Concerns About My Spine: Seeking Advice
At 34 years old, standing at 5 feet 2 inches and weighing 185 pounds, I've had my share of health challenges. Having gone through three pregnancies, two of which were delivered via C-section—most recently in July 2024—alongside dealing with irritable bowel syndrome (IBS), I find myself contemplating my physical condition more than ever. I've endured discomfort in my lower and mid back since adolescence, which is frequently accompanied by hip pain. Engaging in activities for extended durations often results in significant pain that lingers into the night and the following day. Intense workouts like Zumba and high-intensity interval training (HIIT) seem to exacerbate the pain throughout my spine, which has led me to focus on gentler exercises such as spin classes and yoga only. The discomfort I experience manifests as a persistent ache paired with stiffness, leaving me yearning for a solution to relieve it. Stretching provides temporary alleviation, yet the pain intensifies with prolonged activity and subsides when I'm seated. Although I invest in supportive footwear, like Hoka shoes, I haven't felt much improvement. I trust my primary care physician, but often sense my concerns are not taken as seriously as they should be, which leads me to fear that my quality of life might deteriorate as I age. I acknowledge that my significant weight contributes to my pain issues. Just last week, I completed my nursing journey, and I'm now adjusting my diet while committing to regular physical activity, starting with walks. After undergoing a urethra diverticulum removal in July, I’ve been more inactive than I'd like, but I’m eager to regain my mobility. I wonder, am I overreacting or is there indeed a curvature in my spine? Is there anything I can do independently to help improve my situation, or should I seek a referral to an orthopedic specialist?
Answers (1)
8/10/2025, 6:51:00 PM
OpenHealth AI
It's understandable to be concerned about your spine and overall physical well-being, especially with your history of back pain and recent life changes. The discomfort you describe, combined with your active life and the challenges you've faced, warrants paying attention to your symptoms.
Explanation
The discomfort in your lower and mid-back, along with pain in your hips, could result from several factors, including muscle tightness, possible structural issues, or even the cumulative effects of past pregnancies and physical activity patterns. Weight can certainly play a role as well, as excess weight puts additional stress on the spine and joints. The fact that pain subsides when seated may indicate that certain activities are exacerbating the strain on your back.
Gentle exercises like walking, yoga, and potentially low-impact activities are wise choices as they may help strengthen your core muscles, improve flexibility, and reduce discomfort without overloading your spine. Stretching can provide temporary relief, but it’s important to build a routine that supports your back's health long-term.
Next Steps
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Continue Gentle Exercise: Focus on low-impact activities such as walking, gentle yoga, or swimming. These options can improve mobility without placing too much strain on your spine.
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Practice Good Posture: When seated or standing, be mindful of your posture. Keeping your shoulders back and your spine aligned can help alleviate some pressure and discomfort.
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Stability and Core Strengthening: Incorporate exercises that strengthen your core muscles, as a strong core can provide better support for your spine. You might explore physiotherapy videos online that guide you through these exercises safely.
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Monitor Symptoms: Keep a journal of your pain levels in relation to your activities and diet. This can help identify patterns and triggers for your discomfort.
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Weight Management: As you're adjusting your diet and beginning a new exercise regimen, aim for gradual weight loss if recommended by a healthcare provider. This can significantly benefit your back and overall health.
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Consider Professional Guidance: Given your ongoing pain and concerns, it might be beneficial to seek a referral to a physical therapist or an orthopedic specialist for an assessment. They can offer personalized strategies and confirm if there are any spinal curvature issues or other concerns.
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Be Proactive with Your Provider: Maintain open communication with your primary care physician about your concerns. If you feel your issues are not being taken seriously, remember you have the right to seek a second opinion.
By focusing on these actionable steps, you can actively work towards managing your pain and improving your quality of life. Your health journey is personal, and it’s important to feel empowered in your decisions moving forward. Let me know if you need more information on specific exercises or tips!
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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 - 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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.