Relationship between kid coughing and stomach probs?

[carlyai]

My brother in law's 11 year old 6th grade son has what I think is physical stomach/bowel problem, although we haven't ruled out bullying etc.

He gets sever stomach pain (not specific location, but general lower tummy region). He has a dry cough as well.

His grandfather takes care of him as his farther died and mum ran off. Grandmother died a few months ago.

We have taken him to the hospital 6 or more times with no resolution to his problem. The last time we went to the Kuchinari hospital the Dr said stomach flu.

Took him to the Roiet private hospital, who did an external x-ray and said constipation.

All the time he gets medicine or a needle, comes home, and the problem starts again.

If I pick him up from school with the prob., take him to the hospital, get him checked and medicine, when he gets home, after a while he's out playing football like nothing wrong.

I would like to know if anyone knows of medical conditions here in Thailand, Isaan especially, where a kid has a dry cough and stomach/bowel problems.

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[Sheryl]

Strongyloides is a parasite (worm) which, like many worms, can cause abdominal pain and constipation,  but in addition (and unlike most other worms common here) the larvae often migrate into the airways causing a dry cough. While most strongyloides infections are mild, it can sometimes become severe.

 

Hard to imagine, though, that with these symptoms he would not already have been empirically treated for worms (albendazole).

 

With all this boy has been through, psychosomatic explanation for the stomach pain is also a possibility but given that he also has a cough, worth ruling out strongyloides.

 

If you take him to another doctor at any point, make it an infectious disease specialist and ask specifically about strongyloides. I would also push for a chest Xray if the cough worsens or persists continuously for a long time.  If clear, and if it still persists, an ENT should be the next stop (dry cough can be due to irritation from post-natal drip)

 

In terms of where to take him, if possible should go to the KKU Hospital (Srinigraind) in Khon Kaen. They have an after hours clinic where yhe can be seen by a specialist directly and cost is probably less than it would be at a private hospital.

 

 

 

 

 

 

[carlyai]

Strongyloides is a parasite (worm) which, like many worms, can cause abdominal pain and constipation,  but in addition (and unlike most other worms common here) the larvae often migrate into the airways causing a dry cough. While most strongyloides infections are mild, it can sometimes become severe.

 

Hard to imagine, though, that with these symptoms he would not already have been empirically treated for worms (albendazole).

 

With all this boy has been through, psychosomatic explanation for the stomach pain is also a possibility but given that he also has a cough, worth ruling out strongyloides.

 

If you take him to another doctor at any point, make it an infectious disease specialist and ask specifically about strongyloides. I would also push for a chest Xray if the cough worsens or persists continuously for a long time.  If clear, and if it still persists, an ENT should be the next stop (dry cough can be due to irritation from post-natal drip)

 

In terms of where to take him, if possible should go to the KKU Hospital (Srinigraind) in Khon Kaen. They have an after hours clinic where yhe can be seen by a specialist directly and cost is probably less than it would be at a private hospital.

 

 

 

 

 

 

Thanks again Sheryl.

I had arranged to take him back to the Roiet hospital tomorrow morning to see a stomach specialist, but all their phone lines are out, so my wife hasn't been able to make the appointment. We were just going to take off early for the 100 odd km trip.

I'm really only the driver, but start to get involved when things aren't happening.

This morning I went and saw him as had bad stomach and cough and stayed home from school, but this arvo when I checked he was up and about but still sore stomach, but not too bad.

I think before we take off tomorrow I will check if any of his medicine has been worm tablets. If not I will go into KuchinarI and buy some for him to eat, and not go to Roiet and wait and see if he comes good.

If not then we will take him to Khong Kaen as you suggest.

Should I just follow the instructions on the worm medicine packet?

Would he need a follow up dose?

How soon should I know if that was the answer?

At Kuchinari before they have checked his urine and blood and given him an injection but when I asked they said nothing wrong, and the injection was for his stomach pain. (sometimes when the school rings about him I am in Kuchinari at the pool on my own and take him to the hospital without my wife or Thai people, and I think this is what the hospital says, even though the 'stomach flu' I did understand but did not seem right).

Thanks very much again..Makes sense.

If you could answer my 3 questions please that would be great.[emoji1]

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[carlyai]

Thanks again Sheryl.

I had arranged to take him back to the Roiet hospital tomorrow morning to see a stomach specialist, but all their phone lines are out, so my wife hasn't been able to make the appointment. We were just going to take off early for the 100 odd km trip.

I'm really only the driver, but start to get involved when things aren't happening.

This morning I went and saw him as had bad stomach and cough and stayed home from school, but this arvo when I checked he was up and about but still sore stomach, but not too bad.

I think before we take off tomorrow I will check if any of his medicine has been worm tablets. If not I will go into KuchinarI and buy some for him to eat, and not go to Roiet and wait and see if he comes good.

If not then we will take him to Khong Kaen as you suggest.

Should I just follow the instructions on the worm medicine packet?

Would he need a follow up dose?

How soon should I know if that was the answer?

At Kuchinari before they have checked his urine and blood and given him an injection but when I asked they said nothing wrong, and the injection was for his stomach pain. (sometimes when the school rings about him I am in Kuchinari at the pool on my own and take him to the hospital without my wife or Thai people, and I think this is what the hospital says, even though the 'stomach flu' I did understand but did not seem right).

Thanks very much again..Makes sense.

If you could answer my 3 questions please that would be great.[emoji1]

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I've decided to take him to the hospital you recommend in Khon Kaen this morning instead of Roiet.

Thanks for the advice and will tell you how we went

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[Sheryl]

I am glad to hear it.

 

I think it wiser to follow the advise of a specialist at KKU than to self treat with worm medication at this point.

 

If you go through the public channel, in addition to long waits, he will be seen by residents in training and they will have limited time to spend with each patient. Remember the option to see a senior doctor directly through the after hours clinic should you not be impressed/satisfied with what you get through the public channel.

 

Sounds like this boy has been dealt a really bad hand in life so far. I'm glad that he know has an Uncle who really cares and is willing to go out of his way to try to help. Good for you!

[carlyai]

I am glad to hear it.

 

I think it wiser to follow the advise of a specialist at KKU than to self treat with worm medication at this point.

 

If you go through the public channel, in addition to long waits, he will be seen by residents in training and they will have limited time to spend with each patient. Remember the option to see a senior doctor directly through the after hours clinic should you not be impressed/satisfied with what you get through the public channel.

 

Sounds like this boy has been dealt a really bad hand in life so far. I'm glad that he know has an Uncle who really cares and is willing to go out of his way to try to help. Good for you!

Hi thanks.

We are at the hospital...I'm parking while dropped my wife and Mot off at the registration place. I have been here a few times with his grandmother and her stomach cancer.

We are going to stay overnight.

How do I find the after hours clinic?

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[carlyai]

Hi thanks.

We are at the hospital...I'm parking while dropped my wife and Mot off at the registration place. I have been here a few times with his grandmother and her stomach cancer.

We are going to stay overnight.

How do I find the after hours clinic?

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Well ...the Dr was nice and she asked her senior for a second opinion, even did a rectal exam and the conclusion was bad constipation.

Think they ruled out worms as no soiling of his pants and no lose stools.

Seems to be the same diagnosis as from the other hospitals, but the specialist here said Mot has to take the medicine for softening the stools for a lot longer like 3 months.

Has to change his diet with more roughage and more water. That will be a problem as he eats with his 68 year old grandfather farmer who eats sticky rice, and meat and all the other Isaan dishes, but not heap of roughage for a very constipated young boy.

The cough didn't really enter into it, and during the 3 hour trip here, he only coughed once.

Anyway, step by step.

Have to come back in a month.

Not sure why they didn't recommend a course of worm tablets as well.

Thanks again Cheryl.

I'd still like to know where or how to access that after hours clinic, as the dr didn't really comment when I asked about it.





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[Sheryl]

I know the after hours clinic is from 4:30 - 8:30 weekdays and 8 am - noon Saturdays. I would assume  somewhere in the main OPD building. Ask at the information desk, or any random employee walking by, where the "clinic nawk wela" is held.

 

Lack of soiling of pants or loose stools in no way rules out worms.

 

Albendazole (common brand name is Zentel, but there are many others ) is the drug most widely used for worms in Thailand and is sold in all pharmacies OTC  and it is effective for roundworms and hookworms but less so for strogyloides. For strongyloides, the drug used is called Vermectin , also sold OTC.

[Sheryl]

P.S, Thinking it over, if his constipation is not due to worms (a common cause in this part of the world) and since the doctors have presumably excluded any serious GI pathology, maybe  he has become constipated because something is discouraging him from using the bathroom.

 

Suggest you ask him about the bathroom facilities at school and whether there are problems i.e. do kids get bullied (or worse) there? Anyone follow him in? etc.

 

If the home where he lives does not have toilet inside the house then should ask the same re there.

[carlyai]

P.S, Thinking it over, if his constipation is not due to worms (a common cause in this part of the world) and since the doctors have presumably excluded any serious GI pathology, maybe  he has become constipated because something is discouraging him from using the bathroom.

 

Suggest you ask him about the bathroom facilities at school and whether there are problems i.e. do kids get bullied (or worse) there? Anyone follow him in? etc.

 

If the home where he lives does not have toilet inside the house then should ask the same re there.

I have been thinking that it could be bullying or something like that, as Mot is fairly quiet, not very athletic, but supposedly fairly smart. Fits into someone who could be bullied.

I wanted to rule out physical conditions first, but I have been quietly throwing up the proposition of switching schools. I did ask him a while ago about bullying, but he said no, which really doesn't mean much.

There is something not right about the school, as the times I have gone there to pick him up (he rings his grandfather on the mobile), he has been sitting alone on his own in an empty classroom, no teacher or supervision and holding his stomach.

It's a no brainer about moving schools. Mot is in P6 and the school across the road from his house (10 m) goes up to M3. But he catches the van 26 km to Kuchinari. Initially he went to St Joe. as that was supposed to be the best school, then departed grandmother said it was too expensive so he was changed to another gov. school in Kuchinari. To me, there is no reason he shouldn't walk across the road to this school, with all his local friends, but not my call.

Anyway, the next day after the Khong Kaen visit, he didn't go to school as sore stomach.

I spent 6 years looking after the middle and high schools in a very remote Australian Indigenous location.

Here is exactly the same.






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[joeyg]

Worms should be ruled out by ovum and parasite stool culture.  Constipation will not cause coughing.  A large majority of pediatric upper respiratory problems are caused by GI Reflux Disease.  http://www.uptodate.com/contents/acid-reflux-gastroesophageal-reflux-disease-in-children-and-adolescents-beyond-the-basics

[carlyai]

Worms should be ruled out by ovum and parasite stool culture.  Constipation will not cause coughing.  A large majority of pediatric upper respiratory problems are caused by GI Reflux Disease.  http://www.uptodate.com/contents/acid-reflux-gastroesophageal-reflux-disease-in-children-and-adolescents-beyond-the-basics

I thought a stool examination might be needed to show up worms, and said to the Drs that we would stay overnight if one was required.

They said, not necessary as just constipation. I pushed a little, but with no soiling of his pants, loose stools, they ruled out worms, only constipation.

Who am I to argue?

We'll see what happens, step by step.

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[NancyL]

If the boy's diet consists of sticky rice and meat, couldn't that be causing the constipation?  With no woman in the household, it's possible, they're not taking the time to fix salads or cut fruit and vegetables, but simply eating rice and grilling meat.

[carlyai]

If the boy's diet consists of sticky rice and meat, couldn't that be causing the constipation?  With no woman in the household, it's possible, they're not taking the time to fix salads or cut fruit and vegetables, but simply eating rice and grilling meat.

Yes this is correct.

The kids (2 of them) are going to eat what grandfather cooks.

This could be the reason for the constipation, but only one of them has the problem.

My wife buys fruit etc for them, but they have to eat it.

So to me there could be 3 things: worms, school environment, and diet.

As far as the drs are concerned it's diet, so we are trying to get that sorted with the help of medicine as well as diet including more fruit and greens etc.

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[joeyg]

5 hours ago, carlyai said:

Yes this is correct.

The kids (2 of them) are going to eat what grandfather cooks.

This could be the reason for the constipation, but only one of them has the problem.

My wife buys fruit etc for them, but they have to eat it.

So to me there could be 3 things: worms, school environment, and diet.

As far as the drs are concerned it's diet, so we are trying to get that sorted with the help of medicine as well as diet including more fruit and greens etc.

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http://www.aafp.org/afp/2006/0201/p469.html

[joeyg]

Hope he feeling better soon... http://www.healthline.com/health/gerd/constipation

[Hedghog]

It's possible the youngster has compacted stools.

A result of long term constipation.

Softer stools can pass around the hardened stool to some degree,but can also stretch the colon.

The compacted stool may require an enema,or physical removal by a health professional.

If only constipation,Eucirin brand stool softener is an excellent product.

I use it daily,as if not I suffer from drug side effect constipation,related to  morphine intake.

A higher fibre diet,plenty of fluid intake as previously mentioned.

Young people often don't take enough fluids on board.

Hope he improves soon and the illness isn't related to bullying.

[Sheryl]

On 9/12/2016 at 4:54 PM, carlyai said:

I thought a stool examination might be needed to show up worms, and said to the Drs that we would stay overnight if one was required.

They said, not necessary as just constipation. I pushed a little, but with no soiling of his pants, loose stools, they ruled out worms, only constipation.

Who am I to argue?

We'll see what happens, step by step.

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Neither incontinence nor diarrhea are in any way typical of worms. And one would not be admitted to hospital to rule out worms. Either outpatient testing of a stool sample or - more commonly here - empiric outpatient treatment. The reason for often treating empirically is that (1)  it takes 3 separate stool samples to identify worms even 50% of the time (i.e. 3 negative samples in a row still does not rule them out - may just not have been present in the -particular samples examined), (2) unlike in the West, prevalence of worm infestations is high and (3) the treatments are pretty simple and safe.

 

Are you sure you understood them correctly and that they were not saying no need to admit him to hospital because they had ruled out the kind of serious intestinal complications that would warrant it? they can't possibly have said they had ruled out worms on these grounds. Does not make sense.

 

If his cough is continuing strongyloides - which is endemic in Thailand - needs to either be ruled out or empirically treated for.

 

If it is ruled out -- or he is empirically treated but the cough does not improve with time - other investigations are needed e.g. screening for TB and an ENT problem (post nasal drip, irritation from reflux).

[Sheryl]

On 9/12/2016 at 10:42 AM, joeyg said:

Worms should be ruled out by ovum and parasite stool culture.  Constipation will not cause coughing.  A large majority of pediatric upper respiratory problems are caused by GI Reflux Disease.  http://www.uptodate.com/contents/acid-reflux-gastroesophageal-reflux-disease-in-children-and-adolescents-beyond-the-basics

 

Indeed constipation will not cause coughing. Though both coughing and constipation sometimes  share a common cause.

 

But not the case that a most pediatric respiratory problems are caused by GERD. Most pediatric respiratory problems are caused by infections - bacterial, viral, and (in this part of the world) TB.

 

Post-nasal drip, often due to allergy, can also be the culprit.

 

GERD can result in upper respiratory symptoms (though it usually does not, only if the reflux is up into the larynx) but not usually a persistant cough.

[carlyai]

I thank everyone for their replies.

With Thai, I can understand a fair bit, but when it's a new context, I miss chunks of the conversation.

I said we would find accommodation and stay overnight if they wanted a stool sample (didn't know you needed so many, but makes sense).

Usually my wife picks me up if I have really misunderstood the Thai.

I am fairly certain they are just treating for constipation.

They did give him the sodium chloride enema bottles to use soon as we got home and once a week on Friday nights. No vasaline.
I bought some vasaline and my wife said she would go over and show Mot what to do, but by the time she had got there he had a go himself and failed. Poor little bugger, hard to put a bottle of liquid up your bum and hold for 3 to 5 min.

Drs also gave him medicine to take daily to keep him from blocking up. Also talked about fruit, fluids, and other roughage.

Mot has to go back in a month to see if his condition has changed, but we won't be here then.

With the diet: As I said before, and what an Indigenous elder told me several years ago, 'We know what to do (about health, eating, drinking, smoking etc ), we just don't do it.'

Same here. They know Mot should eat the fruit and soups my wife makes, and drink lots of water, but don't do it. Just the sticky rice and chicken or beef with some greens.

I can't see the diet thing working, cause they're going to eat what they always ate.

They still eat the uncooked fish. They still eat the pickled stuff and end up with stomach cancer. Difficult to change.

After Sheryl replied to me about worms (can't spell the s. thingie), I googled it, and printed out an article on s... , in Thai which I took to the hospital and showed the dr and asked to check for it. So I did try.

I talked it over with my wife about just buying the s...medicine but we decided that we didn't know what it would do to his fragile stomach, so we didn't do it.

So back to step by step.


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[joeyg]

10 hours ago, Sheryl said:

 

Indeed constipation will not cause coughing. Though both coughing and constipation sometimes  share a common cause.

 

But not the case that a most pediatric respiratory problems are caused by GERD. Most pediatric respiratory problems are caused by infections - bacterial, viral, and (in this part of the world) TB.

 

Post-nasal drip, often due to allergy, can also be the culprit.

 

GERD can result in upper respiratory symptoms (though it usually does not, only if the reflux is up into the larynx) but not usually a persistant cough.

Should have kept it specific to asthma have to find the site.  Here's a good one Solid 50% caused by gerd.  I remember reading another that said substantialy more.  If food particles and gastric acid hare being aspirated there ya have the coughing.  To R/O must perform upper endoscopy.   Hope this is helpful.  If you want me to consult with the doctor I'd be happy to help.  I'll PM my contact info.  Let me know.  Don't mess around where breathing is concerned.

[carlyai]

Should have kept it specific to asthma have to find the site.  Here's a good one Solid 50% caused by gerd.  I remember reading another that said substantialy more.  If food particles and gastric acid hare being aspirated there ya have the coughing.  To R/O must perform upper endoscopy.   Hope this is helpful.  If you want me to consult with the doctor I'd be happy to help.  I'll PM my contact info.  Let me know.  Don't mess around where breathing is concerned.

Hello and thanks.

I think I will just leave it as it is at the moment and see how his bowl movements go with the new medicine.

I only see him about once or twice a week or more when he has a problem.

He only coughed once on the 3 hour car trip to the hospital before, so it's not like a continuous cough.

I can't just step in and take over.

His grandmother was sick for a few years, but we were overseas working. When we came back, and she was not getting better, I did step in then. She was on all this medicine: the highest dose for blood pressure, cholesterol, antidepressants, heaps of medicine. So I took her to the Roiet private hospital, and it was suggested that she didn't need all the medicine, so she stopped all....with no bad affects. This was over a period.

So we got rid of all this medicine she'd been on for 6 years since her son died (electrocuted at the house).

She was still sick, losing more weight and sore stomach, so I suggested a camera down the stomach at Roiet where they discovered stage 4 stomach cancer.

The family had not done anything in the previous few years when she started losing weight, but now it was many trips to Kong Kean for second opinions, etc, to start radiation, cemo. etc. I had to try and stop this and the husband and I finally got the message across that it was too late.

She died a few months ago.

This took its toll on all of us, and me as the intruder and driver.

So I don't really want to step in again, just step by step.

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[joeyg]

Best of luck hope he'll be just fine...

 

[carlyai]

Update:

Seems it may well have been chronic constipation as Mot seems happy and normal again while keeping his bowles open.

We all went out for a falang baked lamb dinner and apple pie and cream and he handled it well.

Just finished his exams and everything seems ok.


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[Sheryl]

Glad to hear it. Thanks for the update.