###Input :Is it normal for a Urology PA to try to prescribe antidepressants/SSRIs?(Posting this again to fix some things that I needed to fix in this) Age: 24Sex: FemaleHeight: 5'1"Weight: 100Race: CaucasianDuration of complaint: urinary issues for about a year, suspected interstitial cystitis. Appointment was todayLocation on body: urethra/bladderCurrent medications: N/ANo recreational drugs, non-smoker, non-drinkerI had a very uncomfortable urology appointment today and while one of my doctors confirmed this was really weird I kind of would like to hear from other doctors unrelated to the situation.I went in because my gyno suspects that I have interstitial cystitis.I'd like to mention he's very very specific with me about what will happen. He knows that I rely on a really precise description of what the plan is (I have really bad anxiety and sensory issues). So it was weird to me when I went in and the PA immediately scoffed and said "it's never interstitial cystitis. They just claim that and send you off our way". Then she insisted on pelvic floor massage which I am unable to do and I said no to because my gyno and I went over all the options and he didn't think that was even on the board of necessary ideas. She pushed and said that "I injured my shoulder and got pelvic massage therapy and it fixed my shoulder".She claimed she had read all of my charts and medical background and asked if I was taking anything for the pain. I thought she meant Tylenol and said no because it doesn't work. She then started listing off amitriptyline and two other antidepressants/SSRIs. Then cymbalta. I got confused and told her I'm already taking savella and she asked me "what for? What does that do?"Shouldn't she know what that does? It just sent off a really red flag for me because those are usually meds that you need to involve a psychiatrist for. And if she had read my file and is messing with those kinds of meds why would she mess with my antidepressant that is package insert for pain and depression? She also would've seen that I'm prescribed tramadol.She also got really snotty when she asked if I had been surgically diagnosed when I said I had endometriosis which also would have been in my file/medical history. It also seems like any message from my gyno she just threw in the trash pile and came in with her mind made up that he was full of it.I guess I just need to know what to do. If this is normal and she just was kind of awful then okay but it really didn't feel normal. Do I tell someone about this? Who do I tell? She told me "then just go back to your gyno and see what he says" and (as I expected he would) he's sending me to another urologist, I imagine he's wondering why there was a problem.Edit: she also asked me about a bunch of food and drinks, I answered honestly that I just drink water with an occasional soda and about my food habits. Then she sent me home with a list of food to stop eating and all of it is stuff I point blank told her I don't eat. I'm just really upset because I had to drive a long way to get there, do things that will set me back anxiety-wise for days and she didn't even listen to that.Edit 2: There's also the unfortunate fact that the more stressed I got by her ignoring me and getting really pushy the more I started to stim. And she decided the best thing to do was start IGNORING me (I was still speaking to her, just no eye contact and moving my fingers) and only speak to my mother. I was then completely invisible. ###Output :That sounds like a mix of multiple bad things. Theres a strong whiff of functional medicine (read: quackery) in massage for everything and weird food restrictions. Theres stigma against psychiatric treatment and mental illness. And theres ignorance.Theres nothing wrong with a urology PA managing antidepressants if he or she actually has expertise in those medications, but that isnt what happened here. This PA might be right about it not being interstitial cystitis, but even if so behaved so badly that youd want a second opinion anyway.


###Input :Definitely getting a second opinion, hopefully with someone that actually is interested in sitting down and talking things out instead of whatever this whole mess was.Thank you for letting me know that it's not unusual for urology PAs to work with those meds in general ###Output :I think it actually is unusual. Its not unprofessional or absolutely a bad thing, but its unusual.Its not only psychiatrists who manage psychiatric medications, but most of the other doctors (and PAs and NPs) who do it are generalists, so probably family our internal medicine primary care doctors and the occasional gynecologist who does primary care.


###Input :Yeah the savella is for my fibromyalgia and depression, I've cycled through stuff like elavil (ultimately dismissed as an option when I was 14ish) and cymbalta (horrible reaction) so I don't find that so weird. I guess maybe it put me on edge because I've had bad experiences with a lot of those? I'm very touchy about messing with those when I'm settled in one because it's hard physically and mentally and I really don't feel safe unless my psychiatrist is involvedI've gotten the "what's it for" question a lot it was more the "what is that" that got me because I thought it was a pretty well known med ###Output :Sorry this is short. No signal. Speed read the issue. Only have to say.... Cymbalta is a powerful antidepressant which has use in resistant stress incontinence , that is leaking on exercise usually later in life.Amitriptyline has a big role in bladder control mostly for nocturia, peeing at night. It is used at doses much less than when used 50 years ago as an antidepressant but I like to correct people who complain theyve been put on an antidepressant when the dose is 50mg instead of the 300mg it was then. It was a poor antidepressant but people said that their bladders were better


###Input :That's interesting. But also odd because I told her I'm not having incontinence ###Output :Precisely. It doesnt really make sense so maybe another opinion


###Input :My (72M) father was sent off for a number of urology tests, are these standard procedure?72M, 160 lb. He has had frequent urinary urgency for years now, untreated. Recently has gotten much worse, and the need to urinate has been waking him up 5+ times each night. When he does urinate, he has trouble emptying his bladder.I scheduled an appointment for him with a urologist and the urologist prescribed Flomax to him. This was today. The urologist sent off for a number of tests:PSACreatinineUrinalysisAlso, these procedures:Transurethral cystoscopyRenal ultrasound and ultrasound of the urinary tractI'm wondering about the cystoscopy - as this is what my father is most fearful of. I spoke with the urologist and he said this is to see if there are issues that need to be addressed by surgery that the Flomax can't help cure. I'm still not sure what this is done for and if this is standard procedure? Would it be better to just see how he responds to the Flomax and perform the procedure if he doesn't? Or is there value in doing this anyways? ###Output :Flomax was given as due to the likelihood of benign prostatic hyperplasia, and pretty much every guy has an already enlarging prostate when they're above 60 anyway.The cystoscopy is to look into the urinary bladder for any issues that may not be due to the prostate (prostate would still be the number one source of problems in this age group regardless). All these tests should cover all the bases for the probable urinary tract issues for his age.


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


###Input :I did an in home vinegar test yesterday and the area he was referring to did NOT react. I did have a single spot react, but not the one he was referring too. The vinegar test has a high false positive rate so I'll talk to him about that, but still, the visible areas he could have been talking about DID NOT react.I want this guy to be sure i have HPV before he charges me to cut shit that's been there forever. I can take care of a skin tag for under $5 at home. And while I know it's incredibly common to have hpv I want him to be sure if I'm going to have to disclose that with future partners. Maybe I should see a dermatologist?What are some questions I can ask to make sure he's right? ###Output :Easiest and cheapest way is to post a picture here and Ill check it for you. Its a clinical diagnosis and honestly not that difficult to determine.Edit. Also, if you have had unprotected sex with > 1 partner, chances are you have been exposed to the virus.


###Input :http://imgur.com/a/lhCk8a4Again, its been there my entire life, including the skin bridge. I always assumed they were caused by the same shitty circumcision.To your edit: I've never had unprotected sex. That includes oral (not fun). ###Output :Doesnt look like a wart and your history doesnt really support that diagnosis either.


###Input :Bleeding vs. clotting risk - When is heparin bridging appropriate?Hi all, I am just a simple-minded EMT, trying to understand this concept for a family member who recently underwent surgery.The family member has chronic a-fib, which has been well managed with warfarin. He needed a trans-urethral resection of a bladder tumor (TURBT). His cardiologist said he should not be off warfarin for more than 72 hours, and his urology surgeon said to stop the warfarin 48 hours in advance of the surgery (meaning the plan was to resume the warfarin 24 hours after surgery). After the surgery, the surgeon said he was not able to cauterize all of the 'wound' (I am not sure the correct term here), so my family member had a good amount of hematuria, though the surgeon said it was not a life-threatening amount.He was supposed to take aspirin after being discharged, but they ended up admitting him due to a good amount of clotting in the bladder, which required daily irrigation. I am not sure if the nurses ever ended up giving him aspirin or heparin while he was off the warfarin. The surgeon seemed very concerned about the bleeding, and said that my family member could not go back on his blood thinners for another 48 hours after the initially planned resumption (which would result in a total of 5 days off the blood thinners).Now my question is, isn't it easier to fix a bit of bleeding than a blood clot (which could cause CVA, AMI, or PE)? Wouldn't it be better to keep him on blood thinners and handle the bleeding, than to risk a deadly clot?We would ask his surgeon, but it's sort of a foregone conclusion at this point as my family member has already been discharged. So, this is just for my personal education. Thanks for your insight. ###Output :isn't it easier to fix a bit of bleedingGeneral surgeon here. No, it's not always easier. Sometimes the tissues are just oozy, and you can't just throw a simple suture in or cauterize it and make it stop. Sometimes, the more you cauterize something thats oozy and inflamed, the more it oozes and bleeds on you. Sometimes, you just need to let the body do its thing and form a clot. So either you stop blood thinners for as small a window as possible, and accept the risk of developing a clot elsewhere, or you keep them on blood thinners and just let them ooze and ooze and ooze, potentially requiring blood transfusions, which then opens them up to other risks. Others may have other viewpoints, but this is from a surgical view.


###Input :Thank you.Do you always do a heparin bridge or is this contraindicated under certain situations?Does a patient history of a-fib affect the outcome of the risk calculus? ###Output :When considering the decisions here, you need to weigh the benefits and risks of anticoagulation.His stroke risk from afib can be estimated with the CHADS2-VASC score. Look this calculator up online. Most people stand an annualized risk of 2-11% of experiencing stroke. On a day to day basis, that risk is super small. Like 0.001% chance of having a stroke every day he's off anticoagulation, and even that is probably an overestimate of his stroke risk.The risks of bleeding are obvious. He's bleeding into his GU tract. This could occlude his bladder. He could bleed into the wound bed in ways that make his recovery worse. The chance of bleeding while anticoagulated is 100%.The last nail in the coffin is that we have multiple large and well-designed trials (BRIDGE and PERIOP2) that show no benefit to bridging pre or postoperatively in any population we've looked at this far, including mechanical valves in the post-op setting.At this point the only cases where bridging might be worth it is acute DVT/PE within 3 months of surgery, and maybe mechanical mitral valve.


###Input :What monitoring is usually needed when taking a patient off anti-coagulation therapy for surgery? e.g. CT scan, d-dimer?For reference, this family member's CHADS2-VASC score is 4.Thank you for your help. The CHADS2-VASC calculator definitely improved my understanding. ###Output :No monitoring is needed. The idea now is to resume anticoagulation once appropriate from a surgical standpoint. Not uncommon to wait anywhere from 5-14 days post-op to resume anticoagulation depending on how bloody the procedure was.


###Input :I (f25) recently was referred to the one stop urology specialist clinic for tests, but the specialist I saw refused to do any of the tests I was booked in for based on my age.Hi there! I am F25, around 8st (I don't weigh myself due to history of anorexia nervosa), don't drink, smoke cigarettes (have cut down, do not smoke heavily), don't use recreational drugs, and live in England. Previous diagnosis fibromyalgia ~5 years ago, ASD, c-PTSD, juvenile arthritis (age 14). I am prescribed quetiapine XL 200mg once p/day, naproxen as and when needed, promethazine hydrochloride as and when needed, cocodamol as and when needed. I also take a probiotic, vitamin D, iron, vitamin c, and a multivitamin all as supplements once p/day.I have recently been having a lot of medical issues, which my GP is trying to have investigated. I have petechiae all over both arms after sun exposure, internal pain in the chest, and incontinence with internal pain in the kidney area. Also, a year or so ago I had blood tests done which indicated my kidney function was lower than normal. I also have a lot of other symptoms, but these are presumably to do with fibromyalgia, so I won't list them. The incontinence gets worse in the evening and at night, where I am needing to urinate every 10-15 minutes. Pretty much every time I drink anything, I need to urinate straight after. GP sent a urine sample away for lab analysis, which showed microscopic blood in the sample, and protein. I was referred for an emergency CT scan due to the intense pain, which flares up and is not constant, but the hospital declined to do one (due to not having space, I think). I was then referred to the urology clinic for a four hour appointment.When I arrived at my appointment, I was told I would have an ultrasound, a flexible cystoscopy, blood tests, urine test, and flow rate test. After going back into the waiting room, I was shortly called back into the doctor's office. He told me that he would no longer be performing any of the tests I had been booked in for, except for an ultrasound. He did a stick test of my urine sample and told me I had no blood in it, but the blood from my previous sample was microscopic and was only found in the lab analysis, NOT in the initial stick test. I was told that, because of my age, I could not possibly have any health issues, and that he had people with possible bladder cancer who he could be seeing but wasn't able to as I was "taking up [his] time, when others need it more," despite my time being booked in. He explained that the only issue I could have was kidney stones, and also dismissed my pain further when he found out I have fibromyalgia.I then went in for my ultrasound, which came back as no kidney stones. I was then called in and, to the doctor's surprise, told that I don't have stones (which I already knew and had tried to explain - I have had kidney stones in the past, and my recent issues have not been consistent with my previous experience). He said "I'm a surgeon, I look for problems to treat. You don't have stones, so I can't treat you." I asked why I am having incontinence issues, and he said "probably because you are a woman. It's common in women," and when I asked what I'm supposed to do about the awful pain for which painkillers barely touch the side, his best advice was "get pregnant. Pregnancy often cures all sorts of illnesses." I was almost in tears at this point. My response was "I just had a miscarriage in December. I've had two miscarriages," and he said "try again." I said "I don't want to," but he insisted this was the best idea. I also explained that my GP had said there could possibly be an inflammatory issue, and he said it wasn't possible to have inflammation without kidney stones or an infection. He also implied that my fibromyalgia is not real because he "prefers not to label patients if [he has] no real evidence." He also stated that the only reason he was going to do any other tests in the first place was because if he didn't it would be "sod's law" and I'd actually have something wrong.I feel at such a loss. I was so devastated after my appointment, and still ended up being in there for 3.5 hours even though he refused to do any of the tests. Fortunately I had my partner with me, who was able to support me whilst I was sobbing in the waiting room. It's been such a long journey to find a GP who takes my complaints seriously, and have had years of doctors being dismissive. I genuinely thought I might begin to have some answers after the appointment, but I now feel like I'm just five steps back.Is it normal to be refused tests based on age and gender? Is anything he said to me actually true, as I feel like it was all completely dismissive? Should I request to see someone else, or will the same thing happen again? I'm honestly devastated, and concerned for my health. Any advice is welcome, I just want to know what the best way to proceed is, and if there is anything specific that I should be emphasising with doctors in the future to be taken more seriously. I tend to mask and come across as very polite, but maybe it would benefit me better if I acted less positive and worked harder on getting across the severity of the pain? Also, am I able to request any specific blood tests? If so, what would be recommended?Thank you so much for reading, apologies for the long post. ###Output :Medically he may or may not have been justified in not doing all the initial tests - one-stop clinics usually book you in assuming youll need everything even if thats unlikely to be the case. And your urologist is probably a better judge of that than the GP.However, the way you were spoken to is bizarre and clearly inappropriate. Id suggest you contact the PALS service for the hospital you were at and ask your GP to re-refer you to urology - perhaps another urologists outpatient clinic. PALS may also be able to help with that.


###Input :[8 F] Higher WBC than RBC?My 8 year old daughter had labs and her WBC was 8.8 thousand and RBC 4.76. These are both in normal range, but is it actually ok if there are more WBC than red?We do have two doc appts this week for follow up, but my pediatrician did not notate anything about this in the system notes, only made a note for her to increase zinc intake based on her slightly low zinc.She has a variety of other health symptoms that we havent figure out also, but Im just curious if this is specifically alarming.Im sure Im over thinking it. I definitely have some medical anxiety since my mother passed last year, which I completely acknowledge. Thanks for any input!EDIT TO ADD: Conditions- bladder area pain (working with urology), abdominal pain, sometimes has protein in urine, burning feet/neuropathy (new symptom- one month), urine leakage during daytime, pale/flushed face, general malaise ###Output :The units on them are different - the red cells are in millions per cubic millimeter, the white cells are in thousands. Everyone has way more red cells than white. When it comes to the specific numbers on labs, we don't compare them like that.


###Input :What about having 57% lymphocytes? Is that ok too? ###Output :Yes, totally fine.


###Input :Urology or dermatologyAge: 28Sex: maleHeight: 170cm (5'7)Weight: 66kg (145 lb)Race: AsianDuration: several monthLocation: Singapore. Condition is on penisNo other health issueNo medicationMy husband has a little bump on his penis for several month. It's several mm wide, there's a hole in the middle, and can see some black stuff inside. The black stuff is shaped like a thin disk. It does not hurt or itch or anything.We are planning to see a doctor in Singapore to check it out, but I don't know if we should book a urology doctor or dermatology doctor. Any advice? We don't have a general doctor.Thanks in advance! ###Output :Both specialties would be a good choice.


###Input :Concerned over 'Spironolactone' Rx for acne as a maleHello, (30y/o male).I was recently seen by an NP at a Urology center and during my visit my acne was brought up. She just got done some time working in dermatology. I had stated I was not comfortable with something like Acutane since I am trying to have kids and honestly that medication seems very scary to me from a health standpoint. She Rx me something called 'spironolactone'. Coincidentally I was seeing a male health specialist (an NP) the next day and he also brought up my acne and suggested 'spironolactone' out of the blue..Before I picked this up from the Pharmacy I googled it, because I like to know about medications and nowhere does it say this medication is safe or FDA approved for men. It's apparently outstanding for female acne, but as an androgen blocker, is not intended for use in men, and in fact a clinical study showed 100mg of daily use for 3 months in a group of 18 men, 8 of them developed significant gynecomastia..I called and canceled my Rx for spironolactone. I wanted to get an MDs opinion on this. I am a lay person so maybe I was just dramatic here. I am quite confused why two entirely different NPs, practicing in different states, would both suggest spironolactone (100mg a day) for acne in men..Patient History:Pituitary tumor which impacts my testosterone levels (sub 100) so am on 100mg of T a week. I have cut this down and am weaning completely off of it because I am currently 0.00 10x6 for sperm. NP just started me on 5mg of 'finasteride' (for acne due to DHT conversion maybe?) and HCG (0.75mg a week) to try and get that up. Another NP started me on Clomid and suggested I finished off the HCG (*I know, its not ideal to have two providers dictating care for the same thing - but NP #1 didnt know I was at a 0 and wanted to determine if I needed something like Clomid after the analysis came back but I dont see her again for 2 months).*I will say the IM testosterone has changed my life. I cannot explain how much better I feel. Its so profound I almost want to cry. Its like seeing in color for the first time in 20 years. I am sad / nervous to get off of it, but its for a purpose so I can handle that. ###Output :I have never heard of spironolactone being used for men's acne. Without good evidence, I use it frequently in women.


###Input :Reoccurring UTIHi just looking for some advice and what to know looking forward. Before Christmas I had a UTI for approximately 2 weeks, during this time I tried one course of nitrofurantoin (100mg twice daily) which didnt help at all, then two courses of pivmecillinam (200mg three times a day, with a loading dose of 400mg both times) which also didnt help. Eventually I was referred to urology who did bloods (normal), urine dip (positive for protein and blood) and ultrasound of kidneys bladder and ovaries. Scans came back completely normal and the urologist then prescribed ciprofloxacin 500mg twice daily for a week. The cipro seemed to have worked and I was fine over Christmas, but potentially still had some dysuria/frequency though a lot less than before. In the past few days symptoms have come back to the extent that they were before the cipro.Im going to pick up a new prescription for ciprofloxacin in an hour or so and its a 5 day course. Should I be concerned and see a urologist? Or is this just a UTI that wasnt fully treated so has come back?21F, Mixed African-American/White, 60mg fluoxetine daily, 75mg desogesterel daily, 40mg propranolol up to three times daily ###Output :you should probably see your urologist again who may want to do a full urinalysis and culture/sensitivity test.


###Input :Coughing up blood after surgery29M, 150lbs, 57. No medication, no drug use, a drink 1-2x a week.Hello doctors, My husband had a minor urology surgery approximately 8 hours ago. He has been doing well, however, anytime he goes to lay down he begins to cough up bright red blood. It stops as soon as he sits back up. Is this from the intubation? He resident I called could not advise because he was not an anesthesiologist resident. Thanks for any insight. ###Output :Depends in part on the volume of blood. If it's a few specks of bright red blood that he's spitting out after coughing, sure. If it's frank bleeding that he's noting when he lays down, that's something else entirely. If it's the later, it would be atypical to have that happen and last 8 hours. I'd be concerned enough at that point to bring him into the ED.


###Input :Thank you so much! Also, please let me know if you need more details/clarity on his medical history. ###Output :I'm not a urologist, but I imagine the recommendation was for a transurethral resection of prostate (TURP). Relatively routine from my perspective.


###Input :Hello, 23f, 56, 48kg, venlafaxine 37.5mg. For the past few years Ive been having microscopic blood in my urine samples with a few clear ones here and there but nothing has ever been done. Another symptom Ive been having for a few years is on and off stinging when burning and multiple urinations during the night despite not drinking anything. I remember even as a little kid though I would pee throughout the night.I have now finally been referred to urology and have a cystoscopy next week and a CT scan at some point. My other symptoms arewaking up with a full bladder in the morning which is painful almost like a period pain which stays for a little while after I pee.Microscopic blood in urine.Cloudy urine sometimesSometimes burning when I peeBelly feels tight most of the time idk if this is what feeling bloated isHaving to stop and start peeing towards the end to empty bladderPain deep in pelvis during sex sometimes, like that tight period pain (dont know if relevant)On top of all this I have agoraphobia and havent left the house on 3 weeks and now I have to go half an hour away for horrible tests so no idea how Im going to get through this. I suffer from severe health anxiety and Ive convinced myself I have cancer and Im spiralling out of control with worry. I dont know if this is relevant but I also had chlamydia 3 times when I was 17 (6 years ago). Im just hoping for some reassurance that not might not be cancer  ###Output :Could be stone issues, urethritis etc. Def not cancer. Go to your urologist appointments!


###Input :Thank you, could I ask why def not cancer? I will try my very hardest to go ###Output :Too long history, none of your symptoms are signs of cancer and cancer is virtually nonexistent in your age.


###Input :So signs of bladder cancer are: Pain in lower abdomen Pain when urinating Frequent urination during the night Blood in urineAll of these I have? But I do see what youre saying about it being too long history ###Output :But they are not specific to bladder cancer. In fact, they are some of the most common symptoms there is. Microhematuria for instance, is almost to the point where im more surprised when a random f23 surgical ER patient doesn't have it than when she does. (Macrohematuria is another matter altogether).Health anxiety is difficult, and all I can offer is my perspective that your presentation does not in any way signify cancer.


###Input :[32M] Lung Nodule Time!Age 32Sex MaleHeight 6'0Weight 190lbsRace WhiteDuration of complaint: Just startedLocation: Lower Right LungAny existing relevant medical issues: DepressionCurrent medications: WellbutrinHello, everyone. I know lung nodules are typically nothing, but I can't seem to find a whole lot. And I know wait on my pulmonologist appointment to go over the findings. So naturally I'm freaking out anyway.So last year I had gallbladder surgery so I had a CT scan done. I had another one today for something related to urology and a swollen lymph node (everything fine there) and that's when it was discovered.From my understanding, they compared it to the CT scan from January 2021 to the CT scan today, and it was 1cm then and now it's 2.7cm. I was diagnosed preliminary with a lung nodule that has grown into a cavitary lesion by the primary doctor and he's referring me to a pulmonologist. I currently don't have any symptoms.I know it could be dreaded cancer but is there anything else it could be at that size? Most of what I've found online is people talking about 10mm or less.Thanks for any input. I am just looking for possible alternatives so I can focus on that and can sleep until my appointment.I am 32M. 190 lbs and 6 feet tall. I currently take Wellbutrin for depression. I don't drink, I don't smoke, I don't do any recreational drugs. I had asthma from around age 5 until 21/22 when it went into remission. I had pneumonia once when I was 5. ###Output :A growing cavitary lesion is most likely to be inflammatory, infectious, or malignant (probably in that order of likelihood for you). There is a long list of possible causes. Something that big likely warrants further investigation, potentially with a biopsy. The pulmonologist will be able to further narrow what the possibilities may be (heavily dependent on where you live and in-depth past medical history).


###Input :Thank you. I'm in Alabama and the pulmonologist will have access to all my past records because I've stuck with the same facility pretty much my entire life. Tomorrow I will continue my good vibes going into this. Your answer helps alleviate a lot of the anxiety - I know how serious this is. I'll update once I know (pulmonary appointment hasn't been established yet) ###Output :Yea. I wouldnt be too stressed about it. Certainly something to get worked up further, but not something to lose sleep over or run to the ER about as long as youre feeling well.


###Input :Pregnant with kidney mass38 yo female 24 weeks pregnant (IVF) History of hydronephrosis (2017) 3.5 cm simple kidney cyst found while hospitalized for it as well as ovarian cystsI am currently 24 weeks pregnant, I had some pretty bad pain in the same kidney that I had hydronephrosis in years before. The pain only lasted for about an hour but I then had what felt like a UTI so I went to the doctor. My urine tests came back fine but my doc requested ultrasound of my kidneys given my history. I went and got it done and received a call the following morning to go straight to ER that I had an abscess so I did (4.7cm). My urine and cbc both came back ok and didnt indicate any infection so they sent me home with order for another kidney ultrasound in two days. I got that done and it came back complex mass 5.7cm with recommendation for MRI that I cannot get done while pregnant. I have been told that its ok to wait these 4 months but I cant help but be terrified in the meantime. I have an appointment with urologist in 2 weeks. What am I really looking at here? On a scale of 1-10 how concerned should I be that this is cancer? Google is really scaring me. I plan to have MRI while in the hospital after I deliver. What can I anticipate at the urology appt? Any insight is greatly appreciated. Thank you for reading. ###Output :Youll have to wait for the imaging study, but the wait shouldnt be a big deal. I prefer CT renal protocol over MRI, but maybe your urologist may feel differently. Based on the report its hard to say exactly whats going on. Theres no mention whether it is solid or not, which is critically important. Maybe just be a benign complex renal cyst. CT or MRI will clarify.Pelviectasis is minimal dilation of the renal pelvis. Based on your symptoms it sounds like you probably have a mild UPJ obstruction causing intermittent pain (Deidls crisis).Edit: spelling


###Input :Hello everyone;This is my first ever Reddit post and I am finally turning to the deep dark web for some feedback.I am a 40yr old woman who has some medical issues and I have been my own advocate since July 2019. I am still waiting for a family physician for my son and I here in Canada - it's been too long without support.A little back story...I had my son in 2009 and in 2013, I had the lovely pleasure of having a partial hysterectomy - As a lot of you know these two things can cause the uncomfortable issue of incontinence. Well in 2018, after two and a half years of very uncomfortable sexual activity and very embarrassing incontinence mishaps I finally decided to see a specialist.After all the testing, my only option really was: TVT - which is the procedure where you have your bladder lifted in a mesh/sling. Surgery was unable to be booked as at the time my family had some changes and we had to move away. Finally after a year. I received a phone call from a specialist in the new area, and yet again due to some unforeseen family issues - I had moved away yet again to another area. So in July 2019, I started hitting the ground on my own. From that day I was going to walk in clinics for UTI symptoms (blood in urine each time usually every other month until September) - got antibiotics monthly and went on my way. Finally in September 2021. I had to change my tactics. My life was completely upside down, the pain and the symptoms were increasing and I wasn't getting anywhere. So I started going to the Emergency room. And started asking for referrals. I was there twice a month until March 17. I was confirmed to finally see a specialist for my case in June. However; I was still in the emergency room three more times after.Finally I have a specialist!!! How exciting is that? Finally I can get fixed! After a cystoscopy, I remember three things he said to me;-- "You took that like a champ" (loved this made me laugh, I thought he was funny) -- "Unusual growths" -- "We'll fix you"Had a biopsy surgery on June 20th. And then... I had to wait 4 weeks for my next appointment. Let me tell you ya'll I didn't think I had cancer, I am ill tho I know that. I have no appetite, I don't sleep because of the pain. I am wearing adult diapers because I have no control, and the blood is only sporadic, I am tired, I am anxious, I am nauseated, and sick sometimes. I hold a low grade fever of 99.5-101 daily it will not break.Heading to my results appointment. I was ready for a few things...Not CancerDo the surgery to lift my bladder and while in there they will check others to make sure I am ok everywhere else.Meds to clear up whatever is causing these fake uti's - cause every culture would come back negative. The ONLY thing I didn't want to hear was; "I don't know what's going on, let's try these pills, and not do the surgery..."This is what I remember about the appointment...I told him since he likes to make jokes and laugh I had one for him before we started... He said ok shoot."After my biopsy surgery you tried to poison me". His reaction was inquisitive. I explained that I was prescribed Codeine pain meds and I am allergic and it's in file. He blamed it on one of his staff and then never replaced the medication either. (One reason I already lost trust)2. His exact words "Yay you don't have cancer".Kind of like the first meeting here is what I remember him saying...-- "I made a mistake, there weren't actually growth in your bladder. You have a beautiful bladder. It was just murky from this infection." (Lost trust for the second time - you mean I didn't even need a biopsy surgery?!?) -- "I did measurements of your bladder while you were in surgery because when you are under, your bladder is relaxed. And you don't need it lifted." -- I don't know what's wrong, but we are going to treat you with Overratve Bladder (OAB) with pills and a low grade antibiotic forever.  If in 3 weeks there is no change we will increase your dosage. NEXT ONE'S THE KICKER!!!! -- "If that doesn't work I will refer you to someone SMARTER than me". (Lost all faith - he had a diagnosis from a specialist he was choosing to ignore to what put me on medication he didn't even know as going to help me?!?)So ya'll I am not going to lie. I was angry, frustrated, confused and couldn't speak. I took the script and left. After I left, I was beside myself and totally confused. How one specialist 5yrs ago said my only option when I had NO infections or other symptoms, said I had to have surgery... Now I am 9yrs after a hestorectomy, and this doctor hasn't done half the testing to see about a prolapse bladder (which again was diagnosed in 2018).I called my original specialist, he told me I would need to be referred back to him but he was concerned with the fact that he is over 2 hrs away from me now. He advised me to request a 3rd opinion with someone locally.I can say that has been requested... Now how long do I wait for this 3rd opinion?I am seriously in so much pain. I suffer from fibromyalgia and that is the only medication I am taking, so I am unable to manage. I haven't slept in 4 days. I feel like my right hip/leg are going to snap off me. I want to BIRTH something. I feel like I am in that last push pain of birthing... Everyday ... All day... I have been on medications for 5 days. The only thing that has changed, is that I no longer have blood in my urine. That's it.I am tired... Am I wrong for wanting to have a doctor to just please do an internal ultrasound to see if it's prolapsed? I mean seriously I feel like it's coming out. But they won't do that testing at the ER, and this specialist won't do it. How long do I need to wait?!?Thank you for listening... ###Output :Incontinence is s vast vast subject, i can't give you definitive answers online.For a tvt one of the most deciding factors if it will help or not is the Marshall Bonney test (you know the one with the urologist inserting 2 fingers in vagina and lifting motion to full bladder and telling you to cough)Has it been done and what was the result?A tvt or tob isn't always the answer, it doesn't work for any woman, there is a host of urodynamics tests and pelvic floor, abdominal pressure etc etc....that need to be done beforehand.The cystoscopy is also a must before the tvt for multiple reasons i cant describe them all (limited English and time) one of the reasons for the cystoscopy to be done and under anesthesia is to relax completely the abdominal muscles so the urologist can apply pressure to lower abdomen and with other hand to look at the roof and forward wall of bladder so not to miss anything. Without anesthesia he will not be able to see clearly and make a good assessment of the forward wall and roof.The biopsie isn't necessarily done only by suspected bladder cancer but also to outrule something called interstitial cystitis which is somehow similar symptoms to uti with clean uricults.Also not all urologists are the same, some like working exclusively in a practice, work fixed hours, ultrasound, diagnostics, cystoscopy, small stuff. And they know urodynamics and incontinence stuff (diagnostics) much better than me.Others like me work almost exclusively in the hospital performing multiple surgical procedures daily and also doing oncall shifts for EREven in hospitals, some do like 5-6 renoscopie procedures daily, others do kids daily, others the lucky ones do mostly DaVinci robot assisted surgeries, others kidney cancers, others tur-p tur-b holep etc... etc......That's why you can always get a second opinion. A urologist who is good with kidneys and works that daily and is concentrated on the malignancies in urology will not be a good fit compared to a urologist who knows his pelvic floor good and all types of incontinence and meds and bands. Also OAB represents similisr symptoms and can be treated with meds, if tjey don't work and marshall bonney test is negative, then botox injection in bladder is an option that works wonders for someIf you can provide me result of marshall bonney test i can give you a "guess" if tvt is right for you or not. A trustworthy diagnosis i cant provide online.Tvt done unnecessarly not only it will not help but can lead to complete shut close urethra and acute urin retention, so we don't want to do unnecessary procedures that will make matters worse. Also there is conservative approaches like pelvic floor exercises which in some patients do work well.Also TVT/TOB procedures aren't emergency and don't get priority so right now the waiting list at my workplace is about 3 months minimum and if another covid wave hits, it will be delayed further.Another Tip: gynecologists are more than capable of placing a tvt or tob. Its not a complicated procedure. Fairly straightforward but carries risks but rare when done by an expert. So if you can get a faster appointment with a gynecologist then do it.


###Input :[ Please Help ] CT Scan Abdomen and PelvisHi , i am male . the doctor at the Urology hospital asked me to do a CT scan of the Abdomen and Pelvis. will be done next week. My question is, will this CT scan show a testicle report if there is a problem with the testicles. or it is a different scan. because the Scan is for Abdomen and Pelvis ###Output :Nope. Testicles can't really be seen on this kind of CT.


###Input :Were my father's doctors negligent?My father was in hospital being treated for a suspicious catheter bleed and a UTI. As part of this the urologists had stopped all his anticoagulation/antiplatelet medication and presumably because of this he suffered a large ischaemic stroke. He was admitted on a Tuesday and I first noticed the stroke symptoms on the Thursday evening when I attempted to call my father on his mobile phone and when I finally managed to talk to him he had severe aphasia and cognitive decline. I immediately called the ward he was on and told the nurse that this was a very sudden and severe change in my father's condition (my sister had been to visit him that afternoon and he'd been absolutely fine - I had spoken to him earlier too and he was fine then) and the nurse said she would call for a doctor to review him overnight and he'd also be seen by his regular urology doctors in the morning and they would better understand the changes in him. I called the hospital a further two times that evening expressing my concerns about him and that I was concerned he might have had a stroke.On the Friday morning I call him and obviously he was still struggling to speak and still sounding very confused but he was however able to follow along with a conversation. I call the ward and the doctor has bumped my father up to IV antibiotics and fluids. I'm told later in the day that he was sleeping for most of the afternoon and didn't eat much through the day.Then Saturday morning my older sister spoke to the nurse looking after my father again expressing how concerned we are about this major change in him and we're told she will get the on call registrar to come and review him again. Later I am told he's being given stronger antibiotics. Saturday evening my father seems to be improving and is once again eating normally, also able to speak a little better.Sunday morning when I call the ward I am told by the nurse that my father isn't very good and he has been sent for a CT scan because he was really messed up that morning, exceptionally confused, unable to swallow and his aphasia has gotten worse. I called back a while later and spoke to a registrar who confirmed that the scan shows that my father has likely had a stroke. That afternoon he was moved to a specialist stroke ward.Over the last few weeks I've spoken regularly with the doctors on the stroke ward and they seem pretty mortified that it took 3 days for anyone to think to order a CT to check for a stroke. It seems obvious to my sister and I that when we have kicked up a fuss and he's been seen by a doctor they have just assumed that it was delirium brought on by the UTI but according to his notes no one had considered any alternatives. So I'd like to ask, would you consider this negligence?Relevant info81MUKWhite British79Kg5'11"Non smoker, no drugs or alcoholHistory - Alzheimer's, type 2 diabetes, metallic valve replacement and double bypass in 2011, diagnosed with kidney stone in late 2021, left side PCNL at beginning of February and recatheterised after a failed TWOC a few days after surgeryMeds - enoxaparin sodium 80mg twice a day, aspirin 75mg once a day, metformin 500mg two twice a day, gliclazide 80mg two twice a day, oxybutynin 2.5mg twice a day, linagliptin 5mg once a day, tamsulosin 400 micrograms once a day, donepezil hydrochloride 5mg once a day, colcalciferol 1,000 units once a day, bisoprolol 1.25mg once a day, atorvastatin 40mg once a day ###Output :Wait they took a guy with a prosthetic valve replacement off anticoagulation? How bad was the bleeding? Which valve was replaced? This is kind of concerning since mechanical valves need anticoagulation or else they clot and cause  you guessed it, stroke.Were they giving the enoxaparin and aspirin in the hospital??Obviously hindsight is 20/20 and perhaps it wouldnt have changed anything, but it seems like an oversight that no one ordered even a CT.


###Input :I'm unsure on which valve was replaced, I've honestly never thought to enquire. The bleeding wasn't really all that significant, at least that I saw, my father wasn't complaining of being in any pain either and originally I was told that bleeding without pain shouldn't be a concern - it was only when I noticed he was passing clots into his catheter bag that I was told to get him to hospital.They 100% stopped the enoxaparin but I'm not totally sure about the aspirin.Edit: after checking with family we believe it was an aortic valve replacement ###Output :From a US standpoint I agree with everything here. Is it worth having a malpractice lawyer look at this? Yes. Is there a clear delay between stroke identification and likely onset? Yes, it sounds like it. Is there clear harm done? Not necessarily. Im so sorry all this happened, OP. Its hard even if there is no mistreatment.


###Input :This is very helpful, thank you. Regarding the improvement and them seeing anything on the CT - the report on the CT only identified a single stroke and described it as sub-acute so I was told it was likely to have happened a couple of days prior. I thought much the same as you originally, minor stroke on the Thursday and larger stroke sometime Saturday night into Sunday but I was told no.I have been intending on getting in touch with PALS for a while now and this should give me the push I need, at this point I'm not even sure what the situation with the bleed was by the time the stroke happened. It's not been an issue since he was moved to the stroke ward and they resumed anticoagulation (high dose aspirin originally and then unfractioned heparin infusion). ###Output :One thing worth noting is that inflammation after a stroke is worst ~72 hours afterward. The worsening symptoms a few days later may have been related to swelling and inflammation.


###Input :Leukocytes but no BacteriaAge: 34Sex : FemaleHeight: 511Weight: 170lbsDuration of complaint: 3 weeksLocation: USAny existing relevant medical issues: NoCurrent medications: None currently, just finished a round of macrobid.Hey guys, I posted something similar to this in a micro group but things have changed since then so Im just looking for further advice.Almost 3 weeks ago, during a routine exam i showed moderate leukocytes in urine with trace blood. Id had no regular uti symptoms at all other than some pressure after peeing like once. No burning, urgency etc. According to my blood work I was also dehydrated. My NP, who is also my boss & friend, gave me a prescription for Macrobid and sent off a culture. I took the antibiotics for 3 days then I got the call that my culture was negative and to stop the antibiotics. So I did. From there it was back and forth because although I was still asymptomatic I still had leukocytes in my urine. So another culture was sent off - same results 25 - 50k cfu mixed urogenital flora okay cool. So what do I do? NP tells me to just finish the antibiotics so I did. I did get a micro UA done as well and it showed 5-10 wbc with few bacteria, mucus and epithelial cells but none of my urine samples were clean catch.On Saturday after finishing my antibiotics completely I took one of those AZO uti strips after a shower and it had a small purple speck in the middle of the leukocyte pad after 2 minutes. I text my NP to let her know and she sent me in yet another prescription for antibiotics.My concern is that Im not one to take a lot of antibiotics. Actually, I havent taken antibiotics in several years so I feel uncomfortable just taking them with no identifiable bacteria present. I do have a referral to urology but its going to take some time and Im worried about getting a kidney infection. I also feel as though my concerns arent being addressed properly because of my NP being my friend, so she doesnt run the tests she would on a regular patient (IE I had to bug her for the culture and micro ua because she just immediately wanted to give me antibiotics and call it a day).Thanks in advance for any advice, I know its a long read. ###Output :Asymptomatic leukocytes in urine, with no growth on a culture, from a sample that isn't a clean catch, is not a UTI and does not need antibiotics.Stop getting medical "care" from this person. Sounds incompetent. Get an actual PCP, preferably a physician.Urology is gonna be scratching their head on why they have this referral.


###Input :Why are small kidney stones worse than my larger one?Female, 38yrs old, bilateral nephrocalcinosis, no other health concerns and only medications are acute pain relief (30mg codeine & 500mg paracetamol combined tablets at 2 per dose, Tramadol 100mg, Diclofenac suppository 100mg, Buscopan 10mg). Currently in absolute agony.8 weeks ago I passed a 4mm stone that was exceptionally painful. Worse than my unmedicated child birth. That pain started around 7am but by 5pm I had passed the stone. It was horrific, more intense pain than I currently have but at least over in less than 12hrs.I had a CT scan and a follow up call from a urology nurse informed me I only had very small stones, described as like gravel left. No treatment or management plan - just a follow CT in a year.Which would be fine but for the past 2 days I have been in agony in my right kidney. Im on maximum doses of all my home pain relief and Im getting breakthrough pain every 2.5-3hrs.I would love to understand why this is more drawn out than my bigger stone? Im drinking large amounts of water to flush it/them out but Im not passing much urine at a time and theres a lot of blood in there too. I think I could cope better if I knew why this was taking longer or if I could work out just how long this was going to go on for. Urology nurse was very terse and basically just said Theyll pass without intervention. Just take your pain relief.Grateful for any insight/ideas x ###Output :Not a urologist, but we deal with similar issues in the bile duct. When it's a single stone, it is very easy to pop out because there's nothing else obstructing or limiting its dislodgement. However, when the bile duct is full of sludge and copious amounts of smaller stones, it's like trying to pull out a tube full of thick gravel or sand and extraction becomes a lot more tedious and prolonged. My guess is that it's just difficult for the gunk to move through your ureters because it's somewhat clogged up.


###Input :Cant stop peeing blood! Help!Hi everyone! Please let me know if theres any other/better places to ask this but I didnt know where else to go. I am going through hell and feel so embarrassed talking about my bloody pee online but I have gotten blown off more times than I can count. I am 22F 59 with no prior history of UTIs and I have been peeing blood for TWO WEEKS with extreme pain! It started out full and just generally lower abdominal pain, but now Im starting to feel occasional sharp stabbing pain in my side/back which is making me think its my kidneys. Heres a timeline of how all of this has gone:1/2/22- notice blood on the tissue when I wipe for the first time, freak out, schedule an appointment with my GP1/3/22- I go to my doctors appointment, she tests my urine and finds high white blood cell count (infection) prescribes me 5 days of macrobid1/6/22- bleeding gets heavier and abdominal pain gets worse1/8/22- finished my antibiotics, still extremely ill, more pain more blood, I start running a low grade fever and throw up1/10/22- I go to an urgent care, blood found in urine but no signs of infection, gave me a shot of ciprofloxacin and sent pill form home with me, told me if it gets worse to go the emergency room1/12/22- after never noticing a difference in pain or blood I go to the emergency room. They test my blood multiple times, take urine sample, and do a CT scan. My blood work shows elevated white blood cells and elevated high lactic acid levels. They send me in for a CT scan (no contrast) and dont see anything. I get sent home because nothing is in my CT scan and get told if the pain gets worse come backI am in a lot of pain and I dont know what to do. I am STILL peeing blood and having awful pain. I have a urology appointment tomorrow but I dont know if I should wait or go back to the emergency room. My back keeps having these painful twitches and I cant stop shaking. The nurse who discharged me said she thinks its interstitial cystitis and it is an infection that is curable that you treat with antibiotics. I looked it up and thats flat out not true. Other nurses had said all night it seemed like I had a kidney infection, and thats honestly what it feels like. What should I do? ###Output :If they did basic blood work, urine tests, and you haven't had true fever, then you probably don't have a kidney infection.Did you original urine sample ever grow anything in the culture?Do you urine results show blood +? Do they say if they specifically see RBCs or not?Edit: include the actual lab info if you have it availableIt kind of upsets me that the CT A/P was done non con. I guess maybe they were looking for stones... But still. You cannot reliably comment on pyelonephritis on a non con CT.I'm sure they were hunting for stones. Shouldn't really need CT imaging to make pyelonephritis diagnosis.Posts by unflaired users that claim or strongly imply legitimacy by virtue of professional medical experience are not allowed. This includes medical students.


###Input :How urgent is urinary problem?40F, 5'7, 205 lbs, Caucasian.Primary complaint: blood in urine, lower abdominal painHx: Neurogenic bladder from fall in 2009, Intermittent catheterization. Hx of kidney stones, UTIs. Partial loss of feeling due to nerve damage in abdomen. OA/DDD with SCS implant.Painful cath 4 days ago with strange pinkish red tissue string in toilet.3 days ago Pain in right flank/lower back attributed to too much dancing the night before.Yesterday, orangish tinted urine, blood suspected.Today, bright red blood in urine and a strange feeling in my lower abdomen, which I would describe as pain-like.I moved states and have yet to fully establish care locally. I have not seen my primary or urology. I did see a resident yesterday for medication refills, who ordered blood work and a UA for my primary care appointment next month. The blood work is to be done in a week or two to get me back to full strength on my lithium.My question is: should I do the UA today and wait a few days for results or should I go to urgent care?Medical issues: Osteoarthritis, SI joint dysfunction, neurogenic bladder, Bipolar 1 Disorder, anxiety, PTSD, migraines, recurrent Varicella zoster, IBS-DMeds: Lithium 900mg daily Levothyroxine 50mcg ac am Metformin 500 mg bid (for weight loss) Prazosin 6mg nightly Trazodone 200mg nightly Tizanidine 4mg 1 tab am, 2 tabs qhs Alosetron 1mg bid Voltaren gel CannabisSmoke 1 pack/week, drink 1-2 drinks couple times a month (including the 2 heavy drinks night this began), No street drugs.Any light shed on the urgency of this issue would be awesome! Thank you all! ###Output :Sooner rather than later. Urgent care may not be that helpful unless you're pouring out blood or you're obstructed from a blood clot. You should do the UA soon. The only specific reason I'd go to urgent care is if you think it's a UTI which of course is possible given you intermittent cath.The bleeding could be trauma or a stone but the worst case scenario would be bladder cancer, especially since you have a smoking history. A work-up is definitely needed if the hematuria is persistent.


###Input :How to talk to my daughter's pediatrician about a concernUPDATE: The appointment went as expected. The pediatrician wasn't too concerned because she was still able to eat and "looked fine". So I took matters into my own hands and gave her a total of 6 doses of Miralax starting on Thursday. She had MAJOR success yesterday afternoon and finally ate a whole meal.Hi docs, I need advice on how to talk to my daughter's pediatrician about an ongoing kidney & bladder infection without sounding like a crazy mom. She's 12, 52 inches, and now weighs 87 lbs (from 98 lbs).She first became sick on Aug 25th, with fever and vomiting. The first dr visit was diagnosed with a stomach bug and period cramps. Ended up at the ER a few hours later with a temp of 103.7. ER ran tests for hours. Urine came back good, bloodwork showed an infection. After several tests, the conclusion was a kidney infection. Sent home because there were no available beds. This went on for 4 more days, in and out of the ER. After 8 days of yucky, she returned to school.On Sep 20th, I got a call from the nurse to come and get her. Temp was 102.7, BP 90/49, HR 125 and she was vomiting brown. Took her immediately to the ER. ER put her in PICU to treat the kidney and bladder infection. She was in the PICU for 6 days and step down for 3.Went to her pediatrician for the follow-up. She did bloodwork and ordered ultrasounds. Bloodwork wasn't so great. I picked up the ultrasound report and the report stated there was a fecal impaction. I asked the pediatrician, she told me to give her Metamucil and sent me off to a urologist.We had the 2nd urology appointment on Tuesday. The fecal impaction was brought up again when she was going over her (the urologists') ultrasounds and cystography. I asked more questions about this impaction and was told to give her FiberCon or Metamucil. She still has kidney and bladder infections. Urologists put her back on antibiotics.I have an appointment with the pediatrician this week. I really need to seriously discuss this fecal impaction. I have been giving her both Metamucil & FiberCon for about 22 days now. And have given her Milk of Magnesia a few times. She has not had a bowel movement (a small amount) since Wednesday.I have picked up all lab and radiology reports from 2 hospitals and 3 different doctors. The CTs on Sept 1 and Sept 20th note the impaction. Ultrasounds on Sep 22 and Oct 7 also mention the impaction. And now, the urologist mentioned it on Oct 26.She is still not feeling well and not eating much anymore. This morning her temp was 96.9, BP 103/53, HR was 65, and she said she was extremely tired. I logged in to the portal this morning and received Friday's blood and urine labs, neither are great news, but there is some improvement.How do I approach the pediatrician with all this information without sounding like a crazy paranoid mom? Or maybe I am and this is not a major concern or issue? I have asked about this and feel like I was brushed off. I feel kind of crazy as it is because I went to all these places and got the records and put it all together. Thank you. ###Output :First of all, don't ever worry about how you come across to a doctor when you're talking about literally the most important thing in your life - the health of your child. I have parents tell me all the time "OK, don't think I'm crazy." I never do. I go out of my way to tell them I don't think it's crazy and that the reason we're talking is to make sure we're all on the same page and we're both comfortable with the plan.Just express your concerns honestly and in a straightforward way. It is literally their job to help you navigate something that evokes a strong emotional response. If they can't do that, they aren't a good pediatrician. (But thankfully, most pediatrician, in my experience, are excellent at this).As far as the fecal impaction, Metamucil won't cut it. Rectal fecal impaction is a common cause of UTIs, especially in girls (who have shorter urethras than boys). I usually use the big guns - like a Miralax cleanout or a Mg citrate cleanout. Basically the same thing we would do before a scope. This usually helps you start over from ground zero and then you can work on keeping her poop soft with Metamucil or whatever else you think works for her on a daily basis (Miralax is still my favorite for this too).


###Input :Granma here, just wondering...no enemas, these days? ###Output :Enemas work great, but dont go too far up. Cleanouts from above take care of the whole problem at once.


###Input :Alcohol Flush Response. If not allergy, what could it be?44M WhiteAbout 3-4 years ago I developed an alcohol reaction. I can have a single drop of alcohol on my tongue and end up with a bright red, itchy and hot face, and I would sweat. I do not get chest pain. Often, if I ignored then the issue would disappear quickly (10 mins). Often, I could continue drinking and be fine.Sometimes the same alcohol would not do this another time (e.g. same drink one week vs next).I have been tested (23&me) GG for alcohol flush syndrome and am fine.I saw a GP after seeing a post on reddit where someone said something similar and everyone told him it was lymphoma. The GP checked me and said I was fine. I have no weight loss, no night sweats, no obvious lymph node issues.I spoke with an allergist and they said:"These reactions are unlikely to be an allergy as it does not occur every time alcohol is taken and also disappears after the first initial reaction.It might be due to the histamine in the alcohol, or even the presence of sulphites, but if this were the case then the reaction would be maintained throughout the period that alcohol is consumed.We do see people who have had reactions to alcohol, to rule an allergy out, but rarely is an allergy the cause."I am currently on betahistines for something else, and have no reaction, so I don't think it can be histamine allergy, and I have tried some drinks which say "includes sulphites" and have no effect.Last year I have had some urology issues (difficulty peeing). They did not get to the end of it and told me I had 'shy bladder' - I disagree, but I was told I had an enlarged spleen after ultra sound, but later told I did not.So, what could this be if not lymphoma or allergy? My GP is not being very helpful, but it is really affecting my mental health and I am worried a sign of something else.I do not drink any longer. I am currently dealing with a new thing, vestibular migraine, and this is all swirling around in my head. ###Output :A transient effect like this seems more likely to be an autonomic response, which would be very difficult to diagnose and there aren't any tests for it. This sort of thing usually goes away after a few minutes.You might still have an alcohol flush response, despite "normal" genetics from 23&me. There are more genes that have been described recently. The only way to know for sure is to do an acetaldehyde breath test, but this isn't very widely available.


###Input :Total loss of bladder controlWhat would cause a complete loss of bladder control in 17 year old with cerebral palsy. Yes he has cp and thats what his primary wants to relate it to, but hes been in control since age 8 and now suddenly, theres about a 2 second warning before he goes. Sometime he doesnt even know he went. Cp is non progressive. Last 2 months there has been 5 separate episodes of blood (not from urine) in his brief in the morning. After standing for sometime and then sits, he feels a slight pain in the groin area. Urine was cultured, no bacteria was found, only microscopic blood. Referred to nephrology and his kidneys are good but his compliment levels were low. Doc thinks from having COVID in November. Testing again in 2 months. Next step is urology. Thanks in advance for any insight....Edit: he is now being followed for increased hemoglobin and hematocrit in RBC ###Output :How severe is his cerebral palsy? Is he ambulatory? Is he bed bound? in children with significant skeletal deformities or minimal ambulation, kidney stones are very common. These can cause blood in the urine and the urinary incontinence that you are describing. You need to go see a pediatric urologist for evaluation. First step should be checking for a urine infection, but after that imaging with an ultrasound or CT scan is likely the next step.Moderate spastic cp, wheelchair yes, but can walk with a walker short distances. He did have kidney and bladder ultrasound that was unremarkable. He also had a urine culture that was clear of bacteria. Thank you for your repl


###Input :Can CT Scan without Contrast IV detect Pelvic/Abdominal Cancer22m, 220lbs, 5'6. No smoking or alcohol use.Got a CT scan from ER to look for kidney stones and they found none.Quote the patients case was ultimately discussed with urology who agreed with further evaluation with CT abdomen and pelvis to rule out renal and urethral calcinotic/renal pathology. The patient demonstrated no signs of acute intra-abdominal renal pathology. Urology advised to follow up with non-urgent cytoscopy"Im currently experiencing a lot of dull abdominal pain and worried about potentially having cancer in the pelvic region.For 3 months Ive had lower abdominal pain, frequency urinating, pain when urinating, urethral pain.I have no signs of kidney stones, leukocytes or blood in urine. Ive tested negative for bacterial STDs as well and even Hep B and C, Syphilis, HIV at 3 months. ###Output :To answer your question, a non-contrast CT scan does not rule out cancer in the abdomen/pelvis, barring a huge mass or obvious metastases. In fact, even a contrast enhanced CT scan is not very sensitive for several types of cancer.You should discuss with your physician whether or not additional imaging would be warranted. I don't know much about your history but in general, it is exceedingly rare for a 22 year old to suddenly develop some sort of intra-abdominal malignancy.


###Input :What would be used to rule out cancer then? ###Output :Again, I would recommend discussing this with your physician (either primary care or the urologist). We generally do not recommend blanket scanning everyone with CTs and MRIs for non-specific abdominal pain especially in young patients, unless the clinical history warrants further investigation (it's not because we mind the extra work; it would be comically easy to read a bunch of negative studies all day and charge for it).Laypeople and even people in the medical field tend to assume that imaging is a magic answer box, but it oftentimes is not and the potential benefits of imaging may not outweigh the risks/costs.


###Input :Urology - gross hematuria, pelvic pain, no UTI?33F, overweight, white, Canada. History of kidney stones (4 in the last 18 months). Not taking anything to prevent them but Ive reduced sodium and drink a lot of water.In the last 2 months or so Ive had 2 instances of long-ish periods of time where I have visible blood in my urine (sometimes enough that it resembles menstrual blood and other times the tissue is just pink when I wipe) along with abdominal pain and sometimes flank pain. Both times Ive been treated with antibiotics but Ive had negative urine culture. Urinalysis showed blood, mucus and bacteria a couple months ago but Im not sure what my most recent showed. Ive now had blood in my urine since June 26th and what feels like menstrual cramps. I pee fairly often and get up a couple times a night. My last 24 hour urine collection showed big improvements and my kidney ultrasound looked good.Is there anything else this could be besides a UTI? Im hoping my urologist follows up after she called in antibiotics on July 7th. ###Output :How were the urine samples collected? I really hope that they didn't just give you a cup to pee in.Macrohematuria in women can be caused by many things, the most common: hemorragical cystitis (infection) or urolithiasis (not just kidney stones but ureter stones or bladder stones) or an urothel carcinom of the bladder/ureter/renal pelvis, rarely but possible with RCC or a urethral caruncle


###Input :Yes I just peed in a cup both times. I forgot to mention that the bleeding last time was maybe a week after passing a stone so I assumed it was associated with that. The current bleeding hasnt been triggered by anything. How should urine be collected?Im also experiencing some edema in my feet. I thought this was because Im working a new desk job but its to the point that my one foot swells so much that it bruises from my shoe. Also just generally fatigued. ###Output :n a female coming with macrohematuria: this method of peeing in a cup is very wrong for me, its very inconclusive. A woman who says she urinates blood needs a small catheter inserted (transurethral or course) and then through the catheter the urine samples collected.I had many cases of women presenting such symptomatic and very common the urine in the bladder turns out to be super clear, so its becomes an Ob/Gyn issue.You mentioned stones so most likely that's the cause, even after passing a stone sometimes there is an acceptable degree of macrohematuria persisting upto two weeks(rosee urine and not like super dark red with clots) All urologist are more than capable in diagnosing such issues.


###Input :Complex Cystic Mass 8.5 cm x 5.9 cm x 5.0 cm - Left KidneyYesterday I had an ultrasound of my abdomen as I have had intermittent pain on my right hand side by my gallbladder and liver. I did not expect this result, but now it makes a bit of sense as it is probably pushing things over to the right which is causing my pain.I am a 38 year old female.Symptoms: Tired a lot, Full easily, Nauseous oftenLEFT KIDNEY: Normal size. Normal echogenicity with no hydronephrosis. In the left mid kidney there is a complex cystic mass with several septations and which have internal vascularity and areas of mural nodularity. This cyst measures approximately 8.5 x 5.9 x 5.0 cm.I am having difficulty getting a Urology appointment soon as everywhere is booked up until March or April. I have reached out to my primary doctors as well, but I am curios about what my next steps should be.What should I be eating? What should I be doing while I wait for my appointment? What should I not be doing?What tests should I have?I am assuming due to the size it may need to be surgically removed. Is that generally the outcome?Thank you. ###Output :Nothing really to do or not do in the meantime. You can expect that they'll want to do an MRI or multiphase CT to see if there are actually any nodular areas that enhance with intravenous contrast, because that would be suspicious for a cystic renal malignancy. If so, these things tend to be really slow-growing and amenable to just being surgically removed with curative intent.Regardless, I don't think the cyst is causing your abdominal pain and was probably just found incidentally.


###Input :Low right side front abdomen and right lower back pain (kidney?)Age 43 Hawaii Male UsaSo 3 or 4 months ago after a scan someone out in a Urology referral with no other notes other than hidden away positive for nephrolithiasis.Ive had this pain right where my kidney is. It becomes moderately painful after doing moderate work and takes a couple days to settle down.Is this still potentially a stone or would it have passed because of the time frame? ###Output :Stones that remain in the cavities of the kidney will grow and recede based on things like pH and ion concentration over time. They are relatively normal to find, particularly as we get up there in age. They almost never symptomatic, unless they break off and get lodged in the ureterat which point its very symptomatic. Its hard to say what the sensation that youre having is; sounds like its causing a pretty significant obstruction for you that would be worth seeing your PCP about to get it worked up.


###Input :Coughing up blood after surgeryHello doctors, My husband had a minor urology surgery approximately 8 hours ago. He has been doing well, however, anytime he goes to lay down he begins to cough up bright red blood. It stops as soon as he sits back up. Is this from the intubation? He resident I called could not advise because he was not an anesthesiologist resident. Thanks for any insight. ###Output :Depends in part on the volume of blood. If it's a few specks of bright red blood that he's spitting out after coughing, sure. If it's frank bleeding that he's noting when he lays down, that's something else entirely. If it's the later, it would be atypical to have that happen and last 8 hours. I'd be concerned enough at that point to bring him into the ED.


###Input :27Female unable to walk, urinary retention, gastroparesis27 year old female, weight:57kg, height164cm. Previously diagnosed with autism, pernicious anaemia, iron deficiency, epilepsy, POTS.Taking Wellbutrin, lamotrigine, clobozam, vitamin d, iron, vitamin b12 injection, pantoprozole, and now because of gastroparesis I am taking domperidone also gravol IVI have leg weakness and my legs feel heavy and like they will give out on me. I have diminished feeling in them but the EMG came back as completely normal.I had an MRI and an MRI with contrast and it showed a disk bulge effacing the anterior disk space and moderate to severe narrowing of both neural foremen on disk L5/S1Disk protrusion which is mildly protruding into the thecsl sac and causing mild stenosis and mild neural foramen narrowing on L4-5I have gastroparesis which was just diagnosed during this hospital stay. I was vomiting almost everything I ate (which wasnt much because I got full so quickly) and they did a gastric emptying study.I have urinary retention meaning that I am unable to start urinating and it caused me to retain over 2L of fluid. I am currently catheterized. A urologist wouldnt see me because they believed it was a neurological problem but neuro suggested I see urology.I have a lot of the symptoms of Ehlers danlos syndrome as well (hyper mobility type) such as hypermobile joints, hyper elastic skin, soft, easily bruised skin, dislocations and TMJ disorder (which have caused jaw to dislocate many times).I have not been diagnosed with this yet but could the leg weakness and other symptoms be caused by ehlers danlos or is there something else we (the doctors and I) should be looking at.I am doing Physio and am getting a bit better at walking but my weight is mostly in my arms and so my legs dont give out I have been using a chair for the majority of the time here and walking with Physio using a walker. Im really unsteady on my feet and have a hard time controlling where my feet go which is making it hard to walk so I can only do pivot transfers.I had an ultrasound done of my abdomen/pelvis and am not sure the results yetDoctor is referring me to an EDS clinic because no one here knows enough to diagnose me ###Output :Really depends on what the neurological exam shows.


###Input :Made an appointment with a urology office to discuss getting a vasectomy, was told that the initial consults are with a nurse practitioner and not the actual doctor performing the procedure. Is this common practice?I'm assuming I won't even be meeting the doctor until the day of the procedure, which I think is kind of strange and makes me even more nervous than I already am. I know doctors are spread thin and minor procedures like vasectomies are probably low on their list, but I would at least like a few minutes of facetime with the guy that's going to be working on my junk... ###Output :That's typical for many offices. If the doctor is meeting with everyone individually, then that's a lot fewer procedures they can do. Just the way healthcare works in the US.


###Input :21M URGENT UROLOGY HELPI was masturbating excessively yesterday and during / right before ejaculation I lost all hardness and my penis became flaccid, stretchy, and curved to the left. My left testicle is also much more lower now and the right one doesnt doesnt move as smoothly. I basically cant really feel my penis anymore and its hanging very loosely downwards, as are my testicles. I saw a urologist right after it happened and he dismissed any fracture since there was no pain upon inspection and said everything was normal. My penis doesnt look, feel, move the same and i can no longer get a hard erection, the most i can get is a semi erection very loose penis with a 60 degree bend to the left side. What should i do? Had to add that my penis has become much more fatter maybe swollen?, and much more veiny, and has its flaccid size has increased, also scrotum shape is very weird and wrinkly. ###Output :The only thing that sounds abnormal to me is the bend in the shaft of the penis. I'm not a urologist, but if you were unhappy with the urologist that you saw, I would recommend you seek a second opinion from another urologist.


###Input :Yes I just peed in a cup both times. I forgot to mention that the bleeding last time was maybe a week after passing a stone so I assumed it was associated with that. The current bleeding hasnt been triggered by anything. How should urine be collected?Im also experiencing some edema in my feet. I thought this was because Im working a new desk job but its to the point that my one foot swells so much that it bruises from my shoe. Also just generally fatigued. ###Output :In a female coming with macrohematuria: this method of peeing in a cup is very wrong for me, its very inconclusive. A woman who says she urinates blood needs a small catheter inserted (transurethral or course) and then through the catheter the urine samples collected.I had many cases of women presenting such symptomatic and very common the urine in the bladder turns out to be super clear, so its becomes an Ob/Gyn issue.You mentioned stones so most likely that's the cause, even after passing a stone sometimes there is an acceptable degree of macrohematuria persisting upto two weeks(rosee urine and not like super dark red with clots) All urologist are more than capable in diagnosing such issues.


###Input :Urology vs. Nephrology28M, White, No drugs, Social drinker, no tobacco, 2 days kidney painIve had kidney pain for a couple of days. I went to urgent care this morning, but they unfortunately have no lab or imaging capability. They were able to dip my urine and detect blood. I have had no urinary symptoms. Theyre sending my urine for cultures (3 day turnaround) and also referring me to an outside facility for CT (unknown turnaround time).I am in need of a provider that is able to find the problem (and hopefully solution) sooner than later.My only question is, do I need to try and get an appointment with urology or nephrology? ###Output :Urology


###Input :Just got a worrying looking letter in the post following an ultrasound for varicocoele. Is there a urologist here that can help me translate this? (UK) Urology Cancer???Age 33Sex MHeight 6"1Weight 74kgHi All,Im based in UK. Just got this letter but I dunno what it means. Its from the Urologist to my GP that I've been CC'd on so it doesn't make a lot of sense to me. I could wait until I actually hear back from the Doctors but obviously I'm a bit worried now having read this so I hoped someone here could explain it to me. Here are the headlines:'His PSA is at 0.65''Ultrasound scrotum showed left scrotal varicocoele, bilateral mild hydrocoele and of note he had an ultrasound of the urinary tract which showed normal kidneys, a residual urine of 400ml and a soft tissue mobile non-shadowing focus within the bladder which is avascular on Doppler. This is unusual and I am going to review this in our MDT.''We will review him in our MDT urgently.'I have done an ETCI for a flexible cystoscopy'.Can someone please translate this for a layman? Many thanksI've just googled that the MDT is the 'Multi-Disciplinary Team (MDT) consists of a team with specialist training and experience of the diagnosis and management of Urology cancer'. ###Output :You may have a funky mass in your bladder and theyre going to stick a camera up your penis to get a better look at it.


###Input :Mobile means its moving around, which is a good sign in general (means its probably not growing from your bladder). The most likely culprit in these scenarios is a bladder stone. The fact that its nonshadowing makes it unusual because most bladder stones have calcifications that shadow. In any case one has to go in with a camera to take a look at it and do something with it. ###Output :By "mobile" I'm not sure whether they mean like rolling all around the bladder (which in this case sounds like it would be a blood clot, not a stone), or an actual soft tissue mass that is swinging in the breeze but attached to the wall by a stalk.MDTs are used for anything complicated or unusual, not just for cancer.