How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Anthony Bray, MD Your Own Question

Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6852
Experience:  14 years as clinician in the field of Family Practice
13781349
Type Your Health Question Here...
Anthony Bray, MD is online now
A new question is answered every 9 seconds

Will you answer this question http://www.justanswer.com

Customer Question

Will you answer this question

http://www.justanswer.com/medical/7wqtk-does-elevated-gastrin-cause-ulcers.html
Submitted: 1 year ago.
Category: Health
Expert:  Anthony Bray, MD replied 1 year ago.

Anthony Bray MD : Hello!!
Anthony Bray MD : elevated gastrin levels would be expected to be associated with elevated stomach acid levels....
Anthony Bray MD : so >> yes there would be an association of elevated gastrin levels and an increased re fancy or risk if stomach ulcer development....
Anthony Bray MD : I hope this helps! Let me know if you have further questions. I will be happy to get back with you!
Anthony Bray MD : best regards!
Anthony Bray MD : Anthony Bray MD
Customer: What can you tell me about hemorrhagic cystitis
Customer: ?.
Anthony Bray MD : Hello again,
Anthony Bray MD : were you diagnosed with this as your cause of the bleeding??
Anthony Bray MD : this problem is sometimes caused by certain medications but also may be caused by certain infections....
Anthony Bray MD : in your case I suspected infection as the cause. This then should heal as the infection clears...
Anthony Bray MD : it does need follow up to make sure that the blood in the urine has cleared...
Anthony Bray MD : The urologist potentially may need to evaluate the bladder if the blood persists unexpectedly...
Anthony Bray MD : kidney stones, bladder stones and more serious causes such as bladder cancer may need to be ruled out...
Anthony Bray MD : the cancer scenario would not be the more common cause but of course would be the most serious...
Anthony Bray MD : i think that in your case you had a urinary tract infection that caused erosions waitin the bladder....
Anthony Bray MD : in this scenario the erosions should heal and not take that long... Probably no more bleeding by 2-3 weeks out...
Anthony Bray MD : I hope this helps!
Anthony Bray MD : Let me know if you have further questions!!
Anthony Bray MD : best regards !
Anthony Bray MD : Anthony Bray MD
Customer: I was dx with uti a week ago tuesdAy put on macrobid. Then sarurdsy was peeing clots of blood. Mondaybad a ua that showed 3+ blood and 30-50 rbc
Customer: But its still not better
Anthony Bray MD : Hello again,
Anthony Bray MD : The UTI is probably the cause of your bleeding... I would say that the UTI and the bleeding need follow up....
Anthony Bray MD : you may need to finish the initial course of Macrobid and then follow up to confirm that it has cleared. If not then a repeat course of antibiotic would be indicated
Anthony Bray MD : The urine would be in need of follow up to make sure that abnormal presence of blood had cleared...
Anthony Bray MD : I would expect that the blood in the tribe will most likely clear as your bladder has more time to heal from recent infection.
Anthony Bray MD : i hope that this information helps. Let me know if you have further questions. Best regards,
Anthony Bray MD : Anthony Bray MD
Customer: I finished macrobid tueaday and i finished cipro this am
Anthony Bray MD : Then I would advise that you have the follow up check early this next week...hopefully both the UTI and the blood has cleared....
Anthony Bray MD : Let me know if you have anything further.
Anthony Bray MD : Best Regards,
Anthony Bray MD : Anthony Bray MD
Customer: So do a repeat ua? What if theres still blood
Anthony Bray MD : It would depend on the extent....if less blood then I would advocate a repeat follow up in another week...if still 50 rbcs/hpf then a urologist referral and cystoscopy wpould be my recommendation...
Anthony Bray MD : I hope that this helps...Let me know if you have further questions....
Customer: I refuse to havr a cystoscopy
Anthony Bray MD : Well that is your choice.....I hope tthat will be no real need for it...
Anthony Bray MD : Best Regards,
Customer: Are you awake for a cystoscopy
Anthony Bray MD : Yes....yyou would be treated and sedated though....
Anthony Bray MD : you could discuss options for sedation with urologist...
Anthony Bray MD : They may offer more complete sedation in cerrtain facilities such as outpatient surgical centers....
Anthony Bray MD : I hope this helps!
Anthony Bray MD : Let me know if you have further questions...
Anthony Bray MD : Best Regards
Anthony Bray MD : Anthony Bray MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6852
Experience: 14 years as clinician in the field of Family Practice
Anthony Bray, MD and 3 other Health Specialists are ready to help you
Customer: replied 1 year ago.
I have a question. When i had the EUS do you thimk it was necessary to be given all these meds?

PROPOFOL INJ. 1000 MG INT2 1 UNITS $116.10
LIDOCAINE 2% 5ML 1 UNITS $76.00
FENTANYL SYRING 100 MCG UD1 1 UNITS $88.60
MIDAZOLAM SYRINGE. 2 MG UD4 1 UNITS $89.50
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

That actually looks standard and normal for that kind or procedure.(As you know though I am in family practice and so I am not personally performing these pocedures) Thee cocktail you list looks standard to me however....

I hope this is helpful. I hope that you are feeling better both with regard to your stomach and recent UTI...

Take Care,

Anthony Bray MD
Customer: replied 1 year ago.
Whats the difference between family practice dr and internal med dr
Expert:  Anthony Bray, MD replied 1 year ago.
Hello!

Internal medicine and Family practice residency training programs have much overlap. Many of the same type training rotations are covered by both. FP includes training in obstetrics and gynecology and pediatrics. FP has more emphasis on outpatient type problems. Internal medicine would have more intense training in inpatient care and more ICU rotations .

I hope this helps to clarify. Best regards!

Anthony Bray MD
Customer: replied 1 year ago.
Whuch would you suggest i see
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,
Well I think that either is fine but it may depend on your particular needs. If you wish to go to an internal medicine doctor or a family practice doctor then this would serve you well in general for primary care. We FP's do have more training in gynecology for example so if you wanted an FP to take care of routine gyn care such as annual Pap smear then that would be fine. Although all FP's train in obstetrics( in residency I delivered between 50 to 60 babies) most if us in FP do not maintain ongoing practice in obstetrics( some do an added year fellowship in obstetrics and train to do C- sections...)

So as I said it depends on your needs. An FP OR IM doc would treat you primarily for your ulcers or UTI but may refer to the GI specialist in cases needing additional care or procedures such as the upper endoscopy. Similar for the UTI we treat UTI's all the time but the bleeding into the urine if a persisting issue we would consult a urologist. That's basically similar operating procedure for an IM PCP or an FP PCP...

I hope this is helpful! Best regards!

Anthony Bray MD
Customer: replied 1 year ago.
That doesnt help me much. I see ob/gyn for my yearly pap.
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Well I strongly believe in you seeking a doctor with you you feel a strong sense of trust. I think that you should have a positive "gut feeling" with regard to your primary care doctor or specialist. I encourage patients to listen to their instincts when you feel that you may be being " blown off" or otherwise not receiving the best care. I think the individual and the competence of a given doctor would matter to me more so than FP or IM.

My own primary care doctor is FP. Believe me though I know colleagues that I have known to be incompetent or otherwise give very poor care. I know good and bad >> this applies to FP's, IM's and specialists !!!

So as a nurse I would think that you get good input as to the quality if local doctors( we always take things with a grain of salt of course!) being in the medical community should be a help for you to learn who is a good physician vs whom to avoid... Talk with your peers and keep notice as to patient responses... That is usually helpful to help learn the strengths and weaknesses within the local doctor selection.

I also know an excellent cardiologist but with a not so great " bedside manner" reputation.. So there becomes a link with the type of person that I refer to this individual...

I hope this helps some. I wish you the best in selecting good providers as you progress into your future. Take care !

Anthony Bray MD
Customer: replied 1 year ago.
Im thinking of seeing an internal med nurse practioner
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

That would be fine. As I said look to your sense of how well you are being listened to and treated!! A good combination of attention to detail, medical competence, a lack of arrogance, plus a good sense if empathy would be the sort of qualities that I feel would serve you well. I hope this is helpful.

Take care and enjoy the rest of your weekend!

Anthony Bray MD
Customer: replied 1 year ago.
Dr bray im having blood in my vomit again
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

How much have you been vomiting?? This blood could be from the ulcers but may be from injuries at the junction of the stomach and esophagus = Mallory- Weiss tear... This is a common cause if blood in the vomit as well.

Of course with this problem the extent if bleeding is critically important. If you are having signs of large volume of bleeding such as large amounts of coffee ground appearing vomitus or concerning symptoms of possible blood loss such as weakness, light headed sensation, racing of the heart>> then these type concerning symptoms may drive you to need further evaluation at the ER. You are a nurse so this should be an advantage to help you in this type decision.

I am not out to try to get you to go to the ER unnecessarily but do go when you really need to!! I hope this makes sense!

I am sorry that this remains a problem for you! Use Zofran for nausea if you have any. As I have told you I am a fan of Carafate but I recall that your gastroenterologist is not... Use this if it is available to you!

I hope this helps! Let me know if you have further questions or problems and I will be happy to get back with you! Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
I dont want to be scoped again
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

I understand that !! The main point as you know is to determine a relatively minor source of bleeding such as a Mallory - Weiss tear vs a major bleed. A major bleed could be fatal-- you at worst might need intervention -- transfusion and potentially procedures to control the bleeding. More often in a case such as yours the bleeding does not rise to this level of severity. It would be more common to see more limited bleeding. It does become an open ended problem in that if you vomited some blood say 3 tablespoons estimate then that would not require ER visit or intervention at this time..

If you later had more severe development if symptoms such as vomiting more than an estimated cup in volume if frank blood or coffee ground material then you would need to get to the EE... It is going to be a watch this very carefully and respond as you need to in order to take care if yourself...

I hope that you do not have a serious bleed and do not need further intervention. I empathize with you undoubtedly being tired if dealing with this problem. You do need to look at your own situation and think in terms if what you would advise for someone dear to you!!

I hope this is helpful for you. Let me know if you have further concerns! Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
Thanks! You are always so helpful
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again!

Well I try. You of course are most welcome for any degree of help or assurance that i may be able to offer!! I hope that you have a non- serious problem that will not require drastic steps or procedures. I hope that you get healthy again soon!

Take care,

Anthony Bray MD
Customer: replied 1 year ago.
Still have 3+ blood in my urine abd 30-50 rbcs
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Are you seeing a urologist to follow up on this? I know that you don' t want a cystoscopy but I would like to see improvement in this degree of bleeding soon!! Perhaps you could work with a urologist to delay further invasive testing but I would not delay this beyond two weeks... If not markedly improved next week or the one after that. I think that you would be in a position that you should really have it checked into...

I hope this helps. Let me know if you have further questions. I will be happy to get back with you.

( I would have cultured this last urine to ensure no infection was present now as the blood might insure the results of a urinalysis...)

Best regards!

Anthony Bray MD
Customer: replied 1 year ago.
She wont send a referral to urology yet. She saud do repeat ua in 1 month and see if there is still blood. This has been going on for over a week already! The last ua culture showed i had a uti
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again!

Well the timing of the follow up for this problem is not set in syone at all. This is a judgment call and different practioners would emphasize further evaluation at different intervals > some sooner and others later...

I hope that you will be able to successfully negotiate this problem without needing cystoscopy but this possibility is there....

As I said I hope that the most recent urine was cultured...if not perhaps you could ask about it with the next sammple...

I hope this clears up or you soon! Best Regards.

Anthony Bray MD
Customer: replied 1 year ago.
I dont know thati could have a cystoscopy without having a heart attack
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again ,

Well I hope that you will be able to avoid the need for cystoscopy but it is possible that you may need this procedure still. If this should be the case then your doctor could help to prescribe you anxiety medication in days leading up to the test. Of course for the procedure itself you would be strongly medicated ( on this point I would suggest that you discuss options and preferences with the urologist) we have discussed that aspect of the cystoscopy procedure before of course...

I hope that this helps! Let me know if you have further questions . Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
At my clinic they dont medicate. They just use lidocaine jelly
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

I suggest that you discuss possible options with the urologist if you are referred to one ....(if the blood should clear then it may not be necessary...)

Best Regards,

Anthony Bray MD
Customer: replied 1 year ago.
My anxiety about this is going to kill me
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

I'm sorry that you have such a bad series of health problems. I have no doubt that you would be anxiuos with regars to everythingh that is going on...are you on treatment for an anxiety disorder at this time? If not then I think that something for anxiety for you for at least a limited time may be helpful for you....

Best Regards,

Anthony Bray MD
Customer: replied 1 year ago.
Im on 0.5 mg lorazepam amf 150 mg zoloft
And havent noticed any difference. I am so anxious all the time
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Well I think that the potential option of increasing the lorazepam to 1 mg twice a day for example might be considered. I know in the environment these days there is so much concern if abuse potential that your doctor may not be receptive to this. I would think that such an adjustment for a month or two or three may be helpful for you though. The Zoloft tends to help with depression and anxiety as well. The lorazepam would be the more quickly helpful toward anxiety however.

I hope that this helps. Let me know if you have further questions. Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
I feel like a zombie at .5 mg bid
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again!

Well with this type of medicine every individual will have their own tolerance to it. The goal is not to make you overly drowsy or like a zombie of course. So it would seem that the 0.5 mg twice/ day is as far as you should go in the dose here....

Best Regards,

Anthony Bray MD
Customer: replied 1 year ago.
Is there a different med i could try? Byw ihave a urology appt on 8/28
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again!

Well there are several benzodiazepines -- yes --- but the mechanism by which they work would be the same and similar side effects as well. I would see little chance of benefit ( possible but not strong chance) to change to a different one. Klonapin and Valium if anything may have increased drowsiness ... Xanax might have a bit less ( again dose dependent ... So 0.25mg three times a day might compare favorably vs the 0.5 mg bid of lorazepam .... This would be trial and error . I am not enthusiastically recommending any particular change here though ....

Buspar is for anxiety but this takes a couple of weeks to get to full effect... This could be potentially substituted for the lorazepam or used in combination. It too has drowsiness as side effect and I usually prescribe it with the major dose loaded toward bedtime...

The SSRI class is helpful for anxiety but you are on a fairly high dose of Zoloft now...

So some consideration of Buspar may be there but I am not sure that its benefit would necessarily outweigh its side effects with this choice either. I think of the possible changes that this would the one I would most strongly consider. Your treating doctor may have his/ her own preferences...

I hope this helps. Best regards ,

Anthony Bray MD
Customer: replied 1 year ago.
Im not insane. How much buspar do you think
Expert:  Anthony Bray, MD replied 1 year ago.
Hello!

I would start at 7.5 mg twice a day --- usual dose range is 20- 30 mg/ day....max is 60 mg/ day I often dose 15mg tablet as 1/2 pill in AM and 1 and 1/2 pill at bedtime...

I hope this helps. Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
I dont know why my anxiety sucks so much. I have at least 3 panic attacks a day
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again.

I'm sure that it does.....you have had a lot of stress on you....

Take care,

Anthony Bray MD
Customer: replied 1 year ago.
I dont want to add anymore meds to my med list

Atenolol 50 mg. daily
Sertraline 150 mg. daily
Lorazepam. 0.5 mg. BID
Vit D 50,000 u. Weekly
Aciphex 20 mg. daily
Ranitidine 300 mg. BID
Compazine 5 mg. 4x prn
Amitryptaline 25 mg. daily/hs
Fiber 20 gm. daily
Reglan. 10 mg. TID
~ 30 mins before meals
Miralax

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
< Last | Next >
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ
 
 
 

Meet The Experts:

 
 
 
  • Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4043
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
< Last | Next >
  • http://ww2.justanswer.com/uploads/NU/nursescare4u/2013-3-31_03429_JApic.64x64.jpg Nurse Milli, RN's Avatar

    Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4043
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
  • http://ww2.justanswer.com/uploads/agketch/2008-7-14_184046_drketchresized.jpg Dr. Ketch's Avatar

    Dr. Ketch

    Doctor

    Satisfied Customers:

    102
    Medical Degree, Former Assistant Professor at School of Medicine at Yale University
  • http://ww2.justanswer.com/uploads/FA/FamilyPhysician/2013-8-31_191624_JA550x500Photo.64x64.jpg Family Physician's Avatar

    Family Physician

    Doctor (MD)

    Satisfied Customers:

    5622
    Emergency Medicine and Family Practice for over 26 years
  • http://ww2.justanswer.com/uploads/drphophalia/2007-08-23_095626_dr._arun_phophalia.jpg Dr. Arun Phophalia's Avatar

    Dr. Arun Phophalia

    Doctor (MD)

    Satisfied Customers:

    17025
    MBBS, MS (General Surgery), Fellowship in Sports Medicine
  • http://ww2.justanswer.com/uploads/VA/VANP/2012-6-6_235535_Skye2.64x64.jpg A. Schuyler, NP's Avatar

    A. Schuyler, NP

    Nurse Practitioner

    Satisfied Customers:

    12170
    Board Certified NP, MS, RN. Private practice & hospitalist
  • http://ww2.justanswer.com/uploads/TA/tazechip/2012-6-7_135230_drpic.64x64.png Dr. Chip's Avatar

    Dr. Chip

    Doctor (MD)

    Satisfied Customers:

    10029
    Over 20 yrs of Family Practice
  • http://ww2.justanswer.com/uploads/neurosurg/2009-10-06_120923_profile.jpg Dr. Mark's Avatar

    Dr. Mark

    Doctor (MD)

    Satisfied Customers:

    6234
    U.S. Physician/Surgeon in Neurosurgery