[sorry this is so long}Don't know what to do,15year old son getting worse

[Lisastringer]

Hello my name is Lisa and I am very concerned about my son Jacob who is 15years old.It started last year when he was trying out for 9Th grade football.His first try out was March2,2011.This would take place at the high school @3;00p.m.Try out where over at 5:00p.m..This was a cold day and they would be out side doing strength and conditioning  training.When I got to the school at 5p.m. to pick him and his friend up I noticed he looked sick.When he got in the truck and his friend in the back seat.I asked him if he was OK?He said Mom I'm real sick.He lay ed his head on the door and he said"hurry and get home I'm going to throw up.His pupils where so big and under his eyes where black.I noticed his hands they was purple all the way up to his knuckles.I said my goodness why are you so purple?He said "just get me home I'm going to be sick"his friend in the back seat said "Mrs.Stringer his hands have been purple the whole time we was at practice.When Jacob and I got home he vomited 3 times and went to bed.I thought he was sick because he needed to eat"low blood sugar"He got up 2 hours later he seemed a lot better.he got some thing to eat and went back to bed.The next day he was fine.March3..after what happened the day before I made sure he ate a little before going to try out that afternoon.When I picked him up at 5p.m. he was sick again with all the same symptoms.He told me "he shouldn't have eaten,he said  the food made him sick.when we got home he threw up 2 or 3 times and went to bed.Same thing as the day before.March 4..This was terrifying..It had been lightly raining and it was a chilly day.I was on my cell phone when I  pulled up to the school.I look over at a  bench close to the school and I immediately knew some thing was seriously wrong.I told the person on the phone"Oh my goodness some thing is wrong with Jacob.Jacob lifted his head and started to walk toward me.he was so weak and was walking slow and very off balance.He got in the truck and flopped his head over on the door.I asked him whats wrong,he very softly said mom get me home I'm so sick.I asked him if he wanted a water.As I handed him a bottle of water he was so weak the water fell to the floor.That's when I noticed his finger nails{his nail beds where the color of a newborn baby right after birth}.I started to cry and kept saying oh my god what is wrong with you???He couldn't talk.he not only had purple finger nails but around his mouth was white and under his eyes where black,his pupils dialated,he was lythargic, before I got out of the school parking lot he was asleep.I immediately took him to a walk in clinic that was still open.I could not get him awake to go inside.I ran in and asked for help.The nurse that came out helped get him up and get him inside.Honestly I thought he was going to die.The nurse  put the o2 sensor on his finger after I told them to look at his finger nails.the nurse told him "Jacob you need to take some deep breaths for me to get this oxygen up"As he strated to take some deep breaths his o2 started to come up.his blood pressure was elevated as well.They said he was most likely to be dehydrated.They drew blood and said they wouldn't know any thing for a few days.The next day I received a phone call from the nurse and said his liver enzymes were elevated and so was his calcium.She suggested I make a appointment with his primary Doc so I did.His primary ordered a echo cardiogram.A few days later the doc called and said his echo was abnormal and he needed to see a pediatric cardiologist.This was Friday!His appointment was for the following Tuesday.They did another echo and again it was abnormal for his age.They also did a stress test.The techs told Jacob he needed to be on the treadmill for 20mins to get his heart rate up.My husband and I was in the room with him.At about ten minutes I could see Jacob was struggling.He was white around his mouth and then I noticed his hands again where turning blue.My husband and I both jumped up and yelled oh my gosh hes not looking good,His heart rate was 254.The techs kept pulling the o2sensor of  because his o2 was dropping.they saying his o2 sensor was dropping because the room was cold.The last o2reading I seen before they had to stop the treadmill was 86%.Jacob only lasted 11mins.It took 30 minuted of him laying down to get his heart rate back to normal.I was shocked when they said his stress test was normal.The Cardiologist said he has a venous structure on the top of his heart most likely a systemic vein that would not cause any problems.She said most likely Jacobs symptoms was due to dehydration and not heart related.I'm not a doctor so I took her word and we left thinking every thing was ok with my son.Jacob use to be  pretty fit{ big muscles for a young man }he is very physically fit and takes good care of his body or should I say he did.The past few months my husband and I have noticed Jacob's energy is about zero.He goes to school when he gets home from school at 330 he gets a drink and then goes straight to bed.I"ve also notice when he gets home his pupils are almost always dilated and under his eyes are very dark.Looks like he hasn't slept for days.My Mother In law called me very concerned about Jacob as well.She said when he was at her house Jacob did 90sit ups and he just stopped and layed on the floor for a hour.she kept asking if he was ok and all he would say is yup.90 sit ups may seem like a lot for some people but with Jacob its not he use to be able to do 200 with no problem.She said "she could tell he wasn't feeling well.after the hour he layed on the floor he got up and said bye thats when he came home and like always came in got a drink and straight to bed.Two weeks ago football coaches wanted to have a meeting about strength and conditioning also try outs.Jacob asked if he could go to the meeting and said it was Monday Dec12,2011 @5:15 a.m.I agreed to let him go as long as they were not working out.I received a text from him at 6:00a.m. saying "MOM COME GET ME I'M REALLY SICK"I get to the school Jacob was in the locker room and like all the other times he had  dilated pupils,lethargic and needed to vomit, and fatigued.He wouldn't let me see his hands so I could check for discoloring of his nail beds.We got home and he vomited then went straight to bed .See Jacob won't tell any one what he feels like when this happens to him.That makes it very difficult for the school coaches the doctors and my self to figure out whats going on.All I can do is tell the doctors what he looks like when these spells happen.One day when Jacob was at school I got his lap top and did history search.This was heart crushing for me when I realized my son was doing his own medical search on his symptoms.This is what he typed in for his symptoms.Upon exercising I  feels like i'm going to black out,tightness in chest ,shortness of breath and feeling like I can't get enough air, blurred vision.I am scared to death some thing is going to happen to him.He loves to exercise and I know football is so important to him and I also know Jacob doesn't want any one to know including his doctor and me his mom.I have taken all exercising away from him but yesterday I went in his room and noticed he was kind of breathing heavy and I could see his heart beating real fast.I took his blood pressure and it was 161/61 with heart rate 119 beating irregular {home bp monitor}come to find out he was doing sit ups and push ups.He has had a pulmonary function test done and it was normal,drug test was also normal.The school has been notified to stop all exercise activity for him.The football coach said when he noticed Jacob leaving the gym{DEC12 first football meeting}he was doing a jump rope circuit.helped explain blood pressure blue nail beds any thing.This only happens when he exercises.I'm not asking for you to diagnos just asking for some one to tell me what to do and what tests need to be done,any thing would be appreciated

[itdood]

On the dilated pupils, Low O2 sat can cause pupils to fix and dilate.  Your sons 02 sat dropped into the 80% range.  Yes something isn't right there.  Anytime it drops below the 90s it's bad, and it's exponentially bad.  It could cause all those other symptoms you are seeing such as fixed and dilated pupils and the bluing issues.   There are a few things I can think of that would lead to a low 02 sat.  Poor heart output, pulmonary issues.  These issues can then be further broken down.

So low O2 sat seems to be the main issue.  But what is causing it?!?!


On the echo, they would have measured his heart's output called ejection fraction and stroke volume.  If this wasn't brought up then it's probably normal at rest.  I say at rest because it might change under load (exercise).

It seems to me like his heart is beating well, is structurally normal, and he doesn't have any sort of arrhythmia.

I would take the next steps.

Buy an O2 sat monitor for him.  These are cheap.  I recommend the Nonin Go2 Achieve.  Then start monitoring it when he exercises and tell him that if it drops below 92% he needs to stop.  Start keeping a log of when it happens and notes.

One of my suspicions is pulmonary hypertension (transient perhaps?).  Or possible embolism, blocked artery heading into or out of the lungs.

The other suspicion is the anomalous finding of the extra vein on top of his heart.  You didn't say exactly what this is, but some of these can cause circulatory problems.  Some of these extra structures can sometimes divert blood flow away from where it should be going.  If it's a vein on top of his heart then it's probably a pulmonary vein (vein comeing back from lungs to heart).

Perhaps a pulmonary consult would be a next step?

The only other thing I can think of is some sort of viral infection.  

[ku111]

Lisa, I just read this post.  Get him to Neuro.  He needs MRI to rule out Neuro problems.  It can't hurt and you can rule it out.  Believe me I know it is so hard to put your foot down.  I learned a lot and I am not so nice anymore.  Lots of damage to my son.  After MRI, you ask the Neuro to read it NOT just radiologist!  Demand from your primary care an MRI.  Please keep us posted.  

[grendslori]

Okay, Lisa, then one thing you may want to consider is seeing a nuerologist. Dilated pupils are usually a sign of something going on in the brain. Has he ever had an MRI done or a CAT Scan? I hope you did not take my post the wrong way; I too am a mother so I can ubnderstand your worry and concerns as to what is going on. I have a daughter who has gone through everything from a stroke when she was 10 to a heart transplant when she was 22. The oxygen levels of 86% are not normal, but those levels can be low if the person is a shallow breather. Myself included, when I went in for a proceedure recently my O2 sats were in the high 80s, low 90s. They gave me oxygen and it jumped up to 99-100%. I have HCM so I have a problem with being short of breath at times. Most of the time my O2 sats are around 94-96%. I also have Raynaurds so that thought automatically came to mind. Next time his fingers/nails are blue, check the INSIDES of his mouth. That would be an important clue for a doctor that there could be a heart related issue going on. Paleness around the lips basically no one will think anything about that, they also don't consider blueness around the lips as really being that significant in youngsters. You said his regular doctor stopped him for all of his activities? Did I read that right? If he has hit that level of concern, what else is he doing for your son right now? I can tell you that even with heart disease present there are only a very few conditions where a pediatric cardiologist will restrict a child from sports activities. Have you taken him to the ER when he is feeling like this so that an EKG could be run at that precise time? Hang in there. Also, just to let you know, there is a Pediatric Cardiology Forum here on MedHelp for supporting parents with questions and concerns. You may post over on that site as well.

[Lisastringer]

I can understand why my post is confusing,There is so much more thats going on with this issue of my son.My son is the kid who never ever wants any one to think some thing is wrong with him.He never misses school and takes very good care of his body or he tryes to.The thought of some body thinking he is sick or different from any one else would kill him.See Jacob is not the average teen who wants sympathy trust me I'm the mom of a 23 year old who loves sympathy any way he can get it.I also have a 17year old son he's like Jacob doesn't want any one to know any thing and nothing would ever be wrong with him or sick in any way and I have a 10year old who like my 23 year old he loves that special attention and sympathy when he has the flue.So this is not a sympathy getter thats for sure.May be my post would make people think it was only in march and Dec {we only have so much we can type 8000max}lol The dialated pupils only happen when he has the other symptoms and these only happen when he is exerting exercising.Yes I understand where your coming from {him sneaking in his room and working out}but if you knew him, working out,football any thing physical is what he loves more then any thing.The dialated pupils isn't because its dec.The Raynaurds Phenomenon  I am aware of that as well.Raynaurds phenomenon has nothing to do with low oxygen.Raynaurds phen can also becaused by migrain medication and other things but not low oxygen.I appreciate you taking the time to read my post and comment on it.I am not a first time mom who always thinks some thing is wrong with their child.I sure know alot of parents like that.lol.I will keep searching for answers.but again thank you very much.May your day be blessed

[grendslori]

There are a couple of things that come to mind for me after reading your post. The dialated pupils; in December, it's dark most places, even in the home where lights have to be turned on; dialated pupils would most likely be normal. That is an automatic response to the dark. People do not understand that a person can drink until he is blue in the face and yet still be dehydrated; the reason for that happening is because along with the drinking, the person must eat plenty of protein, it's the protein that helps to keep the body hydrated, not necessarily the drinking. The test results surprised me; usually if a person is dehydrated, his creatinine and BUN are elevated yet you say his liver enzymes and calcium were.  Has he been evaluated by a gastrointestinal specialist for the elvated liver enzymes? Are Have those tests been repeated to see if they are still elevated? Ironically, the darkened eyes are amost assuredly from a lack of sleep. With the amount of sleep your son is getting, he may actually be getting too much sleep and therefore, not sleeping well. The blue fingers could be a result of something called Raynaurds Phenomenon which is where the blood vessels constrict; patients having this problem can't put there hands in cold water or in the freezer, they have to wear mittens all the time because this disorder can be very painful. The problem here is that you never mentioned pain. If you think this could be an issue, you may consider seeing a Rhuematologist. Some children have the blue fingers/nailbeds due to a lack of oxygen, the problem is that they would have found the causing factors for that in the echo, without any difficulty. Children who have chest pain due to heart related issues would have to have a VERY SEVERE form of heart disease in ordser to actually have that pain. That disease would be so self limiting that they would never be able to do 90 push-ups let alone 200. They would be lucky just be able to walk across the room. Pain for most children and teens are a usually caused by the heart beating hard and hitting up against the chest wall; in other words they are having palpitations. That feeling is uncomfortable so they describe it as pain. From what I can tell, it appears your son got sick in March and them again in December, this could just be two unrelated viruses that you are dealing with and not connected at all. Most children who are sick, look sick, they throw up and feel horrible, but that does not mean that every time they get sick, it is related. The fact that he is doing things behind your back (push-ups and sit-ups in his room) makes one question if he is not playing on your sympathies. I am not saying this is what is happening, but I have seen this more than once with teens playing their parents. You have to be honest with yourself and ask yourself if this could be a possibility I think if Jacob was my son, I would consider seeing another cardiologist, if nothing else, just to ease your mind. The idea that he is going to drop dead from a heart issues is pretty close to nil. The main cause of athletes dropping dead during practice/game is usually due to Hypertrophic Cardiomyopathy which would have shown up on the echo. Even in that disease, the death rate is only about 2% . Take him for a second option.  

[Lisastringer]

Thank you for your comment,I don't even know where to begine.I guess I will start from scratch because there is deff a problem.Even his primary Doc said{once he had to stop all exercise because of sever symptoms}
"I'm afraid if he continues to exert he is going to drop dead"Thats scary words for a mom to hear.That being said ,why are we not being refered some where?Any way thanks again for reading my long post and  commenting. I will keep you posted on what we are going to do next.

[MichelleP_3811]

I can't say for sure what is going on though it seems obvious your son is having trouble oxygenating when he exercises.  I am not an expert on the heart.  I know what I know from doing research myself about my svt so I wouldn't begin to know what could be causing your sons problem.  It is possible he has afib but I would think that the doctors would have caught that on one of the stress tests.  So the two things I would do if I were you would be take him to the ER the next time it happens and/or go for a second opinion.  Inform the doctor about the symptoms you found on his computer if he is not speaking up himself.  And finally, make sure he hydrates himself before, during and after he exercises, not just after.  If you already become dehydrated then you will be sick after even if you start to drink the water.  That said, I don't know that I have heard of dehydration causing purple fingers so keep on top of this.  Something clearly isn't right.  Do your best to have a frank and open conversation with your son as well.  Maybe there are some things he isn't telling you.  Take care, I hope you get to the bottom of this soon.  Keep us posted on how he is doing.