View Full Version : Giardia
Special K
03-10-2013, 18:07
Who has gotten Giardia? Where and how did you get it? Did you get medical treatment and keep going? How long did it last? What do you do differntly now?
Thanks!
Yes, twice. Both times on weekend hikes. Went to doctor for first round, it was nasty. Self diagnosed second time. (Once you get giardiasis you know the symptoms) I took metronidazole on my thru hike and I am much more careful on water sources. Water+cattle=problems. Both times I got it I was hiking in Ca.
Got it in Russia. It was endemic in the water supply. Did not treat, which would have involved a trip to Moscow. Got over it after a few weeks.
Of the five people in my family, one person must have been naturally resistant. For the rest of us, three recovered without treatment, over periods ranging from three days to three weeks.
One person got treatment in Moscow. The treatment was very unpleasant, and he had recurring bouts over the next few years.
Who has gotten Giardia? Where and how did you get it? Did you get medical treatment and keep going? How long did it last? What do you do differntly now?
Thanks!
Got it once in Alaska, once probably in Idaho, and once in California. I'm confident untreated backcountry water was the source twice, the third time I'm not sure but it was likely water that time as well. I had to see a Dr. all three times and was very sick. I was off the trail (PCT) for about three days, luckily I got treatment or it would have been a lot worse.
From now on I will ignore the "it's as rare as shark attack" baloney and treat all my surface water, including springs.
Lot of people get it on the AT, lots don't.
I spent weeks researching the topic:
http://bucktrack.blogspot.com/2011/03/waterborne-giardia-for-backpackers-no.html?m=1
Snowleopard
03-10-2013, 20:16
Colter, thanks for that research.
I'm always very careful about treating my water in the backcountry and in travel in less developed countries. I haven't had giardia, but I've certainly gotten sick from contaminated water or food in Peru and on the trail in the former Soviet Union. I treated or boiled all my water in Moscow, though it's St. Petersburg (Leningrad) that was supposed to have giardia in the city water. In Moscow I got sick from the only time I ate in a restaurant.
Giardia has been found in drinking water in Mass and VT, but not necessarily in backcountry water. Keep in mind that nobody regularly tests backcountry drinking water. Even water that is normally safe to drink can be temporarily contaminated -- in the Catskills Hurricane Irene destroyed sewage systems and septic tanks dumping sewage into Batavia Kill, which is normally safe to drink. I imagine the same thing happened in places in VT near the AT that were heavily impacted by Irene.
swjohnsey
03-10-2013, 21:20
I don't know how common it is on the AT, didn't get it, did see or hear of anyone who got it, never treated my water.
fiddlehead
03-10-2013, 22:10
Got it in Nepal. 1990.
Took a drug they have there called Tiniba.
This drug is pretty bad for you but knocked it out of my quickly.
(once I got back to Kathmandu and could get it)
Went to Nepal 6 times after this and never got it again.
The last 2 times I even drank the water in many places.
An older Frenchman commented, while we were living in Russia, about the incessant problems American seemed to have with the food and water, "Your food supply is too clean." I agree. It takes exposure to build up immunities.
That said, I normally carry a Steripen with me on backcountry trips, and use it.
WILLIAM HAYES
03-10-2013, 22:57
got it from drinking untreated water which flowed out of some rocks on the side of the mountain. found out later that cattle had grazed on top of the mountain. I took a 14 day protocol 500mg flagyl which knocked it out.
Always treat water, too risky not too,simple process; why put ones self at risk for greater injury while sick and weak.
Special K
03-11-2013, 02:07
I'll be using a SteriPen Journey. I bought the prefilter too (green funnel). In your opinion, should I save the weight and leave the prefilter at home and just use an xtra bandana?
swjohnsey
03-11-2013, 10:27
Giardia is diagnosed with a lab test that most who have "had it" never got. Anyone who had some gastrointestinal disturbance that included diarea had giardia. Most of this was probably caused by poor hygene or eating contaminated food.
on my 2006 Thru-hike i stopped at a place called Black swattora spring in P.A about three miles south of Eagles nest shelter, By the time i got to Port Clinton i was throwing up sick i stayed at the pavillion, and hiked out the next day, as long as i was standing or hiking i was alright but every time i layed down i get real dizzy,cold sweats, start throwing up, i basically had to sleep sitting up for about 2.5 weeks, yes i hiked with it, no i didn't go to a medical center or any thing, at the time i using Aqua-Mira, i quickly changed to a katahdan hiker pro and haven't been sick since.
Slo-go'en
03-11-2013, 11:16
It takes about 2 weeks after injestion to show signs of Giardia, so it is very difficult to pin point where you got it. As swjohnsey pointed out, on the AT it is more common to have self inflicted digestion problems which are often blamed on Giardia. On the whole, water along the AT is very clean, we are very lucky that way. Other parts of the country not so much, like out west. One does have to use some common sense. Drinking out of a large stream or river in a valley, next to a road in farm country isn't a good idea - treated or not.
colorado_rob
03-11-2013, 11:18
Yeah, nice little bit of research there, Colter, thanks. I was diagnosed with this nasty little parasite after a Belize beach/dive trip in 2009. Yikes, quite uncomfortable. Some serious antibiotic knocked it out, I forget the name. I always treated my hiking water before that, and will certainly always continue. Now I take a filter along on my international non-hiking vacations as well. No-brainer for me.
Giardia is diagnosed with a lab test that most who have "had it" never got. Anyone who had some gastrointestinal disturbance that included diarea had giardia. Most of this was probably caused by poor hygene or eating contaminated food.
Those are many of the standard skeptical talking points but I don't think they are supported by good data.
Giardia is diagnosed with a lab test that most who have "had it" never got. Do you have data to support that?
This poll (http://forums.outdoorsdirectory.com/showthread.php/94691-Giardia-Poll-Please-vote!/page3) showed that about 22% of nearly 300 people reported having had giardia, with over 10% of the total having had LAB CONFIRMED giardia. (I know I have.) The largest retroactive study on giardia (http://www.journals.elsevierhealth.com/medline/record/ivp_00029262_105_330%20)I know of used only laboratory confirmed cases to show that the odds of contracting giardia were 3-5 times as high for those drinking untreated backcountry surface water. Most people who DO have giardia never have it confirmed by a lab.
It is also unwise to assume that giardia empirically diagnosed by physicans without lab tests likely isn't giardiasis. People who make those assumptions often claim that they have been drinking untreated water and "never got giardia." Were they lab tested? If not, how would they know? Many "healthy" people are carriers and many people suffer various levels of symptoms without realizing the cause.
Most of this was probably caused by poor hygene or eating contaminated food. That might well be true, there are many causes of minor stomach upsets. But despite statements to the contrary, there is good science showing that many people are getting giardiasis from backcountry water, and good science showing it often makes people very sick. In the study linked above the AVERAGE giardia victim was sick 3.8 weeks and lost about 12 pounds.
There's a reason giardia has the reputation it has.
swjohnsey
03-11-2013, 11:27
One dose, 2000 mg Flagyl (4x500 mg) will knock out giardia.
Giardia has often been found in tests of water sources along the AT, and that's only one pathogen.
Symptoms can develop in as little as one day (uncommon), with a mean of about 7-9 days.
This is the largest hygiene/water treatment study done on the AT to the best of my knowledge (http://onlinelibrary.wiley.com/doi/10.2310/7060.2004.13621/abstract). Not surprisingly, here's what they found: Two hundred and eighty backpackers compiled 38, 940 wilderness exposure days, with 56% (n= 156) experiencing diarrhea. Diarrhea correlated with the frequency of drinking untreated surface water (relative risk (RR) 2.4, 95% confidence interval (CI) 1.0–4.7%, p = .03). Of those who consistently treated water, 45% suffered from diarrhea, whereas 69% of those who inconsistently treated water experienced diarrhea ...Conclusions Lack of hygiene, specifically handwashing and cleaning of cookware, should be recognized as a significant contributor to wilderness gastrointestinal illness. Hikers should routinely disinfect water and avoid untreated surface water.
In my opinion, choosing when to treat surface water before drinking, is like choosing when to wash you hands before eating.
Flagyl usually does work, but Tinidazole is usually a much better choice with less side affects than Flagyl (which can be significant for some people.)
Most backpackers who have gotten giardia would agree that an ounce of prevention is worth a pound of cure.
swjohnsey
03-11-2013, 12:20
For what its worth, I don't wash my hand much, either. One giardia cyst won't give you giardia. Most folks have a certain immunity/tolerance for giardia. Very few of the sources tested along the AT had any giardia and almost none had enough to affect the average person. Don't know where I read it but (probably the internet) but it was estimated that 90% of the folks reported to have giardia were sufferin' from something else. Treat the water you drink if it makes you feel better, you ain't wastin' anything but a little time and maybe a few cents. Hell, placebos work 30% of the time.
Seatbelt
03-11-2013, 12:25
Caught it on a section hike last summer drinking from Laurel Creek just south of Mountaineer shelter. Only place I didn't filter that trip.
swjohnsey
03-11-2013, 12:44
Caught it on a section hike last summer drinking from Laurel Creek just south of Mountaineer shelter. Only place I didn't filter that trip.
Were you diagnosed with a lab test or do you just think you had it?
Seatbelt
03-11-2013, 12:49
Were you diagnosed with a lab test or do you just think you had it?
My hiking buddy drank the same as me, filtered the same, had exactly the same symptoms when we got home(2 weeks later), he went to the doctor and was diagnosed with giardia, I personally never went--just toughed it out... My son however, who also went along, did not drink any unfiltered water and never got sick.
I guess it is possible that I did not have it but we had the exact same outcome.
For what its worth, I don't wash my hand much, either. One giardia cyst won't give you giardia. Most folks have a certain immunity/tolerance for giardia. Very few of the sources tested along the AT had any giardia and almost none had enough to affect the average person. Don't know where I read it but (probably the internet) but it was estimated that 90% of the folks reported to have giardia were sufferin' from something else. Treat the water you drink if it makes you feel better, you ain't wastin' anything but a little time and maybe a few cents. Hell, placebos work 30% of the time.
It has been estimated that one giardia cyst has about a 2% chance of causing infection. Ingestion of one or more cysts may cause disease (source FDA "Bad Bug Book.)
Cysts have been found all months of the year in surface waters from the Arctic to the tropics in even the most pristine of surface waters (http://water.epa.gov/action/advisories/drinking/upload/2009_02_03_criteria_humanhealth_microbial_giardiah a.pdf)
I have sourced a number of scientific papers and public health experts. Frankly, I think it is wise to trust them vs the memories of what someone might have read on the internet. Those papers clearly show that treating water isn't a "placebo effect." Nor is handwashing.
Here's another major scientific study focused on the A.T. One of the conclusions: Methods to purify water need to be used regularly (http://www.ncbi.nlm.nih.gov/pubmed/8482936) That conclusion is based on what is ACTUALLY HAPPENING on the trail. People who don't treat water get sick significantly more often.
swjohnsey
03-11-2013, 15:10
I would guess that about half the water sources I used on the AT were not surface water, so you may be half right.
I only skipped filtering three times at"safe" water sources and got Giardia (although it was never positively confirmed, despite two tests). Now, two years later, I still have problems if I don't take an immodium tablet every day. The doctor said that whatever I had originally is long gone, but that I now have post-infection irritable bowel syndrome. Of any simple choice I've ever regretted making, drinking unflitered water's near the top of the list.
Josh Calhoun
03-12-2013, 18:51
200 miles into the trail and only filtered water 2 times.
200 miles into the trail and only filtered water 2 times.
That is awesome that you are out there on the trail!
I would caution that it's difficult to draw many significant conclusions from your experience so far however.
As can be seen from this thread and many others, it is possible to go for weeks or many years without getting any symptoms from giardia or other waterborne pathogens. It's also very possible to get giardiasis in a single trip.
I know of only two studies (http://bucktrack.blogspot.com/2011/03/waterborne-giardia-for-backpackers-no.html)done that tested people "before and after" backcountry trips. A minimum of 5% picked up giardiasis on one trip, and 24% on the second! Not all cases were sympomatic, and common sense tells me that these groups were relatively unlucky, but it does show that relying on luck and guesswork when not treating backcountry water is risky.
Many people who have gotten by without treating will say it's worth the risk. Most people who have paid the price will tell you that it's definitely not worth it. To quote "10%" Of any simple choice I've ever regretted making, drinking unflitered water's near the top of the list