Dear Alice,

For the past two or three weeks, myself, my wife, and my kids have had flu symptoms on and off. We'll have nausea, vomiting, and diarrhea for about 24 hours, it will go away for a day or two, and then come back. It concerns me as this is not the normal cycle we are accustomed to with the flu. I almost feel we need blood tests or antibiotics or something. What could this be and why does it keep reoccurring?

Dear Reader,

It sounds like you have your hands full (and your toilets for that matter). You're right to be concerned. First things first, contacting your health care provider is an excellent idea. It is a good idea to follow-up with a pediatrician regarding your children. Vomiting and diarrhea can lead to dehydration; and children are especially susceptible to dehydration. You and your wife are, too! Read I'm vomiting and I can't keep anything down — Help! for more information on the signs and symptoms of dehydration when you're feeling this ill.

It's not clear from your letter if your whole family is becoming ill at exactly the same time, or if the illness is working its way through the family, and being passed back and forth. If your family is becoming simultaneously ill, then simultaneously better, and then simultaneously ill again, then what you've described is definitely not a normal cycle for the flu (influenza).  While a lot of different things might be causing your family's troubles, the pattern you're describing sounds like one of exposure. When an entire family falls ill at the exact same time, they've probably been exposed to something at the exact same time.

One possibility is that all of you have been exposed to a parasite. One such parasite, Giardia, is the most common in the United States and is common worldwide. People usually become ill by swallowing water containing the microscopic parasite, though it is sometimes also passed through food. In the U.S., it can be found in streams and lakes in wilderness areas, but it can also show up in municipal water sources, both natural and human made. Even swallowing small amounts (such as accidentally while swimming or using some river water or contaminated well water to brush teeth) can be enough to cause illness. One thing to note — you can have intermittent symptoms according to the life cycle of a parasite, but it would be highly unusual for all family members to be having waxing and waning symptoms on the same schedule. Is your family experiencing symptoms on the same schedule?

Have you gone hiking, camping, or swimming lately? Have you done any travelling? Especially if you went as a family, this could be a possible cause. Giardia can also be passed from person to person contact (children can sometimes become exposed to it in daycare centers, as can daycare staff). Giardia infections can clear up on their own, usually within two months, but you may have intestinal problems even after the parasites are gone. Symptoms include diarrhea, nausea, gas, cramps, fatigue, weight loss, and dehydration. Stools can alternate between watery and soft, which could give the impression that the illness is clearing up.

Any number of parasites or bacteria could be causing your troubles. It's hard to know without more information. Consider visiting your health care provider. If you do, be sure to inform her or him about any recent travelling. You will likely be asked to provide a stool sample. The good news is that once the cause is identified, there are many medications that can clear out the bug, whether it is a parsite or bacterial.

Hope you all have happy stomachs soon,


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