Saturday, 27 March 2010

The Joys of Giardia

Since world water day was this week, let me take the opportunity to share some of what I have learned about caring for a child whose intestines have been damaged by Giardia.

Giardia is an ameobic parasite caused by the consumption of water containing fecal matter. You can get giardia here in the US, typically from drinking from a freshwater lake or stream, or accidentally swallowing a bit of water while swimming in one. It is fairly common in developing countries, and many kids in orphanages suffer from it. All three kids who have come to the US from Tommy's orphanage had it.

Giardia can occur without syptoms, so it is worthwhile to test any child coming from a developing country for it, just to be safe. In our experience, symptomatic giardia resulted in foul smelling diarehha, at least 5 times a day, but often up to nine or ten times a day. It wasn't just gross; it was foul. When we changed those diapers, our eyes would water and bile would rise in our throats. That bad.

One of the first places we went after getting Tommy was the Surgery, where he was diagnosed with giardia and given some medication. The medication had to be ground up and disolved in a tiny bit of water, then poured down his throat. The fastest way to endear a child to a scary Mzungu is to give them nasty tasting medicine...or not. Administering medicine teaches you about tough love in parenting pretty quickly. Tommy improved after taking the medicine, but it was unclear as to whether it was entirely wiped out, so we retreated after we got home with even worse tasting medicine. It once took us two hours to get him to take it. After that we got more clever.

After all the treatments he was cleared, but the diarehha continued. When giardia has been in the body for a long time it can destroy the cilia that line the intestines, resulting in a difficulty in absorbing nutrients and processing food. Tommy had trouble processing lactose, gluten, and beans (all difficult to digest foods, and kids without damage can have trouble with beans). Since removing these things from his diet and starting on pro-biotics we have noticed an improvement. Things still aren't perfect, but they are so much better. If things do not continue to improve, we will start on the specific carbohydrate diet (SCD, also called low-residue), which promotes intestinal healing. I am trying to avoid it because it is pretty restrictive and would require taking away almost all of Tommy's favorite foods. Being gluten free and avoiding lactose is rather easy, except for having to prepare two separate meals and keeping Tommy from eating other kid's snacks when we go out. There are so many wonderful GF products that you can buy, and lactose free milk is easy to find (but oh so expensive).

If you suspect your child has giardia, take them to get treated right away while in-country, then make sure and do follow-up once you are home. Avoiding lactose is wise, because lactose actually encourages parasite growth. Then play with their diet until you find one that gets bowel movements down to 1 to 3 a day. It took us quite a while, but once someone suggested removing gluten as well as lactose things slowly got better. Kids with processing issues caused by giardia are not allergic, they are intolerant (hopefully only temporarily). Tommy can eat small amounts of gluten or lactose (he has a talent for begging goldfish crackers off of other children) without having problems, but if he gets too many we will be in trouble. We don't worry too much about cross contamination, or products that are processed in the same plant with gluten or lactose, as long as they don't directly contain either wheat or milk products. Your child may be different, so see what works for you.

Favorite GF supplies to travel with:
Corn and Rice chex
Rice cakes
Rice crackers
Glutino crackers
Oatmeal (not all brands of oatmeal are completely gluten free because of cross contamination, but we have had no problems using Quaker oats)

GF Foods easily available in Uganda:
Rice, potatoes, posho, matoke, any meat, fruits, veggies. Just avoid bread and chapati. Cheese is so expensive you probably won't buy it, but many aged cheeses do not contain lactose and can be safely consumed.

At home: Most stores now carry gluten-free products. They are pricey, but fairly good. The thing that has made this so easy for us is that Tommy's diet in the orphanage consisted of mostly of sweet potatoes, potatoes, rice and meat gravy. He has never had a cookie or a brownie. Thus, I don't worry too much about getting gluten free versions of those things. Amy's brand frozen foods has a great vegan GF pizza, or at least I assume it is great because Tommy adores it. They are six bucks a pop for a pretty small pizza, so he doesn't get them as often as he would like. He also likes GF chicken nuggets. Although I often have to go to Whole Foods for a good variety of products, Trader Joes carries some good stuff: Puffins, frozen pancakes/waffles (CHEAP!!!), and gingersnaps.

So, those are the "facts" of Giardia as I know them, but living with the effects of Giardia has taught me so much more. Jeff and I have supported clean water projects for some time now, because we "knew" how important clean water was for health and preventing diseases. However, now that I have seen what this means for real people, how dirty water ravages little bodies, I am both more thankful for what we have here in the developed world and more compassionate towards those who live without access to fresh, clean water. For our bodies to function and be healthy clean water is a necessity. Yet for so many people this necessity is actually a luxury that they cannot afford. Thus, they drink water filled with poop, and dirt, and parasites, and they get sick and their bodies cannot thrive. I know, because I've seen this happen to Tommy. I've seen his little face contort with pain from his intestinal distress. I'm thankful I had the medicine to do something about it and the clean water to prevent it from happening again. Most moms around the world are not so lucky. Thus, although giardia has been a trial, I also count it a blessing. It has made me more thankful and it has softened my heart.


Michelle Wilson said...

Amy, this is unbelievably helpful. I'm printing it and putting it in our suitcase! Thank you!

sara said...

Thanks for sharing Amy. Gives me a such a better sense of what actually happens from not having clean water to drink.

Deb said...

Thank you for this info. We are running tests on my daughter who I suspect has Giardia since the summer because of swimming in the town pool. Because its been months with it do you think it'll affect her for life after getting treated?