Diarrhea in Doomsday

You might not want to read this during mealtime.  You have been warned.

 

Do you ever look up toward heaven and ask God, “Really?  I’m trying my best here and now this?  Really??”  I’ve had that experience a few times, usually with things I’d rather not share publicly, either.  This is one of them.  On days like this, I’m so glad most of you don’t actually know me in real life. 

Last month, I experienced something I never had in my previous 50+ years on this planet—unending diarrhea.  The real deal.  Not just a loose stool here and there, but full on sprint-to-the-toilet-or-you-will-be-sorry watery, sometimes projectile diarrhea.  I spent a full week like this, hydrating and trying to figure out what was wrong.  I certainly didn’t want to go to a doctor for this.

The thing was, I had absolutely no other symptoms. 

So I turned to my off-grid references, and they offered little help. However, The Ship’s Medicine Chest and Medical Aid at Sea (a government publication so it’s okay to reprint it here) was a great place to start.  The section covering diarrhea—it’s a long read—is presented below.

 

COLITIS, DIARRHEA, DYSENTERY

Colitis is an inflammation of the large intestine (colon).  Usually there is diarrhea, with or without lower abdominal cramps.  Enterocolitis is inflammation of both the small and large intestines.

Diarrhea is defined as an abnormal increase in the amount, frequency, and fluidity of the evacuations from the intestine.  Diarrhea is not a disease itself but a symptom of trouble in the intestinal tract.  In this respect, it is like cough, chills, and fever, which are general symptoms of many diseases. 

Dysentery is an inflammation of the intestines, particularly of the large bowel.  There may be griping abdominal pains and frequent stools often containing blood and mucus.

Colitis, diarrhea, and dysentery often are used interchangeably to describe a variety of conditions with diarrhea.  Normally, during the process of digestion, food is moved slowly through the intestines to allow for the absorption of the food.  In diarrhea, the motion of the intestines (peristalsis) is speeded up and the stools are soft or semisolid, but may become watery, possibly frothy, and may have a very foul odor.

There are many different causes of diarrhea, colitis, and dysentery.  Generally, the symptoms are caused by an infectious organism or its toxic products.  Infection may be caused by viruses, a wide variety of bacteria, one-celled animals as amoebic and malarial parasites, and many-celled organisms as intestinal worms.

The non-infectious causes include poisoning from heavy metals as mercury, allergies to certain foods, inability to digest foods or absorb the digested foods, and emotional upsets.

In most cases of diarrhea there is inflammation of the intestines.  The loss of fluid through large watery stools may cause serious complications.  Dehydration leading to coma or death may occur when extreme diarrhea is combined with vomiting.  This will cause a loss of the water taken in and of water stored in the body.  Severe dehydration may occur rapidly.  In addition to loss of water, the loss of various chemicals normally dissolved in body fluids may cause complications and death.

Signs which may be useful in determining the cause of intestinal illness and its severity include:

Character of stools—Are they watery?  What is the color?  Is there blood, odor, mucus, or pus?  Are worms visible?  Is it all liquid, or are there some formed pieces?

Frequency of stools—How often does the patient pass stools?

Signs of dehydration—Is the mouth very dry?  Do the eyeballs seem unusually sunken?  If you pinch the skin, does the fold return slowly to its former position?

Other signs—Is there a rash on the skin, or vomiting?

History—Has the patient ever had intestinal symptoms before, if so when?  Does the patient have any idea what might be causing the symptoms?

Epidemiology—Is anyone else sick?  What symptoms do the patients have in common?

There are methods of controlling the incidence of diarrheal illness.  In foreign ports, it is important to drink pure or boiled water, and to avoid uncooked foods and unclean eating places.  Good hygiene should be maintained aboard ship.  Appropriate immunizations should be kept current.

Treatment of Diarrhea

Because the mechanism governing diarrhea is basically the same, regardless of the cause, the means of controlling this symptoms need not be extensive.  The patient should be placed on bed rest and made as comfortable as possible.  A liquid or low-residue diet should be given that includes soft drinks and broths containing salt.  Milk will be helpful if it can be tolerated by the patient.  Spicy, fatty, or greasy foods should be avoided.  If there is blood in the vomitus or in the stools, signs of dehydration (especially a daily weight loss of 3 or more pounds), or decreasing urinary output (less than 500 ml in 24 hours), prompt medical advice by radio should be obtained.  Intravenous fluids, isotonic sodium chloride solution or 5% dextrose and 0.45% sodium chloride solution may be ordered by the physician.

The patient’s feces should be flushed into the ship’s sewage treatment system or retention tank.  Eating utensils and plates should be boiled for 10 to 15 minutes to disinfect them if an automatic dishwater [sic] is not available.

Although adsorbents as kaolin-pectin mixture are of limited effectiveness, they should be given for mild to moderate diarrhea.  In the acute disease, diphenoxylate hydrochloride with atropine should be administered promptly.  Initially, two tablets of diphenoxylate with atropine should be given four times a day.  Most patients will require this dosage level until control is achieved.  Then a downward adjustment of the dosage should be made.  Control may be obtained from two tablets of diphenoxylate with atropine per day. 

Caution

The drug diphenoxylate may make more effective the action of barbiturates, tranquilizers, and alcohol.  Therefore, the patient should be observed closely when these medications are administered together.  Do not give this drug to young children.

Specific causes of diarrhea and some special treatments are outlined below:

Viruses.  Several viruses produce enterocolitis with or without gastritis (vomiting and upper abdominal discomfort).  Usually, there is little or no fever, the onset lasts several hours and the illness is over within two or three days.  The vomitus and stools are watery without blood and mucus.  The patient often feels well between bouts of diarrhea or vomiting.  Epidemics or single cases may develop.

Salmonella.  The salmonella organism, which may be carried in powdered eggs, powdered milk, or other food, as well as by livestock and some pets, produces one kind of food poisoning.  (See p. 157.)  A shipboard epidemic of salmonellosis could occur if the organism is food-borne.

The clinical picture of salmonellosis resembles that of viral enterocolitis.  Without a stool examination the diagnosis is uncertain.  Mucus may be present in the stool, vomiting is absent or insignificant, and a faint rash (rose spots) may appear on the abdomen and trunk.  The illness may last several days.

Shigella.  These bacteria produce shigellosis, clinically similar to salmonellosis.  Bloody diarrhea is more apt to occur with Shigella than with salmonella.  If the illness is severe, medical advice by radio should be obtained.

Staphylococcus.  Staphylococcal food poisoning (see p. 157) is caused by the toxins of staphylococci bacteria which are produced in poorly refrigerated foods as pastries, custards, and mayonnaise.  The symptoms begin rapidly and violently within 1 to 6 hours after eating the contaminated food.  There is considerable vomiting and diarrhea, and abdominal cramps and prostration occur.

Amoeba.  Amoebic dysentery is caused by Entamoeba histolytica, a parasite that infects the bowel.  Amoebiasis tends to be a chronic diarrheal illness that on occasion produces an acute colitis which is indistinguishable from salmonellosis or shigellosis.  The diagnosis requires laboratory identification of the amoeba in the feces.  Usually a fever is present and abscesses may form in the liver or elsewhere, which may prove fatal in exceptional cases.

Cholera.  This is a severe acute enterocolitis caused by Vibrio cholerae bacteria.  Epidemics still occur in the Orient, Africa, and recently in the Mediterranean.  The diarrhea has the appearance of rice water and several quarts of stool may be produced per day.  This may cause rapid dehydration, shock, and kidney failure if not treated with adequate intravenous fluid replacement.  (See p. 174.)  Prompt medication consultation by radio is essential and the patient should be evacuated to a hospital as soon as possible.

Chronic ulcerative colitis.  This is usually a long-standing disorder with a slow onset but it may start with acute diarrhea.  The stools often are bloody and vomiting is rare.  It is hard to distinguish from other forms of colitis without special diagnostic tests.

Regional enteritis.  This is a chronic inflammatory condition of the small intestine and occasionally of the colon.  The cause, as in ulcerative colitis, is unknown.  It may begin with acute diarrhea or abdominal pain similar to acute appendicitis.

Functional or spastic colitis.  This may be caused by emotional or nervous factors.  Usually the disease is a long-standing disorder with alternating constipation and diarrhea.  It is not an acute, prostrating condition as with the infectious types of colitis.  Stools are not bloody and may or may not contain mucus.

Malabsorption and maldigestion.  These conditions occur when food is not broken down (digested) so that it can be absorbed into the blood; or when digested food cannot be absorbed properly by the bowel.  This is usually a chronic condition with a slow onset.  The stools are bulky, foul-smelling, and sometimes frothy, often leaving an oil slick on the water of a toilet bowl.  Generally, the condition does not respond to ordinary measures used for diarrhea.  Malabsorption is rarely if ever a problem requiring emergency measures.[i]

 

While I found the information from The Ship’s Medicine Chest ultimately helpful, it took me a little while to figure things out.

As I said, I had no other symptoms.  No fever, no blood or mucus in the stool, only the slightest bit of abdominal cramping, nothing I would normally even pay any attention to.  No one else was sick.  If it was a simple virus, the diarrhea should have passed after a few days, but I was still going strong on Day 5. 

I kept hydrating and eating as normal.  I tried increasing the fiber in my diet.  Even though I try to avoid pharmaceuticals, I took a dose of Imodium (actually half of the recommended initial dose).  No go.  Actually, I guess I should say “no stop.”  I was still going plenty.  I tried peppermint and chamomile, and maybe some others, to no avail. Thinking I had offended the intestinal gods somehow, I decided to fast for 24 hours, hydrating only with water and chocolate milk.  (The suggestions above indicated that milk would be good if the patient tolerated it, so I went for it.  Adding in the DIY chocolate milk mix made it heavenly.)  The break from the sprints was really nice.  But when I started eating again, so did the diarrhea promptly at 15 hours later, just as it had all week long.

Now we interrupt this gripping account for a little non-commercial message.

My husband and one son are chronically constipated.  Take-a-novel-to-the-toilet chronically constipated.  And yet, when something totally surprises and stresses them out, they get smacked with diarrhea.  Our bodies can do funny (or not) things to us.

And another little snippet.

Over twenty years ago during the routine ultrasound when I was pregnant with our fourth child, the OBGYN informed us that this baby had no kidneys.  Because there was no amniotic fluid, he would eventually pinch the umbilical cord and be stillborn.  Of course, it was an emotional shock and though I handle such things fairly well, I believe, the body still has its ways.  Three days later my forehead erupted in thousands of zits. 

Back to our original programming.

So I got to wondering whether this could be an emotional thing as mentioned in the second to last paragraph from the Ship’s Medicine Chest excerpt above.  Because just before all this started, my son and daughter-in-law, who had gone in for her routine ultrasound at 21 weeks, were informed that their baby had died. 

I decided to try Imodium again, this time starting off with the recommended two pills for the first dose and faithfully taking subsequent doses every four hours.  That finally worked.

And so I share this rather personal account because in the days ahead, others could experience something similar, an emotional shock that wreaks havoc with the body even though the brain says it’s handling things just fine. 

^*Loperamide had just come onto the market when the 1978 edition of The Ship’s Medicine Chest was being published.  It is considered a better choice than diphenoxylate in treating diarrhea and has fewer side effects.

Links to related posts:

Imodium 

DIY Chocolate Milk Mix  

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[i] Ship’s Medicine Chest and Medical Aid at Sea, 1978, 149-51.