Should My Girlfriend's Health Issues Prompt an Emergency Room Visit?
My girlfriend, who is 19, has been facing a series of persistent health challenges that, while troubling, do not seem severe enough for an emergency designation. Here’s a rundown of her symptoms: 1. She experiences daily migraines. 2. She suffers from significant cognitive fog. 3. Nausea frequently hampers her ability to eat. 4. She endures constant pain in her lower back. 5. Fatigue is a constant companion. 6. Anxiety levels are high. 7. She feels widespread body aches, particularly in her legs and ankles, which sometimes hinder her mobility. 8. Occasionally, she experiences intense hot flashes that mainly affect her face. 9. Sleep issues, including insomnia, are commonplace. 10. At times, she struggles with breathing difficulties and has received an asthma diagnosis, even though she doesn’t exhibit typical symptoms for it. 11. There's periodic ringing in her ears, often accompanied by sharp ear pain. 12. She feels a sensation of her heart 'pinching' or 'fluttering' roughly once a day. 13. She has swollen lymph nodes. 14. Her immune system seems compromised; she’s been ill four times since Thanksgiving. 15. There is a strong suspicion of undiagnosed endometriosis. 16. Recent blood tests revealed abnormalities that went largely unacknowledged by her doctors, including low mean platelet volume, elevated absolute basophils, high total iron binding capacity, elevated blood pressure, and decreased hemoglobin levels. Some of these issues have been present for a decade, while others are more recent, and all appear to be escalating. Currently, she is on psychiatric medication to address her anxiety and depression. A major complication is that her parents, who hold extreme religious beliefs and exhibit abusive behavior, do not endorse medical intervention. Additionally, she has no vehicle and cannot afford healthcare on her own. She’s currently in Tennessee for an externship but is originally from Pennsylvania, where her doctor is located, though she won’t be able to visit them anytime soon. I reside in New Jersey. While she manages to get through her workday, she is clearly having a difficult time. Should these symptoms warrant a visit to the emergency room? If she goes, would the staff be able to provide assistance, or merely advise her to book an appointment with her regular physician?
Answers (1)
3/20/2025, 2:11:22 PM
OpenHealth AI
It sounds like your girlfriend is experiencing a complex array of symptoms that are significantly affecting her quality of life. While her symptoms have persisted without seeming acutely severe, they warrant careful consideration, especially given the breadth and escalation of her health issues.
Key Points to Consider:
- Severity and Escalation: Persistent and worsening symptoms, particularly those that interfere with daily activities like eating, mobility, and cognitive function, are important to address urgently.
- Emergency Signs: Certain symptoms, such as difficulty breathing, intense heart sensations, and significant fatigue, can indicate potential emergencies.
Explanation:
Your girlfriend's symptoms span various systems and suggest that her health may be compromised. The combination of persistent pain, cognitive fog, nausea, breathing difficulties, and abnormal blood test results could point to underlying conditions that need further evaluation. Stress from her current living situation and health challenges can exacerbate these issues, making it even more critical to seek help.
Next Steps:
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Immediate Evaluation: Based on her symptoms, particularly the breathing difficulties, heart sensations, and general deterioration in well-being, it would be wise for her to visit an emergency room. Emergency staff can assess her condition and provide immediate support, often being able to connect with social services if she has any barriers to care.
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Documenting Symptoms: Encourage her to keep a detailed log of her symptoms, including when they occur and their severity, which might help healthcare providers to make better assessments.
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Seek Support: If she feels comfortable, consider reaching out to local health advocacy groups or hotlines that can assist individuals in navigating the healthcare system, especially in cases where parental influence is a barrier to receiving care.
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Explore Telehealth: If transportation or affordability is an issue, look into telehealth options where she can discuss her symptoms with a healthcare professional remotely. This could provide her with guidance and possibly prescriptions without the need for in-person visits.
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Emergency Room Expectations: When visiting the ER, she should clearly explain all her symptoms, their duration, and any relevant medical history, including the blood test results and the suspicion of endometriosis. ER staff can be quite thorough and offer support beyond immediate treatment.
By taking these steps, you can help your girlfriend access the care she needs while managing her current challenges and improving her health outcomes. Let me know if you need further guidance!
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - 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WBC: 5.8 × 10⁹/L (SHOWS IMPROVEMENT) - **RBC: 2.93 × 10¹²/L** (IMPROVED but still low) - **Hemoglobin: 72 g/L** (SHOWS IMPROVEMENT but still low) - Platelets: 223 × 10⁹/L (BACK TO NORMAL) - Neutrophils: 30.0% - Lymphocytes: 64.8% - Monocytes: 4.6% ### Biochemistry (January 28, 2026): - Total protein level: 67 g/L (slightly deficient) - Creatinine: 20.7 μmol/L - **Total Bilirubin: 242 μmol/L** (STILL HIGH - unchanged) - **Direct Bilirubin: 142 μmol/L** (VERY HIGH) - **ALT: 50 IU/mL** (DRASTICALLY LOWER from >1000!) --- ## OVERVIEW OF PROGRESS OVER 6 MONTHS | Parameter | August 2025 | January 2026 | Change | |------------------|-------------|---------------|--------------------------| | **Hemoglobin** | 69 g/L | 72 g/L | ↗ Slight improvement | | **RBC** | 2.1 | 2.93 | ↗ Improved | | **ALT** | >1000 | 50 | ✓✓ MAJOR IMPROVEMENT | | **Bilirubin** | 245 | 242 | → Unchanged (still elevated) | | **Portal vein** | 6.1 mm | 3.9 mm (US) | ↗ Decreased | | **Platelets** | 403 | 223 | ↘ Normalized | | **Shunt size** | 9.9 mm | 9.9 mm | → No Change | --- ## CURRENT SITUATION (February 2026 - 7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.