A Grandma Ate Cookie Dough For Lunch Every Week. This Is What Happened To Her Bones.


A Grandma Ate Cookie Dough Every Week For
Lunch. This Is What Happened To Her Bones. CC is a 78 year old woman, presenting to the
emergency room with night sweats, hot flashes, and insomnia. She tells the admitting nurse that she had
unintentionally lost at least 25 pounds over the last 2 months. CC was a grandma originally from South America. She came to the United States with her son
in the 1980s. Every week, CC would bake cookies for her
grandkids. This was their favorite part of the week. Grandma knew exactly the kind of cookies they
loved to eat, and she never forgot to make extras for them to bring back home. While baking, CC would always eat some of
the cookie dough. There was always more than enough for everyone,
and she thought to take the opportunity to have some herself. About 4 months ago she started having trouble sleeping. She was getting night sweats and hot flashes. Everyday, she’d notice her weight decrease
on the scale. She wasn’t eating less. She wasn’t exercising more. She wasn’t sure how this was happening but
she didn’t think too much of it. Skin deep, CC was relatively healthy for a
78 year old. She had type 2 diabetes, but she took her
medicines every day. She had high blood pressure and a heart condition
known as atrial fibrillation, where one part of the heart beats so quickly it doesn’t
actually produce a good contraction allowing blood to pool which could form a clot and
get lodged into her brain and cause a stroke, but this was controlled with medicines too. Just having these 3 problems at 78 years old
isn’t bad. But unintentionally losing 25 pounds in 2
months is probably something very bad. The weight loss isn’t associated with diabetes
because, well she’s eating sugary cookie dough at least once a week and that’s not
exactly something that’ll help you lose weight. CC asked the admitting nurse if the hot flashes
were some sort of low key fever. She was aware of the risks of eating cookie
dough because raw eggs can have the bacteria salmonella, so she wanted to make sure that
she wasn’t getting some kind of infection. Without presenting with nausea, vomiting,
diarrhea, or an actual fever, it doesn’t seem like she has any kind of food poisoning. Because she’s 78, she’s well past menopause,
meaning her night sweats are probably not hormonal. Not much has changed in her lifestyle, so
it’s likely that this sudden weight loss, given her age, could be cancer. Analysis of CC’s blood finds anemia. An meaning without and emia meaning presence
of blood. The size of her red blood cells are normal,
but the problem is she just doesn’t have a lot them floating around in her body. 2 months earlier, CC had come in for her regular
checkup. Blood was drawn then too giving us a baseline
measurement. She had this anemia back then, but it’s
worse now. Nitrogen and a waste product called creatinine
are present at a level 3 times higher now, compared to 2 months ago. The kidneys are supposed to be filtering these
things out of the blood, but now they’re not. Her kidneys are failing. A massive amount of protein in her urine,
more than 40 times the upper limit of normal is collected. Cookie dough has raw eggs. Eggs have a lot of protein. But this isn’t the protein in CC’s urine. Eggs don’t cause kidney failure. Cookie dough can cause food poisoning, but
food poisoning isn’t kidney dysfunction. But diabetes causes kidney damage. Elevated blood sugar levels and increased
inflammation contribute to kidney injury. But if we have a baseline measurement from
2 months ago, the rate of decline is too quick to count this as diabetic nephropathy, meaning
that something else must be causing this problem, which brings us back to cancer. CT scans of her chest, abdomen and pelvis
reveal nothing. Her lymph nodes, which are typically the first
sites to where cancer spreads, were clear. No primary tumor or metastatic disease to
be found so, it doesn’t look like she has a solid organ cancer. But how about bone marrow cancer? That would cause problems with her blood cells
and she does have anemia. Except, analysis of her blood proteins also
reveals no cancer. But the results are borderline and nonspecific. Clearly something is wrong. They show maybe an infection of some sort,
which might point us back to the cookie dough she eats every week. But time is up. She doesn’t have a life threatening emergency. Without a good reason to admit her into the
hospital, CC is discharged from the emergency room and referred to the kidney clinic. They sample some kidney tissue from her to
look at under a microscope. As the days go by, CC’s night sweats become
more intense. She continues to bake the cookies for her
grandkids because she doesn’t want to stress them out. She doesn’t want them to even think that
anything is wrong. This health scare shakes her confidence, but
she doesn’t have cancer, so it might not be that serious, she thought. In the kidney clinic, 2 weeks later, it’s
revealed that CC has deposits of antibodies and complexes in the capsules of her kidneys. These regions of dense build-up tell a story. That her something has been happening with
her immune system for some time now. Antibodies that would be used to combat infections
have infiltrated her kidneys. This accumulation means that maybe she’s
had a chronic, or long term infection ongoing, or that maybe she has an autoimmune disease,
meaning that her immune system has been wrongly activated to attack her own body’s cells. If she’s eaten cookie dough every week for
a long time, and salmonella from the uncooked eggs are in there, then maybe that could be
her chronic infection? But that doesn’t make sense since that would
mean the bacteria would have spilled into her blood at some point in time and that bacteremia,
or bacterial presence in blood, would have been obvious. And without a history of lupus, or arthritis,
or anything like that it also doesn’t look like she has autoimmune disease, we can’t
know for sure. But what we can know for sure, is that CC’s
kidney function has worsened again. Over the next 24 hours, more than 10 grams
of protein are collected from her urine indicating severe kidney injury. Whatever the case is it looks like her immune
system is active. The best way to resolve this inflammation
is to give her corticosteroids, which are medicines that reduce the activity of the
immune system. She’s started on a high daily dose of prednisone
and sent home. But things only got worse. It’s one week later, CC presents again to
the emergency room. This time with fevers, chills, and hematuria. There is now a presence of blood in her urine. She’s nauseous, vomiting and has severe
diarrhea. Salmonella enteritidis, the bacteria commonly
found in uncooked eggs from cookie dough, was isolated from her urine and blood cultures,
as well as her stool, confirming an acute infection. High dose corticosteroids immediately increases
the risk of infection because of its action on the immune system. Her steroid dose is tapered and she’s started
on antibiotics, and her fever quickly resolves. Her urine and blood cultures become sterile
as her infection is rapidly cleared. As she’s discharged again from the hospital,
she is told to stop eating cookie dough. She’s told to stop eating anything uncooked. She’s given a 4 week prescription for antibiotics
to make absolutely sure that her infection is cleared. Explicit instructions given to her were to
complete the entire course, even if she feels ok. And she feels great, until 2 weeks pass. CC can’t stand on her own because of a sharp
pain in her right leg. She starts scratching her back and it becomes
painful as she realizes a giant rash has developed as her fever, nausea, and vomiting return. Back in the emergency room again. The medical team looks at the rash closely. Small plaques and scaling were observed. Usually, rashes come from an allergy. Because she’s on new antibiotics, this might
be an allergic reaction to them. But, an antibiotic rash doesn’t look like
plaques and scales, meaning that this is something else, which is confirmed because CC tells
the medical team, she never filled her prescription of antibiotics because she felt she didn’t
need them. As CC is triaged in the emergency room, she
needs to use the bathroom. Despite the searing, stabbing pain in her
right leg, she didn’t tell the medical team about it. She was too preoccupied with scratching her
back for them to notice. As she gets up, she feels her right leg pulse. She hears a fibrous snap, as she suddenly
collapses on the ground. The medical team suddenly rushes to her. Imaging finds multiple lesions in her fractured
right tibia. CC didn’t tell the medical team that several
years ago, she had broken her leg at this exact spot. Bone biopsy finds salmonella enteritidis as
the causative agent of this osteomyelitis. Osteo meaning bone. Myelo referring to marrow and itis meaning
inflammation, or in this case infection. A bone infection that was found along with a blood culture
confirming again salmonella bacteremia, meaning that within the timespan of just a few weeks,
the exact same bacteria from the eggs in her cookie dough is again infecting CC. The mysterious kidney failure. The severe infection after steroids. The rash. The recurring infection. The medical team realizes that this is a case
of immunocompromise. There only a couple of situations where recurrent
salmonella enteritidis bacteremia could happen. The first is in organ transplant, where medicines
would have been given to suppress the immune activity to prevent the body from rejecting
the donated organ. But CC never had an organ transplant. Meaning that this could be a case of Acquired Immunodeficiency
Syndrome, also known as AIDS. At this realization, the medical team immediately
tests her for Human Immunodeficiency Virus. Serologic testing returned positive. A viral load of 550,000 copies per milliliter
of blood was found. And a measure of her CD4 T cells, which are
the immune cells targeted by the virus, was 60 cells per milliliter of blood. Under 200 cells per milliliter is the criteria
for AIDS as she’s diagnosed with it for the first time, at age 78. This finding is consistent with, everything. HIV is known to cause kidney damage in late
stage disease. This nephropathy is characterized by gross
proteinuria with rapidly progressive kidney disease. The collapsing form of focal segmental glomerulosclerosis
with interstitial inflammation is a classic presentation of HIV associated nephropathy,
but only obvious in retrospect. Rashes are common in HIV patients, and this
rash was not characteristic of an antibiotic hypersensitivity. Very high dose prednisone like the one CC
received is not something you want to give an AIDS patient because the medicine increases
the infection risk of a patient and AIDS itself is a disease where the human immunodeficiency
virus exhausts the immune system, leaving the host vulnerable to infections that just
don’t happen in people who haven’t been infected with the virus. The cookie dough that CC ate every week was
a source of salmonella enteritidis. It put her at risk every time as she ate it
for lunch. And in immunocompetent people, the infection
that you can get from uncooked eggs or mishandled poultry is not common, definitely not recurrent
and mostly likely never in this severity. CC tells the medical team that about 10 years
ago, she broke her right leg. It seemed to heal, but the doctor at the time
noticed reactive sclerosis surrounding an irregular lesion. She never went back for follow-up after her
leg healed, because she never felt the need to. We can only speculate here, but it’s likely
that she was already had HIV, when she was 68. Which brings us to the final consideration
of this case. Most notably, I can’t think of any of my
colleagues, who’d get a history of activity with partners in an elderly woman. It should be obtained, no matter how awkward
depending on the person. HIV is just not the first thing that comes
to mind in someone over 70 years old. Most common are going to be cancer, heart
problems, diabetes. When she was asked, CC did not have much to
say about her activity, except that she was in a monogamous relationship for more than
40 years. She did have a blood transfusion after an
accident about 25 years ago in Latin America which would bring us to the 1990s. If she had hemophilia, this could be a lead
to how she got the infection because well documented violations of basic principles
and ethics from western institutions exist from that time, where HIV contaminated products
were knowingly shipped to the region. These products should have been destroyed. Instead, they were repackaged and distributed,
and sold to other to these other countries. To protect those institutions’ investments. And then it knowingly infected the people who lived in those countries But without evidence of hemophilia which would
indicate the use of these factors in CC, it may not be likely. So much time has passed that we can’t confirm absolutely the reason for her infection, Well, she has the virus. It’s been replicating and depleting her
immune system. But at least, it’s nice that it was caught
this time. With support from her family and the medical
team, the initiation of triplet antiretroviral therapy, CC’s viral load was undetectable
after 6 months. Her rash resolved. Her kidney function improving. Her bones, healing. CC was able to sustain a full recovery. Thank you so much for watching. Take care of yourself. And be well.

100 Replies to “A Grandma Ate Cookie Dough For Lunch Every Week. This Is What Happened To Her Bones.”

  1. Doctors: Make sure you keep taking this medicine for 4 weeks even if you feel better
    CC: Stops taking the medicine 2 weeks in because she felt better
    Me: 😑

  2. Omg they have given that poor woman aids how sad. We don’t know what we are given at anytime from today’s health care. I prefer 1 dr that I know to treat me but it’s no longer a dr it’s twenty you see a total of 10 minutes and then you have to trust that diagnosis. Thank heavens that lady was at a very caring hospital with great drs. Be ware and ask questions about your health and treatment. Very informative physician and knowledgeable.

  3. For all of the bakers out there, DO BOT EAT RAW CAKE BATTER, RAW BROWNIE BATTER, OR RAW COOKIE DOUGH. or anything with raw eggs in it :/

  4. Afraid of eating raw cookie dough? Make your own edible cookie dough by heating up your flour and not adding eggs. You’re welcome

  5. It’s annoying how they give possible answers but just put them down….

    Just tell what happened wtf.
    Why put stuff you know already didn’t happen

  6. I would like to point out that I will probably die single without a child due to the fact that I fear HIV and any STD. It's a really bad fear that I have and it's probably unreasonable, but in my mind its a well placed fear. I almost knew immediately that this had to be an HIV case and I was correct.

  7. ok… kids ALWAYS TRUST YOUR DOCTORS and never EVER eat raw eggs, play with rusted metal, come close to shit, have sexual intercourse without a condom with a partner who may have an std,forget washing your teeth or eat without washing your hands. This might seem obvious, but no… PEOPLE DIE DAILY BECAUSE OF THIS. Take care fellas!

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