An Atypical Infection Presentation

A lesson I shouldn’t have had to learn the hard way.

WARNING: The subject of poop is present in the story below and while this may be a longer read than it needs to be, that’s a significant part of the story.

Hard core fatigue and that motion sickness feeling like I was reading in the backseat of a car on a winding mountain road. These were the two symptoms that hit me on July 25th like an athlete in the MLB batting a thousand swings for the outfield. Immediately followed by a complete loss of appetite, where the mere thought of eating, cooking, or even walking into the kitchen made me nauseated. I couldn’t stomach the thought of my normal healthy diet loaded with fruits, veggies, whole grains, protein, avocados and peanut or almond butter. I couldn’t fathom putting together a beautiful meal and setting the table for my family. I began force feeding myself dry Saltine crackers and the occasional few sips of chicken noodle soup for more than a week.

On the ninth day and following a negative Covid test result, my first visit to a doctor with a detailed explanation of my symptoms at that time led to a standard Comprehensive Metabolic Panel (CMP) and Complete Blood Count (CBC) lab workup plus a few extras like Thyroid, Vitamin D, and Cholesterol — resulting in “Your recent lab results all look great.”

Seeing no improvement after several more days, I requested additional blood work to look at markers for autoimmune issues, Lyme disease, Vitamin B-12, any other potential infectious diseases, liver function, etc. etc. etc. I felt more and more each day like I was living in someone else’s body. The subsequent note I received in MyChart, “Results were normal.” I knew nothing about this was normal. Nothing.

Weeks three and four — still trying to get any calories I could into my body. My symptoms didn’t evolve or change, but rather were compounded with distention of and discomfort in my abdomen, softer poop (see — I told you) and finally diarrhea for more than a week. The doctor ordered an abdominal ultrasound per my request, and a stool sample, which by the way, might have been one of the most horrifying experiences during which I definitely wish I owned a haz-mat suit. Drugs were prescribed and elimination diets were recommended. Insert: On August 17th I shared with the doctor that I had ingested potentially contaminated water on July 12 during an 80-mile bike ride. The tests ordered per the doc’s discretion were for two different bacteria, C Diff and H Pylori.

It was the middle of the fifth week when after a full day at work doing everything I could to make it through, Jesse and I agreed it was time to go to the Emergency Room at St. Luke’s Wood River. We couldn’t take the unknown any longer. I couldn’t maintain the waiting game for whatever this was to subside. My abdomen was more distended and pushing upward in the center of my chest, and I was continuing to lose fractions of pounds per day adding up to multiple pounds per week.

I felt a strange comfort coupled with anxiety checking into the ER. I was hopeful they could dive in deeper to get to the bottom of things, but I was also scared to learn of what they might find. And I was alone in a beige room, much like the color of my recent diet, where I could hear all the unpleasantries of other patients using the restroom on the other side of a shared door. All the same blood labs run again. Another Covid test.

The first news from the ER doc was the report from my abdominal ultrasound. “Your gallbladder is full of what we call ‘sludge,’ so it’s not functioning properly and we’d like to do a CT scan to rule out any factors related to say, a pancreatic tumor or another blockage involving your liver, etc.” Every emotion I could muster simply froze. And with Jesse available only on speaker phone from his clinic in the next building because of Covid, I felt more alone than ever. I was wheeled into the CT scanner so they could do a contrast scan. Then wheeled back to the beige room. Maybe they should aptly name the paint color “Saltines.” Another machine was brought to the beige room to capture a full chest x-ray — just so they could make sure this wasn’t involving my heart or lungs. I felt like every organ of my body was potentially at risk of something but I had no idea what.

I don’t know how long I waited for the ER doc to come back, but my mind could only go to places where he was likely reviewing everything alongside a radiologist and figuring out how to tell me what was wrong. His first words when he did lightly tap on the door and reenter, “I have great news.”

Tears filled my eyes and the doc’s eyes apologized with a look of perplexity. Of course we could only see each other’s eyes — no other facial expressions legible, draped behind our masks. He and the radiologist had indeed reviewed everything together. He commended me for how I have taken impeccable care of my health through the years. Every possible blood test and lab was pristinely healthy. From what they could assess, all appeared to be in the clear other than my gallbladder, for which there would be options to explore with a GI specialist. Fact of the matter was, I knew I was still occupying space in a body other than the one I was used to living in.

“I just want to send off for a couple of additional tests, so we’ll need one more sample before we release you.” Another test. Perhaps I’d receive another note in MyChart in the next few days, “Results were normal.” Little did I know at the time that this decision by the ER doc would be the key to unlocking this mystery.

7:26 a.m. on Friday August 28th. An incoming call from St. Luke’s Wood River. It was the on duty ER nurse calling to see how I was feeling. And to hand me the key. “You have Giardia.”

Relief. Gratitude. Shock. But then immediate embarrassment. Shame (noun): a painful feeling of humiliation or distress caused by the consciousness of wrong or foolish behavior. I knew better.

It all added up. That decision I made on July 12 when I ran out of water on an 80-mile ride had set the stage for a microscopic parasite to wreak havoc on multiple systems in my body and to strip me of the strength and endurance I had built all spring and summer. The three of us on the ride made that same choice. The bug chose me as its victim and it came at me with a vengeance.

“Like a gang of bandits that changes clothes after a heist to avoid capture, the intestinal parasite Giardia lamblia alters its appearance to outwit the human immune system.” — Howard Hughes Medical Institute.

Looking back at the overall timeline I perhaps now understand the irritability and feelings of stress and overwhelm I was experiencing between the time I ingested this scary parasitic organism, while it was setting up shop in my intestines, and then ultimately planning it’s attack on my digestive system. It was an atypical presentation as my symptoms played out, so it went undiagnosed for weeks. Longer than it needed to be.

While the antibiotics are doing their job over the next week to kill the beasties within, I’ll focus on taking methodical steps to restore my gallbladder to its normal function, heal my digestive system, and rebuild my strength and endurance. And I cannot wait to ride my bikes and put my hiking shoes on, as summer rolls into fall and the roads and trails are calling.

And yes, a thank you note is in the mail to the ER doc for those ‘couple of additional tests.’

#giardia #stlukeswoodriver #stlukeshealthsystem #advocateforyourhealth #gratefulformyhealth

A life lived all-in.

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