Health Concerns Following a Cruise
Profile: 22-year-old male, height 5'10", weight 169 lbs, on Zoloft, no history of substance abuse, no pre-existing medical conditions. In September, I embarked on a week-long cruise from Washington to Alaska, making several port stops along the way. I didn't disembark often and consumed only the meals provided by the cruise line. Accompanied by my fiancée, we enjoyed a seven-day trip, spanning from Sunday to the following Sunday. However, by Tuesday night, I experienced a severe fever that left me shivering and unable to get warm. This lasted about an hour before I managed to sleep. The following morning, I awoke, had breakfast, and was immediately struck with intense stomach cramps and diarrhea. Whatever I ate unfortunately passed through me for the duration of the cruise. By Saturday, I began to feel strange sensations in my limbs, akin to tingling, along with a noticeable decline in my mental clarity, as if a fog had settled over my thoughts. My stomach issues subsided at this point. Upon returning home, I visited the emergency room where doctors ran various blood tests including CMP, CBC, and checks for flu and COVID-19. All results were negative, and I was informed that I likely had norovirus, which would eventually resolve on its own. Two weeks later, with no improvement, I reached out to my primary care physician. She conducted further blood tests examining thyroid function, glucose levels, folate, Lyme disease, an ANA panel, a heavy metal profile, EBV, and even a test for factor V Leiden, as well as an abdominal CT scan. The only noteworthy finding was evidence of past EBV infection. Unfortunately, I continued to experience persistent brain fog, developing frequent headaches in addition to my gastrointestinal complaints. Upon requesting a brain CT scan, I received the diagnosis of encephalomalacia in the right frontal lobe, marking the first significant finding in my medical journey. Prior to this cruise, I had been healthy, but I now grapple with stomach pain, severe cognitive difficulties, bloating, frequent belching, irregular bowel movements, nausea, loss of appetite, and complete exhaustion. I've sought help from a gastroenterology specialist, who performed an endoscopy and colonoscopy along with stool samples for parasites, all of which came back normal. The only remaining test pending is for SIBO, which I will take at the end of this month. I’m reaching out to see if anyone might have ideas for additional tests I could undergo while awaiting this results. I've been managing anxiety with Zoloft, which I started about seven weeks ago due to my heightened anxiety levels since the onset of these issues; however, I have not noticed any improvements. Interestingly, I experience sporadic bursts of energy that last about five minutes each day, bringing me back to a feeling of normalcy where I'm happy and motivated. Unfortunately, these moments are fleeting, and I shortly revert to feelings of low mood, fatigue, gastrointestinal disturbances, and mental fog.
Answers (1)
3/22/2025, 1:50:46 PM
OpenHealth AI
It sounds like you’re going through a very challenging time with a combination of physical and cognitive symptoms that emerged after your cruise. Your experiences with severe gastrointestinal issues, cognitive difficulties, and fatigue could be linked to several underlying factors. Let’s explore this further and outline some steps you can consider while awaiting additional test results.
Summary of Key Points:
- Symptoms Connect: You’ve experienced gastrointestinal symptoms, cognitive difficulties, and fatigue following a viral illness that might be tied to norovirus.
- Diagnostic Steps: Negative tests so far, but encephalomalacia has been identified, reflecting brain changes that might be linked to your symptoms.
- Next Steps: Focus on additional tests, lifestyle adjustments, and monitoring for further developments.
Detailed Explanation:
The symptoms you've described following the cruise, including severe abdominal pain, diarrhea, and cognitive changes, may stem from viral gastroenteritis (like norovirus), which can sometimes lead to prolonged gastrointestinal and neurological disturbances. The finding of encephalomalacia indicates there may have been some form of injury or atrophy in part of your brain, which could explain cognitive changes but needs careful evaluation for its implications.
Actionable Next Steps:
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SIBO Testing: Since you have an upcoming test for Small Intestinal Bacterial Overgrowth (SIBO), ensure to follow any preparation guidelines. This test can help determine if there's an abnormal increase in bacteria in the small intestine that could be causing your symptoms.
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Monitor Your Symptoms: Keep a daily diary of your symptoms, noting when you experience bursts of energy, fatigue, gastrointestinal distress, mood changes, and any possible triggers. This information can be helpful for your healthcare providers in tailoring treatment.
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Dietary Adjustments: Focus on eating easily digestible foods to ease gastrointestinal distress. Consider a bland diet (like the BRAT diet: bananas, rice, applesauce, toast) and gradually reintroduce other foods while monitoring for reactions.
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Manage Stress and Anxiety: Maintaining a healthy routine and practicing stress management techniques includes gentle exercise, mindfulness, or relaxation exercises. This is particularly important with your ongoing symptoms and medication for anxiety.
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Follow-up on Neurological Insights: Regularly communicate with your healthcare providers about the cognitive symptoms and the neurological findings of encephalomalacia. Future imaging or consultations may be warranted depending on how your situation evolves.
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Request Additional Tests: Given your ongoing challenges, you could discuss with your doctor the possibility of tests for other autoimmune conditions or chronic infections (e.g. Lyme disease, celiac disease). Given that EBV was present in your tests, exploring chronic fatigue syndrome or related post-viral syndromes might also be insightful.
Your situation is complex, and it’s understandable to feel overwhelmed. Stay connected with your healthcare team, who can continue to provide guidance tailored to your evolving health. If new symptoms arise or you feel significantly worse, prioritize reaching out to your doctor immediately. You're doing well by seeking information and support; keep it up, and take care of yourself.
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