Trucker MD
Bad belly, big toe pain?

By John McElligott, MD

You have a quick lunch at a little café across the road from the truck stop. Soon after, you’re a little sweaty, nauseated, and need to find a toilet pronto. Food poisoning? Probably. Truckers are at high risk for a “gut bomb” – but that’s not the only thing that can give you a bad belly. Let’s take a look.

I got sick to my stomach about an hour after eating lunch. The urgent care clinic near the truck stop told me it was something called gastroenteritis, but I am sure it was food poisoning.
First, gastroenteritis is the term we doctors use for infection or inflammation of the mucous membrane of the digestive tract. It describes what you have, while food poisoning describes how you got it. Food poisoning is a problem likely caused by something you ate.

Bacterial causes of gastroenteritis include E. coli (traveler’s diarrhea, food poisoning, dysentery, colitis, or uremic syndrome); shigella (also causes dysentery); salmonella (from improperly handling poultry or reptiles); and campylobacter (from undercooked meat or unpasteurized milk).

Is there such a thing as just plain old stomach (or intestinal) flu?
Well, there’s a problem with calling it flu. It has no relation to the influenza virus, but it could be a virus. In fact, viral and bacterial are the two main types of gastroenteritis. Viral causes, which account for about 35 percent of cases in children, include “bugs” like adenovirus, rotavirus, calicivirus, parvovirus, astrovirus and norovirus (which is a leading cause in adults). Viral gastroenteritis is usually brought about by poor hand-washing habits or close contact with an infected person.

Are there other causes of gastroenteritis?
Additional causes of gastroenteritis are parasites or protozoans; chemical toxins; heavy metals such as arsenic, lead and mercury; and medications such as antibiotics, aspirin, caffeine, steroids and laxatives. Another common cause of bellyache is lactose intolerance, the inability to digest the milk sugar lactose.

When should I get to the doctor?
If you have diarrhea along with a high fever, diarrhea for more than three days, blood in your stools, or so much vomiting you can’t keep liquids down – get to the doctor. If you show signs of dehydration, like having to urinate less, dry mouth and throat and dizziness – check your temperature. (By the way, you should always carry an oral thermometer in the truck.) If it’s over 101.5 degrees, see your physician or, if you’re on the road, find a clinic. LL

“I had to turn down loads due to pain in my big toe...”

About a month ago, I had a sudden, incredibly unbearable pain attack in my right big toe. I could not wear a shoe or even a sock or touch it. I had to turn down loads and stay home until it went away. What was that and could it come back?

My friend, you have gout. Gout is an inflammatory condition caused by a buildup of uric acid in the blood that leads to crystalline uric acid deposits in the joints. The big toe joint is most commonly affected.

Gout can occur in men and women but most commonly affects men over the age of 50.

Typically symptoms include sudden intense throbbing pain, often in the middle of the night, accompanied by redness and swelling. Attacks can last for up to five days at a time.

Due to its inflammatory nature, gout is often referred to as a form of arthritis or gouty arthritis. It is however, different from osteoarthritis.

A blood test, if taken, may also reveal elevated levels of uric acid in the blood.

To provide immediate relief of symptoms, your orthopedic podiatrist will probably recommend a course of medication to your general practitioner. The most common medication used is called allopurinol. However, if there is not a fast response, you may need a 24-hour urine test to make sure you are excreting uric acid.

For truckers, I try to achieve instant relief. I use an injection of a 40 mg dose of kenalog in the muscle along with 60 mg of toradol intramuscularly and have the patient elevate the foot for a few hours. This often relieves pain in a few hours.

For long-term improvement of gout, custom-made orthotics – cushioning insoles that fit inside your shoes – can help to reduce pain in the ball of the foot, as can protective shields and toe pads.

Dietary changes can also help. High-protein foods – such as cheese, oily fish, chicken, red meats, shellfish, lentils and alcohol – have all been linked to gout and should be avoided in excess. If you are overweight, losing weight will help.

Gout-friendly foods include cherries and pineapple, most berries, fruit and vegetables, brown rice, and foods made from corn, rice, potato or buckwheat flours.

Acute attacks of gout are generally treated with a variety of prescription anti-inflammatory drugs. Ice or cooling lotions can also help during an acute phase.

Because elevated uric acid causes gout, which is a lifetime disease, this one condition is now listed as a cardiac risk factor. So find a good internist and get treated. LL