Giardia

[Lawson Kline]

Who has had Giardia? How long did it last? What were the symptoms you most remember about it?

[Bob Gross]

Giardia symptoms typically show up one week to two weeks after ingestion of the cysts. In some victims, it is self-correcting after one or two cycles. In most victims, it is not self-correcting, and prescription medication is necessary to kill the parasite as well as the good flora of the GI tract. The medication can be administered in daily doses for a week or so, but it can be administered massively within a single day in special situations. The victim may then be free of the organism, but will have a seriously impaired GI system for at least a week or so. It is a lot easier to prevent it than to cure it. Diarrhea is the most common symptom, and secondary symptoms can show as well.

–B.G.–

[Lawson Kline]

Thanks! Have you ever had it? I got really sick a month ago and went to the Dr. about a week later since my symptoms wern't going away. She gave me some acid reflux medicine since I told her I was burping alot. She said whatever I had will go away but I should avoid dairy for a month or so.

Well 1 month later I still have the same symptoms but they now come and go. My friend that got Giardia said that I must have it too because he had the exact same symptoms. He said his went on for 6-8 weeks. I just never knew it lasted so long.

[Bob Gross]

I had Giardia many years ago from drinking impure water at an Army training camp. At the time, it seemed strange since the symptoms didn't show up until 8-10 days later. A physician treated me, and then I was OK a week or two later.

If you do have Giardia, the acid reflux medicine isn't going to do much about the primary problem.

Without killing the parasites in the gut, symptoms tend to recur in cycles. Some victims will have one transient bout of diarrhea, and then it clears without medicine, but you sure can't count on that.

I've been around other people who drank impure water and then got sick, and there is a whole spectrum of primary and secondary symptoms.

–B.G.–

[Lawson Kline]

Yeah the acid reflux medicine didn't do anything but make me burp less. My symptoms come and go in cycles. A few days of feeling good and then a day of feeling like crap. I don't mean to get gross but as you said you get some serious diarrhea. In addition that that I have been low on energy, have cramp like symptoms from time to time, lots of gas, burping, bad breath. I am not a sick person and have been in great health my whole life but this last month has been rough. I am going to the Dr. tomorrow for a follow up and I am sure she will go hmmmm. I better give you some medicine.

[John Nausieda]

Spit test tells you fast.

[Anonymous]

"Well 1 month later I still have the same symptoms but they now come and go. My friend that got Giardia said that I must have it too because he had the exact same symptoms. He said his went on for 6-8 weeks. I just never knew it lasted so long."

You're shooting in the dark without a definitive diagnosis.
You should consider asking your doc to order a stool sample analysis. That is the only sure way to diagnose giardiasis
that I've ever heard of.

[Lawson Kline]

No more shooting in the dark. I will know more tomorrow.

[Bob Gross]

I was trekking in Nepal, and the group had been out on the trail for about 15-16 days. One woman got diarrhea so suddenly that she was "off the trail" a dozen times in one day. We got to the Aid Post at Pheriche and sat down to drink afternoon tea with the two western doctors. She described her symptoms, and then one doctor said that he would not be able to make a diagnosis without a stool specimen. That was produced within a matter of minutes, and it went under the microscope. The doctor reported that in many cases, he has to study the microscope slide for 15 minutes before he sees enough cysts to call it. In her case, the cysts were all over the place, so that agreed with her symptoms. She was given four days worth of Flagyl to take in a single day. That is not the safest drug, but it is very effective. After 24 hours, she was completely clear of the organism, but she was weak as a kitten. Over the next several days, others in the same trekking group got different degrees of the same symptoms. The only one with no symptoms was me. Go figure.

–B.G.–

[Nia Schmald]

"I don't mean to get gross but as you said you get some serious diarrhea. In addition that that I have been low on energy, have cramp like symptoms from time to time, lots of gas, burping, bad breath."

I got giardia twice last summer while hiking the pct and those were my symptoms. One thing that you may want to consider. The doctor in Mammoth that I saw said that there are many false negatives for the giardia test, so he didn't even bother with the test and gave me a 7-day course of flagyl. After one day the symptoms were gone. Three days later I was back on the trail. I still felt weak and it took me almost a month before I felt full strength again but compared to the stories I've heard of people who didn't take the drugs I'll go with better living through chemistry every time.

[Lawson Kline]

Yeah I want some meds haha… Did you have the exact same symptoms to the S?

[W I S N E R !]

I had a negative lab for it, yet the doctor was pretty certain I had it based on symptoms and discussion. Food poisoning doesn't last that long, I had no vomiting, and no other flu-like symptoms. I too was told that false negatives are fairly common. This was based on one stool sample.

I had symptoms for about 2 1/2 weeks before going to the doctor. Fluctuating between the runs and dark, almost greasy stools (not dark like bloody stools though).
I was having waves of nausea. 75% of the day I was OK, but I'd get pretty intense random but short spells of it a few times a day, accompanied by fatigue. The fatigue would often subside and reoccur, just like the nausea.

It was summer and I was trail running about 5 days/week, swimming in three different pools/waterfalls every time I was out, many with high traffic. I also ran out of water on a long run and had to drink about 1 1/2 liters untreated.

I opted for no medication; given I was hydrated and otherwise feeling well, we decided I'd go another week and see what happened, contacting her if symptoms worsened.
They began subsiding in week 3 and I never went back for another test. I haven't experienced anything out of the ordinary since then, although I've heard of the possibility of future flare-ups when untreated.

I've always wondered, is it possible to build an immunity to it? I've always speculated on whether or not frequently ingesting small amounts over long periods of time could build a tolerance…
Summer is here again and I'll be swimming in those same pools/streams many days a week again…It's impossible not to drink more.

[Bob Gross]

Craig, I don't have any recent information. However, the old conventional wisdom was that perhaps 50% of adults are asymptomatic to giardia. Or, maybe they just have one brief hit of diarrhea and they chalk that up to something odd that they ate. I would like to see some modern information.

That means that 50% of us will show some symptoms, and maybe some serious, recurring symptoms. It is ugly. You might be a "carrier" like Typhoid Mary.

–B.G.–

[Brian Lewis]

I'm literally flying out this morning to get back on the AT after having my thru-hike interrupted by Giardia or something akin to it. In my particular case I was already carrying generic Flagyl and started taking it before I got home, just finished a 2-week course of it (nasty tasting pills …).

My particular symptoms didn't include a lot of diahrea; what happened to me is that as soon as I would eat anything my stomach would start to churn and I'd get associated gas, and most importantly I just didn't want to eat and had very low energy. I went from happy 20+ mile days to struggling to do 10.

The not wanting to eat is a particularly big symptom for any thru-hiker; I'd been on the trail for 3 months at that point (started the AT NOBO Feb 25th this year), and had lost most body fat. For a thru-hiker to not want to eat — something's badly wrong.

I don't yet know for sure what I had; I should have gotten the stool sample and lab test, but ultimately never did as I started getting better right about the time I actually saw a doctor. But my energy took a long time to come back and I felt kind of "wonky", just off my game a bit (vaguely like feeling faint or dizzy, a little of both, the latter could be a side effect of the Flagyl).

In fact I'm not certain what I had (have?!?), but I'm getting back on trail tomorrow, hopefully I'll continue to get stronger and be fine going forward …

… as I walk into the worst Lyme infested territory in the country (I got off trail in New York) ! :-)

[Ben Crowell]

Nia wrote: "I got giardia twice last summer while hiking the pct and those were my symptoms."

Interesting. Any idea what area of the PCT you got it on? I guess it could be hard to tell, since the incubation period is so long. Everything I've read says that the chance of getting giardia in the Sierra is basically negligible. Since you didn't get a stool test, I wonder if it could have been something else, like hand to mouth contamination…?

[j lan]

I would suggest anyone taking giardia meds to take live acidophilus after completing your course. Will really help get things back to normal.

[Tim Heckel]

My experience was similar to Brians "…symptoms didn't include a lot of diahrea; what happened to me is that as soon as I would eat anything my stomach would start to churn and I'd get associated gas, and most importantly I just didn't want to eat and had very low energy."

I contracted it from the Vail (town) water. I did get tested and went through the drug treatment; which was no fun either. It took well over a month to normalize.

[Bob Gross]

If you do have to take Flagyl or something to wipe out the organism, you might feel weak and without appetite for a time afterward. I can testify that you can "keep a person on the trail" for at least four days, consuming nothing but Gatorade.

–B.G.–

[Hiking Malto]

I picked up giardia while hiking south out of Sonora Pass on the PCT. I felt weird for about 10 days then all heck broke lose. I lost 15 lbs. in 3 days all on the toilet. Now the gross helpful part. Because giardia inhibits the absorsion of fat you diaraha in a little strange. It not true liquid and it floats. I also had to force myself to eat and it took over a week to confirm what I had even though I knew when I walked into the doctor. After talking the pills 3x5days. I was completely better.

The symptoms were so unique that I'm certain I could instantly self diagnose and I have the "meds" to fight it. I'm planning to thru hike the PCT next year and I will have my little bag of 15 pills because a large number of thru hiker trail journals I've read talk about the hiker getting nailed.

[Graeme Finley]

Funny you got Giardia going south from Sonora Pass. When I hiked the PCT I got something (Gardia/Crypto) twice, and the first time it hit me a little south of Lake Tahoe. I have a suspicion it might have been Wolf Lake, just north of Sonoroa Pass. A lot of people in '07 got sick right around there.

[Tony Beasley]

http://erikschlimmer.com/pdf/GiardiaMyth-Buster.pdf

[EndoftheTrail]

Giardia Myth-Buster Article

[EndoftheTrail]

Tony:

Here' how I see it. Take these different scenarios — three are slam dunk to me and one is "iffy":

Slam Dunk:

1. High occurrence -> high consequences = take precaution!
2. High occurrence -> low consequences = who cares?
3. Low occurrence -> low consequences = who cares?

Iffy:

4. Low occurrence -> high consequences = take prevention or not?

To me, the fourth one requires some balancing. If taking precaution is very costly, then I might decide to just risk it. But if taking precaution is cheap / painless — then why not?

Water treatment to me is like scenario #4. Lots of times, likely nothing will happen. But get hit with giardia and you can be sorry for weeks and months!! Considering how light, easy, and cheap some water treatment methods are — my sentiment is to utilize them.

[Lynn Tramper]

Good article, and jives with my experience. I have never treated my water, and the only time I got (confirmed) giardiosis was from drinking tap water in Hawaii (or it could have been food contamination in Hawaii). So I'm clearly not an asymptomatic carrier.

[Ben Crowell]

Excellent article, Tony — thanks for posting that!

Although the article is 100% about giardia, there are other bugs that can make you sick, like crypto and E coli. What you'll hear from experts like Robert Derlet is that they don't treat their own water. However, these people are also pretty educated about where to get their water. You want fast-moving water. If you're at a lake, the best location is at a fast-flowing inlet, second best at a fast-flowing outlet. You want to avoid streams that flow laterally along trails, because it's easy for them to become contaminated from pack animals. Dairy calves (not adult cattle) are extremely prone to pumping out lots of nasty bugs in their poops.

I don't see how it hurts me one bit to *bring* a strip of ClO2 tablets with me. The cost isn't that great, and the weight is negligible. If I'm thirsty and don't want to wait a long time before drinking, I'll go ahead and drink without treatment. If I'm forced by circumstances to take water from a source I'm suspicious of, I use a tablet. In the in-between cases, I might as well use a tablet, because the expense is minimal, but it's no big deal.

The *big* issue, as the linked article points out, is hand-to-mouth contamination.

Some other links that may be helpful:
http://sierranevadawild.gov/features/water-is-it-safe-to-drink
http://www.wildebeat.net/scripts/E098.html
http://web.archive.org/web/20051026030831/www.yosemite.org/naturenotes/Giardia.htm
http://web.archive.org/web/20051026030806/www.yosemite.org/naturenotes/Derlet1.htm
http://web.archive.org/web/20051031034802/www.sierranevadawild.gov/Learn/coliform.htm

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