Unraveling the Mysteries of SMA Belly

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  • Unraveling the Mysteries of SMA Belly

    By Deborah Bickel PA MPH


    How many readers out there have been struggling with gastrointestinal 

    weirdness’ since moving to San Miguel? Do you keep having episodes of cramping and loose stools despite treatment? Have you come back from eating out and find you are suddenly sick as a dog and spend the rest of the night hugging the toilet and wake up feeling fine the next day? Are you mystified as to what is treatment worthy?
    Here is a brief, simplified guide to managing common gut ailments found most frequently in San Miguel de Allende. Most of the following information and recommendations are based on data from the Centers for Disease Control and Prevention as well as experience of local physicians and information from local laboratories.
    Basically, our guts are responding to bacteria, viruses and single cell organisms called parasites. These are found more frequently in areas with poor water management. This means water and waste come in contact. Those of us who have lived a long time in Mexico or other developing regions usually notice that we get less sick on fewer occasions than when we first started traveling away from the northern hemisphere. There is no clear evidence that we are more resistant, but most sources think resistance and adaptation do occur. The other reason we find ourselves less frequently ill is because we have established better hygiene and made it a habit. We know where to eat out, have purified water at home, disinfect our produce and wash our hands frequently.
    Infectious diseases that affect the gut can be divided into two categories for simplicity’s sake: Sudden or acute onset illness with vomiting and diarrhea, versus chronic ‘low grade’ persistent gut irritation. The acute onset of vomiting and diarrhea is usually caused by bacteria and viruses. In 90 percent of these cases, these illnesses resolve in a few days without treatment. Treatment with the right antibiotics will usually limit the time you are sick, but they place you at risk for side effects, and more importantly can put you at risk for developing resistant strains of bacteria. For those of us who plan to continue living in Mexico, frequent antibiotic treatment should be avoided.

    Most of us want to know what caused a bout of illness so we can avoid eating at a particular taco stand or restaurant. Most of the common viral and bacterial agents that cause diarrheal disease take some time to ‘incubate’ in your gut before onset of symptoms. The range is from six to 72 hours. This can make it hard to know exactly where you came in contact with a bug. Before blaming your last meal, you need to take into account everything you ingested over the past 72 hours.

    The next half of this newsletter will address everyone’s favorite dinner topic: Why do I still have diarrhea? It will feature parasites, worms and the need to run your poop to the laboratory more often than anyone wants to. For those of you who want to know the names of all the possible infectious agents you might be exposed to, a great place to start ishttp://www.atsu.edu/faculty/chamberlain/gastro.htm.

    The question is: What can be safely treated at home and when is medical help needed? The answer to that question is: See a doctor when the symptoms don’t go away and stay away or initial symptoms are very severe or if there is blood in your stool. The reason for this is that long lasting diarrhea accompanied by weight loss, cramping and gas in an otherwise healthy person are usually due to parasites and they do not go away without treatment. Symptoms suggestive of helminthes (worms) include belching, loud gurgling or growling stomach, loss of appetite or an increased appetite, fatigue, and joint pains. You are considered cured if you completed treatment and have no symptoms and tests on separate stools are negative for parasites or their eggs.

    The most common parasites found in SMA are

    • Endamoeba histolytica
    • Giardia (also single cell parasite)
    • Round Worm includes pin worms
    • Hook worm
    • Tape worm
    • Ascaris (worm)

    Parasites don’t always appear in each stool which is why three specimens on different days are recommended. All of these agents are found when water for drinking and cleaning comes into contact with waste. Worms are often found in bodies of unclean water and can invade via water being swallowed. Their eggs can be picked up in moist dirt and enter the body and then grow into adult form.
    Sometimes lab tests reveal an overgrowth of bacteria with or without other parasites. A good clinician will ask for further testing to see what antibiotic will work on the particular bacteria. An overgrowth of bacteria can mean your small intestine is infected as well. The small intestine contains many lymph nodes and is critical to maintaining a healthy immune response in all parts of the body.
    What do you do when your symptoms keep returning after treatment? Increasingly parasites and bacteria are growing resistant to common treatments. Eradication of resistant organisms may require treatment with two antibiotics for a longer period of time. Another consideration is that you are being re-infected by a pet. According to the Centers for Disease Control and Prevention, dogs and even cats can pass giardia and various types of worms to humans. This mode of transmission is not common except in the case of various worms.
    Prevention of parasites include frequent hand washing, avoiding any still standing body of water, disinfect food, only drink purified water. Don’t take antibiotics without a diagnosis. Get your animals checked for worms.
    What do you do if you continue to have gastro intestinal symptoms even though you believe you have been treated with appropriate medications? Unfortunately more than just parasites or bacteria can cause bowel and gut problems Diverticulosis, autoimmune diseases as well as cancer can cause very similar symptoms. The diagnosis is made by examining the small and large intestines with various scoping devices. Often biopsies are taken to confirm a diagnosis.
    Unfortunately many people may have an underlying gastrointestinal disease that only becomes symptomatic when the gut is frequently irritated by infections. It is a mistake to not seek out a definitive diagnosis if you are repeatedly plagued by loose stool, gas or mucus in the stool.
    There are facilities and gastrointestinal specialists here in SMA as well and of course in Querétaro or Celaya. Contact me at 4151157815


     

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