I am unable to provide specific diagnostic or treatment  advice for anyone who is not my patient and whom I have not assessed in person.  Please don't ask me to give a diagnosis by email.  Any information and all suggestions on this website are given with the understanding that you will use your clinical judgement in incorporating them into your practice.  If you want to tell me about a specific clinical case you are struggling with, please make sure that there is no possibility of the person being identified from what you write.  You retain the sole duty of care and clinical responsibility towards your patient.