Last Thread

…back to the Dr. D’s office of infectious disease and the guy that is going to make me better because that’s how a good story would go…

Day 23

“You’ve been poisoned. It’s not a bug bite. You ingested it. What kind of fish did you eat? Grouper? Snapper?

Uh-oh. “I ate snapper.”

“It’s Ciguatera Fish Poisoning! I mean we will do some tests but it is classic presentation! You see there are these dinoflagellates, like the one cell jobs with the tails (he wags his finger). Well they live on the algae that grow on the reef especially where it is damaged. The herbivorous fish pick and eat the algae all day long. I’m sure you’ve seen this snorkeling.”

Yes, I swim with the fishes. I nod. That’s the day this all started.

“In with the algae goes the toxic dinoflagellates (finger wag, wag, wag). And it builds up in the body of the fish. It doesn’t affect the fish in any way. The herbivorous fish are eaten by the carnivorous fish. And a fish eats a fish eats a fish and this builds up in the body of that last fish and that is the one that you ate. Poison fish.”

Oh.

“So, how do you take a shower?

Huh? How the frick does he know about that?! “Well, I sort of know the mark of where to turn the lever and then I wait for it to warm. I stick my fingers in and when it stops burning and stops causing pain I know that it’s no longer cold but hot. When I am finished I then I have to start drying off my upper body with the towel while keeping my lower body under the hot water because if my entire body is wet in the room temp air and uncovered it is unbearable. And I dress in a panic.”

“Yes, I treated one lady for this before and she had to have her daughter test her shower for her to make sure it wasn’t too hot to scald her. So, does you family think that you are crazy?”

This guy is better than Groban. Weird disease. Weird questions.

“I don’t know what they think. I cry a lot and I’m not a crier….So, at dinner, another lady that was with us ordered the same thing. Does she have it?”

“Did she have the GI symptoms?”

“No I checked with her the next day because I thought it might have been the water at the restaurant. We both drank it.” Spicy Grandma.

“Not likely, snapper is one of the worst. Because it’s a frequent eater and doesn’t grow large, it can build loads of this up. And then, a filet of snapper is probably just serving one. Something bigger like a grouper serves more people and so the lifetime accumulation of toxin is spread out. In snapper it’s all in one serving. Concentrated. If she didn’t have the GI symptoms, her fish was probably ok. Yours was not. And since you have it in you, now, you can never eat any of the predatory reef fish again. Putting more toxin in your body would be exponentially worse. Once this man came in and he’d been stung by sting ray and he said he had a heart attack, right there on the beach. I didn’t believe it but…..”

I faded out on this story. But I think the guy made it. I am too distracted by the upcoming ending of my own tale. My poison fish tale.

Oh. “So, how long does it last?”

“There’s no antidote.”

“No, no. I mean…how long until it goes away?”

You see, this guy was so into explaining it, I thought it was leading up to the big reveal. The answer. The solution. The end.

“Well, it’s in you now connected at the cellular level, interrupting them. It is a neurotoxin. It’s about calcium channels and neurons. And it’s attached there. And you need to wait for it to release from your cells.”

“So when will that happen?”

“There’s no way to say.”

What.

Then he goes on about prescribing medications to treat the symptoms. Supportive care. And I get all into that because now I am sweating and if there is med for this stinging. I want it now. Bring it to me you happy, magic man.

“…So, start on this and I will see you in a month and we will see where we are.”

What. See where we are?! “Soooo, am I going to feel better in like 3 weeks or like 6 years?” I smile and tap my wrist where people used to wear watches because I will charm an answer out of this guy. Be funny. Be nice. Be positive.

I need him to tell me when I will be better. Today is that day I find out. That’s the only way that I’ve made it this far. I need a deadline. I will make any deadline.

The tiny, lonely, last thread holding me to this day is taught. At its limit. I’m spinning and the fray is starting just above my head.

He shrugs with a deflated smile and says, gently, “Yes, somewhere in there you will probably start to feel better.” He turns to go.

It’s written on my chart but I make sure to say, “Wait, I am nursing my 4 month old. Are these medications ok for the baby?”

“Oh. You are nursing?”

“Yes. Why? (pause) This poison. It doesn’t pass through breast milk, does it?”

I stare at him. Don’t look like that. Don’t say it. Do. Not. Say. It.

“I don’t know. I will make some calls and get back to you.”

Now, I’m not really sure how I got home. I know that I was crying a bit and it was in relief that I am not crazy. That I will get better and until then I will have medication. Happy Doc is going to call me and say that all is well. Baby is fine.

I come in and share the story with my family. I get online and search and find this:

Ciguatera Fish Poisoning [Sig-whah-terra]: is a foodborne illness caused by eating certain reef fish whose flesh is contaminated with toxins originally produced by dinoflagellates such as Gambierdiscus toxicus which live in tropical and subtropical waters. These dinoflagellates adhere to coral, algae and seaweed, where they are eaten by herbivorous fish who in turn are eaten by larger carnivorous fish. In this way the toxins move up the food chain and bioaccumulate. Gambierdiscus toxicus is the primary dinoflagellate responsible for the production of a number of similar toxins that cause ciguatera. These toxins include ciguatoxin, maitotoxin, scaritoxin and palytoxin. Predatory species near the top of the food chain in tropical and subtropical waters, such as barracuda, snapper, moray eels, parrotfishes, groupers, triggerfishes and amberjacks, are most likely to cause ciguatera poisoning, although many other species cause occasional outbreaks of toxicity. Ciguatoxin is odourless, tasteless and very heat-resistant, so ciguatoxin-laden fish cannot be detoxified by conventional cooking.

­Then I see this:

The symptoms can last from weeks to years, and in extreme cases as long as 20 years often leading to long-term disability. Most people do recover slowly over time. Often patients recover but symptoms then reappear.

Then, this:

Diarrhea and facial rashes have been reported in breastfed infants of poisoned mothers, suggesting that ciguatera toxins migrate into breast milk.

I look at my baby.

DSC_1082

And snap goes my thread.

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