The first time I landed in Shanghai I was in awe of the sheer size of the city and the awesomeness of traveling (for my first time) to another country. As a young musician, my band had been booked as the resident artists in a hotel in China for 6 months. We really felt like rock stars. Our hotel was very well known we had the nicest suites I had ever stayed in. Keep in mind at that time I was used to sleeping in 2-star hotels and our touring van.

Our laundry was done for us, the concierge Hsin Xin (pronounced Sin Shin) called me “Mr. Mitchell” and our food was supplied by the all-day dining room. The food was amazing, and there was something from almost every country. The Indian chef Rajish often made something special for us when he was on shift and spoiled us daily with this very decadent banana dessert that was his mom’s recipe.

Yes, life in Asia was golden, until one day as we sat to eat breakfast and I felt this sudden … urge. Montezuma’s Revenge is the most accurate description I can come up with given the subject matter of this article. While I have never witnessed a volcano erupting, I really felt I was about to understand the process more completely; and very soon. To the bewilderment of my band, I rushed out of the restaurant and, well, I will spare you the details but suffice to say it was 4 days I don’t ever care to repeat.

TD, travellers stomach, travelers diarrhea, Montezuma’s Revenge; whatever the term you use, you don’t want to get it. The common cause of the condition is any bacteria such as Escherichia coli (E. coli), Campylobacter, Shigella, or Salmonella. These bacteria thrive in unsanitary water supplies and raw or undercooked food. Because the western world has a more advanced approach to food safety and sanitation, we would rarely experience any such incidents here. However, in destinations like Asia, Africa, the Middle East, Mexico and Central/South America, the water sanitation and food safety is (by western standards) lower. This presents a high risk for travellers whose immune systems are not used to these conditions. It should also be noted that places like Eastern Europe, South Africa, and some Caribbean islands do carry an intermediate risk as well.

Despite the ads for preventative antibiotics, my doctor was very wary about prescribing them as a preventative measure. According to my doctor, there is a lot of research that is showing the antibiotics used to prevent Montezuma’s Revenge can create even more scary strains of the bacteria. The CDC has gone on record to state that they too do not endorse these medications.

So what’s a traveller to do? Well, my friend here are some tips to avoid TD.

  • Bismuth subsalicylate, or BSS (such as Pepto-Bismol or Kaopectate), has been shown to be effective in preventing and treating traveller’s diarrhea. It is usually not recommended for treatment in children younger than age 12 years. Bismuth subsalicylates may reduce the effectiveness of medicines taken to prevent malaria and should not be used for more than 3 weeks.
  • Avoid drinking local water or ice cubes where you are travelling. Beverages that are usually safe to drink include: tea and coffee (if made with boiled water), carbonated bottled water or soda pop, bottled beer, and wine.
  • If you are planning on being somewhere very remote or far from civilization, water can be filtered or treated with iodine to make it safe to drink. There are also water purifying tablets you can pack with you.
  • If it’s not boiled, well-cooked, or if someone other than you has peeled it; don’t eat it. Raw seafood and milk products usually are high-risk foods for bacterial contamination. Dry foods, such as bread, or fruits that you can peel are safe to eat. Avoid fruits and vegetables that have been cut or handled like grapes, carrot sticks or fruit salads as they will have been washed with untreated water.
  • Contaminated water may be used to clean utensils and plates so always ask for a pot of hot water you can wipe them off with.
  • Be careful brushing your teeth (used bottled water if you can). Also, be aware in the shower if the water is not hot.
  • Avoid eating food from street vendors in high-risk areas. If you purchase food at an outdoor market, make sure you boil it, cook it thoroughly, or peel it before you eat it.
  • Good handwashing is important in preventing the spread of infectious diseases. Washing with treated water or using alcohol wipes or antibacterial gels to disinfect your hands are good ways to reduce your risk.

If you do find yourself in a bought with Mr. Montezuma, hunker down and get comfortable being very close to a bathroom. I’m not going to lie to you, you’re in for a few days of unpleasantness. But these tips can really help.

  • Let your stomach rest. Do not eat for several hours or until you are feeling better.
  • Take frequent, small sips of bottled or boiled water or a rehydration drink and small bites of salty crackers.
  • If possible, drink a solution made with World Health Organization (WHO) oral rehydration salts. Packets of the salts are available at stores and pharmacies in most developing countries. Add one packet to boiled or treated water, making sure to read the instructions regarding the proper amounts of salts and water. Drink the solution within 12 hours if kept at room temperature, or within 24 hours if refrigerated.
  • Give your child a solution of WHO rehydration salts in addition to his or her regular food as long as TD continues. If your baby has trouble keeping the liquids down, try giving frequent sips by spoon.
  • Continue breastfeeding normally. Bottle-fed babies should continue their usual formula.
  • Feed your child starches, cereals, yogurt, fruits, and vegetables.
  • Seek medical help immediately if you or your child has bloody diarrhea, fever, or persistent vomiting, and give rehydration fluids in the meantime.
  • Begin eating a simple diet of bland foods, such as crackers, rice, bread, potatoes, or bananas, which usually will help slow the condition. After you’ve normalized your trips to the bathroom you can resume eating normal again.

Go out and enjoy this big beautiful world, but just take these few precautions and Mr. Montezuma will leave you alone.

Bon Voyage!


Sean Mitchell

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