CONSTIPATION--problem with so many of our drugs
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I truly have to figure out how to do this!
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Judi, we did instructions on Cut, copy, paste and stuff on page 508 of Warm & Fuzzies. The link is in W&F's topic box
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Thanks Sas. I can copy and paste but then when I click to see what I've done - it only a pic. I check this out. Love ya!
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Begin forwarded message:From: Judi Hishon <judihishon@sympatico.ca>
Subject: Fwd: mixture breakdown
Date: April 7, 2016 at 6:52:46 PM GMT-4
To: Judi Hishon <judihishon@sympatico.ca>0 -
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Judi, sorry you are having technical difficulties. Are you trying to copy and paste what you PM'ed me? I can try at my end if that is the case. Thank you for your effort. And thank you Minus2 for your open arms.
Ms. Sas, we were in Kathmandu (capital of Nepal) Nargakot, and Bhaktapur and the surrounding areas. We treated and boiled our drinking water. I'm thinking I might have picked up the bug from one of the orphanages. My youngest was the only one who didn't have lunch there and she was the only one who was not sick. My husband and I got sick about one week after my older daughter. My daughter had it the worst and I had it worse than DH. Neither my husband nor daughter have had the bright yellow watery stool though. Just me.
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Loverly, what tests were done on the three of you? Does sound like you did pick it up elsewhere with DD2 not getting it. Interesting that she didn't. Anyone else in the household. Did you talk to anyone at the orphanage? Did you see a doc in Nepal?
Describe how long the initial bout lasted? Was the course the same for you three? Diarrhea was common to the three. Vomiting? Blood? Fever? Any other symptoms?
What's been the scenario since you returned home. Testing here at home? What doc specialties have you seen?
Some thoughts for now. Your answers will lead to more questions.
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DH and DD1 have not been tested as neither have chronic diarrhea. No, we didn't contact the orphanage or go see any doctor in Nepal. DH and I got it right after we arrived in Singapore. DD1 got it near the tail end of our trip in Nepal. Diarrhea lasted about 2-3 days. No appetite, no blood in stool, fever for 2 days give or take, n/v initially (don't remember if it was 1 or 2 days). Symptoms resolved without any treatment for all three of us. I'm the only one with on and off diarrhea alternating with unformed stool. Seems to be worse when stressed. DH gets diarrhea too when he is stressed. Sorry I am not a good historian....don't remember the exact details. Have not seen infectious dz doc or GI doc. PCP ordered test for Giardia and worms . Both came back negative.
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Lover, thanks but I just can't seem to copy and paste the email. Gets frustrating. I see from your post that you picked your illness up from food which may have been contaminated with water, i.e., cooking, or through the fecal oral route, i.e., unwashed hands, food handler asymptomatic (not showing symptoms), post contamination of food, or food poorly refrigerated/improperly cooked/not hot held properly. What food did your family eat? It is important for the whole family to be tested whether you are showing symptoms or not. Ladies, up here this is a free service provided by our Health Department. Is this the case where you reside or is there a cost?
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So why when I copy and paste the info I can see it and when I submit it, it shows a scanned document with no info?
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Begin forwarded message:From: "Info@skycare" <info@skycarepharmacy.com>
Subject: mixture breakdown
Date: June 1, 2015 at 9:45:12 AM GMT-4
To: <judihishon@sympatico.ca>
Hi Judi: here is the breakdown of your compound...Hope this helps. If you have any questions please give us a call. Thanks, LoriSkycare Pharmacy
540 Davis Drive, Unit 1-2
Newmarket, ON L3Y 2P3
Toll Free (844) SCPHARM (727-4276)
Tel (905) 235-SKY1 (7591)
Fax (905) 235-SKY0 (7590)
www.skycarepharmacy.com
The information contained in this correspondence and any attachments is intended only for the personal and confidential use of the designated recipients named herein. If the reader of this message is not the intended recipient or an agent responsible for delivering it to the intended recipient, you are hereby notified that you have received this documentation and its attachments in error, and that any review, dissemination, distribution, or copying of this message is strictly prohibited. If you have received this communication in error, please notify the sender and return and delete the original message immediately.0 -
O.K. I'm going to have to just type it as the scanned document is "confidential" and won't allow me to copy and paste. Sorry ladies for all of the deleted posts.
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It could be from the water we used to brush our teeth also. But our hosts were not sick though because the water came from the same well. We pretty much atethe same food as the hosts except on two occasions when we visited the orphanage and the handicapped home. Had cooked veggie/lentil dishes prepared while we were there. We had chicken curry(probably prepared in advance) at the orphanage. We hesitated, but only ate a little bit because we felt obliged. Meat is only served to honored guests. How could we say no? Never thought to have family tested. We don't have health care like you do in Canada. We have to pay to get tested, but it's ok.
BTW, we all had Typhoid and Hep A& B vaccine.
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Judi, do you have a smart phone? You can screenshot the doc and post as picture.
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Hmmm, Lover I never thought of that. But I will have to get my husband to do it. Remember, the hosts are used to this water and we are not. That's how I picked up Giardia in Mexico. I was so smart being a Health Inspector that I knew what to eat but didn't think about brushing my teeth. Usually, I brought bottled water with me but not this time. As well, we stayed in a private pensione place that who knows what their filtration system was like. Now, I putting it down to that or when I was at a Mayan village and had a small nibble of corn bread made by the Mayans. Handwashing, hmmmmm? Chicken, could have been but there is an incubation period here - 6 to 72 hours with a average of 12-36 hrs. with a mean of about 18 hours. Difference between Salmonella and Campylobacter is there is blood in the stool but has I said earlier not everyone experiences all of the symptoms. Campylobacter incubation is anywhere from 1-10 days. When I get home I'm going to check my CD book with your symptoms. But has Sas has pointed out, bacteria/viruses can have the same symptoms. Boy, if you didn't have to have your stool sample sent in within 24 hours of taking it, I would say send it here. Come on a trip and visit our local Emergency Department. A lot of people do! But, there is probably a charge which would be high!
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Judi, You are on my wavelength. I'll be doing a diarrhea questionnaire this week. Judi when did you start here? I want Loverly to go back and read from your beginning here.
MT, how's the shoulder? Where are you in treatment? I've almost got full range of motion. For the average person this would be considered full range of motion. The ortho doc gave me a cortisone injection April 1st. He understood why I wanted to do avoidance on the MRI. Hopeful for backstroke range of motion.
LOverly I want you to start a stool diary, please. I brought forward the questionnaire about constipation. You can hold off filling it out until I get the diarrhea one done. Then cut and paste with your answers, so the two questionnaires are in two consecutive boxes. You know I work in spurts any more. What used to take a day, now takes more. You have already started answering questions.
I looked at the infectious disease and morbidity/mortality stats for Nepal last night. Already knew diarrhea is a worldwide serious problem, but wanted to see how Nepal looked. Lot's of bugs.
Does your PCP know that this has been a long standing problem? Have you ever seen a GI doc?
The logical place to start is a GI doc. Particularly, since you have had BC. The Gi doc will likely want to do multiple stool studies and a scope b/c of the diarrhea. It's a two for one evaluation.1. Diarrhea, unknown origin 2. rule out any colon lining abnormality i.e polyps which is a good thing with a hx of BC. Scopes aren't fun, but are an excellent diagnostic tool.
The problem with this approach of GI doc first is it could be a couple or more months till you get to the next step. The next logical step is an Infectious Disease doc referral. That can take another month or more to get an appointment. With diarrheal diseases contracted outside the country a GI doc may not consider something b/c they aren't familiar with the bugs of that distant locale. An exceptional GI doc would though. Whereas, ID docs are very suspicious of bugs globally. Travelers diarrhea is a big deal to them.
Our Judi though can attest to the fact that all docs are not equal to the task. In her case they kept throwing the same drug at her for years, it took that last special doc to look at her history and think of something different. The drug that she was on may or may not be appropriate to your scenario. Testing will indicate if it is. What's very nice about knowing about Judi's scenario is that drug which is very old and very little used is now known to you. It will be on the tip of your tongue to discuss with the doc when the time is right.
Frankly, if you could get your PCP to make both referrals at once it would be great. Two minds working at the same time would be the best case scenario. Insurance though might balk. If you are lucky enough to get both referrals make sure each is aware of the stool studies done.
Obviously, or maybe not so obviously, I think something has taken up residence in your colon. Colonized it. Why you and not DH & DD? Your thought about BC isn't off base. The minutiae being learned about how intricately the immune system works and changes that occur with cancer and disease may have affected you. Are we at the point of understanding, dunno.
The fact that locals didn't show evidence of disease is not uncommon. Their immune systems developed resistance. Think about any society where a new bug was introduced and whole populations were devastated i.e measles and the Maya. Just as you said you had all the required immunizations before traveling, but they only cover a few types of bugs. Anyways this is a start.
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Past history gives perspective to the present problem. Do you have a past history of constipation & how was that resolved?
History of present problem: New onset constipation
When did constipation start?
Physical description of stools? Hard, color, smell, blood streaked, blood in stool versus streaked,
How many days between stools?
Have you kept a chart/record?
How much liquid do you drink a day?(take a couple of days and actually measure)
Have you changed your diet within the last three weeks?
Are you experiencing abdominal pain that you associate with constipation? Abdominal Pain with stools? Crampy. gripping, achy, left sided, right sided, entire abdomen
Does pain in abdomen remain after pooping?
What causes you to finely evacuate?
Other things used to promote evacuation?
Has they're been a change in medications in the last month----when & what?
Pain meds--- identify all by name?
Has they're been a change frequency of taking the pain med within last 3 weeks?
How many pills per day?
How often do you take the pain med?
Last dose?
While taking pain meds what was your routine evacuation time .i.e. daily, every other day etc?
Have Antibiotics been prescribed within the last 3 months and for what reason?
Do you take Probiotics?
List all herbals that you use?
List names of all other drugs on your list(dose not needed)?
List chemo meds if currently in treatment?
What is your immune status?
Is there anything else going on related to constipation that I haven't asked about?
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Loverly, This questionnaire will be tailored to your scenario.
Chief Complaint: Diarrhea, unknown origin. (this chief complaint has it's own ICDM10 code)
Onset: (date)
Location:(country)
Scenario of first symptoms:( take the info that you have already written and organize it sequentially. You are telling the doc your story. Keep the sentence short and factual. It may take a few writings to get it right. Think of this as a puzzle. In a puzzle if you leave a couple pieces out the puzzle can't be completed)
Scenario of present complaint: (describe what happens to you now.) ( since this is now a chronic condition add observations about triggers. If they're no known triggers that's an important observation.
Signs and symptoms: (describe abdominal complaints and diarrhea at original occurrence. In your case you have two separate stories
..........1. S/S's original illness..........2. S/S's Now.
Diagnostic studies:..........1. Original occurrence
..............a. Nepal.
..............b. First doc contact upon return to USA............2. Within last 6 months.
Treatment:...........1. original occurrence
............... a. Nepal
................b. USA after first doc contact
...........2. Last six months.
Associated activity: stool chart: date started and trends
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Going to leave this now and let my brain chew on it. Don't work on this until Judi, MT, April, and you offer input. Lots of minds working together.
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SAS - Shoulder/arm still in the sling. I'm trying to do the exercises he gave me, but am only getting them done once a day instead of 3 times. That's because he said stop if the pain goes over 2-3 and that's resting pain for me now. At least I'm not on any drugs except aspirin. I don't see the ortho again until the end of the month. Thanks for asking. I'm thrilled that you have full ROM again. I can only dream for now.
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MT, sorry to hear about your shoulder. Is it from reconstruction? I don't have full ROM on my MX side....I get spasm on my deltoid if I move my arm at certain angle and I have a big knot on my shoulder. Pain is not to the point where I need med to control. I fogot to tell you that I remember you from Whippitsmom's thread. You asked me an interesting question of why I chose to go with Saline for implants.
Ok Ms. Sas, started the diary (should I add "of A Wimpy Kid" - one of my younger daughter's favorite book) which reminds me to continue logging my nightmares. Had one last night. I'm such a mess. Hah! I was afraid you would mention GI scope. Yuck! Trying to avoid it if possible. Picking my battle. One thing I do notice is when we are on a relaxing vacation, my stool is good most of the time. Psychosomatic??
Glad to hear your shoulder is better. I don't know if I can do back stroke without spasm.
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Lover - nope, I managed to fall & slam into a wall.0 -
K ladies, I looked at my CD book and Lover you have me baffled. You need to fill out the questionnaire before anyone could guesstimate what you may have but in all honesty, spend the money and be tested. Your life depends on it. I do think that with the cancer that your immune system is down and you contracted something that needs to be eliminated. Remember, I spent 20 years before I was finally hooked into someone who could help me and I knew that I was +ve for Giardia.
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Loverly, Judi's so right. Besides I will hex Mitsy to tear the house up if you don't follow through LOL. I just rescheduled my appointment to schedule the scope. I had to cancel it when I fell in Feb.
I looked at the questionnaire again, not seeing the holes yet. Fill it out an post it or PM. If you Pm you won't have the benefit of the collective mind.
Judy, ohhhhhhh so sorry, hugs. What exact date did you fall? Mine was Feb 3rd.
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SAS - I think you mean me about falling. I'm a little behind you. It was a month yesterday on 3/11. I don't see the ortho again until 4/28. Long darn time with only one arm, but at least the pain seems to diminish every couple of days.
The good news is ... ta da... now that I'm off pain drugs the constipation is negligible. I just have to remember to eat my prunes.
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Oh MT, you are just too smart. I read Sas' comment and thought "when did I fall". Glad to hear you are off of pain meds ... had me worried. Always afraid that one can get addicted. Remember, with the use of one arm, who cares about the housekeeping, eh? I'm glad your constipation is negligible .... damm pills causing this!
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MT, you fell and hugged the wall? So sorry. Glad you no longer need the pain drugs.
What questions do you need for me to answer, Ms. Sas and Judi?
I'm a terrible historian. Don't even remember if I had pooped today. Brain on autopilot. I used to have finger size stool with mucus. Have not seen it for maybe 1-2 years, now that I think about it. Sometimes I have mild spasm of upper and lower GI before the big D. If it's explosive, stomach cramps is usually unbearable. I would always sweat and feel like I'm going to pass out. Doc tested me for Celiac, which came back also negative. Had CT scan and everything looked ok except liver had mild fatty deposits. I seldom drink alcohol. Can't seem to pin point which foods trigger it besides high fat. Stress makes itworse.
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Lover - you must have missed previous discussion about our "poop diaries" and how we wouldn't want our children to find them when we die. I had pretty much stopped mine, but I'm back to noting size, consistency & time for every occasion. My normal has always been one every 2 or 3 days, but I can no longer seem to remember the number of days if I don't keep notes. Is this behavior what they call OCD? (used to be anal retentive - pun intended)
Judi - Got your email. I'm hopeless at copying things - especially from a pdf file. The best I can do is type it in. For everyone awaiting the RX that finally worked for Judi, it was Quinacrine hcl 100 mg. I did some poking around and it's also known as Mepacrine - and a brand name of Atabrine. Several sources said it is no longer available in the USA. Here's what I found on one site:
Quinacrine is indicated as a primary agent in the treatment of giardiasis caused by Giardia lamblia. Quinacrine is also indicated for patients with metronidazole-resistant giardiasis and patients who should not receive or can not tolerate metronidazole.Rare resistant cases of giardiasis may require a combination of quinacrine and metronidazole
With that, I'll have to pass over to SAS for any technical review.
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