What Killed Lindsey Graham and Taco Bell -Cyclosporiasis Second Opinion with Dr. Paul Kolodzik E88

In today's episode, Dr. Kolodzik explores the tragic events surrounding Lindsey Graham's passing and delves into the current Cyclosporiasis outbreak. With his extensive ER experience, Dr. Kolodzik provides insights into these medical narratives, offering a deep dive into the causes and preventative measures. Join us for expert commentary on staying informed and proactive in safeguarding your health.

Transcript

SPEAKER_00 0:00

Hey, it's the Second Opinion Podcast with Dr. Paul Kolodzik, where we talk about anything and everything medical. From a sore throat to the future of AI medicine. Dr. Paul is an ER doc and certified in addiction medicine and metabolic health, as well as a best-selling Amazon author. You can learn more about Dr. Paul at his website, dr Paul Kalodzik.com.

SPEAKER_02 0:23

Hey, Dr. Paul Kalodzik. Welcome back. We haven't seen you for a couple weeks. Glad to be here, Terry. Well, I'm glad that you're here.

SPEAKER_01 0:31

Back down in the basement.

SPEAKER_02 0:32

So we were just talking about Notre Dame coming up soon. You're very excited about the season.

SPEAKER_01 0:37

The first game is at Wisconsin at Lambeau Field, the Green Bay Packers Stadium.

SPEAKER_02 0:42

Yeah, I know Lambeau Field. Wisconsin's a tough team.

SPEAKER_01 0:45

Yeah, it'll it'll be fun. I'm going up for it.

SPEAKER_02 0:47

You're going to Lambeau Field?

SPEAKER_01 0:49

Yeah. Are you driving? We're going to drive. Yeah. Yeah. It's about 12 hours.

SPEAKER_02 0:55

That's that's a bit wild.

SPEAKER_01 0:56

There's just no easy way to get there from here, from Dayton. You'd have to go through Chicago to Milwaukee. It's or, you know, maybe to Green Bay. There's no easy way. I'd get to spend 12 hours in the car with my lovely wife, which will be nice.

SPEAKER_02 1:10

Does she feel the same?

SPEAKER_01 1:12

She probably does not. Does not. And then I'll meet my son up there. And uh, you know, him and his wife. We're gonna go actually a beautiful area north of Green Bay called Doer County, out on the peninsula there in Wisconsin. All right. And we're gonna enjoy that for a couple days, maybe go fishing for a few days. Um, and we're excited because my son's wife is with child, and that's gonna be the first grandchild, so we're really excited about that.

SPEAKER_02 1:42

Oh, your first grandchild? That's that's gonna change you now. Are they in Milwaukee or are they in Chicago? They live in Chicago, yeah. That's not that Chicago's five hours. I used to drive it all the time.

SPEAKER_01 1:53

So yeah.

SPEAKER_02 1:53

You can get up there for yeah, okay.

SPEAKER_01 1:57

Um you know, I thought So go go Irish.

SPEAKER_02 2:01

Uh no, go buckey. You want before we get into the topics of medicine and things like that, you want to put any kind of prediction on the table?

SPEAKER_01 2:12

We're gonna have a good season. So I don't know. We play Miami again, so that's tough. That's a tough one. That's a tough one. We play uh Brigham Young, who has always has a good team. Southern Methodist, SMU has good teams, you know. But I I mean, hopefully we'll get through all that and make the playoffs and not get snubbed like we did last year.

SPEAKER_02 2:32

Uh yeah, you're still better. Okay. Uh hey, so we're gonna talk about something that's relevant to me, and I I'm sharing this with the audience because I think they should know. I am a Taco Bell fan.

SPEAKER_01 2:46

I yes, we know where this is going.

SPEAKER_02 2:50

That's kind of what I said the uh when it happens. Here it comes, here it comes. Uh so we would eat there, I eat there once a once once a week. It's my treat. I go get a fruit. Uh by the way, if you didn't know this, you can go to Taco Bell and get a senior drink, which is free. I get a bean burrito, and that's my lunch. And it's about two four two dollars and forty-eight cents for my lunch on Saturdays. That's my treat in life. All right. I I live only in this basement until I go out on Saturdays for Taco Bell. Uh, but I noticed back in mid-May, early June, I was starting to have some crazy symptoms.

SPEAKER_01 3:29

Yeah.

SPEAKER_02 3:30

And we all know what those symptoms are. Yeah, and we don't need them described. No, um you have an immediate urge to go to the bathroom. And by the way, I do want to apologize to the folks at Lowe's.

SPEAKER_01 3:42

Uh why do you give us this these visuals that none of us want?

SPEAKER_02 3:48

I'm trying to paint a picture. Okay. Okay. So what is going on with this and will it eventually go away? Because I went to the doctor, described my symptoms, and they go, Yeah, you could have it, but we need to run some tests. If if this is a new major news story every single night, just give me the prescription.

SPEAKER_01 4:09

Okay. So the bug is cyclosporosporia. Okay. The condition is called cyclosporiasis.

SPEAKER_02 4:17

Yeah.

SPEAKER_01 4:18

Okay. And it's a parasite, actually, not a bacteria. So not a virus, not a bacteria, but a parasite. Well, what kills a parasite? Well, antibiotics at times can be effective against antibiotics and antiparasitic agents as well.

SPEAKER_02 4:33

Okay.

SPEAKER_01 4:34

So, at any rate, this is generally a self-limited disease, and what that means is it goes away on its own with time. Um, I actually reviewed a little bit about this before we got on. There's been like you know, up to 4,000 cases, I think 1,600 uh people have been significantly ill, had to go to the emergency department, or a few admitted, uh, but no deaths. So, and deaths from this cause generally would be because of dehydration because you can't stay up with the fluids.

SPEAKER_02 5:06

Well, man, I was on the 4th of July weekend, right? I was working outside for all these festival stuff, burning up. Yeah, dehydrated.

SPEAKER_01 5:14

Yeah, right.

SPEAKER_02 5:15

And then I had this other issue going along with that.

SPEAKER_01 5:18

So so it's a process that's often what we call relapsing and remitting, which means you know, it'll go on for a while, get a little bit better, then recur, but generally resolves on its own within six weeks or so. Oh, yeah, and and again, unless you're immunocompromised for some reason in general, this should not cause a problem for you. But let's get to the issue of you know, should you be treated or not? Yes. So, and I've had a few patients in the emergency department with this complaint as well. Generally, they come in, we plug an IV in, give them a liter or two of fluids. Um, generally, it's a good idea to get a diagnosis before you treat. So the diagnosis in this case could be done from stool cultures. So you can have people, you know, send their stool up to the lab. Um, a lot of times people, you know, they come in with diarrhea, but then the lab, this is strange. The lab doesn't want watery stool to do their tests. They don't want real hard stool. They want the Goldilocks stool, which they call, which they call forms stool. So, anyways, you can have people bring their stool back.

SPEAKER_02 6:28

What if it's watery? What if that's all you got?

SPEAKER_01 6:30

Yeah, they they say they can't, they re the lab rejects it. They won't do testing on it.

SPEAKER_02 6:35

Okay, so they reject it. So will the doctor just then g play the odds and give me a prescription?

SPEAKER_01 6:41

Yeah, I mean, for a self-limited disease like this, if they're immunocompromised, then the answer is I would treat.

SPEAKER_02 6:46

So with diabetic, would I be immunocompromised?

SPEAKER_01 6:49

Yeah, I mean, and y yes, diabetes diabetic patients are immunocompromised, but yeah, you know, let's look at the whole picture here. What's your blood sugar doing these days? So at any rate, so uh generally I would I would wait for confirmatory findings from from the lab and and then coordinate treatment and follow up with the patient's primary care doctor. Pretty pretty uh simple treatment, which is uh bacterum or scepter, which is an old sulfa antibiotic that has been around for years. So um generally the answer is you you know let it take its course unless somebody's significantly ill, look at doing stool cultures, and then you can treat with bacterum. So but but the question I have is what's the harm if they gave me the prescription? Well, there's this thing called antibiotic resistance terry. Have you ever heard of that? I have which means you shouldn't indiscriminately overuse antibiotics. But what if you haven't been on one in a couple years? Well, it's not this is a population thing, it's not just a Terry thing. Oh, it should be a it's like it's like we don't want to develop resistance to these antibiotics in the general population, and overuse does that.

SPEAKER_02 8:00

Hmm.

SPEAKER_01 8:01

So write it out.

SPEAKER_02 8:05

All right, so I think I might have to tail end of this thing anyway, so I'm writing it out. Um any other words of wisdom on this topic for those people who might be eating a Taco Bell and they're driving in their car?

SPEAKER_01 8:15

No, I I think I think your government's handling it now, right?

SPEAKER_02 8:19

My government's handling it, yeah.

SPEAKER_01 8:22

Not letting the lettuce in from Mexico, right?

SPEAKER_02 8:25

Yeah, that's true. Trump uh didn't you make a joke that uh we're stopping all things from Mexico coming in lettuce?

SPEAKER_01 8:31

Something like that. Okay. Okay. Let's not get too political on this show.

SPEAKER_02 8:35

Okay, so but okay, really the topic that we're going to talk about today is what killed Lindsay Graham? Because this is not only happened to him, but it happened to Catherine O'Hara, correct?

SPEAKER_01 8:45

Right. Different conditions, but both associated with chest issues, vascular issues, blood vessel issues.

SPEAKER_02 8:51

And how would they know if they had it?

SPEAKER_01 8:53

Well, um, so uh these are both difficult diagnoses for for people to recognize, and even sometimes doctors to recognize and tell um it's you know you're heading toward a very bad outcome. So let's talk about Lindsay Graham first, okay? So he had a thoracic aortic aneurysm, and that is a bulging of the aorta just above the heart. So there basically it dilates. People can have abdominal aortic aneurysms, you can have aneurysms in your brain, you know, in smaller blood vessels. Um, but he had a thoracic aortic aneurysm. Okay.

SPEAKER_02 9:37

And uh and an aneurysm for people who I've been described as it's like a balloon.

SPEAKER_01 9:42

It's like a balloon.

SPEAKER_02 9:43

It's just kind of you swelling all of a sudden like a tire. Yeah, and then it pops and it goes.

SPEAKER_01 9:47

So and yeah, I mean you can have as you start getting that swelling early on, you can have um chest symptoms. Like what? Um I mean chest pain in most cases. Okay. Some sometimes um with this condition you can get what's and without an aneurysm, you can get a problem called a dissection, an aortic or vascular dissection. And what happens in that case is there's uh a little opening on the inside of the blood vessel, um, and the blood starts dissecting in the wall of the blood vessel, if you can consider that like a tube. Yeah. And normally, you know, the fluid is running down the tube, but then there's a flap that occurs on the inside, and the blood starts pushing down the wall of the tube, the wall of the aorta, and that's caused a dissection. So those are the two serious issues associated with the aorta in the chest. Um, and and they're just they're you you know, sometimes they can be aneurysms can actually be long term and be followed, and patients. In fact, I've had many patients um that that you know they're following their aneurysms along with ultrasounds or serial CAT scans to make sure they don't enlarge to a certain size. If they do, often they they get scheduled for a surgical repair.

SPEAKER_02 11:08

Yeah, my friend has that. She's monitoring it and she's you know, she's aware that it's either growing or not growing, and and she goes in regularly to check.

SPEAKER_01 11:17

So dissections can lead to more acute problems. Like what? Um well, so for example, as you're uh you you think of your aorta, there's all these other blood vessels coming off the aorta, like the carotids that go up into the neck, or the subclavian that goes out into the arms. And that dissection actually can start occluding those those branches.

SPEAKER_02 11:41

So you mean not sending blood to them?

SPEAKER_01 11:43

Yeah, so in other words, the you know, the dissection occurs down the wall of the aorta, and now it blocks the blood going out to the arm, or it blocks the blood going up to the brain. So you can get neurological type symptoms with that as well.

SPEAKER_02 11:59

Any idea if you described what those symptoms would feel like or be like, what would you what do you think they would be like?

SPEAKER_01 12:04

Yeah, it's just I mean, the the problem is is that a lot of the symptoms related to a dissection don't occur until it's at a near catastrophic state where that that dissection is occurring and blood vessels are being shut off. And of course, obviously, if a blood vessel to your brain gets shut off, um yeah, you know, that results in immediate stroke symptoms. So dissections are dissections are are you know are tough. Aneurysms can be followed, but if the aneurysm hasn't been previously diagnosed, that's a tough one as well.

SPEAKER_02 12:41

Yeah, my dad died of an aneurysm.

SPEAKER_01 12:43

He died of anything.

SPEAKER_02 12:44

No, no, it was in the stomach somewhere.

SPEAKER_01 12:46

Yeah, so that's probably an abdominal aortic aneurysm. You can get aneurysms of blood vessels to the gut as well. Yeah. Mesenteric arteries, but that's that's usually the reason. So um that's one, you know, another reason an emergency physician takes chest pain, you know, very seriously because not, you know, chest pain, everybody thinks heart attack. Right. But you got to make sure there's not a dissection or an aneurysm going on as well.

SPEAKER_02 13:12

So And the way they check that is through an ultrasound.

SPEAKER_01 13:15

Uh actually in the emergency department, we generally get a a CAT scan, generally a contrast CAT scan, which is a CAT scan of the chest with dye, which highlights the blood vessels.

SPEAKER_02 13:27

Yeah, okay. I've had I've had that done before, I remember.

SPEAKER_01 13:31

But uh is is that the was the radiation stuff they stick in your blood, or is that uh well, usually the radiation stuff is for a PET scan, it's for a malignancy evaluation. Oh so this is just dye.

SPEAKER_02 13:43

Okay.

SPEAKER_01 13:44

So um and then as we're talking about chest pain, another uh famous person in the last couple weeks died. Um Catherine O'Hara. Catherine O'Hara. I love her.

SPEAKER_02 13:54

I mean, she's oh my god, she's so funny. So she was the mom in Home Alone 2. Yeah, she was a mom in the sh uh Shits Creek.

SPEAKER_01 14:00

Yeah, yeah. I actually saw, I think, watched some of those. So that was great. Yeah, yeah. So she had a pulmonary embolism. And and is that the same thing as Lindsay Graham or? No. So Lindsay had an aortic aneurysm dissection, and uh um she had um uh a pulmonary embolism. All right, what's that? So a pulmonary embolism is when there's a blood clot in a vein in in the body, not an artery, but could be a arteries push blood out, for example, to your to your toes, and veins bring the blood back. And then you get um you know, you can get blood clots in the veins, um, which then break off and go through the right side of the heart and out into the lungs. And that's what a pulmonary embolism is, because this blood clot is embolizing from the legs out into the lungs.

SPEAKER_02 14:58

So you wouldn't think a little small blood clot that was started than you linger.

SPEAKER_01 15:02

Some of them aren't small, Terry.

SPEAKER_02 15:03

Really? Give me an idea of size.

SPEAKER_01 15:05

Um well, I mean, there can be so so the pulmonary artery um I I would assume is maybe uh that goes out into the lungs is maybe a centimeter to a centimeter and a half wide, and you can have uh blood vessels that occlude uh excuse me, clots that occlude a good part of that. In fact, what you have is you you have the the blood vessel coming out of the heart into the lungs and it by it it starts bifurcating. You know, it starts splitting and then it splits again and then it splits again because you have to get down to a capillary level to for the exchange of oxygen into the blood and the release of carbon dioxide into the blood. So there's this like tree type appearance to the blood vessels in your lungs going out into smaller and smaller branches.

SPEAKER_02 15:53

So you just said something that maybe I've never thought of. When the blood's going into the lungs, the lungs are pr providing oxygen back to that blood. So it flows is that what's going on? Yeah, yeah. Never thought about it.

SPEAKER_01 16:08

Yeah, I mean that's how you get oxygen in your blood. That's how you get your Yeah, and get rid of carbon dioxide.

SPEAKER_02 16:15

And get rid of carbon dioxide. You get rid of carbon dioxide through the blood?

SPEAKER_01 16:19

So the tissues use oxygen and create carbon dioxide. And so the lungs exchange, uh, release carbon dioxide and take in oxygen.

SPEAKER_02 16:31

So when I'm breathing in, I'm taking in oxygen. When I'm breathing out, I'm releasing carbon dioxide. Correct.

SPEAKER_01 16:36

Look at this. This is like 101 over the line. And that's, you know, basic, you know, that's metabolism, you know, this word metabolic that we've been talking about for years. That's really what it is. Okay, the use of the use of different substrates, whether it be food or oxygen, to make your tissues work properly.

SPEAKER_02 16:54

Wow, that's that's crazy. Okay, never mind.

SPEAKER_01 16:56

So, anyways, you can get you can get clots big enough that at the first bifurcation of that artery, um you you get what's called a cat a saddle embolus. The embolism sits there at that first bifurcation. And that and that's a big, big embolus. So it it really, you know, people people die from pulmonary embolisms. And again, difficult diagnosis. People come into the emergency department with a swollen leg, so we get an ultrasound to make sure there's not a uh there's not a blood clot there. Usually unilateral. If there's bilateral swelling, that's usually due to other reasons. But if somebody has swelling on one side, then you worry about that. Um and so when these so when patients come in with with chest pain, it's and chest pain shortness of breath, common complaint. Right. You know, um you're you're focused on a possible cardiac etiology, could this be a heart attack, you know, a coronary artery occlusion, but could it be a thoracic dissection, could it be a thoracic aneurysm, could it be a pulmonary embolus? So you have to have all those considerations because they're all life threats. So that means when you send somebody who comes in with chest pain, send somebody home, you gotta be pretty darn certain that none of those things are going on.

SPEAKER_02 18:19

And in the leg, the blood clot in the leg, because my sister has that and they put her on blood thinner and she has to stay in bed and that kind of crap. Um how long does it take to dissolve one of those?

SPEAKER_01 18:29

Yeah, usually when people are put on anticoagulation, if they have a blood clot in their leg, do generally it's for at least a six-month period of time. Really? Yeah, to dissolve the clot. Or sometimes then people develop chronic clots which don't break off as easily. So And so go ahead. I was just gonna say if if you're dissolving a clot, does it make it any more likely that it's gonna go on pass through and no, because it breaks it down, the medications, the anticoagulants are constructed such to break it down gradually, basically to gradually shrink the clot. Okay. Right. So since we're talking about um pulmonary embolism, you know, you you gotta consider risk factors. A big risk factor is immobility. Okay, that you're just you know, you you you aren't moving around. Maybe you're bedridden for some reason. Right. Um, and what comes up frequently is when people are aware of this, long distance travel. You know, sitting on a plane being on a plane for a long period of time or even in a car for a long period of time. Recent surgery, especially in the lower extremity or the pelvic area, will also uh create an increased risk of um uh pulmonary embolism. Cancers put you in a hypercoagulable state. Hypercoagulation. So just think coagulation.

SPEAKER_02 19:44

Coagulation is how the blood flows. Is it flowing smoothly or flowing?

SPEAKER_01 19:48

Yeah, yeah. Or really is it creating a gel-like substance? You know, is it is it basically creating a clot?

SPEAKER_02 19:55

See, in physics, I would have called that v viscosity. Is that it's related. Yeah, yeah. See, I'm I'm not as dumb as I look.

SPEAKER_01 20:04

No comment. Um so uh cancers put you in a hypercoagulable state as well. And then there are actually some some genetic conditions where people have certain blood clotting disorders that run in the family.

SPEAKER_02 20:18

Wow. Okay.

SPEAKER_01 20:19

So uh and then the other things that you would think about routinely would which is obesity and smoking and increasing age.

SPEAKER_02 20:28

So yeah, increasing age I'm suffering from. Now, if I'm on blood thinners, does that kind of push back any risks?

SPEAKER_01 20:37

Yeah, that that would, yeah, it that certainly decreases the risk of uh a pulmonary embolism. Okay.

SPEAKER_02 20:43

Well, hey, uh this has been a I honestly learned a ton on this podcast, so I'm I'll have to pay you uh for the education. That's a great idea. All right, so we're gonna we're gonna stop it right here. But this has been the Second Opinion Podcast with Dr. Paul Kalazic. We appreciate you guys joining us, and we will see you guys uh or hear you guys or listen to us, whatever you want to have phrase that in a couple weeks. Thanks.