Dr. N. Ashok Viswanath
Infectious Diseases
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
My 20-year-old son was diagnosed with ulcerative colitis six months ago. He has not responded to any medication, which has mainly been Prednisone and interview infusions. Initially, they gave him Lee all day, and he went from painless rectal bleeding to horrible pain to pancolitis.
A couple of weeks ago, he was hospitalized with severe abdominal pain, describing it as glass shards coming through his intestines throughout his abdomen. He also has been bleeding and anemic.
The only response he had to anything were antibiotics which were given during his hospital stay five months ago of Flagyl and Cipro. He has been prescribed Vancomycin during this particular hospital stay. On day three of the bank of Meissen prior to starting Solu-Medrol, the glass shard pain suddenly disappeared. Two days ago, he pooped out what looked like a tapeworm.
After an hour of that, he ate a meal, a full breakfast with no symptoms. He ate lunch macaroni and cheese and chicken strips, with no symptoms. For dinner, he ate spaghetti with meatballs and a large chunk of cheesecake. Again, no symptoms. This was the first day in five months that he ate something and did not get up and run to the bathroom within ten minutes. This was also the first day that he went 24 hours without having a bowel movement. The following morning he had one belly with diarrhea and two that were formed. These were the first formed moments he had had in five months.
During the initial phase and continuing on throughout the last five months, the only inflammatory marker that was raised was the calprotectin. Sed rate and CRP were fine. Recently, however, his CRP went to 1.2, and his platelets went up over 500. His white cell count also jumped up to 17. His white cell count was raised prior to starting IV Prednisone. Everything is dropping back down to normal since this thing came out of him two days ago. He no longer has issues with food, no irritation or cramping. He did have the first dose of Humira after his symptoms improved. They have also given him Imuran once again after his symptoms improved. I am attaching the reports.
Kindly give your opinion.
Hello,
Welcome to icliniq.com.
Did they do any colonoscopy and biopsy study for diagnosing it as ulcerative colitis? The picture which you have uploaded with this query looks like segments of Funis Vermes, so-called rope worms, which is a rare parasitic helminth. They are usually single, but the segments get detached and are passed in the stool. Usually, the entire segments are removed using evacuation enema. These kinds of parasitic infections are mainly due to poor food habits and intake of processed food, and long-term use of steroids. As your son is suffering from previously diagnosed ulcerative colitis, there are chances that there may be a build-up of mucus plaque which are coming out in the stool resembling the rope worm. We will suggest you get the segments examined in the nearby microbiology laboratory for establishing a definitive diagnosis. We need to examine it under a microscope to tell that if it is a mucus plaque or segments of worm. Depending upon the laboratory diagnostic report, we will initiate the treatment.
I hope this was helpful.
Patient's Query
Hi doctor,
Thank you.
He was diagnosed six months ago, but different doctors had opinions like UC or infectious. His symptoms were never touched by Entyvio or oral Prednisone. Since his sudden onset of symptoms six months ago, he has gotten progressively worse, starting with painless rectal bleeding until trying Lialda, which sent him into a horrid bout of pain with diffuse bowel thickening (pancolitis). He was hospitalized with such five months ago and placed on Flagyl and Cipro, as well as IV Prednisone, and improved slightly but within two weeks was back to increasing pain. Three months ago, the pain was quite intense, with him describing it as "glass shards" coming down his entire intestinal tract. His bleeding increased to a point wherein, one month ago, he became anemic. He also could not eat anything without heading to the bathroom in minutes. Finally, he was hospitalized at the end of last month and had a colonoscopy with the GI saying his colon was very angry. It has spontaneous bleeding, and when she pushed on it, it bled. He was placed on Vancomycin. Day three on Vancomycin only (no Prednisone yet), his horrid pain stopped for the first time in months. They did start Prednisone later that day.
He went home from the hospital only to return three days later with increased bleeding. Two days into his stay, he became lethargic (slept all day), had hot and cold flashes, and felt, as he put it like his body was shutting down. Basically, he felt awful.
He went to the toilet eight times overnight. Then in the morning, this thing came out. After this, he ate three meals throughout the day with no symptoms for the first time in months. It did not hurt when he ate. He then did not return to the toilet for a BM until the next morning, which looked as it was beginning to form. He has had watery diarrhea for months. Unfortunately, even though the nurse and his assistant thought it looked weird, they flushed it. We did ask them to do another ova and parasite test, but the results are not back yet. I do understand these things are sometimes not seen on an OP.
The doctor is very resistant to talking about anything other than new medications for his UC. I am beside myself, honestly. Is this all a coincidence? Why has he only responded to antibiotics? Why did his symptoms suddenly get better with the Vancomycin, or more astounding is why did they get better after this thing came out and prior to administration of Humira and Emerin? Is not it normal for this type of thing to be considered? Kindly give your opinion.
Hello,
Welcome back to icliniq.com.
The doctor whom you are seeing would have examined your son and may have differential diagnosis and treat accordingly. Be very cautious with the food which you are giving to your son. There are certain food to be given and certain food not to be given seeing the clinical condition of your son. There are few foods which prevent healing process and worsen the condition. Food intake is very crucial during this period and is considered as a main stay of treatment.
Please follow my advice which I am mentioning below:
1) The food to be avoided for your son for atleast six months includes food which are fatty food, fried food, hot spicy food, fruits vegetables rich in raw fiber, nuts, seeds, beans, caffeinated drinks like coffee and energy drinks, sugary beverages, alcoholic beverages, malt based beverages, candy, sweets and other sources of added sugar. Better to avoid cheese, pasta, spaghetti, noodles, macaroni and meat for six months from now.
2) Do include fruits like banana, peeled apple, cantaloupe, honeydew melon. Can include food like oatmeal, egg, mashed potatoes, boiled rice, bread, etc.
3) Consider consuming milk with turmeric and ginger twice a day. It has natural anti inflammatory property on gut and improves healing process and reduces inflammatory symptoms. If your son is lactose intolerant, avoid cow milk and use dairy free milk such as coconut milk, soy milk, rice milk and oat milk.
4) Consider consuming chamomile flower tea thrice a day.
5) Consider consuming yoghurt, curd and butter milk with crushed ginger and cumin.
6) Inflammatory bowel disease can lead to multiple vitamin and mineral deficiency. Do consider taking supplement rich in calcium, Vitamin D3, Vitamin B12, iron, zinc and folic acid.
7) I will suggest omega 3 fatty acids containing supplement such as cod liver oil capsule once daily for six months.
8) Stay hydrated.
Do remember that food intake is very important in treating gut associated disorders. Do follow our food advice. Your son will improve in few days to weeks.
I hope this was helpful.
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