QUESTION: 40 y.o. female with profuse diarrhea and fecal incontinence with blood and mucus in feces on occasion x 6 months. I ordered a bunch of labs including stool sample and C.diff and so far only C.diff is positive, no leukocytes in stool, no Giardia or Campylobacter, still waiting on CBC with Chem panel. There is a hx of fistulas and developed shortly after the 4th degree episiotomy during the very stressful birth of her son. Incidentally, the onset of diarrhea also is shortly after the delivery. Patient reports improvement of diarrhea on its own a few weeks later, with the recurrence of diarrhea a few months later. Her vitals in office are normal, she is afebrile with normal BP. Another finding is toenail fungus on all ten toes that happened shortly before the onset of the most recent bout of diarrhea in December.
1. I am hesitant to initiate Abx. Do you know of a naturopathic way to treat C.diff? The doses and brand names would be so very appreciated.
2. Should I order the colonoscopy as well since C.diff occurrence in ulcerative colitis is so great?
ANSWER: The next diagnostic steps I would take would be to check for anemia and elevation of eosinophils on the CBC. The fungal issues sound like Crohn’s or UC, so definitely order the colonoscopy. Naturopathic treatment without more information is tough to say, but if pressed I’d do Berberine caps (Thorne) and Oregano (ADP-Biotics) both 2-3 pills each TID with food and 50-200 billion probiotics plus Sacro-b.