laomobai/llama3-1 huggingface dataset:
system: What biologics do doctors prescribe to treat rheumatoid arthritis (RA)?
output: When your doctor first prescribes you a biologic, it's usually an "anti- TNF" drug. These include: Adalimumab ( Humira) Adalimumab-atto ( Amjevita), a biosimilar to Humira Certolizumab ( Cimzia) Etanercept ( Enbrel) Golimumab ( Simponi) Infliximab ( Inflectra, Remicade) Infliximab-abda ( Renflexis), a biosimilar to Remicade Infliximab-dyyb ( Inflectra), a biosimilar to Remicade If the first anti- TNF you try doesn't work for you, your doctor will most likely try another one.
system: Why do biologic drugs seem to work for a while then become ineffective?
output: Sometimes, biologic drugs will help you for a while and then don't work as well. It's not clear why. If it happens to you, tell your doctor. He'll probably switch you to another biologic or add another type of RA drug, like methotrexate or sulfasalazine, so your treatment works better.
system: What should I do if my biologic treatment doesnât help my rheumatoid arthritis?
output: It may take some trial and error to find the biologic drug that works best for your rheumatoid arthritis ( RA), but there's a good reason to keep at it. Most folks eventually find one that helps. And when you do, it may ease your symptoms or cause them to fade completely. You should start to feel better in 4 to 6 weeks, though sometimes it can take 3 to 6 months to work. Your doctor may also prescribe other medicines that work faster to help you in the meantime. But if your symptoms don't improve, let your doctor know. The goal is to find the best medicines for you as quickly as possible. Timely treatment helps protect your body from RA damage.
system: Do biologics work best if you take them on a regular schedule?
output: Your doctor may also prescribe other medicines that work faster to help you in the meantime. If it happens to you, tell your doctor.
system: Why do some biologics work for rheumatoid arthritis (RA) and others don't?
output: But if your symptoms don't improve, let your doctor know. The goal is to find the best medicines for you as quickly as possible. He'll probably switch you to another biologic or add another type of RA drug, like methotrexate or sulfasalazine, so your treatment works better. Some people get more help from biologics than others. Experts can't predict who'll respond well and who won't. But they know that people who get treatment in the earlier stages of RA tend to do better than those who've had the disease for many years. Biologics also work best if you take them on a regular schedule. If you can't do that due to side effects or the cost of the drugs, ask your doctor about your options.
system: What questions might my pediatrician ask during my child's 15-month checkup?
output: Your baby has now entered the toddler years, and you're in for quite a ride! How's your child's appetite? Is she eating a variety of foods? Does she use her fingers to feed herself? Is she using a bottle? How many hours is your child sleeping, including naps?
system: What should I expect from my baby's 15-month checkup?
output: Your baby has now entered the toddler years, and you're in for quite a ride! By now, she may be walking, throwing, exploring everything, and expressing feelings -- including anger. This is a good time to talk to your pediatrician about safety, behavior, and discipline. Weigh and measure your child Perform a physical exam of your child Give your child another dose of the diphtheria, tetanus, acellular pertussis ( DTa P) vaccine, Hib vaccine, or pneumococcal vaccine, and in the fall or winter, a flu shot Depending on the schedule being followed, the measles and chicken pox vaccines may also be given at this time Catch up on any other vaccines that have been missed As your child starts going on outings or to daycare, she will be exposed to many illnesses.
system: What are some healthy feeding tips for my 15-month-old child?
output: Your baby has now entered the toddler years, and you're in for quite a ride! How can I encourage my child to try different foods? Keep offering new foods. If your child doesn't like a food one week, she may love it the next. It takes many times for a child to like some foods, so don't give up! Small children like to imitate their parents. If your child sees you eating a variety of foods, she may do the same. Stick to mostly unprocessed foods such as fruits and vegetables. These provide great nutrition for your baby's growing brain and body. Whole grains are also a good source of nutrition. Keep cutting your child's food into small pieces, staying mindful of potential choking hazards.
system: What are the most common causes of proctitis?
output: Gonorrhea, syphilis, herpes, anal warts, and chlamydia are the most common cause of sexually transmitted proctitis.
system: Where can I find resources for caregivers for multiple sclerosis?
output: Looking for more information on multiple sclerosis? Family Caregiver Alliance (800) 445-8106 www.caregiver.org Multiple Sclerosis Foundation (954) 776-6805 https://msfocus.org National MS Society (800) 344-4867 www.nationalmssociety.org National Caregivers Library www.caregiverslibrary.org National Alliance for Caregiving (301) 718-8444www.caregiving.org Caregiver Action Network (202) 454-3970www.caregiveraction.org Eldercare Locator (800) 677-1116www.eldercare.gov
system: Can high cholesterol affect your eyes and skin?
output: They often form in tendons like the Achilles tendon in the back of your heel. You might also notice them in your hands, elbows, knees, and feet. When xanthomas form on the eyelids, they're called xanthelasmas. Cholesterol can also form deposits around the outside of your cornea -- the clear cover over the front of your eye. This is called corneal arcus, which looks like a silvery blue ring. You can see it as an arc that goes around the outside of your eye, but it won't affect your vision. At your visit your doctor will ask you: What symptoms do you have and when did you first notice them?
system: What statins can be used to treat heterozygous familial hypercholesterolemia (HeFH)?
output: Statins are the main drugs that treat He FH. They block an enzyme your body needs to make cholesterol. Some examples are: Atorvastatin ( Lipitor) Lovastatin ( Mevacor) Pravastatin ( Pravachol) Rosuvastatin ( Crestor) Simvastatin ( Zocor) Other drugs your doctor may suggest to lower cholesterol: Bile acid sequestrants (colesevelam, Welchol) Ezetimibe ( Zetia) Fibrates (fenofibrate, gemfibrozil) Nicotinic acid ( Niaspan, Slo- Niacin) PCSK9 inhibitors To protect your heart and prevent heart disease, you'll need to manage He FH throughout your life.
system: Can eating right and exercising help to treat heterozygous familial hypercholesterolemia (HeFH)?
output: The goal is to lower your cholesterol levels and reduce your risk for heart disease. Part of your treatment will be to make lifestyle changes, such as: Eat a low-fat diet. Avoid foods high in saturated and trans fats, like beef, pork, coconut oil, egg yolks, and whole milk. Instead, eat more veggies, fruits, whole grains, nuts, seafood, lean poultry, and low-fat dairy. Exercise. Walk, bike ride, swim, and do other activities that make your heart pump harder.
system: What can narrow blood vessels from heterozygous familial hypercholesterolemia (HeFH) cause?
output: Narrowed blood vessels can prevent enough blood from reaching your heart. Or a piece of plaque can break off and get stuck in a blood vessel that supplies blood to your heart. If blood flow to your heart gets blocked, parts of your heart muscle can die and you'll have a heart attack.
system: How do you get heterozygous familial hypercholesterolemia (HeFH)?
output: If you have He FH, you inherit a faulty gene from one of your parents. If you're a parent yourself and you have the gene, you've got a 50-50 chance of passing it to each of your children.
system: What can you expect if you have heterozygous familial hypercholesterolemia (HeFH)?
output: Some examples are: Atorvastatin ( Lipitor) Lovastatin ( Mevacor) Pravastatin ( Pravachol) Rosuvastatin ( Crestor) Simvastatin ( Zocor) Other drugs your doctor may suggest to lower cholesterol: Bile acid sequestrants (colesevelam, Welchol) Ezetimibe ( Zetia) Fibrates (fenofibrate, gemfibrozil) Nicotinic acid ( Niaspan, Slo- Niacin) PCSK9 inhibitors To protect your heart and prevent heart disease, you'll need to manage He FH throughout your life. You'll likely need to keep up a good diet, exercise, and take statins and other drugs to control your cholesterol. Tests can find out if your other family members have He FH.
system: What are questions for your doctor regarding heterozygous familial hypercholesterolemia (HeFH)?
output: Your doctor will also do an exam to look for: Bumps in your knees, elbows, and knuckles Swelling in the back of your ankles Yellow growths on your eyelids White half-circles around the colored part of your eye Which medicines are best for me? Do the medications have side effects? How often should I see you? Do I need to see any other specialists? Which ones? Which foods should I avoid? How much exercise should I do and what types are best? Lose extra weight.
system: How can you prevent diarrhea if you're lactose intolerant?
output: Lactose may be found in foods you don't expect, including: Calcium-fortified breads Cereals and baked goods Powdered meal replacements Instant potatoes, soups, and breakfast drinks Pancake, biscuit, and cookie mixes Margarine Salad dressings Products labeled ânon-dairy,â like whipped toppings and creamers, which may include milk-derived ingredients If you are lactose intolerant, the best way to avoid symptoms is to read food labels. Steer clear of products with: Whey Curds Milk by-products Nonfat dry milk powder Dry milk solids Lactose also is found in more than 20% of prescription drugs and in some over-the-counter medicines.
system: If you're lactose intolerant, what non-dairy foods can help you get calcium?
output: They include: Dark, leafy greens and vegetables like broccoli, spinach, and kale Salmon and tuna Beans and legumes Calcium-fortified soy milk and cheeses Almond milk Oranges You may also be able to eat yogurt that has active cultures.
system: How do low levels of lactase lead to symptoms of lactose intolerance?
output: Lactase, an enzyme in the small intestine, breaks down the sugar in dairy products. If your body doesn't make enough lactase, you may get diarrhea and an upset stomach when you eat or drink dairy products. You may have mild, moderate, or severe symptoms, depending on how much lactase your body makes.
system: Which foods can lactose be found in besides dairy products?
output: Lactose may be found in foods you don't expect, including: Calcium-fortified breads Cereals and baked goods Powdered meal replacements Instant potatoes, soups, and breakfast drinks Pancake, biscuit, and cookie mixes Margarine Salad dressings Products labeled ânon-dairy,â like whipped toppings and creamers, which may include milk-derived ingredients If you are lactose intolerant, the best way to avoid symptoms is to read food labels.
system: If you have lactose intolerance, what are the symptoms if you eat or drink dairy prodcuts?
output: Lactose intolerance symptoms include: Diarrhea Nausea Bloating Stomach cramps Gas But there are ways to manage lactose intolerance while still getting the nutrition of dairy foods.
system: Do medications contain lactose?
output: Steer clear of products with: Whey Curds Milk by-products Nonfat dry milk powder Dry milk solids Lactose also is found in more than 20% of prescription drugs and in some over-the-counter medicines. Birth control pills may contain lactose. Even things lactose-intolerant people may take for relief, such as tablets to reduce stomach acid and gas, can contain lactose. Ask your doctor or pharmacist if a medicine has lactose before you take it.
system: Can a a vagus nerve stimulator help treat complex partial seizures?
output: Devices: A vagus nerve stimulator is like a pacemaker for your brain -- it sends mild electrical pulses to a nerve in your neck. Your doctor might recommend this if other treatments haven't worked for you.
system: Are there foods that can help prevent complex partial seizures?
output: Changes to your diet: A special diet -- like the high-fat and low-carb ketogenic diet -- may help prevent seizures in some people.
system: When should you talk to your doctor about your anxiety and sleep issues?
output: If your anxiety does not improve after a few weeks, talk to your doctor. You may have an underlying medical problem (such as an overactive thyroid or a sleep disorder) or a treatable psychiatric condition (such as an anxiety disorder) causing you to feel this way.
system: How effective are enemas for the treatment of encopresis?
output: The phosphate-sodium enema ( Fleet Enema) is probably the most widely used type. Note: Some gastrointestinal specialists discourage the use of enemas and suppositories or any anal intervention because the child associates fear and pain with the anal area. The child may struggle or feel additional trauma when these types of manipulations are performed. Eventually, all impacted stool can be dissolved or disimpacted by using medications taken by mouth.
system: What is the outlook for encopresis?
output: Generally, the outlook for encopresis is excellent for children who undergo the treatment regimen outlined here. Many children who do not undergo treatment are able to resolve the problem on their own as they grow up, but this can take many years.
system: How can you establish bowel movements for your child with encopresis?
output: Establishing regular soft and painless bowel movements is mostly a matter of retraining the child to give up the habit of retaining stool. This is accomplished by giving laxatives every day to produce soft bowel movements. The laxative must be given in doses large enough to produce one or two soft bowel movements every day. The soft stool will be passed easily and painlessly, encouraging the child to have regular bowel movements rather than holding the stool in.
system: How are osmotic laxatives used to treat encopresis?
output: Osmotic laxatives: These laxatives contain agents that are not efficiently absorbed by the intestinal lining. This results in large amounts of extra water in the intestine, which softens the stool. Since all osmotic laxatives work by increasing the amount of water in the colon, it is important that your child drinks lots of fluid while taking any of these laxatives. Like any medication, these should be given only as recommended by your child's health care provider. If the laxative does not seem to be working, do not increase the dose without talking to your child's health care provider.
system: How is an enema used to treat severe encopresis?
output: Evacuation can be accomplished in the following ways: Give an enema or series of enemas: An enema pushes fluid into the rectum. This softens the stool in the rectum and creates pressure within the rectum. This pressure gives the child a powerful urge to pass a bowel movement, and the stool is usually expelled rapidly. The fluid in most enemas is water. Something is usually added to keep the water from being absorbed by the intestinal lining. Widely used enemas include commercial sodium phosphate preparations (such as Fleet saline or Pedia- Lax enemas), saline, and mineral oil enemas. Daily enemas for several days may be needed to completely evacuate the colon.
system: How does biofeedback work to help with encopresis?
output: Biofeedback: This technique has been used successfully to teach some children how to best use their abdominal, pelvic, and anal sphincter muscles, which they have so often used to retain stool.
system: How do laxatives work to treat severe encopresis?
output: Give strong laxatives: Most laxatives work by increasing the amount of water in the large intestine. Some laxatives cause the lower intestine to secrete water and others work by decreasing the amount of water absorbed in the lower intestine. In either case, the end result is much more water in the lower intestine when using laxatives than when not using them. This large amount of water softens formed or hard stool in the intestine and produces diarrhea. Laxatives used for this purpose include magnesium citrate, Miralax, Go LYTELY, and COLYTE products. Treatment for several days may be needed to completely evacuate the colon.
system: How do stimulant laxatives work to help with encopresis?
output: Stimulant laxatives: These agents have direct actions on the lining of the intestinal wall. They increase water and salt secretion into the colon and irritate the intestinal lining to produce contractions.
system: How is encopresis treated at home?
output: Although parents will be following a regimen recommended by the child's health care provider, most of the work of treating encopresis is done at home. It is very important that parents and other caregivers keep a complete record of the child's medication use and bowel movements during the treatment period. This record can be very helpful in determining whether the treatment is working.
system: What are the symptoms of encopresis?
output: Children with encopresis are no more likely than other children to have major behavioral or emotional problems. More than 80% of children with encopresis have experienced constipation or painful defecation in the past. In many cases, constipation or pain occurred years before the encopresis is brought to a doctor's attention. Most children with encopresis say they have no urge to pass a bowel movement before they soil their underwear. Soiling episodes usually occur during the day, while the child is awake and active. Many school age children soil late in the afternoon after returning home from school. Soiling at night is uncommon. In many children with encopresis, the colon has become stretched out of shape, so they may intermittently pass extremely large bowel movements.
system: What is the follow-up care for encopresis like?
output: The extent of follow-up needed for encopresis varies by situation. Your child's health care provider will probably want to see him at least once after treatment is well under way to ensure that the treatment is working or to alter treatment if necessary.
system: What are the principles for treating encopresis?
output: Although many different regimens have been developed for the treatment of encopresis, most rely on the following principles: Empty the colon of stool Establish regular soft and painless bowel movements Maintain very regular bowel habits While there is almost always a large behavioral component to chronic encopresis, behavioral therapy alone, such as offering rewards or reasoning with the child, usually is not effective.
system: When should you see a doctor about encopresis?
output: Any of the following warrants a visit to your child's primary care provider: Severe, persistent, or recurrent constipation Pain during bowel movements Reluctance to have bowel movements, including straining to hold stool in Soiling in a child who is at least 4 years old To diagnose enopresis, your child's health care provider will ask many questions about his medical history, toilet training history, diet, lifestyle, habits, medications, and behavior.
system: How is an anorectal manometry used to diagnose encopresis?
output: With this test, a small tube is inserted into the child's rectum. The tube has several pressure sensors in it. During the test, the doctor can determine how the child is using his or her abdominal, pelvic, and anal muscles during defecation. Many children who have chronic constipation and/or encopresis do not use their muscles in a coordinated fashion during bowel movements. The main objective of manometry is to confirm increased pressure within the anus. Manometry can also show whether the nerves controlling the anal sphincter, anus, and rectum are present and working by measuring reflexes in this area. Manometry can measure how far the rectum is distended and whether sensation in this area is normal. Abnormal contractions of the muscles in the pelvic floor can be documented by using manometry.
system: How long does it take to treat encopresis?
output: The duration of encopresis treatment varies from child to child. Treatment should continue until the child has developed regular and reliable bowel habits and has broken the habit of holding back his or her stool. This usually takes at least several months. Generally, it takes longer in younger children than in older children.
system: How can encopresis affect a child?
output: Over time, the child with encopresis may also develop incoordination of the muscles used to pass bowel movements. In many children, the anal sphincter contracts rather than relaxes when they are trying to push out bowel movements. This disturbed coordination of muscle function, which causes fecal retention, is a key to the diagnosis and is also called anismus or paradoxic contraction of the pelvic floor to defecation.
system: What causes constipation related to encopresis?
output: Some experts believe children become constipated when they do not eat enough fiber, available in fruits, vegetables, and whole grain foods. Many doctors think that some children become constipated because they do not drink enough water.
system: What should parents expect from encopresis?
output: Encopresis is a very frustrating condition for parents. Many parents become angry at the repeated need to bathe the dirty child and to clean or discard soiled underwear. Many parents assume the soiling is the result of the child being lazy or that the child is soiling intentionally. In most cases, this is not the case. Children with encopresis are no more likely than other children to have major behavioral or emotional problems.
system: What is encopresis like?
output: As the colon stretches more and more, the child loses the natural urge to pass a bowel movement. Eventually, looser, partly formed stool from higher up in the intestine leaks around the large collection of harder, more formed stool at the bottom of the colon (rectum) and then leaks out of the anus (the opening from the rectum to the outside of the body). Often in the beginning, only small amounts of stool leak out, producing streaks in the child's underwear. Typically, parents assume the child isn't wiping very well after passing a bowel movement and aren't concerned. As time goes on, the child is less and less able to hold the stool in-more and more stool leaks, and eventually the child passes entire bowel movements into his or her underwear. Often the child is not aware that he or she has passed a bowel movement. Because the stool is not passing normally through the colon, it often becomes very dark and sticky and may have a very foul smell.
system: When should you see a specialist for encopresis?
output: Most cases of encopresis respond to the treatment regimen outlined above. If the soiling does not resolve, your child's health care provider may refer you to a specialist in digestive and intestinal disorders (pediatric gastroenterologist), a behavioral psychologist, or both.
system: How do emollient laxatives work to help with encopresis?
output: Emollient laxatives: These products decrease the absorption of water from the colon, and thus soften the stool, making it easier to pass.
system: How else can an anorectal manometry help with encopresis?
output: Anorectal manometry can also be helpful to rule out Hirschsprung disease, a very rare cause of constipation without encopresis. If Hirschsprung disease is seriously considered as a cause of your child's encopresis, a biopsy of the rectum may be necessary. A biopsy is the removal of a very tiny piece of tissue for examination under a microscope. This is done to look for the absence of nerve function in the rectum, a characteristic sign of Hirschsprung disease.