Concerns About My Medical Care
I’m a 26-year-old woman. Around five months ago, I began noticing that the end of my big toe's nail had become discolored. I consulted my primary care physician, who took some blood samples and referred me to a dermatologist. After a long wait, I finally saw the skin specialist, who took a sample of my nail for testing. Just last week, I received some "partial results" indicating that there’s a pathogenic issue, and I was prescribed bifonazole to treat a fungal infection, which I began using on Monday. However, I’m anxious because it appears that the condition is worsening despite the treatment I’ve started. Initially, it was just a small light spot, but now the lower part of my nail is entirely white, and it seems like it might come off soon. To provide some context, I have a history of mild atopic dermatitis and am on birth control using a patch that contains Norelgestromin and Ethinylestradiol. I also have an upcoming trip abroad in three days, and I've been informed that I can travel while continuing to use the bifonazole solution. Does that seem reasonable to you? Thank you for any insights you can share!
Answers (1)
8/21/2025, 10:22:04 PM
OpenHealth AI
It’s understandable to feel anxious about a worsening condition, especially when you’ve started treatment. Your case involves a fungal infection indicated by the color changes in your toenail and your ongoing treatment with bifonazole. Here’s a structured response to your concerns:
Main Points
- Concerns About Nail Condition: The worsening discoloration and structural changes in your toenail can be concerning, but this may happen with fungal infections.
- Travel Considerations: Traveling while using bifonazole is generally permissible.
- Follow-Up Actions: Monitoring your symptoms and addressing worsening conditions is critical.
Explanation
Fungal infections of the nail can sometimes appear to worsen before showing improvement, particularly in the initial stages of treatment. The complete white color at the lower part of your nail could indicate that the infection is affecting the nail bed more significantly. It’s important to keep in mind that nail infections can be stubborn and may take weeks to fully resolve, even with treatment.
Using bifonazole is an appropriate step, and continuing this treatment while traveling is typically safe. However, it’s essential to remain attentive to your symptoms, especially since you’ve noticed changes that might be concerning.
Next Steps
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Continue Using Bifonazole: Apply the medication as directed, ensuring thorough coverage of the affected area. This will help manage the infection.
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Monitor Symptoms: Keep a close eye on your toe. If you notice more severe symptoms like increased pain, swelling, or any signs of infection (like pus), prompt action may be required.
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Adjust Environmental Factors: Since you're traveling, keep your feet dry and clean, avoid tight footwear, and try to reduce exposure to moisture to support healing.
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Consider Temporary Changes: If the situation worsens, and you have the opportunity, ask your dermatologist for advice during your upcoming check-up when you return. If possible, keep a record of any changes to discuss with them.
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Stay Positive and Calm: Remind yourself that fungal infections often take time to completely resolve. Following your treatment plan diligently is crucial.
If anything concerning arises during your trip or if you have questions about your symptoms, don’t hesitate to reach out for medical advice while away. Wishing you safe travels and a smooth recovery!
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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:** - 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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.