Q: I have been trying to resolve a weird health issue that has kept me from being able to sleep in a bed for months now. Every time a symptoms is identified with certainty the doctors seems to want to call that the problem and treat it only. Any advice on how to diagnose my troubles to a root cause would be a life-saver.
I had an abdominal sonogram diagnosis in June of “fatty infiltration of the liver” observing a mildly (two fingers) enlarged liver. The recommendation was to wait three months and see if there was any change.
The pain associated with this began sporadically (brief and less than once per month) but since testing began it has become commonplace (daily) and often lasts for hours at a time. It’s a painful pressure that’s sometimes reminiscent of “runner’s stitch” and I often have a feeling of my heartbeat reverberating through my abdomen, predominately on the right side. Nightly use of lorazepam and Ranexa seems to make it manageable although I don’t know if that’s just from the diuretic effect or not. Symptoms definitely occur more readily on a full stomach or bladder, often feeling like it is also placing pressure on my kidneys.
Medical testing first began in March when I went to the emergency room due to constantly feeling faint. They chalked it up to anxiety but did record the fact that in the process of lying down for a minute, my blood pressure shot up 30 points. It went back to normal after standing back up. The response from half a dozen doctors since this observation has been unanimous: “I’ve never heard of that; blood pressure should decrease when you lie down.” In the end, I was put on a minimum dose of high blood pressure medication which my doctor took me off due to consistently low readings around 100/60. I’m still reading roughly 110/70 every morning.
Since going to the emergency room, I haven’t been able to lie down or even to bend over without rapidly accumulating symptoms of fainting, tinnitus, lightheadedness, mild dizziness, nausea, and eventually tunnel vision. Throughout this, the pain around where my liver meets my lowest ribs increases. Any firm continuous pressure in that area also seems to be a trigger.
I don’t smoke, drink or take Tylenol. Previous blood tests have identified no liver, thyroid or diabetic issues. I am male, 45, six feet tall and overweight at 220 pounds. My weight hasn’t changed in the last 12 years. Over the last year, I was getting less exercise, sleep and sunlight than normal which, admittedly, was substandard to begin with. Since April I have been regularly gently exercising for 20+ minutes twice a day as I was also showing symptoms of poor/restricted blood circulation when all this started. However, the abdominal pain is starting to interfere with my progress.
Most of the tests done so far have been from my own prompting which is the only reason I have even learned about the enlarged liver. Any tips pointing me in the right direction would be huge. Thank you.
A: First, if you are prompting your physician to order testing despite your varied and plentiful symptoms, you need to find a new primary care physician (PCP). Once you’ve done that, I suggest you have a thorough examination and blood work. Then speak with him or her about a referral to a liver specialist (hepatologist). This is your best starting point since you have been positively diagnosed with an enlarged fatty liver.
Liver enlargement can have many causes, including cirrhosis, hepatitis infections, cysts, non-cancerous tumors, heart failure, and iron/copper/abnormal protein/or fatty substance accumulation. Because your diagnosis was “fatty infiltration of the liver” and you don’t drink, my best guess at the diagnosis would be non-alcoholic fatty liver disease. However, you also mention being overweight and having poor circulation which could mean that your fatty liver is the result of a lack of exercise and poor diet and/or a blockage of the veins that drain the liver (Budd-Chiari Syndrome).
It’s my belief that once you find a caring, concerned PCP, future testing, referrals and diagnosis should follow without your prodding.
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