When Vacation Follows You Home

This week's guest columnists are Drs. Michael Johnson and Sam Defigarelli, Family Practice residents at the University Hospital and Clinics here in Lafayette. The family returns from a cruise ship holiday in the Caribbean.  Everyone, including 10 year-old Gavin, had a blast.  He loved snorkeling, going down the waterslide on the ship, and even the exotic food at ports-of-call.  But even before the bags are unpacked at home, he says "Uh-Oh!" and runs to the bathroom, just in time for the watery explosion from below. Traveler's Diarrhea is a condition that develops soon after returning from trips to resource-limited countries.  Gavin has three potential whammies in his scenario.  These countries often don't have sewage treatment, and snorkeling is a potential contact with contaminated run-off.  Cruise ships and water-parks are known risks for catching diarrhea.  And improperly prepared food could make him sick as well. The biggest concern with diarrhea is dehydration.  Most only have a day or two of loose stools, but some also have nausea, vomiting, cramps, fever, or bloody stools.  When there's lots of vomiting and diarrhea and worries about dehydration, kids should get seen. Most kids only need home treatment- plenty of clear fluids like pedialyte for infants, sports drinks or dilute juices for older kids.  Avoid full strength fruit juices- these can worsen diarrhea.  For copious diarrhea, rehydration solution packets are available at pharmacies, to mix with clean water.  If kids aren't having cramps, nausea, or vomiting, they can eat and have milk.  Bland starchy foods are best- fast food and other heavy greasy food can prolong symptoms.  We say "feed through diarrhea;" don't restrict food if they're hungry!  The sooner they eat, the sooner their guts get back in balance. You'll want to control the spread of infection to you and your family, so that you aren't cleaning up after multiple kids and feeling rotten yourself- a total nightmare!  Wash your hands frequently with soap and water- better than hand sanitizers.  Make sure kids aren't touching or drinking after each other. Prevention while traveling is even better.  Only drink from unopened bottles.  Avoid ice- it could be made with contaminated water.  Eat food served hot, and avoid salads (ingredients washed how?).  And parents, alcohol won't reliably sterilize water or ice, so avoid having your cold one on the rocks. Here is a different scenario than above. It's June, the annual family reunion picnic, with all the aunts, uncles, and cousins . The grills are going and the sides have been put out: coleslaw, potato salad, macaroni salad.  There is a lot going on: pick-up football, pets running about, tables knocked over, umbrellas and chairs being set up, conversations all around.  The hamburgers are late getting on the grill and the sides have sat in the sun.  Everyone's hungry so the burgers are a little under-done, but so what? Any dangerous situations in this story?  It' not the football- it's the mayonnaise-based sides warming in the sun, incubating bacteria like Staphylococcus.  And undercooked hamburger can contain E. coli, a potentially disastrous infection. Food poisoning is all too common in children.  Usually it's just some diarrhea for a day or two and maybe some vomiting if your unlucky.  However, food poisoning with certain bacteria can have worse consequences.  Staphylococcus (a.k.a."Staph") often has a quick onset, within hours of ingestion, and can lead to dehydration and fatigue, especially in younger children.  There are many strains of E. coli too, the worst of which can lead to Hemolytic Uremic Syndrome, a deadly disease involving kidney failure and coma. Treatment of these bacteria infections isn't just giving antibiotics.  In fact, sometimes antibiotics can make the symptoms worse.  There's no treatment besides fluids and rest, and for the really sick kids, hospitalization.  So better to prevent infections than have them! Safe food handling is paramount.  Always cook meat thoroughly, particularly ground meat.  Be careful of your meat source- meat from a single farm, ground in the store, is much safer than meat from multiple feed lots, pre-ground and packaged when it gets to the store.  Never leave mayonnaise-containing food unrefrigerated for more than one hour.  Be sure to wash vegetables and fruits thoroughly- they might be from fields fertilized with manure that contains E. coli. So be careful when you travel, and when you cook at home.  An ounce of prevention is worth several pounds of diarrhea, when vacation follows you home!   +++++++++++