NPF: AMATEUR DIAGNOSIS

As I get older I go on fewer rants in interactions with other humans. I figure "That's what the blog is for, Ed" and don't expose often well-meaning strangers, acquaintances, and friends to my extended ramblings on every conceivable topic of interest. One thing that still gets the full treatment, though, is when people say they have "food poisoning" and then identify the meal that caused it.

It's not an angry rant. I simply point out that A) actual Food Poisoning is a condition that puts people in the hospital where they must be pumped full of IV antibiotics and B) to the extent that food may have caused you gastric distress, you have no idea which food item or meal was responsible. People assume that whatever they ate most recently (or, failing that, whatever the last "ethnic"/foreign food they ate) was the cause. There is zero medical evidence to support that assumption.

Lots of things you eat can inspire an upset stomach or a case of what medical professionals call Thunder Shits. Perhaps something you ate was a little too spicy, a little too oily, a little too teeming with the bacteria with which all food is teeming by the time it enters your mouth. I just returned from Mexico and I haven't taken a solid dump since the first day I arrived in the country. I proceeded to eat every appetizing looking offering from street vendors and outdoor food stalls where refrigeration and food safety procedures could be described as suspect at best. I ate a lot of food prepared in local water full of microscopic landmines waiting to waylay the unconditioned tourist. All of this was done willingly; the deal is, I eat something amazing and later I will defile a bathroom. It's a trade off and it's worth it. I don't have "food poisoning."

Eating all but the worst, blandest food involves some risk. Take that bucket of oysters or mussels, for example. The odds that at least one of those fuckers isn't "off" or "bad" are exceptionally small. You're going to eat it, it's going to be amazing, and maybe later on you will pay the price by shitting like a mink. So be it. If someone offers you seafood that was pulled from the ocean within the previous hour, you eat it and accept the risk. Or maybe you push the envelope at the local restaurant and ask for "Thai spicy" or "Indian hot" and your stomach and intestines end up somewhat irritated at your decision. Or maybe you try unpasteurized dairy products for the first time with predictable results. Oh well. It was worth it.

You may have a transient stomach virus. You may have eaten something too spicy or oily for your delicate constitution. You may have plain ol' overeaten. You may have eaten something that was a little bit beyond its "Best By" date. You may have eaten something at a big stupid chain restaurant wherein one of the stoned teen kitchen workers practiced unsafe food handling procedures. But you don't have Food Poisoning and your precise identification of the meal and item that caused it makes you sound only slightly less silly than someone declaring that they know when the cold viruses entered their body.

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41 Responses to “NPF: AMATEUR DIAGNOSIS”

  1. Turkle Says:

    Hilarious. Excellent work, sir – just the chuckle I needed at work today.

  2. Xynzee Says:

    Usually with seafood, you'll KNOW it's off well before you get it anywhere near your mouth, unless it's a red tide then you'll be truly FUBAR'd.

    All the same, the sudden debilitating bout of gastro is the best way to chuck a sickie. It goes as quickly as it showed up. So stop trying to ruin a good thing for the rest of us. Sheesh! Some people… ;)

  3. Misterben Says:

    I used to know a lady who seemed to claim "food poisoning" every single time she took a dump.
    I guess not enough people have read "Everyone Poops".

  4. Rory Says:

    Actually, according to the National Institutes of Health, poisoning is swallowing "food or water that contains bacteria, parasites, viruses, or toxins made by these germs. Most cases are caused by common bacteria such as Staphylococcus or E. coli." (http://www.nlm.nih.gov/medlineplus/ency/article/001652.htm)

    So, when "stoned teen kitchen workers practice unsafe food handling procedures" and you end up peeing out your butthole, you do, in fact, have food poisoning. Generally a mild case, but it still is food poisoning.

  5. Angelique Says:

    Thundershits is evidence your body is working properly in response to ingesting something that is trying to poison you.

  6. Alan Says:

    Lots of good points, somewhat undermined by one major flaw. Food-borne pathogens are extremely common. Symptoms range from mild discomfort to organ failure; fortunately the former are more common. Sure, discomfort can also be caused by excessive spiciness, oiliness, or quantity, but it can certainly be caused by a wide variety of microbes.

    There is an hypertechnical argument for distinguishing between "food-borne illness" and "food poisoning." You could say that the former is an infection (eg, salmonella) while the latter is a reaction to the toxins secreted by the nasty little buggers (eg, botulism). But that's a definition that nobody uses. If you get sick because of pathogens in your food, you have food poisoning. Fortunately it usually isn't that big a deal.

  7. Andrew Says:

    I have to agree with Alan. I think it's amusing when people say they have the "stomach flu," which per WebMD does not exist. They really have gastroenteritis, which is characterized by the sudden onset of nausea, diarrhea, or vomiting, often caused by microbes in their food, i.e., food poisoning. The influenza virus, which causes the flu, does not cause gastrointestinal symptoms. Disclaimer: I am not a doctor, nor do I play one on TV.

  8. J.D. Says:

    Misterben: In a way, that's a more accurate definition of "food poisoning" than most of the ones Ed ranted on.

  9. swkellogg Says:

    "actual Food Poisoning is a condition that puts people in the hospital where they must be pumped full of IV antibiotics and B) to the extent that food may have caused you gastric distress, you have no idea which food item or meal was responsible."

    Actually, "actual food poisoning" is caused by toxins (hence poisoning), and is not treated with antibiotics. Examples would be S. aureus poisoning and Botulinum toxin poisoning. While poisoning might put you in the hospital, some toxins typically just make you puke your guts up (among other things) . Some poisonings can be relatively slow in onset (botulism) but some like staph can come on within a half hour of ingesting bad food.

    The stuff that requires antibiotics are food borne infections.

    The more appropriate catch-all term would be food borne illness.

  10. Emerson Dameron Says:

    Last time I thought I had "food poisoning," it turned out to be acute pancreatitis.

    At least my former employer hadn't cancelled my health insurance.

  11. Karlo Says:

    I can speak with authority about food poisoning and can confirm that real food poisoning will PUT YOU DOWN. I ate some bad potato salad 30 miles outside Austin (tasted great) but half way through the meal I started feeling "odd" and by the time we got to Austin I didn't know which end to put where – running a moderately high (102) fever and sort of hallucinating (not in a good way, either). I was like that for two days and am probably too stupid to have gone to the doctor but at the end of two days I sat up drank Gatorade and felt all better.

    My second story is a series of "food poisonings" that were evidenced by severe stomach cramps, but not after any particular meal. I did go to the doc with those and got some broad spectrum antibiotics that quelled the symptoms. Worked fine for a few years with a bout or two each year, fixed by antibiotics. I moved up to the mid-west and got some serious bouts – doubled over, pain like you would not believe. Finally went to an emergency room where I got a barium enema and x-ray (the barium enema is a whole other story, but one best told by Tom Wolfe in the Right Stuff) to find diverticulitis. Ended up losing about 10 inches of lower intestine but am OK now – I know the symptoms and am on the look out for cramps that are out of the ordinary (if there are ordinary cramps in men).

  12. c u n d gulag Says:

    I didn't know minks shit enough to warrant a gag!
    Great gag-line though!

    Speaking of gag – I used to try not to gag from laughter when people used to come in and complain that the food they ate last night at the restaurant gave them food poisoning.
    'Really?" I'd say.
    "And what did you have for lunch and breakfast – and what did you eat for the two days before that?
    Because usually, real food poisoning takes at least a day or two to make its presence felt.
    So, it most likely was something you ate BEFORE you ate here."

  13. c u n d gulag Says:

    Btw – I LOOOOOOOOOOOVE hot and spicy food.

    Sadly, it just doesn't love me, anymore…

  14. Brian Says:

    Speaking from experience the only thing worse than mink shit is otter shit. It's like some kind of magical adhesive sealant/dye. It comes out runny, but dries in an awful fish smelling tar like substance.

    As for 'real food poisoning', a roommate in college had Food Poisoning from a Taco Bell so bad that he tore his esophagus vomiting and had to be fed through his nose at the hospital for a few days.

  15. Buy Valves Says:

    Eh, I think it's mostly just a way of talking. Whenever I'm under the weather, I usually attribute it to bad clams — even when I have not eaten any clams.

  16. democommie Says:

    "As for 'real food poisoning', a roommate in college had Food Poisoning from a Taco Bell so bad that he tore his esophagus vomiting and had to be fed through his nose at the hospital for a few days."

    Back in 1994, while enroute to my neice/godchild's wedding (my sister, bless her heart, thought I would ensure that her child grew up in the faith if it came to that pass) I got held at a gate in St. Louis for a "mechanical problem"*. I availed myself of a taco at TB (more appropriate initials for that sort of place Do.Not.Exist.). I then spent the next several days not eating anything, drinking water and spending most of my time on the shitter, pisshitering. I finally went to the hospital at midnight on the night before the wedding and spent an exceedingly expensive night there. That was, per the doc, gastroenteritis brought on by food poisoning.

    Fast forward 15 years. I go to my nephew's wedding, I'm the photographer. I eat a small piece of weird tasting Chinese in my brother's fridge (which he tossed about an hour later). Samosamo as before, except I followed a friends suggestion and pounded the immodium and Gator Ade and was able to make the wedding, deliver my nephew and his bride's wedding pix to universal acclaim and NOT spend several grand at the local medical facility.

    I now eat only food that I personally have cooked unless I'm not home and it looks yummy.

    * My original connecting flight was coming in with out knowing whether it's landing gear was deployed and locked.

  17. ixnay Says:

    A word regarding raw oysters: DO NOT, under ANY CIRCUMSTANCES, combine antacids/stomach acid blockers (e.g. Pepcid, Tagamet, like that) with raw oysters. Oysters seem to harbor bacteria, Vibrio vulnificus, that are normally killed by the extremely low pH of stomach acid. No stomach acid = you will wish you were dead. Once came within a half hour or less of a trip to the emergency room.

    I adore raw North Atlantic oysters, but I am very careful about when I eat them. No problems since that one time.

  18. Major Kong Says:

    Back in my Air National Guard days I used to deploy to Incirlik Turkey.

    There was a condition that went around the base we started calling "The SMA".

    SMA stood for Screaming Monkey Ass. It was the worst case of the shits you've ever had. I think there was weapons-grade plutonium coming out of me. Immodium wouldn't even slow this stuff down. It usually took antibiotics to cure it.

    Nobody could figure out what caused it. People seemed to get it regardless of where they ate. The base hospital sent teams to inspect the local restaurants and they all got a clean bill of health.

    I could count on one or two people being down with it on any given day.

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  20. Leslee Says:

    While working on an archaeological dig in Arkansas City, KS in 1996 I ate a fish sandwich from Sonic one night. Within a half hour of eating the sandwich I went from feeling perfectly fine to vomiting non-stop for 8 hours straight.

    I called it "food poisoning" (I suspected the tartar sauce.)

    What should I have called it instead?

  21. el mago Says:

    Oh, yeah. Food poisoning. Yum. Having worked a few decades as a chef, and having hung out in diverse locales with diverse cuisines, water supplies and hygiene levels, I have a view or two on the topic.

    Yeah, you don't know where your gastric distress came from; it could be anything, like the cook or your server didn't wash after wiping . . . wiping whatever, even a counter. Maybe a cook slapped fish on a cutting board that was just used to cut chicken. That'll do it . . .

    But the most common cause of Thunder Shit is salad bars with the red oak leaf lettuce stuck on the underside of other lettuce leafs, undetected by the prep grunt.

    And this brings me to a true case of poisoning from the same place from two different individuals eating the same lunch at different times. I'm naming names. The place was the Med in Boulder Colorado. The menu item was grilled salmon on a mixed green salad. My fellow vicitim recounted how she was hospitalized and re-hydrated, etc. That would be true food poisoning.

    In my case, eating the same meal some weeks later, suffered dual oral and anal expulsion some 12 to 16 hours later . . . about right. Not food poisoning but yeah, bad bacteria.

    Always had concern about restaurant clients suffering from my sometimes dubious food handling practices in the middle of hectic activity, but wherever I've run the show, the prep grunts do the lettuce right, and poultry is handled like Strontium 90.

  22. Donna Mladjan Says:

    Paratyphoid is one of the illnesses contracted from street food in Mexico or any country where food is prepared without proper refrigeration and sanitation. The street food tastes great, but the consequences are devastating.

    I worked in a doctors' office in L.A. Two of the nurses went to Ensenada with their boyfriends and ate from street vendors. They came back sicker than those pesky minks. With only two bathrooms for a staff of 12, we were soon all standing in line, bent over, and moaning. Took three weeks and doses of strong antibiotics for us all to return to normal. First place we went for lunch to celebrate – La Enchalada!

  23. ladiesbane Says:

    I was about to get all shirty, making Alan and Rory's point (with additional grinding on the logic fail of "if it's not severe, it's not 'real'"), when I recalled that I have a parallel irk: people who use the word "allergic" to mean everything from "I don't care for this food" to "codeine makes me puke up stuff I ate three weeks ago".

    Saying you are allergic to things like green beans was a joke when I was a kid, like saying you were allergic to math homework. Now, people use the term indiscriminately. True allergies involve your immune system, but you can have a bad reaction or a histamine flare, you can experience common side effects, idiosyncratic side effects, swelling, nausea, and all kinds of unpleasant symptoms without it being an allergy.

    So I get the irk, believe me. But I think words like "allergy" and "food poisoning" are simply used as generic terms to convey misery without detailing symptoms. For example, I cannot tell my supervisor I was unable to work yesterday due to Wagnerian thundershits, but if I tell her I had "food poisoning", she will understand that commuting more than five paces from the loo was too perilous to attempt.

  24. Ed W. Says:

    My wife and I had food poisoning once. Got it from some KFC Fried Chicken. The reason we know it was food poisoning is because she ate some of the KFC and had to go to the hospital because of overwhelming projectile vomiting. They admitted her, said something to the effect that "yep, you got food poisoning!", and hooked her up to an IV drip full of whatever it is you give to people with food poisoning.

    The reason we know it was KFC fried chicken is because for some reason, I actually didn't have any of the chicken when it was originally bought. After being in the hospital all night without eating, I was hungry. So, genius that I am, I thought, well, I don't have any food, and I know it was probably the chicken, but if I microwave the chicken for long enough, I'll kill off whatever it is that made the then-girlfriend sick, and I'll be fine.

    Did I say genius? I meant god-damn moron. Because, yep, a couple of hours later, I went "Bleeeeargh" all over the bathroom. I didn't get it as bad as the wife did, which meant I only had about 12 hours of non-stop stomach pain, combined with puke and diarrhea. When I told my sister, who is a doctor, what I had done, she sighed and told me about the bacterial toxin thing mentioned in the comments above, which is why my brilliant plan of extra microwaving didn't work.

    I am told by the wife that at the time, I said something to the effect that "there's nobody I'd rather have food poisoning with than you". She says that this is the most romantic thing I've ever said, because it was definitely *not* a standard romance situation, due to the massive amounts of puking.

  25. Kaleberg Says:

    There are all kinds of food poisoning.
    You can get poisoned eating mushrooms. Some (e.g. false morels) you can eat, but you have to prepare them carefully (blanche, then cook thoroughly). Some mushrooms will simply destroy your liver or kill you outright, others just cause visual distortions, stomach distress and muscular spasms. I've had that kind. Some foods, like acorns, can get you too if you don't do the right prep.
    Listeria from raw milk will probably not kill you if you are fairly healthy and get a moderate dose, but if you are young or old or have a compromised immune system, you don't want to drink raw milk. We have a local raw milk dairy, and we won't serve their milk to a friend of ours who had an organ transplant and is on immune system depressants.
    It's a similar case with salmonella. Most people just get sick. Then they get better. Some don't. If it gets bad, you might need an IV drip.
    Botulism is a whole different category as it is the toxin, not the bacterium that gets you. They use botox to paralyze muscles for surgical and cosmetic reasons. The doses are measured in nanograms and they'll last for months.
    Then there are the variant e coli (e.g. 154) that can be quite dangerous. The outbreaks usually make the newspapers, but some people are affected more than others.
    In other words, there is food poisoning. It is often quite possible to figure out what got you. It is rarely fatal, but can be extremely dangerous.
    The usual problem when dining overseas is that the bacteria set is different, not that it is particularly toxic. This throws off your gut bacteria balance, but your system usually comes to a new balance in a few days. That's not food poisoning. That's just unpleasant.

  26. just me Says:

    Sorry Ed, but this really is amateurish!

    Most food borne pathogens are not treated with antibiotics, however if the profuse vomiting and screaming meanies continue long enough you may well require hospitization for IV hydration, glucose and elctrolytes. This will largely be determined by the species and amount of the bacteria you've ingested, and your body size.

    And it is indeed possible to identify the source of the pathogen, public health units do it all the time. Hence the increasing common recalls on produce and processed meats as properly qualified food inspectors are budget cut from municpal payrolls. And said identification begins by asking the "victims" what they think may be the culprit, people usually have a surprising good idea of exactly where they picked up the nasties.

    It's also a good idea to report to the source any indignity you have incurred. Just yesterday we got the refund cheque for our entire vacation after we sent the resort the PH report detailing the exact species of Salmonella that came from the scrambled eggs which caused my grandson to be taken off the return flight at the airport by the paramedics.

    I know you had a post just recently about the horrors of modern airline travel, and while I have more than a few of my own anecdata for that I would really like to thank the staff of that particular West Jet flight for their outstanding care and professionalism.

    All that said, hope you're feeling better soon, Ed!

    and @ Major Kong – I have a tiny bit of background in microbiology and infectious disease (ok, maybe a tiny bit more than a tiny bit) and a first guess of what you've described would be a water borne source.

  27. Xynzee Says:

    @Mjr: Incirlik? Must have been the dodgy kebab after a big night ;)
    My brother was there in the late 90s.

    As for botulism, what was the logic structure behind: hey, what if I take a syringe full of neurotoxic bacterial excrement and jab it into my face to see if that gets rid of wrinkles?

  28. zebbidie Says:

    CDC estimates that each year roughly 1 in 6 Americans (or 48 million people) get sick, 128,000 are hospitalized, and 3,000 die of foodborne diseases.

    http://www.cdc.gov/foodborneburden/

    At least 45,000 illnesses and 32 deaths resulted from 5,332 outbreaks of contaminated food during 2008 in the European Union, a new report says.

    http://www.foodsafetynews.com/2010/01/food-ills-sicken-45000-kill-32-in-eu/#.U659hPmSx6w

    Enjoy that freedom y'all.

  29. Major Kong Says:

    I do seem to have an "allergy" to mussels but oddly enough I don't have problems with any other shellfish.

    I used to love them. One day, after eating a dozen, I broke out in hives.

    The next time I tried to eat them I started breaking out after the third mussel and decided to quit while I was ahead.

  30. ladiesbane Says:

    Major, the same thing happened to me with eggs. I had always been a runny yolk girl, but then my throat started closing (chest pounding, face turning purple, the gamut). Now I can't even touch Hollandaise, Caesar salad, chewy cookies or brownies, and the entire mayo-based menu from potato salad to Ranch dressing.

    Whether or not it's a true allergy pales in consideration of the "near death experience" of it all. I suspect it's the same for food poisoning.

  31. Comradde PhysioProffe Says:

    "As for botulism, what was the logic structure behind: hey, what if I take a syringe full of neurotoxic bacterial excrement and jab it into my face to see if that gets rid of wrinkles?"

    The logic was very clear and sensible: "hey, this neurotoxin is deadly in large systemic doses because it blocks neuromuscular synaptic transmission, thus paralyzing muscles, and you can't breathe if your diaphragm is paralyzed; if we inject very small doses locally in the face, we will partially paralyze facial muscles, thus relaxing the skin and reducing wrinkly appearance". Incidentally, this same mechanism of action of blocking synaptic transmission is what makes botulinum a useful treatment for things like migraine, spasmodic torticollis, and other spasmodic disorders.

  32. Robert Says:

    I had an interesting experience in college. Wound up vomiting until it came out yellow – is there yellow bile? Went to the Student Health Center, got IM injections of Dramamine and Valium, spent the night in a fetal position on a gurney.

    Don't know if it was 'food poisoning', but certainly unpleasant. In MFK Fisher's delightful little book, "Consider the Oyster", she describes the effects of eating a 'bad oyster'. They range from "I wish this would kill me" to actually killing you. Now THAT is food poisoning.

    People who claim to be allergic to something to get out of eating it are a blight. They make things even more difficult for those with actual allergies.

  33. Alex SL Says:

    It is probably not good for one's health to start ranting every time somebody uses "retarded", "insane" or, in this case "food poisoning" to describe something that a medical professional would not formally diagnose as such. It is understood that we use language somewhat sloppily in everyday life.

    I understand the concern that racism might underlie the immediate suspicion that 'ethnic' food has caused Montezuma's Revenge, but, well, isn't that kind of the most parsimonious explanation? If you don't usually have digestive problems, then you eat something that you don't usually eat, and a few hours later your digestion acts up, isn't that correlation some hint that there might be causation? Isn't it quite logical that people tend to get issues with their stomach if they eat unfamiliar things?

  34. Csicopper Says:

    Reminds me of the skit concerning the first person to eat an oyster.

    More attention should be paid to science based medicine. Nicely done!

  35. Food For Thought Says:

    Stats and info from the WHO on foodborne diseases:
    http://video.nationalgeographic.com/video/magazine/ngm-food-borne-disease

  36. Anonymouse Says:

    @Ladiesbane; I have a similar problem with mayo and mayo-based foods, only in my case, it triggers serious vomiting until it's all out of my system. I've learned to ask about mayo in foods because people put mayo in the weirdest places–one restaurant in the south smeared it all over the bread in a peanut-butter sandwich (which I ordered because they assured me they couldn't make me any kind of lunchmeat sandwich without mayo. I didn't make it clear of the table before the unfortunate (and entirely-predictable) reaction. The waitress's reaction? "Oh, I didn't think you meant it when you asked for no mayo." @@

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  38. Xynzee Says:

    @Anonymouse: LOL! I with you on that. But it's more bottled mayo that brings on the ipecac response—the taste, texture, etc of Kraft class mayo makes me nauseous. Homemade mayo, no problems. The solution I've found is that when there's even a remote chance that the puke inducing slime may be any where near my food, I state in clear and no uncertain terms that I will projectile puke all over the cafe, the counter, and the staff. They HAVE BEEN warned.
    On the off chance they didn't heed my advice, welp, I warned them.

  39. sluggo Says:

    I am allergic to pork. Actually diganosed by a allergist. Strange allergy. Vomit and and other end as well.
    I now think of ham as poison.

  40. sluggo Says:

    Early onset lactose intolerance got me out of school in seventh grade. Slugged down a glass of milk and no test!

  41. Anonymouse Says:

    Thanks, Xynzee! I'll have to try your way! :-) My strategy in the past had been to order something that nobody in their right mind would put mayo in (like a peanut butter sandwich!). Obviously the idiots outsmarted me on that one.

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