Posted 1/25/2007 1:08 PM (GMT -7)
Hey y'all, I thought of sending this nice timeline to my new GI before I see him next week. What do you think? Too lengthy? This pretty much sums it all up...although if you don't want to read it I TOTALLY understand! You guys know everything about my history, maybe you could fill in any blanks, if I've forgotten somepin'.
September – December 2000 : Traveled to Tanzania, East Africa for a semester abroad. Studied wildlife ecology and performed research on parasite transmission in the wildlife population of a game reserve.
Experienced several episodes of severe illness consisting of watery diarrhea up to 20x/day, severe epigastric pain, fevers up to 104 degrees, vomiting, weight loss.
Stool tests confirmed presence of Giardia and amoebae. Treated with a combination of metronidazole and Ciprofloxacin (two 5-day courses approximately one month apart). Symptoms would resolve for 1-2 weeks, then recur.
December 2000 – January 2001 : Returned home after Tanzania trip.
Hospitalized for 5 days for same symptoms as listed above.
Tests run: stool culture (negative); O&P (negative); EGD with biopsies (negative); malaria blood smear (negative). Treated with IV metronidazole and quinine.
February 2001 – January 2003:
Experienced intermittent episodes of watery diarrhea and abdominal pain. Episodes would last approximately one week, then recur every 2-3 months. Was treated on one occasion with metronidazole, but do not recall the outcome of this treatment.
January – March 2003 : Traveled to Ecuador, Peru, and Bolivia to stay with a local family and perform and record music.
In Bolivia, began experiencing severe, watery diarrhea (up to 30x/day) and moderate abdominal pain.
Stool samples tested at a local clinic were inconclusive. Treated with metronidazole (10-day course). Symptoms improved.
April 2003 – November 2004 : Fewer GI symptoms than previously, but again experienced recurring diarrhea and occasional abdominal pain. Self-treated with Immodium.
November 2004 – June 2005 : Began experiencing more frequent symptoms, not attributable to any particular event/foods/stressors.
Profuse, watery diarrhea up to 20x/day, mostly in daytime but occasionally during the night. Mild abdominal pain, weight loss of ~20 pounds, occasional low-grade fevers (approximately 100 degrees), rectal skin tags.
Tests run: fecal leukocytes (positive); fecal occult blood (positive); SBFT (showed duodenal thickening); stool cultures (negative); O&P (negative); colonoscopy with biopsies (negative); EGD (negative for parasitic disease or celiac sprue); 5-HIAA (negative); ESR and CRP (normal); liver panel (normal); CBC (normal).
Treated with Immodium, dicyclomine.
July 2005 – September 2005 :
Experiencing moderate URQ pain intermittently with occasional nausea.
Abdominal ultrasound revealed presence of gallstones. Underwent cholecystectomy with no complications. URQ pain resolved after surgery, but other symptoms persisted. Gallbladder was examined for other pathology, but none was found.
Prescribed cholestyramine for bile acid diarrhea with insignificant results.
September – October 2005 :
Advised to visit academic medical center and traveled to the Mayo Clinic in Rochester, Minnesota.
Examined by gastroenterologist and infectious disease specialist. Tests run: fecal leukocytes (positive); fecal occult blood (positive); stool cultures (negative); O&P (negative); fecal fat test (normal); CBC (normal); colonoscopy with biopsies (negative); EGD (showed superficial gastric erosions); abdominal CT (negative).
Physicians could not explain the presence of fecal occult blood and leukocytes, but said this could be a post-infectious syndrome.
October 2005 – March 2006 :
Symptoms persisted. Also began experiencing severe upper abdominal pain (below ribcage) that would occur infrequently but for hours at a time at a 10/10 level. Visited ER on at least three occasions for this pain and was treated with morphine. Blood work on one occasion indicated increased white count ; no other studies were performed.
For diarrhea, began self-treatment with Immodium and dicylomine as needed, as well as supplements, including calcium citrate and Omega-3 and 6 fatty acids. Diet consisted of whole grains; fish; vegetables and fruits; low-lactose-containing foods such as lactose-free milk, yogurt, and occasional cheeses; red meat less than 1x/week.
March 2006 – December 2006 :
Family Nurse Practitioner prescribed metronidazole and Ciprofloxacin BID x 10 days on two separate occasions. Symptoms improved significantly after treatment for 2-3 months, then returned.
Liver MRI done to check for parasitic disease; study was negative.
January 2007 :
Diarrhea increased in frequency; average 5-10 times per day, typically watery, occasionally with blood. One episode of especially severe upper abdominal pain in the middle of the night, followed two days later by diarrhea that occurred ~50 times over a 2-day period, accompanied by low-grade fever. Diarrhea has continued since then, again on average 5-10 times per day. Weight loss again occurring (7 pounds in 2 weeks).
Nurse Practitioner advised taking Immodium, which slowed the diarrhea, and increased fluid intake. Prescribed metronidazole for diarrhea and hydrocodone as needed for pain episodes. Referral to GI based on increasing symptoms.