of covid. I lived with him from Feb 29- April 3. He was sick from March 23- April 1. I developed a low grade fever last night as well as a headache, and have been very lethargic. Would I be able to be tested without proof that he has antibodies? He and I arent on good terms and I am very concerned. I am also concerned as I lost health insurance April 1st and havent secured a new plan yet.",
  "input": "",
  "output": "Current antibody tests (particularly the home testing kits) are not accurate and of no diagnostic use."
},
{
  "instruction": "Is it safe to go outside for walks? I'm obese and therefore more likely at risk due to my condition, so I'm trying to lose weight. I would get a mask obviously.",
  "input": "",
  "output": "Yes walks alone in open spaces should be fine. That said follow local guidelines - some countries forbid anything but trips out to collect food."
},
{
  "instruction": "Many sources earlier this year kept stressing that the flu was worse than covid19. The flu has been around for a long time. covid19 was new and no one knew much about it yet people kept saying the flu was worse. Now we're where we are now. Why didn't people take it more seriously?",
  "input": "",
  "output": "Those sources were probably not scientists or doctors. This was never not worse than the flu. This is what bad journalism does to our society"
},
{
  "instruction": "Hi guys, this might be a bit of a stupid question, but four weeks ago my ear temperature hit 38 degrees, naturally it scared me so I self isolated, I tried to go on my PC again after 10 days and the same thing happened again. Skip forward another 20 days to today, and it's happened again (37.8 this time)... Can headsets make your temperature rise by like a whole degree? My temp was 37.1 when I went on my PC. I've felt fine for almost three weeks until today. Also can anxiety cause this? cos I am very anxious\/stressed basically constantly atm and do suffer from diagnosed severe anxiety.",
  "input": "",
  "output": "I would certainly suggest taking off your headset for an hour then rechecking."
},
{
  "instruction": "Whats the deal with NSAIDs? Are we able to take them? I dont have covid, just being cautious. Specifically looking to use topical voltaren gel for chronic neck pain. Any advice is appreciated!",
  "input": "",
  "output": "Recent review found no evidence that NSAIDs worsen covid. Youre definitely okay to use NSAID gel such as voltarol."
},
{
  "instruction": "Why cant blood and organ UV radiation be a treatment for Coronavirus?Okay, I know how stupid that sounds, but I didnt want to jump on the bandwagon so I did a couple of minutes of research and I just want to hear from people who know better why this thinking is wrong.I know external UV radiation would not do anything, however:Uv radiation and high humidity has been found to be very effective at killing the coronavirus :https:\/\/www.google.com\/amp\/s\/www.aljazeera.com\/amp\/news\/2020\/04\/sunlight-humidity-kill-coronavirus-fastest-scientists-200424065853466.htmlUltraviolet irradiation of the blood used to be used to treat diseases like pneumonia before antibiotics in the 1950s :https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6122858\/Ultraviolet radiation has been used or suggested before as a way to sterilize organs during organ transplants:https:\/\/www.jhltonline.org\/article\/S1053-2498(18)30378-4\/abstracthttps:\/\/www.efe.com\/efe\/english\/technology\/brazil-develops-technology-for-sterilizing-organ-transplants\/50000267-3933369So what is stopping doctors from, in the worst case scenarios, treating critically ill coronavirus patients by irradiating their blood and\/or a lung?",
  "input": "",
  "output": "Beware quackery."
},
{
  "instruction": "F23 Respiratory Sinus ArrhythmiaHi, I was recently diagnosed with Respiratory Sinus Arrhythmia and prescribed an inhaler. I was only told to use \"as needed\" but I have been having trouble figuring out when \"as needed\" applies. Do I only use it when I feel like I'm having an onset attack? Or at night when I lay down to sleep and my symptoms seem more noticeable? Are both situations applicable? Also any advice on lifestyle changes to ease my symptoms? Thank you in advance.",
  "input": "",
  "output": "A \"respiratory sinus arrhythmia\" is an absolutely normal phenomenon and doesn't need to be treated, as it's normal. What was the inhaler prescribed for?"
},
{
  "instruction": "I was also confused when the physician said she was prescribing an inhaler, the main things I complained about was a feeling of pressure in my chest and my heart feeling as if it was beating faster, but too softly, then skipping a beat and beating harder as if to compensate for the lost beat. I also mentioned how a little over 2 weeks ago I had a severe attack that was causing my muscles to twitch and spasm and i was sweating. The papers from my discharge say asthma but asthma was never mentioned during the visit.",
  "input": "",
  "output": "Agree with above post. Your doc may have prescribed as a diagnostic\/therapeutic trial for some symptoms, but ran out of time to explain it all to you. I'd get in touch with the person who prescribed it to you and ask them, as inhalers aren't typically used in this situation."
},
{
  "instruction": "30 F Not feeling fully recovered 1 month after a Myasthenic Crisis and Acute Respiratory failure30 Female, medical conditions: Myasthenia Gravis, Chronic MigraineMeds: Mestonin 60mg every 4 hours, Cellcept 2x day ( 1st month on medicine)It's been a little over a month since I had a Myasthenic Crisis and was hospitalized in the ICU. I had three days of high-dose steroids and plasmapheresis for 5 days. I was feeling better respiratory-wise but still felt very tired and not back to 100% of where I was before the crisis. I was put on Cellcept by my neuro immediately after release and so far it has made me have less droopy eyes and mouth but I haven't noticed much difference.( Note: I have been diagnosed since late 2019 and on Mestonin, they did not put me on other meds since I responded well at the time. It has since been suggested that the mestonin alone was no longer able to handle the disease and that is why I went into a myasthenic crisis)The past week I have felt the shortness of breath from the Myasthenia come back, and at times I have gone on my CPAP to help reduce the strain and it has made me feel better. I'm starting to feel fatigued again, but not at myasthenic crisis level, so I'm pretty sure the benefits of plasmapheresis wore off. My main concerns are:Is it normal to take a while to recover from a Myasthenic Crisis?Is the reemergence of shortness of breath a troubling symptom?Should I ask my neuro for another treatment or medication? ( I was warned it could take 2-6 months for CellCept to fully work)I do see my neuro early next week, but I'm not sure if these symptoms are troubling enough I should seek medical care sooner or if there are other suggestions I should bring up to my doctor when I see her.",
  "input": "",
  "output": "Yes you really need to contact your neuro doc. You are at risk for another crisis because you had one already. You may need ongoing weekly plasma exchange until you are on stable immunosuppressants. Your docs are the best ones to advise you, you aren't bothering them."
},
{
  "instruction": "Found out I have convex chest at 40 after years of respiratory issues, now what?I am a 40 year old white male. Recently I had some issues with what I believe to be acid reflux (possibly aided by too much coffee) and it made me vomit several times. After telling my doctor this he decided to do a chest x ray and so far has only told me I have a convex chest.As an aside, I have been trying to find answers to joint issues I've had since puberty. My knees feel like they pop off and back in, even when that hasn't happened they swell up and hurt severely if I'm on them too long.Tgis applies to other joints to a lesser degree, I also have scoliosis and severe back pain.What should I ask my doctor to do? What to test for? Sometimes I feel like I have to ask for things with him and I'm worried about my future health.Anyway, thank you for reading and kind regards.",
  "input": "",
  "output": "Chronic dyspnea and chest wall deformities make me think it might be worthwhile to be assessed by a pulmonologist. These lung doctors have a series of tests that can evaluate how much the chest wall deformity may be affecting your overall breathing, and if substantial have different ways of treating it."
},
{
  "instruction": "Need ideas from as many medical minds as possible please! Chronic respiratory failure - hypoxia. Worsening. Low BMI. Ruled out pulmonary and cardiac causes, whats in your differential?51F, 59, thin, white, USA. never-smoker, non-drinker; no prescriptions; unintended weight loss of now 28lbs since January, oxygen desats started in January w\/ exertion, suddenly worsening in the past few days and now on continuous oxygen. Exhausted and weak. X-post for visibility. (This is for my mom)ETA see bottom of this, someone mentioned cervical spine issues, my mom has those, found in MRI in 2020!Ive posted about this a couple of times but need as many ideas as possible, and casting as wide a net as possible as weve hit a dead end and its looking bad.All pulmonary and cardiac testing done. Normal. (Only abnormal test so far has been an elevated 5-HIAA ordered bc hours-long intense hot facial flushing episodes began at the same time as the oxygen desats). Follow up with GI in 2 weeks.Over the past several days oxygen desats started coming on faster and going lower so after respiratory therapist consult now on continuous oxygen. Follow up with the pulmonary doc tomorrow but after 6 months of pulm\/cardiac testing - and now sudden worsening of symptoms over the past few days - it seems like its time to look for other causes.What other specialist besides pulmonology or cardiology would you recommend? What would be in\/on your differential list at this point?ETA: someone mentioned cervical spine issues causing this - here's her MRI of cervical spine and brain brief notes from neurologist about this from 2020:Her MRI of the C spine shows degenerative changes but most notable for disc protrusion at C6-C7 narrows the spinal canal to 5 mm. She is nearly asymptomatic at this point, but still encouraged her to discuss with neurosurgery for opinion given the findings.MRI of the brain shows multiple punctate foci, estimated at 30.",
  "input": "",
  "output": "I've been thinking about your mom since you posted last week about her worsening symptoms.The typical differential diagnosis for hypoxia is pretty simple to workup -- decreased partial pressure of oxygen (altitude), hypoventilation, decreased diffusion, VQ mismatch, and shunt). I would expect any reasonable pulmonologist could pretty easily work through that differential diagnosis, and I suspect if your mom got a shunt study that has gotten a thorough workup.There are some additional, rare causes of hypoxia\/dyspnea that do exist. They are things that we predominantly see in the ICU, as they are typically acute causes. I categorize them as histocytotoxic and competitive. It's a bit complicated:Histocytotoxic causes do not exactly cause hypoxia. An example is cyanide. It uncouples the electron transport chain (ETC), which is the process of how cells utilize oxygen to make energy molecules). When the ETC is uncoupled\/blocked you can not process oxygen, so physiologically it's like your body experiences extreme hypoxia. It's an immediately fatal process, so I can pretty much assure you your mom isn't dealing with cyanide toxicity. Perhaps you could bring up the idea of histocytoxic hypoxia to your mom's pulmonologist, though. She may have a chronic exposure to a substance that is causing hemoglobin dysfunction.Competetive hypoxia\/hypoxemia is related to something that either outcompetes oxygen for hemoglobin binding or changes the hemoglobin conformation so that it no longer binds oxygen as well. There is something called methemoglobinemia (pronounced \"met-hemoglobinemia\", not meth-hemoglobinemia). It's also something we see on an acute setting in the hospital. There is a congenital\/hereditary form, but it usually presents pretty immediately after birth. I wouldn't expect it to arise later in life like with your mother. There are plenty of acquired forms, but these usually happen acutely. It could also be worthwhile to bring up the idea of methemoglobin or other competitive forms of hypoxia\/hypoxemia to your mom's pulmonologist.These are super rare and unlikely things, but it sure sounds like your mom doesn't have a common or simple problem. Hope this helps!"
},
{
  "instruction": "Can coronavirus present as a cough and shortness of breath without other severe symptoms?I know you guys get a stupid amount of these posts, but I'm trying to figure out if I should go to a doctor to get tested, and I figured you guys might be able to tell me if my mild symptoms have any chance of being caused by the coronavirus.Me: female, age 20 (21 in a few days), 5'10\", 160 lbs., no comorbidities, mentally and physically healthy and fit, no drugs\/alcohol, no medications. Possibly came into contact with someone sick.A few of my distant coworkers have tested positive for coronavirus. Two days ago, someone I share a desk with (who works the opposite night shift as me) went home sick with severe symptoms - it really sounds like he has the disease.Now, four days ago, before hearing about these cases, I had a headache, some body aches, a very mild sore throat. I'd explain it as, like, the most mild cold you can have. I popped an ibuprofen and went to work.For the next two days, I continued to have the same very mild symptoms. No fever, no runny nose. I thought it was allergies. But I started developing a cough. At first, it felt like when you exercise too much and can't breathe properly, but with a little chest pain to boot. But these symptoms have gotten progressively worse, to the point where I can't take a deep breath without coughing. My chest burns like someone rubbed some mild capsaicin cream on the inside of my lungs. My heart rate is higher than normal, and I have some mild body aches\/fatigue. When I move around, I get short of breath way too fast. Additionally, today I think I may have developed the mildest of fevers (though I have no thermometer on hand).The feeling in my chest really reminds me of that one time I accidentally mixed bleach and ammonia and breathed in some of the fumes, but a little worse. It's not comfortable, but it's not bad. I am NOT coughing nonstop. I can speak, breathe, and sleep normally. But I undeniably HAVE a cough, and I'm tired. However, the other symptoms are so mild that if it wasn't for the cough, I'd think it was allergies\/psychosomatic symptoms.I did call out of work and am keeping myself at home. I feel HORRIBLE about it because my symptoms are so blasted mild, but it's not worth the chance. I will go to the doctor and get tested if it doesn't go away, but I just figured I'd ask here beforehand - just in case my symptoms in no way match the coronavirus. I've read about people's symptoms, and most people talk about severe upper respiratory symptoms, which I do not have. Everything in me is screaming \"you're being dramatic,\" so I thought I might be able to get an opinion here on whether I am, indeed, just being dramatic.Thank you so much for reading through. I appreciate your time.Edit: I called and asked for a test. They don't want me to be tested because my symptoms are pretty mild, so I will just be staying home for a bit (5 days) to see if my symptoms get worse at all. That's how much ATO I have. If they go away, back to work. If not, I'll talk to HR and risk my job rather than other people's lives :( Thanks for the help.Edit 2: reports of positive tests in my area have been rolling in today, including in my boyfriend's workplace. Yikes.E3: I guess my birthday present is probably going to be unemployment because I'll be doing a full quarantine.E4: happy news! I talked to my employer and I won't be fired if I quarantine! Woot woot! 14 days of bored coughing, here I come.E5 03\/20\/2020: yeah it's getting worse. Chest is on fire. Hopefully this really isn't the coronavirus, because that would suck. Stay safe guys. This shit fucking hurts :)E6 03\/22\/2020: bedridden now and they won't test me. Breathing is hard. I hate this.E7: 03\/26\/2020: finally getting better. I am still extremely short of breath and can't do much or walk far. My lungs still ache, and going out in the cold is the worst. I can't taste or smell very well. However, I am extremely grateful that the worst of the sickness is through. That was probably the sickest I've ever been in my life, and it sure wasn't fun. I'm so glad my employer granted me paid leave; I spent four days in bed and will be self-quarantined for a while yet. Yeah, this was probably the coronavirus. Thanks for your help guysE8: 04\/04\/2020: I am much recovered. However, I am still very out of breath. I ended up calling the covid hotline again (long story involving my now sick roommate) and NOW they want me to get tested - AFTER I HAVE RECOVERED - because I am still very short of breath. The test was this morning (very uncomfortable). Let's watch this test come back negative now XD",
  "input": "",
  "output": "Yes"
},
{
  "instruction": "Thanks. Appreciate it. I will get tested.",
  "input": "",
  "output": "You may not be able to get tested, given the limited supplies in most of the US right now. Please assume you have it and STAY HOME and away from family members who are at risk."
},
{
  "instruction": "Same here i have cough and burning throat and can be hard to breath. I do also have random fevers and the first time it went away but now its returned. And my job flat out refuses to pay unless we are confurmed to have it.",
  "input": "",
  "output": "Don't take ibuprofen!"
},
{
  "instruction": "Not so sure about that. Heard a doc on on of the networks today saying there's no evidence to back this up. Hard to know with a lot of unconfirmed advice going around. Best wishes to those feeling unwell.",
  "input": "",
  "output": "Yeah I'm not sure either, but it's better to be safe at this point. I'd go for Tylenol."
},
{
  "instruction": "Overnight the cases doubled in New York where I GREW UP and my father still lives. ( Mind you he is late 60s something he's as stubborn a mule and won't go inside ugh) It may not have hit us yet but It will. I don't give two shots if he's from Kiribati or Myanmar or even Jupiter. I'm concerned with folks taking it seriously.As for you if you reread my message I clearly state that this guy didn't offend me, to which I'm not making a snarky remark I'm stating \" oh man that fucking sucks what's happening in Italy that shots for real over there, it's gotta be difficult. In which I then go on to wish him well. At NO point in my reply did I ever curse him or put Ill will upon him just the opposite.I APOLOGISE if it came across another way that was not my intent.As for you maybe in the future you might stop and consider the gravity of what's going on. I may personally live in the Midwest for now but I'm shipping out in a week and I have family all over the East coast. Lastly good luck hopefully we can do this again some time, this nothing quite like a decent discourse ",
  "input": "",
  "output": "Please read our rule on claiming credentials"
},
{
  "instruction": "23M I was prescribed Prednisone after getting symptoms of upper respiratory infectionI went to an urgent care yesterday after having a sore throat the night before, I took the prednisone yesterday as well. Now my sore throat has turned into horrible nasal and chest congestion and an even more sore throat. My sister is just finishing up a bout with bronchitis(thats what she was diagnosed with). Is this the right medication for me? My body is telling me its not based on my infection getting worse it seems.",
  "input": "",
  "output": "These things are likely unrelated. Despite the prednisone you would likely have gotten worse anyway. It just seems like cause and effect because of the timeline. You also likely have the same viral infection as your sibling. You really dont need the prednisone unless youre wheezing. You dont really need any medications specifically but can take things for the symptoms such as Tylenol\/Motrin for aches, pains, or fever, OTC cough suppressants, etc. drink plenty of fluids. I assume the urgent care swabbed for flu\/covid? If not that would be something that could direct treatment plan more."
},
{
  "instruction": "Do I have some sort of respiratory infection22M, 5 ft 20, 235lbs. 2 weekends ago went to a family party and we were all drinking and started sharing a bottle that was passed around between like 5 people. The next morning I had a sore throat and just thought it was nothing. It continued for a few more days and after the sore throat went away I got really congested and got a really bad cough that I still have to this day almost 10 days later. My mom also had the same symptoms plus her sinuses were bothering her so she got a covid test that came back negative. I just assumed I wouldnt have covid if my mom didnt if we were both sick. The doctor at the clinic she went to said she had a sinus infection. I havent seen a doc yet but my sinuses havent been bothering me at all just my chest snd a cough. The cough is the worst in the morning then kind of slows down a little then picks up again around the time I want to go to bed. I get in nasty coughing fits to the point where I can barely even breathe and I cough up a ton of green phlegm. Ive had an upper respiratory infection before but it was never this bad. Ive barely been getting any sleep because of this cough. Ive taken mucinex dm, robutussin, and dozens of cough drops but nothing is working.",
  "input": "",
  "output": "Sounds like either COVID or an enormously long list of alternative upper respiratory viral infections. Just because your mom tested negative doesn't mean you don't have COVID as well."
},
{
  "instruction": "Why did urgent care send me home to fight an upper respiratory infection that has put my husbands coworker in the hospital?Age: 28, race: Caucasian, sex:FIve been dealing with an upper respiratory infection these last few days. went to urgent care Wednesday, no fever, sore throat. Negative for Covid, strep, flu. Doc told me to take time off work, could not due to previous attendance issues so Ive been doing half days. Sore throat went away and it feels like my chest is chock full of mucus. I already have mold in my house, so yay. Ive done a nasal spray and taken a decongestant but Im so nervous. I dont want to wait for this to get as bad as Hs coworker did. Urgent care doc struck me as one of those its not a big deal people and denies my illness could get worse",
  "input": "",
  "output": "I mean... we didn't put everyone with covid into the ICU or even admit them all.Illnesses hit different people differently, we base treatment recommendations on your illness severity, not based on what happened to an acquaintance.If you decided to go to work afterwards, it sounds like the urgent care doc 100% made the right call."
},
{
  "instruction": "Contracted respiratory symptoms from my childMy son (10 months old, male) was fussy, with runny nose and coughing between Friday and Sunday last week. Now he's not longer fussy, the runny nose decreased to less than a half and he caughs once or twice a day. He's very active and with good mood.As of Tuesday I started having an itchy throat that led to a sore throat and a runny nose the next day. On Thursday I had elevated temperature (37.8 C) and cough. Friday the cough went on, but temperature was normal. Today the cough feels coming from deeper in my chest, but no fever. I've taken two sars-cov2 antigen test (Thursday and today), both negative.Tomorrow I have an appointment with the family doctor. My partner (41yo female) and her daughter (13 yo female) are starting to develop similar symptoms as I did.Since apparently my son caught an infection and then passed onto us, plus the covid antigen tests came negative for all three (partner, daughter,me) I'm not sure if covid could be ruled out.Could you please share your thoughts? I'm not really sure what to ask specifically, just want to get some opinions and maybe suggestions.Cheers!",
  "input": "",
  "output": "Sounds like the easier solution would've been to get your son tested first, instead of everyone else.Remember that there are plenty of viruses besides COVID that cause similar symptoms. More likely that you have one of those given the negative tests."
},
{
  "instruction": "My best friend died suddenly, and Im trying to figure out what happenedIm sorry if this isnt an appropriate question for this sub - if you have any other relevant sub recommendations, please let me know.29 year old white female, 58\/315lbs, frequent drinker, non smoker, no medications other then OTCs, no known health problems.On December 13, my best friend (we work together) went to her sisters company Christmas party. Towards the end of the night, they got into a fight, which continued until they got home (they lived together). During this fight a shard of glass or mirror punctured her trachea (still dont know the truth as to how this happened, but thats a different story).They had her in the ICU for two days. While in the ER, her lungs stopped working and they put her on a ventilator while in the ICU. Her kidneys started to act up, so they kept her for a full week. I visited her and gave her a care package, we walked around the ward a bit, and she was in pretty good spirits although she got winded easily. Externally, it looked like her injury was healing well.On December 23, she came back to work for a half day. She had subcutaneous emphysema and was retaining water weight for some reason. We took a walk and she got very lightheaded at one point. She was supposed to leave at 2, but she got lightheaded again and said she was going to wait a few minutes before driving, I gave her some water and pretzels. About 10 minutes later, I heard strange gurgling noises coming from her desk (we sat across from each other with a divider in between) so I ran over. She was bent over her desk shaking and barely breathing, her pupils were dilated and she was unresponsive. She also lost bladder control at one point. She fell out of her chair as I was calling 911, and when on the ground she was only breathing 1-2 breaths per minute (agonal breathing?), her face and tongue turned blue and then grey, and she was clenching her jaw. I stayed on the phone with 911 while two of my coworkers started chest compressions. Once the paramedics arrived, they took over, started manually breathing for her, and hooked up an AED (I think), and the first time they stopped CPR she flatlined and wasnt in a shockable rhythm. It took them forever to find a vein that worked, but they finally got one and gave her epinephrine 3 times that I noticed along with sodium bicarbonate. They also intubated her. I dont know if this is standard, it seemed strange to me, but they worked on her for over an hour, maybe even an hour and a half - every time they stopped compressions she would flatline, but after the first time her heart was in a shockable rhythm so they shocked her several times. They were unable to resuscitate her, and told us that she died of kidney and respiratory failure.If any additional information is required, Ill do my best - not sure if I covered everything. I requested a copy of the autopsy report from the county ME but they said the case was referred to a justice of the peace, so I have to contact her directly (and if theres an active investigation she may not release the report). If anyone has any ideas as to what happened here, I would really appreciate it. Thanks in advance.",
  "input": "",
  "output": "Wow, those are quite some tragic events to happen to everyone involved. My condolences.At this stage I guess you will have to wait for the autopsy.My first guess would be a large pulmonary embolism (immobilized in the ICU).A primary cardiac cause seems unlikely. A respiratory or airway cause (suffocation or serious bleeding in the upper airway) I'm not so sure about either, because it wouldn't have such an extremely acute onset and your friend would typically run over in case she was suffocating for instance. A very serious and sudden arterial bleeding (ruptured aortic aneurysm) doesn't make sense either considering her age and history.A major intracranial (subarachnoid) hemorrhage is a second possibility.Again, pure speculation. You would have to wait for the autopsy report."
},
{
  "instruction": "Yea I watched my son die of a PE we knew it was eventually going to happen and the gurgling made me immediately think of that. Sorry for your loss. Please consider some counseling as it can really help work through dealing with unexpected deaths.",
  "input": "",
  "output": "Sorry for your loss. If she actually had SQ emphysema when you saw her that day, I would be concerned that she may have had an air leak and may have developed a tension pneumothorax. A tension pneumothorax can potentially lead to progressive shortness of breath and cardiac tamponade which would drop her blood pressure. In that situation, I would have expected her to be having some chest pain prior to the event and for symptoms to build up. If this happened very suddenly, then I agree that a pulmonary embolus is more likely."
},
{
  "instruction": "Do you think there will be charges brought against her sister? I could see an Involuntary Manslaughter charge for someone where I live happening.",
  "input": "",
  "output": "Sorry to ask, but did the ems people work on her for an hour and half or did they transport her and the docs worked on her for an hour and half?"
},
{
  "instruction": "Ems from op",
  "input": "",
  "output": "Why on earth would EMS work on someone in the field for 1.5 hours instead of transporting?"
},
{
  "instruction": "Depending on the area, sometimes med command directs EMS to stay on scene with an unstable patient. Ive heard them be instructed to stay up to 2 hours before med command calls it, but its so unusual Ive only ever encountered it once. Does seem very very strange, but it also very much depends on rural vs urban settings. A lot of different possibilities.",
  "input": "",
  "output": "Ive heard them be instructed to stay up to 2 hours before med command calls it, but its so unusual Ive only ever encountered it once. Does seem very very strange, but it also very mMakes no sense honestly, intubate, start acls, go."
},
{
  "instruction": "Depends on your area and protocols. Study's have shown improvement in survivability and neuro out come of obtaining ROSC in the field prior to transport. Field terminations are becoming more common in EMS on medical arrests. Mainly in part you're unable to properly work an arrest in a moving ambulance.Requirements in my area for field term are 30 minutes of basic ACLS. Epi, fluids, ET\/ laryngeal airway, bicarb\/ calcium on renal pts. If the patient remains in asystole med controls is contacted for any additional orders, with no change we terminate.",
  "input": "",
  "output": "Yes, improved survivability if ROSC within a certain time frame, 1.5 hrs?"
},
{
  "instruction": "This varies a lot with the culture of EMS agencies, transport distance, etc. I work with some agencies that work it on scene and only transport if they get ROSC or if theres something obvious the hospital can do that they cant. To be fair, unless its a known STEMi that can be cathed, or a cold water drowning, or trauma were just going to do to ACLS too.",
  "input": "",
  "output": "Define what \"we're\" means, you are ems or em?"
},
{
  "instruction": "My particular Emergency department. Things might be different elsewhere",
  "input": "",
  "output": "Your ER Doctors do not use ACLS, nor should any board certified EM physician. It is a backburner protocol that can be implemented while thinking but is ultimately a protocol created for non resuscitationists. Your ED should not be doing \"ACLS too.\" There is also a significant difference in the number of available hands for CPR, med pushing, and ultrasound machine, a pharmacist, a respiratory therapist, etc etc. I know I don't know all the details, but a young person who arrests in the field should be brought into the ER ASAP."
},
{
  "instruction": "If critical care paramedics use thrombylitic agents on scene it requires an additional 90 minutes of CPR, at least in UK guidelines.",
  "input": "",
  "output": "Those don't really exist here. And if they do, they are in remote academic areas where transport should have been quick."
},
{
  "instruction": "Where do you work? A lot of EMS protocols around the world are \"No ROSC = no transport\" except maybe in some extreme cases that can't be treated in the field (ie. PE in some places, or intrapartum cardiac arrest).",
  "input": "",
  "output": "I am so sorry for your loss, it seems you got into a very tough situation but did all you could to help her and gave her and the EMTs the best chances; you're a good friend and person. I would agree with the colle ague that a PE or another clot of some sort (intracranial bleed\/occlusion) comes to mind as a plausible possibility, and that waiting on the autopsy results is the best step. A serious underlying reason would also explain why the resuscitation was unsuccessful."
},
{
  "instruction": "UPDATE ABOUT MY MOM: Chronic respiratory failure - hypoxia w\/o pulmonary or cardiac explanation.51F, 59, thin, white, USA. never-smoker, non-drinker; no prescriptions; unintended weight loss of now 28lbs since January, oxygen desats started in January w\/ exertion, suddenly worsening in the past few days and now on continuous oxygen. Exhausted and weaker every day. X-post.This is just an update for anyone interested. Ive posted about this several times on the various medical subs here out of desperation and have been blown away at the helpful advice and input. I wanted to post an update in case anyone remembers spitballing about this and might be curious about new developments.Today mom had her follow up with her pulmonologist following the normal shunt study. He spent a solid hour with us going over everything shes been experiencing the last six months with a fine tooth comb, reviewing prior records in the hospital system from the past year before the oxygen issue, and doing a thorough physical exam - we knew something crucial might be in those clues.Very long story short - its not a happy update but it unfortunately makes sense given a lot of other problems mom has been having during this same timeframe that just seemed insignificant or unimportant compared to the chronic respiratory failure. Things she thought could sit on the back burner til that was solved, but have been accelerating in just the past 2-ish weeks along with the worsening oxygen desats.Basically, there are several observable, objective signs and symptoms that seem to point to some kind of neurological\/neurodegenerative process\/disorder.He ordered a lot of tests that will be happening next week, and she will be seeing a neurologist for further evaluation on Tuesday.The more we read, the more huge lightbulbs are going off on this kind of process being a possibility. Not going to assume anything, and not trying to be negative, it is just undeniable that a lot of the puzzle pieces fit and we want to prepare for the worst mentally\/emotionally. It's a long way from here to final answers (if we ever get any, we are well aware we might not ever get this figured out, that there are limits to medicine), but I just thought Id update since my moms situation is such a very odd, even bizarre, case. Thanks so much to all of you who have pitched in.",
  "input": "",
  "output": "Glad to hear you've found yourself a solid pulmonologist. Might I ask what institution he\/she is working at? I like to know where there are good folks if I ever need to reach out."
},
{
  "instruction": "I (27F, 65in, 125lbs) was recently prescribed propranolol (20mg twice a day) for migraine prophylaxis. As I was reading through the information, I saw that multiple occurrences of past bronchitis are a significant contraindication. I have had pneumonia several times, and am not sure about bronchitis because the several pneumonia cases I had, I put off going to the doctor until I had to go to urgent care (less than ideal, I know. poverty can really be a bitch.) The last time I had pneumonia I ended up with cracked ribs from coughing so hard.Is it safe for me to be taking propranolol, and are there early warning signs I can look out for if my respiratory system is being negatively impacted? Would I develop a cough?I would call the prescribing PA but not only was it the first time I had an appointment with them, it was also their last week at that job, and they also were a little bit dismissive when i asked if there could be any interactions with my psychiatric medications (bupropion xl 300mg & concerta xr 27mg.)Thanks for your help!",
  "input": "",
  "output": "Previous infections shouldn't affect you today, I wouldn't worry about it too much but yes you are correct, they would be signs. The main sign would be an asthmatic sensation, in which case you should not take any more propranolol and seek help.It's very hard to give good medical advice you seem to have shared lots of pertinent information, I can only suppose, but I suppose there's no problem taking this beta blocker at this moment."
},
{
  "instruction": "Thank you! Would asthmatic sensation feel much different than respiratory symptoms from sickness? I noticed today that drinking very cold things makes me cough and feel like i have an itchy throat\/need to clear my throat. This isnt completely unusual for me, but its been more extreme than normal.",
  "input": "",
  "output": "Not really, shortness of breath, is shortness of breath.Allow me to advise you not to drink very cold things."
},
{
  "instruction": "Is brain fog\/cognitive dysfunction in sleep apnea caused by sleep fragmentation or intermittent drops in SpO2?24M, 176cm, 78kg, mild sleep apnea (AHI = 10), not on any meds, non-drinker, non-smoker.I have had mild OSA for the last 2 years and was only recently diagnosed in March; during this time, my main symptom is brain fog\/cognitive dysfunction which was bad enough to impede my ability to study. I have since been treated with CPAP and I have noticed mild improvement even though I am still not 100% used to the machine and the mask and am hence sleeping only for 6 hours at a time. I still feel sleepy on days where I sleep this little, but the brain fog is improving gradually nonetheless. This makes me wonder: was the brain fog caused by the oxygen deprivation while my OSA was untreated, or was it due to the sleep deprivation? If it was caused by sleep deprivation which occurs as a consequence of the OSA, then why am I experiencing improvement in the brain fog even though I am feeling sleepier than most of the days before I began using CPAP?",
  "input": "",
  "output": "They are both tied in together, as the low oxygen level triggers an awakening response that fixes the low oxygen level but results in sleep fragmentation. Disorders that are associated with frequent awakening but not hypoxia, such as restless leg syndrome, are also associated with \"brain fog\" and other symptoms of poor quality sleep so it isn't really just the oxygen.There are two possibilities here for you.Cognitive dysfunction and daytime sleepiness are not affected equally by quantity\/quality of sleep though they are related. It is possible that 6 hours of higher quality sleep is helpful for your cognitive symptoms, but isn't enough to pay off the sleep debt you've accrued especially since total sleep has decreased. Increasing comfort over time with the CPAP is the rule of thumb, and eventually it tends to become a sleep cue.The other possibility is your cognitive improvement is a placebo effect. Your OSA is mild by AHI, depending on the rest of the picture including nadir oxygen and other symptoms (snoring, high blood pressure etc) this may or may not be causing your symptoms. I think this is less likely.There are some other possibilities with persistent daytime sleepiness when you have started treatment for sleep apnea, including a mixed sleep-disorder, and if it persists may warrant testing in the sleep lab if this wasn't done already."
},
{
  "instruction": "Thanks for the comment. This is more comprehensive than I expected.But what I meant is, without the sleep deprivation\/fragmentation, could the SpO2 drop still cause cognitive dysfunction? My nadir oxygen (lowest Spo2 recorded in my sleep study) was 88% (for a total of 9 minutes, not continuously but distributed across the night), and usually the drops are to the levels between 90-94%. If it was the sleep fragmentation caused by the Spo2 drops that is the culprit, then it doesn't really explain why I have been feeling sharper and yet I am feeling sleepy. I have had insomnia in the past and the sleep deprivation have never given me \"brain fog\" neither, I simply felt so tired that I can't continue with my day anymore subjectively but I wouldn't notice a \"fog\" over my head. One way to illustrate the difference would be the comparison between the times I had to do an all-nighter before I had OSA and when I had to do an exam after having slept say 6 hours the night before while having OSA: I still found it harder to think on my feet in the latter case even though theoretically I should be more tired in the first case due to the acute sleep loss.I don't think that my cognitive dysfunction is a placebo effect because the difference that I have noticed is a bit too big. I have taken anxiety medication (atarax) and followed the advice of a psychologist to just take it easy and relax before as well when my clinicians thought that the brain fog was caused by stress and anxiety, but even though I convinced myself that the it was psychological and even layed off my studies for a whole year, I did not experience any improvement as significant as that which I am experiencing now.I know why I am still feeling sleepy: it is from the simple fact that I get woken up by the sunlight in the morning easily, since the CPAP mask is making it hard for me to put my eye mask on and I haven't learnt to sleep under my duvet yet due to the heat underneath (the CPAP mask is making that a possibility as an added benefit anyhow).",
  "input": "",
  "output": "I don't think that there is a distinction between the SpO2 drops and the sleep awakening here. They aren't really separable since you are treating both.To whit, treating sleep apnea with oxygen supplementation isn't really effective at improving symptoms, and other causes of sleep disruption that don't cause intermittent low oxygen also result in cognitive dysfunction.I see that you are trying to separate these things out but no I don't think it is just that you are recovering from a hypoxic injury to the brain."
},
{
  "instruction": "Right, so basically you're suggesting that the fact that I am noticing improvement despite feeling sleepy can be accounted for by my sleep deprivation being nonetheless less severe in comparison to before I got started on CPAP, even if I haven't been sleeping well for other reasons recently? That can make sense.Are Spo2 drops to the level that I described harmful to the brain? How about the effects of CO2 buildup itself (independent of the fact that it causes you to wake up periodically)?",
  "input": "",
  "output": "Your respiratory drive is related to things other than just low oxygen levels. There is a pacemaker in your medulla that integrates a bunch of data, including carbon dioxide levels, strain, airway narrowing, lung expansion etc.For instance with OSA there are often respiratory effort-related arousals (RERAs) caused by partial airway obstruction. These increase the effort needed to take a breath, but do not cause hypoxemia. They do cause awakening because of the increased work of breathing and the muscle strain sends and alarm signal to higher centers involved in the sleep-wake cycle.So oxygen doesn't cure sleep apnea because this isn't the only reason that there are awakenings. In addition if there is complete airway obstruction then no amount of oxygen is going to help."
},
{
  "instruction": "Is a full neuro-cognitive recovery guaranteed with full compliance with CPAP treatment? I am still finding it hard to focus and think and I've been dead tired today... I was in bed for more than 8 hours... The CPAP is working as intended because my AHIs have only been at around 1.2 on average since I got started on it.",
  "input": "",
  "output": "We don't really deal in guarantees in medicine. Also I don't know if your symptoms are due to your sleep apnea. If they are then good recovery would be anticipated."
},
{
  "instruction": "Well I guess I'm fucked judging by how it feels. I don't see how bouncing back is possible to be honest. If I would think about how I felt at the start of this I was certainly sharper than now so there has been a deterioration over the last 2 years. As far as I know intelligence is supposed to be quite intact\/stable and if that has experienced a gradual decline then I would guess that full recovery is quite unlikely as well. I say this because if I would think about a topic that I know from experience wouldn't have difficulty thinking about before, my train of thoughts stop earlier than it previously does.",
  "input": "",
  "output": "This kind of went from a question about sleep physiology to diagnosis of neurocognitive decline, for which I don't have any information to say that you are or are not \"fucked\", but would be very shocked if you had some sort of irreversible neurodegenerative disorder at age 24.I would continue to give the CPAP time - this is usually the most treatable thing and as you get more accustomed to it the benefit will increase. You had a one-day setback. Depression\/anxiety are the other common causes of these symptoms in a young person."
},
{
  "instruction": "Can chronic CPAP use reduce the natural respiratory strength or capacity?Age: 32 Sex: M Height: 510",
  "input": "",
  "output": "No"
},
{
  "instruction": "3 months sore throat. Urgent care seemed very concerned about oral cancer.https:\/\/imgur.com\/a\/m7onRtJThroat pictures.21 Male. 61 165 lbs. athlete and healthy most of life. Dont smoke and drink on any regular basis. Vaccinated for HPV.Ive had a sore throat for 3 months that began right after a fever but has stuck around. Symptoms include some difficulty swallowing time to time, lots of mucus every morning, and very occasionally pressure near ears, but I wear earplugs every night to sleep right next to train tracks.I visited 1 month into sore throat and was given antibiotics, didnt change anything after full course.Saw them again recently. Negative for all STDs, strep, mono, no growth on culture. Blood work normal as of 1 month ago.This time at urgent care the nurse seemed very concerned it could be oral cancer and urgently referred me to an ENT. Im waiting on that visit on the 28th of April and Im freaking out in the mean time.Thoughts? Thank you for your time.",
  "input": "",
  "output": "Theres nothing in the images youve posted that appears cancerous.Follow-up with a primary care physician, or at least a midlevel PA\/NP who have examined more than a few throats and knows what a normal pharynx looks like.Id probably try to treat your chronic sinusitis with daily flonase in each nostril and a daily allergy pill like zyrtec. Do that for at least a month. Considering you obviously have post-nasal drip, your chronic sinus congestion likely explains the daily morning mucus, sore throat, and ear pressure. And yes, this can cause symptoms that last for weeksespecially if you havent been treating the actual cause.The only person who throws out a diagnosis of cancer in a 21 year old for a sore throat that lasts for three weeks is someone who doesnt know what theyre doing."
},
{
  "instruction": "What are your thoughts on possible differential of acid reflux (respiratory reflux, LPR)?",
  "input": "",
  "output": "Possible, but sounds like OPs describing a lot of upper respiratory symptoms. And if youre in the northern hemisphere right now, its the start of spring allergy seasontheres a lot of people with chronic congestion\/cough that lasts for weeks and is not infectious.I advise my patients frequently who start developing similar symptoms at the change of seasons to grab their antihistamine of choice along with a nasal steroid and use for at least 4-8 weeks."
},
{
  "instruction": "Thank you. It has been 3 months however, not 3 weeks. I definitely agree and appreciate all the info. Im definitely considering acid reflux as a possibility too, though I dont have heart burn. I have been eating pretty late dinners and spicy foods lately.",
  "input": "",
  "output": "Ok so what did the doctor say? Because it would be extremely weird for you to have throat cancer at your age."
},
{
  "instruction": "Have yet to meet doc, it was a Nurse Practitioner that examined me. I agree. After I mentioned Id performed oral sex before symptoms, she suddenly became very alert and mentioned oral cancer and HPV multiple times. I told her I was vaccinated. She still seemed very concerned even after that. She definitely spiked my anxiety more than necessary.",
  "input": "",
  "output": "HPV doesnt cause oral cancer in weeks or even months, but years and decades."
},
{
  "instruction": "I had a bad experience during a procedure and want to make it right.56 yr old female with chronic pain. I had a knee RFA with a new doctor. My most recent previous ones were under deep sedation ( propofol, ketamine, midazolam) in a surgical center because of problems in the past with pain and panic attacks. When I went for the consultation I was told I would be completely sedated with propofol and would not be aware of anything. I asked for an injection of torodol after the procedure as this has what has worked wonderfully for my 3 previous RFAs to control post procedural pain ( I have had gastritis in the past so taking ibuprofen is a no-go for me). The PA said no problem. We discussed in detail previous bad experiences that has lead to a formal diagnosis of PTSD ( anesthesia that resulted in me being conscious of pain, but not being able to tell them to stop the procedure). She took notes and said \" I will be fine\". I am also diagnosed as immunocompromised with a primary IgA, IgG immunodeficiency. They were aware of this.When I got to the procedure they wouldn't let my husband wait with me. This has never happened before and I was not prepared. Then I was notified that I had to be awake for some nerve testing ( my previous 3 RFAs did not do this, I was out through the whole rhing). I asked if it would hurt. I was told there would be \" tingling\". Then I asked about the torodol injection and was told \" we dont do that\". Then they took me back and refused to put the nose canallula under my mask like the other times at the surgical center. I was caught off guard. They shamed me, they raised their voices at me, they made sarcastic jokes. At this point I almost left.I ended up going through with it as I felt trapped because I needed pain relief. The \"tingling\" was short term burst of pain at a level of 7 or 8 for two of the three nerves tested. I was completely unprepared. The last nerve was okay, just weird.My question is how do I make this never happens again? Why didn't they tell me ahead of time that I would be awake. Why did they say \" tingling\" instead of \" maybe pain, it differs among patients\". Why was I refused the torodol after being promised it? Why didn't they tell me about removing my mask at the consultation knowing I'm extremely high risk for all respiratory illness?I have lost trust in this provider and I'm supposed to have another different procedure in two weeks. Botox injections, where I just found out they won't let my husband be with me and I dont understand why. It's hard to find pain doctors and I dont want to change unless I absolutely have to. I just want to try to reestablish trust.Am I overreacting? Is it usual to not let a spouse be in pre-op and I've just been lucky in the past? I've already have had awful experiences in the past, which they know, and I felt trapped yet again. Im considering what to do with the scheduled botox injections as im not sure I can trust them without my spouse being there. I feel like they are going to spring something on me the last minute again when I'malone and vulnerable. Is there any advice you can give me to help me out so I can repair this relationship? I do see a psychiatrist and a therapist for the PTSD. Thank you.",
  "input": "",
  "output": "Sorry you had to go through this.In regards to the Toradol, I understand why they didn't give you Toradol as if you have gastritis from ibuprofen Toradol is almost exactly the same thing which can cause gastritis so shouldn't be given.I've been at hospitals that allow family in the preop area, I've also been to hospitals that don't allow it. Especially after COVID the rules and policies have changed drastically.Some doctors will tell patients there might be some tingling or pressure or something without using the word pain because some people will actually cause themselves more pain by thinking and dwelling on it, a negative placebo effect. It's a personal practice type of thing.The best thing to prevent things like this happening again to be up front with all the staff you are interacting with about your previous experiences such as this. You can talk to the doctor directly and let him\/her know about your negative experience as well."
},
{
  "instruction": "Thanks for taking the time to respond. Your comment about torodol is interesting. My PCP, the previous anesthesiologist, my previous pain management doctors and the new PA all agreed I could have it, all knew my medical history. My PCP said it bypasses my stomach so it's safe. What in the world is going on here? I see your a pharmacist so I am now going to ask some more pointed questions from my providers. They nurse just said, \" we don't do that here \" when I asked for it, nothing about my specific history.I have a hard time believing not allowing my husband back with me was a COVID policy as they don't require masks on staff or patients at this practice. In fact the doctor gave me a snarky comment about me wearing one in pre-op. He said, \" I should take some deep breaths if my mask will allow it\".You may be right about them wanting to avoid a nocebo effect and so they underplay the pain component. I've had the same experience with previous doctors. I always thought consent was a big deal though and knowing what pain you may be in seems to be a part of giving, or not giving, consent for a procedure.I informed them of my negative experiences in detail in order to avoid all this, they knew. I guess I just have to decide if I want to use the mental energy to try again with them.Again, thank you for the response, much appreciated.",
  "input": "",
  "output": "The stomach bypassing actually doesn't affect the mechanism of action that it works. The reason why NSAIDs like Toradol and Motrin cause issues with the stomach is due to the inhibition of COX-1 which happens whether it's taken orally or given IV\/IM."
},
{
  "instruction": "You literally just have to leave and reschedule if you dont feel heard. Its not worth the medical ptsd in my opinion . My rfa for my back I asked for sedation at the center they blew 4 veins and got blood all over, (which triggered my thoughts of cutting i suppress as much as possible), then told me I didnt need sedation anyways and told me my only other option was to leave if I didnt want to do it with nothing . Feeling trapped and not wanting to seem like a wimp I did it with no Iv line of any kind.Ive never heard of them having someone completely out where they cant test the nerve . You can ask for a medrol dosepak tho to help inflammation \/post op pain or go into any urgent care for toradol . Ive done the urgent care option often .Sedation isnt used for like anything injection or nerve burning wise anymore and idk who got the idea to torture patients , cheap insurances not wanting to pay most likely, but it makes me sick . 15 years ago you got sedation even if you didnt want it. We were treated like humans . Oh what a time .Im sorry you experienced this. Therapy has helped me in dealing with some medical ptsd issues . At least the anger and feeling violated .",
  "input": "",
  "output": "We dont sedate all the time because sedation has very high risks and can result in aspiration, inability to ventilate, and death. Sedation is taken very seriously and is a very high risk thing to do."
},
{
  "instruction": "Any respiratory therapists or pulmonologists on here? I feel like I'm getting no support in weaning my 4 month daughter off her home oxygen and my anxiety is through the roof.4 month female15.5 lbsWhiteLow oxygen saturations is the main concernFlovent, bactrim, iron, vitamin d, recently discontinued diuril.My 4 month corrected has been off daytime for months, always 97 and above, usually 99 or 100.Nightime weaning has been more difficult because of her periodic breathing. Its usually the most extreme when she first falls asleep. She will go up and down from 97 to 89\/88\/87\/86 sometimes low 80's every 10 seconds or so. Down 5 seconds, up 5 seconds. This happens over and over again for about an hour, then she comes out of it and sits at 97\/95. Then she goes back into it, usually not dipping as low as the first cycle.The first time they tried to trial her off nighttime they told me to \"watch her\" the night before her appointment. I tried to get more info. When do I put the oxygen back on? What is concerning? \"Just watch her\". So I stayed up as late as I could and tried to peek intermittently. Lowest I saw was 89. This didn't seem like the most accurate sleep study but whatever. She had been tearing out her oxygen every single night at this point for weeks. After me relaying what sats I saw, they decided to wean the diurul first, then check back in in Feb.I reached out this past week because its been impossible to keep her oxygen in. I'm using the works, the strongest adhesives, using mittens, socks, swaddles, and she still manages to get it out. She's also started trying to eat her tegaderm and I am certain she ate some at least one night. And a really problematic rash has been developing on her cheeks from the duoderm. I decided to leave her oxygen out since last week after the tape eating incident and to give her cheeks a chance to heal. I let her NP and NEO follow up know and they are in agreement that we should just leave it out indefinitely and \"see what she does\". But what does that mean exactly! Shes definitely going lower than usual the past couple of days, as low as 83 so far.TLDR: WHEN DO I PUT THE OXYGEN BACK ON WHAT IS SAFE\/NOT SAFE. I have asked her NP time and time over what her parameters are and she never gives me a straight answer. I understand that dips to 80s are fine. But how many? She cycles like this for at least an hour every night, probably a total of 2 or 3 hours. Are these dips cumulatively an issue? We've never gotten an alarm when her oxygen is out (alarms at below 90 for longer than 10 seconds). Should I just based my concern off of that? I have to go back to work in a couple of weeks and will no longer have time to stay up late watching her monitor and watching her naps.",
  "input": "",
  "output": "How are you positioning the NC? Dont tighten it under her chin like an adult would wear it, instead put the prongs in the nose, and adhere the cannula up by her eyes - not level with her nostrils, keeping it up higher will hopefully reduce them coming out, then tighten the cannula up by the top of her head.Tegaderm is pretty weak, I place douderm down on the skin, place the cannula on top, then secure with 3M multipore tape. Taping the cannula to the douderm not to the skin, that way if it is tore off, the skin isnt being torn. Hope this helps."
},
{
  "instruction": "Im doing all of the above but will look into the 3M tape, thank you!",
  "input": "",
  "output": "Hey there. Patience is key. Helping your 27 weeker who needs home oxygen is a marathon, not a sprint. The impact of BPD\/CLD is going to take a while for her lungs to get to the point where she can be off oxygen entirely, and will affect her lungs for the rest of her childhood and to some degree her entire adult life.That being said, trust what your team is saying here. The alarm parameters are perfectly fine as a level for concern. In the NICU, we would only care about desats longer than 10-15 seconds; momentary dips are much more likely to mean nothing. If your team thinks shes ready for room air overnight, particularly given her vigorous attempts to pull the cannula off, I think thats a good sign.Let her alarm do the work. You shouldnt have to be staying up next to her like this. The alarm can tell you when shes going longer than 10 seconds in the 80s. These short blips dont matter as much. If it alarms, just keep track of how many alarms overnight youre having, how long, and the low number reached during the desat. The monitor should be tracking this for you.Its okay. You are doing so much hard work for your daughter right now and are asking a lot of really important questions about how to give her the best treatment and recovery; that shows me that you are taking great care of her. Just keep talking with your team and dont be afraid to ask to speak with them in between appointments if you feel like things are changing."
},
{
  "instruction": "Opinions on posterior tracheopexy for 2.5yr old?My son, 2.5yr old male, 32lbs has severe tracheobronchomalacia and moderate bronchomalacia and a type 1 laryngeal cleft. The bronchomalacia goes deep into the bronchi. Hes had multiple hospitalizations and 2 PICU stays. Most recent in December. His sleep studies always come back as mildly failed. His baseline o2 overnight is 94 with multiple dips into the 70-80s when healthy. Im in Canada and our doctors feel that surgery is too aggressive since he is generally healthy but struggles with respiratory viruses. They also feel that because the bronchomalacia goes deep into the bronchi it cannot be fixed and therefore correcting the tracheomalacia may not do much and they cant correct the bronchomalacia. Doctors at John Hopkins in Florida feel he is possibly a good candidate for the tracheopexy and would like to see him and run tests however that would be all out of pocket (5-10k$ for tests, 100k$ for surgery). When he is sick, his overnight o2 stays in the 80s. I dont even bring him to the ER anymore because often hes fine otherwise. He may sleep more. When he gets lethargic is when I go in now. Doctors here say he will get stronger as he grows. He sleeps around 15hts per day and does get winded easily. Ive pulled him out of daycare as the risk is just too great to his health. Sorry this is all over the place. Opinions?",
  "input": "",
  "output": "My opinion is 100k is a truck load of money when you have a team of doctors telling you it isnt necessary. But my other opinion is multiple 02 dips to the 70s isnt great. Have you tried anything less drastic like home oxygen? I would want to even ask about cpap before pursuing a surgery OOP your doctors dont think you need."
},
{
  "instruction": "Freaking out about my echo results. PLEASE advise.27f 5'3\" 280lbsPLEASE can someone look over my echo results and tell me if there is anything alarming? I am so scared.. (Yes, I have called my cardiologist who is out until Thursday and I truly cannot wait that long)Left Ventricle:The left ventricular chamber size is normal. There is no leftventricular hypertrophy. Global left ventricular wall motion andcontractility are within normal limits. The estimated ejection fractionis 55-60%. Normal left ventricular diastolic filling is observed.Left Atrium:The left atrial chamber size is normal.Right Ventricle:The right ventricular cavity size is normal. The right ventricularglobal systolic function is normal. TAPSE measures 2.2cm.Right Atrium:The right atrial cavity size is normal. The interatrial septum is notwell seen.Aortic Valve:The aortic valve is trileaflet. There is no evidence of aorticregurgitation. There is no evidence of aortic stenosis.Mitral Valve:The mitral valve leaflets appear normal. There is no evidence of mitralregurgitation.Tricuspid Valve:The tricuspid valve leaflets are normal. There is trivial tricuspidregurgitation. Unable to estimate the right ventricular systolicpressure due to incomplete spectral Doppler waveform.Pulmonic Valve:The pulmonic valve appears normal. There is trace pulmonicregurgitation.Pericardium:There is no pericardial effusion.Aorta:There is no dilatation of the ascending aorta. There is no dilatation ofthe aortic root.Venous:The inferior vena cava was not well visualized; unable to accuratelyevaluate size and respiratory change.______________________________________________________________________MeasurementsName Value Normal RangeIVSd (2D) 0.93 cm -IVSs (2D) 1.19 cm -IVS % thickening (2D) 28 % -LVPWd (2D) 0.98 cm -LVPWs (2D) 1.46 cm -LVPW % thickening (2D) 49 % -IVS:LVPW ratio (2D) 0.95 ratio -LVIDd (2D) 4.21 cm -LVIDs (2D) 2.86 cm -LV FS (Teichholz) (2D) 32.1 % -LV FS (cube) (2D) 32.1 % -EF Teichholz (2D) 60.6 % -Ao root diameter (2D) 2.84 cm -LA dimension (AP) 2D 2.47 cm -LA:Ao ratio (2D) 0.87 ratio -Name Value Normal RangeLA ESV SP 4CH (MOD) 44.1 ml -LA ESV SP 2CH (MOD) 38.7 ml -LA ESV BP (MOD) 42.7 ml -LA ESV BP (MOD) index 22.1 ml\/m2 -LV EDV SP 4CH (MOD) 93.7 ml -LV ESV SP 4CH (MOD) 32.5 ml -EF SP 4CH (MOD) 65.4 % -LV EDV SP 2CH (MOD) 66.8 ml -LV ESV SP 2CH (MOD) 30.2 ml -EF SP 2CH (MOD) 54.8 % -LV EDV BP 81.9 ml -LV ESV BP 31.9 ml -BP EF (MOD) 61.1 % -Name Value Normal RangeMV E-wave Vmax 0.91 m\/sec -MV deceleration time 185 msec -MV A-wave Vmax 0.76 m\/sec -MV E:A ratio 1.2 ratio -LV E:e' septal ratio 9.1 ratio -LV E:e' lateral ratio 7.6 ratio -Name Value Normal RangeAV Vmax 1.26 m\/sec -AV VTI 24.25 cm -AV peak gradient 6 mmHg -AV mean gradient 4 mmHg -LVOT diameter 1.91 cm -LVOT Vmax 0.92 m\/sec -LVOT VTI 17.68 cm -LVOT peak gradient 3 mmHg -LVOT mean gradient 2 mmHg -SV LVOT 51 ml -AVA (continuity Vmax) 2.1 cm2 -AVA (continuity VTI) 2.09 cm2 -Ascending Ao 2.86 cm -Name Value Normal RangeMV PHT 54 msec -MVA (PHT) 4.07 cm2 -Name Value Normal RangeTAPSE 2.2 cm -Name Value Normal RangePV Vmax 0.87 m\/sec -PV peak gradient 3 mmHg -RVOT Vmax 0.63 m\/sec -RVOT VTI 10.41 cm -RVOT peak gradient 2 mmHg -FindingsLeft Ventricle:The estimated ejection fraction is 55-60%.Thank you so much!",
  "input": "",
  "output": "This looks like an extremely normal echocardiogram. Like boring normal, nothing interesting or remarkable at all.The regurgitation is described as trivial and trace, which is like saying I saw it so I gotta document it, but its clinically meaningless."
},
{
  "instruction": "8 year old F, 4'1\" - Undiagnosed Condition \/ Continued dry cough - 2.5 years ongoingMedicines: Zyrtec (Switched from Claritin recently due to no positive response), Albuterol, Symbicort 160, pre+probiotic, antacid, - Has had adnoidectomy 2 months ago.My daughter has been going through an extremely long period of troubleshooting and we're still not at the end. What started out as a chronic cough and getting fevers and flu like symptoms were passed off as Covid towards the end of 2020.Then as the months went by it was passed off that she was getting sick at school. Various antibiotics and not getting better.Then in mid 2021 it was passed off as chronic sinusitus and told to use saline solution and more antibiotics.Then a few months later it was allergies and to take Claritin.Then after seeing the allergist it was Asthma because after 60pt test she's not allergic to anything but clearly decrease in breathing capacity so Albuterol.After seeing the cardiologist it was lower respiratory and take Symbicort with Claritin and Albuterol.After seeing ENT it was adnoids. After adnoidectomy she is to keep taking all of the above as well.Here we are two months later my daughter is home from school coughing just as she did two years ago. I have given her antacids and childrens pepto, along with pre+probiotics (largely because of the antibiotics) including all of the above mentioned medicine, and while she's no longer getting the flu-like symptoms she coughs so much she doesn't even realize she's doing it anymore. I don't know what's next. All ideas are welcome.",
  "input": "",
  "output": "Have you seen a pulmonologist? Or was that wrapped in with the allergist?One consideration would be tic cough or somatic cough disorder which would require behavioral therapy. I would especially think about this as you say she doesn't even realize she's coughing. Usually chronic cough is very noticeable to the child. Is she up all night coughing?"
},
{
  "instruction": "1: It really seems like he should have been diagnosed and started treatment for MDS after the bone marrow biopsy\/aspiration in July 2021, not 11 months later given the fact he has tried so many therapies for ITP with no response. It also notes that patients \"typically have mild-moderate thrombocytopenia.\" He has always been below 50K, surely that's not moderate?What is your opinion on his history\/diagnosis?2: I believe the nurses screwed up with premedicating him for his tranfusions during his last hospital visit. He had negative reactions on the two days I know they deviated from what is clearly on his chart AND on the request from his hematologist\/oncologist which tells them what medication he needs when. Then, units aren't even ordered for the following two days, a man who is recorded as transfusion-dependent in his chart. Prior to his hospital visit, the premeds were followed almost exactly with no negative reaction, and after noticing his head bleed, the nurse followed the premeds exactly with no negative reaction. I am going off of his medical history acquired from the hospital which notes exactly when the medication is administered (not being confused with when they charted it). His cause of death is noted as acute respiratory failure due to PNA, but its only because we took him off the oxygen due to the head bleed which I believe they caused.Am I looking at this wrong? Did they mess up?THANK YOUI know, it's a long one. I really appreciate it if you took the time to read through it and give your thoughts and opinions.I know he had a rough disease, and I believe I could accept his death, but something in these hospital notes stinks...",
  "input": "",
  "output": "Having treated many patients like this, these cases are often very difficult to manage. They sent off clonal hematopoiesis of indeterminate potential (CHIP) which is helpful in identifying mutations that may be causing cell abnormalities in MDS and sometimes garners targetable mutations eg IGH, del5q, ringed sideroblasts. However many of these we do not have detailed data given rarity so their effects on treatment are still unclear. In February 2023, that loss of chromosome 7 confers a very very poor prognosis along with refractory thrombocytopenia. I believe getting palliative care involved at this point may have been warranted. I do not believe any treatment wouldve changed his course by this time.I dont think a mistake was made by not treating him since signs of transformation to AML were not evident on the marrow from 2021. A score we use to predict transformation would also predict that prognosis was good with low chance of AML transformation in the next 10 yrs. Your father also has an extensive cardiac history and the drugs we use to treat MDS to AML have significant side effects including heart failure which Ive seen happen before from anthracycline. He had too many comorbidities so Vidaza was appropriate when it was given which is used to treat AML. Wed classify him as medically unfit but not frail and these patients are typically very hard to treat. Patients also become refractory to transfusions over time because their body starts making antibodies towards platelets. I do not think the mix up with premeds made a difference.Watching a loved one die from a hematologic malignancy is not easy, especially MDS. Please make sure you take care of yourself as well. I am very sorry for your loss. You did the right thing letting him go like you did. There was no meaningful way out of his situation where he would go on living a quality life. Please know that his medical team did everything they could."
},
{
  "instruction": "19 month old has had fever since end of JanuaryAge: 19 monthsSex: MaleHeight: 33 inchesWeight: 27lbsRace: CaucasianDuration of complaint: just over three monthsLocation: Southern United StatesAny existing relevant medical issues: Dominant Dystrophic Epidermolysis Bullosa with recessive traits. This is a genetic skin disorder. When googling this disorder, you'll find very bad cases. My son's case is very mild compared to some other children. My child's father also has the same type.Current medications: Tylenol and Motrin as needed.Include a photo if relevant: noneI'm on a mobile app, please forgive me if this looks awful as far as formatting goes. My son and I got COVID back at the end of January. We both seemed to recover okay. We both ran fevers throughout the duration, never above 102F. After recovering, we then noticed a new fever and took him to the doctor where he presented with a high pulse, left ear infection, and an upper respiratory infection. Dealt with that with antibiotics and the fever came and went. Never above 102F. About a month later, still not better. Back to the doctor with a right ear infection and strep throat. Antibiotics once more, different one this time. Two or so weeks later after antibiotics were finished, back to the doctor where he had a double ear infection and still had strep. My husband and I double down at this point and begin sterilizing everything this child touches. We clean his toys and play areas every evening after he goes to bed, sterilize common areas, threw away toothbrush and bottles and sippy cups, wash every single stuffed animal and pillow and change sheets. We went over the top to try and keep the germs at bay. They had him on the strongest antibiotic they could give him at this point. He finishes the antibiotics and we take him back to the doctor to ensure all the infections and strep are gone. They are. Relief, right?No. He still has the fever. He's had a fever of at least 100F nearly every single day since he got COVID at the end of January. The last appointment he had at the doctor where they confirmed ears looked fine and the strep was gone, the doctor said his fever was from teething. A nearly 102F fever from teething? For that long? I'm not buying it. I had another doctor we took him to (before all this) while his regular pediatrician couldn't see him tell me that it wasn't normal for a baby to have that high of a fever while teething.He goes back to the doctor tomorrow. I don't even know what to ask them to test for. I don't know what to even do. They're blaming it on teething. It doesn't seem normal for a toddler to have a fever for this long even when his sickness is no longer there. He doesn't currently have any infected sores from his skin condition, either. Nothing open and nothing oozing or bleeding, so that's not it. It's something else and I have done so much googling to try and figure out what it is he has or what's wrong and I don't know where to turn anymore.Please help. Thank you.",
  "input": "",
  "output": "Hi, wondering what happened with your little one"
},
{
  "instruction": "Pediatrician ordered blood work at the insistence of my husband after trying to say the fever was due to teething. Again. The CBC with differential came back normal, so they said. But in his medical records, it literally says abnormal in the comments. They also did a blood culture and when I asked about that, they said his preliminary results are fine and they were monitoring for the final results. For some reason, I cannot view this in his patient portal.We found something called PFAPA and are wondering if that's what we are dealing with.",
  "input": "",
  "output": "You can post the cbc here if youd like. Its not uncommon for a lab result to flag as abnormal but actually be fine. Blood cultures probably dont appear in your portal until 5 days, but if its negative at 1-2 days then it will almost certainly remain negative. PFAPA is certainly possible, or HIDS, but doesnt really fit the fever pattern.Chronic subtle skin infection was my first thought but sounds like not the case. Could just be back to back to back viruses especially if there are intermittent fever-free days, or mono. Can I presume he doesnt have a central line? I wouldnt be surprised if the doctor tomorrow wants to admit him to the hospital to expedite more testing. We typically send blood for lots of less common infections and non infectious conditions, and sometimes ultrasound and\/or mri looking for signs of a site of infection. Please update here if youre comfortable doing so."
},
{
  "instruction": "I've been concerned about mono. But there's no other symptoms. And wouldn't it have already gotten worse after three months if it were? I would be very surprised if the doctor does anything more than try to blame it on teething again. If I could switch doctors, I would do so in a heartbeat. We haven't had the best experience with her as far as caring goes...He does not have a central line, no. What types of things would the blood work be looking for?",
  "input": "",
  "output": "Viruses can cause fever and no other symptoms in little ones. 3 months is a long time though for one virus. But again if he has had any fever free periods it could just be recurrent normal infections.Testing could look for general inflammation, bone marrow function , mono and other weird infections, autoimmune conditions which would mostly be JIA in a toddler, immunodeficiency, malignancy which seems unlikely here. Many of the diagnoses which cause 3 months of fever do not have a specific test and are tough to diagnose.Im sorry about your experience with your doctor. In my hospital if you showed up in the ER reporting 3 months of fever especially with an underlying condition youd probably be admitted. If it was me and I was unsatisfied with the visit tomorrow Id consider going to the ER at a Childrens hospital if you have one near."
},
{
  "instruction": "2 year old respiratory distress?27 month old female, 27 lbs. Meds: duoneb, albuterol sulfate, epi pens. History: born at 31 weeks, required extensive oxygen support including ventilation for a few weeks. Allergies to eggs, peanuts, coconut, sunflower, dogs.2 year old is on day 3 of a relatively minor cold. She is covid negative as is the rest of the family (we tested for Christmas.) Over night started having a little trouble breathing. Resting resp. rate was between 36 and 40 breaths per minute. Grunting occasionally, minor retractions in rib cage and clavicle. No fever, no vomiting, normal energy all day prior. Normal appetite, normal diaper count. Gave duoneb breathing treatment and noticed slight improvement. (Resp rate went from 40 to 36 bpm.)Does this warrant an ER visit? With covid surging Im hesitant to bring a not yet vaccinated former preemie anywhere she could be exposed. My Childrens hospital offers an e visit option but I feel like this is something theyd need to see and or hear for themselves in person.",
  "input": "",
  "output": "That resp rate is close to normal for her age. The concerning part is the grunting and retractions. That signals she's working hard to breathe. Given her medical history it would be a good idea to have her seen by a doctor. She may need a change to her baseline inhaled medications if she's dealing with a cold."
},
{
  "instruction": "Thank you for your response, and happy holidays. Shes one of three preemies for me so this is not uncharted territory for us. This pandemic makes all of my decisions twice as hard, though. Risk of exposure vs medical treatment  Im calling her on call Ped now.",
  "input": "",
  "output": "Very stressful, I hear you. It's hard to recommend that you dont have her assessed by her pediatrician given the signs of respiratory distress. That's why there are docs on call on holidays, don't feel bad contacting them."
},
{
  "instruction": "COVID-19 FAQNote the information below may well now be out of date. If I get a chance I will update.READ THIS FIRSTIve written this to try to answer some common questions about COVID-19. I will try to answer any other questions you may have.Do not ask what your personal risk is due to whatever medical condition you might have. We simply dont know. Read whats written below - age is the most important factor in determining someones risk of severe disease (ie needing hospital admission) or death.Do not list your symptoms and ask if we can tell you whether you have COVID-19 or what precautionary measures you should take - we cant. You should follow you local public health guidance. If in doubt, isolate and only go to the hospital if absolutely necessary. Read below for more information.Clearly people arent actually reading this and just asking the above anyway, Im no longer going to reply to these questions. I generally reply to all questions, if I havent replied to yours its because youre either asking the above or your answer is contained within this post.What is it?COVID-19 means coronavirus disease 19 (as it was first reported to the WHO on NYE in 2019). It is caused by the SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2).Why is it so bad?COVID-19 is very contagious. Current data suggests an R0 (that is the number of people an infected person will go onto infect) of 2.5-3. By comparison your average seasonal flu with have an R0 of about 1.3. To put this into perspective, if you start with 10 people infected with seasonal flu, over ten infection cycles youll end up with about 138 infected people. With COVID-19 over the same ten cycles youll end up with tens of thousands to hundreds of thousands of infected people. Bear in mind this is not what is going to happen, only what could happen if the a disease was left to spread without effort to slow it. Public health measures to contain it can massively reduce the actual transmission rate.How come more people dont have it?We only know how many confirmed cases we have. For every one person who is ill enough to be tested theres a large group who have mild symptoms only and arent tested. This number varies wildly but seems to be about 1 in 10 (ie for every confirmed case theres another 9 people out there who have COVID but arent symptomatic enough to get tested.How do I know if I have it?The most common symptoms are a fever and a persistent cough. Other flu like symptoms may be experienced. It will be very variable from one person to another. The only way to know is to be tested - access to that depends on whats being done where you live.Can I find out if Ive had it already?Right now no. There is a test in development.Am I going to die?About 1 in 8 of the KNOWN cases (ie only those who are confirmed to have COVID) will end up being hospitalised. About 1 in 6 of this group will become critically ill and need to be managed on an ICU. Of this ICU group about half will die.For the 7 out of 8 cases who arent hospitalised the symptoms are mild enough to be managed at home. Remember for each of these people theres another 8-9 who arent even aware they have it. Some people have no symptoms, for others its the same and a bout of flu.The good news is if youre young youll probably be fine. Young adults and children have excellent survival rates with deaths very rare. Older people on the other hand are at much greater risk. Amongst the 60-69yr age group mortality is around 3%, whilst in the over 80s its approaching 15% (again of confirmed cases).I have a co-morbidity!The biggest risk factor for higher mortality seems to be cardiovascular disease, followed by diabetes and hypertension, then chronic respiratory disease such as COPD.Age remains the biggest risk factor by far, if youre young and you have one of these that doesnt mean youre going to die. It would be sensible to minimise your exposure.Can I go out?All these restrictions on movement are about slowing spread. The big problem for hospitals now is a sudden tsunami of critically ill people that the usual ICU capacity cant cope with. Think of it like taking a train - go rush hour on a week day and its packed and you cant get a seat, much quieter in the middle of the day. Go on a weekend and theres no early morning peak so the passengers are divided amongst more trains thus everyone sits down, even though a similar number of people travel over the course of the day. If we can slow the rate if infection ultimately therell be the same number of cases but they wont all come at once so the hospitals will be able to manage them. Make sense?Every country is different so you should follow your local guidelines. Doctors on this forum come from all over the world, what is right where they live may not be right for you.What can I do to minimise my risk?Wash your hands. Regularly. Avoid large gatherings. Follow local rules and guidance. If you have symptoms then stay away from other people. Take this seriously, because it is.Do not ask if we can tell you whether you have COVID based on your symptoms alone - we cant.Should I stop taking my medication?There have been media reports that people taking certain types of mediation, specifically ACE inhibitors\/A2RBs (eg ramipril\/losartan) or NSAIDs (eg ibuprofen) are at higher risk of catching or complications of COVID. To my knowledge there is no good data to support this. You should continue to take your medication as normal unless instructed otherwise by your doctor.",
  "input": "",
  "output": "Follow local guidelines regarding social contact.Mild can be no symptoms at all to a mild flu like illness.Safe to go out on your own.We cannot comment on individual risk.https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2762130 URL to a paper out of China - the 80% mild figure includes those with viral pneumonia not requiring respiratory support - this will absolutely be the worst viral illness many of us have had"
},
{
  "instruction": "Are things such as a mild sore throat\/ fatigue early signs?",
  "input": "",
  "output": "Possibly yes. Could also belong to another virus. When in doubt, assume you're infected and stay away from others"
},
{
  "instruction": "What about sore throat caused by swollen lymph node? I can see it on one side inside my mouth and my neck is sore to the touch behind that ear. :( Temp has been slightly above 99 Fahrenheit this evening but its my understanding that body temperature fluctuates throughout the day.",
  "input": "",
  "output": "If it's just a node it seems unlikely, but I have no way to tell for sure"
},
{
  "instruction": "Is throat clearing the same as coughing? My coworker has been doing it all day and we share an office.",
  "input": "",
  "output": "not the same, but can be a sign if infection. Im not clairvoyant though."
},
{
  "instruction": "How can I tell if I have new onset of asthma vs. COVID-19? I've had low fever, had to clear my throat but not cough, and have tightness in my chest \/ difficulty breathing and occasional pain in my lungs. There is no wheezing at all, no runny nose or congestion, my airways feel dry. I have no history of asthma, I'm 26 and exercise regularly (been recently training for cardio). The symptoms started in earnest about a week ago and got slightly worse the last few days. I'm trying to figure out if it could be just sudden onset of asthma or if I should be concerned that I have COVID-19. Any thoughts on to what extent these symptoms may resemble asthma?",
  "input": "",
  "output": "New onset asthma in adults rare Infection common"
},
{
  "instruction": "Is it possible that there was a different strain of coronavirus that was non lethal circulating in the US this winter? I got quite sick in December 2019 and the main symptom was sore throat\/persistent cough. Many people in the community were sick as well. It was definitely not flu, I did get screened and was negative and I also get flu vaccination annually. Also the period of fever was short and not particularly high.",
  "input": "",
  "output": "There are a variety of respiratory viruses that cause essentially the same upper respiratory symptoms. This includes other strains of coronavirus but most commonly it's rhinovirus or others. You can't really tell them apart without viral PCR test."
},
{
  "instruction": "Glad you asked this. I also have stage 1 or 2 sarcoidosis which is largely asymptomatic. My brother, however, has fibrosed lungs due to severe sarcoidosis. I worry more about him as he is currently on an immunosuppressant which seems to be helping him.",
  "input": "",
  "output": "Not to my knowledge.That would come under the classification of pulmonary disease so I think would suggest higher risk of severe symptoms, but depends on age and severity of the sarcoidosis."
},
{
  "instruction": "Anti-inflammatories and steroids and COVID19I have seasonal allergies and I take albuterol, nasonex for symptom relief. I read that anti-inflammatories and steroids aggravate COVID19 symptoms. I'm not sick with any symptoms of COVID19, but should I stop taking these just in case?I also take antihistamines (Zyrtec\/loratadine) and a daily inhaler Ventolin (I don't believe that is steroids).",
  "input": "",
  "output": "Good question.This has been widely reported after comments from the French health minister.As I understand is there is no good evidence suggesting any increased susceptibility to, or severity of COVID amongst those taking non-steroidal anti inflammatory medication such as ibuprofen.People who regularly need steroid such as prednisone should absolutely keep taking them as normal unless directed otherwise by their doctor.Ill add a section to the post."
},
{
  "instruction": "Shortness of breath muscle pain I wish they would define and describe these things, I am confused as to what they really mean.I have a persistent feeling that I need to yawn but cant- is that shortness of breath? Im not wheezing, I just feel tight. I had this a week to 2 weeks ago as well but attributed it to being on prednisone at the time.I have localized muscle pain, is that muscle pain? or does it need to be full body?I had contact with two people recently returned from Beijing 19 days ago. There are a few hundred confirmed cases in my area",
  "input": "",
  "output": "Needing to yawn is different from feeling like you can't catch your breath. The latter is shortness of breath. Generalized muscle pain is what you should expect with COVID-19, simmer to a flu or some bad colds."
},
{
  "instruction": "came into this thread looking for the same thing. I had a slight tightness in my chest\/throat without pain. intermittent chills, feeling feverish (but i dont think i actually have a fever), and no coughing.i have no difficulty breathing persay, but taking a deep breath requires more effort than it used to. I dont know if this qualifies as a \"shortness of breath\" because the definition is so vague.. is it considered having \"difficulty breathing\" even if you're not gasping for air?I've had no known contact with anyone with COVID19, been indoors since last Friday. But I live in NYC so I'd say my risk of having already caught it is pretty damn high.",
  "input": "",
  "output": "The feeling you are looking for is if you cannot catch your breath.We'll use this as the new COVID-19 question thread.We can't answer every question, especially those about whether you might or do have a case yourself. For general questions that we might be able to answer and that aren't explained in government and international websites, ask here. If you're asking a lot about your or loved ones' individual risk, look at the resources from reputable sources, like the sites linked in the original post here. We don't know better than the information provided, and we can't provide individual consultation to everyone.What is my risk?We can't answer that. The data available aren't thorough and granular enough, and we don't have full information, and that can't be calculated accurately even for the best-characterized diseases. All that we can say is repetition of the guidelines from the CDC and WHO websites, or other major organizations. Some comorbidities increase your risk. We can't say anything more individualized than that.What should I do [especially with individual risk factors]?There are no secret super-precautions to take. The recommendations are the same for everyone: wash your hands, don't touch your face, practice social distancing. It's more important for you, personally, if you have higher risk, but it's good advice for everyone. It reduces your risk of getting COVID-19, and it reduces your risk of spreading COVID-19 to someone who is higher risk than you.Previous megathreads:"
},
{
  "instruction": "Prediabetic and COVID-19So I know that if you have diabetes and you contract COVID-19 it could be bad. I was diagnosed with prediabetes and was wondering if that carries the same risk if I contract COVID-19",
  "input": "",
  "output": "No evidence of this to my knowledge."
},
{
  "instruction": "I'm in the same boat, I really can't tell if I have shortness of breath, or if it's just anxiety. It's been persistent for about two weeks now, with very few other symptoms like extremely mild cough now and then.",
  "input": "",
  "output": "Top of the FAQ under read this first.Do not seek medical attention unless you are so unwell that you need to go to hospital. Use online resources or call 111."
},
{
  "instruction": "In kind of a difficult situation with my children. 50\/50 weekly custody split. Their mother got them yesterday and tells me 4 hours later that I need to pick them up because she has covid symptoms. It takes everything for me to not go get them but as I understand, conventional wisdom right now is to assume they are infected and not to spread it (leave them there). Youngest is 9 both children healthy. My girlfriend is also immunocompromised. Am I taking the appropriate precautions or is it better to get them out of there?",
  "input": "",
  "output": "Majority of guidance is that the children should be isolated for 14 days if they live with someone who is infected. You should follow local guidance."
},
{
  "instruction": "have an academic question about asymptomatic carriers of covid-19.people who are infected but not showing symptoms - does that mean their body is not responding to the infection, and not creating antibodies to destroy the invading virus?If that's so, does that mean they will be able to infect other people way past two weeks?",
  "input": "",
  "output": "Absolutely they are having a normal immune response."
},
{
  "instruction": "thank you for the response. Quick follow-up (and sorry about the dumb questions): do you mean an asymptomatic carrier will have a normal immune response, therefore will still create antibodies to fight the virus despite being asymptomatic?Or do you mean in spite of having a normal immune response, their body couldn't detect the virus (therefore asymptomatic and won't fight the virus)?",
  "input": "",
  "output": "The former"
},
{
  "instruction": "Hi, hopefully someone can ease my anxiety a little, we have our wedding planned for July of next year, there's still a lot of planning to do, and I'm worried that even though it's over a year away this virus could get big enough that large gatherings will still be banned by then. Is this realistic? Is there enough research going into the virus that we should be able to get on top of it all with vaccines and treatments within a year?I know that there are people out there who's health is on the line, and they have more right than I do to be anxious, but... I'm worried about it too. Basically I just need reassuring that I can keep planning and we won't be living in a post apocalyptic society by then.",
  "input": "",
  "output": "Sorry I cannot predict the future.I will be surprised if this has not settled down in 16 months"
},
{
  "instruction": "What exactly is the difference between the names COVID-19, SARS-CoV-2, and 2019-nCoV?",
  "input": "",
  "output": "Covid19 is the name of the disease,sars cov2 is the name of the virus. The last term isn't used anymore."
},
{
  "instruction": "Is it safe to take anti-histamines if you think you might have COVID? I think I am also experiencing seasonal allergies based on runny nose, sneezing, and dry eyes. I just don't want to suppress my immune response.",
  "input": "",
  "output": "Yes"
},
{
  "instruction": "What are the chances of it spreading through a hvac(forced air) heating system? I live in a basement suite. When my upstairs neighbours get a cough or virus. I seem to get it a few days later.",
  "input": "",
  "output": "We don't know. It's possible."
},
{
  "instruction": "Any potential issues taking albuterol through an inhaler for asthma symptoms if the symptoms are actually being caused by COVID-19 respiratory infections?",
  "input": "",
  "output": "No continue you usual meds"
},
{
  "instruction": "There is a post online circulating by someone who says that she has been in pediatrics for 8 years. Her post indicates that she believes that Covid-19 has been moving through the United States for several months. She describes symptoms, cases she has had come into the practice she works at, and says that she would send samples off for testing if it was possible.Her post has been shared almost 300,000 times. In most of the local posts, there are about 30-50 likes. That means that this is reaching upwards of 15 million people.I am also in the medical field, but as someone who helps make decisions for at-risk patients. In my small town in Florida, this nurse's post has been shared by half of my town. The comments are all in agreement - they've all had this before. It's utter nonsense, shared by people who simply don't understand the first thing about medicine or pandemics.I contacted this nurse this morning and informed her that her post is spreading through my community as well as others, and that it is being used to suggest that people don't need to take this seriously, do not need to socially isolate, etc. I asked her to recant and print a retraction. She threatened to sue me for stalking her. She then went and put a disclaimer on her post telling people to take Covid-19 seriously. The issue is - her words are being copy and pasted, and not shared, so people are still reading her post without the disclaimer. And they're taking it as gospel.I decided this afternoon to call her office, only to find out that there was no way to bring this to her doctor's attention without going through her. She already told me that she manages the Facebook page. Apparently she also screens the emails to her doctor, according to the receptionist. There is no way to contact this doctor directly, and I have tried every way possible. I am hesitant to report her to the board of nursing, and even if I did, I don't have her information.Should I let this be? All I want is for her to print a retraction and remove her original post - I don't want to personally be involved, I just don't want the locals in my town to buy her conspiracy theories. I don't know what to do from here.",
  "input": "",
  "output": "Well youre correct its clearly rubbish but as a physician I have no idea what to suggest"
},
{
  "instruction": "My dad is a domestic US pilot, and he's going to be in my city this week. Would it be a bad idea to still meet up (in a non-public place)? I'm 24, he's 55, we're both currently healthy - as far as we know - without any comorbidities. Feeling like I should cancel but I really want to see him.",
  "input": "",
  "output": "If youre both free of symptoms you can certainly see one another. Large gatherings or unnecessary social contact for those at high risk (elderly, co-morbidities) should be avoided. As always follow your local guidance."
},
{
  "instruction": "12 days ago my father wasn't feeling well (after a week of feeling unwell, with symptoms of common cold), he went to hospital because he was suspected to be infected with coronvirus, he had a chest CT scan and blood test (I think for CBC and CRP), the doctor said his CT scan showed lung infection but it was not coronavirus, they prescribed her some medication and he's got very well and back to normal life.7 days ago or so my mom got sick too with symptoms like fatigue and cough. he went to our local clinic, got some medication and the doctor prescribed her a blood test. she got well too but 2 days ago she went to doctor to check and show her blood test, the doctor told her \"you were close to get coronavirus but the danger has passed\" (excuse my language but I don't know what the fuck he meant!) my mom then has asked her if a lung image is needed and he's replied that it's not needed and her lungs are fine (he's checked her breathing pattern with Stethoscope apparently). he then has prescribed Vitamin D and acid folic in addition to her previous medications such as Amoxicillin. My mom is alright and her illness is mostly gone but I looked at her blood test, these are the numbers:W.B.C: 3700 \/ulRBC: 4.09 (10*6\/ul)Neutrophilis%: 64Lymphocyte%: 36CRP: (Positive) 48 mg\/lShould I be worried? what's the right thing to do? as I checked with test references, her CRP is so high, normal level should be less than 6 apparently. Is it possible that she suddenly and silently get very sick without symptoms, now that she's quite fine?",
  "input": "",
  "output": "Bloods consistent with non-specific infection.Cannot tell you if they have\/had coronavirus without a test."
},
{
  "instruction": "I live my aunt and her boyfriend. They refuse to let me leave or open windows thinking it will make me 100% safe. Does that ensure safety or are there any other things they should o",
  "input": "",
  "output": "You are minimising risk but nothing is impossible."
},
{
  "instruction": "The UK released last night that anyone whos routinely offered a flu vaccine on the NHS due to a chronic condition is now classed in the high risk group Ive got digestive tract paralysis, an ileostomy, dysautonomia, chronic joint pain, chronic fatigue and urinary retention as my main conditions None of these affect my heart or lungs so I accept that I may be higher risk to catch it but in my eyes I shouldnt be higher risk of getting complications except maybe my potassium dropping lower than usual if I struggle with oral intake\/get the rare diarrhoea Do you think Im right in my assessment of my risk or would you consider someone like me high risk for complications too ? Im a 24 year old female by the way who does have a history of being hospitalised with chest infections",
  "input": "",
  "output": "Cannot comment on individual risk.As in the above post age is the biggest risk factor for severe disease."
},
{
  "instruction": "Highly probable that I have Covid 19 and I was wondering if I should continue nursing my 12 month old daughter. She is also feverish but much milder than myself and I was curious if there is any literature or recommendations in regards to breastfeeding. I know other illnesses can pass on antibodies and wasnt sure if this was the same or if I could make her more sick.",
  "input": "",
  "output": "To my knowledge no evidence passed on breast milk.Illness generally very mild in children.QuestiomThank you for the information! This is indeed a pandemic of a lifetime, but i just wanted to clarify the overall death rate: 1 in 10 people are sick enough to get tested, of those 1 in 8 get hospitalized, of those 1 in 6 are critical and of those half die. So the death rate is 1\/10\/8\/6\/2 which is about 0.1% (probably understated a bit because some COVID deaths are misattributed). Is that correct or have I missed something? These numbers seem much lower than what usually gets reported (2% i believe).Data very rough, dont extrapolate from it.Mortality rate quoted for confirmed cases. Far more out there undiagnosed so probably lower than initially thought in the whole population. Mortality rate amongst elderly is horrific."
},
{
  "instruction": "Why dont doctors give people antivirals early on in a cough to prevent lung damage. Why are public health authorities waiting until people need or are close to needing ventilators to test them.",
  "input": "",
  "output": "Multiple studies underway to see if antivirals effective Public health decisions are local and political"
},
{
  "instruction": "I understand social distancing well enough to understand the message. Stay home. For my own mental health, I was wondering if fishing, alone, on a river close to home is something thats still feasible. Is this a situation in which even while alone, in a quiet place in the woods, Im still putting myself or others at risk?",
  "input": "",
  "output": "Close contact needed for transmission."
},
{
  "instruction": "Why isn't thorough nose and face washing being advised with hand washing if the end goal is to keep virus from face (entry points). Thanks.",
  "input": "",
  "output": "People tend not to touch things with their faces, apart from their hands"
},
{
  "instruction": "My doctor found a shadow on my liver in an ultrasound. Im scheduled for a ct scan on Monday and a follow up doctor appointment Friday. However, should this wait? What if Im exposed to covid by going to the dr. On the other hand what if I have cancer and should be seen....what would you recommend?",
  "input": "",
  "output": "Continue normal medical care unless advised otherwise by your doctor"
},
{
  "instruction": "I have about a 28ish BMI so I'm overweight but not obese. Am I at higher risk because of that?",
  "input": "",
  "output": "Government guidance. High risk BMI >40"
},
{
  "instruction": "I have probable covid-19 but dont meet travel\/contact requirements for testing. I am a 28 year old female with no comorbidities, however my lymphocytes are consistently low and neutrophils high in various bloodwork throughout the years. Not sure why.Severe cough for about a week, fever for past five days, influenza A and B negative, virus panel also negative. Chest X-ray shows no pneumonia, but Ive read that covid-19 pneumonia can only be seen on a CT scan. Coughing up frothy sputum almost constantly, pain when breathing, and getting lightheaded with light activity around the house.Naturally I am quarantined with my family however:-should I be concerned about developing pneumonia?-when they talk about the possibility of convos-19 patients developing long-term or permanent fibrosis, what exactly does this mean? What symptoms would one have, and how would one get tested in the first place?Thanks!",
  "input": "",
  "output": "If your symptoms worsen and you are concerned seek reassessment.Given this virus was only identified less than three months ago anyone whos talking about secondary fibrosis or any other long term effects is full of shit."
},
{
  "instruction": "What sort of things should people use disinfectant on?Should they use it on surfaces other people people touch because Covid-19 can live on surfaces?",
  "input": "",
  "output": "Data still emerging about how long it persists on different materials.You cant be too clean"
},
{
  "instruction": "Does Covid-19 just live on people's skin and then gets transmitted by touch?Is it transmitted through bodily fluids?",
  "input": "",
  "output": "Most aerosol spread from coughing onto external surfaces or other people. Coughing onto hands then touching other people also spreads. Hence hand hygiene and social distancing essential"
},
{
  "instruction": "w.r.t the last FAQ point, I have tried to dissect the Lancet letter in question, and am wondering if my interpretation is correct;https:\/\/www.thelancet.com\/journals\/lanres\/article\/PIIS2213-2600(20)30116-8\/fulltextBasically what I understand is that if you are taking ACE Inhibitors, and you encounter a drug interaction with a different drug, there may be additional risk\/complications.However, this is only off investigating dead bodies with comorbidities, so it's not necessarily an accurate representation of the facts.Thanks",
  "input": "",
  "output": "As I understand (DOI I have not read the paper relying on others interpretation) the lancet paper is hypothetical not hard evidence. European society of cardiology has an excellent position paper on the use of ACE- inhibitors\/A2RBs that is available on their website."
},
{
  "instruction": "Can you contact COVID19 by eating food that has the virus? Let me give you an example. You order a take out pizza and the cook sneezes on the pizza so virus droplets are on the food. Are you able to get the virus by eating it or would you have to get the virus on your hands and then touch your nose\/eyes in order to get the virus?",
  "input": "",
  "output": "If someone with covid sneezes on something and you then eat it then yes you could contract it that way.Of course if your local pizza chef has a habit of sneezing on food then serving it Id advise finding a new pizza restaurant."
},
{
  "instruction": "I keep hearing that a large a symptomatic portion of the population spreads the disease because they dont know they have it. If this virus is try spread via droplets, then how do asymptomatic infected people spread it? Wouldnt they need to be coughing, sneezing, etc for it to spread easily? Otherwise wouldnt chances of spreading be super minimal from an asymptomatic person?",
  "input": "",
  "output": "You could also get it from them touching their face then touching a doorknob."
},
{
  "instruction": "I read it can survive 3 hours in the air. Is this true? For example, if you go into an elevator that was previously ridden by someone infected, how likely are you to get infected?",
  "input": "",
  "output": "No, the virus is not likely to be randomly aerosolized as far as we currently know. It's droplets, which can survive on surfaces. The air problem is mostly in the hospital during high risk respiratory procedures."
},
{
  "instruction": "I don't know if this is the right place to ask this, I can post it elsewhere if it's not.I'm 23F, 5'3 117lbs, in canada. drink occasionally and very rarely smokeI've never had the flu, and I hardly ever get colds. The most I'll get is the sniffles, sore throat and a headache in winter. The only times I've been sick with something that I can remember was a stomach bug 2 or 3 times and I think I had strep throat at some point.I've had the flu shot maybe once when I was a kid but I can't remember another time since then. There's no real reason to it, I know I should be getting it but my parents never enforced it so we all just forget out it (my family is like this too, I could count on one hand the times one of got really sick with something.) I know I should because it hurts other people but that's not the point to this. My question is this, from what I understand having a flu shot and getting the flu builds immunity to the virus, right? If I've never had the flu or the flu shot, and I get the COVID19, is my body not gonna take it well? I know you probably don't have an exact answer to this since we are all still learning about it but maybe theoretically could you tell me what you think? or how would I react if I get the seasonal flu?",
  "input": "",
  "output": "Having had seasonal flu or the flu vaccine has nothing to do with how you may react to this covid virus"
},
{
  "instruction": "Low respiratory rate and possible Bradypnea?M35, 57, 190lbsHi all. Ive been tracking my breathing rate using a Fitbit Sense, and it has been fluctuating between 10-11 every night. In addition I snore, occasionally wake up throughout the night, and get lightheaded occasionally (maybe one brief spell once per week), but that often goes when I eat. Otherwise feel fine. I was diagnosed with vertigo a couple of years ago when my dizziness was particularly bad and the medication cleared that up.Is this something to be concerned with? I keep reading that below 12 is abnormal but I cant find much more than that. Is that below 12 when awake? Is 10 ok when sleeping?",
  "input": "",
  "output": "Yes, it's totally fine. It's a pretty useless thing to track."
},
{
  "instruction": "Thank you! My hypochondria gets the better of me sometimes",
  "input": "",
  "output": "So why have a device that gives you too much information with no real need\/ability to analyze it usefully? Get rid of that smart watch thing and move on with life."
},
{
  "instruction": "Can the cause of a respiratory infection be determined by listening to a patient's lungs?Patient is 33F, 5'3\", 105 lbs, has a history of psoriatic arthritis and gerd and takes humira, methotrexate and pantoprazole.Patient has had wheezing and chest congestion for three weeks. PA listened to patient's lungs and said the diffuse rather than focal crackling\/wheezing sound ruled out bacterial and fungal infections. Can these infections truly be ruled out based on sound? No tests were performed.",
  "input": "",
  "output": "No. Classical \"typical\" pneumonia tends to be localized to one part of the lung. \"Atypical\" bacterial pneumonias can be diffuse. I would be very concerned about a patient with an autoimmune condition on multiple immune suppressing medications (especially the humira). Three weeks is a long time to infectious symptoms -- typically if something hasn't gone away in 10-14 days we look into it further. I strongly suggest you seek out another opinion, probably from an MD or DO who will likely have more training and experience than a PA."
},
{
  "instruction": "Results of blood tests show abnormal for a lot of things and I was randomly scheduled to see a respiratory therapist. Please help me understand25 year old male 62 181 lbsNo alcohol ever, no smoking ever, no drugs everActive duty MarineOver the last 2 months, I started having severe stomach pains and have been unable to eat or drink very much which resulted in me loosing 25 lbs. I started vomiting what appeared to be reddish brownish stuff last Tuesday with coffee ground looking things in it that smelled like rotten metallic feces. I went to the ER and had blood work and a CT scan. The scan showed my small intestines were inflamed in some areas, and the blood work that was available immediately showed my bilirubin and coagulation levels are high, which they already knew because I appeared to have jaundice.I checked my online tricare portal for the results of the blood test and UA that took a few days to come back and I learned that my Lipase level is low (66), BUN is high (21), sodium is low (105), Glucose is high (105), bilirubin total (2.7) and direct (.40) are both high, UA RBC is high (67), UA spec gravity is high (1.041), and that Ketones, blood and protein were all moderately present in my urine.I did my best to google what all that meant and all I learned is that there is possibly something wrong with my liver, kidneys, and pancreas. The reason I am extremely confused is that someone at the naval hospital scheduled me to see a RT? This was not communicated to me. I just happened to see it on my patient portal. I knew about the GI doctor referral but why would I need to see a RT? Also, based on what info Ive given, what seems the most likely to be wrong with me?",
  "input": "",
  "output": "Gastritis or esophagitis. PPI should help. Follow up with GI doctor. Can't comment on rest"
},
{
  "instruction": "Thank you for responding! The surgeon also said he is thinking Gastritis. The ER doctor prescribed protonix for home until follow up with GI on the 8th of March",
  "input": "",
  "output": "Omeprazole . Good luck"
},
{
  "instruction": "I have respiratory sinus arrhythmia in my late 20s, is this still normal? RHR is 54bpm and BP is 110\/7026 male, when I breathe in my HR goes up, when I breath out it drops drastically. Most devices clock my RHR at mid 50s bpm. Now it goes up no problem, when I workout it goes up quickly but it also drops fast too. I can go from 160 running a mile and sit down and 40 seconds later its 59 bpm (verified by the good old fashioned finger) I do get lightheaded occasionally but its very much tied to anxiety when I do so not really something that I relate to a heart related issue. Im just curious if this is worrisome? I read respiratory sinus arrhythmia usually goes away in early adulthood but I certainly still have it. Ive had a echocardiogram a few years back (unrelated screening) and it was totally normal. A holter monitor as part of the same screening was fine beyond a few hundred PACs a day and a few dozen PVCs which doc said are normal findings.Anyway is anything worrisome about my heart rate and the breathing affect the HR?",
  "input": "",
  "output": "Nope, not worrying."
},
{
  "instruction": "What kind of viruses cause respiratory and gastric symptomsSo my poor baby, (M, one year old, 28 pounds, no underlying conditions) has been sick for 2 days. 101 fever, diarrhea, vomited once, runny and stuffy nose and a slight cough. I also believe his throat may be sore but it's hard to tell. He just tested negative for flu and covid so I'm wonderimg what types of virus cause these diverse symptoms. I'm not super worried because Hes holding down his drinks, and still being playful through out the day. Hes just napping a lot more and not really eating. Any idea what kind of bug he got? No one else in the house is sick and we don't leave the house other than for work.",
  "input": "",
  "output": "Usually in this age either RSV, adenovirus or rhinovirus"
},
{
  "instruction": "They didn't test him for RSV but now I wish I asked! My 3 year old had it at his age but he was REALLY sick. My little guy is just really run down but still acting fairly normal. Whatever the diagnoses is, won't really change the treatment though so I'm not gonna stress too much :) thanks for the response!",
  "input": "",
  "output": "Posts by unflaired users that claim or strongly imply legitimacy by virtue of professional medical experience are not allowed.If you are a medical professional who wishes to become a verified contributor to this subreddit, please message the moderators with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!We do not accept digital forms of identification."
},
{
  "instruction": "COVID19 megathread #4READ THIS FIRSTthis was written by u\/nowweareall to try to answer some common questions about COVID-19. We will try to answer any other questions you may have.Do not ask what your personal risk is due to whatever medical condition you might have. We simply dont know. Read whats written below - age is the most important factor in determining someones risk of severe disease (ie needing hospital admission) or death.Do not list your symptoms and ask if we can tell you whether you have COVID-19 or what precautionary measures you should take - we cant. You should follow you local public health guidance. If in doubt, isolate and only go to the hospital if absolutely necessary. Read below for more information.Clearly people arent actually reading this and just asking the above anyway, Im no longer going to reply to these questions. I generally reply to all questions, if I havent replied to yours its because youre either asking the above or your answer is contained within this post.What is it?COVID-19 means coronavirus disease 19 (as it was first reported to the WHO on NYE in 2019). It is caused by the SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2).Why is it so bad?COVID-19 is very contagious. Current data suggests an R0 (that is the number of people an infected person will go onto infect) of 2.5-3. By comparison your average seasonal flu with have an R0 of about 1.3. To put this into perspective, if you start with 10 people infected with seasonal flu, over ten infection cycles youll end up with about 138 infected people. With COVID-19 over the same ten cycles youll end up with tens of thousands to hundreds of thousands of infected people. Bear in mind this is not what is going to happen, only what could happen if the a disease was left to spread without effort to slow it. Public health measures to contain it can massively reduce the actual transmission rate.How come more people dont have it?We only know how many confirmed cases we have. For every one person who is ill enough to be tested theres a large group who have mild symptoms only and arent tested. This number varies wildly but seems to be about 1 in 10 (ie for every confirmed case theres another 9 people out there who have COVID but arent symptomatic enough to get tested.How do I know if I have it?The most common symptoms are a fever and a persistent cough. Other flu like symptoms may be experienced. It will be very variable from one person to another. The only way to know is to be tested - access to that depends on whats being done where you live.Can I find out if Ive had it already?Right now no. There is a test in development.Am I going to die?About 1 in 8 of the KNOWN cases (ie only those who are confirmed to have COVID) will end up being hospitalised. About 1 in 6 of this group will become critically ill and need to be managed on an ICU. Of this ICU group about half will die.For the 7 out of 8 cases who arent hospitalised the symptoms are mild enough to be managed at home. Remember for each of these people theres another 8-9 who arent even aware they have it. Some people have no symptoms, for others its the same and a bout of flu.The good news is if youre young youll probably be fine. Young adults and children have excellent survival rates with deaths very rare. Older people on the other hand are at much greater risk. Amongst the 60-69yr age group mortality is around 3%, whilst in the over 80s its approaching 15% (again of confirmed cases).I have a co-morbidity!The biggest risk factor for higher mortality seems to be cardiovascular disease, followed by diabetes and hypertension, then chronic respiratory disease such as COPD.Age remains the biggest risk factor by far, if youre young and you have one of these that doesnt mean youre going to die. It would be sensible to minimise your exposure.Can I go out?All these restrictions on movement are about slowing spread. The big problem for hospitals now is a sudden tsunami of critically ill people that the usual ICU capacity cant cope with. Think of it like taking a train - go rush hour on a week day and its packed and you cant get a seat, much quieter in the middle of the day. Go on a weekend and theres no early morning peak so the passengers are divided amongst more trains thus everyone sits down, even though a similar number of people travel over the course of the day. If we can slow the rate if infection ultimately therell be the same number of cases but they wont all come at once so the hospitals will be able to manage them. Make sense?Every country is different so you should follow your local guidelines. Doctors on this forum come from all over the world, what is right where they live may not be right for you.What can I do to minimise my risk?Wash your hands. Regularly. Avoid large gatherings. Follow local rules and guidance. If you have symptoms then stay away from other people. Take this seriously, because it is.Do not ask if we can tell you whether you have COVID based on your symptoms alone - we cant.Should I stop taking my medication?There have been media reports that people taking certain types of mediation, specifically ACE inhibitors\/A2RBs (eg ramipril\/losartan) or NSAIDs (eg ibuprofen) are at higher risk of catching or complications of COVID. To our knowledge there is no good data to support this. You should continue to take your medication as normal unless instructed otherwise by your doctor.What is my risk?We can't answer that. The data available aren't thorough and granular enough, and we don't have full information, and that can't be calculated accurately even for the best-characterized diseases. All that we can say is repetition of the guidelines from the CDC and WHO websites, or other major organizations. Some comorbidities increase your risk. We can't say anything more individualized than that.What should I do [especially with individual risk factors]?There are no secret super-precautions to take. The recommendations are the same for everyone: wash your hands, don't touch your face, practice social distancing. It's more important for you, personally, if you have higher risk, but it's good advice for everyone. It reduces your risk of getting COVID-19, and it reduces your risk of spreading COVID-19 to someone who is higher risk than you.So a lot of people have reported reduced lung capacity after having recovered from COVID-19, as with pneumonia. Would it be beneficial to practice breathing exercises like the ones listed here, both prior to infection and also after recovery?",
  "input": "",
  "output": "Certainly won't be harmful."
},
{
  "instruction": "Is it okay to go outside to a park? There's a park near my home that is never busy even when the world is normal. Can I go there and have a walk on my own or is it better to just stay inside?",
  "input": "",
  "output": "Yes, that should be fine. Please avoid playground structures, public water fountains, etc."
},
{
  "instruction": "the reason the goverment and every expert is saying dont use mask is to avoid having shortage for the professionals. Can you imagine if they actually recommended using masks? we already have a shortage. thats what I believe anyways..",
  "input": "",
  "output": "Please remember we can't answer every question, especially those about whether you might or not have a case yourself.For general questions that we might be able to answer and that aren't explained in government and international websites, ask here. If you're asking a lot about your or loved ones' individual risk, look at the resources from reputable sources, like the sites linked in the original post here. We don't know better than the information provided, and we can't provide individual consultation to everyone."
},
{
  "instruction": "Please help. Question about THERAPY for person tested POSITIVE. How to treat?A person I know (with whom I had no contact) has just tested positive. He's not being recovered at the hospital but he's had a very high fever for more than ten days.He's been treated with antibiotics so far: Fidato and Trissyl for about ten days after first negative tampon no improvement. Now after a second test - POSITIVE, they switched to Klacid and Augmentin antibiotics. He doesn't have respiratory issues so far so won't be taken to the hospital.What do you think of these meds? Please can you name any anti virals\/ therapies that can be used as a cure?I heard some improved after Tocilizumab (anti arthritis)It would just be useful to understand what options might be taken and I'd like to have opinions from Docs abroad. Thank you so much. I'd appreciate",
  "input": "",
  "output": "If they're treated at home, there is no approved treatment. It's all highly experimental. Chloroquine is used first, tocilizumab is more of a hail Mary treatment because it's very expensive."
},
{
  "instruction": "I tested negative for covid but I do have a virus and all the symptoms that go along with that. The doctor that swabbed me didnt swab my nose but my throat. Last weekI took an ambulance trip because I had chest pain and I could barely breathe. They sent me home with alot tests done and looking good. White blood cell count good etc. So should I treat this as any other virus? Obviously I have been physically isolating myself for almost 2 weeks because thats when my symotoms started. Now Ive been feeling much better and only have shortness of breath.I really want to visit my sister and neice. How long before Im not infectious?",
  "input": "",
  "output": "Yes, you can treat it as any other virus.Honestly, please don't visit your sister and niece right now. Only leave your house for essentials. This is not a time for socializing."
},
{
  "instruction": "Some Asthmatics apparently are being told to increase their Asthma medicine dose to \"prepare\" if you get corona... But my doctor (who I trust) said not to do this. Increase in Asthma medicine dose won't help and increasing your dose when your Asthma is controlled well in never a good idea.Anyone wanna weigh in? I can't imagine increasing Asthma steroids will help prevent or lessen symptoms if you get corona... Or any lung infection",
  "input": "",
  "output": "I'm with your doctor."
},
{
  "instruction": "I'm aware that people are recommended to stay away from taking ibuprofen, cortisone, and other anti-inflammatory drugs. But does this also apply to supplements? For example, St. John's Wort, green tea, and turmeric are all supposed to have anti-inflammatory properties. Would it be better to avoid or limit their consumption at this time?",
  "input": "",
  "output": "Most health care groups have not made any recommendations regarding ibuprofen or other NSAIDs. We simply don't have the information to be able to recommend one way or another. If you have been taking these supplements, it should be fine to continue taking them."
},
{
  "instruction": "SoCal surgeon here.. I would. I do take off my shoes before coming into my home. I'm also leaving amazon packages in the garage for at least a day. New England Journal of Medicine just published data on virus survival on surfaces and air.NEJM says SARS-COV2 coronavirus survives:3 hours in air4 hours on copper24 hours on cardboard3 days on plastic or stainless steel.Here's the source:https:\/\/www.nejm.org\/doi\/10.1056\/NEJMc2004973?fbclid=IwAR0J1UVMFKkWUq3s4lYPJ2guckp8lGel-0b2ApPysnlr_qR7Xa9vMvD5rjQ",
  "input": "",
  "output": "Posts by unflaired users that claim legitimacy by virtue of professional medical experience are not allowed.If you are a medical professional who wishes to become a verified contributor to this subreddit, please message the moderators with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!We do not accept digital forms of identification."
},
{
  "instruction": "I'm already on 400mg Plaquenil for inflammatory poly arthritis. Assuming it's helpful for COVID19, is this offering me extra protection? Note: I am not looking for way around any guidelines, we are being very strict with social distancing, disinfecting high touch surfaces daily, and following our stay at home orders. I'm more curious, really! And wondering if it's safer for me to be the one who goes to the grocery store when needed. Thanks!",
  "input": "",
  "output": "Impossible to answer. We simply don't have data to show whether this would be effective as prophylaxis even if we knew it worked against COVID-19."
},
{
  "instruction": "I am a male in my 20s and use Fluticasone nasal spray for post nasal drip. I heard that this has immunosuppressant qualities. I am otherwise healthy. Should I worry about this and consider stopping the medication until the virus is under control?",
  "input": "",
  "output": "No worries about nasal steroids"
},
{
  "instruction": "If our whole household has Coronavirus, do we still need to isolate from each other?",
  "input": "",
  "output": "No that's pointless"
},
{
  "instruction": "How bad do we let things get before going to hospital? I have a sore throat, headache, and a dry cough and my husband has the same + congestion and a little SOB. Both of us feel okay enough right now but I want to be prepared. Hes also traveling for work (non shut down state and he works alone so no exposing others), and Im trying to keep close tabs on him.",
  "input": "",
  "output": "Same point when you'd go to the hospital for any other illness - when you feel that your symptoms are dangerous and\/or life-threatening."
},
{
  "instruction": "Can my doctor share results\/status of my COVID-19 test with my employer without my permission?I was directly exposed to COVID-19 and my employer has me off work for 14 days. I got tested at my local health center (surprisingly)My employer wanted proof I was tested, I guess I took too long to provide and they called my doctor. My doctor let them know that I was tested.When my results come in, can they share they info with my employer? How do I request my doctor not share my info with my employer? Of course I will tell my employer, but I want to tell them.This is already a weird time as Im getting texts from HR everyday asking how Im doing and it all feels so invasive",
  "input": "",
  "output": "No patient confidentiality prohibits this, unless your employer pays the bills (but even then you'd have to give permission)"
},
{
  "instruction": "The gist of this is that I want to know whether or not I should be worried assuming I were to get COVID-19. I'm not worried about spreading it, that shouldn't be a problem, but just in case I did find myself sick, I do want to know how bad it might hit me.When I was younger I had a bad throat infection that took weeks to get rid of and came back I think twice, and since then a good amount of illnesses I've gotten have come with a lot of pain and swelling in my throat, but not infection. I've heard that this can hit people with respiratory issues quite hard, but because this isn't a respiratory issue, I don't know if this might also be a problem.I should note that I have had what I believe was an asthma attack, almost a decade a go at school. I don't know for sure because it only lasted a few seconds, during which time I couldn't convey to anyone that I wasn't able to breath due to the fact that I wasn't able to breath, and being an idiotic kid I just was like \"well that happened, I don't want to have to be one of those dorks carrying around a puffer throughout school so I'm just going to pretend it didn't.\" I haven't had anything like that happen since, and that was the first time it happened, but I don't know if I need to actually talk to a doctor about that. I'm really more worried about the throat problems, because I get them a lot, but if this is something I should also be concerned about I would like to know.",
  "input": "",
  "output": "You are not a risk group"
},
{
  "instruction": "If loss of smell and taste are symptoms that seem to persist for a long time in asymptomatic patients, how are they supposed to know when they can end quarantine?",
  "input": "",
  "output": "That symptom doesn't count, that's a nerve problem but doesn't indicate that they're still contagious"
},
{
  "instruction": "Inexplicable, itchy rash all over my body with no other symptoms (pics in the comment)20M, non-smoker, occasional drinker (3~4 times per month), no prescription medication. Hives started appearing all over my body two days ago, starting from my torso. (this was several hours after having a drink, just in case that matters) They respond well to cetirizine but return around 20 hours later. They seem to start spreading from different spots everyday: one day from my torso and then from my limbs. They itch quite a lot and some spots are tender to touch, but other than that there have been no other symptoms like any respiratory problem, sore throat or fever.While I am mildly allergic to dust mites, I've never had this kind of flareup that manifests itself on skin. I haven't eaten anything new or changed any laundry or skincare products either.",
  "input": "",
  "output": "Finding a \"cause\" for many with acute urticaria in most patients is not a reasonable expectation. It can be caused my infections, medications, other causes... but is generally idiopathic. If you have airway symptoms seek immediate care.Otherwise, see https:\/\/dermnetnz.org\/topics\/acute-urticaria"
},
{
  "instruction": "That looks very uncomfortable. Im NAD, but have experienced a similar looking rash everywhere as well. Your doctor may be able to help you, but I do know that putting ice packs on the particularly itchy or painful areas really help to relieve the discomfort. Just wanted to give you ideas. Hoping you feel better very soon.",
  "input": "",
  "output": "Finding a \"cause\" for many with acute urticaria in most patients is not a reasonable expectation. It can be caused my infections, medications, other causes... but is generally idiopathic. If you have airway symptoms seek immediate care.Otherwise, see https:\/\/dermnetnz.org\/topics\/acute-urticaria"
},
{
  "instruction": "COVID and Upper Respiratory Infection23 F. 230 lbs and smoker. I went to the urgent care 3 weeks ago and was told I had an upper respiratory infection. I took a 5 day prescription of Azithromycin. Today I tested positive for COVID. Is this concerning that I got these back to back? I never even officially recovered from the upper respiratory infection. Thank you (I am vaccinated, not boosted yet)",
  "input": "",
  "output": "Not really. COVID can be an upper respiratory infection so may still be positive from the first infection."
},
{
  "instruction": "Is 5 days of amoxicillin twice daily a normal treatment time for a mild upper respiratory infection?Age- 25 sex- male height- 5'9 location - green phlegm, sneezing, sore throat, etc.I was given amoxicillin but only for 5 days. Twice a day. I'm assuming the standard dosage. I read online typical treatment is 10 days.Is this long enough usually? The symptoms described here are exactly what the doc was told. Do i need more? It was originally scheduled as a covid visit and the doctor was very short with me, so i don't think they were very thorough in anything. Yes, i know i can get a second opinion, that still doesn't answer me.",
  "input": "",
  "output": "I usually prescribe 500mg three times daily for 5 days for a mild bacterial RTI"
},
{
  "instruction": "What does it mean when my inflammation markers are off the charts, but I FEEL fineAge: 44 Weight: 185 Location of issue: Blood, I guess? Duration? Approx 24 years at this point.So...about 4 years ago, I was diagnosed with RA. The kind that doesn't show up as RA on blood tests, but I have all the symptoms and my inflammation markers are off the charts, so it HAS to be RA based on ruling everything else out, right? That was my doctor's determination.I'm seeing a new doctor next month...one who is in the same practice as my current doctor (who I'm dumping) and the same specialty (rheumatology) as my current doctor. I had a zoom call with New Doctor recently and she was like, \"Why the fuck are your inflammation levels TOO DAMN HIGH when you've been on two different medications for a long ass time now (4 years on sulfasalazine and approx 2 1\/2 years on hydroxychloriquine in combination with the sulfasalazine)? You DO take them as prescribed, right?\" which I totally do.So what does that MEAN? Does it mean my RA is still causing problems even though I feel physically fine most of the time? Does it mean I need to change drugs?I don't have any joint swelling, just occasional pain when I have a flare up. I had no idea (at least not until New Doctor looked at my old blood work results) that my inflammation markers were still off the damn charts even after several years of being on medication to fix that shit.",
  "input": "",
  "output": "What are your labs?"
},
{
  "instruction": "Looking for expertise-rheumatology, immunology..?Hi, I'm a 39yo female, a healthy eater and active with daily cardio exercise. I've been on BP meds since 22yo after I went in for a flu visit and it was recommended I start them. My current is propranolol 60mg ER and that's been about 8 years. Otherwise my health and blood work is good however, over the last 6 months I've noticed in increase in flushing, primarily in the face and upper arms, along with small, closed skin, slightly raised lesion marks here and there. Additionally, I get fairly significant swelling and redness in my hands and feet, along with joint pain in my feet sometimes to the point I feel like my feet bones are going to crumble. I do have a genetically bad back with disc collapse in my lower spine and injections have been recommended for that. But Im not sure that could be related to everything else. My original thought was a food or alcohol allergy as the swelling starts minutes after I eat or drink, which is few and far between. The problem is the swelling then stays all day, to the point I have to take my jewelry off. With that and the redness it is super embarrassing and I feel like my face is 110 degrees so it's also uncomfortable. I drink water, I take vitamins and I feel good in the mornings. Come the afternoon though it's like my body starts to fall apart and feel 80 years old. I feel I'm having inflammatory responses to something but I just can't identify it. I use excema lotions and hydrocortisone as needed on my arms. I'm just at a loss and wondering if it could be medication related, or if there's something I'm missing? Thank you.",
  "input": "",
  "output": "It's difficult to diagnose this without an exam and evaluation. I would take pictures of this flushing (what makes it worse\/better, worse in sun? Etc) for your doctors, as well as any swelling. Try to see if there's a temporal relation to the joint pain\/swelling (morning, night, what makes it better etc). If there's no contraindications, I would recommend trying some NSAIDs to see if it helps the swelling - note that if it does. Always take NSAIDs with food.Also any new supplements you're taking. Some weird stuff in those sometimes."
},
{
  "instruction": "Thank you so much, I will definitely do those things and appreciate your time and response.",
  "input": "",
  "output": "A quick aside, if you're looking this up, I'm sure you'll come across lupus. Lupus requires a constellation of clinical symptoms with the appropriate serologic markers - based on your story so far, I would not say you have lupus yet. Just to ease your mind a bit in case you come across this."
},
{
  "instruction": "I did see that come across...thank you for easing my mind! I keep coming across rheumatoid arthritis and psoriatic arthritis as well. It's just very difficult to identify whether I have a few different things possibly that just happen to be displaying all together (ie. a genuine food\/medication allergy combined with lower body pain from lower back nerve issues, etc). Although i do notice that I have periods of clear skin and minimal discomfort all around, and then it'll transition to a week or two or increased skin redness and sensitivity. The swelling is unfortunately something I'm seeing everyday though.",
  "input": "",
  "output": "Both of those fall under different groups of inflammatory arthritis - this type of arthritis does present with swelling. The pain is typically described as a stiffness that improves with activity - hence it tends to be the worst in the AM or after a long car ride for example. The swelling you have is interesting to me but the character of your pain is a little atypical and the overall picture does not seem to clearly fit inflammatory arthritis.The causes for facial flushing are many - ranging from menopause to thyroid issues. Typically we shoot for a unifying diagnosis but certainly could be more than one - time for a doctors visit!"
},
{
  "instruction": "Fingers, Toes turning black and rotting off. Desperate for answers! Also hematology and rheumatology blood results and symptoms that no doctors can explain.I can't embed images here, so I made a pdf with all text, pictures, and labs. https:\/\/www.scribd.com\/document\/511582218\/askdocs-pdf?secret_password=VqmaLuJA0tGw5bGE5xYp It will be much easier to read the whole thing there, with the images embedded, but I will copy the text here.36F, 55, 115 lb, white.  Primary complaint = fingers and toes turning black and rotten (pictures included).  Existing issues = random red cell destruction without cause, random platelet destruction without cause, swellings and rashes (labs and pictures included).  Medications = iron supplement.  Occasional Claritin, Advil, Prednisone.  No medication right now.  No recreational drugs or smoking.  Rare\/light alcohol (an occasional drink on holidays or weddings)  Rotten Fingers.My left thumb got a blood blister so I put Neosporin and gauze on it.  The pain became so intense that I went 72 hours without sleep.  I went to urgent care, who removed the bandage.  The thumb was very swollen and the top third was black and crusty.  (picture)They sent me to the Emergency Room, where they removed the upper half of the thumb.  The pain completely went away, it was just a little sore and itchy.But a few days later, all the other fingers and 8 of the toes started turning black.(pictures)Thats the hand with the original bad thumb.  The pinkie has a blood blister, the index and ring fingers are turning black and crusting at the very top under the nail, and the middle finger is just inky blue\/black without any crustiness or blisters.  The left picture was taken a day after the right one.  Right Hand:  no crustiness or blisters.  The fingers are just dark.  The index finger is getting kind of gooey (last picture).(pictures)Toes look blacker than fingers but not crusty.  All but the two smallest toes on right foot are turning black.The ER doctors were very kind but nobody knew why my thumb turned black and rotten.  Now here are all the other weird symptoms and bloodtests that doctors cant explain.  None of it seemed like a big deal untl fingers started rotting.  2. Rotting BloodFor years my annual bloodwork showed I was anemic.  For example(picture)But I had no symptoms of anemia other than feeling cold, so my NP said being anemic was just my normal and prescribed an iron supplement.Two or three times a year, I would get symptoms of extreme exhaustion that would last a few weeks.  Most of the time, I felt healthy. But for those weeks, I would sleep the entire weekend, wake up Monday, stumble brain dead through the workday, then get home and fall right back asleep.  After a few weeks, Id start to get better.  For years, my NP said it was nothing, just a virus.  But I never felt sick, just exhausted.  Then a doctor saw me while it was happening.  As soon as she saw me, she took my vitals, looked at my eyes, and said, this isnt all in your head.  We need to take your blood.  Here were those blood results(picture)It turns out that the exhaustion is because my blood starts rotting a few times a year.  I went to hematology.  They tested me for every possible cause of blood destruction.  But everything was normal.Tests included DAT\/Coombs negative, PNH w\/ FLAER no flow cytometric evidence of paroxysmal nocturnal hemoglobinuria No evidence of aberrant loss of GPI-linked markers tested in erythroid or leukocyte populations. Anti-CD45, glycophorin A, CD59, CD24, CD15, CD64, and FLAER tested. Complement: C3C, C4C normal, CH50 high (>60). Cold hemagluttinins: none detected, G6PD - high (>21.00). No hereditary spherocytosis or elliptocytosis. Infections negative.  Blood cultures normal.I can post the tests if anyone needs to see them.3. Bruises and Rotting PlateletsNormally I dont bruise any more than most people.   But once in a while, I get bruises everywhere.  My bra, underwear, and socks all leave big bruises.  Theyre painless and go away in a couple weeks so I never worried about it.  But when a doctor saw and tested, it turned out there were almost no platelets.  The picture shows the bruising left by a loose sock.  My whole shins were just big bruises that followed the pattern of the sock elastic.(picture)In a few weeks they were back up to 40 and the bruises were gone.  Hematologist found no reason for platelets to suddenly drop like this.  They checked for cancers and even took bone marrow but no answers.(picture)All the bone marrow tests like fish and genetics were normal.  4. Symptoms that Seem Autoimmune but Have No Rheumatologic Cause.  Sometimes I get rashes and swellings that doctors think is autoimmune(pictures)Rheumatology has tested EVERYTHING again and again.  Sedimentation rate, ferritin, and CRP are always high.  But nothing else is usually abnormal.(pictures)They biopsied some of the rashes and purpuras (which I dont have pictures of, theyre just little painless red spots that sometimes break out on my legs).  They all showed the same thing, leukocyto elastic vasculitis.  Heres one.(picture)But every other type of test for vasculitis has been negative.   Nobody has explained why someone healthy and pretty young like me should have chronic venous insufficiency either.I have only had one round of tests where there were any abnormal autoimmune results:(picture)But these things were only abnormal that ONE TIME.  Rheumatology has re-tested them so many more times and they are always normal.  They have tested for every other autoimmune disease and they are all normal.  The only rheumatology tests that are often abnormal are sediment rate, creactive, and ferritin being high.   Ddimer and visc is sometimes high but not usually.  PT, INR, and ptt are sometimes high too.  (picture)They dont think its cryoglobinemia because it was only positive once and negative a lot more times.  Also, my C4 was always high or normal and my C3 was always normal, even in the test where there was cryoglobulin.  (picture)The only other thing off on the bloodwork is subclinical hypothyroid.   TSH is high, but T3 and 4 are low normal.  I have no symptoms of  hypothyroid other than being cold.  And the cold could be from anemia.Please, does anybody know what this all means?I had accepted the lack of answers when it was just random blood rotting, swelling, and rashes.  I know the doctors tried hard.  I could live with all that stuff.  But these black fingers, I cant live with it.  It hurts too much.It feels like someone as healthy as me shouldnt have all these symptoms unless its connected somehow.  But nobody knows how.  Rheumatology thinks the rotten blood is not autoimmune because Coombs and other autoimmune tests are always normal.  But hematology says if its not autoimmune, then theres no other answers.  So far, I have no autoimmune diagnoses but doctors still act like I have something autoimmune.Monday I will see my NP and can ask for any tests anybody recommends.IS THERE ANYTHING I CAN DO FOR THE FINGERS AND TOES?  TO MAKE THE BLACK GO AWAY OR MAKE THEM STOP HURTING?I already tried asking a pain forum for tips, but I got a nasty message (Your complaining about 2 weeks of hurt fingers!  Do you understand that we have pain that is severe, intractable and forever*?*  I have ddd and a herniated L5-S1 disc.  I am in 10\/10 agony beyond your imagination.  Your hurty finger is a joke.  Suck it up buttercup) so I deleted it and wont ask for help from patients again.I hope doctors will be more understanding. I get it, that there are other people who have it much, much worse.   But I dont have chronic pain so I never developed a high pain tolerance.  Typing this is killing me. Ive had a broken bones, a vaginal delivery, wisdom tooth surgery, and swollen joints, but none of those hurt that bad.  When Ive broken a bone, its only been blindingly painful for ten or fifteen minutes, then it settles down.  Then a few days of throbbing and aching thats relieved with rest and Advil.  This is the first time Ive had pain that Advil cant relieve and that doesnt settle down with time or rest.  I know other people with bad backs or arthritis have it worse.  I dont need to be told that.  But for me, this is too much.  What can cause this?The doctors seem confident that its not just psychological.But I cant shake the fact that I get more symptoms when Im sad or stressed.  I dont have any chronic mental illnesses, but I go through short periods of feeling down or anxious.  At the hospital, I held it together when they took off the black thumb.  I told myself that it was ok, that the pain was finally gone, that half a thumb isnt that important, that its my non-dominant hand, that I dont need a full left thumb to type or do most activities.  When I got home, I was so happy to be pain free and I had so much to catch up on, I just didnt think about it.  But then I looked at the discharge paperwork and saw that under Reason For Visit, they wrote GANGRENE, WET.  I knew that the thumb wasnt good, but seeing it called GANGRENE made me feel so repulsive and sad.  I spent 10 or 15 minutes just crying.  It was right after that little breakdown that all the other fingers started hurting and turning black.  Could all that crying have caused it?Theres also an odd discrepancy.  My black fingers hurt so much but my black toes dont hurt at all.  How is that possible unless the pain is all in my head?I am desperate for answers or relief if anyone can help.  Thank you to anyone who has read this far.TL-DR:  What causes rotting fingers, rotting blood, rotting platelets, leukocyto elastic vasculitis, swelling, rashes, purpuras, and maybe subclinical hypothyroidism but without showing up on normal blood tests for autoimmune or other diseases?",
  "input": "",
  "output": "This is beyond the scope of all but the most seasoned hematologists and rheumatologists. It MUST be rheumatologic or a bone marrow disorder, nothing else fits all the symptoms. You should be referred out to Mayo Clinic or Johns Hopkins or something. I would say the rapid progressions warrants an inpatient workup until a cause or treatment can be found. If those fingers\/toes get infected you could get septic pretty quick.Some type of small vessel vasculitis fits best, but theyve tested for all the obvious culprits so its hard to say why nothing has been found yet. Its definitely not in your head, but its no surprise that stress makes the symptoms worse. Stress makes a lot of things worse.I wish I could offer you more, but this definitely isnt my field of practice. Hopefully someone else has some ideas.Agreed agreed. This needs an inpatient work-up in a big academic center. We had a similar case on my MICU rotation in residency and he was getting continuous plasmapheresis while we tried to figure out what the cause was."
},
{
  "instruction": "Are there any hematologist\/rheumatologist crossover doctors? Like a single doctor who specializes in autoimmune hematology? It feels like rheumatology and hematology pass me back and forth and like both of them think I'm the other specialist's problem.",
  "input": "",
  "output": "Not that Im aware of unfortunately. The problem is they are both at dead ends and think the other specialty will be able to help. Which is why you need your case elevated to the next level"
},
{
  "instruction": "If one of your fingers is squishy, you need to go have it looked at immediately. If you have gangrene again it can kill you if left untreated. Im just so sorry you are going through this.So when is a black finger just Raynaud's and when is it gangrene? The right index finger isn't squishy, but the skin is breaking down and it's oozing something smelly.",
  "input": "",
  "output": "OP, this is an indication that the tissue has died and has become necrotic. This tissue needs to be removed urgently. I am very concerned that an infection of this tissue could become systemic and fatal, potentially in hours.This is a definite indication to immediately head to an emergency room.I am so sorry you are going through this, but you need to be admitted and likely get surgery so that this does not become immediately life threatening.PLEASE DO NOT WAIT UNTIL YOUR APPOINTMENT IN AM"
},
{
  "instruction": "What to Expect from a Lyme Disease Rheumatology Appointment?I am a 27 year old male, about 5'10\", no remarkable pre existing conditions or allergies, medical history, etc.Some (optional) backstory- I live in and work outside in East TN and various places around the country relatively frequently. I was bit by a tick around April 26 and I estimate it was attached for a few hours (less than 10). Over the next week or two I started having very general symptoms... occassional dizziness, general fatigue, a feeling of weakness, fierce night sweats (probably my biggest complaint.. sweating buckets beginning as soon as I went to sleep), some minor and intermittent joint aches especially in the knees. I measured a fever of 100.4 F on May 8 and tested myself at home for COVID and it returned negative. I also received my 2nd dose of Moderna on 4\/21\/2021.I eventually decided to just have a Teladoc appointment the night of May 8. The phone doc basically said it would be impossible to treat me over the phone and surmised it was Rocky Mountain Spotted Fever and he was not allowed by policy to treat tickborne illness. I went to an urgent care the following day and we decided to begin doxycycline and tested for Lyme\/RMSF. Long story short the test was positive for both and they started a second 10 day course of doxycycline. The nurse practitioner at the urgent care told me I would need to see a rheumatologist, especially for the Lyme diagnosis. They referred me and my appointment is June 22.So here's the question- what should I expect from the rheumatology appointment? I feel fine, the symptoms are gone and I've completed 20 days of an antibiotic. I have a feeling the rheumatologist will kind of just shrug and say if I took 2 courses of doxycycline and I have no symptoms then he's not worried about it. What am I signing up for? Will we at least do a confirmatory test for Lyme\/RMSF?",
  "input": "",
  "output": "The physician can check titers of antibodies to look for previous infection but honestly given that your symptoms have resolved and you were treated for tick borne illness further follow-up really should not be necessary.Suprised they sent you to a rheumatologist for this, arguably could have been managed by general internal medicine vrs infectious diseases"
},
{
  "instruction": "Why would my doctor test my kidney infection if my finger is mysteriously injured?27F, 165cm, 70 kg, white, smoker, drinker, in Netherlands. No drugs, prescription or otherwise.Primary complaint: The middle joint on my left pointer finger is mysteriously painful. I woke up after a normal night (i.e. no drinking, couldn't have forgotten an injury) and the middle joint of my finger hurt, as if it had been slammed in a door. The pain is localized and only experienced when I attempt to bend my finger. It began on the 11th of March.Existing issues: Ehlers Danlos Syndrome, Hashimoto Thyroidism, Anemia, Asthma, AllergiesMy primary doctor saw me today and did not think there was anything biomechanically wrong, i.e. no break, no dislocation. She tested my blood for infections as I've just returned from the tropics (Thailand) but that was negative. She then ordered a lot more blood tests, liver function, kidney function, arthritis, etc.I understand testing for arthritis, but why kidney and liver function? I am an immigrant in the Netherlands, so sometimes there is a bit of a language barrier and I don't completely understand how my finger pain could be related to kidney or liver failure.",
  "input": "",
  "output": "Could be many reasons. Kidney and liver function is good to have if you will be prescribing medication that is filtered by the kidney or liver. Your doctor may be worried about a rheumatologic or infectious disease which can also sometimes affect the liver or kidney. Also some STDs like gonorrhea can cause arthritis and can be tested for in the urine.Those are just basic labs."
},
{
  "instruction": "Hey yall My kiddo (3M, approx 42 pounds, 3.5 feet tall) (daily meds are nexium, senna, zyrtec, tenex, atarax, melatonin) got referred to hematology and I'm drawing a blank on what questions to ask. He had a blood smear that had \"abnormal lymphocytes\" and a high level of lymphocytes. He started seeing Immunology a few months ago because he's always had frequent infections and fevers just about daily for most of his life. Immunology doesn't have any diagnosis, but are thinking of referring him to rheumatology. Im just not really sure what questions to ask or what to say really. If there's a better sub for this, please point me in the right direction. Thanks y'all!",
  "input": "",
  "output": "Where does it say \"abnormal lymphocytes\"? That's unusual language. \"Atypical\" lymphocytes are seen with viral infections, classically mono. If the blood smear was the reason for referral, I would ask what the results mean. If the answer isn't clear, keep asking until you understand. They will tell you the differential diagnosis for the findings and what additional tests they recommend. There might be none.Frequent infections are the rule in childhood, not some weird immune deficiency. Is he really having fevers every single day for 3 years? Also, one of the most common findings with immune deficiencies is poor growth and your son is a tank :) Rheumatologic conditions in preschoolers often come with poor growth, rash, joint swelling, and very abnormal blood tests. But they can be more subtle and I can't say on the internet if that's a possibility in your case."
},
{
  "instruction": "i meant atypical, im sorry! it was in the notes for the test result.He has fever just about every day, if its not fever, its right under fever (99.9-100.3) but most days its 100.4 or higher. He usually gets sick 1-3 times a month, and he stays sick and his pediatrician says thats too much especially for a kiddo not in day care or anything like that. Hes been hospitalized a few times and they havent been able to figure out what causes it. This is something weve been dealing with pretty much since he was born.",
  "input": "",
  "output": "Has he ever had a CRP or ferritin? What was the total WBC and neutrophils on the blood count?I think hematology is unlikely to solve this for you. Between immuno and rheum they may have some recommended tests for uncommon causes of recurrent fevers."
},
{
  "instruction": "Bad, vivid dreams please help (19F)I am 19F with a ton of medical issues. Meds are vilazodone, duloxetine, montelukast, levocetirizine, propranolol, norethindrone\/ethinyl estradiol, and dexmethylphenidate. Conditions are kind of a mess right now because we are still trying to figure out a lot of them but I have allergic rhinitis, either major depressive disorder or potentially bipolar 2 disorder, excessive daytime sleepiness diagnosed as idiopathic hypersomnia but potentially narcolepsy, POTS, ADHD, and most likely Sjgrens (awaiting rheumatology appointment).I have had what I describe as vivid, disturbing dreams for as long as I can remember. I say dreams because I never wake up during them. They are very unsettling and I feel awful when I do wake up in the morning.Last night I fell asleep without taking my medications (I take the majority of my medications at night aside from the stimulant of course). The dreams I had were awful to say the least. Im not even comfortable sharing the details but there was a lot of killing, fear, sexual aspects which I absolutely hated (these aspects were not in any way a good or wanted thing), and the feeling of being trapped. As I mentioned, my dreams are always very vivid and they feel 100% real but I am not in control as one might be with a lucid dream. And for clarification, I hate violence and, if anything, I am sex repulsed. I made a throwaway for this post specifically because I feel so disturbed and ashamed about these dreams.I woke up this morning disoriented, confused, distressed, and with thoughts of wanting to self harm (which I have not done in a long time). I have these dreams often, but not always to this extent.I know medications, especially some of the ones that I take, can cause nightmares. But why would the dreams be worse if I missed my medications? And what in the world can I do to prevent these? Because I felt so terrible when I woke up (and still feel bad now), I want to rinse out my brain so I can remove the dreams from my memory. I would avoid sleep if it were possible but the fatigue and excessive daytime sleepiness make that impossible.Please help because I cant keep dealing with this when I sleep and I dont know what I can do.",
  "input": "",
  "output": "Vilazodone and duloxetine are SNRIs that increase serotonin and norepinephrine levels in the brain. Abruptly stopping or missing your doses can cause low serotonin levels during REM sleep. That'll cause more intense nightmares.Might be helpful to talk to your doctor about adjusting the timing or dosages of your meds to minimize their impact on your sleep\/dreams.Have you thought about therapy to address any underlying psychological issues? Someone can work with you to develop coping strategies and explore any unresolved emotional issues."
},
{
  "instruction": "Sudden unilateral ptosis + sudden frozen back (needed wheelchair briefly)If you fancy yourself a diagnostician, have I got a case for you. 39 yo female; US; 5'3\" 179lbs; Grave's, Hashimoto's, Celiac (Celiac just diagnosed in fall, others well managed with meds for ~6 years).9 days ago - sudden moderate unilateral ptosisMonday was sitting at my desk (no exertion, no recent falls\/trauma etc) and back locked in place, confined to wheelchair upon arrival at hospital. Went to ER and got an acid reducer injection which did enable ambulation again, albeit with altered, ginger gait2 steroid injections Tuesday helped a little bit, still walking very gingerly. Can't bend down. Hurts to sit for long, can't get comfortable, prefer fetal position on my side laying down or in recliner - agony yesterday to lie flat for MRI and x-raysRecent appointments:Emergency eye doctor appointment 8 days ago, nothing identified --> refer to opthalmologist, apt. in 1 monthUrgent care Sunday - no tests performed, referred back to primaryMonday primary referred me to ER where x-rays performed (after identifying it as a muscular issue)Orthopedic doctor Tuesday - ordered lower back MRI. Came back showing moderate disc bulge but nothing that should be causing my 10\/10 pain level, nothing surgery worthyRheumatology Wednesday (yesterday). Ordered blood work (partial results below) referral to neurologistBlood work results:High Rheumatoid factor (15.6 - ref rate up to 14)High alkaline phosphatase (134 - normal up to 121) (this has been chronically high over last 9 months, up in the 150s)High Neutrophils to Lymphocytes Ratio (NLR) - (3.89 - normal should be under 2 or 3 I'm reading a few different things here so any insight is helpful)I had a 23 and Me done recently so I have a ton of information there (positive for DQ and homozygous for HLA-DQB1:02, etc)Persistent symptoms since ~July 2022 -Extreme fatigue and malaiseExtreme brain fogWinded easily (i.e. climbing stairs)Have not taken stairs in 2023 because of weakness and how out of breath it makes meExtreme difficulty getting up from seated positionNeck\/shoulder\/back weakness and pain (diagnosed spinal osteoarthritis and degenerative discs in January 2023 but pain and weakness in neck and shoulders too)Vitamin D deficiencyAnemia (was barely not anemic in the blood work yesterday but was anemic in 3 other blood workups in this period)\"Polyarthritis\" diagnosis in February (additional subsequent Rheumatoid Arthritis diagnosis by Orthopedic doctor but Rheumatologist this week said no)Some headaches, blurry vision, confusion (not necessarily trouble speaking but trouble remembering words occasionally. I typically can't remember the $.50 word so I use the $2 one instead - using bigger vocabulary words more often - I used to be able to \"mask\" this better)Some dysautonomia in that I've had some Raynaud's attacks (been happening ~15 years) just sitting in my living room and sometimes if I get hot I can't regulate my body temp very easily. I will get randomly sweaty (especially on my upper lip it seems?)My most educated guesses: Either myasthenia gravis or Lambert-Eaton, considering the eyelid drooping, muscle weakness especially in trunk and legs, weird sweating, etc. Plus I seem to have every gene on the planet that predisposes you to these conditions.My biggest concern is that those two conditions pop up when your body is trying to fight off an as yet undiagnosed cancer (often SCLC and lymphomas). I am a never smoker but my husband smokes. Originally smoked cigarettes indoors for ~5 years and now has vaped indoors for ~5 years. I also have the double dose of DQB1:02 giving me Celiac. But it also predisposes me to Enteropathy Associated T-cell Lymphoma. I have an eating disorder (ARFID) that is getting in the way of proper management of my Celiac.Please ask me any follow up questions you may have and give me your best guesses. Doctor after doctor is sending me down the line to someone else and I'm afraid of running out of time. I have a 4 year old I would like to spend a little more time with. Thank you so much for even reading this far. I look forward to any replies.",
  "input": "",
  "output": "I dont think you are dying!!The back complaint sounds like a classic musculoskeletal injury. Unfortunately as we get older this is more likely, it can be incredibly painful and can linger. None of these other entities happen quickly like this and you had an MRI.Myasthenia and lambert eaton are not typically painful conditions. I wouldnt diagnose one of these from ptosis, which is more often a local issue with the facial nerve. So i wouldnt go on and say you have cancer, though Dr. Google tends to give this diagnosis with any search.I highly doubt all of these things are tied together by one underlying diagnosis. You are very in tune with your body and human nature is to try to assign a unifying cause."
},
{
  "instruction": "Gaining weight despite incredibly strict diet, rapidly losing function. Seeing second specialist (rheumatology this time) next week.I apologize for the length of this. I want to be thorough, and I need some reassurance while I wait for my referral to the second specialist from the first specialist:32f Utah 5 4 (current weight 186, up from 130) Non smoker\/non drinker\/no recreational drugs.Medical conditions\/history: GERD, migraines, Graves, hashimotos (yes, both. REALLY.) seizures of unknown origin (not epilepsy.) gallbladder removed, sinus surgery for chronic infections, hysterectomy (one ovary left) for severe endometriosis and bleeding. Seeing a rheumatologist next week on a referral for ankylosing spondylitis based on current test results between November and now.Medications: Naproxen, Benadryl, promethazine, lamotrigine, topiramate, tizanidine, pantoprazole, Zantac, rizatriptan, gabapentin. Recently discontinued magnesium, potassium, and hydrochlorothiazide. Botox injections for migraine every 3 months.With all of that said: I finally went to the doctor for the first time in November when my symptoms first peaked. My labs were mostly normal at that point. I had gone from 130-160 very rapidly despite barely eating and it was causing extreme pain, particularly in hands\/feet\/abdomen. Thyroid\/heart\/liver\/kidneys all looked fine. I didnt respond to the diuretic other than to end up in the ER with low potassium.I have changed my diet from what it was then (literally had been eat a small bowl of rice or noodles, if I ate anything, once a day, and then a few bites of dinner for months because of stomach\/intestinal discomfort. Lots of water, but also drank 2\/3 cans of soda a day.) I started eating fruits, vegetables, lean protein, extremely limited processed foods (essentially: yogurt, cheese, unsalted nuts, unsalted almond butters, unsweetened almond milk, low sodium\/low sugar hot sauce or mustard, occasional olives, sparking unsweetened water, low salt seaweed, organic unsweetened or low sugar low salt anything if its in a bag or jar and I am not prepping it raw) I do dry beans, chicken breast, bone broth, plain Greek yogurt, plain coconut water, plain eggs w\/ pepper. Kale, spinach, cauliflower, broccoli, beets, peppers, tomatoes, berries, cucumbers, etc. maybe 1\/2 can of soda every 2 weeks. About 1 serving of complex whole grain\/seed grains a day MAX.Despite this, and still limiting my calories (mostly due to abdominal pain and diarrhea\/constipation) and also pushing through the increasing joint pain and muscle pain\/spasms to be as physically active as possible (I even swam in a lake and hauled kayaks, went on a couple hikes.. although most days, I can hardly open my own medication, and have fallen in the bathroom and while dressing myself) I have gone on to gain an additional 26 lbs, up from 160-186.Most recently, the doctor my PCP referred me to repeated the blood work and my platelets have remained slightly elevated, as were my eosinophils.. but not clinically significant. My potassium has continued to be a little low. ANA was negative, ESR normal, CRP was normal, thyroid, heart, kidneys, liver still normal. 24 hr free cortisol was normal. HLA-B27 (I think thats what its called?) was positive and MRI positive for ankylosing spondylitis.In addition to the progressive weakness and pain, I have also lost control of my bladder 3x since December, have had several episodes of either very high or very low blood pressure, nights like last night where if I breathe too deeply it feels like someone is sitting on my ribs... sort of right along the level where the sternum ends. I struggle to walk on stairs and get electric shocks through my arms, hands, and legs when I walk down them or bend my neck to the side.Since the rheumatologist had my doctor tell me to take Naproxen while I wait to be seen, Ive had a bit less swelling in my ankles, I can actually see the bone. I get a couple hours where I am at least slightly less uncomfortable. I still feel like my skin is on fire. It gets itchy when I get too hot and often turns bright red. My stomach and hands balloon up when I move around, and the soles of my feet get hot and painful and sometimes turn blue. (The soles.. not raynauds... cold and heat dont change it, and its not something that affects the digits.)Does that really explain the rapid weight gain and abdominal pain despite restrictive diet? I am genuinely scared about the loss of function Im experiencing.",
  "input": "",
  "output": "Just a quick clarification. You mention your complex history of thyroid disease (Grave's and Hashimotos), and I think we need more info, especially as hypothyroidism is a common cause of weight gain. You say that your lab results for your thyroid were 'normal', but with either one of these diseases the lab results would almost certainly not be normal. For reference, thyroid labs usually come in various flavors: TSH, Free T4, and depending on the occasion T3\/antibodies. Do you know the specific results of those tests? Also, none of your medications is for the thyroid, and with either of these treatment is usually necessary. Did you have radioablation or surgery in the past?While both autoimmune diseases, Graves and Hashimoto's have opposing outcomes. This would make for an interesting and complex clinical picture, and with more information we might be able to help.And of course, maybe it has nothing to do with the thyroid, but common things being common I still think its worth looking into."
},
{
  "instruction": "Of course. I will share the labs and info I have. My thyroid was the first thing I requested to have looked at when I saw my PCP. Initially, I was diagnosed after I had my first child in 2008 and my thyroid was overactive and I had thyroid antibodies that were really high. (I was put on medication.) After seeing an endocrinologist, he essentially said that I had both issues and it was rare but not unheard of. During my second pregnancy, my levels stabilized and remained stable until a couple years back when they were slightly low, but after an adjustment to some medications I was on (seroquel for sleep) they went back to stable so I wasnt medicated. The one thing that has remained high is the antibody levels. For now, my PCP has monitored them.Here is a link to the labsI added the historical and current thyroid labs, as well as the most recent labs that have been run, and a few imaging reports. If you want to see anything else, or if I didnt quite fit something on a page as well as I think I did, just let me know.Sorry it took me a while to get that up, I appreciate you taking the time to look over it.",
  "input": "",
  "output": "Well, I doubt it's related to the thyroid. Your free T4 is normal, and it's free T4 that causes the symptoms of hyper or hypothyroidism."
},
{
  "instruction": "34F, 54, 125 lbs, nonsmoker, being treated for lymphoma and lupus, seeking oncology and rheumatology guidance for cohesive treatmentHello, I had to add all that info since the auto mod deleted me for not having all of it. Im about halfway through AAVD chemo for stage 4 Hodgkins and see a rheumatologist for lupus. I feel theres a disconnect between oncology and rheumatology in my treatment and Im not finding much online about rheumatology\/oncology, if that is indeed a field that exists. Im willing to travel a few hrs from NJ for treatment, just hoping theres a specialist who is knowledgeable in the treatment of both conditions since lupus, its treatment, and chemo put me at risk for more cancers. Looking forward to any suggestions anyone has. Thank you.",
  "input": "",
  "output": "That field does not exist. The closest medicine gets is with multi disciplinary centers like Mayo or Cleveland Clinic where a bunch of different types of doctors collaborate on your case. I'm sorry you are going through this. Is there some reason why you think it would be best if they were the same person? Is something wrong with your current team? You said there is a disconnect but what does that mean? Perhaps if you talk with both providers, or their office staff, you can have your records synchronized between the offices so you don't feel that way?"
},
{
  "instruction": "Could I have Rheumatoid Arthritis? 24FI'm 24 F. I take Adhd medication- methylphenidate. I also take a vitamin d and b12 supplement. Trying to be referred to rheumatology.I didn't know where else to post this but I desperately need advice. Back in December 2022 I noticed a small lump appear on my right hand on my ring finger. I initially put it down to an injury or chilblains as the weather was so cold. But on New Years eve I developed swelling in my hand that didn't quite go away but would fluctuate.Fast forward to Mid-january 2023 the swelling has gotten worse on my right hand with stiffness setting in and it becoming harder to bend certain joints. I called my doctor he told me to go to A&E to make sure I hadn't injured my hand and sent me for a rheumatoid blood test as my mum has rheumatoid arthritis.Went to A&E no hand injury so then I was waiting for the blood test. I had my test and everything came back normal. But my hands were getting worse, stiffness was worse and my left had was also suffering with stiffness, no swelling though. I had a hand examination at my doctors and they confirmed the stiffness in both hands on all my joints. Also the stiffness doesn't go away, its worse in the morning but only gets a little better. I started to notice other things though: weight loss, sweating, odd fevers, appetite going weird, the fatigue has been horrendous. I'm losing hand strength and can't carry shopping bags for long anymore.Present day: I've lost at least a stone\/ stone and a half in weight since December. I was 87kg last January (2022) now currently 76kg. I want to make it clear that I've done nothing to change my activity level or diet. I've been working in a bookshop the last 2 years. The tiredness is awful, the stiffness seems to be spreading to my knees and shoulders. Even when I'm walking all day they just feel tight. There was a day my shoulder hurt so much and felt so heavy I couldn't actually pick it up. My overall mood is on the floor, I feel so sad all the time. Its hard to hold my toothbrush, hairbrush etc. I can't pull up a blind some mornings. I have a deformity beginning on my finger.At recent doctors appointment my doctor dismissed my concerns and said I just have chilblains. So now I'm worried I've got everything wrong and I'm just being stupid. I know no one can diagnosed me but I just need advice about my hands as I'm at my wits end. Thank you!",
  "input": "",
  "output": "With a family history of rheumatoid arthritis and the symptoms you describe (worse in the morning, systemic involvement, progressive worsening) a rheumatological process is definitely on the table. What specific blood tests have been done already?I take it that youre in the UK given your terminology, and from what I understand generalists act as cost-saving gatekeepers which is appropriate from a systemic standpoint but can be challenging as a patient who feels like theyre not being heard. I would seek out a second opinion if you feel like your current physician isnt listening."
},
{
  "instruction": "The blood tests I have had already are: Rheumatoid factor- my result was < 20.0 iu\/ml Serum urea level- result was 2.9 mmol\/L Total Vitamin D- results 29.5 nmol\/L Serum ferritin- results 30 ng\/mL B12- results 155 ng\/L Folate- results 3.7 ug\/LI've had on and off deficiencies in Vitamin D and B12 since I was 13. Especially Vitamin D, I had a serve deficiency at one point.",
  "input": "",
  "output": "I would push to get an anti-CCP antibody and to see a rheumatologist. Might even have utility in checking an ESR \/ CRP to check your current bodily state of inflammation. Theoretically even if the RF and anti-CCP are negative you can have seronegative RA. Recognize that were anchoring pretty heavily on this given how youve presented the story, so be open to the idea that it could still be something else if the specialist has other thoughts. Worth exploring though, because the benefit of starting on biologic medications in the case of RA is to slow down the progression of joint deterioration."
},
{
  "instruction": "Autoimmune CVID Question - Immunoglobulin Panel27F | 5'8 | Caucasian | USA | Autoimmune concern | No current med except otc Tylenol\/Ibuprofen | No smoking\/drug use | Very rare drink, only celebratory (weddings, birthday, etc) |To keep this as short as possible, I am experiencing general widespread aches and pains (I say my bones hurt a lot\/heavy feeling legs), muscle weakness, joint pain, rashes, petechiae, easy bruising, itchy skin, swollen left axillary lymph node, gastro problems (diarrhea to constipation), chronic sinusitis and extreme fatigue. I have had these symptoms for the past two years or so, but my rash has spread onto my hands and the swollen lymph node will not go down - it doesn't hurt but I do notice it in my arm pit and it is visual when I raise my arm. I went to the doctor, since all my complaints were kind of general and vague she ran an ANA - positive 1:160, speckled. I was sent to Rheumatology, the Rheumatologist checked for Lupus, said I do not look like a typical Lupus pt and all my other Rheum bloodwork was normal (ESR CRP etc). He explained healthy people have positive ANAs. He did want me to go to Dermatology for the rash. He didn't think it looked like Lupus but did say it looked suspicious. He agreed that something was wrong with me as he believes skin is a big indicator in overall health. I went to my original doctor to get a referral to Dermatology - she decided to run an allergy panel and refer me at the same time so the Dermatologist would have everything in my chart they may need. Everything was completely normal, no allergies at all except my igE was at 3 which she flagged as low on my chart, even though the reference said 2.5 was low.After looking low igE up, I am not a doctor so I obviously do not understand a lot of the terminology, but from what I can gather it seems that people with autoimmune conditions usually have a low igE. Not that it is not necessarily a diagnosing factor for anything, but that the two usually go hand in hand *from what I can understand.*My question is: should I request a full immunoglobulin panel? Does having a low igE warrant that? I wanted to touch base with my doctor about the igE but did not want to ask her for an unnecessary bloodwork if igE doesn't correlate with an immunoglobulin panel - if that makes any sense? lol.I have read about CVID and would like to rule this out in my medical journey.Hopefully this all makes sense! Thank you for your time!!",
  "input": "",
  "output": "A low IgE might not warrant a full immunoglobulin panel on its own, but considering your symptoms and positive ANA, I would request one."
},
{
  "instruction": "Rheumatology: a positive ANA then a negative one days later?Male\/ 38 years old\/ USAI had some tests done with my primary care doctor because I had generalized muscle aches, felt run, headaches and cracking joints for a few weeks on and off. I had blood work done and my CRP was 26, my ESR was normal, my rheumatoid factor was normal, my anti-CCP was normal, my ANA IFA was 1:80 positive. Speckled. , and my Lyme panel was normal.I saw a rheumatologist 4 days later who did a repeat of the blood work and those results just came back a little differently. The CRP went down to 15 and the ANA Multiplex Reflex 11 was negative. What do I make of this?",
  "input": "",
  "output": "ANA 1:80 is considered low positive. Some might say negative. Labs like this fluctuate frequently especially if not super positive like 1:320 and higher. And ANAs notoriously fluctuate based on blood storage, travel and lab technician. Its clear based on your CRP that you have inflammation going on. It takes time to garner a rheum diagnosis for most people because the picture isnt crystal clear at the first visit. See what your rheum has to say as the whole gamut of labs is needed for context."
},
{
  "instruction": "Thank you doctor! My rheum called and said he thinks it could be a post viral syndrome, especially since I had Covid 3 months ago. Although I recovered fully, it knocked me out for 16 days. He said viruses or post viral syndrome would explain my High CRP, normal ESR and borderline ANA and cause Inflammation, and even low positive ANA titers. Does that sound right?",
  "input": "",
  "output": "Could be. COVID has been known to cause transient positive ANA. In addition, something like 20% of the general population has a false positive ANA up to 1:80 so we dont read much into it unless the titer is higher."
},
{
  "instruction": "Could I please ask if the results would be higher or lower if there's was a lot of travel and storage involved. I got the test but the lab they sent it to was quite far away (a few hundred miles)",
  "input": "",
  "output": "Lower. When a sample travels it degrades in quality and some dont use the same ANA tests. Labs also run tests on different days. Usually ANA is M-F in most labs but some with lower volume may do M\/W\/F which means your sample may sit for a day or a weekend if you have labs drawn on Friday."
},
{
  "instruction": "Doctors please help my little sister, she can't walk, I'm afraid she's going to die8F, 78lbs, no medication. She was in the hospital for a long time but they discharged her. She is still in pain, please help. I attached the notes of her discharge.The patient is an 8-year-old white female with five weeks of fever, rash, arthralgias. Last month, the patient noted foot pain involving both left and right feet, as well as a blotchy pink rash on the leg that proceeded to spread to the trunk and then arms and then face during that week. The patient had low-grade fevers with temps to a max of 101. This has progressed to the week prior to admission higher fevers with T-max of 103.5. The patient has endorsed muscle pain, particularly in the right leg and arm, and PMD had seen the patient this week noted right knee and right index finger swelling. There is no noted weight change over this time period. No noted diarrhea or swollen nodes. The rash the patient described the week prior had an acute abrupt onset and 5-10 minutes later would dissipate.Rheumatology was consulted on the patient from admission. Lab studies were sent to rule-out an infectious etiology for rash. Strep culture was negative. EKG was also performed to rule-out a prolonged PR interval. EKG was within normal limits. A DNase B antibody was 547 and an ASO titer was 300. While results were elevated, the patient did no meet clinical criteria for rheumatic fever and diagnosis that was most likely entertained was systemic JIA. Further lab work included an ANA which was negative, rheumatoid factor which was negative, a CRP on admission was 8.6 mg\/dL with an ESR about 80. CK and aldolase were within normal limits. Ferritin was elevated at 663. LDH was within normal limits. CBC was reassuring with normal white counts, hemoglobin and platelets; findings nonsuggestive of leukemia. Hepatic panel within normal limits. A chest x-ray was done to rule-out mediastinal mass, and that was negative. From an infectious standpoint, Parvo, CMV, EBV were all negative. Clinically the patient was noted to have a salmon-colored transient rash that would come and go throughout the hospitalization lasting a matter of minutes. No definite arthritis on examination. Oncology was consulted given the history of arthritis and fevers. It was felt in the setting of normal cell lines in evaluating a smear, which revealed no blasts, no indication of hepatomegaly or splenomegaly and uric acid and LDH within normal limits and x-ray that was normal, they felt that further oncologic evaluation was not indicated and a bone marrow was not indicated at that time. Cardiology was also officially consulted because the patient had a 2\/6 ejection murmur on the exam. Cardiology felt the murmur was a flow murmur and evaluated the EKG, which they read as within normal limits, and decided an echo was not indicated to rule-out valvular disease in the setting of the rash and arthritis in an attempt to workup acute rheumatic fever.",
  "input": "",
  "output": "Internal medicine doc here but in my differential is Adult Onset Stills Disease which can still present in children and Rocky Mountain Spotted Fever. The salmon colored rash lasting a few minutes is textbook for Adult Onset Stills Disease.I'm assuming she had blood cultures done at one or multiple points during her admission. Did she have a procalcitonin tested? Did she receive any antibiotics? Any steroids like solumedrol, prednisone etc? Does she still have joint pain? Does this rash show up only during febrile episodes? Any auto immune conditions in the family like lupus, rheumatoid arthritis, hashimotos?"
},
{
  "instruction": "NAD. My son has Adult onset stills disease, also considered SJIA when in a child under 16. His symptoms were rash (with fever) that could disappear when the fever went down. Muscle aches, joint pain. Enlarged spleen, liver. Elevated CRP, ESR, ASO, and Ferritin. Liver enzymes elevated from the swelling. He is on high dose prednisone and biologic injections. Hospitalized for 3 weeks.Its rare op, but your sisters case seems so similar. It needs aggressive treatment early on for the best chance of success\/possible remission",
  "input": "",
  "output": "Yes, the evanescent nature of the rash in this context twigged me to Still's as well. There is a known juvenile onset form that falls under \"SoJIA\" (Systemic-onset Juvenile Idiopathic Arthritis), considered a version of Still's.OP, this sounds exactly like a form of arthritis to a clinician who takes care of children. I agree that what comes to mind for your mother as \"arthritis\" is likely too limited, and that definition might need to be expanded in her mind. Could you look at this, and maybe share it with her? https:\/\/www.arthritis.org\/diseases\/systemic-juvenile-idiopathic-arthritisAbout a third of the way down that page is the SYMPTOMS section, with subsections on Fever, Rash, and Joint Pain. Please read it and see if it rings a bell. Best wishes."
},
{
  "instruction": "As soon as they mentioned the salmon-colored intermittent rash I was like STILLS! Very rare but once you've seen it, you never forget it. Anakinra injections worked great for the patient I worked with, along with a major organ transplant due to damage done by the disease.",
  "input": "",
  "output": "I think we need more information. The workup is well described here, and I agree with their consideration of JIA vs. rheumatic fever vs. oncologic. But Im hoping theres more information than this. What did they ultimately diagnose her with when she was sent home? Did they do anything to treat her (i.e. IV or oral steroids)? If they did treat her, did anything help or improve her symptoms at all? Is she following up with any outpatient specialists? Again, their workup sounds thorough, just seems like some info was left out about what they actually did to treat her."
},
{
  "instruction": "Hi Dr, they diagnosed her with rheumatoid arthritis on discharge and prescribed her something, my mom doesn't think it's arthritis.",
  "input": "",
  "output": "Arthritis in this case is not exactly the same as what most people think of as arthritis. Older people get osteoarthritis where the cushioning between joints breaks down and you get pain from bone grinding against bone. Rheumatoid arthritis (and JIA, or Juvenile Idiopathic Arthritis, which is much more common in kids) are autoimmune disorders where the bodys immune system attacks itself in various places. One place is the joints but it can also cause a whole host of other weird symptoms including fever and rashes.In this case, what youve described sounds highly rheumatologic in nature. RA and JIA both fit in that category, though Id put my money on JIA based on her age and symptoms. A pediatric rheumatologist is your absolute best bet to get this figured out and get her on medications to treat and prevent flare ups like this."
},
{
  "instruction": "NAD.OP, Is the rash painful and burning? Do they resemble hives?I ask because two of my neighbors and three other friends, ages ranging from 16-65 have something very similar. Doctors can't explain it. The 16 year old has been at Stanford Children's for almost a year, and the 65 year old had success being treated with steroids after only a month. Same affliction.They look like hives yes but they come and go on multiple parts of her body within minutes. She says it hurts where the spots are as well",
  "input": "",
  "output": "Juvenile Rheumatoid Arthritis, also known as Juvenile Idiopathic Arthritis, is different from old peoples arthritis. This is an autoimmune problem that needs to be followed with a rheumatologist. The questions and confusion you and your mother are having are both very common and understandable.This is a complicated condition - you and your mother should both go to the next appointment to ask all these questions and more. If you have doubts about her diagnosis or want the test results or discharge summary explained better, talk to her rheumatologist ASAP.Keep taking the NSAID she was prescribed as directed - this is a safe long-term treatment to reduce inflammation (you said Indomethacin in another post). Dont stop her treatment on your own without talking with her doctor.Read more here:https:\/\/www.hopkinsmedicine.org\/health\/conditions-and-diseases\/arthritis\/juvenile-idiopathic-arthritis"
},
{
  "instruction": "I don't doubt the diagnosis but what worries me is that OP stated they live in Upstate NY. Most people around here (I'm by Fort Drum) have to travel to Rochester, Buffalo, or Syracuse if they aren't close enough to NYC. Even worse, if you can't private pay or don't have commercial insurance (translation if you have any form of Medicaid) it can be MONTHS waiting for an appointment, and should an 8 year old go without treatment for several months?Just to give you an idea on time frames: my children's my pediatrician started the process to refer my disabled 12yo son to pediatric endocrinology the 3rd week of August.I got the call LAST WEEK to make an appointment for March 2023 in Syracuse. So that's nearly 7 months from start to finish. FWIW our pediatrician doesn't think my son's issue is endocrine related but due diligence, you know?And this isn't new. Had to bring same boy child to Buffalo when he was 6 for ENT and neurologist appointments (well, Rochester was a possibility but I have family in the Buffalo area I can stay with). Same boy also went to Westchester outside of NYC for medical genetics because the waiting list for Syracuse was 2 YEARS LONG the last I asked and the downstate appointment was \"only\" a five month wait. But, family in the area, so worth the trip to see family too.Sorry for the novel. Thank you for being a pediatrician. <3",
  "input": "",
  "output": "This is true for an outpatient making a new patient appointment that is not deemed medically urgent by either the referring physician or the office receiving the referral.However, when a patient is seen as a consult in the hospital, they are typically seen in relatively short fashion as a follow up patient by that consulting sub-specialist. (EDIT: for diagnoses that need it. Not for every general admission.)A patient with a new diagnosis of JIA would typically be sent home with a 2 week course of an anti-inflammatory and be seen by the consulting rheumatologist or a colleague within that time period to plan the next phase of treatment. This type of case is not discharged without solidifying the plan for follow up."
},
{
  "instruction": "Thank you for your response, I cant recall having that experience. I think it may have happened once with my son when he was an infant (pediatric GI after his second hospital stay) but admittedly my memory is foggy.",
  "input": "",
  "output": "This sounds most like JIA to me. Once a patient is 16 this can be termed Stills disease, which has a characteristic evervescent rash like your sister has. Has she seen a PEDIATRIC rheumatologist? How far are yall from Rochester, NY? Dm me if you prefer."
},
{
  "instruction": "We are a little south of Albany. Are JIA and Stills technically the same thing? We Have an appointment with pediatric rheumatologist next week. Could the reaction have been caused by a vaccine? She got it two weeks before the symptoms started",
  "input": "",
  "output": "I may have said it wrong- Stills is a name given to systemic onset juvenile inflammatory arthritis, its a type of JIA. Peds rheum is exactly who yall should be seeing and they should be able to Advise if her symptoms could be vaccine related or completely different. Keep us updatedSounds like JIA. Episodic rashes and fevers fit. Ferritin supports the diagnosis.Youre mom is wrong and this absolutely sounds like rheumatoid arthritis Im sorry to say. She probably doesnt understand that rheumatoid arthritis is not just joint pain but can be fever feeling generally sick last week the interesting rash that youre describing and other auto immune future so its not like osteoarthritis that you would see in an older person for example"
},
{
  "instruction": "Do doctors take offense to their patients going to a different practice\/not believing the diagnosis?Demographic Info: 24F, 54, 120lbs, white, ~1 year duration, location of pain is basically the joints in my hands, feet, ankle, wrists, knees, and elbows. Non-smoker.Hi all. Sorry if this isnt allowed, Im new here. Ive been to quite a few doctors in the past 10 months (1 Orthopedic, 2 Rheumatologist, 2 Primary Physicians) for the same issues (joint pain primarily, with some secondary concerns). I believe I have an autoimmune disease and suspect its rheumatoid arthritis, but now Im suspecting lupus after my most recent rheumatologist visit. They all have told me (besides the one primary care physician) that it is not rheumatology related, but they have also all either given me either no answer on what it could be or an answer without any real evaluation. The disease\/disorder that they say it could be also doesnt match my symptoms at all.Im really at a loss right now, because I want to believe that they have my best interest at heart, but for me to believe a diagnosis, either the symptoms have to match or there needs to be some kind of test result that indicates something.If I go to a new practice that is two hours away, would that look bad? I want answers, but the practices near me cant provide answers using quantifiable\/visual data.",
  "input": "",
  "output": "I think most doctors don't care. What can get a little bit annoying is when there's clearly nothing relevant to said specialty going on and they keep seeking multiple opinions. It'd be hard for TWO rheumatologists to miss both RA & Lupus, considering these are probably the most bread and butter diseases they see (other than fibromyalgia). But feel free to try a third (technically 6th opinion). You should go to an academic center if you have not."
},
{
  "instruction": "The reason I dont really trust the answers of the rheumatologist is because of the lack of testing\/evaluation\/time really spent trying to understand whats going on. If a doctor ordered a bunch of lab work and based on the lab work decided it was\/wasnt something, I would believe it but they barely looked at my joints, and one flat out said that they dont believe my pain",
  "input": "",
  "output": "Not saying this is your case but an example would be a kid hitting his head then acting normal and coming into the ED. How could you tell he didnt have a head bleed. Well, it is kind of what I do and I know which kids should get a head CT and which shouldnt. So maybe they are seeing something that says no.Another problem is when I see that people have gone to many doctors, I instantly think they are doctor shopping for the diagnosis they want. It definitely biases me and if you go to a rheumatologist, I am going to assume they did their workup, so I am not going to be looking for anything rheumatological. So I am even less likely to draw labs.Not saying either of these things are your case and maybe stuff is getting missed which is a bummer. But all in all, no I dont mind if people get second opinions."
},
{
  "instruction": "I get this vibe a lot too, and I try to bring up questions, but then I get talked down to for asking in the first place",
  "input": "",
  "output": "A big part of medicine is learning to read research and interpret the results. You can find a study showing practically anything (one that springs to mind shows no benefit to wearing a parachute vs not wearing one when jumping from a plane). That doesn't mean the information is valid, or valid in the slightly different context to which it often tries to get applied.Doctors generally appreciate an interested and engaged patient very much. We don't appreciate someone who thinks they know better, especially if there are some obvious, fundamental gaps or flaws in their knowledge. These knowledge gaps may not be addressable in a reasonable time frame, so many of us won't bother to try.We (usually) aren't just gatekeeping treatment, there are sometimes significant potential harms from engaging in whatever revolutionary therapy has been suggested online.Actual expertise can sometimes be indistinguishable from ego, depending on what you go into the consult looking for."
},
{
  "instruction": "You will have to wait a bit as a new patient but that is normal. I referred someone with MS to Mayo's clinic and they did an amazing workup--that person goes there annually now for follow up. I would start by going online to their website for JH and reach out, see what conditions they specialize in. https:\/\/www.hopkinsrheumatology.org\/make-an-appointment\/ I don't have experience with which centers in the country are considered the best for your condition but you can definitely research that too. Any place where you make an appointment will let you know where to have your past records sent, however be prepared to have labs and tests repeated for thoroughness.",
  "input": "",
  "output": "Nobody cares. They'll go about their day and think about other things. I'm sure if you see enough rheumatologists, somebody will diagnose you with an autoimmune disease. You can always find that 1\/10 dissenting opinion if you see enough of them. Same with any other common disease\/complaint in another subspecialty (IBD in GI, heart palpitations in cardiology, etc). See enough of them, you'll get a diagnosis attached to your medical record.It's up to you decide if all the other doctors were just lazy\/stupid and if that final rheumatologist you found that agrees with your self diagnosis is actually correct."
},
{
  "instruction": "F33 - fingers go pale and numbMy best friend, f33, has been having this on and off for years now. She asked me to post on Reddit.Shes always suspected Raynauds Disease. Her fingers go pale white, tingly like pins and needles, and numb. It happens at least once a month.Ill add a photo in the comments.Is there anything she can do? Would there be any long-term issues?",
  "input": "",
  "output": "It's Raynaud phenomenon. Even though it's sometimes linked to some rheumatological conditions, usually it isn't pathological. Consider going to a specialist in family medicine or family medicine if it causes discomfort or if there are other symptoms in association."
},
{
  "instruction": "[F26] Fingers swollen, stiff, w small 'lumps'\/bumps around joints?For the past two weeks + my fingers on one hand have all been pretty swollen and stiff, to the point where I haven't been able to bend them all the way down. There has also been some redness on some of the joints. However, in the past week as the bigger swelling has gone down a bit\/the problem has persisted, I've noticed small bumps around the joints  most of these are kind of hard to capture in pics, but you can feel them lightly running your finger along the skin (i.e. you don't have to press down to feel them). See pics: https:\/\/imgur.com\/a\/TQRDVQSI've been finding this really painful, especially as I work typing all day so it's not been ideal. I've had a p busy 2 weeks so haven't made it to the dr yet, but also keep thinking its about to resolve itself and it just keeps on going  Not itchy at all, just painful.They're worst in the morning in terms of swelling  by the end of the some days I've nearly been able to get them all the way down, or get some of them fully down, & I think its on the way out but then they're just as swollen and stiff the next morning. EDIT: Just realised I should probably say I haven't injured or burnt the hand\/fingers recently, or at least if I did it was so unmemorable I really doubt it is the cause!For the past ~year I've had a fair amount of joint pain and some stiffness which is worst in the mornings, mainly in my hands & knees. However, never had it where it lasts throughout the day for so long & the little bumps are also rly weirding me out. Does anyone know what this is??? Or how I fix it?? Should I get it checked by my GP or is it likely to self resolve?I've also been experiencing a lot of other health complaints (you can prob see in my reddit history lol), like recurrent episodes of mouth and genital ulcers, rashes, etc. All my blood tests ordered by GP have been clear & generally normal  tho have all been done when im generally asymptomatic had one while at A&E for the first flare up of the genital ulcers & had high CRP and monocytes (CRP was 14.9, monocytes 12%  tho monocytes have been between 0.85 and 1.09 in other blood tests which I know is above the 'normal range' in some labs but not the ones used here). So far my GP and some of the community referrals I've had (dermatologist, ophthalmologist) are a bit stumped  waiting on two hospital referrals atm, one for patch testing and one to see a specialist vulval dermatologist. All of the community referrals I've had have suggested my GP refer me to rheumatology but he can't with normal bloods (& wants to wait on hospital referral first to see what they say).",
  "input": "",
  "output": "Rheumatologist here: I agree you should see a rheum. It sounds like it might be some sort of artritis, but it has to be seen in person before a diagnosis could be made. You don't have psoriasis, uveitis or an inflammatory bowel disease? Swelling in other joints? What is your ethnicity? In case of genital ulcers, we should also think of diseases like Behets, but like I said, it should be seen by a rheum.A bit odd that he can't send you with normal lab tests. Clinical presentation is way more important than a blood test."
},
{
  "instruction": "My hands keep turning yellow. Can anyone tell me why?Im a 36F and I have Sjgrens syndrome and endometriosis. I take Plaquinil, hydroxyzine, and a DIM supplement. My CBC, rheumatology bloodwork, and liver bloodwork were all fine. When it happens, my hands sometimes feel a bit numb.",
  "input": "",
  "output": "If you have a question about something visual, like a skin condition, please include one of preferably more of the pictures in your post as an imgur.com link. It makes it easier to help with something when it can be examined visually."
},
{
  "instruction": "F19 ANA development (possibly rapidly?)So context: I'm not allergic to anything and never have been. In November of 2019 I had what I thought was a bug bite on my elbow that exploded into full hives and three days later I was in the ER getting an epinephrine drip (I think. I was super out of it and my mom was too beside herself with worry to focus on what they did) because it developed to the point where my ears and lips were swollen and my throat tightened up significantly. Following that, I've been on heavy antihistamines (A and B) and can't get off them without the hives come back. I've also been having joint pain randomly since then (wrists and ankles primarily)In January of 2022 my allergist ran a lupus diagnostic panel on my blood but there wasn't anything other than general inflammation flagging the systemProblems continue to occur and my former pediatrician got me in with a local rheumatology clinic. I finally get in December 2022 (I'm in college and it had to be while I was on break) and I get the results and I have speckled+homogenous ANAs at a 1:160 ratioTL;DR ANAs went from not showing up to 1:160 in the span of 11 months. Any clue what's up?",
  "input": "",
  "output": "An ANA is a nonspecific test, not a diagnosis. https:\/\/www.rheumatology.org\/I-Am-A\/Patient-Caregiver\/Diseases-Conditions\/Antinuclear-Antibodies-ANA"
},
{
  "instruction": "transient ekg changes?I am a 24F, 5'3, 160 pounds. Location on body: heart duration of complaint: since December 8th, 2022. Symptoms, nearly fainting randomly, sharp chest pains that come and go, lightheadedness that gets worse at times, also knuckles, knees, and hands go pale or purple randomly. Concerned about poor circulation. Meds: none, medical problems: sjogrens syndrome, mild anemia, rheumatology suspects dysautonomia, asthma, sleep apnea (use CPAP), The ER did an EKG last night and in the notes it said the t wave depression was consistent with incomplete right bundle branch block. Yet I went to urgent care today for the same chest discomfort, lightheadedness and near fainting episodes (with seeing colors) (didn't want to go to the ER again) and they showed a normal EKG. Can these changes be trainsient and induced by stress, or lack of sleep? I am also concerned my body is shutting down because my body temperature is lower then it usually is. It's usually 98.5 but it's been between 95-97F these past few days let it can't regulate itsself.",
  "input": "",
  "output": "They can be transient. They can also be due to improper lead placement"
},
{
  "instruction": "Please, please help...no one can figure out whats wrong and at my wits endI've posted here before and no one ever seems to answer but I'm getting so sick that I'm basically bed bound from pain.I'm a 32 yo woman, overweight at 280 lbs, diagnosed with Sjogren's, PCOS, and on these medicines:Metoprolol for tachycardia I've had since childhood Metformin for PCOS Spironolactone for low potassium I've had since childhood (used to have constant racing heart and passed out a lot as a kid because of low potassium) as well as PCOS Nuvigil for chronic fatigue Pilocarpine for Sjogren's dryness Doxepin for ribcage pain Rosuvastatin for high cholesterol Low dose naltrexone 3mg for chronic pain Trintellix for depressionA few years ago, like 5 years now, I was healthy and 125 lbs. Then I had my 2nd child, was about 180 after she was born, and developed PCOS. I could not lose weight and gained a little more and got to about 225.In Dec 2019, my psychiatrist put me on Trileptal for mood stability. About a month later, I started to develop pitting edema and severe low ribcage pain and then had absolutely zero appetite whatsoever. I went to the ER with grade 4 edema, severe low rib pain, and blood in my urine and bloody vaginal discharge. No sign of infection, no excess protein, nothing really out of the ordinary aside from GFR that would dip into the 50s before sometimes coming up again and blood. I did get low iron and potassium, needed iv potassium several times, but they could find nothing to easily explain symptoms. This goes on for nearly a year...I got up to 325 lbs even though I could barely eat or get out of bed. I truly thought I would die.I stopped taking my medicine when I couldn't eat, and noticed I felt worse after taking it again. I also felt worse if I exercised. So I stopped Trileptal and rested for about a month and slowly seemed to recover. Then my OBGYN found uterine polyps and I had surgery to remove them. The next month, my gallbladder was removed. The next month, I had surgery to \"fix\" my urethra since they thought maybe I was having urinary problems stemming from that.But I got better and tried to be okay mentally with the constant dismissals I got from so damn many docs before I finally got some help. It was extremely difficult and I suffered with health anxiety because of it but have done great with therapy. I even managed to get my weight down to 235 after starting exercise after being sure my kidneys were fine again at a consistent GFR over 110.Then a month ago, I got a very bad case of flu. The lower rib pain came back bad. I dismissed it as flu. Recovered from it, then had several days where every muscle in my body felt like it had been lifting heavy weights for days. Everything hurt, and doc said maybe mild myositis from flu. Then I noticed urinary changes. I normally have frequent urination, going a few times a night and usually at least every hour or more. No one can find a cause though. But suddenly not going at night at all and only going like 3 times in the day. Started having white flecks in urine sometimes and strong odor. Then urinalysis started showing blood in urine consistently. Then sharp pains in urethra all the way to anus at times, which I'd had before as well. I have brown vaginal discharge too. A few days ago, I couldn't pee at all and was sent to the er. They can find no reason for my symptoms...nothing on ct, no bacteria in culture, no stones, no nothing. No one knows, but I had to have a foley catheter inserted (was very painful like stabbing) because I had retention and could not pee. Was sent home with it and had it removed next day and I was able to pee again but then developed pitting edema. It's currently grade 1. No cause can be found.I will add in case it is relevant, just before the flu, my pcm referred me to neurology for mris of head and spine and nerve conduction test. I've been having nerve pain for several months. Buzzing, tingling, numbness, shocks, in various places for sustained periods and sometimes just sudden and then goes away. She was thinking the lower rib cage pain may actually be nerve pain since it feels burning at times like the burning headaches in the base of my skull and my neck. My thyroid is sometimes hypo but usually fine, my b12 and magnesium are normal, and I do not have any markers of diabetes other than just being fat currently. My grandma has MS, which she believes was healed by Jesus, but I know enough about it to know that's what she's trying to rule out I'm pretty sure.Can anyone, please , give me some insight about what might be wrong with me? I'm in so much pain with the gnawing, burning pain in the bottom of my ribcage and the electric shock pains in my urethra and anus, and I am so scared of the fact I've got urinary bleeding, vaginal bleeding, and putting edema but no one knows what's up. I've seen rheumatology, nephrology, urology, obgyn, even was sent to a hematology oncologist as a hail-mary.I stay away from Googleing anything because for one, I have too many symptoms to easily fit in a search bar, and I know there's no good coming out of looking at it anyway. I have gotten better care since changing hospital systems after last time this happened, the urologist I saw kept insisting the blood in my urine was from my vagina even though I still had blood in my urine after a catheter was used to sample, and I e just had a really hard time getting docs to push to figure out what's wrong. It feels like since I don't appear to be imminently dying, and they dismiss my pain and exhaustion, no one sees a point in helping.So sorry for the long post but I'm just trying to give as much context as I can. Please let me know if you have any questions as I'm happy to answer.",
  "input": "",
  "output": "In the absence of objective findings on imaging and testing, it is possible that weight in itself can cause the multi-system problems that you have. Obesity unfortunately affects numerous organ systems in subtle ways initially."
},
{
  "instruction": "Help interpreting liver testAge42Sex fHeight 54Weight190Race CaucasianDuration of complaint dates referenced on theLocationAny existing relevant medical issues? so many lol RA,hEDS,Endometriosis,Asthma,Current medications, Zoloft,Simbicort ,prednisone, alburtol,muscle relaxers ciplopram ? ,NambutoneALT 0 - 41 U\/L 4\/4\/21 19 10\/8\/21 20 8\/29\/22 346 8\/30\/22 342 8\/31\/22 352 9\/10\/22 316 9\/17\/22 296AST 10 - 40 U\/L 4\/4\/21 14 10\/8\/21 21 8\/29\/22 215 8\/30\/22 194 8\/31\/22 195 9\/10\/22 193 9\/17\/22 186",
  "input": "",
  "output": "You have active inflammation of your liver. Not sure what the cause is. Could be some autoimmune process, fatty liver, meds, supplements, etc. Favor the first two"
},
{
  "instruction": "ostive ANA test, titer of 1:320 and speckled pattern, but negative Connective tissue testI'm a 35 yo Caucasian female, 5'5 and 170 lbs (back to back pregnancies), I vape, I take Omeprazole and lyrica 200 mg daily. The lyrica is for seizures, not pain.Ok, so I just had a bunch of labs drawn, because I've been having numerous symptoms of an autoimmune disease. Chronic fatigue, mouth sores that will randomly show up, lots of head aches, severe random bouts of pain that show up in joint areas that debilitates me when they \"flare up\". Crippling anxiety, and depression is worsening. And lastly, a random rash that will spread across my cheeks and nose, and sometimes radiate into the tips of my ears.I had a positive ANA test, but the more specific tests showed that I was negative for connective tissue disorders like lupus, RA and sjogrens to name a few. Everything looked fine, and my doctor told me that I probably just have inflammation somewhere in my body.My questions are:. Could I still have something like lupus, even tho the CTD labs were negative, but ANA had all 3 parts show abnormal results? And, this isn't my first positive ANA test. It happened 6 years ago, but nothing further was looked into. Where do I go from here to get better answers? All these symptoms are debilitating my life.",
  "input": "",
  "output": "techincally you could still have something on the spectrum of connective tissue diseases with current antibodies negative, but +ANA are pretty common in the health population. best bet is probably continuous follow up with a single primary care doctor, and referral to whatever specialists they think best."
},
{
  "instruction": "They ended up referring me to an RA. This is the second time I've had a positive ANA test within 5 years. The speckled pattern is what's making me wonder. I have more of the symptoms of an autoimmune disease, than I don't have. I hit almost all symptoms of moderate lupus, without kidney problems, but I HAVE within the last year, had protein in my urine, but I was pregnant at that time. There's a lot going on I feel kinda dismissed by the doctor. It's almost their discretion to diagnose, because of symptoms and positive ANA alone. I've read on many medical documents that a negative anti ds is not absolute to not having an autoimmune disease. I've heard it's hard to get diagnosed, so hopefully the RA can give me some more definite answers, once I actually get in to see them :\/",
  "input": "",
  "output": "lupus had a discrete diagnostic criteria, it might not be as discretionary as you think. unfortunately the symptoms of many rheumatological diseases overlap heavily with many non rheumatological conditions. best of luck."
},
{
  "instruction": "6 year old dying from ARDS all labs are negativeHello, on March 15th my 6yr old son had a fever and cough. This continued through March 17th. He seemed fine the entirety of March 18th. On March 19th he started presenting with a full body light petechial rash and fevers. Appetite, fluid in take and behavior were all very normal. Would occasionally become sleepy with the fevers. Fevers would come down with Tylenol. Over the next two weeks the fevers became more frequent but were still easily treated with Tylenol. On March 31st he began to lose energy and didnt really want to get out of bed. On April 1st he started refused food and drink. The early hours of April 2nd he began vomiting. We had several appointments with his PCM, urgent care, and nurse telehealth during these two weeks. All advising its just something viral and should resolve on its own. After refusing food and drink and then vomiting we decided we couldnt wait the 24 hours to his next appointment and took him to the emergency room. He began requiring blow by O2 while sleeping from night one at the hospital. The petechial rash started to become severe in places where he had any medium to heavy pressure (blood pressure cuff, being held for accessing his port a cath). On April 4th he began needing supplemental o2, between 1.5-5L. After a week in the hospital he was diagnosed with a severe CMV vierma infection. He was started on gancylovir to treat on April 10th. After a few weeks of treatment his CMV levels have finally come down to the 100s (as of early this week). On 4\/13 he was out on high flow o2 due to hypoxia. He continued to range in requirements of 15L-30L and 60%FIO2 -100% FIO2. We were advised his lungs would begin to heal as his cmv number declined which has clearly not been the case. On 5\/1 he was rapid-ed to the ICU due to expected impending respiratory failure with hypoxia. In the icu he had episodes or high hr, blood pressure, and low O2. However, these episodes were short lived at the beginning and after they were over he would go back to his normal goofy self. Over the next 36 hours his episodes became longer and more frequent. He has a planned intubation set for May 3rd at 6am and a planned brohncoscopy set for May 3rd at 9am. Original plans were to begin attempting ex-intubation post procedure. However at approximately 3am on May 3rd he had an episode that did not resolve. He was placed on a ventilator which failed due to CO2 build up, oscillator was attempted and failed due to CO2 build up. He was then placed on bivalve ecmo on max pediatric settings. He remains on max ecmo settings to present day. He has since been diagnosed with ARDS. He has had an extensive infectious disease work up and rheumatology work up. Every test result has come back negative. Tests show high levels of inflammation. Doctors at our current hospital refuse to do a lung biopsy due to expected death during or as a direct result of the procedure. Please help. We are being told were reaching the end of our options here. We have a second opinion request put in with Boston Childrens Hospital but are willing to travel anywhere that may be able to help him. I can provide any and all test results you need to help and the team here is typically willing to run more with plausible explanation. He has a complex medical history as well be no full encompassing genetic diagnosis.He is currently on anti fungals, antivirals, and antibacterials. He also has a BMX drip for a diuretic. He is on several medications for sedation and pain management for ecmo.",
  "input": "",
  "output": "I am so sorry to hear about your son. I have a child about that age, and can't imagine.CMV is not a typical infection in someone with a healthy immune system, usually we see it with transplant or lymphoma but there can be congenital immune system problems that predispose to severe CMV. It can certainly cause all of the symptoms your son is showing including the petechial rash and severe pneumonitis leading to ARDS. It can affect nearly any organ.However CMV can also reactivate due to stress from other issues so it is difficult to say if this is the cause of his symptoms, or just a sign of how sick he is. While it is risky to do a lung biopsy in a person on venous ECMO, if there is no diagnosis within a week it is reasonable to proceed with doing this, with fairly good safety outcomes.https:\/\/pubmed.ncbi.nlm.nih.gov\/27894766\/The most important thing though is if the treating physicians think not only is it safe (there are other issues such as clotting\/platelet disorders beyond ECMO anticoagulation) but if it will change management. Unfortunately a large percent of biopsies will be indeterminate - just showing nonspecific findings of diffuse lung damage from ARDS - and the ones that do change management are generally because they find something that is not treatable. I would entirely defer to your physician team here. They also want very much what is best for your child - doctors and nurses care much more than you may see about thing turning out well - and have the data and expertise to properly advise you.If it is CMV, then the inflammation from the infection will lag well behind the time the virus is cleared with antiviral therapy. He may just need time for the inflammation to improve and then to heal to allow decannulation."
},
{
  "instruction": "Thank you. I fully believe the team here is doing everything thing they can think of. Theyve had entire departments sit down to review his case in multiple departments. The reason we began looking for second opinions is that two of the doctors here on his primary team recommended it. It is very comforting to me that they care more about finding answers for him than being the ones to find the answers. I cant speak enough to how much that says about them as doctors and people.In regards to the cmv inflammation lingering in his lungs. Would there be a high level of infection in that area if a pcr was run from a sample from there if thats what was causing his severe inflammation? If so, would a more aggressive dose of his current antiviral help with it?",
  "input": "",
  "output": "That is reassuring to hear. Sounds like they are doing everything they can.If the CMV is the cause, there's unlikely a high level in the lung if any. The antivirals work reasonably well if there's no resistance, the dosage is generally more than necessary for maximum effect, the levels of CMV in the blood can be tracked, and my guess is they are now at worst quite low.Most of sepsis is instead the body's response to an infection. As the immune response ramps up it starts being less and less precise and the rampaging army of white cells causes widespread injury. This continues after the infection is completely cleared despite a counter-inflammatory response that is trying to resolve all of this overactivity. In fact, the counter-response can be just as harmful if overactive, and there can actually be a state of too much and too little immune response at the same time. This is particularly dangerous since it opens things up to other infections.We actually still don't have very good tools to helpfully manipulate this immune response despite decades of research. There are dozens of therapies that are helpful in mice but later failed clinical trials. Sepsis is very dynamic and complex, nowhere near as simple as \"on\" or \"off\", and until we are able to adequately characterize it in individual patients treatments will continue to mostly be limited to the infection itself and \"supportive care\". Fortunately this is still often sufficient, and we've had good outcomes even in patients who were on ECMO for over a month."
},
{
  "instruction": "NAD but a fellow ICU mom. Been in twice for my 2yr old and multiple hospitalizations in between. Its a very scary place. Just wanted to say I feel you and hope for a good outcome for your little fighter.",
  "input": "",
  "output": "What led to your son having a port?I am sorry this is happening. Has your boy been evaluated for HLH (hemophagocytic lymphohistiocytosis)? ARDS is not a common manifestation of this, but considering the situation of runaway inflammation and that it is occurring in the context of CMV infection, this has to be considered. You can see inappropriate immune stimulation co-occurring with frequent infections and immune deficiency due to there being a milieu of overarching immune dysregulation. Texas Children's Hospital and Cincinnati Children's Hospital are particular specialists in treating these syndromes. I doubt that transfer of a patient on ECMO is possible, but those facilities may at least be able to provide some guidance."
},
{
  "instruction": "Thank you I will ask him team if this has been tested for!Agree with HLH assessment, very tricky disease and its not clear if he was evaluated for it, but sounds like a reasonable suspicion.",
  "input": "",
  "output": "Hey OP! I am sorry that you are facing this trying situation. My heart goes out to you and your child!From what you have described, it seems that not only you, but also the doctors are doing their best!The damage to the lung needs time to heal, something that has become a luxury for your child.As you have stated, all other infectious and rheumatological workup is negative. So, they might have tried steroids or intravenous immunoglobulin to tide through this crisis.We just wait, for your child to fight this through!"
},
{
  "instruction": "Thank you. Theyre nervous to attempt any immune suppression treatments without a diagnosis due to how severe his CMV infection was.",
  "input": "",
  "output": "Well ivig can help. Your child's kidney function test is fine? Is he requiring any inotropes to maintain blood pressure?If kidney is fine and not requiring inotropes ivig might be tried if not used before."
},
{
  "instruction": "Kidneys took a hit due to the aggressive BMX drip to try and alleviate the pulmonary edema. He was on a drip to help with hypertension but has since been able to come off of it in the last 36 hours. Docs were concerned about heart complications as to why he suddenly doesnt need it anymore (blood pressure has been a big problem since being on ecmo) however his echocardiogram came back normal.",
  "input": "",
  "output": "Ok, ivig is contraindicated in renal failure. So, they might bide for time till kidney function improves. It is reassuring to hear that echo is normal."
},
{
  "instruction": "rheum!  Would an underlying autoinflammatory disease be appropriate to suspect? Would it contribute to the severity? Aren't there some that are associated with congenital birth defects too (as OP stated below)?",
  "input": "",
  "output": "Yes and no!On parsing the thread, it is becoming ckear to think on lines of CVID. But, as OP stated, they gave done other rheuunatological workup."
},
{
  "instruction": "What about the ones outside of IDs  like MEVF, MKD, Still's, etc. Would genetic testing be worth it for OP to ask about ?",
  "input": "",
  "output": "I like your thinking. You are covering a huge base. But until and unless we are privvy to all histories, blood work up and labs, we are just conjuncturing possibilities.Regarding genetic test, I do agree that it can be done. The PCP in this case has to make a decision!"
},
{
  "instruction": "I dont know what constitutes a full immune work up. I know his immunology team says he has B cells but they dont do anything. They suspect something similar for his T cells but I was told they cant diagnose him while hes sick. His thyroid panel came back entirely normal. Is there something else I should ask about?",
  "input": "",
  "output": "Yeah. I understand that it may be impolite to ask:Could you provide the cytoflowmetry reports of CD 19+\/ CD4+\/ CD3+\/ CD8+ cells?Since he was given ivig, I might not be able to interpret the current immunoglobulin levels (if atleast 3 weeks have not gone by since he was last given IVIg)."
},
{
  "instruction": "No, he doesnt. He started taking IVIG to help combat the CMV infection. Theyre thinking he has an undiagnosed immune disorder due to how severe the CMV infection was. Hes also had vaccines several times but when tested his body acts like its never seen it before.",
  "input": "",
  "output": "Ok. This is like common variable immune deficiency. The antibody producing b calls just aren't functioning well. That us why his viral illness knocked him bad.But with regular ivig, every 3 weekly (once he recovers) should help him have a normal-ish life."
},
{
  "instruction": "This makes sense to me, as the one case I have personally been involved with with a severe CMV viremia was a child with IgA deficiency, CVID, and bronchiectasis. I also sounds like he has had some chronic health issues in the past so it fits that some\/all of this is connected. No specific clinical advice from me, but Ill be praying for your boy!",
  "input": "",
  "output": "While it wont give answers right now, Im surprised a full genetic work up hasnt been done. They could start with a targeted gene panel for immunodeficiency and or lung problems. In genetics having multiple seemingly unrelated issues is a GREAT reason TO GET testing not a reason to avoid it.I have seen kids recover from ARDS but its long and slow. Getting a second opinion is always your right, but jt doesnt sound like they could move him. Youre doing everything right for him. Im so sorry youre going through this.https:\/\/www.reddit.com\/r\/AskDocs\/comments\/13g4w5i\/6_year_old_dying_from_ards_all_labs_are_negative\/jjz5icx?utm_source=share&utm_medium=android_app&utm_name=androidcss&utm_term=1&utm_content=share_buttonThey did the work up"
},
{
  "instruction": "3 years, No diagnosis, Losing hopeSpecs: 23M, 140lb 61, no drinking, no drugs, no previous health conditions Negative Covid tests and vaxxedHey All,Ill try to keep this short, but here is the deal. Since early highschool my energy levels have always been low, my body has generally felt quite sluggish. I always just attributed this to long school hours and work. My dad would joke, its like you got the hangover without the partyAbout 2 years ago I was done with school and really made an attempt to increase my health and energy to actually enjoy my days. For the next year or so I attempted to improve health through a consistent sleep schedule, diet, regular exercise, vitamins\/supplements, you name it, I tried it. But after feeling consistently worse I began to seek medical help for:Symptoms:Extreme fatigueOverall joint pain, but focused on my backConstant tired burning muscles (as if I climbed a mountain)Canker sores on soft tissue 1.5in+ in diameterMorning nauseaChillsHard lumps on lymph nodesNo staminaSince July of 2019 I began experiencing episodes consistently every 3 monthsFever 103+Mouth sores 1 in+ and tonsils covered in lesionsBed riddenMuscles burnInability to eat or drink due to mouth and throat lesionsMy docs were highly unhelpful as this was the height of covid and docs were quite busy. For the most part I was passed around with little to no results. I am self employed and this is the only reason I am still able to work, as my last episode had me bed ridden for nearly 5 weeks. I was prescribed Lidocaine, magic mouthwash, acyclovir, VitD3. None of these helpedFast forward to 2 weeks ago, and 6 doctors later, I now have $8,500 worth of blood work done. Everything is normal, except I am anemic and discovered 5 herniated discs in my lumbar and neck. My iron levels are ok, but red blood cell count is low.I have been tested for mono, flu, covid, recurring strep, rheumatoid factor, ana reflex, vitamin levels, thyroid, sleep disorders, allergies, just to name a few. All came back normal.Docs are at a loss and dont know where to go next.I have been turned down by Rheumatology, ENT, Hematology, due to lack of symptoms (more or less I look too healthy to hold a place in the queue). I have been told I have the exact same symptoms by friends and family with diagnoses like RA, Lupus, MS, Gall cancer, gout, lymphoma. But I am getting turned down by specialists so tests are not happening.My daily physical health has slipped to a point of now affecting my mental health. I need answers and cannot continue much longer like this. Nothing I try improves or alleviates any pain. I dont know what to do next.",
  "input": "",
  "output": "Ethnicity? Any family members with similar? How long do fevers last for? Is it 3 months like clockwork? What else occurs during these flares, just worsening of oral ulcers? Where exactly in the mouth are these ulcers? Any vomiting or abdominal pain?"
},
{
  "instruction": "White\/CaucasianGrandmother: Lupus, Rheumatoid ArthritisGrandfather: Rheumatoid Arthritis, Lupus, GoutAunt: MSUncle: Anemic, celiac, Rheumatoid Arthritis (I have consulted this uncle, he says it is not celiacs)Yes, 3 months like clockwork, no other symptoms I can think of. I have had stomach pains, but I attribute this to my doc prescribing me antibiotics. I cannot eat for the life of me everything burns when it touches the raw nerves on my throat, so the antibiotics on an empty stomach are likely to blame for the upset stomach. No vomiting.The flare ups ulcers are located on the insides of my lips and cheeks, tonsils, back of throat, and tongue. They are according to my dentist \"the largest non surgical sores I have ever seen\"",
  "input": "",
  "output": "Anyone in the family with recurrent fevers, recurrent mouth sores, recurrent tonsillitis or strep throat, underwent tonsillectomy?Any improvement with steroids?Any labwork during an attack? White count, ESR, CRP in particular.Did your rheumatologist comment on the fevers?"
},
{
  "instruction": "Nobody like mine. The grandmother had pretty bad mouth sores apparently, and she said it improved with her Lupus medication.I have not tried steroids, so I cannot speak to that... All of my blood work has been during non-flareup times. And I have not been able to see a Rheumatologist yet.",
  "input": "",
  "output": "Periodic fevers can be autoinflammatory or infectious in nature. Stability of symptoms favors autoinflammatory which falls under the domain of rheumatology. I wonder if the referral was for mouth sores only; I would highlight the periodic fevers as the indication for further evaluation. You can suggest the possibility of adult onset periodic fever, aphthous stomatitis, pharyngitis and adenitis (adult onset PFAPA) to your PCP, although other similar conditions must be considered as well. A negative ANA does not rule these conditions out. Your PCP can rediscuss the case with the rheumatology department. I would also suggest requesting an appointment with a rheumatologist at an academic center as they tend to have more exposure to and interest in unusual conditions. I would also ask your PCP if a referral to an infectious disease specialist would be useful.Agree with \/u\/m3tac0gniti0n regarding steroids. Patients with PFAPA have significant relief with steroids, so assuming infection is felt to be unlikely a course of steroids started with the next flare may be useful for relief and for diagnosis.Best of luck.https:\/\/rarediseases.info.nih.gov\/diseases\/5657\/periodic-fever-aphthous-stomatitis-pharyngitis-and-adenitis"
},
{
  "instruction": "This was my first thought as well. My daughter had this syndrome when she was in her teens, it seemed to come about during her monthly cycle. It has subsided as she has entered adulthood. The lesions were restricted to her tonsils but with the high fever It mimicked strep and she always tested negative. She's 26 now and hasn't had enough episodes for at least 7 years.",
  "input": "",
  "output": "Feels like you nailed it! Well done!"
},
{
  "instruction": "Other than what is listed in my bloodwork, no. Thank you for your input, simply based on the feedback I have received I may ask my PCP for anymore thoughts regarding the possibility of celiac. Thank you for your input!Of course, I hope it might help you find an answer to your problem. Make sure you continue consuming gluten up til the testing is done. Cutting it out of your diet will cause the inflammatory markers to go down and may make it harder to detect.",
  "input": "",
  "output": "Just briefly looking over it,Sounds autoimmune.See if a rheumatologist will see you.The labs you provided do not help answer this question.This is also about as far from my specialty as you get, so if other docs offer ideas I would go with thatI'd say the same.Maybe some further autoantibodies tests should be done to rule out Lupus or vasculitides. Other tests that come to mind would be ANCA\/Anti-Neutrophil Cytoplasmic Antibody and\/or myositis immunoblot; ANA blot (and ENA blot if needed); rheumatic factor.Maybe, but it's a stretch, if it would be possible, I'd swab the sores and ask for some cultures (fungal and bacterial)."
},
{
  "instruction": "Thank you for your input! I have had an ANA Reflex test done. Is this different from what you describe above? They have suggested swabbing the sores, but ENT turned me down at the time, now I am supposedly waiting for my next flare up and they would swab it then.... we'll see.",
  "input": "",
  "output": "Indeed, that's the right ANA test.Sorry about the ENT. If you have any labs that you could get these done, I'd suggest going in by yourself. Depending on your country, it might not cost much.Before swabbing, don't eat\/drink anything, so it's best to get these tests before brushing your teeth, in the morning."
},
{
  "instruction": "Anti CCP Antibodies. And would recommend having the bloods done during the flare up with inflammation markers like ESR\/CRP. Definitely sounds Autoimmune in nature.",
  "input": "",
  "output": "Yeah, during a flare up is the best choice. I saw that they already had CRP done and it was normal"
},
{
  "instruction": "PBC DiagnosisI'm male, 30 years old, 5'11, 190 pounds. I have Hashimoto's disease and collagen vascular disease. I take 75mcg Synthroid and 400mg hydroxychloroquine per day. A couple years ago I tested positive for antimitochondrial antibodies at 1:80 titer. My liver enzymes have been normal. My total cholesterol is in range but my bad cholesterol is slightly high.My rheumatologist told me that the antibodies are usually seen in primary billiary cholangitis, but that they can be present in rheumatological diseases as well. My diagnosis of collagen vascular disease is a vague label as my only symptoms are low white count and low platelets, declining for a decade. Cancer was ruled out and they tried hydroxychloroquine, thinking it was autoimmune as I already had Hashimoto's disease. My blood counts have been higher since I've been taking hydroxychloroquine.I get my liver enzymes checked twice per year. Should I push for any other tests so that if I have PBC, it can be caught early? My rheumatologist said he wouldn't do a biopsy or ultrasound as my liver enzymes are normal. Is there anything else that can be done?",
  "input": "",
  "output": "You dont treat normal liver enzymes even if you had PBC. But you don't have pbc because your liver enzymes are normal"
},
{
  "instruction": "I've read that the antimitochondrial antibodies can show up years before the disease progresses. Is that true? Should I just continue to have my liver enzymes monitored each year?",
  "input": "",
  "output": "It can but there's nothing to treat"
},
{
  "instruction": "Thanks for the responses. I just want to make sure if I develop the disease it can be caught early. I watched my grandfather die of cirrhosis (not autoimmune) and it is scary, especially as doctors tell me antimitochondrial antibodies are associated with the disease and studies I've read say that most people with the antibodies get the disease.",
  "input": "",
  "output": "People don't check for antimitochondrial antibody in the absence of abnormal liver tests so this is not true at all"
},
{
  "instruction": "The studies aren't true? Or my testing positive for the antibodies isn't true? My rheumatologist did a bunch of autoimmune bloodwork due to my low platelets and white blood cell counts. He said he tested for it as it can be positive in diseases like lupus.",
  "input": "",
  "output": "So it was for lupus. It's irrelevant to pbc because there was no indication to test it"
},
{
  "instruction": "They did a wide array of tests because of my white blood cell and platelet counts as they could not figure out why they were decreasing from year to year and all tests for cancer done by an oncologist were negative. The counts were getting dangerously low. The antimitochondrial antibodies came back positive along with antinuclear antibodies. Then they said I do not have lupus or any identifiable autoimmune disease, but only a vague collection of symptoms. They put me on hydroxychloroquine in hopes it would raise my blood counts as they could not figure out the cause and I already had one autoimmune disease. The rheumatologist said I do not have lupus and that he doesn't know what caused the positive antimitochondrial antibody test. He said it's possible it's a due to a rheumatic disease or that it just happened to turn up positive in the bloodwork.",
  "input": "",
  "output": "Right. But you don't order AMA for pbc unless your liver tests are abnormal. So this is generally worthless. What exactly are you trying to convince me of.If it turns out you have pbc down the line, then you may get treatment if your liver tests are very abnormal"
},
{
  "instruction": "Elevated esr and crp with sudden symptoms (started 2 weeks ago)Hi doctors!27 year old female 6 months postpartum, weaning of breastfeeding currently. (If relevant)A few weeks ago I got a bug (negative for covid) towards the end I started having hand cramps, foot cramps, muscle pain in my legs and arms and joints, tiny spasms all over including my face and then followed by pins and needles all over and sometimes a burning feeling in skin. I will state, I have had this type of thing happen before a couple years back. I also have severe health anxiety and have been under immense stress.I went to the dr. And he did blood work. Cbc, comprehensive panel, vit d, magnesium, b12, esr, and crp. Everything was normal except for the esr and crp. Esr was 40 and I cant remember the crp level, but it was mildly elevated. Fast forward to this week, I went to the er for related symptoms (they have improved some) dr re checked blood work. Esr went up to 55 so obviously I have some inflammation somewhere. They said it wouldnt be from being sick, not caused by being obese, or stressed or anxious. They kind of hinted at MS and let me tell you that sent me into a real panic. Dr suggested my pcp order a mri of spine and brain. My pcp did so and also sent an urgent referral to rheumatology. Urgent as in November 30th being the soonest appt.I looked at my labs from a few years back and had the same elevated markers that went back down. I also had a rheumatology panel done then and everything was normal. Ana negative.My symptoms seem to be improving but Im still not feeling 100%. I have been a ball of anxious nerves since this has started so its hard to tell the difference. Now Im convinced I have ms or some debilitating disease.",
  "input": "",
  "output": "ESR elevation is extremely nonspecific. Any inflammatory condition can raise it. Any sickness can get you to the 40-50s. It's up, but not particularly high.I think your doctor is probably managing things well from what you've described."
},
{
  "instruction": "My symptoms sound serious to me, but the doctor said otherwise. Am I crazy?21M. Been experiencing this for 4 months and its gradually getting worse. Ive been suffering from headaches and chronic arthritic type pain in my shoulders. My neck is stiff and is tight when I turn it from side to side. The centre of my neck is strained, im in a lot of pain and its stopping me from doing my job and uni work. Sometimes its dull and sometimes its really bad when it flares up, but its always there.They said they dont think its anything serious i.e. muscle tension, but theyll do my bloods anyway to check for inflammation. Im just concerned that nothing will show up if they do my bloods when the pain is dull and ill go back to being in pain all the time and I dont want to seem like im crazy going back to see them. If its something serious will it always show up as inflamed? Thanks",
  "input": "",
  "output": "I assume theyre trying to rule out anything rheumatological, which would indeed result in raised inflammatory markers if you have symptoms."
},
{
  "instruction": "Thank you. If it doesnt show up, surely I cant be suffering chronically from all this for 4 months for it to just be muscle tension. Doesnt make sense.",
  "input": "",
  "output": "Very much could be to be honest."
},
{
  "instruction": "Asking on behalf of my sister. Liver lab levels insane, among other strange things.Because the leukemia\/lymphoma lab is taking forever to come back yet we have a ton others, her pcp isnt giving her much more info. Wonky highs and lows.36F, overall healthy, non-drinker and never smoked. Had 2 successful pregnancies and birth. Eats and maintains healthy diet and exercise. 57 145. All vaccines.3 weeks ago she started feeling achey. No upper respiratory stuff but general aches, fatigue and headache. Took several covid tests and negative. Ended up going to Hawaii where she thought she actually had covid there and those were also negative. She was complaining of the same thing. At one point, thought it was sun poisoning. Shes seemed to get worse and worse. A week later, which was 2 days after returning home she went to the ER for what she thought was severe dehydration. It wasnt that but they werent sure what it was. Said to see her pcp.ER doc did a handful of labs. Initially told her to see her pcp for follow up labs for mono or leukemia. Her joints ache, a weird floaty face feeling, no fever, no upper respiratory, majority of joint pain is in her legs and toes feel strange. Headaches here and there. Otherwise, she feels okay. No notice of brushing, bloody noses, rapid weight loss.Labs below. If a number is in here more than once its because it was the second lab test when increased. Nothing of concern went down, but only up. Only test we are waiting on, of course, is the leukemia one. Mono all came back negative and no antibodies.Sediment rate 4 - normal, Smudge cells - mild, C reactive - higher at 12, Polychrom, platelet morph and others in category this tests were all few or normal, WBC 8.02, Rbc 5.1, Hemagblobin 14, Hematrocit 41, MCV 83, Mch 29, Mchc 35, Rdw sd. 40, Mpv 9 - low., Nrbc 0 , Neutrophils 23.5% low, Lymphocyte 70% high, Mono 3.9%, Eos 1.0 % bordering, Baso 1.2%, Ig .1, Neutrophil # 1.8, Lymphocyte # 5.64, Mono # .08, Eos .08, Baso # 10,Edited and added below AST -57, ALT 61,Others I missed: Anion gap 2, Globulin 3.5, Albumin\/gobulin ratio 1All plasma levels seem in range besides glucose bordering high.Can anyone share if youve seen a blood work up look like this? The overall sickness has been going on for 3 weeks now and is increasingly getting worse.If its not CLL like our minds are nervously going towards, do you recommend she ask for a referral to hematology or rheumatology? Weve heard a virus already thrown in there and Im just wondering what virus out there does this to your body bc even tho Im not a dr her liver numbers arent ideal with some other markers showing some poor function Any comment to give insight would be great! Thanks.",
  "input": "",
  "output": "Where are the liver labs? And how did CLL get brought up?"
},
{
  "instruction": "I just went ahead and edited. ALT, AST. Plus a couple others. Whats odd to me - a person that isnt close to a dr; her WBC seems to remain decent. And regardless if its infection or virus I would expect an increase.CLL was brought up bc of the higher absolute lympho count and the moderated smudge cell. The ER doc wrote it on discharge to pcp.",
  "input": "",
  "output": "I'm a ED physician, and this...sounds unusual. In CLL, the white count should be significantly elevated which in this case, it is not. Furthermore, the presence of smudge cells is not necessarily indicative of CLL. I be surprised if this was CLL. This is likely some sort of viral infection if I had to guess."
},
{
  "instruction": "Odd skin reaction to my hands and feet occurring 3 times recently with no changes in lifestyleAge - 26Sex - MaleHeight - 6'Weight - 185Race - CaucasianDuration of complaint + Location - Longest was the first time, on both hands lasting around 3-4 weeks before fully healing The second time on the feet was only 2-3 days The most recent time, today, again on both hands only not as severe as the first time. I have pics only of today's episode but I took a few sets over some hours to see the changes.Any existing relevant medical issues - NoneCurrent medications - NoneInclude a photo if relevanthttps:\/\/imgur.com\/gallery\/rrcI6jTEdit: just added some description of each e6Hey everyone, hopefully someone might know what's going on. So these pictures are 3 hours apart from the initial reaction I felt. This is now the third time something like this happened but each time has been different. They feel like an annoying chemical itch\/burn and come out of nowhere.The first time about 2 months ago my wife and I had gone to the neighborhood pool. Maybe 3-4 minutes getting into the pool and my hands started burning so I pulled them out and they looked like what happen today but a good bit worse. It took about a month to completely heal. I hadn't done anything about it because I assumed it was some reaction to a pool cleaner or something. That day also was fairly busy and there wasn't anyone else showing the same thing. Also it was strange because I had completely submerged as soon as i got in and I didn't have them show up anywhere else. On top of that they looked raisin shriveled for like 2 hours after only 5-10 in the water.The second time is strange too because it looked the same but happened on my feet and it went from 0 - foot arching pain from the burning. I literally walked in the bathroom and I pulled one boot off and I thought I had ants biting me or something. I took off my sock and the same red blotchy chemically burn look and feel all over my foot. I showered right away they felt better and in 2days they went from fairly tender to no issue.Today is the most recent occurrence happening while I was sitting with a patient in the back of the ambulance. I was typing my report and they started burning again from nothing to pretty sensitive really quick. The pictures I posted are about 3 hours apart from each other if that might help anything at all. But even though it's on my hands like the first time, the severity was not nearly as bad as the first time and looks much better after a few hours than that did for a week or two.",
  "input": "",
  "output": "This is not a typical palmoplantar rash. I would be concerned that this dermal inflammatory reaction patter could be caused by a rheumatologic condition or similar. I suggest you seek dermatologic care. A skin biopsy and laboratory evaluation seems appropriate."
},
{
  "instruction": "Sudden loss of mobility - PCP refuses referral\/treatmentHello, I'm a 32(F) in the USA. African-American, 5'2\" and 144lbs. On Jan 3, 2022, I woke up around 2am with a terrible migraine. I had light sensitivity, confusion and extreme pressure behind right eye. Took excedrin but was unable to sleep due to pain. I was finally able to sleep about 45mins later as meds kicked in. Woke up the next day with a regular headache and soreness in right eye. On Jan. 5th, I suddenly became dizziness at work. The room began to rock and tilt causing loss of balance. My right ear felt clogged and I had pain in jaw joint on the right side. I was taken to ER and evaluated for heart attack, stroke etc. All tests came back normal. I remained in the hospital due to continued dizziness\/imbalance but all tests including MRI of head and neck were clear. Was given motion sickness meds but it didn't help. While in hospital, I started having pain in my right hip joint. The joint also pops\/clicks with movement. I've experienced the popping\/clicking since I was 14 years old (18 years and counting) but this is the first time there has been pain. The pain has spread across my lower back. The pain started as a stabbing, pinching pain and is now an achy and the best way I can describe it is bone deep.I also have weakness in my right leg and intermittent numbness. Two weeks ago, I began to experience multiple episodes of urinary and fecal incontinence. The hip and back pain has gotten worse and the dizziness is the same as when it started. Almost all blood test and urine test have come back normal except for my vitamin d levels. My vitamin d value is 10ng\/ml and I was prescribed over the counter vitamin d3 pills (1000unit)An MRI of my lumber spine was done (full report is linked). My PCP said it looked fine but didnt explain anything further. On the MRI it mentions the following:DISCS: L4-5 and L5-S1 disc desiccation and mild to moderate L5-S1 disc space narrowing.BONES: Slight chronic marrow signal changes. Body heights are generally maintained throughout.L3-L4: Slight posterior element degenerative change. Spinal canal and neural foramina are patent.L4-L5: Mild right eccentric disc bulge is slightly improved. Annular fissure. Slight posterior element degenerative changes. Spinal canal and neural foramina are essentially patent.L5-S1: Mild right eccentric disc bulge. Mild posterior element degenerative change. Spinal canal is patent. Slight predominantly bright neural foraminal encroachment.EXISTING MEDICAL ISSUESexercise induced asthma (I take Albuterol as needed)arnold chiari malformationthalassemia traitintermittent fatigueI've also had reoccurring migraines since I was 15 years old along with random, unexplained swelling of my hands and feet. Most recent flare up was unexplained very visible swelling of my left leg in July 2021. (Went to ER and tested negative for clots and gout)I suffer from random bouts of stomach inflammation that has been misdiagnosed as gallbladder disease (gall bladder was removed when I was 16) and has now been attributed to GERD. ( I take omeprazole for stomach and I have a history of stomach ulcers). Most recent flare was October 2021I've also had debilitating back pain since I was 15 years old and have completed physical therapy, acupuncture, multiple courses of steroid injections in my spine and at least 3 courses of prednisone. Pain has been caused by unexplained muscle spasms and bulging discs. I have these flare up at least twice a year.I sometimes have rashes that appear on my back and arms that are often misdiagnosed as ringworm (photos included). Fungal test always comes back negative. So far, the rashes have been diagnosed as eczema and rosacea. Flare ups occur approx once a year for the past 15 years. Rashes sometimes itch but its very mild. Most recent flare up occurred in November 2021.CURRENT SITUATION I requested a referral to be seen in rheumatology and at the spine clinic. PCP did blood test for rheumatoid arthritis plus urine test which came back normal and has refused my rheumatology referral request. PCP also will not refer to spine clinic and has instead enrolled me in a group physical therapy workshop.Dizziness has not changed in 2 months, pain is getting worse, muscle weakness is getting worse but I haven't been prescribed anything. I've been told to use ice and heat and to stretch.LIFESTYLE PRIOR TO CONDITION Before this began, I was very active. I practiced yoga once a week and took dance lessons twice a week. I'm also an avid hiker. I did not fall, over stretched or injure myself in any way prior to these issues. Due to the random flare ups of swollen legs and fingers, I also meal prep and am conscience of what I eat so I believe my diet is pretty good. I've always been an athletic. I played basketball, ran track and played tennis from first grade through high school. In college, I swam and took dance classes most semesters.I'm not used to being in this much pain and not being unable to move for this long. I feel like my PCP doesn't care. I don't know what's happening to my body and because my blood work looks normal, I'm being ignored. Please help! I just want my life back.",
  "input": "",
  "output": "This is a rather complex history so I think it's difficult to give you any proper in-depth input. My main concern here is why you are being managed for this neurological condition by your PCP. Have you seen a neurologist for this? The reason I ask is that you're having multiple neurological symptoms with this sudden bout of headache and unilateral weakness and numbness that you have described. And MRI might be sufficient but a proper and thorough neurological exam is also needed. Unfortunately our current healthcare system does not allow for an in-depth neurological exam even in the neurologists office but at least it's worth a try.Agreed completely. Depending on the specifics of your history and exam, a total spine MRI, maybe slightly different types (sequences) of brain MRI, EMG, full neuropathy and rheumatologic panels may be warranted, as well as imaging of your hip.I will say, for what it's worth, that the fact that the numbness is intermittent is encouraging, and nothing on this lumbar MR report is dangerous or significantly abnormal (though it certainly could account for your back pain). Weakness in a single limb is typically a concerning thing to hear, however issues with the hip joint like you seem to be describing can cause weakness in the muscles surrounding the hip."
},
{
  "instruction": "Thank you. I'm glad the MR report looks good. My doctor didn't talk to me about it so I've been very confused\/concerned. She hasn't done a neuropathy panel or ordered any hip imaging. As for rheumatology panels, I had a serum rheumatoid factor test, a cyclic citrullinated peptide test, a uric acid test and a ESR. I was told that they all came back normal which is why she won't refer me to rheumatology. I will push for hip imaging because that's where most of my pain is. Thanks for the suggestion",
  "input": "",
  "output": "The other workup may or may not be necessary but yes, a simple hip XR makes sense based on your symptoms. I had a patient not so long ago who had gotten multiple extremely extensive neurological workups for left leg weakness, including chasing things that ended up being asymptomatic incidental findings. She presented to us for hip pain soon after, and it became very obvious (supported by an X ray confirming our suspicions) that the weakness was entirely due to arthritis. You never know."
},
{
  "instruction": "I only saw the neurologist while in admitted in the hospital. The visit lasted about 15 minutes. He did brief an assessment, told me that my x-rays and mri looked fine and that was pretty much it. I've asked my PCP for a referral to neurology as well but she keeps saying that since nothing has shown up in any blood work or x-rays, she can't do it. I asked her if it's possible to have a neurological or auto immune disorder that doesn't show up on x-rays and tests but I haven't gotten an answer.",
  "input": "",
  "output": "I am not sure which country you're in but for us here in the US healthcare system when you are in the health insurance system you get health insurance quality care. I often advise my patients to seek out a private neurologist for a deeper exam and insight into what's going on. A neurologist couldn't even examine the right hand in 15 minutes much less do a full head to toe Neuro exam. I encourage you to Google a full neurological exam on YouTube and see what it takes and how extensive it is. When the insurance company will only reimburse you per visit and you have 500k in student loans and malpractice insurance and each patient is a potential lawsuit you tend to do something cursory, order a test and if the test is negative you're protected. I know this isn't fair to patients but it's the agreement we have reached as a society in managing healthcare so I'm trying to arm you with the knowledge to get the right care."
},
{
  "instruction": "Thank you for this. Yes I'm in the US and I have insurance through Kaiser Permanente because my employer has a contract with them. I've had horrible experiences with this hospital and thanks to your response, I now understand why. My next step is going to be working with a private provider. I'm definitely stressed about this because I know the cost will be high but I need to know what's happening to me.",
  "input": "",
  "output": "I haven't heard the best things about Kaiser I must say. I worked there myself before and I wouldn't want to be a sick patient there."
},
{
  "instruction": "Bad Burn on Hand is Getting Worse Over Time Despite Being on Antibiotics.[34] [F]Pictures - https:\/\/imgur.com\/a\/D5iF0BI34F,5'10.5,13 Stone,Caucasian,1Bad Burn + 1 Lesser,Possible Neurological Issue or Rheumatological Issue (MS\/Epilepsy or Fibromyalgia are possibilities being discussed 7 years in)Meds -Lyrica 75mg 2x p\/d + 25mg at night.Solpadol - 3 x p\/d, 1-2 tablets ( 30mg\/500mg ) per taking.Xanax - 0.25-0.5mg when neededAugmentin - I don't have any left to know the dose but it was for Tooth Abscess that was bad and landed me in ERAmoxicillin 500mg one, three times a day.Flagyl 400mg one, three p\/dSolpadine 7\/500mg for times of lesser pain. Not taken regularly.Aceclofenac (Vitafen)100mg. One p\/dDrink once maybe every two-three months.Smoke heavily, daily.Location: IrelandHi all!I burned my ring finger, and, to a lesser degree, my pinky, on a metal pot about two weeks ago.I had a tooth abscess at the time and aprox 5 days went to Caredoc (Irish out of hours Doctor that isn't Hospital) where i was given Amoxicillin.I didn't get the Burn checked out because at the time it was just red and sore like a usual Burn.Next day tooth was worse so I went to A&E where I was given Augmentin as apparently Amoxicillin + the strength was never going to clear up that type of infection.So, for the last 1.5 (ish) weeks I have been on a variety of antibiotics.However, my hand has been getting worse every day.Today, I woke up and my entire hand is swollen and sore.This hadn't been an issue until today.Yesterday was the first time I noticed some swelling but it was only on Ring Finger and pinky.The other cuts on my hand also were filled with pus though they had no reason to be and, weren't before the weekend.I had the Amoxicillin left over so started taking that again.",
  "input": "",
  "output": "Occasionally burns can cause dep tissue infections. Returning to a doctor seems wise"
},
{
  "instruction": "Thank you for the reply.I definitely will be returning, i just was looking for some insight moreso, not medical advice as i dont have any experience with this type of burn.I can't get an appointment for two weeks. That seems like quite a long time to me but I'm not a doctor.",
  "input": "",
  "output": "If it gets much worse, seek emergency care."
},
{
  "instruction": "Also, do you have any idea what level burn this is? I'm having a hard time figuring it out.",
  "input": "",
  "output": "It seems like a full thickness burn."
},
{
  "instruction": "Clots, cysts, and no diagnosis +7m on ...27yo female, 84kg 5ft9, presents w\/ multiple clots in stomach - splenic vein thrombosis, mesenteric vein thrombosis, portal vein thrombosis, for main concern - in addition to other clots present in stomach (8 total). Cysts in spleen and liver, constant upper right flank pain w\/ sickness and diarrhea and stomach distension. Right shoulder\/neck pain. Constant tonsillitis issue, constant fatigue periods followed by unable to sleep for extended periods of time too.Docs determined clots as idiopathic, now on enoxaparin injections 150ml and codeine for pain management. Been under investigation since Dec-21, w\/ no ACTUAL diagnosis. Clots were not caused by a trauma.Had CT, MRI, colonoscopy\/endoscopy. No IBS. Cirrhosis. No gallstones or issues with gallbladder. Seen a haematologist full thrombosis panel completed: all genetic, autoimmune, deficiencies, all negative in tests. Jak2\/PNH\/anticardiolipin\/beta2 glycoprotein all negative. Thought hyatid disease for the clots given in spleen\/liver, however, negative. Under gastroenterology, rheumatology issues ruled out.Abnormal perfusion areas in liver, calcified splenic cysts appear to be long standing but benign in recent MRI. Fatty deposits for 'cysts' in liver, but appear benign again.Recommended weight loss to aid with symptoms and also reduced fats in diet considerably (got an air fryer), lost 10kg since but upper right quadrant pain seems to be getting worse again and sickness\/diarrhea.Getting frustrated with lack of diagnosis as to why clots formed, cysts formed, and what's actually happening to me.No previous medical\/family history of clots or cysts. Mom has had 3 miscarriages, Dad has cardiovascular issues. Both grandmother's had cancer - bowel and throat.Awaiting elastography of liver to measure scarring so far.Anything else I should be requesting to aid in a diagnosis? Any thoughts on a diagnosis?",
  "input": "",
  "output": "Sorry to hear about your troubles. My first thought was a missed covid infection. You may have had it without any particular symptoms, but it can still (rarely) lead to systemic thrombosis in otherwise healthy people. If this ends up being the case, the good news is that it will likely get better. Heres an example case report: https:\/\/casereports.bmj.com\/content\/14\/1\/e241027"
},
{
  "instruction": "I'm vaccinated, had 3 injections.",
  "input": "",
  "output": "Good for you! This makes it less likely, though still possible."
},
{
  "instruction": "Confused from Rheumatology appointment. Doc seemed concerned but also not?25M, 6'4, 195lbs.Been dealing with some health issues that have been affecting me pretty heavily and it was suggested I see a rheumatologist just to be safe.He ran some panels where there seemed to be some out of range factors that he wasn't concerned about. The three he did bring up, though, was aANA Screen IFA - Positive | Pattern was Nuclear, Speckled.ANA Titer - 1:40WBC - 2.4 x10(3)\/mcLHe wasn't worried about these results, either. My WBC is usually right below reference range, but not typically this low. He did say that that WBC count should have an eye kept on it.. but not to worry about a positive ANA screen or a titer of 1:40.Is this anything I should check up on? The bouts of what I deal with are really messing with daily life and aside from an endoscopy (which I struggle to believe would be causing any of my issues) that showed gastritis and duodenitis, as well as some labs that came back \"out of range\" here and there.. these results seem to atleast possibly point towards something?Any feedback is appreciated, thank you.If any other labs are needed, please let me know. I can pull them from online.",
  "input": "",
  "output": "Low WBC and positive ANA are two criteria for lupus. You did not specify what your health issues were though.The presence of a nuclear speckled pattern is often indicative of an autoimmune disorder, as it suggests the presence of antinuclear antibodies."
},
{
  "instruction": "27F immunocompromised and sick for two weeks. Getting worse. Rheumatologist is out of town and ER doctor sent me home pending blood test results that are still processing. Insight?Demographics: 27 female. Height 5ft 6in, weight 190lbs. Married.Conditions: rheumatoid arthritis and lupus; SVT.Meds: 2000mg sulfasalazine, 400mg plaquenil, 200mg Cimzia injection every two weeks.Non-smoker, no alcohol, no caffeine.Duration of complaint: 2weeksI have four doses of pfizer covid vaccine.Currently negative for covid.Two weeks ago before my scheduled Cimzia injection I spiked a low-grade fever. It was about 37.8c. Since then, my temperatures have been 37.5c to 38.5c. Acetaminophen will not bring my temperature down. It initially started with fatigue and headache and fever.Last week I began to get a sore throat, sweating, clamminess, chills, mild sinus pressure, confusion, shortness of breath, and a slight cough.I went in for monthly rheumatology bloodwork on 7\/28. Ill attach the results. Mildly decreased WBC and Neutrophils.On 7\/29 I went to the emergency room as my primary doctor instructed me to because I was not improving. Many cultures were taken. WBC further decreased and neutrophils were more than half of the previous day. There is a WBC Morphology pending pathologist review.Sepsis cultures have not shown any growth over the day.X-ray of chest showed no abnormality.Im confused as to what could be causing this. The ER doctor also said he was confused and it could be a medication or a nasty virus (was not tested for these) and that I have neutropenia and I am quite immune compromised but left it at that.Today, 7\/30, I have had more difficulty breathing, particularly with movement or talking. Im coughing green\/yellow thick mucus. More fatigue. My lungs feel heavy.Im thinking of heading back to the ER tomorrow if symptoms get worse, but Im not sure it will do any good for me or provide me with more.Is there any insights?Ive reached out to my rheumatologists receptionist as well as my primary doctor. However, Monday here is a holiday so the offices are closed. The earliest I could see my primary is on Tuesday, and Im not sure how much further it will progress by then.here is the link to my imgur albumI understand that some of the blood work with the hematology panel is still pending.Also, what does it mean with the WBC morphology Reviewed by technologist Sent to Pathologist for review?Thank you in advanced",
  "input": "",
  "output": "I wouldn't wait a day more. Go to the ER. In my opinion you should be started on broad spectrum antibiotics asap, while waiting for results."
},
{
  "instruction": "How do you feel about patients bringing their own files?How do you feel about patients who bring their own files?Im a 28F and was recently diagnosed with a chronic illness and have at least one more serious medical issue suspected. Im asking for advice navigating the diagnostic and treatment process for multiple complex medical issues.Is there anything a CI patient like me can do to make diagnosing and treating easier? Ive heard other chronically ill patients advise to bring a folder full of all medications, symptoms and symptom changes, lab results, etc. to hand to the doctor each visit. Is that something helpful or would you just think they were extra\/a hypochondriac?Are there any other things ci patients can do\/not do to help? Pet peeves? Im having to go to my pcp or a specialist ALL the time recently and want to make the process as smooth as possible.(For the auto mod: 28F, 5 ft. 10 in., 140 lbs approx., white, dealing with autonomic dysfunction and suspected autoimmune issues as diagnosed by my pcp, neurology, cardiology, and rheumatology teams, have had symptoms for 10 years, medical history previously listed, not taking any relevant medications, no drinking, smoking, or recreational drugs)",
  "input": "",
  "output": "You can bring it but I'd prefer it being sent over before our visit OR letting us review it after the visit. A summary is preferable unless it's truly relevant to what I'm seeing you for. There's just not enough time in a clinic visit to go through a huge stack of medical records"
},
{
  "instruction": "So giving you a copy you could keep would be helpful? Ill keep that in mind!",
  "input": "",
  "output": "Only if it's relevant"
},
{
  "instruction": "Unexplained Wounds need help to find answersMy husband served over in Iraq in 2011 and came home due to a machine gun falling on his groin and he had to have nerve blocks. 4 years later he started developing these ulcers that in a matter of hours would turn necrotic. When he was over in Irag he was stationed near burn pits. We've been to countless specialists such as dermatology, infectious disease, rheumatology, wound care. We've been to 10 different hospitals and not one doctor can find the cause of this. For about 2 years we thought it was Pyroderma Gangernosum, but with PG if you cut into it, it will make it worse. With my husband it helps. We have become so hopeless and this is so debilitating. Hes lost countless jobs we are praying to find answers and find someone who has this awful disease that may know what it is. My Husband is 27 years of age 5 ft 5 he weighs 200lbs doesnt smoke or drink. unexplained Wounds",
  "input": "",
  "output": "Buruli UlcersBrucelosisI only suggest those two as Ive had a patient with the first one who served in the Middle East, and initially a differential was the second. We also get the Buruli ulcers here, but we call them Bairnsdale ulcersId suggest an infectious diseases specialist.What is a burn pit?Oddly enough I couldnt link the WHO page for the first one."
},
{
  "instruction": "Please do this! I have met someone who has had similar complaints and they were not able to get a definitive diagnosis.Also, Schnooks, are you a physician in Australia? I understand Buruli ulcers had some what became an issue in 2018 there. While it isn't an issue here in the States, I wonder if this contributes to misdiagnosis? Thanks for your input!",
  "input": "",
  "output": "I am, anaesthetic registrar.Its not my area, but I think theyre still a problem and actually getting worse (spreading, increasing frequency). They certainly make the news more frequently. Despite the fact theres a syndrome Bairnsdale ulcer down here, apparently theyre a frequently forgotten diagnosis. So it wouldnt surprise me if the same illness would be far from front of mind elsewhere in the world."
},
{
  "instruction": "Buruli (mycobacterium ulcerans) is typically gotten in tropical areas by exposure to contaminated water or bites from infected aquatic type insects iirc. As nasty as these burn pits seem if it were buruli the pits aren't likely the culprit. Burning introduces things into our lungs, which is awful but would not give him this type of infection. If he were stacking the animals etc onto the pit or otherwise handling similar items, well then... bingo.",
  "input": "",
  "output": "Middle East isnt tropical (right?), neither is Bairnsdale (Victoria, Australia), both of these places have Buruli ulcers...I have no idea what is going on in OP, but I know neither of my suggestions are commonly thought of in initial work up stages and Ive seen similar presentations here in Oz. And the historical regions of prevalence of a lot of things is changing.QquestionI said typically, which is accurate. I'm certainly familiar with the Australian outbreak. I recall saying bingo, which feels like agreeing to me, and I do agree. It's a definite possibility the specialists they saw didn't consider it. I suppose I muddied the water for no particularly good reason... That's fair.Can also be contracted by unpasteurized dairyIs there a special test for this?Not really, but Id imagine the requesting physician should mention it in their diagnosis list. (It makes the microbiologists go ah, well look for that by setting up these tests)Basically swabs then culture (mycobacterium grow bloody slowly, so it is an extended culture) and PCR (looks for DNA from the bacteria, quicker, but not always as useful).Thanks for the info re burns pits. I would definitely recommend infectious disease specialist\/s, being in close contact with burning, dead, decaying animals  human waste is a recipe for really weird parasites\/bacteria."
},
{
  "instruction": "Did they inform him of the Burn Pit Registry through the VA?",
  "input": "",
  "output": "These look like theyre due to an exotic infectious agent. He needs biopsies, cultures, and I would think about trying doxycycline for like 6 weeks. Ask your ID doctor about empiric antibiotic treatment and see what they think."
},
{
  "instruction": "We have done all that and he has bottles and bottles of that medicine but there is never an infection WBC is always normal everything is normal. He does have a vitamin c deficiency",
  "input": "",
  "output": "WBC doesnt really mean much. It can be helpful but it doesnt mean this isnt infectious. Has he ever done antimycobacterial therapy? Rifampin, isoniazid, etc?"
},
{
  "instruction": "No but we will look into that with his dr",
  "input": "",
  "output": "Would you mind updating us if this gets diagnosed or if a future treatment works well? I gave you my best impression but this is not like anything Ive ever seen outside of textbooks, and I want to learn from this in case I ever have the chance to help a patient like your husband.QOut of curiosity, I am NAD, but could this be caused from an insect or spider? The reason I ask is I have friend who was bit by a spider while in Afghanistan and he still suffers complications from the wound site. While not near as extreme as what OPs husband is going through, but is it possible that OP is suffering from some sort of parasite or long term degeneration from venom? Would that turn up on any clinical tests? And do you think it would be prudent for OP to contact medical professionals in the country where OP was originally exposed?Has he had biposies of the lesions?QYes he has had biopsies several in fact alot of them come back as a burn but that's not the proble. This is not a burn.The fact that biopsy reports give the wrong answer and he's seen multiple specialists possibly suggests that you're dealing with a new, hitherto undocumented entity. What treatments has he had for this if any? Response to certain drugs could tell us what sort of disease process this is."
},
{
  "instruction": "My husband is fighting for his disability because this is so debilitating he cant work. But without a diagnosis the disability people keep denying himHire a VA disability appeals attorney. It cost me 2 grand twice, the first time got me from 30% to 90% and the second time got me from 90% to 100% total and permanent. I personally have far less severe injuries than what your husband has and was suffering the same issue.There are also attorneys for SSI\/SSDI benefits, though I havent personally used them as applying for SSDI as a 51 year old is relatively easy. As a 27 year old though it is damn hard and you likely will need a lawyer or a few years of trying, and a lawyer works out cheaper in the long term.",
  "input": "",
  "output": "Need more history, things like past medical problems, medications, drug use, etc. Differential as I see it includes infectious, autoimmune, vasculitis, drug use, medication, environmental (especially considering the burn pit). It's very odd that it would take years after that exposure that these ulcers would start, but not impossible. Why has he lost countless jobs? What did previous skin biopsies show? What have his labs shown?"
},
{
  "instruction": "He has no other medical problems, he isnt one any medications, no drug use in fact he quit smoking 5 months ago. He started having small ulcers as soon as he came home but now they are way worse. Hes lost jobs because he has to be off so long and they let him go",
  "input": "",
  "output": "And the skin biopsies? And the labs?Qsome have came back as a burn which they are not and others show nothingAnsNeed the actual reports, which are always available through either a patient portal website or though a medical records department. Also need the lab reports."
},
{
  "instruction": "Does This Really Sound Like Dermatomyositis?BackgroundAge, sex: 31Mheight: 5 11race: whiteprimary complaint: purplish skin along with tachycardia and extreme fatigue\/tirednessduration: I have experienced skin discoloration since I was a kid, but this progressively got worse once I was an adult. The tachycardia started when I was about 24 and has progressively gotten worse.Medications: My rheumatologist has me on hydroxychloroquine (200 mg), prednisone (started at 50 mg, but now taking only 5 mg), and pantoprozole (40 mg). An ER doctor started me on meclizine (25 mg) as needed for dizziness that started about a month ago. I have also been on Adderall XR since 2019. I currently take 25 mg, up to two in the morning. I do not drink, smoke, or use any recreational drugs.Other medical conditions: ADHD. Morphea (I developed this when I was 8, and it has never gotten any bigger). Splenomegaly. In July 2021, I had encephalitis due to reactivation of varicella-zoster virus.I apologize in advance for the length of this post. I just want to be sure I include anything that might be relevant.Starting in 2014, my heart rate would randomly jump up to 120-140 bpm, and I would experience tingling in my extremities. The purplish skin started when I was a child, but it has gotten worse over the last few years. Between 2014 and 2021, I had multiple echocardiograms done to check for any abnormalities of the heart, but doctors never found any. I also wore a holster for a month, and that came back mostly normal.A couple of months after I had encephalitis, a rheumatologist diagnosed me with dermatomyositis based on the redness and scaliness on my knuckles and redness around my fingernails. Lab tests showed that my muscle enzymes (CK, aldolase), liver enzymes, and IgM all were elevated, but additional diagnostic testing has not shown anything to confirm dermatomyositis. Ive had an MRI of my legs, hands, abdomen, lungs, and heart. The abdominal ultrasound showed that I have a slightly enlarged spleen. Everything else looked normal. I have never experienced muscle weakness or the characteristic rash that DM patients usually have. I did see a dermatologist after I started treatment. She said it looked like it could be DM, but there wasnt anything on my skin for her to biopsy.Since my rheumatologist started treating me for DM, my heart rate tends to stay around 80-90 bpm, and the palpitations are much less severe when I do experience them. My most recent blood tests came back normal except for my IgM. However, my skin still turns purplish, and it sometimes feels like there is a rubber band around my arms.I dont know if there is any connection between the encephalitis, tachycardia, and DM, but it makes me wonder if there is something more serious than DM going on. My doctor does not think its necessary to explore other possible causes. She says that the treatment she has me on will treat any rheumatological disease. I really like and respect her. Shes the first one Ive seen who acts like she cares about my health. I just want some kind of confirmation that shes right.I appreciate any feedback, insight, suggestions, etc. Also, I can submit my full CBC report if that would help at all.",
  "input": "",
  "output": "Please include one of preferably more of the pictures in your post as an imgur.com link. It makes it easier to help with something when it can be examined visually. Additionally, share the values of your ANA, ENA, CK, aldolase"
},
{
  "instruction": "Thank you for your response. My apologies for not getting back to you sooner.I am not sure about the ENA. I did a Google search and think I found what test results to include. Let me know if these results are not what you need.Below are the results of lab tests from September 22. These tests were done before I started treatment for DM.CK - 1,063 units\/literAldolase - 26.3 units\/literANA - Negative (<1:80)RNP\/Sm - < 12 unit(s)Anti-Smith - < 12 unit(s)C3c - 107.0 mg\/dLC4c - 20.0 mg\/dLKappa FLC - 12.7 mg\/LLambda FLC - 17.5 mg\/LFLC - 0.73 ratioIgG Card - < 9 GPL-Units\/mLIgM Card - 16 MPL-units\/millileterI'm not sure if ALT and AST help with diagnosing DM, but they came back abnormal. This isn't unusual for me (they've been as high as 240 on tests I've had done over the last 10 years), but I thought I'd include them, just in case:ALT - 56 units\/literAST - 44 units\/literBelow are the changes in some of these values when I had the lab tests performed again on November 4. These tests were done after I had already started prednisone and hydroxychloroquine.CK - 83 units\/literAldolase - 9.2 units\/literIgM Card - 23 MPL-units\/millileterALT - 15 units\/literAST - 14 units\/literHere are the best images I have of the skin discoloration. Because the discoloration on my knees is usually worse while I'm in the shower and right after I get out, I took the photos and video of my knees in the shower. There is nothing graphic in these images, but I wanted to explain why I took them in the shower.Right hand - https:\/\/imgur.com\/icyYOPQKnuckle, right hand - https:\/\/imgur.com\/fD48uK0Left arm - https:\/\/imgur.com\/JVPth2XBoth knees - https:\/\/imgur.com\/bszpHWgRight knee - https:\/\/imgur.com\/cjdn4zVBlanching (Video) - https:\/\/imgur.com\/3KszJT7",
  "input": "",
  "output": "No mention of the most important test - skin biopsy results. Everything you present is less important."
},
{
  "instruction": "She said that there was nothing for her to biopsy. This is the note that she included in her report:Physical exam: dilated nailfold capillary loops of fingernails, L>R. Mild erythema of proximal nail folds of fingernails. Ragged cuticles. No evident Gottron's papules, heliotrope sign, shawl sign, holster sign, or other stigmata of DM. Scalp clear with no erythema or scale-prior labs including myositis panel, CK (elevated), and aldolase (elevated) reviewed. Negative myositis panel noted.-findings on exam today support prior diagnosis of DM (esp in context of markedly elevated CPK and aldolase), although unfortunately there is not a high-yield spot to biopsy to provide additional support of this diagnosis. Suspect that pt's cutaneous findings have improved with plaquenil + prednisone therapy",
  "input": "",
  "output": "Spots change over time. Right hand knuckle that you show could be a Gottron's papule. Lupus can look like this as well, as can many other conditions."
},
{
  "instruction": "3.5f with mystery illness 4 childrens hospitals and 14 specialists cant diagnoseThis is going to be so, so, so long and Im so sorry. But we dont know what else to do. Ive tried to compress it the best I could. 3f with medical mystery.First year of life: -couldnt latch until 2 months old -refused all food, in all forms. -up every 20 minutes every single night, wouldnt nap longer than 30. -had newborn shakes that stuck around a year old. -consistently has BM 60-70% mucus, and majority of time was green.February 2017(1 year old): -staring spells began -CT at hospital was clean, sent us to neuro. -EEG performed, no episodes happened, clean. -lost all of the words she had and remained non verbal, despite starting speech therapy at 18 months, until over 2.Eventually they went away after a few months. Doc said absence seizures are harmless and not to be concerned. Released us from his care.June 2017: 16 months old. -woke up and couldnt walk. Screamed when weight put on leg. Took to urgent care. Urgent care ran labs and found a sed rate of 44. Referred us to an orthopedic surgeon. Orthopedic surgeon did treatment for transient synovitis. When it became clear that wasnt the cause, sent us to rheumatology.August 2017: -diagnosed with Oligoarticular JIA (right knee only at this point). -started on naproxen.November 2017: -first steroid injection. Kenalog into right knee. -two days later, woke up screaming and manically itching legs. Hives sprouted. Face swelled, eyes became black, hives all over neck and face. Started wheezing and gagging, rushed her to the ER. ER said it was an anxiety attack from the itching, not anaphylaxis. -steroid injection worked for about two months.Spring 2018 (2 years old): -staring spells started creeping back. -swelling in both knees was coming and going. She was in extreme pain and couldnt walk more than a few feet. Rheumatologist said it wasnt arthritis, it was growing pains. Referred to PT. -we werent super worried about the staring spells, and wanted to wait until the arthritis was sorted out to see neuro. The staring spells were coming more frequently. Her speech therapist asked us if wed ever had her evaluated for epilepsy, as she sees several kids with it, and our daughters episodes were scaring her. -We decided to get her in with neuro. It would be a two month wait.May 2018: -second opinion rheumatologist said there was obvious arthritis and sent her for a second round of steroid injections. Allergy had deemed the first reaction as a coincidence, not from the injections. -had an allergic reaction to the injections again. -she begins collapsing and falling pretty much non stop. To the point where PT and Speech therapists were suggesting a helmet because she wasnt catching herself when she fell.June 2018: -steroid injections failed -our first appointment with PT. PT noticed several left side deficits, severe balance issues (that were worsening), and wrote a letter to neuro suggesting an MRI be done. -woke up soaking wet, dripping in urine, and her urine was brown. Took her to the ER, ER noted it was brown but testing was normal, and she was well hydrated. -had an episode where myself and her speech therapist were present. Eyes glazed over and she started walking around like she was drunk. She became delirious. Then that turned into manic aggression (totally out of character). It lasted 20 minutes start to finish, ended with several staring spells. Speech therapist wanted to call an ambulance. 4-5 minutes later, she was completely back to normal. Took her to the ER where they said it was behavioral. I insisted they call neuro, who said it sounded like worsening seizure activity and scheduled an EEG for the next month. -pediatrician urged us to go to a different childrens hospital and demand an MRI. CT showed a small arachnoid cyst, MRI was clean. Her left side reflexes were slow, and she had a positive babinski reflex on left foot. -lost gross motor skills like squatting or standing up without using hands. Could no longer identify letters, though she had been able to since before 2. -discharged after a negative EEG, but nothing happened while she was hooked up. Told us to get video. -balance continued to deteriorate, along with left side deficits. -got videos of staring spells, neurologist said that it could be seizures or it could be sensory. She passed sensory tests with flying colors, OT said it was highly unlikely to be sensory. Neuro told us to go to a different hospital. -things calmed down for about 3 weeks.July 2018: -PT started noticing balance issues worsening again, she wouldnt catch herself when she fell or even try to. Began falling 2-3 dozen times a day. -she began dropping. Like a robot running and then its power source dying. My husband and I would have to sprint and throw pillows or our hands under her head to keep it from hitting the floor. We couldnt be more than a few feet from her. She would collapse, lay there for 10-20 seconds in a haze, and then sit up. -July 19th she told us her head hurt. A few minutes later, she looked out of it. I pulled out my phone because it mimicked the look when she had the episode of delirium. She began stumbling, so I pulled her onto my lap. She began aggressively rubbing her face and making weird faces. Her body then began to jerk\/shake. Lasted 20 seconds. When it stopped, she continued to lay down, still, with her eyes glossed over. Her urine was brown again. -pediatrician sent us to ER. Admitting doctor said it was a tonic clonic seizure based on the video. Was attached to a vEEG for 9 hours, nothing happened. EEG was clear. Doctors said it was behavioral and released her from further neurological care. said there was nothing wrong with her. They called her speech therapist who was livid, as she had been watching her deteriorate right along with us. I needed backup since the doctors were blowing me off. Doctors told speech therapist it was behavioral and from sleep deprivation. But she slept 14 hours a night. -as month goes on, shes dropping and having staring spells non stop. -PT says nothing about daughters exam makes sense. Her balance is awful and deteriorating when walking, standing, crawling, kneeling, but she can jump. Shes developmentally advanced so it doesnt seem lime it could be a developmental issue. Shes also watching my daughter turn into a shell of herself and is begging doctors to do something. -MRI of knees and hips was ordered by new rheumy after worsening gait issues. MRI showed a healing stress fracture in the knee, along with bone marrow edema (with no trauma to explain it) -went limp on a ride at six flags and her eyes rolled to the back of her head for a full 2 minutes. -went to playground and she was climbing one of those coils. Body went limp and she fell 5 feet. I caught her and set her down while her arms twitched and she was unresponsive. Slept for several hours after, and took several minutes of shaking to wake up.August 2018: -basically everything continued with no answers from anyone.October 2018: -a 3 day inpatient EEG was scheduled and nothing happened. I mentioned to the doctors that it looked like a mass was growing on her legs and they didnt look. Sent us home. -pediatrician saw the masses and sent us to orthopedic surgeon. -the muscles in her left knee began to atrophy, despite her being crazy 24\/7. She never sits still and is always jumping\/climbing\/running. Orthopedic surgeon said it was definitely neurological, sent us to a new neuro. The atrophy was so bad we were approaching loss of mobility. She still cant walk for more than 1-2 minutes at this point. -atrophy worsens until November. Other symptoms start to go away.November 2018: -started methotrexate injections for the JIA.January 2019: 3 years old. -urine began to darken again. -symptoms started popping up mildly. -had episodes where shed scream and rub her legs manically saying bees were attacking her. She did it both while we were there, and when we werent. I watched her do it on the baby monitor in the middle of the night. -neuro ordered MRI of spine. Normal. -on jan 16th, I heard noises in her room. I looked on monitor and she was sitting and swaying in her bed. I got to her bed to put her back down and by then, she was jerking. I tried to get her attention but she was unresponsive and eyes were glazed over. -I pulled her onto my lap, where she remained out of it. Her body was jerking, and her right leg started convulsing like it was on a washing machine. Once the jerking slowed, I asked her to point out her nose and mouth. She failed but thought she did it. I put her back to sleep, where she remained restless. Her urine was normal again 2 days later. -urine brown again on Jan 25th. Had a staring spell at a birthday party and was unresponsive for 30 seconds. Fell asleep in the car 10 minutes later, slept for 45 minutes, and then woke up screaming. Continued to scream for almost an hour. Urine was clear again a few days later. -Neuro tested for porphyria. Corproporphyria level was 2.5x adults high normal but said it wasnt high enough to be porphyria. No pediatric reference ranges exist.February 2019: -fingers started severely pruning and turning white in just a few minutes, while her sisters hands (who was 1.5) were completely normal. -throughout all of this, little bite\/pimple like bumps showed up on face\/neck\/joints. They come and go. In February, they got bad. No fleas, no bugs, always accompanied other symptoms.March 2019: -GI said that while shes tall, shes short based on how tall she should be since Im 510 and husband is 64. Wanted to run tests. Thinks theres a larger autoimmune disease at play. -genetics said that something is definitely wrong, doctors needs to coordinate. Said porphyria test could have been deteriorated because it sample taken at home and exposed to light in the car. Said hes concerned by the progression and created a team of doctors to evaluate her case. Was afraid it was possibly life threatening. -testing was planned for summer when she began showing symptoms again. She remained asymptomatic.September 2019: -things remained calm, arthritis was under control. -began flaring in both knees and both ankles. -staring spells, balance issues, and not catching herself came back.October 2019: -things are worsening again. -left ankle is atrophying. Neuro wont call me back. -PT is concerned she wont be able to walk soon because the stuff that atrophied last year has never come back. She still cant walk more than a few minutes without collapsing. Sleeping 13 hours a night. Is complaining of pain and isnt eating. -preschool teachers reporting odd behavior and lots of collapsing. -most recently broke her wrist because she fell down the stairs and didnt try to catch herself. She landed on face and chest, with her arm against her chest. -ETA: her urine was brown again this morning for the first time since spring.Any ideas? Weve been to four childrens hospitals and will be pursuing new ones when we move in February. Im so scared for my daughter and still cant understand the lack of concern by the doctors weve seen. I dont want my daughter to suffer anymore and I dont know what else I can do.Thank you so much.",
  "input": "",
  "output": "If a second opinion is needed on this comment, I 100% agree with this. OP is free to try and ask the reddit community out of pure desperation, but be careful of lay comments, even from physicians who aren't experts in OP's child's care."
},
{
  "instruction": "In my opinion Rasmussen would've shown up on an EEG or Scan, as the episodes are lasting a while and the activity of the inflammation would probably have been detected, though it's not impossible. I don't see how this goes in line with the arthritis, the stress fracture indicates that the loss of function and pain should not be purely neurological, maybe there are 2 problems going on simultaneously.I feel that you're a bit lost with doctors who don't do anything. So I'll suggest things to do by yourself:start a detailed diary, try to recall everything, every doctor's visit, result, try and collect the imaging done, lab results. But also start recording symptoms like ataxia, seizures, pain, atrophy. Every day. Also note any environmental changes that might occur shortly before episodes. This should include nutrition, but also stress, long exposure to sun, noise, physical activity. Get videos if you can.buy urine test strips, check her urine when it's normal 2-3 times, then when it gets dark. Check for blood, proteins, sugar. If you can, contact urine when it's brown in a clean jar and have your doctor send it to lab.if you have access to it and feel comfortable, also check blood sugar in normal and episode conditions. Again, note it done carefullyconsider to get psychological evaluation and counselling. Not only are you going through a very difficult situation, you will also avoid people saying that's only behaviour, and you're not willing to accept it. I'm not saying it is, but by acknowledging it a possibility, you rule out one more thing.consider changes in nutrition. Observe if anything changes. Might work, might not. Changes may include protein level, fat level, sugar level, etc.Then, what to do while relying on doctors:I agree with getting a second MRI. One usually isn't enough. It needs 2 to notice changes.did you get a check of the peripheral nerve system? I'd ask the neuro to check that. If they don't call back, they're probably out of ideas. Hey a new one.Get a general ultrasound of the organs.get blood test of porphyrines in normal and episode conditions.get liver and kidney blood test in normal and episode conditionsreach out to get metabolic diseases checked, like fatty acid issues, glycogen issues. Try also getting genetical analysis. I don't know about your financial situation, if you're located in usa and they don't do those, consider a visit in a different country. We have a whole ward here for diagnosis. Try reaching out to mayo or Cleveland.consider reaching out to help groups for genetic or rare diseases. They often have valuable contacts and ideas. https:\/\/www.globalrarediseasecommission.com\/Report\/tracks\/track-1.htmlI wish you all the best!",
  "input": "",
  "output": "Posts by unflaired users that claim legitimacy by virtue of professional medical experience are not allowed.If you are a medical professional who wishes to become a verified contributor to this subreddit, please message the moderators with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!We do not accept digital forms of identification."
},
{
  "instruction": "I would strongly recommend rainbow over ccf for pediatrics.",
  "input": "",
  "output": "So to make sure that I have the situation in a nutshell: 3.5 y\/o female with progressive weakness, intermittent episodes of loss of tone that are not accompanied by EEG changes, intermittent episodes of darker urine in the morning, and a diagnosis of oligoarticular JIA. Please correct anything that I got incorrect and I have some clarifying questions.-what is the state of her motor function now? Can she run, climb a ladder on the playground, fatigue quickly like walking around a store?-do the weakness episodes seem intermittent, like lasting for a few hours to days, or are they every single day.-does she have unsteadiness when reaching for objects? Having her hand seem to stumble past a cup or fork for example?-does she have any drooping of her eyelids? It would be to the point where the black of the pupil is obscured by the lid or she has to lean her head back to look at you.-following steroid injections did any of her other symptoms seem to get better? the weakness and seizure like episodes.-any family history of children passing away or having major medical issues. Do you, your spouse, or the child's siblings have any medical issues?-any issues during the pregnancy or delivery? Did she have to go to the NICU for any reason?"
},
{
  "instruction": "According to what I found online, Mount Sinai has the only genetic test for porphyria. Trust me, I had a couple hundred dollars ready to spend on the genetic testing but everyone I spoke to who was versed in this stuff said it wouldnt make a difference",
  "input": "",
  "output": "TF is going on in here? What is wrong with all of you people? None of you are physicians, I doubt even medical professionals, and even the \"best\" \"written\" comments in here are absolute drivel. You are NOT being helpful. You are torturing someone while stoking a House, MD type fantasy.Dear OP, I sympathize with you. Dealing with a sick kid is trying and tough and this awful thread is NOT useful to your mind state NOR your health.A problem I have noticed in my short career has been clear communications to patients. I highly doubt after 4 hospitals, 14 specialists, and however many other physicians and staff that no one has come up with a diagnosis. What does this mean? I bet at minimum you had multiple different teams with multiple different personnel working on your daughter's case. It's possible the primary team wasn't doing their damn job of synthesizing all of the specialists information into easy to understand information and presenting that information to you. Even when we don't \"know\" what's going on, I can still call something idiopathic (as in I don't know) or I can throw out a variety of possible causes in what we call a differential diagnosis.To everyone saying \"gEt GEnEtIC tEsTiNG\". That's not even how any of this works. Even if we were to use \"genetic testing\" this would only confirm the diagnosis, NOT LEAD US TO THE DIAGNOSIS. Even then it is absolutely unnecessary for treatment in this case. Genetic testing is useful when we are performing family planning or working on research on illnesses. To my knowledge, and I'm open to any updates, bread and butter medicine does not YET have the tools to use genetic testing in the fashion many of you seem to think exists."
},
{
  "instruction": "Thats been our understanding. Genetic testing is like the final puzzle piece once all of the other testing is done, and narrows down the list of possible causes. The geneticist said there was a list about 30 things long that he thinks it could be, but wanted further testing before divulging them, which I get.We have seen 4 childrens hospitals but the specialists span. Weve seen 1 endocrinologist, 1 allergist, 4 neurologists, 3 rheumatologists (our new rheumy actually suggested another opinion since she was out of ideas too), 1 GI, 2 geneticists, 1 orthopedic surgeon, and 1 ophthalmologist. They were supposed to be coordinating on a team that diagnosis rare diseases, but when she remained asymptomatic, we held off. We didnt want to put her through anything more if the tests would be inconclusive, under the direction of the team. But red flags have been popping up over the past few months, and theres been a lack of response or a shrug. The atrophy was so bad in the knee last year that she could barely walk. The muscle\/tissues\/whatever it was never grew back, and she cant walk more than a few minutes. PT is concerned that with the loss of knee support, the ankle atrophy is going to be detrimental. Which is how I ended up here. Her pediatrician finally got neuro to call us and shell now be getting ultrasounds of both legs.I wanted to take a list to her doctor and say could it be any of these?Shes spent most of her life in constant pain, in doctors offices, and its just killing us. I want her to have a normal life, and if she cant, I just want to make it as pain free as possible.",
  "input": "",
  "output": "The most important thing I can recommend is finding a good PCP to make sure you have a medical home. That doctor should keep track of everything and keep the puzzle pieces together for you. I'm hoping that's already your pediatrician. From what you write, it seems like each specialist is stumped and is each trying to treat symptoms as they see it. Let's say we can't find what is going on, this is what we would be doing anyway. I say if things have been continuing to worsen, you may try another hospital system. I'm partial to Mayo, CHOP, and Children's National. On the other hand, you may have to consider that there isn't much to do but keep her comfortable. Palliative doctor's role are just that, keep people with chronic disease comfortable. That may include working with PTs, pain specialists, and whatever other tricks they have up there sleeves."
},
{
  "instruction": "'m not a doctor. Along with a suggestion, I just want to say how sorry I am to hear about your family going through this. I know how terrible I feel when our daughter just has a cold.Because I'm not a doctor, I don't have a diagnosis to suggest, but instead I want to suggest that you start collecting data, lots of data, then find your most analytical friend(s) and get them looking at it. They don't have to be a doctor; they're more likely to work in science, technology, engineering, business or law.What I'm suggesting you collect is literally everything your daughter eats, drinks, does and where she goes, including basic nutritional information what she's eating and drinking - carbohydrates, fats, etc. The same stuff that they put in big letters on most food packages.Along with that, put in what symptoms she had and how bad they were; devise a rating for her day if nothing else, where \"5\" is \"it was a terrible day\" to \"1\" is \"she barely had any symptoms at all.\"This is going to be a complete pain in the ass.If it's a metabolic problem, there's a chance you'll see something like \"when she has a high-carb, low-fat diet, she has a bad day\" or \"when she has a lot of fat, she does great\" or some other permutation.If it's somehow an environmental problem, then maybe you'll see that \"when she stays at grandma's house she's better than when she sleeps at home\" or \"if she doesn't go to school, she's better\" or \"she played in the basement today and she's a wreck.\"The doctors are clearly missing something, and maybe with some analysis you can find some clues to point them in the right direction. You may have the problem that they've already made up their mind about her and there's no changing it; in that case, you also need new doctors.Best wishes.",
  "input": "",
  "output": "Posts by unflaired users that claim legitimacy by virtue of professional medical experience are not allowed.If you are a medical professional who wishes to become a verified contributor to this subreddit, please message the moderators with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!We do not accept digital forms of identification."
},
{
  "instruction": "Rash EVERYWHERE? Please helpHello, so a little background. I am a 23yo F. I suffer from an ED and weigh approximately 80lbs and am 51. I was diagnosed with MCTD, scleroderma, dermatomyositis, and a grocery list of other things, but I feel those are most prevalent to the issues I am having. I also use marijuana regularly as well as vape. So. I moved to MI from MO last summer. Ever since about.. November 2021 I have been having skin issues. The skin is incredibly dry, most spots opened and scabbed and now they hurt and itch. No lotion I have tried (10+) seem to help. I have it on my legs, arms, chest, hip, back, face, behind\/in my ears. Ive never had my skin look like this while living in MO. I have seen my PC and I have a rheumatology appointment end of April. I dont even want to imagine how much more this will progress. Does anyone know what this is? Or how I can manage it to minimize symptoms? Im at a loss. Please help! Skin rash",
  "input": "",
  "output": "Images do not allow us to see the extent and appearance of the eruption. A diagnosis is not possible. You are medically complex and you need dermatology care. I work closely with many rheumatologists and we have mutual respect. I would not count on a rheumatologist to manage your skin."
},
{
  "instruction": "What does high glucose in a CSF mean?28, Female, T1D 14 years, 59 165 lbs. I have upper extremity weakness in my legs and arms, worsening over the last year. Cant walk up stairs, all my tests come back inconclusive including genetic testing and nerve (I mean literally I have had an ENTIRE work up- MRIs, X-rays, blood work, neurology, spine clinic, rheumatology) so Im left with getting a triple muscle biopsy and had a spinal tap today. The only result that came from that was high glucose CSF and I cant find anything about what that signifies versus the low glucose.ETA: additional test results just came back showing high wbc and rbc in the fluid.",
  "input": "",
  "output": "Generally we're looking for low glucose in the CSF, as that's a sign that bacteria may be in there. There's usually a ratio between CSF and serum glucose (CSF is about 60% of serum), so I'd wonder if your serum glucose was just on the higher end when you got the LP done due to your T1DM."
},
{
  "instruction": "Good to know. Im sure Ill hear back Monday, but additionally seeing the high WBC + RBC in the fluid made me nervous.",
  "input": "",
  "output": "How high for each?Reply Wbc 13, rbc 16"
},
{
  "instruction": "My Arms Are Turning Blue, Please HelpTL;DR: I removed lab values, as they are no longer the most recent. I have normal skin underneath, to my knowledge, my skin just sheds blue - unaware as to why. I have neurologic and gastric issues, like already stated in edit one, so no need to retouch on that, just briefed about a new procedure I didnt know was going to be requested. I will update about the (dead) blue skin, the literal reason for the post in the first place, if ever discovered.No confirmed, or believed hematologic issues. I only shed blue skin? My skin recently came off, and its pink underneath like it used to be, for some reason it just comes off in blue heaps (random dead skin, I assume, but unsure as to why the color is blue). The veins are extremely bright, but thats about it underneath, I believe. I already have eczema\/atopic dermatitis, I know that, but this still confuses me because it doesnt appear to be that. I plan on seeing my derm soon just in case.I thought Id add this information, only to discuss how thorough Ive tried to be, but none of which is the cause for it either. I have a whole host of neurological issues, migraines and OC as listed below, among other newly diagnosed issues, like tremors and possible nocturnal seizures (Im epileptic). Im going to be getting a VEEG done, as ordered by the newly epileptologist I just began seeing. My medications are being readjusted, and a hospital is the only safe way to do so.I also have gastric issues, like I said below.Bottom line, thank you all. If I ever figure out why Im shedding blue skin, Ill make sure to share.TL;DR: I took all suggestions as best I could. I was denied by hematology, rheumatology found no issue despite only slightly abnormal values (mainly NOT severe muscular degeneration that Ive now been made aware of, it didnt alarm him like I said), EKG and EEG requested are both normal. There have been newly diagnosed neurologic issues, but easily fixed with botox.Edit: Thank you to everyone who suggested various things that it could possibly be, and please know that I took your advice, both from this post, and the follow-up one I made awhile back, that Ive since deleted. Here is the in-depth follow-up that some had asked me to provide.Hematology: I was denied by two different hospitals, even though I had a thorough PCP referral, as both places said my issues werent possibly blood related. There were no other hematologic options in my area, so I decided I needed to move on from hematology completely, because I wasnt getting anywhere. Ive not been tested for any hemoglobinopathy as suggested on this post, or any other blood-related issue due to this.Rheumatology: This was the major one recommended on my other post, and I actually just went there a couple days ago after a successful (and surprisingly quick) referral. Despite my leg pain, color-changes and other various issues discussed below, the doctor doesnt believe its anything rheumatology related, either. A physician on the other post I had made, suggested getting a work-up and asking about APS (antiphospholipid syndrome), but I was only tested for possible muscle diseases to my knowledge. I havent received those results yet, but Im sure theyll be normal. Well see.Ive also recently had a redo of my heart echocardiogram done (which came out normal) because the last one was poorly imaged. My most recent (required) EEG was completely normal, but Ive been put on yet another epilepsy medication, unfortunately.The only thing Ive been diagnosed with, since when this was originally posted, has been migraines and occipital neuralgia, which I now receive injections for.Original Post:25F, 185lbs, white, non-smoker, non-drinker.TL;DR: major breathing difficulty, chest discomfort\/pressure, (mainly) left leg heaviness\/throbbing, odd blood consistency and possibly abnormal values.Hello, Im in quite a predicament. Ive now been labeled a zebra by a vein specialist, because no one can figure out the reasoning behind my current issues.For context, this is now seems to be a somewhat progressive issue, as different symptoms have arisen as time has gone on. I began not being able to breathe well sometime last year, but every time medical professionals take my O2 stats, it never goes below 98. However, its becoming increasingly harder within these last few months, especially taking deep breaths. After having some bad reflux episodes, I was told I had GERD, and then given some medication. However, Ive now been hospitalized twice for my severe breathing issues, both occasions in September, after my GERD diagnosis (and its well controlled\/no reflux episodes), so I have a feeling its definitely a separate issue. My chest also feels as if theres a crushing force on it very frequently.I started getting severe leg pain, that made my (especially my left) calves feel heavy one minute, almost like carrying around tree trunks, and then pulsing\/throbbing the next. I was scanned for blood clots in my left leg while at the ER, and everything came back normal. The same day I was scanned, a nurse noticed my left arm being a vibrant blue. The ER doctor then pointed out the fact hed noticed that it was also on my right arm at that point, as well. Ultrasounds have recently been done on both my arms, but those results also came back normal.My blood is now starting to be impacted as well I believe, as its appearing to have trouble stopping or clotting quickly. Im not sure if this issue is related to the color-changing or not. My blood will borderline gush out after blood draws\/IV site wounds. My RBC has also been consistently high for awhile now, and my MCH and MCV are now dropping again. The values being abnormal arent by much or extremely significant, but Im not sure the reason for the abnormality either (again, reiterating the fact that Im not sure if its connected to the color-changing or not).",
  "input": "",
  "output": "Except for the bleeding, you're pretty much describing a sickle cell disease crisis. Did you ever have a hemoglobin electrophoresis test?EDIT: I saw the conversation further below. Some common traits for hemoglobinopathies are indeed low hemoglobin, high RBC and low MCV. I'd say you could catch about 80% based on these values (but then, electrophoresis is still required for final diagnosis, or DNA testing for alpha thalassemias). Anemias can be compensated for with high RBC counts. MCV, as in sickle cell anemia, may be normal since the sickeling occurs in the microcirculation at low PO2s.EDIT2:I'll give a short summary of things written below (including personal interpretation of what was written) for any physicians currently tuning in;Summary28F, non smoker, non drinker, not on birth controlFatigueSevere leg pain (excruciating), pulsing, throbbingSevere pain 'everywhere', especially shoulder bladesBlue discoloration in armsOxygenation is fineBoth arms and legs were scanned but no clots were foundNo history for excessive bleeding during surgery or tooth extractionsPeriods were heavy in the past, but no longerPictures could be interpreted as deep-tissue bleeding\/bruising, but no discoloration has been described (cave too recent)No weight loss, fevers, infectionsLiver and spleen are normalLabNo full lab results on hemostasis (e.g. PT, APTT, Fibrinogen)Initially high RGB, normal MCV, hemoglobin. Now all three are decliningNormal d-dimer, normal plateletsNo hemoglobin electrophoresis was donePossibilities (in no particular order)(Acquired) Bleeding disorderThrombosisSickle-Hb C diseaseAnxiety...?"
},
{
  "instruction": "I have not, I dont even know what that is.",
  "input": "",
  "output": "No problem. Would you mind posting your history of values? Mainly hemoglobin, RBC, MCV"
},
{
  "instruction": "Sure! Im going to hit the hay first since its 6 AM here and I havent slept yet, but when I get up, Ill get my bloodwork out.How do you want me to write it out on here? Like the reference ranges, and then my results?",
  "input": "",
  "output": "Screenshots are fine too btw.Otherwise, maybe like so? Dates aren't crucial, just give an indication of how far apart (e.g. months between or hours). If there's a missing value in one of the labs, just put a '-' so the values stay aligned vertically.RBC [ref], x, x, x, x MCV [ref], x, x, -, xI'd update your original post, and we'll go from there."
},
{
  "instruction": "I updated it! I just separated it by the blood test, and it looks kind of chaotic I know, but I tried my best.Ill have to grab ahold of more of my bloodwork at my primarys office soon, so that theres not just three",
  "input": "",
  "output": "Hmm, these results neither confirm nor refute my first thought. But on seeing the photos they remind me more of deep-tissue bruises.Do they ever go away or change color at all? Was a tourniquet placed on your upper-right arm?Could you perhaps elaborate a bit on your bleeding history? Ever had any surgery or tooth extractions? Nose bleeds? How are your periods?Personally really looking forward to the comments of the hematologist."
},
{
  "instruction": "Can alpha thalassemias present with normal hemoglobin, but chronically low ferritin? My hematologist suggested my hemoglobin was normal because I burn through ferritin so quickly. Like OP, my specialists have all but thrown in the towel after four years of treatments (for a diagnosis that has now been thrown out - Von Willebrands 2M).I have had high RBC and low MCV, normal HCT and HGB, low B12 and D (take weekly injection of the former, high dose oral supplement of the latter). Ive had two iron transfusions ~4 years ago. I can provide complete blood work for the last four years if that would help.",
  "input": "",
  "output": "Hemoglobinopathies (like thalassemias) produce red-cells that have a shorter life-span than regular 'normal' red cells. So yes, there is a high turnover and therefore higher demand of nutrients. However, there are other explanations as well. If you like further exploration I would suggest you make a new thread? Results from the last 4 years would give a tremendous head start."
},
{
  "instruction": "I updated D-dimer and platelet results now that Im home to see my bloodwork. I apologize I keep replying, but since you made the list, I thought Id let you know, in case you end up not seeing it.",
  "input": "",
  "output": "Do you have a picture of your blue arms? Is it al over? Are the blue areas painful or itchy?"
},
{
  "instruction": "Theres a small sliver, same area on both sides, that is my pale skin. The rest of my arms are completely blue. Im currently trying to link photos, but I still am in the process of deleting photos, so that my already filled up iCloud storage will allow me to actually create a link lol.",
  "input": "",
  "output": "Would be really useful to see a picture! (Once youve had some sleep)"
},
{
  "instruction": "Dont link through your iCloud to avoid being doxxed or anyone with nefarious intentions causing you more trouble.Edit: create an Imgur account (takes 2 seconds) and link",
  "input": "",
  "output": "Are you on any medications, otc stuff, supplements? Lots of exogenous substances can cause blue pigmentation (colloidal silver, amiodarone, minocycline to name a few)."
},
{
  "instruction": "I put the data in that I was asked for, but I can totally do the whole thing, if you think itd be helpful! Quite a bit of my results are online, though, so Ill probably take some screenshots. Ill add it in the post too, once I do.",
  "input": "",
  "output": "Screenshots would be fine (and probably easier) as long as its readable."
},
{
  "instruction": "I put it in my post! Theres a lot of screenshots lol, so beware, but its every test result Ive received most recently (September 11th).",
  "input": "",
  "output": "Is it just your arms that are blue? And the right started before the left?QYes, just my arms. The left one started turning blue before the right one, its the blood oddity that started in the right. My lips used to also occasionally turn blue months and months ago, but now its strictly my arms.Sorry it took so long to get back to you things have been crazy on my end with covid. Ive been thinking a lot about your case over the last few days. I think its really strange that its only your upper extremities that are changing color. Please keep an eye out for color changes on your legs or other body parts. Typically when there is some form of differential cyanosis (one part is blue and others arent) we think of cardiac defects and if its one specific limb poor perfusion. But given your age and normal echo a cardiac defect causing your symptoms is unlikely. My next best guess would be something like pernicious anemia\/B12 deficiency. This could explain your developing anemia and some of your pain symptoms. The blue coloring could be due to easy bruising related to it. However given that you have microcytic anemia (small red blood cells) and we typically see a macrocytic anemia (big red blood cells) with pernicious anemia\/B12 deficiency. But that doesnt necessarily rule out that as a cause for you symptoms. To evaluate this you would start by checking b12, folate levels. Like other have mentioned you could have a hemoglobinopathy causing the cyanosis and anemia which would be more consistent with your microcytosis. However I would have expected this to show up before now, have some known family history of anemia or bleeding disorders, and\/or have cyanosis or bruising on more of your body than just your arms. My best guess would be some kind of vasculitis causing vasospasm in your arms giving them a cyanotic appearance. The vasculitis could also be causing the pain you experience in your legs. Your developing microcytic anemia could be early anemia of chronic disease with maybe a pinch of iron deficiency thrown in. Id recommend asking for a ferritin and iron level to evaluate the anemia more. In terms of vasculitis workup, its a bit out of my wheelhouse so Id recommend considering seeing a rheumatologist for further evaluation. Those docs typically (or at least the ones I have worked with) are more of the safari guides than other docs and specialize in zebras.Tl;dr: Possibly a vasculitis, consider rheumatology. Also could be B12 deficiency\/pernicious anemia or hemoglobinopathy but less likely due to nerd stuff as above.*edit: Like to add that you should probably also consider seeing a hematologist as well if you havent."
},
{
  "instruction": "Thank you! I appreciate all this information greatly, and I will definitely take the advice. Im sorry things are bad with COVID right now, honestly I couldnt imagine what its like to be a doctor during this pandemic. Ive already had it myself, and my mother almost died from it. Its nasty stuff. Im praying for all of you.I went to the doctor today (my primary), and Ive been given a referral to hematology and cardiology, as most of my previous heart echo was suboptimally imaged and apparently the cardiologist remarked several times that he couldnt see hardly anything. Were making 100% sure its not my heart first, and then were going to hematology because Im having extreme bleeding issues again. I had blood drawn today for a new PT and PTT also and the tubes were filled up within seconds. The phlebotomist even remarked on the situation, and my blood appears to be almost the consistency of water. I was born at the hospital Im going to for hematology, so maybe there can be some connection if possible. Also, apparently on my last echo, it was remarked as me having trivial to mild mitral valve regurgitation but Im not quite positive what that is anyways, or if it is even something to question.Ill definitely be hitting up rheumatology next, especially if these dont pan out.",
  "input": "",
  "output": "Mitral valve is valve on the left side of your heart. The regurgitation means it leaks a little allowing some blood to flow backwards. I wouldnt think much about trivial to mild mitral regurgitation especially if it was a bad echo. I hope you find your answer. Please feel free to DM me at anytime if you have questions or concerns. Always happy to help"
},
{
  "instruction": "Rheumatology- [49][female] Methotrexate and ColdMy mom is a patient of La county hospitals but does\/t have a PCP only a specialty clinic doctor that she sees every 3 months so Im hoping to get some advice. She recently got a cold this past weekend, she tested for covid and had a negative result. She has a cough and is taking Acetaminophen from OTC. She is due to take Methotrexate today due to her Lupus treatment for her flare. Her doctor recently increased her dose to 10 pills weekly which I understand to be an immunosuppressant. How does this affect her if she has a cold? Should she skip until she gets better?",
  "input": "",
  "output": "That's a spectacular question,I wouldn't panic, I don't think it's radically dangerous but this does merit a phone call to the doctor's office. It's important and should be answered by someone who understands her particular history with lupus quite well.I say don't panic because it is not radically uncommon for people to take immunosuppressive drugs when they are in fact sick with an infection, that is the whole basis of taking steroids(the most iconic immunosuppressive drugs) when you have covid, it's looked at like a double-edged sword. So that's good with bad. In theory it could make her cold much more intense and last much longer than it would in a normal person .I don't know how bad her lupus flare is and if that's going to hurt her more withholding the drugs; or how bad her cold is, and if she's really going to fall apart, so I will refrain for making an explicit recommendation.I recommend you get this specialist to give the recommendation, but either way giving it or holding it, she will probably be okay for the meanwhile."
},
{
  "instruction": "Thank you! I feel much less panicked now. Ive tried getting a hold of her doctor but have not able to. Ill continue trying. On the lupus thread, Ive also seen that others have been told by their doctors to skip methotrexate when they had a cold. Ill let her know to skip and take it next week, when shes hopefully back to her normal self.",
  "input": "",
  "output": "I think that's probably an OK decision. Not my decision. I don't know her."
},
{
  "instruction": "Chest\/Neck CT\/PET in preparation for lymph node biopsy for neurological\/rheumatologic(?) symptoms, also showed lung nodule?Hello everyone! I just had a chest CT and neck CT with contrast to evaluate lymphadenopathy of the neck as well as potential lymph node activity of the chest, and to move towards a lymph node biopsy.This is what was found so far (also had an ER ultrasound showing multiple mildly enlarged lymph nodes in parotid, submandibular, levels 1 and 2 no fatty hilum)-Multiple nonenlarged reactive appearing cervical chain lymph nodes bilaterally. Asymmetric 0.9 cm left level 5 and 4\/5 nodes, with preservation of the fatty hilum, likely reactive. Subcentimeter right retropharyngeal node similar to the recent cervical spine MR, with an elongated reactive appearance.My ENT, advised by the rheumatologist I am seeing, was somewhat hesitant on doing the biopsy before having a PET scan done because she stated a biopsy would interfere with a PET\/CT for 12 weeks afterwards. The PET scan was recommended by the rheumatologist, as we do not have solid leads for the issues I am having and per his words can collect more sensitive data. I have symptoms progressing by the day, and would like to go ahead with the biopsy and forgo the PET scan also because of the high radiation dose. My questions are, does a biopsy really impact PET results for so long, and would it make sense to perform? Can I request the biopsy first instead? Also, would an excisional biopsy really be needed over a core needle biopsy?The CT also found a 4 mm right lower lobe nodule adjacent to pleura image versus subpleural atelectasis. Should i be concerned about this nodule or its location, and could it represent a rheumatologic disease process?I appreciate any advice! I am a mystery case to all the doctors I have seen and feel completely utterly hopeless.28F, 57, 172 lbs, Asian, No drug use or smoking of any kind, Current Medications include Levothyroxine, estrogen, and progesteronePrimary Issue- Multi system wide involvement including neurological, dermatologic, possible rheumatologist, endocrinologic- Severe neurological presentation of symptoms beginning as constant left-sided facial pain, progressing to tingling and cold, then constant numbness and deadness of sensation in peri orbital area, decreased corneal reflex, whole cheek, down to jaw, and through lips, combined with massive headaches in occipital temple and behind the eye, feels like face is falling off face and sagging. Loss of muscle in face and body as well as muscle twitching\/pulsing in top and bottom eyelids (right and left) constant muscle twitching\/aches\/pain in random muscles throughout body. Recently spread of pain in parotid, submandibular, occipital, ear canal, left neck, supraclavicular areas with associated mildly enlarged and reactive lymph nodes, mostly on left but also bilaterally. Very recently tightness, compression, and loss of sensation in left front of foot and back of left calf which is still present.Many other non-neurological symptoms, have seen 60+ doctors.Duration: 2 years of worsening symptoms.",
  "input": "",
  "output": "Reactive lymph nodes are usually from some infection or inflammation and biopsy will likely not be helpful. Id say go for the PET first. The lung nodule does not seem worrisome. PET once again may be helpful to see if it is metabolically active"
},
{
  "instruction": "Positive ANA test 1:1280, whats next?Hello im F 24 i weigh 110lbs and am 51 Ive been on a four month journey of trying to figure out whats wrong with me, had an oncology appointment recently as my physicians were suspicious for a lymphoma or leukemia. Had an ANA test along with a myriad of others and it came back positive 1:1280 speckled pattern. im being sent to a rheumatologistIm wondering what are the different things that can come from this positive test? and are petechiae something that happens with autoimmune diseases?ive had widespread lymph node swelling, with some hard immovable ones in my neck and underarmsdaily feversnight sweatsweight loss 10lbs in four monthspetechiae and bruisingred bumps in areas of lymph swellingfacial flushingburning sensation on skin face, neck, shoulders, armswidespread intense itchinessextreme fatigue, weaknessdizzinessupper abdominal pain & hip\/lowback painand migrating pain that feels like growing pains in my bones throughout my body",
  "input": "",
  "output": "Could be lupus, maybe Sjogrens. Both can look like lymphoma and cause most of the symptoms youve listed. Rheum will test a battery of inflammatory markers, immunoglobulins and antibodies for a specific connective tissue disease (CTD). Many CTDs can cause petechiae and purpura due to vascular fragility and small vessel vasculitis. It can take some time to make these diagnoses."
},
{
  "instruction": "Blood work off after MTX. Should I hold the next dose until Rheum consult?30F non-smoker 147 lb 5ft 2in tall, years long history of rheumatoid symptoms and indicative blood work. My degree is in clinical nutrition which means unfortunately I understand the basics of my blood work but am not sure what to do with it. My rheumatologist is out for a week.After 7 weeks of 10 mg oral methotrexate weekly with absolutely no contraindicated medications (sulfa, alcohol, etc) my blood work has come back. I'm just hoping for clarification on if these results are expected with methotrexate, or if I may want to hold a dose until Rheumatology is back in office next week.Creatinine has dropped to 0.51 and was 0.70 prior to treatment. BUN has risen to 24 and was 17 prior to treatment. CRP at 1.4, was 1.3 prior to treatment.If I can ask for any input just to ease my mind, I'd really appreciate it!",
  "input": "",
  "output": "I would not worry about these labs. They are inconsequentially different from prior.For your information - Creatinine is a measure of how well the kidneys are working. We worry more about kidney injury when it is high. BUN is not as specific and should be interpreted in the context of your creatinine. Your CRP is basically unchanged.Your rheumatologist would likely go more based off your symptoms in adjusting your meds, they are probably monitoring side effects of methotrexate so looking at blood counts for signs of low counts and liver function tests. Methotrexate is cleared through the kidneys so if there was a major change in your creatinine it may prompt a dose change. CRP and ESR are inflammatory markers that will be trended.Hope this helps!"
},
{
  "instruction": "Should I see a Rheumatologist?Hi I am 26F, 150lbs, currently only taking hormonal birth control (sprintec). I have been dealing with recurring hand and arm pain for the past four months or so. I'd estimate since the end of January 2023. It started as a sort of tingly feeling in my fingers with some pain around the proximal interphalangeal joint in all 10 of them. I wouldn't describe the tingling as numbness exactly, as it's not the pins and needles that others use to describe it, but it is constant. The pain is in both hands, but my right hand is worse as that is my dominant hand. As there is no specific moment I can remember when this started, I thought this might have been carpal tunnel or some other overuse injury from spending time knitting & crocheting as well as being on the computer 8-10 hours a day for my job\/fun. I stopped knitting as much and when it didn't get better around a month in I stopped knitting completely. The pain does get worse when I use the computer and my phone so I am trying to limit the use of both and I have already switched to using a vertical mouse which didn't seem to make a difference. Specifically when I click the mouse with my right pointer finger I feel a pinch between my ring and pinky fingersI went to an orthopedic hand surgeon who said that he didn't think it was carpal tunnel as those are unusual symptoms for it and even more unusual to be experiencing the pain in both hands. He took X-rays that he said looked normal, and he ordered a bunch of blood tests for me including one for Rheumatoid factor. He also prescribed me physical therapy after I complained about still being in pain. The physical therapist did a bunch of intake tests that showed my grip strength and other strengths were on the low end, but normal and he seemed stumped on how to help me. After 3 sessions of in office physical therapy I did not seem to get better and if anything it's worse. As I now feel regular pain up my arms around my forearm and triceps (feels kind of like a tight stretching) in addition to the pain I described earlier. Also in the last couple of weeks I've experienced actual numbness in both of my pinkys, on seperate occasions. For the record I wasn't as diligent with the PT as I could have been, ie sometimes I would do exercises only once or twice a day instead of the recommended 2-3 times. I was diligent about the heat he recommended though.My blood tests came back all negative so the doctor said that he's at a loss, suggested I maybe make an appointment with a rheumatologist and prescribed me a 4mg medrol dose pack as a last ditch effort. During and after the prednisone I didn't really notice a change in pain levels. That coupled with the negative Rheumatoid Factor suggests to me that maybe there is no inflammation causing this? But I know that seronegative rheumatoid factor exists, hence why I'm now asking on reddit. Does it seem like this could be RA? Would it be worth it to go to the Rheumatologist for this? Was my doctor just wrong and it is some kind of overuse injury and I should just try a new orthopedic doctor? Maybe someone less specialized in the hands because the physical therapist suggested it might be a spinal issue since the pain is traveling up my arms. Should I just give up on doctors and try to be more diligent about the physical therapy on my own?For the record here are all the blood tests I got:CBC W\/PLAT AUTOMATED DIFF - Only showed I have a slightly low red blood cell countANA PANELSEDIMENTATION RATEC-REACTIVE PROTEINRHEUMATOID FACTORURIC ACIDHLA-B27 ANTIGENCYCLIC CITRUL PEPTIDE ABSANACHOICE(R) SPECIFIC ANTIBODIES W\/RFLX TO DSDNA",
  "input": "",
  "output": "Picture does not sound rheumatologic to me. In addition to the negative labs and imaging, most patients have relief with steroids on initial diagnosis of a rheumatologic condition. This tells me what is going on is unlikely autoimmune or inflammatory.Some ideas and thoughts on things that can cause pain\/tingling\/weakness in the arms and hands that I do have are have you ever had any neck trauma or whiplash? Has your B12 and thyroid been checked? Do you have any history of migraines?"
},
{
  "instruction": "No neck trauma or whiplash and I'm not sure my B12 has ever been checked. I went to an endocrinologist last year because I found out I had a high level of thyroid peroxidase antibodies (166 iu\/ml) after testing for a seperate concern, but my T3, T4, TSH were all normal so she said to come back in a year. I hadn't thought about it because the endo seemed very unconcerned, but do you think that could cause this?Also no real history of migraines, I remember I had 2 around when I started puberty and haven't had one since. My (older) siblings do occasionally have them though, not sure if that would matter.",
  "input": "",
  "output": "Hypothyroid can certainly cause some real muscle pain, joint pains and parasthesias (tingling in hands\/feet). As a matter of fact, carpal tunnel syndrome is a common neuro symptom of hypothyroidism and is often reversible with thyroid hormone therapy.Get your thyroid checked. Id still also check B12."
},
{
  "instruction": "69M - prostate cancer? - what to expect?Hello, this is concerning my father (69M). He's 6'3\" and about 15st. Anatomically this concerns this prostate, and geographically we're in the United Kingdom.He is a moderate regular drinker (2-3 small glasses wine most nights) but has never taken recreational drugs. He used to smoke but quit about 35 years ago.He has mild asthma and chronic sinus issues caused by nasal polyps that cause total nasal obstruction. He is awaiting followups for a cauterising surgery, but this seems unrelated.As part of routine bloods, my dad got a psa test about a month ago, which came back at 13.3, which is obviously elevated.His GP hasn't seen him in person and hasn't carried out a rectal exam, but instead referred him to urology. His urology referral was a telephone consult to tell him that he was being booked in for an MRI.He had the MRI (with contrast) last week and today was told that there was something suspicious on the left side of his prostate, and that he would need a biopsy. He hasn't had the biopsy yet.I understand that this is all geared towards a prostate cancer diagnosis, and I understand that at this stage, prostatitis is unlikely. All the clinicians with whom my dad has spoken have been very reticent when he has asked about cancer, but simultaneously tell him he might need a bone scan based on the outcome of the biopsy.I'm under no illusions that prostate cancer is high on the differential, but could benign prostatic hyperplasia still be on the cards? I understand that both conditions are diagnoses histologically, but it would be helpful to know whether PC and BPH look distinct on images?For background info - he has no urinary symptoms but has been losing weight steadily for about 3 years (maybe 4st in 3 years?). Assumption has been that he hasn't been eating much because his nasal polyps have robbed him of his sense of last largely. He also lost his wife (my mum) to breast cancer six months ago. He can't cook and eats rubbish, and also likely has depression.Any insight here would be useful in terms of differentials, outlook (based on the vagaries I've provided) and generally what to expect. I definitely feel that no clinical has been forthright with my father thus far. That's no criticism of the docs, but it hasn't helped him and has compounded his stress as he's gone straight to Google and catastrophised.",
  "input": "",
  "output": "Urologist. Impossible to provide much advice since he hasn't actually been diagnosed with prostate cancer and there are many nuances depending on what type \/ grade \/ stage of prostate cancer we are talking about. Certainly a chance you can have an elevated PSA and no prostate cancer even with an MRI. Only way to find out is biopsy. Results of that would determine what needs to be done.If he does have prostate cancer it is almost certainly localized to the prostate. Options would then be surgical prostate removal, radiation, or surveillance and waiting. Obviously I don't want to go into these with out a proper diagnosis. Biopsy happens in the office, takes about 15 min. Results take a week or two to come back."
},
{
  "instruction": "[Urology] 27M, Pee drops \"leaks\" after peeing. Embarrassed to visit a doctor.As the post says, I am 27M. After peeing few drops of pee leak out after peeing.As a \"solution\", i \"rub\" my penis to move any pee in the canal outside. I do it even from behind the testicles. However recently, it seems even that doesn't work out. As i still get few drops of pee afterward, especially when i sit down.I wanted to go to a doctor, however i am extremely embarrassed. And I am not even sure if there is anything that can be done at this point.The thing is: the reason i believe this is happening, is because when i was a kid, i inserted a thermometer in my urethra, it was deep enough that i felt it penetrating something and pee came out.However if i recall correctly nothing really changed after that incident and this leaking issue started happening about 5 to 8 years ago.",
  "input": "",
  "output": "To put your mind at ease, there is a VERY low likelihood that these issues are secondary to your \"self-exploration\" event that you journeyed on when you were younger. Additionally, there's absolutely no reason to be embarrassed about this. This is what us physicians do on a daily basis, and we do what we do because we love to help people (most of us, that is). And I promise, for every \"embarrassing\" event you think you might be bringing to the table, I guarantee all of us have seen much, much worse. But again, there's absolutely zero shame in what you're going through whatsoever. Get a referral to a urologist from your PCP; all they focus on is genitourinary tract issues, and they should hopefully be able to help you find an answer to what's going on."
},
{
  "instruction": "Piggybacking... had this start happing to an extent sometime in my 30s or 40s, and figured this was just attributable to aging... Would a urologist visit typically be warranted if there's no other symptoms or related trauma that could have caused it?",
  "input": "",
  "output": "It's true that many men will develop these types of symptoms later in life due to something called BPH (benign prostatic hyperplasia), which is essentially when the prostate grows too large and starts \"pinching\" the urethra closed, which subsequently may lead to symptoms such as difficulty starting a stream or completely emptying when they go. However, your 30's is way too early for this to begin occurring. I would start with going to your PCP first so they can do a physical exam and ask more questions, and then they can help decide whether or not a urology consult is appropriate for you."
},
{
  "instruction": "Cystocele76 old woman. Her nurse practitioner diagnosed her with cystocele. What kind of doctor would be the right doctor for cystocele? Would gynecologist be better option than an urologist since the patient is a woman?",
  "input": "",
  "output": "Luckily you don't have to choose: there are urogynaecologists out there, which are gynaecologists who specialize on urological and proctological issues in women. I'd go to one of those."
},
{
  "instruction": "Does OB\/gynecologist fit that category? Medicare physician finder doesn't even have the doctors category of urogynecologist on their web portal.",
  "input": "",
  "output": "Ah, I see. Sorry, I'm not in the united states. It's the right type of doctor, yes, but it doesn't tell you their sub-specialisation. Maybe look the ones you find via the portal up on the internet or call their office?"
},
{
  "instruction": "27m - Urology\/Andrology Question - successful Penile vein ligation and shockwave treatment contra indication? What happens to ligated veins ?Hello to all,I have been diagnosed with severe organic erectile dysfunction and am using PDE5I, injectable PGE1 (Alprostadil) and sometimes alpha-1-antagonists (doxazosin).I am suffering from organic erectile dysfunction and had a successful dorsal vein ligation (3 years ago - superfical and deep dorsal vein as well as two ectopic veins (which helped me to get erections with medication).Even though shock wave treatment might not be very promising I still want to try it and as I happen to live in a country where it is comparatively cheap I am about to do 10 sessions in 5 weeks.But I fear that it might \"unblock\" the vein ligation ?Hypothethically speaking - if the ligated veins where freed from their suture would they pop open again ? Or is there scar tissue built up which will continue to block the vein ?I fear the shockwaves might damage the \"suture\". Since I cannot happen to find information about that online maybe someone can help me out.Thank you and best,",
  "input": "",
  "output": "The suture themselves dissolve after a while. So 3 years later the veins are closed by scar tissue. Also, when a blood vessel is surgically closed, a longer segment of the vein eventually becomes \"clogged\". Sounds very unlikely that anything could break them open again, even if they should deliberately try.So I don't think you should worry about this specific complication. There's probably a lot of other possible complications though, I don't know much about this specific shock wave procedure. Sounds very experimental though. Do you know how it's supposed to help for ED?"
},
{
  "instruction": "Constant 9\/10 flank pain Female 31Hello fellow people of reddit. I hope you are all doing better than I am currently.Overview: I had my first set of kidney stones in may of 2022. I had another set in July of 2022. In December of 2022 I started having constant pain in my flanks. Ive been to the emergency room several times since then. Ive seen urology, Ive seen my pcp, Ive seen the pain clinic, Ive seen a nephrologist. I have bloods done frequently as well as UAs. Ive been ignored and sent home every time when I seek help. Otc meds dont work and the narcotics just make me sick. I feel like Im going insane. Im Im so much pain on a constant basis. My mental health is starting to tank because of this. Any advice would be appreciated.I do have hypercalcemia, and hyperparathyroidism, and my nephrologist believes I could also have necrosis in my kidneys.I am 31, obese, 5 foot 3 inches tall. I have never smoked, dont drink, dont do drugs other than weed in gummy form every now and then.Current Meds are:Concerta, Propranolol, Losartian, Amlodipine, Nebulizer, Quvar, Alb inhalerHere are my most recent labs.UA:https:\/\/gyazo.com\/d5f6f1fc96058f29dd17ea6d2e3126f9https:\/\/gyazo.com\/fca06118e1b739c171942f1b3050492fCBC with Auto Differential:https:\/\/gyazo.com\/940243c0ec3bb61963388832f51c2bd0CMP:https:\/\/gyazo.com\/2586ac67b7574917dcb76db00ddf78ae",
  "input": "",
  "output": "The fact there is calcium oxalate in your urine, plus blood +++ indicates there may be a stone in the process of breaking up, and this is what is causing the pain for you (especially if you have a history of kidney stones). Looks like a slight UTI too, which isn't going to help."
},
{
  "instruction": "Thats what I said, but the only stone they can see is, according to them, no bigger than a grain of sand. The doctor I saw last night also said that I didn't have a UTI. I've had the crystals and blood in my urine every single UA since December.",
  "input": "",
  "output": "You don't have a raging UTI and your culture is negative from what I can see. But there are white blood cells in your urine, and bacteria (though no leucocytes\/nitrates, which tend to be the classic uti markers). Plus, a high number of epithelial (skin) cells, which indicates sample contamination. So, not anything that warrants treating.And yes, kidney stones can literally be a grain of sand size and cause utter havoc."
},
{
  "instruction": "Man, I wish the doctors here would understand that. Because every time Ive gone to the ER (which is a lot unfortunately because I cant deal with the pain and otc meds don't work on it) they just tell me Im being dramatic and to go home.",
  "input": "",
  "output": "I'm sorry to hear that. When I come across patients with pyelonephritis\/renal colic etc, they tend to benefit somewhat from hot water bottles."
},
{
  "instruction": "My heating pad does help to a degree. Sometimes, it helps enough that I can sleep or do whatever it is I need to. And sometimes it does nothing.",
  "input": "",
  "output": "Do you have any imaging? Does the pain come and go? Where is it located? Is it the same as when you had kidney stones? What therapies have you tried, what did urologist say about the pain?"
},
{
  "instruction": "Nephrology says it's probable stones and\/or renal papillary necrosis.s.ne. There's a constant dull ache and then like a colicky pain that gets really bad really fast. It feels very similar to past kidney stones. The pain is on both flanks and spreads to my side right above my hip.I've had a couple of CTs. The last one showed at least one itty bitty stone. There's a constant dull ache and then a colicky pain that gets really bad really fast. It feels very similar to past kidney stones.I've done heat, cold, narcotics, NSAIDS (which the nephrologist said to stop) Ive done physical therapy, exercise, and stretching.The urologist says he didn't see anything and that I'm being dramatic.My PCP says there is something wrong and to see urology.Nephrology says its probable stones and\/or renal papillary necrosis.The pain clinic says Im being dramatic",
  "input": "",
  "output": "I agree that NSAIDS and opiates are not the way to manage this, and I believe your pain you are not \"dramatic\".How high is your calcium? Your hyperparathyroidism is possibly the most crucial thing to get under control. Chronic hypercalcemia obviously predisposes to stones, but also to a disease called nephrocalcinosis which can be painless but sometimes causes marked pain as small rocks of calcium get lodged in the draining portion of the kidney.The other not mutually exclusive possibility is you are having ureteral spasms, which are associated with hyperparathyroidism and hypercalcemia but no stones.So it is crucial to get your hyperparathyroidism under control. Even with \"normal\" calcium this can cause kidney problems and with hypercalcemia can cause kidney failure. If this is already under control then possibly it will get better once the ongoing calcium deposition improves. Dietary changes can also decrease calcium deposition, your nephrologist can advise on these.There are several medications available that are somewhat helpful for ureteral spasms including oxybutynin and tamsulosin but would focus on the underlying cause."
},
{
  "instruction": "My calcium bounces between 11.5 and 13.5. I have surgery to remove the overactive parathyroid glands at the end of next month. It was supposed to be this month but the hospital broke a needed machine the day before it.I will have to looked into the nephrocalcinosis, I haven't heard of it before.",
  "input": "",
  "output": "Holy smoking gun batman.Yes I suspect this surgery will help tremendously with your pain. If it was delayed long you should have been on a calcium lowering agent, though likely a little late to start now."
},
{
  "instruction": "Fun fact my endocrinologist told me to take calcium and vit d.Im really hoping the surgery helps because I might just loose my mind if it doesnt. My calcium has been like this for about three years but I was always told it was fine until recently.",
  "input": "",
  "output": "I don't know the details so I can't really assess what is going on here, but in general we wouldn't let someone be that high for that long. Surgery is usually done fairly early and if not medical therapy offered, targeted at lowering not raising the calcium."
},
{
  "instruction": "Unfortunately, I had a pcp that seemed to believe that everything was either due to menstruation, things I was doing, or that it was due to my low mental health or that I was lying. But he was the only one my insurance would cover. As soon as I switched doctors I got referrals and scans and procedures but that only happened in November of last year.The Ed always said it wasnt that high and it wasnt something to worry about.",
  "input": "",
  "output": "The ED is never going to treat hypercalcemia or really any chronic problems. It isn't acutely life threatening unless very high so not on their radar.They aren't mini-PCPS.Unfortunately people have poor access and get stuck in the ED visit spin cycle with care never moving forward. I think you are on a goodish path now though."
},
{
  "instruction": "The case of the constant invisible urine flood: neuro? Psych? Other?This is a bizarre one, so Im hoping for any ideas here.Pt (family member) is an 80 year old female residing in an assisted living facility with hx of benign essential tremor and recent dx of possible Parkinsonism (tremor, left side more than right. A&Ox4; No signs of dementia; MOCA 7.1 score 28\/30. More hx and meds below) About three months ago, pt c\/o urine constantly running down my legs. She reports that her clothing, shoes and socks get soaked with urine, to the extent that she leaves wet footprints when walking, and smells urine strongly in her room and on her clothing. She has been wearing adult incontinence briefs, but reports that the urine bypasses these briefs.Heres the problem. Family, caregivers, physicians, nurses, and therapists cannot see, smell, nor feel the urine. When pt says her pants are soaked, they appear and feel dry to the touch. Incontinence briefs also feel dry, and there is no sign of urine on pts bedclothes or clothing. She recently spent two weeks in an acute care hospital and another two weeks in a rehab hospital, and in that time, only one instance of urinary incontinence was noted and that was on admittance when it had been some time before she could be seen.She has seen a neurologist who prescribed Sinemet (carbidopa\/levodopa) for her tremors. The neurologist mentioned that Sinemet can exacerbate incontinence, but didnt really address pts insistence that she is constantly having urine flow that soaks her legs and shoes but somehow bypasses the incontinence briefs leaving them dry.She has seen a urologist, who prescribed a bladder training regimen and voiding journal, but a bladder scan showed she is emptying her bladder just fine. Labs show no sign of UTI or other infectious or inflammatory process. Urology suggested this was more likely a sensory issue than a urology issue and referred back to the neurologist.Pt insists that her fellow assisted-living residents can also see and smell the urine, and has reported that she believes the caregivers are lying about not seeing it in order to be polite.Complicating this is that pt has a history of anxiety disorder, depression, sometimes exaggerating physical symptoms and deciding she has a grave condition of some sort until tests are done to rule it out. A psychologist has suggested she may have a personality disorder with emotional dysregulation and attention-seeking features as well.The fact is, though, this pt is miserable and 100% insistent that she is experiencing a constant flow of urine and sitting in wet clothes all the time. We cant get her in to the psychiatrist until late April.Are there ANY ideas of what we may be missing to explain this from a neurological\/sensory standpoint or another place to look? I have been really trying to advocate for this pt but its very difficult when the problem seems to be invisible for everyone but her. On the chance this is not psychosomatic, Id really like to make sure weve considered all options and are not just blowing her off because of her mental health issues.No alcohol, no drugs other than prescribed, no marijuana, no tobacco\/nicotine use.Meds: Sinemet 25\/100 2 tabs tid (Parkinsonism) Bupropion 75mg qam (depression) Liothyronine 5mcg tid (hypothyroid) Levothyroxine 50mcg qam (hypothyroid) Trazodone 50mg qpm (sleep) Buspirone 5mg bid (anxiety) Alprazolam 0.5mg qpm (anxiety\/sleep) Ibandronate 150mg q30day (osteoporosis)Surgical\/other hx: Hysterectomy\/bilateral oophorectomy ~40 years ago Pregnancy: G2P2 ~50 years ago Melanoma removal, L knee, ~5 years agoLabs:CBC shows minor anemia beginning the day after starting Sinemet but seems to be resolving.BMP normal except for elevated AST (last values from Jan 2023 to Mar 2023 were 88, 71, 144, 156, 162, 91, 101 in chronological order.)Imaging:MRI Lumbar spine w and w\/o contrast 2\/1\/2023: they didnt think it had anything that would explain constant urine flow but I can post the report if needed.CT head 1\/30\/2023: impression was: 1. No acute intracranial abnormality.2. Atherosclerosis.",
  "input": "",
  "output": "I would guess these are vivid hallucinaties, resultibg in a delusion. These can be caused by her combination of meds ( levodopa, bupropion and trazodone can cause agitatie and confusion in eldery patients). Did it start after starting levodopa? Parkiinson itself can cause vivid hallucinations too,but often parkinsons is more advanced then. And it could also be caused by depression. Older people often have these kind of delusions when they have psychotic depression.I would go back to the neurologist or psychiatrist for an evaluation. Probably stopping some meds should be tried, or antipsychotics compatible with parkinsons like clozapine added. But ask her doctors first what and how."
},
{
  "instruction": "Oh, I forgot to answer your question: No, this started quite awhile before she started levodopa and buspar.She had been taking bupropion, trazodone, and alprazolam for years, but spent a few weeks in an inpatient psychiatric facility specifically focusing on elderly patients (edit: for depression\/SI) about 9 months ago, and the psychiatrist there doubled her bupropion from 75mg qd to 150mg qd.The urinary problem started about three or four months after that. Two months ago, she was hospitalized for increasing tremor and weakness, at which time a consulting psychiatrist said to titrate her off the bupropion as he felt it was contributing to her anxiety levels. At that time, her bupropion dosage was cut in half to the 75mg she is currently on.The increasing tremor and weakness were determined to have been simple deconditioning due to self-isolating, turning away physical therapists, and not moving around much at all. She went from acute care to an intensive inpatient rehab facility and very quickly (about 2 weeks) regained much of her strength and a decrease in tremors.Thank you so much! We are trying to wean her off bupropion for that exact reason (not hallucinations specifically, but because it can exacerbate anxiety), so thats good to know. We just saw the neurologist yesterday but he sort of waved it away and suggested we discuss med interactions with the pharmacist.Further complicating matters is that shes tried pretty much every SSRI and SSNRI for depression and has had bad reactions to all of them, so bupropion at the time was thought to be a sort of last-ditch effort and seemed to be working for her. Since it also works on dopamine, the neurologist was completely unconcerned about it, but admitted that comprehensive med review was not in his wheelhouse.We did specifically ask the neurologist if this could be related to the Parkinsonism and he said he didnt think so because of the rest of how her condition appears.So, it sounds like I should continue trying to get her into the psychiatrist sooner? So far her other doctors dont seem to think theres a problem that they can speak to.",
  "input": "",
  "output": "For depression with psychotic symptoms, like these hallucinations\/delusion, often tricyclic antidepressants are used, so probably meds she has not tried yet or maybe a few decades ago when they were more common.Personally i would try to get an appointment as soon as possible, because something is clearly not right and she is suffering probably.That could be a psychiatrist specialised in the eldery or (another?) neurologist. Consulting a pharmacist with an interest in psychopharmacology however also a good idea in the meantime.Armchair diagnosis is easy, but i could be very wrong and there is something else going on. This is just some thoughts that came to mind"
},
{
  "instruction": "Child urology: Double kidney, megaurether, uretheroceleFemale, 10 months old, 70 cm, 7.5 kgHi all,I am searching for second opinions and experiences for my 10 months old daughter.She was born with a double kidney whose upper part is polycystic and thus not working properly. The urether of this part became a megaureter, probably because it ends in an ureterocele in the bladder.Her first surgery was when she was 1 month old. They cut into the ureterocele so the urine can flow into the bladder. However, at this point they thought she had only one urether for both systems and thus there had been enough urine to guarantee sufficient flow. When she had a persistent infection with Klebsiella pneumonia, we were referred to specialists who saw the second urether and, 2 weeks later, her second surgery was done to make a urostoma, so the basically standing urine from the megaureter could flow directly outside. The ureter is smaller now and except that she receives prophylactic treatment with antibiotics, everything is normal. But the stoma has to be closed of course. Now there are 2 options:connect the ureter from the dysplastic part of the double system with the healthy ureter from the healthy partcut out the dysplastic part of the double system and part of its ureter, leaving the other part and the ureterocele where they are, as there is no refluxOur doctors recommend option 1), as the surgery is shorter (90 minutes vs 3 hrs) and less invasive (opening up the existing hole from the stoma a bit more vs making an additional cut close to the lungs) and the healthy kidney part is not damaged (vs certain loss of at least 7% function). The only risk is that the connection of the two ureters leaks, which is rare and easily fixed they say.These are all compelling arguments, but we were also told that option 2) is the more common one. Does anyone have experience with similar cases? What's her best option in your opinion?Thank you very much for any feedback!",
  "input": "",
  "output": "!redditsilver"
},
{
  "instruction": "Is it normal for a Urology PA to try to prescribe antidepressants\/SSRIs?(Posting this again to fix some things that I needed to fix in this) Age: 24Sex: FemaleHeight: 5'1\"Weight: 100Race: CaucasianDuration of complaint: urinary issues for about a year, suspected interstitial cystitis. Appointment was todayLocation on body: urethra\/bladderCurrent medications: N\/ANo recreational drugs, non-smoker, non-drinkerI had a very uncomfortable urology appointment today and while one of my doctors confirmed this was really weird I kind of would like to hear from other doctors unrelated to the situation.I went in because my gyno suspects that I have interstitial cystitis.I'd like to mention he's very very specific with me about what will happen. He knows that I rely on a really precise description of what the plan is (I have really bad anxiety and sensory issues). So it was weird to me when I went in and the PA immediately scoffed and said \"it's never interstitial cystitis. They just claim that and send you off our way\". Then she insisted on pelvic floor massage which I am unable to do and I said no to because my gyno and I went over all the options and he didn't think that was even on the board of necessary ideas. She pushed and said that \"I injured my shoulder and got pelvic massage therapy and it fixed my shoulder\".She claimed she had read all of my charts and medical background and asked if I was taking anything for the pain. I thought she meant Tylenol and said no because it doesn't work. She then started listing off amitriptyline and two other antidepressants\/SSRIs. Then cymbalta. I got confused and told her I'm already taking savella and she asked me \"what for? What does that do?\"Shouldn't she know what that does? It just sent off a really red flag for me because those are usually meds that you need to involve a psychiatrist for. And if she had read my file and is messing with those kinds of meds why would she mess with my antidepressant that is package insert for pain and depression? She also would've seen that I'm prescribed tramadol.She also got really snotty when she asked if I had been surgically diagnosed when I said I had endometriosis which also would have been in my file\/medical history. It also seems like any message from my gyno she just threw in the trash pile and came in with her mind made up that he was full of it.I guess I just need to know what to do. If this is normal and she just was kind of awful then okay but it really didn't feel normal. Do I tell someone about this? Who do I tell? She told me \"then just go back to your gyno and see what he says\" and (as I expected he would) he's sending me to another urologist, I imagine he's wondering why there was a problem.Edit: she also asked me about a bunch of food and drinks, I answered honestly that I just drink water with an occasional soda and about my food habits. Then she sent me home with a list of food to stop eating and all of it is stuff I point blank told her I don't eat. I'm just really upset because I had to drive a long way to get there, do things that will set me back anxiety-wise for days and she didn't even listen to that.Edit 2: There's also the unfortunate fact that the more stressed I got by her ignoring me and getting really pushy the more I started to stim. And she decided the best thing to do was start IGNORING me (I was still speaking to her, just no eye contact and moving my fingers) and only speak to my mother. I was then completely invisible.",
  "input": "",
  "output": "That sounds like a mix of multiple bad things. Theres a strong whiff of functional medicine (read: quackery) in massage for everything and weird food restrictions. Theres stigma against psychiatric treatment and mental illness. And theres ignorance.Theres nothing wrong with a urology PA managing antidepressants if he or she actually has expertise in those medications, but that isnt what happened here. This PA might be right about it not being interstitial cystitis, but even if so behaved so badly that youd want a second opinion anyway."
},
{
  "instruction": "Definitely getting a second opinion, hopefully with someone that actually is interested in sitting down and talking things out instead of whatever this whole mess was.Thank you for letting me know that it's not unusual for urology PAs to work with those meds in general",
  "input": "",
  "output": "I think it actually is unusual. Its not unprofessional or absolutely a bad thing, but its unusual.Its not only psychiatrists who manage psychiatric medications, but most of the other doctors (and PAs and NPs) who do it are generalists, so probably family our internal medicine primary care doctors and the occasional gynecologist who does primary care."
},
{
  "instruction": "Yeah the savella is for my fibromyalgia and depression, I've cycled through stuff like elavil (ultimately dismissed as an option when I was 14ish) and cymbalta (horrible reaction) so I don't find that so weird. I guess maybe it put me on edge because I've had bad experiences with a lot of those? I'm very touchy about messing with those when I'm settled in one because it's hard physically and mentally and I really don't feel safe unless my psychiatrist is involvedI've gotten the \"what's it for\" question a lot it was more the \"what is that\" that got me because I thought it was a pretty well known med",
  "input": "",
  "output": "Sorry this is short. No signal. Speed read the issue. Only have to say.... Cymbalta is a powerful antidepressant which has use in resistant stress incontinence , that is leaking on exercise usually later in life.Amitriptyline has a big role in bladder control mostly for nocturia, peeing at night. It is used at doses much less than when used 50 years ago as an antidepressant but I like to correct people who complain theyve been put on an antidepressant when the dose is 50mg instead of the 300mg it was then. It was a poor antidepressant but people said that their bladders were better"
},
{
  "instruction": "That's interesting. But also odd because I told her I'm not having incontinence",
  "input": "",
  "output": "Precisely. It doesnt really make sense so maybe another opinion"
},
{
  "instruction": "My (72M) father was sent off for a number of urology tests, are these standard procedure?72M, 160 lb. He has had frequent urinary urgency for years now, untreated. Recently has gotten much worse, and the need to urinate has been waking him up 5+ times each night. When he does urinate, he has trouble emptying his bladder.I scheduled an appointment for him with a urologist and the urologist prescribed Flomax to him. This was today. The urologist sent off for a number of tests:PSACreatinineUrinalysisAlso, these procedures:Transurethral cystoscopyRenal ultrasound and ultrasound of the urinary tractI'm wondering about the cystoscopy - as this is what my father is most fearful of. I spoke with the urologist and he said this is to see if there are issues that need to be addressed by surgery that the Flomax can't help cure. I'm still not sure what this is done for and if this is standard procedure? Would it be better to just see how he responds to the Flomax and perform the procedure if he doesn't? Or is there value in doing this anyways?",
  "input": "",
  "output": "Flomax was given as due to the likelihood of benign prostatic hyperplasia, and pretty much every guy has an already enlarging prostate when they're above 60 anyway.The cystoscopy is to look into the urinary bladder for any issues that may not be due to the prostate (prostate would still be the number one source of problems in this age group regardless). All these tests should cover all the bases for the probable urinary tract issues for his age."
},
{
  "instruction": "Seeking information regarding dads renal cell carcinoma. Any urologists here?My dad has been having serious issues with vomiting, nausea, and weight loss. They ended up doing abdominal CT because colonoscopy and upper GI scope were normal. There was an incidental finding of a 2 cm heterogenous(I think???) lesion on one kidney. Per radiology report, it says renal cell carcinoma until proven otherwise.Today we saw the urological surgeon who said due to size of tumor and my dads age, hes a candidate for ablation and theyll give him a referral.The appointment was very rushed and I (29 F) went in with my dad because he has a history of TBI and has a hard time remembering\/relaying medical info. We basically were just told that its cancer (which I figured from reading rad report) and that it can be ablated very quickly and the doctor then basically told my dad to drop his pants for a prostate exam so I made a swift exit.My questions lie in whether more imaging needs to be done on my dad to make sure theres not other cancer somewhere? The doc said most likely stage one but theyve only done the abd CT and nothing else?? I understand its a small tumor but does that automatically mean theres no metastasis?? I dont understand how they know that its only stage I without additional testing or imaging? Can anyone give me insight here about this process?We will be following up with that physician where I will be asking for clarification. It was such a whirlwind of an appt and I just didnt feel prepared to ask necessary questions.",
  "input": "",
  "output": "From the information provided, this is not standard of care - but giving us the image files (upload to e.g. dicomlibrary and CT report would be very helpful.Here is NCCN's very helpful patient guideline for kidney cancer.A suspicious 2 cm lesion on a kidney often, but not always is renal cell carcinoma. A 2 cm renal cell carcinoma that's confined to the kidney is usually pretty harmless and very unlikely to relapse or metastasize.The problem is that 1) staging is incomplete and 2) you won't have histology going along with this to confirm that it is indeed renal cell carcinoma and 3) your father has concerning symptoms that are as of yet unexplained.Initial evaluation and staging vitally includes comprehensive labs (CBC, metabolic panel, LDH), abdominal CT with and without contrast, chest CT (or at least, but that's discouraged in the guidelines, chest X-ray) and a thorough physical examination and history.If there are any alarming signs on history or examination, additional imaging must be done. I'd consider vomiting, nausea and weight loss to be alarming. At least brain imaging (preferably MRI) should be done to exclude brain metastases imho.Also, when not performing a partial nephrectomy, which would be preferable to ablation if possible, an initial core needle biopsy to secure histologic diagnosis is recommended. Otherwise you won't ever know what kind of 2 cm mass they burned. The NCCN guidelines stateBiopsy of small lesions confirms a diagnosis of malignancy for surveillance, cryosurgery, and radiofrequency ablation strategies. Ablative techniques may require multiple treatments to achieve the same local oncologic outcomes as conventional surgery."
},
{
  "instruction": "I did an in home vinegar test yesterday and the area he was referring to did NOT react. I did have a single spot react, but not the one he was referring too. The vinegar test has a high false positive rate so I'll talk to him about that, but still, the visible areas he could have been talking about DID NOT react.I want this guy to be sure i have HPV before he charges me to cut shit that's been there forever. I can take care of a skin tag for under $5 at home. And while I know it's incredibly common to have hpv I want him to be sure if I'm going to have to disclose that with future partners. Maybe I should see a dermatologist?What are some questions I can ask to make sure he's right?",
  "input": "",
  "output": "Easiest and cheapest way is to post a picture here and Ill check it for you. Its a clinical diagnosis and honestly not that difficult to determine.Edit. Also, if you have had unprotected sex with > 1 partner, chances are you have been exposed to the virus."
},
{
  "instruction": "http:\/\/imgur.com\/a\/lhCk8a4Again, its been there my entire life, including the skin bridge. I always assumed they were caused by the same shitty circumcision.To your edit: I've never had unprotected sex. That includes oral (not fun).",
  "input": "",
  "output": "Doesnt look like a wart and your history doesnt really support that diagnosis either."
},
{
  "instruction": "Bleeding vs. clotting risk - When is heparin bridging appropriate?Hi all, I am just a simple-minded EMT, trying to understand this concept for a family member who recently underwent surgery.The family member has chronic a-fib, which has been well managed with warfarin. He needed a trans-urethral resection of a bladder tumor (TURBT). His cardiologist said he should not be off warfarin for more than 72 hours, and his urology surgeon said to stop the warfarin 48 hours in advance of the surgery (meaning the plan was to resume the warfarin 24 hours after surgery). After the surgery, the surgeon said he was not able to cauterize all of the 'wound' (I am not sure the correct term here), so my family member had a good amount of hematuria, though the surgeon said it was not a life-threatening amount.He was supposed to take aspirin after being discharged, but they ended up admitting him due to a good amount of clotting in the bladder, which required daily irrigation. I am not sure if the nurses ever ended up giving him aspirin or heparin while he was off the warfarin. The surgeon seemed very concerned about the bleeding, and said that my family member could not go back on his blood thinners for another 48 hours after the initially planned resumption (which would result in a total of 5 days off the blood thinners).Now my question is, isn't it easier to fix a bit of bleeding than a blood clot (which could cause CVA, AMI, or PE)? Wouldn't it be better to keep him on blood thinners and handle the bleeding, than to risk a deadly clot?We would ask his surgeon, but it's sort of a foregone conclusion at this point as my family member has already been discharged. So, this is just for my personal education. Thanks for your insight.",
  "input": "",
  "output": "isn't it easier to fix a bit of bleedingGeneral surgeon here. No, it's not always easier. Sometimes the tissues are just oozy, and you can't just throw a simple suture in or cauterize it and make it stop. Sometimes, the more you cauterize something thats oozy and inflamed, the more it oozes and bleeds on you. Sometimes, you just need to let the body do its thing and form a clot. So either you stop blood thinners for as small a window as possible, and accept the risk of developing a clot elsewhere, or you keep them on blood thinners and just let them ooze and ooze and ooze, potentially requiring blood transfusions, which then opens them up to other risks. Others may have other viewpoints, but this is from a surgical view."
},
{
  "instruction": "Thank you.Do you always do a heparin bridge or is this contraindicated under certain situations?Does a patient history of a-fib affect the outcome of the risk calculus?",
  "input": "",
  "output": "When considering the decisions here, you need to weigh the benefits and risks of anticoagulation.His stroke risk from afib can be estimated with the CHADS2-VASC score. Look this calculator up online. Most people stand an annualized risk of 2-11% of experiencing stroke. On a day to day basis, that risk is super small. Like 0.001% chance of having a stroke every day he's off anticoagulation, and even that is probably an overestimate of his stroke risk.The risks of bleeding are obvious. He's bleeding into his GU tract. This could occlude his bladder. He could bleed into the wound bed in ways that make his recovery worse. The chance of bleeding while anticoagulated is 100%.The last nail in the coffin is that we have multiple large and well-designed trials (BRIDGE and PERIOP2) that show no benefit to bridging pre or postoperatively in any population we've looked at this far, including mechanical valves in the post-op setting.At this point the only cases where bridging might be worth it is acute DVT\/PE within 3 months of surgery, and maybe mechanical mitral valve."
},
{
  "instruction": "What monitoring is usually needed when taking a patient off anti-coagulation therapy for surgery? e.g. CT scan, d-dimer?For reference, this family member's CHADS2-VASC score is 4.Thank you for your help. The CHADS2-VASC calculator definitely improved my understanding.",
  "input": "",
  "output": "No monitoring is needed. The idea now is to resume anticoagulation once appropriate from a surgical standpoint. Not uncommon to wait anywhere from 5-14 days post-op to resume anticoagulation depending on how bloody the procedure was."
},
{
  "instruction": "I (f25) recently was referred to the one stop urology specialist clinic for tests, but the specialist I saw refused to do any of the tests I was booked in for based on my age.Hi there! I am F25, around 8st (I don't weigh myself due to history of anorexia nervosa), don't drink, smoke cigarettes (have cut down, do not smoke heavily), don't use recreational drugs, and live in England. Previous diagnosis fibromyalgia ~5 years ago, ASD, c-PTSD, juvenile arthritis (age 14). I am prescribed quetiapine XL 200mg once p\/day, naproxen as and when needed, promethazine hydrochloride as and when needed, cocodamol as and when needed. I also take a probiotic, vitamin D, iron, vitamin c, and a multivitamin all as supplements once p\/day.I have recently been having a lot of medical issues, which my GP is trying to have investigated. I have petechiae all over both arms after sun exposure, internal pain in the chest, and incontinence with internal pain in the kidney area. Also, a year or so ago I had blood tests done which indicated my kidney function was lower than normal. I also have a lot of other symptoms, but these are presumably to do with fibromyalgia, so I won't list them. The incontinence gets worse in the evening and at night, where I am needing to urinate every 10-15 minutes. Pretty much every time I drink anything, I need to urinate straight after. GP sent a urine sample away for lab analysis, which showed microscopic blood in the sample, and protein. I was referred for an emergency CT scan due to the intense pain, which flares up and is not constant, but the hospital declined to do one (due to not having space, I think). I was then referred to the urology clinic for a four hour appointment.When I arrived at my appointment, I was told I would have an ultrasound, a flexible cystoscopy, blood tests, urine test, and flow rate test. After going back into the waiting room, I was shortly called back into the doctor's office. He told me that he would no longer be performing any of the tests I had been booked in for, except for an ultrasound. He did a stick test of my urine sample and told me I had no blood in it, but the blood from my previous sample was microscopic and was only found in the lab analysis, NOT in the initial stick test. I was told that, because of my age, I could not possibly have any health issues, and that he had people with possible bladder cancer who he could be seeing but wasn't able to as I was \"taking up [his] time, when others need it more,\" despite my time being booked in. He explained that the only issue I could have was kidney stones, and also dismissed my pain further when he found out I have fibromyalgia.I then went in for my ultrasound, which came back as no kidney stones. I was then called in and, to the doctor's surprise, told that I don't have stones (which I already knew and had tried to explain - I have had kidney stones in the past, and my recent issues have not been consistent with my previous experience). He said \"I'm a surgeon, I look for problems to treat. You don't have stones, so I can't treat you.\" I asked why I am having incontinence issues, and he said \"probably because you are a woman. It's common in women,\" and when I asked what I'm supposed to do about the awful pain for which painkillers barely touch the side, his best advice was \"get pregnant. Pregnancy often cures all sorts of illnesses.\" I was almost in tears at this point. My response was \"I just had a miscarriage in December. I've had two miscarriages,\" and he said \"try again.\" I said \"I don't want to,\" but he insisted this was the best idea. I also explained that my GP had said there could possibly be an inflammatory issue, and he said it wasn't possible to have inflammation without kidney stones or an infection. He also implied that my fibromyalgia is not real because he \"prefers not to label patients if [he has] no real evidence.\" He also stated that the only reason he was going to do any other tests in the first place was because if he didn't it would be \"sod's law\" and I'd actually have something wrong.I feel at such a loss. I was so devastated after my appointment, and still ended up being in there for 3.5 hours even though he refused to do any of the tests. Fortunately I had my partner with me, who was able to support me whilst I was sobbing in the waiting room. It's been such a long journey to find a GP who takes my complaints seriously, and have had years of doctors being dismissive. I genuinely thought I might begin to have some answers after the appointment, but I now feel like I'm just five steps back.Is it normal to be refused tests based on age and gender? Is anything he said to me actually true, as I feel like it was all completely dismissive? Should I request to see someone else, or will the same thing happen again? I'm honestly devastated, and concerned for my health. Any advice is welcome, I just want to know what the best way to proceed is, and if there is anything specific that I should be emphasising with doctors in the future to be taken more seriously. I tend to mask and come across as very polite, but maybe it would benefit me better if I acted less positive and worked harder on getting across the severity of the pain? Also, am I able to request any specific blood tests? If so, what would be recommended?Thank you so much for reading, apologies for the long post.",
  "input": "",
  "output": "Medically he may or may not have been justified in not doing all the initial tests - one-stop clinics usually book you in assuming youll need everything even if thats unlikely to be the case. And your urologist is probably a better judge of that than the GP.However, the way you were spoken to is bizarre and clearly inappropriate. Id suggest you contact the PALS service for the hospital you were at and ask your GP to re-refer you to urology - perhaps another urologists outpatient clinic. PALS may also be able to help with that."
},
{
  "instruction": "[8 F] Higher WBC than RBC?My 8 year old daughter had labs and her WBC was 8.8 thousand and RBC 4.76. These are both in normal range, but is it actually ok if there are more WBC than red?We do have two doc appts this week for follow up, but my pediatrician did not notate anything about this in the system notes, only made a note for her to increase zinc intake based on her slightly low zinc.She has a variety of other health symptoms that we havent figure out also, but Im just curious if this is specifically alarming.Im sure Im over thinking it. I definitely have some medical anxiety since my mother passed last year, which I completely acknowledge. Thanks for any input!EDIT TO ADD: Conditions- bladder area pain (working with urology), abdominal pain, sometimes has protein in urine, burning feet\/neuropathy (new symptom- one month), urine leakage during daytime, pale\/flushed face, general malaise",
  "input": "",
  "output": "The units on them are different - the red cells are in millions per cubic millimeter, the white cells are in thousands. Everyone has way more red cells than white. When it comes to the specific numbers on labs, we don't compare them like that."
},
{
  "instruction": "What about having 57% lymphocytes? Is that ok too?",
  "input": "",
  "output": "Yes, totally fine."
},
{
  "instruction": "Urology or dermatologyAge: 28Sex: maleHeight: 170cm (5'7)Weight: 66kg (145 lb)Race: AsianDuration: several monthLocation: Singapore. Condition is on penisNo other health issueNo medicationMy husband has a little bump on his penis for several month. It's several mm wide, there's a hole in the middle, and can see some black stuff inside. The black stuff is shaped like a thin disk. It does not hurt or itch or anything.We are planning to see a doctor in Singapore to check it out, but I don't know if we should book a urology doctor or dermatology doctor. Any advice? We don't have a general doctor.Thanks in advance!",
  "input": "",
  "output": "Both specialties would be a good choice."
},
{
  "instruction": "Concerned over 'Spironolactone' Rx for acne as a maleHello, (30y\/o male).I was recently seen by an NP at a Urology center and during my visit my acne was brought up. She just got done some time working in dermatology. I had stated I was not comfortable with something like Acutane since I am trying to have kids and honestly that medication seems very scary to me from a health standpoint. She Rx me something called 'spironolactone'. Coincidentally I was seeing a male health specialist (an NP) the next day and he also brought up my acne and suggested 'spironolactone' out of the blue..Before I picked this up from the Pharmacy I googled it, because I like to know about medications and nowhere does it say this medication is safe or FDA approved for men. It's apparently outstanding for female acne, but as an androgen blocker, is not intended for use in men, and in fact a clinical study showed 100mg of daily use for 3 months in a group of 18 men, 8 of them developed significant gynecomastia..I called and canceled my Rx for spironolactone. I wanted to get an MDs opinion on this. I am a lay person so maybe I was just dramatic here. I am quite confused why two entirely different NPs, practicing in different states, would both suggest spironolactone (100mg a day) for acne in men..Patient History:Pituitary tumor which impacts my testosterone levels (sub 100) so am on 100mg of T a week. I have cut this down and am weaning completely off of it because I am currently 0.00 10x6 for sperm. NP just started me on 5mg of 'finasteride' (for acne due to DHT conversion maybe?) and HCG (0.75mg a week) to try and get that up. Another NP started me on Clomid and suggested I finished off the HCG (*I know, its not ideal to have two providers dictating care for the same thing - but NP #1 didnt know I was at a 0 and wanted to determine if I needed something like Clomid after the analysis came back but I dont see her again for 2 months).*I will say the IM testosterone has changed my life. I cannot explain how much better I feel. Its so profound I almost want to cry. Its like seeing in color for the first time in 20 years. I am sad \/ nervous to get off of it, but its for a purpose so I can handle that.",
  "input": "",
  "output": "I have never heard of spironolactone being used for men's acne. Without good evidence, I use it frequently in women."
},
{
  "instruction": "Reoccurring UTIHi just looking for some advice and what to know looking forward. Before Christmas I had a UTI for approximately 2 weeks, during this time I tried one course of nitrofurantoin (100mg twice daily) which didnt help at all, then two courses of pivmecillinam (200mg three times a day, with a loading dose of 400mg both times) which also didnt help. Eventually I was referred to urology who did bloods (normal), urine dip (positive for protein and blood) and ultrasound of kidneys bladder and ovaries. Scans came back completely normal and the urologist then prescribed ciprofloxacin 500mg twice daily for a week. The cipro seemed to have worked and I was fine over Christmas, but potentially still had some dysuria\/frequency though a lot less than before. In the past few days symptoms have come back to the extent that they were before the cipro.Im going to pick up a new prescription for ciprofloxacin in an hour or so and its a 5 day course. Should I be concerned and see a urologist? Or is this just a UTI that wasnt fully treated so has come back?21F, Mixed African-American\/White, 60mg fluoxetine daily, 75mg desogesterel daily, 40mg propranolol up to three times daily",
  "input": "",
  "output": "you should probably see your urologist again who may want to do a full urinalysis and culture\/sensitivity test."
},
{
  "instruction": "Coughing up blood after surgery29M, 150lbs, 57. No medication, no drug use, a drink 1-2x a week.Hello doctors, My husband had a minor urology surgery approximately 8 hours ago. He has been doing well, however, anytime he goes to lay down he begins to cough up bright red blood. It stops as soon as he sits back up. Is this from the intubation? He resident I called could not advise because he was not an anesthesiologist resident. Thanks for any insight.",
  "input": "",
  "output": "Depends in part on the volume of blood. If it's a few specks of bright red blood that he's spitting out after coughing, sure. If it's frank bleeding that he's noting when he lays down, that's something else entirely. If it's the later, it would be atypical to have that happen and last 8 hours. I'd be concerned enough at that point to bring him into the ED."
},
{
  "instruction": "Thank you so much! Also, please let me know if you need more details\/clarity on his medical history.",
  "input": "",
  "output": "I'm not a urologist, but I imagine the recommendation was for a transurethral resection of prostate (TURP). Relatively routine from my perspective."
},
{
  "instruction": "Hello, 23f, 56, 48kg, venlafaxine 37.5mg. For the past few years Ive been having microscopic blood in my urine samples with a few clear ones here and there but nothing has ever been done. Another symptom Ive been having for a few years is on and off stinging when burning and multiple urinations during the night despite not drinking anything. I remember even as a little kid though I would pee throughout the night.I have now finally been referred to urology and have a cystoscopy next week and a CT scan at some point. My other symptoms arewaking up with a full bladder in the morning which is painful almost like a period pain which stays for a little while after I pee.Microscopic blood in urine.Cloudy urine sometimesSometimes burning when I peeBelly feels tight most of the time idk if this is what feeling bloated isHaving to stop and start peeing towards the end to empty bladderPain deep in pelvis during sex sometimes, like that tight period pain (dont know if relevant)On top of all this I have agoraphobia and havent left the house on 3 weeks and now I have to go half an hour away for horrible tests so no idea how Im going to get through this. I suffer from severe health anxiety and Ive convinced myself I have cancer and Im spiralling out of control with worry. I dont know if this is relevant but I also had chlamydia 3 times when I was 17 (6 years ago). Im just hoping for some reassurance that not might not be cancer ",
  "input": "",
  "output": "Could be stone issues, urethritis etc. Def not cancer. Go to your urologist appointments!"
},
{
  "instruction": "Thank you, could I ask why def not cancer? I will try my very hardest to go",
  "input": "",
  "output": "Too long history, none of your symptoms are signs of cancer and cancer is virtually nonexistent in your age."
},
{
  "instruction": "So signs of bladder cancer are: Pain in lower abdomen Pain when urinating Frequent urination during the night Blood in urineAll of these I have? But I do see what youre saying about it being too long history",
  "input": "",
  "output": "But they are not specific to bladder cancer. In fact, they are some of the most common symptoms there is. Microhematuria for instance, is almost to the point where im more surprised when a random f23 surgical ER patient doesn't have it than when she does. (Macrohematuria is another matter altogether).Health anxiety is difficult, and all I can offer is my perspective that your presentation does not in any way signify cancer."
},
{
  "instruction": "[32M] Lung Nodule Time!Age 32Sex MaleHeight 6'0Weight 190lbsRace WhiteDuration of complaint: Just startedLocation: Lower Right LungAny existing relevant medical issues: DepressionCurrent medications: WellbutrinHello, everyone. I know lung nodules are typically nothing, but I can't seem to find a whole lot. And I know wait on my pulmonologist appointment to go over the findings. So naturally I'm freaking out anyway.So last year I had gallbladder surgery so I had a CT scan done. I had another one today for something related to urology and a swollen lymph node (everything fine there) and that's when it was discovered.From my understanding, they compared it to the CT scan from January 2021 to the CT scan today, and it was 1cm then and now it's 2.7cm. I was diagnosed preliminary with a lung nodule that has grown into a cavitary lesion by the primary doctor and he's referring me to a pulmonologist. I currently don't have any symptoms.I know it could be dreaded cancer but is there anything else it could be at that size? Most of what I've found online is people talking about 10mm or less.Thanks for any input. I am just looking for possible alternatives so I can focus on that and can sleep until my appointment.I am 32M. 190 lbs and 6 feet tall. I currently take Wellbutrin for depression. I don't drink, I don't smoke, I don't do any recreational drugs. I had asthma from around age 5 until 21\/22 when it went into remission. I had pneumonia once when I was 5.",
  "input": "",
  "output": "A growing cavitary lesion is most likely to be inflammatory, infectious, or malignant (probably in that order of likelihood for you). There is a long list of possible causes. Something that big likely warrants further investigation, potentially with a biopsy. The pulmonologist will be able to further narrow what the possibilities may be (heavily dependent on where you live and in-depth past medical history)."
},
{
  "instruction": "Thank you. I'm in Alabama and the pulmonologist will have access to all my past records because I've stuck with the same facility pretty much my entire life. Tomorrow I will continue my good vibes going into this. Your answer helps alleviate a lot of the anxiety - I know how serious this is. I'll update once I know (pulmonary appointment hasn't been established yet)",
  "input": "",
  "output": "Yea. I wouldnt be too stressed about it. Certainly something to get worked up further, but not something to lose sleep over or run to the ER about as long as youre feeling well."
},
{
  "instruction": "Pregnant with kidney mass38 yo female 24 weeks pregnant (IVF) History of hydronephrosis (2017) 3.5 cm simple kidney cyst found while hospitalized for it as well as ovarian cystsI am currently 24 weeks pregnant, I had some pretty bad pain in the same kidney that I had hydronephrosis in years before. The pain only lasted for about an hour but I then had what felt like a UTI so I went to the doctor. My urine tests came back fine but my doc requested ultrasound of my kidneys given my history. I went and got it done and received a call the following morning to go straight to ER that I had an abscess so I did (4.7cm). My urine and cbc both came back ok and didnt indicate any infection so they sent me home with order for another kidney ultrasound in two days. I got that done and it came back complex mass 5.7cm with recommendation for MRI that I cannot get done while pregnant. I have been told that its ok to wait these 4 months but I cant help but be terrified in the meantime. I have an appointment with urologist in 2 weeks. What am I really looking at here? On a scale of 1-10 how concerned should I be that this is cancer? Google is really scaring me. I plan to have MRI while in the hospital after I deliver. What can I anticipate at the urology appt? Any insight is greatly appreciated. Thank you for reading.",
  "input": "",
  "output": "Youll have to wait for the imaging study, but the wait shouldnt be a big deal. I prefer CT renal protocol over MRI, but maybe your urologist may feel differently. Based on the report its hard to say exactly whats going on. Theres no mention whether it is solid or not, which is critically important. Maybe just be a benign complex renal cyst. CT or MRI will clarify.Pelviectasis is minimal dilation of the renal pelvis. Based on your symptoms it sounds like you probably have a mild UPJ obstruction causing intermittent pain (Deidls crisis).Edit: spelling"
},
{
  "instruction": "Hello everyone;This is my first ever Reddit post and I am finally turning to the deep dark web for some feedback.I am a 40yr old woman who has some medical issues and I have been my own advocate since July 2019. I am still waiting for a family physician for my son and I here in Canada - it's been too long without support.A little back story...I had my son in 2009 and in 2013, I had the lovely pleasure of having a partial hysterectomy - As a lot of you know these two things can cause the uncomfortable issue of incontinence. Well in 2018, after two and a half years of very uncomfortable sexual activity and very embarrassing incontinence mishaps I finally decided to see a specialist.After all the testing, my only option really was: TVT - which is the procedure where you have your bladder lifted in a mesh\/sling. Surgery was unable to be booked as at the time my family had some changes and we had to move away. Finally after a year. I received a phone call from a specialist in the new area, and yet again due to some unforeseen family issues - I had moved away yet again to another area. So in July 2019, I started hitting the ground on my own. From that day I was going to walk in clinics for UTI symptoms (blood in urine each time usually every other month until September) - got antibiotics monthly and went on my way. Finally in September 2021. I had to change my tactics. My life was completely upside down, the pain and the symptoms were increasing and I wasn't getting anywhere. So I started going to the Emergency room. And started asking for referrals. I was there twice a month until March 17. I was confirmed to finally see a specialist for my case in June. However; I was still in the emergency room three more times after.Finally I have a specialist!!! How exciting is that? Finally I can get fixed! After a cystoscopy, I remember three things he said to me;-- \"You took that like a champ\" (loved this made me laugh, I thought he was funny) -- \"Unusual growths\" -- \"We'll fix you\"Had a biopsy surgery on June 20th. And then... I had to wait 4 weeks for my next appointment. Let me tell you ya'll I didn't think I had cancer, I am ill tho I know that. I have no appetite, I don't sleep because of the pain. I am wearing adult diapers because I have no control, and the blood is only sporadic, I am tired, I am anxious, I am nauseated, and sick sometimes. I hold a low grade fever of 99.5-101 daily it will not break.Heading to my results appointment. I was ready for a few things...Not CancerDo the surgery to lift my bladder and while in there they will check others to make sure I am ok everywhere else.Meds to clear up whatever is causing these fake uti's - cause every culture would come back negative. The ONLY thing I didn't want to hear was; \"I don't know what's going on, let's try these pills, and not do the surgery...\"This is what I remember about the appointment...I told him since he likes to make jokes and laugh I had one for him before we started... He said ok shoot.\"After my biopsy surgery you tried to poison me\". His reaction was inquisitive. I explained that I was prescribed Codeine pain meds and I am allergic and it's in file. He blamed it on one of his staff and then never replaced the medication either. (One reason I already lost trust)2. His exact words \"Yay you don't have cancer\".Kind of like the first meeting here is what I remember him saying...-- \"I made a mistake, there weren't actually growth in your bladder. You have a beautiful bladder. It was just murky from this infection.\" (Lost trust for the second time - you mean I didn't even need a biopsy surgery?!?) -- \"I did measurements of your bladder while you were in surgery because when you are under, your bladder is relaxed. And you don't need it lifted.\" -- I don't know what's wrong, but we are going to treat you with Overratve Bladder (OAB) with pills and a low grade antibiotic forever.  If in 3 weeks there is no change we will increase your dosage. NEXT ONE'S THE KICKER!!!! -- \"If that doesn't work I will refer you to someone SMARTER than me\". (Lost all faith - he had a diagnosis from a specialist he was choosing to ignore to what put me on medication he didn't even know as going to help me?!?)So ya'll I am not going to lie. I was angry, frustrated, confused and couldn't speak. I took the script and left. After I left, I was beside myself and totally confused. How one specialist 5yrs ago said my only option when I had NO infections or other symptoms, said I had to have surgery... Now I am 9yrs after a hestorectomy, and this doctor hasn't done half the testing to see about a prolapse bladder (which again was diagnosed in 2018).I called my original specialist, he told me I would need to be referred back to him but he was concerned with the fact that he is over 2 hrs away from me now. He advised me to request a 3rd opinion with someone locally.I can say that has been requested... Now how long do I wait for this 3rd opinion?I am seriously in so much pain. I suffer from fibromyalgia and that is the only medication I am taking, so I am unable to manage. I haven't slept in 4 days. I feel like my right hip\/leg are going to snap off me. I want to BIRTH something. I feel like I am in that last push pain of birthing... Everyday ... All day... I have been on medications for 5 days. The only thing that has changed, is that I no longer have blood in my urine. That's it.I am tired... Am I wrong for wanting to have a doctor to just please do an internal ultrasound to see if it's prolapsed? I mean seriously I feel like it's coming out. But they won't do that testing at the ER, and this specialist won't do it. How long do I need to wait?!?Thank you for listening...",
  "input": "",
  "output": "Incontinence is s vast vast subject, i can't give you definitive answers online.For a tvt one of the most deciding factors if it will help or not is the Marshall Bonney test (you know the one with the urologist inserting 2 fingers in vagina and lifting motion to full bladder and telling you to cough)Has it been done and what was the result?A tvt or tob isn't always the answer, it doesn't work for any woman, there is a host of urodynamics tests and pelvic floor, abdominal pressure etc etc....that need to be done beforehand.The cystoscopy is also a must before the tvt for multiple reasons i cant describe them all (limited English and time) one of the reasons for the cystoscopy to be done and under anesthesia is to relax completely the abdominal muscles so the urologist can apply pressure to lower abdomen and with other hand to look at the roof and forward wall of bladder so not to miss anything. Without anesthesia he will not be able to see clearly and make a good assessment of the forward wall and roof.The biopsie isn't necessarily done only by suspected bladder cancer but also to outrule something called interstitial cystitis which is somehow similar symptoms to uti with clean uricults.Also not all urologists are the same, some like working exclusively in a practice, work fixed hours, ultrasound, diagnostics, cystoscopy, small stuff. And they know urodynamics and incontinence stuff (diagnostics) much better than me.Others like me work almost exclusively in the hospital performing multiple surgical procedures daily and also doing oncall shifts for EREven in hospitals, some do like 5-6 renoscopie procedures daily, others do kids daily, others the lucky ones do mostly DaVinci robot assisted surgeries, others kidney cancers, others tur-p tur-b holep etc... etc......That's why you can always get a second opinion. A urologist who is good with kidneys and works that daily and is concentrated on the malignancies in urology will not be a good fit compared to a urologist who knows his pelvic floor good and all types of incontinence and meds and bands. Also OAB represents similisr symptoms and can be treated with meds, if tjey don't work and marshall bonney test is negative, then botox injection in bladder is an option that works wonders for someIf you can provide me result of marshall bonney test i can give you a \"guess\" if tvt is right for you or not. A trustworthy diagnosis i cant provide online.Tvt done unnecessarly not only it will not help but can lead to complete shut close urethra and acute urin retention, so we don't want to do unnecessary procedures that will make matters worse. Also there is conservative approaches like pelvic floor exercises which in some patients do work well.Also TVT\/TOB procedures aren't emergency and don't get priority so right now the waiting list at my workplace is about 3 months minimum and if another covid wave hits, it will be delayed further.Another Tip: gynecologists are more than capable of placing a tvt or tob. Its not a complicated procedure. Fairly straightforward but carries risks but rare when done by an expert. So if you can get a faster appointment with a gynecologist then do it."
},
{
  "instruction": "[ Please Help ] CT Scan Abdomen and PelvisHi , i am male . the doctor at the Urology hospital asked me to do a CT scan of the Abdomen and Pelvis. will be done next week. My question is, will this CT scan show a testicle report if there is a problem with the testicles. or it is a different scan. because the Scan is for Abdomen and Pelvis",
  "input": "",
  "output": "Nope. Testicles can't really be seen on this kind of CT."
},
{
  "instruction": "Were my father's doctors negligent?My father was in hospital being treated for a suspicious catheter bleed and a UTI. As part of this the urologists had stopped all his anticoagulation\/antiplatelet medication and presumably because of this he suffered a large ischaemic stroke. He was admitted on a Tuesday and I first noticed the stroke symptoms on the Thursday evening when I attempted to call my father on his mobile phone and when I finally managed to talk to him he had severe aphasia and cognitive decline. I immediately called the ward he was on and told the nurse that this was a very sudden and severe change in my father's condition (my sister had been to visit him that afternoon and he'd been absolutely fine - I had spoken to him earlier too and he was fine then) and the nurse said she would call for a doctor to review him overnight and he'd also be seen by his regular urology doctors in the morning and they would better understand the changes in him. I called the hospital a further two times that evening expressing my concerns about him and that I was concerned he might have had a stroke.On the Friday morning I call him and obviously he was still struggling to speak and still sounding very confused but he was however able to follow along with a conversation. I call the ward and the doctor has bumped my father up to IV antibiotics and fluids. I'm told later in the day that he was sleeping for most of the afternoon and didn't eat much through the day.Then Saturday morning my older sister spoke to the nurse looking after my father again expressing how concerned we are about this major change in him and we're told she will get the on call registrar to come and review him again. Later I am told he's being given stronger antibiotics. Saturday evening my father seems to be improving and is once again eating normally, also able to speak a little better.Sunday morning when I call the ward I am told by the nurse that my father isn't very good and he has been sent for a CT scan because he was really messed up that morning, exceptionally confused, unable to swallow and his aphasia has gotten worse. I called back a while later and spoke to a registrar who confirmed that the scan shows that my father has likely had a stroke. That afternoon he was moved to a specialist stroke ward.Over the last few weeks I've spoken regularly with the doctors on the stroke ward and they seem pretty mortified that it took 3 days for anyone to think to order a CT to check for a stroke. It seems obvious to my sister and I that when we have kicked up a fuss and he's been seen by a doctor they have just assumed that it was delirium brought on by the UTI but according to his notes no one had considered any alternatives. So I'd like to ask, would you consider this negligence?Relevant info81MUKWhite British79Kg5'11\"Non smoker, no drugs or alcoholHistory - Alzheimer's, type 2 diabetes, metallic valve replacement and double bypass in 2011, diagnosed with kidney stone in late 2021, left side PCNL at beginning of February and recatheterised after a failed TWOC a few days after surgeryMeds - enoxaparin sodium 80mg twice a day, aspirin 75mg once a day, metformin 500mg two twice a day, gliclazide 80mg two twice a day, oxybutynin 2.5mg twice a day, linagliptin 5mg once a day, tamsulosin 400 micrograms once a day, donepezil hydrochloride 5mg once a day, colcalciferol 1,000 units once a day, bisoprolol 1.25mg once a day, atorvastatin 40mg once a day",
  "input": "",
  "output": "Wait they took a guy with a prosthetic valve replacement off anticoagulation? How bad was the bleeding? Which valve was replaced? This is kind of concerning since mechanical valves need anticoagulation or else they clot and cause  you guessed it, stroke.Were they giving the enoxaparin and aspirin in the hospital??Obviously hindsight is 20\/20 and perhaps it wouldnt have changed anything, but it seems like an oversight that no one ordered even a CT."
},
{
  "instruction": "I'm unsure on which valve was replaced, I've honestly never thought to enquire. The bleeding wasn't really all that significant, at least that I saw, my father wasn't complaining of being in any pain either and originally I was told that bleeding without pain shouldn't be a concern - it was only when I noticed he was passing clots into his catheter bag that I was told to get him to hospital.They 100% stopped the enoxaparin but I'm not totally sure about the aspirin.Edit: after checking with family we believe it was an aortic valve replacement",
  "input": "",
  "output": "From a US standpoint I agree with everything here. Is it worth having a malpractice lawyer look at this? Yes. Is there a clear delay between stroke identification and likely onset? Yes, it sounds like it. Is there clear harm done? Not necessarily. Im so sorry all this happened, OP. Its hard even if there is no mistreatment."
},
{
  "instruction": "This is very helpful, thank you. Regarding the improvement and them seeing anything on the CT - the report on the CT only identified a single stroke and described it as sub-acute so I was told it was likely to have happened a couple of days prior. I thought much the same as you originally, minor stroke on the Thursday and larger stroke sometime Saturday night into Sunday but I was told no.I have been intending on getting in touch with PALS for a while now and this should give me the push I need, at this point I'm not even sure what the situation with the bleed was by the time the stroke happened. It's not been an issue since he was moved to the stroke ward and they resumed anticoagulation (high dose aspirin originally and then unfractioned heparin infusion).",
  "input": "",
  "output": "One thing worth noting is that inflammation after a stroke is worst ~72 hours afterward. The worsening symptoms a few days later may have been related to swelling and inflammation."
},
{
  "instruction": "Leukocytes but no BacteriaAge: 34Sex : FemaleHeight: 511Weight: 170lbsDuration of complaint: 3 weeksLocation: USAny existing relevant medical issues: NoCurrent medications: None currently, just finished a round of macrobid.Hey guys, I posted something similar to this in a micro group but things have changed since then so Im just looking for further advice.Almost 3 weeks ago, during a routine exam i showed moderate leukocytes in urine with trace blood. Id had no regular uti symptoms at all other than some pressure after peeing like once. No burning, urgency etc. According to my blood work I was also dehydrated. My NP, who is also my boss & friend, gave me a prescription for Macrobid and sent off a culture. I took the antibiotics for 3 days then I got the call that my culture was negative and to stop the antibiotics. So I did. From there it was back and forth because although I was still asymptomatic I still had leukocytes in my urine. So another culture was sent off - same results 25 - 50k cfu mixed urogenital flora okay cool. So what do I do? NP tells me to just finish the antibiotics so I did. I did get a micro UA done as well and it showed 5-10 wbc with few bacteria, mucus and epithelial cells but none of my urine samples were clean catch.On Saturday after finishing my antibiotics completely I took one of those AZO uti strips after a shower and it had a small purple speck in the middle of the leukocyte pad after 2 minutes. I text my NP to let her know and she sent me in yet another prescription for antibiotics.My concern is that Im not one to take a lot of antibiotics. Actually, I havent taken antibiotics in several years so I feel uncomfortable just taking them with no identifiable bacteria present. I do have a referral to urology but its going to take some time and Im worried about getting a kidney infection. I also feel as though my concerns arent being addressed properly because of my NP being my friend, so she doesnt run the tests she would on a regular patient (IE I had to bug her for the culture and micro ua because she just immediately wanted to give me antibiotics and call it a day).Thanks in advance for any advice, I know its a long read.",
  "input": "",
  "output": "Asymptomatic leukocytes in urine, with no growth on a culture, from a sample that isn't a clean catch, is not a UTI and does not need antibiotics.Stop getting medical \"care\" from this person. Sounds incompetent. Get an actual PCP, preferably a physician.Urology is gonna be scratching their head on why they have this referral."
},
{
  "instruction": "Why are small kidney stones worse than my larger one?Female, 38yrs old, bilateral nephrocalcinosis, no other health concerns and only medications are acute pain relief (30mg codeine & 500mg paracetamol combined tablets at 2 per dose, Tramadol 100mg, Diclofenac suppository 100mg, Buscopan 10mg). Currently in absolute agony.8 weeks ago I passed a 4mm stone that was exceptionally painful. Worse than my unmedicated child birth. That pain started around 7am but by 5pm I had passed the stone. It was horrific, more intense pain than I currently have but at least over in less than 12hrs.I had a CT scan and a follow up call from a urology nurse informed me I only had very small stones, described as like gravel left. No treatment or management plan - just a follow CT in a year.Which would be fine but for the past 2 days I have been in agony in my right kidney. Im on maximum doses of all my home pain relief and Im getting breakthrough pain every 2.5-3hrs.I would love to understand why this is more drawn out than my bigger stone? Im drinking large amounts of water to flush it\/them out but Im not passing much urine at a time and theres a lot of blood in there too. I think I could cope better if I knew why this was taking longer or if I could work out just how long this was going to go on for. Urology nurse was very terse and basically just said Theyll pass without intervention. Just take your pain relief.Grateful for any insight\/ideas x",
  "input": "",
  "output": "Not a urologist, but we deal with similar issues in the bile duct. When it's a single stone, it is very easy to pop out because there's nothing else obstructing or limiting its dislodgement. However, when the bile duct is full of sludge and copious amounts of smaller stones, it's like trying to pull out a tube full of thick gravel or sand and extraction becomes a lot more tedious and prolonged. My guess is that it's just difficult for the gunk to move through your ureters because it's somewhat clogged up."
},
{
  "instruction": "Cant stop peeing blood! Help!Hi everyone! Please let me know if theres any other\/better places to ask this but I didnt know where else to go. I am going through hell and feel so embarrassed talking about my bloody pee online but I have gotten blown off more times than I can count. I am 22F 59 with no prior history of UTIs and I have been peeing blood for TWO WEEKS with extreme pain! It started out full and just generally lower abdominal pain, but now Im starting to feel occasional sharp stabbing pain in my side\/back which is making me think its my kidneys. Heres a timeline of how all of this has gone:1\/2\/22- notice blood on the tissue when I wipe for the first time, freak out, schedule an appointment with my GP1\/3\/22- I go to my doctors appointment, she tests my urine and finds high white blood cell count (infection) prescribes me 5 days of macrobid1\/6\/22- bleeding gets heavier and abdominal pain gets worse1\/8\/22- finished my antibiotics, still extremely ill, more pain more blood, I start running a low grade fever and throw up1\/10\/22- I go to an urgent care, blood found in urine but no signs of infection, gave me a shot of ciprofloxacin and sent pill form home with me, told me if it gets worse to go the emergency room1\/12\/22- after never noticing a difference in pain or blood I go to the emergency room. They test my blood multiple times, take urine sample, and do a CT scan. My blood work shows elevated white blood cells and elevated high lactic acid levels. They send me in for a CT scan (no contrast) and dont see anything. I get sent home because nothing is in my CT scan and get told if the pain gets worse come backI am in a lot of pain and I dont know what to do. I am STILL peeing blood and having awful pain. I have a urology appointment tomorrow but I dont know if I should wait or go back to the emergency room. My back keeps having these painful twitches and I cant stop shaking. The nurse who discharged me said she thinks its interstitial cystitis and it is an infection that is curable that you treat with antibiotics. I looked it up and thats flat out not true. Other nurses had said all night it seemed like I had a kidney infection, and thats honestly what it feels like. What should I do?",
  "input": "",
  "output": "If they did basic blood work, urine tests, and you haven't had true fever, then you probably don't have a kidney infection.Did you original urine sample ever grow anything in the culture?Do you urine results show blood +? Do they say if they specifically see RBCs or not?Edit: include the actual lab info if you have it availableIt kind of upsets me that the CT A\/P was done non con. I guess maybe they were looking for stones... But still. You cannot reliably comment on pyelonephritis on a non con CT.I'm sure they were hunting for stones. Shouldn't really need CT imaging to make pyelonephritis diagnosis.Posts by unflaired users that claim or strongly imply legitimacy by virtue of professional medical experience are not allowed. This includes medical students."
},
{
  "instruction": "How urgent is urinary problem?40F, 5'7, 205 lbs, Caucasian.Primary complaint: blood in urine, lower abdominal painHx: Neurogenic bladder from fall in 2009, Intermittent catheterization. Hx of kidney stones, UTIs. Partial loss of feeling due to nerve damage in abdomen. OA\/DDD with SCS implant.Painful cath 4 days ago with strange pinkish red tissue string in toilet.3 days ago Pain in right flank\/lower back attributed to too much dancing the night before.Yesterday, orangish tinted urine, blood suspected.Today, bright red blood in urine and a strange feeling in my lower abdomen, which I would describe as pain-like.I moved states and have yet to fully establish care locally. I have not seen my primary or urology. I did see a resident yesterday for medication refills, who ordered blood work and a UA for my primary care appointment next month. The blood work is to be done in a week or two to get me back to full strength on my lithium.My question is: should I do the UA today and wait a few days for results or should I go to urgent care?Medical issues: Osteoarthritis, SI joint dysfunction, neurogenic bladder, Bipolar 1 Disorder, anxiety, PTSD, migraines, recurrent Varicella zoster, IBS-DMeds: Lithium 900mg daily Levothyroxine 50mcg ac am Metformin 500 mg bid (for weight loss) Prazosin 6mg nightly Trazodone 200mg nightly Tizanidine 4mg 1 tab am, 2 tabs qhs Alosetron 1mg bid Voltaren gel CannabisSmoke 1 pack\/week, drink 1-2 drinks couple times a month (including the 2 heavy drinks night this began), No street drugs.Any light shed on the urgency of this issue would be awesome! Thank you all!",
  "input": "",
  "output": "Sooner rather than later. Urgent care may not be that helpful unless you're pouring out blood or you're obstructed from a blood clot. You should do the UA soon. The only specific reason I'd go to urgent care is if you think it's a UTI which of course is possible given you intermittent cath.The bleeding could be trauma or a stone but the worst case scenario would be bladder cancer, especially since you have a smoking history. A work-up is definitely needed if the hematuria is persistent."
},
{
  "instruction": "How to talk to my daughter's pediatrician about a concernUPDATE: The appointment went as expected. The pediatrician wasn't too concerned because she was still able to eat and \"looked fine\". So I took matters into my own hands and gave her a total of 6 doses of Miralax starting on Thursday. She had MAJOR success yesterday afternoon and finally ate a whole meal.Hi docs, I need advice on how to talk to my daughter's pediatrician about an ongoing kidney & bladder infection without sounding like a crazy mom. She's 12, 52 inches, and now weighs 87 lbs (from 98 lbs).She first became sick on Aug 25th, with fever and vomiting. The first dr visit was diagnosed with a stomach bug and period cramps. Ended up at the ER a few hours later with a temp of 103.7. ER ran tests for hours. Urine came back good, bloodwork showed an infection. After several tests, the conclusion was a kidney infection. Sent home because there were no available beds. This went on for 4 more days, in and out of the ER. After 8 days of yucky, she returned to school.On Sep 20th, I got a call from the nurse to come and get her. Temp was 102.7, BP 90\/49, HR 125 and she was vomiting brown. Took her immediately to the ER. ER put her in PICU to treat the kidney and bladder infection. She was in the PICU for 6 days and step down for 3.Went to her pediatrician for the follow-up. She did bloodwork and ordered ultrasounds. Bloodwork wasn't so great. I picked up the ultrasound report and the report stated there was a fecal impaction. I asked the pediatrician, she told me to give her Metamucil and sent me off to a urologist.We had the 2nd urology appointment on Tuesday. The fecal impaction was brought up again when she was going over her (the urologists') ultrasounds and cystography. I asked more questions about this impaction and was told to give her FiberCon or Metamucil. She still has kidney and bladder infections. Urologists put her back on antibiotics.I have an appointment with the pediatrician this week. I really need to seriously discuss this fecal impaction. I have been giving her both Metamucil & FiberCon for about 22 days now. And have given her Milk of Magnesia a few times. She has not had a bowel movement (a small amount) since Wednesday.I have picked up all lab and radiology reports from 2 hospitals and 3 different doctors. The CTs on Sept 1 and Sept 20th note the impaction. Ultrasounds on Sep 22 and Oct 7 also mention the impaction. And now, the urologist mentioned it on Oct 26.She is still not feeling well and not eating much anymore. This morning her temp was 96.9, BP 103\/53, HR was 65, and she said she was extremely tired. I logged in to the portal this morning and received Friday's blood and urine labs, neither are great news, but there is some improvement.How do I approach the pediatrician with all this information without sounding like a crazy paranoid mom? Or maybe I am and this is not a major concern or issue? I have asked about this and feel like I was brushed off. I feel kind of crazy as it is because I went to all these places and got the records and put it all together. Thank you.",
  "input": "",
  "output": "First of all, don't ever worry about how you come across to a doctor when you're talking about literally the most important thing in your life - the health of your child. I have parents tell me all the time \"OK, don't think I'm crazy.\" I never do. I go out of my way to tell them I don't think it's crazy and that the reason we're talking is to make sure we're all on the same page and we're both comfortable with the plan.Just express your concerns honestly and in a straightforward way. It is literally their job to help you navigate something that evokes a strong emotional response. If they can't do that, they aren't a good pediatrician. (But thankfully, most pediatrician, in my experience, are excellent at this).As far as the fecal impaction, Metamucil won't cut it. Rectal fecal impaction is a common cause of UTIs, especially in girls (who have shorter urethras than boys). I usually use the big guns - like a Miralax cleanout or a Mg citrate cleanout. Basically the same thing we would do before a scope. This usually helps you start over from ground zero and then you can work on keeping her poop soft with Metamucil or whatever else you think works for her on a daily basis (Miralax is still my favorite for this too)."
},
{
  "instruction": "Granma here, just wondering...no enemas, these days?",
  "input": "",
  "output": "Enemas work great, but dont go too far up. Cleanouts from above take care of the whole problem at once."
},
{
  "instruction": "Alcohol Flush Response. If not allergy, what could it be?44M WhiteAbout 3-4 years ago I developed an alcohol reaction. I can have a single drop of alcohol on my tongue and end up with a bright red, itchy and hot face, and I would sweat. I do not get chest pain. Often, if I ignored then the issue would disappear quickly (10 mins). Often, I could continue drinking and be fine.Sometimes the same alcohol would not do this another time (e.g. same drink one week vs next).I have been tested (23&me) GG for alcohol flush syndrome and am fine.I saw a GP after seeing a post on reddit where someone said something similar and everyone told him it was lymphoma. The GP checked me and said I was fine. I have no weight loss, no night sweats, no obvious lymph node issues.I spoke with an allergist and they said:\"These reactions are unlikely to be an allergy as it does not occur every time alcohol is taken and also disappears after the first initial reaction.It might be due to the histamine in the alcohol, or even the presence of sulphites, but if this were the case then the reaction would be maintained throughout the period that alcohol is consumed.We do see people who have had reactions to alcohol, to rule an allergy out, but rarely is an allergy the cause.\"I am currently on betahistines for something else, and have no reaction, so I don't think it can be histamine allergy, and I have tried some drinks which say \"includes sulphites\" and have no effect.Last year I have had some urology issues (difficulty peeing). They did not get to the end of it and told me I had 'shy bladder' - I disagree, but I was told I had an enlarged spleen after ultra sound, but later told I did not.So, what could this be if not lymphoma or allergy? My GP is not being very helpful, but it is really affecting my mental health and I am worried a sign of something else.I do not drink any longer. I am currently dealing with a new thing, vestibular migraine, and this is all swirling around in my head.",
  "input": "",
  "output": "A transient effect like this seems more likely to be an autonomic response, which would be very difficult to diagnose and there aren't any tests for it. This sort of thing usually goes away after a few minutes.You might still have an alcohol flush response, despite \"normal\" genetics from 23&me. There are more genes that have been described recently. The only way to know for sure is to do an acetaldehyde breath test, but this isn't very widely available."
},
{
  "instruction": "Total loss of bladder controlWhat would cause a complete loss of bladder control in 17 year old with cerebral palsy. Yes he has cp and thats what his primary wants to relate it to, but hes been in control since age 8 and now suddenly, theres about a 2 second warning before he goes. Sometime he doesnt even know he went. Cp is non progressive. Last 2 months there has been 5 separate episodes of blood (not from urine) in his brief in the morning. After standing for sometime and then sits, he feels a slight pain in the groin area. Urine was cultured, no bacteria was found, only microscopic blood. Referred to nephrology and his kidneys are good but his compliment levels were low. Doc thinks from having COVID in November. Testing again in 2 months. Next step is urology. Thanks in advance for any insight....Edit: he is now being followed for increased hemoglobin and hematocrit in RBC",
  "input": "",
  "output": "How severe is his cerebral palsy? Is he ambulatory? Is he bed bound? in children with significant skeletal deformities or minimal ambulation, kidney stones are very common. These can cause blood in the urine and the urinary incontinence that you are describing. You need to go see a pediatric urologist for evaluation. First step should be checking for a urine infection, but after that imaging with an ultrasound or CT scan is likely the next step.Moderate spastic cp, wheelchair yes, but can walk with a walker short distances. He did have kidney and bladder ultrasound that was unremarkable. He also had a urine culture that was clear of bacteria. Thank you for your repl"
},
{
  "instruction": "Can CT Scan without Contrast IV detect Pelvic\/Abdominal Cancer22m, 220lbs, 5'6. No smoking or alcohol use.Got a CT scan from ER to look for kidney stones and they found none.Quote the patients case was ultimately discussed with urology who agreed with further evaluation with CT abdomen and pelvis to rule out renal and urethral calcinotic\/renal pathology. The patient demonstrated no signs of acute intra-abdominal renal pathology. Urology advised to follow up with non-urgent cytoscopy\"Im currently experiencing a lot of dull abdominal pain and worried about potentially having cancer in the pelvic region.For 3 months Ive had lower abdominal pain, frequency urinating, pain when urinating, urethral pain.I have no signs of kidney stones, leukocytes or blood in urine. Ive tested negative for bacterial STDs as well and even Hep B and C, Syphilis, HIV at 3 months.",
  "input": "",
  "output": "To answer your question, a non-contrast CT scan does not rule out cancer in the abdomen\/pelvis, barring a huge mass or obvious metastases. In fact, even a contrast enhanced CT scan is not very sensitive for several types of cancer.You should discuss with your physician whether or not additional imaging would be warranted. I don't know much about your history but in general, it is exceedingly rare for a 22 year old to suddenly develop some sort of intra-abdominal malignancy."
},
{
  "instruction": "What would be used to rule out cancer then?",
  "input": "",
  "output": "Again, I would recommend discussing this with your physician (either primary care or the urologist). We generally do not recommend blanket scanning everyone with CTs and MRIs for non-specific abdominal pain especially in young patients, unless the clinical history warrants further investigation (it's not because we mind the extra work; it would be comically easy to read a bunch of negative studies all day and charge for it).Laypeople and even people in the medical field tend to assume that imaging is a magic answer box, but it oftentimes is not and the potential benefits of imaging may not outweigh the risks\/costs."
},
{
  "instruction": "Urology - gross hematuria, pelvic pain, no UTI?33F, overweight, white, Canada. History of kidney stones (4 in the last 18 months). Not taking anything to prevent them but Ive reduced sodium and drink a lot of water.In the last 2 months or so Ive had 2 instances of long-ish periods of time where I have visible blood in my urine (sometimes enough that it resembles menstrual blood and other times the tissue is just pink when I wipe) along with abdominal pain and sometimes flank pain. Both times Ive been treated with antibiotics but Ive had negative urine culture. Urinalysis showed blood, mucus and bacteria a couple months ago but Im not sure what my most recent showed. Ive now had blood in my urine since June 26th and what feels like menstrual cramps. I pee fairly often and get up a couple times a night. My last 24 hour urine collection showed big improvements and my kidney ultrasound looked good.Is there anything else this could be besides a UTI? Im hoping my urologist follows up after she called in antibiotics on July 7th.",
  "input": "",
  "output": "How were the urine samples collected? I really hope that they didn't just give you a cup to pee in.Macrohematuria in women can be caused by many things, the most common: hemorragical cystitis (infection) or urolithiasis (not just kidney stones but ureter stones or bladder stones) or an urothel carcinom of the bladder\/ureter\/renal pelvis, rarely but possible with RCC or a urethral caruncle"
},
{
  "instruction": "Yes I just peed in a cup both times. I forgot to mention that the bleeding last time was maybe a week after passing a stone so I assumed it was associated with that. The current bleeding hasnt been triggered by anything. How should urine be collected?Im also experiencing some edema in my feet. I thought this was because Im working a new desk job but its to the point that my one foot swells so much that it bruises from my shoe. Also just generally fatigued.",
  "input": "",
  "output": "n a female coming with macrohematuria: this method of peeing in a cup is very wrong for me, its very inconclusive. A woman who says she urinates blood needs a small catheter inserted (transurethral or course) and then through the catheter the urine samples collected.I had many cases of women presenting such symptomatic and very common the urine in the bladder turns out to be super clear, so its becomes an Ob\/Gyn issue.You mentioned stones so most likely that's the cause, even after passing a stone sometimes there is an acceptable degree of macrohematuria persisting upto two weeks(rosee urine and not like super dark red with clots) All urologist are more than capable in diagnosing such issues."
},
{
  "instruction": "Complex Cystic Mass 8.5 cm x 5.9 cm x 5.0 cm - Left KidneyYesterday I had an ultrasound of my abdomen as I have had intermittent pain on my right hand side by my gallbladder and liver. I did not expect this result, but now it makes a bit of sense as it is probably pushing things over to the right which is causing my pain.I am a 38 year old female.Symptoms: Tired a lot, Full easily, Nauseous oftenLEFT KIDNEY: Normal size. Normal echogenicity with no hydronephrosis. In the left mid kidney there is a complex cystic mass with several septations and which have internal vascularity and areas of mural nodularity. This cyst measures approximately 8.5 x 5.9 x 5.0 cm.I am having difficulty getting a Urology appointment soon as everywhere is booked up until March or April. I have reached out to my primary doctors as well, but I am curios about what my next steps should be.What should I be eating? What should I be doing while I wait for my appointment? What should I not be doing?What tests should I have?I am assuming due to the size it may need to be surgically removed. Is that generally the outcome?Thank you.",
  "input": "",
  "output": "Nothing really to do or not do in the meantime. You can expect that they'll want to do an MRI or multiphase CT to see if there are actually any nodular areas that enhance with intravenous contrast, because that would be suspicious for a cystic renal malignancy. If so, these things tend to be really slow-growing and amenable to just being surgically removed with curative intent.Regardless, I don't think the cyst is causing your abdominal pain and was probably just found incidentally."
},
{
  "instruction": "Low right side front abdomen and right lower back pain (kidney?)Age 43 Hawaii Male UsaSo 3 or 4 months ago after a scan someone out in a Urology referral with no other notes other than hidden away positive for nephrolithiasis.Ive had this pain right where my kidney is. It becomes moderately painful after doing moderate work and takes a couple days to settle down.Is this still potentially a stone or would it have passed because of the time frame?",
  "input": "",
  "output": "Stones that remain in the cavities of the kidney will grow and recede based on things like pH and ion concentration over time. They are relatively normal to find, particularly as we get up there in age. They almost never symptomatic, unless they break off and get lodged in the ureterat which point its very symptomatic. Its hard to say what the sensation that youre having is; sounds like its causing a pretty significant obstruction for you that would be worth seeing your PCP about to get it worked up."
},
{
  "instruction": "Coughing up blood after surgeryHello doctors, My husband had a minor urology surgery approximately 8 hours ago. He has been doing well, however, anytime he goes to lay down he begins to cough up bright red blood. It stops as soon as he sits back up. Is this from the intubation? He resident I called could not advise because he was not an anesthesiologist resident. Thanks for any insight.",
  "input": "",
  "output": "Depends in part on the volume of blood. If it's a few specks of bright red blood that he's spitting out after coughing, sure. If it's frank bleeding that he's noting when he lays down, that's something else entirely. If it's the later, it would be atypical to have that happen and last 8 hours. I'd be concerned enough at that point to bring him into the ED."
},
{
  "instruction": "27Female unable to walk, urinary retention, gastroparesis27 year old female, weight:57kg, height164cm. Previously diagnosed with autism, pernicious anaemia, iron deficiency, epilepsy, POTS.Taking Wellbutrin, lamotrigine, clobozam, vitamin d, iron, vitamin b12 injection, pantoprozole, and now because of gastroparesis I am taking domperidone also gravol IVI have leg weakness and my legs feel heavy and like they will give out on me. I have diminished feeling in them but the EMG came back as completely normal.I had an MRI and an MRI with contrast and it showed a disk bulge effacing the anterior disk space and moderate to severe narrowing of both neural foremen on disk L5\/S1Disk protrusion which is mildly protruding into the thecsl sac and causing mild stenosis and mild neural foramen narrowing on L4-5I have gastroparesis which was just diagnosed during this hospital stay. I was vomiting almost everything I ate (which wasnt much because I got full so quickly) and they did a gastric emptying study.I have urinary retention meaning that I am unable to start urinating and it caused me to retain over 2L of fluid. I am currently catheterized. A urologist wouldnt see me because they believed it was a neurological problem but neuro suggested I see urology.I have a lot of the symptoms of Ehlers danlos syndrome as well (hyper mobility type) such as hypermobile joints, hyper elastic skin, soft, easily bruised skin, dislocations and TMJ disorder (which have caused jaw to dislocate many times).I have not been diagnosed with this yet but could the leg weakness and other symptoms be caused by ehlers danlos or is there something else we (the doctors and I) should be looking at.I am doing Physio and am getting a bit better at walking but my weight is mostly in my arms and so my legs dont give out I have been using a chair for the majority of the time here and walking with Physio using a walker. Im really unsteady on my feet and have a hard time controlling where my feet go which is making it hard to walk so I can only do pivot transfers.I had an ultrasound done of my abdomen\/pelvis and am not sure the results yetDoctor is referring me to an EDS clinic because no one here knows enough to diagnose me",
  "input": "",
  "output": "Really depends on what the neurological exam shows."
},
{
  "instruction": "Made an appointment with a urology office to discuss getting a vasectomy, was told that the initial consults are with a nurse practitioner and not the actual doctor performing the procedure. Is this common practice?I'm assuming I won't even be meeting the doctor until the day of the procedure, which I think is kind of strange and makes me even more nervous than I already am. I know doctors are spread thin and minor procedures like vasectomies are probably low on their list, but I would at least like a few minutes of facetime with the guy that's going to be working on my junk...",
  "input": "",
  "output": "That's typical for many offices. If the doctor is meeting with everyone individually, then that's a lot fewer procedures they can do. Just the way healthcare works in the US."
},
{
  "instruction": "21M URGENT UROLOGY HELPI was masturbating excessively yesterday and during \/ right before ejaculation I lost all hardness and my penis became flaccid, stretchy, and curved to the left. My left testicle is also much more lower now and the right one doesnt doesnt move as smoothly. I basically cant really feel my penis anymore and its hanging very loosely downwards, as are my testicles. I saw a urologist right after it happened and he dismissed any fracture since there was no pain upon inspection and said everything was normal. My penis doesnt look, feel, move the same and i can no longer get a hard erection, the most i can get is a semi erection very loose penis with a 60 degree bend to the left side. What should i do? Had to add that my penis has become much more fatter maybe swollen?, and much more veiny, and has its flaccid size has increased, also scrotum shape is very weird and wrinkly.",
  "input": "",
  "output": "The only thing that sounds abnormal to me is the bend in the shaft of the penis. I'm not a urologist, but if you were unhappy with the urologist that you saw, I would recommend you seek a second opinion from another urologist."
},
{
  "instruction": "Urology - gross hematuria, pelvic pain, no UTI?33F, overweight, white, Canada. History of kidney stones (4 in the last 18 months). Not taking anything to prevent them but Ive reduced sodium and drink a lot of water.In the last 2 months or so Ive had 2 instances of long-ish periods of time where I have visible blood in my urine (sometimes enough that it resembles menstrual blood and other times the tissue is just pink when I wipe) along with abdominal pain and sometimes flank pain. Both times Ive been treated with antibiotics but Ive had negative urine culture. Urinalysis showed blood, mucus and bacteria a couple months ago but Im not sure what my most recent showed. Ive now had blood in my urine since June 26th and what feels like menstrual cramps. I pee fairly often and get up a couple times a night. My last 24 hour urine collection showed big improvements and my kidney ultrasound looked good.Is there anything else this could be besides a UTI? Im hoping my urologist follows up after she called in antibiotics on July 7th.",
  "input": "",
  "output": "How were the urine samples collected? I really hope that they didn't just give you a cup to pee in.Macrohematuria in women can be caused by many things, the most common: hemorragical cystitis (infection) or urolithiasis (not just kidney stones but ureter stones or bladder stones) or an urothel carcinom of the bladder\/ureter\/renal pelvis, rarely but possible with RCC or a urethral caruncle"
},
{
  "instruction": "Yes I just peed in a cup both times. I forgot to mention that the bleeding last time was maybe a week after passing a stone so I assumed it was associated with that. The current bleeding hasnt been triggered by anything. How should urine be collected?Im also experiencing some edema in my feet. I thought this was because Im working a new desk job but its to the point that my one foot swells so much that it bruises from my shoe. Also just generally fatigued.",
  "input": "",
  "output": "In a female coming with macrohematuria: this method of peeing in a cup is very wrong for me, its very inconclusive. A woman who says she urinates blood needs a small catheter inserted (transurethral or course) and then through the catheter the urine samples collected.I had many cases of women presenting such symptomatic and very common the urine in the bladder turns out to be super clear, so its becomes an Ob\/Gyn issue.You mentioned stones so most likely that's the cause, even after passing a stone sometimes there is an acceptable degree of macrohematuria persisting upto two weeks(rosee urine and not like super dark red with clots) All urologist are more than capable in diagnosing such issues."
},
{
  "instruction": "Urology vs. Nephrology28M, White, No drugs, Social drinker, no tobacco, 2 days kidney painIve had kidney pain for a couple of days. I went to urgent care this morning, but they unfortunately have no lab or imaging capability. They were able to dip my urine and detect blood. I have had no urinary symptoms. Theyre sending my urine for cultures (3 day turnaround) and also referring me to an outside facility for CT (unknown turnaround time).I am in need of a provider that is able to find the problem (and hopefully solution) sooner than later.My only question is, do I need to try and get an appointment with urology or nephrology?",
  "input": "",
  "output": "Urology"
},
{
  "instruction": "Just got a worrying looking letter in the post following an ultrasound for varicocoele. Is there a urologist here that can help me translate this? (UK) Urology Cancer???Age 33Sex MHeight 6\"1Weight 74kgHi All,Im based in UK. Just got this letter but I dunno what it means. Its from the Urologist to my GP that I've been CC'd on so it doesn't make a lot of sense to me. I could wait until I actually hear back from the Doctors but obviously I'm a bit worried now having read this so I hoped someone here could explain it to me. Here are the headlines:'His PSA is at 0.65''Ultrasound scrotum showed left scrotal varicocoele, bilateral mild hydrocoele and of note he had an ultrasound of the urinary tract which showed normal kidneys, a residual urine of 400ml and a soft tissue mobile non-shadowing focus within the bladder which is avascular on Doppler. This is unusual and I am going to review this in our MDT.''We will review him in our MDT urgently.'I have done an ETCI for a flexible cystoscopy'.Can someone please translate this for a layman? Many thanksI've just googled that the MDT is the 'Multi-Disciplinary Team (MDT) consists of a team with specialist training and experience of the diagnosis and management of Urology cancer'.",
  "input": "",
  "output": "You may have a funky mass in your bladder and theyre going to stick a camera up your penis to get a better look at it."
},
{
  "instruction": "Mobile means its moving around, which is a good sign in general (means its probably not growing from your bladder). The most likely culprit in these scenarios is a bladder stone. The fact that its nonshadowing makes it unusual because most bladder stones have calcifications that shadow. In any case one has to go in with a camera to take a look at it and do something with it.",
  "input": "",
  "output": "By \"mobile\" I'm not sure whether they mean like rolling all around the bladder (which in this case sounds like it would be a blood clot, not a stone), or an actual soft tissue mass that is swinging in the breeze but attached to the wall by a stalk.MDTs are used for anything complicated or unusual, not just for cancer."
},
{
  "instruction": "Doctor, I'm experiencing a sudden and frequent panic attack. I don't know what to do.",
  "input": "",
  "output": "The best way to do that is to start with psychological therapy and mental health counseling, and to make sure you don't have physical problems causing panic attacks, you also have to run an E.K.G. test for depression and toxicology to eliminate other underlying causes."
},
{
  "instruction": "Doctor, I've had a very long voice a couple of weeks ago that doesn't improve when I take drugs. What's the problem?",
  "input": "",
  "output": "If you want to verify this, you need to do internal and occipital internal and epidemiological tests. You also need to evaluate your eyes and ears to see if there are other diagnostic procedures, such as speech therapy, interviews, or counseling, to eliminate other basilial diseases, your nose, your mouth, and ligaments."
},
{
  "instruction": "Hi, sir, I think it's Turner's syndrome.",
  "input": "",
  "output": "In this case, there are other diagnostic procedures, such as physical skin testing, ultrasound, diagnosis, evaluation and counseling."
},
{
  "instruction": "Doctor, I'm suffering from a disease called Kryptonism, where the testes don't come down into the scrotum properly.",
  "input": "",
  "output": "Then you have to perform an ultrasound to find out the correct location of the testes, and then you have to do a hip test and a rectal exam to make sure that the test is down on the pelvis, otherwise there may be other procedures or procedures associated with the male genitals or the nervous system."
},
{
  "instruction": "Sir, I think I'm addicted.",
  "input": "",
  "output": "I'm sorry, we need to do some tests to figure out the level of addiction, and we need to do intravenous fluids to help release toxins, and we need to measure blood tests, toxic tests, and whole blood cells to measure damage, and we need to do EKGs, and we need to measure glucose levels, and we need to check blood alcohol levels."
},
{
  "instruction": "Doctor, I've been feeling uncomfortable and dry for a while, and I feel pain when I'm having sex.",
  "input": "",
  "output": "The symptoms seem to indicate that there's atrophy, that you have to do a pelvic examination, a uterine cytoplasm, and urine test to eliminate basaltic disease and to recommend breast scan, breast scan, rectal examination, and complete physical skin testing for comprehensive preventive care."
},
{
  "instruction": "Hi, doctor, I think I broke my hand while I was playing basketball, and I'm so sick that I can't move properly.",
  "input": "",
  "output": "I'm sorry, but it's good to do a radiation scan, especially a normal X-ray, to determine the extent of the fractures and the location of the bone, and you can also apply spores or orthopedic casts to support the bones and fix them while the bone is being healed, and you can also consider a movement to stimulate the healing and improve the movement, other injuries and physical therapy."
},
{
  "instruction": "Hi, sir, there's a problem with your mouth, there's pain, there's swelling around, it's hard to eat properly, it's hard to say.",
  "input": "",
  "output": "The first step is to perform a complete physical skin test to determine the extent of the problem. You may need to do a resection or incision or drain based on the severity of the condition. You may also need to do a biopsy to understand the underlying cause."
},
{
  "instruction": "Sir, there's been a problem with eye alignment these days, especially when you're reading a book for long periods of time, and you're seeing things that look double and you often feel the blood of your eyes.",
  "input": "",
  "output": "With your symptoms, it is good to have your eye alignment impaired. It includes eye examinations and ear examinations to evaluate potential underlying problems. You may also need other diagnostic procedures, such as covering and counseling to better understand your history and other factors that can cause symptoms. If diagnosed, you may be able to treat such problems as eyelids, corneas, muscles, and other conditions, such as treatment."
},
{
  "instruction": "Doctor, I recently had a headache after a ureter perforation. What kind of test do I need?",
  "input": "",
  "output": "These include IV fluid replacement, CBC, blood test, electrolyte panel, glucose measure, kidney function, liver function testing, and so on."
},
{
  "instruction": "Doctor, there's been a lot of vomiting lately and it's hard to stand for, and a little bit of food makes you feel like you're doing it.",
  "input": "",
  "output": "The symptoms seem to indicate that there are pystic stenosis. To confirm the diagnosis, a few medical tests must be performed. First, we will order a blood test for radiation imaging, whole blood cells (CBC) and kidney functions. We will also need to check the electrolyte panel and glucose levels and replace the fluid with a vein."
},
{
  "instruction": "Sir, there's pain in your mouth and there's swelling of your salivary glands.",
  "input": "",
  "output": "To diagnose the condition, you need to do a physical skin test, a diagnosis, an evaluation, and a biopsy to test the infected area. You can also use a diagnostic procedure for nose, mouth and pharynx, and make sure that there are potential complications related to diabetes."
},
{
  "instruction": "Good morning, doctor, you have severe pain in your joints and stiff neck and back, and you feel your arms and legs going off and on and off.",
  "input": "",
  "output": "You need to perform some medical tests based on your symptoms. First, we will take a closer look at your joints and your spine through regular X-rays and radiation scans. Then we encourage physical therapy exercises that help reduce pain and stiffness. Then you need to examine your feet and perform other diagnostic procedures, including interviews and evaluations to evaluate your overall health."
},
{
  "instruction": "Sir, I got a bad knee injury last night while I was playing football, and I was in pain, and I couldn't lose weight, and what could be the problem and what tests would be needed?",
  "input": "",
  "output": "The symptoms suggest that you may have injured a knee joint, that you need to do a normal X-ray or magnetic resonance imaging, that you need to encourage splints, physical therapy, or other treatment procedures, depending on the extent of the injury."
},
{
  "instruction": "Doctor, I'm experiencing unusual symptoms such as fatigue, weight gain, and thirst increase, and I'm worried if I'm having an metabolic disorder.",
  "input": "",
  "output": "It's good to run some medical tests based on the symptoms. First you have to do a blood test, a lipid panel, a glucose measure, and a hemoglobin A1c measure."
},
{
  "instruction": "Hi, sir, there's an uncomfortable, stinky secretion that looks like it's got salinitis.",
  "input": "",
  "output": "In order to diagnose salinitis, you have to do a bone test and urine test. You also have to do a scan of the vaginal secretion, including standard pregnancy tests, chlamydia, breast tests, bacteria, horses, culture, and toxic tests."
},
{
  "instruction": "Doctor, you've recently been exposed to faintness, dizzyness, shortness of breath, and heart rate seems to be moving between speed and slow speed.",
  "input": "",
  "output": "Medical tests for diagnosis include E.K.G., ultrasound, cardiac ultrasound, and geostational panels."
},
{
  "instruction": "Doctor, over the last few weeks, I've heard a constant ringing in my ears, and I've been worried.",
  "input": "",
  "output": "All right, we need to do some tests to determine the cause of this name. We recommend eye and after-mouth diagnosis and treatment. We also need to do self-repair imaging. It may also help you to perform other diagnostic procedures for your ears, nose, mouth and throat."
},
{
  "instruction": "Sir, I'm suffering from eye pain and blurred vision, and I'm worried that it might be glaucoma.",
  "input": "",
  "output": "You may need additional medical procedures, such as eye diagnostics, glaucoma, glaucoma, and other internal treatments after initial evaluations, as well as ophthalmology and cataracts, as well as cataracts, eyelids, eyelids, and corneas to address the complications of the disease."
},
{
  "instruction": "Doctor, I think I've been having a diet disorder for a while, and I don't think my relationship with food is very healthy, and it's affecting my mental health, and I often find myself obsessed with weight and food intake, and I don't know how to stop it.",
  "input": "",
  "output": "I think it's helpful to get some medical tests to evaluate your condition, first of all, to help you solve the fundamental emotional problems that can contribute to food disorders through psychological and mental health counseling, and also to determine whether you need to treat mood disorders through screening of depression, through mental and psychiatric evaluation and treatment, to gain a more comprehensive understanding of your mental health."
},
{
  "instruction": "Doctor, yesterday I experienced a sudden weakness and paralysis on the right side of my body, and it lasted for a few minutes and then disappeared, and I also had a hard time talking for a while, so can you help me figure out what's going on?",
  "input": "",
  "output": "We'd like to run some medical tests to confirm the diagnosis, using radiation, blood test, CBC, X-ray computer scan, E.K.G., kidney function test, glucose test, and blood sugar levels."
},
{
  "instruction": "Hi, doctor, I think you're sick of strangulation, back pain, fever, chill, frequent urination.",
  "input": "",
  "output": "It's possible that it's new in the case of symptoms. You need to run some medical tests to check your diagnosis. You need to start with urine, blood, and a full blood count. You may also need to administer intravenous fluid supplements to treat infections. You may need to do a kidney scan and test for kidney function and blood sugar to see if the kidney is functioning properly."
},
{
  "instruction": "Hi, doctor, I think you've got a rotary muscle injury, and I'm feeling shoulder pain and stiffness.",
  "input": "",
  "output": "It's good to get a normal X-ray to eliminate bone-related injuries, as well as self-sensitivity imaging to assess the severity of the injury, and we can prescribe physical therapy that helps strengthen and restore the motorism of the affected shoulder."
},
{
  "instruction": "Doctor, I've been suffering from chronic pain a few months ago.",
  "input": "",
  "output": "I'm sorry, you need to run some medical tests based on the symptoms. First, you need to have some magnetic resonance imaging in the area to identify the cause of the pain, and then you need to do some physical therapy to make sure that you have a basilar disease that can cause pain. Finally, you need a physical therapy that can help relieve the pain. In the spinal canal, you need a catheter, a spinal stethoscope, or some other surgical procedure, or other surgical procedure that can be used to treat the pain."
},
{
  "instruction": "Doctor, there's been some problems during the recent pregnancy.",
  "input": "",
  "output": "To diagnose possible complications, you have to do a series of medical tests, and the first test you have to do is urinate. Patient: OK, what other medical tests do you need?"
},
{
  "instruction": "Sir, I've been feeling discomfort in my abdomen lately, and I think my skin is turning yellow, and I'm worried about whether it's a serious illness.",
  "input": "",
  "output": "The symptoms and the history seem to indicate that liver cancer is in doubt. We need a series of medical tests to confirm the diagnosis. Patient: What kind of medical tests do you need?"
},
{
  "instruction": "Sir, I've had a hard time breathing in the last few days, and I feel like I can't breathe, and I feel like I'm getting stuck in my chest.",
  "input": "",
  "output": "As a result of your symptoms, you need to do radiation scans to make sure that the lung tissue has broken down. You need to do multiple tests, such as normal X-rays (X-rays), blood test (c.C.C.), CBC (C.B.), X-ray computer scans, and E.K.G.D. scans."
},
{
  "instruction": "Sir, I'm really sorry about your hand injury. What test do you recommend?",
  "input": "",
  "output": "It's good to know the extent of the damage, based on a description of the damage, from radiation, which is also commonly called X-rays. You may need to do splints or suture wounds, depending on the results, and you may need to do physical therapy exercises to help you recover, and you may also need to evaluate the treatment of your work to determine whether or not you need language therapy."
},
{
  "instruction": "Doctor, I have severe pain in my upper right abdomen and back with nausea and vomiting.",
  "input": "",
  "output": "The medical tests required to determine the diagnosis of cytoplasm are blood tests, full blood cells, radiation tests, IV fluid supplements, kidney function tests, electrolytes panel, glucose levels."
},
{
  "instruction": "Hi, Doc, I think I hit my ass yesterday, and it hurts a lot and I can't move.",
  "input": "",
  "output": "I'm sorry, because of the symptoms, I recommend radiation imaging procedures, such as regular X-rays or X-rays, which can clarify hip damage. You can also do kidney function tests and I.V. fluid supplements if necessary. This may not require a CAT scan of the head, but may help to stabilize the hip and relieve the pain."
},
{
  "instruction": "Doctor, I've recently been very tired, and I've been feeling swelling and tenderness in my abdomen, and I've also had an ecliptic in my eyes, is that a liver problem?",
  "input": "",
  "output": "It's possible that it's a liver disorder, which is a liver disease, and in order to be diagnosed, you have to do a variety of medical tests, such as blood tests, cell count, blood sugar measurements, electrolytic panels, lipid panels, liver function, hemoglobin A1c measurements, and so on."
},
{
  "instruction": "Sir, I think she's got aortic aortic aneurysm.",
  "input": "",
  "output": "In order to diagnose the chest aortic aneurysm, you need to do a radiology test with your blood tests, your whole blood cells, your X-rays, your blood sugar measurements to check your glucose levels, your kidneys to check your function."
},
{
  "instruction": "Hi, I'm having a severe headache recently, and I'm worried if it's a serious disease.",
  "input": "",
  "output": "I'm sorry, we have to run some tests based on the symptoms, and we're going to do some radiation scans to make sure there's something wrong with the brain."
},
{
  "instruction": "Doctor, I've been diagnosed with congenital rubella. What medical tests do I need?",
  "input": "",
  "output": "You have to have a cornea transplant."
},
{
  "instruction": "Doctor, you've recently been diagnosed with diabetes retinal disease, and what kind of test do you need?",
  "input": "",
  "output": "In the case of diabetes retinal disease, you need to do eyelids, pericardial membranes, pericardial membranes, corneal membranes, retinal ruptures, retinal spurs, and other eye treatments, as well as in the case of retinal retinal disease."
},
{
  "instruction": "Doctor, I've had severe muscle pain, fatigue, sleep problems a few months ago, and I've done some research and I think it's fibromyalgia, so can you help me identify it?",
  "input": "",
  "output": "I'm sorry you're experiencing these symptoms. It's possible to have fibromyalgia based on what you're talking about. To confirm your diagnosis, you need to do a number of medical tests. This includes physical therapy exercises, self-sensitial imaging, other treatment procedures, breast imaging, breast cancer screening, other physical therapy, rehabilitation, bone density tests, and so on."
},
{
  "instruction": "Doctor, I have abdominal pain, and I think it's connected to bowel. Can you help me?",
  "input": "",
  "output": "You need to perform some medical tests to confirm your diagnosis: complete blood count, blood test for kidney function, glucose count, electrolyte panel, radiation imaging and CT scans."
},
{
  "instruction": "Doctor, I think my child has fetal alcohol syndrome.",
  "input": "",
  "output": "We recommend mental health counseling for both of you and your children, and we also need eye and teeth and diagnostics, and we can do a hemoglobin A1c test, but note that cornea transplants, spleens, and uterine removals may not be necessary for the diagnosis of fetal alcohol syndrome because they are treatment for other diseases."
},
{
  "instruction": "Doctor, in the last few days, I've had abdominal pain with the fever, and I'm afraid it's peritonealitis.",
  "input": "",
  "output": "I'm sorry, to check for peritonealitis, we need to do a bunch of medical tests, such as blood tests, radiation scans, CBCs, fluid supplements, X-ray computer scans, kidney function tests, and blood sugar measurements to check glucose levels."
},
{
  "instruction": "Sir, there's a sharp pain in his abdomen, I think he's injured.",
  "input": "",
  "output": "You need to run some blood tests to determine the cause of the pain. You need to do some radiation first. You need to do some blood tests, including CBC and hemolytic tests. You may need to do a scan to see more injuries. You may need to do urine and kidney function tests, depending on the outcome."
},
{
  "instruction": "Doctor, with nausea and vomiting, there's severe abdominal pain, and food digestion is not good.",
  "input": "",
  "output": "Symptoms suggest that acute pancreatic disease may be suspected. To check this, a series of medical tests must be performed. First, a blood test and an ICCCC test will be started and a radiation scan will be performed to determine the level of pancreatic disease. It may be necessary to provide supplements for intravenous fluid and test for kidney function and glucose levels. It also requires a urine test to determine whether a kidney is damaged or not."
},
{
  "instruction": "Doctor, I'm experiencing pain in my legs, swelling and rash.",
  "input": "",
  "output": "In the case of hemolytic I.V., you have to do an ultrasound and a radio scan to check for clots. You also need to use prothrombin analysis to check prothrombin time. You also need to use scar management and physical therapy to help restore leg movements."
},
{
  "instruction": "Doctor, you've been breathing and coughing and coughing lately, and I think you're asthmatic.",
  "input": "",
  "output": "To diagnose it, you need to do routine X-rays, bloodletting gases, spray treatments, other diagnostic procedures, such as stupefying, evaluation, flu virus antibodies, other respiratory treatments, and other diagnostic procedures for skin and substrate tissue."
},
{
  "instruction": "Sir, I think there's a foreign substance in the vagina.",
  "input": "",
  "output": "You need to remove it in non-operative ways to remove it. Before you do the removal, you need to test the bone marrow to determine the exact location of the substance. It's also important to take a standard pregnancy test to remove the complications of the pregnancy."
},
{
  "instruction": "Doctor, I can't sleep because I can feel my legs and I can't sleep at night.",
  "input": "",
  "output": "You know, you may have some anxiety syndrome. You need to book a few tests to check your diagnosis. Starting with interviews and evaluations, you will need to test your feet and perform your hemoglobin A1c tests. You may also need to test your blood pressure, your eyelids, your colon membranes, or some other treatment."
},
{
  "instruction": "Doctor, I've been breathing pretty recently and vomiting scissors, and I'm afraid it's a dissipation.",
  "input": "",
  "output": "OK, so I'm going to recommend a radiology scan to check this out, which includes regular X-rays for the lungs, or an X-ray computer scan (Scan Ct), and we need to run some blood tests to see if there's any infection."
},
{
  "instruction": "Hi, doctor, I've been experiencing headaches, seizures, anorexia in the last few weeks, and I think I've done some research and I think I'm a cystic fan.",
  "input": "",
  "output": "We need to do some tests to confirm the diagnosis: we need to take radiation scans, blood tests, glucose levels, CT scans or MRIs of the head to check the diagnosis."
},
{
  "instruction": "Doctor, I recently had induced abortion surgery, and my body is very weak and in pain.",
  "input": "",
  "output": "I'm sorry, I have to do some tests to make sure my body's getting better. I need to get a blood test, a whole blood count, a urine test, a standard pregnancy test. Patient: OK, what are these tests?"
},
{
  "instruction": "Doctor, my baby is very picky and irritable these days, and I think I'm having Igal's syndrome.",
  "input": "",
  "output": "We need to do a skin examination and some other diagnostics to check the diagnosis. Patient:"
},
{
  "instruction": "Doctor, in the last few days, there's been severe double-circuit strength, and it's also fevery, and it's very cold, and I think it's acute sinusitis.",
  "input": "",
  "output": "You need to do some diagnostic procedures to check your diagnosis based on your symptoms, and you need to analyze the CAT scan and influenza virus antibodies in your head to eliminate other diseases, and you need additional evaluations, and you need to consider other respiratory and physical treatments to improve your symptoms."
},
{
  "instruction": "Doctor, I'm experiencing some symptoms associated with von Hipel-Lindau's disease.",
  "input": "",
  "output": "All right, in this case, we need to make sure that we have a few medical tests, specifically self-sensitial imaging (MRI), full-body skin scan, S-synthesis, or colon endoscopy, and we need to start with a more invasive examination of the central nervous system, the resection, the diagnostic ureter, and the resection of skin lesions."
},
{
  "instruction": "Doctor, I'm experiencing anxiety and depression due to alcoholism.",
  "input": "",
  "output": "We first need to do some blood tests to make sure that there's something wrong with the blood, and we need to do a full blood count, and we need to do a urine test, and we need to measure glucose levels to check the function of the kidneys, and we need to do an EKG to check the function of the heart."
},
{
  "instruction": "Doctor, after giving birth to a baby, I feel very depressed and sad, and I can't get over it after a few weeks.",
  "input": "",
  "output": "I'm sorry, because of the symptoms you're talking about, you might want to check for post-ops and depression, and you might want to check to see if your physical health is in good condition through pelvis and urine tests, and it's important to check to see if there's no breast oil problems, and mental health counseling may help you deal with the emotional difficulties of post-ops."
},
{
  "instruction": "Doctor, I've been having chest pains and respiratory difficulties lately, and I'm afraid it's a serious disease.",
  "input": "",
  "output": "We're going to need to run some medical tests to determine the underlying cause of the symptoms. First, we're going to have to check the blood with blood tests, liposuction panels, and glucose levels, and then we're going to have to check the heart function with E.K.D., and finally we're going to have to check the hemoglobin A1c levels through hemoglobin A1c. Patient:"
},
{
  "instruction": "Hi, doctor, there's been a lot of back and back pain lately, I think you've got spinalitis.",
  "input": "",
  "output": "The first is to take regular X-rays or MRIs to make sure you understand your spinal status more clearly."
},
{
  "instruction": "Doctor, I've been having a persistent bilateral vision problem, and lately my vision has become blurry and I can't focus on things.",
  "input": "",
  "output": "The first test requires several medical tests to confirm the diagnosis. The first test is to take a self-synthetic image (MRI) to get a detailed image of the brain."
},
{
  "instruction": "Doctor, during the last few months, your period has been heavy and painful, and you've been having a bad urination, and you're suspected of uterine muscleoma.",
  "input": "",
  "output": "The tests include a series of medical tests to confirm the diagnosis of hysteroma, which include a hip test, a radiology procedure, CBC (CBC), a urine test, an ultrasound, a breast test and a standard pregnancy test."
},
{
  "instruction": "I don't know what's causing it.",
  "input": "",
  "output": "We need to do some medical tests to determine the cause of the symptoms. We need to start with a full blood count, a standard pregnancy test, urine test, pelvic and breast test, and we need to do an ultrasound test to see if there's something wrong with the reproductive system."
},
{
  "instruction": "Hi, doctor. I'm nervous because there's a lump in my right eyelid.",
  "input": "",
  "output": "Hi, I think we've got a collargeon. The best way to do this is to test and evaluate the eyelids, the periphery, the resection of the cornea, or any other treatment procedures. Depending on the results, you may recommend physical therapy or manipulation, or even a biopsy."
},
{
  "instruction": "Doctor, I think they're pre-diagnosed, and they're experiencing sudden, severe pain, nausea, vomiting in one hip.",
  "input": "",
  "output": "We need to do some medical tests to determine the diagnosis based on the symptoms, and we need to do some radiation tests, such as ultrasound, to find signs of pelvis, and we need to do some blood tests and urine tests, such as the total number of blood cells, to eliminate possible causes."
},
{
  "instruction": "Doctor, I recently had a problem with my eyesight, and I was diagnosed with high blood pressure a few months ago, and I'm worried that it doesn't affect my eyesight.",
  "input": "",
  "output": "It appears to be a retinal disease caused by high blood pressure, which is recommended to check the diagnosis and evaluate the damage. It allows you to test your eyes and detect abnormality or changes in the retina. You may also need to perform a different treatment procedure on the eyelids, the periphery, the corneas, the feet, and the hemoglobin A1c levels."
},
{
  "instruction": "Doctor, there's a great deal of itch and heat, and there's also a thick white secretion, and it looks like it's infected with yeast.",
  "input": "",
  "output": "We also need to do urine tests, standard pregnancy tests, and chlamydia tests."
},
{
  "instruction": "Doctor, I feel a lot of pain and tenderness in the back of my ear.",
  "input": "",
  "output": "You need to run some medical tests to confirm your diagnosis. First, you need to do X-ray scans, which are also called scan CT scans. You also need to do eye and ear diagnostics and diagnostics and treatments to better understand your status. You can also need head scans (Head Ct) and magnetic imaging (MRI)."
},
{
  "instruction": "Doctor, I fell from a high point of view, and I couldn't breathe, and I had a sharp chest pain.",
  "input": "",
  "output": "We need to do some medical tests to confirm the diagnosis. Patient: What kind of medical tests do we need?"
},
{
  "instruction": "Hi, sir, I've got pain in my toe, and I think it's because of my toenails.",
  "input": "",
  "output": "You need to be first tested to see if it's anendibular toenail, and then you need to resect or remove the toenail. You may also need to perform a wound management, incisions and drains if necessary, and you may recommend other diagnostic procedures, such as interviews and evaluations, to identify the underlying causes of endogenous claws."
},
{
  "instruction": "Doctor, I've recently had a bad breath and cough, and I'm always very tired.",
  "input": "",
  "output": "You may have been suffering from increased pulmonary oscillation. To confirm your diagnosis, you need to perform some tests, especially a routine X-ray procedure to evaluate the condition of your lungs. You also need to do some blood tests, including the CBC level, to analyze your blood cells. You may need to provide internal fluid supplements and an electrolyte panel to make sure that your body is functioning properly. Finally, you need to evaluate your kidney function with kidney function."
},
{
  "instruction": "Doctor, there's an open hip wound that doesn't heal, and it's been a few days, and the pain has gotten worse.",
  "input": "",
  "output": "Based on what you've described, it's good to start by making sure that there's bacteria, and it's good to do a full physical skin test to evaluate the extent of the injury, and you might need to close it or brace it, depending on the size of the wound, or if you suspect bone invasion, you might need to do a normal X-ray."
},
{
  "instruction": "Sir, your vision is getting blurry, especially at night, and things don't seem clear.",
  "input": "",
  "output": "You may also need to perform a different diagnostic procedure for the eye to determine the cause of the symptoms. The diagnosis may require other treatment procedures such as eyelids, perforation or corneal surgery, lens and cataract transplants, and cornea transplants."
},
{
  "instruction": "Doctor, I think I swallowed a little object, but I think I got it somewhere in the digestive tract.",
  "input": "",
  "output": "It is good to run a normal X-ray to check the location of the foreign substance according to the symptoms. You may need to do an esophageal dilation, a bronchoscope, an epidemiology, an epidemiology, and a tissue test, depending on the location of the foreign substance. You may also need to provide an I.V. fluid supplement and, if possible, a non-operative removal. In this case, you may need to consider an I.V."
},
{
  "instruction": "Doctor, your eyes are bloodied, you're in pain, you've affected your eyesight, and I think you've got eye infections.",
  "input": "",
  "output": "It's good to do an eye examination and evaluation to determine the degree of infection according to the symptoms. You can also do other treatment procedures that will help alleviate the symptoms, such as removing the eyelids, the peritoneal membranes, and the removal of skin lesions that can cause infection, and further understanding of the underlying causes of infection."
},
{
  "instruction": "Hi, doctor, there's a problem with digestion, and I don't think I can absorb the nutrients that I eat.",
  "input": "",
  "output": "To properly diagnose your condition, you need to do some medical tests, including full physical skin testing, interviews, evaluations, counseling, and other diagnostic procedures, as well as mental health counseling sessions to address psychological factors that can affect lipids and digestion to check cholesterol levels."
},
{
  "instruction": "Doctor, I suspect lead poisoning.",
  "input": "",
  "output": "The medical test for lead poisoning is to measure the amount of lead in the blood through a blood test and to scan the abdomen for damage caused by lead exposure rather than by bone marrow transplants that are not needed for lead poisoning."
},
{
  "instruction": "Doctor, there's a strange twist that doesn't go away on my skin, and it looks like a little clusters of rough skin -- viral warts?",
  "input": "",
  "output": "It is possible, yes, a viral wart. To verify the diagnosis, you must perform a complete physical skin test, and if it is greater or more persistent, you may have to remove or remove skin lesions. You may also need to perform a biopsy to confirm the diagnosis. If the wart is in a certain position, you may need an pelvic examination, or rectal examination. After the procedure, we provide a cure for the wound."
},
{
  "instruction": "Sir, whatever I do, I get a lot of sweat, and it's really uncomfortable, and I'm having trouble with my daily life.",
  "input": "",
  "output": "It's good to have a physical skin test to evaluate the severity of a multiple case according to the symptoms. You may need to perform other diagnostic procedures, such as interviews or counseling. In severe cases, you may need a resection or some other therapeutic nervous procedure, but because there may be a fundamental medical cause for multiple symptoms, you may need prostate specific antigen measurements."
},
{
  "instruction": "Doctor, I think I've had a stroke.",
  "input": "",
  "output": "I'm sorry, if you're considering the symptoms, you're going to need to run some tests first to see if there's a brain abnormality. You're also going to need to do a blood test, including a complete blood count. You're also going to need to do a scan to make sure that you know what's going on in your brain. You're also going to need to check your heart's electrical activity through an EKGG."
},
{
  "instruction": "Doctor, there's a lump of pain that looks like it's getting bigger and bigger in the ass.",
  "input": "",
  "output": "To diagnose and treat this, you need to repair wounds, complete physical skin examinations, incisions and dispersals, and make sure you have a rectal exam, grow a wound, and make sure you're infected, depending on the severity of the cyst."
},
{
  "instruction": "Doctor, I need some tests on my arm.",
  "input": "",
  "output": "God, in the case of a press injury, you must perform a normal X-ray to diagnose fracture or defibrillation. You may also need to use splints to fix the wound and repair the wound. If you have an open wound, you may need to perform a suture or incision or drain procedure. Finally, you may need to do a prothrombin test to check blood clotting."
},
{
  "instruction": "Doctor, I find it difficult to walk and balance, and I'm experiencing a bladder control problem and a back-up, and sometimes I'm experiencing memory loss and confusion, and what's wrong with me?",
  "input": "",
  "output": "You may have to do some medical tests to check your diagnosis and determine your best treatment options. You must first perform an MRI procedure and then perform some other diagnostic procedures, such as interviews, evaluations and counseling."
},
{
  "instruction": "Doctor, I'm losing a lot of hair in scalp and other body parts.",
  "input": "",
  "output": "You're worried, if you're going to be diagnosed with hair loss, you're going to have to do some tests first, and you're going to be able to remove the basilar disease through a lipid panel, which can result in other treatment procedures, such as local corticosteroids."
},
{
  "instruction": "Doctor, I think I'm suffering from hypothyroiditis, fatigue, hair loss, weight gain, dry, pale skin.",
  "input": "",
  "output": "You need to do a comprehensive evaluation based on your symptoms. First, you need to test your blood through a blood test, and then you need to do a full physical test to make sure that your skin is abnormal, and then you need to do a liposuction panel test to check your cholesterol levels, and then you need to do a biopsy and an ultrasound to find signs of inflammation or damage. Finally, you need to measure the hemoglobin A1c and check the correct treatment."
},
{
  "instruction": "Hi doctor, I have a lot of pain in my feet, and I feel very flat in my feet, and I don't know what's going on.",
  "input": "",
  "output": "Medical tests that are needed to determine whether a person is straight based on what God says, are foot examinations, normal X-ray scans, and complete physical skin tests. They can also relieve the symptoms of flat feet with physical treatment exercises, but there is no need for any other non-healthmetic procedures on the rectal and skeletal system."
},
{
  "instruction": "Doctor, you've recently had abdominal discomfort, and you've been feeling fatigued, and it looks like you've got non-alcoholic liver disease.",
  "input": "",
  "output": "To accurately diagnose NASH, you need to run some medical tests, starting with basic blood tests and cBCs to make sure that the blood is abnormal, and then check glucose levels and lipids to see how they affect your system. Finally, to make sure your body is functioning properly, you need to do a scan of the C.T. to make sure your liver is clear."
},
{
  "instruction": "Doctor, your joints are swollen, and especially your knees are in pain, and when you touch them, you feel soft and limited in movement, and it's like sedimentary arthritis.",
  "input": "",
  "output": "I'd like to order a series of medical tests based on the symptoms, including a routine X-ray procedure to check if there's something wrong with the joints, and I might need to perform other treatment procedures, such as joint gypsum, which is to extract excess fluid from the joints."
},
{
  "instruction": "Sir, I think I have a fracture in my arm.",
  "input": "",
  "output": "It's good to do a normal X-ray scan to check the fracture. If the fracture is clear, you can support the fracture and perform physical therapy through a splice or an orthopedic cast. You may also need to take a retraction, extra splint, or a wound, if necessary, but you don't need a head CT scan because you have an arm injury."
},
{
  "instruction": "Doctor, I've recently experienced excessive bleeding in minor injuries, and I'm worried if I'm having a clot problem, and what tests do I need to do to make sure that I don't have a clot?",
  "input": "",
  "output": "You need to run multiple tests based on your symptoms. You need a comprehensive blood test, including CBC. You also need to measure glucose levels, evaluate electrolyte panels, and perform kidney function tests. You also need to do prothrombin analysis to measure blood clotting. If your condition is severe, you may need to implement an I.V. fluid replacement therapy."
},
{
  "instruction": "Doctor, I've been experiencing severe scalp nausea in the last few days, and I'm dizzy, and I don't really fit my eyes, and what's the cause?",
  "input": "",
  "output": "There's a possibility that there will be two internal bleedings to check, including radiation scans, X-ray scans, blood tests, whole blood cells, head CAT scans, kidney function tests, and so on."
},
{
  "instruction": "Doctor, I've recently had a lack of energy and fatigue and a lot of muscle spasms, and I've also had a little bit of chest palpitation.",
  "input": "",
  "output": "You need to do some tests to check for a high potassium hemolytic diagnosis and determine the severity of your condition. This includes a blood test, a whole blood count, an EKG, and an electrolyte panel. You can also use a kidney test to check the function of the kidney, and a radiation scan to find the underlying cause."
},
{
  "instruction": "Doctor, in the last few days, your eyes have been so hot, you've got a lot of blood, you've got an infection in your cornea, so what do you do?",
  "input": "",
  "output": "The symptoms suggest that there may be an infection in the cornea; in order to diagnose and treat it, you have to do a comprehensive eye examination, an eye examination, and an examination and evaluation; in addition to the eyelids, the pericardium, or the cornea, you may need to perform other treatment procedures; in severe cases, you may need to have an cornea transplant."
},
{
  "instruction": "Sir, there's been a lot of chest pain and respiratory problems recently, I think there's a lung abscess.",
  "input": "",
  "output": "To check your diagnosis, you need to do a C.T. scan, X-rays, and you need to start an I.V. fluid replacement, and you need to do some other therapeutic neurosurgery, you need to monitor your heart and prescribe a physical therapy exercise to help you recover."
},
{
  "instruction": "Doctor, high fever, severe headache, joint pain, I'm worried if I have dengue.",
  "input": "",
  "output": "We need to do a blood test called a blood test to see if it's dengue."
},
{
  "instruction": "Hi, sir, there have been times when it feels like there's something in your ear that's been bothering you and is sometimes blocking your ears.",
  "input": "",
  "output": "In order to identify and treat the diagnosis, I would recommend the ophthalmology and ophthalmology and treatment. To determine the severity of the disease, you need to perform other diagnostic procedures and procedures to eliminate growth, such as diagnosis, evaluation and counseling."
},
{
  "instruction": "Sir, there's abdominal and abdominal ovulation, and sometimes you feel nausea and vomiting, and you have toilets, and you don't have gas.",
  "input": "",
  "output": "We need to do a series of medical tests, such as CBC, blood test, radiation, kidney function, electrolyte, glucose test, glucose levels, and an abdominal x-ray (X-ray line)."
},
{
  "instruction": "Sir, when I was playing soccer, I accidentally injured my finger, my fingers were so sick that I couldn't move properly.",
  "input": "",
  "output": "You need to take a radiology scan or a general X-ray to make sure that there are fractures or bone damage in the area. You also need to use the splint to fix your fingers and improve your healing. You may need to repair the wound and close the wound to prevent infection. You may need physical therapy to restore the function of your fingers according to the extent of the injury."
},
{
  "instruction": "Doctor, after taking analgesics because of your headache, your body hurts, and it's like you've eaten too much, and you don't feel good, and your stomach hurts.",
  "input": "",
  "output": "You're going to have to do some tests to check your body's response to your medication, to test your blood test, your whole blood count, your kidney function, your urine test, your IV fluid replacement, your electrolytes panel, your glucose levels, and so on."
},
{
  "instruction": "Doctor, I've been feeling irregular heart rate, shortness of breath, fatigue a few days ago.",
  "input": "",
  "output": "It's possible that you may have heart fibrillation based on your symptoms. To find out, you need to perform some medical tests. Blood tests, E.K.G., CBC, blood sugar measurements, electrolytic panels, IV fluid supplements, and cardiac enzyme measurements."
},
{
  "instruction": "Doctor, I think I'm infected with the urethra, and it's all around the anus.",
  "input": "",
  "output": "In the case of the ureter infection, a medical test is a rectification test. You need to check the area to identify the diagnosis and the extent of the infection. Other diagnostic procedures for skin and substubation, as well as erythema and treatment, cornea transplants, removal of the spleen, removal of the uterus, and organ incisions are not needed to treat the infection effectively with drugs."
},
{
  "instruction": "Doctor, you can't urinate, and sometimes your urine stem is weak, and I think you have a problem with your urethra valve.",
  "input": "",
  "output": "You must also perform urine tests and ultrasound tests to determine the severity of the condition. X-ray computer scans are another test that we can perform. You must also perform various diagnostic procedures such as interviews, evaluations and counseling to understand the disease."
},
{
  "instruction": "Doctor, you've had a cut in your neck, and it's been a long time, and you're starting to get infected, so what do you do?",
  "input": "",
  "output": "We encourage you to do skin tests based on your symptoms, remove the wound from the chest and remove the infected area if necessary, and we can take a microscope test of the wound to identify the bacteria or the toxic cause and use special scar techniques, such as nuts or splints, to treat the wound."
},
{
  "instruction": "Hi doctor, I'm having trouble swallowing and I feel like I've got my food on my neck, and I'm experiencing chest pain, and I'm feeling sore, and you think there's a problem with your esophagus?",
  "input": "",
  "output": "There may be a disorder that affects the esophagus muscle, i.e., in order to check it, you need to perform a radio-film test, such as a barium cube or an esophageal pressuremeter. You also need to do regular X-rays, CBC, heart enzymes, and a kidney function test to make sure you have any other base problems."
},
{
  "instruction": "Hi, doctor, there have been symptoms that you don't hear very well recently, especially when there's a lot of noise around you, and you don't seem to hear as clearly as you used to.",
  "input": "",
  "output": "It is good to evaluate your eyes and ears to determine the cause of hearing loss, as well as other diagnostic procedures, such as interviews and counseling, and to take a closer look at your ears if necessary, and you may also need to perform some treatmental treatment, such as language treatment or other treatment procedures."
},
{
  "instruction": "Doctor, I recently had abdominal problems, and when I pick up a heavy object, I feel the lower part of my abdomen swell, and sometimes it causes discomfort and a little bit of pain.",
  "input": "",
  "output": "The symptoms suggest that there is an abdominal hernia. To check this, it is recommended that you perform a physical dental examination (ML) and an X-ray computer scan (Scan Ct). You may need to treat injuries or other hernias according to the results. You may also need to perform a pelvic examination and other diagnostic procedures (openness, evaluation, counseling) to determine the severity of the hernia."
},
{
  "instruction": "There's cerebral palsy, and there's a problem with motor ability, especially walking and coordination.",
  "input": "",
  "output": "To diagnose cerebral palsy and provide adequate treatment, you need to do some tests. This includes physical therapy exercises to enhance exercise and cognitive capacity. You also need to do other diagnostic procedures, such as evaluations, counseling and interviews to understand the level of the state. You may need to evaluate the work care and treatment of speech to help the language and the ability to communicate."
},
{
  "instruction": "Doctor, I think we have a problem with the abuse of marijuana.",
  "input": "",
  "output": "I'm sorry, you have to start with mental health counseling and psychological therapy based on what you're saying, and you have to do urine tests, psychological and psychiatric evaluations, and treatment, and toxic tests."
},
{
  "instruction": "Doctor, I've been suffering from eyelids and fatigue lately, as well as HlV infection, and I think I've got kryptokocus.",
  "input": "",
  "output": "OK, we need to do some tests to check the diagnosis, first of all, to check the glucose levels, and then we need to run a comprehensive blood test to evaluate the overall blood health, and then we need to run a visual test to evaluate potential eye problems. If necessary, we can encourage physical therapy to improve muscle strength and mobility."
},
{
  "instruction": "Doctor, I'm worried about my weight, because I'm so fat lately, and I'm very uncomfortable.",
  "input": "",
  "output": "I understand that obesity can cause serious health problems, so you have to evaluate your condition with some medical tests. First, you have to measure your blood count, and your lipometers, which are called Cholesterol levels, and you have to measure your glucose levels to see if you have diabetes."
},
{
  "instruction": "Doctor, your abdominal pain continues and your food digestion is not working. What medical tests would you recommend?",
  "input": "",
  "output": "Depending on the symptoms, I recommend a series of medical tests, such as blood test, CBC, urine test, glucose test, electrolyte, kidney function, and EKG."
},
{
  "instruction": "Sir, I'm experiencing a lot of trouble and a lot of chest pain, and I think it's endocardial cancer.",
  "input": "",
  "output": "I'm sorry, but to confirm the diagnosis, we need to do some medical tests, including blood tests, CBCs, radiation scans, blood sugar measurements to check glucose levels, CT scans for X-ray computers, panels for transmissions, and body skin tests (ML)."
},
{
  "instruction": "Doctor, it's hard to breathe and cough a lot, and I feel frustrated and frustrated.",
  "input": "",
  "output": "In order to understand the underlying cause, you have to do a series of medical tests, including such radiation tests as blood cells, kidney function, glucose measurements, normal X-rays, and blood tests and E.K.G. tests to evaluate heart function."
},
{
  "instruction": "Doctor, for a while ago, you've had knee, wrist, ankle pain, joint pain, stiffness, swelling.",
  "input": "",
  "output": "You're probably suffering from juvenile rheumatoid arthritis, and you need to do some medical tests to confirm your diagnosis, so medical tests are blood tests, whole blood cells, urine tests and glucose measurements."
},
{
  "instruction": "I've got scales on my face and my arm, and I'm worried that I'm going to be in pain, and I'm going to be in pain, and I'm going to be in pain, and I'm going to be in pain, and I'm going to be in pain, and I'm going to be in pain, and I'm going to be in pain, and I'm going to be in pain, and I'm going to be in pain, and I'm going to be in pain, and I'm going to be in pain, and I'm going to be in pain, and I'm going to be in pain, and I'm going to be in pain, and I'm going to be in pain.",
  "input": "",
  "output": "According to your client's description, it's good to make sure that you have full evaluations of that area through a skin and a specialist's scan, and then you might need to perform a biopsy and other diagnostic procedures on skin and substrate tissue, which may require resecting of skin lesions or other procedures, depending on the severity of the damage."
},
{
  "instruction": "Doctor, I've had ear pain and fever in the last few days, and sometimes I feel dizzy.",
  "input": "",
  "output": "You need to perform full physical skin testing, interviews and evaluations to confirm your diagnosis, as well as eye examinations, as well as other therapeutic ear procedures, as well as ophthalmology and diagnostics, as well as respiratory and endocrinosis (including endocrinosis)."
},
{
  "instruction": "Sir, it's hard to see an object at a distance or close to it, and it looks blurry and distorted.",
  "input": "",
  "output": "You need to evaluate your vision according to the symptoms, and then diagnose your vision, and also diagnose your vision, as well as your eye condition, which may be a cause of difficulty, and your diagnosis and treatment. You can also perform eyelids, membranes and other treatment procedures, as well as other muscle and eye treatments, to alleviate the symptoms. You may also need to evaluate the anatomy of the eye and diagnose other eye disorders, as well as other radiation-related techniques."
},
{
  "instruction": "Doctor, I have a seizure, and I have a little tumor on my skin, and I'm worried about my health.",
  "input": "",
  "output": "I'm going to recommend some medical tests based on your symptoms. First, you need to do some blood tests, such as the CBC, to check your overall blood health. You also need to take a self-synthetic image (EEG) to see if it's a tumor. Finally, you can do an EEG to measure the abnormal brain activity that causes seizures."
},
{
  "instruction": "Doctor, severe chest pain and difficulty in breathing, coughing, diagnosed with pneumonia a few weeks ago and treated with antibiotics, but the symptoms didn't improve.",
  "input": "",
  "output": "In view of your symptoms and your history, it is possible that there may have been some complications, such as abscess. To check this, you need to do some tests, including radiation scans such as regular X-rays, scan CTs, kidney function, and so forth. You may also need to check heart enzymes and electrolytes panels. In the meantime, you need to begin to supplement your veins to compensate and improve your breathing function."
},
{
  "instruction": "In recent years, my hearing has dropped, and I don't understand very well what people are saying.",
  "input": "",
  "output": "You also need a diagnostic procedure for your nose, mouth, and pharynx. You may need another treatment procedure to treat your condition. You may need to perform a biopsy to eliminate base diseases, but removal of your cornea, spleen, and extrauterine pregnancy is not related to loss of hearing and is unnecessary."
},
{
  "instruction": "Hi, doctor, I think you're having a newborn escarpment, and your skin looks yellow.",
  "input": "",
  "output": "We need to run some medical tests to diagnose, first complete physical skin tests and then check the blood count of the Billy Rubin in the blood. And then we need to do interviews and evaluations and rectal tests. Finally, we need to examine the eyes and the feet and perform a different procedure as needed."
},
{
  "instruction": "Doctor, I've had a good breath for a while, and I've been coughing, and I've got a lot of spades, and I'm worried if you've got a chronic closed lung disease.",
  "input": "",
  "output": "You need to run some medical tests to determine if there is a chronic closed lung disease based on the symptoms. First, you need to perform a normal X-ray to check for lung abnormality. You also need to perform a complete blood count and a few blood tests. You need to have an EKG test to make sure your heart works. You also need to make sure your organs work through glucose levels and kidney function."
},
{
  "instruction": "Sir, I fell down and my elbows were broken. What kind of tests do I have to undergo for treatment?",
  "input": "",
  "output": "You need to do a routine X-ray procedure to check the level of the dislocation. You also wear splints to support your elbow joint. You can also recommend physical therapy exercises to help you recover as part of your treatment. You can also use orthopedic casts if necessary."
},
{
  "instruction": "Doctor, I've had back pain in the last few weeks.",
  "input": "",
  "output": "I'm sorry. I'd like to offer you a dose of radiation based on your symptoms. Patient: What do you do?"
},
{
  "instruction": "Doctor, there's a throat high, there's a little blister in the back of the mouth, and what's the problem?",
  "input": "",
  "output": "It's good to run a full skin test and see if the virus exists through a blood culture test."
},
{
  "instruction": "Sir, I fell when I was playing basketball, and I think I got a shoulder injury, and when I move, it hurts a lot, and I can't lift my arm up my head.",
  "input": "",
  "output": "It's good to evaluate the level of injuries based on symptoms, such as normal X-rays and magnetic resonance imaging, and also physical therapy exercises and splints for recovery, and other treatment procedures or non-operative options for the skeletal system."
},
{
  "instruction": "Doctor, I've been very sick lately, and I think it's an antidepressant, and I've experienced nausea and nausea and I've been sick a lot.",
  "input": "",
  "output": "Depending on the symptoms, blood test, E.K.G., full blood count, kidney function test, IV fluid replacement, urine test and toxic test, a number of medical tests should be performed."
},
{
  "instruction": "Sir, there's an open leg wound, and I think it's infected.",
  "input": "",
  "output": "Right, if you want to handle the wound properly, you have to do a series of medical tests, such as wound management, blood testing, complete physical skin testing, glucose measure, blood culture and wound culture, and you can also consider the techniques of sedation, spores and other injuries to help heal the wound."
},
{
  "instruction": "Doctor, I've had swelling and pain in my legs over the last few days, and I'm worried that I might be having a heart vein thrombosis.",
  "input": "",
  "output": "I'm sorry, we have to run some tests based on the symptoms, first check for blood tests, complete blood count, and radiation to make sure the leg has a clot. We also have to measure glucose levels, check electrolyte panels, and run kidney function tests."
},
{
  "instruction": "I recently felt extremely weak and my muscles didn't develop as they used to, and I'm tired most of the time.",
  "input": "",
  "output": "It's possible that you're experiencing some protein deficiency based on your symptoms. To see this, you need to run some medical tests. You need to run blood tests, urine tests, cBCs, and measure glucose levels. You can also need to run electrolyte tests and start supplements of intravenous fluids as part of the treatment. You can also reserve sessions that will help you deal with the emotional effects of disease."
},
{
  "instruction": "Doctor, you're having sudden muscle spasms and spasms in your arms and legs.",
  "input": "",
  "output": "To diagnose and eliminate other disorders, X-ray computer scans (Scan Ct), magnetic resonance imaging (MRI), kidney function testing (ML), brainwave testing (EG), and other diagnostic procedures (insults; evaluations), are recommended."
},
{
  "instruction": "Doctor, I've been told that there's a lot of pain in the heel of your foot that could cause bone rashes. What medical tests do you need?",
  "input": "",
  "output": "To assess the severity of the condition, you have to do a radiofilming, including a general X-ray of your foot. You may also have to propose physical therapy campaigns to do physical therapy, if necessary, to relieve pain. In severe cases, bone density scans can be recommended to eliminate or eliminate bone rashes. Finally, you may recommend a vaccine to prevent infection or complications during surgery."
},
{
  "instruction": "Doctor, I've recently experienced excessive bleeding and bruises, and my mother has a bleeding disorder, and I think it's von Vilebrandt's disease.",
  "input": "",
  "output": "You can do a blood test and a CBC test based on your symptoms and your family history, and you can do other diagnostic procedures, such as hemoglobin A1C measurements, liposuction panels, interviews, evaluations and counseling."
},
{
  "instruction": "Sir, your back hurts because it doesn't heal properly. Can you help me?",
  "input": "",
  "output": "You need to perform a full physical skin examination and repair of the wound to determine the best treatment. Then you can take a normal X-ray to see if there is bone damage. You can close the wound or remove it through a resection if necessary. You can also resort to home-hescare service for continued treatment. Finally, a CT may be needed to determine the extent of the injury."
},
{
  "instruction": "Doctor, I've been feeling very confused and powerless lately, especially when I'm physically active, and I feel very good breath and chest pain, and I think I'm having a heart problem.",
  "input": "",
  "output": "We need to run some tests to determine the cause of the symptoms. First, we need to remove the heart from the heart through an EKG test."
},
{
  "instruction": "Doctor, I've had some uncomfortable symptoms for a while, and I've been bleeding out of the stool, and I think I have a colonoma, and what kind of test do I need?",
  "input": "",
  "output": "If you want to be sure you're in the right state, you need to do an S-term test or colonoscopy. Then you need to make sure that the tissue is positive or cancer. You may need to re-invasion the colon and biopsy with the results, or you may need to do a rectal exam or some other sub-administal procedure to assess the risk of diabetes complications."
},
{
  "instruction": "Doctor, I'm not always strong, I'm tired, and my muscles are getting worse these days.",
  "input": "",
  "output": "Are you eating well and maintaining a balanced diet? Patient: Yeah, I try to eat as much as I can, but I think something's wrong."
},
{
  "instruction": "Hi doctor, I tried to get pregnant for a while, but I'm not pregnant.",
  "input": "",
  "output": "I recommend that we identify the cause of the difficulty with radiation scans, blood tests, ultrasound, pelvis, other non-healthal procedures for female organs, breast tests, standard pregnancy tests, and so on."
},
{
  "instruction": "Doctor, there's been a recent chest pain and respiratory difficulties, and the attending is suspected of heart disease, and what test do you need to do to confirm this diagnosis?",
  "input": "",
  "output": "You also need to do an E.K.G. test to evaluate the condition of the heart and surrounding tissue, such as CT scans or MRI. You also need to do an E.G. test to evaluate the electrical activity of the heart. You also want to order some blood tests, including the CBC and the readings of the heart enzymes to make sure that the heart is infected and damaged. Finally, you can get more information from regular X-rays, which can affect the kidneys."
},
{
  "instruction": "I don't think it's going to be very well.",
  "input": "",
  "output": "In ADHD, you can typically start with psychological and mental health counseling, and you can also run a depression test to eliminate fundamental problems, which can help you to evaluate psychological and psychological and speech treatments, and you can also consider brainwaves to evaluate brain activity, and in some cases you may need to do brain arteriosclerosis."
},
{
  "instruction": "Doctor, I'm experiencing blindness in one eye, weakness in muscle, paralysis in the limbs, and the doctor said that it could be a cytoplasm.",
  "input": "",
  "output": "You need to perform several tests to check for optics. First, you need to run a blood test or a blood test to check for immunological abnormality. You also need to perform other diagnostic procedures, such as interviews, evaluations and counseling to make sure that there are lesions in the brain and spinal cord. You also need a radiology procedure to test the bone system."
},
{
  "instruction": "Sir, I think there's something wrong with the heart valve, and there's a lot of breathing and chest palpitations.",
  "input": "",
  "output": "We need to do some medical tests to determine the exact state of the heart valve, and we need to get a clear understanding of the problem of EKG, radiation, cardiac ultrasound, and ultrasound, which may require heart valve surgery or physical therapy, depending on the severity of the problem."
},
{
  "instruction": "Doctor, I can feel chest tenderness in the upper part of my chest, and I don't know what's wrong, and I'm very worried.",
  "input": "",
  "output": "I would like to run a radiation scan to test the top of the chest more closely according to the symptoms. This may include regular X-rays (X-rays) and an EKG test to evaluate the electrical activity of the heart. It is also recommended that you perform a CBC test (CBC), a kidney function (kidney function), and a glucose test (lexometers) to evaluate the potential base disease that can cause the symptoms."
},
{
  "instruction": "Hi, doctor, your facial muscles are getting weaker and you're experiencing abdominal symptoms, and your eye movements are affected.",
  "input": "",
  "output": "To confirm this diagnosis, a series of medical tests will need to be performed, as well as self-sensitial imaging (MRI) tests to see if there is any damage to the brain's nervous system."
},
{
  "instruction": "Hi, doctor, I fell down the stairs yesterday and I hurt my arm, and since then I've been so sick that I can't move properly.",
  "input": "",
  "output": "I'm sorry, because of the symptoms, it's good to do a radiation scan to see if there's any damage to the bones of the arm."
},
{
  "instruction": "Hi, doctor, I'm experiencing such strange symptoms as sudden blindness, paralysis and tremors, what do you think causes these symptoms?",
  "input": "",
  "output": "You've got to do some tests to figure out the underlying cause. You've got to do a CBC test first to eliminate infections and other blood problems. You've got to do X-ray computer scans and self-sensiculating scans (MRI) to make sure there's something wrong with your brain."
},
{
  "instruction": "Hi doctor, I've been experiencing pain and swelling in my hands and feet lately, and it's really painful and I don't know what's going on.",
  "input": "",
  "output": "There may be multiple pain syndrome, depending on the symptoms. To diagnose this condition, a series of medical tests has to be performed. These tests involve magnetic resonance imaging imaging (MRRI), physical therapy to help reduce pain and swelling, and other diagnostic procedures to evaluate symptoms and disease, as well as advisation (reviewing, counseling, counseling) to test for lower health problems that can cause symptoms (ac1 of hemoglobin), hemoglobin (AC1) and other foot problems, including CI, as well as other complications."
},
{
  "instruction": "Doctor, I'm experiencing loss of hearing, and I'm often dizzy, and I went to an I.V. specialist, and I was diagnosed with S.I.E.T., which medical test do I need?",
  "input": "",
  "output": "As a result, you will need to resect infected bones, but if your vision is impaired by the disease, you may need a cornea transplant."
},
{
  "instruction": "Doctor, I fell on my bike and hurt my body. I'm in severe pain.",
  "input": "",
  "output": "This may include regular X-rays, X-ray computers, single-story scans, or CAT scans of the head."
},
{
  "instruction": "Hi, doctor, I've recently grown a little bit more weight, even though I've been very tired and weak, and I haven't changed my diet, and I don't know what's wrong.",
  "input": "",
  "output": "Symptoms may indicate lower thyroid function. To confirm this, several tests must be performed. First, we recommend blood tests, liposuction panels, and blood sugar measurements. We will also perform complete physical examinations, including skin tests and breast tests. Finally, there may be a need for diagnostic procedures such as interviews, evaluations or counseling with specialists. We will begin these tests immediately so that you can find the best treatment for you."
},
{
  "instruction": "Hi, doctor, I've been having trouble sleeping for the last month, and it's hard to sleep, and I often wake up at night, and I think it's primary insomnia.",
  "input": "",
  "output": "Your symptoms suggest that you are suffering from primary insomnia. You need to do interviews and evaluations to check your diagnosis. Mental and mental health counseling can help you treat your symptoms."
},
{
  "instruction": "Doctor, I've got a very scary scalp case, and I found a little bug going around, and I think there's a tooth, and what medical test do I need?",
  "input": "",
  "output": "You also need to do a full physical skin test on the scalp to determine the exact type of infection. If necessary, the incision and drain removal will also help assess the severity of the infection and help determine the urgency of the treatment."
},
{
  "instruction": "Doctor, I'm not strong these days, I'm tired, my hands and feet are a lot, and I think I'm out of vitamin B12.",
  "input": "",
  "output": "Symptoms indicate that there may have been a lack of vitamin B12. To verify this, you need to run a series of medical tests. You need to do a blood test, a CBC, a liposuction panel, and a hemoglobin A1C test. You also need to do a breast test, and a magnetic resonance imaging (MRI) test. These tests help determine the correct diagnosis and proper treatment."
},
{
  "instruction": "Hi, I'm afraid you've recently had severe thirst, frequent urination, fatigue, blurred vision, and diabetes.",
  "input": "",
  "output": "Hi, in order to diagnose diabetes, you need to do some medical tests. First, you'll measure the hemolytic blood cell count, and then you'll do a hemolytic hemolytic pigment, and then you'll do a liposuction panel test to check the cholesterol level."
},
{
  "instruction": "Doctor, there's been a lot of severe pain in the throat for quite a while.",
  "input": "",
  "output": "However, a few medical tests have to be performed to check the diagnosis and eliminate the basilar disease, and a medical test required to test the urine, the blood, the radiation, the CBC, the pelvic, the standard pregnancy, the kidney function, and so on."
},
{
  "instruction": "Hi, doctor, I've been having severe abdominal edema for a while, and I look up the Internet and I think I have endometriosis.",
  "input": "",
  "output": "Symptoms suggest that you may have endometriosis. To confirm your diagnosis, you need a few medical tests: a hip test, a urine analysis, an ultrasound; a standard pregnancy test, and a mastectomy. If you find endometriosis in these tests, you may need to perform a resection. You may need a rectal examination to see if there are signs of endometriosis in the area."
},
{
  "instruction": "I'm experiencing a doctor, a joint pain, an unknown fever, fatigue, weight loss.",
  "input": "",
  "output": "In the case of angiosclerosis, we encourage you to do a physical skin test, a wound management, an ultrasound, a liposuction panel, a heart ultrasound, a hemoglobin A1c measurement, and some other diagnostic procedures, which help you understand your condition better and determine the best course of treatment."
},
{
  "instruction": "Sir, I hit my head while I was playing football, and I have a case of dizziness, headaches, and blurred vision.",
  "input": "",
  "output": "We'd like to run a radio scan, such as X-ray computer scan or head computer scan, and we might need to monitor the vital signs through cardiac monitoring, and we might need to do an I.V. fluid replacement, depending on the severity of the injury."
},
{
  "instruction": "Hi, doctor, there's a white spot in your mouth for a while, and I'm afraid it's oral vitiligo.",
  "input": "",
  "output": "Hi there, there may be oral vitiligo, and in order to diagnose this condition, you need to do some tissue tests on the area. You may need a different treatment for your nose, mouth, and pharynx to treat the results of a biopsy. However, prostate specific anti-respiratory measures, prostate removal, cornea transplants, spleen surgery, and other medical tests, such as deuterine oscillation, are not associated with the case."
},
{
  "instruction": "There's a couple of symptoms that seem to have something to do with the kidney, the doctor, that are always tired, your appetite is falling, your feet and ankles are swelling.",
  "input": "",
  "output": "A series of medical tests to see if this is true. These include blood tests, such as the number of whole blood cells, blood sugar measurements to check blood sugar levels, urine tests to check kidney function, electrolyte panels to check your body's salts and minerals, lipocardial panels to evaluate cholesterol levels, and hemoglobin A1c measures to assess overall blood sugar control."
},
{
  "instruction": "Doctor, I'm having a problem with my eyesight, and I recently got a diagnosis of choroiditis, and what medical test do I need?",
  "input": "",
  "output": "You also need to have eyelids, perforations, and other treatments for corneas and corneas. If the disease affects hearing, you may need to do this, and if there's a lesion in the retina and the choroid, you may need a destructive procedure."
},
{
  "instruction": "Doctor, I think I'm a fellow Witness, and the erection doesn't go away for hours, and it's very painful.",
  "input": "",
  "output": "Unfortunately, it's good to run some medical tests based on the symptoms, do some blood tests, complete blood count and urine tests, and measure the urology and insert a catheter into the bladder."
},
{
  "instruction": "Doctor, I've been experiencing muscle weakness for a while, and the doctor said that it might be muscleitis, which medical test do you need?",
  "input": "",
  "output": "In order to manage the symptoms of myocarditis, you need to perform a psychiatric test and do physical therapy, and you need to manage the wound with magnetic resonance imaging imaging (MRI) and bone density scans to determine the level of muscle damage."
},
{
  "instruction": "Doctor, over the last week there's been severe fatigue and persistent backaches.",
  "input": "",
  "output": "You need to run some blood tests, including CBC (CBC) and blood tests to confirm your diagnosis, as well as test kidney function, electrolyte panel, liver function, blood culture, and fluid replacement in your veins."
},
{
  "instruction": "Sir, I've had a lot of pain in my nerves lately, and sometimes I feel like I've been electrocuted and sometimes I feel like I'm burning, and I'm getting a lot of trouble in my daily life.",
  "input": "",
  "output": "In view of your symptoms, it might be good to take a closer look at your body and take a look at self-sensitivity imaging (MRI). You may also need to do some other diagnostic procedures, such as physical therapists, interviewing, evaluations and counseling, to understand your situation better. You may need to consider a catheter or a chiropractic implant, depending on the severity of your condition."
},
{
  "instruction": "Sir, there's a lot of pain in the back and the side, and I've noticed that the urine color has increased, and I'm worried if there's a multiple kidney disease.",
  "input": "",
  "output": "So to check for multiple kidney disease, you have to do a bunch of medical tests, such as urine tests, radiation, blood tests, CBCs, X-ray computer scans, scan scans, ultrasounds, and blood sugar levels."
},
{
  "instruction": "They're suffering from mania and depression, and mood change is affecting everyday life.",
  "input": "",
  "output": "We recommend psychological and psychiatric evaluations and treatment based on the symptoms, as well as testing depression and toxicology to eliminate other fundamental problems that cause mood change, and working care and mental health care can help you manage your symptoms in the long run."
},
{
  "instruction": "Doctor, I'm worried that there's something wrong with you because you're not feeling strong these days and you're feeling very tired.",
  "input": "",
  "output": "First, let's start with some tests to see what's going on. Have you ever been diagnosed with amoloids?"
},
{
  "instruction": "Doctor, I've had a long time since my arms and legs were so weak and sore, and sometimes it's really hard to stand up and even walk properly, and I have a hard time catching things.",
  "input": "",
  "output": "You may have CIDP (CIDP). To verify your diagnosis, you need to run some tests. First, you need to run a blood test and a CBC test to determine if there is any damage to the brain activity and to determine if there is any nerve damage. You also need to do an EEG test for your feet, consult, and use other procedures to understand the same procedure."
},
{
  "instruction": "Doctor, we've been experiencing rapidity and acid reflux over the last few months, and it's getting more frequent and it happens more and more after eating.",
  "input": "",
  "output": "We recommend several tests to diagnose conditions based on the symptoms. To eliminate any other possible condition, we need to do an E.K.G., a G.D. panel, a hemoglobin A1c measure. We'll also do an E.G. test and test for the condition, including the S-adop, colon, and tissue tests. We can also make sure that we know more about the symptoms."
},
{
  "instruction": "Sir, I've got a problem with my eyesight, and I think he's bleeding.",
  "input": "",
  "output": "You may need to do other treatment procedures, such as eyelids, membranes, and corneas, depending on the extent of the bleeding, or you may need other eye muscles and eye and eye care procedures, depending on the circumstances."
},
{
  "instruction": "Doctor, I think you're addicted to antimicrobials, but you're not strong enough, and you're nauseous.",
  "input": "",
  "output": "We need to start with some basic tests to evaluate the damage caused by addiction: blood testing, full blood count (CBC) and electrolyte panels to check blood components and electrolyte levels."
},
{
  "instruction": "Can you help me diagnose and treat it?",
  "input": "",
  "output": "Based on what you've described, it's important to sew up the wound so that the wound is kept clean and protected. You may need to perform X-ray scans (Sanct) or head computer scans to make sure that there are facial fractures or dislocations, depending on the position of the wound."
},
{
  "instruction": "Doctor, over the past few months, I've been having trouble swallowing and breathing along with the symptoms of skin swelling and thickness of fingers.",
  "input": "",
  "output": "To confirm your diagnosis, you need to perform a complete physical skin test with an infected skin biopsy, and you need to remove skin lesions with a wound management, and you need to evaluate and consult other diagnostic procedures, such as whether the disease is not in your internal organs."
},
{
  "instruction": "Doctor, I've been feeling weak and tired these days, and I've been losing muscle strength, and I've had trouble controlling my muscles, and sometimes things look like two things, and what's the problem?",
  "input": "",
  "output": "Symptoms may indicate a significant history history syndrome. To verify the diagnosis, a series of medical tests must be performed. First, you need to evaluate the blood count and see if it is abnormal. You also need to do vision testing and MRI to evaluate the vision, and finally, you need to use a magnetic resonance imaging (MRI) to determine whether there is an abnormality in the brain."
},
{
  "instruction": "Doctor, I'm dizzy, I sweat a lot, and I often lose consciousness on certain days. What's wrong with me?",
  "input": "",
  "output": "It's good to run a series of medical tests to check the diagnosis. These tests include blood tests, blood sugar measurements, CBC, kidney function, electrolytic panels and EKG tests."
},
{
  "instruction": "Doctor, I haven't had my period in three months. Is there a problem?",
  "input": "",
  "output": "Yes, there may be several causes of absence. First, you need to do some medical tests to determine the cause. You need complete blood count, prothrombin time and APT, bone test, standard pregnancy, urine test, ultrasound, and chlamydia test."
},
{
  "instruction": "Sir, I think my ankle's out of place. My ankle's swollen and I'm in extreme pain.",
  "input": "",
  "output": "You need to perform a radio scan, especially a normal X-ray, to make sure you have a temporary fixation. You also provide intravenous fluid replacement with splints. You also use a heart monitor to monitor heart activity. When the initial emergency treatment is complete, you will be given psychological and psychiatric evaluations and treatment while searching for the same damage options as the appendix and splint."
},
{
  "instruction": "Doctor, I've recently felt dizzy and dizzy, and I feel two-vascular nausea, and I think I've been exposed to carbon monoxide.",
  "input": "",
  "output": "It's important to do some medical tests to check for carbon monoxide poisoning, to check the number of blood cells, to test for the level of gases in the blood, to test for the level of blood sugar, to check the level of glucose, to check the heart function, to check the kidney function, to test for kidney function, to test for heart damage, to test for heart enzymes, and to test for the possibility of alcoholism."
},
{
  "instruction": "Doctor, I think you've been experiencing a panic attack recently, and your heart is pounding and your hand is sweating.",
  "input": "",
  "output": "Unfortunately, I recommend an EKG test to eliminate heart problems. It also requires a blood test, such as a blood test, to understand better what's going on. It may also take a CBC scan (CBC) to see what's going on. We need to perform a routine X-ray and some kidney function tests to see if the organs work properly. Finally, we need to check blood sugar levels with glucose measurements."
},
{
  "instruction": "Sir, I've had a lot of pain in my heel lately, especially when I wake up in the morning, and I've read about fasciitis, and I think that's the cause.",
  "input": "",
  "output": "There is a possibility that there may be fasciitis based on the symptoms. The medical examinations required include radiation processing procedures, such as foot testing and regular X-rays. It can also be recommended for physical therapy exercises and splints. It can also be done in geological panels and other treatment procedures."
},
{
  "instruction": "Sir, the objects that are close to you don't seem clear.",
  "input": "",
  "output": "It may be that you have to do some medical procedures on eyelids, corneas, and corneas to evaluate your status. You also need to determine whether corrections are needed to evaluate the eyelids, lenses, and cataracts of your customers. You may also recommend home health services according to the customer's status."
},
{
  "instruction": "Doctor, I think I'm addicted to tranquilizers.",
  "input": "",
  "output": "I'm sorry, but I'm going to have to run some tests to see what's going on -- blood cells, kidney function, urine tests."
},
{
  "instruction": "Doctor, you've got severe blisters and ulcers in your skin, painful and uncomfortable, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you have to run some tests to make sure you're diagnosed. Patient: What kind of tests do you need?"
},
{
  "instruction": "Doctor, I feel pain and chronic pain in my erectile penis, and I think I have pheroni disease, and what medical test do I need?",
  "input": "",
  "output": "We recommend urine tests, rectal examinations, prostate specific antigen measurements to eliminate prostate problems, as well as complete physical skin testing and screening of depression, as well as other diagnostic procedures and treatment procedures that are specialized in male genitals."
},
{
  "instruction": "Sir, there's soreness and chest pain going on, and my friend, who's a nurse, says I think I've got a thermal hernia.",
  "input": "",
  "output": "To confirm this, we recommend some medical tests, including blood tests, whole blood cells, blood sugar measurements, electrolyte panels, kidney function, EKG, and, if necessary, intravenous fluid replacement."
},
{
  "instruction": "Doctor, I think the drugs that I'm taking have an extracurricular effect.",
  "input": "",
  "output": "We have to do some medical tests, and we need EG to check the electrical activity of the brain, and we need a CAT scan of the head to test the physical abnormality, and we need physical therapy to help control the symptoms, and we're going to start replacements of the I.V. fluid."
},
{
  "instruction": "I think I've got Menier's disease.",
  "input": "",
  "output": "To properly diagnose and treat meni\u00e8re's disease, you need to do some other diagnostic procedures, such as interviews, evaluations, counseling, and so forth. You may also need to do an MRI to better understand what's going on in your nervous system. You may need other treatment procedures for your ears. You may also need some diagnostic procedures for your ears."
},
{
  "instruction": "Doctor, there's a lot of pain and discomfort in the anal area.",
  "input": "",
  "output": "To diagnose an analomalies, you need to do a rectal exam, but you may need to do an S-advisory colon or colon endoscopy to evaluate the severity of the severity. In severe cracks, you may need to consider resections or other sub-percution procedures. In each case, you may need a colonal and endometriosis or post-ops and anal biopsy, depending on your condition."
},
{
  "instruction": "There's been a lot of doctors, sneezes, eyebleds, nostrils, and I'm worried if I'm allergic.",
  "input": "",
  "output": "You have to do a complete physical skin test to make sure that you have any allergies, and you also do spray therapy and other diagnostic procedures on your skin and your substrates to identify specific allergens that cause the symptoms."
},
{
  "instruction": "Hi doctor, I've been experiencing a lot of ear pain, secretions and loss of hearing for a long time, and I think I've got chronic sepsis.",
  "input": "",
  "output": "Symptoms suggest that there is a possibility that there may be chronic sepsis, and that the proper treatment may require a thorough ophthalmology, and post-advisive diagnosis and treatment, as well as the removal or removal of an infected tissue, or, if necessary, adenoid resection, not only for the ear, but also for the nose, the mouth, the throat, and other procedures."
},
{
  "instruction": "Hello, doctor, your fingers are so sick that you can't move them properly.",
  "input": "",
  "output": "I think you've got a fracture. I think we need to check it through radiology."
},
{
  "instruction": "Doctor, I've been experiencing the last few weeks of toilet and severe abdominal cramps, and I can't completely see the stool.",
  "input": "",
  "output": "I'd like to run a rectal check to confirm that you're out of work based on symptoms. If necessary, you may need a resection, a biopsy, or some other non-replacental treatment. You may recommend a colectomy, a rectal examination, or anal biopsy, depending on the severity of your condition."
},
{
  "instruction": "Doctor, a few weeks ago, you had a stiff shoulder, neck, butt, and pain, and you had a fever, and you felt tired all the time.",
  "input": "",
  "output": "The medical examinations required for this disease include liposuction panels to check cholesterol levels, either breast scan to eliminate breast cancer, breast scan, bone density test to check for osteoporosis, prostate problems, or other problems in the area, and physical therapy to improve the range of exercise and reduce pain."
},
{
  "instruction": "I've recently had a swelling of my arms and legs, and I think my arms are heavy and my skin is growing, and it's very uncomfortable, and it's very difficult to do simple tasks.",
  "input": "",
  "output": "You may have to do some tests to diagnose and treat your condition. First, you need to do complete physical skin testing. You may need to treat injuries, nuts, splints and physical burns to help you manage your symptoms, and you may need to remove any damage, infection or burns that can cause the symptoms."
},
{
  "instruction": "Doctor, when you urinate, you're in pain and you're bleeding out of your urine, and I'm afraid it's bladder cancer.",
  "input": "",
  "output": "Thank you for sharing your symptoms. In view of your concerns, a few medical tests are recommended to further examine your condition. These include urine, urethra and endoscopic biopsy, X-ray DNA scan, rectal scan, rectal scan, prostate specific antigen measures (prevention of prostate antigens), and tissue testing to determine whether or not there are bladder cancer."
},
{
  "instruction": "Doctor, there's been a lot of shortness of breath and shortness.",
  "input": "",
  "output": "You need to perform some medical tests. First, you need to perform radiology, general X-rays, and neonatal lasers. And then you need to do an E.G.G. and a cardiac enzyme test to check your heart function. Finally, you need to keep track of the activity of the heart using a heart monitor to determine if there's a fundamental viral infection that causes the symptoms."
},
{
  "instruction": "Sir, my eyes are sore and my vision is blurry, and sometimes I see a rainbow ring around the light.",
  "input": "",
  "output": "It is possible that it may be acute glaucoma. To verify this, you must perform an eye examination and evaluation. You may also have to perform a diagnostic procedure for your eyes. You may need to perform other internal treatments, such as resections of the lens or cataracts, depending on the severity of your condition."
},
{
  "instruction": "Doctor, there's a lot of discomfort about the open chest wound.",
  "input": "",
  "output": "Depending on the symptoms, you need to evaluate the level of the wound by X-ray, including general X-rays, as well as intravenous fluid replacement to maintain fluid levels, skin scan to monitor additional skin damage, electrocardiograms to check the heart function, kidney function, and so on."
},
{
  "instruction": "Doctor, there's so much pain in your knee that you can't get it right.",
  "input": "",
  "output": "The symptoms seem to indicate that the scrotum has been decoupled. This requires that you perform a routine X-ray or MRI scan procedure. When diagnosed, you can discuss treatment options, such as physical therapy, splints, or, if necessary, a joint test. You also need treatment for this if you have a non-fracted fracture or defibrillion."
},
{
  "instruction": "Hi, sir, there's a lot of pain in the back and legs, and I think it's a left-bone neurosis.",
  "input": "",
  "output": "Yes, there's a possibility that the left-bone nerve may be united. In order to verify this, you need to do various tests. First, you can better understand the spine through radiation scans such as normal X-ray or magnetic resonance imaging (MRI). As a result, you can recommend physical therapy, other physical therapy and rehabilitation, catheter or spinal stimulators, intra-synthetic injections, bone density, and so on."
},
{
  "instruction": "Doctor, I've recently had a lot of urine, toilets, fatigue, and yesterday I felt a lot of pain in my hands and feet.",
  "input": "",
  "output": "The symptoms are likely to indicate high calcium levels in the blood. To diagnose this, you have to do a lot of medical tests, including blood tests, CBC, glucose measurements, urine tests, electrolytes, electrocardiograms, and full body skin tests."
},
{
  "instruction": "Doctor, when you cough or sneeze, you sometimes urinate, and I think it's embarrassing and uncontrollable.",
  "input": "",
  "output": "We need to do some tests to ensure that the reproductive system is abnormal; we recommend urine tests to check for pelvis and for infection; we also need to test the breast and do a full physical skin test; we need to do a rectification test, and we need to do a lot of excretion problems, and finally, we need to do an inflection procedure and breast scans to remove the urinary tract from the bastal disease."
},
{
  "instruction": "Doctor, there's a painful leg and swelling, but I think it's an arrhythmia.",
  "input": "",
  "output": "In the vein, you need to understand the severity of the J.V.C. to determine which tests are needed."
},
{
  "instruction": "Hi, doctor, there's a little bit of pain in the lower abdomen, and a few tests show that you've been diagnosed with benign kidney cysts.",
  "input": "",
  "output": "You need to run some tests to get more information about the condition and extent of the cyst. You need radiation, urine, blood test, X-ray computer scan or scan C.T., full blood count or CBC, electrolytes panel, depending on the circumstances."
},
{
  "instruction": "Good morning, doctor. The testes are swollen, and I've been nervous for a while.",
  "input": "",
  "output": "First, we need to do some radiation tests to make sure we understand better what's going on, and then we need to do a urine test and a full skin test, and then we need to do an ultrasound scan and a rectal exam."
},
{
  "instruction": "Doctor, you've been suffering from back pain for a while and you've been getting worse lately.",
  "input": "",
  "output": "You may need to add some additional damage to the disk using radiation scans and MRI tests to your status. You can also prescribe physical therapy exercises to improve posture and strengthen your muscles. If necessary, you may also consider catheter or spinal stimulator inserts and other procedures, such as intubation, interview or evaluation of the spinal cord."
},
{
  "instruction": "There's an excessive amount of hair growing on the teacher, on the face, on the chest, on the back.",
  "input": "",
  "output": "You need to do some medical tests to figure out the underlying cause: complete body skin testing, glucose readings to check glucose levels, lipid panel, and phonolin A1c to evaluate the levels of sugar: which additional tests do you recommend?"
},
{
  "instruction": "Sir, I think my feet are dislocation, and I'm so sick that I can't carry my weight.",
  "input": "",
  "output": "In view of your symptoms, you need to perform regular X-rays and radiation scans to evaluate the level of defibrillation. In the meantime, you need to apply splinting to fix your joints and minimize your pain. You also need to supplement your fluid loss and check your kidney function for your overall health."
},
{
  "instruction": "Doctor, there's severe pain in the waist and the side and a lot of nausea, I think.",
  "input": "",
  "output": "In order to diagnose this condition, you have to do some medical tests. These include radiation scans, urine tests, blood tests, blood tests, blood tests, X-ray computer scans, kidney function, replacement of the I.V."
},
{
  "instruction": "Hi, doctor, I've had abdominal and abdominal ovulation over the last couple of weeks, and I've also had toilets and diarrhea, and a friend of mine said it could be gesticulitis.",
  "input": "",
  "output": "The symptoms may suggest that you have to run a S-synthesis, or colon endoscopy. You can also check if there is a small pocket or cabinet inside the colon. You can also check if there is a complete blood count, an X-ray computer scan, a colon endoscopic examination, a urine test including tissue tests, and a blood glucose level. In severe cases, you may need to consider adding intravenous fluids to manage the symptoms."
},
{
  "instruction": "Doctor, there's severe pain in the abdomen that you had operated on a week ago. What kind of tests do you need?",
  "input": "",
  "output": "Depending on the symptoms, radiology, blood testing, full blood count, X-rays, IV fluid replacement, kidney function, urine test, recommend monitoring the underlying causes of pain and monitoring the condition of recovery."
},
{
  "instruction": "Hi doctor, I'm experiencing unconscious movement, and I'm having trouble controlling it.",
  "input": "",
  "output": "In order to diagnose Huntington's disease, you need to do some medical tests, recommend CAT scans or scan CT scans in your head to see if there is a brain condition, you need to do some brain changes through MRI, you need to do some mental health tests, you need to be helped to deal with the anxiety and stress associated with mental health counseling, and you need to make sure that you are able to analyze the condition, and you need to make sure that you have a serious loss of vision."
},
{
  "instruction": "Doctor, I think she's infected with the West Nile virus.",
  "input": "",
  "output": "The essential medical test for the West Nile virus is an abdominal CT scan, but it is not always performed until the disease is more severe (other medical tests do not involve the diagnosis of the West Nile virus)."
},
{
  "instruction": "Doctor, I'm worried that I'm having lymphoma, and I'm experiencing lymph nodes, fatigue, weight loss without cause.",
  "input": "",
  "output": "I understand what you're worried about. I'd like to run some medical tests based on the symptoms."
},
{
  "instruction": "Sir, I've been suffering from skin rashes and itching for a while, and I've been talking to my friends about skin infections due to exposure to sunlight.",
  "input": "",
  "output": "It's good to get a skin scan to determine the extent of skin damage due to the symptoms."
},
{
  "instruction": "Doctor, I've recently been told that I'm really tired, I don't feel strong, my skin looks pale, and I might have something to do with chronic kidney disease, so what do you think?",
  "input": "",
  "output": "In view of your symptoms and your history, it is possible to be an anemia from chronic kidney disease, which requires that you perform a series of blood tests involving whole blood cells, blood sugar measurements, electrolyte panels, urine tests, hemoglobin A1c measurements and liposuction panels."
},
{
  "instruction": "He had an accident last night, and I think he's injured his internal organs.",
  "input": "",
  "output": "Depending on the symptoms, it's important to diagnose and treat your condition properly, including radiation, blood test, Cbc, X-ray computer, X-ray X-ray, urine test, and IV fluid supplements."
},
{
  "instruction": "Doctor, I've been experiencing severe eye pain and discomfort in the last few days, and I've also had eyes swelling and my vision blurry.",
  "input": "",
  "output": "The medical test you need for this disease is an eye examination and evaluation or an infection and possible damage."
},
{
  "instruction": "Doctor, I'm experiencing intubation, stimulation and growth in my eyes, and my vision seems to be blurring as the day goes on, and I think there's some growth in the cornea.",
  "input": "",
  "output": "The medical examinations required for the disease include ophthalmology with eye examination and evaluations, and ophthalmology, as well as the removal of the eyelids, the peritoneal and corneal membranes, and other procedures, such as eye muscles, and eye muscles and repair, lenses and cataracts."
},
{
  "instruction": "Doctor, I think I have a fungus infection in my skin, and I've got a red spot on my arms and legs, and what do I do?",
  "input": "",
  "output": "You need to do a full physical skin test to determine the extent of the infection, and then make sure that the skin is actually mold-inflicted. When the infection is identified, you might need to perform a resection to remove the infected skin, but you also need to perform other diagnostic procedures on the skin and substrate tissue to confirm the severity of the infection."
},
{
  "instruction": "Hi, doctor, I think I've accidentally overdosed on insulin.",
  "input": "",
  "output": "OK, you need to run some physical tests to check your body's response to heavy doses. First you will stabilize your body with intravenous fluid replacement. Then you will need to use glucose measurements to make sure that your blood sugar is too low. And then you will need to check your blood tests, your whole blood cells, your kidney function, to make sure that your body is in full health, and how insulin is being processed. Finally, your electrocardiogram test will make sure your heart doesn't work."
},
{
  "instruction": "Doctor, I've recently been very fatigued and nauseated, and I drink a lot of water, and I don't think I get more urine than I normally do.",
  "input": "",
  "output": "If you delay as a symptom, there may be a possibility that you will have an inappropriate SIADP (SIADH). You need to run some medical tests to see if your blood is abnormal, such as your CBC (CBC). You also need to measure glucose levels, perform urine tests, and do regular X-rays."
},
{
  "instruction": "Sir, I think I've got something foreign in my ear.",
  "input": "",
  "output": "All right, we can verify that based on what you're saying, we need to get rid of the foreign material by non-operation, and we need proper scar management to prevent infection, and we need other therapeutic ear procedures, depending on the severity of the problem."
},
{
  "instruction": "Hi, sir. I've had some discomforts every month before my menstrual period, but I think I'm having premenstrual stress syndrome.",
  "input": "",
  "output": "We need to do some medical tests to see if it's right, start with a hip test, a breast test, a complete physical skin test, and then we need to do a C.B.G. test and a depression test, and finally, we need to make sure that we have a fundamental problem with lipocardial panels and mammography."
},
{
  "instruction": "Hi, doctor, there's pain and swelling in your eyes, and it's very uncomfortable and it's not very visible.",
  "input": "",
  "output": "Symptoms indicate that there may be eye and bile and colitis. To make sure you have some medical tests, you will need to check the CBC levels to see if they are infected. You may need to start replacing your veins and monitor your glucose levels. You also need to do an X-ray scan (CT) of your brain to determine the extent of the infection."
},
{
  "instruction": "Good morning, sir. My leg hurts so much, I can't carry my weight, I have a lot of bruises.",
  "input": "",
  "output": "We recommend ordinary X-rays to check for fractures or fractures according to the symptoms. We also need to take care of injuries with splints to help heal. We may need to shoot magnetic resonance images and perform physical treatments to restore the range of movement. Finally, we need to check your feet to see if there is any further damage."
},
{
  "instruction": "Doctor, I'm experiencing confusion, forgetfulness and disorientation, and I'm also having trouble speaking and writing, and I'm afraid that there's something wrong with me.",
  "input": "",
  "output": "You need to do some medical tests, such as blood tests, whole blood cells, CBC, ordinary X-rays, or radiation imaging, as well as electrocardiograms and kidney function."
},
{
  "instruction": "Doctor, I've been having severe pain in my legs and I've found swelling in my legs over the last few weeks, and I'm afraid it's a serious disease.",
  "input": "",
  "output": "A few medical tests should be performed to determine the cause of pain and swelling according to the symptoms. The first test to be performed is the CBC (CBC) and other hemolytic tests to make sure that the blood is abnormal. You also have to do a X-ray scan to determine whether there is an abnormal growth in the bone. You also need to measure glucose levels like X-rays to prevent diabetes. You may need to run a C.T.R. or an M.R.R., if you want to detect a C.I.D.D."
},
{
  "instruction": "Sir, I think I have rishmania.",
  "input": "",
  "output": "We need to do an abdominal CT scan to diagnose rishmania."
},
{
  "instruction": "Doctor, I think I have Chagas' disease.",
  "input": "",
  "output": "We need to do regular X-rays, radiation, and abdominal CTs."
},
{
  "instruction": "Doctor, I think my arm and leg are in pain and I'm in pain, and I'm often affected by body temperature detection, and I'm worried that it might be spinal co-diagnosia.",
  "input": "",
  "output": "Symptoms indicate that there may be a chance of spinal co-synthetic syndrome. To confirm the diagnosis, you need to perform a radiology and magnetic resonance imaging and other diagnostic procedures, such as interviews, evaluations, or counseling. You may also need to do liver function tests, pelvics, cardiac enzyme measurements (heart enzymes), and finally, you may need a hemoglobin A1c test to check your blood sugar levels."
},
{
  "instruction": "Doctor, I'm worried if you're having pulmonary fibrosis.",
  "input": "",
  "output": "We need to run a series of medical tests to determine the cause of the symptoms."
},
{
  "instruction": "Doctor, I've been feeling short of breath and fatigue lately, and there's also a history of chest palpitations, is there anything to do with mitral valve disease?",
  "input": "",
  "output": "If you want to check this, you need to do a bunch of medical tests, such as radiation shootings, EKGs, ultrasounds, heart ultrasounds, liposuction panels, and other diagnostic procedures, such as heart stress tests."
},
{
  "instruction": "Doctor, I'm experiencing a hard time with tremors, muscle rigidity, movement, and a change in handwriting, and I'm afraid it's Parkinson's disease.",
  "input": "",
  "output": "You need to evaluate and consult other diagnostic procedures to see if you have Parkinson's disease based on your symptoms, and you need to test for the specific prostate antigens, and I'm going to introduce you to some household health care services that can help you to see structural changes in your brain."
},
{
  "instruction": "Doctor, I think you have a gout. Your big toe has severe pain and swelling.",
  "input": "",
  "output": "We need to do some tests to check the diagnosis based on the symptoms, complete blood count, lip panel and hemoglobin A1c measurements, as well as blood tests and normal foot X-rays."
},
{
  "instruction": "Doctor, I've been experiencing severe ear pain and hearing loss over the last few days, and I also feel high fever and pressure in my ear.",
  "input": "",
  "output": "You may need to have a diagnostic procedure, such as an Influenza virus test, inflammation, treatment, and other treatment procedures for your ears, as well as an adenoid resection and / or adenoid resection."
},
{
  "instruction": "I think you're having a problem with doctors, drug abuse, especially Opioids, and I want to get help.",
  "input": "",
  "output": "The first step is to have mental health counseling and psychological care, and a few tests to test urine, depression, toxicity, and blood alcohol, and also psychological and psychological evaluations and treatments to figure out the source of the problem and to establish a treatment plan."
},
{
  "instruction": "Doctor, I've been feeling tired and powerless for a while, and recently I was diagnosed with my bone marrow form syndrome, and what should I do to determine the severity of my bone marrow abnormality?",
  "input": "",
  "output": "In the case of bone marrow deficiency, it's generally recommended that you do a CBC test, a blood cell test, a blood sugar test, a hemoglobin A1c test, and you also need to do a biopsy and bone marrow biopsy to determine the severity of your condition, but you don't need a prostate specific antigen test."
},
{
  "instruction": "Sir, I think your shoulder's broken, your shoulder's sore that I can't move properly.",
  "input": "",
  "output": "You need to perform a radiology scan to confirm that you need to take your shoulder as a normal X-ray and then decide the following steps. You may have to apply splints to fix your shoulder. You may also need an X-ray computer scan or a CAT scan of your head to get a better view. You may need physical treatment based on the level of fracture."
},
{
  "instruction": "Doctor, I'm experiencing swelling legs and frequent urination and fatigue, and I'm worried if you're having a serious illness.",
  "input": "",
  "output": "I understand your concern. When you consider your symptoms, you have to do a series of medical tests to eliminate the possibility of acute kidney damage. You have to measure the CBC, urine test, and glucose levels. You have to run a blood test and evaluate the electrolyte levels to understand kidney function. You also have to do a radio scan to capture the details of the kidney."
},
{
  "instruction": "Doctor, I'm worried about the baby's health because there's so much pain in the abdomen.",
  "input": "",
  "output": "I understand your concern: you have to do some medical tests to evaluate the health of the ear and the baby. You have to do a blood test, urine test, whole blood count, and standard pregnancy test."
},
{
  "instruction": "Hi, doctor, I've had a severe double fever a few days ago, and I'm so worried that I've come to see you.",
  "input": "",
  "output": "I'm sorry, the symptoms suggest that there's a couple of things that you need to do. You need to do some tests to check. You need to get a radio scan, a blood test, an X-ray computer scan, a CBC, an I.V. fluid replacement, an electrolytic panel, a glucose test."
},
{
  "instruction": "Sir, there's been a lot of redness in the gums, and there's a lot of bleeding, and I think there's gum disease.",
  "input": "",
  "output": "You have to do an I&D, depending on your symptoms, and you have to do another non-healthal procedure on your mouth and pharynx to treat gum disease."
},
{
  "instruction": "Doctor, there's a wound in the incision. What medical tests do you need?",
  "input": "",
  "output": "There seems to be a need for a complete physical skin examination, a complete physical skin repair, retraction, splint and other injuries, a resect, an infection or a burn and a culture of the wound."
},
{
  "instruction": "Doctor, there's a case of vomiting pericardial blood.",
  "input": "",
  "output": "We need to do some medical tests to make sure that you're bleeding better, such as a blood test and an electrolyte count, to make sure that your body is doing good with kidney function tests and glucose levels, and finally to check for imbalances by testing the electrolytic panel to determine the location and extent of the bleeding."
},
{
  "instruction": "Doctor, you've got scalp and a red, itchy rash on your face, and you've been diagnosed with boring dermatitis, and what should you do?",
  "input": "",
  "output": "As for your state, complete physical skin testing must be performed along with tissue testing, moderation or other treatment procedures. Also, it is a good way to turn to homehelve services for additional treatment."
},
{
  "instruction": "Doctor, I'm having trouble with drug abuse, especially meth-ephetamine addiction. What medical tests do you need?",
  "input": "",
  "output": "In order to solve the addiction problem, you have to have mental health counseling and psychological care, and you have to pee to make sure you're not using drugs, and you have to have glucose measurements to monitor blood sugar levels, and you need to have a toxic test to determine the damage caused by drug abuse, and you can use a kidney function and an electrolytes panel to determine the health of your kidneys and the balance of your body."
},
{
  "instruction": "Sir, your neck is sore and stiff, it's hard to turn your head one way, and you feel like your neck muscles are contracting all the time.",
  "input": "",
  "output": "There are other diagnostic procedures, such as X-ray computer scans, interviews, evaluations, evaluations, and counseling to see if there is any damage in the bones, and self-synthetic imaging procedures to check for pain, as well as muscle, force, stenography, joint, and postage, and other procedures that may need to be treated."
},
{
  "instruction": "Doctor, I've recently become very weak, and I think it's due to an anti-high blood pressure drug that I'm taking, and I'm feeling dizzy and very fatigued.",
  "input": "",
  "output": "I'm sorry, you may need to run some medical tests to determine the cause of the symptoms. On the basis of what you've said, we encourage you to have some medical tests: I.V. fluid replacement, E.K.G., blood test, full blood count, kidney function (CBC), kidney function, electrolyte panel, and glucose measurement."
},
{
  "instruction": "Doctor, your headache is going up your forehead from the back of your head, and it feels like a tight band around your head, what's the cause and what's the test for?",
  "input": "",
  "output": "The symptoms are likely to indicate that you have a tension headache. To be diagnosed, you need to do some medical tests. These include X-ray computer scans, X-ray scans (Scan Ct), head computer clips, self-responsibility videos. In the meantime, you can recommend a physical therapy campaign to reduce symptoms and help with stress."
},
{
  "instruction": "Sir, I feel like I'm having hemophilia, and I'm tired, and I'm bleeding from my gums.",
  "input": "",
  "output": "In this case, a complete blood count (CBC) test with other diagnostic procedures for skin and substubation should also be performed to determine the extent of the disease by performing a biopsy, an ultrasound, and an X-ray computer scan (TURP)."
},
{
  "instruction": "Doctor, you're oversleeping during the day, and you're awake, and all of a sudden you're losing muscle tension, and you're experiencing hallucinations when you're trying to sleep.",
  "input": "",
  "output": "You've got to do a bunch of medical tests, such as evaluations and interviews, depression tests, MRls, brainwaves, and so on, and you can do several treatments on the eyelids, perforation or corneas to manage the symptoms."
},
{
  "instruction": "Sir, I think I'm allergic to food, and every time I eat peanuts, I get rashes on my skin.",
  "input": "",
  "output": "To diagnose food allergies, you must perform a full physical skin test as well as other diagnostic procedures, such as interviews, evaluations and counseling. You may also need to do some other diagnostics on skin and substubation to make sure you have an allergic reaction. You may also need to measure hemoglobin A1c levels through hemoglobin A1c to eliminate other base diseases."
},
{
  "instruction": "Doctor, I'm experiencing nausea, dizziness, deafness, I think I've got it. What kind of test do I need to have to do to check this out?",
  "input": "",
  "output": "You have to have full blood counts and other blood tests to make sure you have infections or inflammation, and you have to check glucose, kidney function and electrocardiograms, and you have to do an E.K.G. test to check your heart function, and you may need an I.V. fluid replacement."
},
{
  "instruction": "Hi doctor, I'm really nervous these days, my heart is pounding and I'm always anxious and worried.",
  "input": "",
  "output": "It's good to start by treating anxiety through psychological treatment, which can help you to control your symptoms based on what God says, and also recommend an EKG test to check your heart function and eliminate a fundamental heart problem, which can help you to get mental health counseling and heart monitoring so that anxiety does not affect your heart's health."
},
{
  "instruction": "Sir, I'm having a hard time controlling my impulses, and I think I need some help.",
  "input": "",
  "output": "All right, it's good to get mental health counseling and psychological care, and we need to do toxic and blood alcohol tests to avoid drug abuse, and we need psychological and psychological evaluations and treatment, and we also need to do mental and cardiovascular tests."
},
{
  "instruction": "Hi doctor, I've had a lot of tear glands lately, and I'm really sick and I have a lot of tears, and what's going on?",
  "input": "",
  "output": "There may be eye and eye examination and evaluations as well as complete physical skin tests, depending on the severity of the condition, or there may be physical therapy movements, manipulations, and other procedures."
},
{
  "instruction": "Hi, doctor, your nose has been so sick and swollen over the last few days, it looks like it's an abscess.",
  "input": "",
  "output": "You need to perform a diagnostic procedure for your nose, mouth, and pharynx, as well as other diagnostic procedures such as interviews, evaluations, and counseling."
},
{
  "instruction": "Doctor, there's pain and swelling around the navel, and we've found that the area is red and secretions come out, and what's the problem?",
  "input": "",
  "output": "If you want to be diagnosed, not only do you have to cultivate a wound, but you also have to do a full physical skin test. You can also remove skin lesions if necessary."
},
{
  "instruction": "Doctor, I've been feeling fatigue and dizzy lately, and it's easy to get bruises and nosebleeds, and I'm really worried if I have leukemia.",
  "input": "",
  "output": "It's good that you get a series of medical tests, first of all, including blood cells, blood sugar measurements, and electrolyte panels, and secondly, complete skin testing with hemoglobin A1c."
},
{
  "instruction": "Doctor, all of a sudden you're losing your grip on one side of your face, and you can't close one side of your eyes, and it's hard to eat properly.",
  "input": "",
  "output": "Your symptoms suggest that you're suspecting a bell paralysis. To confirm the diagnosis, you need to eliminate another condition by testing X-ray computer scans, X-ray computer scans, EKG scans, kidney function tests, electrolytes, heart enzymes, and magnetic resonance imaging imaging (MRI)."
},
{
  "instruction": "Hi, doctor, I think I've had an allergy in the last few days, and I've got eyes, and I've got eyes, and I've got eyes, and I've got eyes, and I've got eyes, and I've got eyes, and I've got eyes, and I've got tears, and I think I've got allergies.",
  "input": "",
  "output": "Your symptoms suggest that you may have an allergy, and in order to make a treatment plan, you may need to get an eye and a second and a second diagnosis and a second and a second, a complete physical skin examination and absorption, and other diagnostic procedures, as well as a complete physical examination of the skin and subtubation, depending on the severity of the condition, you may need to perform a different procedure on the eyelid, perforation or perforation."
},
{
  "instruction": "Doctor, I think I've had a reaction to the medication that I'm taking, and my heart's not strong enough.",
  "input": "",
  "output": "Depending on the symptoms, you have to perform a series of tests for I.V. fluid supplements, electrolytes, kidney function, EKGs, heart enzyme measures, heart monitoring, potentially drug toxicity tests, and so on."
},
{
  "instruction": "Doctor, I've recently experienced severe fatigue and weight loss, and I've also felt constant pain in my abdomen, and I've had some tests, and I've been diagnosed with adrenal cancer.",
  "input": "",
  "output": "I'm sorry, you have to do a series of medical tests to properly diagnose your condition and monitor it. First, you have to do a blood test to test the cells in your blood. You also have to do a full blood count to check for blood cells. You also have to measure glucose levels to monitor your blood sugar. You may also need to do a full blood sugar test for the last few months. You may need to do a hemoglobin A1c test to measure your average blood sugar levels."
},
{
  "instruction": "Sir, there's a symptom that you've been seeing lately, and I think it's near-sighted.",
  "input": "",
  "output": "In this case, an eye examination and evaluation must also be performed to confirm the diagnosis of the eye. When the diagnosis is established, a treatment procedure needs to be performed for the eyelids, the periphery and the cornea."
},
{
  "instruction": "Doctor, I'm feeling pain and stiffness in my joints, and it's hard to move or perform routine tasks, and I'm wondering if you can tell me what's going on.",
  "input": "",
  "output": "To verify this, you need to perform radiation, especially regular X-rays or X-rays. You can check your member's joints and see if you have any signs of arthritis. You can also recommend physical therapy, other non-alignative procedures, or drugs that help with pain management, depending on the severity of your arthritis. You may also need to do a better examination of your body's health, including your instruments and your hemoglobin."
},
{
  "instruction": "Doctor, I've been pretty tired recently, and I'm experiencing weight gain, and I think I'm having a thyroid problem.",
  "input": "",
  "output": "OK, so in this case, we need to do some medical tests, including blood tests to check thyroid levels, ultrasound tests to check thyroid levels, liposuction panels to check cholesterol levels, and hemoglobin A1c tests to test breast cancer and whether it's diabetic."
},
{
  "instruction": "Hi, doctor, your throat hurts, and you can't swallow it. I think you have pharynx.",
  "input": "",
  "output": "You will also need to do a follow-up test to make sure that the symptoms are related to the underlying mental health problem."
},
{
  "instruction": "Doctor, I have a feeling of weakness and helplessness these days, and I've had a lot of muscle spasms and a lot of hands and feet, and I feel like this might have something to do with the kidney, but I'm not sure, can you tell me what kind of tests I need?",
  "input": "",
  "output": "The symptoms suggest that you may have a lower calcium hemolytic level than normal; you need to run a series of blood cells, kidney function, radiation imaging, and blood sugar tests to determine the cause and severity of your condition; you need to run an E.K.G. test to check your heart's health."
},
{
  "instruction": "Sir, things don't look clear and the colors look brighter than they used to be, and I think they're ecliptic.",
  "input": "",
  "output": "It may also require ophthalmology, including eye examination, as well as other diagnostic procedures for the eye, as well as ophthalmology and treatment. It may also require lens and cataracts, eyelids and other treatments for the cornea, other treatments for the cornea, and other eye treatments, as well as other eye treatments."
},
{
  "instruction": "Doctor, we've been coughing and having trouble breathing over the last few days, and I'm worried if you've got pneumonia.",
  "input": "",
  "output": "It's good to start with a normal X-ray procedure to test your lungs according to the symptoms. You also need to run a full blood count (CBC) and other blood tests to check your blood count. You may also need to supplement your fluid with veins and check your kidney function and electrolyte panels for your body's overall function."
},
{
  "instruction": "Sir, you've got a curving sepsis on your lips. How would you like to treat it?",
  "input": "",
  "output": "It is recommended to complete a full skin test, including a microscope test for infection, but other medical tests, such as pelvic tests, breast, chlamydia, and rectal tests, have nothing to do with oral herpes."
},
{
  "instruction": "Doctor, sometimes I feel like my heart is pounding and my heart is excited, and I'm really worried.",
  "input": "",
  "output": "To check this diagnosis, I want to order E.K.G., radiation, whole blood cells, ultrasound, and an ultrasound."
},
{
  "instruction": "Doctor, I think I've got a Chankloid.",
  "input": "",
  "output": "The medical test for Chankloid isn't any of the procedures you've been talking about, you've got to have a cycloid culture."
},
{
  "instruction": "Doctor, one of the testes is touched by a lump, and it's dull, but you feel constant pain, do you know what the disease is?",
  "input": "",
  "output": "This requires a series of tests, including complete blood cells, blood sugar measurements to check sugar levels, electrolyte panels, radiation imaging procedures such as CT scans, complete skin examination and blood tests."
},
{
  "instruction": "Doctor, I've been suffering from severe scalp neck pain recently, and I've always felt nausea, and I've been told that a friend might have chickenpox.",
  "input": "",
  "output": "These tests include radiation scans, head X-ray computer scans, CAT scans, self-sensitivity videos, MRI and other diagnostic procedures such as interviews, evaluations and counseling."
},
{
  "instruction": "Is it breast cancer?",
  "input": "",
  "output": "We need to do physical and breast imaging and complete physical skin tests for breast cancer, and we need to do a hematology test and a full blood count to evaluate the overall health condition, and we need to do a blood sugar test and a hemoglobin A1c test to evaluate blood sugar levels."
},
{
  "instruction": "Doctor, I'm very weak and tired these days, and my skin has turned very pale, and I'm worried if I'm anemic.",
  "input": "",
  "output": "There may be some anemia in the symptoms. To check this, you need to run some medical tests. You need to check your blood tests, your cell count (CBC) and your blood levels, and your blood count, and your breast tests. You also need to do complete physical and breast tests, and you need to do electrocution panels and X-ray scans to see if there is a primary malignant tumor causing anemia."
},
{
  "instruction": "Hi, doctor, recently there's been a lot of abdominal vomiting and the back color is more severe than usual.",
  "input": "",
  "output": "To confirm it, you need to do a bunch of medical tests, such as blood tests, whole blood cells, blood sugar measurements, electrolytes, liposuctions, and ultrasounds."
},
{
  "instruction": "Hi doctor, I've been experiencing abnormal vaginal bleeding lately, and I'm tired, and I think there's a serious problem.",
  "input": "",
  "output": "We need to run some tests to determine the cause of the symptoms, to test the pelvic, to scan the radiation, and to do some tests on the breast, ultrasound, and other female organs."
},
{
  "instruction": "Hi doctor, I've been having trouble breathing and coughing a lot lately, and I've read about this, and I think it's a cystic fibrosis.",
  "input": "",
  "output": "In order to properly diagnose cystic fibrosis, you need to do a lot of diagnostic procedures, such as staphs, diagnostics, counseling, and so on, and you can also recommend mental health counseling, physical therapy, and other respiratory and nervous procedures as part of the overall treatment plan."
},
{
  "instruction": "Doctor, I have a red, painful skin rash with skin wrinkles, and I've been nervous for a while.",
  "input": "",
  "output": "It's good to get a full physical skin test to determine the degree and location of the rash. You may need to do a resection or biopsy to follow the results. You may need to try to manage the injury and perform other diagnostic procedures on the skin and substrate tissue."
},
{
  "instruction": "Hi, doctor, I've been very weak lately and my skin is getting darker and darker, and I think it's possible that it's Gluco Cortide deficiency.",
  "input": "",
  "output": "Some tests are recommended to confirm this diagnosis, including blood tests, CBCs, urine tests, IV fluid supplements, kidney function, blood sugar measurements, and E.K.G."
},
{
  "instruction": "Hello, sir, your jaw is in pain, especially when you chew or yawn.",
  "input": "",
  "output": "In order to confirm the diagnosis, you need to undergo a diagnostic procedure such as an ophthalmology, evaluation, diagnosis, and ophthalmology, as well as a diagnostic procedure for ophthalmology, treatment, nose, mouth, and pharynx, which may require a central line of veins to be inserted to help diagnose and treat the disorder."
},
{
  "instruction": "Doctor, I'm experiencing such symptoms as abdominal pain, moon, tremor, and I'm worried about Wilson's disease.",
  "input": "",
  "output": "In Wilson's case, a number of medical tests should be performed to establish a diagnosis and treatment plan. The first test is an eye and test and evaluation to make sure that there is an abnormal sediment in the eye. The second test is to photograph the MRI to see if there is any damage to the brain and surrounding tissue. It may also require psychological and psychiatric evaluations and treatment to solve mental health problems. In other cases, there may also be a need for a permanent operation, such as the spleen."
},
{
  "instruction": "Doctor, I've been experiencing a lot of infections recently, and I'm also sick when I urinate, and I'm worried about what tests I need to take.",
  "input": "",
  "output": "The symptoms suggest that you need to do some tests to confirm your diagnosis: get a radiation scan, urine test, ultrasound, entire X-ray, pelvic examination, rectal exam, and so on."
},
{
  "instruction": "Doctor, I'm experiencing skin dryness, blindness, frequent infections because of a vitamin A deficiency.",
  "input": "",
  "output": "You may need a skin scan to assess the level of skin damage. You may also need to know that vitamin A deficiency can cause corneal damage, so you may need a cornea transplant. However, resection of the skin lesions or prostate urethra (TURP) is not recommended."
},
{
  "instruction": "Hi, doctor, I think I've got gonorrhea.",
  "input": "",
  "output": "I'm going to recommend some medical tests to test for symptoms: urine, blood, chlamydia, standard pregnancy, pelvic, whole skin, rectal exam, and so on."
},
{
  "instruction": "Doctor, I think my ribs are broken, and every time I breathe or move my body, I feel a sharp pain.",
  "input": "",
  "output": "You will need some medical tests to confirm the diagnosis. First, you will check whether it is fractured through radiation scans or regular X-rays. Then you will recommend a complete blood count and urine test to remove other basilar diseases. You may also need a CT scan and kidney function test to assess the severity of the injury. You may also need to administer an I.V. fluid supplement to compensate."
},
{
  "instruction": "Doctor, I've been diagnosed with endometriosis. What medical tests do I need?",
  "input": "",
  "output": "You also need to check your eyes with eyelids, colon and corneas, as the tumor can spread, and you need other treatment for eyelids, corneas, and corneas. For diagnostics and treatments, you need eye and tooth surgery. You need lens and cataracts if necessary. You can also need a biopsy to check your diagnosis. In case of each membrane disease, you may need a perforation."
},
{
  "instruction": "Doctor, I've recently felt a lack of energy, fatigue, a change of skin and eyes, and I'm worried if I have hepatitis.",
  "input": "",
  "output": "We need to run some medical tests, based on your symptoms, first do some blood tests, including the total number of blood cells to check for blood loss. We also need to measure glucose levels and check the electrolyte panels with urine tests. We also need to check the kidney function through kidney function tests. It's important to start a blood replacement to support your body during treatment."
},
{
  "instruction": "Doctor, I feel a little uncomfortable in the vagina, and I found a little lump, and it looks like it's a cyst, so what kind of test do I have?",
  "input": "",
  "output": "It's good to have a CBC test, a urine test, a kidney function, depending on your symptoms, as well as a hip test and a standard pregnancy test."
},
{
  "instruction": "Doctor, there's an open wound on your shoulder that doesn't heal. What tests do you need?",
  "input": "",
  "output": "You need to have a laser scan of your shoulder, including a normal X-ray, to close the wound, measure the full blood count, and supplement your veins, as well as perform a kidney function to manage the wound and monitor the kidney function."
},
{
  "instruction": "He's got severe and abnormal vaginal bleeding, and the gynecologist says it could be an extrauterine pregnancy.",
  "input": "",
  "output": "In this case, you need to run some medical tests. First, you need to run a CBC and a CBC test to evaluate your blood count and clotting ability. You also need to perform a radiology procedure to visualize the pregnancy position, such as the ultrasound."
},
{
  "instruction": "Hi, doctor, I've been having chronic knee pain for a while.",
  "input": "",
  "output": "I'm sorry, I have to run some medical tests to investigate your condition, first of all, radiology and general X-rays."
},
{
  "instruction": "Doctor, there's a little yellow oscillator on the white in the eye, and it's growing, so what kind of test do you have to know what's causing it?",
  "input": "",
  "output": "You don't have to do a cornea transplant, do an extrauterine pregnancy, or perform an organ incision, but may require endocrinosis according to the results of the eye test."
},
{
  "instruction": "Hi doctor, I've been having strange symptoms, such as fatigue and joint passage, and the skin looks extremely dry and it's aching, and you know what's causing it?",
  "input": "",
  "output": "The symptoms suggest that there may be a gomoglobulinosis. To check this, you need to do some medical tests: blood test (blood test), Cbc, body skin test (ML), glucose test (leucose count), electrolyte panel and hemoglobin A1c (a1c), and other diagnostics (door assessment, consult)."
},
{
  "instruction": "Doctor, I think I'm suffering from alcohol abuse, and most of the time I feel the need to drink, and my family thinks I'm having a drinking problem.",
  "input": "",
  "output": "Then we'll have to do some tests to make sure that there's liver damage or anemia; we'll need to do a blood test and a CBC; we'll need to do mental health counseling and psychological care to help with the addiction; we'll need to do urine tests to make sure that there are complications; we'll also evaluate the damage done by measuring glucose levels, and we'll consider supplementing my veins."
},
{
  "instruction": "Doctor, I've been having a lot of pain and depression in my hands lately, and I lose my fingers, and sometimes I drop things.",
  "input": "",
  "output": "Symptoms may suggest a few other diagnostic procedures, such as interviews and evaluations of the medical history."
},
{
  "instruction": "Doctor, I've got a problem with the hormone level, and I think it's a pituitary disorder, so will it help us figure out what's going on?",
  "input": "",
  "output": "The first test you need is a blood test, a blood test, which helps you identify the hormone levels. You also need to do autosynthetic imaging (MRI) tests to see if the pituitary gland is abnormal. You may also need other diagnostic procedures, such as interviews, evaluations and counseling. You may also need to evaluate the blood glucose level (A1c) for the test and vision, and you may need to evaluate the results of a blood pressure (A1c) and not check your vision."
},
{
  "instruction": "Doctor, I've had severe pain in my lower abdomen and back over the last few days, and I feel like I'm having a sharp, piercing pain and then I'm gone, and I'm having trouble urinating.",
  "input": "",
  "output": "Symptoms suggest that there may be kidney stones. To verify this, you need to do some medical tests to see if there are any changes in urine that can indicate kidney stones. You may need to take a radiology scan or a CT scan to clarify kidney and urethra. You need to do a full blood count and a full C.T. To determine the best treatment for the damage done by the stones, you need to do a full blood test to determine how to treat them."
},
{
  "instruction": "Hi, doctor, I think I'm autism, and it's hard to communicate and socialize with other people.",
  "input": "",
  "output": "The first step is to undergo mental health counseling and psychological treatment, as well as evaluations of tasks, including speech therapy, and other diagnostic procedures, such as interviews, evaluations and counseling, as well as self-sensitivity imaging (MRI) and brainwaves (EEG) tests."
},
{
  "instruction": "Sir, the post-frequency lymph nodes are swelling and getting tired of the cat, I think they're cat scratch disease.",
  "input": "",
  "output": "All right, so I'm going to have to run some tests, measure glucose levels, measure blood cells, check the kidney function, and make sure that there's something wrong with your eye with complete skin examinations and eye examinations, and then finally, you need a spleen surgery, but it's different from the state of the patient."
},
{
  "instruction": "Doctor, I can't see very well on my left, and I was diagnosed with chronic glaucoma a few years ago.",
  "input": "",
  "output": "With a comprehensive eye examination, you will check your vision and evaluate the retina, the optic nerve, and other structures in the eye. You may also suggest eyelids, pericardium, other treatments for the cornea, eye and eye, as well as other treatment, such as laser fibrosis, fibrillation, and glaucoma."
},
{
  "instruction": "Hi, doctor, there's been increasing symptoms of light flashes and debris floating over the last few days, and I'm worried about the retina, but what do I do?",
  "input": "",
  "output": "The first stage may have been an eye examination and evaluation to confirm the diagnosis. Depending on the level of retinal delays or retinal dentures, recovery, eyelids, perforation, and other surgical interventions, such as other treatment procedures for the cornea, removal or other internal procedures for proper healing."
},
{
  "instruction": "Doctor, I'm extremely weak these days, and I'm dizzy, and I'm badly bruised, and why?",
  "input": "",
  "output": "It's possible that the diagnosis will involve a series of medical tests, such as blood tests, cell count, blood sugar measurements, electrolyte panels, MLs, kidney function, hemoglobin A1c measurements, and so on."
},
{
  "instruction": "Hi, doctor, I think it's an urgent trick, and I don't think I can control the flow of urine, and I keep leaking.",
  "input": "",
  "output": "You need to do some tests to determine the cause of the flux in the symptoms. Start with urine tests to evaluate bladder health. You may need to do an ultrasound test to measure the bladder capacity and see if it's abnormal. You may also need to do a rectal check to evaluate the tension in the anal sphincter."
},
{
  "instruction": "Doctor, I think I've got rabies, and I've been bitten by an organic dog a few days ago, and I've had flu-like symptoms.",
  "input": "",
  "output": "The medical test you need to get is an abdominal CT scan, and you need to make sure that the virus has spread to your internal organs, and then you can proceed with it."
},
{
  "instruction": "Hi, doctor, there's pain on the outside of the elbow when you grab something or lift it up, and it's been going on for weeks.",
  "input": "",
  "output": "The symptoms may also help you manage your condition by providing physical therapy, other treatment procedures, and splints, which are commonly known as tennis Elbos. You may also need an MRI test to eliminate other base diseases. You may also need to recommend other non-healthic procedures to determine what's causing the symptoms."
},
{
  "instruction": "Doctor, an accident caused an eye injury. What do you do?",
  "input": "",
  "output": "You need to evaluate your injuries with an eye examination and evaluation, and then you need to close the wound and repair the wound, and you need to do a head CAT scan and a blood alcohol test to eliminate a fundamental problem, and you need to do plastic surgery on your nose to help with the healing process."
},
{
  "instruction": "Doctor, I think I have syphilis.",
  "input": "",
  "output": "You have to start with a blood test, a physical skin test, a urine test, and you have to check glucose levels, and you have to handle injuries, and you have to do a chlamydia test, and you have to do a breast test."
},
{
  "instruction": "Hi doctor, I recently had a kidney problem with reduced urine volume and overall poor body, and I'm a diabetic and I think I'm involved in kidney disease.",
  "input": "",
  "output": "There you have to do a series of tests to determine the cause of the problem when you consider your symptoms and your history. You have to order a CBC test, a glucose test, a urine test, a hemoglobin A1c test, an electrolyte panel and a lipocardial panel."
},
{
  "instruction": "Doctor, I've recently had a lot of trouble with my nose, which is hard to breathe, and sometimes I have a terrible headache, and it's very uncomfortable to think that there's always something in my nose.",
  "input": "",
  "output": "Depending on the symptoms, a few diagnostic procedures may be needed to determine the cause of discomfort. You may also need to do a interview and evaluation. You may also need to perform a resection to remove what may be the cause of the close. You may also need to do an Influenza virus test to eliminate the infection."
},
{
  "instruction": "Doctor, I've been sick lately, and I think I've stopped taking drugs.",
  "input": "",
  "output": "I think you're going to have to do some tests to figure out the damage, first of all, see if there's any blood test, total blood count, and urine test to make sure that your blood and urine aren't in trouble, and then we need to make sure that you're normal with intravenous fluid replacement and glucose levels to make you feel better, and we need to do a kidney function and see if there's any complications."
},
{
  "instruction": "Doctor, I think I have cavities, and every time I eat sweet or sour food, my teeth get sick.",
  "input": "",
  "output": "The symptoms are very likely to have cavities, and the medical test required is dental X-rays."
},
{
  "instruction": "Doctor, I'm worried that your blood test recently showed high cholesterol levels.",
  "input": "",
  "output": "If you have high cholesterol, you have to run a lipocardial panel test to see collectively the cholesterol level. You also have to measure your blood sugar to see if you have diabetes or prediabetes. You have to do a full physical skin test to evaluate potential heart problems. You have to do an ultrasound to check your E.K.G., your hemoglobin A1c, your blood sugar levels, your blood sugar levels, and your blood pressure in your blood vessels."
},
{
  "instruction": "Sir, I fell down the stairs, got a knee injury, my knees are swollen and in pain.",
  "input": "",
  "output": "In view of the symptoms, I would recommend that you take a normal X-ray to make sure that you have a sepsis fracture. You also need to prescribe physical therapy exercises to keep your knee steady and help you recover. If necessary, you can also take a C.T. scan to check the level of injuries. Note that this injury does not require a head C.T."
},
{
  "instruction": "Doctor, I haven't had a lot of energy lately, and I think I've got a kidney problem.",
  "input": "",
  "output": "To confirm this diagnosis, a series of medical tests, including blood tests, whole blood cells, blood sugar measurements, electrolytic panels, electrocardiograms, normal X-rays and kidney function tests, are performed."
},
{
  "instruction": "Sir, I fell down the stairs and injured my neck, and the pain was so severe that I couldn't move my head.",
  "input": "",
  "output": "It is recommended to scan ordinary X-rays to make sure that there is a fracture in the neck, depending on the symptoms. It is also recommended that you perform a blood test, such as the number of blood cells, to determine whether there is a blood abnormality. You also need to scan a scan to make sure that you have a better image of the infected area. You also need to make sure that these organs function properly, including kidney function and electrocutive panels."
},
{
  "instruction": "Hi, sir, I've been experiencing a lot of muscle spasms lately, especially when you're trying to move, and it's very uncomfortable and painful.",
  "input": "",
  "output": "I'm sorry, I recommend regular X-rays to take a closer look at muscle and bone according to the symptoms, and also set up a physical therapy exercise that helps you to strengthen your muscles and prevent extra cramps, and there may be some other diagnostic procedures that will help you understand the cause of your tics better."
},
{
  "instruction": "Doctor, I've been diagnosed with hemophilia, and can you tell me what tests I need to undergo to understand my condition better?",
  "input": "",
  "output": "In order to monitor hemophilia, you need to have regular hematological tests and CBCs, and ultrasound can help you detect potential internal bleeding, and it's good to consult home health care services for continuous maintenance."
},
{
  "instruction": "Hi doctor, I'm feeling extreme thirst and frequent urination and fatigue, and I smell fruity breath, and I'm worried about some of my relatives who have diabetes.",
  "input": "",
  "output": "To diagnose this condition, you need to perform a series of medical tests, including blood tests, blood sugar measurements, cell count, intravenous fluid supplements, heart enzymes, EKG and kidney function tests."
},
{
  "instruction": "Doctor, there's severe pain on one side of the neck, difficult to swallow, high fever.",
  "input": "",
  "output": "The symptoms suggest that it may be an abscess around the abscess. To determine your diagnosis, you need to do some tests. You need to test your blood test, CBC, and kidney function to assess how well your organs function. You also need to check your electrolyte and glucose levels."
},
{
  "instruction": "Hi, doctor, I'm experiencing symptoms like nausea, vomiting, abdominal ovulation and peritoneal peritoneum.",
  "input": "",
  "output": "First, we can start with a few blood tests, such as CBC, to make sure that there's something wrong with the blood. We'll also measure glucose levels and perform electrolyte panels and kidney function tests."
},
{
  "instruction": "Doctor, in the last few days, I've had a severe case of it all over my body, and I don't know what's causing it.",
  "input": "",
  "output": "In order to diagnose the exact cause of it, you have to do a dermatological examination. You also have to do a medical examination of skin lesions, which is a medical test necessary to determine the cause of it. You can also require a chiropractoral panel and hemoglobin A1c measure to eliminate base disease. If necessary, you can do other procedures."
},
{
  "instruction": "Doctor, you've been too tired and too short of breath these days, and you've got pains in your chest and joints.",
  "input": "",
  "output": "I want to do abdominal CT scans and bone marrow transplants based on your symptoms."
},
{
  "instruction": "Doctor, I'm always tired and red in the eye, and I've got a lot of stomachaches and mysterious bruises.",
  "input": "",
  "output": "The symptoms may indicate that there is an increase in sepsis, a rare blood disease caused by excess red blood cells in the bone marrow. In order to be diagnosed, you need to run a series of blood tests, including a full blood cell count (CBC) and a physical skin test, and you need to check your breast, your work, your feet, your eyes, and see if there are other signs of disease."
},
{
  "instruction": "Doctor, I've recently been very tired and pale in skin, and I've had bruises all over my body, and I think it's going to take a long time to heal.",
  "input": "",
  "output": "I'd like to order some blood tests based on the symptoms: blood tests, blood cells, CBCs, blood sugar measurements, electrolytes, kidney function, hemoglobin A1c, and full body skin tests."
},
{
  "instruction": "Doctor, I think I've got head cancer, and I have trouble touching and swallowing a lump in my neck.",
  "input": "",
  "output": "Unfortunately, if you want to test for a diagnosis, you need to do some tissue tests. This involves micro-checking by taking a small sample of the lump. You need to do a CBC test to see if there's any damage in the blood. You need to do an MRI scan (MRI) and an X-ray scan (Sanct) to improve the range of cancer. You also need to do a fine treatment for cancer cells in the area."
},
{
  "instruction": "Doctor, I can feel muscle spasms and stinging sensations in my fingers and toes, and a few years ago, I was diagnosed with aplastic hyperthyroidism, and I think it's getting worse.",
  "input": "",
  "output": "You will need to do some medical tests to evaluate your condition first. You will need to take a closer look at your response with radiation and regular X-rays. You will also need to do complete physical skin testing to see if there are any related symptoms. You will also need to do a full body skin test to evaluate your overall health condition. You may need to do a self-sensitivity imaging (MRI) to get a better understanding of your condition according to these tests."
},
{
  "instruction": "Sir, there's been a persistent swelling of the neck and difficulty in swallowing, and I'm worried that it might be a thyroid species.",
  "input": "",
  "output": "You need to run some tests to check for thyroidomas, depending on the symptoms. You need to perform blood tests, ultrasounds, liposuction panels, complete physical skin examinations, and tissue tests. If the results are complete, you can confirm the diagnosis. You may recommend resections to remove thyroid species, depending on the severity of the disease. You also need to do a hemoglobin A1c test to make sure that there is no diabetes that can aggravate the thyroid species."
},
{
  "instruction": "Doctor, I can't ignore this anymore.",
  "input": "",
  "output": "Thank you for sharing information. To determine the cause of the fluorescence, a few medical tests need to be performed. The first test should be to make sure that there is something else wrong with the infection or urine. We also need to make sure that there is a physical abnormality in the prostate that might be causing the bone loss through a hip test and a rectal exam. We need to make sure that there is a problem with the ultrasound. We may need to do a better examination of the bladder and the pelvics and other organs to see the effect of the cholesterol."
},
{
  "instruction": "Hi, doctor, I've recently been diagnosed with Edward's syndrome, and what medical tests do I need?",
  "input": "",
  "output": "Hi, I'm sorry, the medical tests required for diagnosis include childhood catheters, microscopic tests, physical therapy exercises, ultrasound, corneal transplants, TURPs, and coronary hemolysis."
},
{
  "instruction": "Doctor, there's a deep wound in your arm that doesn't stop bleeding.",
  "input": "",
  "output": "The wound appears to be open, so we need to close the wound and stop the bleeding, and then we need to take a normal X-ray and make sure that there's something foreign to the wound, and then we need to take care of the wound and make sure that it's splints, and finally we need to do some toxic and hemolytic tests, and in severe cases, we need to do a CAT scan of the head to remove the nerve damage."
},
{
  "instruction": "Hi, doctor, we've recently had muscle problems, and we've been losing a lot of energy, and it's affecting our ability to move, and we're also getting more muscle spasms and tics.",
  "input": "",
  "output": "The first test is a complete physical skin test to evaluate the state of muscle tissue. You also need to perform an E.K.G. test to determine the level of heart function. Finally, you need to perform other diagnostic procedures, such as interviews and evaluations to help manage the symptoms."
},
{
  "instruction": "Hi doctor, there's been a sharp chest pain in the last few days, and it's been investigated, and it looks like it's Mittel Schmertz.",
  "input": "",
  "output": "You also need to do some tests, including urine tests, cBCs and blood tests, to determine the exact cause of the pain, and to eliminate other possibilities, you need to do radiation scans, standard pregnancy tests, pelvis and ultrasound scans."
},
{
  "instruction": "Sir, I've had a lot of pain in my eyes lately, and I think I'm into something.",
  "input": "",
  "output": "I'm going to take a closer look and run some tests first, and then I'm going to take this non-operation out of the eye, and then I'm going to take a closer look at the eye, and then I'm going to take a closer look at the eye, and then I'm going to take a closer look at the eye, and then I'm going to take a closer look at the eye, and then I'm going to take a closer look at the eye, and then I'm going to take a closer look at the eye, and then I'm going to take a closer look, and I'm going to take a closer look, and I'm going to take a closer look at that."
},
{
  "instruction": "Doctor, I've had a lot of rest lately, but I feel tired and numb, and when I do my research, I think it's chronic, but what kind of tests do I have to get to check this out?",
  "input": "",
  "output": "In view of what God has said, it is possible that you will have chronic disease anemia. To check this, it is good to do some medical tests, such as the CBC, the blood sugar test to check your blood sugar levels, the electrolytes panel, the E.K.G., and the whole hemoglobin A1c test to rule out other possibilities."
},
{
  "instruction": "Doctor, I've been feeling depressed and depressed for a long time, and every morning I wake up feeling sad and anxious, and I feel like I'm always feeling down and I can't shake it off.",
  "input": "",
  "output": "You may be suffering from mood failure. To confirm your diagnosis, it is recommended that you have a mental and mental evaluation to determine the best courses of treatment, including psychological and mental health counseling. In other tests mentioned, lipid panels and toxic tests are not necessary for this particular disease."
},
{
  "instruction": "Sir, I think you've got scarlet fever. You've got rashes all over your body, and you've got sore throats.",
  "input": "",
  "output": "I'd like to run a straight-line skin test to confirm the diagnosis based on the symptoms, and I'd like to run an Influenza antibodies test and eliminate the flu-similar infection."
},
{
  "instruction": "Doctor, there's recently been a warm, fatigued swelling of the legs, and there's been high blood pressure in the previous unit, so is it related to my heart?",
  "input": "",
  "output": "It's good to have a series of medical tests, such as blood tests (CBC), CBC, EKG, glucose levels, lipograms, ultrasound scans, and ML, to determine the severity of your body's condition and to make sure that you have a proper treatment plan."
},
{
  "instruction": "Hi, doctor, I've been having a hard time with the drug abuse of barbiturates, and I think it's having a huge impact on my mental and physical health.",
  "input": "",
  "output": "I'm sorry, we need to start with mental health counseling and psychological treatment, and we need to do a series of tests to analyze internal drugs and alcohol levels, including urine tests, blood alcohol levels, and toxic tests to develop treatment plans that suit individual needs."
},
{
  "instruction": "Hi doctor, I'm suffering from irregular menstruation and overgrowth of facial and body hair, and sometimes acne in the skin.",
  "input": "",
  "output": "You may have multiple ovaries syndrome or PCOS (PCOS). To confirm your diagnosis, you need to run a series of medical tests, including blood tests, pelvis, and ultrasound. You also need to test your breasts, perform lipid panel tests, and make sure you're pregnant through a standard pregnancy test. Finally, you need to do a hemoglobin A1c measure to check insulin resistance."
},
{
  "instruction": "Doctor, I've been having a lot of confusion lately, and I'm having a hard time talking and understanding things.",
  "input": "",
  "output": "You need to do some medical tests to check this out. You need to do radiation and magnetic resonance imaging. You need to do other diagnostic procedures, such as contact with physical therapists, evaluations, and counseling."
},
{
  "instruction": "Hi, doctor, I think you've got cysts in your eyelids, and for a while you're nervous and you're starting to affect your eyesight.",
  "input": "",
  "output": "The medical examination required for your condition, depending on the symptoms, is the removal of the cyst, and the biopsy. However, if the cyst damages your vision, you may need a lens and cataract surgery, eyelids, corneas or other treatment procedures or cornea transplants for the cornea."
},
{
  "instruction": "Doctor, in the last few days, my penis has been red, swollen, and painful.",
  "input": "",
  "output": "It's good to do a skin scan, urine test, rectal exam, prostate specific antigen measure, and you can also do a procedure like interview, evaluation, counseling, and other diagnostic procedures, which may encourage vaccination and vaccination as part of a treatment plan."
},
{
  "instruction": "Sir, I think there's something on my neck and I don't think I can swallow.",
  "input": "",
  "output": "The symptoms suggest that there's a foreign substance in the neck that needs to be done with ordinary X-rays to determine the location of the foreign substance."
},
{
  "instruction": "Hi doctor, I'm having a hard time with drug abuse, especially cocaine, and I want to get help.",
  "input": "",
  "output": "I recommend a series of medical tests to evaluate and treat your condition, including mental health counseling and psychological treatment to solve fundamental psychological problems that can cause addiction."
},
{
  "instruction": "Hi, sir. I've been having problems with my eyesight lately, and I've been sick of my eyes every time I move. Can you help me?",
  "input": "",
  "output": "It's possible to be cyclic based on what God has shared. To verify the diagnosis, a series of tests is recommended. You need to perform a radiation scan, an MRI scan, an eye test, and an eye examination. You may also need a diagnostic spinal tap, a cardiac ultrasound, eyelids, pericardial membranes, or some other treatment."
},
{
  "instruction": "Doctor, I've recently had chest pains and my heart seems to beat from time to time.",
  "input": "",
  "output": "Based on what you've explained, it's suspicious of the pericardial contractions."
},
{
  "instruction": "Doctor, one side of your body is weak and difficult to talk about, and you've recently been diagnosed with migraine, and what medical tests do you need?",
  "input": "",
  "output": "You need to have a magnetic resonance image (MRI) to assess the level of brain damage caused by migraine. You also need to have a radiology and X-ray computer scan (CT) test to see if there's any underlying structural abnormality. Regular physical therapy exercises are essential for rehabilitation. Additional evaluations include glucose (glucos levels) to rule out diabetes and a pre-existent panel to check the imbalance."
},
{
  "instruction": "Sir, my second toe is bent down and it hurts a lot when I walk, and I think I have a hammer toe.",
  "input": "",
  "output": "You also need to take regular X-rays to evaluate the level of deformity. If your toes are in contact with your shoes and cause skin irritation, you may need to repair the wound. If you are in a bad state, you may have to remove the bones through a resection or a bone resection. Heart failure is not a test for this disease."
},
{
  "instruction": "Sir, I fell on my bike, and I got a cut on my cheek. What do I do?",
  "input": "",
  "output": "We also need to do radiation scans to make sure that there's damage to bone and tissue, including regular X-rays and a CT scan of the head, and we need to manage injuries to prevent infection."
},
{
  "instruction": "Doctor, I've had swelling and pain in my knee in the last few days, and it's hard to bend or stretch my legs.",
  "input": "",
  "output": "Symptoms suggest that there may be a joint defibrillation. You need to perform a radiology procedure. You may need regular X-rays or MRI scans based on the severity of your condition. You may also need to recommend physical therapy or spores to reduce symptoms. You may also need to check your feet and recommend other non-healthal procedures."
},
{
  "instruction": "Good morning, sir. There's an open wound on your knee. It hurts when you move.",
  "input": "",
  "output": "The open knee wound needs to be treated through repair and skin examination. If the wound is deep enough, you can close it, or you can use splints to keep your knee steady. In severe cases, you may have to remove the wound. I'll introduce you to homehel service if necessary. I'll also check your feet to see if there's any additional injuries."
},
{
  "instruction": "Doctor, I'm suffering from a severe duodenum, memory disturbance, and I went to neurology, and I was diagnosed with E.E.G., and what should I do?",
  "input": "",
  "output": "The medical examinations needed for the encephalocardioma include radiation, magnetic resonance imaging, X-ray computer tetrahing (scanning CT), tonography of the tofu computer, and treatment for depression and physics, which may require a central nervous system incision and defibrillator."
},
{
  "instruction": "Doctor, I think there's a placental cyclotoma, and the peritoneal cortex continues to bleed.",
  "input": "",
  "output": "Unfortunately, a few tests are required to diagnose the placenta's cyclopretum. The first test is a radiation scan. You can see a clear image inside the body. You can also run a blood test, such as a blood test to check blood clotting. You can make clear the structure of the placenta and the uterus through an ultrasound."
},
{
  "instruction": "Sir, there's been a lot of eyes, tears, sneezes, nostrils, and there's a lot of seasonal allergies.",
  "input": "",
  "output": "It is good to start with eye examinations and evaluations to evaluate eye health according to the symptoms. Also, complete physical skin tests to make sure there are skin reactions. You may need other diagnostic procedures, such as interviews, evaluations, or counseling. You may also need to perform some other diagnostic procedures on the skin to run lipid panels and eliminate other base diseases."
},
{
  "instruction": "Doctor, I'm experiencing coughing, chest pains and respiratory difficulties, and I've been vomiting blood a while ago, and I'm worried if I'm getting lung cancer.",
  "input": "",
  "output": "To diagnose or eliminate lung cancer, you need to do a series of medical tests."
},
{
  "instruction": "Doctor, I've been having trouble with my kidney lately, and I think I have a primary kidney disease.",
  "input": "",
  "output": "I understand your concern. I think we should run some blood tests, cBCs, choles, glucose levels, electrolyte panels and lipids."
},
{
  "instruction": "Sir, I'm experiencing abnormal vaginal bleeding and convulsions, and I'm worried about whether it's serious.",
  "input": "",
  "output": "We need to do a blood test, including the total number of blood cells to check your pelvic and blood count according to the symptoms, and we need to do a full skin test on your breast, and we need to do a rectal examination and scan to see if there are any signs of uterine cancer."
},
{
  "instruction": "Doctor, your eyes have been dry lately.",
  "input": "",
  "output": "Other treatment procedures may be needed for eyelids, perforation and corneas. You may also have to perform diagnostic procedures for your eyes and other eye treatments. It is important to be treated and treated for the needs of other eye muscles and eye and internal and internal organs and cataracts and cataracts."
},
{
  "instruction": "Good morning, doctor, you've got a lump in your breast, you've got a tenderness, and I'm worried if you're having a serious illness.",
  "input": "",
  "output": "You need to do a thorough examination of the breast and radiology based on the symptoms. Make sure that there's nothing wrong with the reproductive organs through mammography or mammography. You may need an ultrasound or an ultrasound to get a more detailed image of the breast tissue."
},
{
  "instruction": "Doctor, I think I have a fungus infection in my head.",
  "input": "",
  "output": "The medical tests required for symptoms include complete physical skin examination, resection, wound culture, biopsy, microscopic examination, resection of skin lesions, incisions and drains."
},
{
  "instruction": "Doctor, you've got pain in your teeth, and you're swelling, and I think you've got a dental abscess.",
  "input": "",
  "output": "The symptoms suggest that you have to do an I&D procedure to make sure that you have an I&D cut, which involves a small incision in the abscess area and draining the pus out of the swollen part, and then you have to take a pus sample to make sure that the bacteria that cause the infection are infected and send it to a wound culture, which helps determine the best treatment for the patient."
},
{
  "instruction": "I'm very sick of the recent fever and muscular vomiting symptoms, and I went to the lake last week, and I'm worried if I have leptospira.",
  "input": "",
  "output": "In view of the symptoms and recent activities, it is important to have leptospirasis tested. You also need an abdominal C.T. scan to make sure that your internal organs are damaged. You can also determine whether bone marrow transplants are needed. It's important to deal quickly. You need to adjust the blood loss to make sure you don't have any additional bleeding. Finally, you need to start performing a coronary thrombosis to ensure that your heart is stable."
},
{
  "instruction": "Sir, when you're climbing, you're bitten by a spider, and the wound is swollen red and you feel pain.",
  "input": "",
  "output": "It is recommended to remove scar control, wound culture, incisions and drains, non-operative implants, and other blood vessels if necessary, and also to monitor the heart function by attaching a heart monitor. You may need an I.V. fluid replacement to supply enough water."
},
{
  "instruction": "Doctor, I've been diagnosed with vector syndrome. What medical tests do I need?",
  "input": "",
  "output": "In the case of Blotter syndrome, you need a diagnostic procedure, such as work tests, physical therapy exercises, self-resonance videos, ultrasound scans, other interviews, evaluations and counseling."
},
{
  "instruction": "Hi, sir, there's been a recent case of dizziness and dizziness, especially when you move your head, and sometimes you see two things.",
  "input": "",
  "output": "The symptoms seem to indicate that it's caused by spinal defibrillator failure. To be sure, you need to do some tests. You need to get a full blood count, a CBC, an EKG, a glucose test, an X-ray computer scan, an ultrasound, a cardiac enzyme measure (heart enzyme)."
},
{
  "instruction": "Hi, doctor, I'm experiencing symptoms related to work, such as frequent toilets, rectal bleeding, abdominal cramps, and I'm wondering what could be the problem and what tests should be done.",
  "input": "",
  "output": "In response to the symptoms, I recommend a blood test for your work, your bowel, your colon, your colon, and your blood count, your blood sugar, your electrolyte panel, your kidney function, etc., to evaluate your overall physical health."
},
{
  "instruction": "Doctor, I've been having trouble urinating for the last week, and sometimes it's taken me a long time to urinate, and I'm experiencing bladder leaks, and you know what's wrong with me?",
  "input": "",
  "output": "Symptoms may indicate that you have a mild bladder. You need to do some urine tests to confirm the diagnosis. You need to do a urine test to make sure you have an infection. You also need to do a prostate specific antigen test and a rectal test to see if there is a problem in the prostate. If an ultrasound is not tested for the condition of bladder and urethra, you may need a CT or other diagnostic procedure."
},
{
  "instruction": "Doctor, I'm getting a sense of dizzying around, and I'm a little worried that this is happening a couple of days ago, and I'm going to talk to you about this, and I'm going to talk to you about this, and I'm going to talk to you about this, and I'm going to talk to you about this, and I'm going to talk to you about this, and I'm going to talk to you about this, and I'm going to talk to you about this, and I'm going to talk to you about this.",
  "input": "",
  "output": "You may have a BPV (BPV) positive seizure. To check this, you need to run some medical tests. You need to do a radio scan and X-ray computer scan to test your inner ear. You also need to find additional blood (blood), glucose (CBC), and kidney function in order to make sure that you have a basilarial disease that can cause symptoms."
},
{
  "instruction": "Doctor, I have an unconscious eyelid, and it's difficult for me to engage in everyday activities, and do you know what's wrong with me?",
  "input": "",
  "output": "In order to understand the exact cause and severity of the condition, you need to administer muscle, sinews, injections, stensiles, joint and soft tissue, and other diagnostic procedures, such as interviews, evaluations and counseling, as well as other treatment procedures."
},
{
  "instruction": "Doctor, you're having trouble breathing, and your lymph nodes are swelling, and you're normally very tired.",
  "input": "",
  "output": "You need to run some tests to determine if there is pedophilia based on the symptoms. First, you will need to run a CBC and a blood test to check the red blood cell count (CBC) and the white blood cell count, and then you will need to perform a radio scan like X-ray or MRI to take a closer look at your lungs and lymph nodes."
},
{
  "instruction": "Doctor, I recently became very weak and lost weight, and when I got to the hospital, I was diagnosed with cancer of the opposite sex.",
  "input": "",
  "output": "I'm sorry, because I'm cancer of the opposite sex, I have to do a series of tests to fully diagnose and treat the disease."
},
{
  "instruction": "Doctor, I feel discomfort and stiffness in my fingers, especially when I'm trying to bend my fingers, and sometimes I feel like my fingers are stuck in a bent position.",
  "input": "",
  "output": "In order to manage this condition properly, you need to perform some medical tests. This includes physical therapy exercises that help you increase your wound management, other treatment procedures, and the flexibility and movement of your fingers. You can also use braces to support your affected finger, and you may need to evaluate your work skills to determine whether language therapy is needed."
},
{
  "instruction": "Sir, I've got eyelids, pain when I blink, I think it's a parakeet.",
  "input": "",
  "output": "You may need to perform eye examinations and evaluations, including vision tests, and then check for infection. You may need to consider physical therapy, manipulation, or other procedures based on the severity of the garax. If the stick is not improved, you may need to perform incisions and drains (I&D) or non-operative resections."
},
{
  "instruction": "Doctor, I recently felt extremely fatigued, weak, and disheartening skin, and I'm experiencing joint pain and abdominal pain.",
  "input": "",
  "output": "I'd like to order some medical tests to better understand the cause of these problems based on your symptoms. First, we need to do a blood test and a CBC test, and then we need to complete the actual skin test to evaluate the bronzes you mentioned."
},
{
  "instruction": "Doctor, there's been a lot of pain and swelling in the knee, and I talked to a friend who's a medical professional, and she said that there's a possibility that she's having a bone fracture.",
  "input": "",
  "output": "All right, it's good to take a radiation scan procedure to check your diagnosis according to the symptoms. It can also be done using ordinary X-rays. You may also need a biopsy (removement) to remove the growth of affected bones. You may need complete skin examination and repair of the wound, depending on the severity of your condition. You may also need other procedures, such as interviews, evaluations or counseling."
},
{
  "instruction": "Doctor, in the last few days, I've had a fever and a double abdominal pain, and I'm worried if I have typhoid fever.",
  "input": "",
  "output": "You have to do some medical tests to check for typhoid fever, to test for symptoms, to test for antibodies, blood culture, CBC and blood, but you don't need corneal transplants, atherosclerosis, coronary thrombosis to diagnose typhoid."
},
{
  "instruction": "Doctor, you can see the floating objects and the flashes of light. What's the problem?",
  "input": "",
  "output": "Symptoms may suggest that you're experiencing transmigration of the free body. To confirm the diagnosis, you have to perform an eye examination and evaluation and other diagnostic procedures for your eyes. Treatment may involve the treatment of retinal ruptures or perforations, along with other eye procedures. If necessary, you may need eyelids, perforation or endometriosis, eye cataracts, or other procedures."
},
{
  "instruction": "Sir, there's a skin disease that is getting thinner and less elastic, and I'm curious about what tests we need.",
  "input": "",
  "output": "Depending on the symptoms, it's good to have a dermatologist examine the skin, and the dermatologist can either remove or remove the area to determine the cause of thetrophysic skin disease, or recommend a biopsy."
},
{
  "instruction": "Doctor, I've been so tired and having trouble breathing these days, and coughing and chest pains are continuing.",
  "input": "",
  "output": "To confirm this, we need to do a bunch of medical tests, such as radiation scans, EKGs, X-rays, blood cells, magnetic resonance imaging, and heart monitoring, which help us understand your condition better and establish your most effective treatment plan."
},
{
  "instruction": "Hi doctor, I'm bleeding out after giving birth, and I'm worried that it's been two days.",
  "input": "",
  "output": "Well, I think you've got a lot of uterine paralysis. To diagnose this condition, a few medical tests are recommended: blood tests, CBCs, standard pregnancy, pelvis, urine tests, radiation imaging, ultrasound."
},
{
  "instruction": "Sir, I think I've got protrusion.",
  "input": "",
  "output": "In this case, you need to run some medical tests to check your diagnosis: clamydia, urine, and an abdominal CT scan."
},
{
  "instruction": "Doctor, the cough is continuing, and it's getting worse, and it doesn't look like a common cold or flu, and I've done some research, and I think it's even worse.",
  "input": "",
  "output": "You also need to perform other diagnostic procedures such as spray therapy, interview, evaluation and counseling in order to determine a proper treatment plan. In some cases, you may need to consult home health care."
},
{
  "instruction": "Doctor, I've got Pic. What kind of medical tests do I need?",
  "input": "",
  "output": "You have to get a bone marrow transplant."
},
{
  "instruction": "There's an open wound on your lips that doesn't stop bleeding. What kind of test do you need?",
  "input": "",
  "output": "It's also important to consider head CT scans to make sure there's a primary injury, and it's important to run a blood alcohol test to eliminate drug abuse that can cause injury."
},
{
  "instruction": "I'm experiencing a doctor's fever, neck pain, fatigue, weight loss.",
  "input": "",
  "output": "The first step is to have a blood test, such as blood tests. We also need to do radiation scans, urine tests, pelvis, ultrasound, and glucose measurements."
},
{
  "instruction": "Doctor, there's recently been a little point on the inside of the cheek that doesn't go away, a few weeks ago, and sometimes it hurts when you eat.",
  "input": "",
  "output": "Based on what God has explained, there may be oral perforations. In order to diagnose this, you need to do some tissue tests. This involves taking small amounts of tissue samples from infected areas and sending them to the lab for analysis. You may need to perform additional diagnostic procedures on your nose, mouth, ligaments, and pharynx, or you may need to remove the disease completely by means of an endoscopic procedure or other treatment."
},
{
  "instruction": "Hi, sir, I've recently been injured, and my arm has been injured, and I'm afraid it's very painful, and I can treat it properly.",
  "input": "",
  "output": "Hi, I'm sorry, it's good to perform a thorough skin test with the symptoms, as well as suture the wound and examine the foot, and perform a CAT scan of the head to make sure that there's any injuries in the head."
},
{
  "instruction": "Doctor, I have a severe headache, and I've passed out recently, and the E.R. doctor has said that I'm bleeding in the brain.",
  "input": "",
  "output": "All right, you have to do some tests to evaluate your condition. First, you have to do a radiation scan to determine the damage caused by the bleeding. You also have to perform a CT scan to get a detailed image of the bleeding. You also need to do a complete blood test to check for anemia or blood clots. You also need to do a complete blood count to assess the heart, which can cause bleeding. You may need to do a complete electrocardial examination of your heart."
},
{
  "instruction": "Doctor, I've recently had memory loss and confusion, and I'm worried about Alzheimer's disease.",
  "input": "",
  "output": "You need to do some tests to diagnose your heart function first. You also need to do an E.G.G. scan to see if there is a brain abnormality. Then you need to consult and evaluate an X-ray computer counselor."
},
{
  "instruction": "Sir, I'm having severe pain and discomfort in sex, and my vaginal muscles seem to contract and my sex is getting harder and harder.",
  "input": "",
  "output": "I'd like to suggest that you don't have a problem with your reproductive organs, that you don't have a history of breast cancer, that you don't have a chance of doing breast cancer, that you can test for basilar infection through urine test, that the ultrasound can help you understand structural abnormality in the pelvic region, that the rectal examination can help you understand problems that can cause discomfort in your work or around your body."
},
{
  "instruction": "Hi, doctor, I've been very tired recently, and I've had a lot of pains in my joints, and my skin has become very sensitive, and I've got rashes in my face, and I'm worried if I have SLE.",
  "input": "",
  "output": "Unfortunately, you may have SLE. To check this, you must run several tests. Tests you have to run include blood tests, complete blood count (CBC), glucose count (Cultose count), urine test, full body skin examination (ML), electrolytic panel and lipid panel."
},
{
  "instruction": "Sir, a few months ago, I'm worried if there's something wrong with the ecliptic.",
  "input": "",
  "output": "Depending on your symptoms, you need to do a number of medical tests to determine the cause of menstrual eczema: radiation, blood, ultrasound, pelvic, breast, standard pregnancy, rectal examination, and so forth."
},
{
  "instruction": "Hi, doctor, there's been a constant headache of fingers and arms, and I'm told that the arm is very easy to get tired.",
  "input": "",
  "output": "It's good to start with a physical therapy campaign to alleviate symptoms, and you can do other diagnostic procedures, such as interviews, evaluations, and counseling. You can also check with MRI to see if there's nerve or blood pressure. You can also try other physical therapy and rehabilitation techniques."
},
{
  "instruction": "Doctor, you've got a lump in your wrist and it's getting bigger and bigger.",
  "input": "",
  "output": "The symptoms are likely to indicate that it's a neuroresponsive cyst, which requires that you perform a routine X-ray or MRI scan, and you can also do a complete physical skin test to make sure that it's not another disease. If it's cyclical, you might have to remove it through a resection."
},
{
  "instruction": "Doctor, I can't walk with my knees hurt during a football game last week.",
  "input": "",
  "output": "I'm sorry, we have to do a radio scan to make sure we don't get out of the way. This may include regular X-rays and splints that help stabilize knees. We can recommend physical therapy exercises that help restore to a certain degree. In this case, we may need self-relation (MRI) or other diagnostics (MRI). But in this case, we don't need to do all the brain testing."
},
{
  "instruction": "Doctor, I've been experiencing peritoneal diarrhea for the past few weeks, and there's blood on the sides, and there's always a lack of energy, and what's the problem?",
  "input": "",
  "output": "I'd like to recommend some tests for your diagnosis, a few basic blood and urine tests, including complete blood count and urine tests, as well as glucose levels, kidney function and electrolytes panels, and we're also going to need to take into account the replacement of your veins for fluids."
},
{
  "instruction": "Doctor, I had surgery last month, and I got an infection in the wound, so can you tell me what to do with it?",
  "input": "",
  "output": "You need to take care of your wounds, clean and dressing them, and then check your blood count and blood count to check your blood count."
},
{
  "instruction": "Doctor, I've been feeling very weak lately, I'm tired, and I've got digestive problems, so what's wrong with me?",
  "input": "",
  "output": "The symptoms suggest that you may have a folic acid deficiency, which requires several medical tests: blood tests, CBCs, electrolyte panels, glucose readings, urine testing, kidney function tests, and E.K.G."
},
{
  "instruction": "Doctor, there's been a swelling of the legs and feet over the last few weeks, and it's really uncomfortable, and it's having trouble breathing at times, and I think there's a fluid overload.",
  "input": "",
  "output": "I'm sorry, I have to run some tests based on the symptoms. The first test I'm going to run is the CBC and some hepatic tests. I'm also going to need to do a radiation scan and an EKG. I'm also going to need to do regular X-rays, I'm going to have to measure glucose, and I'm going to do a kidney function test."
},
{
  "instruction": "Doctor, I had a stroke and I had a heart attack recently, and what do I need to do to manage my condition and monitor it?",
  "input": "",
  "output": "Starting with ECGs to measure the electrical activity of the heart, you need to make sure that you have a blood test (blood test) and that you have a blood-related base-to-blood condition that can cause or cause two bases."
},
{
  "instruction": "Doctor, there's been some changes in my skin, and my skin is getting dry and rough, and there's some red spots, and there's some recent lumps.",
  "input": "",
  "output": "It's good to run a skin scan to evaluate the overall condition of the skin according to the symptoms. You may need to do a laboratory test and resect the skin with another diagnostic procedure for skin and subtubation. You may also recommend managing the underlying condition of the skin to evaluate cholesterol levels, including lipocardial panels and new resections."
},
{
  "instruction": "Sir, I've got little black dots floating around in my eyes, and I've been worried lately.",
  "input": "",
  "output": "In order to diagnose and evaluate your condition, you must perform a comprehensive eye examination, eye examination, and evaluation. This can determine whether or not the cause of the wealth, additional diagnostics, or treatments are needed. You may need to perform not only eyelids, perforations, or other treatments for the cornea, but also other procedures within the eye, as necessary."
},
{
  "instruction": "Doctor, you've got a lot of pain in your teeth. I think you've got tooth disease.",
  "input": "",
  "output": "All right, so we need to run some tests to see if we can figure out what's wrong with the teeth, and we need to do other diagnostic radiation and related techniques to figure out what's wrong with the teeth, and we need to prepare for treatment, depending on the severity of the condition, such as facial fractures or dislocations."
},
{
  "instruction": "Doctor, you're all of a sudden in pain and shortness of breath last night. Is that a heart attack?",
  "input": "",
  "output": "We need to do some medical tests to determine the cause of the symptoms, first check the heart's electrical activity through the EKG, then we need to scan the heart and lungs with radiation scans such as blood tests, whole blood cells, normal X-rays, and then we need to combine the condition of the heart and lungs with cardiac enzyme measurements and kidney function tests."
},
{
  "instruction": "Doctor, I don't think your abdominal wound heals. What test do you need?",
  "input": "",
  "output": "The wound in the abdomen needs to be performed, as well as X-ray computer scans to see how deep the wound is, as well as prothrombin analysis to check kidney function and blood clots, as well as an I.V. fluid replacement to help with rapid recovery."
},
{
  "instruction": "Sir, I fell down the stairs this morning and I think I broke my leg.",
  "input": "",
  "output": "In this case, you must perform a radiation scan or a general X-ray to check for fractures. You must also perform a CBC to check your blood count and make sure that your veins need supplements. You must also run a kidney function, E.K.G., and an electrocution panel to see if there are other problems."
},
{
  "instruction": "Doctor, there's a white spot in your mouth, and it hurts when you eat or swallow, and tell me what tests you need to take.",
  "input": "",
  "output": "Symptoms include oral mouth openings, which are yeast infections, which require complete physical skin testing to determine the extent of the infection, and other diagnostic procedures, such as interviews, evaluations, and counseling."
},
{
  "instruction": "Doctor, I have a little scaly rash on my back, which was a couple of weeks ago, and it's spreading now.",
  "input": "",
  "output": "You need to have a full physical skin test to confirm your diagnosis, as well as an eye examination and evaluation to make sure you can test your feet and do a biopsy and don't affect your eyes."
},
{
  "instruction": "Sir, I think she's allergic to animals, and her eyes are so close to them that she sneezes.",
  "input": "",
  "output": "You need to perform some diagnostic procedures to check for animal allergies. You also need to do influenza virus analysis and blood culture tests. But you can eliminate CAT scans and corneal implants in your head, and you don't need to do liver function to make sure that your allergy affects you."
},
{
  "instruction": "Every time I wake up over the last few weeks, I feel dizzy and dizzy, and sometimes I feel like I'm going to faint.",
  "input": "",
  "output": "To confirm this, several medical tests are recommended, including the total number of blood cells, blood tests, electrolytic panels, and glucose measurements."
},
{
  "instruction": "Doctor, during the day, I'm feeling very hard and extremely tired. What's the cause?",
  "input": "",
  "output": "There may be a closed sleep apnea, depending on the symptoms. To check this, you need to perform a number of medical tests, including interviews, evaluations and counseling, EEGs, cardiac ultrasound, eye and diagnostic and treatment, eyelids, ultrasound for the cornea and cornea, and other treatment procedures."
},
{
  "instruction": "Doctor, I'm not feeling strong these days, and I feel tired, especially my leg muscles, and I want to know what's wrong.",
  "input": "",
  "output": "The symptoms seem to indicate that it's caused by hypothermia, which requires a series of medical tests, such as blood tests, cell counts, kidney function, electrolyte panels, glucose measurements, and radiation scans."
},
{
  "instruction": "Hi, doctor, it's been a long time since I had a red scaly spot on my skin.",
  "input": "",
  "output": "Not only do you need to perform a full physical skin test to determine the cholesterol level, but you also need to do a lipid test to check the severity of the cholesterol level. You can recommend other treatment procedures or other diagnostic procedures for skin and substrate tissue, depending on the severity of the dry line."
},
{
  "instruction": "Sir, I think I've lost my shoulder. I'm so sick that I can't move properly.",
  "input": "",
  "output": "I'm sorry. Depending on the symptoms, you need to have a radiology and general X-ray to check your shoulder defibrillation. You may need to wear splints to fix and support the area. You may also need to suggest IV fluid replacements for pain management. You may also need to have physical therapy as part of your treatment plan. You may need a heart monitor to avoid other complications, depending on the case of MRI."
},
{
  "instruction": "Doctor, I've had a lot of abdominal cramps lately, and I don't know what's going on.",
  "input": "",
  "output": "We need to run some medical tests to see if this is true. Patient:"
},
{
  "instruction": "Doctor, I'm experiencing hip pain and abnormal vaginal secretions, and I suspect endocarditis.",
  "input": "",
  "output": "We need to do some medical tests to make sure that it's actually there, and we're going to start with urine tests, standard pregnancy tests, hip tests, and then we're going to do a blood test, whole blood count, blood sugar measurements, and then we're going to do a kidney function test."
},
{
  "instruction": "Hi, doctor, there's been severe backaches, difficulty swallowing, fevers in the last two days, and when I went to a general doctor, I was diagnosed with an abscess.",
  "input": "",
  "output": "It is good to get an I.V. fluid supplement to compensate for the symptoms. You also need to do X-ray computer scans (ScanCt) to check for diagnostics and assess the level of absorption. You may also need to do a kidney function test to check the kidney function. You may need to do a kidney function (including the oscillary function). Lastly, you may need to check with antibodies, or you may need to do a large treatment."
},
{
  "instruction": "Doctor, I've recently found that my fingers and toes turn blue, and I don't have any damage, and I have a bruise in my body, so can you tell me what's wrong?",
  "input": "",
  "output": "You may have to do some medical tests to determine the number and size of your platelets and start with a complete blood count and a blood study."
},
{
  "instruction": "Doctor, I've been having whooping ulcers for weeks, and it's really painful and I don't think it's healing.",
  "input": "",
  "output": "I'm sorry, based on the information you've given me, it's good to do a thorough skin test on the affected area, and to prevent infection, you have to remove the cornea of the wound, and you have to consider resecting or removal of the infected tissue."
},
{
  "instruction": "Doctor, I've been thirsty a lot lately, and I've always had a dry mouth, and I'm not feeling strong, and I'm dizzy. Can you tell me what's wrong?",
  "input": "",
  "output": "You may have to do a few medical tests, such as blood test (blood test), cell count (CBC), glucose test, kidney function test (synthesis), and check to make sure that your veins need supplements to restore the balance between body fluids."
},
{
  "instruction": "Doctor, your hearing seems to fall out as time goes by and your ears don't hear very well.",
  "input": "",
  "output": "There are other diagnostic procedures, such as interviewing, evaluation and counseling to determine the underlying cause of hearing loss. As a result of the diagnosis, there may be other therapeutic ear procedures and diagnostic procedures for the nose, mouth, ligature, and pharynx."
},
{
  "instruction": "Doctor, I think you've got a chronic ulcer spreading in your feet, and a few weeks ago, you've got ulcers and you've started to feel a lot more pain.",
  "input": "",
  "output": "I'd like to offer you some medical tests for your symptoms, first of all, to clean and dress your ulcer properly, first of all to see the extent of the damage."
},
{
  "instruction": "Doctor, I'm often suffering from broken bones and weak bones, and I also feel a lot of pain in my hips and hips.",
  "input": "",
  "output": "You need to run some medical tests based on your symptoms. First, you need to check your blood count and make sure you have a major problem. You also need to do a lipocardial panel test to check your cholesterol levels. You also need to do a bone density scan to see if there are any signs of skin cancer."
},
{
  "instruction": "I'm suffering from a doctor, abdominal pain, abdominal splenic pain, Expression, I think he's a intestinal obstruction.",
  "input": "",
  "output": "A complete blood count, kidney function, and urine test will help you determine the severity of the disease, and may require an I.V. fluid replacement to manage the symptoms."
},
{
  "instruction": "Doctor, I've been having a lot of pain and discomfort lately, and I'm having sickle-cell anemia, and I think I'm having a sickle-cell crisis.",
  "input": "",
  "output": "The first test is the complete hematology panel, including a blood test to check the number and type of existing cells. It also requires a CBC test to determine the number and type of blood cells in your body. It also requires a radiofilping procedure, including an I.V.T. (X-ray), general X-ray, kidney function, and electrical panel."
},
{
  "instruction": "Sir, I think you've got urethra, and when I peed, I felt like I wanted to keep going to the bathroom.",
  "input": "",
  "output": "You need to do some medical tests to diagnose urethra correctly, starting with urine tests, clamydia tests, and microscopic tests to check for bacterial dryness, culture and toxicity, and you can also need to do a blood culture and HlV testing, if necessary, endocrinosis and endocrinosis."
},
{
  "instruction": "Hi, doctor, I think I've got the ear of a swimmer. It's very dark and very painful.",
  "input": "",
  "output": "It's good to do a diagnosis and evaluation to assess the level of infection. We'll also consult with an I.V. specialist for ophthalmology and after-diagnosis and treatment. We'll also cultivate the wound and do incisions and drains if necessary. We may need to remove foreign material from the ear in non-operative ways, and we may need additional diagnostic procedures to properly diagnose the infection and treat it."
},
{
  "instruction": "Doctor, I think I'm addicted to anti-convulsants, and I'm experiencing nausea, vomiting and severe nausea.",
  "input": "",
  "output": "I'm sorry, in this case, you have to do some medical tests to determine the level of addiction. You have to do a CBC test, check the kidney function, test the urine, check the electrolytes. You also need to administer intravenous fluids and monitor glucose levels in order to compensate for the fluid loss of vomiting."
},
{
  "instruction": "Doctor, your left test is really sick and swollen for a while, and I'm worried it might be a test failure.",
  "input": "",
  "output": "It's possible that it's a high-recipital failure, which requires several medical tests to confirm that a medical test for a high-circuit defibrillator requires an I.V. fluid replacement and urine test."
},
{
  "instruction": "Doctor, I'm suffering from respiratory and fatigue swelling of my legs, and my doctor suggested that I might have a tricuspid valve disease, and what should I do to confirm my diagnosis?",
  "input": "",
  "output": "Considerable tests include radiation imaging, cardiac ultrasound, and ultrasound tests, as well as lipids, heart stress tests, hemoglobin A1c measurements, interviews, evaluations, or counseling."
},
{
  "instruction": "Doctor, I'm having pains and difficulties when I urinate, sometimes I get blood mixed up in my urine, and I'm worried if there's any urethra.",
  "input": "",
  "output": "We recommend a series of medical tests based on the symptoms. First, you need to take urine tests to see if there are signs of infection or inflammation. Then you need to perform an ultrasound test to test the urethra structure, such as endoscopic or endoscopic biopsy."
},
{
  "instruction": "Doctor, I'm not feeling strong these days, I'm tired, I'm having a lot of muscle pains, and I have a lot of fractures, so can you tell me what's wrong?",
  "input": "",
  "output": "To see this, we need to do blood tests, blood sugar readings, lipids, full-body skin panels, hemoglobin A1c measurements, depression, bone density tests, etc."
},
{
  "instruction": "Sir, I think there's a wart.",
  "input": "",
  "output": "You need to run some tests to check your doubts. First, it's good to check your blood test and your CBC test to see if there's something wrong with your blood. You also need to do a radiofilping procedure to evaluate your reproductive organs. You also need to do standard pregnancy tests, urine tests, pelvis, and pelvic tests to make sure you don't have any complications from high blood sugar."
},
{
  "instruction": "I've had a lot of pain in my neck lately.",
  "input": "",
  "output": "Well, in order to accurately diagnose the current condition, we need to do some physical therapy exercises first to evaluate the level of pain and improve flexibility, and we need to do magnetic resonance imaging (MRI) and X-ray computer scans (Scan CT) to evaluate the level of neck pain."
},
{
  "instruction": "Doctor, I've been coughing and feeling fatigue and fever since last week, and I'm worried that because my grandfather had tuberculosis, I don't have it either.",
  "input": "",
  "output": "If tuberculosis is suspected, you must perform a normal X-ray first to check for changes in the chest. You also need to perform a complete physical skin test to make sure that there are signs of disease in the skin. There are other diagnostic procedures, such as the lipid panel that evaluates the overall health condition and eliminates other base diseases."
},
{
  "instruction": "I'm experiencing abnormal symptoms, such as teacher, latent, defibrillator, vaginal secretion, which is embarrassing to say, but I think there's a hip fistula.",
  "input": "",
  "output": "Thank you for sharing your symptoms, based on what you're saying, to check your pelvic defibrillation, and other diagnostic and related technologies, as well as an endoscopic and endocardial biopsy, as well as a rectal and E.E.G. test, and another course of treatment may be needed."
},
{
  "instruction": "Doctor, there's been a lot of respiratory problems and coughing, and although the symptoms were initially mild, they got worse over the last few days, and I think it's acute strepitis.",
  "input": "",
  "output": "OK, to make sure you have acute streptomytitis, you need to perform a normal X-ray, including a normal X-ray. You can also perform neblator therapy to ease your airway. You can also perform the influenza virus test to make sure that the cause of your symptoms is a virus, such as the flu. You can also perform blood culture to determine whether a bacterial infection is needed, and you can provide treatment for a respiratory or other neurological procedure if necessary."
},
{
  "instruction": "Sir, I have difficulty reading or concentrating in the neighborhood, and I feel the fatigue of my eyes when I work in the neighborhood.",
  "input": "",
  "output": "To confirm this, we also recommend the ophthalmology and ophthalmology of the eye and the epidemiology of the eye to evaluate vision more accurately, depending on the results we need to consider eyelids, membranes, other treatments for the cornea, lenses, and cataracts."
},
{
  "instruction": "Doctor, I often lose my memory, and I often get confused, and sometimes I don't recognize someone close to me.",
  "input": "",
  "output": "I'm going to recommend a series of medical tests for diagnosis based on your symptoms. First, you have to do an E.K.G. to measure the electrical activity of your heart, and then you have to do a head CT scan to eliminate brain problems. You can propose mental health counseling, physical therapy, speech therapy, or treatment evaluations based on the report."
},
{
  "instruction": "I don't know what kind of worm it is, but it's been bothering me for days.",
  "input": "",
  "output": "It's good to get a skin and a medical examination to assess the severity of the bite, and to see if there's an infection, you have to perform a wound repair and a wound culture. If necessary, you might need to remove non-surgically absorption, which can cause inflammation or inflammation."
},
{
  "instruction": "Doctor, all of a sudden my heart is beating fast and my heart is out of control.",
  "input": "",
  "output": "It is good to book an EKG test to check the electrical activity of the heart according to the symptoms. You should also check the lost water supply and the electrolyte panel to make sure that the heart function works properly. You may also need additional diagnostic procedures, such as interviews and counseling. Finally, you can check for heart enzymes to check for heart damage or evaluate your kidney health with kidney function tests. It is also essential that you use a heart monitor to monitor the activity of the heart."
},
{
  "instruction": "Sir, I'm having frequent chest pains and trouble breathing, and I think I'm having a congenital heart defect.",
  "input": "",
  "output": "We recommend a series of tests to determine the underlying cause of the symptoms: radiation, such as chest X-rays; EKGs to measure the electrical activity of the heart; ultrasound or ultrasound to better understand the structure and function of the heart; and other diagnostic procedures such as interviews, evaluations and counseling; and other diagnostic procedures, such as cardiac stress tests, to measure the ability of the heart to handle the problem."
},
{
  "instruction": "Sir, I think something's stuck in my eye. It's very painful.",
  "input": "",
  "output": "All right, the symptoms suggest that there's a chance that there's a foreign substance in your eye, and you have to remove it by non-operative surgery to make sure that you don't get infected, and you also need to repair the wound, depending on the degree of injury, you have to perform other treatment procedures on your eyelids, your membranes, your corneas, or your eyes."
},
{
  "instruction": "Doctor, I've been sick lately, and I think I'm addicted to gas.",
  "input": "",
  "output": "I'm sorry, I have to do some medical tests to diagnose and treat the current condition. I'm going to start with a normal X-ray, EKG, and an aneurysm. I'm going to do a kidney function and a heart enzyme test to monitor the organ function."
},
{
  "instruction": "Doctor, you're suffering from agronomous skin infection on your feet for a while. What medical tests do you need?",
  "input": "",
  "output": "In the case of agronomous skin infections, it is recommended to perform both physical skin examinations, wound cultures, blood and wound cultures."
},
{
  "instruction": "Sir, I've recently had severe menstrual pains and irregular menstrual periods, and I'm worried that it might be endometriosis.",
  "input": "",
  "output": "To confirm the diagnosis, you need to do a hip test and an endometrium endometriosis test, and you need to do some other diagnostic procedures involving complete body skin, breast, and female organs, and you need an ultrasound to get more information about the uterus."
},
{
  "instruction": "The doctor, my skin, especially my neck and my armpits, has a dark spot, and I'm feeling a little weak these days.",
  "input": "",
  "output": "We'd like to run a skin scan to see if you're a black witness based on your symptoms, and we'd like to see if there's a potential basilar disease using blood tests, lipometers, hemoglobin A1c and glucose measurements."
},
{
  "instruction": "Doctor, I've had chest pain recently, and I'm worried it has something to do with central artery oscillosis.",
  "input": "",
  "output": "First, we're going to take a closer look at the heart and arteries through radiation scans, ultrasounds, and EKGs, and then we're going to have to examine the lipocardial panels and do an ultrasound on the heart."
},
{
  "instruction": "Doctor, I've had rashes all over my body, and it's been very difficult for me for the last few days.",
  "input": "",
  "output": "In order to confirm this diagnosis, we recommend a full physical skin test as well as other diagnostic procedures such as interviews, evaluations and counseling."
},
{
  "instruction": "Sir, I think I've got motosis, and I've been tired and vomiting blood lately.",
  "input": "",
  "output": "We need to get an abdominal CT scan based on the symptoms to make sure that there's something wrong with the internal organs."
},
{
  "instruction": "Doctor, I've been experiencing severe peritoneal diarrhea in the last few days.",
  "input": "",
  "output": "The symptoms can lead to non-infected stomach infections, and we need to run some medical tests to check this out. Patient: What kind of medical tests do we need?"
},
{
  "instruction": "Doctor, I've had trouble urinating for quite a long time, and I sometimes feel like I'm having a lot of urination, and I don't feel completely empty of my bladder, and I'm wondering if there's a problem with the prostate.",
  "input": "",
  "output": "The symptoms suggest that there may be BPH, which requires a series of tests, such as urine tests, blood tests, prostate specific antigen measurements, rectal checks, ultrasounds, liposuction tests, and other diagnostic procedures."
},
{
  "instruction": "Hi, sir. I think I'm having menopause. I'm having blush, mood changes, sleep problems.",
  "input": "",
  "output": "It's good to rule out other potential causes through a hip test and a breast test and also run a lipocardial panel to check the cholesterol level, or perform a full skin scan and rectal examination, such as mammmography, to make sure that everything is normal."
},
{
  "instruction": "Doctor, I feel like I'm having a primary immunodeficiency, and I'm not always strong enough to get a cold.",
  "input": "",
  "output": "To diagnose original immunodeficiency, you will need to do several tests. First, you will need to do a blood test and a full blood count. You will also need to do a full physical skin test. You will also need to perform other diagnostic procedures such as electrolytic panels and interviews, evaluations and counseling. You will also need to do a hemoglobin A1c and magnetic imaging (MRI) test."
},
{
  "instruction": "Sir, there's discomfort and pain in the abdomen.",
  "input": "",
  "output": "It's good to run some medical tests to determine the underlying cause of the symptoms. We need to start with blood tests, ICBs, pelvic tests, and blood sugar measurements. We also need to perform complete physical skin testing and electrolytic panels. Finally, we need X-ray scans (CT) to look at the pelvis. Patient: Thank you, doctor. When do you know?"
},
{
  "instruction": "Doctor, I've recently had a problem with my eyesight, and I've been told that it's getting more and more difficult to see clearly, and I've been told that it could be cataracts.",
  "input": "",
  "output": "To evaluate this further, you need to perform a comprehensive eye examination and evaluation, including eye examination, to determine whether or not the lens changes are needed and whether there are any other treatments for cataracts, eyelids, corneas or corneas."
},
{
  "instruction": "Doctor, I feel a lot of pain and discomfort in my hip, and I think I'm out of hip.",
  "input": "",
  "output": "We recommend radiation shots, especially normal X-rays, depending on the symptoms. We also need to perform CBCs, electrolyte panels, glucose levels, and kidney function tests. We may also need to administer IV fluid supplements to manage the symptoms."
},
{
  "instruction": "Hi, there's so much pain and soreness in the waist, the legs, and the calf, and it's much more painful when you're walking long and standing up.",
  "input": "",
  "output": "Symptoms may indicate that you have to have several medical tests to check. You need to perform such diagnostic procedures as X-rays, MRI scans, radiation imaging procedures, interviews, evaluations and counseling, including CT scans. This may encourage relief through physical therapy exercises, catheters, spinal stimulators, and spinal tubes."
},
{
  "instruction": "Doctor, I'm having severe abdominal pain, vomiting, constipation, I think I have a bowel obstruction.",
  "input": "",
  "output": "You see, you have to do a radiation scan to check your diagnosis according to the symptoms. You have to do a blood test, a full blood count, a urine test. You also have to do regular X-rays and kidney function tests. You also have to start making IV fluid replacements to manage your symptoms."
},
{
  "instruction": "Doctor, I've been in a car accident recently, and I think I've got a heart injury.",
  "input": "",
  "output": "In this case, you have to do some medical tests, first of all, using radiation, including ordinary X-rays, to determine the extent of the damage."
},
{
  "instruction": "Doctor, I've just been diagnosed and I've been told that I have congenital deformity syndrome.",
  "input": "",
  "output": "You must have a full skin test (ML) to assess the level of deformity, and you must perform other diagnostic procedures, including interviews, evaluations, and counseling to understand your condition better."
},
{
  "instruction": "Doctor, I think I've got sporacosis, and there's a red oscillator in my skin, and over time it's spread.",
  "input": "",
  "output": "I'm sorry, to confirm your diagnosis, you have to do a complete physical skin test, and you have to do a full blood count (CBC) and a blood test to better understand your condition."
},
{
  "instruction": "Doctor, with severe skin pain, you have a red-brushed stripe, and when you touch it, your skin is hot.",
  "input": "",
  "output": "Symptoms suggest that you may have lymphocarditis, a few medical tests to properly diagnose and manage lymphatic fibrosis, which includes the number of blood cells (CBC), blood test (blood test), IV fluid replacement, blood replacement, blood culture, wound culture, incisions and drains (I&D)."
},
{
  "instruction": "Doctor, I'm having memory loss, confusion, speech problems, and I've been drinking a lot lately.",
  "input": "",
  "output": "These symptoms may have led to Bernice Corsakov's syndrome, related to alcohol abuse. To verify the diagnosis, you need to perform a series of tests, such as CBC (CBC), blood test, urine test, electrolytic panel, kidney function, replacement for intravenous fluid, and glucose readings, which help you identify the underlying cause and severity of the disease."
},
{
  "instruction": "Doctor, a few days ago, diarrhea, abdominal pain, convulsions continued.",
  "input": "",
  "output": "I'd like to give you some medical tests to check your diagnosis. Patient: What kind of tests do you need?"
},
{
  "instruction": "Doctor, you're having trouble breathing and coughing, I think it's acute bronchitis.",
  "input": "",
  "output": "To confirm the diagnosis and confirm the complications, you need to do a radiology scan, especially a general X-ray, and you need to do a nebulliser therapy to make your breathing easier, and you need to check your kidney function through a kidney function, perform an E.K.G., run a heart enzyme, and monitor your heart using a heart monitor."
},
{
  "instruction": "Doctor, there's been vomiting in the last few days, and I don't know what's causing it.",
  "input": "",
  "output": "I'm sorry, to understand the cause better, we need to do some tests. We need to start with a blood test or a blood test. We also need intravenous fluid injections, whole blood cells, urine tests, electrolyte panels, blood sugar measurements, kidney functions, and so on."
},
{
  "instruction": "Doctor, you've got a foot injury, and it doesn't heal. What tests do you need?",
  "input": "",
  "output": "You also need to make sure that your foot's normal X-rays do damage, you need to close the wound, you need to resect it, you need to brace it, you need to brace it to fix it."
},
{
  "instruction": "I'm experiencing a doctor, fatigue, shortness of breath, chest pain and irregular heartbeat.",
  "input": "",
  "output": "I'd like to encourage you to do a CBC test, a radiation video test, an EKG test, an X-ray, a blood test, an ultrasound test and an ultrasound test, based on your symptoms and your suspicion of myocarditis, which will help you to determine the severity of your disease."
},
{
  "instruction": "Doctor, I'm having high blood pressure and swelling during pregnancy, and I'm afraid it's autobiography.",
  "input": "",
  "output": "It's good to run a series of medical tests based on your symptoms: urine, blood test, ultrasound, pelvis, glucose count, electrolyte panel, interview, evaluation, counseling, and other diagnostic procedures."
},
{
  "instruction": "Hi, doctor, I've been having chest pains and respiratory difficulties lately, and I think I'm having a hemolytic heart disease.",
  "input": "",
  "output": "All right, to diagnose a hemolytic heart disease, we need to do some medical tests -- blood tests, EKGs, full blood cells, glucose levels, liposuction, ultrasound, electrolyte panels."
},
{
  "instruction": "Hi doctor, I'm experiencing some problems with the tumor of the nervous system, and I suspect neurofibrosis, and what kind of medical tests do you need?",
  "input": "",
  "output": "You need to run a series of medical tests to confirm the diagnosis of neurofibrosis. You need to do a complete physical skin test to check for skin-related symptoms. You need to do an MRI test to make sure that there are brain, spinal cord and nerve tumors or any other neurological symptoms, and you need to do other diagnostic procedures, such as interviews, evaluations and counseling."
},
{
  "instruction": "Hi, doctor, your skin is so dark these days, and you've got a red spot on your body, and I think you've got chicken pox.",
  "input": "",
  "output": "It's possible that you have chicken pox, but you have to do a complete physical skin test to confirm your diagnosis, and then you have to do a HlV test to rule out the possibility of HlV infection."
},
{
  "instruction": "Sir, we've been experiencing a recent unknown loss of weight, abdominal pain, accidental urination change.",
  "input": "",
  "output": "You also need to run a hemoglobin A1c test to check your long-term blood sugar levels. Finally, you may need to run a scan and a scan to see your pancreas better."
},
{
  "instruction": "Doctor, there are symptoms of weakness in your hands and feet after taking the medication, and it's hard to balance your body when you walk.",
  "input": "",
  "output": "We need to do some medical tests to determine the cause of the condition according to the symptoms, to check glucose levels, to make sure there are other medical conditions that can cause neurological disease, to evaluate the foot, to perform physical therapy, to perform blood alcohol and toxicity."
},
{
  "instruction": "Doctor, my child's coughing and bleating, I think it's Creep, and what medical tests do you recommend?",
  "input": "",
  "output": "Krup's case typically starts with managing the symptoms with nebulitzer therapy, but it can also be performed by analyzing influenza virus antibodies to eliminate the possibility of a virus infection that can cause krouper. If there is no relief from the symptoms with nebliser treatment and influenza tests, you may need to evaluate other respiratory options, internal and bronchoscopy, endocrinography, and endocrinosis (including endocrinosis) to a greater degree."
},
{
  "instruction": "Doctor, I'm experiencing a low vision of one eye, and I said the ophthalmologist could be weak, and what kind of test should I have?",
  "input": "",
  "output": "In the case of the drug, the physician must perform other treatment procedures for the eye and the liver, the eyelids, the pericardium and the cornea. The presumption also allows you to perform other treatment and diagnostic procedures for your eyes to properly diagnose and treat your condition."
},
{
  "instruction": "Hi, doctor, I've recently been diagnosed with the Meckel Gell's. What medical test should I have?",
  "input": "",
  "output": "You need to have a resection to remove the mekele cell. X-ray computer scans (CT scans) to make sure there are complications. You also need to perform IV fluid replacements to treat disease dehydration."
},
{
  "instruction": "Sir, I think my wrists went out during my soccer exercises yesterday, and it really hurts and I can't feel my swelling.",
  "input": "",
  "output": "I'm sorry, we've got to do regular X-rays and radiation shootings to make sure we don't get out, depending on the symptoms, and we've got to do physical therapy to improve the range of movement with the splints on the wrist, but I think we can skip the non-needed ABGs, cornea transplants, and spleens."
},
{
  "instruction": "Doctor, I'm experiencing ear pain and hearing decline, and I think there's a problem with the pericardium.",
  "input": "",
  "output": "Other diagnostic procedures, such as ophthalmosis, evaluation and counseling, may be needed. You may need to perform a pericardial resection or a pericardial resection based on the extent of the damage."
},
{
  "instruction": "Doctor, I've recently been having a problem with impotence, and I'm really starting to worry.",
  "input": "",
  "output": "I'm sorry, we have to do some medical tests to figure out the cause of impotence, which includes blood tests, urine tests, prostate specific antigen measurements, rectal examinations, liposuction panels, ultrasound, hemoglobin A1c."
},
{
  "instruction": "Doctor, recently there's been a little bit of blood in the urine, and it's gone in a day or two, and what's the cause?",
  "input": "",
  "output": "It's good to run a radiation scan and a CBC test to rule out problems such as test urine, clotting or bleeding to check for symptoms, kidney stones, tumors, or other disorders, and you may need to do an X-ray computer scan (CT scans) or an endoscopic endoscopy and end-stage biopsy."
},
{
  "instruction": "Doctor, I've been so tired and having trouble breathing lately, and my blood pressure has been going up for a while.",
  "input": "",
  "output": "I think you've been suffering from kidney disease for a long time because of high blood pressure. To confirm this, I would like to recommend various medical tests. These tests include blood tests (blood tests), Cbc (cbc), glucose levels (leucose levels), electrolyte panels, electrocardiograms, and hemoglobin A1c measurements (a1c)."
},
{
  "instruction": "Hi, doctor, it's been a long time since I've had knee pain, and I feel bad every time I bend my knee or stand up for a long time.",
  "input": "",
  "output": "Hi, I'm sorry to be disturbed. Symptoms may indicate that you have to do some medical tests to confirm your diagnosis, including radiation scans, general X-rays, physical therapy exercises, self-responsive imaging (MRI) and self-responsibility tests, and other procedures, depending on the severity of your condition."
},
{
  "instruction": "Hi, doctor, I think you've got a thick, fragile, discolored muck that affects your toenails with a fungus infection.",
  "input": "",
  "output": "You also need to check your feet to make sure your skin is affected around the infected claws. You also need to run a hemoglobin A1c measure to check your blood sugar levels. You also need to run a lip panel to evaluate your cholesterol levels."
},
{
  "instruction": "Hi doctor, I'm having pain and discomfort when I urinate, and I've also had the urge to urinate a lot.",
  "input": "",
  "output": "I'd like to run some tests based on the symptoms, and I'd like to start by doing a urine test to see if there's a physical cause. If it's necessary, you can do a CT scan, a u.V., and a biopsy."
},
{
  "instruction": "Doctor, I think I have lime disease, my symptoms are joint pain, fatigue, rash.",
  "input": "",
  "output": "We need to do some tests to identify the diagnosis, and we're going to have to start with a dermatological test, and we're going to have to do MRI, diagnostic test subjects, culture wounds, incisions and drains."
},
{
  "instruction": "Hi, doctor, I think it's because of iron deficiency anemia because I'm too tired and not strong.",
  "input": "",
  "output": "You're right, you need to run some tests to confirm your diagnosis, first of all, to recommend blood tests, cell count (CBC) and blood sugar measurements, as well as electrolyte panels and kidney function tests, and finally, complete physical skin tests to evaluate your physical symptoms."
},
{
  "instruction": "Doctor, there's a disease in the thyroid that causes too many hormones, and it's always nervous and it's double-heart.",
  "input": "",
  "output": "I recommend a comprehensive list of tests based on your symptoms and your history: blood tests, liposuction tests to check your cholesterol, ultrasound to test your thyroid, physical tests for your skin and breast, hemoglobin A1c measurements to check your blood sugar levels."
},
{
  "instruction": "Sir, I've got a cut on my finger, and I'm bleeding for a while, and I'm afraid I'm going to get infected.",
  "input": "",
  "output": "Okay, so I'm going to give you some medical tests based on what you're saying, first of all, you need to stitch up the wound, and then you need to take a normal X-ray to see if there's any damage to the bone or tissue, and you need to manage the wound and keep it stable, and then you need to make sure that it's not infected, and then you need non-operation to remove it."
},
{
  "instruction": "Hi, I'm having a lot of problems, bladder problems, persistent dizziness, heart rate and blood pressure tend to change a lot.",
  "input": "",
  "output": "You need to run some medical tests to confirm your diagnosis, including complete physical skin tests, hemoglobin A1c measurements, liposuction panels, ultrasounds, repair of wounds, and heart ultrasound, which may also require other diagnostic procedures, such as interviews, evaluations, or counseling, to understand your status better."
},
{
  "instruction": "Doctor, there's something wrong with my sexual behavior. I think I'm mentally impaired.",
  "input": "",
  "output": "Thank you for sharing the information. I'd like to recommend some medical tests based on the symptoms, complete physical skin testing, prostate specific antigen measurements and liposuction panels."
},
{
  "instruction": "Doctor, I've recently been very weak and tired, and why?",
  "input": "",
  "output": "To check this, we need to do some blood tests, whole blood cells, blood sugar measurements, electrolyte panels, urine tests, kidney function, EKG tests, and so on."
},
{
  "instruction": "Doctor, I've been experiencing pain and stiffness in my wrists for the last few weeks, and I've had difficulty catching or lifting things.",
  "input": "",
  "output": "You need to do some medical tests to diagnose and treat your condition according to the symptoms. You first need to do some physical tests to check the pain and swelling of your wrists, and then you need to do some radiation or regular X-rays to make sure that there are broken bones or any other damage. You can also recommend that you use braces to get physical or support your wrists."
},
{
  "instruction": "Doctor, I've had a cold a few days ago. I've got nostrils, coughs, noses. What do I do?",
  "input": "",
  "output": "You need to be tested for antibodies to identify the cause of the flu, as well as neblazer therapy and other respiratory treatments that can help alleviate the symptoms."
},
{
  "instruction": "Doctor, I've been having trouble talking, swallowing, walking over the last few weeks, and my muscles have become stiff and weak.",
  "input": "",
  "output": "Depending on the symptoms, there may be a condition called ALS, which requires several medical tests to check the diagnosis and determine the severity of the condition. It involves evaluations of speech therapy, self-sensitivity videos, full physical skin testing, interviews, counseling, and other diagnostic procedures."
},
{
  "instruction": "Hi, sir, I'm worried about the sudden decline in sight on one side of the eye.",
  "input": "",
  "output": "There seems to be a central retinal artery or vein blockage, which requires an eye examination and evaluation, including an ultrasound. Depending on what you have found, you may need additional diagnostic procedures for the eye or other eye, as well as a cardiac ultrasound to make sure there is a possibility of heart disease."
},
{
  "instruction": "Doctor, I'm experiencing sudden, rapid heartbeat and chest discomfort, which usually lasts a few minutes and then goes away.",
  "input": "",
  "output": "To diagnose this condition, you have to do a series of medical tests, including blood tests, EKGs, whole blood cells, radiation imaging, IV fluid supplements, normal X-rays, and heart enzymes measurements."
},
{
  "instruction": "Doctor, I've been experiencing pain and swelling in my legs for a while, and I've heard of I.V. function failure.",
  "input": "",
  "output": "It is good to run a full physical skin test to evaluate the condition of the skin. You also need to do an ultrasound test to assess the severity of the I.V. function. You may need to manage the injury, provide splints and other injuries, and remove the wound from the wound if necessary. In this case, the incision may be recommended, and another procedure may be performed to determine the optimal treatment process."
},
{
  "instruction": "Doctor, I think I've got Trikomonas infection.",
  "input": "",
  "output": "It's important to diagnose the symptoms and treat them. We need to do some medical tests first. We need to test your urine to make sure that you're in trouble. Then we need to do a blood test through a blood test, and then we need to do a hip test to make sure you have inflammation or pressure in your abdomen or vagina. Then we need to do a full blood count and kidney function test, and we need to do a standard pregnancy test to eliminate the possibility of pregnancy."
},
{
  "instruction": "Doctor, I've been suffering from acne for a while, and it's really bothering me, and I'm losing self-worth.",
  "input": "",
  "output": "In order to diagnose acne, you have to do a full physical skin test, and at the same time, you need a lipid panel to evaluate your cholesterol and your neutral fat levels, and you can remove or remove skin lesions according to the type of acne and the severity of it, and you can also do a biopsy and some other treatment."
},
{
  "instruction": "Doctor, I've been feeling so down lately that I don't know why.",
  "input": "",
  "output": "It's good to help you control your emotions based on the symptoms of psychological therapy and mental health counseling. Patient: Do you need medical tests to see if you're depressed?"
},
{
  "instruction": "Doctor, I've been having a hard time with drug abuse for months, and I want to get help.",
  "input": "",
  "output": "First, we need to do some medical tests to determine your status, and then we need to take a blood sample and make sure that the drug use has an effect on your blood cells, and then we need to run a urine test to see if there are residues in your urine."
},
{
  "instruction": "Doctor, I've been having trouble urinating a couple of days ago, and I'm having discomfort while I pee, and what's the problem?",
  "input": "",
  "output": "The symptoms may indicate that there may be lung cancer, which may help us to determine the exact cause of the symptoms and the most effective treatment options, such as urine, blood testing, radiation, rectification, rectal examination, prostate specific antigen measurements, X-ray computer scans, ultrasound scans, and ultrasound tests."
},
{
  "instruction": "Doctor, I've recently been diagnosed with backaches. What medical tests do I need?",
  "input": "",
  "output": "Blood tests, complete physical skin tests, ophthalmology, depression, foot tests and rectal tests are essential."
},
{
  "instruction": "Doctor, a few days ago, my eyes were getting sick and my eyes were getting blood clots, and I'm worried it wasn't just allergies, it was more serious.",
  "input": "",
  "output": "To be sure, you need to do eyelids, perforation and evaluations along with other treatment procedures for the cornea and the cornea."
},
{
  "instruction": "Hi doctor, there's pain and swelling in the testes, and it looks like there's a gonads vein.",
  "input": "",
  "output": "To confirm the diagnosis, I recommend a few medical tests, such as urine tests, ultrasounds, full skin tests performed by a specialist, prostate specific antigen measurements, rectal checks, and other diagnostic procedures, such as interviews, evaluations, and counseling."
},
{
  "instruction": "Doctor, abdominal pain, abdominal ovulation, constipation, I think it's hypersensitivistic bowel syndrome.",
  "input": "",
  "output": "The symptoms that God mentioned may be caused by hyper-sensive bowel syndrome. To diagnose, you need to perform some medical tests, including blood count, lipid panel and blood tests. You may also need a C.T. scan with S-synthesis, colonoscopy, rectal examination or pelvis."
},
{
  "instruction": "Sir, I think my foot's broken, and lately I've had a lot of pain in my feet, so I can't weight myself.",
  "input": "",
  "output": "It's good to do a radiation scan, especially a normal X-ray, to check for fractures according to the symptoms. You may need to take a closer look at your foot with splints, or if you have a wound, you may need to repair the wound. In the case of a fracture, you may need orthopedic casts and physical therapy to help with the healing process."
},
{
  "instruction": "Doctor, I've been to gynecology recently, and I've been diagnosed with cystic cysts.",
  "input": "",
  "output": "You also need to do a blood test (blood test), urine test, CBC test to determine whether you're infected or abnormal. You also need to do standard pregnancy tests and pelvic tests."
},
{
  "instruction": "Hi, doctor. I think I have chlamydia.",
  "input": "",
  "output": "You need to do a clamydia test, and you need to do a micro-test, a urine test, a pelvic examination, a bacterial dorsal test, a culture test, a toxic test, and you need to do an HlV test and a standard pregnancy test."
},
{
  "instruction": "Doctor, I'm very sick, but I think I have a parasite.",
  "input": "",
  "output": "You need to start with a few medical tests to determine the best treatment method. First you need to start with an I.V. fluid replacement to supply enough water. You also need to do a blood culture test to see if there are parasites in your bloodstream."
},
{
  "instruction": "Hi, doctor, I think you've got a fracture in your jaw. It's very painful and you can't keep your mouth shut.",
  "input": "",
  "output": "I'm sorry. It's good to perform a routine X-ray and X-rays, including X-rays and X-ray scans (Scanct)."
},
{
  "instruction": "Doctor, there's a lump under the skin, and my friend said it could be fatty.",
  "input": "",
  "output": "It may be, or it may be, it may be, or it may be, a complete physical skin test to determine the cause of the lump. You may need to do a resection or removal, depending on the size and position of the lump. After the procedure, you may need to manage the wound. You may also need a breast examination, a biopsy, or a lipocardial panel to remove other base diseases."
},
{
  "instruction": "Sir, I think I have a problem with my female genitals, and I feel a lot of pain and discomfort.",
  "input": "",
  "output": "I'm sorry, I'm going to have to do some medical tests, depending on the symptoms. First, I'm going to remove the infection with incisions and drains, and then I'm going to have to make sure that there's another fundamental problem with my pelvis and urine tests, and then I'm going to need to run a standard pregnancy test to avoid complications, so I'm going to monitor this and then I'm going to run a wound culture test to see if there's another infection."
},
{
  "instruction": "Doctor, I've recently experienced respiratory difficulties and chest pains, and additional studies have shown that I've been diagnosed with pulmonary hypertension.",
  "input": "",
  "output": "In the case of pulmonary hypertension, it's good to go through diagnostic procedures such as radiation scans, blood tests, EKGs, ultrasounds, cardiac ultrasounds, cardiac enzyme measurements, interviews with other specialists, evaluations and counseling."
},
{
  "instruction": "Doctor, it's been a long time since I had a lump in my neck, and I'm afraid it's a serious disease.",
  "input": "",
  "output": "It could be a thyroid fracture, and we need to do some tests to identify its properties. Patient: What kind of tests do we need?"
},
{
  "instruction": "Doctor, your teeth are broken and you're bleeding. What medical test do you need?",
  "input": "",
  "output": "We need a head CT scan to check for injuries, wound sutures, head injuries or further damage."
},
{
  "instruction": "Doctor, after a meal, you've got symptoms like nausea, vomiting, diarrhea, abdominal pain, and cold sweat.",
  "input": "",
  "output": "It's good to get a radiology scan, a heart enzyme measure, an X-ray computer scan, a kidney function, a blood sugar test, urine test, a normal X-ray test, which helps you understand the underlying cause of your symptoms and provide needed treatment."
},
{
  "instruction": "Doctor, there's a lot of pain and swelling in lymph nodes, and it's hard to move the neck and it hurts when you swallow.",
  "input": "",
  "output": "You need to do some medical tests, including blood tests, whole blood cells, CT scans, and urine tests."
},
{
  "instruction": "Hello, sir, I was injured in the face in an accident, and I feel a lot of pain and discomfort.",
  "input": "",
  "output": "I'm sorry. We have to do a radio scan to evaluate the injuries properly. Patient: What kind of video processing is there?"
},
{
  "instruction": "Doctor, we've recently had chest pain and respiratory problems, and we're worried whether they're related to aortic valve disease, and what medical tests do we need to do to determine the cause of these symptoms?",
  "input": "",
  "output": "Depending on the symptoms, we recommend the following medical tests: radio imaging, EKG, ultrasound, heart ultrasound, geostational panel, and other diagnostic procedures (diagnosis, evaluation and counseling)."
},
{
  "instruction": "Hi doctor, I've been experiencing joint pain and stiffness for a while, and I asked a friend of mine that it could be rheumatoid arthritis.",
  "input": "",
  "output": "All right, so we need to check this diagnosis through some medical tests, and we're going to start with a full blood count and some hemolytic tests, and we're going to do a full skin test with a hemoglobin A1c, and we're going to need an MRI if necessary, and the physical therapy exercises can be very helpful in managing the symptoms."
},
{
  "instruction": "Doctor, I'm feeling a little discomfort in my testes, and I found a little lump that didn't feel any pain.",
  "input": "",
  "output": "We need to do some medical tests to confirm the diagnosis. Patient: What kind of medical tests do you need?"
},
{
  "instruction": "Doctor, I think I've got absorption. It's spreading.",
  "input": "",
  "output": "To establish the diagnosis and determine the severity, it's best to take a microscope of skin cells, along with your dermatological tests, to make sure that you're infected with bacteria, such as cancer, culture, toxicity, and so forth."
},
{
  "instruction": "Hi, doctor, there's discomfort and pain around the anus, and for a while the area is getting red.",
  "input": "",
  "output": "In order to diagnose this, you need to do a rectal and pelvic examination. You may need to do an S-advisory colon and colon endoscopy to get a closer look. You may need to do a resection, or a drain, or a colectomy, or a bowel endoscopy, or some other sub-strate treatment, such as a bowel repair procedure, to improve the healing process."
},
{
  "instruction": "Doctor, even if the temperature isn't so low, I've been extremely cold and nervous for the last few days, and I'm also confused and having difficulty with movement.",
  "input": "",
  "output": "I'd like to order some medical tests to check the diagnosis, to check the severity of the condition, including blood tests, EKG, CBC, urine tests, normal X-rays, radiation scans, and heart monitoring."
},
{
  "instruction": "Hi, doctor, I think I have an opposite disorder, and I've been having a lot of arguments and a lot of anger lately.",
  "input": "",
  "output": "OK, it's good to have mental and mental health counseling, and you need to test for depression to eliminate basilar illness, and you need psychological and psychiatric evaluations and treatments to see if language therapy can be helpful."
},
{
  "instruction": "Doctor, I have a headache that repeats for a while, and it's very painful, and I think I have a migraine.",
  "input": "",
  "output": "You need to run some medical tests to diagnose your condition according to the symptoms. First, you need to check your nervous system with EEG. You can also need to do magnetic resonance imaging, head computer scan, X-ray computer scans (Scan CT)."
},
{
  "instruction": "Doctor, my hands and feet are squeamish, and I've also had a bad foot injury, and it takes a long time to heal.",
  "input": "",
  "output": "You may be suffering from post-diabetic neurosis. To properly diagnose and treat your condition, you need to do some medical tests. These include blood tests to check your condition, repair your wounds to improve your healing, test your glucose levels, complete physical skin tests, hemoglobin A1c, foot tests, and lip-cs to monitor your blood sugar levels over time."
},
{
  "instruction": "Doctor, you've got discomfort and pain in your test, so do you want to know what kind of test you need to do to figure out the cause?",
  "input": "",
  "output": "These tests include blood tests, prostate specific antigen measures, urine tests, liposuction panels, hemoglobin A1c measurements, rectal and ultrasound tests."
},
{
  "instruction": "Doctor, I think you're having cyclic diabetes, persistent thirst, frequent urination and fatigue.",
  "input": "",
  "output": "To diagnose celiac diabetes, you need to do some medical tests, such as blood tests to check blood cells, urine tests to check blood sugar sugar and proteins, blood - sugar measurements to check blood sugar levels, ultrasound tests to test the development of the fetus, pelvis to check the likelihood of early labor, hemoglobin A1c tests to evaluate the average blood sugar levels for the last two or three months."
},
{
  "instruction": "Doctor, there's a painful and repeated abscess in the armpits and the groins, and there's a lot of discomfort, and there's a scar on the sink, and I'm wondering what to do with it.",
  "input": "",
  "output": "The symptoms seem to indicate that you have a condition called pyorrhea, which requires that a dermatologist perform a direct skin test to determine the severity of your diagnosis, that you may need to repair a wound, and that if you need to do a breast examination, you may need to do a resection, or an I&D, and you may also need to do a work test and an I&D to determine the severity of your condition."
},
{
  "instruction": "Doctor, I've recently been very tired and coughing and feverish, and I've got a sense of frustration in my chest, and what's wrong with me?",
  "input": "",
  "output": "It's good to make sure your lungs are intact through regular X-rays and radiation, and you need to run a blood test, such as a heart enzyme measure and a whole blood count with kidney function."
},
{
  "instruction": "Sir, there's been a lot of swelling and swelling in the eyes with the eyelids, and when I went to the pharmacy, they said that the apothecary could be the peritonealitis caused by bacteria.",
  "input": "",
  "output": "The symptoms are likely to be bacterial pericarditis, and if you want to treat it properly, you have to have nebliser treatment that helps you fight the bacteria that cause the infection by directly transmitting antibiotics to the infection."
},
{
  "instruction": "Doctor, I'm experiencing hallucinations and sleep disorders, and I've experienced a change in thinking and reasoning ability, and I've said that my family seems to slow down and not be tuned.",
  "input": "",
  "output": "Your symptoms seem to be disturbing to you, that you need to order some medical tests to do accurate diagnosis. You need to perform some diagnostic procedures, including radiation imaging, interviews, evaluations, and counseling, including head CT scans. You need to measure heart enzymes, cultivate blood, and monitor your heart function."
},
{
  "instruction": "Sir, I think it's Marfan's syndrome.",
  "input": "",
  "output": "We need to do radiation scans, EKGs, ultrasounds, and cardiac ultrasounds, and we need to do an aortic resection, replacement, or anastomosis, along with a heart - and finally we need to do an HIV test."
},
{
  "instruction": "Sir, you hit your head hard, and you got a wound, and it hurts, and it's dizzy, and what's the problem?",
  "input": "",
  "output": "In order to confirm this, you need to perform a radiation scan. This may include head CT scans, X-rays, or regular X-rays. If the injuries are severe, you may need sutures, repair the wound, and replacement of the I.V."
},
{
  "instruction": "Doctor, I'm experiencing constant pain, with the upper right abdomen and the occasional back with the heat and nausea, and I'm also very tired and weak, and what's the problem?",
  "input": "",
  "output": "Symptoms suggest that you may be suffering from upper-age pneumothoraxitis. To confirm your diagnosis, you need to do some medical tests, such as blood tests, cell count, kidney function, electrolyte panels, radiology imaging, normal X-rays, etc., and you may need to supplement your veins to improve your symptoms."
},
{
  "instruction": "Good morning, doctor, because of the irregular periods in the past few months, you've also experienced extreme mood changes during this period, and what could possibly be the cause?",
  "input": "",
  "output": "There may be an irregular menstrual cycle based on what God says. To check this, you need to make sure that you have more than one set of medical tests, including the total blood count, blood test, pelvic examination, urine test, standard pregnancy test, breast examination and ultrasound."
},
{
  "instruction": "Doctor, a few weeks ago, you've been having a good breath and coughing, and for most of your time, you've been very tired and very weak.",
  "input": "",
  "output": "The symptoms suggest that you may be suffering from an IC lung disease. In order to establish a diagnosis, you will have to do several tests. You will need to do interviews with a specialist in order to make a diagnosis. You may need to do spray treatment, influenza virus antibodies, in order to do an endocardial and endocrinosis, in case of need."
},
{
  "instruction": "Doctor, your right hand has been hanging out for a while, and it's getting worse and worse, and your hands and your forearms are going down, and what's the problem?",
  "input": "",
  "output": "It's very likely that it's monotritis because of the symptoms. To be sure of diagnosis, you need to do thorough evaluations and interviews to learn more about your history and how you live. You need to test your feet and evaluate your coordination. You need to scan your arm's MRI to look at your affected nerves better."
},
{
  "instruction": "Doctor, I think I have malaria.",
  "input": "",
  "output": "OK, we need to run some medical tests to check for malaria. We need to make sure that we get some IV fluid supplements that help replenish fluids and treat heat. With this, we need to do a CBC test (CBC), a blood test to check for various cells in the blood, an electrocution panel that measures the amount of blood that is metastasis, an enzyme that is in the urine or bacteria, and so on."
},
{
  "instruction": "Sir, there's been a lot of physical symptoms, such as headaches, abdominal pain, joint pain, fatigue, and all these tests have come to normal.",
  "input": "",
  "output": "I think you're suffering from a physical disorder, which is a physical disorder in which you have physical pain. A medical test for this condition is psychological therapy and mental health counseling. You may also need to perform a clinical screening test for depression to eliminate a fundamental mental health problem. You can also perform liver function and standard pregnancy tests to eliminate physical causes."
},
{
  "instruction": "Doctor, I think it's dehydrated because I've been feeling dizzy lately.",
  "input": "",
  "output": "These symptoms can be described as hypoglycemia, where the blood volume is getting too low, and you have to order a series of medical tests."
},
{
  "instruction": "Doctor, I always hear voices that are very confused and don't really exist. What's wrong with me?",
  "input": "",
  "output": "You're suffering from schizophrenia, and it's good to have mental and mental health counseling checked, and you need to run some tests to eliminate the underlying diseases that can cause the symptoms, including toxicity, blood alcohol, liver function, cardiovascular gas, prothrombin time analysis."
},
{
  "instruction": "Hi, Doc. I think my knee is torn. I'm so sick that I can't carry my weight.",
  "input": "",
  "output": "I'm sorry, because of the symptoms, it's good to run a radiation scan to confirm the diagnosis. Patient: What kind of radiation sequence is there?"
},
{
  "instruction": "I'm experiencing unusual symptoms like doctor, fever, fatigue, chill, chest rash, I think I have endometriosis.",
  "input": "",
  "output": "Then you have to do some medical tests, first of all, to get a clearer picture of your heart valve, and then you have a blood test, an E.K.G., an E.G.G., an ultrasound, an ultrasound, a heart ultrasound, and a glucose test."
},
{
  "instruction": "Doctor, you've got a lack of energy and high fever, and you're recently infected, and you're treating them with antibiotics, and the fever and weakness don't go away.",
  "input": "",
  "output": "In order to diagnose this, you need to do a series of medical tests, including the CBC, including the blood count (CBC) and the function of your kidneys."
},
{
  "instruction": "Doctor, after several hours of exposure to the sun, I had a feeling of anxiety and nausea, and I had a headache and a very high body temperature.",
  "input": "",
  "output": "I'd like to run some tests to check the condition based on your symptoms: blood tests, glucose measurements, full blood count, kidney function and electrolyte panels."
},
{
  "instruction": "Doctor, there's severe pain and nausea in the upper right abdomen.",
  "input": "",
  "output": "You need to run some medical tests to check your diagnosis according to your symptoms. First, you need to check your blood tests, your cell count (CBC) and your glucose count (the glucose level) as well as your kidney function (the kidney function) and your electrolytic panel."
},
{
  "instruction": "Doctor, I'm very weak, I'm very irregular in heart rate, and I'm worried if you're having a heart attack.",
  "input": "",
  "output": "OK, so we need to check your condition according to the symptoms. We need to detect electrical activity in your heart through EKG. We also need to start using intravenous fluid replacement to restore blood pressure and increase blood flow to your organs. We also need to run a blood test and a complete blood flow test to make sure that you have a basic blood condition. We may need to attach a heart monitor to monitor your heart function constantly."
},
{
  "instruction": "Doctor, I've recently experienced deep breath and chest pain, and I'm always very tired.",
  "input": "",
  "output": "You have to do some medical tests to evaluate your heart condition. You have to do a blood test, an EKG, an ultrasound, a heart ultrasound, and a geostation panel. You can also do interviews, evaluations, and consults. We'll also do a hemoglobin A1c measure to check your blood sugar levels."
},
{
  "instruction": "Sir, I'm suffering from social phobia, and I feel extremely insecure and uncomfortable around people.",
  "input": "",
  "output": "I'd like to suggest psychological or mental health counseling that helps manage social phobias, depending on the symptoms, and we need to do screening for depression in order to eliminate the accompanying illness."
},
{
  "instruction": "Doctor, in the last few days, I've been experiencing severe scalp fever, stiffness in the neck, and I'm afraid it's a serious illness.",
  "input": "",
  "output": "We need to do some medical tests, CBC, radiation, fluid supplements, glucose test, urine test and kidney function."
},
{
  "instruction": "I'm suffering from doctors, fatigue, weakness, ectopic symptoms, anaemia in the family, and I think I'm anemic.",
  "input": "",
  "output": "I recommend you do some tests based on your symptoms and your family history, and we need to do some blood tests and CBC tests to check the health of your red blood cells, and we need to make sure you're infected through blood culture, in which case, I don't think you need psychological therapy, cornea transplants or spleens."
},
{
  "instruction": "Doctor, I'm experiencing irregular periods, and I found abnormal hair growth in the jaw and upper lip, and I suspect hormone disorders, so can you tell me what tests to take?",
  "input": "",
  "output": "The symptoms of irregular periods and abnormal hair growth may indicate that you have to examine your hormone disorders. You have to do some tests for accurate diagnosis. You have to perform full-body skin examinations, breast examinations, pelvis, liposuction panels and ultrasound scans. You also have to perform such procedures as blood tests, interviews, evaluations, and counseling to determine the exact hormone condition."
},
{
  "instruction": "Sir, I think I have Leino's disease, and when I get cold or stressed, my fingers and toes turn white or blue.",
  "input": "",
  "output": "To diagnose Leino's disease, you need to do some medical tests, first complete physical skin tests, then blood tests, and then CBC tests, as well as ultrasounds, heart ultrasound, liposuction panels, and breast tests."
},
{
  "instruction": "Doctor, I've been experiencing joint pain and swelling a couple of weeks ago, and the doctor says that it could be pulsating arthritis.",
  "input": "",
  "output": "The main treatment for pneumatic arthritis is drug and physical therapy. You have to monitor your symptoms and adjust your treatment plans according to the patient's response. You also have to do abdominal CT scans to make sure that your organs are infected."
},
{
  "instruction": "Doctor, I've been experiencing severe skin itching and rash for quite a long time, and there's also a little blister on my fingers and toes, and why?",
  "input": "",
  "output": "It's possible that it's a skin disease caused by a little mite that's digging into your skin, and you have to do a full skin test on your client to make sure that it's diagnosed."
},
{
  "instruction": "I feel a little discomfort in my left ear and I don't think I can hear much of you.",
  "input": "",
  "output": "In order to diagnose this, you need to perform some diagnostic procedures on your ears, which may include other treatment procedures, eye and eyes, diagnosis and treatment, non-operative removal of foreign substances."
},
{
  "instruction": "Doctor, I developed high blood pressure during pregnancy.",
  "input": "",
  "output": "All right, I'm sorry, to diagnose and treat high blood pressure, you need to do a number of medical tests. The first test you need to do is make sure that you have proteins or glucose in your urine through urine tests, and that you have to do an ultrasound test to monitor the baby's health, and that you have to do a fetal monitor to track the baby's heart rate, and that you need to do another test for your condition, such as if you need to do better, or if you need to do another procedure, such as if you need to do an A."
},
{
  "instruction": "Doctor, you have pain in your legs, you have bases, you have light blue discoloration in your toes, and you know what's causing it.",
  "input": "",
  "output": "There seems to be multiple medical tests in order to confirm the diagnosis. First, we need to evaluate the blood level by measuring blood cells and blood sugar, and then we need to take a closer look at the area through radiology and kidney function, and we need to make sure that the basilarial disease is treated properly."
},
{
  "instruction": "Doctor, I'm experiencing a redness of the face with acne and skin itching, which kind of medical test is needed to confirm the diagnosis?",
  "input": "",
  "output": "A complete physical skin test is performed, along with other diagnostic procedures for skin and substrate tissue."
},
{
  "instruction": "Doctor, I fell down and hit my head hard, and since then, there's been a lot of double-vaginal paralysis, and I'm worried if the skull is fractured.",
  "input": "",
  "output": "It is recommended to perform a radio scan or an X-ray computer scan to determine whether a bone fracture is caused by symptoms. You may need to use a head-to-spot (Head Ct) or a normal X-ray (X-ray) to check for diagnosis. You need to perform a bloodletting (CBC) and kidney function to eliminate other potential problems."
},
{
  "instruction": "Sir, there's a lot of pain in the eyes, and there's a lot of swelling in the eyes and a lot of blurry vision, and I'm feeling a little depressed these days, but what if it had something to do with it?",
  "input": "",
  "output": "Symptoms indicate that you may have to do an eye examination and evaluation, including eye examination. You may also need to do a clinical examination, as there is a link between endometriosis and depression, but other tests that you have mentioned, such as the lens and cataracts, the spleen, and the removal of an extrauterine pregnancy, are not associated with the diagnosis."
},
{
  "instruction": "Sir, I fell on my face yesterday, and now I'm feeling a lot of pain, and I can't open my mouth properly.",
  "input": "",
  "output": "In order to diagnose, you need to check the damage through radiation scans. You need to perform X-ray computer monot, normal X-ray (X-ray), or head-spotting, as well as internal fluid replacement, sutures, and repair of the wound."
},
{
  "instruction": "Doctor, I've been having persistent coughing and respiratory difficulties over the last few days, and I think I have bronchitis.",
  "input": "",
  "output": "It is good to start with the nebliser therapy, which helps relieve breathing problems based on the symptoms, but it is good to run additional tests to confirm the diagnosis. It is good to perform a neurologic diagnostic procedure, including endocardial and endoscopic and tissue tests. You may need other respiratory treatments, mouth and pharynx, as well as other ear diagnostic procedures."
},
{
  "instruction": "Hi, sir. I've recently had extreme pain in my jaw, but I think I'm having a problem with my jaw joint.",
  "input": "",
  "output": "I'm sorry, because of the symptoms, it's going to take care of the wound, not just the retraction, splint and other injuries."
},
{
  "instruction": "Doctor, there's a problem with the pain and swelling of the tissue around the workplace.",
  "input": "",
  "output": "There seems to be a direct infection to check the extent of the infection. You may need to do a rectal exam later on. You may need to treat the wound with an I.V. fluid to treat it properly. You may need to do kidney function because the kidney can be affected by a severe infection. You may also need to do a full skin test, and you may need to do an X-ray scan and a drain to relieve the symptoms. Finally, you can do a complete X-ray scan (T) scan to assess the condition."
},
{
  "instruction": "Doctor, I've had a lot of pain and discomfort in my breast lately, and I think it's causing a lot of pain to touch a little lump.",
  "input": "",
  "output": "It's good to run a series of medical tests to check the diagnosis and determine how best to treat the breast. It helps you to evaluate the mass of the breast and the other level of it. Then you can use mammmography, ultrasound and biopsy to determine the exact nature of the lump."
},
{
  "instruction": "I'm experiencing nightmares and flashbacks related to a traumatic event that happened a few months ago, and I'm avoiding it because there's always a feeling of anxiety and a certain situation that causes me.",
  "input": "",
  "output": "Your symptoms suggest that you're suffering from post-traumatic or post-traumatic stress disorder, which is a psychological therapy and mental health counseling that helps you deal with trauma and emotions, and you may need to do a clinical screening and mental evaluation to determine the course of treatment that is most appropriate for you."
},
{
  "instruction": "Sir, there's been strange symptoms of blood in urine and pain in the side of the throat, and I'm afraid it might be kidney cancer.",
  "input": "",
  "output": "There are some medical tests for kidney cancer, such as blood tests, cell scans, radiation, urine tests, X-line computer scans, body reasoncs, ultrasounds, and so on."
},
{
  "instruction": "Sir, I think you've got ectopic cancer -- discomfort in vaginal areas, itching, abnormal secretions.",
  "input": "",
  "output": "I'm sorry, first of all, it's good to do an O.R. test, and it's good to do an O.R. test, or a resection of a female organ, or some other therapeutic procedure, depending on the level of cancer."
},
{
  "instruction": "Doctor, your eyes are bleeding, and you've got itchy, and your eyelids are swollen, and you've been having these symptoms for weeks.",
  "input": "",
  "output": "In order to identify and evaluate the level of inflammation, we recommend a different treatment for eyelids, perforations, and corneas. We may also need some diagnostic procedures for the eye as well as for the eye and the eye, as well as for the eye, which may require lenses and cataracts, depending on the condition."
},
{
  "instruction": "I'm experiencing abdominal pain, abdominal ovulation, diarrhea after eating the wheat food, and I also have skin rashes and a feeling of helplessness.",
  "input": "",
  "output": "There's a possibility that you're suffering from celiac disease, and you need to run a series of tests, such as blood tests, whole blood cells, body skin tests, tissue tests, hemoglobin A1c measurements, liposuction panels, top-end endoscopy, tissue testing, and so on."
},
{
  "instruction": "Doctor, I'm sick of urinating a lot, but when I pee a little bit, I feel a little bit of pain in my lower abdomen.",
  "input": "",
  "output": "The symptoms suggest that you may have bladder disease. To confirm your diagnosis, you need to make sure that you have a bladder infection through a urine test. You need to check your kidney function and make sure that you have an inflammation through a hip test. You need to make sure that you are pregnant through a standard pregnancy test. If you need a liver function test, you need to make sure that you have a basilitis. You may need to insert a bladder catheter in order to obtain a urine sample for testing."
},
{
  "instruction": "Doctor, there's so much pain in your joints and your bones that sometimes you can't get up right, and your strength drops, and you're always tired.",
  "input": "",
  "output": "I'd like to ask you to do some tests to confirm your diagnosis, first of all, to check your blood count, and then to measure your urine test and glucose levels, and then to do some additional diagnostic procedures, including your doctor's interview, evaluation, and counseling."
},
{
  "instruction": "Sir, there's a red spot on the white in the eye, no pain, but it looks weird.",
  "input": "",
  "output": "We're going to need an ophthalmology test and evaluation to confirm the diagnosis. Patient: OK, what other medical tests or treatments do you need?"
},
{
  "instruction": "Doctor, I've been experiencing pain and discomfort in the lower work area for the last few weeks, and sometimes I see a lot of post-plosive blood.",
  "input": "",
  "output": "It's good to get an S-advisory colon or colonoscopy first to check your diagnosis. If necessary, you can also consider a biopsy or a resection."
},
{
  "instruction": "Sir, we're experiencing skin irritations, rashes, and itching every time we touch a particular substance, and I think it's communicable dermatitis.",
  "input": "",
  "output": "You need to do a full physical skin test based on your symptoms. You may also need a biopsy to check your contact with dermatitis. You may need a resection of your skin, or some other diagnostic procedure for your substrate tissue. You may need additional evaluations, you may need to consult home health care for treatment."
},
{
  "instruction": "Hi, doctor, I recently experienced fatigue and dizziness, and I went to another hospital, and I was diagnosed with sinus submersion.",
  "input": "",
  "output": "I'm sorry. It's good to run an E.E.G. to evaluate the electrical activity of the heart according to the symptoms and diagnosis. We also need to do a hepatic test and a CBC to determine the potential underlying cause. We also need to perform radiation imaging procedures and general X-rays (X-rays) to evaluate the level of structural changes that occur."
},
{
  "instruction": "Doctor, I'm worried about high blood pressure.",
  "input": "",
  "output": "If you want to evaluate your blood pressure properly, you need to do multiple medical tests, such as a whole blood test or a CBC test, a liposuction panel to evaluate your cholesterol levels, a glucose level to check your sugar levels, an E.K.G. or an E.G.G. to check your heart activity, or a hemoglobin A1c test to evaluate your blood sugar levels over time, or an ultrasound to evaluate your heart and kidney function."
},
{
  "instruction": "Doctor, a few days ago, there was lower abdominal pain and fever, and there was a vaginal vaginal vaginal vaginal vaginal secretion, and I think there was an inflammation of the pelvis.",
  "input": "",
  "output": "I'm sorry, we need to do some medical tests to test the diagnosis based on the symptoms: we need to do urine, whole blood, standard pregnancy, and kidney function; we also need to do radiation scans and pelvics to determine the exact cause of the symptoms."
},
{
  "instruction": "I'm worried about whether there's liver disease or not.",
  "input": "",
  "output": "You need to do some medical tests to make sure you have liver disease based on your symptoms. You need to do a CBC test, a blood study, a glucose count, an electrolyte panel, a kidney function test, and so on. You also need to do a radiation scan and urine test to understand your condition better."
},
{
  "instruction": "Hi, doctor, I've had a persistent problem with defecation for a while, and I've tried a bunch of treatments, but they don't seem to work.",
  "input": "",
  "output": "Okay, it's good to run some medical tests to find out what's going on. First, we need to make sure we don't have a blockage or a deficiency in the digestive system through radiology and regular X-rays. We also need to run a full blood count and a few blood tests to see if there's any infection or nutritional deficiency that can cause symptoms."
},
{
  "instruction": "Doctor, you've got a lump in your neck, and the diagnosis is that it's thyroid cancer.",
  "input": "",
  "output": "You need to check your blood count and complete your skin test, and then you need an ultrasound and a tissue test to confirm your diagnosis, and you can also recommend radiation and resection for cancer, and you need to check your hemoglobin A1c."
},
{
  "instruction": "Doctor, you've been sick lately, you've got a fever, you've been coughing, you've got a lot of energy.",
  "input": "",
  "output": "I think you've got the flu, and you need to do some tests to diagnose it. Patient: What kind of tests do you do?"
},
{
  "instruction": "Doctor, I think you've recently had a hard time controlling your movement, and having a lot of difficulty walking and maintaining balance.",
  "input": "",
  "output": "I'd like to run some tests based on the symptoms, and I need to do a cardiac ultrasound, an ultrasound, an E.K.G. test to check the heart condition, and I'm going to book a pelvic exam to see if there's anything wrong with it."
},
{
  "instruction": "Hi doctor, I'm experiencing facial and sometimes unconscious movement of the arm in front of my friends, just to know if there's anything I can do.",
  "input": "",
  "output": "You've got to do some tests to determine the best treatment, including psychological care, mental health counseling, interviews and evaluations."
},
{
  "instruction": "Doctor, I found a little lump in my skin growing slowly for a while, and when I touched it, it started to feel rough and nervous, so can you tell me what caused it?",
  "input": "",
  "output": "In order to verify this, you must perform a complete physical skin test with a tissue test. The next step under a specific diagnosis is to remove or remove the solvent. You may also need to consider the damage control and other diagnostics and treatment procedures of the infection."
},
{
  "instruction": "Sir, I have sudden, severe pain in my shoulder and elbow, and I feel weak.",
  "input": "",
  "output": "There are general X-rays and magnetic resonance imaging (MRI) which make sure that there is an abnormality in the area. Physical therapy is also recommended to restore arm power and movement. It may require catheter or spinal stimulator implants, injections in the spinal canal, and other diagnostics (suppression, evaluation, and counseling) to determine the underlying cause of the condition."
},
{
  "instruction": "Sir, there's abnormal vaginal bleeding and pelvic pain, and I'm afraid it's uterine cancer.",
  "input": "",
  "output": "Sir, you need to do some medical tests to diagnose uterine cancer. First, you need to do a pelvic test to check the cervix, the uterus, the ovaries, and so on. Then you can make sure that there are abnormal cells in the cervix. You can also perform mammmography, hysterectomy, and other diagnostic procedures for women's organs."
},
{
  "instruction": "I'm experiencing symptoms of weight gain, diabetes, high blood pressure, and home medicine doctors have asked me to find a lump in my adrenal glands and consult an endocrinologist.",
  "input": "",
  "output": "The first test you need to perform is a urine test to make sure your adrenal glands produce excess hormones. It will lead to magnetic resonance imaging (MRI) and X-ray computer scans (ScanTTT). You may also need to consider other procedures that can help you manage your symptoms better, depending on the results. You may consider other procedures that will help you to test the effect on the heart."
},
{
  "instruction": "Doctor, I feel like I'm in my chest, and I can't swallow it, but I think I'm going to have to do some esophageal tests.",
  "input": "",
  "output": "It is good to start with a blood test or a CBC test to make sure there are signs of infection or inflammation. You also need to take a normal X-ray to check for damage to your esophagus. You also need an EKG and an electrocardiogram panel to check the balance of your heart's health and body fluids."
},
{
  "instruction": "Doctor, what kind of test do you need for a gas continuer?",
  "input": "",
  "output": "You need an abdominal C.T. test to determine the extent of the infection, and you need a spleen surgery, like a spleen, and a bone marrow transplant to replace the infected bone marrow."
},
{
  "instruction": "Doctor, there's discomfort and itching in the vagina, and I think there's yeast infection.",
  "input": "",
  "output": "I'm sorry, I recommend a pelvic examination and urine test to check for diagnosis. You may also need a complete physical skin test and a clamydia test to eliminate other potential problems."
},
{
  "instruction": "Sir, I think you've got spina bifida and back pain and leg arrest.",
  "input": "",
  "output": "We're going to have to run a radio scan to monitor the spine better and accurately diagnose the state. We're also going to have to do an interactive X-ray to make sure that we don't see any damage. We're also going to do general X-rays to help reduce the risk of infection. We're also going to have to do physical therapy to manage the symptoms and improve overall health."
},
{
  "instruction": "Doctor, after taking the medication, you're really sick, you're experiencing nausea, vomiting, nausea, what's the problem?",
  "input": "",
  "output": "In view of these symptoms, there is a possibility that Germany will be given some drug drugs to check the diagnosis and provide the best treatment: complete blood count, kidney function, urine testing and glucose measurements, and also help monitor the heart rate and drain the drug out of the body by means of an I.V. fluid."
},
{
  "instruction": "Doctor, you're not feeling well these days, you're experiencing abdominal pain, anorexia, nausea, you're also drinking a lot, can you tell me what's wrong?",
  "input": "",
  "output": "In view of the symptoms and the intake of alcohol, it is possible that you will have an alcohol - a series of tests to determine your diagnosis. This includes blood tests, CBCs, radiation scans, glucose measurements, intravenous fluid supplements, electrolyte panels, urine tests, and so forth."
},
{
  "instruction": "Sir, I've recently had a very severe look-aggression, and I went to the ophthalmology office and told them it could be malignant high blood pressure.",
  "input": "",
  "output": "In this case, you have to do a series of medical tests to check your diagnosis."
},
{
  "instruction": "Doctor, I've been experiencing severe abdominal discomfort in the last few days, vomiting, constipation and fever, and I think I've done some research on this.",
  "input": "",
  "output": "You need to do some medical tests to check your diagnosis. First, you need to check for signs of infection through blood tests, CBC (CBC) and urine tests. You also need to perform a radiation scan like X-ray computer scan (Scanct) to visualize the level of inflammation of the colon. You may need to start a surgical procedure to repair the internal fluid with vomiting and check the function of your kidneys."
},
{
  "instruction": "Hi, doctor, I have a lot of double-pass passed out, and recently I have symptoms of weakness on one side of my body.",
  "input": "",
  "output": "We need to run some medical tests to confirm the diagnosis, and the first test is to take a blood sample to see if there's something wrong with the blood cells. Patient: OK, what else do we need to do?"
},
{
  "instruction": "Hi, sir, I'm having a lot of water, but I've been feeling a little dizzy lately, and I think it's because of the heat.",
  "input": "",
  "output": "You need to run some medical tests first to check for dehydration, and then you need to take some blood tests and cBCs to make sure that you replace the I.V. fluid, check the kidney function, and check your body's salts and potassium levels through electrocardiograms, and finally check your blood sugar levels through the test."
},
{
  "instruction": "Hi, doctor, I'm suffering from mental disorders such as hallucinations and delusions.",
  "input": "",
  "output": "I'm sorry, for your condition to be properly diagnosed and treated, you need to do a series of medical tests."
},
{
  "instruction": "Hi, sir. I think I have frostbite. My toes and fingers are off and I'm in pain.",
  "input": "",
  "output": "Hi, it's important to eliminate other diseases that can cause similar symptoms, and it's good to perform a complete physical skin test with injury management."
},
{
  "instruction": "Sir, I've recently had a problem with the erection, and I don't know why.",
  "input": "",
  "output": "Depending on the symptoms, it's good to run a physical skin test with a urine test, and you can also need a urethra resection or some other procedure to consider other procedures, such as juvenile catheters inserted on male genitals, or other procedures."
},
{
  "instruction": "Sir, I've been smoking for quite some time, and I think I'm addicted, and I want to quit smoking, but it's hard to quit, how can I help you?",
  "input": "",
  "output": "The first step, of course, is to get mental health counseling and psychological care to understand the psychological problems of addiction, and also to perform the geo-hemologic panels and hemoglobin A1c measurements to see if there's any related health problems, and you can also use Nebulliser therapy to make sure you're mentally and physically healthy."
},
{
  "instruction": "Sir, there's a lot of pain and swelling in her ankle.",
  "input": "",
  "output": "In order to determine the extent of the injury and the best treatment, you have to do a normal X-ray or a self-resonant image, and you also have to recommend a physical therapy that can help you recover with splints and casts."
},
{
  "instruction": "Doctor, you've had tremors for a long time, and it's getting worse day by day.",
  "input": "",
  "output": "We need to do some tests based on what you're saying. We need to do interviews and evaluations. We'll also need to do physical therapy that helps us evaluate the underlying causes of tremor."
},
{
  "instruction": "Doctor, there's an open wound in your ear that doesn't heal. What do you do?",
  "input": "",
  "output": "You can also do head CT scans or scan scans to make sure you don't have any fundamental damage to your head, and you can use the braces in your ear to improve the healing, and then you can do a different therapeutic ear procedure, depending on the need."
},
{
  "instruction": "Doctor, I think there's something wrong with my nose, and when I'm breathing, I feel a sense of reason.",
  "input": "",
  "output": "The symptoms indicate that there's a chance that there's a foreign substance in the nose, and in this case, the medical test required is to remove it non-surgically."
},
{
  "instruction": "Hi, doctor, you're having a lot of menstrual pain, and you don't have an underlying disease to explain, do you want to know what tests you need to do to figure out the cause of the problem?",
  "input": "",
  "output": "For acute menstrual pain, several tests are recommended, such as blood tests, urine tests, pelvic tests, full blood count (CBC), standard pregnancy, breast examination, ultrasound, and so forth, to eliminate a condition that normally can cause pain."
},
{
  "instruction": "Sir, I think my kid's Down's syndrome.",
  "input": "",
  "output": "We need to do complete physical skin tests with interviews, evaluations, counseling and other diagnostic procedures, including mental health counseling and working care for language treatments, physical therapy exercises, and hemoglobin A1c tests and cardiac ultrasound to eliminate related complications."
},
{
  "instruction": "Hi, doctor, I don't have a lot of menstruation, I don't know what's causing it.",
  "input": "",
  "output": "We need to do a series of medical tests to figure out the cause of irregular menstruation, to do both pelvis, breast and skin tests, and to do standard pregnancy tests and chlamydia tests."
},
{
  "instruction": "Doctor, I'm having sharp chest pains and difficulty breathing, and I feel like I'm choking.",
  "input": "",
  "output": "You will need to do some tests, including regular X-rays and kidney function tests. You will also need to perform a complete blood count (CBC) to check your ability to deliver oxygen in your blood, and in severe cases you may need a CT scan (CT) of X-ray computers and an I.V. fluid supplement."
},
{
  "instruction": "Doctor, a few weeks ago, you had pain and swelling in your wrist and thumb, and it hurts when you're trying to grab or pick things up.",
  "input": "",
  "output": "You may need to run some medical tests to verify the diagnosis. You may first get physical tests with braces on your wrists and thumb. You may also need to evaluate work care and consider injections or absorption for muscle, sinews, stenosis, joint or soft tissue."
},
{
  "instruction": "Sir, your back is very sick and you can't move in any particular position.",
  "input": "",
  "output": "This may include regular X-rays, X-ray computer scans (scan CT) and CbC (cbc). Since we need to monitor the water level and kidney function, we can recommend changing the fluid in the veins if necessary."
},
{
  "instruction": "Doctor, I'm worried that I'm infected with HlV, and I'm wondering what kind of tests I need because I'm not feeling well recently.",
  "input": "",
  "output": "It's good to have a series of tests to see if you're infected with HlV; you have to have a full blood count, a blood sugar measurement, and a lipid panel; you also have to do electrocution panels; and finally, it's good to have mental health counseling to help you deal with your diagnosis."
},
{
  "instruction": "Sir, I've got pain and swelling in my salivary glands, and I think I'm having an epidemic of hypotensive hypodermics.",
  "input": "",
  "output": "Yes, the pain and swelling of the sleeping glands are typical symptoms of hyperthyroiditis. You need to order some medical tests to confirm that you have to have blood tests, cell counts, and an abdominal CT scan."
},
{
  "instruction": "Hi, doctor, I'm having a severe headache, and I'm saying that people around me look different, and I think I have a problem.",
  "input": "",
  "output": "These symptoms may indicate sub-arachnoid bleeding. It is good to run some medical tests to check your diagnosis. You need to do radiation scans, head CT scans, and kidney function tests, as well as CBC, blood tests, and I.V. fluid supplements to determine the underlying cause of your condition."
},
{
  "instruction": "Doctor, there's discomfort and pain in the upper right abdomen and digestive problems, nausea and vomiting, can you tell me what's wrong?",
  "input": "",
  "output": "There is a possibility of an AFLP (AFLP) that will help you diagnose your condition. You need to test your urine, pelvic, and ultrasound. You also need to test your clamydia and your breast. You need to do a liver function test to determine the level of liver damage."
},
{
  "instruction": "Doctor, the eyelids go outward, and I feel very dry, and I always feel like something's in my eyes.",
  "input": "",
  "output": "The medical examination required for your condition includes physical therapy exercises, manipulation and other procedures, other treatment procedures for eyelids, perforations and corneas, eye examinations, physical therapy, and, in severe cases, cornea transplants."
},
{
  "instruction": "Hi, doctor, I'm nervous because I have a scar on my left arm. What test do you need?",
  "input": "",
  "output": "We recommend a complete physical skin test to assess the size and severity of the scar, and then we need to do a breast test, which may be a symptom of a fundamental hormone imbalance that can cause scarring, and then we can consider not only the injury management, the removal of skin lesions or other treatment procedures, but other diagnostic procedures, such as interviews and counseling."
},
{
  "instruction": "Doctor, I'm experiencing symptoms after taking milk or dairy, such as nausea, stomach cramps, abdominal ovation, diarrhea, what's the problem?",
  "input": "",
  "output": "You need to do a series of medical tests, such as blood tests, glucose measurements, hemoglobin A1c measurements, liposuction panels, complete physical skin testing, interviews, evaluations and counseling."
},
{
  "instruction": "Hi, sir. I think I'm not hearing well and I'm feeling the pressure in my ear.",
  "input": "",
  "output": "To diagnose and treat this disease, you must perform a diagnostic procedure, such as ophthalmology and susceptibility and treatment, of course questions, evaluations, evaluations, counseling, and so forth. In severe cases, there may be a need for absorption of the ear, nose, mouth, and pharynx, or removal of infected tissue."
},
{
  "instruction": "Doctor, I have severe abdominal pain, and I suspect appendicitis. What do I do?",
  "input": "",
  "output": "To properly diagnose appendicitis, you need to do several tests. First, you need to check your blood count to see if there are signs of infection in your blood, and then you need to perform a radiation scan like an X-ray computer scan (CT scan) to get a detailed image of your abdomen, and then you need to do a urine test and kidney function to eliminate other potential causes of symptoms."
},
{
  "instruction": "Doctor, I'm experiencing rapid heart rate, tremor, weight loss and sleep disorder.",
  "input": "",
  "output": "You need to check your diagnosis through some medical tests. First, you need to do a blood test, which includes a complete blood count (CBC), which also includes a full blood count (CBC) which will also help you determine whether your heart rhythm is normal."
},
{
  "instruction": "Sir, I fell down and I got a cut in my face, and I think I'm gonna have to sew it up because there's a lot of blood.",
  "input": "",
  "output": "Yes, the first test you need to do is close the wound. You also need to repair the wound so that no infection does not occur. You also need to perform a CAT scan of your head to see if there's any additional injuries. You need to check blood alcohol levels because you've fallen."
},
{
  "instruction": "Sir, I think I've defibrillated my spine, and I'm so sick that I can barely move.",
  "input": "",
  "output": "In the light of the symptoms, we're going to have to take a closer look at the spine to see if there's a spinal defect. Patient: What kind of test does that involve?"
},
{
  "instruction": "There's a problem we're having a little bit of a suffocation, there's a lot of pain, there's inflammation, and what do we do?",
  "input": "",
  "output": "Symptoms seem to indicate that there is a condition called parasol scleroderma. You should do a complete physical skin test before deciding what to do best. In some cases non-opusive urology measures may be helpful, but if the condition is severe, you may need to perform a resection along with other diagnostic procedures as required. You may also need to do a procedure on udo catheters and urethra before the procedure is done."
},
{
  "instruction": "Doctor, I'm experiencing severe nausea and vomiting during pregnancy, which causes me to lose weight and lose energy.",
  "input": "",
  "output": "You've got to do some medical tests to figure out the severity of the situation and to check your health. This includes blood tests, urine tests, CBC, I.V. fluid supplements, glucose levels, kidney function, and electrolyte panels."
},
{
  "instruction": "Hi, I think I'm pregnant.",
  "input": "",
  "output": "You have to do a standard pregnancy test first to make sure you're pregnant. Patient: OK, what else do you need to do?"
},
{
  "instruction": "Doctor, I'm very tired and weak these days, and I think my skin looks paleer than usual, and I think I'm short of breath, and I'm afraid that it might be thalassemia.",
  "input": "",
  "output": "The symptoms suggest that you may have some thalassemia. To check this, you need to do some medical tests. You need to do a blood test, a CBC, a skin test, hemoglobin A1c measurements, liposuction panels, and other diagnostic procedures (hemolysis, evaluation, counseling) and HIV tests. This allows you to diagnose your condition and provide adequate treatment for your condition."
},
{
  "instruction": "Doctor, I experienced a lot of bleeding during pregnancy, and the doctor said that it's the extrinsic placenta, and what kind of test should I have?",
  "input": "",
  "output": "Depending on the symptoms, we need to determine the severity of the condition and evaluate the health of the baby and the ear through radiation, ultrasound or ultrasound, urine test, pelvis test, heart ultrasound, breast examination and fetal monitoring."
},
{
  "instruction": "Doctor, after a recent head injury, I lost a severe double-pass consciousness.",
  "input": "",
  "output": "Symptoms require several medical tests to confirm the diagnosis. You need to get a head image from radiation, X-ray computer scans, X-ray scans, X-ray scans (X-ray scans). You also need to perform a blood-red blood cell, white cells, and cBC to measure the number of platelets."
},
{
  "instruction": "Hi, sir. I think I've got something. My feet are too dark, too red, and my skin is peeling off.",
  "input": "",
  "output": "To determine if there are any symptoms, you need to have a thorough skin examination by a dermatologist. You also need to have your feet tested to determine the extent of the infection. You may need to consider resecting the injuries to prevent further complications. You may need to perform a B.1c (Ac1) test to monitor the overall health condition and test for diabetes."
},
{
  "instruction": "Doctor, I'm experiencing shortness of breath and chest pain, and the doctor says there's a thoracotomy, and what should be done to confirm this diagnosis?",
  "input": "",
  "output": "Yes, the symptoms you have described match the thoracotomy. You need to perform a routine X-ray procedure. You need to do some blood tests, such as full blood count, blood sugar, and kidney function. You can also run an EKG test to see if your heart is functioning properly."
},
{
  "instruction": "Sir, lately, the focus of your visual field is not right, and your eyes are easily fatigued.",
  "input": "",
  "output": "There may be an underlying disease in the drug scene. It is good to perform a thorough eye examination and evaluation to evaluate vision, pressure, and overall eye health. You may also need to perform other treatment procedures on the eyelids, perforations and corneas to manage a mild case. You may also need to perform different eye muscles and internal and internal and ligaments, as well as cataracts and cataracts if necessary."
},
{
  "instruction": "Doctor, I think I'm having an out-of-body disease, and I'm experiencing hotness and itching.",
  "input": "",
  "output": "I encourage you to understand your condition better, depending on your symptoms, through a hip test, urine and biopsy, and you can also need a full physical skin test and a breast examination."
},
{
  "instruction": "Doctor, I don't feel strong these days, and I'm worried about vitamin deficiency.",
  "input": "",
  "output": "You need to do some medical tests to identify the root cause. You need to do some medical tests, including the symptoms such as the CBC, the glucose count, and the electrolyte panel to detect vitamin B deficiency."
},
{
  "instruction": "Hi, doctor, your salivary glands are swollen and in pain. What do you think is the problem and what tests do you need?",
  "input": "",
  "output": "You need to do some medical tests to check this out. The first is to get a detailed image of an infected area with an X-ray computer scan (ScanCt). You also need to supplement your veins to reduce inflammation. You may need to do a head scan to see if there's another problem causing the symptoms."
},
{
  "instruction": "Doctor, my chest is getting bigger and I'm feeling a little tenderness. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there is a female form of mammography, which is first performed to determine the extent of the condition, and then complete physical skin testing to see if there is any other problem, then we can do mammmography to test the breast tissue, and then we can consider other treatment procedures, such as biopsy or resection, and we can also do an A1c measurement to make sure that there is a potential base condition."
},
{
  "instruction": "Doctor, I'm experiencing pain and irritation during urination, and I think I'm going to have to go to the bathroom more often.",
  "input": "",
  "output": "The symptoms seem to indicate that there's an infection. To verify this, you have to check your urine with urine tests. You also need to run blood tests, CBC and electrolyte panels to see if there are signs of infection or inflammation. You may need to check your kidney function and glucose levels. You may need an I.V. fluid replacement to relieve symptoms and prevent dehydration."
},
{
  "instruction": "Hi, doctor, we've had rashes and blisters on the skin over the last few days, and they're spreading and getting worse, they're feverish, they're sick.",
  "input": "",
  "output": "You need to run some tests to check your diagnosis and determine how best to treat it. You need a complete body skin test, a glucose count, an electrolyte panel test, a kidney function, a liver function, a liver function, a catheter in the bladder."
},
{
  "instruction": "Hi, sir, I've been feeling back pain and discomfort for a long time, and I finally decided to come to you for medical attention, and I want to know if you can diagnose what's wrong with me.",
  "input": "",
  "output": "I'm sorry, it's possible that the symptoms indicate that the spinal cord may bend. In addition to other diagnostic procedures, such as interviews, evaluations and counseling, we need to perform radiation scans, especially regular X-rays. Treatment may involve physical therapy to manage pain, and other treatment procedures, and we may need to use different physical therapy and rehabilitation techniques based on the degree of spinal S.T.I.E.D.D."
},
{
  "instruction": "Sir, I've recently had a problem with my foot, and it hurts when I walk with a lump next to my big toe.",
  "input": "",
  "output": "It's good to take a normal X-ray to check the diagnosis and see how bad it is. You also need to run a physical examination of your feet to see if there's any other problem. The treatment options may include the removal or removal of your hair, resection of your toes or repair the wounds, and so on."
},
{
  "instruction": "Doctor, I've recently had an irregular heart rate, I think I have an arrhythmia.",
  "input": "",
  "output": "You need to run some medical tests to determine whether arrhythmia is in progress. First, you will check your heart's electrical activity with EKG. You will also need to measure some hematological tests and whole blood cells to determine the potential underlying cause."
},
{
  "instruction": "Hi, doctor, I think you've got a lot of bone pain and a very weak bone, and I've noticed that the joints are very stiff and the bones are easily broken, and what's the problem?",
  "input": "",
  "output": "To verify this diagnosis, you need to run some other medical tests. CBC (CBC), bone density test, S-synthesis, E.A., E.G., G.S., G.V., G.V., G.R., G.R., G.D., G., G.D., G.D., G., G.D., G.D., G., G., C.D.D., test the blood, make sure that there are several microscopes in the blood, and make sure that you understand the condition of bone density in the bone density. This is a final check for the E.B.B.T.T."
},
{
  "instruction": "Hi, doctor, you've got severe facial pain, sudden and severe pain for about two minutes, and it's a lot of times throughout the day.",
  "input": "",
  "output": "Symptoms suggest that there is a pain caused by a third-side neurosis. This is a nerve disorder that causes sharp and sudden pain in the face. To test for a diagnosis, you have to do a lot of tests, including magnetic resonance imaging (MRI), which involves checking EGs (EGs), inside and inside, diagnostics, and other radiations."
},
{
  "instruction": "Doctor, I've been experiencing back pain and stiffness for quite a long time, so much so that I can't get out of bed in the morning.",
  "input": "",
  "output": "It is highly likely that it is active for symptoms. To verify the diagnosis, you need to do some medical tests. First, you need to start with some physical therapy exercises to make sure that physical therapy is helpful for the symptoms. You will also need to do automune imaging (MRI) to see the spines closely. Other tests may include catheters or spinal stimulators, intravascular implants, and other nonsculusal procedures for the skeletal system."
},
{
  "instruction": "Hi, doctor, I'm losing my limbs and my fingers, and I'm also losing a lot of coordination.",
  "input": "",
  "output": "Sir, I would like to recommend a series of diagnostic procedures based on symptoms, including MRI and hemoglobin A1c tests to make sure that you have a nervous disorder."
},
{
  "instruction": "Hi, doctor, I've been nervous for a while because of the lump on my skin, and I'm feeling pain, and I think it's getting bigger and bigger.",
  "input": "",
  "output": "According to your description, it is possible to be a Fiji cyst. If you want to be sure of this, you must perform a complete physical skin test. You may need additional tests, such as excision, repair the wound, or tissue, to determine the cause of the case. Depending on the circumstances, you may need incisions and drains. Would you like to make a reservation so that you can evaluate your condition better?"
},
{
  "instruction": "Doctor, I'm feeling a little dizzy these days, and I think it has something to do with the antipsychotic drugs that I'm taking.",
  "input": "",
  "output": "No, it may be a sign of addiction from anti-psychotic drugs: you have to run some medical tests to understand the severity of the situation; you have to do blood tests, complete blood cells, EKG, urine tests, toxic tests, kidney function tests, and you also need an I.V. fluid replacement to treat the addiction."
},
{
  "instruction": "Doctor, you've got a painful infection in your nose and mouth, and your throat hurts, and sometimes it's hard to swallow, and what's the problem?",
  "input": "",
  "output": "Symptoms seem to indicate that bechtt disease is in doubt. You must perform a diagnostic procedure to confirm the diagnosis. You may also have to perform other treatment procedures to manage the symptoms. If necessary, a biopsy or a discharge may be necessary. In severe cases, mental care may be recommended."
},
{
  "instruction": "Doctor, I'm very nervous and very stressed these days, and I think I have neurosis.",
  "input": "",
  "output": "To check for neurosis, you need to run some medical tests to identify the underlying causes of the symptoms, such as blood tests and blood tests such as CBC (CBC)."
},
{
  "instruction": "Doctor, you've recently had changes in your urination habits, and you're having trouble seeing bloody urine, and I'm afraid it's prostate cancer.",
  "input": "",
  "output": "We need to do some medical tests to determine whether or not we have prostate cancer based on your symptoms: prostate specific antigen measures, rectal checks, ultrasounds, urine tests, tissue tests, and so on."
},
{
  "instruction": "Doctor, I've recently experienced double-pass nausea, and I think my vision is blurry, and I'm worried if there's a brain edema.",
  "input": "",
  "output": "I recommend that you shoot a radiation film, such as an MRI or a CAT scan of your head, as a result of a kidney function test, check your kidney function and glucose levels, and if your cerebral edema is confirmed, you need an I.V. fluid replacement."
},
{
  "instruction": "Sir, I think my fingers are out.",
  "input": "",
  "output": "If you want to check for a dislocation, you need to perform a normal X-ray, including a normal X-ray. Depending on the results, you may need to use a splint or an orthopedic cast to fix the joint. You may also need sutures if you have a wound. After treatment, the job treatment evaluation may help with the overall healing process."
},
{
  "instruction": "Doctor, I think I'm suffering from a traumatic birth, pain in my arms and legs, and I don't think I can move it properly.",
  "input": "",
  "output": "It seems to have resulted in muscle weakness and rigidity due to birth trauma. You have to reserve physical therapy campaigns that help restore strength and mobility. You have to make complete medical procedures, including comprehensive physical skin examinations and evaluations and consultations with other specialists. You can also benefit from the application of medical services with other physical treatments and rehabilitation. You also need to evaluate treatment, language, care, and potential treatment."
},
{
  "instruction": "Doctor, I've been suffering from severe abdominal and digestive problems for a while, and I've done some tests, and I've been diagnosed with chronic pancreatitis.",
  "input": "",
  "output": "The first thing you need to do is check your blood count (CBC), including infection, anemia and other abnormality. You also need to check your glucose levels and your electrolyte panels, along with replacement of your kidneys and liver function and your veins to prevent dehydration."
},
{
  "instruction": "Doctor, there's a lot of pain in your arm, and it feels like a big bruise, and it's been there a couple of days ago.",
  "input": "",
  "output": "We need to do some tests to make sure that we treat the area. We also need to perform a full physical skin test to make sure that there are other lumps or lumps. We also need to do a CT or X-ray scan to make sure there are other potentially serious problems, so we need to do an ultrasound."
},
{
  "instruction": "Doctor, I'm experiencing blush, diarrhea, abdominal pain, and I told him that my friend might have something to do with Carsinoid syndrome.",
  "input": "",
  "output": "We need to do some medical tests based on the symptoms: we're going to do a radiology scan, X-ray computer monographs, we're going to measure electrolyte panels and glucose levels, and we're also going to need complete blood counts and hemolysis, and finally, cardiac ultrasound is essential to determine the level of valve disease associated with Carcinoid syndrome."
},
{
  "instruction": "Sir, I fell off my bike and hit my head very hard, and there's an open wound in my head that doesn't stop bleeding.",
  "input": "",
  "output": "But before we do that, we need to do a radiation scan to make sure that there's internal bleeding or a skull fracture, and we need to do a scan or a head C.T. to see better, and we need to be effective in managing wounds to prevent infection."
},
{
  "instruction": "Doctor, my skin is getting bigger and bigger and bigger and more frequent, and it doesn't hurt, but it doesn't look good, what's the problem?",
  "input": "",
  "output": "There may be boredom, which is a harmless skin disease that is commonly seen in older people. To make sure you have a diagnosis, it's best for a dermatologist to do a direct skin test. You may need a resection, a resection, a biopsy, or a biopsy, depending on the size and location of your growth. You may need other procedures, such as the diagnosis of skin and substrate tissue, and other procedures, such as treatment and treatment of injuries."
},
{
  "instruction": "Hi, doctor. I burned my hand so badly while cooking. What do I do?",
  "input": "",
  "output": "I'm sorry, I have to run a few medical tests based on the symptoms. First, I have to take a normal X-ray in my hand to check the burn level, and then start the wound, and put in splints to protect the area, and finally I have to do a head CT scan to make sure I'm not injured in the head."
},
{
  "instruction": "Doctor, I'm very worried about your health last week, and can you offer me some medical tests to see if everything's normal?",
  "input": "",
  "output": "Yes, we need to run a series of tests to determine the cause of the miscarriage. Blood tests, whole blood cells, and radiation scans can help us to identify blood clots."
},
{
  "instruction": "Doctor, I think we have genital herpes, a blister with pains around our penis.",
  "input": "",
  "output": "I'm sorry, if it's genital herpes, you have to do a lot of tests, including urine tests, pelvis, complete physical skin tests in medical labs, standard pregnancy tests, chlamydia, lipid panel and breast tests."
},
{
  "instruction": "Doctor, I've been under a lot of stress lately, and I can't sleep well, and I can't get rid of my sad moods.",
  "input": "",
  "output": "Medical tests include psychological and psychiatric treatments that help to manage the symptoms, as well as screening for depression in order to assess the severity of depression, including toxic tests and blood alcohol tests to eliminate drug abuse, and also mental and psychiatric evaluations and treatment to cope with your condition, and other physical and rehabilitation treatments may be considered in order to compensate for your condition."
},
{
  "instruction": "Doctor, I'm afraid there's severe pain in the upper right abdomen, so what do you want to do?",
  "input": "",
  "output": "There's a possibility that there's some kind of medical test for a diagnosis, such as blood, whole blood cells, radiation, urine, kidney function, glucose levels, and so on."
},
{
  "instruction": "Doctor, you're having problems with your eyesight, and sometimes you're feeling weak in your arms and legs, and you're having trouble keeping the balance when you walk.",
  "input": "",
  "output": "You may be suffering from multiple sclerosis. To diagnose your condition, you need to do a self-sensitial imaging (MRI) test. You can also consider other diagnostic procedures, such as physical therapy and interview, evaluation, or counseling. You can also consult home health care based on the severity of the symptoms, consider other treatment procedures, and eliminate injuries or burns if necessary."
},
{
  "instruction": "It's been hard to swallow food, it's been a while before, and it's been refluxing, and I'm worried about whether it's a serious disease or not.",
  "input": "",
  "output": "It's good to run an up-to-the-head endoscopy with tissue tests to check the loss of the esophagus according to the symptoms. You also need to do radiation scans, liver function, and blood sugar measurements, including regular X-rays. If necessary, you may need to do an E.G.G. test to evaluate the heart function."
},
{
  "instruction": "Sir, I fell and got badly injured, and I feel a lot of pain in my waist and pelvis.",
  "input": "",
  "output": "The symptoms suggest that there may be a pelvic fracture, which requires a normal X-ray procedure, as well as several blood tests, including complete blood count and kidney function tests, as well as IV fluid supplements and X-ray computer scans (CT scans)."
},
{
  "instruction": "Sir, there's been a lot of breathing and chest pain in recent years, and I've been working in the coal mine, and I'm worried if you've had a sepsis.",
  "input": "",
  "output": "It's important to run a normal X-ray to make sure your lungs are intact based on your symptoms and your work history. You may need to do a biopsy to test your lungs for signs of autism. You may also need neblator therapy to make breathing easier."
},
{
  "instruction": "Hi, sir, I'm recently experiencing chest pain and respiratory problems, and I'm worried because of the high cholesterol level.",
  "input": "",
  "output": "It's good to have some medical tests to check your diagnosis based on your symptoms and concerns. First, you need to check your blood tests, your lipid panels, your blood sugar measurements, and your hemoglobin A1cs to analyze your average blood sugar levels over the last three months."
},
{
  "instruction": "The symptoms of a blood mixture of teachers, abdominal pain, diarrhea, and stools continue, and they are constantly tired and tired.",
  "input": "",
  "output": "It's possible that you have to run a series of medical tests to confirm your diagnosis. This includes blood tests, CBC, S-synthesis, colonoscopy, glucose readings, IV fluid replacements, electrolytic panels and CT scans."
},
{
  "instruction": "Doctor, I recently felt discomfort and pain in my genital area, and I think I'm infected.",
  "input": "",
  "output": "I'm sorry, I have to run some tests to properly diagnose and treat my condition. First, I have to check my urine test to see how well the kidney works. I also have to do kidney function tests to see how well it works. And if I see an absorption, it may also help to identify bacteria in the bloodstream that can cause infection. Blood culture may also need to scan for other fundamental problems."
},
{
  "instruction": "Hi, doctor, I'm experiencing discomfort and pain during sex, and I think I'm infected with the phagoma virus.",
  "input": "",
  "output": "I understand that you need to perform some medical tests to determine whether an HPV infection occurs. First, you need to perform a diagnostic procedure on pelvic tests, breast tests, and other female organs."
},
{
  "instruction": "Doctor, you've recently had chest pains and difficulty breathing, especially when you're moving.",
  "input": "",
  "output": "Depending on the symptoms, I'll recommend EKGs, blood tests, radiation scans, whole blood cells, general X-rays, heart enzymes measurements, kidney function tests."
},
{
  "instruction": "Sir, I fell down the stairs last night and broke my waist, and I couldn't move my legs, and I couldn't feel anything down my waist.",
  "input": "",
  "output": "I'm sorry, because of the symptoms, you have to do a radiation scan, which starts with a normal X-ray, but may require a scan C.T. to get a more detailed image, in which case you need to supplement the water and start physical therapy as soon as possible, depending on the extent of the injury."
},
{
  "instruction": "Doctor, I'm having a lot of trouble breathing with my nose, and I'm having a lot of sinusitis, and I'm told that I have a nose polyps.",
  "input": "",
  "output": "It is recommended to have X-ray scans and diagnostic procedures for noses, mouth and pharynx (CT). You may also need to perform other diagnostic procedures, such as interviews, evaluations and counseling to confirm the diagnosis."
},
{
  "instruction": "Doctor, I've recently developed severe skin itching and scratches, and I've had a lot of stimulation and a lot of discomfort, and I've been diagnosed with herpes.",
  "input": "",
  "output": "I'm sorry, we have to run some medical tests to provide the best medical care. These tests include complete physical skin tests to evaluate the level of the condition. We also need to perform a pelvic examination to prevent infection and stimulate healing. We also need to repair injuries to prevent infection. We also need to use a biopsy of skin lesions or a resection to determine the underlying cause of the disease. There are other procedures that may be necessary to diagnose the skin and the tissues."
},
{
  "instruction": "Doctor, I feel a constant stimulus in the eye, and I think I have a stick.",
  "input": "",
  "output": "You need to perform eye examinations and evaluations, including detailed vision tests. Depending on the severity of Trikisia, you may need to perform other treatment procedures on the eyelids, the periphery, or the cornea. You may also need to remove this substance by non-operative surgery or consider a cornea transplant, but other tests you mentioned, such as the removal of the spleen or the extrauterine pregnancy, have no bearing on this case."
},
{
  "instruction": "Doctor, you've got itchings and skin rashes all over your body, and you've got trouble breathing, and it's like you're losing your eyesight over time, so what's the problem?",
  "input": "",
  "output": "We recommend complete skin tests to make sure that there's an infection that can cause nausea and rash, and we need to do a liver test to evaluate the health of the liver, which helps to make sure that there's an underlying liver disease that can cause the symptoms."
},
{
  "instruction": "Doctor, I'm worried that there's been some symptoms in the last few years that might be serious: abdominal pain, changes in urinary habit, and there's a lot of blood in the stool.",
  "input": "",
  "output": "We need to do some medical tests to test the diagnosis, first measure the full blood count and glucose and electrolyte. Patient: OK, what other tests do you need?"
},
{
  "instruction": "Doctor, I found a spot in my skin that was getting darker and lighter, and I think I have a skin pigment calming disorder.",
  "input": "",
  "output": "To properly diagnose and treat your condition, you must perform a complete physical skin test, including a biopsy and absorption of skin lesions. You may also need to perform other diagnostic procedures for your skin and subcutaneous tissue and provide damage management and other treatment procedures."
},
{
  "instruction": "Doctor, I've been experiencing strange and exaggerated symptoms lately, and I don't seem to be functioning properly, and I feel dizzy all the time.",
  "input": "",
  "output": "It's good to take some tests to check your symptoms. One is mental health counseling and psychological treatment for emotional well-being. The other is psychoanalysis and psychiatric treatment for major mental health problems."
},
{
  "instruction": "Sir, the groins are getting sick and swollen, and they're swelling the lymph nodes around them, and there's defecation and bleeding.",
  "input": "",
  "output": "The symptoms suggest that you may have been infected with the lymphoma, which is a venereal disease. To check this, you need to perform a number of medical tests, such as cardiovascular gas (ABG), blood culture, liver function testing, cardiac enzyme measurements, X-ray computer scans, kidney function, replacement of IV fluid, and so on."
},
{
  "instruction": "You're pregnant or you're not breast-feeding, but you're coming out of your breast, and what's the problem?",
  "input": "",
  "output": "To diagnose the problem, you need to do some medical tests, including blood tests (blood tests), breast tests, standard pregnancy tests, pelvic tests, breast imaging, and full body skin tests to check your cholesterol levels."
},
{
  "instruction": "Hi, doctor. I'm experiencing fatigue, shortness of breath, abnormal heart beat. I'm also easily tired and pale in skin. I suspect G6PD enzyme deficiency. What medical test do you need?",
  "input": "",
  "output": "You may need to undergo a series of medical tests, including blood tests, whole blood cells, or CBC and other diagnostic procedures. You may also need to perform an ultrasound, an ultrasound in the eyelids, pericardial membranes, an angiometer implants, or a treatment procedure to solve the possible effects of the G6PD enzyme deficiency."
},
{
  "instruction": "Doctor, your arm and hands are sick and you've got a fever, and your nerves are pressing around your shoulder, so what kind of medical test do you need?",
  "input": "",
  "output": "It's good to have a series of medical tests based on the symptoms that you need to do to evaluate the level of nerve damage: radiation scans, general X-rays and magnetic resonance imaging (MRI), and you can also ask a physical therapist to evaluate some exercises and work treatments for the right language treatment, and you can use some other non-operative procedures to treat your condition."
},
{
  "instruction": "Sir, I think I've got Toxoplasma, and I'm feeling really depressed and my eyesight is getting worse.",
  "input": "",
  "output": "I'd like to recommend some medical tests based on your symptoms. First, you should evaluate your emotional state through depression tests, and then follow other diagnostic procedures, such as interviews and evaluations to evaluate the level of depression."
},
{
  "instruction": "Doctor, you've got a lump in your breast. I'm really worried.",
  "input": "",
  "output": "Don't worry, we need to do some medical tests to figure out the cause of the lump. We need to do breast examinations, radiation scans, breast scans, according to the symptoms. We also need to do biopsys, ultrasounds, complete skin examinations and pelvis."
},
{
  "instruction": "Hi, doctor, you've got a hand injury, and you've been bleeding for a while, so what do you do?",
  "input": "",
  "output": "We need to close the wound, close the wound, and stimulate the proper healing. We also need to take a regular X-ray to make sure we don't have any foreign or fracture."
},
{
  "instruction": "Doctor, I think I missed an abortion, and I didn't see the fetal heartbeat in the last ultrasound.",
  "input": "",
  "output": "To confirm the abortion, you also need to do a radio screen test, such as an ultrasound or an MRI, and you need to do a CBC test, a hemothorax test, a urine test to see if you have an infection, and you can do a pelvic test, and finally, a standard pregnancy test to check for missing abortions."
},
{
  "instruction": "Doctor, I've been diagnosed with diabetes ketonic acidosis.",
  "input": "",
  "output": "You need a series of medical tests to evaluate your condition. Treatment includes a blood test, such as an I.V. fluid replacement, an ICBC test, a glucose test to refine the blood glucose level, an electrolyte panel to analyze the sodium and potassium imbalance in your bloodstream, a ketone test to check for signs of kidney damage, and a kidney function to evaluate kidney health."
},
{
  "instruction": "Doctor, there's some discomfort and inflammation in the genital area.",
  "input": "",
  "output": "Yes, it's important to make sure you have a medical examination of whether your hair is paternity; you need to have your pelvic and urine tests; you need to check your CBC; you need to do a blood test; you need to do a CBC; you need to do a clamia test; you need to do a clamydia test."
},
{
  "instruction": "Doctor, in the last few days, I've had a fever, I've had a fever, I've had a fever, I've got a nosebleed, I've got a bad urine color, I think I've got a bleeding fever.",
  "input": "",
  "output": "I think it's important to do some medical tests in terms of the symptoms and the history of the disease, so we need to make sure that there's internal bleeding through an abdominal CT scan, and we need to make sure that the nose is in control, so we're also suggesting that we need a bone marrow transplant to treat the damage to blood cells."
},
{
  "instruction": "Hi, sir, I'm experiencing a recurring thought that I can't control, and an irrational urge that's causing a lot of suffering and has an impact on everyday life.",
  "input": "",
  "output": "It's good to start with psychological therapy and mental health counseling to manage the symptoms. It's also good to run a clinical screening test to make sure that depression doesn't cause symptoms. It may also require psychological and psychological evaluations and may be useful."
},
{
  "instruction": "Sir, I hurt my ankle last night in soccer, it's swollen and it's very painful, and what do I do?",
  "input": "",
  "output": "You need to do a radiation scan to evaluate the injuries. You need to do regular X-rays to make sure that there are fractures or dislocations on your ankles. Then you need to do splints or orthopedic casts, depending on the level of injuries. You need to get physical treatment for your rapid recovery. You may need an MRI scan to see the injuries better."
},
{
  "instruction": "Doctor, I've been feeling very weak and tired lately, and I'm also experiencing confusion and headaches.",
  "input": "",
  "output": "The tests include blood tests, whole blood cells, radiation scans, electrolyte panels, glucose measurements, kidney function tests, and other things that may require the replacement of an I.V. fluid."
},
{
  "instruction": "Doctor, it's difficult to swallow food, and it's frustrating.",
  "input": "",
  "output": "There may be an esophageal stenosis. You need to run a few tests to verify it. You need to start with a CBC and an I.V. fluid replacement, and then you need to do an E.T.G., including a biopsy, general X-ray and esophageal extension. You also need to do an E.G.G. and an E.G."
},
{
  "instruction": "Sir, I fell off the ladder yesterday and I injured my ankle, so much so that I could hardly carry my weight.",
  "input": "",
  "output": "I recommend a radio scan to determine if an ankle fracture is caused by symptoms. You may need to wear regular X-rays, splints, or orthopedic casts, depending on the level of the fracture. You may also need physical therapy to help restore the strength and mobility of the fracture. It's also important to test the foot to measure the damage and provide proper damage care."
},
{
  "instruction": "Doctor, I've found that there's a mass in my arm that causes pain, and I'm really worried.",
  "input": "",
  "output": "In order to diagnose it, you need to perform a full physical skin test with a tissue test. You may need to do additional tests, such as MRI or other diagnostic procedures. Treatment may include removal of infected tissue and post-op treatment."
},
{
  "instruction": "Doctor, I've been feeling a lot of pain in my bones lately, and I'm worried if I have a bone disease.",
  "input": "",
  "output": "We recommend a series of medical tests to diagnose the cause of the pain based on the symptoms. First, we can look more closely at the bone through radiation scans, and we need to do a blood test to make sure that there are lower-line diseases that can cause the symptoms."
},
{
  "instruction": "Doctor, I'm experiencing a sudden seizure, and I think the family could be brain cancer.",
  "input": "",
  "output": "A few tests are recommended to diagnose EEC. Blood tests (blood test) and CBC are performed to eliminate other medical disorders that can cause seizures. Then X-ray scans (XCt), self-synthetic imaging (MRI), and head imaging (HADCT) are needed to detect seizures."
},
{
  "instruction": "Hi, sir. I'm having a hard time with personality disorders, and I don't know what to do.",
  "input": "",
  "output": "I encourage you to consider psychological and psychiatric evaluations, psychological treatments and mental health counseling that will help you manage your symptoms."
},
{
  "instruction": "Doctor, I've got sharp pain and rash in my skin, and my friend said it might be shingles.",
  "input": "",
  "output": "You have to do a full physical skin test to confirm your diagnosis."
},
{
  "instruction": "Hi, doctor, there's been a lot of pain in the hip, and it's getting worse over the last few weeks.",
  "input": "",
  "output": "Hi, we need to do some medical tests to check the problem based on the symptoms. Have you ever heard of bloodless necrosis? Patient: No, I've never heard of it."
},
{
  "instruction": "Doctor, I'm having trouble getting sore and sore throats, I think I've got strepitis.",
  "input": "",
  "output": "You can also check for streptopics by testing for flu virus antibodies, and if there's too much infection to cause respiratory problems or sleep apnea, you may need to perform amygdala and/or adenoid resections."
},
{
  "instruction": "Doctor, I've been having trouble controlling my movement lately, and I don't think I'm balanced, and I don't think I'm walking straight.",
  "input": "",
  "output": "We want to do some medical tests to determine the cause of the symptoms based on the symptoms. We need to do some blood tests to check blood count and chemical substances. We also need to do automune imaging tests to evaluate the structure of the brain. With these tests, we need to do interviews, evaluations and counseling to collect information that is necessary to understand your case. We also need to do care and physical therapy, to observe movements and patterns, and to provide the right kind of exercise and pattern."
},
{
  "instruction": "Doctor, I think I've had a mustache, and I've had a headache for weeks, and now I can't pressure my foot.",
  "input": "",
  "output": "I'm sorry, you have to run a complete skin test to see if there's any damage or infection to the symptoms. You also have to measure glucose levels because high blood sugar can cause the symptoms. You need to control the injuries in your feet, splints and other ways. You need to remove the injuries and burns."
},
{
  "instruction": "Doctor, I'm recently suffering from eye dryness and mouth dryness, and I feel fatigue and joint pain, and I think it's Shogren's syndrome.",
  "input": "",
  "output": "The symptoms suggest that it may be Shogren syndrome. To confirm this, you have to run several tests. You have to perform a full-body skin test, breast scan, foot test, eyelids, periphery, corneas and other treatment procedures. You also have to make sure that your entire hip or partial replacement is needed."
},
{
  "instruction": "Doctor, there's a lot of pain and stiffness on your shoulder, especially when you're trying to move your shoulder, and it's not easy to pick up heavy things or to put on a shirt.",
  "input": "",
  "output": "The symptoms seem to indicate that there's some suspicion that there's a pystic fibrosis in the shoulder, which requires several medical tests to determine the severity of the diagnosis. These tests include physical therapy exercises, general X-rays, self-resonant imaging and other non-healing procedures for the skeletal system."
},
{
  "instruction": "Good morning, doctor, abdominal pain, fatigue, eczema, I think you've got viral hepatitis, and what medical tests do you need to make sure of that?",
  "input": "",
  "output": "Depending on the symptoms, it's good to have a series of medical tests, including blood tests, full blood counts, body skin tests, lipids, ultrasounds, and other diagnostic procedures, as well as psychiatric counseling to confirm the diagnosis of viral hepatitis."
},
{
  "instruction": "Hi, doctor, it's hard to swallow during sleep, and you've also found that the back of your neck has got bigger.",
  "input": "",
  "output": "In your condition, the amygdala appears to be in doubt. It is recommended to determine your diagnosis, including physical examination, ophthalmology, ophthalmology and post-diagnosis and other diagnostic procedures. If necessary, you can either remove or remove the adenoid resection or perform some other treatment for the urethra, nose, mouth, and pharynx."
},
{
  "instruction": "Doctor, there's been a lot of abdominal nausea, vomiting, probably gastritis.",
  "input": "",
  "output": "I'd like to recommend some tests to check for gas, such as blood tests (blood test), cBC (cBC), urine test, IV fluid replacement, glucose readings, kidney function test, and electrolyte panels."
},
{
  "instruction": "Sir, I'm worried about the dot on my back. It's been growing and changing in size over the last few months.",
  "input": "",
  "output": "It's important to run a complete physical skin test to see if there are signs of skin cancer based on symptoms, and to make sure that there are cancer cells, you need to perform a biopsy, or any other treatment, or repair, or repair, according to the results of the biopsy, and you need additional diagnostic procedures for your skin and subcutive tissue."
},
{
  "instruction": "Doctor, with rashes and fevers, we're experiencing joint pain and swelling, and I'm worried that if we don't treat the previous case of strepitis properly, we're not going to have rheumatis fever.",
  "input": "",
  "output": "It's good to get an ultrasound, an E.K.G., and a full physical skin test. You also need to evaluate emotional tension through ultrasound and mental health counseling."
},
{
  "instruction": "Sir, I've got a really painful oral ulcer that's happening over and over again, and I look up on the Internet and I think it's an affiliated ulcer, and what do you think?",
  "input": "",
  "output": "The symptoms seem to suggest that it's likely to be an affiliated ulcer, but if you want to confirm the diagnosis, you have to do a tissue test, and you also have to do interviews and evaluations to determine the cause and potential treatment options."
},
{
  "instruction": "Doctor, there's a lot of difficulty in swallowing and a lot of pain in my throat, and I think I have tonsillitis.",
  "input": "",
  "output": "We're going to need to do some medical tests to confirm the diagnosis, not only diagnosis and treatment, but also evaluation and counseling."
},
{
  "instruction": "Doctor, there's been a couple of symptoms recently, and I'm worried if it might be intestinal cancer.",
  "input": "",
  "output": "We first need to run some blood tests, like CBC, to see if there's any damage to the blood, and then we need to do some radiation tests, such as X-ray computer scans, and test for glucose levels and electrolyte panels to see if there's no hormone imbalance or deficiency."
},
{
  "instruction": "Hi, doctor, I think I have a viscous fever on Rocky Mountain.",
  "input": "",
  "output": "None of the medical tests for the Rocky acid stains are listed. You have to do a blood test to confirm your diagnosis."
},
{
  "instruction": "Hi doctor, I've been feeling discomfort and pain lately, nausea and loss of appetite, and I'm afraid it might be stomach cancer.",
  "input": "",
  "output": "We need to do a bunch of medical tests to determine the underlying cause of your symptoms. We need to do a hepatic test with CBC to make sure that there's something wrong with your blood. We also need to do a radiation scan like the X-ray computer scan (Scanct) to test your stomach."
},
{
  "instruction": "Doctor, I'm having a developmental disorder, and I don't know what to do.",
  "input": "",
  "output": "It may be helpful to take some medical tests to help diagnose and treat your condition. You may need to perform a series of tests, including psychological, mental, health, and work-health evaluations. You may also need some diagnostic procedures, such as interviews, evaluations, or counseling. You may need an MRI (MRI) scan to understand the condition better."
},
{
  "instruction": "Hi doctor, I've been under a lot of stress and anxiety lately, and I've lost my sleep and my concentration, and it's affecting my daily life.",
  "input": "",
  "output": "You're experiencing acute stress reactions, and it's good to get mental health counseling, depression, blood alcohol, toxic testing, and you need an E.K.G. to see if your heart is functioning properly, and you need psychological and dental care, depending on the severity of your symptoms."
},
{
  "instruction": "Doctor, I think I've recently had delirium symptoms, I've had difficulty concentrating and tracking things, and I've also felt confused for most of my time.",
  "input": "",
  "output": "It's good to run some medical tests to determine the cause of the network. First, you have to measure some hematological tests and blood cells and measure the glucose levels, and then you have to do urine tests to make sure you're infected or infected, and then you have to do an electrocardiogram to evaluate potential heart problems."
},
{
  "instruction": "Hi, sir. The hard, thick skin doesn't go away. I care a lot these days. What do we do?",
  "input": "",
  "output": "It's good for a medical professional to have a thorough skin test based on his symptoms. A specialist can suggest that he remove or remove a bloodline with a wound management. It may be wise to take a foot test to see if there's a fundamental problem in the foot. In severe cases, he may need to remove a wound or infection or a skin lesion. There are other procedures for skin and subcutaneous tissue that can be performed for proper evaluation."
},
{
  "instruction": "Doctor, I'm experiencing a weakness in my legs and arms, and I'm getting worse day by day.",
  "input": "",
  "output": "It is important to run a few tests to check your diagnosis. First, you need to check your urine with a urine test to see if there is something wrong with your urine. You also need to take another self-synthetic image (MRRI) to confirm nerve damage. There may be other treatment procedures. Since physical therapy can help recovery, there is also a need to detect the presence of an artificial strain (HPV) that can sometimes cause GBS, and so there is also the need to test your heart for an ultrasound."
},
{
  "instruction": "Doctor, I've got back pain, and it's been a couple of weeks, and I can't sit long or stand there.",
  "input": "",
  "output": "You also need physical therapy exercises and manipulations to improve your condition."
},
{
  "instruction": "Doctor, I have a hard time breathing for a while with my nose, and sometimes it's hard to sleep at night, and it's like it's getting stuck.",
  "input": "",
  "output": "To verify this, you need to take into account an X-ray computer monot, which can be clearly visible inside your nose. You may need to consider cosmetic surgery, depending on the level of your nose. You also need to perform a different diagnostic procedure (supplication, evaluation, counseling, etc.) to better understand a particular case. If necessary, you may need to remove your nose, mouth, throat, and so on, and so on."
},
{
  "instruction": "Doctor, I think you have an angioma on your skin. What do you do?",
  "input": "",
  "output": "The first step is to perform a complete physical skin test, and then with tissue tests you can consider resecting or removal of lesions. You may also need to manage injuries. You may also need to perform other diagnostic procedures for interviews, evaluations, counseling, skin and substrates."
},
{
  "instruction": "Doctor, I've heard that my baby was diagnosed with Patau's syndrome.",
  "input": "",
  "output": "I'm sorry about that. When it comes to tests, you have to perform a hip test, complete skin examination and lipocardial panel."
},
{
  "instruction": "Doctor, when you walk, you have constant pain and convulsions in your legs, sometimes to the point of interfering with your sleep.",
  "input": "",
  "output": "I'd like to give you some tests based on your symptoms, including the damage control and skin scan, and an ultrasound to check the blood flow of your legs, and I'd like to make sure that you remove the rickets of the wound, such as the lip panel, the foot, the infection, or the burns, and finally the hemoglobin A1c test."
},
{
  "instruction": "Hi, sir, there's been a lot of chronic back pain these days, and it's getting worse, and I don't know what's causing it, but it's really getting harder to move and to do it the way it used to be.",
  "input": "",
  "output": "I'm sorry, but I recommend several video tests to determine the underlying cause of back pain based on the symptoms. We need to do some radiation imaging procedures, including regular X-rays, X-rays (Scan ct) and self-sensitivity videos (MRI). Then we can better diagnose the problem and recommend treatment that includes physical therapy, catheter or spinal stimulators, injections in the spinal tube, or other treatment procedures."
},
{
  "instruction": "Doctor, you've recently had a heart problem, you've been breathing, you've been tired a lot, what do you do?",
  "input": "",
  "output": "We need to do some medical tests to figure out the cause. Depending on the symptoms, we need to do some blood tests, radiation, CBCs, E.K.G., normal X-rays, glucose levels, and electrolyte panel tests."
},
{
  "instruction": "Sir, your eyes are getting bloody and it's getting itchy, I think it's pericarditis.",
  "input": "",
  "output": "Depending on the symptoms, we recommend a comprehensive eye examination and evaluation, and we also need to do flu virus antibodies to eliminate other fundamental causes, and we need to remove the substance from the eye by non-operation, or we need to perform treatment procedures based on the severity of the condition, including the nervous system, the ear, the eye muscle, or the eye muscle."
},
{
  "instruction": "Sir, there's severe pain in the waist and the right leg, and there's a feeling that the leg goes off, there's a suspicion of the back disk, which test is needed to confirm the diagnosis?",
  "input": "",
  "output": "Yes, your symptoms are signs of the back disk. To detect a diagnosis, you must perform a radiation imaging procedure, such as X-ray or CT scan. You may also need to perform a self-sensitivation imaging (MRRI) to test the soft tissue and nerves. Besides the video, there are other diagnostic procedures to help you recover. There are other diagnostic procedures, such as counseling, or testing, to preserve the severity of the problem, or testing for pain in the spine."
},
{
  "instruction": "Doctor, I've recently had a lack of energy and muscle pain, and when I went to the hospital, I was told that it could be a pericardial dystrophy.",
  "input": "",
  "output": "Oh, I'm sorry, if you want to confirm the diagnosis of femoral dystrophy, you need to run some medical tests."
},
{
  "instruction": "Hi, doctor, I think you're infected with the breast, there's pain, there's swelling.",
  "input": "",
  "output": "Hi, I'm sorry, we need to run a breast test to check for a diagnosis based on the symptoms. Patient:"
},
{
  "instruction": "Doctor, I've had abdominal pain, and I recently learned that my father has abdominal aortic aneurysm.",
  "input": "",
  "output": "In view of the symptoms and family history, there is the possibility that an abdominal aneurysm may occur. To make sure you have this condition, a series of tests must be performed. This includes radiation, blood tests, X-ray computer scans, CT scans, electro-rays (CTC), ultrasound, electrocardiograms, and electrolytic panels."
},
{
  "instruction": "Doctor, I've been having trouble breathing and chest pain lately, and I feel like there's a heavy burden on my chest.",
  "input": "",
  "output": "These symptoms may indicate pulmonary embolism. You need to run some medical tests to verify them. First, you need to make sure you have an abnormal clotting factor through CBC (CBC) and blood tests. You also need to perform a routine X-ray or X-ray computer scan (CT scan) to make sure you have a clot in your lungs. You also need to do an electrocardiogram test to evaluate your heart condition."
},
{
  "instruction": "Hi, sir, I've had some behavioral problems recently, and I fight a lot, and I'm always angry.",
  "input": "",
  "output": "Your symptoms suggest that you may have a behavioral disorder; you may need to do some medical tests to confirm your diagnosis; you may need mental health counseling and psychological treatment; you may need toxic and blood alcohol testing; you may also need psychological and psychological evaluations and treatment; you may need to evaluate speech therapy; you may need to do some brain activity."
},
{
  "instruction": "Hi, doctor, I think I'm having an air embolism.",
  "input": "",
  "output": "We need to do an abdominal C.T. scan to check for an air embolism diagnosis."
},
{
  "instruction": "Doctor, I recently had a mastectomy. What tests do you need now?",
  "input": "",
  "output": "You need to run various tests for healthy recovery. First, you need to run a breast test to make sure that there are signs of complications or potential problems, and then you need to check for a full blood count (CBC) to see if your blood is healthy and balanced."
},
{
  "instruction": "Doctor, there's pain and swelling in your scrotum, and it's also fevery and difficult to urinate.",
  "input": "",
  "output": "You need to run some medical tests to check your diagnosis according to the symptoms. First, you need to check whether there are bacteria in your urine through urine tests. You also need to perform a radiation scan to see if there's inflammation and blockage in the ureter."
},
{
  "instruction": "She's 34 weeks pregnant.",
  "input": "",
  "output": "I'd like to start with blood tests, CBC, and urine tests, as well as an I.V.C., and an aneurysm, as well as an pelvic and prothrombin analysis."
},
{
  "instruction": "Hi, doctor, I think you've got a mollusk epidemic, and it's starting to spread, and some of the spines have white centers.",
  "input": "",
  "output": "Thank you for letting me know that you have to do a full physical skin test to make sure you're infected with mollusks, and you can treat them by resecting skin lesions or by other treatment procedures, and because the chlamydia virus is often associated with the spread and persistence of mollusks, you have to do a chlamydia test."
},
{
  "instruction": "Hi doctor, there's severe pain and swelling in the leg, and there's a few open wounds that don't heal, and can you help me?",
  "input": "",
  "output": "The symptoms suggest that there's necrotic fasciitis, there's a number of medical tests, such as dental skin tests, CBC, scar management, kidney function, electrolyte panels, blood sugar measurements, blood culture, and so on."
},
{
  "instruction": "Doctor, I'm experiencing a serious abnormal vaginal secretion of odorlessness that's been going on for weeks, and you know what's causing it?",
  "input": "",
  "output": "You can experience positive vaginal secretions, or colds, depending on your symptoms. To see the exact cause, you can do a few tests: urine test, pelvic examination, standard pregnancy, chlamydia, breast test, micro test (bacterial dorsal dorsal, culture, toxicity, cyclical examination), and so on."
},
{
  "instruction": "Doctor, I've been having trouble urinating lately, and I think there's something blocking my bladder.",
  "input": "",
  "output": "You need to perform a series of medical tests to determine the cause of bladder obstruction, depending on the symptoms. Starting with urine, rectal examination, prostate specific antigen measures (PBS) will help you evaluate your condition."
},
{
  "instruction": "Hi, doctor, I'm worried about skin spots that change color and shape over time, and I'm afraid they're black.",
  "input": "",
  "output": "We recommend complete physical skin tests, including tissue tests for questionable substrates, as well as other diagnostic procedures for skin and substrate tissue. Patient:"
},
{
  "instruction": "Doctor, I feel uncomfortable in the cervix. Can you offer me some medical tests that I need to take?",
  "input": "",
  "output": "In the case of hysteric disease, there are several medical tests: pelvic, breast, tissue, resect, ultrasound, other long-term diagnostic procedures for women, breast imaging, and so on."
},
{
  "instruction": "Doctor, I think I've been down a few days ago, and I think I have laryngitis, and what kind of test do I need?",
  "input": "",
  "output": "You also need to do internal and endometriosis and tissue tests to make sure you don't have additional complications. You also need to evaluate whether you need to treat your superiors or speech."
},
{
  "instruction": "Hi doctor, I've been having a blister on my hands and feet for a long time, and I'm wondering what's wrong with you.",
  "input": "",
  "output": "First of all, if there's a skin lesion with a precise skin examination of your hands and feet, you can perform a resection, and then you do a bone density scan and a depression test to evaluate your mental health."
},
{
  "instruction": "Doctor, I think I accidentally took too much opioids, it's disgusting and dizzy.",
  "input": "",
  "output": "I'm sorry. It's good to run some medical tests, such as CBC (CBC), kidney function (KFT), and urine, based on the history of the symptoms and use of opioids. You also need to do an E.G.G. to administer IV fluid supplements and evaluate the heart function. It will also help you to do a radio scan to see if there are any additional complications."
},
{
  "instruction": "Hi, doctor, my baby's diaper area is red and very stimulating, and I think it's a diaper rash.",
  "input": "",
  "output": "The first step is a complete physical skin test to identify the severity of rashes, which may require other diagnostic procedures, such as interviews and counseling."
},
{
  "instruction": "Doctor, I've recently experienced a very dark, red skin rash, usually in my arms and legs, and can you tell me what medical tests I need?",
  "input": "",
  "output": "You need to perform a complete physical skin test to understand the rash better according to the symptoms. You also need to make sure that your skin is intact and that you have a pharynoma DNA. You also need to do a hip test and a rectal exam to see if there is a fundamental problem causing it."
},
{
  "instruction": "Doctor, I've had a lot of abdominal pain lately, and I think it's getting worse after dinner, and I feel nausea and vomiting.",
  "input": "",
  "output": "You need to do some medical tests to verify the diagnosis. First, you need to check your blood supply with CBC and some blood tests. You also need to use radiation to monitor your blood sugar levels to make sure that you have an abnormal blood sugar level."
},
{
  "instruction": "Doctor, there's a sharp pain in the groin, and I can feel it coming out of it.",
  "input": "",
  "output": "You need to run a physical test to evaluate the liver hernia according to the symptoms, and you're going to measure the prostate specific antigen levels and run a rectal exam."
},
{
  "instruction": "Hi, doctor, you're getting itchy and red because you've got rashes on your skin, and I'm afraid it's eczema.",
  "input": "",
  "output": "Hi, you're saying it's likely to be eczema, and to make sure we can perform a full physical skin test, assess the wound, and perform a biopsy, or discharge in the skin to determine the best care plan, such as interviews, evaluations, or counseling."
},
{
  "instruction": "Good afternoon, sir, I have a problem with social interaction and communication, and I also have a very limited and repetitive interest, and I suspect Asperger's syndrome.",
  "input": "",
  "output": "Your symptoms may indicate Asperger's syndrome, and I recommend several tests to confirm your diagnosis, first of all you need to do mental and mental health counseling, and then you need to evaluate your language skills through treatment evaluations, and finally you want to eliminate the disorders that are associated with it."
},
{
  "instruction": "Hi, sir, I think I've got a problem with my toenails, and their edges are red and they're producing a little bit of secretion.",
  "input": "",
  "output": "The symptoms suggest that there are some medical tests to determine the best treatment, such as injury care, foot testing, incisions and, if necessary, abdominal and ovulation, bacteria culture, culture and toxic tests."
},
{
  "instruction": "Doctor, there's an open jaw wound that doesn't heal. What kind of test do you need?",
  "input": "",
  "output": "After that, you have to monitor the injury management so that the injury heals, and you have to do a head X-line computer scan (CT scan) or a computer scan (CAT scan) to see if there's an infection in the jawbone."
},
{
  "instruction": "Hi, doctor, I've been tired recently, I'm not strong enough, I've been to a doctor before, and I told him that I could have a white blood cell disease.",
  "input": "",
  "output": "To confirm this diagnosis, a series of medical tests must be performed: blood tests, cBCs, radiation scans, glucose measurements, glucose levels, intravenous fluid replacement, urine test, and electrolyte panels."
},
{
  "instruction": "Hi, doctor, I think it's Kaposi's sarcoma.",
  "input": "",
  "output": "We need to run some tests based on the symptoms: we start with a full body skin test and measure glucose levels; we can suggest cancer chemotherapy (chemotherapy), or removal of the area, depending on the severity of the condition; we can also help you deal with mental health care and mental health care."
},
{
  "instruction": "Doctor, I've been told that backaches can be caused by pre-cipital prefrontal thrombosis. Can you help with the diagnosis?",
  "input": "",
  "output": "The most basic test is to take ordinary X-rays after a radiation scan. Other tests include such diagnostic procedures as magnetic resonance imaging (MRI) and interviews, evaluations, counseling, and, if necessary, catheter or spinal stimulator implants, spinal tube injections, and physical therapy for pain relief."
},
{
  "instruction": "Doctor, I've had severe headaches over the last few weeks, and my vision has been blurry, and I also feel constant pressure in my head.",
  "input": "",
  "output": "The symptoms suggest that it may be a plastic brain tumor, which requires a series of medical tests, including MRI, ophthalmology and evaluations, eye examinations, and a standard pregnancy test for women."
},
{
  "instruction": "Doctor, your eyes arey and red and swollen, I think it's the pericarditis caused by the virus.",
  "input": "",
  "output": "First of all, it's good to do an eye examination and a diagnosis, and we're also going to do an influenza antibodies test to identify the specific virus that causes the pericarditis."
},
{
  "instruction": "Doctor, there's a lot of discomfort in your nose. What tests do you need?",
  "input": "",
  "output": "You also need to do regular X-rays, CT scans, and head CTs to make sure you don't have any other injuries."
},
{
  "instruction": "I've experienced a lot of sudden panic attacks and anxiety.",
  "input": "",
  "output": "Depending on the symptoms, it is recommended to take one of the following drugs: lorazepam, alfrazolam, Clonasepam, Parochatin, venraxin, viraphacin, vimpilon, fruphonsin, expremin, tesmicin, and arkramine."
},
{
  "instruction": "Good morning, doctor, you've got a shrill voice, you've got a lump in your neck, and you've been diagnosed with vocal polyps in the Ivya, which drugs should you take?",
  "input": "",
  "output": "In order to manage vocal polyps, you need to take multiple drugs. The first drug is a Verometazone sinus product that helps control inflammation. You need to stop nicotine and smoke because it can do more damage to the vocal tract."
},
{
  "instruction": "Doctor, I've been diagnosed with Turner's syndrome. What kind of medication should I take?",
  "input": "",
  "output": "You also need to take epidemiamines to prevent infection, to treat skin disease, to treat epimegometoxol, to treat stomach and bowel problems, and to control the stomach and bowel problems."
},
{
  "instruction": "Doctor, I was diagnosed with Kryptonism. What kind of medication should I take?",
  "input": "",
  "output": "You don't necessarily need to take drugs for kryptocrism, but it's good to get inoculated for hepatitis B vaccines, hepatitis B vaccines, Rotavirus vaccines, you can use decimetasone cream to relieve your symptoms."
},
{
  "instruction": "Doctor, I think I'm addicted to ethylene glycol, and I'm dizzy, tired, and I can't breathe very well.",
  "input": "",
  "output": "I'm sorry, based on what you're saying, we can give you a combination of drugs, such as lorazepam, thiamine, charcoal, floric acid, pamotidin, harropericidol, acetylcystein, Trimetobenjamid, sulfatemium sulfin, and lan zapin, which you can prescribe as soon as possible."
},
{
  "instruction": "He's recently had vaginal dryness and itching, and sexual intercourse is very uncomfortable.",
  "input": "",
  "output": "It's good to take estrogen, to help with dryness, to do a combination of predation, or to do an episode, and you can consider beta methasone-chloridol, which is good for it."
},
{
  "instruction": "Doctor, I think your hand has broken during a recent basketball game, and your hand is swollen and you can't move it properly, which drug should you take?",
  "input": "",
  "output": "But notice that carteol is a beta blocker used to treat high blood pressure and the pyramid is a drug used to treat the heart venous vein."
},
{
  "instruction": "Doctor, you've got bile and absorptitis in your mouth. What kind of medicine do you need?",
  "input": "",
  "output": "We're going to need to take Clinda Meisine and penicillin to treat bacterial infections, and we're going to prescribe chlor hexidine to reduce inflammation and to reduce the bacteria in the mouth."
},
{
  "instruction": "Hi doctor, I'm experiencing a poor eye alignment disorder, which drug should I take for treatment?",
  "input": "",
  "output": "Depending on the symptoms, I encourage you to treat eye alignment with a combination of atropine, penyl, cytonic eye drops, tropicamide eye drops, dexamethone-tobracin eye drops, metasoloids, and metasoloids. These drugs also help you to reduce symptoms and improve eye alignment."
},
{
  "instruction": "Doctor, I had a hole in the ureter a few days ago, and I have a severe headache, and it's really hard to concentrate and work.",
  "input": "",
  "output": "It can often cause this type of headache. I'm going to prescribe a drug that will help relieve the pain by taking hydromorphone, prochlorphenazine, and mydalas, which will help relieve the pain and relieve the tension. Finally, to improve the effect of other drugs, we'll prescribe caffeine-venzolate sodium."
},
{
  "instruction": "Doctors, vomiting, nausea, and abdominal pain are continuing.",
  "input": "",
  "output": "To reduce acid production, you need to take accidine and dietylcons to reduce gas and abdominal swelling. You also need cymethylos and silver pulsin to treat skin infections."
},
{
  "instruction": "Hi, doctor, there's a couple of problems in your salivary glands. Can you help me?",
  "input": "",
  "output": "Yes, of course, because of the symptoms, meloxicics, prifexols, decyclopetics, tartide substitutes, mequinol-trettys, plaquetins, deployins, deprotonateds, entourins, loconiums, cefaxilils. These drugs reduce inflammation, increase salivation, and help treat the underlying cause of the disease. It is not important for a patient to be treated with any kind of medication that can be treated properly."
},
{
  "instruction": "Hi, doctor, there's so much pain in the ass and back that sometimes it's hard to walk long or sit down.",
  "input": "",
  "output": "I recommend you take acebutololol, which can help reduce the pressure on bone and muscle, and you can also reduce inflammation and pain by taking botulium toxins A type A directly into your back."
},
{
  "instruction": "Doctor, you've got a knee injury in soccer, and you've been in pain for weeks, and what kind of medication do you need?",
  "input": "",
  "output": "To alleviate symptoms, you have to take a number of drugs together. Condroitine-glucosamine helps relieve joint pain and rebuild cartilage. Cortisone helps reduce inflammation and swelling."
},
{
  "instruction": "Doctor, I've been having some problems recently, and I think I've got a metabolic disorder.",
  "input": "",
  "output": "Yes, I recommend that we begin with a combination of Urso diol, Exenetaid, Alglucosidian Alpha, Levo Carnitin, phenophicic acid, Lallegres, and older potassium, which can help us manage and improve our overall health with metabolic disorders."
},
{
  "instruction": "Hi, doctor. I think I'm sick of it.",
  "input": "",
  "output": "In this case, you have to take drugs that include metro-datasol, plutonium, metro-nisol, terconidasol, terconazol, and micro-massol, and quantina-chlorititititrol."
},
{
  "instruction": "Hi, doctor, I've been experiencing irregular heart rate, dizziness, fatigue recently, and the doctor suggested that I should take medication because I might have sinus syndrome.",
  "input": "",
  "output": "Yes, it seems to be a valid diagnosis for your symptoms. You can prescribe the following medications: Waparin, digusin, Sotalol, and Amiodron for heart control. You also need Torceid, Bumetanide, and dopamine to control the accumulation of fluids. To improve heart health, you need to take vitamin E, and to keep your blood pressure steady, and you need to keep your blood pressure steady."
},
{
  "instruction": "Hi, doctor, I recently had a problem with my eyesight, which seems to be causing a lot of pressure in my eyes, and I think it's getting worse around me.",
  "input": "",
  "output": "I'm going to give you a drug that will help you with glaucoma."
},
{
  "instruction": "Doctor, I feel like I have a diet disorder, and I'm experiencing extreme weight loss, and I can't seem to control my diet.",
  "input": "",
  "output": "All right, so you need to take some drugs to treat the diet disorder: fluoxeccetin, trachon, ketinice, Ramiculin, Topicacics, V\u00e9r\u00e1pacacicin, Minocline, Benczynhoemin, and Petsin."
},
{
  "instruction": "Doctor, a few weeks ago, I had a temporary hemorrhagic seizure, and I'm worried it's going to come back.",
  "input": "",
  "output": "Don't worry, there are some other drugs that can help you prevent another seizure: chloridogrel, deperassylocks, betanecholl, Diphilitamo, kadopente dimeglumin, and vivalluudine."
},
{
  "instruction": "Doctor, there's a sharp pain in the back and a chill when you urinate.",
  "input": "",
  "output": "The drugs needed to treat Cyproflixins, levoploxinsins, ceftlixins, cytoplasm or cepixiums, can help alleviate the fever of the urinary tract."
},
{
  "instruction": "Hi, sir, there's a lot of pain in your shoulder and limited range of exercise.",
  "input": "",
  "output": "In order to control pain and inflammation, it is recommended to use a combination of drugs, including trimalolone, volume barocine, and cortisone."
},
{
  "instruction": "Doctor, I've been suffering from chronic pain for a while, and it's incredibly painful, and I can't do very much in everyday life.",
  "input": "",
  "output": "I'm going to need to take some drugs to control the pain: oxycodon, methadone, carillone, oxoprodol, oxophone, dechlorophon, i.e., Milasisifak, salvela (skelet 1 material), cebimelin, Sorbitol and Colin, which help relieve the pain."
},
{
  "instruction": "Doctor, I'm pregnant, and I've been having a lot of problems recently, so would you recommend a drug that might help?",
  "input": "",
  "output": "For example, you can prescribe a combination of vitamins and supplements that allow you to take all the nutrients you need during pregnancy. You may also need a micronose in case you have a mold infection. You also need Rho (D) immunoglobulins in case you have a fertility problem."
},
{
  "instruction": "Doctor, I have liver cancer. What drug should I take?",
  "input": "",
  "output": "You need to take Spirolon, Oxykodon, Tacrolym, Laktulose, Sor\u00e1pebop, Dexamethasone, Apprefitant (Emen)."
},
{
  "instruction": "Doctor, there's a disease called armory. What are the drugs that you need in your arsenal?",
  "input": "",
  "output": "The drugs needed in the arsenal may depend on the cause of the condition and the severity of the condition, but you may need to take a tyotopeum that helps open your airway and improve your breathing."
},
{
  "instruction": "Hi, doctor, you've been hurt by your hand lately. What kind of medication do you recommend?",
  "input": "",
  "output": "It's good to take etodolacs to relieve pain and inflammation depending on the level of the injury, and because of that, it's also good to be able to numb the nausea and relieve the pain."
},
{
  "instruction": "Doctor, I have a pain in the upper right abdomen, and I've been diagnosed with pysmosis, which drug should I take?",
  "input": "",
  "output": "You have to take a combination of drugs, including methodidasolol, verdazolam, manic acid, ampicillin, plasma protein fractions, vitamin K1 (plastics), deciferin, synaptics, sulfase, sulfuric acid and sulmexacsol."
},
{
  "instruction": "Doctor, you hurt your ass and you're in pain. What kind of medication should you take?",
  "input": "",
  "output": "With painkillers, you can give hydrocodon, and with muscle relaxant, you can prescribe methaksalon."
},
{
  "instruction": "Doctor, I was diagnosed with cirrhosis of the liver. What kind of medication should I take?",
  "input": "",
  "output": "You need to take a combination of drugs, including purocesed, sphincteron, lactose, tarcromus, and nadol."
},
{
  "instruction": "Doctor, I had a chest pain and I was diagnosed with aortic aortic aneurysm. What drug would you recommend?",
  "input": "",
  "output": "Depending on the patient's condition, it's good to take a combination of methofol, nitroglycerin, hydrazine, lavetol, esmolol, pentoxyfilol, cochten, amiodarone, nitrofroform, estropete, dexa metasson medicine."
},
{
  "instruction": "Doctor, I was diagnosed with congenital rubella, which drugs should I take?",
  "input": "",
  "output": "In order to strengthen the immune system, you need to take a rabbit human, T-impressive Grefalyxine, and also a powerful antibiotic to treat the infection that can be caused by weakened immune systems."
},
{
  "instruction": "Hi doctor, I'm experiencing chronic pain and fatigue throughout my body, and I've been diagnosed with fibromyalgia.",
  "input": "",
  "output": "It's recommended that we take Fregabalin, Norttylin, and Milnazion together to alleviate pain and fatigue."
},
{
  "instruction": "Doctor, I've had severe abdominal pain for a while, but recently I was diagnosed with intestinal hemorrhagic, and would you prescribe a drug for this?",
  "input": "",
  "output": "For the treatment of intestinal hemorrhagic acid, we'll deal with bacterial infections and clots, which can be caused by the treatment of methidasol, sassalamine, heparin, and caratite. We'll also need oxygen to help us breathe, sodium to prevent dehydration, guama to help us digest."
},
{
  "instruction": "Hi doctor, I was diagnosed with fetal alcohol syndrome a few years ago, and it's affecting everyday life.",
  "input": "",
  "output": "Yes, there are some drugs that can be helpful: Adderall, methylphenin, Clonithin, Trazodon, Sciprotadin, Guanfacin, nicotine, atomousetera, alanxa, lamothicin, or peritone."
},
{
  "instruction": "Hi, doctor, there's severe abdominal pain, fever, nausea, I think it's peritonealitis.",
  "input": "",
  "output": "It's been diagnosed with methocystase, pentaneyl, vancomycin, ceftamidim, gynaxin, cynacolyscemium, occinium, occassic acid, ditrescence, centnosideb, usp, which can be treated by a combination of drugs."
},
{
  "instruction": "Hi, doctor, I've been diagnosed with abdominal injuries. What drug would you recommend?",
  "input": "",
  "output": "Yes, you have to take a combination of different drugs, such as Becuonium, Visacodil, Memanintin, Semanomeside, Usdium, Josin, Mekmilamin, Grepaplexsazar, Malation Staten, and Zemtojologeng."
},
{
  "instruction": "Hi, doctor, I've been diagnosed with acute pancreatic disease. What medication do you need?",
  "input": "",
  "output": "In the case of acute pancreatic disease, there is a reduction of acetrons for nausea and vomiting, a dihydromodoid for relief of pain, a ditrescence and cellular tetanes for treating bacterial infections, a ditrizophate and ioficol for the treatment of infections, a chloracetic acid for the care of anxiety management, a panacea crotin for digestion, and a panctin."
},
{
  "instruction": "Doctor, there's been a lot of difficulty in breathing recently, and it's very frustrating, and it's difficult to breathe.",
  "input": "",
  "output": "I'm going to recommend some medications based on the symptoms: albumerols, Monteru casts, Platicas, iprotropics, rebalerons, cobvents, Vecometazone soaps, terbulintins, Fred Frnison, or Fred Solson."
},
{
  "instruction": "Sir, I'm feeling uncomfortable with foreign material in vaginal quality.",
  "input": "",
  "output": "I'm going to prescribe Lebor Norgestrell for prevention of pregnancy, and I'm going to prescribe the Mikonasol use product to treat the possibility of foreign infection, but the other drug that you're talking about has nothing to do with the status quo."
},
{
  "instruction": "I can't sleep because of the uncomfortable sensation of a bridge that stops only when I move my legs, and the doctor said it could be anxiety syndrome.",
  "input": "",
  "output": "In the case of GM syndrome, for example, lopiniol, Pramipecsol, Gabapentin, and other drugs, there's a number of other drugs you can use: Modafiyl, Tizanidin, Rezapultan, Sitalyptin, Ramelon, Premidon, Solifintin, Solopecin, and Salicinana."
},
{
  "instruction": "Doctor, I don't think I've been able to breathe lately, and I don't think I've been able to get enough air in, and this happens more and more often, and I'm really nervous.",
  "input": "",
  "output": "In order to cure lung inflammation, we need to take a long-term drug called Boudensandra, and we're going to give you a combination inhaler that helps you to relax your airway. Finally, we need to stop smoking and use nicotine substitutes to suppress your desire to smoke."
},
{
  "instruction": "Hi, doctor, I've recently been diagnosed with cystic disease, so do you want to know what kind of medication to take?",
  "input": "",
  "output": "Yes, for your condition, we're providing you with a combination of drugs, including penicillin, revetylam, calcium carbonate, methophrandium, al - ben dassol, desipamine, sulfate magnesium, nothylin, carbasepine, folic acid and mecaramamine."
},
{
  "instruction": "Doctor, I've recently had a induced abortion procedure, and I'm having some discomfort.",
  "input": "",
  "output": "For example, you can prescribe methalloglobin, which helps control bleeding and spasms. You may also need Rho (D) immunoglobulin to prevent complications in future pregnancy. You may also need a microprostol to help prevent infection of the remaining tissue."
},
{
  "instruction": "Hi, doctor, my baby has teeth syndrome. What medication should I take?",
  "input": "",
  "output": "In the case of dental syndrome, the drug recommended is a Rotavirus vaccine, a pneumonia 7 - a succulent vaccine, a V.V. vaccine, a mummified vaccine, an acid sodium, a measles vaccine, a vaccine for bubonic viruses, a vaccine for turmerculin, a refined protein derivative of turcetiamine, and a cursion."
},
{
  "instruction": "Hi, doctor, I've had severe diarrhea and stomach cramps in the last two days.",
  "input": "",
  "output": "I recommend some drugs that help alleviate the symptoms, and you should use an antibiotic methase to combat the infection that causes intestinal infections. It's also good to help reduce diarrhea by reducing the levels of sodium merium, methranzamide and vomiting."
},
{
  "instruction": "I think he has acute sinusitis, and there are symptoms of blockage, headaches, sinus stress, and so forth.",
  "input": "",
  "output": "It's good to take multiple drugs, depending on your symptoms, such as amethysin or egmenthesia. You also need to take common drugs such as guapenacin, clarium or sefnisin, succ, cepuchos, and bruitous Ac."
},
{
  "instruction": "Doctor, I've been diagnosed with Pon Hippel-Lindau disease. What kind of medication should I take?",
  "input": "",
  "output": "You need to take the Aven dasol, Pimecromus Nationals, acetasolms, Traboprost, Bimatoprost, Brimonine Ancest, Rymonidin, Notttylin, Fulticasone National Products, Raveschamptos, Omb\u00e1ptals, and Zembros."
},
{
  "instruction": "Doctor, I'm having trouble with drug-related psychosis. What drug should I take?",
  "input": "",
  "output": "You have to take drugs, such as lorazepam, ketiaphin and lyridon, along with those drugs, such as haloperidol, benztropine, jiffratidon, epabistsone, nicotine, didarxin, nephrasin, and narlexone."
},
{
  "instruction": "Doctor, I've been feeling so depressed and desperate since I gave birth to a baby that I feel like I'm suffering from acid depression.",
  "input": "",
  "output": "I'm sorry. Postpartum depression is a common condition affecting some women after childbirth."
},
{
  "instruction": "Doctor, I've been experiencing chest pain and discomfort lately, and the doctor introduced me to you, and he said that I suspect coronary cancer, which drug should I take?",
  "input": "",
  "output": "CAD needs to take aspirin, methoprol, chlorplastics, Simbastin, nitroglycerin, carvediol, Isostide, rosvastin, digustin, ejemitia, and lamityl to help control the chest pain, prevent blood clots, and prevent further damage to the arteries."
},
{
  "instruction": "Doctor, I'm experiencing severe back pain and stiffness, which sometimes spreads to my neck and shoulders, and it's hard to move my waist freely.",
  "input": "",
  "output": "I'd like to recommend a drug treatment for pain and stiffness, such as cyclobin, dijemium, caritol, orphenadrine, tesssadin, methalexin, methadone, methadone, methadone, Nabutton, Closazon."
},
{
  "instruction": "Doctor, I've been diagnosed with the pituitary gland, which drug should I take to treat?",
  "input": "",
  "output": "We need to take bromocritin, Testosterone, Rosuvatein, Katergolin, Olmesartan, and we need to take prescriptions for phallicololin, peregolide, deethyride, peraminthide, turmetholin, and triamolol."
},
{
  "instruction": "Hi doctor, I'm experiencing severe menstrual hemorrhage and pelvic pain, and I went to see a gynecologist, and I was diagnosed with hysteroma, which drug should I take?",
  "input": "",
  "output": "To treat amniocentesis, you have to take drugs such as medoxyprogesterone, loprolyphon, progesterone, chlorin, hcg, norretin, navoplin, naturin, burrelol, anti-solin, or sulfenesis."
},
{
  "instruction": "Doctor, I'm experiencing abnormal vaginal bleeding.",
  "input": "",
  "output": "You can have an acute menstrual hemorrhage, and the drug you need is medoxyprogesterone."
},
{
  "instruction": "Hi, sir. I have a collarion in my eyelid. What kind of medicine should I take?",
  "input": "",
  "output": "You need to take a tobramycin eye medicine."
},
{
  "instruction": "Hi, sir, there's a lot of pain down there, and I think it's getting worse.",
  "input": "",
  "output": "The symptoms seem to indicate that there is a pain caused by an infection, a drug needed to treat pain, inflammation and infection. We start progesterone, cecumcytin and cyptoid therapy to reduce infection."
},
{
  "instruction": "Doctor, there's aches and heat and a little secretion in the vagina.",
  "input": "",
  "output": "It's a good idea to take the fluxol, or to use the lynchonasol, or the chloritimazol, or the terta methagol, or the chloromythol-knoxine. If the infection is severe, it can be helpful."
},
{
  "instruction": "Doctor, there's a lot of pain in the back of the ear, and there's probably earlobes, and there's fever, and there's headaches.",
  "input": "",
  "output": "The symptoms suggest that there is a suspicion of pneumorrhagic acid, Trimmonolone, tetrakine, anti-barbital, botany, iorbisol, acelasten, cellocardis, cefefiim, amanthadin, etc."
},
{
  "instruction": "I was diagnosed with a lung contusion. What kind of medication should I take for treatment?",
  "input": "",
  "output": "Morphine, the dopamine toxoid vaccine, cefazolin, pentamyl, ammonium chloride, propopol, mecaramamine, grefaflyxacin, paralysacic acid, and zmtozonog are the drugs needed to treat lung contagion."
},
{
  "instruction": "Hi, doctor, I've been having chest pains and trouble breathing lately, and my heart rate is sometimes irregular.",
  "input": "",
  "output": "The symptoms seem to indicate that you have HOCM, which is a drug that you need to prescribe to alleviate symptoms, such as metoproroll, berapamil, and all memesat\u00e1n."
},
{
  "instruction": "Doctor, it's really painful to have an emotive toe. What kind of medication should I take?",
  "input": "",
  "output": "You need to take the panol, which includes the local terbinapinapins, cyclophylox, and the locals, as well as the oral drugs, which include cephalexin, volume vaccin, and supplexol."
},
{
  "instruction": "Hi doctor, I've been having trouble breathing recently, and I've been coughing, and the doctor thinks it's an increase in lung parasol. What kind of medication should I take?",
  "input": "",
  "output": "You need to take multiple drugs to treat lung parasol increases. Fred Nisolone to reduce inflammation, candeshtan to improve the blood flow of the lungs, ceftriaxide and woodfluxin to treat infection."
},
{
  "instruction": "Doctor, I don't know what medication to take when I've got a cut in my ass. Can you help me?",
  "input": "",
  "output": "Yes, a wound on the ass should be taken first to prevent the spread of infection. I'm going to prescribe cephalexine and cefazolin. I'm also going to make sure that it's in place of the current strain, so I'm going to recommend the dopamine Toxodin vaccine."
},
{
  "instruction": "Hi, sir, I've been to the ophthalmologist recently and I've heard that there's an cornea disease.",
  "input": "",
  "output": "In the case of the cornea disorder, you have to take the Prenisolesolone, the throphyloxin, the tropicamide antimethrax, the peregrine, the propane, the propaine, the antiprobolic, the anti-probolic, the anti-project, the anti-depressant, the rodeo."
},
{
  "instruction": "Doctor, I think there's a foreign substance in the stomach tube, and I'm very uncomfortable with it.",
  "input": "",
  "output": "So it's good to take a few drugs together, first give glucose to relax the stomach muscle so that it can pass freely. Then, to prevent potentially harmful infections, we give it sequentin, and finally, we give it charcoal to absorb the toxic substances that can be consumed with this substance."
},
{
  "instruction": "Hi, doctor, I think I have ophthalmitis. What kind of medication should I take?",
  "input": "",
  "output": "In order to treat ophthalmitis, you have to take multiple drugs, including erysomasin, erythromysin, sulfatamide, sodium ophthane, self-project, vasssic anti-syn, Rotephrine anti-satol, pulsalyxoids, and tetactanesol, and so on."
},
{
  "instruction": "Hi, doctor, we're having trouble digesting and absorbing nutrients from food, and we're having a thin, oily side.",
  "input": "",
  "output": "The symptoms seem to indicate that you are suffering from intestinal absorption disorder, such as vitamin B 12, lynxide calcium, lysoprasol, lysol, pancratin, cymecones, pan creicase, minerals, tobramenine, copperconesine (preservic, 2) pneumatics, and drug therapy."
},
{
  "instruction": "Sir, I think I'm on lead poisoning.",
  "input": "",
  "output": "The drugs needed for lead poisoning are mecamilamine, indium oxytocin in-111, piffequironium, rabbit anti-human T-immoglobulins, etc."
},
{
  "instruction": "Doctor, there's small growths in your hands and feet that have pain that looks like a little cauliflower tap.",
  "input": "",
  "output": "Treatment seems to include more than one of the following: already the Quemods, salicilic acid soups, Treti\u2019s geroniums, grapephylox soups, Trichlorotins, Symethine, Atratithic acid soups, Tastin soups, Ikonazol, Kandi Alvicans extracts, grape resins."
},
{
  "instruction": "Doctor, I've been sweating a lot lately, and it's very uncomfortable and unpleasant.",
  "input": "",
  "output": "I'm going to give you a solution of aluminium hexahideate solution."
},
{
  "instruction": "Sir, I think I'm having a stroke.",
  "input": "",
  "output": "All right, we need to do it quickly. We need to take the alteplase to melt blood clots. We also need to take chloridoscopes to prevent blood clots, lavetalols for control of blood pressure, pospirenitos for prevention of seizures, deferasis for protection of iron and bladder function, Vetanes for controlling blood pressure, vitacone for control of the blood pressure, thalassin for the use of blood pressure."
},
{
  "instruction": "Hi, doctor, I think it's a pyrocyctoma, and I've been feeling really sick and uncomfortable lately.",
  "input": "",
  "output": "I'm sorry, I'm going to give you a few medications to treat the pyrocycenomasine, and I'm going to use chlorins, and beta methasone-chloridol, local products and nitric acid, locally, and I'm going to be able to use it as a solution of sulfate mexium and sodium calcate to relieve pain."
},
{
  "instruction": "Hi, doctor, you've been in a lot of pain and discomfort lately, which drugs should you take?",
  "input": "",
  "output": "Depending on your condition, you have to take a vaccine for Cephalexine, cefazolin, and dopamine toxoids, and chromic baccles, and chromosomines, and lydokines, and lydokines, and lysium lysylate, bequerium, tementinate, and dementia toxodide."
},
{
  "instruction": "Hi, sir, I've recently had problems with memory and balance, and I feel like my bladder isn't completely emptied.",
  "input": "",
  "output": "The symptoms suggest that you have a combination of entourage, anginasin (intubation), acetress, methphenate, pyylamine, lystamine, Galantamine, Indamid, Trimetomide, encapsolin, desalination, desalination."
},
{
  "instruction": "Hi, doctor, your hair has been dropping dramatically over the last few months.",
  "input": "",
  "output": "Depending on the conditions, the drugs are menocysid, a propinolololone, a chlorbetaol bar, a fluoinoid, a low - oscillate, amenic acid, a hydrolytic acidizer, a hydrocyclic acid, a hydrochlorocene, and a polycyclic acid."
},
{
  "instruction": "Recently, I was diagnosed with chamoto thyroiditis, which drug would you recommend?",
  "input": "",
  "output": "The drug recommended for chamoto thyroiditis is tyrexine, which helps regulate thyroid hormone levels."
},
{
  "instruction": "Doctor, I've been diagnosed with non-alcoholic liver disease, which drug should I take?",
  "input": "",
  "output": "In order to treat NASH, you have to take multiple drugs, such as vitamin E, Valgancy claustrovire, mycophenolate mortium, lactoles, nadolins, mesalolin, alsalamines, esporaproctin, dupotitolin, and stratamine, etc., etc., etc., etc., etc., and so forth."
},
{
  "instruction": "Doctor, I'm suffering from thrombosis. What do I need to take to recover?",
  "input": "",
  "output": "In your condition, you have to take a drug called Waffarin, Almethattan, vitamin B 12, cortisone, nephedin, digusin, mecaramamine, Grepalyxin, maralionone."
},
{
  "instruction": "Hi, doctor, there's been some discomfort and pain in your pelvic area recently, and your pelvic organs seem to have escaped, and you feel uncomfortable standing or walking, and what are some of the drugs that help to relieve your symptoms?",
  "input": "",
  "output": "In response to symptoms, it is recommended to take a combination of drugs to address the symptoms of escape and companionship: estrogen and estrogen, which help strengthen the pelvic muscles; antifreeze, which helps treat the problem of urinarysis."
},
{
  "instruction": "Sir, I fell and injured my arm. X-rays confirmed that there was a fracture. What kind of medication should I take?",
  "input": "",
  "output": "I'm going to give you ketamine to control the pain from a fracture, cephalotin to prevent infection, phenopropen to reduce inflammation."
},
{
  "instruction": "Doctor, in recent years, if you've got a skin injury or a scratch, you've lost a lot of blood, and I'm worried if you're having a bleeding disorder.",
  "input": "",
  "output": "I'm going to prescribe drugs that help you to control your blood clots and prevent excessive bleeding."
},
{
  "instruction": "I've been diagnosed with two internal bleeding. What kind of medication should I take?",
  "input": "",
  "output": "Two internal bleedings require a combination of drugs, including penicillin, tetanus toxoid vaccine, and amantadin."
},
{
  "instruction": "Doctor, I'm experiencing muscle weakness, irregular heart rate, fatigue. Tests show high levels of potassium in the blood.",
  "input": "",
  "output": "You need to take polystyrin sodium (kaxalate) to help remove excess potassium from your body. You may also need insulin, bicyclic sodium or acetate calcium to stabilize potassium levels. You may need a drug such as epothein al-procrit or castriol."
},
{
  "instruction": "Doctor, I've been experiencing pain and irritation in my eyes recently, and I've been tested, and I've heard that there's an corneal infection, which drug should I take?",
  "input": "",
  "output": "To treat the corneal infection, you have to take it with you: the nematoxin, dexamethason-tobramycin, and erythromycin, as well as proparacasine anti-solone, and phrenics, according to the severity and symptoms of the infection, and the phrenic anti-solemolemone, and the thropotomy, and the anti-freetone, and the anti-automy."
},
{
  "instruction": "Doctor, I'm having a hard time with a lung abscess. What kind of medication should I take?",
  "input": "",
  "output": "You have to take meropeem, vancomycin, Boudesonid, Dexa metasson, Revetiratam, docucete, etc."
},
{
  "instruction": "Doctor, you're not strong, you've got high fever, you've got body and skin rash, is it dengue?",
  "input": "",
  "output": "It's possible, yes, dengue fever. I recommend: Fermetrin bar, take enough water intake and rest with drugs, hydroxycin, rantidin, and acet aminophen, and you can also monitor your condition and prescribe additional drugs as needed."
},
{
  "instruction": "Hi, doctor. I heard you have chronic sinusitis. Can you prescribe a drug?",
  "input": "",
  "output": "In the case of chronic sinusitis, you may need to take multiple drugs in combination. First, it's good to start with the agmentin, mmetasones, guapenesines, and then you can use acetrema, sefnirer, and cepusmium, if it doesn't work."
},
{
  "instruction": "Doctor, I've been having pain and swelling in my ear for the last few days.",
  "input": "",
  "output": "The skin at the back of the eardrum seems to have a form of earloma, which is an abnormally growing form of ear infection. You have to treat it as soon as possible to prevent further complications."
},
{
  "instruction": "Doctor, I'm experiencing a deep abdominal ovulation that doesn't go away, and I went to the hospital, and they called me Volvolis, and what's the drug for?",
  "input": "",
  "output": "In Volvolis, you have to take morphine for pain relief, meth for infection treatment, Trimeto benjamide for reducing nausea and vomiting, ikexol for video testing, and lactulose for defunctation."
},
{
  "instruction": "Sir, you've hit your finger, it's swollen, it's painful, which drug should you take?",
  "input": "",
  "output": "Sefaxin, Sefazolin, Adasolin Vaccin, Fifibacuin, Sefad Roxyl, E.N.T., Tranylcyproamin, lrando Qin, Huspin, Uspinte."
},
{
  "instruction": "Hi, doctor. I think I'm addicted to overdoses.",
  "input": "",
  "output": "I'm sorry. In your case, the drugs needed are charcoal, acetylcystein, and nalochon."
},
{
  "instruction": "Doctor, I'm experiencing irregular heart rate and shortness of breath, and I'm worried that it might be pericardial fibrillation, which drug do you recommend?",
  "input": "",
  "output": "When you have a pericardium, you generally recommend an anticoagulation like thrombosis to prevent blood clots, and you recommend drugs such as parasemids and digusins to slow down the accumulation of body fluids, as well as divining dibs and divinings to help control heart rate, you can recommend aminotamines or carvelols that help restore normal heart rhythms."
},
{
  "instruction": "Sir, I think you've been infected with urethra, and it's very dark around your anus at night.",
  "input": "",
  "output": "You're right. The drugs that you need are mebendasol, or Pirantel."
},
{
  "instruction": "I was diagnosed with a urethra valve. What kind of medication should I take?",
  "input": "",
  "output": "You have to take multiple drugs to manage your state. This includes a vaccine such as mint, isosorvid monotreme, cesprosil, cassytriol, zyrets, synaptic acid, synaptic acid, hydroxychlorin, lycossamine, Rotavirus, Benalf and B."
},
{
  "instruction": "Doctor, there's an open wound in your neck that doesn't heal. What do you do?",
  "input": "",
  "output": "To reduce the risk of infection, it is recommended that you treat your wounds with anti-comalysis, kolagenase, and nitric acid. It is also recommended that you use anti-comonysine, renasine, and siliculosis to reduce the risk of infection and use nelulose to control the bleeding and use asteroids to help heal. If you have diabetes, try to control your blood sugar levels and blood sugar levels, and take the last real damage to the body."
},
{
  "instruction": "Doctor, I'm having a hard time swallowing, and I've been told that I have a disease called depression, which drugs should I take?",
  "input": "",
  "output": "There are drugs that can include a treatment plan, such as pamotidedin, which reduces acid sprays, mydalas, which help relax muscles during the procedure, destabilizers, destabilizers, calcium calcium to reduce burn, sulfate barium for imaging tests, toltedin that relieves bladder cramps, acid dioxide that lowers cholesterol levels, and ostensitation of the skin, and ostensity of the osmosis."
},
{
  "instruction": "Doctor, I can't hear it right. I've been having this problem for a while, and I think it's an electrical hearing.",
  "input": "",
  "output": "It is recommended, according to the symptoms, to treat hearing loss with such drugs as gualyxcavamide oflacic, oflacic acid, botoxate, orlofadin najal, which is a drug such as methylsel, octopam, mitotanium, maroniejett (Venaceinium-salcium acid)."
},
{
  "instruction": "Doctor, I've been diagnosed with abdominal hernias. Can you prescribe the medication you need?",
  "input": "",
  "output": "Yes, the drugs used in treating abdominal hernias are neostigerin, desplinium, locoranium, arnic national formula, ethers, methylene blues, lime vaccines, amino-salisylic acid, flux acid, flux acid, trivia."
},
{
  "instruction": "You have cerebral palsy. What kind of medicine do you need?",
  "input": "",
  "output": "Your disease requires Bjoklofen, Revetirasemam, botulinum poison A, Topamax, Carvamazephin, Phenobarz, polyethylene glycolin, lycolylint, Olycholopolin, lysalin, buttral, bournisad, and tysadin."
},
{
  "instruction": "Doctor, I've been drinking marijuana for a long time, and I think it's having a huge impact on my life.",
  "input": "",
  "output": "There are drugs for marijuana abuse, such as Myrta Zaczin, Plopegenin, Levocarin, Nacrexson, Akamproceal, Tibitli, Aserphin, Lehferin, and Fence, and Win."
},
{
  "instruction": "Doctor, I've recently been diagnosed with Kryptonococcus, what kind of medication should I take?",
  "input": "",
  "output": "The first drug needs to be administered with a variety of drugs to treat the disease. It needs to be administered with amphothesia B, intravenous injections. It also requires an eye lubricatation to relieve the discomfort of the eye. It also needs to be taken with a hand, bicyclic sodium and fluxide (depression) to prevent further infection, and it encourages the inflammation of the Influnosis virus H1 vaccine to prevent further infection."
},
{
  "instruction": "Doctor, I've been thinking about weight for a long time, and I've tried a lot of diet and exercise programs, but it doesn't seem to work.",
  "input": "",
  "output": "I recommend a combination of drugs, including pentamine, Orristatt, and ciburamine, which was shown to be effective in helping people lose weight."
},
{
  "instruction": "Doctor, I'm feeling a lot of discomfort in my upper abdomen after dinner, and I'm feeling a lot more nausea and nausea, and what's the problem?",
  "input": "",
  "output": "Don't worry, because there's a drug that can help you, you know, reduce your stomach, reduce your stomach, protect your stomach, protect your stomach, relax your stomach muscles, relax your yeast, relax your gas, reduce your gas, and take your bismacosis, and let me know what you're allergic to."
},
{
  "instruction": "Doctor, your elbow is swollen and you're in pain, even when you're not moving.",
  "input": "",
  "output": "It's good to take advantage of Triminollon local products, volume binine, and cortisone injections to reduce inflammation."
},
{
  "instruction": "Doctor, I've been diagnosed with esophageal cancer. What kind of medication should I take?",
  "input": "",
  "output": "You have to take drugs to manage cancer, including methocclopemyd, Sisplatin, prochloralines, the local products of Dexamethasone, fluorous acid, aphretetans, hexa methsone, heptatone, pachtsel, carapetete, supplepets, usphemy, and mplorin."
},
{
  "instruction": "Doctor, I've been having trouble breathing and coughing over the last few days, and I think there's a lot of fluid in my lungs, and it's getting harder and harder to breathe.",
  "input": "",
  "output": "I'm going to give you a combination of drugs like paraserium, nitroglycerin, erythropicum, hydratase, hydralazine, oxygen, metrazone, but I want to know if you're currently on another drug or if there's something that I need to know about."
},
{
  "instruction": "Hi, doctor, I think I have juvenile rheumatoid arthritis.",
  "input": "",
  "output": "All right, to do that, you need to take a combination of drugs, including methocrexecate, folic acid, nafflunomide, Hydexychloroquin, Fred Nissolon, Cerecococcibe, and, if necessary, ethanes, Adarmora, Inflicsian, and Diklomp."
},
{
  "instruction": "Doctor, I've been diagnosed with S.V.D. What kind of drugs do you need?",
  "input": "",
  "output": "You need one of these: fluorous, fluorous, fluorous, localized, executive, trotti, ethodidasol, ketonasol, and Clovetazol; decimetasone; desalinate, or aminosylic acid."
},
{
  "instruction": "There's pain in the ear, there's secretions, and I think it's acute.",
  "input": "",
  "output": "In order to treat the infection, you have to take antibiotics."
},
{
  "instruction": "Doctor, I recently had a problem with my eyesight, and I have a blurry, distorted image, and I was diagnosed with difficulty a few months ago.",
  "input": "",
  "output": "I'm going to give you a prescription for tropicamyd anti-meth, pernium perme, pneumool, depreniolone, turpentolin, atropine, atropape, anti-reject, erythrompin, anti-sol, sodium, sodium, and hypernic."
},
{
  "instruction": "Hi, doctor, I've been diagnosed with sepsis, which drug should I take?",
  "input": "",
  "output": "You've got to take Topammet, Oscarbzeptal, Carvamazephin, Revetira Semam, Divalprox sodium, Clona Semam, Bibatlin, Clochine, Bakofin, Lipithium, Pilopiracate, Trycho."
},
{
  "instruction": "Hi, I've recently been diagnosed with an abscess, and I want you to tell me what drugs you need to take for treatment.",
  "input": "",
  "output": "In the case of the agronoms, you need to take antibiotics, such as ceftagidim, gypsum and sepzolin, and erythromycin."
},
{
  "instruction": "Hi, doctor, I've recently heard that there's been a problem with hearing, that it might be a noan, what kind of medicine do you need?",
  "input": "",
  "output": "In the case of Noan, it's recommended ivandromet, potassium chloride, rovastatin, Cerecoccisin, mekamilamin, grefalyxacin, Mempalyxacics, militagjos, and phrothodols."
},
{
  "instruction": "Doctor, my baby's been diagnosed as a newborn child. What drug can you recommend?",
  "input": "",
  "output": "The treatment suggests that you prescribe \"B\" hepatitis vaccine, \"Eris Rome's ophthalmology\" and the \"symbolizing of triple dyes\" that are commonly used in the treatment of newborn infants, which you would like to discuss with a pediatrician in a very short time."
},
{
  "instruction": "Doctor, there's been a lot of breathlessness and coughing, and I've been asked to consult a specialist, and I've been diagnosed with chronic closed lung disease, and what medication should I take for this disease?",
  "input": "",
  "output": "A chronic closed lung disease can help with such drugs as agitomas, covits, tiotrofoium, erythrophim, kaipenesis, gupenes, ac, ablutomas, and benjotantes, depending on the severity of the condition."
},
{
  "instruction": "Hi, doctor. I think I broke my elbow while I was playing basketball.",
  "input": "",
  "output": "Okay, I need to fix it, and I'm going to give you some drugs to ease the pain and make it easier to do it -- ketamine, propopol, and atropine -- which can only be used in hospitals or in health care centers under the guidance of a licensed medical professional."
},
{
  "instruction": "Doctor, I've been experiencing a lot of back pain and stiffness lately, and I think it's because of spina bifida, which drug should I take?",
  "input": "",
  "output": "It's recommended that you take a combination of drugs, such as volume baracin, Tizanidin, nabumeton, lopivacine, and phyoxycam, combined with drugs such as oximone, ketoprofen, entrel, ithemidol, picher plant, and riboflavin, to relieve and treat the symptoms."
},
{
  "instruction": "Hi, Mr. Herpanzie, I think you've got her throat sore and a little blister in the back of her mouth. What kind of treatment do you recommend?",
  "input": "",
  "output": "You can start with local treatment for the symptoms. To relieve pain and discomfort, I recommend Phenol and Bennector, local colossus colossus colossus, and you can also use calecalsiferol to improve your immune response to the virus causing the infection. Unfortunately, the Factor Ex complex is no longer in use and therefore cannot be used for herrpanzie."
},
{
  "instruction": "Hi, doctor, I've been here with a severe shoulder injury, and I've been sick for days, so I can barely move my arm.",
  "input": "",
  "output": "I'm sorry, but I'm going to prescribe some medication based on the symptoms, and you have to take ketoprofen and dechlorpanchil products to reduce inflammation and pain, and you can also need alfentanyl to relieve severe pain, and finally Sinatratrium is a muscle relaxant that helps you relax your shoulder muscles while you're feeling better."
},
{
  "instruction": "Doctor, I think you're suffering from an addiction to antidepressants.",
  "input": "",
  "output": "We need to act quickly: charcoal, bicyclic sodium, narcissic acid, sodium salic acid, sodium Sorbithol, fluxenephrine,norepinephrine, nicotine, chloridium, chloromasol, mecaramamine, which helps us to absorb the remaining anti-depressants, treat the symptoms, and stabilize them."
},
{
  "instruction": "Doctor, can you prescribe a drug for a wound that's infected?",
  "input": "",
  "output": "Yes, it's good to take Clinda Mycin to treat the infection of the wound."
},
{
  "instruction": "Hi, doctor, there's pain and swelling in your leg, and I'm worried about I.V.P.",
  "input": "",
  "output": "To treat this condition, I have to prescribe one of the following drugs: Waffaline, oxytocin, Heparin, Daltefinin, Pontifix, Gollagin, Salicate, Pyridomin, Elmmothattan, and Nimmetatin (Exercence) to treat this condition, and I am going to give you the best possible treatment for this procedure."
},
{
  "instruction": "Hi doctor, I'm not feeling strong these days, and I'm feeling very tired, and I'm losing my muscles, and I'm having trouble making them.",
  "input": "",
  "output": "I think you're experiencing a lack of protein: polyethylene glycox, Ursool, Paclixol, thiamine, potassium chloride, Tyopiumsine, amypolyxine, axalix, axlexylxos, acetylxos, a drug."
},
{
  "instruction": "Doctor, all of a sudden my muscles are stiff, and I'm having cramps, and it's getting very difficult to manage every day.",
  "input": "",
  "output": "It's good to prescribe chlorazefam, Gabapentin, or Letvetiratam to relieve the symptoms."
},
{
  "instruction": "Sir, I've had extreme back pain in my heels over the last few months, and I've been talking to an analgesics, and I've been diagnosed with calcite bone rashes.",
  "input": "",
  "output": "You can take any drug, such as piroxicak, etocholac, moecciprompen, ketoprofen, controcyt-glucosamine, or betamesone. But it's best to consult with me and decide which drugs are most suitable for you."
},
{
  "instruction": "Doctor, I've been diagnosed with von Vilebrandt's disease. What medication should I take for treatment?",
  "input": "",
  "output": "To treat von Vilebrandt's disease, you have to take a desmopressin or an anti-hemorrhagic gene."
},
{
  "instruction": "Sir, there's an open wound on your back that's really painful. What kind of medication should you take?",
  "input": "",
  "output": "And to keep the wound clean and to prevent infection, you can also need a local solution, a silic acid solution, a sulfiab acid and a povithide yodin."
},
{
  "instruction": "Doctor, your heart rate is irregular and your heart rate has dropped significantly, and you feel dizzy and weak most of the time, and what's the cause?",
  "input": "",
  "output": "It's good to take a drug for treatment: glucose, ascorbic acid, glymephids, atrodarone, atropine, plotine, catalystides, methoids, triametholes, boomerangs, boomerangs and concertins."
},
{
  "instruction": "Hi, sir. I got my E.K.G. results, and they say that I have a colonoma. What kind of medication should I take?",
  "input": "",
  "output": "You need to take a medazolam, a pentane, a propofol before a polypectomy, and then you can take a routerium and hydrocortisone-primide to relieve the symptoms."
},
{
  "instruction": "Doctor, I've been diagnosed with B.P., and what do you need for prostate hyperplasia?",
  "input": "",
  "output": "The drugs needed for prostate obesity are beta metatsson's local product and athtosterone."
},
{
  "instruction": "Doctor, I've been feeling muscle weakness and fatigue lately, and my heart rate feels irregular, and I wonder if magnesium deficiency can cause these symptoms.",
  "input": "",
  "output": "Yes, it's very likely, but it's good to take a magnesium supplement to address the lack of magnesium, which can help you with all kinds of drugs, such as nitric acid magnesium, glucose magnesium, nitric oxide, and so on."
},
{
  "instruction": "We tried to get pregnant for over a year, but it didn't work, and a doctor recently diagnosed an unknown cause of female infertility, which drug would you recommend?",
  "input": "",
  "output": "I recommend a combination of drugs, which includes chlormid, and human pulsar stimulants (Hcg), progesterone, rubrorid, estrogen, Europolyphin (Brevell), menotlopine, letrosmara, Alpha-Austsin, and Garrisin."
},
{
  "instruction": "Doctor, I've got chest pain and respiratory problems, and the doctor's called pulsating, so what kind of medication should I take?",
  "input": "",
  "output": "To reduce inflammation, you have to take nitroglycerin, domecin, caulhitzin, teraxin for pain and sleep, teraxin for lower blood pressure, and microprostrossol and dexlasol to reduce stomach acid."
},
{
  "instruction": "Hi, doctor, I'm having a hard time getting my job done on time, and I'm easily distracted, and I've had a lot of forgetfulness.",
  "input": "",
  "output": "I think you're suffering from ADHD. I recommend drugs that help alleviate the symptoms."
},
{
  "instruction": "Hi, doctor, I've been diagnosed with cytoplasm, which drug should I take?",
  "input": "",
  "output": "In this condition, we recommend ajatio-Prin, Barrofen, Kava-Pen, Carmazepine, polyethylene glaalex, 350, Pregabalin, nitro-Polantoin, paroxine, doxide, oxycodon, Gabapentin, and Syproxine. These drugs are essential for me to prescribe and make regular contact with me."
},
{
  "instruction": "I was diagnosed with lung valve disease. What kind of medication should I take?",
  "input": "",
  "output": "To manage lung valve disease, you can take mekamilamine, kadoridol, devil's croze, etc."
},
{
  "instruction": "Hi, sir, your chest is very sick and swollen, and I read online that it could be T.T.S., which drugs should you take?",
  "input": "",
  "output": "In the case of Tieche syndrome, it is recommended to take some drugs to relieve pain and swelling. First, you need to apply methyl salicilic acid-mentol cream on your throat to prevent clots. You need to use non-balluin to reduce fluoride. You can use fluoride derivatives to reduce stimulation and to reduce allergies. There are other ways to reduce suffocation and pain in your body."
},
{
  "instruction": "Doctor, I've been told that facial muscles have become weaker and the eye movements have become more difficult.",
  "input": "",
  "output": "You're going to need a botulinum type A injection to improve your symptoms according to your diagnosis."
},
{
  "instruction": "Doctor, your arm hurts a lot. What kind of medication should you take?",
  "input": "",
  "output": "To manage the pain and inflammation, you need to take Pirocksikam, Trimetadion, vinjalonium, brompeak, condensation, and Tolnaftate."
},
{
  "instruction": "Doctor, I've been diagnosed with a transition disorder, muscle weakness and seizures, which drugs should I take?",
  "input": "",
  "output": "We need to take Benafaxin and Myrtazafin to help us with the symptoms of depression and anxiety, which can help us control our seizures."
},
{
  "instruction": "Hi doctor, I've had severe pain in my arms and legs over the last few months, and I went to a couple of doctors, and they said that I had multiple pain syndrome.",
  "input": "",
  "output": "You can see Gabapentin, Pregabalin, metitylin, methadone, Ryclopen, Lido-prirokines, Boufredocen, Milfran, Midrin, Flinnisolide, tenobir, and Combire."
},
{
  "instruction": "Doctor, you've been diagnosed with otosclerosis, which drug should you take?",
  "input": "",
  "output": "To maintain bone health, you need calcium supplements, such as calcium silicate and calcium carbonate; you need bonbia to prevent extra bone loss; you need Cerecoccirex to relieve pain and inflammation."
},
{
  "instruction": "Hi, doctor, you're in pain because you're injured in your body. What kind of medication should you take?",
  "input": "",
  "output": "It's good to take metamsalon, which is a muscle relaxant that helps relieve the pain in the wound area."
},
{
  "instruction": "Doctor, I've recently been extremely tired, very weak, and I've gained weight without eating too much, and I've got joint pain, and I have toilets, and what's the problem?",
  "input": "",
  "output": "It's likely to be hypothyroids, or thyroid thyroid."
},
{
  "instruction": "I've been having trouble sleeping in the last few weeks, and it's affecting my daily activities.",
  "input": "",
  "output": "I'm going to give you an ambien that helps you sleep on your symptoms."
},
{
  "instruction": "Hi, doctor, I've recently discovered that there's really a worm in the hair, and I think there's a head tooth.",
  "input": "",
  "output": "All right, I'm going to prescribe one of the following drugs for the head lice treatment: the permetrin, the Lindan, the Peteroneebutum-Firetrin, the Malation, the Nicotion, the Nicotine, the Petroneebutum, the Bentyl, the Alcometazone."
},
{
  "instruction": "Doctor, I've recently found that I'm extremely tired, very weak, and my memory isn't as clear as it used to be.",
  "input": "",
  "output": "The symptoms seem to indicate a lack of vitamin B12, and it's good to take vitamin B12 supplements to treat this condition."
},
{
  "instruction": "Hello, frequent urine, extreme thirst, hunger, blurry vision, I think you have diabetes.",
  "input": "",
  "output": "If you have diabetes, you might need to run some tests on your blood sugar."
},
{
  "instruction": "Doctor, I feel pain and discomfort in my throat, and it's painful for a long time.",
  "input": "",
  "output": "I'm going to prescribe mepenic acid for pain and inflammation based on the symptoms."
},
{
  "instruction": "Doctor, I've been having severe hip pain and severe menstrual periods for a while, and I've been diagnosed with endometriosis, so can you prescribe a drug for me?",
  "input": "",
  "output": "Yeah, I'm going to give you a drug called loprolyde."
},
{
  "instruction": "Doctor, I've been diagnosed with angiosis. What kind of medication should I take?",
  "input": "",
  "output": "It's recommended that hemorrhagic acid mopetyl and cyclotide."
},
{
  "instruction": "Hi, doctor, I think I'm having a concussion, and I hit my head so hard this morning that I'm getting headaches, nausea and confusion.",
  "input": "",
  "output": "I'm sorry to say that it's good to take a multi-fictionyl and a proteria to prevent infection, depending on the symptoms, as well as to use a beryptane to help reduce the vulnerabilities of the brain, and to make sure that there's something wrong with it."
},
{
  "instruction": "Sir, I'm very nervous because my tongue has a white spot on it.",
  "input": "",
  "output": "The symptoms seem to indicate that you've got oral vitiligo, and to treat it, you have to take a drug called grefaflochsar."
},
{
  "instruction": "Hi doctor, I've recently been diagnosed with chronic kidney disease, which drug should I take?",
  "input": "",
  "output": "Depending on your condition, you can prescribe Dar Bephotin Alpha, erypontin Alpha, alopulinol, nitridin, hydrothyl, cassytriol, lavetol."
},
{
  "instruction": "Hi, doctor, I've had a problem with my bladder lately, and I feel like I'm always in need of urine, and I'm having trouble controlling my urethra.",
  "input": "",
  "output": "In response to your symptoms, I'm going to give you a combination of some drugs, and I'm going to prescribe it for you."
},
{
  "instruction": "Sir, I recently had a problem with my eyesight, and I went to the ophthalmosis, and I was diagnosed with it, which drug should I take?",
  "input": "",
  "output": "The drugs needed for choroiditis are Frednisolon, Tropicad anti-Ax, duramax, superpent ophthalms, suppen ophonics, Timool, atropine, methrexe, paracytin, vitamins A, leadership, Dextreamin."
},
{
  "instruction": "Sir, there's a problem, the erection lasts more than four hours, and it's very painful.",
  "input": "",
  "output": "In order to manage this, you have to give multiple drugs, such as Perneg\u00e9prix, terbulintin, Rufrorid, Dialymium, Paberin, Huppintin, Bropusin, Broczyme, Bictin, Schullina, and Schullinda."
},
{
  "instruction": "Hi doctor, I think you've been diagnosed with muscle disease. What kind of medication would you recommend?",
  "input": "",
  "output": "In the case of fasciitis, various drugs are generally recommended according to the severity of the disease: methocrecate, folic acid, Mycophenolite mphetyl, ajatiophrine, Hydoxychloroquine, an immunoglobulins, cycloids, cycloids, pulsolins, fluoride, teratoids, and some of the drugs used in the drug."
},
{
  "instruction": "Hi, sir, I'm not strong these days, I'm tired, my neck is sore and I have trouble swallowing, some lymph nodes are swollen, and I don't want to do anything.",
  "input": "",
  "output": "I'm going to give you a few pills to make you feel better: d\u00e9xa metasone, adda Palen, pentramine, nabufinin, cattunes, trometamines, claudivin, muscle immunoglobulins, lydivins, repaze, desymethesone national cream."
},
{
  "instruction": "Sir, there's a pain in the face and neck, and I think it's a nerve pain. What kind of medication should I take?",
  "input": "",
  "output": "Depending on the symptoms, you can prescribe Gabapentin or Pregabalin to treat the nerves."
},
{
  "instruction": "Doctor, I've been diagnosed with multiple kidney disease. What drug should I take?",
  "input": "",
  "output": "We need to take taturifmus, nefin, cynakaste (Sencipha), lvessartan (Avapro), Balvasit, Sebelamer, Calcitriol, Duta Sterith (Avot), Pinnastlith (professsia), Piscitto (Prectoly), Myrcinos (Sencisician)."
},
{
  "instruction": "Hi doctor, I'm here because I'm experiencing extreme mood change, from being too happy and energetic to extremely sad and desperate, sometimes even suicidal.",
  "input": "",
  "output": "I recommend ketiapine, lamixin, deballicate sodium, lytium, lyphiprosol, lyphoride, vulficionon, vulficionion, i.e., i.e. i.e., i.e., i.e., i.e. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    . . .  . .    . . . . . . . . . . . . . . . . . . . . . . .  . . . . . . . . . . ."
},
{
  "instruction": "Doctor, I'm experiencing fatigue, loss of weight, swelling of the leg, and the doctor said it could be amyloids, can you prescribe the medication you need?",
  "input": "",
  "output": "For example, amoloids should be taken from the formoceids, tyloids, meldalins, d\u00e9sa metasson, ezestym\u00edm\u00e9ves, cytaloprosols, palafols, chaa goatate sodiums, parasols, petrocortisone, hydrocortisone, and hydrocortisone."
},
{
  "instruction": "Hi, doctor, I've been experiencing ethos and stomach acid reflux a few weeks ago, and I'm really starting to care.",
  "input": "",
  "output": "It's a good idea to start taking anti-projects such as omepresol, esophagusol, lysoprosol, pantofrasol, racifax, dexalandin, or Nitithin."
},
{
  "instruction": "Doctor, she's having symptoms of falling vision and falling snow, and the ophthalmologist diagnosed the ophthalmic bleeding, and what kind of medicine do you need?",
  "input": "",
  "output": "You need to take a combination of various drugs to treat the free body hemorrhages: Frednisolone, Tropicad anti-anxiece, Denames, Denisine eryx, bristlecine, rubyxxine, and beb\u00e1xine."
},
{
  "instruction": "I'm experiencing it's itch, it's itch, it's itch, it's antimicrobial, it's addictive, and I'm experiencing it's itch, it's it's it's it's it's it's it's it's it's it's it's it's it's it's it.",
  "input": "",
  "output": "It is good to start taking prednisone and medlysis to reduce the risk of suffocation and hives; it is good to take hydrolysis to help reduce nausea and prevent ulcers; it is also good to take pamothyin or lythin to reduce stomach acid and prevent ulcers. If you have symptoms, you may need to treat fatigue or erythrombosis to treat eryphenesis. For other medications, there may be other forms of hypertensynthesis, which may help to reduce the level of chlorination and inflammation."
},
{
  "instruction": "It's getting worse, it's getting worse, it's needing something to help heal it.",
  "input": "",
  "output": "I'm sorry to say, to treat open wounds in the mouth, it's best to use klindamycin and chlor hexidin to prevent infection. ketamine helps to relieve pain and atropine helps dry excess saliva."
},
{
  "instruction": "She was diagnosed with SD. What kind of medication should she take?",
  "input": "",
  "output": "Clovetazol, hydrocortisone, lactate, urea, and Vacelyn."
},
{
  "instruction": "Hi, doctor, I've been diagnosed with severe dystrophy. What kind of medication do you need?",
  "input": "",
  "output": "The work force requires drugs such as piridostigin, Fred Nisson, Ajatio Princip, Mikophenate morphetyl, vitamin B-12 neostags, dexamethasone, immunoglobulins, intravenous injections, metimas, cytoids, but specific drugs are associated with disease and disease."
},
{
  "instruction": "I went to the hospital and said it was hypoglycemic. What kind of medication should I take to treat it?",
  "input": "",
  "output": "You have to take the Glucagon and the Dia-side that will help you increase your blood sugar levels."
},
{
  "instruction": "Doctor, I'm worried that I haven't had my period in the last few months.",
  "input": "",
  "output": "When you look at what God's saying, it seems like a special menstrual failure, it's a good idea to start taking medoxiprogesterone to control your menstrual cycle."
},
{
  "instruction": "Sir, I think I've lost my ankle. I'm so sick that I can't carry my weight.",
  "input": "",
  "output": "I'm sorry, I'm going to give you the pain reliever Percocet, if necessary, pentane, hydromorphoid, or morphine."
},
{
  "instruction": "I think it's carbon monoxide poisoning. It's dizzy and nauseating.",
  "input": "",
  "output": "The drugs for carbon monoxide poisoning are oxygen."
},
{
  "instruction": "Doctor, we're experiencing panic attacks with physical symptoms such as sudden and intense fear and anxiety, tremors and shortness of breath.",
  "input": "",
  "output": "You're experiencing a panic attack, and I'd like to recommend a drug like Lorazepam that helps you manage your symptoms."
},
{
  "instruction": "Hi, doctor, I've had a lot of pain in my heel lately, and my feet are so sick that I can barely walk on some days.",
  "input": "",
  "output": "To treat pain and inflammation, I recommend a local product, such as Triminollon or Beta Metatsone. It's also recommended that you take NSAIDs, such as etotorolak, Nabumeton, or Indian methin. You can also see local antimicrobials such as selenium sulphide or cortisone cream."
},
{
  "instruction": "Hi, doctor, you can't see the objects that are close to you, and you can read them clearly if you look close to a book or a newspaper.",
  "input": "",
  "output": "I'm going to give you some medication that will help you manage your symptoms: trophocamid anti-respirants, perniumphrine, turpentollate, atropine, fluoresine, fluoresine, nefaxin, anti-fectane, anti-fectane, and anti-pentyl, and anti-pentyl."
},
{
  "instruction": "Sir, I think I'm addicted to tranquilizers.",
  "input": "",
  "output": "The drugs for addiction are charcoal, narcissone, halofericol, flumagenyl, thiamine, nicotine, charcoal-sorbitol, sulfuric acid, acetylcystein, dopamine, and cephthrum."
},
{
  "instruction": "Sir, I feel like I'm in a parasol, and I've got blisters and ulcers on my skin, and it's not healing, it's very painful.",
  "input": "",
  "output": "A combination of drugs must be prescribed to control the immune system and reduce inflammation by using Fred Niisson and Ajatiophrine. We also prescribe chlorbetsolsol, Trimmonolone, Plionidoloids, Nitrogenesis. We also need to prescribe the treatment of mycophenetic morphestheste and minerals to prevent infection. We also need to treat the infection with an infection to prevent the infection."
},
{
  "instruction": "Doctor, I'm experiencing the pain and discomfort of having sex with a bent penis, and after I met a urologist, he diagnosed me with pheroni disease, which drug should I take?",
  "input": "",
  "output": "The symptoms include vitamin E, pentoxyfilin, Silnapil, verapamil, Tammethin, Almesartan, Trino-Fercoret, Palathanium, Quinithin, Carrososol, and India."
},
{
  "instruction": "Hi doctor, I've had a lot of discomfort in my chest lately, so I did some tests, and I was diagnosed with a hemorrhagic hernia, which drug should I take?",
  "input": "",
  "output": "It's good to take Pantoprasol, ddslansofrol, and sucralite to manage the symptoms, which can help reduce stomach acid reflux from the hernia."
},
{
  "instruction": "Doctor, we're experiencing effects outside the body of drugs. What kind of drugs do we need to take?",
  "input": "",
  "output": "It's good to take drugs like benztropine, Tri hexiphenidyl, and amantadin to relieve the symptoms of the effects outside the body."
},
{
  "instruction": "Hi, Doc, I've been experiencing dizziness, hearing loss, deafness, I think I have Menier's disease.",
  "input": "",
  "output": "Yes, the symptoms suggest that it's meni\u00e8ne, estrogen, public fluid, Triamthein, Alyssamine, Yodovin, Dimen Heydrint, Transitoli, Pancreatin, Clotlydon, and Sullin."
},
{
  "instruction": "Hi, doctor, I've recently experienced an allergic reaction: the skin is itchy and I have rashes in my arms and legs.",
  "input": "",
  "output": "I'm going to prescribe some medications that help reduce allergies to the symptoms. In addition to the symptoms, the anti-systamines and anti-histamine pamolins, which reduce the risk of eryphosyngenis, and the anti-respirants, which reduce the inflammation of the erythrombosis, have to be used to reduce it. In addition, there are other forms of hypersynthetics, such as hypersyntheticstics, which can also reduce the effect of erythetic acidic acid, and may also reduce the effect of erytheticsynthetic acid."
},
{
  "instruction": "Doctor, I've been experiencing ear pain and secretions for weeks, and I think it's chronic sepsis, which drug should I take?",
  "input": "",
  "output": "You've got to spend about two weeks with Olyxine and Sefdinir, which helps you fight bacteria in your ear that can cause infection, and you can also use Pluticas to reduce inflammation, and you can use moltin money to manage related pain."
},
{
  "instruction": "Hi, doctor, toilet, abdominal crotch, vomiting, and I've been having a hard time changing for a while.",
  "input": "",
  "output": "The symptoms seem to indicate that you have a rare disease that affects the colon and causes urinary problems. My medication is polyethylene glycoin, 3,350."
},
{
  "instruction": "Sir, there's been severe pain in the shoulder, neck, and ass over the last few weeks, and it's getting worse and harder to move.",
  "input": "",
  "output": "The symptoms seem to indicate that you have multiple dystrophysic muscle pain, which is a steroid drug that reduces inflammation and pain. Note: As a language model, this conversation is a virtual conversation, and it emphasizes that you don't intend to use or take medical advice. It's best to get the help of a professional who has health problems."
},
{
  "instruction": "Recently, I was diagnosed with lymphoma. What drugs can I take to manage lymphoma?",
  "input": "",
  "output": "In general, the drugs prescribed for lymphoma are NGS, Torsemid, Vebasicio, Nitsin, desomytasone, octotide, penoxyfilin, the fulcogenis, the lythase and the methlon."
},
{
  "instruction": "Doctor, I've been diagnosed with bladder cancer. What drug should I take?",
  "input": "",
  "output": "You're going to have to take plymacs, Bcg, Jemsitavin, Pinnastherid, Sisplitin, Afficit\u00e1ntt, Mitomymycin, Pacclitsol, Felopin, Fegrestin, Carboplatin, Paloseron."
},
{
  "instruction": "Doctor, you're having trouble breathing with your breath and chest upsets.",
  "input": "",
  "output": "You need to take multiple drugs to relieve the symptoms. A useful drug is albumerol, eryprotrophium, Fred Nisolon, cobbenettes, rebalbuteols, nitrous oxides, and ARPormoterols, which improves your breathing, slows down your airways, and helps you to open your airways."
},
{
  "instruction": "I'm experiencing severe pain in my right eye and blurry vision, and the doctor suspected acute glaucoma, which drug should I take for treatment?",
  "input": "",
  "output": "The drugs needed to treat acute glaucoma include bremonidine ophthalmoids, Timool, Latanoprost, Vimatoprost ophthalmone, Frednisolone, ophthane, ophthane ophthalmoids, acetacemoids, aphonymoids, and axolide ophthanes, ophthane ophthanes."
},
{
  "instruction": "Hi, doctor, I'm not sure how to treat you when you've got a cut in your chest.",
  "input": "",
  "output": "I recommend that you take the derivative toxoride vaccine first because you're about to get it, and then you have to take the cefazolin, because you need to treat the infection, and it's good to use the ketololac eye drops and codenines to help relieve the pain, because finally you're going to take X-rays to make sure that this doesn't get into the chest cavity, so you're going to get a little bit of sodium, and then you're going to get a little bit of sodium."
},
{
  "instruction": "Hi, doctor. I think I'm decapitated, and I'm really sick.",
  "input": "",
  "output": "Don't worry, we can help you by taking medication to reduce pain and inflammation. Propopol for relief, cecumcytin for prevention of infection, ketamine for treating pain, and tetracycline for preventing further complications."
},
{
  "instruction": "Hi, doctor, I think you've got a lot of back and legs pain and a little bit of left-bone neurosis. What kind of medication would you recommend?",
  "input": "",
  "output": "In your condition, we recommend the use of cyclaven, methocamon, orcretum, orcretin, orcalysperin, or skelacin, or quetzalcine, or quetzalin, or hydrotide, or lytesis, or alothone, to make sure that you are more comfortable with your drug."
},
{
  "instruction": "Hi doctor, I've been experiencing symptoms like fatigue, nausea, constipation, recently found that calcium levels in my blood are high, and what medication should I take for my symptoms?",
  "input": "",
  "output": "There are drugs that can be helpful for high-calcium flow, such as ergo calciferol, rescenic acid, tarcrium, ivandromet, oxcavazete, acetress, estral, meplquine, and reading zelophol, which are the ones that are most suitable for testing."
},
{
  "instruction": "Sir, I've been having a stress breakthrough these days, and I'm having a big problem with my daily life, and should I take drugs to improve it?\"",
  "input": "",
  "output": "\"It's good to take Toltherodin, or Oxybutininin, which can help reduce the urge to relax the bladder muscles and urinate frequently."
},
{
  "instruction": "Doctor, I've been diagnosed with arrhythmia, which drug should I take?",
  "input": "",
  "output": "You have to put on a local cream called Beccaplin topocal."
},
{
  "instruction": "Hi, doctor, I've recently been diagnosed with benign kidney cysts, which drugs should I take?",
  "input": "",
  "output": "You need to take plyomasin, pioglythazon, glucosamine, teloridin, glimephidium, tetrofoium, Nistatin, ruephin Alpha, mestinon, pytosophate sodium, claustropicum."
},
{
  "instruction": "Hi, doctor, I think you've got a maleoma in your testes. What kind of medication should you take?",
  "input": "",
  "output": "You need to take flurviprofen to relieve the pain and swelling associated with the tree, and other drugs that are listed are not needed because they are used to treat other diseases."
},
{
  "instruction": "Doctor, you're suffering from severe back pain, and the doctor's suspect of a sedimentary disk disease, can you prescribe a drug to help relieve the pain?",
  "input": "",
  "output": "Yes, I can prescribe a combination of drugs that can help control pain: Pregabalin, volume barcain, caricaprodol, Tizin, ixin, ibihesol, ibumeton, ifamigol, Opapo, chlorifa, tesssa, tessserod, and Consedo."
},
{
  "instruction": "like doctors, faces, chests, etc., an abnormal hair growth in unwanted body parts, and it's very uncomfortable and uncomfortable.",
  "input": "",
  "output": "To treat this condition, it is recommended that you use a combination of such drugs as plorin cream, sphincter, or anticyclic contraceptives to balance your hormones. In addition, you can also prescribe hydroquinone local creams, as well as adda Paleniselles or Treti\u2019s parasol cream. If you need it, you can make the area bright and desalinate."
},
{
  "instruction": "Sir, I think I lost my foot during a soccer game, and I'm so sick that I can't carry my weight.",
  "input": "",
  "output": "It's good to start with a form of bacacin that helps control the pain based on the symptoms, and we're going to prescribe dechlorophage for pain and inflammation, and we're going to give them cerecoccus to prevent infection, and then we're going to give them selencsyrex to prevent infection."
},
{
  "instruction": "Doctor, I'm in pain in the lower abdomen and I'm having trouble urinating, and after a few tests, the doctor came up with a transfusion diagnosis, which drug should I take?",
  "input": "",
  "output": "We need to combine drugs to treat hydroneprosis, which can help relieve pain and improve urine flow."
},
{
  "instruction": "Doctor, I've been diagnosed with geriatrics. What kind of medication should I take?",
  "input": "",
  "output": "You've got to take rubyprostons to help you control your defecation and prevent toilets."
},
{
  "instruction": "I had surgery yesterday, and it's very painful. What kind of medication should I take?",
  "input": "",
  "output": "To manage the pain caused by surgery, you have to take Orphenadrine, Butor Panol, and chlorogene."
},
{
  "instruction": "Doctor, I was diagnosed with Huntington's disease. What drug would you recommend?",
  "input": "",
  "output": "In the case of Huntington's disease, a combination of drugs should be taken: Quetianine, Memantin, Lisperitone, Sterralin, Tetravenacine, ribulin, atomosetin, tessalyticin, lactose, and Dornets."
},
{
  "instruction": "Doctor, you've been diagnosed with the West Nile virus, which drug should you take?",
  "input": "",
  "output": "You're going to have to take a rabbit anti-T- Lymphoglobulins and jellotags to get rid of the West Nile virus."
},
{
  "instruction": "Doctor, I've been diagnosed with lymphoma. What medication should I take?",
  "input": "",
  "output": "Treatment requires a variety of combinations of drugs, including liposigosin, toxinsruvicin, cyclotus pamethein, and vitin; dexamethasone, pegras team, Newforras, Palonose, Alobovet, Vinvelastin, Alvarone, and Blasine, to prevent further treatment and prevent any more of these disorders."
},
{
  "instruction": "Good morning, doctor, after I was out in the sun, I got a red, itchy rock on my skin, and I think it's sun dermatitis, which drug should I use?",
  "input": "",
  "output": "For rashes and itchings, it's good to use chlorbetasol local ointments, which will help reduce inflammation and ease it."
},
{
  "instruction": "Doctor, I've been feeling extremely fatigued and weak lately, and I've been diagnosed with chronic kidney disease, and I think I'm anemic.",
  "input": "",
  "output": "Yes, your symptoms seem to correspond to anemia caused by chronic kidney disease. To treat anemia, I would like to prescribe Darbepotine alchev, epotin alcret, and pheoprotein, which helps to increase the number of red blood cells and improve the energy level."
},
{
  "instruction": "Hi, doctor, I've been injured in internal organs and I'm wondering what kind of medication to take.",
  "input": "",
  "output": "Sepoxicin for prevention of infection, bequeranium for muscle relaxation, polythylene sulfate for high potassium levels, hydrochlorate for coating stomachs and intestines, sylphaples for improving urinarysis, baffeic acid for imaging, and cessium for skin stimulation, and cerebellum for treating the skin."
},
{
  "instruction": "Sir, what's wrong with having a lot of blood, a lot of pain, even feeling foreign to your eyes?",
  "input": "",
  "output": "Syphilis is a disease of inflammation over the scleroderma or the whites of the eyes, and it seems to be causing a suspicion of pericitis."
},
{
  "instruction": "Doctor, there's a lump in my eye that bothers me a lot.",
  "input": "",
  "output": "You can start treatment with prescribed eye drops, such as wood-pluxin, Fred Nisolon, Roterfrinol-Tobramycine, Vimatopromycist, protomythone, rotephron, dexa methagicone-tobraxin, and gatyploxin."
},
{
  "instruction": "Hi, doctor, I think I accidentally ate too much insulin.",
  "input": "",
  "output": "Don't worry, you can counteract the effects of insulin overdose. I'll give you charcoal that absorbs the insulin in your stomach, glucose that increases your blood sugar, and Exenatide that helps control insulin production."
},
{
  "instruction": "Hi doctor, I've been experiencing excessive thirst, confusion and nausea lately, and I'm also losing urine, and I think I'm having an improper secretion syndrome called SIADH.",
  "input": "",
  "output": "Yes, symptoms suggest that you have SIADH. The drug required for your condition is: Bospiron, Meklin, Rosuvatin, Flystol, insulin, Ceftrisisson, and essomeprosol, which are the most important for immediate relief of current symptoms."
},
{
  "instruction": "Hi, doctor. I think I've got something foreign in my ear. I've got something foreign in my ear for a while.",
  "input": "",
  "output": "All right, I'm going to prescribe a drug that will help you remove the infection or foreign material, which is Ofloxin, hydrogen peroxide, antioxide, tetrakinin, and antipox. If you have too much pain, you can use ketamines, or be able to use anti-cyctase, but if you need to, any of these drugs don't work, and it's good for you to consult your doctor and doctor."
},
{
  "instruction": "Sir, your eyes are in pain and your vision seems to be getting blurry, and you've been to the ophthalmology, and you've been diagnosed with ophthalmitis, which drug should you take?",
  "input": "",
  "output": "You need to take several antibiotics together to treat infection. I recommend egmentin, Klindamycin, or cyprophyloxine. If conditions worsen, you may need to take cepuxine or erisomacin. In severe cases, there are other options: cephdini and cefazolin, which can be used to reduce swelling and discomfort, and can also be helpful."
},
{
  "instruction": "Hi, sir, I fell down last night and I got a serious injury to my leg, so please tell me what medication I need to take.",
  "input": "",
  "output": "It's good to take amykacin, which helps to melt dead tissue and stimulate healing, and phenoprofen, which relieves pain and inflammation, and it's okay to worry about rabies because you've been bitten by a dog earlier this week."
},
{
  "instruction": "Doctor, I've been diagnosed with cirrhosis of the liver. What kind of medication should I take?",
  "input": "",
  "output": "We need to take lactose, sphincterols, peroxones, proprolol, lebocarnisin, neomycin, vitamin A, sulfuric zinc, polythylene sulphate sodium, nexalate, thysine, thiamine, thithium, and casalin."
},
{
  "instruction": "Doctor, I was diagnosed with bone cancer.",
  "input": "",
  "output": "We need to take a combination of drugs, such as mint, oxycodon, fluoride, or lyclastic acid, or lystic acid, or sennom, or ustium, or methina, or cylofos pamid, iphos, glygs, gmbis, zemvin, caplatin, practin, practin, plassololol."
},
{
  "instruction": "Doctor, I was diagnosed with rishmania. What kind of medication should I take?",
  "input": "",
  "output": "You need to take a combination of drugs, including air, meccamin, Trolloredomycin, indiium oxyquinolin - 111, pipenocranium, grefalyxin, rabbit anti-human T-opopuloglyin, ifanic acid, symphonic acid, paralysis, marationium and zmtojono."
},
{
  "instruction": "Hi, doctor, I've been diagnosed with Chagas' disease. Can you suggest a drug that I need to take?",
  "input": "",
  "output": "I'm going to prescribe a combination of mint and air to treat the disease, which will help control the symptoms and control the spread of disease."
},
{
  "instruction": "Doctor, I've recently had the symptoms of arm and leg falling apart, and after a few tests, the doctor diagnosed me as co-operation of the spinal cord, and could you prescribe a drug to help me deal with the symptoms?",
  "input": "",
  "output": "For example, we recommend Gabapentin, which will help manage neurotic pain. It is also recommended that you use a pimecromus localizer, or a Tretty gerontolic, which will help you to relieve your skin irritation or itching. It is also recommended that if you have a urinary problem, you may need to use Triamtheen to help you manage your muscles. To relieve your urinary, you may need to be able to help you by taking care of the visacods, the cesscodron, the cosmoids, and the vats, or the us, and the other muscles, if you take care for the last time."
},
{
  "instruction": "Doctor, I've had a hard time breathing, and I've had a tough feeling about my heart, and it's been going on for a long time.",
  "input": "",
  "output": "The symptoms suggest that you have lung fibrosis, and you have to prescribe some medication that will help you manage your condition."
},
{
  "instruction": "Hi, doctor. I've been having tremors in my hands and legs for a while.",
  "input": "",
  "output": "I think you've got Parkinson's disease, and I'm going to give you a drug called Lophiniol that helps you manage your symptoms."
},
{
  "instruction": "Doctor, I have severe pain in my big toe, and it's swelling red, and I think it's gout.",
  "input": "",
  "output": "Yeah, I think we have a gout, and I'm going to give you a drug called Indo metacin, which helps pain and inflammation."
},
{
  "instruction": "Sir, a few days ago, there was a pain in your ear, and you couldn't hear it, and I think it's anti-diarrhea, which drug should you take?",
  "input": "",
  "output": "In order to treat neumonitis, you have to take armonicillin, agmentin, sefdinir, oflrecsin, self-project, caviar peroxic, or cefachlor, depending on the severity of your symptoms."
},
{
  "instruction": "I'm having a hard time with drug abuse, especially Opioid. What kind of drugs do you recommend to me?",
  "input": "",
  "output": "Depending on your status, it is recommended to take methadone, Bufredochson, Nacrexson, Chlordiszeknside, Pali Feridon, Arkpeid, Tricholopceride, Pergorithium, hydrocortisone, or Hydrocortisone-nemacin."
},
{
  "instruction": "Doctor, I'm not strong these days, and my blood count is too low, so what's the problem?",
  "input": "",
  "output": "It's good to take drugs such as the Darvepotine Alpha, the Esperatine Alpha, and the Nepotin team to improve your blood count, as well as to help with vitamin B12, melfalan, and decitivin."
},
{
  "instruction": "Doctor, you've got a fracture on your shoulder. What kind of medication should you take?",
  "input": "",
  "output": "You have to take the pyramid of Diso, the Verocranium, and the Carvidopa."
},
{
  "instruction": "Hi, doctor, there's some discomfort and pain in the kidney, and I'm worried about acute kidney damage.",
  "input": "",
  "output": "As for acute kidney damage, it's important to start treating it immediately. To manage the situation, acute kidney damage is important."
},
{
  "instruction": "Doctor, I've been having severe headaches with nausea and vomiting lately, and when I was tested, I found out that there's a double abscess.",
  "input": "",
  "output": "The treatment plan consists of vancomysine, dexametasson, ceftriaxone, Tiotal, nitric oxide, mannithol, cytoplam, cytoplasm, atropic acid, atropine, oxcavazepin and methadal."
},
{
  "instruction": "Hi, doctor, there's been a long period of bleeding and bad breath in the gums, which drug should you take to suspect gum disease?",
  "input": "",
  "output": "The drugs needed for the symptoms are penicillin, Clinda Meisin, chlor hexidine, and his nephew, the N.O., which helps relieve pain and discomfort. It's important to manage your teeth and follow a prescribed medication."
},
{
  "instruction": "We've got a wound on the incision. What kind of medication should we take?",
  "input": "",
  "output": "Each wound has to be taken from the wound: celulose, Colagenase, localized nitrogen, methodidasol."
},
{
  "instruction": "There's a peritoneal hemorrhage. What kind of medication should I take?",
  "input": "",
  "output": "You need to take Pantofrazol, polystyrin sulphate sodium, oxytocin, vitamin K, dopamine, glucose, glycerin, iron oxide, venopher, texmin, dextamidin, and so on."
},
{
  "instruction": "Hi, doctor, scalp, eyebrows, nose, a lot of rashes and tinnitus around the nose, a little bit of itch, I think it's boring dermatitis.",
  "input": "",
  "output": "Yes, I think you've got boring dermatitis. It's a good idea to vaccinate a vaccine with 7 vaccines to prevent further complications."
},
{
  "instruction": "Doctor, I'm suffering from drug abuse, especially meth-ampamine, can you prescribe drugs that help me overcome this addiction?",
  "input": "",
  "output": "Yes, you can prescribe a combination of helpful drugs. To manage withdrawal symptoms, you need to prescribe calyphridol, which can reduce the common risk of HIV infection in drug users. Theme japam can also help with anxiety and sleep problems. Benztropine is another drug that can treat certain side effects of methamine use."
},
{
  "instruction": "Hi, doctor, there's been a lot of sore throats and stiffness in the last few days, and I've been told by another doctor, which drugs should I take?",
  "input": "",
  "output": "The drugs that can be used to manage SD are cylobenzaphrine, divozemium, botulinum poison A, orp\u00e9nadrine, the Rotavirus vaccine, botulistan antivenin, hydrolyptane, propapletan, propapletan, and trivattan."
},
{
  "instruction": "Doctor, I think you're addicted to anti-high blood pressure. What kind of medication should you take?",
  "input": "",
  "output": "You need to take a combination of deconfendrummines, certidinin, cicol, acetylcystein, adenosine, glucadon, and you can treat the addiction with anti-high blood pressure, together with melatonin, jiffon, epinephrine, insulin, astrolog, and humane."
},
{
  "instruction": "Doctor, I have a terrible headache recently, which starts at the back of my neck and extends up to my forehead, and I tried ibuprofen, but it doesn't seem to help.",
  "input": "",
  "output": "For treatment, we recommend drugs such as Topiamas, Mydrin, Lizatribtan, El Releptan, Burtor Panol, Diklopac, or Pioccicam, which is the best possible option for specific symptoms."
},
{
  "instruction": "Doctor, I've been losing a lot of energy lately, and I've started to bleed out in my gums, and I feel the dryness and roughness of my skin, and I'm worried that I'm not going to have it.",
  "input": "",
  "output": "If you want to treat hemophilia, you need to take a combination of drugs, including air, indium oxytocin, -111, ipanic acid, which helps you to improve your oxygen levels, improve your immune system, and regulate your thyroid function."
},
{
  "instruction": "Hi, doctor, I think you've got a narcolepsy, and no matter how much you take a break at night, you're going to fall asleep during the day.",
  "input": "",
  "output": "You can see that it's good to take a diet that, depending on the symptoms, will help you improve your perception during the day."
},
{
  "instruction": "Sir, I think I'm allergic to food, and every time I eat a food with nuts, there's rashes, hives, breathing problems, which drugs should I take?",
  "input": "",
  "output": "You need to take a combination of drugs for food allergies. First, you should always carry the vepenhidramine. If you have allergies, take them immediately. Second, pamotidedin needs to reduce your stomach acid and inhibit your histamine production."
},
{
  "instruction": "Doctor, I've been experiencing severe dizziness and dizziness in the last few days, and I think I've got my taste of mummification in my ears.",
  "input": "",
  "output": "All right, the drugs needed for this disease are meklicitin, diizepamum, skopolamine, oxytocin-glucosamine, condrometin-glucomine, monobenznones, hydrolyxylgenium, transodortamine,"
},
{
  "instruction": "Sir, I'm so nervous these days, I don't sleep well, and I'm constantly worried about everything, and what do I do to make myself feel better?",
  "input": "",
  "output": "I can prescribe one of the drugs for anxiety: lorazepam, alfrazolam, chlornazem, bubiron, chlorazepeit, Oksparem, Rocksafin, L-methylolate, Plasefam and Meprobamite."
},
{
  "instruction": "Sir, I have a problem with impulse control, and sometimes I do things I regret right away, and can you recommend a drug for that?",
  "input": "",
  "output": "Yes, if you're having an impulse control disorder, you can prescribe a drug like Risperidone, Quetiapin, DivalProcess sodium, defacotte, alyphoricol, benztropines, methphenate, bubspa, lysa, escarvel, escarpment, escarlide, or jillin."
},
{
  "instruction": "Hi doctor, I've had a lot of tears, and I've heard that it's called pulsar stenosis, which drug should I take?",
  "input": "",
  "output": "However, you do not need any other vaccine, such as d\u00e9xamesone-tobracin anticoagulation, or erythropathine ophthalmosis, but you do not need any other vaccine, such as the Rotavirus vaccine, the Frevena 7 vaccine, the A type A hepatitis vaccine, the Hemophilus B binding vaccine, and the Hemolylus B-T vaccine."
},
{
  "instruction": "Doctor, your nose is getting very sick and swollen, I think it's an abscess.",
  "input": "",
  "output": "It is recommended that you take the phallic and oxymethyl sprays to reduce the swelling of the swelling and relieve pain. It is also helpful for you to relieve the Cormacium effect when you take the perennium. It is also good for you to take a cough anti-freeze dextrose dm, a post-L."
},
{
  "instruction": "Hi doctor, I recently had a problem with my navel, red, swollen, and pain, and I also found out that there was a secretion, and what's the problem?",
  "input": "",
  "output": "To treat this disease, we recommend a local drug called nitric acid, which can help prevent the spread of infection and stimulate healing."
},
{
  "instruction": "Doctor, I've been diagnosed with leukemia. What drug would you recommend?",
  "input": "",
  "output": "There are drugs that need to be taken with leukemia: methocate, Merctoturin, Aklauver, Bincritin, Imitinos, di\u00b7a\u00b7pi\u02b9lu\u00b7xi\u02b9o, ly\u00b7khe\u02b9lon, ly\u00b7ni\u02b9lon, texos pamoids, d\u00e9xawas, balci chlorin, and some of the drugs that need to be taken together."
},
{
  "instruction": "Hi, doctor, I think I have a bell paralysis, my face is weak and my side is paralyzed.",
  "input": "",
  "output": "We're going to give you Fred Nisson, Acyclovir, Balsi Clobire, Pamsy Clovier, and Olofpatadine's eye drops for treatment."
},
{
  "instruction": "Sir, it's been a long time since both eyes are red and snowy and quite uncomfortable.",
  "input": "",
  "output": "I recommend that you use alopatadine anti-anxiety, ketopen anti-anxietin, and Azellatin's anti-anxiety, which can also help control the allergic reactions that lead to condensation. If the symptoms are present, you may also need to use a mometzonone products, or pulsone products, or pulsone products, to make sure that you don't have pain in your eyes, or that you don't have pain in your eyes."
},
{
  "instruction": "Doctor, I'm responding to the medication I'm taking, the skin is itchy and red and it's hard to breathe.",
  "input": "",
  "output": "You have to act quickly so that the symptoms don't get worse, and I'm going to give you a Dipenhydroamin and methylfrednisolin to help you cool down the swelling and relieve your respiratory problems, and if the symptoms don't improve, you might have to give you epinephrine."
},
{
  "instruction": "What drugs do you need to take to treat this disease when you've been diagnosed with adrenal cancer?",
  "input": "",
  "output": "To treat adrenal cancer, you need to take a combination of drugs such as mint, fluornasol, methoccan, chlor hexidin, acycrine, fluorocortisone, phrenisolone, temosolide, ibisol, ironoccan."
},
{
  "instruction": "Sir, the distant object doesn't seem clear.",
  "input": "",
  "output": "I'm going to give you a combination of tropecameth, durameth, pneumacene, proplaine, anti-aussine, aleutine, tetrahydrozolin, anti-resolin, anti-freeze, fluoride, and anti-austeride."
},
{
  "instruction": "Hi, doctor, I'm especially experiencing joint pain and stiffness in my knee.",
  "input": "",
  "output": "The symptoms suggest that you have a daily dose of Celecoccirex, along with an aid to pain relief and inflammation. You may add sodium sodium or cortisone injections to relieve additional pain."
},
{
  "instruction": "I'm suffering from doctors, fatigue, weight gain, hair loss, I think I have thyroid disease.",
  "input": "",
  "output": "Symptoms suggest that you might have thyroid disease, that you should take drugs such as thyroids or parathyroids to control thyroid levels, and that you should also take calcium-vitamin D, calcitriol, and glucose to maintain healthy bones and prevent anemia."
},
{
  "instruction": "Sir, I had a sore throat a few days ago, and when I swallowed the saliva, the pain started to increase.",
  "input": "",
  "output": "I think there's strepitis, and I'm going to give you a poison clinch to help you get rid of the infection."
},
{
  "instruction": "Doctor, the heat and joint pain has been happening repeatedly over the last few months, and the doctor said that I could have chronic rheumatic fever, so would you please let me know which medication to take?",
  "input": "",
  "output": "Yes, depending on your status, we need to take Wapalin, Digullin, Carvedilol, Penicillin, Spirolon, Tepinoxin, Amiodaron, Heizar, Dobutamine, Isorvid Monotrate and methlon."
},
{
  "instruction": "Good morning, doctor, your hands and feet have muscle spasms, weakness, bases, and insensitivity. What could be the problem and what medicine would be needed?",
  "input": "",
  "output": "It seems to be a symptom of low calcium in the blood, low calcium in the blood, and a combination of cassytriol, calcium calcium carbonate, and calcium glubinet to relieve muscle spasms, weakness, and depression in the blood."
},
{
  "instruction": "Hi doctor, I'm having a hard time reading and recognizing faces, and I was told by another doctor that there could be osmosis, which drugs should I take?",
  "input": "",
  "output": "It is commonly used as a combination of drugs: vebacisin, ranibijo, iotoprosophres, and thropoxants."
},
{
  "instruction": "Sir, I've been sick lately, coughing continues, breathing becomes harder, and I went to the E.R. and said I had pneumonia.",
  "input": "",
  "output": "I'm sorry, I recommend the combination of agitomasine and ceftriaxone, both antibiotics that are administered through injections or injections and standard treatment for bacterial pneumonia."
},
{
  "instruction": "Hi, doctor, I think you've got seppox. What kind of drugs do you need?",
  "input": "",
  "output": "You can use one of the following: acyclovir, Val\u00e1las claubire, pampsi chloruvir, the State of the country of Docosano, or the State of Beta Metsson-Clautrimasol."
},
{
  "instruction": "Doctor, I've recently experienced VVC, which drug should I take?",
  "input": "",
  "output": "If you want to treat PVC, you need to take Frequent."
},
{
  "instruction": "Hi, doctor, I have an ulcer with pain in my genital area.",
  "input": "",
  "output": "There's a possibility that there's a diameter to the symptoms, and it's good to take antibiotics, like hyperploxin and ibuprofen, to relieve the pain."
},
{
  "instruction": "She was diagnosed with testicular cancer. What kind of medication should she take?",
  "input": "",
  "output": "We need to take a combination of drugs, such as Sisplatin, Blaomycin, prochloropherase, and Comprotin."
},
{
  "instruction": "Doctor, I was diagnosed with chickenpox. What kind of medication should I take?",
  "input": "",
  "output": "You need to combine revetirastam, lamixin, lamixin, penobarbital, chlorofen, polyethylene glaaloclos, carbagepin, oxcarbate, bicytin, moustamisin, Paci, and Trombin."
},
{
  "instruction": "Hi, doctor, I recently felt extremely weak and dizzy, and after a few tests, the oncologist told me that he had an anemia caused by a malignant tumor.",
  "input": "",
  "output": "We're going to start taking drugs to address malignant anemia, to increase the red blood cells and control the anemia, to take the Darbepoetin Alpha, the Epoetine Alpha, the pharynosis, the phenogenesis, and the Newpos team to solve the malignant tumor."
},
{
  "instruction": "Doctor, the risk of bleeding is increasing due to frequent swelling and inflammation of the esophagus, and what's the cause, and what kind of medication should you take?",
  "input": "",
  "output": "To prevent further complications, you need to take a combination of such drugs as pyromesed, sphincols, moustoles, profraolols, esomyphrol, methylin, pantophacsol, B12 folic acid, and entebard."
},
{
  "instruction": "Hi doctor, I've been diagnosed with endometriosis, and what are the drugs for endometriosis?",
  "input": "",
  "output": "The drugs needed for endometriosis are Medoxyprogesterone, estrogen, free fluid, propopol, possil, latanoprost, cevofluran, megaplas, triamsterone, throampin, phytogen, phytoreol, and pentol."
},
{
  "instruction": "I've been diagnosed with cystic fibrosis, which drug should I take?",
  "input": "",
  "output": "You need to take a combination of drugs such as albumerol, tobramycine, broad vitamins, and pancreatin, which can help you manage your drug."
},
{
  "instruction": "Hi, doctor, I've been diagnosed with parathyroids. What medication do you need?",
  "input": "",
  "output": "Depending on your status, you need drugs such as ergo calciferol, alopolinol, calcium carbonate, cynacascine (Sencisifa), lyseronet, nephrine, calithiole, Darbefoetin Alpha, lymonidin, lymonin, and lynxone."
},
{
  "instruction": "Hi, doctor, I've recently been diagnosed with Gluco Cortide deficiency, which drug should I take?",
  "input": "",
  "output": "You have to take a combination of drugs to treat your condition: hydrocortisone, fluod cortisone, coscin, and Tyroxine."
},
{
  "instruction": "Sir, can you recommend some medication for me, since I'm suffering from a paraplegic hip disorder?",
  "input": "",
  "output": "Yes, of course, it's good to take methography, ettomyx, nabumetone, ketamine, gualyxacid oatic, chlor hexidin, iodocunol, vipiggturium inflammium to treat the disorder."
},
{
  "instruction": "Doctor, I've been diagnosed with Wilson's disease, which drug should I take?",
  "input": "",
  "output": "You need to take a combination of drugs such as Donnepet, Midodin, Nefafax ophthane, Armantadin, and Pramipecsol, together with the drugs that help you manage the symptoms of zigpirem, ekstalofam, quellein, lute, and fluro cortisone, which help you slow down the course of your disease."
},
{
  "instruction": "Doctor, I've been diagnosed with hydroponic urethra, which drug should I take?",
  "input": "",
  "output": "A combination of drugs must be taken to manage the hydrolytic urethrax. To treat infection and urology symptoms, you must take chlorination, nitrograntine, and oxytocin. It is also necessary to take polyethylene glycorex (mirarex) to control the urinary tract. It is also necessary to make sure that a vaccine of seven pneumococcus (periosclerosis) can be treated with an infection (prepensiverosis). In addition, there is no difference in the case of septomycoccus (precosis) and anti-sterinsomiasitin."
},
{
  "instruction": "Hi doctor, I've been feeling extremely fatigued lately, and I don't see it very well in the dark, and I think I'm out of vitamin A.",
  "input": "",
  "output": "Yeah, I think you've got vitamin A deficiency, and the drug you need is vitamin A supplement, and I'll prescribe it for you."
},
{
  "instruction": "I think I've got gonorrhea, and I've got urinary pains and abnormal discharges.",
  "input": "",
  "output": "I'm sorry. I think I have gonorrhea."
},
{
  "instruction": "Hi, sir, I think one of your ribs is fractured.",
  "input": "",
  "output": "I'm sorry, I'm going to prescribe a drug that will help you with pain, that will help you control your pain by taking hydrocodon-guagolinate potassium and using esmol to control your heart rate."
},
{
  "instruction": "I've been diagnosed with ependioma, and can you prescribe a drug for this?",
  "input": "",
  "output": "Of course, Tropiccamide anti-Ax, Fred Nisolone, Pernislox, Perniumphrine, Carcimethylsylulose, Acabos, Venosinate-Plurecein anti-Aussine, Loternoll - Tobrahimin (. P.M.), chlorferinin (.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ."
},
{
  "instruction": "Doctor, I've been diagnosed with hepatitis from toxins. What kind of medication should I take?",
  "input": "",
  "output": "There's a combination of drugs, such as calatres, Ataja Butar, Litovir, Ramibuddin, Emtristavin-Tenocentire, Macopenolent Morpetit, Stavudin, Etamitol, Divorcine, and Dexin, which help treat and reduce the infection of the liver."
},
{
  "instruction": "Doctor, I've been diagnosed with intestinal cysts. What kind of medication should I take?",
  "input": "",
  "output": "Medoxyprogesterone, Rho immunoglobulin, Metilegnobin, and microprostol are prescribed."
},
{
  "instruction": "Sir, you've got a wound on your shoulder and you're in so much pain that you're gonna have to take the medication to treat it.",
  "input": "",
  "output": "Yes, injury on the shoulder has to take some precautions to prevent infection. To prevent it, you have to take a wave-like toxoid vaccine. For infection itself, you will have to prescribe gmentin, which includes a powerful antibiotic, clavialine, and another antibiotic, sepazolin."
},
{
  "instruction": "Doctor, I recently discovered that I have an extrauterine pregnancy, and would you like to suggest what medication I should take for this disease?",
  "input": "",
  "output": "In the case of extrauterine pregnancies, for example, we recommend a combination of drugs including methocate, Rho immunoglysis, methirnogenine, human cytoplasm, cepoxicin, and nonoxic nine."
},
{
  "instruction": "Good morning, sir. He's suffering from chronic knee pain. Do you want to know which drugs can help him?",
  "input": "",
  "output": "For chronic knee pain, it's good to take sodium healuronic acid, healuronan,ethyl localizers, and pluviprofen, which relieves the pain and reduces inflammation of the knee joints."
},
{
  "instruction": "Hi doctor, I've been having eye infection and stimulation for a while, and the ophthalmologist has diagnosed me with pingecuula, which drug should I take?",
  "input": "",
  "output": "It's a disease that's exposed to sunlight, wind, dust, and so forth, that requires proper care and care."
},
{
  "instruction": "Hi, doctor, I recently got diagnosed with hyperglobulins, which drug should I take?",
  "input": "",
  "output": "In the case of amniocrinosis, you have to take omega-3 fatty acids, folic acid, vitamin B12, eryphotin Alpha, thropoplanol, lythroxio, mettotrexate, tettaris, Messsitin, mesergas, Letrozos."
},
{
  "instruction": "I've been suffering from alcohol abuse for a while, and it's having a huge impact on mental and physical health.",
  "input": "",
  "output": "For treatment of alcohol abuse, a combination of drugs is generally prescribed, depending on the severity of the condition. It requires thiamine to compensate for the loss of vitamins caused by alcoholism. It is recommended to reduce the anxiety and other symptoms of withdrawal."
},
{
  "instruction": "Hi, I'm experiencing a lot of hand tremors and soreness that happen at night, and I'm not sure it's wrist tunnel syndrome.",
  "input": "",
  "output": "Yeah, I think it's wrist tunnel syndrome -- there's cortisone that relieves inflammation; there's Pyrocycam for pain; there's Pirido Stigmin that improves nerve transmission."
},
{
  "instruction": "Hi, doctor, there's some problems with the pituitary gland, and I think there's a pituitary disorder.",
  "input": "",
  "output": "In order to address the various symptoms of pituitary disease, it is recommended to take Tyroxin, Somatropine, Testosterone, capergolin, hydrocortisone, hydrocortisone, bromochristin, estrogen, verapil, verapil, and exprominein."
},
{
  "instruction": "Sir, there's a sharp pain in the back and the side of the waist, I think it's a kidney stone.",
  "input": "",
  "output": "Yes, it seems to be a kidney stone. To treat the symptoms and help with the excretion, I will give you a drug like ketorolol Rock and hydromoids."
},
{
  "instruction": "You've recently been diagnosed with autism, which drug should you take?",
  "input": "",
  "output": "We need to take multiple drugs to address the various symptoms of autism: resperidon, chloridin, methpheninating, Addilillal, amylippas lassol, devalpress sodium, Oscarbage, guancipacin, benztunes, d\u00e9c\u00e9tylphenin, mestylsphenin, mesmanismin, and a certain drug, which will be prescribed for certain drugs."
},
{
  "instruction": "Doctor, I think you've got cat scratch disease, your lymph nodes are swollen and you get fever.",
  "input": "",
  "output": "If you want to cure cat scratch disease, you need to take agitomasin or poison clinch."
},
{
  "instruction": "Hi, sir. I have chronic glaucoma. Can you give me the medication I need?",
  "input": "",
  "output": "For chronic glaucoma, of course, we need to take latanoprost, travoprost, bimatoprost anticouple, Brimonine-temoleol anticouple, Fred Nisolin-Tymol, brandy-solone anti-meal, Dorzolide anti-meal, Trokamide anti-mode, phenylactus, and anti-project."
},
{
  "instruction": "Doctor, I've recently been extremely weak and tired, and I went to the hospital for a blood test, and it turns out that I've had a lot of recyclical anemia, which drugs should I take?",
  "input": "",
  "output": "As diagnosed, it is recommended to take a combination of drugs, including the Dar Bephotin Alpha, the Negrosstrax, and the cyclopulin."
},
{
  "instruction": "Doctor, I'm having P.P.D.",
  "input": "",
  "output": "Okay, so I'm going to give you a prescription for Solifenacine."
},
{
  "instruction": "Hi doctor, I'm experiencing fatigue, weakness, pale skin, and blood tests show that I have a hemolytic anemia.",
  "input": "",
  "output": "You also need frenizone to help reduce the production of new red blood cells, which can help reduce the production of antibodies to attack red blood cells."
},
{
  "instruction": "Hi, doctor, I think there's an out-of-the-box case known as Tennis Elvo.",
  "input": "",
  "output": "We recommend a treatment plan involving drugs such as dichlorophag, melocycam, cortisone, and other drugs to reduce swelling and inflammation according to your current condition."
},
{
  "instruction": "Doctor, you're in pain because you've got a cut in your eyes. What kind of medication should you take?",
  "input": "",
  "output": "In order to prevent infection, we need to take vassitin, festacin, Vetadin, and cefazolin. We also need to vaccinate the dopamine to prevent it. In order to reduce inflammation and swelling, we also need to treat it with flavour anti-toxoids and dexato-bracin. We need to treat the muscles and not to treat the utamines with pain."
},
{
  "instruction": "Doctor, I've recently been diagnosed with syphilis, which drug should I take?",
  "input": "",
  "output": "The drugs for syphilis are penicillin."
},
{
  "instruction": "Hi, doctor, I've recently been diagnosed with diabetes kidney disease, which drug should I take to manage it?",
  "input": "",
  "output": "In order to manage diabetic kidney disease, you have to take a combination of drugs, depending on the patient's condition: insulin, insulin glats, glyphinol, insulin aphasias, humane astrologs, phyglotos, lenbela, tarcremops, lostatin, pectos, pectos, pectin, veglinda, and d\u00e9glinda, to manage the condition of the patient."
},
{
  "instruction": "Hi, doctor, there's a lot of problems breathing through your nose, a lot of nostrils and a lot of sneezes, and what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there's a lot of drugs that help relieve the symptoms, such as memetazone sinuses, perc, Oxymethazolins, Azilastensins, Bissins, Robinsine Diems, Trimlons, Clarinthin Diceb, Levosettis, Levosettis, and S\u00e9pros."
},
{
  "instruction": "Doctor, the drug withdrawal symptoms are so severe that it's really hard. Is there any medication you can take to alleviate these symptoms?",
  "input": "",
  "output": "Yes, there are some drugs that can help you with drug withdrawal symptoms. Clonidin can help you with such symptoms as high blood pressure and anxiety. Metacycloin can help you with Opioid withdrawal. Dicyclamine can help you with abdominal cramps and diarrhea."
},
{
  "instruction": "Doctor, you've got a lot of pain in your teeth, so you said you had tooth decay in the dentist. What kind of medication should you take?",
  "input": "",
  "output": "We're going to take antibiotics to treat infection, so we're going to give you penicillin, Clindamycin, or erythromycin; we're going to use pain meds like backin, Ben's nephew, spoze, or clove oil; we can reduce inflammation, and we can use oxymetholin visprey, or chlor hexidin, to prevent secondary infections."
},
{
  "instruction": "Doctor, I'm worried about my health, because the last test showed a high cholesterol level, which drug should I take for high cholesterol?",
  "input": "",
  "output": "It's good to take rosubastatin to lower cholesterol levels."
},
{
  "instruction": "Sir, I think there's a fracture in the scrotum. Can you help me?",
  "input": "",
  "output": "Yes, we need a few drugs: typental, nitrous oxide, local iodine, cevofluran."
},
{
  "instruction": "Doctor, I've been diagnosed with kidney failure. What kind of medication should I take?",
  "input": "",
  "output": "To lower the population, you need to take epoetin Alpha (procrit) to improve the formation of red blood cells, to prevent rejection of kidney transplantation, and also to take hydrophenic mortyls and tarrosomes to lower blood pressure."
},
{
  "instruction": "Hi, doctor, you've got severe pain in your neck because of a broken throat. What kind of medication should you take?",
  "input": "",
  "output": "There's a muscle relaxant, the lochronium, which reduces inflammation of the bones, kalcitonin, isorebid monotreme that expands blood vessels and increases blood flow, calexieferols that help absorb calcium, a sedative penobarbitol, an increased amount of epoproquet, a nerve tube that relieves the number of blood cells, and methin."
},
{
  "instruction": "Hi doctor, I've been experiencing muscle spasms lately, and I'm really uncomfortable and I don't know what to do.",
  "input": "",
  "output": "I'm going to recommend a cyclobenza print, depending on the symptoms."
},
{
  "instruction": "Doctor, you've been diagnosed with hemophilia, which drug should you take?",
  "input": "",
  "output": "In hemophilia, you need drugs such as anti- hemorrhagic factor, factor 8, factor 9, and anti- hemorrhagic factor."
},
{
  "instruction": "Hi, sir, your body is very sick these days and your blood sugar is very high, and your blood levels are very high.",
  "input": "",
  "output": "The drugs prescribed for this condition are insulin, insulin glattos, insulin asparatium, humane, or glucose."
},
{
  "instruction": "Doctor, a few days ago, your throat got really bad and it's hard to swallow, and it's been going on for days.",
  "input": "",
  "output": "The symptoms suggest that there is an abscessity around the urethra. Kleinimasin, egmentin, dexamethasone, to help reduce inflammation, and chlor hexidin, to help reduce the bacteria, will provide chloromyxtase, which helps restore the balance of intestinal benefit bacteria, and therefore can be improved and edulated with anti-respirants and anti-spirants. If you are concerned, you may be able to reduce the pain and the pain."
},
{
  "instruction": "Hi, doctor, I'm having a recent case of cerebral palsy. Can you prescribe a drug for this?",
  "input": "",
  "output": "Yes, I can prescribe some drugs: methocloframide, insulin, insulin, insulin lynx, insulin, asparatium, humane, Ben's nieces and nephews, Pancrearice, Tenno Barbital, Panzialum, Fugitamim, and Lozita Johns."
},
{
  "instruction": "Doctor, a few days ago, I've been suffering from a severe fear of the whole body, and I don't know what the cause is.",
  "input": "",
  "output": "I'm going to give you a drug called depenhydramine, which can relieve the severity of the symptoms."
},
{
  "instruction": "Doctor, I've been diagnosed with sepsis. What kind of medication should I take?",
  "input": "",
  "output": "You need to take Hydroxieurre, anagrelides, evesartane, or lamifil, for your blood pressure, and your skin rash may require a petri dish of sulfate selenium, a theme base for sleep disorders, but vitamin E (vita-e) and lutein are recommended."
},
{
  "instruction": "Doctor, I've been diagnosed with platelet reduction. What kind of medication should I take?",
  "input": "",
  "output": "These drugs include Hydoxiore, immunoglobulins in muscles, lytexio, lyretronic acid, epoeethin Alpha, philagrath, Nepotin, carbolastin, cymetin, carmitin, carmitin, carmitin, carmitin, carmitin, carmitin, carmitin, carmitin, carmitin, vatin, vaccin."
},
{
  "instruction": "We've been diagnosed with head cancer, and what are the drugs that we need to treat?",
  "input": "",
  "output": "In order to treat the disease, you have to take a number of drugs together: oxytocin, cetacinus, Sisplatin, Pacletsel, Carboplatin, Affrefitant, Pleiotane, Suralate, Megape, Megastrolgas, Alvarez, alvetin, and Olysin, to treat the disease."
},
{
  "instruction": "Doctor, I was diagnosed with hyperthyroidism, which drug should I take?",
  "input": "",
  "output": "Colhetin, ethyl ethyl, hydrocortisone, cortison, etochylkun, Hydoxychloroquin, Medotrexe, Doress, Ixorbite, Trimnololone, insulin, Asparat, human, and Rostan."
},
{
  "instruction": "Hi, doctor, your throat is swelling and you're getting bigger over time, I think it's thyroidoma.",
  "input": "",
  "output": "To treat thyroid species, it is good to take methimazol to prevent the production of excess hormones that cause thyroid species. It may also be helpful to take the acidic calcium to improve bone health, reduce acid acid acid to prevent Osteoporosis, and reduce acid acid acidity to prevent stomach acid."
},
{
  "instruction": "Doctor, it's very painful to go through a desperate withdrawal. What drug do you recommend?",
  "input": "",
  "output": "Depending on your status, you should take one of the following drugs: Totterodin, Solifinin, oxyputin, lypenacin, erythropenosine, estrogen, estrogen, poisonous acid, polyethicate sodium, lyssalate, fultosin, fulsatosin, or claustrogen."
},
{
  "instruction": "Doctor, I have Edward's syndrome. What medication should I take?",
  "input": "",
  "output": "This includes polyethylene glycoccus, buttonics, nitric acid, calcium, cetilisine, metrochlorin, influenza vaccine, inertification, air, mecaramamine, Trollicin, indomination, oscillin, oscillium-1-1-1."
},
{
  "instruction": "Doctor, I've got a wound on my arm, and it really hurts. What kind of medication should I take?",
  "input": "",
  "output": "You need to take the lidocaine to reduce the pain, but you need to use the cephaxin to prevent the infection caused by the wound. You also need the dopamine to prevent it from entering the wound, and the vasssin to prevent the bacteria from entering the wound."
},
{
  "instruction": "Doctor, I've been diagnosed with muscular dystrophy. Can you prescribe a drug?",
  "input": "",
  "output": "In the case of muscular dystrophy, you have to take ergo Calciferol, Budsonid, phenophibate, Mexylectin, lyluzo, terrataithed, cetajidim, tetrahydrocanbinol, Pancroase, Triomus, Trio Ditinto, and Calcine."
},
{
  "instruction": "Doctor, I'm having severe hip pain during my monthly period, and I'm having trouble with my daily life, so would you recommend some of the drugs on this condition?",
  "input": "",
  "output": "Mittelshmer is an illness that is characterized by menstrual pain in the middle of a woman's menstrual cycle."
},
{
  "instruction": "Doctor, I'm feeling sharp pain and discomfort in my eyes, and I suspect a pericardial injury.",
  "input": "",
  "output": "Symptoms suggest that it's possible that it's an eyelid, tetrakine, erythromin, proparacan anticoagine, fluoresine, anticoagulants, esophageal anticoagulants, Tobramysine antixin, or woodpousxin."
},
{
  "instruction": "Doctor, I've been feeling depressed over the last few months, and I think I'm having mood failure.",
  "input": "",
  "output": "It's like escithalproams, fluoccetins, vulceptins, chloracems, cythalproms, pyrophasins, viraphacins, bubpilons, tetrastasetins, dupensinsins, or drugs."
},
{
  "instruction": "Doctor, I've got a fever, a sore throat, a rash on my body, and I think I've got scarlet fever.",
  "input": "",
  "output": "You might be right: scarlet fever is caused by bacterial infections, and if left untreated, it can cause serious complications. I'm going to prescribe amyosicin, penicillin, or cefadoxin to treat the infection."
},
{
  "instruction": "Doctor, I've recently been diagnosed with hypertensive heart disease. Can you prescribe a drug?",
  "input": "",
  "output": "Yes, there are some drugs that can treat high blood pressure heart disease: amrodin, Carvedilol, Isosurvid, rosuvatin, fulsuvas, divosin, Dionysin, Sphinollonton, Benafil, Hyradrazin, or Torsedine."
},
{
  "instruction": "Doctor, I'm having trouble with drug abuse, especially barbiturates, and what kind of drugs would you recommend?",
  "input": "",
  "output": "This includes bubrofion, ketatin, trazohadon, chloracems, tinctin, metrometone, benztropine, mertamine, chloral oxide, and akhamprotein."
},
{
  "instruction": "Hi, doctor, I've been diagnosed with PCOS, which drug should I take?",
  "input": "",
  "output": "There's multiple drugs that you need to take in order to manage the S.S.S.S., including methofamines, medoxiprogesterone, chlormidiums, stylins, estradiols, retrozols, orproliths, or progestins and modicons."
},
{
  "instruction": "Hi, doctor, I've been having severe cliques over the last few weeks, and I've also got a fever, and my muscles are very weak, and my family thinks I've got brain disease.",
  "input": "",
  "output": "The symptoms suggest a combination of drugs to treat your condition: baclaupen, kabapentin, Tizanidin, Diagnium, vigabalium, phremicin, introferon berthane, balcones, balcones, dechlorophenes, thomatin, and chlorofylin."
},
{
  "instruction": "Hi, doctor, it's been a long time since I had cysts on my eyelids. Can you recommend a drug that can remove cysts?",
  "input": "",
  "output": "For example, the cyst of the eyelids, we recommend the use of dexamethasone-tobracin eye drops, erythromycin eye drops, or fluorides, which reduce inflammation and helps to prevent further growth and treat cysts."
},
{
  "instruction": "Doctor, your penis head is red and swollen, and it's very dark.",
  "input": "",
  "output": "The symptoms are likely to indicate that it's an inflammation of the scalps and the penises."
},
{
  "instruction": "Doctor, there's something on your neck that you can't swallow. What medication do you need to take to get rid of it?",
  "input": "",
  "output": "You need to take it with you to relax your muscles and swallow foreign substances, such as glucagon, ua, locronium, ketamine, and sodium bicarbonic acid."
},
{
  "instruction": "Doctor, I'm struggling with drug abuse, especially cocaine, and what kind of drugs do I need to treat it?",
  "input": "",
  "output": "Depending on the conditions required, there are Haloferidol, Arkprocet, Naktrexson, Flupenazin, Comvirer, Dissilphiram, Pasambud, Posambud, Lophor and Atobacham."
},
{
  "instruction": "Hi doctor, I've recently had eye problems, blurry vision, poor color vision, pain in the back of the eye.",
  "input": "",
  "output": "I think you're suffering from celiac disease, and I'm going to give you a clatiramer to help reduce inflammation and protect your nerves."
},
{
  "instruction": "I've experienced anxiety, restlessness, tremors since I stopped drinking last week.",
  "input": "",
  "output": "It's good to take a combination of drugs such as lorazepam, chlordiazepab, dijefam, and also include thymine, folic acid, and sulfate magnesium as part of the treatment plan."
},
{
  "instruction": "Doctor, I'm experiencing pericardial contractions, which drugs should I take?",
  "input": "",
  "output": "You have to take propaphenone to treat premature heart contractions."
},
{
  "instruction": "Doctor, I'm experiencing symptoms of weakness or paralysis on one side of the body.",
  "input": "",
  "output": "For paraplegics, it is recommended to start with a combination of 'revetirasetam, 'baklaffen', 'carbarmarzepin', 'dilanin'. You can also use 'botulium toxic A' to manage muscle spasms. If you have a stroke problem, you can use 'irraline, 'bastocrate',' or 'em."
},
{
  "instruction": "Doctor, I think there's a hammer toe, and the second toe is bent downward, and the upper skin is sore and it's sore.",
  "input": "",
  "output": "It is good to combine drugs to manage conditions according to the symptoms. To reduce pain and inflammation, you need to take calcium carbonate, ependrine, and Cerebex as well. Among other procedures, you may need to use cefazolin to avoid infection and anesthesia. Among other procedures, you may need to try to treat the pain with mylamids, phensedol, and may help reduce the pain in your body."
},
{
  "instruction": "Hi, doctor, I fell and I got a cut on my cheek. What do I do?",
  "input": "",
  "output": "You need some drugs to treat the wound. You need to drink the wound from the lidocaine and then clean it with a betasine. You need an antibiotic process and you need to start with a propagolin and a propacle."
},
{
  "instruction": "My joints, especially my knee joints, are swelling and stiffer, and I can't move, and I feel constant pain.",
  "input": "",
  "output": "The symptoms suggest that there's a joint disintegration, which requires medication to reduce inflammation and pain, and I'm going to give you a prescription for the nonsteroid salts, indometacin, which is a supplement to joint health, called condrometin-glucosamine."
},
{
  "instruction": "Sir, you've got a big injury to your knee, and you're very sick and you're worried about infection, which drug should you take?",
  "input": "",
  "output": "To protect you from bacilli, you need to use vassitin injections to prevent infection. You can also offer a form of calagenizers and beccaplamines to help heal your wounds. You can also help stop bleeding and stimulate tissue growth using selyulose."
},
{
  "instruction": "Doctor, I was diagnosed with peritonealoma. What kind of medication should I take?",
  "input": "",
  "output": "We need to take Revetira Semam, Ramelthem, Colestip, Metasalon, Carbamarzepin, Phenopibrate, Campa - Mentol, Probesid, and Nelphables."
},
{
  "instruction": "Doctor, I've recently been diagnosed with brain cancer, which drug should I take?",
  "input": "",
  "output": "Depending on your status, Revetira Semium, Penitone, Dexamethason, Temosolmide, Dexa Metason, Bebashizujo, Okscabazepin, Carboplatin, vitin, thalidomide, and Granium."
},
{
  "instruction": "Doctor, I've been diagnosed with placental eclipsis. What kind of medication do you need?",
  "input": "",
  "output": "In the case of placental implants, you have to take multiple vitamins and acid supplements. You also need dexametasone, vancomycin, methodidasol, doculate, mekmilamin."
},
{
  "instruction": "Hi doctor, I've been having sneezing, eyesicking, tears, nostril symptoms, I think seasonal allergies have returned.",
  "input": "",
  "output": "Yes, I think you're experiencing seasonal allergies. It's good to take antihistamines to alleviate symptoms, such as laratatin, certilicin, or pectogenin, or alegra."
},
{
  "instruction": "Doctor, I've been diagnosed with lung cancer. What drug should I take?",
  "input": "",
  "output": "You need to take dexamethaplatin, d\u00e9xamethasone, pklitzol, procloperates, eloti, lys\u00e9ba, dexamethasone, etopoform, pegrest, teopirastium, Vebastin (Spir\u00edba), dvessientin (Patin)."
},
{
  "instruction": "We've been diagnosed with original kidney disease. What are the drugs you need?",
  "input": "",
  "output": "You need to take Fred Nixon, Mycophenolic morphetils, Tacrolymus, Floitan, and Rosartan, and take care of kidney disease by taking out Hydexychloroquin, Valganicipin, alvariline, chlorolylin, Chloritol, Calstriol, and cycaroline."
},
{
  "instruction": "Hi, doctor, I've recently been diagnosed with uterine cancer. Can you tell me what kind of medication to take?",
  "input": "",
  "output": "In utero cancer, you have to take capoflatin, pacclitsel, paloclotone, d\u00e9xa metason, pheglass, methres, grancertone, amystrossol, amythedes, amythedes, aphids, aphids, axluvimsin, cycarcines, and cycarcine."
},
{
  "instruction": "Doctor, your eyes have been getting dry for a while, and you've got a lot of discomfort, and what's the cause?",
  "input": "",
  "output": "It's good to use a combination of cyclotosporins, latanopros, trotamid anti-anx, throtephrines, tetraprost, traboprost, Frednisol anti-moleones, fluorones, non-brilts, and biliolol-mole, to treat this condition."
},
{
  "instruction": "Doctor, I was diagnosed with fibrocystic breast disease. What drug should I take?",
  "input": "",
  "output": "We need to take together vitamin E, ketoprofen, Alpha-D-Galactosylase, hydrocortisone-Iodoquinol, phenoprofen, fenoprofen, veldon or extracts, Uspin and Condroitin."
},
{
  "instruction": "Hi, doctor, I think you've got a fungus infection in your hair.",
  "input": "",
  "output": "All right, it's good to use ketokonasol to treat your condition."
},
{
  "instruction": "Doctor, you've got a tooth abscess and it's really painful. What medication do you need?",
  "input": "",
  "output": "In order to treat infection, you need to take antibiotics. Penicillin, Klindamycin, or Erizomasin, can be helpful."
},
{
  "instruction": "Doctor, I've had a fever over the last few days, and I've been to a farm last week, and I've been in contact with contaminated water.",
  "input": "",
  "output": "The drugs needed are air, mekamilamin, Trollle domecin, indiium oxymolin, piphecuinium, grefaxoculin, anti-mopoculphosine, oscillator, oscillator, and lysmosis."
},
{
  "instruction": "Hi doctor, I think I was hiking in the woods when I was bitten by spiders and animals, and I'm sick of swelling and itching and breathing.",
  "input": "",
  "output": "The symptoms suggest that there is a poison in the bite, in order to reduce the symptoms of allergies, in terms of depenhydrumamine, Fred Nisson, methyl denisolin, and epitopeline, as well as in order to reduce stomach acid, and in order to prevent infection, hydrolysis and phrenic acid."
},
{
  "instruction": "Doctor, you've been diagnosed with Blotter's syndrome, which drug should you take?",
  "input": "",
  "output": "You need to take a combination of drugs, such as fluticasone, chloritimasol, metrodizolol, document, meccalymin, grefalyxin, maration, militagjo, and phrotajon."
},
{
  "instruction": "Doctor, I've been experiencing nausea, dizziness and headaches for the last few weeks. Can you tell me what's wrong?",
  "input": "",
  "output": "I recommend that you improve your blood flow and lower your blood pressure by taking chloridograss, and acetress, and lystics, and lystanes, and lyphatics, and lystic acid."
},
{
  "instruction": "Doctor, there's some discomfort in the workplace.",
  "input": "",
  "output": "It is recommended that drugs be combined with antiphonol, hydrocortisone-primic acid, mesalamine, magnesium, mebendasol, polyethylene glycollol, methylulose, tesssylulose, posambu, parasipic acid barium, etc., as a result of the symptoms."
},
{
  "instruction": "Sir, I'm having trouble emptying my bladder completely, and I think it's weakened, and what's the cause?",
  "input": "",
  "output": "You may have a weak bladder, and your bladder muscles are weak, and you can't contract properly, and the drug I recommend is betaneol."
},
{
  "instruction": "Doctor, I've been experiencing feelings and dizziness in the last few days.",
  "input": "",
  "output": "The symptoms seem to indicate that you have BPV, and the drugs needed for this disease are mecclinine."
},
{
  "instruction": "Hi, doctor, I'm experiencing an involuntary contraction of the eyelids, often blinking more frequently and sometimes closing their eyes longer than usual.",
  "input": "",
  "output": "I think you're suffering from an eye convulsion, and the most appropriate drug is botulinum toxins A."
},
{
  "instruction": "Doctor, you're having respiratory problems and you're very sensitive to skin, and you're also feeling a lot of fatigue and joint pain.",
  "input": "",
  "output": "I'm going to prescribe some drugs for you that will help you manage the symptoms of Fred Nisson, Hydoxychloroquin, Metochrexate, Ajatio Frine, Rizedronate, Ursodiol, Bostenol, Salmetol, Somletol, Bumetaneid, Ivanod."
},
{
  "instruction": "Doctor, I've been diagnosed with cancer of the opposite sex. What drug should I take?",
  "input": "",
  "output": "Depending on the status of the state, we need d\u00e9xamethasone, dexametazone, proclerferracin, Pachatsel, Ab\u00e1ccijost\u00edn, Paloclastin, Pegfilas Tim, Caflastas, Caflasita Zevin, Zelita Fretttza."
},
{
  "instruction": "Doctor, there's a problem that your fingers don't stretch easily, and it's very painful, and it's ruining your day-to-day life.",
  "input": "",
  "output": "It is good to treat local drugs, such as Trimminolone or Beta Metazone. Cortisone injections can help reduce inflammation of infected areas. It is also possible to manage pain and swelling with pentoxyfilin and piroxicac, but if this doesn't work, you may also need to consider Mycofectopetyl or Ettascampt. Finally, it is not generally recommended to use a vaccine to prevent the spread of a vaccine."
},
{
  "instruction": "Hi, doctor, I have a stick in my eye. What's the drug for the garax?",
  "input": "",
  "output": "The drugs needed for it are erysomasin, erythromysin, sulfatamide, sodium eye drops, Gentamisine, tobramycin, torraticin, tetratiscin, gentamisin, and anti-periosine drugs."
},
{
  "instruction": "I've been diagnosed with hemochromatosis, which drug should I take?",
  "input": "",
  "output": "You need to take Deferazylocks, folic acid, rebalbuerols, sphincteron, Hydxychloroquine."
},
{
  "instruction": "Hi, I've been diagnosed with osmosis. What kind of medication should I take?",
  "input": "",
  "output": "The drug that's recommended for osmosis is volume baracin, cortisone and fluonolone."
},
{
  "instruction": "Doctor, fever, abdominal pain, severe headache, I think he's got typhoid fever.",
  "input": "",
  "output": "Yeah, I think it's possible that it's typhoid, and I'm going to give you some medication that might help you, and I'm going to give you ibuprofen for fever and body, and I'm going to give you antibiotics like Trollsle domycin and Grepalyxin to treat the underlying infection."
},
{
  "instruction": "Sir, I've recently had a problem with my eyesight, and I've felt that it's getting worse, and that it's getting richer and richer.",
  "input": "",
  "output": "To treat this disease, it's good to take multiple drugs together: Trophicamyd anti-methrax, perniumphrine, latanoprostein-fluoresine anticoagine, phrenics, profacanacones, anti-salculins, anti-fectacone, and anti-salculosis."
},
{
  "instruction": "Doctor, my skin has a thin, dry, rough texture, and I think it's absorption.",
  "input": "",
  "output": "According to your description, you may be suffering from an atrophic skin disease called botulium A disease, a botulium a form of botox, a trotti stenosis, a methodidas solution, a six-carbon solution of salaminium, a callogenate solution, a solution of sodium-niol solution, a hydroquilon solution, an escillate solution, and so on."
},
{
  "instruction": "Doctor, I was diagnosed with Aspergilusia. What kind of medication should I take?",
  "input": "",
  "output": "Depending on your status, you may need to take a combination of drugs, including glycopiolate, throtrophic acid, heparin, prochlorerazine, dependramine, rms, and air."
},
{
  "instruction": "Doctor, I've been diagnosed with uterine paralysis. What kind of medication should I take?",
  "input": "",
  "output": "You're going to have to take low-immune glucose, progesterone, calcium polycabone."
},
{
  "instruction": "Doctor, I think she's pre-immortosis. What kind of medication should she take?",
  "input": "",
  "output": "The drug recommended is nitroprogentin, methidasol, and mint."
},
{
  "instruction": "Hi, doctor, I'm having a severe cough and shortness of breath.",
  "input": "",
  "output": "I recommend that you take Agitomacin, an effective antibiotic that can treat bacterial infections, which are caused by 100-day infections based on your symptoms and your history of disease."
},
{
  "instruction": "Doctor, I've been diagnosed with Pix disease. What kind of medication should I take?",
  "input": "",
  "output": "We need to take multiple drugs to control the symptoms of pixum, including air, mecaramamine, trollain leandocunicin, indium oxidolin - 111, pipenocranium, grepafluxine, rabbit anti-human T lymphoglobulins, ifafas acid, ethylocene, ethylocene, slatium, and thimbatum."
},
{
  "instruction": "Sir, there's an open wound on my lips that doesn't stop bleeding, and I'm so sick that I'm worried about infection.",
  "input": "",
  "output": "Okay, I'm going to give you some drugs, and I'm going to try to stop you from using lydokines, and then I'm going to clean up the wound with chlor hexidin and hydrogen peroxide."
},
{
  "instruction": "Hi doctor, there's pain in your mouth, and there's a little red spot around it, and it's hard to eat or talk about without discomfort.",
  "input": "",
  "output": "It's good to use a combination of drugs to treat the lesions in the mouth, depending on the symptoms."
},
{
  "instruction": "Doctor, I've had severe headaches, nausea, vomiting in the last two days, and yesterday I had a seizure.",
  "input": "",
  "output": "The symptoms indicate that there is a possibility of brain hemorrhage, which requires that you take care of your condition by taking la Bevetalol, Mydazorod, Dilantin, Nickadin, Levetira Semam, Mannitol, HYDRA, Barclosen, Dexamethasone, Pospotone, Naalxone."
},
{
  "instruction": "Hi, doctor, I'm having a recent memory loss and confusion, and I'm worried that my family might have Alzheimer's disease.",
  "input": "",
  "output": "Symptoms suggest that it's Alzheimer's disease, which is good to start drug treatment, and the drug I recommend is Donnepet, Memantin, Livatigmine, Gal\u00e1ntamine, Darfrazol anti-Calczymeol, Allenroit-Colciferol, Bromonectin, Pleistol, and Acystitol."
},
{
  "instruction": "Hi, doctor, I think you've got salinitis, and you've got pain during sex, and you're having trouble relaxing your vaginal muscles.",
  "input": "",
  "output": "You can prescribe a combination of drugs that will help you with your symptoms. You can start with estrogen and estrogen, which will help you with vaginal dryness and irritation. You can also add progesterone to control your menstrual cycle. It is recommended that you take an uptocyclone pill that will help you reduce your physiological symptoms. You can also add anti-cyctorone or anti-stoletic acid, which can help you to reduce your physiological symptoms. In case you can add anti-stoletics and anti-stoletics, you can add them to your cholesterol. You can also use a high level of anti-stoletic acid and anti-stoletic acid."
},
{
  "instruction": "Doctor, I've recently been diagnosed with a metastasic pneumothorax, do you want to tell me which drug to take?",
  "input": "",
  "output": "Yes, you have to take a combination of drugs, depending on your condition: frednisone, Hydoxychloroquin, Mycophenic morphetyl, Metochrexe, Ajatio Pr\u00edn, Tarcromus, Chlorophymide, Masophospaic, Mabelefic acid, etc., and poison."
},
{
  "instruction": "Doctor, I've been diagnosed with early ovaries inflection. What drugs should I take to do this?",
  "input": "",
  "output": "The drugs that need to be taken in early ovaries are human cyclic stimulus hormones, chlorins, medoxyprogesterone, estrogen, estrogen, fluoride, thropolyphin, menotrephin (HMG), remorasol and dassol."
},
{
  "instruction": "Hi doctor, I'm experiencing some pain in my arms and shoulders and a constant fatigue in my arm.",
  "input": "",
  "output": "Yes, I recommend Gabapentin, or Lyrica, which is helpful for the nerves in the case of thoracic epidemiology, which can help reduce inflammation."
},
{
  "instruction": "What kind of medication can you take when you have glioma?",
  "input": "",
  "output": "You have to take the petro-cortisone-priming drugs."
},
{
  "instruction": "Doctor, I went to the hospital yesterday, and I was diagnosed with a knee dislocation.",
  "input": "",
  "output": "You need to take Triminolone, Triamtheen, Glucocosamine, Buffibacine, Mecarmamine, but you don't need \"Grepplexacssa,\" \"Malation Nationalist\", \"jemto-Tag\", \"Imlo-Tag,\" \"Grotag\", \"Grotharhans.\""
},
{
  "instruction": "I've been diagnosed with Crohn's disease and I'm curious about what drugs I need to take.",
  "input": "",
  "output": "In the case of Crohn's disease, you have to take drugs like mesalamine, inflamicade, ajatiophrine, methidasol, vitamin B 12, streppasalacine, mermodium, boudezonide, decylomine, or Adalinum."
},
{
  "instruction": "Hi, doctor. Looks like post-op infection.",
  "input": "",
  "output": "It's good to start taking antibiotics based on symptoms. It will help you to combat infection by using vancomycin and necrosis. It will also help you to treat your wounds by using iodine, ciachlorate sodium, and mafeamphin. In case you need to, you can also use acelosomes to reduce swelling and pain. However, if you see signs of infection, you can also treat it with sepuloxide to improve your blood flow and blood flow."
},
{
  "instruction": "Sir, I think I have a folic acid deficiency.",
  "input": "",
  "output": "Depending on the symptoms, it's good to take vitamins B12 and folic acid."
},
{
  "instruction": "Doctor, I feel like my stomach is swollen and my ankle is swollen, and I think there's a fluid overload.",
  "input": "",
  "output": "You need to remove excess body fluids from your body by taking Puerto Sesemid, thorassid, or chloridin. You may also need hemolytic sodium and hemolytic acid to balance your pH levels and prevent blood clots."
},
{
  "instruction": "Doctor, I've been experiencing an irregular heart rate recently, and I'm afraid it's going to be a serious disease when it comes and goes.",
  "input": "",
  "output": "I'm going to give you some drugs that will help you manage your condition."
},
{
  "instruction": "Hi doctor, I recently had a skin problem, and I'm curious about what kind of medication you can recommend.",
  "input": "",
  "output": "For example, we can recommend some drugs for skin disorders: chlorvetasol, trebets, fluonoids, fluoride, silic acid, fluoride, equimide bar, fluoride bar, benzolic peroxide-elysin, and lactic acid, as a result of the symptoms."
},
{
  "instruction": "Hi, doctor, I've recently seen little dots and stains moving in my view, and it's really annoying and distracting.",
  "input": "",
  "output": "I'm going to give you a trophocamid anti-freeze, a peritoneum-flurex, an anti-freeze, an anti-freeze, an anti-freeze to reduce the inflammation and irritation of the eye."
},
{
  "instruction": "Hi, doctor, there's a lot of pain in your teeth, I think it's because of the infection.",
  "input": "",
  "output": "The symptoms seem to indicate that you have tooth disease; don't worry; you can treat it with drugs; you have to take antibiotics, such as penicillin and Klindamycin, and anti-anxiety drugs, such as excretions, cloves, Mentol-Penol; and if you have a severe infection, you may need glucose calcium or cephatin."
},
{
  "instruction": "Sir, I think she's having a heart attack, and her chest's pounding, and she's out of breath, and I can't breathe.",
  "input": "",
  "output": "In the case of a heart attack, you should immediately take aspirin. To prevent extra hemolycerin, methoglycerol, and chlorofics. You should also take blood thinners such as Heparin or oxytocin, which can relieve your chest pain and may require oxygen."
},
{
  "instruction": "There's an open abdominal wound that doesn't heal. What kind of medication should I take?",
  "input": "",
  "output": "S\u00e9fazolin, NSPAdiasis, tetracycline, nattomycin, papillo-methyl, sodium sulfate, Yood and oxaloflatin. But Vima Prost and Flurocortisone don't need to be used for an open abdominal wound."
},
{
  "instruction": "Hi, doctor, you've recently had a fracture in your leg, and you've been in pain, so how do you treat it?",
  "input": "",
  "output": "I'm sorry that you're suffering from a fracture, and I'm going to give you a prescription for lypenacin, intunicin, vitamin K, Dalteparin, plasma fractions, plasmoids, acelassylus, lenopolis, and ulmonomas, to help the healing process and prevent blood clots."
},
{
  "instruction": "Hi, sir. I think I'm in the mouth.",
  "input": "",
  "output": "In the case of oral auger, I'm going to prescribe antimicrobial drugs, such as Nistatin local products, fluorines, chloritamasol, congenial violins, or chloritamazool."
},
{
  "instruction": "Doctor, your skin rash is spreading, and it's very dark.",
  "input": "",
  "output": "OK, if you're an alcoholic, you need to use multiple drugs in combination to treat the drug."
},
{
  "instruction": "Hi, doctor, I think I'm allergic to animals, and every time I go to my friend's house where I raise animals, I have a lot of eyes, a lot of sneezes, and it's hard to breathe.",
  "input": "",
  "output": "All right, it's good to take a combination of drugs that help control allergies based on the symptoms. You need to take a Catetilicine and Platicas, which are useful for treating symptoms. You can also cool your eyes with aolotadin anti-freeze. Finally, it's important to prepare epinephrine for allergic reactions."
},
{
  "instruction": "When you get up, you've got dizzying, fainting symptoms. What's the cause?",
  "input": "",
  "output": "You're experiencing standing hypotensive blood pressure, and it's good to manage your symptoms by taking mydodrocortisone or Nortrylene."
},
{
  "instruction": "Sir, I've been so tired lately, I wake up and I've got a lot of nose trouble, I think I'm having a closed sleep apnea.",
  "input": "",
  "output": "Yes, it looks like a closed sleep apnea, and I can prescribe some drugs that can help you manage your symptoms, and I'm going to write you a prescription for Armodapyyl and cyclones."
},
{
  "instruction": "Hi, doctor, I've been told recently that I've been feeling a little weak and tired, and I've been told that this could be due to hypochonics.",
  "input": "",
  "output": "Yes, you can. It's good to start taking potassium supplements, especially potassium chloride."
},
{
  "instruction": "Hi, doctor, I've recently been diagnosed. What kind of medication should I take?",
  "input": "",
  "output": "The dry line includes local drugs, which can reduce inflammation and slow the growth of skin cells, such as chlorvetasol, calysportion, beta metagone, lymonone, Trimonylon, tarcrium, salsylic acid, which can inhibit and reduce inflammation of the immune system."
},
{
  "instruction": "Doctor, yesterday I was playing soccer when my shoulder collapsed. What kind of medication should I take for pain?",
  "input": "",
  "output": "To manage the pain, you need to have a pentane and oxoprozel, but to resuscitate the disembodied shoulder, you need to have a medium-solm, propopol, trometamine, meto hexitol, etomydate, flumagenyl."
},
{
  "instruction": "Hi, doctor, I've had abdominal vomiting in the last few days, and I've had some tests, and I've been diagnosed with colombia, which drug should I take?",
  "input": "",
  "output": "To alleviate the pain and reduce the swelling of the swelling, and prevent further obstruction of the intestinal tract, you will receive a combination of meperidin, pentobarbital, Trimetobenzamide, and Frednisolon to control inflammation and treat the possibility of infection."
},
{
  "instruction": "Sir, there's a lot of vaginal secretions, and sometimes there's bleeding, and there's hip pain and pain when you're having sex.",
  "input": "",
  "output": "The good news is that you have to take different antibiotics, including atherosine, ceftriaxone, methidasol, poison lynchin, fluxinasol, cefpoxic acid, cefmethol, difmethol, chlorinium and cytoplassine."
},
{
  "instruction": "Hi, doctor, a few days ago, I had a sore throat and hard to swallow, and I think I have a pharynx.",
  "input": "",
  "output": "The symptoms suggest that there may be a growing amount of abscess to fight infection, such as Clinda Maincin, crock gyxin, cytoplasm, or cepixium. It's also good to reduce inflammation and use local steroids such as dexamethasone and phenol to relieve the pain."
},
{
  "instruction": "Doctor, I've recently been diagnosed with proto-pulmonary platelets, which drug can you recommend?",
  "input": "",
  "output": "For primary platelets, you should take drugs such as Hydroxieurre, Angrelide, Triamtheen, and iron oxide."
},
{
  "instruction": "Doctor, I've been diagnosed with hyperarthritis, and what kind of medication would you recommend?",
  "input": "",
  "output": "We can prescribe cortisone, sulindak, tapentar stones to control pain and inflammation, depending on the patient's condition, and we can prescribe kalcipedio to prevent further bone loss."
},
{
  "instruction": "Hi, doctor, I've been diagnosed with a bad ulcer. What drug do you need?",
  "input": "",
  "output": "To treat an ulcer, you need to take a localizer, a kolagenase, a localizer, a sulfadenine, a vaccinine, an oxidin, a cellulose, aceloid, a senno-side, a parasol, a vassine, and silver formula."
},
{
  "instruction": "Doctor, I've been drinking a lot of water lately because of my thirst.",
  "input": "",
  "output": "I'm going to give you some polystyrene sulfate sodium to help lower the high sodium level."
},
{
  "instruction": "Doctor, there's been a recent hearing loss when I went to see a hearing specialist and I heard that there was sensory malformation, which drug should I take?",
  "input": "",
  "output": "You need a momethasone, or azellasten, or azionolon och, to relieve the infection. You also need chlortyldon to manage the high blood pressure or the accumulation of fluid in your inner ear. You also need the chlorinoneone (Q10) and 8 supplements to improve your blood flow."
},
{
  "instruction": "Sir, you have a chronic ulcer in your leg, and it's not better. What kind of medication should you take?",
  "input": "",
  "output": "You need to take calcium from the NS, the NS, the CC, the Colagen, the Celulose, the Baffelin, and the Nitrogen, each of them has to take the locale, the papillin, the tetrakines, the Vetamin, the Petoxypillin, and the acet acid, which helps you treat your ulcer."
},
{
  "instruction": "Hi, doctor, I'm experiencing frequent fractures and pains, and I suspect osteoporosis.",
  "input": "",
  "output": "Yes, it's good to take more than one of the following: Allendette, Ergosiperol, lysedonet, Ivanodnet, Ivannium, calcium, lytrexate, lyxyphin, calcium, calcium and vitamin dvete, depending on the symptoms."
},
{
  "instruction": "Hi doctor, I have Ileus. What kind of medication should I take?",
  "input": "",
  "output": "In the case of Ilus, you have to take multiple drugs, including Ondan Setron, Hydromode, Meperidin, Metrodizol, Oscillisol, decycloin, demacons, thi\u00b7ti\u00b7ti\u02b9kon, thi\u00b7tha\u00b7ni\u02b9a, mai\u00b7sa"
},
{
  "instruction": "Doctor, you're suffering from severe pain and discomfort due to a red blood cell crisis. What medication do you need to take to alleviate your symptoms?",
  "input": "",
  "output": "To manage the red blood cell crisis, you need to combine a number of drugs. This includes hydromodoids, dependride, RMS, merridol, and Boufrinol to help your body produce healthy red blood cells."
},
{
  "instruction": "Doctor, when you urinate, there's a burning feeling and a little secretion. Can you help me?",
  "input": "",
  "output": "Yes, I think you've got urethra, and I'm going to prescribe a combination of antibiotics like Ceftriaxone and Azitomascin or poison clinine, which will help you remove the infection, and you can also relieve pain and heat by using phenophyridin."
},
{
  "instruction": "Hi doctor, I'm having pain and discomfort in the urethra, and I was told by my doctor that it could be prostateitis.",
  "input": "",
  "output": "It's good to take a combination of cyprophyloxin, which helps relieve pain and inflammation based on the symptoms, and it's also good for symptoms when you're taking toxic liposuction."
},
{
  "instruction": "Doctor, I'm having severe pain in my ear, and it looks like I'm in the ear of a swimmer.",
  "input": "",
  "output": "Yes, I think you've got Oflixin, neomycin, acetase, acetate, acetylolone extrins, M-Creclic acetolin, Decalochin, Cyproxine hydrocortisone and acetic acid."
},
{
  "instruction": "Hi doctor, I think you're suffering from an addiction to anti-convulsives, which you've been taking for a while to control your seizures, and now you're having severe side effects.",
  "input": "",
  "output": "All right, I'm going to give you a few drugs that will help alleviate the symptoms, and the first is charcoal, which will help you absorb the remaining anti-convulsive drugs."
},
{
  "instruction": "Doctor, I think I've lost my testicle, and the lower part is too painful.",
  "input": "",
  "output": "It's important to treat this immediately, and I'm going to give you a prescription for morphine, cefazolin for preventing infection, mecamamine for reducing contractions and tics."
},
{
  "instruction": "Doctor, I've been diagnosed with tricuspid valve disease. What drug should I take?",
  "input": "",
  "output": "Clofidocrell, Flavics, Meltyl Fred Nisolon, Waparin, Armantadin, Sotalol, Raviglyctin, Heizar, and Terazocin should be prescribed according to your condition."
},
{
  "instruction": "Doctor, I'm tired and tired these days, my bones and my muscles always hurt, and I'm worried about what's going on.",
  "input": "",
  "output": "The symptoms seem to indicate a lack of vitamin D, and you can prescribe some medications, including enerkaciferol, cholesterol, and vitamin D, and you can add a combination of vitamins that contain minerals for overall health."
},
{
  "instruction": "Doctor, I've been diagnosed with chicken pox. What kind of medication should I take?",
  "input": "",
  "output": "This condition requires taking methocete, microprostol, and Rho immunoglycerin."
},
{
  "instruction": "Hi, doctor, it's been a long time since you've had pain in your neck, because your neck is very uncomfortable, and it's hard to engage in everyday activities, and what kind of medication can you take?",
  "input": "",
  "output": "Depending on the symptoms, it's good to take a combination of drugs, such as Triminin, Tizanidin, Sumittan, Topamex, Topimacin, profraolololol, Lophibaca, Nortitylin, and metasalin, which are known to be effective in treating the effects on the neck."
},
{
  "instruction": "Hi doctor, I'm experiencing coughing, chest pains, sweat loss, weight loss.",
  "input": "",
  "output": "In order to cure tuberculosis, you have to take a number of drugs together. This includes Isoniajid, pirile singles, lyphampins, etambuttol, pyracin amid. And if you're infected with HlV, you have to take it with you."
},
{
  "instruction": "Hi, doctor, I'm experiencing a condition associated with a hip fistula, so how many medications can you suggest for this disease?",
  "input": "",
  "output": "Yes, it's good to take drugs to treat the pelvic fistulas, including cephdinir, nitrofrantine, and barrenicine."
},
{
  "instruction": "Hi, doctor, I've been having trouble breathing for the last few days, and I think I'm getting an inflammation of my airway, and I'm coughing my scissors, and I don't know what's going on.",
  "input": "",
  "output": "It's possible that it's acute streptomyitis, and I'm going to prescribe it with albumerol and Fred Nisol, and I'm going to need rebalbunelols and Boudenids to help open up prayers, and I'm going to use cephretics to fight any possible infection."
},
{
  "instruction": "Sir, it's hard to focus on things that are close to you these days when you're reading a book or working on a basis, everything seems to be blurry.",
  "input": "",
  "output": "I'd like to recommend some drugs that help alleviate the symptoms of tropecamid anti-depression, perniumphrine, prenisolin, fluoresine, anti-freetane, ketopathanin anti-anxiex, propaquine, propaine anti-solone, and reeksolone."
},
{
  "instruction": "Hi, doctor, forgetfulness, confusion, difficulty with a simple task.",
  "input": "",
  "output": "You're suffering from Alzheimer's disease, including donepet, memantin, lybastamine, Gal\u00e1ntamine, Mirtamine, thiamine, plamifsol, visalin, propaililil, and lyxyphen."
},
{
  "instruction": "It's got a bug on its leg, it's got itching, it's uncomfortable. What do you do?",
  "input": "",
  "output": "If you are bitten by a bug, it is recommended that you take a Defenhitramine (Venamine) to relieve the discomfort. You may also need to use a hydrocortisone dispersal to reduce inflammation. If you are infected with a bite, you may also need to use a toxic acidine or Trimetoprolime to treat potentially secondary infections. You may also need to use a non-temporous national use and a local anti-communication device to treat a second infection."
},
{
  "instruction": "We're experiencing rapid heart rate and palpitations, especially during physical activity.",
  "input": "",
  "output": "The symptoms appear to indicate a seizure V-tach. I recommend Cabedilol, Amiodarone, Diagnosis, Spinontone, Isosorbid, Eztylmiv, Sotololol, Sotolazon, Torcemid, McSiltin, Adenine, to manage the symptoms."
},
{
  "instruction": "Hi, doctor, I've recently been diagnosed with congenital heart defects, so can you tell me what medication to take?",
  "input": "",
  "output": "The drugs needed are digulls, encaptofrills, plavizos, chlorotytityls, tremoles, procamids, vaccines for ambritans, prp-ts, bostens, encavirds, anti-hemorrhoids, and epidemises."
},
{
  "instruction": "Doctor, I've recently had a lack of energy, fatigue, stiffness and pain in my joints, and my skin seems to be more sensitive than usual.",
  "input": "",
  "output": "Depending on the severity of the symptoms, Hydoxychloroquine, Fred Nixon, Ajatio Princip, Micophenic mopetylt, methophecate, ergo Calcciferol, Cereceptrebs, Hyro cortisone, drug, palithoconee, and erythrompone."
},
{
  "instruction": "Hi, doctor, there's a foreign substance in your eye.",
  "input": "",
  "output": "You're going to have to use an ophthalmic ophthalmologist."
},
{
  "instruction": "Doctor, I feel very nervous and I can't breathe. I think I'm addicted to gas leaks.",
  "input": "",
  "output": "It's good to take some drugs based on the symptoms. To combat bacterial infections, you have to take cepacles."
},
{
  "instruction": "Hi, doctor, you've got an agronomous skin infection. What medicine do you need?",
  "input": "",
  "output": "We're going to need antibiotics to treat infection, and we're going to recommend bacterium, cephaplexin, or Clinda Maicin, depending on the severity of the infection."
},
{
  "instruction": "Doctor, I just got diagnosed with endometriosis. Can you tell me which drug to take?",
  "input": "",
  "output": "In order to prevent the growth of abnormal cells in the womb, you have to take medoxyprogesterone or mezstrol."
},
{
  "instruction": "Hi, doctor, I have melanoma.",
  "input": "",
  "output": "The drugs needed for your condition are the trotti\u2019s State of the Age, the Boudensand, the Apussin virus vaccine, the HPV (HPV), the erythropod (HPV), the antioxystic beryl - erythropic acid, the paralymium, the paralymium, the lactic acid solution, the minerals, the mineral vitamins, thenoxynosssol 9th, and the Norst."
},
{
  "instruction": "Doctor, you've recently had a severe chest pain and respiratory problems, and you've got heart disease in your family.",
  "input": "",
  "output": "With your symptoms and your family history, I'd like to give you a combination of some drugs that will help you manage your condition: Simbastatin, chloridocrel, hydrolytic acid, Carbetyllicol, Rosathan, Rossathan, Meltica, Petiterit\u00e1n, Petrocrat\u00e1n, and Progratium."
},
{
  "instruction": "Doctor, I've got viral rash, and my body is very itchy. What kind of medication should I take?",
  "input": "",
  "output": "For itching, you need to take a depenhidramine. You can use a calamin or a catalytic soup to help you with rashes. You can also use a colloid otmeal soup to calm your skin, but if you have HIV, then you need to take a stavudin, palivinzias, lamavizinos, and dextane, if you have a cough."
},
{
  "instruction": "Doctor, I'm experiencing severe abdominal pain, abdominal ovulation, diarrhea, nausea.",
  "input": "",
  "output": "You may be suffering from non-infected uterine, promethesis, lomium, dicyclomin, Trimeto benjamide, mesalamine, nasalamine, bismuth subsalic acid, and Valsalis."
},
{
  "instruction": "Hi, doctor, I've been having a lot of urination and a lot of hesitation lately, but I think I'm going to have to go to the bathroom a little bit, I think I'm going to have a prostate tumor.",
  "input": "",
  "output": "Yes, it's possible that it's pro-plomasine to treat the symptoms, and it's prescribed to treat the symptoms, to treat the symptoms, as a drug that can help relax the muscles of the prostate and bladder, and reduce the size of the prostate."
},
{
  "instruction": "Doctor, I've recently experienced facial blush, shortness, mood change, and I think menopause is coming.",
  "input": "",
  "output": "You're experiencing menopause symptoms, and it's good to start taking estrogen, estrogen, fluoride, progesterone, and progesterone to balance your hormonal changes."
},
{
  "instruction": "Hi, doctor, I've been experiencing repeated infections recently, and I've always been tired, and I've had some tests, and I've been diagnosed with original immunodeficiency, and what do I need to do to cure this condition?",
  "input": "",
  "output": "We can give you immunoglobulins, intravenous injections, and immunoglobulins, which prevent bacterial infection, depending on your condition. A mold infection may require methoclate and mycophenollate morphescette to control the immune system. It can help control inflammation, and it may need to be controlled, and it may need to be controlled, and it needs to be controlled, and it needs to be controlled, and it needs to be controlled, and it needs to be controlled, and it needs to be controlled."
},
{
  "instruction": "Doctor, I've been diagnosed with endocardial cancer. What kind of medication should I take?",
  "input": "",
  "output": "The plan is made up of a number of drugs, including pakleysel, capoflatin, dexamethason, local product, Jemsitabin (jemzar), d\u00e9samesason, Palono Setron, prochloraine, Granium, Topothecan, alpatine, Alferas, and Cisparas."
},
{
  "instruction": "Hi, doctor, I've been having trouble with my eyesight lately, and I just realized that there's a cataract.",
  "input": "",
  "output": "A few drugs are needed to solve the problem. Prelimin anti-inflammation might be needed to reduce inflammation and pain, Fred Nisolone might be needed, Tropicamyd anti-Ax, and Pernegrine. It is also recommended to prevent bacterial infection after cataract surgery. Long-term management of the condition requires Lataphas and Gaptixin. In order to avoid the use of anti-symptomy and anti-strutic drugs, you may need to use anti-strutics and anti-strutics to reduce the eyes."
},
{
  "instruction": "Sir, I think my hip's distal, and I can't move my leg because it hurts.",
  "input": "",
  "output": "I'm going to prescribe morphine, propopol, or midazolam, which helps control the pain associated with the symptoms, and I'm going to use ketamine to relax and relax the muscles during the joint. Once the joint is in place, I'm going to prescribe alsalin and tetracycline to prevent infection, and then I'm going to prescribe mesacodil to prevent drug transmission."
},
{
  "instruction": "Doctor, I'm experiencing constant back pain and leg arrest, and MRI shows that you have spina bifida, and what drug can help you with chiropractic stenosis?",
  "input": "",
  "output": "You need to take multiple drugs to manage the spina bifidasis. These drugs include carinaprodol, iofyxol, iophysol, iovics, dichlorifags, moexicyl, methylsyl, methylsylsylic acid, trotylethyltin, propaneylin, lfenylin, Triadium."
},
{
  "instruction": "Doctor, in the last few days, your stomach has been very uncomfortable, and you've got a lot of toilets, and I think you've got a bowel color, which drug should you take?",
  "input": "",
  "output": "It's sad that you're experiencing some discomfort. You need multiple drugs to treat bowel obstructions. You need polyethylene glycolyx, 3350."
},
{
  "instruction": "Doctor, I recently had an accident, and I was diagnosed with a heart contusion.",
  "input": "",
  "output": "It is good to take cortisone to reduce inflammation and pain in the heart. It is also useful to use zirredronic acid, which helps to strengthen the bones. Cylinder is a drug that helps lower blood pressure and lower heart pressure. Sefdir is an antibiotic that helps prevent infection."
},
{
  "instruction": "Doctor, I've been diagnosed with congenital deformity syndrome, which drug should I take?",
  "input": "",
  "output": "We need to combine drugs to treat the state: Pentane, chlor hexidin, propopol, hydrocodon, dexamethasone, ketamine, devalprocess sodium, bodhoeid, Somatropine, Tobrasin, sevela, and cycloids."
},
{
  "instruction": "Hi, doctor, I think I'm parabolic.",
  "input": "",
  "output": "If you have sporosis, the drug is traconazool."
},
{
  "instruction": "Doctor, your arm is red, you're swollen, you're in pain, you've got fever, you've got chills.",
  "input": "",
  "output": "If they don't work, you can try chlorin, ceftriaxone, or clein, or clein. You can consider the combination of antibiotics, such as egmentin, cefazolin, cefthadim, or cefadrock. You can also use the povidonododide to clean up the area, and you can also prescribe the aromatase to prevent it."
},
{
  "instruction": "I've been having problems with memory lately, and I think it's Bernice Corsakov's syndrome.",
  "input": "",
  "output": "Yeah, I think there's some symptoms of this syndrome that we can treat with thymine, chloracepam, floric acid, ketane, bubonicin, biproficin, trachicin, avsiciono, encamidium, primidium, chlorinated sodium, and sodium."
},
{
  "instruction": "Doctor, I've been diagnosed with bowel disease. Do you want to know what medication to take?",
  "input": "",
  "output": "And of course, I'm going to give you a prescription for medazolm, methidasol, nessolin, diatrizoin, nepajodon, sepocytin, thoracone, ammethicin, thrombobire,"
},
{
  "instruction": "Doctor, you've been coughing for a week, and it's getting worse, your throat hurts and you have trouble breathing.",
  "input": "",
  "output": "We're showing signs of acute bronchitis, and we're going to prescribe a drug that will help you recover. We're going to give you a cough and absorption."
},
{
  "instruction": "Doctor, I've been experiencing persistent vomiting in the last few days, and I don't know why.",
  "input": "",
  "output": "I think you're suffering from an unrecognizably persistent vomiting disorder. I'm going to prescribe a drug that will help alleviate symptoms: Ondan Setron, Promethesis, Metovramid, Droferidol, Defeminic acid, mephemic acid, bicarbonium, ibericol, chlorinium, chlorinium, and chlorinate."
},
{
  "instruction": "Hi doctor, I was hiking, and I accidentally got a foot injury, and I'm very sick, and I'm worried about infection.",
  "input": "",
  "output": "I'd like to prescribe a few medications, depending on the severity of the injury and the potential risk of infection, to prevent the spread of the infection."
},
{
  "instruction": "Hi, doctor, recently diagnosed with myocarditis, which drug should I take?",
  "input": "",
  "output": "The drugs needed for myocarditis are carvedillol, nitroglycerin, ceft lyaxoneson, sulfate magnesium, tamiglytone, lozilythazon, glymephid, phyrofoium, boudezide, venica, and Ixane."
},
{
  "instruction": "Doctor, I've been diagnosed with D.A., which drug should I take?",
  "input": "",
  "output": "You need to take lavetalol, methyldopa, or nephedin to prevent seizures, and you need sulfate magnesium, which can be prescribed to prevent blood clotting under conditions."
},
{
  "instruction": "Doctor, I've been having chest pains and respiratory difficulties lately, and I think they're related to hemorrhagic heart disease.",
  "input": "",
  "output": "I'm going to give you some medications for a hemolytic heart disease: cavedilol, chlorofigrel, nitroglycerin, diglycerin, spiololochonton, Isosorbitin, rosotatin, Nia, pheogen, phenophocate, phenophocic, thoracic acid."
},
{
  "instruction": "Hi doctor, I've recently been diagnosed with neurofiberoma, and what drugs do you recommend for treating this disease?",
  "input": "",
  "output": "Depending on your status as a member, methylphenin, amytylthylin, kaboplatin, vitin, cyprocritin, syprotane, lactulose, hydrothylsin, and gharactin. These drugs may help relieve some of the symptoms associated with nerve fibrosis, but may vary in health and health of the individual."
},
{
  "instruction": "I've got rashes and itchings all over my body, and I've been told it could be chicken pox, so what kind of medicine would help?",
  "input": "",
  "output": "The drugs needed for the pox are depenhydrummine, acyclopelin, balcichlorin, paracyclic vaccines, antipox vaccines, cauloid osmeals, asteride anticoupils, triluridine antisines, lyphins, florinsines, and perpentsines, and perpentsines."
},
{
  "instruction": "Doctor, I was diagnosed with pancreatic cancer.",
  "input": "",
  "output": "I'm sorry, for the cancer treatment, we can start a combination of drugs, including Jemsitabin, Dexamethason, Elotin, Palono C\u00e9tron, Calorosicine, Proclausicin, Oxallatin, Grazettin, Phyglagratz, and Fluorine."
},
{
  "instruction": "Hi, doctor, I've recently been diagnosed with neuropathy from drugs, and what kind of medication do I have to take to treat this condition?",
  "input": "",
  "output": "To alleviate the symptoms of neuropathy, you have to take Gabapentin, Pregabalin, Amitylin, Pirido Stigmin, or a combination of these drugs."
},
{
  "instruction": "Hi doctor, I'm having a lot of menstruating, and my gynecologist says it's a specific menstrual period, and what kind of medication do you need?",
  "input": "",
  "output": "I recommend taking medoxyprogesterone, noretin d\u00e9, mestrol or progesterone to control the menstrual cycle and reduce the bleeding."
},
{
  "instruction": "Hi doctor, I've got a problem with vision in my right eye, and my eyes seem to be weak, and I can't concentrate.",
  "input": "",
  "output": "To treat this condition, there is a combination of thropines, tropicamyd anti-anxiety pills, pneumatic anti-pentolate pills, proplatolate anti-freeze, chloropentolate-phenyls, lyphide ophthane ophthane ophthane ophthanes, which can also be prescribed for flux, and edexa methone, which can also be used to alleviate the symptoms of lactic acidic acid."
},
{
  "instruction": "Hi, I heard you've been diagnosed with Mekel's room, so can you prescribe a drug?",
  "input": "",
  "output": "Yes, for pain management, I'd like to give you a prescription for ketoroloch."
},
{
  "instruction": "Hi, sir, I think my wrists are dislocation while I'm playing football, and it's really sick and I can't move much.",
  "input": "",
  "output": "I'm sorry, the defibrillation of the wrist means that the bone is out of place, and I'm going to give you a drug to treat it, and I'm going to give you a propopol to help you get some sleep while you put it back in place, and I'm also going to prescribe medison eye drops to reduce inflammation in the area."
},
{
  "instruction": "Hi, doctor, I think you've damaged your pericardium, and you've got some pain and a little secretion coming out of your ear.",
  "input": "",
  "output": "Because there may be infections based on the symptoms, it's good to use antipirine to treat and relieve pain with the antipirin solution."
},
{
  "instruction": "Doctor, there's a problem with keeping an erection when you're having sex.",
  "input": "",
  "output": "We recommend that you treat your condition by taking drugs such as sildenapil, taalaspill, bardenapyl, moustyl, and papaberin, depending on the underlying causes."
},
{
  "instruction": "Sir, there's blood in your urine, and it's been going on for days.",
  "input": "",
  "output": "It's good to take a phenazopiridin to relieve the pain and discomfort caused by the temporary or benign urine blood, depending on the symptoms."
},
{
  "instruction": "Doctor, I've been diagnosed with kidney disease for a long time with high blood pressure.",
  "input": "",
  "output": "You need to take multiple drugs to manage your state. First, you need to take a freeocetide to reduce the body fluids. You also need to take amodins, chlorins, carvetilols, lavetallols, hydratelines, nephrinols, and nephrinol, which prevent the accumulation of uric acid."
},
{
  "instruction": "Hi doctor, knee pain has been going on for a while, but it's worse when you're climbing stairs or doing some physical activity.",
  "input": "",
  "output": "The symptoms suggest that you may have susceptibility. It's good to take drugs such as dechlorophenac, Cerecoccus, or Meloxycam, to reduce inflammation and pain. You may also see the use of trinolons to alleviate joint pain, which can help you to improve your long-term joint health. If you have pain, you may not be able to treat the pain with virgokinin, or with pain, but it may not be effective."
},
{
  "instruction": "Hi, doctor. I'm having a hard time with claws. What kind of medicine would you recommend?",
  "input": "",
  "output": "You can use ketoconazol, terbinapin, virconnasol, traconasol, gryoulvin."
},
{
  "instruction": "Doctor, I feel like I'm having trouble with my urethra, and when I urinate, I feel like I'm going to urinate a lot.",
  "input": "",
  "output": "So, depending on the symptoms, I can prescribe nitrofuropurantine and Panazopiridin, and I can also prescribe betanesol, which will help relieve the symptoms of hypersensitivity."
},
{
  "instruction": "Hi, doctor. I think I'm suffering from lime disease.",
  "input": "",
  "output": "Ok, it's good to take poison cycline or ceftriaxone to treat lime disease."
},
{
  "instruction": "Hi, doctor, I've been very tired and weak lately, and my skin looks pale, and I don't know what's wrong.",
  "input": "",
  "output": "I think you have iron deficiency anemia. It's good to take iron supplements."
},
{
  "instruction": "Doctor, I can't breathe, I feel like I'm choking, and I've recently been diagnosed with ARDS, which drug should I take?",
  "input": "",
  "output": "Depending on your status, try to treat methylfrednisolin, levoploxin, m\u00e1dzolam, propocholam, propopicium, epretropyum, dopamine, vancomycin, covibebent, Becuunium, oxygen, and woodpixin. These drugs will help reduce inflammation, fight and breathe, and help reservate your medication."
},
{
  "instruction": "Hi, doctor, I've been diagnosed with toxic strepsis, what medication do you need?",
  "input": "",
  "output": "There's some drugs that can help: metimasol, tyoxoids, profile tyranisil, profraol, Trabolopast, etochol, trifllu operas, siliculium, reading hexophol, fluorescine, and benphenyl polylithyl, which are considered toxic in the thyroid."
},
{
  "instruction": "Sir, you've got a cut on your finger, and it's been bothering you for days, and it's really sick and swollen.",
  "input": "",
  "output": "Based on what you have described, we recommend Cefalecsine, lydocaine, volume bacane, and addasel vaccine to prevent further complications."
},
{
  "instruction": "Doctor, I have symptoms that I'm sweating a lot, and I'm dizzy, and I feel like I'm having some sort of magnetic nervous disorder.",
  "input": "",
  "output": "It's good to take a combination of drugs based on symptoms."
},
{
  "instruction": "Hi, doctor, I'm always not strong, I'm tired, and I feel pale and short of breath, and what's the problem?",
  "input": "",
  "output": "To treat anemia, you're going to have to treat epothetine Alpha, Darbepontin Alpha, iron oxide, phenosic acid, nephrasic acid sodium, etheracic acid, baloxide, balcide, vellum, lylinade, or a drug."
},
{
  "instruction": "Doctor, there's pain and swelling in the elbow, and that part feels very soft and bitter.",
  "input": "",
  "output": "Could you prescribe drug therapy, such as Trimimmon local products, melocycam, volume barcine, cortisone, methylylethylic acid, stratol, ethanol, ethanol, ethanol?"
},
{
  "instruction": "Hi, doctor, I think I've got a cold, and I can't breathe, and I'm stuck, and I cough a lot.",
  "input": "",
  "output": "Sir, I recommend that you take kaiaphenesines, which dilute the mucus on the symptoms, pk-Ladrine on the nose, lobbies dm on the cough, and phallics on the throats, which help alleviate the symptoms and treat the cold."
},
{
  "instruction": "Hi doctor, I've recently had difficulty balancing my body, and a few months ago, I was diagnosed with ALS, which drug should I take?",
  "input": "",
  "output": "You need to take lilusol to slow down the progress of the disease. You can also prescribe cropen or Tizanidin to control muscle rigidity. Glycopyroll can help you with excessive saliva flow or saliva flow. Celecoccirex can help you manage pain."
},
{
  "instruction": "Hi, doctor, I've been diagnosed with central retinal arteries or I.V. pulmonary obstructions.",
  "input": "",
  "output": "To treat this disease, you will need a variety of drugs such as bebasicin, tropicamyd ophthane, trovoprost, traboprost, ratanoprosine, lynx, guagore, acelasmoids, acelasmoids, and acelasmoids."
},
{
  "instruction": "Hi, doctor, I'm really worried about having an irregular, rapid heartbeat for a while. Can you help me?",
  "input": "",
  "output": "There are drugs that can help you with these disorders: adenosine, ditatijems, digulloids, floroids, profraololols, Niflololololols, Lalexindium, ibesathan, ibsterenol, Pipronoll, Piternolle-sidentum, and ethosoxyxyl."
},
{
  "instruction": "I'm having trouble with my leg, and I recently found out that it's IV function failure, which drug should I take?",
  "input": "",
  "output": "In intravenous failure, you have to take a variety of drugs to address symptoms such as non-alygenate, collagase, Sylvaniasis, nitrogenic acid, tetrakinin, lysol, calamin, sodium tetra desolate, and lysol."
},
{
  "instruction": "Hi doctor, I've recently experienced vaginal secretions and itching, and I've had urinary pains, and can you tell me what's wrong and what medication to take?",
  "input": "",
  "output": "I suspect Trikomonas infection. The drug you need to take is methodidasol."
},
{
  "instruction": "Hi doctor, you're having a lot of trouble with acne these days, and it's affecting your confidence.",
  "input": "",
  "output": "I'm sorry, but I'll recommend some drugs that can help you with acne: over-oxystic benzoils, Tretti seniors and poison clinch are all good options."
},
{
  "instruction": "Hi doctor, I've been having a hard time with drug abuse for a while, and I'm wondering if there's any drugs that can help.",
  "input": "",
  "output": "Yes, there are some drugs that can be helpful for drug abuse, but drugs that can be prescribed for drug abuse can be different."
},
{
  "instruction": "It's hard to urinate and it's really painful.",
  "input": "",
  "output": "There may be a blockage, depending on the symptoms, that can help relieve the pain and relieve the urine flow by providing drugs such as thoracism, Pinnastead, dutastrid, terazoin, poisonous acid, alpusin, silium, tarapill, elfamine, lyphin, lyphin, harpenacin, etc."
},
{
  "instruction": "Hi, doctor, I'm experiencing excessive thirst and urination, and I'm suspect of pyorrhea.",
  "input": "",
  "output": "So it's good to take desmopressin."
},
{
  "instruction": "Doctor, I'm having a lot of discomfort in the eyes, and I'm having an infection, and I don't know if it's scarlet pneumothoritis, but would you recommend a drug for that?",
  "input": "",
  "output": "Yes, in order to treat Hong Kong-shaped nephritis, you need to take Fred Nisolone, Superpentonic eye medicine, Ua, Britonine anticouples, Metrexate, 'Homotic antixiety', 'Ropamide Angua,' 'Ropcardic Anguysin', 'The Detemme-Plassssin', 'Anxomin',' and 'Anxomin'."
},
{
  "instruction": "Doctor, I've been diagnosed with an I.V., which drug should I take?",
  "input": "",
  "output": "You need to take tadararis, procadoids, alpha-D-gaptodinase enzymes, Insanes, Pesoterodin, Oksprocine, Lidoc-priroca, Trimetofrim, and Sefadoxil."
},
{
  "instruction": "Hi, doctor, I've recently been diagnosed with a foot fracture, which drug should I take?",
  "input": "",
  "output": "You have to take three drugs: Alluoni, Defexamine, and Diflalasson."
},
{
  "instruction": "Doctor, I've been in constant pain in my lower abdomen for the last few days, and I went for an ultrasound, and it turns out there's a cystic cyst.",
  "input": "",
  "output": "A few drugs are prescribed to control the symptoms according to the type and size of cysts. For follow-up MRI, you will be given diitrijo et or ihexol. Often chlorinide can help reduce the size of the cyst. If pain is inextreme, it can be used to absorb it."
},
{
  "instruction": "Doctor, I think I have chlamydia.",
  "input": "",
  "output": "The drugs for chlamydia are the agitomasin, the ceftlicone, the poison cycline, or the cephpo poison."
},
{
  "instruction": "Hello, doctor, I think you have a parasite infection.",
  "input": "",
  "output": "In this case, you have to take meven dasol."
},
{
  "instruction": "Hi, sir. Your jaw is fractured. What medicine do you need?",
  "input": "",
  "output": "\"Sefazolin, Clinda Masin,\" \"Adasel,\" \"Adasside Vaccine,\" chlor hexidin localizers, thiamines, entremiums.\" \"Estrium,\" \"Estrium,\" \"Astrium,\" \"Accidentosomes\", \"Accerosoms,\" \"Venium,\" \"Venicium,\" \"Venium,\" \"Venicium,\" \"Venium,\" \"Cecceroissomin,\" \"Ceccerodisculin,\" \"Prima\" and \"Prime.\""
},
{
  "instruction": "Hi, doctor, I think you're infected with a giant cell virus. What do you do?",
  "input": "",
  "output": "I'm going to give you a prescription for the rabbit population, T-ymphonic Globulin and Grepalyxin, which is used specifically to treat large-cell viral infections."
},
{
  "instruction": "Sir, there's fatty paper on your shoulder. What drug would you recommend?",
  "input": "",
  "output": "In local species, I recommend the Argica Nationalist and the Acetylizers."
},
{
  "instruction": "Hi, doctor, I think there's a female genital infection.",
  "input": "",
  "output": "I'm going to give you two antibiotics combination to treat the infection based on the symptoms, and I'm going to give you lidocaine, which helps ease the discomfort, and Povidon Yood, which helps clean and sterilize the area."
},
{
  "instruction": "Doctor, I've been diagnosed with pulmonary hypertension. What kind of medication should I take?",
  "input": "",
  "output": "After that, you have to take methads, wafarins, carvedilols, cylinagras, spironokton, digullacs, dititams, bosentials, tetrium, burrotanim, hydrotide, hydrogenine, and nephrine."
},
{
  "instruction": "Hi. I've recently been diagnosed with a thyroid fracture. What kind of medication should I take?",
  "input": "",
  "output": "You have to take metimazol and profile tiouracil to manage the thyroid nodes."
},
{
  "instruction": "Doctor, your teeth are broken, and they really hurt. What kind of medication should you take?",
  "input": "",
  "output": "You need to take drugs together to prevent pain and infection, and to prevent bacterial infection you'll need antibiotics like penicillin and Klindamycin, and you're going to need pain meds, such as volume bacin and anti-genetics that help alleviate pain, and finally you'll need to vaccinate a 100-year-old vaccine to prevent aberrant infection."
},
{
  "instruction": "Doctor, I've been suffering from dumping syndrome for the last few weeks, and I don't know what medication to take.",
  "input": "",
  "output": "Depending on the symptoms, I can prescribe a drug that relieves discomfort by combining sodium chloride, pancratin, Nordriptylin, lave prasol, procloperin."
},
{
  "instruction": "Doctor, the lymph nodes are swollen and very painful.",
  "input": "",
  "output": "The symptoms suggest lymph nodeitis, and to treat the infection, I'm going to give you antibiotics, such as deklocrin or cepacler."
},
{
  "instruction": "Doctor, I've had a recent facial injury, and it's very painful. What kind of medication should I take?",
  "input": "",
  "output": "I'm going to prescribe chlorogenes, which helps control the pain, and chlorogenesis vaccines to prevent any possible infection."
},
{
  "instruction": "Doctor, I've been having trouble breathing and fatigue for quite some time, and I've been told that I have aortic valve disease.",
  "input": "",
  "output": "After this, you can manage and help with symptoms that you need to use to monitor, monitor, monitor, monitor, monitor, monitor, and control the symptoms."
},
{
  "instruction": "I've been experiencing joint pain and stiffness for a while, and doctors suspect rheumatoid arthritis.",
  "input": "",
  "output": "In this case, a combination of drugs should be taken to control the symptoms and slow down the course of the disease. Prednisone to reduce inflammation, methoctrexate to slow down joint damage, folic acid to reduce side effects, and hydrocyclic chloroquine to reduce joint swelling, and selyculus to relieve pain, can be taken first."
},
{
  "instruction": "Doctor, I've been diagnosed with an I.V.C. What kind of medication should I take?",
  "input": "",
  "output": "You have to take pyrosine, which helps relax prostate and bladder muscles, which helps you to see urine more easily."
},
{
  "instruction": "It's got red rashes on its face, and it's really itchy and painful, and it started with a small wound, but now it's spreading, and I think it's an abscess.",
  "input": "",
  "output": "Yeah, I think it's an abscess."
},
{
  "instruction": "I was diagnosed with anal fistula. What kind of medication should I take?",
  "input": "",
  "output": "In anal fistula, you have to take multiple drugs, including mesalamine, nitrofurazone, and Adalmujo."
},
{
  "instruction": "Doctor, I think she's hypothermic, she's so cold she's shaking a lot.",
  "input": "",
  "output": "To treat hypothermics, ampice, thi, thi, thi, thi, bichomycin, spiololochon, cobvent, debalprocess sodium, lysperidone, folic acid."
},
{
  "instruction": "We've recently experienced extreme aggression and irritation, and it's hard to comply with authorities' instructions and requests.",
  "input": "",
  "output": "It's good to take a drug called intubation, which will help you manage the opposite disorder based on your symptoms."
},
{
  "instruction": "Doctor, there's a terrible headache that looks like migraine, and it's like my head is exploding and I can barely bear the pain.",
  "input": "",
  "output": "I understand how difficult migraines are, and there are some drugs that you can try to alleviate your symptoms, and I recommend taking a supertrex to help relieve your pain and topiamas to prevent future migraines."
},
{
  "instruction": "Sir, I've just begun to feel like my hands and feet are paralyzed, and I think I'm having post-diabetic neuropathy.",
  "input": "",
  "output": "Then I'm going to give you Gabapentin or Fregalin to treat the neurotic pain. You need to control your blood sugar by taking insulin glatin or glyborides, or by taking insulin as well as excretins, and by taking it to improve your blood sugar control, you can also take it to try to improve your blood sugar control, or to improve your insulin sensitivity. If you have an infection with your foot, you can also treat it with a hysglyglyglytamine, or even better if you don't have an infection."
},
{
  "instruction": "Hi, doctor, we've got a problem with the testes, and I think they're not as active as they used to, and they're not feeling any better, and what's the cause?",
  "input": "",
  "output": "The symptoms suggest that there are some other drugs, such as testostosterone, tarapill, sildenapyl, vitamin B-12 bardenapyl, cale calciferol, coulic acid calcium, protrusa, pheg interferon al-2b, and ribatin, which can be recommended as a cure for some of the most effective drugs."
},
{
  "instruction": "Doctor, I've been diagnosed with agronomous strepitis, which drug would you recommend?",
  "input": "",
  "output": "Yes, at the present time, it's good to take antibiotics, such as poison clinine, Clindamycin, Minocycline, or decrycline. It can also help with local treatment, such as chlor hexidin, peroxide benzoils, Sylber sulphasis, or iodine."
},
{
  "instruction": "Doctor, I'm suffering from fatigue, cough, fever, chest pain, headaches, and I've recently been diagnosed with valentine.",
  "input": "",
  "output": "In order to treat the valley heat, you have to take a number of drugs, including sodium chloride, plutonium, garlic jellies, methimazol, biscodyl, ivestan, merthazaafin, aspirium, trinososylic acid, and sodium trioxide."
},
{
  "instruction": "Hi doctor, I've recently been diagnosed with cariety dementia, and how many drugs can you offer me to manage this disease?",
  "input": "",
  "output": "For example, it is generally prescribed in the case of Louische dementia, with a combination of drugs for better management."
},
{
  "instruction": "Doctor, I was diagnosed with Marfan's syndrome. What drug should I take?",
  "input": "",
  "output": "You need to take multiple drugs to manage your symptoms. This includes berapamil, nadolol, and lysapane. The eye also needs a cyclic antifreeze and antiquated anti-respirants and anti-respirants to protect your immune system."
},
{
  "instruction": "Doctor, I just got diagnosed with multiple myeloma, and what do I need to do to cure this disease?",
  "input": "",
  "output": "In the case of multiple bone marrow species, a combination of drugs, such as bolthezomy, glare de las acid, lexamethasone, relilymide, oxycodon, pamidette, acycloid, e\u00b7po\u02b9pe, ephetin alvetin, etherbetin, ethervetin, elferatitin, and lyphin, help with the blue and help with the blue."
},
{
  "instruction": "Doctor, I got a head injury from an accident. What kind of medication do you need?",
  "input": "",
  "output": "To treat head injuries, you have to take a number of drugs, including beculenium and pancranium, which reduce brain swelling and pressure, and beryptane, which improves lung function, benzalconium soups that prevent infection, plasma protein sprays that increase blood volume, flasmonics, and other things that are known as immunoglobulins, and so on."
},
{
  "instruction": "Doctor, I've been diagnosed with hypertonic pulsitis. Can you prescribe a drug?",
  "input": "",
  "output": "Yes, your disease needs a complex dose of antibiotics, including necrosis, ceftriaxone, ceftajidim, and vancomycin. You also need ursool to help dissolve, and vitamin A to improve your blood pressure, as well as inflixion to reduce the inflammation of the bile ducts."
},
{
  "instruction": "Hi doctor, your period has been irregular in the last few months, and sometimes you're losing a lot of blood and others are very light, and you're also experiencing tics and mood changes.",
  "input": "",
  "output": "It's good to adjust your period by taking medoxyprogesterone, or Modicone, depending on your symptoms, which helps reduce seizures and mood changes."
},
{
  "instruction": "Doctor, I've been having a lot of breathy, dry coughs for a long time, and I've had multiple tests, and I've been diagnosed with IC lung disease, which drugs should I take?",
  "input": "",
  "output": "In order to manage IC lung disease, you have to take a combination of drugs. Erisomasin is an antibiotic that can help treat respiratory infections and it can help reduce inflammation of the lungs."
},
{
  "instruction": "Doctor, there's a painful sensation of arm and leg weakness and weakness of strength, and I just got diagnosed with pneutitis, which drug should I take?",
  "input": "",
  "output": "It's good to start with tygabin, which helps the nerves, and also take fluorviprofen to reduce inflammation of the affected nerves."
},
{
  "instruction": "Doctor, I think I have malaria.",
  "input": "",
  "output": "Malaria is a serious disease that needs immediate treatment, and the drugs that we need to treat malaria are chloroquine."
},
{
  "instruction": "Doctor, a previous doctor diagnosed me with physical disorders, can you tell me what to do to improve?",
  "input": "",
  "output": "It includes lorazepam, essitalofram, ketane, synapin, jaficin, jyphethylin, adibalprox sodium, pentobarbitalum, pulsimulin, intravenous injections, cyclotins, and cypita."
},
{
  "instruction": "I think she's hypotensive. I need you to tell me what medication to take.",
  "input": "",
  "output": "To cure hypotensives, you need to use such drugs as polystylene sulphate sodium or Trimetobensamide, and then you can use a solution of electrolyte, or thrombosmide, and then, depending on what you need, you can prescribe hydroxide aluminum, amila, benztina, amystina, trinium, and polycyssa."
},
{
  "instruction": "I think there's a problem, and I feel like people are watching me, and it's affecting everyday life.",
  "input": "",
  "output": "like reperitridon, benztropine, gyranficin, harroperitone, ketiamine, divalprocese sodium, lyphicin, lyphicin, chlorofin, pulpin, pulsin, lysin, or drug, will be the best choice for any drug."
},
{
  "instruction": "Hi, Doc, I think I got a knee injury, and I fell on my knees in the middle of the basketball game, and now I have a lot of swelling and pain.",
  "input": "",
  "output": "The symptoms suggest that the cartilage plate in the knee or in the middle of the month has ruptured. A procedure is needed to treat this. An anesthetic such as propopol, volume bacukin, or cevofluran will be administered to reduce inflammation and avoid pain in the procedure. It can also be administered with cortisone and aleuric acid sodium to help the healing process."
},
{
  "instruction": "Doctor, I've recently been diagnosed with endometriosis, which drug should I take?",
  "input": "",
  "output": "To treat endometriosis, you have to take hufain, divostin, rosvastatin, lammyfrill, alpusacic acid, Darbephotin Alpha, Boomerthaide, Lompidium, and lavrasol."
},
{
  "instruction": "Hi, doctor, I've been very sick lately, I've got high fever, I've got chills, my body hurts, my blood pressure is very low, and I'm extremely weak.",
  "input": "",
  "output": "It's a serious condition that requires immediate treatment. I'm going to prescribe a combination of drugs to treat this condition."
},
{
  "instruction": "Doctor, I think I have a fever.",
  "input": "",
  "output": "To prevent further complications later on, you have to take alfrazolam, IndaPamid, Barreniklin, Olmethattan, Prabastin, Jombim, Waffarin, Ambrominja, Amodin, and memilamine."
},
{
  "instruction": "Hi, doctor. I've recently been diagnosed with cystitis. Can you prescribe a drug for me?",
  "input": "",
  "output": "Of course, in the case of cynics, you have to take a combination of drugs such as meperidin, demeril, propolinium, cecumcyclicium, cebophyloline, glycophylolate, cell testane, neostagmine, buttorpanol."
},
{
  "instruction": "Doctor, you had a heart attack last night, and you didn't feel much, so what kind of medication should you take?",
  "input": "",
  "output": "We need to take epinephrine, atropine, amiodarone, dopamine, Ditatim, Norepinephrine, bicyclic potassium, peroxyxone, peroxoneum, pyrophonium and sulfuric magnesium."
},
{
  "instruction": "Doctor, I was diagnosed with cardiomyopathy. What kind of medication should I take?",
  "input": "",
  "output": "You have to take cavedilol, Possemid, Lissymid, Lissinfrill, Wachlin, Spylinolkton, Dianglin, Amiodarone, Elybarfrill, Losuvatin, Ramifyl, Rossartan, and Isorvid."
},
{
  "instruction": "Hi doctor, I think I'm a social phobic, and I feel extremely insecure and uncomfortable in social situations, and it's affecting my everyday life.",
  "input": "",
  "output": "The drugs that we can prescribe for social phobias are chlornazepam, stratolin, alprosollam, ketipin, cytalofin, paralysestin, lyoxethin, lamothicin, viraphicin, and araphaselol, and we'll look at how the body reacts to this."
},
{
  "instruction": "Doctor, I'm experiencing a severe scalp fever, and I feel sick and dizzy, and what's the problem?",
  "input": "",
  "output": "To treat this infection, you need to take a combination of drugs such as ceftriaxone, vancomycin, ampicillin, prochlorin, prochlorin, bream, cytoplasm, acycline, phenobarbital, gentamisine, cepuasis, amphorisin, and amphorisin B."
},
{
  "instruction": "Doctor, I've recently been diagnosed with GM, which drug should I take?",
  "input": "",
  "output": "You don't have to worry about it because there's a combination of drugs that you need to treat -- methylphen dating, mecaramamine, lactic magnesium."
},
{
  "instruction": "Hi, doctor, I'm experiencing white fingers and toes and soot and soreness when I'm in the cold or when I'm stressed, which drugs should I take?",
  "input": "",
  "output": "In response to the symptoms and diagnosis of Leino's disease, it's recommended that you manage the symptoms by taking Nifedin, Mycophenol morpetyl, or Hydoxychloroquin."
},
{
  "instruction": "Recently, joint pain and swelling continue after intestinal infection, and the doctor said it could be a reactive arthritis, which drug should you take?",
  "input": "",
  "output": "The drugs needed for reactive arthritis are methocate, sulphasalin, dexamethasone local products, folic acid and methylphrine Nisolone. However, there is no air, no meccamine, no Troll domemycin, no idium oxyquinolin in-111, no piperocranium."
},
{
  "instruction": "Doctor, I think I've got an odome, and I've got a severe skin itching and a red oscillator.",
  "input": "",
  "output": "The medicine needed for the om is the cure for the permetrin locality."
},
{
  "instruction": "Sir, I think you're in there. I think I'm deaf and I can't hear you.",
  "input": "",
  "output": "Yes, it's good to use the Kabamad peroxide peroxide or triethane polypethide oletic drops, which help to soften and remove you. If it doesn't work, you can still see the use of the oxidide or cavamide and hydrogen oxid drops to reduce inflammation. In rare cases of shock, it may be possible to use or use the fluoride osolous acid to reduce inflammation."
},
{
  "instruction": "Sir, I had high blood pressure during pregnancy. What do I need?",
  "input": "",
  "output": "The drugs needed for high blood pressure include aterol, lavetalol, Nityldipin, methylophin, HYDRA, Terbulin, Tioridazine, and sometimes, depending on the specific symptoms, you can also give sulfuric acid, procyclic acid, oxytocin, and even lactic acid."
},
{
  "instruction": "Doctor, I'm suffering from severe pain in my legs and depression, and I've been diagnosed with an arteriosclerosis, which drug should I take?",
  "input": "",
  "output": "To prevent clots, you need to take Wifferin, Heparin, Hexaparin, and Isored de Nitrate to improve your blood flow, which helps you manage your symptoms and reduce your risk of complications."
},
{
  "instruction": "Doctor, you're red, you're having acne, you're having blood vessels, you're exposed to the sun or you're drinking, and you're getting red.",
  "input": "",
  "output": "I'd like to recommend drugs like methodidasol local products, toxiciscline, Azelassan local products, or microcycline, which can help reduce facial inflammation and rash, and avoid causes such things as hot food and harsh weather."
},
{
  "instruction": "Hi, doctor, I think your skull's fractured.",
  "input": "",
  "output": "There's a few drugs that you need to do to prevent tetanus infection: you need to get a dopamine to prevent it; you need a cefazolin to prevent it; you need to do it to control the symptoms and the pain; you need mannitol and response to control the pain."
},
{
  "instruction": "Hi doctor, I'm experiencing eye pain, appendix, and light sensitivity, and I went to an ophthalmologist, and I was diagnosed with staphitis, which drug should I take?",
  "input": "",
  "output": "There are drugs that need to be treated: cyclotonic eye medication, Fred Nisson, Trimlon anti-nollone, Rotephranol anticoup, Brimonine-Tymolol anticouple, Nefamoid anticoup, Inflexicicad, anti-Aphron, and anti-Aphron."
},
{
  "instruction": "Hi, doctor, I think you've recently had an accident that fractured your face. What kind of medication should you take?",
  "input": "",
  "output": "In order to prevent tetanus infection, you need to take a dopamine-method vaccine. Oxy meta-solin rain helps you to relieve your nose, which helps you to prevent infection. Safazolin is an anesthetic gas that is administered during surgery to control pain."
},
{
  "instruction": "Doctor, I've had coughing, shortness of breath, chest pain in the last few days, and I'm afraid it might be bronchitis.",
  "input": "",
  "output": "It's possible that it's a symptom, that it needs to be prescribed to treat the condition: guapenesine, claritoma, Fred Nisolon, Rebalbutol, Vendonite, bod\u00f3nide, woody pulxine, levopapa, and ceftamim."
},
{
  "instruction": "Good afternoon, sir, your jaw is in so much pain that you can hardly eat or speak. You probably have jaw problems.",
  "input": "",
  "output": "To control the infection, you must take penicillin and Kleinmycin. You must also use chlor hexidin and benzoins to reduce inflammation and pain. In the last 10 years, if you don't get it, you may need a strain of immunoglobulins, a human condition."
},
{
  "instruction": "Doctor, there's pain and secretions around the workplace.",
  "input": "",
  "output": "I'm going to prescribe a vaccine for Clinda Misin, nephrite magnesium, nitrograsone, nitrolypsone, difloorone, insulin, gluicin, aphids, prhomsin, prhomsol, pyrofacol, escalic acid, depression, and destethyloxide vaccine for the infection."
},
{
  "instruction": "Doctor, I've been diagnosed with cystic breasts. What kind of medication should I take?",
  "input": "",
  "output": "To treat mammmon cysts, you need to take a dose of Triamtheen, tessartan, preramine, noretindron, and premidone. Follow the medication guidelines carefully and return to your next appointment in two weeks."
},
{
  "instruction": "Hi, doctor, I've been experiencing a lot of anxiety, nightmares and memories since the traumatic event, and I'm having trouble sleeping, and it's affecting everyday life.",
  "input": "",
  "output": "I think you have post-traumatic stress disorder: chlorazepam, ketane, trizodon, bubrofiin, phalin, fluoridetin, lymethylin, lamethythyl, lyphythyl, lyphin, lyphin lysa, physa, drug, etc., etc., etc., etc., etc."
},
{
  "instruction": "Doctor, I've been diagnosed with kidney cancer. What drug would you recommend for treatment?",
  "input": "",
  "output": "There are several drugs to be used in treatment: Sunniop, tatsylymus, vitristin, zyreronic acid, everomus, nephrastin, troboprosin, ibisin, ibisol, some of your reactions and some of your reactions."
},
{
  "instruction": "Hi, doctor, there's red eyelids and swellings and it's itching and it feels dry and bloated, and I think there's a ophthalmitis.",
  "input": "",
  "output": "Yes, I think you have ophthalmitis. The drugs you need to take are the eye drops, the eye drops, and the eye drops."
},
{
  "instruction": "Hi doctor, I've been suffering from Celia for a long time, and what kind of medication would you recommend?",
  "input": "",
  "output": "It's good to take a combination of estrogen, ketotypen ophthyl, and aloe vera to relieve symptoms, and strict observance of the Glutten Free diet."
},
{
  "instruction": "When I peed, I was told it could be bladderitis. What kind of medication should I take?",
  "input": "",
  "output": "We need to take Cyproplexine, Pernasodin, pectolym, nitropurantone, sodium pentonic polypate, Trimethophate, Soliphate, and Vesicin."
},
{
  "instruction": "Hi doctor, I've recently been diagnosed with sickle cell anemia. Can you recommend the medication you need?",
  "input": "",
  "output": "In the case of sickle cell anemia, you have to take a variety of drugs, such as folic acid, hydrocyclic acid, penicillin, deperassylocks, nephrites, moust\u00e8res, physylethyl polycine, temidin, and eight memes."
},
{
  "instruction": "Doctor, there's a pericardial bleed in your eyes.",
  "input": "",
  "output": "We need tetrakines, fluoresine ophthalmology, and Fred Nisolone eyelids."
},
{
  "instruction": "Doctor, I'm feeling pain and discomfort in the anal area, I think it's piles.",
  "input": "",
  "output": "I'd like to recommend some drugs that will help you with your symptoms: mydazolam, docucet, hydrocortisone, Peteryl, merridium, hydrocortisone-prime, hydrocortisone, parasol, methylsine, methylsol, methyls."
},
{
  "instruction": "Doctor, after contact with a particular substance, there's a redness and aching and swelling skin disease.",
  "input": "",
  "output": "It is recommended to use hydrocortisone, Trimmonolon, or desunide to reduce the risk of inflammation, depending on the symptoms. It is also helpful to take antihistamines such as Hydeoxin to alleviate it."
},
{
  "instruction": "Doctor, I've been having fatigue and difficulty breathing lately, and I think my heart rate is slower than usual.",
  "input": "",
  "output": "I think you're experiencing the sinus substrate, and I'm going to give you a drug called the Nevivolol, which helps control your heart rate."
},
{
  "instruction": "Doctor, I was diagnosed with high blood pressure a few days ago. What drugs do I need to take to control high blood pressure?",
  "input": "",
  "output": "If you want to control high blood pressure, you have to take four drugs: hydrochloropathides, amrodin, Almesartan, Benazeril, and they work together to lower blood pressure and control the symptoms."
},
{
  "instruction": "I'm experiencing a doctor, abdominal pain, fever and abnormal discharge, and when I went to a hospital, I was diagnosed with a hip inflammation disorder.",
  "input": "",
  "output": "To treat pelvic inflammation, you need to take a combination of antibiotics, such as poison fever, ceftriaxone, methidasol, cecumcysticin, and Gentamicin."
},
{
  "instruction": "Hi doctor, I've recently been diagnosed with liver disease, so can you tell me what medication to take?",
  "input": "",
  "output": "In the case of liver disease, you have to take Spyolin, Lactulus, Urso, Nadolol, Tacromus, Ritovir, Ramibudin, Atabutara, Stabutin, Pancretin, and Sudobudin."
},
{
  "instruction": "Hi, doctor, I've been having chronic transformovers for a long time. What kind of medication can I take?",
  "input": "",
  "output": "Depending on your status, you can take polyethylene glacials, doculates, glycerium, bisacodyl, lactose, lactose, glycerin, glycerin, sennob, ustium, verdium or benphenyl."
},
{
  "instruction": "You've been diagnosed with thyroid cancer, which drug should you take?",
  "input": "",
  "output": "There are drugs that are taken together to treat thyroid cancer."
},
{
  "instruction": "Hi doctor, I think I have the flu, fever, cough, throat, what should I take?",
  "input": "",
  "output": "The drugs you need to take are Oselta Mivir, Janamivir, or Amanadine. It's also good to take the lobbyist Ac, or Dm, which helps cough and throat pain."
},
{
  "instruction": "Doctor, I have a diagnosis of Dr. Friedrich's dystrophy, which drug should I take?",
  "input": "",
  "output": "You need to take Pluticasone, Albuterol, Oscarvazepine, Syldenap, polyethylene glycolyx, 3350 Myrax, Digulls, Ommeprosol, Ere, Mecamilin, Trolldomycin, and Fridhi exercise realism."
},
{
  "instruction": "Hi, doctor, I've recently been diagnosed with dermatology, which drug would you recommend?",
  "input": "",
  "output": "The drugs needed for the skin type may be the Tretti\u2019s solution, the peroxide benzoils, the cyclofix soups, the salicilicate, the aluminum, and the six-generium solution."
},
{
  "instruction": "Sir, you've got severe pain in your shoulder and your arm, and you can't move your arm properly.",
  "input": "",
  "output": "The symptoms seem to indicate that you have chronic neurotritis, which will help you to treat your condition by providing a combination of caricaprodol, metasalin, pyrocham, plausepam, oscillone, escillate sodium, kennel and bilberry extracts."
},
{
  "instruction": "Doctor, you've been diagnosed with uterine cancer, which drug should you take?",
  "input": "",
  "output": "In treating uterine cancer, you have to take a number of drugs together: potassium chloride, ortocyclen, cisplatin, acetate oxidase, pacclitsel, Mydrine, Noretin Drone, and Phegfilagras, to treat and treat your condition."
},
{
  "instruction": "Hi, doctor, I've recently been diagnosed with adrenaloma, can you tell me which drug to take?",
  "input": "",
  "output": "Yes, in the case of the adrenal glands, you have to take penoxi benjamin, lavevrasol, polyethyllicol 3350, sulfuric iron, pheg interferon al-silatron, ribabirin, calcium-vitral D, tecrograms, masacyls and posilililils."
},
{
  "instruction": "Sir, it's hard to swallow, and I feel like I'm feeling sore inside, and I think I've got esophagitis, and what kind of treatment do you recommend?",
  "input": "",
  "output": "To reduce stomach acid and treat the esophagus, it is recommended that you take drugs such as omeprasol, pantofrazol, lysofrasol, or lave prasol. It may also be good for you to try to calm down your diet and protect your esophagus."
},
{
  "instruction": "Doctor, I think I've got gas period.",
  "input": "",
  "output": "I'm sorry, there's a combination of drugs to be used in this disease: meropeem, air, mekamilamin, Trollle Domecin, Indiium Oxyquinolin - 111."
},
{
  "instruction": "Doctor, the lower abdomen is uncomfortable and it's itching, I think there's a yeast infection, which drug should I take?",
  "input": "",
  "output": "To treat yeast infection, it's good to take the fluxol (depression). It's also good to use the Nistatin soup, the chlorimazol, the chloromysol, the terconisol, the terconasol, the Petamesson-krotimasol, the Butochnasol, or the nitric acid, to alleviate symptoms. If you have intercourse, you may be able to take the form of sodium pneumatic acid, or chloric acid, which can be the last to prevent it."
},
{
  "instruction": "Doctor, I've been diagnosed with spina bifida, which drug should I take?",
  "input": "",
  "output": "These drugs include oxybutin, polyethylene glycolate 3,350, Budsonid, Gennoside Uss, Guadalm, Okscavazepin, Tobramytin, Cromolin, Somolin, Celolate, and Calcium."
},
{
  "instruction": "Doctor, I think I'm addicted to drugs. What do I do?",
  "input": "",
  "output": "To respond to addiction, you have to take a few drugs immediately: charcoal, narcissone, acetylcystein, sodium chlorate, thymine, flumazenill, sulfate magnesium, lytobir."
},
{
  "instruction": "Doctor, I've been drinking too much over the last few years, and I'm worried if you're having an alcoholic liver disease.",
  "input": "",
  "output": "Yes, it seems to be an alcohol-generated liver disease. You need to start taking drugs that will help you manage your condition. You need to try to reduce your body\u2019s body\u2019s body\u2019s body\u2019s body\u2019s body\u2019s body\u2019s body\u2019s body\u2019s body\u2019s body\u2019s body\u2019s body\u2019s body\u2019s body\u2019s body\u2019s body\u2019s body\u2019s body\u2019s body\u2019s body\u2019s body\u2019s body\u2019s body\u2019s body\u2019s body\u2019s body\u2019s body's body\u2019s body\u2019s body\u2019s body's body's body's body's body's blood supply of lactase and sphinctosis."
},
{
  "instruction": "Hi doctor, I'm suffering from high blood pressure and severe headaches, and I'm scared that it might be malignant high blood pressure, which drug should I take?",
  "input": "",
  "output": "The symptoms suggest that it's more likely to be malignant high blood pressure -- lavetalol, nitroglycerin, chloridin, hydroradine, nicardipine, nitrofresidence, and mexyltin."
},
{
  "instruction": "Sir, I think I'm having gastritis, abdominal pain, constipation, fever.",
  "input": "",
  "output": "I'm going to prescribe an antibiotic combination, such as methodidasol, siproploxin, or levoxin, to fight infection. If necessary, you may need to use more powerful antibiotics, such as excretion and appetite."
},
{
  "instruction": "Doctor, I've recently been diagnosed with Moyamoya disease, so do you want to know what kind of medication to take?",
  "input": "",
  "output": "In order to manage Moyamoya disease, you have to take multiple drugs, including aspirin, carbagepins, lyserridin, folic acid, Scotolamine, Hydexiura, glycopillate, Johnny Hexad, Chloricidine, metasalin, and lavetolol."
},
{
  "instruction": "Hi, doctor, I think I'm having a fever loss -- tired, weak, dizzy, wet skin.",
  "input": "",
  "output": "I'm sorry, it's a serious condition caused by dehydration and lack of electrolyte, and I'm going to prescribe a neutral potassium to compensate for the electrolyte and restore the balance of the body."
},
{
  "instruction": "I'm experiencing psychiatric disorders such as doctors, delusions, hallucinations, random ideas. What kind of drugs do you need for this disease?",
  "input": "",
  "output": "The drugs needed to treat a mental disorder include reperitridon, ketipine, eryphrasol, elyphrasa, and gyrus."
},
{
  "instruction": "Sir, I think you've got a frostbite on your toe. Can you prescribe a drug for me?",
  "input": "",
  "output": "Yes, I'd like to give you a prescription for Silver Sulfadiasis."
},
{
  "instruction": "Doctor, I'm experiencing a decrease in the size and elasticity of the erectile penis, and I'm really worried.",
  "input": "",
  "output": "I think you're suffering from a mild thrombosis, which helps improve blood flow to the penis and increase the size and strength of the erection."
},
{
  "instruction": "Hi doctor, I'm addicted to smoking and I need help.",
  "input": "",
  "output": "I can give you a prescription for barrenics to help you stop smoking."
},
{
  "instruction": "Good morning, sir. I think I snuck into my ankle yesterday while I was playing basketball, and it's so swollen and sore.",
  "input": "",
  "output": "I'm sorry, it's good to take pain meds like ketoprofen to reduce inflammation, and you can also help with muscle relaxants such as cyclobin, methocabamol, metasalin, or Orpenadrine."
},
{
  "instruction": "Doctor, we're experiencing symptoms of shaking hands and unconscious shaking of the head, and what's the cause?",
  "input": "",
  "output": "But don't worry because there's a lot of drugs that can help you with your symptoms."
},
{
  "instruction": "Hi, sir. You have a wound in your ear. What kind of medicine do you need?",
  "input": "",
  "output": "Depending on the conditions, the drugs are the Cephalexin, the Bastracin, the derivative - the Toxid vaccine - the cefazolin, the Povidon Yoochsin, the propagine, the Neomycin, the Memecicin, the Lidocaine, and the subject."
},
{
  "instruction": "Hi, doctor, I think I've got a foreign substance in my nose, and I've been in pain for days, and I can't remove it.",
  "input": "",
  "output": "If it doesn't work, you can use ketamine to take a sedative and remove it safely."
},
{
  "instruction": "Doctor, I'm experiencing a very painful and abnormal menstrual pain every month, and I don't know what to do, and I'm having a big day in my life.",
  "input": "",
  "output": "To alleviate the symptoms, we recommend a combination of drugs such as Oto-Cyclen, Medoxyprogesterone, Mepemanic acid, Potia, Modicon, Lopecosib, Valdeksib, etc."
},
{
  "instruction": "Hi doctor, I have Down's syndrome and I'm curious about which drug to take.",
  "input": "",
  "output": "Depending on your status, you need to take Ofloxacin, brompenseine (E.N.T.), cymecone, pegasase, lacosamide, anti-hemorrhoids, Tioridasin, synaptic acid, sulfate and sulfate barium."
},
{
  "instruction": "What are the drugs you need?",
  "input": "",
  "output": "We need morphine, pentane, mydazolam, oxygen, necrosis, calistate, etomy-dating, iovesol, Pancrease."
},
{
  "instruction": "Hi, doctor, I've been having pain and swelling around my wrist and thumb for the last few days.",
  "input": "",
  "output": "You can give me some drugs that help pain and inflammation, and you can use meloxykam and you can put Trimnolone and declaupenum in the ventilatorum, and you can also need a volume of bacacukin and estrofite, depending on the severity of the symptoms."
},
{
  "instruction": "Doctor, you have a fracture in your spine. What kind of medication should you take?",
  "input": "",
  "output": "To improve bone density, you've got to take a tertitaid, and you've got to take an Omnipaque, or an Opamydol, to film diagnostics."
},
{
  "instruction": "Hi, doctor, I recently found out that I was infected with HlV. What drug can you prescribe?",
  "input": "",
  "output": "Yes, if you're infected with HlV, you have to take a combination of antiretroviral drugs. The specific drugs I'm going to prescribe are Emitavita-thenofobirer, Litawir, Calazar, Efaviranz, Commavir, Ramibuddin, Tenocor, Fluor."
},
{
  "instruction": "Sir, there's pain and swelling in your salivary glands and fever.",
  "input": "",
  "output": "Yes, symptoms are likely to indicate that it's influenza, that you have to take antibiotics to prevent bacterial infection, and it's good to take a mix of agmentin and Clindamycin, and you have to take enough rest and drink a lot of water."
},
{
  "instruction": "Hi, doctor, I've been diagnosed with subarachnoid bleeding. What kind of medication should I take?",
  "input": "",
  "output": "To treat substrate bleeding, you have to take penitone, revetirasematam, serecocsib, bubron, lavetol, ejestimabe, espisolin, Nimodivin, nalcson, cosmonos, cosmothone, uspin."
},
{
  "instruction": "Doctor, I've been diagnosed with AFLP, which drug should I take?",
  "input": "",
  "output": "We have to take Ursodiol, methadone, glyburade, Pamotidin, mecamamine."
},
{
  "instruction": "Sir, I think I have epidemiology, and would you recommend a drug for this?",
  "input": "",
  "output": "Yes, in the case of Ectrephion, we need to take the Roterfrinol, Dexamesson-tobramycin anti-Vraxine, Latanoprosin, anti-Mussine, fluoresine, fluoresceans, bank tree extracts, philocarin-mool and ophthanes, cyclones, and anti-freezes."
},
{
  "instruction": "Hi doctor, there's a scar that has been bothering me for a while, and I'm wondering if there's any drugs that can help.",
  "input": "",
  "output": "Yes, there are some drugs that you can try: try Triminolone, Treti Indigo, and Deoxymetazone, which will help you improve the shape of the scar and minimize inflammation."
},
{
  "instruction": "Doctor, I recently discovered that I have lactose intolerance, and what are some drugs that can help me with lactose intolerance?\"",
  "input": "",
  "output": "The drug that's useful for lactose intolerance is an enzyme that's usually a lactase, such as lactase, and you can try polyethylene chlorinol 3350s to manage the diarrhea or toilet that can be caused by lactose intolerance."
},
{
  "instruction": "Sir, there's been a lot of pain in your ear recently, and there's a lack of hearing.",
  "input": "",
  "output": "A combination of drugs should be taken for the function of the Eustaquio, first of all, to take the mometasson bisprei, the spore de la, or the oflexacin. If the symptoms persist, there are other medications such as Trimnon Bispress sprays, cepuxium, Oxymetholin, Dr. Dzlassten, Cyclesssalis, or Cyclasal."
},
{
  "instruction": "Doctor, my lower right abdomen is very sick and fevery, and I suspect appendicitis.",
  "input": "",
  "output": "Symptoms suggest that you need to take multiple drugs to treat appendicitis: morphine for pain relief, methodidasol for preventing infection, stratitin and dithrizo to reduce inflammation, cell tetanes for preventing infection, ipixol for imaging, amerixic acid to treat bacterial infection, bacilli for intestinal infection, bacilli for intestinal infection, and resalilation for the rest of the bacteria."
},
{
  "instruction": "Hi, sir, I think I'm having Graves' disease, and I'm suffering from excessive rashes, weight loss, anxiety.",
  "input": "",
  "output": "All right, I'm going to start the treatment: Tigress, methimazol, profile tiurasil, profraol, thyroid (athyroid gland)."
},
{
  "instruction": "Doctor, I'm experiencing Harry's symptoms, and it's affecting my daily life.",
  "input": "",
  "output": "It's good to put drugs together to manage the illness, such as ambients, ambients, dulypselytin, Romelniol, Myrita Zaffin, Prozacto, Trajotone, Clofalfion, Bhutvattsin, etc., etc., etc."
},
{
  "instruction": "He's got a scar on his face, and it hurts a lot.",
  "input": "",
  "output": "To prevent infection, you have to vaccinate the dopamine Toxoride vaccine, and you have to treat the wound with vaccinate. You can also use the Povidon Yoodin and the Chlor Hexidin posse to clean the wound. You also have to use ketamines to keep your bandages more comfortable, and you have to use the cohesants to keep the paste clean."
},
{
  "instruction": "Sir, I'm feeling a lot of pain and discomfort because my spine's defibrillated.",
  "input": "",
  "output": "I understand that to treat spinal hernias, hydrocodon is used as a painkiller, to reduce inflammation, dexa methasone, to reduce inflammation, caricaprosol to relax muscles, and severe pain to prescribe pythane, and propolymy to prevent infection and to prevent anesthesia."
},
{
  "instruction": "Doctor, you're suffering from a Formography. What kind of medication would it be better to take?",
  "input": "",
  "output": "You have to apply the beta metazone local product twice a day for four or six weeks, which will help reduce inflammation and promote the stretching of the poppy."
},
{
  "instruction": "Doctor, I'm experiencing severe nausea and vomiting during pregnancy, and it's really affecting the quality of life.",
  "input": "",
  "output": "You can use a combination of drugs that help alleviate the symptoms. It's good to start out as a petrogen, promethesis, methocloprade, and piri. If necessary, you can also alleviate skin irritation with local products such as Trimetobemide and miconasol. You can also consider whether or not you can treat the underlying thyroid problems that can cause the symptoms, or you can treat them with the same conditions that might cause them."
},
{
  "instruction": "Doctor, I just learned that I'm pregnant. Can you tell me what kind of medication to take?",
  "input": "",
  "output": "Congratulations on pregnancy! You have to take some other medication during pregnancy. First, you have to take a full-body vitamin called prinetase, which is specifically designed for pregnant women. This means you have to take all the vitamins and minerals that both mother and baby need. You also have to take a bubonic vaccine to prevent the virus from harming the baby. You may also need to use rhoscimosis (preventately boosting) drug, which is immune to prevent certain complications related to blood type."
},
{
  "instruction": "Doctor, I was diagnosed with thalassemia. What drug should I take?",
  "input": "",
  "output": "We need to take folic acid, penicillin, ergo calciferol, imthixin, oxycin, inflimiade, fluxioid, trimilonololone and terazocin, but we no longer need to treat Mediterranean anemia."
},
{
  "instruction": "Doctor, I'm experiencing severe bleeding during pregnancy.",
  "input": "",
  "output": "I think there's an electric placenta, where the placenta covers the cervix, and it's good to take Tioridadine and acid calcium in order to manage the symptoms, which helps control the bleeding and ensures proper development of the baby."
},
{
  "instruction": "Doctor, I've been diagnosed with an epidural bleed. What kind of medication should I take?",
  "input": "",
  "output": "We need to combine drugs to treat the state, including cefazolin, Pentonin, Factor Ix, Pospenitone, El Reteptan, Atrupin, Texamethasemam, Letvetima, Arfiaplisol, Mafimol, and Mamitol."
},
{
  "instruction": "I've been diagnosed with septic arthritis. What are the drugs that you need to take for septic arthritis?",
  "input": "",
  "output": "The drugs for septic arthritis are vancomycin, Linezolith, Cephazolin, Esczklone, decyclymin, ampicillin, oxylin, neviphin, and clausafon."
},
{
  "instruction": "Doctor, I think I've got something, between my toes and the soles of my feet.",
  "input": "",
  "output": "I'm sorry, I'm going to prescribe a drug that can be applied to the affected area, which is a variety of options: chloritimazol, terbinine, ketconnasol, Nistatin, iconosol, chlorofyx, betaxol, tribettzol, trinol, navtyphin, or greibin, depending on the extent of the infection."
},
{
  "instruction": "Hi, doctor, I'm experiencing shortness of breath and chest pain, and I've been diagnosed with a few tests and a thoracotomy.",
  "input": "",
  "output": "The drugs that you need to take are capoflatin, Calesyferol, polystylene sulfate sodium, pulsarinxx, fluoride cortisone, lydokine-prirokines, cephem, eryphant, and ephemium."
},
{
  "instruction": "He was diagnosed with Afakia. What kind of medication should he take?",
  "input": "",
  "output": "Fred Nixolin, Gartifluxin, Nepapexac, Traboprosin, Philoxin, and the anti-synthetic. You can use thropentonic ophthalmics, ampithonic ophthanes, vimaprotos and ophthane ophthanes, tromide and sulfin ophthin."
},
{
  "instruction": "Hi, doctor, the discomfort and pain in the eczema is going on for quite a while, so can you tell me what's the problem, what medication to take?",
  "input": "",
  "output": "The symptoms suggest that you have an out-of-the-out disease: estrogen, fluoride, erythropox, fluoracone, marlas claustrorex, methrin, methidas, phenogenum extract, cytogenis, and ethnogenis."
},
{
  "instruction": "Hi, doctor, there's been a recent health problem with a lack of vitamin B.",
  "input": "",
  "output": "It's good to take vitamins B12, folic acid, pyri singles, which will help restore the proper levels of vitamin B in the body."
},
{
  "instruction": "Sir, there's pain in your salivary glands, and there's swelling.",
  "input": "",
  "output": "Yes, it looks good. It's good to treat bacterial infections caused by Kleinda Maicin, Agmentin, or Cyclesund Nasal. If you have a mold infection, you need to treat inflammation with tervinapine."
},
{
  "instruction": "Hi doctor, I found my breast tissue growing and tender, and I'm afraid it's feminine.",
  "input": "",
  "output": "For example, if you're dealing with a hormone imbalance or a drug, you'll need a drug like tammosis or exegenoid, which can help reduce inflammation if you're having an inflammation."
},
{
  "instruction": "Hi, doctor, I've had a lot of time to pee, but I've got a lot of pain, and I've got a lot of blood in my urine, so what's the problem?",
  "input": "",
  "output": "I'm going to give you some antibiotics, such as cyproflixins, mints, nitrofoplanosin, reboplactins, Trimeprosm, cepixia, or cephrixia to help alleviate pain and discomfort."
},
{
  "instruction": "Doctor, I've been experiencing fatigue, fever, chest pain in the last few weeks, and I'm really feeling really bad.",
  "input": "",
  "output": "I'm going to give you a drug called methoclasmosis, a drug called methoclasol, bubpiron, Caltress, setyrisin, esametamine, lexitin, etamitol, Atocuon, and Reflamide."
},
{
  "instruction": "Doctor, I've got a rash on my skin that's spreading rapidly, and my lips and eyes are starting to swell, and what kind of disease do you recommend?",
  "input": "",
  "output": "I'm going to give you a prescription for dispensium, Fred Nisolin, Hydoxin, Lesaline, minerals, selenium oil, hydrochloric acid, hydrolytic acid, chloratolol, elysmic acid, acyclic acid."
},
{
  "instruction": "Doctor, I've been diagnosed with scoliosis. What kind of medication should I take?",
  "input": "",
  "output": "We need glycophylol, levocarnithin, acetylcystein, Drspirenon, penicillin, phosphate potassium, bosentan."
},
{
  "instruction": "Hi, doctor, there's pain and swelling in your right big toe joint, and I've been told by a friend that it might be a blockage.",
  "input": "",
  "output": "In this case, it's good to take Indian Metacin, Trollmine salicate localizers and ikononasol localizers, which will help alleviate pain and inflammation."
},
{
  "instruction": "Doctor, I'm really worried that I'm experiencing an irregular heartbeat.",
  "input": "",
  "output": "The good news is that there are some drugs that help treat this condition: Ditatim, Amiodarone, Isosorbid, Plikanisin, Appanosin, propaline, propaline, metholes, metholes, methoids, Ibtyloids, diotylids, dioctanes, and diocesisis, which are the most effective drugs for treating this condition."
},
{
  "instruction": "Doctor, I'm experiencing bone pain, headaches, hearing loss, and X-ray photographs that seem to have increased some of the bones, and what's the cause and what drugs would you recommend?",
  "input": "",
  "output": "With symptoms and X-rays, I'd like to recommend a vaccine called Allendrine, which can help prevent bone loss and reduce bone pain."
},
{
  "instruction": "Doctor, I've been experiencing a sudden and severe facial pain over the last few weeks, and I feel like I've been electrocuted on one side of my face, and why?",
  "input": "",
  "output": "The good news is that you can treat them with drugs."
},
{
  "instruction": "Sir, your back and hips are so stiff and painful that you can't bend or move.",
  "input": "",
  "output": "The symptoms suggest that you may have a strong spinal disease. It is recommended that you use a combination of drugs, such as inflamicsin, methocrats, ethanes, entrel, sulphasalacine, and other drugs to treat pain. It is recommended to try to relieve local pain, such as Trimololol and piximmonel, as well as the use of styling and styling products that are useful to your muscles."
},
{
  "instruction": "Hi, doctor, I'm having a stroke with my hands and feet, and I've also found muscle weakness.",
  "input": "",
  "output": "To treat the symptoms, we recommend drugs such as Gabapentin, Fregabalin, Ducquetin, Amitylin, Norttyline, Loffyniol, Teno Forbire, Ramibudin, Capicin, and Q10."
},
{
  "instruction": "Sir, I have a blood cyst on my back, and I don't have any pain, but it's getting bigger.",
  "input": "",
  "output": "In this condition, you have to use \"Tretty Older People's\" and \"Clinda Macin's\"."
},
{
  "instruction": "Doctor, what kind of medication would you recommend when you're suffering from an addiction to antipsychotic drugs?",
  "input": "",
  "output": "like charcoal to absorb toxins, benztropine to control cramps, debalprocess to control moods, flumase to reverse the effects of anti-psychotic drugs, naloxide to reverse potential opioids, and hydrolytic acidic acidic acidation to treat the condition."
},
{
  "instruction": "Doctor, I'm experiencing such symptoms as oral and genital inflammation, skin rashes, joint passage.",
  "input": "",
  "output": "The symptoms suggest that you have multiple drugs to treat your symptoms: Allendronate to treat thinness; lydodenine to help numb the area of your bones; calcipediol to increase your vitamin D levels; iovics to treat your skin ulcers; iovics to reduce your anxiety, ecliptics to reduce the inflammation, and anti-inflammation, and anti-inflammation."
},
{
  "instruction": "Doctor, I've always felt nervous and nervous lately, and sometimes I can't sleep, or I can't focus on work, and I think I'm losing control.",
  "input": "",
  "output": "I'd like to recommend a drug like Divalprocess sodium, reperitone, haloperitone, and lanjaffin to help reduce mood and reduce anxiety, and I'd like to consider the use of chloriaxide for short-term symptoms."
},
{
  "instruction": "Hi, doctor, I've been diagnosed with prostate cancer. What drug should I take?",
  "input": "",
  "output": "You have to take a combination of drugs, such as lubrides, plyomasin, bicarotoids, sildenapras, lyress, teratlis, pyrethyls, parcelselin, parselin, baclestetides, and dulytes, more than any other drug."
},
{
  "instruction": "Doctor, I'm suffering from cerebral edema, which drug should I take?",
  "input": "",
  "output": "There are multiple drugs that you need to take in your cerebral edema, which include eryprotrophium, fluxol, tophemas, toculate, lycolys, lybethyl, lamethyl, amethythyl, mantyl, Somitol, and amiothyl."
},
{
  "instruction": "My fingers look distal, and they really hurt. What kind of medication do I have to take?",
  "input": "",
  "output": "In order to control pain and prevent infection, you have to take cefazolin, Povidon Yood, Petadin, Pen Ostrich, Neomycin."
},
{
  "instruction": "Doctor, I was diagnosed with birth trauma. What kind of medication should I take?",
  "input": "",
  "output": "You have to take leadership, Phenobarbital, Carvamazephin, Nistatin local products, and Devil's toenails."
},
{
  "instruction": "Doctor, I've been diagnosed with chronic pancreatitis. What kind of medication should I take?",
  "input": "",
  "output": "You have to take multiple drugs to manage your state. This includes painkillers hydromorphone, oxycodon, methadone, and bisacodyl. You also need to take pantoprofrel, suklat, and thiamine to treat the stomach ulcers that can occur in pancreatic disease."
},
{
  "instruction": "Hi doctor, I recently had a clot in my arm.",
  "input": "",
  "output": "Yes, in the case of a hemoglobin, it's a good idea to take a benzonat."
},
{
  "instruction": "Doctor, I'm experiencing blush, diarrhea, abdominal pain, and I've been diagnosed with Carcinoid syndrome, which drug should I take?",
  "input": "",
  "output": "In order to control the red tides and diarrhea, you need to take oxytocin to control the acid, and oxytocin to relieve the pain. You also need aminolol for heart rate, aerosesic acid for reducing the accumulation of fluid, sodium for increased blood pressure, air for increased breathing, mecaramin for treating nicotine dependence, chlorin for treating infection, and amniocentesis for cancer."
},
{
  "instruction": "Doctor, there's a deep wound in your head. What do you do?",
  "input": "",
  "output": "You must first vaccinate the dopamine Toxoride vaccine so that you don't get it from it, and then you can put on the Povidon Yood, and then you can sterilize the wound, and then you can put on the oxidin of hydrogen peroxide, and then you can treat the infection and pain with vasscin and tetrakines."
},
{
  "instruction": "Doctor, I found a tumor growing in my skin, brown, black or yellow, and they have a rough texture that doesn't pick up, what can it be, what drugs can you take?",
  "input": "",
  "output": "The drugs that can help you with this disease are the trotti silicose, the chlorvetasol, the fluoroline, the fluoride, the Metroidasol, the already ethod ethosol, the local ethosol, the ketococosol, the sodium solution, the cypasemide, the chlorinate solution, and six chlorinate oxides."
},
{
  "instruction": "Hi doctor, I was cooking, and I had a burn on my hand, and it hurt a lot, and I got a blister on my skin.",
  "input": "",
  "output": "On top of the burn, you need to put on a suffocation device, acetase, and acetase. You also need to put on a wave-toxoid vaccine to prevent infection. You need to relax the pain by using subject, localizing, allergic, beryllananium-lyin."
},
{
  "instruction": "Doctor, I recently had a spontaneous miscarriage. What medication should I take to recover?",
  "input": "",
  "output": "You need metergovin, microproscence, oxytocin, Rho immunoglobulin, Octopam, cepoxytin, chlormid, etc. to speed up your recovery."
},
{
  "instruction": "Doctor, I have an ulcer with pains in my penis, I think it's genital herpes.",
  "input": "",
  "output": "Your diagnosis is likely to be correct. I'll prescribe one of the following drugs to treat genital herpes: acyclopir, balsy claus, or Pamsy claubire."
},
{
  "instruction": "Doctor, I've been very nervous lately, I've been under a lot of stress, I've had a lot of emotions, and what do you think is wrong with me?",
  "input": "",
  "output": "Patient, right, what kind of medication should you take?"
},
{
  "instruction": "Doctor, I have severe pain in the upper right abdomen, and I've had some tests, and I've been diagnosed with pulsar disease, and what medication do I need to take to treat this condition?",
  "input": "",
  "output": "In the case of stalactites, you need to take decycloin and glycopyrolate to help control abdominal cramps. In order to reverse the effect of anesthesia, you need to use a locolymium and cevofloor. In addition to these drugs, you need to treat the post-opal pain and pain with acetosis."
},
{
  "instruction": "Recently I was diagnosed with multiple sclerosis. What kind of medication should I take?",
  "input": "",
  "output": "Interferon Beta-1Phetone (Avotunes), Glatacamer, Vachloren, Modafiylin, Tizinine, Tizadijo (Titalybri), Tiltroidin, Almanta, Solivin, Azaphrine and cyphosin are commonly used as drugs to treat a specific type of drug."
},
{
  "instruction": "Doctor, I felt like I had something in my neck that was hard to swallow, and I'm also experiencing bad breath and undigested food reflux.",
  "input": "",
  "output": "The drugs you need in your condition are vissored and meperidin (demerol) to calm down during the treatment of the genome. You also need to use pyrosin to help lower urine after the procedure."
},
{
  "instruction": "Hi doctor, you've recently had a hip fracture and you're in pain. What would you like to take to relieve the pain and help with the healing process?",
  "input": "",
  "output": "I'm going to prescribe etometics that will help you with pain management, and pamidite will help you to strengthen bones and repair fractures."
},
{
  "instruction": "Doctor, you've been diagnosed with autism. What kind of medication do you need?",
  "input": "",
  "output": "We need a combination of these drugs: atherosine, progesterone, Pluticason, local products, Estradio, Rebalbunelol, insulin, aspilot, humane, Celecoccus, eoglytic, and Convet."
},
{
  "instruction": "Hi, sir, I've recently been diagnosed with hyperchemia, and do you want to tell me what medication I need to take to manage it?",
  "input": "",
  "output": "Yes, it's a drug like Simbastin, Omega-3 fatty acid, rosvastatin, pravastatin, pheopibrate, rovastatin, ethemiv, or niacin."
},
{
  "instruction": "Doctor, I've been having severe peritoneal diarrhea in the last few weeks, and I'm really worried, can you tell me what's going on?",
  "input": "",
  "output": "The symptoms seem to suspect ulcerative colitis, and I'm going to prescribe mesalamine, an anti-inflammatory drug that helps reduce the inflammation of the colon and relieve the symptoms."
},
{
  "instruction": "Doctor, I think you have a genital infection. Can you prescribe it?",
  "input": "",
  "output": "OK, I'd like to start with cephaxine or bamm, but if it doesn't work, then we can start with vancomycin, Klindamycin, or Cyncin."
},
{
  "instruction": "Doctor, I've been diagnosed with HPV. What drug should I take?",
  "input": "",
  "output": "You need to take HPV to treat the NSS, Atazar, Atazar, Emititavin - Teno Povire, Litovir (Hpv), Modicon, Balalo Clovire (Balve Rex), Triclotic Nur, Tenobire, and Lofabyr."
},
{
  "instruction": "Doctor, I'm experiencing chest pain and discomfort.",
  "input": "",
  "output": "The symptoms are actually likely to be anginas, nitroglycerin, chlorofics, hyphalysis, dioxide, Heparin, oxygen, isorbid monotres, lyxyxin, pectylin, pectithylin, vetyl, to control the symptoms and prevent complications."
},
{
  "instruction": "Hi doctor, I recently injured my spinal cord, and I'm experiencing muscle rigidity, pain and convulsions.",
  "input": "",
  "output": "As a result of the symptoms, we can give you bachlorofen, kabapentin, divozefam, or Tizanidin, which will help you control your intestines and bladder."
},
{
  "instruction": "Sir, I'm suffering from nose blockage, nosebleeds, and frequent headaches, and I've been examined and I've been diagnosed with Kopolip.",
  "input": "",
  "output": "All right, I'm going to prescribe a drug that can treat the symptoms according to the diagnosis: \"Mamethasson sinus product\", \"Singuru castre,\" \"Pluticaxone\", \"Pluukxim,\" \"Alumsymousxin,\" \"Borxinxin\", \"Bhemethalxone\", \"Acelasssadnasad\", \"Azlassadnasadnaboude\", and \"Prescent\" to treat the symptoms. This will help you to relax your symptoms."
},
{
  "instruction": "Hi doctor, I'm experiencing severe skin itching and rashes, and I've just been diagnosed with herpes, which drug should I take?",
  "input": "",
  "output": "It encourages using local drugs, such as chlorbetasol, Triminolone, Vetametason, Hydrocortisone, Fluonone, deoxymetagone, phylorenoid, Tarcriummus, or Beta Metsson-Calsiportrien, as well as taking hydrolysis and using lactic acid can help treat the symptoms."
},
{
  "instruction": "Hello, sir. Your eyes are constantly stimulated, and you've got an intubation, and your eyebrows keep rubbing on your eyes and causing discomfort.",
  "input": "",
  "output": "There are a number of drugs that can help you manage your illness: Latanopros, fluorometholone, cyclotine, dexamethasone-tobracin, carteololol, anti-anxiety, ketolin and anti-steal, and anti-molemy."
},
{
  "instruction": "Hi, sir. I think I'm akalysis.",
  "input": "",
  "output": "OK, I recommend the combination of drugs for your condition. For itching and erection, you should use the vepenhidramine. You should also use the formatives of permethrin, hydrocortisone, piperonee side-piretrin."
},
{
  "instruction": "Doctor, I've been diagnosed with colon cancer. What medication do you need?",
  "input": "",
  "output": "You need to take a combination of drugs, including fluoroline, lucovosylin, Vebacisgen, and oxaloclatin."
},
{
  "instruction": "Hi, doctor, I've recently experienced a dermatology disorder that has a dark spot on the skin and a discolored spot on the skin.",
  "input": "",
  "output": "We recommend the combination of hydroquinones, trotti stens, and Trimlons. This will help you to brighten your dark patches and choose your skin tone. You can also improve your coloring by using the tarromus and Clovetazol. Finally, you can reduce inflammation by using ketokosol and desauid soup products."
},
{
  "instruction": "Doctor, I'm experiencing symptoms to attract attention, such as deception, dramatic behavior, and even self-inflicted disorder.",
  "input": "",
  "output": "In the case of the Pactius disorder, you have to take drugs such as chloridocress, lorazepam, cyrolymus, and so forth; ub\u00edquinon, lyvisin, thiamine, tyrescens, lyphinol, lamomyxin, phalcium, phalcium, etc., etc., etc., etc., etc., and so on."
},
{
  "instruction": "Doctor, I was diagnosed with lymphoblastoma, which drug should I take?",
  "input": "",
  "output": "The drugs that you need to take for sex lymphomas are liposuction."
},
{
  "instruction": "Good morning, doctor. I don't know why I have an abnormal juice secretion in my breast.",
  "input": "",
  "output": "It's good to take bromocrptin to reduce the production of prolactin, which may be the cause of fluid secretion, depending on the symptoms."
},
{
  "instruction": "Doctor, I've been diagnosed with G6PD enzyme deficiency. What drug should I take?",
  "input": "",
  "output": "G6PD enzyme deficiency requires taking folic acid, deperoxamine, pentamidin, and carbioxamine."
},
{
  "instruction": "Hi, doctor, there's a lot of pain around your shoulder, I think it's because you're nervous, which drug should you take?",
  "input": "",
  "output": "Based on what God has said, we recommend volume Bains, Trimnolons, cortisone, Beta Metason, Rophibakin or Lochronium, and help alleviate the pain caused by collisions, but if you have side effects of the drug, we can also prescribe a massive laxative to treat your diabetes patients with diabetes."
},
{
  "instruction": "Hi doctor, I've been diagnosed with Toxoplasma, which drug should I take?",
  "input": "",
  "output": "You need to take a combination of drugs, including pirimetamines, sulfasins, lucovolines, and atobacuum. You may also need a calerera, ahtemitin-tenopovirer, epoeten Alpha, and in order to treat eye complications, and in severe cases you may be able to administer cyclicate anti-pentonic drugs."
},
{
  "instruction": "Doctor, I was diagnosed with fibrosis. What kind of medication should I take?",
  "input": "",
  "output": "We need to manage the symptoms of the disease by taking in Triotominin, Velergall-S, rosemide eyelids, estazolam, Pensyklover, black cohosh extracts, and entacones. We can also recommend it for additional support."
},
{
  "instruction": "Doctor, you've got a cut in your hand.",
  "input": "",
  "output": "It's good to take a vaccine for sadocines, cephalexins, baccisins, fessidins, pavidon yoodins, vetastide vaccines, cefadoxide vaccines, photosystem vaccines (divisions), metabolisms, humans, yoods, lobssos, oscillators, and people who are called immunoscientists."
},
{
  "instruction": "You've been diagnosed with a failed abortion, which drug should you take?",
  "input": "",
  "output": "You need to take microprostols that help cause contractions and deliver pregnancies. You can also use oxytocin to induce labor. You can also need Rho immune globulin to prevent future Rh sensitization."
},
{
  "instruction": "Hi, doctor, I've been diagnosed with diabetes ketonic acidosis, which drug should I take?",
  "input": "",
  "output": "You need to take insulin to regulate your blood sugar levels. You can use insulin glatsin, insulin aspats, humane, or insulin demir."
},
{
  "instruction": "Doctor, you've got abnormal skin bumps and lesions on your genital area, and you've got a lot of discomfort and pain, and what's the cause?",
  "input": "",
  "output": "The symptoms suggest that there is a bacterial infection that is generally treated with an antibiotic combination. To remove the bacteria causing this infection, we need to take a local product, cefazolin and Trolldomycin."
},
{
  "instruction": "Doctor, I'm very weak and I'm beginning to experience severe bleeding, and I think there's a bleeding fever, which drug should I take?",
  "input": "",
  "output": "We need to take multiple drugs to treat the bleeding fever: air, mecaramamine, trollaindomycin, negative 11 indiium oxymolin, 'indiium-11 inoxyquinolin', 'Aduan', 'grafeflexacsacsin', 'human anti-globuloculinin,' and 'resolin'."
},
{
  "instruction": "Hi doctor, I'm feeling very nervous these days, and I'm getting a lot of thoughts and actions that I can't control, and I think I'm compulsive.",
  "input": "",
  "output": "Yeah, that sounds like an obsession, and it's good to take a drug called fluoccetin, which is an anti-depressive drug that can help you manage compulsive symptoms."
},
{
  "instruction": "Hi, Doc, I think I've hurt my ankle, and every time I try to move, it hurts.",
  "input": "",
  "output": "The drugs that are needed are deklock gylin and phenophene."
},
{
  "instruction": "Doctor, I've been feeling very weak and tired lately, and I've been drinking a lot of water, and I'm still feeling dehydrated.",
  "input": "",
  "output": "To treat this, you need to be given a drug that will help you increase your sodium levels."
},
{
  "instruction": "Hi, doctor, I've had a hard time swallowing over the last few weeks, and I feel like I've got something on my neck.",
  "input": "",
  "output": "To improve the symptoms of this, we can give you a pantoprosol that reduces stomach acid and betaneol that helps you with esophageal activity."
},
{
  "instruction": "Sir, I think my ankle's broken, and I'm so sick that I can't walk properly.",
  "input": "",
  "output": "Don't worry, we're going to cure you, and I'm going to prescribe calcium during pain, which will help reduce discomfort and inflammation."
},
{
  "instruction": "Doctor, I've been diagnosed with cosmology, which drug should I take?",
  "input": "",
  "output": "You need to take a combination of drugs such as aluminum salts, bincritin, toxic rubins, ethanes, zmsitabins, zemorasyls, bardenapils, iposfamids, methina, dorcel, and glybium, which help you treat your connective tissue."
},
{
  "instruction": "Doctor, I've recently been diagnosed with brain cancer, which drug should I take?",
  "input": "",
  "output": "We need to take more than one of the following drugs: revetiras\u00e9tam, delgentin, lamotrisin, devalprox sodium, carb\u00e1mazephin, topice, oxobaracs, femals, entomosis, gyncosis, fjonomattos."
},
{
  "instruction": "I'm always having a hard time controlling my emotions, and I'm always confused with relationships, and my friends have a hard time being around me.",
  "input": "",
  "output": "In view of your symptoms, I'd like to give you a prescription for Ramythane for personality disorders."
},
{
  "instruction": "Doctor, I've got a lot of pain and blisters on one side of my body, along with a fever and two blood vessels.",
  "input": "",
  "output": "Yes, symptoms seem to indicate that you have shingles, which can be used to treat shingles: acyclobe, balsie chlorex, Pamsie chlorin, Pregabalin, capaccisin, calamins, calamins, calamins, hormatins, anti-symoles, and Rotterno drugs, which are more likely to be used as a vaccine, but it's more likely to be treated than a vaccine, which can be treated as a vaccine, which can be treated as a vaccine, which can be treated as a vaccine, but it can be prevented as a vaccine."
},
{
  "instruction": "Hi doctor, I've been experiencing unconscious movements and sounds a few weeks ago, I think it's a Tourette syndrome.",
  "input": "",
  "output": "It's good to take chloridin, lysperidone or ophophonics to help with the symptoms."
},
{
  "instruction": "Doctor, I've been diagnosed with an angio necrosis. What kind of medication should I take?",
  "input": "",
  "output": "It includes oxycodon, Emtristavin-tenopobire, Litovir, Myco Penicillin mofetilum, Hydroxychlorin, Meloxycam, cycarin, oxyphorel, oxytocin, methadane, methadane, methadane, methadone, and Sabur."
},
{
  "instruction": "Doctor, I have a sore throat, and I think it's pharynx.",
  "input": "",
  "output": "Yes, I think there's streptococcus, which is an antibiotic, and I recommend one of these things: amoxystillin, penicillin, ceph Jesusle, or Cefad Rock, depending on which allergy you have and which one you've been taking before."
},
{
  "instruction": "Hi, doctor, I'm having a little bit of trouble controlling my movements, and I'm getting worse over time, and I'm having problems with balance and language, and what's the problem?",
  "input": "",
  "output": "I think you're going through some of the symptoms of the spinal cerebellum dystrophy -- mertamines, meklins, dulyxetins, revoirs, muscle immunoglobulins, sommetropines, chloratols, chlorazepethetins, Balprojet, and Propocyfen."
},
{
  "instruction": "Hi, doctor, I've been diagnosed with Osteoporosis. What kind of medication should I take?",
  "input": "",
  "output": "You need to take vancomycin, protomycin, cepim, Tetracain, to treat this."
},
{
  "instruction": "Doctor, I've been having dry eyes and mouth and fatigue and joint pain for quite some time, and when I went to a specialist, I was diagnosed with Shogren syndrome, which drug should I take?",
  "input": "",
  "output": "I'm going to give you Hydoxychloroquine, which will help you manage your symptoms, and I'm going to give you cytosphorene, and then I'm going to give you cytosophate, and then I'm going to give you cytosophate, and then I'm going to give you a little bit of epigene, and then I'm going to give you a little bit of edema, and then I'm going to give you a little bit of epigene, and then I'm going to give you a little bit of it, and then I'm going to give you a little bit of it, and then I'm going to give you a little bit of it, and then I'll give you a little bit of it'll give you a little bit of it, and you a little bit of it'll give you a little bit of it, and you a little bit more of it, and you a little bit of it'll give you a little bit of it'll give you a little bit of it a little bit of it a little bit of it a little bit of what you a little bit of a little bit of a little bit of a little bit of a little bit of a little bit of a little bit of a little bit of a little bit of a little bit of it."
},
{
  "instruction": "Sir, I feel a lot of pain and stiffness on my shoulder.",
  "input": "",
  "output": "The drug needed for shoulder peritoneal fibrillitis is cortisone."
},
{
  "instruction": "Doctor, I was diagnosed with viral hepatitis. What kind of medication should I take?",
  "input": "",
  "output": "In order to treat viral hepatitis, you have to take a number of drugs together, including ribabirin, peg interferon Alpha-2B (Silatron), Emtrytavin-Tenophir, Litowir, and Atajavor (reyatage) to remove the virus from your body and reduce liver damage."
},
{
  "instruction": "Good morning, doctor. The amygdala has been swollen and severely affected. What could be the problem or what medication would be needed?",
  "input": "",
  "output": "We need to reduce the inflammation and control the pain in the operation with cevofluan. It's also a non-communicant non-communicative non-communicative non-communicative non-communicative, nitric oxide, anti-stemperative fibrillation, anti-bacterial fibrillation, anti-oxidant septomy, anti-oxidant, and anti-oxidant."
},
{
  "instruction": "Sir, I've been having a lot of abdominal discomfort lately, I think it's gastritis.",
  "input": "",
  "output": "It's possible, it's possible, but I'm going to prescribe a drug that will help you reduce your stomach acid and protect your stomach, and it's good to take it with you."
},
{
  "instruction": "Doctor, I've been diagnosed with skin cancer. Can you tell me what medication to take?",
  "input": "",
  "output": "For example, you may need to take a variety of drugs, depending on the type of skin cancer and the disease you have. This may mean that you will soon meet up with a different level of cancer, including fluoride, pre-Keymode, sulfate, fluoride, fluoride, ethanol, ethanol, ethanolin, six-moles solution, petrol, fluoride, sulfone, calcium, calcium, and potassium."
},
{
  "instruction": "Hi doctor, joint pain, swelling, fever and rash.",
  "input": "",
  "output": "Yes, rheumatis fever. It's good to take a combination of drugs, including amoxicillin, prednisone, and Trimnolon."
},
{
  "instruction": "Hi, I've been having a repeated oral ulcer for a while, which is so painful that it's hard to eat or talk about, which drug would you recommend?",
  "input": "",
  "output": "In the milder case, it is possible to use the Nistatin or Trimlon local product. In the more severe case, you may need an Aemsanox or alasc\u00f3bir to treat the basal virus infection, depending on which case you can use such drugs as acetanoids, fluoride, and colicin."
},
{
  "instruction": "Hi doctor, I think you've got tonsillitis, swelling of the neck, aching of the amygdala, fever, what kind of medication should you take?",
  "input": "",
  "output": "To treat tonsillitis, you have to take antibiotics; it's good to take Sefdinir, or Cepacler; it's effective for bacteria that cause tonsillitis."
},
{
  "instruction": "Doctor, I've been diagnosed with intestinal cancer. What medication do you need?",
  "input": "",
  "output": "In order to do this, you have to take drugs, including prochloro, Palonostetron, and Emptant, together with a number of drugs: lucopholin, atropine, acetana, acetreot, arioline, the fluoride solution, erytencan, vaccina, and floroida."
},
{
  "instruction": "Doctor, can you tell me what medication I need to take?",
  "input": "",
  "output": "The answer is, you have to take poisonclin, which is the most effective drug for treating the viscosity of rockic acid."
},
{
  "instruction": "Doctor, I've been diagnosed with stomach cancer.",
  "input": "",
  "output": "I'm sorry for the drugs you need to take: Sisplatin, Pacletzel, vitamin B 12, Pegfilra team, fluorine, Heparin, Octaloclatin, Palosetasone, epidemisine, ironocene, irontecan, and Caccytane."
},
{
  "instruction": "Doctor, I have a problem with development and I don't seem to be able to follow my peers in terms of learning and understanding.",
  "input": "",
  "output": "There are some drugs that can help alleviate the symptoms, starting with resperidone, methpeny dating, or debalprocess sodium."
},
{
  "instruction": "Doctor, I've been under a lot of stress lately, and I'm always nervous and I can't sleep well at night.",
  "input": "",
  "output": "It's good to take eszopiclone, which is good for sleep, and Narrithane to relieve stress symptoms, which helps you feel better and sleep better."
},
{
  "instruction": "Doctor, I recently experienced confusion, disorientation, hallucinations.",
  "input": "",
  "output": "It is recommended that you combine drugs such as donepet and mementin to improve symptoms, gyncret, zyncrasa, reselgen, and Galantamine to improve your memory, to improve moods, mirstatamines, and in case of tremors, cavito, a capaparous priest, a capaturist, and anti-prescription vaccine to improve blood pressure, to improve blood pressure, to improve blood pressure, to improve blood pressure, to improve blood pressure, to improve blood pressure, to improve blood pressure, to improve blood pressure, to improve blood pressure, and to improve blood pressure."
},
{
  "instruction": "Doctor, your foot's sore, it's getting worse. What kind of medication should you take?",
  "input": "",
  "output": "Adding a local solution of salinic acid or component can also soften and remove the solid flesh. You may also need to use microcline to keep it moist. If it is infected, you may need to use it to treat infection."
},
{
  "instruction": "Hi, I recently received a diagnosis of Gilwan Barre's syndrome, which drug should I take?",
  "input": "",
  "output": "The drugs you're going to take are Gabapentin, the I.V.C.I.V., vitamin B12, desalinations, ribaceins, fluionoids, local products, ivandrine, Tizanidine."
},
{
  "instruction": "Doctor, I feel a lot of pain in my back. I think I have a backache. What kind of medication should I take?",
  "input": "",
  "output": "You can take cyclotin, methocacarmol, carillol, carifon, frexon, metasalin, and Tisanidin, which is the best choice for the ifamydol, Oscimonapon, the dechlorofum, the trollone, methylist-tillin, or the best choice for the plants."
},
{
  "instruction": "Sir, it's hard to breathe through your nose, and it's like you're in a bad spot. What kind of medication should you take?",
  "input": "",
  "output": "Based on what God has shown you, you may need to take a non-symbol spray, such as the Pluticals, the Mumetazones, the Azilastensins, the oscillins, the oscillins, the oscilloids, the Trimolelons, and the like. You may also need to take antibiotics, such as cepuoxyxidin (salocrinosis) or antistase, to control your symptoms."
},
{
  "instruction": "Doctor, I've recently been diagnosed with an arteriosclerosis. What medication should I take for treatment?",
  "input": "",
  "output": "We're also given profraolol, which helps reduce the size of the blood vessel, which can be used as a thrombosis, an anti-angiomyolol, an anti-angiomy, an anti-quimode, a fluoride, a salic acidizer, a tetradenic acidate sodium, a lactate solution, a hypertase, acetase, acetic acid solution, acetase, acetic acidase, acelassstic acid solution, and a tetase."
},
{
  "instruction": "Doctor, I was diagnosed with Patau's syndrome. What medication should I take for this?",
  "input": "",
  "output": "To control the symptoms and reduce discomfort, you have to take etodolins, toterodines, multitruptanes, canecepts, profranols, dilaols, chloratim, chlorazemam, Ere, mecaramin and Trollslexine."
},
{
  "instruction": "Doctor, I've been having chronic back pain for months. What medication can you prescribe?",
  "input": "",
  "output": "The drugs that can be prescribed for chronic back pain are cyclobenzaphrine, methabamol, Carriso Prodol, Orpend\u00f3n, metasalon, Omnisol, Isoboli, and Oxykomol."
},
{
  "instruction": "Doctor, I've been feeling pretty and tired lately, swelling my legs, what's the problem?",
  "input": "",
  "output": "The symptoms suggest that there's heart failure, and we can prescribe drugs such as perocemid, carvedilol, huparin, nitroglycerin, digulycerin, spiololochon, isoordarin, hydrodarin, hydrotide, metholoid, potassium."
},
{
  "instruction": "Doctor, you've got a lot of eyes, and you've got a lot of stimulation, and I think you've got cyclitis.",
  "input": "",
  "output": "In response to your symptoms, I'm going to prescribe eye drops for Gentamycin, gulpasetamide sodium eye drops, neck plascin, erythroxin, tobramycin, and tobramycin."
},
{
  "instruction": "Hi doctor, there's so much back pain that when you take an MRI, you say there's a waist disk.",
  "input": "",
  "output": "Pregabalin, carica prodol, Tizanidin, Omnisol, Ifamigol, Ramelteon, and Romeronium."
},
{
  "instruction": "Doctor, I've heard that you've got a lot of pain in your muscles, that you're not feeling strong, that you've got a lot of muscle pain, so what kind of medication should you take?",
  "input": "",
  "output": "We need to take sodium chloroferic acid, caloric magnesium, nitric oxide, narcissone, thiphibrosyl, methadone, mecaramamine, and grefalyxin."
},
{
  "instruction": "Hi doctor, I think you're having breast infections known as mammacitis, and you're experiencing breast pain, swelling, fever, rashes, can you tell me which drug to take?",
  "input": "",
  "output": "For example, the drugs needed to treat breast infections are Cephalexin, dikklin, cefad Rock, or ampicillin. These are antibiotics that help fight infection. You can use chlor hexidin soup to keep the infected area clean."
},
{
  "instruction": "Sir, there's constant pain in the waist and abdomen, and I just got diagnosed with an abdominal aortic aneurysm.",
  "input": "",
  "output": "In order to manage your condition, you can get prescriptions for poisonous acid, dutasterite, plasma protein fractions, nitrofroproteins, cebimelins, papillemins, lalixines, myododododrines, pyroristols."
},
{
  "instruction": "Doctor, I've been diagnosed with pulmonary embolism. What kind of medication should I take?",
  "input": "",
  "output": "You need to take a number of blood thinners together to prevent blood clots from growing or slowing down. You need to use guaPain, lynx, hexaparin, hexaparin, or daltefin, pontharistarix, and teeplase, depending on your status."
},
{
  "instruction": "Doctor, I'm suffering from a behavioral disorder that has difficulty controlling anger, and often attacks.",
  "input": "",
  "output": "As a result of symptoms, it is recommended to take drugs such as resperitridon, methpeniating, Adderall, and Arlipifrasol, which are prescribed before the pre-existing process, such as Haloferitol, Atomseritin, Dex Metyl Penicin, esophrene, excretivin, excreatives, excreptivin, excretivins, excretins, etc., but before you can evaluate your drug, you should evaluate it before you can prescribe it."
},
{
  "instruction": "Hi, doctor, I think I'm having air embolism. I'm dizzy and I can't breathe.",
  "input": "",
  "output": "All right, I'm going to start treating you right away, and I'm going to prescribe drugs like air, mekamilamine, and pipedocunium, which can help alleviate the symptoms."
},
{
  "instruction": "Doctor, I recently had a mastectomy. What drug would you recommend?",
  "input": "",
  "output": "Yes, of course, for your condition, you need to take Anastridex, Tamsipen, Retrosol, Pacleus Pamid, Mellatonin, Glucosamin, Exemethin, Exemethin, Nelastast, Zolissan, and Euquinon."
},
{
  "instruction": "Doctor, there's pain and swelling in the testes, and they're getting worse.",
  "input": "",
  "output": "I'm going to prescribe antibiotics to solve the infection, for 10 days of cyprophyloxine or two or four weeks of toxic cycline."
},
{
  "instruction": "Doctor, I've had a ruptured membrane. What do I need to take to do this?",
  "input": "",
  "output": "To treat this condition, you have to take penicillin, Lophibacine, metilernovin, microprostol, oxytocin, progesterone, magnesium sulfate, hydrochloric acid, hydrolygenine, volume baracin, and dilantine."
},
{
  "instruction": "Hi, doctor, I have a small, molten pearl-shaped skin disease called cosmological conflict, and what drug would you recommend?",
  "input": "",
  "output": "Yes, streptococcus can be used for a variety of drugs, such as hydrocortisone, prequested localizers, trotti seniors, and anti-immunes."
},
{
  "instruction": "Doctor, I was diagnosed with necrotic fasciitis. What kind of medication should I take?",
  "input": "",
  "output": "You need to take a combination of drugs, such as Clinda Meisin, Cytrosis, janezolith, vancomysin, methadide, methadone, and Gabapentin to treat skin infections."
},
{
  "instruction": "Doctor, I'm experiencing an abnormal vaginal secretion, which doesn't sting or hurt, but it's a little nervous.",
  "input": "",
  "output": "I can prescribe a combination of some drugs based on the symptoms -- methodidasol, fluornasol, methodidasol, etc., etc., etc."
},
{
  "instruction": "There's a bladder problem, and the urine doesn't go well.",
  "input": "",
  "output": "The symptoms seem to suggest that there are bladder obstructions, such as Tomosine, Pinnasad, Apussaire, Dutastressin, Tada Lassin, Glucosamine, Nifedin, Venafiin, Peslina, and Bjordin."
},
{
  "instruction": "Hi, doctor, I've been diagnosed with melanoma. What medication do you need for treatment?",
  "input": "",
  "output": "To treat melanoma, we need drugs such as temozolmide, pacletsel, interferon Alpha-2B (interron A) and dacabazine, such as Bevasion, Sagramosts, desalinations, Alducquinskin, decytoxtoxes (prolukin), decytextoxt, and Alpha-2 A."
},
{
  "instruction": "You've been diagnosed with uterine disease, which drug should you take?",
  "input": "",
  "output": "The drugs needed for endocardial disease are estrogen, pneumonic sodium, metronic acid sodium, metrodidasol, anti-viral vaccines (HPV), prop\u00edbacine, Veta Solol, propanesidium, cochleum potassium, dikloxium, and doroxide."
},
{
  "instruction": "Hi, doctor. I think I have laryngitis. My neck hurts and I can't talk.",
  "input": "",
  "output": "Yes, I think you have laryngitis. I'm going to prescribe a drug that will help relieve the symptoms. You have to take gypenenesin and lobotos, which will help you cough, and a benzonatate, which will help you cope with the infection."
},
{
  "instruction": "Hi doctor, I've got a tough, painful rash in my hand, and I think it's not working. Can you tell me what kind of medication I'm going to use?",
  "input": "",
  "output": "The drugs are Triminolol, Clovetasol, Pleiades, V\u00e9ta Metatsone, Petrina Pinsol, Vaselin State Soup, Hydro Cortisone, Calcium, Dantrellen, Volvasol, Volvasossossos, and all of these vitamins."
},
{
  "instruction": "Doctor, I think I've been taking too much opioids, extremely sleepy and slow to breathe.",
  "input": "",
  "output": "Symptoms suggest that the drugs needed are heavily German, which reverses the effects of opioids; thiamines, which prevent potential brain damage; charcoal, which calms the body from recovery; amylase, which breaks down the blood pressure; dopamine, which helps to maintain blood pressure; sodium, which helps breathe acid, and high blood pressure;"
},
{
  "instruction": "Hi doctor, I think you're very distressed by the red rash on your baby's diaper.",
  "input": "",
  "output": "According to your description, a baby may have developed a diaper rash. It is recommended to treat rashes with Nistatin or chloridimasol. Using hydrocortisone and antioxidate local cream, you can calm that area down. And to prevent future infections, a baby may have a vaccine, an H1NV, an Influential vaccine, a vaccine, a vaccine, a vaccine, a vaccine, a vaccine, a vaccine, a vaccine, a vaccine, a vaccine, a vaccine, a vaccine, a vaccine, a vaccine, a vaccine, a vaccine, a vaccine, a vaccine, a vaccine for hepatitis."
},
{
  "instruction": "Hi doctor, I'm struggling with a squabbling line. What kind of medication do I have to take?",
  "input": "",
  "output": "Depending on your status, you can get a prescription for Trimiminolone, Triminolone, Hydroczynone, Hydroczynid, Fluonoids, Fleissol, Hydrocasquine, Essartan, Dimethyltennipots, and Diethylophon Protein."
},
{
  "instruction": "Sir, in the last week there's been a sharp abdominal edema, and it's been worse when you eat.",
  "input": "",
  "output": "The symptoms suggest that you have a duodenal ulcer, and I'm going to give you a prescription for pantoprosol to reduce the amount of stomach acid and promote healing."
},
{
  "instruction": "Doctor, I think I have a groin hernia.",
  "input": "",
  "output": "The drugs that you need for your condition are Lopybacine and Efedrine."
},
{
  "instruction": "Doctor, I've got a red and itchy spot on my skin, and it's getting worse day by day, so can you tell me what's going on?",
  "input": "",
  "output": "The symptoms suggest that you need a few drugs to manage your humidity: hydrocortisone; hydrocortisin; hydrolysis; Trimonlon; desalination; Vasylin; lssogen; Petrotazos; Petrolimus; Petrolimus; Petrizone; Futicasone; Procine."
},
{
  "instruction": "I have Asperger's syndrome. What medication do you need?",
  "input": "",
  "output": "A combination of drugs should be used, depending on the symptoms: methpeny, reserridon, chlorin, arphiprasol, atomacetin, guanfasin, melanin, melantonin, lexmethylphenin, Oscabazepin, and pulsomin can be used to treat various symptoms related to Asper's syndrome."
},
{
  "instruction": "Doctor, chemotherapy has caused severe ulcers and inflammation in your mouth, very painful and difficult to eat and talk about, and what can you do to alleviate this discomfort?",
  "input": "",
  "output": "We can prescribe a variety of drugs to alleviate the symptoms: acyclobe, Nistatin local products, gransate, hydrochlorite, sodium biolite, hydrochloric acid, hydrochloric acid, mebtoturic acid, bismolsylic acid, and cortium."
},
{
  "instruction": "Hi, doctor. I've got an infection in my finger, and my friend says it could be a toenail.",
  "input": "",
  "output": "Yeah, it looks like you have a hand-to-nomber. It's good to take antibiotics, cephalexine."
},
{
  "instruction": "Doctor, a recent injury caused a jaw injury. What medication do you need?",
  "input": "",
  "output": "Lidocaine, a derivative toxoid vaccine, a bacsitracin, and a fovedon yoodin are needed; epinephrine, tetracaborgon, calcium polycaborgon; tritin, Dactinomycin, and lydo - tetracaine."
},
{
  "instruction": "Doctor, I've been diagnosed with a white blood cell disease. What medication should I take to treat it?",
  "input": "",
  "output": "We need a combination of drugs such as nephrosis, nephras, negpiras, procrastas, tarcromus, ceftazid, cyrofos pamide, merophenem, vitristin, ditacinus, Lidocain, and other products. We can also prescribe Josin, cefim, and preframine, depending on the individual case."
},
{
  "instruction": "Doctor, I've been diagnosed with Kaposi sarcoma, which drug should I take?",
  "input": "",
  "output": "You have to take a combination of drugs such as lintobire, Lophibir, Tennoformir, and Atajanabuzar, which help you to manage the symptoms of the disease."
},
{
  "instruction": "Hi doctor, I've recently been diagnosed with spina bifida, and would you recommend a drug that helps relieve pain?",
  "input": "",
  "output": "Yes, you can prescribe some drugs that will help your condition. It is recommended to take a dechlorifag or pyoxicac to relieve pain and inflammation. In severe cases, cortisone can be used."
},
{
  "instruction": "Doctor, I'm having a lot of eye problems, and the ophthalmologist said it's possible that it's a plastic brain tumor, so can you tell me what kind of medication to take?",
  "input": "",
  "output": "Yes, we need to start with a few medications to manage this condition by taking acetazomoids, topilamas, topiraniums, flute cortisone, Tyrannysin, propanein, caffeine, ketoprofen, hydrocortisone."
},
{
  "instruction": "Hi, doctor. Your eyes are getting blood and it'sching. It's like you've got a pericarditis.",
  "input": "",
  "output": "Yes, I think you have a viral endocarditis. I'll give you eye drops. I'll give you eye drops. I'll give you eye drops from Erisomasine, Guppacemide's eye drops, sodium pills from Cyproplexine, tobramysine anticoagins, and i'll give you one of the anti-polyxinsines."
},
{
  "instruction": "Doctor, I'm really uncomfortable with the damage to my nose. What do I do?",
  "input": "",
  "output": "A few drugs will help: first, use a little lydokines to numb the area; then, to make sure you don't have an infection risk, you have to get an ad\u00e1doid vaccine. Then, apply vassytrasine and Pobiton Yoododen to help heal the wound."
},
{
  "instruction": "Hi doctor, I've got a really nervous and nervous feeling these days, and I'm breathing faster and I'm breathing faster, and I'm having a sharp chest pain, and I'm feeling very frustrated, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms suggest you're suffering from panic disorder."
},
{
  "instruction": "Doctor, I've recently experienced irregular heart rate and palpitations, and I feel extremely depressed and sometimes weird and scary, and what's wrong with me?",
  "input": "",
  "output": "You're suffering from panic attacks."
},
{
  "instruction": "Doctor, sharp chest pain, irregular heartbeat, insomnia and depression.",
  "input": "",
  "output": "It can lead to chest pain, irregular heart rate, insomnia, and it can lead to depression and psychosis."
},
{
  "instruction": "I'm experiencing a doctor, a head injury, insomnia, irregular heart rate, and I feel very depressed and sometimes psychopathic, and what's the cause of all these symptoms?",
  "input": "",
  "output": "Panic disorder can cause stroke, irregular heartbeat, insomnia, depression or psychosis, but it's good to take a deep breath and relax while you're doing some tests."
},
{
  "instruction": "Doctor, there's a lump around your neck, there's a sore throat, there's no way to talk, there's no urine out, there's no problem.",
  "input": "",
  "output": "The symptoms suggest that there are vocal polyps."
},
{
  "instruction": "Doctor, you can see that your neck is sore and your skin is swollen. What's the problem?",
  "input": "",
  "output": "The vocal cords can be caused by tension or excessive use of the vocal cords, and the vocal cords can be swollen and enlarged."
},
{
  "instruction": "Doctor, we've been experiencing a recent substrate, cough, and hearing decline, and what's the cause of these symptoms?",
  "input": "",
  "output": "There may be hooligans in your vocal cords that can cause shock, speech or singing difficulties, which, in severe cases, can lead to respiratory difficulties. It may also cause shock, cough, and hearing loss because of the influence on Paullip's location and vocal cords. You can do some tests to check your diagnosis and discuss treatment options."
},
{
  "instruction": "Sir, I feel like I have a lump in my neck, and my hearing's been down, so what's the problem?",
  "input": "",
  "output": "The symptoms suggest that there's a vocal pole polyps, which can cause a benign tumor in one of the vocal cords, causing hoarse voice, discomfort in the neck, and affect hearing."
},
{
  "instruction": "Doctor, I think there's a kind of hoarse voice and there's a lump in the neck. What's the cause?",
  "input": "",
  "output": "Symptoms can lead to vocal polyps, which can cause a small benign tumor in the vocal cords, which can cause a relaxed voice and the feeling of a lump touching the neck."
},
{
  "instruction": "Doctor, your elbow is numb and your leg is in pain. What's the cause?",
  "input": "",
  "output": "Maybe it's Turner's syndrome, because of the symptoms. Have there been any changes in the body or in the menstrual cycle?"
},
{
  "instruction": "Doctor, there's blood in the stool, there's weakness in the waist, there's pus in the upper jaw, there's pus in the pharynx, there's a lump in the groin, what's the problem?",
  "input": "",
  "output": "The symptoms suggest that you have Turner's syndrome, a genetic disorder that affects women, which can cause a variety of symptoms, such as lymphoma, swelling, low kidneys, precipitation of puberty, which is so rare that you have to do some tests to confirm your diagnosis."
},
{
  "instruction": "We're experiencing symptoms like doctors, hearing lowers, groins, leg pains, and what's the cause of all of these symptoms?",
  "input": "",
  "output": "There's the possibility that there's a genetic disorder called Turner syndrome, which affects a woman with an X chromosome, and it's related to certain physical characteristics and health problems, such as hearing loss, lymph nodes in the neck and groin area, and more than a skeleton that can cause leg pain."
},
{
  "instruction": "Doctor, I'm experiencing a chest pain, a groin mass, a growth failure, leg pain and some emotional symptoms. What's the problem?",
  "input": "",
  "output": "Conner's syndrome is a genetic disorder that affects women's growth and development."
},
{
  "instruction": "Doctor, there's blood in your throat. What's the problem?",
  "input": "",
  "output": "There may be a number of causes, but there's a possibility that you have Turner's syndrome in terms of other symptoms and other forces."
},
{
  "instruction": "Doctor, you've recently got white secretions in your eyes and lumps in your scrotum, and what's the cause of these symptoms?\"",
  "input": "",
  "output": "\"The cyclic veins may be the cause of the symptoms, where the testes on one side or both sides can't get down into the scrotum and remain in the abdomen or in the groin."
},
{
  "instruction": "Doctor, I'm really worried about the lack of growth down below, and what's the cause?",
  "input": "",
  "output": "There's the possibility that there's a Kryptonism, which means that one or both of the testes didn't come down properly during development, that the growth of the affected test could be delayed or inadequate."
},
{
  "instruction": "Doctor, I think my newborn son has been very annoying these days, with pus coming out of his ear and a lump touching his scrotum, and what's the cause?",
  "input": "",
  "output": "With these symptoms, it's possible that your son has Kryptonism, which can cause infection and other complications when the testes don't go down into the scrotum."
},
{
  "instruction": "Doctor, I found pus coming out of the ear, and a baby getting a lot of irritation, and white secretions coming out of the eyes, and pain in the testes, and a lump in the scrotum, and what's the cause of all this?",
  "input": "",
  "output": "It can cause pain and discomfort in the abdomen, and it can produce secretions in other parts of the body, such as the ear and the eye."
},
{
  "instruction": "Doctor, I feel like my newborn son's growth is not as good as expected, and he's got a lot of irritation, and he's got a white secretion in his eyes, and his scrotum and his testicles aren't normal, and what's the cause of all of this?",
  "input": "",
  "output": "Your son may have kryptochism, which is a disease that can cause lack of growth and other symptoms because the test may not involve the white secretions in your eye, but other symptoms are consistent with kryptokinism."
},
{
  "instruction": "Doctor, I'm very sick these days, and I'm diarrheal, and I feel depressed.",
  "input": "",
  "output": "The symptoms seem to indicate an addiction to ethylene glycol."
},
{
  "instruction": "Doctor, I'm very sick these days. I'm fainting and nauseating.",
  "input": "",
  "output": "Have you been using drugs recently or taking certain substances? Patient: Actually, yes, we're using certain kinds of antifreeze to make you feel better."
},
{
  "instruction": "I've had a headache in the last few days, and I have to confess that I'm abusing alcohol and drugs.",
  "input": "",
  "output": "Based on what you're talking about, you may be suffering from an addiction to ethylene glycollo, which requires some testing."
},
{
  "instruction": "Doctor, I've been having strange symptoms lately, and I want to be very hostile and use drugs more often.",
  "input": "",
  "output": "Have you ever been exposed to anything unusual recently, like chemicals or things like that? Patient: In fact, I've been in trouble doing antifreeze work in the garage as you say."
},
{
  "instruction": "Doctor, I'm very sick these days, I'm experiencing drug abuse, loss and hostility, and I'm also abusing alcohol a lot, and what's the cause of all this?",
  "input": "",
  "output": "This type of addiction can cause such symptoms as drug abuse, loss, and even hostile behavior."
},
{
  "instruction": "Doctor, there's lower abdominal pain, and sometimes it's unconscious, there's vaginal secretion, there's upper temporal pain, and there's facial blushing, and what's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that you have atrophy, which causes what you're talking about when the vaginal tissue is thin and dry and causes pain in sexual intercourse, heart failure, and so on, and we can do some tests and talk about treatment options."
},
{
  "instruction": "Doctor, I've been having a hot flashes lately.",
  "input": "",
  "output": "At your age, the hot flashes may be signs of absorption."
},
{
  "instruction": "Doctor, you've got a lot of urinary pain. Tell me what's causing it.",
  "input": "",
  "output": "Astrophysic salinitis may be the cause of urinary pain, which is caused by a lack of estrogen in which vaginal tissue is thin and dry, causing irritation and pain in urination."
},
{
  "instruction": "Sir, there's blood mixed with vaginal secretions, dryness and urine, and there's chest pain, and there's vitiligo, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms that God mentioned were caused by the thinning, drying, and inflammation of the vaginal wall tissue due to reduced estrogen levels in the body."
},
{
  "instruction": "Doctor, do you want to know what caused the recent head pain?",
  "input": "",
  "output": "Astrophysic salinitis can be the cause of pain, which is a disease in which vaginal tissue becomes thin and dry due to reduced estrogen levels."
},
{
  "instruction": "Hi, doctor. Your arm is swollen, your hand is stiff, your wrist is swollen, your wrist is pain.",
  "input": "",
  "output": "The symptoms suggest that there's a fracture in the hand."
},
{
  "instruction": "Doctor, I've recently had a swollen wrist and a painful hand, and I have a very stiff wrist and a swelling arm.",
  "input": "",
  "output": "The symptoms seem to indicate that the hand fracture occurred."
},
{
  "instruction": "What are the causes of these symptoms?",
  "input": "",
  "output": "Based on the symptoms you described, there may have been a broken hand, and I'm going to check the damage through X-rays."
},
{
  "instruction": "Doctor, your wrist is swollen and moving is very painful.",
  "input": "",
  "output": "The symptoms suggest that the hand may have been fractured, and you have to run some diagnostic tests to see if that's true."
},
{
  "instruction": "Doctor, your skin is growing in your mouth. Why?",
  "input": "",
  "output": "It's good to figure out the cause and be tested immediately for the right treatment."
},
{
  "instruction": "Doctor, a week ago, I had acne on my mouth, and I think it's getting worse.",
  "input": "",
  "output": "And that acne can actually be a symptom of tooth abscess or bile fever, and it's good to get a dental or oral surgeon as soon as possible to figure out the exact cause and get the right treatment."
},
{
  "instruction": "Doctor, I have acne and acne in my face and ulcers and toothache in my mouth as my skin grows, and I recently developed skin lesions in my mouth.",
  "input": "",
  "output": "There may be bile and absorptitis in the mouth, an infection of the skin and tissues of the mouth, which can be caused by bacteria or other microbes, which may require antibiotics and/or absorption for treatment."
},
{
  "instruction": "Doctor, your lips are dry and your throat hurts.",
  "input": "",
  "output": "I think there's a bile and abscess or abscess in the mouth."
},
{
  "instruction": "Hi, doctor. I've got throat pain, facial pain, tooth pain.",
  "input": "",
  "output": "It's very likely that there's a bile and abscess or abscess in the mouth because of the symptoms."
},
{
  "instruction": "Sir, I feel foreign in my eyes, and I think my eyes are moving abnormally. What's the problem?",
  "input": "",
  "output": "You may have an eye-syncing disorder."
},
{
  "instruction": "A couple of weeks ago, it looks like you've got a look on your eyes and a swelling of your lymph nodes, and you don't seem to grow as clearly as you used to, or you don't grow as tall as you used to.",
  "input": "",
  "output": "There's a good chance you have eye-symbolism disorder that can cause nausea, lymph nodes, poor vision, poor growth, death, and so on."
},
{
  "instruction": "Sir, I think the eyelids are acting abnormally and the eyes are in conflict with each other, and I'm worried that the scalp looks irregular and doesn't grow as tall as I thought it would be.",
  "input": "",
  "output": "Your symptoms may indicate that you have a condition called eye alignment disorder, which can distort or distort eye alignment. This can cause perplexity or damage the vision of one eye. You can check your diagnosis through a comprehensive eye examination and determine the best possible treatment options."
},
{
  "instruction": "Doctor, I recently had some symptoms in my eyes, and my eyes are moving abnormally, and my eyelids are shaking.",
  "input": "",
  "output": "The symptoms may indicate eye alignment, which is what we call death, which is a condition in which the eye cannot be properly aligned and things can be double-fisted or have deep perception problems."
},
{
  "instruction": "Doctor, I'm experiencing multiple vision, and I'm seeing eye contact, and my lymph nodes are getting worse, and my eyes are moving abnormally, so what's the problem?",
  "input": "",
  "output": "The symptoms suggest that you may have a blind-like disability."
},
{
  "instruction": "Sir, there's been a headache recently, followed by back pain, pregnancy pain, anal pain, backaches.",
  "input": "",
  "output": "It's a common side effect of the procedure, and it can last for days."
},
{
  "instruction": "There's a headache with a teacher, back pain, vomiting, anal pain, neck pain, and tell me what's causing it.",
  "input": "",
  "output": "The symptoms suggest that you have a headache after the urethra."
},
{
  "instruction": "Doctor, I'm having a persistent headache after a urethra procedure: back pain, neck pain, shortness of breath, pregnancy pain, nausea.",
  "input": "",
  "output": "You're experiencing post-traumatic headaches caused by loss of spinal fluid, which is also a symptom of back pain, neck pain, nausea and erectile failure."
},
{
  "instruction": "Doctor, I had a hole in the ureter a few days ago, and since then I have a headache with a hip and a throat pain, and why?",
  "input": "",
  "output": "I think you're experiencing some related pain with the epidemiology."
},
{
  "instruction": "Doctor, what's the problem when you're experiencing a double-pass nausea after the ureter?",
  "input": "",
  "output": "Two-passing nausea is a common condition after the urethra, which is called the ureter toe."
},
{
  "instruction": "Doctor, there's been some symptoms of vomiting and coughing blood on my baby, so can you tell me what might be a problem?",
  "input": "",
  "output": "In view of the symptoms that God explains, the upper and lower muscles of the baby may be too thick for the food to go down to the cattle so that it can cause vomiting, weight loss and dehydration, which can cause stomach bleeding and other complications."
},
{
  "instruction": "Doctor, I'm feeling a burning pain, and the baby has the same symptoms, and what's the problem?",
  "input": "",
  "output": "Because of your symptoms and your child's symptoms, both of you seem to have pyponic stenosis, a condition that is blocked by a passage between the stomach and the small intestine, which we're going to do a few tests to confirm the diagnosis."
},
{
  "instruction": "Doctor, I've been experiencing severe stomach pains over the last few weeks. What's the cause?",
  "input": "",
  "output": "This disease occurs when the openings between the stomach and the small intestine are so narrow that the food backfires on the stomach, causing the pain."
},
{
  "instruction": "Doctor, the baby has a sharp abdominal pain and is often vomiting. What's the cause?",
  "input": "",
  "output": "From the symptoms that God explains, it's possible that the baby will have pyloric stenosis."
},
{
  "instruction": "Doctor, you've been coughing a lot lately.",
  "input": "",
  "output": "His history and symptoms suggest that he has a sleeping disorder."
},
{
  "instruction": "Hi doctor, there's swelling of lymph nodes in the throat and swelling of the skin and throat.",
  "input": "",
  "output": "Well, the symptoms seem to indicate that lymph nodes and throats are swollen due to a sleeping disorder, and it's good to run some tests to confirm the diagnosis and discuss treatment."
},
{
  "instruction": "Doctor, can you tell us the cause of the recent severe facial pain?",
  "input": "",
  "output": "Is there any sign of swelling around your jaw and difficulty opening your mouth?"
},
{
  "instruction": "Doctor, I think the skin around the jawline is getting swollen, and it's getting worse. Can you tell me what's causing it?",
  "input": "",
  "output": "The symptoms seem to indicate that you have a sleeping disorder."
},
{
  "instruction": "There's a doctor, a terminal edema, skin edema, ear pain, cough, and a warm neck.",
  "input": "",
  "output": "The symptoms suggest that you have a sleeping disorder."
},
{
  "instruction": "Doctor, I have a problem walking, I think my legs are broken, and my knees are pounding.",
  "input": "",
  "output": "The cartilage in the joints is not developed properly, so I think it's a symptom of bone cartilage, which causes malformations in the limbs, and we have to run some tests to make sure we're diagnosed."
},
{
  "instruction": "Doctor, your elbow hurts, your bones hurt, your knees hurt. What's the problem?",
  "input": "",
  "output": "The symptoms can lead to bone cartilage, a type of bone disease that affects the body's joints."
},
{
  "instruction": "Doctor, I'm suffering from weakness and swelling in my knees, and I'm ruining my daily life and failing to walk properly.",
  "input": "",
  "output": "The symptoms seem to indicate that you have Osteoporosis, which is a disease that destroys joint bone and cartilage, causing pain, weakness and swelling in your abdomen."
},
{
  "instruction": "Doctor, your ankle pain, your knee swelling, your bone pain, your elbow pain, your knee lumps.",
  "input": "",
  "output": "The symptoms may indicate that there is a bone fracture, a disease that causes pain and swelling in the joint because the joint's bone and cartilage don't develop properly."
},
{
  "instruction": "Doctor, your knees are swollen, your hands and fingers are sick, your feet are in pain, your toes are in pain, your skin is in pain, and you feel like your legs are bent or you're on your knees.",
  "input": "",
  "output": "Osteoporosis is a disease in many parts of the body where cartilage and bone don't grow or develop properly. it can affect the knee, the hand, the foot, and the leg shape can change abnormally."
},
{
  "instruction": "Doctor, knee pain, soreness, swelling of the legs, smoking problems, leg pain continues, and why?",
  "input": "",
  "output": "The symptoms seem to indicate that there are complications of knee injury, heartburn, leg swelling, smoking, leg pain."
},
{
  "instruction": "Sir, your leg's swollen.",
  "input": "",
  "output": "Have you had a knee injury recently? woman: Yeah, I was playing soccer last week, and I slipped my knee."
},
{
  "instruction": "Doctor, I've recently had knee pain and soreness.",
  "input": "",
  "output": "The knee pain may have been caused by injury. Have there been accidents or fractures that can affect the knee recently? Deceptiveness may have to do with acid reflux or gastric reflux."
},
{
  "instruction": "Doctor, your knees are swollen and in pain. Can you tell me why?",
  "input": "",
  "output": "There's a good chance he's injured in the knee."
},
{
  "instruction": "Doctor, your knees are swollen and your legs are in pain. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that the knee injury has caused swelling and leg pain."
},
{
  "instruction": "Doctor, your arm is stiff, you don't eat well, and your baby has a feeding problem, and what's the cause of all this?",
  "input": "",
  "output": "Depending on the symptoms, the ear and the baby may have an metabolic disorder."
},
{
  "instruction": "Sir, I have a low menstrual level and a problem with breast shape and size, and I recently lost a little bit of weight, and what is the cause of all of this?",
  "input": "",
  "output": "I'd like to run some tests to check the diagnosis and discuss treatment options."
},
{
  "instruction": "Hi, doctor, I've recently had a problem with smoking, and I don't think my lungs are working properly.",
  "input": "",
  "output": "Based on what God says, you may be experiencing symptoms associated with metabolic disorder."
},
{
  "instruction": "Doctor, you've got low menstrual capacity, you've got eczema, you've got chest shape and size problems, you're having trouble with your diet, what's the problem?",
  "input": "",
  "output": "We need to do some tests to check this out and determine the best way to treat it."
},
{
  "instruction": "Doctor, I have abnormal vaginal secretions and lower abdominal pain. Can you tell me what's wrong?",
  "input": "",
  "output": "I think you're suffering from salinitis, which is inflammation of the vaginal cortex."
},
{
  "instruction": "Doctor, can you have a problem with being squeamish and in pain during pregnancy?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from salinitis."
},
{
  "instruction": "Doctor, there's been a lot of vaginal and lower abdominal pain, and you're pregnant, and you feel pain during intercourse.",
  "input": "",
  "output": "The symptoms seem to indicate that there is salinitis, an inflammation of quality that can cause pain, secretion and itching, and it can also cause pain during intercourse and during pregnancy."
},
{
  "instruction": "Doctor, I'm experiencing sharp abdominal pain, vaginal pain and pain during sex.",
  "input": "",
  "output": "The symptoms are likely to cause pain and discomfort."
},
{
  "instruction": "Doctor, there's been a recent cytoplasm, and why is that?",
  "input": "",
  "output": "It could be pain, it could be itch, it could cause secretion, it could be vaginal salinitis, which can cause the secretion, which can be diagnosed through a diagnosis, and if necessary, it can be prescribed for treatment."
},
{
  "instruction": "Doctor, you're losing your breath, you're losing your strength, you're getting dizzy, you're even getting a strange secretion of your nipples, what's the problem?",
  "input": "",
  "output": "The symptoms suggest that you have sinus syndrome."
},
{
  "instruction": "Doctor, heart rate is getting faster and fainting more often, and why?",
  "input": "",
  "output": "To put it off as a symptom, sinus syndrome can be the cause."
},
{
  "instruction": "Doctor, you're experiencing faintness, loss of heart rate, shortness of breath and sharp chest pain. What's the cause of these symptoms?",
  "input": "",
  "output": "It's possible that you have sinus syndrome because of your symptoms. Have you experienced any other symptoms recently?"
},
{
  "instruction": "Doctor, I think you've been so tired lately and your heart rate's decreased. What's wrong?",
  "input": "",
  "output": "There may be a condition called arrhythmia syndrome, which affects the natural beat of the heart and causes it to malfunction."
},
{
  "instruction": "Doctor, you've been in a bad breath lately. Is that something to worry about?",
  "input": "",
  "output": "If you're a questioner, the cause is sinus syndrome."
},
{
  "instruction": "Sir, your headaches seem to persist with recent eye symptoms, and your hearing seems to be down.",
  "input": "",
  "output": "From your symptoms, you're suffering from an unknown tinnitus."
},
{
  "instruction": "Hi, doctor, I'm experiencing some of the symptoms that bother me, and I think the eyes are heavy and difficult to focus on, and I think there's a fluid in my ear, and what's the cause?",
  "input": "",
  "output": "I don't think there's any reason to be aware of the cause when you look at the symptoms."
},
{
  "instruction": "Doctor, you've got a feeling of ringing your ears, and you've got a slight decline in your hearing, and you've got some symptoms in your eyes, and what's the cause of this problem?",
  "input": "",
  "output": "The symptoms suggest that there's an unknown reason for this, which is to recognize that there's no external source of voice, but it can be caused by a number of causes, and sometimes there's no obvious cause."
},
{
  "instruction": "Doctor, I'm dizzy and I'm getting water in my ear, and my neck is stiff and my ears are in pain, so can you tell me what's going on?",
  "input": "",
  "output": "Maybe there's some reason that the symptoms don't tell us what's going on."
},
{
  "instruction": "Hey, what's the cause of this, when you have a fever or a sting in your eye, and you see a speck or a cloud in your eye?",
  "input": "",
  "output": "It's probably glaucoma, which can cause blindness if not treated because of damage to the body's vision. It's good to check the diagnostics and discuss treatment options through a comprehensive eye examination."
},
{
  "instruction": "Sir, I've got tears, I've got spots, I've got clouds in my eyes, I've got burns and stings in my eyes, and sometimes I'm afraid I'm going to lose my sight.",
  "input": "",
  "output": "These are all symptoms of glaucoma that can lead to blindness if the eye's optic nerve is not treated, and we need to do a comprehensive eye examination to prevent further loss of vision and start medication immediately."
},
{
  "instruction": "Sir, there's a lot of tears, and sometimes there's eye stings and stings. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that there may be glaucoma that could damage the vision of the body and lead to the vision chamber."
},
{
  "instruction": "Sir, I can't see my right eye, and I can feel it. Can you tell me what's wrong?",
  "input": "",
  "output": "The symptoms suggest that it may be glaucoma. Have you been diagnosed with glaucoma before?"
},
{
  "instruction": "Doctor, I've been hungry lately, but I can't eat.",
  "input": "",
  "output": "We need additional evaluations to figure out what's at the root of the problem."
},
{
  "instruction": "Doctor, acne, excessive appetite, excessive drinking, depression, vomiting, what's going on with me?",
  "input": "",
  "output": "The symptoms suggest that you may have a diet disorder."
},
{
  "instruction": "Doctor, I've been having a bad time eating and feeling depressed lately, and I'm not sleeping well at night.",
  "input": "",
  "output": "I think you're experiencing some of the symptoms of diet disorders, such as anorexia anorexia, and it's good to have a consult with a specialist who can help you manage your symptoms and plan your treatment."
},
{
  "instruction": "Hi, doctor, I'm very angry recently and I'm not sleeping well and I'm not feeling very hungry, so what's wrong with me?",
  "input": "",
  "output": "You can have a diet disorder based on your symptoms, and it's good to do some additional tests to check this diagnosis."
},
{
  "instruction": "Doctor, I'm feeling very nervous and nervous these days, and I don't sleep well at night, and I have a huge increase in appetite, and it's easy to get angry, and you know what's wrong with me?",
  "input": "",
  "output": "These symptoms seem to be food disorders."
},
{
  "instruction": "Doctor, you've had a headache for a while, and what's the cause?",
  "input": "",
  "output": "The symptoms are likely to indicate that you're experiencing a chronic hemorrhagic seizure."
},
{
  "instruction": "Doctor, I've been having strange symptoms lately, my memory loss, my vision blurs, my arm feels weak.",
  "input": "",
  "output": "Based on what God has explained, it's possible that you've had a T.A.P. seizure, and you have to run some tests to check your diagnosis."
},
{
  "instruction": "Doctor, I've been experiencing an abnormal sense of loss and helplessness lately, and I sometimes feel paralyzed in the face, you know what's causing these symptoms?",
  "input": "",
  "output": "The symptoms suggest that you're experiencing a work hemorrhagic seizure, a mini stroke."
},
{
  "instruction": "Doctor, you've lost your strength, you've lost your senses, you've lost your memory, you've got strange facial symptoms, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you've had a chronic hemorrhagic seizure, and it's good to check this diagnosis and do some tests to prevent a real stroke."
},
{
  "instruction": "Doctor, I'm experiencing side pain, vitto, fever and nausea. What are the symptoms?",
  "input": "",
  "output": "This is an infection of the kidney and the urethra, which can cause pain in the side, frequency, fever and nausea."
},
{
  "instruction": "Sir, there's a sharp pain in the lower abdomen. Why?",
  "input": "",
  "output": "The symptoms suggest that you're suffering from a type of kidney infection that characterizes sharp abdominal pain, strangulation."
},
{
  "instruction": "Doctor, you've got a fever, and you've got urinary pericardium. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there's strepsis, which is a type of kidney infection that requires quick treatment to prevent further complications."
},
{
  "instruction": "Doctor, I've had sharp abdominal and back pain for days, and also vomiting and pain on one side of my body.",
  "input": "",
  "output": "The symptoms seem to indicate that you've got cytoplasm that infects your kidneys and your urethra, and you've got to do some tests to check your diagnosis, but it's important to start the treatment immediately to prevent further complications."
},
{
  "instruction": "Doctor, I'm sick of vomiting and I need to pee a lot. What's going on?",
  "input": "",
  "output": "The symptoms suggest that it's strepitis, a kidney infection."
},
{
  "instruction": "Sir, your shoulder is swollen, stiff, painful, weak shoulder, and your tongue looks a little bit weird.",
  "input": "",
  "output": "The swelling, stiffness, pain and weakness are all common symptoms of this type of injury, sometimes causing pain in the neck or back."
},
{
  "instruction": "Doctor, your tongue looks abnormal, your arm convulsions, your arm cramps, your arm pains, what's the problem?",
  "input": "",
  "output": "The symptoms suggest that there's a defect in the rotary root."
},
{
  "instruction": "Doctor, your neck is stiff, your shoulders are swollen, your legs are convulsive, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate that there is a pain caused by a rotary root injury."
},
{
  "instruction": "Sir, you've got shoulder pain, your hands and fingers are very stiff and tight, you've got leg convulsion, you've got pressure on your shoulders.",
  "input": "",
  "output": "The symptoms suggest that you've been injured by a rotary radical."
},
{
  "instruction": "Hi, doctor, there's spasms and spasms in your legs, and your tongue looks abnormal.",
  "input": "",
  "output": "These symptoms don't have to do with rotational muscle damage. Have you ever had pain in your shoulder or your upper arm, difficulty moving your arm, or a weakness in your shoulder? Patient: Oh, sorry, there's pain in your shoulder and your arm, and it's difficult to move your arm, and it feels like you're losing strength in your shoulder."
},
{
  "instruction": "Doctor, I've been experiencing a lot of pain lately, and my knee hurts, and my back hurts, and I have a sharp abdominal pain, and my whole body hurts, and what's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that you have a chronic pain disorder, a chronic pain disorder that you can't fully explain because of injury or basilar illness, and you need to know more about what treatments can help you."
},
{
  "instruction": "Sir, I've had a lot of pain these days, my neck is still in pain, and I feel acute abdominal pain.",
  "input": "",
  "output": "The symptoms seem to indicate that you have a chronic pain disorder."
},
{
  "instruction": "Doctor, I've been experiencing chronic leg pain for quite some time, and why?",
  "input": "",
  "output": "The symptoms seem to indicate that you have a chronic pain disorder, and you can do some tests to confirm your diagnosis and discuss the best treatment possible."
},
{
  "instruction": "Doctor, knee pain, neck pain, pelvis pain, headache, sharp abdominal pain is going on for a while.",
  "input": "",
  "output": "I think you're suffering from a chronic pain disorder because pain appears on multiple levels."
},
{
  "instruction": "Sir, your knee pain and your whole body pain and backaches have been going on for a while, so tell me what caused these symptoms.",
  "input": "",
  "output": "The symptoms seem to indicate that you have a chronic pain disorder."
},
{
  "instruction": "Doctor, I'm pregnant, and I've experienced some stains and bleeding over the last few days, and what's the problem?",
  "input": "",
  "output": "You may be suffering from a common miscarriage threat in the early stages of pregnancy."
},
{
  "instruction": "Doctor, burning abdominal pain, vomiting, lower abdominal pain and headaches.",
  "input": "",
  "output": "The symptoms seem to indicate complications during pregnancy, and it's good to book an O.B. for additional evaluations and treatment."
},
{
  "instruction": "Doctor, I'm experiencing abdominal pain and pain during pregnancy, and there were stains and bleeding, and what was the cause of these symptoms?",
  "input": "",
  "output": "It's important to monitor this condition carefully and follow recommended treatment plans for safe, healthy pregnancy."
},
{
  "instruction": "Doctor, since I found out I was pregnant, there's been a lot of nausea.",
  "input": "",
  "output": "Yes, nausea is a common symptom of pregnancy and is known as morning sickness."
},
{
  "instruction": "Doctor, kidney mass, prostate symptoms, groin, abdominal swelling, what's the problem?",
  "input": "",
  "output": "There's a possibility of liver cancer in the case of symptoms, and it's important to check your diagnosis and run some tests to determine how to treat the best."
},
{
  "instruction": "Teacher, prostate symptoms, the abnormal color and smell of urine, the mass of groin, the rate of heart rate, the palpitation of the abdomen, what's the cause of all these symptoms?",
  "input": "",
  "output": "The symptoms are likely to be liver cancer, and it's good to do some additional tests to check the range and severity of the cancer."
},
{
  "instruction": "Doctor, your abdomen swells, your groin touches a lump, your stomach pains, your urine color and smell weird, your heart rate increases.",
  "input": "",
  "output": "There's a high risk of liver cancer because of the symptoms, and it's good to get a medical checkup immediately to check the diagnosis and start treatment."
},
{
  "instruction": "Doctor, I recently went for a checkup, and the results showed a kidney mass, and what's the cause?",
  "input": "",
  "output": "Unfortunately, kidney mass can be a symptom of liver cancer, and we need to book some additional tests to confirm the diagnosis."
},
{
  "instruction": "Sir, you've recently had strange urine color and smell, sharp abdominal pain and stiffness in your legs and stomach pain.",
  "input": "",
  "output": "There's a possibility of liver cancer based on the symptoms."
},
{
  "instruction": "Hi, doctor. I'm experiencing a nose block with a sharp chest pain. What's the cause?",
  "input": "",
  "output": "The symptoms you described may have to do with this condition. It's good to run some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, there's been a few days of nose blockage, and what's the reason for that?",
  "input": "",
  "output": "Part of the lung, or part of the entire lung, may be due to the minerals that occur when you don't contract or expand properly."
},
{
  "instruction": "I've recently felt stuck and gasped, and my whole body hurts, and what's the problem?",
  "input": "",
  "output": "The symptoms suggest that you may have an armory."
},
{
  "instruction": "Doctor, I've been experiencing a lot of symptoms recently, all over my body, my ribs pain, my fever, my sharp chest pain, my cough.",
  "input": "",
  "output": "Depending on the symptoms, the air sac in your lungs does not contract or expand completely, there may be chest pain, discomfort, coughing armor."
},
{
  "instruction": "Doctor, I'm experiencing sharp chest pains, fever, dizziness.",
  "input": "",
  "output": "Some of your lungs may not contract or swell properly, depending on your symptoms, and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, there are symptoms of weakness in the hands, mass touching, stiffness in the muscles, and there's a lot of pain in the hands and fingers.",
  "input": "",
  "output": "The symptoms suggest that you've injured your hand, or you've got a cyst filled with swelling or fluid, and it's good to take X-rays and MRIs to assess the extent of the injury."
},
{
  "instruction": "Doctor, you've got hand damage, hands and wrist swelling, muscle weakness, what's the problem?",
  "input": "",
  "output": "The symptoms may indicate a fracture or a spinal cord or some other hand injury, and it's good to run some video tests to determine the extent of the injury and the best treatment plan."
},
{
  "instruction": "Doctor, your hands are swollen and your fingers are stiff. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that you've been injured in your hand."
},
{
  "instruction": "Sir, there's been a lot of wrist pain and a lot of hand joint pain. Can you take a look?",
  "input": "",
  "output": "The symptoms seem to indicate that you're in pain with a hand injury."
},
{
  "instruction": "Doctor, sharp chest pain, diarrhea, nausea, yellow skin. Can you tell me what's wrong?",
  "input": "",
  "output": "The symptoms may indicate that there's a disease called pyrectosis, which causes the bile flow and the peritoneal peritoneal passage."
},
{
  "instruction": "Sir, recent symptoms of sharp chest pain, back pain, nausea, strange color or smell of urine loss, what's the cause?",
  "input": "",
  "output": "The symptoms suggest that he's a bile witness, causing inflammation and blockage of the liver and pancreas."
},
{
  "instruction": "Doctor, I'm having a lot of diarrhea these days. What's the cause?",
  "input": "",
  "output": "It can cause inflammation and pain in the abdomen, and it can cause symptoms like diarrhea."
},
{
  "instruction": "Doctor, I've been feeling nauseous for the last few days. What's the cause?",
  "input": "",
  "output": "You can experience nausea due to stethoscopes in the bile, and other symptoms include abdominal pain, vomiting, and ectopic, which is best performed in order to identify the diagnosis."
},
{
  "instruction": "Doctor, there's vomiting and pain on the right side of the body. What's the problem?",
  "input": "",
  "output": "It's possible that the symptoms are stethoscopes with stones blocking the wall between the liver and the intestines, which can cause vomiting and lateral pain."
},
{
  "instruction": "Doctor, there's been some strange symptoms recently, there's a swelling of hands and fingers, and there's a telophase.",
  "input": "",
  "output": "These symptoms may have something to do with hip injury."
},
{
  "instruction": "There's groin pain and swelling of the legs. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate a hip injury, and there's a good chance it's a base or a base."
},
{
  "instruction": "Doctor, I've got so much pain that I can barely move my hip.",
  "input": "",
  "output": "Based on your symptoms and your history, I think you've been injured in your hip."
},
{
  "instruction": "Doctor, I've had leg pain in the last few days.",
  "input": "",
  "output": "The symptoms seem to indicate that a hip injury caused leg pain, and I'm going to give you some tests to confirm your diagnosis."
},
{
  "instruction": "Doctor, your leg doesn't sink in swelling, it's getting worse since your hip injury.",
  "input": "",
  "output": "The swelling of the leg is likely to be due to a clot, which is a common complication of hip injury, where you have to test your diagnosis and start a proper treatment."
},
{
  "instruction": "Doctor, I've recently experienced symptoms of nausea, reflux, shortness of breath, vomiting, abdominal swelling, and what's the cause of all these symptoms?",
  "input": "",
  "output": "The symptoms that God explains may be signs of cirrhosis of the liver, which is a disease that causes a variety of symptoms, such as those that you described when your liver tissue was damaged and replaced with scar tissue."
},
{
  "instruction": "Doctor, we've been experiencing recent shortness of breath, abdominal ovulation, telophase, sharp abdominal pain, and what's the cause of the symptoms?",
  "input": "",
  "output": "The symptoms are likely to indicate a chronic liver disease caused by prolonged alcohol abuse: cirrhosis of the liver, hepatitis, or non-alcoholic fatty diseases."
},
{
  "instruction": "Doctor, I'm experiencing telophase, melena and fatigue. What's the problem?",
  "input": "",
  "output": "There's a possibility that you may be suffering from some of the symptoms that God has described, and you have to run some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I'm experiencing melena and her telophase. Can you tell me what caused it?",
  "input": "",
  "output": "There's a possibility that there's a cirrhosis of the liver because of the symptoms."
},
{
  "instruction": "Sir, backaches, leg cramps, blushing, the color and smell of urine, there's been some abnormal symptoms in recent years.",
  "input": "",
  "output": "In view of the symptoms that God mentioned, the aortic aneurysm may be a major artery that carries blood from the heart above other parts of the body, which is a swelling of the aorta in the chest area, which can cause backache pain, leg cramps or cramps, a lack of blood flow to the lower half of the body."
},
{
  "instruction": "Sir, we've recently had symptoms of chest distress, fatigue, backache pain, sharp abdominal pain, paralysis.",
  "input": "",
  "output": "The symptoms suggest that there's a swelling of the aortic aortic wall in the chest area, which can cause the symptoms you've described, and you have to do some additional tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I recently vomited and felt dizzy, and my skin and eyes turned yellow.",
  "input": "",
  "output": "The symptoms may indicate a chest aortic aneurysm."
},
{
  "instruction": "What's the problem with doctors, seizures, facial pain, hostile behavior, sometimes delusions or hallucinations?",
  "input": "",
  "output": "There's a possibility that there's a form of brain hemorrhage, an epidural hemorrhage, where it's important to test the diagnosis and start treating it immediately."
},
{
  "instruction": "Doctor, I'm experiencing seizures, and I think the baby's very annoying, and I have some memory problems, and how can I help you?",
  "input": "",
  "output": "The symptoms suggest that you have a subdural bleed, which is a form of brain hemorrhage, which can cause seizures and memory problems, which may be life threatening, so it's important to get medical attention immediately."
},
{
  "instruction": "Doctor, I've recently experienced delusions and hostile behaviors.",
  "input": "",
  "output": "The symptoms suggest that you're suffering from pericardial bleeding."
},
{
  "instruction": "Doctor, your eyelids have recently moved abnormally, confused, and your baby has become very sensitive.",
  "input": "",
  "output": "In view of these symptoms, it's suspected that you or your baby have a dura bleed, and it's important that both of you stay in the hospital and get a thorough examination and possible treatment."
},
{
  "instruction": "Doctor, I've recently been experiencing severe scalp seizures and depression and psychosis, and what's wrong with me?",
  "input": "",
  "output": "There's bleeding between the tissue layer around the brain and pericardial bleeding that accumulates blood, which can cause the symptoms you're talking about."
},
{
  "instruction": "Doctor, I've recently had a lot of fatigue, a lot of stiffness in my joints, and I've been having shoulder cramps and spasms, and what's the problem?",
  "input": "",
  "output": "Are there other symptoms, such as rashes, fever or lymph nodes?"
},
{
  "instruction": "Doctor, I've recently experienced shoulder spasms, spasms, ankle pains, and why?",
  "input": "",
  "output": "You could have a bacilli, a viral infection that can cause joint pain and inflammation, and it's important to get tested and get proper treatment."
},
{
  "instruction": "Sir, I've had a lot of urination at night these days, and I'm more angry than usual, and what's the cause?",
  "input": "",
  "output": "It's possible that it's a congenital bacilli, which we need to run a few tests to see, but this disease can cause both excessive urination and mood changes."
},
{
  "instruction": "Doctor, do you know what caused a lot of urination at night, a lot of spasms and spasms on your shoulder, a lot of anger?",
  "input": "",
  "output": "Yes, symptoms suggest that if a pregnant woman gets rubella, she's likely to have congenital rubella in which the virus is transmitted to her fetus."
},
{
  "instruction": "There's a lot of urination at night, with doctors, fatigue, stiffness in the joints, coldness in the breasts, pain in the breast, wear, and a lump in the knee.",
  "input": "",
  "output": "It can cause a variety of symptoms, including the symptoms that you're talking about because of a virus infection during pregnancy."
},
{
  "instruction": "Doctor, I can see that there's something in it, but I don't think I can find anything. What's the cause?",
  "input": "",
  "output": "Diuretic retinal disease is a complication of diabetes affecting the retinal blood vessels of the eye, and there's a lot of other symptoms that can occur."
},
{
  "instruction": "Sir, you've recently had eye problems, your eyesight seems to drop, and sometimes you feel pain in your eyes, and there's an abnormal movement of eyelids, and there's spots and clouds in your eyes.",
  "input": "",
  "output": "The symptoms suggest that you have diabetes retinal disease, which can occur in diabetic patients, which can damage the retinal blood vessels, cause blurry vision, reduced vision, pain, and plaque."
},
{
  "instruction": "Sir, there are abdominal symptoms that cause blood in your eyes, abnormal eyelids, spots or clouds in your eyes.",
  "input": "",
  "output": "The symptoms may indicate that you have diabetes retinal disease, which occurs when high blood sugar damages the retina's blood vessels, which can cause blood loss in the eye, abnormal movement of the eyelids, or there can be two visible objects, or there can be spots or clouds in the eye."
},
{
  "instruction": "Sir, you've recently had eye problems, and you've got spots and clouds in your eyes, and you've got really dark eyes, and it's a little bit less vision, so what's going on?",
  "input": "",
  "output": "The symptoms seem to suggest that diabetes retinal disease is a complication that affects the eye, causing damage to the retina's blood vessels so that they can cause visual problems, such as fracturing, glinting, itching, and poor vision."
},
{
  "instruction": "Doctor, it looks like there's blood in your eyes, there's spots in your eyes, there's clouds, there's blood in your eyes.",
  "input": "",
  "output": "The symptoms seem to indicate that you have diabetes retinal disease."
},
{
  "instruction": "Doctor, there's a sharp pain in your chest. What's the cause?",
  "input": "",
  "output": "The history and symptoms are more likely to indicate fibromyalgia, and would you like me to consult you more closely on this condition?"
},
{
  "instruction": "Doctor, I'm feeling pain and fatigue in my arm. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that fibromyalgia is a disorder that causes extensive pain, tenderness, and fatigue in the body, including the arm."
},
{
  "instruction": "Sir, your shoulder pain, your leg pain, your neck pain, your back pain, your headache, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate fibromyalgia."
},
{
  "instruction": "Doctor, I'm suffering from melena, rectal bleeding, burning abdominal pain and diarrhea.",
  "input": "",
  "output": "The symptoms may be the cause of intestinal thrombosis, which can cause these symptoms because there's not enough blood flow to the intestinal tract. Note: (This conversation is for information, so it's important to get professional medical advice and treatment to qualified medical personnel.)"
},
{
  "instruction": "Doctor, I'm experiencing chills, lower abdominal pain, vomiting, urine down, sharp abdominal pain. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that the intestinal hemorrhagic is suspect."
},
{
  "instruction": "Doctor, urine down, rectal bleeding, lower abdominal pain. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to be intestinal hemorrhagic."
},
{
  "instruction": "Doctor, there's been some weird symptoms of urination, chills, nausea, rectal bleeding, can we figure out what's going on?",
  "input": "",
  "output": "The symptoms seem to indicate that intestinal hemorrhagic is a serious condition in which the blood flow to the intestinal tract is reduced or blocked, and can cause these symptoms with severe abdominal passages."
},
{
  "instruction": "Doctor, I'm having a bleeding job, diarrhea, lower abdominal pain, toilet pain, tell me what might be the problem.",
  "input": "",
  "output": "If you're dealing with symptoms, you can have intestinal hemorrhagics."
},
{
  "instruction": "Doctor, I'm experiencing emotional symptoms, smoking problems, depression or psychiatric symptoms, seizures, and hostile behavior.",
  "input": "",
  "output": "According to the symptoms that God explains, fetal alcohol syndrome, which is a disorder caused by exposure to alcohol in the womb, can cause various mental and physical problems."
},
{
  "instruction": "Doctor, I've recently felt very depressed and emotionally unstable, and I've also felt a lack of strength in my wrists, and I've been angry, and what's wrong with me?",
  "input": "",
  "output": "It can cause a variety of emotional and physical symptoms, such as depression or psychiatric symptoms, emotional instability, loss of wrists, and personality problems. Have you ever been exposed to alcohol during pregnancy?"
},
{
  "instruction": "Doctor, I have a problem with my temper these days, and I feel like I'm getting angry, and it's affecting my personal life and my work life.",
  "input": "",
  "output": "The problem with this might be related to fetal alcohol syndrome, which is a baby's condition when a mother drinks during pregnancy, and one of the symptoms is the difficulty of emotional control, including anger."
},
{
  "instruction": "Doctor, you're experiencing a condition where your eyes are bloodied, your wrists are weakened, and your eyes are bleeding, and what's the cause?",
  "input": "",
  "output": "The symptoms may indicate that you're experiencing fetal alcohol syndrome, which is a condition that occurs in babies who are alcohol-fed during pregnancy."
},
{
  "instruction": "Doctor, I've been feeling very tired and depressed lately.",
  "input": "",
  "output": "Have you ever had a drink during pregnancy? Patient: Yeah, I've had a couple of drinks during pregnancy."
},
{
  "instruction": "Doctor, high fever and sharp abdominal pain are continuing. Do you know what caused it?",
  "input": "",
  "output": "The symptoms may be that you have peritonealitis, which is inflammation of the tissue surrounding the lining of your abdominal wall, usually due to bacteria or mildew infections."
},
{
  "instruction": "Doctor, I've had some symptoms recently.",
  "input": "",
  "output": "What symptoms do you have? Patient: . . uh . . uh . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ."
},
{
  "instruction": "Doctor, I've been experiencing sharp abdominal nausea for the last few days.",
  "input": "",
  "output": "The symptoms seem to indicate that you have peritonealitis."
},
{
  "instruction": "Sir, I'm experiencing menstrual bleeding, back pain, vomiting, groins and nausea.",
  "input": "",
  "output": "The symptoms seem to indicate that you have peritonealitis."
},
{
  "instruction": "Hello, there's a lump of pain in the groin.",
  "input": "",
  "output": "The symptoms suggest that peritonealitis is an inflammation of the membrane surrounding the abdominal wall."
},
{
  "instruction": "Doctor, I'm experiencing abdominal pain and sharp chest pain, and I'm pregnant, and I sometimes feel pain during pregnancy.",
  "input": "",
  "output": "The symptoms seem to indicate an abdominal injury, and we need to do some tests to determine the extent of the injury and the effect of the pregnancy."
},
{
  "instruction": "Sir, there's blood in the periphery and in the urine and in the chest there's a sharp pain. What's the problem?",
  "input": "",
  "output": "It appears to have been caused by an abdominal trauma, as well as damage to the kidney, which can mix blood in the urine, and the chest pain may be caused by the trauma of the injury."
},
{
  "instruction": "Doctor, in the last few days, I've had severe pain in my upper and lower abdomen.",
  "input": "",
  "output": "In this case, it's common for pain to occur both in the upper and lower abdomen. It's best to get an ultrasound or a CT scan to confirm the diagnosis."
},
{
  "instruction": "Doctor, there's sharp chest pain and lower abdominal pain.",
  "input": "",
  "output": "The symptoms seem to indicate an abdominal injury, and we need to do some tests to determine the extent of the injury and how best to treat it."
},
{
  "instruction": "Doctor, there's abdominal pain. What's the cause?",
  "input": "",
  "output": "We need to do some tests to determine the extent of the injury and how best to treat it."
},
{
  "instruction": "I'm experiencing sharp chest pain with a doctor, back pain and stomach pain, and I have a history of alcohol abuse.",
  "input": "",
  "output": "Considering the history of symptoms and alcohol abuse, it's possible that you have acute pancreatic disease."
},
{
  "instruction": "Doctor, there's been a recent case of vomiting sharp abdominal blood. What's the problem?",
  "input": "",
  "output": "Symptoms may indicate acute pancreatic disease, which is caused by inflammation of the pancreas. Pain is generally sharp and severe and can spread on the back. It is rare to vomit blood through blood loss or cough, but it is a serious complication of acute pancreatitis. To identify the diagnosis and start a proper treatment, you need to run some tests."
},
{
  "instruction": "Doctor, I've been experiencing sharp abdominal vomiting for the last few days, and I also have the habit of abusing alcohol.",
  "input": "",
  "output": "In terms of your symptoms and alcohol abuse history, you may have acute pancreatic disease."
},
{
  "instruction": "Doctor, I've been experiencing multiple blood loss, sharp abdominal pain, side pain, diarrhea, burning stomach pain, and what's the cause of all these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate acute pancreatic disease, and you need additional tests to confirm your diagnosis, and you need to take a blood test and an abdominal ultrasound."
},
{
  "instruction": "I'm experiencing doctors, blood loss, sharp abdominal pain, vomiting, burning abdominal pain, hypothermic pain. What's wrong with me?",
  "input": "",
  "output": "You can have acute pancreatic disease, and we're going to do some additional tests to make sure you're diagnosed."
},
{
  "instruction": "Good morning, doctor. Your hands and fingers are swollen, your skin is swollen, your legs are swollen, your feet are swollen, your toes are pain.",
  "input": "",
  "output": "The symptoms are likely to indicate hemolytic hemorrhagic hepatitis from a clot, and I'm going to recommend some tests to confirm the diagnosis, and I'm going to suggest some treatment options."
},
{
  "instruction": "There's a doctor, an abnormal skin, lymphoma, foot or toe pain, a whole body pain, leg pain.",
  "input": "",
  "output": "The symptoms suggest that hemorrhagic hemothoraxitis from a clot is suspect, and it's good to be treated immediately to prevent further complications."
},
{
  "instruction": "Doctor, you've got an abnormal-looking skin on your leg, and you're sick, and your feet and toes are sick, and your legs are swollen.",
  "input": "",
  "output": "I think there's a hemothoraxitis that causes pain, swelling, skin rashes, because it's blood clots in the veins."
},
{
  "instruction": "Doctor, there's a lot of pain in one leg and a little swelling in the skin.",
  "input": "",
  "output": "It's possible that you're suffering from hemolytic hepatitis, which is a disease that causes pain and inflammation due to a clot in your veins."
},
{
  "instruction": "Hi doctor, I've found leg spasms and spasms, legs and feet and toes, and I've found arms and hands swelling, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms suggest that there's a hemolytic hemothoraxitis in the vein from a clot."
},
{
  "instruction": "Doctor, the last few days have been followed by rapid chest pain and shortness of breath, and there's also an allergic reaction to something.",
  "input": "",
  "output": "It's good to get a breathing test and take the appropriate medication to manage the symptoms to check the diagnosis."
},
{
  "instruction": "Doctor, I've had a hard feeling about my heart lately, and it's very painful. What's the symptom?",
  "input": "",
  "output": "I think you're experiencing asthma symptoms based on what God said."
},
{
  "instruction": "Doctor, I've been experiencing a sharp chest pain recently. What's the problem?",
  "input": "",
  "output": "It's possible that it's asthma because of the symptoms. Have you experienced the sound of your breath or your shortness of breath?"
},
{
  "instruction": "Doctor, your breath is pretty and you're getting hot. Do you know what's causing it?",
  "input": "",
  "output": "Yeah, I think it's possible that it's asthma. Have you had this before, or have you had your first symptoms?"
},
{
  "instruction": "Doctor, I've been experiencing a lot of malaise and sharp chest pain lately. What's the problem?",
  "input": "",
  "output": "Asthma."
},
{
  "instruction": "Doctor, there's pus out of the urine, weird skin lesions, weak back.",
  "input": "",
  "output": "The symptoms suggest that there's a foreign substance in the vagina, and it's good to come to the hospital and get tested and discuss treatment options."
},
{
  "instruction": "Doctor, my back is a little weak. It's been a lot of trouble lately.",
  "input": "",
  "output": "Did you put something in vagina recently? Patient: Yeah, actually, I forgot to remove the diaphragm last week after having sex."
},
{
  "instruction": "Sir, I think I've got a problem with my vagina, and I think I've had a bad emotional ups and downs these days, and I've also got a little muscle pouring in on that area.",
  "input": "",
  "output": "Because of the symptoms, there's this problem with vaginal material, and we need to do some tests to check it out."
},
{
  "instruction": "There's a doctor, a urinary tract, an abnormality in size and shape, skin lesions, hip pain and emotional symptoms. What's the problem?",
  "input": "",
  "output": "Not only these symptoms, but also the secretions and discomforts of intercourse, because if you don't treat them, they can cause infection and complications, so it's important that you get medical attention."
},
{
  "instruction": "Hi, doctor, can you tell me what's wrong with my pelvic pain and pus in my urine?",
  "input": "",
  "output": "When you put it off as a symptom, there's this problem with vaginal material. Have you put something into vagina recently?"
},
{
  "instruction": "Doctor, I've been having strange symptoms lately: headaches continue, I get sleepy all the time, legs are abnormally involuntary, sometimes I have difficulty breathing.",
  "input": "",
  "output": "It's particularly characterized by the urge to move your legs when you're trying to get some sleep or rest, and it can lead to abnormal movements, headaches, severe respiratory problems."
},
{
  "instruction": "Doctor, you're not sleeping well these days, you're experiencing insomnia, headaches and daytime drowsiness.",
  "input": "",
  "output": "I think you're suffering from a non-anxiety syndrome."
},
{
  "instruction": "Hi doctor, I've been suffering leg pain, shortness of breath, insomnia a few weeks ago. What do you think is wrong with me?",
  "input": "",
  "output": "The symptoms suggest that you have anxiety syndrome."
},
{
  "instruction": "Sir, I've been having back pain for the past week.",
  "input": "",
  "output": "Do you have any symptoms when you're in bed for long periods of time or when you're sitting down? woman: Like you said, yes, you move your legs a lot while you're lying down."
},
{
  "instruction": "Doctor, I've been experiencing some strange symptoms recently: headaches, fatigue, back pain, shortness of breath, and also the unconscious movement of the leg.",
  "input": "",
  "output": "Because of the symptoms God mentioned, you may be suffering from anxiety syndrome, which is a neurologic disorder, especially when you're sitting or lying down, which is an uncontrolled urge to move your legs, and a lack of sleep caused by the constant movement of the legs can cause fatigue and headaches, which can help you to discuss some of the options that are helpful to the symptoms."
},
{
  "instruction": "Sir, you've been coughing for a while, and I'm worried. Can you tell me what's going on?",
  "input": "",
  "output": "The symptoms seem to indicate that you have emphysema, which is a form of chronic closed lung disease."
},
{
  "instruction": "There's doctors, coughs, all kinds of pain, elbow spasms, tics, sometimes sharp chest pains, and what's the cause of these symptoms?",
  "input": "",
  "output": "There could be a lung tumor, which causes respiratory problems, coughs, chest discomforts, depending on the symptoms, and it can also cause muscle spasms through the muscles in other parts of the body."
},
{
  "instruction": "Doctor, I've been experiencing a number of symptoms in recent years, such as the swelling of the eyes, coughing, overgrowing height, back pain, and what are the causes of all these symptoms?",
  "input": "",
  "output": "The symptoms suggest that you're having menopause."
},
{
  "instruction": "Doctor, I'm feeling heat and cold, and I'm breathing, elbow convulsion, and I'm losing weight, and it's like I'm growing too tall.",
  "input": "",
  "output": "The symptoms seem to indicate that you have cytosis, which is an infection caused by the larvae of a proboscis, which can cause symptoms such as headaches, seizures, muscle weakness, and you have to do some tests to identify the diagnosis and develop a treatment plan."
},
{
  "instruction": "Doctor, I'm experiencing an abnormally involuntary movement, a weakening of elbows, an overgrowth with two continuous passages, and what do you think is a problem?",
  "input": "",
  "output": "The symptoms suggest that you have a parasite infection called cystic fever."
},
{
  "instruction": "Hi doctor, I've been feeling heat and cold recently with elbow spasms and cramps, and I've been vomiting sometimes and having seizures in the past, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms suggest that you have cystic disease, a parasite infection caused by roundworm eggs, which affects the body's parts and can cause seizures, cramps, vomiting and other symptoms."
},
{
  "instruction": "Doctor, vomiting, wrist weakness and seizures. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to lead to cystic cystosis in body tissue, which affects the nervous system, leading to seizures and deterioration of certain parts of the body."
},
{
  "instruction": "Doctor, you're having cramps and spasms with lower abdominal pain.",
  "input": "",
  "output": "The symptoms seem to indicate that you've recently had induced abortion surgery, and in order to get proper treatment, you have to inform your medical staff about recent procedures, have you had an abortion recently?"
},
{
  "instruction": "Doctor, I'm experiencing tics, cramps, menstrual failure, pregnancy problems, menstrual bleeding, can you tell me what's wrong with me?",
  "input": "",
  "output": "From your symptoms, I think you have induced abortion that can cause these complications, and it's good to check and discuss the treatment options that you need through a thorough examination."
},
{
  "instruction": "Doctor, I haven't been around for a while, and I have a clot when it comes out, and I've had some abnormal vaginal secretions, and I've had some problems during pregnancy, and I've stopped getting pregnant with induced miscarriages.",
  "input": "",
  "output": "In view of your symptoms and your history, complications caused by induced abortion can result in blindness or blood clots and vaginal secretions, and it's important to be examined to see if there's any more complications."
},
{
  "instruction": "Doctor, there were some problems in the sharp abdominal passage during pregnancy.",
  "input": "",
  "output": "There's a possibility that there might have been a leading legacy to delay as a symptom, and we need to do some tests to confirm this diagnosis."
},
{
  "instruction": "Doctor, I'm experiencing blood clots, menstrual bleeding, cramps and cramps, sharp abdominal pain, stains or bleeding during pregnancy.",
  "input": "",
  "output": "It's possible that you had induced abortion when you put it off as a symptom."
},
{
  "instruction": "Doctor, the baby coughs a lot these days, and it seems to have decreased its appetite, what's wrong with the baby?",
  "input": "",
  "output": "The baby seems to be suffering from tooth loss syndrome, which is a common symptom of an infant developing a cough, loss of appetite, irritation, and so on."
},
{
  "instruction": "Doctor, my baby has recently had diarrhea, redness of ears, loss of appetite, and it's very annoying.",
  "input": "",
  "output": "The symptoms that God explains indicate that the baby is suffering from Igali's syndrome."
},
{
  "instruction": "Hi, doctor, there's an ear-up and a fever. What is it?",
  "input": "",
  "output": "These symptoms are usually caused by Igali syndrome."
},
{
  "instruction": "Doctor, the baby's appetite seems to have decreased recently.",
  "input": "",
  "output": "The pain and discomfort associated with this can often lead to loss of appetite."
},
{
  "instruction": "Doctor, you've got two-vascular sharp abdominal pain going on. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that you're suffering from infectious stomach infections caused by a virus or bacteria in your digestive tract."
},
{
  "instruction": "Doctor, I'm experiencing diarrhea and loss of appetite. What's the cause?",
  "input": "",
  "output": "It's possible that the symptoms are infectious stomach infections."
},
{
  "instruction": "There's a doctor, a vomiting, a fever, a sharp abdominal pain. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to cause infection intestinal infections caused by viruses or bacteria that can cause inflammation, diarrhea or nausea."
},
{
  "instruction": "Doctor, what's wrong with the recent low fluid flow?",
  "input": "",
  "output": "Yes, there could be infectious intestinal infections, which cause fluids, diarrhea and vomiting, caused by a virus or bacteria inflammation of the stomach and intestines."
},
{
  "instruction": "Doctor, burning abdominal pain, vomiting, sharp abdominal pain, headache, fever.",
  "input": "",
  "output": "The symptoms suggest that there's an infection of the stomach and intestines caused by bacterial or viral infections."
},
{
  "instruction": "Doctor, a few days ago, I had ear pain. Why?",
  "input": "",
  "output": "It's the result of acute sinusitis, which is caused by sinus inflammation and pressure and pain in the surrounding area, including the swelling of the ear."
},
{
  "instruction": "Hi, doctor. It's hard to breathe through your nose and your brain keeps getting sick. What's wrong?",
  "input": "",
  "output": "The symptoms suggest that you have acute sinusitis."
},
{
  "instruction": "Doctor, you've recently had severe facial pain and sinus failure. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you have acute sinusitis."
},
{
  "instruction": "Doctor, I have a headache with nausea. What's going on with me?",
  "input": "",
  "output": "This rare genetic disorder can form tumors in various parts of the body, including the brain, and nausea and headaches may be caused by brain tumors."
},
{
  "instruction": "We're experiencing excessive growth, kidney mass, headaches, seizures, fatigue.",
  "input": "",
  "output": "The symptoms seem to indicate that you have Pon Hipel-Lindau disease. Have you been diagnosed with this disease before?"
},
{
  "instruction": "Doctor, we're experiencing low vision, loss of sense, nausea, fatigue. What's the cause of these symptoms?",
  "input": "",
  "output": "It's a genetic disorder that can cause tumors in various parts of the body, such as the brain, spinal cord, and eyes, which can cause various symptoms, including neurological problems, such as vision problems and sensory disorders."
},
{
  "instruction": "Doctor, there's blood in your urine, there's pain in your knee, and what's the cause?",
  "input": "",
  "output": "It's a rare genetic disorder that can develop various types of tumors in different parts of the body, including kidneys and joints. Note: This conversation is provided only for education and should not be taken as medical advice."
},
{
  "instruction": "Doctor, I've recently experienced hostile behavior, delusions, excessive anger, physical illness, depression and psychosis, and what's the problem?",
  "input": "",
  "output": "The symptoms suggest you're having a drug-related mental disorder."
},
{
  "instruction": "Doctor, I'm experiencing hostile behavior and fear and I'm feeling alcohol abuse and depression.",
  "input": "",
  "output": "The symptoms seem to indicate that you're having a drug-related mental disorder."
},
{
  "instruction": "Hi, doctor, I've been having a lot of drinks lately to get some sleep.",
  "input": "",
  "output": "God's explanation suggests you're having a hard time with drug-related psychosis."
},
{
  "instruction": "Doctor, I'm suffering from depression and psychosis, along with drug abuse, and I'm having problems with movement and a lot of depression.",
  "input": "",
  "output": "Your symptoms suggest you're suffering from drug-related psychosis."
},
{
  "instruction": "Doctor, I've been feeling a lot of anxiety and anxiety lately, and why?",
  "input": "",
  "output": "You may have a mental disorder associated with material things."
},
{
  "instruction": "Sir, I've had a baby six weeks ago, and I can't stop feeling sad, and I'm always nervous and I don't sleep well.",
  "input": "",
  "output": "Postpartum depression is a form of depression that can occur after childbirth, characterized by depression or mental symptoms, anxiety and anxiety, pregnancy or recent birth problems."
},
{
  "instruction": "Doctor, I'm really depressed these days, and I gave birth to a child about two months ago, and since then there's been a lot of pain and depression and depression during pregnancy.",
  "input": "",
  "output": "It's very common to have depression and mood swings after childbirth, and a lot of women have it, but it's important to take care of professional help if feelings of sadness, anxiety, despair and fatigue persist."
},
{
  "instruction": "Doctor, I'm experiencing some abnormal symptoms after giving birth, and I'm feeling so depressed, and I sometimes feel so nervous, and I have a lot of anxiety, and I have a little bit of fracturing and bleeding during my pregnancy.",
  "input": "",
  "output": "Postpartum depression is a common disease affecting many women after childbirth, which can cause a wide range of symptoms, such as drug abuse, depression or mental symptoms, anxiety and neurosis, stains and bleeding during pregnancy."
},
{
  "instruction": "I've recently had drug abuse, delusions, hallucinations, and I had a baby a few months ago, and what's wrong with me?",
  "input": "",
  "output": "Your symptoms and your recent pregnancy seem to indicate that you're suffering from postpartum depression."
},
{
  "instruction": "Doctor, I think you're feeling depressed and having trouble with your drug abuse, and I had a baby a few months ago.",
  "input": "",
  "output": "Postpartum depression can cause a lot of symptoms, including drug abuse after childbirth, and it's important to talk about what's going on and to plan for treatment."
},
{
  "instruction": "I'm experiencing a doctor, a headache, a sharp chest pain, a convulsion of a leg, a spasm, a chest ache. What's the cause of all these symptoms?",
  "input": "",
  "output": "CAD is a condition in which cholesterol builds up on the arteries that supply blood to the heart, causing chest pain, palpitations, and irritation."
},
{
  "instruction": "Doctor, with irregular heartbeat, there's sharp chest pain. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that you have a condition called coronary edema, which occurs when plaque builds up in arteries that supply blood to heart muscle, causes chest pain and irregular heart rate."
},
{
  "instruction": "I'm experiencing a doctor, a head injury, a sharp chest pain, irregular heartbeat, and what's the cause?",
  "input": "",
  "output": "The symptoms suggest that coronary edema is a narrowing of arteries that supply blood to the heart, which can cause chest pain, shortness of breath, irregular heart rate. We need to run some tests to check this out and discuss potential treatment options."
},
{
  "instruction": "Doctor, you've recently had a strange condition: lymphoma, leg convulsion, spasms, truancy, irregular heartbeat, what's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from coronary edema, a condition in which the arteries that supply blood to the heart are narrowed and rigid, causing blood flow and oxygen to the heart muscle."
},
{
  "instruction": "Doctor, I have a sharp chest pain recently. Can you tell me what's wrong?",
  "input": "",
  "output": "There's a possibility that there's a coronary pericardiosclerosis in the symptoms."
},
{
  "instruction": "Doctor, there's pain in your leg, stinging pain, and then it goes away, and what's the cause?",
  "input": "",
  "output": "It's a form of arthritis that affects the spine, which can cause pain in the leg, and I want to run some tests to confirm the diagnosis."
},
{
  "instruction": "Sir, backaches, leg pain, back cramps, tics, muscle spasms are going on for a while. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you have spinalitis, and you have to do some tests to check your diagnosis."
},
{
  "instruction": "Doctor, what are the symptoms of pain in the side and the leg?",
  "input": "",
  "output": "The symptoms could be spinalitis. Do you feel stiffness or tenderness in your neck or back?"
},
{
  "instruction": "Doctor, I'm experiencing severe neck pain, lower body pain, back cramps, cramps, leg pain, tell me what might be the problem.",
  "input": "",
  "output": "The symptoms seem to indicate that you have spinalitis, a form of arthritis that affects the spinal cord and causes pain and stiffness, and you can test it with a few tests and start proper treatment."
},
{
  "instruction": "Doctor, I've been experiencing back cramps and cramps a couple of weeks ago, and what's the cause?",
  "input": "",
  "output": "You may have spinalitis as a symptom."
},
{
  "instruction": "Doctor, I've been experiencing a number of unusual symptoms recently, such as swelling of muscles and a slight loss of sense of certain areas.",
  "input": "",
  "output": "The pituitary gland is a cancer in the pituitary gland in the brain that can cause muscle swelling, loss of sense, low vision, low nose, and a variety of other symptoms, and we need to do some tests to identify the diagnosis and determine how best to treat it."
},
{
  "instruction": "Doctor, I'm experiencing weight gain, long periods of menstruation, nosebleeds, nausea, what's the problem?",
  "input": "",
  "output": "The symptoms can be known as the pituitary gland, which can cause a hormone imbalance in the pituitary gland, causing such symptoms as weight gain, menstruation, corpuscles and nausea."
},
{
  "instruction": "Doctor, nosebleed, muscle edema, sensory loss, nausea, what's the cause?",
  "input": "",
  "output": "These symptoms are signs of the pituitary gland, which is a non-arterial tumor in the pituitary gland that can cause various symptoms, including the hormone imbalance that you're talking about."
},
{
  "instruction": "Doctor, sensory loss, dizzyness, nausea continue for a while. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to be the pituitary gland, which is a tumor that grows in the pituitary gland, which can cause a variety of symptoms, including the symptoms you described."
},
{
  "instruction": "Sir, I'm experiencing low vision. Do you want to know why?",
  "input": "",
  "output": "The symptoms suggest that there's a pituitary gland."
},
{
  "instruction": "Doctor, I'm having a hard time getting pregnant, and my period lasts more than a week, and I'm bleeding through my period, and I have severe menstrual pain, sometimes unconscious urine during my period.",
  "input": "",
  "output": "The symptoms seem to indicate that there's a uterine rootoma."
},
{
  "instruction": "Doctor, sharp abdominal pain, long period of menstruation, convulsions and convulsions.",
  "input": "",
  "output": "The symptoms seem to indicate that there's a uterine rootoma."
},
{
  "instruction": "Sir, I've had a lot of hip pain lately, and my period is very heavy. Can you tell me what's going on?",
  "input": "",
  "output": "I think there's a cancerous tumor in the uterus that can cause pelvic pain and edema, but I'm going to have to run some tests to confirm it, but that's what the symptoms tell me."
},
{
  "instruction": "Doctor, I'm sweating with a sudden menstrual hemorrhage, and what's the reason for that?",
  "input": "",
  "output": "It's not usually associated with sudden menstrual bleeding, but the combination of these symptoms can indicate a much more fundamental medical problem, which is that it's good to do additional tests to figure out the cause."
},
{
  "instruction": "Doctor, I found a clot during my period, so what's the problem?",
  "input": "",
  "output": "It could be an acute menstrual hemorrhage."
},
{
  "instruction": "Hi doctor, I'm experiencing hip pain and unpredictable menstruation, and I have some clots and some vaginal secretions during my period.",
  "input": "",
  "output": "Yes, symptoms seem to indicate that there's a specific menstrual hemorrhage."
},
{
  "instruction": "Doctors, lots of vaginal secretions, sweats, can't predict menstruation, period lasts longer than usual, and we're experiencing some unusual symptoms.",
  "input": "",
  "output": "The symptoms that God has described indicate that you're suffering from unusual menstrual and E.F."
},
{
  "instruction": "I'm experiencing hip pain, sharp abdominal pain, and urinary pain, and my period is longer than usual.",
  "input": "",
  "output": "The symptoms seem to indicate that there's a specific nonmenstrual hemorrhage."
},
{
  "instruction": "There's a problem with your eyes, and you feel itch and you feel it with your eyelids, and your vision is impaired, and what's the cause of your symptoms?",
  "input": "",
  "output": "I think there's a calijion, a little lump on the eyelids, that can stimulate the eye and cause eye problems, but it's not a serious disease."
},
{
  "instruction": "Sir, I've had a lot of snow lately.",
  "input": "",
  "output": "I think there's a little lump in the eyelid that's blocking the oil glands."
},
{
  "instruction": "Doctor, there's a swelling of the eyes, there's a slight lump in the eyelids, there's pain, there's a lump, what's the problem?",
  "input": "",
  "output": "It's a small lump or lump in the eyelid, which can cause pain and swelling in the eye and lead to lesions or rashes in the eyelids."
},
{
  "instruction": "Sir, my eyes are so troubled, they're red, they're swollen, they're itchy.",
  "input": "",
  "output": "I think you're experiencing a calijion."
},
{
  "instruction": "Doctor, your eyes are swollen and swollen.",
  "input": "",
  "output": "The symptoms seem to indicate that you have a collarion."
},
{
  "instruction": "We're experiencing doctor, knee swelling, lower abdominal pain, and skin edema. What's the cause?",
  "input": "",
  "output": "Maybe it's a case of endocrinosis. Have you experienced other symptoms, such as nausea or vomiting?"
},
{
  "instruction": "Sir, there's an unwanted hair growing on your face, and your knees are swelling, and there's a sharp abdominal pain, accompanied by a stern abdominal and pelvic pain.",
  "input": "",
  "output": "The symptoms may indicate that it's cyclic."
},
{
  "instruction": "Doctor, I'm experiencing lower abdominal pain, knee swelling, whole body pain, even acne or acne, but now I have a sharp abdominal pain.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from endostasis, which occurs when the ovaries twist around the blood supply and with severe pain the area swells, and I want to do some tests to identify the diagnosis and determine how best to treat it."
},
{
  "instruction": "Hi, doctor, I've been experiencing a sharp pelvic pain in the last few days, and what's the cause?",
  "input": "",
  "output": "Nitrogen bases can occur when blood supply is blocked when the ovaries are twisted, causing severe pain in the pelvis. It's good to run some tests and scans to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I've been having symptoms of irregular nails, eye swelling, and my recent vision has been impaired.",
  "input": "",
  "output": "This is a symptom of retinal disease caused by high blood pressure."
},
{
  "instruction": "Doctor, you're having strange symptoms, your nails look irregular, your vision seems to fall down, and you see spots and clouds in your eyes, and sometimes pus flows out of your ears.",
  "input": "",
  "output": "It can damage blood vessels in the back of the eye and cause other symptoms such as vision problems, seemingly irregular nails, pus coming out of the ear."
},
{
  "instruction": "Sir, your vision has been poor lately, and you've got lumps on your eyelids. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that retinal disease is a condition that affects the blood vessels of the retina, causing damage to the vision, and a lump of the eyelids can be parakeets, which are common diseases that can occur when bacteria infect the oil glands of the eyelids."
},
{
  "instruction": "Doctor, your eyes are in pain and pus is coming out of your ears. What's the problem?",
  "input": "",
  "output": "These symptoms can cause retinal disease due to high blood pressure, which occurs when high blood pressure damages the blood vessels of the retina, causing fluid leaks into the eye, causing vision problems, which may not involve the two, so additional tests are needed to confirm the diagnosis."
},
{
  "instruction": "Doctor, I've recently noticed that there's a sensation in my eyes, and there's a pain in my eyes, and there's a symptom that sometimes I can't see.",
  "input": "",
  "output": "The symptoms suggest that retinal disease from high blood pressure is developing."
},
{
  "instruction": "Doctor, I recently experienced a sharp abdominal pain.",
  "input": "",
  "output": "The symptoms suggest that there is a suspicion of vaginal yeast infection."
},
{
  "instruction": "Doctor, I'm having an ongoing uterine stimulation, and I'm pregnant right now, so what's the problem?",
  "input": "",
  "output": "The symptoms are likely to indicate that the yeast infection is common during pregnancy and can cause intrauterine stimulation, and it's important to be treated to avoid complications."
},
{
  "instruction": "Doctor, I'm experiencing vaginal pain and uterine stimulation. What's the problem?",
  "input": "",
  "output": "It looks like there's a yeast infection, and you have to see it for confirmation."
},
{
  "instruction": "Doctor, sharp abdominal pain, squeamishness, hip pain, vaginal secretions and skin ugliness. Do you want to know what causes these symptoms?",
  "input": "",
  "output": "The symptoms are likely to indicate that it's yeast infection, and you have to do some physical tests and some tests to confirm this diagnosis."
},
{
  "instruction": "Doctor, there's been a lot of extracurricular stimulation recently, and why is that?",
  "input": "",
  "output": "It's a common fungus infection that can cause the symptoms of vaginal and uterine nausea, fever, pain, and so forth."
},
{
  "instruction": "Hi, doctor, you know, I'm experiencing analystosis, facial pain, ear pain, a sense of deafness, a low hearing loss, do you know what's causing it?",
  "input": "",
  "output": "It's a disease that's infected with the mastic bone at the back of the ear, and you've described it as a common symptom of this disease."
},
{
  "instruction": "There's a fluid in the ear with a doctor, a fever, facial pain and an ear rash. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you have a disease called lactateitis."
},
{
  "instruction": "Hi doctor, cough, headache, facial pain.",
  "input": "",
  "output": "The symptoms seem to indicate that there is masticitis, which is often caused by an infection of the mastoid bone behind the ear."
},
{
  "instruction": "Doctor, it looks like you've been ringing in your ear a few days ago, and your hearing's been down, and you've got coughing and fever.",
  "input": "",
  "output": "The symptoms suggest that there is a suspicion of masticitis, which is inflammation of the back of the ear, and that there may be earlification, lower hearing, cough, fever, and so forth, and I would like to see the diagnosis, and I would like to be examined to determine how best to treat it."
},
{
  "instruction": "Doctor, I've been having headaches a few days ago, and it seems like it's getting worse, and it feels a little dizzy.",
  "input": "",
  "output": "It's an infection in the back of the ear that can cause such symptoms as double-passeria, and we need to do some tests to make sure we're diagnosed."
},
{
  "instruction": "Doctor, there's a lot of back pain and headaches, and why?",
  "input": "",
  "output": "Have you hurt your chest or your back recently? Patient: Yes, sir. I fell off my bike a few days ago."
},
{
  "instruction": "Doctor, I'm suffering from severe double-pass shoulder pain, and I feel dizzy most of the time.",
  "input": "",
  "output": "The symptoms suggest a lung contusion."
},
{
  "instruction": "Doctor, I've been having severe back pain lately.",
  "input": "",
  "output": "I think he's got a lung contusion."
},
{
  "instruction": "Doctor, elbow pain, difficult to breathe, shoulder pain, hip pain, hypothermic pain, low fluid. Can you tell me what's wrong?",
  "input": "",
  "output": "The symptoms suggest a lung contusion."
},
{
  "instruction": "Hi, doctor, you're having dizzyness, and you're having a really bad breath, and you've got back pain, so what's the problem?",
  "input": "",
  "output": "It could be a lung contusion, which is caused by trauma, which can cause respiratory problems, chest pain, headaches, back pain."
},
{
  "instruction": "Doctor, the coughing continues with swelling muscles and aching chests and anxiety and anxiety, and what's the cause of these symptoms?",
  "input": "",
  "output": "It could be non-replicating cardiomyopathy, which causes the heart to become thick, which makes it difficult for the heart to pump effectively."
},
{
  "instruction": "Doctor, cough, bite your nails, shortness of breath, anxiety and irritation, chest irritation.",
  "input": "",
  "output": "The symptoms indicate that the heart muscle is abnormally thick, making it difficult to get blood out of the heart, and that there's a chance that you're going to have non-retardive cardiomyopathy, which can cause coughing, nail biting, shortness of breath, anxiety, chest upset, and so forth."
},
{
  "instruction": "Doctor, I'm experiencing swelling and anxiety with elbow spasms. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there's a non-repair closed cardiomyopathy, which is a condition in which the heart muscle gets thick and interferes with the blood flow, which can be a result of the loss of blood to the muscles."
},
{
  "instruction": "Doctor, I'm feeling a lot of anxiety and anxiety these days, and I feel swelling my legs, and what's the cause?",
  "input": "",
  "output": "The symptoms suggest that there's a possibility that there's HOCM, that the walls of the heart muscle are thick enough to make it difficult for the heart to pump blood effectively, and swelling is the result of a buildup of fluid because the heart doesn't pump blood properly."
},
{
  "instruction": "I've recently felt a bad breath and a weakness in my elbow, and I've also felt nervous and nervous.",
  "input": "",
  "output": "The symptoms suggest that you have HOCM, which is a condition in which the heart muscle is abnormally thick and has difficulty pumping blood and causes respiratory difficulties and weakness of the arm."
},
{
  "instruction": "Doctor, your scalp isching, your feet and toes are swelling, and your throat is swollen.",
  "input": "",
  "output": "The symptoms may indicate that it's an introspective toenail."
},
{
  "instruction": "Doctor, there's skin growing around your toenails, and it's painful.",
  "input": "",
  "output": "I think it's possible it's an introspective toenail."
},
{
  "instruction": "Good morning, sir. There's a problem with the toes. The skin around the toes is stimulated and looks abnormal.",
  "input": "",
  "output": "The symptoms suggest that you have an endometriosis. Have you ever experienced pain or discomfort?"
},
{
  "instruction": "Doctor, I have a strange-looking toe with red toes and an infected skin, and I think it's too sick to be normal.",
  "input": "",
  "output": "The symptoms suggest that there's an introspective toenail."
},
{
  "instruction": "Doctor, for a while you're not feeling well, you're feverish, your nose is blocked, you're dizzy, your ears are red, you can't breathe properly.",
  "input": "",
  "output": "Symptoms can lead to an increased number of white blood cells in the lungs, which can cause inflammation and cause respiratory problems and fever."
},
{
  "instruction": "Doctor, I've had a lot of nosebleeds lately.",
  "input": "",
  "output": "It could be because of increased lung acidosis."
},
{
  "instruction": "Doctor, in the last few days, we've been experiencing nosebleeds, loss of sensations, pain in the entire body, and membrane force, and what's the cause of these symptoms?",
  "input": "",
  "output": "It's possible that you're suffering from increased lung acidosis, which is a disorder in your lungs that causes inflammation because of the excess accumulation of the parasol, which you're talking about as a result of this disease."
},
{
  "instruction": "Doctor, I've had a lot of trouble breathing these days, and I feel dizzy, and I want you to tell me what's wrong.",
  "input": "",
  "output": "There could be an increase in lung acidosis, a disease that accumulates in lung tissue that causes inflammation and respiratory problems."
},
{
  "instruction": "Doctor, I've been dizzy lately. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that you're suffering from increased lung acid."
},
{
  "instruction": "Doctor, I've had a lot of pain in my ass, and when I touch it, it's so warm that it's been bothering me for days.",
  "input": "",
  "output": "I think you're in pain because you've got a hip injury, and you're going to have to decide what's best for you, and you're going to come to your clinic and you're going to have a checkup, and you're going to be in pain, and you're going to be in pain, and you're going to be in pain, and you're going to be in pain, and you're going to be in pain, and you're going to be in pain, and you're going to be in pain, and you're going to be in pain, and you're going to be in pain."
},
{
  "instruction": "Doctor, a few days ago, I had hip pain and leg pain.",
  "input": "",
  "output": "Can you tell us more about the pain, or is it burning, or is it near sharp pain? Patient:"
},
{
  "instruction": "Doctor, it's very soft when your ass is swollen and you touch that part.",
  "input": "",
  "output": "I think there's an open hip wound."
},
{
  "instruction": "Doctor, I've had leg pain for a while.",
  "input": "",
  "output": "There's an open wound in the hip that's causing the pain."
},
{
  "instruction": "Doctor, I've recently had severe pain in my leg.",
  "input": "",
  "output": "This pain can be caused by a wound in the hip."
},
{
  "instruction": "Sir, I've had a lot of tears lately, and I've always got a lot of eyes, and I've got two objects on my eyelids, and I've got rashes.",
  "input": "",
  "output": "You have to do some tests to diagnose exactly what kind of disease it is, but the symptoms that you've described are common symptoms of this type of disease."
},
{
  "instruction": "Sir, your eyes are really hard. They're swollen and red.",
  "input": "",
  "output": "Symptoms can lead to corneal disease."
},
{
  "instruction": "Doctor, I've recently experienced low vision and pain in my left eye.",
  "input": "",
  "output": "Symptoms indicate that there's a possibility of corneal disease."
},
{
  "instruction": "Sir, in the last few days, I've been seeing something in my eyes, and why?",
  "input": "",
  "output": "The symptoms seem to indicate that there's a corneal disease that can cause blindness and discomfort, and you have to test your eyes for the correct diagnosis and proper treatment."
},
{
  "instruction": "Doctor, you're experiencing white secretions in your eyes, white pain in your eyes, and you've recently seen two objects, and what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you have corneal disease, and you have to do some tests to figure out the exact cause of the symptoms, but you're safe because you're doing everything you can to treat them effectively."
},
{
  "instruction": "Doctor, there are symptoms of vomiting, nausea in the neck, and no changes.",
  "input": "",
  "output": "It looks like there's a foreign substance in the stomach."
},
{
  "instruction": "Sir, my neck is sore, and my feet and toes are constantly convulsing.",
  "input": "",
  "output": "It looks like there's a foreign substance in the stomach, and this is what it looks like."
},
{
  "instruction": "Doctor, recently you've been vomiting blood, you've been losing your stool, you've got a problem with your temper.",
  "input": "",
  "output": "There's a foreign substance in the stomach that seems to cause these symptoms."
},
{
  "instruction": "Doctor, I'm having trouble vomiting and swallowing a lot of stuff these days.",
  "input": "",
  "output": "The symptoms suggest that there is a foreign substance in the stomach."
},
{
  "instruction": "Doctor, it's hard to swallow, and you feel like you've got something in your neck, so what's the cause?",
  "input": "",
  "output": "I think there's something in the stomach that's hard to swallow."
},
{
  "instruction": "Doctor, there's been a severe eye tear recently, and what's the cause?",
  "input": "",
  "output": "Endometriosis can be the cause of the symptoms: severe eye infections that can cause tears, intubation and pain."
},
{
  "instruction": "Doctor, I'm experiencing low vision, low eye pain, eye appendix, skin lesions, sinus pain.",
  "input": "",
  "output": "The symptoms seem to indicate that there's an inflammation of the inner layer of the eye, and we need to test the diagnosis and start treating it as soon as possible."
},
{
  "instruction": "Doctor, I've recently had pain in my feet or toes.",
  "input": "",
  "output": "I'm sorry, but your symptoms have nothing to do with the current disease, and I'm sorry to let you know that there's eye disease."
},
{
  "instruction": "Sir, my eyes are really hard. They're so red and swollen.",
  "input": "",
  "output": "I think you're suffering from ophthalmosis when you put it off as a symptom."
},
{
  "instruction": "Doctor, Young-a-ha, diarrhea, sharp abdominal pain, absorption, and tell me what causes these symptoms.",
  "input": "",
  "output": "The symptoms seem to indicate that you're having intestinal absorption disorder."
},
{
  "instruction": "Doctor, I'm experiencing allergic reactions, and recently my baby vomits a lot. What's the problem?",
  "input": "",
  "output": "When you put it off as a symptom, it's possible that the ear and the baby will suffer from bowel absorption disorder, which is when the body doesn't really absorb nutrients from the food."
},
{
  "instruction": "In recent years, the baby has had sharp abdominal pain, diarrhea, vomiting, and nose pressure, and it's very annoying.",
  "input": "",
  "output": "I think you're suffering from intestinal absorption disorder when you can't absorb a certain amount of nutrients and water from the small intestine."
},
{
  "instruction": "Doctor, a two-month-old baby has a lot of vomiting, a lot of toilets and a sharp abdominal pain with diarrhea.",
  "input": "",
  "output": "The baby may have a bowel absorption disorder that can cause these symptoms."
},
{
  "instruction": "Doctor, you've had a toilet in the last few days, and why?",
  "input": "",
  "output": "The bowel absorption disorder, which is a condition in which food is not properly absorbed in the small intestine, can cause toilets, and you have to do extra tests to make sure you're diagnosed."
},
{
  "instruction": "Teacher, ankle pain, fatigue, joint stiffness, eye pain continues.",
  "input": "",
  "output": "There's a possibility that Germany in lead could be very harmful, so you have to have it tested immediately."
},
{
  "instruction": "Doctor, I often peed at night, and I had cramps or cramps on my shoulder.",
  "input": "",
  "output": "You may be suffering from lead poisoning. Have you been exposed to lead at work or at home?"
},
{
  "instruction": "Sir, there's been a lot of shoulder spasms, tics, pain during pregnancy, pain in the breast, wear, and pain in the face and ankle, and why?",
  "input": "",
  "output": "The symptoms seem to be the result of lead poisoning, which can lead to lead-infected diseases that we just talked about."
},
{
  "instruction": "Doctor, I've recently been very angry and frustrated, and I've also had severe pain in my ankles.",
  "input": "",
  "output": "The symptoms suggest that lead poisoning is suspect. Have you had contact with a product that contains lead or lead."
},
{
  "instruction": "Doctor, you've got pain in your eyes and a lump in your knee. Do you know what's causing it?",
  "input": "",
  "output": "You're likely to have lead poisoning depending on your symptoms. Have you been exposed to lead lately?"
},
{
  "instruction": "Doctor, I'm really distressed by the strange skin spots on my fingers and feet.",
  "input": "",
  "output": "It's a common skin disease caused by an HPV virus."
},
{
  "instruction": "Doctor, you've got a strange stone on your finger, and it won't go away.",
  "input": "",
  "output": "I think there's a viral wart."
},
{
  "instruction": "Doctor, I found on my finger skin dots and growing skin lesions, and I also had warts on my face, and why?",
  "input": "",
  "output": "The symptoms seem to indicate viral warts that are caused by viruses that can be spread through contact to other parts of the body."
},
{
  "instruction": "Doctor, I'm experiencing unusual symptoms such as vomiting, cramps and cramps, warts and coughs. What does that mean?",
  "input": "",
  "output": "These symptoms are not related to each other, because vomiting and cramps can cause stomach problems, and the warts can be caused by viral infections and coughs can be caused by respiratory infections, but all of these symptoms are not related to a disease that is characterized by excessive rashes."
},
{
  "instruction": "We're experiencing symptoms of doctors, headaches, warts, redness of ears, do you know what might be the problem?",
  "input": "",
  "output": "Yes, the disease that can cause these symptoms is severe, which is a condition characterized by excessive rashes, but I don't know how this is related to headaches, warts and backaches."
},
{
  "instruction": "Doctor, headache, fever, redness of the ear, cough, and convulsions are happening. What's the problem?",
  "input": "",
  "output": "But since your symptoms are not typical of chronic symptoms, I'd like to run some additional tests for an accurate diagnosis."
},
{
  "instruction": "Sir, when you have a wart in your hand, what's the cause of the redness of your ears?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from a hyperspirium that can cause warts and skin irritations."
},
{
  "instruction": "Doctor, I've recently had a lack of energy and a problem with my memory. What's wrong with me?",
  "input": "",
  "output": "You're having a stroke, and you have to run some tests to check it out, and it's good to go to the hospital immediately and get a scan."
},
{
  "instruction": "We're experiencing a doctor, a memory disorder, a weakness, even depression. What's the cause of these symptoms?",
  "input": "",
  "output": "It's also important to run some additional tests to figure out the cause and extent of the stroke, and to start treatment immediately to prevent further damage."
},
{
  "instruction": "I'm experiencing doctors, dizziness, headaches, memory problems, sometimes depression or psychosis, and what can happen to me?",
  "input": "",
  "output": "From the symptoms that God explains, it's possible that a stroke may have occurred, and it's important to run additional tests to determine the cause and extent of the stroke, and start the appropriate treatment immediately."
},
{
  "instruction": "Doctor, I can't talk about it these days, and I feel depressed, and there's a lot of memory loss, and there's a lot of weakness on the right side of the body.",
  "input": "",
  "output": "It's possible that it's a stroke, and we need to run some tests to make sure that we're diagnosed, and we need to start treating it as soon as possible."
},
{
  "instruction": "Doctor, one of your senses is failing, your focus is failing, and you've got movement problems.",
  "input": "",
  "output": "You might have a stroke if you were to put it off because of the symptoms that you described, and it's good to get medical attention right away."
},
{
  "instruction": "Doctor, we found that there's pain in the anus and that the scalp looks irregular. What's the problem?",
  "input": "",
  "output": "It could be a phallic cyst that grows abnormal skin near the base of the tail."
},
{
  "instruction": "Sir, your entire lower body hurts, your skin swells, and you feel pain around your anus.",
  "input": "",
  "output": "It's a very common disease, but it may require medical attention."
},
{
  "instruction": "Doctor, we found a skin swelling near the tailbone, and what was it that caused it?",
  "input": "",
  "output": "It's likely to be pyrogenoma, which is formed near the tailbone, which can cause swelling and discomfort."
},
{
  "instruction": "Sir, there's a strange mass on your back and there's a lot of pain in your anus, and it's like there's an irregular skin around it and there's a lot of fluid in it.",
  "input": "",
  "output": "The symptoms suggest that there's pyrogenoma, a form of cystic or absorption between the pleats around the tailbone, that the inflammation caused by cystic cysts causes the skin to grow and develop irregularly."
},
{
  "instruction": "Doctor, I found a slight swelling of the waist and irregularness of the scalp, and I also had a sore body and hypothermic pain, so what's the problem?",
  "input": "",
  "output": "The symptoms might indicate that there's a cystic cyst."
},
{
  "instruction": "Doctor, I've been suffering from recent foot pains and tremors. What's the cause?",
  "input": "",
  "output": "The symptoms suggest that he's injured."
},
{
  "instruction": "Hi, doctor, there are some disturbing symptoms.",
  "input": "",
  "output": "What are the symptoms: swelling of the neck and lymphoma?"
},
{
  "instruction": "Doctor, what's the problem with the pain and swelling of the ankles in your hand?",
  "input": "",
  "output": "The symptoms seem to indicate a fracture."
},
{
  "instruction": "Hi, doctor, there's a lot of pain in your feet and toes, especially when you're weighting.",
  "input": "",
  "output": "If the patient had more information about the injuries, the doctor would have been better able to diagnose them."
},
{
  "instruction": "Sir, your hands are swollen and your feet are very sick. Do you know the cause?",
  "input": "",
  "output": "The symptoms seem to indicate a fracture."
},
{
  "instruction": "Doctor, I have recently suffered from motor disorders, memory problems, headaches, even depression or psychiatric symptoms.",
  "input": "",
  "output": "The symptoms are likely to lead to normal pressure chickenpox, a condition that causes the abnormal accumulation of spinal fluid in the brain's chambers."
},
{
  "instruction": "Doctor, you know what's causing these symptoms?",
  "input": "",
  "output": "Yes, I think you're experiencing symptoms of normal pressure chickenpox."
},
{
  "instruction": "Doctor, it's hard to talk, and I feel a lump in my throat together.",
  "input": "",
  "output": "These symptoms can be normal-pressure chickenpox, and you have to do some tests to check your diagnosis."
},
{
  "instruction": "Doctor, you've got involuntary urination, palpitations, motor problems, headaches, buttballs or sores. What's the problem?",
  "input": "",
  "output": "The symptoms may indicate that the brain has a buildup of brain spinal fluid, which causes motor problems, short-term payments, cognitive problems, normal pressure chickenpox."
},
{
  "instruction": "There's a doctor, a head injury, a motor disorder, a butt mass, or a mass. What's the cause?",
  "input": "",
  "output": "These are symptoms of normal pressure chickenpox, where brain spinal fluid accumulates too much in the brain's brain, causing motor disorders, chest rashes, buttocks or sores, which require several additional tests to identify the diagnosis."
},
{
  "instruction": "Doctor, recently your scalp has turned irregularly, your skin has become swollen, you've got acne, you've got spines, you've got skin growth, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you have hair loss."
},
{
  "instruction": "Doctor, your scalp is dry, your textures are rising, and you have acne and acne in your head.",
  "input": "",
  "output": "The symptoms are likely to indicate that hair loss, which affects scalp hair, can dry or peel the scalp and cause acne and acne."
},
{
  "instruction": "Doctor, your skin's swelling and itching. What's the problem?",
  "input": "",
  "output": "The symptoms may indicate hair loss, a form of autoimmune disease that affects the follicles."
},
{
  "instruction": "Doctor, I've been experiencing a recent headgear, warts, and so on, and why?",
  "input": "",
  "output": "Hashimoto thyroiditis can cause a double base because it causes thyroid hyperthyroidism. So warts and gash may be caused by autoimmune diseases such as Hasmoto thyroiditis. You need to run some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I'm always feeling heat, and I've recently gained weight a little bit. What's wrong with me?",
  "input": "",
  "output": "The symptoms suggest that thyroid disease in the Hasmoto is in doubt."
},
{
  "instruction": "Doctor, your menstrual level has increased recently. What's the cause?",
  "input": "",
  "output": "Hashimoto thyroiditis. Any other symptoms, such as fatigue or weight gain?"
},
{
  "instruction": "Hi doctor, I've been feeling a lot of heat lately, and I've been experiencing tension and hypersensitivity in my fingers, and what's the cause of all of this?",
  "input": "",
  "output": "The symptoms suggest that you have autoimmune disease that affects the thyroid, hemoto thyroid disease."
},
{
  "instruction": "Sir, there's been some weird symptoms recently: there's warts in your hands and feet, abnormally heavy period, and you feel a lot of heat all the time.",
  "input": "",
  "output": "Hasmotothyroiditis is a condition in which the immune system attacks the thyroid gland, thus reducing its thyroid function. This condition can cause a variety of symptoms, including the symptoms you described. It's good to check your diagnosis and run some tests to determine how best to treat it."
},
{
  "instruction": "Hi, doctor, there's been some problems with your eyes always getting tired, convulsive, stiff feet and toes and a little weight gain.",
  "input": "",
  "output": "It's likely to be flat feet, which cause movement problems and stiff feet and stiff toes, and weight gain may be caused by foot fatigue and loss of physical activity."
},
{
  "instruction": "Hi, sir. I've recently had knee pain and foot pain.",
  "input": "",
  "output": "The symptoms seem to indicate that you have a flat foot, which can cause pain by causing stress in your knees and your feet."
},
{
  "instruction": "Doctor, I've got movement problems, feet, ankles, toes, often, and I feel stiff and tight all the time.",
  "input": "",
  "output": "These symptoms are typical of flat feet, which are often called arched feet, which can't be properly worn when standing, which can cause pain in the feet, ankles, and toes, causing problems with posture and movement."
},
{
  "instruction": "Doctor, I think you've got pain in your feet and toes, and your feet are going inwards, and you've got movement problems, and what's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that it's likely to be a flat foot, which means that the foot's arch may break down and turn inward, causing the difficulty of pain and movement."
},
{
  "instruction": "Doctor, I have some problems with movement, especially when I walk, with feet feeling very heavy and easily tired, and what's the problem?",
  "input": "",
  "output": "It's a disease that can cause problems in gait and movement because your foot's arch is much more flat than usual."
},
{
  "instruction": "Doctor, sharp abdominal pain, weight gain, loss of sense, nosebleed. What's the problem?",
  "input": "",
  "output": "I think you're suffering from non-alcoholic liver disease."
},
{
  "instruction": "Hi, doctor, I've been experiencing chills and nausea for the last few days.",
  "input": "",
  "output": "I think you're suffering from non-alcoholic liver disease."
},
{
  "instruction": "Doctor, I've been experiencing more sensory problems lately. What's the cause?",
  "input": "",
  "output": "Sensitivity is a common symptom of non-alcoholic liver disease, didn't you have any other symptoms?"
},
{
  "instruction": "Doctor, you're uncomfortable with your movement, you're urinating a lot, you're all sick, you're a lump in your knee, you're stiff, what's the problem?",
  "input": "",
  "output": "The symptoms suggest that blood loss causes the swelling of the knee joint in the mid-month cartilage valve."
},
{
  "instruction": "Doctor, there's a lump in your knee that makes it difficult to move your knees -- elbow spasms, knee stiffness, shoulder pain.",
  "input": "",
  "output": "The symptoms seem to indicate that you have a fibula rupture in the middle of the month, which causes bleeding in your joints, which can cause swelling and pain and restrict movement."
},
{
  "instruction": "Doctor, your knee is in pain and your movement is in trouble.",
  "input": "",
  "output": "I think you have a hemothorax, which is a bleeding condition in your knee joint."
},
{
  "instruction": "Doctor, you've got movement problems, your knees feel stiff and tight, and what's the cause?",
  "input": "",
  "output": "The symptoms indicate that there's a lot of blood in the joint area, which causes swelling and stiffness or coldness in the joints."
},
{
  "instruction": "Doctor, I've got a swollen knee and ankle and a stiff feeling these days. What's wrong with that?",
  "input": "",
  "output": "The symptoms suggest that you have a hemothorax, a hemorrhagic disease with high blood in your joints."
},
{
  "instruction": "Sir, you've recently been drinking urine and getting your urine mixed with blood, and you've been waking up to see urine at night.",
  "input": "",
  "output": "I think you're suffering from hip edema, and you can do some tests to confirm your diagnosis."
},
{
  "instruction": "Doctor, I've been experiencing a number of symptoms recently, that I've always had a full bladder feeling, that I've had an involuntary urination, that I've been overfocusing at night, and that I have to go to the bathroom often during the day, and what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that the muscle and the ligature that support the pelvic organ is weakened, so that the organ can slide down and cause problems like diuretics and Vinbis, while there are treatments that can help to manage the symptoms."
},
{
  "instruction": "Doctor, your urine is recently filled with blood. What's the cause?",
  "input": "",
  "output": "It's a symptom of pelvic edema, muscle and tissue supporting the pelvis are weakened when the organ is pushed down into the vaginal wall, which can lead to urologistic problems, such as mixing urine with blood."
},
{
  "instruction": "There's bladder discomfort, frequent urination at night, vaginal secretions, and even blood mixed with urine.",
  "input": "",
  "output": "It could be a hip edema, which is a condition in which the pelvic muscles are weakened so that the bladder, the uterus, the workplace, the pelvic organs get out of place and press on the wall."
},
{
  "instruction": "We're experiencing menstrual bleeding, vaginal pain, upper jaw pain, excessive urination at night.",
  "input": "",
  "output": "It's a condition where the muscles and tissues supporting the pelvic organs are weakened, and it occurs when the organ falls from its normal position, and it causes the same symptoms that you described."
},
{
  "instruction": "Doctor, there's a lot of pain in your arm and swelling in your wrist. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate a fracture in the arm."
},
{
  "instruction": "Doctor, your arm's swollen and your elbow's swollen and your arm's stiff and warm, and what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate a fracture in the arm."
},
{
  "instruction": "Doctor, your wrists are swollen and very sick. What's the problem?",
  "input": "",
  "output": "Your arm seems to have broken. You need X-ray to confirm your diagnosis."
},
{
  "instruction": "Doctors, wrist pain, elbow stiffness, arm pain, wrist stiffness, shoulder stiffness.",
  "input": "",
  "output": "There's a fracture in the arm that's causing these symptoms."
},
{
  "instruction": "Doctor, your wrist is swollen, your arm hurts, your shoulder hurts, your elbows are stiff, your shoulders are cold, your shoulders are stiff, and you're experiencing cold symptoms.",
  "input": "",
  "output": "The symptoms seem to indicate a broken arm."
},
{
  "instruction": "Doctor, I'm vomiting blood these days. Why?",
  "input": "",
  "output": "Blood spill could be a symptom of blood clotting disorder, and we need to run some tests to see if that's the case."
},
{
  "instruction": "Doctor, there are some disturbing symptoms: there's blood in the urine, there's vaginal pain, and there's swelling legs and knees and vomiting.",
  "input": "",
  "output": "It could be blood mixed with blood, knee and leg swelling, vaginal pain and urine, and it's important to check your diagnosis and start a proper treatment plan as soon as possible."
},
{
  "instruction": "Doctor, I'm swelling my legs, and my menopause starts early, and what's the cause of these symptoms?",
  "input": "",
  "output": "These symptoms may be due to clotting disorders that affect the ability of the blood to clot properly."
},
{
  "instruction": "Doctor, your eyes are inoculated, and you have lymphoma, and you know what's going on with me?",
  "input": "",
  "output": "It's best to run some tests to identify the diagnosis."
},
{
  "instruction": "Doctor, I've recently had leg pain.",
  "input": "",
  "output": "It could be a clotting disorder, which can cause bleeding in muscles and joints, causing pain and swelling."
},
{
  "instruction": "Doctor, since you've recently had memory problems, vomiting, and headaches, what's the cause?",
  "input": "",
  "output": "Symptoms indicate that there may be a double internal bleeding caused by a rupture in the skull, and it's good to run some tests and start treatment as soon as possible to confirm the diagnosis."
},
{
  "instruction": "I'm having symptoms of doctors, motor disorders, vomiting, headaches, joint pains, dizziness.",
  "input": "",
  "output": "The symptoms seem to indicate that two internal bleedings caused by bleeding inside the skull could be very severe and require immediate medical attention."
},
{
  "instruction": "Doctor, it's hard to talk lately, and it's got vomiting.",
  "input": "",
  "output": "The symptoms seem to indicate that there's a double internal bleeding that's bleeding inside the skull, and in order to check this and start a proper treatment, you have to do an immediate diagnostic test."
},
{
  "instruction": "Doctor, recent nausea, sharp abdominal pain, depression or psychiatric symptoms, your body is getting sick and your heart rate is decreasing.",
  "input": "",
  "output": "From the symptoms that God explains, it's possible that you may have high potassium hemolytics that have too much potassium in your bloodstream. You have to run some tests to check your diagnosis."
},
{
  "instruction": "Doctor, I'm very sick these days, and I feel nauseous and dizzy with depression and mental symptoms, and what's the cause?",
  "input": "",
  "output": "The symptoms suggest that you may have high potassium hemolytics that occur when you have too much potassium in your blood, which can cause a variety of symptoms, including those you described."
},
{
  "instruction": "Doctor, since you've been experiencing a recent drop in heart rate, what's the cause?",
  "input": "",
  "output": "Did you ever experience other symptoms, such as weakness of muscle or depression?"
},
{
  "instruction": "Doctor, I've been vomiting a lot lately. What's wrong with that?",
  "input": "",
  "output": "It's more likely that it's a high potassium hemolysis, if you look at it as a symptom."
},
{
  "instruction": "Hi, sir, I'm here because I have a problem with my eyes, and I have spots and clouds, and I'm swollen and red, and I'm experiencing low vision, can you tell me what's wrong with my eyes?",
  "input": "",
  "output": "It's important to start treating the eye as soon as possible to prevent further damage."
},
{
  "instruction": "Doctor, I have a lot of eyes and tears. What's the problem?",
  "input": "",
  "output": "You need to start treating your eyes as soon as possible to prevent further damage."
},
{
  "instruction": "Doctor, you've recently had eye problems, and you've got spots or clouds in your eyes, and sometimes you've got eye stings or stings, and what's the problem?",
  "input": "",
  "output": "The symptoms that you've described suggest that you've got a corneal infection, and it's good to get an eye doctor as soon as possible to plan a proper diagnosis and treatment."
},
{
  "instruction": "Sir, I've had a lot of snow lately.",
  "input": "",
  "output": "I think you've got a corneal infection."
},
{
  "instruction": "Doctor, your eyes are so troubled, your eyes are so swollen, your lips are so swollen.",
  "input": "",
  "output": "The symptoms suggest that there is a suspicion of corneal infection."
},
{
  "instruction": "Doctor, I'm experiencing shortness of breath, loss of wrist, depression, loss of blood, vomiting, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that the lungs have an abscess, which is a serious disease that requires immediate treatment."
},
{
  "instruction": "Doctor, vomiting, cough, sharp chest pain, back pain. What's the problem?",
  "input": "",
  "output": "There could be a lung abscess as a result of the symptoms."
},
{
  "instruction": "Doctor, you're losing your breath, you're bleeding out of your neck, you're losing your wrist, you're vomiting blood, what's the problem?",
  "input": "",
  "output": "In view of the symptoms that God explains, it's possible that your lungs will have an abscess, and you need to take a chest X-ray and take a ray sample to check your diagnosis, and you need to start treating antibiotics immediately."
},
{
  "instruction": "Doctor, I've been experiencing overgrowth and headaches lately. Do you know what's causing it?",
  "input": "",
  "output": "These symptoms can be caused by lung abscess, which can cause local puss in the lungs to cause high fever, shortness of breath, chest pain, coughing of blood."
},
{
  "instruction": "Doctor, you've got shoulder cramps and tics. Why?",
  "input": "",
  "output": "Other symptoms include high fever, severe headaches, joint and muscle pain, fatigue, rashes, immediately needed to be tested for diagnosis."
},
{
  "instruction": "Doctor, you've got shoulder spasms and eye pain and fevers in the last few days.",
  "input": "",
  "output": "The symptoms seem to indicate dengue fever, which can cause severe symptoms due to viral infections transmitted by mosquitos, and I want you to come over for some tests to confirm your diagnosis."
},
{
  "instruction": "Doctor, you've got a pain in your wrist and a lump in your knee. What's the cause?",
  "input": "",
  "output": "It's possible that the symptoms are dengue. Have you experienced other symptoms, such as fever or two?"
},
{
  "instruction": "Doctor, a few days ago, you had a sore throat and shoulder cramps and wrist pains, and why?",
  "input": "",
  "output": "It seems to have dengue, which can cause joint and muscle pain with other symptoms."
},
{
  "instruction": "Doctor, the pain in the ear is going on for quite a while.",
  "input": "",
  "output": "There could be chronic sinusitis."
},
{
  "instruction": "Doctor, sinus, ear pain, headaches are going on for a while. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to be chronic sinusitis, which is an inflammation of the sinuses that lasts more than 12 weeks."
},
{
  "instruction": "Doctor, there's been sore throats and soreness for a while, and what's the cause?",
  "input": "",
  "output": "I think you've got chronic sinusitis, which is an inflammation of the sinus, which causes some of the symptoms of my nose, throat, and throat."
},
{
  "instruction": "Doctor, I've been suffering from sinus thrombosis and sinus pain for quite a long time, and my chest is sore and my nose is sore, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you have chronic sinusitis, a chronic sinusitis that causes inflammation of the sinuses and trouble to breathe and discomfort to you for more than 12 weeks."
},
{
  "instruction": "Doctor, you've got chest problems with facial pain and frontal lobes. What's the problem?",
  "input": "",
  "output": "You seem to have chronic sinusitis."
},
{
  "instruction": "Doctor, I recently felt lumps in my ear and blood in my ears, and there are symptoms of nose blockage and redness in my ears, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate that there is a type of pearl, which can occur in the middle, due to the accumulation of skin cells. Untreated, it can cause hearing loss and other complications. It's important to schedule additional tests for diagnosis and proper treatment planning."
},
{
  "instruction": "Doctor, I've been having a sense of deafness, and recently I've had skin growth and lumps in my ear, and I've had some bleeding in my ear, and I think I've had an allergic reaction, and what's the cause?",
  "input": "",
  "output": "The symptoms can cause hearing loss, paralysis, facial muscle weakness, while the growth of the skin cell, the type of pearl, may also cause ear infections and absorption; additional tests must be done to identify the diagnosis and determine the proper treatment."
},
{
  "instruction": "Doctor, there's blood in your ears, there's lumps in your ears, there's a sense of deafness in your ears, what do you think is the problem?",
  "input": "",
  "output": "The symptoms may indicate that you have a type of calcoma, a type of skin cyst in the back of the pericardium."
},
{
  "instruction": "Doctor, your ear has grown skin, your hearing has decreased, and you have red ears, and you have fluid inside, and you have a sense of deafness, and what's the cause?",
  "input": "",
  "output": "You may have pearls, which are a form of skin growth in the middle ear, which can cause hearing loss, rashes, liquid accumulation and blockage. You have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Sir, there's going to be puss in the ear, redness in the ear, and what's the cause?",
  "input": "",
  "output": "If you're suffering from symptoms, you can have a type of pearl that grows in skin cells, and you can cause inflammation, infection, and secretions in your ears, and you need to be consulted by an I.B. specialist immediately."
},
{
  "instruction": "Doctor, I'm swollen with feet and ankles, and my shoes aren't right, and they're very uncomfortable, and what's the cause?",
  "input": "",
  "output": "One of the causes of telophase is an I.V., and you have to run some tests to make sure you're diagnosed."
},
{
  "instruction": "Sir, there's a lot of toilets these days. What's the cause?",
  "input": "",
  "output": "Maybe there's a boublus that's self-distorted, that's able to cause nausea, nausea, and abdominal pain, and I recommend some additional tests to confirm the diagnosis."
},
{
  "instruction": "Doctor, I've been experiencing diarrhea for the last week. What's the cause?",
  "input": "",
  "output": "There could be a disease called Volvolis, if you put it off as a symptom."
},
{
  "instruction": "Doctors, elbow cramps, sharp abdominal pain, diarrhea, depression or mental symptoms, nausea, what's the cause of the symptoms?",
  "input": "",
  "output": "Volvolis is likely to suffer from stomach rashes, nausea, vomiting and related symptoms."
},
{
  "instruction": "Doctor, my fingers and hands are weak.",
  "input": "",
  "output": "It's the symptom of nerve damage that weakens the force."
},
{
  "instruction": "Sir, I hit my finger a few days ago, and since then my finger is stiff and swollen. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate a finger injury, stiffness and swelling are common symptoms of injuries like this."
},
{
  "instruction": "Good morning, sir. I hit my finger yesterday while playing soccer, and now it's pretty sick.",
  "input": "",
  "output": "The symptoms seem to have damaged the finger."
},
{
  "instruction": "Hello, sir, your fingers hurt a lot, and they're swollen.",
  "input": "",
  "output": "The symptoms seem to indicate injury to the finger."
},
{
  "instruction": "Doctor, your fingers are very painful and swollen, and your fingers feel stiff, and, oh, I think your scrotum is swollen.",
  "input": "",
  "output": "The symptoms you're talking about don't have to do with finger injuries, they're called the scrotum, and you can doubt that your hand or finger is stiff, or your finger is sharp, and I'm going to get a diagnosis."
},
{
  "instruction": "Doctor, I have to admit that I have a lump in my throat, and I've got a lot of blood in my throat, and I'm losing self-worth, and I'm suffering from depression, and I'm abusing alcohol.",
  "input": "",
  "output": "Have you ever taken pain meds or pain meds recently? Patient:"
},
{
  "instruction": "Doctor, I have some problems during pregnancy, and I don't know what's going on, but I'm a little worried.",
  "input": "",
  "output": "Are you taking medication because of pain or discomfort? Patient:"
},
{
  "instruction": "We're experiencing a doctor, a vomiting, a problem during pregnancy, depression, hostile behavior, and throat stimulation. What do you think is the problem?",
  "input": "",
  "output": "There's a serious German possibility of analgesics because of the symptoms. Have you taken pain meds recently?"
},
{
  "instruction": "Doctor, I've recently had a number of health problems: pregnancy problems, low self-worth, choking, alcohol abuse, hostile behaviors, and what's the cause of all of these symptoms?",
  "input": "",
  "output": "It's very likely that you're suffering from analgesic poisoning, and there's a lot of symptoms, including the symptoms you've been talking about, and it's important to get medical attention immediately to prevent further health damage."
},
{
  "instruction": "Doctor, your heart rate has accelerated recently, your head rate has increased, and what's the cause?",
  "input": "",
  "output": "There's the same risk that heart rate may be irregular and often rapid intracranial, raising the risk of stroke or heart failure, and we need to do some tests to confirm this diagnosis."
},
{
  "instruction": "Doctor, what's wrong with having a good breath, a mess, a sharp chest pain, an irregular heartbeat?",
  "input": "",
  "output": "You're experiencing an irregular, often rapid heart rate, heart fibrillation, which can cause shortness of breath, dizzyness and chest pain."
},
{
  "instruction": "Hi doctor, there's been a recent drop in heart rate, dizzyness, irregular heartbeat, increased heart rate.",
  "input": "",
  "output": "The symptoms suggest that there's a pericardial fibrillation."
},
{
  "instruction": "Doctor, you've been in a bad breath lately. Why?",
  "input": "",
  "output": "The symptoms are the same as a pericardial fibrillation, which can cause respiratory problems and chest pain because of an irregular heart rate."
},
{
  "instruction": "Doctor, I've been very tired recently when I try to do something very violent, and my heart rate is always very high.",
  "input": "",
  "output": "The symptoms suggest that the heart rate is the same as the periphery that can cause irregular and frequent rapid fatigue and shortness of breath, and I'd like to discuss treatment options after a few tests."
},
{
  "instruction": "Doctor, anal pain, skin itching, urinary pain, urinary reflux, Coriza, what's the problem?",
  "input": "",
  "output": "The symptoms could be a urethra infection, a common infection caused by Entrevius Vermicullaris, a small, white thread-like parasite that lives in the human colon and the workplace."
},
{
  "instruction": "Hi, doctor, there's been a couple of weird symptoms, a little lump around the neck, and a pain in the urinary tract, and a lot of skin.",
  "input": "",
  "output": "Have you ever seen a worm come out of an anus at night?"
},
{
  "instruction": "Doctor, I'm suffering from urinary bypass. What's the problem?",
  "input": "",
  "output": "The symptoms can be urethra, which is a common parasite that affects the intestinal tract, which can cause discomforts around the anus, stomachaches, diarrhea, and so forth."
},
{
  "instruction": "Hi doctor, I'm experiencing urethra, urinary tract, aching anal, toilet and anal pain. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate you're suffering from an infection of the urethra."
},
{
  "instruction": "I'm experiencing a doctor, anal aura, a burning abdominal pain, ankle pain, and what's the cause?",
  "input": "",
  "output": "Have you ever found a worm that's like a white thread around a stool or an anus?"
},
{
  "instruction": "Doctor, your elbow has been weakened recently. Why?",
  "input": "",
  "output": "It's not a classic symptom of a urethra valve that affects the urinary machine, which can cause difficulty in emptying the bladder or causing infections, loss of weight in an infant, and we have to do some tests to figure out the cause of weakness."
},
{
  "instruction": "Doctor, you've got nausea and lower abdominal pain, and you've got back pain, and you've got back pain, and you've got side pain, so what's going on?",
  "input": "",
  "output": "There's also a case of urethra valve disease, which, due to the abnormal wrinkles in the urethra, narrows the ureter to block the urine flow, and causes nausea, abdominal pain, back weakness, and so forth."
},
{
  "instruction": "There's going to be teachers, toilets, lower abdominal pain, weakness in the elbow, and what's the cause of all of this?",
  "input": "",
  "output": "Depending on the symptoms, there may be a urethra that can cause such complications as toilet and lower abdominal pain, which is not common, but may be one of the related symptoms."
},
{
  "instruction": "Doctor, I'm experiencing side pain, poor elbow pain, lower abdominal pain, toilet pain and upper pelvic pain. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to be urethra valve disease, a condition that naturally blockes the urethra and causes other symptoms such as urination problems and what we're currently experiencing."
},
{
  "instruction": "Doctor, we found a strange skin growing around the tree, and why?",
  "input": "",
  "output": "It seems to be suffering from the urethra, a thin tissue valve that can form in the urethra and cause a blockage in the membrane, and then the urine can go back into the kidney, and eventually cause kidney damage."
},
{
  "instruction": "Doctor, you've got a neck injury, and your heart rate seems very rapid, and it looks like your skin is swollen and your legs and feet are infected, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate that there's a bile bile that's a bacterial skin infection, and it's important to start treating it immediately so that it doesn't spread anymore."
},
{
  "instruction": "Doctor, you've got a neck injury, you're sweating, your feet and your toes are swollen, you're experiencing delusions and hallucinations, what's the problem?",
  "input": "",
  "output": "Symptoms may indicate that there is an infection of the wound that spreads over other parts of the body, such as swelling and swelling, which may indicate more serious infections, such as sepsis, and it's important to start treatment immediately."
},
{
  "instruction": "Doctor, you're experiencing delusions and hallucinations because you've got a scar on your neck. What's the cause?",
  "input": "",
  "output": "The damage could have caused an infection in the bloodstream, which could have caused delirium, which could be sepsis, which requires immediate treatment to prevent further complications."
},
{
  "instruction": "Doctor, your skin is swollen around your neck and it's really painful. What's the problem?",
  "input": "",
  "output": "I think you're saying there's a scar on the neck."
},
{
  "instruction": "Doctor, I found a wound on my neck that had swollen feet and ankles.",
  "input": "",
  "output": "The symptoms seem to indicate that the common symptom of injury infection, the telophase edema, has occurred."
},
{
  "instruction": "Doctor, you're experiencing sharp chest pains and reflux. Do you know what caused it?",
  "input": "",
  "output": "The symptoms that God explains are that you have a condition called akalysia."
},
{
  "instruction": "Sir, I'm having a lot of pain in my ribs, chest pressure, cramps and cramps, and it's hard to swallow. What's wrong with me?",
  "input": "",
  "output": "It's very likely that you're suffering from acalazia, a rare condition that makes it difficult for your lower esophagus muscles to move food and liquid into your stomach."
},
{
  "instruction": "Doctor, I've been feeling uncomfortable lately, having a bad breath, a sharp pain in my chest, and my voice seems to drop, and it's hard to swallow, and what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there is a disease called paralysis, which is a case of poor esophagus, which makes it difficult for you to send your food down to the stomach, which can cause discomfort and pain, which can help you to deal with your symptoms."
},
{
  "instruction": "We're experiencing back pain, we're having hoarse voices, we're having a heart attack, we're also coughing, can you tell us what's going on?",
  "input": "",
  "output": "It's possible that you're suffering from a condition in which your esophagus is not functioning properly, which can cause difficulty and chest pain along with the symptoms that you're talking about."
},
{
  "instruction": "What's the problem, doctor?",
  "input": "",
  "output": "The symptoms seem to indicate that you've got a lot of trouble, because your esophagus muscles can't get your food down to your stomach."
},
{
  "instruction": "Doctor, I recently felt that I had lost self-worth, that my ears had been red, that my hearing had been low, that what was the cause of these symptoms?",
  "input": "",
  "output": "These symptoms indicate the electrical hearing that occurs when sound waves don't reach the inner ear, which can be caused by physical disorders such as infection or allergies or the accumulation of body fluids or perforations in the pericardium."
},
{
  "instruction": "In recent years, my hearing has dropped, and I've got a hoarse voice, and I've got a swelling of the amygdala, and I think it's lower self-worth, so what do you think's going on with me?",
  "input": "",
  "output": "The symptoms seem to indicate that there's an electric hearing problem, and the fluid in the ear is likely to cause hearing loss, and the swelling of the amygdala or the redness of the ear is likely to be the cause of a dull voice, and we can discuss treatment options that help alleviate the symptoms."
},
{
  "instruction": "Doctor, can you tell me what's going on?",
  "input": "",
  "output": "Is there any other problem with hearing?"
},
{
  "instruction": "Doctor, for a while, you've got a nice voice and you can't hear it properly. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you have an electrical hearing disorder, which is a form of hearing hearing that is caused by a blockage or damage in the ear that causes the sound waves to not reach the inner ear properly."
},
{
  "instruction": "Doctor, with abdominal pain, your whole body is sick and your abdomen is swelling, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms suggest an abdominal hernia, which occurs when the organ or the tissue is pushed out through the weak muscles that fix the abdomen."
},
{
  "instruction": "Doctor, sharp abdominal pain, pain throughout the body, and a lump in the groin. What's the problem?",
  "input": "",
  "output": "You're experiencing abdominal hernias, and you need to do some tests to confirm your diagnosis."
},
{
  "instruction": "Doctor, you've got lower abdominal pain, and you've got lumps on your groin, and you feel the reflux after eating.",
  "input": "",
  "output": "We're going to have to do some tests to confirm the diagnosis and discuss the appropriate treatment options."
},
{
  "instruction": "Doctor, your scrotum is swollen a little.",
  "input": "",
  "output": "The symptoms suggest an abdominal hernia."
},
{
  "instruction": "Doctor, you've got a sharp abdominal pain, and you've got pain all over your stomach, and you've got a swelling of your scrotum and a lump in your groin, so can you tell me what's wrong with you?",
  "input": "",
  "output": "The symptoms suggest an abdominal hernia."
},
{
  "instruction": "Doctor, I'm experiencing spasms of my legs, spasms and spasms, and I'm recently blind, and I don't think my height is growing as fast as my age.",
  "input": "",
  "output": "The symptoms seem to indicate that you have cerebral palsy."
},
{
  "instruction": "Doctor, you've got a problem breastfeeding your baby, and your tongue seems to be swollen all the time, and there's also a convulsion in your waist.",
  "input": "",
  "output": "Symptoms may indicate that cerebral palsy, a neurological disorder affecting muscle movement and coordination, is likely to result not only in difficulty in eating or swallowing but also in muscle spasms and stiffness, which can cause back cramps, which may be due to a lack of coordination with the muscles of the mouth."
},
{
  "instruction": "Sir, I've had a lot of spasms and tics in my legs lately, and I feel like my tongue is swelling, so tell me what's causing it.",
  "input": "",
  "output": "The symptoms suggest that there is cerebral palsy, a disorder that affects movement, muscle tension, or posture, which can cause muscle spasms or tics, which can make it difficult to talk or swallow, and explain why the tongue swells."
},
{
  "instruction": "Doctor, your tongue's swollen, your height's not growing, you've got tics, you've got tics, you've got a cut on your lips. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate cerebral palsy, which is a group of disorders affecting movement and muscle tension or posture, and it's good to get additional tests and evaluations to make sure you're diagnosed."
},
{
  "instruction": "Hi doctor, I'm experiencing depression and psychiatric symptoms with excessive anger and low self-worth, and I've been feeling a lot of depression lately.",
  "input": "",
  "output": "You're experiencing the symptoms of marijuana abuse, and overuse of marijuana can lead to depression, low self-worth, even mental episode, and it's important to get treatment and support for this problem."
},
{
  "instruction": "Doctor, I've recently experienced hostile behavior, with drug abuse, personality problems, alcohol abuse, do you know what caused it?",
  "input": "",
  "output": "You're probably suffering from marijuana abuse, and it's important to get help and treatment for drug addiction, and we can discuss treatment options for the next appointment."
},
{
  "instruction": "Doctor, I have low self-worth, low anxiety, anxiety, temper problems, frequent abuse of alcohol, what's the problem?",
  "input": "",
  "output": "The symptoms that God's talking about seem to indicate that you're having a hard time with marijuana abuse, which is known to cause all the problems that you're talking about, we need to talk about lifestyle changes and treatment plans that help alleviate the symptoms."
},
{
  "instruction": "Doctor, I think I'm abusing alcohol. I don't think I can control my intake.",
  "input": "",
  "output": "Did you use marijuana? Patient: Yeah, I'm using it regularly, but what does that have to do with my alcohol abuse?"
},
{
  "instruction": "Doctor, I've recently experienced a very depressed, paranoid, hallucination, and it's easy to get angry and drink a lot, and what's the cause of these symptoms?",
  "input": "",
  "output": "The common symptoms of marijuana abuse are drug abuse, depression, hallucinations, excessive anger, alcohol abuse, which is important to discuss and plan to help you overcome these addictions."
},
{
  "instruction": "Doctor, your eyelids have been tickled, passed out, your eyes have become thin, you've been depressed, you've got mental symptoms, you've got inflammation of your throat, what's the cause?",
  "input": "",
  "output": "The symptoms suggest that you may be suffering from criptokocus, a mold infection that affects your central nervous system, your lungs, your skin, your genitals, etc., and you might be able to run some tests to determine your diagnosis."
},
{
  "instruction": "Doctor, I've recently experienced a number of unusual symptoms: swelling shoulders, seizures, swelling lips, and biting nails is frequent, and I feel stiff or cold on my butt.",
  "input": "",
  "output": "In view of the symptoms that God explains, you may be suffering from kryptokocus, which is caused by mold and can cause seizures, nail bite, joint stiffness, and so forth."
},
{
  "instruction": "Doctor, I've been having strange symptoms recently, my wrist is numb, my ass is stiff and moist, and my lips are swollen.",
  "input": "",
  "output": "From the symptoms that God explains, it's likely to be kryptokocus, an infection caused by mold that can affect the different parts of the body, including the joints and the skin."
},
{
  "instruction": "Doctor, your eyelids are soggy with eczema inflammation, you're also showing depression and mental symptoms, and you're a little bit out of sight, and things seem to overlap, you know what's causing all of these symptoms?",
  "input": "",
  "output": "The symptoms suggest that you have cryptokocus, a mold infection that can affect your central nervous system, your lungs, your skin, etc., which can cause a lot of symptoms, including the symptoms you're currently experiencing."
},
{
  "instruction": "Doctor, I'm experiencing eyelids, ectopic pain, sepsis, shoulder swelling, wrist weakness. Can you tell me what causes these symptoms?",
  "input": "",
  "output": "There's the possibility that it's caused by an inhalation of kryptoccus, which is a fungus infection that can affect the body's various parts of the body, including the lungs, the brain, the skin, and so forth, that it can cause the same symptoms as the ear and the ear."
},
{
  "instruction": "Doctor, I'm experiencing excessive appetite and abnormal breathing. What's the problem?",
  "input": "",
  "output": "It could be obesity, because of the symptoms. Have you noticed any abnormal weight gain recently?"
},
{
  "instruction": "Doctor, I don't think there's enough air to breathe, and I don't think I can stop the food when I'm hungry, and I'm experiencing a few seconds of breath at night, and what's the cause of all this?",
  "input": "",
  "output": "The symptoms suggest that obesity can be the cause."
},
{
  "instruction": "Doctor, I've recently heard abnormal breathing sounds and I've gained quite a bit of weight, and I think there's too much appetite, and what's the cause of these symptoms?",
  "input": "",
  "output": "I think it's because of the symptoms of obesity, and obesity can cause a lot of health problems, with too much body fat, where we can talk about treatment options that help control the symptoms and improve the overall health."
},
{
  "instruction": "Doctor, you've recently had abnormal breath sounds and apnea, and you've gained a lot of weight.",
  "input": "",
  "output": "It's good to start healthy diets for weight management and breathing better, exercise regularly, change your lifestyle."
},
{
  "instruction": "Doctor, I'm experiencing respiratory problems during sleep, sudden weight gain, increased appetite.",
  "input": "",
  "output": "The symptoms seem to indicate obesity."
},
{
  "instruction": "Doctor, I've recently experienced toilets, diarrhea, vomiting. What's wrong with me?",
  "input": "",
  "output": "I think you're experiencing digestive problems."
},
{
  "instruction": "Doctor, I'm experiencing reflux and repression. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from digestive problems."
},
{
  "instruction": "I'm having a stomachache like doctor, toilet, reflux, and burning. What's wrong with that?",
  "input": "",
  "output": "From the symptoms that God explains, it looks like they're digestive problems."
},
{
  "instruction": "Doctor, I've been feeling sick for the past few days, but why?",
  "input": "",
  "output": "The symptoms that God's talking about indicate that you're suffering from digestive problems."
},
{
  "instruction": "Doctor, there's a sharp pain in the chest.",
  "input": "",
  "output": "I think there's a pain caused by digestive problems in the description of the symptoms."
},
{
  "instruction": "Doctor, your arm has been in pain lately, your knees have been in pain, and you've found that your elbow is slightly swollen, and what's the cause?",
  "input": "",
  "output": "It's an inflammation of the septic sac, which is a small fluid that wraps around the joints and cushions the bones, the sinews and the muscles."
},
{
  "instruction": "I'm experiencing doctor, leg pain, elbow pain, knee swelling, arm swelling, and what's the cause of these symptoms?",
  "input": "",
  "output": "You're probably suffering from stenosis, which is caused by inflammation in your pocket, filled with a small fluid that cushions the joints and reduces friction between bones, muscles and sinews."
},
{
  "instruction": "Doctor, I have a swollen arm and a stiff, warm feeling, pain in the elbow and shoulder.",
  "input": "",
  "output": "The symptoms are likely to indicate that you're suffering from viscositis."
},
{
  "instruction": "Doctor, your knees are swelling, elbow pain, shoulder fracture, shoulder pain, hip pain.",
  "input": "",
  "output": "The symptoms seem to indicate that there's stratitis, a condition that causes inflammation in the pocket filled with a small fluid called the smudge sac, which cushions the joints and supplies the lubricating oil."
},
{
  "instruction": "Hi, sir. I've been feeling a lot of cold on my shoulders and arms lately.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from viscositis."
},
{
  "instruction": "Doctor, I've been very tired lately, and what's the cause?",
  "input": "",
  "output": "Blood is a common symptom of this disease, and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "The doctor, the mouth pain, the difficulty of swallowing, the difficulty of breathing, what is the cause of these symptoms?",
  "input": "",
  "output": "Unfortunately, these symptoms can be caused by cancer of the esophagus, which makes it difficult to swallow if there's a tumor in the esophagus, which can cause respiratory problems because of pressure on other organs, such as the lungs."
},
{
  "instruction": "Doctor, I've been very tired and very weak lately, my appetite has been reduced and my stomach pains have become very severe, and I think I'm losing my voice, so what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that the cancer of the esophagus is in doubt, and we need to do some tests to confirm the diagnosis, but it's important to start treating it as soon as possible."
},
{
  "instruction": "Hi, doctor, I've been experiencing a couple of symptoms recently: a bloated stomach, a low appetite, acute pain in the abdomen.",
  "input": "",
  "output": "From the symptoms that God explains, it's important to have a few tests to check your diagnosis and start the appropriate treatment as soon as possible."
},
{
  "instruction": "Hi, doctor, there's a change in the shape of the stool, a decrease in appetite, and a feeling of abdominal tension.",
  "input": "",
  "output": "It could be esophageal cancer."
},
{
  "instruction": "Doctor, you've got a hard, sharp chest and breathing problem. What are the symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate that he's having a lung hemorrhage."
},
{
  "instruction": "Doctor, I've been having trouble breathing lately, and I've had a hard feeling about my heart, and I think my heart rate is slower than usual.",
  "input": "",
  "output": "The symptoms are likely to indicate that you're experiencing lung hemorrhage."
},
{
  "instruction": "Doctor, there's swelling of the legs and lowering of the fluid. What's the problem?",
  "input": "",
  "output": "These symptoms indicate that there's a lung convulsion."
},
{
  "instruction": "Doctor, you've got a hard, sharp chest pain and a slight reduction in heart rate, and you've got a lot more fluid than usual, so what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that he's having a lung hemorrhage."
},
{
  "instruction": "Sir, I recently felt a lot of swelling of ankles and wrists. Why?",
  "input": "",
  "output": "From what God has explained, it's possible that you're experiencing the symptoms of childhood rheumatoid arthritis, which can cause swelling and stiffness of joints as a form of arthritis affecting children and young adults."
},
{
  "instruction": "Hi, sir. I've recently had wrist swelling. What's the problem?",
  "input": "",
  "output": "In view of the symptoms that God has described, there's a possibility of juvenile rheumatoid arthritis."
},
{
  "instruction": "Doctor, I feel the swelling of my hands and fingers, and when I try to move, it hurts, and what's the cause?",
  "input": "",
  "output": "According to your description, you're experiencing symptoms of juvenile rheumatoid arthritis."
},
{
  "instruction": "There's a problem with doctors, knee pain, hip pain, back pain, ankle pain and movement.",
  "input": "",
  "output": "You're experiencing symptoms of juvenile rheumatoid arthritis."
},
{
  "instruction": "Doctor, can you tell me what caused the pain and swelling in your hands and fingers?",
  "input": "",
  "output": "The symptoms suggest that there's a form of arthritis that affects both adolescents and adolescents, pedophilia."
},
{
  "instruction": "Sir, there's dryness on the skin, peeling, tinnitus, roughness, and lesions in the skin.",
  "input": "",
  "output": "The symptoms seem to indicate that there's photo-synthesis, a skin condition caused by ultraviolet radiation, which is characterized by dry, scaly spots on the skin, which can sometimes turn into ulcers or lesions."
},
{
  "instruction": "Doctor, what's the cause of the abnormal skin growth and skin lesions, dots and swelling in the body?",
  "input": "",
  "output": "Symptoms are likely to lead to a condition called photo-sensimulosis, which is a cancer disease, which can lead to skin cancer if you don't treat it."
},
{
  "instruction": "Doctor, there's skin irritation in the scalp and abnormal skin and a little irregularity in the skin rash and new skin lesions.",
  "input": "",
  "output": "The symptoms seem to indicate that there's a long-term sun exposure, photo-spotrosis, and it's good to check your diagnosis with a skin biopsy and discuss treatment options with a dermatologist."
},
{
  "instruction": "Doctor, I feel a little swelling in the skin.",
  "input": "",
  "output": "I think you're going through a photonosis."
},
{
  "instruction": "Doctor, I have some changes in my skin, and I have spots on my skin, and I have very dry skin and scales.",
  "input": "",
  "output": "The symptoms seem to indicate that you've got photo-sensimulosis, which is the cancerous growth of the skin due to sun damage, which can appear as a rough, scaly patch, or as a small, hard stone."
},
{
  "instruction": "Doctor, I'm feeling nauseous, and I think she's vomiting, and she's pulling on her ears, and what's the problem?",
  "input": "",
  "output": "According to your description, the child may have an ear infection, acute neutrophil, which is a common symptom of this disease."
},
{
  "instruction": "Sir, I think I'm deaf and I'm hearing a lot of reason.",
  "input": "",
  "output": "The symptoms suggest that acute sepsis is in doubt."
},
{
  "instruction": "Doctor, for the last few days, you've had a red color in your ear, and you've got a fever and hearing loss, and there's a strange fluid in your ear.",
  "input": "",
  "output": "It's important to start treating her as soon as possible to avoid further complications."
},
{
  "instruction": "Doctor, I feel like I've been hearing down with my ears down, and I think I've been hearing down, and what's the cause?",
  "input": "",
  "output": "I think you're in doubt about acute sepsis due to infection, and you need a thorough examination to confirm the diagnosis, and then you can discuss treatment options."
},
{
  "instruction": "Doctor, I've been very sick lately, vomiting, fevery, deafness in my ears, pulling on my ears, my nose, my nose, my nose, my nose, my nose, my nose, my nose, my nose.",
  "input": "",
  "output": "The symptoms suggest that acute sepsis, which is an ear infection, is suspected."
},
{
  "instruction": "Sir, it's been a long time since my eyes have been bloodied and I've been crying, and I've got a sense of reason and I've lost my eyes.",
  "input": "",
  "output": "The symptoms show that the cornea is irregular, so you've got difficulty with vision, a sort of uncomfortable refraction."
},
{
  "instruction": "Doctor, is there any problem with your peritoneal vision and abnormal eye movement?",
  "input": "",
  "output": "I think you've got a disease called leprosy."
},
{
  "instruction": "Doctor, I've got a problem with my eyes, and I think my eyes are paired, and I'm often exposed and stimulated, and sometimes I feel the abnormal movement of my eyes, and things get distorted.",
  "input": "",
  "output": "It's often caused by eye infection, abnormal eye movement, eye conflicts, and so forth, that the eye can be seen as a pair of eyes."
},
{
  "instruction": "Sir, I've been crying a lot lately. What's the cause?",
  "input": "",
  "output": "It's not just tears, it's the perplexity of vision, eye fatigue, headaches and so forth."
},
{
  "instruction": "Doctor, there's been a lot of pain and tears in your eyes lately.",
  "input": "",
  "output": "These symptoms can be difficult, and they're common eye disorders that cloud the vision and cause the fatigue and discomfort of the eye because of the irregular shape of the cornea or the lens of the eye."
},
{
  "instruction": "Doctor, I think I've been feeling a lot of heat and cold lately and losing a lot of weight, and I've been experiencing some kidney-related symptoms, and what's the cause of all this?",
  "input": "",
  "output": "It's a rare genetic disorder that can cause a wide range of symptoms, including the symptoms you described."
},
{
  "instruction": "Doctor, I've recently experienced some strange symptoms: I'm feeling heat and cold at the same time, and I'm feeling a little bit shoulder pain, and I'm also feeling a little weak in the elbow and waist, and I'm having kidney-related symptoms, and what's the cause of all this?",
  "input": "",
  "output": "The symptoms suggest that you have a rare genetic disorder, which is a rare disease that grows in various parts of your body, such as your kidneys, your brain, your heart, your lungs, your skin, and so forth. The tumor can cause a variety of symptoms, including heat, cold, joint pain, muscle weakness, and so on."
},
{
  "instruction": "Doctor, I've recently experienced delusions and hallucinations, are they signs of serious health conditions?",
  "input": "",
  "output": "Yes, it could be signs of multiple sclerosis, a rare genetic disorder that can cause mental symptoms such as seizures, cognitive disorders, delusions and hallucinations, which can develop in various parts of the body, including the brain."
},
{
  "instruction": "Sir, I'm experiencing back pain and back weakness, and I'm also feeling heat and cold.",
  "input": "",
  "output": "There's a possibility that the symptoms that God's talking about might be S.T.I.E.L.S., and you have to run some tests and run a full test to make sure you're aware of them."
},
{
  "instruction": "Doctor, you're having spasms and tics, you're having trouble talking, you're losing weight, what's the problem?",
  "input": "",
  "output": "It's a rare genetic disease that causes benign tumors in various organs of the body."
},
{
  "instruction": "Doctor, in the last few days, there's been a blockage in my nose. What's the problem?",
  "input": "",
  "output": "The abscess is a condition caused by pus buildup in the chest cavity, often caused by bacterial infections, which causes coughs, fevers, respiratory difficulties, and it's good to do additional tests to identify the diagnosis."
},
{
  "instruction": "Doctor, I recently experienced Coriza, skin lesions, back pain, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate that the abscess is caused by abscess, abscess, absorption of puss, which is mainly a chest that surrounds the lungs, and Coriza and skin lesions are likely secondary symptoms of basilar disease."
},
{
  "instruction": "Doctor, I've recently experienced respiratory difficulties, skin rashes, coughs, skin lesions. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that there's an abscess that causes inflammation, pain and respiratory problems, and it can also cause skin rashes and lesions."
},
{
  "instruction": "Doctor, when you're breathing, you've got some pain and some weird skin rashes.",
  "input": "",
  "output": "It's a condition where there's pus in the space between the lungs and the inner surface of the chest that causes pain when you breathe, and sometimes causes skin rashes, and we'll do some tests and start treating it as soon as possible."
},
{
  "instruction": "Doctor, I've been experiencing emotional symptoms that, for a while, have a stiff, moist neck, and force on the elbow, and what's the problem?",
  "input": "",
  "output": "There may have been noan, which is a hearing loss associated with aging, but these symptoms generally have nothing to do with noan, and it's good to get additional tests to determine the exact cause of the symptoms."
},
{
  "instruction": "Doctor, can you tell me what's causing this recently?",
  "input": "",
  "output": "We've analyzed the symptoms, and it's very likely that the cause of it is Noan."
},
{
  "instruction": "Doctor, I've recently experienced excessive growth and emotional symptoms. What kind of disease?",
  "input": "",
  "output": "You seem to be struggling with noon, a common form of hearing loss, with aging."
},
{
  "instruction": "Doctor, I'm having symptoms that my back is weak, my neck is stiff, my throat is cold, my ears are sick, I'm feeling heat and cold, and I'm growing too much.",
  "input": "",
  "output": "The symptoms seem to indicate that you have a lot of diseases, but noan can cause ear pain, he can cause weakness, and he can also cause hearing loss associated with aging."
},
{
  "instruction": "Doctor, the baby is struggling with breastfeeding, and it's crying a lot, and it's irregular. What's the problem?",
  "input": "",
  "output": "Based on what God has explained, a baby can have a new baby, which is often caused by a newborn baby whose skin and eyes turn yellow and become yellow and breastfeeding and over-responsive. It's also a good idea to have the baby examined and tested to determine the best treatment plan."
},
{
  "instruction": "Doctor, the narcissus's navel is irregular, the stools change, the throat bleeds, the feeding problems, the scalp looks irregular, what's the problem?",
  "input": "",
  "output": "From the symptoms that God has described, I think he's having a newborn eclipsing."
},
{
  "instruction": "Doctor, your ears are full of water, your stomach's filled, your scalp looks irregular, what's the problem?",
  "input": "",
  "output": "The baby may have a new baby, and the baby may have a new baby, which is a disorder common to newborns with high levels of bilirubin in their blood, turning yellow in their skin and eyes, and we need to do some tests to make sure that they're diagnosed."
},
{
  "instruction": "Hi, doctor, I think my baby's not growing properly, and I think it's having a mid-term, and it's called a lot, and it's got a little secretion out of its neck.",
  "input": "",
  "output": "Yes, because of what you've explained, a baby may have a newborn ectopic."
},
{
  "instruction": "Doctor, your throat hurts and coughs for a while, and what's the cause?",
  "input": "",
  "output": "Symptoms can lead to chronic closed lung disease, which is difficult to breathe and can cause coughs and so forth. Note: this conversation is for the sake of explanation. If you think you have these symptoms, consult your doctor or visit a medical institution."
},
{
  "instruction": "Doctor, it's hard to breathe, and there's a lot of noise recently, it's fevery, it's breathy, what's the problem?",
  "input": "",
  "output": "The symptoms suggest that it is COPD, a chronic lung disease that can cause respiratory problems, anxiety, and respiratory problems, but since fever is not a classic symptom of chronic closed lung disease, we'd like to run some tests to identify the diagnosis."
},
{
  "instruction": "Doctor, I've been experiencing a number of symptoms recently: coughing, chest upset, sharp chest pain, shortness of breath. What's the cause of these symptoms?",
  "input": "",
  "output": "You may have a chronic closed lung disease, which usually occurs when you're exposed to long-term lung-damaging stimulants, such as cigarette smoke and air pollution."
},
{
  "instruction": "Doctor, your neck hurts, your nose is blocked, your nose is hot, your chest is sore, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate a chronic closed lung disease."
},
{
  "instruction": "Doctor, there's sore throats, sharp chest pains, fevers, coughs, and so forth. What's the problem?",
  "input": "",
  "output": "I think you have COPD, which is characterized by prolonged respiratory problems and poor air flow due to inflammation of the airways."
},
{
  "instruction": "Doctor, there's a lot of pain and swelling in the elbow.",
  "input": "",
  "output": "The symptoms suggest that the elbow has been decommissioned."
},
{
  "instruction": "Doctor, I'm experiencing symptoms of weak arm strength, severe elbow swelling, and what happened to me?",
  "input": "",
  "output": "The symptoms seem to indicate that the elbow dislocation occurred."
},
{
  "instruction": "Doctor, there's pain in the wrist and swelling in the arm. What's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate a elbow dislocation."
},
{
  "instruction": "Doctor, can you tell me what's wrong with your elbow? It's swollen and painful. It's hard to move your arm.",
  "input": "",
  "output": "The symptoms suggest that the elbow has been decommissioned."
},
{
  "instruction": "Doctor, you've got a sharp pain in your arm, and you've also found a lump in your elbow. What's the problem?",
  "input": "",
  "output": "You need to come to the hospital immediately for medical examination and treatment."
},
{
  "instruction": "Doctors, lower body pain, loss of sensation, arm pain, hip pain, back pain. What's the cause of all these symptoms?",
  "input": "",
  "output": "It's a sedimentary disease that affects the spinal disk and the joints, which can cause all the symptoms you've described."
},
{
  "instruction": "Doctor, I've recently experienced leg pain and loss of sense, and what's the cause of these symptoms?",
  "input": "",
  "output": "It's a spinal disease that affects the spine, which can cause discomfort and neurological problems in the leg, and we need to do some tests to confirm the diagnosis."
},
{
  "instruction": "Sir, the pain in the entire body, the pain in the neck and the arm continues, do you know what might be the problem?",
  "input": "",
  "output": "I think it's a spinal injury, based on the symptoms."
},
{
  "instruction": "Sir, you've got neck pain, back pain, leg pain, shoulder pain going on, do you know what's causing it?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from a spina bifida that affects the spine and the joints, which is most common in the neck and the waist and can cause pain, stiffness and mobility."
},
{
  "instruction": "Doctor, there's red ears, cough, oral ulcers, abnormal skin, loss of appetite, what can happen to me?",
  "input": "",
  "output": "I think I have herpes."
},
{
  "instruction": "Hi doctor, I've been feeling really bad lately -- lymph nodes, insomnia, fever, tongue lesions, mouth ulcers, what's the problem?",
  "input": "",
  "output": "Herpanzina is a common viral disease that causes fever, throat and mouth ulcers, which also causes small blisters and lesions in the tongue and cheek."
},
{
  "instruction": "Doctor, can you tell me what's wrong with your tongue having a very painful ulcer?",
  "input": "",
  "output": "Symptoms can lead to a viral infection called herpes, which causes a small, painful ulcer or lesion in the tongue, throat or the roof of the mouth."
},
{
  "instruction": "Doctor, your ears are red and your skin looks weird. What's the problem?",
  "input": "",
  "output": "These symptoms seem to indicate a viral infection called herpes, which usually causes skin rashes, such as blisters on the back of the neck and in the mouth and redness of the ears."
},
{
  "instruction": "Doctor, in the last few days, my arm has been stiff and I have a muscle spasm on my shoulder.",
  "input": "",
  "output": "And when you look at what God says, it seems to me that you've injured your shoulder, and stiffness and muscle spasms are common symptoms of that area's injuries."
},
{
  "instruction": "Hi, doctor, there's pain in the neck and the arm. Can you tell us what's going on?",
  "input": "",
  "output": "These symptoms can be caused by shoulder injury."
},
{
  "instruction": "Sir, neck pain, elbow pain, stiffness or pain in the arm, swelling of the shoulder.",
  "input": "",
  "output": "The symptoms seem to have hurt your shoulder, and you have to do some additional tests to make sure you're diagnosed."
},
{
  "instruction": "Sir, there's a lot of pain in your arm and shoulder.",
  "input": "",
  "output": "I think you've injured your shoulder."
},
{
  "instruction": "There's a lot of pain in the shoulder that spreads to the throat. What's the cause?",
  "input": "",
  "output": "The pain in the neck may have to do with the shoulder injury."
},
{
  "instruction": "Doctor, I've recently had headaches, excessive drinking, fainting, drowsiness. What's the problem?",
  "input": "",
  "output": "The symptoms indicate that Germany is more likely to be an antidepressant. Have you taken an anti-depressants recently?"
},
{
  "instruction": "Doctor, I'm experiencing allergic reactions and memory problems. What's going on with me?",
  "input": "",
  "output": "You can be experiencing an addiction to antidepressants."
},
{
  "instruction": "Doctor, I've been feeling very depressed lately, and I've had a history of drug abuse.",
  "input": "",
  "output": "What kind of medication have you been taking lately? Patient:"
},
{
  "instruction": "Doctor, I've been so depressed over the last few days that I've had a hard time getting out of bed, and I can't stop crying.",
  "input": "",
  "output": "I think you're experiencing an anti-depressive disorder that can cause emotional symptoms like depression."
},
{
  "instruction": "Doctor, I think I've been abusing drugs lately.",
  "input": "",
  "output": "Drug abuse can be a lot of symptoms. Can you tell us more about the use of drugs? Patient: I've been taking a lot of anti-depressants recently to treat depression."
},
{
  "instruction": "Doctor, I have a wound that looks like I'm infected with my arm -- fever, loss of appetite, abnormal skin and lesions in my skin.",
  "input": "",
  "output": "I think the wound's infected."
},
{
  "instruction": "Doctor, your arm's skin seems to be infected, and your body fluids are getting high, and you're finding skin lesions, and your appetite is decreasing, and your skin looks abnormal.",
  "input": "",
  "output": "It's important to clean the wound regularly to avoid further complications, and I'm going to prescribe an antibiotic that you can take."
},
{
  "instruction": "Doctor, I have skin lesions in my leg, and I think I'm infected.",
  "input": "",
  "output": "It could be an open wound infection."
},
{
  "instruction": "Doctor, there's skin lesions, and I think the skin of the arm is infected, and why?",
  "input": "",
  "output": "I think he's infected with an open wound."
},
{
  "instruction": "Doctor, there's swelling and pain in the leg, and there's abnormal skin lesions nearby, and there's a fever.",
  "input": "",
  "output": "I think you're infected by what you're saying."
},
{
  "instruction": "Doctor, there's been a constant convulsion of the leg, and what's the symptom?",
  "input": "",
  "output": "This may be due to a disease called DVT, which limits the conversation back and forth to time management and specific guidelines."
},
{
  "instruction": "Doctor, I've been experiencing a number of unusual symptoms recently: my arms are falling off, my legs are swollen, and I think I've lost the ability to smell or taste.",
  "input": "",
  "output": "The symptoms suggest that there may be DVT, which is usually a clot in the heart of the leg, but it can also occur in the arm."
},
{
  "instruction": "Hi, doctor, there's a couple of days of leg pain and swelling of ankles, and why?",
  "input": "",
  "output": "It could be DVT, depending on the symptoms, which is more than one heart vein in the body, which is normally a clot in the leg."
},
{
  "instruction": "Doctor, I feel swollen legs, my horse's swelling, my leg convulsion or spasm, and I feel my arm swelling.",
  "input": "",
  "output": "The symptoms suggest that there's a DVT, which is a clot that forms deep in the body, usually in the leg vein, which can cause swelling and pain. Since DVT can be dangerous if not treated, it's important to have immediate medical attention."
},
{
  "instruction": "Doctor, I'm extremely tired and dizzy these days, and I'm suffering from toilets and smoking, and I'm feeling very weak, and I'm sick and sick, and what's the cause of all of this?",
  "input": "",
  "output": "The symptoms seem to indicate that he's suffering from a protein deficiency."
},
{
  "instruction": "Doctor, I don't have a lot of energy lately, so why?",
  "input": "",
  "output": "I think you're experiencing a protein deficiency."
},
{
  "instruction": "Hi, doctor, I'm not feeling very well these days, and I've been feeling dizzy, sick and sick, and I'm also feeling a lot of energy all over.",
  "input": "",
  "output": "Your symptoms seem to be due to a protein deficiency, and if you don't have enough protein, you can have these symptoms that you're experiencing now."
},
{
  "instruction": "Doctor, I've been vomiting in the last few days, and why?",
  "input": "",
  "output": "There could be a protein deficiency depending on the symptoms."
},
{
  "instruction": "Doctor, sharp abdominal pain, nausea, fatigue, constipation. Do you know what caused it?",
  "input": "",
  "output": "Yeah, it could be a protein deficiency."
},
{
  "instruction": "Doctor, I'm experiencing loss of sense, swallowing of the neck, seizures, abnormal movement of the eyes. Can you tell me what causes these symptoms?",
  "input": "",
  "output": "I think you're suffering from muscular dystonia because of these symptoms."
},
{
  "instruction": "Doctor, I recently had spasms and spasms in my arm, and memory problems, and why?",
  "input": "",
  "output": "The symptoms seem to indicate that you have a condition called myocardial rigidity, which is an involuntary muscle spasm or rigidity that can affect any part of your body, including your arms and legs, and may have something to do with memory problems."
},
{
  "instruction": "I'm experiencing doctors, insomnia, muscle swelling, loss of throat, memory problems, abnormal movement of the eyes, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you have a disease called muscle dystonia."
},
{
  "instruction": "Doctor, you're experiencing insomnia, arm cramps, tics, and sometimes seizures.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from a neurologic disorder that is characterized by involuntary muscle spasms or tics, or atherosclerosis."
},
{
  "instruction": "Doctor, I've recently experienced a number of unusual symptoms: abnormal movement of the eyes, constant sleepiness, memory loss, some body loss, and a little muscle swelling, and what's the cause of all these symptoms?",
  "input": "",
  "output": "The symptoms suggest that you're experiencing an involuntary muscle spasm, or a neurotemperial spasm, which can affect the various parts of your body, including your eyes, and other symptoms include drowsiness, memory loss, loss of sense, and muscle edema."
},
{
  "instruction": "Doctor, you've got joint pain, and you've got innerburn, and you've got movement problems.",
  "input": "",
  "output": "I think the symptoms are that there's a rush in the cartilage."
},
{
  "instruction": "Hi, doctor, I've got a lot of pain in my leg, mainly around my ankle.",
  "input": "",
  "output": "Based on what God says, I think there's some pain caused by bone spurs of the fibula."
},
{
  "instruction": "Doctor, I've recently had a pain in my elbow.",
  "input": "",
  "output": "It can be caused by bone spurs in the fibula."
},
{
  "instruction": "The teacher, the ankle pain, the leg pain, the foot pain, the toe pain, the weight gain a little bit.",
  "input": "",
  "output": "It can be caused by a bony spur when you put it off as a symptom."
},
{
  "instruction": "Doctor, I'm experiencing ankle pain, muscle pain, elbow pain.",
  "input": "",
  "output": "The symptoms seem to indicate that there's a bone in the heel bone that's growing, that's causing pain and discomfort."
},
{
  "instruction": "Doctor, what's the reason why your waist is weak, your menstrual level is high, your throat is filled with blood, your nose bleeds, your ear size and shape seem abnormal?",
  "input": "",
  "output": "These symptoms may be caused by the disease of von Vilebrandt, a rare, long-lasting hemorrhagic disorder that affects blood clotting ability."
},
{
  "instruction": "Doctor, I've recently discovered that nosebleeds are common and that the ear shape looks abnormal, and what's the cause?",
  "input": "",
  "output": "It's possible that it's a disease called von Villebrandt's disease, which affects blood clotting and ability, which can cause abnormal bleeding in frequent noses and ears."
},
{
  "instruction": "Doctor, your muscles are swelling and your period is longer than usual, and the size and shape of one ear seems a little bit abnormal.",
  "input": "",
  "output": "It causes prolonged menstrual bleeding, injury, or abnormal bleeding after surgery."
},
{
  "instruction": "Sir, your menstrual level is high, your scalp is tough, your stools are filled with blood, and what's the problem?",
  "input": "",
  "output": "If you put it off as a symptom, there could be Pon Billebrandt's disease, a bleeding disorder that affects the ability to form blood clots."
},
{
  "instruction": "Hi, doctor, I've had a lot of pain in my wrist lately, and I've always felt a lot of fatigue, so can you tell me what caused it?",
  "input": "",
  "output": "The symptoms suggest that there is a disease called von Vilebrandt's disease."
},
{
  "instruction": "Hi doctor, I have a back injury, and I recently found an unexpected gain in weight, and why?",
  "input": "",
  "output": "Open back wounds can be signs of infection, weight gain can be symptoms of diabetes."
},
{
  "instruction": "Sir, I found that the wounds on my back didn't heal, that the lower body pain continued, that my throat was moist and my skin was growing weird.",
  "input": "",
  "output": "Your symptoms and your explanations seem to indicate that the bile and abscess has developed into a chronic wound that needs to be treated immediately to prevent further complications."
},
{
  "instruction": "Doctor, there's open wounds on your back, and you're experiencing weight gain and irregular heartbeat.",
  "input": "",
  "output": "Your symptoms don't have to do with back injuries, and the symptoms you're experiencing can be caused by a condition called hypothyroidism."
},
{
  "instruction": "Sir, we found a skin lesion that looks like a back injury. What's the problem?",
  "input": "",
  "output": "I think you've got a scar on your back, but the wound can be caused by a cut, a perforated wound, a bite from a worm, and so on, and I'm going to take a closer look at the exact cause and severity of the wound."
},
{
  "instruction": "Sir, there's a wound on the back and the heart rate seems to be irregular. What's the problem?",
  "input": "",
  "output": "An infection caused by a back injury can affect the electrical stimulation of the heart, causing irregular heart rate, which may require taking antibiotics and dressing the wound regularly to prevent further infections and complications."
},
{
  "instruction": "Doctor, your heart rate is irregular and your breath is bad. What are the symptoms?",
  "input": "",
  "output": "The symptoms you've described suggest that a heart block has occurred. You have to run some tests to check this out."
},
{
  "instruction": "Doctor, you've recently felt irregular heart rate, sharp chest pain and weakness. Do you know what caused these symptoms?",
  "input": "",
  "output": "If you're going to have to run some tests to make sure, but if you're going to do that, it's important to act quickly."
},
{
  "instruction": "Sir, I've recently gained weight a little bit, and I've felt my heart beat irregularly, and sometimes I feel like I'm skipping a beat, and I've lost my breath and passed out a few times.",
  "input": "",
  "output": "It's important to start treating this diagnosis as soon as possible to avoid complications."
},
{
  "instruction": "Doctor, I've been a little dizzy lately, and my heart rate is constantly changing, and I sometimes lose my breath.",
  "input": "",
  "output": "A heart block is a condition in which the electrical signal to control the heartbeat is stopped, causing slow or irregular heart rate, decreased heart rate, increased heart rate and other symptoms."
},
{
  "instruction": "Hi, doctor, sharp chest pain, irregular heartbeat, fainting, weight gain and chest stress.",
  "input": "",
  "output": "A heart block can cause cardiac blockage, which can cause chest pain, irregular heart rate, loss of weight, and chest stress as the electrical signals that regulate the heart rate stop or slow down."
},
{
  "instruction": "Doctor, I've been experiencing reflux and rectal bleeding lately. What's the cause?",
  "input": "",
  "output": "We need to run some tests and discuss how best to treat them."
},
{
  "instruction": "Hi, doctor, there's a sharp abdominal pain, and there's blood from the stool, and there's a secretion from the side, and there's a change in the shape.",
  "input": "",
  "output": "I think you're suffering from a colonaroma, and you need to do some tests to confirm this diagnosis."
},
{
  "instruction": "Doctor, there's a secretion on the side, anal pain, absorption, absorption, absorption, rectal bleeding. What's the problem?",
  "input": "",
  "output": "The symptoms could be the colonaroma, which requires additional tests to confirm the diagnosis."
},
{
  "instruction": "Doctor, I'm experiencing negative pain, urine decline, recent weight loss and skin growth.",
  "input": "",
  "output": "When you put it to the symptoms, you can have your urethra, your urethra, your urethra from birth, your urethra is not at the end of your penis, it's at the bottom of your urinary tract, it's in the case of pain and urination, and it's in the case of some of the other symptoms that you've mentioned."
},
{
  "instruction": "Hi doctor, I've recently lost weight and I've had a little bit of discomfort in my lower abdomen, and recently I've had a little bit of difficulty in urinating.",
  "input": "",
  "output": "Proplasia is a condition in which urine is released out of the body from an abnormality due to a genetic defect in male urethra, and it can dehydrate and cause some discomfort in the lower abdomen."
},
{
  "instruction": "Doctor, there's been a lot of symptoms, such as the recent urinary decline, the eclips, the development of the skin, the color of the urine, the smell of the urine, and what's the root cause of these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from urethra, a congenital defect in a man's urethra that doesn't develop properly, which can lead to problems like urine reflux, yellowness, skin growth, urine color or smell change."
},
{
  "instruction": "Doctor, there's a chest pain, there's a penis pain, there's a bad urination color, there's a bad smell. Can you tell me what's wrong?",
  "input": "",
  "output": "Symptoms are likely to lead to urethra, a congenital defect affecting a man's urethra, which can cause pain in the urine and lead to infection in the urethra."
},
{
  "instruction": "Doctor, you're having seizures, you're having seizures, you're having nausea, you're having trouble breathing. You know what's wrong?",
  "input": "",
  "output": "Yes, it could be a symptom of magnesium deficiency."
},
{
  "instruction": "Doctor, I'm having sharp abdominal pain, shortness of breath, spasms of my legs, and I recently had a seizure. What's wrong with me?",
  "input": "",
  "output": "The symptoms seem to indicate a lack of magnesium."
},
{
  "instruction": "Doctor, there's been a lot of convulsion, seizures, vomiting, soreness, breathing problems, and you know what's causing these symptoms?",
  "input": "",
  "output": "Yes, these are signs of magnesium deficiency."
},
{
  "instruction": "Hi, doctor, sharp abdominal pain, nausea, diarrhea, nausea, what's the cause?",
  "input": "",
  "output": "It could be magnesium deficiency in terms of symptoms."
},
{
  "instruction": "We're experiencing doctors, vomiting, dizziness, sharp abdominal pain, seizures and respiratory problems.",
  "input": "",
  "output": "I think you're suffering from a magnesium deficiency."
},
{
  "instruction": "Doctor, I'm experiencing a decline in sexual appetite, a loss of blood or secretions or menstruation on the nipples, and I'm worried, what's wrong with me?",
  "input": "",
  "output": "You're experiencing a female barrenness that you don't know what's causing it."
},
{
  "instruction": "Doctor, you haven't had your period in months, and you have very little period, and what's the cause?",
  "input": "",
  "output": "You're suffering from a woman's barrenness that you don't know the cause from symptoms."
},
{
  "instruction": "Doctor, I tried to get pregnant for a while, but it didn't work, and there were other symptoms of bleeding and secretions, and in sexual intercourse, and I couldn't predict my period.",
  "input": "",
  "output": "The symptoms seem to indicate that there is an unknown female sterilization that requires several additional tests to identify the diagnosis and find the best way to treat it."
},
{
  "instruction": "Doctor, your nipples are bleeding or secretions, and unwanted hair is growing, and your period is getting longer than usual.",
  "input": "",
  "output": "It's possible that you're suffering from a common cause of unknown female barrenness: multiple-acquired N.P.S.S."
},
{
  "instruction": "Doctor, I'm experiencing pain during intercourse, irregular abdominal failure, menstrual failure. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there's an unknown female barrenness."
},
{
  "instruction": "Doctor, I've had chest pains and shortness of breath, and why?",
  "input": "",
  "output": "The symptoms seem to indicate that there is an inflammation of the heart in the pockets surrounding the heart."
},
{
  "instruction": "Doctor, I've been having trouble breathing lately.",
  "input": "",
  "output": "It's possible that it's a symptom, and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Hi, doctor, I've had chest pains these days and I'm sick of breathing, and sometimes I feel sick.",
  "input": "",
  "output": "It can cause chest pain and respiratory difficulties due to an inflammation of the lining of the heart, and you have to run some tests to confirm it, but if it's diagnosed, you have a treatment plan."
},
{
  "instruction": "Doctor, I'm experiencing breathy, chesty, sharp chest pain, irregular heartbeat. What's the problem?",
  "input": "",
  "output": "It's possible that it's an inflammation of the membrane surrounding the heart."
},
{
  "instruction": "Sir, I'm feeling really down these days, low self-worth and sometimes aggressive towards other people, and I feel like I've stopped growing and I'm suffering from depression and psychosis, and what's wrong with me?",
  "input": "",
  "output": "The disorder is characterized by symptoms such as low self-responsibility, hostile behavior, lack of growth, depression or psychiatric symptoms."
},
{
  "instruction": "Doctor, I've had some problems these days, and I'm always anxious, nervous, and angry, and I don't feel like I'm growing up as I expected.",
  "input": "",
  "output": "Considering your symptoms, you might be able to diagnose Attention Deficit Hyperaction Disorder."
},
{
  "instruction": "Doctor, I'm feeling very nervous and nervous these days, drug abuse, antisocial behavior, even compulsive behavior, and what's going on with me?",
  "input": "",
  "output": "Depending on the symptoms, there may be hyperactive disorders or ADHD."
},
{
  "instruction": "Sir, I've recently been doing antisocial behavior with depression and psychiatric symptoms. Can you tell me what's going on?",
  "input": "",
  "output": "The symptoms suggest that you may be suffering from over-explicit behavior disorder."
},
{
  "instruction": "Sir, there's pain throughout the body, and there's too much hair, along with uterine pain. What's the problem?",
  "input": "",
  "output": "It's a rare autoimmune disease that affects the eye and spinal nerve, and it's good to get some tests to confirm your diagnosis."
},
{
  "instruction": "Doctor, I've lost my senses and I've got pain. What's the problem?",
  "input": "",
  "output": "There's the possibility that there's some sort of a symptom that affects the optic nerve and spinal cord, and that's an autoimmune disease."
},
{
  "instruction": "Doctor, I've been experiencing a number of unusual symptoms recently: swelling of the shoulder and touching lumps in the knee, and frequently biting nails, and pain in the arm, and I've found that there's too much hair on some parts of the abdomen.",
  "input": "",
  "output": "It's a rare autoimmune disease that affects the optic nerve and spinal cord."
},
{
  "instruction": "Doctor, I've had urinary pain a few days ago. What's the problem?",
  "input": "",
  "output": "There's a possibility that you're suffering from the symptoms of a cytoplasm."
},
{
  "instruction": "Sir, when you're urinating these days, there's a lot of pain. What's the cause?",
  "input": "",
  "output": "The uterine pain may be caused by a number of causes, but in your case, it may have to do with chiropractors."
},
{
  "instruction": "Doctor, I'm having emotional symptoms these days.",
  "input": "",
  "output": "I want to know what emotional symptoms you're experiencing. Patient:"
},
{
  "instruction": "Doctor, your elbow is weak, and sometimes it feels hot or cold, and what's the cause?",
  "input": "",
  "output": "There's a possibility that there's a lung valve disease, and I'd like to have additional tests and evaluations to confirm the diagnosis."
},
{
  "instruction": "Doctor, I've been experiencing a number of unusual symptoms recently: wrist weakness, leg pain, elbow spasms or spasms.",
  "input": "",
  "output": "These symptoms can be caused by lung valve disease, which is caused by a valve that separates the heart from the lungs, which is a disorder in the bloodstream."
},
{
  "instruction": "Doctor, I'm suffering from a weakness in my back. What's the cause?",
  "input": "",
  "output": "The cause of back weakness could be lung valve disease, which is a condition in which the heart's lung valves don't function properly, and blood backs up in the right ventricle, which can lower the oxygen level in the body and make you feel weak."
},
{
  "instruction": "Doctor, there's a little bit of pain in the breast, there's a little bit of wear, there's back pain, there's a lot of breathing, what's the problem?",
  "input": "",
  "output": "The symptoms that God has described suggest that you have T.T.S."
},
{
  "instruction": "Doctor, I'm experiencing sensory and rib pain. What's the problem?",
  "input": "",
  "output": "You're experiencing symptoms of T.A.S., do you feel swelling or tenderness in your chest?"
},
{
  "instruction": "Doctor, I'm experiencing sharp chest pains and nausea. What's wrong with me?",
  "input": "",
  "output": "The symptoms are likely to be T.A.S., which causes inflammation and tenderness in the chest area, and we need to do some tests to identify the diagnosis."
},
{
  "instruction": "Doctor, I'm experiencing sharp chest pains and chest pains, and why?",
  "input": "",
  "output": "The symptoms suggest that you have T.A.S."
},
{
  "instruction": "Doctor, you've recently started to have pain in your eyes, and I don't think the pupil is flat, and what's the cause?",
  "input": "",
  "output": "You may have cerebral palsy, which affects the nerves controlling the movement of the eye and the face."
},
{
  "instruction": "Doctor, eye pain, facial pain, loss of sense, impaired vision, difficulty speaking, what's the problem?",
  "input": "",
  "output": "The symptoms suggest that it's possible that it's a nervous disorder."
},
{
  "instruction": "Doctor, it's hard to say, and your vision is failing, and you have abdominal symptoms, facial symptoms, headaches, which look like two things.",
  "input": "",
  "output": "You're suffering from a cerebral nervous disorder that occurs when more than one of the brain nerves controls facial muscles, vision and language."
},
{
  "instruction": "Doctor, you've got facial pain, and you've got cramps and tics in your face, and what's the cause?",
  "input": "",
  "output": "It's possible that you're having a brain attack when you put it off as a symptom."
},
{
  "instruction": "Doctor, I think my arm is swollen.",
  "input": "",
  "output": "I think you've injured your arm."
},
{
  "instruction": "Hi, doctor, we found that your arm is in pain and your hand is swollen, and you know what's causing it?",
  "input": "",
  "output": "The symptoms suggest that you have a spinal cord or a fracture in your arm, and it's a good idea to go to the hospital and get an X-ray to see the extent of the injury."
},
{
  "instruction": "Doctor, your arm is stiff and moist and your hands and fingers are swollen, and your joints are in pain.",
  "input": "",
  "output": "The symptoms suggest that you've injured your arm."
},
{
  "instruction": "I feel a little bit of pain in my doctor, my arm, especially my wrist and joints, and I've also lost a little bit of sense, and what's the cause?",
  "input": "",
  "output": "It could have caused damage to the nerves or the sinews, causing joint pain and loss of sense."
},
{
  "instruction": "Doctor, I'm experiencing seizures, coughs, allergic reactions, loss of focus, abnormally involuntary movements.",
  "input": "",
  "output": "When you look at the symptoms that God has listed, it looks like you've got a transition disorder."
},
{
  "instruction": "Doctor, I'm experiencing symptoms that I think are debilitating, fatigue, cough, and allergic.",
  "input": "",
  "output": "The symptoms suggest that you may have a transition disorder."
},
{
  "instruction": "Sir, I've been experiencing allergic reactions and depression and seizures for a while. Can you tell me what's wrong?",
  "input": "",
  "output": "The symptoms seem to indicate that you have a psychological transition disorder that can cause neurological symptoms. Have you had emotional pain recently?"
},
{
  "instruction": "Doctor, you've been coughing lately and you've been feeling very weak. What's wrong with me?",
  "input": "",
  "output": "It's very likely that you're having a transition disorder, which is a neurological condition in which emotional stress is a physical symptom, which can cause a lot of physical symptoms, coughing, feeling helpless, and so on."
},
{
  "instruction": "Doctor, I've recently had a seizure, and I've had it, and it's gone, and I'm really worried, what do you think is the problem?",
  "input": "",
  "output": "I think you're experiencing a transition disorder."
},
{
  "instruction": "What's the problem with teachers, backaches, motor disorders, abnormal involuntary exercise, arm pain, neck pain?",
  "input": "",
  "output": "Symptoms suggest that it's a complex pain syndrome."
},
{
  "instruction": "Doctor, I'm experiencing sensory loss, back pain, feet or toes pain, neck pain.",
  "input": "",
  "output": "The symptoms seem to indicate that there's a compound pain syndrome."
},
{
  "instruction": "Hi doctor, I recently discovered an abnormally involuntary movement of the legs, and I've got movement problems, and there's constant pain in the legs.",
  "input": "",
  "output": "The symptoms that God's talking about seem to indicate that you have complex pain syndrome, which in general causes abnormal movement, mobility, and particularly constant pain in the limbs."
},
{
  "instruction": "Doctor, I've been suffering from back and back pain a few weeks ago, and it's getting worse every day.",
  "input": "",
  "output": "The symptoms are likely to be complex pain syndrome."
},
{
  "instruction": "Doctor, there's a pain in your hands and fingers and a pain in your body, and there's a slight loss of sense and a problem with movement, and there's a little back pain, and you know what's causing these symptoms?",
  "input": "",
  "output": "The symptoms suggest that you're suffering from a compound pain syndrome."
},
{
  "instruction": "Doctor, I'm having a weakness in the strength of aches and elbows and hips, and I've got a swelling of my muscles, and I've got a sense of deafness in my ears, and I need you to tell me what's wrong.",
  "input": "",
  "output": "I think you're experiencing the symptoms of ibiosis, which affects the middle ear, which can cause a feeling of fullness or stress in the ear, and can affect hearing."
},
{
  "instruction": "Doctor, there's been emotional symptoms with the recent spasms in the elbow and the weakness in the elbow, so can you tell me what's wrong with me?",
  "input": "",
  "output": "It's a disease in your ear that causes abnormal bone growth: hearing loss, tinnitus, dizziness, and loss of balance. Since the symptoms can point to other problems, it's good to get an accurate diagnosis."
},
{
  "instruction": "Doctor, I've had a hearing loss recently, and I've been biting and experiencing emotional symptoms, and I feel a little swelling in my muscles, and what's the cause of all this?",
  "input": "",
  "output": "There may be osmosis, which can affect your hearing upper room, which can lead to hearing loss, which may involve stress and anxiety, which are often associated with hearing loss."
},
{
  "instruction": "Doctor, your muscles have been swollen lately, your wrists have been weakened, and you've been biting your nails a lot.",
  "input": "",
  "output": "Your symptoms seem to be a little confusing because you don't normally measure up to a disease called esclerosis. This is actually a condition that can affect the bone in the middle and cause hearing loss. It is best to schedule it so that the specialist can make a proper evaluation."
},
{
  "instruction": "Sir, there's a lot of pain in your shoulder.",
  "input": "",
  "output": "The symptoms suggest that you've been injured in your body, and you've had shoulder pain."
},
{
  "instruction": "Doctor, there's been a lot of sinus blockage, neck pain, headaches. What's the problem?",
  "input": "",
  "output": "It's possible that these symptoms are caused by injuries in the body, and if you want to make an accurate diagnosis, you might have to examine them more closely and do some tests."
},
{
  "instruction": "Doctor, you've got lower body pain and rib pain, and what's the cause?",
  "input": "",
  "output": "The symptoms suggest that you've been injured in your body."
},
{
  "instruction": "Doctor, I have a couple of symptoms in the scrotum and the testicle, along with rib and lower body pain.",
  "input": "",
  "output": "It seems to be able to cause these symptoms due to injury in the body, and we have to do some additional tests to determine the extent of the injury and how best to treat it."
},
{
  "instruction": "Doctor, I feel sore, sore, sore noses, and sore bones, and what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate injury to the neck or the back of the body, and we need to do some tests to determine the extent of the injury and how best to treat it."
},
{
  "instruction": "Sir, I haven't had my period for a while, but I always feel cold when I put on a bunch of clothes.",
  "input": "",
  "output": "It's a lack of menstruation and cold, and it's possible that it's hypothyroidism."
},
{
  "instruction": "Doctor, I'm experiencing weight gain and facial blushing. What's the problem?",
  "input": "",
  "output": "It seems to be hypothyroidism, which means that the thyroid doesn't produce enough hormones to regulate metabolism and body temperature."
},
{
  "instruction": "Doctor, there are some unusual symptoms: you haven't had your period for months, you have your facial blush, and it's like your wrist is swelling.",
  "input": "",
  "output": "Low thyroid function is likely to be hypothyroidism, which can cause irregular periods of menstruation, facial blush, wrist swelling, and so forth, in which the thyroid does not produce enough hormones. You need to do some tests to confirm your diagnosis."
},
{
  "instruction": "Hi, doctor, you've been experiencing leg cramps, spasms, menstrual delays, fatigue, wrist swelling, cold.",
  "input": "",
  "output": "The symptoms are likely to reduce thyroid function. Have you changed your weight or mood recently? You have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, there are symptoms of poor circulation, increased weight, and swelling of the wrist.",
  "input": "",
  "output": "It's possible, as a symptom, that it's hypothyroidism."
},
{
  "instruction": "Sir, we've recently experienced abnormal breathing, headaches, sleepwalking, can you tell us what caused these symptoms?",
  "input": "",
  "output": "The symptoms suggest that you have primary insomnia, a sleep disorder that is difficult to sleep with and low sleep quality."
},
{
  "instruction": "Hi, doctor, there's a lot of scalp neck pain and a lot of seizures last week, and what's the cause?",
  "input": "",
  "output": "Symptoms suggest that you may have primary insomnia."
},
{
  "instruction": "Doctor, I can't sleep well, and I've been up all night listening to abnormal breathing sounds, and what's the cause?",
  "input": "",
  "output": "The symptoms suggest you're suffering from primary insomnia."
},
{
  "instruction": "Sir, you don't sleep well at night, and you often wake up often at night because you're out of breath.",
  "input": "",
  "output": "The symptoms appear to be apnea, and may be caused by primary insomnia."
},
{
  "instruction": "Hi doctor, I recently experienced sleepwalking, headaches, fatigue, neck pain, even delusions and hallucinations.",
  "input": "",
  "output": "Some of the symptoms you're talking about have to do with original insomnia, and I suggest further evaluations to check your diagnosis."
},
{
  "instruction": "Doctor, skin fluid, warts, membrane force, skin lesions, coughing continues. What's the problem?",
  "input": "",
  "output": "The person who can cause these symptoms is more likely to be infected, and you have to start treating them immediately after being tested."
},
{
  "instruction": "Hi, I'm coughing and breathing every time I smoke.",
  "input": "",
  "output": "These symptoms are not necessarily related to the smoking habit, and tests show that scalp lice may have caused coughing and respiratory difficulties more often than usual, by scraping your head and stimulating your throat and your prayers."
},
{
  "instruction": "Hi, doctor. I have skin rashes and lumps on my leg. Do you know what caused it?",
  "input": "",
  "output": "Yes, these symptoms are usually caused by this infection."
},
{
  "instruction": "Sir, scalp is a treat.",
  "input": "",
  "output": "I think there's teeth."
},
{
  "instruction": "Doctors, skin rashes, smoking problems, scalp itching, warts, nose muscles, what's the cause of all these symptoms?",
  "input": "",
  "output": "There may be someone who can cause all these symptoms."
},
{
  "instruction": "Doctor, I'm experiencing a strange condition: memory disorder, facial blush, leg spasms, tics, and a strange-looking tongue.",
  "input": "",
  "output": "The symptoms seem to be due to vitamin B12 deficiency."
},
{
  "instruction": "Doctor, there are symptoms of abnormal tongue and excessive sweat. What's the problem?",
  "input": "",
  "output": "It could be a symptom of a vitamin B12 deficiency, and we need to do some tests to identify the diagnosis."
},
{
  "instruction": "Doctor, I'm having strange symptoms, and my hair is losing too little than it used to be, so can you tell me what caused it?",
  "input": "",
  "output": "It's actually a symptom of vitamin B12, and vitamin B12 affects hair and skin health."
},
{
  "instruction": "Sir, my tongue is very strange, my tongue is very red and shiny, and what's the cause?",
  "input": "",
  "output": "There may be a lack of vitamin B12, which causes the tongue to feel red, shiny, sick or burned."
},
{
  "instruction": "Hi, doctor. I've been experiencing a lot of soreness, too little hair, too much blushing, more sensory, you know what's causing these symptoms?",
  "input": "",
  "output": "Yes, the symptoms seem to indicate a lack of vitamin B12."
},
{
  "instruction": "Doctor, you've recently had severe thirst and kidney symptoms. Can you tell me what's wrong?",
  "input": "",
  "output": "What you're saying is you're probably diabetic, and diabetes can cause excessive thirst and kidney damage over time."
},
{
  "instruction": "Doctor, I'm having kidney symptoms. What kind of disease?",
  "input": "",
  "output": "Diabetes can cause kidney damage over time, causing frequent urine, leg swelling, loss of appetite, and so on. To prevent these complications, it's important to monitor blood sugar levels and get regular checkups."
},
{
  "instruction": "Doctor, it's like you're still thirsty and you're gaining weight for no apparent reason. What's the problem?",
  "input": "",
  "output": "There's a possibility that diabetes may have developed from the symptoms, and we need to run some tests to see if we can do that."
},
{
  "instruction": "Doctor, despite the regular diet and exercise routine, you've been gaining weight lately, and why?",
  "input": "",
  "output": "Are there other symptoms of diabetes, like increased thirst, frequent urine or fatigue?"
},
{
  "instruction": "Doctor, I've been experiencing kidney symptoms recently. Do you want to know what's causing them?",
  "input": "",
  "output": "Now, these symptoms are generally associated with diabetes, and have you experienced weight loss, which you can't see or explain with your thirst, your urine, or your urine?"
},
{
  "instruction": "Doctor, I'm really thirsty these days, so no matter how much water I drink, I'm thirsty.",
  "input": "",
  "output": "The symptoms seem to indicate that you have a higher blood sugar level, and you have diabetes, which causes severe palpitations in many of the symptoms, and it's good to run a blood test to make sure you're diagnosed."
},
{
  "instruction": "Doctor, you've got urinary pain and a sharp stomach pain. Can you tell me what's going on?",
  "input": "",
  "output": "You're experiencing a chronic pain condition that affects the ectopic, or ectopic pain, which can be heat, it can be itch, it can be sharp, it can affect the surrounding areas, such as the abdomen."
},
{
  "instruction": "Doctor, we're experiencing spasms and tics together, and we're also getting more pain during pregnancy, and why?",
  "input": "",
  "output": "You have a condition called intrauterine uterine pain, which can lead to cramps, cramps and pelvic pain, which is common during pregnancy."
},
{
  "instruction": "Doctor, I'm experiencing urinary pericardial, sharp abdominal pain, convulsions, and vaginal pain, and what's the cause of all of these symptoms?",
  "input": "",
  "output": "It's characterized by chronic pain in the uterine area, which can include urinary tract, abdominal pain, cramps, cramps, and vaginal pain."
},
{
  "instruction": "Sir, I'm experiencing hip pain, burning abdominal pain, side pain, sharp abdominal pain, with discomfort in sexual intercourse.",
  "input": "",
  "output": "The symptoms suggest that there is an ectopic eczema, a chronic pain disorder affecting the eczema and the surrounding area."
},
{
  "instruction": "I'm experiencing a doctor, nausea, lower abdominal pain, cramps and cramps, and urinary pain, and what's the cause of all of these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate that you have ectopic pain, a chronic pain disorder that affects the vagina."
},
{
  "instruction": "Sir, there's been a lot of lower abdominal pain, and I'm having a lot of menstrual problems this month, and I'm having a lot of pregnancy, and it's really painful, and what's the problem?",
  "input": "",
  "output": "Endometriosis is a disease in which tissue similar to the endometriosis found in the womb normally grows outside of the uterus, which can cause pain and discomfort and affect reproductive ability during menstruation."
},
{
  "instruction": "We're experiencing pelvic pain, facial blush, sharp abdominal pain, and what's the cause of these symptoms?",
  "input": "",
  "output": "It's possible that you're suffering from endometriosis, which is a disease in which tissues that normally wrap around the uterus start to grow outside of the uterus."
},
{
  "instruction": "Doctor, I'm experiencing chills, sharp abdominal pain, heavy menstrual flow, but sometimes I don't have a menstrual period, and there's a burning abdominal pain.",
  "input": "",
  "output": "And endometriosis is a disease that causes inflammation and pain when tissue surrounding the uterus grows out of the uterus."
},
{
  "instruction": "Doctor, since you haven't had your period for over a month, what's the cause?",
  "input": "",
  "output": "Endometriosis is a disease in which tissue similar to the endometriosis grows out of the womb and doesn't menstruate, and it can also cause pelvis pain and infertility."
},
{
  "instruction": "Sir, vaginal pain, lower abdominal pain, menstrual bleeding, menstrual menstrual hypersis, pelvic pain, what's the problem?",
  "input": "",
  "output": "The symptoms suggest that you have endometriosis, you have to run some tests to be sure, but that's possible."
},
{
  "instruction": "Sir, there's skin lesions and lumps on your leg and pain and a little swelling. Can you tell me what's going on?",
  "input": "",
  "output": "Yes, skin lesions, lumps, pain, and lymph nodes can lead to severe tissue damage if neglected."
},
{
  "instruction": "Doctor, I've been experiencing severe headaches in the last few days, and why?",
  "input": "",
  "output": "Did you notice other symptoms, such as fever, rash or joint passage?"
},
{
  "instruction": "There's a lump on the leg, and it's swollen.",
  "input": "",
  "output": "There's a possibility that there's angiotritis based on what God has told us, that we need to do some tests and videos to identify the severity of the disease."
},
{
  "instruction": "Doctor, I have a lump in my leg, and I feel like my skin is self-obvious, and I've been having severe leg pain lately.",
  "input": "",
  "output": "It can be an inflammation of the blood vessels that can cause a variety of symptoms, such as lumps, lumps, skin irritations, ear problems, and pain."
},
{
  "instruction": "Doctor, there's a lump in the leg, and it's there for a while, and it's not very small.",
  "input": "",
  "output": "According to your description, it's possible that it's an inflammation of the blood vessels, and it's a good idea to come to the hospital to make a diagnosis and a treatment plan."
},
{
  "instruction": "Doctor, there's been a lot of nausea and back and neck pain recently.",
  "input": "",
  "output": "It could be a concussion, but did you fall or hit your head recently?"
},
{
  "instruction": "Doctor, you've got back pain, you feel sleepy all the time, you see two things, what's the problem?",
  "input": "",
  "output": "In view of the symptoms that God mentioned, I suspect a concussion. Have you had a head injury recently?"
},
{
  "instruction": "There's doctors, neck pains, difficulty speaking, ribs pain, memory problems, abdominal symptoms. What's the cause of all these symptoms?",
  "input": "",
  "output": "The symptoms suggest that the concussion is suspect."
},
{
  "instruction": "I'm experiencing doctors, neck pains, memory problems, nausea and facial pain.",
  "input": "",
  "output": "The symptoms seem to indicate a concussion; it's important to avoid activities that can make the symptoms worse; it's important to seek a hospital visit and discuss treatment plans."
},
{
  "instruction": "Sir, you're feverish and your elbow's spasms, and the biggest concern is that your tongue has a strange white lesion, and what's the cause of these symptoms?",
  "input": "",
  "output": "From God's explanation, I think you're suffering from oral vitiligo, which is a white spot or lesion in your tongue, which can cause fever and muscle spasms in other body parts, such as elbows."
},
{
  "instruction": "Doctor, I've been vomiting blood recently. What's the cause?",
  "input": "",
  "output": "Oral vitiligo is a condition that causes white spots and lesions in the mouth, causing bleeding and blood loss."
},
{
  "instruction": "Doctor, I recently lost weight and found a white spot in my mouth.",
  "input": "",
  "output": "It's possible that you have a condition called oral vitiligo, which is a white or gray spot in your mouth, which you can't scratch, and you can't touch it, you can't touch it, you can't touch it."
},
{
  "instruction": "Doctor, you've got a fever, you've got a spasm in your elbow, you've lost your elbow, you're losing weight, you're vomiting blood, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms you've described suggest that there's oral vitiligo that has a white spot inside your mouth, which can cause fever and weight loss and may also contribute to blood loss because of lung cancer. It's a good idea to set aside an appointment with a tumor specialist as soon as possible for proper diagnosis and treatment planning."
},
{
  "instruction": "Doctor, I've been experiencing some strange symptoms recently, and I've had a lot of weight loss, and I've had a lot of back tension, and also my elbow is having spasms and tics.",
  "input": "",
  "output": "The symptoms are likely to be oral vitiligo -- have you ever found a white or gray spot in your mouth or lips, which is a common symptom of this disease?"
},
{
  "instruction": "Doctor, in recent years you've been getting very cold and swollen feet and legs. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that there is a chronic kidney disease, and we need to test it with some tests, and we need to start a treatment plan as soon as possible."
},
{
  "instruction": "Doctor, I'm very tired, even though I haven't done anything recently, and I've always felt a lot of cold, and there's a couple of symptoms in my kidney -- what's the problem?",
  "input": "",
  "output": "There's a possibility that there's chronic kidney disease, that you have to run some tests to make sure, but these are the common symptoms of chronic kidney disease, and it's important to discover it early and start treating it as quickly as possible so that the kidney doesn't get damaged anymore."
},
{
  "instruction": "I've noticed recently that you've lost your breath and your urine color and smell, and you've got kidney-related symptoms, what's wrong with you, sir?",
  "input": "",
  "output": "Symptoms can lead to respiratory problems, changes in urine color and odor, chronic kidney disease that can cause a variety of kidney-related symptoms."
},
{
  "instruction": "Doctor, you're short of breath, you're feeling cold, you're feeling strange in the color and smell of your urine.",
  "input": "",
  "output": "There may be chronic kidney disease, depending on the symptoms, and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I've been really tired lately, and my urine color and smell are weird. What's the problem?",
  "input": "",
  "output": "These symptoms may be signs of chronic kidney disease, and I'm going to have to do some tests to make sure, but I need to talk about treatment options right away."
},
{
  "instruction": "Doctors, kidney symptoms, fatigue, shortness of breath. What's the problem?",
  "input": "",
  "output": "These symptoms can lead to chronic kidney disease."
},
{
  "instruction": "Doctor, I've been losing my breath lately, and I don't know why.",
  "input": "",
  "output": "Have you ever experienced other symptoms, such as fatigue and leg swelling?"
},
{
  "instruction": "Doctor, your urine is frequently dried up and you have a chest pain, so can you tell us what caused these symptoms?",
  "input": "",
  "output": "I think we have bladder disease."
},
{
  "instruction": "Hi, doctor, there's blood in your urine, there's sharp abdominal pain in your urine.",
  "input": "",
  "output": "The symptoms seem to indicate that you have bladder disease."
},
{
  "instruction": "Doctor, you're bleeding out of your urine. What's the problem?",
  "input": "",
  "output": "There could be bladder disease that can mix up blood in the urine, and we need to do some tests to figure out what's causing the symptoms."
},
{
  "instruction": "Doctor, I've recently had hip pain and urinary pain, and I've been experiencing Coriza and sharp abdominal pain for a while, so can you tell me what's wrong with me?",
  "input": "",
  "output": "The symptoms seem to indicate that there is a bladder disease."
},
{
  "instruction": "Doctor, I've been experiencing some symptoms recently: there's a blockage in the nose, there's pain in the urine, there's blood in the lower abdominal pain and there's probably a bladder problem.",
  "input": "",
  "output": "I think there's a bladder disease based on what God says, and we need to run some tests to identify the diagnosis and determine the best way to treat it."
},
{
  "instruction": "Doctor, you've recently seen spots or clouds in your visual field, and your eyes are really dark. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to be choroiditis, which can cause damage to the vision and discomfort due to inflammation of the retina and the choroid in the eye."
},
{
  "instruction": "Doctor, you've recently had knee spasms and spasms, and you've got eyes and you've got eyes and you've got two objects.",
  "input": "",
  "output": "It's possible that there's an inflammation of the retina and the choroid, and there's two of them, or there's aggravating, or there's a sharpness in the eye, and knee cramps or cramps may not have anything to do with this disease, and we need some additional tests to confirm the diagnosis."
},
{
  "instruction": "Doctor, you've got eye pain with your vision and your eyes, and what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from choroiditis, which can cause inflammation in the innermost layer of the eye, causing pain, vision problems and itching."
},
{
  "instruction": "Doctor, I'm experiencing knee cramps, cramps, back weakness, eye pain. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from choroiditis."
},
{
  "instruction": "Doctor, there's spasms and spasms in the knee, and it's got eyes. What's the problem?",
  "input": "",
  "output": "There may be cyclicitis, which can cause nausea or perplexity in the eye, or muscle cramps or cramps. It's good to have your eyes examined to make sure you're diagnosed."
},
{
  "instruction": "There's pain all over the body, there's pain in sex, and there's a lot of drug abuse.",
  "input": "",
  "output": "If you're a symptom, you're probably suffering from a condition that's going on for hours, apart from sexual arousal, which can be caused by drug abuse and other low-inflection conditions."
},
{
  "instruction": "Doctor, I'm experiencing bipolar disorder, pain in my entire body, pain in my penis, and I have to tell you that I've been on drugs and had allergic reactions in the past.",
  "input": "",
  "output": "It's a long-term, painful rash, often caused by sickle cell disease, drug use, or allergic reactions."
},
{
  "instruction": "Doctor, I'm experiencing erectile failure, penis pain, pain in my entire body, and I think I'm allergic to it, and sometimes backache pain.",
  "input": "",
  "output": "You're probably suffering from suffocation for a few hours, and pain can be caused by the erection and muscle pain, and in rare cases you can have allergic reactions, and back pain can be a secondary symptom of the pain you're experiencing."
},
{
  "instruction": "Doctor, I'm experiencing pain during sexual intercourse, leg cramps, cramps, zoru. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from bipolar disorder, which is a long-term, painful erection that can last for several hours without sexual stimulation, and it's important to get additional tests and start immediately to treat your diagnosis."
},
{
  "instruction": "Doctor, lower body pain, headache, knee pain, weakness and skin rash. What's the problem?",
  "input": "",
  "output": "There may be weakness, pain, and palpitations in the muscles that can cause skin rashes, and we need to do some tests to make sure we're diagnosed."
},
{
  "instruction": "Doctor, I've recently had movement problems -- leg pain, back pain, skin rash, hip pain.",
  "input": "",
  "output": "The symptoms are likely to be myelitis, inflammation of the muscles, and I have to run some tests to find out, but this seems to be the most potent cause."
},
{
  "instruction": "Doctors, loss of sense, weakness of legs, loss of sense, even headaches. What's the cause of these symptoms?",
  "input": "",
  "output": "It's a rare disease that causes muscle inflammation and mildew, which requires some testing and imaging to confirm the diagnosis."
},
{
  "instruction": "Sir, I've had a lot of back pain lately. Do you know what it is?",
  "input": "",
  "output": "Yes, you may have muscle inflammation, weakness, and pain."
},
{
  "instruction": "Doctor, I've been tired for days, I've had a fever, I've had pain in my ear, and I'm sick, and I cough a lot.",
  "input": "",
  "output": "The symptoms suggest that it's possible that it's monocyclerosis, and I think we need to do a blood test to see if it's possible."
},
{
  "instruction": "Hi doctor, I recently experienced coughing, headaches, throat pain, do you know what caused it?",
  "input": "",
  "output": "The symptoms seem to indicate that he has monocyclerosis, which is also known as a disease of the virus that spreads through infected saliva, which encourages sufficient rest and water intake to manage the symptoms."
},
{
  "instruction": "Doctor, you've been sick lately, you've been sick, you've got skin rashes, you've got headaches, you've got ear pain, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that he's suffering from monooxysclerosis."
},
{
  "instruction": "I've had constant headaches over the last few days.",
  "input": "",
  "output": "I think I've got monooxystosis."
},
{
  "instruction": "Doctor, I had a headache a couple of days ago, and I've had a swelling of lymph nodes. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that he has what is commonly called monooxysclerosis."
},
{
  "instruction": "Doctor, I've been experiencing arm pain and hip pain for the last few days. Do you know what's causing it?",
  "input": "",
  "output": "Yes, symptoms can indicate that you're suffering from a neurological disorder that causes pain along a nervous path."
},
{
  "instruction": "Doctor, I've had a lot of pain in my arm lately.",
  "input": "",
  "output": "You may be suffering from a neurotic disorder."
},
{
  "instruction": "Doctor, I've been suffering from severe back pain recently. What's the cause?",
  "input": "",
  "output": "The cause of back pain can be neurosis, which is a form of nerve damage affecting the back nerves."
},
{
  "instruction": "Hi doctor, neck, shoulder, and arm pain. Do you know what the symptoms are?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from nervous pain, which can cause pain in your neck, your shoulder, your arm, along a path that your nerves pass through."
},
{
  "instruction": "Teacher, back pain, hip pain, hip pain, shoulder pain, aching pain, what's the problem?",
  "input": "",
  "output": "And I think you're experiencing a neurotic disorder, a pain condition in the path that your nerves pass, and it's good to check this diagnosis and get a medical examination to determine how best to treat your symptoms."
},
{
  "instruction": "Doctor, I'm experiencing side pain, vitto, kidney mass and urinary pain, and what's the cause of these symptoms?",
  "input": "",
  "output": "You may have multiple kidney diseases."
},
{
  "instruction": "Doctor, I'm having back-to-back skin rashes, frequent urination. What's the problem?",
  "input": "",
  "output": "There's the possibility that there's multiple kidney diseases, which are cystic diseases in the kidney, which can cause skin growth and urology problems in the case. It's good to get additional tests to make sure you're diagnosed."
},
{
  "instruction": "like doctor, urine base, skin growth, side pain. What do you think's going on?",
  "input": "",
  "output": "There may be multiple kidney diseases due to the symptoms, and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "The doctor, the head pain, the blood in the urine, the sharp abdominal pain, what's the problem?",
  "input": "",
  "output": "Have you experienced any other symptoms, such as high blood pressure or bed-wetting?"
},
{
  "instruction": "Hi, doctor, I've recently had some discomforts, such as a chest pain, frequent urination, and sharp abdominal pain, and I recently discovered kidney sores and skin growth, and who knows what the symptoms are?",
  "input": "",
  "output": "The symptoms seem to indicate multiple kidney disease."
},
{
  "instruction": "Doctor, I'm feeling so depressed and I'm drinking so much, and I'm feeling nervous and nervous most of the time.",
  "input": "",
  "output": "People with this disorder, along with depression and anxiety, can rely on alcohol abuse as a form of self-treatment, and it's common to experience depression or psychiatric symptoms during depression episodes."
},
{
  "instruction": "Hi, doctor, I think you're sleeping better at night than usual, and you're watching me, and you're drinking more alcohol than you normally are, and you've got a lot of fear and fear that suddenly comes.",
  "input": "",
  "output": "The symptoms suggest that it may be bipolar, which is characterized by extreme mood changes, including insomnia, excessive anger, delusions, hallucinations, alcohol abuse, and so on."
},
{
  "instruction": "Doctor, I've recently had a hard time with alcohol abuse, and I don't know what's going on with me.",
  "input": "",
  "output": "It's possible you're experiencing bipolar symptoms, and bipolar often drinks to deal with mood changes."
},
{
  "instruction": "Doctor, I've been feeling very nervous and nervous lately, and I've been having excessive anger and temper problems, and I've been abusing drugs.",
  "input": "",
  "output": "Have you ever been diagnosed with mental health?"
},
{
  "instruction": "Hi doctor, I've been feeling anxious and nervous lately, and I've been abusing alcohol, and I've been avoiding going out because of fear and phobia, and I've been using drugs lately, and sometimes I experience delusions and hallucinations.",
  "input": "",
  "output": "The symptoms seem to indicate that bipolar disorder is characterized by extreme mood swings and mental health, often leading to behaviors such as drug abuse, delusions or hallucinations."
},
{
  "instruction": "I'm biting my nails, and I'm having a heart attack. What's the cause?",
  "input": "",
  "output": "The symptoms suggest that there may be an abnormal protein called amyloid, a rare disease that accumulates in various organs of the body."
},
{
  "instruction": "Doctor, I've been very tired of my eyes lately. It's very uncomfortable.",
  "input": "",
  "output": "It could be amyloidism."
},
{
  "instruction": "Sir, I've been feeling a lot of anxiety and anxiety lately. What's the cause?",
  "input": "",
  "output": "Symptoms suggest that you may be experiencing anxiety symptoms from a condition called amyloidism."
},
{
  "instruction": "Doctor, the strength of your legs and hands seems to be weakened, and your fingers are affected, and there's a little bit of pain in your face, and what's the cause of these symptoms?",
  "input": "",
  "output": "Based on what God has explained, there may be a chronic inflammable hyperstitivity syndrome that can affect the nerves in the limb and cause pain or paralysis, but I'll refer you to a neurologist who can help you with your diagnosis and treatment."
},
{
  "instruction": "Doctor, there are symptoms of body weakness, spasms in the legs, local sense of weakness, what are the symptoms?",
  "input": "",
  "output": "Depending on the symptoms, there could be chronic inflammation, hyper-resistant neuropathy, or CIDP."
},
{
  "instruction": "Hi, doctor, I've recently experienced a strange condition: poor focus, dizziness, abnormal involuntary movements, facial pain and leg pain.",
  "input": "",
  "output": "The symptoms seem to indicate that you have chronic inflammation, called CIDP."
},
{
  "instruction": "Doctor, I'm experiencing focus weakness, motor problems, loss of sense, abnormal involuntary movements. What's the problem?",
  "input": "",
  "output": "Depending on the symptoms, there may be chronic inflammatory hyperstitial neuropathy or CIDP, a rare condition of the terminal nervous system that affects the water around the nerves, causing not only abnormally involuntary movement, but also debilitating and motor problems."
},
{
  "instruction": "Doctor, I'm having problems with movement, leg weakness, sensory loss, weakness, what could be the problem?",
  "input": "",
  "output": "Depending on the symptoms, there could be CIDP."
},
{
  "instruction": "Doctor, vomiting, nausea and swallowing. What is the cause of these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate that there's a gastritis refluid disease or a gastritis refluid disease."
},
{
  "instruction": "Sir, it's hard to swallow and it's got sharp chest pain. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate GERD."
},
{
  "instruction": "I'm experiencing a doctor, a sore throat, a sharp chest pain, chest upset, cough, a shuffling voice, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there is a gastritis refluid disease."
},
{
  "instruction": "Doctor, I'm experiencing a chesty, sharp abdominal pain, and why?",
  "input": "",
  "output": "These are symptoms of GERD."
},
{
  "instruction": "Doctor, I'm experiencing coughing, vomiting, sharp chest pains and chest pains. What's wrong with me?",
  "input": "",
  "output": "Yes, it's a common symptom of gastritis reflux, which occurs when stomach acid backfires on the esophagus, causing irritation and discomfort."
},
{
  "instruction": "Doctor, we found that your eyes are in pain and have some bleeding in your eyes. What's the problem?",
  "input": "",
  "output": "Depending on the symptoms, there's the possibility that the free body bleeds when the blood leaks out and causes pain and bleeding, such as the gel in the back of the eye."
},
{
  "instruction": "Doctor, I'm having strange symptoms, and I see spots and clouds in my vision, and my eyes are very sick, and what's the cause?",
  "input": "",
  "output": "Symptoms indicate that you may be suffering from a disease called thropolysis, which is a clear gel that fills the space between the lens and the retina, which is important to diagnose and treat as soon as possible so that your vision is no longer impaired."
},
{
  "instruction": "Doctor, your left eye is not very good, and you're bleeding, and I don't know what's going on with your tears.",
  "input": "",
  "output": "The symptoms indicate that there's a lot of fluid bleeding, which occurs when the blood vessels of the eye are lowered into a free body, causing loss of vision and loss of vision."
},
{
  "instruction": "Sir, I've had a lot of pain in my eyes lately. Do you know what caused it?",
  "input": "",
  "output": "The symptoms could be that there's a blood loss in the eye, which can cause pain and loss of vision."
},
{
  "instruction": "Doctor, you've been bleeding out your eyes in the last few days. What's the cause?",
  "input": "",
  "output": "The symptoms suggest that he's bleeding from the free body."
},
{
  "instruction": "Doctor, I'm feeling so down and I can't breathe.",
  "input": "",
  "output": "I think you've been experiencing depression or psychosis with your short-term symptoms. Have you taken antimicrobial drugs recently? Patient:"
},
{
  "instruction": "Doctor, I feel very depressed these days and sometimes I feel like I'm losing my mind, and I feel less breath and limited movement than I normally do, and I'm also swollen with feet and legs, and what can happen to me?",
  "input": "",
  "output": "I think there's an antimicrobial addiction: depression, psychiatric symptoms, allergic reactions, respiratory problems, motor disorders, telophase -- all of the symptoms that you're experiencing are related to this condition, and you have to do some tests to check your diagnosis and determine your best plan for treatment."
},
{
  "instruction": "We've got skin rashes, shortness of breath, depression, movement and posture problems. Can you tell us what's going on?",
  "input": "",
  "output": "From the symptoms that God explains, I think you're suffering from an antimicrobial addiction, and it's important to resolve this problem as soon as possible to avoid further complications, and I encourage you to stop using antimicrobials and accept medical care."
},
{
  "instruction": "I'm so tired and sad, doctor, it's hard to stand up and cough, and I'm allergic to something.",
  "input": "",
  "output": "Depression, psychiatric symptoms, posture problems, allergic reactions and coughs are all common signs of this type of addiction."
},
{
  "instruction": "Doctor, I've been feeling a little weird lately, and I think I'm short of breath, and I think I'm allergic.",
  "input": "",
  "output": "It's important to stop taking drugs that can cause this reaction and get medical help as soon as possible."
},
{
  "instruction": "Doctor, I've been feeling very depressed lately, and I've been experiencing nausea with my telophase and weird stings, and what's wrong with me?",
  "input": "",
  "output": "Depression or psychiatric symptoms, nausea, telophase and sensations are generally associated with this type of addiction, and we need to do some tests to identify the diagnosis and provide the right treatment."
},
{
  "instruction": "I think there's a doctor, posture problem, telophase, abnormal involuntary movement, and there's an allergic reaction.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from an antibiotic addiction."
},
{
  "instruction": "Sir, your tongue bleeds and your hands and feet swell.",
  "input": "",
  "output": "The symptoms can cause injury in the mouth, and blood in the tongue, and so on, and so on, and we have to do some tests to confirm the diagnosis."
},
{
  "instruction": "The doctor, the toothache, the neck swelling, the lips edema, the mouth ulcer, what's the problem?",
  "input": "",
  "output": "I think there's a wound in your mouth that can be caused by trauma, infection or endocarditis, and you have to examine the wound more closely to see the underlying cause."
},
{
  "instruction": "Doctor, you've got a cut in your mouth, and you've recently had a swelling of your neck and a sneeze, and what's the cause?",
  "input": "",
  "output": "The symptoms could lead to an infection in the mouth called Ludwig condensation, a swelling of the neck and spreading into the airway, causing sneezing and shortness of breath."
},
{
  "instruction": "Doctor, I found blood in my mouth and ulcers. It's pretty painful.",
  "input": "",
  "output": "Oral ulcers can be caused by a number of causes, including trauma and infection, and it's important to be examined by medical professionals and immediately treat them to prevent further complications."
},
{
  "instruction": "Doctor, your lips are swollen, your tongue is bleeding, and your mouth is bleeding, and you have sneezing and toothache.",
  "input": "",
  "output": "The symptoms seem to have caused all this damage, and it can be caused by accidentally biting, dental procedure, or infection, and you have to clean up the wound and prescribe antibiotics to avoid further complications."
},
{
  "instruction": "Doctor, I found abnormal growth in my skin, hard and growing, and what's the cause?",
  "input": "",
  "output": "Based on what you're talking about, there could be a disease called scleroderma, which causes the skin to become hard, stiff, and abnormal skin growth."
},
{
  "instruction": "Doctor, there's warts in the skin and there's so much itching, and the skin looks abnormal, and why?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from SD."
},
{
  "instruction": "Doctor, I have strange skin lesions in my hands and arms, and recently I have a really dry, scaly skin, swollen lips, strange skin growth, what's the problem?",
  "input": "",
  "output": "Symptoms can lead to a disease called scleroderma, a rare autoimmune disease that can cause dryness, peeling, roughness and growth of skin, which is a common symptom of swelling of the lips."
},
{
  "instruction": "Doctor, I'm experiencing skin drying, texture, scales, roughness, skin irritation, skin lesions, abnormal skin rashes, do you know what's causing these symptoms?",
  "input": "",
  "output": "Yes, symptoms are likely to cause SD, which affects the body's connective tissue, including the skin, which can cause a thick, hard skin that you're talking about."
},
{
  "instruction": "Doctor, I've recently developed skin ugliness, skin rashes and irritations, and my skin looks very dry and rough, and my lips start to swell.",
  "input": "",
  "output": "Scleroderma is a chronic autoimmune disease that affects the different connective tissues of the skin and the body."
},
{
  "instruction": "Doctor, I've recently experienced a decline in focus and reduced vision. What's the problem?",
  "input": "",
  "output": "There may be a condition called severe dystonia, which can cause muscle weakness and reduced vision, which requires additional evaluations to identify the diagnosis."
},
{
  "instruction": "Doctor, you keep getting dizzy, your arm feels so heavy, and sometimes you have abdominal symptoms and frequent headaches that look like two things, and what's the problem?",
  "input": "",
  "output": "It's possible that the symptoms are severe muscle disease, which causes muscle weakness, including the arm and the eyes, and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Sir, there's a dizzying symptom that looks like two things and vomits a spade, and what's the cause?",
  "input": "",
  "output": "The symptoms suggest that it could be severe work force."
},
{
  "instruction": "Sir, we've recently experienced abnormal symptoms, such as shortness of breath, abnormal movement of eyelids, street coughs, low vision, and sometimes abdominal symptoms.",
  "input": "",
  "output": "It's possible that it's a neuromuscular disorder, which affects the muscles that are affected by the symptoms of weakness or paralysis, that can cause respiratory problems, eyelids, dot cough, vision problems, abdominal pain, and it's good to consult a neurologist for proper diagnosis and treatment."
},
{
  "instruction": "Doctor, I need you to tell me what's going on.",
  "input": "",
  "output": "The symptoms are likely to be severe work force, which is a neuromuscular disorder that weakens the muscles that control movement, including the muscles that are used in speech and eye movement."
},
{
  "instruction": "Doctor, you're sweating, you're fainting, you're dizzy, you're having problems with your movement.",
  "input": "",
  "output": "The symptoms seem to indicate that you have hypoglycemics, which are too low, are you monitoring your blood sugar levels?"
},
{
  "instruction": "Sweat sweat, exercise disorder, nausea, seizures, drowsiness, what's the cause?",
  "input": "",
  "output": "I think you're experiencing low blood sugar, hypoglycemia. Are you monitoring blood sugar levels?"
},
{
  "instruction": "Hi, doctor, you've recently had a problem with movement, with paralysis, weakness, and feeling ill. Can you tell me what the problem is?",
  "input": "",
  "output": "You're experiencing hypoglycemia, or hypoglycemia, which can cause headaches, tremors and what you're talking about."
},
{
  "instruction": "Hi, doctor, depression, nausea, dizziness, abnormally involuntary movement, drowsiness, what's wrong with me?",
  "input": "",
  "output": "The symptoms may indicate that the blood sugar level is getting too low, or hypoglycemia."
},
{
  "instruction": "Doctor, I've been extremely sleepy and weak lately, and why?",
  "input": "",
  "output": "It looks like you're suffering from hypoglycemia, which is a condition that causes fatigue and weakness because your blood sugar levels are so low."
},
{
  "instruction": "Doctor, we've recently experienced such symptoms as vaginal secretions, nausea, weight gain, lower abdominal pain and edema, but the biggest concern is that the menstrual cycle has been gone for a while.",
  "input": "",
  "output": "Because of your symptoms, you don't seem to have a period of menstruation due to a disease called PCOS, and you have to do some medical tests to confirm this diagnosis."
},
{
  "instruction": "Doctor, I haven't had my period for months, and it's a long-term period. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that there is a disease called PCOS."
},
{
  "instruction": "Sir, I've been suffering from breast pain for a while, and I haven't had a period of months, so what's the problem?",
  "input": "",
  "output": "You're experiencing a period without any particular cause, and it's important that you do a thorough examination and a blood test to eliminate such base disorders as pregnancy and thyroid problems."
},
{
  "instruction": "Doctor, we've been experiencing sharp abdominal pain, breast pain or wear, nausea, and lower abdominal pain in the last few weeks.",
  "input": "",
  "output": "You're experiencing symptoms of spontaneous menstruation, which means that you haven't had your first menstrual period until you're 16, or that you haven't had a menstrual period for three years."
},
{
  "instruction": "Hi, doctor. I've got a problem with my ankle. My ankle's been swelling and it's been really painful for the last few days.",
  "input": "",
  "output": "I think my ankle's decapitated."
},
{
  "instruction": "Doctor, your wrist's been weakened, your emotional ups and downs lately, and you've lost a lot of weight.",
  "input": "",
  "output": "The symptoms suggest that the ankles are disrepaired."
},
{
  "instruction": "Doctor, I'm experiencing ankle pain, elbow weakness, wrist weakness and some emotional symptoms.",
  "input": "",
  "output": "The symptoms seem to indicate that the ankles are decapitated, and we need to do some video tests to confirm the diagnosis."
},
{
  "instruction": "Sir, I'm experiencing pain in my ankle, heat and cold, backaches, fatigue of my eyes, and I'm losing weight.",
  "input": "",
  "output": "The symptoms suggest that the ankles are decapitated, and we need to do some tests to confirm this diagnosis."
},
{
  "instruction": "Doctor, elbow spasms, spasms, ankle pains, backaches, what's the disease?",
  "input": "",
  "output": "It looks like your ankle's decapitated because of your symptoms, and it's good to take X-rays to make sure you get medical attention."
},
{
  "instruction": "Doctor, I've recently experienced elbow spasms and spasms. Can you tell me what's wrong?",
  "input": "",
  "output": "The symptoms suggest that Germany is likely to be one of the carbon monoxides, and have you ever been around a sealed space or a gas device that is poorly ventilated lately?"
},
{
  "instruction": "Doctor, you're very sick these days, vomiting and diarrhea are continuing, and you're experiencing emotional symptoms.",
  "input": "",
  "output": "The symptoms are that it's possible for Germany to be one of the carbon monoxides."
},
{
  "instruction": "Doctor, I've been diarrheating for a few days, and I'm always very tired.",
  "input": "",
  "output": "It's possible that you're suffering from carbon monoxide poisoning because of these symptoms, have you ever been exposed to a potential source of carbon monoxide, such as a heating system or a gas plant defect?"
},
{
  "instruction": "Doctor, I've been really confused and emotionally upset lately, so what's wrong with me?",
  "input": "",
  "output": "The symptoms suggest that carbon monoxide poisoning is suspect. Have you ever been to a place where carbon monoxide can be found, near a gas stove or a closed garage?"
},
{
  "instruction": "Doctor, I've been feeling a lot of dizzy lately.",
  "input": "",
  "output": "You may be suffering from carbon monoxide poisoning from symptoms. Have you been exposed to carbon monoxide recently?"
},
{
  "instruction": "Doctor, I've been feeling really nervous and nervous lately, and I have headaches, and I have an irregular heartbeat, and what's wrong with me?",
  "input": "",
  "output": "I think you're having panic attacks."
},
{
  "instruction": "Doctor, you've got a good breath and a headache, and you've lost your senses, and you've got a bad feeling about your heart, and what's the problem?",
  "input": "",
  "output": "Panic attacks can cause rapid breathing, headaches, chest upsets, sensory loss may be caused by hyperventilation during panic attacks."
},
{
  "instruction": "Doctor, I've been having a hard time lately, and I've been having a lot of symptoms over the last few weeks, such as shortness of breath, loss of sense, irregular heart rate, double-passing chest pain, what's the problem?",
  "input": "",
  "output": "Panic attacks are a sudden episode of extreme fear and anxiety that causes the same physical symptoms you just mentioned, and it's good to have proper medical evaluations and treatment to manage anxiety and panic disorders."
},
{
  "instruction": "Doctor, it's hard to breathe these days. It's too fast and shallow.",
  "input": "",
  "output": "I think you're experiencing a panic attack."
},
{
  "instruction": "Doctor, what happened to your heart and your breathing?",
  "input": "",
  "output": "The symptoms seem to indicate that you're having panic attacks."
},
{
  "instruction": "Doctor, I'm feeling really weird these days, and I've had a very difficult breath, a deep heart, and I've passed out.",
  "input": "",
  "output": "You may be experiencing panic attacks, and fainting is a common symptom of panic attacks, and that's something that we need to discuss in more detail during counseling."
},
{
  "instruction": "Doctor, sharp chest pain, dizzyness, shortness of breath. What's the problem?",
  "input": "",
  "output": "The symptoms suggest you're having a panic attack."
},
{
  "instruction": "Hi, doctor, there's bone pain and swelling of the ankle. What's the problem?",
  "input": "",
  "output": "Is there a lot of activity involved in running or jumping?"
},
{
  "instruction": "Doctor, your feet, your toes, your scalp, your muscles, what's the problem?",
  "input": "",
  "output": "The symptoms seem to make me suspect fasciitis."
},
{
  "instruction": "Good morning, doctor, your feet are swollen, your toes are swollen, your bones are broken, your feet are convulsed, your feet are convulsed, your movements are affected.",
  "input": "",
  "output": "The symptoms seem to indicate that you have fasciitis, which is a common condition that affects the ligaments of your feet, and it's good to rest on your feet, put on an ice pack, and put on a supportive pair of shoes."
},
{
  "instruction": "Sir, you've got pain in your feet and a spasm in your toes. What's the cause?",
  "input": "",
  "output": "I think there's some symptoms of fasciitis, which is an inflammation of the pads of the foot that can be caused by excessive running, frost, or walking."
},
{
  "instruction": "Doctor, I have a lower body pain and a painful bone, and I feel a little knee pain, and what's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate mechanism, which is caused by inflammation of the tissue that connects the heel bone to the toe, causing pain in the ankles, ankles and lower thighs."
},
{
  "instruction": "Doctor, there's a convulsion or spasm in the neck, and there's a problem with vision, and there's very little vision, and everything looks blurry, so can you tell me what the problem is?",
  "input": "",
  "output": "The symptoms seem to indicate that you have a primitive, or ophthalmology, that light does not form on the retina, but is focused on the back of the eye, and that objects farther away than the normal refraction of the eye, may appear more clearly, such as the dimming of the eye, the blood of the eye, and so forth. It's a good idea to have your eye tested by an eye doctor or an eye specialist for proper diagnosis and treatment."
},
{
  "instruction": "Sometimes I feel like I'm going to be blind, and then I get cramps and cramps in my neck.",
  "input": "",
  "output": "The symptoms seem to indicate that you have a primitive or primitive condition, which causes the eyes to become tired and can cause headaches, neck cramps, and vision disturbances, and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Sir, I'm experiencing some of the symptoms associated with the eye, which are abnormally moving, difficult to talk about, difficult to talk about, and other symptoms associated with the eyes, and what could be the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you have a primitive or a primitive condition."
},
{
  "instruction": "Doctor, I've been experiencing strange symptoms recently, and my eyelids seem to be moving abnormally, and what's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that there's a primitive called a primitive, and it's difficult to get close to an object because of refraction, and it can lead to eyelids or abnormal movements of the eyelids."
},
{
  "instruction": "Doctor, I'm experiencing the symptoms of alcohol abuse, insomnia, excessive anger, movement problems, and confusion of speech.",
  "input": "",
  "output": "Have you taken any tranquilizers or sleeping pills recently?"
},
{
  "instruction": "Doctor, I'm suffering from depression and motor disorder, and I also have a history of drug abuse.",
  "input": "",
  "output": "The symptoms that God has described suggest that addiction to tranquilizers is at stake."
},
{
  "instruction": "Doctor, I've recently been extremely sleepy and difficult to tell clearly, and I've also been suffering from depression and mental illness.",
  "input": "",
  "output": "Your symptoms suggest you're suffering from a sedative addiction. Have you been taking tranquilizers recently?"
},
{
  "instruction": "Doctor, I'm always extremely sleepy, I'm experiencing delusions and hallucinations, and I feel depressed, and I can't move my body.",
  "input": "",
  "output": "Your symptoms suggest that you're suffering from an addiction to tranquilizers, which can cause drowsiness, delusions, depression, motor disorders, have you taken any tranquilizers recently?"
},
{
  "instruction": "Doctor, I've recently experienced dermatosis and skin lesions. Do you know what the symptoms are?",
  "input": "",
  "output": "It's a rare autoimmune disease that affects the skin and forms lesions."
},
{
  "instruction": "Doctor, I've been having some symptoms recently: my feet are sick and swollen and my feet and my hands are looking weird.",
  "input": "",
  "output": "It's a rare autoimmune disease that can cause abnormal blisters and skin lesions in many parts of the body, including the feet and the hands."
},
{
  "instruction": "Doctor, for the last two weeks, I've been experiencing skin ugliness, and I'm also worried about the irregular look of scalps, skin lesions and skin irritations, and what's causing the skin to look abnormally.",
  "input": "",
  "output": "The symptoms suggest that you're suffering from a self-immune disease, a self-immune disease that causes blistering and inflammation of the skin and the mucous membranes, and you have to do some tests to identify the diagnosis and determine how best to treat it."
},
{
  "instruction": "Doctor, I developed skin lesions and rashes in my body, as well as pain in my fingers and hands as well as in my mouth.",
  "input": "",
  "output": "In view of the symptoms that God has given us, it's possible that tawny is an immune disease that causes painful blisters and ulcers in the periphery, such as skin and mouth, which affects both men and women of all ages, but is more common to adults than middle age."
},
{
  "instruction": "Teacher, ankle, foot, leg, swelling. Do you know what's causing it?",
  "input": "",
  "output": "Yes, telophase or leg swelling can be symptoms of parasol, self-immune disease that causes blisters on the skin and atherosclerosis, which can affect organs, such as the lungs and the kidneys."
},
{
  "instruction": "Doctor, there's a lump in your scrotum.",
  "input": "",
  "output": "Depending on the symptoms, there may be pheronine, which is the disease of lumps and plaques, and it's important to get a specialist's consult."
},
{
  "instruction": "Hi, doctor, you've got a lump in your penis, and you've got abdominal pain.",
  "input": "",
  "output": "The symptoms suggest that you have pheroni disease."
},
{
  "instruction": "Hi, doctor, I've been experiencing erectile failure for the last few weeks, so can you tell me why?",
  "input": "",
  "output": "Symptoms may indicate that it's due to feroni disease."
},
{
  "instruction": "Doctor, you've got a wart in your penis and you're experiencing erectile failure. What's the problem?",
  "input": "",
  "output": "The symptoms indicate that there's a chance that there's a periphery disease, which can cause scar tissue in the penis to bend or bend at the time of the erection, or lead to an erection failure."
},
{
  "instruction": "Excuse me, doctor, there's a lot of blood in your urine and a lot of sweat.",
  "input": "",
  "output": "There may be pyronic diseases that can distort the symptoms and eventually cause pain in the erection, but they usually don't bleed or sweat in the urine, so we need to do some more tests to figure out the root cause of the symptoms."
},
{
  "instruction": "Doctor, you're experiencing sharp chest pains, shortness and reflux. Do you know what's causing these symptoms?",
  "input": "",
  "output": "Have you ever felt hard to swallow or had a lump in your neck?"
},
{
  "instruction": "Doctor, I feel like I'm burning my chest, especially at night after a meal. What are the symptoms?",
  "input": "",
  "output": "I think you're struggling with the common symptom of a heater hernia, which is ethos."
},
{
  "instruction": "Sir, there's been a lot of back pain recently, and there's a lot of heartburn and reflux. Do you know what's causing it?",
  "input": "",
  "output": "Yes, you may be suffering from a Heattal hernia."
},
{
  "instruction": "Hi, doctor, I've been suffering from vomiting lately.",
  "input": "",
  "output": "It could be a heater hernia, but did you experience intestinal gas or acid reflux?"
},
{
  "instruction": "Doctor, I'm vomiting sharp chest pains and blood. What's the cause?",
  "input": "",
  "output": "This condition occurs when part of your stomach goes up into your chest through a hole in your diaphragm, which can cause chest pain, difficulty in swallowing, vomiting blood, and so forth."
},
{
  "instruction": "Doctor, I have a problem with my movement, and I don't think I can move as gently as I once did.",
  "input": "",
  "output": "Based on your description and your history, it's possible that it's a symptom of the extra effect of the drug you're taking."
},
{
  "instruction": "Doctors, delusions, seizures, nausea, anxiety, anxiety. What's the problem?",
  "input": "",
  "output": "Have you started taking new drugs recently?"
},
{
  "instruction": "Doctor, I'm feeling very nervous and nervous these days, and why?",
  "input": "",
  "output": "It can be an extraneous effect of certain drugs that we're taking based on the symptoms."
},
{
  "instruction": "Doctor, I've recently had cramps, cramps, and edema. Can you tell me what's wrong?",
  "input": "",
  "output": "The symptoms seem to indicate that you're experiencing effects outside of the drug's body."
},
{
  "instruction": "Doctor, I'm experiencing bleeding and severe ear pain in my ear. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that Menier's disease is a disease affecting the inner ear that can cause dizziness, tinnitus and hearing loss."
},
{
  "instruction": "Doctor, there's a continuous double-pass pain in your ear. Do you know what's causing it?",
  "input": "",
  "output": "Menier's disease is a disease that affects the inner ear, which can cause dizziness, loss of hearing, and loss of hearing."
},
{
  "instruction": "Doctors, earaches, headaches, nausea, soreness, a sense of deafness, do you know what's causing it?",
  "input": "",
  "output": "The symptoms suggest that he has Menier's disease."
},
{
  "instruction": "Hi, doctor, I'm experiencing allergic reactions and deafness with a feeling of deafness. What's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate Menier's disease."
},
{
  "instruction": "Hi, doctor, I've been having a lot of dizziness lately, and what's the cause?",
  "input": "",
  "output": "It could be Menier's disease, which affects the inner ear, which can cause dizziness or dizziness."
},
{
  "instruction": "Doctor, there's been a recent bleeding of the workplace, sharp abdominal pain, vaginal dryness, prostate symptoms, irregularity in the navel, what's the problem?",
  "input": "",
  "output": "I think you're struggling with anal lining tearing, and the symptoms that you've described are common symptoms of this disease."
},
{
  "instruction": "Hi, there's vaginal dryness and spasms and spasms in the anal area, and you know what's causing it?",
  "input": "",
  "output": "Yes, I think you're suffering from severe symptoms."
},
{
  "instruction": "Doctor, there's blood in your throat, there's blood, there's rectal bleeding, there's also sharp abdominal pain, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate an analbery."
},
{
  "instruction": "Doctor, I have some changes in the shape of the stool, and I'm experiencing prostate symptoms, so can you tell me what's going on?",
  "input": "",
  "output": "There seems to be a crack in the anal tube, which changes the shape of the stool and sometimes causes symptoms similar to prostate problems."
},
{
  "instruction": "Doctor, there's been a change in the shape of the variation, and there's a loss of employment, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate an anal crack."
},
{
  "instruction": "Doctor, your tongue is swollen, allergic, skin rashes.",
  "input": "",
  "output": "The symptoms seem to indicate an allergy."
},
{
  "instruction": "Doctor, what causes the swelling of the eyes and tears?",
  "input": "",
  "output": "Have you been exposed to a new allergen recently?"
},
{
  "instruction": "Doctor, we're experiencing fluid reduction, telophase and allergic reactions. What's the problem?",
  "input": "",
  "output": "These symptoms are often associated with allergies. Have you been exposed to anything new or unusual that can cause allergic reactions recently?"
},
{
  "instruction": "Doctor, I've been experiencing telophase and cough for days, and why?",
  "input": "",
  "output": "Cough and telophase are common symptoms, and you have to do some tests to make sure you have exactly what you're allergic to."
},
{
  "instruction": "Doctor, your lips are swollen, so it's uncomfortable. Do you know what's causing them?",
  "input": "",
  "output": "Yes, it could be allergies."
},
{
  "instruction": "Doctor, I've been pulling my ear with a sense of deafness, and I've found a fluid in my ear, and what's the symptom?",
  "input": "",
  "output": "It's a disease that accumulates in the middle ear inflammation and fluid, often caused by bacteria or viruses."
},
{
  "instruction": "Doctor, I think you're allergic to your ears getting a little bit red, and I think you're pulling on your ears.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from chronic sepsis."
},
{
  "instruction": "Doctor, sinus pain, deafness in the ears, allergic reactions, ear pull, ear pain.",
  "input": "",
  "output": "The symptoms suggest that you may have chronic neutrophics."
},
{
  "instruction": "Doctor, your ears are still bleeding. What's the problem?",
  "input": "",
  "output": "It could be chronic sepsis."
},
{
  "instruction": "Sir, your feet are so swollen that they hurt a lot. What's the problem?",
  "input": "",
  "output": "I don't think it's related to the foot. Have you had a finger injury or injury recently? Patient: Yeah, I fell down a few days ago and hit my finger, and it's still sick and swollen, and that's why?"
},
{
  "instruction": "Doctor, your hands and fingers are swollen with stiffness and tightness, and your feet and toes are swollen.",
  "input": "",
  "output": "I think there's a finger fracture that can cause swelling and stiffness in the hands and fingers, or swelling in the feet and toes, which may have something to do with this or may be a separate problem."
},
{
  "instruction": "I feel pain in my hands and fingers, and every time I try to pick up something, it hurts.",
  "input": "",
  "output": "The symptoms suggest that there's a fracture in the finger, which requires X-raying."
},
{
  "instruction": "Doctor, I've recently had pain in my hands and feet.",
  "input": "",
  "output": "The symptoms suggest that there's a finger fracture."
},
{
  "instruction": "Doctor, you've got pain and swelling in your hands and fingers, your toes and your feet.",
  "input": "",
  "output": "The symptoms suggest that there's a finger fracture."
},
{
  "instruction": "Doctor, I've been feeling a lot of heat and cold lately. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to cause Hishspung's disease, which causes defecation and other related symptoms because the colon's nerves don't develop properly."
},
{
  "instruction": "Doctor, your back is weak and your eyes are bleeding. What's the cause?",
  "input": "",
  "output": "You may have Hishspung disease, which affects the colon and interferes with normal urination, causing back weakness and eye fatigue."
},
{
  "instruction": "Doctor, your wrist's getting weak, and you're suffering from vomiting, and why?",
  "input": "",
  "output": "The symptoms are likely to be Hushspung's disease, too difficult to see the stools, or the swelling of the abdomen?"
},
{
  "instruction": "Hi, doctor. I'm curious about what's causing this with the symptoms of biting nails for a long time.",
  "input": "",
  "output": "The symptoms suggest that the Hishspung disease can lead to chronic toilets and other intestinal problems, causing anxiety and nail biting behavior."
},
{
  "instruction": "Doctor, I'm experiencing nail bite, toilet, elbow weakness, vomiting. Can you tell me what's going on?",
  "input": "",
  "output": "The symptoms are likely to be Hushspung's disease, which is difficult to pass through because the colon nerves are in trouble, and it can also cause vomiting and muscle weakness in real clinical environments, but it may be longer, but only one step back and forth for the purpose of the work."
},
{
  "instruction": "Doctor, I have a lot of pain in my legs and a lot of anger these days, and I also feel sharp chest pain.",
  "input": "",
  "output": "Symptoms suggest that there's a possibility that multiple muscle pain in the shoulder, neck, as well as hips, can cause pain and stiffness, but it can also affect other body parts, such as the legs, and it can also cause mood changes and chest pain."
},
{
  "instruction": "Doctor, I'm losing weight in my legs, and I'm getting pain all over my body, so what's the problem?",
  "input": "",
  "output": "The symptoms may indicate that there's an inflammation of the muscles, often in the shoulder and the buttocks, which causes muscle stiffness, a rheumatous multiple muscle pain."
},
{
  "instruction": "Sir, it's hard to swallow, and there's shoulder pain, fatigue, muscle pain, stiffness in the whole body.",
  "input": "",
  "output": "The symptoms indicate that there is a suspicion of a polymatismy muscle pain, an inflammation that causes various muscles, especially shoulder, neck, buttock pain and stiffness, which can also cause fatigue and difficulty in swallowing."
},
{
  "instruction": "Doctor, I've been experiencing a lot of symptoms lately: my whole body is sick, my leg is weak, my heart rate is irregular, my shoulder hurts, my temper changes.",
  "input": "",
  "output": "All of these symptoms could be due to a disease known as the rheumatous polymystic muscle pain."
},
{
  "instruction": "Doctor, you've got swelling your neck, swelling your feet and toes, swelling your legs, touching a lump around your neck.",
  "input": "",
  "output": "The symptoms suggest that you have lymphoma, which can accumulate in your body, which can cause swelling of your arms or legs, but may also occur in other parts of your body."
},
{
  "instruction": "Doctor, you've got skin lesions in your arm, and you've got body fluids, and you've got lumps in your neck, and you've got swellings in your throat, and what's the cause of these symptoms?",
  "input": "",
  "output": "From the symptoms that God explains, it's possible that lymph nodes occur when the lymphatic system accumulates fluid, and usually the arm or the leg is swollen, and the skin lesions and the lumps of the neck that you're talking about are the common symptoms of this disease."
},
{
  "instruction": "Doctor, I think there's a lump in the neck and a lymphoma with a hypodermic current, and what do you think is wrong with me?",
  "input": "",
  "output": "The symptoms you described suggest that you have a lymphoma."
},
{
  "instruction": "Doctor, recently my skin looks strange, it's thick, it's hard, it's shiny.",
  "input": "",
  "output": "The symptoms are likely to be lymphoma, where the lymphatic fluid accumulates and the tissue swells, and what looks abnormally on the skin is the general symptom of lymphoma."
},
{
  "instruction": "Doctor, I've been experiencing a number of problems recently, and I'm having trouble holding down urine, and I've found a penis secretions, and I think there's a prostate problem.",
  "input": "",
  "output": "It's good to run some tests to confirm this diagnosis and start treating it as soon as possible."
},
{
  "instruction": "Doctor, a mass of kidney and groin is touched and blood is added to the urine, and why?",
  "input": "",
  "output": "It's possible that it's bladder cancer, which is a symptom, and it's good to run some tests to see if it's diagnosed."
},
{
  "instruction": "Doctor, there's a mass in the bladder. What's the cause?",
  "input": "",
  "output": "It's possible that it's bladder cancer, depending on the symptoms, and you have to do some additional tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I'm having prostate symptoms, and I'm bleeding out of my urine, and what's the cause?",
  "input": "",
  "output": "It's likely to be bladder cancer because of the symptoms, and you have to do some additional tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I feel pain during sex. Can you tell me why?",
  "input": "",
  "output": "It may be a symptom of bladder cancer, and we need to do some tests to make sure that it's diagnosed."
},
{
  "instruction": "Doctor, in the last few days, I've been experiencing a burriness, a nose and a nose.",
  "input": "",
  "output": "The symptoms seem to indicate that you're experiencing acute bronchitis spasms."
},
{
  "instruction": "Doctor, I've been breathing lately, and I have a sore throat. What's wrong with that?",
  "input": "",
  "output": "The symptoms suggest that the lung muscle may have a sudden contraction of an acute windpipe."
},
{
  "instruction": "Doctor, I'm feeling really bad these days. Headaches, noses, vomiting, chest upsets, noses are going up. What's the problem?",
  "input": "",
  "output": "I think you're experiencing acute bronchitis spasms."
},
{
  "instruction": "Doctor, I'm experiencing vomiting and sharp chest pain. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're experiencing acute bronchitis spasms."
},
{
  "instruction": "Doctor, you've recently had a breathing problem: you've got a good breath, you've got a bad nose, you've got a good sound when you're breathing, you've got a bad breath when you're breathing, you've got a cough.",
  "input": "",
  "output": "Your symptoms may indicate that you're having acute bronchitis cramps, and I'm going to give you some tests to check your diagnosis and then recommend the appropriate treatment options."
},
{
  "instruction": "Sir, I'm experiencing eye pain, low vision, low vision, blood loss, loss of hair -- tell me what's wrong with my eyes.",
  "input": "",
  "output": "The symptoms suggest that you have acute glaucoma, which is a sudden rise in the pressure of the eye, which is an emergency and requires urgent treatment."
},
{
  "instruction": "Doctor, what's wrong with your recent eyes and your eyes and your spots and clouds?",
  "input": "",
  "output": "I think you have acute glaucoma, which can cause acute pain, intubation and loss of vision, as the pressure of your eyes suddenly increases, and you need urgent treatment to prevent further damage to your eyes."
},
{
  "instruction": "I'm experiencing a doctor, a good time, a low vision, a burn or a sting of the eye, a speck in my vision, a tear in my eyes, an excessive tear, what's the problem?",
  "input": "",
  "output": "The symptoms seem to have acute glaucoma, and it's good to have additional tests and tests to check the diagnosis and start a proper treatment."
},
{
  "instruction": "Doctor, I feel sore eyes and sore eyes and sore eyes and sore tears.",
  "input": "",
  "output": "The symptoms suggest that it might be acute glaucoma."
},
{
  "instruction": "Doctor, you've got a spot on your eyes, and you've got a blind spot, and you've got a blur in your eyes, and what's the problem?",
  "input": "",
  "output": "The symptoms are likely to be acute glaucoma."
},
{
  "instruction": "Doctor, there's an open wound in your chest, and your lips are swollen. What's the problem?",
  "input": "",
  "output": "The swelling of the lips is not related to the open chest wound, but the open chest wound can be caused by a stab wound or a fever wound."
},
{
  "instruction": "Doctor, there's a sharp pain in the chest and swelling of the lips. What's the problem?",
  "input": "",
  "output": "There may be sharp chest pain, and the swelling of the lips may be due to an allergic reaction to something, and it's important to treat it immediately to avoid potential infections."
},
{
  "instruction": "Doctor, there's sharp pain in the chest and swelling of the lips. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate a chest injury caused by pain and swelling of the lips, and you have to be examined immediately to determine the extent of the injury and provide the needed treatment."
},
{
  "instruction": "Doctor, there's open wounds in the chest and swollen lips. What's the cause?",
  "input": "",
  "output": "In terms of symptoms and drug abuse, open chest injuries can be self-injury wounds, and swelling lips can be caused by allergic reactions."
},
{
  "instruction": "Hi, doctor, I've been experiencing sharp chest pain for the last week, and I don't think my chest hurts, and I have to tell you that there's a history of drug abuse.",
  "input": "",
  "output": "The symptoms suggest that there's a chest injury, and sharp pain may be exposure to the injury, and it's best to stop using drugs immediately to avoid further complications and come back for treatment as soon as possible."
},
{
  "instruction": "Sir, there's a sharp pain in your knee.",
  "input": "",
  "output": "The symptoms suggest that there is a scrotum dislocation."
},
{
  "instruction": "Doctor, I've got a lot of stiff, warm knees these days, and I've got a problem with my pregnancy.",
  "input": "",
  "output": "It can cause stiffness and stress in the knee, and it can be aggravated by the tension of pregnancy. Patient:"
},
{
  "instruction": "Doctor, I've recently had a lot of pain in my knee and I think there's a lot of fluid around my knee.",
  "input": "",
  "output": "The symptoms suggest that the scrotum, the knee bone, has been decoupled."
},
{
  "instruction": "Sir, your knees are so sick, it's really hard to bend, and your knees are swollen.",
  "input": "",
  "output": "You can cause knee pain, swelling and stiffness."
},
{
  "instruction": "Hi, doctor, your knee is swollen a little bit, and there's a little bit of pain, and what's the cause?",
  "input": "",
  "output": "There's a possibility that there might have been a scrotum defect, depending on the symptoms."
},
{
  "instruction": "There's back cramps, cramps, lower body pain, sensory disturbances, motor impairments, and the color and smell of urine.",
  "input": "",
  "output": "I think you're experiencing left-bone neurosis."
},
{
  "instruction": "Doctor, I've got movement problems, my leg's weak, my leg feels sore, and I have lower pain, and I have strange urine color and smell, and what's the problem?",
  "input": "",
  "output": "The symptoms suggest that you have left-bone neurosis."
},
{
  "instruction": "Hi doctor, I've been experiencing leg cramps and back pain a few weeks ago, and also my legs and back cramps, and it's getting harder and harder to move.",
  "input": "",
  "output": "The symptoms seem to indicate that left-bone neurosis is a condition that causes pain and cramps in the abdomen, caused by the pressure or irritation of the left femur that goes down from the waist to the leg."
},
{
  "instruction": "Doctor, there's a weakness in your leg. Do you want to know what's causing it?",
  "input": "",
  "output": "It can be caused by a disease called left-bone neurosis."
},
{
  "instruction": "Hi, doctor, my leg strength has been weakened with lower body pain and sensory pain, and what's the problem?",
  "input": "",
  "output": "I think you've got left-bone neurosis."
},
{
  "instruction": "Hi doctor, back pain and back pain and back pain and movement problems, your legs are weak and your urine color and smell is weird.",
  "input": "",
  "output": "I think you're experiencing the symptoms of left-bone neurosis, which is a condition that puts pressure on the left-bone nerve, which is common to left-bone neurosis patients, how many tests do you order to make sure that they're diagnosed?"
},
{
  "instruction": "Doctor, my hands and fingers have been weakened.",
  "input": "",
  "output": "It's probably because of a high blood calcium hemolysis, where the calcium level is too high, and it's good to do some tests to check your diagnosis."
},
{
  "instruction": "Doctor, there's been a recent weakness in your leg, so can you tell me why?",
  "input": "",
  "output": "One of the causes of leg weakness could be high calcium hemolysis. Any other symptoms?"
},
{
  "instruction": "Doctor, I've recently felt a weakness in my hands and fingers and an irregular growth of my nails.",
  "input": "",
  "output": "The symptoms seem to indicate that you have a high-calcium hemorrhagic disease, which occurs when there's too much calcium in your blood, where muscles, including your hands and fingers, are weakened and changes in the shape of your nails."
},
{
  "instruction": "Doctor, you're not feeling well, you're having trouble urinating. What's wrong with me?",
  "input": "",
  "output": "I think you're experiencing a lot of high-calcium hemolysis in your blood, which can make your body sick and difficult to urinate, and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, for a while there were spasms and spasms in the arm. What was the cause?",
  "input": "",
  "output": "The symptoms may indicate high-calcemia in the bloodstream, where there's too much calcium."
},
{
  "instruction": "Doctor, I'm experiencing involuntary urination through the urinary tract. What's the cause?",
  "input": "",
  "output": "like cough, sneeze or exercise, which means that your pelvic muscles are weakened by certain activity or movement, so that your urine leaks."
},
{
  "instruction": "Sir, there's blood in the hip pain and urine. What's the cause?",
  "input": "",
  "output": "I think you're suffering from a stress-responsive urine solution when you cough, sneeze, laugh or exercise. Patient: Oh, okay, how do you treat it?"
},
{
  "instruction": "Doctor, you have frequent urination, increased weight, and urinary pain, do you have anything to do with the disease?",
  "input": "",
  "output": "Yes, these symptoms can be caused by stress-repair."
},
{
  "instruction": "I'm experiencing some of the symptoms of doctors, bladders, weight gain, or involuntary urination. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate you're suffering from a stress breakthrough."
},
{
  "instruction": "Doctor, I'm experiencing strange symptoms, such as a chest pain, facial blush, weight gain, and what's the reason?",
  "input": "",
  "output": "I think you're experiencing the stress benefits that are common to women."
},
{
  "instruction": "Doctor, you've got a rat in your leg, you've got a spasm, you've got leg pain.",
  "input": "",
  "output": "The symptoms suggest that you're suffering from a swelling and cyclic system right below the surface of your skin."
},
{
  "instruction": "Doctor, there's pain throughout the leg, and there's lumps or lumps on one leg, and I think the skin of the leg is infected.",
  "input": "",
  "output": "The symptoms suggest that he's got an arrhythmia."
},
{
  "instruction": "Doctor, you've recently had spasms and spasms in your legs, and why?",
  "input": "",
  "output": "It can cause discomfort and pain, convulsions and cramps in the leg. Have you ever found a prominent vein on the leg?"
},
{
  "instruction": "Doctor, what's the problem with leg spasms and spasms?",
  "input": "",
  "output": "Depending on the symptoms, there could be an arrhythmia."
},
{
  "instruction": "I'm experiencing doctors, backaches, involuntary urination, side pain, and what's the cause?",
  "input": "",
  "output": "The symptoms may indicate positive kidney cysts."
},
{
  "instruction": "Hi, doctor, we're experiencing prostate symptoms like urinary problems, weak flow, and what's the cause of these symptoms?",
  "input": "",
  "output": "It can cause similar symptoms by pressing pressure on the prostate, and it's good to run some tests to see that."
},
{
  "instruction": "Sir, there's been a recent backache.",
  "input": "",
  "output": "I think we have a benign kidney cyst that can cause backaches."
},
{
  "instruction": "Doctor, I'm experiencing erectile failure, loss of appetite, backache and involuntary urination. What's the problem?",
  "input": "",
  "output": "These symptoms show positive kidney cysts."
},
{
  "instruction": "Doctors, vomiting, backaches, loss of appetite, backaches, urine, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms suggest that there's a positive kidney cyst that's filled with fluid in the kidney that causes pain and discomfort and that causes nausea and blood in the urine."
},
{
  "instruction": "Doctor, there's a lot of pain in the testes and difficulty in urinating, and I think there's a little bit of a lump in the scrotum.",
  "input": "",
  "output": "It's caused by the accumulation of fluid around the testes, causing swelling and discomfort, and the same problem with skin growth."
},
{
  "instruction": "Sir, a few days ago, I had lower abdominal pain, and why?",
  "input": "",
  "output": "The symptoms suggest that the testoma in the pocket around the testes has a fluid in it, which can cause discomfort and pain in the lower abdomen."
},
{
  "instruction": "Doctor, we found skin growth in the testes.",
  "input": "",
  "output": "There's a buildup of fluid in the tissue around the testes, which can cause swelling and sometimes skin growth."
},
{
  "instruction": "Doctor, I'm worried about the symptoms that I'm experiencing: there's a growing skin in the scrotum and in the testes, and there's a loss of exhalation, and there's frequent urination, and there's blood in the urine at night.",
  "input": "",
  "output": "Your symptoms seem to indicate that it's from the testoma."
},
{
  "instruction": "Doctor, you've recently had some pain in your testes and a lump in your scrotum, and you've also had lower abdominal pain.",
  "input": "",
  "output": "The symptoms seem to indicate that there's a form of testoma, a condition in which fluid around the testes causes a high-frequency swelling and discomfort."
},
{
  "instruction": "Sir, I feel a lot of pain in my lower body. Do you know what's causing it?",
  "input": "",
  "output": "The symptoms that God's saying are that you're suffering from a sedimentary disk disease, a condition that causes backaches when the disk between the spines is worn out."
},
{
  "instruction": "Doctor, a few weeks ago, there was a pain in the neck and back, and what was the cause?",
  "input": "",
  "output": "It's a symptom that you're likely to have a sedimentary disk disease that can gradually cause back and back pain over a period of time."
},
{
  "instruction": "Sir, I've been having a lot of pain in my hip, hip, leg, and arm lately.",
  "input": "",
  "output": "The symptoms seem to indicate that there is a deterioration of the disk disease."
},
{
  "instruction": "Doctor, I've got pain all over my body, pain in my ass and my shoulder, and I've lost my senses, and I feel back pain.",
  "input": "",
  "output": "There's a good chance that there's a side-to-side disk disease from the symptoms."
},
{
  "instruction": "Good morning, sir. There's an arm pain coming up with back pain in the urethra.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from a sedimentary disk disease."
},
{
  "instruction": "Doctor, I've tried to get pregnant for a year, but I don't think I'm pregnant, and I'm worried if there's something wrong with me.",
  "input": "",
  "output": "Uh, especially the hair on my face and chest."
},
{
  "instruction": "Doctor, I'm experiencing what looks like abnormal skin, such as acne, acne, skin spots, unpredictable menstruation, and I'm also having trouble with sleep because of apnea.",
  "input": "",
  "output": "Because of the symptoms you've described, you may be experiencing multiple motherhood, which is one of the other symptoms that women have told you about with too much hair on their face, chest, back, or abdomen."
},
{
  "instruction": "Sir, you've got acne and spines and abnormal hair growth. Do you want to tell me what's going on?",
  "input": "",
  "output": "We think you're suffering from bulimia, which is a disorder of overgrowth of hair on abnormal parts of the body, with acne and acne."
},
{
  "instruction": "Doctor, I found that there was too little skin dot and hair growing on certain parts of my body, and why?",
  "input": "",
  "output": "It's a disorder that causes excessive hair growth in areas where there's less or less hair normally, which can, in some cases, develop into skin dots."
},
{
  "instruction": "Doctor, I'm experiencing abnormal skin with acne, lots of menstruation, too little hair in some areas, and hair in others that I don't want, and what's the cause?",
  "input": "",
  "output": "The symptoms suggest that you're suffering from multiple motherhood."
},
{
  "instruction": "Doctor, the blood of the eyes, the weakness of the wrist, elbow spasms, or convulsions.",
  "input": "",
  "output": "These symptoms may not seem relevant to each other, but they're actually common signs of foot dislocation."
},
{
  "instruction": "Sir, there are strange symptoms that seem to have a problem with my foot.",
  "input": "",
  "output": "What kind of problem is it, what kind of symptoms you're experiencing: it looks like your foot's out, your foot feels hot and cold at the same time, and what's the cause?"
},
{
  "instruction": "The back is weak, the elbow is weak, the wrist is weak, and sometimes the elbow convulses or tics.",
  "input": "",
  "output": "The symptoms suggest that your foot is defibrillated, and you have to have a diagnosis and a diagnostic test to see if you're going to be able to diagnose it."
},
{
  "instruction": "Doctor, I've recently experienced elbow spasms and spasms, and I've been decapitated, so can you tell me why?",
  "input": "",
  "output": "Elbow spasms and spasms are likely to have nothing to do with the dislocation of the foot, but the defibrillating of the foot means that the bone is out of its normal position."
},
{
  "instruction": "There's doctors, back pain, upper jaw pain, kidney symptoms, sharp abdominal pain. What's the problem?",
  "input": "",
  "output": "It's a symptom that we put off, and it can be a symptom of a reception."
},
{
  "instruction": "Sir, I've been experiencing a lot of lower and lateral pain. Can you help me understand what's going on?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from a condition called swelling and pain caused by a buildup of urine in your kidney, and it's important to run some tests to find out how best to treat it."
},
{
  "instruction": "Doctor, I've recently had some problems with blood coming out of the urine and vomiting, with pain in the testes and chest pain.",
  "input": "",
  "output": "These symptoms could be signs of dilation of the kidney, where urine accumulates and the kidney swells, and you have to run some tests to make sure you're diagnosed."
},
{
  "instruction": "There's a teacher, vomiting, pain in the testes, pain in the side, symptoms in the kidneys and bladder.",
  "input": "",
  "output": "The symptoms suggest that the kidney doesn't have a proper urine output, that there's a swelling and damage in the kidney, and we'll talk about treatment options after we run some tests to confirm the diagnosis."
},
{
  "instruction": "Hi, doctor, what's the cause of the pain in the side and back?",
  "input": "",
  "output": "The symptoms are likely to indicate that you have a reception syndrome, which is a condition in which urine backs up and causes swelling in the kidneys."
},
{
  "instruction": "Doctor, there's blood in your throat, there's abdominal pain, there's abdominal pain, there's toilet.",
  "input": "",
  "output": "It's possible that, depending on the symptoms, there's a small sac in the colon lining and there's some inflammation or infection."
},
{
  "instruction": "Doctor, since you've been experiencing diarrhea and nausea lately, do you know what's causing it?",
  "input": "",
  "output": "The symptoms are likely to indicate that you're experiencing geristism."
},
{
  "instruction": "Doctor, I've recently experienced some symptoms, including abdominal nausea, and what's the cause?",
  "input": "",
  "output": "Did you experience abdominal pain or abdominal ovulation?"
},
{
  "instruction": "Sir, I've been bleeding from the recent stools.",
  "input": "",
  "output": "It could be Gesy."
},
{
  "instruction": "Doctor, there's blood on the stool. Why?",
  "input": "",
  "output": "The symptoms can be caused by Gesie, which is a condition of the intestinal wall."
},
{
  "instruction": "Doctor, what's the problem with the sharp chest pain and headaches that go on after surgery?",
  "input": "",
  "output": "Unfortunately, it's normal to feel from mild post-op pain to severe pain, but symptoms suggest that there may have been a resection of the chest after the fluid accumulates around the lungs."
},
{
  "instruction": "Sir, I'm experiencing back pain and sharp abdominal pain after surgery. Can you tell me what caused it?",
  "input": "",
  "output": "The pain you're experiencing is normal post-op symptoms, possibly post-op inflammation and tissue trauma."
},
{
  "instruction": "Sir, I'm experiencing post-op neck pain, vomiting, toothache, nausea.",
  "input": "",
  "output": "The symptoms suggest that you're experiencing a common side effect of post-op surgery -- nausea and vomiting -- because of the posture that you had during the surgery."
},
{
  "instruction": "Doctor, I've been having a lot of back pain and nausea lately. What's the cause?",
  "input": "",
  "output": "You're experiencing post-op pain and nausea."
},
{
  "instruction": "Doctor, I had surgery a few days ago, and I'm having some symptoms, and I'm feeling nausea, and I'm having lower abdominal pain, and I think there's toothache, vomiting and back pain.",
  "input": "",
  "output": "Your symptoms suggest that post-op pain may have occurred, that you should take a break to relieve the pain and take prescribed medication, and if the symptoms persist, you should go back to the hospital."
},
{
  "instruction": "Doctor, I've been feeling so nervous and nervous lately. What's the problem?",
  "input": "",
  "output": "Symptoms suggest that you may be experiencing anxiety symptoms from Huntington's disease. Have you experienced any other symptoms?"
},
{
  "instruction": "Doctor, I've been feeling nervous and nervous lately, with no apparent reason for my elbows.",
  "input": "",
  "output": "These symptoms can be signs of Huntington's disease, a genetic disorder affecting the brain that can cause various physical and mental symptoms."
},
{
  "instruction": "Doctor, I'm suffering from toilets, sharp abdominal pain, overgrowth, facial symptoms, loss of sense, and what's wrong with me?",
  "input": "",
  "output": "It's a genetic disorder that affects the brain and the nervous system, and it can cause a wide range of physical and mental symptoms, including those you mentioned."
},
{
  "instruction": "Hi, doctor, I've been experiencing a couple of symptoms recently: loss of sense, back pain, fatigue, what's the problem?",
  "input": "",
  "output": "Symptoms suggest that you may be suffering from Huntington's disease."
},
{
  "instruction": "Doctor, I'm experiencing drug abuse and loss of sense, and what's the cause of these symptoms?",
  "input": "",
  "output": "These symptoms can be signs of the rare genetic disorder, Huntington's disease, which affects the brain and damages nerve cells progressively, causing drug abuse and sensory loss."
},
{
  "instruction": "Doctor, what's the problem with your shoulder cramps and spasms that persist for a while?",
  "input": "",
  "output": "The symptoms may indicate that he was infected with the West Nile virus."
},
{
  "instruction": "Hi doctor, there's a lump in your knee and a pain in your ankle, and you're experiencing pain during pregnancy, and what's the problem?",
  "input": "",
  "output": "Have you been bitten recently, or have you lived in areas where there's a lot of mosquitoes?"
},
{
  "instruction": "Doctor, I've been really tired lately, and I've had strange pain in my face and wrist, and what's the cause?",
  "input": "",
  "output": "The symptoms suggest that the West Nile virus is a viral infection that can cause fatigue, facial pain, wrist pain, and so forth."
},
{
  "instruction": "Doctor, I've had a lot of urination at night, so what's the cause?",
  "input": "",
  "output": "It's possible that you might have been infected with the West Nile virus as a symptom, and it's good to run some tests to check your diagnosis."
},
{
  "instruction": "Doctor, there's one bump on the neck, there's another lump on the shoulder.",
  "input": "",
  "output": "It's possible that it's a lymphoma because of what God said, and I want to run some tests to confirm the diagnosis."
},
{
  "instruction": "There are symptoms of doctors, kidney symptoms, fatigue, hooliganism, recurrentness, deafness, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that lymphoma is suspect, and it's important to have additional tests and evaluations to identify the diagnosis and determine how to treat the best."
},
{
  "instruction": "Doctor, there's pain in your mouth, there's lumps on your groin, and what's the cause?",
  "input": "",
  "output": "The symptoms are likely to be lymphoma, which is a form of cancer affecting the lymphatic system, which requires additional tests to identify the diagnosis."
},
{
  "instruction": "Doctor, I've been very tired lately, and I've been touching a lump in my neck, and my muscles are getting really hard, and I feel stiff all over my body.",
  "input": "",
  "output": "The symptoms are likely to be lymphoma, which requires additional tests and scans to identify the diagnosis."
},
{
  "instruction": "Doctor, I've recently experienced reflux and muscle pain. Do you want to know what's causing it?",
  "input": "",
  "output": "These symptoms can be diagnosed with lymphoma, and we recommend additional tests to check your diagnosis, and get a appointment with your oncologist."
},
{
  "instruction": "Sir, there's skin lesions in the hand and face, and the scalp looks irregular.",
  "input": "",
  "output": "You've spent a lot of time under the sun without adequate protection?"
},
{
  "instruction": "Doctor, I've got rashes on my skin, dry and scaly scales, and I've found that the scalp looks a little irregular, and it's got acne and it's growing skin.",
  "input": "",
  "output": "The symptoms suggest that you're suffering from skin infections caused by exposure to sunlight."
},
{
  "instruction": "Doctor, I've recently had some unusual symptoms: abnormal rashes in the face and a lack of growth in the skin.",
  "input": "",
  "output": "Do you spend a lot of time outdoors, or are you often exposed to the sun? Yes, I work in the fields, and I'm mostly in the sun."
},
{
  "instruction": "Doctor, you've got trouble with your face, and your scalp's getting itchy, and I need you to tell me what's wrong.",
  "input": "",
  "output": "You may be suffering from skin infections caused by exposure to sunlight, and you may be allergic to your face, and it may also be the result of exposure to sunlight."
},
{
  "instruction": "Doctor, I have a strange condition in my skin that looks dry, scaly and rough, and it also looks abnormal.",
  "input": "",
  "output": "You're probably suffering from skin infections caused by exposure to sunlight, and the symptoms you described are common to this disease."
},
{
  "instruction": "Sir, your ankles are swollen, you're breathing, you're having kidney-related symptoms and telophase, and what's the cause?",
  "input": "",
  "output": "The symptoms suggest that you have anemia from chronic kidney disease."
},
{
  "instruction": "Doctor, I don't feel strong these days, and I feel tired.",
  "input": "",
  "output": "I think we have anemia from chronic kidney disease."
},
{
  "instruction": "Hi, doctor. I've got swelling ankles. Do you know what the cause is?",
  "input": "",
  "output": "It could be anemia caused by chronic kidney disease."
},
{
  "instruction": "Doctor, I've been experiencing a number of symptoms recently, that the kidneys don't work properly, and I feel like I'm losing my breath, and I have a black clot, and I'm getting a lot of cold.",
  "input": "",
  "output": "The symptoms suggest that you're suffering from anaemia from chronic kidney disease, which is a common symptom of anemia, and black blood clots can be a result of intestinal bleeding caused by anemia, and you need to examine it more closely and start treating it as soon as possible."
},
{
  "instruction": "Doctor, I've recently been extremely tired and my ankles are swelling, and I've gone to the bathroom more often than usual, and do you know what causes these symptoms?",
  "input": "",
  "output": "Well, the symptoms seem to indicate anaemia due to chronic kidney disease, which can cause fatigue, swelling of ankles, increased urine, and we need to do some tests to make sure we're able to do that."
},
{
  "instruction": "Doctor, your anus hurts and your whole body hurts. What's the problem?",
  "input": "",
  "output": "It's possible that these symptoms are caused by injuries in one of the internal organs, and we have to do some tests to determine the extent of the injuries and how best to treat them."
},
{
  "instruction": "The doctor, the anal pain, the difficulty of breathing, the pain in the ribs, the pain in the side, the low urination, what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate damage to one of the internal organs, such as the kidney or the spleen, and you have to do some tests to identify the diagnosis and determine how to treat the best."
},
{
  "instruction": "Doctor, you're sick, you're urinating a lot, you're bleeding your urine, there's rib pain, there's sharp chest pain, what's the problem?",
  "input": "",
  "output": "The symptoms may indicate internal organs, especially kidney and lung damage, and we need to do some tests to confirm this diagnosis."
},
{
  "instruction": "Doctor, the side pain and urine aren't going to go well, and it's painful to breathe.",
  "input": "",
  "output": "The symptoms seem to have damaged the internal organs, and we need to do some tests to identify the diagnosis."
},
{
  "instruction": "Doctor, there's blood in the urine, there's a lot of urine, there's rib and anal pain, and what's the reason?",
  "input": "",
  "output": "The symptoms are that more than one internal organ, especially the kidney or bladder, is likely to be damaged, and it's good to run some diagnostic tests to determine the damage and the appropriate treatment process."
},
{
  "instruction": "Sir, there's spots and clouds in your visual field, and you can feel your eyes very light. What's the problem?",
  "input": "",
  "output": "If you look at the symptoms of spots and clouds and snowy eyes, you're likely to have scleroderma, which is an inflammation of the white part of the eye known as the sclera."
},
{
  "instruction": "Sir, you've recently had symptoms of tears, headaches and squeamishness, and your skin looks weird, so what's the problem?",
  "input": "",
  "output": "This disease can cause skin changes, as well as pain, appendix, and tears, but it may not have something to do with it, and it may be a different problem."
},
{
  "instruction": "Sir, I've been crying a lot lately. What's the cause?",
  "input": "",
  "output": "The symptoms suggest that you have a disease called scleroderma."
},
{
  "instruction": "Doctor, the pain of the eyes with the headache continues and the eyes become sore and sore, and there's more tears than usual, and what's the problem?",
  "input": "",
  "output": "Scleroderma is a condition that causes inflammation of the white eye and clouding the vision of the appendix, the pain and the case. It's good to check the diagnosis through a few tests and start treating it as soon as possible."
},
{
  "instruction": "Doctor, you've got your eyes tinged, you've got your eyes dimmed, you've found other eye symptoms, like tears, and what's the cause of all of these symptoms?",
  "input": "",
  "output": "Scleroderma is an inflammation of the scleroderma, which is the upper part of the eye, which can cause nausea, sore vision, excessive tears, and I'm going to prescribe some medications to relieve inflammation and irritation."
},
{
  "instruction": "Doctor, I've recently had eye burns and stinging symptoms with her, and I think there's spots and clouds in her eyelids, and a little bit of eyelids.",
  "input": "",
  "output": "I think you're familiar with the symptoms that God mentioned, that these are non-malignant lesions that normally grow in transparent tissues of the eye and sometimes grow on the cornea."
},
{
  "instruction": "Doctor, I can see that there's something wrong with your eyes and your scalp looks irregular, and why is that?",
  "input": "",
  "output": "You may have a disease called spores, which causes discomfort in the white layer of the eye, and may affect vision in severe cases, because irregular scalps share the same properties as eye blood vessels, which may be less common."
},
{
  "instruction": "Sir, you've recently seen spots or clouds in your visual field, and you've got very close eyes, so can you tell me what's causing them?",
  "input": "",
  "output": "There's a disease called pytomy, which occurs when tissue grows in the membrane, which is the white part of the eye, which can lead to other symptoms like stimulation and what you're experiencing today."
},
{
  "instruction": "Doctor, in the last few days, we've discovered that scalps arey and hair is too low in parts of the hair.",
  "input": "",
  "output": "The symptoms suggest that there's a fungus infection in the scalp, and the hair is falling off."
},
{
  "instruction": "Doctor, I'm experiencing skin dryness, texture, scales or roughness, acne or acne, skin lesions and skin itching.",
  "input": "",
  "output": "You have to do some tests to confirm your diagnosis, but I'm going to give you antibacterial drugs for treatment."
},
{
  "instruction": "Hi, doctor, you've got skin problems, and your skin is getting very dry, and you've got lipids, and you've got acne.",
  "input": "",
  "output": "The symptoms suggest a fungus infection in the skin."
},
{
  "instruction": "Doctor, your skin looks abnormal, your nails get irregular, your skin swells, your scalps get itchy, your skin rashes.",
  "input": "",
  "output": "The fungus infection is common and can affect the scalp, the nails, the feet, the groins, the various parts of the body."
},
{
  "instruction": "Doctor, acne, irregular nails, skin lesions, scalp hair. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that there's a fungus infection in the skin."
},
{
  "instruction": "Doctor, I've been having strange symptoms in my skin lately: swollen skin, acne, irregular nails, and it's also very dry and it seems to be losing a lot of texture.",
  "input": "",
  "output": "This type of infection can lead to skin swelling, acne or acne, irregularly-looking nails, skin dryness, peeling, scales, roughness, etc."
},
{
  "instruction": "Doctor, you've recently seen scalps that are dark and irregular, and we've found skin swelling a little bit, and what's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that there's a fungus infection in the skin, or cataracts."
},
{
  "instruction": "Doctor, you've got a swollen skin disease, and you've got scalps, and your skin looks abnormal, so what's going on?",
  "input": "",
  "output": "The symptoms suggest that there's a fungus infection in the skin, which can cause swelling and itching in the infected area and change the shape of the skin, which can be treated with anticoagulants, so treatment will make some progress."
},
{
  "instruction": "Doctor, I'm experiencing emotional symptoms and milderization in my wrists, so can you help me identify the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that you've had too much insulin. Have you had too much insulin recently?"
},
{
  "instruction": "Doctor, I've been feeling heat and cold lately, my back has been weakened, and I've also had some emotional symptoms, and what's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that there was an overdose of insulin."
},
{
  "instruction": "Doctor, there are symptoms of weakness in the elbow, of heat and cold, of weakness in the back.",
  "input": "",
  "output": "These symptoms can be related to low blood sugar levels and poor health and temperature changes due to excessive insulin overdoses in the body when insulin is given too much or produced."
},
{
  "instruction": "Doctor, I've recently had a weakness in my wrists and emotional symptoms. What's the problem?",
  "input": "",
  "output": "Are you taking insulin pills? Patient: Yes, I'm using them."
},
{
  "instruction": "They're experiencing overgrowth, and they're very depressed, and sometimes they have psychiatric symptoms.",
  "input": "",
  "output": "Given these symptoms and forces, it's possible that you've taken too much insulin."
},
{
  "instruction": "Doctor, your nails recently broke and you're diarrheating. What's the cause?",
  "input": "",
  "output": "It's possible that you're experiencing insulin overdose from your symptoms."
},
{
  "instruction": "Doctor, I've recently experienced shoulder pain, headaches, helplessness. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that there may be SlADH, which means an improper secretion syndrome of ADHD."
},
{
  "instruction": "Hi doctor, shoulder pain, nausea, eye fatigue, weakness, dizziness. Can you tell me what's wrong?",
  "input": "",
  "output": "SIADH is a disease in which the body produces too many anti-dialysis hormones, leaving too much water in the kidney to cause the body to metastasize."
},
{
  "instruction": "Doctor, I'm experiencing heat, shoulder pain, dizzying, eye fatigue. What could happen to me?",
  "input": "",
  "output": "Symptoms can lead to an inappropriate SIADH, an anti-dialysis hormone that causes too much fluid in the body, such as fever, dizziness and eye fatigue, which may not have much to do with the shoulder pain, so additional tests are needed."
},
{
  "instruction": "Doctor, I can't shake my neck.",
  "input": "",
  "output": "Do you have any discomfort or pain in your ear lately? woman:"
},
{
  "instruction": "Doctor, can you tell me what's wrong with your ears and your scalp?",
  "input": "",
  "output": "I think there's a possibility that there's a foreign substance in my ear that can cause pain and sometimes cause the same abnormal sense that you described in scalps, and I'm going to run a test for confirmation, but that's my initial diagnosis."
},
{
  "instruction": "Doctor, I've had ear pain in the last few days.",
  "input": "",
  "output": "I think there's something foreign in your ear."
},
{
  "instruction": "Doctor, I've been hearing a lot of noise in my left ear lately, and I feel like something's stuck in there.",
  "input": "",
  "output": "It looks like there's some foreign material in your ear, and your hearing's down, and you've got to look at it, and you've got to get rid of it if it's necessary."
},
{
  "instruction": "Doctor, there's blood in the ear, there's skin irritation in the ear, and there's hysteria last night, so what's the problem?",
  "input": "",
  "output": "It's like a foreign substance comes into your ear, and it's like you have to test your ear and check it out."
},
{
  "instruction": "Sir, there's so much menstruation these days, there's so much tension and so much irritation that you know what's causing it?",
  "input": "",
  "output": "I think you're having premenstrual tension syndrome, which is a common disease affecting many women, and it's caused by hormonal changes during menstruation."
},
{
  "instruction": "Doctor, I'm experiencing premenstrual tension, sensitivity, hip pain, long periods of menstruation, headaches and menstrual pain.",
  "input": "",
  "output": "I think you have premenstrual tension syndrome."
},
{
  "instruction": "I'm experiencing doctors, vomiting, burning abdominal pain, lower abdominal pain, premenstrual tension, or hypersensitivism.",
  "input": "",
  "output": "The symptoms suggest premenstrual stress syndrome."
},
{
  "instruction": "Hi doctor, I'm experiencing lower abdominal pain, long period of menstrual and pelvic pain, do you know what's causing it?",
  "input": "",
  "output": "You're experiencing premenstrual stress syndrome, a common symptom affecting a lot of women prior to menstruation, and there are a number of treatment options that can help you manage your symptoms, including drugs and changes in your lifestyle."
},
{
  "instruction": "Doctor, I'm feeling very low and insecure these days, because of my period?",
  "input": "",
  "output": "Yes, you can, because of the symptoms, you're experiencing premenstrual tension syndrome, which can cause premenstrual depression or psychosis."
},
{
  "instruction": "Good morning, doctor. Your eyes are bloodied and you have other eye symptoms. What could be the problem?",
  "input": "",
  "output": "The symptoms suggest that there's eye and bile and bileitis."
},
{
  "instruction": "We're experiencing a doctor, a terminal edema, neck edema, eye pericardium, skin aching. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there's eye and bile and colitis, which is an infection of the soft tissue inside and inside, which can cause the symptoms that you're currently experiencing, but you have to do some tests to confirm your diagnosis."
},
{
  "instruction": "Doctor, your eyelids are swollen, your face is in pain, your throat is swollen, your eyesight is down.",
  "input": "",
  "output": "The symptoms are likely to have eye and bile and colitis, which is an infection affecting the tissue around the eye, and we need to take a closer look."
},
{
  "instruction": "Doctor, telophase, eye symptoms, lower hearing, skin hair, swelling of the neck, how can you help?",
  "input": "",
  "output": "Your symptoms suggest that you're suffering from eye and bungness, which is a serious infection that affects eye tissue and can spread around you, and you have to consult your doctor immediately to prevent further complications."
},
{
  "instruction": "Doctor, you can't see very well, and you've got a lot of pain on one side of your face.",
  "input": "",
  "output": "The symptoms suggest that there may have been eye and bile and bileitis."
},
{
  "instruction": "There's doctors, ankle swelling, knee stiffness, leg failure, motorism, and a baby's feeding problem.",
  "input": "",
  "output": "We recommend physical testing and imaging to determine the extent of the injuries and how to treat them."
},
{
  "instruction": "Sir, I've got a problem with my leg, and it's really hard to keep my legs swollen and walking, and I don't think I can properly nurse a baby.",
  "input": "",
  "output": "It's important to test and treat the leg as soon as possible to prevent further complications."
},
{
  "instruction": "Sir, I fell and injured my leg, and since then my knees have been swelling.",
  "input": "",
  "output": "According to the symptoms that God explains, injury or inflammation may cause excessive fluid in and out of the knee joint."
},
{
  "instruction": "Teacher, ankle pain, knee swelling, foot or toe pain, and the nails seem to be irregular. What's the problem?",
  "input": "",
  "output": "It could have affected the ankles, the knees, the feet, and the toes, which could have been a sign that the toes were damaged."
},
{
  "instruction": "Hi, doctor, I was injured a few days ago, and my nails are irregular, and I'm having difficulty moving them, and I'm swollen, and I'm having pain in my feet and toes, and what's the cause of all of these symptoms?",
  "input": "",
  "output": "The symptoms suggest that the leg has a clot called DVT, and it's important to get a doctor's office immediately to prevent further complications."
},
{
  "instruction": "Doctor, what's the cause of this post-anoma that you've been experiencing lately?",
  "input": "",
  "output": "The telophase can be a symptom of liver brain disease."
},
{
  "instruction": "Doctor, I've recently experienced sharp abdominal pain, seizures and loss. What's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from a liver disorder."
},
{
  "instruction": "Doctor, I've been very weak recently, and I've passed out a few times, and I also experience sharp abdominal and extreme fatigue.",
  "input": "",
  "output": "The symptoms suggest that the liver can't remove the toxins from the blood, and it's experiencing liveral brain disease that can cause confusion, fatigue, abdominal pain, and sepsis."
},
{
  "instruction": "Doctor, I've recently experienced drug abuse, depression or psychiatric symptoms, difficulty breathing, seizures.",
  "input": "",
  "output": "The symptoms you've described may indicate that you have liver brain disease."
},
{
  "instruction": "Doctor, I'm really worried that there's a lump in my arm.",
  "input": "",
  "output": "It's possible that it's bone cancer because of the symptoms, and in order to be sure, you have to do a tissue test."
},
{
  "instruction": "Sir, back pain, ribs pain, leg pain, joint pain is going on for quite a long time, and why?",
  "input": "",
  "output": "It's probably bone cancer, because of the symptoms, and it's good to run some tests to check your diagnosis."
},
{
  "instruction": "Doctor, I recently experienced back pain and muscle pain. What's wrong?",
  "input": "",
  "output": "It's possible that it's bone cancer because of the symptoms."
},
{
  "instruction": "Hi, doctor. There are a few things that worry me: rib pain, muscle pain, motor disorder, back pain.",
  "input": "",
  "output": "It's possible that it's bone cancer, depending on the symptoms, and you need additional tests to confirm your diagnosis."
},
{
  "instruction": "Doctor, you've got joint pain and swelling in your leg, and it's getting worse every day, so what's the problem?",
  "input": "",
  "output": "It's possible that it's bone cancer because of the symptoms, and we need some additional tests to confirm the diagnosis."
},
{
  "instruction": "Doctor, you have a sharp eye pain. Can you tell me what caused it?",
  "input": "",
  "output": "The symptoms may indicate that you have lysmania, a parasite infection caused by a sandfly, which affects your skin in general, but it also affects your eyes, which can cause rashes, irritations and pain."
},
{
  "instruction": "Doctor, I don't know what's going on, but I've got a lot of anger these days, but there's also shoulder cramps and tics, eye pain, breast pain and wear and wrist pain.",
  "input": "",
  "output": "Symptoms indicate that you may have lysmania, a parasite that is transmitted by a sandfly; other symptoms may be fever, weight loss, spleen or liver."
},
{
  "instruction": "Doctor, I pee too often at night. What's the problem?",
  "input": "",
  "output": "It's probably because of a parasite called leshmaniasis, and you have to be tested for a diagnosis."
},
{
  "instruction": "Sir, I recently developed facial and ankle pain with shoulder spasms and spasms, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms are likely to indicate that you have Rishmania disease, which is a parasite caused by infected sand flies."
},
{
  "instruction": "Doctor, you've got a lump in your knee, and you're very tired, and you've had pain during pregnancy, and you've had pain in your ankles and your face, and you know what's causing all these symptoms?",
  "input": "",
  "output": "Reshmania is a disease caused by parasites that are transmitted to humans by being bitten by infected sand flies: symptoms include lesions, fever, loss of weight, spleen, or obesity."
},
{
  "instruction": "Doctor, your new joint is stiff and tired, and why?",
  "input": "",
  "output": "It's caused by a parasite called trypanosoma cruzi, which can cause joint strength, shortness, fatigue."
},
{
  "instruction": "Doctor, I've recently experienced some strange symptoms: excessive anger, breast pain and wear, facial pain, wrist pain, excessive urination at night.",
  "input": "",
  "output": "The symptoms are likely to lead to Chagas' disease, which can cause a variety of symptoms, including what you just described as a parasite infection caused by the tripanomoma cruise worm, and we need to do some tests to identify the diagnosis."
},
{
  "instruction": "Doctor, can you tell me what's wrong with your shoulder convulsion, spasms, and fatigue?",
  "input": "",
  "output": "It's caused by a parasite called trypanosoma cruzi, which is generally found in Latin America."
},
{
  "instruction": "Doctor, what's wrong with having a lot of urine at night and a lot of pain in your face?",
  "input": "",
  "output": "The symptoms seem to suspect Chagas \u2019 disease, which is a parasite infection called trypanosoma cruzi."
},
{
  "instruction": "Doctor, I've recently experienced joint rigidity and shoulder spasms, and I've also had chest pains.",
  "input": "",
  "output": "The symptoms seem to indicate that you've been suffering from Chagas' disease. Have you been to Central and South America recently?"
},
{
  "instruction": "Doctor, I'm experiencing side pain, stiffness of the arm, stiffness of the arm, swelling of the shoulder, breast pain, and what's the problem?",
  "input": "",
  "output": "It's a rare disease that occurs when the spinal cord is filled with fluid, and it can cause a lot of symptoms, including the symptoms you described, and it's important to get a proper diagnosis and treatment."
},
{
  "instruction": "Doctor, I've been having headaches over the last few days. Can you tell me what's going on?",
  "input": "",
  "output": "Headaches can be caused by a number of causes, but in the case of the questioner, the co-scientism of the spinal cord is suspect."
},
{
  "instruction": "Sir, your feet and toes are in pain, your hands and fingers are swelling, and your legs feel powerless and heavy, and what are the causes of all these symptoms?",
  "input": "",
  "output": "These symptoms may be the result of a disease called spinal cosmosis, which is a rare disease that forms fluidized cysts in the spinal cord, which can cause a lot of symptoms, including nerve damage and what you're talking about."
},
{
  "instruction": "Doctor, I'm feeling severe back pain and weak leg strength. What problem do you think?",
  "input": "",
  "output": "The symptoms are likely to be a co-scillation of the spinal cord."
},
{
  "instruction": "Doctor, do you know what caused this?",
  "input": "",
  "output": "The symptoms suggest that there's a cyst in the spinal cord, and there's a co-scientity of the spinal cord that causes pain and weakness in the body, and I'd like to run some tests to confirm this diagnosis."
},
{
  "instruction": "Sir, it's hard to breathe these days, and it hurts when you breathe and when you breathe.",
  "input": "",
  "output": "The symptoms seem to indicate lung fibrosis, which is a lung disease that causes scar tissue in the lungs, making breathing difficult."
},
{
  "instruction": "Doctor, there's been a lot of breathing, fainting, coughing, shortness of breath, sharp chest pain.",
  "input": "",
  "output": "The symptoms that God described suggest that you have pulmonary fibrosis."
},
{
  "instruction": "Doctor, I've been falling down a lot lately, and I've got a lot of eyes, and it's hard to breathe properly.",
  "input": "",
  "output": "The symptoms suggest lung fibrosis."
},
{
  "instruction": "Good morning, doctor, you've been feverish and coughing for weeks, do you know what's causing it?",
  "input": "",
  "output": "Lung fibrosis is a disease that can cause respiratory problems, fatigue and persistent cough by causing scarring in the lungs, and it's important to do some tests to make sure you understand the cause of the symptoms."
},
{
  "instruction": "Doctor, I've been having trouble breathing lately. What's the cause?",
  "input": "",
  "output": "The symptoms suggest that you may be suffering from lung fibrosis."
},
{
  "instruction": "Doctor, you're experiencing an irregular heartbeat, and you're constantly feeling foreign sensations in your throat.",
  "input": "",
  "output": "Symptoms indicate that there's a possibility of a mitral valve disease."
},
{
  "instruction": "Doctor, there's a headgear, and why is that?",
  "input": "",
  "output": "Have you ever experienced other symptoms, such as shortness of breath or fatigue?"
},
{
  "instruction": "Doctor, we've recently experienced shortness of breath, increased heart rate, and dizziness. What's the problem?",
  "input": "",
  "output": "Symptoms indicate that there's a possibility of a mitral valve disease, which occurs when the valves between the left and the left ventricles of the heart fail to function properly, and causes a variety of symptoms, such as shortness of breath, increased heart rate, and nausea."
},
{
  "instruction": "Doctor, I've recently had some symptoms of weight gain and nightmares.",
  "input": "",
  "output": "I think you're experiencing the symptoms of mitral valve disease, with shortness of breath and fatigue?"
},
{
  "instruction": "Doctor, there's been a sharp chest pain recently, and what's the cause?",
  "input": "",
  "output": "Symptoms indicate that there's a possibility of a mitral valve disease."
},
{
  "instruction": "The doctor, the agorax, the difficulty in speaking, the weakness in my leg, the weakness in my movement, what's wrong with me?",
  "input": "",
  "output": "Symptoms suggest there's a chance of Parkinson's disease."
},
{
  "instruction": "It's hard to move your arms and legs these days, and your muscles seem really stiff or tight, so what's the problem?",
  "input": "",
  "output": "You're experiencing some early symptoms of Parkinson's disease, some additional tests to check your diagnosis, but at the moment, focus weakness and muscle rigidity seem to be the biggest cause."
},
{
  "instruction": "Doctor, the symptoms of stiffness and dizzyness and inability to speak are continuing. What's the problem?",
  "input": "",
  "output": "The symptoms you described make Parkinson's disease suspicious."
},
{
  "instruction": "Doctor, your feet and toes are very sick and swollen, and why?",
  "input": "",
  "output": "You seem to have a common form of arthritis called gout."
},
{
  "instruction": "Doctor, you've got a lot of joint pain. What's the cause?",
  "input": "",
  "output": "Is there any sign of swelling or fever or redness in the joints?"
},
{
  "instruction": "Doctor, your hands and ankles are swollen and your fingers are in pain. What's the problem?",
  "input": "",
  "output": "It's a common form of arthritis, which causes inflammation and pain, because of the symptoms of gout."
},
{
  "instruction": "Doctor, I'm experiencing pain in my feet or toes, pain in my ankles, swelling in my ankles, knee pain and swelling in my feet or toes.",
  "input": "",
  "output": "The symptoms suggest that you have gout, which is a form of arthritis caused by an excess of uric acid in your bloodstream."
},
{
  "instruction": "Sir, there's pain and swelling in the ankles and swelling in the hands and fingers.",
  "input": "",
  "output": "It's a form of arthritis that causes sudden, severe pain in the joints, especially the ankles and feet, swelling and swelling of the hands and fingers."
},
{
  "instruction": "Doctor, I've been having it a couple of days ago. What are the symptoms?",
  "input": "",
  "output": "I think you're suffering from middle-class heart disease."
},
{
  "instruction": "Doctor, there's a problem with your ears, and your ears are blocked, and your throat is sore, and your hearing's sore, and you're vomiting and your nose's running.",
  "input": "",
  "output": "With the symptoms of cochlear, throat pain, hearing decline, nose blockage, vomiting, we're beginning to suspect infection, and we want to check our ears for diagnosis and proper treatment."
},
{
  "instruction": "Doctor, I feel stuck in my ears. Why?",
  "input": "",
  "output": "It could be inflammation behind the pericardium and neutrophicitis in the fluid."
},
{
  "instruction": "Doctor, you've got nostrils, you've got secretions in your ear. What's the problem?",
  "input": "",
  "output": "I think there's a possibility that it's strep."
},
{
  "instruction": "Doctor, I've been feeling really bad lately, and I've got a fever, and I can't hear what's going on.",
  "input": "",
  "output": "It's an ear infection that can cause all the symptoms you've described."
},
{
  "instruction": "Doctor, I've recently been having mood changes and personality problems, and sometimes I can't seem to be able to control my anger without a reason.",
  "input": "",
  "output": "Our mood change and our temper problems could be signs of Opioid drug abuse."
},
{
  "instruction": "Doctor, I've been having a hard time with drug abuse for a while, and that has had a big impact on my life, and I think I've had a lot of low self-worth lately.",
  "input": "",
  "output": "From what God says, it seems that you're having a hard time with Opid abuse, which can lead to low self-worth and other negative consequences. It's important to solve this problem as soon as possible."
},
{
  "instruction": "Hi, doctor, I'm feeling a lot of anxiety and anxiety, especially in the morning.",
  "input": "",
  "output": "Have you used drugs or opioids recently? woman: Actually, yes, I'm using opioids because of back pain."
},
{
  "instruction": "Doctor, I've been having strange symptoms lately, acting antisocially, feeling depressed, sometimes seeing and hearing things that don't exist, and it's easy to get angry.",
  "input": "",
  "output": "You're experiencing drug abuse, especially Opioid abuse, which can include antisocial behavior, depression, delusions, hallucinations, excessive anger."
},
{
  "instruction": "Doctor, I've recently experienced excessive anger, temper problems, antisocial behavior, what do you think causes it?",
  "input": "",
  "output": "In view of the symptoms, excessive use of the opioid can cause these behavior changes, drug abuse can have a significant impact on a person's mental health and behavior."
},
{
  "instruction": "Doctor, I've been throwing up a lot of scissors lately. What's the cause?",
  "input": "",
  "output": "And the cause of it may have to do with bone marrow diagnosis."
},
{
  "instruction": "Doctor, I've been feeling bad lately.",
  "input": "",
  "output": "It could be bone marrow form syndrome."
},
{
  "instruction": "Doctor, there's been a continuing chill and a cough, and what's the cause?",
  "input": "",
  "output": "It's a type of blood cancer that can cause infection, anemia and bleeding, and it's good to run some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, it's hard to speak, and it's throwing up. What's the problem?",
  "input": "",
  "output": "These symptoms can indicate bone marrow form syndrome, and you have to run some tests to make sure that you have it."
},
{
  "instruction": "Doctor, coughing continues, and it's getting harder and harder to talk.",
  "input": "",
  "output": "It could be bone marrow form syndrome."
},
{
  "instruction": "Hi, doctor, there's a change in the shape of the stool, there's a real pain in the arm, there's a pain in the bone, there's a weakness in the arm, there's a swelling on the shoulder, what's the problem?",
  "input": "",
  "output": "The symptoms could be the pain caused by a shoulder fracture, which requires X-rays to be diagnosed, but may be caused by this injury."
},
{
  "instruction": "Good morning, doctor. I've got a swollen neck and a stiff, warm shoulder.",
  "input": "",
  "output": "The symptoms seem to indicate a shoulder fracture."
},
{
  "instruction": "Doctor, your shoulder is swelling. You have pain when you move your arm. What could be the problem?",
  "input": "",
  "output": "The swelling is a common symptom of this disease, it's good to check the diagnosis and take X-rays to determine the severity of the fracture."
},
{
  "instruction": "Sir, there's severe pain in the shoulder and the arm, and there's a feeling of stiffness and coldness in the shoulders and the arms.",
  "input": "",
  "output": "The symptoms suggest that the shoulder fracture is in doubt."
},
{
  "instruction": "You're experiencing sharp abdominal pain, shortness of breath, urinary reflux and vomiting. What's the problem?",
  "input": "",
  "output": "The symptoms suggest you're suffering from acute kidney damage, and you need to do some tests to confirm that you're coming to the hospital immediately."
},
{
  "instruction": "Doctor, I've been dizzy lately, and I've also been very weak, and what's the problem?",
  "input": "",
  "output": "Your symptoms suggest that you're experiencing acute kidney damage."
},
{
  "instruction": "Doctor, I've been feeling dizzy lately. What's the cause?",
  "input": "",
  "output": "It's possible that you have acute kidney damage, depending on your symptoms, and you have to run some tests to see if you're doing it."
},
{
  "instruction": "Doctor, there's blood in the urine, sharp abdominal pain and other kidney-related symptoms.",
  "input": "",
  "output": "The symptoms seem to indicate acute kidney damage, which can result in a mix of blood in the urine, abdominal pain and other kidney-related symptoms, and we need to do some tests to check the diagnosis and see the severity of the condition."
},
{
  "instruction": "Doctor, I feel a little swollen in my legs.",
  "input": "",
  "output": "Have you ever experienced other symptoms, such as loss of urine or difficulty breathing?"
},
{
  "instruction": "Doctor, I've had a clot during my period, and I'm pregnant now, and I have contractions and back pains during pregnancy.",
  "input": "",
  "output": "The symptoms suggest that the pregnancy is threatened."
},
{
  "instruction": "Doctor, I'm experiencing lower abdominal pain and blood failure during my period of menstrual periods. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that pregnancy can be dangerous."
},
{
  "instruction": "Doctor, you have a clot during your period of menstruation, pain during pregnancy, a little bit of vaginal secretion.",
  "input": "",
  "output": "The symptoms suggest that pregnancy can be dangerous, and it's important to get medical attention immediately for the safety of both the mother and the fetus."
},
{
  "instruction": "Doctor, there's vaginal secretions and back pain.",
  "input": "",
  "output": "This could be a sign that pregnancy is dangerous."
},
{
  "instruction": "Doctor, you have hip pain and a clot during your period. What could be the problem?",
  "input": "",
  "output": "These symptoms can be a threat to pregnancy, and it's important that additional tests be done to identify the cause of these symptoms and provide proper treatment."
},
{
  "instruction": "Doctor, you've got a fever, you've got a lump in your tongue, you've got a sharp pain in your chest, and recently, you've been really depressed and confused, and what's the cause of all these symptoms?",
  "input": "",
  "output": "You can suffer from two internal abscess, a brain abscess, which can cause all these symptoms, and you need immediate treatment to avoid serious complications."
},
{
  "instruction": "Sir, I've had a bit of a backache lately, and I feel like a sharp pain, and then it goes away.",
  "input": "",
  "output": "I'm sorry, but back pain has nothing to do with the two internal abscess, which can cause headaches, fever and confusion in the brain."
},
{
  "instruction": "Doctor, with fever and back pain, we're experiencing depression and psychosis. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that pus in the brain may be caused by two internal abscess, and you have to do some tests to confirm your diagnosis."
},
{
  "instruction": "Doctor, I've recently experienced headaches, weakness, seizures, back pain, do you know what's wrong?",
  "input": "",
  "output": "Yes, I think you're suffering from a double internal abscess that has pus in your brain, and the symptoms that you're describing are consistent with this diagnosis, and you have to do some tests and start treating it as soon as possible."
},
{
  "instruction": "Sir, your lips and chin are swollen and you have gum pain, fever and mouth ulcers.",
  "input": "",
  "output": "Because of your symptoms, gum disease can cause swelling, pain, fever, or oral ulcers can be the result of gum infection."
},
{
  "instruction": "Doctor, I have an oral ulcer and a lot of gum pain, and why?",
  "input": "",
  "output": "You seem to have gum disease."
},
{
  "instruction": "Doctor, a few days ago, I had facial pain. What's the possible cause?",
  "input": "",
  "output": "It could be gum disease. Have you been bleeding or swollen from your gums lately?"
},
{
  "instruction": "Doctor, your lips are swollen, you've got a fever, you've got an ulcer in your mouth, what's the problem?",
  "input": "",
  "output": "These are symptoms of gum disease."
},
{
  "instruction": "Doctor, I recently experienced gum pain and gum hemorrhage. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to lead to gum disease, an inflammation and infection of the gums, which can lead to upper teeth if you don't treat it, if you don't treat it."
},
{
  "instruction": "Doctor, I've got skin lesions, I think I've got skin infection on my leg, and I've also had symptoms called by the barge.",
  "input": "",
  "output": "It seems that damage caused by surgical incisions can cause skin lesions and infections, which have no direct bearing on the injury, but may be side effects of a particular drug or diet change."
},
{
  "instruction": "Sir, there's been a lot of menstruation recently, so does it have anything to do with the incision?",
  "input": "",
  "output": "Yes, you can, because if you have a wound, you're trying harder to heal yourself, and so your period can change a little bit, but it's always best to have your body tested to see if there are other basilar diseases that can cause a menstrual strain."
},
{
  "instruction": "Doctor, there's an open wound on the incision area, and there's a lot of swelling in the skin.",
  "input": "",
  "output": "The swelling of post-op injuries is a common symptom after surgery, a natural reaction of the body to the injury, but it can be a sign of infection."
},
{
  "instruction": "Doctor, there's a wound on the incision area, and I've sneezed a lot lately.",
  "input": "",
  "output": "Sneaking can be a symptom of respiratory infection, which can spread to the wound, causing further complications."
},
{
  "instruction": "Doctor, we've recently discovered that there's a lot of nausea, and there's a lot of dark, boring stools.",
  "input": "",
  "output": "Based on what God says, it's possible that you're experiencing a stomach bleed, which is caused by bleeding in the digestive tract, and can cause such symptoms as nausea, melena, and so on."
},
{
  "instruction": "Doctor, I've been experiencing a period recently.",
  "input": "",
  "output": "Have you ever found blood in your throat or in your vomiting?"
},
{
  "instruction": "Doctor, I've been vomiting a lot lately.",
  "input": "",
  "output": "There could be a pericardial bleeding."
},
{
  "instruction": "Doctor, I'm experiencing fainting and rectal bleeding. Can you tell me what's wrong?",
  "input": "",
  "output": "It looks like there's a pericardial bleeding from the symptoms, which is in the digestive tract."
},
{
  "instruction": "Sir, what causes scalp to develop skin rashes with it and rashes on your face?",
  "input": "",
  "output": "The symptoms suggest that there are boring dermatitis, a common skin disease that can affect the scalp and the face."
},
{
  "instruction": "Sir, there are a few symptoms in your recent face: red, scaly skin and a slightly oily spot.",
  "input": "",
  "output": "The symptoms seem to indicate that you have boring dermatitis."
},
{
  "instruction": "Doctor, I have too little skin, too little hair, too little scalp, skin dryness, texture, scales, roughness, skin growth, what's the problem?",
  "input": "",
  "output": "Symptoms may include scalp, face, ears, chest, and so forth, which is a common skin disease that causes inflammation, itching, and texture, which is boring dermatitis."
},
{
  "instruction": "Doctor, I'm having skin cancer, and I have skin rashes, and I need you to help me figure out the cause.",
  "input": "",
  "output": "The symptoms seem to indicate that there's boring dermatitis, which is a common inflammation of skin that affects the bulk of the scalp, the face, the chest, and so on."
},
{
  "instruction": "Doctor, I'm experiencing skin itching, dry, peeling scalps, skin growth, it also looks abnormal, tell me what's wrong.",
  "input": "",
  "output": "The symptoms suggest that there is boring dermatitis, a common skin disease that causes red, peeling and oily spots on the scalp, face, chest and other parts of the body."
},
{
  "instruction": "Doctor, I'm experiencing delusions, fears, phobias, breathlessness, and sometimes hallucinations.",
  "input": "",
  "output": "With alcohol abuse, depression and psychiatric symptoms are common in this type of drug abuse."
},
{
  "instruction": "Doctor, I feel anxious and nervous all the time, and I experience pain during pregnancy, and I feel sick.",
  "input": "",
  "output": "Have you ever used drugs, especially metampamine? Patient: Yes, sir. How did you know?"
},
{
  "instruction": "Doctor, I'm sick and I've been abusing alcohol lately, and I've experienced pain during pregnancy and sometimes delusions and hallucinations.",
  "input": "",
  "output": "These symptoms are generally associated with the use of methatamine, which is important to be treated to manage addiction and related health problems."
},
{
  "instruction": "Doctor, I'm experiencing breathlessness, anxiety, anxiety, trepidation. Do you know what's causing it?",
  "input": "",
  "output": "The symptoms are likely to have side effects due to methmamphetamine abuse. Have you used this drug recently?"
},
{
  "instruction": "Doctor, I've had a lot of pain in my neck lately.",
  "input": "",
  "output": "The symptoms seem to have a fatality."
},
{
  "instruction": "Doctor, in the last few days, you've had spasms and cramps in your neck. What's the problem?",
  "input": "",
  "output": "Depending on the symptoms, there's a disease called near death, which causes the muscles of the neck to automatically contract, causing spasms, spasms, and twists in the neck."
},
{
  "instruction": "Sir, I'm having constant shoulder pain, and I can feel a lump on my shoulder, and I can feel the pain in my arm, and I can feel an involuntary abnormal movement, and sometimes my legs feel weak.",
  "input": "",
  "output": "This neurological disorder causes the symptoms described by causing abnormal muscle contractions, where we can discuss treatment options for managing pain and improving quality of life."
},
{
  "instruction": "Doctor, for the last few days, I've experienced stiffness or coldness in my neck.",
  "input": "",
  "output": "Depending on the symptoms, there's a disease called near death, which is a symptom of involuntary contraction of the neck muscle that causes the head to lean one way."
},
{
  "instruction": "Sir, you know what's causing these symptoms?",
  "input": "",
  "output": "Yes, from the symptoms, it's suspected of near death, which is a condition in the neck that causes spasms, which causes the head to lean toward the side and the shoulder to feel a lump or a lump. Patient: Oh, okay, how do you treat it?"
},
{
  "instruction": "Doctor, I've been feeling a lot of heat lately, and I've been suffering from depression and psychiatric symptoms.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from an addiction to anti-high blood pressure, and you have to run some tests to check your diagnosis, and it's important to stop taking the drug immediately and come to me as soon as possible."
},
{
  "instruction": "Doctor, I'm experiencing skin cancer, and I'm allergic to it, and I'm feeling a local weakness, a skin rash, a general weakness.",
  "input": "",
  "output": "These symptoms seem to be caused by addiction to the high blood pressure drugs you're taking, and it's important to get medical attention immediately so that you can get the treatment you need."
},
{
  "instruction": "Doctor, I've been experiencing some strange symptoms, such as a recent weakness of focus, a feeling of depression, skin itching, can you tell me what caused these symptoms?",
  "input": "",
  "output": "The common symptoms of this disease are poor focus, depression or psychiatric symptoms, skin problems, and several tests are required to identify the diagnosis and start immediately to treat it."
},
{
  "instruction": "Doctor, allergic reactions, dizziness, skin rashes. What's the cause?",
  "input": "",
  "output": "I think it's an addiction to anti-high blood pressure."
},
{
  "instruction": "Doctor, I've recently been numb and my skin is very dark, and I think I've had some sort of allergic reaction, and I've got a weak sense of focus and a swollen tongue.",
  "input": "",
  "output": "The symptoms seem to indicate that he's suffering from an addiction to anti-high blood pressure."
},
{
  "instruction": "Doctor, I've been having severe menstrual problems, anxiety, anxiety lately.",
  "input": "",
  "output": "I think you're suffering from a tension headache."
},
{
  "instruction": "Doctor, I'm having a menstrual sedation. What's the problem?",
  "input": "",
  "output": "I think you're suffering from a tension headache."
},
{
  "instruction": "Doctor, I'm experiencing ohan, sinus pain, neck pain. Do you know what's causing it?",
  "input": "",
  "output": "I think you're having a tension headache."
},
{
  "instruction": "Doctor, I've been experiencing a lot of menstrual and sinus pain lately.",
  "input": "",
  "output": "You're experiencing a tension headache that can cause pain and discomfort in your head, your face, and sometimes your sinuses."
},
{
  "instruction": "Sir, I'm afraid you're falling down a lot these days, and you've been drinking too much, and I don't think you can control it.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from alcoholism, and if you're losing your alcohol intake and you're having difficulty controlling it, you need help."
},
{
  "instruction": "Sir, I'm feeling depressed these days, and I'm drinking more than I normally am, and I feel the abnormal movements of my body, and what's wrong with me?",
  "input": "",
  "output": "From what God said, I think you're experiencing alcoholism."
},
{
  "instruction": "Doctor, there's been a sharp chest pain. What's the reason?",
  "input": "",
  "output": "Have you been drinking lately? woman: Yeah, I'm drinking a lot."
},
{
  "instruction": "Doctor, I'm experiencing a sharp abdominal pain, and I feel very depressed, and sometimes I experience delusions and hallucinations and depression and mental symptoms, and what's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that you're experiencing alcoholism, which can cause all the symptoms you've described, have you been drinking too much recently?"
},
{
  "instruction": "Doctor, I have a couple of skin dots in my body, and I have a stiff, moist joint, and what's the cause?",
  "input": "",
  "output": "Hemorrhagic disease is a disease caused by a lack of vitamin C in the diet, which can cause changes in the skin, joint pain, stiffness, and so forth."
},
{
  "instruction": "Doctor, hip pressure, blood of the eyes, lumps or lumps on the knee, and sometimes bed-wetting.",
  "input": "",
  "output": "The symptoms seem to indicate that hemorrhagic disease is a disease caused by vitamin C deficiency, which can cause a lot of symptoms, including the symptoms you described."
},
{
  "instruction": "Sir, I've found that there's a lot of pressure on the pelvis, and that the joints are overgrowing with stiff, moist sensations, and I'm worried that my knee's got a lump in it.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from blood clots caused by a lack of vitamin C in your diet, which can cause joint pain, stiffness, and general discomfort."
},
{
  "instruction": "Doctor, your joints are stiff, they're warm, they're experiencing ectopic pain and bed - wetting. What's the problem?",
  "input": "",
  "output": "Your symptoms are consistent with your body's vitamin C deficiency, which is hemophilia, are you eating a balanced diet, or are you eating a limited diet, or are you allergic to food?"
},
{
  "instruction": "Doctor, I'm experiencing sharp abdominal pain, eczema decline, what's the problem?",
  "input": "",
  "output": "The symptoms are likely to indicate that hemolysis is caused by a deficiency of vitamin C, which can cause abdominal pain, joint pain, gum disease, as well as other symptoms of what you're saying."
},
{
  "instruction": "Sir, I'm experiencing delusions, temper problems, headaches, abnormal involuntary movements, you know what's wrong with me?",
  "input": "",
  "output": "Yeah, I think you're experiencing the symptoms."
},
{
  "instruction": "Doctor, we've recently had a problem with sleep patterns, we're often tired during the day, we try to get enough sleep at night, and we don't sleep well, and we also have a problem with our tempers and our breathing sounds weird.",
  "input": "",
  "output": "It's a neurologic disorder that affects the brain's ability to control sleep-sensitivity, and it can also cause apnea and abnormal breathing."
},
{
  "instruction": "Doctor, you're extremely sleepy during the day, you're gaining weight for no reason, you're having problems with your temper, you're showing abnormal involuntary movements, what's the problem?",
  "input": "",
  "output": "You may have a neurologic disorder that affects your ability to control sleep-sensitivity."
},
{
  "instruction": "Doctor, I'm experiencing abnormal weight gain. Can you tell me why?",
  "input": "",
  "output": "It could be a neurological disorder that can affect sleep-rescue cycles and cause daytime drowsiness and night sleep disorders, leading to weight gain."
},
{
  "instruction": "Hi, doctor, I've been experiencing a few unusual symptoms lately, always tired and sometimes easily forgotten, and I have a very difficult feeling of breathing and sometimes choking, and recently I've experienced strange dreams and hallucinations, and can you tell me what's causing them?",
  "input": "",
  "output": "It's a neurological disorder that affects sleep-sensitive cycles and causes excessive sleepiness during the week."
},
{
  "instruction": "Doctor, telophase, skin rash, cough, vomiting, sneezing, what's the cause of these symptoms?",
  "input": "",
  "output": "I think you're allergic to food. Have you eaten new foods recently?"
},
{
  "instruction": "Doctor, I'm experiencing abnormal symptoms, such as shortness and skin itching, and sometimes my feet swell.",
  "input": "",
  "output": "The symptoms seem to indicate that you're allergic to food. Have you eaten any other food recently?"
},
{
  "instruction": "Hi doctor, there's a problem with swelling hands and allergic reactions. What's the problem?",
  "input": "",
  "output": "Hi, symptoms can make you allergic to food."
},
{
  "instruction": "I'm experiencing doctor, vomiting, abnormal skin, swelling of hands and fingers. What's wrong with me?",
  "input": "",
  "output": "It may be a symptom of food allergies, and a few tests will help you to identify certain foods that you're allergic to, and then eliminate them from your diet to prevent future reactions."
},
{
  "instruction": "Sir, I think I'm allergic, and I vomited twice this morning after eating something, and now my hands and fingers are swollen, and I have skin rashes in my arms and legs.",
  "input": "",
  "output": "I think you're allergic to food when you look at what God says."
},
{
  "instruction": "Doctor, I'm experiencing pain in the ear, weakness, deafness, nausea. Can you tell me what's wrong?",
  "input": "",
  "output": "It causes nausea and balance problems and often earmarks. Do you have a feeling of disarray and instability?"
},
{
  "instruction": "Doctor, severe headaches, nausea, nausea, ear pain. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from mumps."
},
{
  "instruction": "Doctor, you're sweating, you're making sound out of your ears, you're losing energy, you're getting spots, you're getting clouds, you're getting dizzy, what's the problem?",
  "input": "",
  "output": "The symptoms suggest that there is an infection called mummification, which affects the sense of balance and hearing."
},
{
  "instruction": "Doctor, I'm experiencing ringing in the ear, dizziness, ear pain, shortness of breath, loss of strength.",
  "input": "",
  "output": "It's an internal illness that can cause all the symptoms that you've described, and it's recommended additional evaluations to check the diagnosis and determine how best to treat it."
},
{
  "instruction": "Doctor, I'm feeling nausea, headaches, deafness in my ears. What's the problem?",
  "input": "",
  "output": "These symptoms seem to indicate that there's mummification."
},
{
  "instruction": "Doctor, you've been in a bad breath lately. Can you tell me what's causing it?",
  "input": "",
  "output": "The shortness of breath can be a symptom of anxiety. Have you been anxious or stressed lately?"
},
{
  "instruction": "Sir, I've recently been experiencing a two-way, abnormally involuntary movement. Can you tell me what the problem is?",
  "input": "",
  "output": "I think you're experiencing anxiety from your symptoms."
},
{
  "instruction": "Doctor, every time your heart rate is irregular and tense or worried these days, it's going to keep happening.",
  "input": "",
  "output": "You're experiencing anxiety symptoms that can cause physical symptoms, such as irregular heart rate, and it's important to manage anxiety through treatment and drug treatment so that it doesn't have a long-term effect on your health."
},
{
  "instruction": "Doctor, I've been really nervous lately, I've been afraid, I've got phobias, and sometimes I have depression or mental symptoms.",
  "input": "",
  "output": "Sir, I think you're experiencing anxiety from what you're talking about, and one of the common symptoms of anxiety is an increase in heart rate, which I'm not talking about, but you need to pay attention."
},
{
  "instruction": "Doctor, I've been feeling a lot of anxiety and anxiety lately, and I've had unusual involuntary movements, and sometimes I feel very low and I experience depression or mental symptoms.",
  "input": "",
  "output": "With some tests and evaluations, we can check the diagnosis and discuss treatment options."
},
{
  "instruction": "Sir, I have a problem controlling my temper these days, and my appetite has increased greatly, and I feel pretty depressed, and I sometimes get paranoid, and I take antisocial behavior, and I get angry with it for no apparent reason, and what's wrong with me?",
  "input": "",
  "output": "The symptoms seem to indicate that you have an impulse control disorder."
},
{
  "instruction": "Sir, my period is longer and I feel anxious and nervous all the time, so can you tell me what's causing these symptoms?",
  "input": "",
  "output": "The impulse control disorder can cause a wide range of symptoms, including what you're talking about, and it's important to consult a mental health professional and make a proper diagnosis and treatment plan."
},
{
  "instruction": "Sir, I feel extremely anxious and nervous these days, and I don't feel able to control myself and my impulses.",
  "input": "",
  "output": "I think you're experiencing symptoms of impulse control."
},
{
  "instruction": "Doctor, you've recently had a very long period of menstruation. What's the problem?",
  "input": "",
  "output": "It could be the result of an impulse control disorder that causes moods, behavior and social norms, and I recommend a comprehensive evaluation to help you understand the right course of treatment."
},
{
  "instruction": "Sir, we found symptoms of excessive anger, insomnia, temper problems, hostile behavior, antisocial behavior.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from an impulse control disorder."
},
{
  "instruction": "Sir, I'm experiencing an abnormal movement of coughing and eyelids, and I have some symptoms in my eyes.",
  "input": "",
  "output": "I think there's a lot of stenosis that causes the symptoms that you're talking about when your tears don't go out properly, and you have to do some tests to make sure you're aware of that."
},
{
  "instruction": "Doctor, my eyes always cry and feel red. What's the problem?",
  "input": "",
  "output": "It's a condition where the tear is narrowed or blocked, and the tears don't come out of the eye properly, which can cause excessive tears, blood loss and other symptoms."
},
{
  "instruction": "Doctor, there's too much tears and a lot of diaper rashes and coughs. What's the problem?",
  "input": "",
  "output": "There could be tears that can cause skin irritation around the eyes, and coughs may not be relevant, so you have to evaluate them separately."
},
{
  "instruction": "Doctor, I've been experiencing nodules in the last few weeks. What's the problem?",
  "input": "",
  "output": "The symptoms can lead to tears."
},
{
  "instruction": "Sir, I haven't felt the movement of eyelids in a while. What's the cause?",
  "input": "",
  "output": "It's because the tear ducts are narrowed or blocked, and they don't release them properly, so it's an abnormal movement of the eyelids, which is a state of overstuff and irresponsibility."
},
{
  "instruction": "Hi, doctor, there's been a couple of symptoms recently: headaches, nose blockage, stomachaches, and my baby is very annoying, and what's the cause of all of this?",
  "input": "",
  "output": "Headaches, cochleas, loss of appetite, and opulence are all common symptoms of this disease, and you have to do physical testing to identify the diagnosis and determine how best to treat it."
},
{
  "instruction": "Doctor, I recently had a sore throat and pain in my ear.",
  "input": "",
  "output": "The symptoms suggest that there may be an abscess in the nose."
},
{
  "instruction": "Doctor, your appetite loss, your ear pain, your nose pressure continues. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that there's an abscess."
},
{
  "instruction": "Doctor, I've recently had a sore throat and a low appetite.",
  "input": "",
  "output": "You could have an abscess in your nose."
},
{
  "instruction": "Doctor, loss of appetite, ear pain, blockage, headaches, throat pain, what's the problem?",
  "input": "",
  "output": "I think there's an abscess, which is a common form of pus in the sinus tissue."
},
{
  "instruction": "Sir, I'm really worried about my health, and I've got an irregular back, a weak back, puss on my scissors, skin rashes, and so on.",
  "input": "",
  "output": "It's a bacterial infection that affects the navel, which can cause secretions and irregular forms, which can spread over other parts of the body, causing skin rashes, back weakness and pus in the ear."
},
{
  "instruction": "Sir, if there's pus on the scissors, why is that?",
  "input": "",
  "output": "It's possible that it's omphalitis, which is an infection of the navel stump, and it can cause pus among other symptoms."
},
{
  "instruction": "Doctor, your muscles are swollen with emotion these days, and you've found that your skin is yellow, and what's the problem?",
  "input": "",
  "output": "It's an infection of the navel, which can cause emotional symptoms, muscle swelling, and ulna, which requires several tests to identify the diagnosis and begin treatment immediately."
},
{
  "instruction": "Doctor, I have an irregular stomach and a weak back, and my baby is very irritable, and my back is weakened with elbow cramps and spasms.",
  "input": "",
  "output": "To put it off, there's the possibility that the baby may have had endocarditis, which is an infection, which can cause a variety of symptoms, such as abdominal swelling, fever, hypersensitivity, weakness, and the need to get the baby to the hospital immediately for diagnosis and treatment."
},
{
  "instruction": "Doctor, you've recently had a swelling of muscles, a bloated stomach, and emotional symptoms. Do you know what the problem is?",
  "input": "",
  "output": "It's possible that the symptoms are ombs that are infected with the navel. Have you ever been red in the navel, or have you ever had a secretion?"
},
{
  "instruction": "Doctor, your mouth has been sore lately, your muscles have become stiff, and why?",
  "input": "",
  "output": "Have you experienced any other symptoms, such as fatigue and frequent infections?"
},
{
  "instruction": "Doctor, you've got kidney and gum bleeding. Can you help me understand what's going on?",
  "input": "",
  "output": "Symptoms suggest leukemia, which is a type of cancer affecting the blood and bone marrow, and it's good to do some blood tests and bone marrow biopsy to confirm the diagnosis."
},
{
  "instruction": "Doctor, I'm experiencing stiff, warm muscles with pale eyes, and why?",
  "input": "",
  "output": "Leukemia can be leukemia, which can lead to abnormal white blood cells growing into blood cancer that interferes with the normal function of other blood cells, causing muscle rigidity, stress and paleness."
},
{
  "instruction": "Sir, I've recently seen a lot of urine, and I've had a lot of kidney symptoms, and I've had a lot of blood in my urine, and I've had a lot of pain in my mouth, so tell me what's wrong.",
  "input": "",
  "output": "Leukemia can cause abnormal blood cells to grow and interfere with the body's ability to fight infection or control red blood cells."
},
{
  "instruction": "Doctor, I'm experiencing involuntary abnormal movements, weakness, facial symptoms, telophase, eyelid lesions, and why?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from velple paralysis, which is a condition in which one side of your face is weakened or paralyzed, and there may also be rashes or lesions in your eyelids."
},
{
  "instruction": "Doctors, low vision, low telophase, loss of sense, and so on, and why?",
  "input": "",
  "output": "The symptoms seem to indicate that you have velple paralysis, which affects the nerves that control one side of your face because of facial paralysis, which may include loss of taste, loss of face, convulsions, a smile on one side or difficulty with your eyes."
},
{
  "instruction": "There's a doctor, a telophase, a sense loss, eyelids. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that you have a bell paralysis."
},
{
  "instruction": "Doctor, you've recently started to have lesions in your eyelids, and you've got paralysis in your face.",
  "input": "",
  "output": "The symptoms seem to indicate that you have a bell paralysis, which is a condition in which one side of your face is weakened or paralyzed, which can cause rashes or lesions in your eyelids."
},
{
  "instruction": "What's wrong with the abnormal involuntary movement on the left side of the face and the poor vision on the left side of the eye?",
  "input": "",
  "output": "According to your description, you're experiencing a bell paralysis."
},
{
  "instruction": "Doctor, you cough, you cry, you feel so hot and so hot, your eyes are so red, what's the cause?",
  "input": "",
  "output": "It can cause all the symptoms you've described in your general allergic response."
},
{
  "instruction": "Doctor, I have some symptoms in my eyes, red, hot, sneezed, and I also have too many tears.",
  "input": "",
  "output": "The symptoms seem to indicate that you're allergic to endometriosis."
},
{
  "instruction": "Sir, with the pain of the eyes, the tears, the heat, and the feeling of pain, there's soreness and intubation going on.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from an allergy."
},
{
  "instruction": "Doctor, what's wrong with your eyes getting swollen and allergic?",
  "input": "",
  "output": "Symptoms are likely to indicate that it's an allergy pericarditis."
},
{
  "instruction": "Hi doctor, I have some symptoms in my eyes, and my eyes are really dark and swollen, and I have eye pain, and I'm allergic, and I'm coughing.",
  "input": "",
  "output": "The symptoms seem to indicate that you're allergic to endometriosis."
},
{
  "instruction": "Doctor, your lips are swollen, and it's really painful. What's the problem?",
  "input": "",
  "output": "Your lips can be swollen by an allergic reaction to drugs you've taken."
},
{
  "instruction": "Hi, doctor, I've been experiencing nausea, telophase, vomiting in the last two days, and I'm afraid yesterday my lips are swollen and I'm allergic.",
  "input": "",
  "output": "The symptoms you're talking about are the general side effects of a particular drug, if you have a new drug recently."
},
{
  "instruction": "Doctor, we're doing a lot of nausea and vomiting these days, and we're also turning strange skin.",
  "input": "",
  "output": "The symptoms seem to indicate a drug response."
},
{
  "instruction": "What happened when you had symptoms like doctor, telophase, skin rash, abnormal skin, nausea?",
  "input": "",
  "output": "Have you started taking new drugs recently?"
},
{
  "instruction": "Doctor, what's the problem with the nausea and swelling of your feet in the last few days?",
  "input": "",
  "output": "These symptoms are often related to drug reactions, so they can be drug reactions. Have you started taking new drugs recently?"
},
{
  "instruction": "Doctor, I'm experiencing coughs, nausea, nosebleeds. What's the problem?",
  "input": "",
  "output": "These symptoms can be the result of adrenal cancer."
},
{
  "instruction": "Doctor, I recently had diaper rashes and nosebleeds. What's the problem?",
  "input": "",
  "output": "It's possible that the symptoms indicate adrenal cancer, and it's good to run some tests to confirm this diagnosis."
},
{
  "instruction": "We're experiencing doctors, nosebleeds, skin rashes, hearing decline. What's the problem?",
  "input": "",
  "output": "It's possible that it's adrenal cancer, because these symptoms can be linked to adrenal cancer, and I want to get additional tests to confirm it."
},
{
  "instruction": "Sir, your eyes have been soggy these days. Is it allergies or other problems?",
  "input": "",
  "output": "It's possible that it's near-sighted enough to cause discomfort and cover to the eyes."
},
{
  "instruction": "Doctor, there's some eye problems, there's some pain in your eyes, there's some abnormal movement of your eyelids, there's some blindness, and what's wrong with your eyes?",
  "input": "",
  "output": "You're experiencing near-sightedness or near-sightedness, which occurs when your eyeballs are too long or your corneas are so bent that the light is misfocusing your eyes and the distant objects are not visible."
},
{
  "instruction": "Sir, I've been experiencing a recent decline in vision, and I think the eyelids seem to move abnormally, and they're just getting dark.",
  "input": "",
  "output": "Your symptoms seem to indicate that you have nearsightedness, which is often called nearsightedness."
},
{
  "instruction": "Doctor, blindness, pain, abnormal movement, spots -- you know what?",
  "input": "",
  "output": "These symptoms are associated with what is commonly called nearsightedness, and how many tests can we do to identify a diagnosis?"
},
{
  "instruction": "Sir, there's a lot of tears and abnormal movement of eyelids. What's the problem?",
  "input": "",
  "output": "You may have near-sightedness, or near-sightedness -- near-sightedness, while distant objects are common eye diseases that look dim."
},
{
  "instruction": "Doctor, I've been experiencing leg and joint pain for a while. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to be sedimentary arthritis, which occurs when protective cartilage, which cushions the bone end, takes over time to cause pain, stiffness and swelling in the joints."
},
{
  "instruction": "Hi, doctor. There's been knee weakness, muscle pain, joint pain, knee swelling, hip pain. Can you tell me what's wrong?",
  "input": "",
  "output": "The symptoms seem to indicate that you have a sedimentary arthritis."
},
{
  "instruction": "Doctor, there's been a lot of pain in your legs, your back, your butt, just tell me what's causing it.",
  "input": "",
  "output": "Symptoms indicate that it's likely to be sedimentary arthritis, which can cause pain and stiffness, especially in the joints of the legs, the hips and the hips."
},
{
  "instruction": "Doctor, there's been a lot of pain and swelling in your knee lately. What's the cause?",
  "input": "",
  "output": "It's a form of arthritis that causes pain, swelling and stiffness with the cartilage of the joints over time."
},
{
  "instruction": "What's the problem with the doctor, the back, the ankle, the muscles, the knees, even the terrible pain in the hands and fingers?",
  "input": "",
  "output": "As the cartilage of your joints goes on, you seem to suffer from osteoarthritis, which causes pain and discomfort."
},
{
  "instruction": "Doctor, I have a feeling I'm having a hard time with my neck. What's wrong with that?",
  "input": "",
  "output": "The symptoms seem to indicate that there is a possibility of thyroid disease."
},
{
  "instruction": "Doctor, I've got a lump in my neck and a lump in my neck these days, and I think my neck is pouring more than usual.",
  "input": "",
  "output": "These symptoms can be caused by thyroid disease, which requires additional tests to be diagnosed, but is more likely that the thyroid won't function properly."
},
{
  "instruction": "Doctor, your throat is swollen, it's hard to swallow, and you've got facial blushing, and what's the problem?",
  "input": "",
  "output": "These symptoms indicate that you can have thyroid disease, and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I've been experiencing a number of unusual symptoms that are so frustrating and so hot in the face, that there's a lump around the neck and so on and so forth.",
  "input": "",
  "output": "The symptoms seem to indicate that you have thyroid disease, and you have to do some tests to check it out."
},
{
  "instruction": "Doctor, I've got a hard feeling about my neck, and I've got a lot of secretions out of my neck, and in recent years, my behavior has gotten very rough.",
  "input": "",
  "output": "These symptoms may have something to do with thyroid disease, and it's good to book a blood test to check the thyroid hormone levels."
},
{
  "instruction": "Doctor, coughing continues and breathing is painful. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that there is strepitis in the throat or in the back of the throat."
},
{
  "instruction": "Sir, I've had a lot of trouble swallowing lately.",
  "input": "",
  "output": "The symptoms suggest that you've got the pharynx."
},
{
  "instruction": "Doctor, a few days ago, coughing and coughing continued and it was difficult to swallow without pain, fever, sharp abdominal pain recently, what's wrong with me?",
  "input": "",
  "output": "The symptoms seem to indicate that strepitis is suspect, that it's good to take a break and get plenty of fluids, and I'm going to give you antibiotics that help you with post-op infections."
},
{
  "instruction": "Doctor, I feel discomfort in my neck, and I feel a tight neck, and I get a lot of secretions, and what's the cause?",
  "input": "",
  "output": "Symptoms can lead to chronic rheumatic fever, which can cause inflammation after death, and it's important to do some tests to identify the diagnosis and plan the treatment."
},
{
  "instruction": "Doctor, I've been having a heart attack lately.",
  "input": "",
  "output": "Did you experience joint pain or fever?"
},
{
  "instruction": "Doctor, there's been signs in your ear recently that you've got nausea, dizzyness, shortness of breath, what's the reason?",
  "input": "",
  "output": "The symptoms seem to indicate that you have chronic rheumatic fever, which is the rare complications that can be caused by untreated pharynxitis."
},
{
  "instruction": "Hi, doctor. What's wrong with you? You can't breathe, you can't feel your legs.",
  "input": "",
  "output": "It's possible that you have low calcium hemolysis because of your symptoms."
},
{
  "instruction": "Doctor, there's been a lot of breathing, loss of sense, sharp abdominal pain, sharp chest pain, what's the problem?",
  "input": "",
  "output": "The symptoms suggest that you have low calcium levels in your blood."
},
{
  "instruction": "Doctor, I'm experiencing constipation and loss of sense, and what's the cause?",
  "input": "",
  "output": "The cause of the symptoms could be a disease called hypocalcemia, which lacks calcium in the blood."
},
{
  "instruction": "Doctor, I'm feeling nausea and sharp abdominal pain.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from low calcium hemorrhagic disease."
},
{
  "instruction": "Sir, you've recently had tears, and you've got symptoms that you can't see. What's the cause?",
  "input": "",
  "output": "It's possible that the symptoms are ecliptic, which affects the center of the retina, causing blindness."
},
{
  "instruction": "Hi, sir. There's a symptom of two recent objects.",
  "input": "",
  "output": "The symptoms are likely to be ecliptic."
},
{
  "instruction": "Doctor, there are symptoms of blindness in one eye, and spots and clouds in the eye, and there are excessive tears and bleeding in the eye, as well as abnormal movement in the eyelids.",
  "input": "",
  "output": "It's a disease that affects the eczema of central vision, which can lead to progressive blindness, blindness and distorted vision. It's good to understand the extent of the disease and to discuss possible treatment options through comprehensive eye examinations."
},
{
  "instruction": "Doctor, I'm seeing strange symptoms in my vision, and I don't think the spots or the clouds are going to go away.",
  "input": "",
  "output": "According to your description, you may be suffering from osmosis. Do you have any signs of bleeding in your eyes?"
},
{
  "instruction": "Doctor, I've been experiencing a recent decline in vision. What's the cause?",
  "input": "",
  "output": "The symptoms you just described suggest that it's possible that it's ecliptic."
},
{
  "instruction": "Doctor, I'm experiencing sharp chest pains, my nose strength, my nose strength, my weakness, what's the problem?",
  "input": "",
  "output": "The symptoms are likely to indicate pneumonia."
},
{
  "instruction": "Doctor, I've recently been experiencing an epidural force, and why?",
  "input": "",
  "output": "It's likely Coriza symptoms of pneumonia."
},
{
  "instruction": "I'm experiencing a doctor, vomiting, choosyness, gurgling, fever and sharp chest pain. Do you know what's wrong with me?",
  "input": "",
  "output": "Yes, the symptoms suggest pneumonia."
},
{
  "instruction": "Doctor, do you want to know what's going on with your recent experience of vomiting and helplessness?",
  "input": "",
  "output": "I think there's pneumonia, which is a lung infection that can cause nausea and helplessness, and I think it's good to get additional evaluations and treatment to make you feel better."
},
{
  "instruction": "Doctor, you've got a lot of pain these days: vomiting, breathlessness, shortness of breath, chills -- what's the problem?",
  "input": "",
  "output": "The symptoms are likely to be pneumonia, which can cause coughing and respiratory problems due to inflammation in the air sacs of one side or both lungs, and it's important to start treatment immediately to prevent complications."
},
{
  "instruction": "Sir, I've got inflammation of my lips, so what's the disease when the skin around me is itchy and swollen?",
  "input": "",
  "output": "It's very likely that it's strepsis, because of the symptoms."
},
{
  "instruction": "Doctor, you have an ulcer with a pain in your lips, and the skin around it is swollen, and you have a recent fever.",
  "input": "",
  "output": "The symptoms seem to indicate streptosis."
},
{
  "instruction": "Doctor, you've got an ulcer in your mouth, and it's too close.",
  "input": "",
  "output": "Did you have blisters around your mouth or your lips?"
},
{
  "instruction": "Doctor, I have a sharp chest pain. Can you tell me what caused it?",
  "input": "",
  "output": "The symptoms may indicate early contractions or V-tach."
},
{
  "instruction": "Doctor, I'm experiencing back cramps, cramps, erectile failure, increased heart rate, sharp chest pain and palpitations.",
  "input": "",
  "output": "A series of symptoms that God has described can be caused by early ventricular contractions."
},
{
  "instruction": "Good morning, doctor, with breathy, chesty, sharp chest pain, shortness of breath, and so on, but what's the problem?",
  "input": "",
  "output": "It's possible that you're experiencing early ventricular contractions, an irregular heart rate that can cause these symptoms based on the symptoms."
},
{
  "instruction": "Doctor, what's the cause of your recent chest cramps and back cramps?",
  "input": "",
  "output": "You might be experiencing early contractions, or PVCs, in terms of your symptoms."
},
{
  "instruction": "Hi doctor, I recently experienced eye pain, facial pain, lumps in the knee, do you know what's causing it?",
  "input": "",
  "output": "Yes, the symptoms you described may indicate that it's Chandron's disease."
},
{
  "instruction": "Doctor, I'm experiencing wrist pain, breast pain, ankle pain, facial pain, excessive anger.",
  "input": "",
  "output": "These symptoms can be a sign of the Chankloid, which is a bacterial venereal disease that causes pain in the penis, which can cause swelling and tenderness in the groin."
},
{
  "instruction": "Doctor, I have excessive anger, eye pain, fatigue, pregnancy pain, knee trauma.",
  "input": "",
  "output": "It's a bacterial infection that can cause ulcers and lumps in the genital area, thighs or groin, but you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Sir, I feel pain in my breast, I feel bitter, and I feel stiff and tired in my joints, and I also have fatigue, excessive anger, ankle pain.",
  "input": "",
  "output": "The symptoms seem to indicate that you've got cycloids, a bacterial infection that causes painful ulcers in the genital area, which can cause complications if the lymph nodes in the groin are swollen and not treated."
},
{
  "instruction": "Doctor, there are lumps and lumps and pains in the knee during pregnancy.",
  "input": "",
  "output": "These symptoms can be caused by a venereal disease called Chankloid, and it's important to be tested and treated immediately to prevent complications."
},
{
  "instruction": "Doctor, I've been feeling nauseous lately. Do you know what's wrong?",
  "input": "",
  "output": "Have you ever been hit or swollen in a test? Patient:"
},
{
  "instruction": "Doctor, I think my arm is infected. Is it skin infection or is it more serious?",
  "input": "",
  "output": "And the symptoms are not limited to skin infections, but they can spread from the lymph nodes of the armpits to the lymph nodes, which can cause lymph nodes."
},
{
  "instruction": "Doctor, there's a lump in your scrotum.",
  "input": "",
  "output": "There's a possibility that it's cancer of the test, and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I've got urinary pain, and I've got pain in my testes.",
  "input": "",
  "output": "There's a possibility that there's cancer of the test, and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I've been experiencing a number of symptoms recently: hearing low, nausea and groin pain.",
  "input": "",
  "output": "I think we need an urgent medical examination, which is the symptoms of testicular cancer, and we need to do some tests to confirm the diagnosis."
},
{
  "instruction": "Doctors, seizures, memory problems, stiffness in the arm. What's the problem?",
  "input": "",
  "output": "The symptoms could be chickenpox, which is a condition in the brain where the spinal fluid accumulates."
},
{
  "instruction": "Doctor, my hands and feet are off, and I feel paralyzed.",
  "input": "",
  "output": "Symptoms can lead to chickenpox, which is a condition in the brain where the spinal fluid accumulates."
},
{
  "instruction": "Doctor, I've been experiencing more than just seizures and sensations.",
  "input": "",
  "output": "It's a disturbing symptom, and I think you've got chickenpox from what you've described."
},
{
  "instruction": "Doctor, I have a problem with movement, and it's getting harder and harder to move.",
  "input": "",
  "output": "There's the possibility that you're going to have chickenpox, which can accumulate fluid in your brain, causing not only motor problems, but many other symptoms."
},
{
  "instruction": "Hi, doctor, there's a lump in the breast, bleeding and secretions coming out of the nipples, and it's also stiff, and it feels tight.",
  "input": "",
  "output": "Your symptoms may indicate breast cancer, and you have to do some additional tests to check it out, and it's good to get breast imaging and tissue testing to see the level of cancer."
},
{
  "instruction": "Doctor, what's the cause of the pain and weariness in the breast?",
  "input": "",
  "output": "The symptoms suggest that you have breast cancer, and I recommend additional tests to check it out."
},
{
  "instruction": "Doctor, I recently had a stiff or warm joint, but why?",
  "input": "",
  "output": "Can you tell me if there are other symptoms? Patient:"
},
{
  "instruction": "Doctor, there's a mass in the breast, and there's a secretion in the face of the blush and the nipples, and what's the problem with that?",
  "input": "",
  "output": "It's probably breast cancer because of the symptoms, and it's good to book a breast scan and a tissue test to check your diagnosis and discuss treatment options with your specialist."
},
{
  "instruction": "Doctor, a couple of days ago, we've been calling back, and what's the cause?",
  "input": "",
  "output": "It's possible that it's anemia due to a malignant tumor in history and symptoms, which is a common symptom of this disease, and you have to do some tests to confirm it."
},
{
  "instruction": "Doctor, recently hard to swallow, nosebleed, vaginal pain, anal pain, what's the cause of these symptoms?",
  "input": "",
  "output": "Symptoms indicate that it's likely that the anemia caused by malignant tumors caused by cancer cells causing bleeding and damaging red blood cells in the body, and it's important to start treating them as soon as possible to treat the underlying malignant tumors and to manage the anemia."
},
{
  "instruction": "Doctor, it's still bleeding. What's the cause?",
  "input": "",
  "output": "Could have been a history and symptoms of anemia caused by malignant tumors. Have you been feeling weak or tired lately?"
},
{
  "instruction": "Doctor, I've been very tired recently, and I've had vaginal pains, and I can't swallow food, and I'm showing facial blushing.",
  "input": "",
  "output": "These symptoms suggest anemia from malignant tumors."
},
{
  "instruction": "Sir, I've had some vaginal pain recently. Can you tell me what caused it?",
  "input": "",
  "output": "Your history and symptoms suggest that it may have caused vaginal pain caused by anaemia caused by malignant tumors, and you have to do additional tests to make sure you're diagnosed."
},
{
  "instruction": "Sir, there's been anal pain, there's a black blood clot, there's an abscess, there's a lot of pain going on down there, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that the esophageal vein is a condition in which the esophageal vein is overweight, which can cause bleeding, which can cause the symptoms you just mentioned, which requires immediate medical attention to manage and control this condition."
},
{
  "instruction": "Doctor, I've been feeling nauseous lately.",
  "input": "",
  "output": "The nausea can be caused by the esophageal vein."
},
{
  "instruction": "Doctor, you've been very weak lately, and you've got skin problems, and tell me what's causing these symptoms.",
  "input": "",
  "output": "The symptoms may indicate that the ophthalmic vein has internal bleeding and a debilitating effect of hypotensive blood pressure, which can also be a symptom of this disease."
},
{
  "instruction": "Sir, there's been anal pain, burning abdominal pain, nausea, what's the problem?",
  "input": "",
  "output": "The symptoms may indicate that there's a diuretic vein growing in the lower wall of the esophagus, which can cause bleeding in the digestive tract."
},
{
  "instruction": "Doctor, you've recently been confused, and you've seen a change in the shape of your stool.",
  "input": "",
  "output": "There's a possibility that there's an esophageal vein, and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "I'm experiencing vaginal secretions, spasms, cramps, hip pain, and I haven't had a lump in my throat for a while, so what's the problem?",
  "input": "",
  "output": "In view of the symptoms that God has described, there's a possibility of endometrium cancer, and you have to do some tests to check your diagnosis."
},
{
  "instruction": "Hi doctor, there's been spasms and cramps in the lower abdomen for the last week, and there's a lump in the throat, there's a very dryness, there's an abnormal vaginal secretion, and there's a little bit of vaginal bleeding after menopause, and what's the cause of these symptoms?",
  "input": "",
  "output": "It's possible that you have endometriosis, depending on your symptoms, and you have to do some tests to confirm this diagnosis."
},
{
  "instruction": "Doctor, with hip pain, there's an indiscretion, and there's a lump in the eczema, and there's a lot of menstrual periods, and there's a lot of problems.",
  "input": "",
  "output": "There may be endometriosis because of the symptoms, and it's important to do some tests to identify the diagnosis and determine how to treat the best."
},
{
  "instruction": "Doctor, there's a mass in the throat after menopause, and there's a vaginal secretion and vaginal bleeding, and what's the problem?",
  "input": "",
  "output": "Symptoms suggest endometrium cancer, which is recommended for additional tests and evaluations to check the diagnosis and discuss treatment options."
},
{
  "instruction": "Doctor, I'm experiencing postmenopausal bleeding, vaginal perches, cramps and cramps, long period of menstrual bleeding, what's the problem?",
  "input": "",
  "output": "Depending on the symptoms, there's a possibility of endometrium cancer, and we need to do additional tests to confirm the diagnosis."
},
{
  "instruction": "What's the problem, doctor?",
  "input": "",
  "output": "There may be cystic fibrosis, a genetic disorder that affects respiratory, digestive and reproductive organs, depending on the symptoms."
},
{
  "instruction": "Doctor, I'm experiencing menstrual bleeding, colds, coughs, spots, clouds, loss of blood in my eyes.",
  "input": "",
  "output": "Cystic fibrosis, a genetic disorder affecting the lungs, pancreas and other organs, can cause a mix of symptoms such as coughing, shortness of breath, and corpuscles, and a variety of complications such as respiratory infections, bowel obstructions, liver disease, diabetes."
},
{
  "instruction": "Doctor, I'm not feeling well these days. I don't know what's wrong.",
  "input": "",
  "output": "The symptoms suggest that you may have cystic fibrosis, a genetic disorder affecting your lungs, your pancreas and other organs, and it's good to run some diagnostic tests to identify the diagnosis."
},
{
  "instruction": "Doctor, I'm experiencing skin growth with acne and what appears to be abnormal skin spots, and why?",
  "input": "",
  "output": "The symptoms suggest that you have a skin disease called Intertrigo."
},
{
  "instruction": "Sir, your skin looks weird, your skin grows, your feet swell, your skin rashes, your dryness.",
  "input": "",
  "output": "The symptoms suggest that there are intertregos, skin disorders that cause inflammation, rashes, and itching because two skin areas are frictioning with each other and the water is accumulating and causing inflammation."
},
{
  "instruction": "Sir, your throat is very sick and your skin is being stimulated, and your skin looks abnormal, and it's very dark, and you have rashes on your skin, and what's wrong with me?",
  "input": "",
  "output": "The symptoms seem to indicate that there is an intertrego, a skin disorder that causes skin rashes, itchings, and skin rashes, such as the neck, against the skin or the clothing."
},
{
  "instruction": "Sir, there's a spot in your skin that hurts a lot of your throat. What's the problem?",
  "input": "",
  "output": "I think you're experiencing the tickle, which is a skin condition that can cause inflammation, rash and pain, caused by friction and humidity in skin wrinkles."
},
{
  "instruction": "Sir, I think there's some spots on the skin and I think there's a lot of swelling in the feet and toes these days.",
  "input": "",
  "output": "You've got intertrigo, a skin disease that's caused by moisture, bacteria, friction, etc."
},
{
  "instruction": "Doctor, I've been having a very difficult and difficult experience lately, so can you tell me why?",
  "input": "",
  "output": "The symptoms seem to indicate a parathyroid type, which is a condition in which the parathyroid gland has a tumor in the parathyroid, and the thyroid hormone is over-growing, which can cause weakness and difficulty swallowing."
},
{
  "instruction": "Good morning, sir, for the last few days, you've been in bad shape, you've got flu-similar syndrome, you've got tongue lesions, and what's the reason?",
  "input": "",
  "output": "A parathyroid type is a non-arterial growth in one of the parathyroids, which can cause a variety of symptoms, including what you're experiencing. It's good to run some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, you're hard to swallow, you've got memory problems, you've gained a lot of weight, and why?",
  "input": "",
  "output": "The symptoms are likely to indicate that it's a parathyroid type."
},
{
  "instruction": "Doctor, do you know what might be the problem with recent kidney symptoms and memory problems?",
  "input": "",
  "output": "These symptoms can be caused by parathyroids."
},
{
  "instruction": "Doctor, you've been sick lately, you've got ribs, you've got history of drug abuse, and what's the cause?",
  "input": "",
  "output": "This condition occurs when the adrenal glands don't produce enough cortisone hormones, and it can cause the same symptoms you described."
},
{
  "instruction": "Doctor, I'm experiencing side pain, aches, ribs pain, lack of growth and kidney symptoms. What's wrong with me?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from Glococortiside deficiency, which can cause a lot of symptoms, including the symptoms that you've described, when your body doesn't produce enough steroids."
},
{
  "instruction": "Doctor, she's breathing pretty, she's got side pain, and she has movement problems during sleep.",
  "input": "",
  "output": "Other symptoms associated with this condition are apnea and rib pain, and you have to do some tests to confirm your diagnosis."
},
{
  "instruction": "Doctor, I'm apnea, I'm sick and breathing, and why is that?",
  "input": "",
  "output": "This may be due to a disease called glucose cortide deficiency, which is a disorder in the body that doesn't produce enough hormones to regulate metabolism and immune systems."
},
{
  "instruction": "Doctor, there's pain in the eyes and neck. Do you know what's causing it?",
  "input": "",
  "output": "Yes, there may be an occipital hip disorder that can cause pain in the eyes and throat, and I propose a test to confirm the diagnosis."
},
{
  "instruction": "Doctor, your ears are red, your facial pain, your toothache, your throat pain, your ear pain.",
  "input": "",
  "output": "I think you're experiencing the symptoms of TMJ, also known as the TMJ."
},
{
  "instruction": "Doctor, I've been having some discomfort lately, there's nose pain, there's neck pain, there's eye pain, you know what's causing all these symptoms?",
  "input": "",
  "output": "Yes, I think there's a TMD which affects the joints that connect the skull to the jaw, which can cause pain and discomfort on the part that you're talking about."
},
{
  "instruction": "Doctor, I feel a lot of pain in the eyes, a lot of pain in the throat, a lot of hearing, a lot of nose force. What's the problem?",
  "input": "",
  "output": "These symptoms can be shown to be a condition of the occipital joints that have problems with the muscles that are involved in chewing and moving the jaw."
},
{
  "instruction": "Doctor, there's a redness of the ear. Is it an infection?",
  "input": "",
  "output": "The redness of the ear can actually be a symptom of temporal hip trouble, or TMD. Have you had a hard time opening your jaw or opening your mouth recently?"
},
{
  "instruction": "Doctor, there's hard to swallow, there's insomnia, there's a strange breath, and what's wrong with me?",
  "input": "",
  "output": "I think you're experiencing symptoms of Wilson's disease."
},
{
  "instruction": "Doctor, you've recently had eye problems, you've been suffering from apnea and insomnia, and what's the cause?",
  "input": "",
  "output": "The symptoms are likely to lead to Wilson's disease, which can lead not only to the disease that copper accumulates in the body, but also to neurological and psychiatric symptoms."
},
{
  "instruction": "Doctor, I'm experiencing a low vision, abnormal breathing, eating difficulties and general fatigue.",
  "input": "",
  "output": "Wilson's disease is a genetic disease that accumulates copper in various organs, including the liver and the brain."
},
{
  "instruction": "Doctor, I've been having strange symptoms lately: my eyesight seems to be getting worse, I'm having trouble swallowing, I'm not feeling strong, I'm often fainting, what's wrong with me?",
  "input": "",
  "output": "With these symptoms, it's possible that Wilson's disease is a genetic disease in which copper accumulates in the body, which can cause a variety of symptoms, such as poor vision, difficulty in swallowing, weakness, and blindness."
},
{
  "instruction": "Doctor, I'm experiencing apnea and food consumption and thirst, and what's the cause of these symptoms?",
  "input": "",
  "output": "Wilson's disease is a rare genetic disease that can cause these symptoms by accumulating copper in the liver, in the brain, in the eyes, in the various body organs."
},
{
  "instruction": "Doctor, the involuntary urination, the blood's mixed with the urine, there's a chest pain, there's a fluid in the ear, and what's the possible cause?",
  "input": "",
  "output": "The symptoms seem to indicate that it's caused by hydroponic urethra."
},
{
  "instruction": "What's the problem?",
  "input": "",
  "output": "I think there's a tubular reflux in the bladder, where urine is refluxing from the ureter to the kidney, which is a common symptom of the disease."
},
{
  "instruction": "Doctor, you're experiencing involuntary urination and fever. What's the problem?",
  "input": "",
  "output": "It's possible that the symptoms indicate that you're suffering from the uterine reflux, which is an infection and inflammation of the urethra, which is the reflux of the bladder to the kidney."
},
{
  "instruction": "Doctor, I'm experiencing involuntary urination, kidney symptoms, blood in urine, reflux.",
  "input": "",
  "output": "The symptoms suggest that there's a fetid reflux, which occurs when urine backs up from the bladder to the kidney, causing infections and other complications, and we need to do some tests and tests to confirm the diagnosis."
},
{
  "instruction": "Doctor, I've been experiencing overgrowth lately, and why?",
  "input": "",
  "output": "Overgrowth can be a symptom of vitamin A deficiency. Are you eating enough food rich in vitamin A?"
},
{
  "instruction": "Doctor, I've been experiencing neck spasms and joint stiffness for quite some time, so can you tell me what caused these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate a lack of vitamin A."
},
{
  "instruction": "Doctor, your eyes are bleeding, and you've got lumps or lumps on your knees.",
  "input": "",
  "output": "These symptoms can be caused by vitamin A deficiency, and it's important to get a blood test for the correct diagnosis."
},
{
  "instruction": "Doctor, I've been experiencing a recent decline in sexual desire, and what's the cause?",
  "input": "",
  "output": "One possible cause could be vitamin A deficiency. Any other symptoms?"
},
{
  "instruction": "Doctor, you've got uterine pain and swelling of the shoulder, and why?",
  "input": "",
  "output": "The symptoms that God has described may indicate a vitamin A deficiency."
},
{
  "instruction": "Doctor, I'm experiencing vaginal secretions, vaginal pain and sharp abdominal pain.",
  "input": "",
  "output": "In terms of symptoms, gonorrhea is likely to be infected, and gonorrhea is a venereal disease that can cause these symptoms in women."
},
{
  "instruction": "Sir, every time you urinate, there's a lot of pain, and there's a lot of vaginal pain.",
  "input": "",
  "output": "The symptoms suggest that she's infected with gonorrhea."
},
{
  "instruction": "Doctor, there's a problem with movement, and I don't think the muscles are cooperating with each other, so can you tell me what's wrong?",
  "input": "",
  "output": "This venereal disease can cause joint pain and motor problems."
},
{
  "instruction": "Doctor, I've got a severe itching in my genital area. Can you tell me what's wrong?",
  "input": "",
  "output": "I think she's infected with a sexually transmitted disease known as gonorrhea, but we need to do some tests to confirm it."
},
{
  "instruction": "Doctor, I'm experiencing vaginal perplexity during pregnancy, fracturing, bleeding, sharp abdominal pain. What's the problem?",
  "input": "",
  "output": "Gonorrhea is a common venereal disease that can cause these symptoms, and it's best to get tested and treated as soon as possible."
},
{
  "instruction": "Doctor, I'm experiencing arm pain, butt pain, back pain, whole body pain, shortness of breath.",
  "input": "",
  "output": "The symptoms seem to indicate a fracture of the ribs, and these are all common symptoms of rib fractures."
},
{
  "instruction": "Doctor, hip pain, rib pain, shortness of breath.",
  "input": "",
  "output": "The symptoms suggest that there's a rib fracture."
},
{
  "instruction": "Doctor, I've got a lot of back pain.",
  "input": "",
  "output": "The symptoms suggest a broken ribs."
},
{
  "instruction": "Doctor, you've got side pain, back pain, respiratory pain, bone pain, can you tell me what's going on?",
  "input": "",
  "output": "The symptoms suggest a fractured ribs."
},
{
  "instruction": "Sir, there's a weird lump on your back, and it hurts for a while.",
  "input": "",
  "output": "I think there's a rib fracture. Let's take an X-ray."
},
{
  "instruction": "Doctor, what's the cause of your eye infection?",
  "input": "",
  "output": "It may have something to do with your diagnosis, cerebral palsy."
},
{
  "instruction": "Sir, your eyelids are swelling, your eyes are hurting, your muscles are swelling, your skin looks abnormal.",
  "input": "",
  "output": "The symptoms suggest that there's a type of brain tumor that can metastasize and cause swelling and pain, which can also affect the muscles and cause abnormal skin patterns, and we need to do some tests to identify the diagnosis."
},
{
  "instruction": "Doctor, I've been experiencing a few symptoms in my eyes lately: heavy eyes, sometimes not very well. What's the problem?",
  "input": "",
  "output": "There may be endometriosis, a brain tumor that affects the optic nerve, which can cause visual problems, and we need to do some tests to make sure that we're doing it."
},
{
  "instruction": "Doctor, your body is very sick these days, you're experiencing nausea, sharp abdominal pain, even depression.",
  "input": "",
  "output": "In view of the symptoms that God explains, we suspect hepatitis from toxins, we need to run some tests to make sure, but it's important to start treating them as soon as possible."
},
{
  "instruction": "I'm experiencing doctors, vomiting, nausea, ectopic, upper abdominal pain. What could be the problem?",
  "input": "",
  "output": "Are you exposed to any harmful chemicals or drugs recently?"
},
{
  "instruction": "Doctor, sharp abdominal pain, diarrhea, fatigue, stomach pain continues. What's the problem?",
  "input": "",
  "output": "Now, the symptoms you're experiencing are common hepatitis symptoms, and it's good to run some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, there's been a lot of depression lately, stomach pain, rectal bleeding, diarrhea, skin problems.",
  "input": "",
  "output": "I think toxins caused hepatitis."
},
{
  "instruction": "Doctor, there's been a sharp pain in the lower abdomen and there's been too much menstruation. What's the problem?",
  "input": "",
  "output": "It's possible that the symptoms are intestinal cysts, and we need to do some tests to make sure that we're doing this."
},
{
  "instruction": "Hi, doctor, I'm experiencing menstrual bleeding and lower abdominal pain with spasms and spasms, and I'm pregnant and I'm facing some of the problems of pregnancy.",
  "input": "",
  "output": "If you have cysts on your vagina, you can develop a variety of symptoms, such as menstrual bleeding, hip pain, and lower abdominal pain, which can also cause some difficulty during pregnancy."
},
{
  "instruction": "Doctor, there were some problems during pregnancy, and there were menstrual bleeding. What's the problem?",
  "input": "",
  "output": "It can cause problems during pregnancy and cause menstrual bleeding."
},
{
  "instruction": "Sir, there's been a lot of menstrual swings and tics recently, and I'm having lower abdominal pain, and I'm pregnant, and I'm having a lot of pain.",
  "input": "",
  "output": "The symptoms suggest that cysts can cause spasms and spasms, and they can cause menstrual and lower abdominal pain, and it's common for cysts to cause pain during pregnancy."
},
{
  "instruction": "Hi doctor, I'm experiencing vaginal secretions and lower abdominal pain, do you know what's causing it?",
  "input": "",
  "output": "It's important to come to the hospital for diagnosis and treatment options."
},
{
  "instruction": "Sir, there's a scar on your shoulder, and it's really stiff and firm, and what's the cause?",
  "input": "",
  "output": "It's possible that the symptoms may have caused 50 of these injuries, or there's a lot of pneumothoritis."
},
{
  "instruction": "Sir, what's wrong with recent wrist pains, shoulder fractures, shortness, shoulder pains?",
  "input": "",
  "output": "The symptoms suggest that there's an open shoulder wound."
},
{
  "instruction": "Sir, there's an open wound on the shoulder, and there's a swelling in the arm, and there's a pain in the wrist.",
  "input": "",
  "output": "The symptoms suggest that the arm is swollen because of infection of the wound and lymphocarditis, which can be caused by swelling the nerves or blood vessels, and I'm going to give you an antibiotic to treat the infection, and pain to relieve the wrist pain."
},
{
  "instruction": "Doctor, there's an open wound on your shoulder that doesn't heal properly.",
  "input": "",
  "output": "The effects of alcohol on the immune system don't seem to heal from drinking symptoms."
},
{
  "instruction": "Sir, there's an open wound on your shoulder that makes you feel warm and stiff. What's the problem?",
  "input": "",
  "output": "It's important to keep the wound clean and properly dress it to prevent infection and promote healing."
},
{
  "instruction": "Doctor, there's spasms and tics in the lower abdomen, and what's the problem?",
  "input": "",
  "output": "The symptoms may indicate an extrauterine pregnancy, and it's good to have additional evaluations and tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I'm experiencing hip pain and menstrual bleeding. What's the cause?",
  "input": "",
  "output": "Depending on the symptoms, it could be an extrauterine pregnancy."
},
{
  "instruction": "Doctor, during pregnancy, you have vaginal secretions, nausea, stains, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms may indicate an extrauterine pregnancy, which occurs when a fertilized egg implants outside the uterus, generally in the Fallopian tube, can cause vaginal bleeding, secretions and dizziness."
},
{
  "instruction": "Doctor, I'm experiencing vaginal secretions, dizzyness, convulsions, menstrual bleeding and pain during pregnancy.",
  "input": "",
  "output": "Your symptoms suggest that you may be experiencing an extrauterine pregnancy."
},
{
  "instruction": "Hi, doctor, I'm pregnant and I'm experiencing a sharp abdominal pain.",
  "input": "",
  "output": "Patient: What are some of the other problems that can happen during pregnancy if you're having an extrauterine pregnancy?"
},
{
  "instruction": "Doctor, I've been suffering from leg pain and back pain for a while now.",
  "input": "",
  "output": "Do you have chronic knee pain? woman: Yeah, actually, it's been a long time since my knee began to hurt."
},
{
  "instruction": "Doctor, your knee is swollen and stiff, and you've got hip pain. What's the cause?",
  "input": "",
  "output": "The symptoms may be the swelling of the knee joint, the stiffness, and the chronic knee pain, which is accompanied by hip pain."
},
{
  "instruction": "Doctor, I've been experiencing joint pain, leg swelling and hip pain for quite some time, and why?",
  "input": "",
  "output": "There's chronic knee pain, a common problem that can be caused by excessive use of knee joints, injury or arthritis."
},
{
  "instruction": "Doctor, I've been experiencing leg pain, leg swelling, knee swelling for a while, and what's the cause?",
  "input": "",
  "output": "From the symptoms that God explains, it may be chronic knee pain caused by arthritis in the knee joint or injury."
},
{
  "instruction": "Hi, doctor, your knee is swollen and back pain and knee pain have been going on for quite a while. Can you tell me what's wrong?",
  "input": "",
  "output": "The symptoms seem to indicate that there are sedimentary arthritis that causes chronic knee pain, swelling and back pain."
},
{
  "instruction": "Doctor, we're having symptoms of spots or clouds in our eyes, and sometimes we have difficulty breathing, and the scrotum is still there, so what's the problem?",
  "input": "",
  "output": "I think there's a pingeekula, and the symptoms you're experiencing may have something to do with that disease."
},
{
  "instruction": "Doctor, I've been experiencing more than my senses for a while. Why?",
  "input": "",
  "output": "It may be a symptom of a number of disorders, but in your case, it could be Pingecuula, the growth of yellow tissue in the colon."
},
{
  "instruction": "There's been recent headaches, drowsiness, crying, and sometimes there's eye pain, and there's difficulty breathing at night, and what's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that there is a peritonealitis that can cause the white eye of the eye to have an appendix, a stimulus, a dryness, and it can also cause apnea or sleep apnea, which is a condition that stops breathing during sleep."
},
{
  "instruction": "Doctor, can you tell me what caused the recent drowsiness and headaches?",
  "input": "",
  "output": "You may have a disease called Pingeekula, which is generally associated with eye dryness, which can cause irritation and pain in the eyes."
},
{
  "instruction": "Doctor, I've been feeling fatigue lately, so why?",
  "input": "",
  "output": "The symptoms, and the latest tests, seem to indicate that she has a hyperglycrine hemolysis."
},
{
  "instruction": "Doctor, I have recently felt stiff or cold and very tired in my knees, and why?",
  "input": "",
  "output": "You may have a hyperglyphinosis, which can cause joint pain, stiffness, and fatigue because it has a high blood level."
},
{
  "instruction": "What's wrong with your knees being stiff or salty and your throat being filled with blood?",
  "input": "",
  "output": "The symptoms suggest that there is a hyperthyroidism, a high level of immunoglobulins in the blood, which can cause stiffness or coldness in the joints, and can cause a thrombosis that can cause bleeding, which can mix up blood in the throat, so that additional tests can be recommended to confirm the diagnosis, and then a proper treatment can be started."
},
{
  "instruction": "Doctor, I've been very tired lately, and I've got a lot of blood in my throat, and what's the cause?",
  "input": "",
  "output": "The symptoms may indicate that there's hyper-immune glucose in the blood, which can cause fatigue and intestinal bleeding, and we need to do some tests to make sure that we're doing it."
},
{
  "instruction": "Sir, I'm always tired.",
  "input": "",
  "output": "Oh, right. Any other symptoms? Patient: No, I'm just tired."
},
{
  "instruction": "Sir, I have a problem these days: I'm drinking a lot, I'm aggressive, I'm feeling very bad, and I've also got worse smoking, and I've found that words often get repressed when I'm not drunk.",
  "input": "",
  "output": "Your symptoms suggest you're experiencing alcohol abuse."
},
{
  "instruction": "Doctor, I'm depressed, even though everything seems to be working out recently.",
  "input": "",
  "output": "Depression can be the result of alcohol abuse. Have you drank much more or more often than you normally do?"
},
{
  "instruction": "Doctor, I'm struggling with alcohol abuse, drug abuse, smoking problems, anxiety, and neurosis.",
  "input": "",
  "output": "You seem to suffer from alcohol abuse."
},
{
  "instruction": "Doctor, I'm feeling really down these days, and I think I'm feeling a lot less self-worth, and I'm having trouble quitting.",
  "input": "",
  "output": "The symptoms seem to indicate that alcohol abuse is having a hard time."
},
{
  "instruction": "Sir, I've been having problems lately, and I'm having more alcohol than I normally do, and I'm smoking a little bit.",
  "input": "",
  "output": "The symptoms that God's talking about indicate that you're having a hard time with alcohol abuse."
},
{
  "instruction": "Doctor, I'm vomiting blood, I'm depressed, and sometimes I act hostilely, and what's the cause of this?",
  "input": "",
  "output": "I think you're suffering from alcohol abuse from the symptoms you just described. Have you been drinking too much recently?"
},
{
  "instruction": "Hi, doctor, there's been a lot of pain in your hand or fingers lately, and why?",
  "input": "",
  "output": "I think you're suffering from wrist tunnel syndrome, which is a condition that causes sores, soreness and pain in your hands and arms."
},
{
  "instruction": "Hello, doctor, your arm and hand are weak.",
  "input": "",
  "output": "I think it's wrist tunnel syndrome."
},
{
  "instruction": "Doctor, your hands and fingers are swelling, and you're still feeling out of touch, elbow pain, weakness of strength, and I don't know what's wrong.",
  "input": "",
  "output": "You've been using your hands a lot lately, or did you repeat them over and over again?"
},
{
  "instruction": "Hi doctor, your wrist pains and your hand strength have been weakened over the last few days, and you also feel your fingers pricked and pricked, and what's the problem?",
  "input": "",
  "output": "The symptoms are likely to be wrist tunnel syndrome, a condition that causes pain in the hands and fingers, weakness and insensitivity due to pressure on the right wrist nerves."
},
{
  "instruction": "Good morning, doctor, with elbow pains, your hands and fingers are swollen and your wrists are pained, and you feel stiff or tight.",
  "input": "",
  "output": "The symptoms suggest you're suffering from wrist tunnel syndrome."
},
{
  "instruction": "Doctor, we're experiencing facial blushing together. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you have a pituitary disorder, and you have to do some tests to confirm this diagnosis."
},
{
  "instruction": "Doctor, the nipples are constantly bleeding, secretions, weight gain, acne, acne, and drowsiness.",
  "input": "",
  "output": "The symptoms are likely to lead to pituitary disorders, which can cause a wide range of symptoms, such as the imbalance in hormones produced by the pituitary gland."
},
{
  "instruction": "Doctor, weight gain, headache, acne in the face. What's the problem?",
  "input": "",
  "output": "The symptoms may indicate a pituitary disorder, and we need to do some tests to make sure that it's diagnosed."
},
{
  "instruction": "Doctor, you've suddenly gained weight over the last few months, despite no major changes in diets or exercise routines.",
  "input": "",
  "output": "It can affect the production of certain hormones that are responsible for metabolism and weight control."
},
{
  "instruction": "We're experiencing doctors, sterilization, acne, headaches, body fluids, and what's the cause of these symptoms?",
  "input": "",
  "output": "These symptoms can be caused by a pituitary disorder that can affect the development of hormones that cause infertility, acne or acne, headaches and body fluids."
},
{
  "instruction": "Doctor, I've had symptoms of a lot of urination lately.",
  "input": "",
  "output": "It's a common symptom of kidney stones. Have you ever experienced pain or discomfort when you urinate?"
},
{
  "instruction": "The doctor, the side pain, the blood in the urine, the upper jaw pain, the nausea, the lower abdominal pain, can you tell me what's wrong?",
  "input": "",
  "output": "There's a high risk of kidney stones because of the symptoms, and it's good to do some video tests to check the diagnosis and plan the treatment."
},
{
  "instruction": "Doctor, there's blood in your ureter urine and vomiting, and what's the cause?",
  "input": "",
  "output": "It's possible that the symptoms are kidney stones, and it's good that you get additional tests."
},
{
  "instruction": "Doctor, your back is severe, your urine is filled with blood, and you have vomiting and lower abdominal pain, and what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that it's caused by kidney stones."
},
{
  "instruction": "Doctor, I've been having strange symptoms recently: obsessions, compulsiveness, temper problems, edema, constipation, poor growth, what are the symptoms?",
  "input": "",
  "output": "The symptoms you've described are likely to be autism -- some additional tests to test for a diagnosis, but these are symptoms that are common in autism patients."
},
{
  "instruction": "He doesn't like to interact with other people, he's often on his own, he's obsessed, he's obsessed, he doesn't seem to grow up like other kids his age, he's having trouble talking.",
  "input": "",
  "output": "Based on what you've described, it's possible that your child has autism; autism is a developmental disorder affecting social interaction, communication, and behavior."
},
{
  "instruction": "Doctor, I'm experiencing a restless, dislocation and seizures. What's wrong with me?",
  "input": "",
  "output": "There's a possibility that it's autism in terms of symptoms."
},
{
  "instruction": "Doctor, I'm experiencing hostile behavior, eyelids, constipation, and what's the cause?",
  "input": "",
  "output": "Autism is a neurological developmental disorder affecting social interaction, communication, and behavior."
},
{
  "instruction": "There's rashes in the skin, lesions in the skin, and there's also loss of sense. What's the problem?",
  "input": "",
  "output": "The symptoms can lead to cat scraps of disease."
},
{
  "instruction": "Hi, doctor. Your eyes are swollen and your headache is severe.",
  "input": "",
  "output": "Have you ever been scratched or bitten by a cat lately? woman:"
},
{
  "instruction": "There's a lump on the groin and a swelling of the skin. What's the problem?",
  "input": "",
  "output": "It's possible it's a cat scratch disease, it's possible that after being scratched or bitten by a cat, the bacteria come into the body, where they can pour out lymph nodes and skin around a scratch or a bite."
},
{
  "instruction": "Doctor, it's snowy.",
  "input": "",
  "output": "Do you have a cat in your house? Patient: Yes, I do. But what does that have to do with my eyes?"
},
{
  "instruction": "Doctor, I have a feeling I've been losing my senses lately, but why?",
  "input": "",
  "output": "Have you recently had contact with cats or, as you said, have you had contact with your neighbor's cat a few days ago?"
},
{
  "instruction": "Sir, there are symptoms in your eyes, such as perforations of vision, severe eye pain, backlight, loss of vision around the lights, what's the cause?",
  "input": "",
  "output": "The symptoms suggest that you have chronic glaucoma, and chronic glaucoma is a condition in which the pressure of the eye damages the optic nerve, causing loss of vision."
},
{
  "instruction": "Doctor, you've recently had eye problems, white secretions in your eyes, pain in one eye.",
  "input": "",
  "output": "You're suffering from chronic glaucoma."
},
{
  "instruction": "Doctor, I've had a lot of pain in my eyes lately.",
  "input": "",
  "output": "You seem to have chronic glaucoma."
},
{
  "instruction": "Hi, doctor, there's been a lot of symptoms in the eye these days: changes in eye pain, white secretions, excessive tears, perceptibility.",
  "input": "",
  "output": "There are symptoms of a disease called chronic glaucoma, chronic glaucoma can cause optic nerve damage, and if not treated in time, it can lead to permanent vision loss."
},
{
  "instruction": "Doctor, low vision, lumps in eyelids, spots or clouds in your eyes, eye pain, white secretions in your eyes, what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms are likely to cause damage to the optic nerve, and if you don't treat it, it's likely to be chronic glaucoma, where you can lose your eyesight, and you have to do some tests to check your diagnosis and establish a treatment plan."
},
{
  "instruction": "Doctor, I'm experiencing a feeling of warmth or warmth, an abnormal movement of the eyelids with one eye, and what's the cause?",
  "input": "",
  "output": "The symptoms suggest that there is a retina, a serious disease that separates the retina from the back of the eye, which can cause blindness and other visual disorders such as the one you described."
},
{
  "instruction": "Sir, there are symptoms that seem to have two things recently, and can you tell us what caused them?",
  "input": "",
  "output": "There may be some retinal implants that you need to do some tests to see this, but it's important to be treated immediately if it's retinal."
},
{
  "instruction": "Sir, you can't see, you can't see, you can't see, you can't see, you can't see, you can't see, you can't see, you can't see, you can't see.",
  "input": "",
  "output": "The symptoms seem to be suffering from retinal retination, and it's a good idea to get a good eye and a good eye appointment to check your diagnosis."
},
{
  "instruction": "Doctor, I recently experienced bleeding in my eyes, tears, pain in my eyes and abdominal symptoms. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from retinal bumps."
},
{
  "instruction": "Sir, I don't see anything in my right eye, and I feel like a cloud.",
  "input": "",
  "output": "The symptoms seem to indicate that the retinal retina is a disease that separates from the surrounding tissue, and if it is not treated, it can lead to blindness."
},
{
  "instruction": "Hi, doctor, I've recently had a dry mouth and a facial blush, and why?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from absorption anemia."
},
{
  "instruction": "Doctor, I'm so tired these days, and I don't think I'm growing tall at all, and I have no strength in my legs, and I feel swollen.",
  "input": "",
  "output": "Responsive anemia is a rare disease that causes fatigue, lack of growth, weakness of legs, and low fluid flow in the bone marrow, where there's not enough new cells in the bone marrow."
},
{
  "instruction": "Doctor, I have a recent weakness in my leg.",
  "input": "",
  "output": "The weakness of the leg may be due to absorption anemia."
},
{
  "instruction": "Doctor, your mouth has been so dry over the last few weeks, and what's the cause?",
  "input": "",
  "output": "Renewal poor anemia is likely to result in a lack of red blood cells, white blood cells and platelets in the bone marrow."
},
{
  "instruction": "Doctor, there are times when you urinate frequently and sometimes you can't control it. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate you're experiencing a B.P.P."
},
{
  "instruction": "Doctor, I'm having bladder-related symptoms, and I have to go to the bathroom a lot all day, and it's very uncomfortable.",
  "input": "",
  "output": "The symptoms suggest that it's probably a peritoneal blockage."
},
{
  "instruction": "Doctor, I'm experiencing involuntary urination, poor concentration, excessive urination at night, and low urination.",
  "input": "",
  "output": "It occurs when the bladder is not completely emptied and the urine is constantly leaking, and it can cause excessive urination and deuterization at night, and we need to do some additional tests to figure out the underlying cause and determine how best to treat it."
},
{
  "instruction": "Doctor, I'm experiencing the symptoms of stiffness in the hands and fingers, the problems of the bladder, the complications of the blood in the urine, the rash failure, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate you're experiencing a B.P.P."
},
{
  "instruction": "Doctor, there's pain and wear in the breast, and I've been over-expressed lately, and do you know what's causing it?",
  "input": "",
  "output": "It's possible that you have rabies, that you can cause pain and pain in an infected part of your body as you go through it, and that you can cause excessive anger."
},
{
  "instruction": "Hi, doctor. There's been a lot of wrist and facial pain recently. Do you know what's causing it?",
  "input": "",
  "output": "The symptoms may have caused rabies. Have you been bitten recently by animals?"
},
{
  "instruction": "Doctor, I feel excessive anger and pain in my eyes. Can you tell me what's causing it?",
  "input": "",
  "output": "The symptoms are likely to have rabies. Have you had contact with animals recently?"
},
{
  "instruction": "Doctor, you get a lot of urine at night, and you get lumps in your knee, and you feel pain during pregnancy and wrist pains, and what's the cause of these symptoms?",
  "input": "",
  "output": "There's a chance that you have rabies based on your symptoms. Too much urination, knee mass, and wrist pain are common symptoms of rabies."
},
{
  "instruction": "Doctor, you've recently had a severe skin cancer. Can you tell me what's causing it?",
  "input": "",
  "output": "Skin itching can be a symptom of hemolytic anemia. Any other symptoms?"
},
{
  "instruction": "Doctor, a few weeks ago, I had cough, telophase, fever, weakness, joint pain. What's wrong with me?",
  "input": "",
  "output": "The symptoms suggest hemolytic anemia."
},
{
  "instruction": "Doctor, I've been experiencing skin cancer recently. What's the cause?",
  "input": "",
  "output": "It could be a symptom of hemolytic anemia. Have you had any other symptoms recently?"
},
{
  "instruction": "Doctor, you've been feeling nausea lately, and you've developed telophase. What's the cause?",
  "input": "",
  "output": "Symptoms suggest hemolytic anemia; hemolytic anemia is a condition in which the red blood cells are destroyed faster than the body can make new red blood cells, causing such symptoms as anemia, sulfur, pericardiosis, and so forth."
},
{
  "instruction": "Doctor, I'm not feeling any better these days, my legs are swelling, and I feel like I'm getting a fever, and I'm coughing, and I feel like I'm feeling a lot more pain.",
  "input": "",
  "output": "The symptoms suggest that you're suffering from hemolytic anemia, which is faster than your red blood cell generation, and we're going to do some tests to make sure that you're diagnosed, and we're going to start treating you right away."
},
{
  "instruction": "Doctor, there's a lot of pain in your wrist, and it hurts a lot every time you pick up something or move your arm, and what's the cause?",
  "input": "",
  "output": "It's possible that the symptoms have what's commonly known as tennis elfitis."
},
{
  "instruction": "Sir, your elbow is swollen, your shoulders and your hands are in pain.",
  "input": "",
  "output": "The symptoms seem to indicate that there is a condition known as external osmosis, or tennis evo, caused by excessive use of the wrist and fingers arm muscles, which cause elbow pain and swelling."
},
{
  "instruction": "Doctor, you feel pain in your hands and fingers with stiff, cold pain, and you feel a lump or a lump in your elbow, and what's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that there's an external hypertritis known as tennis eloquia, an inflammation of the elbow's tendons that causes pain and stiffness in the hand or finger."
},
{
  "instruction": "Doctor, elbow swelling, wrist pain, joint pain. What's the problem?",
  "input": "",
  "output": "I think you've got what's often called tennis eloquence, an inflammation of the arm muscles and the tendon that connects the elbow to the outside of the elbow."
},
{
  "instruction": "Doctor, there's an open-eye wound, there's eye pain, there's low vision, what's the problem?",
  "input": "",
  "output": "And from these symptoms, there seems to be an open-ended injury to the eye, which is also called the cornea temples."
},
{
  "instruction": "Doctor, your knees are weak and your eyes are swollen.",
  "input": "",
  "output": "His eyes are damaged, so he needs medical attention immediately."
},
{
  "instruction": "Doctor, your eyes are in pain, your eyes are in spots or clouds, your eyes are in trouble, your eyes are swollen.",
  "input": "",
  "output": "These symptoms seem to have caused eye injuries."
},
{
  "instruction": "Doctor, your knees are weakened, your vision is dimmed, your eyes are in pain.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from an open eye wound."
},
{
  "instruction": "Sir, there are symptoms of acute eye pain and foreign skin, as well as secretions and appendixes.",
  "input": "",
  "output": "The symptoms seem to indicate that there's an eye heat wound, which can be caused by a scratch on the surface of the eye, and can cause pain, inflammation, and secretions, which are important for immediate medical attention to prevent further damage to the eye."
},
{
  "instruction": "Doctor, your heart rate is accelerating with a recent skin rash, and why?",
  "input": "",
  "output": "These symptoms are common in syphilis patients, who recently had non-protective sex or shared needles, and it's important to get tested and treated as soon as possible."
},
{
  "instruction": "Doctor, you've got muscle passing headache, and you've got a lump in your arm, and you've got a lump in your chest, and your feet and toes are swollen, and what's the problem?",
  "input": "",
  "output": "Syphilis, of course, can cause lumps or sores in the body, as well as chestaches and swelling of feet and toes."
},
{
  "instruction": "Hi, doctor. There's muscle flow in the chest. What's the problem?",
  "input": "",
  "output": "It's possible that the symptoms are syphilis. Any other symptoms?"
},
{
  "instruction": "Doctor, what's the problem with recent chest problems?",
  "input": "",
  "output": "It could be syphilis, because of the discomfort of the chest. Any other symptoms, such as rashes or fevers?"
},
{
  "instruction": "Doctor, you've got a headache in your chest, swelling your feet and toes, and what's the cause?",
  "input": "",
  "output": "Syphilis is a venereal disease that can cause a wide range of symptoms, such as chest irritation and swelling of feet and toes, and it is important to be tested and treated as soon as possible to avoid further complications."
},
{
  "instruction": "You know what's going on?",
  "input": "",
  "output": "Yes, I think you have diabetes kidney disease, which can be common in patients with this disease, and you have to do some tests to check the diagnosis and discuss treatment options."
},
{
  "instruction": "Doctor, I'm experiencing erectile failure, shortness of breath and swelling of my legs, and what's the cause of these symptoms?",
  "input": "",
  "output": "These symptoms may be caused by diabetes, kidney disease, and you have to do some tests to check your diagnosis."
},
{
  "instruction": "Doctor, I've been angry a lot lately, my nails look irregular, and when I breathe, I get sick and my legs swell.",
  "input": "",
  "output": "These symptoms may be signs of diabetes, and it's important to manage the blood sugar level and monitor kidney function to prevent further damage."
},
{
  "instruction": "Doctor, Coffee, nose block, sinus pain and headaches continue. What are the symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate a sinus infection, which we call sinusitis."
},
{
  "instruction": "Sir, there's been a lot of coughing and nosebleeds. What's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that there's a lot of nose disorders like hypertonic acrobatics and copolips, and we need to do some tests to figure out the exact cause."
},
{
  "instruction": "He's got a fever, he's got a really bad nose. What's the problem?",
  "input": "",
  "output": "like sinusitis and sinusitis, and you can do some tests to check your diagnosis."
},
{
  "instruction": "Sir, the sinuses have been really painful and stuck. What's the cause?",
  "input": "",
  "output": "The symptoms suggest that there is a nose disease called sinusitis."
},
{
  "instruction": "Sir, I've had some pain and headaches in my ear lately, and I think it's got something to do with my nose.",
  "input": "",
  "output": "I think there's sinusitis or absorption that can cause ear pain and headaches, and I'm going to do some tests to make sure."
},
{
  "instruction": "I've been feeling really depressed, and having seizures, and I've always been nervous and nervous, and I've been vomiting a lot, and what's the cause of these symptoms?",
  "input": "",
  "output": "I think you're experiencing drug withdrawal."
},
{
  "instruction": "Doctor, I'm feeling so depressed and sick these days, and there's this strange involuntary movement, and what's wrong with me?",
  "input": "",
  "output": "Depression and pain can be withdrawal symptoms, and abnormal involuntary movements can be side effects."
},
{
  "instruction": "Doctor, I've been feeling very nervous and nervous lately, and I also feel physically and nausea, and what's the cause of these symptoms?",
  "input": "",
  "output": "I think he's suffering from drug withdrawal."
},
{
  "instruction": "Doctor, I've been experiencing anxiety and tension with antisocial behavior lately, and I feel sick all over my body, and I've been experiencing it a lot.",
  "input": "",
  "output": "Have you stopped taking drugs or substances that are currently dependent on your body?"
},
{
  "instruction": "Doctor, I'm very nervous and nervous, and I'm being antisocial, and I've been feeling chilly and recently having a seizure, and what's wrong with me?",
  "input": "",
  "output": "I think you're experiencing drug withdrawal symptoms."
},
{
  "instruction": "Sir, your throat is swollen, your toothache, your mouth pain, your abdominal edema, your gum pain, what's the problem?",
  "input": "",
  "output": "The symptoms are likely to lead to tooth decay, which causes pain, inflammation and even swelling, which requires dental examination for diagnosis and proper treatment."
},
{
  "instruction": "Sir, the gums are sore and sore. What's the problem?",
  "input": "",
  "output": "There seems to be a tooth decay, a common dental disease that can cause gum stimulation and pain."
},
{
  "instruction": "Doctor, I'm having symptoms of blushing, fluid dexterity, vomiting, poor growth, poor speech, and what's the cause of these symptoms?",
  "input": "",
  "output": "Renewal poor anemia can reduce the ability to fight infection, fatigue, weakness, and bleeding when the bone marrow doesn't produce enough red blood cells, white cells, platelets."
},
{
  "instruction": "Doctor, I've been losing my energy lately and my mouth is getting dry, and I've been losing my tongue, and I've been releasing lots of fluids, and what's the cause?",
  "input": "",
  "output": "Renewal poor anemia is a rare disease in the body when not enough red blood cells, white cells and platelets are created."
},
{
  "instruction": "Sir, she's got a fever, her mouth's always dry, and she just vomited blood, so what's the problem?",
  "input": "",
  "output": "Symptoms can lead to recyclical anemia, which is a disease in which the body cannot produce enough new blood cells to reduce its immunity and increase its risk of infection."
},
{
  "instruction": "Doctor, I'm experiencing hot flashes, vomiting, nausea. What's the problem?",
  "input": "",
  "output": "These symptoms can be shown to be recyclical anemia, which is a rare disease in the body that stops producing new blood cells."
},
{
  "instruction": "Doctor, I'm experiencing facial blush, weakness of legs, vomiting, hypodermics, helplessness. What's the problem?",
  "input": "",
  "output": "The symptoms may indicate that you've got a lot of recyclical anemia, which is a rare disease in which you can't produce enough blood cells in your body, and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Sir, I'm suffering from prostate problems and erectile failure, and I can't control my bladder, so I'm often bleeding urine.",
  "input": "",
  "output": "He's not completely emptying the bladder, and as a result, he's suffering from a abdominal pain, which means that urine leaks out of the bladder, which can cause swelling failure due to prostate problems or nerve damage, and he can start with some tests to determine the extent of the problem and the treatment options."
},
{
  "instruction": "Doctor, I'm experiencing the symptoms of involuntary urination, erectile failure, and sometimes dehydrate. What's the problem?",
  "input": "",
  "output": "It's a symptom that's likely to have a peritoneal pain in it."
},
{
  "instruction": "What's the problem?",
  "input": "",
  "output": "I think there's a peritoneal demand."
},
{
  "instruction": "Doctor, I'm having trouble urinating, and my bladder is always so full that I feel like I'm about to burst, and I can't see urine when the blood is mixed up in my urine.",
  "input": "",
  "output": "I think it's one of the best."
},
{
  "instruction": "Doctor, I'm experiencing excessive anger, eye pain, frequent urination at night, do you know what caused it?",
  "input": "",
  "output": "It's a viral disease affecting the nervous system that can cause aggressive behavior, eye pain, excessive urination."
},
{
  "instruction": "Doctor, your joints are stiff or salty, you feel fatigue, excessive anger, facial pain, what's the problem?",
  "input": "",
  "output": "Symptoms are likely to cause rabies, which can affect the brain and spinal cord with viral infections that are bitten by infected animals."
},
{
  "instruction": "Doctor, I'm having stiff joints, lumps in my knee, facial pain and extreme fatigue, and I think I'm getting a lot of anger over minor things, so can you tell me what's wrong?",
  "input": "",
  "output": "The symptoms you've described suggest that you're likely to suffer from rabies, which is rare, but it affects the nervous system by severe viral infections and can be transmitted by salivating infected animals such as dogs and bats."
},
{
  "instruction": "Hi, doctor, I'm so tired these days, and I don't think it's too much, but I think it's getting too much fatigue.",
  "input": "",
  "output": "Blood is one of the earliest symptoms of this viral disease affecting the central nervous system."
},
{
  "instruction": "Doctor, I've been feeling fatigue lately, and I'm always tired long after I've been asleep, so can you tell me why?",
  "input": "",
  "output": "Hemolytic anemia may be the cause of fatigue, and hemolytic anemia is a disease that causes fatigue and weakness because there's not enough red blood cells to carry oxygen throughout the body."
},
{
  "instruction": "Hi, doctor, there's been a recent symptoms of abdominal palpitation, fever, cough, and telophase. Do you know what caused this?",
  "input": "",
  "output": "The symptoms that God described indicate that you have hemolytic anemia."
},
{
  "instruction": "Doctor, I'm having a persistent cough and swelling of my legs, and I don't think there's ever been an allergic reaction, so what's the problem?",
  "input": "",
  "output": "Hemolytic anemia, which is likely to be destroyed faster than red blood cells are replaced, can cause such symptoms as coughing, telophase, allergic reactions."
},
{
  "instruction": "Doctor, can you tell me what it is?",
  "input": "",
  "output": "The symptoms suggest hemolytic anemia."
},
{
  "instruction": "Doctor, I've had a lot of nausea and fatigue lately.",
  "input": "",
  "output": "It's possible that the symptoms are hemolytic anemia, and we need to do some blood tests to identify the diagnosis."
},
{
  "instruction": "Hi doctor, elbow pain, hand or finger stiffness, wrist pain, sensory abnormality. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that because of excessive use of the elbow muscles and the sinews, you have what is commonly known as tennis elfitis."
},
{
  "instruction": "Doctor, I've recently had a lot of joint pain in my arms and wrists, and I'm really starting to care.",
  "input": "",
  "output": "The symptoms seem to indicate that you have an external sinusitis or tennis Elbo, which can also affect your wrists and arms with a painful condition on the outer or the outer part of your elbow."
},
{
  "instruction": "Sir, there's shoulder pain, irregular abdominal pain, and hand or finger pain.",
  "input": "",
  "output": "The symptoms suggest that there's an external hyperthermitis called tennis eloquira."
},
{
  "instruction": "Doctor, elbow swelling, wrist pain, elbow mass, lump, shoulder pain. What's the problem?",
  "input": "",
  "output": "I think you've got some of the extra-inflammatory use of the tendon that's attached to the upper pelvis, called tennis eloquia. Have you done any activity that you've recently used your elbow muscles repeatedly?"
},
{
  "instruction": "Doctor, what's the reason why your right elbow's off, and your right elbow's sharp, and the mass's touching?",
  "input": "",
  "output": "I think there's an external hypertilisitis called tennis eloquia, which is a common symptom of this disease, or a lump or a lump, which is caused by inflammation of the elbow's tendon and can be quite painful."
},
{
  "instruction": "Doctor, there are a few symptoms in my eye: there's a white secretion, there's a lot of itching, and I think it's swollen and it's bleeding.",
  "input": "",
  "output": "There's a possibility that your symptoms may cause eye damage, that you have to do some tests to confirm this diagnosis, but it's important to get a doctor's care immediately to prevent further damage to the eye."
},
{
  "instruction": "Doctor, you've got a cut in your eyes, and you've got a problem.",
  "input": "",
  "output": "The symptoms seem to indicate that you have a disease called pericarditis."
},
{
  "instruction": "Sir, I can't see anything because my eyes are so sick. What's wrong with my eyes?",
  "input": "",
  "output": "The symptoms suggest that the eye injury is open."
},
{
  "instruction": "Doctor, I have some symptoms that bother me, and I'm swollen because of eye problems, and I feel that my knees are weakened.",
  "input": "",
  "output": "We need to go as quickly as possible to the ophthalmologist to examine the eye and determine the best way to treat the injury."
},
{
  "instruction": "Doctor, you've got eyes and pain.",
  "input": "",
  "output": "The symptoms suggest that the eye injury has occurred."
},
{
  "instruction": "Doctor, your heart rate is rapid, your chest is perturbed, your feet are swollen, your toes are swollen, your arms are touched, your muscles are weakened, what are the causes of all these symptoms?",
  "input": "",
  "output": "There's a possibility that it's syphilis, which is a symptom, and we need some additional tests to confirm the diagnosis."
},
{
  "instruction": "Doctor, I've been experiencing a couple of symptoms recently: skin is getting darker and heart rate is getting higher than usual, and I'm worried about some of the complications of pregnancy.",
  "input": "",
  "output": "As a result of the symptoms that God explains, syphilis is likely to be contracted, and this venereal disease can cause skin cancer, increased heart rate, and complications during pregnancy. It's important to be tested and treated as soon as possible to prevent additional health problems."
},
{
  "instruction": "Doctor, I recently developed muscle pain. What's the cause?",
  "input": "",
  "output": "Have you experienced any other symptoms?"
},
{
  "instruction": "Doctor, do you know why?",
  "input": "",
  "output": "There's a possibility that you might have had syphilis from the symptoms."
},
{
  "instruction": "Doctor, I've been having strange symptoms recently, my heart rate has increased, my feet and toes are swelling and headaches are continuing, and I'm pregnant and I've had some problems.",
  "input": "",
  "output": "It's important that you immediately get tested for your own safety and that you check for diagnosis and start treatment."
},
{
  "instruction": "Doctor, I've recently experienced erectile failure and vertigo, and what's the cause?",
  "input": "",
  "output": "These symptoms may be signs of diabetes's complications, diabetes's kidney disease, and you have to run some tests to check this diagnosis, and it's important to start treatment immediately to prevent further damage to the kidney."
},
{
  "instruction": "Doctor, it's hard to breathe and it hurts. What's going on?",
  "input": "",
  "output": "Have you experienced other symptoms, such as swelling of the body or increasing fatigue?"
},
{
  "instruction": "Doctor, I'm still thirsty and I'm bleeding from the stool. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from a diabetic kidney disease."
},
{
  "instruction": "Doctor, I've been having strange symptoms lately, and I've been overextended with anger, and I've got blood in my throat, and I'm not growing well, and my legs are swollen, and I'm having trouble breathing.",
  "input": "",
  "output": "Diabetes is a complication of diabetes affecting the kidney that can cause high blood pressure, swelling of the legs and respiratory problems."
},
{
  "instruction": "Doctor, in the last few days, there's been a lot of pain in the sinus, and what's the cause of this discomfort?",
  "input": "",
  "output": "The most likely cause of sinus pain is sinusitis, a common nose disease."
},
{
  "instruction": "Doctor, I've had ear pain in the last few days.",
  "input": "",
  "output": "It could be caused by a nose disease."
},
{
  "instruction": "Good morning, doctor, nosebleed, cough, headache, nose pressure. What's wrong with that?",
  "input": "",
  "output": "The symptoms suggest that there may be nose disease, especially non-saltitis."
},
{
  "instruction": "Sir, I have trouble breathing through my nose.",
  "input": "",
  "output": "I think there's some kind of nose disease. Can we take a closer look?"
},
{
  "instruction": "Doctor, you've got a fever, you've got a nosebleed, you're having trouble breathing, and you're experiencing nose and sinus, and what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you have a nose disease called sinusitis."
},
{
  "instruction": "Doctor, you've got a lot of pain in your body lately -- antisocial behavior, vomiting, pain in your body, seizures, sharp abdominal pain -- and what's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from drug withdrawal. Have you stopped taking drugs recently?"
},
{
  "instruction": "Doctor, I've been experiencing sharp abdominal nausea for the past few days, so what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're experiencing drug withdrawal. Have you stopped taking drugs recently?"
},
{
  "instruction": "Doctor, what's the problem with the rapid abdominal pain, vomiting, and chills?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from drug withdrawal."
},
{
  "instruction": "Doctor, I've been feeling nauseous lately, and I don't know why.",
  "input": "",
  "output": "Have you ever stopped taking drugs that you're currently taking, or have you stopped taking them recently? Patient:"
},
{
  "instruction": "Hi doctor, I've been experiencing vomiting for a while, pain in my body, sharp abdominal pain and nausea.",
  "input": "",
  "output": "Have you stopped taking drugs or drugs recently?"
},
{
  "instruction": "Doctor, there's been a recent swelling and anxiety in the skin and an earache, and I don't know what's causing it.",
  "input": "",
  "output": "These symptoms are not directly related to the skin or the ears, but may have to do with the tooth decay. Have you ever experienced tooth pain or sensitivity?"
},
{
  "instruction": "Doctor, I've been experiencing a number of symptoms recently, with a swelling of the jaw and neck and a swelling of the skin, and I'm nervous and I can't sleep properly.",
  "input": "",
  "output": "The symptoms seem to indicate that you have cavities, that tooth infections spread to the jaw and neck, causing inflammation and swelling, and that it's important to treat them as soon as possible to avoid further complications."
},
{
  "instruction": "Doctor, there's a swelling in the jaw. Why?",
  "input": "",
  "output": "The decay is a bacterial infection in which the acid produced by the bacteria in the tooth melts the minerals of the teeth and causes the decay."
},
{
  "instruction": "Sir, there's pain in your mouth. What is it?",
  "input": "",
  "output": "The symptoms seem to have cavities."
},
{
  "instruction": "Doctor, you've got a lot of pain in your face and in your ear, and I need you to tell me what's wrong.",
  "input": "",
  "output": "You're suffering from tooth decay, which is also called tooth decay."
},
{
  "instruction": "Doctor, your chest is pounding at night, and your urine is often wet. What's the problem?",
  "input": "",
  "output": "The symptoms are that it's likely to be high cholesterol in your blood, and you have to do some tests to check this diagnosis."
},
{
  "instruction": "Doctor, I'm experiencing recent weight gain. Can you tell me what caused it?",
  "input": "",
  "output": "Weight gain can be a symptom of multiple diseases, but in patients it's likely to be high cholesterol. Patient: high cholesterol? What's that, sir?"
},
{
  "instruction": "Hi, doctor, I've been experiencing a couple of reasons lately.",
  "input": "",
  "output": "It could be a symptom of high cholesterol. Have you checked your cholesterol levels recently?"
},
{
  "instruction": "Doctor, your legs are slightly swollen and you're looking at the black side. What's the cause?",
  "input": "",
  "output": "It's possible that the fracture could cause inflammation and swelling in the leg, possibly as a result of internal bleeding caused by the fracture."
},
{
  "instruction": "Doctor, your knees are getting weak, your bones are getting sick, your knees are swelling, and why?",
  "input": "",
  "output": "The symptoms suggest that you have a scrotum fracture."
},
{
  "instruction": "Doctor, your knees are so weak that it's hard to walk. What's the cause?",
  "input": "",
  "output": "I think it's possible it's a scrotum fracture."
},
{
  "instruction": "There's ankle pain and leg swelling, and there's a little melena and leg pain.",
  "input": "",
  "output": "There's a scrotum fracture."
},
{
  "instruction": "Doctor, you've got back cramps, tics, hip pain.",
  "input": "",
  "output": "The symptoms suggest that there's a scrotum fracture."
},
{
  "instruction": "Doctor, you're feeling nausea, your abdomen's swelling. What's the cause?",
  "input": "",
  "output": "In view of the symptoms, it's possible that it's a kidney failure, and you have to run some tests to be sure, but it's important to start treating it as soon as possible."
},
{
  "instruction": "Doctor, sharp chest pain, vomiting, weakness, weakness, shortness of breath.",
  "input": "",
  "output": "The symptoms are likely to be kidney failure, and it's good to get some lab tests and video scans to check your diagnosis."
},
{
  "instruction": "Doctor, we're experiencing recent vomiting, sharp chest pains, abdominal edema, weakness and weakness. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that it's a kidney failure."
},
{
  "instruction": "Doctor, you've got vomiting, your leg's swollen with fluid. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there are kidney failure, which requires additional tests to confirm this diagnosis."
},
{
  "instruction": "Doctor, you've recently had lymph nodes and swelling of the arm. What's the possible cause?",
  "input": "",
  "output": "The symptoms suggest that he's an ex-con."
},
{
  "instruction": "Doctor, hip pain, low self-worth, elbow pain, reflux. What's the cause of all this?",
  "input": "",
  "output": "Based on what God has said, it is possible that a fracture in the femur is likely to cause pain in the hip and elbow. Low self-worth may be due to injuries affecting movement and activity, and reflux may be a side effect of analgesics taking. It is highly recommended to take X-ray scans to see if there is a fracture."
},
{
  "instruction": "Sir, hip pain, back pain, back pain, reflux, side pain, do you know what's causing it?",
  "input": "",
  "output": "Yeah, I think you've got a fractured neck, and these symptoms are common in this type of injury."
},
{
  "instruction": "Doctor, there's been a lot of pain in your recent hip, elbow, and groin, as well as a lot of lack of energy and a lot of desire, and what's the problem?",
  "input": "",
  "output": "There's pain in the hip, elbow and groin. Low self-worth can also be the result of current pain and discomfort. We need to do some tests to identify the diagnosis and determine how best to treat it."
},
{
  "instruction": "Doctor, we're suffering from groin pain and bladder problems, and we've also had reflux and backaches.",
  "input": "",
  "output": "You seem to have a broken neck, and this may cause some pain and discomfort in what you're talking about."
},
{
  "instruction": "Doctor, I'm experiencing unusual involuntary movements and arm pains, and what's the cause?",
  "input": "",
  "output": "You're experiencing muscle spasms."
},
{
  "instruction": "Doctor, I've recently had leg pain.",
  "input": "",
  "output": "The leg pain may be caused by muscle spasms."
},
{
  "instruction": "Sir, back pain, leg pain, loss of sense, back pain, even headache.",
  "input": "",
  "output": "The symptoms seem to indicate that there are muscle spasms that cause back pain and leg discomfort, which can affect the nerves, and can cause sensory pain and headaches."
},
{
  "instruction": "Can you tell me what's wrong?",
  "input": "",
  "output": "I think you're experiencing muscle spasms."
},
{
  "instruction": "Doctor, I'm experiencing sharp chest pain, with abnormally involuntary movements, with backaches, neck pains, shoulder pains, and why?",
  "input": "",
  "output": "The symptoms seem to indicate that you're experiencing muscle spasms."
},
{
  "instruction": "Doctor, it looks like my arm and my hand are infected. Can you tell me what caused it?",
  "input": "",
  "output": "The symptoms suggest that you're having a bleeding disorder known as hemophilia. Have you had injury or surgery recently?"
},
{
  "instruction": "Doctor, I've been having a headache for the last few weeks. Can you tell me why?",
  "input": "",
  "output": "In terms of the history, it's possible that you have a headache from hemophilia, and you can do some tests to check your diagnosis."
},
{
  "instruction": "Doctor, I've recently experienced a strange condition: I don't have a period, I cough, I have severe leg pain, what is it?",
  "input": "",
  "output": "Hemophilia is a genetic hemorrhagic disorder that affects the body's blood clotting capacity, which can cause excessive bleeding, bruises, joint pain, and swelling."
},
{
  "instruction": "Doctor, gum hemorrhage, melena, the skin of my arm, or my hand, is infected, and I'm experiencing leg pain and uterine contractions, so what's wrong with me?",
  "input": "",
  "output": "Hemophilia is a rare genetic disease in which blood doesn't clot properly."
},
{
  "instruction": "Doctor, I'm experiencing contractions of the uterus, so what's the cause?",
  "input": "",
  "output": "There could be hemophilia, a hemorrhagic disorder, where the blood doesn't clot properly, which can cause natural bleeding and lead to uterine contractions during pregnancy."
},
{
  "instruction": "I'm having a lot of symptoms these days: neck pain, Vinbis, burning chest pain, coughing, sharp abdominal pain.",
  "input": "",
  "output": "And I think you're going through a high-pressure high-keton situation because of these symptoms."
},
{
  "instruction": "There's doctors, thirsty, faint, frequent urine, burning chest pain. What's the cause?",
  "input": "",
  "output": "The symptoms could be hypertonic high sodium hemolysis."
},
{
  "instruction": "What's the problem with having a doctor, a faint, burning chest pain, cough, dry mouth, low vision?",
  "input": "",
  "output": "You can experience a hypertonic hyperplastic hyperketon condition that can occur in an uncontrolled Type 2 diabetic, which is a serious condition that requires immediate treatment."
},
{
  "instruction": "Doctor, no matter how much water I drink, I keep thirsty.",
  "input": "",
  "output": "It could be hypertonic hyperbaric high potassium, as a symptom."
},
{
  "instruction": "Doctor, there's been a lot of burning chest pain, loss, weakness, mouth ulcers, can you tell me what's going on?",
  "input": "",
  "output": "The symptoms seem to indicate that you're experiencing a high-pressure high-ketton state, which is a serious condition in your body that produces a lot of ketons and accumulates acidic blood, which can cause these symptoms."
},
{
  "instruction": "I'm experiencing a doctor, an earache, a headache, a lymph node. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to be the abscess around the amygdala."
},
{
  "instruction": "Doctor, I'm red and difficult to swallow, and I'm so overwhelmed. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that there's an abscess around the amygdala, and you have to examine the neck for a diagnosis."
},
{
  "instruction": "Doctor, there's chills and swelling of lymph nodes, and it's really hard to swallow with a swelling of the neck, and it's like the neck is tightening, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms suggest that there is an abscess around the amygdala."
},
{
  "instruction": "Hi doctor, I've got a sore throat and a tight neck, and my throat is swelling red.",
  "input": "",
  "output": "The symptoms suggest that there's an abscess around the amygdala."
},
{
  "instruction": "Doctor, there's a lot of lymph nodes in your throat, so why?",
  "input": "",
  "output": "The reason the lymph nodes are swollen is because of the abscess around the abscess."
},
{
  "instruction": "Sir, we're having a recent transition, loss of sense, diarrhea and fatigue. What's the problem?",
  "input": "",
  "output": "Yes, you may be suffering from cerebral palsy, where your stomach muscles aren't functioning properly, and you may not be able to digest your food properly."
},
{
  "instruction": "Sir, I'm experiencing abdominal pain, reflux and intestinal edema. Can you tell us what caused these symptoms?",
  "input": "",
  "output": "I think you're experiencing stomach paralysis, which affects the muscles of the stomach, and it's not emptying the stomach properly."
},
{
  "instruction": "Doctor, I recently experienced acute chest pain and diarrhea. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from stomach paralysis, which can take too long to empty the contents of the stomach into the sore throat, which can cause abdominal pain, nausea, diarrhea, and it's good to run some tests to identify the diagnosis."
},
{
  "instruction": "Doctor, I'm experiencing a sharp abdominal pain, a sharp abdominal pain, with the sensory upper hand. What's the problem?",
  "input": "",
  "output": "The stomach muscle can't function, so there's a delay in stomach excretion, and there's a stomach case of nausea, vomiting and abdominal pain."
},
{
  "instruction": "I'm experiencing doctor, toilet, stomach pain, nausea, abdominal sensory loss, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate that the muscles of the stomach are not working properly, and that the release of food from the stomach to the small intestine is a delay in stomach paralysis."
},
{
  "instruction": "Hi, doctor, there's skin rashes, loss of sense, allergic reactions, skin itching, fluid reduction, do you know what's causing it?",
  "input": "",
  "output": "I think you're experiencing what is known as atopy dermatitis."
},
{
  "instruction": "Doctor, I'm experiencing vaginal hair, and I've had some problems during pregnancy, and I recently discovered something that looks like an abnormal skin, and why?",
  "input": "",
  "output": "The symptoms that God mentioned, particularly vaginal, indicate the possibility of yeast infection, but given the fact that there was a problem during pregnancy, and the appearance of abnormal skin, there is also the possibility that there might be a condition called cosmosis, which is good to have a thorough examination to confirm the diagnosis."
},
{
  "instruction": "Sir, I've recently developed an aura in the skin for no apparent reason, and I've also sneezed a lot.",
  "input": "",
  "output": "Sneaking may be related to allergies caused by these same causes."
},
{
  "instruction": "Doctor, I'm experiencing skin drying, texture, scales, roughness, a lot of sneezes, a lot of skin, a lot of skin.",
  "input": "",
  "output": "The eczema can cause dry, scythed skin, it can cause bad skin, it can cause sneezes, it can cause sensory disturbances, it can be diagnosed with a few tests, and then the treatment can be started."
},
{
  "instruction": "Doctor, I'm experiencing a scalp itch with a recent allergic reaction, and I can feel it, and I can feel it, and I can see it on my skin, and you know what's causing it?",
  "input": "",
  "output": "It's good to use drug shampoos and local creams to relieve the symptoms of itching and also to avoid contact with substances that either use new hair products or cause allergic reactions."
},
{
  "instruction": "Doctor, I'm feeling fatigued with stiff, moist sensations in my joints, and I'm feeling strange lumps and lumps in my knees, and what's the problem?",
  "input": "",
  "output": "It's a symptom that there's a possibility of fatty embolism, which occurs when a small lump of fat circulates through the bloodstream, restricts the blood flow and reduces the oxygen supply to the tissue."
},
{
  "instruction": "I'm experiencing doctor, wrist pain, pregnancy pain, fatigue, eye pain, joint stiffness or warmth.",
  "input": "",
  "output": "The symptoms are likely to lead to fatty embolism, which occurs when a drop of fat enters the bloodstream and puts it into a small blood vessel throughout the body, causing pain and discomfort."
},
{
  "instruction": "Doctor, I've recently experienced shoulder spasms and spasms, and I'm often tired and my eyes are in pain, and what's the problem?",
  "input": "",
  "output": "Do you have any recent injuries or surgeries?"
},
{
  "instruction": "Doctor, you've recently had a severe skinache and headaches. Do you know what caused these symptoms?",
  "input": "",
  "output": "The symptoms could indicate a condition called red blood cell growth."
},
{
  "instruction": "Doctor, can you tell me what's wrong with your recent joint pain and headache?",
  "input": "",
  "output": "The symptoms you've described indicate that it's likely to be red blood cell desalination."
},
{
  "instruction": "Doctor, I have skin lesions in my body and joint pain and swelling, and what is the cause of these symptoms?",
  "input": "",
  "output": "Depending on the symptoms, there may be sepsis, which can cause a lot of red blood cells in the bone marrow, causing a variety of symptoms, such as skin lesions, joint pains, and swelling."
},
{
  "instruction": "Doctor, I've recently experienced symptoms of weight gain, skin itching, eyelids, joint pain, and what are the causes of these symptoms?",
  "input": "",
  "output": "You're probably suffering from a rare blood disease, a rare blood disease that produces too much red blood cells in your body, which is very common in patients with this disease."
},
{
  "instruction": "Doctor, there's blood mixed in the stools, the navel is irregular, nosebleed, tired, scalp looks irregular, what's the problem?",
  "input": "",
  "output": "The symptoms suggest that her platelet count is low, and there's a decrease in her platelets that can cause abnormal bleeding."
},
{
  "instruction": "I'm experiencing a doctor, a nosebleed, an irregular look of scalp, mouth pain, lymphoma.",
  "input": "",
  "output": "These symptoms can be caused by a disease called platelets reduction, which has less blood platelets than normal, which can lead to bleeding disorders, including corpuscle and oral pain."
},
{
  "instruction": "Doctor, fatigue, mouth pain, irregular abdominal pain, blood in the stool, lymph nodes.",
  "input": "",
  "output": "The symptoms suggest that you have low bloodletting."
},
{
  "instruction": "Doctor, lymphoma, blood in your urine, blood in your gums, and your scalp looks irregular.",
  "input": "",
  "output": "The symptoms you've described indicate that there's a good chance that you're going to have a platelet reduction."
},
{
  "instruction": "Doctor, I've recently experienced a strange condition where my tongue has lesions, my eyelids are swollen, my urine is filled with blood, my navel is touched irregularly, you know what's wrong?",
  "input": "",
  "output": "Yes, according to the symptoms, hemothorax loss appears to be a disease that can cause bleeding, bruises, spots, and so forth, in the body of the tongue, in the eyelids, in the belly."
},
{
  "instruction": "Doctor, I'm experiencing tongue pain and oral pain, and I've also had lesions in my tongue, and recently, my voice has been turned into a hoarse voice, and what is the cause of these symptoms?",
  "input": "",
  "output": "The symptoms are likely to lead to head cancer, early diagnosis is so important in managing this disease that it's good to book a tissue test as soon as possible to confirm it."
},
{
  "instruction": "Doctor, there's pain in the tongue, there's lumps in the neck, there's pain in the face, there's blood, there's a loud voice, and what's the cause of all this?",
  "input": "",
  "output": "In terms of symptoms, there's a possibility of head cancer, and you have to do some tests to check your diagnosis and plan your treatment, and it's important to start the treatment as soon as possible and get the best results."
},
{
  "instruction": "Doctor, you've got a lump around your neck, you've got a block of ears, you've got lesions in your tongue, what's the problem?",
  "input": "",
  "output": "We need to run some tests to confirm the diagnosis, but it's important to start treating it as soon as possible."
},
{
  "instruction": "Doctor, your neck is soy and your tongue's sore. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to be head cancer, and we need to do some tests to identify the diagnosis."
},
{
  "instruction": "Doctor, I have joint pain, especially back pain, and I have skin lesions and weakness in my elbow, so can you tell me what's going on?",
  "input": "",
  "output": "The symptoms suggest that you're suffering from hyperthyroidism."
},
{
  "instruction": "Hi doctor, I've recently had knee pain. Do you want to know what caused it?",
  "input": "",
  "output": "It's characterized by reduced sensitivity to parathyroid hormones that can affect bones and cause pain."
},
{
  "instruction": "Doctor, I've been having strange symptoms recently, I have skin lesions, I have back and ankle pains, and what's the cause?",
  "input": "",
  "output": "There may be a rare genetic disorder that affects the body's ability to respond to the parathyroid hormone in response to symptoms, which can lower calcium levels and cause bone and skin problems and muscle pain."
},
{
  "instruction": "Doctor, I've had a lot of pain in my ankle and ass these days. Do you know what's causing it?",
  "input": "",
  "output": "The symptoms are likely to indicate that it's a parathyroid dystrophy."
},
{
  "instruction": "Doctor, skin lesions, wrist swelling, hip pain. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that you may be suffering from hyperthyroidism."
},
{
  "instruction": "Doctor, you've got a lump in your neck. Why?",
  "input": "",
  "output": "Depending on the symptoms, you can have thyroid paper."
},
{
  "instruction": "Doctor, I've recently experienced symptoms like weight gain and facial blushing, and why?",
  "input": "",
  "output": "These symptoms are generally associated with the thyroid species, which causes the thyroid gland to grow in the neck."
},
{
  "instruction": "Sir, I've got a bone pain lately. Can you tell me what's wrong?",
  "input": "",
  "output": "It's like there's a thyroid gland in your neck that's growing too much, and it's causing pain because the swelling hits the bone."
},
{
  "instruction": "Doctor, I've recently been hard to swallow, no strength in my arms, and I've gained a lot of weight.",
  "input": "",
  "output": "The symptoms seem to indicate that the thyroid is overweight and that it's a thyroid disease, which exerts pressure on the airway and the esophagus."
},
{
  "instruction": "Doctor, it's hard to swallow, it's swollen, it's a facial blush, it's a lump around your neck, it's painful, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there is a lot of pain caused by thyroidoma."
},
{
  "instruction": "We've got doctors, bladder problems, urine reflux, upper jaw pain, blood mixed with urine, unconscious urination, and what's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from an acute pain in the urine, which is a common symptom of urination before you get to the bathroom."
},
{
  "instruction": "There are symptoms of frequent urination with doctors, prostate, squeezy, backaches, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there is a desperate delay."
},
{
  "instruction": "Doctor, we've recently been experiencing the symptoms of involuntary urination and bladder problems, and we've also been suffering from senility.",
  "input": "",
  "output": "In the case of the symptoms that God mentioned, there's a possibility that it's a desperate shock."
},
{
  "instruction": "Sir, it's been a long time since we've had toilets, but recently, there's been a desperate withdrawal symptoms. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there is a desperate cure for urination, which is a condition that you can't tolerate if you're overexerting your bladder, and because of the pressure on your bladder, you have to do some tests to make sure you're diagnosed and encourage proper treatment."
},
{
  "instruction": "Doctor, your urine is often dry and you feel pain in your urination. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there's an urgent demand for urine, which is an involuntary urination disorder that suddenly feels a strong need to urinate."
},
{
  "instruction": "Doctor, I have a little swelling on my shoulders and a stiff, warm joint. What's the problem?",
  "input": "",
  "output": "Symptoms may indicate that you're suffering from a rare genetic disorder called Edward's syndrome, which affects the development of multiple organs and body organs, and I recommend additional tests and evaluations to confirm the diagnosis."
},
{
  "instruction": "Doctor, there's a pain that doesn't go away near the eczema.",
  "input": "",
  "output": "Don't you have any other symptoms? Patient: No, this is the only symptom."
},
{
  "instruction": "Doctor, eczema pain, nail bite, wrist weakness and fever.",
  "input": "",
  "output": "It could be a genetic disorder called Edward's syndrome, which causes severe over-development, such as getting a webbed finger or a weak muscle or a heart defect, which requires immediate treatment."
},
{
  "instruction": "Hi, doctor, I felt a chest pain, a nail bite, fever, weakness of the wrist and eye intersecting.",
  "input": "",
  "output": "You may have a genetic disorder called Edward's syndrome, which characterizes severe developmental abnormalities, such as small jaw, fist grips, fingertips, shaking feet."
},
{
  "instruction": "Doctor, I'm experiencing overgrowth, toothache, nail bite, shoulder swelling, what's the problem?",
  "input": "",
  "output": "Symptoms indicate that you may have a genetic disorder called Edward's syndrome, which is caused by an extra copy of chromosome 18."
},
{
  "instruction": "Can you tell me what's wrong?",
  "input": "",
  "output": "The symptoms suggest that there's a nerve injury to the arm, and there's a possibility that one of the arm's sinews or one of the muscles may have been damaged, and you have to examine the wound to see the extent of the injury."
},
{
  "instruction": "Hi, doctor, you've got a injury to your arm, and you've got a lot of elbow pain. What's the problem?",
  "input": "",
  "output": "The symptoms can cause inflammation or irritation of the elbow's tendons."
},
{
  "instruction": "There's a wound in the arm, a lump or a lump on the elbow, a swelling of the elbow, a weakness in the hand or finger, and what's the problem, Doctor?",
  "input": "",
  "output": "It seems to have damaged the cyclic nerve, causing a cytoplasmic nerve paralysis, which weakens or numbs the muscles associated with the cyclical nerve, and reduces the sensation of the arm and hand."
},
{
  "instruction": "Doctor, there's been a lot of pain in your arm, and recently your knee has been weakened, your elbow pains, what could be the problem?",
  "input": "",
  "output": "The open wounds of the symptoms and the arm are likely to lead to infections like bile and sepsis, and to prevent further complications, it's important to solve this problem as soon as possible."
},
{
  "instruction": "Doctor, I have a wound in my arm, and I feel weak in my hands and fingers.",
  "input": "",
  "output": "It could be that your hand and fingers are weakened by the nerves in your arm."
},
{
  "instruction": "Doctor, I've been coughing and feeling fatigue lately, and why?",
  "input": "",
  "output": "It's very likely to be muscular dystrophy, and we need to do some tests to identify the diagnosis."
},
{
  "instruction": "Doctor, I've been coughing a lot lately, and I've been tired all the time, and I've got a lot of hip pain.",
  "input": "",
  "output": "The symptoms are likely to be muscular dystrophy, which requires additional tests to confirm the diagnosis, but the symptoms match this disease."
},
{
  "instruction": "Doctor, you've got hip pain, abdominal pain, and you've got abdominal pain, and you're feeling too cold.",
  "input": "",
  "output": "The symptoms are likely to indicate that you have muscle weakness and muscle dystrophy, which is a genetic disease that causes muscle loss, and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Sir, I'm experiencing peregrine, fatigue, shortness of nose, cough, weakness, do you know what's causing these symptoms?",
  "input": "",
  "output": "Well, I think there's a possibility of muscular dystrophy, unfortunately there's no way to cure this disease, but we can work together to manage it and improve the quality of life."
},
{
  "instruction": "Doctor, can you help me while I've been experiencing a persistent double-pass loss?",
  "input": "",
  "output": "The symptoms seem to indicate that you have muscular dystrophy, and you have to do some tests to check your diagnosis."
},
{
  "instruction": "Doctor, I'm experiencing involuntary urination, menstrual pain, sharp abdominal pain. What do you think is wrong with me?",
  "input": "",
  "output": "Mittel Schmetz is a ovulation disease that can cause intestinal pain in the ovulation, so it's good to track down the menstrual cycle and take pain meds if necessary."
},
{
  "instruction": "Doctor, you have a fever and a sharp abdominal pain. What is it?",
  "input": "",
  "output": "Where's the pain? Patient:"
},
{
  "instruction": "Doctor, I've recently had abdominal pain. Can you tell me what's wrong?",
  "input": "",
  "output": "From the symptoms that God explains, I think you're experiencing at Mittel Schmertz, which is a kind of ovulation that some women experience in ovulation."
},
{
  "instruction": "Doctor, you're having severe menstrual pain, long period of menstruation, sharp abdominal pain. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there's a metel Schmertz, a condition that causes ovulation and pain in the abdomen, and it can also prolong menstrual periods."
},
{
  "instruction": "Doctor, you've recently had pain in your side, acne, vomiting, what's the problem?",
  "input": "",
  "output": "Your symptoms are consistent with a disease called mitel Schmertz, which occurs in ovulation, which can lead to acne, acne, nausea, vomiting."
},
{
  "instruction": "Hi, doctor, I've been having eye pain for the last few days.",
  "input": "",
  "output": "The symptoms may indicate an cornea wound, a scratch on the transparent protective layer in the front of your eye. Have you noticed anything recently in your eye?"
},
{
  "instruction": "Doctor, what's the problem?",
  "input": "",
  "output": "You could have a cornea wound, a scratch on the surface of the eye."
},
{
  "instruction": "Hello, doctor, your eyelids are swollen and your eyes are torn, and your eyes are dirty and hot.",
  "input": "",
  "output": "The symptoms suggest that there's a peritoneal wound."
},
{
  "instruction": "Sir, tears, low vision, low eye capacity, white secretions from the eyes, swelling of the eyes, what's the problem?",
  "input": "",
  "output": "It's good to come to the hospital and get a proper diagnosis and treatment."
},
{
  "instruction": "Doctor, there's a lot of pain in your eyes.",
  "input": "",
  "output": "It could be the cornea."
},
{
  "instruction": "Hi, sir. I've been so tired lately, and I think I'm bleeding out. Can you tell me what's going on?",
  "input": "",
  "output": "The symptoms suggest that you have chronic anemia."
},
{
  "instruction": "Doctor, I've been sick for the last few weeks, and I've got backaches and emotional symptoms, and you know the cause?",
  "input": "",
  "output": "Symptoms can lead to anemia caused by chronic illness."
},
{
  "instruction": "Doctor, I'm not strong these days, and I'm often vomiting.",
  "input": "",
  "output": "The symptoms you described may be caused by anemia of chronic illness."
},
{
  "instruction": "Doctor, I'm extremely tired these days, and I'm experiencing emotional symptoms and dizziness, and I'm gaining weight, and my nose and my nose are continuing.",
  "input": "",
  "output": "The symptoms seem to indicate chronic anemia."
},
{
  "instruction": "Sir, recent vomiting, chills, and emotional ups and downs are getting worse.",
  "input": "",
  "output": "The symptoms suggest that you have chronic anemia."
},
{
  "instruction": "Sir, I'm feeling a lot of downs these days, and I'm experiencing anxiety and anxiety, along with my memory problems and my pent-up symptoms.",
  "input": "",
  "output": "The symptoms seem to indicate that you have mood failure."
},
{
  "instruction": "I'm so depressed these days that I'm no longer interested in sex, and I feel anxious and nervous, and sometimes I experience depression or psychosis, and what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you have mood failure, which can cause the decline of sexual appetite as a form of depression, as well as anxiety, anxiety, and even mental illness, and you can work together to develop a treatment plan that helps you feel better."
},
{
  "instruction": "Doctor, I've been having strange symptoms recently: I've been spoken down, I've been antisocial, I've always been anxious, I've always had anxiety, I've got fear and phobias, and I've completely lost my sexual appetite.",
  "input": "",
  "output": "There's a possibility that you may suffer from mood failure, which is a form of chronic depression, which can cause a range of physical and emotional symptoms, such as poor speech, anxiety, phobia, or loss of interest in sex."
},
{
  "instruction": "Sir, I've been very nervous lately, and I've developed fear and phobia, and I'm acting in a antisocial way towards other people.",
  "input": "",
  "output": "Based on what you're talking about, it's possible that you're suffering from mood failure, a form of mood disorder characterized by chronic and persistent depression, which is one of the common symptoms of fear and phobias associated with this disorder."
},
{
  "instruction": "Sir, I've been feeling a lot of anxiety and anxiety lately.",
  "input": "",
  "output": "Your symptoms suggest that you're having mood failure."
},
{
  "instruction": "Doctor, I've got skin rashes, coughing, difficulty swallowing, groin pain, what's wrong with me?",
  "input": "",
  "output": "The symptoms suggest that you have scarlet fever."
},
{
  "instruction": "Doctor, what's the problem?",
  "input": "",
  "output": "The symptoms suggest that scarlet fever is suspect."
},
{
  "instruction": "Doctor, your throat hurts really bad and your mouth hurts a lot.",
  "input": "",
  "output": "The symptoms are likely to be scarlet fever, which is caused by streptococcus, which is characterized by sore throats, fever and rashes, which require physical examination and several tests to determine the diagnosis."
},
{
  "instruction": "Doctor, I've got a sore throat, a fever, a sore nose, a skin rash, what's wrong with me?",
  "input": "",
  "output": "I think I've got scarlet fever."
},
{
  "instruction": "Doctor, I'm so tired these days, and I'm so frustrated, and I recently gave birth to a baby, and now I feel like I'm having trouble breathing and I'm losing fluid.",
  "input": "",
  "output": "High blood pressure affects the heart and heart function, causing such symptoms as fatigue, chest stress, shortness of breath, low fluid flow."
},
{
  "instruction": "Doctor, I'm experiencing shortness of breath, sharp chest pain, swelling of the legs, chest upset and fatigue. Can you tell me what the problem is?",
  "input": "",
  "output": "From the symptoms that God explains, I think you have high blood pressure heart disease, which occurs when high blood pressure exerts too much pressure on your heart, and causes a lot of symptoms like the one you described."
},
{
  "instruction": "Doctor, you're not sleeping well these days, and you're always tired, and you're always feeling tired, and you're feeling like your heart is beating a lot, and what's the cause of all of these symptoms?",
  "input": "",
  "output": "You're experiencing symptoms of hypertensive heart disease, high blood pressure continues to rise, causing heart damage over time."
},
{
  "instruction": "Doctor, you've been having trouble breathing lately. What's the cause?",
  "input": "",
  "output": "Your symptoms may be the result of hypertensive heart disease."
},
{
  "instruction": "Doctor, I've been feeling really nervous and nervous lately.",
  "input": "",
  "output": "Are you taking new drugs or drugs? Patient:"
},
{
  "instruction": "Sir, I'm very depressed these days, and I feel like I'm acting more aggressive toward my family and friends, and I'm having trouble with drug abuse.",
  "input": "",
  "output": "What you're saying is that you're having problems with the abuse of barbiturates, which leads to depression and hostile behavior, and we're going to have to run some tests to make sure, but we're going to talk about treatment options from today."
},
{
  "instruction": "Doctor, I've recently been very annoying and hostile to my family and friends, and I'm abusing some drugs, so can you tell me what's wrong?",
  "input": "",
  "output": "You're experiencing drug abuse, especially the symptoms of barbiturates, which can cause irritation and change in behavior."
},
{
  "instruction": "Doctor, I'm experiencing menstrual hemorrhage, menstrual absence, facial blush, weight gain and menstrual pain.",
  "input": "",
  "output": "It's very likely that there's multiple ovaries syndrome, and you have to order some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I'm experiencing weight gain, infertility, convulsions, cramps, menstrual bleeding. What's the problem?",
  "input": "",
  "output": "Symptoms can lead to multiple ovaries syndrome, a hormone disorder affecting the ovaries, which can cause irregular menstruation, weight gain, and pregnancy."
},
{
  "instruction": "Sir, I have a lot of hygiene, I can't predict it, I have a lot of hip pain and menstrual pain, and what's the cause of these symptoms?",
  "input": "",
  "output": "There's a possibility that there's multiple ovaries syndrome, which can cause abnormal menstruation, severe bleeding, hip pain, and menstrual pain, which affects women during the past few years."
},
{
  "instruction": "Sir, you've recently lost memory, and you can't sleep well. What's the cause?",
  "input": "",
  "output": "Because of memory problems and insomnia, it's possible that you're suffering from an inflammation of the brain."
},
{
  "instruction": "Doctor, I've been experiencing joint pain, leg pain, insomnia in the last few days, and why?",
  "input": "",
  "output": "It's good to have some medical tests to check your diagnosis."
},
{
  "instruction": "We're experiencing doctors, insomnia, ticklishness, joint pain. What's the cause of these symptoms?",
  "input": "",
  "output": "It's possible that, as a symptom, it's encephalitis, which is an inflammation of the brain."
},
{
  "instruction": "Doctor, I'm experiencing sensory loss, seizures, motor disorders. What's wrong with me?",
  "input": "",
  "output": "It's possible that it's brain disease because of the symptoms, and you have to run some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, in the last few days, we've had fatigue and leg pain, and we've had memory problems and leg weakness, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms suggest that you're suffering from encephalitis of the brain caused by a viral infection."
},
{
  "instruction": "I'm experiencing doctors, joint pain, memory loss, weakness, loss of sense, loss of sense. What do you think is the problem?",
  "input": "",
  "output": "The symptoms may indicate that there's a lot of brain encephalitis that can cause these symptoms, and I recommend some tests to test the diagnosis and determine how to treat the best."
},
{
  "instruction": "Doctor, we found muscle swelling in the eyelids. What's the problem?",
  "input": "",
  "output": "It looks like there's cysts in the eyelids, and we need additional tests to determine the right treatment."
},
{
  "instruction": "Doctor, we found that snowy eyes and abnormal eyelids were moving, and there were lumps to the eyelids and wrinkles to the skin, and what was the problem?",
  "input": "",
  "output": "The combination of these symptoms is probably due to the cysts of the eyelids."
},
{
  "instruction": "Hi, doctor, there's lesions or rashes in your eyelids that don't go away. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that there's a cyst in the eyelid."
},
{
  "instruction": "Sir, I'm suffering from eye pain and abnormal movement of eyelids. Can you tell me what's wrong?",
  "input": "",
  "output": "The symptoms suggest that it might be an eyelid."
},
{
  "instruction": "Hi doctor, there's lesions in the eyelids, there's lumps, there's also some eye symptoms like poor vision and pain.",
  "input": "",
  "output": "The symptoms could be eyelids."
},
{
  "instruction": "Doctor, your penis is in pain and skin lesions have been detected.",
  "input": "",
  "output": "The symptoms may indicate that you have a disease called epidemiitis."
},
{
  "instruction": "Hi doctor, I'm experiencing skin rashes, penis secretions, skin lesions, fevers, diaper rashes.",
  "input": "",
  "output": "The symptoms seem to indicate that there's eartritis, which can cause skin infection or inflammation in the head of the penis, which can cause secretions, rashes and fever."
},
{
  "instruction": "Doctor, what's the problem?",
  "input": "",
  "output": "The symptoms suggest that there is a suspicion of eartritis."
},
{
  "instruction": "Doctor, you've got rashes and itchings on your genital skin, and it's really uncomfortable, and what's the cause?",
  "input": "",
  "output": "It can cause rashes, itching and rashes due to inflammation of the skin of the penis head."
},
{
  "instruction": "Hi, doctor, I have a rash in my abdomen, and it's really scary, and I feel like a diaper rash if I'm not wearing a diaper.",
  "input": "",
  "output": "It's an inflammation of the penis's head, which can cause nausea and rash."
},
{
  "instruction": "Doctor, there's been a lot of coughing and throataches these days, and a lot of saliva in the baby, and sometimes it's pretty, it's swollen with lymph nodes.",
  "input": "",
  "output": "I think there's a possibility that there's something in the neck that can cause coughing, throataches and shortness of breath, and the baby can vomit more often, and it's best to come to the hospital as soon as possible to prevent further complications."
},
{
  "instruction": "Doctor, vomiting, neck swelling, lymphoma and respiratory difficulty. What's the problem?",
  "input": "",
  "output": "The symptoms can cause swelling and respiratory problems with a foreign substance in your neck, and you might need to do a medical examination and scan to make sure there's something that's blocking your airway."
},
{
  "instruction": "Doctor, your throat is swollen and you can't stop coughing.",
  "input": "",
  "output": "It's like there's a foreign substance going into your neck, and it's swelling your throat, and it's being stimulated, and it's coughing."
},
{
  "instruction": "Doctor, lymph nodes, neck swelling, throat pains, baby feeding difficulties. What's the problem?",
  "input": "",
  "output": "I think there's something in the neck that's causing these symptoms, and we need to do some video tests to pinpoint the exact location and get rid of it immediately."
},
{
  "instruction": "Doctor, it's hard to breathe and it's swollen.",
  "input": "",
  "output": "It looks like there's a foreign substance in the neck, as a symptom."
},
{
  "instruction": "Doctor, I recently experienced nightmares and depression or mental illness, and why?",
  "input": "",
  "output": "Symptoms are likely to be caused by drug abuse, especially cocaine, which is a common symptom of cocaine abuse."
},
{
  "instruction": "Doctor, I've been so angry lately that I can't control it.",
  "input": "",
  "output": "Have you used drugs or substances recently? Patient:"
},
{
  "instruction": "Doctor, what's wrong with me that I keep having nightmares and get angry at little things?",
  "input": "",
  "output": "I don't know, I haven't been using cocaine for a while, but could that be the cause?"
},
{
  "instruction": "Sir, I'm feeling so depressed these days, and I can't get over my depression, and sometimes I have really weird thoughts and behaviors, and it's very scary.",
  "input": "",
  "output": "I think depression can be the result of drug abuse -- have you taken illegal drugs like cocaine recently?"
},
{
  "instruction": "Doctor, I've been drinking over the last few weeks, and I don't know why I can't quit.",
  "input": "",
  "output": "Drinking abuse seems to have something to do with drug abuse. Patient: What drug abuse?"
},
{
  "instruction": "Doctor, there's been a lot of pain in your eyes and a lot of fatigue in your eyes. What's the cause?",
  "input": "",
  "output": "The symptoms are likely to indicate that you're suffering from cytitis."
},
{
  "instruction": "Doctor, there's a lot of discomfort in your eyelids, you know what's causing it?",
  "input": "",
  "output": "The symptoms suggest that you have cytitis."
},
{
  "instruction": "Doctor, one eye is bleeding and all of a sudden you can't see. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to cause cytitis, which is an inflammation of the optic nerve that temporarily blinds one eye and causes fatigue."
},
{
  "instruction": "Doctor, there are symptoms that you can't see, that you have spots, that you have clouds, that you can't see, that you can't see.",
  "input": "",
  "output": "The symptoms seem to indicate that you have cytitis, which causes inflammation or swelling in the optic nerve."
},
{
  "instruction": "Doctor, I've recently experienced a very confused, paranoid, hallucination, and I'm feeling very depressed, and I sometimes have chest pain, and what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from alcohol withdrawal, which can cause seizures and life- threatening complications, so it's important to get medical attention immediately."
},
{
  "instruction": "Doctor, I'm feeling abnormal movements, sharp chest pains, nausea. What's the problem?",
  "input": "",
  "output": "I think you're experiencing alcohol withdrawal symptoms. Did you stop drinking when you drank too much?"
},
{
  "instruction": "Doctor, I've recently had a lack of energy and a sharp chest pain, and my behavior is quite antisocial, and I'm abusing alcohol, so what's wrong with me?",
  "input": "",
  "output": "You're experiencing alcohol withdrawal symptoms, which are symptoms of people who have been drinking too much alcohol suddenly stop drinking."
},
{
  "instruction": "Doctor, you're very sick these days, you're experiencing vomiting, sharp chest pains, dizzyness, abnormal involuntary movements, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from alcohol withdrawal, and it's important to get medical attention immediately to manage the symptoms and prevent further complications."
},
{
  "instruction": "Doctor, I've been feeling a lot of pain and nausea lately, and sometimes I feel like I'm going to pass out, and I'm also showing depressing thoughts and mental symptoms, and what's the problem?",
  "input": "",
  "output": "I think you're suffering from alcohol withdrawal because of what God has explained to you."
},
{
  "instruction": "Doctor, I'm feeling very depressed and depressed these days, and sometimes I faint or dizzy, and frankly, I've been drinking for quite some time, and what's wrong with me?",
  "input": "",
  "output": "Depression or psychiatric symptoms, senility or dizziness are all common symptoms of alcohol withdrawal, and it's important to consult a medical professional as soon as possible to manage these symptoms."
},
{
  "instruction": "Sir, I've been numb lately, dizzy, even passed out of my office yesterday, and I feel strange delusions and hallucinations.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from alcohol withdrawal."
},
{
  "instruction": "Doctor, your heart rate is beating irregularly, and sometimes it seems like you're skipping a beat or adding a beat, and what's the cause?",
  "input": "",
  "output": "The symptoms suggest that there's a pericardial contraction, which can cause the upper chamber of the heart to contract earlier than normal, causing irregular heart rate."
},
{
  "instruction": "Doctor, my heart is pounding and I think I'm breathing easily.",
  "input": "",
  "output": "Your symptoms suggest an increased heart rate in the upper part of the heart can cause increased heart rate and respiratory distress, early heart contractions."
},
{
  "instruction": "Doctor, your heart rate has accelerated recently. Why?",
  "input": "",
  "output": "It could have an irregular contraction of the heart, an increased heart rate, an early heart contraction."
},
{
  "instruction": "Doctor, your muscles are swollen, your urine is often dried up, and you even have pus in your urine, and your heart rate is irregular.",
  "input": "",
  "output": "There may be an early pericardial contraction, depending on the symptoms, when the upper chamber of the heart contracts earlier than normal, which can cause irregular heart rate and other symptoms such as the present experience."
},
{
  "instruction": "Doctor, I'm experiencing symptoms of one side of my body becoming weak, having movement problems, having seizures, stiffness in my arm, and what's the cause?",
  "input": "",
  "output": "It's likely to be migraine, and it's weakened on one side of the body, causing problems such as movement, seizures, stiffness in the arm, stiffness, and so on."
},
{
  "instruction": "Doctor, I've had terrible headaches in the last few days.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from migraine."
},
{
  "instruction": "Doctor, there's an involuntary abnormality, a sign that you can't talk to with aches and pains on one side of your body, can you tell me what it is?",
  "input": "",
  "output": "The symptoms seem to indicate that you have migraine, which is a paralysis of one side of your body, or a debilitating side of your body."
},
{
  "instruction": "Doctor, there are symptoms of weakness, stiffness, and general weakness. What's the problem?",
  "input": "",
  "output": "The symptoms of arm weakness, stiffness, and a general sense of weakness seem to indicate that there's a side of the body that's weakened or paralyzed, and we need to do some tests to identify the diagnosis."
},
{
  "instruction": "Doctor, you've recently had convulsions, cramps, loss of energy, movement problems, and you've been experiencing a condition that causes your speech to get convulsed and your speech to get convulsed.",
  "input": "",
  "output": "The symptoms seem to indicate a paralysis of the body, which is paralysis or weakness, which is a good idea to get an appointment with a neurologist for additional evaluation and treatment options."
},
{
  "instruction": "Sir, your feet have skin lesions and skin growth and your nails look irregular.",
  "input": "",
  "output": "The hammer toes look like an illness where the toes can be struck by the shoes, causing skin lesions and skin growth, and the toes can show irregular shapes."
},
{
  "instruction": "Doctor, there's a little skin growing near the nail of your toe that looks abnormal and feels a little bit pain and discomfort when you walk.",
  "input": "",
  "output": "The skin growth that you're talking about may be T-eyed or bloated, which is a common symptom of this disease, which occurs when the toes bend naturally and cause pressure and friction in the skin."
},
{
  "instruction": "Sir, I think you've got a problem with the movement of your toes, and I don't think you can move as freely as any toes.",
  "input": "",
  "output": "The symptoms suggest you're experiencing a hammer toe, which causes one or more of your toes to bend into an abnormal position, making it difficult to move and uncomfortable."
},
{
  "instruction": "Hi, doctor. There's a swelling of feet and toes, and there's a loss of sense.",
  "input": "",
  "output": "The hammer toe is a condition in which the middle of the toe is bent into a hammer, and the toes are swollen and the senses are gone because the bent toes are under pressure."
},
{
  "instruction": "Doctor, your skin grows a little bit and your nails look irregular. What's the problem?",
  "input": "",
  "output": "The hammer toe is an abnormally bent joint in the middle of the toe that looks like a hammer."
},
{
  "instruction": "Doctor, you've got a cut on your cheek, and your wrist hurts a lot, and you've got body fluids, and what's the problem?",
  "input": "",
  "output": "The wounds on the cheek seem to be a separate problem, but wrist pain and body fluids are symptoms of wrist tunnel syndrome."
},
{
  "instruction": "Doctor, there's open wounds on the cheek, wrist pain, fluid decline. What's going on?",
  "input": "",
  "output": "The bruises on the cheek may be caused by injury or infection, but wrist pain and fluid decline have nothing to do with the injuries, and they may have a separate disease called absorption."
},
{
  "instruction": "Doctor, you've got a cut on your cheek, and you've got pain in your face. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that there's an injury to the cheek."
},
{
  "instruction": "Doctor, we found that there was an open wound on the cheek, and there was fluid around it.",
  "input": "",
  "output": "It's a common skin infection caused by bacteria that can cause fluid around the wound."
},
{
  "instruction": "Doctor, you've got a wound on your cheek, and it looks like there's a fluid on it, so what's the disease?",
  "input": "",
  "output": "The symptoms seem to indicate that there is a disease called sepsis."
},
{
  "instruction": "We have doctors, we have knee pain, we have movement problems, we have ankle swelling, we have ankle pains, we have wrist swelling, what's the problem?",
  "input": "",
  "output": "The symptoms suggest that there's a joint decapitation, which can accumulate excess fluid in the joints, causing pain, swelling and motor problems."
},
{
  "instruction": "Doctor, your legs are swollen and your ankles are swollen.",
  "input": "",
  "output": "The symptoms you've described may indicate a joint decapitation, and we're going to do some tests to test the diagnosis."
},
{
  "instruction": "Teachers, ankles, knees, elbows, legs, wrist swellings continue, and why?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from joint thrombosis, which is a disorder that causes swelling and stiffness in your joints with excess fluid."
},
{
  "instruction": "Hi doctor, I recently had a stiff, cold knee and swelling of my legs and ankles, a little bit of pain in my knees and elbows.",
  "input": "",
  "output": "The symptoms suggest that there's a joint defibrillation, which can cause fluid buildup in the joint sac, causing stiffness, swelling and pain around the joint."
},
{
  "instruction": "Doctor, your wrists and knees are swollen, your knees are stiff or cold, and what's wrong with me?",
  "input": "",
  "output": "The symptoms seem to indicate a joint disintegration."
},
{
  "instruction": "Doctor, your leg is hurting and swelling, and there's an open wound on your knee, and what's wrong with me?",
  "input": "",
  "output": "The symptoms seem to indicate an open wound on the knee."
},
{
  "instruction": "Doctor, there's an open wound in the knee, and I think the skin of the leg is infected, and there's a little bit of leg pain.",
  "input": "",
  "output": "Your description suggests there's an infection in the knee wound."
},
{
  "instruction": "Sir, there's a injury to the knee and swelling of the leg. The skin of the leg seems to be infected. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there's a bile bile that's a bacterial skin infection, and we need to start treating it immediately to stop the spread."
},
{
  "instruction": "Doctor, there's an open wound in the knee, and I think the skin of the leg is infected.",
  "input": "",
  "output": "It's a bacterial skin infection that affects deeper layers of the skin, and you have to start treating antibiotics immediately."
},
{
  "instruction": "Doctor, can you tell me what's wrong with your knee and your leg's swollen?",
  "input": "",
  "output": "I think there's an infection called bile fever in the wound."
},
{
  "instruction": "I've lost my arm and my hearing, so can you tell me what's wrong?",
  "input": "",
  "output": "The symptoms are likely to be peritonealoma, which is a form of tumor in the brain that can cause nerve damage, including weakness and loss of hearing."
},
{
  "instruction": "Doctor, I've recently had seizures, and I've had a lack of energy, and I've experienced nausea and loss of focus.",
  "input": "",
  "output": "Your symptoms indicate that it's possible that it's a type of peritoneal tumor that forms in the membrane tissue surrounding the brain and the spinal cord, and it's good to do some tests to identify the diagnosis."
},
{
  "instruction": "Doctor, you've got facial pain, you've got nausea, you've got a little low vision, what's the problem?",
  "input": "",
  "output": "It's possible that it's a dura because of the symptoms."
},
{
  "instruction": "Doctor, what's wrong with your memory problems lately, with hearing loss and weakness?",
  "input": "",
  "output": "It's a type of brain tumor that occurs in a protective tissue surrounding the brain and the spinal cord, and it's good to do some tests to identify the diagnosis."
},
{
  "instruction": "There are symptoms of a doctor's hearing, low hearing, facial pain, nausea, poor vision, poor focus, and what's the possible cause?",
  "input": "",
  "output": "It's possible that it's a type of peritoneal tumor that can occur in the brain and spinal wall, depending on the symptoms, and it's good to do some tests to identify the diagnosis and determine how best to treat it."
},
{
  "instruction": "Doctor, abdominal swelling, loss of appetite, blindness, memory loss, helplessness, what do you think's wrong with me?",
  "input": "",
  "output": "It's possible that it's brain cancer, and we need to do some additional tests to figure out what's causing it, and get you into the hospital immediately."
},
{
  "instruction": "like doctors, blindness, loss of appetite, seizures, speech problems. What's wrong with me?",
  "input": "",
  "output": "There's a possibility that it's brain cancer because of the symptoms, and you have to run some tests to identify the diagnosis."
},
{
  "instruction": "Doctor, in recent years, I've been feeling very weak, I've had severe headaches, and I've also lost my appetite, and I can't get rid of the strange symptoms of weakness in my legs, so what's wrong with me?",
  "input": "",
  "output": "It's very likely that it's brain cancer as a symptom, and we need to do some tests to identify the diagnosis and determine how best to treat it."
},
{
  "instruction": "Can you tell me what's going on with the symptoms of late blindness and loss of appetite?",
  "input": "",
  "output": "It's possible that it's brain cancer because of the symptoms."
},
{
  "instruction": "Doctor, we're experiencing poor focus, memory problems, headaches, blindness, speech disorders, and what's the cause of all of these symptoms?",
  "input": "",
  "output": "You may have brain cancer because of your symptoms, and it's good to run additional tests to check your diagnosis."
},
{
  "instruction": "Doctor, I'm experiencing emotional symptoms and frequent contractions during pregnancy, and I think something's wrong.",
  "input": "",
  "output": "Your symptoms suggest that you're experiencing a placental early onset, but I don't know what you're talking about during pregnancy, because it's not typical of placental passage."
},
{
  "instruction": "Doctor, is it a sign of a serious illness when you're feeling nausea?",
  "input": "",
  "output": "Yes, nausea can be a symptom of a variety of diseases. Can you describe the other symptoms? Patient:"
},
{
  "instruction": "Doctor, we're experiencing stains and bleeding during pregnancy with contractions and cramps. What's the problem?",
  "input": "",
  "output": "It's possible that you're experiencing a placental eclipsis from your symptoms."
},
{
  "instruction": "Sir, I'm having strange symptoms these days, eyelids are becoming dark, eyes are growing too thin, wrists are becoming weak and emotional.",
  "input": "",
  "output": "It doesn't seem like you've got a single disease from what God said, and it's important to perform a thorough physical test and some diagnostic tests in order to understand the underlying cause of the symptoms."
},
{
  "instruction": "Doctor, I'm experiencing stains and bleeding during pregnancy, and why?",
  "input": "",
  "output": "There's the possibility that you have a placental cyclopulation, which is a disease in which the placenta is partially or completely separated from the lining of the uterus before the baby is born, which is a serious condition and requires immediate action."
},
{
  "instruction": "Doctor, your eyes are torn too much and your throat hurts. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate seasonal allergies known as pollen allergies."
},
{
  "instruction": "Doctor, there's a lot of earaches and coughs and nostrils. What's the cause of these symptoms?",
  "input": "",
  "output": "You seem to be suffering from seasonal allergies or hay fever."
},
{
  "instruction": "Doctor, do you know what caused Coriza's recent symptoms?",
  "input": "",
  "output": "It's likely because of seasonal allergies, also called hay fever."
},
{
  "instruction": "Sir, the sinuses are sick and the eyes are really dark, and your nose is getting stuck and your nose is constantly coming out, so what's the problem?",
  "input": "",
  "output": "We're seeing seasonal allergies known as pollen allergies."
},
{
  "instruction": "Hi. What's the cause of your recent cough and eye problems?",
  "input": "",
  "output": "The symptoms suggest that you're suffering from a seasonal allergy called hay fever."
},
{
  "instruction": "Doctor, after you've had enough sleep these days, you feel a lot tired. What's the cause?",
  "input": "",
  "output": "While fatigue may be caused by a number of causes, it's possible that lung cancer is the result of smoking, and it's best to run some tests to be sure of that, but it's best to do it quickly."
},
{
  "instruction": "Doctor, what happened when you've been coughing in blood lately and your appetite's falling out and you're having trouble breathing?",
  "input": "",
  "output": "It's possible that it's lung cancer because of the symptoms, and you have to have some tests to check it out."
},
{
  "instruction": "Doctor, I recently felt very tired and low in appetite, and it's hard to cough and breathe from time to time.",
  "input": "",
  "output": "The symptoms suggest lung cancer, and I recommend a few additional tests to make a treatment plan that meets your particular request."
},
{
  "instruction": "Hi, doctor, I'm tired all the time, I'm tired, I'm tired of smoking, and I feel less hungry than I normally do.",
  "input": "",
  "output": "It's good to run some tests to see if you have lung cancer based on your symptoms."
},
{
  "instruction": "Doctor, we've recently had smoking problems and respiratory problems, and we're also losing strength in our legs and vomiting blood, and what are the symptoms?",
  "input": "",
  "output": "It's very likely to be lung cancer as a symptom, and I want to book some tests to check the diagnosis and discuss treatment options."
},
{
  "instruction": "Doctor, I'm experiencing erectile failure, and the nail shape has become irregular.",
  "input": "",
  "output": "These symptoms could be the result of a primary kidney disease, and you have to do additional tests to check your diagnosis."
},
{
  "instruction": "Doctor, I'm experiencing melena, a black member, and why?",
  "input": "",
  "output": "Symptoms can lead to these symptoms due to primary kidney disease, which affects kidney function, and it's important to run additional tests to make sure you're accurate."
},
{
  "instruction": "Doctor, there's blood in your urine and your nails look irregular. What's wrong with me?",
  "input": "",
  "output": "The symptoms seem to indicate that there is a primary kidney disease, and we need to run some tests to see if we can do that."
},
{
  "instruction": "Sir, there's been spasms and spasms in your leg recently, and blood comes out when you urinate, and I think you've got kidney-related symptoms.",
  "input": "",
  "output": "The symptoms seem to indicate a primary kidney disease, and it's good to run some tests and see what treatment options you can provide to confirm this diagnosis."
},
{
  "instruction": "We're experiencing some symptoms involving doctors, thirst, helplessness, erectile failure, stiffness of legs or stress and kidneys.",
  "input": "",
  "output": "Your symptoms may indicate that you have a primary kidney disease, and it's important that you check your diagnosis with additional tests, and then you start a personal treatment plan to manage it and improve your kidney function."
},
{
  "instruction": "Doctor, I'm experiencing vaginal bleeding, even though I've already had menopause, and I'm also continuing hip pain and facial blushing, so can you tell me what caused all of these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate that uterine cancer is likely to occur, and it's important to test it with a few tests and start treating it as soon as possible."
},
{
  "instruction": "Sir, I've had some gum pain recently. What is it?",
  "input": "",
  "output": "I'd like to run additional tests to see if there's cancer of the womb based on the history and current symptoms."
},
{
  "instruction": "Doctor, I'm experiencing hip pain, facial blush, muscle pain. Can you tell me what's wrong?",
  "input": "",
  "output": "It could be uterine cancer, as a symptom."
},
{
  "instruction": "Doctor, there's a lump on the groin and a lesion in the tongue. What's the problem?",
  "input": "",
  "output": "From the symptoms that God explains, it may be uterine cancer, which can spread to other parts of the body, such as the groin, causing lesions in the tongue."
},
{
  "instruction": "Doctor, you've been touched by a lump on the groin, and recently there's been a lot of menstruation, and what's the cause?",
  "input": "",
  "output": "It's a common symptom of uterine cancer, and you have to do additional tests to make sure that you're diagnosed and that you're planning a treatment."
},
{
  "instruction": "I want you to tell me what's causing the mass on the groin.",
  "input": "",
  "output": "The groin in the groin may be caused by metastasis of uterine cancer, and it's good to do some more tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, you've recently had lesions in your tongue. What's the problem?",
  "input": "",
  "output": "Tongue lesions can be symptoms of uterine cancer. Any other symptoms?"
},
{
  "instruction": "Doctor, there are some strange symptoms in my eye that look like two things, and sometimes the eyelids are moving, and there's a lot of tears, no matter what my will is, what's the cause?",
  "input": "",
  "output": "I don't think we know what's causing it because of the symptoms."
},
{
  "instruction": "Sir, what's the problem with white secretions coming out of your eyes?",
  "input": "",
  "output": "There seems to be a change in eye secretions, such as the increase in the amount of mucus caused by the unrecognizable eye dryness."
},
{
  "instruction": "Doctor, I have a feeling in my eyes. What's the problem?",
  "input": "",
  "output": "I don't think we know what's causing it."
},
{
  "instruction": "Doctor, your eyes are in pain, and sometimes you see spots or clouds in your eyes.",
  "input": "",
  "output": "I don't think you know what's causing it."
},
{
  "instruction": "Doctor, I think my vision has been impaired by the hotness of my eyes and the feeling of warmth, and I see spots and clouds in my eyes, and I keep crying.",
  "input": "",
  "output": "The symptoms seem to indicate that there's an unrecognizable ophthalmology, which is a common condition in which tears are not produced enough in the eyes or the quality of the tears is not good enough."
},
{
  "instruction": "Doctor, your period is getting longer. Why?",
  "input": "",
  "output": "And this can be caused by a disease called fibrocystic breast disease, what changes or lumps did you find in your breast?"
},
{
  "instruction": "Doctor, I'm getting a lot of moons with skin irritations, and sometimes I don't have a period, and why?",
  "input": "",
  "output": "The symptoms seem to indicate fibrocystic breast disease."
},
{
  "instruction": "Hi, doctor, I've been experiencing some symptoms recently, chest pains, and I haven't had my period for a while, and my skin around my chest is quite stimulated.",
  "input": "",
  "output": "The symptoms seem to indicate fibrocystic breast disease."
},
{
  "instruction": "Doctor, your period has become irregular, you have your period lasts longer than usual, you have your period rarely comes out at all, and it's probably more than usual.",
  "input": "",
  "output": "Depending on the symptoms, there may be fibromyal breast disease, which interferes with the hormone balance, causing irregularity in the menstrual cycle."
},
{
  "instruction": "Sir, your scalp looks irregular, your skin is swollen and it's getting ugly, and what's the problem?",
  "input": "",
  "output": "The symptoms suggest that there's a fungus infection in the hair."
},
{
  "instruction": "I've been suffering from skin cancer lately.",
  "input": "",
  "output": "It looks like there's a fungus infection in your hair."
},
{
  "instruction": "Doctor, the skin is swollen and it's itchy in the area where the hair is.",
  "input": "",
  "output": "These symptoms could be caused by hair mold."
},
{
  "instruction": "Hi, doctor. What's causing the scalp to look irregular?",
  "input": "",
  "output": "There could be a fungus infection called the hair glands."
},
{
  "instruction": "Doctor, jaw and gum, pain and swelling in the face.",
  "input": "",
  "output": "The symptoms suggest that there's a dental abscess."
},
{
  "instruction": "Sir, there's a lot of pain in the gums and in the mouth and symptoms in the face.",
  "input": "",
  "output": "The symptoms suggest that there's a dental abscess."
},
{
  "instruction": "Sir, I'm suffering from facial pain, skin swelling, telophase, mouth pain, and so forth.",
  "input": "",
  "output": "I think there's a dental abscess, and we need to do some tests to check the diagnosis and provide the treatment we need to prevent further complications."
},
{
  "instruction": "Hi, sir, there's a lot of pain in the mouth and face, and there's a lot of fluid in the mouth, and it hurts when you open your mouth.",
  "input": "",
  "output": "The symptoms seem to indicate a tooth abscess, which may require a thorough examination, but it's a common problem, where you have to take a drug to treat infection without pus."
},
{
  "instruction": "Doctors, gum pain, toothache, jaw swelling, swelling of the neck. What's the problem?",
  "input": "",
  "output": "Are there any signs that you're sensitive to hot or cold foods and drinks?"
},
{
  "instruction": "Doctor, do you know what the disease is when your joints are stiff and your ankle's pain?",
  "input": "",
  "output": "You may have had leptospira because of your symptoms. Have you had contact with contaminated water or animals recently?"
},
{
  "instruction": "There's doctors, ankle pain, excessive anger, breast pain, soreness, knee mass, what's the problem?",
  "input": "",
  "output": "The symptoms may indicate that you have leptospira, a bacterial infection that is exposed to contaminated water or soil, and you need to get some tests and be treated as soon as possible to identify the diagnosis."
},
{
  "instruction": "Hi, doctor, I've had a lot of pain in my ankle lately, and what's the reason for that?",
  "input": "",
  "output": "With ankle pain, it's possible that you have leptospirosis. Have you had high fever, body disease, or vomiting recently?"
},
{
  "instruction": "Doctor, I'm experiencing a stiff, warm feeling in my joints, excessive anger, fatigue, wrist pain, and what's the cause of all these symptoms?",
  "input": "",
  "output": "The symptoms suggest that you have leptospira, a common bacterial infection caused by contact with contaminated water or soil, and it's good to check your diagnosis with a few tests and start treating it as soon as possible."
},
{
  "instruction": "Doctor, we're experiencing pain during pregnancy, pain in the eyes, facial pain, and what's the cause of these symptoms?",
  "input": "",
  "output": "From the symptoms that God explains, it's possible that it's leptospira, and we need to do some tests to confirm the diagnosis, but it's important to get treatment as soon as possible."
},
{
  "instruction": "Doctor, your skin is swollen and it's very dark. Do you know what caused it?",
  "input": "",
  "output": "The symptoms are more likely to be poisoned by a bite from a spider or an animal, and it's good to take a closer look and figure out the extent of the injury, and you may need additional treatment to alleviate the symptoms."
},
{
  "instruction": "Doctor, your feet and toes are swollen and you have telophase. What's the cause of these symptoms?",
  "input": "",
  "output": "Depending on the symptoms, it's possible that a bite or a bite in a spider or an animal might cause a poison, and it's important that you immediately get a doctor's consult and figure out the cause and get proper treatment."
},
{
  "instruction": "Hi, doctor, I've been having strange symptoms recently, my legs and feet are swollen, and I've had allergic reactions.",
  "input": "",
  "output": "Did you ever get bitten by spiders or wild animals recently?"
},
{
  "instruction": "Doctor, you've got skin rashes, your arm's swelling.",
  "input": "",
  "output": "like a spider or an animal bite, and there's other symptoms like body fluids, skin swelling, sensory abnormality, and that's what we're going to do."
},
{
  "instruction": "Doctor, there's lower abdominal pain. Can you tell me what's causing it?",
  "input": "",
  "output": "It's possible that you're suffering from symptoms related to back-to-back syndrome."
},
{
  "instruction": "Doctor, it seems that the recent eye is moving in two different directions, and what's the cause?",
  "input": "",
  "output": "There's the possibility that you're going to have back-to-back syndrome when you're considering other symptoms and disorders, which can cause more than one eye problem, such as one side or one side of the eye intersecting."
},
{
  "instruction": "Doctor, there's lower abdominal pain and sometimes it feels hot and cold.",
  "input": "",
  "output": "It's a rare genetic disorder that affects multiple organ systems, including digestive tract, heart, and spinal cord, which can cause lower abdominal pain and temperature changes."
},
{
  "instruction": "Doctor, I'm experiencing a chest pain, elbow and wrist weakness, emotional symptoms, and sometimes my eyes seem to intersect.",
  "input": "",
  "output": "Based on what God has explained, I think there's a rare congenital disorder called Backt syndrome that can affect the systems of the long-term and cause a variety of physical and developmental disorders. I want to do some more tests to check the diagnosis and discuss treatment options."
},
{
  "instruction": "Doctor, I've been experiencing some emotional symptoms recently.",
  "input": "",
  "output": "Emotional symptoms can be caused by a variety of disorders, but in questioners' case, they can be related to vector syndrome."
},
{
  "instruction": "Doctor, can you tell me what's going on with your recent arm and leg pain?",
  "input": "",
  "output": "The symptoms suggest that the arteries that supply the brain stem and cerebellum may be blocked or narrowed and that there is a decrease in blood flow to the back of the brain."
},
{
  "instruction": "Doctor, I'm experiencing weakness, sharp chest pain, motor disorder, leg pain, swelling. What's the problem?",
  "input": "",
  "output": "I think you're suffering from spina bifida."
},
{
  "instruction": "I'm sweating with doctors, back pain, feet or toes weakened, aggravation. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to be spinal desalination, and it's good to do some tests to check the diagnosis and start a treatment plan."
},
{
  "instruction": "Doctor, I have vomiting and leg pain. What's wrong?",
  "input": "",
  "output": "The spine, or the basilar artery, may be narrowed or blocked and suffering from reduced blood flow to the brain and the cerebellum, which can also cause other symptoms, such as nausea, speech disorders, and vision problems."
},
{
  "instruction": "I'm experiencing a doctor, a rectal hemorrhage, a burning abdominal pain, diarrhea.",
  "input": "",
  "output": "The symptoms suggest that you have a job disorder, an inflammation of the bowel, and it's good to do some additional tests to determine how to treat the best."
},
{
  "instruction": "Doctor, we've found recently that there's soreness and sharp abdominal pain, and there's so much blood mixed in the stool, and the anus is very, very dark.",
  "input": "",
  "output": "You're experiencing symptoms of work sickness, piles or inflammation of the bowel, and it's important that you do some tests to diagnose and treat your condition."
},
{
  "instruction": "Doctor, there's a fire extinguisher problem, there's a dark, delayed side, and there's a around the anal, and what's going to happen?",
  "input": "",
  "output": "The symptoms are likely to indicate that you have a rectal illness, and you need extra diagnostics and tests to determine a specific diagnosis and treatment plan."
},
{
  "instruction": "Doctor, do you know what's causing the tics and tics that are occurring in the workplace?",
  "input": "",
  "output": "There may be job disorders, such as workplace problems, which can cause tics and tics in the area of the workplace, depending on the symptoms."
},
{
  "instruction": "Doctor, there's changes in the shape of the side, and variation and diarrhea take turns, and what's the cause?",
  "input": "",
  "output": "Depending on the symptoms, there may be job disorders such as hypertensive bowel syndrome or inflammation of the bowel, and additional evaluations and tests are recommended to determine the underlying cause and the appropriate treatment."
},
{
  "instruction": "Doctor, I've been experiencing some of the symptoms of erectile failure, urination, involuntary urination, prostate and bladder.",
  "input": "",
  "output": "The symptoms seem to indicate that there's an impotence bladder."
},
{
  "instruction": "Doctor, the involuntary urination, the blood in the urine, and there are symptoms similar to prostate cancer, and what's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that the bladder muscles are so weak that you can't completely empty your urine, and there are other symptoms of urination that show that you're urinating, and it's important to diagnose this condition properly so that you can start treating it as soon as possible."
},
{
  "instruction": "Doctor, I've recently had a weakness in my wrists, and I've been experiencing erectile failure, and I've also had problems with involuntary urination and prostate symptoms, and what's the problem?",
  "input": "",
  "output": "Your symptoms suggest that you have a pathological bladder, which is a disease in which bladders can't contract properly, dehydrate urine, and there's plenty of flux."
},
{
  "instruction": "We're having prostate symptoms -- teachers, urinary problems, blood in the urine, emotional symptoms, bladder symptoms.",
  "input": "",
  "output": "The symptoms seem to indicate that you have an impotent bladder."
},
{
  "instruction": "Doctor, there's been a lot of elbow spasms and tics recently, but why?",
  "input": "",
  "output": "It's more likely that the bladder muscle is weakened and is not able to empty the contents of the bladder properly, which is associated with the incapacity of the bladder."
},
{
  "instruction": "Doctor, I think I'm going to pass out, and I'm having headaches, and I'm dizzy, and I'm sick, and what's the problem?",
  "input": "",
  "output": "The symptoms suggest that there's a positive seizure body satellite suspension."
},
{
  "instruction": "Doctor, in the last few days, I've been experiencing a frontal edema headache, and why?",
  "input": "",
  "output": "The symptoms may indicate that you have a disease known as BPV."
},
{
  "instruction": "Doctor, your ears are ringing for quite a long time. Do you want to know what's causing them?",
  "input": "",
  "output": "It could be a symptom of a disease called BPPV, where small calcium crystals in the inner ear are altered."
},
{
  "instruction": "Hi, doctor, I'm having a strange condition these days, and I'm hearing sounds in my ears, and I'm crying, and sometimes I'm vomiting.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from positive S.P.I.C. or BP.V., which is a common condition in your ear where small calcium crystals escape and cause nausea, nausea and deafness."
},
{
  "instruction": "Doctors, deafness, nausea, hearing degradation, vomiting, helplessness. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that there's a positive seizure, a body satellite suspension, or a BPPV."
},
{
  "instruction": "Doctor, I'm experiencing weakness in my arms, muscle spasms, building and spasms, and I have lesions and rashes on my eyelids, backaches, and sometimes blindness.",
  "input": "",
  "output": "You're suffering from an eye convulsion."
},
{
  "instruction": "Doctor, the eyelids have tics and tics and lesions in the eyelids, especially the muscles in the legs, and recently, the vision has been blurry.",
  "input": "",
  "output": "The eyelids seem to have an involuntary muscle contraction and convulsion, which can cause a wide range of symptoms, such as eyelids or rashes, muscle spasms or cramps, weakness of leg, blindness, in severe cases."
},
{
  "instruction": "Doctor, there's been a lot of spasms and tics recently, and there's some rashes with strange pain in the eyelids, and there's a slight loss of strength in the arms and legs, and there's a lot of pain in recent sex.",
  "input": "",
  "output": "I think you're experiencing an eyelid convulsion, which is characterized by eyelids, other symptoms of ophthalmology are weakness, pain during intercourse, cramps, weakness in the arm, and I'll do some tests and evaluations to make sure that you're diagnosed."
},
{
  "instruction": "Doctor, you've got eyelids or rashes, low vision, low leg strength, what are the symptoms?",
  "input": "",
  "output": "Anesthesia is a neurological disorder that causes abnormal contractions or spasms of the eyelid muscles, which can lead to impaired vision and other muscle weakness in the body."
},
{
  "instruction": "Doctor, I've been experiencing a recent bloating, facial pain, chest upset. What's the cause?",
  "input": "",
  "output": "It's possible that it's pedophilia based on the symptoms, and I recommend some additional tests to check the diagnosis."
},
{
  "instruction": "Doctor, there's a persistent coughing and a soreness in the hands and feet, and what's the cause of these symptoms?",
  "input": "",
  "output": "There may be pedophilia, which affects the body's organs, including lungs, skin and nervous system, depending on the symptoms, and it's important to do some tests to identify the diagnosis and determine how best to treat it."
},
{
  "instruction": "Doctor, there's been recent chest irritation, muscle pain, cough, facial pain, and what's the cause of these symptoms?",
  "input": "",
  "output": "Depending on your symptoms, your lungs, lymph nodes, skin, and other parts of your body, may be pedophilia, which causes inflammation."
},
{
  "instruction": "Doctor, I've got some pain in my face and I'm really tired lately. What's the problem?",
  "input": "",
  "output": "It's possible that you have a condition called pedophilia based on your symptoms. Have you had trouble breathing or coughing recently, or have you had chest upset?"
},
{
  "instruction": "Doctor, I'm experiencing chest distress, shortness, eye pain, fatigue, facial pain. What's the problem?",
  "input": "",
  "output": "I think you're suffering from pedophilia, an inflammation that affects your body's organs."
},
{
  "instruction": "Hi doctor, I've been experiencing a lot of spasms and spasms of my legs lately, and do you know what's causing them?",
  "input": "",
  "output": "My leg spasms and spasms could be symptoms of metastatic cancer. Have you been diagnosed with cancer?"
},
{
  "instruction": "Doctor, vaginal dryness, loss of appetite, fatigue, leg cramps or tics. What's the problem?",
  "input": "",
  "output": "Unfortunately, these symptoms can indicate metastasis."
},
{
  "instruction": "Doctor, I'm so tired these days, I'm so weak in focus, and I don't eat very well these days, and what's the cause of these symptoms?",
  "input": "",
  "output": "Symptoms suggest that there's a chance that there's metastasis, that we need to run some tests to make sure, but it's best to start treating it as soon as possible."
},
{
  "instruction": "There's a strange mass around the neck, and I'm experiencing vaginal dryness and leg spasms, and what's the cause of all this?",
  "input": "",
  "output": "There may be metastasis, and you need to run some tests to see if you can, but it's important to fix it as soon as possible."
},
{
  "instruction": "Doctor, there's a lump around your neck that's been going on for weeks, and it's getting bigger and bigger, so can you tell me what's going on?",
  "input": "",
  "output": "The symptoms are likely to be metastasis, and I'm going to order some tests to confirm this diagnosis."
},
{
  "instruction": "We've got blood in our ears, stiff shoulders, spasms in our hands and fingers, stiffness in our backs, what's the problem?",
  "input": "",
  "output": "There are a number of symptoms that might not be related to each other, but there's the possibility that you might have a finger that's bent and has a finger that's stuck and then goes back to its place, a trigger finger."
},
{
  "instruction": "Doctor, the skin of your arm or your hand seems to be infected, your back is stiff or moist, your hands and fingers are swollen, your bones are sick, what's the reason?",
  "input": "",
  "output": "I think you have the trigger finger, which is a finger disease."
},
{
  "instruction": "Sir, I've recently had some symptoms in my hand, such as an infection of the skin of my arms and hands, swelling my hands and fingers and aching bones.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from trigger resin, also called finger disease."
},
{
  "instruction": "Sir, I think you've got pain in your hands and fingers and an infection in the skin of your hand or your arm, and it's swelling your hand or finger, and I need you to tell me what's wrong.",
  "input": "",
  "output": "The symptoms suggest that you have trigger fingers that bend and then pop right out, and you can cause pain, swelling and inflammation in affected fingers, skin infections can occur by scratching or rubbing your hand."
},
{
  "instruction": "Sir, I can feel the stinging sensation on my finger, and it looks like my finger is paralyzed, and I can't move it properly.",
  "input": "",
  "output": "The symptoms seem to indicate that there are trigger fingers that cause sensory disturbances or low-pressure symptoms."
},
{
  "instruction": "Doctor, the skin is swollen in the eyelids. What's the cause?",
  "input": "",
  "output": "I think there's a garax, a common snow infection with red eyelids and swollen eyes."
},
{
  "instruction": "What's the problem?",
  "input": "",
  "output": "It's a small, painful mass under the eyelash, which can be caused by bacterial infection."
},
{
  "instruction": "Doctor, you've got pain and itching in your eyes, and why?",
  "input": "",
  "output": "It looks like there's a small, painful cloud of garax inside or outside the eyelids."
},
{
  "instruction": "Hi, doctor, there's a lot of discomfort in the eye, there's rashes and swelling in the eyelids, red eyes and tears.",
  "input": "",
  "output": "The symptoms seem to indicate that there is a garax, which is a small protrusion that appears near the eyelids or at the edge of the eye, usually caused by bacterial infections and can cause pain and irritation."
},
{
  "instruction": "Doctor, your eyelids are red and swollen and painful, and there's skin all around you that looks abnormal, so can you tell me what's going on?",
  "input": "",
  "output": "The symptoms seem to indicate that there's a garax, a common disease that infects the oil glands of the eyelids and causes swelling, swelling and pain, which can be treated with heat and antibiotics if necessary."
},
{
  "instruction": "Doctor, it's hard to talk, it's started to bleed in the neck, it's started to hurt bones, it's got hip and joint pain.",
  "input": "",
  "output": "The symptoms seem to indicate hemochromatosis, a condition in which iron accumulates too much. The treatment option involves regularly removing blood to lower iron levels and control the symptoms."
},
{
  "instruction": "Doctor, there's pain in the testicle. Can you tell me what's causing it?",
  "input": "",
  "output": "The cause of the pain is hemochromatosis, which is a condition in which we absorb too much iron from the food we eat to cause iron overload in the tissues of the body, including the testes."
},
{
  "instruction": "Doctor, you're in pain, you're in pain, you're in pain, you're in pain, you're in low hair, you're in abnormal skin.",
  "input": "",
  "output": "It's possible that the iron can be absorbed into the body so much that it's stored in many organs that it's causing damage over time, so we need to run some tests to confirm the diagnosis."
},
{
  "instruction": "Sir, there's hip pain and bone pain. What's the cause?",
  "input": "",
  "output": "The symptoms suggest that there is a genetic disorder called hemochromatosis, which accumulates too much iron in the body."
},
{
  "instruction": "Doctor, I've been experiencing lower abdominal pain for a while, and I also feel abnormal skin growth and itching.",
  "input": "",
  "output": "God explains that you may have a condition called osmosis, a bone tumor that can cause skin growth and itching, and you have to do some tests to confirm your diagnosis."
},
{
  "instruction": "Doctor, your skin looks abnormal, there's hip pain, there's knee pain, and what's the cause?",
  "input": "",
  "output": "It's possible that it's a bone tumor that can occur near the knee or the pelvic, causing pain and discomfort. The abnormal skin shape may be caused by the tumor pressing against the skin. We recommend several video tests to confirm the diagnosis."
},
{
  "instruction": "Doctor, I'm very nervous because I have severe hip pain and a lump in my skin. Do you know what the disease is?",
  "input": "",
  "output": "Osteoporosis and skin lesions are common symptoms of this disease."
},
{
  "instruction": "Doctor, we've discovered that the skin grows on the legs, and it looks like a lesion.",
  "input": "",
  "output": "According to your description, there appears to be a cartilage tumor, a benign bone tumor that results from skin growth or lesions."
},
{
  "instruction": "Doctor, there's skin itching and foot pain and toe pain. What's the problem?",
  "input": "",
  "output": "Your symptoms can be a type of bone tumor that usually occurs in childhood or adolescence, which can cause pain by pressing on the nerves and tissues around the tumor, and in some cases it can cause skin problems."
},
{
  "instruction": "Doctor, I've been losing my spirits lately, and my heart rate has been reduced, and you know what's causing it?",
  "input": "",
  "output": "Yeah, I think you're suffering from Kusing's syndrome, given your symptoms and your history."
},
{
  "instruction": "Doctor, I recently experienced shoulder pain and emotional symptoms. What's the problem?",
  "input": "",
  "output": "I think you're experiencing the symptoms of Kusing's syndrome. Have you noticed any changes in your body or your mood?"
},
{
  "instruction": "Doctor, I'm experiencing shoulder pain, muscle swelling and weight gain. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you have Kusing's syndrome."
},
{
  "instruction": "Doctor, there's a scrotum in your scrotum. What do you think is the problem?",
  "input": "",
  "output": "It could be a symptom of a disease called Kusing's syndrome."
},
{
  "instruction": "Sir, there's pain in your ankle. Do you know what caused your ankle pain?",
  "input": "",
  "output": "Yes, ankle pain can be the symptoms of typhoid fever, abdominal pain, diarrhea or fatigue."
},
{
  "instruction": "Doctor, you're experiencing pain during pregnancy, wrist pain, pain in the breast, or wear. What's the cause of these symptoms?",
  "input": "",
  "output": "It's important to check this diagnosis and run additional tests to start the treatment immediately."
},
{
  "instruction": "Doctor, with the pain of the eyes, your joints have stiff or salty symptoms and high fevers.",
  "input": "",
  "output": "The symptoms suggest that it's possible that it's typhoid, and we need to do some tests to confirm the diagnosis."
},
{
  "instruction": "Doctor, your eyes are bleeding. What's the cause?",
  "input": "",
  "output": "The symptoms seem to be the cause of the medulla deformity."
},
{
  "instruction": "Doctor, what's the cause of the recent pain and frequent tears in your eyes?",
  "input": "",
  "output": "It's important to check this diagnosis with a thorough eye examination and discuss treatment options."
},
{
  "instruction": "Sir, there's two objects in your left eye, and you can't see some of them. What's the problem?",
  "input": "",
  "output": "The symptoms could be the result of a transmigration of the free body."
},
{
  "instruction": "Doctor, there's been some symptoms in my recent eye, and I'm afraid I'm going to be blind because there's some other symptoms in my vision, so can you tell me what's wrong with my eye?",
  "input": "",
  "output": "The symptoms seem to suggest that there's a transmigration of the free body of the eye, which can lead to blindness, depending on where the vision is dimmed or distorted, and it's important to get a doctor's attention immediately if you have a problem with your vision."
},
{
  "instruction": "Doctor, I'm worried that my eyes are swollen and my eyes are covered, and I'm also worried that I see spots and clouds in my eyes.",
  "input": "",
  "output": "It's important to get an ophthalmologist as soon as possible, because this disease can rarely cause blindness."
},
{
  "instruction": "Doctor, I found too little hair in my arms and legs, and what's the cause?",
  "input": "",
  "output": "Depending on the symptoms, there may be skin-responsive diseases."
},
{
  "instruction": "Doctor, you've got symptoms that your hair is growing too little, your skin is swelling, your lips are swelling, do you know what's causing it?",
  "input": "",
  "output": "You may be suffering from a rare condition called angiosis, which is swollen by various parts of the body, including the lips, which causes skin contractions."
},
{
  "instruction": "Sir, you've recently felt your lips swollen, your skin thinned and fragile. What's the problem?",
  "input": "",
  "output": "It's good to get a dermatologist for additional evaluations and treatment."
},
{
  "instruction": "Doctor, you've recently had warts and itchings on your skin, swelling and spotting. What's the problem?",
  "input": "",
  "output": "The symptoms that God has described seem to indicate that there's atrophy of skin, which is also called skintrophy, where the skin is thin and the warts become itch, it's itch, it's itch, it's splint, it's there, it's there, it's there, it's there, it's there, it's there, it's there, it's there, it's there, it's there, it's there, it's there, it's there, it's there's there."
},
{
  "instruction": "Doctor, my skin is swollen and I have warts, and why?",
  "input": "",
  "output": "I think there's an absorption and atrophy that can cause warts, and I think we're going to need to examine them a little bit more."
},
{
  "instruction": "Doctor, you're losing your breath, and you're touching a lump in your knee, and your shoulder's swelling, and your sexual appetite's dropping.",
  "input": "",
  "output": "The symptoms may indicate aspergillus, a fungus infection that can affect the lungs, bones and other organs, and we need to do some tests to identify the diagnosis and start treatment as soon as possible."
},
{
  "instruction": "Doctor, I've recently experienced hearing problems and neck cramps, and I've also developed the habit of biting my nails and losing my breath, and I think my sexual appetite is suddenly gone.",
  "input": "",
  "output": "Symptoms indicate that Aspergillasia may be caused by a fungus infection affecting the respiratory system that can cause hearing loss, neck cramps, nail bites, respiratory problems, and sexual loss."
},
{
  "instruction": "Doctor, we found that there was a drop in sexual desire and overgrowing of hair on certain parts of the body.",
  "input": "",
  "output": "The symptoms are likely to be Aspergulus, a fungus infection caused by Aspergulus mold, which can cause a variety of symptoms, such as poor sexual appetite due to hormonal imbalances, abnormal growth, and so on."
},
{
  "instruction": "Doctor, I can't hear you anymore.",
  "input": "",
  "output": "It could be Aspergulus."
},
{
  "instruction": "Doctor, your sexual appetite has dropped, and you've recently vomited blood. What's the problem?",
  "input": "",
  "output": "The symptoms could indicate a mold infection called Aspergillus."
},
{
  "instruction": "Doctor, I'm experiencing menstrual bleeding with contractions, and I'm having problems with my last pregnancy, and I'm suffering from infertility, and what's the cause of all these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate that you have uterine inability to contract, which is a disease that causes pregnancy and infertility because of the loss of the ability of the uterus to contract properly."
},
{
  "instruction": "Doctor, you're experiencing some color and bleeding during pregnancy, and you're having trouble getting pregnant again.",
  "input": "",
  "output": "The symptoms may indicate that you're suffering from uterine paralysis, which causes excessive bleeding and other complications after delivery, and if you don't treat it properly, you can lead to infertility."
},
{
  "instruction": "Doctor, I've been experiencing a lot of lower abdomen and sharp abdominal pain recently, and I've had some problems during pregnancy.",
  "input": "",
  "output": "Because of your symptoms and your history, you may be suffering from uterine paralysis, which is a condition in which the uterine muscles can't contract properly and cause excessive bleeding and lower abdominal pain after delivery, which can also cause sharp abdominal complications during pregnancy."
},
{
  "instruction": "Doctor, I'm experiencing sharp abdominal and lower abdominal pain during pregnancy.",
  "input": "",
  "output": "His symptoms seem to be uterine inability to contract after delivery and contract, causing severe bleeding, and he can also cause pain during pregnancy and stains or bleeding, and he needs to go to the hospital for further evaluations and treatment."
},
{
  "instruction": "Doctor, you've got a sharp abdominal pain during pregnancy, back cramps, cramps, and you're having a hard time with your pregnancy.",
  "input": "",
  "output": "The symptoms suggest that your uterus can't contract properly after delivery, and you're suffering from a severe bleeding and painful uterine paralysis."
},
{
  "instruction": "Doctor, I've recently found that my pelvis are under a lot of pressure, and some of the areas are overgrowing, and what's happened to my body?",
  "input": "",
  "output": "There's the possibility that the symptoms are less familiar, or that I've had pork or wild hunting, which is causing a parasite infection, and I have to be diagnosed and treated as soon as possible."
},
{
  "instruction": "Hi, doctor, I've got a lump in my knee that bothers me for a while. Do you know what it's like?",
  "input": "",
  "output": "In the case of the symptoms you described, it's possible that it's protozoa. Have you ever eaten a less cooked meat or raw meat recently?"
},
{
  "instruction": "Doctor, I'm experiencing swelling of the shoulder, neck or cramps, sharp abdominal pain, bed-wetting and overgrowth. What's going on with me?",
  "input": "",
  "output": "I think we're seeing symptoms of protrusion, parasites that occur from eating less cooked pork that's infected by the larvae of the trichinella worm."
},
{
  "instruction": "Sir, pelvis stress, urinary pain, sharp abdominal pain, please tell me what's wrong.",
  "input": "",
  "output": "The symptoms seem to indicate that you have protozoia, which is a parasite from eating raw meat or raw meat, especially pork, and you need to be tested and treated as soon as possible."
},
{
  "instruction": "Doctor, I've had some strange symptoms recently: swelling shoulders, overgrowing, pressure on the pelvic. What's the problem?",
  "input": "",
  "output": "In view of the symptoms that God has given us, it seems to be a proboscis Witness, a disease caused by less cooked meat, especially by a parasite called trikinella sulalis, which is infected by people who consume pork."
},
{
  "instruction": "Doctor, sharp abdominal pain, shortness of breath, headaches, persistent cough. What's the problem?",
  "input": "",
  "output": "It's very likely that the symptoms are 100-day injuries."
},
{
  "instruction": "Doctor, I think our baby's been very annoying these days, and it's been bleeding. What's going on?",
  "input": "",
  "output": "Other symptoms are dry coughs, fatigues, shortness of breath, and it's important to get the baby to the hospital as soon as possible for a proper diagnosis and treatment plan."
},
{
  "instruction": "Doctor, there's been a lot of pain and pain in the breasts and ankles, and why?",
  "input": "",
  "output": "Rheumatic arthritis is a chronic autoimmune disease that affects multiple joints, which can cause inflammation in the breast."
},
{
  "instruction": "There was pain in the breast and wrist during the pregnancy and a lot of urination at night, and there was a little bit of pain in the eyes, and you know what caused these symptoms, doctor?",
  "input": "",
  "output": "The symptoms seem to be not only breast pain associated with pregnancy, but also the condition of wrist tunnel syndrome, which can be caused by celiac diabetes, and the pain in the eyes may be high blood pressure, giving additional tests to check for pregnancy diabetes and high blood pressure, and we can discuss options for handling wrist tunnels and breast pain."
},
{
  "instruction": "Hi, doctor, your joints are stiff or they're warm, and what's the reason for that?",
  "input": "",
  "output": "Pixia, a rare, progressive neurologic disorder that affects the brain, that accumulates a protein called Taw that causes brain cells to die and eventually causes such symptoms as joint strength and stiffness."
},
{
  "instruction": "Doctor, I'm experiencing excessive anger and pain during pregnancy, and also constant shoulder cramps and tics.",
  "input": "",
  "output": "It's a rare genetic disorder affecting the brain that causes progressive problems in behavior, personality and cognitive capacity, and can also explain shoulder symptoms by causing muscle spasms and rigidity."
},
{
  "instruction": "Doctor, there's been a lot of shoulder spasms and tics recently, and what's the cause?",
  "input": "",
  "output": "You're experiencing the symptoms of a disease called Pixia."
},
{
  "instruction": "Sir, your lips are dry and your lips are damaged. What is it?",
  "input": "",
  "output": "I think there's a lip infection or a simple herpes virus infection."
},
{
  "instruction": "Hi, sir, there's a cut on your lips and a little bleeding in your mouth.",
  "input": "",
  "output": "Based on your symptoms and your history, I think your lips are damaged."
},
{
  "instruction": "Sir, I don't think your lower lip heals, but it's very painful.",
  "input": "",
  "output": "The damage is likely to be oral ulcers, which can be caused by multiple factors such as trauma or infection, and we'll look at them and see how to treat them properly."
},
{
  "instruction": "Sir, can you prescribe a drug when your lips are very dry and there's a bleeding mouth ulcer in your mouth?",
  "input": "",
  "output": "I'm going to give you a local antibiotic cohesion that can be applied to the throat, and you don't have to touch or rip the wound to prevent further stimulation."
},
{
  "instruction": "Doctor, we've recently discovered that the horse has been compromised, and there's blood in the mouth, and there's also a little ulcer in the mouth.",
  "input": "",
  "output": "It's important to keep the area clean and not give further stimulation to prevent infection."
},
{
  "instruction": "Doctor, fluid reduction, pregnancy pain, anal pain, leg convulsion or spasm. What's the problem?",
  "input": "",
  "output": "You're experiencing symptoms of acute thyroid disease, which not only causes pain and discomfort in the neck due to inflammation of the thyroid gland, but also causes other symptoms, such as the one you described."
},
{
  "instruction": "Hi, doctor, I've been having strange symptoms recently, and I've had contractions and uterine uterine contractions, and what's the reason for that?",
  "input": "",
  "output": "These symptoms can be associated with acute thyroid disease, which causes other symptoms, such as pain, fever, fatigue and contractions and uterine erythrombosis, which is an inflammation of the thyroid gland."
},
{
  "instruction": "Sir, there's been some abnormal symptoms during the recent pregnancy, including stains, bleeding, and a mix of blood in the stools.",
  "input": "",
  "output": "The symptoms may indicate abnormal uterine bleeding and acute thyroid disease, which can cause pericardial bleeding, which I recommend further tests and evaluations to confirm this diagnosis."
},
{
  "instruction": "Doctor, there's recently been a mix of blood in the stool. What's the cause?",
  "input": "",
  "output": "One possible cause may be hyperthyroiditis, which is inflammation of the thyroid, but it's not a common symptom of this disease that's being combined with blood, and it's important to take a closer look at the underlying cause."
},
{
  "instruction": "Doctor, the contractions of the uterus, the spasms of the legs, the spasms of the legs, the fracturings of the pregnancy, the midst of the pregnancy, the bleeding, the fluid decline.",
  "input": "",
  "output": "Thyroid disease is caused by inflammation of the thyroid gland, which can cause a hormonal imbalance in the body."
},
{
  "instruction": "Doctor, I have pain in my ear and blood in my mouth.",
  "input": "",
  "output": "And because of this, there seems to be an oral perforation of the peritoneal membrane."
},
{
  "instruction": "Doctor, I've been experiencing facial and oral pain in the last few days, and recently I've also found an oral ulcer, and why?",
  "input": "",
  "output": "The symptoms suggest that there's a lesion in the oral pericardium."
},
{
  "instruction": "Doctor, there's a toothache, and I think there's a lesion in the mouth. What's the problem?",
  "input": "",
  "output": "It can cause pain, discomfort and other symptoms in the mouth."
},
{
  "instruction": "Sir, we're experiencing facial pain, cough, ear pain, throat pain.",
  "input": "",
  "output": "The symptoms seem to indicate an inflammation of the mouth or an ulcer, an oral perforation, which can be caused by viral infections, allergies, or oral trauma."
},
{
  "instruction": "Hi doctor, I found something in my mouth that had a fever and a pain in my face and a lesion in my mouth, and what's the problem?",
  "input": "",
  "output": "In terms of symptoms and lesions in the mouth, this is a common condition that can cause discomfort and pain."
},
{
  "instruction": "I've got a doctor's injury, and I've got a stiff, warm shoulder.",
  "input": "",
  "output": "The symptoms suggest that you've injured your shoulder joint with an open wound, and it's good to take an X-ray immediately to make sure you don't have a fracture or a dislocation."
},
{
  "instruction": "Doctor, there's an open wound in the arm, and I think the skin around it's infected. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that there may have been a bacterial infection in the wound."
},
{
  "instruction": "Doctor, a recent accident caused an arm injury, the skin of the arm and the hand seem to be infected, and when you touch it, it feels warm, and the shoulder feels stiff, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms suggest that there may be a trauma injury, the stiffness of the shoulder or the shock may be the result of the injury, the skin infection may be exposed to bacteria. To prevent further infection, you need to clean the wound and prescribe antibiotics."
},
{
  "instruction": "Doctor, you've got a lot of swollen wrists, and I think you've got a lot of damage. What's the cause?",
  "input": "",
  "output": "According to your description, you may have been injured by a trauma such as a pillow wound or a stab wound, and you have to look into it to figure out the exact cause and recommend the right treatment."
},
{
  "instruction": "Doctor, we have a problem with movement.",
  "input": "",
  "output": "The symptoms suggest that you're suffering from endogenous internal bleeding."
},
{
  "instruction": "Doctor, my words got down, I felt depressed, and I had a seizure with a weak focus, and why?",
  "input": "",
  "output": "The symptoms may indicate that you have internal bleeding, which is a type of stroke caused by internal bleeding in the brain tissue, which can cause the symptoms that you're currently describing."
},
{
  "instruction": "Doctor, I'm experiencing poor focus, low vision, blindness and nausea. What's the problem?",
  "input": "",
  "output": "The symptoms may indicate that there's a bleeding brain inside the brain, and we need to do brain scans to see this, because it's an emergency, and we need to do it quickly."
},
{
  "instruction": "Doctor, over the last few days, I've had a breakdown and a headache, and I don't know what's going on.",
  "input": "",
  "output": "The symptoms suggest that there may have been an internal bleeding in the brain."
},
{
  "instruction": "Doctor, I'm experiencing low vision, low vision, weakness, nausea, depression, and what's the cause?",
  "input": "",
  "output": "The symptoms are likely to indicate that you have a stroke, a stroke caused by internal bleeding, which is an emergency situation that requires immediate medical attention, and you need to do some video tests to determine the exact cause of the symptoms."
},
{
  "instruction": "Doctor, I'm going to go through some sort of awkward, hostile behavior, difficulty in speaking, muscle convulsion, contractions, tics, irregular scalps, what are the conditions that cause all of these symptoms?",
  "input": "",
  "output": "From the symptoms that God explains, it's possible that you have Alzheimer's disease, but the correct diagnosis can only be made with full evaluations and multiple tests."
},
{
  "instruction": "Doctor, I've recently experienced delusions and hallucinations, and I've also had muscle spasms, contractions, or tics, along with fear and phobias, and sometimes actions turn into hostile, eye stings or stings, and what's the problem?",
  "input": "",
  "output": "The symptoms suggest that Alzheimer's disease is a progressive brain disorder that affects memory, thinking, behavior; it's common for AD patients to experience delusions, hallucinations, muscle cramps, contractions, cramps, fears, phobias, hostile behaviors, eye burns and stings."
},
{
  "instruction": "Doctor, I've recently had movement problems and hostile behaviors, and I'm also feeling nervous and depressed.",
  "input": "",
  "output": "Alzheimer's disease is a progressive neurological disorder that affects behavior, including memory, cognitive function and depression, restlessness, and hostile behavior."
},
{
  "instruction": "Doctor, I'm restless, I'm having movement problems, I'm experiencing fear and fear, hostile behavior and depression.",
  "input": "",
  "output": "These symptoms are often associated with Alzheimer's disease, which is a neurological disorder affecting brain thinking, speech and motor skills."
},
{
  "instruction": "Hi doctor, I think you're having discomfort and pain during sex, and there's a lot of urination, dryness, hip pain, and vaginal secretions.",
  "input": "",
  "output": "It can cause the symptoms of pain and bulimic diabetes, vaginal dryness, hip pain, vaginal secretions, and we can talk about treatment options for controlling the symptoms."
},
{
  "instruction": "Doctor, I'm experiencing dental pain, menstrual excess, vaginal pain, menstrual pain. What's the problem?",
  "input": "",
  "output": "There's a possibility of vaginal disease, which causes pain and discomfort by unconscious contractions of vaginal muscles, which can be tested with a few tests to determine the diagnosis and find options for treatment."
},
{
  "instruction": "Doctor, there's been a constant flow of chest pain, vaginal pain, lower abdominal pain, facial blush, sharp abdominal pain, what do you think is the problem?",
  "input": "",
  "output": "This condition causes an involuntary muscle spasm in the pelvic muscle, causing pain and discomfort during sex or vaginal examination."
},
{
  "instruction": "Doctor, menstruation, sharp abdominal pain, vaginal pain, what's the problem?",
  "input": "",
  "output": "It's a disease that causes pain and discomfort during intercourse, during gynecology, and during gynecology."
},
{
  "instruction": "Doctor, I'm experiencing facial blush and urination, and there's a little bit of pain in the top of the vagina and the skull, and what's the cause?",
  "input": "",
  "output": "Depending on the symptoms, there may be unconscious contractions of the pelvic muscle, so that it's difficult or impossible to insert in sex, or tomphonics, and facial blush and frequent urination may be related to the anxiety and stress associated with salinitis."
},
{
  "instruction": "Hi doctor, I've recently had a strange condition: regional weakness, menstrual periods haven't started for two months, joint and knee pain, and what's the cause of these symptoms?",
  "input": "",
  "output": "From the symptoms that God has described, it's possible that you have all of these red-synthetic luphus or SLE."
},
{
  "instruction": "Doctor, your whole body is swollen, your hair is too low, your muscles, your legs, your hands, your fingers, your fingers, your stiffness, and what's the cause of all this?",
  "input": "",
  "output": "The symptoms seem to indicate that you've got a full-fledged scarlet lophus."
},
{
  "instruction": "I'm experiencing doctor, joint swelling, joint pain, leg swelling.",
  "input": "",
  "output": "Depending on the symptoms, there's a possibility that there's a transgender-synthetic ruphus."
},
{
  "instruction": "Doctor, I've got a stiff, moist feeling in my hands and fingers these days, and what's the cause?",
  "input": "",
  "output": "This is an autoimmune disease in which the body's immune system attacks healthy tissue, causing inflammation and damage."
},
{
  "instruction": "Sir, I'm experiencing dry, lipid scalps, and I don't seem to be growing tall for a long time, and why?",
  "input": "",
  "output": "The symptoms that God said might be caused by early ovaries failure."
},
{
  "instruction": "Doctor, I'm experiencing too little hair, too little hip pain, pain in intercourse, unpredictable menstruation.",
  "input": "",
  "output": "You're experiencing early ovaries failure."
},
{
  "instruction": "Doctor, I'm experiencing hip pain, menstrual bleeding, poor growth, blushing, weight gain. What's wrong with me?",
  "input": "",
  "output": "You're experiencing early inflection of the ovaries, a condition that doesn't function normally before the age of 40 that causes hormonal imbalances and causes the same symptoms that you described."
},
{
  "instruction": "Doctor, I'm having a hard time getting pregnant, and I'm experiencing facial blushing, and what's the cause?",
  "input": "",
  "output": "Symptoms are likely to indicate early inflection, which means that the ovaries may not function properly and can cause other symptoms such as infertility and facial blushing."
},
{
  "instruction": "Doctor, your appetite's falling, your shoulder and your arm's pain. What's the problem?",
  "input": "",
  "output": "I think you're suffering from thoracotomy, which is a disorder in which the nerves and blood vessels of the neck and the shoulder are forced into pain in the shoulder and the arm, and your appetite is impaired."
},
{
  "instruction": "Doctor, there's been a lot of pain in the shoulder, in the hand, in the finger, and there's also sharp chest pain.",
  "input": "",
  "output": "The symptoms seem to indicate that you have thoracic edema, a nervous and blood vessel-pressive disorder in the space between the clavicle and the first rib."
},
{
  "instruction": "Doctor, I'm experiencing pain in the hand, weakness in the hand, pain in the hand, pain in the shoulder and sharp chest pain. What's going on with me?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from chest ventricular syndrome, and have you ever had an arm, a hand, or a sore hand?"
},
{
  "instruction": "Doctor, we've been experiencing back pain, loss of appetite, and neck pain in the last few days.",
  "input": "",
  "output": "It's possible that you're suffering from thoracic extremism."
},
{
  "instruction": "Sir, there's been recent loss of shoulder, sharp chest pain, back pain, arm pain, what's the problem?",
  "input": "",
  "output": "Yes, I think you're suffering from a blood vessel in the space between the collarbone and the first rib, or a nerve-pressive disorder called thoracic edema syndrome, which can cause the symptoms you're currently experiencing."
},
{
  "instruction": "Doctor, your wrist and hand are in pain, and you've got a marked swelling.",
  "input": "",
  "output": "The symptoms seem to indicate that there is a pain caused by cystic cysts."
},
{
  "instruction": "Doctor, you've had pain in your knee, and now you've got a lump or a lump in your wrist, so what's the problem?",
  "input": "",
  "output": "From the symptoms that God explains, it's possible that the cyst is a glial cyst, which can occur along the joints or the tendons, often causes pain and discomfort, and it's a good idea to make an appointment so that you can see it and decide how best to treat it."
},
{
  "instruction": "Sir, your hands and wrists are in pain these days, and your fingers are in pain, and your legs are swollen, and you're feeling pain there.",
  "input": "",
  "output": "Celiac cysts are non-molecular lumps, which occur mainly along the wrists, hands, and joints, which sometimes cause pain and can grow in size, which is likely to affect the nerves around you."
},
{
  "instruction": "Doctor, there's a mass on your wrist that's very painful.",
  "input": "",
  "output": "The symptoms suggest that it's probably a cyst."
},
{
  "instruction": "Doctor, you've recently had swelling of your legs and knee pain. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that it's probably a cyst."
},
{
  "instruction": "There's pain in the knees, shoulders, and joints.",
  "input": "",
  "output": "You could be suffering from a knee dislocation."
},
{
  "instruction": "Doctor, you've recently had a stiff, cold knee, a little bit of shoulder pain.",
  "input": "",
  "output": "The symptoms seem to indicate that the knee has been decommissioned."
},
{
  "instruction": "Sir, my knees are stiff and cold, and I'm in a lot of pain.",
  "input": "",
  "output": "The symptoms suggest that the knee has been disrepaired."
},
{
  "instruction": "Doctor, your knees are stiff, they're warm and they're swollen, and it's very difficult to move your knees freely.",
  "input": "",
  "output": "The symptoms seem to indicate that the knee joint has been decommissioned, and it's important to be tested and treated immediately to prevent further damage."
},
{
  "instruction": "Sir, your knee's been in pain for a while, and if you move, it hurts, and you don't seem to be able to find the right position.",
  "input": "",
  "output": "You're likely to suffer from knee dislocation, which occurs when the knee joint bone is removed from its normal position, often due to knee trauma or injury."
},
{
  "instruction": "Doctor, sharp abdominal pain, abdominal swelling, rectal bleeding, and the blood in the stools are continuing, and what's the cause?",
  "input": "",
  "output": "The symptoms are likely to be Crohn's disease, which can cause all the symptoms you've described."
},
{
  "instruction": "I've been experiencing anal pain, joint pain, nausea and rectal bleeding lately. What's the problem?",
  "input": "",
  "output": "It's likely to be Crohn's disease, an inflammation that affects digestive tract, that causes such symptoms as abdominal pain, diarrhea, fatigue and weight loss."
},
{
  "instruction": "Doctor, I'm experiencing sharp abdominal nausea. What's the cause?",
  "input": "",
  "output": "The symptoms suggest you have Crohn's disease."
},
{
  "instruction": "I'm suffering from symptoms like teacher, reflux, gas, nausea, vomiting.",
  "input": "",
  "output": "I think you're suffering from Crohn's disease because of the symptoms that God mentioned."
},
{
  "instruction": "We're experiencing a doctor, a joint pain, a sharp abdominal pain, and an abdominal ovation, and what's the cause of these symptoms?",
  "input": "",
  "output": "There's a possibility of Crohn's disease depending on the symptoms."
},
{
  "instruction": "Doctor, I recently had a baby with swelling of the jaw, swelling of the ear, abnormal skin, what's the problem?",
  "input": "",
  "output": "There seems to be post-op or post-birth infections, and it's important to be treated immediately to prevent further complications."
},
{
  "instruction": "Doctor, you're having a sharp abdominal pain after surgery, so what's the cause?",
  "input": "",
  "output": "It's possible that the post-op infection caused the pain, and we need to run some tests to see if that's true."
},
{
  "instruction": "Doctor, your legs are swollen, your arms are infected, your hands are infected, and you've been pregnant lately, and your stomach is irregular.",
  "input": "",
  "output": "The symptoms suggest that there's post-op infections that can occur after surgery or other medical procedures, and it's important to get medical attention immediately so that the infection doesn't spread anymore."
},
{
  "instruction": "Sir, I've been sick lately, I've had a fever, I recently delivered a baby, and I want you to know what might be the problem.",
  "input": "",
  "output": "Your symptoms and recent pregnancies indicate post-op infections."
},
{
  "instruction": "Doctor, I've lost my breath and I've recently vomited blood. What's the problem?",
  "input": "",
  "output": "The symptoms are very likely to indicate a folic acid deficiency."
},
{
  "instruction": "Doctor, I'm really worried about the dark, sticky side of the face.",
  "input": "",
  "output": "I think you're experiencing a condition called melena, which can be caused by a number of factors, one of which is a lack of folic acid in the body."
},
{
  "instruction": "Doctor, I recently vomited blood and became very weak, and I see black on the stool, and I'm always tired.",
  "input": "",
  "output": "It's possible that the symptoms are causing a folic acid deficiency."
},
{
  "instruction": "Doctor, you're suffering from depression, delusions, hallucinations, respiratory problems during pregnancy, what's the problem?",
  "input": "",
  "output": "The symptoms seem to be due to a folic acid deficiency."
},
{
  "instruction": "Doctor, I've been feeling very weak lately, and I've been experiencing melena, and I've been vomiting blood last night, and I'm always tired.",
  "input": "",
  "output": "The symptoms suggest a lack of folic acid."
},
{
  "instruction": "Doctor, there's been a lot of difficulty breathing, nausea, sharp chest pain, and there's also a lot of swelling in the feet and legs.",
  "input": "",
  "output": "I think you're experiencing a lot of fluid overload."
},
{
  "instruction": "Doctor, your hands and fingers are swollen, your body fluids are down, and you're experiencing vomiting and respiratory problems.",
  "input": "",
  "output": "The symptoms suggest that there's a drop in fluid."
},
{
  "instruction": "Doctor, your legs and hands are swollen and fluid is high. What's the cause?",
  "input": "",
  "output": "The swelling of the legs, the telophase, the body fluids, the hand, or finger swelling, it looks like you're going through a lot of fluid overload."
},
{
  "instruction": "Doctor, you've got a strong, sharp abdominal pain that's vomiting and swelling your hands and fingers.",
  "input": "",
  "output": "The symptoms suggest that there's a drop in fluid."
},
{
  "instruction": "Doctor, your breathing difficulties and nausea are continuing, and you've vomited a few times, and your feet and legs are swollen.",
  "input": "",
  "output": "The symptoms seem to indicate that there's a lot of excess fluid in the body, which is so high that it causes swelling and respiratory problems, that treatment needs to be started immediately to prevent further complications."
},
{
  "instruction": "I'm so tired, I'm tired, and I feel hot.",
  "input": "",
  "output": "You're probably suffering from an abnormal heart rhythm, which can cause symptoms that can't withstand fatigue and heat."
},
{
  "instruction": "Doctor, we've recently been suffering from fatigue and chest irritation, sharp chest pains and symptoms of BB, and what's the cause of these symptoms?",
  "input": "",
  "output": "Symptoms indicate that you may have an abnormal heart rate, an abnormal heart rate that can cause chest stress, fatigue, and sharp chest pain."
},
{
  "instruction": "Doctor, I'd like to go to the bathroom a lot, but what's the problem?",
  "input": "",
  "output": "The symptoms may indicate that you're experiencing a pericardial heart attack, a sort of irregular heartbeat that accumulates fluid in your body, where you often urinate."
},
{
  "instruction": "Doctor, we've recently experienced irregular heart rate and breathlessness. What's the problem?",
  "input": "",
  "output": "It's very likely that the symptoms are the same."
},
{
  "instruction": "Doctor, what's the cause of your heart's perplexity in recent years?",
  "input": "",
  "output": "Heart disease, a heart disorder, can cause irregular heart rate and chest irritation."
},
{
  "instruction": "Doctor, I have rash on my skin, and it's really dry and peeling.",
  "input": "",
  "output": "You're experiencing the symptoms of skin disease, rashes and dryness can be symptoms of such conditions as eczema and dryness, and it's good to schedule a routine with a dermatologist as soon as possible for accurate diagnosis and effective treatment."
},
{
  "instruction": "Doctor, we found that skin lesions and skin lesions look abnormal and the skin swells. Can you tell us what the problem is?",
  "input": "",
  "output": "The symptoms that you've described are generally associated with this disease, and it's good to run some tests to diagnose certain types of skin disease."
},
{
  "instruction": "Doctor, I've been experiencing skin irritation for the last few days. Can you tell me what caused it?",
  "input": "",
  "output": "The symptoms seem to indicate that you have skin disease."
},
{
  "instruction": "Doctor, I'm experiencing skin cancer, and I have acne and acne on my face, and I have abnormal skin appearance and some lesions, and what's the problem?",
  "input": "",
  "output": "I think you're suffering from a skin disease, which is a condition that you've described, that you've been suffering from, you've been suffering from, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got skin disease, you've got, you've got, you've got, you've got, you've got, you've got some symptoms, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you know, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you know, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got, you've got"
},
{
  "instruction": "Doctor, my skin looks abnormal and it's very dark, and I have some growth in my skin, and I have a feeling of swelling, and my skin is very dry and constantly peeling.",
  "input": "",
  "output": "There are several types of skin diseases that can cause these symptoms, such as eczema, dry glands or mold infections, so it's important to get a proper diagnosis and treatment plan from a dermatologist."
},
{
  "instruction": "Doctor, in the last few days, we've discovered that the vision is poor and the black spots are still floating.",
  "input": "",
  "output": "In general, you're experiencing some wealth related to aging or eye trauma, and you have to test your eyes for a diagnosis."
},
{
  "instruction": "Doctor, you've got spots and clouds in your vision, and you've got tears, and you've got impaired vision, and what's the problem?",
  "input": "",
  "output": "It's generally harmless and caused by changes in the inner glass of the eye, but I would like to have an eye examination to eliminate any other possible cause."
},
{
  "instruction": "Hi, doctor, there are strange symptoms in your vision: your eyes are often tickling or tickling, and you see spots or clouds in your eyes, and I think your vision has been impaired lately.",
  "input": "",
  "output": "The symptoms are likely to indicate that there are small spots in the eye or cloud floating through the eye, which is often caused by changes in the glass, such as the gel that fills the eye, but sometimes the older one is more common, because it may be a sign of a more serious eye problem, so it is important to take the eye specialist's examination and rule out a fundamental problem."
},
{
  "instruction": "Sir, what's wrong with seeing a stain or a cloud in your eye while your eyes are getting hot and warm?",
  "input": "",
  "output": "You're experiencing a little stain or a cloud of wealth, which can be caused by a change in glass, which is a substance like the gel of the eye, which occurs as you get older."
},
{
  "instruction": "Doctor, pain in the mouth, toothache, surrounding swelling, jaw edema, mouth ulcer, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you have tooth disease, and you have to look into it to be sure, but these symptoms are generally associated with the disease."
},
{
  "instruction": "Sir, there's a lot of pain in the gums, and there's a little swelling, and there's an ulcer in the mouth.",
  "input": "",
  "output": "The symptoms seem to indicate that you have tooth disease."
},
{
  "instruction": "Doctor, I'm a little worried about the swelling of the lymph nodes.",
  "input": "",
  "output": "Do you have dental pain? woman: Yeah, tooth pain a couple of days ago."
},
{
  "instruction": "Sir, gum hemorrhage, swelling around the gums, facial pain, gum pain, what could be the problem?",
  "input": "",
  "output": "You're probably suffering from gum inflammation and inflammation of the teeth, and you might want to make a reservation for your dentist to test your teeth and gums."
},
{
  "instruction": "The doctor, the mouth pain, the ear pain, the headache, the gum pain, and the telophase.",
  "input": "",
  "output": "Symptoms can lead to tooth disease."
},
{
  "instruction": "Doctor, heart pressure, arm pain, burning chest pain, heart rate, heart rate, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate a heart attack, and you have to go to the hospital immediately so that you can properly diagnose and treat a heart attack."
},
{
  "instruction": "Doctor, you've got a sharp pain in your chest. Why?",
  "input": "",
  "output": "It's possible you're experiencing a heart attack based on what God said."
},
{
  "instruction": "My chest is sore and I feel lower pain and sore throat. Doctor, can you tell me what's wrong with you?",
  "input": "",
  "output": "It's good to run some tests to confirm and diagnose what appears to be a heart attack, and if you sit down, we'll ask for a blood test and an E.K.G. test."
},
{
  "instruction": "Doctor, your heart rate is rapid, you're sweating, your arm's pain, and what's the cause of these symptoms?",
  "input": "",
  "output": "There's a possibility that you're experiencing a heart attack based on your symptoms, and it's important to get immediate treatment to avoid further complications."
},
{
  "instruction": "Doctor, what's the reason for this experience of faintness and irregular heartbeat?",
  "input": "",
  "output": "It's possible that you're experiencing a heart attack as a symptom, and it's good to do some tests to figure out what's causing the symptoms."
},
{
  "instruction": "Doctor, your navel is irregular, your abdomen is swollen, you can't see. What's the problem?",
  "input": "",
  "output": "The open abdominal wound can cause these symptoms."
},
{
  "instruction": "Doctor, you have an open abdominal wound and a sharp abdominal pain, and you can't see anything.",
  "input": "",
  "output": "I think you're suffering from a perforated ulcer perforated stomach or sore throat, a abdominal wound caused by an ulcer, which can be caused by complications of a disease, and you have to operate immediately."
},
{
  "instruction": "Sir, there's an irregular, sharp abdominal pain, and all of a sudden you can't see it.",
  "input": "",
  "output": "Symptoms may include abdominal open wounds, which cause irregular and sharp abdominal pain, but it's not a common symptom of open wounds; it's a good idea to have an eye doctor immediately examine you for extra vision loss."
},
{
  "instruction": "Doctor, you're sweating, and you've got a sharp abdominal passage that you can't see.",
  "input": "",
  "output": "The symptoms suggest that open abdominal injuries have caused this problem, and it's important to test and treat the wound as soon as possible to prevent further complications."
},
{
  "instruction": "Doctor, you've got movement problems with your hip feeling stiff and moist, and you've got knee pain and swelling as well as hip pain.",
  "input": "",
  "output": "According to the symptoms that God explains, there may be broken legs, and it's important to take X-rays to check the diagnosis and determine the extent of the fracture, and to help restore pain management and physical therapy."
},
{
  "instruction": "Hi, doctor, there's pain in the leg, swelling, swelling ankles and aching knee.",
  "input": "",
  "output": "The symptoms suggest that there's a fracture in the leg, and you need an X-ray for confirmation."
},
{
  "instruction": "I'm experiencing a doctor, hip pain, stiffness, swelling and ankle pain.",
  "input": "",
  "output": "I think there's a fracture in the leg. X-rays have to be taken to make sure."
},
{
  "instruction": "Doctor, your legs are swollen, your hip is stiff, and you're warm, and why is that?",
  "input": "",
  "output": "Do you have a fracture in your leg?"
},
{
  "instruction": "Doctor, I have a weird feeling these days, like I'm feverish, coughing, and I'm buried in my mouth.",
  "input": "",
  "output": "The symptoms suggest that you may have an oral mouth opening, which is a form of yeast infection."
},
{
  "instruction": "Hi, doctor, you've got pain in your mouth and skin rashes, fevers, diaper rashes, you've been coughing a lot lately, and I need you to tell me what's going on.",
  "input": "",
  "output": "The symptoms may include oral mouth opening, a yeast infection that affects the mouth and sometimes the skin, which is common to children and people with poor immune systems, which requires antimicrobials to treat them."
},
{
  "instruction": "Hi, doctor, there's an ulcer in your mouth, and it's painful to eat.",
  "input": "",
  "output": "You can have oral mouth pain, yeast infection that causes white spots in your mouth. Patient: How did you get this infection?"
},
{
  "instruction": "Doctor, you've recently become overextended, you've got skin rashes, and you've got warts, and you've gained weight, and you're a little nervous about fear and phobia, and what's wrong with me?",
  "input": "",
  "output": "It's a skin disease that starts out with a large, scaly spot called a hair patch, which is usually harmless and disappears within six or eight weeks, because weight gain and excessive appetite can be caused by other factors, and fear and phobias may not have anything to do with this skin disease."
},
{
  "instruction": "Doctor, my body is growing warts and skin, and I've gained some weight lately, and I also have more acne and pimples than usual, and why?",
  "input": "",
  "output": "It's a type of skin disease that causes warts, skin growth, acne or acne, and weight gain may be caused by other causes, but other symptoms seem to indicate it."
},
{
  "instruction": "Doctor, I don't think my rash is going to go away on my skin.",
  "input": "",
  "output": "It looks like it's got abscess, a form of skin rash that can last for weeks."
},
{
  "instruction": "Doctor, I have a rash in my body that looks abnormal, and why?",
  "input": "",
  "output": "The symptoms seem to indicate that there is a skin disease called non-plasticoma."
},
{
  "instruction": "Hi, doctor, your scalp has been dry for a while, and there's a lot of lipids going on, and what's the cause?",
  "input": "",
  "output": "The symptoms suggest that there's boring scalpitis, and have you found a spot on your skin that looks like pink or red scales?"
},
{
  "instruction": "Doctor, every time I'm around an animal, I'm experiencing acne, membrane force, allergic reactions, and I tend to get a pair of eyes, and what's going on with me?",
  "input": "",
  "output": "You're more likely to experience allergies to animals, such as acne, acne, appendix, nose pressure, allergic reactions, and it's important to avoid further exposure to animals so that these symptoms don't get worse."
},
{
  "instruction": "Doctor, I've been experiencing a number of symptoms recently: blockage, fever, decapitation of the wrist, the eyes are sore and the neck is sore, what's the problem?",
  "input": "",
  "output": "I think you're allergic to animals. Have you had contact with animals recently?"
},
{
  "instruction": "Doctor, what's the problem with your post-ops and coughs going on?",
  "input": "",
  "output": "You might be allergic to animals because of your symptoms. Have you been with pets or animals lately?"
},
{
  "instruction": "Doctor, I'm having a hard nose, and I've been having a lot of trouble lately.",
  "input": "",
  "output": "I think you're allergic to animals. Have you been with pets or animals lately?"
},
{
  "instruction": "Doctor, it's been snowy recently. What's the cause?",
  "input": "",
  "output": "You might be allergic to animals. Do you have pets at home?"
},
{
  "instruction": "Doctor, I keep fainting and dizzying, with increased heart rate, increased heart rate, and a feeling of helplessness, but what is the cause of these symptoms?",
  "input": "",
  "output": "The symptoms that God's talking about indicate that you're suffering from standing hypotensive blood pressure."
},
{
  "instruction": "Hi, doctor. I've been feeling two-pass fatigue lately. What's wrong?",
  "input": "",
  "output": "The symptoms can lead to standing hypotensive blood pressure."
},
{
  "instruction": "Doctor, I'm so tired these days, my heart is jumping irregularly, and I have headaches, and I sometimes feel bad to breathe, and I think my heart rate is faster.",
  "input": "",
  "output": "Aggressive hypotensive hypotensive blood pressure, which appears to be suffering from a drop in standing blood pressure, can cause fatigue, irregular heart rate, headaches and respiratory problems."
},
{
  "instruction": "Doctor, I've been feeling dizzy lately, and I've been feeling a lot of fatigue. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there's standing hypotensive hypotensive blood pressure, which, when it's up, suddenly drops, causing nausea and fatigue."
},
{
  "instruction": "Hi, sir, I'm experiencing this in my sleep, and why?",
  "input": "",
  "output": "Insulination during sleep is a symptom of an OSA, a sleep disorder that stops breathing repeatedly during sleep."
},
{
  "instruction": "Doctor, you're very sleepy during the day, and when you wake up in the morning, you feel very dry.",
  "input": "",
  "output": "The symptoms seem to indicate that you have a closed sleep apnea, which is a condition in which your airways are partially or completely blocked, your breathing is stopped and your sleep quality is low."
},
{
  "instruction": "Sir, I can't sleep at night, I'm tired during the day, and I can't breathe.",
  "input": "",
  "output": "I think you're experiencing the symptoms of OSA."
},
{
  "instruction": "Doctor, I hear an abnormal breath during sleep. What are the symptoms?",
  "input": "",
  "output": "I think you have a closed sleep apnea based on what God has explained."
},
{
  "instruction": "Doctor, I'm experiencing abnormal activity during sleep, and I've recently gained weight a little bit, and why?",
  "input": "",
  "output": "These symptoms can indicate closed sleep apnea."
},
{
  "instruction": "Doctor, I recently had a good breath and a headache.",
  "input": "",
  "output": "These symptoms may be signs of a disease called hypochalemia, which has low blood potassium levels."
},
{
  "instruction": "Doctor, I recently experienced diarrhea and vomiting. Why?",
  "input": "",
  "output": "The symptoms suggest that you may be suffering from low-calamity hemorrhagic disease."
},
{
  "instruction": "Doctor, fainting, loss of sense, sharp chest pain, diarrhea -- what could be the problem?",
  "input": "",
  "output": "It's possible that the symptoms are hypochonics."
},
{
  "instruction": "Doctor, I'm experiencing weakness, headaches, sharp abdominal pain, and why?",
  "input": "",
  "output": "These symptoms may be signs of hypochonics, which is a low level of potassium in the blood."
},
{
  "instruction": "Doctor, two-pass vomiting, sharp chest pain continues. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from low levels of potassium in your blood."
},
{
  "instruction": "Doctors, acne rashes, skin rashes, itching scalps, what's the disease?",
  "input": "",
  "output": "Dry glands generally appear as skin rashes, acne or acne, scalp itching."
},
{
  "instruction": "Doctors, skin textures, scales, roughness, skin growth, abnormal skin, dryness.",
  "input": "",
  "output": "The symptoms seem to indicate that you have a dry line, which is a skin disease that quickly accumulates in skin cells that causes scaly textures, itchings, inflammation."
},
{
  "instruction": "Doctor, you've recently had a severe skin coating and swelling, and why?",
  "input": "",
  "output": "It's possible that it's a line from the symptoms."
},
{
  "instruction": "Hi doctor, there are irregular skin rashes in scalp and skin skin, and we also found acne and acne and skin lesions, and what's the cause of all of this?",
  "input": "",
  "output": "It's a common skin disease that can cause what looks like abnormal skin lesions and acne and acne."
},
{
  "instruction": "Doctor, your arm is swollen, your leg is numb, your neck is touched, your shoulder is touched, what's the problem?",
  "input": "",
  "output": "It's a symptom that's caused by a shoulder dislocation, and it's a good idea to test the diagnosis and then suggest the appropriate treatment."
},
{
  "instruction": "Sir, there's a lump on my shoulder and it's red inside and out of my nose.",
  "input": "",
  "output": "It's possible that the shoulder will be distended, and the area will be swollen, and the redness of the nose may be due to the pain and stress caused by the distaff."
},
{
  "instruction": "Doctor, your shoulders are stiff, you've got cold, you've got lumps on your shoulders, you've got swollen arms, you've got a stiff feeling, you've got red inside and out of your nose.",
  "input": "",
  "output": "The symptoms suggest that the shoulder has been decommissioned."
},
{
  "instruction": "Hi there, doctor, shoulder, arm, wrist pain, and my leg weakened.",
  "input": "",
  "output": "Have you been injured or fell recently?"
},
{
  "instruction": "Sir, you've recently had wrist pain and a lump in your neck and a weakness in your legs.",
  "input": "",
  "output": "The symptoms suggest that the shoulder has been decommissioned."
},
{
  "instruction": "Doctor, there's a sharp abdominal pain and blood coming from the stool.",
  "input": "",
  "output": "It's possible that it's a symptom, and you have to do some tests to confirm your diagnosis."
},
{
  "instruction": "There's blood in the doctor, vomiting, abdominal pain, stools, diarrhea, toilets, what's the problem?",
  "input": "",
  "output": "The symptoms are likely to be intestinal scleroderma, a condition in which one part of the bowel slips into the other, and there is a mix of blood in vomiting, abdominal pain, stools, changes in bowel habits, so you can go to the hospital immediately because you need immediate treatment."
},
{
  "instruction": "Doctor, I've been very emotional lately, and I've been vomiting a lot, and I've got sharp abdominal pain.",
  "input": "",
  "output": "It occurs when one part of the bowel slips into the other and causes blockage, inflammation and pain in the abdomen, which can cause vomiting and emotional pain."
},
{
  "instruction": "Doctor, what's the problem with the recent growth of the bowel, with the nausea and the blood mixing in the stools?",
  "input": "",
  "output": "Symptoms indicate that it's likely that one part of the bowel is intestinal schistosomiasis, which is the disease that slips into the other part."
},
{
  "instruction": "Doctor, I'm having a lot of trouble with hip pain these days. What's the cause?",
  "input": "",
  "output": "It's possible that it's an inflammation of the cervix, and I recommend additional evaluations to check the diagnosis and discuss treatment options."
},
{
  "instruction": "Doctor, vaginal pain, pregnancy pain, lower abdominal pain, burning abdominal pain, nausea, what's the problem?",
  "input": "",
  "output": "The symptoms are most likely to be endocarditis, which can cause the symptoms you described because of inflammation in the cervix."
},
{
  "instruction": "Doctor, can you tell me what caused the pain during pregnancy?",
  "input": "",
  "output": "The symptoms could be hysteritis. Did you find any bleeding or secretions?"
},
{
  "instruction": "Doctor, you're having cramps and cramps in your lower abdomen, and when you urinate, you feel a lot of pain and a lot of heat in your stomach, and you get a lot of nausea, which is why?",
  "input": "",
  "output": "Symptoms indicate that you may be suffering from an inflammation of the cervix, an infection, a stimulus, or an allergic reaction, and it's good to have a pelvic examination and a few laboratory tests to identify the diagnosis and start a proper treatment."
},
{
  "instruction": "Doctor, the pain is continuing with nausea and vaginal pain during pregnancy. Do you know what's going on with me?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from endocarditis."
},
{
  "instruction": "Sir, you're coughing, and you're having headaches, and your ears are hurting, and your throat's swollen, and what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there's an inducer abscess."
},
{
  "instruction": "Hi, doctor, I'm having a sore throat and a sore nose and sore throat. Can you tell me what's causing it?",
  "input": "",
  "output": "We need to do some tests to make sure we're clear, but the infection is likely to cause pus sacs in the back of the throat."
},
{
  "instruction": "Doctor, your neck hurts, you have headaches, you're vomiting, your throat is swollen, your body is sick, what's your disease?",
  "input": "",
  "output": "I think there's a pharynx abscess."
},
{
  "instruction": "Doctor, my neck hurts and my chest hurts.",
  "input": "",
  "output": "There could be a pharynx. Have you had a swelling of your throat or an allergic reaction recently?"
},
{
  "instruction": "Doctor, I've been vomiting a couple of days ago. What's the problem?",
  "input": "",
  "output": "There could be a pharynx."
},
{
  "instruction": "I'm experiencing a doctor, a rectal hemorrhage, a bloating, aggravation, eye symptoms, extreme fatigue. What's wrong with me?",
  "input": "",
  "output": "And these symptoms can lead to spontaneous platelet reduction."
},
{
  "instruction": "Good morning, sir. I've been having trouble lately, and I've had strange symptoms in my eyes.",
  "input": "",
  "output": "It's possible that the symptoms indicate that you're suffering from proto-respirosis."
},
{
  "instruction": "Sir, I've been feeling anal pain and extreme fatigue lately. Can you diagnose it?",
  "input": "",
  "output": "It's possible that the symptoms indicate that you're suffering from proto-respirosis."
},
{
  "instruction": "Doctor, I've got rashes, eye symptoms, dizzying, anal pain, rectal bleeding. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that hemolytic platelet reduction is a rare blood disease that produces too much platelets in the bone marrow, causing clots and bleeding problems. It's good to run some tests to check the diagnosis and discuss treatment options."
},
{
  "instruction": "Sir, leg pain, groin pain, back pain, hip pain, hip stiffness or abrasion, do you know what the symptoms are?",
  "input": "",
  "output": "The symptoms suggest that there's a high arthritis that can cause pain or stiffness in the area you're talking about."
},
{
  "instruction": "Doctor, hip pain, knee pain, groin pain, backaches, what's the problem?",
  "input": "",
  "output": "The symptoms are likely to be hyperarthritis, which causes pain and stiffness in the hip."
},
{
  "instruction": "Sir, a few months ago, you've had problems with your lower body movements and pain.",
  "input": "",
  "output": "The symptoms seem to indicate that you have hip arthritis."
},
{
  "instruction": "Doctor, there's been a lot of joint pain in your hip lately. Do you know what caused it?",
  "input": "",
  "output": "The symptoms suggest that you may have hip arthritis."
},
{
  "instruction": "There's a doctor, a joint pain, a groin pain, a lower body pain, a backache. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you have hip arthritis, which causes pain and stiffness as the hip cartilage slowly wears over time."
},
{
  "instruction": "Doctor, I feel skin pain and I can't talk, and I can't cover my urine.",
  "input": "",
  "output": "The symptoms suggest that you have an ulcer."
},
{
  "instruction": "Doctor, the skin of your legs and feet seems to be infected, and it's very painful. What's the problem?",
  "input": "",
  "output": "From the symptoms that God explains, I think there's an ulcer in the tub."
},
{
  "instruction": "Doctor, it's hard to say, it's hard to say, it's like there's a side effect. What's the problem?",
  "input": "",
  "output": "When you put it off as a symptom, you're probably suffering from a sore, which is a form of skin ulcer caused by constant pressure on one side."
},
{
  "instruction": "Doctor, you've got a problem with your sense of smell or taste. Can you tell me what's wrong?",
  "input": "",
  "output": "like when you're in bed or sitting in a wheelchair for a long time, these ulcers can cause long hours of pressure on a particular part of your body."
},
{
  "instruction": "Doctor, I recently got a fever and a lack of energy. What's the problem?",
  "input": "",
  "output": "What you're saying is that you're suffering from a high-sodium hemolysis."
},
{
  "instruction": "Doctor, I've been feeling very depressed lately, and I feel like I'm having some mental symptoms.",
  "input": "",
  "output": "There's the possibility that you're experiencing a high-sodium hemolysis in terms of your symptoms and your history of disease."
},
{
  "instruction": "Doctor, vomiting, fainting, apnea, shortness of breath, fever. What's the problem?",
  "input": "",
  "output": "The symptoms may indicate that you have high levels of sodium in your blood, and you need to do some blood tests to confirm your diagnosis."
},
{
  "instruction": "I'm really sick these days. My whole body hurts and falls down a lot.",
  "input": "",
  "output": "The symptoms could indicate a high-sodium hemolysis."
},
{
  "instruction": "Doctor, you're having a lot of menstruation, a lot of fever, and you're having trouble breathing. What's the problem?",
  "input": "",
  "output": "This is a condition that occurs when there's too much sodium in the blood, which can cause a lot of symptoms, including the symptoms that you're currently experiencing."
},
{
  "instruction": "Doctor, I can't hear you very well. Your hearing seems to have been somewhat impaired.",
  "input": "",
  "output": "The symptoms seem to indicate that there are sensory malformations."
},
{
  "instruction": "Doctor, I have a lump in my neck and I can't hear it very well.",
  "input": "",
  "output": "Your hearing problem may have something to do with the back of your neck. It may be sensory nerve hearing."
},
{
  "instruction": "Doctor, I think your hearing has been down lately. What's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that there's sensory nerve hearing."
},
{
  "instruction": "Doctor, my nose is blocked, my ears are tickled, my ears are hoarse. What's the problem?",
  "input": "",
  "output": "The symptoms could be sensory nerve hearing."
},
{
  "instruction": "Sir, I recently had a problem in my ear, and I think there's a fluid in my ear, and there's a constant sound, and there's a lump in my neck.",
  "input": "",
  "output": "It's important to understand the level of hearing loss and the underlying cause of hearing loss, and so we need to look at the mass of the neck as well."
},
{
  "instruction": "Doctor, there's a lot of skin pain going on. What's the problem?",
  "input": "",
  "output": "A chronic ulcer can be very painful, usually caused by an open ulcer on the skin."
},
{
  "instruction": "There's an ulcer in the leg that doesn't heal, and it looks like the skin around it is infected.",
  "input": "",
  "output": "The symptoms seem to indicate that you have a chronic ulcer, which can be seen in a few tests, but can be caused by a variety of factors such as poor circulation, diabetes, obesity, and so on."
},
{
  "instruction": "Doctor, I've had a lot of skin pain lately.",
  "input": "",
  "output": "The symptoms suggest that you have a chronic ulcer."
},
{
  "instruction": "Doctor, there's a lot of skin pain going on. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that you have a chronic ulcer."
},
{
  "instruction": "Doctor, can you tell me what's wrong with your recent skin pain?",
  "input": "",
  "output": "The symptoms seem to indicate you're suffering from a chronic ulcer, and you need to do some tests to confirm your diagnosis."
},
{
  "instruction": "Sir, I've had a lot of back pain lately.",
  "input": "",
  "output": "It could be osteoporosis."
},
{
  "instruction": "Doctor, I'm experiencing a memory disorder and abdominal ovulation, and I've also had a lot of urination at night, as well as hip pain and joint pain, and what's the problem?",
  "input": "",
  "output": "You're probably suffering from bone weakness and fragile osteoporosis, and you have to do some tests to check your diagnosis."
},
{
  "instruction": "Good morning, doctor, we've got a stiff, bloated back together. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to lead to osteoporosis."
},
{
  "instruction": "Doctor, we have symptoms that we often urinate at night. What are they?",
  "input": "",
  "output": "Night Binsus may be caused by a number of causes, but for the inquirer, osteoporosis can be associated with a bone that is weak and fragile, which can lead to a lot of urination at night."
},
{
  "instruction": "I'm experiencing a painful bone, aching joint pain, hip pain, stiffness, memory problem.",
  "input": "",
  "output": "The symptoms seem to indicate that you have osteoporosis, a condition in which bones are weak and fragile, which can lead to painful fractures in your hip, spine and wrist."
},
{
  "instruction": "Doctor, diarrhea, nausea, sharp abdominal pain continues. What's wrong with me?",
  "input": "",
  "output": "These symptoms seem to indicate that there is an illus."
},
{
  "instruction": "Doctor, I'm experiencing anal pain, stomach pain, vomiting. What's wrong with me?",
  "input": "",
  "output": "Symptoms indicate that there is no normal bowel movement or decline so much that it's likely to be intestinal obstruction, nausea, vomiting, and so forth."
},
{
  "instruction": "Doctor, I've been feeling nauseous for a few days. What's the cause?",
  "input": "",
  "output": "Do you have abdominal pain or disarray? woman: Yes, doctor, I had an uncomfortable, even more complex feeling."
},
{
  "instruction": "Doctor, there's been diarrhea and nausea in the last few days. What's the cause?",
  "input": "",
  "output": "Eleus is a disease that can cause nausea and diarrhea, and we need to do some tests to identify the diagnosis."
},
{
  "instruction": "Doctor, knee pain, whole pain, vomiting, sharp abdominal pain, what are the symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate that there's a red blood cell crisis."
},
{
  "instruction": "Doctor, I'm experiencing a burning abdominal pain, and why?",
  "input": "",
  "output": "I think there's a red blood cell crisis because of the symptoms, and we need to do some tests to check it out."
},
{
  "instruction": "Doctor, there's so much pain in the leg and sore abdominal pain. What's the problem?",
  "input": "",
  "output": "I think there's a red blood cell crisis because of the symptoms."
},
{
  "instruction": "Doctor, the burning abdominal pain doesn't go away. Do you know what caused it?",
  "input": "",
  "output": "Yes, it's very likely you're experiencing a red blood cell crisis, which is a common symptom of sickle cell disease in patients."
},
{
  "instruction": "Doctor, burning abdominal pain, back pain, fever, leg pain, arm pain, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from a sickle cell crisis. Have you been diagnosed with sickle cell anemia?"
},
{
  "instruction": "Doctor, I've found that there's a penis pain and a penis secretion, and there's a chest pain and a sharp abdominal pain, and you know what's causing all of these symptoms?",
  "input": "",
  "output": "The symptoms are likely to be urethra, which is associated with inflammation of the urethra or infections, which can cause negative pain, secretions, upper jaw and abdominal pain."
},
{
  "instruction": "Sir, I'm experiencing hip pain, skin itching, penis secretions, and penis pain.",
  "input": "",
  "output": "Symptoms are likely to indicate that you have a disease called urethritis."
},
{
  "instruction": "Sir, you've recently had severe urinary pains. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate urethra, which is an inflammation of the urethra, which can cause urinary pain."
},
{
  "instruction": "Doctor, I've recently had an uncomfortable condition in my urine, and I've been experiencing a mixture of blood in my throat, and I've had a chest pain, and I've had a sore throat, and I've had a sore throat, and I've had a pain in my throat, and I've had a lot of pain in my throat, and I've had a lot of pain in my throat, and I've had a lot of pain in my throat, and I've had a lot of pain in my throat, and I've had a lot of pain in my throat, and I've had a lot of pain in my throat, and I've had a lot of pain in my throat, and I've had a lot of pain, and I've had a lot of pain in my body, and I've had a lot of pain, and I've had a lot of pain in my stomach, and I've had a lot of pain in my body of pain, and I've had a lot of pain in my body of pain, and I've had a lot of pain in my body, and I've had a lot of pain in my throat, and a lot of pain, and a lot of pain in my body of pain, and a lot of pain, and a lot of pain, and a lot of pain, and a lot of pain, and a lot of pain, and a lot of pain in my body of pain, and a lot of pain, and a lot of pain, and a lot of pain, and a lot of pain, and a lot of pain, and a lot of pain, and a lot of pain, and a lot of pain, and a lot of pain, and a lot of pain, and a lot of pain, and a lot of pain, and a lot of pain of pain of pain of pain of pain of pain of pain of pain, and a lot of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain of pain",
  "input": "",
  "output": "The symptoms that God's talking about may indicate that you're suffering from urinary tractitis."
},
{
  "instruction": "Hi, doctor, you have a problem with sexual health, you can't have sex as usual.",
  "input": "",
  "output": "Proplasia is an inflammation of the prostate and can cause pain and discomfort in the lower abdomen."
},
{
  "instruction": "Doctor, I'm having a lot of discomfort because I'm having trouble with urination, and I'm also having prostate symptoms, and why?",
  "input": "",
  "output": "The symptoms that God's talking about indicate that you're not urinating well and that you have prostateitis that causes prostate obesity, and you have to do some tests to confirm your diagnosis."
},
{
  "instruction": "Doctor, I've got chills and lower abdominal pain.",
  "input": "",
  "output": "The symptoms may indicate that you have prostate inflammation, which can cause fever, chills, lower abdomen or back pain, which requires additional tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I've seen urine frequently, and I've got blood in my urine, and I've got lower abdominal pain.",
  "input": "",
  "output": "I think you have prostate disease. Have you had trouble urinating, or have you experienced extreme pain?"
},
{
  "instruction": "Doctor, I'm experiencing erectile failure and urinary pain. What's the cause of the symptoms?",
  "input": "",
  "output": "Prostatitis is likely to be prostateitis, an inflammation of the prostate that can cause pain and discomfort in urination and sexual activity."
},
{
  "instruction": "Doctor, I've got red ears, and I've got a feeling of deafness in my ears, and I've got a little bit of water in my ears, and I hear a continuous ringing of my ears.",
  "input": "",
  "output": "The symptoms seem to indicate that there is an external gastritis, also known as the swimmer's ear."
},
{
  "instruction": "Doctor, there's a ringing sound in your ear, and it's been bothering you a few days ago.",
  "input": "",
  "output": "The symptoms seem to indicate that there's an external gastritis."
},
{
  "instruction": "Doctor, there's blood in the ear, there's fluid in the ear, there's pain in the ear.",
  "input": "",
  "output": "I think there's an external gastritis called the swimmer's ear."
},
{
  "instruction": "Doctor, there's some ringing in the ear, some hearing loss, facial pain, and there's a feeling that there's a fluid in the ear.",
  "input": "",
  "output": "The symptoms you just described show that there's an externalitis called the swimmer's ear."
},
{
  "instruction": "Doctor, you've got blood in your ears, facial pain, decreased hearing, and why?",
  "input": "",
  "output": "The symptoms are likely to indicate that it's an external gastritis, commonly known as a swimmer's ear."
},
{
  "instruction": "Doctor, I've been sick lately, and I've had difficulty making things clear.",
  "input": "",
  "output": "Are you taking anti-convulsants? Patient: Yes, I've been prescribed."
},
{
  "instruction": "Doctor, you're experiencing seizures, motor disorders, eye pain. Do you know what's causing all these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate an addiction to anti-convulsants, and we need to run some tests to see if we can do that."
},
{
  "instruction": "Doctor, I've had a lot of pain in my eyes lately, and I'm very sick, and you know what's causing it?",
  "input": "",
  "output": "Yes, it's possible to be an addiction to anti-convulsants, which can cause side effects, such as eye pain and feeling disease, and we need to do some tests to check this out, but it's important to start treatment immediately."
},
{
  "instruction": "We're experiencing doctors, seizures, headaches, pain in the eyes, vomiting and conditioning. What's the problem?",
  "input": "",
  "output": "I think there's been an addiction to anti-convulsants. Have you taken anti-convulsants recently?"
},
{
  "instruction": "Doctor, you're having a continuous seizure, and you're hearing a constant sound in your ear, and you're sick.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from an addiction to anti-convulsants."
},
{
  "instruction": "Doctor, I'm experiencing elbow spasms, spasms, back pain, scrotum, some emotional symptoms.",
  "input": "",
  "output": "It's possible that it's a high-recipital failure, according to the symptoms."
},
{
  "instruction": "Doctor, there's a couple of symptoms that are really disturbing, that the muscles in the groins are swollen and the elbows are weak, and it's like a scrotum is swelling.",
  "input": "",
  "output": "The symptoms may indicate that it's a hypertonic failure, which is a condition in which the testes that supply the blood to the test block the blood flow and cause swelling and pain, which is essential to immediate treatment in order to prevent permanent damage to the test."
},
{
  "instruction": "Doctor, I'm experiencing back pain and emotional symptoms, elbow spasms and tics.",
  "input": "",
  "output": "Symptoms suggest that the testes may be a hyperrecipital failure, which causes pain and swelling in the scrotum, but back pain, emotional symptoms and elbow spasms generally don't have to do much to determine the exact cause of the symptoms."
},
{
  "instruction": "Hi, with elbow spasms and sharp, burning abdominal pain.",
  "input": "",
  "output": "The symptoms suggest that it's caused angina, a condition that causes blood loss and severe pain, and it can also cause cramps in abdominal pain and in other parts of the body."
},
{
  "instruction": "Doctor, there's abdominal pain, swelling and burning in the muscles near the testes, you know what this is?",
  "input": "",
  "output": "The symptoms seem to make it suspicious of the testes, which occur when the sperm that supplies the blood to the test is twisted, causing severe pain and swelling, sometimes nausea or vomiting, which is an emergency, so you need to be treated immediately."
},
{
  "instruction": "Doctor, I've recently experienced some unusual symptoms: emotional ups and downs and downs, back pains and throat sensations.",
  "input": "",
  "output": "The symptoms that God has described seem to indicate that there's a tricuspid valve disease, has there ever been shortness of breath or swelling of legs or abdomen, which is a common symptom of this disease?"
},
{
  "instruction": "Doctor, I'm experiencing emotional symptoms, loss of wrists, biting nails, overgrowth, and sometimes concurrent eyes.",
  "input": "",
  "output": "It can cause not only the emotional symptoms that you're experiencing, but many other symptoms, including muscle weakness and growth problems."
},
{
  "instruction": "Doctor, I've been experiencing emotional symptoms with anxiety and anxiety lately, and back pain, and wrist weakness and elbow weakness, and what's the cause of all these symptoms?",
  "input": "",
  "output": "This disease can cause a variety of symptoms, including anxiety, tension, emotional symptoms, loss of wrist and elbow strength, which can sometimes lead to swelling in the abdomen, causing pressure to the waist, which may involve some additional tests and tests to confirm the diagnosis, but it will work together to treat the symptoms and improve the quality of life."
},
{
  "instruction": "Doctor, I'm experiencing elbow spasms, loss of wrists and aching eyelids, and recently, there's been eyesicking and emotional symptoms, and what's the cause of these symptoms?",
  "input": "",
  "output": "These symptoms may be due to tricust valve disease that affects blood flow between the right ventricles, and we need to do some tests to confirm the diagnosis."
},
{
  "instruction": "Doctor, I've recently experienced a strange condition: spasms and tics in the elbows, constant anxiety and anxiety, and excessive hair growth, which is like the loss of the wrist and the rest of the body.",
  "input": "",
  "output": "The symptoms that God's talking about indicate that there's a tricuspid valve disease."
},
{
  "instruction": "Doctor, I've been experiencing a few symptoms recently, frequent and excessive urination at night, a little discomfort in the scrotum and the testes.",
  "input": "",
  "output": "The symptoms seem to indicate that there is a condition called urethra percussion, which occurs when the urethra narrows so that normal urination is difficult."
},
{
  "instruction": "Doctor, I have urinary pain.",
  "input": "",
  "output": "There could be a urethra in terms of symptoms."
},
{
  "instruction": "Sir, we've recently had a problem with urine, which is that urine is too frequent, and sometimes it's subconscious to urinate.",
  "input": "",
  "output": "From your symptoms, the urethra appears to have developed a utensil that narrows the urethra, making it difficult for the urine to pass through, causing the symptoms of night bed rest, involuntary urination, and so forth."
},
{
  "instruction": "Doctor, there's blood in the urine and there's a lot of urination at night. What's the problem?",
  "input": "",
  "output": "It's like there's a urethra that narrows the urethra, which can cause edema, bleeding in the urine, or a lot of urinating at night."
},
{
  "instruction": "Doctor, I've got stiff arms, stiff backs, and my mouth is dry recently, and I don't get menstruating very often.",
  "input": "",
  "output": "It's a common disease that causes muscle weakness, bone pain and fatigue."
},
{
  "instruction": "Hi doctor, I'm experiencing stiff arms, stiff skin stimulation, dry mouth, joint pain, irregular menstruation.",
  "input": "",
  "output": "The symptoms may indicate a lack of vitamin D."
},
{
  "instruction": "Doctor, your arm's been stiff, it's been tight, it's been gaining weight, it's been a lot of months, and what's the problem?",
  "input": "",
  "output": "These symptoms may be signs of vitamin D deficiency, are you getting enough sunlight or supplements?"
},
{
  "instruction": "Doctor, I don't think I can breathe when I smoke these days, and sometimes I can't breathe.",
  "input": "",
  "output": "Because of your symptoms, you may have a vitamin D deficiency, which is common to smokers, and lack of vitamin D can cause respiratory problems, you may need to take supplements, or you may need to adjust your diet."
},
{
  "instruction": "I'm experiencing joint pain, skin irritation, stiff backs and colds, and can you tell me why?",
  "input": "",
  "output": "Symptoms indicate a high risk of vitamin D deficiency."
},
{
  "instruction": "I'm experiencing doctors, vomiting, backaches, side pain, dizziness. What's the problem?",
  "input": "",
  "output": "There's a possibility that there's a water spot to postpone the symptoms, which is a rare form of abnormal growth in the uterus during pregnancy, which can cause the same symptoms as you described."
},
{
  "instruction": "Doctor, I've had some strange symptoms recently: low vision, sharp abdominal pain, a spot or bleeding during pregnancy, what's the problem?",
  "input": "",
  "output": "It's a rare type of tumor that forms during pregnancy, and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I'm having some pain and discomfort during pregnancy, and I'm feeling dizzy and nausea most of the time, and I'm also having abdominal pain.",
  "input": "",
  "output": "From the symptoms that God explains, there seems to be a water-based point where a fertilized egg does not develop into a baby but grows into a tumor, which can cause pain during pregnancy, pregnancy, dizziness, nausea and burning abdominal pain."
},
{
  "instruction": "Doctor, you've recently had backaches. What's the cause?",
  "input": "",
  "output": "Did you ever pass an abnormal vaginal hemorrhage or a grape-shaped cyst?"
},
{
  "instruction": "The doctor, the neck pain, the back pain, even the shoulder pain, it's really painful, you know what causes these symptoms?",
  "input": "",
  "output": "Yes, there's a good chance that you have a pain disorder affecting your neck, which is also called a backache."
},
{
  "instruction": "Doctor, I recently experienced arm pain, insomnia, sensory loss. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that there's a pain disorder affecting the neck."
},
{
  "instruction": "Doctor, you're in pain in your arms and shoulders, you're dizzy, you're not sleeping well, and your stiff neck doesn't go away.",
  "input": "",
  "output": "You may have a pain disorder affecting your neck: arm and shoulder pain, nausea, insomnia, stiffness in the neck or shortness of the neck, which is a common symptom of the disorder, which requires several additional tests to be diagnosed, but you can start treating the symptoms immediately."
},
{
  "instruction": "Sir, I don't think I've been feeling any pain in my shoulder for a while, so what's the problem?",
  "input": "",
  "output": "The symptoms that God's talking about indicate that there's a possibility that the pain in the neck is caused by C.B.D."
},
{
  "instruction": "Doctor, I've recently had a number of unusual symptoms: vaginal senility, inability to breathe, around the neck, shortness of breath, overexploitation, what's the problem?",
  "input": "",
  "output": "The symptoms seem to make it suspicious, and we need to run some tests and start a treatment plan immediately."
},
{
  "instruction": "Doctor, skin drying, texture, scales, roughness, sweat, neck secretions, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you have tuberculosis, and it's good to run some tests to check your diagnosis and start treating it immediately."
},
{
  "instruction": "I've got itchy, and I've got it in my chest.",
  "input": "",
  "output": "The symptoms you're experiencing may be signs of tuberculosis. Did you cough?"
},
{
  "instruction": "Doctor, when you breathe, you're in pain, you're sweating, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain, you're in pain.",
  "input": "",
  "output": "The symptoms are that TB, a bacterial infection that affects the lungs, is more likely to cause these symptoms, and we need to run additional tests to confirm the diagnosis, but it's important to start treatment immediately."
},
{
  "instruction": "Sir, I've been having a hard time with my heart, and I've been feeling foreign in my neck lately.",
  "input": "",
  "output": "The symptoms that God's talking about indicate that tuberculosis has developed."
},
{
  "instruction": "Doctor, heartburn, rectal hemorrhage, back pain, muscle swelling, scrotum. What's the problem?",
  "input": "",
  "output": "To put it off as a symptom, a hip fistula may be the cause."
},
{
  "instruction": "Doctor, I'm experiencing analystosis, rectal bleeding and scrotum. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that there is a hip fistula."
},
{
  "instruction": "Doctor, I've been experiencing heartburn and back pain in the last few days, and do you want to know what's causing it?",
  "input": "",
  "output": "To put it off as a symptom, a hip fistula may be the cause."
},
{
  "instruction": "Doctor, I've had muscle swelling for a while, so can you tell me what caused it?",
  "input": "",
  "output": "The symptoms could be the cause of the pelvic fistula."
},
{
  "instruction": "Doctor, what's the problem when you've got a lot of nausea and back pain that's been going on for a long time?",
  "input": "",
  "output": "I think you're suffering from a hip fistula."
},
{
  "instruction": "Doctor, my baby has recently become very irritable and feverish, and it's like it's bleeding a nostril.",
  "input": "",
  "output": "The symptoms that you've described indicate that babies are more likely to have acute C.T."
},
{
  "instruction": "Doctor, in the last few days, I've had coughs and fevers and appetites, and I have nosebleed, and what can happen to me?",
  "input": "",
  "output": "The symptoms seem to indicate that you have acute stratitis."
},
{
  "instruction": "Doctor, I've been sick these days, and when I'm vomiting and breathing, I feel a sense of festering, what's the problem?",
  "input": "",
  "output": "The symptoms are likely to be acute stratitis, a common respiratory infection that affects infants especially in small lung prayers."
},
{
  "instruction": "Doctor, it's pretty, it's painful when you breathe, and it's got a nose.",
  "input": "",
  "output": "The symptoms seem to indicate acute stratitis."
},
{
  "instruction": "Doctor, my baby's been really annoying and coughing a lot these days, and I think it's too much to breathe and too much to breathe.",
  "input": "",
  "output": "These symptoms suggest that the baby may have had acute stratitis."
},
{
  "instruction": "Sir, you've got the hotness of your eyes, the itching of your eyes, the tears and the spots in your eyes.",
  "input": "",
  "output": "These symptoms suggest that there may be noon, a normal aging disorder that affects your ability to see nearby, that it's good to have your eyes examined to check your diagnosis and discuss your treatment options."
},
{
  "instruction": "Sir, over the last few weeks, we've been experiencing eye pain, excessive tears, intubation, itching, fever, what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate that you're struggling with noon, a condition associated with aging, where the lens of the eye becomes less flexible and harder to focus on nearby objects."
},
{
  "instruction": "Doctor, I think you've got a lump in your eyelids, a foreign substance in your eye, and sometimes you can't talk, and you have tears, and you have pain in your eyes, and what's the problem?",
  "input": "",
  "output": "These symptoms seem to affect the eye's ability to focus on nearby objects because of aging."
},
{
  "instruction": "Sir, I've got a problem with my eyes. What are the symptoms?",
  "input": "",
  "output": "I think you're experiencing noan symptoms."
},
{
  "instruction": "Doctor, I have symptoms that don't sleep well at night, that my body is inert, that I have difficulty moving or remembering things.",
  "input": "",
  "output": "Because of the symptoms that God mentioned, you may be suffering from dementia, which affects memory, thinking, behavior and exercise, and you have to do some tests to establish your diagnosis and plan your treatment."
},
{
  "instruction": "Doctor, I'm losing my sense of smell and taste, and I'm experiencing the movement and paralysis of my hands and feet, and what's the cause?",
  "input": "",
  "output": "Unfortunately, these symptoms can indicate a neurological disorder known as dementia."
},
{
  "instruction": "Doctor, what are the symptoms of my involuntary movement abnormally manifest and movement problems?",
  "input": "",
  "output": "The symptoms seem to make dementia suspicious."
},
{
  "instruction": "Doctor, I've been experiencing a very strange condition recently, which is that I'm feeling a lot of sensory abnormalities, a lot of dizziness, abnormally involuntary movements, and can you tell me what's causing it?",
  "input": "",
  "output": "In view of the symptoms that God mentioned, it's possible to be an early sign of dementia, and it's important to do some additional tests to identify the diagnosis and determine how to treat the best in the future."
},
{
  "instruction": "Doctor, I haven't slept well lately, and sometimes I feel weak on one side of my body, and I can see and hear things that don't exist.",
  "input": "",
  "output": "It seems to be a form of dementia, because of what God says about it: depression and mental symptoms, insomnia, poor concentration, delusions and hallucinations are common in dementia patients; it's best to get additional evaluations and tests to check the diagnosis and discuss treatment options."
},
{
  "instruction": "Doctor, I think you're bitten by a bug, and your hands and legs are swollen, and you've got fluid.",
  "input": "",
  "output": "The symptoms seem to indicate that you're allergic to a bug bite."
},
{
  "instruction": "Doctor, your arm is swollen and your skin looks weird. What's the problem?",
  "input": "",
  "output": "I think I'm bitten by a bug."
},
{
  "instruction": "Doctor, your legs are swollen and your eyes are swollen.",
  "input": "",
  "output": "I think I'm bitten by a bug."
},
{
  "instruction": "Sir, you've got a problem, your arm is swollen, your eyes are too swollen to see, and it's like you're getting skin rashes and you're getting fluid deposits in your body, and what's the cause of all this?",
  "input": "",
  "output": "These symptoms are generally associated with allergic reactions to worm stings, and if they're not treated properly, they can be very serious. It's good to take antihistamine immediately to cool down the swelling and prevent further complications."
},
{
  "instruction": "Doctor, after being bitten by a worm, your skin is swelling.",
  "input": "",
  "output": "I think I'm bitten by a bug."
},
{
  "instruction": "Doctor, there's been a couple of recent problems: heart rate seems to be decreasing, and speech may be compromised, and there's also sharp chest pain, and what's the cause of all these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate that there's a seizure V-tach, a few tests to confirm the diagnosis, but we're going to work together in a treatment plan to alleviate these symptoms."
},
{
  "instruction": "Doctors, heart rate increase, irregular heart rate, heart rate decline, shortness of breath, weight gain, what's the reason?",
  "input": "",
  "output": "The symptoms seem to indicate that you have a seizure V-tach."
},
{
  "instruction": "Doctor, I'm experiencing chest distress, irregular heart rate, head rate, heart rate, increased heart rate. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that he has a seizure V-tach."
},
{
  "instruction": "Doctor, I've been having strange symptoms recently, with my eyes becoming even eyes and my limbs swelling with lymph nodes, and what's the problem?",
  "input": "",
  "output": "Symptoms are likely to cause congenital heart defects, which can cause a lot of symptoms like what you said about heart structure, and we need to do some tests to confirm the diagnosis."
},
{
  "instruction": "Doctor, what's wrong with your hands being stiff, your heart rate is down, your appetite is too high?",
  "input": "",
  "output": "There's a possibility that there's a congenital heart defect that causes a lot of symptoms, including the symptoms that your heart didn't develop before birth, that you have to be properly diagnosed and treated by a heart specialist."
},
{
  "instruction": "There are many symptoms of doctors, infant feeding problems, lack of growth, lymph nodes, irregular navels, and sometimes there's sharp chest pain, and tell me what's going on.",
  "input": "",
  "output": "It looks like there's a congenital heart defect in the structure of the heart that exists from birth, which can cause a lot of symptoms, including the symptoms you've been talking about, and we need to do additional tests to identify the diagnosis and discuss how best to treat it."
},
{
  "instruction": "Doctor, I'm experiencing a form of undergrowth, sassy, sharp chest pain, excessive appetite. What's the problem?",
  "input": "",
  "output": "There could be congenital heart defects."
},
{
  "instruction": "Doctor, what's the cause of the irregular, sharp chest pain in the navel?",
  "input": "",
  "output": "I think there's some sort of congenital heart defect affecting the heart, and you have to consult a heart specialist for additional tests and evaluations."
},
{
  "instruction": "Doctor, your arm is sick, you're hard to swallow, you're sick, you're sore, what's the problem?",
  "input": "",
  "output": "It's important to do some tests to identify the diagnosis and plan the treatment."
},
{
  "instruction": "Doctor, I felt sick all over my body with pain, and recently my arms and legs were swelling.",
  "input": "",
  "output": "The body seems to have this reaction due to a connective tissue disorder, which is called lymphoma, which is a common symptom of this disease."
},
{
  "instruction": "Doctor, I've been very tired lately, and I don't know what's wrong.",
  "input": "",
  "output": "The connective tissue disorder you have. Patient: What exactly is it?"
},
{
  "instruction": "Doctor, I've been sick lately.",
  "input": "",
  "output": "It could be a connective tissue disorder."
},
{
  "instruction": "Doctor, I'm always tired.",
  "input": "",
  "output": "You may be experiencing fatigue, a common symptom of connective tissue disorders."
},
{
  "instruction": "Doctor, there's a problem with my eyes. I think I've got a foreign substance in my eye.",
  "input": "",
  "output": "Based on what God has explained, it seems that there is a foreign substance in the eye, which can cause swelling of the eyelids and abnormal movement of the eyelids."
},
{
  "instruction": "Hi, doctor, I've been looking at you a couple of days ago, and I think I'm sick of your eyes.",
  "input": "",
  "output": "It looks like there's a foreign substance in your eye, and I'll look at it and see what's going on."
},
{
  "instruction": "Sir, I've got a lot of eyes and I've been crying all the time.",
  "input": "",
  "output": "These symptoms indicate that there may be a foreign substance in the eye that's causing irritation."
},
{
  "instruction": "Doctor, I've got a strange feeling in my eyes, and I think I've got something in my eye, and my eyelids are acting abnormally, and they're very dark.",
  "input": "",
  "output": "Have you been exposed to any particles or dust that you can see recently?"
},
{
  "instruction": "Doctor, I've been sick lately, and I've got nausea, and my neck hurts, and I can't breathe.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from gas poisoning."
},
{
  "instruction": "Doctor, I've been having very disturbing symptoms recently, and I'm hearing a lot of mess, a lot of nausea, and what's the problem?",
  "input": "",
  "output": "The symptoms that God has described suggest that you may have been addicted to gas, and it's important that you get medical attention immediately."
},
{
  "instruction": "Doctor, you've got a lot of pain in your body lately -- nausea, dizziness, shortness of breath, shortness of breath, your nose -- and what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate you're suffering from gas poisoning."
},
{
  "instruction": "It looks like your legs are swollen and infected, and your legs are swollen and your skin looks abnormal.",
  "input": "",
  "output": "Symptoms suggest that agronomous skin infections are suspected."
},
{
  "instruction": "Doctor, there's pain in your feet and toes, pain in your hands and fingers and swelling, and there's a strange change in skin and swelling in your hands and your feet.",
  "input": "",
  "output": "The symptoms seem to indicate that agronomous skin infections are a form of skin infection caused by bacteria, which can cause a variety of symptoms, such as skin rashes, pain and swelling, which may lead to horse rashes or abnormal skin patterns."
},
{
  "instruction": "Doctor, I've been having strange symptoms recently -- swelling of my feet and legs, rashes and pain in my legs, what's the problem?",
  "input": "",
  "output": "The symptoms suggest that there's agronomous skin infection."
},
{
  "instruction": "Doctor, you've got skin lesions on your leg, so there's swelling and pain. What's the problem?",
  "input": "",
  "output": "I think there's a bacterial skin infection, agronomous skin infection, caused by bacteria."
},
{
  "instruction": "Doctor, there's a lot of pain in your hands and fingers, and why?",
  "input": "",
  "output": "It could be agronomous skin infection caused by bacteria invading through the cracks in the skin."
},
{
  "instruction": "Doctor, I'm experiencing postmenopausal muscle edema, menstrual excess, vaginal bleeding, and I'm also developing vaginal secretions, and I recently developed puss in my ear.",
  "input": "",
  "output": "You can have endometriosis, where the endometriosis is too thick for symptoms, which can lead to menstrual menstrual edema or irregular menstrual bleeding and postmenopausal bleeding."
},
{
  "instruction": "We're dealing with doctors, backaches, menstrual overload, muscle edema, vaginal secretions, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms suggest that you have endometriosis."
},
{
  "instruction": "Hi, doctor, we've recently had health problems -- puss on the liver, vaginal secretions, hip pain, and we can't predict the cause.",
  "input": "",
  "output": "These symptoms could be the result of this disease, and it's important to run additional tests to check this out and get proper treatment."
},
{
  "instruction": "Sir, even after menopause, vaginal bleeding continued to increase, so what's the problem?",
  "input": "",
  "output": "I think you're suffering from endometriosis, which is a condition in which the endometriosis is so thick that it causes abnormal bleeding."
},
{
  "instruction": "Teacher, hip pain, pus on the scissors, menstruation, weakness of the waist, and involuntary urination.",
  "input": "",
  "output": "The symptoms you described suggest that it's likely to be endometriosis, and you have to do some tests to confirm your diagnosis."
},
{
  "instruction": "Doctor, I'm feeling pain and pain in my breast, and I've got skin spots, acne and fluid decline, and I have strange skin lesions, and you know what causes these symptoms?",
  "input": "",
  "output": "Yes, there can be melanoma, which is often characterized by dark, thick skin patches and can be accompanied by symptoms such as the one you described."
},
{
  "instruction": "Sir, I'm having trouble breathing at night, and sometimes I wake up with a breath.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from sleep apnea, which is a common condition in patients with melanoma, and you have to do some additional tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I'm experiencing infertility and allergic reactions, and I've also found that the skin is growing a little bit, and I'm experiencing breast pain and pain.",
  "input": "",
  "output": "It's a skin disease that occurs frequently in people with insulin resistance, overweight, diabetes, especially in the neck and the groins, which can cause skin growth and discoloration, and in women, sterilization and breast pain."
},
{
  "instruction": "Doctor, I've been experiencing some strange symptoms recently: allergic reactions, apnea, noticeable weight gain, and what's the cause of all of these symptoms?",
  "input": "",
  "output": "It's generally characterized by skin changes such as skin wrinkles, wrinkles, darkness, and increased weight."
},
{
  "instruction": "Hi doctor, you have warts around your neck and your armpits, and you're allergic to your skin, and you've got pain in your breast, and you've got sore throats, and you've got sore throats, and you've got sore throats, what's the problem?",
  "input": "",
  "output": "It's a skin disease, usually caused by dark skin spots between the neck and the armpit. Sometimes it's a symptom of base disease, such as diabetes or hormonal imbalance, which can cause chest pain and depression. It's a good idea to run some tests to determine the cause of the problem."
},
{
  "instruction": "Doctor, we've recently experienced hand spasms, joint pains, shortness of breath, fatigue, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms suggest that you may be suffering from a central hardening of the arteriosclerosis."
},
{
  "instruction": "We're experiencing symptoms of a blood mixture in the doctor, his sores, fatigue, irregular heart rate, weight gain, urine, what's the cause of these symptoms?",
  "input": "",
  "output": "It's possible that the symptoms can cause a lot of symptoms, including the decrease in blood supply over the rest of the body, which is caused by the blockage of the arteries."
},
{
  "instruction": "Hi, sir, I'm experiencing post-pulmonary and kidney-related symptoms, so can you tell me what you have?",
  "input": "",
  "output": "The symptoms seem to indicate that there's an arteriosclerosis, which can cause the heart's arteries to narrow or block up, causing fluid decline and kidney problems. It's good to check the diagnosis and run some tests to plan for treatment."
},
{
  "instruction": "Doctor, joint pain, fatigue, shortness of breath. What's the problem?",
  "input": "",
  "output": "These symptoms could be caused by cyclic atherosclerosis, which is a condition where plaque builds up in the arteries of the heart and restricts blood flow."
},
{
  "instruction": "Doctor, your lips are ulcerated and your skin looks weird. What's the problem?",
  "input": "",
  "output": "It's a viral rash that causes skin rash, which can lead to mouth ulcers."
},
{
  "instruction": "Doctor, in the last few days, you've got a fever, and you've got a red spot all over your body.",
  "input": "",
  "output": "It's likely to be viral rash in terms of symptoms, which is a common rash that can occur when the body is fighting a viral infection."
},
{
  "instruction": "Doctor, can you tell me what's going on with your nose and your skin?",
  "input": "",
  "output": "It's a viral infection that can cause rashes in the skin and cause membrane force."
},
{
  "instruction": "Doctor, there's a scar on your lips that doesn't go away. What is it?",
  "input": "",
  "output": "It could be viral pornography."
},
{
  "instruction": "Doctor, your ears are down and your skin is tight, and what's the cause of these symptoms?",
  "input": "",
  "output": "It may be viral rashes, which can occur in the skin, which can cause the ear to be attracted or itching."
},
{
  "instruction": "Doctor, I have a lump in my knee that's getting bigger and bigger, and I'm really worried about the pain.",
  "input": "",
  "output": "It's a rare disease caused by the inhalation of fungus spores, which can cause lumps or sores in the body, including the knee."
},
{
  "instruction": "Doctor, there's a lump in your knee. Do you know what this is?",
  "input": "",
  "output": "The symptoms may indicate that it's a fungus infection, that's caused by an inhalation of fungus spores found in soil or rotting trees."
},
{
  "instruction": "There's doctors, fatigue, wrist pain, pregnancy pain, facial pain, frequent urination at night.",
  "input": "",
  "output": "You may have a fungal infection, a fungus infection caused by an inhalation of soil or decaying organic material, which can cause symptoms such as fatigue, joint pain, facial pain, and uterine symptoms."
},
{
  "instruction": "What do you have?",
  "input": "",
  "output": "The symptoms you described indicate that you're suffering from cytosis."
},
{
  "instruction": "Doctor, I'm experiencing pain during pregnancy, fatigue, ankle pain, stiffness or coldness in my joints, can you tell me what caused all these symptoms?",
  "input": "",
  "output": "The symptoms suggest that you're suffering from a form of bacilli that can affect the different parts of your body, including your joints and lungs, and it's good to start treating them as quickly as possible after a few diagnostic tests."
},
{
  "instruction": "Doctor, I'm experiencing vomiting and rectal bleeding. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that non-infected stomach infections are suspected."
},
{
  "instruction": "Doctor, you've been getting a fever lately, so what's the cause?",
  "input": "",
  "output": "Did you experience abdominal discomfort or diarrhea?"
},
{
  "instruction": "Doctor, headache, nausea, sharp abdominal pain, do you know what caused it?",
  "input": "",
  "output": "The symptoms suggest non-infected stomach infections."
},
{
  "instruction": "Sir, there's been a lot of vomiting these days, and there's a lot of abdominal pain.",
  "input": "",
  "output": "The symptoms seem to indicate that you have non-infected hyperperiotitis."
},
{
  "instruction": "Doctor, sharp abdominal pain, headache, rectal bleeding, nausea, a lot of blood.",
  "input": "",
  "output": "The symptoms seem to indicate that you have non-infected stomach infections."
},
{
  "instruction": "Doctor, you've got less urine, you've got pain in your testes, and why?",
  "input": "",
  "output": "Depending on the symptoms, there could be BPH."
},
{
  "instruction": "Doctor, there's a lot of urination, and there's a swelling of the scrotum, and what's the cause?",
  "input": "",
  "output": "From the symptoms you described, it's possible that you're going to have benign prostate obesity or BPH."
},
{
  "instruction": "Doctor, you get too much urine at night, too much urine during the day, too much bladder discomfort, prostate obesity, what's the problem?",
  "input": "",
  "output": "Proplasia is a common condition in older men who have an enlarged prostate gland that can cause urination problems."
},
{
  "instruction": "Doctor, you've got lower urine levels, your scrotum is swollen, you've got pain in your testes, you've got frequent urinations, you've got occasional unconscious urination, what's the problem?",
  "input": "",
  "output": "I think there's a BPH, because of the symptoms, that the prostate is overweight, and it's having difficulty with your urine loss, your hesitation, your involuntary urination, and it can also cause swelling and pain in the testes."
},
{
  "instruction": "Doctor, I often peed at night, and sometimes it's hard to take a piss, so what's the problem?",
  "input": "",
  "output": "I think there's a possibility that there's a BPH in the symptoms, a common disease that causes these symptoms by pressing the urethra when the prostate becomes overweight."
},
{
  "instruction": "Doctor, there's recently been symptoms of blushing, a lot of menstruation, a lot of sweating. What's the problem?",
  "input": "",
  "output": "Menopause is a natural process that occurs at the end of a woman's reproductive organs."
},
{
  "instruction": "Hi doctor, I've recently had a strange condition, my period has stopped completely, and I've experienced vaginal and pelvic pain, and sometimes I can't predict it.",
  "input": "",
  "output": "Menopause is a natural biological process that tells us the end of the menstrual cycle: menstrual absence, epsis, pelvic pain and unpredictable menstruation are all common symptoms of menopause, suggesting changes in lifestyles or hormone therapy in order to alleviate the symptoms."
},
{
  "instruction": "Doctor, I haven't had my period in the last six months, and I've had a decline in sexual desire, and I've had hip pain.",
  "input": "",
  "output": "Menopause is a natural biological process that every woman experiences as they get older, and that means that her reproductive organs end up, which is common in menopause and can be diagnosed with a proper test."
},
{
  "instruction": "Doctor, I'm experiencing weight gain, water loss, long periods of menstruation and vaginal dryness. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to indicate that you're having menopause."
},
{
  "instruction": "I'm experiencing a doctor, vaginal dryness, rash, weight gain. What's the cause?",
  "input": "",
  "output": "It's very likely you're suffering from menopause."
},
{
  "instruction": "Doctor, over the last few days, I've had a constant headache, and why?",
  "input": "",
  "output": "One of the causes of headaches is a primary immune deficiency, which can weaken the immune system and make it more vulnerable to infection and cause headaches."
},
{
  "instruction": "Doctor, your appetite is reduced, your whole headache, your stomach pain, your cough.",
  "input": "",
  "output": "It's possible that the symptoms are autoimmune immunodeficiency, and you have to run some tests to identify the diagnosis."
},
{
  "instruction": "Doctor, I've been experiencing skin irritation and stomach pain a lot lately, and why?",
  "input": "",
  "output": "These symptoms could be caused by a primary immunodeficiency disorder."
},
{
  "instruction": "Doctor, can you tell me what's wrong with your oral ulcers, your whole headache, your temper problems, your arm rigidity, your tongue absorption?",
  "input": "",
  "output": "Symptoms suggest that there is a primary immune deficiency in which the immune system does not function normally, which can cause repeated infections, oral ulcers, and a host of other symptoms that you're talking about may have something to do with immune system function disorders."
},
{
  "instruction": "Doctor, I'm experiencing reflux and abdominal swelling, and what's the cause?",
  "input": "",
  "output": "There's a possibility that the symptoms are endogenous cancer, and I recommend additional tests to check the diagnosis."
},
{
  "instruction": "Doctor, you're experiencing a recent problem with eating, fluid decline, abdominal ovulation, and you're touching a lump in the groin.",
  "input": "",
  "output": "There's a possibility that it's an endocardial cancer when you consider what God says about the symptoms and the fractures. It's important to make sure you're diagnosed and to perform additional tests and video tests to determine your best care plan."
},
{
  "instruction": "Doctor, what's the cause of the recent loss of appetite and menstruation?",
  "input": "",
  "output": "It's possible that the symptoms are endogenous cancer, and it's best to consult a tumor specialist for additional tests."
},
{
  "instruction": "Doctor, I've had a sharp abdominal pain over the last few months, and I've had problems with kidney-like symptoms and diets.",
  "input": "",
  "output": "The symptoms suggest that it's possible that it's endocardial cancer, and it's best to get additional tests and treatment as soon as possible."
},
{
  "instruction": "Sir, I feel like there's something foreign in my eye. What's the cause?",
  "input": "",
  "output": "There's the possibility that you have cataracts in your eyes, and cataracts are diseases that affect your vision because the eye's natural lens gets mixed up."
},
{
  "instruction": "Doctor, what happened to your eyes and everything looking blurry?",
  "input": "",
  "output": "The symptoms seem to indicate a cataract, which is a condition where the eye's natural lens gets mixed up and the vision gets dimmed."
},
{
  "instruction": "Sir, I've got a lot of tears and I feel like I'm stuck in the eye, and I see spots and clouds and I see snow.",
  "input": "",
  "output": "The cataracts can cause aching of the eyes, loss of color, tears, and eye contact, which is a common symptom of cataracts, too, of spots and clouds in the field of vision."
},
{
  "instruction": "Doctor, I'm experiencing symptoms of the eyes, such as the halo around the lights and the blurry vision, as well as the abnormal movement of the eyelids and the pain of the eyes.",
  "input": "",
  "output": "It's likely to be cataracts, and cataracts are diseases that affect your vision because your eye lenses get mixed up, and there's all sorts of symptoms, such as a blurry around the light, or a blur in your vision, and there's a lot of pain in your eyes."
},
{
  "instruction": "Hi doctor, I've been feeling a little bit blurry in the eyes, and there's a little blurry vision, there's a couple of things that look like things, there's a little bit of pain in the eyes.",
  "input": "",
  "output": "It's likely to be cataracts, which can cause blindness in the eyes, periphery in the eyes, perforation in the eyes, periphery, and sometimes pain."
},
{
  "instruction": "Sir, I've got a lot of knee pain, and I don't know what's causing it.",
  "input": "",
  "output": "The symptoms seem to indicate a hip defibrillator."
},
{
  "instruction": "Doctor, I've had knee pain in the last few days. Can you tell me why?",
  "input": "",
  "output": "It could be a hip defibrillator."
},
{
  "instruction": "Doctor, I recently had knee pain and I'm abusing alcohol. Do you know what caused these symptoms?",
  "input": "",
  "output": "Yes, the symptoms seem to indicate hip dislocation, knee pain is more likely to come from hip pain, alcohol abuse can lead to a fall or an accident that can lead to hip dislocation."
},
{
  "instruction": "Doctor, I've been experiencing a lot of back pain and hip pain lately, and I'm drinking a lot, so what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate a hip defibrillator, alcohol abuse may be the cause of the problem."
},
{
  "instruction": "Doctor, I have severe pain in my leg.",
  "input": "",
  "output": "The hip could have been defibrillated."
},
{
  "instruction": "Doctor, you've got backaches going on for a while and it's getting worse and worse, and you've got headaches, and you've got legs going off, and you know what's causing them?",
  "input": "",
  "output": "There's probably a narrowing of the spinal cord, which can push the nerves into symptoms such as backaches, headaches, sensory disturbances, or leg arrest, and we need to do some tests to identify the diagnosis and determine the best treatment plan."
},
{
  "instruction": "Doctor, you've recently had a problem with backaches, movement, and what's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from spina bifida, a condition in which the spinal cord narrows down and compresses the nerves, causing pain and motor disorders, and it's good to go through some tests and talk about treatment."
},
{
  "instruction": "Sir, you've got shoulder pain, headache, arm pain, neck pain going on, and you know what's causing it.",
  "input": "",
  "output": "The symptoms seem to indicate that there's a spina bifida, which is a condition that narrows the spinal cord and compresses the nerves, causing pain and discomfort in various parts of the body."
},
{
  "instruction": "Doctor, I'm experiencing arm pain, neck pain, hip pain, headache and shoulder pain.",
  "input": "",
  "output": "The symptoms seem to indicate that there's a spina bifida."
},
{
  "instruction": "Doctor, there's been a lot of problems with movement these days.",
  "input": "",
  "output": "The symptoms you've described indicate that you're suffering from spina bifida."
},
{
  "instruction": "Doctor, we've been vomiting blood recently, and we've got toilets. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from intestinal obstructions."
},
{
  "instruction": "Doctor, what's the problem with vomiting without a lot of variation?",
  "input": "",
  "output": "The symptoms may be that the bowel is blocked by intestinal obstruction and that there is no normal passing of the stool and other body fluids, and it's important to get proper treatment to alleviate the symptoms and prevent complications."
},
{
  "instruction": "Doctor, I've been experiencing diarrhea in the last few days. Is this a serious problem?",
  "input": "",
  "output": "Diarrhea can be a symptom of intestinal obstruction, and it's a serious condition that's partially or completely blocked, and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Sir, I've been throwing up an anal pain, abscess, nausea, defibrillation, blood, and what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that intestinal obstructions occur when the intestines are blocked and food and liquid cannot pass through the digestive tract."
},
{
  "instruction": "Doctor, your wrist has been weakened, your chest pains and elbow strengths have been weakened, and what's the problem?",
  "input": "",
  "output": "The symptoms could be heart contusions."
},
{
  "instruction": "Doctor, your wrist weakness, your elbow cramps or tics, your eyelids, your sharp chest pain, what's the problem?",
  "input": "",
  "output": "The symptoms suggest a heart contusion."
},
{
  "instruction": "Doctor, I've been having strange symptoms recently, with my eyes being paired and my eyelids being wet, and I feel so weak in my wrists and my butts are stiff and wet, so what's the problem?",
  "input": "",
  "output": "Are you experiencing chest pain or difficulty in breathing? It's best to do some tests and physical tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I'm biting my nails, my hair is growing too much, my eyelids are covered, and I'm experiencing apnea and death symptoms, and what's the cause of all of these symptoms?",
  "input": "",
  "output": "These symptoms often occur when you have a chest injury or a heart attack, and it's good to run some tests to check your diagnosis and start treating it as soon as possible."
},
{
  "instruction": "Doctor, I've been having strange symptoms lately, and I've been fainting all the time, and I've found eyelids, and I've found that my eyes seem to be double-eyed, and I've grown too much in my body.",
  "input": "",
  "output": "The symptoms may indicate a heart contusion."
},
{
  "instruction": "Sir, despite healthy eating habits and regular exercise, I'm worried because my height isn't growing very well. Can you tell me what's wrong?",
  "input": "",
  "output": "Your history and symptoms suggest that you have a rare genetic disorder that affects growth and development, congenital deformity syndrome, and you have to do some tests to confirm your diagnosis."
},
{
  "instruction": "Sir, there's gum pain, it's hard to eat, there's probably fluid on your legs, and what's the cause of all this?",
  "input": "",
  "output": "It's possible that it's a case of congenital deformity, and we need some additional tests to confirm the diagnosis."
},
{
  "instruction": "Doctor, it was difficult to eat a few weeks ago, and there was discomfort and pain in the ribs.",
  "input": "",
  "output": "In your symptoms, you may have congenital deformity syndrome that can affect your body's bone and muscle development, including ribs, which can explain the pain you're experiencing."
},
{
  "instruction": "Sir, you've got rib pain, stiffness of leg, gum pain, and earring going on, and sometimes I don't know if what I'm looking at is real or hallucinating, do you know what's causing all these symptoms?",
  "input": "",
  "output": "The symptoms suggest that there's congenital deformity syndrome, which can cause a number of disorders in the body, including ribs, legs, gums, ears, and even the brain, which leads to delusions and hallucinations."
},
{
  "instruction": "Sir, I've had a lot of gum pain lately, and I want you to know why.",
  "input": "",
  "output": "The cause of gum pain may be congenital deformity syndrome, a genetic disorder affecting the development of the baby's body parts that causes various health problems, such as gum pain."
},
{
  "instruction": "Doctor, you've recently had knee pain and ankle pain and a lump in your knee. What's the problem?",
  "input": "",
  "output": "It's a fungus infection that can form lumps in the skin, common to those who deal with roses, earth or moss, and it's good to get some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, there's been a lot of weird symptoms, facial pain, chest pain, knee swelling, pregnancy pain, and, above all, too much anger.",
  "input": "",
  "output": "The symptoms suggest that you have sporosis, which can cause pain and swelling in various parts of the body due to mold infections, and you have to do some tests to identify the diagnosis and start treatment as soon as possible."
},
{
  "instruction": "Good morning, sir. I've had knee pain a few days ago. Can you tell me why?",
  "input": "",
  "output": "In terms of the symptoms that you just mentioned, you're likely to have stromatricosis, a fungus infection that normally spreads through skin injury or injury."
},
{
  "instruction": "Doctor, I'm still having ankle pains, and I recently had a lump in my knee.",
  "input": "",
  "output": "Symptoms may indicate sporacitis, a mold infection that is often transmitted by rose spines or soil, and it's good to run some tests to see if this is true."
},
{
  "instruction": "Doctor, I feel pain and wear in my breast.",
  "input": "",
  "output": "Do you have any other symptoms with this kind of pain and sore throat? It's not a patient, it's not a patient, it's just that the pain is getting worse and it doesn't seem to go away."
},
{
  "instruction": "Sir, your feet are in pain and your toes are bumpy, and the skin of your head and neck looks infected and strange.",
  "input": "",
  "output": "The symptoms seem to indicate that lymphocarditis, an infection of the lymph nodes caused by bacteria, is important to get medical care and start treating it as soon as possible to prevent any further complications."
},
{
  "instruction": "Hi, doctor, you've recently had swelling and pain in your throat. Do you know what caused it?",
  "input": "",
  "output": "It's an inflammation of the lymphatic tube that can cause such symptoms as edema and pain in the part of the lymphatic tube. We recommend additional tests to check the diagnosis and discuss treatment options."
},
{
  "instruction": "Sir, there's a lot of pain in your neck these days. Can you tell me what's going on?",
  "input": "",
  "output": "The symptoms suggest that lymphocarditis is suspect."
},
{
  "instruction": "Doctor, I've recently had swelling of my neck and pain in my feet.",
  "input": "",
  "output": "You may have lymph\uc2dcitis."
},
{
  "instruction": "Doctor, your neck swells and your leg has abnormal skin, and your arm and head skin seem to be infected, and what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate lymphatic fibrosis, which is a swelling and reddening of the lymphatic tract, which can lead to skin infections."
},
{
  "instruction": "Hi, doctor, I've been having strange symptoms recently, my hands and feet are squeamish, and I feel sick.",
  "input": "",
  "output": "The symptoms may indicate that you're experiencing sensory abnormality, which is a common symptom of Bernice Corsakov's syndrome, which is usually caused by vitamin B1 deficiency, which is common to alcohol abusers."
},
{
  "instruction": "I'm experiencing doctors, fainting, headaches, hostile behavior, anxiety and anxiety, memory problems, you know what's wrong with me?",
  "input": "",
  "output": "The symptoms seem to indicate Bernike Corsakov's syndrome, a neurological disorder caused by vitamin B1 deficiency."
},
{
  "instruction": "Doctor, I'm experiencing the symptoms of vomiting blood, and I have a history of alcohol abuse, and what's the cause?",
  "input": "",
  "output": "You're experiencing symptoms of Bernice Corsakov's syndrome, which is caused by prolonged alcohol abuse, and it's important to get medical attention immediately."
},
{
  "instruction": "Sir, I'm nervous and nervous and my arm hurts. Do you know what's causing it?",
  "input": "",
  "output": "It's possible that you're suffering from Bernice-corsakov's syndrome, which is a neurological disorder that can result from a thiamine deficiency caused by chronic alcohol abuse, which can cause anxiety, anxiety, even pain in the limbs, weakness."
},
{
  "instruction": "Doctor, I've been suffering from depression and psychiatric symptoms recently, and I've been vomiting blood, and what's the problem?",
  "input": "",
  "output": "The symptoms suggest that you have Bernice Corsakov's syndrome due to a lack of vitamin B-1."
},
{
  "instruction": "I'm experiencing doctor, toilet, weakness, faintness, vomiting and sharp chest pain. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you have intestinal disease."
},
{
  "instruction": "Doctor, I'm experiencing a feeling of faintness, sharp abdominal and chest pain, nausea, stomach pain.",
  "input": "",
  "output": "The symptoms can lead to bowel disease, and we need to do some tests to diagnose the exact condition, and can you tell us more about the pain?"
},
{
  "instruction": "Doctor, I'm feeling really weak and sharp pain in my chest, and I've been vomiting twice today, and I've passed out once, and what's the problem?",
  "input": "",
  "output": "We need to do some tests to figure out the exact cause, but first we're going to start with the drug therapy to ease the symptoms, and I'm going to help you get better as soon as possible when you get some rest."
},
{
  "instruction": "Doctor, I'm experiencing nausea and rectal bleeding. What can happen?",
  "input": "",
  "output": "Depending on the symptoms, it may be signs of bowel disease, and we need to do some tests to figure out the exact cause."
},
{
  "instruction": "Doctor, I've been feeling very weak lately, and I've been suffering from constipation, and I've just passed out, and I've had abdominal pain.",
  "input": "",
  "output": "The symptoms seem to indicate that you have bowel disease."
},
{
  "instruction": "Doctor, your chest is sore and your throat is sore. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate acute bronchitis."
},
{
  "instruction": "Doctor, you have a sore throat, a cough, and a bad breath, and why?",
  "input": "",
  "output": "The symptoms seem to indicate acute bronchitis."
},
{
  "instruction": "Doctor, I'm having a cough, a noseache, a sore throat, and a sore chest, so what's the problem?",
  "input": "",
  "output": "The symptoms suggest acute bronchitis."
},
{
  "instruction": "Doctor, I have difficulty breathing, and I feel like I'm losing my breath.",
  "input": "",
  "output": "The symptoms suggest that you have acute bronchitis."
},
{
  "instruction": "Doctor, I've been vomiting in the last few days. What's the cause?",
  "input": "",
  "output": "I think you have acute bronchitis."
},
{
  "instruction": "Doctor, there's continued vomiting that we don't know what's going on, and so on, and so on, and so forth, and so forth, and so forth, and so forth, and so forth.",
  "input": "",
  "output": "The symptoms seem to indicate that you have stomach and bowel infections, stomach infections."
},
{
  "instruction": "Doctor, I'm experiencing persistent vomiting and sharp abdominal pain, and I've had a lot of problems during pregnancy.",
  "input": "",
  "output": "I think there's a disease called guaguto, which causes severe nausea and abdominal pain that can occur during pregnancy, and it's important to get a doctor's attention if these symptoms persist."
},
{
  "instruction": "Doctor, we've been experiencing persistent vomiting in the last few days, along with nausea and abnormal involuntary movements.",
  "input": "",
  "output": "The symptoms seem to indicate that there is a condition called delayed motorism, which is a side effect of the long-term use of certain drugs that affect the brain, which requires additional tests to identify the diagnosis."
},
{
  "instruction": "Doctor, I've been vomiting a few days ago, and I don't know why.",
  "input": "",
  "output": "It's possible that it's a symptom, but it's important to run some tests to confirm the diagnosis."
},
{
  "instruction": "Doctor, a few days ago, vomiting is continuing, and there's sharp abdominal pain, nausea, dizzyness and trouble during pregnancy.",
  "input": "",
  "output": "The symptoms suggest that you're experiencing dehydration and loss of weight with severe vomiting during pregnancy. Let's check some tests to see if there are any options for diagnosis."
},
{
  "instruction": "Sir, there's a lump in your foot that has pain, and there's skin lesions.",
  "input": "",
  "output": "The symptoms suggest an open foot injury."
},
{
  "instruction": "Doctor, I have skin lesions on my feet, and the nails look irregular, and I have swollen feet and toes, and what's the problem?",
  "input": "",
  "output": "I think there's an open foot wound."
},
{
  "instruction": "Doctor, there's a lump in your foot that has pain, and it's pretty swollen.",
  "input": "",
  "output": "You know, if you look at what you're saying, it's good to clean up the wound, bandage it, and watch the change, in order to prevent infection."
},
{
  "instruction": "I don't know when I got here.",
  "input": "",
  "output": "Well, according to you, I think you've got a foot injury. Have you been injured in that area lately?"
},
{
  "instruction": "Sir, I've got a problem with my foot, my leg looks infected, my toe is swollen, and my nails look irregular.",
  "input": "",
  "output": "I think there's an swelling and infection in the foot, and irregular nails can be a symptom of this disease."
},
{
  "instruction": "Doctor, there's been a sharp chest pain and a long cough. What's the cause?",
  "input": "",
  "output": "It's possible that the symptoms indicate that you're suffering from heart muscle dystrophy, and you have to do some tests to confirm this diagnosis."
},
{
  "instruction": "Sir, what's the problem with chest trouble, scissors, shortness of breath, cough, dizziness?",
  "input": "",
  "output": "The symptoms suggest that there is an inflammation of the heart muscle, myocarditis."
},
{
  "instruction": "Doctor, I've recently been experiencing a breakdown, palpitations, diarrhea, and what's the cause?",
  "input": "",
  "output": "Are you experiencing chest pain or respiratory problems?"
},
{
  "instruction": "Doctor, you've got a fever, you've got a sore chest, you've got trouble breathing, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that myocarditis is suspect, that it's an inflammation of the heart muscle normally caused by viral infections or autoimmune reactions."
},
{
  "instruction": "Doctor, I'm having a fever, I'm having trouble breathing, I'm feeling sick and weak, and what's the problem?",
  "input": "",
  "output": "The symptoms are likely to be cardiomyocarditis, which is inflammation of the heart muscle due to viruses, bacteria, or mold infections."
},
{
  "instruction": "Doctor, I'm experiencing pain during pregnancy, along with abdominal pain and uterine contractions, and I'm having a lot of headaches, and what's the cause?",
  "input": "",
  "output": "The symptoms suggest that you're suffering from autobiography, a complication of pregnancy, which is characterized by high blood pressure, liver, kidneys, and so on, and it's important to monitor closely the health and well-being of both mothers and fetuses."
},
{
  "instruction": "Doctor, there's a problem with spasms and spasms during pregnancy, and spots and clouds in my eyes, and I've been pregnant recently, and what's wrong with me?",
  "input": "",
  "output": "It's important to manage the symptoms and get medical attention immediately to ensure the mother and the baby's safety."
},
{
  "instruction": "Doctor, I'm experiencing contractions, spasms and cramps, pains during pregnancy, headaches.",
  "input": "",
  "output": "The symptoms are likely to be autobiography, which can be very serious if you don't treat it because of an illness that can occur during pregnancy, and it's good to test it with a few tests and start treating it immediately."
},
{
  "instruction": "Doctor, I recently gave birth, and I'm having symptoms of redness. What's the problem?",
  "input": "",
  "output": "Your symptoms, your recent pregnancy history, seem to indicate that you're suffering from a serious pregnancy complication, such as high blood pressure and kidney and liver, and you need to be treated immediately by a doctor."
},
{
  "instruction": "Doctor, I feel like I'm having a telophase, and I'm having a lump in my throat. What's the problem?",
  "input": "",
  "output": "It's very likely that there's a hemolytic heart disease, and you have to do some tests to check your diagnosis."
},
{
  "instruction": "Doctor, we've been experiencing recent shortness of breath, increased heart rate, lymph nodes, fatigue, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate hemorrhagic heart disease."
},
{
  "instruction": "Doctor, I'm experiencing sharp chest pain and muscle pain, and why?",
  "input": "",
  "output": "There's a possibility that there's a hemorrhagic heart disease from the symptoms."
},
{
  "instruction": "Doctor, your neck is so hard and your chest's beating these days, and I can feel your heart beating, your legs and your arms swelling, what's going on?",
  "input": "",
  "output": "The symptoms seem to indicate that you have a hemolytic heart disease, which means you have to do some tests, but you have to narrow your arteries so you don't have enough blood and oxygen to your heart, which can lead to heart palpitations, increased heart rate, swelling of your arm and so forth."
},
{
  "instruction": "Doctor, you've lost your leg, you've got an abnormal inert movement, you've got a lump in your foot, you've got an abnormal skin, you've got a lump in your neck, what's the problem?",
  "input": "",
  "output": "It's not uncommon for a patient with neurofiberoma to experience weak legs and involuntary movements; it's common for a lump of feet and neck to run some tests to make sure that they're actually nerve fibrosis."
},
{
  "instruction": "Doctor, I can feel a lump in my throat.",
  "input": "",
  "output": "It could be a symptom of neurofibrosis, and you have to run some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, you've been having severe headaches for a while. What's the cause?",
  "input": "",
  "output": "In view of the history and symptoms, there may be headaches associated with neurofibroidism, which is a tumor growing in the nervous system, which can sometimes cause headaches."
},
{
  "instruction": "Hi, doctor, there's a wart and a lump in your foot, and I don't know what it is.",
  "input": "",
  "output": "Neurofibrosis is a genetic disorder that causes a tumor to grow in the nerve, and among other symptoms, there can be warts and lumps in the skin, which is good for additional tests and evaluations to make sure you're diagnosed."
},
{
  "instruction": "Doctor, your legs are swollen, your legs are weakened, and you have warts on your skin, and what's the cause?",
  "input": "",
  "output": "There may be neurofibrosis, a genetic disease that causes tumors in the nervous system."
},
{
  "instruction": "There's a strange skin rash, and it's very dark, and it's got fever, and it's got eyes, and what's the problem?",
  "input": "",
  "output": "The symptoms suggest he has chickenpox."
},
{
  "instruction": "Doctor, I've been having these symptoms recently, my skin keeps getting wet, my eyes get red, and I'm coughing, and I feel like I'm having a pain in my test, and my baby's getting a lot of irritation.",
  "input": "",
  "output": "In view of the symptoms that God has mentioned, the chickenpox is a common infectious virus infection in children that can cause a wide range of symptoms, such as itching skin, eyes, cough, and pain in the testes, and in some cases it is important to remain in isolation until it is no longer contagious."
},
{
  "instruction": "Sir, I'm so sick these days, I'm so sick and I've got a really ugly rash on my skin, and I'm worried that it doesn't have a bad effect on my baby while I'm pregnant.",
  "input": "",
  "output": "The symptoms seem to indicate that he has chickenpox, which is particularly dangerous during pregnancy, and you have to stop the spread of the disease by avoiding contact with other people, and you have to come to the hospital immediately."
},
{
  "instruction": "Doctor, coughs and pains are continuing. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you have chickenpox. Did you have a rash on your body?"
},
{
  "instruction": "Doctor, I've been coughing and annoying all day, and I've had some problems during pregnancy, and I'm sick and my eyes are red, and I'm worried about what happened to me.",
  "input": "",
  "output": "It's a common viral infection that causes rashes, coughs, bodies, eyes, eyes. It's important to take sufficient rest, eat enough water, and not scratch the rash. It's important to take a cure that you can buy without prescription to relieve pain and heat."
},
{
  "instruction": "Teacher, toilet, irregular scalp, abdominal suffocation, even vomiting blood. What's the problem?",
  "input": "",
  "output": "It's possible that it's pancreatic cancer because of the symptoms, and you have to run some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, my whole body hurts. What's the problem?",
  "input": "",
  "output": "It's possible that it's pancreatic cancer, depending on the symptoms, and it's good to run some tests to be sure."
},
{
  "instruction": "Doctor, you've got pain throughout your body, sharp abdominal pain, nausea, abdominal suffocation, rubella, what's the cause of these symptoms?",
  "input": "",
  "output": "Unfortunately, these symptoms are often associated with pancreatic cancer, which requires several tests to properly diagnose pancreatic cancer, but it's important to deal with them quickly."
},
{
  "instruction": "Doctor, I've recently been really tired and swollen for a while, and I've got nausea and pain all over my body, and most of all, my skin has turned yellow.",
  "input": "",
  "output": "You have to run some tests to make sure you're diagnosed, but your symptoms are a sign of this disease."
},
{
  "instruction": "Doctor, I'm experiencing foot and toe pain, cough, exercise disorder, even facial pain.",
  "input": "",
  "output": "Yes, symptoms can lead to neurological disorders caused by drugs. Have you taken drugs that can cause these symptoms recently?"
},
{
  "instruction": "Doctor, there's been a lot of fatigue these days.",
  "input": "",
  "output": "You may be experiencing fatigue as a result of the symptoms of neurosis caused by drugs."
},
{
  "instruction": "Doctor, your feet are numb. What's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from a neurological disorder caused by a drug. Have you been taking drugs for a long time recently?"
},
{
  "instruction": "Doctor, I'm experiencing a sharp abdominal weakness, and I'm also experiencing more sensory changes in my arms and legs, and what's the cause of these symptoms?",
  "input": "",
  "output": "It's possible that the symptoms are neurological disorders caused by drugs, which are diseases that nerve cells that send signals to the muscles, to the skin and to the internal organs that are damaged or destroyed by certain drugs."
},
{
  "instruction": "Doctor, your throat is sore and your ears are constantly being pulled. What's the cause?",
  "input": "",
  "output": "It's like he's caught up in a kroup."
},
{
  "instruction": "Doctor, I'm feverish and I can't breathe.",
  "input": "",
  "output": "There's the possibility that there's a Crebru that affects your prayers, that you cough, that you breathe, that you get viral infections that happen to young children, but that can affect adults as well."
},
{
  "instruction": "Doctor, nostrils and coughs continue. What's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that he's got a krup."
},
{
  "instruction": "Doctor, there's so much pain in your voice and throat and your ears keep pulling. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that he's got a krup."
},
{
  "instruction": "Doctor, I'm suffering from shortness of breath, shortness of breath, fever, vomiting. Can you tell me what the symptoms are?",
  "input": "",
  "output": "It's a viral infection affecting your vocal cords and organs, which is most common for children under six years of age."
},
{
  "instruction": "Hi, sir, you've recently had a lot of menstrual problems, a lot of menstrual problems, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there are multiple cases of exceptional menstruation."
},
{
  "instruction": "I'm experiencing a doctor, a vaginal secretion, an unpredictable menstrual period, a hemorrhagic edema, a sharp abdominal pain, and I don't know what's going on with me.",
  "input": "",
  "output": "The symptoms may indicate that it's a chronic menstrual disorder."
},
{
  "instruction": "Doctor, I'm recently experiencing unpredictable menstruation, which is too heavy and too frequent, and what's the cause?",
  "input": "",
  "output": "It's possible that the symptoms are acute menstrual hyperstitivity."
},
{
  "instruction": "Doctor, I'm experiencing sharp abdominal and pelvic pain during my period, and why?",
  "input": "",
  "output": "These symptoms may be caused by an overextended menstrual disorder, which is a severe or long-term illness for which women have no known cause."
},
{
  "instruction": "Doctor, I've developed menstrual pains with vaginal secretions, which are getting longer and unpredictable these days, and also cramps and cramps, and what are the causes of all these symptoms?",
  "input": "",
  "output": "The symptoms suggest that you're having a lot of menstrual bleeding and a long-term chronic menstrual strain."
},
{
  "instruction": "Doctor, there's a white secretion in the eyes, pus in the ears, eye bumping, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there is a disease called weakness, or death, in which one eye is worse than the other, and so the brain starts to depend more on the better-looking eye, which is the result of the brain's attempts to use two eyes at the same time."
},
{
  "instruction": "Doctor, I think you're feeling strange in your eyes and out of your normal position. What's the disease?",
  "input": "",
  "output": "You seem to be suffering from a drug problem, which is a common visual disorder caused by an unconscious, lazy habit of snowing or lighting your eyes."
},
{
  "instruction": "Doctor, my eyes seem to be twisted, and I don't see clearly. What are the symptoms?",
  "input": "",
  "output": "I think there's some sort of mildness in the symptoms."
},
{
  "instruction": "Doctor, I've been having some eye problems recently, and my eyes are paired up, and they're acting abnormally, and there's a white secretion in my eyes, and there's a lot of pain.",
  "input": "",
  "output": "It's a disease in the brain where visual information is abnormally developed or processed and the vision of one or both eyes is impaired."
},
{
  "instruction": "Sir, my eyes are falling apart and I feel pain in my eyes. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to be mild."
},
{
  "instruction": "The doctor, the lower abdomen, the upper abdomen pain, the knee lumps and the sexual decline. What's the problem?",
  "input": "",
  "output": "The symptoms you just described suggest that it's Megel Gesil."
},
{
  "instruction": "Doctor, I'm experiencing bed - wetting, excessive growth, a decline in sexual appetite, and eczema. What's the problem?",
  "input": "",
  "output": "It's possible that it's Megel Gesil, which is a disease in which the small spurt of the bowel can cause these symptoms, and it's good to run some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, you're experiencing swelling shoulders, loss of sexual desire, fatigue in the eyes, pain in the eczema, pressure on the pelvic, and what's the cause of these symptoms?",
  "input": "",
  "output": "Depending on the symptoms, there may be a mekkel crab that has a small pocket on the lining of the bowel, which can cause a variety of symptoms, including the one you described."
},
{
  "instruction": "Sir, I've recently experienced eye fatigue and stomach pain, and why?",
  "input": "",
  "output": "Megel Gell's condition is often caused by the spurt of the bowel that exists from birth, but when it comes to inflammation, infection, and nausea, it can cause abdominal pain and other symptoms, and the blood in the eye can be a separate problem."
},
{
  "instruction": "Doctor, depression and the fatigue of the eyes are getting worse these days, and your wrists are hurting a lot.",
  "input": "",
  "output": "I think you're struggling with your wrist dislocation."
},
{
  "instruction": "Doctor, your wrist is weak.",
  "input": "",
  "output": "I think my wrists are decapitated."
},
{
  "instruction": "Doctor, I've had a lot of pain in my hands lately.",
  "input": "",
  "output": "The symptoms suggest that the wrists are decapitated."
},
{
  "instruction": "Hi, doctor, I've been having some symptoms lately, and I've been feeling a lot of heat and cold, and I've had a lot of pain in my hands and fingers with depression.",
  "input": "",
  "output": "The feeling of heat and cold may be caused by nerve damage caused by distaff, depression may be caused by chronic pain in the hands and fingers."
},
{
  "instruction": "Doctor, I've been feeling very depressed lately and experiencing changes in body temperature.",
  "input": "",
  "output": "Do you ever feel any pain or discomfort in your wrist?"
},
{
  "instruction": "Doctor, you've got pus coming out of your ear, hearing falling, ears ringing, ears getting sick, ears getting red, what's the problem?",
  "input": "",
  "output": "I think you've got some of the symptoms that you've described from a disease known as a pericardial rupture or injury: trauma in the ear or infection in the ear; you need to test your ears to see the diagnosis and determine how best to treat it."
},
{
  "instruction": "Doctor, I've been coughing a lot lately and my ears are hurting. What's the problem?",
  "input": "",
  "output": "There could be a pericardial perforation that can cause pain in the ear with a cough."
},
{
  "instruction": "There's a doctor, there's an epidural, there's an ear secretion, there's a flu, there's a sense of deafness in the ear, and there's a little bit of bleeding in the ear yesterday, and you know what's causing it?",
  "input": "",
  "output": "It could be caused by sudden changes in pressure, such as air travel or diving, which can be caused by ear infections or injury."
},
{
  "instruction": "Sir, I recently had a problem in my ear: pus coming out, blood coming out, fluid coming in, and hearing isn't the same.",
  "input": "",
  "output": "The symptoms you've described are common symptoms of the pericardial perforation."
},
{
  "instruction": "Doctor, it's ringing in your ears, flu-like symptoms, pus coming out of your ears, even bleeding out.",
  "input": "",
  "output": "It's good to come to the hospital for a thorough examination to check the diagnosis and discuss the treatment options."
},
{
  "instruction": "Sir, I'm experiencing an infant in sex. Can you tell me what's causing it?",
  "input": "",
  "output": "like diabetes, heart disease, anxiety or depression."
},
{
  "instruction": "Doctor, erectile failure, blood in the urine, prostate symptoms, sexual pain.",
  "input": "",
  "output": "Maybe there's something that can cause all the symptoms that you've described."
},
{
  "instruction": "Doctor, there's blood in your urine. What's the cause?",
  "input": "",
  "output": "The symptoms you're experiencing are called heterogenesis, and they're generally not related to impotence, but it's a condition where you have difficulty in getting or retaining the erection during sexual activity."
},
{
  "instruction": "Doctor, you're experiencing sexual pain, sexual pain, sexual decline, is that a serious problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from desalination."
},
{
  "instruction": "We're experiencing a doctor, we're having Vin\u00f1os, we're having urinating, we're having prostate symptoms, we're having pain in sex, we're having excessive urination at night, what's the problem?",
  "input": "",
  "output": "The symptoms that God has described may indicate that it's inoculated."
},
{
  "instruction": "Doctor, I'm experiencing an involuntary urinary tract, a chest pain, a sharp abdominal pain. What's going on with me?",
  "input": "",
  "output": "Depending on the symptoms, there could be temporary or benign blood in the urine."
},
{
  "instruction": "There's a combination of blood in the doctor's skull pain, involuntary urination, in urinary pain, in the lower abdominal pain and urine.",
  "input": "",
  "output": "Symptoms can cause temporary or benign urine contamination due to infection or kidney stones, and we need to do some additional tests to confirm the diagnosis."
},
{
  "instruction": "There are symptoms of blood mixed into the urine with doctors, urinary pain, sharp abdominal pain, and back pain.",
  "input": "",
  "output": "Yes, you're experiencing a combination of blood in temporary or benign urine, and the symptoms you've described are likely to be caused by infection or kidney stones."
},
{
  "instruction": "Doctor, I'm experiencing a chest pain and lower abdominal pain.",
  "input": "",
  "output": "It looks like there's temporary or benign blood in the urine."
},
{
  "instruction": "Doctor, I've been experiencing an involuntary urination and bladder stimulation in the last few days, and I've had difficulty holding urine, and I've got blood in my urine, and what's the cause of these symptoms?",
  "input": "",
  "output": "According to the symptoms you've described, you can have a disease called hemolysis, which is a temporary or benign condition in which the blood in the urine is mixed with the urine, but it requires additional tests to be properly diagnosed."
},
{
  "instruction": "Doctor, you stutter, you stutter, you stutter, you not speak well, you have kidney symptoms, you feel a lot of cold, and what's the cause of all this?",
  "input": "",
  "output": "You may be suffering from kidney disease from high blood pressure for a long time."
},
{
  "instruction": "Doctor, there are strange symptoms that don't vary well, that your hair is too low, that you can't talk, that you're not comfortable with your kidneys, and what's the cause of this?",
  "input": "",
  "output": "The symptoms seem to indicate that you have kidney disease caused by prolonged high blood pressure, and it's important to get some tests to check your diagnosis, and to start the appropriate treatment as soon as possible, and avoid further complications."
},
{
  "instruction": "Doctor, you've recently had spasms on your feet, stuttering, and the number of times you go to the bathroom is much more frequent than usual, and you've got a problem with toilet control.",
  "input": "",
  "output": "Symptoms can lead to kidney disease caused by long-term high blood pressure, which is generally associated with kidney disease, including diabetes and defibrillation, and it's important to check your diagnosis with additional tests and start treating them as soon as possible."
},
{
  "instruction": "Doctor, I've been having strange symptoms lately, but my feet and toes are constantly having cramps and cramps, and I'm always too hungry, and sometimes I have problems making things clear.",
  "input": "",
  "output": "Symptoms may indicate kidney disease due to prolonged high blood pressure, and excessive appetite can be a sign of anemia caused by kidney problems, and muscle spasms and speech difficulties can often be caused by electrolysis, which is associated with kidney disease."
},
{
  "instruction": "Doctor, your knee has been weakened lately, and you feel stiff or cold. What is it?",
  "input": "",
  "output": "The symptoms seem to indicate that smoky cartilage pericarditis is a condition that causes knee pain, weakness and stiffness in the lower cartilage to soften and worsen."
},
{
  "instruction": "Doctor, you've been overextended these days, and you've got kidney-related symptoms.",
  "input": "",
  "output": "Excess appetites may be symptoms of uncontrolled blood sugar, but if you combine kidney-related symptoms, you're likely to have kidney disease caused by long-term high blood pressure."
},
{
  "instruction": "Doctor, I've been experiencing a number of unusual symptoms recently, such as the color and smell of urine, the good breath, the stuttering and stuttering of speech.",
  "input": "",
  "output": "The symptoms you've described suggest that there is a possibility of kidney disease caused by long-term high blood pressure, which can change urine color and smell, which can also be common in people with kidney disease, and excessive appetite can be a result of kidney disorders."
},
{
  "instruction": "Doctor, I've recently found it difficult to speak with good breath and too little hair and cold, and I also have some kidney-related symptoms.",
  "input": "",
  "output": "Your symptoms suggest that you have kidney disease from high blood pressure for a long time."
},
{
  "instruction": "Sir, I've been suffering from an inconsequential condition lately, and why?",
  "input": "",
  "output": "As a result of your medical history, it is likely that the changeover is due to kidney disease caused by prolonged high blood pressure, which affects the muscles and nerves of the workplace, causing difficulty in controlling the defecation. It's important to manage high blood pressure and kidney disease in order to prevent further complications."
},
{
  "instruction": "Doctor, you've recently had leg pain and elbow pain and a lot of bone and joint pain.",
  "input": "",
  "output": "Yeah, I think you've got sigmolygosis, which is a condition in which the cartilage of the cartilage softens, breaks down, causes pain in the knee, and causes pain in other parts of the body due to the reward movement."
},
{
  "instruction": "Hi, sir, there's elbow and joint pain with a weak knee and a stiff or warm feeling.",
  "input": "",
  "output": "Yes, I think you've got cytoplasm, which causes pain and milder pain. You've got to do some tests to check your diagnosis and discuss treatment options."
},
{
  "instruction": "Doctor, I've got a lot of pain in my legs these days, and I've got movement problems.",
  "input": "",
  "output": "The symptoms may indicate that you're suffering from cartilage cartilage, which affects the cartilage under the cartilage."
},
{
  "instruction": "Doctor, there's swelling and weakness in the knee. Can you tell us what's causing it?",
  "input": "",
  "output": "Symptoms indicate that cartilage perforation is likely to be a condition in which the cartilage below the cartilage deteriorates."
},
{
  "instruction": "Hi, doctor, you've recently had a weakness in your knee and swelling. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from smoky cartilage."
},
{
  "instruction": "Doctor, your legs and feet are too low, your skin is growing, your feet and toes are in pain, your legs and your feet seem to be infected, your skin is sore, what's the problem?",
  "input": "",
  "output": "The symptoms may indicate that you're suffering from a hand-nail fungus, which affects your feet, your nails, your surrounding skin."
},
{
  "instruction": "Doctor, there's skin itch, there's skin rashes, there's too little hair, there's diaper rashes, there's skin growth, what's the problem?",
  "input": "",
  "output": "The symptoms suggest that you're suffering from a hand-tricked fungus, which is also called a toenail mousse."
},
{
  "instruction": "Doctor, I found that I had a strange diaper rash and my toe hair was gone. What's the problem?",
  "input": "",
  "output": "I think you're experiencing the symptoms of a fungus infection affecting the nail around your toes and fingers and the skin, and hair loss is a common symptom of this disease."
},
{
  "instruction": "Doctor, I think I've got dryness on my skin, textures, scales, leg and foot infection, and my nails look irregular, and they're swollen and it's itchy, and what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you have a hand - toenail fungus, also known as the toenails, which cause a variety of symptoms, such as skin dryness, peeling, scales, skin edema, skin aches, and so on, as a fungus that affects the claws and the surrounding skin."
},
{
  "instruction": "Doctor, what's wrong with your nails looking irregular, your hair being too low, your diaper rash?",
  "input": "",
  "output": "The symptoms seem to indicate that there's a fungus infection that affects the claws of your hands, which can cause skin rashes in other parts of your body."
},
{
  "instruction": "Doctor, I'm experiencing aches and bladder-related symptoms, and there's an involuntary urination and BB. Do you know what's causing it?",
  "input": "",
  "output": "I think you're suffering from the symptoms of urethra, which may be a couple of different causes, but you have to do some tests to figure out the exact cause."
},
{
  "instruction": "There's a mix of blood in the doctor, in the urine, in the urinary tract, in the upper part of the skull, in the urine, and there's side pain, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate that you have the disease of urethra."
},
{
  "instruction": "Doctor, I'm experiencing involuntary urination, bladder-related symptoms, acute abdominal pain, and what's the problem?",
  "input": "",
  "output": "With the symptoms that God has described, you can have back-to-back disorders."
},
{
  "instruction": "Doctor, there's a lot of chest pain, and I feel like something is being pulled down in the bladder.",
  "input": "",
  "output": "You may have a urethra disorder, you can cause pain in bladder, pelvis or penises, and it's good to get additional tests to figure out the exact cause."
},
{
  "instruction": "Doctor, I've just had a lot of pain in my side, and I've been going through it, and I've been having a really hard time urinating, and sometimes I've been unconsciously looking at a little urine, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms you've described may indicate that there's a problem with urethra."
},
{
  "instruction": "Doctor, I've recently had a fever, a chill, a skin condition, and I've had some strange facial symptoms, and I've lost some of my senses in my body, and you know what's wrong?",
  "input": "",
  "output": "Yes, these symptoms are common symptoms of lime disease, usually related to a tick bite during outdoor activity, and it's important to start treating them quickly to prevent further complications."
},
{
  "instruction": "Doctor, I've been experiencing some symptoms recently: hip pain, skin rash, facial problems.",
  "input": "",
  "output": "In view of the symptoms, it's possible you've had lime disease. Have you spent any time in the woods or in the lawn lately?"
},
{
  "instruction": "Hi doctor, I'm experiencing a recent headache, fever, skin rash, sensory loss.",
  "input": "",
  "output": "These symptoms may be signs of lime disease, or have you spent any time outdoors in areas where there's a lot of tick bites or tick populations recently?"
},
{
  "instruction": "Hi doctor, I've recently had hip pain, and I've had a bad skin, and I've been feeling depressed, and lately I've had a fever.",
  "input": "",
  "output": "Because of your symptoms, you've been to a forest or a meadow where ticks are common lately, where lime disease is often bitten by ticks."
},
{
  "instruction": "Doctor, I'm experiencing hand pain, skin rashes, fatigue, psychiatric symptoms, and it also looks strange to my skin.",
  "input": "",
  "output": "Your symptoms and skin shape make lime disease suspicious."
},
{
  "instruction": "Doctor, there's been a lot of reflux recently. What's the cause?",
  "input": "",
  "output": "Could be iron deficiency anemia. Have you been tired or exhausted lately?"
},
{
  "instruction": "Sir, there are strange symptoms of reflux, gain of weight, loss of breath, loss of work -- can you tell us why?",
  "input": "",
  "output": "The symptoms suggest that you have iron deficiency anemia."
},
{
  "instruction": "Good morning, doctor. Can you tell me what's wrong with Ohan and the fuss?",
  "input": "",
  "output": "The symptoms seem to indicate that you have RDS."
},
{
  "instruction": "There's a doctor, a sharp chest pain, hemorrhoids, fevers, depressed symptoms, he coughs, you know what's wrong with me?",
  "input": "",
  "output": "There may be acute respiratory problems, or ARDS, depending on the symptoms."
},
{
  "instruction": "Doctor, there's been a lot of shortness of breath and aggravation. What's the problem?",
  "input": "",
  "output": "Depending on the symptoms, there could be ARDS."
},
{
  "instruction": "Doctor, there's been a lot of coughing and respiratory problems, and there's been a lot of vomiting, and what's the cause?",
  "input": "",
  "output": "I think we have ARDS, which is a serious disease that can occur when fluid builds up in the small air sacs of the lungs, making breathing difficult, often caused by lung injury or infection."
},
{
  "instruction": "Doctor, I've been throwing up a spade lately. What's the problem?",
  "input": "",
  "output": "It's possible that you're suffering from acute respiratory distress syndrome."
},
{
  "instruction": "What's the cause of the recent irregular heart rate?",
  "input": "",
  "output": "It can cause hyperthyroidism in the thyroid, which can lead to chest palpitations and irregular heart beats."
},
{
  "instruction": "Hi doctor, I've recently experienced a very tired and abnormal inert movement, and I feel a slight swelling of the neck and an irregular beat of the heart.",
  "input": "",
  "output": "The symptoms seem to indicate that there is a toxic polythy thyroidoma."
},
{
  "instruction": "Hi doctor, you're sweating, abnormal movement of eyelids, percutaneous, neck swelling, and you want me to tell you what I have?",
  "input": "",
  "output": "The symptoms seem to indicate that you have toxic polythyroidoma, how many tests can you run to check your diagnosis and discuss treatment options?"
},
{
  "instruction": "Sir, I'm experiencing abdominal symptoms and overexplosive symptoms. What's the cause?",
  "input": "",
  "output": "The symptoms may indicate that there's a toxic strepoma, and you have to run some tests to check your diagnosis."
},
{
  "instruction": "Sir, I'm experiencing sinuses and abnormal inert motion, and I think the eyelids are acting abnormally, and I feel strange to the eye, and what's the cause?",
  "input": "",
  "output": "Depending on the symptoms, there may be a number of toxic polythyroidomas that occur when there are multiple types of thyroid hormones in the thyroid, which can cause a variety of symptoms, including the symptoms you described."
},
{
  "instruction": "Hi, doctor, there's a wound on your finger, and your hand is swollen.",
  "input": "",
  "output": "The wound seems to have caused an infection called bileitis, which needs to be cleaned up and dressing as soon as possible so that the wound doesn't spread."
},
{
  "instruction": "Sir, there's a wound on your finger, and it's very painful, and your fingers are very stiff and you feel joy.",
  "input": "",
  "output": "The symptoms seem to indicate that there's a injury to the finger, and the stiff, short feeling may be due to swelling and inflammation around the wound."
},
{
  "instruction": "Hi, doctor, there's an open wound on your fingers and a swelling in your hands and fingers, and it looks like your skin is infected.",
  "input": "",
  "output": "According to your description, your fingers seem to have had a bacterial infection that caused swelling and skin changes, and it's important to clean the wound and dress properly so that it doesn't spread."
},
{
  "instruction": "Sir, there's a wound on your finger, and it hurts, and it also makes your fingers stiff and it feels tight.",
  "input": "",
  "output": "The symptoms seem to indicate that there's some kind of pain, stiffness, or joy, due to injury to the fingers and inflammation of the surrounding tissue."
},
{
  "instruction": "Sir, there's a wound on your finger, and I feel very stiff and tight. What's wrong with your finger?",
  "input": "",
  "output": "The stiffness of the fingers can be due to the opening of the finger wound, which is a common symptom of open wounds affecting the muscles and tissue surrounding the wound."
},
{
  "instruction": "Doctor, I'm so tired these days, and I think I need to rest every few hours.",
  "input": "",
  "output": "It's one of the symptoms that can cause fatigue, and we need to run some tests to make sure that we're diagnosed, but it's important to solve this condition as soon as possible."
},
{
  "instruction": "Doctor, in the last few days, my appetite has been reduced and it's been difficult to swallow, and I've been fainting a lot, and I've been experiencing back pain and nausea, so can you tell me what might happen?",
  "input": "",
  "output": "The symptoms suggest that you have a magnetic nervous disorder, which affects the function of the magnetic nervous system to regulate involuntary behavior such as breathing, heart rate, blood pressure, and digestion."
},
{
  "instruction": "Doctor, there's skin lesions, leg pains, headaches, difficulty in swallowing. What's the problem?",
  "input": "",
  "output": "These symptoms could be caused by a magnetic nervous disorder."
},
{
  "instruction": "There's a problem with your eyes, sir, I don't think the size of the pupil is the same, and I've been having some back pain lately, so can you tell me what's wrong?",
  "input": "",
  "output": "The symptoms that God says may affect the muscles of the eye, causing the size of the copper ball to become unequal or cause back pain, require several tests to determine the diagnosis."
},
{
  "instruction": "Sir, I'm suffering from terminal swelling and headaches. What's the problem?",
  "input": "",
  "output": "Symptoms indicate that there is a possibility of a magnetic nervous disorder that affects the nerves that control the automatic functions of the body."
},
{
  "instruction": "There's a problem with doctors, knee pain, prostate symptoms, fatigue, sexual pain, or orgasm.",
  "input": "",
  "output": "It's a condition that affects sexual desire and behavior, which can cause physical symptoms like what you're experiencing."
},
{
  "instruction": "We're experiencing a doctor, a Joru, an erection failure, a decline in sexual appetite. What's the problem?",
  "input": "",
  "output": "It's very likely that there are psychiatric disorders that affect sexual function and sexuality, and it's important to discuss them in detail and find potential treatments."
},
{
  "instruction": "Doctor, I have problems with orgasms, depression, sexual pain, erectile failure and prostate symptoms.",
  "input": "",
  "output": "I think you have a mental disorder that can cause all the symptoms that God has described, and it's good to make an appointment with a mental health professional, to discuss the symptoms, to find a possible cure."
},
{
  "instruction": "Doctor, I have prostate symptoms and sexual pain, so what's the problem?",
  "input": "",
  "output": "You're suffering from a psychological disorder that requires some tests to confirm your diagnosis, but you can treat it with treatment and medication."
},
{
  "instruction": "Doctor, I take a piss unconsciously. What's the problem?",
  "input": "",
  "output": "You're suffering from a psychiatric disorder that causes involuntary urination, especially bed-wetting."
},
{
  "instruction": "Doctor, I'm extremely tired these days, and I have symptoms of breathing easily, and what's the cause?",
  "input": "",
  "output": "Anemia occurs when red blood cells or hemoglobin levels are lower than normal and can cause fatigue and shortness of breath."
},
{
  "instruction": "Doctor, I'm not very strong these days. What's the cause?",
  "input": "",
  "output": "Defections indicate that there's a potential for anemia."
},
{
  "instruction": "Doctor, I've been very tired recently, and I've been vomiting blood, and I've found a black side in the toilet, and I've found more hair falling than usual, and what's wrong with me?",
  "input": "",
  "output": "Anemia is a condition in which the red blood cells can be small enough to cause a change in fatigue and the shape of the stool, the symptoms of the black side, the hair, which looks like a tar."
},
{
  "instruction": "Doctor, you've been in a bad breath lately.",
  "input": "",
  "output": "Have you ever felt fatigue or weakness, along with shortness of breath?"
},
{
  "instruction": "Doctor, I'm feeling a lot of breath, aches, nosebleeds, fatigue, and I recently had a baby, and I don't know what the cause of this is.",
  "input": "",
  "output": "Anemia can lead to anemia due to your symptoms and your recent pregnancy, which can cause the symptoms that you've described in your blood red blood cells or hemoglobin levels below normal, which may require some blood tests to identify the diagnosis, but can be treated."
},
{
  "instruction": "Doctor, I'm having a lot of pain these days, I'm having pain in my ankles, my wrists, my feet, my legs, sometimes I feel pain in my joints, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate hay fever, a condition that causes pain due to inflammation of the body's tendon."
},
{
  "instruction": "Doctor, I've been experiencing wrist pain and elbow pain for the last few weeks.",
  "input": "",
  "output": "The symptoms suggest that you have hay fever."
},
{
  "instruction": "Doctor, I've been experiencing arm pain and elbow pain for days. What's the problem?",
  "input": "",
  "output": "The symptoms that God explains are consistent with a condition called dryitis, which is an inflammation of the sinews that connect muscles and bones."
},
{
  "instruction": "Doctor, I've had a lot of pain in my elbow over the last few days, especially when I'm moving my arm.",
  "input": "",
  "output": "The symptoms suggest that hay fever is suspect."
},
{
  "instruction": "Doctor, you've got a noseometriosis and throat pain, so why?",
  "input": "",
  "output": "I think you've got a cold."
},
{
  "instruction": "Hi doctor, fevers, coughs, throataches, ear pain. What's wrong with me?",
  "input": "",
  "output": "I think you've got a cold."
},
{
  "instruction": "Doctor, your headache is severe and your throat really hurts. What's the cause?",
  "input": "",
  "output": "I think it's a cold that's accompanied by these symptoms. Take a break and drink plenty of water."
},
{
  "instruction": "Doctor, your throat hurts too much. What's the cause?",
  "input": "",
  "output": "It seems to have a cold, and it's often one of the symptoms of the cold that includes throatache, and it's important to take a break and take care of yourself during recovery."
},
{
  "instruction": "Sir, I think I have a cold all day, and my nose doesn't stop.",
  "input": "",
  "output": "The symptoms suggest that you have a cold."
},
{
  "instruction": "Doctor, I have symptoms that are hard to talk about, that are fatigued, that are hard to swallow, and what's the cause?",
  "input": "",
  "output": "Symptoms are likely to indicate ALS, known as ALS."
},
{
  "instruction": "Doctor, I've been feeling pain in my legs, fatigue, weakness in my muscles, weakness in my legs for a while, and what's the problem?",
  "input": "",
  "output": "The symptoms are likely to be lugeric disease, which affects the nerve cells of the brain and spinal cord, leading to progressive neurological problems, including muscle weakness."
},
{
  "instruction": "Doctor, I've been too tired and too hard to swallow these days.",
  "input": "",
  "output": "The symptoms indicate that ALS is a neuroresponsive disease that affects nerve cells that are responsible for the functional movement of muscles."
},
{
  "instruction": "Doctor, I have a feeling of weakness in my hands and fingers these days. What's the cause?",
  "input": "",
  "output": "It can be a symptom of mybsorption, a progressive neuroresponsive disorder that affects the neurons in the brain and in the spinal cord that ultimately causes muscle weakness and contraction, ALS."
},
{
  "instruction": "Doctor, I'm feeling extremely fatigued, and my legs are convulsing, and my muscles are getting weaker, and I'm having an abnormal, involuntary movement, so can you tell me what's going on?",
  "input": "",
  "output": "There may be ALS, which is also known as ALS, which affects nerve cells that control voluntary muscle, which can cause weakness, convulsions and abnormal movement."
},
{
  "instruction": "Doctor, there's been some symptoms in your eye recently that there's a spot or a cloud in your eye with a pain in your eye, and sometimes it's like you don't see it.",
  "input": "",
  "output": "These symptoms can be suspicious of central retinal arteries or vein closing, which can lead to severe blindness."
},
{
  "instruction": "Doctor, you're experiencing low vision, low vision, double vision, irregular heartbeat. What's the cause of all these symptoms?",
  "input": "",
  "output": "The symptoms suggest that you have a central retinal artery closed, or a central retinal vein closed."
},
{
  "instruction": "Sir, there's going to be signs of elbow pain, abdominal pain, spots or clouds in your visual field, and you know what's causing these symptoms?",
  "input": "",
  "output": "Well, the symptoms seem to indicate a central retinal artery or vein obstruction."
},
{
  "instruction": "Doctor, I'm feeling very weird these days, and I'm sweating, and my heart is beating very fast, and I feel like something is going to pop out of my chest.",
  "input": "",
  "output": "From the symptoms that God explains, it's very likely that there's a seizureic, pericardial V-tach."
},
{
  "instruction": "Doctor, there's been some strange symptoms in my face recently, and I feel red and I feel like my eyes are sticking out, and what's the cause?",
  "input": "",
  "output": "There's a possibility that there's a seizure-systic VVT, which causes a sudden increase in heart rate, which causes redness of the face and swelling of the eyes, and it's good to run some tests and make additional evaluations to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I'm experiencing symptoms of strange face, difficult breath, pericardial sweat, do you know what's causing it?",
  "input": "",
  "output": "Your symptoms suggest that you're experiencing a sudden, rapid heart rate disorder, a seizure-symbolic V-tach."
},
{
  "instruction": "Doctor, there's red face and rapid heart rate and sweating, and what's the cause?",
  "input": "",
  "output": "It's possible that it's a seizure-sympathic VVT."
},
{
  "instruction": "Doctor, there are recent swelling of the ankles, I don't know what they are, but one ankle is bigger than the other.",
  "input": "",
  "output": "The symptoms may indicate that you're having an I.V. failure, which means that your leg veins are having difficulty pumping blood back into your heart, so your ankles and legs are swelling."
},
{
  "instruction": "Doctor, body fluids, swelling of the leg, skin infection of the leg, leg pain, what's the problem?",
  "input": "",
  "output": "The symptoms suggest that you're suffering from IV failure."
},
{
  "instruction": "Doctor, I'm having symptoms that my leg's not circulating well, that my leg is always tired and sick, and what's the cause?",
  "input": "",
  "output": "I think there's an I.V. failure of the leg vein to send blood back to the heart, which leads to blood circulation, which can cause such symptoms as leg pain and swelling."
},
{
  "instruction": "I'm experiencing a doctor, a blood circulation disorder, body fluids, burning chest pains, skin lesions and abnormally-looking skin -- what's wrong with me?",
  "input": "",
  "output": "The symptoms suggest that you're suffering from IV failure."
},
{
  "instruction": "Doctor, I feel swollen and heavy, and when I walk, I feel pain, I think I have fluid on my legs, what's the problem?",
  "input": "",
  "output": "I.V.C. has a problem sending blood from the limbs to the heart, and it's caused by the drop of fluid in the legs, which can also cause lymph nodes and leg pain."
},
{
  "instruction": "Doctor, there's been an ongoing lower abdominal pain. What's the cause?",
  "input": "",
  "output": "Could it be Trikomonas, a parasite-based venereal disease, or do you have secretions or itching?"
},
{
  "instruction": "Doctor, I'm suffering from vaginal nausea. What's the cause?",
  "input": "",
  "output": "It could be trikomonas, a parasite disease, and we need to do some tests to identify the diagnosis."
},
{
  "instruction": "Doctor, I'm experiencing vaginal and side pain. What's the cause of the symptoms?",
  "input": "",
  "output": "These symptoms are usually caused by Trikomonas infection, and you have to run some tests to check your diagnosis."
},
{
  "instruction": "I'm experiencing a doctor's pelvic pain, vaginal secretions, perplexity, lower abdominal pain, burning stomach pain, what's the problem?",
  "input": "",
  "output": "The symptoms are likely to be trikomonas infection, and you have to do some tests to confirm your diagnosis."
},
{
  "instruction": "Doctor, I've been experiencing abdominal pain during the last few days of pregnancy. Can you tell me what caused it?",
  "input": "",
  "output": "Symptoms suggest that it may be Trikomonas, a parasite that can cause abdominal discomfort during pregnancy, that it should be tested as soon as possible and treated as soon as possible."
},
{
  "instruction": "Sir, I have a long period of menstruation, my skin has spots, my hair looks too low, my scalp looks irregular, and I want you to know what's causing all of these symptoms.",
  "input": "",
  "output": "You're experiencing acne, a common skin disease affecting your skin follicles and oil glands, which can cause symptoms that you've described, such as menstruating during periods of menstruation, skin spots, hair hair is too low, and your scalp looks irregular."
},
{
  "instruction": "Hi, doctor, we've recently had skin problems -- swelling of the skin, trussing, drying and cyclical -- what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from acne."
},
{
  "instruction": "Sir, it's been a long time since you had a red stone on your face, but your skin looks abnormal, you know what's wrong?",
  "input": "",
  "output": "I think you've got acne, which is a common skin disease, caused by a red sore."
},
{
  "instruction": "Sir, I've been thinking about my nose, and it looks like my nose has been altered, and I think my scalp is irregular, and it looks like my skin is abnormal, and my period is longer than normal, and I think I have too little hair on my head.",
  "input": "",
  "output": "It's important to talk to a dermatologist about how to treat acne."
},
{
  "instruction": "Doctor, I've become very nervous lately, and I'm nervous, and I'm nervous, and I'm drinking more, and I'm feeling a lot worse, so why do you think I'm doing that?",
  "input": "",
  "output": "I think you're suffering from depression when you look at your symptoms, and it's good to have therapy and medication to help you manage your symptoms."
},
{
  "instruction": "Sir, I'm feeling so down these days, I don't have the energy to do anything and I don't want to talk to anyone.",
  "input": "",
  "output": "I think you're suffering from depression."
},
{
  "instruction": "Doctor, I've been drinking a lot lately, and I get mad a lot faster than usual, and what's the cause?",
  "input": "",
  "output": "Alcohol abuse and excessive anger are common symptoms of depression, it's important to consult on mental health and plan for treatment."
},
{
  "instruction": "Sir, I'm very depressed these days, and I've lost interest in things that used to make me happy, and I feel like everyone's against me, and I don't have a purpose in life, and I'm relying on alcohol and drugs to deal with it.",
  "input": "",
  "output": "Depression is a mood disorder that can cause constant sadness, despair, loss of interest in what you once enjoyed, and it's common for people who are depressed to resort to drug abuse to deal with it. It's important to discuss treatment options and plan for symptoms."
},
{
  "instruction": "Doctor, I've been having a lot of trouble with memory, sleep problems, and I feel more hostile than usual, and you know what's wrong with me?",
  "input": "",
  "output": "I think you're suffering from depression from the symptoms you just described, which is a common mental health condition that affects a lot of people, and we can discuss treatment options that can help you feel better."
},
{
  "instruction": "Recent symptoms of hostile behavior, depression or psychiatric symptoms, depression, smoking problems, excessive anger.",
  "input": "",
  "output": "The symptoms seem to indicate that you've been under drug abuse. What kind of drugs have you been using lately?"
},
{
  "instruction": "Sir, there's something weird going on. I'm looking at things that don't exist.",
  "input": "",
  "output": "These symptoms seem to be disturbing: have you used drugs, substances, or alcohol recently? Patient:"
},
{
  "instruction": "Hi, doctor, I've been feeling down lately and I don't know why.",
  "input": "",
  "output": "Have you abused drugs or substances recently? Patient: Yes, actually, that's true. I've been using cocaine occasionally for months."
},
{
  "instruction": "Doctor, I've been feeling so down lately that I'm relying on alcohol.",
  "input": "",
  "output": "I think you're having a hard time with drug abuse, which can lead to depression or psychiatric symptoms, and we're going to have to discuss treatment options."
},
{
  "instruction": "Doctor, I've been experiencing sharp abdominal and back pain in the last few days, and I think I'm going to go too far at night.",
  "input": "",
  "output": "The symptoms may indicate that there's a lung color."
},
{
  "instruction": "Hi, doctor, I've got bladder and side pain symptoms.",
  "input": "",
  "output": "The symptoms seem to indicate that it's likely to be lung cancer, and we need some additional tests to identify the diagnosis."
},
{
  "instruction": "Doctor, I'm experiencing a sharp abdominal and urinary reflux, and there's blood in the urine, and there's prostate symptoms.",
  "input": "",
  "output": "The symptoms can be caused by a variety of factors such as prostate obesity, kidney stones, and immediate treatment to relieve pain and prevent further complications."
},
{
  "instruction": "I'm experiencing a doctor, a Vin\u00f1o, a urinary pain, a sharp abdominal pain, a chest pain, an involuntary urination. What's the problem?",
  "input": "",
  "output": "There could be a urethra, a closed urine that blocks normal flow through the ureter system."
},
{
  "instruction": "Doctor, there's a lot of chest and side pain, and there's a little bit of discomfort in the bladder.",
  "input": "",
  "output": "The symptoms suggest that there's a lung color in the urethra."
},
{
  "instruction": "Doctor, I've been experiencing some sort of disturbing, emotional symptoms recently. Do you know what's causing them?",
  "input": "",
  "output": "The symptoms are likely to indicate that it's a form of backbrush, which is a rare disease that causes excessive urination and dehydration because the body doesn't have the proper balance of body fluids."
},
{
  "instruction": "Doctor, I'm experiencing excessive appetites, I'm biting nails, my elbow weakness, elbow convulsion or tics, and what's wrong with me?",
  "input": "",
  "output": "It's possible that the symptoms are back-to-back, and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, your elbow is weak, you can't swallow, your butt is stiff, your ass is cold, your eyelids arey.",
  "input": "",
  "output": "The symptoms suggest that you have diabetes, and you have to run additional tests to confirm this diagnosis."
},
{
  "instruction": "I'm experiencing symptoms like doctor, difficulty in years, weakness in elbows, Bin\u00f1os, ticklishness, biting nails, what's the cause of these symptoms?",
  "input": "",
  "output": "Have you had an increase in thirst or dehydration?"
},
{
  "instruction": "Sir, I've got a problem with my eyes, and I think my eyes are swelling and my vision is getting worse, and I can't see.",
  "input": "",
  "output": "It could be measles, which is inflammation of the cilia in the iris and the cilia in the eye."
},
{
  "instruction": "Doctor, I have strange symptoms in my eyes: red eyes, blurry, frequent headaches, and I have constant tears, and sometimes my eyes sting or sting.",
  "input": "",
  "output": "The symptoms suggest that you're suffering from the red of your eye and the inflammation of your cilia, which is a good idea to arrange for an eye specialist to make a diagnosis and get proper treatment."
},
{
  "instruction": "Doctor, your eyes are swollen, your eyes are swollen, you've got headaches, you've got spots, you've got clouds, you've got eye pain, what's the cause of these symptoms?",
  "input": "",
  "output": "There's a possibility that it's caused by symptoms, that it's got inflammation of the iris and the cilia in the eye, and we need additional tests to make sure we're diagnosed."
},
{
  "instruction": "Doctor, in the last few days, I've been having eye infections, and it's been dark, and it's been swelling, and there's spots and clouds in my eyes, and what's the problem?",
  "input": "",
  "output": "Symptoms are likely to lead to an inflammation of the iris and circomas inside the eye, and it's best to be examined by an eye doctor as soon as possible to get a proper diagnosis and treatment, which can lead to severe complications if not treated without treatment."
},
{
  "instruction": "Sir, I've been crying with a lot of severe eyes lately, and I feel like something's stuck in my eyes.",
  "input": "",
  "output": "The symptoms seem to indicate that measles is caused by inflammation of the iris and the cilia, which often causes eye pain and discomfort."
},
{
  "instruction": "Doctor, we found that the scrotum touched the mass and the skin grew. What's the problem?",
  "input": "",
  "output": "There could be a pericardial vein that expands or expands, which is the common cause of the skin growth of the scrotum and the mass of the scrotum."
},
{
  "instruction": "Sir, I've got infertility, penis pain, groin pain, scrotum and scrotum swelling, and what's the cause of these symptoms?",
  "input": "",
  "output": "Depending on the symptoms, the vein in the scrotum can be diagnosed as swollen and dilated, with a goiter vein."
},
{
  "instruction": "Sir, I'm experiencing lower abdominal pain, scrotum edema and penis pain. Would you like to know what might be the problem?",
  "input": "",
  "output": "It's possible that the symptoms are the cause of the gonads, which are enlarged and swollen veins, which can cause lower abdominal pain, discomfort, scrotum and scrotum edema."
},
{
  "instruction": "I'm experiencing a doctor, an erection failure, lower abdominal pain, an involuntary urinary tract, a penis pain, and I've found that under the penis, the skin grows, and what's the problem?",
  "input": "",
  "output": "The symptoms can lead to a high-recipital venous vein, which can cause pain and discomfort due to an excess of veins in the scrotum that form a mass."
},
{
  "instruction": "What's the problem with the symptoms of a doctor's scrotum, inflection, erectile failure, involuntary urination, and lower abdominal pain?",
  "input": "",
  "output": "The symptoms suggest that you have a pericardial vein."
},
{
  "instruction": "Hi, doctor, I've been experiencing this sort of sharp, burning stomach pain recently, and I've got nausea, and I've got toilets, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate you're suffering from hypersensitivity bowel syndrome."
},
{
  "instruction": "We're experiencing a doctor, a burning abdominal pain, a bloating sore, a rectal hemorrhage, lower abdominal pain and reflux.",
  "input": "",
  "output": "You're experiencing symptoms of hyper-temperative bowel syndrome."
},
{
  "instruction": "Doctor, I'm experiencing bloating, rectal bleeding, diarrhea, insomnia, lower abdominal pain. What's wrong with me?",
  "input": "",
  "output": "The symptoms seem to indicate you're suffering from hypersensitivity bowel syndrome, which is the most likely diagnosis, if you have to do some tests."
},
{
  "instruction": "Doctor, I'm experiencing nausea, anxiety and anxiety, sharp pain in the lower abdomen.",
  "input": "",
  "output": "The symptoms suggest that you have hyper-sensitivity bowel syndrome."
},
{
  "instruction": "Doctor, I've been feeling sick lately, and I don't know what the symptoms are.",
  "input": "",
  "output": "You're experiencing symptoms of hypersensitivity bowel syndrome. Do you have any discomforts or changes in urinary activity?"
},
{
  "instruction": "I'm experiencing ankle swelling, foot swelling, foot stiffness, toes. What's wrong with me?",
  "input": "",
  "output": "I think there's a fracture in his foot. You need to get an X-ray to see."
},
{
  "instruction": "Sir, I'm tired of my feet, and I'm feeling pain in my ankle. What's the problem?",
  "input": "",
  "output": "It looks like there's a fracture in the foot, and we need to take X-ray to check it, but the symptoms indicate that the fracture is likely to be the cause."
},
{
  "instruction": "Hi, sir. I've been having pain and swelling in my ankle lately, stiff feet and toes, and I have a sense of joy.",
  "input": "",
  "output": "The symptoms seem to indicate that the fracture of the ankle is in doubt, and we need to do some tests to confirm the diagnosis."
},
{
  "instruction": "Hi doctor, I've got swelling ankles and swelling feet and severe pain. Can you tell me what's going on?",
  "input": "",
  "output": "The symptoms suggest that you have a fractured ankle."
},
{
  "instruction": "Doctor, I've had a feeling of weakness in my feet lately.",
  "input": "",
  "output": "Was there an injury or accident that could have caused this? Patient: Yeah, I fell down the stairs last week and my feet hit the ground."
},
{
  "instruction": "We're experiencing doctors, vomiting, lower abdominal cramps, cramps, nausea. What's the cause of these symptoms?",
  "input": "",
  "output": "There's a possibility that it's an endogenous cyst, which means you have to do some tests to make sure that it's there, but it's very likely."
},
{
  "instruction": "Doctor, I'm experiencing cramps and cramps in my lower abdomen, sharp abdominal pain, vomiting and menstrual pain, and I also felt a burning abdominal pain.",
  "input": "",
  "output": "The symptoms suggest that there's a cystic cyst."
},
{
  "instruction": "Doctor, I've been experiencing a lot of nausea lately. Do you want to know why?",
  "input": "",
  "output": "The symptoms suggest that there's a cystic cyst."
},
{
  "instruction": "Doctor, there's been a lot of spasms and tics recently.",
  "input": "",
  "output": "The symptoms suggest that there's a cystic cyst."
},
{
  "instruction": "Doctor, I'm experiencing sharp abdominal cramps and tics. What's the cause?",
  "input": "",
  "output": "There's a possibility that it's an endogenous cyst, and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I'm experiencing skin itching, penis secretions, vaginal sensitism. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that she's infected with chlamydia, which is a venereal disease that can cause these symptoms."
},
{
  "instruction": "Doctor, we found some discomfort in your penis and abnormal vaginal secretions.",
  "input": "",
  "output": "In terms of symptoms, it's possible that she was infected with chlamydia, a venereal disease that can cause pain and secretion in both men and women."
},
{
  "instruction": "Every time I go to the bathroom to pee, it's really painful. What's the cause?",
  "input": "",
  "output": "There's an infection called chlamydia that can cause urinary pain, and it's good to be tested to check the diagnosis and discuss treatment options."
},
{
  "instruction": "Doctor, there's recently been a sharp abdominal and penis secretion. What's the problem?",
  "input": "",
  "output": "These symptoms are often associated with chlamydia. Have you recently had a new partner and a non-protective relationship?"
},
{
  "instruction": "Doctor, there's a lot of urinary pain. Can you tell me what's wrong?",
  "input": "",
  "output": "Maybe it's chlamydia. Have you been sexually active lately?"
},
{
  "instruction": "Doctor, skin rash, sinus pain, cough, weird skin, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you have a parasite, and you have to run additional tests to see which parasites you're dealing with."
},
{
  "instruction": "Doctor, you've got a fever in the last few days, and why?",
  "input": "",
  "output": "What kind of parasites have you been exposed to recently?"
},
{
  "instruction": "Doctor, we haven't had a lot of urine lately, and we've had a lot of swelling in our hands and fingers, and we have a sharp abdominal pain, and what's the cause of all this?",
  "input": "",
  "output": "These symptoms can indicate parasites, and if you want to check them, you need to do some tests, which can be parasite infections or pyrariasis, and you need to start treating them immediately."
},
{
  "instruction": "Doctor, there are symptoms of fever and swelling of lymph nodes.",
  "input": "",
  "output": "We need additional evaluations and tests to verify, and we're going to make a medical appointment for further investigations."
},
{
  "instruction": "Doctor, your eyes are swollen and you're in pain.",
  "input": "",
  "output": "The symptoms suggest a fractured jaw."
},
{
  "instruction": "Sir, there's a problem with the jaw. There's swelling of the jaw and swelling of the eyes. There's pain in the mouth and skin stimulation in the mouth.",
  "input": "",
  "output": "The symptoms suggest that there's a fracture in the jaw."
},
{
  "instruction": "Sir, we've got telophase, gum hemorrhage, eye pain, bone pain. What do we do?",
  "input": "",
  "output": "The symptoms seem to indicate that a fracture could cause eye pain, gum bleeding, and telophase."
},
{
  "instruction": "Doctor, I'm experiencing skin irritation, eye pain, mouth bleeding, gum pain, mouth pain.",
  "input": "",
  "output": "The symptoms suggest that you have a broken jaw."
},
{
  "instruction": "There's pain in the doctor, in the eyes, in the mouth, in the gums, and why?",
  "input": "",
  "output": "The symptoms may indicate a broken jaw."
},
{
  "instruction": "Doctor, you feel your joints stiff and salty, and you feel a lump in your knee, so can you tell us what causes these symptoms?",
  "input": "",
  "output": "Symptoms suggest that it's a large-cell virus infection, a common virus infection that affects the different parts of the body, including joints, that can cause stiffness and swelling, and a lump in the knee may be the result of this infection."
},
{
  "instruction": "Doctor, you've recently felt extremely fatigued, and you've had symptoms of frequent urination at night, do you know what's causing it?",
  "input": "",
  "output": "You may have been infected with CMV, depending on your symptoms. Have you experienced fever or muscle pain?"
},
{
  "instruction": "Doctor, I've been having facial pain for days. What's the cause?",
  "input": "",
  "output": "It could be a giant cell virus infection. We need to test it with some tests."
},
{
  "instruction": "Doctor, I've been feeling really tired and very violent anger lately, and I've also had eye pain, and I'm pregnant, and I'm having abnormal pain.",
  "input": "",
  "output": "It's a common virus that can cause fatigue, mood change, eye pain, and can cause complications during pregnancy, so you have to monitor your condition closely."
},
{
  "instruction": "Doctor, there's a lump in your breast, there's pain in your throat, there's skin lesions, there's pain in your bones these days, can you tell me what's wrong?",
  "input": "",
  "output": "It seems to be a non-musual growth of fat tissue, a fatty species, which can cause discomfort, especially when it's located in sensitive areas, where there's usually no pain. You have to do some additional tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, you have a lump in your leg and a lump in your neck, and why?",
  "input": "",
  "output": "It's possible that it's fatty, the growth of fat cells that form lumps or lumps under the skin, and it's generally not harmful or cancerous, but it's good to get tested to be sure."
},
{
  "instruction": "Doctor, I have a strange lump in my skin, and I don't think it hurts, and it doesn't hurt, but I think it's obvious.",
  "input": "",
  "output": "It could be a fatty species, which is the non-mal cancerous growth of fat cells under the skin, which is shown by skin lesions."
},
{
  "instruction": "Hi, doctor, I have three lumps in my body -- my legs, my back, my neck -- and I don't feel any pain, but I'm nervous to have a lump.",
  "input": "",
  "output": "The symptoms suggest that it's possible that the growth of a harmless fat cell is a fatty species, but it's important to do physical testing to confirm the diagnosis."
},
{
  "instruction": "Doctor, you've got vaginal pain during pregnancy, groin pain, skin lesions, fevers, spots or bleeding.",
  "input": "",
  "output": "It's important to start treating them as soon as possible to prevent complications."
},
{
  "instruction": "Doctor, I'm worried about the fever. Can you tell me what's causing it?",
  "input": "",
  "output": "It's possible that it's a female genital infection, and heat may be a sign of an infection in that area, and you have to do some tests to identify the diagnosis and prescribe the treatment."
},
{
  "instruction": "Doctor, there's been a lot of vaginal secretions recently.",
  "input": "",
  "output": "It could be a sign of female genital infections."
},
{
  "instruction": "Doctor, I have vaginal secretions. What's the cause?",
  "input": "",
  "output": "The symptoms are likely to be female genital infections."
},
{
  "instruction": "Doctor, there's skin lesions in the genital area, and there's a very stimulating feeling there, and there's a little bit of vaginal pain recently, so help me figure out what's wrong.",
  "input": "",
  "output": "The symptoms are likely to be female genital infections, which require several tests to be checked, but it's important to be treated immediately to relieve discomfort and prevent further complications."
},
{
  "instruction": "Hi, doctor, I've been very tired lately and my feet and ankles are swelling, and I have trouble breathing sometimes.",
  "input": "",
  "output": "The symptoms suggest that lung high blood pressure is suspect."
},
{
  "instruction": "Doctor, apnea, telophase, body pain, shortness of breath, fatigue, what's wrong with me?",
  "input": "",
  "output": "You can have pulmonary hypertension."
},
{
  "instruction": "Doctor, I've been very tired lately, and I've been vomiting blood sometimes, and it's hard to breathe, and my heart beats very fast, and what's the cause of these symptoms?",
  "input": "",
  "output": "Lung hypertension can cause high blood pressure in blood vessels carrying blood from the heart to the lungs, which can cause fatigue, blood loss, shortness of breath, and heart failure, which I recommend further testing so that you can check your diagnosis and start a proper treatment as soon as possible."
},
{
  "instruction": "Doctor, I'm so tired these days, I don't think I'm going to be able to keep up with my normal routine.",
  "input": "",
  "output": "Blood can be a symptom of pulmonary hypertension. Are you having trouble breathing or chest pain?"
},
{
  "instruction": "Doctor, I have a thyroid node, and I recently had a hearing problem, so does it have anything to do with my condition?",
  "input": "",
  "output": "Yes, there are cases where thyroid nodes affect the surrounding structure, including the nerves that are responsible for the vocal cords and hearing, and it's important to have additional tests to determine the cause of the symptoms."
},
{
  "instruction": "Doctor, there's a problem with an insufficiency of swallowing, a hoarse voice, a lump in the neck, and it's like a swelling of the neck and a low hearing.",
  "input": "",
  "output": "According to the symptoms that God explains, it is possible that the thyroid node is a gland that is filled with solids or liquids in the thyroid, which is in the throat, which can cause a variety of symptoms, including the symptoms that you're talking about."
},
{
  "instruction": "Hi doctor, I've recently experienced a strange condition where there's a lump in my neck, and I'm always tired and my hearing seems to be down, and I feel so cold and so weak in my waist, what's the problem?",
  "input": "",
  "output": "The symptoms you've described may indicate that there's a thyroid cut."
},
{
  "instruction": "Doctor, if you have a lump around your neck and it doesn't go away, what is it?",
  "input": "",
  "output": "I think she has a thyroid fracture. Any other symptoms?"
},
{
  "instruction": "Doctor, you've got a lot of weight gain, your hearing seems to be getting worse, and you've got back pain.",
  "input": "",
  "output": "These symptoms can be caused by thyroid nodes, and we need to do some tests to make sure that they're stable."
},
{
  "instruction": "The gums bleed and the lips dry. What could be the problem?",
  "input": "",
  "output": "There could be broken teeth that stimulate the gums and the lips."
},
{
  "instruction": "Hi, doctor, there's been a lot of pain in your mouth recently.",
  "input": "",
  "output": "It looks like your teeth are broken, and you're in pain."
},
{
  "instruction": "Doctor, your teeth are broken, and your lips are swollen, and your feet and ankles are swollen.",
  "input": "",
  "output": "It's possible that there's an infection because the swelling of the lips is likely because of the spread of the infection, and telophase is the result of a physical reaction to the infection as soon as possible."
},
{
  "instruction": "Doctor, there's pain in your mouth and a lump in your jaw. What's the cause?",
  "input": "",
  "output": "The teeth are broken, and it seems to be uncomfortable around you, and it's likely that you're going to have to take a closer look and take X-ray to see what's going on."
},
{
  "instruction": "Doctor, your lips are swollen and your teeth are broken. What's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that the infection in the broken teeth causes the lips to swell, which may require neurotherapy or tooth rashes."
},
{
  "instruction": "Sir, there are a number of symptoms, such as intrauterine pain, weight gain, ear pain, eyelids, headaches, and so on.",
  "input": "",
  "output": "Yes, I think there's a lot of dumping syndrome that can cause eczema inflammation, weight gain, ear pain, eyelids, headaches, etc., and we need to do some tests to identify the diagnosis and discuss the treatment options."
},
{
  "instruction": "Doctor, I'm sick these days, especially after dinner.",
  "input": "",
  "output": "The symptoms could be dumping syndrome."
},
{
  "instruction": "Doctor, I've been feeling fatigue lately, and I've had a lump in my knee, and what's the cause?",
  "input": "",
  "output": "It's possible that you're suffering from Adamping's syndrome, which is a disease in which food moves too quickly to your stomach to cause fatigue and sometimes to cause malnutrition, but I want to take a closer look to make sure that you don't have knee lumps or lumps."
},
{
  "instruction": "Doctor, there's been a lot of abdominal pain, and recently there's a lump in your knee, and it's like you're growing too tall.",
  "input": "",
  "output": "I think you're suffering from dumping syndrome because of your symptoms."
},
{
  "instruction": "Doctor, I've been having strange symptoms recently: my knee is touched by a lump, my eyelids are covered, my hair is overgrowing, my ears are sick, and I have headaches, and what's the cause of all this?",
  "input": "",
  "output": "I think you're suffering from dumping syndrome because of your symptoms."
},
{
  "instruction": "Doctor, I've got a fever in the last few days.",
  "input": "",
  "output": "The symptoms suggest that you have lymph nodes."
},
{
  "instruction": "Hi, sir. I've been having vomiting these days.",
  "input": "",
  "output": "Did you notice that the lymph nodes were swollen?"
},
{
  "instruction": "Doctor, I'm experiencing neck pain, ear pain, skin swelling and fever.",
  "input": "",
  "output": "The symptoms suggest that you have lymph nodes that cause inflammation of lymph nodes."
},
{
  "instruction": "Hi, my neck hurts a lot.",
  "input": "",
  "output": "The symptoms indicate that there's a possibility of lymph nodeitis."
},
{
  "instruction": "Doctor, you have facial pain and neck pain. What's the problem?",
  "input": "",
  "output": "I think he's got a facial injury."
},
{
  "instruction": "Hi, doctor, your mouth hurts, your eyes swell, your mouth bleeds.",
  "input": "",
  "output": "The symptoms seem to indicate that he was injured with bruises and fevers on his face."
},
{
  "instruction": "Sir, your mouth is bleeding.",
  "input": "",
  "output": "It looks like he's bleeding out in his mouth from an injury to his face."
},
{
  "instruction": "Doctor, facial pain, red around your nose, nose bleeds, and your ears bleed.",
  "input": "",
  "output": "The symptoms suggest that there's a bleeding and nosebleed in the ear, and we need to do a checkup and a video shoot to determine the extent of the injury."
},
{
  "instruction": "Sir, you've got a facial injury, and you've got blood in your ears, and you've got facial pain, and you've got mouth pain.",
  "input": "",
  "output": "The symptoms seem to indicate that you have a facial injury with a broken jaw, ear, or trauma; it's good to check the extent of the injury and do some video tests to plan your treatment."
},
{
  "instruction": "Doctor, I've been experiencing an abscess recently.",
  "input": "",
  "output": "It could be symptoms of aortic valve disease."
},
{
  "instruction": "Doctor, you're experiencing irregular heart rate, leg spasms, shortness of breath. What's the problem?",
  "input": "",
  "output": "The symptoms could indicate aortic valve disease."
},
{
  "instruction": "Doctor, I've been fainting a lot lately. Why?",
  "input": "",
  "output": "It could be a heart disease called aortic valve disease."
},
{
  "instruction": "Doctor, there's leg spasms, spasms, fatigue, sharp chest pain, lymphoma. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate aortic valve disease."
},
{
  "instruction": "Doctor, I've been experiencing a number of symptoms recently, with lymph nodes and trepidation, and why?",
  "input": "",
  "output": "The symptoms are likely to lead to aortic valve disease, which occurs when the aortic valve of the heart doesn't work properly, and can cause the same symptoms that blood reverses into the heart."
},
{
  "instruction": "Doctor, you're in pain in your wrist and you're weak in your hands and fingers. What's the problem?",
  "input": "",
  "output": "Symptoms indicate that there's a possibility of rheumatoid arthritis."
},
{
  "instruction": "Doctor, I've got knee pain and my whole body pain. What's wrong?",
  "input": "",
  "output": "I think you have rheumatoid arthritis."
},
{
  "instruction": "Doctor, your hands and fingers are weak, your joints are swollen, your wrists are in pain.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from rheumatoid arthritis."
},
{
  "instruction": "Doctor, I feel like my hands and fingers hurt, my knees hurt, my body hurts.",
  "input": "",
  "output": "The symptoms seem to indicate that you have rheumatoid arthritis, so how many tests do you want to run to confirm your diagnosis?"
},
{
  "instruction": "Doctor, your fingers are swollen and your wrist is in pain. What's the problem?",
  "input": "",
  "output": "You seem to have a long-term autoimmune disease that causes joint inflammation and pain, rheumatoid arthritis."
},
{
  "instruction": "Doctor, there's a lump of skin growing in your scrotum, and it's also a groin pain, and there's a lump or a lump in your leg.",
  "input": "",
  "output": "The symptoms suggest that there's a cyst forming in the obituary, which is a small tube behind the testes, that can cause pain and swelling in the groin, and that there can be lumps or lumps in the scrotum."
},
{
  "instruction": "Hi, doctor, you've got frequent urination and groin and pain in the testes, and recently you've found a lump on your leg and a scrotum swelling, and you know what's causing all of these symptoms?",
  "input": "",
  "output": "Yes, the symptoms suggest that there's a blood sac, which is a fluid that's caused by the oscillator, which can cause swelling of the scrotum and pain in the testes and can sometimes cause discomfort in the groin."
},
{
  "instruction": "Doctor, there's pain in the testicle. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that there's a chance that there's pulsitis."
},
{
  "instruction": "Doctor, you've got skin rashes, so it's really dark, and your skin is swollen, and you've been coughing a lot lately, and it looks like the skin of your head and neck is red, and it's infected like it's flying.",
  "input": "",
  "output": "From the symptoms that God explains, there seems to be an abscess, which is a highly contagious skin infection caused by staph bacteria or streptococcus bacteria."
},
{
  "instruction": "Doctor, the skin of your head and neck seems to be infected, and your nose is inflamed, and you have skin rashes and coughs.",
  "input": "",
  "output": "The symptoms seem to be absorption; it's a highly infectious bacterial skin infection."
},
{
  "instruction": "Doctor, you're feverish, coughing, and your skin's getting weirdly swollen. What's the problem?",
  "input": "",
  "output": "I think it's possible that the symptoms are absorption, a bacterial skin infection that causes the same symptoms that you normally described."
},
{
  "instruction": "Doctor, there's an inflammation of skin and nose that looks abnormal to the skin, and what's the cause of these symptoms?",
  "input": "",
  "output": "A highly contagious bacterial infection can cause red ulcers and blisters in many parts of the body, including the nose."
},
{
  "instruction": "Doctor, your skin is swollen. What is it?",
  "input": "",
  "output": "It could be absorption."
},
{
  "instruction": "Doctor, there's some secretions coming out of the side, and there's some toilets. What's the problem?",
  "input": "",
  "output": "I think the symptoms you're experiencing are those of anal fistula."
},
{
  "instruction": "Doctor, there's backaches and cramps, and there's secretions on the side.",
  "input": "",
  "output": "It's very likely that you have an anal pore because of your symptoms."
},
{
  "instruction": "We're experiencing a doctor, aberrations, anal pain, back cramps, and we've found a mass touching or swelling around the anus, and there's a lot of blood in the throat, but what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate you've got a chirrhea."
},
{
  "instruction": "Doctor, I've been having recent miscalculations.",
  "input": "",
  "output": "There may be an anal fistula, which is a small tunnel between the skin and the anus, which can leak out of the stool."
},
{
  "instruction": "Doctor, I have a lower body pain.",
  "input": "",
  "output": "Did you feel discomfort or secretion on your anal area? Patient:"
},
{
  "instruction": "Doctor, I've recently been feeling low and feeling depressed, and I've been having symptoms of depression, and I want you to know what's causing these symptoms.",
  "input": "",
  "output": "Hemorrhagic disease occurs when your body temperature drops below normal, and can cause loss of sense, weakness, even depression or mental illness."
},
{
  "instruction": "Doctor, I've recently had a feeling of stiffness or joy in my legs, and why?",
  "input": "",
  "output": "If you've been exposed to low temperatures for long periods of time, it's particularly likely that it's a case of hypothermics. Have you experienced any unusual cold recently?"
},
{
  "instruction": "Doctor, your wrists are weakened, you're numb, you're swelling your legs. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from hypothermic disease."
},
{
  "instruction": "Doctor, your legs are stiff, your wrists are weak, your legs are swollen, your skin rashes are developed, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate that the body's temperature is below normal, and some of the body's bloodstream and oxygen is decreasing."
},
{
  "instruction": "Doctor, I'm experiencing swelling of my legs and weakness of my wrists. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from hypothermic disease."
},
{
  "instruction": "Hi, sir, I'm experiencing a restless, sad, depressed thought, excessive anger, antisocial behavior, do you know what's going on with me?",
  "input": "",
  "output": "The symptoms seem to indicate a rebellious resistance disorder, which is a form of behavior disorder characterized by anger, irritation, and challenging behavior, which can also be associated with depression or psychiatric symptoms."
},
{
  "instruction": "Sir, I feel very depressed and angry all the time.",
  "input": "",
  "output": "The symptoms seem to indicate that you have a rebellious resistance disorder."
},
{
  "instruction": "Sir, I'm having trouble controlling my temper these days, and I'm being very hostile to other people, so can you tell me what's wrong?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from a rebellious disorder, which is a form of behavioral disorder that is characterized by persistent personality problems and hostility toward others."
},
{
  "instruction": "Doctor, I've been acting hostilely these days, fighting everyone, even having a little argument, what's the problem?",
  "input": "",
  "output": "From what you've explained, there's a hostile resistance disorder, which is prone to hostile behavior and anger and aggression."
},
{
  "instruction": "Doctor, I've been fainting a lot lately. What's wrong with me?",
  "input": "",
  "output": "It's possible that you have a rebellious disorder, but it's usually not a common symptom of this disorder, and you might have to run some tests to figure out what's causing your blindness."
},
{
  "instruction": "Doctor, my period has been too long and I've been vomiting a little bit. What's the problem?",
  "input": "",
  "output": "The symptoms you just mentioned are very common in migraine, and it's a good idea to visit a neurologist to plan a proper diagnosis and treatment."
},
{
  "instruction": "Doctor, there's been some strange symptoms, your vision is getting worse, your face is getting weird, you're getting sick, you're getting headaches, what's going on with me?",
  "input": "",
  "output": "The symptoms you described are typical of migraine, and you can look at treatment options that help alleviate the symptoms."
},
{
  "instruction": "Doctor, you're having a memory problem and your period is longer than usual. What's the problem?",
  "input": "",
  "output": "I think you're having migraine headaches, and are you experiencing both light and sound sensitivity?"
},
{
  "instruction": "Doctor, I've had a headache in the last few days. Can you tell me what's wrong?",
  "input": "",
  "output": "I think you have a migraine."
},
{
  "instruction": "Good morning, doctor, nausea, nausea, spots, clouds, and I'm experiencing vomiting, and what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you have migraine, which is a neurological disorder that is characterized by repeated headaches, often accompanied by visual and sensory disorders."
},
{
  "instruction": "Doctor, I'm experiencing hand and finger spasms, leg pain, motor disorder, lymphoma.",
  "input": "",
  "output": "The symptoms suggest that you're suffering from a neurologic disorder at the end of diabetes."
},
{
  "instruction": "Sir, my feet are swollen. I don't know why.",
  "input": "",
  "output": "Could be signs of post-diabetic neuropathy, or have you ever experienced other symptoms, such as feet, hands off, and so forth?"
},
{
  "instruction": "Doctor, there are symptoms of stiff, swollen feet or toes that are difficult to move, and there's also a loss of sense in the feet, and it looks like the skin of the legs and the feet is infected.",
  "input": "",
  "output": "The symptoms suggest that you're suffering from a neurological damage caused by diabetes, at the end of diabetes."
},
{
  "instruction": "There are symptoms of doctors, leg pain, lymph nodes, blood circulation disorders, motor disorders, sensory loss.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from post-diabetic neuropathy, which is a disorder caused by nerve damage caused by hyperglycemic blood sugar."
},
{
  "instruction": "There's been a few symptoms in the scrotum, and there's a lump in the scrotum, and there's a lot of such symptoms as reflux, skin dot, fatigue, and pain in the testes, and what's the cause of all these symptoms?",
  "input": "",
  "output": "There's a possibility that you may be suffering from a condition that requires urgent treatment based on your symptoms, and that you have to perform some medical tests to determine the type of test disorder to encourage proper treatment."
},
{
  "instruction": "Doctor, I found a little lump in the scrotum. What is it?",
  "input": "",
  "output": "According to the description of the lump being touched in the scrotum, there could be a gonads, and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I'm experiencing erectile failure, frequent urination at night, prostate symptoms, and a shrill voice.",
  "input": "",
  "output": "The symptoms seem to indicate that you have a googlytic disease."
},
{
  "instruction": "Doctor, your sexual appetite drops, your scrotum touches the mass. What's the problem?",
  "input": "",
  "output": "Symptoms indicate that there's a high probability that there's a high incidence of test scores, such as ultrasound, tissue tests, and so on."
},
{
  "instruction": "Good morning, doctor, loss of sexual desire, excessive anger, pain in the test, what's the cause of these symptoms?",
  "input": "",
  "output": "There's a possibility that you're going to have a test and a few tests to figure out the exact cause and the treatment."
},
{
  "instruction": "The pressure on the pelvic, the problem during pregnancy, the pain during pregnancy, the contractions of the uterus, doctor.",
  "input": "",
  "output": "You can have cyclic diabetes, depending on your symptoms, and you have to run some tests to make sure you're aware of that."
},
{
  "instruction": "Doctor, I'm experiencing pelvis stress, analism, qualitativeness. Can you tell me what's wrong?",
  "input": "",
  "output": "I think there's a type of diabetes that occurs during pregnancy -- pregnancy diabetes -- and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I've been feeling a lot of pressure on my hip lately. Can you tell me what caused it?",
  "input": "",
  "output": "Are you regularly monitoring blood sugar levels?"
},
{
  "instruction": "Doctor, your appetite is overextended, your butt is stiff, your anus is difficult, and what's the cause?",
  "input": "",
  "output": "It's possible that it's a pregnancy diabetes, but it's important to start monitoring your blood sugar levels and managing your diet to prevent complications during pregnancy."
},
{
  "instruction": "Doctor, there's been some discomfort recently: the anus is extremely dark, the vaginal areas are red, and we're experiencing contractions of the uterus, and what's the problem?",
  "input": "",
  "output": "These symptoms are common in pregnant women, and it's good to run some tests to see if they're pregnant diabetes."
},
{
  "instruction": "Hi, sir, there's pain in your arm, pain in your lower body and a lump in your arm, and there's acne and acne in your skin.",
  "input": "",
  "output": "The symptoms suggest that you have a skin condition, an agronomous milditis, caused by a lump of pain under the skin, especially in the sweat glands, which can also cause acne-like lesions in the skin."
},
{
  "instruction": "Hi, doctor, we found that the skin of your arm or your hand was infected and your arm was swollen.",
  "input": "",
  "output": "Depending on the symptoms, there may be a condition called agronomous sepsis, which is a chronic skin disease caused by small, painful lumps under the skin, which can lead to even more serious symptoms."
},
{
  "instruction": "Doctor, there's lumps and lumps in the breast, there's arm pain, there's lower body pain, there seems to be an infection in the skin of the arm or the hand, and what's the problem?",
  "input": "",
  "output": "The symptoms could be that there's a lump of pain or a chronic skin disease called absorption in the body that has sweat glands, such as the armpits, the groins, the breasts, and so forth."
},
{
  "instruction": "Doctor, there's a lump under your arm, there's a skin lesion, there's another lump in your groin.",
  "input": "",
  "output": "I think there's a painful lump on the skin, or a chronic skin disease that causes inflammation."
},
{
  "instruction": "Hi, doctor, I've got a swelling of my skin and a lesion in my skin.",
  "input": "",
  "output": "From the symptoms that God explains, it's likely to be a chronic skin disease, an agronomous milditis, caused by a lump of pain under the skin on the abdomen, under the groin, under the buttocks, and so forth."
},
{
  "instruction": "Doctor, there are swelling shoulders, back pain, fever, hand or finger pain, breathing problems going on.",
  "input": "",
  "output": "When you look at the symptoms that God's talking about, it's possible that you're suffering from valley fever, a fungus infection that spreads through soil and air spores in certain areas."
},
{
  "instruction": "Doctor, you've got chills, you've got difficulty breathing, you've got swollen shoulders, you've got joint pains.",
  "input": "",
  "output": "The symptoms may indicate that there is a valley heat, and it's good to do some tests to check the diagnosis."
},
{
  "instruction": "Doctor, your shoulder is swollen, you've got chills, your hands and fingers are sick, you've got back pain, and why?",
  "input": "",
  "output": "I think there's a valley heat."
},
{
  "instruction": "Doctor, I've been having trouble breathing with chills lately. What are the symptoms?",
  "input": "",
  "output": "The symptoms may indicate that there's a valley heat, and we need to do some additional tests to check it out."
},
{
  "instruction": "Doctor, there's nose and eye pain. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from a bacterial pericarditis."
},
{
  "instruction": "Doctor, cough, nostril, fever, very bloodied eyes.",
  "input": "",
  "output": "It looks like you've got a pericarditis caused by bacteria."
},
{
  "instruction": "Doctor, you've got a sharp eye pain. Why?",
  "input": "",
  "output": "It's because of the peritoneal disease caused by bacteria, which can cause the eyes to develop intubation, stimulation and secretion, and it's good to use antibiotic eye drops immediately."
},
{
  "instruction": "Sir, there's blood in the eyes, there's itching, there's ear pain, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate that there's a pericarditis caused by bacteria."
},
{
  "instruction": "Sir, you've got a fever, a broken ear, a cough, and now you've got eyes and swelling.",
  "input": "",
  "output": "The symptoms seem to indicate that it's endocarditis due to bacteria."
},
{
  "instruction": "Sir, I feel like my fingers and feet are out of touch and I feel like I'm out of touch. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're experiencing sensory disorder, a common symptom of caricose dementia, and it's good to run some tests for an accurate diagnosis."
},
{
  "instruction": "Doctor, I've recently been experiencing dizziness, and what's the reason for that?",
  "input": "",
  "output": "What you're experiencing may be the symptoms of carousel dementia, any other symptoms?"
},
{
  "instruction": "Doctor, I'm experiencing delusions and hallucinations, dizziness, memory problems, seizures, depression or mental illness. What's wrong with me?",
  "input": "",
  "output": "It affects the brain, causing problems in movement, thought and behavior, and it's important to get formal evaluations and diagnostics."
},
{
  "instruction": "Doctor, I've been having strange symptoms lately, and I've always been dizzy, and I've always been depressed, and I've been told, and I've also seen hostile behaviors.",
  "input": "",
  "output": "Because of these symptoms, the brain's abnormal protein calm suggests that you're suffering from a form of Alzheimer's, a form of dementia, which affects thinking, reasoning, and independent function."
},
{
  "instruction": "Doctor, your heart rate has accelerated recently, and your heart rate has gotten worse. What's the problem?",
  "input": "",
  "output": "Marfan's syndrome is a genetic disorder that affects the heart, the eyes, the skeletal system, and heart rate is a common symptom of this disease."
},
{
  "instruction": "Doctor, I feel pain all over my body. Do you know what caused this discomfort?",
  "input": "",
  "output": "Marfan's syndrome is a genetic disease that affects the body's connective tissue, which can cause pain and pain throughout the body."
},
{
  "instruction": "Doctor, I'm experiencing poor focus, increased heart rate, pain throughout the body, depression, emotional symptoms, all of these symptoms, do you know what's causing them?",
  "input": "",
  "output": "Yes, the symptoms you described suggest that it might be Marfan's syndrome. Any other symptoms?"
},
{
  "instruction": "Doctor, I think your abdomen's swollen. What's the cause?",
  "input": "",
  "output": "Because of the swelling of the abdomen, it's possible that it's a complication of multiple myeloma."
},
{
  "instruction": "Hi, doctor, I've been feeling stiff and extremely fatigued lately.",
  "input": "",
  "output": "It's possible that you have multiple myeloma because of your symptoms, and you have to do some tests to check your diagnosis."
},
{
  "instruction": "Doctor, your body is stiff and your lips are swollen, and you feel symptoms in your face.",
  "input": "",
  "output": "From the symptoms that God explains, it may be multiple bone marrow, a form of blood cancer that affects the type of bone marrow cells, and you have to run some tests to make sure you're diagnosed."
},
{
  "instruction": "There are symptoms of doctors, memory problems, buttocks or lumps, facial symptoms, stiffness of the whole body.",
  "input": "",
  "output": "There could be multiple bone marrow cells, cancer of the inner bone marrow cells that cause these symptoms, and we need to run some tests to identify the diagnosis and start the proper treatment."
},
{
  "instruction": "Doctor, what's the cause of the swelling of the lips and abdominal edema?",
  "input": "",
  "output": "There's the possibility that you've got a head injury, that you've got a head trauma, that your facial muscles and nerves are swollen, your lips are swollen, and you've got abdominal pain, and it's good to do a thorough test to determine the extent of the injury."
},
{
  "instruction": "Doctor, what's wrong with the backache, the earring, the abdominal pain, the headache that you had last week after you hit your head?",
  "input": "",
  "output": "The symptoms seem to indicate head injury or concussion, and it's important to have a thorough examination to assess the extent and scope of the injury."
},
{
  "instruction": "Doctor, you hit your head, and then you got a pain in your face. What's the cause?",
  "input": "",
  "output": "Have you experienced any other symptoms, such as headaches or aches?"
},
{
  "instruction": "Doctor, your ears are ringing and you have back pain and headaches.",
  "input": "",
  "output": "Symptoms can lead to head injuries, some tests to determine the severity of the injury and the best treatment plan."
},
{
  "instruction": "Sir, I hit my head hard yesterday, and my nose was red and my nose was a little red, and I passed out for a few seconds.",
  "input": "",
  "output": "The symptoms seem to indicate a head injury, and we need to do some tests to make sure that there's some internal bleeding in the brain, and it's best to avoid complications as soon as possible."
},
{
  "instruction": "Doctor, abdominal pain, urine residue, abdominal extenuation. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there's an upper planet of pulsitis."
},
{
  "instruction": "We're experiencing doctors, urinary tract, diarrhea, sharp abdominal pain, and sensitizing.",
  "input": "",
  "output": "The symptoms seem to indicate that there are bacterial contagion, an infection that can cause inflammation in the intestinal tract, and it's good to run some tests and start treating it as soon as possible to identify the diagnosis."
},
{
  "instruction": "Doctor, you have a good breath, and you have a nausea, and you can tell me what's causing it.",
  "input": "",
  "output": "The symptoms seem to indicate that there's a coronary pneumothorax, which is an inflammation of the ducts, which can cause sores, fever, abdominal pain, vomiting, which requires some laboratory tests and imaging to identify the diagnosis."
},
{
  "instruction": "Doctor, I can't see you pee and I think you're urinating in your bladder. What's the problem?",
  "input": "",
  "output": "There may be an inflammation in the bile, an upper-endoid pystitis that interferes with the normal flow of bile, but urine reflux is not a common symptom of this disease."
},
{
  "instruction": "Doctor, I've been experiencing a number of symptoms recently: fever, abdominal stenosis, sharp abdominal pain.",
  "input": "",
  "output": "There's the possibility that there's a disease called epidemiological cytitis, which is caused by an infection in the duct that can cause this type of symptoms, and we need to do some tests to make sure that we're diagnosed."
},
{
  "instruction": "Doctor, I'm worried about the frequency and infertility of the moon. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that there is an irregular menstrual cycle."
},
{
  "instruction": "Hi doctor, I'm having a clot during my period. What's the problem?",
  "input": "",
  "output": "I think there's an irregular menstrual cycle."
},
{
  "instruction": "Sir, I've had severe menstrual and hip pains in the last few months. Can you tell me what might be a problem?",
  "input": "",
  "output": "The symptoms suggest that there is an irregular menstrual cycle."
},
{
  "instruction": "Doctor, I'm experiencing abdominal pain with irregular periods. What's the problem?",
  "input": "",
  "output": "You seem to be struggling with an irregular menstrual cycle."
},
{
  "instruction": "Doctor, you've had a lot of menstrual problems, and you're having more menstrual problems, and you're experiencing cramps and lower abdominal pain, and you're having problems with your pregnancy.",
  "input": "",
  "output": "The symptoms seem to indicate an irregular menstrual cycle, which can cause frequent periods of menstruation, cramps and cramps, lower abdominal pain, infertility and even sharp abdominal pain."
},
{
  "instruction": "Doctor, we have abnormal breath sounds, ear pain, shortness of breath, nose strength. What's the problem?",
  "input": "",
  "output": "There's a possibility that there's an ICP, and you have to do some tests to check your diagnosis."
},
{
  "instruction": "Doctor, drowsiness, shortness of breath, shortness of breath, gas and cough continue, and what is the cause of all these symptoms?",
  "input": "",
  "output": "The symptoms suggest that you may be suffering from an IC lung disease."
},
{
  "instruction": "Hi, doctor, I've been coughing and cochlear for the last few weeks. What's the problem?",
  "input": "",
  "output": "There may be some epilepsy lung disease based on the symptoms, and we need to do some additional tests to make sure we're diagnosed."
},
{
  "instruction": "Doctor, cough, cough, sore throat, drowsiness, shortness of breath. What's the problem?",
  "input": "",
  "output": "The symptoms are very likely to lead to IC lung disease."
},
{
  "instruction": "Doctor, the elbow pains and the power of the hands and fingers have been weakened.",
  "input": "",
  "output": "The symptoms seem to indicate that you're monotritis."
},
{
  "instruction": "I'm experiencing doctor, wrist pain, hand or finger pain, leg pain. What's the problem?",
  "input": "",
  "output": "It's a form of nerve damage that can affect a single nerve, which can cause pain in various parts of the body."
},
{
  "instruction": "What's the problem with the symptoms of doctors, wrist pains, feet, toes, hands, or fingers?",
  "input": "",
  "output": "The symptoms suggest that you have a neurologic disorder that affects only one nerve."
},
{
  "instruction": "I'm experiencing sensations in my arms, in my hands, in my fingers, in pain in my stomach, in pain in my feet, in my toes, in pain in my ankle.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from a single nerve inflammation or a damaged monotritis."
},
{
  "instruction": "Doctor, I feel a strange sensation in my arm with pain in my hands and fingers.",
  "input": "",
  "output": "The symptoms seem to indicate that you're monotritis."
},
{
  "instruction": "Doctor, I have a terrible headache that doesn't go away, and it's been going on for days.",
  "input": "",
  "output": "I think she has malaria. Any other symptoms?"
},
{
  "instruction": "Doctor, you've got a lump in your knee, and you've got a pain in your body.",
  "input": "",
  "output": "These symptoms are common in people who are infected with malaria. Have you been to areas where malaria has a high incidence recently?"
},
{
  "instruction": "Doctor, your eyelids arey and your knee is touched by a lump or a lump. What's the problem?",
  "input": "",
  "output": "You may have malaria, which is a mosquito-borne disease, and your symptoms may be a common symptom of this disease."
},
{
  "instruction": "Doctor, I'm not strong. My whole body hurts. What's the problem?",
  "input": "",
  "output": "The symptoms you just described suggest that you may have been infected with malaria, and you need to do some tests to make sure you're aware of that."
},
{
  "instruction": "Doctor, you've been losing a lot of energy over the last few days, and your wrists have been weakened, and you've been sick, and you've been having headaches, and what's the cause?",
  "input": "",
  "output": "There's a possibility that you're infected with malaria by your symptoms."
},
{
  "instruction": "Sir, I've had a lot of depression lately, and I've passed out at random.",
  "input": "",
  "output": "I think you're experiencing some of the symptoms of physical disorders that God's talking about."
},
{
  "instruction": "Doctor, insomnia, pain throughout the body, difficulty in breathing, depression. What's the problem?",
  "input": "",
  "output": "Physicalized disorders can be physical disorders, which involve pain and other physical symptoms, without any confirmation of medical causes."
},
{
  "instruction": "Sir, I've been sick lately, my whole body keeps getting sick, and I don't sleep well at night, and I'm tired and tired all the time.",
  "input": "",
  "output": "I think you've got some physical disorders, physical disorders that experience physical symptoms without basic medical causes, often related to stress and anxiety."
},
{
  "instruction": "Doctor, I'm very depressed these days, and I have a feeling that I'm going to keep getting sick.",
  "input": "",
  "output": "It's characterized by a number of physical discomforts and depressions or psychiatric symptoms that don't have a specific organic cause."
},
{
  "instruction": "Hi, doctor, there's been some disturbing symptoms recently.",
  "input": "",
  "output": "You're experiencing a general breakdown throughout the body, a little pain, a little dizziness, and sometimes you're having difficulty breathing."
},
{
  "instruction": "Doctor, I haven't been very strong lately. Why?",
  "input": "",
  "output": "It's possible that you're suffering from hypoglycemia, which is an abnormally low amount of blood circulating in your body."
},
{
  "instruction": "Doctor, I've been dizzy and nauseated and very low on appetite lately. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from hypotensive disease, which is a decrease in blood volume."
},
{
  "instruction": "Doctor, do you know what caused the recent rapid abdominal and fluid decline?",
  "input": "",
  "output": "The symptoms seem to indicate that you're experiencing a decrease in blood volume in your body."
},
{
  "instruction": "Doctor, you've been sick lately, you've got nausea, dizziness, diarrhea, what's wrong with me?",
  "input": "",
  "output": "The symptoms seem to indicate you're suffering from hypotensive disease, which is a condition characterized by low blood volume."
},
{
  "instruction": "Doctor, I've been dizzy lately, and diarrhea and vomiting continue, and I don't think I have a lot of appetite these days.",
  "input": "",
  "output": "You're probably suffering from hypoglycemic disease -- body fluids and loss of appetite are also common symptoms of this disease."
},
{
  "instruction": "Doctor, I've been having a problem with my temper lately, and I'm always nervous and nervous, and I'm having trouble with drug abuse, and I can't sleep at night, and I always feel depressed, and what's the cause of all this?",
  "input": "",
  "output": "It's a serious mental disorder that affects people's thinking, emotions and behavior. It can cause anxiety, depression, behavioral problems, drug abuse and insomnia."
},
{
  "instruction": "Doctor, I've recently had a problem with my temper, and I've been too angry, and I don't sleep very well, and I don't think I have a very good sense of self-worth, so what's wrong with me?",
  "input": "",
  "output": "Based on what you've explained, have you ever heard voices or experienced hallucinations?"
},
{
  "instruction": "Teacher, I'm having a strange experience with things that don't show up, and I feel like people are watching me, and I feel a lot inferior to everyone else.",
  "input": "",
  "output": "The symptoms seem to make it suspicious, so we can discuss treatment options and make plans to manage the symptoms."
},
{
  "instruction": "Doctor, I'm experiencing delusions and hallucinations, and I'm becoming overly angry and self-aware, and I'm also experiencing personality problems and depression and psychiatric symptoms, and what's the cause?",
  "input": "",
  "output": "There's the possibility that you're suffering from bipolar disorder, which affects people's thinking, their emotions and their behaviors, and it's a good idea to book a mental health consult with a mental health professional to discuss the symptoms and find options for treatment."
},
{
  "instruction": "Doctor, I've recently experienced temper problems, anxiety and anxiety, and I've also developed fears and phobias that I've never had before, and I'm having trouble sleeping.",
  "input": "",
  "output": "Symptoms suggest that you may be suffering from bipolar disorder, a chronic mental disorder that affects people's thinking, behavior and emotions, and if you're experiencing hallucinations or delusions, it's important to get additional treatment."
},
{
  "instruction": "Hi, doctor, your whole body is stiff, your knee joints are swollen, you feel a lump or a lump, you feel stiff and firm, and what's the cause?",
  "input": "",
  "output": "Depending on the symptoms, there's the possibility that the knee ligaments or the skull plate ruptures in half a month."
},
{
  "instruction": "Doctor, your knees are stiff, your knees are pain and swelling, tell me what's wrong.",
  "input": "",
  "output": "Symptoms indicate that the cartilage plate may have been torn in the knee ligaments or in the middle of the month, which can be caused by sudden movements or accidents caused by injuries that are common to athletes."
},
{
  "instruction": "Doctor, I feel a lump in my knee and a weakness in my leg. What's the problem?",
  "input": "",
  "output": "It could be a cartilage ruptured knee ligament or half a month, which can cause swelling and lumps and weaken the leg."
},
{
  "instruction": "Doctor, I've recently had a lot of swelling in my joints and a lot of weakness in my knees, and I also have stiff legs, and I often have cramps and cramps in my knees.",
  "input": "",
  "output": "The symptoms seem to indicate that the cartilage plate ruptured in the knee ligaments or in the middle of the month, but we need to do some tests to check it out, but we may need surgical treatment."
},
{
  "instruction": "Doctor, I'm experiencing nausea, shortness of breath, chest pain, wear, fatigue, lower body pain. What's the problem?",
  "input": "",
  "output": "The symptoms indicate that there's a chance of endometriosis."
},
{
  "instruction": "Doctor, you've lost your breath, your heart rate's accelerated, and you've been experiencing lower body pain, and what's the cause?",
  "input": "",
  "output": "The symptoms suggest that endocarditis is causing inflammation of the lining of the heart."
},
{
  "instruction": "Doctor, you have sharp chest pain. Why?",
  "input": "",
  "output": "The symptoms indicate that endometriosis is a disease caused by bacterial or fungus infection that causes inflammation of the lining of the heart and heart valves."
},
{
  "instruction": "Hi, I'm experiencing irregular heartbeats and chills.",
  "input": "",
  "output": "The symptoms indicate that there's a chance of endometriosis."
},
{
  "instruction": "Doctor, you've got a fever, you've got a stomachache, you've been experiencing occasional depression or psychosis, and why?",
  "input": "",
  "output": "If you look at the symptoms that God explains, it's possible it's sepsis."
},
{
  "instruction": "Doctor, I'm not feeling well these days, and I can't shake it off, and I'm always feeling tired.",
  "input": "",
  "output": "We need to run some tests to see, but sepsis is a serious disease caused by an infection in the bloodstream."
},
{
  "instruction": "Doctor, you've been coughing lately.",
  "input": "",
  "output": "It could be a symptom of sepsis."
},
{
  "instruction": "Doctor, you're feverish, you've got chills, you've got trouble breathing. What do you think I'm having?",
  "input": "",
  "output": "The symptoms are likely to be sepsis, which is a serious disease that leads to tissue damage, organ failure, and even death due to excessive immune response to infection."
},
{
  "instruction": "Doctor, I've had nails, I've lost sense, I've been dizzy, and I've passed out.",
  "input": "",
  "output": "The symptoms seem to make it suspicious of heatstroke."
},
{
  "instruction": "Doctor, you've been so hot these days that you've got nausea, vomiting and chills, and you've passed out last night.",
  "input": "",
  "output": "The symptoms seem to indicate that you've got heatstroke, so be careful in a hot environment, get enough water, and if the symptoms persist, you're going to need medical attention and medical attention."
},
{
  "instruction": "Sir, your body is very sick these days, and you're going to vomit and faint, and you're going to lose your senses, and you're going to have really high body temperature, and even your heart's going to have two heart parts.",
  "input": "",
  "output": "You need plenty of fluids to cool down as soon as possible and avoid dehydration, and come to the hospital immediately for treatment."
},
{
  "instruction": "Doctor, tell me why it's getting hot all of a sudden.",
  "input": "",
  "output": "You're experiencing heatstroke, which occurs when the body is overheated because of prolonged periods of high temperatures or intense exercise."
},
{
  "instruction": "There's doctors, kidney symptoms, upper abdominal pain, abdominal suffocation, reflux, back pain.",
  "input": "",
  "output": "It's possible that you're suffering from an inflammation of your bladder."
},
{
  "instruction": "Doctor, I've been experiencing this sharp, burning stomach pain over the last few days with some side pain and some kidney symptoms.",
  "input": "",
  "output": "Condensation is likely to result in an inflammation of the bladder, which can cause abdominal pain, abdominal suffocation, sometimes side pain and kidney symptoms, and we have to do some tests to determine the diagnosis and determine the best treatment plan."
},
{
  "instruction": "Doctor, you have abdominal pain, lower body pain, nausea, sharp chest pain and burning stomach pain.",
  "input": "",
  "output": "It can cause pain, nausea and vomiting in the upper right abdomen, which can be sharp or convulsive, which can spread through the right shoulder or back."
},
{
  "instruction": "We're experiencing abdominal pain -- doctor, reflux, vomiting, burning -- and what's the cause?",
  "input": "",
  "output": "The symptoms suggest that pulsitis is suspect."
},
{
  "instruction": "Doctor, I'm experiencing abdominal pain, sharp abdominal pain, lower body pain, abdominal tension and kidney symptoms.",
  "input": "",
  "output": "The symptoms you described indicate that you may be suffering from cholesteritis in the bladder, which can cause pain in the upper abdomen, and can sometimes spread to the lower body."
},
{
  "instruction": "Doctor, you're experiencing swelling arm, sharp chest pain, weakness, reduced heart rate, paleness.",
  "input": "",
  "output": "These symptoms indicate a heart attack, and we need to do some diagnostic tests to test it and start immediate treatment to prevent further damage to the heart."
},
{
  "instruction": "Doctor, I'm experiencing trouble breathing, increased heart rate, loss of breath, palpitations, weakness of focus, what's wrong with me?",
  "input": "",
  "output": "I think you've experienced a heart attack because of your symptoms, and it's good to run some tests to check your diagnosis and start the treatment immediately."
},
{
  "instruction": "Doctor, I'm experiencing reduced heart rate, sharp chest pain, bilateral pain, shortness of breath, focused weakness. What's the problem?",
  "input": "",
  "output": "These symptoms seem to indicate a heart attack, and it's good to run some tests and start the treatment immediately."
},
{
  "instruction": "Doctor, you're losing your breath, you're losing your face, you're losing heart rate, what's the cause?",
  "input": "",
  "output": "There's a possibility that a heart attack may have occurred from the symptoms, and we need to act quickly and get it to the hospital immediately."
},
{
  "instruction": "Doctor, I feel really uncomfortable in my chest, and I can hear my heart beat all over the place and feel pale.",
  "input": "",
  "output": "These symptoms can lead to heart attacks, and it's good to do some tests to make sure."
},
{
  "instruction": "Doctor, I always feel very tired and tired, and why?",
  "input": "",
  "output": "You can have cardiomyopathy, a heart muscle disease that can cause fatigue, shortness of breath and other related symptoms."
},
{
  "instruction": "Doctor, I've had a lot of chest pains lately, and I've had a hard time breathing.",
  "input": "",
  "output": "This is a common symptom of cardiomyopathy. Patient:"
},
{
  "instruction": "Doctor, telophase, weakness of muscle, palpitations, frequent urination at night, what's the disease?",
  "input": "",
  "output": "The symptoms indicate that the heart has difficulty pumping blood through its entire body, so it's likely to have heart disease, heart disease, which is a heart muscle disease, which is a condition of terminal edema, muscle weakness, trepidation, and night anxiety."
},
{
  "instruction": "Doctor, I'm experiencing irregular heart rate, chest upset, double-sized heart rate, decreased heart rate and weight gain, and what's the cause of these symptoms?",
  "input": "",
  "output": "It's good to schedule additional tests to check this diagnosis and discuss treatment options."
},
{
  "instruction": "Doctor, I've been gaining weight lately, and I'm not eating more than usual.",
  "input": "",
  "output": "Cardiomosis is a heart muscle disease that causes the heart muscle to become fat and weak, making it difficult for the heart to pump its blood effectively throughout its body, and weight gain is a common symptom of this disease."
},
{
  "instruction": "Doctor, I'm feeling very low and depressed these days, and I don't have the strength to fit in with anyone.",
  "input": "",
  "output": "You seem to be suffering from social phobia."
},
{
  "instruction": "Sir, I don't sleep well these days, and I feel anxious and nervous all the time, and I'm feeling so depressed and out of control of my temper.",
  "input": "",
  "output": "And when you look at what God says, you seem to have social phobias."
},
{
  "instruction": "Doctor, I've had a headache in my neck since yesterday. What's the cause?",
  "input": "",
  "output": "Because of neck pain, there's the possibility that you're infected with a membrane that surrounds your brain and spinal cord, and you're suffering from pericarditis that could threaten your life, and you need to be treated immediately by a doctor."
},
{
  "instruction": "Doctor, I'm feeling sick and nauseated, and I'm experiencing this back and forth vomiting with a persistent cough.",
  "input": "",
  "output": "The symptoms indicate that there's a suspicion of enshrined encephalitis in the membranes surrounding the brain and the spinal cord, which is an inflammation of the protective membranes surrounding the brain and the spinal cord, which is a serious condition that requires immediate medical attention."
},
{
  "instruction": "Doctor, I've had neck pain in the last few days, and why?",
  "input": "",
  "output": "If you're dealing with neck pain, it's possible that it's encephalitis, and it's good to get medical attention immediately."
},
{
  "instruction": "Doctor, you've got stiff neck, backaches, aching pains, and what's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from endocarditis, and it's important to get a doctor's attention immediately."
},
{
  "instruction": "Sir, I've got a fever, I've got a pain in my body, and I've got a stiff, moist feeling in my throat, and I've got pain in my back and my neck.",
  "input": "",
  "output": "There's a possibility that you're suffering from endocarditis, which is a protective membrane that covers the brain and spinal cord, which can cause inflammation of the pituitary membrane, which can cause heat, body, stiffness, stress, back pain and neck pain, which is important to be evaluated as soon as possible and which can determine the best treatment."
},
{
  "instruction": "Doctor, what's the cause of the recent weakness of the wrist and sharp abdominal pain?",
  "input": "",
  "output": "These symptoms can be caused by a genetic disorder called triangulosis, which has a problem with red blood cell shape, which can cause anemia and yellowness."
},
{
  "instruction": "Doctor, there are symptoms of leg pain, excessive growth, trepidation, neck pain, loss of wrist -- what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there is a blood disease called GM, and we need to do some tests to confirm this diagnosis."
},
{
  "instruction": "Doctor, I'm experiencing weakness of elbows, pain in the neck, elbow cramps, cramps, backaches. What's the problem?",
  "input": "",
  "output": "Symptoms can lead to something called triangulosis, which is a rare genetic disease that turns red blood cell form into a sphere and breaks down in the early stages, which can cause anemia and other complications."
},
{
  "instruction": "Hi, doctor, I've been experiencing a number of symptoms recently: back weakness, ecliptic, elbow spasms, spasms, leg pain, sharp abdominal pain.",
  "input": "",
  "output": "The symptoms suggest that there is a disease called GM, a genetic disease that produces abnormal red blood cells in the form of a sphere and breaks down more easily than normal, causing anemia and other symptoms."
},
{
  "instruction": "I had some pain in my leg, and I felt like I was overgrowing my height, and my elbows and my waist, and I recently had skin rashes, do you know what caused all this?",
  "input": "",
  "output": "It's suspected that red blood cells have abnormal genetic blood disease, which can break down more easily than normal, causing a number of symptoms, including anemia and the symptoms you described."
},
{
  "instruction": "Hi, doctor, you've got eye symptoms that blur your vision and dry your eyes, so can you tell me what might be a problem?",
  "input": "",
  "output": "These symptoms affect the muscles and tissues around the eye, and can indicate thyroid disease, a hormone disorder that causes inflammation and swelling."
},
{
  "instruction": "Doctor, I've been experiencing low growth, low sexual appetite, eye symptoms, acne, acne, menstrual pain for a long time, and what's the cause?",
  "input": "",
  "output": "Symptoms can lead to hormonal disorders."
},
{
  "instruction": "Doctor, over the past few months, with unpredictable menstruation, I've had whole headaches, acne and acne, and why?",
  "input": "",
  "output": "The symptoms that God's talking about indicate that you have a hormone disorder."
},
{
  "instruction": "Doctor, I'm experiencing menstrual pain, a total headache, unpredictable menstruation, reduced sexual appetite, excessive growth.",
  "input": "",
  "output": "These symptoms indicate hormone disorders, especially terminal obesity, and it's good to run additional tests to check your diagnosis."
},
{
  "instruction": "Doctor, I'm experiencing sensory problems, back pain, hands or fingers pain, wrist swelling, and some skin lesions.",
  "input": "",
  "output": "The symptoms may indicate that it's Leino's disease."
},
{
  "instruction": "Doctor, I'm experiencing sensory loss of fingers and toes, along with skin lesions, and I'm also having poor circulation, and my whole body pains, and what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from Leino's disease."
},
{
  "instruction": "We're experiencing doctors, back pain, blood circulation disorder, pain in the whole body, loss of sense and some of the symptoms of the eyes.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from Leino's disease."
},
{
  "instruction": "Doctor, your hands and fingers are swollen, your hands are swollen, your wrists are swollen, your senses are strange.",
  "input": "",
  "output": "The symptoms suggest that Leino's disease is suspect."
},
{
  "instruction": "Doctor, your hands and feet don't circulate very well, and what's the cause?",
  "input": "",
  "output": "The symptoms are most likely to be leino's disease, which is a disease in which the small blood vessels that supply blood to the fingers and toes narrow down and the blood flow in this area decreases."
},
{
  "instruction": "Doctor, it's very painful because you have a lump in your knee, and why?",
  "input": "",
  "output": "I think you're experiencing symptoms of reactive arthritis."
},
{
  "instruction": "Doctor, I'm experiencing excessive growth, loss of sexual desire, and hip pain, and why?",
  "input": "",
  "output": "You may have an arthritic arthritis, a form of arthritis that causes inflammation in your joints, in your eyes, in your urethra."
},
{
  "instruction": "Doctor, I'm experiencing excessive growth, loss of wrists, knee mass, mass, knee pain.",
  "input": "",
  "output": "It's an inflammation form of arthritis that can occur in response to infections in other parts of the body."
},
{
  "instruction": "Hi doctor, I'm experiencing neck cramps, tics, wrist weakness, intrauterine pain and back pain. What's the problem?",
  "input": "",
  "output": "Well, the symptoms seem to indicate that you have a reaction arthritis, which is usually caused by the body's infection, which can cause joint pain, swelling and stiffness."
},
{
  "instruction": "Doctor, your nails are sore, your hip pain, your knee mass or sore, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you have responsive arthritis, and you have to do some tests to confirm your diagnosis."
},
{
  "instruction": "Sir, you're experiencing swelling of your feet, strange skin, rubles during pregnancy, skin rashes, swelling of the skin.",
  "input": "",
  "output": "The symptoms suggest that there is an om, a skin infection caused by a tick."
},
{
  "instruction": "Doctor, I've been experiencing a number of symptoms recently: red organs, dry skin, tanning, and abnormally visible rashes on the diaper area, and I'm worried about the potential problems of pregnancy.",
  "input": "",
  "output": "Based on what you've described, it's likely to be infected with otrus, which can cause skin rashes and abnormal skinforms, of course. It can cause dryness, peeling and texture, especially if you're pregnant, getting treatment as soon as possible to prevent further complications."
},
{
  "instruction": "Doctor, you've got skin rashes, and they're really itchy, and you've got abnormally infected areas, and you've got diaper rashes, and your skin is dry, peeled, and you've got scales, and what's the problem?",
  "input": "",
  "output": "The symptoms suggest that there is an om, a skin infection caused by a tick."
},
{
  "instruction": "Doctor, scalp is itchy and it's itchy, and it's pregnant, and I need you to tell me what's going on.",
  "input": "",
  "output": "It's an infectious skin disease in which aphids penetrate into the skin and cause severe soreness and rash. Head and body hair are the common symptoms of this disease, which can be dangerous and need immediate medical attention."
},
{
  "instruction": "Doctor, your scalp is soy and your skin looks so weird, what's wrong with me?",
  "input": "",
  "output": "The symptoms seem to indicate that she has an odome, which is an infection of a little tick that penetrates the skin, and causes severe soreness, and rashes."
},
{
  "instruction": "Hi, doctor, I've been having sinus thrombosis and fever for the last few days.",
  "input": "",
  "output": "I think there's a shock to you that can cause these symptoms."
},
{
  "instruction": "Doctor, I've been having symptoms that have blocked my nose lately. What are they?",
  "input": "",
  "output": "It's possible you've been shocked to have symptoms like nose blockage."
},
{
  "instruction": "Doctor, what's wrong with your ears getting red?",
  "input": "",
  "output": "Maybe it's because of your shock, which can cause you to get red and provoke."
},
{
  "instruction": "Doctor, my nose has been blocked, my ears have been deaf, my ears have been broken, my hearing has been low.",
  "input": "",
  "output": "To put it off as a symptom, I think it's caused by your shock."
},
{
  "instruction": "Sir, you've missed your period, and you've got your hip pressure, and you've got a little bit of squeamish spots, and you've got a little traffic during pregnancy.",
  "input": "",
  "output": "The symptoms seem to indicate that you're experiencing pregnancy high blood pressure."
},
{
  "instruction": "Doctor, we're experiencing cramps and tics together during pregnancy. What's the problem?",
  "input": "",
  "output": "Yes, I think you've got high blood pressure, which is a form of high blood pressure during pregnancy that can cause seizures, headaches, and other complications."
},
{
  "instruction": "Doctor, I've been experiencing a recent contraction of the uterus. Do you have any symptoms to worry about?",
  "input": "",
  "output": "The symptoms seem to indicate a pregnancy high blood pressure, and you have to take proper treatment and precautions to avoid further complications."
},
{
  "instruction": "Doctor, I need you to tell me what's causing the B.P.P. and the bleeding during pregnancy.",
  "input": "",
  "output": "Symptoms suggest that you may have a form of celiac hypertension that can cause bone pressure and bleeding during pregnancy."
},
{
  "instruction": "Sir, a few days ago, there was severe pain in the groins and the feet, as well as swelling the knees and legs.",
  "input": "",
  "output": "The symptoms seem to indicate that he's in doubt about myocardial embolism, and he needs to do some tests and scans to confirm his diagnosis."
},
{
  "instruction": "Doctor, I've been experiencing a couple of symptoms recently, severe leg pain, loss of the same leg sensation, and can you tell me what caused them?",
  "input": "",
  "output": "Your symptoms are consistent with an arteriosclerosis, which usually occurs when blood clots or other substances from other parts of the body block the artery of the leg."
},
{
  "instruction": "Doctor, you've recently had severe groin pain and a strange skin, and your period is getting longer than usual, and you're experiencing lymph nodes and sensory loss.",
  "input": "",
  "output": "The symptoms seem to indicate that there is a condition called an arteriosclerosis, a condition that can cause pain, skin changes, and sensory loss in the arteries of the legs. It can also affect the flow of blood to the uterus, leading to longer periods of menstruation."
},
{
  "instruction": "Doctor, my skin looks different and abnormal, and why?",
  "input": "",
  "output": "This is a condition that occurs when a clot or plaque blocks the arteries of a leg or an arm and restricts the blood flow, which can cause changes in skin color, texture or temperature."
},
{
  "instruction": "Doctor, your skin looks weird and your left leg is swollen.",
  "input": "",
  "output": "The symptoms seem to indicate that an artery that supplies blood to the legs has a blockage of Martcho E. embolism."
},
{
  "instruction": "Hello, sir, there are skin-related symptoms, such as skin growth, warts, lymphoma, skin lesions, abnormal skin, and what is the disease that I have?",
  "input": "",
  "output": "The symptoms that God's telling us are likely to be injections: injections are common skin diseases with red faces and small lumps of pus on the face, which can sometimes cause skin growth, warts and lymph nodes, which may also be signs of skin lesions and abnormal skin infections."
},
{
  "instruction": "Doctor, what's wrong with the swelling of the skin?",
  "input": "",
  "output": "Because of the swelling of the skin, you may have a disease known as injections."
},
{
  "instruction": "Doctor, why do you have a pimple or a pimple in your face?",
  "input": "",
  "output": "Is there any symptoms of redness or redness of face?"
},
{
  "instruction": "Doctor, I'm experiencing an abnormal appearance of skin with skin drying and skin peeling, as well as eye problems and lymphoma, and tell me what might be the problem.",
  "input": "",
  "output": "It's a common skin disease with red faces, bumpy blood vessels, and, depending on the circumstances, it can cause dryness, irritation, eyelid swelling, which is a rare complication of this disease."
},
{
  "instruction": "Doctor, I'm experiencing some of the symptoms associated with lymphoma and the eyes.",
  "input": "",
  "output": "The symptoms are likely to be injections, which can cause multiple symptoms, including lymphoma and eye problems."
},
{
  "instruction": "Doctor, I've recently experienced drug abuse, poor hearing, deafness, fainting, persistent headaches.",
  "input": "",
  "output": "The symptoms that you've described may indicate a fracture of the skull."
},
{
  "instruction": "I'm experiencing doctors, nosebleeds, headaches, nausea, deafness, and I've passed out a few times, and what's going on with me?",
  "input": "",
  "output": "There may be a skull fracture due to symptoms, and we need to do some video tests to make sure we're diagnosed."
},
{
  "instruction": "Sir, your nose bleeds, your throat hurts and you have a headache.",
  "input": "",
  "output": "The symptoms suggest that a fracture of the skull occurred."
},
{
  "instruction": "Doctor, I've been suffering from recent vomiting, fainting, neck pain, depression.",
  "input": "",
  "output": "The symptoms suggest that the fracture of the skull is in doubt. Have you abused drugs recently?"
},
{
  "instruction": "Doctor, I'm experiencing symptoms like depression, deafness, blindness, and recently a change in my face.",
  "input": "",
  "output": "I think these symptoms are due to a fracture in the skull, and we have to do some additional tests to determine the extent of the fracture and provide the right treatment."
},
{
  "instruction": "Doctor, your wrist is weakened, your upper abdomen is in pain, your eyes are blurry, your throat is in pain.",
  "input": "",
  "output": "The symptoms suggest that you have staphitis in the middle of the eye, which is inflammation of the grape membrane, which can be caused by autoimmune disease or infection, and it's good to have an eye examination and a few blood tests to determine the root cause of staphitis."
},
{
  "instruction": "Hi, doctor, I've been experiencing a couple of symptoms recently: very poor eyesight, weakness in the elbow, cramps and cramps, and I'm often biting my nails.",
  "input": "",
  "output": "Yes, I think you've got staph, which affects your eyes and elbows and many other parts of your body, and if you don't treat them without treatment, you can cause severe symptoms, such as blindness."
},
{
  "instruction": "Doctor, there are a few strange symptoms that are getting worse and weaker in your eyesight and weaker in your elbow, and you've got abdominal pain, and you've been biting your nails, and what's the cause of this problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from staphitis, which is an inflammation of the eye, which can lower your vision, but it can also lead to joint pain, weakness or insensitivity in certain parts of the body, and sometimes stomach problems, and it's good to do more research to make sure that this is actually the cause of the symptoms."
},
{
  "instruction": "Doctor, you've recently had elbow spasms or spasms. What's the cause?",
  "input": "",
  "output": "It's an inflammation of the grape membrane, which is the middle layer of the eye, which can cause multiple symptoms of joint pain, stiffness and muscle spasms besides eye problems."
},
{
  "instruction": "Doctor, you've got red inside and out of your nose, and you've got telophase, facial pain, headaches, even blood loss. What's wrong with me?",
  "input": "",
  "output": "I think his face's broken."
},
{
  "instruction": "Doctor, your eyes are in pain and you've been drinking a lot lately. What's the problem?",
  "input": "",
  "output": "The symptoms suggest a facial fracture."
},
{
  "instruction": "Hi, doctor, abdominal pain, blood loss of lips, red inside and outside of the nose and swelling of the eyes.",
  "input": "",
  "output": "I think you have a facial bone fracture."
},
{
  "instruction": "Doctor, your nose is red inside and out. What's the cause?",
  "input": "",
  "output": "Have you had any injuries or injuries to your face lately?"
},
{
  "instruction": "Doctors, sneezes, headaches, a sense of deafness in the ear, there's going on. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to cause an inflammation of the organ, which can cause respiratory problems, coughs, and so forth. Take a break, avoid smoke, and see if the symptoms get worse."
},
{
  "instruction": "Doctor, cough, headache, nose pressure, shortness of breath, throat pain. What's the problem?",
  "input": "",
  "output": "It could be bronchitis, according to the symptoms you've described."
},
{
  "instruction": "Hi, doctor, there's an ongoing cough.",
  "input": "",
  "output": "It could be bronchitis."
},
{
  "instruction": "The doctors, the earaches, the hooliganism, the backaches, the fevers, the noses are going on.",
  "input": "",
  "output": "I think you have bronchitis."
},
{
  "instruction": "Doctor, I'm having trouble breathing, double-pass fever, and I'm also having a lot of sneezes these days, and I'm having a lot of shortness of voice.",
  "input": "",
  "output": "According to God's description of the symptoms, bronchitis is an inflammation of the organs, which can cause respiratory problems, respiratory problems, shortness of breath, voices, usually caused by viral or bacterial infections."
},
{
  "instruction": "Doctor, facial pain, headaches, toothache, gum pain is continuing, and I think it's a little swollen face.",
  "input": "",
  "output": "I think you've got a TMJ that affects the jaw joint and can cause pain and swelling in the face as well as in the scalp."
},
{
  "instruction": "Sir, your mouth is sick and hard to swallow, your jaw is swollen and you have dental and gum pain, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate that you're having a jaw joint disorder like TMJ."
},
{
  "instruction": "Doctor, what's the problem?",
  "input": "",
  "output": "The symptoms suggest that you have a TMD that affects the jaw joints and the surrounding muscles, and you need to be diagnosed as soon as possible and start treating them."
},
{
  "instruction": "Doctor, you've got a lot of jaw pain lately.",
  "input": "",
  "output": "There seems to be a jaw joint disorder called TMD."
},
{
  "instruction": "Sir, there's facial pain, there's mouth pain, there's gum pain, there's a lump in your neck.",
  "input": "",
  "output": "You may have a TMJ disorder, which can cause facial pain, mouth pain, and gum pain. A lump of throat may also be associated with this disorder. It's good to consult a specialist to check the diagnosis and discuss treatment options."
},
{
  "instruction": "Doctor, I've been having a lot of discomfort lately -- a lot of swelling, a lot of pain in the testicle, pain in the anal, and a lump around the anus.",
  "input": "",
  "output": "The symptoms suggest there's an indirect infection."
},
{
  "instruction": "Doctor, there's pain in the testicle. What's the cause?",
  "input": "",
  "output": "There may be indirect infections that can cause pain in the test, and we need to do some tests and start treating antibiotics to see what's going on."
},
{
  "instruction": "Hi doctor, I've been experiencing some symptoms recently: scrotum edema, fluids, rectal bleeding, skin lesions and skin growth. Can you tell me what's wrong?",
  "input": "",
  "output": "There's a possibility that there's a second-hand infection when you put it off because of the symptoms that God explains."
},
{
  "instruction": "We're experiencing a doctor, a dermal edema, body fluids, acne or acne, a pain in the testes. What's the problem?",
  "input": "",
  "output": "If you look at the symptoms that God has described, it could be indirect infection. We'll do some tests to make sure you're diagnosed and we'll discuss treatment options."
},
{
  "instruction": "Doctor, pain in the anus and swelling of the scrotum caused the skin to grow and the lesions to develop.",
  "input": "",
  "output": "The symptoms seem to indicate a direct infection."
},
{
  "instruction": "Hi, doctor, there was a little bit of pain and pain in the breast, and recently there was a lump or lump in the arm, and what was the problem?",
  "input": "",
  "output": "It's possible that it's a female cyst, which occurs in breast tissue and is filled with non-mal cancerous fluid that can sometimes cause pain or discomfort."
},
{
  "instruction": "Doctor, there's pain and wear in the breast, irregular navel, a lump of arm, a cough, a lump of neck.",
  "input": "",
  "output": "It's possible that it's because of the symptoms, but you have to run some diagnostic tests to identify the diagnosis."
},
{
  "instruction": "Doctor, there's a change in my chest because my skin grows, there's a mole, there's a mass in my breast, there's an irregularity in my navel, there's a vaginal dryness, and I'm worried, what's the problem?",
  "input": "",
  "output": "It's possible that it's a female cyst, which is a pouch filled with fluid that can occur in breast tissue, which can cause lumps or lumps in the breast and cause changes in the skin in the area, but we have to do some tests to confirm the diagnosis."
},
{
  "instruction": "Doctor, she's bleeding out of the nipples. What's the problem?",
  "input": "",
  "output": "I think it's possible that it's a breast cyst, a common disease that produces a small pocket filled with fluid in the breast tissue."
},
{
  "instruction": "Doctor, there's been a lot of pain and wear in the breast recently.",
  "input": "",
  "output": "Based on what you're talking about, it's possible that it's a breast cyst, which can cause pain and discomfort in a pocket filled with fluid that can form in the breast tissue."
},
{
  "instruction": "Doctor, I have a very nervous and nervous feeling these days, and sometimes I see things that don't actually exist, and what's wrong with me?",
  "input": "",
  "output": "I think you're experiencing post-traumatic stress disorder from the symptoms that God explains. Have you experienced a traumatic event recently?"
},
{
  "instruction": "Doctor, I've been feeling a lot depressed lately and feeling a lot less self-worth.",
  "input": "",
  "output": "You're suffering from post-traumatic stress disorder."
},
{
  "instruction": "Doctor, I've been experiencing a number of symptoms recently: alcohol abuse, depression, personality problems, and fear and phobia.",
  "input": "",
  "output": "Your symptoms suggest that you're suffering from post-traumatic stress disorder, and low self-worth can be the result of this disorder."
},
{
  "instruction": "Doctor, I'm experiencing drug abuse, depression, excessive anger, insomnia, alcohol abuse.",
  "input": "",
  "output": "These are typical symptoms of post-traumatic stress disorder, where people usually experience traumatic events, such as combat, rape, and natural disasters, and then post-traumatic stress disorder."
},
{
  "instruction": "Hi doctor, I'm experiencing depression and psychosis, hostility, fear and phobia, insomnia, what's wrong with me?",
  "input": "",
  "output": "Your symptoms suggest that you're suffering from post-traumatic stress disorder, which can cause depression, anxiety, avoidance and sleep disorders."
},
{
  "instruction": "Doctor, I recently had an ultrasound, and I found a mass in my kidney, and what does that mean?",
  "input": "",
  "output": "It's possible that it's kidney cancer, depending on the symptoms, and you have to run some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I'm experiencing kidney and prostate symptoms, and will you tell me what might be a problem?",
  "input": "",
  "output": "There's a possibility that there's a kidney cancer that can cause prostate symptoms, because of the symptoms, you have to do some tests to make sure you're correct."
},
{
  "instruction": "Doctor, I've found that there's kidney mass, and that there's an increase in heart rate with excessive urination at night, and there's prostate symptoms.",
  "input": "",
  "output": "When it comes to your symptoms and kidney mass, it's very likely that it's kidney cancer, and it's good to book a tissue test and discuss treatment options with the oncologist."
},
{
  "instruction": "Doctor, we've got a lot of urine at night, we've got a lot of urine, we've got a bit of urine, we've got kidney symptoms, we've got blood in our throats, what's the problem?",
  "input": "",
  "output": "It's probably kidney cancer because of the symptoms, and it's good to run some tests to make sure you're diagnosed, and start treating them as soon as possible."
},
{
  "instruction": "Doctor, there's blood coming out of the urine and some kidney-related symptoms. What's wrong with me?",
  "input": "",
  "output": "It's possible that it's kidney cancer based on what God says, and it's good to do some tests to check the diagnosis and establish a treatment plan."
},
{
  "instruction": "Doctor, I don't think I sleep well at night, and I've had a lot of emotional ups and downs these days, and there's a lump in my breast, and my feet are swollen.",
  "input": "",
  "output": "It's possible that it's ectopic cancer, and you have to do some tests to make sure you're diagnosed, first of all, to make sure that your pelvic and breast cancer are related."
},
{
  "instruction": "Hi, doctor, you've recently had a terminal edema, your body is sick, you've got back pain, you've also had hypodermics, you've got a breakdown, what's the problem?",
  "input": "",
  "output": "It's important to do some tests to check the diagnosis and plan the treatment, so can you get a medical appointment as soon as possible?"
},
{
  "instruction": "Doctor, there's an abnormally involuntary movement and telophase, along with a feeling of pain in the body, and what's the cause of these symptoms?",
  "input": "",
  "output": "It's possible that the symptoms are ectopic cancer, and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, back pain, abnormal involuntary movements, emotional symptoms, soft elbows, pain all over the body.",
  "input": "",
  "output": "The symptoms are likely to be external cancer, a rare form of cancer that occurs outside the female genitals, and it's good to have some tests and screening to confirm the diagnosis."
},
{
  "instruction": "Doctor, I recently experienced back pain and some emotional symptoms.",
  "input": "",
  "output": "It might be a symptom of ectopic cancer, and it's good to get additional tests to see if it's uterine cancer."
},
{
  "instruction": "Doctor, you have a rash on your eyelids and a white secretion in your eyes. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there's a ophthalmitis, an inflammation of the eyelids, which can cause rashes, lesions, and secretions."
},
{
  "instruction": "Sir, it's snowy. What's the cause?",
  "input": "",
  "output": "I think it's possible it's ophthalmitis."
},
{
  "instruction": "Doctor, your eyes are bleeding and there are other symptoms. Can you tell me what might be the problem?",
  "input": "",
  "output": "The symptoms suggest that you've got a ophthalmosis."
},
{
  "instruction": "Doctor, it really bothers me because my eyes are swollen and my eye is covered with lesions, and I'm going to open up a lot of eyes, and I'm going to sting, and what's going on?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from ophthalmitis."
},
{
  "instruction": "Hi, doctor, there are some symptoms in my eyes that I recently had a lot of tears and rash in my eyelids.",
  "input": "",
  "output": "The ophthalmitis is not only red and self-obtrusive, it's also an inflammation of the eyelids, which are marked by eyelashes and teary eyelids, which can be caused by bacterial infections and other factors."
},
{
  "instruction": "Doctor, there's been a number of symptoms recently: swelling of the legs and aching of the stomach, nausea and reflux, and there's a mass touching one leg.",
  "input": "",
  "output": "These are symptoms of a physical disease, autoimmune disease that affects the sores when you're eating gluten, and so forth, and so forth, and so forth, and so forth, and so forth."
},
{
  "instruction": "Doctor, I've been experiencing an abscess recently. What's the cause of the telophase?",
  "input": "",
  "output": "Considering the history of the disease, the biggest cause of telopeoma is probably Celia disease. Have you ever been diagnosed with Celia disease?"
},
{
  "instruction": "Doctor, I've recently been very tired and experiencing chest pain and diarrhea.",
  "input": "",
  "output": "The symptoms suggest that you're in doubt about Celia's disease, and you should get a test to check it out."
},
{
  "instruction": "Doctor, I'm experiencing vomiting, reflux, sharp abdominal pain and nausea, and I think I'm allergic to certain foods.",
  "input": "",
  "output": "Symptoms indicate that there is a potential for celiac disease, a digestive disorder that can cause a variety of symptoms such as vomiting, reflux, sharp abdominal pain, nausea, and so forth."
},
{
  "instruction": "Doctor, I've recently experienced some strange symptoms: allergic reactions after eating certain foods, and I'm always extremely tired and I think my feet are swelling.",
  "input": "",
  "output": "These may be signs of Celia's disease. Have you eaten wheat or barley or rye products recently?"
},
{
  "instruction": "Doctor, I've got sharp pain on the right side of my body, and I've got a lot of pain in my bladder, so I've got pain in my pelvis and in my abdomen, and I've got blood in my urine yesterday, and I need you to tell me what's wrong with me.",
  "input": "",
  "output": "The right side pain may be from inflammation of the bladder wall or from kidney infections."
},
{
  "instruction": "Doctor, I'm experiencing abdominal and urinary pain, and there's blood in the urine, there's back and back pain, and sometimes I'm tired of urinating, and what's the cause of all this?",
  "input": "",
  "output": "The symptoms seem to indicate that there's a bladder infection caused by infection, which can cause symptoms such as lower abdominal pain, urinary tract, blood in the urine, back pain, urination, and so forth."
},
{
  "instruction": "Doctor, I've been having a lot of discomfort lately, and I can't take a piss, and I have to go to the bathroom a lot all day.",
  "input": "",
  "output": "It's likely to be bladder disease, which causes bladder inflammation, which lowers urine and causes frequent urination."
},
{
  "instruction": "What's the problem with bladder discomfort, side pain, urinary pain, and blood mixed with urine?",
  "input": "",
  "output": "The symptoms you described suggest that there's a bladder infection caused by bacteria, and it's good to start treating antibiotics as soon as possible to treat the infection."
},
{
  "instruction": "Doctor, I'm experiencing lower abdominal and pelvic pain. What's the cause?",
  "input": "",
  "output": "It's possible that, as a symptom, it's an inflammation of the bladder, and it's usually caused by bacterial infection."
},
{
  "instruction": "Doctor, you've got a fever, you've got a temper problem, you've got a symptom that's pulling your ear, what's the problem?",
  "input": "",
  "output": "Now, these symptoms might be related to sickle cell anemia, or do you have a history of sickle cell anemia in your family?"
},
{
  "instruction": "Sir, I've got a bad temper these days, I've got a fever, I've got an irregular stomach, can you tell me what's going on?",
  "input": "",
  "output": "The symptoms may indicate that irregular red blood cells have a lot of sickle cell anemia, a genetic blood disease that causes pain, fever and other complications in small blood vessels."
},
{
  "instruction": "Doctor, I have leg pain, sexual pain, personality problems, my whole body is sick, my lips are always dry, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate sickle cell anemia, which is a genetic blood disease affecting the shape of red blood cells that causes pain and other health complications."
},
{
  "instruction": "Sir, there's aches and pains in the eyes, facial pain and headaches.",
  "input": "",
  "output": "The symptoms may indicate that the blood vessels of the eye rupture, causing the peritoneal bleeding under the peritoneum."
},
{
  "instruction": "Hi, doctor, there's eye pain in the eyes, there's a sense of color in the eyes, and there's a lot of blood in the eyes. What's the problem?",
  "input": "",
  "output": "I think he's bleeding from the pericardium."
},
{
  "instruction": "Doctor, I feel facial pain, I feel foreign to my eyes, and I also have impaired vision, and what's the problem?",
  "input": "",
  "output": "There could be a pericardium bleed under the membrane of the eye, which can cause these symptoms, but it doesn't usually affect vision very long."
},
{
  "instruction": "Doctor, your eyes are bloodied and your vision is slightly impaired.",
  "input": "",
  "output": "The symptoms suggest that he has a hypotensive hemorrhage."
},
{
  "instruction": "Doctor, I've had some pain in my face lately.",
  "input": "",
  "output": "Did you see that your eyes are covered with blood? Patient:"
},
{
  "instruction": "Doctor, tell me what's wrong with the sharp abdominal stools that are changing.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from piles."
},
{
  "instruction": "Doctor, we've experienced rectal bleeding, we've found blood in the stool, we've also got melena, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from tooth disease, which is a condition of swelling and inflammation of the veins of the work and the anus."
},
{
  "instruction": "Sir, there's a lump around the anus touching or swelling, and there's a sharp abdominal pain with a dark red side.",
  "input": "",
  "output": "The symptoms suggest that there's an inflammation of the veins at work or anal, and there's a piles around the anus that cause swelling or swelling and sharp abdominal pain."
},
{
  "instruction": "Sir, I need you to tell me what's going on with anal substrate and abscess and a rectal bleeding.",
  "input": "",
  "output": "The symptoms seem to be piles."
},
{
  "instruction": "Doctor, I've been experiencing some uncomfortable symptoms recently, and I found that there's a lot of vaginal pain, and there's a lot of blood in the throat, and there's a lot of lower body pain, and you know what's causing it?",
  "input": "",
  "output": "Have you ever experienced discomfort or pain when you're standing on a stool or sitting for a long time? It's a disease that causes urinary pain and bleeding due to swelling and inflammation of the veins of the work or the anus."
},
{
  "instruction": "Doctor, I've had a lot of skin problems these days, and why?",
  "input": "",
  "output": "Contactal dermatitis is an allergic reaction caused by direct contact with stimulants or allergens."
},
{
  "instruction": "Doctor, I felt that my skin had become very dry and easily shed, and I also had spots and acne on my skin, and what was the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you have contact with dermatitis."
},
{
  "instruction": "Doctor, your arms and legs have spots on your skin, and why?",
  "input": "",
  "output": "Have you had contact with new soaps, laundry detergents, or textiles recently?"
},
{
  "instruction": "Doctor, you've got skin rashes, your eyes are swollen, and some skin dots look different, so what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there is a contact with dermatitis, which is an allergic reaction to substances that have contact with the skin, such as cosmetics, jewelry, or plants."
},
{
  "instruction": "Doctor, you've got skin rashes, you've got skin swelling, you've got irritations, you've got discomforts, you've even got some dots on your skin, can you tell me what's wrong?",
  "input": "",
  "output": "The symptoms seem to indicate that you have contact with dermatitis, which is a skin disease caused by an allergic reaction to contact matter that causes redness, itching, swelling, swelling, and so forth, often in people who wear diapers or use certain cosmetics or local drugs."
},
{
  "instruction": "Doctor, I'm not feeling well these days.",
  "input": "",
  "output": "There's a sinusal submersion."
},
{
  "instruction": "Doctor, I've been experiencing symptoms recently, and would you like to know what might be a problem?",
  "input": "",
  "output": "Have you ever experienced other symptoms, such as dizziness or shortness of breath?"
},
{
  "instruction": "Doctor, there are symptoms of recent fatigue and chest palpitations.",
  "input": "",
  "output": "The symptoms seem to indicate that there's a sinus submersion."
},
{
  "instruction": "Doctor, I've been feeling so dizzy, so weak, sore in my chest lately, I don't know what's wrong.",
  "input": "",
  "output": "This condition is characterized by a slow heart rate. Note: conversation is very short and is for explanation. In the real world, you might have to ask more questions in order for a doctor to make a proper diagnosis."
},
{
  "instruction": "Doctor, you've recently had a heart and breath. What's the problem?",
  "input": "",
  "output": "The symptoms may indicate that there's a sinus substrate, which can cause these symptoms when the heart is beating slower than normal, and we can do some additional tests to confirm the diagnosis."
},
{
  "instruction": "Doctor, there's been a lot of recent headaches.",
  "input": "",
  "output": "His B.P.'s high."
},
{
  "instruction": "Doctor, there's been a lot of recent headaches.",
  "input": "",
  "output": "Don't you have any other symptoms? Patient:"
},
{
  "instruction": "Doctor, there's been a sharp chest pain recently, and why is that?",
  "input": "",
  "output": "Could be signs of high blood pressure based on the symptoms. Are you regularly monitoring blood pressure?"
},
{
  "instruction": "Doctor, there's a sharp chest pain. What's the symptom?",
  "input": "",
  "output": "The symptoms suggest that there's high blood pressure that can cause chest pain, and we need to do some tests to check this out."
},
{
  "instruction": "Doctor, I've been experiencing back pain and lower abdominal pain for the last few days.",
  "input": "",
  "output": "Are there other symptoms, such as vaginal secretions and fever?"
},
{
  "instruction": "Doctor, there's a sharp pain in the lower abdomen, mainly near the top of the skull, and what's the cause of this pain?",
  "input": "",
  "output": "According to your description, you're likely to have a condition called pelvic inflammation, which affects mostly female reproductive organs and can cause pain and discomfort in the lower abdomen."
},
{
  "instruction": "Doctor, I'm experiencing urinary pericardial upper pelvic pain, and I'm also feeling a lot of hip pain, and what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there's an inflammation of the pelvic side, which can be caused by an infection of the female reproductive organs."
},
{
  "instruction": "Doctor, you've been very sick lately, you've found nausea, vomiting and strange vaginal secretions, and you've also experienced pain in your lower abdomen and menstrual bleeding.",
  "input": "",
  "output": "There are symptoms that can lead to an inflammation of the pelvic system, which can cause nausea, vomiting, vaginal secretions, chest pain and abnormal bleeding, and we want to check the diagnosis and start treating it as soon as possible."
},
{
  "instruction": "I'm experiencing vomiting with doctors, with side pain, with hip pain, with hip pain, with back pain, and with upper jaw pain.",
  "input": "",
  "output": "It's a common symptom of pelvic disease, bacterial infection in female reproductive organs, and you have to run some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, there's a lot of sores and stomach pains going on. What's the problem?",
  "input": "",
  "output": "There's a possibility of liver disease because of the symptoms, and I'd like you to come over for some tests to check your diagnosis."
},
{
  "instruction": "Doctor, do you mind telling me what can be a problem when there's bad breath, weakness, heartburn, and stomach pain?",
  "input": "",
  "output": "There's a high risk of liver disease because of the symptoms, and we need to do some tests to identify the diagnosis and determine the best treatment plan."
},
{
  "instruction": "Doctor, I've been experiencing a lot of heartache and stomach pain lately, and can you tell me what caused these symptoms?",
  "input": "",
  "output": "It's possible that it's a symptom of a liver disease based on what God says, and I want to run some tests to identify and evaluate possible damage."
},
{
  "instruction": "Doctor, what's the problem with your abdominal pain and swelling of your legs and ankles?",
  "input": "",
  "output": "The symptoms seem to indicate liver disease, and I want to order some blood tests and video tests to confirm the diagnosis."
},
{
  "instruction": "Doctor, you've recently had back and back pain. What's the cause?",
  "input": "",
  "output": "It can be liver disease, because of the symptoms, and we need to do some tests to make sure that we're doing it."
},
{
  "instruction": "Hi, doctor, there's been a couple of recent problems: burning abdominal pain, rectal bleeding, and sometimes nausea.",
  "input": "",
  "output": "Yes, the symptoms suggest that you have chronic toilets."
},
{
  "instruction": "Hi, doctor, there's blood in your rectal bleeding and your stool, and what's the cause?",
  "input": "",
  "output": "It's possible that it's chronic variation when you're looking at what God's instructions are."
},
{
  "instruction": "Doctor, I've recently had stomach problems, and I've always had more stomach pain, and I feel nausea, and it's hard to go to the bathroom.",
  "input": "",
  "output": "The symptoms seem to indicate that you have chronic toilets."
},
{
  "instruction": "Doctor, I'm experiencing anal pain, vomiting, sharp abdominal pain, stool change and nausea.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from chronic disparity."
},
{
  "instruction": "Sir, I haven't had a good urination lately, and I'm experiencing a burning abdominal pain, rectal bleeding, lower abdominal pain, nausea.",
  "input": "",
  "output": "It seems to me that you're suffering from chronic constipation."
},
{
  "instruction": "Doctor, your legs are numb and your throat lymph nodes are swollen, and your throat is swollen and a lump is touched, and what's going on?",
  "input": "",
  "output": "It's very likely that it's thyroid cancer because of the symptoms, and it's important to do some tests to identify the diagnosis and determine how best to treat it."
},
{
  "instruction": "Doctor, what's the problem when you experience delusions and hallucinations and your whole body becomes stiff?",
  "input": "",
  "output": "It can be a condition of hyperthyroidism, and it's rarely a symptom of thyroid cancer, and it's good to run some tests to rule out the possibility of thyroid cancer."
},
{
  "instruction": "Doctor, I feel a lump around my neck, and I feel tired all the time, and I feel stiff and swollen.",
  "input": "",
  "output": "It's possible that it's thyroid cancer, and you have to run additional tests to make sure you're diagnosed, and it's important to treat it as soon as possible."
},
{
  "instruction": "Doctor, I'm very tired recently, and I feel lumps in my neck, and I think I'm swollen with lymph nodes, so can you tell me what's going on?",
  "input": "",
  "output": "It's possible that it's thyroid cancer, but your symptoms are signs of thyroid cancer, first of all, by organizing the mass in the neck and then making sure that the cancer has spread to the lymph nodes."
},
{
  "instruction": "Doctor, I feel stiff, lymph nodes swelling, and I feel fatigue, and I feel lumps in my neck.",
  "input": "",
  "output": "It's possible that it's thyroid cancer because of the symptoms, and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, in the last few days, I've been suffering from diarrhea and nose damage, and what's the cause?",
  "input": "",
  "output": "Diarrhea and nose force are common symptoms of the flu."
},
{
  "instruction": "Doctor, I'm vomiting and I'm feverish, and I'm sick, and what's wrong with me?",
  "input": "",
  "output": "The symptoms suggest that you may have had the flu."
},
{
  "instruction": "Sir, I'm not feeling well. I have coughs, diarrhea, fevers, headaches.",
  "input": "",
  "output": "The symptoms seem to indicate that you have the flu."
},
{
  "instruction": "Doctor, you're coughing and diarrheating. What's the problem?",
  "input": "",
  "output": "It's a common symptom of the flu, and it's good to get enough rest and lots of fluids to make you feel better."
},
{
  "instruction": "Doctor, you've got lumps or lumps on your knee, and you've got ectopic pain. What's the problem?",
  "input": "",
  "output": "Have you ever experienced concertedness or balance problems, difficulty in speaking or swallowing, abnormal eye movements?"
},
{
  "instruction": "Doctor, cough, back stiff, back pressure, back pain, endocardial swelling and ear pain. What's wrong with me?",
  "input": "",
  "output": "The symptoms seem to indicate that Friedrich has a true motor dystrophy."
},
{
  "instruction": "Doctor, your back is stiff, your back is cold, your throat is sick, your ears are sore, your eyelids are sore, what's the cause of all these symptoms?",
  "input": "",
  "output": "The symptoms suggest that Friedrich's motorism is a rare genetic disorder that affects the nervous system and causes problems with coordination and balance."
},
{
  "instruction": "Doctor, there's a lump in your knee, there's a lump, there's a bloating, there's a bloating, there's a bloating, there's a problem.",
  "input": "",
  "output": "The symptoms that God explains may be due to a rare genetic disorder that affects the nervous system and interferes with coordination and exercise, that is, Friedrich's motor dystrophy."
},
{
  "instruction": "Doctor, I've got a lump in my arm, and I've got a lump in my knee, and what's the cause of these symptoms?",
  "input": "",
  "output": "These symptoms can be caused by a rare genetic disorder called Friedrich's exercise syndrome, which affects the nervous system and can cause difficulty in movement and condensation."
},
{
  "instruction": "Sir, I have a problem with my temper, and I have abnormal eyelids, so can you tell me what's causing this?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from a chronic disorder, which is characterized by repeated, involuntary movements or outbursts, and the abnormal movement of the eyelids known as eye spasms is a common symptom of the disorder."
},
{
  "instruction": "Sir, I've been feeling very depressed lately, and I'm experiencing a stiffness in my entire body, so can you tell me what caused it?",
  "input": "",
  "output": "It's possible that you're suffering from a chronic disorder, which is a disorder that causes repeated, involuntary movements or outbursts, which can often accompany the rigidity of the whole body with depression or psychiatric symptoms."
},
{
  "instruction": "Doctor, your body is stiff and your eyelids are unconscious. What's the problem?",
  "input": "",
  "output": "There's a chance that there's a T-tick, which is a sudden, repetitive movement or sound, and some people get it from an inexorable impulse, which may have something to do with hardness, and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I recently had a problem with physical movement, and I had a problem with my temper, and I had cramps and cramps, and sometimes I have groin pain, and my body is acting abnormally involuntary, and what's the cause of all this?",
  "input": "",
  "output": "The symptoms suggest that you have a T-shirt disorder."
},
{
  "instruction": "Doctor, what is the cause of the swelling of the skin in your arm?",
  "input": "",
  "output": "It might be skin polyps, but it's usually a little skin growth in the neck, the armpits or the groins, and it's a good idea to get a reservation for elimination."
},
{
  "instruction": "Hi, doctor, you've got skin irritation, skin itching, and your scalp is irregular.",
  "input": "",
  "output": "You may have skin polyps because of the symptoms you described."
},
{
  "instruction": "Hi, doctor, I recently had a couple of skin dots on my body. What's the problem?",
  "input": "",
  "output": "This skin dot could be a symptom of skin polyps, and to be sure, you need to be tested for skin."
},
{
  "instruction": "Doctor, I have several skin dots in my body, and why?",
  "input": "",
  "output": "It could be skin polyp, a positive growth in the skin, which is normally harmless, but it's always good to be tested."
},
{
  "instruction": "Doctor, with a sharp pain in the neck and the arm, there's a weakness in the left arm, and there's also a weakness in the fingers, and there's a feeling of weakness in the fingers.",
  "input": "",
  "output": "I think there's a condition called pasanazi-tuner syndrome, which affects the nerves in the shoulder and the arm, which is a rare disease that causes weakness and pain."
},
{
  "instruction": "Doctor, you're in pain these days, your hands, your fingers, your shoulders, your neck, even your elbow, and you've got a little bit of back pain.",
  "input": "",
  "output": "The symptoms are likely to cause pain in the hands, fingers, neck, elbows, which affects the nerves in the shoulder, and backaches may have something to do with this, or may be a separate problem."
},
{
  "instruction": "Doctor, I'm experiencing back pain and sensory loss. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from chronic neurotritis, which affects the nerves of your shoulders and arms, causing pain, weakness and loss of sense."
},
{
  "instruction": "Doctor, what's the cause of your neck pain?",
  "input": "",
  "output": "It's very likely that it's cytoplasm, which is inflammation of the nerves in the shoulders and the arms."
},
{
  "instruction": "Hi, doctor, I've been experiencing unpredictable menstruation for months. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that it's cancer of the cervix, and it's good to book a pelvic exam as soon as possible, as soon as possible, and a cyclic cytoplasm to determine the cause of irregular menstruation."
},
{
  "instruction": "We're dealing with doctors, menstrual pains, menstrual pains, menstrual menstrual menstrual edema, abdominal edema, what's the problem?",
  "input": "",
  "output": "The symptoms suggest that you may be suffering from endocardial cancer, and it's good to run some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I'm experiencing hip pain, trouble with diet, vaginal secretion, menstrual transition, eczema. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that uterine cancer is in doubt, and we need to run some tests to check the diagnosis and discuss treatment plans."
},
{
  "instruction": "Doctor, I've recently experienced vaginal sensitism, menstrual overload, anorexia intolerance, extracurricular stimulation. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to be uterine cancer, and it's good to get a uterine cytoplasm test as soon as possible to identify the diagnosis."
},
{
  "instruction": "Doctor, you're experiencing unpredictable menstruation, and you seem to have swollen abdomen, so what's the cause?",
  "input": "",
  "output": "It's possible that it's cancer of the cervix, which is a symptom, and it's good to do some additional tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, your breath is pretty, your scissors are pussy, your muscles are swollen, you're ruby, what's the problem?",
  "input": "",
  "output": "It's possible that it's an adrenal gland, which is a disease that causes these symptoms by developing tumors that produce excess hormones in the adrenal glands."
},
{
  "instruction": "Doctor, muscle edema, elbow convulsion or spasm, shortness of breath, back pain, and sharp abdominal pain. Can you tell us what caused these symptoms?",
  "input": "",
  "output": "The symptoms may indicate that it's an adrenal gland, which can cause abdominal muscle edema, which is caused by a tumor in the adrenal glands, and increased hormone production can cause cramps and cramps and respiratory disturbances in the body, and back pain can be the result of this disease."
},
{
  "instruction": "Doctor, I've been down my waist for a while, and I'm not breathing. What's the cause?",
  "input": "",
  "output": "It's possible that it's an adrenal gland, which can cause a variety of symptoms, such as weakness, shortness of breath, which is caused by tumors that grow from adrenal glands."
},
{
  "instruction": "Doctor, there's back pain with puss on the scissors, elbow spasms, cramps, toilets, backaches -- what's the problem?",
  "input": "",
  "output": "You may have a disease called anaphase, which causes a non-arterial tumor in your adrenal glands, which produces an excess of hormones, which can cause a variety of symptoms, including the symptoms that you've described, and you need to do some additional tests to confirm your diagnosis."
},
{
  "instruction": "I'm experiencing symptoms of doctors, backaches, muscle swelling, anxiety, anxiety, shortness of breath. What's wrong with me?",
  "input": "",
  "output": "It's possible that this is an adrenal gland, which is a type of tumor that grows in the adrenal glands, which can cause a lot of symptoms, including the symptoms that you've described."
},
{
  "instruction": "Doctor, cough, throat, difficulty swallowing, sharp abdominal pain continues. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that there is a suspicion of esophagealitis."
},
{
  "instruction": "Doctor, I've been suffering from recent vomiting, stomach pain, and sore throat. What's the problem?",
  "input": "",
  "output": "You're probably suffering from pericardial esophageal esophageal esophageal esophagitis, but you have to do some tests to confirm your diagnosis."
},
{
  "instruction": "Doctor, there's been a lot of sore throats, stomach pains, sharp chest pains, coughs, difficult to swallow.",
  "input": "",
  "output": "The symptoms seem to indicate that hemorrhagicitis is an inflammation of the esophagus, which is caused by the desalination of the urethra."
},
{
  "instruction": "Sir, I've had a lot of pain in my neck lately.",
  "input": "",
  "output": "It could be a sign of the esophageal disease."
},
{
  "instruction": "Doctor, you're experiencing shoulder spasms or tics, knee lumps or sores, wrist pains, sharp abdominal pain and excessive anger.",
  "input": "",
  "output": "There may be gas Gore as a symptom, which is rare but severe bacterial infection affects the muscles and often causes the bacteria to go into open wounds, and it's important to get urgent treatment to prevent further complications."
},
{
  "instruction": "Doctor, we're experiencing shoulder cramps, fatigue, breast pain, wear and pain during pregnancy, and what's the cause of these symptoms?",
  "input": "",
  "output": "Unfortunately, these symptoms may have to do with the gas period, which is a life- threatening bacterial infection, and we need to start treating it immediately so it doesn't spread anymore."
},
{
  "instruction": "Doctor, you can feel a lump or a lump in your knee.",
  "input": "",
  "output": "It's a symptom of the gas Gore, which is a serious bacterial infection that can occur when the Chloridium bacteria infect the wound or the injury."
},
{
  "instruction": "Doctor, you've got a lump in your knee and you've been feeling extremely tired lately. What's the problem?",
  "input": "",
  "output": "There could be gas Gore, a bacterial infection that kills tissue based on the symptoms and produces gas in an infected tissue, which can be very serious, and needs immediate treatment."
},
{
  "instruction": "Good morning, sir, you've recently had a lot of discomfort from vaginal, diaper rashes, skin mask, do you know what the symptoms are?",
  "input": "",
  "output": "Yeah, I think you've got yeast infection, which is a common disease in which yeasts multiply too much in such areas as genital areas and skin wrinkles, so don't worry because they can easily be treated with anticoagulants."
},
{
  "instruction": "Doctor, there's vaginal pain. What's the cause?",
  "input": "",
  "output": "Depending on the symptoms, there could be yeast infections."
},
{
  "instruction": "Doctor, I'm experiencing diaper rashes with hip pain, and I'm pregnant now, and I'm facing some of the problems of pregnancy, and why?",
  "input": "",
  "output": "All symptoms are yeast infections, common mold infections that can happen to anyone, but pregnant women are especially vulnerable, don't worry, because there are treatments that can help you recover."
},
{
  "instruction": "Doctor, we're experiencing vaginal secretions and frequent urination. What's the problem?",
  "input": "",
  "output": "I think there's a yeast infection."
},
{
  "instruction": "Doctor, there's a lot of skin itching. Can you tell me what's causing it?",
  "input": "",
  "output": "I think there's a yeast infection."
},
{
  "instruction": "Good morning, doctor, you have back pain, and sometimes your eyes are acting abnormally, and there's also a ringing sound in your ears.",
  "input": "",
  "output": "Symptoms indicate that there's a possibility of spina bifida, which can cause a wide range of symptoms, such as back pain, vision and back movement because the spine doesn't develop properly before birth."
},
{
  "instruction": "Doctor, I'm experiencing involuntary urination, blood circulation, abnormal eye movement and weakness of the leg.",
  "input": "",
  "output": "The symptoms suggest that you're suffering from spina bifida, or do you have a family history of a neurotolic defect or spina bifida?"
},
{
  "instruction": "Sir, what's the problem with your feet inside and your eyes moving abnormally?",
  "input": "",
  "output": "The symptoms may indicate that there's a congenital defect called spina bifida, which affects the development of the spine and the nervous system."
},
{
  "instruction": "Hi, doctor, you've got skin lesions on your back, and you've got infertile urination all the time, so what's the problem?",
  "input": "",
  "output": "The spina bifida is a disease that doesn't develop properly in the spine and spinal cord, which can cause skin lesions, backaches, bladder control problems, and it's good to run some tests to make sure you're diagnosed."
},
{
  "instruction": "There are symptoms of doctors, memory problems, headaches, abnormal eye movement, weak leg strength, and a little secretion in the neck.",
  "input": "",
  "output": "The symptoms suggest that you're suffering from a congenital defect that affects spinal and spinal development, which can cause a variety of symptoms, including the symptoms that you've described, and it's good to run some tests to identify the diagnosis and determine the level of the condition."
},
{
  "instruction": "Doctor, there's been a breakdown in speech recently, and what's the cause?",
  "input": "",
  "output": "The symptoms are that it's possible that Germany is one of the drugs."
},
{
  "instruction": "Doctor, I went through delusions and hallucinations, and I got confused, and I got very sleepy, and I felt my whole muscle stiff, and I almost passed out yesterday.",
  "input": "",
  "output": "The symptoms seem to indicate that you're experiencing drug addiction, and it's important to evaluate the drugs that you're currently taking, and to adjust them to prevent further complications, to make sure that you're not taking drugs that can interact with each other or cause these symptoms."
},
{
  "instruction": "Doctor, I've recently been in a state of shock and delusion, and I've recently had allergic reactions, and I've been abusing alcohol a lot.",
  "input": "",
  "output": "It's important to stop because alcohol abuse can make things worse, and it's good to get some tests and start treating them as soon as possible."
},
{
  "instruction": "Sir, I've been having strange symptoms recently, I've been drinking more than usual, I've been having delusions and hallucinations, and I've been able to get more confused, and I've just passed out of my job.",
  "input": "",
  "output": "I think you're experiencing drug addiction because some drugs can be dangerous if you mix them with alcohol, so you have to let me know what drug you're taking, and I'll do the best you can with some tests."
},
{
  "instruction": "Doctor, I'm feeling so down these days, my body is stiff and I can't speak very well.",
  "input": "",
  "output": "There are drug addiction symptoms, which are caused by the medication, which can lead to depression or psychiatric symptoms, stiffness in the body, poor speech, and you have to stop taking the drug immediately and call the emergency services for treatment."
},
{
  "instruction": "Sir, I've been experiencing abdominal pain for quite some time, and why?",
  "input": "",
  "output": "The symptoms seem to indicate that you have an alcoholic liver disease. Have you ever had excessive drinking?"
},
{
  "instruction": "Doctor, there's recently been a mix of blood in the stool, and why?",
  "input": "",
  "output": "Depending on the symptoms, there could be alcohol-generated liver disease."
},
{
  "instruction": "Doctor, you have a kidney mass and a sharp abdominal pain.",
  "input": "",
  "output": "Symptoms suggest that you may have an alcoholic liver disease."
},
{
  "instruction": "Doctor, I'm experiencing abdominal pain, kidney sores, blood vomiting, abdominal suffocation, sharp abdominal pain.",
  "input": "",
  "output": "From your symptoms, you're more likely to have an alcoholic liver disease."
},
{
  "instruction": "Doctors, recent diarrhea, weight gain, kidney mass, sharp abdominal pain -- what's the problem?",
  "input": "",
  "output": "The symptoms are likely to lead to an alcohol liver disease, and it's good to run some tests to check the diagnosis and discuss treatment options."
},
{
  "instruction": "Doctor, I'm experiencing terminal swelling and shortness of focus and shortness of breath. Can you tell me what's wrong?",
  "input": "",
  "output": "The symptoms are likely to be malignant high blood pressure, which is very high in blood pressure, which can damage the organs, and it's good to get medical attention right away."
},
{
  "instruction": "Doctor, I'm experiencing a recent seizure. Can you tell me what's going on?",
  "input": "",
  "output": "The symptoms seem to indicate a severe form of high blood pressure, malignant hypertension."
},
{
  "instruction": "Doctor, I've been experiencing some symptoms recently, and I've had some very depressing and mental thoughts, and I've had seizures a few weeks ago, and there's a sharp pain in my chest that's been going on.",
  "input": "",
  "output": "Malignant high blood pressure is a serious form of high blood pressure that can cause complications in many organs in the body, and it's good to check the diagnosis and run some tests to start treatment as soon as possible."
},
{
  "instruction": "Doctor, I've lost touch with my fingers and toes, and why?",
  "input": "",
  "output": "Symptoms can lead to a disease called malignant high blood pressure, which can lead to severe forms of high blood pressure, which can cause organ damage and loss of limbs."
},
{
  "instruction": "What problem do you think there is when you're experiencing a doctor's headache, a headache, a telophase, seizures, and focus edema?",
  "input": "",
  "output": "It's possible that you're suffering from malignant high blood pressure as a symptom."
},
{
  "instruction": "Sir, there's side pain and lower abdominal pain, and there's blood in the stool, and there's a sharp, burning abdominal pain.",
  "input": "",
  "output": "The symptoms seem to indicate that there's an inflammation of the small sacs or crabs that occur in the hydrant lining."
},
{
  "instruction": "Doctor, sharp abdominal pain, side pain, chills. What's the disease?",
  "input": "",
  "output": "The symptoms seem to make it suspicious."
},
{
  "instruction": "Doctor, you've got diarrhea and burning abdominal pain, and recently you've found that there's blood mixed in your throat, and what's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that there's an inflammation or infection in the small pockets that form along the wall of the bowel."
},
{
  "instruction": "Doctor, I've got nausea, I've got abdominal pain, I've got chills and pains on my side, and what's wrong with me?",
  "input": "",
  "output": "Yes, I think the symptoms indicate that you have vertigo."
},
{
  "instruction": "Doctor, you've got a fever and a pain in your upper and lower abdomen. There's a chill. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from gastritis, which is an inflammation or infection in your small pocket or pocket on your colon wall."
},
{
  "instruction": "Doctor, do you know what's causing the weakness in your elbows and wrists these days?",
  "input": "",
  "output": "The symptoms are likely to lead to Moyamaya's disease, a rare disease affecting the blood vessels of the brain, which can cause a variety of symptoms, including limb and limb weakness, which we would like to do some tests and scans to make sure that we have a treatment plan."
},
{
  "instruction": "Doctor, you're experiencing strange sensations like sensory pain and elbow spasms or tics, and you feel like your eyelids are getting itchy and your elbows are getting weaker.",
  "input": "",
  "output": "Yes, symptoms may indicate that Moyamaya's disease is a rare disease that narrows blood vessels to the brain, causing loss of sense, weakness, and convulsions in the area."
},
{
  "instruction": "Sir, what's the problem with your recent eyelids, your excessive growth, your headache?",
  "input": "",
  "output": "The symptoms suggest that you have Moyamoya disease."
},
{
  "instruction": "Sir, you've had a lot of headaches lately, and your right eyelids are itchy, and you're biting a lot of nails.",
  "input": "",
  "output": "The symptoms suggest that you have Moyamoya disease."
},
{
  "instruction": "Doctor, I'm experiencing a weakness of elbow, eyelids, loss of sense, overgrowth, seizures.",
  "input": "",
  "output": "Moyamoya disease is a rare disease that affects the blood vessels of the brain, reducing the supply of blood and oxygen, causing various neurological symptoms."
},
{
  "instruction": "Doctor, I've been really dizzy and really sick of my brain lately, and I feel hot all the time, so what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from a fever loss."
},
{
  "instruction": "Doctor, I'm so sick today, it's disgusting and dizzy.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from heat fatigue."
},
{
  "instruction": "Doctor, I've been very sick lately, and I have nausea and horrible headaches.",
  "input": "",
  "output": "Have you been exposed to high temperatures or done too much?"
},
{
  "instruction": "Doctor, I've recently experienced a really hot, sharp chest pain, and I've also had a lot of fluid, a lot of sweat, and a lot of breath.",
  "input": "",
  "output": "Hemorrhagics can occur when the body is overheated and perspired and the body loses too much body fluids."
},
{
  "instruction": "Doctor, what's the cause of your recent vomiting symptoms?",
  "input": "",
  "output": "The symptoms seem to be caused by heat fatigue."
},
{
  "instruction": "Doctor, I've been feeling very depressed lately, and sometimes I hear voices that no one else can hear, and I've been using drugs more often, and recently I've been very scared and paranoid, and what's wrong with me?",
  "input": "",
  "output": "It can include depression or psychiatric symptoms, drug abuse, fear and phobia, and hostile behavior."
},
{
  "instruction": "Doctor, I've been taking drugs recently, and I've started experiencing strange things, for example, seeing and hearing things that don't exist.",
  "input": "",
  "output": "Based on what God has explained, it is possible that you are experiencing symptoms of psychiatric disorders that can be caused or aggravated by drug abuse."
},
{
  "instruction": "Doctor, I've recently experienced fear and phobia, and I've always had a very nervous and nervous feeling that I can't sleep.",
  "input": "",
  "output": "It's possible that you have mental illness when you put it off as a symptom."
},
{
  "instruction": "Doctor, I've recently experienced insomnia, fear, phobia, and I'm always anxious and nervous, and sometimes I behave very hostile and hysterical, and you know what's wrong with me?",
  "input": "",
  "output": "Mental illness is a mental disorder that can lead to delusions, hallucinations, confusion of thinking, and it's also a symptom of fear and phobia, anxiety and anxiety and behavior changes."
},
{
  "instruction": "Sir, I've recently experienced delusions and hallucinations, and I can't sleep at night, and I feel depressed, so what's wrong with me?",
  "input": "",
  "output": "Mental illness is a condition of delusions, hallucinations and difficulty in sleeping due to a mental disorder in the process of thinking, and I recommend that you take it for a proper diagnosis and treatment plan."
},
{
  "instruction": "Hello, doctor, your back is weakened, your hands and fingers are swollen, you're faint, you're feeling heat and cold, and what's going on with me?",
  "input": "",
  "output": "It's very likely that you have frostbite because of your symptoms, and you're going to come to the hospital, and you're going to have it tested, and you're going to have it treated properly."
},
{
  "instruction": "Doctor, I've recently found that you've been biting your nails in excess of heat and cold, and you've had back pain, and you've passed out before, and you've found your hands and fingers swelling, and what's the problem?",
  "input": "",
  "output": "It's likely to be frostbite, which can expose your skin and base tissue to cold, cause injury or severe complications, and it's good to be treated immediately to prevent further damage."
},
{
  "instruction": "Doctor, you're not strong, you're weak, you're feeling heat, you're feeling cold, what's the problem?",
  "input": "",
  "output": "Has it been in cold weather recently, or has it been exposed to extreme cold temperatures for long periods?"
},
{
  "instruction": "Sir, your hands and fingers are too swollen and painful.",
  "input": "",
  "output": "The symptoms indicate that frostbite may have occurred. Have you been exposed to extremely low temperatures for long periods of time recently?"
},
{
  "instruction": "Doctor, there's an abnormal chest pain of a very sharp feeling.",
  "input": "",
  "output": "Have you ever been exposed to cold weather lately? Patient:"
},
{
  "instruction": "Doctor, I have a skin that looks abnormal in my penis.",
  "input": "",
  "output": "It's possible that there's a mild defibrillation from the symptoms."
},
{
  "instruction": "Sir, I've had a lot of urination lately. Do you want to know what caused it?",
  "input": "",
  "output": "There's the possibility that there's angina by the symptoms, which can cause problems not only with esophageal discharge, but also with urinary function."
},
{
  "instruction": "Doctor, you've got a lump in your penis, and you've got a pain in your groin, and you've got a bad skin, and you've got more urine than usual, and you've got a little penis secretion.",
  "input": "",
  "output": "I think you've got deciduous dystrophy."
},
{
  "instruction": "Doctor, I've recently discovered that there's a lot of sores in the chest, and there's a lot of bruises and skin in the penis, and it's like there's always a drop in the erection, and it's always a redness in the penis, and what's the cause of all these symptoms?",
  "input": "",
  "output": "When you put it off as a symptom, it's the result of the scrotum dystrophy."
},
{
  "instruction": "Doctor, my penis has a penis and it's a little bit red. What is it?",
  "input": "",
  "output": "Maybe it's deciduous dystrophy."
},
{
  "instruction": "Doctor, you've recently had sharp chest pains, excessive anger, headaches.",
  "input": "",
  "output": "The symptoms seem to be the result of smoking or addiction to tobacco."
},
{
  "instruction": "Doctor, you've been coughing a lot lately, and it's like you're getting a lot of anger, and if you take a deep breath, it hurts your heart, and what's the cause of these symptoms?",
  "input": "",
  "output": "These symptoms can be caused by the stimulation and damage that smoking or cigarette intake can cause to the respiratory system and overall health. Have you ever smoked or used tobacco products?"
},
{
  "instruction": "Doctor, I've had a sharp chest pain in the last few days, and why?",
  "input": "",
  "output": "Do you smoke or use tobacco products? Woman: Yeah, I'm smoking about a pack a day."
},
{
  "instruction": "Sir, I've been vomiting blood lately. Why?",
  "input": "",
  "output": "Do you smoke or eat tobacco products? woman:"
},
{
  "instruction": "Doctor, I've been experiencing constant headaches, excessive anger, sinus failure, can you tell me what's wrong?",
  "input": "",
  "output": "I think you're suffering from smoking or addiction. Have you smoked recently or used tobacco products recently?"
},
{
  "instruction": "Doctor, wrist pain, back pain, arm pain. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that in one of those areas, there's a base or tension, and you need physical testing and video imaging to confirm your diagnosis."
},
{
  "instruction": "Doctor, knee pain, headache, back pain, shoulder pain all at once.",
  "input": "",
  "output": "The symptoms seem to indicate that you're a little more than one of your joints or one of your muscles, or you're nervous."
},
{
  "instruction": "Teacher, ankle pain, leg pain, back pain, neck pain, back pain continues.",
  "input": "",
  "output": "Have you ever missed an ankle or pulled a leg or a back muscle recently?"
},
{
  "instruction": "Doctor, I have a headache.",
  "input": "",
  "output": "Have you had your back or any tension lately? Patient:"
},
{
  "instruction": "We're experiencing a doctor, aerobic pain, sinus pain, movement problems, abnormal involuntary movements. Do you know what causes these symptoms?",
  "input": "",
  "output": "The symptoms suggest that you're experiencing an involuntary tremor, which can lead to an involuntary shaking or shaking of the arm, leg, head or voice."
},
{
  "instruction": "Doctor, I had a slight loss of feeling in my arm, and I felt stiff and cold, and I felt dizzy and scared and phobic, so can you tell me what's wrong?",
  "input": "",
  "output": "The symptoms seem to indicate that you have chronic tremors, which are neurological disorders that cause some part of the body, especially arm and hand involuntary tremors or tremors."
},
{
  "instruction": "Hi, doctor, I've been having strange symptoms lately, and my memory seems to be getting worse, and my arm feels stiff and firm.",
  "input": "",
  "output": "This neurological disorder can affect memory function and muscle control, causing stiffness and tremor in the arm. You have to arrange an appointment with a neurologist for additional evaluation and treatment options."
},
{
  "instruction": "Hi, doctor, I've been experiencing fear and phobia with a couple of movement problems, and I've got a stiff, tight arm and a little muscle pain, and I've found abnormal inertity.",
  "input": "",
  "output": "I think you're experiencing the symptoms of a neurologic disorder that causes involuntary tremors or tremors in one part of the body, or in a number of other parts of the body."
},
{
  "instruction": "Doctor, I've been having strange symptoms recently: memory disorder, fear and fear, stiffness in the arm, stiffness in the arm, muscle pain.",
  "input": "",
  "output": "The symptoms seem to indicate that there's a chronic tremor, which is a neurological disorder that causes certain parts of the body, usually involuntary shaking of the hand and the head, and it can also cause other symptoms that you're talking about."
},
{
  "instruction": "Doctor, I feel facial pain and deafness in my ears.",
  "input": "",
  "output": "There seems to be an open wound in the ear."
},
{
  "instruction": "Doctor, you've got a memory problem with a wound in your ear, and why?",
  "input": "",
  "output": "The damage in the ear can cause the infection to spread to the brain and cause memory problems, and you can have a disease called encephalitis."
},
{
  "instruction": "Doctor, I feel like I'm having a hearing block, and I feel like I'm bleeding a little bit, and I'm hearing a ringing sound in my ear for a few days.",
  "input": "",
  "output": "The symptoms that you're talking about are the same as this disease: you have to prescribe antibiotics to prevent infection, you have to keep your ears clean and dry to promote healing, and it's important to keep your ears dry until the wound is completely healed."
},
{
  "instruction": "Doctor, there's some weird symptoms in your ear, such as memory impairment, fluid, deafness, and deafness.",
  "input": "",
  "output": "The symptoms may indicate that I have an infection, which can cause an external ear injury, which can lead to the symptoms that I'm currently experiencing."
},
{
  "instruction": "Doctor, there's a constant feeling of ringing in the ear, ear pain, deafness in the eye, a little bit of symptoms in the eye.",
  "input": "",
  "output": "The symptoms seem to indicate that there's a scar in the ear that can cause discomfort and pain."
},
{
  "instruction": "Doctor, nosepower, red inside and out of the nose. What's the problem?",
  "input": "",
  "output": "There's a foreign substance in the nose that can cause these symptoms."
},
{
  "instruction": "Doctor, it's getting red inside and out of my nose, and it's been bothering me for days.",
  "input": "",
  "output": "I think there's a foreign substance in my nose. Have you ever put something in my nose recently? Patient:"
},
{
  "instruction": "Doctor, there's been a persistent coughing disorder for a while, and what's the problem?",
  "input": "",
  "output": "There's a foreign substance in your nose that seems to be causing your nose blockage and your ray cough, and you need to be tested to get rid of it."
},
{
  "instruction": "Doctor, your nose is getting red and you're coughing with scissors and nosebleeds.",
  "input": "",
  "output": "No, these symptoms aren't common cold symptoms, but they're more likely to cause a foreign substance in the nose that's causing the corpuscle and bleeding."
},
{
  "instruction": "Doctor, you know what's causing it?",
  "input": "",
  "output": "It looks like there's a foreign substance in your nose that causes these symptoms, and you have to look at the foreign material and get rid of it if it's necessary."
},
{
  "instruction": "Hi, I'm experiencing a long period of menstruation, accompanied by vaginal sensitism, secretions, blood clots, and what's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that there is a special menstrual pain."
},
{
  "instruction": "Doctor, I'm experiencing a lot of pain during my period, and I think it's going to last longer than I normally do, and I'm bleeding and I'm having hip pain, and what's the problem?",
  "input": "",
  "output": "The menstrual pain is a condition in which women experience severe bleeding and pelvic pain, before or during menstrual periods."
},
{
  "instruction": "Doctor, I've been having an unpredictable menstrual period for a while, and I've had vaginal edema, and my period lasts more abnormally than before, and I've had problems that I haven't fully menstruated for months.",
  "input": "",
  "output": "The symptoms seem to indicate that you have a condition called menstrual pain, which is called menstrual pain."
},
{
  "instruction": "Sir, I'm experiencing long, sharp abdominal pain, and I'm now having my period every two or three months.",
  "input": "",
  "output": "The symptoms seem to indicate that there is a special pain cycle called menstrual pain."
},
{
  "instruction": "Sir, I've been suffering from lower abdominal pain, menstrual menstrual failure, menstrual excess, thrombosis, and so on during my period, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate that you're experiencing multiple menstrual pains."
},
{
  "instruction": "Doctor, it's been a while since you got a fever, and your nose got stuck, and your nose got hard to swallow, and you had a temper problem, so what's the problem?",
  "input": "",
  "output": "It's not likely to be a common cold or a flu, it's possible to be a genetic disorder called Down syndrome, characterized by intellectual disability, unique facial characteristics, and many other health problems, and I want to get some diagnostics."
},
{
  "instruction": "Doctor, cough, loss of appetite, apnea, cold water in the ear, hard to swallow.",
  "input": "",
  "output": "The symptoms seem to indicate Down's syndrome."
},
{
  "instruction": "Doctor, it's hard to swallow and talk these days, and your nose is blocked, and your appetite seems to fail, and your baby's not very good at feeding.",
  "input": "",
  "output": "People with Down's syndrome often have difficulty swallowing, speaking, and nose strength."
},
{
  "instruction": "Doctor, I have a problem with my temper, and my baby's having trouble with breastfeeding, so can you tell me what's causing it?",
  "input": "",
  "output": "As a result of the symptoms you've described, it's possible that you or your baby are suffering from Down syndrome. It's best to get additional tests and evaluations for an accurate diagnosis."
},
{
  "instruction": "Doctor, I'm having seizures, swallowing, difficulty speaking, infant feeding, what's the problem?",
  "input": "",
  "output": "The symptoms can be affected by Down's syndrome, which requires additional tests to confirm the diagnosis."
},
{
  "instruction": "Doctor, I'm having a sharp abdominal pain and urination problem, and I'm having a very frequent period and I'm thinking about infertility.",
  "input": "",
  "output": "Your symptoms seem to indicate that you're struggling with a specific period of menstrual illness."
},
{
  "instruction": "Doctor, there's pain in the breast, there's soreness in the breast, and there's so much tension.",
  "input": "",
  "output": "Symptoms indicate that it's possible that it's a bulimic menstrual period."
},
{
  "instruction": "Doctor, I'm experiencing infertility, sharp abdominal pain, vaginal secretions.",
  "input": "",
  "output": "The symptoms that God's talking about indicate that you're suffering from multiple menstrual conditions."
},
{
  "instruction": "Hi doctor, I'm experiencing unpredictable menstrual pains, breast pains and pain, and what's the cause?",
  "input": "",
  "output": "I think you're experiencing a specific menstrual period."
},
{
  "instruction": "Sir, in the last few months, I've felt very low menstrual levels, and why?",
  "input": "",
  "output": "The symptoms seem to indicate that you're experiencing unusual menstrual periods."
},
{
  "instruction": "Doctor, I've been breathing and coughing a lot lately. What's wrong?",
  "input": "",
  "output": "The symptoms may indicate that the air leaks into the space between the lungs and the chest wall, so that the lungs collapse and there's a pneumothorax that causes difficulty in breathing and coughing."
},
{
  "instruction": "Sir, there's pain in the shoulder.",
  "input": "",
  "output": "Have you ever had a sharp, piercing chest pain suddenly started when chest pain, shortness of breath, or breathing?"
},
{
  "instruction": "Sir, it's hard to breathe and your ribs hurt, and there's a spade and there's a pain in your shoulder and side.",
  "input": "",
  "output": "It's possible that the symptoms are the pericardium that breaks the lungs."
},
{
  "instruction": "Good morning, sir, with coughs, backaches, shoulder pain, sharp chest pain.",
  "input": "",
  "output": "There's a possibility that you're having a shortness of breath because you've acknowledged the symptoms and the abuse of drugs."
},
{
  "instruction": "Hi, doctor, I've been having some pain in my arm for a while, and it really bothers me.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from Dqueuin's disease."
},
{
  "instruction": "Doctor, I've got some pain in my shoulder. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that you may have Dqueurven's disease."
},
{
  "instruction": "Hi, doctor, there's pain in your arm, stiffness in your wrist, and what's the cause?",
  "input": "",
  "output": "It's a disease that causes pain and stiffness due to inflammation of the thumb of the wrist."
},
{
  "instruction": "Hi, doctor, arm pain, hand and finger pain, abnormal involuntary movement, wrist pain.",
  "input": "",
  "output": "It seems to be a symptom that affects the thumb cord in the wrist."
},
{
  "instruction": "Hi, doctor, you've recently had telophase in your arms and severe pain in your arms and wrists, and why is that?",
  "input": "",
  "output": "The symptoms suggest that Dqueberven's disease is suspect."
},
{
  "instruction": "Sir, with hip pain, I'm having stiff, warm muscles, and what's the reason?",
  "input": "",
  "output": "It looks like there's a fracture in the spine, and you need an X-ray to confirm it."
},
{
  "instruction": "Doctor, what's wrong with the pain in the bone and the lack of strength in the arm?",
  "input": "",
  "output": "It's important to take X-rays to check the diagnosis and determine the severity of the fracture, and then evaluate the arm function to see if there's any nerve damage."
},
{
  "instruction": "Doctor, there are symptoms of stiffness in your hands or fingers. What's the possible cause?",
  "input": "",
  "output": "Could be a spinal fracture. Did you get hurt or fall before?"
},
{
  "instruction": "Doctor, I need you to tell me what's wrong with my legs, my hip, my neck.",
  "input": "",
  "output": "The symptoms may indicate a spinal fracture, and it's important to test the diagnosis through a video test and start treating it as soon as possible."
},
{
  "instruction": "Doctor, I've recently had movement problems and hip failure, and I've also had a sense of muscle buildup and hip pain, and what could be the problem?",
  "input": "",
  "output": "The symptoms are very likely to cause spinal fractures, which can lead to movement problems, hip weakness, muscle rigidity, stress, pelvic pain, which we need to check with X-rays, but in the meantime, it's good to avoid activities that can make the symptoms worse."
},
{
  "instruction": "Doctor, I've been a drug addict for a few years, but recently, I've had a change in my health, and I've always had a lot of fatigue, weight loss, skin rashes, and what's the problem?",
  "input": "",
  "output": "If you look at your symptoms and your drug abuse history, you're likely to be infected with HlV, a viral infection that attacks your immune system, and it's good to get tested as soon as possible to check your diagnosis and start treatment if necessary."
},
{
  "instruction": "Doctor, you have nightmares and your mouth hurts a lot. What's the problem?",
  "input": "",
  "output": "These symptoms suggest that you may have been infected with a human immune deficiency virus."
},
{
  "instruction": "Doctor, you've had a recent nightmare and you've got pain in your mouth. What is it?",
  "input": "",
  "output": "It's very likely that you're experiencing two of the symptoms of a human immunodeficiency virus infection."
},
{
  "instruction": "Doctor, what causes fear and phobia?",
  "input": "",
  "output": "Phobias and fear may be caused by a number of causes, but in some cases they may be symptoms of a human immunodeficiency virus infection (HIV). Have you been tested recently for HlV?"
},
{
  "instruction": "Doctor, you're feverish, your ass is stiff, you're cold, you're snowy, what's the problem?",
  "input": "",
  "output": "It's possible that you're suffering from hypothyroiditis, which is usually fever, which is swollen, but your hip is stiff, it's cold, it's hard, it's hard, it's hard, it's hard, it's hard, it's hard, it's hard, it's hard, it's hard, it's hard, it's hard, it's hard, it's hard, it's hard, it's hard, it's hard, it's hard, it's hard, it's hard, it's hard, it's hard, it's hard, it's hard, it's hard, it's hard, it's hard, it's hard to go down, it's hard, it's hard to go down, it's hard to go down, it's hard, it's hard to go down, it's hard to go down, it's hard to go down, it's hard to go down."
},
{
  "instruction": "Doctor, you're experiencing the same symptoms as the flu that bite your nails, and you've got a fever, and what's the cause?",
  "input": "",
  "output": "There's the possibility that you're suffering from hypotonic substitis, if you put it off as a symptom."
},
{
  "instruction": "Doctor, neck, shoulder, jaw swelling, flu-like symptoms, what's the problem?",
  "input": "",
  "output": "I think he's got something to look at. Have you had contact with someone who's got something to look at recently?"
},
{
  "instruction": "Hi, doctor, there's a sign that your nails are tickling and your ears are getting sick and you know what's causing these symptoms?",
  "input": "",
  "output": "There's a possibility that it's an epidemic of substrateitis, and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, there's pain in the ear, and I have a stiff, warm ass, and what's the problem?",
  "input": "",
  "output": "It's a viral infection that affects your salivary glands and can cause pain in your ears and ass stiffness or stress, and you have to do some tests to confirm your diagnosis."
},
{
  "instruction": "Doctor, you've recently had a lot of nosebleeds and strange eyes, and your neck pains aren't going away, so what's the problem?",
  "input": "",
  "output": "The symptoms suggest that you may have had a subarachnoid hemorrhage, which is a form of bleeding that occurs between the brain and the tissue that covers the brain, which can cause severe headaches, neck pain, and seizures."
},
{
  "instruction": "Doctor, I'm experiencing bleeding from my ears, weakness, neck pain, nosebleed, dizziness.",
  "input": "",
  "output": "Symptoms indicate that sub-arachnoid bleeding is a form of stroke caused by bleeding in the area between the brain and the tissue covering the brain."
},
{
  "instruction": "Doctor, I'm worried that you've had a lot of nosebleeds lately.",
  "input": "",
  "output": "It's actually caused by subarachnoid bleeding, and it's important to schedule some diagnostic tests to make sure it's subarachnoid bleeding and provide the right treatment."
},
{
  "instruction": "Doctor, I've been vomiting a lot lately. Do you know what caused it?",
  "input": "",
  "output": "It could be sub-arachnoid bleeding, which is a serious condition that requires immediate treatment to avoid complications."
},
{
  "instruction": "Doctor, I've been dizzy lately.",
  "input": "",
  "output": "Do you have severe headaches or stiff neck symptoms? Patient: No, not really."
},
{
  "instruction": "Hi doctor, I've been experiencing a number of unusual symptoms recently: stiff or salty hips, elbow spasms or cramps, pain during pregnancy, loss of elbow strength and biting a lot of nails.",
  "input": "",
  "output": "The symptoms suggest that it's possible to be an AFLP, a rare but serious liver disease that occurs during the third stage of pregnancy, and it's important to be treated immediately to prevent complications between the mother and the baby."
},
{
  "instruction": "I'm experiencing a doctor, a sharp abdominal pain, elbow cramps or tics, eyelids and elbows.",
  "input": "",
  "output": "The symptoms suggest that there's an AFLP, which is a rare but potentially serious disease that can occur during the third stage of pregnancy, and it's good to run a few tests to check the diagnosis and start treatment immediately."
},
{
  "instruction": "Sir, I feel like my eyelids are moving abnormally, and my eyes are swelling, and I have a spot in my vision, and I feel like there's a foreign substance in my eye.",
  "input": "",
  "output": "The symptoms seem to indicate that there's an ophthalmography, a condition that causes eyelids to go back to the outside, and to cause irritation and discomfort to the eyes, which can be corrected with some treatment options."
},
{
  "instruction": "Doctor, it's like your eyes arey and your eyelids are acting abnormally, and you also feel pain in your eyes and a sense of reason.",
  "input": "",
  "output": "The symptoms suggest that an eyelid has an external eyelid that goes outward, which can cause irritation, pain and injury to the eye by friction with the cornea. We need to do a thorough test to identify the diagnosis and recommend treatment options."
},
{
  "instruction": "Doctor, I've been experiencing certain symptoms recently: tears and swelling in my eyes, lesions and rashes in my eyelids, and sometimes spots and clouds in my eyes.",
  "input": "",
  "output": "I think you're suffering from an external ophthalmitis, which is a condition in which the eyelids lie down in your eyes, causing problems in your tear glands and your cornea."
},
{
  "instruction": "Doctor, there's rashes in the eyelids, swelling eyes, and it's itching. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there is an externalocardial disease."
},
{
  "instruction": "Doctor, you've got lumps in your breast and skin pains with acne, and why?",
  "input": "",
  "output": "In the case of symptoms, there's usually a condition called edema, which is caused by a painful mass known as abscess or cysts, which is similar to acne or acne, but can be much worse."
},
{
  "instruction": "Doctor, I found strange lumps and skin lesions in my ear. What's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that there's a Celtic scar."
},
{
  "instruction": "Sir, there's a lump in your ear that feels like a little bump.",
  "input": "",
  "output": "The symptoms suggest that the ear has a keloid scar."
},
{
  "instruction": "Sir, I'm worried that there's a lump in my ear and the skin grows.",
  "input": "",
  "output": "The symptoms suggest that there's a Celtic scar."
},
{
  "instruction": "I'm experiencing skin pain, acne, it's got new skin growth, and I've found lumps in my breast.",
  "input": "",
  "output": "Symptoms can lead to a disease called non-repair scarring."
},
{
  "instruction": "Doctor, after you take your dairy products, you're getting convulsions, cramps, headaches, sharp abdominal pain, what's the problem?",
  "input": "",
  "output": "The symptoms can lead to lactose intolerance, which occurs when the body cannot digest lactose, which is the sugar found in milk and dairy products."
},
{
  "instruction": "I'm experiencing this kind of abdominal pain, the doctor, the choroid, the headache, the muscle pain, the burning pain, and a little bit of convulsions, and you know what's causing it?",
  "input": "",
  "output": "The symptoms seem to indicate that you have lactose intolerance, which means that the body can cause the symptoms that you've described because you can't properly digest lactose, the sugar in milk and dairy products."
},
{
  "instruction": "Doctor, there's been recent weight gain, diarrhea and headaches. What are the symptoms?",
  "input": "",
  "output": "Your symptoms may indicate lactose intolerance. Have you eaten dairy recently?"
},
{
  "instruction": "Doctor, you're experiencing burning abdominal pain, muscle pain, headache, swelling, weight gain, do you know what causes these symptoms?",
  "input": "",
  "output": "These symptoms may be caused by lactose intolerance, which is a sugar in milk and other dairy products, which is difficult for the body to digest."
},
{
  "instruction": "Doctor, I'm experiencing sharp abdominal pain, burning abdominal pain, cramps, cramps, headaches, weight gain.",
  "input": "",
  "output": "The symptoms seem to indicate that you have lactose intolerance."
},
{
  "instruction": "Hi, doctor. I'm having trouble with my ears, and my ears are swollen red, and I can't hear them properly, and I hear abnormal breath sounds, and I feel my nose is blocked.",
  "input": "",
  "output": "The symptoms seem to indicate that there is a malfunction in the function of the Eustaki tube."
},
{
  "instruction": "Hi, sir, there are some symptoms that I'm worried about.",
  "input": "",
  "output": "So tell me what you're going through. Patient: the amygdala seems to be swollen and red, and it seems to be allergic, and the ear pain doesn't seem to go away."
},
{
  "instruction": "Doctor, I can't hear properly. I think I've lost my hearing.",
  "input": "",
  "output": "It may be the cause of a Utakio malfunction."
},
{
  "instruction": "Sir, I recently had a problem with my ear, and I think there's a constant ringing sound in my ear, and I think there's a fluid in my ear.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from an allergic reaction or swelling or redness of the amygdala?"
},
{
  "instruction": "Doctor, I've had a sense of deafness for days, and what's the cause?",
  "input": "",
  "output": "You're experiencing a disorder that causes pressure and discomfort in your ear because of a tube that connects the middle ear to the neck."
},
{
  "instruction": "Doctor, you have abdominal pain in your appetite and vomiting, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms are likely to indicate that it's appendicitis."
},
{
  "instruction": "Doctor, you've been getting nauseous lately and you've got pain in your right abdomen.",
  "input": "",
  "output": "The symptoms could be appendicitis."
},
{
  "instruction": "Doctor, I've been very sick for the last few days, and I've got a lot of nausea and a lot of appetites, and I'm really troubled by the sharp pain in my lower abdomen.",
  "input": "",
  "output": "I'd like to run some tests to confirm this, but if you don't treat appendicitis, you have to act quickly, because it can be life threatening."
},
{
  "instruction": "Sir, I have abdominal pain, and it's been bothering me for days, and I don't know what's causing it.",
  "input": "",
  "output": "It's possible that the symptoms are appendicitis, and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I'm experiencing abdominal pain, nausea, loss of appetite, burning stomach pain.",
  "input": "",
  "output": "The symptoms suggest that appendicitis is a factor that might require further testing, but that's a possible diagnosis."
},
{
  "instruction": "Doctor, you're experiencing muscle spasms, building and spasms with involuntary urination.",
  "input": "",
  "output": "The symptoms suggest that you have Graves' disease."
},
{
  "instruction": "Doctor, I've been sweating a lot lately.",
  "input": "",
  "output": "The symptoms suggest that Graves' disease is suspect."
},
{
  "instruction": "Doctor, we're experiencing abnormally involuntary movements, feet or toes, nausea, nausea. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to be Graves' disease, a autoimmune disease that causes a variety of symptoms, including the symptoms that the thyroid produces so much thyroid hormone."
},
{
  "instruction": "Doctor, I'm experiencing aggravation, abnormally involuntary movements, involuntary urination, and what's the problem?",
  "input": "",
  "output": "It's possible that this is Graves' disease, and you have to run some tests to make sure you're diagnosed."
},
{
  "instruction": "There are many symptoms of doctors, blood loss, muscle spasms, involuntary urination, dizziness, weight gain, and what's the cause?",
  "input": "",
  "output": "This autoimmune disease is known to cause a number of symptoms, including muscle spasms, involuntary urinarysis, dizziness, weight gain, and blood loss."
},
{
  "instruction": "Doctor, I'm feeling really nervous and nervous these days, and I'm feeling excessive anger, muscle swelling, back weakness, depression, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from a pathological disorder, which requires additional tests to confirm this diagnosis."
},
{
  "instruction": "I'm feeling a lot depressed these days, and I feel like I'm depressed, and I feel like I'm at the lowest point in my life, and I get puss in my urine, and I get spasms and spasms in my elbows.",
  "input": "",
  "output": "You're likely to be depressed by your symptoms, but you're probably suffering from a pathological disorder, and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Sir, I'm feeling so down these days, and I feel like I'm at the bottom, and my muscles are swelling for no reason, and I'm experiencing strange thoughts and experiences that don't really seem to be happening.",
  "input": "",
  "output": "From your symptoms, I think you're suffering from a pathological disorder that can lead to a sense of separation from reality, depression, distorted physical perception, hallucinations and delusions."
},
{
  "instruction": "Sir, I have a problem with memory, and sometimes it's easy to forget, and what do you think is the problem?",
  "input": "",
  "output": "It's possible, based on what God says, that you're experiencing the symptoms of a pathological disorder, which, above all, can cause memory problems."
},
{
  "instruction": "Doctor, there's puss in the urine, weakness of the waist, swelling of the muscles, weakness of the waist. What's the problem?",
  "input": "",
  "output": "It's possible that you're suffering from a pathological disorder, but urine pus, back weakness and muscle swelling are not typical of this disease, and it's good to get some additional tests to understand the underlying cause of these symptoms."
},
{
  "instruction": "Doctor, your jaw is swollen, your nose is red and your eyelids are swollen and your wrist is swollen.",
  "input": "",
  "output": "These symptoms indicate that injuries or infections caused facial injuries or spread."
},
{
  "instruction": "Sir, you've got a cut in your face, and it's too hot, and you've got swollen wrists and chins.",
  "input": "",
  "output": "The injury is infected, so the wrist and jaw are swollen, and it could also be a fever."
},
{
  "instruction": "Hi doctor, I have a big problem with my face, and I have a wound, and my wrist and neck are swollen, and I'm having kidney-related symptoms.",
  "input": "",
  "output": "The symptoms suggest that the damage to the face and the swelling of the wrist and neck may be caused by an infection, so kidney symptoms may not be relevant, so additional evaluations are needed, you start with treatment, and additional tests will be done to determine the cause of kidney symptoms."
},
{
  "instruction": "Doctor, there's been a lot of symptoms recently: swelling of the neck, stiffness of the legs, pain in the face, symptoms in the kidneys.",
  "input": "",
  "output": "Symptoms seem to cause facial pain, which can cause swelling of the neck and stiffness of the leg may be due to the spread of infection in the wound."
},
{
  "instruction": "Doctor, I've had backache pains in the last couple of weeks, and now I'm experiencing a weakness in my wrists, a weakness in my hands, in my fingers, in my elbow, and what's the cause?",
  "input": "",
  "output": "This could be the cause of back pain and wrist, hand, finger weakness and pain and elbow weakness."
},
{
  "instruction": "Doctor, I've lost my arms and legs with neck and back pain. What's the problem?",
  "input": "",
  "output": "It's likely to be a spinal defibrillator, which is a symptom, and it's good to run additional tests to see if it's diagnosed."
},
{
  "instruction": "Doctor, you're overgrowing your legs, your legs are hurting, you're feeling hot, you're feeling cold, you're feeling back pain, you're feeling loss, what's the problem?",
  "input": "",
  "output": "The symptoms suggest that you have a spinal hernia, you have to manage the deformity, you have to prevent further damage to the area, and I'm going to recommend that you get a checkup and treat it."
},
{
  "instruction": "Doctor, your elbow has become too big and too weak. What's the cause?",
  "input": "",
  "output": "The symptoms could indicate a spinal dislocation."
},
{
  "instruction": "Sir, it's very difficult to urinate because you're often urinating and you're afraid to urinate, but it's very hard to see it.",
  "input": "",
  "output": "The symptoms seem to indicate that the portal is so tight that it doesn't contract, that there's trouble with urination, that there's saturation, that there's saturation, that causes inflammation, that there's infection."
},
{
  "instruction": "Doctor, I've had a lot of pain in my penis lately.",
  "input": "",
  "output": "Did you ever find it difficult to contract a scrotum portal? It was hard to put it in like you said."
},
{
  "instruction": "Doctor, your penis is red, it's painful, it's hard to urinate, and you're always having it.",
  "input": "",
  "output": "The symptoms seem to indicate that there's suffering from a Formography."
},
{
  "instruction": "Doctor, I've had a lot of stomach pain lately, and why?",
  "input": "",
  "output": "It causes severe nausea and vomiting during pregnancy and can cause abdominal pain."
},
{
  "instruction": "Doctor, severe nausea, bleeding, sharp abdominal pain, headaches, stomach pain continues, and what are the causes of all these symptoms?",
  "input": "",
  "output": "It looks like it's a form of severe morning sickness, which can occur during pregnancy."
},
{
  "instruction": "Doctor, I'm experiencing sharp abdominal pain during pregnancy, pain, headache, burning abdominal pain, vomiting.",
  "input": "",
  "output": "The symptoms seem to indicate severe nausea, vomiting, and abdominal headaches characterized by pregnancy, which can include medications and I.V. fluids to control the symptoms and prevent dehydration."
},
{
  "instruction": "Doctor, these days, you've been really dizzy, you've been losing your energy, you're not losing your stomach pain, so what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're a victim of pregnancy, which can lead to severe nausea and vomiting, which can cause dehydration, dizziness, weakness, and stomach pain."
},
{
  "instruction": "Doctor, you're pregnant with nausea and vomiting and pain and headaches.",
  "input": "",
  "output": "You're experiencing a form of edema that can cause excessive vomiting and dehydration during pregnancy."
},
{
  "instruction": "Doctor, there's been some problems during pregnancy, and I've experienced contractions, and what's the cause?",
  "input": "",
  "output": "The symptoms are likely to lead to complications of pregnancy, and we need to monitor the symptoms and make sure everything's going well through a routine checkup."
},
{
  "instruction": "Doctor, there's been a lot of pressure on the pelvis, and recently there's been a crush, and what's the cause?",
  "input": "",
  "output": "It's possible that you're pregnant based on the symptoms that your pelvic pressure and stains or bleeding are common during pregnancy, and it's best to schedule a pregnancy test to see if you're pregnant."
},
{
  "instruction": "Doctor, you're experiencing convulsions and convulsions during pregnancy and problems and pain. What's the problem?",
  "input": "",
  "output": "It's normal for a pregnant woman to experience convulsions and cramps with some pain and discomfort, but if she has severe symptoms or complications, she should immediately visit gynecology."
},
{
  "instruction": "Doctor, I'm having some problems with pregnancy, and I'm having a lot of contractions.",
  "input": "",
  "output": "From the symptoms that God explains, it seems like there's an early labor, and it's important to monitor closely for the health of the mother and the baby."
},
{
  "instruction": "Doctor, you're in pain during pregnancy, there's stains, there's pressure on your pelvic, and what's the cause?",
  "input": "",
  "output": "I think you're experiencing complications from pregnancy, and you need a medical appointment to make sure that both the mother and the baby are healthy."
},
{
  "instruction": "Doctor, I've been very tired recently, and I've had a very hard time, and I've had pain in my testes, and I've had a runny nose, so what's the problem?",
  "input": "",
  "output": "Mediterranean anemia, which is a genetic blood disease that affects the body's hemoglobin production, can cause fatigue and chest bleeding."
},
{
  "instruction": "Doctor, there's been an ongoing reflux, and what's the cause?",
  "input": "",
  "output": "This could be a symptom of thalassemia. Have you been diagnosed with this disease before?"
},
{
  "instruction": "Doctor, I've recently had some unusual symptoms: my elbow is weak, my back is sore, my knees are swollen, what's the problem?",
  "input": "",
  "output": "Mediterranean anemia is a genetic blood disease that affects the development of hemoglobin in the body, which can weaken and swell the joints due to lack of oxygen in the body."
},
{
  "instruction": "Doctor, I've been very tired and very tired lately, and my muscles are starting to swell.",
  "input": "",
  "output": "The symptoms seem to indicate that you have thalassemia, and you have to do some tests to check your diagnosis."
},
{
  "instruction": "Doctor, I'm experiencing back loss, arm pain, elbow weakness, low vision.",
  "input": "",
  "output": "It seems to be a form of thalassemia, which affects the production of hemoglobin, which can cause a variety of symptoms, including anemia and present symptoms."
},
{
  "instruction": "Doctor, I'm having a pregnancy problem, and I've recently had contractions, and I've had a lot of pain, and I've also found some stains and bleeding during pregnancy.",
  "input": "",
  "output": "The symptoms suggest that the placenta covers the cervix and there's an electric placenta that causes bleeding and early labor, which can be closely monitored for the safety of the mother and the baby and, if necessary, a C-section."
},
{
  "instruction": "Doctor, what's the problem when you're experiencing vaginal secretions, involuntary urination, stains, bleeding, and uterine contractions during pregnancy?",
  "input": "",
  "output": "The symptoms suggest that the placenta is at the bottom of the uterus, where there's an electric placenta that partially or completely blockes the cervix, which can cause bleeding and labor, and that bed rest and premature delivery can be needed to prevent complications for both mother and baby."
},
{
  "instruction": "Doctor, I'm experiencing a little delusion and involuntary urination, along with a problem during pregnancy and contractions.",
  "input": "",
  "output": "It's a complication of a pregnancy that causes the placenta to cover the cervix partially or completely, bleeding, contractions and other symptoms that you're experiencing."
},
{
  "instruction": "Doctor, you're having cramps and tics during pregnancy, and you're having some problems.",
  "input": "",
  "output": "There may be an electric placenta that partially or entirely covers the cervix, which can cause convulsions, bleeding and complications during pregnancy."
},
{
  "instruction": "Doctor, I recently experienced vaginal secretions and uterine contractions, and I have some problems with pregnancy.",
  "input": "",
  "output": "It's a disease in which the placenta partially or completely covers the cervix and causes bleeding and contractions, which can be serious and require close monitoring during pregnancy."
},
{
  "instruction": "Hi, doctor, aches, backaches, backaches, depression, mental symptoms, wrists -- what's the problem?",
  "input": "",
  "output": "Symptoms can lead to an epidural hemorrhage between the external lining of the brain and the skull, which can cause nausea, backaches, backaches, depression or mental illness, wrist weakness, which can be life threatening, so immediate emergency treatment is important."
},
{
  "instruction": "Doctor, there's a hot, cold feeling with the weakness of the elbow, back and side pain, and why?",
  "input": "",
  "output": "The symptoms seem to indicate an epidural bleed, and I'm going to do some more tests to confirm the diagnosis."
},
{
  "instruction": "I've had doctors, emotional symptoms, lower hearing, lower back, backaches, backaches, heat and cold. What's the problem?",
  "input": "",
  "output": "In view of these symptoms, there could be an epidural bleed, which means there is a bleeding of the protective membrane between the spinal cord and the spinal bone, and it's important to be treated immediately to prevent further complications."
},
{
  "instruction": "Doctor, I've been having a lot of trouble with dizzying sensations these days, and I feel depressed and hearing loss, and I feel very weak in the waist, and what are these symptoms?",
  "input": "",
  "output": "From the symptoms that God explains, an epidural hemorrhage can be a symptom of an epidural bleeding on the surface of the brain, which can cause a variety of symptoms, such as nausea, mood changes, hearing problems, back weakness, and so forth."
},
{
  "instruction": "Doctor, you're losing your wrist, you're feeling heat, you're feeling cold, you're feeling dizzy, what's the problem?",
  "input": "",
  "output": "The symptoms could indicate an epidural bleed, and we need to do some tests to check it out."
},
{
  "instruction": "Doctor, you've got pain in your legs and ass, and you've got problems moving your legs.",
  "input": "",
  "output": "The symptoms seem to indicate hemolytic arthritis, which is an infection that causes joint inflammation."
},
{
  "instruction": "Sir, your knees are swollen, your elbows are swollen, your skin looks strange, and your body is getting sick, so can you tell me what's wrong?",
  "input": "",
  "output": "The symptoms seem to indicate that you have septic arthritis, which can become very serious if you don't immediately treat your joints with an inflammation, which is better if you start treating them as soon as possible."
},
{
  "instruction": "Doctor, there are strange symptoms, such as an infection of the skin of the arm and the hand, and ass pain.",
  "input": "",
  "output": "The symptoms seem to indicate hemolytic arthritis, a few tests to confirm it, but these are very common symptoms of sepsis arthritis."
},
{
  "instruction": "Sir, I've been feeling a bit of a pain in my hands and fingers these days.",
  "input": "",
  "output": "The symptoms seem to indicate that you have septic arthritis."
},
{
  "instruction": "Doctor, you've had leg pain, and now you've got pain in your hand, or your finger, and your arm looks infected, and your arm looks hot, and you know what's causing it all?",
  "input": "",
  "output": "Hemolytic arthritis is a joint infection that causes pain, swelling and stiffness."
},
{
  "instruction": "Doctor, there's swelling, pain, skin stimulation with skin rashes on your feet, and why?",
  "input": "",
  "output": "From the symptoms that God explains, it seems that you have something, which is usually caused by mildew infections in your feet."
},
{
  "instruction": "Doctor, your feet have skin lesions. What's the problem?",
  "input": "",
  "output": "It's a fungus infection that affects the skin of your foot."
},
{
  "instruction": "Doctor, there's a severe soreness in the scalp and an irregular appearance of skin, and what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there's a mole that normally occurs in the feet but can spread to other parts of the body, such as the scalp."
},
{
  "instruction": "Doctor, you've got some annoying skin-scorching on your feet. What's the problem?",
  "input": "",
  "output": "I think there's something to the symptoms, which is a mildew infection that normally causes the skin between the toes toe toe toe toe to the skin and torrid torrid to the skin."
},
{
  "instruction": "Doctor, your feet have skin dryness, texture, scales, rashes. What's the problem?",
  "input": "",
  "output": "It's a fungus infection that grows on the skin of your feet."
},
{
  "instruction": "Hi doctor, I found a side pain and a little secretion in my throat. Can you tell me what might be a problem?",
  "input": "",
  "output": "The symptoms suggest that this is the cause."
},
{
  "instruction": "Doctor, I'm getting a fever. I don't know why.",
  "input": "",
  "output": "There could be a thoracic decapitation."
},
{
  "instruction": "Doctor, I recently experienced rib pain, shortness of breath and back pain. What is the cause of these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate that there is a buildup of the chest membranes between the lungs and the chest, which is the fluid, which requires additional tests to be diagnosed."
},
{
  "instruction": "Doctor, I've had back pain and respiratory problems lately. What's wrong?",
  "input": "",
  "output": "It's possible that the symptoms are the result of a thoracic decapitation."
},
{
  "instruction": "Hi, sir. I'm not feeling any better these days, and I have a sharp back pain.",
  "input": "",
  "output": "The symptoms seem to indicate that there's a pericardial edification, an excess of fluid in the chest cavity surrounding the lungs, causing weakness and back pain, and we need to do some tests to identify the diagnosis."
},
{
  "instruction": "Doctor, there are a few symptoms in your recent eye: impaired vision, itching, intubation, what's the problem?",
  "input": "",
  "output": "The symptoms can be diagnosed in a mild way, which is, because the eye doesn't have a lens, it can cause these particular symptoms."
},
{
  "instruction": "Doctor, it looks like there's a spot or a cloud in your eye, and your eyes are bleeding.",
  "input": "",
  "output": "The symptoms you've described may be the result of a drug that doesn't have a lens in the eye."
},
{
  "instruction": "Doctor, your eyes are inoculated, you're in pain, you're in pain, you're in a mass on your eyelids, and what's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate an epidemiology, a disease that causes the eye's natural lens removed during cataract surgery."
},
{
  "instruction": "Doctor, there's a lump in your eyelids, there's a lot of pain in your eyes, and there's spots and clouds in your eyes, and what's the cause?",
  "input": "",
  "output": "You've had surgery to remove a fertilized eye?"
},
{
  "instruction": "Doctor, there's a lump in your eyelids, and it's very red, and it's tight, and it's stinging, and what does this mean?",
  "input": "",
  "output": "These symptoms can be caused by a disease called weakness with no eye lenses. Have you had eye surgery or have you had contact lenses before?"
},
{
  "instruction": "Doctor, I've been suffering from the disease for the last few days, and what's the cause?",
  "input": "",
  "output": "Depending on the symptoms, there could be an outpatient disease, especially yeast infection."
},
{
  "instruction": "Sir, you're feeling uncomfortable with quality problems, such as vaginal secretions, sexual pain, hip pain, skin lesions and sensitivism.",
  "input": "",
  "output": "The symptoms that God's talking about suggest that you have an out-of-the-box disease, and with some tests, you can identify the exact cause of the symptoms and provide a proper treatment plan."
},
{
  "instruction": "Doctor, I have some weird symptoms, and I don't know what's going on, and I'm sick when I grow up and urinate, and I have strange skin lesions.",
  "input": "",
  "output": "From the symptoms that God mentioned, it's possible that you're going to have an out-of-body disease, and it's a good idea to go to the hospital and talk to them about how they can be treated and how they can be treated."
},
{
  "instruction": "Doctor, it's so painful because of the growth of your skin in your utero, there's so much pain in your urine, there's soreness, there's so much sexual pain, what's going on with me?",
  "input": "",
  "output": "It can affect your daily activity and your sexual function by causing chronic pain, heat, and discomfort to your throat, and it can also cause skin changes in the area and it can be scary."
},
{
  "instruction": "Doctor, you've got lumps in your breast and your skin is growing, and you're experiencing skin dryness, peeling, scales, roughness, hip pain, lesions in your skin, what's the problem?",
  "input": "",
  "output": "The symptoms that God's talking about indicate that you have an out-of-body disease."
},
{
  "instruction": "Doctor, headaches, difficulty in speaking, muscle spasms, dizziness, I've been vomiting once, can you tell me what's going on?",
  "input": "",
  "output": "The symptoms seem to indicate all the symptoms that you're talking about because of a vitamin B deficiency."
},
{
  "instruction": "Doctor, I've been feeling dizzy and nauseated for days, and I've had allergic reactions, and recently I've been coughing and vomiting, and what's the problem?",
  "input": "",
  "output": "Vitamin B is important to the nervous system and, if lacking, can cause nausea, nausea, cough, and even allergic reactions."
},
{
  "instruction": "Doctor, I have hip pain a couple of days ago. Can you tell me what caused it?",
  "input": "",
  "output": "It's very likely that there's a vitamin B deficiency in the symptoms."
},
{
  "instruction": "Doctor, I've had some strange symptoms recently, and I think I'm allergic, and I have muscle spasms, and contractions, and I have a lot of headaches, and why?",
  "input": "",
  "output": "God explains that you may have a vitamin B deficiency, which can cause allergic reactions, muscle spasms, contractions, cramps, headaches."
},
{
  "instruction": "Doctor, I've been having a hard time talking lately, and I'm feeling nauseous, and what's the cause of these symptoms?",
  "input": "",
  "output": "This condition can cause speech deficits and nausea, and we need to do some tests to identify the diagnosis."
},
{
  "instruction": "Teacher, lymph nodes, ear pain, neck mass, neck swelling, facial pain, what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms suggest that you're suffering from an inflammation of your salivary glands."
},
{
  "instruction": "Sir, the symptoms of a sore throat, swollen jaw, and telophase continue. What's the cause?",
  "input": "",
  "output": "The symptoms that God's talking about indicate that there's some suspicion that there's an inflammation of the salivary glands."
},
{
  "instruction": "Sir, the lymph nodes are swelling and the throat is swelling.",
  "input": "",
  "output": "The symptoms seem to indicate that you have cyalonic strepitis."
},
{
  "instruction": "Doctor, I'm experiencing telophase, neck pain, nose pain. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from cyalomaitis."
},
{
  "instruction": "Sir, there are symptoms that are hard to swallow, that your throat hurts, that your ears hurt, that your face hurts.",
  "input": "",
  "output": "I think you're suffering from hypothyroiditis, which is inflammation of your salivary glands."
},
{
  "instruction": "Doctor, your chest has been swollen and sick lately, and it looks like you're changing the size and shape of your breast.",
  "input": "",
  "output": "The symptoms suggest that the male breast tissue is suffering from an over-developed female form of breast disease."
},
{
  "instruction": "Sir, there's been a lot of pain in the neck, back and bones and a little bit of pain in the chest. Do you know what's causing it?",
  "input": "",
  "output": "The symptoms seem to indicate that the male breast tissue is a woman's female breast that swells and softens, which may require a more detailed examination for an accurate diagnosis, but at the present time, it is more likely."
},
{
  "instruction": "Doctor, there's a pain in the breast because there's a mass in the breast, and it's a little bit weird in shape and size, and there's also a bit of pain in the neck, so what's the problem?",
  "input": "",
  "output": "Because of the symptoms that God explains, female mammography is an abnormally obese condition in men's breast tissue, which can cause lumps or lumps of tissue to touch, pain, pain, and changes in size and shape."
},
{
  "instruction": "Sir, there's irregular navel and weight gain, skin swelling, and tell me what's wrong.",
  "input": "",
  "output": "The symptoms seem to indicate that you have female breast disease, which is a condition in which male breast tissue swells and grows larger than normal."
},
{
  "instruction": "Doctor, it's been difficult recently to urinate with sharp abdominal passages.",
  "input": "",
  "output": "The symptoms suggest that the infection is suspect."
},
{
  "instruction": "I've had quite severe symptoms recently, nausea, lower abdomen and back pain.",
  "input": "",
  "output": "The symptoms suggest that the infection is suspect."
},
{
  "instruction": "Hi, doctor, there's a lot of nausea and upper and lower abdominal pain, and what's the cause?",
  "input": "",
  "output": "It could be a major infection, in terms of symptoms, to be tested for a diagnosis so that the treatment can begin as soon as possible."
},
{
  "instruction": "Sir, the side pain and urine don't come out very well, and the lower abdomen hurts a lot.",
  "input": "",
  "output": "The symptoms seem to indicate that the infection is suspect, and we can do some tests to check it out."
},
{
  "instruction": "Doctor, cough, elbow convulsion, excessive growth, back weakness and loss of appetite.",
  "input": "",
  "output": "Hestoplasma is a fungus infection caused by the inhalation of mold spores called hyperplasma Capsulatum, found in soil and new waste, which can cause respiratory problems, joint pain, discomfort, and weight loss."
},
{
  "instruction": "Doctor, I'm experiencing elbow spasms, spasms, back weakness, and why?",
  "input": "",
  "output": "There's the possibility that you've got hyperplasma, a fungus spores called hypersulatum, which can affect your lungs and cause the same symptoms that you described as spreading over other parts of your body."
},
{
  "instruction": "Doctor, I'm experiencing the symptoms of elbow spasms and tics, heat and cold, elbow weakness, coughing and tears.",
  "input": "",
  "output": "It's a symptom of hyperplasma, a fungus infection caused by the intake of spores from bird or bat waste, which can cause muscle weakness, including respiratory symptoms, fever, and muscles around the elbow joints."
},
{
  "instruction": "Doctor, I feel pain all over my body, and I also get excessive tears, and I lose my back, and I lose my appetite, and what's the cause?",
  "input": "",
  "output": "Your symptoms point to a fungus infection called Histoplasma, caused by an inhalation of a fungus sporum called Histoplasma Capsulatum."
},
{
  "instruction": "Doctor, your whole body grows too much, your whole body gets sick, your eyes keep bleeding. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to be hyperplasma, a fungus infection affecting the lungs that can cause overexploding of other body parts, such as the growth of the body, the body, the eyes, and so on, and it's good to check the diagnosis and start treating it as soon as possible."
},
{
  "instruction": "Sir, I've had a bad cold lately, and my skin is so dark. Do you know what this is?",
  "input": "",
  "output": "The symptoms suggest that there's a multiple-pattern disorder that causes inflammation of the skin and the membranes."
},
{
  "instruction": "Doctor, I recently had a problem with my nose, and my nose is running out, and I've been feeling a lot of discomfort for a while.",
  "input": "",
  "output": "It's a skin disease caused by a virus or a bacterial infection, and it's one of the symptoms of an inflammation of the nose membrane."
},
{
  "instruction": "Doctor, I'm experiencing skin pain, fluid decline, eye pain, allergic reactions, some skin lesions.",
  "input": "",
  "output": "There may be an allergic reaction to the symptoms, or there may be some type of skin disease, multiple blushing, where you have to run some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, an allergic reaction with oral ulcers and fever continues. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you have multiple forms of measles, skin disease that can cause rashes, rashes and blisters on the skin surface."
},
{
  "instruction": "Doctor, you're having trouble vomiting and swallowing. Do you know what's causing it?",
  "input": "",
  "output": "Yes, these symptoms may be signs of multiple blushing, which is a form of over-sensitivity that causes skin lesions that affect the periphery, causing vomiting and senility."
},
{
  "instruction": "Sir, you've got a lower body pain and you feel your feet and toes stiff or tight. What's the symptom?",
  "input": "",
  "output": "From what God says, I think it's possible that it's chiropractic, which is caused by an abnormal beat of the spine that can cause lower pain and stiffness in the limbs."
},
{
  "instruction": "Doctor, I've had a low-body pain for a while, and what's the reason for that?",
  "input": "",
  "output": "The cause of the lower body pain can be chiropractic. Have you ever been diagnosed with oscillosis?"
},
{
  "instruction": "Doctor, your leg is weak, your knee is swollen, you're having movement problems, you're having lower pain, what's the problem?",
  "input": "",
  "output": "There's a possibility that there's a chiroplasmosis, a condition that can cause these symptoms by the fact that the spine is bent to the side and the legs are distributed without the weight and pressure of the legs."
},
{
  "instruction": "Hi, doctor, especially after exercise or exercise, you're experiencing muscle spasms, contractions or tics, do you know what's causing them?",
  "input": "",
  "output": "Well, the symptoms seem to indicate that there's a spina bifida that can cause muscle imbalance and tension that can cause muscle spasms, building and spasms, and it's important to have a proper diagnosis and treatment plan to solve these problems."
},
{
  "instruction": "Doctor, your knees are swollen, your legs are weak, your legs are difficult to move, your knees are stiff or cold, your urine color and smell are weird.",
  "input": "",
  "output": "If the spine is bent, it can affect the alignment of the body, causing pain and discomfort in the knees, legs and other parts of the body, and also changes the color and smell of urine abnormally."
},
{
  "instruction": "Hi doctor, I found knee pain, foot pain, big toe skin growth, and what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that abrasion is a condition in which the bone comes out of a joint at the base of the big toe, which can cause pain and discomfort, especially when you're walking, or when you're wearing tight shoes."
},
{
  "instruction": "Sir, I have a feeling of growing skin on my feet and swelling of my legs, and also stiffness and knee pain.",
  "input": "",
  "output": "The symptoms suggest that the lower part of your big toe has a bone fractured joint, so there's a periphery that sends out the bone."
},
{
  "instruction": "Sir, my feet are growing with skin, causing a lot of stimulation, and it's hard to move them properly, and there's a lump in my toe, and what's the cause?",
  "input": "",
  "output": "It's possible that it's a scallop, which is a condition in which a bone is forced into a joint at the base of your big toe, causing skin irritation, and there's also a condition that can affect the ability to move your feet properly, and it can cause discomfort when you walk."
},
{
  "instruction": "Sir, I have a problem with my foot, and I think I'm infected with the skin of my foot, and I have a swelling of my toes, and I have some weird spots on my skin, and I can't move my feet properly.",
  "input": "",
  "output": "The symptoms that God's telling us are that there's some kind of pain that's caused by the periphery, which is that the periphery, which not only causes swelling, rash, and skin irritation, but also makes the foot difficult to move."
},
{
  "instruction": "Doctor, there's been a lot of pain in the chest -- headaches, shortness of breath, leg cramps, cramps, sharp chest pains -- and what's the cause?",
  "input": "",
  "output": "You're experiencing an arrhythmia, which is an irregular heart rate, which requires additional tests to confirm this diagnosis."
},
{
  "instruction": "Doctor, I'm experiencing sharp chest pains, increased heart rate and fatigue. What's the problem?",
  "input": "",
  "output": "The arrhythmias can cause a variety of symptoms, including the symptoms you described as causing irregular heart rate."
},
{
  "instruction": "Sir, I've been feeling a lot more tense lately, and I've been feeling a lot more pain in my chest, and my heart rate has gotten faster than usual.",
  "input": "",
  "output": "The symptoms suggest that you may be experiencing an arrhythmia, which is an abnormal heart rhythm, which can cause weakness, chest upset, sharp chest pain, increased heart rate, and so forth."
},
{
  "instruction": "I'm experiencing a doctor, aches, a leg convulsion, a convulsion, a weakness, a sharp chest pain. What's the problem?",
  "input": "",
  "output": "These symptoms can indicate a condition called arrhythmia, which is an irregular heart rate where the heart beats too fast or too slowly, and you have to run some tests to make sure you're diagnosed."
},
{
  "instruction": "Sir, there's been spasms and spasms in your leg recently, and you've got chestaches and fatigues, and why is that?",
  "input": "",
  "output": "The symptoms may include chest discomfort, fatigue, and sometimes arrhythmia, an abnormal heart rate that can cause muscle spasms or spasms on the legs."
},
{
  "instruction": "Doctor, I've recently had back pain, delusions and hallucinations, and also elbow cramps, and apnea, and all my body pains, and what's wrong with me?",
  "input": "",
  "output": "The symptoms seem to indicate that you have the disease, which is a rare disease that causes your body's bones to become too large and weak, causing pain, nerve damage, and hearing loss."
},
{
  "instruction": "Doctor, I feel very sleepy these days. What's the cause?",
  "input": "",
  "output": "Have you ever experienced pain or deformity in a bone? Patient:"
},
{
  "instruction": "Doctor, earring, elbow cramps, abnormal breath sounds, abnormal skin, nail bite, can you tell me what's wrong?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from the disease, which affects the bone and can cause a lot of symptoms, including the ones you're talking about, and you have to do some tests to confirm your diagnosis."
},
{
  "instruction": "Doctor, I've been urinating a lot, I've been sick, I've experienced delusions, hallucinations, backaches, drowsiness, what's the problem?",
  "input": "",
  "output": "It's a disease that affects bones, causing malformations and fractures. It can cause bone pain, frequent urination, sleepiness."
},
{
  "instruction": "Doctor, you've got pain all over your body and you're always very tired. Do you know what's causing it?",
  "input": "",
  "output": "Yeah, it looks like you're suffering from the disease, and it's a bone disease that's weakened and modified, so have you ever had a bone problem or a deformity?"
},
{
  "instruction": "Doctor, you're experiencing a swelling of the eyes and an involuntary abnormality, and what's the cause?",
  "input": "",
  "output": "The symptoms are that there's a third chance of neurosis."
},
{
  "instruction": "Doctor, I've been experiencing severe headaches for a while. What's the cause?",
  "input": "",
  "output": "It's very likely that you have a third degree of neuropathic disease, which can cause severe facial pain, which is like a electrocution."
},
{
  "instruction": "Doctor, I've been having strange symptoms recently, my eyes swell, my tongue hurts, and I feel strange in my face.",
  "input": "",
  "output": "The symptoms you've described suggest that there may be a third degree of nerve pain, which can cause facial pain, which can lead to sensory abnormality or sensory loss in the area, and we need to do some tests to confirm the diagnosis."
},
{
  "instruction": "Doctor, I'm experiencing unusual involuntary movements and severe eye pain.",
  "input": "",
  "output": "The symptoms seem to indicate that you have three-dimensional neurosis, which is a sudden, severe pain on one side of the face, often caused by activities such as speaking, chewing or brushing of teeth."
},
{
  "instruction": "Doctor, an involuntary abnormal movement, facial pain, tongue pain, what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate that there is a third degree nerve pain, which affects the facial tritial nerve, which can cause extreme facial pain and affect other parts of the face, such as the tongue."
},
{
  "instruction": "Doctor, I've had a soreness and severe joint pain lately, and why?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from an arthritic spinalitis, a form of arthritis that affects the spine and other joints, which normally starts with back stiffness and pain, which can spread over your hips and shoulders."
},
{
  "instruction": "I'm experiencing more pain in my legs, more pain in my joints, more pain in my senses. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that there's a suspicion of active spinalitis."
},
{
  "instruction": "Doctor, elbow pain, joint pain, whole body pain, and also acute back pain.",
  "input": "",
  "output": "I think you've got strong-pressive spinalitis, which affects the spine, but also causes pain and problems in other joints of the body."
},
{
  "instruction": "Doctor, there's pain in the ribs.",
  "input": "",
  "output": "Considering the symptoms and the history of the disease, there's a good chance there's a strong spinalitis, any other symptoms?"
},
{
  "instruction": "Sir, I've got a really bad back these days. Can you tell me what's causing it?",
  "input": "",
  "output": "The symptoms suggest that it's an arthritic backitis, a form of arthritis affecting the spine and the ceiling joints, which can cause stiffness, pain and even some inflammation in the back."
},
{
  "instruction": "Doctor, I've been really dizzy lately. What's the cause?",
  "input": "",
  "output": "Have you ever experienced other symptoms, such as weakness in your limbs, insensitivity or depression?"
},
{
  "instruction": "We're experiencing doctors, aggravation, weakness of legs, abnormal involuntary movement and leg pain. What's the problem?",
  "input": "",
  "output": "The symptoms may indicate that you have a terminal neurologic disorder, and you have to do some additional tests to confirm your diagnosis."
},
{
  "instruction": "Doctor, your body's moving is weird and your arm feels weak, and why?",
  "input": "",
  "output": "The symptoms that God's talking about suggest that you may be suffering from a neurotic disorder at the end of the day."
},
{
  "instruction": "Doctor, I've been experiencing some strange symptoms recently: loss of sensation, back pain, foot pain, leg strength -- what's the problem?",
  "input": "",
  "output": "You seem to have a terminal nervous disorder."
},
{
  "instruction": "Doctor, paralysis, loss of sense, weakness of arm, back pain, memory problems, what's the problem?",
  "input": "",
  "output": "These symptoms seem to be a neurologic disorder in the last few years."
},
{
  "instruction": "Sir, I have a lump in my hand, and a lump in my chest, and a strange growth in my skin.",
  "input": "",
  "output": "The symptoms seem to indicate that it's a blood cyst, which can occur in many parts of the body, such as the hand, the breast, or the skin."
},
{
  "instruction": "Sir, do I have to worry about growing a lump in my chest and something strange in my skin?",
  "input": "",
  "output": "It's probably a Fiji cyst, which usually doesn't require treatment unless it's infected or caused discomfort by a common benign tumor filled with a wax called Fiji, but it's good to have your diagnosis checked and checked to eliminate other possible diseases."
},
{
  "instruction": "Doctor, there's irregularly-looking scalp, abnormally-looking skin, lumps or lumps of arm, lumps or lumps of breast, skin swelling.",
  "input": "",
  "output": "It's very likely that it's a blood cyst, which is a common non-mustical cyst in skin filled with such substances as cheese."
},
{
  "instruction": "Sir, there's a lump in your neck that's getting bigger and bigger, and there's an abnormal swelling of skin on top of it, and there's a couple of dots.",
  "input": "",
  "output": "It's a blood cyst, which is a common benign tumor filled with Fiji, a sticky, oily substance from the oil glands of the skin, that can be removed with a simple operation."
},
{
  "instruction": "Sir, there's a lump on your finger, there's a skin that looks abnormal, there's also a skin dot in your hand, and what's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that there's a blood cyst, which is a small, benign cyst, which can appear in many parts of the body, such as the hand, the finger, and so forth, so let's take a closer look and see if we can diagnose it."
},
{
  "instruction": "Sir, I can't sleep very well these days, no matter how tired I am, I can't sleep.",
  "input": "",
  "output": "Insomnia is a common symptom of an anti-psychotic addiction. Have you taken a drug that can cause these symptoms recently?"
},
{
  "instruction": "Doctor, I'm experiencing chest distress, faintness, depression, mental symptoms, dizziness, sharp chest pain. What's wrong with me?",
  "input": "",
  "output": "The symptoms seem to indicate that he's suffering from an addiction to antipsychotic drugs."
},
{
  "instruction": "I'm experiencing a doctor, a fainting, a difficulty in speaking, a drowsiness, a sense of breasts, and what's going on with me?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from an addiction to antipsychotic drugs."
},
{
  "instruction": "Doctor, I'm experiencing anxiety and anxiety, along with a disease in my tongue and a feeling of discomfort in my chest.",
  "input": "",
  "output": "From the symptoms that God explains, you're experiencing an addiction from an antipsychotic drug, which is so serious that it's important to get medical attention immediately because it requires immediate medical attention."
},
{
  "instruction": "I'm experiencing doctors, neck pains, low vision, vomiting, anxiety and neurosis, and what's going on with me?",
  "input": "",
  "output": "These symptoms show that we have betchet's disease, a rare disease that causes inflammation in the blood vessels throughout the body, which can cause a variety of symptoms, including those you described, and it's important to get a specialist's advice for proper diagnosis and treatment."
},
{
  "instruction": "Doctor, what's the problem with these days of anxiety and anxiety and neck pain and sharp abdominal pain?",
  "input": "",
  "output": "Have you ever experienced other symptoms, such as inflammation of the eyes or skin lesions?"
},
{
  "instruction": "Doctor, diarrhea, sharp abdominal pain, shortness of breath, vomiting, what's wrong with me?",
  "input": "",
  "output": "The symptoms suggest that you may have betchet's disease."
},
{
  "instruction": "Doctor, I've been feeling very nervous and nervous lately, and I've been coughing and vomiting, and I've got sore throats and blurry vision, and what's the cause of all these symptoms?",
  "input": "",
  "output": "Symptoms suggest that you may have autoimmune disease called bets, which characterizes whole body inflammation and causes anxiety, vomiting, cough, neck pain, blindness in severe cases."
},
{
  "instruction": "Sir, I have a problem smoking these days, and I'm very depressed. Do you know what's going on?",
  "input": "",
  "output": "I think you've been suffering from neurological symptoms, including the difficulty and anxiety and depression of addiction. Have you ever been stressed or stressed out, especially lately?"
},
{
  "instruction": "Sir, I'm having trouble smoking these days, and I can't stop trying.",
  "input": "",
  "output": "I think you're experiencing the symptoms of neurosis, which can cause anxiety, phobias, compulsive behaviors like smoking, and so on."
},
{
  "instruction": "Doctor, I've been having a lot of double-passed smoking problems, and I've been feeling very weak for most of my time, and why?",
  "input": "",
  "output": "It's a mental health condition that can cause various psychological symptoms, such as anxiety, depression, or compulsive disorder."
},
{
  "instruction": "Doctor, I've been feeling a lot of anger lately and having trouble quitting.",
  "input": "",
  "output": "The symptoms seem to indicate that you have neurosis."
},
{
  "instruction": "Doctor, I've been having strange symptoms lately, and my headaches continue, and I can't sleep at night.",
  "input": "",
  "output": "The symptoms seem to indicate that you're experiencing neurosis, which is a form of mental disorder that can cause various physical symptoms, such as headaches and insomnia."
},
{
  "instruction": "Doctor, I'm experiencing an involuntary urination, a blush, a night BB, and other prostate-related symptoms. What's the cause of these symptoms?",
  "input": "",
  "output": "It's very likely that it's prostate cancer, and you have to run some tests to make sure you're diagnosed, and it's important to find out early so that you can start treatment as soon as possible."
},
{
  "instruction": "Doctor, I've had a lot of trouble with urinating, and I've had an involuntary urination, and I've got blood out of my urine, so what's wrong with me?",
  "input": "",
  "output": "I think it's possible that it's prostate cancer because of the symptoms, and it's good to test some tests and discuss future treatment plans."
},
{
  "instruction": "Doctor, I've recently experienced erectile failure and involuntary urination, and there are symptoms of bladder trouble and excessive urination at night.",
  "input": "",
  "output": "It's possible that it's prostate cancer because of the symptoms, and it's good to book a prostate test as soon as possible to identify the cause of the symptoms."
},
{
  "instruction": "Doctor, I'm experiencing the blues and the prostate symptoms, along with pain during sex and excessive urination at night.",
  "input": "",
  "output": "There's a possibility of prostate cancer, but it's important to manage the symptoms and start treating them as soon as possible so that the cancer doesn't spread anymore."
},
{
  "instruction": "Doctor, I have a headache, and I have a feeling of stiffness and warmth in my body, especially in my arm, and I don't know what's going on, but I've been nervous for a while.",
  "input": "",
  "output": "Your symptoms suggest that you're experiencing swelling of the brain due to excessive body fluids, which can cause headaches and muscle rigidity, and you have to take immediate action to treat this condition."
},
{
  "instruction": "I'm experiencing doctor, arm pain, dizziness, sensory loss. What's the cause?",
  "input": "",
  "output": "The symptoms may indicate that there's a cerebral edema, a condition in the brain where the fluid accumulates too much, causing swelling and pressure."
},
{
  "instruction": "Doctor, I'm experiencing arm pain and headaches with the blind, and I can't talk, and I have vomiting, and do you know what causes these symptoms?",
  "input": "",
  "output": "The symptoms suggest that you have some cerebral edema in your brain that can cause these various symptoms, and you need to do some tests to confirm this diagnosis, but it's good to start immediately to minimize further damage."
},
{
  "instruction": "Doctor, I've been very sick lately, and I've been vomiting a lot, and I've been dizzy, and I've been sick, and I've been sick, and I've been sick, and I've been sick.",
  "input": "",
  "output": "You've described symptoms that may be caused by cerebral edema."
},
{
  "instruction": "I'm experiencing doctors, neck pains, low vision, loss of sense, poor focus and persistent headaches. What's wrong with me?",
  "input": "",
  "output": "The symptoms seem to indicate that you have cerebral edema."
},
{
  "instruction": "Sir, fingers and hands hurt a lot, and I feel swollen and stiff. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that your fingers have been disembodied."
},
{
  "instruction": "Sir, my fingers are so swollen that they really hurt. I think my fingers are broken.",
  "input": "",
  "output": "When did you get hurt?"
},
{
  "instruction": "Sir, I've had a lot of pain in my fingertips lately.",
  "input": "",
  "output": "The symptoms suggest that your fingers are disembodied."
},
{
  "instruction": "Doctor, it's hard to talk and your wrists and fingers hurt a lot.",
  "input": "",
  "output": "The symptoms suggest that your fingers have been disembodied."
},
{
  "instruction": "Doctor, do you know what caused the weakness of the back and swelling of the muscles?",
  "input": "",
  "output": "Yes, you may be suffering from birth trauma. Have you ever had back problems or muscle problems after childbirth?"
},
{
  "instruction": "Doctor, I'm hard to say, and I'm not growing as tall as I am, and I've had a little bit of depression and psychosis, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms seem to be traumatizing at birth, which can cause brain damage and development delay and mental health problems."
},
{
  "instruction": "I don't know why I'm doing this, sir, but there's so much change in mood these days, and I feel so low and depressed that sometimes I feel like I'm out of touch with reality.",
  "input": "",
  "output": "These symptoms can be the result of birth trauma, which can affect a person's mental health and can cause depression or mental illness."
},
{
  "instruction": "Doctor, I recently experienced elbow spasms and spasms, and why?",
  "input": "",
  "output": "These tics are likely to be caused by trauma at birth, and they occur when babies are under prolonged pressure on their shoulders at birth, causing nerve damage."
},
{
  "instruction": "Doctor, it's hard to make the last word clear, and it's pus out of the spade, and what's the cause?",
  "input": "",
  "output": "It's possible that the symptoms are affected by trauma at birth."
},
{
  "instruction": "Doctor, something's happened to my skin and I've been drinking a lot lately.",
  "input": "",
  "output": "It's possible that you may have chronic pancreatic disease, alcohol abuse may be the cause of this disease, skin growth may be the result of complications of this disease."
},
{
  "instruction": "Doctor, you've got a lot of pain in your body these days -- nausea, abdominal pain, soreness all over your body, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms indicate that there is a chance of chronic pancreatitis."
},
{
  "instruction": "Doctor, I've had back pain lately.",
  "input": "",
  "output": "The history and symptoms suggest that you have chronic pancreatic disease."
},
{
  "instruction": "Doctor, I've been sick lately, and I've been feeling nausea and pain all over my body, and, frankly, I've been abusing alcohol for a long time.",
  "input": "",
  "output": "This condition is often caused by prolonged alcohol abuse and can cause inflammation and damage to the pancreas, causing nausea and general pain."
},
{
  "instruction": "Sir, your feet are swollen, your skin appears to be different, your breasts are touched by lumps, and what's the problem?",
  "input": "",
  "output": "It's possible to be a hemothorax, an abnormal skin, a lump or a lump in the breast."
},
{
  "instruction": "There's a mass in the breast, and there's a swelling in the skin around it, and there's a whole body of pain, what's the problem, sir?",
  "input": "",
  "output": "It's a local swelling filled with blood from injury or trauma, and it's good to check this out and run some tests to start a treatment plan."
},
{
  "instruction": "Doctor, I'm experiencing a terminal edema, and what's the reason for that?",
  "input": "",
  "output": "Have you experienced any trauma lately?"
},
{
  "instruction": "Doctor, your scrotum is swollen, your groin is sick, your body is sick, and what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there's a clot."
},
{
  "instruction": "Doctor, I have pain all over my body.",
  "input": "",
  "output": "Could be signs of hemothorax, but have you been bruised or injured in a certain area recently?"
},
{
  "instruction": "Doctor, I've been experiencing some strange symptoms recently: swelling of the shoulder and loss of sexual appetite. What's the problem?",
  "input": "",
  "output": "Symptoms are likely to lead to Carcinoid syndrome, which can cause a tumor in the intestines to produce hormones that can cause a variety of symptoms, including shoulder swelling and lower sexual appetites."
},
{
  "instruction": "Doctor, what's wrong with the lump in your knee, the pressure on your wrist, the pain in your throat?",
  "input": "",
  "output": "These symptoms can be a rare disease called Carcinoid syndrome, do you have such symptoms as blushing or diarrhea?"
},
{
  "instruction": "Doctor, we've been experiencing a recent decline in sexual appetite and overgrowth. What's the problem?",
  "input": "",
  "output": "This may be due to Carcinoid syndrome, which is a type of tumor called carcinoid tumor, which is a rare disease caused by excessive production of serotonin and other hormones."
},
{
  "instruction": "Hi doctor, you're experiencing joint stiffness, stress, involuntary urination, and you've got knee lumps or lumps.",
  "input": "",
  "output": "The disorder that God has is called Carcinoid syndrome, which is rare when cancer cells release chemicals into the bloodstream, causing the symptoms mentioned above."
},
{
  "instruction": "Doctor, I've been having strange symptoms recently: the eyelids are getting very thin and the nails are biting, and my wrists are getting weaker and my shoulders are swollen, and I've also experienced involuntary urination.",
  "input": "",
  "output": "The symptoms seem to indicate that Carcinoid syndrome is a rare disease caused by a form of cancer, which can cause red, diarrhea, a thousand sounds, and it can cause it to have it, it's difficult to feel it, and it's good to check a few tests and start treating it immediately."
},
{
  "instruction": "Hi, doctor, there's an open head injury that's continuing to cause headaches. Can you tell me what the symptoms are?",
  "input": "",
  "output": "The symptoms seem to indicate that the headache is caused by an open head wound, and it may also have inflammation in the area."
},
{
  "instruction": "Doctor, you've got an open head injury, and you've got a lot of headaches. What's the problem?",
  "input": "",
  "output": "The open head injury is likely to be the cause of the headache, which is called traumatic brain damage."
},
{
  "instruction": "Doctor, you have a headache and a head injury. What's the problem?",
  "input": "",
  "output": "The open head injury could be from a head injury like a concussion."
},
{
  "instruction": "Doctor, you have a head injury and you're abusing alcohol. Can you tell me what's wrong with me?",
  "input": "",
  "output": "The open head injury may indicate trauma, but alcohol abuse has a good chance of causing an alcohol neurosis."
},
{
  "instruction": "Doctor, I have a head injury, and I've been abusing alcohol lately. What's the problem?",
  "input": "",
  "output": "The damage to the head may be from trauma, but alcohol abuse may be interfering with the proper healing."
},
{
  "instruction": "Doctor, you've got a lot of skin these days.",
  "input": "",
  "output": "You may have a skin disease that causes non-mustical growth in the skin, boredom, or boredom, which is a common disease among older people."
},
{
  "instruction": "Doctor, I have a wart on my skin, and I have an abnormal shape, and my skin is dry and peeled off with rashes, and why?",
  "input": "",
  "output": "Boredom cystosis is a cancerous skin growth that can cause warts, dryness, peelings, scales, roughness, abnormal appearance."
},
{
  "instruction": "Doctor, I found a strange rash in my skin and a few skin growths, and what's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that boredom is a common symptom of non-malial growth in the skin."
},
{
  "instruction": "Doctor, I'm experiencing skin irritations, and I've got a couple of abnormal skin spots in my body.",
  "input": "",
  "output": "In view of what God has explained, in general, you may be suffering from a non-malign skin growth, which appears to be a light brown or brown spot on the skin. Boredomism usually occurs in adults over middle age and can easily be treated. We encourage you to consult them to check your diagnosis and discuss treatment options."
},
{
  "instruction": "There's a doctor, a skin irritation, a rash around your penis, a painful wrist and bleeding in your ears, and what's the disease that I'm going through?",
  "input": "",
  "output": "There seems to be a combination of problems with skin irritations and rashes around the sexual organs. The wrist pain may be a spinal injury or a nervous injury. Blood in the ear can be a pericardial rupture or a sudden change in pressure in the head. It's good to have a thorough examination to check your diagnosis and proper treatment plan."
},
{
  "instruction": "Doctor, I feel skin irritation and wrist pain.",
  "input": "",
  "output": "I think he's burned."
},
{
  "instruction": "Doctor, I have a headache recently.",
  "input": "",
  "output": "Headaches can be caused by burns. Have you been burned recently?"
},
{
  "instruction": "Doctor, your elbow and knees are in pain, so you're in pain for a while.",
  "input": "",
  "output": "Yeah, actually, I was cooking a few days ago, and did it have anything to do with my pain?"
},
{
  "instruction": "Doctor, skin irritation, wrist swelling, elbow pain, hand and finger pain. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you've been burned."
},
{
  "instruction": "Doctor, you're having a lot of uterine contractions and hip pains, and you're also experiencing cramps and cramps, and sometimes you're bleeding between menstrual periods.",
  "input": "",
  "output": "It's important to check your diagnosis, to do some tests and tests to determine what's best for your health."
},
{
  "instruction": "Doctor, you've got abdominal pain and stains during pregnancy, and you've got pains and problems during pregnancy, and what's the cause of all these symptoms?",
  "input": "",
  "output": "There's a possibility that you're experiencing a natural miscarriage from your symptoms, and it's good to do some additional tests to identify the diagnosis and determine how to treat the best."
},
{
  "instruction": "Doctor, I've been experiencing abdominal pain, pelvic pain and clot during my period, and I've had abdominal pain that burns during pregnancy.",
  "input": "",
  "output": "It's important to have a thorough examination to make sure that there's no underlying cause of miscarriage."
},
{
  "instruction": "Doctor, I'm experiencing pain and menstrual overload during pregnancy, and I'm also bleeding during pregnancy, or I'm having clots during menstruation, and I'm having menstrual bleeding, and what's the problem?",
  "input": "",
  "output": "It's possible that you're experiencing a natural legacy, which is known as miscarriages, and it's good to schedule an ultrasound to see if you're pregnant."
},
{
  "instruction": "Doctor, there's a problem with pregnancy, abdominal pain that burns during pregnancy, and menstrual bleeding.",
  "input": "",
  "output": "You're experiencing a natural legacy known as miscarriages, and it's good to come to the hospital as soon as possible to check your diagnosis and discuss treatment options."
},
{
  "instruction": "Hi, doctor, I've been experiencing vaginal nausea and secretions recently, and I'm pregnant recently, so can you tell me what the problem is?",
  "input": "",
  "output": "In view of the symptoms and the recent pregnancy, it appears that genital herpes has occurred. It's best to get tested and make a reservation to discuss treatment options."
},
{
  "instruction": "Doctor, I've been experiencing a number of symptoms recently, and I've been pregnant recently, and since then there's been a lot of pain in vaginal, urinary and pelvis, and what's the problem?",
  "input": "",
  "output": "It's a common venereal disease that can cause these symptoms, and I'm going to recommend some drugs to ease the pain and reduce the likelihood of transmission to partners."
},
{
  "instruction": "Sir, there are symptoms of vaginal sensitism, urinary pain, groin pain, vaginal secretions, skin lesions, and what are the causes of these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate that she's infected with genital herpes."
},
{
  "instruction": "I've been experiencing symptoms like doctor, vaginal secretion, skin pain, and I've been pregnant recently.",
  "input": "",
  "output": "The symptoms suggest that you have genital herpes."
},
{
  "instruction": "Doctor, you have lesions in your penis and vaginal pain. What's the cause?",
  "input": "",
  "output": "The symptoms may indicate genital herpes, and I'm going to have to do some tests to confirm the diagnosis."
},
{
  "instruction": "Sir, I recently experienced delusions and hallucinations, and why?",
  "input": "",
  "output": "The symptoms seem to indicate that you're experiencing an adaptation response, which may be a response to a stress event in your life that caused delusions or hallucinations."
},
{
  "instruction": "Sir, I'm experiencing personality problems, fears and phobias, delusions and hallucinations, nightmares and excessive anger.",
  "input": "",
  "output": "From the symptoms that God has described, you seem to be suffering from an adaptational response."
},
{
  "instruction": "Sir, I'm really nervous these days -- I can't sleep well, and I've got fear and phobia, and I feel really depressed and I'm at the lowest point in my life.",
  "input": "",
  "output": "I think you're having a hard time with the adaptation response, and the symptoms that you've described are probably related to this condition."
},
{
  "instruction": "Doctor, I'm experiencing a lot of anxiety, delusions and hallucinations, and I'm having a lot of trouble controlling my temper, and I haven't had a good night's sleep a few days ago.",
  "input": "",
  "output": "I think you're experiencing an adaptation from your symptoms."
},
{
  "instruction": "Sir, I've got a problem with my temper these days, and I'm angry at little things, and I don't know why.",
  "input": "",
  "output": "It's a psychological response to stressful situations and changes in life, and it's important to work together to understand the cause of stress and to figure out how to manage it."
},
{
  "instruction": "Doctor, you've been sweating a lot lately. What's the cause?",
  "input": "",
  "output": "It may be a symptom of a number of symptoms, but in the case of the questioner, were there other symptoms, such as abdominal pain or nausea?"
},
{
  "instruction": "Doctor, there's been a lot of reflux, intestinal pain, vomiting, back pain lately.",
  "input": "",
  "output": "It's possible that it's pyromosis when you put it off as a symptom."
},
{
  "instruction": "There's doctors, sharp abdominal pain, sharp chest pain, and what's the cause?",
  "input": "",
  "output": "The symptoms that God has described may indicate that it's pyloric."
},
{
  "instruction": "Doctor, you've been through a lot lately. What's the problem?",
  "input": "",
  "output": "Have you ever had pain in your right stomach or back or experience nausea or vomiting?"
},
{
  "instruction": "Doctor, sharp abdominal pain, sore throat, back pain, nausea and lower body pain.",
  "input": "",
  "output": "These are symptoms of stalactites. Have you ever turned yellow or hot in your skin or your eyes?"
},
{
  "instruction": "There are symptoms of doctor, ticklishness, helplessness, weakness of leg strength. What's the cause?",
  "input": "",
  "output": "The symptoms are likely to be multiple sclerosis, and it's good to do additional tests to check your diagnosis."
},
{
  "instruction": "Hi doctor, I'm experiencing a loss of touch and focus in my arms and legs, and also a feeling of stiffness and sagging in my legs, and what's the cause of all of these symptoms?",
  "input": "",
  "output": "The symptoms suggest multiple sclerosis."
},
{
  "instruction": "Hi, doctor, I've been having a very strange condition lately, and I'm constantly forgetting things, my arms and legs, and I feel paralyzed, and I get dizzy when I get up.",
  "input": "",
  "output": "It's very likely that it's a symptom that you have to run some tests to confirm it, but it's important to start treating it as soon as possible to manage the symptoms and slow down the course of the disease."
},
{
  "instruction": "Doctor, I've recently been very tired, my arms and legs are falling apart, and I'm experiencing paralysis, and I have a headache, and I feel like I don't have any energy.",
  "input": "",
  "output": "The symptoms seem to indicate that multiple sclerosis is a disease affecting the central nervous system, which can cause fatigue, abnormality, headaches, weakness, loss of sense."
},
{
  "instruction": "Hi, doctor, I've been tired lately and I've had problems with my memory.",
  "input": "",
  "output": "The symptoms seem to indicate that there are early signs of multiple sclerosis, and we need to do some tests to identify the diagnosis."
},
{
  "instruction": "Sir, it's hard to swallow, and I feel so weak in my elbow.",
  "input": "",
  "output": "There may be a genker gesyl, which is difficult for you to deal with because of the symptoms, and if you don't treat it, you can lead to nerve damage, which can cause the elbow to lose its strength."
},
{
  "instruction": "Doctor, there's a weakness in the elbow, and there's a backache. Do you know what's causing it?",
  "input": "",
  "output": "Yes, it's possible that the symptoms are Genker Gyllus, which can cause symptoms such as nausea, reflux, neck, shoulder, and back pain in the throat wall. Do you want to book extra tests to confirm your diagnosis?"
},
{
  "instruction": "Doctor, your nails break, your throat hurts, your back hurts, and why?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from genker's diverticulitis, a condition that causes trouble and throat pain in the back of your neck, but the backache isn't the symptom of this disease."
},
{
  "instruction": "Doctor, your back is weak and your throat is sick. What's the problem?",
  "input": "",
  "output": "It's possible that it's Genker Gysyl, which is a condition that has a part in the throat that can cause depression and cause other symptoms, such as backaches and sometimes backaches."
},
{
  "instruction": "Sir, you're losing your elbow, you're feeling heat, you're feeling cold, you're losing your waist, you're being hard to swallow, you're getting sore throats.",
  "input": "",
  "output": "There's a possibility that there's a Janker crab disease that can cause a small pocket around the neck, which is difficult to swallow and that can cause other symptoms, such as weakness and pain, and if you want to check the severity of the situation, you need to have additional tests."
},
{
  "instruction": "Doctor, it's hard to talk about these days, it hurts, it hurts, it feels like my leg hurts, I feel like I'm a pain in my body, and you know what's causing it?",
  "input": "",
  "output": "The symptoms may indicate a hip fracture, which can lead to all the symptoms you've described, and you have to do X-ray to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I recently experienced hip pain, side pain, speech difficulties, delusions and hallucinations.",
  "input": "",
  "output": "The symptoms you're experiencing, especially hip pain, and the difficulty of speaking, are common in this condition, caused by the pain and stress caused by the fractures, though not common in the lateral pain, delusions and hallucinations."
},
{
  "instruction": "Sir, I'm experiencing leg pain, whole body pain, delusions, hallucinations, side pain, back pain, tell me what's wrong.",
  "input": "",
  "output": "The symptoms suggest that you have a hip fracture."
},
{
  "instruction": "Doctor, your groins hurt, your bones hurt, your butt pain. What's the problem?",
  "input": "",
  "output": "You might need X-rays for confirmation, but it's good to avoid intense activity and relax until you know more about it."
},
{
  "instruction": "Sir, there's a lot of pain in the groin and a lot of pain in the bone, and it's hard to talk, and sometimes there's delusions and hallucinations.",
  "input": "",
  "output": "The symptoms suggest that you have a hip fracture, and you can do some video tests to confirm your diagnosis, and then you can plan your treatment."
},
{
  "instruction": "Doctor, I've been experiencing vomiting, coughing, throataches, chest upsets a few weeks ago. What's the problem?",
  "input": "",
  "output": "It's a lung disease that normally occurs when you're exposed to coal, silica, or asbestos, and you inhale dust particles."
},
{
  "instruction": "Doctor, it's hard to breathe and I feel stuck. What's the cause?",
  "input": "",
  "output": "The symptoms are likely to indicate that it's a lung disease caused by partial particle inhalation, autism."
},
{
  "instruction": "Sir, I've been coughing and coughing for a while. Can you tell me what's going on?",
  "input": "",
  "output": "The symptoms seem to indicate that you have autism, which is a lung disease caused by prolonged breathing of harmful particles, such as silica, asbestos, coal, and so forth."
},
{
  "instruction": "Doctor, vomiting, absorption, fever. What's wrong with me?",
  "input": "",
  "output": "The symptoms you've described suggest that you're likely to suffer from autism."
},
{
  "instruction": "Doctor, you cough your spades and your breath is bad, and you hear a little bit of breath, and there's a little bit of heat, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms that God's talking about are likely to indicate that you have a history of autism."
},
{
  "instruction": "Sir, I've been smoking lately, and I think my legs are swollen from time to time, and why?",
  "input": "",
  "output": "The symptoms that God's talking about may be high blood pressure, too much fat or lipid in the blood, which can cause blood circulation and cause lymph nodes, which can also increase cholesterol in the blood vessels, making the condition worse."
},
{
  "instruction": "Doctor, you have a sharp chest pain. What do you think is the problem?",
  "input": "",
  "output": "The symptoms may indicate high blood fat, high blood pressure, and you have to run some tests to check this out."
},
{
  "instruction": "Doctor, I'm experiencing weight gain, sharp chest pain, smoking problems, and what's the cause of these symptoms?",
  "input": "",
  "output": "I think there's a hyperphysia that characterizes high blood lipids or fat levels, which can cause weight gain, chest pain and smoking problems."
},
{
  "instruction": "Doctor, your leg's swollen, and recently you've been smoking cigarettes, and you're having trouble breathing. Can you tell me what's going on?",
  "input": "",
  "output": "It could cause lymph nodes or swelling of the leg, especially if you're a smoker."
},
{
  "instruction": "Sir, I've been looking at the black side for a while, and I'm worried.",
  "input": "",
  "output": "I think you're experiencing melena, and the symptoms and the history indicate that you're suspecting ulceric colitis."
},
{
  "instruction": "Doctor, there's been a lot of blood in your throat over the last few days, and I've been bleeding at work. Can you tell me what's going on?",
  "input": "",
  "output": "The symptoms seem to indicate ulcerated colitis, a chronic disease that causes urinary hemorrhage, causing inflammation and ulcers in the colon and in the rectal lining of the job."
},
{
  "instruction": "Doctor, I'm experiencing sharp abdominal and rectal bleeding, and the color of the stool has turned black.",
  "input": "",
  "output": "The symptoms seem to indicate that ulcerary colitis is a chronic inflammation that affects the colon, which causes abdominal pain, rectal bleeding, and so on."
},
{
  "instruction": "Doctor, you've got abdominal pain, hemothorax, lymph nodes, burning abdominal pain, what's the problem?",
  "input": "",
  "output": "The symptoms are likely to be ulcerated colitis, a chronic disease that causes inflammation and ulcers in the colon and in the workplace."
},
{
  "instruction": "Doctor, I think my newborn son is extremely annoyed and sick these days.",
  "input": "",
  "output": "I think your son has a male genital infection, and I'd like you to take him for a test."
},
{
  "instruction": "Doctor, your scrotum is swollen, your penis is red, your baby's annoying, and there's a little bit of oscillation in your penis.",
  "input": "",
  "output": "Symptoms suggest that it's a male genital infection caused by venereal disease or bacterial infection, which requires immediate treatment to prevent further complications."
},
{
  "instruction": "Sir, I'm experiencing redness and swelling of the penis with groin pain, and there's also an abnormal appearance of skin in that area.",
  "input": "",
  "output": "You probably have genital herpes, a viral infection that affects male genitals, and you can do some tests to make sure that you can start treatment."
},
{
  "instruction": "Doctor, my scrotum is very swollen and I feel a big lump, and why?",
  "input": "",
  "output": "The symptoms seem to indicate that male genital infections, which are also called sinusitis, are very important for immediate testing and treatment in order to prevent complications."
},
{
  "instruction": "Doctor, there's pain in the groin. What's the problem?",
  "input": "",
  "output": "It looks like there's an infection in the male genitals."
},
{
  "instruction": "Doctor, you have a lump in your hand, eyelids, frequent urination, swelling around the anus.",
  "input": "",
  "output": "It's possible that you're suffering from the presence of a phagoma virus or a pharynoma virus."
},
{
  "instruction": "Doctor, what's the reason for the recent release of lots of spades?",
  "input": "",
  "output": "Depending on the symptoms, it's possible that you've been infected with an HPV, and you've got to run some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I've recently had frequent urination, edema, joint pain, and warts.",
  "input": "",
  "output": "The symptoms seem to indicate that you're infected with an HPV virus, and you have to do some tests to check your diagnosis and determine the right treatment."
},
{
  "instruction": "There's a lot of trouble with involuntary urination and frequent toilet visits, but what's the cause?",
  "input": "",
  "output": "This could be the result of the pharynx virus, also known as the phagoma virus."
},
{
  "instruction": "I'm experiencing a doctor, a vaginal secretion, an indomitable urinary tract, a cough, a quantity. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to indicate that he was infected with the genital papillomavirus."
},
{
  "instruction": "Hi, doctor, arm pain, burning chest pain, facial blushing.",
  "input": "",
  "output": "Angina is a condition that doesn't supply enough blood and oxygen to the heart, that causes chest and chest discomfort, which can spread the pain through the arm and cause the blush."
},
{
  "instruction": "I'm experiencing facial blushing with doctors, arm pain, lower body pain, sharp chest pain, and what's the cause?",
  "input": "",
  "output": "The symptoms suggest that the coronary artery is narrowed down, and there's a chance that you're suffering from angina when there's not enough blood supply to the heart muscle, and it's good to run some tests to confirm this diagnosis."
},
{
  "instruction": "Doctor, I've been sweating a lot lately.",
  "input": "",
  "output": "Do you have chest pain or discomfort? woman:"
},
{
  "instruction": "Doctor, I'm experiencing facial blush, head sores, dizziness, arm pain, sharp chest pain.",
  "input": "",
  "output": "It seems to be angina, which means that the blood supply to the heart is limited, causing chest and chest discomfort."
},
{
  "instruction": "Doctor, we're experiencing rapid heart rate and irregular heart rate and bilateral rhythm, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate that there's not enough blood flow in the heart muscle, so there's angina that causes chest pain, respiratory difficulty, and so forth."
},
{
  "instruction": "Doctor, I'm suffering from shoulder pain, arm pain, neck loss, arm weakness.",
  "input": "",
  "output": "The symptoms suggest spinal damage."
},
{
  "instruction": "Doctor, back pain, neck cramps, spasms, shoulder pain, foot or toe strength has been weakened.",
  "input": "",
  "output": "The symptoms are likely to indicate spinal injuries, and we need to do some additional tests to identify this diagnosis and determine the extent of the injuries."
},
{
  "instruction": "Doctor, I'm experiencing neck pain, headaches, neck stimulation, arm weakness. What's wrong with me?",
  "input": "",
  "output": "I think he's injured in the spinal cord."
},
{
  "instruction": "Doctor, recent arm weakness and shoulder pain. What's the cause?",
  "input": "",
  "output": "These symptoms can indicate spinal injuries caused by trauma or accident, and you need to get an MRI to check them out."
},
{
  "instruction": "Doctor, a couple of days ago, I had a headache and I got a lot of blood in my nose. What's the problem?",
  "input": "",
  "output": "Did it not feel difficult to breathe into your nose or get stuck in your nose?"
},
{
  "instruction": "Doctor, we've had allergic reactions a few days ago, we've had shortness of voice and shortness of breath, and recently we've started to have facial pain, and what's the problem?",
  "input": "",
  "output": "These little non-malignant growths can cause the symptoms you described as respiratory difficulties and facial pain. You have to run some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, the sinuses have been very sick for a long time, and they seem to have a good voice, so what's the problem?",
  "input": "",
  "output": "The symptoms suggest that you may have Kopolip."
},
{
  "instruction": "Sir, there's been facial pain, allergic reactions, a hoarse voice, an frontal headache in the last few days, and what's the problem?",
  "input": "",
  "output": "I think Kopolip is the cause of the symptoms."
},
{
  "instruction": "Sir, there's been a lot of hoarse voices, sinus pain, redness in the ear and coughing.",
  "input": "",
  "output": "It's a condition that can cause these symptoms, either in the nose or in the sinus."
},
{
  "instruction": "Doctor, there's been a long period of itching. What's the problem?",
  "input": "",
  "output": "The symptoms that God's talking about indicate that you're suffering from simple herpes."
},
{
  "instruction": "Doctor, it's very uncomfortable to experience skin ugliness around your sex organs, and I'm experiencing a lot of pain in sexual intercourse with him, and I'm very concerned about the growth of skin around the vagina, and I also have acne and perplexity in the same area.",
  "input": "",
  "output": "The symptoms seem to indicate that you are suffering from sepsis, a skin disease that becomes leathery when there is a tight spot on the skin. It may appear on any part of the body, but it often occurs around the vagina. If you scratch or rub a part of the body, it can cause skin irritation and discomfort. It's important to start with a local cream or cascading that helps relieve the symptoms, and it's important not to scratch the area to prevent further damage."
},
{
  "instruction": "Sir, I've been experiencing vaginal and red skin lesions and scalp hair, and what's the cause?",
  "input": "",
  "output": "The symptoms that God's talking about indicate that it's likely to be horridness caused by herpes."
},
{
  "instruction": "I'm experiencing doctors, skin drying, textures, scales, roughness, and why?",
  "input": "",
  "output": "You may have a simple skin case, a thick, scaly spot on the skin surface, mostly due to frequent itching and skin scratches, causing skin damage and inflammation."
},
{
  "instruction": "Doctor, I discovered that skin grows on the quagmire and that it's also quite dry and peeling, and it's hard to talk and it has acne in its skin.",
  "input": "",
  "output": "The symptoms suggest that there is a simple eczema, a skin disease caused by chronic scratching or rubbing habits, which can cause excessive skin growth, drying, peeling, scales, and roughness, which can also cause it to be covered in the intrauterine or groin, and may also cause small acne, such as acne in the area."
},
{
  "instruction": "Doctor, you've got pain in your eyes and swelling in your eyes, and you've found pus in your scissors, what's the problem?",
  "input": "",
  "output": "There may be Trikicia, which causes irritation, pain and sometimes secretions, which we'll do some tests to make sure that the eyelash grows in the eye."
},
{
  "instruction": "Doctor, there's been a couple of weird symptoms recently, there's pus coming out of the spade, and there's a feeling of weakness in the waist.",
  "input": "",
  "output": "These may be signs of Triciasis, eye infections that cause irritation and discomfort as the eyebrow grows inside the eye."
},
{
  "instruction": "Doctor, I feel strange in the eyes. What's the cause?",
  "input": "",
  "output": "It could be Trikicia, a condition in which eyelashes grow into the eye, and eyelashes that cause irritation and discomfort."
},
{
  "instruction": "Doctor, I'm experiencing aching eyes with elbow cramps and spasms, and I feel a little bit of a skin in my eyes with an intubation.",
  "input": "",
  "output": "The symptoms may indicate that you have Trikia disease, which causes your eyebrows to grow inward and sometimes scratch your cornea."
},
{
  "instruction": "Doctor, your back has been weakened lately, your vision has been impaired, your eyes have been bloodied, your eyes have been dark, and you've found pus in your scissors, and can you tell us what caused these symptoms?",
  "input": "",
  "output": "I think there's Trikicia, a condition that causes the eyelash to grow inwards, which can cause inflammation of the eyes, and it can cause inflammation of the eyes and lower vision."
},
{
  "instruction": "Doctor, I've recently experienced unusual symptoms of overgrowth, saturation, a broken leg or kneeling, and you know the cause?",
  "input": "",
  "output": "The symptoms may indicate that you have a parasite infection known as acariasis, which can cause the ticks to invade your skin and develop overgrowth and bone injuries and so on."
},
{
  "instruction": "Doctor, your scrotum is swollen and your legs are bent, and your hair is growing too much, and your skin is very skiny.",
  "input": "",
  "output": "The symptoms suggest that there's an acariasis, which is a parasite infection caused by a tick, which can cause swellings, deformity, overgrowth, skin itching, and a few tests to identify the diagnosis and start immediately."
},
{
  "instruction": "Doctor, your wrist has been weakened for a while, and you've got skin rashes. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to indicate that it's an acariosis."
},
{
  "instruction": "Doctor, weird symptoms of heat and cold, overgrowth, skin rash, what's the problem?",
  "input": "",
  "output": "The symptoms suggest that you're suffering from akaria, a skin disease caused by a small mite that lives on the surface of your skin, which can cause the symptoms you're talking about."
},
{
  "instruction": "Doctor, there's swelling of the scrotum and bending of the legs, and there's a slight emotional weakness and weakness in the elbow, and what's the cause of all this?",
  "input": "",
  "output": "It's possible that you're suffering from akaria, which is caused by a rare skin disease caused by a tick, which can affect the skin of your body, which can cause swelling, knee pains, and emotional symptoms."
},
{
  "instruction": "Doctor, there's a mass around the anus that's touching or swelling, there's a rectal bleeding, there's a secretion in the throat.",
  "input": "",
  "output": "The symptoms are likely to be colon cancer, and it's good to do some tests to check the diagnosis and plan the treatment."
},
{
  "instruction": "There's a doctor, a rectal hemorrhage, anal pain, a lump touching or swelling around the anus. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to be colon cancer, and it's good to check the diagnosis and schedule some tests to start treating as soon as possible."
},
{
  "instruction": "Doctor, there's a mass around the anus that's touched or swollen and very painful, and there's a rectal bleeding.",
  "input": "",
  "output": "If you're dealing with symptoms, it's possible that it's colon cancer, which is a good idea to book a colonoscopy and check for diagnostics and discuss treatment options."
},
{
  "instruction": "Doctor, there's been recent cases of secretions coming out of the throat. What's the cause?",
  "input": "",
  "output": "It could be colon cancer, and it could be released by the body's immune response to cancer cells, and it's good to check your diagnosis through colon endoscopic tests."
},
{
  "instruction": "Doctor, there's a lump around the anus, there's swelling, there's blood on the stool, there's pain around the anal, what's the problem?",
  "input": "",
  "output": "It's possible that it's colon cancer, if you're going to be diagnosed, and you're going to have to have a colonoscopy and additional tests."
},
{
  "instruction": "Doctor, what's the cause of your recent face with acne and pimples?",
  "input": "",
  "output": "Maybe it's a symptom of a skin pigment calm disorder called shortness."
},
{
  "instruction": "Doctor, I'm experiencing skin dryness, texture, scales, roughness with acne and acne.",
  "input": "",
  "output": "The symptoms seem to indicate that you have a skin pigment disease, which can be vitiligo or melanoma, and it's good to do some tests to make sure."
},
{
  "instruction": "Doctor, I've found that there are several skin dots in my body, and they look different from what I've already had, and I've been struggling with acne and acne, and now I've got skin rashes that don't disappear, and what's wrong with me?",
  "input": "",
  "output": "Kimmy is characterized by brown, gray or black spots on the skin, skin spots, acne, acne, skin lesions and rashes."
},
{
  "instruction": "Sir, you know what's causing that?",
  "input": "",
  "output": "The symptoms suggest that you're suffering from skin dryness, texture, scales, roughness, skin pigmentation, which can cause an abnormal appearance of the skin. It's good to check this diagnosis and be tested to discuss treatment options."
},
{
  "instruction": "Doctor, there's too little hair in your head and parts of your body, and your skin is swollen and you have a lot of acne and pimples, and you know what's going on?",
  "input": "",
  "output": "The symptoms seem to indicate that you have a dermatology disorder called vitiligo, which can cause loss of melanin pigment in the skin, causing white spots, hair loss and acne."
},
{
  "instruction": "Hi, doctor, there's been a lot of elbow spasms and spasms, so what are the symptoms?",
  "input": "",
  "output": "There's the possibility that the symptoms are actually sexually impaired, a disease that acts as if it were intentionally ill or injured, even though it doesn't actually hurt."
},
{
  "instruction": "Doctor, there's been some weird symptoms recently, that my elbows are getting ratged and my lips are swelling for no reason, and I feel like I'm growing too much.",
  "input": "",
  "output": "To put it off as a symptom, I think you have a real disorder, which is a psychological disorder that deliberately deceives or produces physical or psychological symptoms in order to gain attention or compassion."
},
{
  "instruction": "Sir, I've had strange symptoms of eyelids and sore hands and sore feet and a slight decline in my memory.",
  "input": "",
  "output": "The symptoms seem to indicate that you're experiencing a factor disorder, a disorder in which individuals deliberately forge or exaggerate the symptoms in order to gain medical attention or sympathy."
},
{
  "instruction": "Doctor, I've had some strange symptoms recently: my nails are frequently biting and my lips are swelling, and I feel a strange sensation in my arms and legs like a pin or a needle, and sometimes I get a rat in my elbow or a spasm.",
  "input": "",
  "output": "I think you're experiencing a real disorder in order to attract attention or to give you a role as a patient, and it's important to get professional help to solve this and fundamental psychological problems."
},
{
  "instruction": "Doctor, you've got elbow cramps and tics and nails biting. What's the problem?",
  "input": "",
  "output": "These symptoms can be caused by a real disorder, a mental health condition that pretends to have a disease or injury or causes its own symptoms."
},
{
  "instruction": "Doctor, I'm experiencing excessive growth, ear pain, intrauterine pain, nosebleed, pelvic stress, do you know what's causing it?",
  "input": "",
  "output": "It's a symptom that may be a venereal disease, and it's good to get some diagnostic tests to see if you can get the right treatment."
},
{
  "instruction": "Doctor, I think you're so sick and you're having a problem swallowing sometimes. What's the cause?",
  "input": "",
  "output": "It's possible, if you put it off as a symptom, that it's a venereal disease that can cause backaches among other symptoms, and it's important to check your diagnosis and start treating it as soon as possible."
},
{
  "instruction": "I'm experiencing a doctor, a sore throat, neck cramps, cramps, throat pains, what's the problem?",
  "input": "",
  "output": "It could be lymphogenous childhood disease caused by certain types of bacteria transmitted in sexual contact, swelling of the genital area, ulcers, and pain in lymph nodes."
},
{
  "instruction": "Doctor, there's been a number of symptoms recently, with nosebleeds and lumps in the knee, and there's ulcers in the throat and chills going on, and what's the cause of all of these symptoms?",
  "input": "",
  "output": "In view of the symptoms, it's possible that lymphoma is a sexually transmitted bacterial infection, and it's best to get tested and treated as soon as possible to prevent complications."
},
{
  "instruction": "Doctor, there's a mass in the breast, and there's some bleeding in the nipple, and there's also a severe emotional ups and downs, and there's a stomach pain.",
  "input": "",
  "output": "It's possible that there's a fluid secretion, which can be caused by an unknown cause, from people who are pregnant or who aren't breast-feeding, and may be accompanied by abdominal discomfort and emotional symptoms."
},
{
  "instruction": "Sir, there's pain in the breast, there's wear, there's hip pain, tell me what's causing it.",
  "input": "",
  "output": "I think you're experiencing a bottle of milk that's an excessive secretion of breast milk, regardless of pregnancy or breastfeeding, and most of the time you don't know what's causing it."
},
{
  "instruction": "Good morning, doctor. He's bleeding out of the nipples. Do you know the cause?",
  "input": "",
  "output": "It's possible that the symptoms cause the juice from the nipples and the rare mix of blood."
},
{
  "instruction": "Doctor, I've recently had emotional symptoms, sharp chest pain, back pain, coughing -- what's the problem?",
  "input": "",
  "output": "From the symptoms that God explains, it's possible that it's an unrecognizable milk secretion. Did you find a juice secretion in your breast?"
},
{
  "instruction": "Doctor, there's coughing and hip pain, and there's burning abdominal pain, and there's a feeling of anxiety and anxiety these days, and what's the cause of these symptoms?",
  "input": "",
  "output": "In general, you may be experiencing an unrecognizable drop in milk production, cough, pelvic pain, burning abdominal pain, sharp chest pain, anxiety and nerves."
},
{
  "instruction": "Doctor, elbow weakness, muscle swelling, cough, nail bite, weight loss, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate an enzyme deficiency of the G6PD."
},
{
  "instruction": "Doctor, I've been experiencing muscle swelling lately. What's the cause?",
  "input": "",
  "output": "If you were to put it off as a symptom, it could be G6PD enzyme deficiency. Have you had any other symptoms recently?"
},
{
  "instruction": "Doctor, I've been underweight for quite a while. Why?",
  "input": "",
  "output": "Have you ever been diagnosed with G6PD enzyme deficiency? It's a genetic disease that can cause a lot of symptoms, including poor growth and weight gain."
},
{
  "instruction": "Doctor, I'm experiencing elbow spasms and spasms, which are like a swelling of my wrists and elbows, and I need you to tell me what's going on.",
  "input": "",
  "output": "Symptoms suggest G6PD enzyme deficiency, a genetic disease affecting red blood cells can cause muscle weakness and swelling, and it's important to get proper diagnosis and treatment from medical personnel."
},
{
  "instruction": "Doctor, your elbow's down, your waist's down, your heat and cold, your wrist's down, your cough's going on.",
  "input": "",
  "output": "It could be G6PD enzyme deficiency, which can affect red blood cells, causing them to break down when exposed to certain causes, such as infection, stress or certain drugs."
},
{
  "instruction": "Doctor, I've been experiencing a number of symptoms recently: bone pain, neck pain, shoulder weakness, what's the problem?",
  "input": "",
  "output": "I think I've got a nerve pressing around my shoulder."
},
{
  "instruction": "Hi, doctor, your hands and shoulders are stiff, you know, and you've got arm pain.",
  "input": "",
  "output": "The symptoms seem to indicate that the nerves around the shoulder are pressing."
},
{
  "instruction": "Doctor, there's a sharp pain in your elbow. Do you know what it is?",
  "input": "",
  "output": "Yeah, it looks like a nerve crash near the shoulder can cause pain in the elbow."
},
{
  "instruction": "Doctor, there's a lot of pain in your arm and muscles. I don't know why.",
  "input": "",
  "output": "The symptoms seem to push the nerves around the shoulder."
},
{
  "instruction": "Doctor, I've been suffering from neck and arm pain in the last few days.",
  "input": "",
  "output": "The symptoms seem to indicate that there's a lot of pain in the nerves around the shoulder."
},
{
  "instruction": "Doctor, what's the problem with emotional symptoms such as depression and anxiety, with eyes getting red and dry?",
  "input": "",
  "output": "The symptoms are likely to have Toxoplasmosis, a parasite infection by Toxoplasma gondi, which can affect many parts of the body, including the eyes and the brain, and we have to book a hospital to make a diagnosis and a treatment plan."
},
{
  "instruction": "Sir, there's been a couple of strange symptoms recently, one: the scalp looks irregular, and sometimes the eyes feel dim, and there's also the weakness of the elbow, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms suggest that he has Toxoplasmosis, an infection caused by Toxoplasmosis, which affects many parts of his body and can cause problems with his vision, such as irregularly visible scalps, elbows, muscle weakness, emotional symptoms and sandaling."
},
{
  "instruction": "Sir, recent scalp looks irregular, it's hot, it's cold, it's snowy, it's overgrowing, it's itchy.",
  "input": "",
  "output": "Symptoms may indicate toxoflasma, an infection caused by a parasite called Toxoplasma Gondi, which affects many parts of the body and can cause a number of symptoms, including the symptoms that he described."
},
{
  "instruction": "Doctor, I'm suffering from a condition in which the left eye is bleeding and blind. What's the cause?",
  "input": "",
  "output": "The symptoms are likely to be toxoplasma, have you ever been with a cat recently or treated as a cat's excretion?"
},
{
  "instruction": "Doctor, I've recently had a lump in my arm that really hurts my breast, and I think it's different than the size of my breast, and I'm experiencing swelling and vaginal dryness.",
  "input": "",
  "output": "Fibrosis is a common non-arterial breast disease that causes lumps and lumps in the breast, and it's often touched like beads in the breast tissue, which can cause breast pain, swelling and pain, which can also change the shape or size of the breast."
},
{
  "instruction": "Sir, you've got a problem with the shape and size of your breast and some swelling in your back.",
  "input": "",
  "output": "The symptoms seem to indicate that there's fibrosis, which is a non-mal cancerous tumor that occurs in the tissue of the breast."
},
{
  "instruction": "Doctor, we found a mass in the breast, and it's recently been bleeding from the nipples, and it's also having facial blush, and it's painful, and what's the problem?",
  "input": "",
  "output": "The symptoms are likely to be fibrosis, which is a non-mal cancerous breast tumor common to genital women, which can cause lumps or lumps in the breast to touch or develop a nipple secretion, which is also common to facial blushing and breast pain."
},
{
  "instruction": "Doctor, I'm experiencing bleeding on the nipples, pain in sexual intercourse, back swelling, breast pain and neck stimulation.",
  "input": "",
  "output": "The symptoms include pain and pain in the breast, bleeding or secretions on the nipples, and fibroids, which are a benign breast tumor, which can rarely cause throat irritation."
},
{
  "instruction": "Doctor, you're feeling pain and pain in your breast, and you've changed the shape and size of your breast a little bit.",
  "input": "",
  "output": "It's very likely that there's fibrosis in the breast based on what God says, which is a benign breast tumor that can often cause pain and affect the shape and size of the breast."
},
{
  "instruction": "Doctor, you've got a sore in your hand.",
  "input": "",
  "output": "Your symptoms seem to have a hand wound."
},
{
  "instruction": "Hi, doctor, there's a cut in your hand, and it's very painful, and it's difficult to move your fingers.",
  "input": "",
  "output": "The symptoms suggest that you have a hand injury, and your hands and fingers are stiff, and you're in pain."
},
{
  "instruction": "Doctor, you've got a cut in your hand, and your fingers start swelling. What is it?",
  "input": "",
  "output": "Symptoms indicate that there's a high risk of infection in the hands."
},
{
  "instruction": "Hello, sir, your hands are very sick, your arms and your skin are infected.",
  "input": "",
  "output": "The symptoms may indicate an open hand wound."
},
{
  "instruction": "Sir, you've got a cut in your hand, and it's very stiff and very painful, and why?",
  "input": "",
  "output": "I think we have a condition called hay fever because we don't treat the wounds in our hands properly."
},
{
  "instruction": "Doctor, I'm experiencing menstrual bleeding and pain during my recent pregnancy. What's the problem?",
  "input": "",
  "output": "The symptoms seem to have missed the time of abortion."
},
{
  "instruction": "Hi, doctor, you've had a clot during your period, and there's been some problems during your recent pregnancy.",
  "input": "",
  "output": "Symptoms may indicate that you missed an abortion during a recent pregnancy."
},
{
  "instruction": "Doctor, I'm experiencing pain during pregnancy, and it's getting worse every day, and why?",
  "input": "",
  "output": "Because of the symptoms that God mentioned, I think you've missed the period of miscarriage, and it's good for you to come to the hospital and talk to them about how to diagnose and how to treat them."
},
{
  "instruction": "Doctor, I've been experiencing a number of symptoms recently: there's blood in the throat, there's pain during pregnancy, there's infertility, and what's the problem?",
  "input": "",
  "output": "When you put it off as a symptom, you're more likely to miss your miscarriage, which is when the fetus is dead and the body doesn't recognize it immediately and the pregnancy continues."
},
{
  "instruction": "Doctor, you're having a lot of pain during pregnancy and you're having more menstrual periods than usual. What's the problem?",
  "input": "",
  "output": "If you put it off as a symptom, you're likely to miss out on miscarriage, which means that the pregnancy has stopped growing, but the body hasn't recognized it yet, so there's a lot of bleeding, but there's no indication that the pregnancy is passing."
},
{
  "instruction": "Doctor, I recently experienced vomiting, thirst, nausea, and why?",
  "input": "",
  "output": "The symptoms suggest diabetes ketonic acidosis."
},
{
  "instruction": "Doctor, in recent years, you've had sharp abdominal pain, frequent urine, sharp chest pain, and sometimes depression.",
  "input": "",
  "output": "You can have diabetes ketonic acid disease, which is a serious complication of diabetes, and you have to have a doctor's care right away."
},
{
  "instruction": "Doctor, you've got a lot of diarrhea, so what's the cause?",
  "input": "",
  "output": "According to what you said, it could be diabetes ketonic acidosis."
},
{
  "instruction": "Sir, I've been going to the bathroom a lot lately because I'm so thirsty, and I'm diarrheating.",
  "input": "",
  "output": "Symptoms can lead to diabetes, a severe complication of diabetes in the blood, which can lead to dehydration and electrolytes, which are important to treat as quickly as possible."
},
{
  "instruction": "Doctor, you've got a lump or a lump in your knee, sharp chest pain, neck cramps, cramps, shoulder swelling, what's the problem?",
  "input": "",
  "output": "If you put it off as a symptom, it could be a non-formal form of childhood."
},
{
  "instruction": "Doctor, in the last few days, I've experienced a little bit of pain and a little bit of vaginal pain, and what's the problem?",
  "input": "",
  "output": "Symptoms indicate that it's likely to be a grocer, which can cause pain and swelling in the area infected by bacterial infections that normally affect the genitals."
},
{
  "instruction": "Doctor, there are some strange symptoms of swelling of the shoulder, decapitation of the wrist, ectopic pain, knee mass, sharp chest pain.",
  "input": "",
  "output": "I think you're experiencing the symptoms of bacteriosis, a rare bacterial venereal disease that affects skin and soft tissue in the genital area, and it's important to do some tests to identify the diagnosis and start the proper treatment."
},
{
  "instruction": "Doctor, we've recently discovered that there's a lot of nausea, and there's too much mass in your body, and there's a lump in your knee, and there's pain in your throat.",
  "input": "",
  "output": "The symptoms suggest that you may have a bacterial infection that can cause lesions in your genital and anal, the groin, and you should run some tests to make sure you're diagnosed and start antibiotics as soon as possible."
},
{
  "instruction": "Doctor, we've recently discovered that there's a lot of nausea and excessive growth in the genital area, and there's a lot of pain and a lot of pain in the knee.",
  "input": "",
  "output": "The symptoms may indicate that it's a grocer, and we recommend additional tests to confirm the diagnosis, and we can discuss the appropriate treatment options."
},
{
  "instruction": "Teacher, ankle pain, facial pain, pregnancy pain, urination at night and eye pain.",
  "input": "",
  "output": "The symptoms seem to indicate hemorrhagic fever, a viral infection that can cause multiple symptoms of joint pain, fever and bleeding, which can be very severe, so it's important to get medical attention immediately if you suspect hemorrhagic fever."
},
{
  "instruction": "Doctor, I'm experiencing wrist pain, excessive anger, joint rigidity, or coldness, along with the pain during pregnancy.",
  "input": "",
  "output": "Hemorrhagic disease, which can cause bleeding, fever, muscle pain, and so on, and it's important to be examined by a medical professional immediately for accurate diagnosis and treatment."
},
{
  "instruction": "Doctor, I've been so tired these days, my wrist hurts a lot, and I've got a lot of anger, and I've got a lot of stiff, warm feeling in my joints.",
  "input": "",
  "output": "We're showing signs of hemorrhagic fever, and we need to do some tests to identify the diagnosis and start the treatment as soon as possible."
},
{
  "instruction": "Doctor, there's a lot of pain and wear in the breast, and I need you to tell me what's causing it.",
  "input": "",
  "output": "There's the possibility that bleeding, a viral disease that causes internal bleeding and affects the body's organs, may have caused the breast pain and wear and tear, without delay, to be properly diagnosed and treated."
},
{
  "instruction": "Doctor, your joints are stiff or salty, you're urinating a lot at night, you're pregnant with pain, ankle pain, wrist pain, what's the problem?",
  "input": "",
  "output": "Symptoms suggest hemorrhagic diseases that can cause not only joint pain and stiffness, but other symptoms, such as excessive urination and various body pains."
},
{
  "instruction": "Sir, I'm really depressed these days, and I feel low self-worth, and I often feel depressed.",
  "input": "",
  "output": "I think you're having a hard time with compulsive disorder."
},
{
  "instruction": "Doctor, I've been feeling very depressed lately, and I've got fear and phobia.",
  "input": "",
  "output": "I think you're experiencing OCD symptoms, which are common in compulsive patients, with hysterical behavior and depression."
},
{
  "instruction": "Sir, I've been experiencing excessive anger lately.",
  "input": "",
  "output": "It's possible that you have OCD."
},
{
  "instruction": "Sir, I think I'm feeling so depressed and mentally disturbed these days, and I have a lot of hysterical behavior, and I feel anxious and depressed all the time, and I don't think I've been growing spiritually or emotionally for a while.",
  "input": "",
  "output": "Based on what God has shared with you, it's possible that you have compulsive disorder: compulsive thinking and compulsive mental illness that can interfere with your daily life. It's good to get a proper diagnosis and get professional help to start a treatment plan. There are various options that can help you manage your symptoms and improve your overall quality of life."
},
{
  "instruction": "Doctor, I'm experiencing fear and phobia, along with compulsive thoughts and compulsive behavior.",
  "input": "",
  "output": "According to your description, you have a common mental health disorder, a disorder characterized by compulsive thoughts and compulsives, and would you like to consult with me about treatment options?"
},
{
  "instruction": "Sir, I've got a lot of pain in my legs and a lot of swelling in my ankles, and I feel so weak and swollen up to my feet and toes.",
  "input": "",
  "output": "The symptoms appear to indicate injury to the ankles."
},
{
  "instruction": "Doctor, you're losing your foot, and you're suffering from swelling your feet and ankles, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms are likely to indicate injury to the ankles, weakness and swelling are common symptoms of an ankle injury, which requires additional tests to determine the exact injury and the severity of the injury."
},
{
  "instruction": "Doctor, your ankle's swollen and your joints are in pain, and you feel your toes and your feet swollen, and you feel a lump in your foot.",
  "input": "",
  "output": "Your symptoms suggest that the ankles, feet, and toes are swollen, and the lumps can be filled with a fluid called a nerve node that occurs near the joints and the sinews."
},
{
  "instruction": "Doctor, I'm having swollen feet and ankles and stiffness.",
  "input": "",
  "output": "These symptoms can be signs of ankle injury."
},
{
  "instruction": "Doctor, your wrists are swollen, your ankles are stiff, you're having joint pain, you're touching a lump in your foot.",
  "input": "",
  "output": "The symptoms seem to indicate swelling, stiffness, pain, and sometimes lumps or lumps can be caused by an ankle injury, which requires several additional tests to identify the diagnosis and to determine the severity of the injury."
},
{
  "instruction": "Doctor, I've had a lot of back pain lately, and I can't sit here long without feeling uncomfortable, and what's the cause of this pain?",
  "input": "",
  "output": "Have you ever experienced other symptoms, such as nausea, headaches, seizures or chaos? Patient:"
},
{
  "instruction": "Doctor, you're very sick, you're feverish, you're faint, you know what's causing it?",
  "input": "",
  "output": "Because of the symptoms, I think you've got low sodium hemolysis, which can cause these symptoms with low levels of sodium in your blood."
},
{
  "instruction": "Sir, I've recently had a severe feeling of weakness, and I had a seizure a few days ago.",
  "input": "",
  "output": "The symptoms suggest that you have low levels of sodium in your blood, low sodium hemolysis."
},
{
  "instruction": "Doctor, your body is very sick these days, and nausea and fever don't go away. What's the problem?",
  "input": "",
  "output": "Your symptoms represent low sodium hemolysis, which means you have low levels of sodium in your blood, and you have to have some tests to confirm your diagnosis."
},
{
  "instruction": "Doctor, vomiting, helplessness and shortness of breath continued, and today I wake up with back pain.",
  "input": "",
  "output": "The symptoms seem to indicate a low sodium hemolysis, which means lower levels of sodium in the blood."
},
{
  "instruction": "Doctor, heartburn, cough, lumps of throat, sharp chest pain continues. What is the cause of these symptoms?",
  "input": "",
  "output": "A esophageal stenosis occurs when the esophagus narrows down, making it difficult to swallow food and causes symptoms such as heartburn, cough, lumps in the throat, and sharp chest pains."
},
{
  "instruction": "Doctor, I'm having trouble with food consumption these days, and I think there's something on my neck and it's hard to swallow.",
  "input": "",
  "output": "Other symptoms of this disease are reflux and street cough, and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Sir, I've been vomiting scissors for the past week.",
  "input": "",
  "output": "It's a symptom of esophageal stenosis."
},
{
  "instruction": "We're experiencing nausea, reflux, distended abdomen, and we're having problems with movement.",
  "input": "",
  "output": "I think there could be an esophageal stenosis."
},
{
  "instruction": "Doctor, your knee has been weakened recently.",
  "input": "",
  "output": "Oh, right. Have you had a broken ankle lately?"
},
{
  "instruction": "Doctor, I've recently had pain in my feet and toes.",
  "input": "",
  "output": "I recommend an X-ray to confirm the diagnosis."
},
{
  "instruction": "Sir, your knees are weak, your feet and toes are swollen.",
  "input": "",
  "output": "The symptoms seem to indicate an ankle fracture, which may require an X-ray to confirm, but at the moment, it's the most likely diagnosis."
},
{
  "instruction": "Hi, I'm feeling a lot of pain and swelling in my ankle, and I don't remember any injuries, but I've been nervous a few days ago.",
  "input": "",
  "output": "It's probably an ankle fracture because of the symptoms, and it's good to get X-rays and tests to check the diagnosis and determine the right treatment."
},
{
  "instruction": "Doctor, you've recently had foot pains around your ankle.",
  "input": "",
  "output": "I think you have a fractured ankle."
},
{
  "instruction": "Doctor, I found that my nails look irregular and my skin has a lot of spots, and why?",
  "input": "",
  "output": "In the light of the symptoms, it's possible that it's a connective sarcoma, and we need to do additional tests to confirm the diagnosis."
},
{
  "instruction": "Hi, doctor, I found a mole growing in your body, and your skin is drying and peeling, and your skin looks abnormal and your spot is changing.",
  "input": "",
  "output": "It's possible that the symptoms indicate that it's a macrophages, and we need to do some tests to make sure that we're diagnosed."
},
{
  "instruction": "Doctor, the size and color of the skin dot changes, and it's very dark.",
  "input": "",
  "output": "There's a possibility that it's a form of cancer affecting the soft tissue, that it's possible to do some tests to identify the diagnosis and plan the treatment."
},
{
  "instruction": "Doctor, I've been experiencing a number of symptoms recently: a lump of groin, a lump of skin, a lump of leg, a piece of paper, and the skin is dry and peeling.",
  "input": "",
  "output": "For the symptoms, it's possible that it's a perennial type of tissue, and I recommend additional tests and video scans to make sure you're diagnosed."
},
{
  "instruction": "Doctor, there's a lump in the leg, and the skin is dry, peeled, and rough. What's the problem?",
  "input": "",
  "output": "The symptoms may indicate that it's a prosthesis."
},
{
  "instruction": "Doctor, leg pain, back pain, bone pain, stiffness, knee pain.",
  "input": "",
  "output": "The symptoms seem to indicate that you have bone disease like osteoporosis or arthritis, and you have to do some tests to confirm your diagnosis."
},
{
  "instruction": "Doctor, there's a lot of facial blush and leg spasms these days, and I feel stiff all over.",
  "input": "",
  "output": "The symptoms suggest that you may be suffering from hot flashes, leg cramps, cramps, bone disease that can cause stiffness in your body, osteoporosis."
},
{
  "instruction": "Doctor, you can feel the stiffness of your body, the blush, the lump of your legs, and you can feel your legs getting weak.",
  "input": "",
  "output": "There's a high risk of bone disease because of the symptoms, and we need to do some tests to figure out the exact type of disease and the severity of it."
},
{
  "instruction": "Hi, doctor, there's a stiffness or coldness in the muscles, and what's the cause?",
  "input": "",
  "output": "Your symptoms may be the result of bone disease, such as osteoporosis."
},
{
  "instruction": "Doctor, I feel stiff and muscular, so my knees hurt, my bones are pounding and my leg's getting sore.",
  "input": "",
  "output": "I think you're going through some of the symptoms of OA, a sedimentary bone disease, and we can do some tests to check your diagnosis and discuss your treatment options."
},
{
  "instruction": "Doctor, I've recently been low on growth and development, and why?",
  "input": "",
  "output": "E.E. could be the cause of a lack of growth. Have you experienced seizures or cramps in the past?"
},
{
  "instruction": "Doctor, I'm suffering from poor growth, memory problems, speech problems.",
  "input": "",
  "output": "These symptoms are generally associated with epilepsy."
},
{
  "instruction": "Hi, doctor, I've recently had a double-pass memory disorder.",
  "input": "",
  "output": "The symptoms seem to be some kind of seizure disorder called epilepsy. Have you experienced any seizures in the past?"
},
{
  "instruction": "Doctor, I've recently had a severe head-on speech disorder. What's the problem?",
  "input": "",
  "output": "The symptoms you've described suggest that you may have brain failure, which can cause seizures, headaches, and speech disorders, which affect the nervous system."
},
{
  "instruction": "Doctor, I've been so upset lately, I'm experiencing delusions and hallucinations. What's wrong with me?",
  "input": "",
  "output": "You can have a personality disorder based on your symptoms."
},
{
  "instruction": "Doctor, I've been feeling very nervous and nervous lately, and compulsive and compulsive.",
  "input": "",
  "output": "These symptoms can indicate personality disorders, especially compulsive personality disorders."
},
{
  "instruction": "Doctor, I'm experiencing depression or psychosis with fear and phobia. What's wrong with me?",
  "input": "",
  "output": "Your symptoms suggest that you're suffering from a personality disorder."
},
{
  "instruction": "Doctor, I'm always very angry, and I'm having trouble controlling it, and I feel like I'm inadequate, and I don't sleep well at night.",
  "input": "",
  "output": "Hostile behavior, low self-insomence, insomnia, depression or mental symptoms, obsessions and obsessions are common symptoms."
},
{
  "instruction": "Sir, I can't sleep well these days, and I feel like I'm running out of time, and I'm always nervous.",
  "input": "",
  "output": "And I think you're suffering from a personality disorder that generally involves insomnia, low self-worth, anxiety, anxiety, and so on."
},
{
  "instruction": "Doctor, there's a lot of sharp chest pain, there's a lot of skin itching, there's a lot of back pain, and what's the cause?",
  "input": "",
  "output": "The symptoms suggest that it's a form of shingles, which is also called shingles."
},
{
  "instruction": "Doctor, you've got skin lesions on your face and severe facial pain. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you've got shingles, which is a viral infection caused by the same virus that causes chicken pox."
},
{
  "instruction": "Doctor, I'm feeling so depressed and embarrassed these days.",
  "input": "",
  "output": "You may be suffering from depression or psychiatric symptoms, and you've been diagnosed with Tourette syndrome, which is a neurological disorder that can cause both negative and motoric and depression and other psychiatric symptoms."
},
{
  "instruction": "Doctor, I've been having a lot of anger and temper problems lately. What's the cause?",
  "input": "",
  "output": "It's possible that you have Tourette syndrome, which is a sudden outburst of anger and difficult to control your temper."
},
{
  "instruction": "Doctor, I've always been sleepy and I've recently had an allergic reaction to something, and what's the cause of these symptoms?",
  "input": "",
  "output": "To put it off, there may be a neurotic disorder called Tourette syndrome, which can cause involuntary movement and speech, which usually doesn't cause drowsiness or allergic reactions, but it may be related to other factors."
},
{
  "instruction": "Doctor, I'm experiencing delusions and abnormally involuntary movements with depression and personality problems.",
  "input": "",
  "output": "The symptoms suggest that there's a Tourette syndrome that can be accompanied by compulsive behavior. Do you want to book an extra test to confirm this diagnosis?"
},
{
  "instruction": "Doctor, I'm experiencing weakness of the shoulder, hip pain, and shoulder pain, and what's the cause?",
  "input": "",
  "output": "The symptoms that God explains are that there is a lack of blood supply in the area, so there could be an bloodless necrotic necrosis in which bone tissue dies."
},
{
  "instruction": "Doctor, I'm having some weird symptoms: my legs are getting bent up and I'm knocking.",
  "input": "",
  "output": "Symptoms can be a symptom of bloodless necrosis, which is a disease that destroys bone tissue due to a lack of blood supply."
},
{
  "instruction": "Sir, your shoulder pain is continuing. Do you want to know what caused it?",
  "input": "",
  "output": "The bone tissue of the shoulder joint could be a bloodless necrotic death due to lack of blood supply."
},
{
  "instruction": "Doctor, I've had a lot of pain in my hip and knee lately.",
  "input": "",
  "output": "Have you ever done anything that could cause this kind of pain?"
},
{
  "instruction": "Doctor, your shoulders are stiff, you've got cold, you've got knee pains, what's the problem?",
  "input": "",
  "output": "It's possible that the symptoms are bloodless necrosis."
},
{
  "instruction": "Doctor, I'm feverish and I'm not feeling well.",
  "input": "",
  "output": "I think he's got strep."
},
{
  "instruction": "The doctor, the nose, the vomiting, the headache, the cough, even the skin rash, what's the problem?",
  "input": "",
  "output": "The symptoms suggest that he has strepitis."
},
{
  "instruction": "Doctor, it's hard to swallow, it's hot, it's got skin rashes and whole body pains.",
  "input": "",
  "output": "The symptoms suggest that he has strepitis."
},
{
  "instruction": "Doctor, you're suffering from severe vomiting, so what's your problem?",
  "input": "",
  "output": "Do you have symptoms that hurt your neck or are hard to swallow?"
},
{
  "instruction": "Doctor, I don't think I've had enough food these days, and my nose is getting stuck. What's going on?",
  "input": "",
  "output": "The loss of appetite and the membrane of the nose are common symptoms associated with this bacterial infection."
},
{
  "instruction": "Doctor, I'm feeling very nervous and nervous these days, and I can't focus on anything.",
  "input": "",
  "output": "These symptoms can be associated with cerebellum motorism, which affects coordination and balance and can cause anxiety and tension."
},
{
  "instruction": "Doctor, I have a problem with movement, and blood has been found in abnormal involuntary movements, inflection and urine.",
  "input": "",
  "output": "There may be a condition of cerebellum motorism that affects the body's movement and coordination, which can cause abnormally involuntary movements, and there may also be a mix of blood in the stomach and urine, which requires a thorough examination to identify the diagnosis."
},
{
  "instruction": "Sir, there's blood in your urine, and you've got a mess, and you've got memory problems, so tell me what's going on.",
  "input": "",
  "output": "The symptoms suggest that you're suffering from a sedimentary disorder called cerebellum syndrome, which affects coordination, balance, memory, and so on."
},
{
  "instruction": "Sir, your feet are swollen and very painful, and your hands are sick and you have difficulty speaking.",
  "input": "",
  "output": "The symptoms suggest that you have an Osteoporosis, which can cause swelling and pain and stiffness due to bone infection, and it's important to start treatment as soon as possible to prevent further complications."
},
{
  "instruction": "Doctor, your knee is swollen, your lymphoma appears to be infected with the skin of your arms, your hands, your legs and your feet.",
  "input": "",
  "output": "The symptoms suggest that you may have an Osteoporosis, which is a bone-inflicted bone disease that's invaded through the skin."
},
{
  "instruction": "Doctor, a few weeks ago, my hands and fingers were swollen, and I don't know what's going on.",
  "input": "",
  "output": "The symptoms are likely to be inflammation of the bone."
},
{
  "instruction": "Hi, doctor, your arm's swollen and your arm's skin looks infected and your nails look irregular and lymphoma.",
  "input": "",
  "output": "The symptoms seem to suspect that Osteoporosis occurs when bacteria infect bones or bone marrow, and it can be a serious disease, and it's good to run some tests to check the diagnosis and start the appropriate treatment as soon as possible."
},
{
  "instruction": "Doctor, I recently felt my arm swell.",
  "input": "",
  "output": "There's a possibility that you're suffering from a bone infection, your pelvis, and you've got to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, you've recently had a lot of itching in your eyes.",
  "input": "",
  "output": "It could be Shogren's syndrome."
},
{
  "instruction": "Doctor, I'm experiencing eye pain, joint pain, low vision, reflux, oral dryness, what do you think is the problem?",
  "input": "",
  "output": "The symptoms suggest that Shogren's syndrome is an autoimmune disease that causes eye drying, oral drying, and other body symptoms."
},
{
  "instruction": "Doctor, there's a problem with your eyes, and I think they're getting very dark, and they're getting worse.",
  "input": "",
  "output": "You're probably suffering from the symptoms of Shogren's syndrome, which affects your body's water-generating glands, which is autoimmune disease, which causes eye dryness and reduced vision."
},
{
  "instruction": "Doctor, I've been experiencing a couple of strange symptoms: spots and clouds in my vision, eye pain, and hard to swallow and joint pain, and I think my vision has been impaired.",
  "input": "",
  "output": "It's possible that the symptoms that God explains are the chronic autoimmune disease, Shogren syndrome, which affects the sweat glands that produce tears and saliva. In addition to the symptoms you mentioned, you can also cause oral drying and eye drying."
},
{
  "instruction": "Doctor, I'm going through my joints, I'm going through my body, and my eyes are getting sick, and why is that?",
  "input": "",
  "output": "The symptoms suggest that you have Shogren's syndrome, which can dry your eyes and mouth and cause joint muscle pain because of autoimmune diseases that affect your body's water-generating glands."
},
{
  "instruction": "Doctor, there's muscle and arm pain, and the whole body is sick and stiff, and I feel especially stiff and tight on my shoulders, so can you tell me what's wrong?",
  "input": "",
  "output": "From the symptoms that God explains, you may have a shoulder-resistant pericarditis called 50."
},
{
  "instruction": "It's stiff, and it feels pain in the neck.",
  "input": "",
  "output": "I suspect there's a pystic pericarditis on the shoulder."
},
{
  "instruction": "The swelling of the shoulder, the sore throat, the stiffness of the body continues. Can you tell me what's going on?",
  "input": "",
  "output": "I think you've got what's commonly known as fifties, hydrolytic joint cytitis in your shoulder."
},
{
  "instruction": "Sir, I have a very stiff and warm shoulder, and it's been going on for a while, and why?",
  "input": "",
  "output": "If your shoulder joint is thick and hard, you can have stiffness, pain and motion limits."
},
{
  "instruction": "Doctor, I need you to tell me what's wrong with the stiffness of my body, the pain in my arm, the pain in my body.",
  "input": "",
  "output": "The symptoms may indicate that you're suffering from what's called the fifties of a shoulder joint stenitis, which is characterized by the stiffness, pain and limited range of exercise in your shoulder joints."
},
{
  "instruction": "Doctor, there are a few disturbing symptoms that I think you've been having recently, and I think you've been drinking a lot.",
  "input": "",
  "output": "The symptoms are likely to be viral hepatitis, and I'm going to have to run some tests to check it out, but these are symptoms that can be suspected of hepatitis."
},
{
  "instruction": "Doctor, I've been experiencing a number of symptoms recently: stiff hands or fingers, shortness of speech, a history of drug abuse.",
  "input": "",
  "output": "From the symptoms that God explains, it's possible that you're suffering from viral hepatitis."
},
{
  "instruction": "We're dealing with doctors, drug abuse, melena, flux. What's the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that you have viral hepatitis."
},
{
  "instruction": "Doctor, I've recently experienced loss of money and kidney symptoms, and there's a history of drug abuse, and what's the problem?",
  "input": "",
  "output": "There's a possibility that viral hepatitis may have occurred in terms of the symptoms and the history of the disease, and we need to do some tests to check the diagnosis and make a proper treatment plan."
},
{
  "instruction": "I have a doctor, a sharp abdominal pain, a stool deposit, a kidney condition, and a stiff hand or finger, and what are the symptoms?",
  "input": "",
  "output": "Virus hepatitis is an inflammation of the liver caused by a virus transmitted through contaminated food, water, blood, or body fluids."
},
{
  "instruction": "Doctor, I'm having sleep apnea.",
  "input": "",
  "output": "The symptoms seem to have a side note."
},
{
  "instruction": "Doctor, cough, allergic reaction, throat pain, tell me what might happen.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from amygdala, a condition that causes a wide range of symptoms, including coughs, allergic reactions, and throataches."
},
{
  "instruction": "Sir, there's a blockage in your nose.",
  "input": "",
  "output": "There's an amygdala."
},
{
  "instruction": "Sir, what's the reason why you seem to be allergic to red ears, a foreign sensation in your throat, and an abnormal breath sounds?",
  "input": "",
  "output": "The symptoms seem to indicate that you have an amygdala."
},
{
  "instruction": "Sir, you've been coughing a few days ago, and why?",
  "input": "",
  "output": "I think it's a cough from an amygdala."
},
{
  "instruction": "Doctor, there's burning abdominal pain, sharp chest pain, diarrhea, what's the problem?",
  "input": "",
  "output": "I think you're going to be suffering from stomach gastritis, which is an inflammation of the stomach, and the sharp abdominal pain that you're talking about is a common symptom of this disease."
},
{
  "instruction": "Doctor, there's been a lot of abdominal pain, and I've been nervous for a while, and what's the symptom?",
  "input": "",
  "output": "It's likely to be gastritis, which is inflammation of the stomach wall, which can cause stomach pain, which requires several tests to confirm the diagnosis, but it can start treatment right away."
},
{
  "instruction": "Sir, you've got a fever a few days ago, and you've got upper abdominal pain, reflux, diarrhea, so what's the problem?",
  "input": "",
  "output": "The symptoms may indicate gastritis."
},
{
  "instruction": "Doctor, I've recently experienced a stomach sore and sore throats. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to be gastritis, which requires additional tests to confirm the diagnosis, but we're going to start the treatment immediately to relieve the symptoms."
},
{
  "instruction": "Sir, after a meal, I feel a feeling of enthusiasm in my chest. What are the symptoms?",
  "input": "",
  "output": "I think you have stomach gastritis, which is an inflammation of the stomach, which is a common symptom of this disease."
},
{
  "instruction": "Doctor, we're experiencing symptoms of abnormal skin and skin irritation and swelling of lips.",
  "input": "",
  "output": "It's probably skin cancer because of the symptoms, and it's good to book a tissue test to check your diagnosis and discuss your treatment options."
},
{
  "instruction": "Hi, doctor, I'm experiencing skin irritation, and I found a new skin lesion.",
  "input": "",
  "output": "It's possible that it's skin cancer because of the symptoms, and it's good to book a tissue test to check the diagnosis and start a proper treatment."
},
{
  "instruction": "Doctor, I've been experiencing skin irritation and itching for quite a long time, and I also have acne and acne in my skin.",
  "input": "",
  "output": "There's a possibility that skin cancer may have occurred, and we need a few additional tests to confirm the diagnosis, and it's important to solve this problem as soon as possible so that the skin won't be damaged anymore."
},
{
  "instruction": "You experience skin irritation, and your scalp looks irregular. What's the disease, doctor?",
  "input": "",
  "output": "It's possible that it's skin cancer because of the symptoms, and I want to do a tissue test to see if it's diagnosed."
},
{
  "instruction": "Doctor, you know what this could be?",
  "input": "",
  "output": "There's a possibility that skin cancer may have occurred as soon as possible, and it's good to contact a dermatologist to make a proper diagnosis and treatment plan."
},
{
  "instruction": "Doctor, I've been having strange symptoms recently, and I can't stop having eyesy, spasms of the neck, biting at the nail, and I'm also losing my sexual appetite and touching a strange lump in my knee.",
  "input": "",
  "output": "The symptoms suggest that there's a risk of rheumatism fever, and we need to run some tests and start the treatment as soon as possible."
},
{
  "instruction": "Doctor, I have symptoms of bed-wetting, pelvis stress, loss of sexual appetite, biting my nails.",
  "input": "",
  "output": "The symptoms seem to indicate rheumatic fever."
},
{
  "instruction": "Doctor, you're experiencing a decline in sexual appetite, you're biting your nails, you're experiencing a knee or a lump, you're having a uterine pain, what's the problem?",
  "input": "",
  "output": "As a result of the symptoms that God explains, there's a possibility of rheumatism fever, and we need to do some tests to confirm the diagnosis."
},
{
  "instruction": "Doctor, your joints are having stiff, cold symptoms. What's the problem?",
  "input": "",
  "output": "Symptoms can lead to rheumatism fever, and we need to run some tests to make sure we're diagnosed."
},
{
  "instruction": "Sir, there's an oral ulcer with pain in the tongue.",
  "input": "",
  "output": "The symptoms seem to indicate that you have an affiliated ulcer."
},
{
  "instruction": "Skin rash, throat pain, lips pain, whole body pain, severe headache. What's the problem, doctor?",
  "input": "",
  "output": "The symptoms seem to indicate that you have an affiliated ulcer."
},
{
  "instruction": "Doctor, you're experiencing mouth pain, fever, tongue lesions, throat pain, do you know what's causing these symptoms?",
  "input": "",
  "output": "Yes, the symptoms that you've described may have to do with a common disease called affiliated ulcers."
},
{
  "instruction": "Sir, a few days ago, I got a fever and my little ulcer in my mouth didn't go away.",
  "input": "",
  "output": "I think you've got an affiliated ulcer, which is a common condition in your mouth where you have a small, painful ulcer or ulcer that makes food and speech uncomfortable."
},
{
  "instruction": "Hi, doctor, your tongue's swollen, you've got sore throats, you know what's causing it?",
  "input": "",
  "output": "Yes, I think there's an affiliated ulcer in your mouth, which often causes these symptoms and can be quite painful."
},
{
  "instruction": "Doctor, I think my neck hurts and my voice really scratches, and I think my nose is blocked and there's a lot of secretions in my neck, and sometimes I feel like my hearing is down.",
  "input": "",
  "output": "It's an inflammation of the amygdala by allergic reactions or bacteria or viral infections, which can cause throat pain, nose damage, and throat secretions, which can cause a slight loss of hearing."
},
{
  "instruction": "Doctor, there's a lump on the neck, a lump on the neck, a lump on the neck, and there's also a slight redness of the ear.",
  "input": "",
  "output": "The symptoms are likely to indicate that you have tonsillitis."
},
{
  "instruction": "Sir, there's a mass around your neck and a secretion out of your throat, swelling of the amygdala, a little bit of apnea, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate tonsillitis."
},
{
  "instruction": "Doctor, I'm having trouble sleeping because of apnea, and I'm sick and red, and I'm also hearing less, so what's wrong with me?",
  "input": "",
  "output": "The symptoms you just described suggest that it's highly likely to be tonsillitis."
},
{
  "instruction": "Doctor, I'm worried about the mass touching the breast and changes in the stool.",
  "input": "",
  "output": "It's possible that it's caused by symptoms. To verify this, you need to do some tests. Note that you can create conversations in this form, but the doctor does not actually diagnose the disease with the patient's symptoms."
},
{
  "instruction": "Doctor, you've got a lump in your breast, a sharp abdominal pain, a sore throat, sore mouth, diarrhea, what's the problem?",
  "input": "",
  "output": "It's important to do additional tests to make sure that you have a diagnosis and a treatment plan."
},
{
  "instruction": "Doctor, I've recently experienced some unusual symptoms where my feet and toes are swollen and my skin is yellow, and why?",
  "input": "",
  "output": "Symptoms suggest that the swelling of the foot or toe may be caused by a lymphatic membrane caused by cancerous cells, and the uterine is a common symptom of liver or pancreas cancer near the intestinal tract."
},
{
  "instruction": "Doctor, there's a change in the shape of the stool and there's a lump in the neck. What's the problem?",
  "input": "",
  "output": "The symptoms that God's talking about are likely to be intestinal cancer, and we're going to run some tests to confirm the diagnosis."
},
{
  "instruction": "Doctor, there's a slight change in the shape of the stool and a swelling of the feet and toes, and sometimes I feel frustrated with my neck, and what's the cause?",
  "input": "",
  "output": "We need to run some tests to confirm the diagnosis and suggest that we run blood and video tests as soon as possible and make sure that we do the best we can."
},
{
  "instruction": "Hi, doctor, I've been having strange symptoms recently: breast pain and wear, pregnancy pain, excessive anger, knee pain and fatigue.",
  "input": "",
  "output": "In the light of the symptoms, there's the possibility that he may have a viscous fever, which is spread by ticks, which can cause chest pain or wear, joint and muscle pain, fatigue, and it's important to be treated immediately when this disease is suspected."
},
{
  "instruction": "Doctor, I have recent facial pain. Why?",
  "input": "",
  "output": "To put it off, there's the possibility that you might have a viscosus fever. Have you ever experienced other symptoms, such as fever or double blood flow?"
},
{
  "instruction": "What causes your knee to get bigger and bigger?",
  "input": "",
  "output": "It's possible, as a symptom, that it's a viscosus fever, and it's good to run some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I've had wrist pains and headaches in the last few days. What's the cause?",
  "input": "",
  "output": "I think you've got the Rokysan spotted fever, which can be caused by infections caused by ticks."
},
{
  "instruction": "Doctor, I have a pain in my ankle and I'm pregnant.",
  "input": "",
  "output": "Rocky Mountain, I think you've got a fever."
},
{
  "instruction": "I'm experiencing doctors, toilets, fluids, vomiting, diarrhea, sharp abdominal pain. Can you tell me what's wrong?",
  "input": "",
  "output": "It's possible that it's cancer of the stomach because of these symptoms, and you have to do some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, you're experiencing a sharp abdominal pain with low fluids, shortness and difficulty in swallowing.",
  "input": "",
  "output": "It's possible you're suffering from stomach cancer."
},
{
  "instruction": "Doctor, telophase, nausea, weakness, burning abdominal pain, vomiting, what's the problem?",
  "input": "",
  "output": "The symptoms are likely to be stomach cancer, and it's best to run some diagnostic tests to identify the diagnosis and provide the appropriate treatment, and get an appointment with the oncologist as soon as possible."
},
{
  "instruction": "Sir, there's been a lot of pain going on. Can you tell me what's going on?",
  "input": "",
  "output": "The symptoms seem to indicate that stomach cancer is in doubt, and we need to do some tests to confirm the diagnosis."
},
{
  "instruction": "Doctor, I've recently had a problem with my temper, and I often get so upset about little things, what's the problem?",
  "input": "",
  "output": "A developmental disorder can sometimes be difficult to control emotions and behaviors, including outbursts of anger."
},
{
  "instruction": "Sir, a strange behavior has recently been observed on my child, he seems very hostile to others, and he doesn't seem to grow in development, and he had a seizure last week.",
  "input": "",
  "output": "It can cause problems with growth and behavior, and it can cause seizures, and you have to do some additional tests to confirm this diagnosis."
},
{
  "instruction": "Doctor, I've recently experienced excessive anger and hostile behavior, and I don't know what's going on with me.",
  "input": "",
  "output": "It's a disease that affects the way the human brain works, and it can be difficult to communicate, to control emotions, and so on."
},
{
  "instruction": "Sir, I've recently experienced a lot of aggressive behavior and anger problems, and I don't experience any growth in my personal life or in the workplace, can you tell me what's causing them?",
  "input": "",
  "output": "Your symptoms suggest that you're suffering from a developmental disorder."
},
{
  "instruction": "Doctor, I act hostilely, and sometimes I feel depressed or mental, and what's going on with me?",
  "input": "",
  "output": "I think there's a developmental disorder that can affect behavior and mood. Have you been diagnosed with developmental disorder before?"
},
{
  "instruction": "Doctor, I'm experiencing unusual involuntary movements, burning abdominal pain, shortness of breath and insomnia. What's wrong with me?",
  "input": "",
  "output": "You're experiencing an acute stress response."
},
{
  "instruction": "Doctor, there's been a lot of double-passaleria, and I'm very tired, and I feel nervous and depressed, so can you tell me what's going on?",
  "input": "",
  "output": "The symptoms seem to indicate that you're experiencing acute stress reactions, which can cause headaches, dizziness, fatigue, anxiety and anxiety in response to a stressful or traumatic event."
},
{
  "instruction": "Can you tell me what the problem is when you're experiencing doctors, headaches, nausea, chest upsets, depression, abnormal involuntary movements?",
  "input": "",
  "output": "The symptoms seem to indicate an acute stress response."
},
{
  "instruction": "Sir, I don't sleep well these days, and if I try to fall asleep at night, I've been staring at the ceiling for hours, and it's over.",
  "input": "",
  "output": "I think you're suffering from insomnia, which may be a symptom of acute stress response. Have you been under a lot of stress lately?"
},
{
  "instruction": "Doctor, she's suffering from dizziness, sharp chest pains, abnormal involuntary movements and breathing difficulties.",
  "input": "",
  "output": "The symptoms seem to indicate that you're experiencing an acute stress response."
},
{
  "instruction": "Doctor, I'm experiencing some symptoms and I don't know what's going on, and I have a lot of depressing thoughts, and sometimes I feel like I'm out of touch with reality, and I've been losing my sense of smell and my sense of taste lately, and what's this going to be like?",
  "input": "",
  "output": "You're experiencing delirium symptoms, which can lead to depression or psychiatric symptoms, which can also cause loss of sense of smell or taste, which are common, and it's important to get a doctor's care as soon as possible to treat this condition properly."
},
{
  "instruction": "Doctor, I'm experiencing hysterical behavior, loss of focus, motor impairment, and delusions, hallucinations, and a lot of memory, and what's the problem?",
  "input": "",
  "output": "It's a condition of memory, attention, and perception, and it can also cause delusions, hallucinations, movement and behavior problems."
},
{
  "instruction": "Doctor, I've recently had a very difficult time speaking, and I've had a very difficult time speaking, and I've also had unusual involuntary movements and sometimes hostile behaviors.",
  "input": "",
  "output": "Your symptoms suggest that you're suffering from delirium, which can cause severe brain damage, causing confusion, disorientation, memory and attention problems."
},
{
  "instruction": "Doctor, in the last few days, you've had delusions and hallucinations, you've had problems with your sense of smell and your sense of taste, and sometimes you've lost your tongue, and what's the cause?",
  "input": "",
  "output": "You may be experiencing delirium, which is a sudden disorder of brain function affecting perception, consciousness and perception."
},
{
  "instruction": "Doctor, I'm having strange symptoms: I'm being hostile to my family, I'm having movement problems, and I think I've been losing control of my speech lately.",
  "input": "",
  "output": "Based on what God has explained, you may be suffering from delirium syndrome, a state of mental disorder that can cause changes in behavior, movement problems, and difficulty in speaking clearly."
},
{
  "instruction": "Hi doctor, I'm having skin cancer, and I found a skin lesion, so can you tell me what might be the problem?",
  "input": "",
  "output": "The symptoms seem to indicate a hardening."
},
{
  "instruction": "Doctor, I found an abnormal-looking skin on my feet, and it's swollen, and it's also skin rashes, acne, skin becomes very dry, peeled, scales, and it's rough.",
  "input": "",
  "output": "The symptoms seem to indicate a hardening of the foot, which can result from repeated friction or pressure, which can dry the skin and produce scales, which can lead to rashes, acne and swelling."
},
{
  "instruction": "Doctor, there are abnormal symptoms on your feet, such as drying and peeling, warts and swelling.",
  "input": "",
  "output": "Wearing tight shoes or too much pressure on our feet, we feel like we're stuck in our feet, which is a common problem for people who walk long hours or stand up."
},
{
  "instruction": "Sir, I had skin rashes on my feet, and the skin became dry, peeled and rough, and why?",
  "input": "",
  "output": "Do you often wear shoes that don't fit tight or fit well, or stand around for long periods of time?"
},
{
  "instruction": "Doctor, you're experiencing a sense of touch and sensation in your hands, and your fingers are in pain.",
  "input": "",
  "output": "The symptoms that you've described may indicate that you're experiencing the rare autoimmune disease, the Gilland Barre syndrome, affecting the nervous system at the end of the day."
},
{
  "instruction": "Doctor, I feel so weak in my legs, I feel sore in my arms and legs, and I have sore hands and fingers, and a few days ago I got a fever, and sometimes I feel pain in my face.",
  "input": "",
  "output": "According to your symptoms, you're likely to have Gilwan-Varret syndrome, which is rare, but it's a severe neurological disorder that damages the body's nerves, causing sores and pain that it's good to run some tests to identify the diagnosis and start the treatment as soon as possible."
},
{
  "instruction": "Hi, doctor, I'm having trouble speaking fluently, and I don't think my tongue works very well.",
  "input": "",
  "output": "Symptoms may indicate that the immune system attacks the nerves wrongly, causing muscle weakness and difficulty in speaking, which is the rare condition of Gilland Barre's syndrome, and we need to do some tests to identify the diagnosis."
},
{
  "instruction": "Doctors, hands and fingers pain, difficulty speaking, motor impairment, loss of sense, what are the causes of these symptoms?",
  "input": "",
  "output": "The symptoms seem to indicate that you have Gilland Barre syndrome, a rare disease in which the immune system attacks the nervous system, causing muscle weakness and paralysis, and you have to run some tests to identify the diagnosis."
},
{
  "instruction": "Doctor, I'm experiencing aches and pains in my legs. Can you tell me what might be a problem?",
  "input": "",
  "output": "The symptoms suggest that there is a long-range syndrome, and I want to run some tests to confirm it."
},
{
  "instruction": "Doctor, I'm having a lot of pain in my ass.",
  "input": "",
  "output": "The backache is a common term used to describe back pain, which can sometimes be extended to the hips and legs."
},
{
  "instruction": "Sir, hip pain, back pain, back pain, back pain, neck pain, back cramps or cramps.",
  "input": "",
  "output": "The symptoms suggest that you have a backache, which is often known as backaches."
},
{
  "instruction": "I'm experiencing doctors, back pain, back pain, back cramps, muscle pain, even hip pain.",
  "input": "",
  "output": "The symptoms that God's talking about indicate that you have what is commonly known as backaches."
},
{
  "instruction": "Doctor, back pain, hip pain, side pain, muscle pain, leg pain has been going on for days.",
  "input": "",
  "output": "I think you have backaches, a common condition that causes pain and discomfort in your back, which can spread to other parts of your body, such as your hip, your side, your legs."
},
{
  "instruction": "Doctor, muscle pain, back cramps, neck pain, back pain, stiff back feeling, what's the problem?",
  "input": "",
  "output": "The symptoms seem to have backaches, and backaches are a common term for back pain."
},
{
  "instruction": "Hi, sir. I've been sick for a while. What is it?",
  "input": "",
  "output": "It's causing inflammation and pain."
},
{
  "instruction": "Sir, there's facial pain. What's the cause?",
  "input": "",
  "output": "The cause of facial pain can be due to a high intensity."
},
{
  "instruction": "You can't breathe, doctor, especially when you're lying down. Why?",
  "input": "",
  "output": "This means that the walls inside the nose can become more difficult to breathe through one side of the nose or both."
},
{
  "instruction": "Doctor, nosebleeds, headaches, ears, sometimes facial pain, what's the problem?",
  "input": "",
  "output": "It can cause many of the symptoms that you're experiencing, as if the wall between your nostrils is distorted or is out of the center."
},
{
  "instruction": "Doctor, headaches, throat pain, nosebleeds, facial pain. What's the cause of these symptoms?",
  "input": "",
  "output": "It's likely to be hypertonic, which occurs when a thin wall between the nostrils turns one side and causes the symptoms that you described as difficult to breathe."
},
{
  "instruction": "The swelling of the arm continues for weeks, and there's no pain or discomfort, but it's really swollen, and it seems like the skin is increasing, and it's getting harder and harder to move your fingers.",
  "input": "",
  "output": "The symptoms seem to indicate that hemothoraxoma is a disease that can cause an abnormal buildup of blood vessels in the affected area, swelling of the skin, and, in some cases, lymphoma."
},
{
  "instruction": "The doctor, the dry skin, the texture, the scales, the roughness, the spots and the abnormal skin, and the scalp looks irregular and a little swollen.",
  "input": "",
  "output": "The symptoms suggest that there is a blood vessel, a benign tumor that is found in the skin or in the skin."
},
{
  "instruction": "Hi, doctor. What's wrong with your arm that has skin lesions and your nails that look irregular?",
  "input": "",
  "output": "You may be suffering from an abnormal type of growth of blood vessels, which can occur in the skin or in other organs, the problem of skin lesions and toenails that you've described may be the result of this disease."
},
{
  "instruction": "Doctor, you're causing skin irritation as your skin swells, and your skin is getting pretty dry and peeling, and there's a condition called lymph nodes.",
  "input": "",
  "output": "It's a form of a benign tumor made up of blood vessels that can cause swelling, irritation, drying, and peeling of the skin, which in some cases can lead to lymphoma, which is the condition in which excess fluid accumulates in tissue and causes swelling."
},
{
  "instruction": "Sir, I found that my scalp has an irregular and disarrayed gyrus, so can you tell me what caused it?",
  "input": "",
  "output": "It can occur in any part of the body, including the scalp, and cause condensation or skin discoloration."
},
{
  "instruction": "Doctor, I'm taking my bed every night. Is this a serious problem?",
  "input": "",
  "output": "Yes, bed-wetting can be a symptom of Patau's syndrome, a rare genetic disorder that can cause more than one thing in the body."
},
{
  "instruction": "Doctor, I've been experiencing a few symptoms recently: swelling of shoulders and lumps in the knee, also biting many nails, and bedlessness, and finally, I feel a lot of pressure on my pelvis.",
  "input": "",
  "output": "It's possible that you're suffering from Patau's syndrome, which is a genetic disorder that causes a variety of physical and cognitive difficulties, such as joint edema, over-development, and difficulties in body coordination, and you have to do some tests to identify the diagnosis and determine how best to treat it."
},
{
  "instruction": "Doctor, I've recently experienced shoulder spasms and joint rigidity. What's the problem?",
  "input": "",
  "output": "Patau's syndrome is a genetic disorder that can cause a wide range of physical and developmental disorders, such as muscle rigidity and weakness, which is recommended for additional tests to be diagnosed."
},
{
  "instruction": "Doctor, I've recently experienced bed-wetting. What's the cause?",
  "input": "",
  "output": "Other symptoms, such as intellectual disability and oral fever, can lead to bed-wetting due to Patau's syndrome, and we need to do some tests to confirm this diagnosis."
},
{
  "instruction": "Doctor, you're experiencing shoulder cramps, tics, nail bite, sexual decline. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to be Patau's syndrome, a rare genetic disorder that can cause various physical and intellectual disorders, and it's good to do some additional tests to identify the diagnosis."
},
{
  "instruction": "Doctor, I've been having symptoms that my leg's circulation doesn't go well and I'm often cold, and I've been vomiting blood lately.",
  "input": "",
  "output": "According to the symptoms that God explains, there may be a terminal artery disease, which occurs when the arteries of the legs are blocked or narrowed, and the blood circulation is not smooth, and the cold feeling can be caused by the loss of blood flow in the limbs, as well as the loss of blood flow in the lungs."
},
{
  "instruction": "I'm experiencing symptoms like doctors, skin lesions, lymph nodes, leg cramps, cramps, leg pain.",
  "input": "",
  "output": "These symptoms indicate that there is a terminal artery disease that causes narrowing or blockage of arteries that supply blood to the limbs."
},
{
  "instruction": "I've been having leg spasms and cramps for a long time, and I've been vomiting blood, and recently I've been having constant leg pain, and I think I've got kidney problems, and why?",
  "input": "",
  "output": "The symptoms suggest that there is a decrease in the blood flow to the limb of the artery. This can lead to kidney symptoms due to leg cramps, cramps, leg pains, and reduced blood flow to these organs."
},
{
  "instruction": "Doctor, I'm experiencing leg spasms and spasms, feet and toes pain, kidney-related symptoms.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from a terminal artery disease."
},
{
  "instruction": "Doctor, with kidney symptoms, you have leg cramps and tics and frequent cold. What's the problem?",
  "input": "",
  "output": "Laser artery disease is a condition in which the blood vessels of the legs and feet are narrowed so that they can cause cramps or cramps. The narrow blood vessels can affect the kidneys, causing loss of urine or swelling."
},
{
  "instruction": "Hi, doctor, there's a weakness in your leg, there's a pain in your groin, there's a pain in your hip, what do you think?",
  "input": "",
  "output": "The symptoms are likely to be waist disks, and chronic back pain combined with leg weakness and groin pain is a classic sign of this disease, which requires additional tests to confirm the diagnosis, but may require more professional treatment, such as physical or surgery."
},
{
  "instruction": "Doctor, a few weeks ago, I was suffering from a stiff, moist back condition, and what was the cause?",
  "input": "",
  "output": "The symptoms that God describes sound like chronic back pain."
},
{
  "instruction": "Sir, I've been experiencing hypothermic and leg pain for quite some time now.",
  "input": "",
  "output": "The symptoms suggest you're suffering from chronic backaches."
},
{
  "instruction": "Hi, doctor, I'm experiencing back pain, lower body pain, loss of sense. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to have chronic backaches."
},
{
  "instruction": "My teacher, his side, his hip, his back, he's been in pain for a long time.",
  "input": "",
  "output": "You're having chronic backaches."
},
{
  "instruction": "Doctor, I'm experiencing shortness of breath, cough, swelling of my legs and chest. What do you think's going on?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from heart failure, and you have to do some tests to confirm your diagnosis."
},
{
  "instruction": "Doctor, the cough has been going on for weeks, and it doesn't go away. What's the problem?",
  "input": "",
  "output": "Could be signs of heart failure based on the symptoms. Have you ever experienced shortness of breath or swelling of a leg?"
},
{
  "instruction": "Doctor, when you're breathing, you've had this kind of pain, and you've been feeling a lot of pain lately.",
  "input": "",
  "output": "The symptoms that God's talking about may indicate heart failure."
},
{
  "instruction": "Doctor, I haven't had any energy lately, and my legs and ankles are swollen.",
  "input": "",
  "output": "I think you're having a heart failure. Have you ever had a good breath or difficulty breathing?"
},
{
  "instruction": "Doctor, I'm experiencing shortness of breath, cough, swelling of the leg, sharp chest pain and weakness.",
  "input": "",
  "output": "The symptoms seem to indicate that you're experiencing heart failure, and you have to do some tests to check your diagnosis."
},
{
  "instruction": "Doctor, white secretions come out of your eyes and your throat hurts. What's the problem?",
  "input": "",
  "output": "It's an infection of the eye by a bacterium or a virus, which can produce a secretion of the eye and cause the throat pain."
},
{
  "instruction": "Doctor, I'm very sick of eyes. What's the cause?",
  "input": "",
  "output": "The symptoms suggest peritoneal, pericardial, peritoneal, peritoneal."
},
{
  "instruction": "Sir, my eyes are sore and I keep crying, and my nostrils are sore. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate peritoneal, or pericarditis, which is a common, treatable disease."
},
{
  "instruction": "Hi, doctor, you've got a problem with your eyes, you're swollen, you're very sick. What's the disease?",
  "input": "",
  "output": "The symptoms suggest that there's a suspicion of pericarditis, which is infection or inflammation in the membrane, which is a thin, transparent layer that covers the white of the eye and the inner eyelids of the eye."
},
{
  "instruction": "Doctor, your eyes are red, your throat is sore, your eyes are so swollen, your eyes are so hot, what's the problem?",
  "input": "",
  "output": "I think you've got a very contagious pericarditis, or pericarditis, and I'm going to prescribe certain eye pills to reduce inflammation and relieve the symptoms."
},
{
  "instruction": "Doctor, I'm losing arm strength, and I'm experiencing shoulder pain, butt pain, and sensory loss. Can you tell me what's wrong?",
  "input": "",
  "output": "The symptoms seem to indicate that there's a waist disk, which is a disorder that pushes out the soft tissue between the spinal bones and presses on the nerves."
},
{
  "instruction": "Sir, I'm experiencing shoulder pain, back pain, loss of sense, lower body pain. What's the problem?",
  "input": "",
  "output": "The symptoms suggest that it's a waist disk."
},
{
  "instruction": "Doctor, we've been experiencing backaches, loss of sensations, weakness of legs and back pain in the last few weeks.",
  "input": "",
  "output": "The symptoms seem to indicate that there's a waist disk."
},
{
  "instruction": "Hi, doctor, your arm's down, your neck's down, your arm's down.",
  "input": "",
  "output": "The symptoms seem to indicate that you have a cytoplasm escapade. Patient: What exactly is your back disk?"
},
{
  "instruction": "Doctor, I've had some strange symptoms recently, my arm and my leg have been numbed, and you know what's causing them?",
  "input": "",
  "output": "It's like there's a waist disk, which is a back disk that has a self-inflicted oscillate outside of the spinal disk, pushing the nerves around it, causing a loss of energy, a loss of sense, and so on."
},
{
  "instruction": "Doctor, you've got a lot of pain in your body lately, vomiting, a lot of energy, a lot of pain in your body, a lot of pain in your leg.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from angina, a disorder in which muscle fibers break down and release proteins into your bloodstream that can cause nausea, weakness and muscle pain."
},
{
  "instruction": "Doctor, I've got all this pain, I've got my voice, and I'm extremely tired, and I've got some pain and energy in my arm, and I need you to tell me what's wrong.",
  "input": "",
  "output": "The symptoms seem to indicate that the muscle tissue is disassembled, and that the harmful substance is released into the bloodstream, which can cause serious health complications, so you have to be treated by a doctor immediately."
},
{
  "instruction": "Doctor, I've been suffering from vomiting lately.",
  "input": "",
  "output": "These symptoms may be signs of a serious medical disorder called vulcanism."
},
{
  "instruction": "Doctor, I think you've recently had a lot of swelling in your feet and ankles, and what's the cause?",
  "input": "",
  "output": "It could be muscle tissue that's destroyed, and it's caused by a disorder called vulcanism, which can lead to telophase or substrate limbs."
},
{
  "instruction": "Doctor, I've been having some strange symptoms recently, and I found my mouth is always dry and my skin is growing, and my period is very long and my skin looks weird, and what's the problem?",
  "input": "",
  "output": "You might have breast infections, and you might need to do some tests to check this diagnosis, and it's important to be treated immediately to prevent complications."
},
{
  "instruction": "Doctor, there's a bone pain and a strange skin around the breast.",
  "input": "",
  "output": "It's suspected of breast infection, which is also called mammacitis."
},
{
  "instruction": "Doctor, you're feverish, you're chilly, you've got abnormal skin in your breast, what's the problem?",
  "input": "",
  "output": "It's very likely that there's breast infections, which are also called mammacitis."
},
{
  "instruction": "Doctor, I'm experiencing oral dryness with other symptoms recently, and I'm having a longer period of menstruation, and I also have lumps and lumps in my breast.",
  "input": "",
  "output": "Symptoms suggest that breast infection, which is also known as breast disease, can occur in breast-feeding women and can cause rashes, fevers, and tenderness in infected breasts, and it's important to get treatment as soon as possible to prevent complications."
},
{
  "instruction": "Doctor, I think my abdomen is swollen. What's the cause?",
  "input": "",
  "output": "It could be an abdominal aortic aneurysm."
},
{
  "instruction": "There are symptoms like doctors, burning abdominal pain, side pain, urine reflux, groin pain, and heart disease. What's the problem?",
  "input": "",
  "output": "You're suffering from abdominal aortic aneurysms, which are the breakthroughs of the aorta, which can cause life- threatening bleeding, which can be treated with surgery, so early diagnosis is important, and it's good to get an abdominal CT scan to confirm your diagnosis."
},
{
  "instruction": "Doctor, there's been recent groin pain, shortness of breath, swelling of the arm.",
  "input": "",
  "output": "There's a possibility that there are abdominal aneurysms that can cause the major blood vessels that supply blood to the abdomen, the pelvic and the leg to grow and weaken."
},
{
  "instruction": "Doctor, I've been experiencing some strange symptoms recently, having trouble urinating, a lot of back and stomach pain, sometimes sharp chest pain, what's the problem?",
  "input": "",
  "output": "The symptoms suggest that you have an abdominal aortic aneurysm, which is a potentially life- threatening condition in which the major blood vessels of your abdomen (the aorta) are weakened and begin to swell, which can cause pain and complications such as urinary reflux and sharp chest perforation."
},
{
  "instruction": "Hi, doctor, I'm experiencing a swollen, burning abdominal pain, and you know what's causing it?",
  "input": "",
  "output": "It's the swelling of the aortic wall, the largest blood vessel in the body, that can cause symptoms like the one described."
},
{
  "instruction": "Doctor, there's been severe back pain, blood loss, weakness, coughing over the last few days. Can you tell me what's wrong?",
  "input": "",
  "output": "The symptoms suggest that you have pulmonary embolism, and you have to do some tests to confirm that you need to get a chest X-ray and a CT scan immediately."
},
{
  "instruction": "Doctor, sharp chest pain, leg pain, cold sweat, back pain, coughing continues, what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you have pulmonary embolism, which can cause blood clots in your lungs, which can threaten your life, and it's good to get medical attention immediately."
},
{
  "instruction": "Doctor, blood loss, sharp chest pain, weakness, cough, leg pain. What's the problem?",
  "input": "",
  "output": "All the symptoms you're experiencing can be signs of pulmonary embolism."
},
{
  "instruction": "Doctor, you've been sweating a lot lately. What's the cause?",
  "input": "",
  "output": "The cause of overexploitation is pulmonary embolism. Have you ever experienced other symptoms, such as shortness of breath or chest pain?"
},
{
  "instruction": "Hi, doctor, I've got a problem with my temper these days, I get angry and sometimes I get into physical fights.",
  "input": "",
  "output": "From what God has explained, I think we're experiencing a behavioral disorder that can turn children and adolescents into angry, violent, and physically aggressive behavior and emotional disorders."
},
{
  "instruction": "Doctor, I'm experiencing delusions and hallucinations, and I've been feeling very low and depressed lately.",
  "input": "",
  "output": "And I think you've got some sort of behavioral disorder that can cause not only depression, but delusions and hallucinations, and we can discuss treatment options to manage the symptoms."
},
{
  "instruction": "Doctor, I've been fainting a lot lately, and can you tell me what's wrong?",
  "input": "",
  "output": "It's important to get a full evaluation to understand the underlying cause of the symptoms."
},
{
  "instruction": "Doctor, I'm experiencing delusions and hallucinations, and I'm also hostile to other people, and can you tell me what causes these symptoms?",
  "input": "",
  "output": "In general, you may be suffering from childhood or adolescence-diagnosed behavior disorder and emotional disability."
},
{
  "instruction": "Hi doctor, I've recently experienced depression and depression or psychiatric symptoms, and I've had seizures and I've felt a lack of physical growth.",
  "input": "",
  "output": "The symptoms suggest that you may have a behavioral disorder."
},
{
  "instruction": "Doctor, what's the problem with the pain and wear in your breast?",
  "input": "",
  "output": "Do you have trouble breathing or chest pain? Patient: No, not really."
},
{
  "instruction": "Doctor, I feel pain and wear in my breast.",
  "input": "",
  "output": "It's possible that you're suffering from air embolism because of your symptoms."
},
{
  "instruction": "Doctor, I'm having a lot of urination at night, a lot of breast pain, a lot of wear, a lot of stiffness, a lot of pregnancy, a lot of shoulder cramps.",
  "input": "",
  "output": "You're probably experiencing a lot of symptoms, but air embolism is the most likely cause of all of these symptoms, and we need to do some tests to make sure we're aware of that."
},
{
  "instruction": "Doctor, I'm experiencing facial pain, excessive anger, shoulder convulsion, pain during pregnancy, and extreme fatigue.",
  "input": "",
  "output": "It's likely to be air embolism, which is blocked by air or gas bubbles."
},
{
  "instruction": "Doctor, I've been having a couple of difficulties lately -- smoking has caused respiratory problems, a lump in the breast and a lot of pain, and I'm also having spasms on my legs, and I'm having lymph nodes -- what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you've had a mastectomy. Have you had an operation to remove one or both of your breasts?"
},
{
  "instruction": "Doctor, what is the cause of the swelling of the skin in the chest?",
  "input": "",
  "output": "It could be side effects of a mastectomy."
},
{
  "instruction": "Doctor, you're having a burning chest pain, reflux, breast shape and size problem, and there's a smoking problem.",
  "input": "",
  "output": "In general, you're suffering from breast cancer, a mastectomy that surgically removes one or both breast cancer."
},
{
  "instruction": "Doctor, can you tell us what caused the recent smoking problem?",
  "input": "",
  "output": "Have you had a mastectomy in the past? Patient:"
},
{
  "instruction": "There's doctors, lymph nodes, nausea, smoking problems, leg cramps, cramps, breast pain or pain.",
  "input": "",
  "output": "I think she's had a mastectomy."
},
{
  "instruction": "Doctor, I think there's a little swelling of the scrotum and a lump. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there's sinusitis, which is an inflammation of the sinuses, which are near the testes, which often cause a swelling of the bladder and a lump to be touched."
},
{
  "instruction": "Sir, your abdomen's swollen and your lower body pain. What's wrong with that?",
  "input": "",
  "output": "The symptoms seem to indicate that there is a suspicion of sinusitis, which is inflammation of the testes of the testes, and we can do some tests to confirm the diagnosis."
},
{
  "instruction": "Hi, sir, I'm having urinary pericardium, and I'm feeling a lower intestinal pain, and I have blood in my urine, and a lump in my scrotum, so can you tell me what might be the problem?",
  "input": "",
  "output": "I think you've got a burrigo squire, which is a sperm-transmitted tube in your testes, which is usually caused by bacterial infection, and pain in the lower abdomen or the pelvis, pain in the urinary tract, and blood in your urine, which can cause a lump in your scrotum."
},
{
  "instruction": "Doctor, you feel a lump in your scrotum, and you feel lower abdominal pain, and what's the possible cause?",
  "input": "",
  "output": "It's a symptom that can be suspected of inflammation of the sinuses, which are in the back of the testes, where there's swelling, pain and tenderness in the affected part of the body."
},
{
  "instruction": "Doctor, I've been having symptoms like this lately: weakness of the waist, sharp abdominal pain, weakness of the back, abnormal change in the size and shape of the ear, abnormality of the fever.",
  "input": "",
  "output": "The symptoms seem to indicate that you're experiencing an early pericardial rupture, which involves a ruptured pocket containing fluid that surrounds and protects the fetus, which can lead to premature sepsis delivery."
},
{
  "instruction": "Doctor, I'm experiencing seizures, backaches, sharp abdominal pain. Do you know what caused it?",
  "input": "",
  "output": "Well, the symptoms suggest that there's a pain caused by an early pericardial rupture, which occurs when a bag filled with fluid surrounding the baby ruptures before delivery, causing complications for both the mother and the baby."
},
{
  "instruction": "The doctors, the seizures, the backaches, the size of the ears, the contractions of the uterus continue, and why?",
  "input": "",
  "output": "The symptoms suggest that there's an early perforation of the amniocentesis."
},
{
  "instruction": "Doctor, we're experiencing symptoms of swelling muscles, weakness of elbows, and stains during pregnancy.",
  "input": "",
  "output": "The symptoms suggest that there's an early perforation of the amniocentesis, and we need to do some tests to confirm the diagnosis."
},
{
  "instruction": "Doctor, what's the problem with elbow pains, seizures, and lack of strength?",
  "input": "",
  "output": "It's suspected of a peritoneal premature rupture, which occurs when the membrane surrounding the baby ruptures before delivery and the fluid leaks."
},
{
  "instruction": "Doctor, there's a wart in the skin, accompanied by acne, itching, it's splint, it's worried.",
  "input": "",
  "output": "To put it off, there's the possibility that you have a streptococcus infection, a viral infection that has a little wart in your skin."
},
{
  "instruction": "Doctor, you've got this weird lump on your skin that looks like a pimple, and it doesn't go away.",
  "input": "",
  "output": "It looks like a little pearl-like stone that looks like a pimple or a pimple is infected with streptococcus, a viral infection in the skin."
},
{
  "instruction": "Hi doctor, I have acne or acne in my skin, and it doesn't go away with normal acne therapy.",
  "input": "",
  "output": "If you put it off as a symptom, you're more likely to have a viral skin infection called streptococcus."
},
{
  "instruction": "Doctor, there's a strange skin growing that looks like a little bump in your penis. What is it?",
  "input": "",
  "output": "If you put it off as a symptom, it's possible that you're infected with cytoplasm."
},
{
  "instruction": "Doctor, there are symptoms of hip pain and swelling of the arm and overgrowing of the body, and what's the problem?",
  "input": "",
  "output": "The symptoms suggest you're suffering from a serious bacterial skin infection that destroys skin and muscle tissue, necrotic fasciitis, which can threaten life, so it's important to be treated immediately."
},
{
  "instruction": "Hi, doctor, there's been some weird symptoms recently: skin lesions are abnormally visible and overgrowing, and you're experiencing vaginal pain, can you tell us what caused these symptoms?",
  "input": "",
  "output": "The symptoms are likely to lead to severe bacterial infections that can affect skin and soft tissue, which, if left untreated, can lead to the death of tissue and eventually to sepsis, which is important to start treating as soon as possible to prevent serious complications."
},
{
  "instruction": "Doctor, hip pain, hand or finger pain, vaginal pain.",
  "input": "",
  "output": "These symptoms are likely to lead to necrotic fasciitis."
},
{
  "instruction": "The swelling of the legs, vaginal pain, arm swelling, leg pain continues. What could be the problem?",
  "input": "",
  "output": "Symptoms indicate that it's likely to be necrotic fasciitis, a serious bacterial infection that can spread quickly and kill tissue, and you have to be treated immediately."
},
{
  "instruction": "Good morning, sir. I've got a hip pain, and I also found skin lesions near the area. Do you know what caused it?",
  "input": "",
  "output": "Symptoms can lead to necrotic fasciitis, a serious bacterial infection that can spread rapidly throughout the body if it's left untreated."
},
{
  "instruction": "Doctor, sharp abdominal edema, oscillation, it's sore. Can you tell me what's going on?",
  "input": "",
  "output": "The symptoms seem to indicate a benign secretion called cold."
},
{
  "instruction": "We're experiencing doctors, urinary pain, vaginal pain, upper pelvic pain, problems during pregnancy, sharp abdominal pain, and what's the cause of these symptoms?",
  "input": "",
  "output": "There may be positive vaginal secretions common to women, depending on their symptoms, but more tests are needed to confirm this diagnosis."
},
{
  "instruction": "Doctor, there's been some problems during pregnancy, and I'm experiencing sharp abdominal edema.",
  "input": "",
  "output": "The symptoms seem to indicate a benign secretion called cold."
},
{
  "instruction": "Doctor, there's been a number of problems in recent years when you're experiencing it, and you're experiencing some benign secretions, and you're also experiencing a chest and pelvic pain during pregnancy, can you tell me what's going on?",
  "input": "",
  "output": "The symptoms are likely to indicate that there is some cold or positive vaginal secretions that occur when the levels of estrogen in the body increase and the vaginal secretions increase."
},
{
  "instruction": "Doctor, you have pain during pregnancy and a little bit of vaginal secretion.",
  "input": "",
  "output": "You may be experiencing cold, which is a form of benign vaginal secretions that can occur during pregnancy, which can result from hormonal changes and increased blood volume in vaginal areas, but you have to do some tests to eliminate infection or other base diseases."
},
{
  "instruction": "Doctor, erectile failure, blood in the urine and sometimes involuntary urination.",
  "input": "",
  "output": "It could be bladder obstruction."
},
{
  "instruction": "Sir, I'm experiencing telophase, bed-wetting, bed-wetting, night-wetting. Can you tell me what's wrong?",
  "input": "",
  "output": "You're suffering from bladder obstructions because of your symptoms."
},
{
  "instruction": "Doctor, we've been experiencing involuntary urination in the last few days. What's the problem?",
  "input": "",
  "output": "Because of the infertile urinary symptoms, there could be bladder obstructions."
},
{
  "instruction": "Doctor, there's a problem with urinating and there's no normal urination.",
  "input": "",
  "output": "I think there might be bladder obstructions."
},
{
  "instruction": "Sir, I have a problem in bed at night, and I have to go to the bathroom often during the day, and my feet and ankles are swollen, and what's the cause?",
  "input": "",
  "output": "The symptoms seem to be the cause of bladder obstruction, which is leaky at night and can cause frequent urination during the day, which is a common side effect of the disease."
},
{
  "instruction": "Doctor, I recently discovered that the skin has become very dry and has been stripped off, and I've started to worry because there are so many spots on the skin.",
  "input": "",
  "output": "It's likely to be melanoma, which is a form of skin cancer, which often results in dry or scaly skin and abnormality, which is a good way to test the diagnosis and discuss additional treatment options."
},
{
  "instruction": "Doctor, there's a lump on the back and a swelling of lymph nodes, and I feel a little bit of skin irritation.",
  "input": "",
  "output": "It's possible that the symptoms are melanoma, which is a form of skin cancer, and you have to run some tests and do some tissue tests to identify the diagnosis."
},
{
  "instruction": "Doctor, the lymph nodes in your throat are swollen. Do you want to know what might be the problem?",
  "input": "",
  "output": "The symptoms are likely to be melanoma, which is a form of skin cancer that can spread into lymph nodes and cause lymph nodes to swell."
},
{
  "instruction": "Doctor, your eyelids arey and have strange skin lesions, and what's the cause?",
  "input": "",
  "output": "It's possible that the symptoms are melanoma, a type of skin cancer that can metastasize into other parts of the body."
},
{
  "instruction": "Doctor, what's the cause of this sudden hot flashes?",
  "input": "",
  "output": "The hot flashes can be symptoms of uterine disease, which requires additional tests to be accurately diagnosed."
},
{
  "instruction": "Sir, the vaginal bleeding continues after menopause, and there's also discomfort and pain in the pelvis.",
  "input": "",
  "output": "If you consider symptoms, there may be a uterine disease, and it's important to run some tests to figure out the root cause of the symptoms."
},
{
  "instruction": "Doctor, I've been having some unusual symptoms recently, which are quetzal and facial blushing.",
  "input": "",
  "output": "The symptoms seem to indicate that you have a uterine disease, and you have to do some tests to confirm this diagnosis."
},
{
  "instruction": "Doctor, I'm experiencing hip pain, local weakness, sharp abdominal pain.",
  "input": "",
  "output": "If you're dealing with symptoms, you might have an acute uterine disease, and it's good to run some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, I'm experiencing local weaknesses, vaginal secretions, pain in intercourse, and urinary pain. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from endocardial disease."
},
{
  "instruction": "Doctor, I've got a fever, I've got a lump in my nose, I've got a really frustrating neck, and I've got a little bit of membrane force.",
  "input": "",
  "output": "The symptoms indicate that there is a suspicion of laryngitis, which can be caused by an allergic reaction."
},
{
  "instruction": "Doctor, I think your nose is blocked and allergic, so what are your symptoms?",
  "input": "",
  "output": "The symptoms could be laryngitis."
},
{
  "instruction": "Doctor, I've recently had a very short neck, together with my nose, my stomach, my nose, my throat, my throat -- what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that he has laryngitis."
},
{
  "instruction": "Doctor, your neck hurts and your ear hurts. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to be laryngitis, which is inflammation of the vocal cords or the larynx."
},
{
  "instruction": "Doctor, you have a patch with lesions in your leg, and it looks like your skin is infected, and your skin is very dry, and it has scales.",
  "input": "",
  "output": "You're suffering from a chronic condition that can cause small blisters and lesions in your hands and feet, drying and peeling skin."
},
{
  "instruction": "Doctor, I'm experiencing ankle pain and skin cancer, and I've also found skin lesions in my legs and feet, and it looks like acne and acne are recurrent and it's infected with the skin.",
  "input": "",
  "output": "I think there's a history of skin disease that causes blisters and skin irritations in the hands and feet, and it can also cause pain, itching and inflammation in the infected area."
},
{
  "instruction": "Sir, I have skin lesions in my feet, and I feel pain in my ankle. What's the cause?",
  "input": "",
  "output": "It's a skin disease with tiny blisters on your hands and feet, which can sometimes involve pain or discomfort."
},
{
  "instruction": "Doctor, the scalp is dry, it has different properties, it has skin lesions, and why?",
  "input": "",
  "output": "From the symptoms that God explains, you seem to be suffering from a severe condition: skin disease with fingers, palms, and sometimes blisters on your feet."
},
{
  "instruction": "Doctor, I'm experiencing what looks like abnormal skin, skin lesions, skin ugliness, along with frequent urine -- can you tell me what's wrong?",
  "input": "",
  "output": "It often involves frequent urination due to skin diseases such as fingers, toes, palms, and soles of feet with small, delicate blisters."
},
{
  "instruction": "Doctor, I'm extremely confused and difficult to say clearly.",
  "input": "",
  "output": "The symptoms seem to indicate that he's suffering from an addiction to opioids."
},
{
  "instruction": "Doctor, I've been feeling bad lately, and I think I've got a drug abuse problem, and I feel so much pain in my arm and I feel so weak.",
  "input": "",
  "output": "The symptoms seem to indicate that you're experiencing Opioid poisoning. Have you used opioid recently?"
},
{
  "instruction": "Doctor, aggravation, difficulty speaking, weakness of arm strength, and movement.",
  "input": "",
  "output": "I think the symptoms are that you're suffering from Opioid poisoning, possibly abusing it or mixing it with alcohol?"
},
{
  "instruction": "Hi doctor, I'm very sleepy and dizzy these days, and I can't talk, and I have a movement problem.",
  "input": "",
  "output": "The symptoms seem to be suffering from an addiction to opioids, and the feeling that the body is sick is also common."
},
{
  "instruction": "Doctor, I'm very sleepy and often vomiting, and I also have a lot of pain in my arms, and why?",
  "input": "",
  "output": "The symptoms suggest that addiction to opioids is suspect."
},
{
  "instruction": "Doctor, there's blood in the baby's throat and there's a problem with the nose, the fever, the diarrhea, the temper.",
  "input": "",
  "output": "I think he's having a diaper rash."
},
{
  "instruction": "Sir, with diaper rashes, we're experiencing vomiting, fever, redness of the ear, and a blockage of nose.",
  "input": "",
  "output": "I think there's a viral infection that causes symptoms, including diaper rashes, that can be prescribed for cream and ointments to relieve diaper rashes and general medicine to relieve heat and block strength, but it's important to get enough water and take enough rest and replenish it."
},
{
  "instruction": "Doctor, I have diarrhea and diaper rash. Can you tell me what's wrong?",
  "input": "",
  "output": "The symptoms are likely to indicate that it's a diaper rash."
},
{
  "instruction": "Doctor, there's blood on the stool, there's skin rash, there's diarrhea, there's membrane force, what's going on?",
  "input": "",
  "output": "I have a diaper rash."
},
{
  "instruction": "Doctor, you've recently had skin problems, and your skin is getting really dry and rough, and you've got mouth ulcers and acne on your face.",
  "input": "",
  "output": "I think you're experiencing stylus, a skin condition that affects both the skin and the inside of the mouth -- skin dryness, peeling, texture, roughness -- which, of course, can lead to oral ulcers and acne."
},
{
  "instruction": "Doctor, I found my body growing skin, and it looks abnormal, and I also developed skin lesions.",
  "input": "",
  "output": "Your symptoms seem to be symptoms of a condition called slatitude glands, which is generally small, molten pink or purple rubles on the skin, and can occur anywhere in the body, including the penis and the mouth."
},
{
  "instruction": "Hi, sir, there's a problem these days, and it's hard to talk about it with dryness, texture, scales and rough skin rashes.",
  "input": "",
  "output": "The symptoms suggest that it's likely to be a flatline, a skin condition that can make it difficult for you to speak to your mouth and your neck."
},
{
  "instruction": "Sir, something strange happened to my skin.",
  "input": "",
  "output": "According to you, it could be a flat boat."
},
{
  "instruction": "It's hard to say, and the skin is very dry, and it has scales.",
  "input": "",
  "output": "There could be plagiarism, a skin disease affecting the membrane and the skin."
},
{
  "instruction": "Doctor, what causes you to keep vomiting blood?",
  "input": "",
  "output": "Your symptoms suggest that this is a duodenal ulcer, which requires additional tests to confirm your diagnosis."
},
{
  "instruction": "There are symptoms of changes in the shape of doctors, headaches, nausea, sharp, burning abdominal stools, and what's the problem?",
  "input": "",
  "output": "The symptoms suggest that you have a duodenal ulcer."
},
{
  "instruction": "Doctor, I'm experiencing vomiting and sharp abdominal pain, changes in the shape of the stool and continues to cause nausea.",
  "input": "",
  "output": "The symptoms suggest that you have a duodenal ulcer."
},
{
  "instruction": "Doctor, would you please tell me what caused the bleeding in the throat and stomach pain?",
  "input": "",
  "output": "The symptoms are likely to indicate that it's a duodenal ulcer."
},
{
  "instruction": "Doctor, I think there's pain all over the abdomen and a lump in the scrotum, so what's the problem?",
  "input": "",
  "output": "It's important that the hernia be examined and treated with surgery."
},
{
  "instruction": "Doctor, there's pain in the groin, there's lumps, there's redness, there's swelling, there's swelling, can you tell me where the problem is?",
  "input": "",
  "output": "The symptoms suggest that there is a liver hernia."
},
{
  "instruction": "There's doctors, sexual erections, lower abdominal pain, abdominal edema and groin pain. What's the cause of all these symptoms?",
  "input": "",
  "output": "It looks like there's a groin hernia on the surface of the groin."
},
{
  "instruction": "Doctor, your scrotum is swollen and uncomfortable, and there are some symptoms in your scrotum and testicle.",
  "input": "",
  "output": "The symptoms may indicate that there is a liver hernia, and the mass of groin that you're talking about may be a symptom of the same disease."
},
{
  "instruction": "Doctor, there's pain all over the abdomen, and I suspect a serious illness.",
  "input": "",
  "output": "It's possible that it's a further hernia because of the symptoms."
},
{
  "instruction": "Doctor, there's been an allergic reaction recently, and the skin looks very strange.",
  "input": "",
  "output": "The symptoms seem to indicate that you're suffering from eczema."
},
{
  "instruction": "Doctor, there are strange symptoms in the skin, such as swelling, warts, lesions, what are they?",
  "input": "",
  "output": "You seem to be suffering from eczema, warts, and eczema, which causes various types of skin lesions."
},
{
  "instruction": "Hi, doctor, the horrible skin rash isn't going away because it's so dark and red, I don't know what to do.",
  "input": "",
  "output": "Now, eczema is a common disease that results from inflammation of the skin, red and painful rashes. There are several options for treating the symptoms, such as using medicinal cream and avoiding causes that can aggravate the eczema, and so on."
},
{
  "instruction": "Doctor, my body has warts, skin lesions, abnormal skin, and it's got itching, skin rashes, and what's the cause?",
  "input": "",
  "output": "There seems to be eczema, which is a skin disease that causes the form of itching, rashes and general rash in the skin, and it can also cause warts and skin lesions."
},
{
  "instruction": "Doctor, I have a red oscillator on my skin, and it's a lot of it, and I feel swelling and irritation in my skin.",
  "input": "",
  "output": "The symptoms seem to indicate eczema."
},
{
  "instruction": "Doctor, I'm experiencing lack of growth, delusions or hallucinations, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms that God said could be caused by a number of causes, but based on what he said, they could be Asperger's syndrome."
},
{
  "instruction": "Doctor, I've been experiencing a number of symptoms recently, and I've developed obsessions and obsessions with personality problems, and sometimes I faint.",
  "input": "",
  "output": "I think God's talking about Asperger's syndrome."
},
{
  "instruction": "Doctor, I have nightmares, anxiety, anxiety, temper problems, and I've passed out a few times.",
  "input": "",
  "output": "Have you ever had difficulty with communication, social interaction, or repetitive behavior? It's important to consult experts for additional evaluations and treatment options."
},
{
  "instruction": "Doctor, I'm having strange symptoms these days, I'm being antisocial and hostile, and I'm feeling very depressed, and I sometimes have mental symptoms, and what's wrong with me?",
  "input": "",
  "output": "You're likely to have Asperger's syndrome based on your symptoms, and you have to do some tests and evaluations to check your diagnosis."
},
{
  "instruction": "Sir, there's a lot of pain in the tongue and a lot of fever. What's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there's an inflammation of the membrane surrounding the digestive tract."
},
{
  "instruction": "Doctor, it's hard to swallow. Why?",
  "input": "",
  "output": "Maybe it's the pystitis."
},
{
  "instruction": "Hi doctor, your tongue swells and your tongue hurts and your mouth hurts, and what's the cause of these symptoms?",
  "input": "",
  "output": "It's possible that you're suffering from the symptoms."
},
{
  "instruction": "Doctor, the swelling of your tongue really bothers you. Why?",
  "input": "",
  "output": "There's a possibility that you're suffering from sensititis because of your symptoms, which is the result of chemotherapy or radiation, which causes inflammation and swelling in your mouth."
},
{
  "instruction": "Sir, you've got a fever, and you've got lesions in your tongue, and you've got gum pain. What's the problem?",
  "input": "",
  "output": "The symptoms are likely to indicate that it's scleroderma."
},
{
  "instruction": "Good morning, doctor, your nails look irregular, your hands and fingers have pain, your skin looks infected, your arms and your hands have sinuses, and what is this?",
  "input": "",
  "output": "There's a hand-trick that can cause pain and swelling in the affected area caused by infection around the claws, which is probably not relevant and may be a separate problem, which can be prescribed to treat the infection."
},
{
  "instruction": "Sir, your feet are swollen and very painful, and I don't know what's going on, but I can barely walk.",
  "input": "",
  "output": "From what you've described, I think you've got a hand-toenail, a lot of infections around your claws that affect your toes and fingers, and do you feel red or tenderness around your toenails?"
},
{
  "instruction": "There's skin dryness, texture, scales or roughness, and it looks like the skin of the leg or foot is infected, and it looks abnormal, and it's experiencing sinus edema, what's the problem, doctor?",
  "input": "",
  "output": "The symptoms are likely to indicate that there are handnails that are infected with the skin around the nail or toenails, but non-communism generally has nothing to do with this disease, and it's good to take antibiotics or antimicrobial drugs based on the degree of infection."
},
{
  "instruction": "I don't know what's wrong.",
  "input": "",
  "output": "What you're talking about is that there's a hand toenail, which can cause swelling and pain in the infected area around the toenails."
},
{
  "instruction": "Doctor, there's a recent pain in the feet and hands, and there's a marked swelling of the toes and fingers, and what's the cause of these symptoms?",
  "input": "",
  "output": "The symptoms suggest that there's a toenail that's infected with the skin around the claws or the nails."
},
{
  "instruction": "Doctor, there's a lot of swelling of the lips and a lot of damage to the jaw. What's the cause?",
  "input": "",
  "output": "The symptoms suggest that the jaw is swollen because the jaw is damaged."
},
{
  "instruction": "Doctor, your mouth hurts and you have facial pain with some symptoms on your face.",
  "input": "",
  "output": "It seems to cause pain and other symptoms because of a jaw injury."
},
{
  "instruction": "Hi, doctor, your jaw is not healing, your wrist is swelling.",
  "input": "",
  "output": "There may be an infection that, depending on the symptoms, can spread from the jaw to the neck to the chest, which can also cause the wrist to swell if left untreated."
},
{
  "instruction": "Doctor, you've got a jaw injury, and you've got facial pain, mouth pain, and wrist swelling.",
  "input": "",
  "output": "The symptoms seem to indicate that there's an infection of the wound and surrounding tissue, which is called bong and keratitis, and we need to get antibiotics faster so that it doesn't spread any more."
},
{
  "instruction": "I'm experiencing doctors, fatigue, sharp abdominal pain, fever and nausea. What's wrong with me?",
  "input": "",
  "output": "You can have white blood cells, and you have to run some tests to make sure you're diagnosed."
},
{
  "instruction": "Doctor, in the last few days, I've been feverish and nauseated. What's the problem?",
  "input": "",
  "output": "There may be a white blood cell disease that can cause fever and nausea, and you need to run some tests to confirm this diagnosis."
},
{
  "instruction": "The doctors, the grocers, the body fluids, the nausea, are continuing. What's the cause of these symptoms?",
  "input": "",
  "output": "You may be experiencing complications from white blood cell disease depending on your symptoms, and it's important that you test them with a few tests and start treating them as soon as possible."
},
{
  "instruction": "Hi, doctor, sharp abdominal pain, low fluid, mouth pain and vomiting.",
  "input": "",
  "output": "Yes, it's possible that the symptoms are white blood cells, and we need a few more tests to confirm this diagnosis."
},
{
  "instruction": "Doctor, I'm experiencing chills, sharp abdominal pain, fluid decline, mouth pain, diarrhea, what's wrong with me?",
  "input": "",
  "output": "The symptoms can lead to white blood cells, and it's good to run some tests to check the diagnosis and discuss treatment options."
},
{
  "instruction": "Doctor, I've had foot pain a few weeks ago, especially when I'm walking long and standing, and I'm having sharp, stinging pain in my toes.",
  "input": "",
  "output": "Has anyone ever noticed any unusual skin lesions or discolored patches anywhere in the body?"
},
{
  "instruction": "Doctor, I'm experiencing excessive growth, sharp abdominal pain, depression, foot or toe pain.",
  "input": "",
  "output": "I'm sorry to inform you that all your symptoms are signs of Kaposi's sarcoma."
},
{
  "instruction": "Hi doctor, I've recently had leg pain and I'm losing weight. Do you know what caused these symptoms?",
  "input": "",
  "output": "Yes, symptoms could be carposi sarcoma. Have you noticed any unusual skin lesions or discoloration in your body?"
},
{
  "instruction": "Hi, doctor, I'm experiencing overgrowth with this passage, skin lesions, coughing continues, what's the problem?",
  "input": "",
  "output": "The symptoms suggest that it may be a form of abnormal tissue growth and skin lesions, the Kaposi sarcoma, which requires several tests to identify the diagnosis and start proper treatment."
},
{
  "instruction": "Doctor, for the past few days, I've had a feeling of weakness in my back. Do you know what caused it?",
  "input": "",
  "output": "The symptoms are likely to be carposi, a type of cancer that affects skin and other tissues, and we have to do additional tests to confirm the diagnosis."
},
{
  "instruction": "Doctor, there's so much pain and soreness in the breast, and I think my legs are getting really bad these days, and my legs are getting weak, and I'm having cramps and cramps.",
  "input": "",
  "output": "It's a condition in which one of the spines slips from place to place to press the nerves and cause pain in the leg or weakness."
},
{
  "instruction": "Sir, I've been suffering from neck pain a few weeks ago. Can it help me figure out the cause?",
  "input": "",
  "output": "The symptoms seem to indicate that you have a condition called spinal precipital precipitation, which is a spinal disease that can cause backache pain and stiffness when the spinal cord slips from place to place."
},
{
  "instruction": "There's a teacher, leg pain, leg cramps, weakness and difficulty in moving, and I've been having back pain for a while.",
  "input": "",
  "output": "According to your symptoms, you're probably suffering from precipitous prefrontal failure, which means that one of the spines is out of my position, pushing the nerve around me."
},
{
  "instruction": "Doctors, back pain, sensory loss, neck pain. What's the problem?",
  "input": "",
  "output": "And these symptoms can indicate that there's spinal prefrontal failure."
},
{
  "instruction": "Doctor, I'm experiencing leg spasms, sensory disturbances and lower body pain. Do you know what caused it?",
  "input": "",
  "output": "Yes, it looks like one of the spinal bones is slipping from place to place and pushing the nerves, and these symptoms are generally associated with this disease."
},
{
  "instruction": "Doctor, low vision, low body fluids, headaches, abnormally involuntary movements, signs or clouds in your visual field, do you know why?",
  "input": "",
  "output": "The symptoms may indicate that you have a condition called a plastic brain tumor, which occurs when pressure inside your skull increases and can cause vision problems, headaches and other symptoms."
},
{
  "instruction": "Hi, doctor, I've recently experienced a strange condition where you see spots or clouds in your visual field, you feel dizzy, you feel pain in your eyes, and can you tell me what's causing it?",
  "input": "",
  "output": "It's possible that the pressure inside the skull may be increasing, causing problems with vision, dizziness and eye pain, and we need to do more tests to make sure that we're diagnosed."
},
{
  "instruction": "Doctor, there's a pain in your eye with a dizzying, cyclical condition, and we've recently found spots or clouds in your visual field, and can you tell me what's going on with me?",
  "input": "",
  "output": "These symptoms could be caused by a plastic brain tumor, where pressure inside the skull is increasing for no apparent reason."
},
{
  "instruction": "Hi doctor, I have spots or clouds in my visual field, and I have symptoms of involuntary movement, skin swelling, fluid decline, what's the problem?",
  "input": "",
  "output": "This suggests that there could be a plastic brain tumor."
},
{
  "instruction": "Doctor, i don't look right, i have a lot of eyes, i have a lot of eyes, i have too much tears, what's the problem?",
  "input": "",
  "output": "The symptoms that God's talking about indicate that i am suffering from a virus."
},
{
  "instruction": "Doctor, you cough and you get a strange white secretion in your eyes. What's the problem?",
  "input": "",
  "output": "Virus pericarditis means there's an infection that causes inflammation of the eyes, and you can experience itch and itching with other symptoms."
},
{
  "instruction": "Doctor, your nose is blocked, your eyes are sore, you're coughing, you're coughing, what are the symptoms?",
  "input": "",
  "output": "The symptoms that God's talking about make me suspect that this is a virus."
},
{
  "instruction": "Doctor, your eyes swell, your white secretions come out, and your nose is blocked, your eyes are pricked, you've got heat, what's the problem?",
  "input": "",
  "output": "It's peritonealitis caused by the virus."
},
{
  "instruction": "Hi doctor, you've got a problem with your vision, and you've got a lot of blood in your eyes, and you've found a white secretion in your eyes, and what's the problem?",
  "input": "",
  "output": "The symptoms seem to indicate that there is a pericarditis caused by the virus, which is often called pericarditis."
},
{
  "instruction": "Doctor, your nose hurts, your knees are weak, your hearing is failing, your facial pain and your neck is weak.",
  "input": "",
  "output": "The symptoms can damage the nerves due to complications caused by sepsis, causing facial pain, neck weakness and hearing loss, which may not have anything to do with knee weakness."
},
{
  "instruction": "Doctor, you've got a cut in your nose, and your knee is weak, and your hearing is weak, so what's the problem?",
  "input": "",
  "output": "The symptoms can cause staph infection in the wound, affecting the knee, causing hearing loss, and you have to start treating it immediately."
},
{
  "instruction": "Doctor, there's a scar on your nose, and there's a blush, and what's the cause of these symptoms?",
  "input": "",
  "output": "The hot flashes are common symptoms of menopause, but generally they're not related to the damage to the nose, which can cause heat by the symptoms."
},
{
  "instruction": "Doctor, you've got a cut in your nose, and you've got headaches, and you've got a lot of blood in your nose lately, and your face hurts.",
  "input": "",
  "output": "It can cause facial pain, nosebleed and headache, and you have to wash and monitor the wound to prevent infection."
},
{
  "instruction": "Doctor, your nose's damaged, so you're experiencing blush, facial pain, low hearing -- what's the problem?",
  "input": "",
  "output": "He's got a nose infection, and he's got a wound, and as a result, he's experiencing a blush, a facial pain, a low hearing, and he's got sinusitis."
}
]