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Traveler’s Diarrhea: The Basics

This is a guest post by Dr. Erik McLaughlin.


Traveler’s Diarrhea: The Basics

Known around the world by many names including “Montezuma’s revenge,” “Delhi belly” and “mummy tummy,” traveler’s diarrhea (TD) is the most common illness faced by travelers. Nothing can slow down a fun trip as easily as TD — and it can also have serious health implications. TD typically lasts four to six days, and 90 percent of cases occur within the first two weeks of travel.

Anatomy You Need to Know

The gastrointestinal tract starts at the mouth and ends at the anus. After food enters the mouth, it passes through the esophagus to the stomach, where it sits for approximately 45 minutes. After being broken down by gastric secretions, food matter enters the small intestine (duodenum, jejunum, and ileum in order). The small intestine is the site where most nutrients are absorbed by the body. From the small intestine, food matter begins to look more like feces as it progresses to the large intestine or colon. The colon absorbs water from the food material before the material passes through the anus and exits the body as feces.


Recognizing the warning signs of TD, such as blood in the stool, fever, or abdominal cramping, can help a savvy traveler know when to seek medical help.

TD has many definitions; the presence of three or more loose-formed stools in one day is a good one. Abdominal cramping, nausea, vomiting and fever may also occur. The presence of blood in the stool can indicate that infection has directly damaged the intestinal wall and should be taken seriously. Read more »

This post, Traveler’s Diarrhea: The Basics, was originally published on by Paul Auerbach, M.D..

Drug Safety In Preventing Acute Mountain Sickness

This is a guest post by Dr. Jeremy Windsor.


Steroids and Acute Mountain Sickness

In recent years, many attempts have been made to identify safe and effective medications to prevent acute mountain sickness (AMS). Acetazolamide (Diamox), currently the “drug of choice” for this purpose, is not perfect and occasionally causes objectionable side effects. Dexamethasone (Decadron), a powerful steroid medication, has become increasingly popular for prevention and treatment in certain circles. While there is ample evidence to suggest that dexamethasone is effective, a recent case report highlights that this drug is not without risk.

In the latest issue of the journal Wilderness & Environmental Medicine [WEM 21(4):345-348, 2010] in an article entitled ”Complications of steroid use on Mt. Everest,” Bishnu Subedi and colleagues working for the Himalayan Rescue Association (HRA) described the case of a 27 year-old man who was prescribed a course of three drugs, including dexamethasone, intended to support him during his attempt to climb Mt. Everest. After more than three weeks of taking the medications, the mountaineer noticed the appearance of a rash and decided to stop taking them. Rather than wait for the rash to subside, he chose to continue his acclimatization program and ascend to Camp 3 at 7010m altitude. The patient arrived exhausted and confused; onlookers quickly recognized that something was seriously wrong and so a rescue party was organized to help him back to safety. Read more »

This post, Drug Safety In Preventing Acute Mountain Sickness, was originally published on by Paul Auerbach, M.D..

Book Review: Heading Outdoors Eventually Leads Within

Heading Outdoors Eventually Leads Within” is a small book written by Kathy and Craig Copeland and published through their company, Here’s a summary from the website:

Everyone walks. What distinguishes hikers is that walking does more than transport us, it transforms us. But nowhere is the thoughtful undercurrent of hiking celebrated. The wisdom we glean from the wilds is a match lit in the rain. That’s why we created this book: to cup our hands around the flame. These journal entries are the mental waypoints we recorded while hiking 30,000 miles / 48,280 km (more than the circumference of the Earth) through wildlands worldwide. Accompanying them are photos of the places (primarily the Canadian Rockies, Utah canyon country, and New Zealand) where we conceived and noted the initial ideas. We hope our words and images compel you to recognize, voice, own and honour the thoughts arising from within while heading outdoors. Doing so will deepen your fulfillment. A truly adventurous life is contemplative as well as vigourous.

It is important for me to state at the outset that my opinions, like those expressed in most book reviews, are highly personal. What I write about “Heading Outdoors Eventually Leads Within” are my impressions, and you may not agree with them. I am beginning with this comment because I truly had mixed feelings about the book. There were parts that seemed right on target, for me personally, and parts that seemed to miss the mark. I am certain that the authors have great pride in their work, and they are to be congratulated for their efforts. Read more »

This post, Book Review: Heading Outdoors Eventually Leads Within, was originally published on by Paul Auerbach, M.D..

Obesity, Smoking And Life Expectancy

When we think of people who enjoy the outdoors, the images in our minds are often of healthy and vibrant individuals — stereotypes are young athletes engaged in vigorous activities like climbing, biking, skiing, etc.

Of course, going outdoors is for everyone, and persons may be young or old, active or sedentary, and healthy or infirm. We carry our personal health status with us wherever we go, and the health habits we pursue in our daily lives form the framework for our participation in adventures, recreation and other outdoor activities.

Therefore, public health issues are important, be they adherence to precautions to avoid infectious diseases or lifestyle modifications to maintain optimal physical and mental health. Read more »

This post, Obesity, Smoking And Life Expectancy, was originally published on by Paul Auerbach, M.D..

StingMate: A New Treatment For Jellyfish Stings

As many of you know, I serve as a medical advisor to the Diver’s Alert Network (DAN) regarding incidents involving hazardous marine animals. This includes jellyfish (and related animals) stings.

I’m always on the lookout for new therapies or modifications of existing therapies to treat marine stings (envenomations). At a recent gathering of Beneath the Sea, I was introduced to Smithwick’s StingMate intended for jellyfish sting first aid. The product is composed of 5% acetic acid gel containing menthol. Acetic acid 5% is usually the concentration found in household vinegar, and menthol is a component commonly used in topical anti-itch preparations. StingMate is sold in a 4 fluid ounce manual spray bottle. The instructions that accompany the product are standard for proper first aid treatment of a jellyfish (or related species) sting:

1. Apply the StingMate gel
2. Scrape the skin to remove the stinging cells (nematocysts)
3. Reapply the gel
4. Rinse the skin

I would annotate these instructions to allow an initial decontamination time (first application of the gel) to be a minimum time of two minutes. In terms of scraping the skin, the standard dictum is to apply shaving cream (foam) and use a straight-edge razor or very sharp edge to scrape the cream from the skin. The reapplication of gel should once again be for at least a few minutes.

How vinegar is effective is not without some controversy. Most authorities believe that it renders the stinging cells inoperative, so that they cannot fire. That makes the most sense, because it is unlikely that the vinegar could penetrate the skin and neutralize active venom, although it is possible that vinegar might inactivate surface venom that it is able to reach. The important thing is that vinegar is an effective remedy and absolutely essential to treat the stings of most of the world’s most hazardous (and potentially lethal) jellyfish, such as the Indo-Pacific box jellyfish. I have used vinegar effectively for years, so I have every expectation that StingMate will prove to be a clinically useful product.

Oceangoers should be aware that allergic reactions to jellyfish stings are possible, so should also carry allergy medications or an allergy kit with their first aid supplies.

Preview the Annual Meeting of the Wilderness Medical Society, which will be held in Snowmass, Colorado July 24-29, 2009.

Join me from January 24 to February 2, 2010 for an exciting dive and wilderness medicine CME adventure aboard the Nautilus Explorer to Socorro Island, Mexico to benefit the Wilderness Medical Society.

This post, StingMate: A New Treatment For Jellyfish Stings, was originally published on by Paul Auerbach, M.D..

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