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Hello. In Mid-May I spent two weeks traveling in a

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Posted on Mon, 9 Jul 2018
Question: Hello. In Mid-May I spent two weeks traveling in a remote region of Russia. While there I ate a significant amount of local food and primarily drank water collected by my father-in-law from a potable spring. Around one week into the trip I started experiencing headaches, which is fairly uncommon for me. After experiencing constipation for much of the trip, on the final day I experienced a considerable amount of diarrhea. The diarrhea continued multiple times a day for at least one week after I returned home to the United States. It has largely abated now, though it still returns occasionally. However, I now am finding myself experiencing increasingly frequent symptoms of dizziness and nausea - almost that same as what someone would feel being on a high floor in a tall building that is swaying due to heavy wind gusts. I also have noticed dark urine since returning home, and most recently, that smoking cigarettes causes me to feel unusually dizzy and ill to a point where I sometimes can't finish one and need to lay down afterwards. (I've smoked around 7 cigarettes a day since I was 18 years-old and while that clearly isn't good for me, I've never experienced any type of reaction like that at any point.) I'm concerned that a simple viral infection would have resolved by this point, though I certainly could be wrong about that. I just scheduled an appointment with my PCP for tomorrow evening, but wanted to check and see if you have any preliminary thoughts based on what I've said here and/or suggestions for specific questions to ask my doctor when I see him. Thank you very much in advance for all of your assistance.
Best, XXXXXXX
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Answered by Dr. Mahboob Ur Rahman (41 minutes later)
Brief Answer:
it looks like an infectious diarrhea which is not rare in travelers.

Detailed Answer:
Hi Mr XXXXXXX welcome to 'Ask a doctor' service. My name is Dr Rahmn, MD , I have read your question and here is my advice,
what you said it looks like you have got some sort of infection of your bowel. this what we call 'traveler diarrhea', there are two important group of organisms that would cause most of the cases,
1. bacterial; this is more common,it generally produce loose motion which has high frequency like 6 more times,even more then 10 times a day, it gives fever, and it generally starts abruptly .there can be many bacteria involved .
2. protozoa; these include ameabisis ( caused by ameba , ) or giradisis caused by gieadia . this is more slower, does not produce high fever, and frequency is mostly less then 6 times.
however this is not a firm rule and things cab be either way, and mostly what we do is to examine the stool to see for the organism or its ova or can get a culture of stool for the organism.

so your can be either one,but it looks to be an infectious one, if you have fever and headache , possibility of solmonella ( enteric fever) cannot be ruled out. that generally produce fever , that can be high grade.
regarding viral diarrhea, you are very right, it should have settled by now, and virus generally produces diarrhea with very high frequency
at the moment i would advise you take a lot of fluids, i am confident nothing is serious, and your meeting with you doc would probably sort it out. he probably would be doing your blood counts, and electrolytes, to be sure thats normal, as diarrhea sometimes worsens it . also checking your bp.
To know the cause, as we said he probably would be doing stool examination, staining and if needed ,culture as well after your examinaton.
i dont think this is any serious or complicated issue ,i hope you wont need to ask him a lot question, we routinely encounter such patients, and give them the appropriate antibiotics , that heals in few days .

hopes i have answered your query, i would be glad to answer any further question if you have.
get well soon .
regards,
Dr Rahman.
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Mahboob Ur Rahman (1 hour later)
Dear Dr. XXXXXXX

Thanks very much for responding to my questions. My one remaining question relates to the consistent and gradually worsening dizziness and nausea I continue to experience. Are those symptoms typical for types of infections you listed above? I read somewhere online that increased dizziness when smoking a cigarette was a symptom of a specific type of parasitic infection a person can contract when drinking certain unfiltered water. That sounded very strange to me, but it's definitely something I've been experiencing recently and never have before. The general dizziness and nausea throughout the day is quite unusual for me as well. Just want to make sure you don't see anything concerning about those issues either. Thanks again for your help.
doctor
Answered by Dr. Mahboob Ur Rahman (38 minutes later)
Brief Answer:
this can be explained by your disease but must be confirmed to be sure.

Detailed Answer:
Hi again Mr XXXXXXX

You're right, however in this context, hope nothing is serious,
The dizziness and nausea you said can well be explained with this type of infection, like the infection itself ( giardiasis especially) can cause dizziness and nausea, maldigestion, food poisoning, dehydration, the toxin in the gut, even pain abdomen or constipation or gut irritation, can give someone nausea and dizziness.

Yes, dizziness and nausea may be sometimes serious. However, that is then accompanied by more alarm symptoms like severe spinning, heating loss, fainting or unable to stand or walk, persistent vomiting, severe pain abdomen and a lot more. I'm happy that you do not have any alarm symptom at the moment. However, this must be confirmed by your doc tomorrow by your detailed examination, and investigation. hopes your doc tell you more details of this after seeing you to be sure that nothing is serious.

Honestly, I'm not sure about any special relation between any parasite and smoking causing dizziness (maybe if any exists) but smoking itself can worsen a lot of health-related issues, especially related to the Chest and the bowel that's what appears to be happening to you ..mechanisms are a lot and would be too much to explain here.

So it appears the same story but let your doc see you in detail, and would check your lab reports to be very safe.

Hopes this clears your query,
Please don't hesitate to ask anything if you have in your mind.
Regards


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Dr. Mahboob Ur Rahman

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Practicing since :2012

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Hello. In Mid-May I spent two weeks traveling in a

Brief Answer: it looks like an infectious diarrhea which is not rare in travelers. Detailed Answer: Hi Mr XXXXXXX welcome to 'Ask a doctor' service. My name is Dr Rahmn, MD , I have read your question and here is my advice, what you said it looks like you have got some sort of infection of your bowel. this what we call 'traveler diarrhea', there are two important group of organisms that would cause most of the cases, 1. bacterial; this is more common,it generally produce loose motion which has high frequency like 6 more times,even more then 10 times a day, it gives fever, and it generally starts abruptly .there can be many bacteria involved . 2. protozoa; these include ameabisis ( caused by ameba , ) or giradisis caused by gieadia . this is more slower, does not produce high fever, and frequency is mostly less then 6 times. however this is not a firm rule and things cab be either way, and mostly what we do is to examine the stool to see for the organism or its ova or can get a culture of stool for the organism. so your can be either one,but it looks to be an infectious one, if you have fever and headache , possibility of solmonella ( enteric fever) cannot be ruled out. that generally produce fever , that can be high grade. regarding viral diarrhea, you are very right, it should have settled by now, and virus generally produces diarrhea with very high frequency at the moment i would advise you take a lot of fluids, i am confident nothing is serious, and your meeting with you doc would probably sort it out. he probably would be doing your blood counts, and electrolytes, to be sure thats normal, as diarrhea sometimes worsens it . also checking your bp. To know the cause, as we said he probably would be doing stool examination, staining and if needed ,culture as well after your examinaton. i dont think this is any serious or complicated issue ,i hope you wont need to ask him a lot question, we routinely encounter such patients, and give them the appropriate antibiotics , that heals in few days . hopes i have answered your query, i would be glad to answer any further question if you have. get well soon . regards, Dr Rahman.