Double Doody – fun with the cyclospora stomach bug

Hoo boy, what a week I had last week. The cyclospora parasite made it pure misery. For several days, I didn’t dare stray far from a bathroom. Fortunately, I got smart, acted quickly, and was back on my feet much sooner than I could’ve been. Here’s my story.

Friday evening, June 26th, my wife was taking me the airport for a three day weekend I was spending with our daughter. On the way we stopped at our local Lebanese restaurant for some to-go food. I sat in the passenger seat, stuffing my face as we weaved through rush-hour traffic to the airport. I polished off the kabobs and hummus but was sad not to get to my tabbouleh.

I made Kelly promise not to gobble up my tabbouleh as I kissed her goodbye and walked into the airport.

The weekend away visiting our daughter was wonderful. I would taunt Kelly with a photo of some amazing meal we were eating and she would joke about how good my tabbouleh is! She remained true to her word and I finished off my tasty snack when I returned Sunday night, June 27th.

Thursday, July 2nd was somewhat hot as a heat wave settled into North Carolina. Kelly and I both had Friday July 3rd off so we treated Thursday like the start of our weekend. I’d been given a gift card for a great local restaurant within walking distance of us. It was to be a nice celebration. We ate a lovely meal outside and then took a 20-minute stroll back home. Kelly remarked that she was feeling a little sluggish but assumed it was just the heat.

The next day Kelly was hit seemingly out of nowhere with severe intestinal distress, including vomiting and diarrhea. She was basically leveled, spending what was supposed to be our lovely three day weekend on the couch or in bed instead. We both scratched our heads: was it something she ate at our local restaurant Thursday night? If so, why wasn’t I sick, too? We had sampled each other’s meals. I thought about reaching out to the restaurant but decided I wasn’t confident enough that they were to blame. And, Kelly’s distress went on for more than one day.

In my experience when I get food poisoning, I know within hours. My body will let me know immediately that something is wrong. I will hate life for a day or so, then my body gets over it. Kelly’s dragged on unusually. This was odd.

My first symptoms sneaked up on me. I was lyign on the couch Sunday afternoon (April 5th), watching a Netflix movie. I found I couldn’t get my head comfortable on the couch pillow. It seemed to induce a headache. For a few moments the room spun, and then I got that familiar taste in my mouth that signals that I’m about to lose my lunch. I stepped into the bathroom and did just that, feeling significantly better.

Kelly’s strength seemed to come back a bit so I worked at my office on Monday, July 6th as planned. Nothing seemed out of the ordinary for me in the morning but the afternoon increasingly became a struggle to focus. I could barely keep my eyes open during my late-afternoon meeting and headed out the door the moment I could. Extreme fatigue had started to set in. I was fast asleep by 7 PM.

Alas, the night was not restful. I leapt out of bed a half-dozen times on my way to the bathroom. Relentless diarrhea. When morning arrived, I gave Kelly a weak smile and admitted that I, too, was a victim. Misery loves company, right?

Early on Tuesday morning (July 7th), I called out from work. Most of the day was spent either asleep on the bed or the couch, or running into the nearest bathroom. Painful stomach cramps hit. I felt alternately hot and cold as a storm raged within my body.

Food did not appeal to me, at all. Zero appetite. The first day I skipped eating all together. Instead I drank as much water as I could tolerate. Fortunately, I had no more issues with the front end; only the back end.

Another restless night Tuesday night had me again calling out of work Wednesday. I noticed my nose was now intently tuned into everything that could possibly annoy me. In fact, it wasn’t just smells – anything at all that could possibly annoy me seemed to be magnified ten times. A smelly trash can? Hate it. New eBay purchase smells like cigarettes? Hate it. Actors on TV drinking alcohol? Hate it. Too much sun coming through the windows? Hate it. Coffee? Hate it. My entertainment became lying on the couch and staring at my bare feet for hours on end. Nothing on TV appealed to me. I couldn’t bear the idea of starting at a screen, any screen. The storm inside me needed to calm and anything that didn’t support this was right out.

The good news is that my strength seemed to be slowly coming back. I’d been able to eat some oatmeal, toast, bananas, and other “bland” foods. On Thursday morning (July 9th), my appetite had returned enough to get me eating a sausage and cheese biscuit I fished out of my freezer.

I began to see some reports of a mysterious stomach bug, mainly centered in Michigan. Cyclospora is its name. I don’t know if that’s what hit us or not, but I can damn sure tell you that whatever it was was far nastier than any stomach bug I’d ever been hit with. This was clearly unusual. I get my healthcare through the VA, so I sent a message to my doctor there, asking if I could be tested for cyclospora.

Six more times up early Friday morning. I was bleary-eyed and getting worn down. Not having heard back from my regular VA doctor, I decided to go to the emergency room at the Durham VA hospital. Unlike most ERs I’ve visited, there was almost never any waiting at the Durham VA. I readied my body for the 45 minute car ride out there and stepped through the doors a little after 8 AM on Friday, July 10th.

As I expected, the waiting room was empty. I told the check-in nurse what I was being seen for and briefly took a seat. Another nurse took my vitals and soon I entered room 1: the first patient of the day.

The ER doctor, Dr. Heatherlee Bailey-Cooner, had a quick, witty mind and a soothing demeanor, which is in my opinion not the norm for an emergency medicine doctor. She asked about my symptoms before asking me to stick out my tongue.

“Oh, yeah,” she chuckled. My mouth hadn’t been open for half a second before she was turning to the nurse, ordering fluids. Apparently, I’d been quite dehydrated and not really known it.

As I waited for the IV to do its magic, I was tasked with providing a stool sample for testing. The nurse laughed when he gave me the kit. “You’ll probably be like nine out of ten people who can’t produce.”

Sure enough, I had nothing in the hopper. There was no way I was crossing I-40 with any possibility of an … uh, internal accident. I stared at the dripping saline and scrolled through my phone.

One PM rolled around. I gave up on providing the sample but got sent home with a collection kit, some anti-nausea medicine, and some probiotics. The IV had pumped two full liters of fluid into me. I was surprised.

Once home, I again napped when I could. About 7:30 PM, I was able to collect a sample! Within literally minutes I was on my way back to the Durham VA. I was not going to let another day of this misery go by!

I dropped off the sample at 8:30 PM. When I returned home, I kicked myself. On my desk were six additional labels I was supposed to attach to the collection cup. I panicked that key tests would not be done. Desperate, I called the VA’s ER nurse and pleaded for them to perform all the tests that I neglected to attach to the cup. She assured me they would reach out if there was anything I needed to do. I slept very close to the phone Friday night.

When Saturday morning (July 11th) rolled around, I refreshed the lab results page and only saw one report listed. None of the parasite panels were listed. I was crestfallen knowing that I’d now have to make another trip back out to Durham, get a new collection kit, and start this all over again. It wasn’t enough that I could get treatment for cyclospora, I was adamant that my case be counted. I felt strongly that this illness was being massively underreported, and wanted to do what I can to raise awareness.

I was just about to hop back in the car when I refreshed the labs page once more and whooped at the top of my lungs! “I’ve got it!” I yelled to Kelly. I had to clarify that I’d gotten my results – that I’d not have to jump through hoops again.

I scrolled down the parasite panel page to cyclospora. There was the word, “DETECTED.” Boom, vindication.

I was still looking at the webpage when my phone began to ring. The ER doctor on call told me the results and informed me that a prescription for antibiotics would be waiting for me at the Durham VA pharmacy. Again, I was on the road in minutes!! At 10:20 AM that Saturday, I took my first dose of SMX-TMP, otherwise known by the brand name, Bactium.

I’d read that the antibiotics would make an immediate impact on my health and they certainly did. My stomach wasn’t completely quiet that Saturday night but I’d only gotten up once instead of the six times I’d done the previous night. By the end of the day Sunday, I had no trace of any diarrhea. Success!

So what do I think happened? Kelly ate the tabbouleh days before I did and she got sick days before I did. Seems to fit. The time frame was perfect, too: about 5-7 days after eating the tainted food we got sick.

• Cyclospora isn’t passed human to human. It must infect food or water, and it has to be shed outside of the body for about 7 days before it can infect anyone. Given the runtime for this, it is challenging to pinpoint a source. This is especially true since cyclospora is a parasite and not bacteria. There is no DNA fingerprint which flags a particular outbreak.
• I am disappointed that no one from the health department has contacted either Kelly or me. I may have to reach out them myself just to get the ball rolling.
• I suspect that leafy greens are to blame. If I had to guess, I’d point the finger at Taylor Farm de Mexico, the culprit in the 2014 cyclospora outbreak. Leafy greens can be mixed into anything. If it were berries or the like, chances are their purchase and consumption would be pretty straightforward to track. As I write this I am seeing some initial reporting that Taylor Farm’s lettuce has been identified as a source. But we didn’t have any lettuce in our tabbouleh, we had parsley. It turns out Taylor Farm is also a major supplier of parsley.
• Getting ahead of the dehydration is challenging. I completely failed at it, and I am a guy who carries a water bottle around almost everywhere. Couple this with an extremely hot summer here in Raleigh, with heat indexes of 105 degrees or higher, and maintaining hydration becomes nearly impossible.
• Expecting people to sit (ha!) through seven days of this misery before seeking relief is patently absurd. Only a lucky soul who hasn’t suffered through it would spout such advice. I was at my wit’s end after three days of it. I wasn’t going to suffer one minute more of this misery if I could help it. There’s a real chance that advising people to wait a whole week puts them in danger of severe dehydration, possibly ending in a hospital stay.
• I suspect that cases are woefully undercounted. That’s why I jumped through the hoops to get tested.

Kelly reminded me tonight that tabbouleh wasn’t even my first choice for a side; I was going to get grape leaves but they were out. So, the tabbouleh that I’d wanted to eat so badly might have turned out to have done me in. I guess you just never know.