Unexplained Health Issues
At 27 years old, and standing at 5'6" with a weight of 150 pounds, I have found myself facing a troubling battle with chronic fatigue and frequent bouts of dizziness, even during moments of rest. The onset of these issues can be traced back to an unusual ocular migraine I had shortly after ringing in the New Year. Though I have encountered ocular migraines before, this particular incident was unlike any previous experience. Following its conclusion, I was overwhelmed by an incessant feeling of dread, coupled with heightened anxiety and panic that clung to me relentlessly throughout the day. Along with these mental strains came debilitating fatigue and a sensation of lightheadedness. In the time since, I’ve also been experiencing: - Constant pressure in my forehead - Intermittent discomfort in the back of my head - Sensitivity to light that occasionally lasts for weeks - Chronic swelling in the lymph nodes on the left side of my neck, a condition that has persisted for five years following a mono diagnosis, leading me to question if this may be connected to my current symptoms. At first, I believed my symptoms were psychological, prompting me to consult a psychiatrist. After exploring various medications and therapies, they determined that I did not meet the criteria for clinical depression or panic disorder. Eventually, I discovered that I had been exposed to significant mold in my apartment, which may have been present for an extended period. Results from a Farmer’s Lung panel confirmed the presence of Penicillium betae, thus compelling me to relocate. However, it has now been nearly three months since my exit from that environment, and yet I continue to endure daily fatigue, dizziness, and relentless headaches, which are taking a severe toll on my overall well-being. Recent laboratory tests indicated deficiencies in both vitamin D and B12, for which I have commenced supplementation. I recently consulted a neurologist who has recommended an MRI and MRA later this month. Their hypothesis suggests that I might require improved sleep and enhanced management for migraines. I was prescribed nortriptyline, commencing with 10mg at night, before increasing to 20mg in the second week, and aiming for 30mg in the third. Initially, the 10mg dosage yielded positive results, significantly improving my condition. However, upon escalating to 20mg, I began experiencing severe faintness during any activity that elevated my heart rate. After just two days of this distress, my physician advised me to revert to 10mg. Regrettably, this past week has felt like a regression, as I find myself back at square one. I am making concerted efforts to improve my condition by staying hydrated, engaging in 30 minutes of running four times a week, and averaging 6 to 7 hours of sleep nightly (with the occasional lucky night reaching 9 hours). Nevertheless, I remain trapped in a cycle of persistent fatigue, faintness, and disruptive headaches. This situation is extremely disheartening, causing me to feel on the brink of losing my sanity. I am acutely aware that something is amiss, and at my age, I shouldn’t be enduring this struggle every single day.
Answers (1)
7/15/2025, 3:21:30 AM
OpenHealth AI
I'm truly sorry to hear about the challenges you're facing with chronic fatigue, dizziness, and headaches. It sounds extremely overwhelming, especially with the added physical and mental strain from the ocular migraine and your exposure to mold. Let's break down your situation and focus on actionable steps you can take to help improve your well-being.
Key Points:
- Persistent Symptoms: Your ongoing fatigue, dizziness, and headaches, especially following significant life changes like mold exposure, need careful attention.
- Recent Medical Guidance: It's good that you're under the care of a neurologist and have been exploring treatment options, including supplements for deficiencies and medication for migraines.
Explanation:
Chronic fatigue and dizziness can be caused by various factors, including vitamin deficiencies (like the B12 and D you're addressing), migraines, stress, and potentially unresolved effects of mold exposure. The symptoms you've reported, including pressure in your forehead, light sensitivity, and lymph node swelling, point toward a complex interplay of physical and possibly psychosomatic factors.
Your improvement on the initial dosage of nortriptyline suggests that this medication can have a positive impact, but the side effects at a higher dosage are concerning. Your neurologist's approach to reassess the medication might be key to your recovery.
Next Steps:
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Medication Management:
- Continue with the current dose of nortriptyline (10mg) as advised and communicate any side effects promptly to your healthcare provider. Discuss the option to try a different class of medications or alternative treatments if side effects persist.
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Lifestyle Adjustments:
- Prioritize sleep hygiene: Aim for consistent sleep cycles, reduce blue light exposure before bed, and create a calming bedtime routine to improve quality sleep.
- Nutritional Support: In addition to your vitamin D and B12 supplements, ensure your diet includes plenty of omega-3 fatty acids (found in fish, walnuts, and flaxseeds) and antioxidants (like fruits and vegetables), as they can support brain health and reduce inflammation.
- Gentle Exercise: Although running is beneficial, consider incorporating low-impact activities like walking, yoga, or swimming to help reduce dizzy spells and fatigue while still keeping you active.
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Monitor Symptoms:
- Keep a detailed symptom diary to track your fatigue levels, headaches, light sensitivity, and any connections with activities or food. This can help identify patterns or triggers and provide valuable information for your healthcare providers.
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Explore Alternative Therapies:
- Consider integrating therapies such as cognitive-behavioral therapy (CBT) or mindfulness practices to help manage anxiety and stress, which might be exacerbating your physical symptoms.
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Look for Medical Follow-ups:
- Await the results of the MRI and MRA. It’s crucial to pursue these tests as they can provide insights into your neurological health. Follow up regularly with your neurologist to adjust your treatment plan as necessary.
Remember, your feelings are valid, and seeking a diagnosis can sometimes take time. It’s great to see that you are proactive about improving your health. Stay patient with yourself, and continue to advocate for what feels right as you collaborate with your healthcare team. If concerns escalate or you experience new symptoms, don’t hesitate to reach out for immediate help.
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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. 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