DEAR DR. ROACH: In 2008, out of nowhere, I had a severe chill and a temperature of 103 F, while feeling very ill. I was admitted to the hospital, where I was found to have E. coli in the blood. Antibiotics cleared it up, and I was sent home. About a week later, the same thing happened. After several weeks of this, they tried to find out what was causing it. They removed my gallbladder and a piece of my bowel, but never found the source of the infection. I was sent home on antibiotics, and have been on them ever since. Have you ever heard of this? — R.S.

ANSWER: I have seen people with recurrent bacterial infections of the blood, but seven years of antibiotic treatment without finding a source is beyond the scope of my experience. There must be a source somewhere, and the places I have seen were foreign materials in the body (especially vascular grafts or plastic catheters) and abscesses, which are walled-off pockets of infection. E. coli is a bacteria that normally lives in the bowel, so I would be concerned about a bowel abscess, such as a diverticular abscess, coming from a small outpunching in the wall of the colon.

I am sure your doctors looked for the source carefully, but I don’t understand keeping you on antibiotics all this time. On the one hand, I see the “if it isn’t broken, don’t fix it” mentality, but long-term antibiotics can cause harm. I suggest you see an infectious disease specialist, who may take you off the antibiotics and do a sophisticated test, like an indium scan, to find areas in the body where white blood cells are congregated in large numbers.

DEAR DR. ROACH: My mother lives in Florida and has had problems with fatigue and low energy. I have asked her doctor to please give her vitamin B-12 injections, even though her B-12, thyroid, vitamin D, and complete blood count are all in the normal range. Her doctor does not believe in B-12 injections. Do you have an opinion? — L.I.

ANSWER: Trying to find a cause of fatigue and low energy is very difficult, sometimes impossible. Her doctor looked for many of the most common causes. There literally are hundreds of others, but rather than ordering many low-yield blood tests, I think she may need a fresh look, including a whole new history and a complete physical examination. There have been many times in my own practice when I am unable to figure things out and just decide to take a fresh look from the beginning.

As far as B-12 injections go, I agree with her doctor. If she doesn’t have a B-12 deficiency, then a B-12 shot is unnecessary. It may cause a benefit due to the placebo response, but as shown in another column this week, even a B-12 shot can, rarely, cause some side effects.

In my experience, the most common cause of fatigue in someone in whom a careful history, physical exam and appropriate laboratory studies have failed to reveal a cause is depression. Depression, especially in the elderly, sometimes shows up as fatigue and fairly mild other symptoms. There are effective treatments, both with and without medication.

READERS: The booklet on hepatitis explains the three different kinds. Readers can obtain a copy by writing: Dr. Roach Book No. 503, 628 Virginia Dr., Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.


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