Dear XXXXX,
Thanks for contacting Ayurveda with your concern and going by your history following points needs clarification before proceeding for further work up and management.
1.     You said you were diagnosed hypothyroid and in the next line thyroid profile is normal,so point which is to be clarified: IS or WAS? Because weight loss can also result for over treating an under active thyroid?
2.     Weight loss suggests some underlying disease and as low grade fever, and other associated features are there, make sure suitable X-ray along with Ultrasongraphy of Abdomen is done to rule out any Lung or Intestinal disease.
3.     You haven’t mentioned about the bowel habits i.e. whether constipation or loose stool is there to rule out any Inflammatory Bowel Disease which can be a cause of weight loss and blood in stool.
4.     Were you treated with Avloclor for Amoebiasis whose side effect are the symptoms which you have already mentioned and moreover it is a parasitic infection of intestine resulting in blood mucus stool and weight loss.
5.     Pain is in right abdomen so best option is to consult a Gastroenterologist who will either go with Endoscopy or Colonoscopy.
6.     Please revert back with your views regarding the same,will be duly looked upon.
Dr. Munish Sood
MD. (Ayu.) Kayachikitsa
Consultant & Physician
Naimittika Clinic.

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Dear XXXXX

1.     What is your assessment of weight loss: whether it is lost grossly or it is a small weight loss? And what is the relationship of APPETITE with Weight loss i.e. is appetite increased or decreased with weight loss???
2.     Any history of addiction to alcohol or drugs,malabsorption syndromes?
3.     Examine for Hb%,WBC,ESR,FBS & Urine Routine.
4.     Though CT-Abdomen came out normal (i.e. Malignancy with chronic amoebic hepatitis can be excluded), go with Chest X-ray to rule out any lung pathology.
5.     Are you free from Amoebiasis now? Go for Sigmoidoscopy to rule out Amoebic ulcer in Intestine, also presence of mucus in stool is/can be due to Ulcerative colitis, IBS, Malabsorption syndrome
6.     If you see occasional blood streak go for stool test for occult blood.
7.     Endoscopy/biopsy attached reports are still not in the Query section, so unable to comment anything, make sure you have done the needful, regarding the same.

Dr. Munish Sood

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Dear XXXXX,

Thanks for providing additional details. My comments based on the reports are as follows:

1. Stool Examination is Negative; thus high eosinophil count due to parasitic infection is less likely.

2. History of Asthma/Bronchitis (Allergic Disorder) was in childhood. As the recent chest X-ray came normal, it is a positive sign. Consider consulting a chest physician if symptoms recur.

3. WBC count came normal - eosinophilic leukemia is less likely. It is preferable to perform H.I.V. test as routine if weight loss contiues.

4.Make sure you are not on drugs like Aspirin, Iodides, Nitrofurantoin, sulphonamides which can result in Eosinophilia

5. Consult with your Doctor and discuss about the possibilities of "Tropical Eosinophilia” (low grade fever, loss of weight, fatigue and abdominal pain are some of its symptoms)

6.“Eosinophilic esophagitis” is written in the Endoscopy report (clinicopathologically) with inactive gastritis with negative for H.Pylori infection. You are given dietary modification.

Hope this answers your query. Let me know if you need clarifications.

Dr. Munish Sood
Naimittika

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1.     Regarding esophagitis:
. AVOID: newly harvested rice,chick pea flour,white dal,horse gram, potato,brinjal,spices,tea-coffee,alcohol,junk food,day sleeping (nap is good),sesame,salt,curd,refined flour and citrus fruit.
.Take: wheat, green gram,bitter gourd,white gourd melon, well cooked green leafy vegetables (not raw),old rice,harad,garlic,honey,pomegranate,amla (indian gooseberry)
2.     Home remedy: you can take Soda bicarbonate 10gm or olive oil 10ml once a day (don’t take at once rather sip at gap of 10 minutes)
3.     Bone pain could result from deficiency of Vitamin D, apart from any other source, so make an appointment regarding the same with an Orthopaedic Surgeon.
4.     Boils themselves are not infective but the bacteria that causes it are, although your sugar came out to be normal, consult with your Doctor for any other pathology.

Dr. Munish Sood

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