Have a cardiologist and a pulmonologist team up to rule out alcohol induced dilated cardiomyopathy with extensive myocardial fibrosis, which compromises the function of the Heart as a pump, even in the presence of normal test results. The Heart ends to be booth-shaped in this condition.

In the absence of a heart disease, this could be severe chronic obstructive lung disease. More Social and chest hx is needed.

Otumdi Omekara, MD

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Generalized body ache without anything to suggest viral infection, is often the after effect of vigorous exercise, sports, manual labor, or other fast-paced physical activities. Lactic acid accumulation in the muscles account for the pain, which goes away after it wears off in a day or two. Your body ache could be the early manifestation or prodromal phase of a viral infection. If you been in contact with friends or family members who have recently had viral infections, you may be incubating one. Do not suppress the body ache with pain meds yet until you have a better sense of what could be causing it. However you need to avoid vigorous activities meanwhile to allow for possibly accumulated lactic acid to wear off.

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You have probably lost so much fluid the through imperceptible perspiration to the point being hypovolemic (low blood volume). Your rapid heart bit is your body attempt to keep up with the normal circulatory demand especially to the brain. The low blood volume also accounts for your feeling chilly, because blood is shunted away from the skin to the vital organs.

The chest pain is most likely angina pain (heart muscle pain) since the heart is working extra hard without getting enough oxygenated blood supply for the increased work. You need to proceed to an urgent care facility where you can be rehydrated at once before your circulatory system shuts down. I wish you the best possible outcome.

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It all depends on whether or not you have recently had a normal menstrual cycle. The least you can do is to take a pregnancy test to be sure you are not pregnant. Then wait for the first day of your next cycle to initiate your oral contraceptive pill. Make sure your current stock from one year ago has not expired. If there is any doubt make an appointment to see your PCP or gynecologist.

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Thanks for adding this photograph. The bull eye nature of the skin lesion suggests bug bite and Lyme disease. You need to see your PCP immediately for full evaluation and tteatment.

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Tingling sensation by itself does not prove very helpful for any meaningful diagnosis. It will be nice to know some of the circumstances surrounding it's occurence. Are you hanging your arm over a chair? Are you laying your head over your right arm when you are sleeping? How long does it last? What makes better or worse? Has it happened in the past and stopped; for how long? Please provide the answers to those questions, so that I can help you figure out what is going on.

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Your description suggests more of bug bite with possible Lyme diseases, considering that this is Lyme season. Let a doctor take a close look at your bull eye skin lesion and get more detailed history of where you have been camping recently and confirm the diagnosis of Lyme disease. If it is ring worm or something else, the doctor will be better able to say so.

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At 53 your mom is just about where her body is no longer able to effectively regulate her body temperature. Since she spend most of the day in water, heat stroke might be more from exertion from vigorous swimming activity. She also needs a lot of encouragement at her age to drink a lot of water. A combination of dehydration and vigorous activity more than doubles the risk of a heat stroke.

The human body would normally break in to heavy sweating when the body temperature is 100+. But with dehydration it is forced to conserve water by cutting down on sweating and urination, which allows the core body temperature to rise to stroke level.

There are sugar free slightly favored drinks that are easier for older adults to drink in large quantities. Also check with your local pharmacy for oral rehydration fluids similar to the infusions given to the patients admitted into the hospital. Whichever is available should be provided to your mom during this summer period to help her stay hydrated.

If the AMS is such that she is unaware of her environment, you must take her at once to the ER so that she can be quickly rehydrated, before her systems shut down.

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Here are the highlights of an eMedicineHealth article that fully answers your question. For more details, just follow the link below. This will probably explain why your doctor could not just give you one concrete answer. She has to rule out a lot of other options before settling for the suggestion of heavy metal poisoning, Hepatitis C or hepatic cancer, which are all notorious for very high levels of ALT and AST.

Diseases That Cause Abnormal Aminotransferase Levels

The most common diseases causing abnormally elevated ALT and AST are:

Acute viral hepatitis, such as hepatitis A or B
Chronic viral hepatitis, such hepatitis B or C
Cirrhosis of the liver (scarring of the liver due to long standing inflammation of the liver)
Liver damage from alcohol abuse or alcoholic fatty liver
Hemochromatosis (a genetic condition causing long standing liver damage due to iron build up in the liver)
Diminished blood flow to the liver (from shock or heart failure)
Medications That Cause Abnormal Aminotransferase Levels

Intentional medication overdose, such as acetaminophen (Tylenol liver damage)
Acetaminophen (Tylenol or other medications with a Tylenol component, such as Vicodin)
Some pain medications, or example, diclofenac (Voltaren) and naproxen (Naprosyn, Anaprox, Aleve, Naprelen)
Cholesterol-lowering medications, statins, for example, atorvastatin (Lipitor) and simvastatin (Zocor).
Some antibiotics, for example, sulfonamides and nitrofurantoin (Macrodantin; Furadantin; Macrobid)
Some tuberculosis medications, for example, isoniazid (Nydrazid, Laniazid, INH)
Some anti-fungal medications, for example, fluconazole (Diflucan) and itraconazole (Sporanox)
Some psychiatric medications, for example, tricyclic antidepressants
Some seizure medications, for example, phenytoin (Dilantin), carbamazepine (Tegretol, Tegretol XR , Equetro, Carbatrol), and valproic acid (Depakote, Depakote ER, Depakene, Depacon) Continue Reading

Less Common Causes of Abnormal Aminotransferase Levels

There are many other causes of the abnormally elevated blood liver enzyme levels in addition to those mentioned above. Some of these conditions include the following:

Wild mushroom poisoning
Wilson's disease, due to excess buildup of copper in the liver
Metastatic cancer to the liver (cancer spread from another organ to the liver)
Cancer of the liver (hepatocellular carcinoma)
Auto-attack immune hepatitis (the body's own immune system attack the liver cells)
Pregnancy
Inflammatory bowel disease such as Crohn's disease or ulcerative colitis
Gallstones
Obesity, which can cause infiltration of fat into liver cells causing inflammation (called fatty liver or steatohepatitis)
Alpha-1-antitrypsin deficiency Continue Reading

Source: eMedicineHealth
http://www.emedicinehealth.com/liver_blood_tests/article_em.htm

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It sounds like you have a stone in your left kidney obstruction g the outflow of urine. That is usually associated with severe left flank pain as the ureter tries to extrude the stones by contracting vigorously.

The cystic mass observed in the ultrasound could be a hydronephrotic (urine baloonned) left kidney pelvis.

You need to see a urologist for expert evaluation and treatment. In the mean time do not gulp in liquids. Just sip fluids frequentry to avoid full kidney pelvis which triggers ureteral contractions and causes the severe pain..

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Your description of your upper abdominal pain is so vague that one can hardly accurately relate it to any of the sstructurres in your abdominal or thoracic atea. The commonest connection between upper abdominal pain and and shoulder blade pain is gall bladder infection with outlet obstruction.

If the pain returns you should get details of its trigger, time of onset, character, intensity, exact location, its radiation to other parts of the body, other associated symptoms, what makes better or worse, etc. Take that information to an urgent care center if you can not see your PPPCat once, so that you can be physically examined and tested fo establish a diagnosis.

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Here is a link to the CDC Guideline for Zika Prevention.

http://www.dromekara.com/p/zika-iru.html

Please let me know if you have any more question about Zika virus infection. Have a pleasant trip.

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Going by your limited clinical history, it would appear that you have bled into the olfactory lobe of your brain following a blunt head injury. The pressureeffect of the blood may account for the head ache, fluid sensation, olfactory smell sensation, and cerebral never stimulation. See a neurologist as soon as you can.

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PS:
This is a typical description of postural hypotension.......

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6/2/16
The spasms in my upper rib cage
From: SD (Female)
Permalink:http://doctorbase.com/message/thread_reply?thread_id=9834232
Shianne Dunlap profile image
Jun 3, 04:19 AM
SD
I appreciate your taking the time to answer my question. These happen on both sides of my body. They are extremely painful. Kind of like a calf spasm, but it takes my breath away because it's up on the sides of my chest. I do take high blood pressure medicine and medicine to try to control my very rapid heart rate. I've never had any problems with my heart up to this point. I don't have insurance, so my only option is an emergency room. It's just timing it out to when they're happening.
Pain Severity: 8 out of 10
Duration: 29 days

Reply

6/3/16

Thank you SD for choosing me for further consult about your chest spasms. Like I suspected, you actually have a heart condition called cardiac arrythmias probably ca used by your hypertension. Hypertensive cardiomyopathies (hypertensive heart muscle diseases) can culminate in heart attacks when narrowed heart blood vessels fail to supply enough oxygenated blood to hypertrophic (thickened) heart muscles.

If the resulting heart muscle injury affects the Purkinjie fibers that conduct electricity within the heart, then, there is irregularity of heart beats and heart rate extremes (too fast or too slow).

The doctor who is treating your hypertension and arrythmias, should refer you to a social worker to help you qualify for medical assistance. A cardiologist will be in the best position to get you qualified for medical assistance program.

Search the DHS and Kaiser Permanente websites for available medical assistance progrms. Keep me posted on further developments.
Otumdi Omekara

Otumdi Omekara, MD
Preventive Medicine Specialist in Portland, OR
Level: Master Contributor (92)
Website: Dromekara.com Health & Fitness Publishing

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Lower abdominal pain radiating to your back, without details regarding its timing, trigger, character, intensity, associated symptoms, frequency, etc can not lead to any reliable diagnosis. The pain could be related to your womb, ovaries, stomach, intestines, liver, gall bladder, urinary bladder, or pancreas.

So, it will be nice for you to add some more details, or make an appointment to see a doctor, who can physically examine your abdomen for clinic signs of abdominal problems.

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PS:
Fatty food worsens the pain as the gall bladder tries to respond to the demand for digestive bile. Adequate water intake may also be helpful for dissolving the gall stones.

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agree with the doctor who wants you to head straight to ER, because heart attack could cause yawning through vasovagal effect of severe chest pain. My problem with that is that you are just 20 years old. I would need a history of familial hypercholesterolemia or adolescent hypertrophic aortic stenosis to lean heavily on that diagnosis.

The localization of the associated chest pain to your left arm and shoulder is strongly in favor of some form of heart attack. The severe chest pain causes excessive baroreceptor reflex release of acetyl choline which causes capillary vasodilation with reduced venous return to the heart.

The resultant low cardiac output briefly leads to inadequate brain perfusion (also affecting the hypothalamic respiratory center), causing a brief apnea (cessation of breathing). But low oxygen supply to the brain quickly increases the partial pressure of of carbon dioxide in cerebral circulation, to the point of overeiding the apneic effect of low oxygen pressure, and reactivation of the respiratory center. If the oxygenation of the brain is not quickly restored, low oxygen pressure ultimately depresses the respiration beyond recovery.

All of this happens between 60 and 180 seconds, which is the time needed to get a heart attack patient into ER for survival.

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Without the discharge from your belly button, this would have been a simple supraumbelical hernia. But now I am thinking of a cyst with sinus, connected or unconnected to the peritoneal space (space enclosed by the inner lining of the abdomen). You are going to have to add a pict ure or show this lump to a doctor for a definitive diagnosis.

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At 23, I woun't worry so much about a heart attack except you have familial hypercholesterolemia (high cholesterol) or adolescent hypertrophic aortic stenosis. Pain around the tip of the left shoulder blade, especially after a fatty meal associated with coughing and throwing up, would suggest gall bladder problem.

The only way to ascertain the diagnosis is have a physician fully evaluate you. Pay attention to the color of your eyes, stool and urine as well as what makes the pain better or worse, plus weight changes. Your doctor will appreciate that set of information.

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Going by your description of your mom's health, she appears to have a chronic wasting disease most likely causing her swollen abdomen. Top on the list, based episodic diarrhea and fluctuating blood sugar will be advanced cancer of the head of pancreas, now obstructing the flow of bile and pancreatic enzymes. In the early stages the insulin producing islet cells may grow bigger and cause low blood sugar. But with subsequent destruction of the whole pancreas in late stages, high blood sugar appears due to lack of insulin production.

The only way to verify this theory is to have her fully evaluated by a doctor. Even if it late stage cancer, at least, you know what you are dealing with, and whether it runs in your family, and what preventive measure her off springs can take.

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Cough with plenty of phlegm tells me that might be an older adult with COPD. If the antibiotic treatment is not helping, the you doctor may need to do or repeat sputum culture and sensitivity test to decide on a more effective antibiotic.

If you have not been fully evaluated, then it will be necessary to rule out other possible causes of chronic obstructive and productive, especially in association with bloody sputum and weight loss. If I get your feedback with more details, I might in a better position to narrow down the diagnosis.

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If azithromycin has failed, the it will be nice see your doctor again for culture and sensitivity tsets to find an effective antibiotic for your c b lamdia. Taking azythromycin for a weeK has no guarantee of cure.

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Thanks for your detailed history, which points to low blood pressure attacks (postural hypotension). The pounding of your heart is an attempt by your heart to pump more blood to your brain to prevent the fainting sensation and dizziness, due to low insufficient blood and oxygen supply to your brain.

Normally, the barorecptors in the blood vessels detect changes in the blood pressure and send reflex feedbacks to the hypothalamus in the brain, to increase or decrease circulating adrenaline which causes vascular constriction and squeezes out more blood from the peripheral microcirculation in the brain. When this reflex fails the blood pressure changes dramatically with with posture change.

Hypotension could result from acutell severe blood loss (internal or externsl), disrupted neural transmission (from demyelinating diseases like multiple sclerosis) or inadequate adrenaline production ( from adrenal failure, in addison's disease) or prescription medication side effects.

You need to see a doctor to figure out the possible cause of your syncopal attacks. The first step might be to lower the dosage of phentermine, whose side effects include hypertension, rapid heart beats, and dizziness. It is possible that phentermine induced hypertension triggers reflex hypotension leading to random episodes of sncopal attacks.

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Deep cervical nodes receive lumphatic vessels from deeper mediastern al (rib cage) structures. Since they are firm but mobile and loose to the skin, I am less coerced about malignancy. What I am more concerned about are chronic granulomatous diseases like tuberculosis, syphilis, tuphoid fever, toxoplasmosis, coccidiomycosis, HIV, etc. Good a thing you have already been evaluated by a provider. Your test results will guide further action. Keep me posted about your test results. Best wishes.

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Your description ties in with mild possible bacterial food poisoning. Since the toxin is preformed, it's onset can be as early as 2-6 hours, which is why you can easily link the symptoms to your last meal or drink. Be sure to report the source of the chicken to your health department. More episodes like yours reported by other patients could form the basis for the recall of chicken products from a particular company. Allow the mild diarrhea that commonly occurs with food poisoning to flush out the toxins. Do not take antidiarrheal medications. The symptoms should clear within 24 hours. Beyond that you may need to see a provider.

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If you were living in western United States, I would be thinking of tick-bourne relapsing fever. But out there in Florida, I am more concerned about malaria and tuberculosis for you. Since you said nothing about coughing and weight loss, it is hard to be conclusive. The earlier you see a primary care doctor to fully evaluate you, the better for you.

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Your description sounds more like Tinea cruris. If you have been working out and sweating into the perineal area with soaked underwears not changed overnight, it makes you vulnerable for fungal infections. Same goes for not showering after intimate contact with the opposite sex. So your first step toward arresting the situation is to wash the area clean twice daily and keep it dry with non prescription antifungal powder (not cream). The cream is useful when the itching has extended to your lower legs and feet. Light sponging also helps in the leg area. Where that doesn't help, you may have to see a doctor for full evaluation and and definitive diagnosis.

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Thanks for adding the picture of your rashes. Although it is not a typical bull's eye rash, it shows a bite mark. Depending on where you visited in the last 2-4 weeks, that could be a tick bite, which causes Lyme disease, which in turn could account for most of the symptoms you described. Since this is almost Lyme season, you should see a doctor near you for full evaluation. The earlier the diagnosis is made, the better the chances of eradicating the disease, and the less the complications.

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You may have thorn or strained the cruciate ligaments inside the knee joint. Quite often there might be associated hemarthrosis (blood inside the joint) which delays healing. The patellar and menisci may also be thorn. If any of these is confirmed by x-Ray or CAT scan, you will need an orthopedic surgeon to go in and clear things up to avoid permanent functional deficits like stiff joint.

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Thanks for providing the photograph. It shows that you probably have a residual hematoma (pocket of blood) that is resolving well. Give it another week, and it should clear. However, for any headaches, dizziness or blurring of vision, you must see your PCP for possible neuro referral.

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I am a bit surprised that a doctor saw your friend and sent him back to school without ruling out tuberculosis in the presence of hemoptysis (coghing up blood). Going by what you described he might be actively bleeding into her left lung from eroded bronchial vessels in a tuberculous cavity.

Your friend needs to head straight to the ER for immediate pleural tap before his left lung collapses under the pressure of accumulated blood (hemothorax). Even before a Chest X-ray film is deveoped, a simple blood test can say if he has atIve tuberculosis or not.

Ruling TB in or out ensures that he is admitted into the right ward for lung drainage, blood replacement and possible surgical intervention. Admitting him into a TB ward without confirmation unnecessarily exposes her, while admitting him into a regular ward unnecessarily expose other patients to tuberculosis. Keep me posted if your friend is sent home again without ruling out TB, so that I can report it to the health department.

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PS:You need to have a full workup by a team of orthopedic and neuro surgeons......... or recommend suitable back braces........

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PS: Here is a link to a YouTube video that will answer all your questions about puberty and menstruation.

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Assuming your blood pressure is normal, and given that your health appears stable on your current medications, I would change your current medications to other types in the same categories.
Imitrex is known to have adverse reactions including severe hypertension, cerebral hemorrhage and subarachnoid hemorrhage. The nose bleeds could be an alternative to cerebral hemorrhage during medication induced hypertensive crisis. So, you should see your doctor as soon as possible to avoid having a hemorrhagic stroke. If he or she is reluctant to change the medications, you should get a second medical opinion. I wish you the best possible outcome.

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It is obvious that you are having mall related allergic reactions. What is not clear is what you come in contact with at the mall that triggers it. I know that some people are allergic to nylon and some other textile materials. So, it will be nice if keep a record of the things you frequently touch at the mall and begin to note the last thing or things you touched before the onset of each attack. Other than that this could also simply be hysteria, if you are unconsciously try to make whoever accompanies to to the mall to buy you something out of sympathy. Let me know which one it is.

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It sure sounds like you have allergic rhinitis, but only if your job or hone envirinment exposes you to hay, can it be called hay fever. It also has to be seasonal, especially during Spring. Your first move to control your nasal stuffiness will be to avoid hay or any other identify allergies that trigger it. The are many options for nasal membrane stabilizers or nasal decongestants. Have your healthcare provider recommend the best options for you. You can also go for Allegra D and others advertised on TV. I wish you the best possible solution to your problem. Check out my article on How Asthma can Be Avoided at www.dromekara.com.

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With a blunt injury to your sheen, you initially had a bruise. But the subsequent re-injury moved it up to bone crack if not fracture. If it feels warm that suggests acute sterile inflammation of muscle or bone tissue. But you need to see a doctor to be sure there is no infection. Osteomyelitis or bone infection can be difficult to treat and it's spread through the blood is also very easy.

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If your PCP can do a biopsy of the lump itself for lab test, that will help with ascertaining whether it is cancerous or not. If he/she is unable to perform a needle or puch biopsy in an outpatient clinic, then you need to ask for a surgical consult.

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Since you have said nothing about your menstrual history, it might be safe to assume that you are not pregnant. Going by the history of hair loss and weight gain at your age, I would suspect polycystic ovarian syndrome. Your best bet will be be to see a gynecologist for a full workup. Only after a futile search for an organic cause of your weight gain will it be advisable to put you on a generic weight loss program. I wish you the best possible outcome.

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Considering your age, I think you may have STD superimposed on chronic inflammatory bowel disorder. Although you have not mention recurrent diarrhea, abdominal pain, nausea and vomiting, I thinkyou probably have exprienced them in a mild form before your constipation. Chronic Chrones Disease causes not only inflammatory obstipation (a form of constipation), but may also cause complete bowel obstruction. So you need to see a gastroenterologist for full evaluation and treatment for possible CD and STD. Controling the inflammatory obstruction is a lot safer than an emergency surgery for gut obstruction in Chrones Disease. I wish you the best possible outcome.

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Some of the asthma medications you may be taking are known to have angina (chest ) pain and bronchial spasm (constriction) as some of their adverse reactions. So you need have your doctor review your asthma treatment, possible dosage adjustment or substitutions.

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The greying of your finger and to nails off and on may be related to your fluctuating hemoglobin level caused by anemia. What you see as grey nails in a black person would been seen as pale white nails in a white person. If the cause of your anemia has been diagnosed and your hemoglobin is stabilized with treatment, you should not be extra worried about your recurrent grey nails.

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Here is what I think. Since your leg pain affects both legs, its cause is most probably systemic and blood related. Since It also started early in life, and it may be genetic in origin. So request your doctor to evaluate you further for ischemic bone pains from sickle crisis or thalassemia if you are white. In either case good nutrition and adequate health maintenance to keep your hemoglin level above 9 -10 will prevent those severe bone pain crises.

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It sounds like you are having mild food poisoning or gastroesophageal reflux. But the mild diarrhea points more to food poisoning. You probably also have a dull kind of headache. Bland liquid diet over a 24 hour period is usually enough to tide you over the short duration of the effects of mild food poisoning. Do not take any antidiarrheal medications, to ensure that residual toxins are flushed out. Beyond this, you must go to ER for full evaluation and treatment.

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You should call and let the doctor know that you are feeling better on the bland diet and ask if you should still proceed with peptobizmol. Chances are that he/she may want you to just observe the gastritis for a few more days and return to normal diet, if you are still feeling better. What you must avoid, is whatever food or drink triggered the gastritis in the first place.

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Yes you should hurry to the ER. With active vomiting, bloody diarrhea, and hives breakout, you are probably dealing with severe food poisoning with an overlay of food allergy. Other causes of hemorrhagic gastroenteritis also need to be ruled out. The possibility of your going into toxic shock is the main reason you should hurry into ER.

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Yes, you should see a doctor to investigate your postural hypotension. There may be transient cerebellar ischemia causing your loss of balance when you get up from lying down position. In the mean time, sit in bed for a minute or two when you wake up from sleep, before stepping out of bed.

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Obiously you have bacterial right finger nail bed. It is called paronychia. If you can afford to see a doctor, go in and have the green pus tested. It is more like pseudomonas. But culture and sensitivity of the pus will help the doctor match the infection with the right antibiotic medication. Where you can not afford a doctor visit, you just wash your finger nails up to six times a day with Listerine mouth wash and apply any OTC antibiotic ointment (from Dollar Tree) to the affected fingers. If that doesn't help, you must find a way to see a provider at an urgent care facility to rule oUT bone infection. Let me know how it goes.

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This sounds more like peptic ulcer disease (PUD) or gastroesophagial reflux disease (GERD). Have you had any previous episode? Have you noticed any blackening of your stool, which usually accompanies slowly bleeding gastric ulcers? Is worsened or relieved by food intake? You need to see a doctor for a full workup. Meanwhile, eat small frequent, soft, non-spicy meals. Never go to bed on empty stomach, especially if you drink alcohol. A glass of milk when the pain wakes you up from sleep might help dilute the acid. Wish you all the best.

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I see a black mole in your picture. First time around this is precancerous. But now that it has recurred after you self-excised it, you must quickly rule out active skin cancer. Make an appointment to see a dermatologist immediately. Wish you a good outcome.

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I would give your ankle a rest for four to eight weeks under the care of a physical therapist, if there are no other complications.

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Fasting blood sugar of 283mg/dl calls for active control and dietary regulation, not just exercise. You need to see an internal medicine specialist to evaluate and manage your type 2 diabetes properly. Diabetes could be affecting your kidneys and your high blood pressure could be due to kidney disease. This is called diabetic nephropathy.

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Somnolence and fatigue are common reactions associated with trazodone. Diarrhea and abdominal pain can be the side effects of Wellbutrin. Syntec has depression as one of its side effects. Your doctor may need to switch you to a different OCP, which may even mean you will have no need for trazodone and Wellbutrin. Let me know how that goes.

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I imagine that your pregnancy was stressful to the point of leaving with a stress ulcer, also known as Curling's ulcer. This typically happens in severe burns patients. Protonix helps it heal. But stress control helps you avoid recurrence. You may need counseling on stress management. In the mean time you should eat non-spicy, non-fried frquent small meals. Don't go to at night with an empty stomach. See your gastroenterologist as often as necessary.

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I think you are dealing with gastro-esophageal reflux diseases (GERD). The normal gastric acidity may not give you heartburn. But when it trickles up the esophagus to the throat, it kind of burns the throat, giving you the heat sensation. So I would have you sleep on your left side, propping up your head with a pillow for about a week, to see how it affects the heat sensation in your throat. Where that makes no difference, you should see an END specialist.

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Calf muscle tear with intact Achilles tendon is not a cause for anxiety over return to normal mobility. With muscle injury and secondary infection comes muscle pain and spasm. Follow your doctor's instructions until your calf wound heals. He should provide you with catches for now. After the wound heals, physical therapy will help you re-establish normal walk. Best wishes.

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Give your hand enough time to heal properly under the expert care you currently have. You should be able to return to boxing as a professional. Best wishes.

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Edit: needle-biopsied, not nipple-biopsied.

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The best treatment for fistula is surgical exploration of the tunnel and laying open to prevent recurrence. So you need to see a surgeon with a detailed history.

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Tachycardia is your body's attempt to correct hypotension or low blood pressure. One the adverse reactions of the eliquis, you are currently taking for PE recovery, is hypotension. So your pulmunologist may want to reduce its dosage gradually or change it to avoid your going into hypovolemic shock.

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Bright red blood in your vomits suggests gastric erosion, which ibuprofen is most likely causing now. You should go to ER so that the active gastric bleeding can be controlled endoscopilly. The ER doctor is most likely to discontinue the ibuprofen until you can be reviewed by your cardiologist. I wish you the best possible outcome.

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This is more like a severe flu attack. Stay on Thermaflu , otc decongestant cough syrops, and pain pills for another four days. If you are not feeling better, you should see your PCP to rule out sinusitis and pneumonitis. Get up to date with your flu shots after recovery.

Otumdi Omekara, MD

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Yes the discharge from a yeast infection, if not adequately cleaned, could cause itching, rashes, escoriation of the perineal skin. Usually clears with full internal antifungal treatment, topical antifungal cream and frequent change of underwear during active discharge. Make sure your partner also uses antifungal cream to avoid recurrence

Otumdi Omekara, MD

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Considering your age, I would think of ovulation pain, especially if this your mid cycle. Where the pain persist for more than a couple of more days, it will be necessary for you to be examined by a doctor to rule out appendicitis and right kidney disease, amongst other differentials. Let me know how that goes. Best wishes.

Otumdi Omekara, MD

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It would appear that a bone spickle in your neck touches the sensory nerve to your lips when you move your head in certain directions. This could be elicited by physical examination of your head and upper neck. An X-ray or CT Scan of the upper neck may be needed for its confirmation.

Unless you have a history of familial high blood cholesterol, I will attribute your heart symptoms to the medications you are taking for depression. Your doctor may consider tailing off those medications and changing to other alternatives.

Otumdi Omekara, MD

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It sounds more like a hairline rib fracture, which could occur during contact sports, forceful coughing or vigorous erobic workout. Even though hairline fractures may be hard to sport on X-rays, a chest X-ray might help to rule out rib fracture. You may want to see cardio thoracic doctor. I wish the best possible outcome.

Otumdi Omekara, MD

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It is better to take your dad to ER so that the tongue injury and the associated bleeding can both be properly evaluated and treated.

Otumdi Omekara, MD

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If you did not have the joint pains and tingling while you were taking Losartan and Minastrin Fe then it is very likely that Bactrim is causing your current symptoms. Ask your doctor if you can discontinue the drug or have a change of antibiotic. Where those symptoms go away, then it will a confirmation that Bactrim was responsible for your joint pains.

Otumdi Omekara, MD

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I suspect you have been hanging your left arm over the top of your recliner. What this does is to compress the axillary nerve under your left armpit, which would cause the numbness and tingling. Try a change of position and see what happens. Where that doesn't help, you need to make an appointment to see your pcp to see if the e-cig and your life style has anything to do with it.

Otumdi Omekara, MD

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Energy drinks are notorious for containing enough caffeine to make your heart beat too fast or even fibrillate. So, if regular coffee is not your friend, then energy drink will be too dangerous for you. With regards to your type one diabetes, caffeine will create some resistance for your insulin or even raise your blood sugar beyond normal. Power naps can help you better with your studies than coffee. Good luck.

Otumdi Omekara, MD

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This could be a form of vertigo. Are you also having sinus or ear infections? You may want to see an ENT doctor to be sure there is no problem.

Otumdi Omekara, MD

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May be you should start by describing what you mean by symptoms of anemia so that you and I can be on the same page. I recently had a question like yours where the patient thought his cold intolerance was primarily symptomatic of anemia. Although that was possible it turned out to be from hypothyroidism. Assuming your symptoms are of anemic origin, your PCP will need to test your blood to find out what could be causing it.

Anemia in the face of adequate nutrition suggests heavy blood loss through menstruation (in women), heavy sequestration or breakdown (in sickle cell disease, G6PD deficiency, congenital spherocytosis, tape worm/hook worm infestation, etc.). There could also be problem with utilization of the nutrients, as in chronic lead poisoning, iron malabsorption and folic acid deficiency. So, you need to schedule an appointment with your doctor as soon as possible figure out what is going on.

Otumdi Omekara, MD

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With drastic weight loss, history of chronic left sided abdominal pain that radiates to your back, and vomiting, I suggest you see a gastroenterologist for possible gastroscopy and biopsy. I am concerned about stomach cancer and pancreatic cancer. The cyst could be a pocket of blood from bleeding gastric ulcer. It probably disappeared following the resorption (enzymatic digestion) of the collection of blood in surrounding tissues. Meanwhile, avoid spicy foods, and eat small frequent meals.

Otumdi Omekara, MD

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Follow up Answer:
I am glad that the second ultrasound confirmed everything okay. Now, what I don't understand is why you are considering surgical abortion of a 9 week fetus when you guys plan to get married in a few years. Even in the best hands instrumental evacuation of the womb is quite risky.

Bleeding can be a problem, especially if there is placenta acreta (tightly adherent to the womb). The womb itself has been softened by progesterone at this point, and is very vulnerable to rupture with surgical instruments. Infection in a bloody womb can easily become systemic, and even lead to disseminated intravascular coagulopathy, which lethal.

Wound infection poses the risk of endometrial (inner womb surface) scarring and fallopian tube obstruction. The latter two will in turn pose infertility problem when you get married and feel ready for babies. You may need counseling before you make up your mind on where to go from here.

Otumdi Omekara, MD

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(Error-proofed Answer)The only way to find out is for you to see a doctor who will send you for lab tests after a quick examination. Soon after the specimens have been collected for culture and sensitivity, the doctor may prescribe some antibiotics for you to prevent any potential STD from getting complicated. One week is already too long to wait.

Otumdi Omekara, MD

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(Error-proofed Answer)
This sounds more like a petit mal or absence seizure. The crying would be the aura. The stiffness, the rolling of his eyes and quick recovery without any recollection, all tie into the picture. This is probably not his first attack. It will be nice for him to be seen by PCP or neurologist, to establish the diagnosis and put him on appropriate treatment. Now that you have an idea of what is going on, you will avoid shaking his head next time it happens.

Otumdi Omekara, MD

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(Error-proofed answer)
I don't think you need to be upset. Your wife's bone marrow is getting all the help it needs and doing the best it could, considering that she started out with a low hemoglobin level of 6.7. Even where the hb is normal at the onset of pregnancy, fetal demand tends to pull it downward. Check with your doctor to see that she is getting enough folic acid and dietary protein. If her appetite is low, she may need a little boost. Where she remains anemic after delivery, she might need hematology consult to figure out the cause of her chronic anemia. Hopefully you guys don't have lead piping in your home to suggest lead poisoning, which is notorious for chronic resistant anemia.

Otumdi Omekara, MD

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(Error-proofed Answer)
For a teenager like you cold intolerance suggests inactivity. This is barring any established diagnosis of endocrine malfunction or insufficiency. The control of core body temperature by the brain hypothalamus is accomplished through hormonal control of body metabolism. An active life style keeps the thyroid gland, the adrenal gland, small blood vessels and the liver active and well developed in their metabolic functions. The artereoles and venues in particular coordinate with the peripheral nervous system to limit heat loss through sweat when the body metabolism is low. Your doctor may need to run complete metabolic and hormonal panels on you to see which regulatory components are deficient. In the mean time get involved in some cardio and aerobic workouts or sports.

Otumdi Omekara, MD

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(Revised Answer)
When I hear irritability, disorganization, pacing, and flight of thought it makes me think of the possibility of some form of schizophrenia or schizoaffective disorder. You need to see a psychiatrist as soon as possible, especially if you are also hearing voices that ask you to do something very bad, like to kill someone. With accurate diagnosis and treatment you can still enjoy good quality of life.

Otumdi Omekara, MD

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(Revised Answer)
If you are Coombs positive, that means your blood serum contains antibodies against red blood cells, be they your own or those of other people. So, when your blood is exposed to that of another person, your serum antibodies will attack their red blood cells causing the blood to clump or agglutinate. What this means is that your blood can not be transfusion into other people even if you belong to the same blood group. Also, if you get pregnant and your serum antibodies come into contact with your baby's red blood cells, they may be destroyed, leading to intrauterine death. This is similar to what happens when you have Rh negative blood and your baby has Rh positive blood. The production of these antibodies can be suppressed with steroids as needed, or the recipient's blood can be totally replaced under critical conditions. I hope this is not too much information for your simple question.

Otumdi Omekara, MD

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Yes you need to call 911. People in your age bracket are known to have a form of congenital aortic outlet hypertrophic stenosis that can get severe enough to give you a heart attack. Usually such cases are first noticed during vigorous sports activities like soccer of football game. But yours is occurring with mild exertion of sitting up and breathing. This may or may not be related to your Chrohns Disease.

Otumdi Omekara, MD

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Your mom's central chest pain needs a little more description to figure out if it is originating from her chest muscles, bones, lungs, heart , gut, or skin. Since heart attack in women can be be very subtle, I encourage her to see a doctor as soon as possible. There isn't much room for guess work here.

Otumdi Omekara, MD

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Since this is the first time ever you are missing your period without evidence of pregnancy, it will be better to wait and see if you will have a period in the next couple of weeks. Where you miss it for a second time, then it will be necessary to do a full hormonal investigation to see establish the cause of your amenorrhea (cessation of menses). It could be phantom pregnancy pseudocyesis), polycystic ovarian syndrome or several other conditions. Your kind of anxiety over pregnancy has been shown to have the capacity to create physical signs of pregnancy like swollen abdomen, breast fullness and weight gain. The brain then misinterprets those signs and initiates the release of the real pregnacy hormones (estrogen and progesterone), which then complete the full picture of a true pregnancy without a baby in the womb. Even after a full laboratory investigation, the next step is usually to try to regulate the menstrual cycle with contraceptive peels or injections, unless there is contraindication.

Otumdi Omekara, MD

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This sounds more like viral infection, and one candidate that has been linked with upper respiratory tract infection and urethritis is adenovirus. But the good news is that the symptoms should clear in about 7 days. Where that fails to happen you need to see your pcp or urologist. for full workup.

Otumdi Omekara, MD

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This could be menstrual pain (dysmenorrhea) or appendicitis. But without fever, nausea, vomiting or pain radiating down your right lower limb, it will be better to observe you on Ibuprofen until your menstrual period is over. Then you will be re-valuated for appendicitis. But the pain should get worse in the next couple of days, you must proceed to the ER or call 911.

Otumdi Omekara, MD

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Did your doctor stop your Celexa abruptly or did you tail it off while building up the Prozac for at least two weeks (the earliest time for it to kick in)? Did you hit the maximum dose of 40mg/day for Celexa before it was dropped? What you are experiencing appears to be exactly what happens when Celexa (or infact any other antidepressant) is stopped abruptly. While drug combination can be synergistic, it would appear that your best bet at this time will be to have your doctor tail you off trazodone and xanax so as to know exactly what Prozac is doing to you. With the mixed bag of prozac, trazodone and xanax, it is hard to say which drug is causing which side effect.

Otumdi Omekara, MD

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How about a followup lab test in a couple of weeks to confirm that you and your partner are both free of chlamydia infection before you resume sexual activity.?

Otumdi Omekara, MD

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I agree with Dr. Semion and Dr. Cavazos. This type of nonspecific dermatoneuritis is most likely to be atopic in nature. Something in your hair products is not well received by your scalp. So, make some changes as suggested and see what happens. Over the counter soothing creams may be helpful too. Good luck.

Otumdi Omekara, MD

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This looks like a simple perineal boil or furuncle. But given the location and your age, I would screen for STD and diabetes. Have your pcp drain it and send some pus, blood and urine sample for lab work, before you are started on a broad spectrum antibiotic. Wish you the best possible outcome.

Otumdi Omekara, MD

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I am glad you already feeling better. It sounds like you had mild self-limiting bacterial food poisoning. Once any food doesn't smell right I would stay away from it. Make sure your refrigerator temperature stays below 40 degrees Fahrenheit while your warmer temperature stays above 40. As for your being pregnant or not your next cycle will say.

Otumdi Omekara, MD

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You are already on Augmentin, so I would not be too concerned about bacterial infection What I will be concerned about is rabies. If the dog is in your neighborhood, find out its immunization status against rabies. If uncertain, go to ER for anti rabies serum and anti rabies vaccine. Call daily to be sure that the dog is still alive over the next 2-3 weeks. If it is reported dead within this period, that suggests it had rabies when you were bitten. Report to the health department so that the dog's head will be examined at autopsy to confirm the diagnosis. I wish you the best outcome.

Otumdi Omekara, MD

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This is not anemia. It is more like hypothyroidism. Is there a swelling in the lower front area of your neck? Are you also gaining weight? It will be nice if you can go in for thyroxine panel workup. If the diagnosis is confirmed you may be started on thyroxine replacement therapy. In the mean time make sure the salt you add to your food is iodized.

Otumdi Omekara, MD

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Constant headache and dizziness at your age, which is especially made worse by vigorous activity suggestive hypoglycemic headache. It appears similar to the headache some people experience when they feel dizzy and hungry. If you are currently on treatment for juvenile diabetes, it might be necessary to adjust your dosage downward. Otherwise it might be necessary to screen you for glycogen storage disorders, which make it difficult for a person's liver to store glucose adequately or release it appropriately during vigorous activities.

Otumdi Omekara, MD

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First let me state that there are three anatomical forms of eye pain: peri-ocular, arising from structures surrounding the eyeball, ocular, arising from the eye globe itself, and retro-bulbar, arising from structures behind the eye globe. It is generally the retro-bublbar pain that is more frequently associated with headache because it's causes directly affect the optic nerve as it exits the orbit into the brain. The commonest causes of retrobulbar pain include: optic neuritis (inflammation of optic nerve), orbital myositis (inflammation of eye socket muscles), and nonspecific causes arising from the pressure effect of intra-orbital inflammation on the optic nerve. Also included among the nonspecific headaches are the cluster headaches, migraine headaches, sinus headache, eye strain from prolonged reading, astigmatism, and referred pain. Sorting through these potential causes of your eye pain and headache will best be done by an eye care professional. In the mean time resting and lubrication your eyes, along with good sleep and non-prescription pain peels might be helpful.

Otumdi Omekara, MD

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Your blue sclera has been diagnosed to be of anemic origin. Chronic aneamias like sickle cell anemia and severe hook work related anemia are known to make the sclera look blue or due poorly oxygenated blood in scleral micro-circulation. Once the deficiency is corrected and the oxygen carrying capacity of the red blood cells improve, the sclera gradually returns to normal. A more dramatic illustration is the change that occurs when a patient in hemorrhagic shock is transfused with some units of blood.

Otumdi Omekara, MD

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The feeling of a mobile lump in the upper part of your air passage, could be a little pedunculated polyp in the uvula area. You may want to see your pcp for oral exam and possible referral to an otolaryngologist.

Otumdi Omekara, MD

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Given that the recent STD screens for you and your partner were negative, this could be a form of drug reaction, especially sulpha drugs. If you are currently on any medications, I would suggest you see your doctor for a review.

Otumdi Omekara, MD

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If my baby falls on his head, I would feel anxious that he might have fractured his skull or broken his neck. The level of my anxiety will be determined by his briefly passing out or not. If he passed out even for a minute I would take him to the ER for status check. If he fell hard enough to sustain a bruice, he might also have had a brain concussion with mild or moderate intracranial bleeding. The ER may find no need for an MR I and just have you observe him closely, especially for seizures.

Otumdi Omekara, MD

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This sounds a lot like sleep paralysis, a form of parasomnia. I suggest you make an appointment to see your mental health provider. Until you are able to see your provider, here is a link for more information to help you understand some of your sleep experiences.
https://sleepfoundation.org/ask-the-expert/sleep-and-parasomnias.

Otumdi Omekara, MD

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Caring for dying loved ones can be emotionally and mentally very challenging. Not being able to understand some of the weird symptoms can make it even more challenging. Her current bowel movements may just be spurious diarrhea. When there is stagnation in the gut, the residual bowel contents are eaten up by the resident gut bacteria to produce some toxic wastes that may cause diarrhea. The good news is that it is self-limiting. It should stop once all the toxins as flushed away with the diarrhea. Since the bm is heavy the hospice staff may need to consider fluid replacement, if that is okay with you. Hang in there and take it one day at a time.

Otumdi Omekara, MD

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Well, the first thing I would like to know is whether someone actually punched you recently or previously. A stabbing pain points more to rib fracture, which is not commonly spontaneous at your age. Is there a history of vehicle accident, fall from height, or collision in contact sports? Is this pain worsened or improved by posture, medication, breatbhing, coghing or using the bathroom etc? At what point exactly is the pain? Any swelling, rash, blister or bruises around the spot? Any restriction of body movement. If you come into urgent care today with these answers, I will examine you, make a province diagnosis of traumatic run fracture and carry out some tests to rule it in or out.

Otumdi Omekara, MD

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When it comes to chest pain, the diagnosis requires that I get enough information to decide if it is arising from the skin, soft tissues, muscles, bones, lungs, heart, or gut. So I would like to know the exact location on your chest, whether it is associated with swelling or bruising, whether it is stationary or shifts, whether it radiates to other parts of the body or is ameliorate or worsened by position, activity oty brathing. I would also like to know when and how it started, any previous episode, character of the, pain (sqeezing, sharp, dull, etc), the intensity of the pain on a scale of one to ten; any history of Chest injury, any involvement in contact sports or fall from height. In addition I would like to know if there pain on inspiration, expiration, or coughing, whether you have a history of cough, heart attack, or bone disease, and whether the pai limits any particular motions. When I get the answers to these questions, I will be in a better position to conduct a focused physical examination that will lead me to a provisional diagnosis.

Otumdi Omekara, MD

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The history a day trip by your son, followed by painful right leg that prohibits weight bearing, is inadequate for determining what the problem could be. I need to know kind of trip, geographical location of destination, what kind of activities he participated in, during which activity the leg pain starte, whether he sustained accidental fall or collision, the character of the pain, the intensity of the pain, and whether or not the limb is swelling or losing strenth. I will also like to know if he has had a similar experience in the past. Answers to these questions will enable me to do a focused physical examination of the. right leg and come up with a working diagnosis.

Otumdi Omekara, MD

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Based on your history alone, you may have knee joint instability that needs to checked out by a doctor. Like you already suspect, there could have een a silent tear or subluxation of the ligaments that hold the joints together. The fact that your left knee buckles under your weight, suggests that the front side ligaments that help you stand straight are weak or thorn. Those ligaments are attached to the patellar, which is attached to the tendons of the anterior muscles and the two big bones that form the knee joint (femur and tibia). Buckling in the absence of a history of knee injury, could suggest weakness of the anterior muscles (hamstrings). The cruciate ligaments inside the knee joint will also need to be evaluated by physical examination. Depending on the physical findings, some radiological tests may done to visualize the status of the bones and articular surfaces of the knee joint. An orthopedic consult will ultimately be needed to review the results and agree on the best treatment modality for stabilizing the left knee. Temporary knee braces may used initially to support the left knee prior to any invasive surgery.

Otumdi Omekara, MD

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The tests that would be conducted with your blood and urine samples will not be decided solely on the basis of your flu symptoms. There has to be history of risky life style and possible exposure to potential or diagnosed HIV patient, accidental inoculation with contaminated needle. At the end of the consult, you will be told exactly what you will be tested for to rule out or rule in a set of differential diagnoses. Your blood will not be tested for any condition you have not been made aware of, or to which you have not given consent. A simple phone call to the urgent care provider will clear any doubts about what you are being tested for.

Otumdi Omekara, MD

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