Travellers' diarrhoea
This is one of the most common problems holidaymakers face when travelling outside their own country.
For most folk it is just downright unpleasant and spoils days of their holiday but as a diabetic it can be really dangerous. You lose both fluids and glucose during a bout of diarrhoea and this upsets your blood glucose control and causes dehydration. Getting control back can be difficult.
For this reason no diabetic should travel abroad without carrying a broad spectrum antibiotic such as ciprofloxacin (e.g. Ciproxin) to treat diarrhoea fast.
It may not be possible to find medical treatment easily if you are in the rural area of an under developed country.
The usual causes of travellers’ diarrhoea are:-
1. Contaminated food and drink
2. Food that has gone off
3. Toxins
For a fascinating and very detailed, if slightly perturbing, insight into travellers' diarrhoea go to ciwec-clinic.com
Do I have travellers' diarrhoea?
Medically it is agreed that the passing of more than 3 loose stools in 24 hours constitutes travellers' diarrhoea. However if you have fever, vomiting and abdominal pain with a lesser number of lose stools then the diagnosis of travellers' diarrhoea must still be considered.
Sensible precautions should help you avoid travellers’ diarrhea.
The simple instruction is given in an old saying that still holds good - “Cook it, boil it, peel it, - or leave it!”
More complex instruction are those following:-
Wash your hands frequently and dry them well using air or a clean paper towel. Always, always do this before putting anything, even a sweet, in your mouth.
Pay special attention if you bite your nails! On that note - Antiseptic wipes are a good thing to carry with you.
You may be fastidious but what about the person who shakes your hand when greeting you or concluding a sale, or the person who gives you change. What do you know of their hygiene habits?
If there is any doubt as to the purity of the water do not drink tap water or use ice cubes – stick to bottled water from a sealed bottle. This is the best one can do but even that is not 100% safe as one has no control over the quality control in the country of origin.
Canned fizzy drinks like cola are safe because the act of adding the fizz, carbonation, lowers the pH and makes them too acidic for the harmful bacteria.
Any beverage made with boiled water is alright but make sure the milk going into it has been pasteurised.
If sanitary conditions are suspect then avoid dairy produce such as milk, cream, soft cheese, ice cream, any sauce made with these products,
Do not eat salads. Not only may they have been washed in dodgy water but in some countries farmers use human excrement as cheap fertiliser on crops and this can pass on harmful human bacteria to the folk eating those crops.
Never eat cooked food that has been allowed to go cold – buffets are a problem area here.
Especially avoid any dish containing cooked rice that has been allowed to cool. It can harbour a bacterial toxin which is not destroyed by reheating.
Eat only foods that are served ‘piping hot’. Fortunately most of the bacteria that cause diarrhoea are destroyed, or at least inactivated, at temperatures above 140deg F (65deg C).
Do not eat fruits that you have not washed and peeled yourself.
Under no circumstances buy and eat food from roadside vendors.
Beware of eating in ‘local’ restaurants. If you really want ‘go local’ then ask to see the kitchen. Make sure it is free of flies and other creepy crawlies, there is no old food sitting around in pots and the chef and servers appear clean and disease free. If they will not grant you this request do not eat there.
Remember that even if their hygiene is good strange exotic foods that you are not used to may still cause stomach upsets, but this will not be as severe as bacterial diarrhea.
Tempting though it may be avoid products from ‘home distilleries’. Although little thrives in liquid with a high alcohol content some products may have been watered down with unsafe water or other unsavoury fluids. Then there is the dastardly affect some of these raw alcohol’s can have!
Treatment.
Antibiotic treatment is not recommended for most travellers but because of the danger of diarrhoea to diabetics it is for us.
A good idea is to take an antibiotic, like ciprofloxacin, as soon as possible. This is a prescription drug so if you do not have it with you, you will need to find a doctor. It may be a good idea to get a prescription from your doctor before leaving home, ‘just in case’.
Bacterial diarrhoea usually comes on rapidly while other forms have a slower onset.
If the symptoms are gone in around 24 hours after taking the antibiotic then the cause was probably bacterial.
Usually cases will go away on their own in a week or so but there are things you can do to help. Basically you treat the symptoms.
Anti-diarrhoea drugs such as Imodium or Lomotil may be of help, (to adults only, they should never be given to children) but they can also cause harmful side effects so should not be used without a doctor’s agreement, and never if you have a fever or bloody stools.
Drink plenty of fluids. You will be loosing fluids fast and need to replace them. You will be amazed at just how much fluid you can lose with diarrhoea and this is made worse if you are also vomiting. You may need to drink 4-5 litres a day!
The best drinks are bottled water, diluted fruit juice if from a safe source, cola, thin soups or hot Bovril. The latter two have the added advantage of replacing salts.
If you have planned ahead it is possible that your first aid kit contains some form of rehydration powder such as Dioralyte or Electolade, which is perfect for getting your electrolyte balance right again and for re-hydrating you.
These are particularly helpful for small children, older people and folk, like us, with added complications.
A ‘home remedy’ rehydration fluid can also be made up by mixing a litre of water with half a teaspoon of salt (do not use more than this as to much salt will just increase your dehydration) and six teaspoons of sugar or honey. I know the thought of all that sugar is making you twitch but dehydration and electrolyte imbalance is just as dangerous at the moment. Remember to keep monitoring your Bg’s.
Once you start looking for solid food consider bland foods such as dry toast, biscuits, cereals, rice, bananas and roast or grilled chicken.
If you are ‘low carbing’ this can be difficult but remember you need to get some food into you to get well again. The best advice is to eat what appeals to you at the time.
Avoid spicy food, alcohol, and coffee.
Take plenty of rest until you are feeling well again.
Diarrhoea or dysentery?
You will see both these terms used. There is no clear cut distinction but when stools contain pus, mucous and blood it is usually due to some organism invading the wall of the intestine. If these show up then the name dysentery is often used in place of diarrhoea.
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