DR. HOOK- Gotta run! Traveler's diarrhea ruins the fun
Pharmaceutical representatives, a.k.a. pharm reps, tend to be a bit pushy because they have only seven seconds on average to talk to a doctor. I know you can say a lot in seven seconds because I've always been a fast talker, like Charo. On the TV news at NBC29, I usually recite the disease name, pathology, clinical presentation, and treatment in the first five seconds. Whew! Thank goodness my asthma occurs only during exercise.
There are a few pharm reps I really like– so I tend to chat with them. One of my favorites got married last year and went on a fantastic honeymoon. Most newlyweds get china for gifts, but they actually went to China! I was so eager to hear about his adventures which include having a Sherpa to guide them around. So Indiana Jones!
I imagined their walking on the Great Wall of China and waiving to astronauts, eating freshly made lo mein, learning about the Dynasties (minus Blake and Crystal Carrington). I didn't imagine them hanging on death's door with travelers diarrhea (TD).
Yep, the Sherpa hit the fan when they were there. TD occurs in about 40-60 percent of travelers to "developing" countries. Classic TD is defined as three or more unformed stools (loose bowel movements) in 24 hours. Plus there has to be one of the following associated symptoms: nausea, vomiting, abdominal cramps or pains, fever, or blood in the stools.
On average, TD symptoms occur 4-14 days after arrival to the country and usually last 1-5 days. Ten percent will persist more than a week, and two percent will persist more than a month. It tends to be more of an inconvenience than harmful.
Ninety percent of cases of TD are bacterial, in particular our old friend E. coli. Parasites like Giardia are more common in St. Petersburg and mountainous waters. Cruise ships tend to harbor viruses like Norwalk virus.
E. coli lives in the colon and is transmitted by poop. (Ever read in restaurant restrooms, "Employees must wash hands"? This is to prevent transmission of E. coli and hepatitis B to dining patrons.) So believe it or not, that expression, "Don't drink the water!" when you travel is true. But the #1 way to get TD is through food.
Vendors on the street and disreputable restaurants in developing countries are a major source of TD. Unsanitized streets harbor bacteria that can get on food and into your GI system. Yum-yum becomes bum-bum.
E. coli-riddled water used to clean lettuce and raw vegetables/fruits can easily cause TD. Table condiments such as guacamole and pico de gallo in Mexico and South America are well known to be associated with TD. So in the middle of a salsa dance, the salsa might come pouring out of you.
Many people believe that alcohol will sterilize water and ice, but it doesn't. (Even gin, which can remove the paint off your car, can't). Hot tea and coffee tend to be safe, but the water needs to be boiled for at least 3-5 minutes. Carbonated water tends to be safe as well.
Overall, Imodium is safe if the victim doesn't have a high fever or blood in the stools. Imodium can prevent dehydration and allow the vacation to continue! Hydration is very important, and sugared water with electrolytes is best (like fruit juice). Cipro is probably the best antibiotic to treat TD (unless you're pregnant or a child).
Fortunately, the honeymooners who experienced Shanghai Surprise first hand, like Madonna & Sean Penn, had Cipro with them. They were sick for a few days, but they made it through the rest of their vacation.
I asked the pharm rep how he felt to be back. His response? "Pooped!"
#