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At hospitals, gastric distress is a part of the holiday tradition

As millions sit down to Thanksgiving dinners, emergency room staffs are getting ready for a busy day. 'It never fails,' one doctor says.

November 25, 2009|By Rong-Gong Lin II

Take this as a cautionary tale.

The man was covered in sweat, clutching his chest, when he entered an emergency room on Thanksgiving some years back. His words are fixed in the memory of Dr. Mark Morocco, associate residency director of emergency medicine at UCLA.

"I just ate a lot of meatballs. . . . Oh, my God, here it comes!" he said, then vomited into a sink in the triage area.

The diagnosis? More than a dozen of his mother's meatballs, all crammed into his stomach.

Yes, on this Thanksgiving you can eat too much, too quickly, to the point where you might just feel sick enough to go to the emergency room.

"There's folks who . . . can literally fill themselves up with undigested food," Morocco said. "We see, routinely, people who come in who think they are dying, and really what they have done is overeaten, and they just feel bad."

In the early hours of Thanksgiving, while footballs are tossed or watched and turkeys roast, emergency rooms are typically empty. It's after the eating begins in the afternoon that people start to arrive.

"It never fails, every year," said Dr. Nagi Sous, who heads the emergency room at Kaiser Permanente Los Angeles Medical Center in Hollywood.

There are the times when whole families turn up.

"One badly cooked turkey can easily strike a blow at a dozen people at grandma's house on Thanksgiving," Morocco said. "If you thaw a turkey wrong or cook a turkey wrong . . . it's an opportunity for turkeys to get even with the human population."

The problem waddles into the kitchen when a cook thaws a turkey for 12 hours on a countertop or leaves the roasted bird out for two or three hours before serving it.

During that time, a virus or bacterium can land on the food and start growing, Sous said. A virus can cause gastroenteritis, also known as the stomach flu. Simply reheating the meat may not fix the situation. Although bacteria will die under heat, the toxins made by the bacteria that cause illness can survive even in a hot oven.

Morocco cited a classic case reported in 1986 by the U.S. Centers for Disease Control and Prevention, in which a buffet served to 855 people at a New Mexico country club sickened at least 67 people. Twenty-four needed emergency treatment or hospitalization. Scientists later determined that the turkey had Staphylococcus aureus bacteria, which were also found in two food handlers' noses.

"The turkey had cooled for three hours at room temperature after cooking -- a time and temperature sufficient for bacterial proliferation and toxin production," officials concluded.

Sous said those experiencing upset stomachs should be drinking only clear liquids; any more eating or taking aspirin or Alka Seltzer will just bring on an encore.

Sometimes, trips to the hospital are triggered by a fish bone stuck in the esophagus. Other times, it's a chicken bone. Or a large piece of pork. Or a chunk of steak.

Such a sufferer can breathe but might not be able to eat any more food or even swallow saliva.

When that happens, doctors can insert a long tweezer into the mouth to take out the offending item, or push down a long tube, with a tiny camera attached on it, to nudge the food to the stomach, said Dr. Gail Carruthers, director of the pediatrics emergency department at Long Beach Memorial Medical Center and Miller Children's Hospital.

She exhorted people to follow two bits of advice. "Don't overeat. Chew your food."

There are more serious scenarios people should keep in mind.

People with heart conditions should avoid too much salt, which can trigger an accumulation of fluid in the lungs, making it difficult to breathe, Sous said.

And Carruthers warned that some symptoms of indigestion are similar to those of a heart attack. If you're having severe indigestion symptoms, especially if accompanied by sweating, you might consider going to the ER to have it checked out, Carruthers said.

"You may just have indigestion," she said, "but let us figure that out."

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