###Input :what is wrong with me? respiratory problems and oedema doctors baffled need ideashi I know this is a long shot and I'm not looking for a replacement for a diagnosis by a "real life" doctor - I have been having a long series of tests and scans etc etc and been in and out of hospital for months. It's just a matter of curiosity really.I became ill with what I thought was asthma in roughly june last year. It started with terrible chest pain that I woke up with and called an ambulance when I was no better after 4 hours. The pain was roughly central and felt like I'd been kicked by a horse and I was very short of breath. In hospital my O2 was measured at 71% which they blamed on my smoking habit. I had an x ray and ecg and everything seemed fine.I went home and continued to have terrible breathing problems which I thought was asthma for about a month before I was referred to minor injuries by my GP. They did an x ray and freaked out and got all the students to listen to them tapping my chest because one side was almost completely full of fluid. I got rushed to hospital in an ambulance and admitted. I had a chest drain put in and then had to go to a specialist hospital to have a heart drain put in as I had fluid on both lungs and around my heart. After a couple of weeks I was allowed to go home.Unfortunately the problem has persisted and I've been in hospital 3 times now, with my chest no better. I also had a.broken rib which I think was the result of coughing after I caught a cold at christmas. That's healed up now but I still have swollen legs and a swollen tummy and trouble breathing that has me gasping after a few steps. I'm on a diuretic for the swelling and it's been increased twice.I've had all sorts of scans, x rays, blood tests, ecgs, and most recently had a broncoscopy with a fine needle aspiration biopsy of swollen lymph nodes in my lungs. None of the tests have shown anything and the consultant says he is baffled and they are going to have a meeting about me. I have to go back in to hospital soon for a few days to have my chest drained and a thoracoscopy (?) - camera between my ribs and a biopsy.I've given up smoking but it hasn't helped. My O2 isn't as bad as it was in june/july though - tends to be high 80s or low 90s. I also hit menopause at the exact same time that my health took a nosedive and haven't had a period since june '22. I was also diagnosed with diabetes type 2 and high cholesterol when I was hospitalised in august and have been taking medication for that.So far tests have been negative for cancer but he says it can't be entirely ruled out.Does anyone have any insight at all or any ideas as to what might be wrong with me?age 51sex femalerace whiteweight 230lbslocation ukdiagnoses: schizoaffective, type 2 diabetes, asthma, high cholesterol, bilateral pleural effusion and cardiac effusionmeds: furosemide (? diuretic tablets), statin, a tablet for diabetes that is supposed to increase insulin after meals, folic acid, salbutamol inhaler. Supposed to be taking metformin but it makes me have an upset tummy and I found that difficult as I am living in a hotel at the moment and don't want to have an accident so I haven't been taking it. Up until august last year I was on paliperidone injections 75mg (invega) for schizoaffective disorder but they stopped those in case it was making me ill. ###Output :I would have a CT scan of the chest and abdomen to get a more detailed image of the fluid collections and any other abnormalities. I would get a culture of the fluid obtained during the thoracoscopy procedure to determine if there is an underlying infection, and then a biopsy of the pleural and pericardial tissues to determine the cause of the effusions.Shortness of breath, swelling, and fluid accumulation can be symptoms of congestive heart failure. Your history of high cholesterol and type 2 diabetes increase your risk for this condition.


###Input :Can I fly on a plane with weakness of respiratory muscles?(neuromuscular disease)Male, 24 years old. Live in Canada. 100kg, 200 Cm tall.I have an unknown neuromuscular disease that weakens my diaphragm, throat and skeletal muscles, and affects my cognition. I also have Ehlers-Danlos Syndrome.I want to know if my daytime oxygen is normal, and my Co2 levels are normal, is it safe to fly in a pressurized cabin on a plane? It's quite hard to breathe at times but I had a sleep study a couple weeks ago and it was fine. ###Output :Can't answer that over the internet with the limited information. Would recommend talking to your doctor about a test called a High Altitude Simulation Test (HAST), where they used oxygen blenders to simulate a lower pressure with a lower partial pressure of oxygen. A lot of airline companies require it for people with lung disease to fly.


###Input :Is a low respiratory rate a problem? (Bradypnea)Is a resting respiratory rate of 5-6 breaths per minute indicative of a problem? Online it seems there are some sites (non medical...) which think a low breath rate is healthy. But on medical sites I find references to the medical problem of bradypnea.40M, caucasian, 178cm, 90kg, drink alcohol. Resting heart rate of approx 55-60BPM. Blood pressure normal to slightly elevated.Existing conditions: anemia - taking iron supplement. Possible IBS. Have done little exercise over the past 12-18 months due to fatigue caused by anemia. ###Output :low RR with self measurement without other symptoms is not a problem.


###Input :COVID-19 FAQ #2Updated 6th AprilThe below comes from multiple sources as well as the direct experiences of myself and my colleagues.If you would like more information I highly recommend this free e-book written by two German physicians, it is available in multiple languages and is very up to date: https://covidreference.comIs it really as bad as they say?Yes. This is the most serious public health crisis of the last hundred years. By the time this is over many thousands will have died before their time. Do not underestimate the effect this will have on global societyThese are my symptoms, do I have COVID-19?Right now (assuming you live in an endemic country) any infective symptoms are COVID-19 until proven otherwise. Such symptoms may include any or all of:FeverCough (productive or dry)FatigueMuscle aches (particularly chest pain)Sore throatSwollen glandsLoss of sense of taste or smellDiarrhoeaThis is not an exhaustive list. Take home message: if youre not sure assume you have it and quarantine appropriately.When should I seek medical attention?Any breathing difficulties should be discussed with a doctor. This may be breathlessness at rest or on exertion, such as climbing the stairs. If youre struggling to do the things you normally do then seek assessment.You should have a low threshold for seeking assessment if you are at high risk of exposure, for example if youre a healthcare worker.I have no symptoms, should I stay at home?Yes.At this moment you must stay at home. You must only go to work if your job is essential for the running of the country or your local health service (although I accept not every country has introduced income support for those who have to stay at home.Dont see anyone socially unless you live together.If you do go out for work or supplies then stay at least 2m away from other people. Do not touch each other. Wash your hands religiously.What treatments are there?So far nothing.Either you get it and your recover, or you develop ARDS, in which case you will need to be admitted to ICU and ventilated.Chloroquine/hydroxychloroqine inhibits the ACE2 receptor in your cells, this is the path the virus takes you infect you. There is, to my knowledge, no published data at this time suggesting that it makes any difference.There are multiple trials into antiviral medications but again nothing has been published to my knowledge (please correct me if Im wrong).Am I high risk?The majority of people who get C-19 will have a mild disease. A minority will develop severe disease that requires ventilation and may lead to death.The biggest risk factor for developing severe C-19 is age. Below the age of 50 the disease is rarely severe. In children it is almost always mild. The groups most at risk are the over 70s and over 80s.As mentioned earlier there is some suggestion that higher viral exposure (such as experienced by healthcare workers) may lead to a more severe disease course.In terms of other medical problems some people should take extra precautions. Those receiving cancer treatment or taking immunosuppressants are at greater risk. Asthma seems to convey greater risk but mainly among those with more severe disease (such as those on biologic treatments, daily prednisone or those who have previously been admitted to intensive care).Men seem to be at higher risk of severe disease. We dont know why.Other conditions may have implications. If you are curious about your personal risk due to a comorbidity there is lots of useful information on patients charity websites, for example asthma UK.I have elderly relatives, what should I do?Everything you can do to facilitate them staying at home away from others. If you live with them avoid them as much as possible.Talk to them now about what they would want if they got COVID and got sick with it. Would they want an ventilator? Would they want ICU? Over here hospital inpatients arent being allowed visitors. Admission may mean dying alone, on an intensive care unit with no one allowed to see you. Its a hard discussion but better that everyone knows what everyone wants now.What is it?COVID-19 means coronavirus disease 19 (as it was first reported to the WHO on NYE in 2019). It is caused by the SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2).Why is it spreading so fast?COVID-19 is very contagious. Current data suggests an R0 (that is the number of people an infected person will go onto infect) of 2.5-3. By comparison your average seasonal flu with have an R0 of about 1.3. To put this into perspective, if you start with 10 people infected with seasonal flu, over ten infection cycles youll end up with about 138 infected people. With COVID-19 over the same ten cycles youll end up with tens of thousands to hundreds of thousands of infected people. Bear in mind this is not what is going to happen, only what could happen if the a disease was left to spread without effort to slow it. Public health measures to contain it can massively reduce the actual transmission rate.Can I find out if Ive had it already?Right now no. There is a test in development.What can I do to minimise my risk?Wash your hands. Regularly. Avoid large gatherings. Follow local rules and guidance. If you have symptoms then stay away from other people.To my knowledge there is no evidence that wearing a surgical mask in public will be of any benefit.Should I stop taking my medication?There have been media reports that people taking certain types of mediation, specifically ACE inhibitors/A2RBs (eg ramipril/losartan) or NSAIDs (eg ibuprofen) are at higher risk of catching or complications of COVID. To my knowledge there is no good data to support this. You should continue to take your medication as normal unless instructed otherwise by your doctor.Is tickle in throat same as a dry cough? Two days ago I woke up with chills, diarrhea and pounding headache. Headache is gone but now have tickle in throat that makes me want to cough. Could that be corona virus?? ###Output :If you aren't coughing, you don't have a cough, do you? You could still have the coronavirus, infections can have very variable symptoms.


###Input :Are you no longer contagious when your symptoms disappear?Ive tried reading through the comments but couldnt find any direct answer. A friend of mine was in contact with someone who tested positive and Im worried. He said his symptoms were gone after two weeks of being sick but he got tested the week they hung out and got the results two days after the handout. ###Output :Not thought to be, but not confirmed.We are recommending you wait until at least 72 hours after your symptoms have resolved to end self-isolation (and symptoms resolving while you're still having tylenol around the clock doesn't count)


###Input :NYC, immuno-compromised. Delay medical appt's? Better or worse? ###Output :Depends if time critical or routine


###Input :Ive been sick with some Covid19-like symptoms for 25 days now and Im 90% better now. I cant get tested where I am but my GP and I have been assuming thats what it is so Ive been isolated and all that good stuff.My question is, if my respiratory infection was by some chance NOT Covid19, am I now at increased risk of complication if I do contract it now that Ive just experienced pneumonia or something like it? ###Output :No


###Input :Would a motorcycle helmet protect against virus? I know I'll look silly, but I don't want to buy face masks so that they are saved for the healthcare professionals. ###Output :No


###Input :If you have a cough, but no fever or fatigue, are you okay? Can allergies cause a sore/itchy throat AND a cough? ###Output :Any cough right now is covid until proven otherwise.


###Input :What should you do if you develop the symptoms? They're so generic, and the hospitals are being overwhelmed, plus it IS allergy season. Advice online seems to suggest you should only seek treatment if you have a pre-existing condition, or one of the more serious signs like shortness of breath. However, my whole city went under a 2-week quarantine starting a week ago after a woman had a coughing fit in a store in a neighboring county, and she did test positive! I don't know any other details of the case though. Right now I'm worried if someone even so much as clears their throat near me. I haven't gone out since the quarantine stated, but my mother (who I live with) has been going to work (she's only one of like 4 or 6 people who are, and she has to go to work because she can't take all her paperwork home with her, its just too much), and she claims the idiot locals are completely disregarding the quarantine even though we HAVE had at least four confirmed cases in this city alone! This has made me really paranoid. The local community isn't exactly known for being healthy, and the whole city seems to be overrun with Trump supporters too which doesn't bode well with him denying its a problem. ###Output :If you develop symptoms you stay at home. If you develop breathing difficulties you seek medical assessment - follow local protocols.


###Input :Are swollen lymph nodes involved with the virus at all? I woke up today with VERY swollen and sore lymph nodes on my neck underneath my jaw, both sides. ###Output :Not typically, but possible


###Input :Where are they at with antibody tests? Internet says they exist but are hard to get. ###Output :Lots of companies are touting these but to my knowledge none have been proven to be reliable yet.


###Input :I have been experiencing fatigue lately: my RHR is higher (~55 instead of ~45-50); I get really tired when I try to run, even though I am a runner that does 50 mpw; I feel dizzy for a few seconds when I stand; etc. I have felt fatigued for the past 5-10 days and none of the other symptoms of COVID-19 have appeared. I think the fatigue is potentially from not being as hydrated as usual, the weather getting warmer, or my different eating habits with this whole quarantine situation.However, I am worried that it could be COVID-19. I am wondering what the actual chances of this being COVID-19 are; how many people actually only get fatigue without any of the other symptoms? I get the FAQ states any of the symptoms should be conservatively assumed to be COVID-19 but I am looking for a more statistical response. Thank you! ###Output :Sorry I am unable to give a statistical response based on your vague set of symptoms.


###Input :Do the fevers fluctuate? I've been tested and will get my results with 24 hours. I've been exposed to a covid + person and have had fatigue, mild cough, body soreness (as if I worked out). My normal temperature is around 97.4 it raised to 99.8, 100.5, and the back to 98.5 . ###Output :Yes. Sounds like possible covid.


###Input :My wife tested positive for COVID-19 several weeks ago and has now had a fever for over a month, while I am asymptomatic. We have been quarantined for the entire month and have not left our house. Her doctor recently gave her antibiotics as she believes my wife has a secondary infection that is causing the fever to linger. Is it safe for me to see family (while maintaining 6 ft/mask/etc of course)?Edit: My family has also been self-quarantined, they are relocating to their vacation home which is close to me. ###Output :We are still treating people as infectious if they have a fever so you should continue to quarantine. You cant prove that your wife isnt infectious or that you arent asymptomatically carrying it. Check your local guidance on whether you should be socialising with others regardless of your Coronavirus status.


###Input :There has been some mention of pinkeye being a possible symptom of the virus. Is there any potential truth to this or is that likely a symptom of something unrelated? ###Output :Not to my knowledge


###Input :31F, ~125 lbs in NYC (a hard-hit neighborhood in Brooklyn). Pre-existing conditions: classical EDS (with ID'd genetic mutation) and mild dysautonomia. In 2018 I had a very bad case of mono and by early 2020 was just getting over the fatigue from it.I've been sick with suspected covid-19 for almost a month now and just can't seem to get 100% over it. Week 2 was the worst, couldn't eat and lost almost 10 pounds (was originally at 130 lbs and now starting to gain a little of it back) and had chest pain. I had ordered a pulse oximeter, which arrived halfway through Week 3. Readings are mostly normal, it once dipped to 94 briefly. Have had persistent low-grade 100-degree fever (99.5-100.3) that lessens a little at night and worsens in the afternoon, comes with chills and sweats. Pretty fatigued and get winded doing normal things in my apartment like cooking (I live alone.) I have swollen lymph nodes (two that have bugged me since the mono that swell with any infection since then, one on the back of my head and one in my thigh [?!], other lymph nodes affected through this were the ones in my armpits and groin).After 4 weeks of fever, my PCP asked me to come in for a physical and bloodwork. Lungs sounded fine, temp measured 99.4 in the office (morning), throat was red, lymph nodes in armpits were felt by her but didn't seem unusually large. Metabolic panel and CBC came back normal -- not even elevated white blood cell count. Dr was a little concerned about the buggy lymph node in my thigh and said it should be imaged when the pandemic is over....but that will probably be months from now. I was diagnosed with "fever of unknown origin." Tylenol and Aleve relieve some discomfort, but don't bring the low-grade fever down. It just likes to stay put at about 100. (I normally run in the 97s-98s.)I am starting to worry about lymphoma because of that lymph node. It was imaged (ultrasound) when it first appeared in 2018 and was deemed large but noncancerous. Since then I've caught some more bugs than usual but attributed that to recovering from mono and a particularly bad cold/flu season in the city.My PCP is getting harder and harder to reach since she is now working in the ER to help those that are in dire need of help, and I don't want to bother her too much since I'm not dying...I'm just mildly ill and not getting better.Are there cases of mild covid19 that just seem to linger on and on and on like this? I had some friends who had mild cases around the same time as me and recovered in 2 weeks and are completely better now. I'm nearing 5 weeks and still sick. Is this just how covid19 is in some people, or do I need to be worried about cancer? I'm sorry, just really scared and won't be able to get regular/thorough medical help for the time being. ###Output :Most likely prolonged recovery. Lymphoma very very unlikely, but review with your primary doctor when theyre back open.


###Input :Does anyone know if taking antibiotics for a bacterial infection while potentially being infected with coronavirus is dangerous?Ive had a fever the last couple days with sever headaches, however I dont fit the criteria for testing where I live. This morning I noticed what seems to be a times flare up on my left foot. A couple hours later and my toe has swollen and there is a redness spreading slowly up my foot. I spoke to a doctor over the phone and mentioned the fever, and gave my other symptoms. The doctor prescribed me with some antibiotics for my foot and said theyll fax to the pharmacy for me.Im just worried that the antibiotics would be detrimental to my immune system if I do have covid-19. ###Output :No benefit but doesnt seem to worsen things either. Current agreement is to give antibiotics if any suggestion of a bacterial infection instead of/in addition to COVID.


###Input :I and my mother just came back from England 10 days ago (flew to Romania). We're in self-isolation, haven't gone out even for shopping. When we were at the border the doctor told us to call our GP or 112 (emergency number) if we get symptoms. I have just heard Mom properly cough, very loudly and persistently, and it lasted a while. The airport and plane were very crowded so I wouldn't be surprised if we have it. Mom doesn't want to call our GP because she is afraid of a hospital quarantine. 112 seems a bit drastic for some coughing. There's a national covid19 information hotline. Should I call them? Should I just talk to her and we agree to continue self-isolating for a month beyond the government enforced period? If I am honest, I'm kind of scared of a hospital quarantine too because I feel like it might make her (and maybe me) worse. I'd much rather just self-isolate at home, but I feel like if we don't know she/I are positive she'll really want to go out grocery shopping and stuff. She's also probably going to want to meet with my Dad (who is 64, has diabetes, hypertension, liver problems, is overweight and has had a benging tumor in his intestine for which he's been operated). She's 49 and I'm 17. Should I not call anybody and just talk to her? Call the hotline? Call 112? ###Output :I dont know what measures Romainia is taking but I would encourage you to follow all local guidance. If the cough lasts more than an hour then call.


###Input :I heard her, she had breaks but it was very very loud and it was about an hour, she was trying to silence it and go to sleep. Im not sure how seriously they mean call 112 though. Ill call the information hotline in the morning and see what they say. ###Output :There is a strong chance she has covid. Follow all local guidelines


###Input :I'm trying to find an answer to this because the CDC released conflicting information.How much benefit is there to cloth/homemade masks? My understanding is they don't help much, they don't block coronavirus, and if anything they increase risk because people are constantly touching/removing/adjusting them.Surely there isn't much benefit in wearing a homemade mask at work if I have to remove it for lunch and then put it back on. I'm just touching my face more. ###Output :The benefit of the public wearing masks is really going to be in prevention of transmission from folks that are asymptomatic but spreading the virus. You could be spreading it right now. Please wear a mask so that you don't get others sick. We don't know exactly how much benefit this will have, but it's a simple enough thing to ask people to do.You shouldn't be touching your face at all when removing a cloth mask.


###Input :An article mentioned that hypertension is a significant risk factor.Does this refer to untreated hypertension or treated, or both?If someone had hypertension that has been successfully treated for years or decades, is it still a risk factor? ###Output :Hypertension seems to be a risk factor. Whether that is because of the hypertension itself or because of the associated micro and macrovascular damage cause by untreated hypertension we do not know.


###Input :Allergy season is coming up, which means sneezes and sniffles. Currently I take a steroidal nose spray to cope, I also have access to non-steroidals if needed. Will a steroid nose spray have any negative affects vis-a-vis covid19? I do not have it, but dont want to make things more difficult than it needs to be. ###Output :Nasal steroids safe to continue


###Input :I keep hearing "I had the virus back in November!"In November of 2019, there wasn't a surge of deaths and hospitals becoming inundated with ill people.The virus didn't just decide to start becoming highly contagious in March 2020.I find it hard to believe these people actually did have it already months ago. ###Output :Unless these people were living in Wuhan then it is phenomenally unlikely they had covid in November.


###Input :Someone told me it was a matter of controversy that COVID-19 is transmitted via breath.Is that controversial like it is controversial to say that smoking causing lung cancer? :-). ###Output :Theyre talking nonsense


###Input :What is a good source of news about the progress of the pandemic?I tried MedCram on youtube, but it goes off on tangents.People keep recommending web sites teenagers built.I would like a news source that would tell me the numbers, the trends, what has been learned, and what the recommendations are. ###Output :In terms of hard stats on numbers of cases/deaths etc http://worldometers.infoIn terms of everything else the ebook listed at the top of the FAQ


###Input :Can someone who was sick in Feb with what they thought was the flu, now test positive for Covid-19?Or in other words, is the virus similar to Hep-C where you can still test positive weeks after recovery because of antibodies? ###Output :There is no reliable antibody test yet available.Once one exists it should be able to confirm exposure within the last year, perhaps longer. The immune response still not fully understood.


###Input :Age 23. Female. North Colorado. 55. Maybe 105 pounds. I have Ehlers Danlos Syndrome with Vascular Complications, Gastroparesis, and an AVM in my dueduom that bleeds periodically ( started bleeding again yesterday) (currently anemic because of this). My father recently told my family that he tested for antibodies of covid. I lived with him from Feb 29- April 3. He was sick from March 23- April 1. I developed a low grade fever last night as well as a headache, and have been very lethargic. Would I be able to be tested without proof that he has antibodies? He and I arent on good terms and I am very concerned. I am also concerned as I lost health insurance April 1st and havent secured a new plan yet. ###Output :Current antibody tests (particularly the home testing kits) are not accurate and of no diagnostic use.


###Input :Is it safe to go outside for walks? I'm obese and therefore more likely at risk due to my condition, so I'm trying to lose weight. I would get a mask obviously. ###Output :Yes walks alone in open spaces should be fine. That said follow local guidelines - some countries forbid anything but trips out to collect food.


###Input :Many sources earlier this year kept stressing that the flu was worse than covid19. The flu has been around for a long time. covid19 was new and no one knew much about it yet people kept saying the flu was worse. Now we're where we are now. Why didn't people take it more seriously? ###Output :Those sources were probably not scientists or doctors. This was never not worse than the flu. This is what bad journalism does to our society


###Input :Hi guys, this might be a bit of a stupid question, but four weeks ago my ear temperature hit 38 degrees, naturally it scared me so I self isolated, I tried to go on my PC again after 10 days and the same thing happened again. Skip forward another 20 days to today, and it's happened again (37.8 this time)... Can headsets make your temperature rise by like a whole degree? My temp was 37.1 when I went on my PC. I've felt fine for almost three weeks until today. Also can anxiety cause this? cos I am very anxious/stressed basically constantly atm and do suffer from diagnosed severe anxiety. ###Output :I would certainly suggest taking off your headset for an hour then rechecking.


###Input :Whats the deal with NSAIDs? Are we able to take them? I dont have covid, just being cautious. Specifically looking to use topical voltaren gel for chronic neck pain. Any advice is appreciated! ###Output :Recent review found no evidence that NSAIDs worsen covid. Youre definitely okay to use NSAID gel such as voltarol.


###Input :Why cant blood and organ UV radiation be a treatment for Coronavirus?Okay, I know how stupid that sounds, but I didnt want to jump on the bandwagon so I did a couple of minutes of research and I just want to hear from people who know better why this thinking is wrong.I know external UV radiation would not do anything, however:Uv radiation and high humidity has been found to be very effective at killing the coronavirus :https://www.google.com/amp/s/www.aljazeera.com/amp/news/2020/04/sunlight-humidity-kill-coronavirus-fastest-scientists-200424065853466.htmlUltraviolet irradiation of the blood used to be used to treat diseases like pneumonia before antibiotics in the 1950s :https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122858/Ultraviolet radiation has been used or suggested before as a way to sterilize organs during organ transplants:https://www.jhltonline.org/article/S1053-2498(18)30378-4/abstracthttps://www.efe.com/efe/english/technology/brazil-develops-technology-for-sterilizing-organ-transplants/50000267-3933369So what is stopping doctors from, in the worst case scenarios, treating critically ill coronavirus patients by irradiating their blood and/or a lung? ###Output :Beware quackery.


###Input :F23 Respiratory Sinus ArrhythmiaHi, I was recently diagnosed with Respiratory Sinus Arrhythmia and prescribed an inhaler. I was only told to use "as needed" but I have been having trouble figuring out when "as needed" applies. Do I only use it when I feel like I'm having an onset attack? Or at night when I lay down to sleep and my symptoms seem more noticeable? Are both situations applicable? Also any advice on lifestyle changes to ease my symptoms? Thank you in advance. ###Output :A "respiratory sinus arrhythmia" is an absolutely normal phenomenon and doesn't need to be treated, as it's normal. What was the inhaler prescribed for?


###Input :I was also confused when the physician said she was prescribing an inhaler, the main things I complained about was a feeling of pressure in my chest and my heart feeling as if it was beating faster, but too softly, then skipping a beat and beating harder as if to compensate for the lost beat. I also mentioned how a little over 2 weeks ago I had a severe attack that was causing my muscles to twitch and spasm and i was sweating. The papers from my discharge say asthma but asthma was never mentioned during the visit. ###Output :Agree with above post. Your doc may have prescribed as a diagnostic/therapeutic trial for some symptoms, but ran out of time to explain it all to you. I'd get in touch with the person who prescribed it to you and ask them, as inhalers aren't typically used in this situation.


###Input :30 F Not feeling fully recovered 1 month after a Myasthenic Crisis and Acute Respiratory failure30 Female, medical conditions: Myasthenia Gravis, Chronic MigraineMeds: Mestonin 60mg every 4 hours, Cellcept 2x day ( 1st month on medicine)It's been a little over a month since I had a Myasthenic Crisis and was hospitalized in the ICU. I had three days of high-dose steroids and plasmapheresis for 5 days. I was feeling better respiratory-wise but still felt very tired and not back to 100% of where I was before the crisis. I was put on Cellcept by my neuro immediately after release and so far it has made me have less droopy eyes and mouth but I haven't noticed much difference.( Note: I have been diagnosed since late 2019 and on Mestonin, they did not put me on other meds since I responded well at the time. It has since been suggested that the mestonin alone was no longer able to handle the disease and that is why I went into a myasthenic crisis)The past week I have felt the shortness of breath from the Myasthenia come back, and at times I have gone on my CPAP to help reduce the strain and it has made me feel better. I'm starting to feel fatigued again, but not at myasthenic crisis level, so I'm pretty sure the benefits of plasmapheresis wore off. My main concerns are:Is it normal to take a while to recover from a Myasthenic Crisis?Is the reemergence of shortness of breath a troubling symptom?Should I ask my neuro for another treatment or medication? ( I was warned it could take 2-6 months for CellCept to fully work)I do see my neuro early next week, but I'm not sure if these symptoms are troubling enough I should seek medical care sooner or if there are other suggestions I should bring up to my doctor when I see her. ###Output :Yes you really need to contact your neuro doc. You are at risk for another crisis because you had one already. You may need ongoing weekly plasma exchange until you are on stable immunosuppressants. Your docs are the best ones to advise you, you aren't bothering them.


###Input :Found out I have convex chest at 40 after years of respiratory issues, now what?I am a 40 year old white male. Recently I had some issues with what I believe to be acid reflux (possibly aided by too much coffee) and it made me vomit several times. After telling my doctor this he decided to do a chest x ray and so far has only told me I have a convex chest.As an aside, I have been trying to find answers to joint issues I've had since puberty. My knees feel like they pop off and back in, even when that hasn't happened they swell up and hurt severely if I'm on them too long.Tgis applies to other joints to a lesser degree, I also have scoliosis and severe back pain.What should I ask my doctor to do? What to test for? Sometimes I feel like I have to ask for things with him and I'm worried about my future health.Anyway, thank you for reading and kind regards. ###Output :Chronic dyspnea and chest wall deformities make me think it might be worthwhile to be assessed by a pulmonologist. These lung doctors have a series of tests that can evaluate how much the chest wall deformity may be affecting your overall breathing, and if substantial have different ways of treating it.


###Input :Need ideas from as many medical minds as possible please! Chronic respiratory failure - hypoxia. Worsening. Low BMI. Ruled out pulmonary and cardiac causes, whats in your differential?51F, 59, thin, white, USA. never-smoker, non-drinker; no prescriptions; unintended weight loss of now 28lbs since January, oxygen desats started in January w/ exertion, suddenly worsening in the past few days and now on continuous oxygen. Exhausted and weak. X-post for visibility. (This is for my mom)ETA see bottom of this, someone mentioned cervical spine issues, my mom has those, found in MRI in 2020!Ive posted about this a couple of times but need as many ideas as possible, and casting as wide a net as possible as weve hit a dead end and its looking bad.All pulmonary and cardiac testing done. Normal. (Only abnormal test so far has been an elevated 5-HIAA ordered bc hours-long intense hot facial flushing episodes began at the same time as the oxygen desats). Follow up with GI in 2 weeks.Over the past several days oxygen desats started coming on faster and going lower so after respiratory therapist consult now on continuous oxygen. Follow up with the pulmonary doc tomorrow but after 6 months of pulm/cardiac testing - and now sudden worsening of symptoms over the past few days - it seems like its time to look for other causes.What other specialist besides pulmonology or cardiology would you recommend? What would be in/on your differential list at this point?ETA: someone mentioned cervical spine issues causing this - here's her MRI of cervical spine and brain brief notes from neurologist about this from 2020:Her MRI of the C spine shows degenerative changes but most notable for disc protrusion at C6-C7 narrows the spinal canal to 5 mm. She is nearly asymptomatic at this point, but still encouraged her to discuss with neurosurgery for opinion given the findings.MRI of the brain shows multiple punctate foci, estimated at 30. ###Output :I've been thinking about your mom since you posted last week about her worsening symptoms.The typical differential diagnosis for hypoxia is pretty simple to workup -- decreased partial pressure of oxygen (altitude), hypoventilation, decreased diffusion, VQ mismatch, and shunt). I would expect any reasonable pulmonologist could pretty easily work through that differential diagnosis, and I suspect if your mom got a shunt study that has gotten a thorough workup.There are some additional, rare causes of hypoxia/dyspnea that do exist. They are things that we predominantly see in the ICU, as they are typically acute causes. I categorize them as histocytotoxic and competitive. It's a bit complicated:Histocytotoxic causes do not exactly cause hypoxia. An example is cyanide. It uncouples the electron transport chain (ETC), which is the process of how cells utilize oxygen to make energy molecules). When the ETC is uncoupled/blocked you can not process oxygen, so physiologically it's like your body experiences extreme hypoxia. It's an immediately fatal process, so I can pretty much assure you your mom isn't dealing with cyanide toxicity. Perhaps you could bring up the idea of histocytoxic hypoxia to your mom's pulmonologist, though. She may have a chronic exposure to a substance that is causing hemoglobin dysfunction.Competetive hypoxia/hypoxemia is related to something that either outcompetes oxygen for hemoglobin binding or changes the hemoglobin conformation so that it no longer binds oxygen as well. There is something called methemoglobinemia (pronounced "met-hemoglobinemia", not meth-hemoglobinemia). It's also something we see on an acute setting in the hospital. There is a congenital/hereditary form, but it usually presents pretty immediately after birth. I wouldn't expect it to arise later in life like with your mother. There are plenty of acquired forms, but these usually happen acutely. It could also be worthwhile to bring up the idea of methemoglobin or other competitive forms of hypoxia/hypoxemia to your mom's pulmonologist.These are super rare and unlikely things, but it sure sounds like your mom doesn't have a common or simple problem. Hope this helps!


###Input :Can coronavirus present as a cough and shortness of breath without other severe symptoms?I know you guys get a stupid amount of these posts, but I'm trying to figure out if I should go to a doctor to get tested, and I figured you guys might be able to tell me if my mild symptoms have any chance of being caused by the coronavirus.Me: female, age 20 (21 in a few days), 5'10", 160 lbs., no comorbidities, mentally and physically healthy and fit, no drugs/alcohol, no medications. Possibly came into contact with someone sick.A few of my distant coworkers have tested positive for coronavirus. Two days ago, someone I share a desk with (who works the opposite night shift as me) went home sick with severe symptoms - it really sounds like he has the disease.Now, four days ago, before hearing about these cases, I had a headache, some body aches, a very mild sore throat. I'd explain it as, like, the most mild cold you can have. I popped an ibuprofen and went to work.For the next two days, I continued to have the same very mild symptoms. No fever, no runny nose. I thought it was allergies. But I started developing a cough. At first, it felt like when you exercise too much and can't breathe properly, but with a little chest pain to boot. But these symptoms have gotten progressively worse, to the point where I can't take a deep breath without coughing. My chest burns like someone rubbed some mild capsaicin cream on the inside of my lungs. My heart rate is higher than normal, and I have some mild body aches/fatigue. When I move around, I get short of breath way too fast. Additionally, today I think I may have developed the mildest of fevers (though I have no thermometer on hand).The feeling in my chest really reminds me of that one time I accidentally mixed bleach and ammonia and breathed in some of the fumes, but a little worse. It's not comfortable, but it's not bad. I am NOT coughing nonstop. I can speak, breathe, and sleep normally. But I undeniably HAVE a cough, and I'm tired. However, the other symptoms are so mild that if it wasn't for the cough, I'd think it was allergies/psychosomatic symptoms.I did call out of work and am keeping myself at home. I feel HORRIBLE about it because my symptoms are so blasted mild, but it's not worth the chance. I will go to the doctor and get tested if it doesn't go away, but I just figured I'd ask here beforehand - just in case my symptoms in no way match the coronavirus. I've read about people's symptoms, and most people talk about severe upper respiratory symptoms, which I do not have. Everything in me is screaming "you're being dramatic," so I thought I might be able to get an opinion here on whether I am, indeed, just being dramatic.Thank you so much for reading through. I appreciate your time.Edit: I called and asked for a test. They don't want me to be tested because my symptoms are pretty mild, so I will just be staying home for a bit (5 days) to see if my symptoms get worse at all. That's how much ATO I have. If they go away, back to work. If not, I'll talk to HR and risk my job rather than other people's lives :( Thanks for the help.Edit 2: reports of positive tests in my area have been rolling in today, including in my boyfriend's workplace. Yikes.E3: I guess my birthday present is probably going to be unemployment because I'll be doing a full quarantine.E4: happy news! I talked to my employer and I won't be fired if I quarantine! Woot woot! 14 days of bored coughing, here I come.E5 03/20/2020: yeah it's getting worse. Chest is on fire. Hopefully this really isn't the coronavirus, because that would suck. Stay safe guys. This shit fucking hurts :)E6 03/22/2020: bedridden now and they won't test me. Breathing is hard. I hate this.E7: 03/26/2020: finally getting better. I am still extremely short of breath and can't do much or walk far. My lungs still ache, and going out in the cold is the worst. I can't taste or smell very well. However, I am extremely grateful that the worst of the sickness is through. That was probably the sickest I've ever been in my life, and it sure wasn't fun. I'm so glad my employer granted me paid leave; I spent four days in bed and will be self-quarantined for a while yet. Yeah, this was probably the coronavirus. Thanks for your help guysE8: 04/04/2020: I am much recovered. However, I am still very out of breath. I ended up calling the covid hotline again (long story involving my now sick roommate) and NOW they want me to get tested - AFTER I HAVE RECOVERED - because I am still very short of breath. The test was this morning (very uncomfortable). Let's watch this test come back negative now XD ###Output :Yes


###Input :Thanks. Appreciate it. I will get tested. ###Output :You may not be able to get tested, given the limited supplies in most of the US right now. Please assume you have it and STAY HOME and away from family members who are at risk.


###Input :Same here i have cough and burning throat and can be hard to breath. I do also have random fevers and the first time it went away but now its returned. And my job flat out refuses to pay unless we are confurmed to have it. ###Output :Don't take ibuprofen!


###Input :Not so sure about that. Heard a doc on on of the networks today saying there's no evidence to back this up. Hard to know with a lot of unconfirmed advice going around. Best wishes to those feeling unwell. ###Output :Yeah I'm not sure either, but it's better to be safe at this point. I'd go for Tylenol.


###Input :Overnight the cases doubled in New York where I GREW UP and my father still lives. ( Mind you he is late 60s something he's as stubborn a mule and won't go inside ugh) It may not have hit us yet but It will. I don't give two shots if he's from Kiribati or Myanmar or even Jupiter. I'm concerned with folks taking it seriously.As for you if you reread my message I clearly state that this guy didn't offend me, to which I'm not making a snarky remark I'm stating " oh man that fucking sucks what's happening in Italy that shots for real over there, it's gotta be difficult. In which I then go on to wish him well. At NO point in my reply did I ever curse him or put Ill will upon him just the opposite.I APOLOGISE if it came across another way that was not my intent.As for you maybe in the future you might stop and consider the gravity of what's going on. I may personally live in the Midwest for now but I'm shipping out in a week and I have family all over the East coast. Lastly good luck hopefully we can do this again some time, this nothing quite like a decent discourse  ###Output :Please read our rule on claiming credentials


###Input :23M I was prescribed Prednisone after getting symptoms of upper respiratory infectionI went to an urgent care yesterday after having a sore throat the night before, I took the prednisone yesterday as well. Now my sore throat has turned into horrible nasal and chest congestion and an even more sore throat. My sister is just finishing up a bout with bronchitis(thats what she was diagnosed with). Is this the right medication for me? My body is telling me its not based on my infection getting worse it seems. ###Output :These things are likely unrelated. Despite the prednisone you would likely have gotten worse anyway. It just seems like cause and effect because of the timeline. You also likely have the same viral infection as your sibling. You really dont need the prednisone unless youre wheezing. You dont really need any medications specifically but can take things for the symptoms such as Tylenol/Motrin for aches, pains, or fever, OTC cough suppressants, etc. drink plenty of fluids. I assume the urgent care swabbed for flu/covid? If not that would be something that could direct treatment plan more.


###Input :Do I have some sort of respiratory infection22M, 5 ft 20, 235lbs. 2 weekends ago went to a family party and we were all drinking and started sharing a bottle that was passed around between like 5 people. The next morning I had a sore throat and just thought it was nothing. It continued for a few more days and after the sore throat went away I got really congested and got a really bad cough that I still have to this day almost 10 days later. My mom also had the same symptoms plus her sinuses were bothering her so she got a covid test that came back negative. I just assumed I wouldnt have covid if my mom didnt if we were both sick. The doctor at the clinic she went to said she had a sinus infection. I havent seen a doc yet but my sinuses havent been bothering me at all just my chest snd a cough. The cough is the worst in the morning then kind of slows down a little then picks up again around the time I want to go to bed. I get in nasty coughing fits to the point where I can barely even breathe and I cough up a ton of green phlegm. Ive had an upper respiratory infection before but it was never this bad. Ive barely been getting any sleep because of this cough. Ive taken mucinex dm, robutussin, and dozens of cough drops but nothing is working. ###Output :Sounds like either COVID or an enormously long list of alternative upper respiratory viral infections. Just because your mom tested negative doesn't mean you don't have COVID as well.


###Input :Why did urgent care send me home to fight an upper respiratory infection that has put my husbands coworker in the hospital?Age: 28, race: Caucasian, sex:FIve been dealing with an upper respiratory infection these last few days. went to urgent care Wednesday, no fever, sore throat. Negative for Covid, strep, flu. Doc told me to take time off work, could not due to previous attendance issues so Ive been doing half days. Sore throat went away and it feels like my chest is chock full of mucus. I already have mold in my house, so yay. Ive done a nasal spray and taken a decongestant but Im so nervous. I dont want to wait for this to get as bad as Hs coworker did. Urgent care doc struck me as one of those its not a big deal people and denies my illness could get worse ###Output :I mean... we didn't put everyone with covid into the ICU or even admit them all.Illnesses hit different people differently, we base treatment recommendations on your illness severity, not based on what happened to an acquaintance.If you decided to go to work afterwards, it sounds like the urgent care doc 100% made the right call.


###Input :Contracted respiratory symptoms from my childMy son (10 months old, male) was fussy, with runny nose and coughing between Friday and Sunday last week. Now he's not longer fussy, the runny nose decreased to less than a half and he caughs once or twice a day. He's very active and with good mood.As of Tuesday I started having an itchy throat that led to a sore throat and a runny nose the next day. On Thursday I had elevated temperature (37.8 C) and cough. Friday the cough went on, but temperature was normal. Today the cough feels coming from deeper in my chest, but no fever. I've taken two sars-cov2 antigen test (Thursday and today), both negative.Tomorrow I have an appointment with the family doctor. My partner (41yo female) and her daughter (13 yo female) are starting to develop similar symptoms as I did.Since apparently my son caught an infection and then passed onto us, plus the covid antigen tests came negative for all three (partner, daughter,me) I'm not sure if covid could be ruled out.Could you please share your thoughts? I'm not really sure what to ask specifically, just want to get some opinions and maybe suggestions.Cheers! ###Output :Sounds like the easier solution would've been to get your son tested first, instead of everyone else.Remember that there are plenty of viruses besides COVID that cause similar symptoms. More likely that you have one of those given the negative tests.


###Input :My best friend died suddenly, and Im trying to figure out what happenedIm sorry if this isnt an appropriate question for this sub - if you have any other relevant sub recommendations, please let me know.29 year old white female, 58/315lbs, frequent drinker, non smoker, no medications other then OTCs, no known health problems.On December 13, my best friend (we work together) went to her sisters company Christmas party. Towards the end of the night, they got into a fight, which continued until they got home (they lived together). During this fight a shard of glass or mirror punctured her trachea (still dont know the truth as to how this happened, but thats a different story).They had her in the ICU for two days. While in the ER, her lungs stopped working and they put her on a ventilator while in the ICU. Her kidneys started to act up, so they kept her for a full week. I visited her and gave her a care package, we walked around the ward a bit, and she was in pretty good spirits although she got winded easily. Externally, it looked like her injury was healing well.On December 23, she came back to work for a half day. She had subcutaneous emphysema and was retaining water weight for some reason. We took a walk and she got very lightheaded at one point. She was supposed to leave at 2, but she got lightheaded again and said she was going to wait a few minutes before driving, I gave her some water and pretzels. About 10 minutes later, I heard strange gurgling noises coming from her desk (we sat across from each other with a divider in between) so I ran over. She was bent over her desk shaking and barely breathing, her pupils were dilated and she was unresponsive. She also lost bladder control at one point. She fell out of her chair as I was calling 911, and when on the ground she was only breathing 1-2 breaths per minute (agonal breathing?), her face and tongue turned blue and then grey, and she was clenching her jaw. I stayed on the phone with 911 while two of my coworkers started chest compressions. Once the paramedics arrived, they took over, started manually breathing for her, and hooked up an AED (I think), and the first time they stopped CPR she flatlined and wasnt in a shockable rhythm. It took them forever to find a vein that worked, but they finally got one and gave her epinephrine 3 times that I noticed along with sodium bicarbonate. They also intubated her. I dont know if this is standard, it seemed strange to me, but they worked on her for over an hour, maybe even an hour and a half - every time they stopped compressions she would flatline, but after the first time her heart was in a shockable rhythm so they shocked her several times. They were unable to resuscitate her, and told us that she died of kidney and respiratory failure.If any additional information is required, Ill do my best - not sure if I covered everything. I requested a copy of the autopsy report from the county ME but they said the case was referred to a justice of the peace, so I have to contact her directly (and if theres an active investigation she may not release the report). If anyone has any ideas as to what happened here, I would really appreciate it. Thanks in advance. ###Output :Wow, those are quite some tragic events to happen to everyone involved. My condolences.At this stage I guess you will have to wait for the autopsy.My first guess would be a large pulmonary embolism (immobilized in the ICU).A primary cardiac cause seems unlikely. A respiratory or airway cause (suffocation or serious bleeding in the upper airway) I'm not so sure about either, because it wouldn't have such an extremely acute onset and your friend would typically run over in case she was suffocating for instance. A very serious and sudden arterial bleeding (ruptured aortic aneurysm) doesn't make sense either considering her age and history.A major intracranial (subarachnoid) hemorrhage is a second possibility.Again, pure speculation. You would have to wait for the autopsy report.


###Input :Yea I watched my son die of a PE we knew it was eventually going to happen and the gurgling made me immediately think of that. Sorry for your loss. Please consider some counseling as it can really help work through dealing with unexpected deaths. ###Output :Sorry for your loss. If she actually had SQ emphysema when you saw her that day, I would be concerned that she may have had an air leak and may have developed a tension pneumothorax. A tension pneumothorax can potentially lead to progressive shortness of breath and cardiac tamponade which would drop her blood pressure. In that situation, I would have expected her to be having some chest pain prior to the event and for symptoms to build up. If this happened very suddenly, then I agree that a pulmonary embolus is more likely.


###Input :Do you think there will be charges brought against her sister? I could see an Involuntary Manslaughter charge for someone where I live happening. ###Output :Sorry to ask, but did the ems people work on her for an hour and half or did they transport her and the docs worked on her for an hour and half?


###Input :Ems from op ###Output :Why on earth would EMS work on someone in the field for 1.5 hours instead of transporting?


###Input :Depending on the area, sometimes med command directs EMS to stay on scene with an unstable patient. Ive heard them be instructed to stay up to 2 hours before med command calls it, but its so unusual Ive only ever encountered it once. Does seem very very strange, but it also very much depends on rural vs urban settings. A lot of different possibilities. ###Output :Ive heard them be instructed to stay up to 2 hours before med command calls it, but its so unusual Ive only ever encountered it once. Does seem very very strange, but it also very mMakes no sense honestly, intubate, start acls, go.


###Input :Depends on your area and protocols. Study's have shown improvement in survivability and neuro out come of obtaining ROSC in the field prior to transport. Field terminations are becoming more common in EMS on medical arrests. Mainly in part you're unable to properly work an arrest in a moving ambulance.Requirements in my area for field term are 30 minutes of basic ACLS. Epi, fluids, ET/ laryngeal airway, bicarb/ calcium on renal pts. If the patient remains in asystole med controls is contacted for any additional orders, with no change we terminate. ###Output :Yes, improved survivability if ROSC within a certain time frame, 1.5 hrs?


###Input :This varies a lot with the culture of EMS agencies, transport distance, etc. I work with some agencies that work it on scene and only transport if they get ROSC or if theres something obvious the hospital can do that they cant. To be fair, unless its a known STEMi that can be cathed, or a cold water drowning, or trauma were just going to do to ACLS too. ###Output :Define what "we're" means, you are ems or em?


###Input :My particular Emergency department. Things might be different elsewhere ###Output :Your ER Doctors do not use ACLS, nor should any board certified EM physician. It is a backburner protocol that can be implemented while thinking but is ultimately a protocol created for non resuscitationists. Your ED should not be doing "ACLS too." There is also a significant difference in the number of available hands for CPR, med pushing, and ultrasound machine, a pharmacist, a respiratory therapist, etc etc. I know I don't know all the details, but a young person who arrests in the field should be brought into the ER ASAP.


###Input :If critical care paramedics use thrombylitic agents on scene it requires an additional 90 minutes of CPR, at least in UK guidelines. ###Output :Those don't really exist here. And if they do, they are in remote academic areas where transport should have been quick.


###Input :Where do you work? A lot of EMS protocols around the world are "No ROSC = no transport" except maybe in some extreme cases that can't be treated in the field (ie. PE in some places, or intrapartum cardiac arrest). ###Output :I am so sorry for your loss, it seems you got into a very tough situation but did all you could to help her and gave her and the EMTs the best chances; you're a good friend and person. I would agree with the colle ague that a PE or another clot of some sort (intracranial bleed/occlusion) comes to mind as a plausible possibility, and that waiting on the autopsy results is the best step. A serious underlying reason would also explain why the resuscitation was unsuccessful.


###Input :UPDATE ABOUT MY MOM: Chronic respiratory failure - hypoxia w/o pulmonary or cardiac explanation.51F, 59, thin, white, USA. never-smoker, non-drinker; no prescriptions; unintended weight loss of now 28lbs since January, oxygen desats started in January w/ exertion, suddenly worsening in the past few days and now on continuous oxygen. Exhausted and weaker every day. X-post.This is just an update for anyone interested. Ive posted about this several times on the various medical subs here out of desperation and have been blown away at the helpful advice and input. I wanted to post an update in case anyone remembers spitballing about this and might be curious about new developments.Today mom had her follow up with her pulmonologist following the normal shunt study. He spent a solid hour with us going over everything shes been experiencing the last six months with a fine tooth comb, reviewing prior records in the hospital system from the past year before the oxygen issue, and doing a thorough physical exam - we knew something crucial might be in those clues.Very long story short - its not a happy update but it unfortunately makes sense given a lot of other problems mom has been having during this same timeframe that just seemed insignificant or unimportant compared to the chronic respiratory failure. Things she thought could sit on the back burner til that was solved, but have been accelerating in just the past 2-ish weeks along with the worsening oxygen desats.Basically, there are several observable, objective signs and symptoms that seem to point to some kind of neurological/neurodegenerative process/disorder.He ordered a lot of tests that will be happening next week, and she will be seeing a neurologist for further evaluation on Tuesday.The more we read, the more huge lightbulbs are going off on this kind of process being a possibility. Not going to assume anything, and not trying to be negative, it is just undeniable that a lot of the puzzle pieces fit and we want to prepare for the worst mentally/emotionally. It's a long way from here to final answers (if we ever get any, we are well aware we might not ever get this figured out, that there are limits to medicine), but I just thought Id update since my moms situation is such a very odd, even bizarre, case. Thanks so much to all of you who have pitched in. ###Output :Glad to hear you've found yourself a solid pulmonologist. Might I ask what institution he/she is working at? I like to know where there are good folks if I ever need to reach out.


###Input :I (27F, 65in, 125lbs) was recently prescribed propranolol (20mg twice a day) for migraine prophylaxis. As I was reading through the information, I saw that multiple occurrences of past bronchitis are a significant contraindication. I have had pneumonia several times, and am not sure about bronchitis because the several pneumonia cases I had, I put off going to the doctor until I had to go to urgent care (less than ideal, I know. poverty can really be a bitch.) The last time I had pneumonia I ended up with cracked ribs from coughing so hard.Is it safe for me to be taking propranolol, and are there early warning signs I can look out for if my respiratory system is being negatively impacted? Would I develop a cough?I would call the prescribing PA but not only was it the first time I had an appointment with them, it was also their last week at that job, and they also were a little bit dismissive when i asked if there could be any interactions with my psychiatric medications (bupropion xl 300mg & concerta xr 27mg.)Thanks for your help! ###Output :Previous infections shouldn't affect you today, I wouldn't worry about it too much but yes you are correct, they would be signs. The main sign would be an asthmatic sensation, in which case you should not take any more propranolol and seek help.It's very hard to give good medical advice you seem to have shared lots of pertinent information, I can only suppose, but I suppose there's no problem taking this beta blocker at this moment.


###Input :Thank you! Would asthmatic sensation feel much different than respiratory symptoms from sickness? I noticed today that drinking very cold things makes me cough and feel like i have an itchy throat/need to clear my throat. This isnt completely unusual for me, but its been more extreme than normal. ###Output :Not really, shortness of breath, is shortness of breath.Allow me to advise you not to drink very cold things.


###Input :Is brain fog/cognitive dysfunction in sleep apnea caused by sleep fragmentation or intermittent drops in SpO2?24M, 176cm, 78kg, mild sleep apnea (AHI = 10), not on any meds, non-drinker, non-smoker.I have had mild OSA for the last 2 years and was only recently diagnosed in March; during this time, my main symptom is brain fog/cognitive dysfunction which was bad enough to impede my ability to study. I have since been treated with CPAP and I have noticed mild improvement even though I am still not 100% used to the machine and the mask and am hence sleeping only for 6 hours at a time. I still feel sleepy on days where I sleep this little, but the brain fog is improving gradually nonetheless. This makes me wonder: was the brain fog caused by the oxygen deprivation while my OSA was untreated, or was it due to the sleep deprivation? If it was caused by sleep deprivation which occurs as a consequence of the OSA, then why am I experiencing improvement in the brain fog even though I am feeling sleepier than most of the days before I began using CPAP? ###Output :They are both tied in together, as the low oxygen level triggers an awakening response that fixes the low oxygen level but results in sleep fragmentation. Disorders that are associated with frequent awakening but not hypoxia, such as restless leg syndrome, are also associated with "brain fog" and other symptoms of poor quality sleep so it isn't really just the oxygen.There are two possibilities here for you.Cognitive dysfunction and daytime sleepiness are not affected equally by quantity/quality of sleep though they are related. It is possible that 6 hours of higher quality sleep is helpful for your cognitive symptoms, but isn't enough to pay off the sleep debt you've accrued especially since total sleep has decreased. Increasing comfort over time with the CPAP is the rule of thumb, and eventually it tends to become a sleep cue.The other possibility is your cognitive improvement is a placebo effect. Your OSA is mild by AHI, depending on the rest of the picture including nadir oxygen and other symptoms (snoring, high blood pressure etc) this may or may not be causing your symptoms. I think this is less likely.There are some other possibilities with persistent daytime sleepiness when you have started treatment for sleep apnea, including a mixed sleep-disorder, and if it persists may warrant testing in the sleep lab if this wasn't done already.


###Input :Thanks for the comment. This is more comprehensive than I expected.But what I meant is, without the sleep deprivation/fragmentation, could the SpO2 drop still cause cognitive dysfunction? My nadir oxygen (lowest Spo2 recorded in my sleep study) was 88% (for a total of 9 minutes, not continuously but distributed across the night), and usually the drops are to the levels between 90-94%. If it was the sleep fragmentation caused by the Spo2 drops that is the culprit, then it doesn't really explain why I have been feeling sharper and yet I am feeling sleepy. I have had insomnia in the past and the sleep deprivation have never given me "brain fog" neither, I simply felt so tired that I can't continue with my day anymore subjectively but I wouldn't notice a "fog" over my head. One way to illustrate the difference would be the comparison between the times I had to do an all-nighter before I had OSA and when I had to do an exam after having slept say 6 hours the night before while having OSA: I still found it harder to think on my feet in the latter case even though theoretically I should be more tired in the first case due to the acute sleep loss.I don't think that my cognitive dysfunction is a placebo effect because the difference that I have noticed is a bit too big. I have taken anxiety medication (atarax) and followed the advice of a psychologist to just take it easy and relax before as well when my clinicians thought that the brain fog was caused by stress and anxiety, but even though I convinced myself that the it was psychological and even layed off my studies for a whole year, I did not experience any improvement as significant as that which I am experiencing now.I know why I am still feeling sleepy: it is from the simple fact that I get woken up by the sunlight in the morning easily, since the CPAP mask is making it hard for me to put my eye mask on and I haven't learnt to sleep under my duvet yet due to the heat underneath (the CPAP mask is making that a possibility as an added benefit anyhow). ###Output :I don't think that there is a distinction between the SpO2 drops and the sleep awakening here. They aren't really separable since you are treating both.To whit, treating sleep apnea with oxygen supplementation isn't really effective at improving symptoms, and other causes of sleep disruption that don't cause intermittent low oxygen also result in cognitive dysfunction.I see that you are trying to separate these things out but no I don't think it is just that you are recovering from a hypoxic injury to the brain.


###Input :Right, so basically you're suggesting that the fact that I am noticing improvement despite feeling sleepy can be accounted for by my sleep deprivation being nonetheless less severe in comparison to before I got started on CPAP, even if I haven't been sleeping well for other reasons recently? That can make sense.Are Spo2 drops to the level that I described harmful to the brain? How about the effects of CO2 buildup itself (independent of the fact that it causes you to wake up periodically)? ###Output :Your respiratory drive is related to things other than just low oxygen levels. There is a pacemaker in your medulla that integrates a bunch of data, including carbon dioxide levels, strain, airway narrowing, lung expansion etc.For instance with OSA there are often respiratory effort-related arousals (RERAs) caused by partial airway obstruction. These increase the effort needed to take a breath, but do not cause hypoxemia. They do cause awakening because of the increased work of breathing and the muscle strain sends and alarm signal to higher centers involved in the sleep-wake cycle.So oxygen doesn't cure sleep apnea because this isn't the only reason that there are awakenings. In addition if there is complete airway obstruction then no amount of oxygen is going to help.


###Input :Is a full neuro-cognitive recovery guaranteed with full compliance with CPAP treatment? I am still finding it hard to focus and think and I've been dead tired today... I was in bed for more than 8 hours... The CPAP is working as intended because my AHIs have only been at around 1.2 on average since I got started on it. ###Output :We don't really deal in guarantees in medicine. Also I don't know if your symptoms are due to your sleep apnea. If they are then good recovery would be anticipated.


###Input :Well I guess I'm fucked judging by how it feels. I don't see how bouncing back is possible to be honest. If I would think about how I felt at the start of this I was certainly sharper than now so there has been a deterioration over the last 2 years. As far as I know intelligence is supposed to be quite intact/stable and if that has experienced a gradual decline then I would guess that full recovery is quite unlikely as well. I say this because if I would think about a topic that I know from experience wouldn't have difficulty thinking about before, my train of thoughts stop earlier than it previously does. ###Output :This kind of went from a question about sleep physiology to diagnosis of neurocognitive decline, for which I don't have any information to say that you are or are not "fucked", but would be very shocked if you had some sort of irreversible neurodegenerative disorder at age 24.I would continue to give the CPAP time - this is usually the most treatable thing and as you get more accustomed to it the benefit will increase. You had a one-day setback. Depression/anxiety are the other common causes of these symptoms in a young person.


###Input :Can chronic CPAP use reduce the natural respiratory strength or capacity?Age: 32 Sex: M Height: 510 ###Output :No


###Input :3 months sore throat. Urgent care seemed very concerned about oral cancer.https://imgur.com/a/m7onRtJThroat pictures.21 Male. 61 165 lbs. athlete and healthy most of life. Dont smoke and drink on any regular basis. Vaccinated for HPV.Ive had a sore throat for 3 months that began right after a fever but has stuck around. Symptoms include some difficulty swallowing time to time, lots of mucus every morning, and very occasionally pressure near ears, but I wear earplugs every night to sleep right next to train tracks.I visited 1 month into sore throat and was given antibiotics, didnt change anything after full course.Saw them again recently. Negative for all STDs, strep, mono, no growth on culture. Blood work normal as of 1 month ago.This time at urgent care the nurse seemed very concerned it could be oral cancer and urgently referred me to an ENT. Im waiting on that visit on the 28th of April and Im freaking out in the mean time.Thoughts? Thank you for your time. ###Output :Theres nothing in the images youve posted that appears cancerous.Follow-up with a primary care physician, or at least a midlevel PA/NP who have examined more than a few throats and knows what a normal pharynx looks like.Id probably try to treat your chronic sinusitis with daily flonase in each nostril and a daily allergy pill like zyrtec. Do that for at least a month. Considering you obviously have post-nasal drip, your chronic sinus congestion likely explains the daily morning mucus, sore throat, and ear pressure. And yes, this can cause symptoms that last for weeksespecially if you havent been treating the actual cause.The only person who throws out a diagnosis of cancer in a 21 year old for a sore throat that lasts for three weeks is someone who doesnt know what theyre doing.


###Input :What are your thoughts on possible differential of acid reflux (respiratory reflux, LPR)? ###Output :Possible, but sounds like OPs describing a lot of upper respiratory symptoms. And if youre in the northern hemisphere right now, its the start of spring allergy seasontheres a lot of people with chronic congestion/cough that lasts for weeks and is not infectious.I advise my patients frequently who start developing similar symptoms at the change of seasons to grab their antihistamine of choice along with a nasal steroid and use for at least 4-8 weeks.


###Input :Thank you. It has been 3 months however, not 3 weeks. I definitely agree and appreciate all the info. Im definitely considering acid reflux as a possibility too, though I dont have heart burn. I have been eating pretty late dinners and spicy foods lately. ###Output :Ok so what did the doctor say? Because it would be extremely weird for you to have throat cancer at your age.


###Input :Have yet to meet doc, it was a Nurse Practitioner that examined me. I agree. After I mentioned Id performed oral sex before symptoms, she suddenly became very alert and mentioned oral cancer and HPV multiple times. I told her I was vaccinated. She still seemed very concerned even after that. She definitely spiked my anxiety more than necessary. ###Output :HPV doesnt cause oral cancer in weeks or even months, but years and decades.


###Input :I had a bad experience during a procedure and want to make it right.56 yr old female with chronic pain. I had a knee RFA with a new doctor. My most recent previous ones were under deep sedation ( propofol, ketamine, midazolam) in a surgical center because of problems in the past with pain and panic attacks. When I went for the consultation I was told I would be completely sedated with propofol and would not be aware of anything. I asked for an injection of torodol after the procedure as this has what has worked wonderfully for my 3 previous RFAs to control post procedural pain ( I have had gastritis in the past so taking ibuprofen is a no-go for me). The PA said no problem. We discussed in detail previous bad experiences that has lead to a formal diagnosis of PTSD ( anesthesia that resulted in me being conscious of pain, but not being able to tell them to stop the procedure). She took notes and said " I will be fine". I am also diagnosed as immunocompromised with a primary IgA, IgG immunodeficiency. They were aware of this.When I got to the procedure they wouldn't let my husband wait with me. This has never happened before and I was not prepared. Then I was notified that I had to be awake for some nerve testing ( my previous 3 RFAs did not do this, I was out through the whole rhing). I asked if it would hurt. I was told there would be " tingling". Then I asked about the torodol injection and was told " we dont do that". Then they took me back and refused to put the nose canallula under my mask like the other times at the surgical center. I was caught off guard. They shamed me, they raised their voices at me, they made sarcastic jokes. At this point I almost left.I ended up going through with it as I felt trapped because I needed pain relief. The "tingling" was short term burst of pain at a level of 7 or 8 for two of the three nerves tested. I was completely unprepared. The last nerve was okay, just weird.My question is how do I make this never happens again? Why didn't they tell me ahead of time that I would be awake. Why did they say " tingling" instead of " maybe pain, it differs among patients". Why was I refused the torodol after being promised it? Why didn't they tell me about removing my mask at the consultation knowing I'm extremely high risk for all respiratory illness?I have lost trust in this provider and I'm supposed to have another different procedure in two weeks. Botox injections, where I just found out they won't let my husband be with me and I dont understand why. It's hard to find pain doctors and I dont want to change unless I absolutely have to. I just want to try to reestablish trust.Am I overreacting? Is it usual to not let a spouse be in pre-op and I've just been lucky in the past? I've already have had awful experiences in the past, which they know, and I felt trapped yet again. Im considering what to do with the scheduled botox injections as im not sure I can trust them without my spouse being there. I feel like they are going to spring something on me the last minute again when I'malone and vulnerable. Is there any advice you can give me to help me out so I can repair this relationship? I do see a psychiatrist and a therapist for the PTSD. Thank you. ###Output :Sorry you had to go through this.In regards to the Toradol, I understand why they didn't give you Toradol as if you have gastritis from ibuprofen Toradol is almost exactly the same thing which can cause gastritis so shouldn't be given.I've been at hospitals that allow family in the preop area, I've also been to hospitals that don't allow it. Especially after COVID the rules and policies have changed drastically.Some doctors will tell patients there might be some tingling or pressure or something without using the word pain because some people will actually cause themselves more pain by thinking and dwelling on it, a negative placebo effect. It's a personal practice type of thing.The best thing to prevent things like this happening again to be up front with all the staff you are interacting with about your previous experiences such as this. You can talk to the doctor directly and let him/her know about your negative experience as well.


###Input :Thanks for taking the time to respond. Your comment about torodol is interesting. My PCP, the previous anesthesiologist, my previous pain management doctors and the new PA all agreed I could have it, all knew my medical history. My PCP said it bypasses my stomach so it's safe. What in the world is going on here? I see your a pharmacist so I am now going to ask some more pointed questions from my providers. They nurse just said, " we don't do that here " when I asked for it, nothing about my specific history.I have a hard time believing not allowing my husband back with me was a COVID policy as they don't require masks on staff or patients at this practice. In fact the doctor gave me a snarky comment about me wearing one in pre-op. He said, " I should take some deep breaths if my mask will allow it".You may be right about them wanting to avoid a nocebo effect and so they underplay the pain component. I've had the same experience with previous doctors. I always thought consent was a big deal though and knowing what pain you may be in seems to be a part of giving, or not giving, consent for a procedure.I informed them of my negative experiences in detail in order to avoid all this, they knew. I guess I just have to decide if I want to use the mental energy to try again with them.Again, thank you for the response, much appreciated. ###Output :The stomach bypassing actually doesn't affect the mechanism of action that it works. The reason why NSAIDs like Toradol and Motrin cause issues with the stomach is due to the inhibition of COX-1 which happens whether it's taken orally or given IV/IM.


###Input :You literally just have to leave and reschedule if you dont feel heard. Its not worth the medical ptsd in my opinion . My rfa for my back I asked for sedation at the center they blew 4 veins and got blood all over, (which triggered my thoughts of cutting i suppress as much as possible), then told me I didnt need sedation anyways and told me my only other option was to leave if I didnt want to do it with nothing . Feeling trapped and not wanting to seem like a wimp I did it with no Iv line of any kind.Ive never heard of them having someone completely out where they cant test the nerve . You can ask for a medrol dosepak tho to help inflammation /post op pain or go into any urgent care for toradol . Ive done the urgent care option often .Sedation isnt used for like anything injection or nerve burning wise anymore and idk who got the idea to torture patients , cheap insurances not wanting to pay most likely, but it makes me sick . 15 years ago you got sedation even if you didnt want it. We were treated like humans . Oh what a time .Im sorry you experienced this. Therapy has helped me in dealing with some medical ptsd issues . At least the anger and feeling violated . ###Output :We dont sedate all the time because sedation has very high risks and can result in aspiration, inability to ventilate, and death. Sedation is taken very seriously and is a very high risk thing to do.


###Input :Any respiratory therapists or pulmonologists on here? I feel like I'm getting no support in weaning my 4 month daughter off her home oxygen and my anxiety is through the roof.4 month female15.5 lbsWhiteLow oxygen saturations is the main concernFlovent, bactrim, iron, vitamin d, recently discontinued diuril.My 4 month corrected has been off daytime for months, always 97 and above, usually 99 or 100.Nightime weaning has been more difficult because of her periodic breathing. Its usually the most extreme when she first falls asleep. She will go up and down from 97 to 89/88/87/86 sometimes low 80's every 10 seconds or so. Down 5 seconds, up 5 seconds. This happens over and over again for about an hour, then she comes out of it and sits at 97/95. Then she goes back into it, usually not dipping as low as the first cycle.The first time they tried to trial her off nighttime they told me to "watch her" the night before her appointment. I tried to get more info. When do I put the oxygen back on? What is concerning? "Just watch her". So I stayed up as late as I could and tried to peek intermittently. Lowest I saw was 89. This didn't seem like the most accurate sleep study but whatever. She had been tearing out her oxygen every single night at this point for weeks. After me relaying what sats I saw, they decided to wean the diurul first, then check back in in Feb.I reached out this past week because its been impossible to keep her oxygen in. I'm using the works, the strongest adhesives, using mittens, socks, swaddles, and she still manages to get it out. She's also started trying to eat her tegaderm and I am certain she ate some at least one night. And a really problematic rash has been developing on her cheeks from the duoderm. I decided to leave her oxygen out since last week after the tape eating incident and to give her cheeks a chance to heal. I let her NP and NEO follow up know and they are in agreement that we should just leave it out indefinitely and "see what she does". But what does that mean exactly! Shes definitely going lower than usual the past couple of days, as low as 83 so far.TLDR: WHEN DO I PUT THE OXYGEN BACK ON WHAT IS SAFE/NOT SAFE. I have asked her NP time and time over what her parameters are and she never gives me a straight answer. I understand that dips to 80s are fine. But how many? She cycles like this for at least an hour every night, probably a total of 2 or 3 hours. Are these dips cumulatively an issue? We've never gotten an alarm when her oxygen is out (alarms at below 90 for longer than 10 seconds). Should I just based my concern off of that? I have to go back to work in a couple of weeks and will no longer have time to stay up late watching her monitor and watching her naps. ###Output :How are you positioning the NC? Dont tighten it under her chin like an adult would wear it, instead put the prongs in the nose, and adhere the cannula up by her eyes - not level with her nostrils, keeping it up higher will hopefully reduce them coming out, then tighten the cannula up by the top of her head.Tegaderm is pretty weak, I place douderm down on the skin, place the cannula on top, then secure with 3M multipore tape. Taping the cannula to the douderm not to the skin, that way if it is tore off, the skin isnt being torn. Hope this helps.


###Input :Im doing all of the above but will look into the 3M tape, thank you! ###Output :Hey there. Patience is key. Helping your 27 weeker who needs home oxygen is a marathon, not a sprint. The impact of BPD/CLD is going to take a while for her lungs to get to the point where she can be off oxygen entirely, and will affect her lungs for the rest of her childhood and to some degree her entire adult life.That being said, trust what your team is saying here. The alarm parameters are perfectly fine as a level for concern. In the NICU, we would only care about desats longer than 10-15 seconds; momentary dips are much more likely to mean nothing. If your team thinks shes ready for room air overnight, particularly given her vigorous attempts to pull the cannula off, I think thats a good sign.Let her alarm do the work. You shouldnt have to be staying up next to her like this. The alarm can tell you when shes going longer than 10 seconds in the 80s. These short blips dont matter as much. If it alarms, just keep track of how many alarms overnight youre having, how long, and the low number reached during the desat. The monitor should be tracking this for you.Its okay. You are doing so much hard work for your daughter right now and are asking a lot of really important questions about how to give her the best treatment and recovery; that shows me that you are taking great care of her. Just keep talking with your team and dont be afraid to ask to speak with them in between appointments if you feel like things are changing.


###Input :Opinions on posterior tracheopexy for 2.5yr old?My son, 2.5yr old male, 32lbs has severe tracheobronchomalacia and moderate bronchomalacia and a type 1 laryngeal cleft. The bronchomalacia goes deep into the bronchi. Hes had multiple hospitalizations and 2 PICU stays. Most recent in December. His sleep studies always come back as mildly failed. His baseline o2 overnight is 94 with multiple dips into the 70-80s when healthy. Im in Canada and our doctors feel that surgery is too aggressive since he is generally healthy but struggles with respiratory viruses. They also feel that because the bronchomalacia goes deep into the bronchi it cannot be fixed and therefore correcting the tracheomalacia may not do much and they cant correct the bronchomalacia. Doctors at John Hopkins in Florida feel he is possibly a good candidate for the tracheopexy and would like to see him and run tests however that would be all out of pocket (5-10k$ for tests, 100k$ for surgery). When he is sick, his overnight o2 stays in the 80s. I dont even bring him to the ER anymore because often hes fine otherwise. He may sleep more. When he gets lethargic is when I go in now. Doctors here say he will get stronger as he grows. He sleeps around 15hts per day and does get winded easily. Ive pulled him out of daycare as the risk is just too great to his health. Sorry this is all over the place. Opinions? ###Output :My opinion is 100k is a truck load of money when you have a team of doctors telling you it isnt necessary. But my other opinion is multiple 02 dips to the 70s isnt great. Have you tried anything less drastic like home oxygen? I would want to even ask about cpap before pursuing a surgery OOP your doctors dont think you need.


###Input :Freaking out about my echo results. PLEASE advise.27f 5'3" 280lbsPLEASE can someone look over my echo results and tell me if there is anything alarming? I am so scared.. (Yes, I have called my cardiologist who is out until Thursday and I truly cannot wait that long)Left Ventricle:The left ventricular chamber size is normal. There is no leftventricular hypertrophy. Global left ventricular wall motion andcontractility are within normal limits. The estimated ejection fractionis 55-60%. Normal left ventricular diastolic filling is observed.Left Atrium:The left atrial chamber size is normal.Right Ventricle:The right ventricular cavity size is normal. The right ventricularglobal systolic function is normal. TAPSE measures 2.2cm.Right Atrium:The right atrial cavity size is normal. The interatrial septum is notwell seen.Aortic Valve:The aortic valve is trileaflet. There is no evidence of aorticregurgitation. There is no evidence of aortic stenosis.Mitral Valve:The mitral valve leaflets appear normal. There is no evidence of mitralregurgitation.Tricuspid Valve:The tricuspid valve leaflets are normal. There is trivial tricuspidregurgitation. Unable to estimate the right ventricular systolicpressure due to incomplete spectral Doppler waveform.Pulmonic Valve:The pulmonic valve appears normal. There is trace pulmonicregurgitation.Pericardium:There is no pericardial effusion.Aorta:There is no dilatation of the ascending aorta. There is no dilatation ofthe aortic root.Venous:The inferior vena cava was not well visualized; unable to accuratelyevaluate size and respiratory change.______________________________________________________________________MeasurementsName Value Normal RangeIVSd (2D) 0.93 cm -IVSs (2D) 1.19 cm -IVS % thickening (2D) 28 % -LVPWd (2D) 0.98 cm -LVPWs (2D) 1.46 cm -LVPW % thickening (2D) 49 % -IVS:LVPW ratio (2D) 0.95 ratio -LVIDd (2D) 4.21 cm -LVIDs (2D) 2.86 cm -LV FS (Teichholz) (2D) 32.1 % -LV FS (cube) (2D) 32.1 % -EF Teichholz (2D) 60.6 % -Ao root diameter (2D) 2.84 cm -LA dimension (AP) 2D 2.47 cm -LA:Ao ratio (2D) 0.87 ratio -Name Value Normal RangeLA ESV SP 4CH (MOD) 44.1 ml -LA ESV SP 2CH (MOD) 38.7 ml -LA ESV BP (MOD) 42.7 ml -LA ESV BP (MOD) index 22.1 ml/m2 -LV EDV SP 4CH (MOD) 93.7 ml -LV ESV SP 4CH (MOD) 32.5 ml -EF SP 4CH (MOD) 65.4 % -LV EDV SP 2CH (MOD) 66.8 ml -LV ESV SP 2CH (MOD) 30.2 ml -EF SP 2CH (MOD) 54.8 % -LV EDV BP 81.9 ml -LV ESV BP 31.9 ml -BP EF (MOD) 61.1 % -Name Value Normal RangeMV E-wave Vmax 0.91 m/sec -MV deceleration time 185 msec -MV A-wave Vmax 0.76 m/sec -MV E:A ratio 1.2 ratio -LV E:e' septal ratio 9.1 ratio -LV E:e' lateral ratio 7.6 ratio -Name Value Normal RangeAV Vmax 1.26 m/sec -AV VTI 24.25 cm -AV peak gradient 6 mmHg -AV mean gradient 4 mmHg -LVOT diameter 1.91 cm -LVOT Vmax 0.92 m/sec -LVOT VTI 17.68 cm -LVOT peak gradient 3 mmHg -LVOT mean gradient 2 mmHg -SV LVOT 51 ml -AVA (continuity Vmax) 2.1 cm2 -AVA (continuity VTI) 2.09 cm2 -Ascending Ao 2.86 cm -Name Value Normal RangeMV PHT 54 msec -MVA (PHT) 4.07 cm2 -Name Value Normal RangeTAPSE 2.2 cm -Name Value Normal RangePV Vmax 0.87 m/sec -PV peak gradient 3 mmHg -RVOT Vmax 0.63 m/sec -RVOT VTI 10.41 cm -RVOT peak gradient 2 mmHg -FindingsLeft Ventricle:The estimated ejection fraction is 55-60%.Thank you so much! ###Output :This looks like an extremely normal echocardiogram. Like boring normal, nothing interesting or remarkable at all.The regurgitation is described as trivial and trace, which is like saying I saw it so I gotta document it, but its clinically meaningless.


###Input :8 year old F, 4'1" - Undiagnosed Condition / Continued dry cough - 2.5 years ongoingMedicines: Zyrtec (Switched from Claritin recently due to no positive response), Albuterol, Symbicort 160, pre+probiotic, antacid, - Has had adnoidectomy 2 months ago.My daughter has been going through an extremely long period of troubleshooting and we're still not at the end. What started out as a chronic cough and getting fevers and flu like symptoms were passed off as Covid towards the end of 2020.Then as the months went by it was passed off that she was getting sick at school. Various antibiotics and not getting better.Then in mid 2021 it was passed off as chronic sinusitus and told to use saline solution and more antibiotics.Then a few months later it was allergies and to take Claritin.Then after seeing the allergist it was Asthma because after 60pt test she's not allergic to anything but clearly decrease in breathing capacity so Albuterol.After seeing the cardiologist it was lower respiratory and take Symbicort with Claritin and Albuterol.After seeing ENT it was adnoids. After adnoidectomy she is to keep taking all of the above as well.Here we are two months later my daughter is home from school coughing just as she did two years ago. I have given her antacids and childrens pepto, along with pre+probiotics (largely because of the antibiotics) including all of the above mentioned medicine, and while she's no longer getting the flu-like symptoms she coughs so much she doesn't even realize she's doing it anymore. I don't know what's next. All ideas are welcome. ###Output :Have you seen a pulmonologist? Or was that wrapped in with the allergist?One consideration would be tic cough or somatic cough disorder which would require behavioral therapy. I would especially think about this as you say she doesn't even realize she's coughing. Usually chronic cough is very noticeable to the child. Is she up all night coughing?


###Input :1: It really seems like he should have been diagnosed and started treatment for MDS after the bone marrow biopsy/aspiration in July 2021, not 11 months later given the fact he has tried so many therapies for ITP with no response. It also notes that patients "typically have mild-moderate thrombocytopenia." He has always been below 50K, surely that's not moderate?What is your opinion on his history/diagnosis?2: I believe the nurses screwed up with premedicating him for his tranfusions during his last hospital visit. He had negative reactions on the two days I know they deviated from what is clearly on his chart AND on the request from his hematologist/oncologist which tells them what medication he needs when. Then, units aren't even ordered for the following two days, a man who is recorded as transfusion-dependent in his chart. Prior to his hospital visit, the premeds were followed almost exactly with no negative reaction, and after noticing his head bleed, the nurse followed the premeds exactly with no negative reaction. I am going off of his medical history acquired from the hospital which notes exactly when the medication is administered (not being confused with when they charted it). His cause of death is noted as acute respiratory failure due to PNA, but its only because we took him off the oxygen due to the head bleed which I believe they caused.Am I looking at this wrong? Did they mess up?THANK YOUI know, it's a long one. I really appreciate it if you took the time to read through it and give your thoughts and opinions.I know he had a rough disease, and I believe I could accept his death, but something in these hospital notes stinks... ###Output :Having treated many patients like this, these cases are often very difficult to manage. They sent off clonal hematopoiesis of indeterminate potential (CHIP) which is helpful in identifying mutations that may be causing cell abnormalities in MDS and sometimes garners targetable mutations eg IGH, del5q, ringed sideroblasts. However many of these we do not have detailed data given rarity so their effects on treatment are still unclear. In February 2023, that loss of chromosome 7 confers a very very poor prognosis along with refractory thrombocytopenia. I believe getting palliative care involved at this point may have been warranted. I do not believe any treatment wouldve changed his course by this time.I dont think a mistake was made by not treating him since signs of transformation to AML were not evident on the marrow from 2021. A score we use to predict transformation would also predict that prognosis was good with low chance of AML transformation in the next 10 yrs. Your father also has an extensive cardiac history and the drugs we use to treat MDS to AML have significant side effects including heart failure which Ive seen happen before from anthracycline. He had too many comorbidities so Vidaza was appropriate when it was given which is used to treat AML. Wed classify him as medically unfit but not frail and these patients are typically very hard to treat. Patients also become refractory to transfusions over time because their body starts making antibodies towards platelets. I do not think the mix up with premeds made a difference.Watching a loved one die from a hematologic malignancy is not easy, especially MDS. Please make sure you take care of yourself as well. I am very sorry for your loss. You did the right thing letting him go like you did. There was no meaningful way out of his situation where he would go on living a quality life. Please know that his medical team did everything they could.