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Example 6, Patient SK
Date of Birth: 04.04.1965
Gender: M
Email: yourname@yourname.com
Weight: 195 pounds or 88.6 kg
Allergies: Ceftin® (Cefuroxime), Claritin® (Loratadine), Codeine
Medical Conditions: High Blood Pressure, Type II Non-Insulin Dependent Diabetes Mellitus, High Cholesterol, HIV/AIDS, Coronary Artery Disease, Scabies treatment starting 1 weeks ago, History of Syphilis, Inflatable Penile Prosthesis Implantation in 1985, Erectile Dysfunction.
Current Medications Taken: Covera-HS® (Verapamil Special Release) 180 mg at bedtime, Accupril® (Quinapril) 20 mg every morning, Lipitor® (Atorvastatin) 40 mg every morning, Aspirin 325 mg every day, Imdur® (Isosorbide Mononitrate) 60 mg 2 times a day, NTG (Nitroglycerin) 0.4 mg tablets sublingually every 5 min as needed for chest pain, if not resolved after 3 doses, call 911. Lasix® (Furosemide) 40 mg every day, Potassium Chloride 10 Meq daily with food. Glucophage® (Metformin) 500 mg 2 times a day, Actos® (Pioglitazone) 15 mg every day. Elimite® (Permethrin) 5 % cream apply at bedtime from the neck down to toe after shower, message well and left on for 8 hours then wash off, repeat one treatment after 7 days. Combivir® (Lamivudine 3TC/ Zidovudine ZDV) 1 tablet 2 times a day, Crixivan® (Indinavir) 800 mg 3 times a day.

Dr. Chan: You are releasing a lot of secret of your job or life. The Covera-HSâ 180 mg must be taken at bedtime so the maximum drug effect will be in the morning because a lot of patent has morning blood pressure surge. Please take the Imdurâ at 9 am and 5 pm for you need to have a nitrate free period of 8 hours for the long-term benefit of this drug. You can take Lasixâ 40 mg in the morning with Potassium Chloride 10 Meq together with breakfast. Actosâ 15 mg can be taken at bedtime but it has to be consistence for effective blood sugar control. Glucophageâ 500 mg can be taken at 9 am and 5 pm with Imdurâ with meals. Aspirin 325 mg can be taken at bedtime with food. Remember that regular schedule dosing is important to the effect of the drugs, except NTG 0.4 mg only used for emergency chest pain and Elimiteâ cream used only 2 times totally. "Justify your existence in expense of others by b??????? t?? l??, " this is an unusual philosophy. I learn a lot form you too. Yes, the sugar reducing supplements in http://www.bayho.com/MM001.ASP?pageno=172 can help you. However, if you add the supplements on top of your regular diabetic medication, the sugar balance may be disturbed and you should check the blood sugar regularly during the initial transition for any unusual level. I am not telling you to quit the Glucophageâ or Actosâ. The chromium is a good start since it helps your body to stabilize the blood sugar. Print out the entire evaluation for your physician for reference. Chromium is a nutrient important for your glucose metabolism. Lower sugar level or hypoglycemia is an unlikely side effect during addition of chromium, people may become unconscious or in coma from lower sugar level. Please always keep some sugar tablets handy for emergency, use it when you feel dizzy. Glucophageâ can cause a life-threatening reaction called lactic acidosis but it only occurs in very small number of patients in clinical trials. If you have sour breath, tiredness, dehydration or disorientation. Immediately stop the Glucophageâ and call your physician. All communication is confidential with Secure Socket Layer (SSL) protection. Our email contains no identifiable information to outsider. People intercepting our email will not know who you are but you have to make sure that you are using the secure sever to pick up your email for protection at your end. Redistribution of fatty tissue such as buffalo hump and protease paunch are side effects form your HIV/AIDS therapy. There is no known treatment for your symptoms. Your Type II diabetes Mellitus may be HIV/AIDS related too as increase sugar level is another but treatable side effects of HIV/AIDS therapy. If your are not following the HIV/AIDS regimen, opportunistic infections like Pneumocystis carinii pneumonia (PCP), Mycobacterial avium complex (MAC), Cytomegalovirus (CMV) or Crytococcosis…etc with devastating complications can infect immuno-compromised patient like you. I am not in a position to scare you but keep you informed of the possible result. Let me know if you are interested in those topics later.

SK: I appreciate your professional consultation and will recommend you to other friends. You consultation fee is a small price to pay with the expertise you have. I am glad to find you on the net to solve my problem. It is difficult to keep the secret of my fun job. The world will be shocked if I publish my adventure and responsibility. At least I am proud to let people know that I am a lucky guy of having this high pay unusual position. Thank you of your information and concern of my health. Others HIV/AIDS topics are too far reaching for me at this moment, I am sure will contact you for help if those terrible things happen to me.


Example 7, Patient

Name: AS
Date of Birth: 04.05.1966
Gender: M
Email: yourname@yourname.com
Weight: 250 pounds or 113 kg
Allergies: DiflucanÒ (Fluconazole), TrimoxÒ (Amoxicillin) Suspension, BusparÒ (Buspirone), DalmaneÒ (Flurazepam).
Medical Condition: Schizophrenia, Anxiety & Irritability, Obsess Compulsive Disorder (OCD), Congestive Heart Failure, Impetigo, Aggression.
Current Medications Taken: Lanoxin® (Digoxin) 0.25 mcg daily. Accupril® (Quinapril) 40 mg daily. Lasix® (Furosemide) 80 mg every day. Bactroban® (Mupirocin) Cream apply 2 time daily to affected area. XanaxÒ (Alprazolam) 1 mg 3 times daily as needed for anxiety. Inderal LA (Propanolol LA) 160 mg daily. HaldolÒ (Haloperidol) 0.5 mg 2 times a day and as needed for agitation (discontinued 1 year ago). CogentinÒ (Bentropine) 0.5 mg 2 times a day (discontinued 6 months ago). Luvox® (Fluvoxamine) 100 mg at bedtime. Monthly Behavior Counseling.

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AS: Dr. Chan, I want to get your opinion of my interesting conditions. I held a very high position in a big company years ago but was demoted because of my poor job performance. This may be related to my medical disorders. My supervisor understands that I am a worker rather than a thinker or a leader. I lost my temper easily especially when someone disagree with me. Luckily enough, I am still a manager because of my connection.

Dr. Chan: You are doing very well actually with your diagnosis. A lot of patient like you just cannot function or achieve in the competitive world. What is your concern? Do you have very high self-esteem or grandiosity?

AS: My concern is that I have discovered ways to help myself without medications. Yes, I am a high achiever but it upsets people and even customers call me a JXXX. A lot of people hate me, may be I am not doing things right. I like to give orders. It is great pleasure of doing so to relieve my anxiety or fill my satisfaction of being a boss. I still have my schizophenic personality, however, no medications are taken at this moment. Regular visit to psychiatrist or counselor helps me a lot. I found everything “unacceptable” and even I am “unacceptable” to myself. What should I do?

Dr.Chan: Oh! This is great if you can find ways to relieve your symptom without medicines. However, building your pleasure by giving orders is not a good way to manage or run an organization for long-term success. You have to lean from your demotion while being a manager. Learn more, listen more and become realistic are better to cope with every day’s challenge. Through negotiation or discussion is a better way to find a solution than aggression. It is good to know that you realized you are “unacceptable”.

AS: However, things went well until 6 months ago until a monday night, I suspended an unfortunate subordinate and I felt great. Since then, I love to suspend people and I am doing it every couple weeks now. Nevertheless, the pleasure of making other people suffers keep rebouncing. I really want to do it on a weekly basis. Is it possible that I develop tolerance of doing this? But, there is a big problem. I cannot suspend my superior for any reason. It really doesn’t take long for me to suspend all my subordinates then I have to suspend myself at the end for pleasure.

Dr. Chan: Drug therapy tolerance is very common on narcotics or certain psychiatric drugs. Making other suffers is not a long-term solution for your disorder. Have you learned to be reasonable and acceptable on common sense? You are very smart to know the consequence of your action, this is a realistic view.

AS: I hate to be reasonable and listen to other unless they are my boss. Then I have no choice. I am the manager and they should be listened to me. There are customers complained about me to the corporate office that I am being rude, a JXXX, unprofessional, unfit to be a manager. But I do not care of being a JXXX. Being a JXXX is my satisfaction as well. By the way, I like to use the excuse of “I Have High Expectation” to do carry on my JXXX mission.

Dr. Chan: I am educated in pharmaceuticals but not psychiatric field. It will be more appropriate if you can talk to your psychiatrist or counselor for assistance. I will refund your money because I cannot help you. It is very interesting that you like to make people suffers and being a JXXX. I wish you luck and be well.


Example 8, Patient AK

Name: SK
Date of Birth: 04.04.1965
Gender: M
Email: yourname@yourname.com
Weight: 195 pounds or 88.6 kg
Allergies: Ceftin® (Cefuroxime), Claritin® (Loratadine), Codeine
Medical Conditions: High Blood Pressure, Type II Non-Insulin Dependent Diabetes Mellitus, High Cholesterol, HIV/AIDS, Coronary Artery Disease, Scabies treatment starting 1 weeks ago, History of Syphilis, Inflatable Penile Prosthesis Implantation in 1985, Erectile Dysfunction.
Current Medications Taken: Covera-HS® (Verapamil Special Release) 180 mg at bedtime, Accupril® (Quinapril) 20 mg every morning, Lipitor® (Atorvastatin) 40 mg every morning, Aspirin 325 mg every day, Imdur® (Isosorbide Mononitrate) 60 mg 2 times a day, NTG (Nitroglycerin) 0.4 mg tablets sublingually every 5 min as needed for chest pain, if not resolved after 3 doses, call 911. Lasix® (Furosemide) 40 mg every day, Potassium Chloride 10 Meq daily with food. Glucophage® (Metformin) 500 mg 2 times a day, Actos® (Pioglitazone) 15 mg every day. Elimite® (Permethrin) 5 % cream apply at bedtime from the neck down to toe after shower, message well and left on for 8 hours then wash off, repeat one treatment after 7 days. Combivir® (Lamivudine 3TC/ Zidovudine ZDV) 1 tablet 2 times a day, Crixivan® (Indinavir) 800 mg 3 times a day.

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For High Blood Pressure, Coronary Artery Disease:

Covera-HS® 180 mg at bedtime, Accupril® 20 mg every morning, Aspirin 325 mg every day, Imdur® 60 mg 2 times a day, NTG 0.4 mg tablets sublingually every 5 min as needed for chest pain, if not resolved after 3 doses, call 911. Lasix® 40 mg every day, Potassium Chloride 10 Meq daily with food.

For High Cholesterol:
Lipitor® 40 mg every morning

For Type II diabetes:
Glucophage® 500 mg 2 times a day, Actos® 15 mg every day.

For Scabies:
Elimite® 5 % cream apply at bedtime form the neck down to toe after shower, message well and left on for 8 hours then wash off, repeat one treatment after 7 days.

For HIV/AIDS:
Combivir® 1 tablet 2 times a day, Crixivan® 800 mg 3 times a day.

You have to remember taking the HIV/AIDS meds according to schedule. Missing dose is the major reason for treatment failure. Please take Combivirâ every 12 hours and Crixivanâ 800 mg every 8 hours on EMPTY STOMACH, then you will have a more consistence serum drug level to fight HIV/AIDS virus. I have received your lab reports, thanks. Your CD4 Count is 945 and viral load is in undetectable level. This is terrific and the HIV/AIDS drugs are working very well for you. The very potent antiviral therapy with 2 Nucleoside Reverse Transcriptase Inhibitor (NRTI) and 1 Protease Inhibitor (PI) is one of the standard care you can have with this disease. Do you have any concern in change of body size? However, the viral resistance will develop over time due to non-compliance or natural viral selection. Then, you will be switching to other HIV/AIDS meds later.

SK: I am taking a lot of medication in the morning, what is your recommendation to move some meds to be taken at bedtime or afternoon? Any supplements that you suggested to me for my health? Of course I will try my best to survive. If there is an unlucky person become my target, this is a wonderful time to justify my existence in expense of others. Do not think that I am selfish; you know the consequence of having HIV/AIDS. Moreover, I really do not know what else I can do beside my specialty. Our unit specialized in C???????? O???????? C???? and V????????????. We even have a slogan to symbolize our joyful mission: “B???? A L?? Every Day, Catch Me? Go Away!” For some peculiar reasons, all of us like to drive prominent big car. They are much safer in chase and collision. I appreciate your Social Security Phone number and will keep it in my safe for reference. How do you spell moral? Are the reducing sugar dietary supplements good for me? What should I watch out for the side effects? My physician told me that I am taking a very potent antiviral drugs for HIV/AIDS. I understand the important of exact timing to take the drugs. Taking those HIV/AIDS meds during work may be tough. But, I still can manage to keep my privacy for 6 months now. B??????? t?? l?? is my only talent, when it comes to protect my own right, no one can do a better job than me. Not even mentioned that I have backup too. Please make sure that all communication is confidential. Yes, I am concern about the increase of waist size and wrinkles around my nose area. What can I do about it?


What is your response time for email consultation?
The average response time for email consultation is 12-24 hours on week days. We are closed on the weekend. If in any case you do not get an response within 24 hours with proof, we will extend your membership free for 7 days.

Example , Patient BB

Name: BB
Date of Birth: 12.31.1942
Gender: M
Email: yourname@yourname.com
Weight: 170 pounds or 77 kg
Allergies: Penicillin, Bactrim DS® (Sulfamethoxazole/Trimethoprim)
Medical Conditions: Anemia, Anxiety, Gout
Current Medication Taken: Tofranil® (Imipramine) 10 mg at bed time, Xanax® (Alprazolam) 0.5 mg 3 times a day, Paxil® (Paroxetine) 20 mg every day, Iron tablet Ferrous Sulphate 345 mg 2 times a day, Zyloprim® (Allopurinol) 100 mg every day

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BB: Why I only sleep 4 hours at bedtime and the anxiety is worsen in the morning? Can I mix the Iron tablet with other medicines that I am currently on? I had been feeling extremely tired for the last 2 months. The cold infection does not go away after couple treatments. I was on three courses of antibiotics by three physicians: Amoxicillin 500 mg 3 times a day for 10 days, then Keflexâ (Cephalexin) 500 mg 3 times a day for 10 days, and finally Augmentinâ 750 mg 2 times a day for 10 days. The cold infection was finally gone. My temper is extremely bad when I go to work in the morning but it get better after taking Xanaxâ 0.5 mg at 7:30 am. It is going to affect my work performance since all of my employee does not like me in the office. I am afraid that I may lose my job. After seeing three physicians for the cold and tiredness, although the infection was gone, I am still feeling very tired. extreme fatigue all day long. What is your evaluation, Dr. Chan?

Dr. Chan: You can mix the iron tablet with Paxilâ, Xanaxâ and Zyloprimâ. But the iron tablets may make you constipated and turn your stools dark black. This is a very common side effect and taking with food may help you for constipation. How long you have been on Xanaxâ and Paxilâ for anxiety? What kind of anxiety do you have? Is it for height, for particular person or for social occasion? How long you have been on the Zyloprimâ? Did your physician have a blood work done on your recently?

BB: I have been on Xanaxâ for about 8 months, Paxilâ for 2 weeks and have been hospitalized for anxiety 2 times in last 6 months. I fear for the social occasion or meeting people. Zyloprimâ is for my gout; I am on this drug for more than 2 years now. My family physician did a blood test on me 1 month ago; then she putted me on Iron tablet.

Dr. Chan: Are you using Xanaxâ as needed or on a regular basis? One of the rare but significant side effects of Zyloprimâ is bone marrow suppression. You may feel extreme tiredness and prone to frequent infections too. If your physician has a blood work done on you, she may have noticed some unusually change in your lab report. Can you fax your lab result to me? Taking the Iron tablet only help your anemia. I would really like to see your lab report for a more comprehensive evaluation.

BB: The Xanaxâ is taken only as needed three times a day if I have the anxiety symptom, or bad temper. What should I do now for the Zyloprimâ, I am afraid to take it any more?

Dr. Chan: Regarding your question of sleeping only 4 hours at night, you physician may increase the dose of Tofranilâ to help you sleep. Tofranilâ 10 mg at bedtime is a very low dose. Your physician can go up to 25 mg or even 50 mg at bedtime. Also, good sleep habit is essential to have a refreshing sleep. Good sleep habits like regular sleep hours, no heavy meals before sleep, mild but not vigorous exercise before sleep can help you go to sleep faster and easier. Please remember to make your room dark and a comfortable bed is a must too. Your anxiety worsen in the morning may be due to your short 4 hours sleeping time. Therefore, you have to take the Xanaxâ 0.5 mg in the morning to control the anxiety. Yet, the Xanaxâ will impair your motor skills. Do not drive if you are on Xanaxâ as you may have an accident because of the drug.

BB: I only use Xanaxâ when I have a bad temper or anxiety. Not before driving or when I go to work. But I will keep that in mind for safety. Let me take this evaluation to see my physician and fax the lab result to you. Is the Paxilâ 20 mg good for my anxiety? I saw the ads on TV and ask my physician to prescribe to me. I have been using it for 2 weeks now but not feeling any better. Why?

Dr. Chan: Paxilâ is classified as Selective Serotonin Reuptake Inhibitor (SSRI) like the popular Prozacâ, and it is also approved for Social Anxiety Disorder. When using this class of medication for your anxiety, you have to take it up to 4 weeks or longer to experience the full response. So, please be patient on Paxilâ. Paxilâ 20 mg every day is a good starting dose. You should take it in the morning unless you have significant drowsiness form Paxilâ. I am glad that my evaluation helps you. Regarding your lab report, you are mild anemic with unusual low white cell count and blood abnormalities consistence with bone marrow suppression. If you experience unusual bleeding, please call you physician as soon as possible. I strongly recommended you to let your current doctor aware of stopping Zyloprimâ and seek second physician opinion for your bone marrow suppression treatment.

BB: I am seeing a new physician now and she stops my Zyloprimâ immediately. Also, she gives me an injection twice weekly in her office with very frequent lab analysis for follow up. Thanks for helping me out here. Some of my friends will be contacting you soon for consultation.



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