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###Input :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? ###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.
###Input :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. ###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.
###Input :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? ###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.
###Input :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. ###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?
###Input :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 ###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?
###Input :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! ###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.
###Input :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. ###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.
###Input :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. ###Output :It's probably going to be Gilbert's. But who knows, sometimes it's not.
###Input :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. ###Output :Hemolysis is the only other common thing
###Input :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. ###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.
###Input :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! ###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.
###Input :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. ###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
###Input :Would those number be something to worry about in this setting? My AST and ALT? ###Output :Lose weight. Lots of it. Any damage as of now is still reversible. Later, not so much
###Input :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. ###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.
###Input :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 ###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.
###Input :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 ###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.
###Input :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. ###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
###Input :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. ###Output :Nope.It is preferred but not as big as a concern
###Input :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! ###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.
###Input :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? ###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.
###Input :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. ###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
###Input :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? ###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
###Input :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. ###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
###Input :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. ###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).
###Input :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. ###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.
###Input :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 ###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.
###Input :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? ###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?
###Input :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! ###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.
###Input :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 ###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.
###Input :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. ###Output :Some take a while, especially electrophoresis. Feel free to come back and post with more results.
###Input :Monoclonal protein 1.76 Beta globulin 1.66 Still waiting on the rest. ###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.
###Input :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. ###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.
###Input :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. ###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.
###Input :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 ###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.
###Input :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 ###Output :Have they ever ruled out hypercortisolism with a suppression test ? I can't find in your tests cortisol and ACTH values either
###Input :I don't believe so, that doesn't sound familiar. Is this something I should speak with Hematology about once I see them? ###Output :It's an endocrine disorder that would fit most of your symptoms (and also the high WBC count)
###Input :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. ###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.
###Input :Just curious, why 8am? Is it tied to when most people get up or does it have to do with circadian rhythms and such? ###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 )
###Input :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. ###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.
###Input :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) ###Output :Your TSH is fine, 0.7 is a good value
###Input :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. ###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?
###Input :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. ###Output :Have you been checked for an umbilical hernia? either by imaging or by a general surgeon?
###Input :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! ###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.
###Input :Is this hematology panel indicative of chronic lymphocytic leukemia in a 61yo female?HematologyWBCA134.0-10.0109/LRBC4.463.50-5.001012/LHemoglobin140115-155g/LHematocrit0.40.35-0.45L/LMCV9182-98flMCH31.427.5-33.5pgMCHC347300-370g/LRDW1311.5-14.5%Platelet Count270150-400109/LDifferentialNeutrophils4.12.0-7.5109/LLymphocytesA7.91.0-4.0109/LMonocytes0.70.1-0.8109/LEosinophils0.20.0-0.7109/LBasophils0.10.0-0.2109/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. ###Output :Not really. White count is only 13
###Input :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. ###Output :CLL typically has white counts in the hundreds, not 13.Without more details on the chest pain I cant really comment
###Input :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. ###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.
###Input :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 ###Output :To me it looks like iron deficiency
###Input :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. ###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
###Input :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. ###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?
###Input :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. ###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.
###Input :What are your thoughts on the left shift? ###Output :That's nonspecific. Causes could range from an infectious process, an autoimmune process, a malignant process, or none of the above.
###Input :Oh okay I see. Thank you! Did you see my other comment about the CALR test type? ###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.
###Input :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========================================================================= ###Output :Vaccinated and immune
###Input :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 ###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.
###Input :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 ###Output :They're designed nutritionally balanced so you just need to match the calories you need.
###Input :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. ###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.
###Input :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? ###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.
###Input :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. ###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?
###Input :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? ###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.
###Input :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! ###Output :I would go today. 300 calories a day is not sustainable and your *body will be taking damage from that.
###Input :(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 ###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.
###Input :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.) ###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)
###Input :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. ###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.
###Input :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 ###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)
###Input :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! ###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
###Input :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 :) ###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.
###Input :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! ###Output :You can do a phone appointment with an RD.
###Input :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 ###Output :They will die. This is not enough food to live. She needs to go to the hospital.
###Input :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. ###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.
###Input :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. ###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...
###Input :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. ###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.
###Input :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! ###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".
###Input :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. ###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.
###Input :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 ###Output :Most boys are done growing by 16. You were likely close to your adult height regardless by age 15.
###Input :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' ###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.
###Input :It is just quite frankly wrong, every countries education system and reliable sources all say boys stop growing at about 19-21 ###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.
###Input :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. ###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.
###Input :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 ###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.
###Input :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? ###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.
###Input :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. ###Output :5'2" is an extremely normal height. I'm sorry to hear about your eating disorder but you're a completely normal height
###Input :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. ###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.
###Input :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! ###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!
###Input :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. ###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
###Input :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. ###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?
###Input :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 ###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
###Input :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! ###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.
###Input :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? ###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.
###Input :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? ###Output :Its not normal. Just low weight worsens it. Whoever ordered the imaging should be the one to make the next referral.
###Input :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! ###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.
###Input :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. ###Output :This isn't at all concerning. I agree with your doctor.
###Input :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! ###Output :I agree with your doctor's suggestion. This wouldn't concern me.
###Input :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. ###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.
###Input :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 ###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
###Input :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? ###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.
###Input :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. ###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.
###Input :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? ###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.
###Input :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? ###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.
###Input :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? ###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.
###Input :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! ###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.
###Input :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? ###Output :Removed under rule 7. Please do not post pseudoscience/pseudomedicine or other non-medical interventions in this subreddit.