Loperamide have negative effects from rebound constipation. If a suspicion exists of diarrhea associated with organisms that can penetrate the intestinal walls, such as or "Salmonella", loperamide is contraindicated as a primary treatment. Loperamide treatment is not used in symptomatic "C. difficile" infections, as it increases the risk of toxin retention and precipitation of toxic megacolon. Loperamide should be administered with caution to people with liver failure due to reduced first-pass metabolism. Additionally, caution should be used when treating people with advanced HIV, as cases of both viral and bacterial toxic megacolon have been reported. If abdominal distension is noted, therapy
Things Ain't What They Used to Be Be", "Blue Serge" and "Moon Mist". Jazz musician and historian Chris Tyle argues that most likely Mercer Ellington came up with the melody and his father then arranged the song for the band. The song is most often played as an instrumental. Lyrics were written by Ted Persons. Johnny Hodges played it first, in Hollywood on July 3, 1941. Duke Ellington played it for the film "Cabin in the Sky" (1943). Things Ain't What They Used to Be "Things Ain't What They Used to Be" is a 1942 jazz standard with music by Mercer Ellington and lyrics by Ted Persons.