A Mom Ate 5 Day Old Sushi For Dinner.
This Is How Her Brain Shut Down.
JC is a 34 year old woman, presenting to the emergency room, with insomnia, sensory deficits,
and psychosis.
Her husband, Jonathan, tells the admitting nurse that she had a psychotic episode the
night before, bent over and curled up on the floor, before suffering urinary and fecal
incontinence.
She hadn’t slept for at least the last 3 days.
About 9 months ago, JC had some trouble.
She got home late from work.
She didn’t have any food in her fridge and everything was closed.
She found some sushi in her fridge, that she bought from the gas station a few days ago.
She wasn’t sure if it would be ok, but she hadn’t eaten all day.
And she knew she wouldn’t be able to sleep that night if she didn’t have anything to
eat.
Immediately after eating the 5 day old gas station sushi, JC felt good.
It slid down smoothly, and she didn’t really even need to chew it.
5 day old leftovers were always a little sketchy in her mind, especially if it was from the
gas station.
And the fish did taste a little sour, but just put some more soy sauce on it to mask
it out, she thought.
This 5 day old, gas station sushi was so uneventful, she didn’t even remember eating it.
As the days passed, life was normal for JC.
But about 5 months ago, and 4 months after that night, JC started having insomnia.
She’d go to bed at 11pm, but would toss and turn.
She’d close her eyes, but nothing would happen.
And she could watch as the sun would rise at 7am.
The day following her sleepless night would be filled with anxiety and confusion.
She would feel like her heart was beating in her neck.
She dreaded night time, knowing she could end up watching the sun rise again the next
morning.
It was around this time that JC would periodically feel her stomach cramp.
It would come and go, and she could feel it jiggle and shake.
Sometimes, it’d be followed by the loosest and most watery stool she had ever had her
in her life.
She told her husband that it felt like a fish was flapping around in her belly.
JC wasn’t sure if she was just too stressed, or whatever was going on with her sleep.
She tried melatonin.
She tried essential oils and special teas.
Some nights she’d sleep OK, but there was no consistency.
Nothing made any sense.
JC started seeing little bugs crawl around the walls.
She couldn’t see them directly in her field of view, but they would hang around on the
sides of her eyes.
She could see little creatures creep and crawl around.
She was so exhausted from her insomnia that she wasn’t sure if it was because of the
sleep depravation, but as the days passed, those bugs on the walls started crawling underneath
her skin.
One night, while JC was wide awake, she couldn’t feel her hands and feet.
And as she got up from bed, she felt her pants were wet, as a warm fluid started rolling
down her leg, becoming colder the further it dripped down.
She realized it was urine, but she had no idea how she let it happened.
In the urgent care clinic, 7 months after eating the 5 day old sushi, JC did appear
to be healthy.
Just looking at her, doctors couldn’t find any immediate problems.
Her diet was OK, maybe a little aggressive in the calorie deficit, but she exercised
regularly.
Her blood tests all returned normal.
The urgent care doctor didn’t really want to tell her that it was all in her head.
You know what, maybe you’re stressed, and we can give you some magnesium to help you
sleep, he said.
Stress causes insomnia.
It causes urinary incontinence.
JC’s young, she’s healthy, she’s not pregnant.
Medicines might cause additional side effects, so the doctor was convinced: cognitive-behavioral
was the best solution here.
JC could maybe sleep one night a week still, so there was some hope.
And nobody ever mentioned anything about some days old sushi JC ate for dinner one night,
because JC herself didn’t even remember she had eaten it.
As she expected, the cognitive-behavioral therapy did absolutely nothing for her insomnia.
One night, her husband saw her mumbling to herself in the corner.
She was shaking, and her pants were wet.
As she passes out and starts having a seizure, Jonathan calls for 911, and she’s brought
to the emergency room where we are now.
At examination, doctors weren’t entirely sure what was happening.
But looking at her blood underneath a microscope, doctors find that JC had macrocytosis.
Macro meaning large.
Cyto meaning cell but in this case, referring to red blood cell, and osis denoting an abnormal
state.
Abnormally large red blood cells.
But not only were they large, she overall had less red blood cells than normal, something
known as anemia.
An meaning without and emia meaning presence of blood.
Without enough red blood cells to carry oxygen to her organs, this could explain why she
was so exhausted over the last several months.
But if those blood cells are bigger than normal, then maybe they could hold more oxygen than
normal, so it should all even out, right?
Doctors find that JC’s red blood cells aren’t just larger than normal, they never fully
matured.
Some of her white blood cells were malformed.
Something was wrong with their nucleus.
And because the nucleus is where the DNA and genetic material is, this means that JC has
a problem that would cause her blood cells to be immature, but something’s wrong.
Anemia by itself usually can’t cause neurologic problems.
JC doesn’t just have insomnia, she can’t control her bladder.
She has hallucinations and delusions.
And an exam finds that she has sensory ataxia.
A meaning without and taxia meaning order.
Sensory meaning her awareness of the position and movement of her body.
This was combined with impaired reflexes, all of this pointing to some potential neurodegeneration
on JC’s part.
If her blood cells aren’t properly formed because something’s wrong with her ability
to make DNA, then something similar could be happening to her nerve cells too, meaning
the anemia and neurodegeneration are happening because of the same problem.
And when cells aren’t maturing properly, this could be because of a nutritional deficiency.
Doctors note that JC was slender.
She had indents in her cheeks which could mean potential malnourishment and she was
less than 70 percent of her calculated ideal body weight, a clinical measure based on height.
Her husband confirms that over the last several months, she decreased her daily intake from
2 meals, down to just breakfast in the morning that would sometimes only be a cup of coffee.
Even after she started dieting several months, she just simply ate less every day.
In the step-down unit, doctors looked closer at another blood test.
Most nutrient levels were normal, but her vitamin B12 level, was really low, telling
doctors exactly what they need to know.
Vitamin B12 is a nutrient needed by humans.
Our bodies don’t make it so, we need to source it from our diet.
And its impact in the body is indirect.
DNA is made inside the cells, so that genetic material can be passed down when cells reproduce.
Vitamin B12 is important in creating (Adenine and Guanine, purines) DNA backbones.
So when there isn’t enough of B12, proper DNA isn’t made.
Red blood cells in the body live for 120 days before they’re broken down and new ones
are made.
Everyday when you have a stomach movement, the fecal matter is brown as a result of red
blood cell breakdown.
And in JC’s case, if the proper DNA isn’t created, then her new blood cells don’t
form properly, explaining her macrocytosis.
In the mitochondria, powerhouse of the cell, vitamin B12 promotes ATP production, which
cells use for energy.
If B12 isn’t present, energy production is disrupted, but even worse, different chemicals
start building up.
The nerves need lots of energy to function, so they use a lot of ATP.
Build up of these different chemicals start forming in the fatty myelin sheath, which
helps transmit electrical signals all throughout the nervous system.
As these chemicals accumulate and build up because vitamin B12 isn’t there to make
the right chemicals, they start eating away at the myelin, degrading it, causing neurodegeneration
(subacute combined degeneration).
She can’t sleep because of the nerve damage.
She’s delusional, psychotic, and hallucinating, because of the nerve damage.
Doctors give JC vitamin B12 injections, to kickstart her recovery.
As the days go by, JC starts to recover and become herself again.
She’s able to sleep well again, for the first time in several months.
Doctors recommend she take supplemental Vitamin B12 by mouth and move off her restrictive
diet, as they discharge her from the hospital.
Over the next several weeks, things seem to go well for JC.
She’s eating more, and her quality of sleep is OK, but not great.
Two months later, she had her first sleepless night, again.
She started taking more and more vitamin B12 gummies.
But then the bugs started crawling underneath her skin again.
And she started hallucinating, again, all of this, while taking more and more of the
vitamin gummies that the doctors had told her to take.
She starts to believe that the vitamins weren’t really her problem as she develops delusions
again.
And finally as she has another seizure, she’s brought back to the emergency room again.
At examination this time, doctors find macrocytosis again.
They check her blood, and even though she’s been eating more food than before, and taking
those gummies, her vitamin B12 levels were less than 10% the normal value.
If she’s eating more now than before, and taking actual vitamin supplements, then why
are her b12 levels be low?
She’s eating it, so that’s not the problem.
So maybe she’s not absorbing it.
It doesn’t look like she has any problems with her stomach, so, if GI tract hasn’t
been damaged, then could there be something living in her GI tract that’s consuming
all of her vitamin B12?
At this thought, doctors took a look in JC’s stool.
In it, they found eggs measuring about 40 by 60 micrometers long.
It wasn’t just a couple eggs, there were thousands.
This was in addition to segments that probably broke off of what appeared to be a species
of tapeworm.
Doctors asked JC if she had eaten some grains recently.
Sometimes, grains can be contaminated with rodents, and insects.
Actually, it’s almost impossible to have completely clean food, so there’s a good
chance you’ve eaten some “objectionable matter contributed by insects, rodents and
birds.”
But some tapeworm parasites can live in infected insects, which can make their way into contaminated
grains.
This could be what infected JC, but she was dieting.
She didn’t eat carbs often.
And as doctors asked her this, she remembered the 5 day old gas sushi she ate, more than
9 months ago.
The stomach cramps.
The loose stools that followed them.
The feeling of a fish flapping around in her belly.
All of this pointing to a giant tapeworm that has been living, and reproducing inside of
JC, that came from some contaminated fish of 5 day old gas station sushi.
Doctors identify the tape worm as Diphyllobothrium latum, one of the largest tapeworm known to
infect humans, that can grow up to 30 feet long into the intestines.
This species, has a unique affinity for vitamin B12, and is well known to compete with the
human host for the nutrient.
Because JC had already been at risk of having low B12 because of her heavy calorie restriction,
this only made her situation worse, when a parasite started to grow inside of her, and
prevent her from getting any vitamin B12.
Because the tapeworm was in her small intestines by the part where it joins in to her stomach, it would
suck out all the B12 from food she ate, so when she received B12 injections in the hospital,
it looks like she started to get better probably because the injection went right into the
blood, and not through the gut, where the parasite could extract B12, like it did in
the gummy vitamins she ate afterwards.
As the B12 stores in her liver started to become depleted, and they were probably already
low because of how she ate before the 5 day old sushi, her nerves started wasting away,
because wrong chemicals were made in the cells, without vitamin B12.
Those wrong chemicals built up, and slowly ripped apart her nerves.
It started with insomnia, then she couldn’t feel her hands and feet.
Then she saw bugs crawling on the walls, before they started crawling under her skin, and
before her psychosis, sensory ataxia, and her seizures.
Medicine was given to remove the parasite.
Even if the tape worm can lay over 1 million eggs per day, and live 10 years in the human
gut, all it takes is a single dose of anti-parasitic medicine to cure JC.
The medicine forces calcium into the worm, causing its muscles to cramp up, paralyzing
it.
With the tape worm’s defenses down, the immune system finally recognizes it, and attacks
it as the worm slips out of the intestines, and out of the body.
And as JC started her full recovery, she was finally able to have a good night’s sleep,
again.
Thanks so much for watching.
Take care of yourself. Watch out for those gas station sushi leftovers.
And Be Well.