Genova stool test says: STILL no growth of Lactobacillus

[gigismom]

DS (age 3) had Genova stool testing a few months ago that showed that he had no growth of Lactobacillus and instead had an infection of Klebsiella (bad bacteria) and a fungus that I can not remember the name of right now.  We have been on the GAPS diet for the past many months though we have had occasional minor slip ups.  He is also IgE allergic to eggs, soy, nuts, and fish so avoid those as well as all the GAPS restrictions.  This has not been easy. He takes digestive enzymes, viracen (to kill the bad bacteria), fCLO, HLC Pharmax Probiotics (mindlinx), vit D, mag.  He has been on the probiotic for many months and takes 1/2 capsule in the morning and 1/2 in the evening.  Anyway, he is really MUCH better...bowells are better, behaviour and sleep are better, eczema gone, growing and talking and all those great things. He does not react to herbs and spices and chocolate anymore.  We did another follow up stool test and just got the results yesterday.  The bad bugs are gone but still no growth of Lactobacillus and the Bifido are too low.  I am so disheartened by this.  I was hoping to be able to add in some food like quinoa or buckwheat or something.  We are tired of eating like this.  (FYI I am nursing him so I stay on his diet strictly and my girls each have some gut dysfunction and food intolerance and so are following much of the same path also).  I realize this is progress but why NO GROWTH of lactobacillus?  Should we try another probiotic?  I really want it to be dairy free and he can not tolerate FOS/inulin/chicory root. I know this is a long term commitment and that change is slow in the gut.  We started this path 18 months ago and have been on the current plan for almost a year.  Shouldn't we be seeing more change by now?  Any ideas for what to change in our approach to help the good bacteria stick around? Also, he has a terrible problem of with holding bowell movements which complicates all of this as I try to sort out what is caused by what.  Any ideas of how to convince him it is ok to poop?  His bowell movements are always soft and only maybe 2x in his life have been hard enough to be painful.   thanks so much...

jen

[sbgrace]

Well, if he's taking viracen regularly (am I reading that right?) to kill off those bad guys it is killing off all the bacteria each time (so the good guys like lactobacillis too). Am I understanding properly that he continues to take that or was it a treatment you've since stopped?

Some probiotics just don't survive digestion. I'm not sure if the ones you are using have research to show they do or not?

He's withholding despite experiencing no pain? Does he get constipated with that witholding?

[gigismom]

Yes he is taking the viracen every day and continues to do so until the MD gets back to us.  Yesterday we saw the physician's assistant because his MD is out on maternity leave.  I asked her that same question (doesn't the viracen also kill the good bacteria?)  she was not very committal in her answer and stated she would discuss this with the MD when she consulted with her as she does each day about each patient she sees.  The Pharmax probiotics are supposed to be very strong and survive digestion very well.  This is one of the reasons we chose them.  He does with hold and has had slow transit constipation his entire life (that is why we are on this path).  He had stopped with holding for a number of months but is back to that now.  We all had the flu a few weeks ago and his supps got a bit messed up and he had 1 hard bowell movement and I think this set him back into the old pattern.  His MD has suggested neurofeedback to treat this behavioural component but I have not had time to research this yet and the treatments (of which he may need many) are $90 each. He will hold his poop for a number of days until finally he can not hold it anymore.  It is not hard (consistency) though, I think, because of the mag and the prune juice he takes daily.  thanks for any input...

jen

[sbgrace]

Ok. That's a clearer picture to me. If the viracen kills bad bacteria it kills the good too. Occasionally you see a claim that natural antibioitcs spare beneficial but there is no scientific sense to that imo and I've never had a knowledgeable doctor or person make that claim. So if the stuff works it's killing your probiotics.
He still needs them though so bad guys don't come back and take hold--just do the probiotics at least 3 hours after the viracen each and every time (some say half way between doses) and realize you are killing them off with every single dose and so won't see them in your cultures. Hopefully the viracen is not permanent (I'd question a lot if the doctor intended it to be...) I'd expect to see the probiotics live once I stopped the viracen.

The withholding does sound fear based then. Everyone I've known with that issue goes with the use this substance (often miralax or, if natural, a magnesium based I'd assume) so loose they can't hold it anymore type things until the fear goes away. Biofeedback, if effective, sounds better to me if you can swing it. That's a hard situation.

[gigismom]

actually that is exactly what I thought and the reason I questioned her.  She said something like the mechanism of breaking the cell wall or something.... for the reason the good bacteria should be spared.  She did say she wasn't sure and would talk to the doctor about it.  It did not make sense to me.  I know the viracen is something that will be stopped and maybe that will be a change she suggests after the PA and doctor talk together.  I hope so because he really hates taking it.  We do give the probiotic 3 hours after the viracen and that was what his doctor had recommended.  Thanks for your input.   As for the with holding... he has the strongest sphincter I've ever encountered!  He can hold it even if the poop is super runny.  In fact, I think he tries harder when it is runny because he hates the feeling.  He is not potty trained as I have not wanted to add a power battle into this already difficult problem.  However, some friends irl feel that if we established a regular routine around sitting on the potty chair and trying to poop at around the time he generally gets the urge to go (which is generally in the evenings) every day he will eventually develop a more normal bowell pattern.  This sounds great except he will not even sit on the potty chair with his pants and diaper on much less naked.  He gets frantic if I try to gently encourage him to sit on it even clothed so I do not push it.  I feel like I am experienced mother and have confidence in my choices about many somewhat non-mainstream parenting practices I have adopted over the past 11 years of motherhood.  But, this one has me stumped.  I really don't know what to do, if anything. 

[sbgrace]

I couldn't get one of mine to even consider sitting on the potty to poop either. My dad babysat one time and he got him to go on the potty and my problem was solved. I have no idea why he was willing to do this for grandpa and so resistant with his daddy and I (as in fearful resistant). I don't know how you get past that. Does he have something he would absolutely love that he could do on the potty each evening (a video or something?) The baby step goals could be just to sit there to get his whatever and make it fun and exciting...then in diaper....then just sit without clothes, finally it's ok to let out a bit of poop and we'll have a party...that sort of thing?

One of mine (different kid) trained only by being naked all the time he was awake. Your son might hold until he gets ready for bed in that case though. If he's pee trained (is he pee trained for sleep too)? I'd consider trying pants free completely at some point.

[gigismom]

I like the idea of baby step goals.  He is not potty trained for pee either (also because he so forcefully refuses to sit there long enough).  I know every kid is different but my girlshad such an easy time learning to use the potty at much younger than he is now.  Because of his but problems I have been reluctant to press the issue but we may try to gentle encourage him in that direction.  thanks again for your input.  I am hoping to hear back from the PA today and am interested in hearing what she has to say.  I have to say that I was not very impressed with her though I absolutely LOVE his doctor.  I think I will reshedule the next follow up until after she returns from maternity leave

jen

[gigismom]

so I heard back from the PA... I am more and more not impressed with her.  She said she spoke to the doctor and that the doctor said to stop the viracen and digest gold (but she actually said sygest gold... sygest is the name of another supp that she had recommended yesterday so I am not sure what she actually meant).  I can definitely see stopping the viracen but the digest gold?!  I wonder what the reasoning behind this is?  She said that the doctor had agreed with her recommendations of starting a few other homeopathic remedies.  One of them is Notatum and the other is the Sygest (which is a cream to rub on his abdomen that she says promotes gut healing).  The box of the Notatum says it is "for the relief of cold symptoms, earaches, bacterial infections, and respiratory infections."  Doesn't sound like gut dysbiosis to me.  She also said the doctor would like to start another supp that I am not sure how to spell because she said it so fast on the message sy-d-tech-tox (??)  something for detox I think.  Sigh... I can't wait to see the actual doctor again because I really want to understand why he needs this stuff.  He has been so reactive to various supplements and I believe that the least amount of supps the better (for us anyway).  I told them to have her call my cell and she called my home number and of course I wasn't home when she called and now the office is closed.  Sigh...

[sbgrace]

Hmmm...what was genova showing with your last culture outside of the lack of good bacteria?

[gigismom]

I have been searching my house all morning and can not find my copy of the most recent Genova results (those that I got this week).  So here's what I have and can remember

April of 2010:

Beneficial Bacteria:

lactobacillus....NG

E. Coli....4+

Bifido...4+

Additional Bacteria:

alpha haemolytic streptococcus (non pathogenic)...4+

gamma haemolytic stroptococcus (non pathogenic)....4+

Klebsiella (possibly pathogenic)....4+

Steptococcus agalactiae gp B (non pathogenic)...3+

Mycology

rhodotorula species (non pathogenic)...1+

January 2011:

Beneficial Bacteria:

lactobacillus...NG

E coli....4+

Bifido....3+

From what I can remember there were no other bacteria listed and nothing under mycology.  I will call on Monday to get another copy of the test results if I don't find it before then.

I have decided at this point that I am going to stop the viracen as I also feel that this has to be at least partially responsible for the no growth on the lactobacillus.  It is great that we got rid of the bad bugs but now we need to allow the good ones to grow too.  As much as I want to add in some grains, I don't think this is the best time.  I feel like his flora is so delicate and very easily we could swing back into an overpopulation of bad bacteria by feeding them the wrong carbs.  If I ever have more than 2 minutes of uninterrupted computer time I need to find out where in the colon the lactobacillus live and where the bifido live.  Seems like where ever the bifido are living might be healthier as they were able to stick around even despite the viracen.  Seems like we are making progress but the gut lining is not healthy enough to allow the lactobacillus to stick.  In the meantime, he tried so hard yesterday to hold the poop.  He was fussy and difficult and uncomfortable for an hour or so trying not to go.  Finally, I gave him a liquid suppository and he had a soft but large volume bm within 30 seconds.  I hate giving him these.  I know that eventually he would have gone if I had let him be.  He was so fussy and miserable.  This causes so much stress for rest of the family as they watch him suffer.  I don't know if doing the suppository is the right move or not but at least it gets it over with.  Immediately after he went, he was happy and comfortable and playing independently again.  I tried to connect this good feeling with having pooped but he just gets upset if I even talk about it. 

jen

[gigismom]

FOUND IT!!

I was correct with the numbers above for the beneficial bacteria

Additional Bacteria:

alpha haemolytic streptococcus (non pathogenic)...3+

gamma haemolytic streptococcus (non pathogenic)...3+

Mycology

No growth

so yes, no pathogenic bacteria and no fungus now

[sbgrace]

Ok. I don't see why you're still killing things then. I think you may want to up your good bacteria intake for a while depending on how much you're taking. When I stop the "killing" things I often follow up with one of the big take over bacterias for a while (like culturelle). I guess because I feel it gives us more of a healthy type blank slate to start adding in the populating types. So I'd over-do the good bacteria right now as you make the transition to not killing stuff.

[gigismom]

thank you for walking through this with me.   I agree and have increased his probiotic as of yesterday.  We will see how it goes.  I am definitely going to cancel our upcoming appt with the PA and wait until his doctor comes off of maternity leave to follow up again.   I guess we will have to do another genova test at some point.  thanks again for your input.