Diarrhoea and Vomiting

 "My child won't stop vomiting, any food or drink he has, he just vomits it back up!"

Tommy, a four year-old boy, sits quietly in his mother's lap. He had been vomiting 4-5 times each day for the past 2 days. Every time his mother gives him something to drink, he would vomit it back up 20 minutes later. He has not had any food except for one or two crackers. He has also been passing loose watery bowel motions.

He has also had a fever.  

What should we do?

1. Lower the fever - unwell kids are generally lethargic and look tired because of a high temperature. They tend to become more energetic when the fever is lowered. Paracetamol and Ibuprofen are both good choices, and do not interfere with each other, while working on pain and temperature in different ways. So feel free to use both! An important point is to dilute the flavour of the medicine, as they can be quite sickly sweet, potentially making them vomit again. Do this by adding water to the dose they are on.

2. Small amounts, frequently - when they are feeling nauseated, stretching the stomach with too much fluid can trigger another episode of vomiting! Give a teaspoonful of fluids every 5 minutes if you have to.

3. Keep up the fluids - even if it seems like they vomit a lot, if they drink some fluids, some will still enter the intestines and be absorbed.  

4. Rehydration solution recipe - 1 liter of water, half a teaspoon of salt, 6 teaspoons of sugar. Drink up!

5. Vomiting and diarrhoea is the body's way of flushing out the bug that is causing the illness. It is not the frequency that is the problem, it is whether the body has enough fluids to do that. So drink up!

A quick way to assess whether a child is dehydrated - mouth, is it wet or moist? Do they cry tears? If their tongue is moist and they still have tears, they are very likely still very well hydrated.

If in doubt, get checked with a doctor!

Allergy vs. Intolerance vs. Side Effects

Recently a patient came to me with a cough and a lot of green sticky mucus coming out of his nose, along with a list of other symptoms. We agreed that he had a sinus infection.

"Don't give me erythromycin, I'm allergic to that," he explained.  I asked him to clarify what reaction he has to it, and he says that he gets severe nausea and vomiting with it.

Which brings me to a fairly confusing situation for a lot of people: What's the difference between allergy and side effects? And what about intolerance, is that different again? 

Allergy - hypersensitive reaction of the body to certain things. This can be medicine, or things in the environment, eg. grass pollen. The body has an immune system that rises up against things that could damage us, and attack it. In the course of attacking, it may cause 'collateral damage' as well. An allergy reaction can range from a simple rash (temporary 'collateral damage' to the skin), to anaphylaxis, which is a life threatening whole body reaction. This would be cause to avoid the offending medication completely, as it can potentially be bad for health.

Side Effects - if a medicine is to be effective, there will always  be potential side effects. For example a side effect of some antibiotics is to cause diarrhoea (See my Probiotics post from earlier).  This is not the body's reaction to the medicine itself, rather the medicine has an additional effect, that is unwanted. Therefore it is called a side effect. This may not be grounds to avoid the offending medication, however if the side effect is severe enough, sometimes it is best to avoid it anyway. However it does not necessarily mean this medicine is bad for health.

Intolerance - generally refers to food, not medicine. If the body cannot process a particular food, then this would be deemed an intolerance. For example, most humans have a certain degree of cow's milk intolerance. Some reactions are severe - most commonly abdominal pains, and diarrhoea; and some reactions minimal - no symptoms at all. This is due to the fact that some people are not able to digest lactose, or milk sugar.   It would be a personal choice, to avoid or continue taking the particular food - dependent on how it affects the body, but in general it is not bad for health.

Take milk for example:

A milk allergy, would be after taking milk, the skin breaks out in a rash or eczema gets worse. I would advise to avoid milk.

Getting the runs after having a glass of milk, would be considered an intolerance. Perhaps only indulge once in a while, in the comfort of your own home when you can rush to the bathroom.

Take antibiotics for example: 

Antibiotic allergy could cause a range of symptoms, for example itchy and swollen tongue - avoid!

Antibiotic side effect - could be nausea and vomiting. Which in the case of my patient with the 'allergy', turns out one of the most common side effects of erythromycin is nausea, vomiting, and diarrhoea.  

Ask your doctor if a particular reaction is an actual allergy, which would almost definitely exclude the use of that medicine in the future.  

Cough Cough Cough!

Is coughing bad for health?
A lot of my patients come to me, worried about the amount of coughing they or their child has.

I will often reassure them that coughing in itself is not actually dangerous in the majority of the cases, in fact, it is actually the body's way of protecting itself.

When we have a cold, because of gravity, a lot of mucus drips down into the main breathing tube (trachea), or even lower down. This mucus brings a lot of virus or bacteria with it.

This irritates the lining of the trachea, making us cough, to bring up the mucus.

If we did not cough, the mucus with a lot of bugs is allowed to sit on the lungs, where it is warm and moist, and the bugs starts to reproduce. Then the head cold turns into a chest infection (pneumonia), otherwise known as an infection of the lungs. This can make us very unwell indeed.

Therefore, in most cases, coughing is actually the body's protective mechanisms working properly!

However, as we all know very well, coughing can often be disrupting and uncomfortable, not to mention painful at times. Therefore sometimes medicines may need to be prescribed to allow some break from the relentless coughing – something to suppress the cough. I usually recommend only using this at night to allow some sleep, but not during the day. This is just so the body can clear up the mucus.

Antibiotics does not target the cough itself, rather the bacteria that may be causing the mucus and irritation. That is why not all coughs require antibiotics, and antibiotics doesn't always get right of a cough right away.

One of the few times when coughing is a big problem – is in Whooping Cough, or Pertussis.

Whooping Cough in young children, especially under 1 years old, can cause coughing so severe that they run out of breath!

If in doubt, speak to your doctor about your concerns.

Probiotics

"Should I take probiotics with these antibiotics?" Recently a patient in her early 30's, with a long history of repeat throat infections, asked me.

In recent years, there has been increased interest in the use of probiotics.

What are probiotics?

They are consumable beneficial bacteria, that will settle in our guts once we take it.

Bacteria in our gut?

There are actually a lot of food we consume, that we cannot digest properly. We have a whole lot of good bacteria living in our intestines, that help break down the food we eat, which we then absorb.

This is why sometimes during or after a course of antibiotics, we can get an attack of diarrhoea – because the good bacteria have greatly reduced in numbers, causing us to pass a whole lot of undigested food, and a lot of it.

The purpose of taking probiotics, is to replace the good bacteria that has been lost during a course of antibiotics.

For someone who is prone to indigestion, diarrhoea, or requiring multiple courses of antibiotics, probiotics would be a great way to maintain the health of the digestive system.

Is having yoghurt enough?
There certainly are some beneficial bacteria in yoghurt, however almost never enough. With transporting and sitting on the shelves at the supermarket, there would not be enough to be helpful by the time it gets to our refrigerator.

Probiotic supplements or special probiotic yoghurt would be the way to go.

In the end, for my patient with the recurrent throat infections, I prescribed her a course of antibiotics, but I also recommended that she take probiotics, for the throat.

BLIS K12 Throat Guard (TM), is the only probiotic specifically designed for the health of the mouth and throat. It was developed right here in New Zealand, at the University of Otago. It has been proven to be helpful in reducing the number of throat infections, in particular Streptococcal pharyngitis, commonly known as 'strep throat'. Ask your pharmacist about this product if you or your child suffers from throat infections, tonsillitis or bad breath (halitosis).

The best way to think about repeat throat infections, is to compare it with a neighbourhood of houses.

If a whole lot of 'nice' people live in the houses, the neighbourhood would be a good area. If a whole lot of 'nasty' people live in the houses, the neighbourhood would be a bad area.

If we move the 'nasty' people away, there would be a whole area of empty houses.

Nice or nasty people may move in, making it a good or bad area (again).

After we kill off the bad bacteria, if good bacteria move back in, you won't get a sore throat.

But if the bad ones come back, you will get another sore throat. Probiotics replaces the empty houses (your throat or guts) with good bacteria – making the area a happy place!

Superfoods versus Prostate Cancer

Earlier this year, a group of scientists have proven the effect of superfoods on slowing down prostate cancer. The team is led by a British oncologist - Professor Robert Thomas of Cambridge University Hospitals.

In a trial involving 203 men with prostate cancer, a combination of pomegranate, green tea, turmeric and broccoli extract were given to half of the group, while the other half took the placebo.

After six months, the trial group taking the purified polyphenol-rich food pill had reduced PSA levels by 63%, compared to the placebo group.

PSA, or Prostate Specific Antigen, is a protein in the blood that is produced by the prostate gland, which is an indicator of prostate cancer.  

Although polyphenol-rich foods have been shown to have anti-cancer properties in the laboratories, there had, up to now, few studies that have shown a strong relationship between these properties and slowing cancer in patients.

Professor Thomas had been invited to the American Society of Clinical Oncology (ASCO) conference in Chicago earlier this year, and presented these landmark results in front of 28,000 oncologists. The scientific organising committee chooses 10 of the most significant research projects in each cancer topic from around the world.   

He said, "We hope this will help millions of men to help combat the onset of prostate cancer. "  

As well as the large clinical effect on PSA, the study also showed there were virtually no adverse effects and significantly fewer men proceeded to potentially toxic therapies at the end of the study.  

 “Healthy eating and lifestyle is the main way of helping to combat the development of cancer but men can now also turn to a whole food supplement which has been shown to work.”