Smelling Sh*t
I made some of my students smell the organic waste material excreted from the anal end of a patient yesterday during the night rounds.
Don’t get me wrong. I am no sado-masochist trying to make my student’s life more miserable.
I wanted them to smell the unique unpleasant smell of stool mixed with blood, otherwise known as melena (actually when I googled ‘melena’ on Google Image, I got pictures of naked ladies!!!). It’s got a unique pungent smell and looks typically black and tarry; a lot like the inside of chinese dumplings with black beans paste (tau-sar-pau).
Any similarities? 
A patient in my ward had an upper gastrointestinal bleed (UGIB) and so passed out a lot of melenic stool. The ward nurses were changing his diapers just as I was passing that way with students in tow. I saw it as an opportunity to get them to take a deep breath, close enough to the patient to experience the smell.
My intentions were noble of course…I wanted them to recognise the smell, so that in the future if they come across a similar scent again while attending to a patient, they would be alerted to the possibility of an UGIB, without even having to tear open a patient’s diapers to see.
My students probably thought I have finally lost it (and the last marble in my brain) when I first asked them to do the unpleasant and unexpected task, but then they saw I was serious. And so, one by one, they gamely went near the patient and took a deep breath.
I swear I could see their faces turned a darker shade of green. 
But I am certain they will NEVER forget the smell, ever. Like I told them, not everything in medicine is pleasant.
Wed, 281107 @ 1315; post-call and suffering the beginning of a major migraine! Sigh…
Hi,
I was able to see an Infectious Disease doctor on the seventeenth. He referred me to a certified Tropical Disease doctor who specializes in these types of parasites. I will see her on April 6th. I’ve also made an appointment for the next day to see an Infectious Disease G. I. doctor. The I.D. doctor told me that one of the pictures was definitely a tapeworm and the other picture is possibly Ascaris, but since he could not examine the mouth (not having the worm present), he could not tell for sure. He also took a look at my MRI and said that the picture looked funny and it was possible that there are Ascaris in the transverse colon, and that I should print out any pictures I have and give them to the Tropical Disease doctor along with my MRI and CT discs so she can look at them. Glad to be moving forward.
I’m concerned though because I have been having, at times, increased abdominal pain, but I’m able to pass stool. The other day, however, I became very concerned when I passed out a ten inch long twisted thing that looked like my intestinal lining. There was a small piece of stool in the middle of it. Basically, the section looked like the tubing that sausage is stuffed into (like a sausage link), but approximately 1/4″ wide or slightly wider (as wide as the barrel of a ball point pen). It was shriveled with furrow lines running down the length of it. I have not done enemas, stool softeners, or anything else to be causing this to happen. I’m afraid that there is really something wrong intestinally. I think there is a stricture or partial blockage somewhere, but I’m still able to go. Don’t mean to be so graphic but I believe this is abnormal and should not be coming out of me.
I saved the thing. Put it in a clean plastic container and froze it until I can see the doctor a week from now. My mom and sister looked at it and they both said that it looked abnormal and said that I should save it, so I did. My mom wanted me to go to the hospital, but I told her that I was not in severe pain so I did not go. Although I am sickened about having to collect this stuff to prove to the doctors what has come out of me, I feel like I have no choice considering what I’ve gone through in the last year. Take care. Teresa
Thanks Teresa! The pictures are awesome! They are definitely ascaris and tape worm. I wonder why your doctor disbelieve you! I can’t really make out the worm on MRI. I must say your quilts are lovely!!! And you have lost so much weight! I hope and pray your problems will get sorted out soon. Take care and thanks for sharing.
Hey,
I created a Photobucket site. Here is the link to the pictures. http://s711.photobucket.com/albums/ww115/tarheelx4/ The picture of me sitting next to the pumpkins is a more recent one. The other picture is of me when I won my ribbon for a quilt I made and before I became really ill and lost a total of 60 pounds. There is one picture of the decomposing tapeworm that came out four days after surgery, and two pictures of roundworms that came out earlier in the spring. GI doctor wanted me to take pictures if I passed anything. This really grossed me out to have to take pictures to prove what I was passing out of me, but you do what you have to get help. Finally, there are two pictures of a CT axial cut and MRI axial cut images that show the insides of my transverse colon. On the MRI, you can see a piece of barium I think along with what appears to be Ascaris. CT scan cut of the same area also shows what appears to be Ascaris. I don’t think that these are pictures of mesenteric vessels, because there is a area of gas, so I think this is inside the colon, but I just don’t know for sure. What do you think?
Teresa
hi again teresa, a good way to share your photos would be to uoad them to free storage sites like photobucket or facebook and place the link here. that way everyone can take a look.
Hi,
I still have the photos and would be happy to share them with you. I have found that the best way to send them to anyone is by “jpeg.” That way they can be blown up and zoomed in on. If you can tell me how to post them, I would be glad. Some other history that I never understood is, when I first started having seizures, I had a high C-reactive protein, high SED rate, and a 1:160 ratio ANA. I was also having a rash type thing going on with my face and neck. Later, and more ANA’s, ELISA tests, among other tests for autoimmune disorders, my ANA went up to 1:1280 ratio. None of the other autoimmune tests were positive though. A few months after I passed the tapeworm in August 2008, I went back to my rheumatologist (December 2008)and showed her the pictures of the parasites and asked her if parasites could cause a raised ANA like I had. She said that she did not think so, but she would do some research and let me know. A few days later she called me back and told me, “Yes.”
I have read so much about Ascaris and tapeworms. A lot of research that I read was from eMedicine and Medscape, but I was also able to get into research literature from India and South America. I found that there have been cases of Ascaris where patients did not have raised eosinophils or raised amylase, lipase, or any other liver function tests, but yet, they found dead and alive ascaris outside of the intestines in the abdominal cavity without any signs of perforations/small holes in the intestines. They found one little girl who had no raised values in her blood work, yet she had 35 alive and dead ascaris in her common bile duct. Further, on KUB’s ascaris have been seen in the stomach and esophagus, and last week I read a case study on a Syrian woman who came down with meningitis and a two year old girl who also came down with meningitis. The Syrian woman survived but the two year old girl died of a brain abscess. The Syrian woman’s CSF study almost mirrored my CSF values exactly. She had 1% raised WBC, 86% Lymphocytes, and 14% Monocytes. Serum negative for antibodies to Echinococcus granulosa or cysticercosis. The antitoxoplasma immunoglobulin (Ig)-G titer was 113 IU/ml, and there was no antitoxoplasma IgM detected. The little girl had six different bacteriums in her spinal fluid that are only found in the intestine. It did not state her other values in the abstract. My first lumbar puncture/CSF showed 136 WBC, RBC 50, SEG 2, Lymphocytes 83, Monocytes 15, raised protein, normal glucose, gram stain CSF showed heavy PMN’s (don’t know what that is), no organisms found, herpes test of csf was negative. Cultures for parasites and bacteriums were negative after three days so they were thrown out. Next CSF, two nights later, showed 156 WBC, higher Lymphocytes, not sure of Monocytes — but still raised up to around the same level, and Macrophages. Cultures again were negative The case study also went on to talk about other studies where one man became ill and died of poliomyelitis due to an Ascaris larvae in the brain on the thalamus and of course studies where death occurred due to eosinophilic meningoencephalitis and as of 13 November 1997 which is when this case study was conducted, no case studies had been reported where Cerebral lesions consistent with cerebral A. lumbricoides larva migrans were seen. So, with this in mind, I do not want to state definitively, that Ascaris larvae are in my brain, nor do I want to state, that I have neurocystercercosis, but as of today, I passed out in my stool, what appears to be decomposing fragmented worms.
I know that during the lifecycle of an Ascaris roundworm, I would somehow ingest an egg or more than one egg, they hatch in my stomach/intestine, and the larvae go through the intestinal wall, up through the liver’s biliary system, into the lungs where they stay for a while, until they travel up the trachea and you swallow them down into the stomach and they go to the intestines and develop into adults. If there are males and females, they mate and the cycle begins again. What I’ve always wondered is since I had/still have colonic constipation which was almost like a blockage, and at what point, so constipated where I herniated my bowel and bladder, wouldn’t it be possible that I was shedding eggs into my intestine, but the eggs were hatching in my intestine for the most part instead of passing out of me because of the amount of blocked up stool that was adhered to the ascending colon. I know this sounds so disgusting to think that I was that blocked up. Believe me, I kept going back to my doctor and telling him that my abdomen was hurting.
Incidentally, Lab Corp did say that when you are testing for O & P, you should not take any kind of stool softeners, or do any enemas, etcetera, because for some reason it screws the test up. Further, the parasitologist told me that Ascaris eggs and D. Latum eggs are heavy and actually sink to the bottom of the O & P bottles so it is important to have a skilled Lab technician testing for these parasites.
Day before yesterday, I ran into a lady who started working at a quilt shop that I go to. It just so happened that she was a supervisor in a big Miami, Florida hospital for 25 years. The owner of the shop introduced her to me because the owner is a good friend of mine, and knew that I had meningitis and had been dealing with trying to get a proper diagnosis of a parasitic infection. The retired lab technician who also was a microbiologist said that there was no way that I had viral meningitis with macrophages in my spinal fluid. Further, she said that there are a lot of times that no bacteria grows from the cultures, but the patient still has either bacteria meningitis. She said, that there was definitely a possibility that I had parasitic meningitis and she finally said that the tests are only as good as the technician that is doing them.
Perhaps these reasons are why my tests are coming back negative.
I would also be happy to send you a picture of a King size bed quilt that I made which won two 2nd place ribbons in the state of North Carolina at two separate quilt shows. It is called “Christmas Star Flower.” As I said, just let me know how I can post the pictures.
I will try and keep fighting, I’m just exhausted. My sister arrives today and we are driving down to New Orleans to try and get help with an Infectious Disease doctor. My appointment is next Tuesday. Thank you for your help once again. It is greatly appreciated.
Here is the journal web address:
“Cerebral Manifestations of Ascaris lumbricoides”
http://mitpress.mit.edu/e-journals/JCN/articles/002/Tatter.html
Teresa
Thanks for sharing with us your story and long struggle, Teresa. The thought of neurocysticercosis did cross my mind earlier and now that I have further history from you, that makes it even more likely. I am amazed that you have passed out worms so many times and yet no one seem to take your complaint seriously.
Over here, in a tropical country and where non-Muslims take lots of pork, this diagnosis is often, surprisingly, not thought of. Our main cause of seizures here are infective causes like TB, or other bugs in immunosuppressed people, alcohol related or post-infarct or stroke; other than epilepsy.
There is an alternative to praziquantel which is albendazole, taken at higher doses over a one month period. This treatment should be given in patient rather than out patient and the patient’s neurological status be monitored carefully.
If you still have the photos you took, perhaps you might want to share it with us.
we could learn from it.
I also believe you are a fighter and I look forward to seeing one of your beautiful quilts! Cheers and God bless.
Hi,
Thank you for answering me. I found out that the number one reason for adult onset seizures is pork tapeworm. I had pork in Poland in 2001 and came back and started having seizures approximately 1 to 1 1/2 months later. Colonoscopy was negative in April 2008. Actually, this all started with me having severe hot flashes (I am 47 and in full blown menopause – hysterectomy at 28) in spring of 2007 and dropping 25 pounds in July/Aug. 2007. Fall 2007 did not have an appetite. January 2008 went fourteen days without bowel movement and when I finally did go on January 20th and cleared myself out, approximately one hour later, I started having diarrhea and a lot of dark red blood but still discernibly red blood in stools — in all probably lost half a cup of blood over three different watery stools. ER thought the blood was coming from higher up in cecum area or a little higher and was sure it was not at the rectal location. March 2008 still having problems with abdominal pain and at times pain like gallbladder attacks (no gallbladder since 1987). March CT/MRI scans shows lesion on liver 2cm. April 2008 I pass a ball of Ascaris. Approximately 8 or 9 of them tightly bound up. One of them was six inches long. Specimen taken to hospital, but I never find out if specimen is identified as Ascaris. Months later, I’m told by technician who originally received the specimen that it was lost or thrown out because only O & P testing was ordered and not Parasite Identification CPT code. In May I herniate my bowel and bladder from colonic constipation (I assume) and parasites. Next time I pass a worm I took a picture of it and it was sent to Lab Corp. Unbelievable as it seems, my GI doctor is informed that that specimen was rejected as well. Regardless of this, GI doctor puts me on Mebendazole and I start passing a whole lot of Ascaris. Over the next few months, I’m still having abdominal pain, diarrhea, constipation, black tarry stools, and massive amounts of thick mucous that is jelly like, along with what appears like decomposing worm fragments that are bile colored, along with what still appears to be decomposing worms. Since you are a doctor and were speaking about blood in stool and your experience with medical students, I’m hoping I will not gross you out. July 2008 my GI doctor puts me on Mebendazole for the third time because I’m supposed to have rectocele and cystocele repairs on August 19th 2008. Morning of surgery I do two enemas to prepare for surgery. For approximately a week before surgery I did not have any bowel movement. Saturday before surgery I completed the Mebendazole treatment that began first week of August where you take 100mg Mebendazole twice a day for three days, wait two weeks and do the same treatment over again. Anyway, when I did the two enemas, the only thing that came out were what appeared to be worms. A lot of them again, but no stool. By Friday – four days after surgery on August 22nd, my abdomen was killing me and quite frankly, felt like I was about to rupture my appendix. I called my surgeon and he gave me permission to do an enema. He told me to have my husband assist me and to be very careful. Approximately ten minutes later I went to the bathroom and I passed a mass of tangled up stuff that appeared to be a tapeworm. I took it out of the toilet with a plastic spoon and put it on a paper towel. I had a box of surgical gloves (I use them for gardening and my daughter uses them when she cleans the cat box), so I put some on along with a face mask and examined the damn thing with a magnifying glass. You could tell it was a partially decomposing tapeworm because in different areas you could still see the segmentations and you could definitely see the genital pores. My husband took a picture of it. He is a pilot and had taken medical leave to take care of me. Since this was early in the evening on a Friday night, we placed the thing into a clean plastic container with a lid and I froze it. My mistake because I was told that it could not be accepted by the hospital laboratory because freezing it messes it up. This thing set in my freezer for several weeks before I could convince anyone to look at it. By that time it looked like it had freezer burn on it. I gave the hospital lab a 4 x 6 picture of the thing when it came out of me. They said it just looked like mucous to them. I blew the picture up to an 8 x 10 picture and pointed out the genital pores and segments. I was told that they could not identify anything with a picture. I told them that they still had the specimen sitting in the freezer in the lab. All I got was that they could not help me. I persisted and actually went and spoke with the pathologist with my sister-in-law in tow. This got me no where and when I left, I was in tears. I finally sent the pictures to an animal parasitolgist. He said that I was definitely dealing with an Ascaris and some type of tapeworm. Possibly fresh water fish tape worm called D. Latum (I had had sushi approximately three times in the previous two or three years and one time I know it tasted bad so I spit it out) or pork tapeworm. When I was in a rural area of Poland in 2001 I was at a bed and breakfast with nine other women. We were served pork at several meals. We also ran out of bottled water on the last morning. We were told that the water in the pitcher on our table was bottled water — now I’m not so sure. The parasitologist also told me that D. Latum can cause B-12 deficiency and pork tapeworm can cause cystercercosis & neurocystercercosis, and Ascaris can go to your brain. Further, he said that he has even seen people who had D. Latum that really challenged their bodies and caused cystercercosis in the intestine and abdomen too. Finally, he said that if you’ve had Ascaris a long time (like years), it can become chronic where you rarely pass eggs (no positive O & P tests) and it is rare to pass tapeworm eggs because the eggs are in the segments. He also said that he has read cases about people that have had tapeworm for years and did not know it. He wanted to know where I traveled. When I told him I went to Germany, Holland, and a rural part of Poland, he explained to me about night soil being used in Poland, and a high percentage of people in the farming communities (where I was) actually have tapeworm and roundworm, and the filtration systems in their water supplies are extremely antiquated. Incidentally, I was hospitalized for three weeks at 8 years old while living in Turkey in 1969 with Salmonella. I’ve only been with my husband for the last twenty-five years. I’ve never tested positive for Tuberculosis and chest CT done last month was negative. I’ve read that people who had chronic cases of a parasite like Ascaris needed to be on a monthly single dose regimen for approximately one year. Further, I looked up Mebendazole and it states that it is a good treatment for Ascaris, and while it can help to get rid of tapeworm, it often leaves the scolex behind, therefore, Praziquantel should be used. Further, that a steroid should be used to prevent complications. I know that this is not Strongyloides (steroids should not be used if it was this parasite due to hyperinfection) because of the size of the worms that came out. I have desperately tried to get well and now my system is extremely weakened. I am scared as I said before. Like a lot of people in the U.S. facing a hard time, I’m worried that I will not get well before my husbands airline company goes bankrupt. I cannot understand why all the infectious disease departments at Duke, UNC, and Raleigh would not see me simply because I did not pass out eggs. I recently went in to see my Ob-gyn and took a glass jar in with me that had a whole lot of the decomposing worms in it. My Ob-gyn saw them and said that they looked like worms to her and if they were not worms, they were completely abnormal and should not be having that come out of me. She also is the one that said there was no way that the liver lesions I have could be focal nodular hyperplasias because I only did birth control pills for one year. Anyway, I’ve written a diary here. I guess out of shear frustration and worry. I tried to help my GI doctor help me, but he did not want to read my research. He said, that he appreciated my research and knowledge on the two parasites, but the O & P tests were negative and he gave me Mebendazole three times. He would not let me take Praziquantel because it can cause seizures and I already have seizures and activity on top of the seizures. In all my science classes, I was always told that “You cannot prove a negative.” I believe that the big picture is not being looked at with me. I never meant any disrespect by doing my own research, but when a GI doctor and GP tell you they know nothing about parasites, you start researching yourself if you want to get well. I would have never done any research if the O & P tests had come back positive and I’d taken the treatment and gotten better. This is not the case. I’m not better. I don’t think I’m HIV positive because I used to give blood and was tested for that before I could donate on a regular basis. The lesions were found on the Thalamus and in the Corona Radiata. Neurologist found another one in the White Matter and not sure if there are others. These lesions showed up quickly, and with the meningitis, and recent parasitic past history, it all just seems way to coincidental. I will take your suggestions and try and get those tests done. I’ve decided to go out of state to another hospital. Thanks again for listening to me. I used to be so happy. Used to make beautiful quilts. I barely have the strength now to cook dinner and keep up with my chores. I’m also very tired now and weak. Can’t help but be scared that I might die before everything is solved. I know that can happen but I try and remain mostly positive. My family tells me I’m a fierce fighter. At first I was, but I really am starting to give up hope. I really appreciated your help. Thank you.
Teresa
wow.. this is called a physician methology.. I like this. always can reason out well!! bravo!
Hey Teresa,
Firstly, thank for visiting my blog.
Wow! Your history seems so complicated. Let me try and sort it out with the info you have offered.
I would like to say that it is unlikely to be parasites. The Mebendazole tablets you took should have taken care of that if it is parasites infestation. Black tarry stool do smell sickly sweet. The smell is very distinctive.
The description of your stool leads me to think that it might be some inflammatory bowel disorder or even irritable bowel syndrome. Diseases like Crohn’s and Ulcerative colitis may present with bloody stool and loss of weight and also anemia. However, seizures is not a typical feature of IBD. Irritable bowel syndrome may present in either diarrhoea predominant or constipation predominant but bleeding per rectum or black tarry stool is unusual.
The seizures you have experiences is worrying. You did not specify where the lesions were on the MRI brain. The CSF findings are not suggestive of viral infection. I would rather think of chronic diseases like Tuberculous meningitis. You also mentioned a calcified nodule in the abdomen attached to the intestine. I wonder if this is a calcified TB granuloma.The significant weight loss would be in favour of this diagnosis. Also absorption may be hampered if there is TB in the terminal ileum, leading to vitamin B deficiency and cause macrocytic anemia.
I am thinking of disseminated TB affecting the intestines, brain and liver. The platelet count is still within normal limits and should not be alarming. Chronic typhoid or salmonellosis might have some of the features you have described.
I would like to suggest a few things you might want to consider.
1. Consider a colonoscopy to look for evidences of growth/infection/IBD and biospy any lesions.
2. Suggest to your doctor to screen you for TB.
3. Consider screening for HIV if there are any risk factors.
These are my 2 cents worth. Any one of my fellow medical colleagues would like to add some helpful suggestions for Teresa?
I hope you get the matter sorted out and wish you all the best.
Hi,
If dark tarry stools have been in intestine for an extremely long time due to parasite, but it still looks black, but the blood is broken down so much that stool blood test will not change color? The stool test I’m speaking about is where you smear a small amount of the black stool onto a cardboard stool test strip and if there is blood it changes color. Along with this tarry stool for the last year, I also have diarrhea frequently along with semi-normal stool that is filled with extremely thick mucous that looks like jelly. Parasitologist said I was definitely dealing with Ascaris Lumbricoides and tapeworm (don’t know what type) after he looked at pictures of what came out of me. Was in Poland in 2001 and when I came back I started having seizures (no seizure history in family). Do blood stools have a sickly sweet smell to them. Also, the dark tarry stools have fissures in them and look like ribbon (narrower on one end and little wider on other. Have not passed eggs. Did take mebendazole three separate times where you take it for three days twice a day and wait two weeks and take it again. Lost 25 pounds in one month, gastritis, abdominal pain, mild hepatomegaly, occasional abdominal pain that felt like and reminded me of gallbladder attacks (I know what they feel like because mine was removed in 1987). Also, just came out of hospital with Meningitis. First spinal tap CSF showed 136 White blood cells, 87 protein, 2 neutrophils, 56? glucose (Know glucose was normal). Second spinal tap CSF showed 156 white blood count, Monocytes & Macrophages. Was told after first spinal tap it was probably viral. After second tap, and macrophages, I cannot see how that is. Also, small lesions showed up on brain MRI, but nobody knows what they are. Further, two liver lesions 2cm and 1 cm — second one showed up seven months after first one, that may or may not be focal nodular hyperplasia or adenomas (after 5 MRI’s of abdomen). Only did birth control pills for one year. Another calcified pelvic lesion (2cm) that appears to be attached to my small intestine. It moves up and down, left and right and shows up in different pelvic areas depending on upright or supine KUB’s and how much stool I have in my intestines. KUB’s also showed colonic constipation. I am wondering if I had parasitic meningitis. Over two year period, my platelets dropped from 245 to 164. Other things look like anemia of some sort. Also, several blood tests showed low RBC’s, high white count, eosinophils, high monocytes. I am scared to death and since I did not pass eggs in my stools, was not able to get into any infectious disease departments here in North Carolina. I’m a 47 year old female with two grown kids. Does this sound like parasites to you.
Darn…weird as it sounds, I wish I was there to catch a whiff of that. It IS after all the best way to learn…
I have seen many ppl peel off the outer layer of the pau skin before they eat the pau.
Not because of “manual water spraying”, but, they feel uneasy when they think of how many hands have molested the pau b4?
Aii, medicine and food are inseparable right.
I still remember cendol and the slime, doc!
You know you’ve clocked enough clinical hours when you walk into the ward and be able to sniff out malaena!
Should let them taste as well
But hopefully not us
OMG……how can you do this to one of my favourite snack???
Actually my (deceased or is it dead-ed) grandpa (maternal side, whom I have never met) was a pau-maker and my mum told me those days, in order to add moisture to the ’skin’ of the pau, he will spray water all over the paus from his MOUTH!!!! Those days they don’t have all the plastic water sprayer we have these days. And that really turned me off eating the ’skin’ for a long time (I happen to love the ’skin’). Now I eat them, convincing myself that people now are generally (hopefully) more hygienic. Ugh!! And that’s why, a lot of people actually peel and discard the ’skin’ layer of the pau before eating. Such a waste.
No la dobbs. It was not intentional but now you have given me ideas… heh heh…
Aisay Jimbo. First it was cendol, now tau sar pau. Trying to get us to stop eating local snacks izzit?
hua,,,, so imaginative dr. eve ni.. u know My grandpa will resist tau sha pau whenever he sees one.. in his mind, he always think of tau sha pau is made of shit…:evil:
Thank God, I don’t really like tausar-bao.
*splatters tausar bao all over the screen and keyboard*..Thanks jimbo..