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!

 

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Screamin’ Down The Road- Traveling With Children

On January 13, 1982, Air Florida Flight 90 crashed into the icy Potomac River in Washington during take-off.  Joe Stiley, one of the few survivors, saw the crash coming, seeing out his window how the plane was falling to the river.  He tucked into the “brace” position and told his secretary sitting next to him to do the same.  The plane crashed into a bridge and then into the Potomac.  Joe blacked out and awoke with the cabin full of water. He methodically unbuckled his seat belt, undid his secretary’s, and they swam to the exit and to the surface.  Joe was one of the few people who bothered to read the safety card every time he flew, note his nearest exit, and count how many seat rows to that exit.

In disasters like these, surviving comes down to following safety instructions to the letter, immediately.  When you are flying, read that safety card every time.  Look up and find where your exits are.  Read how to open the emergency doors.  If the oxygen masks come down, put yours on first so you don’t black out before you can get your child’s on. Leave your luggage behind- trying to take it with you slows down everyone else’s exit.

However, don’t be put off from air travel.  My family and I love to fly and it is as safe as sitting in your bedroom.  Disasters like above are very rare.  In fact, the most dangerous part of any flying trip is the car ride to the airport.  Most of us drive more when traveling with our families and cars are much, much more dangerous than airliners.

So wear those seatbelts and buckle your kids into car seats properly.  Check your tires before long car trips.  And here are a few tips to keep your kids happier so they don’t distract from your driving.  Let them drink only water.  If kids drink soda or juice, they will have to take more bathroom stops.  With water, they only drink if they are truly thirsty. Have snacks and entertainment for them- DVDs, games, books.  On long drives my family loves books on tape.  We so enjoyed Harry Potter that even after an 8 hour car ride, we would sit in the driveway at home just to hear the end of a chapter.

Hotels are another safety and comfort consideration.  At 5am one morning in a hotel in Mobile, the fire alarm went off.  Being well trained by their Emergency Dad, my family popped immediately out of bed and headed for the exit.  In fact Mr. Prepared was the last out, having a little trouble getting my shoes on.  We were all the way down the stairs before all-clear was called.  On our way back up, we were surprised how few other guests had even peaked out to see what was going on.  In a real fire, I sure like my family’s chances better than theirs.

In her book The Unthinkable, Amanda Ripley shows how people survive disasters.  In airplanes it means following your safety card like Joe Stiley above.  In hotels it means practicing finding your exit, crawling on your hands and knees under smoke. Count the doors to the stairwell.  Go down the stairs- it’s fun to pop out and find yourself in some forgotten alley and make your way back.  Don’t stay above the fourth floor- that’s as high as Fire Department ladders reach, in case fire traps you in your room.

Again, keeping your kids comfortable in hotels makes traveling more fun.  Use that hotel pool!  Exercise after sitting in a car all day will help them sleep.  Keep your usual routines- eat together, read bedtime stories, be calm and unfrustrated.  Bring comfort medicines- ibuprofen or tylenol for aches, cough drops for dry throats in dry hotel air.  Searching for a pharmacy at 11pm in an unfamiliar town is a real drag!

So when traveling, be prepared.  Review and follow all safety tips.  Buckle up.  And don’t forget your bathing suits!