AOPA Pilot Magazine - August 2011 - 34

FLYWELL

BY DR. JONATHAN M. SACKIER

The beast with many names

ontezuma’s Revenge is a politically incorrect phrase, but (a) nothing political is correct and (b) you immediately know what I mean:

family member gets sick and others do not, dietary indiscretions are responsible for much of the grief TD causes. Avoid the water and eating partial or totally uncooked foods, or those potentially washed in contaminated water such as salads or soft fruits. If you have chronic heartburn (see “Fly Well: Heartburn and the Art of Aircraft Maintenance” AOPA Pilot, March 2011) and use daily “PPI” drugs such as omeprazole; TD may be more likely as these medicines reduce stomach secretion. Roman Runs, Caribbean Calypso, Traveler’s DiarDiagnosis is usually fairly straight-forward and rhea (TD). Leaving America, aboard your aircraft other than symptoms and a clinical examination, Dr. Jonathan M. or the airlines, you are not alone. Inside your belly stool samples may be checked by the lab to identify Sackier is a native are gazillions of friendly bugs who call your colon the responsible organism or to have a peek for paraof London now “home.” As one of 100,000,000 people trekking to sites or their eggs under the microscope. living in Virginia. warm, lesser developed climates your gut is exposed The likely course is 24 hours of abject misery and to new bacteria and other organisms, hostile invada ruined trip; rest is key, maintaining hydration with ers helping Montezuma exert his wicked revenge. TD is where an electrolyte solution. If you cannot retain liquid, seek medione passes at least three unformed stools/day indicating the cal attention to provide intravenous fluids, especially in a hot intestines now host the Symptom Superbowl—nausea, vomit- climate where dehydration can set in earlier. One dangerous ing, fever, and cramps. sequel is called “Hemolytic Uremic Syndrome” where kidney The most common culprits have fancy Latin names; E.coli damage can even be fatal. If not making a rapid recovery, get (frequently induces food-borne illness), Shigella, Salmonella, to a doctor. The use of antibiotics to suppress an attack still and Campylobacter. Norovirus causing 80 percent of “cruise ship provokes controversy and these drugs are also sometimes preTD,” is nasty and also afflicts those on long flights. If one passen- scribed to head off TD at the pass. The most commonly used ger makes frequent, green-faced restroom visits, use a different are fluoroquinolone (ciprofloxacin or levofloxacin), rifamaxin loo, as using contaminated toilets may lead to infection. (Xifaxan), and azithromycin (Zithromax). Various medicines About 40 to 50 million suffer TD consequences every year, reduce diarrhea episodes, such as loperamide or, when travelmore commonly in tropical or semi-tropical locales such as ing outside the United States, kaolin and morphine, which also Haiti, Dominican Republic, southern Asia, and Africa, and more address the pain. If TD is accompanied by fever or blood in the so during rainy season. Other Caribbean islands and China and stool, do not take such meds as they increase how long the bugs Russia carry a 15-percent risk. Given that the problem is caused are in contact with the gut. Chronic complications are rare but include persistent diarby unfamiliar bacteria entering your body, folks traveling to the United States from high-risk zones can also succumb to the rhea, bloating, constipation, and pain. Younger women are Washington Waltz or Tampa Tango (as a Haitian may call it). especially prone to develop irritable bowel syndrome, affecting Industrialized westerners are exposed journeying to lesser- five to 10 percent of patients, more likely if TD was characterized developed zones, but even visiting posh western European by fever or weight loss and a history of depression or anxiety. countries can induce TD if your gut meets new bugs. ReturnBefore traveling overseas, speak to your doctor or local travel ing to remote locales might protect you from a second episode. clinic and discuss your risk factors. Decide what you will eat and Youngsters suffer greater risk because of their more frag- drink and stick to it. Consider whether you are a candidate for ile physiology and because they like to pop things into their prophylactic antibiotics and also look into other options; bismouths. Adolescents, with their huge appetites, failure to take muth subsalicylate is quite effective and some swear by herbal advice, no sense remedies like probiotics (Lactobacillus GG and Saccharomyces o f m o r t a l i t y, boulardii) or eating oodles of “live” yogurt. The recommendaand willingness tion to only consume alcohol, while good for a giggle, is not to try “street sensible. Alcohol induces dehydration, and chronic inebriation AOPA Aviation Summit food” are also at is not wise, especially for pilots. Join Dr. Jonathan M. Sackier at AOPA Aviaincreased risk. Maybe because I am interested in the bowels, am English, or Although there just plain odd, I will provide a prize to the person who comes tion Summit, September 22 through 24, in are genetic risk up with the best TD epithet I have not heard! Hartford, Connecticut, for health-related factors explaindiscussions. www.aopa.org/summit ing why one Email the author at jonathan.sackier@aopa.org. 34 • AUGUST 2011

AOPA PILOT •

http://www.aopa.org/summit

AOPA Pilot Magazine - August 2011

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