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I’ve posted here before but I’m really not getting to see…

Hello. I’ve posted here before...
Hello. I’ve posted here before but I’m really not getting to see what’s wrong
I’m feeling unwell. Weak nausea reflux change in stool ( paler. Not white or clay but pale) and weird pain on my scalp on the top of my head. on exams we only see liver microcyst, spleen that according to dr is limit 13-14 cm, and that my liver goes all the way to the left hypochondria but that’s a variant.
I don’t know what wrong. Am waiting for internal medicine consult but I don’t know what’s wrong. Neither does my GP.
I’m only 34 and never had any issues. I don’t know if it’s relevant but father passed away from higher grade neuroendocrine cancer at 55 y o and sister has idiopathie hyper prolactenimia
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Answered in 2 minutes by:
3/24/2018
Sumanth Amperayani
Sumanth Amperayani, Board Certified MD
Category: Medical
Satisfied Customers: 612
Experience: Consultant Pediatrician at Kanchi Kamakoti CHILDS Trust Hospital
Verified
Hi...Welcome to Just Answer. I am Dr. Sumanth Amperayani and I am here to help you today. I have 13 years of experience in the field of Health Care at a tertiary care referral hospital. I will do my level best to alleviate your health concern. I am currently reviewing your question. I will be back in a moment to guide you further.Kind regards ***** ***** Sumanth Amperayani
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on exams we only see liver microcyst, spleen that according to dr is limit 13-14 cm, and that my liver goes all the way to the left hypochondria but that’s a variant.Can you please clarify more on the above Phrases and sentences which you have posted so that we can move further.
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Customer reply replied 1 month ago
Hello. We’ve spoken before.
So I had an mri and mrcp.
They say spleen is 13-14 cm long. And that’s limit of normal. But no anenomegalopathy associated ...
Also liver micro cyst that does not enhance afterncontrast injection. So again they aren’t concerned
Last thing is that the left lobe of the liver goes all the way to the left side. It’s called hypochondria in French. But they say it’s a variant that’s normal. Some people have a liver like that
Customer reply replied 1 month ago
But I still have weird pains and just a general unwellness. Nausea no appetite weak unwell :(

HI...I remember that you have a doubt about urobilinogen and I had clarified on this.

From what you say as it is a microcyst and it is not enhancing on the contrast you can be rest assured that it is normal.

The liver being like that can be a normal variant or it could be a sign of chronic liver disease. But if it so, the liver function test should have been abnormal and I vividly remember that your liver function test and hemoglobin were completely normal.

I am sorry to say this and please do not take it otherwise, I feel that you are anxious about your health and you need not be so.

You have good reasons not to be anxious like - liver function tests being normal and also the doctors there telling that it is normal.

" I sincerely ***** ***** I have helped you, and that I have earned my 5 star rating today! Please remember to rate my service by selecting the 5 stars at the top of the screen (this is the only way we professionals get credited for our time and professional effort). We can continue here until you are satisfied, simply use the reply box and let me know.

A bonus is highly appreciated....Thank you!".

If you are happy with my interaction and guidance, next time if you have any health concern, you can approach me directly at the following link please -

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Kind regards ***** ***** Sumanth Amperayani

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Customer reply replied 1 month ago
Honnestly i am anxious. But it’s because I feel unwell all the time. And i find all these little things are just annoying. Like the spleen. It’s in the upper limit of normal and the liver is normal in size but expands ... it’s all due to what ? I know my blood tests are normal ...
Hi... I appreciate your honesty in accepting that you are feeling anxious.
I also understand that you are worried about the small abnormalities which are found out in scans and in correlation you are also feeling unwell.
But as a physician who has seen many such cases and with 13 years of experience in a tertiary care Hospital setup, I feel that you are not in danger of any serious disease or disorder.Logically speaking this is not correlating with any of the known serious pathological process. So I suggest that you be rest assured.
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Customer reply replied 1 month ago
I’m also stressed because I don’t feel good. And my dad had something so rare. I’m scared that we’re not finding my issue
Please don't feel stressed out as it is not that we are not finding out your problem.
If there was a real problem going on then they should have been some blood test abnormality which are not there.
Not only that, you need not worry about the small microcyst in the liver and spleenomegaly which you are having, as it could be physiological and normal finding.Neuroendocrine tumors do not have symptoms like this.
There would be hypertension hot flushes and other symptoms which are not there currently in you.
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Customer reply replied 1 month ago
Also I find that my eyes are a bit yellow. Can I send you a photo ?
Please upload an image and I will see and get back to you.
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Customer reply replied 1 month ago
It has a tint. We can’t see it properly on photos.
Customer reply replied 1 month ago
Eyes
Customer reply replied 1 month ago
My eyes were white before ;( more clear
Even now they are very white and I do not see any clinical abnormality in them. The white part of the eye called sclera which you are quoting as having an yellow tint in your first image is a completely normal finding.
This does not qualify for a jaundice or a liver disorder please.But to further clarify your doubts about your health I would like to know what are all the symptoms which are making you feel unwell.Let me know about all your symptoms so that I can do some symptom analysis and get back to you.
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Customer reply replied 1 month ago
the “yellowing” of the sclera is normal ?
that much amount of yellowing of sclera is normal.And any yellowishness of sclera which is clinically important should have a total bilirubin of at least more than 3mg/dL.
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Customer reply replied 1 month ago
I know. But I find that my eyes are not as “white and limpid” as before
As the age progresses the sclera also accumulates some amount of yellowishness which is normal. I am not telling that at 34 years you are old, but at the same time I am just telling you that this amount of yellowish discoloration of the sclera is normal.
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Customer reply replied 1 month ago
Ok
Customer reply replied 1 month ago
I have extreme exhaustion. And nausea and pains in my abdomen area. The thing is I actually have pain where the spleen is ... anyhow it’s not unbearable but it’s there. Also I feel weak and like spaced out almost always. Have trouble concentrating and everything causes me to be run down
Customer reply replied 1 month ago
It’s like even getting up
To make breakfast for my kids is super hard physically. Not mentally. Because I want to be active and do all I was doing. It’s physically that I feel unable and never feel ok. I don’t even know how to explain
Customer reply replied 1 month ago
It’s not a depression. I’m also feeling pressure in my head. It’s all very weird and not like me
Hi... I understand your concern.
From the symptom analysis of what you say and keeping in mind the past history of normal blood tests I feel that you are going through chronic fatigue syndrome.I suggest that you take regular Vitamin D and iron supplements for a period of 1 month along with fruits daily twice a day for antioxidant effect. With this I feel that you will feel rejuvenated and better.
Hope this helps and I am open for discussion further if you have any more doubts.
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Customer reply replied 1 month ago
Chronic fatigue can cause malaise ?
Customer reply replied 1 month ago
Because I’m not just fatigued. Im feeling u well. Sorry to bother you ...
Customer reply replied 1 month ago
Oh yeah and my appetite is not that great
You are not bothering me at all and it is my duty to clarify the doubts of my patients.You may not feel fatigued but all the symptoms which you are quoting is fitting into chronic fatigue syndrome along with loss of appetite which is also adding up.Feeling of unwellness and malaise are very well explained in chronic fatigue syndrome.
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Customer reply replied 1 month ago
the spleen and liver ? They just are a random finding ?
Customer reply replied 1 month ago
Or could it be somehow linked ?
Customer reply replied 1 month ago
Also chronic fatigue can last for years no? That’s not good
Customer reply replied 1 month ago
everything is hard to do. Even simple tasks I like
Customer reply replied 1 month ago
I always feel off and out of it
Many times as I am in a teaching Institution and as a medical teacher I keep teaching my students that we should never do any unnecessary investigation lest inadvertently will end up in some problems. I feel this is what has happened for you that you went through an MRI scan which showed a small microcyst which is found out incidentally and the splenomegaly also.
If splenomegaly is really bad then there would have been anaemia and also low platelet count because spleen would have destroyed the RBC and platelets.So I feel that the enlarged liver and spleen are only an incidental finding.Yes chronic fatigue syndrome can last for years together and that is why it is named as chronic.People with chronic fatigue syndrome do not feel like doing their own work which they like and this is the exact symptom of chronic fatigue syndrome.
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Customer reply replied 1 month ago
Also have si joint pains in specific spots. Had an mri os sacroiliac joints and it showed one spot of 9mm bone edema of subchondral bone. Again nothing that seems to be linked to the pain. I don’t know if it’s relevant
Customer reply replied 1 month ago
at times even watching tv in bed I don’t feel well
Hi... You are telling that you have been feeling unwell even when you are watching TV by just lying down on bed. I feel that it seems more psychological feeling of unwellness rather than any physical or organic problem causing this uneasy feeling.I am extremely sorry to say this but I feel that the stress and anxiety is taking the toll out of you and making you even more distressed about your health condition. I again reassure you that you need not worry about your health and please try to control your anxiety and stress regarding your health.Yoga and meditation will help a lot in tackling such sort of situations.Kind regards ***** ***** Sumanth Amperayani
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Customer reply replied 1 month ago
I understand the incidental findings completely. But I will try to explain from the beginning why I’m having issues with believing that’s what it is
So it all started in December 2016... night sweats and just unwell. Then did blood test and nothing came up. Then January till March back pain. Did mri and also for some reason abdominal ultra sound. At that point spleen was unremarkable at around 12 cm
Then continued to be unwell ended up at the hospital in September. They redid abdominal us and spleen was 14 cm. So for me the change from 12,5 to 14 cm means something came up...
And then the mri and you know the rest.
But I was convinced I was really sick all of last year because i felt so unwell.
Also the reason why I’m sticking on the spleen is that I’m saying that if we find out what’s causing it to be bigger then we can find out what’s wrong and maybe I’ll get better ... I don’t know if it makes sense. The fact that i have knowledge of the health and physical physiology is probable not good in my case. Anyhow. Also I have pain in my spleen area. When I run or jump
Around. Which I didn’t have prior to all of this. That’s why I’m having issues believing
It’s just an incidental fonding.
Customer reply replied 1 month ago
Also my skin is itchy in various spots so of course for me it pointed to bilirubin issue

Hi...I have gone through the history in detail. I agree that splenic enlargement is to be followed up.

But I do not see any reason for the liver enlargement to be worried about.

Definitely none of the symptoms you have are related to the problem your father had, neither is it related to the problem of your sibling. I can reassure you on those.

Coming to the liver enlargement - you can be res assured as there is no biochemical liver abnormality.

I am sending you link to some articles so that it will put your mind at ease.

Left lobe of liver need not always be pathological.

https://www.ncbi.nlm.nih.gov/pubmed/1257438

https://radiopaedia.org/articles/beaver-tail-liver

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602636/

"If you need more help, please reply to continue our conversation.

Kind regards ***** ***** Sumanth Amperayani

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Customer reply replied 1 month ago
I agree with you for the liver. However for the spleen what can I do ? I mean the CBC is normal so no leukemia or lymphoma... there’s no other abnormal finding on imaging ... so what can I do to follow it up?
Customer reply replied 1 month ago
What else can cause the spleen enlargement ?

Hello, may I know what is the span or measurement of the spleen in the ultrasound or in the MRI please?

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Customer reply replied 1 month ago
Oh and also for the liver just to let you know I was the one that was worried. In some exams the radiologist would comment on it and then on the next no. And they always said liver is normal in size ...
Customer reply replied 1 month ago
For the spleen it it started at 12,5 cm on ultrasound last year in March. Then in summer or September it was 13,5-14 cm
On mri it is 13,5 or 14,3 depending on the radiologist. It was measured twice.
They say it’s at the limit of normal
Customer reply replied 1 month ago
The dr I’m seeing now says that starting at 14 we investigate for blood or lymph cancers ... but because my CBC is normal she’s stuck
Customer reply replied 1 month ago
I’m just fed up and tired of feeling unwell. And I’m sure something is up ... we just can’t seem to figure what. And honestly I really appreciate talking to you because here in Canada it’s hard to exchange with a dr like this

Hi...the normal spleen span is 11cm in adults.

I agree that it is more - but without any peripheral clinical manifestations and blood work showing abnormalities, I think that we should wait and I assure you that nothing serious is happening till now.

There is nothing serious till now, but, I will also tell you a medical fact that - unless the appropriate time comes, the disease will not manifest even if it there. How much ever you investigate - it does not show up. I am no telling this to scare you that something is lingering and we are not finding out. I am just telling you a fact which I have seen in my practice till now.

But at the same time - I reassure you also with another medical fact - if spleen enlargement is pathological then it will start culling out the RBC and platelets and they will be very low. Anemia will be evident with low Hemoglobin nd there will be low platelet counts which is not there in your case. So I reassure you that nothing serious is going on please.

Thank you for your appreciation and kind words.

I am happy that my interaction was helpful for you and put your mind at ease. In future you can opt me as your favorite medical expert so that you can ask me a question directly. I will be happy to help anytime.

Kind regards ***** ***** Sumanth Amperayani

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Customer reply replied 1 month ago
for the spleen to be “enlarged” but no other clinical manifestation other than my “unwell” being ... it’s not enough to say something is seriously wrong ? We just wait and see if something come up eventually ?
Customer reply replied 1 month ago
You still think it’s chronic fatigue syndrome even with the spleen and all?
Customer reply replied 1 month ago
Also I know spleen liver go hand in hand and i was somewhat stressed because I though maybe it was some sort of splenomegaly caused by the liver ...

HI...I am not telling that we should wait for something to come up eventually.

At the same time I also explained you how to analyze the splenic enlargement and based on labs, why you need not worry.

It could still be chronic fatigue syndrome.

No please, you need not worry about something bad going on in liver causing splenic enlargement.

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Customer reply replied 1 month ago
the spleen for now it’s idiopathic splénomégali3 ? I understand how it works completely my symptoms just don’t add up with the physical findings. And the spleen is the only abnormal issue other than my state
Customer reply replied 1 month ago
Even now woke up have nausea and feel unwell. Always the same
Customer reply replied 1 month ago
It’s that we assume noting is going on but I don’t feel well. If I were ok than I would not care at all
I understand your concern... I sympathize with you and if possible can you try over the counter antiemetic and proton pump inhibitor reduce this nausea. Sometimes when you are stressed out this acid reflex can be really troublesome.
The best combination would be pantoprazole with domperidone.
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Customer reply replied 1 month ago
But again like me you don’t see any additional test I can do ?
Customer reply replied 1 month ago
I’m just worried That:
A it’s never going to go away and I won’t be able to be me again
B that it’s something serious and it’s just not being found
Hi..
1. There is no additional test that you should be doing as of now.
2. It is not true that it is not going to go away. As it has increased it may decrease also, as till date no specific reason has been found out.
3. You need not worry about it being something serious because it is absolutely not. The best proof that it is not something serious is - all your lab work has been normal till now.
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Customer reply replied 1 month ago
there’s nothing more we can do? Just wait and hope It goes away? And no
Bone marrow biopsy or anything else ?
When the peripheral blood smear examination is itself normal, the bone marrow may not reveal anything please.
But as such to go ahead with such N invasive procedure, there should be some clinical evidence, which is lacking here please.
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Customer reply replied 1 month ago
Last thing. Could it be some auto immune issue ?
Customer reply replied 1 month ago
Oh and last thing. Regarding the spleen. My iron values have decreased in the last year. And the ferritin is low low. So could it be slowly destroying my rbc or not likely
Hi...
I do not think this is an autoimmune issue because there are no clinical or biochemical or laboratory pointer pointing out towards an auto immune disorder.Serum iron and serum ferritin values are to be considered pathological only when they are lower than the normal range.
Fluctuations of these parameters when they are within the normal range slight ups and downs are not to be taken as a disease process.
May I know what are your iron and ferritin values and what are the normal ranges in the particular lab.
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Customer reply replied 1 month ago
Lab
Customer reply replied 1 month ago
we just don’t know why I feel this way. Even the pain in the sacro iliac area is not explanation?
Also I don’t know if it’s relevant but my fecal calprotectrin was 178 and référence is under 50. But it’s apparently not high enough to do anything else ... I’m just so lost
Customer reply replied 1 month ago
I just recieved the report for my mri mrcp and they say I have multiple “discrete” cysts not suspect. But I didn’t have that last yeah. I only had 1
They also saw an “opaque “ focal incompletely caracterized on my left lung. And they recommend an x Ray to check. What does that mean. I don’t even want to go look on the internet.
It’s in French the report

I have just seen the blood report uploaded by you and it seems normal.

Can you load the MRI images here please.

I do not require the report...I can read the MRI by myself.

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Customer reply replied 1 month ago
There’s so many :(
Customer reply replied 1 month ago
I don’t know which ones
Customer reply replied 1 month ago
they say focal opacity that are incompletely characterized and that need x ray correlation

Hi...focal opacity is in the lung. I agree. What about the liver microcyst, which have become multiple now.

When was your last MRI and when is the latest one...Dates please?

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Customer reply replied 1 month ago
1- focal opacity in the lung? They say focal opcoties... as in multiple :( and they say posterior junction of I guess middle and upper lobe
Customer reply replied 1 month ago
2 for the cyst they say microcyst is still 4 mm but there are various areas of annomalies of signal hyperintense B50, some hyperintense HASTE, without corroleraion T1, VIBE pre and post contrast ...
Customer reply replied 1 month ago
I had this mri last week Thursday
Customer reply replied 1 month ago
had had a entero mri in November last year. They had seen the microcyst on that one last year but not the rest
Customer reply replied 1 month ago
The spleen is 13,4 cm on both
Customer reply replied 1 month ago
Sorry don’t know if it’s clear. They saw the micro cyst on entero mri in November but not the other anomalies which they characterized as “discreet” cysts

Are you having any respiratory difficulty or weight loss or chronic fever?

Did you travel to any tropical country in the last 2 years?

Is there any history of TB contact within the past 2 years please?

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Customer reply replied 1 month ago
Haiti 2 times ...
Customer reply replied 1 month ago
Dominican Republic

Hi... In that case the only other option and probability which you need to rule out is Tuberculosis.

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Customer reply replied 1 month ago
I don’t think I have tb because I had the vaccine in early childhood
Customer reply replied 1 month ago
The opacities? Cancer ?

BCG vaccine taken in infancy does not prevent against all types of Tuberculosis. Moreover the vaccine efficacy is questionable after 15 years of life.

The opacities cannot be 100% be termed as cancer without any other systemic manifestations like weight loss fever excessive sputum with blood or any other cancer causing secondaries.

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Customer reply replied 1 month ago
I had random fever but thought it was a cold.
Customer reply replied 1 month ago
My father had lung metastasis and liver mets with no known primary. His was discorde because he also had bone mets... so right now I am panicking.
Other than that the opacities could be something else ?
Customer reply replied 1 month ago
I do have sputum lately that comes out randomly. But again thought it was from a cold
Hello... I feel that you should definitely get worked up for tuberculosis.
The only other possibility which can go on like this with questionable symptoms and with the history of travel to tropical country with or without a probable contact is Tuberculosis.If you are really worried about neuroendocrine tumor you should get yourself a screening test of VMA in the urine."If you need more help, please accept the proposed extra talktime and reply to continue our conversation. If you do not require further assistance, your 5-star rating at this time is greatly appreciated".
Kind regards ***** ***** Sumanth Amperayani
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Customer reply replied 1 month ago
What’s is vma? Serotonin related ?
Customer reply replied 1 month ago
for the liver ? What’s the thought ?
VMA is vanillyl mandelic acid. This will be elevated in the urine if it is a neuroendocrine tumor. This is just a screening test and not a confirmatory test.
Liver is just showing a microcyst and I would say just follow up is required for it and nothing else.
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Customer reply replied 1 month ago
liver and lungs not related ?
Customer reply replied 1 month ago
I just feel so unwell and things keep popping up
I suggest that you work up for tuberculosis and once this is negative, you stop investigating yourself for another two or three months unless you have chronic fever or exercise significant weight loss.
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Customer reply replied 1 month ago
But I mean if the radiologist said to do an X-ray of Kung I guess we have to do I e
Customer reply replied 1 month ago
One
Customer reply replied 1 month ago
for you the lung opacities on mri are not concerning ?

Unless I see the MRI images I cannot comment on this please.

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Customer reply replied 30 days ago
I don’t know what images to send you

Then send everything. I will look out for the abnormalities. I understand that you do not know what images to send please.

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Customer reply replied 30 days ago
I will see what I can do. It’s a lot of pictures
Customer reply replied 29 days ago
Ok for the lung i will wait and see the X-ray.i just have a question about the liver cysts...
in the mri there’s one 4 mm micro cyst and various areas of annomalies of signal hyperintense B50, some hyperintense HASTE, without corroleraion T1, VIBE pre and post contrast ...
what does that mean ? Does it mean that the various areas are cysts? I know you did not see the images but according to the report does this mean that it’s not of a “bad” nature ?
Customer reply replied 29 days ago
Does it mean that the cysts are not of malignant nature because of their appearance ?

Hello...I would be glad to continue here. I have already proposed a premium service. Either accept the service or rate this interaction a 5 star rating and open up a new question please.

Kind regards ***** ***** Sumanth Amperayani

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Customer reply replied 29 days ago
How do I accept ?

Hi...You can rate me 5 stars like how you have done last time and press accept under the proposal lead or please contact our customer care team regarding this.

Sumanth Amperayani
Sumanth Amperayani, Board Certified MD
Category: Medical
Satisfied Customers: 612
Experience: Consultant Pediatrician at Kanchi Kamakoti CHILDS Trust Hospital
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Sumanth Amperayani and 87 other Medical Specialists are ready to help you
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Customer reply replied 29 days ago
If it doesn’t work can I contact you again ?

Hi..I am happy that my interaction was helpful for you and put your mind at ease. In future you can opt me as your favorite medical expert so that you can ask me a question directly. I will be happy to help anytime.

Pose a direct question to me please after you opt me as your favorite expert.

Kind regards ***** ***** Sumanth Amperayani

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Customer reply replied 29 days ago
Well you do listen. I’m not to at ease because my issue is that stuff keeps popping up :( and don’t know why. I wish I was able to let you see the mri images somewhere :(

Do not bother about what images to upload, please upload all the images in a fresh question and I would pick up from those the images which I need to see and get back to you please.

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Sumanth Amperayani, Board Certified MD
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Experience: Consultant Pediatrician at Kanchi Kamakoti CHILDS Trust Hospital

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Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.

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