Crohn's Disease / Water Purification [Archive]

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MorrisseyFan

10-22-2005, 23:03

Singe03

10-23-2005, 01:05

Boiling enough water to drink for an entire hike is going to be a challenge for a few reasons. Its either a number of longish breaks during the day to stop and boil water or carrying an unpleasant amount of water daily should you choose to do it all at night in camp. It will also add a good amount of fuel and thus weight to your load. Not to mention, boiled water is kind of flatish tasting, I never really liked it.

Basically every method has some drawbacks, I used polar pure and had no problems, even got so used to the iodine flavor that normal water tasted funny for a long time after I got back.

frieden

10-23-2005, 08:09

I either have Crohn's Disease or Ulcerative Colitis (the doctors aren't sure, and sometimes it just happens that way...*shrug*), so when I get a bug in my tummy, it hits me harder than it might hit someone else. In short, water purification is a big, important question mark for me.
I'm basically in the same boat. I was going to use a SteriPen, but am unsure about the reliability. Since stress is the best way to mess up your immune system, I'm not going to stress about it. I'll get the best filter for the weight that I can, and carry as much bottled water from town stops possible. I'm also going to carry a chemical solution (prob. tablets), as a backup.

I'm also learning about herbs/supplements that I can use to minimize this problem. A lot of this will be dual purpose. For example, I've read here that people take B vitamins to avoid ticks. Well, with the added stress on your body from hiking long distances, you should be taking a B vitamin mix, anyway. Once you start adding stuff, though, it gets tricky, so do your research. I have for years, and know very little. I get frustrated at chocolate milk ads, which push their product for the calcium. Chocolate inhibits the uptake of calcium! If you aren't sure what negates what, take your supplements 2 hrs. apart. There are herbal supplements available to get rid of intestinal parasites, but I've never taken them. You might consider having some in your bounce box.

soulrebel

10-23-2005, 08:29

don't have crohn's but have met a few people that have sufferred from it. My/their recommendation. Probiotics aka stuff in yogurt, sauerkraut, fermented foods. Primal Defense caplets by www.gardenoflife.com (http://www.gardenoflife.com/) come to mind or the powder. This will do more than anything to help boost your intestinal immunity.*

The main thing in avoiding stomach illness is personal hygiene.

I have a steripen-don't carry it unless i'm going to haiti or the like. You'll want lithium batteries which dramatically increase the cost for water.

The two of us rely on ULA amigo gravity just b/c it's easy to use, I like having a drip spigot in camp for chores/hygiene, and it was cheap/light. Used to use chemicals solely, but taste and immediate gratification are more important than saving 5oz. GL

*(disclaimer: not a doctor so this will probably kill you...might as well drink bleach-j/k :) However, I am an endurance athlete and spend many hours studying nutrition--and knock on wood haven't been sick in years!

rickb

10-23-2005, 08:55

orangebug

10-23-2005, 10:32

Talk with your gastroenterologist, but I doubt that you are much more prone to Giardia and Crypto than the average fool out there. If you wish to avoid those two parasites, longer boiling or bleaching is required. Filtering or purification (filter plus an iodine Rx) might make sense if there is a special problem for you.

Attention to toilet and cooking hygiene is still probably more important - considering that others may not be as mindful of the problem as are you. Don't share GORP and be particularly keen to use alcohol gel for sanitation.

SGT Rock

10-23-2005, 10:36

MorrisseyFan

10-23-2005, 11:31

Rock,

I can only tell you how it effects me; different folks can have very different experiences. On a day-to-day basis, I'm more susceptible to heartburn, loose stools, bloating - basic gasto-intestinal problems. I have several intestinal ulcers, and the lower-right quadrant of my belly constantly hurts to a some, usually very small but sometimes not-so-small, degree.

All of this is largely controlled with medication and diet. The main medicine I take (Imuran) puts a big hurt on my immune system, so for me cuts take longer to heal and illnesses tend to require medication instead of going away on their own. As for diet, fiber helps and yogurt and other pro-biotic foods really help (thanks for the link soulrebel), while caffeine and chocolate are big no-no's. (Some suggest avoiding very spicey food as well, but I think the pleasure of eating Indian or Thai far outweighs the potential grief...not that I expect to find a masuman curry lying on the side of the AT....)

In short, water retention isn't typically a problem for me. I'm concerned about getting a bacterium or virus that would be nothing to most folks.

Frieden,

You're definitely right about stress being the best way to mess things up. I'll look into the herbal supplements, and I think soulrebel might have really hit things on the head. I sometimes take a probiotic called Flora-Q when things get really out of whack, but it's kind of expensive and wouldn't hike well at all.

Orangebug,

I'm definitely going to take some Purel (or equivalent) with me. Is there anything out there better than that?

Thanks to everyone for your help!

orangebug

10-23-2005, 12:37

Purel is just an more expensive form of alcohol gel. Marketing, you know, like the ads for water treatment.

Panzer1

10-23-2005, 12:44

On the other hand, I've read that the rates of illness are very similar among those who purify their water and those who do not. Arrg!
I never bought into this theory. I think it is common sense that purifying water would have an impact on the rates of illness. I would think that the impact would be a big impact. Keep in mind that there is not currently any scientific way of determining if this is true or not. So in the end I think you have to go with common sense. If you believe that backcountry water can sometimes have bad things in it, then it seems that treating water should have an effect on the rates of illness. Just go with common sense..

I would also like to add that dirty hands are probably a very big source of illness. So keep your hands clean while hiking. Again, I have no scientific proof of this, just common sense.

Panzer

weary

10-23-2005, 13:04

FWIW:

I think an internet search and/or conversation with your physician would show that boiling water for a couple seconds is just as effective as boiling it for 4 minutes. Something to consider. A concerned hiker might treat water a couple different ways, depending on how it looks. As a SOBO, I was "inspired" to drink out of some rather miserable puddles when there was no other alternative. I only boiled in those (few) situations. Also, I think there is general agreement that hand washing can play a huge role in not getting bugs in the backcountry.
Rick is right, as usual. Once water reaches the boiling point all the bugs are long since dead. If I remember right, DelDoc questioned whether even a full boil was needed, that by the time a few bubbles emerged from the bottom of a pot the harmful bugs were dead.

Regardless, boiling is the only treatment that will kill all the harmful living creatures found in water. Chemicals and filters at best will only kill most of the harmful critters.

I drank directly from cold springs near the trail. But most nights I boiled a couple of quarts of water for use the next day, especially when the trail went through low lying farm and town areas. This was easy to do because I carried a wood-burning Zip stove.

The usual "flat" taste associated with boiled water was never a problem. Boiling removes the oxygen, thus giving the water a flat taste. It took but a few minutes of sloshing around in the bottles in my backpack to restore the oxygen.

Weary

Nightwalker

10-23-2005, 13:26

Purel is just an more expensive form of alcohol gel. Marketing, you know, like the ads for water treatment.
Wal-Mart has an inexpensive version with a nice citrus scent.

Panzer1

10-23-2005, 14:12

Once water reaches the boiling point all the bugs are long since dead.
Weary
Yes, I agree too. I can remember being told this in college biology. Since you won't have a thermometer to measure the water temp with you, boiling is just a sign that the water is hot enough.

Panzer

Youngblood

10-23-2005, 14:54

Wal-Mart has an inexpensive version with a nice citrus scent.I'd be careful with scented stuff... sometimes scents can act like magnets for flies, mosquitos, noseeum's and the like.

TooTall

10-23-2005, 14:58

Not being familiar with the problems of Crohns, does it make you more supceptible to chemical sensativity, general upset stomach, or stomach diseases; or is a physical condition that makes it hard to retain water in your system in the first place?

It's an auto-immune inflammation of the bowels. Your own body starts attacking and destroying the lining of your stomach and intestines.

tlbj6142

10-23-2005, 15:40

My wife (and mother) have Crohns, and have undergone multiple surguries resulting in a few feet of their instestines being removed. This is the reason why my wife will never going backpacking with me. Everything and anything makes her run for the toilet. I think some of it is phyical and a portion mental.

However, if she decieded to take a trip with me, I would get a First Need filter (though the Katadyn Hiker would be just as good) and put a half-dose of Aqua Mira in each quart for good measure. There just wouldn't anything left alive in the water 15 minutes after that ritual.

Anumber1

10-23-2005, 15:45

most people get sick in the outdoors not from the water they drink, but from cooking/eating in un-sanitary conditions. Carry that hand sanitizer and use it. Wash your pots and pans right after you eat, and dont do anything you wouldnt do in your own kitchen at home.

Nightwalker

10-23-2005, 15:49

I'd be careful with scented stuff... sometimes scents can act like magnets for flies, mosquitos, noseeum's and the like.
In alcohol gel? Hmmm...

I've seen that it's the sweet, sticky stuff that often goes with the scent that does the fly/bug/whatever drawing, but YMMV.

MorrisseyFan

10-23-2005, 16:19

From what I've read, the CDC suggests fully boiling water for three minutes in altitude (or one minute at sea level) to kill crypto. Check out http://www.cdc.gov/ncidod/dpd/healthywater/factsheets/crypto.htm. Having mentioned that, the site goes on to say that appropriate filters are just as safe, so that seems to be the more realistic route to take.

I'm not a surgical candidate (it's just not that severe for me), and this is something I've dealt with for almost 20 years now (and I'm still in my 20's). I don't think this would be an impossible trip for me; it's just a trip where I'll need to be extra aware. Thanks for all your help!

rickb

10-23-2005, 17:04

You would believe the CDC over Weary and me? ;)

Probably a good idea, but then again they'll tell you that bottled water isn't safe either.

On a potentially more usefull note, one thing to consider when using and selecting a filter is the issue of cross contamination. If you believe that your filter is sucking up all manner of pathogens every time your filter, its safe to assume that you will be carting around a very concentrated load after even a few weeks of filtering, right?

At a minimum, you would want to have seperate bags to keep you intake and outtake hoses completely seperate. You would want to make sure that any dribble from the contaminated side of the filter wont work its way around to the clean side. In short, you would want to understand your filter before you go hiking with it.

In your case, you might want to make a clean cap for the output end of the filter. Just a thought. You might even want to carry a spare output hose for when things get mixed up. Or keep the clean hose in a screw top bottle. Or not. My point is really to conside how the filter will be stowed away, and to be cognizent of what the contaminated concentration might end up leaking on.

Also, even though crypto can't be gotton rid of by chemicals, I am thinking its the other stuff that is more common. Might be worth filtering and treating it.

SGT Rock

10-23-2005, 17:48

Roland Mussler's book did show some interesting statistics about water treatment/filtering and rates of illness. As I remember it, the rate of illness of a filter user and a never filter/treat hiker were almost the same (as I remember it, the no filter/treat was slightly better) - and there has a been a lot of stuff written on personal hygiene and gastric intestinal illness. So actually, intuitively - unless you are drinking septic water, it just makes common sense to clean your hands and not count on a water filter for protection.

Also, the stuff I have read shows that the huge majority of waterborne illnesses happen in ,municipal water supplies where some issue has gotten into the system. There was a good article that we have added here:
http://www.whiteblaze.net/forum/showthread.php?t=9880

It talks about Giardiasis and one of the references talks about how:

“Neither health department surveillance nor the medical literature supports the widely held perception that giardiasis is a significant risk to backpackers in the United States. In some respects, this situation resembles (the threat to beachgoers of a) shark attack: an extraordinarily rare event to which the public and press have seemingly devoted inappropriate attention.”[2]

Anyway...

Thanks for explaining your condition. How about before you hit the trail, experimenting with some of the options you have for water treatment. Try Iodine and then iodine with Vit C and if you can hack it using tap water, then your incidence of illness in the back country from water should be about the same as in town - you will have at least ruled out water treatment as a likely cause of stomach issues you have on the trail.

Panzer1

10-23-2005, 19:45

SGT Rock

10-23-2005, 19:47

To give some extra info for some of my references.From page 96 of "Long Distance Hiking: Lessons Learned from the Appalachian Trail"

"Table 13-3
Type of Purification Method Versus Frequency of Gastrointestinal Illness Experienced on the Trail:

Purification Method..........% of Users Who Became Ill..........Giardia Only
Iodine.................................26%........ ..............................6%
Filtering..............................30%........ ...............................9%
Boiling.................................34%....... ...............................3%
Chlorine...............................75%........ ..............................0%
No Treatment.......................27%............... .......................3%
Average..............................30%.......... ............................6%

Note: The number of chlorine users is only four, so the apparent frequency of illness is not statistically significant."

Mueser, Roland. "Long Distance Hiking, Lessons Learned from the Appalachian Trail". Camden, ME: Ragged Mountain Press, 1998.

Sly

10-23-2005, 20:05

All about giardia, water borne diseases and intestinal ailments. This article should probably be pinned.

http://www.yosemite.org/naturenotes/Giardia.htm

SGT Rock

10-23-2005, 20:13

I think that even Roland Musslerr would agree that his survey about the relationship between water treatment and illness is essentially useless.

For example, the number of people surveys was very small. Too small to draw any conclusions.

Also, people who did get sick had no way for sure of knowing if it was from water or food or something else. They could only guess. The people who responded that they got sick could have gotten sick from dirty hands, ect.

Also, the survey was voluntary, so maybe more people who got sick fillled out the survey skewing the results.

Panzer

On some of that I agree. But the other article about Giardiasis also mentions illness other than Giardiasis gastrointestinal diseases and as a reference uses a report that tracks the reports by doctors to the CDC across the entire US. In that report, the author also comes to the conclusion that sanitation is more important.

Also from Mueser's book, data from a lab on effectiveness of methods:

From page 96 of "Long Distance Hiking: Lessons Learned from the Appalachian Trail"

"Table 13-4.

Laboratory Tests of the Effectiveness of Various Purification Methods:
Method........................Effectiveness
Iodine 8 hours......................99.9%
Iodine 30 minutes.................Up to 90%
Filter, New..........................100%
Filter after 88 liters...............About 75%
Chlorine (Halogen).................Less effective than Iodine
Heating 70C, 10 minutes.........100%
Heating 50C-60C, 10 minutes...95% to 98%"

So while all these methods seem to be as effective at the beginning, filtering is the lowest after 88 liters - which should be about 1.5 months on the trail, give or take. And the entire time the effectiveness will be dropping. So again, I wouldn't rely on a filter given this scientific test.

But go to page 98 of the same book when he mentions another survey done by "The Journal of Family Practice" where he states:

"In view of the similar results in this study and our sample, my own attention has been directed to an explanation that lies outside of the water purification process. The findings of both these studies fails to bear our any consistent picture relating frequency of illness to water purification. Yet all together, the data reflects evidence of more than 300 hikers over a person-time sample exceeding 100 years of exposure. It seems probable that some systematic explanation for gastrointestinal illness beyond the simple water-purification process is likely."

Then he goes on to talk about food sharing and hand sanitation.

Mueser, Roland. "Long Distance Hiking, Lessons Learned from the Appalachian Trail". Camden, ME: Ragged Mountain Press, 1998.

And from "Giardia Lamblia and Giardiasis With Particular Attention to the Sierra Nevada ":

"Camp cooks in particular need to pay special attention to cleanliness. Wash hands thoroughly, especially before handling utensils and preparing meals. If you contract giardiasis in the back*country, blame your friends…not the water. "

"Giardia Lamblia and Giardiasis With Particular Attention to the Sierra Nevada." Retrieved 26 July 2005 from http://www.californiamountaineer.com/giardia.html

SGT Rock

10-23-2005, 20:14

All about giardia, water borne diseases and intestinal ailments. This article should probably be pinned.

http://www.yosemite.org/naturenotes/Giardia.htm

That is one of the articles I have been referring to and quoting from Sly. Thanks :D

Sly

10-23-2005, 20:18

That is one of the articles I have been referring to and quoting from Sly. Thanks :D

LOL... that it is. :welcome

fiddlehead

10-23-2005, 20:39

One thing I just found out two days ago. The results from a test done between these antiseptic hand cleaners (recommended in the above article) and soap found "no difference" in hygiene results between the two.

CaptChaos

10-23-2005, 21:01

Wal-Mart has an inexpensive version with a nice citrus scent.
You can get a very good hand sant by going to www.citrusmagic.com (http://www.citrusmagic.com) . They make a very good hand sant. Used to work for them and it was a very good seller.

weary

10-23-2005, 21:07

All about giardia, water borne diseases and intestinal ailments. This article should probably be pinned.

This is an excellent scientific report. Everyone should read it.

Key points include:

"The water that wilderness travelers are apt to drink, assuming that they use a little care, seems almost universally safe as far as Giardia is concerned. The study referred to earlier,2 in which the researchers concluded that the risk of contracting giardiasis in the wilderness is similar to that of a shark attack, is telling. What they did find is that Giardia and other intestinal bugs are for the most part spread by direct fecal-oral or food-borne transmission, not by contaminated drinking water. Since personal hygiene often takes a backseat when camping, the possibility of contracting giardiasis from someone in your own party—someone who is asymptomatic, probably—is real. Recalling that up to 7 percent of Americans, or 1 in 14, are infected, it is not surprising that wilderness visitors can indeed come home with a case of giardiasis contracted not from the water…but from one of their friends.

This theme, that reduced attention to personal hygiene is an important factor for contracting giardiasis in the wilderness, is becoming more frequent in the literature.2, 10, 14, 37, [38]

Outside of the Sierra, Giardia cysts in concentrations “as high as four per gallon [§]” have been detected in untreated water in northeastern and western states. [39] But even with this concentration, one would have to consume over nine liters of water to have a 50 percent chance of ingesting 10 or more cysts.

Indeed, there may be as much unwarranted hysteria surrounding Giardia in wilderness water in these other areas as there is for the Sierra. For example, an oft-cited report describing acquisition of the disease by 65 percent of a group of students hiking in the Uinta Mountains of Utah [40] is now viewed with considerable skepticism. Specifically, the attack rate was far beyond that usually seen with water-contracted giardiasis, no cysts were identified in the suspect water, there was no association between water consumption rates and the likelihood of the disease, and the authors categorically discounted food-borne or fecal-oral spread, stating that it had never been reported (correct at the time).2

Personal observations

I started visiting the Sierra Nevada in the early 1950s and have spent much of my free time there. I have never treated the water, and I have never had symptoms of giardiasis as a consequence of my visits. My many similarly active friends and acquaintances also drink the water with no ill effects. But because of other organisms possibly present, we are always careful to “drink smart”:

Drink from large fast-flowing streams whenever possible, preferably those entering from the side rather than those paralleling the trail.
Drinking water from a lake is best advised at the inlet, with the next best place at the hopefully fast-flowing outlet.
Few Giardia cysts survive harsh Sierra winters. Contamination begins essentially anew each year, so springtime water is safer than summer or fall.
Water at higher elevations is safer than lower, partly because of reduced human and animal presence up high, and partly because water flowing to lower elevations picks up more contaminants the more distance it travels.
The colder the water is, the more likely it is freshly melted, meaning less opportunity for contamination.
Because filtration of water through soil removes Giardia cysts, deep well water is considered safe.7 By implication, springs in the wilderness should be, too.
One would think that after a heavy snow year, when streams run full and long, some kind of “flushing out” effect of lakes and streams must be occurring. Conversely, it makes sense to be more cautious in dry years.
Avoid water that likely could have passed through an area subject to heavy human or animal use.
If it doesn’t look good—it’s cloudy or has surface foam—treat it or don’t drink it.
If in doubt, treat it—but how? While useful in many instances, chlorine is not in general effective for Giardia disinfection, which is why swimming pools are primary sources for the disease. The best filters work, although they are costly, heavy, and bulky, and many are somewhat awkward to use.8, [41]

Boiling is usually inconvenient, but if you are preparing hot water for meals anyway, you may as well take advantage. Giardia cysts are highly susceptible to heat, and simply bringing water to 150° F. for five minutes,10 to 176° for a minute,8 or 190° momentarily, will kill them. But boiling for a few minutes at altitude is usually recommended because of the other organisms that may be present. At 10,000 feet elevation, water boils at 194°; at 14,000 feet, 187°.

Iodine is probably the best treatment choice, being inexpensive, convenient, and safe. Iodine is effective against most bacteria and viruses, too—and over a wide range of temperatures. (But Cryptosporidium may be resistant to iodine.) A popular system uses iodine crystals in a saturated water solution. Methods exist to mask or remove the iodine taste.

Summary figures

Here are some of the Giardia cyst concentrations discussed in various places above. Units are cysts per liter.

Concentration
Comment

~1000
Typical swimming pool contamination

~100
Giardiasis is plausible [**]

~10
Minimum needed to contract giardiasis**

~1
Some wilderness water outside California

0
.12
San Francisco water

0
.108
Worst Sierra Nevada water

0
.030
Los Angeles water

0
.013
Mt. Whitney at Trail Camp

0
.003
Mt. Whitney at Whitney Portal

Conclusions

In a recent letter [42] the Supervisor of the Inyo National Forest admitted: “As to whether or not Giardia exists in the Sierra, we are not in a position to state a fact one way or the other.” This is a significant admission. So why do they persist in informing everyone that giardiasis is a potential hazard when visiting the Sierra Nevada?

First: They know that some waters might be contaminated by something, and Giardia is the organism on people’s minds so needs no elaboration. Contaminated water is certainly possible at lower elevations and in some locales. Noting in particular that novice hikers cannot be expected to make correct choices of which sources may be safe to drink, they point out that a conservative approach is to treat all water.

Second: If a person believes, albeit incorrectly, that they contracted giardiasis from Sierra Nevada water, they cannot accuse the Forest Service of not warning them. Potential confrontations are therefore avoided.

Unfortunately, this approach results in an incorrect perception of overall water quality in the Sierra by the general public. It also means that if someone contracts a gastrointestinal illness after a visit, they will be more apt to blame the water, having been “forewarned” that all water is suspect. And so the myth is perpetuated.

Untreated Sierra Nevada water should be, almost everywhere, safe to drink—if you “drink smart.” If you don’t “drink smart” you may ingest diarrhea-causing organisms. But it won’t be Giardia.

Because up to 1 in 14 of us carries the Giardia parasite, we all need to do what we can to keep the water pure. Defecate away from water, and bury it or carry it out.

Camp cooks in particular need to pay special attention to cleanliness. Wash hands thoroughly, especially before handling utensils and preparing meals. If you contract giardiasis in the backcountry, blame your friends…not the water.

High Sierra water has far too few Giardia cysts for you to contract an infestation from it. Even if you go somewhere where the concentration is high, you probably won't get giardiasis. If you do get giardiasis, you probably won't have any symptoms. If you have symptoms, they will probably go away by themselves in a week or so. If they don't or you develop serious persistent symptoms, you should seek medical treatment. Finally, those contracting giardiasis may develop immunity to it, thus lowering the likelihood that they will get it again.

There is certainly no reason for anxiety about giardiasis. Fewer than 1 percent of those who have an infestation, or about 5 percent of those with symptoms, need medical help.

Recommendation

Our wilderness managers are in a position to educate the outdoor public about the real culprit in the Giardia lamblia story: inadequate human hygiene. When they acknowledge that Sierra Nevada water has fewer Giardia cysts than, for example, the municipal water supply of the city of San Francisco, maybe they will turn their attention to it.

The thrust of the following observation is long overdue:

“Given the casual approach to personal hygiene that characterizes most backpacking treks, hand washing is likely to be a much more useful preventative strategy than water disinfection! [††] This simple expedient, strictly enforced in health care, child care, and food service settings, is rarely mentioned in wilderness education materials.” 2

About the author

Bob Rockwell is an active mountaineer who made his first trip into the Sierra Nevada in 1952 to climb Mt. Whitney, and he repeats this climb several times annually. He has a bachelor's degree in Physics from UC-Berkeley, and a PhD in Aeronautical and Astronautical Engineering (Biomechanics) from Stanford. In the course of making over a thousand ascents of hundreds of individual Sierra Nevada mountains, he has never filtered or otherwise treated the water and he has never contracted symptoms of giardiasis. Retired since 1990, he is now able to fully indulge in his favorite pastime and spends more time there, never treating the water, than ever before.

References

--------------------------------------------------------------------------------

[†] The referenced sources use a variety of units for portraying cyst concentration: cysts per 100 liters, per 100 gallons, etc. For uniformity, all have been converted to cysts per liter since that is the size of the typical backpacker’s canteen.

[‡] These calculations involve use of a tool called the Poisson distribution.
[§] Author’s words.
[**] If one liter is consumed.
[††] Emphasis is in the original.

--------------------------------------------------------------------------------

[1] Wilkerson, James A., MD: Medicine for Mountaineering and Other Wilderness Activities. The Mountaineers, 4th edition, 1992
[2] Welch, Thomas R. and Welch, Timothy P.: Giardiasis as a Threat to Backpackers in the United States: A Survey of State Health Departments. Wilderness and Environmental Medicine, Vol. 6, 1995
[3] Rockwell, Bob: Giardiasis: Let’s Be Rational About It. Summit Magazine, Nov.-Dec. 1987

[4] Rockwell, Bob: Giardia Lamblia and Giardiasis, with Implications for Sierra Nevada Visitors. California Mountaineering Club Newsletter, Vol. 7 no. 2, April 1996
[5] Rockwell, Bob: Giardia Update. California Mountaineering Club Newsletter, Vol. 8 no. 2, April 1997
[6] Juranek, Dennis D.: Giardiasis. Centers for Disease Control and Prevention, 1990
[7] Swartz, Morton N., MD: Intestinal Protozoan Infections. Scientific American Medicine, 1994
[8] Kerasote, Ted: Great Outdoors; Drops to Drink. Audubon, July 1986
[9] Microbial Risk Assessment for Reclaimed Water. EOA, Inc., Final Report. Oakland, CA, 1995
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[12A] Giardia and Cryptosporidium Levels are Low in Sierra Nevada Pack Stock. University of California Agriculture and Natural Resources News Tips, December 1999

[13] Moser, Penny Ward: Danger in Diaperland. Health, September/October 1991
[14] Suk, Thomas: Eat, Drink and Be Wary. California Wilderness Coalition

[15] Berkow, Robert, MD, Editor: Parasitic Infections—Giardiasis. The Merck Manual, 14th edition, 1997
[16] Wilkerson, James and Caulfield, Page: Wilderness Water Disinfection. Appalachia, No. 4, Winter 1985-86
[17] Bemrick, W. J.: Some Perspectives on the Transmission of Giardiasis. Giardia and Giardiasis: Biology, Pathogenesis and Epidemiology, Erlandsen and Meyer, Editors, Plenum Press, 1984
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[19] Communicable Diseases in California, 1994, 1995. State of California Department of Public Health.

[20] Vitusis, Ziegfried, chief microbiologist at the EPA. Quoted in Backpacker, Dec. 1996
[21] Kappus KD, Lundgren RG and Juranek DD: Intestinal Parasitism in the United States: Update on a Continuing Problem. American Journal of Tropical Medicine and Hygiene. Vol. 60 no. 6, 1994

[22] Giardiasis Surveillance—United States, 1992—1997. Centers for Disease Control and Prevention, August 2000.
[23] Porter, J. D., et al: Giardia Transmission in a Swimming Pool. American Journal of Public Health, Vol. 78 no. 6, 1988
[24] 2000 Annual Water Quality Report. Stanford Utilities Division and San Francisco Public Utilities Commission.
[25] Annual Water Quality Report for 2000. Los Angeles Department of Water and Power

[26] Bean, Nancy H., PhD, et al: Foodborne Disease Outbreaks, 5-year Summary, 1983 – 1987. Centers for Disease Control and Prevention, March 1990
[27] Ortega, Y.R. et al: Giardia: Overview and update. Clinical Infectious Diseases, Vol. 25, 1997
[28] Rendtorff, R: The Experimental Transmission of Human Intestinal Protozoan Parasites. American Journal of Hygiene, Vol. 59, 1954
[29] Cravaghan, P. D., et al: Inactivation of Giardia by Anaerobic Digestion of Sludge. Water Science Technology, Vol. 27, 1993
[30] Mayo Clinic Family Health Book. Mayo Clinic Foundation for Medical Education and Research, 1996
[31] Tintinalli, J. et al, editors: Parasites: Giardia Lamblia. Emergency Medicine, 3rd edition, 1995

[32] Soave, Rosemary: Cryptosporidiosis. Textbook of Medicine, edited by James B. Wyngaarden et al, 1991
[33] Kramer, Michael H. et al: Surveillance for Water-Borne Disease Outbreaks—United States, 1993-1994. Centers for Disease Control and Prevention, 1996
[34] Peter, G., MD, editor: Chapter 3: Summaries of Infectious Diseases. American Academy of Pediatrics. 1994 Red Book: Report of the Committee on Infectious Diseases
[35] The Bad Bug Book. US Food & Drug Administration, Center for Food Safety & Applied Nutrition, 2001.
[36] Open File Report No. 86-404-W. Dept. of the Interior, US Geological Survey, 1986
[36A] Suk, T. J. et al: The Relation between Human Presence and Occurrence of Giardia Cysts in Streams in the Sierra Nevada, California. Journal of Freshwater Ecology, Vol. 4, No. 1, June 1987

[37] Zell, S. C. and Sorenson, S. K.: Cyst Acquisition Rate for Giardia Lamblia in Backcountry Travelers to Desolation Wilderness, Lake Tahoe. Journal of Wilderness Medicine, No. 4, 1993
[38] Giardiasis Fact Sheet. Centers for Disease Control and Prevention, May 2001

[39] Ongerth, J. E. et al: Backcountry Water Treatment to Prevent Giardiasis. American Journal of Public Health, Vol. 79 no. 12, 1989
[40] Barbour, A. G. et al: An Outbreak of Giardiasis in a Group of Campers. American Journal of Tropical Medicine and Hygiene, Vol. 25, 1976
[41] Gorman, Stephen: Mountaincraft: Water Treatment. Summit Magazine, Fall 1993

[42] Bailey, Jeffrey E., Forest Supervisor, Inyo National Forest. Personal correspondence, November 19, 2001

rickb

10-23-2005, 21:27

I agree with everything that has been posted of late, but it might not be applicable to the person who started this thread-- except for the part stressing the importance of personal hygiene.

The Sierra article and others accept the fact that water is contaminated, but suggest that level of contamination is just not high enough to make you sick. You? Who is you?

For a person with Crohns, some of the critical mass assumptions regarding the bugs might be different.

Just a thought.

In these special circumstances I'd carry soap, nuke and/or filter my water, and actually wash my pot and spoon after a meal.

Nightwalker

10-24-2005, 01:30

Excellent, excellent post, Weary.

I found out that the best way to remember to use the hand-san is to keep it in the zip-loc with the TP. That way, you always have it when you need it! Dr. Bronner's at other times and places as well, but alcohol will definitely kill fecal coliform.

I don't filter, or rarely do. I treat with chlorine if suspicious of the source. In many, many years of hiking, I've gotten sick less than a handful of times, and that was probably food, not water, related.

OB was ahead of the curve time-wise on pushing the Purell. He probably kept a lot of us from spending some unwanted trail-side, painful days.

This is an excellent scientific report. Everyone should read it.

Key points include:

"The water that wilderness travelers are apt to drink, assuming that they use a little care, seems almost universally safe as far as Giardia is concerned. The study referred to earlier,2 in which the researchers concluded that the risk of contracting giardiasis in the wilderness is similar to that of a shark attack, is telling. What they did find is that Giardia and other intestinal bugs are for the most part spread by direct fecal-oral or food-borne transmission, not by contaminated drinking water. Since personal hygiene often takes a backseat when camping, the possibility of contracting giardiasis from someone in your own party—someone who is asymptomatic, probably—is real. Recalling that up to 7 percent of Americans, or 1 in 14, are infected, it is not surprising that wilderness visitors can indeed come home with a case of giardiasis contracted not from the water…but from one of their friends.

The Hog

10-24-2005, 06:43

Giardia is just the tip of the iceberg as far as waterborne illness is concerned. According to the book Drinking Water Microbiology, the majority of waterborne gastrointestinal diseases are viral in origin. That doesn't, however, mean that it's safe to ignore protozoal (giardia, crypto) and bacterial pathogens.

Whatever means of treatment you use, by all means pick one that handles viruses, bacteria, AND protozoans. Iodine alone won't do that.

Once you've had one of these illnesses, you will, in all probability, be an instant convert to properly treating your water. If not, you've got to ask yourself, why would you want to put your trip of a lifetime at risk?

SGT Rock

10-24-2005, 08:10

I've been sick with them before and still work with iodine.

SGT Rock

10-24-2005, 08:20

BTW, according to the CDC, water filters won't remove viruses:

Portable Water Filters

Certain types of portable water filters can also remove some types of infectious agents from drinking water. However, most of the portable filters on the market do not effectively remove viruses, thus chemical disinfection of water is needed after filtering with such filters to make the water safer for drinking. Some portable water filters designed to remove parasites (Giardia/Cryptosporidium) have an "absolute” pore sizes of 0.1 to 1-micrometer and, therefore, may also remove most diarrhea-causing bacteria. See the Division of Parasitic Diseases' Guide to Water Filters and Bottled Water to learn about different filters and those that filter Cryptosporidium. Viruses are smaller than 0.1 micron and will NOT be removed by filters with a pore size of 0.1 or larger. To kill viruses that may pass through these filters, add iodine (as described above) to the filtered water before you drink it.

Note: Chlorine in various forms has also been used for chemical disinfection. However, it is not as reliable as iodine for killing disease causing organisms in the wide range of water-quality conditions that travelers might encounter

"Treatment of Water to Make it Safe for Drinking ". Retrieved 24 Oct 2005 from http://www.cdc.gov/travel/water_treatment.htm

And to add to that: read the discription of hiking filters and filtes for your home and find that they usually have filter sizes 1 micron or larger. So how did the CDC say to remove the viruses - chemical treatment.

Some filters can remove viruses by using iodine in the filter.

So does iodine kill viruses:

Iodophors. Iodine compounds are available as iodophors, which are combinations of elemental iodine and a substance that makes the iodine soluable in water. They are good disinfectants, but do not work well in the presence of organic material. Iodophors are effective against bacteria, fungi, and many viruses. In hatcheries, iodine is used on equipment and walls, and for water disinfection. Iodine is the lease toxic of the disinfectants discussed here. Many iodine products can stain clothing and porous surfaces. Examples: Betadine, Iofec, Isodyne, Losan, Tamed Iodine and Weladol.

Jeffery, Joan. "Sanitation-Disinfection Basics". Extension Poultry Veterinarian, University of California-Davis. Retrieved 24 Oct 2005 from http://www.vmtrc.ucdavis.edu/s_sanitat.html

peter_pan

10-24-2005, 08:30

Like a house that has a sink in the kitchen and the bathroom I carry hand sanitizer in two locations ... a one/ two oz bottle in the belt pouch ( always available aka kitchen) and a two oz bottle with the tp ( readily available and a reminder to wash up).

Pan

The Hog

10-24-2005, 08:35

I've been using Exstream for years. It's a drinking water bottle with a filter assembly on the inside. You fill the bottle, screw on the cap and attached filter assembly, and squeeze. That forces the water through filters that remove bacteria and protozoans (including crypto and giardia), then through an iodine resin that inactivates viruses. Although the flow rate is pretty pitiful, the resulting water is pathogen free and there's no waiting. I used to boil my drinking water, but this method is much better.

As with most filter systems, you have to make sure you change the filters regularly. Why? Because bacteria are adept at colonizing filters. Once a colony of bacteria is established, it's only a matter of time before large numbers of bacteria break through the filter and give you a nice infective dose.

SGT Rock

10-24-2005, 08:37