Dealing with Montezuma

TD can hinder an otherwise spectacular trip.
Traveler’s diarrhea is a serious problem.

The Aztec two-step. Montezuma’s revenge. Traveler’s trots. No matter what you call it, the very words are enough to strike fear in the heart of even the most intrepid globetrotter. Traveler’s Diarrhea (TD) is the most common health-related problem encountered while traveling – and it’s no laughing matter.

TD is characterized by an increase in unformed stools (typically, four to five a day) and is often accompanied by abdominal cramps, nausea, vomiting, malaise and fever. Such symptoms are enough to spoil any vacation.

This unwelcome malady can be caused by bacteria (i.e. E. Coli, Salmonella), parasites (i.e. Giardia), viruses (i.e. Rotavirus) or fungal infections. Most often, it’s contracted by ingesting contaminated food or water. According to the Centers for Disease Control and Prevention (www.cdc.gov), the areas of highest risk for Traveler’s Diarrhea include low-income regions of Africa, Asia, Latin America and the Middle East. Areas of intermediate risk are most of the countries of southern Europe and some Caribbean islands. Low-risk destinations include northern Europe, Canada, the U.S., Australia, New Zealand and some Caribbean islands.

Preventing Montezuma’s Revenge

To best prevent Traveler’s Diarrhea, avoid raw or uncooked meat; meat that has sat at room temperature for an extended period of time; food from street vendors; raw fruits and vegetables unless they can be peeled or shelled; undercooked eggs; tap water; ice; unpasteurized milk; unsealed beverages; and ice cream (unless from reputable sources).

Safe beverages, according to the CDC, are bottled carbonated beverages, beer, wine, hot tea, hot coffee, or boiled water appropriately treated by iodine or chlorine. Water should be boiled 10 minutes. If treating with chlorine (4-6% concentration), use two drops per quart or liter and let the water stand for 20 minutes. If you do not know the concentration, use 10 drops.

If treating with iodine (4-6% concentration), use two drops per quart or liter and let stand 40 minutes (use five drops for 2%). In some countries, fish and shellfish may contain poisonous biotoxins. Check with the World Health Organization (www.who.int) before going.

Another source of possible infection is contaminated recreational water — including swimming pools that are not adequately disinfected.

Due to increased resistance to antibiotics, taking them for prophylaxis (to prevent diarrhea) is no longer recommended unless your immune system is compromised or you are severely ill.

Another form of prevention is Bismuth subsalicylate (Pepto-Bismol). Taken in an adult dosage of two 262 mg pills four times a day, it is up to 65% effective in preventing some forms of Traveler’s Diarrhea. It should not be taken for more than three weeks. The medication can turn the tongue and stool dark, cause ringing in the ears, nausea, constipation and adverse reactions in those sensitive to salicylates (the ingredient in aspirin). It can interfere with some medications, so check the label or ask a pharmacist if you are taking other medicines. It is not recommended for children under three.

Those under age 19 should not be given any medicines containing salicylates if they have a fever-causing illness such as influenza or chicken pox. Salicylates have been associated with Reye Syndrome ― a deadly disease affecting all the organs of the body, especially the liver and brain.

In general, the CDC does not recommend Bismuth subsalicylate (Pepto-Bismol) due to the many side effects and adverse reactions. Their recommendation for prevention is to avoid food and water that could possibly be contaminated.

Treating Montezuma

TD is usually short-lived. Antimotility drugs (drugs that slow down or stop diarrhea) do not treat the diarrhea, but can help with the symptoms. For treatment of uncomplicated TD, antimotility agents such as loperamide (Imodium), and diphenoxylate/atropine (Lomotil) can be used. In some incidences, these drugs may increase the symptoms of TD. Those with blood in their stools or those with a fever should not use them and treatment should be stopped if there is no improvement in 48 hours. Be sure to check the box for any contraindications. It should not be given to children under two years of age. Check with your doctor before giving it to older children.

Bismuth subsalicylate (Pepto-Bismol) mentioned above as a prophylactic can decrease the amount of loose stools and the length of illness.

Antibiotics may be needed for those with blood in the stool, fever, abdominal cramps, and nausea and vomiting. Samples of stool will help the doctor determine if the diarrhea is caused by a bacteria or parasite and what antibiotics will work to clear it up. An antibiotic cannot clear up a viral illness.

Preventing dehydration is essential. It is also helpful to replace some nutrients lost with diarrhea. Gatorade is helpful with this. Also, the World Health Organization offers packets of “oral rehydration salts” (ORS) that can be mixed with water to help replace lost nutrients. This is available in stores and pharmacies. Check the package instructions for proper preparation. Pedialyte makes an “oral electrolyte maintenance” solution for a child that comes in freezer pops or drink form.

Children and infants will dehydrate more quickly than adults and need to be watched closely for signs of dehydration, such as dry mouth, decreased or absent tears, decreased or absent urine, sunken fontanels (for infants), and weak or rapid pulse. Obtain emergency medical help if your child is showing these signs.

Call the doctor if your diarrhea lasts more than three days; if it goes away and comes back; is severe for longer than 24 hours; if there is blood or mucous in the stool; if there is severe abdominal pain; if there are signs of dehydration (increased thirst, dry mouth, decreased or absent urine, rapid or weak pulse); or if you have a fever over 101.5 F (38.5 C).

The best way to prevent TD is sensible eating and drinking habits. Remember these slogans:

– “Rule of P — Food is safe if it is peelable, packaged, purified or piping hot.”

– “Boil it. Cook it. Peel it. Or, forget it”

These simple tips can help you avoid Montezuma and enjoy your trip.

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