Need your thoughts please

[M37CO]

About 5 weeks ago, while driving, I had the uncontrollable urge to go to the bathroom (stool).  This caused a significant amount of anxiety.  Although I made it to a rest room, this feeling of having to go persisted the entire day.  This continued to take place for at least a week, and it was also accompanied by  a "tightness" in my stomach, almost like a cramp.  About a week went by, and all of a sudden I had chronic diarrhea (several x/day).  I finally went to the doctor and I can't tell you all of the tests they have done, but I know they did CBC and some other blood work to check my Liver.  I have also had tests done on my stool, which have all come back negative.  During my first visit I was prescribed the antibiotic Flagyl.  During the course of the antibiotics my symptoms seemed to get better except for an upset stomach.  Now I'm up to week 5.  My PCP basically has told me they can’t do anything else and I need to go see a GI specialist.  The problem is, I can't get into see one for another week and a half.  My symptoms at present time are occasional diarrhea, but not nearly as persistent.  That being said, I still have anxiety because I don’t yet trust my bowels.   My stomach isn't nearly as upset.  (Note: No vomiting).  At one point I also had pretty significant gas.  I am now also suffering from fatigue.. kind of weak in the knees. My sinuses also are congested.   I am just trying to rule things out at this point until I do get in to see the GI specialist.  I have done countless searches on the internet which can be as you know a good thing, but in cases like this, it can also be even more troubling.  Although I am not considered "high risk" some of these symptoms also seem to be present with someone who has HIV... I do not have any rashes or anything like that.. So naturally, I'm worried about that now too... (I will get a test to be sure... I  seem to be worse in the mornings.   Any thoughts would be greatly appreciated!

[Kevin Pho, MD]

You need some kind of lower endoscopy at this point - either a flexible sigmoidoscopy or colonoscopy.  This can exclude masses, strictures as well as colitis.

Sending the stool off for analysis and culture can also be done to exclude infection.  Blood tests to look for celiac disease can also be considered.

These options can be discussed in your upcoming appointment with the GI physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_

[cheffie]

Definately find a doctor who can help you. Also consider getting tested for bacteria or parasites. You may have picked something up from food. Just another thing to consider. Good luck. Keep us posted on your progress.

[vcdlady]

I agree with all of Dr. Pho's excellent advice, including when he wrote:

"Sending the stool off for analysis and culture can also be done to exclude infection.  Blood tests to look for celiac disease can also be considered."

Because Flagyl is used to treat either Giardia or Clostridium difficile, I'm wondering if you may have had either Giardia (a parasite that is spread by drinking infected water that animals pooped in, like streams, etc.), &/or a BACTERIAL INFECTION of the large intestine (maybe small intestine too) called Clostridium difficile (abbreviated C. difficile, or, C. diff.).

If it's CLOSTRIDIUM DIFFICILE, this bacterial infection can be diagnosed by a stool culture, that is looking for C. difficile. How do I know? Because I have it! I took Keflex (a Cephalosporin type of broad spectrum antibiotic) for just 5 days, for a cut on my arm that had gotten infected, and on the 6th day--diarrhea began bigtime (orange, terrible smell, liquid, jelly-ish, with some mucus, and abdominal cramping--were my symptoms--sorry for being graphic.).

After a few days of this diarrhea & cramping, I sent in a stool sample, and, bought a "friendly" yeast "probiotic" (probiotic means friendly organism), called Saccharomyces boulardii, (from the refrigerated section of a health food store) which has been studied by both European and American researchers (on actual patients), and this S. boulardii friendly yeast, is said to both inhibit the C. diff, bacteria, and also blocks their toxin from attaching to intestinal wall's cells.

I'm also using the probiotic bacteria, called Acidophilus (Lactobacillus various species) and Bifidobacteria.

Saccharomyces boulardii (probiotic/friendly, yeast) is thought to be a "variety" (sub-species) of the live version of Brewer's/Baker's yeast. Health food stores sell the "killed" Brewer's Yeast, for its Vitamin B complex content. S. boulardii is LIVE yeast cells/organisms.

There are 2 major brands of Saccharomyces boulardii, sold in America, that I know of, and I don't really know which is better, yet. I started with Jarrow, and am now trying the Florastor (by Biocodex), and will see which I like better.

One brand is Jarrow. Their S. boulardii capsules (5 billion friendly yeast organisms per capsule) needs refrigeration. They are reasonably priced, and can be bought at health food stores. It stopped my diarrhea, but I still have the C. difficile. It may take a couple of months to get rid of the C. difficile, I've been told.

The other brand is Biocodex, and their product name is FLORASTOR. This product is made in France (hence the fancy price). It says it doesn't require refrigeration, but is very expensive. It can be bought at large pharmacies (drug stores), including discount types (like Walgreen's), and, at some supermarkets, such as City Market (related to King Sooper's)., etc.

A couple of warnings about Saccharomyces boulardii to be aware of:

1) If a person's immune system is extremely depressed, &/or the person has a "central venous line", for example if in an ICU/intensive care unit in a hospital, &/or a naso-gastric feeding tube, such people should work with their doctors, to be sure they don't get a potentially dangerous or fatal "fungemia" (fungal infection in the blood), from this normally friendly yeast! (normally non-pathogenic). From what I've read, if this happens, anti-fungal medications can eliminate the yeast infection (only very rarely caused by S. boulardii).

This probiotic (normally friendly organism) is not Candida albicans (an unfriendly yeast, that is pathogenic/disease forming, if in large numbers), but, still, work with your doctors, just in case your immune system is more depressed than you thought it was.

2) If a person has a "sensitivity" to yeast proteins, for example, with Crohn's Disease, where yeast protein sensitivity has been associated with Crohn's Disease, don't take this product, unless your doctor OK's it first, and closely monitors you.

A very knowledgable and respected researcher who has written many medical journal articles about the benefits of using Saccharomyces boulardii (friendly yeast) and "Culturelle" (one strain of Acidophilus friendly bacteria), is Lynne V. McFarland, in Seattle, Washington. Google her name, and you'll see lots of her helpful articles. She uses these probiotics, alternating with some antibiotics. (I've opted to try the probiotics without antibiotics.)

Apparently, the C. diff. bacteria, when hungry, send out toxins (poisons), that attach to intestinal cells, dissolving the cells, providing nourishment for the Clostridium difficile bacteria, and I believe that this damages the interior lining of the colon, causing something called pseudomembraneous Colitis! (See Dr. Cho's comment above, about possible colitis).

Many people get C. diff, from having taken "broad spectrum" antibiotics. Had you taken any?

People can also catch C. difficile from it being spread around by hospital personell &/or patients, in  hospitals! It's called a nosocomial infection (means cought frequently by being exposed to it, in a hospital!). (continued in next message).

[vcdlady]

(continued from above comment):

About CELIAC DISEASE (Thank you Dr. Cho, for mentioning this!)

Yes, Celiac Disease (one type of gluten sensitivity) can cause bad diarrhea that is frothy, foul-smelling, light colored, and fatty (from small intestinal mal-absorption). Celiac Disease occurs in about 1 out of 100 people, in America (higher incidence in Ireland, England, Scotland, Scandinavian countries, Italy, Northern European countries in general, the Middle East, and North Africa)

Interestingly, it has been recently discovered that even NON-Celiac types of GLUTEN SENSITIVITY (formerly called gluten intolerance), can cause diarrhea and mal-absorption. Gluten-sensitive people (non-Celiac type) may be found in as many as 1 out of 3 people! (according to gastroenterologist Dr. Kenneth Fine, of Dallas, TX)

Gluten is a protein-like substance, found in wheat, rye, barley, spelt & kamut (ancient forms of wheat), bulghur (wheat), wheatina (a cereal made from wheat), farina (a cereal made from wheat), envelope glue, stamp glue, and gluten can hang around in the tiny pores of non-stick cookware (like Teflon, etc.)., and gluten can persist in many previously "glutenized" cutting boards (plastic & wood).

A very helpful website about gluten sensitivity (and it's way more common than previously thought),  is Dr. Kenneth Fine's "EnteroLab" website, at http://www.finerhealth.com

Also, sensitivity to certain MILK PROTEINS, can cause similar digestive problems, that gluten can cause, including villi damage in the small intestine, that looks just like Celiac Disease! (villi are tiny, finger-like, microscopic projections, that line the interior lumen/space, within the small intestine, and the villi both give off digestive enzymes, and also have tiny blood vessels such as capillaries and lacteals, that digested food molecules/end products of digestion, can be absorbed into, to get into the bloodstream, to get to all the cells to nourish the whole body).
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Another parasite to get tested for (spread by contaminated water), by a stool sample test, is Cryptosporidium. I was tested and thank goodness, it was negative.
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Another infection to rule out, by getting a stool sample test done, is Salmonella (spread by feces from people in restaurants who don't wash their hands properly and then touch food they are preparing). I was tested, and again, happy that it was negative.
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Good luck to all. Wish me some, too! And thanks again, Dr. Cho!

If anyone knows of any gastroenterologists in Colorado, who use Saccharomyces boulardii and Acidophilus, to help their Clostridium difficile patients, please let me know! Post a message here on this forum with names.

VCDlady
http://cantbreathesuspectvcd.com

[vcdlady]

Another thing about C. difficile: This nasy bacteria (related to Botulism food poisoning, and related to Tetanus/Lockjaw, and, related to gas gangrene!), forms "SPORES", that can last for a long time, either inside the small or large intestine, and, even outside--on toilet seats, siderails of hospital beds, etc.

So, how can someone get rid of the persistent C. diff. spores? Supposedly, other NORMAL flora (good bacteria) in other normal people's stools, can get rid of the spores. So, in places like Australia and maybe Kansas (not sure where), some doctors are helping C. difficile patients who need a last resort, by "implanting" normal stools into the colon/large intestine of very sick C. difficile patients. This apparently has a high success rate, although it doesn't sound too nice.

I've read that the Saccharomyces boulardii, although it eats up the C. difficile bacteria, does NOT eat up the spores! And, the "Culturelle" ("GG" type of Acidophilus, sold by Nutricology) &/or other Acidophilus species, also eat the C. diff. bacteria, but NOT the spores, from what I've read.

If anyone knows of an American patient forum, for Clostridium difficile patients, &/or for antibiotic associated diarrhea patients, let me know, by posting a comment here.

VCDlady
http://cantbreathesuspectvcd.com

[M37CO]

I really appreciate all of the feedback I have gotten thus far.. It is refreshing to know people will take the time to try and help me out!  A little more background... I was perscribed the Flagl prior to any tests being done on my stool.  After that didn't seem to work they did stool tests and said everything was fine.  My symptoms have changed drastically from the onset of this.  At this point my bowel movements are almost normal.  Maybe a little more sudden and frequent, but not even close to how they were 3-4 weeks ago.  At the moment I just feel very tired (but not sleepy) if that makes sense.  I have a history of sinus infections prior to having surgery so I know what an "infection feels like" and for the most part that exactly how it feels.  I do have an upset stomach in the morning, but after getting some food down, that seems to go away.  I just am very tired.... I have essentially fired my primary doctor and am going to see someone else tomorrow.  I'd like to know what it is, but I'd bet a different antibiotic would do the trick (unless it's a viral infection).  One more side note, I did take a probiotic after I was on the Flagl.  I have since stopped taking it as it didn't seem to make a difference.  If I have a viral infection, how long would I expect it to be with me??  I haven't been to my office since the Holiday, and although I am working from home, I have to admit, my mind is racing with the different possibilities of what may be wrong with me, and as you can imagine, it's not a good feeling.  Thanks again!

[vcdlady]

I found it! It's a great patient support forum, called: C. Difficile Support Group, at this link: http://cdiffsupport.com/phpBB/index.php

This great website has useful information, doctors' names who are experts at treating C. diff. patients, research info, medical journal article (references), various treatment options, and what patients have experienced, tried, what worked, and what didn't work for them, etc., for Clostridium difficile!

Some other things to get stool tested for, in addition to C. difficile, can include Giardia, Salmonella, Cryptosporidium, etc.

Hope you find a great doctor to help you get diagnosed, soon, and I hope you feel better!

VCDlady
http;//cantbreathesuspectvcd.com