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Best ways to treat diarrhoea
Apr 15, 2004

Dear Dr. Although I am infected with Cryptosporidium I noticed that the "type" of diarrhoea I had when this was caused by this parasite (it was watery and I was really incontinent)is different from the diarrhoea I have now since my CD-4 count has improved after a stringent use of T-20 and loads of other meds. But, it means I still have diarrhoea and I just wonder what you would suggest I should do to minimize this boring aspect since it influences my movements (I don't dare to go out to places where I am not sure there is a toilet for instance)and all my internist would suggest I take is Loperamide which I think is absolutely useless. Can you perhaps give me some good advice what to do and what to suggest to my doctor?

Thanks for your advice!

P.S: I did have a treatment against these parasites called fumagillin but I do not think I need to take this right now.

I assume there is no evidence for persistant infections, pancreatitis, malabsorption, and lactose intolerance? Some patient benefit-in the setting of non-specific or PI associated diarrhea with AIDS-from a variety of approaches with no single recommendation being usually effective. For some use of SB-Normal Stool Formula (Shaman Pharmaceuticals), or calcium supplements, or oat bran or other fiber tablets can help. Lomotil or tinture of opium can be helpful in severe cases as can Sandostatin. I have had some patients who have done been helped by pancreatic enzyme supplements in the setting of mild pancreatic irritation. KH

Response from Dr. Conway

I am sorry to hear about your problem.

In general terms, it is important to make sure that specific causes of your diarrhea have been ruled out. This is accomplished with:

1. Stool tests (looking for bacteria and parasites) 2. Some X-rays (an ultrasound or CT scan of your abdomen to make sure there isn't a problem with your liver or lymph glands or some other issue that will explain your problem) 3. A sigmoidoscopy or colonoscopy to make sure there isn't an infection, a cancer or some other cause of your diarrhea that is specific to your situation.

Obviously, if something is found, then a specific treatment may be available.

Barring this, you would be surprised how well Loperamide can work, especially taken in higher doses four times a day. You may wish to give it a try. Some people have also used codeine pills to get it under control. A more intriguing approach is octreotide injections, if these are available to you.

Good luck...



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