Why has this stomach bug left me so weak?

A FEW weeks ago, I was diagnosed with salmonella food poisoning.

I was very ill and also developed a urine infection. I needed to pass urine but couldn’t, only blood, accompanied by a terrific pain. After a urine test I was prescribed ciprofloxacin, which cleared this up, but it took every tablet to do this.

I am 71 and now am feeling so tired — I have never felt like this before. My GP said it will take a while to feel better. Can salmonella lie dormant in your system and then reoccur? I would like to know, as I don’t think I could go through this again.

Name and address withheld.

By the time you read this I hope you will be fully recovered. If there wer e any residual salmonella bugs in your system it is likely they will have been eradicated by the ciprofloxacin, the antibiotic prescribed to treat the urinary infection that occurred when you were so depleted after the gastroenteritis.

Salmonellae are bacteria that can cause a number of types of infection, including gastroenteritis (an infection of the bowel or gut — gastroenteritis can also be caused by viruses, such as the norovirus).

they are usually transmitted to humans through consumption of food that has been contaminated by infected faeces — the bacteria live in the guts of many animals and can affect meat, eggs, poultry and milk. they can also be passed on by infected humans. Salmonella causes about 10 per cent of all bacterial food poisoning.

the main symptoms of gastroenteritis are nausea, vomiting, fever, diarrhoea, and stomach cramps. these usually occur eight hours to three days after eating contaminated food. the condition usually resolves itself by the tenth day, and the main treatment is a suitable fluid and salt replacement, We such as Dioralyte.

WE generally do not t r eat i t with antibiotics if t he patient is otherwise in good health and under 50. however, we do use antibiotics in patients who are so ill as to be hospitalised, or those with compromised i mmunity, such as patients taking steroids.

During the convalescent period, it is common to continue excreting the bacteria without any symptoms — this will go on for some weeks.

this represents a potential danger to others as, in theory, the bacteria can be passed on.

If you’d had just the gastroenteritis, you wouldn’t normally have been given antibiotics. however, a urinary tract infection supervened, which is why you were given ciprofloxacin.

that infection was probably coincidental, though your dehydration or general weakness may have contributed to it. By chance, ciprofloxacin is the antibiotic that would be chosen to treat a patient with salmonella gastroenteritis.

this was fortuitous, as it provides some reassurance that if there were any residual salmonella organisms in your intestinal tract, these will have been eradicated, completing your recovery.

I suggest your exhaustion is the result of the cascade of one serious infection after another — and, at 71, this hit you very hard.

you wrote to me a little while ago and if you are no better as you read this, then you must be seen by your doctor, re- examined and re-investigated.

We do know that adults over 50, particularly those who have atherosclerosis — a build-up of plaques on their major arteries — are at risk of infection of the lining of the blood vessels by the salmonella organisms.

around 10 per cent of those with gastroenteritis due to salmonella will have a bacteraemia (a bacterial infection in the bloodstream) and a small percentage of those will get bacteria lodging in the plaques.

you may not know whether you had a bacteraemia — the urine test can only reveal bacteria in the urine. If organisms did escape into your bloodstream, it is, in theory, possible that there is a persisting illness; your short course of ciprofloxacin may have suppressed but not eradicated that, and if you are continuing to be exhausted and ill, you must be investigated further.

But if salmonella organisms are still in your system, a recurrence of gastroenteritis is most unlikely. I HAVE developed an umbilical hernia, which revealed itself a few days after a Pilates class. I had aches from the exercise, then a lump appeared in the area of my tummy button. I am 74 and used to exercise, so this was a shock. My GP confirmed my condition.

Now I am unsure how to behave, whether to exercise or swim or not. I find I cannot eat as much as before, otherwise I feel bloated. The hernia is becoming a nuisance. How should I treat it?

Dorothy Gates, by email. an UMBILICAL hernia is neither a sinister nor a dangerous occurrence, though clearly the emergence of a lump in the middle of your abdomen has alarmed you.

a hernia is a protrusion of a viscus — an internal organ — through its normal covering. an umbilical hernia is the protrusion of some of the contents of your abdomen through a defect in the abdominal wall near what we call the umbilicus, or naval.

these are often seen in babies and small children, but disappear as the muscles strengthen and the defect closes, so no action is needed.

When an umbilical hernia occurs in an adult, it is down to several factors, such as muscles weakening with age, increased fat in the abdominal wall, and anything that raises the pressure in the abdomen such as pregnancy, persistent coughing, constipation, heavy lifting or playing a wind instrument.

you must have had a degree of weakness at that point and there was something about the Pilates class that opened up the gap in the muscles enough for the hernia to pop out.

THE concern here is ‘strangulation’ — when the contents of the hernia sac twist and cut off the blood supply. this depends on how big the hernia opening is. If the hernia has a wide opening, it will fall back inside when you relax, such as when lying down. If this is the case, doctors can be fairly certain that strangulation won’t happen.

If the neck is narrow, the hernia won’t disappear when you lie down. In that case it can usually be massaged back, but strangulation is a greater possibility. But if this occurs, an emergency operation is essential to avert the risk of the section of intestine in the hernia dying.

there are times when a hernia cannot be massaged back inside, in which case we refer to ‘incarceration’, and such hernias are more likely to strangulate.

your symptoms of tightness and bloating imply that perhaps a loop of intestine is trapped in the hernia and it is therefore incarcerated. make sure your doctor is aware of these symptoms, as it could mean you might need to be referred for surgical repair — not a major process, probably i nvolving only one night in hospital and it can be performed under local anaesthetic.

Once you have clarified with your GP whether or not the hernia is incarcerated, and discussed your response to eating, my advice would be to continue with all of your exercise activities without reservation. I would draw the line at weight lifting and taking up the oboe or tuba, but otherwise swim, maintain your Pilates sessions and carry on.