DIarrhoea

Diarrhoea-There’s hardly anyone who hasn't experienced this condition at one point or the other in their lifetime. I define diarrhea as that condition that makes you and the toilet (if you can find one) to form an emotional bond.Thanks to diarrhoea, you may discover you are frequently racing to the toilet to empty the smelly contents of your bowels in a hasty, very watery and most undignified manner. While I’m enjoying waxing poetic about the brand of abdominal torture that is diarrhoea, this article is really about how to handle it right. 

A lot of people don’t know that diarrhoea kills, and that children below 5 years old are often the victims of death by diarrhoea. Sometimes diarrhoea is self-limiting-meaning it will stop on its own in just a couple of hours. Other times diarrhoea may be a side effect of a drug you’re taking or food you'e not used to or it may be caused by infection (bacterial, viral or protozoal).

Common bacterial infections that can cause diarrhoea
In Nigeria, examples include Salmonella Typhae (typhoid), Escherichia Coli and Vibrio cholerae and are generally gotten from taking contaminated food or water. Most of us call it food poisoning or if you're overseas traveller’s diarrhoea. Sometimes, these bacteria can be gotten through handshaking with infected persons and then consuming food with your contaminated hands, since many local dishes are eaten that way. 
It's not odd to find people simply rinsing their hands before eating a local dish when washing with soap and water will be more appropriate to separate you from the grime you may have acquired during the day.

Treatment
It's a common and very wrong practice when people get diarrhoea to chug down flagyl (metronidazole) or tetracycline or Thalazole or a combination of any two in whatever dose they deem fit, which means taking 2, 3, tablets as often as they desire. Unfortunately, the resulting effect of taking antibiotics sporadically because of diarrhoea, that may not need antibiotics, is that resistance to antibiotics is on the increase and health providers are discovering the need to shift patients from first line antibiotics (which are the best choice of antibiotics with less side effects) to second line antibiotics (which have slightly more side effects) to even the third and possibly final antibiotics (at which point the patient is now quarter to go), as modern medicine may have run out of treatment options. Now all of these issues could be easily avoided by taking these 3 simple steps when faced with the dreaded diarrhoea. 

Before we start running through the steps, a word of caution:1.· If your diarrhoea is bloody (even if it's one or two drops of blood) or you also have fever or both, it’s advisable you do not play the lottery with your life-Ignore step  2, and consult your health provider as step 2 can worsen your treatment.

2. If your diarrhoea continues for more than 24 hours and is not improving, despite the advice in step 1 to 3 below, then immediately consult your health provider

STEPS TO TAKE

1. Rehydrate, rehydrate and rehydrate some more.

One very bad side of diarrhoea, (whether the easy type that stops on its own or the dangerous kind that seems to go on forever) is that you end up flushing a good percentage of your body water down the toilet. With increasing frequency of your restroom visits, you will start to feel weak, tired, and might even crawl in to take your next dump on your hands and knees. This is because, you’re not just passing out ordinary water and faeces, you’re passing out minerals, salts, aka nutrients in your blood that keep the body balanced and it’s starting to take its toll on you. Taking medicine called ORS, Oral rehydration salts mixed with at list one liter of water can help prevent this.

A quick test to see if you’re getting too dehydrated is if you gently pinch your skin and release it and it doesn’t return to its normal appearance but remains obviously wrinkled for more than 2 seconds. The duration of the wrinkling tells you how far gone you are. It’s also an important sign for mothers of babies and small children to be aware of so you can quickly realize the danger your child is facing, since he/she will not be able to speak up like an older child would. Often, dehydration is a major contributor to the cause of death by diarrhoea. 

If you can't find one to buy, you can treat by making your own home-made ORS-i.e. Oral Rehydration Salts. Do this by mixing:

1/2 teaspoon of salt & 6 cubes of sugar (or 6 teaspoons of sugar) in 100cl or 1 Litre bottle of water. Most packaged bottles, ragolis, cway etc are sold in 1/2 Litre sizes (50 cl), so that means you need 2 bottles. you can also boil and cool your water and use an empty 1 Litre bottle to measure. You should carry this mixture everywhere you go, drinking about 200ml (a small cupful) frequently (about 10 times or more) and until you start to feel better. You should also continue to eat small amounts of non-oily food or biscuits like crackers as this will help you recover sooner 

Some people argue that eating or drinking ORS will only increase the frequency of stooling. This is most certainly not true, however you should avoid consuming high fat foods like milk or drinks like coffee or alcohol. You can also buy already prepared ORS powder from a nearby pharmacy.
For children, its recommended you also buy zinc tablets and then crush and mix one 10mg tablet with the water. Taking zinc is good for adults too.

2. If rehydration fails or appears insufficient: Use anti-motility treatments

This means that there are some ways to reduce the frequency of your stool to the point of stopping the diarrhoea. An easy to access medicine is ‘Loperamide’. I recommend you have one at home for keeps.

Recommended dosage for Loperamide: You should take 2 tablets to start and then 1 tablet after each loose stool, however if you’ve already taken 4 tablets and the stool frequency hasn’t receded, you should take it as a sign that this may be an infectious diarrhoea that may require antibiotics. Also, if several house mates who eat the same food as you simultaneously have diarrhoea, it’s less likely to be a coincidence and more likely to be that you’re dealing with infectious diarrhoea. Nevertheless, most cases of acute diarrhoea are over by this stage or show signs of stopping after taking steps 1 and 2.

3a. Use a Probiotic:
Some of you have never heard this term-probiotic- before. One of the perks of modern medicine and pharmacy is the discovery of beneficial micro organisms and ability to package them in capsules for you to take. One of such called: Saccharomyces boulardii or S.boulardii for short is a nice type of yeast found to be very useful for tackling annoying diarrhoea causing micro organisms in your stomach. It does this by replacing the bad microbes in your stomach and welcoming the growth of the good microbes (FYI, there's good bacteria in your stomach also). This is an especially good treatment for persons with frequent episodes of diarrhoea as your digestive system needs to have enough good guy microbes to help prevent another infection. 

Dosage: The recommended dose is one capsule (which usually contains 200-250mg of S. boulardii), taken one or two times daily (depending on diarrhoea severity) for 5 days. Your doctor may especially recommend this for you if you tend to have prolonged episodes of diarrhoea, even after you have completed antibiotic treatment. However, if your immune system is compromised by prolonged sickness, severe anaemia, blood loss, or HIV, this method is definitely not for you, as your body may not be able to accommodate any additional microbes (good/bad) and it can cause an infection.

3b. If all fails, it's time for the big guns, antibiotics:
For acute diarrhoea that does not stop on its own and is not responding to any treatments in 1 or 2, I have advised you consult your health professional. Usually, they will recommend antibiotics to you. Some commonly recommended treatments include:

Septrin (Trimehoprim-sulfamethoxazole) 960mg taken two times daily for 5 days.
OR Amoxicillin 500mg taken 3 times daily for 5 days
OR Ciprofloxacin 500mg two times daily for 5 days.

When using antibiotics, you MUST complete your treatment, If you stop taking the antibiotic too soon, the troublesome bacteria that are left will start to multiply again, and may cause another infection. There is also a risk that these bacteria will be ‘resistant’ to (no longer killed by) that antibiotic. This means that it might not work next time, and you might need a different antibiotic, which might not work as well or cause more side-effects.
PS. The doses indicated above are adult doses and MUST not to be given to children in the same measure. For children, a combination of ORS with Zinc is usually sufficient
Other important points:
Ciprofloxacin should not be given to growing children as it may affect their joints and bones. Tetracyclines should not be given to children below 10 years because it can cause permanent discoloration of their teeth. 

Tell me what you use for diarrhoea by commenting below.

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