Lumbar prolapse, pain management using exercises, medicines, diet - Online Doctor Chats
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Practicing since : 2005
Answered : 2408 Questions
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Doctor : hi
User : Hi
Doctor : how can i help u
User : I have Back pain since 2 years
User : From last one year
Doctor : please proceed with your Query
User : there is pain in my right leg
User : also below the foot
User : I had visisted many orthopeadics in AIIMS and other hospitals
User : also visited doctors in
Doctor : ok
User : But no body is bale to diagnose properly
User : MRI shows
Doctor : has the pain reduced
User : protrusion at L5 S1 level but
User : no nerves are pressed
Doctor : ok
User : The pain is like I can bear with it
User : the pain also is there n Big toe
Doctor : ok
User : but it reduces some time and also increase some time
User : walking is no problem
Doctor : are yu able to do the routine activities
User : after 2-3 km it again starts
User : yes
Doctor : are yu any treatment
Doctor : was any surgery done
User : yes XXXXXXXX therapy almost 30 times
User : no
User : nothing is done as nerves are not pressed
Doctor : did yu use any lumbar belts
User : yes some time
Doctor : or any physio therapy was done
User : yes
User : it helps for some days and agiain pain starts
User : The problem is no body is able to say exact cause of pain infoot and changing pain
User : I want to know is it something else or related to the back only
Doctor : ok
Doctor : are yu on medications
User : helo
Doctor : are yu a paid customer
User : yes
User : I paid just now
Doctor : ok i will help u in this
User : May on know what are you specialised in
Doctor : i am general practisionor
User : ok
Doctor : shall we continue
User : yes
User : u can
Doctor : as per your history and the clinical findings
Doctor : and MRI reports its looks like lumbar prolapse
User : Does the pain in lower foot and big toe is because of that
Doctor : yes i will explain to yu
User : because the doctors say the prolapse disc doesnt presses the nerve
Doctor : the pain from the back can radiate to the foot
Doctor : even if dont press the nerves
User : ok
User : but it doesnt radiate ..its cramp feeling in my lower foot onla and then big toe
User : which changes very quickly
User : when i lie down its better as soon as i start walking it starts paining
Doctor : do yu get the pain in the foot following the back pain
Doctor : or does both the pain are diffrent
User : and from 2 day back there is needling feeling in the back of foot sometimes
User : back pain is now as a burning senstaion which I am used to it
Doctor : ok
User : I feel both the pain are different
Doctor : are yu on any medications for these
User : but when i lie down on the right side then the radiating feling starts from back to lower foot
User : no at present not
Doctor : not even pain killer or muscle realaxants
User : but two months back i took some NSAIDs
User : zyloric
Doctor : ok
Doctor : how was the relief
User : not much
User : one was etoricoxib
User : as I remmeber
Doctor : ok
User : if u give me 1 minute I will tell u exact name
User : right now i am in germany and doctors here have told for orthopeadic sole
Doctor : ok take your time no problem
User : as they dont find any reason for foot pain
User : I have gone throgh EMG two time also but no findings came
Doctor : ok
Doctor : it means the nerve supply to the muscle is not affected
Doctor : and the muscle disorder is ruled out
Doctor : its only the protrusion of the disc gel
User : I have some time sore knee also
User : always the right leg
User : all the problem I am writing is with right leg
User : Now please tell what should I do
Doctor : i will help u in this
User : Last EMG was done 6-7 months back
User : Last MRi was done 4 month back
Doctor : now these are 2 diffrent issues
Doctor : let me talk about the back ache and disc prolapse
Doctor : now yu have stopped pain killers
User : these are medicinse I took for 1 and half moth
User : etoricoxib 90 mg once a day after breakfast &
3:08 PM tab zyloric 100 mg after dinner for one month
Doctor : are yu doing any lower back exercises
User : yes from last 2 years
User : I am doing
User : but I stop when painincrease
User : but as of today I am doing it
Doctor : can yu explain this to me
User : one is bending knees to chest
User : with both legs
User : 2)rasing legs
Doctor : ok
User : 3) raisng back
User : 4) king queen : turning both leg on one side and head the other
User : 5) pressing the floor with back (buttock)
Doctor : ok
User : 6) bending on one knee rasing one hand and other leg back ward all in 90 degree
User : apart from this I do breathing exercises
Doctor : did the neurologist advice any surgery
User : the above exercise I have written may be not in the order I do
User : no ..no body has adviced surgery till now
Doctor : not a problem
User : I have been to 2 nerologist in india and 2 ingermany
User : also 3-4 orthopedic in india and in germany
User : All of them told to do exercise and strengthen your back muschle
Doctor : ok
Doctor : was any surgery advised
User : the problem is that i am not dying with th epain
User : but it is all the day annoying me and I feel with each and every movement
User : No No surgery adviced
Doctor : ok
User : They say when the nerves are not pressed there is no need of surgery
Doctor : yes yu are correct
User : On doctor in Max hospital delhi told that you have to live with this pain
Doctor : until the nerves are pressed
Doctor : or the bulge is too big
Doctor : the need of surgey is not there
User : Is the pain in foot or big toe is because of disc bulge
Doctor : the main stay of treament is
Doctor : no its not related to each other as per your history
Doctor : does the pain in the back radiates to thighs and buttocks
User : some times
User : after sitting for 45 minutes
User : or so
Doctor : thats normal after sitting for 45 min
User : I have to get up after 30-45 minutes my back starts burning
Doctor : do yu have soreness and stiffness of the back muscles
User : yes on the right back there is soreness
Doctor : any tingling and burning sensation in the foot
User : while sitting but very minor
User : some time central lower foot
User : there isneedling
User : when I lie on the right side
Doctor : ok
Doctor : any difficulty in micturation
Doctor : means urination
User : no
Doctor : or passing stools
User : nothing
Doctor : ok
User : all is fine
User : My uric acid test was also done
User : and it wa sok
Doctor : any numbness of foot and back
Doctor : ok
User : numbness is very rare in foot some time
Doctor : the nerve involovement is ruled out
Doctor : as per your symptoms
Doctor : the nerves are not compressed
Doctor : but there can be minor pressure on the nerve or swelling
User : ok
Doctor : due to muscle swelling and soreness
Doctor : when this happens
Doctor : rarely yu can get some numbness and tingling
Doctor : as the surgery is ruled out
Doctor : the other options are
User : most the pain in knee and foot are changing place in very short time inhalf an hour or if I walk it starts and whenI walk for 15-20 minutes it gets better and then it again come back
Doctor : the exercises as yu mention ed earlier was
Doctor : are muscle strengthening exercises
Doctor : which strengthen the mucsles
Doctor : and also relaxes it
Doctor : and improves the blood supply
Doctor : but one thing is the exercises should not be done when yu are in acute pain
Doctor : it can worsen it
Doctor : are yu there
User : yes
User : I am watching yur text
Doctor : ok
User : Is this problem found in other patients also or its a unique .......
User : because it has started depressing e
User : I dont run
User : I always have to think whatever I do about my pain
User : and I am still 28 years old
Doctor : are yu married
User : yes
User : yes
Doctor : do yu have kids
User : know
User : no
User : no kids
Doctor : married since
User : I take all th precaution not to lift heavy things good posture
User : 2006
User : its three years
Doctor : are practising any family planning methods
User : earlier I was
Doctor : ok'
User : but from last three month we are planning
User : for baby
Doctor : is the penile erection normal
User : yes
Doctor : ok
User : how long I have to live with this pain
User : and what is the solution ?
User : or is there any solution ?
User : or is it something serious which doctors are unable to diagnose
User : ?
Doctor : no not like that
Doctor : its a problem faced by most of the patients
Doctor : if they have disc prolapse
Doctor : this problem is unique
Doctor : is not unique
Doctor : the best is to prevent further attacks
User : further attacks ?
Doctor : or not to worsen the disc prolapse
User : but this foot tingling pain,knee soreness and big toe pain is troubling more than back pain
Doctor : acute pains when the disc protrusion worsens
User : What should be my course of action ?
User : now
Doctor : let me finish the back pain
Doctor : then discuss one by one
User : ok
Doctor : as i said even if the nerves are not compresssed
Doctor : a minor pressure on the nerves can cause tingling pain and soreness in the foot
Doctor : its better yu follow the exercises
Doctor : and continue
Doctor : a pain killer with muscle relaxant will help u in this
User : ok
Doctor : Tab. Hifenac-MR two times a day for 15 days after food
Doctor : not to continue for lomger durations
Doctor : sprays will hlep u
Doctor : VOVERAN spray will also help u
User : I am noting down
Doctor : ok
User : and activities
User : does and donts
User : jogging gym,or swimming
Doctor : Also, sleep in the most naturally comfortable position on whatever is the most comfortable surface.
Doctor : Advice given in the past used to be to sleep on a firm mattress.
User : I put pillow below my knee whle sleeping
Doctor : its good will help u
Doctor : execises like swiming and early morning walk
Doctor : jogging will help u
User : withjogging the knee pain increases
User : so dont do it
Doctor : ok
Doctor : brisk walking
Doctor : are u using any lumbar belts
User : I have it
User : but I dont use it
User : some doctors say use it
User : some says dont use it
Doctor : even after using the belts the relief can be 30- 35%
User : ok
Doctor : with some psychological effect the pain free symptoms may to 50%
Doctor : but the advantage is it limits the movement of spine
User : pscological effect
User : I didt understood
Doctor : and thus the friction
Doctor : and pain relief
User : ok
Doctor : coming to pscologiacal effect
Doctor : some patients feel that after the use of belt the condition has improved
User : ok
Doctor : take healty foods
Doctor : esp green leafy veg
User : food I am taking is very healthy
User : I am vegetarian
Doctor : ok
User : do yoga two times a day
Doctor : ok
User : my weith is very normal
User : weight
Doctor : Vitamin B12 tablets or injections will help yu in
Doctor : muscle and nerve strengthening
Doctor : nerve regeneration
Doctor : its has helped a lot in few patients
User : so i should also take tabelets of vitami B12
Doctor : or injections will help
Doctor : it also reduces the tingling and soreness
Doctor : of the foot
User : injections will be given in spine ?
User : or near spine
Doctor : no its intramuscular
User : ok
Doctor : to the muscle thats buttocks
Doctor : physical therapy can help only in useful for few days
Doctor : again the pain can recurr
Doctor : is that ok
User : yes i think
User : final is how log I have to wait patiently
User : with these
Doctor : any more queries on back ache
User : course of action
User : to see some positive outcomes
Doctor : once the protrusion has ocured
Doctor : the best thing is to not to make the protusion worst
Doctor : after all the tips i gave
Doctor : u can follow this and see the response in 20 30 days
User : so I summarize it as :-1 wear lumbar belt 2)eat medicines 3) do exercises 4) and vitamin b 12 medicines
Doctor : yes yu are correct
User : Medicines i will not get her in germany
Doctor : now coming to knee and foot pain
User : but I wil try to get from india from some of my freinds
User : ok
Doctor : ok thats fine
User : please carry on
Doctor : i think the numbness and tingling will reduce once the back ache is reduced
Doctor : and if yu take these treatments
Doctor : coming to the pain
Doctor : is the range of motion in the knee and ankle reduced
User : no
Doctor : any swelling
User : nothing
Doctor : where exactly the pain is on the knee
User : it is around knee
Doctor : ok
User : around central knee
Doctor : its better to wait for some time
User : some times just in the middle of knee as neddling when I step
User : but it goes when I walk for some time
Doctor : these symptoms can subside after the treatment
User : I have noticed when I sit more the knees also gets sore
User : So can the knee pain also be linked to disc
Doctor : if not then an X-ray or further investigation may be needed
User : prtrusion
Doctor : no X-ray of knee
User : the orthopedic here cheked my knee but didnt say any problem
User : but he dint did the xray
Doctor : ok
User : because I also feel the knee pain is also changing around the knee areas
User : and please note that its on only one side
User : right side
User : lik enow its not there
Doctor : thats wat yu can wait
User : but when the back or foot become worse it also gets sore and heavy
User : ok
Doctor : if the symptoms getting worsened the other options can be reviewed
Doctor : Is there any thing else I can help you with?
User : at this moment
User : its fine
User : how can i contact u again
User : your name
Doctor : i am Dr
Doctor : Please fill the feedback form say done when done.
User : how can i contact u again
Doctor : tomorrow the same time
Doctor : every day i will available
User : i want to contact you say after 14-15 days
Doctor : yes u can
User : may i ask which city you practise
User : then thanks for you answres
Doctor : in banglore
User : and i wish you a nice days ahead
Doctor : Have you filled the feedback form?
User : yes
User : i have laready sent it
Doctor : Thanks for consulting HealthcareMagic. Bye for now. Please refer your friends to our service.
User : i will bye and take care
Doctor : take care bye
Doctor : hi
User : Hi
Doctor : how can i help u
User : I have Back pain since 2 years
User : From last one year
Doctor : please proceed with your Query
User : there is pain in my right leg
User : also below the foot
User : I had visisted many orthopeadics in AIIMS and other hospitals
User : also visited doctors in
Doctor : ok
User : But no body is bale to diagnose properly
User : MRI shows
Doctor : has the pain reduced
User : protrusion at L5 S1 level but
User : no nerves are pressed
Doctor : ok
User : The pain is like I can bear with it
User : the pain also is there n Big toe
Doctor : ok
User : but it reduces some time and also increase some time
User : walking is no problem
Doctor : are yu able to do the routine activities
User : after 2-3 km it again starts
User : yes
Doctor : are yu any treatment
Doctor : was any surgery done
User : yes XXXXXXXX therapy almost 30 times
User : no
User : nothing is done as nerves are not pressed
Doctor : did yu use any lumbar belts
User : yes some time
Doctor : or any physio therapy was done
User : yes
User : it helps for some days and agiain pain starts
User : The problem is no body is able to say exact cause of pain infoot and changing pain
User : I want to know is it something else or related to the back only
Doctor : ok
Doctor : are yu on medications
User : helo
Doctor : are yu a paid customer
User : yes
User : I paid just now
Doctor : ok i will help u in this
User : May on know what are you specialised in
Doctor : i am general practisionor
User : ok
Doctor : shall we continue
User : yes
User : u can
Doctor : as per your history and the clinical findings
Doctor : and MRI reports its looks like lumbar prolapse
User : Does the pain in lower foot and big toe is because of that
Doctor : yes i will explain to yu
User : because the doctors say the prolapse disc doesnt presses the nerve
Doctor : the pain from the back can radiate to the foot
Doctor : even if dont press the nerves
User : ok
User : but it doesnt radiate ..its cramp feeling in my lower foot onla and then big toe
User : which changes very quickly
User : when i lie down its better as soon as i start walking it starts paining
Doctor : do yu get the pain in the foot following the back pain
Doctor : or does both the pain are diffrent
User : and from 2 day back there is needling feeling in the back of foot sometimes
User : back pain is now as a burning senstaion which I am used to it
Doctor : ok
User : I feel both the pain are different
Doctor : are yu on any medications for these
User : but when i lie down on the right side then the radiating feling starts from back to lower foot
User : no at present not
Doctor : not even pain killer or muscle realaxants
User : but two months back i took some NSAIDs
User : zyloric
Doctor : ok
Doctor : how was the relief
User : not much
User : one was etoricoxib
User : as I remmeber
Doctor : ok
User : if u give me 1 minute I will tell u exact name
User : right now i am in germany and doctors here have told for orthopeadic sole
Doctor : ok take your time no problem
User : as they dont find any reason for foot pain
User : I have gone throgh EMG two time also but no findings came
Doctor : ok
Doctor : it means the nerve supply to the muscle is not affected
Doctor : and the muscle disorder is ruled out
Doctor : its only the protrusion of the disc gel
User : I have some time sore knee also
User : always the right leg
User : all the problem I am writing is with right leg
User : Now please tell what should I do
Doctor : i will help u in this
User : Last EMG was done 6-7 months back
User : Last MRi was done 4 month back
Doctor : now these are 2 diffrent issues
Doctor : let me talk about the back ache and disc prolapse
Doctor : now yu have stopped pain killers
User : these are medicinse I took for 1 and half moth
User : etoricoxib 90 mg once a day after breakfast &
3:08 PM tab zyloric 100 mg after dinner for one month
Doctor : are yu doing any lower back exercises
User : yes from last 2 years
User : I am doing
User : but I stop when painincrease
User : but as of today I am doing it
Doctor : can yu explain this to me
User : one is bending knees to chest
User : with both legs
User : 2)rasing legs
Doctor : ok
User : 3) raisng back
User : 4) king queen : turning both leg on one side and head the other
User : 5) pressing the floor with back (buttock)
Doctor : ok
User : 6) bending on one knee rasing one hand and other leg back ward all in 90 degree
User : apart from this I do breathing exercises
Doctor : did the neurologist advice any surgery
User : the above exercise I have written may be not in the order I do
User : no ..no body has adviced surgery till now
Doctor : not a problem
User : I have been to 2 nerologist in india and 2 ingermany
User : also 3-4 orthopedic in india and in germany
User : All of them told to do exercise and strengthen your back muschle
Doctor : ok
Doctor : was any surgery advised
User : the problem is that i am not dying with th epain
User : but it is all the day annoying me and I feel with each and every movement
User : No No surgery adviced
Doctor : ok
User : They say when the nerves are not pressed there is no need of surgery
Doctor : yes yu are correct
User : On doctor in Max hospital delhi told that you have to live with this pain
Doctor : until the nerves are pressed
Doctor : or the bulge is too big
Doctor : the need of surgey is not there
User : Is the pain in foot or big toe is because of disc bulge
Doctor : the main stay of treament is
Doctor : no its not related to each other as per your history
Doctor : does the pain in the back radiates to thighs and buttocks
User : some times
User : after sitting for 45 minutes
User : or so
Doctor : thats normal after sitting for 45 min
User : I have to get up after 30-45 minutes my back starts burning
Doctor : do yu have soreness and stiffness of the back muscles
User : yes on the right back there is soreness
Doctor : any tingling and burning sensation in the foot
User : while sitting but very minor
User : some time central lower foot
User : there isneedling
User : when I lie on the right side
Doctor : ok
Doctor : any difficulty in micturation
Doctor : means urination
User : no
Doctor : or passing stools
User : nothing
Doctor : ok
User : all is fine
User : My uric acid test was also done
User : and it wa sok
Doctor : any numbness of foot and back
Doctor : ok
User : numbness is very rare in foot some time
Doctor : the nerve involovement is ruled out
Doctor : as per your symptoms
Doctor : the nerves are not compressed
Doctor : but there can be minor pressure on the nerve or swelling
User : ok
Doctor : due to muscle swelling and soreness
Doctor : when this happens
Doctor : rarely yu can get some numbness and tingling
Doctor : as the surgery is ruled out
Doctor : the other options are
User : most the pain in knee and foot are changing place in very short time inhalf an hour or if I walk it starts and whenI walk for 15-20 minutes it gets better and then it again come back
Doctor : the exercises as yu mention ed earlier was
Doctor : are muscle strengthening exercises
Doctor : which strengthen the mucsles
Doctor : and also relaxes it
Doctor : and improves the blood supply
Doctor : but one thing is the exercises should not be done when yu are in acute pain
Doctor : it can worsen it
Doctor : are yu there
User : yes
User : I am watching yur text
Doctor : ok
User : Is this problem found in other patients also or its a unique .......
User : because it has started depressing e
User : I dont run
User : I always have to think whatever I do about my pain
User : and I am still 28 years old
Doctor : are yu married
User : yes
User : yes
Doctor : do yu have kids
User : know
User : no
User : no kids
Doctor : married since
User : I take all th precaution not to lift heavy things good posture
User : 2006
User : its three years
Doctor : are practising any family planning methods
User : earlier I was
Doctor : ok'
User : but from last three month we are planning
User : for baby
Doctor : is the penile erection normal
User : yes
Doctor : ok
User : how long I have to live with this pain
User : and what is the solution ?
User : or is there any solution ?
User : or is it something serious which doctors are unable to diagnose
User : ?
Doctor : no not like that
Doctor : its a problem faced by most of the patients
Doctor : if they have disc prolapse
Doctor : this problem is unique
Doctor : is not unique
Doctor : the best is to prevent further attacks
User : further attacks ?
Doctor : or not to worsen the disc prolapse
User : but this foot tingling pain,knee soreness and big toe pain is troubling more than back pain
Doctor : acute pains when the disc protrusion worsens
User : What should be my course of action ?
User : now
Doctor : let me finish the back pain
Doctor : then discuss one by one
User : ok
Doctor : as i said even if the nerves are not compresssed
Doctor : a minor pressure on the nerves can cause tingling pain and soreness in the foot
Doctor : its better yu follow the exercises
Doctor : and continue
Doctor : a pain killer with muscle relaxant will help u in this
User : ok
Doctor : Tab. Hifenac-MR two times a day for 15 days after food
Doctor : not to continue for lomger durations
Doctor : sprays will hlep u
Doctor : VOVERAN spray will also help u
User : I am noting down
Doctor : ok
User : and activities
User : does and donts
User : jogging gym,or swimming
Doctor : Also, sleep in the most naturally comfortable position on whatever is the most comfortable surface.
Doctor : Advice given in the past used to be to sleep on a firm mattress.
User : I put pillow below my knee whle sleeping
Doctor : its good will help u
Doctor : execises like swiming and early morning walk
Doctor : jogging will help u
User : withjogging the knee pain increases
User : so dont do it
Doctor : ok
Doctor : brisk walking
Doctor : are u using any lumbar belts
User : I have it
User : but I dont use it
User : some doctors say use it
User : some says dont use it
Doctor : even after using the belts the relief can be 30- 35%
User : ok
Doctor : with some psychological effect the pain free symptoms may to 50%
Doctor : but the advantage is it limits the movement of spine
User : pscological effect
User : I didt understood
Doctor : and thus the friction
Doctor : and pain relief
User : ok
Doctor : coming to pscologiacal effect
Doctor : some patients feel that after the use of belt the condition has improved
User : ok
Doctor : take healty foods
Doctor : esp green leafy veg
User : food I am taking is very healthy
User : I am vegetarian
Doctor : ok
User : do yoga two times a day
Doctor : ok
User : my weith is very normal
User : weight
Doctor : Vitamin B12 tablets or injections will help yu in
Doctor : muscle and nerve strengthening
Doctor : nerve regeneration
Doctor : its has helped a lot in few patients
User : so i should also take tabelets of vitami B12
Doctor : or injections will help
Doctor : it also reduces the tingling and soreness
Doctor : of the foot
User : injections will be given in spine ?
User : or near spine
Doctor : no its intramuscular
User : ok
Doctor : to the muscle thats buttocks
Doctor : physical therapy can help only in useful for few days
Doctor : again the pain can recurr
Doctor : is that ok
User : yes i think
User : final is how log I have to wait patiently
User : with these
Doctor : any more queries on back ache
User : course of action
User : to see some positive outcomes
Doctor : once the protrusion has ocured
Doctor : the best thing is to not to make the protusion worst
Doctor : after all the tips i gave
Doctor : u can follow this and see the response in 20 30 days
User : so I summarize it as :-1 wear lumbar belt 2)eat medicines 3) do exercises 4) and vitamin b 12 medicines
Doctor : yes yu are correct
User : Medicines i will not get her in germany
Doctor : now coming to knee and foot pain
User : but I wil try to get from india from some of my freinds
User : ok
Doctor : ok thats fine
User : please carry on
Doctor : i think the numbness and tingling will reduce once the back ache is reduced
Doctor : and if yu take these treatments
Doctor : coming to the pain
Doctor : is the range of motion in the knee and ankle reduced
User : no
Doctor : any swelling
User : nothing
Doctor : where exactly the pain is on the knee
User : it is around knee
Doctor : ok
User : around central knee
Doctor : its better to wait for some time
User : some times just in the middle of knee as neddling when I step
User : but it goes when I walk for some time
Doctor : these symptoms can subside after the treatment
User : I have noticed when I sit more the knees also gets sore
User : So can the knee pain also be linked to disc
Doctor : if not then an X-ray or further investigation may be needed
User : prtrusion
Doctor : no X-ray of knee
User : the orthopedic here cheked my knee but didnt say any problem
User : but he dint did the xray
Doctor : ok
User : because I also feel the knee pain is also changing around the knee areas
User : and please note that its on only one side
User : right side
User : lik enow its not there
Doctor : thats wat yu can wait
User : but when the back or foot become worse it also gets sore and heavy
User : ok
Doctor : if the symptoms getting worsened the other options can be reviewed
Doctor : Is there any thing else I can help you with?
User : at this moment
User : its fine
User : how can i contact u again
User : your name
Doctor : i am Dr
Doctor : Please fill the feedback form say done when done.
User : how can i contact u again
Doctor : tomorrow the same time
Doctor : every day i will available
User : i want to contact you say after 14-15 days
Doctor : yes u can
User : may i ask which city you practise
User : then thanks for you answres
Doctor : in banglore
User : and i wish you a nice days ahead
Doctor : Have you filled the feedback form?
User : yes
User : i have laready sent it
Doctor : Thanks for consulting HealthcareMagic. Bye for now. Please refer your friends to our service.
User : i will bye and take care
Doctor : take care bye
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