Seeking Relief from Severe Back Pain [19F]
Greetings! I'm [19F] and I'm reaching out because I've been dealing with bouts of intense pain in my lower back. It's the kind of pain that makes even the smallest movements excruciating. I weigh roughly 194 pounds and stand at 5'6", leading a mostly inactive lifestyle, although my activity levels have fluctuated over the past couple of years. The initial episode occurred over a year ago while I was performing sit-ups at the gym. I felt a bit of discomfort in my lower back, but when I woke up the following day, the pain was so severe that I could hardly function. I blamed it on poor form during my workout. The pain persisted all day at a steady level and finally started to dissipate after a few days. Since that incident, I've encountered this intense pain approximately four to five times again without any clear triggers. It typically starts with a sharp, pinching sensation near my lower spine, which makes it impossible for me to stand up straight. I've noticed that if I remain immobile during these moments, the aftermath is even more painful, making any subsequent movement extremely challenging—whether lying down, sitting, or even walking. These episodes have struck me during various activities, like showering, washing dishes, coming home from school, lugging empty boxes down the stairs, and even at social gatherings. The situations may vary, but the sensation remains constant. Describing the pain has been difficult; it's quite peculiar. My lower back becomes excessively warm, and the pain radiates toward my hips, but it doesn't extend to the front of my body or down my legs. It seems trapped in my spine area. Last December, after enduring one of the most severe episodes that lingered for days, I consulted two different specialists: an orthopedist and a sports medicine physician. I underwent X-rays from both the front and side perspectives. They identified a slight curvature in my spine leaning to the left and a bit of compression in the lower vertebrae, yet both concluded it wasn't anything to worry about. Following that appointment, I had another X-ray taken to assess the length of my legs, which would account for the spinal deviation, but the difference turned out to be a mere 1.5 millimeters, insignificant by most standards. Both doctors suggested that I should consider losing weight and left it at that. While I understand that my weight may be impacting my overall health, the diverse triggers for my pain confuse me; it feels somewhat dismissive since neither doctor took the time to examine the area of pain directly. Currently, I’m dealing with a broken toe that has halted my swimming routine, but I'm attempting to maintain a level of fitness. I’m constantly anxious about when this pinching sensation will strike next. When it does, it’s incredibly debilitating—so much so that I often find it hard to attend school or even manage to move around in my bed. I can spend hours in tears, feeling desperate and scared about whether this could signify a more sinister health issue beyond just needing to lose weight. If anyone has suggestions or can relate to my experience, I would greatly appreciate your insight. Thank you for taking the time to read this. 🙏🏽
Answers (1)
4/4/2025, 3:50:48 AM
OpenHealth AI
It sounds like you're enduring a lot of discomfort and anxiety regarding your lower back pain, which can be incredibly challenging both physically and emotionally. You’ve described recurring episodes that significantly impact your daily life, and I commend you for seeking help and information about managing this.
Understanding Your Pain
Lower back pain can arise from various causes, including muscle strain, issues with spinal alignment, and even stress related to your lifestyle or physical activity levels. Given your history of severe pain following specific movements and the recent findings of slight curvature and compression on X-rays, it's understandable why you're concerned about the nature of your pain.
Next Steps for Relief
Here are prioritized action steps you can take to help manage your pain and potentially improve your overall situation:
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Pain Management:
- Heat Therapy: Apply a heating pad or warm towel to your lower back for 15-20 minutes several times a day to help relax tight muscles.
- Over-the-Counter Pain Relievers: Consider using NSAIDs (like ibuprofen or naproxen) if it's safe for you, to help reduce pain and inflammation.
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Gentle Movement:
- Stretching and Strengthening: Begin with gentle stretches that focus on the lower back and surrounding muscles. Exercises like the cat-cow stretch or pelvic tilts might help. You can find guided videos or instructions online to avoid straining your back further.
- Core Strengthening: When possible, engage in exercises that strengthen your core. A strong core provides support to your lower back.
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Posture Awareness:
- Ensure proper posture while sitting and standing. It can help to set reminders to adjust your position or take short breaks to move around.
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Mind-Body Techniques:
- Consider activities like yoga or Pilates, which can enhance flexibility and strength. Many classes focus on back health and can be adapted to your fitness level.
- Breathing exercises or mindfulness techniques may help manage anxiety surrounding your pain episodes.
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Monitor Your Episodes:
- Keep a pain diary to track when these episodes occur, including what activities you were doing before the pain started and any accompanying symptoms. This can help identify potential triggers.
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Consultation on Weight and Fitness:
- Given the recommendation from your specialists regarding weight management, consider collaborating with a nutritionist who can help you create a balanced meal plan that supports your goals and lifestyle. They can help you manage your weight in a healthy way while considering your pain.
Seeking Support
- Engage with support groups or forums where individuals share similar experiences. This can provide validation and additional coping strategies.
- It might also be beneficial to consult a physical therapist, as they can offer personalized exercises and strategies tailored to your needs.
Final Thoughts
You are not alone in this journey, and it's important to take proactive steps while being gentle with yourself. The fluctuating nature of your pain can indeed be frustrating; focusing on managing the symptoms and improving your overall fitness will be constructive. If your pain episodes worsen or you encounter new symptoms, it's advisable to follow up with a healthcare provider for further evaluation.
Please take care and remember to prioritize self-compassion during your healing process.
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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:** - **Portocaval shunt size: 9.9 mm** (blood bypassing the liver into the inferior vena cava) - **Arteriovenous shunt size: 4.4 mm** - **Portal vein size: 6.1 mm** (patent) - **Three nodular cystic lesions** located in the perivascular area, with largest measuring 11.6×20.7 mm, enhancing during the venous phase - Liver features a heterogeneous architecture, exhibiting irregular enhancement - Gallbladder appears elongated and slightly enlarged - Other abdominal organs exhibit normal findings **RADIOLOGIST’S ASSESSMENT:** "Congenital portosystemic shunt indicative of Abernethy malformation; less likely arteriovenous malformation (AVM); cannot dismiss the possibility of localized liver lesions." **ADVICE:** Seek consultations with an abdominal and vascular surgeon. ### Blood Tests (August 1, 2025): **Complete Blood Count:** - WBC: 10.44 × 10⁹/L (normal range) - **RBC: 2.1 × 10¹²/L** (LOW - indicating severe anemia) - **Hemoglobin: 69 g/L** (CRITICALLY LOW; normal is 117-166) - Platelets: 403 × 10⁹/L (elevated) **Biochemistry Analysis:** - Urea: 1.80 mmol/L (normal) - Creatinine: 33.4 μmol/L (normal) - **ALT: >1000 IU/mL** (EXTREMELY HIGH - severe liver dysfunction) --- ## FOLLOW-UP IMAGING (December 16, 2025 - 5.5 Months Old) ### Liver Ultrasound: **RESULTS:** - Right lobe: 64 mm, left lobe: 43 mm - Liver capsule appears irregular and vague - **Parenchyma: heterogeneous, showing 7 hypo-isoechoic nodules** (sizes range from 11.5×10.7 mm to 17.6×15.4 mm) - Capsule features uneven contours - Blood flow noted during Doppler examination - No dilation in intrahepatic bile ducts - **Portal vein: 3.9 mm** (decreased from 6.1 mm - indicating improvement) - Common bile duct: 1.4 mm - Gallbladder: measures 43.7×9.2 mm (pear-shaped, wall thickness 2.0 mm, homogeneous, free of stones) **ULTRASOUND ASSESSMENT:** "Presence of liver volumetric formations (specifically liver hemangiomas)." --- ## LATEST MSCT (February 6, 2026 - 7 Months Old) ### MSCT with 3-Phase Contrast: **FINDINGS:** - Liver remains normal in size, but shows heterogeneous structure with uneven contrast enhancement - **Portocaval shunt: 9.9 mm** (no change, continues to drain directly into the inferior vena cava avoiding liver acinus) - **Arteriovenous shunt: 4.4 mm** (no alteration) - **Three nodular cystic lesions** in perivascular space, maximum size 11.6×20.7 mm, enhancing in the venous phase - **Portal vein: 6.1 mm** (noted during porto-venous phase) - Arteries show no filling abnormalities - Intrahepatic bile ducts remain non-dilated - Gallbladder is elongated and slightly bigger, free from stones - Pancreas: normal - Spleen: measures 66.9×38.5 mm (not enlarged), splenic vein is 3.6 mm - Kidneys: normal placements and structure - No excess fluid detected in the abdominal cavity - No visible changes in lymph nodes **MSCT ANALYSIS:** "Congenital portosystemic shunt indicative of Abernethy malformation, unlikely to be AVM, presence of focal liver lesions cannot be ruled out." **RECOMMENDATION:** Engage with an abdominal and vascular surgeon. --- ## RECENT BLOOD WORK (December 2025 - January 2026) ### Complete Blood Count (January 19, 2026): - 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.