Mysterious Symptoms
Greetings! I am a 23-year-old female, standing at 165 cm and weighing 63 kg. For the past four months, I have been experiencing tingling sensations, akin to tiny insects crawling beneath my skin, predominantly affecting both sides of my body, including my arms and legs, with particular intensity in my palms and soles. Occasionally, I also feel this tingling on my face. I have undergone an MRI scan of my brain, which returned normal results. Additionally, other blood tests indicate that my health is generally okay, although I did find slight deficiencies in calcium and vitamin D. For the past month, I have been taking supplements for calcium, vitamin D, folic acid, and iron, but the tingling persists. I have never had a tick bite or been diagnosed with Lyme disease. Moreover, I do not suffer from anxiety or stress. I am at my wit's end and would greatly appreciate any advice on what steps I could take next to address this persistent issue. Thank you for your assistance!
Answers (1)
9/4/2025, 12:40:48 PM
OpenHealth AI
It's understandable to feel concerned about persistent tingling sensations, especially when you've already undergone tests that show normal results but still have ongoing symptoms. Tingling can be caused by various factors, including nutritional deficiencies, nerve-related issues, or even less common conditions.
Explanation:
Given that your MRI was normal and your blood tests indicate generally good health—with slight deficiencies in calcium and vitamin D—it's essential to consider a few key points:
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Nutritional Deficiencies: While you're addressing your vitamin D and calcium levels through supplements, it can take some time for symptoms to resolve even after supplementation. Ensure that you are getting enough of these nutrients through a balanced diet.
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Nerve Health: Tingling could be related to nerve issues, which can arise from vitamin deficiencies, thyroid disorders, or other neurological conditions. Since you mentioned no stress or anxiety, we can rule those out as contributing factors.
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Other Causes: Conditions such as peripheral neuropathy or myofascial pain syndrome might not be obvious but could lead to tingling sensations.
Next Steps:
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Dietary Considerations: Ensure you are consuming foods rich in calcium (dairy products, leafy greens) and vitamin D (fatty fish, fortified foods). Consider including a broad spectrum of vitamins in your diet since deficiencies can sometimes lead to neurological symptoms.
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Continue Supplements: Keep taking your supplements as prescribed for calcium and vitamin D, but monitor any changes in your symptoms. It may take a few months for noticeable changes, and it’s essential to stay consistent.
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Symptom Diary: Keep a journal documenting your symptoms. Note when they occur, their intensity, any specific activities that might lead to worsening sensations, and any dietary changes. This can help identify patterns and trigger factors.
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Consult a Neurologist: Given your ongoing symptoms, consider following up with a neurologist for a more detailed evaluation of your nerve health or explore other potential causes that might have been overlooked. Bringing your symptom diary will be beneficial during this appointment.
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Physical Activity: Engage in regular light physical activity, which can help with circulation and nerve function. Activities like walking or yoga can be beneficial.
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Limit Caffeine and Alcohol: Both substances can sometimes exacerbate nerve sensations, so moderating intake might be worth considering.
By taking these steps, you can work towards identifying the cause of your symptoms and hopefully finding relief. If symptoms worsen or new symptoms arise, please reassess your approach and seek further evaluation. Your well-being matters, and it's important to keep pursuing answers.
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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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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.