Brief Answer:
further necessary information

Detailed Answer:
Dear
Thanks for contacting the Ayurveda section of [A]YUSH and after reviewing your case history and answer given by another eminent physician I'm of the following opinion:

1.there was a history of gastroenteritis (food poisoning] 5 weeks ago [vomiting + diarrhea], so dehydration could be one cause of your fatigue/lack of concentration.

PS. check with your serum electrolytes [potassium and sodium] and may require intravenous fluid therapy

2. As in your medications tried section: all reports are normal this could be late sequelae of gastroenteritis [but second opinion is always welcome]

3. Please make sure to check with parameters like pulse, blood pressure and degree of dehydration with your doctor's help. If those are normal, try the following:

i. Plenty of water, liquids, orolyte, old brown rice, porridge [without milk], moong/masoor dal,pomegranate,bottle gourd,honey,cumin,black tea,ganji, buttermilk,biscuits,overripe banana,coconut water,fruit juices,soft diet,soft rice,idli

ii. Avoid coffee, tea, salt, junk/processed food and HIGH protein diet

iii. Drink plenty of water, at least 8-10 glasses per day, which improves urine output, and rehydrates the skin and add little of black pepper, lemon and salt to it or simply have ORS sachets

iv. Cilantron juice (Coriander/Dhaniya) either purchased or made at home is an ideal drink for you.

Do revert back with your concerns

Dr. Munish Sood
Consultant Physician
Naimittika

direct online link: bit.ly/drmunishsood

---

Brief Answer:
seek opinion

Detailed Answer:
Dear
Thanks for reverting back
. In best position, I would suggest you to see an LLMD [Lyme-literate M.D] since most general doctors/physician don't know that much about Lyme and how to treat it properly and taking antibiotics in such condition will only worsen the symptoms

PS. One has to exclude other infections which can mimic insect bite like MRSA, Lyme disease. [test most often to detect Lyme disease is ELISA test]

Dr. Munish
Naimittika

---

Brief Answer:
further necessary information

Detailed Answer:
Dear
Thanks for reverting back

1. As you have been diagnosed with enteric [typhoid ] fever thus do let me know about the following:

i. About your widal titre: whether O agglutinins are active [active disease] or H- agglutinins [result of previous inoculation]

ii. If it is diagnosed after third/fourth week, steroids [prednisone] should not be used as there is chance of precipitation of intestinal hemorrhage or perforation

iii.     The titre has no correlation with the severity of the illness

iv.     Due to high rates of false positivity and false negativity, misinterpretation is very common

2. Two important complications of typhoid are carrier state and chronic cholecystitis and keep a check on some life-threatening complications associated with typhoid-like: intestinal hemorrhage, myocarditis, septicemia, meningitis, acute peripheral circulatory failure

PS. kindly consult your attending physician for an exhaustive list and remain under regular supervision.

3.     DIETARY REGIME

i. Take: old brown rice, rice gruel, porridge, moong/masoor dal, potato, bitter gourd, Guduchi, black grapes, pomegranate, light diet, rest, buttermilk, raisins, goats milk/ghee lukewarm water, soft rice with milk/ghee/plain dal, boiled vegetables, little lime pickle or papad for taste but no chilies, plenty of fluids and water every 2-3 hours, plain-lime-coconut-electral water, bread butter, toast jam, cornflakes, apple, banana, pear, citrus fruits, dry fruits, biscuits.

ii. Avoid sesame seeds, fast/junk food, heavy/constipating/distending food, contaminated food/water, excess physical exertion, daytime sleeping, bathing [sponging is good], alkalies, green leafy vegetables [salad], curd, sprouted cereals.

4. In Ayurveda, we generally adopt 'Sannipata Jwar Chikitsa' for the management of typhoid fever.
Since treatment also depends upon the stage of enteric fever [I-II-III-IV week] thus kindly consult with your attending physician, here treatment will be furnished as a whole i.e. prescription which is followed in carrier cases:

1. Mrityunjaya Ras: 2 tablets, twice daily with ginger juice
2. Shadangya paneeya: 30ml twice daily: for thirst
3. saubhagya vati: 250mg
ananad bhairav Ras: 125 mg
XXXXXXX XXXXXXX bhasm 125mg.. with honey twice daily

4.     You may go for Immunisation against Typhoid either Orally [in form of capsules][ or Parenteral [in form of injection]

Dr. Munish
Naimittika Clinic

---

Brief Answer:
diagnosis of enteric fever

Detailed Answer:
Dear
Thanks for reverting back

1. A titre above 1:160 is suggestive of enteric fever in a nonimmunized person and as said earlier the titre has no correlation with the severity of the illness [so check after 1 week]

PS. remember that the test can come positive even after a full course of treatment [check titre serially with 2 weeks interval] so need not to worry and if symptoms are decreasing and the person is feeling active/healthy then on the basis of this we judge that person is cured of typhoid.

2. If the titre remain in this range go for blood and stool culture and if comes negative it means that Widal is showing false positive results [do a culture test by Bactec automated system, since it will directly find the bacteria from blood whereas widal detects the antibodies, produced by our body against the bacteria]

PS. the bacilli may persist in the gallbladder for months or years

Dr. Munish
Naimittika Clinic

---

Brief Answer:
specialist opinion is required

Detailed Answer:
Dear
Thanks for reverting back

1. As mentioned earlier, that typhoid is well known for affecting intestine, joints, intestines and blurred vision, confusion, frequent squinting has been mentioned as the complications of the disease. [Agarwal, L. P.: "Eye diseases", Kitab XXXXXXX XXXXXXX p. 511, (1963).].

PS. As typhoid fever is capable of producing toxic and degenerative changes in the tissues throughout the body, thus the involvement of eye is not surprising [if present], and complications are usually seen after the third week so check with an Ophthalmologist to exclude the same and also a Neurologist opinion for any CNS involvement.

2.     Will let you know the alternatives if ophthalmologic/Neurological examination comes normal.

Dr. Munish
Naimittika

---

Brief Answer:
go for second opinion

Detailed Answer:
Dear
Thanks for reverting back

1. Second opinion and examination are always welcome to uncover any ongoing pathology which might have remained benign during earlier consultation and examination.

2. In my personal opinion, you should have a co-management arrangement, i.e. where an optometrist and ophthalmologist will be working as a team for your eye problem

PS. in rare instances sometimes an Autoimmune disease can cause the same, so regular supervision and follow-ups are necessary [you may ask for a Medicine specialist opinion]

Dr. Munish

---