Ask the doc
Dr. Neeraj K. Gupta, Consultant General Physician, Safdarjang Hospital, New Delhi replies to this week’s questions.
My daughter (17) seems to suffer from repeated intestinal infections. Her stools are often greenish in colour. A year and a half ago, she was down with severe amoebiosis and had to discontinue her education. After that she has not gained any weight. Her appetite is very poor and she complains of pain in the diaphragm. What is the remedy for her problem? Nirmala
Answer: Your daughter seems to have a significant intestinal problem, which requires detailed investigation. Green stools often indicate that bile (which is green) does not get enough time to change colour, as it makes its way through
intestine, due to the action of normal bacteria of large intestine on bile salts. This decreased colon transit time may be due to celiac disease, ulcerative colitis, Crohn’s disease, infections due to salmonella/shigela/giardia or amoeba, laxative or antibiotic abuse. Symptoms like abdominal pain, weight loss, loss of appetite require investigations like stool test, sigmidoscopy, biopsy to rule out major disorders. Irritable bowel syndrome is a possibility and a visit to gastroenterologist is a must.
For six years, I have been irregularly passing smelly and loose stools with a little pain. This year the pain is constant and there is abdominal activity. This is probably a sequel to amoebiasis, as I had to eat out for a protracted period. I have a history of amoebiasis. I am 57 years old. I also have COPD and high blood pressure. No treatment seems to work. Will colonoscopy be risky? What should I do to get a proper diagnosis? Ajay
Answer: Irregular smelly, soft or loose stools suggest that fat content of stools is high; a condition called steatorrhea. High fat in stools mean either higher intake or poor production of digestive enzymes like lipase or bile salts o
r poor absorption of fats from the intestine. Affliction of pancreas or gall bladder can be responsible. Bacterial overgrowth, lack of acid (like with aging, use of antacids), chronic stress, diabetes, inadequate fibre in diet, medications or conditions that disrupt the absorptive lining of intestines (like Crohn’s disease and celiac disease) are other reasons. Generally after infections including amoebiasis, bowel irritability persists for some time and can cause frequent stools. Colonoscopy is very safe and, considering your age and your chronic symptoms, is definitely warranted.
I would like to clarify that a diagnosis of “Chronic Intestinal Amoebiasis” is often a misnomer. A person complaining of frequent stools, often semisolid or loose, at times with mucus or rarely with blood, accompanied with abdominal pain is diagnosed as amoebiasis. If occurring frequently diagnosis changes to chronic amoebiasis. However, post-mortem findings have never corroborated these and conditions are generally ulcerative colitis (if having blood and mucus) or simply irritable bowel syndrome (IBS). Amoebiasis is always acute and sigmoidoscopy (a lighted fibre optic probe investigation) will reveal ulcers in terminal colon. Biopsy will confirm amoebic necrosis and amoeba in the tissue. Unfortunately other tests like cysts in stool (may be carrier state), serological tests like IHA, CIEA or flouroscence antibody test are cumbersome, expensive or not always diagnostic and may be impractical. It is always cheaper to try a therapeutic course with meteronidazole (proper dose is 800mg three times a day) or tinidazole. Unfortunately (or fortunately) these drugs can benefit patients of IBS (as do some placebos), giardiasis, infections with anaerobic organisms of the intestines and Helicobacter pyloridis infections, a known cause of peptic ulcer. Further, only few subtypes of amoeba E.histolytica are pathogenic (e.g. type 11, X1, XII). Amoebiasis is a disease that afflicts an unhygienic person. It is more likely that a person passing blood or mucus in the stools is suffering from ulcerative colitis. In diabetics or hypertensives, Ischemic colitis is a possibility.
I have High Blood Pressure. Whenever I work continuously for a couple of hours, I get very weak and my BP rises. In a few minutes my left leg gets swollen and it becomes difficult for me to walk. What is the problem? Shankar
Answer: Hypertensive people, especially in sedentary job, are highly prone to developing clotting in the deep veins of the calf, a condition called deep vein thrombosis. Prolonged sitting posture, diabetes, smoking, deranged lipid prof
ile are risk factors. Swelling in one leg is a warning signal. Please get it investigated.
I was diagnosed TB infected one year back and, after taking medicines for six months, I was told that I was free from the disease. Now I don’t get any cough, but my sputum is black in colour for three months. But I don’t get any fever or cough. My weight is also constant. But I feel that I have developed breathing problem. I feel the need to take rest or sleep more than before. Is there any chance of reinfection? Are my present symptoms due to my Past TB? Name withheld
Answer: A six-month, short-course chemotherapy for tuberculosis of the lung is curative and generally does not recur. Tuberculous bacteria, however, are never permanently eradicated and in conditions of severe fall in immunity levels,
in conditions like AIDS, cancer, chemotherapy, TB may relapse. Generally grey sputum or black is due to environmental pollution. Breathing difficulty depends upon lung damage caused due to lung tuberculosis earlier, bronchial hyper-reactivity emerging following recovery from tuberculosis or simply conditions like anaemia.Consult your physician.
I am 37 and have a seven-year-old boy. I suffer from high blood pressure, which was diagnosed in 1999 in the third month of pregnancy. Since then I am on medication. Currently I am taking Covance-D once a day. Generally my BP is normal but at times it is 140/90 in the evening. I weigh 80 kg and doctor has prescribed Obirex 10 mg, which I am taking for last one year now but my weight is still 80 kg. What should I do? Name withheld
Answer: Hypertension detected prior to 20 weeks of pregnancy is generally due to essential hypertension unless there were other complications. I hope you have undergone a thorough investigation especially since hypertension and obesity can be a part of metabolic syndrome. Obirex itself can lead to high blood pressure. Therefore, see an experienced cardiologist.
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