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Dr. R. Bora
Dr. R. Bora, Doctor
Category: Health
Satisfied Customers: 5227
Experience:  14 years experience in the emergency room.
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I believe I have an enlarged spleen with pain to left side

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I believe I have an enlarged spleen with pain to left side under my rib cage. When I lay on my back I can see an area on the left rib that is swollen. After reviewing my last mri, liver was 17 cm and found a mass belived to be a cvernous hemangioma 2012. I have terrible muscle fatigue to whole body but especially to left side ( face, arm and leg) with parathesia. I also have had several spider angiomas pop up on chest, arms and back. I have a weird feeling when I eat foods with carbs and suffer from hypoglycemia. I have seen a neurologist and rheumatologist who both said "look at your liver". All tests have been negative ( hep b/c, LFT's, WBC, hgb). Cardiac test shows my left EF is 50 percent and bilateral internal carotids are 40 percent blocked. I dont drink or do drugs and was a runner before this recent episode. When I exercise I dont feel good. I can try to exercise until i cant any more but the next day I have no pain just quivering, like i dont have lactic acid or something, so no more exercise until I figure this thing out. The muscle problems started in 2008 and was told they were nothing so I ignored as much as possible but now it is becoming debilitating. I also had the spider angiomas cauterized in 2010 but are back with a vengence. my GP say's "well I cant see anything so your fine". I am a nurse and am disgusted at how I'm being treated. I have been researching for years and the closest thing to my condition is GSD but not sure which one. If you have any advice I would sure appreciate it. Thank you in advance
Submitted: 1 year ago.
Category: Health
Expert:  Dr. R. Bora replied 1 year ago.
Hello and welcome, I am happy to help you today.

I have read through your question.

What tests have you done to diagnose Glycogen storage disease?

When did the muscle fatigue start?
Customer: replied 1 year ago.
About 7 years ago I began with muscle twitches and was dz with benign facicular syndrom. At that time I also told the Dr that when I work out my muscles were not soar the day after. It was like I never worked out. His response was "maybe you are just fit". I stopped working out and running for 6 months and felt like I was getting weak so I started back to running again with no muscle soreness. In the last year my muscles have become shaken and fatigued. I have noticed increased hypoglycemia, so began carrying food with me at all times. It went to the er 2 months ago and they called a code stroke due to left sided pins and needles to face arm and sever cramping to left leg. Sine than I have noticed an abundance of spider angiomas to chest arms and back. They have checked for autoimmune disease sle, polymyositis, biopsy of spider angioma (neg for vasculitis), colonoscopy and GED (hx of colon ca in 2008), MRI brain, sle, ab igg, anti smooth muscle antibody free t3/4, panca, sst cmv, proteinase parvovirus, c reactive protien, see rate, vit b12 (344 now supplements), vit d (36 now supplements), sjogrens, aldolase, creatinine kinase, echo left ejection fraction low normal @50 percent, mra of ne k with 40 percent stenosis, and I'm sure I forgot some. Ultrasound of liver states "hemangioma remains 2.7 cm but unable to identify or visualize at this time". When I asked my dr about it she said "she know nothing about the liver and I'm sure it is fine". My muscles are aching like they have just come out of being asleep.
Customer: replied 1 year ago.
My dr was very mean during our last conversation. She asked me "are you willing to have a liver biopsy because with a hemangioma at the lower right you could bleed out!" I said yes because I can't live like this and would like to get back to work. She than Sid "we'll if it causing you problems what do you want us to do". I said resect it and her reply was ok I just want to know how far you are willing to go". I am so upset and scared of what is going on with my body and just need someone too look at the whole picture without trying to scare me.
Expert:  Dr. R. Bora replied 1 year ago.
Thanks for all that information.

Now, if you suspect GSD and want a diagnosis, you should check for the enzyme glucose 6 phosphatase which is usually deficient and results in all the symptoms.

You can also get a muscle biopsy done.

Both these tests will help to identify if you have GSD and which type you may be having.

You should get an MRI of the liver known as a liver scan to confirm the presence of the hemangioma. You could avoid a biopsy as a liver scan is almost diagnostic.


If you have any further question, I would be happy to help you.


I hope my answer has helped you.



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Customer: replied 1 year ago.
As I was reading more tests I found that my common bile duct was 7 mm. What do you think about my muscles not responding to exercise? Does this sound like GSD or do you have any other avenues I can persue as I have only been researching on the Internet and medical books. Does that test test for all GSD?
Expert:  Dr. R. Bora replied 1 year ago.
CBD of 7 mm is upper limit of normal or some consider it to be mildly prominent. However, you should correlate if your GB has sludge in it that might have tracked down to the CBD.

Most common variety of GSD is type 1 which can be diagnosed by G6PD deficiency and the other types by mucsle biopsy. This is the ultimate test for GSD as the diagnosis is almost 100%.



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Customer: replied 1 year ago.
Is a muscle biopsy the only way to check or can it be checked via blood? Would they find it through a liver biopsy? I would prefer the one with the quickest most accurate way.
Customer: replied 1 year ago.
And about my muscles not sore and quivering after exercise, should I stop exercising. What do you think about my ejection fraction and blocked carotids at 42 years old .
Expert:  Dr. R. Bora replied 1 year ago.
As I said, a muscle biopsy is more diagnostic than a liver biopsy because only type I affects the liver whereas all the other types affects the muscles. But you can do both for a complete diagnosis.

Yes, there are blood tests like for glucose 6 phosphatase enzyme deficiency which checks for type I, the most common variety.

You can do light exercise like water aerobics.

For the low ejection fraction, you should check your heart for valvular diseases. You need to talk to a cardiologist.

The blocked carotids could indicate that you have high blood triglycerides and cholesterol levels. Get them checked immediately.

I believe I have answered all your questions.

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Dr. R. Bora, Doctor
Category: Health
Satisfied Customers: 5227
Experience: 14 years experience in the emergency room.
Dr. R. Bora and 6 other Health Specialists are ready to help you
Customer: replied 1 year ago.
Yes you have answered all my questions. Thank you for all your halo. Excellent!

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