Paolo's case history

[Paolo]

Once upon a time (July 23 06), I was rudely awakened by gut pain I thought would kill me. Thinking it was IBS (which I'd experienced years ago), I tried waiting it out for a couple of hours, but that was no good. I went to the ER, and by 9 that night I had surgery to remove a cecal volvulus (i.e., my ascending colon had twisted, blown up like a balloon, and had to be removed; the small intestine got reconnected directly to the transverse colon).

Prior to surgery, I was given 1 gram of Mefoxin, a cephalosporin antibiotic, to prevent infection. As far as I know, there was no post-surgical antibiotic treatment. After recuperating in hospital for 5 days, I returned home, and 4 days later I began to have watery diarrhea with a constancy unlike anything I could remember, as was the odor. After a few days, the surgeon said it takes some time for the colon to adjust to the new length of bowel. I also had a lot of right abdominal pain, but that was the site of the surgery.

The next week, he suggested a stool test and a CT with contrast. He told me he was testing for an infection that can arise from the use of antibiotics, but he was almost certain I couldn't have that because of how short the exposure to antibiotics was. Darned if they didn't call the next morning and tell me it was positive. Also said my colon was distended. That was the start of the 10-day flagyl treatment.

Two days after the flagyl was done, the symptoms returned. He changed me to 250 mg Vancocin qid and referred me to a GI specialist. There was little change in symptoms, so I retested for CDiff toxin. This time it was negative (surprise--I was superdosed with Vanco!). The GI ordered a colonoscopy which he called "unremarkable" except for a small ulcer at the site of my surgery. He ordered Questran daily, 3 Xifixan tablets tid for 14d, and tapering Vanco regimen for 35d to follow the ongoing high dose protocol.

That brings me to the present, where black tarry stools have entered the picture. It's clear I'm bleeding. The pain in the right abdomen hasn't disappeared with the healing surgical wounds--it comes and goes, but it doesn't feel much different in degree. This week the GI increased the Questran to qid, added Imodium tid, and ordered a dramatic reduction of Zoloft, an antidepressant known to be about as powerful at causing bleeding as aspririn (surprise to me!). My stools have been semi-formed since taking the Questran, but the number of trips to the BR (still 5-10/day) make work an impossibility (I teach). The most distressful complaint right now is hemorrhoids, not so much for bleeding (as that's quite minimal) but for pain--ohmigod! I'm also so fatigued that I can hardly stay awake more than 3 hours at a time on a good day.

I'm now setting up for some serious probiotic recolonization. I'm not at all sure that anything was displaced during the prep for the colonoscopy, because what's going on right now sure seems to be Cdiff, at least to me!

I know the end is in sight, I just can't quite see the light yet!