Aa
Knee isues
How bad is my MRI results?
Imaging updates:
7/9/2013 knee MRI
Impression:
Right knee
1. Oblique undersurface tear of the body, posterior horn, and
root of the medial meniscus. Free edge tear of the body of the
lateral meniscus with undersurface extension into the posterior
horn. 2. Intact cruciate ligaments. 3. Tricompartmental
cartilage loss and findings consistent with CPPD. 4. Subchondral
degenerative changes are. No evidence of insufficiency fracture.
Left knee
1. Horizontal tear involving the entire medial meniscus with
undersurface involvement of the posterior horn and root. Intact
lateral meniscus. 2. Intact cruciate ligaments. 3.
Patellofemoral and medial compartment cartilage loss and findings
consistent with CPPD.
Imaging updates:
7/9/2013 knee MRI
Impression:
Right knee
1. Oblique undersurface tear of the body, posterior horn, and
root of the medial meniscus. Free edge tear of the body of the
lateral meniscus with undersurface extension into the posterior
horn. 2. Intact cruciate ligaments. 3. Tricompartmental
cartilage loss and findings consistent with CPPD. 4. Subchondral
degenerative changes are. No evidence of insufficiency fracture.
Left knee
1. Horizontal tear involving the entire medial meniscus with
undersurface involvement of the posterior horn and root. Intact
lateral meniscus. 2. Intact cruciate ligaments. 3.
Patellofemoral and medial compartment cartilage loss and findings
consistent with CPPD.
had to split it up
DATE: June 24, 2013 at 1137 hours
COMPARISON: The lateral knee radiographs 4/1/2010
HISTORY: 48-year-old male with bilateral knee pain
FINDINGS: Right knee. There is chondrocalcinosis within the
medial and lateral compartments. There is decreased medial
compartment joint space. There are marginal osteophytes medial,
lateral, and patellofemoral compartments. There is subchondral
cyst formation of the lateral knee. There is increased sclerosis
of the medial femoral condyle which is out of proportion with the
degenerative changes. This is concerning for spontaneous
osteonecrosis of the knee, however is stable compared to the
prior study. The medial meniscus protrudes medially suggesting a
meniscal tear. There is a fabella. No effusion. No acute
fracture. Vascular calcifications.
Left knee. Chondrocalcinosis within the medial compartment.
There is normal joint space. There are small marginal osteophytes
of the 3 compartments. A fabella. No effusion. No acute fracture.
Vascular calcifications.
Impression:
Right knee. 1. Increased sclerosis and subcortical cyst
formation and the medial femoral condyle may be degenerative or
may represent an area of SONK, similar exam from April 12, 2010.
2. Moderate tricompartmental osteoarthritis, mildly progressed.
3. Chondrocalcinosis. 4. Atherosclerosis.
Left knee. 1. Mild tricompartmental osteoarthritis, similar to
the prior study. 2. Chondrocalcinosis. 3. Atherosclerosis.
COMPARISON: The lateral knee radiographs 4/1/2010
HISTORY: 48-year-old male with bilateral knee pain
FINDINGS: Right knee. There is chondrocalcinosis within the
medial and lateral compartments. There is decreased medial
compartment joint space. There are marginal osteophytes medial,
lateral, and patellofemoral compartments. There is subchondral
cyst formation of the lateral knee. There is increased sclerosis
of the medial femoral condyle which is out of proportion with the
degenerative changes. This is concerning for spontaneous
osteonecrosis of the knee, however is stable compared to the
prior study. The medial meniscus protrudes medially suggesting a
meniscal tear. There is a fabella. No effusion. No acute
fracture. Vascular calcifications.
Left knee. Chondrocalcinosis within the medial compartment.
There is normal joint space. There are small marginal osteophytes
of the 3 compartments. A fabella. No effusion. No acute fracture.
Vascular calcifications.
Impression:
Right knee. 1. Increased sclerosis and subcortical cyst
formation and the medial femoral condyle may be degenerative or
may represent an area of SONK, similar exam from April 12, 2010.
2. Moderate tricompartmental osteoarthritis, mildly progressed.
3. Chondrocalcinosis. 4. Atherosclerosis.
Left knee. 1. Mild tricompartmental osteoarthritis, similar to
the prior study. 2. Chondrocalcinosis. 3. Atherosclerosis.
harshaw, michael wayne CONFIDENTIAL Page 13 of 20
EXAM: MR Lumbosacral spine without IV contrast dated 4/11/2013
at 1516 hours
COMPARISON: Lumbar spine radiographs dated 1/26/2012
INDICATION: 48-year-old male with low back pain
TECHNIQUE: Axial T1 and T2, and sagittal T1, T2, and STIR
sequences were performed.
FINDINGS: The lumbosacral spine is normal in alignment. There is
mild anterior wedging of T12 which appears chronic. The conus
medullaris is visualized at the L1 level. No evidence of
intrinsic or extrinsic spinal cord lesions. The bone marrow
signal is heterogeneous. There is disc desiccation and L1-L2,
L3-L4, L4-L5, and L5-S1 and mild associated height loss at L1-L2
harshaw, michael wayne CONFIDENTIAL Page 15 of 20
and L5-S1. Incidental note of a fatty phylum.
Axial images were obtained from L1 through S1.
L1-L2: There is a mild disc bulge. No significant neural
foraminal narrowing or spinal canal stenosis.
L2-L3: There is no evidence of disc bulge. No significant neural
foraminal narrowing or spinal canal stenosis.
L3-L4: There is mild diffuse disc bulge causing mild bilateral
neural foraminal narrowing. No significant spinal canal stenosis.
L4-L5: There is mild diffuse disc bulge and mild bilateral facet
and ligamentum flavum hypertrophy causing mild bilateral neural
foraminal narrowing. No significant spinal canal stenosis.
L5-S1: Diffuse disc bulge, asymmetric to the left anterior
aspect. No significant neural foraminal narrowing or spinal canal
stenosis.
Impression:
Mild degenerative changes of the lumbosacral spine as described
above.
S
EXAMINATION: Magnetic resonance imaging of the left shoulder
without intravenous contrast.
DATE: March 22, 2013 at 1426 hours
COMPARISON: Plain radiographs of the shoulder from February 7,
2013.
HISTORY: Patient is a 48-year-old male with a history
degenerative joint disease. Presenting for evaluation.
TECHNIQUE: The examination was performed on a 1.5 Tesla magnetic
resonance imaging scanner using the following sequences: Axial T2
medic, axial proton density. Coronal proton density, STIR, and
T2. Sagittal proton density, T2 fat-sat, and T2.
FINDINGS:
ROTATOR CUFF, LIGAMENTS, TENDONS, AND MUSCLES: There is abnormal
T2 hyperintense signal changes within the supraspinatus,
infraspinatus tendons. The tendons however remain intact.
The long head of the biceps tendon is intact.
There is mild atrophy of the teres minor.
GLENOHUMERAL JOINT: The joint is normally aligned. The anterior
and posterior labrum are intact. The articular cartilage is
intact. There is no joint effusion.
ACROMIOCLAVICULAR JOINT: The joint is normally aligned. There is
joint space narrowing of the acromioclavicular joint with
associated subchondral cystic changes. However, there is no
significant osteophytosis.
BONE: There is unremarkable bone marrow signal. Specifically,
negative for fracture, osteomyelitis, osteonecrosis, or marrow
replacing process.
BURSAE AND SOFT TISSUES: The bursae and soft tissue surrounding
the shoulder are unremarkable.
Impression:
1. Supraspinatus and infraspinatus tendinopathy however, the
tendons remain intact.
2. Mild degenerative joint disease of the acromioclavicular joint
without large osteophytes.
I
DATE: June 24, 2013 at 1137 hours
COMPARISON: The lateral knee radiographs 4/1/2010
HISTORY: 48-year-old male with bilateral knee pain
FINDINGS: Right knee. There is chondrocalcinosis within the
medial and lateral compartments. There is decreased medial
compartment joint space. There are marginal osteophytes medial,
lateral, and patellofemoral compartments. There is subchondral
cyst formation of the lateral knee. There is increased sclerosis
of the medial femoral condyle which is out of proportion with the
degenerative changes. This is concerning for spontaneous
osteonecrosis of the knee, however is stable compared to the
prior study. The medial meniscus protrudes medially suggesting a
meniscal tear. There is a fabella. No effusion. No acute
fracture. Vascular calcifications.
Left knee. Chondrocalcinosis within the medial compartment.
There is normal joint space. There are small marginal osteophytes
of the 3 compartments. A fabella. No effusion. No acute fracture.
Vascular calcifications.
Impression:
Right knee. 1. Increased sclerosis and subcortical cyst
formation and the medial femoral condyle may be degenerative or
may represent an area of SONK, similar exam from April 12, 2010.
2. Moderate tricompartmental osteoarthritis, mildly progressed.
3. Chondrocalcinosis. 4. Atherosclerosis.
Left knee. 1. Mild tricompartmental osteoarthritis, similar to
the prior study. 2. Chondrocalcinosis. 3. Atherosclerosis.
COMPARISON: The lateral knee radiographs 4/1/2010
HISTORY: 48-year-old male with bilateral knee pain
FINDINGS: Right knee. There is chondrocalcinosis within the
medial and lateral compartments. There is decreased medial
compartment joint space. There are marginal osteophytes medial,
lateral, and patellofemoral compartments. There is subchondral
cyst formation of the lateral knee. There is increased sclerosis
of the medial femoral condyle which is out of proportion with the
degenerative changes. This is concerning for spontaneous
osteonecrosis of the knee, however is stable compared to the
prior study. The medial meniscus protrudes medially suggesting a
meniscal tear. There is a fabella. No effusion. No acute
fracture. Vascular calcifications.
Left knee. Chondrocalcinosis within the medial compartment.
There is normal joint space. There are small marginal osteophytes
of the 3 compartments. A fabella. No effusion. No acute fracture.
Vascular calcifications.
Impression:
Right knee. 1. Increased sclerosis and subcortical cyst
formation and the medial femoral condyle may be degenerative or
may represent an area of SONK, similar exam from April 12, 2010.
2. Moderate tricompartmental osteoarthritis, mildly progressed.
3. Chondrocalcinosis. 4. Atherosclerosis.
Left knee. 1. Mild tricompartmental osteoarthritis, similar to
the prior study. 2. Chondrocalcinosis. 3. Atherosclerosis.
harshaw, michael wayne CONFIDENTIAL Page 13 of 20
EXAM: MR Lumbosacral spine without IV contrast dated 4/11/2013
at 1516 hours
COMPARISON: Lumbar spine radiographs dated 1/26/2012
INDICATION: 48-year-old male with low back pain
TECHNIQUE: Axial T1 and T2, and sagittal T1, T2, and STIR
sequences were performed.
FINDINGS: The lumbosacral spine is normal in alignment. There is
mild anterior wedging of T12 which appears chronic. The conus
medullaris is visualized at the L1 level. No evidence of
intrinsic or extrinsic spinal cord lesions. The bone marrow
signal is heterogeneous. There is disc desiccation and L1-L2,
L3-L4, L4-L5, and L5-S1 and mild associated height loss at L1-L2
harshaw, michael wayne CONFIDENTIAL Page 15 of 20
and L5-S1. Incidental note of a fatty phylum.
Axial images were obtained from L1 through S1.
L1-L2: There is a mild disc bulge. No significant neural
foraminal narrowing or spinal canal stenosis.
L2-L3: There is no evidence of disc bulge. No significant neural
foraminal narrowing or spinal canal stenosis.
L3-L4: There is mild diffuse disc bulge causing mild bilateral
neural foraminal narrowing. No significant spinal canal stenosis.
L4-L5: There is mild diffuse disc bulge and mild bilateral facet
and ligamentum flavum hypertrophy causing mild bilateral neural
foraminal narrowing. No significant spinal canal stenosis.
L5-S1: Diffuse disc bulge, asymmetric to the left anterior
aspect. No significant neural foraminal narrowing or spinal canal
stenosis.
Impression:
Mild degenerative changes of the lumbosacral spine as described
above.
S
EXAMINATION: Magnetic resonance imaging of the left shoulder
without intravenous contrast.
DATE: March 22, 2013 at 1426 hours
COMPARISON: Plain radiographs of the shoulder from February 7,
2013.
HISTORY: Patient is a 48-year-old male with a history
degenerative joint disease. Presenting for evaluation.
TECHNIQUE: The examination was performed on a 1.5 Tesla magnetic
resonance imaging scanner using the following sequences: Axial T2
medic, axial proton density. Coronal proton density, STIR, and
T2. Sagittal proton density, T2 fat-sat, and T2.
FINDINGS:
ROTATOR CUFF, LIGAMENTS, TENDONS, AND MUSCLES: There is abnormal
T2 hyperintense signal changes within the supraspinatus,
infraspinatus tendons. The tendons however remain intact.
The long head of the biceps tendon is intact.
There is mild atrophy of the teres minor.
GLENOHUMERAL JOINT: The joint is normally aligned. The anterior
and posterior labrum are intact. The articular cartilage is
intact. There is no joint effusion.
ACROMIOCLAVICULAR JOINT: The joint is normally aligned. There is
joint space narrowing of the acromioclavicular joint with
associated subchondral cystic changes. However, there is no
significant osteophytosis.
BONE: There is unremarkable bone marrow signal. Specifically,
negative for fracture, osteomyelitis, osteonecrosis, or marrow
replacing process.
BURSAE AND SOFT TISSUES: The bursae and soft tissue surrounding
the shoulder are unremarkable.
Impression:
1. Supraspinatus and infraspinatus tendinopathy however, the
tendons remain intact.
2. Mild degenerative joint disease of the acromioclavicular joint
without large osteophytes.
I
Doc this is my mri and xrays of my back and knees. I would like to now how bad all of this is?
COMPARISON: Bilateral knee radiographs June 25, 2013
HISTORY: The patient is a 48-year-old man who has right knee pain
with popping and buckling.
MENISCI: The There is an oblique undersurface tear involving the
body, posterior horn, and root of the medial meniscus.
There is a free edge tear of the body of the lateral meniscus
with horizontal undersurface extension into the posterior horn.
LIGAMENTS AND TENDONS:
The anterior and posterior cruciate ligaments are intact.
The medial collateral ligament is intact.
The iliotibial band, mid third lateral capsular ligament, fibular
collateral ligament, biceps femoris tendon and conjoined tendon
are intact.
The quadriceps tendon and patellar ligament are intact.
The muscles and tendons of the pes anserinus group and
semimembranosus are intact
JOINT:
There is irregularity and and blooming artifact seen in the
lateral patellar cartilage. There is diffuse thinning of greater
than 50% of the medial patellar cartilage. There is diffuse
cartilage thinning of greater than 50% thickness within the
medial compartment with a 2 cm focal area of cartilage loss at
harshaw, michael wayne CONFIDENTIAL Page 6 of 20
the weight-bearing surface. There is associated cortical
irregularity of the medial femoral condyle. There is mild diffuse
cartilage thinning of less than 50% thickness in the lateral
compartment.
No effusion.
BONE:
The bones all have normal configuration.
There is abnormal marrow signal and cystic change of the medial
femoral condyle, lateral femoral condyle, and posterior lateral
tibial plateau. There is no evidence of insufficiency fractures.
There is linear abnormal signal involving the lateral most aspect
of the lateral femoral condyle and extending to the distal
femoral metaphysis and diaphysis which is likely sequelae of
prior surgery.
BURSAE AND SOFT TISSUES:
No Bakers cyst.
Impression:
Right knee
1. Oblique undersurface tear of the body, posterior horn, and
root of the medial meniscus. Free edge tear of the body of the
lateral meniscus with undersurface extension into the posterior
horn. 2. Intact cruciate ligaments. 3. Tricompartmental
cartilage loss and findings consistent with CPPD. 4. Subchondral
degenerative changes are. No evidence of insufficiency fracture.
MENISCI:
There is a horizontal tear of the entire medial meniscus with
undersurface involvement of the posterior horn and root. A 5 x 3
x 15 mm parameniscal cyst is present.
The lateral meniscus is intact.
LIGAMENTS AND TENDONS:
The anterior and posterior cruciate ligaments are intact.
The medial collateral ligament is intact.
The lateral collateral ligament is thickened but intact and may
represent a remote strain. The iliotibial band, mid third lateral
capsular ligament, biceps femoris tendon and conjoined tendon are
intact.
The quadriceps tendon and patellar ligament are intact.
The muscles and tendons of the pes anserinus group and
semimembranosus are intact
JOINT:
There is blooming artifact and cartilage irregularity seen in the
patellofemoral cartilage. There is mild, less than 50% thickness
thinning of the medial compartment cartilage. Lateral compartment
cartilage is unremarkable.
No effusion.
BONE:
The bones all have normal configuration.
The bone marrow signal is within normal limits. Specifically,
negative for fracture, osteomyelitis, osteonecrosis, or marrow
replacing process.
BURSAE AND SOFT TISSUES:
No Bakers cyst.
Impression:
Left knee
1. Horizontal tear involving the entire medial meniscus with
undersurface involvement of the posterior horn and root. Intact
lateral meniscus. 2. Intact cruciate ligaments. 3.
Patellofemoral and medial compartment cartilage loss and findings
consistent with CPPD.
HISTORY: 48-year-old male with bilateral knee pain
FINDINGS: Right knee. There is chondrocalcinosis within the
medial and lateral compartments. There is decreased medial
compartment joint space. There are marginal osteophytes medial,
lateral, and patellofemoral compartments. There is subchondral
cyst formation of the lateral knee. There is increased sclerosis
of the medial femoral condyle which is out of proportion with the
degenerative changes. This is concerning for spontaneous
osteonecrosis of the knee, however is stable compared to the
prior study. The medial meniscus protrudes medially suggesting a
meniscal tear. There is a fabella. No effusion. No acute
fracture. Vascular calcifications.
Left knee. Chondrocalcinosis within the medial compartment.
There is normal joint space. There are small marginal osteophytes
of the 3 compartments. A fabella. No effusion. No acute fracture.
Vascular calcifications.
Impression:
Right knee. 1. Increased sclerosis and subcortical cyst
formation and the medial femoral condyle may be degenerative or
may represent an area of SONK, similar exam from April 12, 2010.
2. Moderate tricompartmental osteoarthritis, mildly progressed.
3. Chondrocalcinosis. 4. Atherosclerosis.
Left knee. 1. Mild tricompartmental osteoarthritis, similar to
the prior study. 2. Chondrocalcinosis. 3. Atherosclerosis.
COMPARISON: Bilateral knee radiographs June 25, 2013
HISTORY: The patient is a 48-year-old man who has right knee pain
with popping and buckling.
MENISCI: The There is an oblique undersurface tear involving the
body, posterior horn, and root of the medial meniscus.
There is a free edge tear of the body of the lateral meniscus
with horizontal undersurface extension into the posterior horn.
LIGAMENTS AND TENDONS:
The anterior and posterior cruciate ligaments are intact.
The medial collateral ligament is intact.
The iliotibial band, mid third lateral capsular ligament, fibular
collateral ligament, biceps femoris tendon and conjoined tendon
are intact.
The quadriceps tendon and patellar ligament are intact.
The muscles and tendons of the pes anserinus group and
semimembranosus are intact
JOINT:
There is irregularity and and blooming artifact seen in the
lateral patellar cartilage. There is diffuse thinning of greater
than 50% of the medial patellar cartilage. There is diffuse
cartilage thinning of greater than 50% thickness within the
medial compartment with a 2 cm focal area of cartilage loss at
harshaw, michael wayne CONFIDENTIAL Page 6 of 20
the weight-bearing surface. There is associated cortical
irregularity of the medial femoral condyle. There is mild diffuse
cartilage thinning of less than 50% thickness in the lateral
compartment.
No effusion.
BONE:
The bones all have normal configuration.
There is abnormal marrow signal and cystic change of the medial
femoral condyle, lateral femoral condyle, and posterior lateral
tibial plateau. There is no evidence of insufficiency fractures.
There is linear abnormal signal involving the lateral most aspect
of the lateral femoral condyle and extending to the distal
femoral metaphysis and diaphysis which is likely sequelae of
prior surgery.
BURSAE AND SOFT TISSUES:
No Bakers cyst.
Impression:
Right knee
1. Oblique undersurface tear of the body, posterior horn, and
root of the medial meniscus. Free edge tear of the body of the
lateral meniscus with undersurface extension into the posterior
horn. 2. Intact cruciate ligaments. 3. Tricompartmental
cartilage loss and findings consistent with CPPD. 4. Subchondral
degenerative changes are. No evidence of insufficiency fracture.
MENISCI:
There is a horizontal tear of the entire medial meniscus with
undersurface involvement of the posterior horn and root. A 5 x 3
x 15 mm parameniscal cyst is present.
The lateral meniscus is intact.
LIGAMENTS AND TENDONS:
The anterior and posterior cruciate ligaments are intact.
The medial collateral ligament is intact.
The lateral collateral ligament is thickened but intact and may
represent a remote strain. The iliotibial band, mid third lateral
capsular ligament, biceps femoris tendon and conjoined tendon are
intact.
The quadriceps tendon and patellar ligament are intact.
The muscles and tendons of the pes anserinus group and
semimembranosus are intact
JOINT:
There is blooming artifact and cartilage irregularity seen in the
patellofemoral cartilage. There is mild, less than 50% thickness
thinning of the medial compartment cartilage. Lateral compartment
cartilage is unremarkable.
No effusion.
BONE:
The bones all have normal configuration.
The bone marrow signal is within normal limits. Specifically,
negative for fracture, osteomyelitis, osteonecrosis, or marrow
replacing process.
BURSAE AND SOFT TISSUES:
No Bakers cyst.
Impression:
Left knee
1. Horizontal tear involving the entire medial meniscus with
undersurface involvement of the posterior horn and root. Intact
lateral meniscus. 2. Intact cruciate ligaments. 3.
Patellofemoral and medial compartment cartilage loss and findings
consistent with CPPD.
HISTORY: 48-year-old male with bilateral knee pain
FINDINGS: Right knee. There is chondrocalcinosis within the
medial and lateral compartments. There is decreased medial
compartment joint space. There are marginal osteophytes medial,
lateral, and patellofemoral compartments. There is subchondral
cyst formation of the lateral knee. There is increased sclerosis
of the medial femoral condyle which is out of proportion with the
degenerative changes. This is concerning for spontaneous
osteonecrosis of the knee, however is stable compared to the
prior study. The medial meniscus protrudes medially suggesting a
meniscal tear. There is a fabella. No effusion. No acute
fracture. Vascular calcifications.
Left knee. Chondrocalcinosis within the medial compartment.
There is normal joint space. There are small marginal osteophytes
of the 3 compartments. A fabella. No effusion. No acute fracture.
Vascular calcifications.
Impression:
Right knee. 1. Increased sclerosis and subcortical cyst
formation and the medial femoral condyle may be degenerative or
may represent an area of SONK, similar exam from April 12, 2010.
2. Moderate tricompartmental osteoarthritis, mildly progressed.
3. Chondrocalcinosis. 4. Atherosclerosis.
Left knee. 1. Mild tricompartmental osteoarthritis, similar to
the prior study. 2. Chondrocalcinosis. 3. Atherosclerosis.
MEDICAL PROFESSIONAL
Hi!
Usually oblique and horizontal tears of the medial meniscus involve the white portion of the medial meniscus and are not fully repairable. The tear in the red zone of medial meniscus will heal with rest, elevation, ice and compression, followed by physiotherapy. However, usually since big tears do not repair fully, partial or complete removal of meniscus (meniscectomy) is performed.
Also there is evidence of Calcium pyrophosphate dihydrate disease (CPPD) deposition or chondrocalcinosis or pseudogout. It is usually treated with non-steroidal anti-inflammatory drugs (NSAIDs), intra-articular or systemic corticosteroids, or, high-dose colchicine. Please consult an orthopedic specialist. Take care!
The medical advice given should not be considered a substitute for medical care provided by a doctor who can examine you. The advice may not be completely correct for you as the doctor cannot examine you and does not know your complete medical history. Hence this reply to your post should only be considered as a guiding line and you must consult your doctor at the earliest for your medical problem.
Usually oblique and horizontal tears of the medial meniscus involve the white portion of the medial meniscus and are not fully repairable. The tear in the red zone of medial meniscus will heal with rest, elevation, ice and compression, followed by physiotherapy. However, usually since big tears do not repair fully, partial or complete removal of meniscus (meniscectomy) is performed.
Also there is evidence of Calcium pyrophosphate dihydrate disease (CPPD) deposition or chondrocalcinosis or pseudogout. It is usually treated with non-steroidal anti-inflammatory drugs (NSAIDs), intra-articular or systemic corticosteroids, or, high-dose colchicine. Please consult an orthopedic specialist. Take care!
The medical advice given should not be considered a substitute for medical care provided by a doctor who can examine you. The advice may not be completely correct for you as the doctor cannot examine you and does not know your complete medical history. Hence this reply to your post should only be considered as a guiding line and you must consult your doctor at the earliest for your medical problem.
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