Bad water, gut bugs and the horrors of Navy corpsmen

[That Java Guy]

FYI - this story took place Sept 2004.

For a little more than the last year I had been suffering from a weird - disabling painful abdominal problem that would hit me every 5 weeks like clockwork. That had been going on ever since I came back from a 3 month trip to a nearby 3rd world country (I got back November 03). The shit really sucked and got worse every time - I had been hospitalized for it the last 3 episodes before "The big trip".

Now I kept telling the docs that it was cyclic and most likely parasitic in origin. Since my labs had been coming back normal the say - "Hmmm - we don't no what it is, so here is some morphine for the pain and come back if it happens again. And remember, we are real doctors so quit trying to diagnose yourself". I was really getting tired of this shit! On the 3rd of Sept '04 it hit me again - I went to the hospital but that time brought along my trusty P.A. - An old 18D with 15 years of downrange time in S. America. We do the paperwork together and this time it's a little different. Along with all the other suck - I'm having extreme RLQ pain. The Navy doc on duty has me drink some radioactive stuff - then sends me off to CT. At CT the folks there have what looks like a 3L camelbak hanging from the ceiling waiting for me. I say "hey man - where ya gonna put all that fluid" to which I am answered "in you, and not by mouth" Son of a! Just when I thought things could not get any worse!!!

So - after the CT is done and I am draining - I get a knock on the door, I'm told I'm going to surgery. OK - I'm down with that, anything to stop the pain...Well, we all thought wrong. When the surgeon comes in to see me he talks for a while and then says - I'm going to treat you with antibiotics - you can move around too much to have any intestinal inflamation. I tell him I know all about this stuff but I'm hard like that :lifter and have been fighting through the pain - he scoffs at that and sends me off to get admitted.

So - I get checked in just when a typhoon hits Okinawa, I was going to check myself out the next day but now I'm stuck. Turns out the doc that is stuck in here with me actually listens. we talk and in addition to all my other meds he puts me on high dose IV metronidozole. (I've been NPO for 3 days now). He also checks my CT and decides I need surgery right away. While all this is going on I hit the head and manage to shit out about a thousand little pods - half a mm long with a hook on one end and a tail on the other. I think - hey, eggs - I have been right!!!! But - I'm still enroute to surgery. OK - we send some off to the lab and away to surgery I go.

Now, before I go any further, let me just say all of my surgeries have been very pleasant and recovery has been a breeze. Not this time folks. I guess I wasn't waking up fast enough for someone so I am hit with reversal agent - 10x the normal amount!!! (no - I'm not making that shit up, doc filled me in on the details) I am immediatly wide awake with no analgesic control at all!!! My surgery consisted of 2 scopes, me being split from belly button to pubic bome and the removal of remains of my appendix, and some small and large intestine - fucking ouch!!!! - 65mg of morphine later, along with toradol and 02 for my now depressed resp drive I was under control. That was an hour of the most fucking awful intense pain of my life. I am told that I took a swing at a few people but no one will tell me who reversed me like that - hmmm, I wonder why???


So - a few days later I am up and moving around in that circus of a place that the Navy calls a hospital ward. I have done my own IVs because the medics messed them up - done my own blood draws and given myself an NG tube twice. I was done letting these fools practice on me. The doctor I had was great but the nursing staff was full of morons!!!!!

Turns out my bowels were all inflamed and I was just being hard and working through it - in your face doc #1 - I did have a parasitic infection - Ameobiasis to the point where the numbers blew my appendix - and, all my intestines, large and small, were adhered together where the appendix used to be so all that had to be cut out.

Attached a couple pics for y'all - I did self care for my wound (delayed primary closure) - if those wackjobs couldn't draw blood right than no way was anuone working on my wound but me.

Dan

[That Java Guy]

FYI........

Amoebiasis

About 10 percent of the world's population is infected with E.Histolytica. It is the third most common cause of death (after Schistosomiasis and Malaria) from parasitic infections. It has a very high incidence in tropical countries like India, Mexico, Central and South America. About 90 percent of infections are asymptomatic (do not produce any symptoms) and the remaining 1O percent produces a spectrum varying from dysentery to amoebic liver abscess.

Cause and Pathogenesis

It is caused by a protozoa, Entamoeba Histolytica. It is commonly spread by water contaminated by faeces or from food served by contaminated hands. Even vegetables grown in soil contaminated by faeces can transmit the disease. When the cyst of Entamoeba Histolytica enters the small intestine, active amoebic parasites (trophozoites) are released, which can invade the epithelial cells of the large intestines, causing flask-shaped ulcers. It can also spread to other organs like the liver, lungs, and brain by invading the venous system of the intestines. If it invades the liver, it causes formation of the typical anchovy paste like pus. Asymptomatic carriers pass cysts in the faeces

Symptoms and Signs

It can either occur as intestinal or extra-intestinal amoebiasis.

Intestinal amoebiasis

The most common type of amoebic infection is asymptomatic cyst passage. Symptomatic patients initially have lower abdominal pain and diarrhoea and later develop dysentery (with blood and mucus in stool). Fulminant infection with high grade fever, severe abdominal pain and profuse diarrhoea occurs in children and in patients receiving steroids. Severe gastric distention of the bowel can occur. Amoebomas (inflammatory mass lesion developing in chronic amoebiasis) can present like a malignancy.

Extra-intestinal amoebiasis

Patients show symptoms of fever and right upper abdominal pain. Jaundice is rare. Amoebic liver abscesses can also present as pyrexia of unknown origin. The abscess can sometimes rupture into the pleural, peritoneal or pericardial cavities.

Investigations and Diagnosis

Stool examination is the commonest examination done for diagnosis. Though neutrophils and Charcot-Leyden crystals can be found, haematophagous trophozoites are diagnostic. Since trophozoites are killed rapidly by water or drying, at least three fresh stool specimens have to be examined for a positive diagnosis. Fresh stool or concentrated stool examination is positive in 75 to 95 percent of patients. Serology is positive in more than 90 percent patients with invasive amoebiasis.

Barium studies are contraindicated in acute amoebic colitis for fear of perforation. Fucking "doc" could have killed me right then and there!!!!Ultrasound, CT and MRI scans of the abdomen can be useful in diagnosing hepatic amoebiasis. Since abscesses resolve slowly or may even increase in size during treatment, clinical response is more important in the follow-up rather than repeated scans.

Acute intestinal amoebiasis should be differentiated from organisms causing traveller's diarrhoea (which is due to a bacteria called Escherischia Coli) and also inflammatory bowel disease. Amoebic liver abscess has to be differentiated from pyogenic abscess which are seen in older patients with underlying bowel disease or after surgery.

Treatment and Prognosis

Asymptomatic patients can be treated with luminal agents like Liodoquinol or Diloxanide Furoate. Patients with acute colitis require supportive therapy (rehydration) and Metronidazole, followed by luminal agents. Metronidazole is also the drug of choice for amoebic liver abscess. Second line agents like Chloroquine and Emetine are no longer used. Prognosis is generally good with treatment unless complications of abscess rupture occurs when surgical intervention may be required.

Prevention

Treatment of asymptomatic cyst carriers and good sanitation and water facilities are fundamental in the prevention of amoebiasis. Vaccines are not available.



Source

Dr. V.Ramasubramaniam MBBS, MD, MRCP.



Dr.V.Ramasubramaniam is an Assistant Professor of Medicine and heads the Division of Infectious Diseases at the Sri Ramachandra Medical College and Research Institute

[That Java Guy]

So - long story short, treat your water :D

Dan

[The Reaper]

Another use for the Miox, or will it kill amoebas?

TR

[Eagle5US]

Well done! Glad you are OK, don't eat the little retards next time will ya? Maybe the scar tissue will help your wiener point skyward. :D

Eagle

[That Java Guy]

Miox kills everything :D

CLICK HERE (http://photobucket.com/albums/v233/javahed/misc%20gear/Cascade%20designs/Miox%20medical/?action=view&current=miox-chart.jpg) for a chart showing what the Miox can do.

Eagle - Bwa ha ha! Roger that man!

Dan

[swatsurgeon]

my greatest disappointment in the medical world is the inability to put 2 and 2 together to make 4.....abdominal pain, 3rd world country = live little bugs until proven otherwise.
A huge problem is that the docs treating you the 1st time DIDN'T listen and see the obvious.....DAMN DOCTORS!!!
Glad you're in one piece but now out of action for 6 or so weeks.
Hang in there, high protein diet, multivitamines and a water purifier and all will be well (should be at least).
ss

[QRQ 30]

It isn't just the Navy. While in Thailand my car and I went to a party and my car got too drunk to drive. We had a wreck and I had a very deep gash in my bicep. Still under the influence of local anesthetic (Mekong and beer) I watched as the USAF medic commenced to suture my arm. I told him he had to do some internal suturing rather than just sewing the surface ends together. He told me he was the expert and to STFU. In less than a week the wound became infected and we had to go the debredement route

[Roguish Lawyer]

Welcome to the Board, Dan. Great posts.

[That Java Guy]

Glad you're in one piece but now out of action for 6 or so weeks.
Hang in there, high protein diet, multivitamines and a water purifier and all will be well (should be at least).
ss



Thanks but I am OK now. This was last September - I bounced back like a super ball :D

RL - thanks!

Dan

[Bill Harsey]

Amazing Story Dan.

I'm glad your healed and good to see you here too.

[That Java Guy]

Sir - it's a pleasure to be here, thank you.

Dan

[Guy]

So - long story short, treat your water :D

Dan

Or go to another AO. :D

Bottled water is the norm for certain areas, no wonder it costs more than gasoline.

[That Java Guy]

Or go to another AO. :D

Bottled water is the norm for certain areas, no wonder it costs more than gasoline.

Ha ha ha - hey, name one of our AO's with good water.

Bottled - we have busted Thais and those happy folk from the PI filling water bottles from the tap and then capping them with machines. Needless to say - we did not contract through them :D

But - if anyone working South or Central America wants to play exchange student I'd be willing to give that a shot for a couple months :)

Dan

[Guy]

Ha ha ha - hey, name one of our AO's with good water.
NONE! That's why you see so much bottled water. Ain't too much water to be found at all in the ME countries.

Bottled - we have busted Thais and those happy folk from the PI filling water bottles from the tap and then capping them with machines. Needless to say - we did not contract through them :D

The Iraqis played that game also. Slice the bottom of the bottle...ever so slightly. ;) :)

But - if anyone working South or Central America wants to play exchange student I'd be willing to give that a shot for a couple months :)

Dan

I agree there.

[DoctorDoom]

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