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Staying Healthy on the Road Medical info, e.g. malaria, vaccinations, travel medical tips, medical insurance, where to find a doctor.
Photo by George Guille, It's going to be a long 300km... Bolivian Amazon

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Photo by George Guille
It's going to be a long 300km...
Bolivian Amazon



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  #16  
Old 22 Nov 2022
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Originally Posted by Lonerider View Post
Having done 22 years in Her Majesty’s Army and eating the then Army Catering Corps food both in camp and on operations I would like to think it’s prepared me for the worst (sarcasm)
The human body turns food to s**t in 24 hours, the Catering Corps can do it in 24 minutes...
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  #17  
Old 22 Nov 2022
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Originally Posted by estebangc View Post
First off, apologies if I did not find the thread for this topic

I understand that the best way, it is to eat local food -especially, raw uncooked- progressively, so that your stomach gets used to it, while using common sense with limitations (local people, used to germs and bacteriae also get sick and food poisoned).

Do you have any tricks to ease the process or adapt somehow beforehand? Curiosity to know if anyone stopping washing hands, eating old food/leftovers…

Esteban
Eating raw and uncooked food??? Eh - no, no way, no way at all!!! Except food thats supposed not to be cooked and raw such as fruits and some veggies of course.

The only way to prepare your stomach for Farawaystan is to bring Ciprofloxacillin pills. I NEVER travel anywhere where its hot without a solid storage of such pills. I have had just too many foodpoisonings - so I have learned the hard way.

Of course I eat local food, and a good advice is to eat where the locals eat as a such place have usually have good and clean food for a reasonably price as well.
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  #18  
Old 22 Nov 2022
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There's a distinction to be made between prevention of GI upset before the fact and treatment once you have it. With regard to the latter, I'm going to politely disagree with Snakeboy's post: I carry cipro as he does, but a lot of the most common stomach bugs are parasites, not bacteria, and they're better treated with metronidazole (Flagyl) and its close relatives. This includes, for example, giardiasis and amoebic dysentery; I'm personally acquainted with both.

In some locales, strict avoidance of uncooked foods is a good idea--South Asia is the obvious example. I once got giardiasis eating salad in a five star hotel restaurant in Katmandu, mistakenly thinking the luxurious setting ensured proper food handling. In other places I've eaten uncooked food without incident--North Africa, much of South America, the Caucasus. But people frequently get sick (and sometimes die) of food poisoning here in the USA, so there are no guarantees.

If you routinely eat a lot of salads at home as I do, it's a hard habit to break. Fortunately, there are lots of ways to eat veggies and produce which don't expose you to microbes; lettuce doesn't cook well, but spinach, peppers, onions, tomatoes, broccoli, even cabbage and [insert your favorite cooked vegetable here] certainly do. Usually there are sauce or stew options, and in a pinch I'll resort to overcooked, limp veggie sides for the sake of better nutrition.

I also carry multivitamin/mineral supplements, and I sometimes remember to use them.
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  #19  
Old 24 Nov 2022
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Originally Posted by markharf View Post
There's a distinction to be made between prevention of GI upset before the fact and treatment once you have it. With regard to the latter, I'm going to politely disagree with Snakeboy's post: I carry cipro as he does, but a lot of the most common stomach bugs are parasites, not bacteria, and they're better treated with metronidazole (Flagyl) and its close relatives. This includes, for example, giardiasis and amoebic dysentery; I'm personally acquainted with both.

In some locales, strict avoidance of uncooked foods is a good idea--South Asia is the obvious example. I once got giardiasis eating salad in a five star hotel restaurant in Katmandu, mistakenly thinking the luxurious setting ensured proper food handling. In other places I've eaten uncooked food without incident--North Africa, much of South America, the Caucasus. But people frequently get sick (and sometimes die) of food poisoning here in the USA, so there are no guarantees.

If you routinely eat a lot of salads at home as I do, it's a hard habit to break. Fortunately, there are lots of ways to eat veggies and produce which don't expose you to microbes; lettuce doesn't cook well, but spinach, peppers, onions, tomatoes, broccoli, even cabbage and [insert your favorite cooked vegetable here] certainly do. Usually there are sauce or stew options, and in a pinch I'll resort to overcooked, limp veggie sides for the sake of better nutrition.

I also carry multivitamin/mineral supplements, and I sometimes remember to use them.
You are of course totally correct when you say there are two different approaches when it comes to stomach problems and food poisoning and the first is to prevent and the second is to treat.

Preventing isnt easy, especially when youre on the move constantly and seldom spend more than a few days in the same place. We can and should be careful about our own hygiene, especially about hand hygiene after a toilet visit and such, and of course look, smell and taste carefully if we are unsure if food are good or not good. But what goes on with the food before we buy and eat it is beyond our possible knowledge. So we have use our common senses…
As you wrote - we can get a stomach bug even in a 5 star restaurant just as easy as from a handcart foodstall in the streets of southeast Asia.

When it comes to treating a stomach bug infection - well its fine to disagree. We can try to have a fruitful discussion about this subject.

First my personal experiences - when I took off on my RTW trip I also carried Flagyl for the treatment of stomach bugs. Flagyl or Metrodinasole as is its generic name is mostly used to treat amoeba anf parasitic infections but it isnt effective against most bacterias - as far as I understand. Anyhow I carried Flagyl and not Cipro because I had an idea that this was the better medication for GI infections.
So my first encounter with severe stomach bugs was in Kazakhstan. I took Flagyl but no help in that. I travelled with a US guy who had been in ths US army foe most of his life, he was just retired. He had been to the US Army doctor before he took off and he carried Cipro. So eventually I got some Cipro from him and voila after a day I was 99 % ok again. The same happend a couple of weeks later upon entering China. I got really sick and could hardly go out of bed for a couple of days, only to the toilet 1-2 times pr hour. Flagyl did not help this time either so I had to borrow Cipro from my travel mate again. So the US army docs certainly knew his stuff! And again - voila after 2 tablets I was good to go again. And later on in Thailand, Cambodia, Indonesia, Bolivia (3 freaking times in that country alone) Peru, Colombia, Panama etc etc - I have always stuck to Cipro and it has always cured me up quickly.

I did some research and remember I read an article that was written by a doctor here in Norway where Im from and he wrote that Ciproflxacillin would be effective on approx 95 % of all stomach bugs one could aquire. And by that that would be the most important medication to bring on a longer travel abroad to hotter parts of the world. And I think that doctor also recommended Flagyl when stool was bloody too.

I have also used mr Google to ask what bugs that normally causes food poisoning and according to for example this site from the UKs NHS the 4 most common bugs are:
Campylobacter
E. Coli
Salmonella
Norovirus
https://www.nhs.uk/conditions/food-poisoning/
And other sites I could find also mentiones similar or identical causes/bugs. And none of these are parasites as you mention are the main reason for GI infections. So I wonder what sources you have for what you write that parasites are the most common causes to GI troubles?

For sure there are many parasites that can cause food poisoning/Gi infection - but to my knowledge they are not the main cause of such problems.

The correct way to treat a real stomach/GI infection is to take a sample of the stool and grow it in a lab and thus find what bug that causes the infection - so that the treatment can be directed directly towards that specific bug.

Of course out on the road this is seldom possible unless youre admitted to a hospital, so some kind of self diagnosis is neccesary.

I have found out that what I read in that article from the norwegian travel clinic doctor that Cipro will be efficient on 95 % of all bugs you hit out in the third world why travelling to be true. Other might have different experiences - and it is interesting to hear about it…

PS - Im not a native english speaker so my language might be a bit awkward when it comes to such detailed topics as in this thread. I ask for understanding of this and Im happy to be correctes if my language isnt quite correct….
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  #20  
Old 24 Nov 2022
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Originally Posted by Snakeboy View Post
...PS - Im not a native english speaker so my language might be a bit awkward when it comes to such detailed topics as in this thread. I ask for understanding of this and Im happy to be correctes if my language isnt quite correct….
Your English is VERY good and completely understandable. While it's not perfect, it's better than some native English speakers...
So don't worry about it!


Great write-up too, thanks!
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  #21  
Old 24 Nov 2022
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Hello

For medical advice go to a doctor spezialised in travelmedicine.
Get all the shots you can and some emergency medications.

In 2nd and 3rd world counties:
-Bottled water (or treat it yourself, filter, uv etc.), expensive but worth it, use it also to brush the teeth.
-Cook your own food, if boring, the web is full of advice.
-McDonald’s is a beam of light shining through the clouds from heaven.

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  #22  
Old 24 Nov 2022
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Originally Posted by DaveGetsLost View Post
Planning to ride from northeastern US to Ushuaia. How can I get salads? Clearly shouldn't have lettuce on street tacos.

What are my chances with a salad at a "good" restaurant? Can I clean salad greens well enough in camp?

Even riding in western Canada or walking in Europe, I get too much meat and not enough greens (for me).

I'll have to adapt my diet to what's available, what's safe, plus some local specialties. Balance needs to include salads.

I've ridden all over US and Canada and visited Europe but this is my first foray into Mexico and south. Been studying Spanish for over 2 years for this trip.
We've eaten salads in tiny roadside restaurants throughout Latin America with no problems. Businesses which do not take of hygiene go broke, and social security is less than adequate for the people running these places. I have noted that on the few occasions I've had minor stomach upsets (with one exception) it has been in restaurants in the USA, and not while travelling.
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  #23  
Old 24 Nov 2022
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Originally Posted by Snakeboy View Post
When it comes to treating a stomach bug infection - well its fine to disagree. We can try to have a fruitful discussion about this subject.
You're right, and I was wrong; parasites are less common than bacteria as sources of stomach upset. I'm afraid I fell into the trap of confusing my personal experience with what is generally true. After your post I did a bit of my own research, which confirmed the essence of what you said.

My direct experience has been that presumed bacterial GI stuff usually self-resolves, while giardiasis lasts and lasts without resolution, responding only to anti-parasitic meds like metronidazole. I've also had amoebic dysentery, which has a somewhat different presentation but worse potential outcomes, and is also effectively treated with metronidazole (and similar, like tinidazole). Note that these experiences involved South Asia--specifically Nepal and India--and rural West Africa. I've had no similar experiences elsewhere in Africa, Asia, Europe, or the Americas.

On extended travels I carry antibiotics from a couple of different families (usually a fluoroquinolone and a penicillin), an anti-parasitic like metronidazole, plus a raft of other meds and first aid supplies. I'm a big fan of self-diagnosis and treatment, but of course official advice is to consult medical professionals at every opportunity--none of these meds are without side effects, some serious. Metronidazole, for example, is considered a carcinogen.

As for that research, here are reliable estimates for annual waterborne infections in just the USA: Otitis external ("swimmer's ear"), 4,670,000; Norovirus, 1,330,000; Giardiasis, 415,000; Cryptosporidiosis, 322,000; Campylobacteriosis, 171,000. (The same source stated an estimated 219 annual *deaths* from swimmer's ear, suggesting that none of these is to be taken lightly.) In any case, although norovirus is three times as common, there are nearly a half million cases of giardiasis--and this is in the USA, where water supplies are generally quite safe.

My apologies for posting without first checking my assumptions, and my thanks for disagreeing calmly and respectfully! Wishing you continued safe journeys and boundless enjoyment!

Mark
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  #24  
Old 24 Nov 2022
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Quote:
Originally Posted by estebangc View Post
First off, apologies if I did not find the thread for this topic

I understand that the best way, it is to eat local food -especially, raw uncooked- progressively, so that your stomach gets used to it, while using common sense with limitations (local people, used to germs and bacteriae also get sick and food poisoned).

Do you have any tricks to ease the process or adapt somehow beforehand? Curiosity to know if anyone stopping washing hands, eating old food/leftovers…

Esteban
Before I departed to travel/work throughout China I checked in with my MD and ND (naturopathic doctor) with much the same questions as you have posted.

As has already been stated by others my MD recommended shots and cypro – which I anticipated.

My ND however took me on a slightly different course and suggested I improve my gut health with pro-biotics before departure.
This was a new concept to me at the time.

I started the daily pro-biotic (apparently a product developed by/with NASA for the Space program) and immediately noticed an enormous difference in mood, energy and stamina during exercise.
This initially surprised me as I considered myself in excellent health.
I have become a big believer in the importance of gut health or biome in general.

He also recommended a natural antibiotic GSE or grapefruit seed extract which I still use to deal with moderate bugs and viruses while travelling or at home.

One thing I remember Ted Simon commenting in one of his books was how when his mood was seriously down (i believe while jailed upon arrival in SA) or he was very tired his susceptibility to illness noticeably increased.


HTH - Have a good trip
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