Armchair Drs. needed

[Ruth0552]

I am clean out of ideas and it is pretty odd.

Had some indigestion on July 5th, diarrhea started AM July 6th, and has continued since then. Several times a day, but not relentless. Not changes based on what I eat, whether I take Pepto, etc. No other symptoms at all. I went to see my gastroenterologist on the 14th. My gastro is out until August so I saw her NP. NP did not really do much of an “exam,” usually my gastro palpates my whole abdomen, but I guess that is neither here nor there. NP wanted to start with a stool sample. Dropped off stool sample at the lab on the 15th. She did not do anything else. I almost asked for a course of metronidazole but figured I’m not a Dr and I should just keep my mouth shut.

I’m going to see my 92 year old grandmother Weds., so I thought it prudent to get a Covid test so I went to do that yesterday. It happened to be at the urgent care center for the hospital that has my PCP and the lab where my stool sample was run, and he said the stool sample was all negative. I can’t see those lab results online, so I don’t know if they somehow have it set to only let patients see lab results after the Dr. has clicked something, or if the Dr at urgent care was just confused about they had requested and they aren’t all back yet. They said their Covid tests are taking 1-2 days.

It is now almost 2 weeks of diarrhea. The NP did not seem to have any bright ideas and no, I did not start any new medications, eat any odd foods, or travel. At this point, when I talk to her, I assume tomorrow, I’m going to ask for antibiotics anyways. If I brought my dog to the vet with a stool sample that looked like this I would definitely be going home with a course of metronidazole. I really think somehow I got some kind of parasite or infection in my gut. I can’t think of what else would have come on so suddenly.

If anyone else has any suggestions, I’d be interested in hearing them. I’m not feeling very confident in drs and the medical field in general right now since I was hospitalized in May. I have a feeling the NP’s next suggestion is going to be a colonoscopy which I feel is a pretty big jump in diagnostics.

[JanM]

Giardia, or another intestinal infection. Who knows what the NP actually said for the lab to check for.

[Scribbler]

Go see a doctor, not a nurse practitioner.

I occasionally get persistent diarrhea that I suspect is linked to low level food borne illnesses because I only ever get it when I ve been indulging in restaurant food. Especially raw fish. Never on straight home cooking.

I have found that it will clear up with several days of the probiotic Florastor which is specific to e coli overgrowth. Also eating less maybe just yogurt and liquid until it settles down.

In people and horses my observation is that diarrhea can become almost chronic if you poop out all your beneficial gut bacteria and don’t replace them.

[Bluey]

Hope it is not that you are positive for COVID, diarrhea being one common symptom.

[Ruth0552]

I started taking probiotics almost right away. Typically if I have some kind of continuing GI issue, a few days of yogurt and probiotics will fix it. Not this time. Everything just goes right through me.

I had the order for the lab for a day, and while I don’t remember everything on there I think it was a pretty standard check- I know C Diff and Giardia were both on there along with several others.

Someone else was encouraging me to check all my meds for any side effects but literally none of them have a habit of causing chronic diarrhea.

[poltroon]

This sucks, OP.

May I say, two weeks of severe diarrhea is a big deal and it may be time to be more of a nuisance about it to your doctors. I had C Diff many years ago, and I was too polite, thinking it was just a little thing. Plus, I had a doctor appointment coming up soon. Plus, when I talked to them I was fairly cheerful, sure that my problem would be fixed soon. I always felt better in the mornings - which is when I was talking to them - and miserable at night. I ended up in the hospital with a temp of 104 F, a very low BP, and an electrolyte imbalance so severe that I could have died. It’s really easy for your electrolytes to get messed up in this state.

You have a GI doc so maybe you’re past this, but another obstacle is that we tend not to be graphic enough when describing feces. It matters if it’s watery, dark, stinky, etc. Fecal incontinence of any kind is a giant red flag.

You don’t want to self-medicate while still doing diagnostics, but some treatments that may be helpful include products like biosponge and activated charcoal - check with your doctor. I’d also suggest, since the yogurt isn’t helping, switching to a refrigerated powdered probiotic and eliminating dairy. When I was sick, I became temporarily lactose intolerant, and yogurt made everything worse.

Keep a food diary, if you aren’t already. This may help you see what foods are making things better or worse, and maybe give your doctor some clues if there isn’t a pattern apparent to you. I’d also try to record how you are feeling if there are any changes. And, probably record poop frequency too. Feels weird but if I had brought that data to my doctor earlier it might have spared me a lot of trouble later.

Nothing wrong with a good NP. Problem is probably not the credentials but that particular person and their experience level. I got some of the best recovery help from a dietician who had worked with many C Diff patients - she was possibly more knowledgeable on that particular topic than my MD.

[Graymaresrule]

Do you eat foods on this list? [URL=“https://www.healthline.com/nutrition/foods-high-in-fodmaps#section1”]https://www.healthline.com/nutrition...dmaps#section1

My recent bouts of heavy duty antibiotics seem to have killed off the critter in my gut that objected to most of the foods on the list but before they gave me explosive gas and, well you know…

[Ruth0552]

Well I think @JanM is going to win this one. I looked up symptoms of giardia and it pretty much hit the nail on the head. AND it’s notoriously difficult to diagnose, which was also true when I worked as a vet tech, so even if my test comes back negative I could still have it. And @poltroon you are so right. I didn’t think smell was a diagnostic tool so I didn’t mention the fact that my stool and any gas I have smells like a goddamned sewer.

Anyways. Hopefully by the end of today I’ll have all my tests back and all this sorted out.

[candyappy]

@Ruth0552

Well I think @JanM is going to win this one. I looked up symptoms of giardia and it pretty much hit the nail on the head. AND it’s notoriously difficult to diagnose, which was also true when I worked as a vet tech, so even if my test comes back negative I could still have it. And @poltroon you are so right. I didn’t think smell was a diagnostic tool so I didn’t mention the fact that my stool and any gas I have smells like a goddamned sewer.

Anyways. Hopefully by the end of today I’ll have all my tests back and all this sorted out.

I just read this and Giardia was my thought too. Only because my FIL had it once and that was his experience too. When does gas ( or the other) ever smell pleasant??

Hope it resolves quickly. If you have a well you might need to get your water tested and if you have city water you may want to check it as well and boil first before you use it for drinking or cooking etc…

[Ruth0552]

Covid test was negative. Stool sample was also all negative. I had to call to get both. I hadn’t heard from either place and it was getting later so I called and got results.

I’ve called the gastro place AGAIN since then to see when I’ll be hearing back from the NP and have STILL not heard back and it’s after 6 PM. Super peeved. I did tell the gal on the phone that I think I might have Giardia and she said well we tested you for that and it was negative. Are these people idiots or do they think I’m an idiot? Giardia doesn’t show up in every stool sample. Why am I educating them or why are they lying to me? And no, this was not a receptionist, I had pressed the button for medical advice so I think it was a nurse. And for that matter why did I make my husband drive me 30 minutes to an appointment last week and not even get examined? Why couldn’t that have been a zoom/phone appointment?

After being hospitalized in May and now this, any faith I had left in the medical profession is quickly dwindling. The customer service and patient care that I saw in veterinary medicine when I was a tech (or even now with my own pets) was far better than anything I’ve received.

[sparkygrace]

@Ruth0552,last year I hade similar symptoms. A change in diet, parasite tests, and other stool tests were negative. The problem got worse and worse. and my doctor finally told me she was stumped and I needed a colonoscopy to get a diagnosis. The appointment was two months out and I suffered through the summer. The gastroenterologist did a biopsy of my colon and I was diagnosed with microscopic collagenous colitis, an autoimmune disease. Treatment with a specialized steroid cleared it up, but it has come back. It’s worth asking about about. I actually found info about it myself by researching medical journals and the gastro confirmed what I found.

It took five months before I got a diagnosis and treatment. There was no sense of urgency and I really suffered.

I also had C. diff years ago. It was caused by overuse of a powerful antibiotic after two oral surgeries You will know if you have it because you will want to DIE.

[LilRanger]

Did they test the stool for COVID-19 as well? From what I have read, COVID-19 can affect only particular areas, so a nasal-pharygneal swab would not catch it if it’s in your GI tract. If when you go back, they have nothing, be sure to ask about that.

[Simkie]

Are you on a well?

It might be worth while to test the water if so. It’s been a year of weird weather, and an overgrowth of coliform or e coli in the well probably would not show with a stool sample?

[WavyRider]

I had symptoms like this for a long time and it ended up being SIBO (Small intestinal bacterial overgrowth). Worth looking into.

[Ruth0552]

I finally talked to the NP twice on Tuesday. She felt it was unlikely to be Giardia since I had tested negative for it (? Most people do???). I ended up back and forth with her on the phone a couple times and she she was in touch with actual GI Dr who is out. NP did jump straight to wanting to do a colonoscopy, as I suspected she would, but my regular GI doc wants to do some bloodwork and another type of stool sample first, then possibly a bacterial overgrowth test. So we are ruling out a few other things. I still wanted to try a week of metronidazole, NP did not want to prescribe that without a positive test result of some kind, but my GI Dr told her to do it anyways so now I’m starting a week of metronidazole. If I had a bacterial overgrowth I would be treated with antibiotics for several weeks anyways, so… And she mentioned another thing it could be, which would be treated with pepto 3 times a day for a really long time, but I don’t remember what it was. It was something found either in the colonoscopy or the 2nd stool sample but I don’t remember. I tried taking Pepto though, and it made no difference.

I am on city water, not a well. I suppose I could have the water tested, but my understanding of giardia is that there is a lot of places you can get it, particularly if you deal with livestock, and it can just chill in your system with no symptoms for quite a while. So I could have gotten it anywhere, if that is in fact, the problem.

[hoopoe]

Just read there is an outbreak of Cyclospora related to bagged lettuce mixes. See FDA web site

[Ruth0552]

Yup read all about the cyclospora yesterday. I definitely ate tacos with shredded iceburg lettuce from fresh express multiple times in the weeks before the 4th of July. I would have thought I’d be sicker if I had cyclospora but they also say not everyone even shows symptoms. Guess I’ll call the GI place back tomorrow… now do I start the metronidazole or not? It does not treat cyclospora.

[Ghazzu]

I’d give the metronidazole a try. It should have a pretty quick effect if it’s the right therapy.

[ToughShet]

@sparkygrace

@Ruth0552,last year I hade similar symptoms. A change in diet, parasite tests, and other stool tests were negative. The problem got worse and worse. and my doctor finally told me she was stumped and I needed a colonoscopy to get a diagnosis. The appointment was two months out and I suffered through the summer. The gastroenterologist did a biopsy of my colon and I was diagnosed with microscopic collagenous colitis, an autoimmune disease. Treatment with a specialized steroid cleared it up, but it has come back. It’s worth asking about about. I actually found info about it myself by researching medical journals and the gastro confirmed what I found.

It took five months before I got a diagnosis and treatment. There was no sense of urgency and I really suffered.

I also had C. diff years ago. It was caused by overuse of a powerful antibiotic after two oral surgeries You will know if you have it because you will want to DIE.

+1. Mine wound up being lymphocytic colitis, but that’s also only detectable with a colonoscopy. Treatment’s pretty iffy, but diet changes helped me (it took awhile to figure out what triggered it. In my case, soy and uncooked dairy have become no-go’s.) Also no more NSAIDs for life because that’s the one strong correlation they thing merits caution. I’m on a newer drug for my MS that thankfully seems to help, too. There isn’t a lot of info out there but I can share what I learned if it ever becomes something your gastros explore.

[sparkygrace]

@ToughShet, I know someone else who had lymphocytic colitis. Becoming lactose intolerant or having a problem with gluten is common with colitis. Dairy is a huge problem for me, so I stick to lactose free products. I can eat hard cheeses, though. My colitis was probably caused by years of taking Prevacid. I do take a NSAID occasionally for achilles tendon pain even though I am supposed to avoid it.

@Ruth0552, has your doctor suggested dropping dairy from your diet? It’s worth a try. Anyone can develop lactose intolerance with no other outstanding medical conditions.