Larger Ascaris try to stay below the head region while their larvae can be almost anywhere. Just because you live in that region hardly protects you against them... You just reducing the risk via sanitation/hygiene some control over food and water. But you can get infected with anything in the USA from big roundworms to tapewroms and some crazy tropical staff. Ascaris is the second most common parasite infection in the world after pinworms. If albendazole fails... As it did in my case so far and many others you just shooting in the dark really. Albendazole does kill many of them but some do manage to survive be it down to med limit in circulation, amount, some worms being more resistant by nature... You name it... Piperazine or niclosamide don't really affect them that much. With the systemic tissue infection like in your and my case only albendazole can help you here. It will help but it might not cure it. At least you can keep them under control. Don't get me started about docs. They are extremely badly educated and very biased when it comes to parasite infection. So my advice for now is keep using albendazole (3-4 cycles). When you feel bad on it it's usually good because parasites suffer and die. And don't forget it's a war for your body... Your immune system see it everyday as a fight for survival with them... Try to help your body as much as you can...