Carrie (2:35)

Thank you so much. I'm so glad to be here, Carrie.

Erin (2:38)

We usually start the episode by talking about what life was like when you were younger. Were you an active person, what your health was like?

Carrie (2:47)

Okay. Again, my name is carrie. I am 54, I'll be 55 here in a couple weeks. I'm a mom. I'm a wife. My husband and I have been married for 26 years. He's a retired firefighter paramedic. I have two adult boys, 24 and 21. I grew up in Southern California, North Orange county, and currently reside there. I was a stay at home mom for 20 years plus about three years ago when my husband retired, I went back to work. I am very healthy. I walk about 20 miles a week on average. My only complications with medical throughout my history would be I had two premature babies. I polyhedramnios when I was pregnant and I didn't realize that until my water broke at 30 weeks. But they're both healthy and thriving. So I'm always the healthy one in the family, it seems. A mom of boys, right?

Erin (3:48)

No time to be. No time to. No.

Carrie (3:50)

No time to be.

Erin (3:51)

And so can you tell us your story is a bit different from a lot of the stories we hear and then that this is based off of kind of a singular event. So can you bring us back to the days leading up to this event?

Carrie (4:04)

Of course. So last summer, this is now 2024 in July, I went to. We have a family beach house in San Clemente, which is just south of us in California, and we go there annually. My husband comes, my boys bring friends, and it's a lot of work on me because I cook for everyone and I usually send them off four or five days into the trip. And I'd say, all right, you guys go home. I'm gonna bring my girls in and we're going to just finish out the week. Towards the end of that week, I was feeling like I couldn't catch my words. Like I had some brain fog going on. Like, simple words. I just couldn't remember their name. So I'm like, huh, that's weird. And I didn't think much of it. And as I said, I rarely get sick. But when I was unpacking from that trip and cleaning the house up before leaving, I just felt exhausted. It just took the life out of me. There's quite a few stairs at the beach house. So unpacking and bringing, just going up and down, up and down. I just sat in my car and just like, oh my gosh, I'm exhausted. So I. I'm chalking it up to that. I just cleaned the house. It's been a long week. I've unpacked. I'm bringing home a lot of Stuff. So I come home, and I get a good night's sleep. I wake up, and my girlfriend calls, and she says, hey, do you want.

Anna (5:29)

To go on a walk?

Carrie (5:29)

And I said, sure. We usually do a long walk on Saturdays. And so I do my normal walk. It's hot because we're in July and it's five miles. She is just getting over being sick. And I felt fine on the walk, but I came home exhausted. It's like from the inside out. I feel like I got hit by a truck. It was that full body soreness. I felt like I had a fever, chills, headache. I said, maybe it's Covid. Covid. Last summer was going around in Orange County. So I'm like, maybe it's Covid. Let me just sleep it off. So I wake up the next morning, and my back is just on fire. I tell my husband. I'm like, I think I need to go to the chiropractor. And now I'm supposed to go to work the next week, and I can't move. So my symptoms are getting worse. So now I'm thinking, it must be Covid. All the symptoms I have, it's all sounds like Covid, right? I thought my back was due to going from the beach house bed to my bed. So now I'm calling my parents. I'm like, what number is your setting on your sleep number? Because I need to match it, because I think that my bed's too soft. So I'm thinking it's the bed. I'm telling my husband. I'm like, our bed's too old. I think we need a new bed. And I do have back issues from time to time. It does go out every couple times a year. So it wasn't that unheard of that my back was hurting. The next day comes, I feel like I have a fever. I'm asking my husband, do I have a fever? He's a paramedic. He's a firefighter. He's like, it doesn't feel like it. I can't find a thermometer. For the life of me, I can't find one in the travel bag. I can't find one in the. Where it's supposed to be. So I order one, right? It comes on Monday, and it says, I have 103.4.

Anna (7:22)

That's not.

Carrie (7:23)

Yes, it's not good.

Erin (7:25)

It's not good.

Carrie (7:26)

So my husband's like, you probably have Covid. I said, I'm gonna go in. Okay. So now it's Tuesday. I go to urgent care. I Call into work, sick. I only work part time, but now I've already been gone a week for the beach house.

Erin (7:41)

It's always a bad look, right?

Carrie (7:43)

Yeah. It doesn't look. I'm like, oh, my God. They think I'm milking it. I'm not that person. I promise you, Anna.

Erin (7:49)

I'm not that person.

Carrie (7:51)

I go into urgent care. I'm the first one there. Thankfully, they get me in. I wear a mask just in case I do have Covid. They take my temperature. I have 102. My blood pressure a little bit elevated, 126 over 79. So they take a urine sample and they check me for Covid. They check me for influenza A and B. I felt like I was sitting in this room forever. He comes back and he says, we think you have a possible uti. You're negative for Covid. You have a possible UTI and your urine is dirty. And I'm like, I don't have any pain. Going to the bathroom. He says, there's mucus in your urine. I'm going to give you Cefdin here, which is an antibiotic, and follow up with your doctor in a week. I said, okay. I go home, I tell my husband. He says, okay. So I just go down and go lay down. So my brain fog is continuing, and it's getting harder to concentrate. It's harder to be on my phone or to watch tv. It's just hard to concentrate. And I've never had that feeling before, but I'm like, oh, this is really getting to me. And later on that day, early into the next morning, I have a new symptom emerge. And it's chest spasms, and it's lasting for about 20 seconds, and then it goes away, but then it comes back. It just feels painful. So now I'm thinking, oh, God, is it a heart attack? Is it my gallbladder? I'm thinking, what could this be? So he says, just go get more tests. Go get some blood work done. Go to the er. I go to the er. They test my blood work now. So they only tested my urine at the urgent care. So now I'm in the er. They did blood work, they tested me for hepatitis. All of them. Covid again. Influenza A and B. They give me an ekg, they give me a urinalysis. They do a chest X ray, an ultrasound and a CT scan. They're covering everything.

Anna (10:05)

You got the blue plate special with that. That is a lot.

Carrie (10:08)

I totally did. I think maybe because my age, maybe the chest pain, they just wanted to roll out, whatever.

Anna (10:14)

Yeah.

Carrie (10:14)

And now in thinking about this, as my memory recalls, it started to hurt me to walk from room to room. Exhaustion is now hitting me again and probably lack of food, and it's wiping me out.

Erin (10:31)

So.

Carrie (10:31)

So they come back. They tell me my urine has leukocytes, protein ketones, and high specific gravity. My chest is clear, no pneumonia. My labs, however, tell a different story. He says that I have elevated liver enzymes. And my first readings, my AST was 126, my ALT was 139, and my white blood count was 4.1. I'm low and I think my ASTA ALT should be between 0 and 30. I think that's the range. So I asked him about my chest and he says, well, we found fluid around your pancreas. I read the chart notes and it says, considering acute pancreatitis and para hepatitis, which Chlamydia, gonorrhea is suspected. That's what the notes say, which is now concerning me, that he thinks that I have a sexually transmitted disease. But I get it, you have to check for everything. And my liver enzymes were elevated.

Erin (11:38)

The point about the pancreas, right. The pancreas is a. It's called a retroperitoneal organ. It lives in the back of your body. So the fact that you were having sex, severe back pain, and potentially having an inflammation of the pancreas and also experiencing chest pain because it is. It's literally right in the center but in the back isn't an unreasonable thing to think that this could be related to that.

Carrie (12:03)

Yeah, okay, that's good to know.

Erin (12:05)

But also, it's usually sometimes brought on after eating meals because that's. The pancreas releases the digestive enzyme. So it doesn't sound like this was related to anything food wise, right?

Anna (12:18)

Yeah, it just seems like a weird bundle of symptoms.

Carrie (12:23)

I agree. But he says my EKG was normal. He second the guy before his opinion. He's like, we just think you have a bad UTI and continue with the oral antibiotic and I'm going to give you a shot in the arm of ceftriaxone. He gave me a shot in the arm and he says, follow up with your doctor in a week.

Erin (12:46)

I just want to make note of something because another one of our guests has had this same issue where they test for a uti, but they don't have UTI symptoms. They don't have burning with urination, it's not painful to pee. But they have the markers in the first, what's called the UA the urinalysis, which is testing for if there is protein leakage, if there are signs of white blood cells, which is a sign of inflammation or infection. But you don't know if there is actual bacteria until your analysis has been sent for culture. So sometimes in the setting where, okay, you have the symptoms, it's burning, it's painful, you have the positive leuk esterase, you have the positive proteinura, they go, okay, this is a uti. We don't need to wait for the bacteria to come back. We know what this is. But in your case, you weren't having symptoms, but you were having positive findings on your analysis, which I'm guessing we're going to learn was not due to necessarily a bacteria in your bladder. It was a sign of damage to the kidneys.

Carrie (13:58)

Right. And at that time, I'm thinking I was just in urgent care the day before. I really don't have much antibiotic in my system, so I agree with him. I just want to make sure my chest, my EKG was all fine. I wasn't having a heart attack, the whole thing. So I go home and I said, okay, hopefully in a couple of days I'll start feeling better. So now I'm calling out to work again. I say I have a uti. And then Thursday to Saturday, I take a turn for the worse. I have to cancel a trip. My best friend from college, she lives in Texas. We were supposed to go to her lake house. I had to call her and I said, I'm not going to be on that plane on Friday. We can't go because something's going on with me. She was sad and she says, let's just reschedule. And pretty much as soon as I came home, my chest pain stops and I start getting a dry cough. So now I'm thinking I probably just have the cold or the flu. Maybe I caught something at the beach house. I have a fever, so now I'm taking Tylenol and ibuprofen on the regular. I cannot get my temperature down. It's 102, 103 at all times. It goes down a little bit, but then it spikes right back up. Insomnia is getting worse. I'm having a really hard time sleeping and I have no focus. The phone, the tv, there's nothing. I'm just laying in bed. It got to the point where in the middle of the night, I was getting up from insomnia, going to the bathroom, and the toilet lid would be down, and it hurt me to bend over and lift the toilet lid, it got that bad. And it hurts to move. Just bending down a little bit to lift that lid up. My husband, a couple months after this situation, he's like, I have something to confess to you. I'm like, what? He says, I thought you were milking it during that time. And I'm like, what? He's like, yeah, I thought you were milking it. I thought you weren't sick. And I need to apologize for you for that because he's very funny. He was just trying to make light of it. And this guy has been through over 20 orthopedic surgeries. He walks and is in chronic pain. He's at five every day. So he's like, you don't know pain? I'm like, I don't. Yeah, I know what you've gone through. So now Sunday comes along. I wake up at 4:30 in the morning because I can't sleep. I go out in the living room. He wakes up at 6 o', clock. And as he explains it, he's a paramedic firefighter. Was that for over 27 years. He says, as a paramedic, when you walk into a room and it could be full of people, your eyes will find the sick person. You just know that look. He came out of the bedroom into the living room. He looks at me and he says, I'm taking you to the ER right now. And I just said, okay. And my only request was, can you drop me off and can I wait for you to park the car? Can I just go in one of those wheeling chairs? I don't think I am able to walk into the building. And he says, yeah, whatever you need. Thinking back, I'm like, why couldn't I walk in the building? It must have been so bad. Now I'm coughing, I have shortness of breath, and then my head is just pounding from this cough that is just very active. They immediately triage us and get us into a room, knowing I had been there four or five days earlier. And they had some blood markers, so they drew some bloods and did some more urine. And then they also gave me a chest X ray. And my white blood cell counts are now at a 13.8. My NA is at 125 and.

Erin (17:56)

My.

Carrie (17:56)

AST is at 421 and my ALT is at 392. So I'm in the 400s. It should be what, 0 to 35.

Anna (18:08)

Can you explain what those are? Just for those of us who don't.

Carrie (18:14)

Know what those are, they're Part of.

Erin (18:16)

Liver function tests, and they're just a quick marker to see how well your liver is doing. So similar to, like, your kidneys, we measure something called a creatinine, a bun, and creatinine. For the liver, we measure an AST alt. So those are some quick measures to show that her liver is in failure. Her sodium, which is the na, is starting to trend lower, which is another marker of. Potentially something is wrong with the kidneys. Right. It's not able to filter all the different electrolytes through your body. Her white cell count has gone from low normal to high normal. I would say probably it's the higher end of normal, but creeping towards abnormal. But it's significant that she went from a 4 to a 13.

Anna (19:03)

Right.

Carrie (19:03)

If you.

Erin (19:04)

If you initially came in at 11 and then your next round was 13, you'd be like, okay. But to have a significant change in the concentration of white cells is also significant. So basically, all of her lab work.

Anna (19:17)

Is trending worrisome towards, like, kidney failure. Correct.

Erin (19:21)

Right now, her liver functions are what's most concerning because those are really, really elevated.

Carrie (19:27)

Liver is not looking good. I'm sitting in this ER room without a bed, just two chairs. So my husband and I are sitting in this bed, and I just say, is there any way I can just lay on the floor? I just need to lay down. He says, you are not laying down on this ER floor. Fortunately, they get me into a bed. They tell him we're admitting her into the hospital. We don't know what's going on. I get my IV started, and I get the heart monitor on, and they're changing me out of my clothes into the gown. And my husband notices a rash develop on my torso. And he says, it went from my lower trunk all the way up into my arm, but as soon as it came on, it went away. So he's like, I just saw this rash come upon her, and it went away. They said, we believe it. We don't know what's going on. They put me on the heart monitor. He's watching the heart monitor, so he's wanting to see what is going on with my heart. He later tells me, within 30 seconds to a minute, I was in sinus tachycardia. I had cvt, afib and aflutter. And he explains, I've only seen a flutter a couple times in the field. Like, you don't see this wave.

Anna (20:50)

What's the difference between afib and aflutter?

Erin (20:53)

A flutter is a very. It's a very specific tachycardia. Where your heart is racing. But the pattern on the ekg, we call it saw tooth pattern, it looks like jaws, like.

Anna (21:04)

Oh, like the edge of a. Like of a saw.

Erin (21:07)

Yeah, yeah. So that is a very recognizable pattern. Whereas afib, it's an uncoordinated pattern, but the A flutter is a coordinated tachycardia.

Anna (21:20)

Like set spacing, set rises and drops within that. Okay.

Carrie (21:24)

So he then tells the doctor who was right there, and he says, your wife is very sick and we don't know why. And so my husband's thinking is, I'm gonna stroke out or I'm gonna have a heart attack right in front of him. It really affected him just knowing the little bit of medical he does know and seeing it. He was very nervous.

Anna (21:46)

How were you feeling? Were you even there or were you checked out because you were so tired?

Carrie (21:50)

I hear him say it, but I remember laying on my side and making eye contact with either a doctor or a nurse, probably 15ft away from me on the computer. And her and I are just locked eye to eye. And she's looking at me going like, I don't know what's wrong with you. And I'm just looking at her going like, I'm done. I was just done. I was in that much pain. So now my labs come back from my chest X ray. I had pneumonia in the upper lobe of one of my right lungs. And they put me on the face mask to give me oxygen, and I feel like I'm suffocating in that thing. I was exhausted. So my husband's trying to control my phone and answer everyone and kind of get the message out that I'm being admitted into the hospital. He tells everyone that my kidneys aren't functioning properly. My charts say acute kidney injury, and the diagnosis is I'm now septic. I have pneumonia in my right upper lobe. They're concerned for pulmonary embolism and acute kidney injury. I ended up getting sent up to the sepsis wing of the hospital. And one of the notes I just read here the last week when pulling up my chart again, it says, high probability of imminent life threatening deterioration with risks of severe morbidity or death, which it's hard to read now, but at the time I was feeling it.

Erin (23:23)

And just because we've had a couple of guests who have had sepsis, and I think to help set the scene for our listeners who maybe don't understand what that means or what it entails, but sepsis itself is not an infectious process. So typically your body has an infection, but sepsis is the body's overreaction to the infection. And so the damage doesn't come from the bacteria or the infection itself. The damage comes from your own body's response at overreacting to the infection. And that's why so many body systems become involved because it's a total body over response.

Carrie (24:15)

My husband asked the doctor, are they going to intubate her? And the team says they want to avoid that if at all possible. They're wanting to just keep me on the oxygen, just see what's going on. So my voice is now down to two words, a breath. I couldn't say complete sentences. It was very labored. When my husband left that evening to go home, it was really hard for him to say goodbye. He was very upset and as I said, he thought I was going to have a stroke or have a heart attack. All I say is it's in God's hands. I've had a great life. If it's my time, it's my time. I'm okay, I don't need to see anyone. I was okay to die, which I can't believe I even said it at the time, but it got that bad.

Erin (25:07)

And we've talked about that before. There's a feeling of dread, right?

Carrie (25:11)

I was just done. That night in the hospital was the worst night ever with the oxygen mask. I felt like I was suffocating. I have everyone coming in. The X Ray boys at 6am Would crank on those lights. They would come in with their little plates and try sit me up. I now can't sit up without assistance in the bed. I can't move. They had to put a commode right next to the bed because I can't move to get to the bathroom. I remained tachycardic and febrile. They end up putting on me on a high flow oxygen at between 40 and 60 liters of oxygen the next day because I felt like it was just going to die. And if anyone's ever had a high flow oxygen that will give someone PTSD that the noise that that makes.

Anna (26:01)

Is.

Carrie (26:01)

Out of this world. It's just this constant loud hum. And your mouth is open and your mouth is dry. The oxygen pressure that's going into your nose is so severe. And this is a picture of me with my high flow oxygen.

Anna (26:23)

For those of you who are listening along in that photo, it looks like your worst day ever. I think that's the best way to put it. You can very much tell that you are over it and that you don't feel good. And the person we are seeing in front of us right now is a very different Carrie.

Carrie (26:39)

Thank you. I have breathing treatments now every three hours during the day. I can't sit up without assistance. They still don't have any diagnosis. My husband has to tell my kids, you need to go see your mom. She's very, very sick. I'm not sure what's going to happen. So my boys come in, and my son was giving me a Bible and said, mom, you gave this to me when I was struggling in high school. I think you need to have it now. So that was really sad. But I was glad that I was able to see them as well. So during that day, around noontime, my muse score goes from a six to a seven within an hour. And what does that mean, Erin?

Erin (27:30)

They're like criteria for how you measure how poorly decompensating someone is. So how low your blood pressure is, how high your heart rate is, what your labs. And it's a way to quantify how badly your body is doing as a total system.

Anna (27:47)

Okay. So the higher the number, the worse the situation.

Carrie (27:50)

So the team that was working on me is stumped on what was wrong. They end up calling in an infectious disease expert. And she is affiliated with the hospital, but as a side hospital. So all my labs she doesn't get directly. The lab that she works with isn't the lab that this hospital works with, but she comes in. Fortunately, my husband is there when she does come in, and she immediately does the stethoscope on my lungs. And here you go to the doctor appointment. You take a deep breath, and you're proud of that deep breath you take. Right when she asked me to take my breath, it is. And I just looked at her and my eyes are wide. I'm like, oh, my gosh, this is all I can do. So now I'm in dual pneumonia that's in both lungs. And she declares respiratory failure and bilateral pneumonia. At that time, she sits down and does a deep dive with my husband. And she just says, I need to know everything about your life. Where you've been, what your day to day life is, what you've eaten. Like, she just wants to know the whole thing. So. So I tell her I was at the beach house. I tell her I walk. I tell her I walk the bridal trails in our neighborhood every day, that I walk 20 miles a week. And she initially suspects that I have valley fever, which is, I guess, mold spores from the soil that can go up in the air and then get into your lungs and I said, is this in my area? And she says, I have had a case in your area. And I said, okay, let's test. So in the meantime, she tests a battery of all these other diseases as well. And they're going out to San Diego, Utah, Berkeley, Arizona, South Carolina. And with that, they have long lead times. It takes a while to get there for them to review. So. So nothing is fast in trying to diagnose a disease.

Anna (30:02)

I just looked up valley fever because I was curious, and sometimes I do that. And first of all, it's a condition that did get a nice rebrand because the real name for it is. I'm gonna botch this. But coccidomycosis, I was thinking maybe it.

Erin (30:17)

Was Cryptosporidium, but sounds like it's Coccyosporidium, but it's a form of a mold or a yeast that grows. There was some Netflix show where it's the mold that takes over people. That's what we're.

Anna (30:29)

The fungus.

Erin (30:30)

Yes.

Anna (30:30)

I watched a documentary on fungus, and it scared me because they are smart and they are organized, and they will kill us. I mean, what.

Erin (30:39)

Those fungus and molds, they are more common in the Southwest, usually in drier, arid conditions. You were in Southern California. Not exactly the same, but yeah.

Carrie (30:52)

So she looks at all my meds that I'm on, and she adds doxycycline and zybox orally every 12 hours. They're antibiotics. Just trying to see if one's going to click overnight, though my AST and my ALT are trending down, so now they're in the 200. So they're telling my husband, oh, her labs are looking good. She's still not out of the woods, but they're looking better. My heart rate is so still out of control, and my white blood count is now at an 8.8. They bring in a pulmonologist, and she confirms that I have dual pneumonia, and she and I have ARDs. ARDs?

Erin (31:33)

When the infectious disease doctors said that you had double pneumonia and respiratory failure. So ARDS is almost like a form of sepsis. Right. It's that the lungs have now gone into acute distress. Again, not necessarily because of the infection, but because of the reaction to the infection. And so sometimes it'll look like just a whiteout on chest X ray. You're supposed to see through the lungs on X ray, but when you see a whiteout, then you know you're in ards.

Anna (32:00)

And that's Acute Respiratory distress syndrome.

Carrie (32:03)

Yep, that's what I've got going On. So at this time, my family now I give my husband my phone. I said, you deal with them. I can't even concentrate. I'm not doing this. Group texts are going around. I did not want to see a single person because I can't talk. I'm on this high flow oxygen. I really can't hear because the noise is so loud. My breasts are very labored, and I just didn't want to feel like I had to entertain them. I just didn't want to be something that they just stood there and just looked at me. But this created some tension in the family. So specifically my parents.

Anna (32:44)

Well, in defense of them, you are an ards, which not everybody comes back from. So people are potentially concerned that this may be the last time they speak with you. So I get why there is probably.

Carrie (32:58)

Tension, but I didn't care to see them, which is sad for me. I feel bad for them that, like, I don't want to see them. And finally my husband comes in and he's just like, they're now saying, you cannot keep her from us. And at the time, my husband has my phone in my hand and my mom is calling. My parents are divorced and she lives out in Indio. So she's just like, I'm coming in. And then my girlfriend from Texas, who I was supposed to be on vacation with, I'm not sure what my husband relayed to her, but she just says, I am on the next plane out.

Anna (33:35)

I don't think you should feel so bad that you didn't really want to see them, because it's not like you were all there. Like, you were on a lot of drugs. You were exhausted and tired. You had a very uncomfortable device in your face. You probably had a lot of different side effects from both what you're experiencing and the medication you're taking. I don't think there should be any guilt about saying you didn't want to see people. I think that's just a byproduct of everything you were going through. You couldn't mentally comprehend that they were thinking, this is the last time we might see her. You were just like, hit me through today. And anything else might be too much of an emotional burden.

Carrie (34:11)

And my brain just hurt. I'm the CFO of our family. I do everything for. I manage everything. The schedules, the groceries, everything. I do all of that. So when my husband comes into the room and he says, being you is very hard. Just on my phone in general, he's always saying, let's get together with these people. Can you send a text. So now he's having to do it and he's like, this is really difficult. Like, yeah.

Anna (34:36)

You're like, no, no, no snake, right? No snake. It is hard.

Carrie (34:42)

My girlfriend from Texas arrives on Wednesday. I think my family comes in on Tuesday night. It was short. I think the nurses even encouraged them to not visit long. But when my girlfriend walked in from Texas, my godson lives in la. At the time, he picked her up and took her to the hospital to see me. And I'm the godparent to both of her kids and her oldest child, 12 years ago yesterday he passed away and he was 13 years old. He died of a brain tumor. So she is such the strongest person I know. And for her to drop everything to come see me, just met the world. She stayed with me that whole time in the hospital. She slept on the chair, she asked questions. She knows a lot about medicine from her son, going through what he did. And she was my patient advocate. We had laughs together. It was just great to have her by my side during that time. But when she walked in for the first time, my godson, he's tears in his eyes and I'm like, oh my God, do I look that bad? Every time someone came to visit, I could just see the emotion on their face because I didn't look like me and I didn't feel like me. But my oxygen starts to improve and on Thursday I move from a high flow oxygen to a cannula. I'm on five liters now. And that was a lifesaver. The one doctor comes in and she's like, okay, you're doing better, your numbers are all good. We're thinking about moving you to a step down facility. And I'm like, wait, what? And I don't know if it was insurance based or not, but my infectious disease doctor comes in and I tell her they're wanting me to go to a step down facility and she's like, absolutely not. Two weeks ago you were a healthy 53 year old woman who walks 20 miles a week. You are not going to a step down facility. And I just love her for that. And I felt release then because everyone's telling me my numbers are getting better, my lungs are getting better. I just didn't feel better. It's still painful to sit up. I've got a cough, I can't walk. And I wasn't ready to go home or to this facility to try to recover the rest of me. I was comfortable where I was. And thankfully she helped me continue to stay There.

Anna (37:10)

God bless her for that.

Carrie (37:11)

Yeah. So the next day, Friday night, I feel like I'm doing better. I talked to the doctors, results are not coming in of what I possibly have. I don't have any answers yet at this point.

Erin (37:24)

You would have had access to your urine culture, your blood culture, your sputum culture, and so those three things had not yielded any results.

Carrie (37:36)

Nothing's positive. They say in order for us to release you, you have to have portable oxygen in your house. So now it's a Saturday morning, my girlfriend is calling everyone to try to find some portable oxygen. They want a hospital bed and a walker.

Anna (37:59)

So while you had ards, it's not actually a diagnosis. They don't know what caused that. And you're going home?

Carrie (38:07)

Yes, but my lungs are looking clearer. So the high flow oxygen, the breathing treatments every three hours, it's working. And I'm not labored as much in breathing or talking.

Anna (38:20)

But did it stress you out to go home and not know what caused it?

Carrie (38:24)

The main thing that was concerning me right then was my heart, the littlest of things, it would shoot up to 150. So that was my biggest concern, coming home.

Anna (38:34)

So that was still happening.

Carrie (38:35)

Yes.

Anna (38:36)

Only your lungs really got better.

Carrie (38:39)

My lungs and my blood work, my ast, my alt, they're looking better.

Erin (38:44)

You know those markers, the ast, alt, those are super elevated when you have liver cirrhosis. So in your case, you didn't have a permanent liver injury or permanent kidney injury. You had a temporary dysfunction of your liver and your kidney. But when you don't know what the cause is, you don't know if that's going to continue to trend down or if it's going to all sudden rise again.

Carrie (39:11)

Right. And I'm coming home with 13 medicines. So some of these medicines are working. Something is getting my numbers good. I'm feeling better, so I'm on the right track. I am not scared. My husband is a retired paramedic. He is at home with me. I just questioned how long it was going to take for me to get back to my normal activity. But when I do get home, I need assistance with everything. I hadn't bathed in over a week and I get in that shower. My girlfriend's in the shower with me, my husband's in the shower with me. Luckily I have a bench in the corner and she's washing my hair. My husband's bathing me. I couldn't do anything. So now I have the pulse ox on me. They're checking my oxygen levels and it's Going down into the low 90s. I can't brush my hair without my heart spiking. My infectious disease doctor just said, I don't want you getting up. You need to be in that bed for seven days. You only need to get up to go to the bathroom. There was days where my goal today is just getting up to brush my teeth. Like that was a goal. And sometimes I didn't even meet that goal. The fatigue was just incredible still. But now some results are coming back that Dr. Ho had sent out, and they're negative. I'm getting no answers. I get a new result in my chart. And so I look. It says negative.

Anna (40:43)

The. My chart is a blessing and a curse.

Carrie (40:45)

Exactly. So I'm at home, my girlfriend leaves on Sunday, and it's now my husband, he's doing it all. He's doing the kids, he's arranging the food coming in from the neighbors who are bringing food to us. What he did for me over those three weeks that I was just. I couldn't do anything. I can never repay him for that. It was incredible to see what your family does in your time of need. Because I'm always that person who helps everyone else out, and I was so grateful for them. So during this time, I'm at home watching the news, and I was seeing some reports of West Nile virus and typhus come up a couple times. And I talked to my husband, and we were going to go see Dr. Ho the next day. And I just said, maybe we should find out if I. She tested me for this. So the test that she has sent out, which turned out negative, are hep, abc, adenovirus, valley fever, cryptococcal herpes, cmv, ebv, N, A, fld.

Anna (41:58)

I don't know what any of these are, but it's a lot.

Carrie (42:01)

It's a lot. But they're all negative. And when I go in to see her for the first time, I'm dragging my oxygen, and she just looks at me and she's like, do you know how sick you were? And I'm like, yeah. And she's like, no, no, no. Do you realize how sick you were? I'm like, yeah, I know how sick I was. But we sit with her and she's like, I don't know what you have. And so my husband and I said, we just saw recently on the news that West Nile and typhus are going around. And she's like, do you want to test for that? I'm like, yeah, let's test for those. Like, why not? Can you Think of anything else that we haven't tested for. Let's just try that. So I get off my daytime oxygen a couple weeks later. I'm now only on nighttime oxygen. And that weekend I feel good enough to go to a local concert. And I'm wearing my N95 mask. I don't have oxygen. We go to this concert, it's towards the end of it, I get a bling on my watch and it says, you have a new result in your chart. I pull it up and sure enough, positive rickettsia, typhi or marine typhus. I'm three weeks out and all of these markers are coming out red, red, red, positive, positive, positive. At the concert, I look it up and I'm like, what is typhus? And it says, an infected flea. And this infected flea lives on a rat, a possum or a feral cat and can be found in Southern California, Hawaii and Texas. I can't make this up.

Anna (43:50)

When did you touch a rat, a ferret or a feral possum?

Carrie (43:54)

Not a feral cat, a feral cat. I don't touch these animals on a regular basis. I promise you this. So I guess what happens is flea becomes infected by chewing on these little varmints. And then this infected flea jumps to a live host. At the time, I lost my 12 year old dog last year. In April, I get a new puppy. I am taking the puppy to the vet. I'm giving her shots, she's getting them regularly. I'm walking my other dog on the trail, on the bridal trail. And when I got my puppy, the breeder says, do not give your puppy oral flea medications because it could result in death. And so she advises for a spray solution. And I'm thinking, I don't have fleas in my yard. My older dog doesn't have fleas. And I want to wait as long as I can can to give the flea medicine. And my girlfriend who I walk with her dog just had a neurological reaction to the flea med days earlier, right? And so I'm like, I'm going to hold off on getting the flea medicine as long as I can. She's not walking on the trails with me, she's not going outside, I'm not taking her to visitors, she's just in the backyard. And so I don't start her on this flea meds. So now I'm thinking, where did I get bit by a flea? How did this happen and where was this bite? So I recall being at the beach.

Anna (45:26)

House, the stupid beach house.

Carrie (45:29)

Nothing good happens at the beach house. I Remember getting there earlier that week and looking on my forearm and there was a scab. And I remember picking it and it bled. And I'm like, that's weird. So I go into my dad's cabinet and I put a band aid on it, and I thought, these band aids are really nice. And I add them to my Walmart order for next time. I'm like, that's how I remember if.

Anna (45:52)

That'S not the most relatable way. So don't. You got bit by hopefully Amazon receipts.

Carrie (45:58)

They were really good bandaids. I guess when this flea bites you, not only does it bite you, but it bites you and it defecates at the same time. Yeah. And that poop gets into your bloodstream. So I think when I scratched it, it also aided in that fecal matter to get into my bloodstream.

Erin (46:19)

But that is always one of the questions when, as any doctor is trying to figure out the origin of an infection. We always ask, have you had any recent bug bites? That is like one of the number one questions that we ask. Did anyone ask you, did you have a recent bug bite?

Carrie (46:38)

No one asked me. And nor would I have thought that this was. Because I think I was cleaning out drawers and I thought it was just a scrap. But now I'm thinking I finally have an answer, a disgusting answer at that. So there's a couple different scenarios of how I got bit. So I went to the vet twice during the beginning of July with the puppy to get her final shot. And then she was really itching, and so I ended up giving her flea med. And then the doctor also gave her a shot, thought she could have had allergies. So I was in the vet twice that week. I could have gotten it from the vet's office, too, who knows? But I was holding the puppy. There was a house four doors down, which was a reclusive house. He ended up dying. It was an older man. They sold her for cash in the beginning of July. They cleared it out of vegetation. My son's birthdays are in the beginning of July. And I recall on my son's birthday dinner, my older son saw a mouse in the house that day. And after the birthday dinner, I said, we're going to Lowe's. We're going to get some mousetraps. I cannot have this in my house. So that could be another option. Or when the house was cleared out, the vegetation, all of these animals scattered. In July, it was hot. So the dog and the puppy are sleeping on the grass outside. And we have possums that Scale the walls. She could have gotten too close to the possum and. Or the possum. She shed some fleas, and the puppy laid where the possum was at and got the flea on her. I also could have gotten a flea from the bridal trail. So there's a couple different options. We don't really know how I got the flea. The next day, after I find this news out, the Department of Public Health calls me. They talked with me for half an hour, and they said, we're going to trace back your infection date to the beginning of July. And so now I'm looking at my photos. I'm giving her all this information about the house down the street, me going to the vet. I'm looking at my calendar of what I did, and then I said, are you going to give this to the news? I don't want to be on the news tomorrow. And she says, you know what? Honestly, I don't know how the news gets a hold of this information.

Anna (48:48)

Oh, you're one of the five people that have it. Oh, no.

Carrie (48:52)

So I heard it from the news. That's why I'm asking my doctor. I'm like, hey, this is happening in Fountain Valley in Santa Ana. I don't know. Maybe it got to our neighborhood in north Orange County.

Anna (49:02)

Yeah, that's a whole story now that they're going to want to tell. Oh, dear Lord.

Carrie (49:06)

I actually don't tell anyone because I want to confirm with Dr. Ho. So my husband and I keep this stuff to ourselves. And we end up going into her office, and we just say, hey, did you see the results? And she says, no, I don't have access to your chart. What happened? And I said, marine typhus came back positive. Her reaction was quite disturbing because she was so excited. This was her first case.

Anna (49:34)

This has happened to me. And it's the worst feeling ever when.

Carrie (49:37)

They'Re like, yes, and you're like, no, I know I don't want this. But actually, in a way, I was glad because I knew the result of it.

Erin (49:45)

But, Carrie, you're the one who found it out. She didn't find it out. You are the one who asked to test for it. Okay? She should not be basking in this glory because you are the one who solved your own mystery.

Carrie (49:59)

But if anything, if this gives her more tools to test the next patient who has my symptoms.

Erin (50:04)

We had a guest earlier who her diagnosis ended up being a disease called porphyria. And an orthopedic surgeon who happened to be randomly walking by said, I remember One mentor told me, if you can't figure it out, it's porphyria. And so you need these cases to stick in your mind so that the next time someone has these seemingly unrelated symptoms or things that you can't figure out to just remember. But really, she did save your life because she did order the doxycycline. You couldn't wait for the three weeks to find out what the diagnosis was. You would have been dead. So the fact that she just added that as a potential treatment without even knowing what it was is what saved you in the end.

Carrie (50:49)

So doxycycline is the only antibiotic that will treat marine typhus. And as soon as my infectious disease doctor came in that Monday, she added that to my regimen.

Anna (51:02)

Do you know what's wild to me is that I have heard of typhoid, typhus. Like, I've heard these are diseases, right?

Erin (51:10)

Typhoid Mary, yeah, that's registered in my brain.

Anna (51:14)

But if you said to me, like, what does typhus do? I'd be like, I don't know, kills people. And how many diseases like that? I don't know what happens with malaria. Like, I know malaria, I hear about malaria. I know that it gets transferred by mosquitoes, but if you told me these are the symptoms of malaria, I'd be like, I don't know. And it's funny how we know these diseases, but I couldn't tell you what it's like to experience that.

Erin (51:39)

But the reason why the Department of Public Health contacted you is because the real treatment is vermin control, right? So now the Department of Health has to go through extra measures to round up all the rats and the possums and the whatnot and to control the infection at the source. It's considered an old timey disease because it wasn't until we instituted public health measures as a system to take care of cleaner water sources. You don't know what diphtheria looks like because no one you know has ever had diphtheria, because we control that through public health measures, which is a vaccine in this case. Now, typhoid does not have a vaccine, but what we do have is animal control. And to try and keep as sanitary.

Carrie (52:25)

Conditions as possible, vector control does come. And I would like to add the flea that bit the puppy. Dogs are immune to typhus, so they don't get sick from this typhus flea, only humans do. And doxycycline is the only thing that will work.

Anna (52:44)

It's interesting because we often view these diseases as not relevant or not anything that could ever happen to us. Yeah, but I think it goes to show the importance of, of some of our public health systems and actually preventing people from getting those diseases. So, yeah, you did get it, which is awful. But because of you finding it out, getting it reported, others will not get it because the health system will jump in and handle it. And it does make me concerned how some changes in our current health structure are when we begin to better understand the other things those organizations do.

Erin (53:23)

I mean, the administration has completely gutted pretty much any reporting outcomes anymore. It's hard to know how many diseases are out there. No one reports them and records them. And that's to your case. The reason why you even found out was because someone else had reported it and recorded it and released it to the news. And that's a function of the news. Right. The news is supposed to keep us informed of potential outbreaks. And when you hear about like a Legionnaires outbreak from an air conditioning event in a hospital, or salmonella outbreaks or recalls for food.

Carrie (53:58)

So Vector control not only comes out and talks to us, they post signs all over the neighborhood.

Anna (54:08)

Oh, dear Lord.

Carrie (54:09)

We live next to an elementary school. There is hundreds of people walking by this sign. The neighborhood is seeing me walk up and down with oxygen. Not only do they post the signs on the polls, they hand out the nice laminated card to every one.

Erin (54:28)

This is amazing.

Carrie (54:29)

Thankfully, days earlier we sent a mass group text out and I admitted to it. And I posted a big Facebook post and just said, this summer after I had accepted the fact that I had typhus. And then I just stress the importance of the summer hot weather, getting your dogs vaccinated. Give flea meds to animals in the summertime when it was hot, when the fleas were more present. So it took my heart a while to recover back to normal. Dr. Ho wanted me to get an eeked KG and an echo and a stress test and I was able to do that. A couple months later it came back, which now I have mitral and mild tricuspid regurgitation. So my valve, my tricuspid valve doesn't close properly. But he's like, let's just hold off for a couple more years. Let's see if it changes or does anything different. I was able to get back walking. Initially, I couldn't walk up to four doors up without my heart rate skyrocketing. And I was able to walk on the trails with my husband with assistance. I was like, no one ever passes me on the trail. All these people are passing Me now, because I was a 20, 25 minute mile and I was eventually able to get back to that. We had to cancel our trip to Yellowstone last year. I'd been planning that for over a year and my doctor just says, no, you're not going into that elevation or hiking. Are you crazy? So we changed that vacation and we just completed that three weeks ago, which it was an 11 day road trip, which was amazing. To end this, I hope everyone just stays healthy out there. Just know your body. When your symptoms do arise, they can mirror so many different diseases. But just go with your gut and stay healthy and keep your dogs vaccinated and flea meds on them. And fortunately, typhus only happens in California and Texas and Hawaii. So the majority of you guys out there.

Erin (56:30)

Guys, I'm going to Hawaii on Sunday.

Carrie (56:33)

Do not get around rats, possums, or feral cats. Dr. Nance, I have one question for you.

Anna (56:41)

Did you ever get over being. And I don't know why I didn't throw this out there. Typhoid carry.

Carrie (56:49)

My husband likes to joke about it whenever typhus is brought up in our family. Now he just looks at me and he says, but did you die? And he loves quoting movies. I guess it's a quote from Hangover, but did you die? And I'm like, you shed a tear. I saw. He's like, I think I had something in my eye.

Anna (57:08)

You called in everybody to see me.

Carrie (57:11)

I ended up getting a workout show recently that says, but did you die? So he has fun with it, but luckily we can laugh about it now.

Erin (57:19)

Well, you live to tell the tale. And you told hold the Tale on a national podcast. So thank you, Carrie, for sharing your story. I know we had a lot of fun on this podcast, but that is an absolutely terrifying scenario where you go from 100 to 0 in the matter of days. And it's just another example of how fleeting your health can be and how dangerous sepsis is. So the more we can share stories about sepsis and the presentation of sepsis so that people are aware is probably the most valuable thing we could do on the Internet today.

Carrie (57:56)

Right? Agreed. Thank you, girls.

Erin (57:59)

Thank you.

Anna (58:00)

Thank you so much. Carrie, you were lovely. I don't know what's worse, Erin, getting typhus or your whole neighborhood knowing that you got typhus and receiving like basically a bulletin board of your condition.

Erin (58:17)

Yeah, well, those, those, you know, the public health pamphlets, they would freak me out even if I saw them as a doctor.

Anna (58:27)

Right?

Erin (58:27)

Because then you're like, wait, what? What's going on? Who has this. And then it becomes this witch hunt, you know, oh, 100.

Anna (58:35)

And the lady with the oxygen down the street is. That's pretty. It's pretty much a dead giveaway. I probably would revert to, like, Covid era crazy, which is when, you know, we were taking the wipes and wiping down the groceries and, you know, like, wiping down the door, like I would. I live in this house. I don't leave this house. The germs can't get me in the house.

Erin (58:57)

You know, in this case, this. This particular type of murine typhus is. And why she kept saying the word vector is because that has to be spread physically from an animal to an animal to a person, in that it was from opossum to a flea to a dog, you know, to. To her leg, the person to her arm.

Disclaimer Narrator (59:21)

Right.

Erin (59:21)

So she's not going to give typhus to her neighbor. But potentially a flea that's in the neighbor's yard could infect the neighbor. And we were talking off camera about how important the CDC is and our public health infrastructure. And, you know, a lot of the conversation about vaccines is that they are a victim of their own success. Right. They have been so successful at keeping cases of tetanus and diphtheria and, you know, rubella mumps, okay, that. That people don't even understand how serious those diseases are or how deadly they could be. And if we stop the systems that have been in place to protect us, we can see massive and very quickly. We saw a lot of measles outbreaks last year. You know, things can change very quickly.

Anna (60:17)

I would also say, too, that it definitely opened my eyes that I should be more informed about what our health organizations do, what services they provide us. Because there's a lot of conversations right now, politically and even just in general in the media about what our healthcare system should and should not be doing, where funding should be spent, what should be done. And it's like, I don't know what this organization does for me. Right. I didn't know before this episode that they will come in and deal with a vermin problem to help ensure the safety of a neighborhood. And so I think there's all these things that we're just uneducated about, and I personally have taken it to this episode that I need to go back and learn the ways in which these structures care for us, and then also how I speak about them so that I can have a better voice about why we need certain programs. Right.

Erin (61:09)

I mean, one of the. One of the viruses.

Carrie (61:11)

Yeah.

Erin (61:11)

When she brought Up West Nile virus.

Anna (61:13)

Right.

Erin (61:13)

What does the public health structure do? They track those cases so that they can do mosquito spraying from, like, a statewide perspective. So they are trying to cut off the exposure really at the source. But you can't do that as an individual. Right. I can't have control over the mosquitoes. Only the public health systems can try and take control of the mosquitoes. And that's why sometimes they'll have these, you know, big planes that do, you know, mosquito spraying when it gets to the particularly dangerous levels, but it's about protecting the population as a whole.

Anna (61:52)

It's a lot. I just. It's more and more, as we listen to this, we know I know so much about health, but then I just learn all the things I don't know. And it's kind of stressful to realize what I don't know and like, how can I make good choices about these things when it does seem a little endless? But, you know, it is what it is. I'd also say what was kind of interesting, too, is when we were talking about the infectious disease doctor, which is basically Dr. Colombo is the best way to put it, like, the doctor that's brought in to figure out stuff when it. When it just doesn't make sense. Right.

Erin (62:31)

Well, that. And then they really are the experts at understanding which specific treatment and antibiotic and antiviral is appropriate for treating that infection. But a lot of times the infectious disease doctors are brought in because we don't know what's going on, and we really rely on that. You know, there are infectious disease specialists who specialize in tropical illnesses from all different parts of the world. So every infectious disease doctor kind of has their. Their niche. But, yeah, they really are the ones who are like. They are the doctors who. And exactly how Carrie described it. Right. They sit down in the chair, they ask you about, you know, what did you do yesterday? What did you do the day before? Did you go on any trips? Did you go to the sp Spa? Did you. You know, they are trying to find what could be the potential exposures. You know, what did you eat? They will. They will ask you, you know, breakfast, lunch and dinner. Give it to me. You know, did you go out to the restaurant?

Anna (63:28)

Yeah.

Erin (63:29)

You know, did you cook at home? Did you go hunting? These are all clues. All these questions are very intentional because we are trying to find clues as to the source of the infection. So. So, yeah, I. The infectious disease doctors, they're. They're a very mysterious group of people because they usually don't live at the hospital, they usually have patients as outpatients and then they come in the evenings after they've seen their patients in the office, and then they, like, make their way over, like, waiting on the infectious disease doctor because. Right. Carrie said, like, she. She didn't have access to the labs because she's not based in the hospital.

Anna (64:11)

So.

Erin (64:11)

Yeah, there are these, like, mysterious creatures who just come at night and then. And then they leave a note and you're like, wait, where did they go? I missed them. What happened? I wanted to talk to them. No, they're gone.

Anna (64:21)

Infectious disease doctors, the nightcrawlers of the hospital. Because I just got a mental picture of, you know, this strange doctor coming in at night.

Erin (64:31)

Yeah, the infectious disease doctor is Never there at 10am Never there? No, no. But, no, this was a great episode because no one had any idea. I. I could not have predicted it. I had to look up all the information about. About typhus. I. I had no clue.

Anna (64:49)

Again, it's interesting that, like, I am familiar with the disease, but I could not tell you anything related to it other than at one time in our history, people got this disease a lot more than they get it now.

Carrie (65:00)

Yeah.

Erin (65:02)

Well, thank you everyone for listening. If you like this episode, please give us a review. Please let us know in the comments what you thought of the episode. Please share it with your family and friends. And if you have a story that you would like featured on the Medical Detectives, please email us at storieshemedicaldetectivespodcast.com thanks.

Anna (65:24)

Everyone for listening and have a great week. The Medical Detectives is a Soft Skills media production produced by Molly Biscar. Sound designed by Shane Drause. If you have a medical story you'd like to see featured on the Medical Detectives, please email it to Stories at the Medical Detectives Podcast.

Disclaimer Narrator (66:00)

The information provided on the Medical Detectives is for informational and entertainment purposes only and should not be considered medical advice. While we may feature licensed medical professionals, including doctors, we are not your personal doctors and no doctor patient relationship is established by listening to this podcast or interacting with our content. All discussions are general in nature and may not apply to your specific health situation. Always seek the advice of a qualified healthcare professional before making any medical decisions or taking any action based on the content of this podcast. Never disregard professional medical advice or delay seeking treatment because of something you have heard on this show. If you are experiencing a medical emergency, please contact emergency services immediately or consult a qualified healthcare provider.