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What You Need to Know About Stomach Flu
STEVEN J. LIPSKY MD, FACEP

The main difference between a “stomach flu” and “food poisoning” is duration. Both usually have vomiting and diarrhea, fever and chills to varying degrees, and abdominal cramps, but food poisoning should not last more than 24 hours, while a stomach flu may last up to 3-4 days. Also, food poisoning usually has a more abrupt onset with all of the above symptoms occurring almost simultaneously, within 1/2 hour to 24 hours after ingesting tainted food, while the symptoms of viral gastroenteritis may occur more gradually with vomiting or diarrhea occurring before the other begins.

The cause of food poisoning is usually an exotoxin (liquid) produced by staphylococcus bacteria very frequently, or an endotoxin (on the bacteria itself) such as from shigella, salmonella, campylobacter, or E. Coli. Ingesting food that has not been cooked thoroughly, or reheated, or improperly stored, or made from fresh vegetables/fruits that weren’t washed before preparation, is the main culprit. Use of antibiotics for treating some of these bacteria is controversial, since it is felt that they can cause the germs to become invasive into the walls of the intestines, and thus prolong illness.

Viral gastroenteritis, or “stomach flu”, occurs from the “fecal/oral” route, i.e. someone who has the virus does not properly wash their hands after using the toilet, and a healthy person touches a surface that the infected person touched, or their soiled clothing, or shakes hands with him/her, and then touches their own face or mouth. It has no cure.

Treatment of both is similar, except for the decision whether or not to use antibiotics. Only clear liquids in sips (no more than 1 oz every 3-5 minutes—that’s only 2 tablespoons!!) to start if vomiting/ nauseous. This lets liquids slide by the stomach. If one is thirsty and ingests a large quantity of liquid rapidly, the distention of an already irritated stomach causes reflex regurgitation. Thus, small amounts, frequently is indicated. However, if one also has diarrhea, then constantly ingesting liquids slides by the stomach, but keeps stimulating the bowels and thus propagates the diarrhea. So, if one has both vomiting and diarrhea: take clear liquids in small amounts frequently until thirst is slacked, but then wait 1-2 hours before repeating.

Also, it is important to not drink only water. One loses sodium, potassium, and other chemicals in the emesis and diarrhea that are important to maintain a normal heart rhythm. Drinking only water will further dilute them in the bloodstream, with potential life-threatening consequences. While Gatorade, Powerade, and other “sport” drinks have electrolytes, they are made to replace sweat, not emesis or diarrhea. Coconut Water on the other hand, has almost the same concentration of electrolytes as human serum, although slightly more potassium (which is good when having both vomiting and diarrhea) and glucose. “Pedialyte” is good for children, but pretty much intolerable to take for anyone older. (Holding one’s nose while drinking/eating unpleasant substances greatly improves the process, since we really “taste” with our sense of smell – the tongue has limited sensations.)

The World Health Organization/UNICEF and others have looked at ORT (Oral Replacement Therapy) because of the unavailability of enough i.v. fluids in Third World countries when Cholera or Rotavirus epidemics occur to replace the massive fluid losses of these diseases. There are many different products of electrolyte powders that can be added to 1 qt of clean water. In general they contain: 1 tsp of salt, 1/2 tsp. of baking soda, and 2-4 tblsp of sugar or honey at a minimum. One can make the same if in a pinch. It is also now recommended to restart regular feedings in children after 6-8 hours if possible. Bananas, applesauce (apple juice can cause diarrhea), rice, and toast are binding. Keep away from caffeine drinks that will stimulate the bowels.

We use injectable, “ODT”s (oral dissolving tablets), or suppository medications to stop the vomiting, and “OTC” (over the counter) Kaopectate or Imodium AD to stop diarrhea in viral gastroenteritis, along with i.v. fluid replacement if needed. I prefer Acetaminophen to control fever and aches, since NSAIDs like Ibuprofen (Advil, etc.) or Naprosyn ( Aleve, etc.) are irritating on the stomach. Also, taking a non-milk-product-containing ProBiotic (at least 9 billion cfus/dose) 3x/day, will replace the normal good bacteria in your intestines that are lost from either of these diseases causing increased diarrhea. ProBiotics have no side effects, and are tasteless. If you cannot control symptoms by yourself, please call us before becoming dangerously dehydrated, or go to the nearest E.R.!!

In closing, we wish everyone a Happy and Healthy Holiday Season, and All the Best in 2013 (that is, if the world doesn’t end on Dec. 21) !!!

Please share this email with the link below if you think that you can help someone you know prevent or treat the stomach flu this season.



What You Need to Know About Our Flu and Viral Epidemics
STEVEN J. LIPSKY MD, FACEP

We have been seeing 3 viral syndromes lately:

1) Flu-Like: consisting of low grade fever, malaise, weakness, headache, runny/stuffy nose with post-nasal drip causing coughing (especially during sleep), and nausea.

2) Influenza (it started as type B, but now is type A H1N3): like #1 but with higher fever, severe muscle aches, and some diarrhea and nausea as well

3) Norovirus: which causes fever (often high), and only extreme vomiting and diarrhea (no URI symptoms), lasting about 3 days, and often requiring i.v. hydration (it’s the “stomach flu” virus that causes huge outbreaks on cruise ships, etc.).

For those smart enough to get their “Flu Shot”, they are protected against getting #2 between about 60-100%. However, many folks say: “I don’t get a Flu Shot because it gives me the flu!”. This is impossible! The injectable immunization consists of completely dead viruses that act only as a template for your body to make antibodies to them. However, it takes about 2 weeks to make these antibodies, and if one is exposed to the Influenza Virus during (or shortly before) the immunization, then one can come down with the flu before you have enough time to mount resistance. Also, some people do not make enough antibodies to ward off a subsequent infection. Getting a Flu Shot in Sept. – Oct. should protect for the entire flu season, which hit earlier than normal this year and is still rampant in the West. However, it is still advisable to get one now if you have not already!

The young child Nose Spray Immunization is a weakened virus, and although the CDC says it is too weak to cause the flu in healthy patients, this is a possibility in immunocompromised ones (e.g. those with leukemias/other cancers, HIV, insulin-dependent diabetes, etc.).

Although, as our readers have previously been explained, antibiotics won’t kill a virus (it’s like trying to use weedkiller to kill a gopher!), we have been having success treating the symptoms of #1 and #2 with:

Tylenol for fever, headache and muscle aches (Ibuprofen and Naprosyn–ie. Advil and Aleve–can further upset a tender stomach)

Pseudoephedrine (the “Sudafed” you have to show your driver’s license for) and prescription Fluticasone Nasal Spray for runny/stuffy nose/post-nasal drip

Prescription Hydrocodone Cough Syrup ( e.g. Hydromet or Tussionex – all Walgreen’s are currently out of Hydromet in the Valley!) and Pro-Air HFA (i.e. Albuterol Metered Dose Inhalers) for cough and chest congestion

Prescription Odansetron for nausea/vomiting (along with Phenergan or Compazine Suppositories if uncontrollable)

OTC (i.e. “Over The Counter”) loperamide (e.g.Imodium AD) along with an OTC Probiotic powder or capsule of at least 9 billion cfus (i.e.”colony forming units”) 3x/day for diarrhea.

For those who truly appear to have Influenza (the nasal swab test is only about 50% accurate, and thus worthless in our opinion), and did not get a Flu Shot, we are adding prescription Oseltamivir (e.g. Tamiflu) that is very effective at ameliorating the symptoms of Influenza Type A & B if taken within 48hrs of onset (their literature says it’s effective up to 96hrs, but in our experience it’s not!).

Remember to stay home and away from others until you are O.K. if you become ill – one is infectious to others from 1-2 days before you come down with symptoms, until at least you’re completely normal (some studies say that you can transmit the virus up the 3-4 days after you’re completely normal!!). Cough into your elbow(not hands!) and wear a disposable surgical mask if you must go out, to prevent transmission. Wash hands with soap (it’s not necessary to use “antibacterial soap”) and warm water, front and back, vigorously for at least 30 seconds, frequently (and especially after being in public places). Bedrest and lots of clear liquids are very beneficial, and I personally like CoQ-10 at least 125mg 1-2x/day, a daily high potency B-Complex Vitamin, and at least 1000mg of Vitamin C daily, as well.

Please share this email with the link below if you think that you can help someone you know prevent or treat the stomach flu this season.


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