Question Title: Please help, any clue?

I am an otherwise very healthy, high energy 35 y.o. woman with no
history of GI problems. I came back from several months in
Costa Rica and the South Pacific, and have been feeling awful.
I ate a piece of raw fish in Hawaii in October, got VERY ill
after, and have not been the same since.....My symptoms are
intermittant nausea, vomiting, extreme fatigue, upper stomach pains,
infrequent diarrea, low fever a couple times. At first I thought I'd gotten over it
after doctors treated me w/ Albenza for parasites (tho' all
my stool samples were normal)....only to feel worse then ever
several weeks later. I was exploring a GI route w/ all this but really
I don't have much diarrea or a lot of pain. The main thing
is fatigue, upper ab discomfort and nausea.....So I asked the
doc had they tested me for hepatitis, he said no, only for]
liver function, which was normal. All my blood tests have bee
normal except elevated WBC. Also no blood in stool. So now I'm being tested for all
the Hep strains. Do you have any other suggestions of infectious
diseases or parasites I should be tested for that wouldn't show
up on routine testings of blood and stool samples? Things are
getting so bad I'm having trouble working now. Also I work with
disabled kids and don't want to be spreading anything.

By the way I thought about irritable bowel/stress but it just doesn't
make sense to me. I've been through a lot of stress in my life
and never reacat in my stomach. Also don't really have diarrea.

Thanks so much. PLEASE give any informed thoughts you may have.
Please give clues/suggestions!

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Ms. M:

I appreciated your most interesting letter and I can appreciate your frustration. I understand that you are having a lot of fatigue and nausea since returning from Costa Rica and the South Pacific.

First, of all, I am happy that you are being checked for hepatitis A. This is a form of viral hepatitis that you can get from just eating contaminated food or water when traveling. Your normal liver enzymes make this diagnosis somewhat unlikely but I am happy you are being checked out.

I am not sure what specific parasites need to be checked out. Most parasites are included in what we call a standard ova and parasite test. In addition, a fair number of other parasites respond to albendazole. One common parasite is giardia and sometimes it is hard to pick up with standard tests. Some individuals pick up a bacterial infection in the stomach called helicobactor pylori when traveling and this can cause fairly impressive nausea. Sometimes we perform endoscopy of the stomach in patients with persistent nausea. We can rule out inflammation of the stomach (gastritis), we can rule out helicobactor pylori and we can also check for giardia. We can also rule out a more unusual process related to foreign travels called tropical sprue.

I do note that many people do not feel well after returning from extensive travels and sometimes we aren’t able to find out why. People eventually recover on their own but it can take awhile. This is not a reason to be checked out thoroughly. However, I would try not to get too discouraged.

I hope this information is helpful to you. Good luck with your problem. If you have additional questions or more information, feel free to post the material back to MEDHELP or you are always welcome to contact us directly at Henry Ford at (313) 916-8865. If you are in the Detroit area, we would always welcome to come see us. We have a very active group of liver and gastrointestinal specialists.

This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.

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