Seeking Insights on Lab Results
Greetings, I am a 34-year-old woman recently diagnosed with Pernicious Anemia. My primary care physician mentioned that she wouldn't reevaluate my B12 levels— which have been persistently low—until I consult a specialist. Unfortunately, that appointment has been delayed significantly, so I have started supplementing with B12. Currently, I am experiencing numbness in my extremities and episodic dizziness that sometimes leads to brief blackouts lasting over 10 seconds. For the past four months, I have also been struggling with severe cystic acne that appears along my jawline. Just when I think I've managed to control it, I wake up to discover a fresh pimple. Last year, I underwent a bilateral salpingectomy; I have never been pregnant nor given birth. During my consultations prior to the surgery, my gynecologist identified pelvic adhesions and removed them. Despite that, I continue to endure pain in my right ovary, persistent acne, and have regular menstrual cycles, but with erratic blood flow and hot flashes. As a next step, my primary care provider ordered tests to evaluate my hormone levels. However, I received a call from her assistant informing me that "everything is normal" according to the lab results. This leaves me feeling uncertain; it seems either too superficial an assessment was made or my issues are being overlooked. I apologize if my concerns sound trivial, but I am seeking a second opinion. How can my lab results indicate normal levels while I am experiencing these significant symptoms? Could it be that I’m overreacting? I appreciate your help immensely. My initial four tests were flagged, and I was informed that LabCorp had no clear data regarding either regular or abnormal hormone levels. Thank you once again for your understanding. Here are my lab results for reference: - MCV: High at 103 - MCH: Moderately high at 33.2 - BUN: Low at 5 - BUN/Creatinine Ratio: Low at 6 - LH: 11.3 - FSH: 11.1 - Testosterone: 32 - Free Testosterone: 2.8 - Estradiol: 61.6 - TSH: 2.430
Answers (1)
7/29/2025, 5:31:23 PM
OpenHealth AI
Thank you for sharing your situation, and I'm here to help you navigate these concerns with clarity and understanding. You've raised multiple important issues, and it's understandable to feel uncertain when experiencing such symptoms despite lab results indicating "normal" levels.
Main Points:
- Your symptoms—numbness, dizziness, pelvic pain, and cystic acne—deserve thorough investigation, especially given your diagnosis of pernicious anemia.
- Lab results may not always reflect the full picture of your health, as symptoms can sometimes exist even when standard tests are within normal ranges.
- It’s important to prioritize symptom management and advocate for further assessment of your concerns.
Explanation:
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Pernicious Anemia and Symptoms: Pernicious anemia can lead to a deficiency in vitamin B12, which is crucial for nerve function. Symptoms like numbness and dizziness can arise from low B12 levels, and also from other underlying conditions.
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Cystic Acne and Hormonal Imbalance: Hormonal fluctuations can significantly impact skin health. While your lab results came back "normal," hormones can still fluctuate and may not always be captured accurately in a single test. Persistent symptoms like acne may be due to other factors, including diet, stress, or even side effects from any medications you may be taking.
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Pelvic Pain: Your history of pelvic adhesions and salpingectomy could also contribute to ongoing discomfort. While hormone levels appeared normal, the pain you're feeling warrants further exploration as it could be due to other causes.
Next Steps:
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Document Symptoms: Keep a detailed diary of your symptoms, noting when they occur, their severity, and any patterns you notice. This can provide invaluable information to any healthcare provider you consult next.
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Follow-Up on B12 Supplementation: Since you've started B12 supplements, track any changes in your symptoms. If you notice improvement, this could help the specialist evaluate your treatment effectiveness. However, still prioritize the appointment with a specialist for a comprehensive assessment.
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Seek a Specialist: Given the complexity of your symptoms, request an appointment with an endocrinologist for a more in-depth evaluation of your hormone levels and potential underlying issues. Also, consider seeing a dermatologist for your cystic acne, who can explore appropriate treatments tailored to your specific needs.
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Consider a Second Opinion: If you continue to feel that your concerns are not being adequately addressed, seeking a second opinion from another primary care physician or specialist may be beneficial. This ensures that all your symptoms are thoroughly considered.
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Lifestyle Management: In the meantime, maintain a healthy diet, stay hydrated, and manage stress through relaxation techniques. Addressing lifestyle factors can support overall health and may help alleviate some symptoms.
Remember, your concerns are valid, and advocating for your health is a crucial step. Keep prioritizing your well-being and seeking the right support. If you have further questions or need more detailed advice, feel free to ask.
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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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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.