Anyone know a good gastroenterologist familiar with hiker ailments?

[10%]

After having a stellar digestive track for the last 43years, immediately after my return from a three- week trip in June on thesouthern end of the AT, where I drank untreated water a few times, I startedhaving diarrhea. After going to the ER, ageneral practitioner, and a gastroenterologist and giving each of them a stoolsample (all of which came back negative for anything like Giardia or cryptosporidium)and having a colonoscopy, everybody is just scratching their heads. I’m wondering if the problem is that thedoctors in Columbus, Ohio, haven’t had much experience with this kind of thing,whereas a doctor nearer to the AT or other wilderness areas might know what todo. If anyone knows anyone, I’d love tobe able to call him or her and get his or her insight—I might even considerdriving 7 or 8 hours to get an appointment with him or her. Any help would be appreciated!

[Trailweaver]

Well. . . chances are really good that you do have Giardia. It's been a while since my courses on this, but as I recall, it is difficult to detect because of the way it "hides" in the intestine. You can have a stool specimen that is "negative" once, and your next specimen will be positive (but not the one you give to your doctor), your next two may be "negative" and your next three "positive." Not every specimen will have the Giardia in it every time. You basically have to have the absolute worse case of cases for it to be detected - in other words, you may go for months being really sick, being tested (and being "negative"), and not finding a doctor who really believes you have it (and will write a prescription for it) because they simply don't see it often enough (and it isn't showing up in every stool you have).

Your best bet may be to go to a teaching hospital (or maybe a hospital close to the trail?) where they do see it and treat it occasionally. Some doctors will treat you based on your history (you were on the trail and drinking untreated water) and symptoms (you're sick with diarrhea) and some simply will not. Most doctors today just won't treat you without being absolutely sure of what they're doing. Meanwhile, you're left being really sick and nowhere to go. It's pretty miserable, isn't it?

So now you know why you should treat your water every single time. I'm sorry you're sick. Hope you get better soon.

[BobTheBuilder]

You need better doctors. I travel internationally and my doctor gave me a scrip for some antibiotics to take if get 'sick' for more than 24 hours and if imodium doesn't fix the problem. And this is just in case! If your doctor is afraid of giving you an antibiotic because some test is negative, offer to sit over a garbage can in his waiting room and provide samples until he is satisfied.

[DLANOIE]

After having a stellar digestive track for the last 43years, immediately after my return from a three- week trip in June on thesouthern end of the AT, where I drank untreated water a few times, I startedhaving diarrhea. After going to the ER, ageneral practitioner, and a gastroenterologist and giving each of them a stoolsample (all of which came back negative for anything like Giardia or cryptosporidium)and having a colonoscopy, everybody is just scratching their heads. I’m wondering if the problem is that thedoctors in Columbus, Ohio, haven’t had much experience with this kind of thing,whereas a doctor nearer to the AT or other wilderness areas might know what todo. If anyone knows anyone, I’d love tobe able to call him or her and get his or her insight—I might even considerdriving 7 or 8 hours to get an appointment with him or her. Any help would be appreciated!

Driving 7-8 hours with diarrhea would be torture!

[DLANOIE]

After having a stellar digestive track for the last 43years, immediately after my return from a three- week trip in June on thesouthern end of the AT, where I drank untreated water a few times, I startedhaving diarrhea. After going to the ER, ageneral practitioner, and a gastroenterologist and giving each of them a stoolsample (all of which came back negative for anything like Giardia or cryptosporidium)and having a colonoscopy, everybody is just scratching their heads. I’m wondering if the problem is that thedoctors in Columbus, Ohio, haven’t had much experience with this kind of thing,whereas a doctor nearer to the AT or other wilderness areas might know what todo. If anyone knows anyone, I’d love tobe able to call him or her and get his or her insight—I might even considerdriving 7 or 8 hours to get an appointment with him or her. Any help would be appreciated!

Driving 7-8 hours with diarrhea would be torture!

[Spokes]

You need better doctors. I travel internationally and my doctor gave me a scrip for some antibiotics to take if get 'sick' for more than 24 hours and if imodium doesn't fix the problem. And this is just in case! If your doctor is afraid of giving you an antibiotic because some test is negative, offer to sit over a garbage can in his waiting room and provide samples until he is satisfied.

I got the same advice from an Infectious Disease Physician prior to traveling internationally and was prescribed Ciprofloxacin (fluoroquinolone) which, come to find out, has a couple FDA "Black Box warnings" most notably for causing tendon ruptures. Not good, especially for avid hikers.

Regarding the OP, the CDC indicates diagnosis is difficult since Giardia cysts can be excreted intermittently and therefore recommends that taking "multiple stool collections (i.e., three stool specimens collected every other day) increase test sensitivity". See more HERE.

Interestingly, I believe most physicians near and along the AT just go ahead and prescribe treatment options without all the fanfare especially if you show up with a loaded backpack and smelling of hiker funk.

[njordan2]

Ask your doctor for tinidazole. The trade name is Tindamax. It is a broad spectrum antiprotozoan. It is used for alot of different things that seem unrelated.

I went throught the same thing after gettting off of the trail. After the doctor heard the time frame I drank ground water, he was convinced it was giardia or something like it, even though the tests did not show it. Fortunately, he said he had worked in Tanzania and saw this before, including the symtoms in himself. He prescribed to me what he prescribed to himself years ago. He prescribed one single giant 2000mg Jesus pill, (something you take once and it cures everything). The pharmacy did not have the single pill, so I took four 500mg pills all at once. In 48 hours I felt markedly better. However, 2 or 3 days later, I felt worse again. Then about 5 days later, in a 24 hour period, I suddenly was 80% better. Within 3 or 4 days after that, I would say over 90% better. So in summary, after taking the dose, it still took another 2weeks to approach 100% cured.

On a side note, prior to being treated, I was progressively getting worse for about 6 weeks and lost 15lbs of weight. I had gone to another doctor twice and he could find nothing to treat. Very similar to your situation.

[10%]

Thanks to everyone for your help! It souunds like you've given me some great suggestions!

[Hooch]

Did they check your stool specimens for C-Diff (clostridium difficile)? That'd be my first thought. But what do I know? I'm just a little nurse.

[rhjanes]

On about your third trip in, you Gastro or GP should have just treated you for it anyway. I was doing construction work 20-some years ago and kept having bad diarrhea, every few days. Tests kept showing, nothing! My GP said he was treating me with broad spectrum stuff to kill "gut parasites" and such. That was all it took, one round of meds. He told me at the time, that intestinal bugs can be difficult to "catch". by the time you are having diarrhea, that is them in some phase of their life cycle and (Anyway, I forget.....but "hard to diagnosis" was my take away, along with the meds that killed them).

[Tom Murphy]

I travel internationally and my doctor gave me a scrip for some antibiotics to take if get 'sick' for more than 24 hours and if imodium doesn't fix the problem. And this is just in case.

A good doctor doesn't hand out scrips for antibiotics "just in case". Doing so helps nature evolve antibiotic resistant super bugs.

[The Solemates]

did they test for campylobacter? my wife has contracted that before. the other tests like giardia etc came back negative in her instance.

[colonel r]

As for a doc, find an internal medicine guy who has done work (mission trips) to third world countries. They get to see all those ailments daily while there.

[Spokes]

A good doctor doesn't hand out scrips for antibiotics "just in case". Doing so helps nature evolve antibiotic resistant super bugs.

Overuse of antibiotics is a problem but there's nothing wrong with doctors prescribing them as a prophylactic treatment. Infection Disease physicians do on an international travel consult, depending on what countries you plan on visiting.

In fact the CDC suggests you take along antibiotics for self-treatment of moderate to severe diarrhea.

[Doc Mike]

Just get it treated based on symptoms. If you can't find someone closer come see me.

Doc Mike

[Snowleopard]

Giardia and cryptosporidium are common enough in urban areas that doctors in Columbus OH should know how to diagnose and treat them. Bacteria also cause diarrhea and are probably more often the cause. A lot of the time no antibiotic treatment is necessary and it'll get better on its own. After some time in an area, sometimes you adapt to the presence of different intestinal fauna. Serious diarrhea is a different matter and needs to be treated more aggressively. There are downsides to these antibiotics -- they kill off beneficial intestinal bacteria as well as what's making you sick.

I've gotten sick on travels to third world countries and took nothing stronger than peptobismol, but did not have serious diarrhea (i.e., didn't need intravenous fluids, etc.) I treated or boiled all my water, including in cities in Peru and Russia. Doctors in Peru are quite expert in treating diarrheal illnesses, but it's a long trip.

I've considered patenting travel to places with poor sanitation as a weight loss plan.

[10%]

Did they check your stool specimens for C-Diff (clostridium difficile)? That'd be my first thought. But what do I know? I'm just a little nurse.

I know they checked for a list of seven or eight things, which I saw written on the lab orders at one point, but, unfortunately, I don't remember everything that was on there. I had a friend with C-Diff, though: he lost a lot of weight and thought he was having cardiac problems for a year-or-so before someone figured out what was going on.

[Enic]

Depending on where you live in the Columbus area, I know a NPthat does a lot of missions trips, and may be willing to treat on your symtons. Check out Sunbury Family Practice. The missions trip person is named Vogt.

[Wise Old Owl]

There are lots of stuff that cause diarrhea - not having beer for a time and then going back to draft in a large quantity...skip the antibiotics ... there is one thing that really clears it up...two immodium per day and lots of low cal not orange Gatorade. after several days get back on the directions on the imodium bottle and start a bland diet for a short while....and avoid alcohol.

[ScottP]

How does your gut respond to dairy? If things get painful fast after eating dairy, it's a sign of giardia. Might sway your doc into prescribing.