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Need help with medical diagnosis
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My 16yr old daughter randomly started having episodes where she gets light-headed, her right hand and right foot begin tingling and feel like they're going to sleep. Sometimes she has shortness of breath and starts getting really scared. She describes it as if she's about to fall asleep then shakes herself out of it. There is no pain associated and comes and goes all times of day. Sometimes it lasts 30 seconds, sometimes a few minutes.

On Sunday evening it was so bad I took her to the ER and she was telling me she was sure she was going to die. In the ER, they did a blood test, urine analysis, CT scan of her brain and an EKG. 6 hours later they told her everything looked normal and sent her home.

It's been happening on/off for about a month. It started 2 days after she was stung on the foot by a stingray while surfing. After being stung she went straight to our doctor where they immersed her foot in hot water, gave her a tetanus shot, and prescribed antibiotics.

No change in diet, no high stress levels, no other abnormalities whatsoever.

I suppose it's possible the venom from the stingray sting is causing strange issues, which align with what I've read online. What I haven't found is a case where it's still going on after a month. The symptoms are kind of similar to a TIA, but I would imagine something would've presented from the work done at the ER(?).

At the moment, the path is to get an ultrasound on the stingray sting location and determine of part of the barb is still present. If so, they'll have to remove it. If not, then we are totally stumped as is our doctor.

I also suspect the shortness of breath is a reaction to the 'episode' and her anxiety levels jump, but could also be related.

Any ideas?
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Re: Need help with medical diagnosis [JD21] [ In reply to ]
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Without trying to be an alarmist, which this comes across as, I would request an MRI for MS.

It's probably not, but a lot of the symptoms sound like it could be and an MRI is simple.

Good luck.
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Re: Need help with medical diagnosis [JD21] [ In reply to ]
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JD21 wrote:
My 16yr old daughter randomly started having episodes where she gets light-headed, her right hand and right foot begin tingling and feel like they're going to sleep. Sometimes she has shortness of breath and starts getting really scared. She describes it as if she's about to fall asleep then shakes herself out of it. There is no pain associated and comes and goes all times of day. Sometimes it lasts 30 seconds, sometimes a few minutes.

On Sunday evening it was so bad I took her to the ER and she was telling me she was sure she was going to die. In the ER, they did a blood test, urine analysis, CT scan of her brain and an EKG. 6 hours later they told her everything looked normal and sent her home.

It's been happening on/off for about a month. It started 2 days after she was stung on the foot by a stingray while surfing. After being stung she went straight to our doctor where they immersed her foot in hot water, gave her a tetanus shot, and prescribed antibiotics.

No change in diet, no high stress levels, no other abnormalities whatsoever.

I suppose it's possible the venom from the stingray sting is causing strange issues, which align with what I've read online. What I haven't found is a case where it's still going on after a month. The symptoms are kind of similar to a TIA, but I would imagine something would've presented from the work done at the ER(?).

At the moment, the path is to get an ultrasound on the stingray sting location and determine of part of the barb is still present. If so, they'll have to remove it. If not, then we are totally stumped as is our doctor.

I also suspect the shortness of breath is a reaction to the 'episode' and her anxiety levels jump, but could also be related.

Any ideas?

I agree with Nova. Get her checked out as he prescribed, and I don't want to be an alarmist either. The two events may be related -- and I don't know the specifics when it comes to stingray venom -- or they may not. Better to be safe than sorry.

It sounds like they were pretty thorough on their workup in the ER. An MRI and a few neurological tests are typically definitive, and the CT should have ruled out any sort of TIA. They also don't sound like absence seizures (petit mal seizures). Like Nova advised, I would have her checked for any sort of progressive neurological deficits or related illnesses, just to be safe.
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Re: Need help with medical diagnosis [JD21] [ In reply to ]
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Has she ever had any anxiety or stress related issues? Anxiety and panic attacks can manifest in a huge range of symptoms, from tingling limbs, chest pounding, dizziness, and the list goes on. Work with the doctor(s) to rule out the more significant medical concerns first, but keep this in mind also.
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Re: Need help with medical diagnosis [JD21] [ In reply to ]
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I agree- get her worked up. Maybe ask if there is a risk of blood clots after stingray stings that could be causing issues? I googled and found a few not very quality claims on it.

And I have no medical knowledge- just totally freaked out by clots after a bunch of my co-workers have had problems.
Last edited by: Moonrocket: Mar 14, 18 12:23
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Last edited by: spudone: Mar 14, 18 12:29
Re: Need help with medical diagnosis [bm] [ In reply to ]
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I appreciate all of the responses. She has never had any anxiety or stress related issues and does not seem under and undue stress at this point. My sister is an ER nurse who spoke with my daughter and my sister did not believe it was a panic attack (for various reasons).

I'll push for the MRI so atleast we can rule out anything beyond what a CT scan might show.

There is very sparse information available regarding stingray venom, but if compared to rattlesnake venom it can do some really weird things to your nervous system but a month seems a rather long time to suffer the effects - perhaps there's still a piece of the stinger in her foot which will show up on the ultrasound she is scheduled for.

I'm skeptical it's related to the stingray and would rather go to the more extreme measures (like the brain MRI) and work backwards. It's pretty scary to have a teenager convinced she's dying because she can't control her body and can't breathe.

Thanks again for all the input.
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Re: Need help with medical diagnosis [spudone] [ In reply to ]
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The ER doc ruled out stroke, clot, heart issues, etc from the blood work and CT Scan / EKG. They didn't seem too concerned that it was a serious issue but I suspect ER docs are more 'in the moment' and it's either life-threatening in the moment or requires admission into the hospital or they send you on your way.

My kid is not prone to over react and is pretty calm and stable overall so when I see her struggle I take it seriously.
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Re: Need help with medical diagnosis [JD21] [ In reply to ]
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I'm retracting my previous DX, although I still recommend a MRI of the head.

It really sounds like she has some type of infection from the sting ray and is now having some kind of auto immune response. Some pathological infections come from the most unlikely sources and take a while to manifest themselves. If you cannot find the answer, I would think Infectious disease doctor.

https://emedicine.medscape.com/...le/772683-medication

I'm sorry she is going through this. In my 30+ years in medicine I've seen a ton of unlikely stuff, but the worst is not knowing what it is. A DX is somehow comforting.

Again, best of luck.
Last edited by: Nova: Mar 14, 18 14:02
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Re: Need help with medical diagnosis [Nova] [ In reply to ]
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Thank you so much.

We will keep at it and there is certainly the possibility it'll stop and we'll never know. Do you think trying an antihistimine might be worthwhile? And wouldn't an infection or allergic reaction present in urine or blood analyses?
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Re: Need help with medical diagnosis [JD21] [ In reply to ]
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JD21 wrote:
Thank you so much.

We will keep at it and there is certainly the possibility it'll stop and we'll never know. Do you think trying an antihistimine might be worthwhile? And wouldn't an infection or allergic reaction present in urine or blood analyses?

An Antihistamine probably won't help, but it won't hurt to try.

An infection might be there and the doctor might not even notice from the blood work. An increase in total WBC would be an outright indicator that something is happening >10-12, however, the total WBC doesn't always go high enough to alert the doctor. The TYPES of WBC are the key. With the thinking of a bacterial infection one would look at a neutrophilic response. >85%. It could also be an mono response with >10-15%. In this case prophylactic antibiotics would be expected.

Other types of thinking could be an immune defense response with an increase in lymphocytes. The reaction could be against the toxins produced by the bacteria and not the bacteria themselves. In this case you treat the the toxins by flushing them out and the bacteria with ABX therapy.

The ultra sound is the right thing, but I would also push for the MRI, if the ultrasound is negative.

I'm not sure I'm making a lot of sense and therefore confusing you more. Sorry if that's the case.

In a more simple answer, It could be an infection that has spread. It could be an infection and a response to the toxins. It could be a response to the left over barb or the original toxins. (I admit to knowing NOTHING about stingray toxins.) Or it could be something completely different and it just happened to coincide with the stingray sting. That's why I originally thought MRI.
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Re: Need help with medical diagnosis [JD21] [ In reply to ]
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So sorry to hear about your daughter, can't tell you how many stingray stings I have treated over the years. And hot water is really the only comfort in the beginning when you want to cut off your foot to stop the pain. But that is usually just what it is, severe pain and it usually goes away within hours. Only lasting affects are a sore spot maybe a few days later.

SO yes look for some splinter that may have lodged, that could be a source of infection. You are on the right track, rule things out and keep moving forward. I would not dismiss anxiety or panic attacks, maybe not the root cause, but could be making it seem worse than it actually is. When someone starts to become hyperaware of their breathing or every little twinge in their bodies, it can be an instant trigger to panic, and for things that happen every day unnoticed usually.

I spent a year and a half looking for something concrete after my heart surgery as to why I could not feel good enough to train, trouble breathing, and tired all the time. Went to an army of virologists, got every test, and one day the last one said I told your story to my husband who is a psychologist. He thinks you may have PTSD. He fixed me in one day. I was elated and frustrated that it took so long to find something so simple, of course after the fact.

I only tell this story to you right now because sometimes it is something so simple, it gets overlooked. Slingblade, remember that one, I think it is out of gas says Billy Bob Thornton!!(after a mechanic worked on it for 8 hours and could find out why it wouldn't start)
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Re: Need help with medical diagnosis [JD21] [ In reply to ]
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You gotta land there last, do all the due diligence first, but this seems like anxiety to me. Sometimes just acknowledging that is enough to fix it and if it's not it's easily treatable. The tests need to be done, I guess, but once they're normal the emphasis needs to be on the fact that she is fine, not that something could be being missed. Bad things don't come and go, they come, stay and get worse. Should it be a real something it'll become obvious at some point down the road.
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Re: Need help with medical diagnosis [spudone] [ In reply to ]
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spudone wrote:
I've had a blood clot before and the shortness of breath caught my eye but she's young, and the other symptoms sound more like an allergic reaction - maybe to the venom. Odd that it's still going on after so long though.

I'd definitely want a close exam / ultrasound of where she was stung and maybe see what the doc thinks about an antihistamine.

@JD21: have the docs definitively ruled anything out yet?

They may have already run a D-Dimer test for blood clots in the ER, but if not it's worth having it done to rule out a thrombus.
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