###Input :Pediatric Abilify weaning schedule?Hi Reddit Docs, My 8yo (9 in April) son has been on Abilify for about a year, up to 15mg. Long story short we dont feel that it is making a difference and in fact hes getting worse, more physical/aggressive, even violent at times. Especially since we added clonidine again. (In addition hes being treated by a physician who specializes in ADHD, not a psychiatrist. He was diagnosed by a psychologist with ADHD, depression, and motor coordination development disorder. I had to see this Dr because he was diagnosed during the height of the pandemic and no psychiatrist was available. Basically threw different combinations of Vyvanse, guanfacine, clonidine, and Adderrall at him, hes currently on Adzenys, Abilify and just came off clonidine. Finally got him some Lexapro a few months ago and his baseline mood has improved but the outbursts are worse. Ive been trying again to get a psychiatrist with no luck. I currently have an emergency intake visit scheduled in 4 days with a social worker who is supposedly going to get us a faster referral visit.) What is the recommended taper schedule to come off the Abilify? Wanting to make sure current provider is giving us accurate info. Thank you! ###Output :I am not sure what the guidelines for treating children are where you reside but to me this seems like a hodgepodge of medication. I would personally be very concerned to write out so many medications (some of which counteract each other).My first question would be what was the main problem with your son before he got medicated? Why did you seek help? Is there family history of psychiatric illness?The tapering really depends on the patient and the symptoms experienced. One could recommend to reduce 5mg every week (so 15mg, 10mg and finally 5mg before stopping). This can be further adjusted depending on any side effects. This can be also adjusted more finely if you have an oral solution instead of tablets.


###Input :Pediatric4 y/o female, turning 5 next month. No significant PMH. Complaining of pin point pain around umbilical area that hurts more when I breathe in and out. Also complaining of GERD symptoms described it perfectly without knowing obviously when I eat my food and drink too, it goes down to my belly and then comes back up and I have to swallow it again.Started complaining of both these symptoms over the last 24 hours.No bulge can be noticed or palpated, even when coughing or taking deep breaths.What could this be? ###Output :Gastric or duodenal ulcer, GERD, constipation. Would talk to pediatrician about it. Can do a trial with famotidine if it sounds like reflux to them with a more thorough history. If its a one off episode its unlikely to be anything to worry about if it self resolves. Look for food triggers and anything that helps or makes it worse in the mean time.


###Input :Pediatric burnsMy daughter is 4 years old and was burned with hot water earlier today. She was taken to our local emergency room within about 20 minutes of the accident. The burns are on her chest/belly area covering approximately 65% of the front. The doctor did not specify but I believe it's 2nd degree burns as the top layer skin has came off. The er gave hycet plus gave her a prescription for hycet and silvadene cream. They gave some thin blue towels of hold over the burn area with instructions to not begin the cream or put anything else on it until it stops leaking fluid from the burn. Now she has blue towel fuzz stuck to the burn area and I was told not to wet the wound nor cover with anything else. I don't want to go against the er doctors instructions but I just have a bad feeling that this is going to end up infected. Do these instructions sound correct? Is there anything else I should be doing? Given the burn is on her chest I'm not sure I'm allowed to include a photo but if the mods allow it. ###Output :This burn would likely meet criteria for inpatient management based on the described size and severity of the burn. Im surprised they would send you home. You should be able to lightly rinse the fibers off but every time you rinse it and if you have any abrasion, you risk destroying the epithelialization of new skin. There is a balance between dressing changes and allowing time for healing. Additionally moisture can increase the risk of infection. Generally speaking the fuzz is likely harmless, so you would have to use your judgement as to whether it needs to be removed based on the amount attached and any soiling or other factors present.If there is a significant amount, Id recommend a return to the emergency room for further management and discuss admission to the inpatient service or transfer to a burn center for further care. Burns often require more significant care than just the initial skin damage, especially if a significant portion of the trunk has been burned. In pediatric patients it is even more imperative to get proper care to ensure proper healing and limit future difficulties secondary to poor healing.They can be managed at home for minor burns, but if you are not comfortable with the care and it has not been described in enough detail that you feel comfortable, return to the ED. Your child will thank you in the future if you get proper care now. Its unfortunate that this may require an additional trip to the emergency room, but I wish you the best and hope your child has a speedy recovery.You may wish to try a different emergency room for a second opinion if you did not feel like you received adequate care at the first one.


###Input :Pediatric lupus?My 11 y/o daughter had three weeks of low grade fever, headache, body ache, fatigue, nausea and low appetite. Multiple negative tests - covid (including antibody), mono, strep, flu, RSV. Had a positive urinalysis for bacteria and blood - did a round of Bactrim but the symptoms remained. Current meds for asthma - symbicort, xopenex as needed, singular.Doc ran some more blood tests - looks like some were autoimmune tests. Can I get some interpretation of these ANA titer results? Recommend seeing a pediatric rheumatologist? ###Output :That's quite a high ANA titer (means very positive). Time to see a peds rheum.This is not the place to push Lyme pseudo-medicine.


###Input :Definitely in a tick borne illness area - Lyme tests are in these results too - but she was only reactive on one of the bands. I think that means shes negative? ###Output :That means she's negative. Please don't listen to the internet panic about Lyme disease. It's easy to test for and straightforward to treat.


###Input :Pediatric Wellness Exam around PubertyI am trying to find a new pediatrician for my daughter (11y/f). We went to a local female pediatrician, who was nice, albeit a little rushed and pushy. We talked for a little while, and the pediatrician did ask if she had her period yet or not. She has not. Upon physical examination, with little notice (hey I'm going to do this, and then did it) the doctor pulled up my daughter's shirt and bra, and then pulled up her pants at the waistband to look at her vaginal area. My daughter was struggling to not let her do this and is now traumatized by the interaction and felt like she could have given a little more warning. I know that physicians are very busy and have many patients to see, but I feel like I've failed to protect my daughter from this. I would think a conversation asking if she is developing breast tissue or pubic hair would have been just as efficient without stressing my child. Or even saying what she is going to do before doing that kind of exam. Is this a normal practice on a wellness exam? My daughter will not be returning to this doctor. ###Output :It is normal practice to check these areas, yes. Sounds like the doctor could have explained the process a bit better. At this age, I generally talk to the patient about what I'm going to do and why, then ask for their assent before proceeding.


###Input :7yo old with Hashimotos and Lichen SclerosisMy apologies for such a vague request but Im searching for any answers of how these two are connected or if we should be traveling out of state for second opinions. My daughter was diagnosed in the past year with both conditions. We live in the US (Nevada). She currently sees a pediatric endocrinologist and a pediatric urologist (we do not have a pediatric gynecologist where I live and our pediatric dermatologist is a male and my daughter wasnt comfortable seeing him).My issue is that everywhere we take her they comment on how rare her conditions are or how they havent treated it before. To me, that doesnt mean they are incompetent or she is receiving poor treatment, I just wonder if there are people who do treat these conditions more frequently and if it is worth our time to seek second opinions.Definitely not rich, but could most likely cover basic assessments if need be.Thank you in advance! ###Output :If someone has one autoimmune condition, they are at increased risk of developing other autoimmune conditions. These are both autoimmune conditions but unrelated except for the autoimmune diathesis. No comment on the thyroid disease, but skin biopsy results are definitive and treatment of lichen sclerosus is usually straightforward.


###Input :For my son.Age: 8 months old Weight and height: 20 pounds and 2 foot No medications being taken No smoking No current medical issues Location of complaint: headIll start with saying we took him immediately to the ER and got seen by a neurosurgeon at a pediatric hospital afterwards. They said he was good to go after observing him for a few hours and said his CT scan was clear of any bleeding or fractures by both the ER and neurosurgeon at at the pediatric hospital.I was at work and my wife called me and told my son fell back off of the couch, which is about a foot and half up off the floor (which is hard tile, there is a rug there as well about a quarter of an inch thick if that.)She picked him up and then said he was crying but then he stopped and his eyes rolled to the back of his head, he started bubbling at his mouth and got stiff. Wasnt responding to anything. I work at the hospital where we brought him into the ED at and I saw him, I was moving him but he wasnt responding either so they called in a code and gave him 2.5mg diastate to help him out. After they gave him that, I saw him start moving and making noises. Afterwards they took a CT scan on him which, at that point, I was informed by one of the doctors there it was clear from any fractures or bleeds. However, I was also told that since there wasnt a radiologist there the doctor told me she couldnt say for sure. At this point, they send us to the pediatric hospital where he was seen by the neurosurgeon, who told us she didnt see anything either and it looked clear to her as well. Afterwards we were three from about 10:30-5:00 pm. During the time we waited he fell asleep and ate like normal, didnt throw up or anything. Neurosurgeon came back and did some other tests, he grabbed some keys she had and played with them like he normally does with things. From there, they discharged us and said to watch him over the next 48 hours for any changes in behavior or anything out the norm. Neurosurgeon stated she doesnt think he had a seizure but doesnt know for sure since the scan was done about 20-25 minutes after he arrived and wasnt sure if it was done too early. For a bit of a better timeline of events, he fell about 8:59 a.m. and arrived at the hospital about 9:05 a.mSo after we got home hes been completely normal. Even today hes been fine. He has a regular check up in about two weeks but I want to do a follow up and wanted your alls advice due to the fact of how he was immediately after the fall, since that seemed to be the part that had most of the providers a little stumped. I did on searching on google (I know) to see if I could find anything similar to the situation but found nothing that seemed similar to it. They way a nurse and the neurosurgeon explained what it was, that it couldve been he had response to the trauma of the pain and that his was reaction was what made him go into that state. I apologize for the long read but there was no short version that had enough info. But, if theres a question that anyone needs answered for more context please let me know. ###Output :t's hard to say if he seized or not. Seizure after head injury isn't super rare. You can have seizure in absence of bleeds or fractures. The timing or findings of the CT has no bearing on whether he seized.He may have been concussed. Concussion is a clinical diagnosis, and is not something that is diagnosed by imaging.I frankly would be shocked if he had seizures or concussion from the fall, as described. I've seen >100 babies with falls like this, none have had serious injury.I've seen many infants and toddlers with falls from 2nd story window/balconies. I don't recall any ever having serious head injury.But yeah, likely either a weird pain response, or concussion. Or there is more to this story than an 18" fall onto carpeted floor.


###Input :Trans (FTM) invasive exam at endocrinology visit *repost **is this common practice??4 years ago i had visited a pediatric endocrinologist for my first dose of T after 2 years of therapy. i had done everything i needed to, i was excited, i was desperate the endocrinologist did everything routine blood tests, usual physical examinations during the physical, it was quite apparent that i did have excess hair and signs of hyperandrogenism. the blood work even indicated that my cholesterol was high. the day of my follow-up he had asked me to wear a gown so he can check down there i dont remember ever getting a reason why but he did let my mom stay in the room and brought a chaperone. i was desperate so i let him do it. it haunted me for a while.4 years later. i had learned that that examination apparently isnt routine via my friends and this examination was never reported in any of my records so i decided to give him a call about it to express my concerns. he told me that people who have hyperandrogenism, their clit grows so he wanted to check for signs of that and anything that can indicate for signs of a tumor, that is causing it so that he would order a CT scan if he suspected iti still dont know how a physical examination can make that clear but i felt pressured today so i just agreed just like i did 4 years ago he even admitted to checking several patients clits for a baseline for T but he said he doesnt do it anymore because its uncomfortable or has a (female) nurse do it if he feels its necessary.i still dont have an answer im afraid i gave consent that day under false pretenses i feel strange just leaving this alone even though i dont think he had any ill intentions.should i ask for another opinion? or am i making this a bigger problem than it is? ###Output :Sounds like they were assessing for clitoromegaly and they werent very sensitive to your needs or reading the room. I dont think this is common for FTM physical exams, especially when youre displaying signs of hyperandrogenism.What I can say is that my guess is a pediatric endocrinologist is definitely more likely to assess genitalia because they are the ones that first pick up on hormonal imbalances caused by tumors or abnormal genitalia so it may actually be within their scope. I think they were being thorough during a time when trans care was evolving given that they brought a chaperone. If they did a full pelvic exam then that would certainly raise some red flags.I think your being uncomfortable was warranted and I dont think what they did is standard practice. However, Im not sure Id pursue it anymore given that a genitalia exam in some cases might be appropriate. Again, if penetration occurred then Id be more worried. Today, this would typically be monitored by a Gyn as part of a multidisciplinary team.


###Input :What exactly do percentiles mean for pediatrics?I took my two year old for his appointment today he weighed 32.2 lbs/90th percentile and his height was 34.5/63rd percentile.I know this might sound bad, but does this mean my child is on the short and chunky side? Only asking because I didnt mention his diet and the doctor never brought it up except to cut out juices and switch to 2% or 1% milk for him.. but didnt seem concerned with his weight and said his teeth were great.I shouldve asked, but my son was trying to get into everything, it got hectic and it completely slipped my mind to ask ###Output :He's on the heavier side for kids his age. He's still taller than average, though, so in general he's just a bigger than average 2yo.Switching to low-fat milk and avoiding sugary beverages are standard things that we suggest at this age, so I wouldn't read into the pediatrician talking about those. That's the recommendation for every kid!


###Input :The only time percentiles posed a problem for my kiddos was when they were used to detect a head growth problem in one of my kiddos  extra imaging was requested and there was an actual reason for the extreme jump off of the datum points off of the growth curve.Would it be fair to suggest that growth curves and percentiles are used to detect changes in growth? ###Output :Yes, that's a good way to explain it. When we're watching from visit to visit, we're looking at the trend in percentile over time.50th percentile would be exactly average, 90% percentile means in a room of 100 kids his age hes heavier than 90 of them.


###Input :low neutrophils high lymphocytes pediatricMy son is 3 years old. Got a ton of blood work for his weight I guess. He's 27lbs. He has high energy and no concerns other than occasional constipation. The blood work came back with low neutrophils 21% and high lymphocytes 71% (which has me sick to my stomach thanks to Google. WBC, RBC and hemoglobin is normal. Hematocrit is low 32.9% with the range min of 34%. His neutrophils absolute is 1.56 which is in range but on the low end of the range that says the min is 1.50. Lymphocytes absolute is in range. All morphology is normal. His ferritin is low at 23 with the standard low being 36. Everything else is normal. They did a lipid panel which I didn't have him fast as no one informed me. And his triglycerides were pretty high at 238mg/dl. He had half a sugar cookie an hour before and I was feeding the other half during his blood draw to distract him. VLDL was high at 48mg. Everything was normal on lipid. Carbon dioxide was low at 17.0mm. ###Output :First off keep in mind the percentages always have to add up to 100. So either the neutrophils are low because the lymphocytes are high, or the lymphocytes look high because the neutrophils are low. So he's got one problem, not two. Based on the other values my guess is that it's probably the low neutrophils but I'd have to see the absolute numbers.His iron is a little low but otherwise everything else is normal. Do you have a hard time getting him to eat meat? Because it's likely just dietary.In general, I really recommend against googling labs because it always comes up with scary stuff. Those aren't cancer values if that's what you're worried about. Could be he's fighting off an infection, could be related to a malabsorption issue or dietary deficiency, could just be normal for him.If it were my patient or my child I would think it's not likely a big deal, but would want to recheck at some point in the next few months to see if it changes. Keeping in mind I'm a family doctor and not a pediatrician, so they may have a slightly different plan.


###Input :Neutrophils Absolute Your Value 1.56 103/uL Standard Range 1.50 - 8.50 103/uL Lymphocytes Absolute Your Value 5.26 103/uL Standard Range 2.70 - 10.50 103/uL Monocytes Absolute Your Value 0.44 103/uL Standard Range 0.10 - 1.10 103/uL Eosinophils Absolute Your Value 0.15 103/uL Standard Range 0.00 - 0.90 103/uL Basophil Absolute Your Value 0.00 103/uL Standard Range 0.00 - 0.20 103/uL Bands Absolute Your Value 0.00 103/uL Standard Range 0.00 - 2.10 103/uL ###Output :Honestly that doesn't really look awful. Mild neutropenia. Not particularly scary.


###Input :Ascites 4 weeks post-op, acute renal failureUpdate: Over 5L of fluid was drained from my dads abdomen today. The fluid was high in creatinine and consistent with urine. He initially felt much better, but then started experiencing extreme pain, likely from muscle spasms due to the drastic change in his body over the course if only 2 hours. His O2 dropped to 86 due to the pain. He is now medicated for pain and sleeping on and off. We are hoping that his status will improve over the next few days. Thank you to everyone that commented.70M, 6ft even, 205 lbs, Barrett's esophagus, eczemaHistory of heavy smoking decades ago that was reduced to once or twice per day in the 1980s. Uses edibles/microdosing to manage anxiety and depression.Regular medications include acid reducers for well-monitored esophagus and fish oils and supplements for controlled eczema. Very active lifestyle for age including managing half acre yard, frequent 15 to 20 mile bike rides when weather permits, strength training at gym multiple times per week.January 12th, dad underwent robot assisted prostate removal. Lymph nodes were clear and there was one area where cancer had spread one millimeter into outside tissues. No radiation is recommended at this time. He was disharged home with a catheter. The catheter was removed one week later, but about 18 hours after it was removed, he was having trouble urinating and developed severe pain. He went to the ER cathed again. He was determined to have continued swelling in his urethra.A few days later, a cystogram with his surgeon revealed a small tear in his bladder where his bladder and urethra meet. His surgeon said that he expects the tear to heal on its own.My dad was admitted to the ER today for increasing discomfort in his abdominal area with pain and diarrhea. When I showed up, I noticed that his abdomen was visibly distended. CT confirmed ascites. Nothing else to note other than a 2 mm calcification in a kidney and cirrhosis. He is a recovered alcoholic that hasn't touched alcohol in 37 years. Labs shows some RBCs and WBCs in his urine. Also indicated acute kidney failure. BUN 56 mg/dL, creatinine 4.54 mg/dL, eGFR-Cr 13 mL/min/1.73m2.It is a lymphatic leak? Maybe urine leak caused it? If so, what next? ###Output :In a patient with cirrhosis and new onset renal failure with swelling by the prostatic urethra, your dad appears to be at risk for urinary retention because of how much inflammation and swelling there is by the pelvis at the neck of the urethra. A simple noninvasive bladder scan can be done at the urologist's office after he voids or is allowed to empty his bladder completely , called a "post void residual". If there is more than 300-450 cc (every doc has their own cutoff) after a reasonable attempt to empty every last drop, he is considered to have urinary retention. This can cause urine to flow backwards and cause backpressure into the kidneys, effectively causing hydronephrosis (which can be picked up on a renal ultrasound (ultrasound of kidneys), or CT scan of the abdomen. Obstructive uropathy is this condition and can be source of renal failureAlso, ascites is not uncommon in decompensated cirrhosis. Make sure your dad is on a low salt diet. Also it is important to check a Complete metabolic panel or hepatic function panel to see his albumin level. Low albumin can contribute to ascites. Your dad could be in what we call hepatorenal syndrome if his cirrhosis is not under control and can lead to renal failure and death.


###Input :What would cause someone to spiral into acsites when they have not touched alcohol in 37 years? He quit drinking when he was only 33 years old and hasn't had a drop since. He has never had any issues with his liver before.I will put his CT impressions, but I don't recall seeing anything about hydronephrosis. ###Output :low albumin levels coupled with changes in portal pressure can cause this too, as can increased salt in diet or from IV fluids he had received during surgery. You mentioned the CT had findings of cirrhosis. Cirrhosis physiology is complex and would need complete liver function panel, INR, Tbili, serum albumin, Na levels to fully evaluate severity


###Input :Thank you. I just got off the phone with his surgeon, and we were able to talk for about 30 minutes. He feels that there is a continued bladder leak and that we are likely to find that the fluid collection is high in creatinine. They are putting a drain in tomorrow and they'll test the fluid. If this is the case, his kidney function is likely not as poor as it appears, as his body is reabsorbing creatinine through his peritoneum. I did ask him to run a liver panel out of an abundance of caution and he agreed. ###Output :If that's the case, then this is a Urinoma I believe. Still though a creatinine of 4.54 and BUN of 56 is quite high but you're dad's urologist is right that creatinine can be inflated in this rare but unique scenario. BUN would be expectedly a bit higher if his creatinine were that high but not always. Cystatin C measurement can be another surrogate used to indirectly measure his true GFR. That hole wont repair itself unless the urologist diverts the urine elsewhere and hence the drain is needed. Bladder wont heal if there's continuous flow of any liquid, in this case urine, through the hole.


###Input :Thank you for your input. I feel significantly more at ease. Hopefully, this is truely just the continued leakage. When my dad's labs came through electronically, I was initally shocked and alarmed. Now I feel cautiously optimistic.His urologist us going to mess with catheter sizing and try to inflate the balloon a bit more to put a bit of a stretch and seal up that leak. He'll give it two more weeks to see if the fistula can repair itself before going in for a corrective surgery. ###Output :I'd be worried about a bladder leak given the bladder injury. Need to aspirate and sample that fluid before writing it off as simple ascities, imho.


###Input :They are putting a drain in tomorrow morning, so we will find out what thr fluid is then. I feel extremely frustrated right now that there isn't more of a sense of urgency. ###Output :Either the fluid is persistent leak from the tear which seems somewhat likely. The other possibility is obviously cirrhosis with ascites. As a prior heavy alcohol user, long-term smoker likely some degree of poor lifestyle habits (ie dietary) and his age he has more than enough risk factors to develop cirrhosis.Either way, sampling the fluid will give the necessary info


###Input :My husbands diagnosis. Please help. I posted a few months ago about this and you were all so helpful.Pt: 41 y/o male, former marine, non smoker, very occasional drinker, 170 lbs 60.My husbands official diagnosis is Metastatic renal cell carcinoma, which spread to his lungs. They went in and took the tumor off the kidney (he has horseshoe kidney so he only technically has one) and he was very optimistic about getting it all from that area. Said his body encapsulated the tumor and they didnt see anything else on his kidney. They said there were nodes in his lungs, but that they werent treating and just want to keep an eye on until mid December, then talk about what to do if they grow. The problem is, he is weak and is having trouble breathing.No chemo, no radiation, no immunotherapy yet or maybe at all. Is this normal?His lymph nodes have been so swollen I can see them under his collar bone, and in his neck. Im worried. Is metastatic a automatic stage 4 diagnosis?Is his prognosis good? His oncologist and doctor seem to think so, but they wont really speak on anything early on. They said we would meet in December and talk more then. What do I do now?My husband isnt able to work, and is taking time off from getting his degree. He can barely walk around without being winded. I have picked up extra shifts at work, so I dont get to see him and how hes doing. I just want to know if I should trust what they are telling us, or ask for them to check him again since hes so weak. Help? Im losing my mind.Thank you. I appreciate you all so very much. ###Output :Dont wait, call the oncology office now and let them know these concerns, they may need to start other treatments sooner.See a palliative care doctor ASAP. They are experts in cancer pain. Some cancer treatment centers also have anesthesiologists or rehab doctors who are experts in cancer pain.Oncologists are experts in the extreme complexities of treating cancers. There is a lot more to having cancer, and it's best to have an interdisciplinary team.


###Input :He definitely needs to be checked out sooner rather than later, so if the oncologists cant see him urgently then he should still see primary care, or failing that, go to ED where they can check him over and perhaps even do a CT to establish whats going on with his nodes / progression. ###Output :Yea an ER doc can check to make Sure he hasnt developed a PE (blood clot in the lungs) which is common and cancer and causes shortness of breath. The CT will also see if the cancer is bigger. Just be sure to go to an ED thats affiliated with his oncologist so they can see the images


###Input :Pts horseshoe kidney would handle it better than an. NSAID for, say, minor pain. But metastasizing cancer pain is of a much higher order. Hell be initially given Norco, probably transition to higher-order opiates via a learned palliative oncology Al pain specialist. ###Output :That is an outrageously inappropriate pain regimen for a young person with advanced cancer.


###Input :I agree. I was shocked. Its hard as his wife to watch him suffer. The man never complains, and if he says in hurts, it hurts. ###Output :I'm seeing a lot more tylenol/NSAID management for post operative patients (c-sections, hernias, hysterectomies, etc). However we always give narcs for breakthrough. The cancer patients are the exception, particularly the stage 4 ones. They still get non narcotic pain alternatives but that's in combination with narcs.


###Input :Based on all of your comments it truly sounds like its time for a second opinion. Your current oncologist doesnt sound effective nor compassionate and you and your husband deserve a doctor who will listen to your concerns, treat symptoms, and treat his cancer rather than wait another few weeks which could be crucial ###Output :Im a urologist and I've treated cancer like this.So he should definitely be in some type of therapy if he has metastatic renal cell cancer. Typically this is immunotherapy which is typically not too hard on the body (this is significantly easier than something like chemo). There are many medications out there that all have pretty good effects on cancer. It sounds like your husband had a cytoreductive nephrectomy" where the kidney is taken out even though we know the cancer is spread. The goal is to just get as much cancer out as possible. Typically if there is remaining cancer (in the lungs for example) we then give immunotherapy however you do need to wait about 6 weeks after surgery for recovery. I'm not sure where he is on his recovery from surgery. Bottom line, I would talk to your oncologist about starting treatment, especially immunotherapy.Yes stage 4 = metastatic cancer. This is true of essentially all cancers.i will be blunt his prognosis is not good. With appropriate treatment his chance of living another 5 years is probably ~20%. This doesn't mean he'll die tomorrow but his time is limitedMore worrying is how young he is - 41 is incredibly young. You mentioned he is a veteran - he should see someone asap at the VA. If he had any exposure during combat he may be able to have all his medical bills covered. This is incredibly long and bureaucratic process but would be something I'd strongly suggest looking into.I am sorry but I hope this helps


###Input :It helps me, as you are being honest and upfront and thats what I need.So theres really not a good chance hes going to walk away from this? If you personally had to put time on it, can you tell me about how long?Thank you for that well thought out and honest reply. His doctors told him that he was going to be fine, but everything I have read online (I know Dr google isnt good, but I have scoured so many articles)Maybe thats why they want to wait until December? He is recovering very slowly. Hes also in a ton of pain and nothing I do helps. His doctors wont prescribe things as they claim its too hard to get around the red tape. I dont understand. Im treating him with edible THC as well as CBD because he wasnt eating. I was honest with them about this, and they didnt seem to see a problem with it.My heart is broken, but thank you for telling me your opinion here. It means a lot. ###Output :Cancer related pain is one of the major indications for opioid pain meds. Im not sure what red tape these doctors are on about. I think its time for a second opinion.


###Input :NAD, but both of my parents had metastatic lung cancer. There was literally zero red tape in getting them pain meds. My father passed 7 years ago, and was getting fentanyl patches, morphine, and Norco. My mom just passed 3 months ago and she had morphine and OxyContin. Your husbands pain should be treated. ###Output :Is he getting medical care through the military or civilian hospitals? There's a huge difference in quality as well as the fact that you cannot sue if a practitioner has dropped the ball.


###Input :If he has a positive Virchow node, they need to see him like right now ###Output :This is all (unfortunately) correct except OPs husband didn't get cytoreductive radical nephrectomy but partial nephrectomy, due to having only one kidney to start with.


###Input :That doesnt sound good. ###Output :Yes, this partThey said there were nodes in his lungs, but that they werent treating and just want to keep an eye on until mid December, then talk about what to do if they grow. The problem is, he is weak and is having trouble breathing.doesn't sound good at all. Sounds like his metastases are growing pretty fast when he's already noticing bulging from lymph nodes and trouble breathing from lung metastases. But we don't really have enough information to make this determination right now. Missing information:The exact histopathology (is it clear cell renal cell carcinoma or something more exotic?)Imaging reportsThe date of imaging and surgery to get a feeling for the timeline and progression dynamicsWhy his treating physicians said that "his body encapsulated the tumor" when they also said he has lung metastases, and why they didn't indicate systemic therapy and why they seemed to think his prognosis is good.Taking the most likely case based on incomplete information: In metastatic classic clear cell renal cell carcinoma, no chemotherapy is indicated ever, because chemotherapeutic agents don't help, which has been tried and demonstrated over and over. Effective medications are immunotherapy (checkpoint inhibitor antibodies like pembrolizumab), TKIs (tyrosin kinase inhibitors that can be taken orally, like sunitinib, pazopanib, cabozantinib or axitinib) and as probably less effective alternatives medications that inhibit vascular growth (e.g. bevacizumab or lenvatinib) or mTOR-inhibitors (e.g. temsirolimus).What's indicated precipitates on your husband's other medications, comorbidities, performance status (overall health) and other stuff.Also, in oligometastatic renal cell carcinoma, locally ablative therapies can be used to kill all the metastases you can detect at the moment, for example radiosurgery, microwave ablation etc., but your husband's case doesn't sound like that from the very limited information we got.Edit: As /u/Porencephaly already wrote, your next step is to contact his oncologist's office. They need to determine what the problem is right now (maybe it's even an infection and not metastatic progression) probably with new CT imaging and formulate a plan of action.His trouble breathing could be due to anemia, or a number of infections, or heart problems, or lymph node metastases compressing blood vessels or a bronchus, or pleural effusion, or whatever else... this is all more probable than trouble breathing due to lung metastases themselves, which surpisingly rarely are symptomatic in this way.


###Input :Thank you!! Ill get him in ASAP! ###Output :Heme/Onc fellow here, agree with everything youve said.Ill add my two cents and say that in addition to immunotherapy, VEGF inhibitors such as axitinib, cabozantinib, and lenvatinib are options as well. Many of the first-line treatment regimens are a combination of immunotherapy (either pembrolizumab or nivolumab) + one of the VEGF inhibitors. Combination immunotherapy (ipilimumab+nivolumab) is also an option as well for many patients. If someone has non-clear cell histology, the preferred regimens change a bit (and clinical trial is much preferred) but a lot of the same treatments are used.For someone who has a large burden of disease and is symptomatic from it, a combo of VEGF inhibitor + immunotherapy might be better than immunotherapy alone, just because the response rate is faster. But ultimately the choice depends a lot on factors like what other medical conditions someone has and what side effects theyre willing to tolerate, because we dont have any head-to-head trials showing that one regimen is better than the other.


###Input :Seeking information regarding dads renal cell carcinoma. Any urologists here?My dad has been having serious issues with vomiting, nausea, and weight loss. They ended up doing abdominal CT because colonoscopy and upper GI scope were normal. There was an incidental finding of a 2 cm heterogenous(I think???) lesion on one kidney. Per radiology report, it says renal cell carcinoma until proven otherwise.Today we saw the urological surgeon who said due to size of tumor and my dads age, hes a candidate for ablation and theyll give him a referral.The appointment was very rushed and I (29 F) went in with my dad because he has a history of TBI and has a hard time remembering/relaying medical info. We basically were just told that its cancer (which I figured from reading rad report) and that it can be ablated very quickly and the doctor then basically told my dad to drop his pants for a prostate exam so I made a swift exit.My questions lie in whether more imaging needs to be done on my dad to make sure theres not other cancer somewhere? The doc said most likely stage one but theyve only done the abd CT and nothing else?? I understand its a small tumor but does that automatically mean theres no metastasis?? I dont understand how they know that its only stage I without additional testing or imaging? Can anyone give me insight here about this process?We will be following up with that physician where I will be asking for clarification. It was such a whirlwind of an appt and I just didnt feel prepared to ask necessary questions. ###Output :From the information provided, this is not standard of care - but giving us the image files (upload to e.g. dicomlibrary and CT report would be very helpful.Here is NCCN's very helpful patient guideline for kidney cancer.A suspicious 2 cm lesion on a kidney often, but not always is renal cell carcinoma. A 2 cm renal cell carcinoma that's confined to the kidney is usually pretty harmless and very unlikely to relapse or metastasize.The problem is that 1) staging is incomplete and 2) you won't have histology going along with this to confirm that it is indeed renal cell carcinoma and 3) your father has concerning symptoms that are as of yet unexplained.Initial evaluation and staging vitally includes comprehensive labs (CBC, metabolic panel, LDH), abdominal CT with and without contrast, chest CT (or at least, but that's discouraged in the guidelines, chest X-ray) and a thorough physical examination and history.If there are any alarming signs on history or examination, additional imaging must be done. I'd consider vomiting, nausea and weight loss to be alarming. At least brain imaging (preferably MRI) should be done to exclude brain metastases imho.Also, when not performing a partial nephrectomy, which would be preferable to ablation if possible, an initial core needle biopsy to secure histologic diagnosis is recommended. Otherwise you won't ever know what kind of 2 cm mass they burned. The NCCN guidelines stateBiopsy of small lesions confirms a diagnosis of malignancy for surveillance, cryosurgery, and radiofrequency ablation strategies. Ablative techniques may require multiple treatments to achieve the same local oncologic outcomes as conventional surgery.


###Input :Distended abdomen, fatty liver, enlarged spleen and left renal fullness?Hi everyone!Just wondering if anyone has any ideas as even my GP seems to be stumped!I'm female, 32, MODY diabetes on insulin and high blood pressure (on nifedipine). Have a history of colon polyps but most recent colonoscopy in June was clear.The last few months I've been struggling with swelling in my stomach (photo) I look heavily pregnant and it is so uncomfortable, and the few weeks I've started having pain around my right rib area and into my back. Also have extreme fatigue.2 different GPs examined me and both were certain it was fluid so referred me for ultrasounds.I had these last week and had the results today - there is no fluid! The ultrasound did confirm moderate fatty liver, an enlarged spleen and left renal fullness.GP has referred me to haematology to look into the spleen, but said the fatty liver is only moderate and wouldn't cause the pain etc. He also doesn't know what the left renal fullness means but I do have a repeat enal ultrasound tomorrow.Full blood count was normal, kidney function came back normal but GFR had dropped from 85 in April to 62 last week, ALT on liver function only slightly raised to 62, cholesteral high at 6.3 with triglycerides at 7.3mmol.Anybody have any ideas at all as to what could be causing the swelling etc?Thanks - sorry it was such a long post! ###Output :An ultrasound cant tell the difference between fat and fibrosis. Your labs and imaging findings of enlarged spleen are concerning for possible liver disease. You should see a gastroenterologist for further work up.


###Input :Dont you think a gynecological exam is warranted? ###Output :I honestly dont know if abdominal fullness is a reason for a gyn exam. I wouldnt think so though if youre not having other symptoms (bleeding), but not my area of expertise


###Input :That's doodoo. If fibrosis is significant, US can easily tell the difference between cirrhosis and fatty liver. ###Output :An ultrasound can show other signs of cirrhosis and can give an idea if a liver is cirrhotic appearing but it doesnt actually measure fibrosis/scar tissue. Sono it doesnt show fibrosis. Youd need a biopsy or fibroscan for that. Or an mri with elastography. 97wrongggggff


###Input :You said if it can tell the difference. Measure is another thing. Ultrasound can tell the difference between a fatty liver and a highly fibrotic one/cirrhotic. But yeah, it can't measure the amount. Unless you do an ultrasound fibroscan. In that case. Ultrasound can measure the amount  ###Output :You can have an ultrasound that just shows fat and that liver can definitely be a cirrhotic liver even if the ultrasound doesnt call it. Thats my point.


###Input :My sebum creatinine level is 5.7 and I want to reduce it by following a renal diet. Is it possible?I am 23F, 55kgs and 5'1. I had high creatinine level of 17, then went through dialysis for 2 sessions and reduced it to 5.7. I do not want to go through dialysis again as it made me feel very weak and made me vomit blood and feel sick. Instead of dialysis, I want to follow the renal low protein diet and take my meds (ketosteril, iron supplements because of my low haemoglobin and antacids). Is it possible to reduce creatinine by this margin without dialysis? ###Output :I suspect the answer is no, but it's a better question for your kidney doctor. My understanding is that the renal diet won't restore renal function, but reduces the amount of things that don't dialyze well (certain dietary proteins, phosphorus, etc). If you have been started on dialysis I suspect that your kidneys have failed. Your kidney doctor is the one tell give you prognosis if there is a chance of you regaining kidney function or if dialysis would be a long-term thing.I would strongly caution against trying this on your own or skipping dialysis sessions without first discussing with your kidney doctor. It's very possible that dialysis is literally keeping you alive.I'm sorry but this needs more info.


###Input :I'm willing to give any info. What should I add? ###Output :I'd add the history: what doctor did you see, why was your creatinin so high/what was the reason for your kidney failure, did they tell you doing dialysis twice was enough? This post is very confusing


###Input :Would bladder or ovaries be checked on a CT scan for renal stones?A few months ago I (24f) was in the ER for gross hematuria and the doctors there did a CT scan, suspecting renal stones. Nothing showed up, and its now suspected to be related to my endometriosis as its having a cyclic presentation around my period.The doctors also noted a 4 cm ovarian cyst on my right ovary, which makes me think that the CT scan wasnt just focused on the kidneys.Anyway, all this to say: Im pretty sure the gross hematuria is from bladder endometriosis (which my doctors believe it to be), but Im a bit worried its something more serious like a tumor or large cyst. Would my earlier CT scan rule out these possibilities, or should I maybe make an appointment to do more imaging? ###Output :Would have been seen on the CT.


###Input :Potential Renal neoplastyWent to er for massive dehydration and what I thought was a intestinal blockage. That issue resolved itself but during CT scan for blockages, etc, noticed something on my kidney."Indeterminate lesion in the lower pole of the left kidney measuring 1.7 x 1.5 cm. This is suspicious for a possible renal neoplasm. A follow-up non emergent dedicated pre and post-contrast renal CT would be recommended to further evaluate."Not asking for medical advice, going to get it further checked asap, but anyone with experience here - how concerned should I be? It's the weekend and I can't call pcp and I'm trying to keep my wife from panicking, honestly. The er doc seemed fairly concerned. ###Output :Based on CT results it's literally indeterminate. You need further imaging which will likely happen rather quickly.


###Input :potential kidney/renal issues? or maybe something else?Hi,I really need so advice, I'm 27 male from UK, bmi within range, slim/average build,Over a year ago now I had a dull ache in my right mid back side which radiated down my flank.I saw my Dr who did a urine sample and a ultrasound, both were fine.. a year ago, however the pain has still persisted.I've gone back and forth to the Dr's who are now being quite stubborn and won't do anything else apart from constant urine tests which come back normal, they won't assist or try other avenues.This pain has continued to plague me, sometimes I have zero pain, live normally, and a hour or so later or the next day I could get the pain back which feels like a deep ache, (like I've been kicked in the testes) this hasn't got any better by itself for a year. And now it's starting to worry me as now when the pain happens, I now get a tender testicle on my right side.At first I thought maybe my underwear are a bit tight, so I've spent a lot of time not wearing underwear to give them space, it's made no difference, as soon as that back pain starts it moves down my flank, and eventually in my testicle where the pain can last 1hr to 5hrs and if like magic completely disappears until the next episode which is usually that same day or the next.I dont know where else to turn, I'm considering going private for gp , who could push me back onto the nhs and refer me. Bypassing my nhs gp. I'm starting to be concerned it could be something more serious which is not being detected and could get worse.I just want the pain to go.The pain severity out of 10 can range from a 2, to a 8, it makes me feel nauseated if it's bad.Thanks in advance. ###Output :Sounds like a ventil stone in the right ureter, can be seen easily with a native CT scan of abdomen/pelvis.The ultrasounds and urine analysis were done to rule out the most common causes which are hydronephrosis and pyelonephritis.A ventil ureter stone doesn't always cause a hydronephrosis to be seen in the ultrasound. And a microhematurie although is present in most cases of urolithiasis but not always.The next logical step is a native CT scan. Book an appointment with your urologist


###Input :Thank you this sounds similar, I will have to ask my Gp as in the UK we can't book direct with specialists, you need a gp to do so if they feel it's necessary.I cant find anything on ventil stones, but have found a lot of info on ureter stones which sounds very similar. Thanks again ###Output :Ventil stones are rare, i have only 2-3 cases per year. I don't know if the name in english is same as in german, we call them ventil stones because they act as a ventil or imagine as a Gate, the ventil stone moves a bit=blocks urinary tract causing hydronephrosis and massive pain, then a bit later this stone moves again and opens the way so to say and then urine flows normally and hydronephrosis dissappear so pain goes away. The native CT scan can 100% detect it. If you experience fever with the pain you rush to the Er, otherwise go to your gp as you said.


###Input :I have a secret IUD and need to undergo a non-invasive pelvic ultrasound, will it be detected?Hi! I'm a 22 year old woman who lives in a conservative Muslim society and I need to undergo a pelvic ultrasound to test for PCOS. I secretly got an IUD while living abroad, never thought I would have to move back to my home country so wasn't prepared for this situation. My mother accompanies me wherever I go because I'm never allowed out of the house alone.I recently had my blood checked and the test report includes: levels of FSH, LH, estradiol, progesterone, testosterone, renal function tests, liver function tests and a lipid profile. Can a doctor come to a conclusion about whether I have PCOS based off my hormone levels, or is an ultrasound mandatory? ###Output :Yes, they will 100% see it on an ultrasound.Often the hormone results are all theyll need for the diagnosis, but in some cases doctors will recommend the ultrasound to get information on the size and appearance of the ovaries. Its possible to decline to get the ultrasound. If you really dont want one, the doctor may be okay with skipping it.Or is there a way you can go to the ultrasound with another family member who you trust to know about the IUD?


###Input :Could they slip a written note to the tech or doctor to not verbally mention the IUD in front of mom? ###Output :In conservative Muslim countries, it's not uncommon for doctors to share information about adult children with their parents. It would not be safe to send this type of note/email and risk it being shared with the parents.Read more here. (Excerpt from "Factors influencing sexual and reproductive health of Muslim women: a systematic review" below)" Unmarried women seemed to be concerned with healthcare providers informing family members about their visits and expressed worries regarding providers sharing information discussed during consultations. For some single women, family members often accompanied them during health visits, making it impossible for them to discuss any issues privately.A study in Egypt revealed that although patient records were stored securely in filing cabinets in the family planning clinics, a number of healthcare providers stated that they allowed family members to view womens health records. In addition to providers lack of respect for confidentiality, another contributing factor is that in the Egyptian family health model, womens medical records are a part of the combined family health records and could be easily accessed by any family member "


###Input :Thank you so much for your answer! I was not aware of this! ###Output :#1. PCOS can be diagnosed by simply having irregular or absent cycles plus excess hair growth. Ultrasound is definitely not necessary. #2. Unfortunately, if a pelvic ultrasound is done the IUD will be quite obvious.


###Input :NAD, but is it possible for you to call your doctor on your own? Explain the situation, I'm not sure if that is feasible where you are or not, but they really do need accurate medical history ###Output :You don't need an ultrasound to diagnose PCOS. It's clinical history + exam + hormone levels.If you have a hormonal IUD, though, this can affect diagnosis and treatment plan. Hormonal contraceptives are the first line treatment for PCOS, anyway.


###Input :In Australia you wouldn't need it because you already meet criteria. That being said the treatment doesn't really change wether you label it as PCOS or not - it's to go on hormonal contraceptives. ###Output :In your case, you still don't need the ultrasound tbh. You need clinical OR laboratory signs of hyperandrogenism (in your case, hirsutism) Coupled with absent periods, you have two features. As long as they don't suspect another etiology (which can be tested for via blood), you can be diagnosed.


###Input :Sorry to piggyback this comment but just out of curiosity, can PCOS ever be a possible diagnosis even if hormonal blood test results indicate otherwise? I have always some of the physical symptoms (long periods, cystic acne, mild hirsutism), and my consultant gynaecologist diagnosed me with having PCOS after observing that my ovaries were enlarged and pearly during a laparoscopy to excise endometriosis. But bloods I had taken when I was much younger, and further bloods I had taken 2-3 years after this surgery showed that my androgen & testosterone levels were within normal ranges, so my GPs opinion is that I dont have it (regardless of my consultants observations). Ive never quite known what to make of this difference in opinions. Any thoughts? ###Output :Yes, if hormonal blood tests are normal and there's no obvious signs of hyperandrogenism (in your case, the hirsutism seems subtle), then that's when ultrasound comes into play. Your GYN did a laparascopy and visualized the ovaries directly, which would replace the ultrasound in this case. Also, women with PCOS tend to have skipped or absent periods, not prolonged periods. So, I can see why your GP would be skeptical.


###Input :MRI Renal ResultsAbdominal Wall: Umbilical defect approximately 9mm TRVCan someone explain this to me? Is this a hernia, if so how is this possible?Also originally I received the mri for a renal mass that was first discovered in 2017 of 3.6 cm and on my recent MRI exam is now 1.1 cm? Does this mean it could still be cancerous or most likely benign? ###Output :Tiny (presumably fat-containing) umbilical hernia which is so common that half the time we don't mention it.Can't conclude anything about the renal lesion without the full description. If it's one complete thing that has decreased in size, then yes it's benign. If there was a 3.6 cm cystic lesion that has gotten smaller but now has suspicious features, that's a different story.


###Input :Respiratory rate while sleeping?Age: 26 Gender: Male Weight: 170 lbs Height: 510I do not smoke or drink.Hello! I have been monitoring my sleep with my apple watch and have seen my respiratory rate be pretty low which from what Ive seen isnt good.Occasionally I see it between 10-11 and apparently last night at 9.5?I dont know if you guys can offer if the apple watch is even a good indicator or accurate. Which is why I rather ask yall.Thank you for helping, wishing you the best. ###Output :That's normal


###Input :Thank you so much!At what point would you consider it to be abnormal? I obviously have no knowledge other than the vagueness I see which is 12-20. ###Output :It's more abnormal to be tracking your resp rate while asleep.


###Input :68M Recurrent right sided nosebleeds resistant to treatment followed by respiratory infectionMy dad is a 68 year old Mexican (mestizo) male. At the time of his first nosebleed, he was diagnosed with diabetes, high cholesterol, and prehypertension. He's 5'6" and weights 180 pounds. He rarely drinks and doesn't smoke or use recreational drugs. He's prescribed metformin, insulin, aspirin, and lovastatin but refuses to use the last two. He also has arthritis in his elbows, for which his doctor tells him to use ibuprofen as needed. I don't know his cholesterol levels or A1C.About two weeks ago now, had a nosebleed (limited to the right nostril) for the first time in over 30 years while he was cleaning the garage. We asked him if he accidentally hit himself, scratched his nose, or sneezed but he insisted that it just started out of nowhere. Initially he was able to stop the bleeding but later that same day the bleeding resumed while he was moving some boxes (15-35lbs). We were unable to stop the bleeding and he went to the emergency room where they tried to stop the bleeding with Tranexamic acid and, after that failed, cocaine hydrochloride before ultimately applying an anterior nasal packing. His blood pressure was checked and it was high 143/83 but the doctor said it could be due to the stress of the situation and didn't warrant immediate treatment (side info, he had a heart rate of 85, low 60s seems to be normal for him). He was told to go back in two days to remove it and cauterize the affected area. He was also prescribed cephalexin (I'm assuming to prevent opportunistic infections). Apart from the nosebleed, he seemed fine. He was a little shook from the experience but was feeling good. No other symptoms.Two days later he went to get the nasal packing removed and the doctor determined nothing needed to be cauterized. My dad was told to be careful for a few days and to schedule an appointment with his PCP, which he did. He has that appointment later today. Two days after getting the nasal packing removed, he woke up with a bloody nose that he was unable to stop. He went to the ER again where they ended up cauterizing his nose. He had some minor discomfort from the procedure but was fine otherwise. He was also referred to an ENT doctor and was able to schedule an appointment, but it's a month from now.Since then, he's experienced 1 more severe nosebleeding episode. He went to the ER and got it treated with lidocaine and since his blood pressure was higher 153/89, he was prescribed blood pressure medication (something starting with an an L -- I don't have the documents on hand). He was also given a nose clip and finally had some lab work done (cbc, complete metabolic panel, and prothrombin time test -- those results will probably be discussed today). He's since experienced two minor nosebleeding episodes that have been effectively treated at home. In addition, starting the day his nasal pack was removed he started experiencing symptoms of what appears to be a respiratory infection. This will be explained in the next paragraph.The day my dad got his nasal pack removed, he complained of discomfort in the nose and sinuses. Some discomfort was to be expected but the day after he started developing a sore throat which eventually progressed to a dry cough, headache, coughing fits and nocturnal fever (no thermometer available to record temperature). He went to urgent care which prescribed him prednisone and azithromycin. It's been two days since and there's been no change on his condition on that front. The illness appears to be communicable since my mom started displaying symptoms about 4 days after my dad. It's possible that he caught the bug during Easter since we had a small gathering (<8 people) though no one else was displaying symptoms at the time or has displayed symptoms since. My dad has been tested for both covid and the flu, for which he has tested negative. It's also possible he caught it while seeking treatment for his nosebleed due to the area of treatment but I'm wondering if the two could be interrelated.It's concerning that after having no nosebleed or symptomatic medical issues for so long (other than the diabetes), one would present so abruptly and severely without any physical trauma or changes in medicine or lifestyle habits. My questions would be what would be some of the most likely causes of nosebleeds in someone with his medical history (hypertension seems to be a big one)? His visit with the PCP is today. What would be some good things to bring up or ask about in his upcoming visit that his doctor might overlook but could be important? ###Output :Hypertension does not cause nosebleeds, not does it prolong them. Except very rarely and dramatically they are not from an artery.The most common cause is actually nosepicking, so grill him more about this. Dry air, a cold, allergies and exposure to dust in his garage are other likely causes. Once you start getting them they tend to persist for a while. He is not on a blood thinner.While waiting for ENT he can use saline nasal spray to keep it moist, use a humidifier at night, and learn how to apply effective pressure to stop the bleeding.


###Input :I guess one of the possible causes they explored during his first visit was nosebleed due to hypertensive crisis but yeah, it doesn't seem like the doctors think hypertension was the cause of his nosebleedsThe dust in the garage does seem like a likely culprit considering it had been two years since it had last been cleaned out. It's just alarming that a man that hasn't experienced a nosebleed in decades would suddenly have recurrent nosebleeds but it sounds like it's not too out of the ordinary to experience them in succession like that, so that's reassuringI'm sure his PCP will grill him about picking or rubbing his nose since he has a habit of doing that, though one would hope he'd be following the doctors' instructions to not touch the area after the first nosebleedWe'll get him a humidifier. Hopefully his visit with the PCP will provide answers or more specific questions ###Output :It's usually from irritation in an area called Kiesselbach's plexus in the front of the nose. The ENT can cauterize this, usually helps. Noses bleed, it is very rarely a sign of cancer or hematologic disease.Rarely the sinus packing can cause a sinus infection. His symptoms sound more like a viral URI with the dry cough and sore throat plus infecting your mother.


###Input :Myasthenia gravis and respiratory infectionHi my first language is not english so please excuse any mistakes. I (24f) have Myasthenia gravis and even though I take several immunosuppressants such as Prednisolon, Azathioprin and weekly Efgartigimod alfa infusions my symptoms are quite severe.I had multiple myasthenic crises the last few months. The last time I was in the hospital was this January because my symptoms worsened due to a covid infection and I was treated with intravenous immunoglobulins and nirmatrelvir/ritonavir. I was released 10 days ago.Two days ago I started to notice that I have symptoms of a respiratory infection (coughing, runny nose, sore throat, breathing is difficult and so on) and the symptoms of my MG worsened too. I am really afraid to call my doctors because they work at the hospital and when my symptoms get worse they admit me to the hospital. I can't stand hospitals anymore. I had several plasmapheresises, was intubated, had a feeding tube, a thymectomy and so on. I am very thankful for all their efforts and they saved my life several times but everything in me has the urge to be as far away from the hospital as possible...Do you think I should be admitted again or is there any possible solution to treat this at home? And if I contact my doctors would it be irresponsible of them to treat me at home? ###Output :Sorry, but I dont think your question can be answered over the internet. The decision to treat for an MG flair requires a thorough physical exam. It may be worthwhile to note that MG can be very difficult to treat, and its reasonable for your doctor to be conservative and bring you into the hospital. If left untreated it can be rapidly fatal, especially if youre at home.


###Input :(26F) If a breathing pattern disorder is corrected (respiratory alkalosis/chronic hyperventilation), how long does it take for serum bicarbonate to return to normal levels?I developed chronic hyperventilation due to tachycardia. Sustained low CO2 dropped my bicarbonate levels. My heart rate is now under control and breathing pattern disorder in the process of being corrected. How long can I expect it to take for my bicarbonate levels to return to a normal range? ###Output :Bicarbonate levels will usually normalise within days once CO2 levels are corrected. The kidneys are very good at what they do - I wouldnt worry too much about your bicarb levels if all else is well/improving.


###Input :Viral respiratory infection fever not getting better.22M, 5'10, 157 lbs, no drug use, no known health conditions or allergies. I got sick early in the morning on January 7th around 1 AM or so. Instantly got hit with fever, cough, sore throat, headache. Jan 9th I developed severe ear pain and pressure as well as ringing and echoing. NP looked and said it was an ear infection and prescribed amoxicillin. On January 7th my fever peaked at around 101.5-102. I took Tylenol to reduce it and it worked well. On the days after that my fever fluctuates from around 99.5 F to 100.5-101 F. It hasn't gone down from there. Doctor's office didn't detect fever today but they were using a forehead thermometer. At home my thermometer once again showed 99.5 which has now increased to 101 in the evening. My oxygen levels, HR, and BP were all fine. I cough a lot with mucus and sometimes it hurts but nothing crazy. Should I be worried? How long does fever typically last and when should I seek out help? I took a covid test today and should be getting results tomorrow as well. ###Output :That's fine. Nothing to worry about


###Input :M19 70 kg . Possible influenza but no respiratory problems.Hi . So my sister got influenza, and got diagnosed. And then I got the fever and the dizziness.So here are my concerns. I a barely coughing (I had like 10 painful coughs the whole day) but other than that I am breathing fine. I am feeling kind of itchyich in my trachea but nothing more.I am also concerned by my dizziness that comes and goes for 5 seconds.Thoughts? ###Output :Im not sure I follow your question. Influenza has a spectrum of symptoms. Sounds like you have influenza.


###Input :How do you clinically distinguish a Viral Upper Respiratory Tract Illness from a Bacterial one?Medical student here, year 2Well I've been reading about respiratory pathogens and found out that while viruses are the most common cause for these, bacterial infections can have terrible sequelae when not treated (RHD), so how does a doctor clinically determine if the person presenting to them has Viral or bacterial infection so that right measures can be taken?I'm assuming throat swabs for every single person wouldn't be very economical and just or would they be? ###Output :Usual disclaimer: no one can provide specific medical advice for a person or condition without an in-person interview and physical examination, and a review of the available medical records and recent and past testing. This comment is for general information purposes only, and not intended to provide medical advice. No physician-patient relationship is implied or established.Streptococcal pharyngitis is a fairly distinct clinical syndrome compared to a garden variety viral respiratory infection. Classically, the symptoms are severe sore throat and fever, and the signs are exudative tonsillitis and tender anterior cervical lymphadenopathy. While sore throat is common in viral infection, exudative tonsillitis is less so, and viral syndromes are often accompanied by cough and coryza, which strep infections do not produce.These distinctions are codified in the Modified Centor Criteria, which can give you a pretest probability for the presence of strep throat, and guide your testing and treatment decisions. Here is a link to a calculator that can help you.https://www.mdcalc.com/calc/104/centor-score-modified-mcisaac-strep-pharyngitisBacterial infections of the respiratory tract typically refer to pharyngitis, tracheitis, sinusitis, or pneumonia depending where along the tract you are worried about. Each will have their own physical exam findings, risk factors and severity that over time, you learn to distinguish.Since you're mentioning throat swabs, testing for EBV, flu, RSV, COVID, or Group A Strep can quickly be done with rapid point-of-care testing if they have risk factors (we can use clinical decision making tools like Centor criteria to help us as well).


###Input :Are there these associations like, if pharyngitis is bacterial in etiology the person most likely presents with fever, while viruses produce a runny nose, are any such associations there and are these correct? ###Output :Not that simple. Viral infections can also cause fever. Runny nose tends to be more viral than bacterial.


###Input :M25 215lb viral respiratory infection and low body tempHello Im M25 and weigh 215 lb. I have been recently (yesterday)diagnosed with a viral respiratory infection and have been experiencing mostly coughing (for a week) and sinus drainage; however, my body temperature has remained consistently lower than normal. Im typically at 98.6 F but Im currently approximately at 96.4. Im using a thermometer under my tongue. Is this drop in body temperature normal? ###Output :This does not sound concerning. Try a blanket.


###Input :Thank you for your comment. What worries me is that Im wearing a jacket and am using a blanket in bed right now. ###Output :Throw away your thermometer for an easier life.


###Input :Can you get an outer ear infection from upper respiratory illness?~2.5 weeks ago I caught a mild illness  sore throat with swollen lymph nodes on left side only. Negative COVID tests.My left ear felt a little clogged afterwards but seemed to be improving.Yesterday, it rebelled. Lots of pain inside, worse today. Jaws a bit sore too and sometimes the pain spikes when I turn my head left.Diagnosed with outer ear infection, prescribed Ciprodex drops.After curiously reading up on it (only had an inner & middle one before), Im feeling confused and wondering if this makes sense.- How does a throat illness/infection end up in your outer ear? Are they unrelated?- Can you get an outer ear infection if your ear hasnt been wet recently?- If it isnt an outer ear infection, will the drops still work?Most of what I read talked about swimmers ear and there being water involved, but embarrassingly between the illness and some other stuff I havent showered in like 2 weeks so it's been dry.I've had past vestibular issues so am extra concerned about addressing this right/quickly so it doesn't start causing other trouble.Thanks! ###Output :This is a common thing that gets referred to me, and as an ENT this issue slowly kills me inside. Differentiating between an outer and middle ear infection should be quite simple.If you can answer yes to the following questions, then you may have an outer ear infection (aka otitis externa):Is there white/yellow/brown/red stuff draining from my ear?Does the physical ear hurt when I pull on it or press on it?Did it hurt when they stuck the otoscope in my ear canal (more than it may usually if you have sensitive ears)?When they examined the ear, did they see redness, inflammation, drainage in the ear canal itself?If no, then you don't have an external ear infection.If you have a middle ear infection and they gave you drops, the only time this is useful is if you have a hole in your eardrum, and this will often also lead to drainage from the ear.A middle ear infection can be quite painful as well, but you shouldn't be able to really touch the pain in the same way.What is very common post-cold and what you may likely have is Eustachian tube dysfunction. This can result in fluid in the middle ear space, but doesn't necessarily mean an infection. This is treated from the nose side with either short course afrin, sudafed, oral steroid (low dose, short course), Flonase, saline irrigations, or any combination of the above.This all comes with the obvious caveat that I have not examined you and cannot specifically comment on your case or rule out an otitis externa, otitis media, or whatever else.


###Input :can cutting off sugar cure an upper respiratory infection?20F, 5'4, 116 lbs., do not drink, do not smoke/drink/use drugs, USAI got sick around October 29, 2022, after going to the doctor, I was prescribed a 10-day antibiotic dose that was finished around November 11. Although my harsh symptoms were gone afterward, such as tiredness, body ache, and congestion, all of a sudden after the antibiotics I got this harsh cough that was productive with green mucus. The cough was not a dry cough like I had before/during my antibiotics but rather came from my chest and is very loud. I have trouble breathing with this cough. Knowing its been around 40 days and I haven't stopped coughing so much so my back is killing me from the constant coughing, 4 days ago I went to the doctor. He basically told me to cut off sugar from my diet, no junk food, and eat only vegetables and soup for 20 days and I should feel better. (I was a little confused about this suggestion because he never asked about my diet beforehand, previously, I didn't eat junk food every day and I include veggies and fruit in almost every meal. I am quite active and have been consistently healthy.) I was not prescribed anything that can help my mucus but was prescribed cough syrup and an inhaler.I am not sure if a change in diet is a solution and I'm wondering if I should ask for a chest x-ray because I have difficulty breathing.Also this doctor didn't even check my breathing until I had asked him to. He said my lungs sounded fine but did hear mucus in my bronchi.Side note: after finishing my antibiotics I took probiotic pills and drank kombucha, could that have caused this? ###Output :Generally speaking, eating less sugar and increasing plant-based food is a good thing for your health; but you shouldnt expect this change to make any real difference with an acute infection. I expect in 20 days youre going to feel a lot better regardless of a change in your diet.


###Input :My (35m) heartrate is not going down after recovering from a respiratory virus.I'm 35, male, 5'11 and 215lbs. I was fighting a respiratory virus for the last 2 weeks. My symptoms are basically gone at this point, but my RHR has not recovered. It is normally around 62bpm and has been stuck around 92bpm for the last few days. I understand that it can be elevated while fighting an illness, but I expected it to return to normal as I got better. I do not drink caffeine, alcohol, or take any medications that could raise it. I have an appointment to get a Holter monitor for an unrelated sinus arrhythmia in a couple weeks and I'm concerned it might skew the results. The only thing I can think of is I haven't been eating much in the last couple weeks due to a sensitive stomach so I don't know if the lack of nutrients might be causing something to be going on. I've been drinking lots of water as well. ###Output :Give it a few months to reset


###Input :26F - little streaks and spots of blood in phlegm but no symptomatic respiratory/sinus/throat illness and no coughing26FWhen I brush my teeth, I suck the mucus in my throat out into my mouth and spit into the sink. For the past few days, I've noticed bright red spots and streaks within the mucus. Not too much but it's there. I have had no recent infections or illnesses. No recent coughing or sore throat either. Everything sinus or respiratory has been normal. I used to vape and smoke between 18-23 years of age, and the volume of air I can take in during a deep inhale has shortened as a result of the smoking/vaping based on my subjective, highly inconclusive observations.Have been experiencing noticeable and moderate ongoing fatigue as well. ###Output :Not concerning. Congratulations on being nicotine free though! your body thanks you.


###Input :My disease may have caused respiratory involvement.Hello, I am 28 years old male 165cm 22kg Malay. I have been diagnosed with rare disease named Congenital Fiber Type Disproportion Myopathy in 2010. I also suffered Combined Scoliosis and Lordosis and has to use wheelchair. The scoliosis made my left lung smaller than my right lung. I refused spine surgery as I deemed the risks outweighed the benefits. I discontinued medical checkup in 2011 as there's no other treatment available. My skeletal muscles is progressively weaken over the years. Since last month after recovered from a flu, I've been having daytime sleepiness despite 7-9 hours of sleep. I also frequently woke up from a dream with a headache. Rarely, I woke up choked or gasping for air. I also has multiple awakening at night. My Gp prescribed me with 0.25mg Alprazolam few days ago to help me sleep better. I did get uninterrupted sleep, but it did not help with daytime sleepiness. I stopped Alprazolam after I read about the withdrawal symptom. I planned to schedule an appointment with sleep specialist. I'm afraid my disease has respiratory involvement. ###Output :Your post raises concern for chronic hypercapnic respiratory failure  basically you skeletal disease causing chest wall restriction leading to hypoventilation. A benzo (such as alprazolam) would acutely worsen this, not surprised things got worse. Strongly recommend you see a pulmonologist asap. You probably need something like nocturnal BIPAP to blow off CO2 and improve your symptoms.


###Input :Can someone explain "respiratory failure" to me?30F, persistent pneumonia and shortness of breath. Sp02 sits at around 88 but as low as 50 on exertion.I have been treated at an outpatient clinic and visited by nurses daily, I have been given oxygen to use at home. My doctor said I have respiratory failure but I am unsure if this is just a general term, or if it means my lungs are dying, or something else?The term "failure" makes it seem serious/life threatening but I have not had anything explained to me.Should I be worried? ###Output :Respiratory failure usually has a different meaning than being used here - what's the clinical situation causing this?Respiratory failure is often technically defined as either low oxygen levels or high carbon dioxide levels due to your lungs not working as well as they should. You can have acute respiratory failure, like if you get pneumonia or have an asthma attack; you can also have more chronic respiratory failure where your lungs dont work as well in generallike with emphysema.Its hard to know whats going on in your exact condition and what the prognosis is without more informationbest thing to do is ask your doc.In your case respiratory failure is defined by your need for oxygen -- chronic hypoxic respiratory failure. "Failure" in this situation means your lungs aren't working well enough on their own to sustain your life, so you need the oxygen. If your lungs weren't failing you wouldn't need oxygen.Should I be worried?That's a very common question on this sub, and often it's not answerable over the internet. In your case I'd certainly be worried. It sounds like you are quite young for having developed chronic respiratory failure, and it doesn't sound like you have a clear diagnosis (probably meaning there isn't a clear treatment plan going forward). You should keep asking questions to your doctors until you get answers; and if you haven't seen a pulmonologist yet you should seek one out ASAP. "Persistent pneumonia" isn't a diagnosis.


###Input :27F Overweight  dizzy, nauseous, weak, sleepy, and seeing some black spots from time to time  respiratory acidosis?It's been a month since I've been having these weird symptoms  headaches, dizziness, nausea, weakness (specially on the legs), faintness. I feel confused some times as well.I also have bad GI problems such as bad absorption, diarrea, and/or constipation depending on the date.After 5 trips to the ER with pain on the left part of my chest, and confirming that my heart was fine, all I got diagnosed with was anxiety and POTS.But today I did some blood tests and my Bicarbonate levels were low (20; normal range is 22-29).Could I have respiratory acidosis although my oxygen levels are 95% and up?Or is this more a metabolic thing?I do feel like I can't breathe properly recently. ###Output :Your bicarbonate level is fine. It was maybe outside of the lab reference range, but it's nothing to worry about at all


###Input :Sorry for doubting, but  Are you 100% sure? I have my doctor's appointment on Monday. I just want to know if this is something treatable, or if I should go to the ER. ###Output :Yeah it's fine, not at all urgent.


###Input :I don't have kidney problems that I know of.But do you think my lungs are alright? Could it wait till Monday to check? I feel I can't breathe properly, but just because I'm terrified of not breathing properly. ###Output :Youve been to the ER 5 times. I would assume they checked your oxygen levels and someone listened to your lungs.


###Input :Yes, they have listened to my lungs several times, but they have never said anything bad there. My oxygen levels are always 95%+.I just had an abdominal ultrasound scan and aside from some fat in my liver and some bile salt in my vesicle, they didn't find anything. No comment on any acid in my stomach whatsoever.I also had a chest X-ray plaque and they didn't say anything bad was going on in my lungs.I have high uric acid  9.0 (limit is 5.7).Is it safe for me to sleep today and tomorrow and wait till my Monday appointment? ###Output :Do you have kidney problems? Did anyone suggest baking soda or tums? Do you eat a lot of meat?


###Input :Getting circumcised. What else can I say was done at work as an excuse?EDIT: Wow thanks for all the replies!TLDR: whats a fairly minor procedure with a ~2 week recovery time that I can say I had done instead of a circumcision?  Im a 34 year old male and I have to get circumcised for medical reasons (phimosis and frenuloplasty that didnt work)I have a physical job as a Paramedic, so will be on alternate duties in the office for a couple weeks. Ive done so before with a busted ankle.However Ill be working around people who are medically trained to various levels, and theres always ice breaker conversations about how you ended up in alternate duties. Well Id rather not tell Carol from accounts about my dong, so is there another procedure I could say I had done that isnt as embarrassing?I could say its none of your business or similar, but that might make things awkward and probably make it obvious its dick related.Im thinking of saying an inguinal hernia repair? Seems like a similar recovery time, a bit tender below the belt kinda thing??Any other ideas?Thanks docs! ###Output :Tell people you had macropenis and that you had to have a surgical reduction, since it was just too big.


###Input :Doesn't HIPPA protect him from having to tell his work anything more than that it's a medical issue ###Output :No, thats not HIPAA. HIPAA prevents healthcare providers from telling anyone at work if they ask. Your employer does have limited rights to information for sick leave and I think most privacy is under the ADA.


###Input :Yes, that you're having surgery not what the surgery is for.The point was that their job has no right to ask specifics ###Output :No. HIPAA is concerned with covered healthcare entities not disclosing your medical information to other people without your information. It doesn't address your coworkers asking about your surgeries.


###Input :O I get that but that not the fkn point I'm trying to make. ###Output :HIPAA does NOT protect him from his employer asking about medical conditions. This is more of an ADA issue if anything.HIPAA has nothing at all to do with this situation.


###Input :It does if they call my doctor to ask. Hippa protect any thing about my health being shared ###Output :HIPAA says your doctor can't disclose that info. It doesn't say they can't call and ask.I can call and ask your doctor. If he tells me, he's committed a HIPAA violation. Not me.HIPAA has nothing to do with OP's responsibility (or lack thereof) to disclose medical information to his employer. Neither are HIPAA bound entities.


###Input :Inguinal hernia seems like a good excuse. Same region, common in men, not very invasive surgery similar to circumcision ###Output :No, OP doesnt need an explanation, they said as much. But OP also said they would rather have a simple excuse on hand that doesnt raise any eyebrows rather than tell someone its none of their business and invite scrutiny. Some people are more comfortable with that than others.


###Input :I'm not sure, my dad had one and was advised no heavy lifting for six weeks post op ###Output :I would say testicular torsionNo guy is asking any questions after that


###Input :I disagree. If I didnt already know what it was, Id definitely ask what it is haha ###Output :I think hernia is fine


###Input :One of my sons had to have surgical repair for penoscrotal webbing, sounds somewhat similar, and I also didnt feel comfortable blasting private details about that around casually. we made similar jokes about it being a penis reduction. But usually I just said he had a urological surgery/procedure and left it at that. If some asshole really tries to pry about details after that then they deserve the nunya response. Edited to add- he was about a year old when he had surgery, so different in that regard but still not comfortable telling people details about my babys private part situation ###Output :Hernia repair is fine.However honestly if it was me, I would just be up front about it.You're having a medical procedure to correct a problem with your health, and your coworkers are healthcare workers.If carol from accounting gets nosey, just offer to show her before and after photos! (But don't really, because you would totally get in trouble.)


###Input :Dont tell them you are getting circumcised. Medical co-workers can be the worst. ###Output :Thats your approach which is fine. But OP made it clear theyd be more comfortable if they just had an easy excuse that doesnt raise eyebrows. OP shouldnt have to explain themselves, but not everyone is comfortable with that.Id go with hernia.Is there a reason why you have to give the info in the first place?"I'm on alternate duties for medical reasons" should be more than enough for anyone who isn't your doctor. Honestly "I'm on alternate duties" with no further details whatsoever is a complete sentence already.You can say hernia repair if you want, not saying you can't, but it's a bit bizarre to me that you've been put in a position where you feel like you have to reveal more than you wanted to or make something up just for an ice breaker with Carol from Accounting. An ice breaker should be, like, "what tv shows are you watching recently" or "what's your favourite meal"! Not "please explain something potentially very personal".


###Input :NAD ... Tell'em you had a hysterectomy, and then grin and walk away.I get that you'll need to say something because people are like that. But it's not up to you to tell. I, personally, head for "humor" to shut it down. ###Output :Since this has nothing of an actual repercussion medically, you could try saying something in line of abscess drainage or an excision of lipoma/sebaceous cyst, etc.,


###Input :Honestly, just say that you had to have a procedure done that you'd rather not talk about. I work in the medical field too and I have never had anyone push after saying that. ###Output :Vasectomy, cord lipoma removal.Where I am, hernia repair earns you 4-6 weeks of light duties.


###Input :respiratory/co2/bipap/desatrespiratory/co2 retention/bipap/desatsHello everyoneI am a caregiver to my 47y male [5'11 155lbs, Caucasian, no alvohil quit smoking in 2020 after 22 years of cigarettes and lots of cannabis, on 60mg sildenafil 3x a day; inhaled treprostinal, b1, Folic acid, vit d, calcium, o2 and temporarily prednisone after hospital] partner with CHF, pulm hypertension, and copd emphysema. DX in 2018. Was put on 3L of o2 24/7 in 2020 and then May of this year began having frightening symptoms which turned out to be CO2 retention. He's been to the hospital 3x in 5 weeks, been intubated once and on hospital bipap twice. We have our own bipap bit it's part of the philips recall so until we became aware of this co2 problem, we weren't using it. The dr recommended we do as it was riskier without it.However everytime I would put him on it, he would desat 10-15% and hold there. I thought it was the machine, the mask, the toxic fumes from the recall, etc. I have now rented a machine, have a new mask, and when he got out of the hospital o2 sats were good while on it. However its now been 2 weeks, although using it every day and trying to keep him out of the hospital his CO2 has built back up judging by his symptoms.Been trying to use the bipap anyway and just fight to keep o2 sats up, had a mask leak the other day , finally got the new part and it doesn't seem to be leaking anymore but still he desats 30%, it seems like it takes some time (hr , hr and a half) to burn off the first layer of co2 before he can stabilize o2 sats so just been trying to get him over that hump.When o2% drops it seems to get stuck like airway is closed or diaphragm paralyzed! If I crank the o2, sometimes it works to help his sats cycle up, but mostly not. I haven't been able to keep Bipap on more than hhr at a time the last day as it drops under 80, and a couple times under 70. Trying to do some research and my theory was a bronchospasm but his inhalers (prosir snd combivent) and/or breathing treatment of a Ipratropium bromide/albuterol seem to make his sats worse than before use.Last night it cycled down to mid 70s on the bipap for the 5th or 6th time but wouldn't come up and I pulled him off, put him back on the cannula. However the spasm continued once he was off it, no matter how much I cranked the o2, it would cycle down to 70s or low 80s and sit there awhile. Then it might cycle up but fall right back down. He was making efforted breaths, with a high respiratory rate. Took ages before this cycle stopped and his o2 sats stabilized in 90s.My question is does this sound like a bronchospasm? Hypopnea? Paralyzed diaphragm? Just recently got a wellue o2 ring and have noticed so me drops to 78% out of nowhere, when he's just sitting and it will hold there for 10-30 seconds and then go up. I've actually noticed on the chart a couple days ago, it happened 3x, almost exactly 10 minutes apart while on bipap so was wondering if it was related to the heart cycle. Don't know if these events are even related/the same thing.Any insights? I can't keep him on the bipap/can't get out the co2 when I can't keep his o2 up!! I was gonna leave in the cannula and just hold the bipap mask up to his face tonight so it's easy to remove if o2 starts falling but still may help trigger some deep exhales to blow off co2? Is this a good idea or not? To kind of spot treat without strapping everything on that's difficult to get off, switch over to cannula if sats drop?I'm at the end of my rope, haven't slept more than 1 hr increments for months, i really don't want him going hmback to the hospital they always seem to break something else on him!! The drs cant understand the anount of damage to his lungs for his age/history. Are there diaphragm exercises to strengthen? Does it sound like a spasm? Any theories or information helps! ###Output :Most likely the oxygen supply is decreased due to high pressures inside the mask during inspiration. Do you have a second oxygen supply and nasal cannula? If so, put on a nasal cannula under the BiPAP mask and run it at 8-15 L/min. This will help provide a higher amount of oxygen during inspiration.


###Input :Yeah one of the doctors suggested that, we did try that a couple weeks ago and it didn't help, we didn't have a proper dual ventilation setup so the mask didn't seal as the cannula was in the way. When his CO2 is low he's able to stay above the 90s, even a few days ago when it was high but not too high, as long as I held the mask on when there was a leak he was staying in the 90s but given that this happens desat after the BiPAP is off I feel like there's some other explanation like his lungs are freaking out ###Output :I have to disagree. I would try to find a dual ventilation setup to try.


###Input :I will try anything but respectfully how do you account for the desat cycle to 70s for an hr and a half after thr bipap is off? ###Output :Could be entirely unrelated to the desaturation when putting the BiPAP on.


###Input :Yeah I'm wondering that, bc it just happened, just not as long or as low and he hasn't had the bipap on for 12 hrs. I'm wondering if the bipap exacerbates it but there's another issue like diaphragm or bronchospasm. ###Output :I wouldn't think bipap would exacerbate it. I do think there's likely another reason for his desats, like bronchospasm. Not likely a diaphragm problem. Follow up with his doctor.


###Input :If it is a broncospasm should the Ipratropium bromide/albuterol nebulizer treatment and/or proair albuterol inhaler and/or combivent inhaler (Ipratropium bromide/salbutamol) make it better or worse? I've read some conflicting things and the neb used to help his o2 sats , I would use it before bipap but now with the heavy co2 , all those treatments seem to make his sats worse by 5%+. ###Output :It should make it better. It sounds like he's needs to see a doctor


###Input :I (63m) was diagnosed with ALS about 8 weeks ago. Needless to say, this has been a devastating diagnosis for me and for my spouse. Symptoms started 2 years ago with diffuse cramping, and minor dyspnea upon exertion. The cramping continued, then I developed more dyspnea, and then fine motor skill weakness in left>right hand. An EMG in March of this year showed major motor neuron issues, and the suspected MND was confirmed as ALS by two specialists. I am 5'9, 170 lb. I am on riluzole and Relyvrio, still waiting on the Radicava because the fucking insurance company is taking its sweet time and would probably prefer that I die in the meantime so that they don't have to pay for it. Here's my issue: my main symptom, which has slowly progressed, then more quickly starting in Feb of this year, is respiratory muscle weakness (diaphragm and chest wall muscles). I cannot breathe lying flat, and have to use a BiPap machine at night or I get hypercapnia. I am increasingly fatigued during the day, and often short of breath even just moving around the house or doing simple chores. I can walk a mile slowly, but have to take a break halfway, and it's taxing. I understand from my voluminous reading about this shitty disease that most people die from respiratory failure at the end, and that that is usually the last set of symptoms they get. Respiratory muscle weakness is more rare as a presenting symptom. Given that it's really the first major problem I am having, my fear is that it's going to be the thing that takes me out, and that it could happen rather quickly. I am trying to get my affairs in order, have an advanced directive on file with my PCP and am doing all other estate planning and power of attorney, etc., as fast as I can. I do not want tracheostomy or gastrostomy under any circumstances, I do not want to simply exist hooked up to machines. Quality of life is paramount, and my spouse has agreed to all of my wishes. We do not have children. How will it end when it ends? I am still relatively mobile and can use my limbs and hands, no real issues with voice or swallowing. I imagine that at some point I will simply not be able to breathe any more without the NIV, and that even that will not work at some point. What I am unsure of is what it looks like getting to that point, and what happens when I simply can't breathe any more and an NIV doesn't work. I want to go quietly and easily, without struggle. Do I state that I want continuous deep sedation at some point, and if so, when? Any guidance or feedback at all is welcome. ###Output :One of the worst diseases. I'm so sorry OP.I can promise you that there is no reason you should in any way be suffering physically at the end of life. You will not stop receiving treatment. We cannot treat ALS but we can treat pain, shortness of breath and anxiety/fear very very effectively. Your ALS neurologist or pulmonologist should be able to put you in touch with a hospice program and I think talking to them may reassure you.Opiates for instance are almost always successful at relieving shortness of breath and pain. Benzodiazepines are sometimes used for anxiety. These are given in doses of whatever you need to be comfortable. With a good hospice plan you should have nothing to worry about as far as untreated symptoms.The setting is also a consideration. Home hospice can be challenging mostly from a care standpoint. Often patients with ALS already have in place a high level of care at home and can stay there with a few hours a day of hospice nursing. If the nursing needs are significant or can't be met, the other option is to choose to do what is called inpatient hospice. This is in a setting that is more like a hotel than a hospital, visitation restrictions are (in general) quite relaxed, and there is 24 hour nursing care. They are very focused on quality end of life treatment.You are dealing with your own mortality and grief. This is more than enough. What you shouldn't be fearful of is feelings of pain or shortness of breath. I suggest meeting with the hospice people in the near future even if you are not yet ready for this. They can answer questions and plan about how you want this to be done.