###Input :Ruptured calcaneofibular ligament and ?fracture of the anterior process of the calcaneus I am a little unsure of where that exactly is on the ankle after looking at multiple diagrams, doctors werent helpful enough in explaining it.- backstory if youre interested:Ill try and keep this short, history of ankle injuries in the past, never quite this bad on that ankle (other one has had reconstructive surgery).I am a 24yo Female who works in emergency as a critical care RN.Rolled the ankle after stepping on a hockey ball 2.5 weeks ago. First 3 days was horrendous, then the pain settled and all I needed was Panadol once a day.XR on day 1 said no fractures. Went home and played another game of hockey a week later (with some pain after of course).US at week 1 said fully ruptured ligament and small ossicle 2.8mm indicating a possible fracture. Recommended CT.CT at 2 weeks showed possible cortical fracture at anterior process of calcaneus.Now Ive had ligament damage in the past, on the other ankle, and this feels relatively minor in comparison.Im being told by an orthopaedic surgeon that I need to be in a moon boot. I am ambulating fine on flat ground with rigid strapping tape on to replace the broken ligament.Its relatively painless to poke around the ankle area. Im not sure I even understand exactly where this supposed fracture is.Im worried by going in a boot when Im coping so well, will hinder my recovery and extend the time itll take me to get back to sport.I can attach some paperwork in the comments.Whats your opinions? Is it possible theres no fracture? ###Output :Usual disclaimer: no one can provide specific medical advice for a person or condition without an in-person interview and physical examination, and a review of the available medical records and recent and past testing. This comment is for general information purposes only, and not intended to provide medical advice. No physician-patient relationship is implied or established.The anterior process of the calcaneus is deep inside the foot, and thus fractures do not always produce tenderness, as you cannot palpate it directly. I assume that when you say "no bone pain", this is what you are talking about.Fractures of the anterior process can be occult, not seen on plain x-ray due to the overlap of bones in the area, and sometimes CT or MRI are needed to confirm.I am a little surprised at you posting here, as you are a registered nurse who has access to emergency physicians and have already seen an orthopedic specialist for consultation. The opinion of your orthopedic specialist is that you have a fracture, and the treatment recommended is immobilization. No one who has neither examined you nor had access to your imaging studies will be able to give you better advice.The rationale behind immobilization of such fractures is simple: the foot has many bones that articulate (touch and move) with each other. Broken bones that do not heal well will cause permanent pain and debility due to interruption of the way the bones can move in relation to each other.If you want a second opinion, then see another foot specialist, bring them all of the imaging tests on DVD (reports are of limited use in these situations).


###Input :Height: 1.8m (5' 11")Weight: 64kg (141lbs)Race: CaucasianLocation: Seattle, WA, USA (German born, Berlin)Vices: occasional vaping with very weak nicotine content, no drinking, no illicit drugs, chronic pain patient (fentanyl patches, 50 microgram)Current physical conditions: pituitary macroadenoma, adrenal cortext carcinoma, and a ton of implants and artificial bones. I cannot afford treatment for either and my insurance, medicaid, will not pay for removal of either or even treatments since my treatment is HCG, which comes from only fertility clinic pharmacies, and medicaid doesn't cover and fertility treatments for menCurrent mental health conditions: PTSD, bipolar, BPD, ADHD, generalized anxiety, and recently depression. All are treated quite effectivelyMedications (total daily doses): 50microgram fentanyl patches, 6mg prazosin, 12mg tizanadine, 7.5mg mirtazipine, 2700mg gabapentin, 2mg clonidine, up to 150mg hydroxyzine, 80mg Latuda, 200mg Lamotrigine, 40mg viibryd, 10mg melatonin, 8mg ondansetronEmergency Usage Only Medications: Hospital only: 100mg dex, 20mg morphine, 4mg lorazepam all IV for cluster headaches; Personal use: 50mg IM dex for cluster headaches, epi-pen for food allergiesWARNING: This will be long. I deeply apologise, but I feel like I need to be very specific and include context to get an accurate answer, if one even exists.----------------------------------------------CONTEXT:I want to start this off by saying I don't particularly believe in homeopathy, certain Eastern medicine, religion (I'm agnostic, borderline atheist), or the paranormal. I do many things for work, taking whatever pays me, but I have spent the majority of my career as a data architect in medical research. I believe in what can be proven, but I also acknowledge we can't prove absolutely everything to be true or false and that the sciences are ever changing and ever growing. I would also note that my life have been a very challenging one and I seem to have the single worst luck of anyone I've ever personally met. I've been very stressed and it has gotten significantly worse of late, though I've been told that I'm handling it quite well. Of course, I also acknowledge that there's plenty of people who've lived much worse lives. I'm not trying to play the victim or be arrogant.----------------------------------------------IMPORTANT LEAD IN:I went to bed last night around 23:00. I woke up an hour or so later to the sounds of small booms outside the front of my house. I initially thought I'd imagined it, but I rolled over and say all 3 of my cats with their faces pressed against the window screen, ears perked up. The sounds actually happened. A few moments later, I heard out smartlock on the front door unlock followed by the door opening and closing. Aside from internal doors, the front door is the only "normal" door to the house. the others are sliding doors that were all locked and barred and sound completely different when opened and closed. My roommate was asleep in his room and had been for hours. Nobody else lives here. Once again, I thought I imagined it, but the cats had all left my room and run downstairs to the door, which is what they do when someone comes over or gets home from work, errands, or whatever. I then head a set of male and female voices coming from downstairs. I grabbed a replica Master Sword (from The Legend of Zelda game series my roommate gave me a few years back) and went to my roommate. I tried to wake him up repeatedly, but he just mumbled something inaudible and rolled away over and over. So I went downstairs quietly. I spent 15-20 minutes walking around the house, following the voices, but never found anything. One of my cats, Needles, kept running off towards the voices then coming back to yell at me to follow him to them, which is what he does whenever someone comes home and I don't instantly go see them, but I never could find them. He's an utter attention whore. After that, I gave up and went back upstairs. Within 5 minutes I heard the door open and close again and the voices stopped. I don't have the greatest hearing in the world and never got close enough to make out what they were saying. I checked my Nest doorbell camera and at no point did anyone walk past the door. It is always recording and saved online for 5 days and, with the way it's positioned, it couldn't possibly fail to see someone come in or leave. I checked my smart lock app to see how it was unlocked and it said it was unlocked using a key by a user named "error". To clarify, the account's username that opened it was not literally "error", but rather that the app produced an error trying to identify the user. There are no physical keys to our house. It's entirely electronic and only myself and my roommate have the access codes.I have no explanation for what happened. I was wide awake for it all. The cats saw it. My smartlock confirms it. It definitely happened.----------------------------------------------THE REAL ISSUE:After that all happened I went back to sleep. It generally takes me hours to fall asleep, however that's not what happened last night. I always fall asleep with the TV on for noise, but turned down. South Park is what I had on last night and throughout the course of the night, I could clearly identify the voices and episodes as they came and went, even during the "dreams" I'm about to talk about, but NOT during the dream at the end of my story. That's a VERY important thing to note. After maybe 30 minute I felt like I was asleep, but I wasn't. I could feel my sheets, feel my head and arms on the pillow, move around, and feel my cat against my leg. That said, I started "dreaming" as if I was asleep. I'd note now that I've only ever had 1 lucid dream before and it was right after my long-term secret fiance had left me. It was stressful cause I simply came home to an empty house one day. I hadn't heard a word from him all day and all that was left was a quit-claim, signed and notarized, leaving the house entirely to me and taking his name off it and a hand-written note saying "I'll always love you. I'm sorry". Never heard from him again. He was my world even though he wouldn't allow anyone to know we were together cause he desperately wanted to be "straight". I cried myself to sleep for quite literally years, though over time it became a silent cry. I've been told the stress caused the lucid dream. I have countless wonderful stories about him, but he did give me me a strong case of PTSD, which I already had to deal with from an extremely abusive father.Back to the story now. During this "dream" I found myself on a cement platform in a park with a table and two chairs in front of me, underneath a pavilion. There were lots of oak trees, azaleas, and camellias, like a park would look like where I grew up in New Orleans. A cup of my favourite tea was waiting for me. An middle-to-late aged woman was sitting at the table in a white pants-suit. She had blue eyes and gray hair. She introduced herself as "death" and asked me to sit and chat with her for a while. She discussed my life with me and asked me many questions. She knew things about me that I didn't even realize myself. My memory of it is hazy, however. The "dream" lasted 30-45 minutes. During the "dream" I was able to freely move my "sleeping" physical body. Movement would cause a strange type of interference with the dream that I cannot really describe, but as soon as I stopped moving it went back to being incredibly vivid. At one point I sat up entirely, walked to my desk, and scooped up one of my other cats, and brought him back to bed and wrapped my arms around him. I felt entirely real. I had fully control over my body and words through the entire "dream". At some point in the dream she asked me to stop moving around cause it made her "presence" more difficult and she insisted I trust her that it was real. Over the next 7 hours I had 7 more nearly identical "dreams". Each dream was roughly the same, but the scenery and other person changed. Each "person" I talked to presented themselves as some kind of aspect of life. The ones I remember were: Death, Joy, Lust, Love, Pain, and Plague. I'm struggling to recalled specifics about the conversations, but they all insisted it was real and that I was safe. Each discussion was different and revolved around the aspect of life they claimed to be.I woke up completely after that and was confused, scared, and for some reason, relieved. It felt like everything was going to be ok. I've only experienced that feeling one other time. In December 2016, I was run over, intentionally, by a woman in an SUV while I was crossing the road on my motorcycle. She ran her light with the goal of killing me cause she was enraged by the pride flag sticker on the back of my motorcycle. It's a long story that I've shared many times, but this is already long so I'll skip most of it. The force of the impact sent me flying 30 feet and I slammed into an oak tree and the majority of my body was either broken of entirely shattered and I damn well knew it. In relatively short order, I grew cold from my chest and it spread throughout my body and I knew what was happening. I was about to die. I suddenly felt this massive calming wave overtake me and felt like nothing could ever be wrong and everything is ok. I blacked out shortly later and when I woke up again, I was looking at EMTs and a nurse who'd been attempting to revive me. I had been dead for around 5 minutes and had been kept alive by the person who was driving behind me and just so happened to be an ER nurse heading to work at the hospital less than a mile away.Back to the story again, I was awake for around an hour after all those experiences and ended up falling back asleep. This time, however, I had a regular dream, technically a nightmare, which is normal for me. I suffer from night terrors that are truly horrible and take 6mg of prazosin at night to prevent them. I still get them from time to time, but the overwhelming majority of my dreams are standard issue nightmares. I rarely have any positive dreams.As a reminder, I'd mentioned earlier that I had South Park on throughout the night. During the bizarre "dreams", I could hear the voices and episode as they came and went and even laughed at a particularly funny scene and told the "aspect" I was currently talking to about it when it happened. In my last dream of the night, the standard-issue nightmare, I could NOT hear the TV, could NOT control my body, and was completely asleep. I'm not sure what that means overall, but I feel like it's a VERY important detail.----------------------------------------------THE QUESTION:Quite simply, what in the absolute hell happened to me last night?! I don't know what to make of any of it. As I said, I'm not spiritual or religious in any way, but this is causing extreme level of conflict and concern within me. Furthermore, I've been around a lot of dying people, I live with a doctor and dated him for the last 6 years (we broke up a few months back, but still live together), I've dated other doctors, I spend a ton of time at doc appointments and in hospitals, and I myself work as a data architect in medical research most of the time. I'm very aware that when people are nearing the end of their lives, most (60%, if I remember right) will hallucinate loved ones, angels, or even demons, and have long conversations with them over and over. In my experience, and to best of my knowledge, this usually happens within a few days preceding their death, but can happen as far as a few months in advance. Is that what I just experienced? I certainly have serious conditions, but I'm otherwise perfectly healthy. Other than my migraines, cluster headaches, and chronic pain I feel perfectly fine. I've had the migraines and clusters since I was a kid and the chronic pain since I was run over and nearly murdered. Nothing new has come up. I have been much more depressed and anxious about life lately as I've had awful dating experiences, am struggling horribly to land a new job, and the end of my lease is coming up soon and I will have nowhere to live, but I feel like I'm handling it well.I'm exceptionally worried about what happened last night. I want to see a doctor about it, but I have absolutely no clue who I'd go to. I know there's "doctors" who study dream analysis, but I talked to my ex about it, the doctor I live with, and we both feel like that's psuedo-science and doesn't carry any real validity. Because I'm currently laid off, aren't receiving unemployment, and am only earning money by doing freelance and contract work, I have to use medicaid for insurance. There's no available therapists or psychiatrists I can go to cause I can't afford their cash rates and the ones who accept medicaid are seriously booked up and have multi-year long wait lists. I'm on all of the wait lists, but I'm definitely not gonna hear back anytime soon. I can't afford cancer treatments either and medicaid won't pay for them.My mother insists all of it was a dream and I didn't wake up at any point through all of this. That's 100% false. I damn well know when I was awake and what I experienced. I have proof from the cats seeing and hearing what I did and the history on my door lock. I talked to a friend studying psych and he suggested I could be schizophrenic, but he's not a doctor or even a therapist and I was diagnosed as schizo year ago and treated for it, which worked, but when I moved to WA and found a much better psychiatrist, she vehemently disagreed, changed me to my current diagnosis and changed my medications which work far better, so I'm inclined to believe she was right. My psychiatrist in Louisiana was not on good terms with the board and was wildly aggressive with diagnosis and treatment for all her patients. Her results were remarkable, but her methods were HIGHLY questionable and she was quick to prescribe controlled meds. She had me on lorazepam and adderall while I was also on 50mg of Percoset daily from my neurologist. I absolutely never had any problems, complications, or side effects because of this and it was actually extremely helpful in helping me hold down a job and be a functional adult, but it's generally not appropriate to do. I desperately need my ADHD treated to hold down a job, but the state of WA will not allow you to be on more than 1 controlled medication at a time. I understand, but it makes life extremely difficult for me and I think it's completely unfair to make me choose between living in intense pain or being able to focus for more than 5 minutes at a time. Writing this post has taken me over 3 hours cause I keep walking away and doing other things.Anyway, any advice would be amazing. thank you for reading and I'm sorry for the length.TL;DRHad a series of "dreams" last night that didn't work like any dream I've ever had where I could freely move my physical body, which upset the "people" I was talking to in the "dreams". During the series of "dreams" I met personified aspects of life itself, like love, death, regret, plague, etc that held conversations with me about my life. A while after the series of "dreams" ended, I ended up going back to sleep and having a normal nightmare where I couldn't control my sleeping, physical body and things were normal. Now I'm wondering if that's my version of dying people hallucinating loved ones and I don't know what to do or what kind of doctor to see about it.That said, please, PLEASE read the full post. There's way more to this and the TLDR makes me sound like a lunatic. I spend a lot of time carefully writing it up and explaining everything, like the insanely critical context the TLDR is missing, please read it. ###Output :Sounds like lucid dreams. I dont want to Monday morning quarterback your doctors but thats a dizzying (literally) array of psychoactive medications you have all mixing together that probably played some role too.


###Input :Hi docs! Im currently in the neurology critical care unit with an aunt (78F) who was flown from our local hospital to this one. We knew that it was a smaller bleed, but not much else. Im the one that will be asking questions on behalf of her children (who are with me) so that we can fully understand whats going on. What are the questions that I should ask in order to get the most explanation all around? ###Output :I'm so sorry your family is going through this. I'm board-certified in both emergency medicine as well as critical care. Going to need a little more information in order to help tailor the appropriate questions to ask. What information have you received so far about your aunt's current situation, and what is her current condition (e.g. is she on a ventilator, acting appropriately, etc.)? Have the docs given any updates on her prognosis and/or next steps, medically?


###Input :Thank you so much. No information other than that she was resting and that the bleed was small. They said that they would try their best, but wouldnt guarantee anything. Thats all the doctor told her son. :/ ###Output :Well, that's certainly not very helpful or enlightening at all :/ Idk your aunt's medical history, how the bleed occurred, or what intervention's her medical team has already performed so far. However, it's reassuring that the bleed is reportedly small. Important things that would be good to ask would be:-What interventions have been performed so far, and why? Also, which interventions/procedures can be expected in the future? -How severe is the bleed, and what deficits can be expected following recovery vs. what are the chances of a full recovery (note, they likely won't commit to a specific answer to this question, because there's no good way to predict patient outcome, but notifies the care team that you're actively involved in the patient's care and want to be kept in the loop)? -What does the recovery time/process look like if/when her bleed improves? -Are there any additional co-complications going on? -is there any specialized care that is going to be required following recovery? -How often can we expect patient updates from the doc in the future? -Does the providing physician have any specific concerns of their own that we should be aware of?Additionally, it's probably worth asking what support is provided by the hospital that's available for friends/family of the patient. If you have any additional information to share, please post here so that specific questions can be appropriately addressed.


###Input :I chose his CRNP because I was having chest pains and I already knew that I was hypertensive. I'm an advanced EMT and although my scope is nowhere near a CRNP, I can still diagnose myself for what is critical and what is not.This woman is under half of my age. I'm not comfortable with someone fresh out of medical school. She told me that I had to go to the ER. I paid $140 for an office visit for her to tell me that I had to go to the ER, after taking my blood pressure. I already knew that I was hypertensive and they told me over the phone to come in to get some kind of high blood pressure medicine.I told her that and she told me that I needed an EKG and a CBC workup. She told me they could do that at on-site, but without insurance, it would run me around $1,400... and it had to be paid, NOW. Words fail me here. All of this could have been told to me on the phone.I told her that I couldn't afford that out of pocket. She told me that I was going to be sent home... without any medicine. I said, "Let's review here... It's such an emergency that I have to go to the ER or pay for tests now, but you can send me home without medicince???" Unbelievable. I left, had to pay my $140, and went home with no medicine. I got home, at square one again, and was $140 poorer.The social worker called me later that day and she was also an EMT. I told her what I just typed. She emailed the doctor and a few hours later, I was prescribed some amlodipine that could be picked up immediately at my pharmacy.I received better care from a social worker that I paid nothing, than from a CRNP that I had to pay for... amazing. The CRNP obviously didn't even go to the doctor for consult. ###Output :I'm not comfortable with someone fresh out of medical school.NPs do not go to medical school. They are knowledgeable and can treat common illnesses, but they are not medical doctors.Are you located in the US? Do you not have insurance?


###Input :What kind of school do they go to, then? I assumed that they went to some kind of medical school, since their scope is higher than a registered nurse.I am in the US and I just got insurance. ###Output :What exactly is your question? Any given decision to see an MD vs an APP is a balance of complexity and access.


###Input :31F, went to the ER due to stomach pain and uncontrollable shivering. She was admitted to the ICU and had extremely low blood sugar, hypothermia, hyperkalemia, blood in the stool, gram positive cocci in pairs and chains, anemia, and she had been previously diagnosed with endometriosis. They found cysts in the liver, hypodensity in the left side of the brain and have been taking several tests. ER gave her 3 blood transfusions for the anemia and she now has a swollen back, legs, hands, and feet. She is still anemic even after the 3 blood transfusions. She has undergone multiple MRI, ultrasounds, CAT scans, and blood works but they aren't sure what is causing everything.Her vitals at admission were:K 5.9Hgb 5.5Glucose 17Temp 94.5WBC 5700She started antibiotics yesterday morning and her second ecg was normal. She was taking oxycodone for pain but is now on morphine and lidocaine. Doctors said that she had a reaction to her 3rd blood transfusion and her heart rate went up and blood pressure went down. She is now on medication for that. She has not been allowed any food or water today after the reaction. An MRI found that she has lesions in her brain but the nuero surgery consultant said they were not going to do any procedure.Has anyone had experience with something similar and what was the diagnosis? ###Output :While I have lots of experience with patients like her, I dont think theres much that can be said over the internet to help. She has a severe critical illness with what sounds like septic shock. The best people to answer your questions is the team of doctor taking care of your sister.


###Input :Im 30 years old and after a very long and defeating search for a doctor willing to listen, I was finally diagnosed with Nutcracker Syndrome. I have surgery in 1 month, but I am in debilitating pain. Im a critical care nurse of 8 years and no stranger to the difficulties with pain management faced and felt by both physicians and patients. What I was baffled by was the extreme amount of gaslighting I faced as I tried to get this syndrome ruled in/out. Ive fought for months to NOT end up in this position (stuck in pain) by advocating for myself yet listening to each physicians advice, and trying to be a good patient and human being.I was in pain management but left the clinic because the doctor wasnt willing to work with me in any way. I was given Meloxicam, Gabapentin, and one 5mg Norco per day. Only the Norco would do much of anything. I had an appointment set up with a new clinic before I left, but its not till Dec. 12th and my pain has gotten MUCH worse even in the last week. I will also still have to wait the 2 weeks to actually get any medication (as far as i understand).My surgeon cannot prescribe me anything, and I see a PCP who uses holistic and traditional medicene (basically started me on tons of supplements) and really seemed to help me, its pricey but worth it as they are also more available. BUT, they cannot prescribe pain medication as they are a cash pay direct care practice. Ive called other pain clinics and they cant get me in until even later dates, Ive texted every doctor Ive worked with and their leads have fallen through. Meanwhile, the pain is so horrible I can hardly eat or move, and getting worse by the day. I went to the ED out of desperation a couple days ago and the doctor was kind and gave me 14 Norco 5s which help the pain a bit for about 2-3 hours. But I desperately need something stronger and more permanent (obviously).As far as options, My surgeon suggested going back to the ER for more pain meds (which was weird) or my PCP though he knows they cant prescribe those meds. The ER doctor suggested a new PCP which Im considering but Ive had good support with my current one and feel they are far more accessible, especially considering something new happens each week it seems like (strep B UTIs, hypothyroidism, gallbladder and liver issues, you name it). Plus idk if anyone would feel comfortable writing me opiates on a new patient visit.Is it even worth trying a new PCP? Would it be pointless to keep both my current PCP and see a new traditional PCP that could help with pain ? Or should I switch altogether? When my current pain meds run out I WILL have to go back to the ED because it gets that bad and Im no wimp. Its a solid 7-8/10 WITH the Norco on board. Would a second ED physician even consider writing Another script?Should I try and speak to the actual doctor I will be seeing Dec 12 about my hopeless situation or insist that the nurse tell him about it?Im really at a loss, Im in Indiana so medical marijuana isnt an option. I would appreciate any advice, leads, anything. I feel like Ive been failed for a year straight, and I was hoping I would be taken more seriously as someone whose also in healthcare, but its sadly not been the case. TIA ###Output :I'm sorry OP, this is awful. Not familiar with the health care system where you live and why your PCP can't prescribe opioids, but can you see them for help navigating how to have this addressed? I agree it looks bad if you start seeing a new PCP or go back to ED but perhaps letters from your current PCP explaining the situation would be helpful?


###Input :Thats a good thought, I have asked them to call the pain management place I have an appointment at the attempt to get me in sooner. I will see if they will do that as well :) Nothing can hurt at this point. And thanks for the validation because honestly, Ive started questioning if its really all that bad (though I know it is).Its crazy what a year of being chronically ill can do to the mind, even someone familiar with the healthcare system (Im in the U.S.). A lot of doctors here would love to be able to help me out but legally cant, or if they can would have to fear for their license (presumably).The ED giving me the small script they did was even kinda going out on a limb. It all comes down to the fact that not many doctors arent familiar with nutcracker syndrome because its rare, and the extreme pain isnt a well known fact about it. So it makes me seem as if Im drug seeking, but one look at my background and its clear theres not history of anything whatsoever.I mean i worked in ICU for 8 years around every narcotic imaginable, and still could be if I wasnt this sick. And I was charge nurse of a high acuity unit. The doctors Ive worked with have helped me alot in this process but their hands are tied on the opiate thing. ###Output :I'm not familiar with the syndrome but it's not hard to look it up. It's very sad that because of the opioid abuse pandemic we've gone so far the other way that people can't get adequate pain relief for appropriate indications.Good luck, and I hope the surgery is effective!


###Input :I had an awful IUD experience, involving vomiting and fainting as a result of the pain level. I would rate my IUD insertion worse than passing a kidney stone or breaking bones. Im not alone with this experience. If you search IUD on TikTok or other female-dominated subreddits, youll see an abundance of women/ teenage girls who have also described the IUD pain as the worst pain in their life. Ive noticed a trend of increased pain particularly among nulliparous women.The Intensity of pain doesnt seem to be acknowledged by many medical providers though, as many patients are told it will be a slight pinch and arent properly informed about the pain involved. As a result, many of us did not properly prepare for the persisting pain by arranging a ride home from the appointment, a day off from work/school, or mental preparation for pain. Many providers both seem to acknowledge that extreme reactions to the insertion are normal, but the pain isnt enough to warrant preparation or pain medicationsI played rugby, basketball, football, and softball. Ive had many broken bones and torn ACLs. Ive also passed kidney stone. The IUD insertion pain was by far worse and longer than any of the aforementioned pain events. If I was offered pain medicine for all those events, why is nothing given for IUD insertions to reduce the associated pain and discomfort? Is there a specific reason?Edit- I should mention Im directing this question to medical professionals in the US.Edit 2- Ill admit I havent looked into any of the studies about this. We had one doctor chime in that studies show that extreme pain is not the norm, but the trend Im seeing in person and across social media appears contradictory to those findings. Would any medical professionals be willing to share the specific studies that are being referenced for care? Im a PhD student in a different area of public health research, but I wouldnt mind doing some critical review of the publications while I have the time. Update: so far I've only found a few relevant articles in my Uni's database. Most are about a decade or older and have really small sample sizes, like n=40 or less. The more recent articles are recognizing the pain of insertion as an issue, but I'm not finding a lot of resources so far. If anyone has a specific research study they reference when learning, I'd be thrilled to look at it.Edit 3 -I started to search for articles. This is the first abstract I found:"Concerns about pain during IUD insertion are a major barrier to use of IUDs among adolescent and young adult patients who may otherwise be interested in this method. Although few studies of pain control options have been conducted in this population, available data suggest that several pharmacologic interventions discussed in this chapter may be beneficial. Pre-procedure naproxen, ketorolac, or tramadol can help to reduce post-procedure discomfort. Paracervical nerve blockage with lidocaine-based anesthetics, topical lidocaine spray, or EMLA cream also appears to reduce pain with IUD insertion. Intravaginal 2% lidocaine gel may reduce pain with tenaculum and speculum placement. This chapter will discuss the complex nature of pain in gynecological procedures, including IUD placement, and the impact of anxiety and fear on pain perception. It will also review clinical guidelines to assist with pain control during procedures and describe evidence-based pharmacological pain control modalities that can be used during IUD procedures." Optimizing IUD Delivery for Adolescents and Young AdultsTho I don't have full access to the text, this abstract is making it apparent that pain management is a valid concern and there are options. Can doctors weigh in more on those options? If it is indeed a recognized problem in the medical community, why aren't these options considered?Update 4: I have 26 peer-reviewed articles to review. Slamming a coffee and Ill get you my quick-and-dirty lit review asap. ###Output :I don't do IUD insertions, but pain management should be discussed and offered.I don't care what the studies say. Sometimes you just need to be a human and empathize with other humans. Medicine is as much an art as it is science.


###Input :Im a 26F, 173lbs, 57 I have SLE Lupus, Ehlers Danlos Syndrome, and Idiopathic inter cranial hydrocephalus.I just had a CT W/O of the brain and neck yesterday. Reason for this was because Ive been having terrible headaches lately. I received a message today stating THIS REPORT CONTAINS FINDINGS THAT MAY BE CRITICAL TO PATIENT CARE.Impressions:Hyperdensity seen in the right frontal along anterior aspect of the right superior frontal sulcus concerning for focus of subarachnoid hemorrhage. Sorry for the all caps I just copied and paste. What does this mean? Thank you for your help ###Output :Physician, Emergency Medicine | ModeratorAgree 100% with /u/sspwnage. Closing this thread as there is no other message that needs to be said other than call 911 or go immediately to the ER (and tell them your CT scan yesterday showed bleeding in the brain). I am a little surprised no physician called to tell you about this which I assume is just an oversight.PhysicianYou need to go to the emergency room ASAP. That CT is showing you are having bleeding in the brain. This is probably the cause of your headaches but they will need to run more tests. Seriously drop what you are doing and go, brain bleeds need to be monitored and seen by a neurosurgeon ASAP.


###Input :Hi there. Female, 20yo with Panic Disorder, GAD, MDD, BPD, the works. Hate it.Anyways, I've had psychiatrists keep me on Prozac 40mg most of my life and it's been the most comfortable. A numbing experience, but it did the job. Years ago, I tried Wellbutrin but at the time I had COVID (which actually amped my anxiety) and thought my anxiety getting worse was due to Wellbutrin, so I was taken off. Back to prozac for 2 more years. Recently, I got off it again and got on Wellbutrin 150mg due to sexual side effects and hoping it'd help my anxiety.It did not. In fact, it made anxiety worse and I've had awful panic attacks, physical symptoms that have been cleared by my GP after tests showed nothing was physically wrong.Talked to the psych, and he said "Ok well I can cross taper you from Wellbutrin slowly back to Prozac.".I swear I keep hearing never to take those together, and even my past psych wanted me to be off prozac completely before getting on Wellbutrin years ago.Note I have horrible health anxiety and dread feeling any negative physical symptoms (to the point I annoy my GP about it) and it's starting to make me feel helpless. I'm constantly bothering people and terrified of dying, and just... Feel like a waste of time to my doctor, a waste of resources to my nearby hospital when a panic attack gets so unbearable it feels like I'm fucking dying, and a bother to my loved ones even though they try to be helpful and reassure me I'm not dying.Last night was possibly the worst panic attack since I've been on Wellbutrin, even worse than Prozac PAs. Basically I was eating soft stick candy, swallowed a whole piece because I have a bad habit of not chewing my food, felt like it was stuck in my throat, tried coughing/throwing it up, began to panic when my throat started feeling weird after trying to force myself to throw up, and panic ensued. Fiance checked, nothing was in my throat and turns out it was probably a phantom feeling in my throat.But anyways, about the medication.So... I've agreed to do a cross taper and lower to 100mg for 2 weeks before adding in Prozac 20mg if I felt ok.Is this ok?Also, secondary question.What do you think of patients who suffer from these things? I'll be completely honest... I genuinely feel like a horrible person for wasting the time of people who help others that really need it.I had gone to an Urgent care when I started experiencing really bad breathlessness and a nurse came in to talk to me, I told them what I was feeling and mentioned it felt worse than most of my panic attacks. She asked me if I had a history of anxiety, answered yes, and she did my vitals and left. Later a doctor came in to check on me, nurse pulled her back outside and I had heard her say "No no, she's having a Panic attack" and their voices became more muffled as they walked away.It just... Kinda confirmed what I was already feeling and connected with other experiences of having gone to hospitals feeling absolutely shitty, with doctors recognizing me and seeming annoyed, or seeing my GP look at me with.. I dunno, not really pity, but something else that just makes me feel like I'm disappointing him, and it's not his fault... It just sort of destroys me, because every time he clears me of any physical illness, he just reminds me to find a suitable therapist and combine it with my medications, despite me knowing and not telling him most therapists around me have a year long waiting list and the ones I tried that DID hear me out... Well, didn't help at all. One I tried recently missed appointments constantly, telling me to wait until next week... for 4 weeks straight. And when I finally saw her, I wanted nothing more than to just spill the beans and vent and try and work through recent trauma with just a really horrible and abusive friendship that I'd managed to cut off, and...She said that before that, we had paperwork to fill out for the next 2 sessions. Not homework or therapy paperwork, mind you, paperwork paperwork.It's just... A helpless feeling. I feel like a bother to most doctors having the anxiety I have. I want to get to a therapy asap to stop having these obsessive thoughts about my health, and in turn, let you guys do what you do best, y'know?I'm really sorry to bother you all here. I guess I want some insight? Validation? Criticism? Confirmation of whether or not it's a huge inconvenience/nuisance for you all? I'm not sure... Any answer on the second half is welcome. Thanks, and again, sorry. ###Output :Physician - PsychiatryProzac and Wellbutrin are very often prescribed in combination and is perfectly safe.You need to chew before you swallow your food. Basic skills of life here. There's a reason we have teeth. Please use them.There's nothing inherently wrong with you seeking medical reassurance when you're anxious about something, but also understand that medical resources are limited and healthcare workers are burnt out and very overworked. If someone comes in for the 4th or 5th time with anxiety symptoms that are similar to the past 4-5 times, it's human nature for the doctors to automatically assume it's anxiety again, which is neither medically urgent nor emergent. It becomes harder and harder for the doctor to justify medical workups when the cause seems very obvious.Having experienced anxiety symptoms for so long and so often, you can learn to recognize when it's anxiety vs something new that would feel different. You can learn how to start taking an active part in recognizing triggers of your anxiety and learning to avoid triggers (i.e. CHEWING your food) or de-escalate your symptoms before they become severe. As a psychiatrist, I'm acutely aware of how difficult is to find a therapist who can take insurance within a reasonable wait list (you should still get on those wait lists, it'll be your turn eventually). In the meantime, you can look into online Cognitive Behavioral Therapy (CBT) courses you can do on your own from home. It's not as effective and personalized as working with your own therapist, but it can get you to start learning the basic skills and concepts and start practicing those skills while you're waiting for a therapist. Therapy will be essential for long-term control of your symptoms. Meds alone will never be enough.


###Input :This is... An incredibly well thought out and insightful comment :')Yeah the chewing the food part was definitely my own fault, even my parents point out I eat way too fast and it's always been a terrible habit to break out of, something in my brain, whenever I try to chew, just says "Stop it, it's food, get it in before it's gone" so I'm genuinely trying to slow down but slip up like yesterday.The medical reassurance thing has sparked up pretty recently and I'll try my best to at least limit the urges to go. The problem is that even though I've had countless panic attacks, something new ALWAYS pops up. A different symptom that just freaks me out every time, jumps up out of nowhere, and automatically is flagged as "This is new. Panic, you're dying." Just when I get used to one symptom, another pops up. Like the breathlessness, which was never really a symptom until recently. Something I noticed after I'd gone to the doctor and got cleared was that trying to tell myself "You're fine, it's new, but nothing is wrong with your lungs and heart, just distract yourself." Tada, as soon as I'm not thinking about it, it goes away, and as soon as I think "Hey, look at that! It went away!" It comes right back because I focus on it, even if it's positive. But at least I got that down, trying to tell myself as long as I'm breathing and not unconscious I don't need to go to a hospital.About the CBT online courses, I had no idea that existed. Usually I'd only take DBT for years and not CBT even though I thought it would help more (but therapists kept saying "well you have BPD so let's focus on DBT" even though... I graduated it.)I usually assumed I NEEDED a person to have CBT therapy with, so is there a specific site you'd recommend? I'm genuinely kinda excited at the prospect of it being online. ###Output :One suggestion I have is for your to start keeping a list of the symptoms you have when you have anxiety/panic, and also checking out descriptions of anxiety symptoms from REPUTABLE medical websites like WebMD, MDConsult, Stanford Health, Massachusetts General Hospital, Johns Hopkins Health, etc, and generate a master list. When you have a new symptom, check it against the master list to see if it's considered a common anxiety symptom, and if it isn't THEN go get a medical workup.You can do a Google search for online CBT classes (be aware these are not usually Free, and if they are, there's usually a catch). Here are a few with good reputations:https://cbtonline.com/https://www.beatingtheblues.co.uk/private-patients/https://cogbtherapy.com/free-online-cbt-workbook (this is free, no catch, but very basic)


###Input :This is amazing. I've never considered a master list and I'll get on that right away. I kinda wanna make a physical and digital one and make them both look nice, so it seems I've got a new art project :DAlso the free online CBT workbook seems best while I look for a CBT therapist or at least get into the therapy waiting list from the psychiatric hospital nearby I get medications from. I apologize for being a little difficult, but here's my question:Concerning symptoms in general, what if it's a new symptom that feels particularly severe or a general symptom from before that feels significantly more severe than usual?Usually I start to panic once let's say... I have dizziness, and suddenly that dizziness morphs into lightheadedness and a feeling faint sensation. Luckily I've been able to tell myself "just lie down, this is probably anxiety" but that was waaaay before, with my health anxiety ramping up again I'm afraid of just freaking out once something comes up and I forget in the moment.Although, I do guess that comes with the territory of learning my symptoms. But like I said, if a symptom is extremely severe, I should probably check with other things like accompaniment of other symptoms that are new and not anxiety related, or if something happened to spark the symptom right? I'm really sorry, I just wanna make sure I know when to panic and when not to, although I realize that's also something I'll need to work on, controlling panic. ###Output :I encourage you to read up on Box Breathing techniques. When someone gets stressed or anxiety, its easy to start hyperventilating, and hyperventilating can induce anxiety symptoms. So learning how to control your breathing can go a long way towards getting anxiety and panic symptoms under control. As soon as you notice that youre feeling anxious, take yourself away from the trigger and go find a quiet private place, preferably dark, and take 5-10 minutes to do the Box Breathing technique. Most anxiety symptoms will go down by doing that and youll be able to better differentiate where youre having anxiety or an actual new concerning symptom.https://www.webmd.com/balance/what-is-box-breathingI also would suggest you find some guided progressive muscle relaxation videos on YouTube and start learning that skill. Its incredibly effective at calming anxiety attacks. If you can successfully complete a whole session, youre probably not going to feel much anxiety afterwards.


###Input :Hey! Im a 33F. 59, 215lbs. Diagnosed with arthritis in my back in 2020. No daily medications normally. ER just started me on prednisone 60mg daily, metaxalone 800mg TID and diclofenac 75mg BID. I have had chronic back pain for years now. I work as a nurse and as you all know the constant pulling and lifting of patients is hard on the back. I did some dumb things as a new grad working short in long term care and ended up with lots of back pain. I went in 2020 to have it evaluated. My NP did an X-ray and it just showed arthritis. She ordered PT but at that time I was working a covid unit and they started mandatory extra shifts and I wasnt able to schedule the PT. About 6 months ago I started having issues where when I would go to stand up my back would catch and Id be stuck bent over for several minutes until it loosened up. I kept saying I was going to schedule an appointment but never did. (I know, I know. ) At work the other night my toes/foot went numb. I ended up going to the ED. They did a CT scan of my lumbar spine and told me I had bulging discs. When the ER NP came in, he told me I had 4 bulging discs in my lumbar spine and he felt they were causing nerve compression which was causing my numbness/tingling. He said I was at risk of herniating and put me on a 10 lb weight restriction until I follow up with primary care for a MRI. (They are a small ED and have no MRI available.) The CT report just came through on MyChart and it says I have bulges at L4-L5 and L5-S1. So am I understanding that that would only be 2 bulging discs? Im thinking my husband and I maybe just misunderstood him when he came in. This is a different side of nursing for me and Im not too sure about the risks and such with disc issues. Is the risk of herniating really high? My job wont put me on light duty because it didnt happen there and they just told me to ask for help with transfers/boosts. I work on a very heavy floor thats not considered ICU but they still call it critical care. Its lots of post ops and amputations. It tends to require a lot of lifting and pulling. Im just feeling really anxious about work and I guess am just looking for reassurance/ guidance. Interestingly enough two days before my foot went numb I was having nerve pain going across my shoulders and radiating down my arms. So Im sure Ive got stuff going on higher up as well. I was able to get a PCP follow up on Wednesday so Im hoping to get more information there.Also- is it common for the numbness tingling to come and go? Im assuming its the meds helping? Because at first it was continuous. Now sometimes it travels up my leg into my thigh but It wont last very long. Maybe an hour or so and then goes away.Sorry for the novel- thank you if youve gotten this far. ###Output :I question everything this ER NP has told you. You're correct, if your report says L4-L5 and L5-S1 that's two discs. Not sure why they said that those disc bulges are causing the pain. It's well known that imaging findings in back pain, particularly minor and common findings of disc degeneration, do not correlate well with back pain. That is to say, imaging findings like yours are not necessarily the pain generator. Was a physical exam done with a lower extremity Neuro exam?


###Input :The NP, MD and nurse never once looked at my foot. I was at work when it started. Im a vascular nurse so I checked pulses and my other nurse friend did a very quick assessment for weakness but it was fine. At the ED they all just kept telling me it was sciatica, which Ive had before but its never made anything go numb. Then once the CT came back they said it was nerve compression from the bulging discs. ###Output :Hopefully your primary care doc will actually do a physical exam.I'd caution you against recommending things based off of what you've seen. That's unsafe, inaccurate and bad practice.


###Input :This post is about my dad, who is about to leave the hospital after a 2 night stay.Age: 55Sex: MHeight: 5'8"Weight: ~180-200Race: whiteDuration of complaint: 5 daysLocation/issue: Esophageal tear, 4 stomach ulcersAny existing relevant medical issues: T2 diabetes, high BP, GERD, alcoholic for ~25-30 years, anxiety, compressed ulnar nerve due to bulging cervical discs - lots of back pain and numbness in armCurrent medications: metformin, no BP meds (had a bad rxn), alprazolam, venlafaxine, there are others I can't remember but they're not super relevant to my concernI'll be brief here, but can answer questions if needed. I don't live near my parents so I'm hearing everything from my mom.Wednesday: Dad isn't feeling great, but that's not uncommon due to the alcoholism-diabetes combo and current back pain. Mom and dad go to the gas station, dad goes to the bathroom, employee informs mom that dad has passed out in the bathroom. They call the ambulance, blood sugar is 54, he's given glucose, and feels better. Refuses to go to hospital, mom takes him home.They walk inside, he feels lightheaded again and vomits multiple times. Mom goes to get a towel and he then passes out and begins to aspirate vomit. Mom sits him up and slaps his back until he can breathe again. Brief comedy break- he says "wow! I feel better!" He goes to the bathroom and is bleeding a lot from his rectum. Refuses again to go to the hospital (he's an ornery fellow, but it's understandable because he doesn't have insurance).Thursday: He goes to his PCP Thursday morning and PCP says he has lost up to 1/3 of his blood and needs to go to the hospital. Dad refuses again. No major events occur the rest of the day.Friday: Dad tells mom he's feeling alright, he eats some food, seems normal. She goes to work. She returns and I'm not sure what exactly happened, but he begins bleeding profusely from the rectum again and goes to the hospital Friday evening.Drs can't identify the source of bleeding and are thinking diverticulitis. He continues to bleed and is given 5 pints of blood over the course of the evening/overnight. They prep him for colonoscopy in the morning. Drs tell mom situation is critical and to be prepared for the worst.Saturday: Dad doesn't respond well to the barium so they do endoscopy through the mouth instead and find an esophageal tear and 4 stomach ulcers. The esophageal tear finally resolves on its own so they didn't do any repair. Rectal bleeding largely subsides but there is still some with every BM. They plan to do a colonoscopy later. Hemoglobin was 9 at intake, now is 7.6. He's on a magnesium drip and gets another pint of blood for a total of 6 pints. Saturday night is not too eventful. Blood pressure is low despite typically high BP.Sunday: Bleeding has mostly subsided. Hemoglobin is still very low. BP still low. GI doctor no longer wants to do colonoscopy and says dad can go home. Floor Dr and nurse think he should stay. Dad is worried about medical bills and claims the hospital is "trying to kill him" so has opted to go home.I have two questions- should he really be going home?? And given he is a physically dependent alcoholic, should he be given alcohol or no? Mom says he was not given alcohol during his stay and did not have any seizures or severe withdrawal symptoms. Last time he had alcohol was probably sometime Friday morning or afternoon. I know quitting alcohol cold turkey is very dangerous so I'm surprised he has been mostly ok in that regard. He's anxious, irritable, and paranoid that the hospital is killing him, but otherwise not terrible. Is he over the hump after 2 days cold turkey? Should my family remove all alcohol from the house and keep him dry? Supervised small doses?I'm surprised he's allowed to discharge himself so soon after nearly dying, when his stats are still bad and his doctors don't even agree. My family hasn't been given much information and don't know how best to take care of him at home. He can be quite the asshole and doesn't listen to anyone (even his doctor) so restricting alcohol or anything else would be difficult.I'd appreciate any advice on home care, what to look out for, and especially what to do about alcohol. For reference his intake varies a lot but sometimes it's as high as a whole 750mL bottle of rum in one day. Supposedly it has been "less" lately due to acid reflux.Edit Sunday Aug 7th: his hemoglobin had gone up, but dropped back to 7.7 and there's a small amount of blood in his stool. So he's still at the hospital for now. ###Output :Glad that he is staying in the hospital.He should strongly consider medications such as naltrexone (oral or intramuscular injections that last for 30 days) or acamprosate which can reduce alcohol cravings. This is the type of medication he should get a prescription for once he is discharged. Once he is home, remove any triggers he might have at home.Wish you and your dad the best


###Input :My son (19M) 6'1" 210lbs who lives approx. 2 hours away at university. No relevant health history besides depression. No routine meds. Doesn't smoke or drink. Yesterday, around 18:00 apparently, he took 50 500mg acetaminophen tablets in a suicide attempt. I was notified at around 02:00 this morning by my ex-wife. I immediately called 911 and notified them of the situation. Ultimately he was taken to the ER a little after 03:00. I have been unable to speak with him due to being Baker Acted. My ex-wife was able to find out that they'd given him something to induce vomiting. My question is roughly 9 hours after ingestion he should definitely be receiving Acetadote, right? I'm not saying that he he isn't, but it wasn't mentioned apparently. It has been quite sometime since I've worked in critical care (RN), but we would have definitely put him on Acetadote. Am I safe in assuming this is the case? Also, in an otherwise healthy young man, what, if any, longterm complications might we be looking at? Thanks in advance for any help. ###Output :No long term complications if he recovers from this, which he should if the timing is correct. There's only 2 ways these go 1) liver failure or 2) complete recovery. He should be early enough in his overdose to be treated.


###Input :My sister (30, Hispanic, 5'3", about 250 lbs) has several medical conditions and a long history of undiagnosed neurological symptoms.Two or three years ago, she started having numbness and weakness in her hands and feet and sometimes arms and legs that got much worse in the heat. She was having a couple of other symptoms at the time (can't remember, but I think one was having trouble seeing out of one eye) that made us wonder if she might need to be screened for M.S., but she didn't have insurance at the time and it resolved after a couple of months, so she never got it checked.Last year in June, she started having multiple grand mal and absence seizures per day, including episodes of stat ep, and an EEG confirmed temporal lobe epilepsy. She also had periods of disorientation with no obvious seizure activity. She tried several medications and they finally settled on max dose Depakote. She has not had a seizure in six months that she knows of.Two or three months ago she suddenly developed the inability to tell if her bladder was full and she also had sudden full releases of her bladder. This has been improved with medication.On June 8th, she went to the ER for a severe headache. She was diagnosed with cervicogenic headache caused by muscle spasms in her back and neck (new onset).On June 29th, the ER gave her a steroid injection (for asthma) in the front of her left thigh and her thigh immediately went numb. It remained numb until this past Monday, when she developed severe pain in her thigh with difficulty walking and bearing weight on that leg. There was no redness, swelling, or other obvious indication of infection or blood clot. Her PCP said it was likely femoral nerve entrapment as a result of the injection and that it would likely resolve over time.Last night (Thursday), just before 5 pm, she had a sudden onset of left sided numbness in her face, neck, left arm, and left leg. She could no longer feel the nerve pain in her thigh at all. She also had blurry vision in both eyes. The paramedics noticed slurred speech, word finding problems, and facial droop. She was able to make it to the stretcher with help. By the time that she got the ER (level 2 stroke center), her entire left side was paralyzed and she had zero sensation on that side. Whenever she tried to lift her left leg, visible muscle spasms were present in her thigh. She also could not feel her pubic region at all and had great difficulty urinating. At no point did she have a headache. She said she had no lapse in memory and does not believe she had a seizure (her SO was with her also). Her blood pressure and blood glucose were normal. Head CT and MRI did not show signs of either a hemorrhagic or ischemic stroke. After a couple of hours, she showed slight improvement - able to slightly lift her affected arm and leg, although she still has no sensation. The facial droop and slurred speech had mostly resolved, but she was still having word finding problems. She was told it was likely a TIA caused by her Nexplanon and that it would be completely resolved by morning. They said if it wasn't a TIA, it could either be an unusual presentation of a seizure or a psychiatric condition (she has depression, anxiety, PTSD, and ADHD, all controlled). She was admitted to the step down unit for observation. They said they could not give her any of her medications until the hospitalist approved them.This morning (Friday) my sister had recurrence of the left sided numbness and could no longer move her arm and leg. The hospitalist was surprised to find that the symptoms had not resolved. The hospitalist said it was likely not a TIA and that they would be looking for other causes, like M.S. The symptoms slowly began to improve again, then the numbness returned along with the paralysis. This has improved slightly again. She had a repeat head MRI and CT, an echo, and a carotid ultrasound, all normal. She was assessed by speech therapy (normal) and PT/OT, who found severe deficiencies and recommended inpatient rehab. At no point throughout the day was she given any of her regular medications, including her Depakote, which is critical for her. The nurse didn't answer any of her call lights all day, and she sat in her own urine for hours, tried desperately to hold her bowels because he was so irritated every time she called that she was afraid to use her call light.Her case worker informed her that both local inpatient rehabilitation centers denied her admission because she didn't meet the criteria based on the neurologist's diagnosis (which we had not yet been updated on). Finally the neurologist came and did a super quick assessment. My sister could lift her left arm about three inches off the bed and her left leg about two inches, and still had almost no sensation. She still could not walk or bear weight at all. The neurologist said that they had ruled out all emergent causes and that it was probably a manifestation of conversion disorder and that it would go away in a few weeks. She will be discharged tomorrow and given a referral for home health.After the neurologist left, my sister started crying. She felt dismissed and judged and crazy and she started wondering if she was faking the whole thing. I reassured her that what she was feeling was real and that I believed her 100%. I called the patient advocate, but they were gone for the weekend. I contacted the house supervisor and requested either a different neurologist or a transfer to another hospital. She said she would talk to the neurologist to see what he was thinking. After they talked, they basically denied both requests, as well as a request for inpatient rehab or PT, and said she would still be discharged tomorrow.There are stairs that lead up to her mobile home. Her SO is not strong enough to assist her with the at home care she needs until home health comes through and she will clearly need significant around the clock care. She will not be adequately cared for at home.I'm not sure if we should just do the best we can until she can contact her regular neurologist on Monday (there is no after hours emergency line), or if we should check her out tonight and take her to an academic hospital for a second opinion and further testing. Our closest major cities are Shreveport, LA (1 hr), Little Rock, AR (2.5 hr), and Dallas, TX (2.75 hr). Any advice would be extremely helpful.This is what I know about her medical history:Hard of hearing Temporal lobe epilepsy (June 2021), last known seizure 6 months ago Cervicogenic headache due to neck/back spasms (June 8) Asthma Unstable SVT (frequent episodes for awhile, but no episodes in a few years) Fibromyalgia Left leg - possible femoral nerve entrapment (June 29) Rectal abscess surgery (Feb 8) ADHD Depression Anxiety PTSD Chronic/frequent laryngitis? (sore throat, loss of voice, and fever every two to four weeks for at least a year, not diagnosed) Upper back pain/vomiting when eating (April) Severe sleep apnea - hasn't received CPAP machine yet Urinary incontinence Non-alcoholic fatty liver disease Chronic rib pain - both sides, since teenager Enlarged spleen (Dec 2020) Hypertension Hyperlipidemia COVID (2020) PCOS Acid refluxThese are the medications I'm aware of:Ozempic (for weight loss) Metformin (for weight loss) Cymbalta Depakote Albuterol Gabapentin Oxybutynin Indomethacin Trelegy Singulair NexplanonShe rarely drinks alcohol - causes back and shoulder pain. She does not smoke cigarettes. She has her medical marijuana card for epilepsy, but rarely used it until this week, when she began smoking frequently to try to control the leg pain.Please let me know if you have any questions. ###Output :I hate to be that physician but in the absence of any actual findings on multiple MRI, ECHOs, Carotid US, sometimes conversion disorder may be more likely than a rare esoteric disease. That being said, what led you away from conversion disorder?


###Input :Thank you for responding. I thought that required a pretty significant stressor. The only thing that's come up in the past couple of weeks is the nerve injury. Nothing else has really been stressful lately and her mental health has been under control. The altered mental status and muscle spasms left me with the injection that it is medical in nature. Also her history of neurological issues presenting over the past three years. I was thinking Todd Paralysis or MS might be more likely. They didn't do a spinal MRI, a spinal tap, or nerve conduction studies. Not sure if it was necessary or not. ###Output :Conversion disorder does not require a significant stressor to be present, although significant is a relative term in itself. That being said, an extensive work-up would include MRIs with/without contrast of brain, cervical spine, thoracic spine, lumbar spine +/- lumbar puncture. If this has all been done and negative, it is more likely conversion then a obscure neurological disease although the latter in itself is difficult to rule out.


###Input :Given the timeline Ive described, would it be reasonable to assume the relationship between Covid and these complications?Would it be reasonable to assume the relationship between MI and demand ischemia?Interestingly, the transfer hospital did not initiate treatment for COVID-19. Could this have changed the trajectory of the case? ###Output :Sounds like the likely timeline is COVID infection --> demand ischemia, MI. Given the situation, it sounds like the transfer hospital and receiving hospital appropriately triaged the issues and treated the most life-threatening issue (the acute MI) first.This patient had a lot of risk factors for getting very sick with any infection, not just COVID. Going without clopidogrel likely also helped precipitate the MI, though no one will be able to say to what extent.I don't think that initiating COVID treatment at time of presentation would have made much difference.


###Input :Hello all... I am a white 33yr old male, 5'9 180lbs no meds taken currently. This is the second time I have had cellulitis in two months. I was wondering if sea moss was beneficial in any way to help the healing process as well as make it faster it's extremely painful and I have it on both of my feet in lower legs I'm afraid to go to the hospital because of the area that I live in they are too quick to judge and stereotype you and I have extreme anxiety going to the hospital so is there anything that I can do to get this healed and taken care of as quickly as possible please any and all comments ideas and suggestions are welcome and will not be criticized or Taken the wrong way ###Output :If on both legs not likely to be cellulitis.Please include one of preferably more of the pictures in your post as an imgur.com or imbb.com link. It makes it easier to help with something when it can be examined visually.


###Input :My dad (52M, no prior health issues except mildly high blood pressure, on a blood pressure med) is currently hospitalized for a pneumothorax after an injury. He broke several ribs, and one of them pierced his lung. The pneumothorax was small, so we assumed hed heal fine on his own, but yesterday he had to be transferred to the critical care unit because he had developed AFib in his sleep. Once his heart rate was stabilized, they put in a chest tube, because X-rays showed air and fluid. Hes been draining a lot of blood and fluids from the tube.They arent sure if the AFib was caused by the collapsed lung, but he has no history of irregular heartbeat or heart problems. Is this common after a pneumothorax? ###Output :Essentially, anyone can develop atrial fibrillation at any time for numerous reasons including you and I. That being said, the stressors on his body could have induced a state conducive to this, or it is possible that these are 2 separate problems that happen to occur around the same time, ie a person with a stroke who also has a UTI. One would not have necessarily induced the other in this case.


###Input :Please take the time to read this. I am extremely sick and not sure if I am going to survive much longer.31M. 5'8"; 125LB; Caucasian; trouble breathing/abdominal pressure; 7 year duration; condition undiagnosed - separate diagnosis of reactive hypoglycemia; current medication (Acarbose 50mg every meal); ZERO drugs/drinking/smoking/vaping/caffeine;My name is Jason Otto. I've been so sick for so long I don't care about online anonymity anymore. Here's a pic of me to prove I'm not making this up:https://ibb.co/1vHzn3xI am extremely messed up. I have been unable to work for the last 8 years and savings have nearly run out. I am now homeless (living out of my car). I have traveled the United States in search of help and I am currently at Harvard. I thought I would get help here but it's more of the same: condescending doctors who take very little time to even talk to the patient and figure out what's wrong. I don't know where else to turn.I am currently looking for a doctor that gives a shit about his/her patients. I'm looking with someone with integrity. I am willing to travel anywhere in the country and can be there within 24 hours. Most dismiss me after the usual 20 minute appointment and tell me nothing else can be done. There is no brainstorming, no critical thinking, no followup, nothing. I don't think that these people understand how serious this situation is. I cannot work, I can barely get out of bed (now my car-seat) in the morning, my cognition is in the toilet and I am unable to function in daily life. I am a vegetable.My problems began in April 2013. I had been having gastritis for a good 6 months and was treated unsuccessfully by several GI docs and their PPIs and H2 blockers. Out of desperation, I went to a chiropractor at the recommendation of a friend. He said he sees all sorts of weird stuff and he will ACTUALLY LISTEN TO YOU. Sold.I see this guy and he thinks my gastritis is due to a hiatal hernia. I now know that this can be seen on an xray and that he was completely full of shit, but I was desperate so just told him to "fix me please". Desperation breeds bad decision making, and without family support I didn't think twice about it.He said he could manipulate it back into place and laid me down on the table, stuck his fingers in exceptionally hard, deep into my abdomen, just under my ribs, about an inch below my xiphoid process, and pushed in and pulled down toward my naval very forcefully.I feel like he moved something out of place.Since then I have had trouble breathing, eating, and feel like I'm constantly being hit in the stomach. I feel like the life is being sucked out of me. It's hard for me to move, it's hard for me to think, refreshing sleep is next to impossible, and I feel like I'm stuck in overdrive all the time because I am so uncomfortable that I cannot calm down. Something feels out of place in my abdomen, almost like it was shifted downward, and no one can seem to tell me what it is or how to treat it.I've had CTs, MRIs, xrays, and many other tests. GI has been ruled out with extensive testing (EGD, barium swallow studies, gastric emptying scans, etc.) It feels like it is outside of my GI tract, almost as if my liver has been displaced. When you go to a doctor and say you are having problems in the epigastric area, you are referred to a GI. GI has been ruled out, and there is nothing wrong. It feels like it's some sort of organ or something else that has been forcefully moved. I feel like I'm in hell in my own body.I struggle to focus because I feel the need to constantly lay down. It's like being hit in the stomach and needing to sit there for a moment to just relax and catch your breath, but the feeling is constant and never goes away. This has crippled me and I cannot do simple things like reading books.If anyone has any idea on what this could be, or has any recommendation on where to go or who to see, PLEASE let me know. I'm someone who always repays the favor, and if you can point me in the right direction or help me in any way, I will more than make it up to you.I used to be a somebody, and now I'm rotting away in my vehicle. I've lost 40 pounds because the thought of food makes me sick, and I cannot find relief.Thank you.-MAlso, THERE IS NO PAIN. I need to make that clear. It's pressure/tension that is constant and I do not feel pain with this at all.I also feel a beating heartbeat in the area, like my heart is pushing against it. The heartbeat is pronounced.Here is a link to an image I uploaded showing the area (under xiphoid process, near liver and diaphragm): https://ibb.co/ByrJ4xSScan list:CT chest, abdomen; MRI chest, pelvis, abdomen; xray chest, pelvis, abdomen; Abdominal ultrasound; Echo, stress test; Tons of blood workEGD; Barium Swallow Study; Colonoscopy; Gastric Emptying Scan; Capsule Endoscopy; Pillcam ###Output :This is now getting filled with bad advice and advertising. I think good suggestions that will come up have come up, and the discussion is over.


###Input :Since you're already in the neighborhood, have you tried this group? https://undiagnosed.hms.harvard.edu/ ###Output :UDN is a good thought, and I think worth looking into. I hope this suggestion gets upvoted more. They have great success stories and are run by great people. It also illustrates that "I am at Harvard for medical care" can mean a bunch of different hospitals, clinics, and doctors, who all have varying expertise and areas of focus.However, a couple things to point out:It's a research study, so not the same as "having a doctor." You also need a study recommendation letter from a health care provider."We cannot accept all applicants." Eligible participants "have at least one objective finding." I honestly don't know how they define that, e.g. is weight loss objective enough?"After all of the necessary information is received... it typically takes 6-8 weeks... to decide whether to accept...."They have about 12 clinical sites across the US, not just Boston.Not trying to dissuade OP. If it were me, I would absolutely be looking at UDN. Let them decide whether you're eligible or not. I'm just trying to provide perspective about what to expect.


###Input :Thanks!It does seem structural but I'm having a hard time getting anyone to believe me. Most docs don't even want to hear my history of how this happened. They're on auto-pilot and seem to just want to know what the symptoms are.I'll look into sympathetic nerve damage. ###Output :Posts by unflaired users that claim legitimacy by virtue of professional medical experience are not allowed.If you are a medical professional who wishes to become a verified contributor to this subreddit, please message the moderators with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!We do not accept digital forms of identification.


###Input :Thanks I added that to my list of things to look into and will be following up with someone on Monday to hopefully evaluate it. I have a list of everything that everyone on here has said and I'm going to bring it to the attention of the next doctor I find. ###Output :To be honest I wonder if you had some traumatic injury to the celiac plexus. This sounds like a neuropathic pain secondary to the chiropractic manipulation. This is a very unusual story you give, so I can't say I have a strong hunch what is going on, but this seems like a reasonable thought. I'm sorry you've ended up in this predicament. You may consider seeing a pain specialist for discussion about a very particular procedure of a type of nerve block.


###Input :I've been thinking the same, and am trying to find out how to know for sure. I'm told that x-rays show the diaphragm, as well as CT scans, but nothing is ever mentioned. I've had an ultrasound of the abdomen as well which I was told would show something if there was a problem, but nothing is coming up. ###Output :Just so you know, x-rays show the diaphragm so-so, but not great. CT would certainly show more detail. Earlier you stated a hiatal hernia "can be seen on an xray," which is true in the sense that an obvious one would show up, but not all would show up.Likewise, an ultrasound of the abdomen could in theory show some diaphragm abnormalities, but that's not often what the sonographer and radiologist will be looking at most closely.


###Input :t that's not often what the sonographer and radioloThank you.I have had a lot of imaging, including CTs, over the past several years. Do you think a second opinion from a radiologist would be a good idea? Usually you get an order from a doctor and the radiologist does and reads the scan, but are there options for people who just want a radiologist to look over old testing? Can I pay someone to look at old tests? ###Output :In general, radiologists definitely look at old scans, and that could be considered a second opinion. This pretty much means the patient has to bring the images on CDs.However, when this happens, it involves a "front line" non-radiology doctor (medicine, ortho, neuro, etc.) who sees the patient and usually is ordering a new scan and wants to know how today's MRI of the hip compares to the 2015 scan from Far Across The Country Clinic, LLC. Rarely the front line doc might have old scans only and just want his/her local radiologist to take a look as a courtesy.I have never run across exactly the 2nd part of what you're suggesting: patient directly sees/pays a radiologist to review stuff (with no front line doc involved). This probably exists somewhere in the world, but it has a sort of "boutique" feel to it.


###Input :Hi Docs & Medical Community -Coming to you all hear with some saddening news. It's been approximatley six weeks since my partner "attempted" suicide via hanging, and I have had extremely limited information on his current condition due to a variety of factors. These include being a non family-member, and his remaining family being very difficult to work with, less than caring of his current condition, and not being the ideal parents. The background for these are for another subreddit, but I'm happy to divulge any information if you all need more. I will try to be as analytical and non-emotional as I can in this post, as I'm only attempting to gather information from those directly involved in the field, as opposed to my resources of compiling random pages on the internet. Hope you all can help, and if you need any information please ping me.For security reasons, this is a throwaway, but I will be checking the post on my main account routinely and can log back in to answer any questions you all may have. Thank you very much for your help.I made an original post on r/TrueOffMyChest yesterday, that you can find here. It may have some information that may be relevant, although focuses more on my emotional state and less on the actual medical facts.---Patient Information: USA, 25M, 6'0", 192, White, Attempted Suicide Via Hanging - Hypoxic Brain Injury. No exisiting medical issues - daily workouts w/ weightlifting and cardio, very diet and food aware. Current medications include 20mg daily Wellbutrin, started 2-3wks before event happened. Prior to Wellbutrin, 20mg of Prozac daily. Casual smoker (vape-nicotine) and regular alcohol intake (2-3 drinks/mo). No recreational drugs. Past history of mild depression and anxiety, routine therapy. Zero previous suicide attempts or thoughts at self-harm.---The last several weeks have been quite stressful and devastating as you can imagine. There's a lot more to the information-specific side of the story, but the long story short is an abusive, neglectful, and incredibly religious mother, who has cut off her son. She is unwilling to call the hospital for daily updates, and obviously they can't release any information to myself or his friends, as we're not family. We have been able to get some limited information through friends of friends - my partner was a graduate school student in biology, and has many friends who know some individuals who work at the specific hospital he's at and were able to nail down some information. With the exception of yesterday's update, in which my partner's best friend drove to the hospital and used one of his friends there to squeeze some actual information (I'm not sure that's legal, but we are totally in the dark and the only person who has information will not share for her own greed), we know nothing concrete.The information yesterday was helpful in a way. For my full emotions, I can't say I'm any better, but from a purely medical standpoint I'd like some help deciphering it. Again, I understand this is a sticky situation involving HIPPA and legality, so want to be clear that I am not advocating for any unethical or illegal reporting standards. I fully understand the rationale and logistics behind HIPPA and it's protection laws. I hope, from a personal perspective, you all can see how we had to do what we did in order just to learn SOMETHING. I am not a judgemental person, but his mother is subjectively awful for her behavior in the past and now, withholding information and not even picking up half of the hospitals calls regarding updates about her own son. We just have to work with what we have.The reason I bring this up at all is due to the fact I want to stress the 'concrete' nature of the status update yesterday - while all of our other updates have had questionting validity due to them being passed through multiple sets of ears and open to interpetation, this one came directly from the source. Anyways, I will attempt to construe a timeline below:Mid-Feburary: Initial incident occured. I discovered my partner hanging by a constructed noose in his bedroom. While I don't know how long he was cut from oxygen, I know that it was >4min and <11min. If it was closer to 4, I'd assume he'd be awake by now. If it was closer to 11, I figured he may be confirmed brain dead and/or medically dead at this point.I called 911 and began CPR immediatley. 911 was quick response, and from call time to arrival was no more than 3-4 minutes. In this 3-4 minute period, I opened his airway and performed CPR while simeltaneously on the phone. I did not detect a pulse nor breathing, and once the EMTs arrived, they relocated me into another room for comfort & questioning while attending to him in the field. They shocked his heart back from AFIB, and I do not remember them confirming if they restarted his pulse.Late-Feburary: 13 days after event. I have no information. I am called by my attorney (who I called to be safe and attempt to find out more info) to see if he knows anyone who can get any contact update. I have contacted his mother by now who has expressed her disgust for her son and says he is an "unforgiveable sinner" and wishes not to be contacted by me anymore. When my attorney calls, he gives me no information other than "no brain activity." I immediatley assume brain death, and am disheartened (to say the least) at this news. I assume at this point that it is irreversible and he will not wake up.Early-March: Limbo period of no information update. My attorney can only guarentee me that he will have any information if she dies - in which case I will be informed.Through grapvine comprised of partner's close friends, limited information is listed that he has been transferred to a highly-rated neurosurgery hospital, and has been moved from "Critical" to "Critical-Stable". His body is improving, but no update on his brain status and activity. No one knows who authorized the transfer, or if it was done by the State or a hospital administration decision. His mother does not answer my request for comment. Brain activity has gone from "no brain activity" to "little to no brain activity" if that makes a difference - it did not to me, at least not at the time.Late-March/Present: Partner's best friend made the state-crossing drive to his current hospital, which as of yesterday, he is still at and not reported medically dead. Source-based information was relayed as follows: Still in "Critical-Stable" condition, with significant brainstem activity. They would not say if it was a persistent or permanent vegetative state, rather they listed it as a "medically-induced coma to allow the brain to heal." They implied that they COULD wake him up if he wanted, but they were holding off to see if he would have a better response. I'm unclear on what that means. They could not give him an exact date on when he was moved from one "level" of inactivity or trauma to the other, so I cannot confirm that. They said his OFFICIAL condition was "Stable, but Unresponsive" which could mean a number of things. I am optimistic that they have taken away the notion of a sudden brain death, but am trying not to a) get my hopes up, and b) speculate on anything that was not explicitly confirmed.In addition to those updates, they said his vitals were normal, and he had sleep/wake cycles, but no voluntary response to stimulation. Whether this is due to a brain injury or the medically-induced coma or some combination of the two is unknown. While he is still on a ventilator, it was reported that it is no longer breathing FOR him, simply assisting him in his breath. His heart was put on bypass, but is pumping on it's own at the moment. This is the last update I have.---So, here we are. This is a lot of words. I want to state - I don't know how to feel. I'm not writing this post for someone to sit here and tell me it's going to be okay. I know, logically, there is a very small percent change (<5%, if not smaller) of him ever waking up, and a fraction of that small chance of him being "normal" in the sense that he was.My intention with this post is to try and get some real life experience from those who have seen something similar or have an area of expertise in this field. I've read a LOT of things on the internet, some of which make sense, some of which don't, and some of which conflict each other.IF YOU HAVE ANY ADDITIONAL QUESTIONS OR NEED ANY MORE INFORMATION, PLEASE LET ME KNOW. WILL UPDATE AS SOON AS I CAN.---I'm not religious, but ask all of you to send some good thoughts his way. You never know. I know that there are a thousand possibilities of varying severity through this outcome. I'm hoping it's the one that he's happy with. ###Output :Thats a very sad and difficult situation, Im so sorry.Im not sure we can help a lot with all this second hand information.The fact that he has a wake/sleep rhythm and triggers the ventilator means that hes not brain dead. The first fact means hes probably moving to (at least) a persistent vegetative state.The chances that he recovers without important disability are slim. Its very hard to predict if this remains in the range of persistent vegetative state or if more consciousness will recover. A next step would be if meaningful communication would be possible.An MRI, EEG and the results of a neurological exam will help inform prognosis, but there still will be significant uncertainty.


###Input :Age 40 Sex MHeight 6'1 Weight 190 Race W Duration of complaint Week Location Left index Any existing relevant medical issues PsA Current medications Biologic Include a photo if relevantLast weekend when planting a very large agave/century plant, I got three spines in my left index finger. Two I got out (but they hurt for days after -irritant/poisonous?). The third I felt a stick but didn't see a mark and couldn't find anything to remove. All week the finger has been warm, red, stiff, and a bit swollen. No change in a week, though now the first joint is a bit painful when pushing on it. I've got PSA, so used to having stiff hands, but this is a little different.I've held a very bright flashlight to it and cannot see any foreign body under the skin.For sure had DTAP 8yrs ago when my first was born. Not sure since.Go to the GP? Let it ride? If the doc, do they just throw oral antibiotics at it, or is there something more effective? ###Output :Missing critical elements of history and no images. You may have an infection and you should seek care. Infections in the hand can be serious.


###Input :29F, 5'2, 80 something lbs, end stage liver failure etc.This one might be long, but I appreciate any kind of advice or input. I'm concerned my sister has been kind of pushed to the side since COVID19 and she's currently in critical, critical condition despite having been discharged. My family is confused on what to do, how to help her, especially since she's been denied a liver transplant. But anyways, here it goes:On March 5th my sister was found collapsed on her bathroom floor, she was completely yellow. Her boyfriend rushed her to the ER, where he was told to call family (us) because she wouldn't make it. From there she was transferred to a larger hospital, placed in surgical ICU and had a team immediately on her case. At this point her liver was failing, and she had an infection but they didn't know the source nor the bacteria causing it. She couldn't breathe on her own etc. Over the next week they threw all the antibiotics at her hoping something would stick, put a tube in her stomach to drain fluid that had built up around her bladder, put her on 24/7 dialysis since her kidneys began to fail, so many tests ran, I unfortunately can't recall all the details right now but if there are any specific questions I can likely answer.It was very touch and go for a while but her fever had gone away despite never finding out the source of infection. She was tolerating the dialysis and the last day I saw her she looked like she was doing a little bit better. Then COVID-19 hit my state and we were no longer allowed to visit her. Phone updates from the RN told us she was doing better, but they never had any specific information on what specific doctor's were saying, questions we had just weren't getting answered and my sister was unable to tell us what was going on. Within one week, we were told she was well enough to go down to general, despite previously being told she would go down to regular ICU first, and be in the hospital for at the very least a total of 6 weeks. She could breathe (not very well) on her own at this point and could communicate, so the hospital was no longer relaying information to us despite her not being in good enough condition to actually understand what was going on and couldn't remember what doctor's were saying to her. The next day we get a call that she's getting a port placed for out patient dialysis, and she was discharged that same day.We knew she wouldn't be 100% obviously but thought she would be better than she is. She comes home and can't walk, can't breathe very well at all, is completely yellow, is in constant pain and honestly looks like she won't be able to make it much longer. We don't know if she can survive with this liver, she was denied a transplant (whole 'nother story) and despite getting outpatient dialysis she looks worse and worse. She was told she was getting a home care nurse, they aren't coming now. She was supposed to originally be getting PT, they won't come out anymore (honestly don't think she's at that point now anyways). I'm trying to facilitate the care she needs and I'm trying to get her appointments set up but all doctors are only doing video call (completely understand). I'm just so scattered right now and have no idea why she was discharged. Should I take her back? Will they even be able to do anything? I don't understand and I'm just looking for any kind of advice I can get.Edit: The liver failure was precipitated by alcohol abuse and exasperated by the sepsis from her bladder infection. The last we had heard from the transplant team was that she was considered a good candidate (after 3 interviews) despite the alcohol abuse. We got a letter in the mail yesterday stating the denial. I am not trying to negate from the alcohol abuse, that was the reason her liver failed. Just that she also had a lot else going on that led to the condition she is in. ###Output :Posts by unflaired users that claim legitimacy by virtue of professional medical experience are not allowed.If you are a medical professional who wishes to become a verified contributor to this subreddit, please message the moderators with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!We do not accept digital forms of identification.


###Input :Ineligible? Its probably the alcohol. Transplant has very strict regulations. I cant believe any transplant team would say shes a good candidate if she lost her liver due to alcohol abuse. Just like with cigarette smokers. You have to quit and show at least 6 months to a year smoke free before you can even get on the list. Its a long process.I had to wait five years after my stomach cancer to get my transplant. So I did my best to follow my diet and restrictions set forth by my nephrologist and dialysis center.Im only speculating, about your situation. Im sorry if any of this sounds harsh.It took 3 years of waiting on the list and finally as my health took a turn for the worse, my ex donated his kidney to me 15 months ago.If she will not comply with the program, theres no reason to transplant a healthy organ in a person who wont stop those destructive behaviors. The restrictions/rules are there for a reason. I had So many moments of pure anger, crying, frustration and hopelessness. But thats normal considering the situation.I AGREE, she needs to be hospitalized. Her dialysis center should be advocating for her. Find out who is the social worker for her clinic and contact them ASAP.Also, did you know that for a liver - you can donate just a portion - it doesnt need to be the entire organ for a successful transplant. You (family) could still get tested while you work with the transplant team to make her eligible.My mom has cirrhosis of the liver & she too was ineligible because she was a heavy smoker and soda drinker. She wouldnt quit. Shes outlived all the doctors predictions. But shes suffered tremendously. I finally got her and my dad to quit about five years ago. Shes still too afraid to have transplant, shes set in her ways. So everyday is sheer hell at this point. Im terrified for her with COVID-19. One person has already died at her assisted facility living.Heres my take on part of the reason she was worse after she came home is most likely the dialysis. Its a new thing for her body. It has to adjust to it slowly over the next few months. Depends on how bad she is. It wrecks havoc on your body. You can have extreme lethargy, dizziness, headaches, nausea and cramping.She has End Stage Liver Disease. She is living with terminal illness. The only real thing besides humor & my kids that helped me cope was educating myself. About my disease, dialysis etc.I am so sorry this is happening. Wishing you both the best in the future to come. ###Output :It's hard to tell you what's happening or what to do without more detailed info, although I completely understand that you do not have this information, and this is all exacerbated by the current isolation requirements. If I were you I would be focused on finding someone to talk to who can explain things better to you or her medical power of attorney (which, by the way she should definitely have at this point). Does she have a follow-up appointment with a liver doctor within the next week?What medical problems did your sister have prior to March 5th when she was found down in the bathroom? Do you understand what is the primary source of her liver failure? Most common things are alcohol abuse, hepatitis C, or toxicity from a Tylenol overdose... others have what's called "cryptogenic" liver disease which means "it's a mystery" but these cases usually don't present as rapidly and dramatically. Sometimes even young healthy patients just have really bad luck and get a bad viral hepatitis that leads to fulminant hepatic failure in a very short time span.Reasons for being denied a spot on the transplant list generally fall into one of three categories: 1 - not sick enough yet, 2 - too sick or has other serious other problems that mean even with a transplanted liver she would not survive long enough to benefit from the very scarce resource of a liver donation, and 3 - not eligible due to history of current or recent alcohol or drug abuse.From what you describe it sounds like she was reasonably healthy and has had a sudden dramatic decline in her health which included an ICU stay with multi-organ failure (liver, kidneys). Then at some point she had somewhat "stabilized" enough, although remained in overall poor health due to her illness. At this point she was discharged home with home health, outpatient dialysis, and PT for rehab, but given the current worldwide situation those services are not being very reliable. Pain, weakness, and some shortness of breath are honestly part of her disease and may not (by themselves) warrant re-admission to a hospital... depends on the severity and whether there is any intervention that could be done in a hospital setting to improve her. Perhaps she should have been discharged to a skilled nursing facility, but these have specific requirements which she may not have met. I can speculate all day but without detailed information it is hard to give good answers.I'm sorry for what you and your family are going through - both the fear of your sister's declining health as well as the uncertainty and confusion you are dealing with. I know it must be very frustrating. Like I said above, the most important thing is getting more info. And if she truly is getting sicker and looking worse at home them take her back to the hospital ER. They may or may not readmit her, but at least she would be evaluated and you'd have a chance to talk with someone about her situation.