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January 10, 2014 1:05 PM Subscribe
i'm in delhi. pretty sure i ate something i shouldn't have. anything i can do to prevent the onslaught, or do i just await the inevitable?
at the assurance of a highly-rated tour guide, i partook of some food that, in retrospect, i wish i hadn't. this all happened about 12 hours ago. i have no symptoms of the dreaded delhi belly as of yet. the guide's trip advisor ratings are impeccable, and his general awareness of cleanliness and health seemed good and western-sensitive, so maybe my worry is for naught. but just the same - i worry. so - is there anything i can do now to ward off any unpleasantness? i have all the requisite meds - cipro, azithromycin, pepto, immodium. there is much travel in my near future - situations wherein i will not have the luxury of proximity to a (comfortable) toilet. hope me?
at the assurance of a highly-rated tour guide, i partook of some food that, in retrospect, i wish i hadn't. this all happened about 12 hours ago. i have no symptoms of the dreaded delhi belly as of yet. the guide's trip advisor ratings are impeccable, and his general awareness of cleanliness and health seemed good and western-sensitive, so maybe my worry is for naught. but just the same - i worry. so - is there anything i can do now to ward off any unpleasantness? i have all the requisite meds - cipro, azithromycin, pepto, immodium. there is much travel in my near future - situations wherein i will not have the luxury of proximity to a (comfortable) toilet. hope me?
Unsanitary food isn't going to magically make you sick if it doesn't have pathogens in it. Maybe you'll get sick, but if you're not already, it's also possible that you won't get sick. When I lived in India I became progressively laxer and laxer, eventually drinking water out of cups at restaurants (not that I advise this), and never had so much as an upset stomach. I'm not saying people don't get sick; just saying that it's not a foregone conclusion. Stressing out about it might cause something psychosomatic!
posted by threeants at 1:17 PM on January 10, 2014 [1 favorite]
posted by threeants at 1:17 PM on January 10, 2014 [1 favorite]
When I get food poisoning, it comes on fast - a few hours at most. By 12 hours, I'd feel like I had dodged a bullet. I wouldn't take any of the items you have at your disposal without having a symptom. If you don't have diarrhea, Immodium and Pepto can be very constipating and that's no good either.
It's probably not helpful now, but my favorite traveler's companion for potentially dodgy food is activated charcoal in capsules. You can take a handful of them if you suspect a problem and they do a great job of limiting food poisoning in my experience. Plus, no major side effects or constipation.
posted by quince at 1:18 PM on January 10, 2014 [4 favorites]
It's probably not helpful now, but my favorite traveler's companion for potentially dodgy food is activated charcoal in capsules. You can take a handful of them if you suspect a problem and they do a great job of limiting food poisoning in my experience. Plus, no major side effects or constipation.
posted by quince at 1:18 PM on January 10, 2014 [4 favorites]
Start drinking more water. If you do get something that gives you diarrhea at least you'll be ahead of the curve on hydration.
posted by de void at 1:18 PM on January 10, 2014 [2 favorites]
posted by de void at 1:18 PM on January 10, 2014 [2 favorites]
What was the food?
What result are you most specifically worried about?
I would personally wait for symptoms to appear rather than dosing yourself with antibiotics prophylactically. IANAD, though, and maybe someone will chime in with better advice about that.
If you are worried about having diarrhea and not being near a toilet, of course yes take immodium or something, why the hell not? It will plug you right up.
If you are worried that you will start feeling ill on a day when you need to be up and about and might not feel up to it, it couldn't hurt to know where the tylenol is in your pack, or to throw a few into your day bag just in case you find yourself sinking midday.
I don't see what pepto bismol could possibly do for you if you're asymptomatic. Also, pepto bismol is for indigestion, not contaminated food or bacterial infections. I was really glad I packed it after I accidentally drank an entire pot of Tibetan butter tea in Darjeeling, but it's not going to prevent a bacterial infection from eating contaminated food.
The best advice I would give you is that, if you feel sick, clear your day and try to just rest up, keep hydrated, and have a solid head on your shoulders about what your symptoms actually are rather than randomly dosing yourself with powerful medications for no reason.
Also, eat yogurt.
posted by Sara C. at 1:19 PM on January 10, 2014
What result are you most specifically worried about?
I would personally wait for symptoms to appear rather than dosing yourself with antibiotics prophylactically. IANAD, though, and maybe someone will chime in with better advice about that.
If you are worried about having diarrhea and not being near a toilet, of course yes take immodium or something, why the hell not? It will plug you right up.
If you are worried that you will start feeling ill on a day when you need to be up and about and might not feel up to it, it couldn't hurt to know where the tylenol is in your pack, or to throw a few into your day bag just in case you find yourself sinking midday.
I don't see what pepto bismol could possibly do for you if you're asymptomatic. Also, pepto bismol is for indigestion, not contaminated food or bacterial infections. I was really glad I packed it after I accidentally drank an entire pot of Tibetan butter tea in Darjeeling, but it's not going to prevent a bacterial infection from eating contaminated food.
The best advice I would give you is that, if you feel sick, clear your day and try to just rest up, keep hydrated, and have a solid head on your shoulders about what your symptoms actually are rather than randomly dosing yourself with powerful medications for no reason.
Also, eat yogurt.
posted by Sara C. at 1:19 PM on January 10, 2014
It's probably not helpful now, but my favorite traveler's companion for potentially dodgy food is activated charcoal in capsules.
Keep in mind, too, that India isn't the moon, and pharmacies exist. You can always go to a pharmacy, describe your symptoms, and get access to pretty much the same medication one could get in the west. You can also ask specifically for activated charcoal. Feel free to send a friend to the pharmacy on your behalf if you're not up to the walk.
The one time I got sick in India, I just went to the pharmacy and told them I was vomiting and had diarrhea. They gave me some antibiotics. It was very cheap. I took the antibiotics. The next day I was right as rain and enjoyed the rest of my stay immensely.
posted by Sara C. at 1:24 PM on January 10, 2014 [1 favorite]
Keep in mind, too, that India isn't the moon, and pharmacies exist. You can always go to a pharmacy, describe your symptoms, and get access to pretty much the same medication one could get in the west. You can also ask specifically for activated charcoal. Feel free to send a friend to the pharmacy on your behalf if you're not up to the walk.
The one time I got sick in India, I just went to the pharmacy and told them I was vomiting and had diarrhea. They gave me some antibiotics. It was very cheap. I took the antibiotics. The next day I was right as rain and enjoyed the rest of my stay immensely.
posted by Sara C. at 1:24 PM on January 10, 2014 [1 favorite]
I second taking an immodium just for shits (SEE WHAT I DID THERE HA). I am really good at talking myself into sad poops when I eat something I think might be funny, and the immodium will do a good job of heading off any extreme emergency unpleasantness, whether from the actual food or you getting worked up and stressed about it.
posted by phunniemee at 1:24 PM on January 10, 2014 [4 favorites]
posted by phunniemee at 1:24 PM on January 10, 2014 [4 favorites]
Nthing taking the immodium now if you're worried. Anxiety itself can cause stomach issues and you really have nothing to worry about from taking the immodium prophylactically.
posted by forkisbetter at 1:43 PM on January 10, 2014
posted by forkisbetter at 1:43 PM on January 10, 2014
Traveller's diarrhea is fortunately not usually very violent. When I was on fieldwork last summer every foreigner on our team (so, eight of us) got it at one point or another during the trip. Nobody was debilitated or in a lot of pain – we just had to spend an inordinate amount of time in the bathroom and make sure we drank extra fluids. It's also treatable, but I'd wait until I was showing definitive symptoms before treating.
For now, don't do anything except take it easy and drink some extra water to help keep your gut clean and happy. If you have a bout of diarrhea, take a gram of azithromycin and a dose of Immodium. You can continue taking half-gram doses once a day for the next four days if necessary, but a gram of azithro usually clears up the problem and by the time the immodium wears off you'll be back to normal. You won't poop for a couple of days, but that won't do you any harm. Don't keep taking the immodium, as you can do yourself harm (not to mention cause yourself considerable discomfort) if you take it more than occasionally.
You'll be fine, in any case. Traveller's diarrhea is not fatal to otherwise-healthy adults. It generally clears up on its own in a few days at the most, even without treatment. Worst case scenario you'll just have to make sure you're close to a toilet for a while (you carry your own toilet paper, right?) and drink extra water.
posted by Scientist at 2:04 PM on January 10, 2014
For now, don't do anything except take it easy and drink some extra water to help keep your gut clean and happy. If you have a bout of diarrhea, take a gram of azithromycin and a dose of Immodium. You can continue taking half-gram doses once a day for the next four days if necessary, but a gram of azithro usually clears up the problem and by the time the immodium wears off you'll be back to normal. You won't poop for a couple of days, but that won't do you any harm. Don't keep taking the immodium, as you can do yourself harm (not to mention cause yourself considerable discomfort) if you take it more than occasionally.
You'll be fine, in any case. Traveller's diarrhea is not fatal to otherwise-healthy adults. It generally clears up on its own in a few days at the most, even without treatment. Worst case scenario you'll just have to make sure you're close to a toilet for a while (you carry your own toilet paper, right?) and drink extra water.
posted by Scientist at 2:04 PM on January 10, 2014
Food poisoning hits fast. Think a couple of hours not 12 hours.
Just a warning, my SIL took a dose of an Imodium because everyone else in her family had the runs and she wanted make sure she didn't get it so she could take care of kidsshe didn't poop for 5 days and she said the pain was excruciating from the constipation. When she finally went to the doctors about it, they said it is best to poop these things out if you can, your body is trying to get rid of all the crap in your system for a reason. I'd suggest a half dose if you must take one without having any symptoms.
posted by wwax at 2:21 PM on January 10, 2014
Just a warning, my SIL took a dose of an Imodium because everyone else in her family had the runs and she wanted make sure she didn't get it so she could take care of kidsshe didn't poop for 5 days and she said the pain was excruciating from the constipation. When she finally went to the doctors about it, they said it is best to poop these things out if you can, your body is trying to get rid of all the crap in your system for a reason. I'd suggest a half dose if you must take one without having any symptoms.
posted by wwax at 2:21 PM on January 10, 2014
I had always been under the impression (since being treated for salmonella in college) that loperamide/Immodium and other constipation-causing medications were the absolute wrong thing to take if you didn't want to encourage additional reproduction of whatever's making you sick in the first place.
So, maybe don't do that. But generally if you're not in distress within 4-8 hours, you're safe.
posted by Lyn Never at 2:28 PM on January 10, 2014 [3 favorites]
So, maybe don't do that. But generally if you're not in distress within 4-8 hours, you're safe.
posted by Lyn Never at 2:28 PM on January 10, 2014 [3 favorites]
Yes, I concur very strongly with Lyn Never. Immodium caused me no end of horrors when I took it for what I thought was simple traveler's sickness and which turned out to be amoebic dysentery. I mean, take it if you want, I guess? But if at any point the stuff coming out of your butt is copious explosive bloody froth then stop taking it right the fuck away and go to the hospital immediately.
posted by elizardbits at 2:53 PM on January 10, 2014 [1 favorite]
posted by elizardbits at 2:53 PM on January 10, 2014 [1 favorite]
loperamide/Immodium and other constipation-causing medications were the absolute wrong thing to take if you didn't want to encourage additional reproduction of whatever's making you sick in the first place.
It's not super great, but if you know you have diarrhea and know you have a 6 hour bus ride tomorrow, it's not going to kill you.
The real thing you want to avoid is being so afraid of the symptom of diarrhea that you just take a bunch of immodium thinking that'll make the problem go away forever.
posted by Sara C. at 3:04 PM on January 10, 2014
It's not super great, but if you know you have diarrhea and know you have a 6 hour bus ride tomorrow, it's not going to kill you.
The real thing you want to avoid is being so afraid of the symptom of diarrhea that you just take a bunch of immodium thinking that'll make the problem go away forever.
posted by Sara C. at 3:04 PM on January 10, 2014
Also in most cases the real answer is just to slow the fuck down and stay at the hotel with your miserable chapped ass, rather than trying to immodium the pain away.
posted by Sara C. at 3:06 PM on January 10, 2014 [2 favorites]
posted by Sara C. at 3:06 PM on January 10, 2014 [2 favorites]
something you can be taking generally is a grapefruit-seed extract or some oil of oregano. they have really disinfectant properties. So if you're taking them on a regular basis, they can kind of clean up the crap that could cause problems later. also probiotics are helpful to keep the healthy bacteria growing in your body. all of these things are available from a health food store. (probiotics are found in non-sweetened yogurt too).
while i agree with other respondents that food poisoning is a fast-acting thing, other problems (e coli, parasites, etc etc) can brew in your gut for up to a week before making themselves known. so it's a good idea to be dosing yourself with the stuff i mentioned above, in order to avoid the unpleasantness, especially in a country your body isn't used to.
posted by andreapandrea at 3:22 PM on January 10, 2014
while i agree with other respondents that food poisoning is a fast-acting thing, other problems (e coli, parasites, etc etc) can brew in your gut for up to a week before making themselves known. so it's a good idea to be dosing yourself with the stuff i mentioned above, in order to avoid the unpleasantness, especially in a country your body isn't used to.
posted by andreapandrea at 3:22 PM on January 10, 2014
elizardbits: "But if at any point the stuff coming out of your butt is copious explosive bloody froth then stop taking it right the fuck away and go to the hospital immediately."
I think this is the kind of universally sage advice that applies in every situation, both at home and abroad.
posted by colin_l at 4:23 PM on January 10, 2014 [5 favorites]
I think this is the kind of universally sage advice that applies in every situation, both at home and abroad.
posted by colin_l at 4:23 PM on January 10, 2014 [5 favorites]
Do you have any symptoms of gastrointestinal distress right now, or of generally feeling sick, or are you just second-guessing what you ate?
I think you're free and clear after twelve hours, unless you know you have an unusually slow digestive period or something. If you haven't pooped since, your next poo may be less than ideal, but food poisoning hits fairly fast. Anything more serious like a parasite will have to wait until you can be more certain, you shouldn't take medication willy-nilly on a hunch.
posted by yasaman at 5:38 PM on January 10, 2014
I think you're free and clear after twelve hours, unless you know you have an unusually slow digestive period or something. If you haven't pooped since, your next poo may be less than ideal, but food poisoning hits fairly fast. Anything more serious like a parasite will have to wait until you can be more certain, you shouldn't take medication willy-nilly on a hunch.
posted by yasaman at 5:38 PM on January 10, 2014
Activated charcoal. Take it even if it is late.
Do not take anything which will stop the process. If it needs to come out, it needs to come out.
posted by Riverine at 6:43 PM on January 10, 2014
Do not take anything which will stop the process. If it needs to come out, it needs to come out.
posted by Riverine at 6:43 PM on January 10, 2014
IANYD. Some of the advice above is well intentioned but inaccurate.
Please see the CDC Traveler's Health page for Traveler's Diarrhea for reference. Here are a few tips:
- The only evidence-based prophylaxis for traveler's diarrhea noted is bismuth subsalicylate (Pepto Bismol). The page has the dosing if you're interested. Any medication has potential side effects that you should consider cautiously before using - you feel fine now, why mess with a good thing? Probiotics have mixed evidence but probably wouldn't hurt if you are going to be obsessing about this unless you do something.
- Antimotility agents like Imodium are generally not used prophylactically (for reasons eloquently outlined above). They can be used when you actually have symptoms of diarrhea, but are not advised to be used with bloody diarrhea or diarrhea with a fever due to concerns for prolonging the illness if you have dysentery (the CDC page doesn't mention it but it's considered OK to use Imodium in dysentery if you are concurrently using antibiotics).
Most importantly, if you take away nothing else from this discussion, note this:
"At this time, prophylactic antibiotics should not be recommended for most travelers.
Prophylactic antibiotics afford no protection against nonbacterial pathogens and can remove normally protective microflora from the bowel, rendering a traveler more susceptible to infection with resistant bacterial pathogens. Additionally, the use of antibiotics may be associated with allergic or adverse reactions in a certain percentage of travelers and may potentially contribute to drug resistance."
Don't take antibiotics, especially fluoroquinolones which have a long list of potential serious side effects from C difficile to Achilles tendon rupture, if you have no symptoms of disease. Please!
Side note: I had never heard of people using activated charcoal for infectious diarrhea before. Activated charcoal is used in cases of medication overdose with certain medications that charcoal can help clear from the system. I tried searching PubMed for "activated charcoal traveler's diarrhea" and "activated charcoal infectious diarrhea" and came up with nearly nothing, except this:
"Kaolin-pectin, fibre and activated charcoal have no place in the treatment of diarrhea and dehydration in infants and children. There is no conclusive evidence that they reduce stool losses, duration of diarrhea or stool frequency (22). Although nontoxic, disadvantages may include adsorption of nutrients, enzymes and antibiotics in the intestine as well as masking the severity of fluid loss into the intestine."
Therefore I cannot concur based on any research evidence that activated charcoal would be effective in your situation.
posted by treehorn+bunny at 9:23 AM on January 11, 2014 [4 favorites]
Please see the CDC Traveler's Health page for Traveler's Diarrhea for reference. Here are a few tips:
- The only evidence-based prophylaxis for traveler's diarrhea noted is bismuth subsalicylate (Pepto Bismol). The page has the dosing if you're interested. Any medication has potential side effects that you should consider cautiously before using - you feel fine now, why mess with a good thing? Probiotics have mixed evidence but probably wouldn't hurt if you are going to be obsessing about this unless you do something.
- Antimotility agents like Imodium are generally not used prophylactically (for reasons eloquently outlined above). They can be used when you actually have symptoms of diarrhea, but are not advised to be used with bloody diarrhea or diarrhea with a fever due to concerns for prolonging the illness if you have dysentery (the CDC page doesn't mention it but it's considered OK to use Imodium in dysentery if you are concurrently using antibiotics).
Most importantly, if you take away nothing else from this discussion, note this:
"At this time, prophylactic antibiotics should not be recommended for most travelers.
Prophylactic antibiotics afford no protection against nonbacterial pathogens and can remove normally protective microflora from the bowel, rendering a traveler more susceptible to infection with resistant bacterial pathogens. Additionally, the use of antibiotics may be associated with allergic or adverse reactions in a certain percentage of travelers and may potentially contribute to drug resistance."
Don't take antibiotics, especially fluoroquinolones which have a long list of potential serious side effects from C difficile to Achilles tendon rupture, if you have no symptoms of disease. Please!
Side note: I had never heard of people using activated charcoal for infectious diarrhea before. Activated charcoal is used in cases of medication overdose with certain medications that charcoal can help clear from the system. I tried searching PubMed for "activated charcoal traveler's diarrhea" and "activated charcoal infectious diarrhea" and came up with nearly nothing, except this:
"Kaolin-pectin, fibre and activated charcoal have no place in the treatment of diarrhea and dehydration in infants and children. There is no conclusive evidence that they reduce stool losses, duration of diarrhea or stool frequency (22). Although nontoxic, disadvantages may include adsorption of nutrients, enzymes and antibiotics in the intestine as well as masking the severity of fluid loss into the intestine."
Therefore I cannot concur based on any research evidence that activated charcoal would be effective in your situation.
posted by treehorn+bunny at 9:23 AM on January 11, 2014 [4 favorites]
Lyn Never: "I had always been under the impression (since being treated for salmonella in college) that loperamide/Immodium and other constipation-causing medications were the absolute wrong thing to take if you didn't want to encourage additional reproduction of whatever's making you sick in the first place."
This was the consensus for a long time, and it's still the received wisdom on the subject. However, it was never proven – it was always just one of those "stands to reason" bits of medical wisdom – and recent research (i.e. finally someone got around to actually checking in a rigorous way) has shown that it actually doesn't make a difference in terms of final outcome or recovery time for traveller's diarrhea, and that it's fine to go ahead and take the Immodium if you feel like it would help. At least, that is what I was told in the most recent Wilderness First Aid course I took (this was last Spring).
posted by Scientist at 8:54 AM on January 12, 2014
This was the consensus for a long time, and it's still the received wisdom on the subject. However, it was never proven – it was always just one of those "stands to reason" bits of medical wisdom – and recent research (i.e. finally someone got around to actually checking in a rigorous way) has shown that it actually doesn't make a difference in terms of final outcome or recovery time for traveller's diarrhea, and that it's fine to go ahead and take the Immodium if you feel like it would help. At least, that is what I was told in the most recent Wilderness First Aid course I took (this was last Spring).
posted by Scientist at 8:54 AM on January 12, 2014
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posted by colin_l at 1:06 PM on January 10, 2014 [1 favorite]