Entering
the Medical System

What can I expect when I seek medical help?

Contents

When you seek medical care for diagnosis and treatment for food poisoning, you will likely enter the system through:
  • your pediatrician
  • your family medicine doctor
  • a hospital emergency room
During this first medical contact, you can expect the following three actions to be taken:
  • oral history
  • physical exam
  • diagnostic testing

1. Oral History:

You can expect detailed questions about your symptoms and specific foods eaten in the last few days. You’ll likely be asked:

  • if others in your household are sick
  • if you’ve recently taken antibiotics
  • if you’ve travelled anyplace where food or water could be unsafe
  • if you’ve visited a farm/had contact with animals
  • if you have a fever or bloody bowel movements

2. Physical Exam:

You will be given a physical exam and checked for signs of dehydration, severity of abdominal pain, and neurological status.

3. Diagnostic Testing:

Most importantly, you should expect that your doctor will order diagnostic tests to identify the etiology, or cause of your illness. Today’s standard of care dictates that if any of the following signs and symptoms occur in patients, laboratory testing should be done to provide important diagnostic clues, particularly for very young, elderly, or immunocompromised patients, all of whom are more vulnerable:

  • Bloody diarrhea
  • Weight loss
  • Diarrhea leading to dehydration
  • Fever
  • Prolonged diarrhea (3 or more unformed stools per day, persisting several days)
  • Neurologic involvement, such as paresthesia (skin tingling, prickling, burning, or numbness), motor weakness, cranial nerve palsies
  • Sudden onset of nausea, vomiting, diarrhea
  • Severe abdominal pain

When I awoke, I was in intensive care at St. Mary’s Hospital/Mayo Clinic with doctors and student doctors as well as nurses all around me. I was screaming for my mom.

She was at the end of my bed, also being bombarded by people. While I was being poked and prodded, Mom was being asked a ton of questions about my health history, my disposition, my home and family, all kinds of information. I know they were doing what they needed to help me get better but Mom and I both just wanted them to leave us alone so that she could hold me and tell me things would be okay.

Because of a huge delay in our flight, Dad got to us about an hour or so after we arrived at the hospital. He had driven until 3 AM. He was tired.
We all were.

⁕ Ashley, childhood E.coli/HUS survivor

If diagnostic tests to identify pathogens are not automatically ordered you should specifically request them in order to identify the cause, confirm a diagnosis, and start appropriate and timely medical care.

If testing is still discouraged, you are entitled to a second opinion, and you should confidently pursue one. Too often patients are sent home, only to be hospitalized later, wasting precious time in identifying the infectious organism and beginning appropriate treatment.

Testing is a large, complex, and rapidly changing issue. There is great disparity in how it is applied within different medical settings.

For more information to help yourself or your loved one, as well as supporting references that you may want to share with your doctor, please go to the ABC’s of Laboratory + Imaging Studies.

Emergency Room

The Emergency Room (or Emergency Department) is where you can get initial answers and evaluation.

Patients with severe symptoms will likely end up going directly to the emergency room (ER), or will be sent there by their pediatrician or family physician.

If your community has more than one hospital, give careful consideration to the question of which hospital would have the most resources and capability. If you don’t know the answer, ask your pediatrician or family doctor, or any contact you might have in the medical community.

When you arrive in the ER, a registered triage nurse will ask questions about the patient’s general health and symptoms. He or she may assign a priority level based on your medical history and current condition according its level of urgency. If symptoms worsen while you wait to see a doctor, notify the emergency technician or triage nurse immediately.

You will also be registered. Registration gathers information for your patient record and obtains your consent for treatment. Both are necessary to allow the ER doctor to order diagnostic tests and determine treatment.

You may have to spend time in the waiting room – depending on how busy it is and the urgency of other patients’ conditions which may take precedence over yours. It is not unusual to wait for hours to be seen by a doctor, so try to understand that the ER staff is doing its best with other patients’ oftentimes life-threatening situations.

Should the patient need to use the bathroom, let the ER staff know first. Ask them if they can give you the supplies to collect a urine and/or stool sample. The patient should not eat or drink unless hospital staff say it is okay to do so.

Once the patient is moved from the waiting room to the treatment area, symptoms will be assessed again. During treatment, the Emergency Department staff in this area will help keep you comfortable and informed.

“I regret so much being casual about which Emergency Room I chose.

I was out of town with the children and made my choice based on the closest one to our hotel. I also chose it because its name “University Hospital” sounded like it was a teaching institution.

As it turned out, the hospital had no university affiliation; and within 24 hours of being admitted my husband and I and our new doctors in University Hospital were begging for an emergency transfer to a better equipped nearby hospital.

We needed a hospital with a pediatric intensive care unit able to handle our child.

It took a lot of effort, a lot of wasted time, incredible stress, and an ambulance in the middle of the night to end up at the right place.”

⁕ Mary Heersink, mother of an adolescent E.coli/HUS survivor

An IV line may be inserted in the arm or hand to administer fluids and medicines. Tests will be ordered. It is common for patients suspected of having food poisoning to receive blood and urine tests to look for dehydration, infection and kidney function.

An abdominal X-ray or other imaging tests may be ordered of the colon and appendix. It is very important that the Emergency Department (ED) collect a stool sample and test for foodborne pathogens. Ask the doctor or nurse to be sure that pathogen testing is done. Results of the pathogen testing will be very important to determine the cause of the illness.

For more detailed information, see: ABC’s of Laboratory + Imaging Studies

Your condition will be reevaluated after initial test results come in, and the ED physician will determine whether you should be admitted to the hospital or discharged.

If you are sent home:

  1. you’ll be given written instructions on how to care for your symptoms,
  2. directions for any prescribed medications, and
  3. recommendations for follow-up medical care with your primary care doctor.

                              Before you leave the hospital:

Ask how you will be informed about the laboratory testing results.

Ask what specifically you should watch for with worsening symptoms and what to do if you do not improve within a specific timeline.

The day passed and I was still in the hospital without a diagnosis.

Ariel, thankfully, was still by my side and scrolling through Twitter when she found a Chicago Tribune story about a possible food poisoning outbreak at my favorite taco joint. “Have you eaten there recently?” she asked. She immediately told the doctors who said, “Ah, Yes! That makes sense.”

They had a few other cases arrive because of the restaurant’s proximity to the hospital. Well, yeah! How could they not think to test for that, then?! (SMH) They wanted a stool sample … but I’d been sick for days, and hadn’t had anything to eat for days, and there was virtually nothing left in my system to pass.

About 36 hours after I entered the hospital they were finally able to determine that I had E. coli O157. I was so angry in that moment ... I lost a whole day in the ER and had to return the next day to do it all over again. That lost day would end up costing me thousands of dollars.

Regrettably, the lesson I learned from this, is that if a hospital has a certain, well-known reputation, then one should believe that reputation and try to avoid that hospital – even if, in your most dire hour, it is the most convenient option.

⁕ Joe, E.coli O157:H7 survivor

Testing + Test Results

Why is it important to know what is making me sick?

Because there are more than 250 different viruses, bacteria, and parasites that can cause food poisoning, it’s imperative that accurate testing be conducted early, not only for your individual case, but to help investigate and prevent other illnesses in the event that your infection may be part of an outbreak.

If foodborne illness is suspected, your doctor should submit appropriate specimens for laboratory testing. The most common lab tests are stool cultures which may take several days to render results.

These cultures grow bacterial isolates which reveal critical information: which organism is making you sick, what its DNA fingerprint is, and which if any antibiotics can be used to treat your infection.

From a public health respective, DNA fingerprinting is crucial to our national surveillance system (PulseNet) which is designed to detect clusters of foodborne illnesses and to stop implicated food from being further consumed. Legally, DNA fingerprinting allows the victims of foodborne pathogens to learn if their illness was part of an outbreak, and to identify the commercial source of their contaminated food.

There are also faster laboratory tests that can reveal the cause of your illness within hours, instead of days. These are Culture-Independent Diagnostic Tests (CIDTs). Although their speed presents a clinical advantage for you, they do not reveal the organism’s DNA or its antibiotic resistance. This poses a large disadvantage for public health workers who need that information to stop outbreaks and contain antibiotic resistant strains.

Ideally, both types of testing will be available to you:

  • Traditional stool cultures which produce bacterial isolates, and
  • Culture-Independent Diagnostic Tests.

It would certainly help you personally, and it would advance the larger public health objective for you to ask your Emergency Room doctor for both forms of these tests.

Blood tests will probably also be ordered to test for bacteria like Listeria and viruses like Hepatitis A. A blood test can also reveal inflammation and dehydration to show how sick you are.

Laboratory tests can render false negative results if the patient stops “shedding” the organism by the time he or she is sick enough to seek medical care. Nonetheless, they can help explain the cause of, and steer the management of illness.

Reporting Test Results

What happens with my test results?

The following are very helpful links to share with your caregiver, if necessary. It is unlikely that you will encounter any reluctance to test and to test thoroughly; but if you do, you may want to print out this page and request that it be entered into your official medical record.

“I remember not feeling heard.

I went to about 12 infectious disease doctors and kept telling them I had fevers and felt like things were biting me under my skin.

The doctors kept telling me they thought I had depression and should consider going on depression medication.

Even once I got the diagnosis, the doctor who confirmed the diagnosis through the Centers for Disease Control told me he didn’t believe the diagnosis and didn’t want to give me the medication until after the CDC ran the test again.

I insisted on the medication because in had been ill for nearly one year and I could hardly lift my head up.”

⁕ Ines, Schistosomiasis survivor

Once laboratory testing results are available, your doctor or hospital should inform the local health department if testing detects a reportable pathogen.

It is not your responsibility as a patient or family member to report cases of foodborne illness to your county, city, or state health department.

However, you should be aware that almost everywhere in the United States infections with the following pathogens are reportable :

  • Salmonella
  • Shiga-toxin producing E.coli (STEC) including E.coli O157 and other aero groups
  • Listeria
  • Shigella
  • Vibrio
  • Hepatitis A
  • Hemolytic Uremic Syndrome (HUS), and infection with other pathogens may also be reportable.

The authority of reporting diseases rests on the state level, and states voluntarily notify the Centers for Disease Control and Prevention (CDC) of infections. This list of pathogens and diseases is annually updated by a national council of epidemiologists with input from the CDC.

Once the test results are reported to the local health department, someone from the health department may contact you, most likely a public health nurse. You may be interviewed to gather information that could possibly help health officials identify the source of infection.

You’ll be asked about recent travel, activities and the food eaten by the patient in the previous days and weeks. It generally takes a number of patients to track infections back to a common source.

If you do not hear from the health department, ask your doctor if the diagnostic laboratory or clinical microbiologist have definitely reported your positive lab results to the health department. This way you can help public health workers connect the dots more quickly and possibly prevent more families from getting sick.

Your case deserves to be entered into the national network of public health agency laboratories that conduct surveillance, helping them to detect possible outbreaks, intervene early, and prevent others illnesses.

“ I remember it like it was yesterday.

It started as an upset stomach that progressively got worse. Then came the diarrhea, followed a couple hours later by intense vomiting. I remained curled up on the bathroom floor for the next 36 hours not knowing what was happening to me.

When I went to the emergency room, I was taken right in. I was given 3 liter bags of IV solution just to rehydrate me. They wanted a stool sample, which was just blood at this point. It was this testing that showed the antibiotic-resistant strain of Salmonella I contracted from the ground beef I handled a week earlier.

The CDC did a good job helping me remember the ground beef I bought. They seized the 2 remaining pounds I had in the freezer. These packages tested positive and [the store where I purchased the meat] issued a recall.

It has been a slow road to recovery.”

⁕ Ken, Salmonella survivor

My mom doesn’t drive and my dad is blind – and I couldn’t get home to help them – so we all just bided our time.

Then the next day my mom got sick. I called an ambulance to take her to the hospital. She has a history of heart and intestinal issues and needed immediate attention. The next day, I got home, took my dad to his oncologist who admitted him to the hospital. I went through the Emergency Room to get checked out. No one ever tested me or suggested it.

Tests on my parents indicated they did not have Salmonella, E. coli, or any of the usual foodborne illnesses. I requested they keep testing. My dad’s doctor stopped testing early on. My mom’s doctor, who was the admitting doctor through the Emergency Room and an orthopedic, told her and me verbally that he knew we all had a foodborne illness and that it wasn’t a bacteria, instead a virus. He said testing was more difficult for that.

The hospital was working in concert with the local health department and state lab. They couldn’t determine what bug we had eaten. Finally, the state lab suggested all testing stop, as it was getting too costly.

I rocked the boat by begging the doctor and local health department to continue testing. They refused. The health department told me they could not request the doctor to test at all. Talk about bureaucracy!

My mom was in the hospital for 6 days and my dad for 4. My mom’s doctor suggested she recover in a rehab facility. No, I took her home with me. She was very weak.

When we got all of our financial records together, we sought legal advice on how to be reimbursed for our medical bills. They totaled less than $50,000, but people on set incomes cannot afford unanticipated emergencies such as this.

When we got the medical records, we found doctors never put in writing their comments to us regarding foodborne illnesses and they refused to do so after we went back and asked. If the tests had been conclusive as to what made us sick, we could have sued. Two days after we were there, the county health department found the restaurant to have a filthy kitchen and improper temperature for hot and cold foods – a perfect breeding ground for contamination.

Four months after getting sick, my mom broke out in painful shingles. They bother her daily – still.

When my parents and I were sick, and the medical community wasn’t answering my questions, I had no one to turn to for advice. I learned about STOP through a news story. I found solace in knowing I wasn’t alone in the bitter world of foodborne illnesses.

⁕ Greta, foodborne illness survivor
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