Search for tag: "diarrhea"

Dr. Gellner: Diarrhea in children can be caused by many things, but some Old Wives' Tales out there about diarrhea are just plain not true. We'll separate diarrhea facts from fiction on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Remember that one thing that one person told you that one time about what you should or shouldn't do when raising your kids? Find out if it's true or not. This is Debunking Old Wives' Tales with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Everyone says that diarrhea is part of the stomach "flu." Imagine me doing air quotes. That's a myth. There are many viruses that cause diarrhea, however, influenza normally affects the upper respiratory system, not the digestive system, thus, the flu vaccine will not protect against diarrhea.

When it comes to medications, yes, this is true. Some medications can cause diarrhea, especially antibiotics. They kill both good and bad bacteria in the entire body. Giving your child probiotics will help replace the good bacteria and decrease the diarrhea.

What about sugar? This one's true, as well. Sugars in soda, sports drinks, and even natural sugars found in fruit can cause diarrhea. We see diarrhea in toddlers a lot because they drink a lot of juice, and actually, the diagnosis for that is "toddler's diarrhea" and it resolves when parents cut out juice. Sugar draws fluid into the intestines, making the stools more watery. Some sugar substitutes, like Sorbitol, and caffeine even, have the same effect.

Parents often say that their child has diarrhea because they're teething. That one's a myth. Your baby can be cranky or irritable, but if they have diarrhea or a fever, that's going to be a virus, not teeth.

What about fiber? Okay, this one's tricky. Soluble fiber, like what is found in beans, peas, oatmeal, peeled fruits, and cooked vegetables, causes water to be absorbed in the intestines and the stool gets harder, but insoluble fiber, found in the skins of raw fruits and vegetables, whole grains, and wheat bran, may speed up stools as they pass through the intestines and cause diarrhea.

If your child has diarrhea, the most important thing is to make sure your child is hydrated. That's the biggest risk for kids, and the younger they are, the bigger the risk. And if your child's diarrhea lasts longer than three weeks or has blood in it, then it's time to visit your pediatrician.

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Interviewer: What should you do if you have a case of diarrhea? We're going to find out next on The Scope.

Announcer: This is From the Frontlines, with emergency room physician Dr. Troy Madsen on The Scope.

Interviewer: Dr. Troy Madsen is an emergency room physician at University of Utah Health. Let's talk about diarrhea and what should somebody do if they start having diarrhea? Should they be taking some medication? Should they be going to see their doctor? When should they start worrying?

Dr. Madsen: So diarrhea is obviously not the most pleasant topic. It's something probably all of us have dealt with at some point or another. But it's one of those things where you kind of have to give it time. And we do occasionally have people who come to the ER who have had diarrhea for say 12 hours or so. And they're very concerned. And they don't look particularly dehydrated, they've been able to drink plenty of fluids and stay hydrated. They don't have other medical issues that would make them more likely to get really dehydrated. So those are the kind of situations where you know, you really want to give it some time to see what happens.

Because most cases of diarrhea, assuming it's from some sort of a bug or maybe something you ate, are going to get better within 24 hours. Maybe they'll last two days, maybe up to three days, but even if someone comes to the ER and they said, "I've been having diarrhea for two or three days." And I look at them and it's not like their lips look really dry and their eyes look sunken or they look like they're just really dehydrated. And they're not the kind of person who has lots of medical issues that would make them more likely to get dehydrated. I say, well, not a lot of testing we really need to do here. We don't really need to test for really unusual infections. You're probably going to get better within a day and usually it does.

So if you're someone who has diarrhea I'd say, give it a couple of days. Keep drinking fluids. You can try drinking electrolyte drinks. Those might help and make a difference. You're not losing lots of electrolytes, which can be an issue. But if it's gone on for longer than that.

If you're getting beyond three days and maybe into four or five days and maybe you've been camping recently. Or you've been swimming in mountain streams or lakes or drinking from mountain streams. Or you have a new pet. Or you have a pet turtle you found out while you were traveling and you pulled it out of a stream. These unusual things that would set you up for something more serious like giardia or salmonella. Things where we start to think about unusual infections. Those would be cases to come to the ER or see your doctor and get tested for that.

Interviewer: So generally, up until about two days, if somebody came into the ER you wouldn't run many tests if they looked healthy and they weren't at high risk of something else, you just have them wait and see?

Dr. Madsen: Most likely. I mean the reality of the ER there is the dynamics of the ER where the fact that someone comes in the door they often just get testing done. But it's typically not really necessary.

Interviewer: So if it was a family member you would say just wait it out for another day or so?

Dr. Madsen: I would. If a family member called me and said I've had diarrhea for a day or two I'd say wait it out. I would ask them has it been bloody diarrhea? That raises concern for me. But most of these cases people are just having kind of normal diarrhea. Just frequent bowel movements. Watery, they're not describing blood in their bowel movements. If you're seeing those sorts of things, that's going to change things a bit. But, typical diarrhea. Give it a couple of days.

Interviewer: Would you recommend taking any sort of antidiarrheal?

Dr. Madsen: If we're worried about an infection like salmonella. So those unusual cases where let's say you've had recent foreign travel or you have had recent exposure to mountain streams and you're drinking from mountain streams or swimming in lakes. There we're hesitant to say use something like Imodium. Just because people that have those infections can then become chronic carriers of the disease or it can make things worse. But in the average case of diarrhea where those are not a concern, I think Imodium is perfectly fine. I don't think there's a problem at all. If it can help you get through the day, get through work, whatever you have to do. No issues with that.

Again we're talking here about the average person who doesn't have a lot of medical issues. Times where you would be more concerned about diarrhea. Even after a day or two would be . . . If you do have some medical problems that make you more prone to dehydration. Maybe you take a water pill. Something for heart failure or for kidney issues that takes water off. And then you're losing fluids because of diarrhea. Maybe you then start to feel light headed. Or you're dizzy. These would all be things where I would say where I would say yeah, you need to come to the ER. You may need some IV fluids. We may need to rehydrate you.

Also, very young children. If they are really just not taking fluids well. When they cry, they're not making tears. Their eyes look sunken. You look at their mouth, their lips look dry. Again, reasons to go to the ER even after maybe even 12 to 24 hours of diarrhea.

Interviewer: Sounds like in the common cases it's dehydration you're most worried about?

Dr. Madsen: Exactly, dehydration and then along with that electrolyte abnormalities where you can lose electrolytes with the diarrhea.

Interviewer: All right, so watch out for those things. Think about, have I done anything strange or unusual recently that might be the cause of this that could be a little bit more insidious. Otherwise just wait it out.

Dr. Madsen: Exactly, give it some time. It'll run its course. You'll probably get better within a day or two.

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updated: May 30, 2018
originally published: September 6, 2016

Interviewer: Using Imodium to treat opioid withdrawals: a bad idea. We'll find out more about this disturbing trend next on The Scope.

Announcer: This is "From the Frontlines" with emergency room physician Doctor Troy Madsen on The Scope. On The Scope.

Interviewer: Doctor Troy Madsen is an emergency room physician at University of Utah Health Care and he said he'd seen a couple instances where people are using Imodium, which is an anti-diarrhea medication, as a way of trying to treat their withdrawal symptoms from opioids. I find this hard to believe. What's going on?

Dr. Madsen: Yeah. So this is really interesting. So as you may know, there's an opioid epidemic in our country and the Centers for Disease Control has acknowledged this and said we have so many people who are using opioids now. So prescription opioids, things like Percocet, Norco, Oxycodone are using that for to get high. Essentially what they may consider it legal high because they're getting a prescription or it's a prescription medication they're buying from someone.

So then, these individuals may then be saying to themselves, "I really can't be doing this. I need to get off this medication." So they're finding things on the Internet that discuss using Imodium or loperamide is the generic name and using that to sort of detox, taking that as a bridge to give yourself some of the same effects as the opioids give you while allowing your body to adapt and adjust and then gradually get off the medication.

Interviewer: So, first of all, bad idea trying to self-treat an addiction like that?

Dr. Madsen: Absolutely, not a great idea. But the reason they're doing this is because it's probably been out there for years and then I think it's just gained steam with some people posting things on the Internet about this. But Imodium or loperamide is actually an opioid. It doesn't give you the same high as things like Oxycodone, but it has kind of the same effects, acts on some of the same receptors in the body.

That's why it help with diarrhea because if you've ever heard of someone who says, "Hey, taking all these Percocets and I can't have a bowel movement. It constipates me." Well, that's kind of how this stuff works for diarrhea. Same kind of idea. It slows down the bowels but also then acts on somebody's same receptors in the body that opioids act on that people are using for highs.

Interviewer: Yeah. So self-treating bad but, above and beyond that, Imodium causes other problems that you see then?

Dr. Madsen: It does. And the big thing we're seeing is some of these people are just taking such incredibly high doses that it's been putting their heart into these arrhythmias, these abnormal heart rhythms that are life-threatening. And that's where we see it in the ER. I've seen cases of people coming in who are in just these crazy heart rhythms, these life-threatening heart rhythms and it's because they're taking large doses of Imodium and then that is triggering this heart rhythm.

And really, it's the kind of heart rhythm where you've got to shock their heart to get them out of it, get them on medication, do something for it or their hearts just not going to keep working and they're going to die from this.

Interviewer: That doesn't sound much better.

Dr. Madsen: It doesn't. It's not a great thing to do.

Interviewer: It doesn't sound like a great solution to the original problem.

Dr. Madsen: Yeah, there's not. There are much better solutions to opioid addiction and to getting off that. It's a sort of thing where you've come into the ER, we will often get people into in-patient detox programs. We can also prescribe medications that can help with this. So I would not recommend taking Imodium or loperamide. Again, that's the generic name for it. I would not recommend taking that to treat an opioid addiction because of the threat of these abnormal heart rhythms.

And this really comes up because there was actually just a study published or report in one of the big emergency medicine journals talking about increasing cases of this and increasing calls to poison centers for people who are taking more and more of these medications to try and treat opioid addictions and then are having very bad effects from this.

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Dr. Gellner: Like all food allergies, milk allergy can be difficult to manage in a child. How can you help your child when milk is a common ingredient in so many foods? I'm Dr. Cindy Gellner with some tips for this tricky food allergy on today's Scope.

Announcer: Keep your kids healthy and happy. You are now entering the Healthy Kids Zone with Dr. Cindy Gellner on the Scope.

Dr. Gellner: A milk allergy is not the same as lactose intolerance. Lactose intolerance only affects the digestive tract and it cause symptoms such as bloating, gas, and diarrhea. A milk allergy is a reaction by your child's immune system to the protein in milk. Our immune systems normally respond to bacteria or viruses that attack the body, but sometimes the body's immune system mistakenly believes that a harmless substance such as the proteins found in milk are harmful.

In order to protect the body, the immune system goes on attack with antibodies against that food. And the next time you eat that food, your immune system releases huge amounts of histamine to protect the body against the evil food proteins. That is what causes the symptoms that make us so miserable.

Casein is the main protein found in milk. It is found in the solid part of milk called curd when the milk goes sour. Whey, which is the liquid that remains once the curd is removed, contains the rest of the proteins. Your child can be allergic to the proteins in the curd, the whey, or both.

In very young children, cow's milk is the leading cause for allergic reactions. Milk is one of the eight foods that are responsible for food allergies in children. The other foods include eggs, soy, peanuts, tree nuts, wheat, fish, and shellfish. The good news is that most kids outgrow milk allergy by two or three years of age.

If you think your child is allergic to milk, dairy products, or any other food, it is important to get a diagnosis from your pediatrician or an allergist. Usually the history of the reaction is all we need to determine the allergy. But there are blood tests to confirm for some of these foods.

Milk allergies are typically discovered very early in formula and breast-fed babies. If a mother drinks cow's milk, the milk protein also comes out in her breast milk. The symptoms seen in milk allergy depend on whether or not the child has a slow or rapid reaction to milk.

The slower reaction is more common and the symptoms develop over time. Symptoms that occur slowly over several hours or sometimes days include diarrhea, often with streaks of blood, wheezing, rashes like eczema flares, and failure to grow very well. Symptoms that occur rapidly within seconds to hours may include severe wheezing, vomiting and hives.

If a mom is nursing, the pediatrician will most likely recommend avoiding milk products to the mom and taking calcium and vitamin D supplements instead. If your baby is formula fed, sometimes pediatricians will recommend a soy-based formula. These formulas contain soybean proteins, vitamins and minerals. The switch to soy formula helps for about half of the baby's allergic to milk. For those babies who still have reactions to milk proteins, pediatricians recommend hypoallergenic formulas. There are two types.

Hydrolyzed formulas contains proteins that have been broken down so they are easily digested and less likely to cause a reaction. These include Nutramigen, Alimentum and Pregestimil. Elemental formulas have proteins in their simplest form and are used when hydrolyzed formulas continue to cause symptoms. These include Neocate and EleCare.

The only treatment for a child with a milk allergy is to completely avoid milk and foods that contain milk products. Many processed food and restaurant foods contains milk or processed milk products. And you will need to change the way you shop and prepare foods.

The first step is to learn how to read labels and become familiar with ingredients that contains milk or dairy products. Always ask about ingredients if you are not sure. Foods and ingredients that contain milk include milk from other animals such as a goat, as well as yogurt, cheese, cottage cheese, cream, anything with casein or whey, butter and sadly chocolate. And also be careful of any ingredients that begin with "lac" such as lactose, lactate, lactalbumin, and lactic acid, and also fat replacers such as Simplese.

Reading labels to avoid allergens has become a lot easier. Foods that contain common allergens must be listed in plain language on the ingredient list. There are still some things to watch out for when reading food labels. Watch out for the words "may contain". Milk may not be an ingredient but the food may be made in a factory which also produces foods made with milk. If you see the words "may contain," there may be very little of the allergen or there may be a large amount.

A common question from parents is how to avoid cross contamination. Avoid battered or fried foods. The oil is often used for many different items, some of which may contain milk. Separate cooking utensils, cutting boards, and dishes used to prepare dairy products from those used to prepare food for your child.

Your child can still have a healthy diet as well as continue to enjoy some kid favorites. The main nutrients found in milk are protein, calcium, vitamin D and riboflavin. It is important to either take supplements or eat foods that are high in these elements. There's a lot of protein in milk, poultry, pork, fish, beans, nuts, and seeds. Ask your pediatrician about calcium and vitamin D supplements. Good sources of riboflavin are meat and eggs, whole grain or enriched cereals, and dark green leafy vegetables. Many foods such as bread and orange juice are now supplemented with calcium and vitamin D.

There are several brands of soy and rice milks that are enriched with calcium. They can be used for drinking and to pour on cereal. If milk is part of a recipe just to provide liquid, you can substitute water. Soy and rice milk, as well as fruit juice works well when substitutes baking. Oils, milk-free margarines, and soy butter can take the place of butter.

You can also visit foodallergy.org where there are many other helpful tips. Prepare your child's lunch at home. Talk with teachers about your child's needs. Ask the teachers to keep an eye out and explain the situation to other children if needed. Have the teacher call you if there is a special event or party planned so that you could bring a few modified treats that your child enjoys and can share with other kids. Make a card that lists foods and ingredients that should be avoided and give one to the teacher.

Living with food allergies is possible. I'm proof of that. By making others aware of your child's food allergy, you will keep your child safe. If your child is old enough, even as young as three or four, make sure they are aware of their food allergy. This will empower them to be in charge of their own health.

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