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Six Letters Re: Oral Rehydration Solutions

Jim,
During my many travels in Asia and Central America I never brought along medications to stop diarrhea, only to prevent it. Diarrhea is natures way of getting rid of something your body doesn't want in it. Preventing that can lead to serious problems. Water and food born bugs (bacteria, not parasites) can be dealt with by taking Doxycycline Hyclate as a prophylactic.
Prior to the likely encountering of suspect food and water, such as a bug out situation, a pill a day will keep you reasonably safe. You should be able to talk your doctor into proscribing for emergency use only or you can pick them up over the counter in any Third World country.
I also take along Keflex in case of wound infections. Google has a wealth of info on these and other medications if you can't find a doctor willing to advise on TEOTWAWKI situations. - LRM in Perth, Western Australia

Sir:
My mother was recently hospitalized and learned the hard way. She had taken some antibiotics to fend off an infection. Antibiotics kill off the bacteria in our intestines (the good and bad kind). In her case, it killed off a larger portion of the good bacteria which led to an imbalance. The bad bacteria began to thrive. The diarrhea she had would've helped get rid of the build up of that bad bacteria. However, she took an anti- diarrhea

When the bad bacteria builds up like that and your body can't get rid of it, the bad bacteria begins to poison you (as it did her). She couldn't eat or drink anything without throwing up because her stomach was no longer in a condition to absorb any water or nutrients. She suffered from severe dehydration and malnutrition.

Her condition [Clostridium difficile] is commonly referred to as "C-Diff". She was in the hospital for a week and a half and is slowly recovering now.

So, if you get diarrhea after taking antibiotics, it may be best to just let nature "run" its course. Just be sure to drink lots of fluids. - Daron in San Diego, California

Jim,
You recently posted a letter from a reader inquiring about oral rehydration solution. I have chosen to stock up on oral rehydration salts instead of pre-mixed solutions such as Pedialyte.

The salts are packaged in little foil sachets. When mixed with water, each sachet produces one liter of oral rehydration solution. They can be purchased in bulk from a company called Jianis Brothers either by the carton (125 sachets) or by the case (5 cartons = 625 sachets). I don't recall how much I paid but I believe the unit price was around 50 or 60 cents per sachet - much less expensive than Pedialyte.

The sachets are convenient, compact and durable and I believe they would make a great little barter item if the need should ever arise.

The web site of The Rehydration Project contains a wealth of information on dehydration due to illness as well as treatment using oral rehydration therapy: Contact information for Jianis Brothers is also available on the same site. Sincerely, - Michael in California

Dear Mr. Rawles,
In reference to the recently-posted question/answer concerning anti-diarrheals, I have just a couple of comments from a pharmacist's perspective.

1. As the poster mentioned, loperamide (aka, Imodium) is available over-the-counter (without a prescription) in the same strength as the old prescription product. This effective anti-diarrheal is not considered an opioid, and does not appear on the DEA's Controlled Substance list, as does diphenoxylate/atropine (aka Lomotil - Schedule V). Be aware that individual states can add drugs to their own controlled substance list, but I don't know of any that have done so with loperamide. The dosing depends on recurrence of diarrhea episodes, but take no more than 8 tablets (16mg) per 24 hours period.

2. The bismuth subsalicylate-containing anti-diarrheals, such as Pepto-Bismol and Kaopectate and their generics, contain an active ingredient similar to aspirin, and in quantity, can have a similar effect on bleeding (inhibits platelet function). Therefore, be sure to stay under the daily maximum dosage of 8 30ml (1oz.) doses. Also, if you have any ongoing bleeding problem, such as active gastric ulcers, shy away from these products.

Thank you for all you do! Best Wishes, - S.H. in Georgia

Sir,
The most effective anti-diarrheal medications are usually sulfa drugs.

In my travels there have been times when I have lost 20 lbs. in a few days time due to the effects of diarrhea. I've had it so bad that the Air Force took a C-141 out of service to decontaminate it.

And my travels started when I was three years old (42 years ago now) so I have lots of practice in dealing with this issue. Outside of the US and Western Europe you have to assume that the water supply is contaminated and you will come down with something at some point. I've reached the point where I routinely add purification tablets to even bottled water in some countries.

First and foremost, if diarrhea is not caused by a virus then usually it is caused by a bacterial bloom in the body. When you travel from one area to another the normal flora and fauna in the body change to match what is local to the environment. As a result the balance of the flora and fauna in the body gets out of whack and you end up with the common traveler's diarrhea. If you have not drunk/eaten food in your home environment that was not processed/packaged/etc. etc. then you can get the same effect the first time you eat natural foods (farmer's market ...). A low dose of a sulfa drug usually is enough to take care of this problem. (Sulfa drugs are usually over the counter in most countries outside of the US.) In the US the doctor will normally prescribe Ciprofloxacin. Living and working in Turkey I learned to say "Streptomagma var mu?" or "Do you have Streptomagma (a sulfa drug)" -- and the same phrase will work across the near east (from Turkey through Afghanistan).

One of the tips/tricks that I have picked up over the years is to eat yogurt or other foods that contain live bacteria and/or drink a shot or two of hard alcohol. This helps stave off but does not 100% prevent diarrhea. But it is critical to continue to eat yogurts once you are treating the diarrhea symptoms with medicines as it helps to re-balance the flora in your body and prevent a second round of problems.

For viral infections (or protozoa) you just have to suffer unless you can get your hands on prescription only drugs. Nitroimidazoles seem to have the best effect on Giardia but when I've taken them in the past (seven Giardia infections to date) they are rough on the body. Hence oral rehydration is probably the best route unless you have a severe case of it. Amoebic dysentery is also common in many parts of the world -- and is almost untreatable and you have to suffer with it for years after your initial infection. Again oral rehydration (and having a wee bit more than 7% body fat) helps the most.

One of the better oral rehydration products out there is Ceralyte. Gatorade and other sports drinks usually are too much sugar and the wrong types of salts for long term oral rehydration (such as during an attack of Giardia which I have now had several times). You will also find Crystal Lite (and the store brand generic equivalents) makes a sugar free rehydration mix. My preference for these two routes comes down to portability and long storage life. (I mentioned that I carry several packets of rehydration powder with me in my travel kit.) I also lean towards using the Crystal Lite mix as I have a tendency at my age to pack on pounds even with a vigorous workout schedule.

The other tip to add? Always carry toilet paper with you. It is horrible to have dysentery in a country like Indonesia where the public toilets (even in office buildings) don't have toilet paper and you are using leaves and newspapers in a vain attempt to clean up afterwards. - Hugh

Hi,
I read the recent post about dealing with diarrhea, and while I have made sure we have some OTC pills such as Imodium stored, I have also stocked up on dried Blackberry Leaf and made tinctures. It works extremely well in ending diarrhea, our family has had the chance to use it a few times over the years and it does indeed work. My darling husband says it tastes kinda 'woodsy', and I admit is is not the best flavor, but it certainly works. Just a teaspoon at first and maybe another teaspoon if there is another 'episode', but we have found that one teaspoon usually does the job the majority of the time, only a few times have we had to use a second dose. It can also be put in water or juice and taken that way.

I just wanted to pass this on. Dried blackberry leaf can be found at any online herbal store like www.MountainRoseHerbs.com [in Oregon] and a one pound bag is very inexpensive, around $8. Id suggest that interested people buy two bags and tincture them up right away with any 80 proof vodka to have it on hand when needed. Though it can be made into a tea or decoction, I prefer to tincture for long term storage.

All the best to you and yours and God Bless. - Karen F. in Colorado

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