Now For Something Completely Different

I notice I've been grousing a lot on the old blog lately. Time - sez I to myself - to write something uplifting, or at least useful. Vacation time is just around the corner. So here:

Don’t Deny the Devil

There are certain things in the making of recreational choices that color one’s judgment, like a well-tinted pair of sunglasses can make a day look more glamorous than it really is, or a quickly drained dram of tequila can have the same effect on a candidate for social intercourse.

The hint of danger is one of those “certain things.” Hints of danger have various thresholds for individuals. Popping one’s ‘chute a thousand feet closer to the ground than usual might hint of danger to a jaded skydiver making the experience beguiling recreation. To the rest of us there are usually less well-defined danger hints. Just considering that hit of tequila, for instance, puts some people off as being ‘way over the limit, fully into danger.’ Depends on your age sometimes, or on your personal history with tequila.

One definition of “hints” of this sort is that the actual danger is more or less deniable. “Never happen” is a solid denial. One with a little less certainty is “Never happen to me.” Could happen, but me? Nah. Then there is the best, spiciest denial, taking the benefits of a hint of danger to the max, the “could happen, but...” you can handle it. This leads to double checking the backup parachute, packing the snakebite kit, putting the extra inner tube in your backpack for the bike ride; so it is not a bad thing at all.

These hinted dangers are not always glamorous or fodder for a good story (“That little rattler must have snuck into my sleeping bag while I was boiling the coffee...”) Consider, if you will, the inherent limitations of telling the story of your bout with la Tourista.

That is the danger this little piece is about, The Touristas, an ailment so vile that it is the “Devil” in the title. There is an almost universal hint of the danger of Tourista in travel, especially to Mexico and an odd mix of other second world countries.

Like many real dangers, it is somewhat misunderstood. Since it involves the less speakable bodily malfunctions, diarrhea for the most part, there is an inevitable aura of bano humor around it. (“Take a canteen of Pepto-Bismol with you, amigo!”), which is classic “could happen, but...” denial. It could happen, but you can handle it. Well, here are the hard, cold facts.

Definition: At worst, “the touristas” is a hybrid viral/bacterial/parasitic/toxin affliction involving the whole alimentary canal, mouth, esophagus, stomach, duodenum, small intestine, colon and anus, plus everything that depends on that wonderful system, i.e. every other part of your tender body. There are milder forms, say only involving bacteria and not quite so devilish, but let’s look the whole demon in the eye here.

First, Tourista is one helluva lot more common than snakebite or smushed skydivers. It happens a lot. Be a tourist in the land of Tourista often enough and you will have a dance with that devil. It’s a statistical thing. Avoidance is the best therapy, of course. So follow the common sense of:

LIST ONE.

  1. Face it, it could happen. Think ahead.

  1. Be careful about where and what you eat. (References may be the only functional criterion.)

  1. Wash your hands like your happiness depends on it. (Guess what?)

  1. Eschew ice cubes. (Parasites and their pals don’t mind low temperatures.)

  1. Drink only beer, Coca Cola and Perrier (Good for the local economy, too.)

  1. Take preventative drugs. (There are a bunch – ask your doctor)

Even with all that, there is the horrible truth... It can still get you. I am talking first hand experience here.

If it does, you might decide a good, clean snakebite is preferable. Tourista is one sombitch of a short-term disease. So let’s get down and talk Tourista.

It can start pretty much anywhere between the in/outlets, but probably the most common beginning is in the tummy. The digestive action in the stomach goes dead stop to start with. Whatever last you ate simply sits there. Those valves that pass the most recent meal down the tubes, so to speak, go on strike and nothing moves. You feel overly full. “Why did I eat so much?” you say, then you typically comment, “Hell, I didn’t actually eat all that much,” but you feel like you ate two horses and a cavalryman. While you know this is not a good sign, in all likelihood it won’t occur to you that this is the start of something really bad because you felt this way last Thanksgiving and nothing much came of it. Also, whatever stereotype you have of Tourista doesn’t include this overly full feeling.

Next thing you know, blam, one of the other valves -- the one that is supposed to keep what you ate eaten -- suffers a system crash and you are lucky if you make the toilet, renamed for the event the vomitorium. There it all is, undeniable and wretched, blasting out of your mouth, up your nasal cavity and all around the place. I have asked several victims of this situation what they think in this early stage of the disease. My conclusion is that the mind is a wondrous thing, because the most common response is “I always feel better after I barf.” Right.

Timing is everything, as you have heard, and that was as likely scripted in hell as heaven, for as surely as penance follows sin, diarrhea follows hotly after regurgitation with Tourista, often so hotly that you are still trying to clear burning excretions out of your nose when yet another major valve failure comes to the fore. All this can escalate to genuine excess as you can imagine, with “firing from both barrels” barely adequate as a description. There is a perverse timing of another sort: mostly this all happens around midnight.

The victim of this bodily revolt, the inner person, is rather like a novice sailor caught in a violent squall. The mind tears in two directions at once. One direction is pain, confusion, resentment, “this can’t be happening,” self-pity and a fine panic. The other is more practical and generally shaped by the kind of person you are and how you habitually deal with problems. With some it is to blame. “That goddamn café; those dirty, germ ridden sonsabitches who never wash their hands; that vice ridden health department lackey who takes pesos over public health,” etc. With others it is solution searching. “Is the Pharmacia open? What are the best short-term remedies? Do I need to see a doc? How the hell can I find a doc in Matamoras at midnight?”

It is to this second crowd that my advice is aimed. Not that it will actually help much, but it can’t hurt.

WHAT TO DO WHEN THE BAD BUG BITES

This is a simple list. It’s simple because there are relatively few things you can do. If List One demonstrably didn’t work, go to:

LIST TWO

1. Kill pain. (It helps 2 through 8 below. Besides, it’s an American tradition.)

2. Stop barfing. (“Anti-emetics” are the ticket. Phenergan, Reglan, Merezine, Meclizine and a whole menagerie of other –zines are available with a prescription. Perhaps the only effective over-the-counter antiemetic is benadryl.. The problem is holding down whatever you swallow, so try to get a suppository. Be careful, some of them burn – something you really don’t need at a time like this.)

3. Fight dehydration (…After you accomplish #2, drink lots of bottled water, sports drinks [Gatorade, et al], Pedialite [baby stuff]; NOT beer, colas, coffee, milk, Tequila.)

4. Slow the out-of-control peristalsis (Any of the loperamide meds – like Imodium; better yet, codeine [Also good for # 1 & 8 – and which you can frequently get over the counter in Mexico], and there are a whole bunch of non-prescription potions: attapulgite, bismuth subsalicylate (Pepto-Bismol), kaolin/pectin (Kaopectate). They sort of work.

5. Reduce inflammation (not to get personal, but use Tucks or other medicated wipes. Put soothing balms like Preparation H where the sun don’t shine.

6. Suppress anxiety. (If you or a traveling partner has a Xanax, Valium or Klonopin, try to keep some down. If you are an herb nut and have cats claw, kava kava or the like, be very careful – who knows about these and gut trauma?)

7. Adjust your schedule (Forget the snorkel dive in the Cinotes until the plague passes. Even forget today’s plane if it’s bad enough.)

8. Be philosophical (Be philosophical.)

9. Identify and Attack the microorganisms (This goes beyond simple shit, so to speak. Check out this list of bad guys from Boston University. Either look at their site: http://www.bu.edu/COHIS/infxns/common/diarrhea/diarrhea.htm,

… Or just read their list here.

INVADING AGENTS

Escherichia coli (Enteroinvasive E. coli)

Salmonella (Salmonellosis)

Campylobacter

Yersinia

Parasitic Causes

Giardia lamblia

Cryptosporidium

Entamoeba histolytica

Viral Causes

Rotavirus

Norwalk Agent

Calciviruses

TOXIN PRODUCING

Cholera (Vibrio cholerae 01)

Shigella (Shigellosis)

Escherichia coli (Enterotoxigenic E. coli)

E. coli O157: H7 (Enterohemmorrhagic E. coli)

Clostridium difficile

Bacillus cereus

9. SO… If you are really sick (more than a day is a good marker), get thee to a competent physician and have him give you the latest neutron-bomb-level medication.

I hope this didn’t gross you out, and enjoy your vacation!

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