Interesting conversation with a doctor

[nongsung]

Some 15 years ago (when on Holiday in Isaan) I have met a young boy that did not seem to have friends, did not play football, did not race his motorbike,

did not smoke, did not drink but was always with his nose in books. I called him ‘the Nerd’.

As soon as we arrived in the village he would visit me several times to practice his English. He was a nice guy but boring and I was always happy to see him leave.

Fast forward 15 years and that Nerd is a doctor now and my wife kept contact with him through Line. He works in Sakon Nakhon which is a 150 kilometers from our village.

 

I’m battling diarrhea for for as long as I permanently started to live here (2009). It a on/off kind of thing; violent morning diarrhea for weeks then a bout of obstipation and if I’m lucky a couple of weeks of a normal stool. And then back to the diarrhea again. But only in the mornings.

So far I have had two gastroscopies and recently a colonoscopy but no reason could be found; numerous kind of medication could not solve the problem either.

 

My wife (apparently) talked with ‘the Nerd’ about my problems and later he consulted us by phone. He asked all the specifics and said that he would think about it and come back to us.

Well he did, drove his car to our house, asked more questions and came up with the following:

 

I must have some kind of travellers diarrhea and most probably caused by a strain of e-coli.

He said that this particular strain is not harmful for Thais because they grew up with it but Westerners are vulnerable to this strain. In Thailand hospitals can identify e-coli pretty easily but strain identification can only be done in a handful of places in Thailand. E-coli is a kind of non-issue for doctors in Thailand because Thais have (mostly) no problems with it.

 

He said that e-coli (and most probably this specific strain) is everywhere. On fruit, vegetables, banknotes, all fresh products, water (of course) and most bottled water as well!

Even bottled drinks are no guarantee that the e-coli is not present. I’m a milk junkie, drink at least 1,5 liters per day but it’s pasteurized, a no-go if e-coli is involved.

According to him that is the one of the reasons why it’s so difficult to export these items to Western countries because the hygiene/quality is below par.

 

So we have to step-up in hygiene.

Although my water is filtered it most probably contains e-coli so I’ll install a UV because all our plates, cups, forks, moves etc are washed with contaminated water.

For the time being (as currently all our water piping is being replaced) I brush my teeth with Evian water. I microwave plates, cups etc before using them and I don’t drink/eat things that haven’t been boiled, cooked, steamed or fried. 

I now regularly wash my hand after doing things that could have me exposed.

 

For me his observations would make a lot of sense because if I travel to Europe for a holiday my symptoms disappear within a couple of days.

 

But what I would like to know if someone (Sheryl?) can confirm his story or blow some holes in it. After all, I’m not a doctor and the precautions I currently take could be over the top but in any way are cumbersome.

 

Some insights would be appreciated.

 

Regards,

 

Nongsung

 

 

 

[worgeordie]

I don't think drinking at least 1.5 litres of milk per day is going to help

with your diarrhea,try stopping for a couple of weeks to see if there 

are any improvements.

regards worgeordie

[jak2002003]

Your problem is you are drinking too much milk.

 

Cut out the milk.  You may even be lactose intolerant. so its not good idea to drink any milk.

 

I can't believe the doctor told you it was e coli bacteria.  How on earth would he know that without tests and taking a culture of your gut bacteria... he is just wild guessing.

 

 

[nongsung]

I've cut down on milk one month ago, one cup a day and that's it.

Right now I'm collecting stool for culture testing so in a couple of weeks I should know more. But to me it makes sense that in Thailand I'm having gut problems and when I'm back in Europe everything is back to normal in a couple of days...

[al007]

Fascinating story, logically could well be right

 

However if correct, might be impossible, to avoid it by stepping up hygiene methods and regime

 

Another approach is how does one build immunity to it

 

Maybe contact hospital of Tropical Medicine in London, and ask them, also ask them where in thailand is the top research establishment,  on this subject, then talk to them

 

What else is different when you go to Europe, does you wife go with you

 

Does your geographic location in Thailand make a difference 

 

If you stay in a hotel here does it still persist

 

You need to start listing every single fact you can think of, if you can identify it at least then you can start looking for the carriers of it etc

 

Boredom is not in the short term likely to be your problem

 

Good luck

[chubby]

are you of Asian descent  at all ?   if you want to solve this, why would you insist on even a 'cup of milk  per day,  just stop it for a month to  take that out of the equation ?

 

so, no tests or physical exam  was done at all ?  why not get a proper 'workup' from a GI specialist,  sigh.....

http://www.aafp.org/afp/2014/0201/p180.html

http://emedicine.medscape.com/article/928598-differential

 

maybe your not that serious about fixing the problem, really ?

doesn't sound like you have a 'virulent' strain to me ,  or did you at least wikipedia ?

https://en.wikipedia.org/wiki/Escherichia_coli#Role_in_disease

[nongsung]

I'm born in Europe and I have taken milk out of the equation a couple of months ago. Cut out milk completely for over two months. Did not make a difference and right now I'm back using a little milk in my tea. Stopped drinking coffee but that did not made a difference either. My stool & blood have been tested numerous time in 2016 and once parasites were found and treated with Flagyl. I have undergone physical exams; an MRI of the abdomen, two gastroscopies and recently a colonoscopy so don't tell me I'm not that serious about fixing my problem. I was even tested for TB (x-ray & sputum) because that could be an underlying reason too.

So my GI is using the catch-all 'IBS' but going back to Europe for a couple of weeks I'm completely fine.

Can eat and drink whatever I want and won't get sick and haven't had diarrhea once. So there must be something in Thiland that enters my body and it can't cope with that. It's an ongoing investigation of trial and (unfortunately) mostly error...And since I'm not a doctor  I was hopeful that some TV members could point me in the right direction. I can't be the only one in Thailand having these problems...

Edited January 15, 2017 by nongsung

[surinteacher2016]

after reading an article about bacteria in honey I cut that out and sure enough no more gut issues. I dont drink that much milk

[chubby]

ok, I see that you are 'serious" sorry.  

reminds me of folks with allergies, whom can spend a great deal of effort trying to solve what is causing issues.    But,  you've gotten 2nd and 3rd GI Doctor 'opinions'   and only offered  "IBS"  no  other  "differential" diagnosis ?

 

No harm posting here, just easier to speculate with complete information, though, of course, this isn't ever gonna be available for complicated problems, here on Dr. TV   :)

 

There are plenty of chronic bowel diseases, I'm sure, like those unfortunate folks with Chrone's  Disease I suppose.   Our bodies are really just hosts to a big world  of bacteria ,  as the good ones and the bad ones  fight it out ,  Microbiome,  fascinating if you google some podcasts on it ...... have you ever drank  Kefir   or  yogurt with 'active cultures'  ;    I hope you don't resort  to   therapeutic  enemas  :)

 

 

[nongsung]

Right now I don't know where I stand; today (7 days after my colonoscopy) I had my first BM and was pretty normal.

It might stay that way or the diarrhea might come back again, who knows...

Right now I'm on the same regime; I drink exactly the same, I eat exactly the same, every day.

Drinks: tea with a little milk, Bulgaria drink yoghurt, some water. Lunch: toast with some jam, dinner: fried fresh

vegetables with chicken. In between some Yolida yoghurt and once a day Probac7 (pro-biotics), 1000mg Vit C

and a 1000mg Multi Vitamin. If I keep doing this for another week or so and if the diarrhea does not come back

I can start to make small changes to my diet. Would like that because I can't stand hearing my wife asking me

'darling, vegetables with chicken?' day after day...

Let's what happens...

 

 

[CaptHaddock]

I must have some kind of travellers diarrhea and most probably caused by a strain of e-coli.

He said that this particular strain is not harmful for Thais because they grew up with it but Westerners are vulnerable to this strain. In Thailand hospitals can identify e-coli pretty easily but strain identification can only be done in a handful of places in Thailand. E-coli is a kind of non-issue for doctors in Thailand because Thais have (mostly) no problems with it.

 

If this were true then we would expect this ailment to be a common complaint of Westerners in Thailand.   On the contrary, however, the OP seems to be the only such sufferer on TV.  So, lazy Thai thinking that if a foreigner has an ailment it must be due to his being a foreigner.

 

Since the op does not show the same symptoms in Europe it is presumably something in his Thai environment.  He should try eliminating one element after another including food items, but everything else he can think of as well.   Maybe boil his drinking water for a while, too.  Takes a lot of effort, but looks like the only option.

[katana]

What that doctor said was pretty much my conclusions as well.

I've seen Thais and farang eat the same food from a group meal and the Thais have no problem with it but the farang are left with chronic diarrhoea.

Sometimes newcomers can build up a resistance to it after several months. Sometimes they can't.

I knew one foreigner who had to leave Thailand because of constant stomach problems and never being able to build up resistance to the food.

I've often wondered what bacteria it is. Since night soil is I believe still used in some parts of Thailand for fertilizer, he may well be right on the escherichia coli strain.

Edited January 17, 2017 by katana

[nongsung]

15 hours ago, CaptHaddock said:

So, lazy Thai thinking that if a foreigner has an ailment it must be due to his being a foreigner.

 

Since the op does not show the same symptoms in Europe it is presumably something in his Thai environment.  He should try eliminating one element after another including food items, but everything else he can think of as well.   Maybe boil his drinking water for a while, too.  Takes a lot of effort, but looks like the only option.

CaptHaddock, thanks for replying!

It's certainly not lazy Thai thinking; he checked all my treatments of the past and the results from blood-tests, stool-tests, gastroscopy, colonoscopy & x-rays. He listened carefully to my story and the issues I'm having and took that all in account before he came up with e-coli. I know that there are quite a lot of 'lazy thinking Thai doctors' around here, a quick diagnosis and off you go with bags full of medication but this one is different (where have that heard that before ;-). We know him for years, I've earned tons of respect by helping him with his English and I'm pretty sure that he is trying to help me to get to the bottom of it. 

And a lazy Thai would not hop in his car and drive 150 kilometers to visit me without charging me. His family lives in this village too and after he left us me did visit them but 10 minutes later

he drove out of the village.

So yes, we are trying to find out now what is causing it; strictly on the same diet for a week now and I'll not introduce new foods/drinks until my guts settle. Everything is boiled, cooked, steamed, fried and in a few days/weeks we might know more.

Edited January 18, 2017 by nongsung

[rijb]

I switched to coconut milk.  It has a high fat content.  So, you have to go easy on it.

 

It seems to be safe.  And baby coconuts love the stuff!

[nongsung]

4 hours ago, katana said:

Sometimes newcomers can build up a resistance to it after several months. Sometimes they can't.

I knew one foreigner who had to leave Thailand because of constant stomach problems and never being able to build up resistance to the food.

I've often wondered what bacteria it is. Since night soil is I believe still used in some parts of Thailand for fertilizer, he may well be right on the escherichia coli strain.

Katana, thanks for replying!

1995 was my first trip to Thailand and since then every trip has resulted in severe diarrhea. At first you are adventurous; try the local food, try the fried bugs, you know

what I mean. Then you start to cut back on that because being sick while on holiday isn't exactly what you want. Then finally you move to Thailand (2009) and then

that very same problem comes (and goes) but never goes away. And the diarrhea gets worse, more frequently and it lasts longer before it disappears for a week

or sometimes a month or two. My body obviously can't cope with something that enters my system and is unable to built resistance to it (whatever that is).

And, being 62 I noticed that over the years my 'healing powers' aren't the same anymore. You cut yourself and an infection is just around the corner and it takes much

longer to heal then when I was younger. That might explain why my gut problem is increasing...

Back to Europe? Want to avoid that at all costs...

Night soil is a good one. I'll look into that since I have two septic tanks behind my house. Might be the time to inspect the workings of it since that was built when

I still was in Europe.

[nongsung]

11 minutes ago, rijb said:

I switched to coconut milk.  It has a high fat content.  So, you have to go easy on it.

 

It seems to be safe.  And baby coconuts love the stuff!

rijb, thanks!

Yeah, I have a couple of coconut trees in my garden en love that stuff too.

I only overdid it (three a day) and got the ... shits. Kind of natural anti vermin as well.

[rijb]

5 minutes ago, nongsung said:

rijb, thanks!

Yeah, I have a couple of coconut trees in my garden en love that stuff too.

I only overdid it (three a day) and got the ... shits. Kind of natural anti vermin as well.

 

That's good too.  

 

But, I was talking about coconut milk available in stores.  It's very thick and creamy.  I like the Makro brand, in a box...not a shell.  

[mfd101]

2 comments: (1) when I was a child in NZ many decades ago - a milk & butter-consuming country (margarine was banned!) - whenever I was sick and more specifically with tummy upset, my mother would stop me drinking the bottle or 2 of milk I downed every day. I still stop all dairy products - including yoghurt - on the rare occasions I get diarrhea here in Thailand & it certainly makes a difference, at least for me (2) when I do get it and it's lasting longer than I want (say, 2nd day), I take Noroxin/Norfloxacin pills (& it has several other names depending on which country you're in) - for me, 3 pills over 1.5 days as per the instructions in relation to meals, and it's fixed. BUT: it's a strong antibacterial and can have dangerous side-effects, the most common of which is painful tendons in the foot. It's available in Western countries only by prescription & is no longer available in some Western countries because of its serious side-effects. In Thailand you can get it over the counter (surprise! surprise!). I have never had a problem with it ezcept slightly tender tendons and have used it on & off over the last 6 years since it was on the medical list for a trip through China, Central Asia & Russia. Worth a try, particularly if you're otherwise in good health, but not if you're taking multiple other tablets or are generally in poor health.

[nongsung]

Just to give you all an update. Diarrhea came back, Saturday mild, Sunday worse (and started to feel sick) and Monday it was just violent. Went to the hospital and before my turn had to visit the toilet (for release number 15) and (apparently) went in a kind of shock. Passed out with cardia arrest! The wife saw hospital crew retrieve me from the toilet and later (at ER) performing CPR on me and I came around quickly. Of course I am admitted now and beeing treated with dual anti-biotics, since white bloodcell count went through the roof.

The cardiac arrest was a result of a septic shock and CPR was done because my heart came back after some 25 seconds but only at 30 bpm...

Scary stuff.  But, according to the doctors, my heart is in good shape (it was monitored for 24 hours) and it only happened because of the septic infection.

The anti biotics are doing their job, white blood cell count is getting; lower diarrhea is a loose stool now but feeling absolutely knackered.

Keep you posted.

 

Nongsung

 

Technically I was dead for 25 seconds and believe me; there's nothing, no bright lights, no welcoming voices, just nothing, like you switch off the light.

Edited January 25, 2017 by nongsung

[Sheryl]

Good grief!

 

I suspect it will indeed turn outy to be a strain of e. coli, there are some that are quite toxic.

 

How did they know to get you from the toilet? Were you able to pull an alarm before you passed out?

[rijb]

Glad your back.  Maybe it's time to leave the country, until you can fully recover.  Get well soon.

[nongsung]

 

1 hour ago, Sheryl said:

Good grief!

 

I suspect it will indeed turn outy to be a strain of e. coli, there are some that are quite toxic.

 

How did they know to get you from the toilet? Were you able to pull an alarm before you passed out?

Felt already very dizzy so I took the disabled toilet. Wife knew that I was not ok and waited for me. She went inside and  I remember saying to her that I was about to pass out she then alarmed the staff.

 

 

Edited January 25, 2017 by nongsung

[nongsung]

41 minutes ago, rijb said:

Glad your back.  Maybe it's time to leave the country, until you can fully recover.  Get well soon.

Rijb, thanks and yes, right now I'm planning some recovery time with my eldest daughter. Once I know when I will be discharged and fit to fly I'll be on an plane straight away

[nongsung]

On 1/25/2017 at 3:19 PM, Sheryl said:

 

I suspect it will indeed turn outy to be a strain of e. coli, there are some that are quite toxic.

As far as I could understand the doctor today it's e-coli indeed.

The cotton swap revealed that... And the suspicion of my 'nerd' doctor was correct as well.

To my surprise I'll be discharged tomorrow, I'll have to continue taking antibiotics and try to regain 7 kilo's of lost weight.

To be continued...

Edited January 26, 2017 by nongsung

[chubby]

I believe, a fairly common scenario, with lose  of large amount of fluids  is  an electolyte imbalance,  e.g  your potassium K+, which can lead to arrythmia , which can lead to cardiac arrest. 

 

septicemia is not uncommon, but less dangerous when  caught early , this causes hypotension  and 50% of the elderly  may not survive  it.  

 

did you get   defibrilatted ( shock paddles )  ? ; I am not aware that CPR is great  for  un fibrillating  someone,  though, I'm sure it happens   ....

 

Can't you just eat Western  Food,  and Sterilzed Water  or something ,  maybe buy yourself  an autoclave ?

https://duckduckgo.com/?q=autoclave+machine+amazon&ia=products

 

Or move to a new location, somewhere else in Thailand ?

 

 

[paul18620]

I don't know you at all ,but I wish you a fast recovery and the pills they give you gets rid of the e-coliand you feel better after the scare you just had.

[nongsung]

13 hours ago, chubby said:

I believe, a fairly common scenario, with lose  of large amount of fluids  is  an electolyte imbalance,  e.g  your potassium K+, which can lead to arrythmia , which can lead to cardiac arrest. 

 

septicemia is not uncommon, but less dangerous when  caught early , this causes hypotension  and 50% of the elderly  may not survive  it.  

 

did you get   defibrilatted ( shock paddles )  ? ; I am not aware that CPR is great  for  un fibrillating  someone,  though, I'm sure it happens   ....

 

Can't you just eat Western  Food,  and Sterilzed Water  or something ,  maybe buy yourself  an autoclave ?

https://duckduckgo.com/?q=autoclave+machine+amazon&ia=products

 

Or move to a new location, somewhere else in Thailand ?

 

 

Thanks Chubby for your reply.

 

Yes, electrolyte imbalance had certainly something to do with it. I lost so much liquid in such little time and I just could not replace this with ORS drinks.

 

They were preparing the paddles but in the meantime someone started to pump

my chest quickly (around 10 times). Then my hart came back to it's normal rhythm.

Well, that's what my wife told me anyway.

 

An autoclave is an interesting suggestion. You can achieve similar results with

a microwave but forks, knifes, spoons etc are a no go. So yes, I'll look into an autoclave, thanks!

 

And about food; my wife is very carefull, everything is fully cooked, steamed, fried etc. And currently we are in the process of installing a new watertank (and new piping, taps etc) for kitchen and bathroom. Although the water will come from a factory I'm still going to cook that before brushing my teeth with it.

 

Another cause for e-coli could be that my wife brought a kitten into our home 'to catch mice'

Well it got pregnant and now we have 1 cat & 4 kittens. I have changed the litter box daily...My inlaws are going to take care of the cats now (they live accross the road).

 

Moving to a new location is something that I would like to avoid but I keep an open mind about it.

 

Thanks!

 

[Sheryl]

While not impossible, the cats are an unlikely source for this.

 

Usual culprit is undercooked meat or vegetables

 

Restaurants and food vendors here often fail to cook meat sufficiently.

[nongsung]

Ok, Waiting for my wife to settle the hospital bill and then we will go home.

My energy levels are low and can feel I have been seriously ill. One step at the time is all that matters now.

The biggest hurdle is the cardiac arrest, makes me feel not sure about my body and that scares me. It's between my ears I know but 'don't worry'  and 'everything is ok' does not work for me at the moment.

On a positive side; I quit smoking 'cold turkey'.

Anyway, all board members that replied; thanks and thanks for the heart warming messages.

 

regards,

 

Nongsung.

[nongsung]

One problem after another... Last week suddenly started to feel very dizzy and shaky and thought I was going to pass out. Felt like an enormous hypo

and some water with glucose I felt a little better. This happened again the next day and the day after so I contacted my trusted doctor and he told me to

come and have my blood checked. Seems to have pre-diabetes but I could like to have this discussed with BM's with a bit more knowledge than me.

Fasting glucose was 120 and HbA-1C just 3.2. Doctor told me that the low HbA-1C indicates that my pre-diabetes is only recent.

I have cut my sugar intake (almost) completely and trying to adapt to a diet for diabetics. Fruit, rice, cooked/grilled fish etc but I'm struggling to keep me

from feeling dizzy & shaky; many small meals instead of 2 or 3 big ones but the mornings are awful.

Questions: can this be related to the strong anti-biotics I was given recently, I would guess so because I have never had any problems with being

so dizzy and shaky. It's something that happened out of the blue after my e-coli scare. And could this be a temporary thing or do I have to accept the

fact that I'm going to be full-on diabetic in the near future.

Second, I also seem to have high cholesterol(163), Tri (130), HDL (37) and LDL (144) so the approach is a strict diet and excercise; I have started to do

a daily (speedy) walks and increasing the distance every day. Baby steps, yesterday just 1.5 km but I have never been a fan of physical things.

Questions: is brisk walking for 30 minutes a day (and strict diet) enough to get the Cholesterol levels in check or is there something that I've overlooked.

And, with diet and excercise when can I expect these levels to go down (not that I'm impatient, just wanna know).

 

Hopefully more knowledgeable BM's can give me some insight in these (new) matters to me.

 

Thanks in advance,

 

Peter aka Nongsung

 

As I have struggled with my guts for more than 8 months now I don't understand why no one (no doctor) never checked my cholesterol apart from my

trusted doctor who saved my life... I was asked not so long ago if I wanted full bloodwork (Including HIV) and I was ok with that. Everything came back

normal (well, that's what they said)...