What do you do if you catch the Norovirus

Here's what you do when you get the stomach flu.

Disclaimers: I'm a family doctor writing these recommendations, in my 72nd hour of illness, and my 20-month-old baby is in his 60th hour of illness. I haven't had solids except chickpeas, saltines, and a couple cans of chicken noodle soup for the past 3 days. I've been taking care of a sick baby for the past 2.5 days. Don't sue me.

"Do not drink or eat until you've stopped throwing up. Yes, I know WebMD says to drink as much as you can so you don't get dehydrated. Baloney! I had to give a patient 3 bags of IV fluids because he tried to follow their advice. If you're vomiting, what's the point of drinking anything?!"

Stomach Flu Treatment

Rest.

Prepare your sick bed with the following:

A bucket for vomiting
A waterproof cloth that you can wash, in case you get vomit on the bed, so you don't have to keep washing all of the sheets
Water for rising your mouth— NOT for drinking
Fluoride mouthwash, if you can stand the smell of it while sick, to rinse your mouth after vomiting. Stomach acid is really corrosive for the teeth, but brushing will probably make you gag.
Tissues
A heating pad
Chewable acidophilus tabs
Easy access to the toilet
Plenty of toilet paper

If you don't have everything, don't worry. Just do what you can. If you have a lot of stomach pain, try some Tums, Pepcid, or Tylenol. If it's really a lot of pain, go to the emergency room. If you can tolerate the discomfort, you don't have to take drugs. Once you stop vomiting, and you're starting to feel thirsty again, wait 2 hours. If you are still thirsty, then you can start to drink clear fluids.

What are clear fluids? Water, chicken broth (not cream of chicken, chicken noodle, or anything except the clear, see-through chicken broth), jello (not pudding), ginger ale (de-fizzed by boiling, if the fizzing bothers you). You are allowed to have whatever you feel like having in the clear fluid category. I wrote water below, but you can have broth, jello, or ginger ale instead.

Drink 1 tablespoon of water every 15 minutes
After an hour, you can increase to 2 tablespoons of water every 15 minutes
After another hour, you can increase to 4 tablespoons of water every 15 minutes
After another hour, you can increase to a quarter cup of water (2 ounces) every 15 minutes
After another hour, you can increase to half a cup of water (4 ounces) every 15 minutes
Do not exceed 1 cup (8 ounces) of water every 30 minutes at any time during the first 24 hours. If you get nauseated, wait an hour. If you vomit at any point, go back to the beginning.

If you happen to have some metamucil or equivalent fiber product with psyllium husks (NOT the same as Citrucel, Miralax, chewable fiber tabs, or inulin-based fiber stuff), you can add that to your clear liquid when you get to the half a cup stage. My theory is that it helps to sequester viruses as it moves through the intestines. Just a theory. I haven't seen any research.

After 24 hours of not vomiting, you can start to try solids. You might hear about the BRAT diet. It stands for Bananas, Rice, Apples, and Toast. What about Saltines, you might ask? I count that as toast. It's fine. I've been eating toasted chickpeas, unsalted saltines, and Campbell's reduced salt chicken noodle soup. I think tomorrow I'll have some rice porridge with soy sauce and a little tuna. (Weird, but it's my comfort food.) My baby was looking pretty good last night and had kept down quite a bit of fluids. He kept pointing to the watermelon, so I gave in and gave him about a quarter cup of cubed watermelon. 30 minutes later, we had to wash a rug. Lesson learned: don't give in. Tonight, he had chickpeas, chicken broth, jello, and water. He didn't want Saltines, probably because he knew that it required lots of saliva to eat, and he was too dry for that. He's making a wet diaper a few times a day, so I know that he's not too dehydrated. If your baby's not making wet diapers, crying tears, or if you're not sure he's hydrated, go see your doctor.

NO DAIRY!!! That means, no yogurt, no cheese, no milk, no cream, no ice cream. For a week or more. Start slowly back on dairy. If you drink milk and get diarrhea again, stop drinking milk for a week. The parts of the intestines that help digest dairy products are damaged with these illnesses, and you'll just get bloating, gas, diarrhea, pain, and indigestion.

Avoid fatty foods, spicy foods, caffeine, and anything that you don't digest well. I plan to avoid spicy foods and red meat for a few days. If you get caffeine withdrawal headaches, then go ahead and have caffeine. Don't drink caffeinated tea because you think tea is good for you. Caffeine can stimulate your gut, and your symptoms may worsen. Herbal tea should be fine. But do be careful if you're taking herbs as a treatment unless you really know what you're doing.

In summary, the treatment of stomach flu includes resting, slow re-introduction of clear fluids, acidophilus, fiber, and avoiding foods that make things worse.

Caveats:

If you have blood anywhere, call your doctor or go to the emergency room.
If this continues more than a couple of days, call your doctor or go to the emergency room.
If you have chronic medical problems to begin with, call your doctor.
If you feel lightheaded, you may be dehydrated. If you can't drink because you're still vomiting, and you're having frequent watery diarrhea, then you may need IV fluids. Some doctor's offices can give you IV fluids, some can't— call your doctor. Urgent care clinics usually can. Emergency rooms definitely can give you IV fluids.
If you have a young child with it, and you've never dealt with this before, go see a doctor.
If you are worried about anything, go see your doctor.

Have someone drive you if you're sick. Don't try to drive to the doctor, urgent care, or ER by yourself.

Possible questions:

Tylenol. I don't recommend taking Tylenol, ibuprofen, or anything else for fevers and chills unless it's really high (like 103 or above) or if you're really really uncomfortable with the fever. The reason is because a fever is your body's natural way of fighting viruses. High temperatures will kill viruses, so it's okay to let a fever run its course.

When I was sick, I never really had a high temperature, but I was freezing cold and achy despite wearing lots of layers and hiding under my thick blanket. I had to use a heating pad to warm up. I could have used two – one for my front and one for my back, but I didn't want to overload the surge protector, and I was too tired to look for the other heating pad. (Side note: Heating pads are great for all kinds of muscle aches, and since we're on the computer all of the time, we get backaches a lot.) I admit I never took my temperature, but I just never felt hot. Sometimes, you may not run a fever, per se. Chills are part of the same spectrum. Chills, sweats, fevers, shakes, and general temperature irregularity (for example, when everybody's cold but you're hot and sweating) are indications of a "fever" problem. My baby is currently sleeping under covers despite wearing long sleeves. He hates blankets and squirms out of them normally. So either he's too tired to notice or he wants it. He also refused ice yesterday, which I thought would be an easy way to control the amount of fluids he was able to drink. He normally love ice.
Nursing:

I have a 20 month-old baby who nurses, especially for sleep. Thank goodness he knew better while he was sick to his stomach. He just slept without nursing the night he was throwing up every 20 minutes. He sleeps in our family bed, so we had a rotation of 5 waterproof crib liners going through the night, laundry machine and dryer constantly going. He'd fall asleep for about 20 minutes. Then I'd hear his stomach churning, and he'd start to squirm. I'd turn on the lamp on to I could see. Then he'd start to heave. That's when I'd make sure he was on his side so the vomit doesn't gag him. After a few heaves, he'd settle down. I waited about 30 seconds to make sure he was done. Then I'd wipe him off with some tissues and put down a new crib liner. He'd fall back asleep and I'd put the used crib liner in the laundry, along with all of the other laundry. It made for a long night, but eventually he slowed down.

The next day, he seemed a bit better, so I followed my usual protocol with fluids. I gave him a chewable acidophilus tab, the recommended progression of water/chicken broth/organic blueberry juice jello, and a few chickpeas, since my husband had toasted some as a snack. He slept an amazing amount that day, more than when he was first born even. He's never slept as much as they say babies should sleep, so when he slept for 20 in 24 hours, I was astounded. But I'm not worried. We should follow what our bodies tell us to do most of the time. If it's telling us to sleep, then that's what we should do.

I mentioned that I nurse him, and I still did even while he's sick. But it's milk! A big no-no, right? True, but human milk is very different for babies. It's much easier to digest than cow's milk. Plus, since I was sick, I'm making lots of antibodies against the same virus. Those antibodies will help him. Most likely, it will kill off some viruses in his tummy before they get digested. He never threw up the milk for me. I can't promise that for you, if you are my situation, but I wouldn't discourage breast feeding. If it doesn't work out, then I guess you might have to pump for a while.
Stomach flu:

IT'S NOT THE FLU! It's one of my pet peeves in medicine. The stomach flu is not The Flu. The Flu that you get the flu shot for is Influenza, which does not cause severe vomiting and diarrhea. Influenza can occasionally cause mild stomach upset and sometimes vomiting, more so in children who tend to vomit when they get a fever. But Influenza does not cause the so-called stomach flu. So The Flu Shot (which prevents Influenza) will not protect you from the stomach flu, nor will it cause the stomach flu.

The stomach flu is caused by completely different viruses. There are many different viruses that can cause stomachaches, nausea, vomiting, diarrhea, fever/chills, and headaches. The most common ones are norovirus (cruise ship virus), rotavirus (winter, daycares, there's a new vaccine for children!), and adenovirus. Norovirus is the most common— maybe 50%. Rotavirus is becoming much less common because of the new vaccine for babies, but still around— maybe 15-20% in adults. Rotavirus tends to be more severe than norovirus and causes young babies to be in the hospital for IV fluids because symptoms drag on for well over a week.

How do you know if you have the stomach flu? Well, did you catch it from someone with very similar symptoms? If so, then it's probably the stomach flu. But if you're not sure, go see your doctor. What are the symptoms? The most obvious ones are nausea, vomiting, stomachaches, and eventually diarrhea.
Vaccines:

Yes, I have given my child every vaccine recommended for him, including the influenza (flu) vaccine, and the rotavirus vaccine. There is no vaccine for the norovirus. The norovirus is also known as the Norwalk virus or the Cruise ship virus. It's extremely contagious and onset of symptoms is 1-2 days after exposure. It spreads around daycares very easily, especially in the winter. It causes vomiting, diarrhea, stomachaches, and some other symptoms. For a full list from the definitive source, see here. http://www.cdc.gov/features/norovirus/

I probably picked it up from the clinic. I only work there 1 day a week now. I worked all day on Tuesday, and by Wednesday night, I wasn't feeling right after dinner. I went to bed early that night and felt terrible all day Thursday. I never vomited, but I had bad stomachaches, chills, and achiness all day. I slept a lot on and off that day. I was worried that I had early appendicitis until my baby threw up at 2:30am. Then I was somewhat relieved that it wasn't appendicitis. I guess I didn't wash my hands cleanly enough while at work on Tuesday.

It's now Saturday night, and I'm feeling 70% better. My baby's probably at 40%. He's no longer vomiting, but really tired and whiny. He's sleeping more than when he was a newborn.
Imodium AD and other anti-diarrheal treatment: Not recommended. Diarrhea is a great way for your body to pass the virus out of your body. Holding it in may just make you sick longer. However, if you must travel and don't have easy access to a clean bathroom, then you must do what you must do.
Gatorade/Pedialyte: Gatorade is just salted, sugared water. It has a reputation of being healthy, but it's not. If you like it, fine. If you don't have it, don't make a special trip out to get it. I consider it junk food, and we don't EVER drink it. Actually, ginger ale is not "healthy" either. It's full of sugar, just like any other soft drink. But it does have a ginger flavor, which may help to settle your stomach.

If you have a sick child, you'll be suggested Pedialyte. It's fine. It's very overpriced salted, sugared water. If you don't feel confident in your child's ability to tell you what they want, or if you have a baby and the doctor says so, then go ahead and use it. Actually, if you have a baby, you should probably see your doctor if it's your first go-around with a stomach bug. Here's how to make your own version of Pedialyte. In 1 liter of clean drinking water (like a medium sized bottled water bottle), add 6 teaspoons of sugar, 1/2 teaspoon of sea salt. (Normal salt's okay, but sea salt has more of the minerals that you're losing. If you have low-sodium salt that has some potassium, that works well too.)

Alternatively, you can just let your child tell you what they want: chicken broth, water, or pure unsweetened juice. Mine's a salt fiend, like me, so he drank equal parts chicken broth and water. He had just a few table spoons of organic blueberry juice jello. Regarding the gelatin. I did not buy Jello brand junk food. I got some Knox unflavored gelatin and some pure juice (no added sugars such as corn syrup, no sorbitol!!! which makes diarrhea worse, just plain old juice and water – check the ingredients). You may need to look in the healthy/organic food section or the “expensive” juice section to find pure juices. I chose blueberry because my baby loves to eat berries. If I really wanted to get all health-nutty, I might have looked for vegan gelatin or used agar agar, which I did for his "birthday cake," but he's sick, I'm sick, we can take some shortcuts.

Again, if you're doing this for more than 3 days and not getting better, consider going to see the doctor.

Why chicken broth? It's got sodium and potassium, which are electrolytes you can use. You feel stronger with some salt in your body, holding on to the fluids. You lose a lot of potassium when you have diarrhea. If you have doctor-recommended sodium or potassium-restricted diet from CHF, kidney illness, etc., you shouldn't listen to anything in this article. You need to see your doctor. This article is for healthy people only.
Acidophilus (a probiotic)
has been repeatedly shown to reduce the duration of symptoms for a stomach bug. It's natural, generally safe, and is found in the vitamins and supplements section of most drug stores. As far as "treatment" goes, it's the most effective pill you can take to treat the stomach flu. If you can't find it, ask the pharmacist to help you. Pharmacists are not only there to serve you behind the counter, they love giving advice and are well-trained for it. I like the chewable because you don't have to swallow a lot of fluids to get it down. It's better than the powder because one wrong inhalation with powder in your mouth, and you'll be coughing for a while. But powder's good for babies. We had some powder for the baby, which I mixed in with his water, and I bought some chewables for me.

Other terms: Viral gastroenteritis, acute gastro.

GI bug, stomach flu, stomach virus are all possible terms you might hear. There may be other terms. I practice in the Northeast, so you may have another thing you call it where you are.

It is not the same thing as food poisoning, although you can catch it from raw seafood.

Antibiotics: It's not caused by a bacteria, so antibiotics will not help. In fact antibiotics will probably make it far worse.

If your diarrhea started after starting to take antibiotics, you probably don't have the stomach flu. Call the doctor who gave you antibiotics or your regular doctor.

Bacterial stomach bugs: You will hear about outbreaks of shigella at a daycare, salmonella on a salad line, E. coli on a ground beef recall, etc. Those are NOT the stomach flu. Those are much more serious, and even healthy people can die if untreated. If you're not sure, check with your doctor.

Disinfection If you like to clean, read the bottom of this page for norovirus cleaning procedures. http://www.cdc.gov/features/norovirus/

I figured that it's such an extremely contagious illness that it's pretty much impossible to disinfect our house once infected. I'm not even going to try. As long as the vomit is scooped up, wiped down with our regular enzymatic "green" cleaner, it's good enough. I'm washing the laundry with hot water and regular detergent, like I always do.

So what does extremely contagious mean? Well, if the norovirus caused us to become zombies, we'd be in a serious zombie apocalypse. To make things more clear, let's rate HIV as a 1 on the level of contagiousness. We'll put tuberculosis at a 2. Mono (kissing disease) would probably be a 3 in my book. Strep throat is about a 4. Norovirus is a 5. Once infected, you shed virus (that is, contagious) for 2-3 weeks. It stays infectious in carpet for almost 2 weeks. Soap and alcohol sanitizers DO NOT kill norovirus.

My husband said that he had a hint of nausea yesterday, which passed almost immediately. He's been fine since. He's probably had the same strain or a similar strain in the past, so he didn't get sick. Or maybe his cells just don't match this particular virus in the way me and the baby's did. Thank goodness he's not sick because he's been so helpful when I was too sick to function.

There is currently a bad strain of norovirus sweeping the nation (http://www.usatoday.com/story/news/health/2013/01/24/new-norovirus-bug-f...). It's a worse norovirus season than most this year. I hope you stay healthy!

This article has nothing to do with SleepPhones, but I figured I'd share my techniques because I find myself writing them down all of the time in my practice. And I might have friends who'd benefit. Apparently, the stomach flu is in town.

Wei-Shin Lai, MD, CEO of SleepPhones

more info

Feb. 16, 2013

Update Feb 17 noon

Right now, our status is 5% (day 1), 50% (day 3), and 70% (day 4).

Well, we thought my husband was in the clear since he was surely exposed early Friday, and it had been almost 48 hours. But alas, at the 48th hour, he started feeling like his stomach was in knots and fatigue. We had a full day of travel scheduled and began driving in hopes that it was just because he stayed up late. Half way there, the bucket was used, and we had to stop at a gas station for the toilet. We canceled our plans and drove back home.

The baby's still not very energetic, but he's making wet diapers. He's had nothing to eat or drink except breast milk, which isn't really much at his age. He's refused everything this morning. I think he's still nauseated. His appetite's usually best in the evenings anyway.

I had another can of chicken noodle soup many hours ago and I'm still not hungry. After 4 days of not eating much, I realize how much trouble eating really is. All of the time it takes to feed everyone, wash the pots, wash the dishes, buy the groceries, cook, take out the trash, recycling, and compost really takes many hours from your day!

Update Feb 19

50% (Day 3), 90% (day 5), 95% (day 6). Me and the baby are back to a regular diet. My husband insisted to eating pizza at Day 3. He ate half of a frozen pizza and seems to be fine. My husband's brother is visiting for the week. He is currently fine.

Update Feb 20

We're all back on dairy products, and everybody seems to be much improved.