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Hi There Dr. I Would Like To Ask Regarding My

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Posted on Tue, 5 Nov 2019
Question: Hi there Dr. I would like to ask regarding my recent doctor visit and the medications i was asked to buy. A little about my condition, I have been having constipation for the last 3 or more months. It started with having no Bowel movement(BM) in one or two days. Soon after, it developed into four or five days. there were times where i couldn't see any BM for a week. When this happened, i talked to a doctor, and i was recommended to use "Ready to use Enema" and that didn't help me, all that came out with the liquid i put in. Then i changed into repositories. This helped me with a quick BM every time i use it. After few times of using, its effectiveness faded away. Basically it wasn't helping as much. My body sort of adapted to it. Every time i have a BM, the first two inched are very dry and a small circle crumbled together. The following is Mushy and pencil thin. Keep in mind, to make a small BM, i have to breath and push hard for several minutes. I usually stay in bathroom for over 30 minutes. Once every other day if i am lucky. My diet was good. I have been healthy all my life. I exercise. I don't know what could cause this. A week ago, i visited a Gastrointestinal specialist. I told him about an incident i had in a restaurant about 2 years ago. After eating in the restaurant, i started to have a cramp on my left side abdominal. After that, i couldn't make any BM for 4 to 5 days. I applied a lot of air and massaging pressure to my belly, and a day after, i made a very painful MB. What came out was a "Mucoid Plaque." Continued for a couple of days and disappeared. After that everything turned normal.

After telling the Dr, this history and my current condition, he immediately told me that i have a chronic SIBO with constipation. I didn't make any tests. H just told me that this is what i have. And he prescribed me "Rifaximin" and "Neomycin" taken together.
Rifaximin, 2 pills, 3 times per day with food.
Neomycin, 2 pills, 2 times per day, taken with Rifaximin.

Until the medications arrive, i am taking "Linzess." 1 pill 30 minutes before breakfast. And
Antrantil( a herbal pill) taken with food. 2 pills 3 times per day

After searching how strong this medications are, i would like to know what your thoughts are on my health condition, and on the pills. Or if i should visit another GI Dr?
Also the medication is ordered from Singapore due-to being very expensive in the U.S. Are there any difference in medications sold in the U.S and Asia? mainly quality and safety?

Thank you so much! And hoping to hear from you!
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Follow up: Dr. Ramesh Kumar (0 minute later)
Hi there Dr. I would like to ask regarding my recent doctor visit and the medications i was asked to buy. A little about my condition, I have been having constipation for the last 3 or more months. It started with having no Bowel movement(BM) in one or two days. Soon after, it developed into four or five days. there were times where i couldn't see any BM for a week. When this happened, i talked to a doctor, and i was recommended to use "Ready to use Enema" and that didn't help me, all that came out with the liquid i put in. Then i changed into repositories. This helped me with a quick BM every time i use it. After few times of using, its effectiveness faded away. Basically it wasn't helping as much. My body sort of adapted to it. Every time i have a BM, the first two inched are very dry and a small circle crumbled together. The following is Mushy and pencil thin. Keep in mind, to make a small BM, i have to breath and push hard for several minutes. I usually stay in bathroom for over 30 minutes. Once every other day if i am lucky. My diet was good. I have been healthy all my life. I exercise. I don't know what could cause this. A week ago, i visited a Gastrointestinal specialist. I told him about an incident i had in a restaurant about 2 years ago. After eating in the restaurant, i started to have a cramp on my left side abdominal. After that, i couldn't make any BM for 4 to 5 days. I applied a lot of air and massaging pressure to my belly, and a day after, i made a very painful MB. What came out was a "Mucoid Plaque." Continued for a couple of days and disappeared. After that everything turned normal.

After telling the Dr, this history and my current condition, he immediately told me that i have a chronic SIBO with constipation. I didn't make any tests. H just told me that this is what i have. And he prescribed me "Rifaximin" and "Neomycin" taken together.
Rifaximin, 2 pills, 3 times per day with food.
Neomycin, 2 pills, 2 times per day, taken with Rifaximin.

Until the medications arrive, i am taking "Linzess." 1 pill 30 minutes before breakfast. And
Antrantil( a herbal pill) taken with food. 2 pills 3 times per day

After searching how strong this medications are, i would like to know what your thoughts are on my health condition, and on the pills. Or if i should visit another GI Dr?
Also the medication is ordered from Singapore due-to being very expensive in the U.S. Are there any difference in medications sold in the U.S and Asia? mainly quality and safety?

Thank you so much! And hoping to hear from you!
doctor
Answered by Dr. Ramesh Kumar (30 minutes later)
Brief Answer:
Proper investigations should be done.

Detailed Answer:
Hello and thank you for choosing HealthcareMagic for your query my dear patient,
Have seen your details and I appreciate your concerns,
Coming to your query-
Small intestinal bacterial overgrowth (SIBO) is a medical condition in which a person has an unusually large population of bacteria in their small intestine.However the symptom you are having currently was pain on left side. Usually that part contains large intestine and colonic area starts from there. Constipation is also usually associated with large intestine and not small intestine. Stools are stored in rectum and mucous is secreted to lubrictate the passage to pass stools easily however if stools are dry or on using enema if only mucous is passing it means that the problem is not in digesting area(small intestine) but is there in excreting area(large intestine).
Secondly SIBO is a diagnosis made after investigation and not by just listening to symptoms of patient. To be easy I could say that constipation could be a result of poor motility of intestines or lack of fiber in diet or just age related change. Now how could the doctor be so sure that it's SIBO.
Protocol should be -
Few tests like Stool routine and microscopy along with culture and sensitivity should be done to be sure if there is really large population of bacterias or not.
Thirdly our gut consists of millions of species of good bacteria yeast and fungi which help to digest food properly. So giving antibiotic blindly that too two antibiotics (you have not mentioned the doses of Rifampicin and Other one please mention them in follow up) can kill them and make your problem even more worse. So this test should be done.

Secondly a proper colonoscopy should be done to see if there is some pathological problem with intestines. If motility is fine etc.Coloscopy tube contains high definition camera and doctor could see the complete large intestine.

Quality of Asian drugs are good and work very well don't worry about that(If purchased with proper bill).

Kindly mention the doses of Rifaximin and Neomycin suggested by him.
Was any probiotic given.
Any laxative or stool softener?
Was any test done for impaction of stools?

Please revert back for a better answer.
waiting!

Above answer was peer-reviewed by : Dr. Kampana
doctor
doctor
Answered by Dr. Ramesh Kumar (0 minute later)
Brief Answer:
Proper investigations should be done.

Detailed Answer:
Hello and thank you for choosing HealthcareMagic for your query my dear patient,
Have seen your details and I appreciate your concerns,
Coming to your query-
Small intestinal bacterial overgrowth (SIBO) is a medical condition in which a person has an unusually large population of bacteria in their small intestine.However the symptom you are having currently was pain on left side. Usually that part contains large intestine and colonic area starts from there. Constipation is also usually associated with large intestine and not small intestine. Stools are stored in rectum and mucous is secreted to lubrictate the passage to pass stools easily however if stools are dry or on using enema if only mucous is passing it means that the problem is not in digesting area(small intestine) but is there in excreting area(large intestine).
Secondly SIBO is a diagnosis made after investigation and not by just listening to symptoms of patient. To be easy I could say that constipation could be a result of poor motility of intestines or lack of fiber in diet or just age related change. Now how could the doctor be so sure that it's SIBO.
Protocol should be -
Few tests like Stool routine and microscopy along with culture and sensitivity should be done to be sure if there is really large population of bacterias or not.
Thirdly our gut consists of millions of species of good bacteria yeast and fungi which help to digest food properly. So giving antibiotic blindly that too two antibiotics (you have not mentioned the doses of Rifampicin and Other one please mention them in follow up) can kill them and make your problem even more worse. So this test should be done.

Secondly a proper colonoscopy should be done to see if there is some pathological problem with intestines. If motility is fine etc.Coloscopy tube contains high definition camera and doctor could see the complete large intestine.

Quality of Asian drugs are good and work very well don't worry about that(If purchased with proper bill).

Kindly mention the doses of Rifaximin and Neomycin suggested by him.
Was any probiotic given.
Any laxative or stool softener?
Was any test done for impaction of stools?

Please revert back for a better answer.
waiting!

Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Ramesh Kumar (8 hours later)
Hi Dr. Thank you for your answer.

* The doctor was saying that since i don't have any blood or other signs in my stools, there is no need to conduct a colonoscopy. That is what he said.
* The left side abdominal pain was 2 years ago, after the restaurant visit. Now, the pain is all around by abdominal. Specially in the middle area.
* I have mentioned all medications and their dosage above. It is as follow:
Currently taking:
1) Until the medications arrive, i am taking "Linzess(stool softner)." 1 pill 30 minutes before breakfast.
2) Antrantil( a herbal pill) taken with food. 2 pills 3 times/day
* Once the below medications arrive, I will immediately stop consuming Linzess and Antrantil.

Medications ordered:
1) Rifaximin, to be taken 2 pills, 3 times/day with food.
2) Neomycin, to be taken 2 pills, 2 times/day with Rifaximin.

* In the last there months, i took laxatives, Miralax, and repository pills, none of them made any difference. Didn't help at all. The only thing that worked is Anal repository. I am still using this as needed. That is the only way i make a Bowel Movement.

* 6 months ago, when i made a full body checkup, i did three kind of stool tests. And the result for all tests was that everything was normal.

Thank you Dr. And hope to hear back from you!







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Follow up: Dr. Ramesh Kumar (0 minute later)
Hi Dr. Thank you for your answer.

* The doctor was saying that since i don't have any blood or other signs in my stools, there is no need to conduct a colonoscopy. That is what he said.
* The left side abdominal pain was 2 years ago, after the restaurant visit. Now, the pain is all around by abdominal. Specially in the middle area.
* I have mentioned all medications and their dosage above. It is as follow:
Currently taking:
1) Until the medications arrive, i am taking "Linzess(stool softner)." 1 pill 30 minutes before breakfast.
2) Antrantil( a herbal pill) taken with food. 2 pills 3 times/day
* Once the below medications arrive, I will immediately stop consuming Linzess and Antrantil.

Medications ordered:
1) Rifaximin, to be taken 2 pills, 3 times/day with food.
2) Neomycin, to be taken 2 pills, 2 times/day with Rifaximin.

* In the last there months, i took laxatives, Miralax, and repository pills, none of them made any difference. Didn't help at all. The only thing that worked is Anal repository. I am still using this as needed. That is the only way i make a Bowel Movement.

* 6 months ago, when i made a full body checkup, i did three kind of stool tests. And the result for all tests was that everything was normal.

Thank you Dr. And hope to hear back from you!







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Follow up: Dr. Ramesh Kumar (7 minutes later)
I forgot to mention that i have excessive Gas and bloating.
default
Follow up: Dr. Ramesh Kumar (0 minute later)
I forgot to mention that i have excessive Gas and bloating.
doctor
Answered by Dr. Ramesh Kumar (11 minutes later)
Brief Answer:
Follow up.

Detailed Answer:
Hi again,
Anal repository causes contraction and relaxation in rectal muscle and helps to pass stool....This is clearly suggestive that something may be wrong with musculular contraction and relaxation or nerve supply to that area.
Hence colonoscopy should be done.
Another catch is that gas and bloating is suggestive of stagnation of food.
Stagnated food is acted upon by bacterias and fungus releasing large amount of gas (incomplete fermentation of food).

You got me wrong I want to know the doses of Rifaximin suggested to you by doctor like 200 mg thrice or 550 mg?

As pain is now in complete abdomen therefore possibility of irritable bowel syndrome has to be ruled out.
But IBS is a diagnosis of exclusion so unless every test is normal and symptoms are there patient is not IBS.

As stool tests were all normal just a few months back chances of SIBO are very less.

Please reply with doses of Rifazimin prescribed.
Waiting.
Thanks.

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
doctor
Answered by Dr. Ramesh Kumar (0 minute later)
Brief Answer:
Follow up.

Detailed Answer:
Hi again,
Anal repository causes contraction and relaxation in rectal muscle and helps to pass stool....This is clearly suggestive that something may be wrong with musculular contraction and relaxation or nerve supply to that area.
Hence colonoscopy should be done.
Another catch is that gas and bloating is suggestive of stagnation of food.
Stagnated food is acted upon by bacterias and fungus releasing large amount of gas (incomplete fermentation of food).

You got me wrong I want to know the doses of Rifaximin suggested to you by doctor like 200 mg thrice or 550 mg?

As pain is now in complete abdomen therefore possibility of irritable bowel syndrome has to be ruled out.
But IBS is a diagnosis of exclusion so unless every test is normal and symptoms are there patient is not IBS.

As stool tests were all normal just a few months back chances of SIBO are very less.

Please reply with doses of Rifazimin prescribed.
Waiting.
Thanks.

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
default
Follow up: Dr. Ramesh Kumar (5 hours later)
Hi again, i aplogize for miss understanding your question.
The dosage for Rifaximin is 550mg and 500mg for Neomycin.

Thank you!!


default
Follow up: Dr. Ramesh Kumar (0 minute later)
Hi again, i aplogize for miss understanding your question.
The dosage for Rifaximin is 550mg and 500mg for Neomycin.

Thank you!!


doctor
Answered by Dr. Ramesh Kumar (17 minutes later)
Brief Answer:
Follow up.

Detailed Answer:
Hi there,
No not at all,
Maximum dose of Rifaximin even in patients of IBS is 550 mg twice.
Here you would have 550 mg thrice along with 500 mg twice Neomycin.
No
Change your Gastro.
Get a second opinion.
Even if it's SIBO and all Rifaximin maximum dose is 550 mg twice daily.
Only in patients with Heapatic encephalopathy we use higher doses.
Please see another Gastroenterologist before taking such heavy doses of antibiotics that too with clear stool tests.
I would strongly recommend you for a secondary opinion from a Gastro in person. You could discuss the answers given by me with him and revert back with what he says.
Till you meet the second consultant take probiotic preferably Econorm three times a day.
Eat yoghurt thrice.
Eat two cups of fruit gauva banana apple oranges and kiwi daily.
Green vegetable salad before dinner.
As a rule of thumb the amount of raw food in your diet should be equal to amount of cooked food in a day.
Take very light and easily digestible food preferably vegetarian for few weeks.
No junk food and all.
Follow up with Drs suggestion.
You can continue with anal repositories till that time.

Follow ups are welcome,
Hope I was helpful,
Thanks and do rate the answer.


Above answer was peer-reviewed by : Dr. Raju A.T
doctor
doctor
Answered by Dr. Ramesh Kumar (0 minute later)
Brief Answer:
Follow up.

Detailed Answer:
Hi there,
No not at all,
Maximum dose of Rifaximin even in patients of IBS is 550 mg twice.
Here you would have 550 mg thrice along with 500 mg twice Neomycin.
No
Change your Gastro.
Get a second opinion.
Even if it's SIBO and all Rifaximin maximum dose is 550 mg twice daily.
Only in patients with Heapatic encephalopathy we use higher doses.
Please see another Gastroenterologist before taking such heavy doses of antibiotics that too with clear stool tests.
I would strongly recommend you for a secondary opinion from a Gastro in person. You could discuss the answers given by me with him and revert back with what he says.
Till you meet the second consultant take probiotic preferably Econorm three times a day.
Eat yoghurt thrice.
Eat two cups of fruit gauva banana apple oranges and kiwi daily.
Green vegetable salad before dinner.
As a rule of thumb the amount of raw food in your diet should be equal to amount of cooked food in a day.
Take very light and easily digestible food preferably vegetarian for few weeks.
No junk food and all.
Follow up with Drs suggestion.
You can continue with anal repositories till that time.

Follow ups are welcome,
Hope I was helpful,
Thanks and do rate the answer.


Above answer was peer-reviewed by : Dr. Raju A.T
doctor
doctor
Answered by Dr. Ramesh Kumar (1 hour later)
Brief Answer:
Follow up.

Detailed Answer:
Hi and thank you so much for appreciation.
I won't comment on whether your GP is wrong or right.
All doctors want their patients to be fit and fine and we are under that oath but yes giving high doses of antibiotics without even properly investigating a patient is something not good.

In an era when we have investigations with us we should first use them to fullest.

As far as medicine is concerned even a pharmacist could prescribe you medicines.
Doctor are there to make diagnosis and when technology is there we should use it to the fullest.

Remain in touch and a very good luck.
Hope I was helpful.
Do rate the answer.
Thank you once again.

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
doctor
Answered by Dr. Ramesh Kumar (0 minute later)
Brief Answer:
Follow up.

Detailed Answer:
Hi and thank you so much for appreciation.
I won't comment on whether your GP is wrong or right.
All doctors want their patients to be fit and fine and we are under that oath but yes giving high doses of antibiotics without even properly investigating a patient is something not good.

In an era when we have investigations with us we should first use them to fullest.

As far as medicine is concerned even a pharmacist could prescribe you medicines.
Doctor are there to make diagnosis and when technology is there we should use it to the fullest.

Remain in touch and a very good luck.
Hope I was helpful.
Do rate the answer.
Thank you once again.

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Ramesh Kumar (10 minutes later)
Thank you very much Dr for all your helpful answers. You really saved me from so much further suffering and complications. I will absolutely take your advises into action. I will make an appointment and visit another GI Dr this week. I will message you with the new Doctor's results.
Thank you! And have a great day or night.
default
Follow up: Dr. Ramesh Kumar (0 minute later)
Thank you very much Dr for all your helpful answers. You really saved me from so much further suffering and complications. I will absolutely take your advises into action. I will make an appointment and visit another GI Dr this week. I will message you with the new Doctor's results.
Thank you! And have a great day or night.
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Follow up: Dr. Ramesh Kumar (24 hours later)
Hi Dr, just wanted to askm one last questions. You mentioned using technologies to diagnose patients. Do you have a recommendation to which types of machine or kind of i should tell my doctor to check me with? I want to make sure i find exactly what is wrong with me. Thank you, and sorry for the late message!
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Follow up: Dr. Ramesh Kumar (0 minute later)
Hi Dr, just wanted to askm one last questions. You mentioned using technologies to diagnose patients. Do you have a recommendation to which types of machine or kind of i should tell my doctor to check me with? I want to make sure i find exactly what is wrong with me. Thank you, and sorry for the late message!
doctor
Answered by Dr. Ramesh Kumar (51 minutes later)
Brief Answer:
Follow up.

Detailed Answer:
Hello dear,
You could insist him to perform a Colonoscopy along with MRI test.
Colonoscopy uses high definition camera to see inside you intestines while MRI is another machine which splits water in various part of abdomen to look for proper blood supply.
Part with less blood supply would split up less water.
Hope I was helpful.

Thank you.
Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Ramesh Kumar (0 minute later)
Brief Answer:
Follow up.

Detailed Answer:
Hello dear,
You could insist him to perform a Colonoscopy along with MRI test.
Colonoscopy uses high definition camera to see inside you intestines while MRI is another machine which splits water in various part of abdomen to look for proper blood supply.
Part with less blood supply would split up less water.
Hope I was helpful.

Thank you.
Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Ramesh Kumar (5 hours later)
Brief Answer:
Thank you

Detailed Answer:
Thank you so much,
This is my direct link which you could use in future to contact me ASAP.
http://doctor.healthcaremagic.com/doctors/dr-ramesh-kumar/72660
Regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. Ramesh Kumar (0 minute later)
Brief Answer:
Thank you

Detailed Answer:
Thank you so much,
This is my direct link which you could use in future to contact me ASAP.
http://doctor.healthcaremagic.com/doctors/dr-ramesh-kumar/72660
Regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
default
Follow up: Dr. Ramesh Kumar (10 minutes later)
Great, i will let him know to order me those test.
Thank you very much for everything Dr XXXXXXX
default
Follow up: Dr. Ramesh Kumar (0 minute later)
Great, i will let him know to order me those test.
Thank you very much for everything Dr XXXXXXX
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Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2906 Questions

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Hi There Dr. I Would Like To Ask Regarding My

Hi there Dr. I would like to ask regarding my recent doctor visit and the medications i was asked to buy. A little about my condition, I have been having constipation for the last 3 or more months. It started with having no Bowel movement(BM) in one or two days. Soon after, it developed into four or five days. there were times where i couldn't see any BM for a week. When this happened, i talked to a doctor, and i was recommended to use "Ready to use Enema" and that didn't help me, all that came out with the liquid i put in. Then i changed into repositories. This helped me with a quick BM every time i use it. After few times of using, its effectiveness faded away. Basically it wasn't helping as much. My body sort of adapted to it. Every time i have a BM, the first two inched are very dry and a small circle crumbled together. The following is Mushy and pencil thin. Keep in mind, to make a small BM, i have to breath and push hard for several minutes. I usually stay in bathroom for over 30 minutes. Once every other day if i am lucky. My diet was good. I have been healthy all my life. I exercise. I don't know what could cause this. A week ago, i visited a Gastrointestinal specialist. I told him about an incident i had in a restaurant about 2 years ago. After eating in the restaurant, i started to have a cramp on my left side abdominal. After that, i couldn't make any BM for 4 to 5 days. I applied a lot of air and massaging pressure to my belly, and a day after, i made a very painful MB. What came out was a "Mucoid Plaque." Continued for a couple of days and disappeared. After that everything turned normal. After telling the Dr, this history and my current condition, he immediately told me that i have a chronic SIBO with constipation. I didn't make any tests. H just told me that this is what i have. And he prescribed me "Rifaximin" and "Neomycin" taken together. Rifaximin, 2 pills, 3 times per day with food. Neomycin, 2 pills, 2 times per day, taken with Rifaximin. Until the medications arrive, i am taking "Linzess." 1 pill 30 minutes before breakfast. And Antrantil( a herbal pill) taken with food. 2 pills 3 times per day After searching how strong this medications are, i would like to know what your thoughts are on my health condition, and on the pills. Or if i should visit another GI Dr? Also the medication is ordered from Singapore due-to being very expensive in the U.S. Are there any difference in medications sold in the U.S and Asia? mainly quality and safety? Thank you so much! And hoping to hear from you!