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| Traveler's
Tummy - Information
and Tips |
Call
it what you will: Montezuma's Revenge, the Traveler's Trot, the
Toltec Two-Step, the runs, traveler's tummy or the commonly accepted
TD (for Traveler's Diarrhea); but don't call it fun. Symptoms
include diarrhea, stomach cramps, nausea, and vomiting. Further, it
can be dangerous, causing severe dehydration, malnutrition, and
worse. An American Medical Association study found that almost one
quarter of all visitors to Jamaica during 1996-97 suffered from TD.
Half of those were severely affected, and 6% sought a doctor's care.
Additionally, travelers noted they were "incapacitated"
for an average of 12 hours. Not the way to spend your only vacation.
Vaccine Under Consideration
A common cause of TD is the presence of E coli (as well as
salmonella) in water and food, and a vaccine against E coli is under
development. Until then, however, here are our tips for treating the
Trot if you happen to contract it.
Avoidance is the Best Policy
Jamaica isn't the worst place in the world to be; studies conclude
that fully 30-40% of travelers to high risk areas contract some form
of the ailment.
Avoiding TD is your best tactic, yet the vast majority of travelers
in the AMA study violated most of the basic tenets of TD avoidance.
95% had ice cubes in their drinks, 90% had eaten salads, over 80%
drank tap water or consumed dairy products. Less than 3% avoided all
potentially contaminated water. And then we ask why we aren't
feeling so well!
For tips on avoiding TD altogether, read our information on Drinking
Water and Food Safety.
Worldwide Risk Levels for TD
Note that in high risk areas, it may be all but impossible to avoid
some incidence of TD.
High risk: Most developing countries in Latin American, the
Middle East, Africa, and Asia
Intermediate risk: most Caribbean Islands, Southern Europe
Low risk: The United States, Canada, Northern Europe, New
Zealand, Australia, and some Caribbean Islands.
Causes of TD
A change in diet, dehydration from flying, a change in climate,
stress, and even lack of sleep can cause simple traveler's diarrhea.
Additionally, exposure to unfamiliar microbes, E coli, and
salmonella will cause identical symptoms. In most cases, TD is
easily treated, a mere inconvenience in your travels. However, more
serious ailments are possible, including dysentery, cholera,
giardiasis, and other intestinal disorders. See below for more on
these conditions.
Dehydration and TD
Many of the symptoms of TD can be caused by simple dehydration. Your
first approach should be to rehydrate; even if you have E Coli
contamination, you'll need to keep yourself hydrated since you'll be
losing fluids rapidly. Of course, you MUST use a clean water source.
See the Travel Health Online offers a
broad view of the topic or The HealthLink tips
for preventing dehydration.
Identifying TD
As outlined above, symptoms can include diarrhea, stomach cramps,
nausea, and vomiting. These symptoms can be relatively severe, but
should not persist for more than 48 hours or so, or be allowed
become so violent that the affected person is at serious risk. Even
simple TD can be life-threatening under some conditions, so always
be careful to consider medical attention if symptoms seem to worsen
or continue.
Common bacterial diarrhea usually sets in very rapidly and without
warning, and is not typically accompanied by bloody stools. Over 80%
of TD is considered bacterial diarrhea.
There are other, arguably more serious maladies that cause similar
or identical symptoms to common TD:
Dysentery - The appearance of blood or mucus in the stool is a sign
of potential dysentery; in this case, you should seek medical
advice.
Giardiasis is a somewhat more complex intestinal disorder that can
recur repeatedly for weeks after the conclusion of travel, as
giardia has a longer incubation period than most bacteria. Read more
in our Drinking Water feature.
Cholera - The appearance of severe, watery diarrhea spotted with
mucous can be indicative of cholera. Cholera is very dangerous, and
warrants immediate medical attention.
Other conditions accompanied by fever, lethargy, persistent diarrhea
lasting more than 48 hours, or severe diarrhea may require treatment
with antibiotics, and are cause for medical intervention.
Treatments (Not Always Cures)
First and foremost, you'll want to alter your diet. Staying hydrated
is first priority; drink bottled fluids, and avoid caffeinated
drinks such as soda, coffee, and tea, as well as alcoholic drinks.
The most common treatment for TD is the use of Pepto Bismol, or the
stronger Lomotil or Imodium, but understand that these products
merely relieve the symptoms, and don't actually provide a cure. In
fact, in severe cases of abdominal distress, the tendency of these
treatments to "block up" your digestive system can
actually be counterproductive or dangerous.
Note that these products may contain aspirin, and that the active
ingredient, bismuth subsalicylate, can cause a blackening of the
tongue and stools, and occasionally ringing in the ears. These side
effects disappear when treatment is discontinued.
Antibiotics should probably only be taken in fairly severe cases. A
common and effective antibiotic is Ciprofloxacin, also known as
Cipro, which is taken in 500mg doses twice daily. Norfloxacin is
another effective antibiotic. Once symptoms relent, you can
discontinue taking the antibiotic; doctors indicate that you don't
have to see the treatment through full cycle as with most
antibiotics.
These treatments are useful in the case of "bacterial
diarrhea," but not for amoebic dysentery, viruses, or food
toxins. In fact, in these cases, you can make your infection worse.
A simple rule: if there is blood in your stool, or if you have a
fever, pass on these products.
Treating Infants and Children
Travel Health Online has an excellent resource for
treating infants and children.
When to Seek Medical Attention
- If there is blood or mucus in your stool.
- If you have a fever.
- Symptoms persist for more than 48-72 hours.
- You cannot keep down light food or, especially, liquids.
For tips on locating a doctor while traveling, see our Health
Care Abroad page.
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