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roundworms (Ascaris), elevated monocytes & eosinophils, abdominal/p...
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roundworms (Ascaris), elevated monocytes & eosinophils, abdominal/pelvic pain

Hi, I posted basically the same thing under Internal Medicine/Hematology expert forum, but it doesn't look encouraging at all, it looks like it takes months to get an answer there, I'll take it on the chin and move on. Here's my problem, I would appreciate even the smallest bit of information, thank you:

I'm a 45-year-old, 155-lb, 6-ft Caucasian male, over the years I have had muscle burning/twitching, 4 weeks ago I eliminated a 4-in intestinal roundworm (doctor saw it and said it was Ascaris Lumbricoides, it did look like it) and took Albenza 400mg, 1 dose. Two weeks later I had bloodwork done, please see below (the results were consistent with other bloodwork I had over the years, and no doctor reacted to those numbers). My chief complaint is that my abdomen/pelvis feels inflamed, as do  other muscles (e.g., the buttocks twitch and feel uncomfortable when I sit down). I also have been having some actual pain in the abdomen, CT scans and MRIs revealed nothing. All my ova & parasites tests over the years negative, and I had no other way to verify the actual worm eradication.

I am wondering if my condition could be a reaction to the toxins released (possibly over the years) by the intestinal worms, or if there is something wrong hematologically (I do feel that I am missing some essential nutrient that I cannot replace no matter what and how many supplements I take). I am particularly concerned with what to me appear as elevated monocytes (11.5%) and eosinophils (4.4%); I understand that the eosinophils could reflect the Ascaris infestation, but I am wondering what caused the monocytes to be so high. Any suggestion/information would be appreciated, thank you so much for your time, sorry about the lengthy message, bloodwork results follow.

GLUCOSE 80 mg/dL
BUN 17 mg/dL
CREATININE 0.97 mg/dL
eFGR >60 mL/min/1.73m2
SODIUM 139 mmol/L
POTASSIUM 3.7 mmol /L
CHLORIDE 102 mmol/L
CARBON DIOXIDE 25 mmol/L
CALCIUM 9.5 mg/dL
PROTEIN, TOTAL 7.4 g/dL
ALBUMIN 4.8 g/dL
GLOBULIN 2.6 g/dL (calc)
ALBUMIN/GLOBULIN RATIO 1.8 (calc)
BILIRUBIN, TOTAL 0.8 mg/dL
ALKALINE PHOSPHATASE 38 U/L
AST 23 U/L
ALT 21 U/L

WBC 5.7 Thousand/uL
RBC 4.89 Million/uL
HEMOGLOBIN 15.5 g/dL
HEMATOCRIT 45.6 %
MCV 93.3 fL
MCH 31.8 pg
MCHC 34.0 g/dL
RDW 13.3 %
PLATELET 158 Thousand/uL
NEUTROPHILS 2542 cells/uL 44.6 %
LYMPHOCYTES 2212 cells/uL 38.8 %
MONOCYTES 656 cells/uL 11.5 %
EOSINOPHILS 251 cells/uL 4.4 %
BASOPHILS 40 cells/uL 0.7 %
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740419_tn?1309281786
3 months on and still no answer on the "Expert" forum, black holes do exist, apparently, thank God I don't care anymore
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Avatar_f_tn
Welcome to the gastroenterology community!  If you paid to get on the expert forum (some of them cost money) then you should contact MedHelp to get your money back.  If you posted for free (some of them are free) then you should realize that these experts have jobs and when they answer on MedHelp, they are often volunteering their time and not being paid for this.  Also, we are very busy too and sometimes you need to "bump" your post to get us to see it.

What were the results of the stool samples you've had?
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740419_tn?1309281786
Thanks for answering, I appreciate it!
The stool samples were negative for Ova & Parasites over the years, EXCEPT the very last ones I had done in December (after my original post in October), which came back positive for Entamoeba Hartmanni (2 out of 3), and Endolimax Nana (1 out of 3). I was told they were not pathogenic and that I should not worry, my worry is that they may have mistaken E. Histolytica for E. Hartmanni, since it's quite possible they mistook E. Nana for E. Hartmanni (I have no way of knowing how experienced the lab technician/pathologist was).
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740419_tn?1309281786
I just realized what I said above has a bit of ambiguity in it, I should have said that the strange thing to me is that there wasn't a 100% agreement between the 3 results, 2 of them indicated E. Hartmanni, and 1 indicated E. Nana, and it's possible neither of them is right (E. Hartmanni looks a lot like E. Histolytica, only it's smaller, not sure how easy it is to distinguish between them).
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740419_tn?1309281786
Here's some follow-up info, I just had an upper GI X-ray w/ small bowel follow-through, and it looks like I have an obstructed appendix (at least partially obstructed, the contrast liquid definitely did not go into it). The appendix is flexible, though, and my gastroenterologist told me it's nothing to be worried about, but I really don't believe him and intend to see if my problems come from some form of chronic appendicitis (yes, I do feel some intermittent mild pain in both the right and left lower quadrants, and some stinging around the belly button). The doc did send me (at my insistence) to a surgeon for further evaluation/laparoscopy, we'll see. I've been suffering for years, now I am really curious if the appendix is the culprit. Thank you.
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Avatar_f_tn
I agree with you about your appendix.  There is such a thing as a chronic appendicitis.  I would recommend getting a second opinion (like the surgeon) and maybe even a third opinion because that result is not normal.
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740419_tn?1309281786
Thank you for the prompt feedback and recommendation, will report here once I have new information, cheers!
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Avatar_f_tn
Good, keep us updated.  Sometimes it takes a while to find the right GI doctor who will make the right diagnosis.
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740419_tn?1309281786
Hi, I posted some cool X-ray pictures of my (partially blocked) appendix here:

http://www.medhelp.org/photo_collections/list/13948?personal_page_id=903718

Picture #1 in the set also shows my hand in the X-ray, with the index finger indicating the point of pain (pretty close to the appendix, I wasn't looking at the X-ray screen when the picture was taken, I didn't know the appendix was there). BTW, the X-rays were taken over 3 weeks ago, the same pain (if not worse)  is still present, radiating at times into thigh, hip, belly button, and lower back.

Meeting with surgeon did not go well, he started by saying "there is no chronic appendicitis, I know where you're trying to lead me", the discussion went downhill from there (he wasn't very interested in the pictures or the description of my pain). He offered to "take a look" laparoscopically but he didn't seem very knowledgeable, I essentially said no thanks and scheduled another appointment with a different surgeon, will post updates here.
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Avatar_f_tn
Good, you made the right choice to see another surgeon.
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740419_tn?1309281786
Quick update, here are some ultrasound pics of my appendix taken in my home town in Romania, confirming the partial blockage (arrows pointing to obstruction):

http://www.medhelp.org/photo_collections/list/15453

The doc (an internist) said "chronic appendicitis" right away (no political correctness whatsoever), and encouraged me to see a surgeon for open appendectomy very soon. I told him I was going to have it removed laparoscopically in the US (which is true, I did find a very good surgeon here in the US who also did not have a problem recognizing chronic appendicitis, I am doing pre-op tests right now for June 15 surgery, if I survive I'll post some updates), but he did not seem too convinced I was going to last that long, my parents couldn't sleep, my friends were also putting pressure on me to get it over with, but I did not want to completely ruin my short vacation, and after so many years I know how much abuse my appendix can take (and yes, the poor fellow is still bothering me in the same way).
Bottom line, I now have tests two months apart showing problems with the appendix, some doctors are better than others, and I am very mad that some conditions take so long to diagnose. Don't give up, thanks 915 for your help, I'll post updates and probably document this ordeal under a different tag when it's over. Good luck to you all.
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Avatar_f_tn
Have you had another CT scan done after this ultrasound?  Also, I wouldn't worry about the surgery.  That is a very commonly done surgery and I'm sure you will do fine with it.  Good luck.
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740419_tn?1309281786
No, I haven't had another scan or X-ray after the ultrasound, that's probably the proper thing to do, but I already had to jump through hoops to get the GI X-ray done a couple of  months ago. The pain is there, though, and I was feeling it right under the ultrasound probe during the test.
Thank you for your help and encouragement, I'll post updates as soon as I can.
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740419_tn?1309281786
I finally had the appendectomy 10 days ago, the surgeon said the appendix was long, scarred, had some adhesions, and was filled with fecal matter (although I had done a bowel prep the day before, had a lot of laxatives and drank only clear liquids). He said it looked like chronic appendicitis, indeed. I AM actually feeling much better, apart from the surgery pains (nothing hurts after I eat, and there is no more stabbing in the RLQ several times a day). The pathology report on the removed appendix was pretty unimpressive, though (to a layman like me), it said the appendix was 6.5 cm/0.4 cm (MUCH longer than what the ultrasound estimated last month - 3.4 cm/0.8 cm), it had smooth serosal surface, lumen lined by tan mucosa, reactive lymphoid follicles and admixed eosinophils within the lamina propria, not sure if any of this taken out of context actually indicates a problem.
Anyway, thank God for good people and excellent doctors that do exist, thank you 915 for all the help and encouragement, and I hope everybody finds the help they need as soon as possible. Don't give up, if you feel something's not quite right, it probably isn't, and you shouldn't be popping anitbiotics till the end of time (or your own end, whichever comes first). I am going to post a short entry on the chronic appendicitis forum, again, 915, you were right and I will not forget, in a way this forum has saved my life. I will be praying for everybody who needs help and I'll come back here from time to time.

P.S. One interesting (and scary) thing, the doctor was prepared to resect any section of the bowel that looked unhealthy, and one of the nurses asked me before the surgery how long this whole business had been bothering me; when I said a few years, she shook her head, fortunately nothing else was damaged. Also interesting, my mother also had chronic appendicitis, i.e., not acute, when she was in her 20s, she put up with the pain for months before having the appendix removed (my father had acute appendicitis in his 20s and was easy to diagnose).
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