Recovering from viral gastroenteritis

September 18, 2011 1:16 PM

Some questions about recovering from viral gastroenteritis...

I have had watery, fishy-smelling diarrhea, nausea and abdominal pain since August 30th.

After two ER visits where fluids were administered, a week after the diarrhea started, I was in the hospital for another week, to have a CT scan, colonoscopy, IV fluids and two stool samples.

I am now on week three, and my diarrhea, nausea and pain continue. I have lost about 15 lbs over this time period.

I can control the diarrhea with Lomotil, but the nausea is not responding well to common anti-nausea medicines (Zofran and Promethegan). I was prescribed Neurontin for pain, but this medicine makes me feel physically ill and so I do not take this. From researching Neurontin, this seems to be a common side effect. It also appears to be used to treat a type of pain that seems unrelated to whatever I am afflicted with. I am taking no other pain medicines (other than OTC Tylenol).

So far, the tests have eliminated appendicitis, Crohn's, IBS, C. diff, and Salmonella. Apparently a third stool sample is required to eliminate parasites, but this hasn't been taken. I don't know why the GI specialist and hospital did not follow up on this.

My GI specialist is on vacation and will not be available for another week and a half, and I will be seeing my primary care doctor tomorrow and would like to focus my questions on what hasn't been looked at, as well as managing symptoms.

What other tests should I ask about, which might help diagnose this? What questions should I ask to help control nausea and pain? (I don't want to come off as a pill junkie—how do I make it clear that I am trying my best to manage this situation?)

I have missed a lot of work, I am out of paid sick leave, and I need to start making progress on this. I suspect that my anxiety over missing work and continual weight loss (along with associated runs, nausea and pain) is not helping with the healing process.

Currently, the primary care doctor is saying that time will heal this, but I do not feel like my body is making a lot of progress fighting this off, whatever it is.

I would like to know what I need to say exactly to a doctor to get him or her to take my situation more seriously, including asking about other tests that he or she may have overlooked, or whether I should seek the advice of another (non-GI) specialist.

Thank you for your knowledge and advice.

posted by anonymous to health & fitness (9 answers total)

Why are you convinced that this is viral? Get a stool test for campylobacter immediately, and if your doctor is a kind man, convince him to give you a course of antibiotics before the results come back. I had an experience very similar to yours, and it went on for five weeks before I finally found a GP who said "DUH, you have campylobacter" and gave me antibiotics.
posted by telegraph at 1:25 PM on September 18, 2011 [1 favorite]

Hmm...is this where I tell the internet about that time I had diarrhea for two weeks? Looks like it's gonna be.

So, I had diarrhea for two weeks once. Still don't know what caused it, but a good course of Cipro knocked it out. I don't know why, but you're right--it is SO hard to get GP to listen to your pooping complaints.

After the several days (maybe about 5? I think?) of my sickness, when it became clear it was getting worse instead of better, I made an appointment and went in to see a doctor. (I didn't have a set PCP at that time, just a physician group I went to.) They dismissed it, told me to stay off of dairy (I LOVE dairy), go on a BRAT diet, and let it run its course.

Well, it didn't. It got worse instead of better. I stopped the restricted diet after a few days so I didn't starve to death, and ate and drank probably quadruple what I would normally eat so I didn't lose too much weight or get dehydrated. I called the doctor again, they gave me a prescription for Lomotil said to keep letting it run its course. Things were still bad, except that now I had the luxury of shitting on my own schedule, even though the Lomotil made me feel bloated and awful otherwise. Called the doctor again a few days later, they said again to keep letting it run its course.

A few days later, still getting worse instead of better, I called the doctor yet again and said "I HAVE BEEN SHITTING FOR TWO WEEKS STRAIGHT. THIS IS NOT NORMAL. I AM NOT OK. YOU NEED TO FIX ME BECAUSE I THINK I'M DYING AND NO ONE SEEMS TO CARE." Yes, I shouted. Yes, I got dramatic. Yes, I got an appointment that day.

I went in (this time to a different doctor), and she gave me a kit to take stool samples to check for parasites. Woo! So fun! She also gave me a prescription for a course of Cipro, but told me I shouldn't take it until the results from my stool sample came back. Well, that wasn't going to happen. I went home, collected my sample like a boss, then dropped it off and picked up the prescription the same day.

After a day on Cipro (of course I finished the entire pack, as directed), the shits were gone.

I am convinced that if this had hit me back in the 1800s, I would have died from whatever intestinal cray-cray was going on. But we do not live in the 1800s. Go back to the doctor ASAP and basically demand an antibiotic. Demand that you get this sorted now. You have to advocate for yourself.

Good luck. I know how awful this is (well, almost: you've been dealing with it longer than I did), so I really hope it gets resolved soon.
posted by phunniemee at 1:38 PM on September 18, 2011 [2 favorites]

re: the pain and nausea - if it is the kind of thing you're okay with, smoking weed will likely help abate these issues very well.
posted by elizardbits at 1:45 PM on September 18, 2011

2nd elizardbits. Marijuana saved my bathroom when I had a bout of the simultaneous curses. I still had fluid pouring out of my ass, but at least I didn't puke up the pedialyte any more.
posted by wierdo at 3:17 PM on September 18, 2011

From the OP:

"I don't know if this is viral in nature. This was the diagnosis the GI reached after the two stool studies, CT and colonoscopy came up negative for various ailments. I suspect that this is a catch-all term, used when no specific causes for symptoms are found. I am not a doctor but I am skeptical of this diagnosis, myself, as when I have had a flu-like (viral) illness in years past, it has always cleared up within a few days, once my immune system kicks in. I am increasingly more convinced that I have some bug hanging around my gut, but I do not know what to ask the doctor to test (beyond those tests already performed).

"Thank you for the campylobacter suggestion. Not all but some of my symptoms line up with a cholera infection, as well. I take a proton-pump inhibitor which reduced the acidity of my stomach, which probably makes it easier for unwelcome bacteria to get a hold. I will argue more forcefully for antibiotics tomorrow, but I think my doctor will want to match the antibiotic to the specific bug, particularly as overuse of antibiotics confers resistance."

posted by jessamyn at 3:39 PM on September 18, 2011

I absolutely think you should continue getting the infectious angle worked on, but you may also want to read up on post-infectious irritable bowel syndrome, an exciting condition in which your body fights off an infection but continues to have all kinds of GI symptoms due to how acute the initial inflammatory response/trauma was. Stress and anxiety can exacerbate the problem. I spent a month (a month!) recovering from food poisoning in my junior year of college. One of the things that helped was being extremely conservative with diet, which mostly amounted to eating extremely small meals of bland soup, bread, pasta, and bananas. For a month. And even then, every time I ate I felt kind of ill. It sucked, but it did eventually go away.
posted by deludingmyself at 4:15 PM on September 18, 2011

And two things on re-read:
- There is no "test to diagnose IBS"
- If you've had no antibiotics, the primary goal of your appointment tomorrow should be to demand them. A z-pack, some cipro, whatever. Individual one-off tests for specific bacteria do not rule out all bacterial infections (see the comments about campylobacter above), and you're at the point where your doctor should be willing to try antibiotics to see if it resolves the situation. (Note: U.S. perspective, not sure where in the world you are.) If your PCP is unwilling and you're in the U.S., perhaps try another doctor or a walk-in clinic.
posted by deludingmyself at 4:22 PM on September 18, 2011

I think my doctor will want to match the antibiotic to the specific bug, particularly as overuse of antibiotics confers resistance.

I don't know about you, but I've been on antibiotics...two? maybe three? times in the last ten years. I have concerns about antibiotic-resistant strains of bacteria, too, but unless your particular medical history has you on and off antibiotics regularly, this is the time to bust out one of your "free passes".

The ones we worry about are people like my roommate, who has had a hacking cough for the last six months, and every once in a while pops one of the penicillin pills she got (and never finished) from two years ago when she had bronchitis.

That's what causes antibiotic resistance. Not giving a broad-spectrum antibiotic one time to a person with a serious problem. Just make sure you take the entire course of whatever is given to you and follow your dosing instructions. I wouldn't leave your appointment without a prescription in hand.
posted by phunniemee at 4:28 PM on September 18, 2011 [2 favorites]

Yeah, if you have it much longer they'll probably change the diagnosis from viral gastroenteritis to post-infectious IBS, as deludingmyself says above. I have no idea how they would have eliminated IBS, since that's often the diagnosis of exclusion and the only thing left once they've ruled everything else out. Do you mean it doesn't yet meet the Rome criteria for diagnosing IBS? If so, that might just be because you haven't had it long enough.

It sucks and you have all my sympathies. I've been there (although not hospitalized -- that must have been horrible).

I found being very specific about my symptoms and how they were affecting me was helpful in getting the doctors to take me seriously. So not "it's making my life hard," but rather "I've been woken from sleep by symptoms, and it's affecting my ability to go to work." Not "I feel gross," but rather "My abdominal pain levels are between a 2 and a 5, with frequent cramping and [details elided]."

I agree with the people above about asking for antibiotics. If you want something specific to ask about, it might be worth asking your doctor about rifaximin. It's approved for traveler's diarrhea and recent studies have shown a positive effect for some people with IBS. (Note: I am not a doctor.)

In the event that antibiotics don't work, or work but only somewhat: if they suggest probiotics and you decide to give that a try, go for the more expensive version with lots of bacteria (both in terms of number of strains and number of organisms). I found zero effect from the lower-end, three-strain probiotics and a surprisingly high level of help from the twelve-strain variety. (This could be due to the fact that expensive placebos are more expensive than cheap placebos, but the effect, at least for me, is strikingly different.)

Good luck! I hope you're feeling better soon.
posted by pie ninja at 4:33 PM on September 18, 2011