diff --git "a/icliniqQAs_alpaca.json" "b/icliniqQAs_alpaca.json"
new file mode 100644--- /dev/null
+++ "b/icliniqQAs_alpaca.json"
@@ -0,0 +1 @@
+[[{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is it fine to exercise with knee pain?"}, {"role": "assistant", "text": "from your description it appears that you may have anterior knee pain which sometimes presents as pain at the back of the knee. the second possibility is that you have over done your exercise and hamstrings are sore and the lower end of the knee cap is inflamed. either way you should rest and ice the area of pain and give it time. i suggest you add nsaids (nonsteroidal anti-inflammatory drugs) for a week for an additional anti-inflammatory action. for further information consult an orthopaedician and traumatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "suffering from anxiety restlessness and taking clonazepam & mirtazapine. i had depression & panic attacks for the last 7 years. need a second opinion."}, {"role": "assistant", "text": "depression anxiety restlessness and panic attacks are best respond to a combination of a selective serotonin reuptake inhibitors (ssris) and benzodiazepines. mirtazapine is not the most efficient ant depressant and it is not a true ssri as fluoxetine paroxetine citalopram and sertraline are. i recommend 20 to 40mg of paroxetine (slowly titrated up from 10mg) and 1mg of either clonazepam or ativan (lorazepam) every 8 hours as needed for anxiety. glaucoma precludes use of any anticholinergics such as hydroxyzine or benadryl (diphenhydramine). ssris are also at times likely to make glaucoma worse but a preliminary trial is always worth it. revert back to a psychiatrist online for further help --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can a thyroid patient eat soybean and fenugreek?"}, {"role": "assistant", "text": "patients with hypothyroidism usually gain weight. your issue is weight loss which is seen in hyperthyroidism. as your thyroid tsh is in the normal range you can continue the same treatment. for gaining weight you need to take food which is adequate that is it should be rich in calorie and protein like eggs and green vegetables. kindly manage to take appropriate calories for your age and then have some physical activity so that it will increase your weight. for further information consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am not getting my periods after taking fenugreek seeds. why?"}, {"role": "assistant", "text": "fenugreek seed cannot affect your fertility do not worry. a delayed period could be because of stress or hormonal imbalance so please get a urine pregnancy test to rule out pregnancy first. for further queries consult an infertility specialist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "kindly suggest me a therapy to overcome heat allergy."}, {"role": "assistant", "text": "your problem is a characteristic of cholinergic urticaria. it is a type of urticaria where patients are allergic to their own sweat. so whenever a patient sweats for example due to heat sun stress exercise. etc. the patient develops hives. levocetirizine can suppress the problem till you take it. once you stop taking it your problem will recur. the management actually depends on you. if you are fine taking cetirizine daily then no harm or else you can go for biological treatment which is a new form of treatment. it can permanently cure the problem and you may no longer require cetirizine. they are very safe with almost no side effect. for further information contact a dermatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can taking multiple antibiotics cause redness and dryness of vagina?"}, {"role": "assistant", "text": "how are you doing? sorry to hear what you have been through. i feel you are having an imbalance in the normal and abnormal organism growth. for a normal vagina you need both normal and abnormal organisms. when you take too many antibiotics one after other it kills most of the abnormal organisms so the balance is shifted and you get symptoms. now let me give you a list of things you can do: if sexually active abstinence at least till you are fully better. also have your partner checked. check his urine and semen for any significant infection. have a urine culture and sensitivity if there is any sterile pyuria that is pus cells without any growth have only the sensitive antibiotics for the minimum duration. get a vaginal swab for culture and sensitivity. antifungals and antibiotics can be used if needed. get your blood sugars and thyroid profile checked. avoid vaginal douches. use bland or inert vaginal washes just to wash the exterior. and no need to use an unnecessary vaginal suppository. keep the perineal and vaginal area as dry as possible. avoid synthetic undergarments as they hold water for long use cotton ones. do not use any undergarment at night. keep taking probiotics. your bmi (basal mass index) is in the lower limit. so have a lot of fruits vegetables juices curd milk egg white high-protein and low-fat diet. take a lot of citrus fruits as this improves your resistance and immunity. avoid any local cosmetics or new washing powder. hope i have been of help to you do write back. all the best. for further queries consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "other than baclofen which medicine can be used for muscle stiffness?"}, {"role": "assistant", "text": "thank you for the detailed information. i am happy to see your father improve gradually. here is what i suggest. there is no other medicine for stiffness. however physiotherapy should be carried out aggressively to prevent worsening of stiffness. one should rule out infection of the bed sore. if there is infection antibiotics are needed and rarely surgical debridement might be indicated. if there is no infection you can also apply phenytoin powder on the bed sore. the powder helps to hasten the healing process. i do see that there are chances of improvement. but i believe that he will not be able to do his daily activities independently and will remain dependent on others. in the latest scan i see that there is hydrocephalus also called post traumatic hydrocephalus. if the craniotomy flap is tense and there is increase in the water content in the brain he will benefit from ventriculoperitoneal shunt surgery to relieve the water accumulation in the brain. this surgery can be done by the same neurosurgeon who performed the first surgery. i cannot comment whether he will be able to speak or not. all i can say is that he might improve in his sensorium (consciousness) some more. for further information consult a neurosurgeon online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my fiance is having diabetes type 2. will she face any problem during pregnancy?"}, {"role": "assistant", "text": "i read through your query and understood your concern. she can take progesterone tablets (medroxyprogesterone 10mg twice daily) to postpone her period. these tablets may increase the requirement of antidiabetic medicines (tablets/insulin). so she needs to monitor her blood sugar level (at least two/three times during the period she is taking tablets) to make sure that sugar control is fine. contraceptive pills used nowadays are low dose pills and have little/no impact on diabetes. even if sugar levels increase it can be treated by increasing the dose of antidiabetic medicines. so she can use low dose contraceptive pills. just consult your physician once before starting those pills to make sure that the medicines do not interact with each other. during pregnancy - if her sugar control is fine from 3 months before pregnancy during pregnancy and till delivery of baby there will practically be no problem to the mother and baby. if sugar control is not good there may be many problems about which there is no need to worry right now. revert back to a gynaecologist online for further queries --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "one of the hairs in eyebrow has changed to blond. is that normal?"}, {"role": "assistant", "text": "in your paternal family is there any history or case of vitiligo in which a person develop white patches or graying of hairs? right now i can say that you can get it trimmed for now. if there is a genetic history of vitiligo in your family then there can be many chances for you to develope such thing and do notice it next time on all your hair growing area. for now you can take tablet follihair (biotin) multivitamin tablet take it once in a day for one month and get your cbc (complete blood count) done. for further information consult a hair transplant surgeon online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my son has severe constipation after taking paxil. please help."}, {"role": "assistant", "text": "i can understand your concern regarding your son's gastric problem after taking paxil (paroxetine) as it is a drug of ssri (selective serotonin reuptake inhibitors) group which is known to cause constipation in children. i suggest to prevent constipation after consulting your specialist doctor you reduce paxil dose up to a half tablet and gradually increase it up to an effective optimal dose. give high fiber diet increase water intake and encourage him for mild to moderate exercise. do not worry as these symptoms are temporary and are resolved with time. for further queries consult a psychiatrist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "why is my son having continuous chest congestion?"}, {"role": "assistant", "text": "first off all i would suggest you to carry out chest x-ray and complete blood count to rule out lung infection like bronchitis. foracort is a combination of budesonide a corticosteroid and anti-inflammatory and formoterol a long-acting bronchodilator used to control his symptoms and improve lung function. this drug will not affect his immunity. it is most probably only due to allergy that is triggering his symptoms. common allergens could be dust pollution in metro hairs of house pets cold etc. yes you are right as your son will grow his body will tolerate better. the best supplements to boost your child\u2019s immune system are vitamin d and zinc. the herbs elderberry (sambucus) and astragalus are best for recurrent respiratory tract infections. for allergies fish oil vitamin c and nettles are good. revert back after the tests to an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can essential tremor get transferred genetically?"}, {"role": "assistant", "text": "i have read your question with care and understand your doubts regarding essential tremors. if not treated the person will not be able to do or will do with much difficulty works involving fingers like writing mixing food button shirts etc. activities which require co-ordinated movements of the fingers will be affected. essential tremors can be due to various reasons and a few of these reasons are transmitted genetically. a few are acquired. even among the ones which are transmitted genetically it can be ad ar xd xr that is autosomal dominant autosomal resistant x-linked dominant and x-linked resistant respectively. so unless we know the exact cause of this tremor we cannot answer about genetic transmission. without knowing the exact cause the answer for this question is 0 to 100 (0 for acquired and 100 for ad). the cure of essential tremor depends on the cause. a few causes can be cured completely a few causes can be controlled and a few cannot be cured at all. again the link with other illness and disorders depends on the cause of the tremor. coming to this particular patient who has this when going to new places or during anxiety this tremors can be controlled with proper medication. you have to consult a neurosurgeon who has had experience in successfully treating such patients for physical evaluation. for further information consult a neuro surgeon online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "on application of selsun blue shampoo my cheek turned white. please help."}, {"role": "assistant", "text": "what do you mean by white patches? was it diagnosed as pityriasis versicolor or vitiligo? please send images. what medications have you used till now? revert back with the answers to the above questions to a dermatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "does the absence of the white half moon on nails indicate a thyroid problem?"}, {"role": "assistant", "text": "the absence of the white half moon also called as lunula is not uncommon and may be a normal variant and there is no need to worry about it. i guess rest of your nail is normal. however it can be associated with low hemoglobin and inadequate diet. treatment is not needed for this condition but underlying condition needs to be treated. there is no direct relation with thyroid disease but you can get yourself tested if you are having symptoms like lethargy constipation weight gain etc. you should also get your hemoglobin tested. focus on a balanced diet with green leafy vegetables fruits etc. hope this helps you and get back if you have any doubts. for further queries consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "why do i feel weak while sitting and working?"}, {"role": "assistant", "text": "there are various causes like thyroid problems anemia vitamin deficiency especially vitamin d and even psychological issues which are the most common. you should get hemoglobin levels thyroid function test and vitamin d levels checked. i suggest you try doing the following: try taking multivitamin supplements like syrup zincovit or a to z two teaspoons once a day for 3 to 4 weeks. replace tea with coffee and have two to three times a day especially before some important work which will provide adequate interest and stimulation. regular exercises or sports will be helpful. gradually taper off addictions if any. you will probably need vitamin d supplements after the test. try doing yoga in the morning. do you have any psychological issues like stress or depressive? if yes then you need to consult a psychiatrist. revert with more information to a general medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is leucoderma curable?"}, {"role": "assistant", "text": "with your descriptions it seems that you are having focal vitiligo or chemical leucoderma due to footwear. it is primarily an autoimmune disease with a familial predisposition presented with chalky white or milky white in appearance. other autoimmune diseases may be associated like pernicious anemia diabetes alopecia areata (patchy hair loss) and thyroid disorder. so you need to do blood sugar t3 t4 and tsh (thyroid stimulating hormone). i suggest ointment tacrolimus 0. 1% during night hours and mometasone 0. 1% cream in the daytime for six months or may be more depending on your response to the treatment. revert back after a month to a dermatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to control premature ejaculation?"}, {"role": "assistant", "text": "i have read and understood your problem. premature ejaculation is very common problem and is usually not associated with any disease. but may be due to anxiety and sometimes however may be problem with prostate gland and thyroid hormone. you can learn to control premature ejaculation by doing this exercise. pull your muscles that you pull at the end of urination for few seconds then release repeat this several times daily. another is stop-start technique: when you feel that you are going to ejaculate stop the sexual stimulation and divert your mind the penis will relax. after sometime start the stimulation again and repeat the procedure. over few months you will gradually increase your ejaculation time. most often it is a chronic problem; you have to take medicines in between and period off medicine. you can apply lignocaine gel to head of penis 10 minutes before sex and wipe it off before starting sex. usually medicines like dapoxetine 60 mg are given two to three hours before sex but you have to get a prescription from your doctor. best wishes. for further information consult a sexologist online --><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can psychiatric drugs induce constipation?"}, {"role": "assistant", "text": "for motion formation one needs to take at least 1 to 1/2 liters of liquid in a day and eat lot of vegetables and fruits. psychiatric drugs and antibiotics can induce constipation. we need to enhance gut motility and bulk the motion. please try the following combo to get rid of constipation: pegred or pegmove (polyethylene glycol) three scoops with a glass water. lactihep (lactitol) four teaspoons at bed time. velgut (probiotics) morning and night half an hour after food. albol or bendex 400 (albendazole) one tablet chew at bed time. for further information consult a medical gastroenterologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to treat premature ejaculation through ayurveda?"}, {"role": "assistant", "text": "you need to improve your stamina first to have a better sex life. eat healthy nutritious food like almonds dates milk fruits and sprouts. do workout for 45 minutes daily to improve stamina. ashwagandha rasayana - this is an excellent ayurveda medicine for stamina improvement. take one teaspoon of this medicine twice daily before food. shilajitwadi lauha vati - this helps to treat premature ejaculation. take one tablet twice daily after food. take them for two months and consult again for a follow up. revert back after two months to an ayurveda specialist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have thyroid problem my hr and bp fluctuates often. why?"}, {"role": "assistant", "text": "as seen in your brief history there are some fluctuations in your blood pressure as well as heart rate. i would advise you to get an ecg done as soon as possible as we have to see what sort of heart rhythm are you on. the doctor who has suggested you propranolol must have done your ecg. so if it is a sinus rhythm (normal fluctuating rhythm) then it is not much to worry about. but if it is some sort of abnormal rhythm (arrhythmia) then it has to be taken care of. secondly propranolol 20 mg thrice a day is quite a heavy dose. propranolol 10 mg twice a day should be started and should be increased every week if required. if you are having chest discomfort after having propranolol then just drop the medication for this morning and noon and see if you are normal. as of now i would like to have a detailed history of you as cardiology suggestion can only be given after taking a detailed history. what is your age? is there any history of early onset of cardiac disease in your family? from how long are you hypertensive? are you an anxious personality? how is your sleep? do you have heartburn or gastritis or or flatulence very often? please explain your lifestyle? do you smoke or drink alcohol? do you have any history of arrhythmias in the family? was propranolol advised by your gp or cardiologist? revert back with the answers to the above questions to a cardiologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to cure premature ejaculation?"}, {"role": "assistant", "text": "as you know that the first thing in medicine is establishing a diagnosis which is correct. so i would like to ask you a few questions. did you consult a psychiatrist before this consultation for your problem? since when have you been married? was this problem since marriage? or there was a time of normality between marriage and start of this problem? if there was a time of normality then what was its duration? is erection proper? what is the frequency of intercourse? do you have this problem of premature ejaculation every time you do sexual intercourse? do you suffer from any medical or psychiatric problem? if yes then what and since when? are there any medications which you are taking? if yes what and since when? what is the approximate time you take to ejaculate after penetration? do you feel tense or anxious during sexual intercourse? how is your general health and nutritional status? are you addicted to any substances? do you have any family history of medical or psychiatric problem? revert back with the answers for the above questions to a sexologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to overcome premature ejaculation?"}, {"role": "assistant", "text": "please answer few questions. how long it has been there? let me know your complete sexual history. since when are you sexually active? and number of partners? what is your masturbation history? do you suffer from any systemic illness such as diabetes and hypertension? for further information consult a sexologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is my premature ejaculation due to fear or a lifelong problem?"}, {"role": "assistant", "text": "i read your query and understand your concerns. from the available description it appears that there is a psychogenic premature ejaculation. holding it for 30 minutes while having oral sex and not holding even for a few minutes during penetrative sex is clearly indicative of psychological premature ejaculation. there is no indication that you have a lifelong premature ejaculation. it is definitely treatable either with medication or psychotherapy. i understand your fear about medication but there is no indication that it causes decrease in sex drive. in regard to other methods of treatment kegel exercise has the most value. through kegel exercise try to hold ejaculation up to 15 seconds initially and increase by 1 or 2 seconds per day. the results may take time but there will be a definite improvement. for further doubts consult an andrologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to overcome premature ejaculation using ayurvedic medicines?"}, {"role": "assistant", "text": "the best medicine for premature ejaculation is regular intercourse with shortened period of foreplay. also avoid long gaps between coitus (sexual intercourse). we never suggest any type of spray lotion or oil application during intercourse because it might harm your genital organ. ayurvedic oral medicines may be taken. capsule stresscom 2 capsules to be taken twice daily with milk in the initial phase. for severe and chronic cases other medicines are added depending upon the condition. consult an ayurveda specialist online to assess your condition --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "suffering from premature ejaculation. i ejaculate faster and the sperm comes out quickly."}, {"role": "assistant", "text": "you are suffering premature ejaculation. it is not a disease only a complaint. it may be due to stress fear poor sleep smoking etc. you can take the capsule lvate at 7. 30 pm daily for three months. it works gradually and has excellent result without side effects. follow up with a sexologist online after three months --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am facing premature ejaculation. how do i overcome it?"}, {"role": "assistant", "text": "i completely emphasize with you. the problem of premature ejaculation is quite common and is distressing to a young man but is seldom discussed. see most of the time the problem is secondary to the anxiety attached to your expectations in the bed. it has been wrongly projected by unscientific magazine articles and porn that a man can last for 30 minutes or more. honestly most of the male ejaculate before 5 minutes. when you are anxious about not lasting long in bed you actually do not enjoy the act of intercourse and keep on thinking about prolonging the act without enjoying it. the preoccupation and anxiety about not lasting enough in fact cause hyperarousal and lead to premature ejaculation. moreover when the male start to thrust himself into the partner the moment he undress leads to early termination of coital act (the sexual union that takes place between male and female during insertion of penis into the vagina). there are also lots of young man who are suffering from premature ejaculation without any associated anxiety or apprehension. such men as well as you may benefit by taking oral medication like tablet dapoxetine or paroxetine before sexual act. but in your case i would like to suggest relaxation techniques like breathing exercises and progressive muscular relaxation. regarding your problem pertaining to non-retractable foreskin my opinion is that you must consult a surgeon. it is always better to remove foreskin if it is causing inflammation or itchiness. non-retractable foreskin is often associated with problems of genital hygiene that may subsequently lead to chronic infections. so make an appointment with a general surgeon. for further queries consult a sexologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "does thyroid problem delay pregnancy?"}, {"role": "assistant", "text": "i suggest you follow the same dose as you are not a hyperthyroid yet. also if you are planning for your marriage and pregnancy then this tsh value is normal. if the tsh (thyroid stimulating hormone) value is less than 0. 3 u/ml then the dosage of tablet has to be reduced. for further information consult an endocrinologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "why is the tip of my penis turning white?"}, {"role": "assistant", "text": "please send me an image. it might be vitiligo or balanitis xerotica obliterans. revert with more information to a urologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to correct premature ejaculation and nonretractable foreskin?"}, {"role": "assistant", "text": "i read your query and understood your concern. the condition that you described is known as acquired phimosis. is the surface of your foreskin healthy? or is there some erosion itching or ulcer? and since how long have you had it? if the superficial skin is normal the best option would be to consider circumcision. else if it has any signs and symptoms we can treat it accordingly and this might improve the condition. regarding premature ejaculation that you talked about can you tell me the average time of ejaculation? is the time based on copulation or masturbation? revert back with the answers for the above questions to a sexologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "thyroid problem. taking homeopathy medicines. female 42 5 feet. what should she do"}, {"role": "assistant", "text": "i fully appreciate your concerns. you have not mentioned whether thyroid is underworking or overworking. thyroid gland produces thyroid hormone. thyroid hormone deficiency occurs if thyroid gland is underactive (hypothyroidism). under these circumstances the patient needs daily dose of thyroid hormone supplementation. no other treatment is required. if thyroid gland is hyperactive (hyperthyroidism) medicines to curb hyperactivity are given. i will be able to give helpful advice if you send me thyroid hormone levels estimation if done. i personally feel that homeopathic treatment will not help. i am sure that you will benefit from the advice. please feel free to revert back to an endocrinologist online for further clarifications --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can thyroid problem be the reason for stress and anxiety?"}, {"role": "assistant", "text": "though your tsh (thyroid-stimulating hormone) is raised it does not require treatment with thyroxine but needs monitoring. follow steps of sleep hygiene such as sleeping and waking up at regular time avoiding caffeinated drinks at least 8 hours before sleep avoid using television mobile laptop etc. half an hour before sleep instead do relaxing activities like taking a hot shower etc. practice relaxation techniques like breath relaxation exercise daily. maintain a journal and log down any distressing thought on it. if these methods do not help then consult a psychiatrist either on this platform or nearby for detailed evaluation and treatment. for further information consult a psychiatrist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "kindly suggest a solution for my son's continuous fever."}, {"role": "assistant", "text": "it would be helpful if you do a cbc (complete blood count) and crp (c-reactive protein). from that we can understand the level of infection. also tonsillitis can also be so severe that it may last for up to 10 days. betadine gargle three times a day with warm water for three days are advisable as it acts locally on the throat. for further information consult a child health specialist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i suffer from premature ejaculation and poor erection. i have tried herbal/ayurveda products with no results at all. please help."}, {"role": "assistant", "text": "i read your query and understand the concern expressed by you. in regard to the current medication i would like to inform you that parocen cr is one option for premature ejaculation but does not have any effect on weak erection. it can be said that in last three years a new molecule is approved for the treatment of premature ejaculation which is equally effective and do not have common side effects encountered with parocen cr or other drugs which were in use three years back. i am not sure why your doctor prescribed you nano leo as it has minimal effect on erection. it is used for increasing testosterone level which has more effect on desire rather than erection. as you informed that you do not have any problem with desire the possibility of using nano leo is ruled out. regarding the viagra it has definite effect on erection and there is no doubt that it can be effective in your case. having said this i would like to know what was your initial problem premature ejaculation or weak erection? i commonly observed that people with erection problem try to rush the sexual intercourse because of fear that they will not able to maintain the erection for sufficient time. this kind of rushing develops artificial premature ejaculation. i need to inform you that if you developed your premature ejaculation in response to erection problem then there is need to treat only erection problem. as the cause suggests with treatment of erection problem the premature ejaculation will be treated automatically. in case you feel that both the problems are independent then there is need to address both issues simultaneously for correction of the problem. before we move to treatment part of the problem we need to identify the possible cause of the problem. i request you to post following details in the follow up query so that the cause of problem can be determined and so the treatment. 1. what do you mean by weak erections and premature ejaculation? describe what you think in detail. 2. how did the problem start whether it was of acute onset or was it on and off initially? 3. progress of the problem in the last six months. 4. duration of sexual activity - both maximum and minimum duration in last one year. 3. frequency of the problem in a week or in a month. 4. what are the factors that increase the problem in bedroom. 5. factors that relieve the problem - thoughts situations partner place etc. 6. do you get early morning or night erections? 7. if yes how frequent? 8. your marital status and partner details. 9. effect on your marriage or relationship so far. 10. details of any other medical illnesses. 11. medications you are receiving currently. 12. medications which you tried till date and their results. 13. any investigations done so far and if yes details of the same. as you know erectile dysfunction is a complex disorder it needs thorough evaluation for treatment. revert back to a sexologist online for further follow up --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my daughter has cough. shall i give her dexona?"}, {"role": "assistant", "text": "please do cbc (complete blood count) and a chest x-ray before starting dexona (dexamethasone) as it is a steroid. also there may be a history of childhood asthma (hyper-reactive airway disease) and it is better to be sure before giving this medicine. this mostly looks like hyper-reactive airway disease for which the initial treatment is a common cough and cold medicines. if this does not reduce then you should add dexona or even better hydrocortisone. later on you should add montelukast and if this also does not take care of the issue then nebulization with duolin (salbutamol and ipratropium) and budecort (budesonide) is advised. the last drug route of choice is inhalers. these are the steps involved in the treatment and control of hyper-reactive airway disease. this treatment plan should be made by a physician in person after detailed evaluation. as of now you can use dexona but with the consent of the physician and after the tests that i told you so that we can be sure that there is no infection. please note that hyper-reactive airway disease is an age bound process and usually resolves by the age of 8 years. sometimes very rarely it may last up to 12 years. the medicines explained to you above only help in controlling the disease and they do not cure it. for further information consult a paediatrician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have severe constipation and bloating problem with slight vaginal bleeding. please help."}, {"role": "assistant", "text": "i would need a little bit more history how many times during a week do you have a bowel movement? please go online and type bristol stool chart and let me know the consistency and type of the stools you are having in general from a month. have you had diarrhea before the given month? do you have to strain to defecate? how are your menstrual cycles usually? any family history of thyroid disorders or colon cancer? do you feel very cold when everyone is comfortable? have you lost any weight lately? revert with more information to an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can vitiligo occur in later stages of life?"}, {"role": "assistant", "text": "vitiligo can be inherited in the family but not in every member of the generation. it is not necessary for vitiligo to develop in childhood; the onset can be at any stage of life. inheritance was thought to be autosomal dominant with variable expression and incomplete penetrance. it means the next generation may or may not have vitiligo. there is fair chance that the next generation may not have it and can skip generations. vitiligo is not predictable. so there are equal chances. for further information consult a dermatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i need a second opinion regarding itp."}, {"role": "assistant", "text": "isolated low platelet count with normal hemoglobin and cbc (complete blood count) usually is the key laboratory finding for itp (idiopathic thrombocytopenic purpura) as there in this case. it is the diagnosis of exclusion however. i need few more details about his medical history. did he ever had gingival bleeding epistaxis (nose bleeding) or any spontaneous bruising? any history of dark foul smelling stools or melena? is there evidence of viral illness like fever or diarrhea or upper respiratory tract infection? does he have any splenomegaly? itp is a primary immune mediated destruction of platelets by self-generated antibodies to platelets. it is of two types acute and chronic. acute itp usually follows infection and has spontaneous resolution in eight weeks or two months. chronic itp persists longer than six months without any cause. management includes conservative and observation alone for the one who do not have any signs of bleeding or mild cutaneous manifestations as in this case. in case of any bleeding or life threatening complications i order to suppress immune mediated destruction of platelets which will require iv immunoglobulin methylprednisolone and platelet transfusion. as of now he can be managed conservatively and continuous watch on bleeding manifestations should be followed. if the condition persists for more than six months that is if it progresses to chronic itp then drugs like eltrombopag and nplate - romiplostim can be tried to stimulate platelet production for the one who experience inadequate response to steroids. now platelet count and bleeding manifestations are to be continuously monitored till it reaches normal and prednisone dose should be tapered to avoid long term complications of corticosteroids. as i said do watch for bleeding manifestations like large spontaneous bruises melena gingival bleeds gastrointestinal bleeding altered sensorium and confusion. do not let him to play as falls may lead to hematomas and internal bleeds. do not worry. in most cases it resolves spontaneously. for further information consult a general medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am having constipation problem and a feeling of incomplete evacuation. how to solve it?"}, {"role": "assistant", "text": "we are here to help you. you probably are suffering from chronic constipation associated with acid reflux disease and that requires evaluation for the cause. if no cause is found we would say that you have idiopathic constipation. i would advise you the following. consult your specialist doctor discuss with him or her and take treatment with consent. get a thyroid function test done as hypothyroidism might be the cause of the constipation that you are having. i suggest laxative like lactulose in the night. increase fiber in the diet and take fruits like papaya which are bulk forming. i suggest a combination of pantoprazole and levosulpiride once daily. another thing that you can take is isabgol husk. you can take three teaspoons full in night time and as it is bulk-forming. it may help you with your constipation. once you are constipation free you do not strain during stools and our piles problem would go away on itself. for further information consult a medical gastroenterologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i guess my constipation and blocked urination are interlinked. please help."}, {"role": "assistant", "text": "chronic constipation is a delicate issue that worsens one's quality of life and is hardly solved definitively. except the watery diet it requires bowel enemas time after time and use of laxatives continuously. if you can apply enemas then do it right now to empty your bowel and thus ease the urination. it seems to be a mechanical obstruction of your urinary tract by the pressure of the rectum to the urinary ways or prostate. enlarged prostate and bladder weakness may have developed in the course of your chronic constipation. if you cannot urinate even after the defecation you may need bladder catheterization and you would better go to your healthcare center. continue your watery diet use high fiber foods fruits and vegetables. use laxatives daily such as lactulose if you feel difficulty with bowel movements. also do physical activity every day. for further information consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my legs are itchy and red. is that due to insect bite?"}, {"role": "assistant", "text": "it looks like some bed bug bitten case. avoid scratching that area if you develop the itch. i suggest you antihistamine drug like tablet levocetirizine 5 mg twice daily for five days and tablet acenac-p (aceclofenac and paracetamol) twice daily for five days. consult your specialist doctor discuss with him or her and take medicine with consent. apply clindamycin lotion and do not wash the area to avoid any bacterial infection. avoid touching that area frequently and do not apply anything over it. for further information consult a dermatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how long should i continue levocet m for itchy throat?"}, {"role": "assistant", "text": "your symptoms seem to suggest that you are suffering from allergy. levocet m (levocetirizine and montelukast) is given for the same purpose. it is true that the medicine should be taken for a few months regularly. it has minimal side effects like dryness of mouth drowsiness and daytime sleepiness. it is advised that you take levocet m in the night and avoid driving after taking the medicine. ideally i would like to see your nose using nasendoscopy which is an office procedure. also i would like to know more details about the surgery that was done. if you have the papers then you may please scan the same to me in a query as this will let us diagnose your current condition. for allergies we also suggest nasal spray like metaspray (mometasone) or flomist (fluticasone). consult your specialist doctor discuss with him or her and take the treatment with consent. these sprays are taken in the morning and in the evening two puffs in each nostril for about two weeks and thereafter the dose is reduced and stopped after a month or two. i advice you to take the following blood test as well serum total ige. this will give an indication about the allergy status and we can investigate further to know which allergens cause allergy in you. for further information consult an ent otolaryngologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "are acidity and constipation the withdrawal symptoms of quitting smoking?"}, {"role": "assistant", "text": "it is good that you have stopped smoking. but the withdrawal symptoms do not manifest as acidity. although it can cause constipation but not after a month of quitting. your cholesterol levels are high and it is the cause for persistent gerd (gastroesophageal reflux disease). your ldl (low-density lipoprotein) levels are also high which is bad cholesterol. also your sgot (serum glutamic-oxaloacetic transaminase) levels are high which suggests liver injury. i would suggest you to try lifestyle modifications initially to reduce your cholesterol levels since your values are not very high. target should be total cholesterol lower than 180 and ldl lower than 100. to release constipation increase fiber in your diet and avoid fatty and fried foods. drink lots of water and do regular exercise. for further doubts consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is it true that schizophrenia runs in family?"}, {"role": "assistant", "text": "schizophrenia is a complex psychiatric disorder and sometimes tend to run in families. however it does not imply it is a monogenic disorder where the inheritance rate of disease is higher and more easily predictable. currently there is no scientific evidence to support your doubt that whether marrying your boyfriend will increase the risk of schizophrenia in your to be child very significant. so let us not get too worried. for further information consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "kindly let me know some medicine for itchy throat?"}, {"role": "assistant", "text": "this itching like symptom is known as post nasal drip. the best medicine would be the use of anti-allergic combination like levocetirizine and montelukast once daily at night. consult your specialist doctor discuss with him or her and take the medicine with consent. do steam inhalation regularly for at least 10 days. revert back after 10 days to a pulmonologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is stammering a genetic problem?"}, {"role": "assistant", "text": "stammering has got a multiple etiology and pathogenesis. a hereditary component in this has been extensively studied. a recent study was done including 12 children and 5 generations of the family were investigated. the hereditary component is not the only thing that is important. there are other factors related to environmental like the way children are brought up the circumstances the child faces etc. which will decide this. chances of the heriditary component are variable accordingly to different studies. it differs with the genetic component of mother and father if both are having this chances of around 25% according to some studies. if only one parent is having then chances are still less. also the mode of inheritance is also not clearly identified. there is a significant limitation in the available literature on these studies. my final opinion is the chances are less if the child is brought up in a healthy environment and family with a proper speech there from childhood. it should never be a cause to stop marrying i suppose. for further information consult an family physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "does chronic constipation lead to prostatitis?"}, {"role": "assistant", "text": "as you suspect the symptoms might be due to chronic prostatitis or a similar entity chronic prostatic pain syndrome. it needs a per rectal examination. per rectal examination is not that painful as you suspect. urine culture after a per rectal examination will turn to be positive if it is chronic prostatitis. it needs a 4 week course of trimethoprim alpha blocker drugs and anti-inflammatory drugs. it has to be treated with trimethoprim or levofloxacin. the probable causes:secondary to uti (urinary tract infection). differential diagnosis:chronic prostatic pain syndrome. regarding follow up:for further queries consult an urologist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to prevent further deterioration of gap between the front teeth?"}, {"role": "assistant", "text": "i have read through your complaint and the relevant details. tooth gaps in the front are inherited in families to a certain extent. a study has even proved that there is as high as 62. 5% of patients have midline gap running in families. you also have mentioned that one of your incisor teeth is rotated. this means the tooth has adjusted to space during the eruption of other permanent teeth in that row. these midline gaps can be easily corrected. there are a lot of methods to correct them. but considering your age i advise you to visit your nearby orthodontist that is braces specialist to analyse the condition. you need not worry that your teeth are deteriorating because gap closure treatment through braces does not involve any grinding of any tooth. also i would recommend you to choose braces treatment in order to correct the rotated tooth as well as the closure of the gap for a successful long time result. this is better comparing any filling procedures which cannot be claimed to be permanent. the braces treatment takes up to one year to complete. but it is worth the wait. you can smile without any shy. for further information consult a dentist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is levocetirizine sufficient to cure nasal congestion and cough?"}, {"role": "assistant", "text": "your infection will be most probably a viral infection because of the season now. however we can be sure of that only after a swab is taken and it is cultured to see if there grows any bacteria in it. i give you the following suggestions to take care of the problem. however only after a thorough examination i will able to arrive at a more confirm diagnosis and institute decisive treatment. levocetirizine can be continued in the night alone. mostly the dose prescribed is 5 mg. for cough try some cough lozenges which can be taken orally. some expectorant syrup will help lighten the mucus and help cough the sputum out better. if you get fever take paracetamol 650 mg. take abundant rest if fever ensues. if fever present then it is prudent to consult a doctor and take the appropriate antibiotics. cold and nasal congestion can be alleviated using nasal decongestant drops like xylometazoline 0. 1% or oxymetazoline 0. 05%. take three drops in each nostril and lie down for 10 minutes. thereafter take steam inhalation. this i suggest you to do twice daily for three days. take salt water gargles three to four times a day. take plenty of hot fluids and refrain from having any cold products or drinks. avoid smoking and drinking during the course of all these medications. better to avoid them altogether. if fever does not relieve then you must consult a doctor. it could be worsening and you may require antibiotics or injections. if you get throat pain then it is a sign of inflammation and salt water gargles will be helpful. because of throat infection your nodes may get enlarged and become painful. if cough is not productive and if it is dry you should be seen by a doctor to ascertain if any wheeze is present. if so you have to take bronchodilators to ease the bronchial passages for air and mucus to pass through. as the details provided are insufficient and i have not examined you i cannot be decisive whether the infection is a viral or bacterial one. i cannot be sure regarding whether the upper respiratory tract presentation is of some other disease like dengue leptospirosis h1n1 etc. however the latter chances are less do not worry for now. but promptly consult with a doctor in case you are not relieved of symptoms. here i would like to emphasize the importance of green leafy vegetables to be taken daily nutritious protein rich food regular exercise and breathing exercise which if performed regularly can help prevent such infections. differential diagnosis:1. viral rhinopharyngitis. 2. acute upper respiratory tract infection. regarding follow up:for further information consult an allergy specialist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "please help with my allergic reaction to cherries."}, {"role": "assistant", "text": "you got an allergic reaction and there is no need to worry. i suggest antihistamines and tablet montek-lc containing montelukast with levocetirizine. i also suggest antacids along with that. consult your doctor discuss with him or her and take the medicine with consent. beware of cherries next time and wash them thoroughly before eating. for further information consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can you suggest an alternative to accutane for acne?"}, {"role": "assistant", "text": "you should visit your physician as soon as possible. all these can be symptoms of obstructive jaundice. to confirm get your blood tested for complete blood count and liver function test. also get a urine routine microscopic test and ultrasound abdomen. stop oral isotretinoin and continue applying topical medications like a combination (clindamycin and adapalene) gel at bedtime or any other creams or gel that you are using. for further information consult a dermatologist online --><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my friend's son has been diagnosed with hypochondroplasia. kindly suggest the best treatment."}, {"role": "assistant", "text": "hypochondroplasia is a rare and genetically inherited condition. it involves the skeletal system and the child's height and weight are definitely low. and birth history also suggests some abnormality. what about the parents status is anyone affected or are they normal? very rare tests have been performed and he has been examined at reputed institutes and already seen by genetic specialist. the child needs a multispeciality/multidisciplinary approach: 1. he might not reach normal height. there is no specific treatment for that. growth hormone which we use in other conditions would not help him. there are some limb lengthening surgeries done later in life. these are complex surgeries which involves orthopaedics and should be done in multispeciality setups. some other movement restrictions can occur at elbows/knees and these can be managed by orthopaedicians and helped by physiotherapists. 2. enlarged head due to more fluid in the brain. this rarely requires surgery and can be done by a neurosurgeon. mri brain does not show any such features now. if any symptoms appear then probably he will need a repeat mri. 3. fits occur in a few children. this can be treated at any children's centre and can be seen by a paediatrician or a neurologist. 4. with respect to the development special teaching/training programs might be required. psychological support is needed as the child grows up which can be rendered by a child psychologist/psychiatrist. 5. hearing problems are frequent and hence get regular check ups done by an ent specialist/paediatrician who will guide you. unfortunately there are no medications to cure this disease. genetic disorders can affect many body systems. the best we can do is treat the symptoms that are caused. there are more severe forms of the disease which can be life threatening. hypochondroplasia is only a milder form. hope this information is helpful. be in regular follow up with a paediatrician online who will guide to the concerned specialist when required --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is it safe to take levocetirizine daily?"}, {"role": "assistant", "text": "it seems that you have seasonal allergies may be due to dust pollens pets etc. so the best solution is to first find out the cause of allergy and to take preventive measures. cetirizine can be taken but only for short durations. gradually stop cetirizine. you can take homeopathy medicine kali bich 30 potency (kali bichromicum - potassium dichromate). take five drops in little water thrice daily. take this medicine half an hour before meals. you can use mask when you step out from home. do more physical exercise and morning walk for inner strength and yoga. follow the instructions and revert back after a month. for further information consult a homeopathic physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have ocular hypertension will it lead to glaucoma? is there a risk of inheritance and blindness?"}, {"role": "assistant", "text": "i reviewed your history. it seems from the history that you are having ocular hypertension. since the results of visual field optic disc changes and oct are normal there is no glaucoma. but treatment of ocular hypertension is necessary for you to prevent development of glaucoma. hence you need to start the treatment and aim should be to bring the intraocular pressure below 16 mmhg and keep it around 14-15 mmhg. if treatment and follow up is done the risk of blindness is minimal or nil but better follow up and treatment is important in your case. glaucoma is known to be inherited and hence your children need examination in late adulthood probably at around 30 years after one baseline evaluation now. but do remember not all children will have glaucoma only evaluation is required. if there is no glaucoma then the risk is same as for general population. hope it helps. consult an eye care ophthalmologist online for further clarifications --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i want my eyebrows and eyelashes to be thicker. help me."}, {"role": "assistant", "text": "thickness and size of eyelashes and eyebrows depend on your genetic inheritance. if your genetic makeup indicates your eyelashes to be thin then they will not grow bigger than your genes allow. in case your genetic material indicates your eyelashes to be thick and beautiful and because of some disease they do not grow well the following steps will help: treat dandruff or any other fungal infection of scalp and skin underlying eyebrows. apply almond oil not refined almond oil (since it has mineral oil mixed with it) but pure almond oil namely badam rogan. it will make your eyebrows grow thicker gradually. consult an ayurveda specialist online for further queries --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "are high sugar and raised liver enzymes side effects of protonix?"}, {"role": "assistant", "text": "is this the only liver function test you have? i wanted to trend it. plaquenil (hydroxychloroquine) and protonix (pantoprazole) both can cause elevated liver function test but it is relatively rare with protonix. i also want to make sure that you are not using aspirin tylenol or cholesterol medications since they can have direct effects on the liver. another important point is that the slight elevation of lipase and blood sugar can happen in pancreatitis which again could be a rare side effect of protonix. but this point goes against the fact that the elevation of blood sugar is out of the proportion to the lipase levels. a person who has prediabetes may develop full blown diabetes transiently under physiological stress. i was trying to understand if you had been tested for diabetes ever and if this blood sugar was obtained in fasting. for high blood sugars i would suggest that you try to avoid high carbohydrate diet soda bakery products white bread or pasta and juices. hydrate yourself with plenty of water. can you please share your symptoms and for how long did you have them? please also share if you have been worked up for lupus or autoimmune hepatitis and your entire medication list if you can? revert back with the details to an internal medicine physician online --><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to increase my height? i am 23 years old."}, {"role": "assistant", "text": "growth in terms of height drastically reduces after puberty. you have not mentioned your gender. theoretically with proper nutrition and under ideal circumstances growth in height stops in women at 18 years and in men at 24 years. this does not consider other factors like family tendencies and genetic inheritance. i suggest you to have nutritionally rich food like milk and milk products egg yolk lean meat like fish fresh fruits and vegetables. you can also indulge in stretching exercises and yoga that will give you better posture and help you to look taller. if you are overweight focus on losing weight. sleep for at least 8 hours a day. you need to drink 6-8 glasses of water a day to detoxify your body. following these tips will help in maintaining ideal body condition. that coupled with yoga and other exercises should help you. consult a nutritionist online for further follow up ---><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can cocaine cause elevation in lfts?"}, {"role": "assistant", "text": "first of all cocaine did not make lft (liver function test) rise just taking it for two days. it is possible only if you have been taking cocaine from long time. second thing is alt (alanine transaminase) 90 and ast (aspartate transminase) 86 are not that high values which will make any damage to your liver. please answer the following questions to help you in detail. do you take alcohol? if so since when and how many times a day? did you have any fever in the past two months? had any medications like pain killers or antibiotics or herbal products recently? did you gain any weight in the past four months? revert back with the answers for the above questions to a general medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "why was i prescribed with folic acid glycomet and oosure for delayed period?"}, {"role": "assistant", "text": "your doctor started medicine on the basis of your delayed periods and considering it as pcos (polycystic ovarian syndrome). that is why glycomet (metformin) and oosure. you must get yourself investigated and confirm the reason for delay. as for now since 13 days are over you should have done a urine for pregnancy test. if not done then get a scan done which will tell you the reason for delay whether pregnancy or it will show if polycystic ovaries. moreover since it will be on day 2 of cycle and it will guide your gynecologist about the number of follicles in the ovary. if the scan is fine then i will advise you to get yourself investigated for conceiving including your husband's semen examination. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what is the reason for delayed periods after having protected sex?"}, {"role": "assistant", "text": "how are you doing? pregnancy need not be the only reason for no periods. if you have used proper protection and the urine test for pregnancy is negative then you do not have to worry about pregnancy. any young lady will take about 19 to 21 years of age to have a mature brain-ovary hormone axis so till then once in a while you may miss your periods. next month it will be fine. is there any recent sudden increase or decrease in body weight? or any episode of significant mental or physical stress or anxiety happiness depression? any recent history of hormone use to alter periods? get a thyroid profile and serum prolactin level checked if abnormal it needs correction to have ovulation on time. as you have ruled out pregnancy i suggest taking any of the oral birth control pills contraceptive pills or 21 pills packet like tablet novelon dear 21 ovral g duoluton l or intimacy plus 3. take one tablet twice a day for ten days and throw away the 21st pill no matter what the cause is she will get her periods within 7 to 10 days. consult your specialist doctor discuss with him or her and start taking the medicine after their consent. for more information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "menstrual period delayed for 45 days now. pregnancy test came negative. what could it be?"}, {"role": "assistant", "text": "if you are having delayed period there could be lots of reasons for it. first on the list is pregnancy which you have ruled out already. second cause could be pcod which gives rise to multiple tiny cysts in your ovaries with failure in ovulation thereby leading to no menstruation. third cause is hormonal imbalance or thyroid related issues. so i would suggest you to check your thyroid and prolactin staus and also get a tvs done to see the condition of your ovaries. for bringing out your periods you can try medroxyprogesterone acetate 10mg daily for 5 days. however it will not cure your primary cause. you must find out the primary cause to get permanent relief. consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can taking two i-pills within a span of two weeks cause delayed periods?"}, {"role": "assistant", "text": "i have read and understood your problem. period starting early is due to effect of i-pill. you do not need to do anything. but if you have taken two i-pills in two weeks for contraception then it is better to continue with femilon (combination of desogestrel and ethinyl estradiol). for further doubts consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "why do antibiotics clear acne?"}, {"role": "assistant", "text": "i have read your query. yes acne is caused by a bacteria called propionibacterium acnes but beside this other factors also play in forming acne. change in keratinization pattern in pilosebaceous unit which leads to a keratinous material to cause blocking of sebum secretion leads to comedone formation. these comedones plugging and complex interaction between androgens and bacteria in the plugged pilosebaceous units leads to inflammation. this is the reason for using antibiotics for the management of acne along with medicine like retinoids (adapalene or isotretinoin) for maintaining keratinization. for further doubts consult a dermatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "would antibiotics during pregnancy cause any harm?"}, {"role": "assistant", "text": "taking another course of antibiotics would cause no harm but infection if occurs again and again may be harmful to pregnancy. you are right in your worry that it may be an extra course as your wife took one recently. but as i said it is better to play on the safe side in pregnancy. there is no harm. she can take another course of antibiotics and please get her blood sugar levels. high sugar levels can sometimes be a reason for recurrent urinary infection. kindly advise her to take plenty of fluids. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "could delayed periods be a sign of early onset of menopause?"}, {"role": "assistant", "text": "if you have been regular with your menses these years and this is the first episode at 53 years of age when the menses have been delayed by two weeks the causes can be a possible initiation of perimenopausal stage where menses are often delayed for a month or two and slowly tend to stop in next one to two years. perimenopausal stage can be verified with the hormonal fsh (follicle stimulating hormone) and lh (luteinizing hormone) levels which if high shall indicate an onset of perimenopausal stage. however it is suggested that pregnancy should anyways be ruled out and if negative then you can wait naturally for your menses to resume. hence try maintaining a menstrual calendar and keep a mark for your dates duration of flow and quantity to evaluate the possible onset of a perimenopausal state. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "delayed period after abortion. please help."}, {"role": "assistant", "text": "please ask her to wait for a week for her period to start. if it does not start by then she can repeat urine pregnancy test. if the test turns out to be negative ask her to take tablet medroxyprogesterone acetate 10 mg twice daily for five days. period normally starts within a week of stopping tablets. try to avoid unprotected sex during these seven days. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is antibiotic a must for seasonal allergic cough?"}, {"role": "assistant", "text": "with the conversation i understand that you are a 33 year old male suffering from cough especially during the months of september and october through the years. therefore it is clear that you are suffering from allergic bronchitis. it is considered to be seasonal. this cough exacerbates in specific months like september and october in your case. during such exacerbation it is advisable to take a steroid bronchodilator and an antibiotic. in your case decadron (dexamethasone) is the steroid proair hfa aerosol (albuterol) is the bronchodilator and zithromax z-pak (azithromycin) is the antibiotic. accordingly antibiotic should be prescribed only if infection is present and if there is yellow or green colored sputum production fever and chest congestion. bronchodilator in the form of aerosol spray helps to relieve bronchospasm and to get rid of any inflammation associated with it. i would suggest you to continue with the aerosol spray as prescribed by your doctor. check for few days. if the symptoms of cough recur then start the antibiotics. when the allergic bronchitis exacerbates you can use proair inhaler and seroflo inhaler (combination of fluticasone and salmeterol) or budecort (budesonide) inhaler together. the two inhalers have a specific way of usage. you can check it with your physician. for further information consult an allergy specialist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to manage my mother's plantar fasciitis?"}, {"role": "assistant", "text": "plantar fasciitis which is inflammation of foot tissue can be reduced by decrease weight bearing by wearing different footwear and by physiotherapy. tens (transcutaneous electrical nerve stimulation) will not be an effective one. you need to take ultrasound therapy with analgesic cream use and it will be more effective. tens therapy is only temporary and will not give a problem solving approach. even though it will not give any side effect there will not be a benefit too. so kindly take ultrasound therapy which is essentially needed for 15 days and the protocol is 1 mhz and 1. 5 w/sq cm for 10 minutes daily. for further information consult a physiotherapist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can antibiotic affect the outcome of hiv test?"}, {"role": "assistant", "text": "as i am not aware of your previous history. please explain your problem in detail. revert back with a detailed history to a hiv aids specialist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have a terrible upper back and shoulder pain and i feel drowsy. what to do?"}, {"role": "assistant", "text": "i would like the following details. did you take any x-ray? have you tried physiotherapy? was the mri with or without contrast? do you feel missed heartbeats when you feel drowsy? do you get sweaty or get a sinking feeling? if yes then you need a 24- hour holter ecg (electrocardiography) reading to rule out any arrhythmia. if you have a click on the neck which is painful and makes you faint or feel drowsy then i think you need an mra (magnetic resonance angiogram). i will also suggest you consult an ent specialist. revert with more information to a fitness expert online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my operated knee is comparatively weak. why?"}, {"role": "assistant", "text": "it usually happens when the physiotherapy was not progressively increased or physiotherapy was done intermittently. weakness is due to muscles not being conditioned to presurgery levels. you need to increase the level of exercises. start jogging cycling and training with weights. doing this for one month properly will get you back to presurgery levels. probable diagnosis:ligament with slight weakness. regarding follow up:revert after a month to an orthopaedician and traumatologist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can physiotherapy heal diastasis recti?"}, {"role": "assistant", "text": "first of all congratulations for delivering a beautiful baby. i have gone through your medical history in detail. diastasis of 2. 5 cm is considered a moderate degree of diastasis as far as our classification is considered. diastasis is usually hard to heal up completely only with physiotherapy. since the defect is bony it takes lots of aggressive manouvers to get the bones back together. initial three to four weeks after delivery are the most important days if you want to get back the diastasis to normal with physiotherapy. if you have an immediate post-delivery x-ray then you can get a new x-ray done and compare the diastasis gap in both x-rays to see the progress. if it is still the same even today then there are very fewer chances that this may improve only with physiotherapy. you can use gradually compressing pelvic belt which can be tightened gradually day by day. if even this does not help then you may need surgery to get the diastasis normal. try and post an x-ray of the pelvis here so that i can guide you better. for further information consult a physiotherapist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what is the treatment for the fungal infection on my right hand?"}, {"role": "assistant", "text": "have you applied any creams? do you have a history of diabetes or hypertension? in the case of a fungal infection you can try using onabet (sertaconazole) cream or episert (sertaconazole) cream or dk gel (miconazole) twice a day. but if there is a recurrence then oral antifungal medications should be considered. please send images so i can suggest some medicines. revert with more information to a dermatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "will antibiotics reduce the effect of oral contraceptive pills?"}, {"role": "assistant", "text": "while some antibiotics do induce hepatic enzymes to decrease the efficacy of contraceptive pills amoxicillin is not one of them and can be safely used without the fear of contraceptive failure. however it is important to stick to the contraceptive schedule. if you have taken crisanta (ethinyl estradiol) regularly without missing any pills then you can rely on it completely. if you have missed a couple of pills or more then it will be prudent to use a backup method like condom. crisanta has to be used regularly as advised. there is no modification in the course or dosage necessary. no backup contraceptive required if you have not missed any pills in this cycle and have been taking crisanta for more than one cycle. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what can be the reason for back pain and stiffness?"}, {"role": "assistant", "text": "from the way you described it seems that you have a locked back. so you need a few medicines and physiotherapy. instructions to reduce back pain and stiffness are as follows: avoid lifting heavy weights sitting for a long time and two wheeler rides. avoid arching your back; instead bend your knees to pick up something from the floor. improve your posture while sitting and try to get up from your chair for every 20 minutes. take a quick walk around then continue working and always sit on a chair with back support. do not get up suddenly from a sleeping position. rather turn to the side and then get up. take bed rest if you feel severe pain. do hot fomentations locally over the affected area at least twice a day. i suggest you to apply oxalgin gel (diclofenac) for local application twice a day. i also suggest tablet pregabalin 75 mg one tablet at night for 15 days before food at 7 pm every day and tablet etoricoxib 60 mg one tablet at morning and night for 10 days after food. you can take rabeprazole 20 mg one tablet at night for 10 days before food and shelcal (calcium carbonate and vitamin d3) 500 mg one tablet at morning and night for 30 days before food. take d-shine 60 k one tablet daily for ten days and then once a month for 11 months. take these tablets only if you are not allergic to them. consult your specialist doctor discuss with him or her and take the medicine with their consent. these tablets will also help the heaviness of the head. if back stiffness does not reduce then you will need some blood investigation. do physiotherapy like mckenzie back extension exercises back core strengthening exercises glute strengthening exercises and passive straight leg raising exercises. these exercises can be done initially under a supervision of a physiotherapist or learn to do it at home. only regular exercises can give the result. once the pain gets reduced then do the following activities like swimming yoga and walking which are good for you. jogging running and weight lifting may aggravate back problems. the probable causes:1. locked back. 2. ankylosing spondylitis. regarding follow up:revert back if stiffness persists even after seven days to a orthopaedician and traumatologist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "delayed periods even after taking gestin. what is the reason?"}, {"role": "assistant", "text": "tablet gestin (allylestrenol) contains natural progesterone which is given for 5 days to bring about withdrawal bleeding. you have not mentioned how long you have taken the drug. withdrawal bleeding usually occurs 48 hours after stopping the drug to up to 7 days. if you are still in that period then you should wait for your period to commence. if you are over that then i suggest you to do certain tests like transvaginal sonography tsh (thyroid stimulating hormone) and amh (anti-mullerian hormone testing). considering your age you could be in your perimenopause (stage nearing menopause) where menstrual irregularities are common. revert back after the tests to an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am having problems with my whole skeletal system. please help."}, {"role": "assistant", "text": "are the findings that you have quoted your impression or seen and mentioned by a physiotherapist or doctor? have you been prescribed any physiotherapy? have you had bloods taken to rule out any other cause of muscle weakness fatigue? do you exercise regularly? sometimes the things you have mentioned are postural and get fixed through proper physiotherapy. though the scoliosis is mild first it needs to be investigated and confirmed by x-rays and the degree documented such that any progress can be picked up. have your vitamin d levels checked? please get yourself examined and i am fairly hopeful that manual therapy and physiotherapy will work in most cases. revert back with the asked details to a chiropractor online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can you advise medication for fungal infection?"}, {"role": "assistant", "text": "fungal infection indeed is very problematic if it becomes recurrent. first of all you keep the following precaution in mind. do not keep the area wet at all. use powder frequently to keep it dry. avoid itching and do not scratch it. change the undergarments regularly. avoid excessive sweating and wet clothes. do not apply any general or steroid creams like betnovate etc. do not stop the medicine once you cure. continue medicine for long time to completely kill the fungal. check diabetes and thyroid it is really recurrent even after proper treatment. now treatment part: ketoconazole cream (kz cream) plus tablet terbinafine (gris odt) 250 mg for two months. terbinafine cream plus fluconazole 150 mg twice in a week for two months. tablet itraconazole 200 mg twice in a day and kz cream for one month these are treatment combinations. please continue any one of it. for further information consult a dermatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what is the treatment for vaginal fungal infection?"}, {"role": "assistant", "text": "the fungal vaginal pessary usually dissolves intravaginal. you may experience some vaginal discharge mixed whitish fluid which can be candidial infection and also some amount of dissolved medication. i suggest you to wash yourself with alkaline vaginal wash and then re-insert the tablet at night again and continue for at least six nights. consult your doctor discuss with him or her and take the medicine with their consent. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "please help with my recurrent fungal infection."}, {"role": "assistant", "text": "with your given description it looks like resistant tinea cruris infections or may be erythrasma (skin condition affecting the folds in the body) you have not mentioned the duration of individual drugs you have taken. itraconazole is a good drug for this but you have to take 100 mg daily for around 28 days. along with this you can try sertaconazole cream with fusidic acid cream to cover erythrasma twice daily for minimum of three months. follow certain general measures such as: avoid heat moisture and maceration (softening by soaking). dry the body folds finger and toe webs thoroughly after bathing. the probable causes:may be not taken full duration of the course of medicines for fungal infection. investigations to be done:1. blood sugar. 2. skin scraping for koh (potassium hydroxide). differential diagnosis:1. tinea cruris. 2. erythrasma. 3. candidal dermatitis. probable diagnosis:recalcitrant tinea cruris. regarding follow up:revert back after the tests to a dermatologist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can fungal infection cause low grade fever?"}, {"role": "assistant", "text": "this is a chronic fever which is called as pyrexia of unknown origin when we are unable to ascertain a cause. as your blood tests and x-ray are normal lung infection is ruled out. conditions causing chronic fever are numerous. also certain infections like tuberculosis hiv and malignancies can cause it. but in your case it is unlikely as there is no weight loss or other risk factors neither you have an x-ray abnormality. now we move to the lymph nodes. do you have any lymph node swelling? if yes then get it tested. try to get an ultrasound of abdomen to rule out lymphadenopathy. get a urine routine and culture as sometimes a mild urine infection can get unnoticed and cause fever. get a blood glucose and renal function test too. if everything comes normal then we should look for anemia. a low hemoglobin can cause low grade fever and fatigue. fungal infections usually cause severe illness. to confirm if it is a fungal infection a blood culture is required. for further information consult a general medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have fungal infection in my ear. is it mandatory to stay at the hospital overnight for a microsuction?"}, {"role": "assistant", "text": "i would like to tell you that fungal infection in ear is quite common and it may be treated by: cleaning the ear: cleaning may be done by suction or syringing or by cotton swab. antifungal ear drops to be used three or four times a day. anti-inflammatory medicine to relieve pain and swelling in the ear canal. most of the times patients are treated as out door patients but some times if there are some associated complications or patient's general condition is low due to some other associated diseases then hospitalization becomes essential. revert back to an ent otolaryngologist online for further follow up --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "if someone with a fungal infection swims in a pool won't it spread to others through the water?"}, {"role": "assistant", "text": "i understand your concern. swimming is considered as a safe recreational activity. but that is not totally true. chlorination of water is known to kill most of the microorganisms (which include bacteria viruses fungi and parasites). but there are several factors to be considered like: 1) type of microorganism (some organisms may be resistant to chlorination). 2) adequate chlorination (if sufficient chlorine is not added there could be a chance of acquiring infection). 3) duration of chlorination (when a microorganism is introduced into the water the chlorine may not kill the organism right away some resistant organisms may survive longer in the water). 4) microbial load (the stage of infection of the infected person is also important during the acute acute/highly infective stage chances of spreading infection may be higher). it is very important for people with skin infections or diarrhoea to stay away from the pools for a period of 14days after recovery. this can only be monitored by the people entering the pool themselves. if you are swimming regularly try not to swallow water while swimming. take a shower immediately after swimming. if you develop any symptoms like rashes over the skin or diarrhoea consult your doctor immediately. request the pool authorities to put up a notice requesting members to stay away from the pool if they are sick. if you have kids who are swimming follow the same advice and change their nappies immediately after swimming. also take your kids to the toilet every 30 minutes during their swimming session to prevent them from excreting in the pool. consult a general practitioner online for further follow up ---><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "are there remedies to stop early maturity?"}, {"role": "assistant", "text": "hypothyroidism itself can be one of the causes of this prematurity. when have you got thyroid levels done? i suggest you to repeat if not done recently. what is the height of the child and her current weight? how much dose of thyroid hormone you are giving? investigations to be done:1. ultrasonography of neck. 2. anti-tpo antibody (anti-thyroid peroxidase) 3. check levels of t3 t4 and tsh (thyroid-stimulating hormone). regarding follow up:revert back with the answers to the above questions to a child health specialist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what could be the potential risk of not taking medicine for hypothyroidism?"}, {"role": "assistant", "text": "i have a few follow up questions. please answer them. what was the reason for the hypothyroidism and growth hormone deficiency? were there any other hormone deficiencies as well? what other medical problems do you have? when did you last have your thyroid blood work done? can you send the results of the laboratory? treatment for hypothyroidism is extremely important as it is a metabolic hormone and your body and all organs need it for functioning well. without this everything in the body can get sluggish such as weight gain depression tiredness and cold intolerance and in extreme cases it will lead to hospitalization complications like hypothermia (decreased body temperature) slow heart rate and coma. growth hormone deficiency treatment is required for growth of bones and muscles in childhood but in adulthood the treatment recommendation will depend on the cause of the deficiency. revert back with the answers to the above questions to an endocrinologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can menstrual cycle affect diabetes blood work?"}, {"role": "assistant", "text": "no blood results of sugars are not affected by normal physiological changes in the body. the menstrual period is a physiological stress on the body. if your body is producing normal levels of insulin to control the sugars then it will go ahead with normal production. only when you do something out of normal like excessive exercise or fever or any medications or certain steroid tablets or injections then the blood sugar will be affected. hope the bleeding was not massive or very painful. if these were excessive and out of normal levels then blood sugars may slightly change. also the hormones in periods from ovaries do not affect the blood sugars. for further doubts consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am suffering from hypothyroidism and taking eltroxin and thyronorm. but cholesterol is raising. what to do?"}, {"role": "assistant", "text": "cholesterol may increase on its own or the increase may be secondary to hypothyroidism. a secondary raise will settle down after 8-12 weeks of optimal control of thyroid status. otherwise it will require consideration for medication. till that time please eat diet low in saturated fats/carbohydrates. avoid sweets and fried items. also you can start doing exercise under supervision. will provide more insight if you can come up with the actual lipid profile and thyroid status to an endocrinologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can diabetes make my hands itchy and numb?"}, {"role": "assistant", "text": "i am sorry to know that despite the best efforts you are not responding with current antidepressants and there are active symptoms. i suggest the following treatment given a diagnosis of diabetes with depression. tablet duloxetine (duzela m) 30 mg in the morning and 30 mg in the evening. the reason for recommending this medicine is because it is quite effective for pain symptoms associated with diabetic neuropathy along with depression. tablet aripiprazole (arpizol) 5 mg in the morning. although it comes from an antipsychotic group of medicines my purpose here is to augment the action of antidepressants while addressing anger associated with depression. tablet lonazep (clonazepam) can be continued as per the current level if there is adequate sleep. in case sleep has been an issue despite the medicines i will recommend upping the dose of lonazep to 0. 5 mg at bedtime. regarding vilazodone i think it should be removed as it is causing intolerable side effects. also this particular antidepressant has little role in pain associated with neuropathy and i think duloxetine will be a better option. there is need to stop tobacco. this is because many of the medicines mentioned above have poor efficacy when tobacco is consumed. you need to consult your diabetes doctor as poor control of diabetes could be a significant reason for the poor response. consult your specialist doctor discuss with him or her and start taking the medicines after their consent. in case you have more questions feel free to write back to me. for further queries consult an andrologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have hypothyroidism. i want to reduce weight. please advise me the diet and exercises."}, {"role": "assistant", "text": "your weight gain may be partially due to hypothyroidism. you may start with brisk walking for 20 minutes daily and gradually increase it to 45 minutes daily. please do not lift heavy weights at this age. this may cause more harm than benefit. try oats muesli brown bread egg whites for breakfast. lunch should be a complete meal with no ghee on rotis. dinner can be soup veggies with roti dalia(broken wheat) dal roti. do not be on empty stomach for more than 2 hours during day time or the time you are awake. take light snacks fruits juices shakes in between your meals. else your metabolism can slow down. please tell me how much thyroxine are you taking and your tsh level and medicine details so that i can see whether thyroid is not the cause of your problem. please note: not eating for long periods or being on empty stomach could slow down metabolism and potentially increase weight. already hypothyroidism itself slows down metabolism. so do not fast but eat little meals. definitely you will lose weight if you follow this. revert back to an endocrinologist online for further help --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "will diet and exercise regress mild concentric lvh?"}, {"role": "assistant", "text": "do not worry completely stop smoking and alcohol forever. do not restart again as it will adversely affect your health. i suggest you try taking these following medicines. consult your specialist doctor discuss with him or her and start taking the medicines after their consent. tablet aztor 10 (atorvastatin) once daily after dinner. tablet cardace 2. 5 (ramipril) one tablet before breakfast this will bring down your blood pressure. your target blood pressure should be 120/80 mmhg. avoid fried fatty salty and spicy food. we will review after two months. revert after two months to a cardiologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to monitor diabetes?"}, {"role": "assistant", "text": "instead of kombiglyze (combination of saxagliptin and metformin hydrochloride extended release) take tablet tenepride (teneligliptin) and also take metformin (exermet or glyciphage) extended release 1000 mg in the afternoon. get an x-ray of the pain region and upload it with the opinion of a radiologist which will be given by radiologist in all scan centers. tablet tayo 60 k is the most important one for vitamin d. take one tablet a week. if possible get sun sessions between 11 am to 1 pm stand under direct sunlight for 15 minutes. get a glucometer. make a chart of your blood glucose readings as fasting morning (before breakfast advisable to take only water) postprandial (take tablet before breakfast and check 2 hours after breakfast) prelunch (just before lunch) and pre-dinner. maintain this chart in all seven days of a week. if sugar level is below 100 then contact your doctor immediately. if tiredness sweating or other symptom occurs check sugar at that time immediately and mention what is the problem time and sugar level. from your blood test it is evident that you have high hs-crp high hba1c low vitamin d and b12 low iron and low mean corpuscular hemoglobin concentration (mchc). chronic carbohydrates based diet and less vitamin d caused diabetes in you. stress also may be a factor. revert back with the readings chart to a general practitioner online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "please suggest some exercise and supplement for weak bones."}, {"role": "assistant", "text": "i have understood your concern. dislocation is accidental slippage of bone from the actual space and when it happens it will make surrounding muscles ligaments and capsule over stretch and so ultimately pain will be due to all structures. first you need to strengthen the surrounding muscles perfectly with the faith that you will improve. it may take six months or more. do not worry about it and you need to have more patience. in supervision of skilled physiotherapist you need to do all exercise. you can take some pain relieving modalities like ift and swd therapies (interferential therapy and short wave diathermy) by which pain intensity will decrease. but this is not a permanent option. non-vegetarian food will not affect much. i insist to rely on pure vegetarian protein and calcium diet. take bananas and milk as much as possible. avoid junk foods and do proper exercise. for further information consult a fitness expert online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "will diabetes during pregnancy affect the baby?"}, {"role": "assistant", "text": "we are here to help you. diabetes is a big problem and so the pregnancy during diabetes is labeled as high risk pregnancy. it is very uncertain to know what side effect might occur. however the side effects can vary from person to person. it is very difficult to comment about what actually might have happened to the baby. if the sugar level gets low during cesarean section then yes the baby is at risk. high blood sugar instantly does not stop the heart or affect the baby. it affects the mother by making her more prone to infection and diabetic ketoacidosis (body produces excess ketones). uncontrolled blood sugar during pregnancy will affect the baby. for further doubts consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is there any exercise to tighten the bulbospongiosus muscle?"}, {"role": "assistant", "text": "first of all bulbospongiosus and pubococcygeus are the different part of pelvic floor muscles and kegel exercise works on all these muscles to strengthen them. there are no separate exercises for individual muscle. it is important to know for what reason you want to do this exercise. is there any urinary problem or sexual problem or any other? so that if your problem is not getting cured with this exercise then further treatment can be offered. to get best result of this exercise you should perform it at least three times a day with at least 20-30 repetitions. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i had diabetes during pregancy 4 years back. when my baby was born the sugar levels were normal"}, {"role": "assistant", "text": "it is well known that diabetes during pregnancy is a forerunner for diabetes in later life. it is good that you checked your blood levels faithfully after your delivery and that is why you were able to identify the high levels. having found out about these high levels it is time for you to meet a physician or diabetologist to start treatment. the target sugar level for fasting is 100 and for 2 hours after a meal is 140 mg/dl. adhering to a strict diet and regular exercise may reverse diabetes completely in early stages. you have not mentioned your age or desire for future pregnancy. in either case we can help you. for further information consult a diabetologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "every time i exercise on treadmill my legs are itching. how do i prevent this?"}, {"role": "assistant", "text": "i want to assure you not to worry as everything is going to be fine if proper care and treatment is opted in for. i have thoroughly gone through your case and understand your genuine health concerns. the probable causes:this is a very common problem for a lot of treadmill users doing cardio exercises. the main issue is the sensitivity of the skin. it looks very simple but i found this fact after a research on 150 people of different ages and with different health status but with the same issue of blushing and itching on the legs while using the treadmill. reasons: dry skin in the legs. wearing tight clothes/jeans or trousers while exercising on the treadmill. wearing tight and above ankle socks. treatment plan:1. wear cotton-only trousers (100% cotton; not mixed with any synthetic fiber). 2. it is better to wear ankle socks compared to above ankle socks. 3. wax properly and timely on the legs and apply eucerin cream (extra dry treatment lotion) on the legs especially when doing the treadmill. 4. there must be a proper ventilation in the room where you do the treadmill. 5. keep a judicious supply of water to avoid dehydration. 6. you need to keep a good and healthy diet full of vitamins minerals and fluids (vegetables salads fruits salmon fish nuts dry fruits). 7. avoid caffeinated drinks like coffee tea beverages energy drinks etc. 8. it is possible that you may still feel itching and redness for the first couple of days so it is better to take tablet cetirizine 1 hour before workout. and apply hydrocortisone cream if you feel that the redness is not going away on its own after an hour of completing workout. in a few days you will not get the problem anymore. regarding follow up:for further clarifications consult a general practitioner online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is stretching exercise helpful for tight foreskin?"}, {"role": "assistant", "text": "you seem to be having tight foreskin which is called phimosis. there are two options available for this problem namely preputioplasty and circumcision. it is better to correct this problem before marriage. otherwise it would lead to paraphimosis following intercourse. for further information consult a urologist online --><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "while doing exercise i feel shortness of breath and sweating. why?"}, {"role": "assistant", "text": "thanks for consulting me at this platform. i have thoroughly gone through your case and can well understand your genuine health concerns. i think you need to carry out taking the same medication as this is a mandatory medication. exercise induced asthma may also cause shortness of breath. excess sweating is natural and this is also a side effect of almost every medication used for lowering heart rate. it is called postural hypotension in which you feel sleepy and sometimes weak when standing up from sitting position. for further information consult a cardiologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "exercises to do when one has ankylosing spondylitis with an andersson lesion."}, {"role": "assistant", "text": "hi you have to inform us your age duration of symptoms whether you are on any medical management extent of your body joints and spine involvement etc. considering all these have been done i would suggest you to concentrate on deep breathing exercises and pranayama. also we advise you to avoid the use of high pillows or a soft bed. now as you know the chest expansion is limited when one is having ankylosing spondylitis swimming is a good exercise that helps most joints in addition to the back. you may also need to check your vitamin d status and the calcium phosphorous and alkaline phosphatase levels. yoga can be tried but will have to be individually tailored. all the best for a sporty day. consult a physiotherapist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "will exercise or diet help me in normal delivery?"}, {"role": "assistant", "text": "the following aid in normal delivery: your stature must be tall. there should be adequate pelvis. the baby should be in vertex position. this can be predicted only when you cross 37 weeks. you can have a normal diet and regular antenatal exercises till then. yoga also helps but you are too early in pregnancy to predict the same. for further follow up consult a gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "please help me through ayurveda to clear acne."}, {"role": "assistant", "text": "as you are 21 year old the acne is mainly due to hormonal changes. as far as scars are concerned do not peel or squeeze your acne. the scars which are already present can be lightened off. for acne try herbal things at home because the cause is very important. as your hormones will get balanced with age the acne will start reducing. take turmeric and sandalwood powder and add rose water to it. make a paste and apply this paste early in the morning. after 10 minutes wash it off gently with water and wipe your face with a soft cotton towel. for scars i suggest you apply aloe vera gel on them twice a day. this will help in lighting them. use mild herbal face wash and do not use harsh soap for face. avoid going directly in sunlight apply sunscreen before going outside. avoid taking the stress avoid excessive spicy and junk food caffeinated drinks etc. drink plenty of liquids and take fresh fruits and vegetables. however if acne is due to some infection then you need to visit a nearby dermatologist otherwise hormonal related acne problem will settle down with time. for further information consult an ayurveda specialist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to get relief from dandruff?"}, {"role": "assistant", "text": "the causes of dandruff are any of the following. not enough hair brushing and shampooing dry skin seborrheic dermatitis diet without proper nutrition mental stress and allergic reaction to any hair or skin care products. the dandruff treatment includes taking care of the above things to not happen. medical agents such as pyrithione zinc (fungistatic and bacteriostatic property) salicylic acid and sulfur plain salicylic acid selenium sulfide and ketoconazole are used to dandruff. proper water intake and healthy routine to bed prevent generation of extra heat in the body and dryness of the scalp. for further information consult a dermatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have developed hair dye allergy. please help."}, {"role": "assistant", "text": "as per the details given it seems that you have hair dye allergy. most of the hair dye products contain a chemical called ppd (para phenylenediamine) which is responsible for allergic reactions. in such cases i advice my patients to strictly avoid application of hair dye. you may use herbal henna for dyeing hair. i advice my patients to apply topical steroid like hydrocortisone on the affected area. antihistaminics like levocetirizine also help. you need clinical examination. so you should visit your doctor so that he can examine you and give you prescription accordingly. you can share my opinion with him. stay healthy. consult a dermatologist online for further follow up --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "while treating a patient for depression when can we add in celexa?"}, {"role": "assistant", "text": "you seem to be dealing with a patient with treatment-resistant depression. what is the thyroid status of the patient? since you have tried ssris (selective serotonin reuptake inhibitor) and the patient seems to be a non-responder to these i feel that celexa (citalopram) will not benefit this patient. i suggest a mood stabiliser lamotrigine 25 mg to the existing venlafaxine. i would also consider a low dose of olanzapine 5 mg at night as augmentation. you can also prescribe bupropion 150 mg once daily to the existing combination. let us wait for one month and look for at least 25 percent reduction in hamilton depression rating scale scores. if still non-responsive then you can add 25 mcg of thyroxine to the current regimen and admit the patient for a course of electroconvulsive therapy. for further doubts consult a psychiatrist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have twin baby girls. one of them is not gaining weight. please help."}, {"role": "assistant", "text": "keep trying to give breast feeds as much as possible till 6 months completion. different brands of milk powder have different tastes. so you can change what they like (as advised). do not dilute more or give more concentrated milk. usually dilution mentioned on the package can be followed i. e 30 ml for 1 scoop for most of the brands. but check with the manufractures' note. do not use feeding bottle. use bowl and spoon. you can use undiluted dairy milk (pasteurized ones). check with your local paediatrician for supplements if needed. check if there is adequate weight gain. maintain proper hygiene while feeding when using formula feed or top milk. do not compromise on hygiene. i would like to know the following: what supplement do you use now? how do you prepare it? how do you feed the babies? how much (quantity) do you feed them? how do you measure the quantity? how about the acceptability from both of them? do you maintain a chart regarding the weight gain? if so please attach it in the follow up query. do they have any other medical issues? finally breast feeding is the best for the babies. revert back with the details to a paediatrician online for further follow up --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my 4 month baby has not passed stools. please help."}, {"role": "assistant", "text": "it is common to have decrease in stool frequency or constipation after switching from breast milk (breastfeeding) to formula feed. as long as your child is feeding well passing gas from below has no vomiting and has a soft belly there is nothing to worry about. it is normal to pass stool once every 2-3 days. also you may note change in stool color (green) after switching to formula feed. in this scenario you can try using a cotton q-tip (cotton swab). apply some lubrication on it and stimulate the rectal area to see if your child passes stool. if this does not help then try seeing your local pediatrician who can help with rectal stimulation and passage of his stool. for further queries consult a paediatrician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to remove pimples and the scars on my face?"}, {"role": "assistant", "text": "pimple is somewhat hormonal and due to oily skin. remember the following measures to control pimples. do not use hair oil and avoid oily foods chocolates and milk products. do not use any steroid creams. face wash and soaps are not the treatment and they do not help. do not touch the acne and avoid pressing it. regarding treatment of pimple i suggest clindamycin (clintop faceclin or clear gel). this is more of preventive and curative so i tell patients to use it all over face in the morning and use adapalene gel (adapalene or differin) over acne in the night. i also suggest you to take tablet doxy (doxycycline) 100 mg once in a day. consult your doctor discuss with him/her and take the medicine with consent. if you have acne marks avoid direct sunlight exposure as much as you can. wear sunglass cap and cover exposed part of your body all the time use sunscreen thrice in a day such as 10 am 12 pm and 3 pm. it has to be applied all over the face. sunscreen spf (sun protection factor) should be around 50. use anti-pigmentation cream over pigmented parts like kojic acid hydroquinone depiwhite cream etc. in the night. ideal treatment is glycolic acid peels. sittings of six to eight peels must be required. post acne scars are three types. box scar ice-pick (pinpoint scars) and rolling scars. pinpoint scars are difficult to treat while box scars are easy. no cream or tablet can help you out in scars. best technique is co2 fractional laser and subscision. it takes five to six sitting but results are better than any other procedure. dermaroller and subscision are also other methods but less effective than the above. fillers do have hiding effect. it fills the pits and gives impression of fullness and it is not permanent. if scars are not much prominent then peels also could be effective. these are technique you can go through. all procedures take four to five sitting and five to six months for better results. for further information consult a dermatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i brush my teeth twice daily. even then my teeth are yellow. what to do?"}, {"role": "assistant", "text": "even after brushing twice daily if your teeth remain yellow then there are chances of calculus deposits on your teeth. brushing alone does not remove calculi. a painless dental procedure called scaling has to be done immediately. scaling is a must for you at this stage because calculi left untreated will cause gum problems. consult a dentist online to know more about scaling --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to confirm my pregnancy?"}, {"role": "assistant", "text": "the history typically suggests an implantation bleed but as your dark brown bleed coincides with the menstrual due date. it may have been scanty menses as well. now as you have done the urine pregnancy test after 7 days post missed periods and it was negative it does rule out pregnancy. as you feel that you may still be pregnant the best way is the blood serum beta hcg test (human chorionic gonadotropin) which can be done to allay your doubt. if the beta hcg levels are more than 1 then the pregnancy is confirmed. else if it is less than 1 then it is ruled out completely. the symptoms you are experiencing can be safe attributed to premenstrual syndrome if the test is negative. premenstrual syndrome mimics early pregnancy symptoms like headache nausea sore breasts mild cramps and increased frequency of urination. this may indicate that you may resume your menses in a few days if the beta hcg is negative as well. for further doubts consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "does lexapro take a long time to start working?"}, {"role": "assistant", "text": "if lexapro (escitalopram) caused insomnia then it is better to take the drug in the morning after breakfast. this drug is an ssri drug (selective serotonin reuptake inhibitor) and helps to reduce depressive symptoms when taken regularly. buspirone is an anti-anxiety drug that helps to reduce the symptoms. in my opinion lexapro is the better choice for mixed anxiety and depressive symptoms. for further doubts consult a psychiatrist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my period has been late by 4 days. i am trying to conceive. please help."}, {"role": "assistant", "text": "i understand your concern completely here with regards to inability to conceive. the fact that you have just missed your menses by four days usually the urine pregnancy test is not conclusive till eight days post missed periods. go for a serum beta-hcg test. if it has been done and it show low level of hcg then you are not pregnant. i presume you are talking about serum beta-hcg test here which is negative. i am not sure if your husband has been investigated for his semen analysis and quality as this is the first thing which should be done. secondly it is important to know about your own fertile period which is the best time for the woman to conceive. thirdly it is important to learn whether your menses have been regular hormonal profile is normal and you are ovulating regularly. so if you have undergone any tests already then please send them across for a review. revert back with the test results to an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to get rid of bad breath? i floss brush every morning and night but still suffer from bad breath."}, {"role": "assistant", "text": "do not worry. after following these tips you will feel better and get rid of bad breath by 2 weeks. start using chlorhexidine mouthwash thrice a day for 4 weeks. do saline water mouth rinses (take lukewarm water in a small cup and add 1/4th teaspoon salt in it) thrice a day for 2 weeks. avoid soda drinks and food that may cause acidity watch your diet carefully. if you are already having complaints of acidity or heart burning or stomach ulcer problem then visit gastroenterologist because stomach problems can be one of the major causes of bad breath. check in mirror if you have yellow plaque or calculus deposits around the teeth and gum margins then first visit your dentist and get scaling done and then use mouthwash and do saline rinses. the results will be quickly evident. check if you are a mouth breather and try to control the habit. read dentist advice to get rid of bad breath. follow up after 2 weeks. stay happy."}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "shall i use mtp kit as my last period was before 43 days?"}, {"role": "assistant", "text": "first you have to check urine for pregnancy. the pregnancy test will be positive from the next day after the missed periods. so you should get two lines if pregnant now. once confirmed have a scan to confirm the location of pregnancy. mtp (medical termination of pregnancy) kit will dislodge the pregnancy if it is intrauterine. so its location has to be confirmed whether inside uterus or not. unfortunately if it is in the tube then management is different. once intrauterine pregnancy is confirmed then you can use mtp kit any day sequentially. it is most effective up to 12 weeks of pregnancy earlier lesser the bleeding. you have a lot of time so do not be in a hurry. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my teeth are yellow. is scaling only a temporary process to clean the teeth?"}, {"role": "assistant", "text": "yellowing of teeth is mainly due to one of the following or a combination of these: 1) tartar or plaque deposits (soft yellowish deposits) on the teeth. 2) calculus deposits (calcified hard deposits) on the teeth. 3) fluorosis - internal discoloration of the teeth due to altered fluorine content in the drinking water. you have given an excellent description of the clinical condition of your oral cavity. from your history it is very clear that the yellowness of your teeth is due to plaque and calculus deposits. plaque as you have mentioned is yellowish and creamy. this gets partially removed with brushing. calculi are hard deposits either yellowish greenish or sometimes blackish in color. they are firmly attached to the teeth and do not go off with brushing or tooth powder. even the abrasiveness of the tooth powder cannot remove the calculi. during childhood due to improper brushing there are chances of plaque and calculus formation over the teeth. because children at this age tend to be playful and do not concentrate on oral hygiene. \"tooth worms\" as people say are nothing but bacteria that affect the teeth. these bacteria act on the teeth and cause demineralization of the teeth and lead to tooth decay and cavities. the lower incisors and canines are more prone to plaque and calculus deposition (v shaped deposition in accordance with the tooth morphology) due to inability of us to reach the inner sides of these teeth while brushing. at this age of yours these deposits may be due to: 1) improper brushing technique. 2) brushing only once a day. 3) malalignment of your teeth. 4) crowding of your teeth (due to inadequate spacing in between the teeth). 5) if you are having any prosthetic teeth (crown bridge removable appliances). 6) if you are undergoing orthodontic treatment (wire braces). dental scaling is the procedure that removes plaque and calculi. but it does not mean that these deposits will not come back again. continuous oral hygiene maintenance after scaling is mandatory to prevent recurrence of plaque and calculi. hence scaling is not a wastage of money it is an investment to prevent one's teeth and gums from infections and thereby increase the life of the teeth. so a permanent solution for your problem is to follow these steps to maintain oral hygiene: 1) brush with toothpaste and brush twice daily. the head of the toothbrush should be angulated in such a way that it reaches all the teeth and all the interior and hidden parts of the teeth. 2) use an antibacterial mouthwash only for the time period for which the dentist has prescribed. because long term use of mouthwash itself will cause staining of teeth. 3) rinse your mouth thoroughly soon after every meal. 4) in case you are wearing wire braces or prosthesis use the specific tooth brushes (orthodontic toothbrushes) to clean the teeth thoroughly well. 5) use interdental toothbrushes to clean the minute spaces in between the teeth. 6) visit a dentist once in every 6 months and get a scaling done if necessary. as your doctor has told regular use of colgate toothpaste is sufficient. sensodyne toothpaste is not needed for you since it is used for hypersensitive teeth. glodent toothpaste helps in stain removal and it can be used if extrinsic stains are present on the teeth. it does cause teeth whitening. regular use of mouthwash is not essential. you can use hexidine mouthwash for about two weeks and then stop it. bleaching is the procedure used to remove internal or intrinsic staining of the teeth which is not required for you. and finally pearl white color of the teeth indicate that they are unhealthy. teeth which are slightly yellow without any deposits on them are said to be healthy. hope this answer helps you. take care. consult a dentist online for further follow up --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my mouth stinks very badly. what shall i do?"}, {"role": "assistant", "text": "get a full mouth scaling done from a dentist. start using antibacterial mouthwash (example: listerine) twice daily for two weeks. this is the best for stinking mouth (bad breath/ halitosis). another method for cure of bad breath is saline mouth rinse. take a small cup of lukewarm water and add 1/4th teaspoon of salt in it and rinse thrice daily for 10 days. you must get the cause identified. treating the root cause will give a permanent solution for bad breath. if the halitosis remains evenafter the use of mouthwash for two weeks consult a dentist online for further treatment."}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "took urine pregnancy test on the 1st day of missed periods. is that right?"}, {"role": "assistant", "text": "you tested too early with a urine pregnancy test. please wait for three to four days and then retest if period does not start by then. urine pregnancy test though theoretically can give correct result on the day of a missed period practically it is not that sensitive and you need to wait for three or four days extra for beta hcg (human chorionic gonadotropin) to rise enough to be detected by a urine test. another possibility is a genuine negative pregnancy and impending period causing cramps. the second possibility is that of threatened miscarriage or ectopic pregnancy in which case the rise of beta hcg is slow and cannot be detected in urine test so early. it is too early to draw any conclusion and you need to wait for the situation to become clear. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to prevent bleeding on brushing?"}, {"role": "assistant", "text": "you should use betadine gargle as mouthwash twice daily for 15 days to reduce the swelling of gums and bleeding and also to keep your teeth clean. it would be better if you could go to a dentist for physical evaluation. ask your dentist to do cleaning of your whole mouth (dental scaling) to remove calculus and plaque from your teeth and gums. cleaning will reduce the bleeding and helps to maintain good oral hygiene. try to get your mouth clean routinely every six months to get healthy gums. for further information consult a dentist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "there is a tooth decay started in my all tooths on lower backsides"}, {"role": "assistant", "text": "if you think it is a decay that has started in your teeth i would like you to go to your nearby dentist and get it confirmed. if it is decay then your dentist might suggest you to get some dental fillings done. if it is just stains that you are noticing then the stains could be removed by dental scaling that is cleaning. decay can be formed due to lots of food impaction in the back tooth regions which is a very common complaint. sometimes even though we are good in brushing there are areas where the brush cannot reach. for further information consult a dentist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is it fine to use mifepristone for abortion after c-section?"}, {"role": "assistant", "text": "first please confirm the pregnancy with a serum beta-hcg test (human chorionic gonadotropin) as urine pregnancy test is not reliable till eight days post missed periods. if the hcg levels are more than 5 ng/dl then she is pregnant. in that case as she has been a post c-section case medical abortion is not to be undertaken with either mifepristone or misoprostol simply. because the c-section scar would still be weak by one year and there are often chances of uterus rupture. the best option in that case would be an ultrasound guided dilation and curettage procedure for surgical abortion. please meet your gynecologist and get the needful. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is it normal to miss periods after taking i-pill?"}, {"role": "assistant", "text": "amenorrhea is not a disease. amenorrhea is simply absence of the menstrual cycle. a lot of females have missed periods for one or two cycles after taking i-pill and this is normal. in most cases cycle resumes after one or two missed periods. so no need to worry. within one to two months her periods will resume. so no need to do anything. as she bled three to six days after taking i-pill there is no risk of pregnancy. the amenorrhea is the side effect of i-pill only. it is not a matter of fear. no need to do anything. just remain relaxed and wait for her periods to resume. for further information consult a sexologist online --><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "why have i missed my periods?"}, {"role": "assistant", "text": "this type of missed period could be due to ovarian cyst which can also cause painful cramps with brownish spotting. polyp can also cause pain with brownish spotting. if your hormonal profile is normal then yes you will get periods. please get lh (luteinizing hormone) and fsh (follicle stimulation hormone) done to understand about delayed period if it reoccurs. please share images of ultrasound to guide you further. revert back with the images to an obstetrician and gynaecologist online --><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i bled after i-pill but missed period on due date. am i pregnant?"}, {"role": "assistant", "text": "first of all relax. you are not pregnant. your periods came early because of i-pill medicine (emergency contraceptive pill). sometimes it can make periods come early and sometimes it can delay. in your case it made your periods early. but i want to caution you that you should not use i-pill medicine in daily routine as it is a very strong medicine and have side effects also. in your case you did not even need to take i-pill because your periods finished on 12th and you had sex on 15th. you cannot become pregnant if you do sex in the first 10 days of your periods. for further information consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am suffering from depression and not getting well with ssri. please help."}, {"role": "assistant", "text": "you are currently on ssri (selective serotonin reuptake inhibitor). have you consulted a psychiatrist or your cardiologist regarding medicines for depression? several medications are available for treating depression but each drug takes on an average of two weeks to exert the effect. one point i would like to mention is that you are on clonotril (clonazepam) and ativan (lorazepam). both should be tapered off. besides medicines meditate daily for at least half an hour in the morning. it will help a lot. maintain a stress diary and log your thoughts daily. in some cases certain drugs do not help but still depression can be cured. for further information consult a psychiatrist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am doing better with my anti-anxiety drug. do i need counseling?"}, {"role": "assistant", "text": "from your detailed information i feel that you have responded to medication. all ssri (selective serotonin reuptake inhibitor) medications tend to over time make the person who takes them more relaxed. this could be attributed to the main task of reducing anxiety. thus maybe a lower dose for a few months may benefit. importantly absence of anxiety or motivation is more troublesome. also i do not think that any counseling will help you. as you are already aware and attend to the problem of not pursuing tasks to completion cbt (cognitive behavioral therapy) or nlp (neuro-linguistic programming) or coach may help. for further information consult a psychiatrist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is laser treatment safe for acne scars?"}, {"role": "assistant", "text": "for acne in your age group it is always important to rule out pcos (polycystic ovarian syndrome). to find that out you need to tell me whether you have irregular periods. how many days does your period date shift from the expected date? do you get any hair growth in facial areas like upper lips or chin? although your weight is correct for your height pcos can be present in thin individuals as well. we can start the treatment for acne depending on your hormonal profile results. fillers are of different types depending on the area to be treated such as tear trough (under eyes) lips cheeks etc. nowadays all doctors prefer to use semi-permanent fillers because of their advantages. these typically last for a year on an average. revert back with the answers to the questions to a dermatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can fluoxetine cause disturbed sleep?"}, {"role": "assistant", "text": "fluoxetine is known to cause significant insomnia in many patients as it is an activating drug. being an selective serotonin reuptake inhibitor (ssri) fluoxetine causes sexual dysfunction. both these side effects can be treated by taking tablet trazodone (brand name trazaril) 25 mg at night time. it antagonizes the side effects of fluoxetine. after two weeks if needed the dose can be increased to 50 mg. the probable causes:fluoxetine induced sexual dysfunction or insomnia. probable diagnosis:ssri induced sexual dysfunction. treatment plan:tablet trazodone 25 mg at night time. regarding follow up:for further queries consult a psychiatrist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "seven days since i missed my period. pregnancy tests negative. why?"}, {"role": "assistant", "text": "if you have taken the urine pregnancy test after seven days of missed periods then the results are usually conclusive. you may repeat the test after 48 hours and if it is still negative then you are not pregnant. the delay can possibly be due to stress induced hormonal imbalance especially during this cycle due to stressors which can easily delay your menses. if your menses do not arrive naturally in next one week then you may opt for a withdrawal bleed with progesterone. a single delayed period is not an indication for infertility workup. repeat the tests and consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am not sure if i have rosacea. please help."}, {"role": "assistant", "text": "rosacea is a skin disorder that affects people above 30 years. other than acne like lesions people with rosacea have redness of face and dry skin associated with burning sensation. they also have redness and irritation in the eyes. the redness of the face is aggravated by triggering factors such as weather changes stress alcohol consumption exercise and spicy food. yours clinical condition is not rosacea since your history is contradicting with the above said information. you seem to have acne. the cysts are a part of acne. acne varies in severity from individual to individual. some may have mild acne which may come off and on. others may have almost incessant eruption of acne which may leave behind post acne hyperpigmentation and acne scars. for acne you need to be constantly taking care care of your skin until the tendency for new acne formation dies down. topical treatment of acne mainly revolves around topical antibacterials (clindamycin gel or nadifloxacin gel) benzoyl peroxide and topical retinoids. topical retinoids are comedolytic thereby preventing new acne. for inflammatory acne (papules and pustules) i advise to start with one of the oral antibiotics either azithromycin doxycycline or minocycline. cystic acne is an indication for starting oral retinoids. they are the most effective drugs for acne and are usually first choice in severe acne or cystic acne or moderately severe acne or acne not responding adequately to traditional anti-acne medications or acne significantly affecting the quality of life of patients regardless of severity. you could also take a few peeling sessions like salicylic acid peels from a dermatologist. salicylic acid peels are specific for acne. acne is a recurrent condition and once your acne is brought under good control with oral and topical anti-acne medicines you should still continue to use a cream/gel (topical retinoid) for maintenance of improvement. topical retinoids are ideal for maintenance of improvement because they are comedolytic as well as anti-inflammatory thereby preventing the formation of new acne. for further follow up consult a dermatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "shall i get chemical stress test to know the reason for tachycardia?"}, {"role": "assistant", "text": "episodic tachycardia in the setting of pac and pvc (premature atrial and ventricular contractions) is suggestive of arrhythmia may be atrial fibrillation or flutter. we should try to find the cause for it. do you smoke or have alcohol or any other stimulant drugs? do you suffer from snoring interrupted and unrefreshed sleep daytime sleepiness headaches etc? is there any history of exertional chest pain? since your holter has not picked anything the next step is the stress test. there is no harm in undergoing it and it will help us to rule out ischemic heart disease as well. do you have had any episodes when you were on holter? if not and you are having those episodes more frequently now then you can consider wearing holter again. otherwise undergo the stress test. the next option is electrophysiological studies and it is an invasive test but will diagnose and treat the arrhythmia in the same setting. i guess echo must be normal before starting flecainide. regarding treatment i would suggest beta blockers like metoprolol 25 mg to 50 mg according to heart rate and flecainide should be pill in pocket approach that is as and when needed. for further information consult a cardiologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my overall sexual desire has gone down after taking tablet flunil. should i stop taking this drug?"}, {"role": "assistant", "text": "fluoxetine (tablet flunil 20) belongs to the ssri (selective serotonin reuptake inhibitors) class of antidepressants. fluoxetine is one of the notorious antidepressants in relation to sexual side effects. the available data indicate that about 30-40% of those taking fluoxetine develop some sexual side effects. in regard to reversal of side effects it is said that once you stop the drug the side effects recover almost completely. there is no need to worry if you are recovering from the ailment for which flunil was prescribed. but if you do not see any improvement even after four weeks of treatment then it is advisable to stop flunil and use some better alternative. you can consult a psychiatrist online for safer alternatives. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what will be the reason for headache chest pain and dizziness?"}, {"role": "assistant", "text": "there are two possibilities. one is anxiety episodes and the other one is cardiac arrhythmia like psvt (paroxysmal supraventricular tachycardia) or atrial fibrillation in which heart rate suddenly goes up and also suddenly decreases. do you have any palpitations or increased heart rate? if yes then it can be cardiac arrhythmia. how long does it persist? blood pressure falls during these episodes and one has dizziness fainting blackouts and sometimes syncope. usually ecg is normal as it is generally done in between the episodes. ecg done during the episodes will show abnormality. you will need 24-hour holter monitoring. so you should visit a nearby cardiologist for these investigations. also hemoglobin and thyroid test should be done. ln order to abort such episodes you should try to cough hard. until the time your evaluation is complete you can ask your local doctor for tablet ciplar la (propranolol) 20 mg once a day which will cover for both the things. for further information consult a general medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is surgery necessary for heartbeat irregularities?"}, {"role": "assistant", "text": "your heart condition is a cardiac arrhythmia which is called psvt (paroxysmal supraventricular tachycardia) in which heart rate suddenly goes up and also suddenly decreases. the blood pressure falls during these episodes and one has dizziness fainting blackouts and sometimes syncope. ln order to abort such episodes you should try to cough hard or do neck massage as advised. there are two options for this as follows. if it is well controlled on medicine and you are not willing for electrophysiological studies then you can continue with medicine. but you need to take this medicine lifelong. electrophysiological studies which is an invasive test and it is a minor procedure which can treat the arrhythmia permanently in most of the cases. during this procedure the doctor approaches your heart through an artery with needle and wire. for more information consult a cardiologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have lot of acne scars on my face that make me look ugly. please suggest me treatment for the same."}, {"role": "assistant", "text": "contractubex gel is topically applied to reduce scars. it is very effective on various types of scars. other modes of treating scars include: fractional laser treatment - a non-invasive technique to remove scars. it is the best option but is slightly expensive. microdermabrasion - a non-surgical mechanical method of removing the outermost dead skin cells layer. subcision - a surgical method to remove acne scars. dermaroller therapy - generates new cells. but the procedure is decided depending upon the type of scar. consult a dermatologist online to find out the best treatment option for your acne scars. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can implantable cardioverter defibrillator cause afib?"}, {"role": "assistant", "text": "implantable defibrillators are implanted to terminate an episode of atrial arrhythmia. afib (atrial fibrillation) is also a type of atrial arrhythmia. the icd not only provides treatment for atrial arrhythmias but also provides treatment for ventricular arrhythmias as well as rate-responsive dual chamber pacing for the treatment of bradycardia. the pacing attempts to gain control over the arrhythmia by interrupting the pathway of the atrial arrhythmia and uses low energy pacing which is usually goes unnoticed by the patient. in cases when atp (antitachycardia pacing) is successful the patient may not even be aware that they have had an arrhythmia until their device follow-up. so the answer for your question is icd cannot cause atrial fibrillation until and unless it is implanted incorrectly; rather it will terminate an episode of atrial fibrillation automatically. for further information consult a cardiologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what causes dull cramping discontinuous chest pain?"}, {"role": "assistant", "text": "we are here to help you. from the way you are describing it seems either you had an arrhythmia that time or you had angina pain. since your blood pressure and heart rate are in normal ranges without medicines you should avoid any medicines at this time. i would recommend for you a treadmill test that is a stress test to rule out any angina on exertion. if that comes out to be normal then you would need to go for holter monitoring. take antacid drug like omeprazole for this purpose as this would help you in fighting with acidity as a cause of chest pain. however acidity is very unlikely to be a cause for that. i hope it helps you. revert back after the tests to a cardiologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what are the ways to remove acne scars?"}, {"role": "assistant", "text": "for acne take a course of tablet azithromycin 500 mg daily on three consecutive days in a week for four to six weeks and continue with benzoyl peroxide 2. 5 percent gel on the pimples in the morning and adapalene gel at night on the pimples. as far as scars are concerned you can try using tretinoin 0. 05 percent cream on the scars at night. it will not have significant benefit but you can give it a try. otherwise you can consider going for laser treatment microneedling sessions or surgical correction for the scars. besides this avoid oiling of scalp keep your face dry avoid using creams and moisturizers and reduce the intake of sugary foods. for breast changes and lump i would recommend you to consult a surgeon as he will be able to guide you better regarding these symptoms. for dandruff use a ketoconazole shampoo every alternate day to start with and then taper slowly once improvement is seen. along with this use a good quality conditioner after hair wash and start with tablet keraglo eva (gamma lenolenic acid) once daily for hair fall. this needs to be continued for a minimum of three to four months. for back pain consult an orthopedician and for allergy consult an ent specialist. baking soda and lemon juice will not have any effect on acne scars. so you can stop using them. dairy products are known to aggravate acne so reduce their intake. i do not think the burning sensation is due to acne scars. you should go for la shield sunscreen gel over your entire face at intervals of three to four hours during the daytime. for further information consult a dermatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "kindly advise regarding my chest pain as the test results are normal."}, {"role": "assistant", "text": "cardiac origin of chest pain is highly unlikely in a 29 year old female. female has a cardioprotective hormone called estrogen which usually delays the onset of coronary artery disease till 65 years. the pain you get is most likely because of high levels of your anxiety or overthinking. once shunt reversal in pfo (patent foramen ovale) is ruled out then you can ask your cardiologist to start you with a low dose of ssri (selective serotonin reuptake inhibitor) like paroxetine along with low doses of anti-anxiety medicine benzodiazepine like clonazepam for two to three months. as echo and blood profile is normal it is not cardiac. however you have not mentioned if you are a smoker or alcoholic. is there any family history of early cardiac death? what is the shunt direction in pfo in 2d echo? what are the symptoms of lung congestion? how long does the pain last? what is the frequency of your pain and is it associated with sweating? a thorough history is a must before giving a cardiac clearance. please answer the above. for further information consult a cardiologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my mother does not complain of chest pain but her ecg is abnormal. how?"}, {"role": "assistant", "text": "your mother's test results show abnormalities. that is why the doctor has recommended cag (coronary angiography). the ecg shows st segment flattening at v which indicates ischemia (reduced blood supply) and can lead to a heart attack. it can occur in patients without chest pain. the choice for the type of angiography should be made by the attending physician. he or she will be in the correct position to decide the best for her based on his experience. there is nothing much to panic. it is mostly due to the long-term effects of diabetes. for further information consult a cardiologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "despite taking medicine for the past four years i am facing depression and anxiety. why?"}, {"role": "assistant", "text": "depression and anxiety treatment should be given for long duration for best results. even with medicine your symptoms are persistent so this is not the time to stop the medicines. but the prescription should be evaluated. do not think of reducing the doses by own and talk to your doctor before making any change in the prescription. cognitive therapy with a good psychologist can help you to come out of depression. the therapy runs in sessions and a proper therapeutic relationship is made between the patient and psychologist. this can reduce the need to drugs. supplements containing omega fatty acids vitamin b12 etc. can be used in diet and will naturally potentiate the actions of antidepressants. for further information consult a psychiatrist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to cope with exam failure?"}, {"role": "assistant", "text": "success and failure are part of life but we should keep trying. when we are down only way is up. i know it is easier said than done but you have to keep trying and persistence is the only key to success. here are a few steps that can help you. do meditation daily for at least half an hour in the morning. follow a routine exercise regularly and take a balanced diet rich in antioxidants and omega fatty acids. you study in small shifts of half an hour followed by 5 minutes rest. also give at least one hour daily for your hobbies. share your feelings with family or close friends as sharing helps a lot. remember every problem has a solution you just need to try solving it and help is just a step away. for further information consult a psychiatrist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is cabg the only solution for coronary artery disease?"}, {"role": "assistant", "text": "i have carefully reviewed your health query and feel sorry for your father's health issues. it is a concerning disease process. i never recommend to leave it as such and do nothing much for an advanced coronary artery disease. he has got triple vessel involvement and in such circumstances the best next step is to go for cabg surgery (coronary bypass graft) especially if there is no obvious contraindication. no partial angioplasty is not a solution to the problem. although he has no obvious signs or symptoms but you should know well that the disease inside has progressed much and anytime with or without strenuous physical activity he may get a severe heart attack that can be really dangerous and lethal. i would go with the suggestion of cabg right away. for further information consult a cardiologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "either mr angio or ct angio which will show brain aneurysm clearly?"}, {"role": "assistant", "text": "ct angiography has sensitivities of 77% to 97% and specificities of 87% to 100% for picking up an aneurysm. mr angio sensitivity and specificities are way less than ct angio. so when ct angio is negative for an aneurysm it is good news. even more important to know is that with level 1 evidence the 1 or 2 mm aneurysm does not require intervention when they are unruptured and patient is under 36 non-smoker not hypertensive or with negative family history of aneurysms. i assume that you are not a smoker or hypertensive as you have not mentioned anything about that. take care. for further information consult a neurologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what should i do to concentrate in my studies?"}, {"role": "assistant", "text": "i can understand your concern. the recurrent distractibility could be occurring due to anxiety and should be evaluated. intrusive thoughts during studying result in distraction. if remembering the things related to the past and imagining things are causing distress then that is most probably due to anxiety and need treatment. please consult a psychiatrist for evaluation of this problem and for treatment. if there are no intrusive thoughts then supplements containing omega fatty acids vitamin b12 and e can be used to improve the concentration. it will help in improving focus in your case. for further doubts consult a psychiatrist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "why do i keep getting a lot of negative thoughts about my health?"}, {"role": "assistant", "text": "these kind of ruminations are quite common especially in premenstrual period. the things that will help you are as follows. meditate daily for at least half an hour in the morning. daily write down whatever that comes to your mind uncensored and never read it again. avoid caffeinated drinks and add foods rich in antioxidants and omega fatty acids in your diet. if these things do not help even after two weeks then consult a psychiatrist. for further queries consult a psychiatrist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i want to know whether my liver is in bad condition."}, {"role": "assistant", "text": "the liver is a workhouse for metabolism of protein and fat (lipids). when there is an excess of lipid in your blood than the capacity to metabolize by the liver the excessive lipids start to accumulate in hepatic cells known as fatty liver. this is an ongoing process if not taken proper steps to prevent it. i am sure that your liver is not in bad condition at all and it can be reverted to normal metabolism by regular exercise intermittent fasting use of omega fatty acids containing oils in diet reducing fat content in diet and by avoiding alcohol. the probable causes:diet and alcohol. investigations to be done:lft (liver function tests) and ultrasonography abdomen. probable diagnosis:fatty liver. treatment plan:conservative treatment. preventive measures:1. regular exercise. 2. intermittent fasting. 3. use of omega fatty acids containing oils in the diet. 4. reducing fat content in diet. 5. avoiding alcohol. regarding follow up:for further information consult a medical gastroenterologist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "which is the best peel for rosacea?"}, {"role": "assistant", "text": "rosacea is a condition which may get aggravates during season change temperature change exercise alcohol and stress. in rosacea skin becomes very sensitive and you cannot apply for any other medicines. as you said treatment prescribed by the previous doctor worked for you you can continue those medicines. we use salicylic acid (20% to 30%) or azelaic acid peels. rosacea makes skin very sensitive so we defer using peels at home as peels contain acid which may also harm if not applied under supervision. patient friendly peels are not easily available. you can go to your local dermatologist and ask for these peels. meanwhile i suggest you topical salicylic acid 2% gel or azelaic acid 20% gel. why do not you like to take oral medicines if you have pimples like lesions in rosacea? they also work very well. for further information consult a dermatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is my dht level causing mild hair fall and flaky scalp?"}, {"role": "assistant", "text": "flaky scalp not responding to noskurf (combination of climbazole piroctone olamine aminodermine and almond oil) lotion may be scalp psoriasis and need steroid plus salicylic acid 6 % combination lotion. the pain is due to hair root inflammation which is commonly seen in male pattern baldness. i would suggest you get the following test done. serum dht (dihydrotestosterone) level. thyroid profile. cbc (complete blood count). if dht is high then we have a specific treatment for that. both psoriasis and hair fall may increase due to stress. it is good that you are taking preventive steps. revert with more information to a dermatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am just fed up with my dark complexion. please prescribe me some skin whitening product."}, {"role": "assistant", "text": "natural complexion is the best. cosmetics do more harm than good. you can avoid them. melanin pigment in the skin protects against cancers. presence of more melanin in the skin gives the dark complexion. you can use sunscreen lotions which help in preventing tan due to sun. there are mild peeling agents with salicylic acid used in skin peel treatment. to discuss regarding the skin peel treatment consult a dermatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can cotaryl cream be used to cure dry and flaky skin (ichthyosis)?"}, {"role": "assistant", "text": "ichthyosis as you rightly mentioned is a genetic condition leading to excessively dry and flaky skin. there is no cure for this condition but it can be controlled by using right medications and thus bringing the normal texture back. for the same follow these suggestions: use a mild soap like cetaphil soap. use lukewarm water to bathe and add liquid paraffin (2 caps full) in the water. after having the bath use a cotton wash cloth to slightly rub off the scales. this will dislodge the scales. always pat your skin to make it dry. use a thick emollient after bathing like cetaphil dam. mix cetaphil dam cream and cotaryl cream in equal amounts and apply all over the body. apply cotaryl cream over the affected area at night. and whenever you feel the need of moisturiser just use plain cetaphil dam. take diet rich in omega fatty acids such as fish nuts flax seeds and etc. once in a week use an oat meal scrub. mix powdered oats cream and milk and apply it over body and scrub it off. follow all these above steps regularly and you will be sure notice a positive change. consult a dermatologist online for further help --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am unable to sleep at night because of stress. please help."}, {"role": "assistant", "text": "i feel sorry for your loss. your problems are stress unable to sleep at night and body pain. so basically it is your stress that is leading to other problems. stress can be managed both by medication as well as by lifestyle modifications (behavior therapy). first try lifestyle modifications which include: drink plenty of water. whenever you sit idle make it a practice to take deep breaths. include one tomato in your diet daily. add omega 3 fatty acid supplements. exercise outdoor regularly. exercise will help to release endorphins which will lift the mood and activity levels. breathing for relaxation - inhaling and exhaling exercise or yoga. take diets rich in protein carbohydrates and low in fats. increase the intake of walnuts hazelnut flax seeds in diet. these diets are known to be a rich source of omega fatty acids. also proper sleep hygiene needs to be practiced daily so as to help you to maintain good sleep in the long run. sleep hygiene entails following important points. adhering to a fixed sleep in and wake up time. wearing loose cotton clothes at night for sleeping. keeping the room dimly lit and well ventilated. changing room or bed temporarily. avoiding stimulant substances in the late evening or night such as coffee tea etc. and also avoid watching television or listening to music late at night. avoid eating heavy oil rich fried meals late in the evening and at night. take small frequent meals at regular intervals and dinner at 8 pm with good time interval between dinner and sleeping. a warm cup of hot milk15 minutes before going to bed can help in good sleep. these lifestyle modifications will help in improvement of symptoms and you will feel better. if symptoms persist even after lifestyle changes then visit a psychiatrist. drugs like modafinil or armodafinil will help to maintain daytime alertness and will reduce fatigue. visit a psychiatrist for proper prescription of this drug. for further information consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can we use glycerin suppository twice a week for my 2 month old daughter?"}, {"role": "assistant", "text": "this must probably be your first child that is why this query. please note that children under the age of six months may pass stools either 10 to 15 times a month or once in 2 to 3 days. and it is absolutely normal. you should be worried only if the child has not passed stools is vomiting and has abdominal distention. otherwise it is fine. also you can give neopeptine (combination of simethicone amylase and papain) and decolic (combination of diazepam and dicyclomine) when required. no harm would be done. for further queries consult a paediatrician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "though my baby is exclusively breastfed why does he fail to thrive?"}, {"role": "assistant", "text": "please note that the weight gain of your baby is fine. normally birth weight doubles by the age of 6 months which i think it has. as for 7-1/2 months of age the weight is only a very little bit lesser probably because of reflux issues. also babies pass stools either 10 to 15 times a day or once in two to three days so i do not think there is constipation. i feel that if the baby had any major problems then the child will not be able to become double of birth weight by 7 months of age. according to me the child is having a fair amount of weight gain which is slightly on the lower side probably due to the reflux which will go away eventually with age. also you can give multivitamins and calcium supplements to help the baby. also give mashed foods along with breast milk to the baby. for further information consult a paediatrician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i do not have oily foods but still have pimples. why?"}, {"role": "assistant", "text": "i can understand your concern. you need to take proper medicine for the treatment of pimples so that dark spots will not appear. use a salicylic acid face wash twice daily and apply benzoyl peroxide 2. 5 percent gel on the pimples twice daily. along with this take a course of tablet azithromycin 500 mg daily for three consecutive days in a week for six weeks. for the dark spots apply tretinoin cream 0. 05 percent on the dark spots at night in minute amounts. sometimes dandruff is also associated with pimples. if you have dandruff use ketoconazole shampoo twice weekly along with tablet fluconazole 200 mg twice weekly. besides this keep your face dry avoid applying oily creams and moisturizers. you can use cosmetics labeled as noncomedogenic reduce the intake of sugary foods and avoid direct sunlight. the probable causes:seborrhea or hormonal imbalance. probable diagnosis:acne vulgaris with post inflammatory hyperpigmentation. regarding follow up:revert back after six weeks to a dermatologist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my baby is fussy while passing stool. is it due to anal fissure?"}, {"role": "assistant", "text": "yes it can be anal fissures. also you can look for a skin tag around perianal area which occurs in anal fissure. does the child have constipation or tight stools? because if it is an anal fissure then we will have to see the cause of hard stools as the difficulty to pass stool can cause fissures. he should also be checked for hypothyroidism. is there any blood in stools? most likely it is anal fissure. the rest all can be said on examination for which you should see a pediatrician. for further doubts consult a paediatrician online --><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "please suggest some good shampoo for dandruff."}, {"role": "assistant", "text": "i have gone through your complaints. you should start with shampoo containing salicylic acid and ketoconazole. use it every alternate day in the beginning. once you notice improvement gradually taper it to twice weekly and then once weekly. along with this apply clotrimazole and betamethasone combination lotion on the affected areas of the scalp twice daily. i also recommend you to take tablet ketoconazole 200 mg once daily in the morning and tablet levocetirizine 5 mg at bedtime. continue this treatment for two weeks and revert back. the probable causes:1. immune factors 2. hormonal factors 3. fungal infectionprobable diagnosis:seborrheic dermatitis. preventive measures:avoid oiling of scalp as it will increase your dandruff. regarding follow up:revert back after two weeks for follow up to a dermatologist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "would zantac make allergy skin test false positive?"}, {"role": "assistant", "text": "at present you are suffering from allergic rhinitis converting to allergic asthma. get your absolute eosinophilic count done and you need to go for spirometry only at the time of the attack to pinpoint the diagnosis. the differential diagnosis includes allergic bronchiolitis. i suggest you fexofenadine 180 mg at night and pantoprazole 40 mg half an hour before breakfast. if eosinophils are raised then i suggest you diethylcarbamazine. consult your specialist doctor discuss with him or her and take treatment. for further information consult an allergy specialist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "kindly suggest a good brand of infant formula for baby constipation?"}, {"role": "assistant", "text": "i can understand your concerns. if child is constipated on dexolac premium then you can switch to nan pro 1 lactogen 1 or similar advance. all are equally good. nan pro 1 is more preferred. for further queries consult a paediatrician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "baby passes stool only after two days. is it normal?"}, {"role": "assistant", "text": "if your baby is breastfed it is perfectly normal to pass stool less often. on the other hand it does not seem normal for such a young kid. if it continues for more than 2 weeks get him checked by a paediatrician. consult a paediatrician online to know the management of constipation in children --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "does peanut butter pose any allergy threat?"}, {"role": "assistant", "text": "you have asked an interesting question. peanut allergy is one of the most severe food allergies. it can cause itchiness urticaria swelling eczema sneezing asthma abdominal pain drop in blood pressure and cardiac arrest. it may even result in anaphylactic death if not controlled in the right time. the routes of exposure of the allergen are mostly the accidental ingestion of peanuts or pb by the concerned person (who is hypersensitive to peanuts). air-borne particles in a farm or factory or crushing environment may cause respiratory symptoms in allergic individuals. however the odor of peanut butter or its mere proximity have not produced any allergic symptoms in various studies conducted. hence answering your questions. it is safe to carry peanut butter in plane. if you are carrying it as part of hand baggage (cabin baggage) make sure it is packed properly in a colored container. this is just to prevent any psychogenic allergic symptoms in those susceptible individuals who may see the butter and develop allergy (however such psychogenic reactions are very rare but still documented in studies). since the pb as such is not an allergen by sight/proximity/odor a susceptible person need not take extra precautions to avoid allergy when someone else is carrying pb. however since psychogenic reactions can occur it may be advised that such a susceptible person may change his seat to another seat away from person who is carrying peanut butter. for further information consult an allergic specialist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my child struggles and tenses up so hard to pass stools. is there something she can be given to overcome this?"}, {"role": "assistant", "text": "your child has constipation. the common causes for constipation are anal fissure and dietary factors. if it has been for less than one month duration start lactulose 7ml twice a day for 15 days and revert back. give her high fibre diet and plenty of fluids. make your child sit in warm water for about 15 minutes daily such that her hips and buttocks are inside the water (sitz bath). if the constipation has been there for more than a month get these blood tests done: cbc (complete blood count) ttga (tissue transglutaminase antibody) iga thyroid function test and revert back to a paediatrician online --> <link> to know more about constipation in children read this article --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have chronic allergies which become worse in winter. please suggest ayurvedic medicine."}, {"role": "assistant", "text": "the allergic symptoms usually aggravate during winter season. it continues from november till february based on the climate in your place. you have not mentioned about the allergic site (nose or lung or skin). if it is nose or lung the dryness due to winter can trigger the allergic response in nose. in this situation you need to maintain moisture by just applying a drop of coconut oil in each nostril before going to bed. on the other hand you can apply a drop of anu thailam (an ayurvedic nasal drops for allergy) in each nostril before going to bed. during evenings and nights when it is too cold you need to protect your ears (by keeping cotton plug) nose (by applying oil drops) head (by covering head with a woolen cap) and hands and feet (by wearing gloves and socks). the external cold stimulus triggers the allergic response. so prevent yourself from the cold stimulus to avoid allergy. if you have allergic asthma then it is better to practice pranayama and yoga. breathing exercises will help you. if you have allergic skin disorder then you can use vaseline or vegetable oils to gently apply on the skin. this helps in overcoming the dryness due to the cold climate. the skin manifestation should also be examined by a physician to decide the proper medication. revert back to an ayurveda specialist online for further follow up --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to cure eye allergy?"}, {"role": "assistant", "text": "your doctor is right in saying that your son has allergic conjunctivitis. eye allergies called allergic conjunctivitis are a common condition that occurs when the eyes react to something that irritates them called an allergen. the most common allergens are dust and pollens. the eyes produce a substance called histamine to fight off the allergen. as a result the eyelids and conjunctiva (the thin filmy membrane that covers the inside of your eyelids) become red swollen and itchy with tearing and burning. the key to treating eye allergies are avoid or limit contact with the substance causing the problem. avoid rubbing eyes instead do cold compresses. use antiallergic eye drop like olopatadine along with lubricating eye drop. we prescribe mild steroid in pulse dose in case allergy is severe. in longstanding allergy we also prescribe tacrolimus (talimus ointment) with very good results. some doctors also prescribe cyclosporine instead of tacrolimus and that is also effective in longstanding cases. this will help you and i am very sorry to say that there is no medicine to cure allergy. only way is to stay away from all those things that you are allergic to. also this allergy will trouble him every year and usually after puberty it decreases. for further information consult an eye care ophthalmologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "having allergy problems for many years. i always have running nose or sore throat or excessive sneezing and coughing and cannot breathe normally. please help."}, {"role": "assistant", "text": "i totally understand your concern regarding cure of allergies. unfortunately allergy of the nose cannot be totally cured but definitely can be prevented. i would recommend the following:1. get an allergy skin test done; so as to identify the allergen. avoiding the allergen is half the solution to the problem. the allergen source could be dust sources like carpets/bedding/mattresses. avoid indoor plants/pollens. pet fur/hair is also a common cause. 2. get a ct scan of your sinuses. you could be having polyps in your sinuses; which may be contributing to your nose block. if so; your ent doctor may advise you to undergo a surgery to open up your sinuses; to enable you to breathe better. 3. taking a steroid spray regularly will give relief of your symptoms. you do need to take it for 2-3 months during the season. taking an antihistamine like allegra with steroid sprays is beneficial in moderate allergic rhinitis. 4. the latest treatment is immunotherapy; offered in some allergy centres. you can contact your local specialist for the same. it is a permanent cure; but it takes a long time for the immunity to develop. hope the above helps. if you do have a scan do share it with me and i can guide you further. keep your allergies under control; as a neglected sneeze can lead to aggravation of your wheeze. consult an ent otolaryngologist online for further help --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "why does my friend have numbness after hemilaminectomy surgery?"}, {"role": "assistant", "text": "it sounds like your friend is bothered by the persistent tingling and numbness in his left foot. i understand these sensations can be quite irritating especially if your work involves standing for long periods. did he have these tingling sensations in the same areas before the surgery? if so have these worsened after the surgery or remained the same? i assume his symptoms before the surgery were also on the left side and his hemilaminectomy was also performed on the left side. it will be nice if i could see the preoperative mri images to see what the hemilaminectomy was done for. often if the surgery involves removal of a large herniated disc or the space available for the nerve is very less (stenosis) then the nerve may get bruised during surgery due to retraction. this means that in order to decompress the nerve the surgeon has to retract the nerve to go around the nerve and remove the compressing elements. if the compression is severe the nerve gets bruised easily and there may be persistent numbness and tingling in the areas of the leg and foot that are geographically supplied by that nerve. since the surgeon has advised him to wait it out i assume this is likely the case. swelling of the foot is common if the nerve supplying that area is not fully functional. the weak muscles in the leg and foot are not able to push the blood back up towards the heart and gravity causes this dependent area to swell up. this is often seen at the end of the day and gets better at night when he sleeps. it is difficult to predict how long the tingling will last. it could be a few months. the fact that there is tingling and not pure numbness is actually encouraging although it is more irritating to the patient. if it were a complete nerve injury then only numbness would be experienced. the presence of tingling means that the nerve is just irritated inflamed and swollen due to the bruising. if the tingling is very bothersome he may try some neuralgic pain medications like gabapentin or pregabalin. nonsteroidal anti-inflammatory medications (nsaids) may also help in this situation. there is a very rare possibility of other complications like recurrent disc herniation other post-surgical changes irritating the nerve etc. these are difficult to diagnose and usually need a new mri with contrast. however it is advisable to delay such investigation for at least for two to three months after surgery since the mri images at this stage will be obscured by the post surgical changes. if the symptoms of tingling and numbness are progressively worsening and if he develops back pain a new mri may be needed irrespective of the time since surgery to rule out infection or instability. the probable causes:surgical retraction of nerve that may have caused it to bruise. investigations to be done:none if symptoms are not progressively worsening. differential diagnosis:recurrent disc herniation. treatment plan:gabapentin or pregabalin and nsaids. regarding follow up:for further doubts consult a spine surgeon online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is it normal to have palpitations during pregnancy?"}, {"role": "assistant", "text": "the palpitations you are experiencing are mostly a normal phenomenon during pregnancy. it is known as sinus tachycardia. nevertheless it is better to get an ecg done to reaffirm my suspicion. the hives and skin issues are also could be due to the hormonal changes in pregnancy. treatment plan:ecg if sinus tachycardia and then no need of any active intervention. regarding follow up:for further information consult a cardiologist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have episodes of dull pain over my left eye. what could be causing this?"}, {"role": "assistant", "text": "i read your query and understood your concerns. from the available description it is clear that you are having frontal sinusitis which can explain all of your symptoms except tingling sensation in groin. presence of pain on touch (tenderness) pain while in reclining position and coincidence of pain with post-nasal drip favors the clear cut diagnosis. one thing is that the episodic nature of pain which is not common with frontal sinusitis but can occur in few cases. i feel that pain over left eye and tingling sensation is not casually related as there is no condition which can explain both these symptoms on basis of single disease. the one possibility is anxiety associated with recurrent pain can be cause of tingling over the groin area although constant nature of tingling on same location points against anxiety. we can expect that complete neurological examination will reveal the true nature of association. at this moment i must assure you that this is not something serious and get yourself treated for sinusitis to break the event of chains. for further information consult a neurologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my partner bled heavily after 3 years of menopause. what to do?"}, {"role": "assistant", "text": "postmenopausal bleeding is the vaginal bleeding which occurs 1 year after attaining menopause. it should be evaluated particularly in whom with a family history of carcinoma. pmp bleeding patients are at high risk of endometrial cancer. the causes of pmp bleeding include vaginal atrophy (the most common) hormonal replacement therapy for menopause like tamoxifen endometritis or endometrial infection endometrial hyperplasia endometrial carcinoma cervical polyps cervical carcinoma and any other gynecological carcinoma. better to go for tvus (transvaginal ultrasound scan) pap smear and then endometrial biopsy based on the wall thickness. for further information consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what is the possible cause for increased heart rate?"}, {"role": "assistant", "text": "it can be a sinus tachycardia. a sinus tachycardia is a sinus rhythm with an elevated rate of impulses defined as a rate greater than 100 beats per minute in an average adult. the normal resting heart rate in an average adult ranges from 60 to 100 beats per minute. there are a number of causes for a sinus tachycardia. the most common causes include anemia smoking (increased nicotine acts a stimulant) or elevated anxiety level. drugs like propranolol and clonazepam will be given to you initially for 21 days depending on your anxiety levels sleep cycle and habits (smoking or alcohol use). for further information consult a cardiologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "swelling and hard bumps on elbow sore stiff hands in the morning. should i go to a rheumatologist?"}, {"role": "assistant", "text": "on icliniq. from your history it seems that you are suffering with rheumatoid arthritis. this is more in females having morning stiffness of the joint and improve during the day and presence of nodules over bony prominences. yes you need to go to a rheumatologist for proper evaluation and regular follow up. it is an autoimmune disorder which will affect various organs of the body at various stages. if delayed to start with the treatment it can cause restriction of movements of the joints and involvement of other organs also. investigation to be done are: cbc lft rft x-ray rh factor ana hiv hbsag anti hcv tft. management is with nsaids and other dmard's that can be decided after proper evaluation. you can follow up with a rheumatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have bad faeces smell coming from my nose when i breathe. what could be the possible causes?"}, {"role": "assistant", "text": "bad smell during breathing could be due to various reasons. let us see those one by one. malignancy: an intranasal (inside the nose) or intraoral (inside the mouth) malignancy can produce foul smell that can be perceived as faeces smell by the nose. malignancy can be painless and without any symptoms. malignancies of paranasal air sinuses also produce foul odor. dental infection: a tooth decay can produce bad smell. dental infection usually produces significant pain. food particles get collected inside the decayed tooth and hence cause the bad smell. sinusitis: chronic sinusitis can cause constant post nasal drip and purulent discharge (pus discharge). this results in foul odor. maxillary sinusitis commonly produces foul odor. sinusitis will have other symptoms like headache facial pain nasal blockage post nasal drip etc. foreign body inside nose: a foreign body which has got stuck inside nose without being removed for many days will produce purulent discharge and smell. the discharge will be from one side of the nose. it is common among kids. foreign body produces nasal block. atrophic rhinitis: it is a disease where the normal space inside the nose gets increased due to destruction of the anatomy. also the condition causes merciless anosmia (loss of sensation of smell). the sufferer cannot perceive any smell but the people around him can get the extreme foul odor emanating from the patients nose. atrophic rhinitis also presents with crusting inside nose and nose block. maggots in nose: maggots are larval stage of fly (chrysomia). maggots usually occur in association with atrophic rhinitis. fly lays its eggs inside nose leading to maggots inside nose. they are attracted to the foul odor and they themselves aggravate the odor. tonsillitis: pus accumulated over the tonsil can cause bad smell. tonsillar enlargement with infection and consequent foul breath is common in many children. other symptoms of tonsillitis include fever throat pain enlarged lymph nodes of neck difficulty and pain while swallowing. nasal diphtheria can produce foul odor. diphtheria produces a membrane over the affected mucosa. rhinitis caseosa: it is a destructive disease producing foul odor. it was thought to be a fungal disease exact etiology is still not clear. tuberculosis: tb of nasal mucosa produces granulomatous inflammation and caseating necrosis consequent death of tissues and foul smell. hope i have cleared your query. further evaluation and clinical examination is required. regarding follow up:for further follow up consult an ent otolaryngologist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what could be the reason for blurred vision following a hit on the eye?"}, {"role": "assistant", "text": "after trauma with the ball there could be many things that can cause blurring. it could be a simple eyelid swelling or small abrasion on the cornea the front transparent surface of the eye. other causes may be inflammation in the eye or blood inside the eye called hyphema. sometimes after trauma pupil dilated due to sphincter muscle damage and that also produces blurring. lens subluxation or small vitreous hemorrhage can also cause blurring. after trauma with the ball there may be swelling in the back of the eye (retina) called commotio retinae - berlin's edema. so you need a complete eye examination from an eye specialist so that the exact cause of blurring could be established and treated if needed. after trauma with the ball there may be orbital bone fracture and double vision. also there is a risk of retinal detachment in life time and this may manifest as flashes floaters or a sudden decreased vision or a curtain in the field. so my advice is to go to your eye specialist and get your eyes checked. he will treat you accordingly. for further information consult an eye care ophthalmologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is morning phlegm with blood related to allergy?"}, {"role": "assistant", "text": "yes it is related to your allergy. sometimes with excessive sneezing you may have this capillary bleeding. nothing to worry as it is coming only in the morning associated with sneezing. try to avoid contact with pollen. i suggest you to use antihistamines and leukotriene inhibitors tablet allegra 180 mg (fexofenadine) once a day and tablet montelukast once a day. sometimes you may need to use steroids if symptoms are severe to evaluate. consult your specialist doctor discuss with him or her and take the medicine with their consent. do you have any cough or throat pain? get a chest x-ray posteroanterior (pa). check blood for bleeding and clotting time. get a detailed check of your nose and throat by your medical practitioner to see any nasal polyp and other things. revert back with the answer to the above question to an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can i take antihistamines (an otc drug) when pregnant?"}, {"role": "assistant", "text": "antihistamines are used to treat allergy symptoms. we have two generations of antihistamines: first generation antihistamines like chlorpheniramine dimenhydrinate diphenhydramine doxylamine are considered safe to use during pregnancy. these medications have sedative effect (cause sleepiness). the newer non-sedating antihistamines like cetirizine desloratadine fexofenadine and loratadine are best avoided in pregnancy as we have no strong evidence confirming its safety in pregnancy. hope this helps. consult a general medicine physician online for further queries --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "why cpvt is not evident on ekgs?"}, {"role": "assistant", "text": "we are here to help you. cpvt - catecholaminergic polymorphic ventricular tachycardia is a devastating condition and is usually found and detected on holter monitor or on stress test if asymptomatic. in case of acute attack if a person has severe chest pain or syncope then at that time it can be documented in ecg. if your panic attack is due to cpvt then definitely it would have appeared in your ecg. it is very unlikely that you have cpvt. your sinus tachycardia is suggestive of anxiety. however i would recommend you to get your thyroid profile done if not done yet. for further information consult a cardiologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i took tablet metronidazole 5 hours after i had taken 20 ml of red wine. what can i do now?"}, {"role": "assistant", "text": "hi metronidazole and alcohol interaction causes disulfiram-like reaction. this leads to nausea vomiting tachycardia (increased heartbeat) shortness of breath etc. if you had consumed red wine 5 hours before the drug intake then it is all right. there is nothing much to fear. you may have nausea and vomiting but that would be minimal and temporary. 5 hours is ample time for the wine to be metabolized in the body. for further follow up consult a family physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am getting swelling over my face followed by toothache. why?"}, {"role": "assistant", "text": "the swelling that you have seems to be an abscess or pus due to infection. this infection is most likely due to your tooth decay over a long period of time which has spread to bone and around your soft tissues like muscles. in the face region swelling increases rapidly in size due to multiple natural pathways that connect each other. it is a potentially dangerous situation. the abscess needs to be drained quickly. if allowed to progress then it may lead to infection spreading to brain or even may lead to breathing difficulty. i suggest you antibiotic augmentin 625 mg twice daily along with analgesics. contact an oral surgeon or a dentist as soon as possible for physical evaluation and take the medicine with consent. follow up and get the tooth treated once infection subsides. do warm salt water rinses and apply ice to the swelling. do not apply heat as it will spread the infection further. the probable causes:tooth infection or abscess spread to vital spaces in the face. probable diagnosis:space infection due to tooth decay. treatment plan:1. abscess drainage. 2. antibiotics. 3. analgesics. 4. serratiopeptidase or other proteolytic enzymes. regarding follow up:for further information consult a dentist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is it necessary to replace my tooth crown after 9 years?"}, {"role": "assistant", "text": "most crowns can last up to 15 years depending on the type of material used for making crown. sometimes crown replacement is neccessary when there is excessive wear or fracture in crown or there are complications due to tooth decay. so if that is the reason why that dentist suggested you crown replacement then it is neccessary. otherwise if the crown is fine and it is kept plaque free then no need to replace it. for further information consult a dentist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "following skin firming treatment i got very large bulges on my lower face. is this normal?"}, {"role": "assistant", "text": "you might be suffering from granuloma formation following allergic reaction to injected substance. in some cases they may take years to subside. a physical examination is required to confirm the diagnosis and a long course of prednisolone may be needed to hasten the recovery. for further information consult a plastic surgeon online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what could be the reason for increased heart rate of my pregnant wife?"}, {"role": "assistant", "text": "tachycardia which she had was mostly probably psvt (paroxysmal supraventricular tachycardia) or other svt (supraventricular tachycardia) which are usually episodic in nature. so the reading which you had of 123 was probably not due to her old heart problem psvt but it was sinus tachycardia may be because of activities or stress dehydration pain etc. and baseline heart rate at the time was also probably in the same range. heart rate is the highly variable parameter. heart rate normally changes with many things like anxiety activities fever dehydration and many other and this is very well normal. the heart rate of 120 to 140 could normally be achieved. if one has an episode of psvt then he would be symptomatic like severe palpitations shortness of breath chest pain and heart rate is usually above 150. so the heart rate of 95 is normal and no need to worry. the heart rate of 123 was not probably psvt or svt but just a sinus tachycardia. if it was then these are episodic tachycardia and returns to baseline on their own. if she has repeat episodes then she should cough hard to abort the episode and may be neck massage if taught by a doctor after neck examination. for further information consult a cardiologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have toothache even after applying fluoride varnish? why does this happen?"}, {"role": "assistant", "text": "dental varnish contains fluoride is anticarious and hence prevents progression of tooth decay. pit caries are very minute and very minimal cavities that are superficially present on the teeth. pit caries do not require fillings because to do the filling a little bit of normal tooth structure has to be drilled. so varnish is preferable in very small cavities like yours. rarely small pit caries seen clinically might have progressed deeply (in a triangular pattern with apex seen outside but broad base deep inside the tooth). yours might be of this type and hence causing pain. follow up with a dentist online after taking an iopa (intraoral periapical x-ray) to confirm the deep caries --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how long will it take to get cured of lichen planus?"}, {"role": "assistant", "text": "lichen planus is a chronic and self-limiting disease. it has been seen that skin lesions subside within 9-12 months in about 50 percent of the cases. since you are still developing fresh lesions you will have to take a course of tablet prednisolone 20 mg daily for 6 weeks which can be reduced gradually. you seem to have severe itching which is not responding much to levocetirizine. i would recommend you take tablet hydroxyzine 25 mg twice daily till the itchy subsides. along with this apply clobetasol propionate on the itchy areas. but if large surface area is involved dilute it in a moisturizing lotion in the ratio of 1:4. this will surely help you. the probable causes:1. immune dysfunction. 2. genetic causes. 3. dental amalgam. 4. stress. 5. anxiety. 6. depression. differential diagnosis:lichenoid drug eruption. probable diagnosis:lichen planus. preventive measures:reduce stress and anxiety. regarding follow up:revert back after four weeks for follow up to a dermatologist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "though my ekg showed sinus tachycardia why did not my doctor worry about that?"}, {"role": "assistant", "text": "i understand you are worried. please do not worry. sinus tachycardia is just fast heart rate and yours is just slightly elevated. probably you were a little anxious during the time of the examination. st and t changes are often seen in normal healthy patients. it could be due to some medications. it is highly unlikely that you have any cardiac related issues at this age. but if you have experienced any chest pain of recent or shortness of breath then it could be a cause for worry. if you do have symptoms such as shortness of breath or chest pain then i will advise that you repeat the ekg test as a conclusion because it cannot be drawn from one ekg test result. for further information consult a cardiologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to cure my father's severe cold and cough?"}, {"role": "assistant", "text": "your father is suffering from bronchial asthma. the current medications foracort 200 mcg inhaler (budesonide and formoterol) and nasonex (mometasone) nasal spray were given for asthma. as there is no relief even after taking tablet clavam (amoxicillin and clavulanate) and tablet prednisolone it indicates that the dose of current inhaler is not sufficient. so i suggest that it is important to increase the dose of foracort inhaler to 400 mcg two puffs twice daily followed by gargling. i also suggest levolin inhaler (levosalbutamol) two puffs thrice daily and benz pearls (benzonatate) two puffs twice daily. consult your doctor discuss with him or her and then take the medicines with consent. for further information consult a pulmonologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have inappropriate sinus tachycardia. should i get a pacemaker?"}, {"role": "assistant", "text": "firstly do not get depressed this is not a life-threatening condition and may resolve with time. the symptoms may be troublesome for some time. how much are your resting and maximum heart rate? you should get yourself evaluated by a psychiatrist for anxiety and depression which i think is causing your poor quality of life. i assume all other causes are ruled out like thyroid low hemoglobin and postural orthostatic tachycardia syndrome. the echocardiogram is also normal i guess. in treatment it is better to continue medicines because results of ablation are not very good and it may give rise to a need for a permanent pacemaker. a pacemaker is also not a good option in your age group as strenuous activities and heavy sports need to be restricted after this. besides regular surgeries to replace batteries may be troublesome. so i think you should continue with medicine. i suggest taking beta blockers like metoprolol 25 mg once a day or ciplar la (propranolol) 20 mg once a day. this should be tried rather than ivabradine. consult your specialist doctor discuss with him or her and start taking the medicine after their consent. hope this helps you and get back if you have any doubts. for more information consult a cardiologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can i take prednisolone for asthma?"}, {"role": "assistant", "text": "the thing is it takes one to two months to stabilize asthma in the case of taking inhaled steroids. please confirm whether your inhaled drugs contains fluticasone or beclomethasone as these are inhaled steroids for asthma. i suggest you prednisolone 40 mg once a day for a week then 30 mg for next week then 20mg for next and then 10mg and 5 mg and stop. by that time your inhaled steroids will begin to work. also i suggest you oral drugs like tablet deriphylline retard 300 mg twice or tablet doxofylline 400 mg twice a day. in addition to the above i suggest tablet containing montelukast with levocetirizine daily at night for a month. consult your specialist doctor discuss with him or her and take treatment for asthma with consent. for further information consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "two of my wisdom teeth are impacted. is it better to remove?"}, {"role": "assistant", "text": "cavities or tooth decay is chronic infections that spread further at a slow rate in most cases. the other thing to consider is any pain or associated symptoms with the cavities which are indicative of active acute infection that has already spread deeper. so if the cavities are without symptoms then it would be fine to wait for a few months as well. however depending on the current state of infection which can be evident from x-ray i could give a more conclusive answer. about the wisdom teeth if these are unerupted at your age then it is recommended that you get them removed as they present a chance for cyst formation etc. it is not urgent though. this is more prophylactic than definitive. complications of removing wisdom teeth depend upon the location and position of the wisdom teeth. yes a very small chance for more complications at a later age. but the overall complexity would have been informed by the dentist or oral surgeon already. for further information consult a dentist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "would lad lesion cause tachycardia?"}, {"role": "assistant", "text": "blockage of 70% is referred to as noncritical blockage. i suggest tablet ecosprin 75 mg (aspirin) every night so that the blockage will not progress in the future. tachycardia can be because of a large number of causes varying from anxiety stress anemia decreased coronary blood supply and defective electrical currents in the heart. tachycardia can be of two types. sinus tachycardia and arrhythmias. in sinus tachycardia heart rate increases but the rhythm of the heart remains normal. this can be corrected easily with the help of beta blocker. arrhythmias can cause disturbed rhythm of the heart and are to be taken very seriously. they can even be fatal. i would suggest you to go for an ecg 2d echo and holter test for getting evaluated. if you have an ecg then attach a copy so that i can see the basic rhythms of your heart. smoking and alcohol can also cause palpitations. but you have not mentioned them. for further information consult a cardiologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "am i in trouble with 20% gum bone loss at the age of 45?"}, {"role": "assistant", "text": "the amount of bone loss that is 20% is not alarming at 45 years of age. it is routinely seen in patients at this age. there is no need to worry as it does not mean that the tooth will fall off soon. try to maintain the current level by using a warm salt water gargle twice a day or as much as possible or even a mouthwash solution will help. go for routine checkup once in every six months and get your teeth cleaned to maintain good oral hygiene. the x-ray would have been more helpful for me to give a better diagnosis. kindly watch out for loose teeth and show to your dentist. for further information consult a periodontist online --><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my teeth has gradually becoming yellow. what can be done?"}, {"role": "assistant", "text": "i suggest you visit a dentist and get your teeth cleaned for gum pain and bleeding. for yellow teeth use baking soda salt and lemon juice paste to brush your teeth and then use normal tooth paste. use this paste twice a week only and it will give you good whitening. also you should maintain oral hygiene properly and use mouthwash after brushing. you can use peel of banana to rub on teeth for whitening but that is not applicable everywhere. visit the dentist soon to get relief from gum pain and bleeding. wish you a good dental health and happiness. for further information consult a dentist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i feel bone on the extraction site. how to get it fixed?"}, {"role": "assistant", "text": "i have read through your complaint and the relevant details. the bone exposure is a common thing after extraction of teeth. but as far as there is no pain you need not worry about it. may be the extraction was a bit difficult on the lower left wisdom tooth and the gums are healing slowly. please do not disturb the healing process by touching the socket with the tongue often. this might delay healing even further. also do not aggressively brush or rub salt over that area. sutures are not indicated during the healing process. if at all it is considered it should have been put immediately after the extraction. keep observing the region for another week and if not healed or becomes painful then you go to the dentist for application of a healing paste. meanwhile maintain good oral hygiene and gargle lukewarm salt water twice daily. this will flush out the debris locked in the socket and promote healing. thank you. for further information consult a dentist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how will the doctor identify my lazy eye vision percentage?"}, {"role": "assistant", "text": "there are many methods to check vision according to the age of the patient. it is different for preverbal or verbal children and for adults. many types of vision charts available. snellen chart is one of them. there are etdrs chart early treatment diabetic retinopathy study) keeler logmar chart bailey-lovie chart etc. for lazy eye usually crowded charts are preferred with more letters in one row like etdrs chart. then some other tests are also done like color vision stereopsis (depth perception) near vision refraction for best corrected visual acuity and complete eye examination to rule out any cause of decreased vision in lazy eye. you need a full eye examination. your eye doctor will do accordingly and then advise appropriate treatment. for further information consult an eye care ophthalmologist online --><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what can be the reason for blurry image itchy eyes and headache?"}, {"role": "assistant", "text": "actually there are many causes of decreased vision and itching for which you need to rub your eyes. please answer a few questions. since how long you are using glasses? when you had your last refraction? do you have any eye allergy itching watering or redness that get worse in specific season? is this problem persist all day or it is more in the morning or evening? have you got an eye examination or using any drops currently? so from the complaints you described there may be just a change in refraction. if your refraction (glass number) is changing again and again then you might need to get a full eye examination and a few investigations. in cases with repeated change in refraction quickly there are chances of a condition called keratoconus in which shape of the cornea becomes conical and gets thin. at your age the cause of excessive rubbing may be allergic conjunctivitis called vernal keratoconjunctivitis (conjunctivitis due to some seasonal allergy). keratoconus is more common in people who have vernal keratoconjunctivitis. other causes may some congenital corneal dystrophy in which superficial corneal layers are peeled off with mild rubbing and cause blurred vision. so i would advise you to get a complete eye examination and your eye doctor can order some investigations like corneal topography if needed. then further management will depend on the eye examination. revert back with the answers to the above questions to an eye care ophthalmologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how do i recover from excess saliva production?"}, {"role": "assistant", "text": "the causes of hypersalivation include excessive starch intake reflux disease pancreatitis liver disease oral infections and decreased saliva clearance. so before trying any medication try some lifestyle modification. if that did not help then you can use some medication. hope this will help you and wishing you a faster recovery. treatment plan:1. avoid high starch food like potato bread cereals rice and corn. 2. maintain oral hygiene. 3. avoid spicy and fried foods. regarding follow up:revert back for further information to an ent otolaryngologist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am a 30 year old male suffering from glaucoma since 2 years. i have heaviness and itching in my eyes"}, {"role": "assistant", "text": "i need a few answers from you before deciding on the reasons for heaviness or itching. can you please give the details for the following questions? are you on anti-glaucoma medication? if so can you name them? when was the last eye examination done what was the eye pressure? what is the grade of glaucoma? itching can be because of specific anti-glaucoma medications. i need to know the eye pressure to decide whether your current heaviness is due to the anti-glaucoma medications. this is to decide whether we need to change or continue the medication or decide on any other modalities of eye pressure control in relation to the severity of glaucoma. revert back with the details to an eye care ophthalmologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i had phenyl and suffering from throat inflammation. please help."}, {"role": "assistant", "text": "obviously you will have some complications of the chemical substance you have drunk. mucosa of upper gastrointestinal and respiratory tract is more sensible to react against chemicals than the stomach. also you have protected your stomach somehow by using allegra (fexofenadine) pantos (pantoprazole) and sucralfate. now i would recommend you to consult an ent specialist to check your throat and ear tubes. i suggest you take allegra dexamethasone 4 mg twice daily and if your ears or nose feels blocked then xylometazoline by nasal drops. consult your doctor discuss with him or her and take the medicine with consent. you would better consult an ent doctor and a gastroenterologist as soon as possible for further information consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how many times a day should i brush my teeth?"}, {"role": "assistant", "text": "welcome to icliniq. com. the best oral hygiene maintenance method is to brush your teeth with a soft or medium toothbrush and fluoride toothpaste. the electronic toothbrush does not offer any real additional benefit to normal individuals. it is the movements of the toothbrush made by our hands that bring about thorough cleaning. most of the toothpastes available in the market are good as long as they contain up to 1000 ppm fluoride. brushing three times is good. the main goal is to clean the food deposits from all areas. rinsing the mouth after meals is good yet a simple method to keep the mouth clean. using a mouthwash causes no real problem in relation to upsetting the microflora or healthy bacteria. you can continue to use it once a day. professional cleaning is recommended every 6 to 12 months depending on your plaque and calculus forming tendency. due to plaque deposition over a long period there is temporary decalcification that might occur on the tooth surface. thus on professional cleaning when it is removed there will a slight increased sensitivity. however it does not remove the enamel layer at a significant level. so once we continue to use the fluoride toothpaste with a toothbrush along with natural fluoride in water the tooth surface gets remineralized. and then the sensitivity disappears. for further information consult a dentist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "why does running nose sneezing and blocked nose happen?"}, {"role": "assistant", "text": "i have gone through your query and can understand your health concern. running nose can be due to upper respiratory tract infection. you can take tablet allegra m (combination of montelukast and fexofenadine) twice daily for about three days. warm water gargles with salt added in it will help you if done thrice a day. you can try steam inhalation with capsule karvol added in it three to four times a day. while taking steam just break the capsule and add the liquid part in hot water and inhale it for 15 minutes. if you have bad throat infection also then you can take tablet levofloxacin 500 mg once daily for five days. hope you get well soon. for further information consult a general medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what is the reason for my disturbed sleep and morning drowsiness?"}, {"role": "assistant", "text": "i have gone through your query. you are suffering from two problems. one is nasal block and the other is sleep disturbance which may be insomnia. you can stop xaria plus (combination of montelukast and fexofenadine). instead of that you can take flutiflo-ft - fluticasone nasal spray once daily along with nasoclear nasal drops as and when required. sleep disturbance may be due to insomnia and so need sleep hygiene. stop drinking coffee or tea in the evening do regular exercises in the evening and sleep in the lateral position. try simple changes to your daytime and pre-bedtime routine. keep a regular sleep schedule go to sleep and get up at the same time each day including the weekends. set aside enough time for sleep. most people need at least seven to eight hours each night in order to feel good and be productive. make sure your bedroom is dark cool and quiet. cover electrical displays use heavy curtains or shades to block light from windows or try a sleep mask to shield your eyes. turn off your television smartphone and computer a few hours before your bedtime. the type of light these screens emit can stimulate your brain suppress the production of melatonin and interfere with your body\u2019s internal clock. will try conservative management initially and if not improving then you may need sleep study and medications like melatonin. i want to know whether you have snoring. the probable causes:stress related sleep disorder. investigations to be done:sleep study after one month. differential diagnosis:obstructive sleep apnea (osa). probable diagnosis:insomnia. treatment plan:conservative management like sleep hygiene avoid coffee and tea and do regular exercises. regarding follow up:revert back after a month to a sleep medicine physician online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i had sex in the 5th week of pregnancy and saw vaginal bleeding. why?"}, {"role": "assistant", "text": "at five weeks of pregnancy if you have had intercourse with your husband which was not advisable the bleeding is likely to be decidual separation at the uteroplacental junction and should well be ruled out by an urgent transvaginal ultrasound. it would be prudent to rule out any retroplacental clot which if seen indicates threatened miscarriage. ideally you should visit your casualty and get the ultrasound done. if things are fine then you should practice absolute bed rest with progestational support till the bleeding stops. traveling is not advised at all. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "why am i getting prolonged foul order vaginal bleeding?"}, {"role": "assistant", "text": "you can bleed more sometimes due to irregular menses because of hormonal (chemical) levels of your body and its effect. but you can bleed also due to cervical erosions and infection there. i personally never recommend tampons. because your menstrual blood contains some bacteria and pathogens which can infect. and when you use tampons due to the collected blood it gives a media to growth of that bacteria. the body can resist infection up to a limit and as the limit crosses you get signs and symptoms of infection for which you may have to take treatment. now in your case foul-smelling discharge and discoloration of the discharge are the signs of infection. now i have to see actually where the infection is. so best consult your nearby gynecologist. let him see where the infection is and what type of discharge actually is. and if required then send the discharge for examination. by this we will know the type of infection and can give treatment accordingly. most probably you are having history which seems to be likely bacterial vaginosis. it is a mixed infection. you will need to take the antibiotic course for 10 to 15 days and follow some precautions to avoid recurrence. now as far as antibiotics are concerned i have to see the first type and nature of discharge and smell. so better get consulted nearby for that. kindly keep up the following precautions: do not use tampons. use pads and change more frequently during menses. keep the area around the vagina as dry as possible especially during menses. change underwear more frequently if required. use cotton underwear if possible. drink more water as your urine becomes clear. do clean vaginal area and immediately after urination and after every time you do sex. these will help to avoid recurrence. and firstly complete the drug course to completely eradicate the infection. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i had depo injection and i am bleeding continuously. is there any way to stop the vaginal bleeding?"}, {"role": "assistant", "text": "i understand that you are a candidate in whom implanon did not suit well. it is good that you got it removed. you switched over to depot injection almost immediately. ideally you should have given a gap of a month and should have been placed on antifibrinolytics for the control of bleeding. nevertheless now that the depot shot is in some irregularity in periods is expected for 2 months or so. but this present bleeding can be reduced and stopped by antifibrinolytics like tablet tranexamic acid 500mg thrice a day for 5 days. you may choose to start them as early as possible. they do not have any side effects. but will help you stop the bleeding. for further follow up consult a gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i had vaginal bleeding after unprotected sex. is this menstrual or miscarriage bleeding?"}, {"role": "assistant", "text": "they are likely to be your menses and not a miscarriage as you had a normal menstrual bleed for six days each month. miscarriage would have been confirmed if serum beta hcg test had been positive. for further queries consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to control continuous abnormal vaginal bleeding?"}, {"role": "assistant", "text": "i totally understand your situation. if the bleeding has not responded to deviry (medroxy progesterone) then i would suggest you take her to the hospital and get her admitted. she would need some blood work done to see her blood parameter also would require injectable progesterones in addition to tranexamic acid (blood clotting medicines). if that also does not help then she would require injectable estrogen. meanwhile the ultrasonography and blood work should give an indication as to why this sudden non-stop bleeding occurred. do not leave it undiagnosed as bleeding so heavily in that age group is not a good sign and might be due to an underlying serious issue. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what is the reason for high monocyte and eosinophil?"}, {"role": "assistant", "text": "rheumatoid arthritis is one of the causes for high monocyte count and multisystemic involvement. hence treatment for that is nonsteroidal anti-inflammatory drugs and disease modifying drugs like leflunomide etc. the high eosinophil count causes include allergy parasitic infection skin conditions and pulmonary eosinophilia etc. according to the cause the specific treatment can be given. for allergy antiallergic medication like fexofenadine is useful. you have not mentioned total count value peripheral smear examination and value of differential count. so peripheral smear examination and clinical correlation needed in such case. please consult your physician for examination and get further work up according to the need. take care. for further information consult a hematologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is there nothing that can be done about the pain from scoliosis and hypermobility?"}, {"role": "assistant", "text": "it looks like your doctor is treating you for rheumatoid arthritis. however what is not clear is the fact that how this conclusion was arrived at. have they done these tests - esr crp rheumatoid factor blood test anti-ccp antibodies test? how long does the morning stiffness last? how many joints in the finger/hands do you experience pain and actual tenderness? i am asking these questions inorder to match your signs and symptoms with eular or the new american college of rheumatology guidelines. also i wonder why methotrexate was not started as a primary drug. please clarify the above with your doctor. now coming to living with symptoms you should respond in a reasonable period of time say 6 weeks at maximum both clinically and with regards to the inflammatory markers crp esr etc. if this is not happening a review of diagnosis and medicines must be done. finally the scoliosis per se does not cause pain and neither does hypermobility unless they are long standing and gross. perhaps seeing a good manual therapist is a way forward to control your spinal symptoms. hope this helps and revert back to a rheumatologist online for further follow up --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "kindly suggest a medicine for acne."}, {"role": "assistant", "text": "i understand that you have acne problem. you can continue with cetaphil-os cleanser. also i suggest epiduo gel (adapalene and benzoyl peroxide) at night. i would like to know if your periods are regular and any recent stress. also it would help if you can lose some weight. please get back with the answers as we can treat the underlying issue. thank you. revert back with the answer to the above question to a dermatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can x-ray differentiate rheumatoid arthritis and osteoarthritis?"}, {"role": "assistant", "text": "there is a strong possibility that this is gout. considering that it occurred relatively acute it is possible that it is gout. the diagnosis of gout is by crystal examination in joint fluid and on clinical examination of joints. of course osteoarthritis is one of the leading causes of arthritis after 40 and the big toe is a common joint. however since the treatment is very different for both it is worthwhile visiting a rheumatologist. x-rays can show that you have oa but then there may be concomitant gout as well. rheumatoid arthritis generally does not present like this. for further information consult a rheumatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can i use benzoyl peroxide throughout my life for acne?"}, {"role": "assistant", "text": "you can use benzoyl peroxide continuously until you have any side effects like itching rash and dryness of skin. also you should stop immediately once you know that you are pregnant or you can stop once you are planning to get pregnant. iit does not have any effect on fertility but it can affect the baby. you can also use clinmiskin gel (adapalene and clindamycin) once at night on the face for acne. consult your specialist doctor discuss with him or her and take treatment with consent. omega 3 have only supportive role. you can take supplements but do not search for fish because fish oil may increase your acne. for further information consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is l-glutamine safe for a rheumatoid arthritis patient?"}, {"role": "assistant", "text": "leaky gut syndrome (leakage of undigested food or other substance due to damaged intestinal wall) is more of a hypothetical thing. a lot of researches are still going on and it is believed to trigger the autoimmune reactions in the body. but yes it is safe to take the l-glutamine with rituximab. no contraindications to it as such. make sure she avoids outside food as you do not want to catch an infection which can trigger the rheumatoid arthritis. for further information consult a rheumatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to get quick relief from cold and nasal congestion?"}, {"role": "assistant", "text": "i have gone through your query and can understand your concern. i suggest tablet allegra 180 mg (fexofenadine) twice daily for five days. one tablet is to be taken in the morning and one at night after meals. consult her doctor discuss with him or her and take the medicine with consent. try to maintain a gap of at least three hours between diabetic medicines and allegra. as such reactions are rare but still maintain the gap. give her steam inhalation four times a day. there is no need to give her cetirizine if you are giving allegra. for further information consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what test should i do to know the reason for tingling sensation?"}, {"role": "assistant", "text": "i understand your symptoms and your question. it may be peripheral neuropathy. i would like to know your age and whether you have diabetes. if you have any back pain radiating to the legs then it can be a spinal problem. i suppose you do not have back pain. the second possibility is hypothyroidism in which there can be such symptoms. if not checked then you need to check thyroid profile. you should get ssep (somatosensory evoked potential) and ncv (nerve conduction velocity) studies of both lower limbs. we will know the function of the nerves in the lower limb. you can get it done at any electrophysiology laboratory. you should get free t4 and tsh done (thyroid-stimulating hormone) to rule out thyroid problem. i suppose you would have done b12 levels before starting the injections. regarding medicines the dose that you are taking now is not adequate. i would suggest you tablet trigabantin 300 mg (gabapentin) twice a day after food and tablet pregabalin 75 mg at bedtime. consult your specialist doctor discuss with him or her and take the medicine with consent. you may feel little giddiness after these medicines but that will settle in three to four days time. for further information consult a neurologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is there a permanent cure for pulmonary hypertension?"}, {"role": "assistant", "text": "both rheumatoid arthritis and pulmonary hypertension are chronic diseases. as there is no permanent cure for it the aim of treatment in such case is control of symptoms only. medicines help only to control the symptoms. you are a known rheumatoid arthritis patient and now have developed pulmonary hypertension which is idiopathic. now to manage breathlessness you are using long-term oxygen support. this is just the progression of both diseases which makes it difficult to manage. at present you are taking tablet sildenafil 20 mg twice daily. i would like to recommend tablet ambrisentan (pulmonext) 5 mg once daily with tablet tadalafil 20 mg daily if liver function test is normal. i strongly suggest you to discuss these drugs with your pulmonologist and make sure you are taking the tablet under his guidance only. continuous oxygen supplementation should be given to keep oxygen saturation above 95%. close monitoring of all vital parameters is very important. regular checkup with cardiologist for monitoring pulmonary artery pressure recommended. these medications will help to reduce the need of oxygen to some extent and help to improve exercise intolerance. as i told treatment of pah (pulmonary arterial hypertension) is very complex and runs long. so close supervision with pulmonologist is very important. monitoring liver and renal function along with the use of these drugs is necessary to avoid side effects. for further information consult a pulmonologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can vitamin d deficiency cause pain while closing hands?"}, {"role": "assistant", "text": "vitamin d deficiency will not cause pain in closing hands and neither tingling sensation. motor weakness like dropping of light objects is also not caused by vitamin d deficiency. all these are usually caused by nerve compression or has origin in brain. the next step would be to do a detailed neurological examination by a neurologist to find out the structures affected such as brain spinal cord nerves etc. only then we can think of the possible etiology or cause. after clinical examination you would require mri of brain and spine along with nerve conduction studies to reach a diagnosis. revert back after the investigations to an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "will any of my regular medications cause tingling sensation of scalp?"}, {"role": "assistant", "text": "i want to assure you that everything is going to be fine soon. i have thoroughly gone through your case and can well understand your genuine concerns."}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have a congenital malformation of the l5 lamina retrolisthesis and spondylitis. please advice."}, {"role": "assistant", "text": "i have studied your case. due to compression of nerve root there can be tingling sensation numbness and pain in your arm. also there is large disc bulge which is compressing over spinal cord. for these symptoms analgesic and neurotropic medication can be started. avoid lifting weights. you can consult a physiotherapist for help. physiotherapy like ultrasound and interferential therapy will give quick relief. i will advise to check your vitamin b12 and vitamin d3 levels. if nerve compression becomes symptomatically severe then surgical decompression will give permanent relief. consult an orthopaedician online for further follow up --> <link> take care."}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what might be the possible cause of pain in the lower left side of back and stomach?"}, {"role": "assistant", "text": "based on your complaints it looks like it could be a case of kidney stones. please go to your nearest hospital and get an x-ray kub (kidney and urinary bladder) done. sometimes kidney stones are not visible on an x-ray. in that case further tests might be needed. usually small kidney stones are eliminated by the body on their own while passing urine. in case it is big in size treatment is necessary. however as a first step please get an x-ray done. for further information consult a general practitioner online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what is your opinion about my knee pain after 12 years of surgery?"}, {"role": "assistant", "text": "here are a few suggestions. i suggest anti-inflammatory tablet like voveran 75 mg (diclofenac) twice a day after meals. consult your doctor discuss with him or her and take the medicine with consent. for swelling use a compression bandage and ice the area for 20 minutes at a time. avoid squatting lunges and stairs till the pain subsides. also you need a good manual therapist to assess you for hamstring tightness quad weakness including vmo (vastus medialis oblique - thigh muscle) and gluteal weakness. try the above out for at least 10 days followed by three to four weeks of physiotherapy to get complete relief. for further information consult an orthopaedician and traumatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what can cause tingling sensation in muscles?"}, {"role": "assistant", "text": "this tingling sensation can be due to a transient nerve compression. this nerve compression can be due to a muscle spasm or due to abnormalities in the thoracic spine. you should improve your posture and avoid sitting for long hours. avoid bending your back to lift heavy weights. apply voltaren gel (diclofenac) over the area twice daily. keep hot fomentation twice daily. do mckenzie back extension exercises twice daily. it will surely help you. if back pain still persists then get back to me as you will require prescription for medication. for further information consult an orthopaedician and traumatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have swelling and numbness after mandible surgery. how long will it take to subside?"}, {"role": "assistant", "text": "the post-operative swelling and numbness after mandible fracture surgery are common. the swelling is mild as you have mentioned. then it should resolve in another one to two weeks as the tissues heal. the numbness is because the mental nerve which runs through the mandible is hurt at some point during surgery. it can last from a few days to even three months. in most of the cases the numbness will fade away automatically when the nerve regeneration takes place. you will feel pricking kind of electric shock at times during the day as a sign of nerve healing. but if the numbness lasts for more than three months then it should be given attention. meanwhile i suggest tablet nurokind 500 (mecobalamin) once daily after meals for 30 days which helps in nerve repair. consult your doctor discuss with him or her and take medicine with consent. for further information consult a dentist online --><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "why is the medication for schizophrenic disorder causing weight loss and lethargy?"}, {"role": "assistant", "text": "it seems that you are suffering from a bipolar affective disorder and currently in the depression phase. according to me your thyroid disturbances should have been treated while taking lithium rather than discontinuing it as lithium is the best medicine for your condition. loss of appetite is due to magnesium valproate tablets as it causes liver dysfunction. i suggest you get a liver function test done. i would advise you try increasing magnesium valproate to minimum 500 mg twice daily and also increase amisulpride in low dose. consult your specialist doctor discuss with him or her and increase the dosage with their consent. before starting bupropion you should have tried minimum effective doses of current medication. i would like to see your recent thyroid profile for better understanding. revert with more information to a psychiatrist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can i have pineapple to cure acid reflux?"}, {"role": "assistant", "text": "acid reflux also known as gerd (gastroesophageal reflux disease) is a condition related mostly to the esophageal sphincter incompetence. low to moderate grades of gerd are treated first with antacid drugs which is the best and the first non-invasive solution. severe cases require surgery to reinforce the sphincter. as for the pineapple there are controversial opinions among doctors. some of them do not recommend it because it is a highly acidic fruit and can worsen the symptoms. while others recommend it as it may have good effects due to bromelain. you can try it for a week and see how your heartburn goes through. if you decide to avoid drugs and use foods then i would recommend you high calcium foods and basic ones such as milk which buffer the acids. also you have to eat in small portions several times avoid spicy fatty and acidic foods and also avoid late evening meals. use antacids if these measures fail. for further information consult a general medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "does masturbation cause arm numbness and pain?"}, {"role": "assistant", "text": "i have read your question with care and understand that you have numbness of your hands when you sleep. first and foremost masturbation is physiological and it is a normal phenomenon. it does not cause any problem or any side effects. it does not interfere with your general health and with your sex life. it dose not cause hand numbness or elbow pain. so there is no need to stop it and worry about this. please do not believe non-medical articles or rumors. coming to your job with computers this is repetitive strain and it can be a reason for the hand numbness. you need to consult a neurosurgeon in person to undergo clinical examination measurement of muscle reflexes and sensory system examination to know if there is a nerve compression which causes the numbness. also to know whether the numbness is just postural due to reduced blood flow. we cannot determine the cause of numbness without clinical examination. about hypothyroidism i suggest you to get your thyroid profile done before taking any drugs. for further information consult a neurologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "kindly suggest some solution for sudden knee pain."}, {"role": "assistant", "text": "thanks for writing to this platform. you have written sudden onset pain in the knee region since morning with no history of any injury to the knee. also i want to actually know whether there are any associated signs or symptoms of any inflammation like skin redness swelling local warmth etc? if it is just a localized knee pain with no associated symptoms my advise to you will be: gentle anti-inflammatory medications like tablets etoshine (etoricoxib) or paracetamol can be taken in small doses for five to seven days. adequate calcium and vitamin d supplementation as per requirement. intensive ice packs at home for three to four times in a day. activity modification as in to give adequate rest and avoid heavy physical activity till your pain subsides. see how it goes for around two weeks of time. normally the pain should settle within a week. if your condition does not improve then we need to get certain investigations done. do not hesitate to contact me should you need any further information/sos (as necessary). for further information consult an orthopaedician and traumatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am planing to go for liposuction for weight loss. my weight is 78kgs"}, {"role": "assistant", "text": "your bmi - body mass index is 30. 4 kg/m2. generally we perform bariatric surgery to achieve permanent weight loss for any patient whose bmi is 30 kg/m2 or above. liposuction is not a treatment option for weight loss. it is a cosmetic procedure for body shaping. there is a set point for fat storage for everyone. this is not altered by liposuction. weight loss by liposuction diet control exercise naturopathy amway herbalife etc. is temporary as all these methods do not have any effect on set point for fat storage. so any fat that is removed in liposuction will reaccumulate over a period of 6 months to two years. those who can reduce weight by diet control and exercise does not need liposuction and those who cannot reduce weight by above methods will not reduce even after liposuction. bariatric surgery provides permanent weight loss as it lowers set point for fat storage. if you are looking for permanent weight loss then bariatric surgery is the only scientifically proven method for that. for further information consult a general surgeon online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have chest congestion acid reflux and heartburn. is it gerd or a heart attack?"}, {"role": "assistant", "text": "thanks for your query. let go of your anxiety. gastroesophageal reflux disease is 80 % corrected by simple diet and lifestyle modifications. so i would suggest you try the following. lose your weight. if your bmi (body mass index) is 25 or above you need to lose weight. coffee chocolates citrus juices tomato-based products peppermints onion family beans etc. are some of the food that you need to avoid to relieve the symptoms. if you are fond of eating it is time to stop it. reduce your food intake. instead of increasing the quantity increase the frequency. eat five short meals instead of three bigger ones. if you sleep just after or within three hours of meal intake this habit needs to be stopped. increase the interval. when you sleep elevating the head at least 8 inches would be a good addition to the plan to combat gerd. bending stooping and upside down hangings with all other unnatural postures need to be avoided. your symptoms could also be due to multivitamin deficiency especially vitamin b12 deficiency. hope this helps. for more information consult a general medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what can cause genital numbness?"}, {"role": "assistant", "text": "the two most common causes of perineal or genital numbness is compression of the nerves in your spine (called as cauda equina) or compression of the nerves in the perineum itself. only sensory loss is uncommon but still possible in cauda equina syndrome (ces) since it is more commonly associated with other symptoms. compression of nerve in the perineum typically occurs in cyclists. i will suggest you to go to the closest er (emergency room) urgently. you need to be evaluated to reach the correct diagnosis. they may also order an mri for you to identify the exact site of nerve compression since the treatment varies as per the site of compression. delay in treatment may make the symptoms irreversible. for further information consult a neurologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "kindly help us with an ayurveda remedy for severe menstrual pain."}, {"role": "assistant", "text": "please tell me about her age of menarche her menstrual cycle and the number of days she bleeds. is she on any medication? is this the first episode of heavy bleeding? my advice to your wife is to go in for a pelvic ultrasonography (ugs). she can continue using evecare. along with that ask her to take the following medicine. to relieve the pain she can start taking rajah pravartini vati or rajocaps - two capsules twice a day. take the capsule 10 days prior to expected menstruation date with warm water. ask her to take 1 tablespoon of phala kalyanaka ghrita with milk twice daily. revert back with the answers for the above questions to an ayurveda specialist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my pregnancy test remains positive after abortion. why?"}, {"role": "assistant", "text": "if you had an ectopic pregnancy then it would show on the sonogram. pregnancy test could be positive due to leftover tissue. as it was removed it should be examined by histopathology test. sometimes hcg (human chorionic gonadotropin) producing trophoblastic tissue (it is similar to a healthy pregnancy tissue) persists inside uterus giving positive pregnancy tests. if your test comes positive then you should do titer of serum beta-hcg every third day to see if it is rising or falling. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my iud got displaced and i am late for my periods. does it mean ectopic pregnancy?"}, {"role": "assistant", "text": "you are missing the most important thing that is the pregnancy test is an error which means it is not positive. of course if iud (intrauterine device) is displaced from the normal position there is a chance of pregnancy and also of tubal ectopic pregnancy. but it is not that all cases have a tubal pregnancy. only after around 14 to 20 days of missed periods you can see the baby's heartbeat on the scan. there is no matter how good the scan is. the thing which you saw could be your heartbeat and it can be mistaken. the red and blue color is doppler scan which just shows the flow of blood to and fro. the most confirmatory test would be serum beta hcg (human chorionic gonadotropin) and this can diagnose a pregnancy no matter how small it is. only when the value goes above 1500 iu/ml the baby's sac can be seen on the scan not before. so you can decide when to scan. the discharge can be the fluid from uterus cavity or cervical canal when the iud came out. fallopian tube swelling on the scan is not very conclusive. for further information consult an obstetrician and obstetrician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "am i under correct medication for my symptoms? is it gerd?"}, {"role": "assistant", "text": "from going through the information you have provided it is clear that currently you are on treatment for suspected gerd - gastroesophageal reflux disease (acid reflux disease). you have been having intermittent problems over five years. acid reflux can cause breathlessness and waking up from sleep at night. some might feel and describe heartburns but others may not actually feel the burning sensation. the symptoms can be worsened by stress anxiety and panic attacks. my recommendations are an endoscopy procedure called gastroscopy will help to check for any weakness in the valve at the lower end of the food pipe (gullet or esophagus) and to directly visualize any evidence of inflammation there that is reflux esophagitis. following the above test you may require a 24 hour ph monitoring study and a manometry test to confirm that acid is refluxing back whenever you have symptoms and that there is no problem with motility of the gullet. i agree with you that i would not continue on perinorm cd (metoclopramide). i tend to give it only for nausea or vomiting. nexpro (esomeprazole) 40 mg is best taken once daily in empty stomach in the morning. if despite this symptoms persist it can be taken twice daily before food that is before breakfast and the other before dinner at night. you can take topcid (famotidine) 40 mg at bedtime to prevent symptoms at night. some people with gerd may find that eliminating certain food helps to improve their symptoms. for example avoiding spicy foods raw onion garlic black pepper citrus products and juices of orange grapefruit or cranberry tomato products chocolate or brownies caffeine sodas coffee tea etc. peppermint fatty or greasy foods. eat smaller and frequent meals. try to eat more slowly try to spend at least 30 minutes per meal and avoid eating on the run. avoid large high fat meals. avoid late evening snacks or eating before bed. avoid lying flat after eating; try sitting up for at least two hours after finishing a meal and sleep on your left side. try light walking for 15 to 30 minutes following a meal. try chewing non-mint type chewing gum for 30 minutes following a meal. raise the head of the bed 6 to 8 inches to prevent reflux when sleeping. extra pillows may only elevate your head. try putting pillows under the mattress near the head of the bed or use a special wedge. avoid tight fitting clothes around the abdomen. i wish you a speedy recovery. investigations to be done:1. gastroscopy. 2. 24 hour esophageal ph monitoring and esophageal manometry. probable diagnosis:1. gerd. 2. functional dyspepsia. regarding follow up:for further information consult a medical gastroenterologist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i feel like something stuck in throat. how to get rid of this?"}, {"role": "assistant", "text": "gerd (gastroesophageal reflux disease) does cause this something stuck in throat feeling but more importantly you have stress. stress does cause gerd and such change in voice which you have. the inability to speak as before is due to stress and this in turn is increasing your stress. it is a kind of chain reaction. first of all relax. you are fine. take a deep breath. get away from all your worries. work out the issues and get rid of them. for further doubts consult an ent otolaryngologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "am i suffering from achalasia or gerd?"}, {"role": "assistant", "text": "your primary diagnosis is esophageal candidiasis and antral gastritis. these are medical conditions and managed with medical treatment only. although treatment for esophageal candidiasis lasts little long duration. the esophageal manometry test is not required for these conditions and neither for gerd. the esophageal manometry test is to confirm esophageal motility disorder in which esophageal dilatation is common. also these disorders have a common presentation like you difficulty in swallowing. in contrast to the above mentioned conditions achalasia is a surgical condition and requires surgery. yes you require manometry test in suspicion of dilated esophagus. but do this test after completion of treatment for esophageal candidiasis for at least after 15 to 20 days. investigations to be done:upper gi endoscopy and esophageal manometry. probable diagnosis:1. achalasia cardia. 2. esophageal dysmotility syndrome. regarding follow up:for further information consult a medical gastroenterologist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my friend is suffering from neuropathic pain after a thalamic stroke. please help."}, {"role": "assistant", "text": "thalamus is the part of the brain through which all sensory information is relayed. after a stroke involving the thalamus many times the patient develops thalamic pain syndrome which is very poorly responsive to medications. but as you told that it was relieved to some extent by gabapentin and the patient has already tried pregabalin and carbamazepine with no improvement. so in such case trial of a new medicine can be given in a hope to get some betterment. for the spasticity the patient is already on lioresal. if that is not showing any improvement then injection botox (botulinium toxin) in the stiff muscles of the left hand can be tried. but it is a costly injection and is needed to be repeated every 4 to 6 months. i suggest trying tablet duloxetine 30 mg twice daily. it is effective for pain and also for depression. consult your specialist doctor discuss with him or her and start taking the medicines after their consent. for more information consult a neurologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "should i take prevacid in the night for gerd?"}, {"role": "assistant", "text": "you should try a combination of lansoprazole and domperidone for one month. avoid fasting and having spicy food. take small and frequent meals. investigations to be done:1. cbc (complete blood count). 2. lft (liver function tests). 3. upper gastrointestinal endoscopy. differential diagnosis:dyspepsia (indigestion). probable diagnosis:gerd (gastroesophageal reflux disease). regarding follow up:revert back after 15 days to a medical gastroenterologist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is gerd(gastroesophageal reflux disease) curable permanently through medicines?"}, {"role": "assistant", "text": "gerd (gastroesophageal reflux disease) can be treated effectively with medications like omeprazole pantoprazole and with combination of prokinetic drugs like domperidone. in addition to drugs the modification of life style is important such as: eating small quantity of food at frequent intervals. sitting upright after eating. avoiding spicy fried and sour foods. quit smoking and alcohol habit if it is present. avoid caffeinated drinks such as tea and coffee. and also go for investigations such as upper gi endoscopy with the doctor's advise and if any underlying surgical conditions they should be corrected accordingly. so i advise you to consult a gastroenterologist for examination and investigations. hope i have answered your query. revert back to a surgical gastroenterologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to avoid recurrence of ectopic pregnancy?"}, {"role": "assistant", "text": "i understand your concern. actually there is no treatment or medicine to prevent ectopic pregnancy. only thing to look for is to avoid using copper-t for contraception as this may increase the chance of ectopic pregnancy in case you conceive. take care to get an early ultrasound as soon as you discover pregnancy next time. also there is high chance of around 10%-15% to get your next pregnancy too as ectopic. no process or medicine is available presently to prevent this condition. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to prevent stroke?"}, {"role": "assistant", "text": "here are some tips to prevent stroke. regular exercises like brisk walking and jogging according to your capacity for at least 30 minutes a day and five to seven days a week in nearly all peoples. regular exercises help in reducing weight decrease lipid level and blood pressure and also assist in controlling blood sugars. healthy diet like avoiding fat oil and a high-calorie diet. individuals should consume five or more servings of fruits and vegetables daily. individuals should replace refined grains like white bread rice with whole grains whole bread and brown rice. should avoid red meat and instead have sea foods eggs beans nuts and seeds as a source of protein. it is very important to prevent and treat hypertension. because high bp is an important cause of hemorrhagic stroke. blood pressure should be regularly monitored and medicine should not default. the recommended dietary sodium intake for the general population is less than 2. 3 g of sodium or 6 g of sodium chloride. low sodium intake is associated with decreased risk of hypertension and stroke. avoid smoking and excessive alcohol. smoking puts one at a high risk of stroke and heart diseases. one should not get abdominal fat deposition or obesity. yoga should be included in daily routine and has multiple health benefits. prevent diabetes with a healthy lifestyle early diagnosis and regular treatment. the american diabetes association (ada) recommends testing at three-year intervals for diabetes in all adults with bmi more than or equal to 25 kg/m2 and one or more additional risk factors for diabetes family history sedentary lifestyle smoking etc. and in individuals without risk factors testing begin at age 45 years. the individual with risk for stroke like family history and obesity should be screened for lipid abnormalities and started on lifestyle modification and drugs. aspirin especially in those with moderate to high risk of stroke which will be assessed by the doctor and prior history of stroke. patients with irregular heartbeats should be evaluated with ecg and other investigation urgently and started on blood thinners to prevent clot formation and stroke. so if someone has it then they should get themselves evaluated. polypills consisting of combinations of drugs like aspirin statins and blood pressure medication as advised by the doctor should be consumed on a regular basis. for further information consult a cardiologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to avoid ectopic pregnancy?"}, {"role": "assistant", "text": "if tuberculosis have not done irreversible damage to the tube and endometrium (inner lining of the uterus) then pregnancy can happen either naturally or with treatment. a simplest way to check these two things is one mid-cycle ultrasound (around day 13 or 14 of menses) to see the uterine lining (anything more than 8 mm to 9 mm should be reassuring) and one tubal patency test like hsg (hysterosalpingogram). in case of damaged or blocked tubes ivf would be a better option (in vitro fertilization) as it will also reduce the chance of ectopic pregnancy. for further information consult an infertility specialist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my mother suffered a hemorrhagic stroke and she is in a coma. can she recover?"}, {"role": "assistant", "text": "the neurological deficit in a patient who suffered from hemorrhagic stroke depends on the areas of the brain affected and the pressure from the edema. the tube in the brain (external ventricular drain or ventriculoperitoneal shunt) are management for that edema pressure. with time that blood starts to reabsorb. some part of the brain might get permanently damaged and the remaining part may begin to take up the functions of damaged part (plasticity of the brain). but this process is very slow and may take few months too. until that time the supportive care has to be continued like medical management physiotherapy nursing care bladder bowel and back care. i would like to see the ct or mri images eeg along with hospital case summary for better judgment. revert with more information to a neurologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "why is there numbness along my fingertips?"}, {"role": "assistant", "text": "you have mentioned numbness in your hand finger tips and the area mentioned appears to be that of median nerve region. now if this pain and numbness are severe and persistent then the advice to you is to get nerve conduction study done and look for severity of compression. if compression is severe then the initial trial of the brace can be given. but if there is no improvement then a small surgery in the form of carpal tunnel decompression should be done. also medication for neuropathic symptoms like pregabalin or gabapentin should be initiated along with vitamin b12 supplementation as it acts as a neuro regenerator. also can you also tell me whether you have any neck pain with pain radiating in upper limbs or any other vascular issue as clinical presentation can also be same in the condition? revert with the details to an orthopaedician and traumatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "am i a possible candidate for stroke?"}, {"role": "assistant", "text": "there are chances of cardioembolic stroke (some clot or infected vegetation) particle that your ophthalmologist is suspecting. cardiologist will do echocardio and see if any source of that in your heart. for prevention of stroke you take one high dose of aspirin 325 mg and atorvastatin 80 mg and then aspirin 150 mg with atorvastatin 40 mg every day. if it is not infected vegetation (as in infective endocarditis) then you can prevent stroke and any other infarction. for further information consult a cardiologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "will i get an ectopic pregnancy if i had sex on the date of period?"}, {"role": "assistant", "text": "firstly as you had bleeding after eight days post unwanted 72 intake it ensures that you are not pregnant. your fresh menstrual date would now be the date of the bleeding started after the ecp (emergency contraceptive pill). there is a likelihood that next menses may be delayed by a week to 10 days which is a known side effect of unwanted 72. neatly it is not an ectopic pregnancy. but the chance of endometriosis rises if intercourse is undertaken during menstrual bleed which can later lead to ectopic if endometriosis gets severe. if still you wish to conclusively rule out pregnancy then you may get a serum beta hcg (human chorionic gonadotropin) test done. if the hcg levels are less than 3 miu/ml then you are surely not pregnant. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i feel numbness in penis. is it due to nerve impingement?"}, {"role": "assistant", "text": "this is a localized numbness that we are bothered with. disease starting from this region without any other associated symptoms is quite rare and without them we may not think of a systemic pathology right away. have you tried nerve tonics? i suggest back strengthening exercises and pregabalin 75 mg once a day for two weeks. vitamin b12 levels and hba1c should be helpful. consult a specialist doctor discuss with him or her and take the medicine with consent. lack of erections may suggest a more systemic disease but we need to have more a detailed talk before we can attribute symptoms. for further information consult a urologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can uterine fibroid be cured without surgery?"}, {"role": "assistant", "text": "the heavy bleeding may be due to the fibroid and menopausal symptoms. hence we need to treat fibroid and hormonal imbalance. for your condition i suggest you try taking the following medicines. consult your specialist doctor discuss with him or her and start taking the medicines after their consent. tablet aloes compound two tablets thrice a day. capsule rasagandhi mezhugu one tablet twice a day. tablet chitramoola kuligai one tablet twice a day. you need to continue these drugs for three months. within one week the bleeding will stop. then gradually the uterine fibroid will be reduced in size. after few more months your uterus will become normal. if you can collect or buy the bark of jambul tree crush 50 gm of the bark with 300 ml of water. boil in mild flame and reduce it to 50 ml. then drink it. this should be consumed in the morning and evening on an empty stomach. this has the potential to stop the excess bleeding. use banana flower in cooking. it is also good to control uterine bleeding. another option is using hormones given by a gynecologist but that should be your last option. this drug gives only symptomatic relief it does not reduce the fibroid uterus size. for more information consult an ayurveda specialist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have gerd. please help."}, {"role": "assistant", "text": "at the age of 24 year it is unlikely that you have ulcer in the stomach. it could be gerd (gastroesophageal reflux disease) that is causing all these symptoms but after long time it may cause ulcer. if you are not responding to ppis (proton-pump inhibitors) then it could be h. pylori infection that is causing the problem. the investigations you have mentioned are not having much abnormalities except mild anaemia. the management of gerd symptoms include medicines as well as dietary modifications and exercise with position maneuvers. usually we do not do investigations but if it is not responding to medicines then it is needed. advice:tablet omeprazole 20mg twice a day half an hour before food intake. syrup gelusil 5ml along with food (you can take every time) continue it till you have pain and heartburn. tablet amoxicillin 1000mg twice a day for 15 days. tablet clarithromycin 500mg twice a day for 15 days. avoid oily and spicy meal coffee and tea. do exercise daily (walking or jogging). take small and frequent meals. avoid liqiuds prefer solid and semisolid food especially before sleep. sleep in left lateral position with elevation of head end. you have anaemia so please take iron and folic acid (100mg iron combination) once daily. these disorders have great relation to behaviour and mood changes so please alleviate any tension. get thyroid function test (tft) and fasting glucose level done. do not quit your job instead work with more energy and enthusiasm. i have provided the treatment plan with medicines and other measures for 15 days. revert back to a medical gastroenterologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "should i take some medicine to stop heavy bleeding after an i-pill?"}, {"role": "assistant", "text": "the bleeding could be due to withdrawal effect caused by i-pill. but it should not be heavy and continuous. if there is heavy bleeding and if it continues for more than 2-3 days/more than your normal menstrual bleeding please visit a gynaecologist for examination to rule out some other cause. if bleeding decreases you can safely wait for two more days and it should subside by then. consult an obstetrician and gynaecologist online for further follow up --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have numbness in my left foot. what could have caused this?"}, {"role": "assistant", "text": "you have mentioned numbness in the inner part of the left foot as your main symptom. most commonly numbness is a manifestation of a nerve involvement it can be compression of the nerve at an anatomical site like in back or anywhere along the course of the nerve or it may be a manifestation of a systemic disease like diabetes or any condition that leads to what we call as neuropathy. now your trigger has been the yoga courses which you do on a regular basis every year but you have done may be for a prolonged period this year. being an orthopaedic surgeon i may not be able to guide you anything regarding yoga and its usefulness but it is logical to stop all these postures till your condition settles and improves. my guess is that there has been some prolonged compression during your classes or there could be an entrapment somewhere along the course of your nerve. i need to know from you: whether you have any back pain? is there any radiating pain from the spine region all along the course of your limb? apart from numbness are there any other symptoms of neurological involvement like weakness paresthesias burning sensations etc. also present? if the answers to above questions are no my suggestion to you will be to wait for a few days and start with medications for neuropathic symptoms like pregabalin or gabapentin along with vitamin b 12 supplementation and it is a good possibility that your symptoms may subside over next 4-6 weeks because there might be nerve neuropraxia (mid nerve injury). in case your symptoms do not improve or if they increase then i suggest you to get few blood tests done and nerve conduction studies to look for any compressive pathology. get back to an orthopaedician and traumatologist online for further queries --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "which is a better birth control pill than ortho-cyclen?"}, {"role": "assistant", "text": "i think you should first get investigated for the cause of heavy bleeding. get your routine blood tests like cbc (complete blood count) blood sugar thyroid profile coagulation profile and liver function tests along with a scan of abdominal organs and pelvis. if you have problem with estrogen and progesterone combination which is present in tablet ortho-cyclen then you can start with progesterone tablets containing norethisterone from day 5 to 25 continuously for control of bleeding. another best way for this treatment as well as birth control is the use of mirena (levonorgestrel intrauterine contraceptive device). you can discuss this with your doctor. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "having on and off heavy bleeding other than normal menstruation. why?"}, {"role": "assistant", "text": "the intermenstrual bleeding that you are experiencing this cycle is likely to be due to progesterone deficiency during the luteal phase which can be due to stress induced hormonal imbalance and leading to breakthrough bleeding. it is imperative for you to get a serum progesterone level done by day 21 of your cycle where the progesterone levels less than 21 ng/dl shall indicate progesterone deficiency. you shall require cyclical progesterone therapy for controlling such bleeds. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "will taking sysron ncr prevent pregnancy?"}, {"role": "assistant", "text": "sysron ncr (norethisterone) is basically a hormone which is used to control heavy bleeding during periods. i am afraid that sysron ncr does not have any contraceptive action in it. you must take precautions to not get pregnant during its use. your partner can use barrier methods like condoms. you can also try oral contraceptive pills which will also bring down the flow during your period. it will act in two ways. contraception regularizing your cycle and bringing down flow. you must take doctor's advise before starting any new drug. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what should i do for heavy bleeding following i-pill?"}, {"role": "assistant", "text": "the fact that the menses have started after 10 days of i-pill intake ensures that there is no pregnancy. the pain and heavy bleeding are secondary to the progesterone effect of the high dose progesterone pill like i-pill. it is suggested that you should take tablet trapic-mf (tranexamic acid) twice a day for next three days. this should take care of pain and bleeding. consult your doctor discuss with him or her and take the medicine with consent. you may increase your water intake and use hot fomentation locally to reduce pain as well. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have lower abdomen pain and alarming weight loss. will it be due to ibs?"}, {"role": "assistant", "text": "considering your symptoms i will also go with the diagnosis of ibs. but my line of treatment will be based on ayurveda diagnosis. in your case it is vata koshta - your digestive system afflicted by vata (increase in the gas in the intestines). treatment for ibs will be a three pronged approach. follow all three religiously for best results. the probable causes:1. outside food causing infection in intestines. 2. anxiety and nervousness. treatment plan:medication: i can see that you have started some medications already. better you go for the following medicines. 1. bilwadi lehyam - a semisolid preparation. take 5 g of this 10 minutes before food twice daily. 2. lavana-bhaskar churnam - a powder. take 2 teaspoon and mix it with a glass of warm water or preferably with a glass of buttermilk and have it 10 minutes after dinner. this powder will be salty to taste. 3. jeerakadyarishtam - a liquid preparation. 3 teaspoon of this liquid diluted with 10 teaspoon of water and take after food twice daily. you can take this after breakfast and lunch. 4. dhanwantaram gulika - a tablet. this medicine need not be taken regularly. you complained of nervousness causing stomach upset. in case you develop such a feeling then pop two tablets. this will manage the problem. before food or after food does not matter. take these medications for 45 days and revert back. then i will add medication for weight gain. exercise: 30 minutes of regular exercise is mandatory. you can pick whichever you like such as walking yoga playing cycling and gym. apart from this do 10 rounds of deep breathing exercises twice daily. diet: 1. have curry leaves fresh fruits especially citrus fruits and pomegranates are very good for you. 2. have nutritious food and fibrous veggies like beans carrots and all gourds are recommended. 3. soak about 8 to 10 dry grapes or raisins overnight in water and have it the next day. 4. try having at least 1 bowl each of fruits and vegetables daily. preventive measures:1. avoid overtly spicy food deep fried food and stale food. 2. stay calm. this condition is easily curable. regarding follow up:revert back after 45 days to an ayurveda specialist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "shall i take calcarea carbonica to achieve weight loss?"}, {"role": "assistant", "text": "well weight loss is a very gradual process and the treatment includes management of diet a regular exercise regime and in the end medicine. many of the patients achieve desired results with strict diet and lifestyle modifications. homoeopathic treatment for weight loss or for any disease depends upon what kind of personality and constitution the patient has. calcarea carb is although a very good medicine for weight loss but does not work in every case. so instead of this you may start up with phytolacca berry tablets of reckeweg which is specifically known for weight loss. you can consult me for weight loss diet plan also. for your back pain i feel it might be due to extra weight and weakness of back muscles. both these factors contributing to back pain will be taken care once you start with regular exercise. no medicine can help you no matter how much you take if your back pain is because of these two reasons. if problem still persist then you can consult me. but my sincere suggestion try the above things and then switch to medicines. the probable causes:lack of exercise and diet imbalance. differential diagnosis:metabolic disorders. probable diagnosis:obesity. treatment plan:start with diet modifications and regular exercise. preventive measures:avoid junk food. regarding follow up:follow up after 15 days to a homeopathic physician online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "please help with my issues of weight loss memory loss and body pain."}, {"role": "assistant", "text": "vitamin d3 levels should be between 20 to 50 ng/ml. a level of 34 ng/ml vitamin d is normal and is ruling out vitamin d deficiency. if the weight loss is of short duration it may be due to thyroiditis or some acute infection. if the weight loss is of longer duration it may be due to no appetite malabsorption or some chronic disease like tuberculosis and diabetes. i advise you to consult your physician. you may need to have blood and urine tests for confirmation along with thyroid profile blood sugar and chest x-ray. regarding memory loss there can be a variety of causes for memory problems like dementia other amnestic syndromes depression anxiety and brain lesions. it is important that you have a proper assessment to determine the cause. vitamin b12 and omega-3 fatty acid supplements may be helpful. try to avoid stress. for further information consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what is the difference between nephrolithiasis and soft tissue calcification?"}, {"role": "assistant", "text": "nephrolithiasis means kidney stones and soft tissue calcification means any part of renal parenchyma gets high deposits of calcium and show up in x-ray. i want to know the reason for x-ray done. is she having pain in the flank or burning sensation in urine or fever or vomiting or any other urinary complaints? if yes then we should straight away do an ultrasound to confirm these findings. for further information consult a nephrologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "does atorvastatin cause weight loss?"}, {"role": "assistant", "text": "atorvastatin itself does not cause any weight loss. it is an anti lipid drug which lowers your lipids in blood that means it will decrease chances of heart blockage. and you will not loose any weight because of atorvastatin itself. there can be minor side effects with atorvastatin such as constipation fatigue etc. consult a cardiologist online for further queries regarding atorvastatin --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is there any ayurvedic treatment for kidney stones?"}, {"role": "assistant", "text": "renal calculus can be removed easily by ayurvedic medicines. as you mentioned 3 mm sized two stones is present in your left kidney the size of the stone is small and easy to remove. i suggest you try taking the following. gokshuradi guggulu one tablet twice daily. patharina one tablet twice daily. neeri syrup 15 ml twice daily. trinapanchamula kwatha 15 ml twice daily. the probable causes of renal stones are drinking less than sufficient amount of water having a sedentary lifestyle eating fried and spicy junk foods. try the following preventive measures. drink plenty of water. do yoga and meditation along with light exercises. avoid tomato apple cabbage spinach cucumber etc. consult your specialist doctor discuss with him or her and start taking the medicines after their consent. follow-up after 15 days. revert after 15 days to an ayurveda specialist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can high fever and chill occur due to kidney stone?"}, {"role": "assistant", "text": "high fever and chill are indicative of infection indeed and as we have a cause rightly evident there are chances that you may be developing hydronephrosis (accumulation of urine in swollen kidney) in the right kidney and a secondary infection following stasis of urine (stoppage or reduced flow of urine) in the kidney leading to nephritis. though urine culture generally picks up infection in the bladder nephritis is more of a clinical diagnosis with pain and tenderness in the renal angle and high grade fever accompanying it. ideally you should be started on prophylactic antibiotics to control the infection sooner before septic features or septicemia may occur. i think you should take a second opinion from another urologist too. for further information consult a urologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am suffering from knee pain loss of appetite and vitamin b12 deficiency. please help me."}, {"role": "assistant", "text": "you might have developed knee osteoarthritis which is a wear and tear of the joints because of excessive weight on the weight bearing joints. this mostly occurs with advancing age but these days it is not uncommon to find it in young obese individuals. i would advise you to get hemogram x-ray knee joint serum calcium vitamin d levels esr (erythrocyte sedimentation rate) and crp (c-reactive protein). for osteoarthritis i would suggest you do the following. consult your specialist doctor discuss with him or her and start taking the medicines after their consent. practice knee and quadriceps strengthening exercises. give hot fomentation to the knee. you can try applying diclofenac ointment locally. if the pain is severe then try taking diclofenac tablet. if you are overweight you should lose weight. start exercising but avoid using the treadmill. cycling and swimming are wonderful options for you. for vitamin b12 deficiency you can try taking capsule nurokind gold (multivitamin) once daily for three months. and for gerd (gastroesophageal reflux disease) a combination of pantoprazole and domperidone helps greatly. i hope it helps you. if you have any further query please ask me. for more information consult a medical gastroenterologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have heavy bleeding and spotting at times. is there a possibility that i might have ectopic pregnancy?"}, {"role": "assistant", "text": "if pregnancy is the concern then the best way to find out is to get a blood serum beta hcg test done. this is a confirmatory test for pregnancy as the urine pregnancy kits may show false positive results. if the levels of hcg are more than 1 or raised then pregnancy is confirmed. if the level is less than 1 then pregnancy is completely ruled out. if the test is positive then you should undergo an ultrasound pelvis to locate the pregnancy for its site which could be intrauterine or possibly in the tubes (ectopic). if the usg shows extrauterine pregnancy then you would require a laparoscopic salpingectomy to remove the damaged tube along with the ectopic. if the pregnancy is intrauterine then you may decide upon continuing the pregnancy. if the test is negative then the possible cause remains uti (urinary tract infection) or a possible pid (pelvic inflammatory disease) or endometriosis. also stress per se can cause derangement of hormonal balance and can cause heavy bleeding inspite of being on continuous progesterone pills. this can be controlled with antifibrinolytics in the absence of pregnancy. for further follow up consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am having headache and my period is late. could it be a hormonal headache?"}, {"role": "assistant", "text": "it can be a hormonal headache. but hormonal headache comes every time you have hormonal changes in your body. this episode of headache is first time for you i suppose. to make a diagnosis of hormonal headache we need to wait and see if it happens every time before your period. i would suggest you tablet topiramate 50 mg twice a day and tablet flunarin 10 mg (flunarizine) at bedtime. consult your doctor discuss with him or her and take the medicine with consent. if your headache persists for long especially when you stop the above medicines then please get an mri brain done to rule out the other possible causes of headache. for further information consult a neurologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to prevent headache in myopia?"}, {"role": "assistant", "text": "myopia is the most common refractive error at your age. at 17 years progression of refractive error or your glass numbers is expected. so do not worry. as your height grows so does the length of eye ball in some cases. please get your glasses remade with comfortable design and redo an eye test with your local ophthalmologist. sometimes a change in the number will cause you a headache. please continue reading. take precautions to read under good illumination to avoid headache. for further information consult an eye care ophthalmologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how do we detect kidney stones?"}, {"role": "assistant", "text": "since you have got stone problem so early and since you are a recurrent kidney stone former you need thorough evaluation to prevent further stone episodes. you should collect the stone you pass in urine and do ftir (fourier transform infrared) spectroscopy analysis to know the composition. you also need a 24 hours urinary metabolic evaluation to know the exact problem leading to stone formation. the stone size as per ultrasound may not be accurate so please get a ct kub (computed tomography of kidneys ureters and bladder) to know the exact number and size of the stone. pain is due to blockage of the ureter when the stone comes down from the kidney. eswl (extracorporeal shockwave lithotripsy) is definitely a good option for stones up to 15 mm size. i hope you become stone free soon. for further information consult an urologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my tooth pain continues even after three weeks of rct. kindly help."}, {"role": "assistant", "text": "if even after three weeks of root canal treatment and the pain is not relieved then you should show to the dentist as there may be some infection is remaining. your dentist should take an x-ray again to check for infection and either repeat the procedure or give you medicine and reduce the height of the tooth. if the root canal treatment fails then he will advice to extract that tooth. take care. for further doubts consult a dentist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am experiencing headaches due to light sensitivity. why?"}, {"role": "assistant", "text": "we are here to help you. your symptoms are suggestive of a migraine only. the new symptom that you have noticed also is in favor of a migraine headache. in such case i would recommend you not to worry as all your investigations are within normal limits. migraine headaches are precipitated by light sounds sleep deprivation illness and medicines. once we are sure that the person has a migraine we start our patient on migraine prophylaxis. if you are on migraine prophylaxis slowly your severity and frequency of attacks would reduce and time will come when you will have almost no attacks. drugs are decided based on the frequency and the severity of the headache. sleep disturbances are also kept in consideration. for migraine prophylaxis the most commonly used drugs like flunarizine propranolol and amitriptyline. in the case of acute pain triptans like sumatriptan and rizatriptan are used. in the case of acute pain not responding to triptans we use painkiller nsaids (nonsteroidal anti-inflammatory drugs) like diclofenac. you also need to modify your lifestyle. you should sleep at least 8 hours at night that too daily in a fixed time slot. avoid sleeping in the day time. if you sleep in the day you will have difficulty in falling asleep on time in the night and the whole cycle of peaceful sleep would get disturbed. avoid alcohol beer caffeine lemon and cheese in the diet. you need to follow these lifestyle modifications for the purpose of getting rid of medications after a few months course. people who modify their lifestyles usually get rid of medications after six months course. for further information consult a neurologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how long can i wait for my second step of root canal treatment?"}, {"role": "assistant", "text": "routinely the root canal treatment has three steps in total. pulp extirpation. root canal preparation. root canal filling. since you have mentioned that pulp removal was done under emergency there are more chances of remnants of pulp along with bugs to be left behind in the roots inside. in your first visit most of the pulp and pus should have been removed and that is why you got no pain until now. the maximum time usually allowed to start up root canal preparation is four weeks but it does not mean that you will lose the tooth waiting long. however it is best when the treatment is finished in short time frame unless it is medicated in the case of severe infections. there are high chances of root canal treatment attempted tooth when left untreated to get broken down because of no strength and no proper protection such as a cap. hence i advise you to get your next appointment as soon as possible and go ahead with the treatment plan. for further information consult a dentist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i suspect my knee pain as calcium deficiency. please advise."}, {"role": "assistant", "text": "no this is not a calcium deficiency. probably it is prepatellar bursitis. the symptoms of calcium deficiency will not be confined to one knee and it is unusual in young persons. for further information consult an orthopaedician and traumatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can my wife use serrax-d while breastfeeding?"}, {"role": "assistant", "text": "your concern is right. the drug serax-d a combination of serratiopeptidase and diclofenac potassium should not be advised in case of pregnancy or with lactation. although it does cause problems like diarrhea bleeding and rash data is lacking regarding safety in such kids. this may be the personal experience of your gynecologist as they may not have seen any bad effects and so they are using it. but according to literature we should not use it. there is no clear indication of this medicine in your case. use of antibiotics and analgesics can heal the wound. so my conclusive advice is to stop serratiopeptidase and continue the rest of the medicine. please discuss my opinion with the treating doctor and stop the medicine with consent. a little advice for the baby's weight; breastfeed her until six months of age. do not use formula feed. after six months start a cereal-based diet to ensure adequate weight gain. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "kindly give your advise for my breastfeeding wife's cold and fever."}, {"role": "assistant", "text": "this seems to be a viral infection and will most probably be self-limiting in 5 to 10 days. she needs to do gargles with lukewarm saline water (water with salt in it). i advise her to brush the teeth as usual twice a day especially before going to bed. ask her to take plenty of fluids and proper rest for better results. for fever i suggest acetaminophen every 4 hourly until there is no more fever. she can consult her doctor discuss with him or her and take the medicine with consent. for further doubts consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is i-pill safe while breastfeeding?"}, {"role": "assistant", "text": "yes if you want to use it as an emergency contraceptive then it is safe during breastfeeding. you can take but the best contraceptive during breastfeeding is copper-t insertion (intrauterine contraceptive device). for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "would braces close wide gap between front teeth?"}, {"role": "assistant", "text": "you need to get root canal treatment for the upper and lower central teeth then placement of a fixed partial denture (fpd ceramic crowns) on them to close the space. this will give a permanent solution to your problem. it will give you a much better esthetic solution. kindly show it to your dentist and ask for fixed partial denture. it will take about two weeks to finish the treatment. for further information consult a periodontist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is it safe to take carbamazepine while breastfeeding?"}, {"role": "assistant", "text": "your doctor is right. carbamazepine can get secreted in breast milk and it is the safest antiepileptic during lactation. 1 month old baby sleeps a lot. they can sleep for about 18 to 20 hours a day. they will wake up only for feeds. as long as the baby is gaining weight it is fine. also note that keeping your baby on breast milk has many advantages over formula. breast milk has enzymes which help in better digestion. breast milk also contains various antibodies produced in your body which provides immunity to the newborn. it is recommended that you breastfeed your baby for at least up to 6 months of age. for further information consult a lactation counselor online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what treatment should i get for nerve root compression?"}, {"role": "assistant", "text": "we are here to help you. i understand such radicular pain is very troublesome. for pain i advise the following. kindly consult your specialist doctor discuss with him or her and take treatment with consent. a combination of pregabalin and methylcobalamin. to do hot fomentation of the affected area and apply diclofenac ointment locally. to get physiotherapy done particularly ultrasonic heat massage. ssri (selective serotonin reuptake inhibitors) like duloxetine helps in long term. tramadol can be taken for pain relief. but if the nerve compression is very severe causing motor weakness and tingling on any side of the body then surgical intervention would be required. for further information consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am having severe pain in breast while breastfeeding. please advice."}, {"role": "assistant", "text": "you have not mentioned the specific site where you get the pain. is it in and around the nipple or is it deep inside? if the pain is in and around the nipple then it is most likely due to faulty technique while feeding. these are the instructions for proper breastfeeding technique: make sure that you insert not only the nipple but the whole areola (the dark colored area around the nipple) into baby's mouth. by this way the nipple lies touching the baby's hard palate while sucking. also do not forget to rest the baby's head in the corner of your elbow. while feeding your baby's tummy should touch your tummy. now considering that you are not doing any faulty technique or posture and still getting the pain deep inside: it could be due to opening of milk ducts each time the baby sucks. also check out if there is any congestion i. e milk clogging in your breast. also see for any crack in your nipple which is very common in the initial days of lactation. examine your breast with the palm of your hand and if you could notice any lump in your breast it could be milk trapped inside. in any of the above reasons you have to visit a gynaecologist as soon as possible. consult a lactation counselor online for further follow up --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what should i do for my dizzy feeling?"}, {"role": "assistant", "text": "from your description it looks like you are suffering from dizziness. this could be due to two reasons. one is your blood pressure and the other is your body's balance mechanism. so i would recommend that you get your blood pressure checked and also a physician in person will be able to check if it is a balance problem by performing a physical exam. you should meanwhile take rest and drink lots of water. also it would be ideal if you mentioned your age since many problems are age-related and a more accurate diagnosis can be then made. as far as medicines help you will need a cinnarizine tablet to control this temporarily. consult your doctor discuss with him or her and take the medicine with consent. for further information consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what to do for back soreness?"}, {"role": "assistant", "text": "if you are feeling too dizzy then please visit the nearest emergency hospital as soon as possible. for back ache if it is acute that is started or increased in the last 24 hours then you can apply ice pack or otherwise apply hot fomentation. your back soreness needs to be assessed. please visit a physiotherapist or a physician for a physical evaluation. for further information consult a chiropractor online --><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my wife is a breastfeeding mother. can she take paracetamol for fever?"}, {"role": "assistant", "text": "first of all temperature above 100 degrees fahrenheit is regarded as fever and not below that. baby is supposed to be breastfed at all times. however if the mother is suffering from a disease it is advised for her to wear a mask and feed. because that is the route by which infection from the mother can be passed on to the baby and not through milk. paracetamol taken by the mother in the prescribed doses will not harm the baby. for further information consult a paediatrician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "while breastfeeding which medicine can i take for cold?"}, {"role": "assistant", "text": "the only safe drug that you can take while breastfeeding is tablet paracetamol 500 mg thrice daily for three days after food. you can do hot water vaporization for nasal congestion. you should avoid taking any other medications till you are breastfeeding. yes you can take flight. but if you get chest pain again then i advise you to get an ecg done. you seem to have a viral infection which can be contagious. but you can use a handkerchief every time. you should also have plenty of water in a day. all the above should be sufficient. probable diagnosis:upper respiratory tract infection. regarding follow up:revert after five days to a general practitioner online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am feeling uneasy and my bp reading is lower than usual. why?"}, {"role": "assistant", "text": "how much coversyl (perindopril) and starpress (metoprolol) you are taking? have you confirmed the readings twice? if your bp is low then you certainly need to reduce the dosage of either coversyl or starpress. let me know the dosage so that we can modify it. also monitor your blood pressure thrice a day for one week and once or twice. if such low bp occurs then you can have salt and sugar water to raise it. i guess you did not have any chest pain or heaviness. in short there is no need to worry. we will just reduce the dosage and also space out the drugs like one in the morning and other in the evening. you discuss these issues with your doctor. for further information consult a cardiologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i over-exerted myself in the gym. how to quicken the recovery?"}, {"role": "assistant", "text": "i have gone through your query and i can understand your concerns. all the symptoms you have mentioned are suggestive of dehydration and hypotension caused by physical exhaustion. you do not need to worry regarding this as it will subside by itself with conservative management. i suggest you the following as a first line management. take plenty of oral fluids and take adequate bed rest. check your blood pressure level. if you are hypotension you may require iv fluids to rehydrate yourself. if symptoms persist despite all these then consult a general physician and get evaluated. the probable causes:physical exhaustion. probable diagnosis:dehydration. regarding follow up:for further information consult a general practitioner online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what is the sound that i hear when i close my ears with my fingers?"}, {"role": "assistant", "text": "this sound can be normal. when we close our ears we do not hear outside sound so we feel that there is some sound coming from our body. if you have a cough or cold it can also lead to similar symptoms due to eustachian tube block. to rule out any pressure changes in your ear you can get a test called tympanometry. and get you blood pressure checked. for further queries consult an ent otolaryngologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am breastfeeding my child. is it safe for me to use metronidazole cream?"}, {"role": "assistant", "text": "you have been diagnosed with bacterial vaginosis (bacterial vaginal infection). metronidazole cream has to be applied vaginally for cure of the infection. vaginal application leads to absorption of metronidazole but it is only 2% of the oral dose. only a small amount out of this gets into breast milk. your question about the breastfeeding is pertinent but you are going to use the cream only for 5 days. perhaps you can avoid breastfeeding your child during this period. no major study has given a clear answer regarding the safety and ill effects of the drug in such a situation. consult a paediatrician online for further follow up regarding an alternative diet for your child during this period --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what is the reason for my arm pain?"}, {"role": "assistant", "text": "there is a possibility that there may have been multiple attempts at the same site before taking the blood sample. this causes extravasation of blood in the surrounding tissues as well leading to hematoma formation often accompanied with discoloration of skin. this may also cause increase in compartment pressure (caused when pressure builds up within the muscle) cause pain especially while stretching. you may use hot fomentation locally over the site for 15 minutes each thrice a day. definitely you will be benefitted from this. for further doubts consult a family physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am suffering from dizziness and low bp. shall i continue atenolol 50 mg?"}, {"role": "assistant", "text": "i would like to ask a few questions. do you ever complain of chest pain associated with palpitation? is there any family history of heart disease? since how long you are taking atenolol? do have complained of shortness of breath or edema over legs and feet? i would like you to get the following tests done. echo to check the pumping action of the heart and ecg. your triglycerides are on the higher side. my advise is atorvas 20 mg (atorvastatin) once daily after meals for a month. consult your specialist doctor discuss with him or her and alter the dosage of atenolol and get your bp monitored regularly. investigations to be done:ecg and echo. regarding follow up:revert back with the answers to the above questions to a cardiologist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what could cause foreign body sensation in the eye?"}, {"role": "assistant", "text": "your present problem of dryness and foreign body sensation is not related to dilatation done by your doctor. for dryness the doctor has prescribed you systane eye drop which is a very good lubricating eye drop. the cause of foreign body sensation could be meibomitis (inflammation of meibomian glands). for that you can do hot fomentation and lid massage with index finger from up to down. you can also apply antibiotic steroid combination eye ointment over the lid margins. also keep using systane eye drop. for further information consult an eye care ophthalmologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am feeling pain after root canal treatment. why?"}, {"role": "assistant", "text": "your doubt is partially right. the root canal treated tooth might get some entrapped bacteria which causes you pain. it cannot be straight away told that the nerve was not completely removed. there are some reasons for postoperative pain. improper shaping of the canal which clogs debris and bugs. improper disinfection of the root canals. high occlusion. you have to get your next dental appointment as soon as possible where your high occlusion will be corrected or the root filling is removed and medication (dressing) is placed inside the canals for two to three weeks to ensure the infection is gone down. after that proceeding with a permanent root filling and crowning the tooth with a ceramic cap would be better. for immediate pain relief please take the painkiller as already prescribed by your doctor. for further information consult a dentist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can i have root canal treatment for cracked molar?"}, {"role": "assistant", "text": "i have read through your complaint and the relevant details. a cracked tooth can be root canal treated depending on the direction of the crack within the tooth especially if it involves the vital part of the tooth called the pulp. the pulp is the vital part. when it is inflamed or infected you get pain. so in this case root canal treatment will help you get rid of the pain. it is in this sequence that the treatment should have gone. first root canal treatment then crown lengthening and then temporary crown followed by a permanent crown. but the pain you experience at the moment seems to occur because of increased height in the temporary crown. it can be corrected by shaping the portion of the crown which gets hit first when you bite. the reason for the general pain is again the same one. the decision of whether root canal treatment has to be done or not can be confirmed only with an x-ray. hence i am unable to say you without witnessing the x-ray of the tooth. i request you to send me the x-rays if you have any. it will help me give you a better answer. revert with x-rays to a dentist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what could be the cause for rise in bp?"}, {"role": "assistant", "text": "a blood pressure of 145/85 mmhg comes under grade 1 (mild) systolic and prehypertensive diastolic blood pressure. nifedipine use should be stopped as soon as possible. nifedipine can cause hypotension and results in severe tachycardia. basically you do not need any medication for blood pressure right now. your problems are because of your higher anxiety levels. i suggest you do 45 minutes of strenuous exercise daily. avoid oily and fast food. take a low salt diet and eat lots of fibers and fruits. drink plenty of water. stop all the antihypertensive medications. for your raised anxiety level i suggest you take tablet clonazepam 0. 25 mg once before sleep for 14 days. please consult your specialist doctor discuss with him or her and take the medication with consent. do not overthink about the blood pressure. food cannot cause this problem especially if you do not have an acid peptic problem or heartburn or peptic ulcers. revert back after 10 days to a cardiologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i get headaches when i go out in the sun. please suggest some ayurvedic cure."}, {"role": "assistant", "text": "the symptoms you have mentioned here are indicating towards a migraine headache. however no diagnostic test can surely rule out a migraine. its diagnosis is mainly based on the symptoms. in a migraine there is no definite pain and pain occurs at any time. some people say that a migraine usually occurs on one side of the head and is accompanied by nausea and vomiting but this is not true in all cases. the pain can be all over the head and other symptoms might be present or absent. i suggest you try doing the following. wear sunglasses cover your head with a scarf and use an umbrella whenever you go out in the sun. before going outside always drink one glass of water it will keep you hydrated and will help you. you can take sandalwood oil and massage your scalp a night before washing your hair. avoid excessive intake of tea coffee and caffeinated drinks. some foods also increase the problem of headaches so avoid those. avoid using perfumes deodorant sprays etc. as strong smell may exaggerate the problem. avoid stress anxiety and loud noises. follow a particular sleep pattern i mean try to sleep daily around the same time. if possible try to avoid mobile television laptop etc. an hour before sleep as these emit blue light which hinders normal sleep pattern and also promotes headaches. pranayam is helpful in headaches. so if you can spare 5 to 10 minutes then practice it daily. in medications i suggest you try taking the following. consult your specialist doctor discuss with him or her and start taking the medicines after their consent. pathyadi kwath 15 to 20 ml with an equal amount of water twice a day for six weeks. godanti bhasma 250 mg with water twice a day for four to six weeks. it is an ayurvedic painkiller. shir shuladi vajra ras two tablets twice a day with water for four to six weeks. this ayurvedic medicine is also a painkiller and is used in headaches of various etiology. if you find it tedious to take multiple medicines then you can take only one of these two painkillers or can take two of them for one month. kamdudha ras 250 mg twice a day with water for four to six weeks. it will help in cooling you down internally. take anu taila and put one drop of this oil in each nostril once a day for one month. take powder of sandalwood camphor and jatamansi and. mix all in equal amount and add water or rose water and apply this paste on the forehead while you have a headache. take one teaspoon of coriander powder and add it in one cup of water and keep it for a night. drink it early in the morning on an empty stomach. if you are taking allopathic medicine then take above medicine along with that after consulting your physician. however for a migraine there is no curative treatment. it can only be avoided with the help of medicines and lifestyle changes and sometimes the headache may not disturb you for so long and sometimes may trouble you often so follow a healthy way of life. also stop these medicines during your periods. you can start them after the period gets over. i hope you are satisfied with my answer. for further queries consult an ayurveda specialist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i feel a hole in the tooth after root canal treatment. should i worry about infection?"}, {"role": "assistant", "text": "the whole procedure you described is pretty standard and usually expected. during root canal treatment till it is completed a temporary filling is placed in the hole. this hole on the back of the tooth is where the root canal treatment is done from. however normally before the crown cutting for a permanent cap it is filled with permanent cement. the hole does not heal by itself. a filling is placed in it. if your root canal is completed then there is nothing to worry about infection. if your root canal is not completed then the infection of any will get cleared out of it. the food particles getting stuck do not cause infection per se. for further information consult a dentist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my headache persists even after pituitary tumor surgery. what to do?"}, {"role": "assistant", "text": "i read your query and understand your concerns. although headaches are common after pituitary gland tumor the presence of on and off headaches after one month of surgery indicates more possibility of continuing migraine rather than surgery. this is evidenced by triggering of headaches following sun exposure and delay in meals. above all the positive history migraine for years indicates that a migraine is continuing and pituitary adenoma was just a coincidental finding which was revealed on mri scan. regarding management of a migraine i feel the same treatment which was effective in the past for migraines should be continued. in case no such progress achieved till date then we need to look for alternative options to control migraine headaches. for further information consult a neurologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is headache a symptom of hiv?"}, {"role": "assistant", "text": "i can understand your anxiety which is quite obvious in this situation. however transfer of the hiv virus through oral sex is low. but it depends on any cuts abrasion on your penis and any ulcer in her mouth. if this is possible then get a blood sample of her because that can be tested for hiv (human immunodeficiency virus). 14 days is a short period for acute hiv infection manifestation but still it is not a guarantee. if cost is not an issue then you can do hiv viral load which can detect viral rna within 10 days of infection. on personal ground i do not think that your symptoms are hiv related. these look more stress related. i will add that hiv is not the only infection you should be worried as you can get other std (sexually transmitted diseases) like hpv (human papilloma virus) syphilis and gonorrhea. as i said above you can do a hiv viral load test which can detect viral rna within 10 days of infection. also next time in addition to being careful i will say that you should present early because the drug useful for prevention is most active in the first 72 hours of exposure. for further information consult a general medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "does vitamin deficiency cause twitching and tingling?"}, {"role": "assistant", "text": "vitamin b12 deficiency can cause subacute combined degeneration of the cord. so the treatment is daily vitamin b12 or vitamin b complex supplementation for 12 weeks. your vitamin d levels are also low. the treatment is vitamin d capsules 60000 iu every sunday for 12 weeks. in your present scenario for twitching the first line of management is vitamin b12 supplementation and vitamin d supplementation. consult your specialist doctor discuss with him or her and take the medicines with consent for 12 weeks and you will have a dramatic improvement in the next three months. revert back after three months to a neurologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can headache occur as a side effect of bp medicine?"}, {"role": "assistant", "text": "first tell me in detail about your headache to help you in better way. what is the quality of your headache? is it either pulsatile which means tis-tis or squeezing or aching? do you have any associated symptoms like nausea vomiting facial swelling difficulty in vision vertigo difficulty with noise etc? for how long have you been suffering with this headache? is your blood pressure in normal limit or still raised? do you have asthma? do you have any depressive symptoms like low mood loss of interest weakness disturbed sleep and appetite feeling of hopelessness guilt suicide etc? revert back with the answers for the above questions to an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my daughter has headache blurred vision numbness of arm and face. is it an emergency?"}, {"role": "assistant", "text": "i am afraid to say that the clinical history of your daughter appears to be more than just a viral sinusitis. viral sinusitis is probably an incidental finding. abrupt onset of headache blurring of vision difficulty in speaking numbness in face and arm is very characteristic of an intracranial pathology likely a vascular etiology. she must be examined by a neurologist and must undergo a brain imaging like mri of brain at the earliest. please take her to a neurologist immediately for physical examination. this appears to be a neurological emergency. i can confidently say that viral sinusitis is not the cause of the symptoms here. please be in follow up and keep me updated about the clinical developments. please write a review as it would be of help to me. revert back to a neurologist online for further follow up --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am getting nightmares. how can you help me?"}, {"role": "assistant", "text": "nightmare in adults can be due to various reasons. the most common of them being not having a good sleep. practice sleep hygiene such as sleeping and waking up at the regular time avoiding caffeinated drinks for at least 8 hours before sleep avoid using television mobile laptop etc. half an hour before sleep. daily exercise and breathing relaxation exercise like yoga can help. take a light diet in the night and avoid taking refined carbohydrates or sugars and heavy protein diet for dinner. for further information consult a psychiatrist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am a diabetic and have severe burning pain in feet. why?"}, {"role": "assistant", "text": "we are here to help you. it seems that you have been suffering from diabetic neuropathy. however i would like to exclude vitamin b12 deficiency as well as high uric acid before stating this. so i would like you to get the following investigations. serum vitamin b12 assay serum uric acid hba1c and nerve conduction study of both legs. once the tests are done then we can discuss the treatment part of diabetic neuropathy. for further information consult a diabetologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how do i control dandruff and hair fall?"}, {"role": "assistant", "text": "for severe dandruff you should take oral medicines apart from topical treatment. consider taking tablet ketoconazole 200 mg once daily for two weeks and apply candid b lotion (clotrimazole) on the affected scalp twice daily. as far as shampoo is concerned use shampoo containing ketoconazole every alternate day to start with and then taper slowly as you feel improvement. shampoo has to be used for a long time as dandruff and hairfall is a chronic disease. avoid oiling your scalp. for further information consult a dermatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i feel pain in the epigastrium part of my stomach. is it an acid reflux?"}, {"role": "assistant", "text": "based on your description it looks like gerd (gastroesophageal reflux disease). yes sometimes it becomes chronic and it is a very unpleasant feeling. in chronic cases esophageal sphincter may be incompetent too which leads to acid reflux. conservative therapy with antacids and diet is the first way of treatment. i suggest you use pantoprazole at morning and maalox syrup after meals. consult a specialist doctor discuss with him or her and take medicines with consent. avoid food at bedtime and also foods like caffeine chocolate spices gas drinks. use a pillow to raise your head more while sleeping. i advise you to get an upper digestive tract endoscopy. it determines the cause of gerd stomach and esophagus lesions. if the traditional method fails surgery is the final treatment with sphincter reinforcing. for further information consult an internal medicine physician online --><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to treat my mother's sigmoid colon ulcer?"}, {"role": "assistant", "text": "the white sticky bowel movements have many reasons but on considering the medical history of your mother it is most probably due to severe inflammation of the intestine. the antibiotics taken for the urinary tract infection could have caused an attack of her previously diagnosed ulcerative colitis. she should stop that antibiotic. go back to the doctor to switch to another antibiotic based on the results of urine analysis. she may also need a probiotic to reduce antibiotic-related diarrhea. she should avoid large meals and stick to a healthy diet. ask her to avoid coffee and carbonated beverages. she should continue her colon ulcer medications. for further information consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am 14 weeks pregnant and i suffer from severe acid reflux. should i consult a gastroenterologist?"}, {"role": "assistant", "text": "i am sorry that you have severe discomfort. you know that acid reflux and nausea are common in pregnancy. sometimes small and frequent meals can be tolerated. i suggest you try taking a ginger-based candy 15 minutes before you get out of bed. it is better not to drink a lot of liquid with the meal or lie down right after a meal. tea greasy food spicy food food with strong smell and soft drinks can increase the problem. as you have severe discomfort i would recommend you see a gastroenterologist as soon as possible. sometimes a short admission of serum therapy can help the stomach to calm down. i wish you get better soon. for more information consult a medical gastroenterologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "why am i bleeding after taking contraceptive pill?"}, {"role": "assistant", "text": "the extra bleeding could be due to the pill. however it would depend on the pill you took. if you have taken an emergency contraceptive pill then yes that would be the reason of excessive bleeding. however if you have taken a normal contraceptive pill then it will not protect you against pregnancy. though your details are not complete i need further details to guide you better. so please give further details. revert back with further details to an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can a bad cold cause variation in lymphocyte count?"}, {"role": "assistant", "text": "low lymphocytes can result from a viral infection. as you are giving history of common cold and cough following which your lymphocytes are low there is nothing to worry at all as all this is due to viral infection only. this would recover soon. for further information consult a general medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my wife has peculiar headache near left ear. what is it?"}, {"role": "assistant", "text": "headache which you have described could be migraines. i would need to know answer of few questions which would help me in getting to the right diagnosis. any history of headache (ha) in your wife's family or your children? how does the headache feel - throbbing pulsating or pressure type? does she get any aura (symptoms) prior to start of her ha such as flashing of lights colors stars black dots etc? did she experience any numbness over face or fingers? describe her ha severity in grade 1-10 1 - minimum and 10 - maximum. what brings her ha and what relieves it? for example sleep food and dark room. is she sensitive to noise and sound during her ha? does she get nausea or vomiting with these ha? does she get any redness in eyes tearing in eyes (left eye) with these ha? does she have any motion sickness brain freeze with ice cream or wet hands? does she take any medicine for these ha? since your ha frequency are frequent (when they occur they occur as multiple episodes in a day). once i have answers to these questions i would discuss about management (drugs). in the interim it is good and reassuring that ct head is normal which tells you there is no mass occupying lesion or increase icp (intracranial pressure). also mild increase in tsh (thyroid stimulating hormone) should not be associated with her ha. things she should do in the interim are drink water 2 l per day and keep herself well hydrated. exercise daily and run 2 km at 4 km/hour speed at least. have a good sleep for eight hours a day. revert back with the answers for the above questions to a neurologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what are the treatment options for chronic sinusitis?"}, {"role": "assistant", "text": "an ent doctor would have advised you to undergo endoscopic sinus surgery and septoplasty. surgery is the treatment of choice because your problem seems to be chronic (from longer duration). if you do not want surgery then you can take nasal spray (a combination of steroid and antihistamines) for a month mucolytics for a week and antibiotics for 14 days. early morning jogging is really good for patients having sinusitis. please follow the advice for a month and check if you have any improvement in your symptoms. since the pollution levels are high in your locality i would advise you to do exercise and jogging at home itself. for further information consult an ent otolaryngologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what is the treatment for red sputum?"}, {"role": "assistant", "text": "acute sinusitis should be treated with 10 days of amoxicillin and what you are having is acute on chronic sinusitis. i would suggest completing the course for next five days. continue the steaming and use saline nasal spray. do not blow your nose so hard. if the antihistamine is making your nose dry then do not use it use paracetamol for pain relief. allegra (fexofenadine) is a good medication but sometimes can cause nasal dryness. once the nasal dryness is cured you can also use nasal steroid that has fluticasone or use nasonex (mometasone) or nasacort (triamcinolone). use one spray in each nostril throughout the spring season. for further information consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my mom is a ckd patient and my bp is high. should i consult a doctor for hypertension?"}, {"role": "assistant", "text": "i understand what you are going through but there is no need to worry. hypertension is very common these days because of the prevalence of bad lifestyle genetic predispositions etc. in your case your mom's history of ckd (chronic kidney disease) increases your chance of hypertension. i suggest you get cbc (complete blood count) lipid profile urine analysis and ekg (electrocardiogram) to review your cardiovascular system. to help reduce your blood pressure changes have to be made as follows. lifestyle modification is the first step you have to eat healthily. eat more of vegetables nuts fruits whole grains fish and chicken. try to exercise at least 3 to 5 days in a week. reduce salt intake and always get adequate sleep. if after three weeks your blood pressure does not normalize you will have to start taking medications. for more information consult a cardiologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can you suggest ayurveda medicine for sinusitis?"}, {"role": "assistant", "text": "anu thailam - ayurvedic nasal drop apply 2 drops in each nostril before bed and at morning. nirgundi thailam - apply 10 drops on scalp top of head and rub with fingers. this should be done at 6. 30 am. then take bath after 7. 30 am in normal water. take a dried turmeric stick. show it on the fire in a candle. once the turmeric stick gets burnt then blow it to stop fire. now you can see the smoke coming off from the turmeric. show this below your nose and take deep breath so that the turmeric smoke should enter into your nostrils. start pranayama (breathing exercise) and yoga practice. these will give a permanent solution for your nasal block and sinusitis. for further information consult an ayurveda specialist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can recurrent uti be caused by holding urine in for long?"}, {"role": "assistant", "text": "your history suggests that you have very frequent urination and poor flow with recurrent uti (urinary tract infection). i would like to know the following. do you have constipation or numbness of the sole? how frequently do you get up at night? has any catheter been put in your urethra for any reason? do you have to rush to pass urine? the urine analysis does not show significant pus cells why do feel that you have uti? probable cause: bladder irritability. sphincter dysfunction. investigation to be done: uroflowmetry. i suggest taking the following: tablet tolterodine 2 mg. tablet tamsulosin 0. 2 mg at bedtime. psyllium husk three teaspoons with two glasses of water. your post-void retention is 30 ml which is also fair. i think you have dysfunctional voiding. revert with more information to a urologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can mucosal polyp in maxillary sinus cause headache?"}, {"role": "assistant", "text": "it is chronic maxillary sinusitis secondary to mucosal polyp and so go for a ct paranasal sinus. it will tell about the dimensions of mucosal polyp and its operability. till then i suggest you the following medicines. consult your specialist doctor discuss with him or her and take the medicines with consent. tablet cefpodoxime plus clavulanic acid combination for five days twice daily. tablet relent (cetirizine) one tablet twice daily for five days. capsule darolac (lactic acid) thrice daily for five days. tablet sumo (nimesulide) half tablet as and when necessary; maximum three times a day. for further doubts consult a general medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "why am i urinating more than 10 times a day?"}, {"role": "assistant", "text": "please measure your fasting and postprandial blood glucose level as you might have diabetes. it is usually accompanied with increased thirst and increased hunger. also please get a urine analysis as you might have a urinary tract infection. it is usually accompanied with burning sensation or pain during urination. for further information consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i develop sinusitis and severe cough in winter. i also have hair fall problem. kindly advise."}, {"role": "assistant", "text": "it is important to get your sinuses and nose clinically examined for any conditions that might require treatment. some people also develop allergy and this happens more often in the winter season. to make a diagnosis of possible allergy a complete blood count (cbc) is suggested and high eosinophil count is an indication of allergy. if your severe cough is due to high eosinophil count then you should take particular medications to suppress the allergy. hair fall commonly occurs due to any stress and also if it runs in your family. for hair fall please consult a dermatologist and take a prescription for minoxidil 5 percent solution that can be applied in small amounts of 1 to 2 ml each day for hair growth. for further queries consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can seizures be related to chronic sinusitis?"}, {"role": "assistant", "text": "we usually recommend antiepileptic if someone has two seizures within 24 hours. in approximately 70% cases we may not be able to identify any specific cause for seizures for example - infection stroke focal cortical dysplasia (fcd) and tumor as in your case. sinusitis is an incidental finding and at present it seems to be unrelated to epilepsy. you should complete antibiotic course as prescribed for its coverage. for epilepsy he will need antiepileptic drugs (aed). there are many aed to choose from but once you have been given keppra (levetiracetam) you can continue the same as it is a new generation drug with minimal side effects and drug interaction. with the limited information i have i would recommend starting it to prevent future seizures. your neurologist can provide you with its optimal dosing. high white blood cell (wbc) could be related to sinusitis or as a transient rise from seizure itself. it should come down by itself. it would be good to know how long his seizure was and what he did during his seizure. did he passed urine stool or bite his tongue during the episode? revert back with the asked details to a neurologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i feel constant throat irritation and acid reflux. please share your thoughts."}, {"role": "assistant", "text": "the foreign body sensation in your throat is basically due to acid reflux. it is irritating the throat as acid raises high up to cause stickiness. along with all the medicines you are taking i would add few lifestyle measures. avoid a sedentary lifestyle and at least move around a bit after your meals may be just 5 to 10 minutes. drink plenty of water and avoid constipation. you can add roughage to diet avoid spicy and fried foods. i suggest pantoprazole 40 instead of zantac (ranitidine) and an antacid syrup two tablespoons thrice daily. consult your specialist doctor discuss with him or her and take treatment with consent. for further information consult an ent otolaryngologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can burning sensation of throat occur from acid reflux?"}, {"role": "assistant", "text": "burning sensation behind throat is most commonly caused due to acid reflux. it can be also due to chronic smoking. as you smoke and drink you have much more chance of acid reflux. i suggest you to avoid spicy oily food for two weeks and tablet pantop (pantoprazole) 40 mg once daily for two weeks. consult your specialist doctor discuss with him or her get a thorough physical examination and take the tablet with consent. for further information consult an ent otolaryngologist online --><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what is the permanent solution for testicular pain?"}, {"role": "assistant", "text": "a minimally thickened cord is of questionable importance. please get your urine analysis also. idiopathic orchialgia is very common in young people. i suggest you wear scrotal support. the testes carry a spiral muscle called cremaster with them while coming out of the abdomen to lie in the scrotum at the birth of a male child. the testes are in a dynamic position hanging in the scrotum. they adjust according to stimulus like temperature change touch and excitation. in some young people this causes pain due to strong muscles. with aging this decreases. if it bothers a lot then you may need treatment. keep them close to the body by using scrotal support. this is neuropathic pain so i suggest tablet pregabalin as and when required. consult your doctor discuss with him or her and take medicine with consent. treatment plan:continue antibiotics for 10 days. it takes time to resolve the pain of epididymitis may be four weeks. regarding follow up:for further information consult a urologist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what is the treatment for sinusitis?"}, {"role": "assistant", "text": "we are here to help you. you are suffering from chronic sinusitis. and i feel this is all allergic and you do not need antibiotics. usually an acute attack takes five days to settle down. but if you have persisting sinusitis you would require ct paranasal sinuses. if the ct shows slight sinus infection then it can be treated with conservative treatment. but if the infection is severe you would require surgery for the same. the conservative management of sinusitis includes the following: steam inhalation four to six times a day. to take antiallergic like levocetirizine. in cases who do not respond to antiallergic drugs can opt for fluticasone nasal spray. short course of antibiotics like amoxicillin and clarithromycin will help. please share my opinion with your doctor before acting upon it. i hope it helps. for further information consult a general medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "suffering from acid reflux and bloating for the third time in a year. why?"}, {"role": "assistant", "text": "you described two different entities here. if you have indigestion due to any reason then you may have bloating burping heaviness of abdomen and early satiety. this occurs due to less enzymes available from the stomach gall bladder and pancreas for digestion due to a variety of causes. if you have a weak junction of esophagus with the stomach then swallowed food with stomach acid move into esophagus and produce symptoms of gastroesophageal reflux. acid reflux will give you burning pain in the chest and upper center part of the abdomen nausea heaviness after meals and symptoms of acidity. you might need further evaluation to confirm the diagnosis. investigations to be done:ct scan of abdomen and upper gastrointestinal (gi) endoscopy. differential diagnosis:1. indigestion. 2. hiatus hernia. 3. esophagitis. probable diagnosis:gerd with gastritis. treatment plan:continue treatment for gastritis. regarding follow up:for further information consult a medical gastroenterologist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to find out the reason for extreme sweating muscle stiffness and cramp?"}, {"role": "assistant", "text": "for better understanding i need more details from you. do you get high blood pressure with these episodes? is there any flushing? do you have diabetes? is there any medical problem that runs in the family? you can get kidney function hba1c urine analysis urine osmolality tsh (thyroid-stimulating hormone) liver function and plasma metanephrines during this episode. revert back with the answers to the above questions to an endocrinologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am getting sharp headache and abrupt vision shift. what does it sound like?"}, {"role": "assistant", "text": "your symptoms could be due to ocular migraine brain lesion vasculitis hypertension and stress. i would suggest you to consult a neurologist and have yourself examined. you need to carry out mri brain to exclude any brain lesion as the cause for your symptoms. also have your blood pressure measured. in your case it seems to be due to migraine since you have a history of migraine. for further information consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i suffer from erectile dysfunction. can i take trazodone with fluoxetine and cialis?"}, {"role": "assistant", "text": "i have gone through your history. based on your history your erectile dysfunction is due to side effects of fluoxetine. erection problem can be psychological or organic (problem with blood supply of the penis) or drug-induced. cialis (tadalafil) will help if you have any problem with blood supply of the penis which is not the case with you. you should not take fluoxetine with trazodone and cialis. i suggest you try taking trazodone without fluoxetine. if possible consult your psychiatrist and ask him to modify the medicines for you. i think cialis will not help at this stage. for more information consult a urologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "do i need to check hormones for erectile dysfunction?"}, {"role": "assistant", "text": "did you check this hormone early morning? preferably sample should be given before 9 am to an endocrinology reputed laboratory. lot of errors can happen and always test for total testosterone. now you can control your diabetes and start some exercises. preferably morning or evening walking is enough for 30 to 45 minutes. control alcohol and stop smoking. repeat total testosterone after one month. if it is less than 250 ng/dl then you can consult an andrologist or urologist. for further doubts consult an andrologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my wife has been suffering from migraine and gastric irritation. what to do?"}, {"role": "assistant", "text": "we are here to help you. her stomach irritation seems to be because of the migraine only. let me brief you about the migraine and its treatment. if you are suffering from migraine headaches then you should be started on medicines for the prophylaxis of the migraine. you have not mentioned the pattern of your wife's headache as you have to be sure that a headache is due to migraine. so i will brief you about the pattern of migraine headaches. migraine headaches are usually unilateral associated with throbbing vomiting sensations irritability and intolerance to lights and sounds. a person who has a migraine wants to sit in the dark and does not like anyone to speak. treatment given to her is fine but my experience and recommendations say that either sibelium (flunarizine) or topirol (topiramate) should be given along with amitriptyline (tryptomer) and see the effects. for further information consult a neurologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "do you recommend probiotics for acid reflux?"}, {"role": "assistant", "text": "your symptoms are suggestive of irritable bowel syndrome. yes probiotics play a wonderful role in this. in fact the famous probiotic for this purpose available in market are darolac-ibs and vsl-3 (lactic acid). you can take them twice a day. for further information consult a medical gastroenterologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "are herbal medicines effective in curing erectile dysfunction?"}, {"role": "assistant", "text": "the drugs levosulpiride and flupentixol will cause side effects like reduced libido or erectile dysfunction. levosulpiride results in increased prolactin concentration and thus ultimately poor erection. as you have stopped the medicines just a week back it will take time to normalize the hormone levels. in most cases potency improves in about four to eight weeks. so do not remain stressed. be calm and relaxed. the problem will reduce in some time. the probable causes:drug induced hyperprolactinemia. investigations to be done:serum prolactin and testosterone if needed. treatment plan:wait and watch. if needed pde-5 (phosphodiesterase-5) inhibitors can help. regarding follow up:for further information consult a sexologist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what is the solution for erectile dysfunction and premature ejaculation?"}, {"role": "assistant", "text": "erectile dysfunction and premature ejaculation can cause significant distress to a person. if your erectile dysfunction is persistent then i would advise you to get your serum testosterone and serum prolactin done to rule out any hormonal cause. if that comes back normal then most likely the cause of your problem is psychological. for erectile dysfunction medicines like sildenafil and tadalafil are used. these are pde-5 inhibitor drugs and have great efficacy in improving erection. the drug can be used even on sos basis (as and when required) about half to one hour before intercourse. for early discharge medicines like dapoxetine are used. the drug helps to delay the ejaculation time and thus help to solve your problem. dapoxetine is available in fixed combination form with sildenafil also and the drug combination will help in your complaints. please visit a psychiatrist for prescription of this drug and get your investigations done. do not remain distressed as these problems will get improved with medicines easily. the probable causes:anxiety and hyperexcitation. investigations to be done:serum testosterone and prolactin. treatment plan:sildenafil and dapoxetine combination. regarding follow up:for further information consult a sexologist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am getting erectile dysfunction as a side effect of dutasteride. please help."}, {"role": "assistant", "text": "drugs like dutasteride acts by inhibition of conversion of testosterone to its more active and potent form of dihydrotestosterone. thus the side effects may include loss of libido erectile dysfunction low mood irritability and depression. although the frequency of such adverse effects is not very high but they are potentially frustrating. sometimes reduced libido may not be due to a direct side effect of dutasteride but is purely psychological. but still if you have noted significant reduction in sexual desire and erection i suggest you stop the medication. with prolonged use the condition may be irreversible and no doubt that would be more troublesome than loss of hair. let me give you two tips for both the problems. apply onion juice on scalp daily. it has got miraculous effect. consume three garlic cloves raw and crushed daily. you can swallow it with water. within a month you will see drastic improvement in libido and erection. onion juice contains sulfur which increases production of keratin. garlic on the other hand cleanses fat and cholesterol deposition from smaller blood vessels thus improving erections by supplying more blood to the penile tissues. for further information consult a sexologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "kindly suggest ways to overcome migraine."}, {"role": "assistant", "text": "i clearly understand your symptoms. the basic reason behind the whole issue is the autonomic imbalance which your nervous system shows to specific sensory inputs. let me simplify that thing for you. all the senses give input to our brain like smell vision taste hearing and touch. out of these five the first two can have relatively major influence on our autonomic nervous system. the autonomic nervous system is the part of nervous system which regulates blood circulation digestion respiration cardiac rhythm etc. the alteration of blood flow in the brain produces those flashes of light and sometimes a lost patch of vision in a field. now people with migraine have little problem with these autonomic regulations and that is what is happening to you. the new smell is excessively disturbing your autonomic nervous system and so you have all the symptoms which you described. the olfactory system gets adapted relatively quickly. so if you continue to go there eventually you will get adopted. if that does not happen then you can use mechanical barriers such as a small mask to avoid the smell up to a certain extent but it may not help much. for nausea i suggest emefilm (ondansetron) 8 mg a thin mouth dissolving film of medicine to be kept below the tongue when you feel nauseated and topiramate 50 mg twice a day for headache. consult your doctor discuss with him or her and take the medicine with consent. for further information consult a neurologist online --><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "why should we avoid oral contraceptive pills after 40 years?"}, {"role": "assistant", "text": "natural estrogen is cardioprotective as it increases the level of hdl (high-density lipoprotein) and decreases the level of ldl (low-density lipoprotein). oxidation of ldl cholesterol is believed to be the initiator of atherosclerosis. estradiol and other estrogens are believed to inhibit this process. hormone replacement therapy - hrt rapidly increases the level of c-reactive proteins in the body a marker of inflammation associated with increased risk of cardiovascular disease. recently two major studies found that hrt in postmenopausal women increases the risk of breast cancer. another study proved that hrt in postmenopausal women increases the risk of cardiac events and thrombosis. hence women should be advised to cease therapy postmenopause. however a detailed analysis showed that the time of initiating hrt postmenopause plays a crucial role. when initiated within five years of menopause in a healthy woman estrogen-based hrt has far more benefits than adverse outcomes. the pros of hrt includes: reduces symptoms of menopause. reduce osteoporosis dementia and colon cancer. improves cardiovascular system. the cons of hrt are: doubles the risk of thromboembolism. doubles the risk of breast cancer. so pros and cons are to be evaluated before initiating hrt in postmenopausal women. for more information consult a cardiologist online --><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "could i have your opinion on my erectile dysfunction and low libido?"}, {"role": "assistant", "text": "i have a few questions as a follow up. when was your puberty? do you find any change in shaving frequency? are you getting morning erections? is there any history of testicular surgery? have you had mumps? when did you last take ecstasy (mdma - methylenedioxy-methamphetamine)? is there any double vision? revert back with the answers to the above questions to an endocrinologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have pain in the eyes and severe headache. what could it be?"}, {"role": "assistant", "text": "these symptoms indicate migraine headache. these vision related symptoms are present in aura (temporary visual disturbances that precede the migraine headache). the treatment is by use of analgesic drugs in acute episodes and by use of prophylactic drugs like flunarizine to prevent recurrent attacks. consult a general medicine physician online for further investigations and treatment --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am 26 years old female who has ptsd bipolar and major depression. i also suffer from migraines anxiety and insomnia."}, {"role": "assistant", "text": "i read your concerns. i feel that topamax 200mg which works well for migraine has a little role in bipolar disorders. studies show that monotherapy with topamax is not recommended but instead of taking topamax you can try sodium valproate (depakote xr 750mg at night) which will be helpful to you in both your migraine and bipolarity. divalpoex sodium (depakote) has sedative property as a side effect. so it will be helpful to you in your insomnia. if you take 750 mg of dep. at night then you can reduce the night dosage of clonapin and gradually increase the dosage of depakote to 1000 mg and reduce the clonapin. you can also take 500mg in morning and 1000mg at night. and i feel that if you are feeling depressed then only you should take paxil otherwise there is no role of it in bipolar disorder. if your migraine is severe then you should take propranolol 10mg twice a day. but you have to take care about your heart because you complained about side effects of seroquel. propranolol is beta blocker it is used in prophylaxis for migraine. and i feel that if you use it you finally will get relief from your migraine. i do not know whether you have ever tried non benzos like zolpidem zopiclone eszopiclone. you should try that also for your sleep. i feel that these will satisfy some of your concerns. you can book for an online therapy at icliniq for further consultation with me either via video session or on phone."}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am suffering from migraine for the last 15 years. there is throbbing pain is on the one corner of the head"}, {"role": "assistant", "text": "both carbamazepine and flunarizine have side effect of memory loss. you should take tablet vasograin. it is most effective at the onset of migraine. once migraine starts though it reduces some symptoms but not so effectively. so along with it take tablet diclomol (combination of diclofenac and paracetamol) twice a day for three days. it is very effective to control migraine. if headache is very severe you can also take injection voveran intramuscularly. you also need to take tablet razo (rabeprazole) 20 mg twice a day to prevent acidity. for further information consult a neurologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "having spotting after emergency contraceptive pill. is there anything to worry?"}, {"role": "assistant", "text": "first of all this is not acceptable if you take i-pill frequently. as these pills are of high hormonal content it can mess up your internal hormonal balance. so you may have these types of few abnormal bleeding for the following few weeks. now the intermenstrual bleeding or spotting might be due to ovulation itself and does not warrant any treatment. i suggest you to start regular contraceptive pills from the first day of your next cycle onwards. it will help you not only for protection but also for regularization of cycle. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "does a contraceptive pill affect periods?"}, {"role": "assistant", "text": "oral contraceptive pills are quite safe and do not affect periods in bad way. though does not protect 100% but chance of pregnancy is almost nil. if you have sex once a month then you can take emergency pill but it is known to be less effective. it should not be used more than once a month. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "does taking contraceptive pills before and after sex avoid pregnancy?"}, {"role": "assistant", "text": "theoretically abstinence is the only way to ensure that one does not get pregnant. however practically speaking there are many ways to avoid pregnancy. it ranges from using condoms to contraceptive pills to intrauterine devices to achieve longer contraception. if no method is used and pregnancy is feared then one can even use emergency contraceptive pills. it has to be used occasionally but definitely not more than once a month. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is it safe to take oral contraceptive pill?"}, {"role": "assistant", "text": "combined oral contraceptive pill (cocp) is absolutely safe for her. it does not cause cancer (low dose cocp). just check the content of cocp which she is taking. if dose of estrogen (ethinyl estradiol) is 20 or 30 mcg she can safely continue the medicine. in fact cocp in such a case prevents endometrial cancer due to its progesterone content. regarding missed period it normally does not happen with cocp. normally period starts between 3 and 15 days of stopping the last tablet in the pack. if it has been more than 15 days since last tablet consult a gynecologist. if it has been less than 15 days she can wait till 15 days from last pill for periods to come. in any case she cannot start next pack without having periods unless instructed by doctor after examination. do not forget to tell her to use another form of contraception like condom if she is sexually active. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "had an emergency contraceptive pill after sex. can i be pregnant?"}, {"role": "assistant", "text": "as you had taken one unwanted 72 within 24 hours after the intercourse you must have received a withdrawal bleed after 5-7 days. if yes then the date of the withdrawal bleed would form your fresh lmp (last menstrual period) and you should be starting your count for next menses from that date. as the pregnancy tests are negative you are not pregnant from that sexual encounter. hence considering the possible withdrawal bleed your next menses should start only by now. as you have started experiencing mild cramping and vaginal mucoid discharge which are part of pms (premenstrual syndrome) it is indicative that you will start your menses soon. hence please be patient for another one week and you will get your menses. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "could you advise on my tiredness weakness and faint feeling following viral infection?"}, {"role": "assistant", "text": "two points are very important here. they are abnormal heart rhythm and tiredness. which type of abnormal heart rhythm are they trying to treat with propranolol? it seems like you have supraventricular tachycardia and the type depends upon the ekg and ep study. did you have any of these? the tiredness is very classical with propranolol. how much are you taking? the other possibility for tiredness could be viral myocarditis which could be seen on the echocardiogram. revert with the details to an internal medicine physician online --><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i took emergency contraceptive pills few days back. i am bleeding today. am i pregnant?"}, {"role": "assistant", "text": "no. you are not pregnant. you had your emergency contraceptive pills on 26th november so this bleeding must be withdrawal bleeding due to that drug. but if bleeding does not settle get one ultrasound scan done and keep assured. revert back to a gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "have started my contraceptive pills on the third day. would they be effective?"}, {"role": "assistant", "text": "yes this oral contraceptive pill is more than enough for contraception. do not take any other medication as this will work as a contraceptive. you may or may not experience slight nausea abdominal cramping lightheadedness and headache but these will eventually settle down. it is because of the hormone present in the pill. most of the times it is very mild and goes unnoticeable. if you have symptoms and feel unbearable then do consult your gynecologist. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "though i am on stalopam i am not getting sleep. what to do?"}, {"role": "assistant", "text": "i understand your concern. escitalopram may not help you to sleep since it does not have much sedative property. feliz plus has clonazepam in it which will aid in sleep but is not recommended long term. since you have not mentioned any other symptoms regarding the prescription of stalopam i am assuming that you do not have any other symptoms except sleep disturbance. for a beginning start practising sleep hygiene do a bit of exercise in the evening and avoid drinking coffee after 5 pm. if you are still unable to get sleep then i suggest you tablet ramelteon 8 mg known by brand name rametax which is very physiological and devoid of side effects. consult your specialist doctor discuss with him or her and take medicine with consent. but i will advise you to try the non-medical approach. if you have symptoms of anxiety or depression then it is better to continue stalopam. for further information consult a psychiatrist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is herpes zoster dangerous?"}, {"role": "assistant", "text": "as you know it is a viral infection. it takes 7 to 10 days for the lesions to heal. but in patients who are diabetic old age secondarily infected and with an incomplete antiviral dose or seropositive it can take up to 15 days to get cured. in elderly age group even after the skin lesions heal the patient might experience intense pain in that particular area. it is called as postherpetic neuralgia. kapsi gel can be applied (capsaicin) once the skin is completely healed to relieve pain. consult your specialist doctor discuss with him or her and take the medicine with consent. how many days before she was diagnosed? what is her age? please send images of the area. revert back with the answers to the above questions to a dermatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is there any medicine to control anger?"}, {"role": "assistant", "text": "the first step is to prevent yourself from acting out during anger episodes. while getting angry either do reverse counting from 20 to 0 or deep breathing. after calming down give logical suggestions to yourself against losing temper in that particular situation. log down the events resulting in stress and weekly review them. then think some alternative response from your side to resolve it. practice relaxation exercises like yoga (pranayama). follow steps of sleep hygiene such as avoiding caffeinated drinks. remember that every problem has a solution. you just need to try solving it. for further information consult a psychiatrist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have been suffering from throat pain headache and weakness sickness since last 2 days."}, {"role": "assistant", "text": "hi from your query i understood that you have simple viral infection causing the upper respiratory tract infection (urti). so you have to take tablet febrex plus three times in a day for 3 days. use saline gargling for throat pain. use steam inhalation if there is any nasal block. better to take an antibiotic also tablet levofloxac 500mg once in a day for 3 days. if there is no relief with this you have to do blood test and urine test. for further evaluation revert back to a general practitioner online --><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "why do i feel lazy and sleepy the whole day?"}, {"role": "assistant", "text": "thank you for sharing your complain with us. most probably the cause behind your mentioned problem is sleep disorders like sleep apnea and rls (restless legs syndrome). sleep disorder such as sleep apnea affects the quality of sleep and makes a person more tired during all day. other medical problems which can cause similar manifestations are diabetes hypertension and weight gain. you are overweight to your height and should maintain a healthy bmi of 23. your weight should be around 55 according to your height. i would suggest you to exercise regularly. practice some form of relaxation exercise like deep breathing exercise and yoga. eat a healthy diet and avoid smoking or alcohol if you consume. take your prescribed medicines regularly if any. try to go to bed at same time every night and wake up also the same time every day. avoid watching tv before going to sleep. i would suggest you to get checked for mentioned causes first with your general practitioner and if your gp is concerned then will refer you to sleep therapist for further evaluation. for further information consult a general practitioner online --><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "while using contraceptive pill will i remain protected during pill free days?"}, {"role": "assistant", "text": "i guess you are taking combination pill that is hormonal contraceptives containing both estrogen and progestin (synthetic progesterone). these act by preventing your ovulation and making your cervical mucus thicker. you need to take combination pills within five days after the start of the period. then you need not follow other means of contraception. you may start combination pills at any time and only concern is that you will be protected from pregnancy 7 days from then. yes you need not take pills in the fourth week and this will initiate your withdrawal bleeding that is you will have a menstrual bleed in that week and you will be protected. some measures you need to follow. you need to ensure that you take these pills regularly at the same time each day. if you vomit immediately following pill consumption then take one more pill. you should not miss the pill. if you miss a period then do not panic as irregular periods are common. you need to confirm by urine pregnancy test. for further doubts consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "are these medicines the apt ones for keratitis?"}, {"role": "assistant", "text": "let me share some facts about viral infection of eye. primary viral infection of the eye is usually followed by recurrent infection that may involve any or all layers of cornea. cornea has three layers: epithelium stroma and endothelium. it is when the stroma affected it causes stromal keratitis. this may be due to direct infection or your own body's immune response to viral antigens. most common viral keratitis is herpes simplex viral keratitis. stromal keratitis is usually recurrent. the treatment prescribed to you is according to the protocol. you need to ensure that you use them accordingly and apply topical medication five times daily. the response should be evident by two to four days. if not then you can change from acyclovir to ganciclovir ophthalmic gel 0. 15% five times daily or trifluridine 1% drops nine times daily. topical corticosteroid pred forte (prednisolone) is to bring down your immune response and is thus indicated in immune mediated non-necrotizing stromal keratitis. debridement can sometimes be tried according to the lesion. antiviral medications should not be taken for more than 10 to 14 days as they cause epithelial toxicity. patients with frequent recurrences of ocular hsv may be placed on a long-term regimen of oral antiviral medication at the prophylactic maintenance dose. valacyclovir has been shown to be as effective as acyclovir in reducing the recurrence of ocular hsv disease. have a word word with your treating physician if you are worried about recurrence. take care. for further information consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my daughter finds it difficult to fall asleep. why?"}, {"role": "assistant", "text": "i understand that you along with your child are going through tough time. the weight of your child is a little bit more than expected for that age. encourage her to play outdoor games and do regular exercises. avoid watching television or movies that have an impact on her just before going to bed. snoring could be due to nose block or adenoids or overweight. if the problem is persistent please consult a sleep disorder specialist for further evaluation and treatment. take care of your child. for further information consult a paediatrician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "does my daughter's thyroid level warrant a follow up?"}, {"role": "assistant", "text": "the viral infection she might have caught from her school and there is no need to worry. usually that is self-limiting. we adapt the policy of wait and watch unless there are no complications and i think there are none. with respect to thyroid i suggest you do not panic. tsh (thyroid-stimulating hormone) of 5. 12 at this age in the morning is normal. her anti-tpo (thyroperoxidase antibody) is also negative. is there any family history of thyroid illness? she will not have joint pain for a tsh of 5. 12. the joint pain could be associated with viral infection. i would suggest repeating tsh and free t4 after six weeks. for further information consult an endocrinologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my son complains of stomach pain and discomfort. what would be the likely reason?"}, {"role": "assistant", "text": "there could be some gas problem probably which is a minor issue. i suggest syrup colicaid (simethicone) 2. 5 ml thrice a day for three days. also i would advise against drinking raw milk. please sterilize and drink. please educate your son about raw milk that it can cause diseases and the need for sterilization. for further information consult a paediatrician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have been burping with stomach pain and discomfort. what can be the reason?"}, {"role": "assistant", "text": "after going through your concerns carefully i feel your symptoms may be due to any one of the following. gerd (acid reflux). small intestinal bacterial overgrowth. ibs (irritable bowel syndrome). i suggest you tablet pantoprazole 40 mg and zenflox-oz (combination of ofloxacin and ornidazole) for 14 days. consult your specialist doctor discuss with him or her and take treatment with consent. the fact that your symptoms disappear after taking zenflox-oz it means that your symptoms are due to large or small bowel infections. i would suggest you do hydrogen breath test to rule out or confirm small intestinal bacterial overgrowth. for further queries consult a medical gastroenterologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "suffering from floating stool and stomach pain. how can i help myself to get better?"}, {"role": "assistant", "text": "i can understand your concern for your symptoms. floating stool is suggestive of abnormal digestion and absorption of fat from the diet which leads to an excess amount of fat in the stool. stomach ache and gas are suggestive of indigestion due to lack of intestinal digestive enzyme supplementation. your history of type 1 diabetes along with these symptoms are suggestive of an inadequate amount of pancreatic juice (exogenous enzymes) for digestion. the probable causes:autoimmune pancreatitis. investigations to be done:ct scan abdomen with contrast lipase amylase and upper gi endoscopy (to rule out gastritis). differential diagnosis:severe gastritis. probable diagnosis:autoimmune pancreatitis. treatment plan:continue treatment for diabetes pancreatic digestive enzyme supplementation and treatment for acidity. preventive measures:avoid oily and spicy food. take fat-free and high protein diet. regarding follow up:for further information consult a medical gastroenterologist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my 4 year old has stomach pain. what is he suffering from?"}, {"role": "assistant", "text": "is he passing stools? this is a very important question because if he is not then it may point to obstruction. another possibility is that there may be some mild gastritis. you can manage the pain by giving syrup colicaid (simethicone) 5 ml only when there is the pain. for the vomiting you can give syrup ondem (ondansetron) 5 ml thrice a day for three days. wait for at least half an hour after giving ondem to give any food or water. i would also prefer if you get him evaluated physically since he is lethargic you said. he may be dehydrated. for further information consult a paediatrician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "shall i use drugs to get sleep?"}, {"role": "assistant", "text": "you try to exclude diet such as white flour products sugar tea coffee chocolates cola fatty foods fried foods excessive use of salt and strong condiments. breakfast should contain fresh fruits dried fruits and whole cereals. lunch should consist of large mixed salad. a cup of hot milk sweetened with honey at bedtime will be beneficial to get sound sleep. regular exercises like jogging joint exercises yogasanas are ideal exercises. do pranayama (breathing exercise) relaxation techniques and hearing soft music at bedtime may be helpful. hot foot bath at bedtime has significant effect on sleep. revert back after two weeks to consult a naturopathy specialist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i feel sleepy during office hours even after 8 hours sleep at night. please advice."}, {"role": "assistant", "text": "feeling sleepy during office timing is most commonly caused by absence of a sound sleep at night. sleeping for 8 hours during night not always means that you are having a healthy sleep. a healthy sleep is determined by the following factors: duration of the sleep. sleep-wake timings. number of awakenings during sleep at night. daytime sleepiness or drowsiness. any distress or dysfunction associated with sleep disturbances. as you told that you are sleeping for about 8 hours at night and your age is 24 years this is an adequate sleep at this age (6-8 hours). however if you still feel sleepy during your office hours this can be due to inadequate sleep in terms of quality of sleep. ensure that you are sleeping at an adequate time and getting up at adequate time in morning. no frequent awakening at night which reduces the quality of sleep. besides this few other things also hamper sleep quality such as: affective states anxiety states psychosis. endocrine disturbances such as hypothyroidism or hyperthyroidism. activating agents like tea coffee stimulant abuse. underlying physical illness. lack of interest in work boredom and burnout syndrome at work place also can cause sleepiness. i would recommend you a few changes that you can make at your work place such as make your work area more stimulating work in chunks take breaks in between your work do not work for long hours at a stretch drink water in between avoid too much tea/coffee in order to work continuously get involved in conversations in between for a while to refresh yourself. also try and maintain sleep hygiene at bed time. besides this if you continue to have this problem seek an opinion from a sleep medicine physician online get yourself evaluated for any of the above causes for sleep disturbances --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my daughter has stomach pain and foul smelling farts. please help with the treatment."}, {"role": "assistant", "text": "the first striking point i have noted in your history is the weight of the child. 10 kg for a 5 year old is very less. this history coupled with the history of abdominal pain and indigestion may be indicative of a metabolic disorder or disorder associated with digestion of food. it needs to be evaluated with blood urine and stool tests after complete physical evaluation. as of now cyclopam (dicyclomine and simethicone) is the only treatment. but additional treatment may be required based on the results of the tests obtained and physical evaluation. for further information consult a paediatrician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can i take practin and decdan to gain weight?"}, {"role": "assistant", "text": "the tablets practin (cyproheptadine hydrochloride) and decdan (dexamethasone) would just add water retention in the body and not increase the muscle mass. so once you leave it your body shall return back to low weight itself. so practin and decdan are not recommended for instant weight gain. gradual weight gain is always advisable. an increase in 500 kilocalories per day can result in increasing the body weight by 0. 5 kg per week. eat plenty of healthy fats. have egg yolks meat with animal fat coconut oil and other healthy fats. increase calorie intake of healthy foods that include bananas. chew the food properly to improve digestion. keep a track of your weight gain as this is essential. it is healthy to increase approximately 5 to 6 kg per month. the right combination of healthy food exercise correct breathing rest and sleep go a long way in healthy and happy life. for further information consult a family physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "why do i have persistently high hb and hct?"}, {"role": "assistant", "text": "you are having celiac disease in which because of malabsorption vitamin b12 deficiency and folate deficiency can occur. this deficiency also can be developed if polycythemia present in which proliferation more. here hemoglobin and hct is high as per history. hence if it is persistently elevated then polycythemia a form of blood cancer should be ruled out. for that one molecular investigation useful that is the detection of jak2 mutation. if polycythemia confirmed then phlebotomy is done regularly and other suitable medication prescribed like anagrelide that prevents thrombosis in such case if platelet count also high in cbc. rule out metastatic hodgkin's lymphoma also as you have a history by ct scan and bone marrow biopsy study. celiac disease is a form of autoimmune disease and gluten-free diet prescribed for that. take care. consult nearby oncologist for examination with keeping all this in mind. for further information consult a hematologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i got slight epidermal prick while tattooing. is the risk of infection high?"}, {"role": "assistant", "text": "there are lot of medical issues which can occur from tattooing like hiv infection tetanus hepatitis b and c and allergic reactions. nowadays tattooists reduced such risks by following universal precautions working with single use items and sterilizing their equipment after each use. as you mentioned your piercing was done only till the epidermis the infection is highly unlikely (very very less chance) that you will contact any infection. even if the needle was infected it requires contact with body fluids like blood. so you can relax. still i would like to make the following points:- in case of an hiv infection the test takes about 2-3 months to be positive. hence there is no way to find out if you got infected which is again highly unlikely. there is something called post-exposure prophylaxis (pep) given to individuals who have been exposed to the virus and includes three drugs given only under doctor's supervision. you can discuss this with your doctor. if you frequently get a tattoo done make sure your tetanus and hepatitis b vaccines are up-to-date. always have clear knowledge about the infections spread by tattooing like hiv and hepatitis and their mode of spread. take care and stay safe. for further doubts consult a hiv aids specialist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "we are not sure about my friend's diagnosis. kindly help."}, {"role": "assistant", "text": "one thing for sure is that he is having periodic hemolysis with adequate bone marrow response and he has a severe vitamin b12 deficiency. his corrected rpi (reticulocyte production index) is 2. 7% which means that his bone marrow is responding to the anemia appropriately. the broad differential here would be medication induced hypothyroidism vitamin b12 folate deficiency lead poisoning alcoholism and hemolysis due to ssd (sickle cell disease) or liver disease since he has transaminitis and elevated bilirubin. elevated ldh (lactate dehydrogenase) elevated reticulocyte count and low haptoglobin are indicators of hemolysis. he has splenomegaly as well which again favors either a chronic liver disease or most likely hemolysis. however the only tricky portion is his low wbc (white blood count). i do not think that it is a bone marrow process. it is more like peripheral destruction or nutritional deficiency. i do see that the vitamin b12 is very low at 209 and he has a normal g6pd level (glucose-6-phosphate dehydrogenase). i also reviewed that his bm was normal and his electrophoresis does not comment upon the sickle cell s or c disease. please mention whether he had any additional testing or work up for hemolytic anemia. i would like to know if he had a tsh done. why is he taking medications (all of them) including prednisolone azathioprine rituximab and mycophenolate? why is he not taking the vitamin b12 and vitamin d? these medications are toxic to bm and should not be used without a concrete diagnosis. revert back with the answers to the above questions to an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can vitamin b12 deficiency cause depression and anxiety?"}, {"role": "assistant", "text": "yes vitamin b12 deficiency causes severe depression. also thoughts like not being able to fulfil duties can induce guilt and worse depression. please take your friend to a psychiatrist for treatment with a combination of antidepressants and cognitive behavior therapy for best results. please continue his vitamin b12 replacement as going on. eating green vegetables and white meat like chicken and fish will help. for further information consult a psychiatrist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "after receiving tattoo should i be concerned about hiv infection?"}, {"role": "assistant", "text": "i have read your query in detail and do understand your concern. the conditions you have mentioned are not the risk factors for acquiring an hiv infection. the risk is there only if a drop of some hiv positive person's blood from the gun was transferred directly into your skin while tattooing. even then there is 3/1000 chances of you getting hiv from that drop of blood. so the probability of this happening is almost negligible. though hiv testing is not needed in your case but to relieve yourself from the associated anxiety you may get an elisa (enzyme-linked immunosorbent assay) for hiv test done after 12 weeks of possible exposure. the symptoms you have described are non-specific symptoms which can also be seen without any underlying cause and not indicative of hiv infection. for further doubts consult a hiv aids specialist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "why did my stomach pain end up in hospital admission?"}, {"role": "assistant", "text": "according to your complaints past history investigations and present condition you might have ibs-c that is irritable bowel syndrome constipation type with differential diagnosis of intestinal motility disorder. the latter condition produces symptoms of intestinal obstruction very similar for which you required hospitalization. both antroduodenal and rectal manometry can be done only during endoscopy and colonoscopy respectively. and if your doctor has a suspicion for motility disorder he can take biopsy tissue from a particular part of intestine during this. you needed hospitalization because your symptoms your intestine movement were so worse and caused significant dilatation of intestines which itself hampers motility. this requires aggressive treatment to decompress intestine to prevent blood supply movement and integrity of the intestinal wall the probable causes:intestine dysmotility. differential diagnosis:primary motility disorder of intestine. treatment plan:supportive medications need to be continued. preventive measures:avoid constipation adequate amount of fluid intake and can try semi-solid or crushed diet during active symptoms. regarding follow up:for further information consult a medical gastroenterologist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what are the causes of vitamin b12 deficiency in a non-vegetarian?"}, {"role": "assistant", "text": "having vitamin b12 deficiency in a non-vegetarian is unlikely. why did you get your vitamin b12 levels checked? what is your hemoglobin level? do you drink alcohol? you can use nervijen capsule (combination of benfotiamine folic acid methylcobalamin nicotinamide and pyridoxine hydrochloride) safely. revert with more information to a general medicine physician --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "will irregular period affect my fertility?"}, {"role": "assistant", "text": "all these problems of periods are due to overweight. your expected weight is around 55 kg to 60 kg. it is easy to say just to reduce. but it is quite impossible to reduce so much. please put some effort to do it for at least 2 to 5 kg per month. it is a start. reduce all high calories diet and junk bakery food. but you should not fast. have regular exercise especially for the middle segment of the body like aerobics or brisk walk. all the fat in the body gets converted to hormones. you would have seen big men having breast as their fat is producing the female hormone. this hormone will affect the normal cycle of ovulation and you will not get the periods regularly. your fat distribution will be mainly around mid-segment such as thighs breast back and hip but not below knees and elbows. also there will be black discoloration behind the neck side of breast and inner aspect of thighs. kindly get a scan to check polycystic ovaries. in the meantime also check your empty stomach early morning thyroid profile and serum prolactin. these hormones can also affect your periods and can be corrected. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i touched a used needle. is there any chance of me getting hiv infection?"}, {"role": "assistant", "text": "the risk of infection from needlestick injuries depends on: the factors that influence exposure to a greater volume of blood (for example: visible blood on the device needle which has been placed directly into an artery or a vein of an hiv positive person). viral load of the source patient. deeper injuries and by hollow-bore needles (especially those needles with larger gauges). diabetics use fine gauge needle and that too for injecting insulin into the skin rather than into a blood vessel. moreover the needlestick injury you have mentioned here actually did not prick deep enough you just touched the needle and i think your chances are minimal if at all. are you unsure about the hiv status of the patient? if you are sure that the used needle belongs to him and no one else and if you know the person very well you may straight away go and tell him/her about the incident and your reason to be anxious and inquire about the person's hiv status. that would be the easiest way. you may get a hiv combo test (antigen and antibody based test) done after 1 month of exposure for your own peace of mind. consult a hiv aids specialist online for further help --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to correct vitamin b12 deficiency?"}, {"role": "assistant", "text": "i had gone through all the data posted. the treatment duration for b12 deficiency depends upon the cause severity and symptoms. for example vitamin b12 deficiency is common in strict vegetarians. so we advise them to take injection daily once intramuscularly for one week and then weekly once for four weeks and then monthly once in six months. if pernicious anemia is the cause where there is a defect in the absorption of vitamin b12 then we will advise to take the same course for a longer duration. it also depends up on the signs and symptoms like low hemoglobin neuropathy etc. so if you are a strict vegetarian or the cause of b12 deficiency has not been evaluated then i suggest tablet containing b12 1000 mcg weekly two days. kindly review with further details so that i can help you better. revert back with further doubts to an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is it safe to take clenbuterol being overweight and asthmatic?"}, {"role": "assistant", "text": "the drug you have mentioned is a beta2-adrenergic agonist and it can cause bronchodilation in asthmatics and can also burn fat. it has other side effects also such as it can cause tremors increased heart rate high blood pressure muscle cramps and can also alter potassium level in your body. so it is better to avoid it. i would recommend you to go with natural ways of weight reduction. since you are already taking anti-asthma drugs there is no need of taking this drug. you can take other short acting beta2-adrenergic agonist as required. for further information consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what should people with pcos eat and should not eat?"}, {"role": "assistant", "text": "people with pcos usually are obese or overweight. however there are lean people with pcos also. people with pcos will usually have insulin resistance. so try to avoid sugary foods and keep a check on your weight and follow a regular exercise routine. this will help to cure the disease also. take good quality carbohydrates with whole grain meals. avoid fats and bakery products. you can take lean meat skinless chicken. avoid juices and take lots of fruits and salads. hope it helps. consult an obstetrician and gynaecologist online for further help --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my problem is regular hair fall. how to control hair loss? please help."}, {"role": "assistant", "text": "before i can help you please tell me the average number of hairs that fall for you in a day? are you taking any sort of medications? have you fallen sick in the past one year? does your father or paternal uncles have baldness? do you have dandruff? you can start with biotin 10 mg orally and minoxidil 5 % topically. but to be sure it is male pattern baldness or androgenetic alopecia i will need the details i have mentioned above. get back to a dermatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can i reduce weight by going to gym?"}, {"role": "assistant", "text": "you are overweight. you have to reduce your weight to around 65 kg to live a healthy life. your lipid status and blood pressure may become normal once you shed those extra kilos. going to the gym is a good initiative and i suggest you not to lift weights until you become 90 kg. first reduce your weight by severe dieting eating very less. i suggest you to walk daily for 40 minutes quickly like 6 km per hour after one or two months convert it into jogging. within two months you must be doing two hours of this every day. after reducing 10 kg you do one hour jogging and one hour gym activity. and never stop your dieting and exercise ever in your life. it will lead to getting the same weight again. for further information consult a general medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have stretch marks all over my body. how to get rid of them?"}, {"role": "assistant", "text": "you have a body mass index - bmi of 28 which comes in overweight category. stretch marks result from excessive stretching of the skin. so i will highly recommend you to reduce weight by at least 7-8 kg. once stretch marks are formed they are hard to treat. number of treatments is available with varying success. co2 laser (carbon dioxide laser) : this will give you skin tightening over the affected area but again get treated for visible parts only and not the entire body as it will be quiet expensive. nonablative nd:yag (neodymium-doped yttrium aluminium garnet) laser and er (erbium-doped) glass lasers: these are skin tightening lasers. dermaroller and prp (platelet rich plasma): this is non-laser procedure with platelet rich plasma injected in the stretch mark to induce skin tightening. vitamin e capsules: used with variable success. vitamin c tablets: can be used as supplements. all of these treatments have varying success rate ranging from no improvement to 50% improvement. for the above treatments you will have to visit a dermatologist. for further information consult a dermatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "having dandruff and hairfall. suggest an ayurvedic procedure or medicine."}, {"role": "assistant", "text": "there are many reasons for dandruff. close examination can help diagnose the exact reason for dandruff. i am sharing some steps which usually help cure dandruff. use mahabhringraj oil (any good brand) at night to massage scalp with finger tips. saturate the scalp. on the next morning use herbal shampoo with minimal preservatives and chemicals. rinse thoroughly afterwards. remains of shampoo on the scalp also lead to white flakes on scalp. avoid using conditioner in fact you will not need it if you once started using maha bhringraj oil as said above. avoid using hair dryer. brush your hair regularly to remove any dead tissues. in routine use a light refined oil. if dandruff still persist consult a dermatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can pregnancy occur outside uterus?"}, {"role": "assistant", "text": "whatever your doctor said is true. but there is no need to be afraid. even when it is an ectopic pregnancy it can be managed efficiently with medicines or laparoscopy in the modern era. an ectopic pregnancy will not cause pain bleeding etc. unless it is about to rupture. the second possibility is that of late ovulation with multiple pregnancies. pregnancy in that case will be seen late on ultrasound. you can just repeat beta hcg (human chorionic gonadotropin) after 48 hours to know about status and doctor will decide accordingly. the only caution is that if it turns out to be an ectopic pregnancy just follow your doctor's advice. for further doubts consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can stress cause hair fall?"}, {"role": "assistant", "text": "let me explain everything about hair fall. 100-150 hair fall every day is very normal. so it should be considered as hair loss only if the number of hair falls more than this. generalized hair fall in female is mostly due to stress poor sleep poor nutrition and excessive blood loss due to menstruation. stress alopecia is also common in which female keeps their hair very tight in certain manner which creates tension in root and cause hair fall. straightening and other procedure also cause weakness of root. other condition like fever typhoid malaria thyroid etc. can also cause hair fall but these are less common. regarding treatment have good sleep. eat proper food with green vegetables and fruits. take iron and multivitamin like follihair for at least three months. check your blood hemoglobin. if it is less then she should start iron and folic acid supplement. also check thyroid and diabetes to rule out other cause. for further information consult a dermatologist online --><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "does hair fall stop immediately with the use of proscar?"}, {"role": "assistant", "text": "both minoxidil and finasteride takes time to act and in some cases it will take two to three months. both are fda - food and drug administration approved for androgenic alopecia. you should always remember that if it is used once then you need to take it for a lifetime. otherwise you would come to a previous stage of baldness. for further doubts consult a dermatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "pregnancy tests are negative but am still having pregnancy symptoms. why?"}, {"role": "assistant", "text": "i understand your concern. i see two problems in your history. let me tell you the reason and solution. birth control pills come in a pack of 21 or 21 active plus seven dummy pills or the single dose of an emergency contraceptive pill. whichever you take will suppress your body's natural hormones. if you forget to take the pill in between or take it haphazardly your natural cycle is out of the track but do not worry as it can be corrected. get a urine pregnancy test done if not done recently. then have the same oral combined birth control pill (21 pills) twice a day for ten days and throw away the last pill. within next 7 to 10 days you will surely have your periods. all these bleeding on and off will disappear and then from the first day of the bleeding have the next packet of 21 pills once at night for 21 days. your bmi (body mass index) is more which is the bigger problem. from your history i presume you to have pcod (polycystic ovarian disease) this is usually associated with obesity irregular menstrual cycles no periods for few months followed by heavy periods with clots and fleshy masses spotting on and off. you develop an extra pad of fat around the mid segment of the body especially waist thighs and breast. excessive body hair growth hair fall dark lower half of the face acne oily face dark skin in the back of the neck inner thighs and under surface of the breast. pcos will not allow ovulation to occur at times and so you cannot get pregnant till treated. it also increases your chances of early pregnancy abortions. but this has a solution. just delay pregnancy for a few months as your weight has to be reduced. once you reduce your weight you would not need any medicine to get periods or to get pregnant and the pregnancy will be healthy. i suggest you try the following to reduce weight. avoid fasting junk food and red meat. reduce snacks in between meals. have low calories and high-fiber diet. do regular exercise aerobics yoga and brisk walking. get your thyroid profile and serum prolactin test done in empty stomach. you can continue the same 21 pills packet to regularize periods till you shed some weight. try to reduce 2 to 4 kg per month. do not hurry on weight reduction as it will be difficult to maintain. as soon as you reduce at least 5 kg you will see changes. for further queries consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is hair fall common after a surgery?"}, {"role": "assistant", "text": "you are suffering from acute telogen effluvium. telogen effluvium is a self-limiting disorder and is very common after any surgical procedure. keep taking the multivitamins and there is no need for minoxidil because it is mainly for androgenic alopecia. if you applied it once then you need to apply it for the whole life. do not worry; the hair will return to normal within four to six months. so no active intervention is needed. for further information consult a dermatologist online --><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "pregnancy test shows negative shall i take medicine to induce periods?"}, {"role": "assistant", "text": "in your case if pregnancy test has been negative even till date then you are surely not pregnant. the delay and irregularity need to be evaluated and investigated to rule out pcos (polycystic ovarian disease) hypothyroidism or hyperprolactinemia which are the most common reasons for oligomenorrhea in young women. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "during pregnancy when will the gender of the baby be more accurate?"}, {"role": "assistant", "text": "i understand your concern. i cannot say that 26 weeks of gestation is too early to declare the gender. but due to baby's position and as baby moves constantly it can be a bit difficult to make out the gender accurately. it will be more accurate after 32 weeks. for further information consult a fetal medicine specialist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "pregnancy test positive. on the 9th day had slight bleeding why?"}, {"role": "assistant", "text": "this is a threatened miscarriage as it would be termed medically as the pregnancy test is positive. but ultrasound is not contraindicated as it is necessary to localize the pregnancy and rule out ectopic pregnancy as well which can have similar presentation with bleeding along with pain abdomen. so get an ultrasound done. if there is a gestational sac seen inside uterus then you can be placed on progesterone support hcg injections (human chorionic gonadotropin) to allow placental cytotrophoblastic invasion into endometrium thereby supporting pregnancy and also absolute bed rest should be followed. but there is absolutely no indication of termination at present when even fetal pole has not arrived. the decision can be taken if the pregnancy does not grow till nine weeks. revert back after the ultrasound abdomen to an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "pregnancy tests were negative but i passed blood clots. what could it be?"}, {"role": "assistant", "text": "as the pregnancy tests were negative even after eight days post missed menses it ensures that you are not pregnant. the symptoms you had were common pms symptoms (premenstrual syndrome) which subsides slowly once the menses start. there is a possibility that a large endometrial chunk would have got passed out during the start of the flow due to delayed menses this time. so just allow the menses to continue and you should be fine. the chunk was definitely not a gestational sac or pregnancy as the pregnancy tests were negative. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to overcome my depression symptoms?"}, {"role": "assistant", "text": "i can understand your concern. you are on 20 mg nexito (escitaprolam) modafinil 25 mg and 25 mg quetiapine even with these medicines your symptoms are persistent. so some minor changes in medicines will help you to come out of these symptoms. in suggest try taking amisulpride 25 to 50 mg in place of quetiapine it will help in reducing these negative symptoms. this will reduce the daytime sedation too. the dose of modafinil can be increased to 100 mg in the morning after breakfast. this will improve the daytime alertness and will surely improve your functioning. i advise you to get your thyroid function test and vitamin b12 levels done. hypothyroidism and low vitamin b12 levels are common reasons for persistent depressive symptoms. include vitamin b12 and omega-3 fatty acid supplements in your diet and you will surely see improvements. please follow these steps and consult your treating doctor about the dose adjustments. for more information consult a psychiatrist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my pregnancy tests are negative. can i be pregnant after taking i-pill?"}, {"role": "assistant", "text": "i have gone through your history and understand your concerns. in her case the chances of pregnancy are not present. symptoms associated with it can be due to impending period or a cause of infection. stay calm and wait for her periods. for further queries consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "pregnancy tests are positive even after taking 2 mtps vaginally. why?"}, {"role": "assistant", "text": "you have already taken all the tablets but unfortunately you have taken it wrongly. the second dose of 2 tablets of misoprostol were to be taken after 36 hours and not before. the remaining two should have taken after 6 hours of the previous 2. now you must wait for the bleeding and abdominal cramps to initiate on its own in next 48 hours. if the bleeding does not ensue in next 48 hours then get an ultrasound pelvis done to reascertain an intrauterine pregnancy or whether it is an ectopic pregnancy. if intrauterine then safely a surgical abortion can be performed under ultrasound guidance by a gynecologist. there is no role of repeating the kit again. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to tackle depression until i meet my psychiatrist?"}, {"role": "assistant", "text": "this is quite obviously appears to be the re-emergence of depression due to stoppage of medications. it should ideally be treated by reinstitution of the medicines. if that is not possible then certain temporary measures can be used. sleep deprivation is said to have depressant effects. sleep 6 hours per day but not less than that. eat chocolates. exercise for an hour five times a week. stay away from dim lit and depressing rooms. get exposed to bright light. give more time for your favorite hobbies and past times. make it a point to talk to your close friends and relatives once a day. follow the above until you meet your psychiatrist for a physical evaluation. for further information consult a psychiatrist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my friend is under depression due to work stress. please help."}, {"role": "assistant", "text": "persistent work stress could lead to adjustment disorder and increases the risk of depressive and anxiety symptoms. she is suffering from polio and has work stress. these are probably the reasons that she behaves weird. if her symptoms persist then please consult a psychiatrist in person for physical evaluation and her treatment. with proper treatment she would come out of this bad phase. ssris (selective serotonin reuptake inhibitor) are the drugs of choice for these symptoms. for further doubts consult a psychiatrist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to confirm depression?"}, {"role": "assistant", "text": "you should understand the difference between depression and disappointment. disappointment also manifest symptoms as in the case of the depression. were you deeply disappointed in the near past say within one year? you did not have any bad experiences and your family does not have any depression history. that is perfect. you feel numb sad and worthless. feeling irritable and spending more time alone. these are some of depression symptoms but your problem is never depression. from the given symptoms i see this as an attitude problem related to some sort of disappointment. you are just 19. i suggest you forcefully change your habit. do not be alone. be with family members or friends. if you do not have friends then make friends. go outside and socialize. engage in physical activities and outdoor or indoor games. you will have many things to study. do it. divert your attention to more productive creative and positive things rather than brooding yourself worthlessly. i do not see depression now. if you continue the present attitude and behavior further then it could lead to depressive disorder. please do compulsively as i advised. for further information consult a psychiatrist online --><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am a depression patient and taking medicines for long time. now i feel very sleepy and facing concentration problem."}, {"role": "assistant", "text": "first of all i need to know what was the drug how long you took that medicine and have you felt tolerance to either effect or side effect of that drug? at this stage i like to inform you that with current available medication only two thirds of the patients improve the remaining and the other one third fail to improve even after trial of multiple drugs. the next course of action is decided on the basis of residual symptoms magnitude of improvement comorbid medical and psychiatric conditions tolerability and affordability to name a few. in your case your doctor may be right but if you are taking same medication for more than six weeks then it is time to intervene. if the concentration problem arose after the use of drug then it might be the side effect of drug itself and in that case it needs replacement. if the prescribed drug dose is in lower range side then increasing the drug dose might be the solution. at this stage i would like to tell you that drugs available currentlyt may be used for improving concentration after a detailed history of the patient and review of all previous drugs. i suggest you to approach a psychiatrist either online or in person for correction of your problem. you can also book a slot for an online video chat session i will be happy to help you out."}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "to overcome my depression anxiety and stress i started masturbating. i feel weak."}, {"role": "assistant", "text": "masturbation is actually a normal behavior. but it should not be excessive in frequency which may cause fatigue and back pain. you need not see a doctor right now. just divert your thoughts into much important things in life like studying enjoying outdoor sports finding good friends etc. try to reduce the frequency of the practice to about twice or thrice a week. this is the transient period in everyone's life when urge to explore and also trying to experience new things especially sexual pleasure occurs. as you are physically and mentally mature the problems that you are facing now will resolve spontaneously. apart from this as you said \"proper diet and lifestyle changes\" are to be followed: eat nutritious foods (encourage fruits vegetable salads nuts cereal sprouts). limit processed and deep fried foods. indulge in outdoor sports which you are interested like swimming etc. sleep adequately at least 7-8 hours as it is much needed for your normal growth too. avoid smoking and drinking alcoholic beverages. just follow these for a month and let me know how do you feel. get back to a sexologist online for further follow up --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can i take augmentin during pregnancy?"}, {"role": "assistant", "text": "yes augmentin (amoxicillin) is safe in pregnancy. please go ahead. for further doubts consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how do i come out of my failure?"}, {"role": "assistant", "text": "success and failure are the two sides of the same coin. you can never predict what will happen. life is never a smooth sailing boat. it is full of ups and downs. life does not end when you fail once. life is much more than your exams. you gain experience when you go through failures and hardships. you become tough and will learn to handle more difficult situations in the future. if you have fallen down get up and pursue your goal. be persistent till you achieve your goal. all great people gone through failures before they become successful in life. success will come when you are optimistic. be brave and face life. for further information consult a psychiatrist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is mymox used to stop lactation?"}, {"role": "assistant", "text": "mymox (amoxicillin) is an antibiotic and has nothing to do with lactation or milk production. sudden weaning of baby may lead to both physical and emotional effects on both the mother and her baby. gradual weaning is good. medical suppression of lactation is not advised due to accompanying untoward effects. try doing the following. try using supportive padded bras. manual expression of the milk just enough to relieve pain or engorgement. do not empty the breasts at a time. frequency and time for emptying vary. for more information consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i could not bear the separation of my boyfriend. please help."}, {"role": "assistant", "text": "from what you are describing it appears that he left you and it is irreversible. many things in life are irreversible such as death separation and so on. one must learn to let go and accept the loss. the more we try to hold on the more it hurts. it may seem difficult to let go but trust me as that is the most logical thing to do right now. discuss your pain with a trusted friend or a relative. go out and meet friends. strengthen your existing friendships and make new friends. spend more time on your hobbies. these alternative relationships will swell and fill the void left by him. after some time you will feel much better. remember that you lived happily before you met him also. you never know what life has in store for you. may be there is something more beautiful that is going to happen. try these techniques and if you are still having problems medicines can be started that will definitely improve how you are feeling. take care. for further information consult a psychiatrist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to get rid of folliculitis?"}, {"role": "assistant", "text": "you need to take oral as well as topical antibiotics. start with tablet augmentin (combination of amoxicillin and clavulanate) 625 mg twice daily for a week and apply mupirocin ointment on the pimples twice daily till they resolve. this normally takes 7-10 days. if they are recurrent then go for blood sugar fasting to rule out diabetes and pus culture to find the exact bacteria responsible for your folliculitis. the probable causes:staphylococcus aureus bacteria. investigations to be done:blood sugar fasting and pus culture. probable diagnosis:folliculitis. preventive measures:frequent hand washing prevents spread of infection. regarding follow up:revert back after a week to a dermatologist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "will accutane help in acne breakout?"}, {"role": "assistant", "text": "accutane (isotretinoin) alone can control your acne well. birth control pills are given to avoid pregnancy while on accutane treatment. if there is no sexual activity contraceptive pills can be safely withheld. however it is very important to understand that accutane can cause serious side effects on the fetus if at all pregnancy occurs while on treatment. for further information consult a dermatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what causes acne when we were on our period?"}, {"role": "assistant", "text": "during menses body have spurts of androgen. these androgen causes stimulation of pilosebaceous duct and leads to acne during this period. these types of acne usually appear in chin area may be because of more concentrated pilosebaceous unit localized to this place. do maintain hormonal imbalance with the help of antiandrogen to reduce acne during these days. for further information consult a dermatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "a patient with a fresh knee replacement has taken pre-medication amoxicillin 2g. what antibiotic can be given for her tooth abscess?"}, {"role": "assistant", "text": "i have read through your query in detail. please find my observations below. amoxicillin is still a better antibiotic for dental abscess as compared to other medicines. it is the first choice of medicine even for dental abscess. it is better to continue with amoxycillin as a treatment option for her. metronidazole or clindamycin is given only in case of severe infection. the order of preference of drugs for dental abscess in a patient is: amoxicillin erythromycin or clarithromycin or clindamycin metronidazole. ciprofloxacin is usually not given at first. she can be given amoxicillin on her next appointment as well. the above information is as per latest updates on pharmacological treatment of dental abscess. please keep in mind any allergy the patient might have to any of the medications and prescribe an alternative choice. hope this answers your question. please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements. revert back to a pharmacologist online for further follow up --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how can i overcome the problem of assuming things?"}, {"role": "assistant", "text": "i read your query and understand your concerns. although we assume in one or the other way but it is not like that. the fact is first someone becomes topper successful and then his style are appreciated leading to wider recognition. we as a society focus more on successful people and try to imitate them in the way of writing or dressing but it is not the style which makes somebody a topper. it is the hard work and intelligence that make you topper. i mean to say that things are in different order. like successful person leads to the identification of his style. so you definitely need to get into how you can achieve something rather than trying to imitate others. do not have much spare time to engage in these thoughts and have some work which helps you in achieving something. whenever you are alone try to connect with friends and family. use stop technique. just say stop loudly when you feel there are excessive thoughts. for further information consult a psychologist counsellor online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "why do i get attracted to both men and women?"}, {"role": "assistant", "text": "i have gone through your query and understood your concerns. firstly if you feel attracted towards men and women both it is just your sexual orientation. it is not a disorder. the more you will try to get rid of these feelings the more they will disturb you. secondly entering the vagina is a very different feeling as compared to just rubbing it over the clitoris. your wife can best tell whether you penetrated her or not. if you wife is very sensitive you can give sufficient time in foreplay. rubbing followed by fingering and penetration should be the plan. this will solve the problem of tight muscles also. the head of the penis is always sensitive. if your penile foreskin is tight your surgeon can help. otherwise its normal to have a sensitive penile head. 40% sperm motility is not too low in my opinion you do not need any medication for it. slowly as you would be able to do intercourse properly your wife can conceive. gradually she can guide your penis into her vagina. hope this helps. for more information consult a psychiatrist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what is your opinion on my breathing issues?"}, {"role": "assistant", "text": "we are here to help you. i have some questions that you need to answer. since how long are you feeling breathing difficulty? does your problem aggravate on waking or it comes any time even at rest? do you feel that you need to take deep breaths? how is your sleep? ever did you wake up due to difficulty in breathing? if yes then how did it settle? revert back with the answers to the above questions to a pulmonologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i had a serious breakup with my girlfriend. i feel lonely. what do i do?"}, {"role": "assistant", "text": "relationship issues need to be settled down before it starts disturbing you. you have to fully understand what will it lead to and how will it affect your life in long run. when you get into any relationship for more than a year you start associating and sharing your feelings with that person which is quite obvious. in any breakup the reason for breakup is very important to deal with. you have not mentioned it here. if you had mentioned it would have been even more helpful in suggestions. suggestions: it seems that you have not yet accepted that you had a breakup. the reason for it must be challenged and accepted on your part. once you deal with that it will be easier for you to move on. try journaling or writing to an unknown friend (or to yourself) and share your emotions and feelings honestly. do not avoid recalling your memories because the more you avoid the more you get into it. go through it with the help of a counsellor and it will make you feel much better. follow up with the details of your relationship issue for the better management. consult a psychiatrist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "for depression would it be sorted out if i go for counseling?"}, {"role": "assistant", "text": "from what you have described you could be suffering from depression. depression of such intensity requires medication and cure is possible in such cases. breath relaxation exercises or meditation is also helpful but not a substitute for medications. investigations to be done:1. thyroid profile. 2. zung's self-rating depression scale. differential diagnosis:mdd (major depressive disorder). regarding follow up:for further doubts consult a psychiatrist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to overcome the fear of my boyfriend cheating on me again?"}, {"role": "assistant", "text": "i can understand your situation. after knowing that your boyfriend was cheating on you in the past you have repetitive intrusive thoughts that he can cheat again. this feeling of suspiciousness is normal to some extent but if it is troubling you making you restless and disturbing your daily routine then treatment is required. i will suggest you forget the past you have already planned to marry him. it will be better if you have positive thoughts in your mind. you can also visit a psychiatrist for counseling and behavioral therapies to learn how to control negative thoughts. keep yourself busy in work do some light exercises yoga etc. talk to your boyfriend about how you feel. it will help overcome negative thoughts. for more information consult a psychiatrist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to remove acne black spots?"}, {"role": "assistant", "text": "i would suggest you to apply melalite xl cream (tretinoin) on the black spots at night in minute amounts. please consult your doctor discuss with him or her and take the treatment with consent. continue this for three weeks and revert back. revert back after three weeks to a dermatologist online --><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "does acne itch?"}, {"role": "assistant", "text": "was it just acne or may be some insect bit? because in acne there will not be any itching. so i think it is some insect bite and the same thing happened to another part of the body. due to scratching you further triggered the inflammation. i suggest the following treatment. consult a specialist doctor discuss with him or her and take the medicine with consent. mild steroid and antibiotic cream such as flutivate cream (fluticasone) is a good one. also can use fucibet cream (betamethasone and fusidic acid) once in a day. i suggest one antibiotic too. tablet augmentin 625 mg (combination of amoxicillin and clavulanic acid) twice in a day for 7 days would be a good option. i would like to add some oral steroid tablet wysolone 20 mg (prednisolone) for 3 days in the morning after food. revert back after a week to a dermatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have acne since the age of 13. kindly get me a solution."}, {"role": "assistant", "text": "i have read your query and i understand your concern. acne has several grades depending on the type of lesions. in grade 1 i prefer to advise topical clindamycin in the morning and benzoyl peroxide alternatively with topical retinoids in the night-time. oral antibiotics are also given like doxycycline or minocycline or azithromycin in grade 2-4 acne. avoid hair oil application and oily food in the diet. in responding cases consideration is given to start oral retinoids. kindly upload the images so that i can actually visualize the lesions and advice you to my best. also mention the details of treatment you have already taken. revert back with the images to a dermatologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can allergic reaction occur due to tylenol 3 or amoxicillin?"}, {"role": "assistant", "text": "i have gone through your query and can understand your health concern. the allergic reaction can be due to amoxicillin only because acetaminophen and codeine will not cause any allergic reaction. i suggest you to stop amoxicillin. you can use any of the cephalosporin instead of amoxicillin. for allergic reaction i suggest some antihistamine drug twice daily for three days. amoxicillin and other drugs of this group are very common to cause allergic reactions. as you have mentioned that you never developed such reaction in the past and this is the first time i tell you that it can happen. i suggest you not to take amoxicillin in the future. for further information consult an allergy specialist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to judge a person wisely?"}, {"role": "assistant", "text": "every person has numerous traits or habits. a person is sum total of his thoughts words and actions. when you think of judging a person it is making a global judgment. if you really need to be objective you need to judge a person's actions habits and thoughts individually. but i get what you mean to ask. here are my thoughts on it: judge a person by how much he contributes to the welfare of others. judge a person on the basis of his thoughts. it is only thought which defines an individual. judge a person by his actions in the past and present. judge on the basis of how he treats his subordinates because there is only way of treating the boss. judge on the basis of his behavior during crisis not when things are going great. judge on the basis of what he does for the welfare of others not on the basis of how much he earns. judge on the basis of his common sense not his qualifications. judge not on his looks but on how he makes others feel. another thing to note is that it is neither wise nor necessary to judge people all the time. no one has perfect judgment. because judgment is subjective and based only on available facts not on the whole truth. besides it can make us prejudiced unnecessarily. also people change with time. for further information consult a psychologist counsellor online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my brother's illness bothers me a lot. i am deprived of sleep. please help."}, {"role": "assistant", "text": "pain of near ones make you feel helpless. this weakens your strength somehow. symptoms like lack of sleep disturbance and tension occur when you feel stressed for any reason. but you have to be strong for your brother. if you feel low he will become worse and lose his will power to fight the illness. follow these to be mentally strong: have a healthy and good diet for yourself. take good care of yourself. take a walk on daily basis for easing out. keep sharing thoughts with someone about how you feel. unless you make yourself equipped with strength it will not be beneficial for your loved ones. for a psychological counselling consult a psychiatrist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have pcos and had unprotected sex. are there chances of me being pregnant?"}, {"role": "assistant", "text": "yes for now you need to take i-pill to avoid getting pregnant within 72 hours preferably within 12 hours. but emergency contraception is not to be taken on a regular basis as it has progesterone and as you have been diagnosed with pcos (polycystic ovarian syndrome) there is already a long follicular phase (first phase of the cycle). you should consult a gynecologist for regular contraception like low dose oral contraceptive pills as they even help in pcos and regularising the cycle. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "could omeprazole cause changes in ecg and increase the heart rate?"}, {"role": "assistant", "text": "anxiety and panic are the first possibilities. sudden onset of palpitations is a very unusual sign of heart attack. none of the investigation and symptoms are compatible with the heart attack. although there are some ecg changes like q waves which can be present are indicative of heart damage in case of heart attack. but your echo is normal and so no need to worry at all. there is also t-wave insertion in lead 3 and non-significant elevation in avr. so given these changes i would advise for some stress test like treadmill test or stress thallium which you did not mention anything about. if you have not undergone it then you can have it to rule out the possibility of inducible ischemia. the qrs prolonging of such mild degree is not significant and this much variation may normally occur with different ecg. it is not very common with omeprazole. for further information consult a cardiologist online --><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am suffering from post-ssri sexual dysfunction. please help."}, {"role": "assistant", "text": "i can understand your concern regarding your symptoms and side effects of the medications. the symptoms you mentioned above are showing that you are suffering from dysthymia and moderate depression. depression itself is a cause of poor sexual drive. lexapro that is escitalopram may cause loss of libido and sexual dysfunction as you have already stopped this medicine long ago depression is the primary cause of your symptoms. i will suggest you try taking newer invented molecules like vilazodone. this drug has no daytime somnolence and sexual dysfunction. it will help you in early recovery. take it for at least three months and then stop slowly by tapering. consult your specialist doctor discuss with him or her and start taking medicine after their consent. within a couple of weeks you will feel better and these drugs have fewer chances of withdrawal depression when they are stopped and tapered slowly. behavioral therapies like cbt (cognitive behavioral therapy) or dbt (dialectical behavioral therapy) and counseling will help you to cope up your stress and will help you to maintain a happy state of mind. visit a nearby psychiatrist for a proper prescription and counseling. your symptoms are curable 20 % of the population spend some part of their life in depression and half of them overcome with this illness. hope my answer helped you. for further queries consult a psychiatrist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "suffering from anxiety and panic attacks for the last 3 years. need second opinion on the prescription."}, {"role": "assistant", "text": "i read your query and understood your concern. as per your diagnosis of anxiety and panic attacks there should be no doubt whether you need neurologist or psychiatrist. both these conditions come under the domain of psychiatrist and they are more able to treat these conditions. other than anxiety and panic attacks you have got addiction problem because of the wrong use of medicines. in my view there is no role of soltus in case of anxiety and panic attacks. if you feel fine with an online psychiatry consultation session (via phone or video chat) then i will be happy to help you. you con contact me by either putting a detailed query or booking an online consultation."}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i had a horrible panic attack two weeks ago. my arms and legs went numb. what can i do to stop this?"}, {"role": "assistant", "text": "the treatment includes some medicines and psychotherapy. 1) medication includes antidepressants (ssri's tci) antianxiety drugs. it is better to see some doctor before taking any medicine as the best medication for your panic attacks will depend on a variety of factors like presenting symptoms co morbid disorders and treatment goals. 2) psychotherapy (cbt i. e cognitive behaviour therapy) treatment of panic attacks. cbt works to help the patient to change his thoughts and perceptions that are contributing to fear and anxiety. once you begin to accept panic attacks you can start to change the way you respond to them. for example instead of reacting to physical symptoms with nerve-racking thoughts such as \u201ci am losing control \u201d you can respond to them with increased calm and clarity. relaxation techniques such as deep breathing mindfulness meditation or yoga can be practised to help you get in touch with your relaxation response. repeating positive affirmations such as \u201cdespite my anxiety i accept myself \u201d can also help in getting past fear. by working on changing how you react you can start to remain in control during panic attacks. the next time you have a panic attack try to remember the three a\u2019s of overcoming your fears: acknowledge accept and alternative response. these three steps can assist you in changing the way you react to symptoms and get through panic attacks with less fear. listed here is a simple step-by-step exercise that can help you overcome your fear of panic attacks: acknowledge - the next time you notice increased anxiety or panic symptoms simply pause and take a breath. take this moment to recognize that you are experiencing heightened panic and anxiety. this simple act of acknowledging your symptoms at the start of a panic attack can give you a sense of power over your fears. accept - rather than trying to run away from or resist your symptoms come to terms with the fact that you are having a panic attack. acceptance does not mean that you are giving in to panic but can provide you with the clarity needed to get through panic attacks. alternative response - instead of becoming wrapped up in your fear remind yourself that these are simply symptoms of a panic attack and that you have nothing to be afraid of. during a panic attack your flight-or-fight reaction may be trigger feelings of stress and fear. reframing these feelings can allow you to more effectively cope with them. so for example if during an attack you start to react with fear or a need to flee remind yourself that your symptoms will soon subside. instead of thinking \u201ci am afraid of my panic attack \u201d try to reframe this to \u201ci am feeling overly excited. \u201d when frightening thoughts such as \u201ci am going to lose my mind\u201d arise try to shift this perception be repeating to yourself \u201ci am okay \u201d or \u201cthese feelings will pass. \u201d you can book for an online therapy or telephone counseling for further counseling and treatment from us."}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i am a hiv negative man married to a hiv positive woman. we would like to have a child. please advice."}, {"role": "assistant", "text": "yes there are very good chances of you getting infected with your wife during sexual intercourse. so you should take proper precaution before sexual intercourse. yes. chances of a baby getting infected with hiv from a hiv positive mother are very high. you should consult a doctor for your wife's treatment during pregnancy with a drug called zidovudine to prevent your baby getting infected with hiv and she should not breastfeed her baby. hope i have answered your query. if you have further questions revert back to a hiv aids specialist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "in my 18th week of pregnancy clubfoot was diagnosed. should i undergo amniocentesis?"}, {"role": "assistant", "text": "clubfoot (twisted foot) is not an uncommon anomaly and its prognosis is good. it means it is correctable in most cases. amniocentesis is an invasive procedure. if you have already undergone biochemical markers like a dual marker or triple test and they are negative then the risk of other anomalies is very low. i will suggest you to take a scan from a fetal medicine expert near you. if no other anomalies are seen by him or her on that scan then just for a club foot amniocentesis is not required. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "are the opacities in my chest x-ray due to cold?"}, {"role": "assistant", "text": "there is an opaque small mass that could be just a normal blood vessel or an abscess or a cystic mass. but in order to confirm you need an mri scan of your chest. the cold and throat pain are not the cause of these opacities. for further information consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to confirm if my heart is in good condition?"}, {"role": "assistant", "text": "you have to reduce weight as you have family history of heart disease and obesity itself a risk for heart disease and diabetes. there is no problem with your cholesterol test. it is fine. to find out whether you have any heart problem at present or not i would advise you to get ecg (electrocardiogram). 2d echo (two-dimensional echocardiogram). tmt (treadmill test). in tmt it will be clear that whether at present your heart is fine or not. reduce weight by jogging 30 minutes a day. do not smoke. eat more of vegetables fruits and nuts. avoid cheese ghee butter and non-vegetarian foods. revert back after the investigations to a cardiologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have taken harmoni-f for three months. now planning for a baby. when will i get pregnant?"}, {"role": "assistant", "text": "it will take 3-6 months for you to get pregnant. start taking folic acid tablet. hope it helps. consult an obstetrician and gynaecologist online for further help --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "other than chest x-ray what test should be done for cough?"}, {"role": "assistant", "text": "i understand your concern. see as you said your mother is suffering from active tb (tuberculosis) tb in the child should also be ruled out first. it may be just pneumonia but tb should be ruled out with some more investigations mentioned below. is the child gaining weight adequately? what is her present weight? was bcg (bacillus calmette-guerin) given at birth? when was your mother diagnosed and when tb treatment started? investigations to be done:1. mantoux test. 2. complete blood count. 3. gastric aspirate for afb (acid fast bacilli). treatment plan:an antibiotic should be given for seven days. regarding follow up:revert back with the answers to the above questions to a paediatrician online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can frequent masturbation cause problems while urinating?"}, {"role": "assistant", "text": "i am sorry to know about your problem. frequent urination is a common problem called overactive bladder. other than this mild pain in the urogenital region can be due to neural pain. masturbation usually does not cause these problems. i hope you had already taken a course of empiric antibiotics. i would suggest you try taking capsule tolterodine 4 mg and tablet nortimer (nortriptyline) 25 mg once at night for a month. consult your specialist doctor discuss with him or her and start taking the medicines after their consent. for further queries consult an andrologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can a breathing treatment given before a chest x-ray hide lung cancer?"}, {"role": "assistant", "text": "i have read through your query. please find my observations below. breathing treatments like nebulizers will not hide any suspected lung cancer when given before taking a chest x-ray. chest x-ray is a basic investigation used to screen the lungs field and heart and usually done as a routine investigation. a routine chest x-ray usually picks up any nodules or mass in the lung fields that might represent lung cancer and is not affected by the patient taking nebulization therapy. if there are strong reasons to suspect a lung cancer then a ct scan chest is the best investigation and gives complete detailed overview of the lungs. in conclusion breathing treatment will not hide a lung cancer when given before taking a chest x- ray. consult a radiologist online for further follow up --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "will excess masturbation affect weight?"}, {"role": "assistant", "text": "frequent masturbation does not have much effect on your health. you can maintain a strict exercise regimen along with the proper diet you are having. start muscle strengthening exercises such as wall press pushups abs strengthening etc. drink milk every day with two bananas. apple is a must for once a day. maintain your weight does not decrease in any way. can have dry fruits in the evening such as almonds apricots etc. have salmon or tuna fish. have 8 hours of sleep which is mandatory. engage yourself in your work so that you do not get free time for unnecessary things. for further information consult a nutritionist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is masturbation a harmful act?"}, {"role": "assistant", "text": "masturbation is normal and not harmful. it does not cause physical problems or sexual problems. masturbation does not cause hair fall. both are due to the effect of testosterone. in boys of young age the effect of testosterone is high which is normal and cause desire to masturbate. hair fall may be due to low vitamin or scalp infection or high testosterone. frequent sex is not harmful. you can do it daily. no you do not have premature ejaculation. ejaculation in less than one minute is pe. she can be satisfied before sex by finger or oral sex. it is better to pull the foreskin before insertion. if you have done oral sex for 8 months without any problem then no further issue. anal sex can be done but regular may cause tear in the anus and a condom should be used. for further doubts consult a sexologist online --><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can i conceive with adenomyosis?"}, {"role": "assistant", "text": "firstly let me tell you that sonography is not always suggestive of adenomyosis. it cannot diagnose it. for diagnosis you have to send biopsy of the uterus. in adenomyosis there is pain before during and after menses. there is also focal and diffuse type of adenomyosis. whatever you read on the internet is about diffuse or generalized adenomyosis. a few things on focal adenomyosis are available because most of the time it goes undiagnosed or has very mild symptoms that do not hamper routine. so just focus on the present and start trying for pregnancy. in fact if you get pregnant and pregnancy goes up to term or near term then there is a chance of cure from adenomyosis theoretically. if you do not have the symptoms of clear adenomyosis then there is a chance that it is not adenomyosis. so do not worry and take chance for a year. if you do not get pregnant then consult a gynecologist as normal people. for further information consult an obstetrician and gynaecologist online --><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can masturbation cause negative thoughts?"}, {"role": "assistant", "text": "masturbation will never cause these problems as you are having. semen is produced daily. so even if you do daily there is no harm. but too much of anything is bad as you can utilize your time for something useful to you. you have not mentioned your age. i suggest you to do masturbation on alternate days. do not stop doing it which will help you realize that it is not harming you. secondly negative thinking has nothing to do with masturbation. you should start doing some exercise daily. spend some time in meditation and prayer. learning yoga and meditation will help you a lot. for your depression i suggest you to consult a psychiatrist who will help you to boost your confidence with few medicines for a short time. be happy and find different ways to be happy. remove the fear of masturbation. for further information consult a sexologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can excessive masturbation cause loss of energy and depression?"}, {"role": "assistant", "text": "masturbation is a normal thing. it is a myth that masturbation is wrong unhealthy and leads to weak body and mind. it is a normal way of a sexually healthy person to get self-satisfaction. the myth that masturbation is unhealthy is perpetuated by some quacks to earn money and fool people. the symptoms that you described such as reduced physical and mental energy known as anergia difficulty in thinking depression weak immune system and other physical symptoms are suggestive of depressive disorder. depression is a mental disease which can have lot of physical symptoms along with sad feeling weak and guilt. mind affects the whole body. a lot of times the cause of physical health problems is mental problem. the treatment for depression is antidepressant and counseling. also you need to get over your guilt over masturbation. for further information consult a sexologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can i continue my pregnancy with a high tsh level?"}, {"role": "assistant", "text": "yes you are right. hypothyroidism can affect the fetal brain development especially in early pregnancy. thyroid hormone is normally very important for many functions of the body. it helps in the early development of the fetus. the brain is one of the parts of early organ development. in early pregnancy fetus mainly depends on mother's thyroid level because fetus itself cannot produce up to around 11 to 12 weeks (three months). there is no data available whether you have taken treatment early and adequately. but yes there is data that hypothyroidism can affect brain development and function in baby permanently and whatever damage occurs is irreversible. if you are taking thyroxine (levothyroxine) 50 mg and the level is this high then you need to increase the dose. and if you have started treatment just now then continue and repeat according to the doctor. as far as termination is concerned that is totally the couple's call. if you are prepared to take care of a mentally handicapped baby and related problems for the rest of life then you can definitely continue. if you are not prepared for that then you can go for termination. first control thyroid level and then try for pregnancy after you have a normal thyroid level. you will have to take tablets for hypothyroidism for the rest of your life. only dose adjustment will be required time to time according to the thyroid level. so the last choice is yours. you know what can happen. if you are ready for it then go for it and do whatever you have to minimize that. get treated for hypothyroidism more aggressively and control as early as possible. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is masturbation the reason for my premature ejaculation?"}, {"role": "assistant", "text": "i can understand your concern. first of all i would like to tell you that masturbation is not the reason for the problem of premature ejaculation you are having. masturbation is a safe habit and most of the men masturbate. diabetes increases the risk of premature ejaculation. so i would advise you to maintain the blood sugar levels. if that is not controlled then consult your doctor for dose adjustment of the drug. for premature ejaculation you can think of taking dapoxetine. the drug is a ssri drug (selective serotonin reuptake inhibitor) and you can take it on as necessary basis. the drug will help to delay the time. the drug is safe to use and free of serious side effects. please talk to your doctor about the prescription of this drug. for further information consult a sexologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "after delivery how long should i wait to get my tooth pulled?"}, {"role": "assistant", "text": "you can go for tooth extraction in a week or two after child birth as the amount of local anesthesia that can reach the breast milk is very less and does not cause any serious complication. however you should once consult a neonatologist or your obstetrician and gynecologist to confirm depending on the medical health of your newborn. and then you can proceed for extraction without any worries. all the best for your delivery. for further doubts consult a dentist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "from the mri kindly explain the severity of my low back pain."}, {"role": "assistant", "text": "your problem is sciatica but it has not yet progressed to a severe stage. at this stage you need rest and the following treatment. consult your specialist doctor discuss with him or her and take treatment with consent. tablet aceclo sr (aceclofenac) as needed do not use continuously. tablet mecalfa pg (multivitamin) daily in the night. when the acute pain is subsided please consult a physiotherapist for back strengthening exercises. for further information consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "does my mri explain as to why am i feeling lost and confused?"}, {"role": "assistant", "text": "your mri of the brain is normal except some sinusitis. i would like to ask a few questions. since when are you experiencing these symptoms? do you have a headache or vomiting? is there any history of seizures or loss of consciousness? how is your sleep? are you taking any medication? i would suggest you get the following investigations done. eeg (electroencephalogram). contrast study of mri brain. if required lumbar puncture and csf (cerebrospinal fluid) examination. thyroid profile. anti-tpo (thyroperoxidase) antibodies. kidney and liver function test. vitamin b12 level. the differential diagnosis of your condition are as follows: depression. limbic encephalitis. encephalopathy. revert with more information to a neurologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "during masturbation i felt some pain on the back side of my neck and head. please help."}, {"role": "assistant", "text": "masturbating 2-3 times a week is healthy unless you get addicted to the habit. this kind of pain or sprain happens due to increased blood flow to your penile region and vasoconstriction along with it. it resolves spontaneously once the excitation is over. this can be relieved by little stretching after masturbation or by doing exercises for 30 minutes every day. there is nothing serious to worry about. if the pain persists consult a sexologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "would you kindly suggest diet for a pregnant woman?"}, {"role": "assistant", "text": "a pregnant woman needs a good balanced diet. before going to that i will suggest you one thing. as your wife is hypothyroid the need for thyroid hormones increases by 50% in pregnancy. you need to increase the dose to 75 mcg. go for a thyroid profile and adjust dose accordingly with the help of your doctor. regarding diet plan have a glass of milk 300 ml twice a day. it gives the calcium needed for pregnancy. in the first trimester they face the problem of nausea and vomiting. so ask to take plenty fluids and more of vegetables and fruits. avoid oily foods in breakfast. in the afternoon should take at least four cups of rice with dal and vegetables. in the night three cups of rice or three rotis. take non-vegetarian that is chicken or fish twice a week. you can also have mutton once in 15 days. eggs to be taken daily or at least once in two days. for further information consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "should i cleanse my body before starting workout to reduce weight?"}, {"role": "assistant", "text": "it is really nice to hear that you want to have a change in your life. this will be an example for other ladies also. cleansing the body is essential but before that cleanse your mind with lots of positive attitude towards life. never forget to pamper yourself. always try to find some time to go through some motivational videos every day that will increase your motivation. fix a proper routine time everyday for waking up cooking prepare your children lunch snacks and dinner. go for an evening walk every day along with your children if possible so that you can look after them. follow a strict diet cut down carbohydrates from your diet chart and add more protein with cereals and pulses. add green vegetables and fruits. do meditation and yoga every day for a minimum of 30 minutes. spend more quality time with your children; play with them with lots of playful activities which will in turn become a workout for you. do stretching exercises for your upper lower body and trunk to improve your flexibility. follow these simple steps for a month and then you can post me back with your feedback. have a nice fresh beginning again in your life. best of luck. revert back after a month to a fitness expert online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is there any medicine in ayurveda for conceiving a baby boy?"}, {"role": "assistant", "text": "i just read your query. in ayurveda or any other branch of medicine there is no medication that will help you to conceive a baby boy. no medication can do that. moreover the chromosome responsible for baby boy (y chromosome) is inherited by the male partner that means the gender of a baby whether it is a boy or a girl is determined by father and not by mother. some people claim that they give medicine for baby boy and promote them in the name of ayurveda medicine but no medicine can do that. for further doubts consult an ayurveda specialist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is there any harm in using ovasafe and duphaston if i plan to delay pregnancy?"}, {"role": "assistant", "text": "these medications are very safe. i suggest you folic acid supplements as it has to be taken three months before planning to for pregnancy. you can discontinue ovasafe and duphaston till you want to plan for pregnancy. but you can continue folic acid supplements. even if you take the medications there is no harm. the only thing could be that your chance of pregnancy will be high. as you do not want to get pregnant for the next months you can avoid those two medications. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my wife has thyroid and not able to reduce weight. please help."}, {"role": "assistant", "text": "i read your query and understand your concerns. from the available values it appears that her thyroid function test is within normal limits but slightly at lower side. no medication is required in regard to thyroid as she does not have any symptoms related to thyroid function like fatigue irritability amenorrhea depression weight gain despite low intake of food dry skin and loss of hair to name a few. in case she has any symptoms then a trial of 25 mcg thyroxine (levothyroxine) should be attempted on a daily basis. for further doubts consult a general practitioner online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "kindly suggest a diet plan to reduce weight and belly fat."}, {"role": "assistant", "text": "you can practice some brisk home body poses and exercises other than walking or running. also reduce your calorie with low carbohydrate diet. have mainly two roti mix vegetables citrus fruits and cucumber. take vegan based diet less organic foods sleep more for a minimum of eight hours. hope you do not have problem of constipation. no stress no smoking and hard drinks (if any). no cola or sweetened drinks. avoid spicy foods outside street foods fried foods junk foods cream based foods. eat less salt and no sugar. have high quality protein rich foods whole wheat foods and also reduce or stop having rice and rice meals. both for your weight loss and tummy fat or extra visceral fats (unwanted body fat) i suggest to keep on mild exercises like yoga or body poses 15 minutes morning as well as before going to bed. mild walking possible but not heavy strenuous exercises. avoid rice but brown rice can be taken. do work out at gym and at least do free hand exercises for maximum time. you better have a calculated diet plan. cooking oil white oil or olive is better within 20 ml. so saturated fats like butter ghee fat containing rich dairy foods should also be avoided. no lentil local greens too much peas spinach cabbage or tomatoes. strictly avoid all trans fats rich foods. take soft bland timely quality foods with almost nil oils low or very low animal products and all related high animal proteins foods are strictly restricted with spare bad fats at home is best diet for you. the probable causes:high protein high fat containing foods and rich junk foods. treatment plan:1. diet. 2. exercises mild to moderate. regarding follow up:follow up after 15 days to a dietician online. ---><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "what is the recommended dose of folic acid while planning for pregnancy?"}, {"role": "assistant", "text": "i suggest you tablet folvite 5 mg of folic acid one tablet per day. the recommended dose of folic acid is a controversial topic. various doctors favor 1 mg to 5 mg per day. the best part is that the folic acid has no side effects. it is a water-soluble vitamin and an excess of it gets excreted in urine. so we recommend 5 mg per day to all our patients. when sufficient dose is harmless there is no need to take a chance by giving low doses. one more concern of mine is that you have to check with your neurologist if it is safe to go ahead with pregnancy while on lamictal (lamotrigine). the safety of lamictal is not established by studies. but if your physician has good experience with personal case series then i think you can continue. for further information consult a neurologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "is mri with contrast useful for endometrial issues?"}, {"role": "assistant", "text": "there is likelihood of serum progesterone deficiency. et (endometrial thickness) 7. 7 indicates a luteal phase defect and spotting indicates irregular shedding. get a serum progesterone level test done. if low then cyclical progesterone would have to be started. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can i take spirulina 500 mg tablet twice to replace the intake of 2. 5 mg folic acid and vitamin b?"}, {"role": "assistant", "text": "the amount of folic acid or vitamin b available in capsule of spirulina is not sufficient to meet the daily requirements of these vitamins. so it is important to substitute it by other vitamin supplements. for further clarifications consult a general medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "kindly recommend an alternative for zincofer-xt."}, {"role": "assistant", "text": "as this drug is composed of iron supplement and folic acid you can take any available iron and folic acid supplement even as two separate medications. you can take it in the morning with orange juice to increase iron absorption. for further information consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "does my ecg look like i have ever had a heart attack?"}, {"role": "assistant", "text": "it is good to see your detailed history for which i have asked for. firstly your ecg is perfectly normal. for anything to be wrong in case of ecg the changes should be present in at least two consecutive leads at a time. in your case whether it is a t-wave or q it is always there in one lead which does not signify anything. as your stress echo and all cardiac enzymes are normal (far superior to ecg in diagnosing a problem) you are cleared from cardiac side. secondly you say that you were prescribed statins (atorvastatin). one of the most common side effects of statins is myalgia (pain in a muscle or group of muscles). the generalized body ache and dull aching in nature is a characteristic feature of myalgia. i request you to consult your doctor and immediately stop atorvastatin. also get your liver function test done. kindly ask your doctor to shift you either on niacin or fenofibrate if you are intolerant to statin. ecg is always interpreted by a doctor. the machine most of the times provide us with artifacts. do not worry; your ecg is perfectly alright. from your history you have severe anxiety levels and attacks called panic attacks. every attack of panic disorder presents with same symptoms as you have mentioned. i can feel that you are obsessed by the thought that you are having any sort of a cardiac ailment. try to overcome your obsession. if you smoke or drink then stop it. try meditation for at least 30 minutes a day and do regular exercise. i suggest tablet paroxetine 12. 5 mg once daily for 21 days and tablet clonazepam 0. 5 mg once daily for 21 days for anxiety. consult your doctor discuss with him or her and take the medicine with consent. panic disorder and your anxiety are induced by obsession and it needs to be treated. the probable causes:1. myalgia induced by statins. 2. panic disorders. 3. obsession induced anxiety. investigations to be done:liver function test. regarding follow up:for further information consult a cardiologist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "should i avoid folic acid during mthfr pregnancy?"}, {"role": "assistant", "text": "truly speaking mthfr - methylene tetrahydrofolate reductase mutations are widely spread and all most one half of the population is having or carrying these mutations by different extent. by different extent i mean to say various levels of affection or involvement that is from very insignificant disease to severe disease. i do want to know that in which category you are now. this is fairly judged by the serum levels of homocysteine which is the protein that is increased in the blood. if you have a severe mthfr defect then you need to avoid folic acid and also need to screen some fetal congenital defects like spina bifida or anencephaly at an earliest. but if you do not have any specific symptoms with this mutation then there is no harm to take these vitamins. pai mutations (plasminogen activator inhibitor) could result in abnormalities in blood clotting disorders. this actually poses no bar for taking folic acid in pregnancy state. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "suggest me any medicine and guide me reduce weight."}, {"role": "assistant", "text": "the best way to reduce weight is by regular physical exercise and balanced diet. you can lose weight by reducing your intake of oily food and sweets. it is also important to space your meals in such a way that you have more frequent small meals (and not heavy meals). regular physical exercise in the form of some cardio and strength training will make you fit and strong. sleep and hydration are equally important when you try to lose weight. ensure that you take lots of fluids and that you get at least 6-8 hours of sleep per day. medicine to lose weight: as a doctor i never really recommend my patients to take medicines to lose weight. only one drug is approved for use in india- orlistat. if you really want to take it you can take tablet orlistat 60mg thrice a day (after your 3 major meals). as i have seen in practice and also research results say that orlistat does not produce too much change in weight. it shows just a small percentage of weight loss when coupled with low-calorie diet and exercise. and orlistat has its own share of side effects: fatty/oily stool oily spotting intestinal gas with discharge a feeling of needing to have a bowel movement right away increased number of bowel movements or poor bowel control. rare but serious side effects can occur: symptoms of liver disease (such as persistent nausea/vomiting severe stomach/abdominal pain dark urine yellowing eyes/skin) symptoms of kidney stones (such as back pain pain while urinating pink/bloody urine). bottom line: i do not recommend medicines for weight loss. i can make a good diet chart and exercise regimen for you if you would like to follow up in which case you will have to get back to me with your details- your daily food routine your work timings your daily sleep cycle the kind of exercises you prefer etc. i hope that answers your question. revert back to a fitness expert online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "how to reduce weight through yoga?"}, {"role": "assistant", "text": "as per the data your weight is too high for an individual. you need to rebuild your lifestyle by giving time to exercise and yogic techniques. especially fast rounds of suryanamaskara will help you with your problems. start slowly and day by day increase the speed of practice. also you can practice some dynamic yogic techniques along with it for faster effects. along with yogic asanas dieting also helps you to get rid of your problems. cut down the carbohydrates like rice and use finger millet and include plenty of fruits and vegetables in your diet. try to consume lemon honey and water daily morning in an empty stomach. please do not consume any fast food or junk food to lose weight. the main thing is that you need to be active in your day-to-day life. give enough time to workout and running meditation is nothing but controlling your mind which ultimately relaxes your mind and body. a relaxed mind will always have a healthy body. you can try practicing nadi shuddhi pranayama for nine rounds as a basic step. later on will proceed further. while practicing pranayama you have to completely concentrate on your breathing pattern and the changes that happening in the body. the probable causes:lifestyle changes. investigations to be done:bmi (body mass index). treatment plan:suryanamskara diet plan - lemon and honey juice consume more fruits and vegetable instead of rice and fast food meditation and pranayama. preventive measures:yogasanas workout running exercises and diet. regarding follow up:for further doubts consult a yoga specialist online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can hiv cause throat inflammation as a presenting symptom?"}, {"role": "assistant", "text": "most of the doctors sterilize the equipment in a solution which is kept on their examination desk. you have not mentioned the time duration between exposure and the onset of symptoms though hiv does not cause throat inflammation as a presenting symptom usually. still you can have to get a hiv dna or rna pcr (polymerase chain reaction) test done to rule out any chance of acquiring an infection. for further doubts consult a hiv aids specialist online --><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "does hiv spread through toilet sharing?"}, {"role": "assistant", "text": "to be straight from the situation you described there is no need to worry at all. i do understand your obsession. at the outset you cannot be sure that the poop that has spiked onto your penis belongs to hiv infected person. assuming the worst case scenario hiv will not spread through contact with the following body fluids. sweat tears saliva feces or poop and urine. for further information consult an internal medicine physician online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i had unprotected sex yesterday and i am worried about hiv and other stds. what do i do?"}, {"role": "assistant", "text": "we do not know the hiv (human immunodeficiency virus) status of the person with whom you had sex and also your baseline hiv status the other thing you mentioned that you do not have medical access for next three months. considering the availability of only lamivudine and zidovudine on your ship and assuming that your baseline status is negative i suggest you the following. to start with zidovudine 300 mg and lamivudine 150 mg twice a day at 12 hours interval postmeal for 28 days. it is recommended to start it as soon as possible within 72 hours of exposure. do not miss a pill. the first side effect with these could be in the form of nausea vomitings and anemia. get your baseline hiv status hepatitis b serology hepatitis c antibody syphilis serology gonorrhea and chlamydia pcr and hemoglobin levels checked whenever feasible. take light meals. i advise you to use a barrier contraceptive (condoms) each time you have sex to avoid the risk of hiv and other stds (sexually transmitted diseases). reduce the number of sexual partners and avoid sexual contact with a person of unknown status. assuming the baseline hiv status is negative repeat your hiv-antibody test at three months and six months interval of exposure. consult your specialist doctor discuss with him or her and start taking the medicines after their consent. for more information consult an hiv aids specialist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "had i-pill after unprotected sex but did not get periods on time. why?"}, {"role": "assistant", "text": "after the i-pill intake periods generally start in the next 7 to 10 days. so please be patient. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "my hiv tests fall under false negative. do i have hiv?"}, {"role": "assistant", "text": "out of nearly hundred person having sex with hiv (human immunodeficiency virus) positive person hardly less than one may get infected. the chances of acquiring hiv after sexual exposure is less than one percent. i would suggest you to get hiv rt-pcr (real-time polymerase chain reaction) and elisa (enzyme-linked immunosorbent assay) for hiv- 1 and hiv- 2 antibody from two different laboratory. as far as progression of the disease is concerned hiv-rna would be positive. false positive or negative do not occur every time. be positive. revert back with the test results to a hiv aids specialist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i had unprotected sex. what are my chances of getting pregnant?"}, {"role": "assistant", "text": "please do not be worried. you have done a right thing by taking i-pill within 72 hours of last sexual intercourse. you were not likely to menstruate on your actual due date simply because it takes about 5-7 days for bleeding to occur after taking i-pill. it is also a known side effect of i-pill that the following menses may be delayed or may be heavy. in case periods do not resume in the next 10 days then you must do a urine pregnancy test to rule out pregnancy. if the test comes as negative then please do not take any medication. just wait for your periods to return till then practise barrier contraception. if the test is positive which is unlikely though keeping in mind that i-pill does not cause any congenital abnormalities in fetus you would need to make an informed decision as to continue or terminate the pregnancy (which can be done by medical methods in early first trimester after ultrasound scan confirmation). things can be tackled at each step. so please do not panic stress per se can delay your menses further. try to keep yourself relaxed. consult a gynaecologist online for further follow up --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can unprotected sex for a minute cause hiv?"}, {"role": "assistant", "text": "the chance of transmission of human immunodeficiency virus (hiv) by single unprotected intercourse with a hiv positive person is 1/200 to 1/1000. it is very low. she may be negative so she might have asked it. probably the test done was antibodies tests. it is considered as conclusive after three months. you can go for hiv-1 and 2 rna pcr (polymerase chain reaction) at this stage to allay your anxiety. the symptoms are not specific and do not suggest hiv. it may be due to any simple respiratory infection. you can get it examined by an ent specialist to relieve your anxiety about throat infection. for further information consult a hiv aids specialist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i had unprotected sex. can hiv testing be a risk for me?"}, {"role": "assistant", "text": "let me answer your queries one by one. no you are talking about the case of extreme rarity and you have tested enough to prove yourself negative. your girlfriend has no chance to get acquire hiv. these are the most accurate test available and detect both antigen and antibody. no human immunodeficiency virus (hiv) testing will not cause a risk to you. i have seen two such cases in my residency. but you are not having hiv. for further clarifications consult a hiv aids specialist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i had unprotected sex during my infertile days. can i be pregnant?"}, {"role": "assistant", "text": "please wait for a week for your period to start. if it does not start by then you will have to do urine pregnancy test to rule out pregnancy. period could have been delayed due to stress. another rare possibility is that of pregnancy. though you mentioned the days you had sex as your infertile days sometimes occasionally ovulation could be delayed making the days fertile. still you had taken emergency pill (though it is highly effective in preventing pregnancy protection offered is not absolute). so there can be little chance of pregnancy which you need to rule out first. if you want to rule out pregnancy earlier you can do blood beta-hcg test negative result of which will rule out pregnancy. other option as i told is to wait for a week. if pregnancy test comes negative and still period does not start you can induce period by taking tablet medroxyprogesterone acetate 10 mg twice daily for five days. period generally starts within a week of last dose of tablet. it will not induce period if you are pregnant. for further information consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can anxiety cause foot drop and twitches in the body?"}, {"role": "assistant", "text": "it is good that your foot drop is improving in a five weeks period. the twitches that you are feeling may be due to anxiety also. if it was als (amyotrophic lateral sclerosis) the foot drop would be unlikely to improve. as it is improving it is unlikely to be als. did you undergo any medical investigation for this foot drop? are you taking any medications for it? i suggest you undergo the following investigations. mri of the spine with a screening of the entire spine. ncv (nerve conduction velocity) of all four limbs. there can be many causes for foot drop. you should meet a neurologist for investigations to find reasons for foot drop and its proper management. for more information consult a neurologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "can hiv be transmitted through oral sex?"}, {"role": "assistant", "text": "frequency of sex has nothing to do with e. coli bacteria (escherichia coli). prostatitis is very resistant to treat so it is not necessary that if you have taken treatment it will not recur. sometimes you have to take 4 to 6 months of treatment for prostatitis. this is the main reason why you are still having the pain. semen and culture usually do not cover all std's (sexually transmitted diseases) and lower abdominal pain is a non specific symptom and can be attributed to prostatitis. yes hiv (human immunodeficiency virus) could be transmitted through oral sex. so if you know the person it is better to get her tested because if she is not hiv positive then you need no testing. nevertheless you can go for hiv 1 and 2 antibody test by elisa (enzyme-linked immunosorbent assay) method and hiv rt-pcr (reverse transcription polymerase chain reaction). i hope the above information is useful to you. for further queries consult a hiv aids specialist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "anxiety is every day of my life. rarely i do get a small break without anxiety. it has been 10 years."}, {"role": "assistant", "text": "with your brief description it appears that you are suffering with some anxiety disorder most probably generalized anxiety disorder. the drug you are taking is neither sufficient nor appropriate when we are having a lots of safer and more effective drugs currently. i assure you that you can get rid of most of the anxiety symptoms with proper treatment. as you have the chronic problem you need to consult a psychiatrist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i had unprotected sex and got ulcer in scrotum and mouth. will it be herpes?"}, {"role": "assistant", "text": "i assure you not to worry as everything is going to be fine if proper care and treatment is opted in for. i have thoroughly gone through your case and can well understand your genuine health concerns. the probable causes:the scrotal issues are due to the dryness of the skin and skin hair follicle infection. there is hyperkeratosis on the scrotal skin. all of these issues develop due to unhygienic urogenital habit and unhygienic skin condition of the areas of the external genitalia. no need to worry as i am suggesting very effective remedies for you to get better in a short period. the mouth sores are due to throat infection and it looks like a mixture of bacterial and viral infection. so you need to start the treatment immediately. treatment plan:for genital skin issues:- 1. the most important medical remedy for you is to shave the area completely including scrotum pubic area and the groins with a blade. make it a habit to do undershave (armpits and the genital area) before the hair grow very tiny. 2. keep the area clean and dry and apply hydrozole (combination of hydrocortisone and clotrimazole) cream on the whole of the genital area including scrotum. 3. you should take a prescription for amoxicillin. keep taking paracetamol every 8 hourly until you no more have fever. 4. apply some gel like orajel (benzocaine) on the mouth ulcers and stay for 5 minutes. then rinse with tap water. 5. do gargles with scope mouthwash. take plenty of water and proper rest. regarding follow up:for further information consult an internal medicine physician online. ---> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "i have anxiety disorder and was prescribed with 5mg lorazapam. but this dosage gives poor response. is it safe to take one more tablet?"}, {"role": "assistant", "text": "com. at this moment you can take another 0. 5mg but do not repeat it after that. tomorrow you can discuss your poor response to the 0. 5mg lorazepam either with your physician or you can discuss with me online if online therapy for a psychiatry consultation is fine with you. in my view 0. 5mg is a correct dose initially to manage anxiety disorder. hope another 0. 5 mg will help you at this moment."}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "had unprotected sex today. should my partner take contraceptive?"}, {"role": "assistant", "text": "if she is in her ovulation period then better to take an emergency contraceptive pill. ovulation occurs 14 days prior to the expected menses. imagine her periods is of 28 days then unsafe days are from 11th day of menses to 20th day. ovulation is unpredictable as the cycles of menses. so such a long unsafe period for extra safety. if you had sex before 11 days and after 20 days of first menstrual day then chances of pregnancy are very less. you need not take i-pill. if not then take i-pill at the earliest. for further doubts consult an obstetrician and gynaecologist online --> <link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "suffering from anxiety attacks which are of a sudden onset. i am a schizophrenia and heart attack patient."}, {"role": "assistant", "text": "i assume that you are having good life with current medicines baring anxiety attacks. the possible reason for your anxiety attacks are: current medication- can you outline the onset of anxiety attacks after starting one or another medication that you are taking currently. part of schizophrenic illness- if you have these attacks irrespective of medication status that it is likely that these are the part of your schizophrenic illness. withdrawal effect of one or another drug- if you are inconsistent in taking your medicine then this reason is a strong possibility. the duration of anxiety attacks is one of the strong factor that determines the diagnosis. before we proceed for medication or treatment of these attacks you are requested to post more information about it. you can also book for an online phone or video chat consultation so the problem can be evaluated in detail. please provide the following details: duration of anxiety problem. frequency of problem. course over years or months. any association (decrease or increase) with current medication. duration of each episode. preceding factor to anxiety episodes. used coping skills by you. magnitude to which your life affected by anxiety attacks. any sleep problem palpitations dryness of mouth tremor restlessness. at this moment my advice is to shift the aripiprazole to morning time and continue the rest of the medicines. consult a psychiatrist online with the above mentioned details. ---><link>"}], [{"role": "system", "text": "You are a helpful assistant."}, {"role": "user", "text": "suffering from anxiety and depression. doctor prescribed mirap and clonazepam. need a second opinion."}, {"role": "assistant", "text": "mirap is a mirtazapine which is indicated for depression. in my professional experience it is not as efficacious as the ssris such as fluoxetine or paroxetine or citalopram. mirap at the dosage of 15mg does help the patient to sleep better but it is also known for significant weight gain upto 10lbs in 2 weeks. clonazepam is indeed an useful adjunct and helps with the anxiety component. but i only prefer to use it as an \"as needed adjunct\" and no standing doses. i can help you better if you are fine with booking a session for an online therapy for a detailed evaluation."}]]
\ No newline at end of file