<s>[INST] I have a 5 year old daughter that has neurofibromatosis and multiple benign tumors in her brain and spinal cord she gets severe migraines and is taking amitriptyline, neurontin, maxalt as needed and recently added Lamictal. At her last check up the pain management doctor noticed her pulse at a rate of 129. I have noticed and counted even during her sleep it beats 125-135. Is this normal? Lately off anf on she complains of mild chest pain at the same place you can see her pulse almost beating out of her chest and neck. She had an EKG which showed normal sinus rythym. Should i be concerned? [/INST] its really sad. keep an eye on renal profile, because her disease have association with renal involvement. hypertension may also be explained secondary to renal involvement dr husnain </s>