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Ask Dr. Muneeb Ali Your Own Question

Dr. Muneeb Ali
Dr. Muneeb Ali, Doctor
Category: Medical
Satisfied Customers: 1354
Experience:  MBBS, MD.Currently working in Critical Care Medicine with 6 year experience in internal medicine
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Ive had diarrhea for 7 days and have had stomach cramps -mild to severe as well. Ot

Customer Question

I've had diarrhea for 7 days and have had stomach cramps -mild to severe as well. Other that this I feel perfect. No fever, no vomitting etc. Perfect. I went to a clinic on Friday and he said it is likely a stomach bug and gave me a requisition for a stool sample, which I handed in today. Is this likely a parasite given the term? The cramping is less now, but the diarrhea is more frequent.
Submitted: 4 years ago.
Category: Medical
Expert:  Dr. Muneeb Ali replied 4 years ago.
Hi,
Welcome to JA and im sorry to hear about your problem,

Can i ask what color is the stool? is it watery or semi solid in consistency?
Any blood in stool?
Any other medical conditions? medications?
Does the stool float in water and is it foul smelling?
Have you had such episodes in the past?
Customer: replied 4 years ago.
No blood. The color now is yellowish green, which I assume is bile. There isn't much in it. It appears to have pieces of food. It is not solid at all, totally liquid. I take ranitidine for a hiatus hernia and have done for 15 years. Never had an episode like this before, lasting this long. Can I take Imodium?
Expert:  Dr. Muneeb Ali replied 4 years ago.
Thanks for the additional information and the quick reply,

Well from your history and the information that you have given me it doese seem like that you do have an infectious pathology of the gut which is normally termed as gastroenteritis, now gastroenetritis is of various types most commonly it is of bacterial origin but a bacterial infection takes a more fulminant course that is it will cause severe diarrhea alongwith fever, vomiting, blood in stools etc however there are several pathogens which are less virulent and can cause the symptoms which you are experiencing.

The other infectious agent can be a parasite which attaches itself to your intestine or other parts of the gastric tract and cause diarrhea alongwith other symptoms such as shortness of breath, loss of blood in stools (microscopic) alongwith over time iron deficiency. This can also lead to the development of chronic diarrhea which means persisting diarrhea for more than 2 months.

But in your case i would classify the diarrhea as acute diarrhea secondary to infectious agent and it DOES need to be treated and the course of action that your physician is following is the correct one, getting a stool culture alongwith with microscopic examination will reveal any infectious agent and then you can be treated with teh appropiate antibiotics. In the meantime it is VERY VERY important to keep hydrated most of the problems occur due to dehydration which can lead to serious conditions such as renal failure and even shock. SO its very important to keep your hydration status good alongwith replenishing your electrolytes by taking electrolyte rich fluids like gatorade and ORS (Oral rehydration Salt).

If your diarrhea is excessive greater than 8-10 epidoses per day, you can take upto two tablets of immodium (max 3 times a day) to reduce the symptoms but it is not recommended to regularly take this. This is because immodium decreases the motility of the gut and in case of infections of the gut it will cause the infectious agent to stay inside the body and cause further harm but taking it occasionally (once or twice to reduce the symptoms) is fine.

I hope this answers your question

Customer: replied 4 years ago.
So for the record, are you suspecting an infection or parasite?
Expert:  Dr. Muneeb Ali replied 4 years ago.
A parasite infestation IS an infection. Infection is a broad term indicating that the actual causative organism can be a bacterium,virus or a parasite.So when we say infection we mean it can be any one of the three.

Now in your case this seems like a low grade bacterial infection rather than a parasite infestation. Ofcourse i can be wrong because this is a diagnosis which can only be made on tests (stool and blood). Regardless of the causative organism most diarrheal episodes are treated with metronidazole and ciprofloxacin both for a period of 5-7 days.


For your information, a stool test which shows,

WBCs - indicates a bacterial infection
Eggs - indicates parasites (the type depends on the egg)


So in short i think this a bacterial infection but we can only know for sure after your tests come back. In the meantime, hydrating yourself is very important and keeping your electrolytes in the normal range is also very important. Try using the BRAT diet which comprises of Bananas (good source of potassium), Rice, Applesauce and toast.

I hope this helps


Customer: replied 4 years ago.
Last week I ate my normal diet, steak, veg, chicken, Corona etc. The diarrhea then was 4-5 times per day. I started the BRAT diet on Saturday, and now the episodes have increased significantly, especially in the morning. This morning I went 12 times, but have only gone once since 11 a.m.
Also I read that to test stools for parasites, they should be checked three times with different samples. Given the high number of false negatives on one test, should I ask my doctor to requisition more samples if the first is negative?
Expert:  Dr. Muneeb Ali replied 4 years ago.
It is advisable to retest for parasites if one result comes back negative however in most cases if the test is negative and the patient is symptomatic, i normally prescribe antibiotics and check their response. In most cases the antibiotics do help in relieving the symptoms.

Now for parasites, you can also have your doctor check your CBC which would show increased levels of eosinophils (in some cases) which would also help in the diagnosis.


Customer: replied 4 years ago.
Regardless of the infection, is it unlikely to resolve on its own?
Expert:  Dr. Muneeb Ali replied 4 years ago.
IF this is a bacterial or parsitic infection, its unlikely that it will resolve on its own. However viral infections do resolve on their own but 7 days into the symptoms, a viral infection should show signs of settling down instead of flaring up as it did in your case this morning with 12 episodes.

So its more likely to a bacterial or parasitic infection rather than a viral infection, so its not likely to settle on its own.

Dr. Muneeb Ali, Doctor
Category: Medical
Satisfied Customers: 1354
Experience: MBBS, MD.Currently working in Critical Care Medicine with 6 year experience in internal medicine
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Customer: replied 4 years ago.
Still going strong today. 6 episodes in already this morning. I am thinking of going to the emergency room at my local hospital as the clinic I went to is closed until Thursday and that appears to be the earliest I would get the results of my tests. I am going to Montreal this weekend for the Grand Prix and do not want to be running back and forth to a port a toilet. Basically I want some relief. Can a doctor, given my situation and length of this, simply prescribe me the dose I would need to get me on the road to recovery?
Expert:  Dr. Muneeb Ali replied 4 years ago.
I think you are thinking of doing the right thing, continous diarrhea with this frequency and intensity can cause several problems and the tests dont take a long time. You should definitely go to a ER now and do tell them that it has now been 8 days with intense diarrhea.

Now im worried about the fact that you dont suffer from electrolyte imbalances or dehydration which can lead to kidney damage. Thos two conditions can be life threatning. Considering your history and symptomotology, if i was in place of the ER doc i would have prescribed antibiotics and i do believe the ER doc would do so if required depending on your clinical exam.

Customer: replied 4 years ago.
I am just worried the ER doc will order another stool sample, which will delay any prescription. As for dehydration, I am fine that way. Plenty of water, Gatorade, and BRAT diet. I haven't really lost any weight. Urination regular. Yesterday after the morning outbursts, I didn't go after 1 p.m. I woke up this morning and within minutes I was on the toilet to start today's round.
Expert:  Dr. Muneeb Ali replied 4 years ago.
If i say i know that he will definitely prescribe the antibiotics i would be lying, the normal way to go about this is to get a stool sample first and then think of start antibiotics BUT it all depends on the doctor, many of us get the sample and start the antibiotics in the meantime and if the sample comes back negative we stop the drugs otherwise have the patient continue them.

So it all depends on the doctor who is treating you but i am glad to hear that you are taking care of your hydration levels.
Customer: replied 4 years ago.
So if the doctor today decides to wait for the results, which wont be till late this week or early next, can I load up on Imodium so I can enjoy the race this weekend? I haven't taken any yet during this bout. Also, how will alcohol affect me?
Expert:  Dr. Muneeb Ali replied 4 years ago.
A stool sample usually takes 1 day that is the routine examination but the culture can take 3 days or more depending on the culture medium and the conditions under which it is grown, which would mean yes it could be until late this week.

What you can do to enjoy the grand prix is that take two imodium before going to the venue to watch the race and that should keep you ok for the next 4-6 hours atleast, taking a couple of imodium off and on isnt harmful, yes taking it regularly for the whole time you have diarrhea that is a problem (considering this is infectious diarrhea).

Alcohol per se wont actually worsen the diarrhea but alcohol due to its dehydrating qualities can cause you become dehydrated quickly especially if you take large quantities alongwith uncontrolled diarrhea. This can be problematic. Secondly, excessive quantities of alcohol have been known to cause diarrhea on its known due to its effects on the gastrointestinal tract and its motility. So its best to abstain from alcohol during this time period.

Customer: replied 4 years ago.
My plan was to take some imodium, bring a cooler with a few beers and a couple gatorades and water. I was going to go on a 2 beer, 1 water rotation, and throw in a gatorade once or twice during the day. I am not planning on getting trashed by any means. We have been planning this weekend for two years and I want to enjoy it as much as possible, while being smart about it. As much as possible I guess while drinking beer and taking imodium. Do you know if the anitbiotics are prescribed, can they be taken with alcohol, and how long do they take to start working?
Expert:  Dr. Muneeb Ali replied 4 years ago.
The antibiotics take atleast a couple of days to start working and most antibiotics shouldnt be taken with alcohol because that interferes with their metabolism. Alcohol induces the liver enzymes and since most antibiotics are metabolized by the liver in some part that would increase their metabolism and decrease their efficacy.

I can understand that you have been planning to enjoy this weekend for a long time and this puts a damper on your plans but it would be best to abstain from alcohol until your symptoms subside, its possible that by this weekend you symptoms start to settle down with treatment. But until they do my sincere advice would be to abstain from alcohol, even beer. Its good to know that you are concerned and aware about your health.
Customer: replied 4 years ago.
I went to the emergency room yesteday and was told that they don't usually treat bacterial infections, that most people get over them on their own, and that anitbiotics sometimes make things worse. I was told to go on a clear liquid diet for 48 hours, and that this would stop the diarrhea and reset my bowel.
So, I thought, after 8 days, the advice was to starve myself. I went to another clinic right after and was given a cipro prescription. I started it last night. Both doctors yesterday told me the BRAT diet can make things worse and told me to eat normally, but to avoid all dairy until a couple days after I feel better. So I had pasta for dinner, gatorade, some chips to a movie I watched with some diet 7-UP. Woke up this morning and had a solid experience on the toilet. HOORAY!. Now, do I keep taking the Cipro after 1 pill? How long till I go back to a fully normal diet ie coffee, alcohol etc?
Thanks, XXXXX XXXXX way, you have been so helpful.

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