Seeking a Doctor Who Looks Deeper Than the Quick Tumor Diagnosis
Patient Details: 57-year-old female, height 5'6", weight 136 lbs. Medications currently prescribed: Suboxone, Ativan, Phenobarbital. Lifestyle choice: Uses vape products. Medical history: Elevated blood pressure, previous substance use issues with fentanyl and meth, recently undergone detox, affected by a COVID-19 infection while in withdrawal. Presenting concern: Experiencing intense pain behind her right eye for the past 24 hours, had a collapse that included temporary loss of speech and visual disturbances, brain mass detected with biopsy results still awaited. Narrative: My mother, aged 57, has just completed a residential treatment program for detoxification from fentanyl and meth. During this period, she faced intense physical and emotional turmoil, including severe spikes in blood pressure, alongside a COVID-19 infection. On the 11th day of her withdrawal journey, she started feeling an excruciating headache characterized by piercing pain behind her right eye. Shortly afterward, she collapsed. For a brief time, she lost the ability to speak but regained her speech progressively within a few minutes. She also experienced a momentary loss of vision in the same eye. At the hospital, her blood pressure readings were alarmingly high at 180/144, but it stabilized to 144/116 shortly thereafter. Imaging results indicated a mass located on the left side of her brain, which the medical team believes has developed recently. A preliminary examination performed by a surgeon during the biopsy suggested the mass appeared cancerous, although conclusive pathology reports are still forthcoming. Adding to our confusion is the fact that prior to her detox, my mother seemed to be in relatively good health without any noticeable neurological issues. The rapid onset of these symptoms took place during the withdrawal process and following her COVID-19 infection. I have several inquiries that weigh heavily on my mind: 1. Could the significant stress from detoxification, along with blood pressure fluctuations and her COVID-19 infection, have caused conditions that might mimic a brain tumor (such as a stroke or lesion)? 2. If the medical team believes the mass formed recently, does this indicate a higher probability of it being benign, or is that irrelevant? 3. What is the typical occurrence of sudden brain masses being benign compared to malignant tumors? 4. In the event of a cancer diagnosis, what critical questions should we be asking our healthcare team to thoroughly comprehend her prognosis and treatment pathways? Personal Reflection: What concerns me deeply is the coincidental timing and the multiple factors converging at once. The extreme withdrawal symptoms, elevated blood pressure episodes, COVID infection, and her collapse — each are known to potentially cause significant changes or damage within the brain. Given this convergence of events, I find it hard to believe that this is simply a straightforward tumor that went unnoticed. It feels like too easy of an explanation, and I am in search of a medical professional who will approach this case with a fresh perspective.
Answers (1)
9/15/2025, 10:02:01 PM
OpenHealth AI
It's understandable to feel overwhelmed by your mother's situation, especially with the complexities involved in her recent health changes. Here’s a summary addressing your main concerns followed by actionable steps moving forward.
Main Points:
- Stress and Health Changes: While detoxification, COVID-19, and high blood pressure can lead to significant neurological symptoms, the presence of a brain mass needs careful evaluation.
- Character of the Tumor: The speed of mass formation can vary, and while some recent growths can be benign, others may not be.
- Prognosis and Treatment Discussions: Formulating targeted questions for healthcare professionals can help clarify her condition and potential treatment.
Explanation:
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Stress and Symptoms: The combination of detoxing, fluctuating blood pressure, and a recent COVID-19 infection can indeed impact brain health. These factors may lead to a variety of neurologic symptoms similar to those caused by a tumor, including strokes or transient ischemic attacks (mini-strokes). Stress and high blood pressure can elevate the risk of vascular events that affect brain function. It's essential to address these factors alongside the neurological findings.
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Mass Characteristics: When it comes to brain masses, their recent development does not necessarily correlate to benignity. Tumors can arise rapidly in response to underlying conditions or remain asymptomatic for a long time. The characteristics of the mass (such as its size, location, and imaging appearance) will provide more clues, which you can follow up with the medical team.
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Benign vs. Malignant: Statistically, many brain tumors can be benign, particularly if they’ve developed recently. However, malignant tumors or those with aggressive characteristics can also appear abruptly. The distinction typically requires biopsy results, which should provide clarity on the nature of the mass.
Actionable Next Steps:
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Document Symptoms: Maintain a diary of your mother’s symptoms, noting any changes or new developments. This will be helpful during consultations with her medical team.
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Discussion with Healthcare Team: Prepare for her next appointment by outlining critical questions to ask, including:
- What are the specific characteristics seen on imaging scans?
- How does her recent medical history (detox, COVID-19) interact with her current health issues?
- What are the next steps if the mass is confirmed benign or malignant?
- What are the potential treatment options based on different diagnoses?
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Seek a Second Opinion: If it feels appropriate, consider discussing her case with another neurologist or oncologist who specializes in brain tumors. This may provide additional perspectives and confirm the best course of action.
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Focus on Blood Pressure Management: Since her blood pressure readings have been critically high, ensuring she adopts effective lifestyle changes and takes prescribed medications to manage her blood pressure is crucial. Discuss lifestyle changes with her healthcare provider, such as dietary adjustments and regular follow-ups.
Conclusion:
While the situation is undoubtedly complex, taking these steps can promote a better understanding of your mother's condition and ensure she receives comprehensive care. Your proactive engagement in her treatment journey is essential, and seeking clarity and support is the best approach during this challenging time. Please feel free to reach out for more information or specific concerns as you navigate this process.
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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.